•La pandemia de COVID-19 nos ha obligado a diseñar nuevas formas de dispensar cuidados médicos. En este contexto, la telemedicina se propone como principal alternativa a la clásica atención sanitaria ...presencial.•El colapso de los centros sanitarios durante la pandemia ha dificultado el seguimiento de los problemas crónicos de salud como la diabetes tipo 2, impidiendo un seguimiento o tratamiento adecuado.•Adaptar las guías de práctica clínica en forma de recomendaciones y algoritmos de decisión adaptados al nuevo escenario profesional permite homogeneizar y estandarizar la atención sanitaria que se ofrece a los pacientes con diabetes tipo 2.
Las circunstancias actuales provocadas por la COVID-19 nos obligan a los profesionales de atención primaria a idear nuevas formas de garantizar la atención sanitaria de nuestros pacientes con diabetes tipo 2 (DM2). Existen evidencias que respaldan la eficacia de la telemedicina en el control glucémico de los pacientes con DM2. Ante la rápida adaptación de la práctica clínica al uso de la telemedicina, el Grupo de Trabajo de Diabetes de la Sociedad Española de Medicina Familiar y Comunitaria (SemFyC) optó por elaborar un documento de consenso plasmado en un algoritmo de actuación/seguimiento telemático en la atención de los pacientes con DM2.
The current circumstances cause by the COVID-19 force primary care doctors to find out new ways to guarantee the health care of our type 2 diabetes patients. There is evidence that supports the remote consultation efficacy in the glycemic control in patients with type 2 diabetes. Facing the rapid adaptation of clinical practice to the remote consultation use, from de Diabetes Group of the Spanish Society of Family and Community Medicine (SemFyC), we have prepared a document embodied in a telematic action / monitoring algorithm in the care of patients with type 2 diabetes.
Control of glycaemic levels as well as cardiovascular risk factors (CVRF) is essential to prevent the onset of complications associated with type 2 diabetes mellitus (T2DM).
To describe the degree of ...glycaemic control and CVRF in relation to diabetes duration.
Multicentre cross-sectional study in T2DM patients seen in primary care centres during 2007.
Demographical and clinical characteristics, antidiabetic treatments and development of disease complications. Diabetes duration classification: 0-5, 6-10, 11-20 and >20 years. Logistic regression models were used in the analysis.
A total of 3130 patients; 51.5% males; mean age: 68±11.7 years; mean diabetes duration:7.0 (±5.6) years, median: 5 (interquartile range:3-9) years; mean HbA1c: 6.84 (±1.5), were analyzed. There has been a progressive decline in HbA1c levels (HbA1c > 7% in 25.8% of patients during the first 5 years and 51.8% after 20 years). Blood pressure values remained relatively stable throughout disease duration. The mean value of low density lipoprotein (LDL) experienced a slight decline with the progression of the disease, but due to the significant increase of cardiovascular disease (CVD) after 20 years of duration, less patients reached the recommended target (LDL < 100mg/dl) in secondary prevention. Logistic regression model controlling for age, sex and CVD showed that diabetes duration was related to glycaemic control (odds ratio: 1.066, 95% confidence interval: 1.050-1.082 per year) but not to blood pressure or LDL control.
The degree of glycaemic control and the risk factors in relation to the duration of T2DM followed different patterns. Diabetes duration was associated with a poorer glycaemic control but in general had a limited role in blood pressure control or lipid profile.
Abstract
Objective:
To assess clinical inertia, defined as failure to intensify antidiabetic treatment of patients who have not achieved the HbA1c therapeutic goal ( 7%).
Research design and methods:
...Multicenter cross-sectional study. Clinical inertia was assessed in a random sample of type 2 diabetes mellitus (T2DM) patients seen in primary care centers.
Results:
A total of 2783 patients (51.3% males; mean age: 68 ±11.5 years; diabetes duration: 7.1 ±5.6 years; mean HbA1c: 6.8 ±1.5) were analyzed. Of those, 997 (35.8%) had HbA1c >7%. Treatment was intensified in 66.8% and consisted of: dose increase (40.5%); addition of oral antidiabetic (45.8%); or insulin treatment initiation (3.7%). Mean HbA1c values in patients for whom treatment was intensified vs. non-intensified were 8.4% (±1.2) vs. 8.2% (±1.2), p < 0.05. Clinical inertia was detected in 33.2% of patients and diminished along with treatment complexity: lifestyle changes only (38.8%), oral monotherapy (40.3%), combined oral antidiabetics (34.5%), insulin monotherapy (26.1%) and combination of insulin and oral antidiabetics (21.4%). Clinical inertia decreased as HbA1c increased: 37.3% for HbA1c values ranging between 7.1%-8%; 29.4% for the 8.1%-9% HbA1c range and 27.1% for HbA1c 9%. Multivariate analysis confirmed that diabetes duration, step of treatment and HbA1c were related to inertia. For each unit of HbA1c increase clinical inertia decreased 47% (OR: 0.53).
Limitations:
The retrospective design of the study precluded an accurate investigation about reasons for lack of intensification that could actually be justified by some patient conditions, especially patients' lack of adherence.
