ResumenEl adecuado tratamiento de la diabetes mellitus tipo 2 (DM2) incluye la alimentación saludable y el ejercicio (150 min/semana) como pilares básicos. Para el tratamiento farmacológico, la ...metformina es el fármaco de elección inicial, salvo contraindicación o intolerancia; en caso de mal control, se dispone de 8 familias terapéuticas (6 orales y 2 inyectables) como posibles combinaciones. Se presenta un algoritmo y unas recomendaciones para el tratamiento de la DM2. En prevención secundaria cardiovascular se recomienda asociar un inhibidor del cotransportador sodio-glucosa tipo 2 (iSGLT2) o un agonista del receptor de glucagon-like peptide-1 (arGLP1) en pacientes con obesidad. En prevención primaria, si el paciente presenta obesidad o sobrepeso la metformina deberá combinarse con iSGLT2, arGLP1 o inhibidores de la dipeptidilpeptidasa tipo 4 (iDPP4). Si el paciente no presenta obesidad, podrán emplearse los iDPP4, los iSGLT2 o la gliclazida, sulfonilurea recomendada por su menor tendencia a la hipoglucemia.
To analyse the relation between face-to-face appointments and management of patients with type 2 diabetes mellitus (T2DM) visited in primary care practices (PCP).
Retrospective study in 287 primary ...care practices (PCPs) attending>300,000 patients with T2DM. We analysed the results of 9 diabetes-related indicators of the Healthcare quality standard, comprising foot and retinopathy screening, blood pressure (BP) and glycemic control; and the incidence of T2DM. We calculated each indicator’s percentage of change in 2020 with respect to the results of 2019.
Indicators’ results were reduced in 2020 compared to 2019, highlighting the indicators of foot and retinopathy screening (-51.6% and −25.7%, respectively); the glycemic control indicator (-21.2%); the BP control indicator (–33.7%) and the incidence of T2DM (-25.6%). Conversely, the percentage of type 2 diabetes patients with HbA1c > 10% increased by 34%.
PCPs with<11 weekly face-to-face appointments offered per professional had greater reductions than those PCPs with more than 40. For instance, a reduction of −60.7% vs −38.2% (p-value < 0.001) in the foot screening’s indicator; −27.5% vs −12.5% (p-value < 0.001) in glycemic control and −40.2 vs −24.3% (p-value < 0.001) in BP control.
Reducing face-to-face visits offered may impact T2DM patients’ follow-up and thus worsen their control.
Background The electronic medical records software of the Catalan Institute of Health has recently incorporated an electronic version of clinical practice guidelines (e-CPGs). This study aims to ...assess the impact of the implementation of e-CPGs on the diagnosis, treatment, control and management of hypercholesterolaemia, diabetes mellitus type 2 and hypertension.Methods Eligible study participants are those aged 35–74 years assigned to family practitioners (FPs) of the Catalan Institute of Health. Routinely collected data from electronic primary care registries covering 80% of the Catalan population will be analysed using two approaches: (1) a cross-sectional study to describe the characteristics of the sample before e-CPG implementation; (2) a controlled before-and-after study with 1-year follow-up to ascertain the effect of e-CPG implementation. Patients of FPs who regularly use the e-CPGs will constitute the intervention group; the control group will comprise patients assigned to FPs not regularly using the e-CPG. The outcomes are: (1) suspected and confirmed diagnoses, (2) control of clinical variables, (3) requests for tests and (4) proportions of patients with adequate drug prescriptions.Results This protocol should represent a reproducible process to assess the impact of the implementation of e-CPGs. We anticipate reporting results in late 2013.Conclusion This project will assess the effectiveness of e-CPGs to improve clinical decisions and healthcare procedures in the three disorders analysed. The results will shed light on the use of evidence-based medicine to improve clinical practice of FPs.
