Our study aimed to evaluate the performance of primary healthcare physicians (PCPs) in managing glycemia, lipids, and blood pressure in people with type 2 diabetes mellitus (T2DM) in Catalonia, ...Spain.
We included 3267 PCPs with 367,132 T2DM subjects in a cross-sectional analysis of the SIDIAP (Sistema d'Informació per al Desenvolupament de la Investigació en Atenció Primària) database for the year 2017.
: 63.1% of PCPs were female, with an average practice size of 1512 subjects. T2DM individuals had a mean (standard deviation) age of 70 (±12.2) years old, a mean body mass index (BMI) of 30.2 (±5.21) kg/m
, and a median diabetes duration of 8.8 years. Overall, 42.6% of subjects achieved target glycemic control (glycated hemoglobin < 7%). Notably, 59.2% maintained blood pressure < 140/90 mmHg during the 12-month study period. The multivariable analysis identified positive associations between glycemic control and female PCPs, practice sizes (1000-1500 people), a higher proportion of patients aged ≥ 65 years, and rural practices. Combined glycemic, lipid, and blood pressure target attainment was associated with medium-sized practices and those with a higher proportion of patients aged ≥ 65 years.
Practice size, patient age distribution, and rurality are factors associated with the performance of PCPs in the control of glycemia, lipids, and blood pressure in T2DM subjects in primary health care centers in our region.
The DE-PLAN was a European multicenter study, with the primary objective of testing whether a community-based lifestyle modification programme could serve as a means of primary prevention for type 2 ...diabetes (T2D) in high-risk individuals (based on the FINDRISC questionnaire). The aim of this study was to examine the impact of a 1-year community-based lifestyle intervention on health-related quality of life (HRQOL) in individuals from four participating European centers (Athens, Barcelona, Krakow, Kaunas), through a post-hoc analysis.
Each center was allowed to implement different intervention strategies specifically tailored to the needs of their corresponding population sample. Before and after the intervention, participants underwent clinical evaluation, anthropometric measurements, an oral glucose tolerance test and lipid profile measurements. Health-related quality of life was assessed using the validated HRQOL-15D questionnaire. A difference of ±0.015 in the 15D questionnaire score was set as the threshold of clinically meaningful change.
Data from 786 participants (67% females, mean age 59.7±9.4 years, BMI 31.5±4.5 kg/m2) with complete data regarding the HRQOL were analyzed (Athens: 104, Barcelona: 434, Krakow: 175, Kaunas: 70). After 1 year, a significant overall improvement in HRQOL was shown, as depicted by a change of 15D score from baseline value (0.88±0.9) to post-intervention (0.90±0.87, P<0.001), achieving the threshold of clinically meaningful change. A significant weight reduction was also observed (-0.8±4.0 kg, P<0.001). In multivariate analysis, improvement in HRQOL was independently associated with lower 15D score at baseline (P<0.001) and self-reported increase in overall exercise time (P<0.001) as assessed through specifically designed trial questionnaires.
A community-based lifestyle intervention programme aiming at T2D prevention, applied on a heterogeneous population and with varied methods, was shown to improve overall health-related quality of life to a clinically meaningful degree.
BackgroundMetabolic syndrome (MS) is defined by the clustering of specific metabolic disorders in one subject. MS is highly prevalent globally and currently considered a growing public health ...concern. MS comprises obesity, hypertension, dyslipidaemia and insulin resistance. Mechanisms linking MS with cancer are poorly understood, and it is as yet unknown if MS confers a greater risk than the risk entailed by each of its separate components. The main objective of this study is to compare the association between MS and 14 site-specific cancer against the association between one or two individual components of MS and cancer. The secondary objective is to evaluate the time elapsed since the diagnosis of MS and the subsequent onset of cancer within the 2006–2017 period by sex.Methods and analysisA case–control study will be conducted for the main objective and a cohort of patients with MS will be followed for the evaluation of the second objective. Incident cases of fourteen types of cancer in patients ≥40 years of age diagnosed prospectively will be selected from electronic primary care records in the Information System for Research in Primary Care (SIDIAP database; www.sidiap.org). The SIDIAP database includes anonymous data from 6 million people (80% of the Catalan population) registered in 286 primary healthcare centres. Each matched control (four controls for each case) will have the same inclusion date, the same sex and age (±1 year) than the paired case. Logistic regression and a descriptive analysis and Kaplan-Meier analysis will be performed, in accordance with the objectives.Ethics and disseminationThe protocol of the study was approved by the IDIAP Jordi Gol Clinical Research Ethics Committee (protocol P17/212). The study’s findings will be published in a peer-reviewed journal and disseminated at national and international conferences and oral presentations to researchers, clinicians and policy makers.
