To assess adherence to self-monitoring of blood glucose and the main factors associated with it, particularly those related to self-perception of glycemia, in patients with diabetes on insulin ...therapy.
An epidemiological, observational, prospective, multicenter study conducted in standard clinical practice in primary care, outpatient centers, and hospitals from different Spanish regions. Sociodemographic, clinical and treatment data were collected. Patients were considered adherent to self-monitoring if they performed the minimum number of controls recommended by the Spanish Society of Diabetes (SED).
Adherence was shown in 61.6% of patients. Factors associated to adherence included treatment with less than three insulin injections daily (OR 2.678; 95% CI 2.048- 3.5029; p <0.001), presence of peripheral vascular disease (OR 1.529; 95% CI 1.077 - 2.171; p=0.018), alcohol abstinence (OR 1.442; 95% CI 1.118 - 1.858; p=0.005), and collection of the glucose test strips from the pharmacy (OR 1.275; 95% CI 1.026 - 1.584; p=0.028). Adequate self-perception of glycemia was found in 21.4% of patients.
Our results show a suboptimal adherence to the recommended protocol for blood glucose self-monitoring in patients with diabetes on insulin therapy. Independent variables associated to good adherence were treatment with less than three insulin injections dailyu, presence of peripheral vascular disease, alcohol abstinence, and collection of glucose test strips from the pharmacy.
Abstract Objective To assess adherence to self-monitoring of blood glucose and the main factors associated with it, particularly those related to self-perception of glycemia, in patients with ...diabetes on insulin therapy. Patients and methods An epidemiological, observational, prospective, multicenter study conducted in standard clinical practice in primary care, outpatient centers, and hospitals from different Spanish regions. Sociodemographic, clinical and treatment data were collected. Patients were considered adherent to self-monitoring if they performed the minimum number of controls recommended by the Spanish Society of Diabetes (SED). Results Adherence was shown in 61.6% of patients. Factors associated to adherence included treatment with less than three insulin injections daily (OR 2.678; 95% CI 2.048–3.5029; p < 0.001), presence of peripheral vascular disease (OR 1.529; 95% CI 1.077–2.171; p = 0.018), alcohol abstinence (OR 1.442; 95% CI 1.118–1.858; p = 0.005), and collection of the glucose test strips from the pharmacy (OR 1.275; 95% CI 1.026–1.584; p = 0.028). Adequate self-perception of glycemia was found in 21.4% of patients. Conclusions Our results show a suboptimal adherence to the recommended protocol for blood glucose self-monitoring in patients with diabetes on insulin therapy. Independent variables associated to good adherence were treatment with less than three insulin injections daily, presence of peripheral vascular disease, alcohol abstinence, and collection of glucose test strips from the pharmacy.
Insulin replacement therapy in people with diabetes mellitus type 1 (DM1) is to obtain a physiological reproduction as possible, both the pharmacokinetic characteristics of insulin as delivery ...systems. It has scored two avenues of research: get new insulins and develop new forms of insulin regimen. The advent of insulin analogues has made to the treatment a physiological profile. The most reproducible insulin delivery has been based mainly on the use of a System of Continuous Subcutaneous Insulin Infusion. These two important objectives but not would optimize the treatment for themselves or good glycemic control of the person if they were not attached to a therapeutic education program in diabetes. The usual therapeutic education program conducted by nurses but obviously integrated into the organization and work of a multidisciplinary team, involves the proper selection of the person and the fulfillment of objectives to be aware and know-how, attitudes and skills.