Gestational diabetes mellitus (GDM) is globally increasing due to changes in risk factors such as gestational age, obesity, and socioeconomic status (SES). This study examined trends of GDM ...prevalence over ten years using a real-world Primary Health Care database from Catalonia (Spain). Methods: A retrospective analysis of pregnant women screened for GDM was conducted, using clinical and SES data from the SIDIAP database. Results: Among 221,806 women studied from 2010 to 2019,17,587 had GDM, equating to a 7.9% prevalence (95% CI 7.8–8.04). GDM subjects were older (33.5 ± 5.1 vs. 31.2 ± 5.6 years; p < 0.001) and had higher BMI (29.2 ± 5.1 vs .27.8 ± 4.8 kg/m²; p < 0.001) than non-GDM individuals. Overall GDM prevalence remained unchanged throughout the study, although an increase was observed in younger women (below 20 years: 1.28% 95% CI 0.59–2.42 in 2010 to 2.22% 95% CI 0.96–4.33 in 2019, p = 0.02; ages 20–25.9 years: 3.62% 95% CI 3.12–4.17 in 2010 to 4.63% 95% CI 3.88–5.48) in 2019, p = 0.02). Age, BMI ≥ 25 kg/m2, deprived SES, and previous hypertension and dyslipidaemia were positively associated with GDM.
This study offers insights into GDM prevalence in Catalonia (Spain),showing overall stability except for a rising trend among younger women.
•The prevalence of GDM in Catalonia was 7.9%.•GDM prevalence was stable during the study period.•GDM prevalence increased in younger women.•Age & BMI were positively associated with GDM.•High SES were negatively associated with GDM.
Aim
To evaluate whether a specially designed multicomponent healthcare intervention improves glycaemic control in subjects with poorly controlled type 2 diabetes.
Materials and Methods
A cluster, ...non‐randomized, controlled, pragmatic trial in subjects from 11 primary care centres with type 2 diabetes and HbA1c of more than 9% (> 75 mmol/mol) was conducted. The intervention (N = 225 subjects) was professional and patient‐centred, including a dedicated monographic visit that encouraged therapeutic intensification by physicians. The sham control (N = 181) was identical to that of the intervention group except that the dedicated visit was omitted. The primary outcome was to compare the reductions in HbA1c values between the groups at 12 months of follow‐up.
Results
The mean age at baseline was 59.5 years, mean diabetes duration was 10.7 years and mean HbA1c was 10.3% (89.0 mmol/mol). Patients in the intervention arm achieved significantly greater HbA1c reduction than those in the sham control group at 12 months (mean difference −0.62%, 95% CI = −0.2%, −1.04%; P = .002). A larger percentage of intervention participants achieved an HbA1c of less than 8% (44.8% vs. 25.5%; P = .003) and were more frequently treated with more than three antidiabetic therapies (14.4% vs. 3.5%; P = .0008). Intervention was the only variable associated with higher odds of HbA1c less than 8% (odds ratio = 2.52; 95% CI = 1.54‐4.12; P < .001).
Conclusions
A multicomponent intervention including a dedicated visit oriented at reducing therapeutic inertia by primary care physicians can improve glycaemic control in poorly controlled patients with type 2 diabetes.
Highlights • Frequent eye screening helps to identify DME early, facilitating prompt treatment. • Treatment of patients with DME should take a collaborative, holistic approach. • Including ...ophthalmologists in multidisciplinary diabetes teams may enable this. • Engaging multidisciplinary teams early may help to improve patient outcomes.