The DE-PLAN-CAT project (Diabetes in Europe-Prevention using lifestyle, physical activity and nutritional intervention-Catalonia) has shown that an intensive lifestyle intervention is feasible in the ...primary care setting and substantially reduces the incidence of diabetes among high-risk Mediterranean participants. The DP-TRANSFERS project (Diabetes Prevention-Transferring findings from European research to society) is a large-scale national programme aimed at implementing this intervention in primary care centres whenever feasible.
A multidisciplinary committee first evaluated the programme in health professionals and then participants without diabetes aged 45-75 years identified as being at risk of developing diabetes: FINDRISC (Finnish Diabetes Risk Score)>11 and/or pre-diabetes diagnosis. Implementation was supported by a 4-channel transfer approach (institutional relationships, facilitator workshops, collaborative groupware, programme website) and built upon a 3-step (screening, intervention, follow-up) real-life strategy. The 2-year lifestyle intervention included a 9-hour basic module (6 sessions) and a subsequent 15-hour continuity module (10 sessions) delivered by trained primary healthcare professionals. A 3-level (centre, professionals and participants) descriptive analysis was conducted using cluster sampling to assess results and barriers identified one year after implementation.
The programme was started in June-2016 and evaluated in July-2017. In all, 103 centres covering all the primary care services for 1.4 million inhabitants (27.9% of all centres in Catalonia) and 506 professionals agreed to develop the programme. At the end of the first year, 83 centres (80.6%) remained active and 305 professionals (60.3%) maintained regular web-based activities. Implementation was not feasible in 20 centres (19.4%), and 5 main barriers were prioritized: lack of healthcare manager commitment; discontinuity of the initial effort; substantial increase in staff workload; shift in professional status and lack of acceptance. Overall, 1819 people were screened and 1458 (80.1%) followed the lifestyle intervention, with 1190 (81.6% or 65.4% of those screened) participating in the basic module and 912 in the continuity module (62.5% or 50.1%, respectively).
A large-scale lifestyle intervention in primary care can be properly implemented within a reasonably short time using existing public healthcare resources. Regrettably, one fifth of the centres and more than one third of the professionals showed substantial resistance to performing these additional activities.
AimThis study’s objective was to assess the risk of severe in-hospital complications of patients admitted for COVID-19 and diabetes mellitus (DM).DesignThis was a cross-sectional study.SettingsWe ...used pseudonymised medical record data provided by six general hospitals from the HM Hospitales group in Spain.Outcome measuresMultiple logistic regression analyses were used to identify variables associated with mortality and the composite of mortality or invasive mechanical ventilation (IMV) in the overall population, and stratified for the presence or absence of DM. Spline analysis was conducted on the entire population to investigate the relationship between glucose levels at admission and outcomes.ResultsOverall, 1621 individuals without DM and 448 with DM were identified in the database. Patients with DM were on average 5.1 years older than those without. The overall in-hospital mortality was 18.6% (N=301), and was higher among patients with DM than those without (26.3% vs 11.3%; p<0.001). DM was independently associated with death, and death or IMV (OR=2.33, 95% CI: 1.7 to 3.1 and OR=2.11, 95% CI: 1.6 to 2.8, respectively; p<0.001). In subjects with DM, the only variables independently associated with both outcomes were age >65 years, male sex and pre-existing chronic kidney disease. We observed a non-linear relationship between blood glucose levels at admission and risk of in-hospital mortality and death or IMV. The highest probability for each outcome (around 50%) was at random glucose of around 550 mg/dL (30.6 mmol/L), and the risks flattened above this value.ConclusionThe results confirm the high burden associated with DM in patients hospitalised with COVID-19 infection, particularly among men, the elderly and those with impaired kidney function. Moreover, hyperglycaemia on admission was strongly associated with poor outcomes, suggesting that personalised optimisation could help to improve outcome during the hospital stay.