Conclusions:
Clinical inertia affected one third of T2DM patients with poor glycemic control and was greater in patients treated with only lifestyle changes or oral monotherapy. Treatment changes were performed when mean HbA1c values were 1.4 points above therapeutic goals.
The current circumstances cause by the COVID-19 force primary care doctors to find out new ways to guarantee the health care of our type 2 diabetes patients. There is evidence that supports the ...remote consultation efficacy in the glycemic control in patients with type 2 diabetes. Facing the rapid adaptation of clinical practice to the remote consultation use, from de Diabetes Group of the Spanish Society of Family and Community Medicine (SemFyC), we have prepared a document embodied in a telematic action / monitoring algorithm in the care of patients with type 2 diabetes.
Objetivo: Determinar las variables clínicas asociadas al deterioro del metabolismo glucémico en población nomoglucémica con factores de riesgo para la diabetes mellitus tipo 2 (DM2) o prediabéticos.
...Material y métodos: Se diseñan 3 cohortes de seguimiento, con pacientes de las consultas de atención primaria: normoglucémicos con factores de riesgo de DM2, prediabéticos, y pacientes con DM2 de reciente diagnóstico, llamados diabéticos. Se analizan los antecedentes personales y antropométricos, antecedentes familiares, hábitos tóxicos, actividad física, síntomas y complicaciones relacionadas con la diabetes y datos analíticos.
Resultados: 545 pacientes, evaluados al inicio, a los 2 y 5 años de seguimiento. Edad media 60±12 años, IMC 30,1±5,1, HTA 48,6%, HbA1c media normoglucémicos, 4,8%(4,8-5), prediabéticos 5,2%(4,9-5,3%) diabéticos 6,5% (5,6-8,5%). A los 5 años el 17,1% de los normoglucémicos son prediabéticos y el 22,6% de los prediabéticos son diabéticos. En los normoglucémicos se ha relacionado el consumo fármacos diabetogénicos, especialmente los diuréticos, con una incidencia aumentada de prediabetes a los 5 años (OR 24,6 95%; 6,25-96,8). Los niveles elevados de colesterol a los 5 años también se ha relacionado entre los normoglucémicos con la incidencia de prediabetes (OR 4,0 IC95%; 1,13-14,2).
En los prediabéticos, la incidencia de diabetes, se relaciona a los 2 años con la elevación de los triglicéridos (OR 7,6 IC95%;1,1-62) y la edad ≥ 60 años, (OR 4,6 IC 95%; 1,47-14,7), y a los 5 años, con la elevación de colesterol total (OR 4,6 IC95%; 1,3-16,1) y de triglicéridos (OR 3,7 IC95%; 1,23-11,2).
Conclusiones: La incidencia de prediabetes entre los normoglucémicos fue del 17%, de DM2 entre los prediabéticos del 22,6% a los 5 años del seguimiento. Los factores identificados relacionados con la progresión a DM2 han sido la edad ≥60 años, colesterol y triglicéridos elevados. El consumo de fármacos, sobre todo diuréticos, también se ha relacionado con la evolución a DM2.
Objective: To determine the clinical variables associated with a deterioration in glycemic metabolism in normoglycemic sample with risk factors for diabetes mellitus type 2 (DM2) or who are prediabetic.
Methods: Three follow-up cohorts with patients in primary care consultations were designed: normoglycemic patients with risk factors for DM2, prediabetic patients and newly diagnosed DM2 patients. Personal and anthropometric history, family history, toxic habits, physical activity, symptoms and complications related to diabetes and laboratory data were analyzed.
Results: 545 patients, assessed at baseline, and 2 and 5 years follow-up. Mean age 60 ± 12 years, BMI 30.1 ± 5.1, 48.6 % hypertension , average in HbA1c normoglycemic patients, 4.8 % ( 4.8 to 5 ), in prediabetic patients 5.2% ( from 4.9 to 5, 3%) and in diabetic patients 6.5% ( 5.6 to 8.5 %). At 5 years follow-up, 17.1% of normoglycemic patients became prediabetics and 22.6 % of prediabetic patients became diabetic. In normoglycemic patients, the consumption of diabetogenic drugs, especially diuretics , was linked with an increased incidence of prediabetes at 5 years (OR 24.6 , 95% CI , 6.25 to 96.8). At 5 years, elevated levels of cholesterol was among normoglycemic related to the incidence of pre-diabetes (OR 4.0 95% CI, 1.13 to 14.2 ) .
In prediabetic patients, the incidence of diabetes at 2 years of follow-up was association with elevated triglycerides levels (OR 7.6 95% CI, 1.1 to 52 ) and age ≥ 60 years (OR 4.6 95% CI: 1.47 to 14.7 ), and at 5 yearswas association with elevated total cholesterol levels (OR 4.6 95% CI: 1.3 to 16.1 ) and hight triglycerides levels (OR 3.7 95% CI ; 1, 23 to 11.2 ) .
Conclusions: At 5 years follow up, the incidence of prediabetes among normoglycemic patients was 17% and the incidence of DM2 among prediabetic was 22.6%. The identified factors associated with progression to DM2 were age > 60 years, elevated cholesterol and triglycerides. The consumption of drugs, especially diuretics, has also been associated with progression to DM2 .
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