Background Metabolic syndrome (MS) is the simultaneous occurrence of a cluster of predefined cardiovascular risk factors. Although individual MS components are associated with increased risk of ...cancer, it is still unclear whether the association between MS and cancer differs from the association between individual MS components and cancer. The aim of this matched case-control study was to estimate the association of 13 types of cancer with (1) MS and (2) the diagnosis of 0, 1 or 2 individual MS components. Methods Cases included 183,248 patients ≥40 years from the SIDIAP database with incident cancer diagnosed between January 2008-December 2017. Each case was matched to four controls by inclusion date, sex and age. Adjusted conditional logistic regression models were used to evaluate the association between MS and cancer risk, comparing the effect of global MS versus having one or two individual components of MS. Results MS was associated with an increased risk of the following cancers: colorectal (OR: 1.28, 95%CI: 1.23–1.32), liver (OR: 1.93, 95%CI: 1.74–2.14), pancreas (OR: 1.79, 95%CI: 1.63–1.98), post-menopausal breast (OR: 1.10, 95%CI: 1.06–1.15), pre-menopausal endometrial (OR: 2.14, 95%CI: 1.74–2.65), post-menopausal endometrial (OR: 2.46, 95%CI: 2.20–2.74), bladder (OR: 1.41, 95%CI: 1.34–1.48), kidney (OR: 1.84, 95%CI: 1.69–2.00), non-Hodgkin lymphoma (OR: 1.23, 95%CI: 1.10–1.38), leukaemia (OR: 1.42, 95%CI: 1.31–1.54), lung (OR: 1.11, 95%CI: 1.05–1.16) and thyroid (OR: 1.71, 95%CI: 1.50–1.95). Except for prostate, pre-menopause breast cancer and Hodgkin and non-Hodgkin lymphoma, MS is associated with a higher risk of cancer than 1 or 2 individual MS components. Estimates were significantly higher in men than in women for colorectal and lung cancer, and in smokers than in non-smokers for lung cancer. Conclusion MS is associated with a higher risk of developing 11 types of common cancer, with a positive correlation between number of MS components and risk of cancer.
To determine the diagnostic performance of home blood pressure self-monitoring in white-coat hypertension using a 3-day reading program.
One hundred and ninety nontreated patients recently diagnosed ...with mild-moderate hypertension, selected consecutively at four primary healthcare centers in the city of Barcelona, were included. Each patient underwent morning and night home blood pressure self-monitoring with readings in triplicate for three consecutive days, followed by 24-h ambulatory blood pressure monitoring. The normality cut-off point value for home blood pressure self-monitoring and daytime ambulatory blood pressure monitoring was 135/85 mmHg.
Sixty-three patients were diagnosed with white-coat hypertension with home blood pressure self-monitoring (34.8%; 95% confidence interval: 27.9-42.2) and 74 with ambulatory blood pressure monitoring (41.6%; 95% confidence interval: 33.7-48.4). No statistically significant differences were observed between home blood pressure self-monitoring values and those of diurnal ambulatory blood pressure monitoring 137.4 (14.3)/82.1 (8.3) mmHg vs. 134.8 (11.3)/81.3 (9.5) mmHg. Home blood pressure self-monitoring diagnostic performance parameters were sensitivity 50.0% (95% confidence interval: 38.3-61.7), specificity 75.7% (95% confidence interval: 66.3-83.2), positive and negative predictive values 58.7% (95% confidence interval: 45.6-70.8) and 68.6% (95% confidence interval: 59.4-76.7), respectively, and positive and negative probability coefficients 2.05 and 0.66, respectively. Analysis of different normality cut-off points using a receiver operating characteristic curve failed to produce significant improvement in the diagnostic performance of home blood pressure self-monitoring.
The diagnostic accuracy of a 3-day home blood pressure self-monitoring reading program in white-coat hypertension was poor. Ambulatory blood pressure monitoring continues to be the test of choice for this indication.
Diabetes is a major global epidemic and places a huge burden on healthcare systems worldwide. The complications of type 2 diabetes (T2D) and related hospitalizations are major contributors to this ...burden, and there is strong evidence that the risk for these can be reduced by early action to identify and prevent progression of people at high risk of T2D and ensure tight glycemic control in those with established disease. In response to this, the Berlin Declaration was developed by four working groups of experts and ratified by healthcare professionals from 38 countries. Its aim is to act as a global call to action for early intervention in diabetes, in addition to providing short-, medium- and long-term targets that should be relevant to all nations. The Berlin Declaration focuses on four aspects of early action, and proposes actionable policies relating to each aspect: early detection, prevention, early control and early access to the right interventions. In addition, a number of treatment targets are proposed to provide goals for these policies. To ensure that the suggested policies are enacted in the most effective manner, the support of specialist care professionals is considered essential.
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