•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.
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.
We estimate the incidence and risk factors for fatal and non-fatal events among the COVID-19 infected subjects based on the presence of obesity or diabetes during the initial three epidemiological ...waves in our region.
This was a retrospective cohort study. A primary care database was used to identify persons with COVID-19. We stratified for subjects who either had diabetes mellitus or obesity. The follow-up period for study events was up to 90 days from inclusion.
In total, 1238,710 subjects were analysed. Subjects with diabetes mellitus or obesity were older and had a worse comorbidity profile compared with groups without these conditions. Fatal events were more frequent among people with diabetes and during the first wave. In the second and third waves, the number of study events decreased. Diabetes was a risk factor for fatal events in all models, while obesity was only in the model adjusted for age, sex, diabetes and COVID-19 waves. HIV, cancer, or autoimmune diseases were risk factors for mortality among subjects with COVID-19 in the fully-adjusted model.
Diabetes was an independent risk factor for mortality among people with COVID-19. The number of fatal events decreased during the second and third waves in our region, both in those with diabetes or obesity.
•Diabetes was risk factor for mortality among people with COVID-19.•The number of fatal events decreased during the second and third waves.•Cardiovascular and neurological complications highly present events among people with DM.•HIV had a four-fold probability of mortality during the 90-day follow-up.
Abstract Background European studies on quality of diabetes care in an unselected primary care diabetes population are scarce. Research question To test the feasibility of the set-up and logistics of ...a cross-sectional EUropean study on Care and Complications in patients with type 2 diabetes (T2DM) in Primary Care (EUCCLID) in 12 European countries. Method One rural and one urban practice from each country participated. The central coordinating centre randomly selected five patients from each practice. Patient characteristics were assessed including medical history, anthropometric measures, quality indicators, UKPDS-risk engine, psychological and general well-being. Results We included 103 participants from 22 GPs in 11 countries. Central data and laboratory samples were successfully collected. Of the participants 54% were female, mean age was 66 years and mean duration of diabetes was 9.6 years. Besides, 18% were using insulin, 31% had a history of cardiovascular disease, mean HbA1c was 7.1% (range 6.6–8.0), mean systolic blood pressure was 133.7 mmHg (range 126.1–144.4) and mean total cholesterol was 4.9 mmol/l (range 4.0–6.2). Conclusion A European study on care and complications in a random selection of people with T2DM is feasible. There are large differences in indicators of metabolic control and wellbeing between countries.
OBJECTIVE:Several studies have shown that evening intake of aspirin has antihypertensive effect in healthy adults, which has not been proven in patients with cardiovascular disease, who mostly take ...aspirin in the morning. We have evaluated the antihypertensive effect of bedtime administration of aspirin in patients with cardiovascular disease already treated for hypertension.
METHODS:This is a multicenter randomized triple-blind placebo-controlled crossover trial, with hypertensive patients treated with aspirin for secondary prevention. There was a baseline-randomized assignment to 2-month periods of bedtime aspirin (100 mg) first and morning-time aspirin later, or inversely, both periods separated by an open label 2–4 weeks period of morning-time aspirin. At the start and end of each treatment period, a 24-h ambulatory blood pressure monitoring was performed. The main outcome measure was mean 24-h blood pressure. The analyses were performed according to the intention-to-treat principle.
RESULTS:Overall, 225 patients were randomized. No significant differences were observed in ambulatory blood pressure by time of intake of usual low doses of aspirin. The mean SBP/DBP was 123.2/69.9 (95% CI 121.58–124.9/68.86–76.86) with bedtime administration and 122.4/68.8 (95% CI 120.76–124.01/67.85–69.83) with daytime administration (P = 0.3 and P = 0.23 for SBP and DBP, respectively).
CONCLUSION:Administering aspirin at bedtime rather than in the morning does not modify the 24-h ambulatory blood pressure in hypertensive patients in secondary cardiovascular prevention.The trial was registered with ClinicalTrials.gov (number NCT01741922).
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