Resumen Introducción La educación terapéutica (ET) se ha introducido progresivamente en los programas de atención a la diabetes mellitus para dotar a las personas con diabetes, sus familiares y ...cuidadores de los conocimientos necesarios para la autogestión de la enfermedad. El estudio Diabetes Attitudes, Wishes and Needs 2 (DAWN2) contribuye a clarificar cuáles son las necesidades no cubiertas en relación con la autogestión de la enfermedad y la ET a disposición de las personas con diabetes y sus familias. El objetivo de este trabajo es analizar los resultados del estudio DAWN2 relativos a hábitos de autocuidado y la asistencia a actividades de ET en España. Métodos El DAWN2 es un estudio internacional, observacional transversal. En este trabajo hemos tomado en consideración la muestra española de personas con diabetes (502) y familiares (123). Resultados Las personas con diabetes manifiestan tomar la medicación prescrita en la pauta recomendada por su médico 6,4 días de media a la semana y reconocen autocontrolar su nivel de glucosa una media de 3,4 días a la semana. El 86% de los pacientes con diabetes mellitus tipo 1 y el 59% de los pacientes con diabetes mellitus tipo 2 reconocen haber recibido algún tipo de actividad educativa, al igual que el 21% de los familiares. Conclusiones Los educadores en diabetes deberían reforzar los mensajes acerca de los beneficios derivados del autocuidado, en especial para los pacientes que están en las etapas iníciales de la enfermedad. Asimismo, convendría mejorar el acceso de familiares y personas con diabetes mellitus tipo 2 a programas de ET y reflejar en la cartera de servicios de los centros sanitarios los programas de ET disponibles para las personas con diabetes y sus familiares.
Therapeutic education (TE) has been gradually introduced progressively into diabetes mellitus care programs with the aim of providing patients and their families or caregivers with the necessary ...skills for the self-management of the disease. The Diabetes Attitudes, Wishes and Needs 2 (DAWN2) study helps to clarify what are the unmet needs with regards to self-management and the TE offer available to patients and their families. The objective of this paper is to analyse the results of the DAWN2 study regarding self-care habits and participation in TE activities in Spain.
The DAWN2 is an observational, cross-national study. In this paper, an analysis was performed on the Spanish sample of diabetic patients (502) and family members (123).
Patients report taking their medications as recommended by their doctor an average of 6.4 days/week, and self-monitor their blood glucose an average of 3.4 days/week. The large majority (86%) of patients with diabetes mellitus type 1, 59% of patients with diabetes mellitus type 2, and 21% of family members state to have participated in education activities.
Diabetes educators should reinforce the messages about the benefits of self-care, particularly for patients who are in the early stages of the disease. Likewise, access for family members and people with diabetes mellitus type 2 to TE programs should be improved, and these programs for diabetic patients and their families should be included in the services portfolio of health centres.
Abstract Introduction Therapeutic education (TE) has been gradually introduced progressively into diabetes mellitus care programs with the aim of providing patients and their families or caregivers ...with the necessary skills for the self-management of the disease. The Diabetes Attitudes, Wishes and Needs 2 (DAWN2) study helps to clarify what are the unmet needs with regards to self-management and the TE offer available to patients and their families. The objective of this paper is to analyze the results of the DAWN2 study regarding self-care habits and participation in TE activities in Spain. Methods The DAWN2 is an observational, cross-national study. In this paper, an analysis was performed on the Spanish sample of diabetic patients (502) and family members (123). Results Patients report taking their medications as recommended by their doctor an average of 6.4 days/week, and self-monitor their blood glucose an average of 3.4 days/week. The large majority (86%) of patients with diabetes mellitus type 1, 59% of patients with diabetes mellitus type 2, and 21% of family members state to have participated in education activities. Conclusions Diabetes educators should reinforce the messages about the benefits of self-care, particularly for patients who are in the early stages of the disease. Likewise, access for family members and people with diabetes mellitus type 2 to TE programs should be improved, and these programs for diabetic patients and their families should be included in the services portfolio of health centers.
Eighty to 90% of patients attended in emergency departments are discharged to home. Emergency department physicians are therefore responsible for specifying how these patients are treated afterwards. ...An estimated 30% to 40% of emergency patients have diabetes mellitus that was often decompensated or poorly controlled prior to the emergency. It is therefore necessary to establish antidiabetic treatment protocols that contribute to adequate metabolic control for these patients in the interest of improving the short-term prognosis after discharge. The protocols should also maintain continuity of outpatient care from other specialists and contribute to improving the long-term prognosis. This consensus paper presents the consensus of experts from 3 medical associations whose members are directly involved with treating patients with diabetes. The aim of the paper is to facilitate the assessment of antidiabetic treatment when the patient is discharged from the emergency department and referred to outpatient care teams.
