¿Adelantan el diagnóstico de la diabetes tipo 2 los nuevos criterios de la Asociación Americana de Diabetes?

ObjetivoAnalizar el intervalo temporal entre la primera hiperglucemia basal ocasional (HBO) y el diagnóstico de diabetes mellitus tipo 2 (DM2) al aplicar los criterios de la OMS y de la Asociación Americana de Diabetes (ADA).DiseñoEstudio observacional, retrospectivo. Ámbito del estudio. Centro de atención primaria urbano.SujetosUn total de 104 pacientes con DM2, diagnosticados entre 1991 y 1995, con antecedentes de HBO.Mediciones o intervencionesEdad, género y otros factores de riesgo, fechas de la primera HBO (glucemia basal 3 110 mg/dl), del diagnóstico según criterios OMS (2 glucemias basales 3 140 mg/dl o 3 200 mg/dl a las 2 horas de la sobrecarga oral de glucosa [SOG]) y aplicando criterios ADA (2 glucemias basales 3 126 mg/dl) y los intervalos en meses entre ellas.ResultadosDe los 222 pacientes diagnosticados, 104 (47%) presentaban antecedentes de HBO. La edad en el momento del diagnóstico fue 60,8 años (DE, 10,1), siendo un 53% mujeres. En 51 casos (49%) se realizó SOG. La mediana (rango) del intervalo entre la primera HBO y el diagnóstico fue de 16 meses (0–101) en los que se realizó la SOG y de 45 (1–104) en los que no se practicó (p = 0,003). En estos últimos, los criterios ADA lo redujeron a 31 meses (0–97) (p < 0,001) y en 27 de ellos que no cumplían ambos criterios a la vez el intervalo fue de sólo 10 meses (0–93) (p < 0,001). Conclusiones. La no realización de la SOG comporta un retraso en el diagnóstico que puede ser contrarrestado con la aplicación de los criterios de la ADA.ObjectiveTo analyze the period of time between the first occasional fasting hyperglycaemia (OFH) and the diagnosis of type 2 diabetes mellitus (DM2), using the World Health Organization (WHO) criteria or the American Diabetes Association (ADA) criteria.DesignRetrospective, observational study.SettingUrban primary care centre.Subjects104 patients with DM2 diagnosed between 1991 and 1995 who had a previous OFH.MeasurementsAge, gender and other risk factors, dates of the first OFH (fasting plasma glucose 3 110 mg/dl), the diagnosis according to WHO criteria (2 fasting plasma glucose 3 140 mg/dl or 3 200 mg/dl two hours after the oral glucose test tolerance (OGTT)) or with the ADA criteria (2 fasting plasma glucose 3 126 mg/dl), and the intervals in months between them.ResultsOf the 222 diagnosed patients, 104 (47%) had previous OFH. Age at diagnosis was 60.8 (SD 10.1) and 53% were women. OGTT was performed in 51 cases (49%). The median (range) of the interval between the first OFH and diagnosis was 16 months (0–101) for those who were undertaken an OGTT, and 45 months (1–104) for those who were not (p = 0.003). In these last ones, ADA criteria reduced the interval to 31 months (0–97) (p < 0.001). In 27 of these patients who did not satisfy both criteria at the same time, ADA criteria reduced the interval to 10 months (0–93) (p < 0.001).ConclusionsNot performing the OGTT means a delay in diagnosis which can be countered by applying the ADA criteria

The effectiveness of a community-based, type 2 diabetes prevention programme on healthrelated quality of life. The DE-PLAN study

Background and aims 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 posthoc analysis. Materials and methods 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. Results 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&lt;0.001), achieving the threshold of clinically meaningful change. A significant weight reduction was also observed (-0.8±4.0 kg, P&lt;0.001). In multivariate analysis, improvement in HRQOL was independently associated with lower 15D score at baseline (P&lt;0.001) and self-reported increase in overall exercise time (P&lt;0.001) as assessed through specifically designed trial questionnaires. Conclusion A community-based lifestyle intervention programme aiming at T2D prevention, applied on a heterogeneous population and with varied methods, was shown to improve overall healthrelated quality of life to a clinically meaningful degree. © 2019 Karamanakos et al. © 2019 by the authors. Licensee MDPI, Basel, Switzerland