The use of the new International Association of the Diabetes and Pregnancy Study Groups criteria (IADPSGC) for the diagnosis of gestational diabetes mellitus (GDM) results in an increased prevalence ...of GDM. Whether their introduction improves pregnancy outcomes has yet to be established. We sought to evaluate the cost-effectiveness of one-step IADPSGC for screening and diagnosis of GDM compared with traditional two-step Carpenter-Coustan (CC) criteria.
GDM risk factors and pregnancy and newborn outcomes were prospectively assessed in 1,750 pregnant women from April 2011 to March 2012 using CC and in 1,526 pregnant women from April 2012 to March 2013 using IADPSGC between 24 and 28 weeks of gestation. Both groups received the same treatment and follow-up regimes.
The use of IADPSGC resulted in an important increase in GDM rate (35.5% vs. 10.6%) and an improvement in pregnancy outcomes, with a decrease in the rate of gestational hypertension (4.1 to 3.5%: -14.6%, P < 0.021), prematurity (6.4 to 5.7%: -10.9%, P < 0.039), cesarean section (25.4 to 19.7%: -23.9%, P < 0.002), small for gestational age (7.7 to 7.1%: -6.5%, P < 0.042), large for gestational age (4.6 to 3.7%: -20%, P < 0.004), Apgar 1-min score <7 (3.8 to 3.5%: -9%, P < 0.015), and admission to neonatal intensive care unit (8.2 to 6.2%: -24.4%, P < 0.001). Estimated cost savings was of €14,358.06 per 100 women evaluated using IADPSGC versus the group diagnosed using CC.
The application of the new IADPSGC was associated with a 3.5-fold increase in GDM prevalence in our study population, as well as significant improvements in pregnancy outcomes, and was cost-effective. Our results support their adoption.
This article estimates the frequency of cardiovascular (CV) events that occurred after diagnosis in a large Spanish cohort of patients with systemic lupus erythematosus (SLE) and investigates the ...main risk factors for atherosclerosis. RELESSER is a nationwide multicenter, hospital-based registry of SLE patients. This is a cross-sectional study. Demographic and clinical variables, the presence of traditional risk factors, and CV events were collected. A CV event was defined as a myocardial infarction, angina, stroke, and/or peripheral artery disease. Multiple logistic regression analysis was performed to investigate the possible risk factors for atherosclerosis. From 2011 to 2012, 3658 SLE patients were enrolled. Of these, 374 (10.9%) patients suffered at least a CV event. In 269 (7.4%) patients, the CV events occurred after SLE diagnosis (86.2% women, median interquartile range age 54.9 years 43.2-66.1, and SLE duration of 212.0 months 120.8-289.0). Strokes (5.7%) were the most frequent CV event, followed by ischemic heart disease (3.8%) and peripheral artery disease (2.2%). Multivariate analysis identified age (odds ratio 95% confidence interval, 1.03 1.02-1.04), hypertension (1.71 1.20-2.44), smoking (1.48 1.06-2.07), diabetes (2.2 1.32-3.74), dyslipidemia (2.18 1.54-3.09), neurolupus (2.42 1.56-3.75), valvulopathy (2.44 1.34-4.26), serositis (1.54 1.09-2.18), antiphospholipid antibodies (1.57 1.13-2.17), low complement (1.81 1.12-2.93), and azathioprine (1.47 1.04-2.07) as risk factors for CV events. We have confirmed that SLE patients suffer a high prevalence of premature CV disease. Both traditional and nontraditional risk factors contribute to this higher prevalence. Although it needs to be verified with future studies, our study also shows-for the first time-an association between diabetes and CV events in SLE patients.
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