Característiques diferencials de l'aterosclerosi subclínica en la diabetis mellitus

Aquesta tesi està formada per 4 articles publicats en revistes d'impacte internacional i les principals conclusions s'exposen a continuació. Els pacients amb diabetis mellitus tipus 2 presenten major prevalença de malaltia ateromatosa subclínica que els subjectes sense diabetis mellitus. El rol dels professionals de la infermeria és essencial en la prevenció i promoció de la salut, mitjançant la realització dels procediments ecogràfics, la identificació dels factors de risc cardiovasculars i l’educació per a la salut. S’ha desenvolupat i estandarditzat un mètode ecogràfic de quantificació del senyal de vasa vasorum de l’adventícia de la caròtida comú que és vàlid, fiable i reproduïble. L’avaluació del senyal de vasa vasorum en l’adventícia de l’artèria caròtida comú pot ser un nou marcador per a l’exploració i monitorització del procés ateroscleròtic. Els pacients amb diabetis mellitus tipus 1 presenten major senyal de vasa vasorum que aquells que no tenen diabetis, suggerint que la paret de les grans artèries es pot considerar també una diana de la microangiopatia diabètica. No s’ha pogut demostrar una associació entre el senyal de vasa vasorum i la presència de retinopatia diabèticaEsta tesis esta formada por 4 artículos publicados en revistas de impacto internacional y las principales conclusiones se exponen a continuación. Los pacientes con diabetes mellitus tipo 2 presentan mayor prevalencia de enfermedad ateromatosa subclínica que los sujetos sin diabetes mellitus. El rol de los profesionales de la enfermería es esencial en la prevención y promoción de la salud, mediante la realización de procedimientos ecográficos, la identificación de los factores de riesgo cardiovasculares y la educación para la salud. Se ha desarrollado y estandarizado un método ecográfico de cuantificación de la señal de vasa vasorum de la adventicia de la carótida común que es válido, fiable y reproducible. La evaluación de la señal de vasa vasorum en la adventicia carotidea puede ser un nuevo marcador para la exploración y monitorización del proceso aterosclerótico. Los pacientes con diabetes mellitus tipo 1 presentan mayor señal de vasa vasorum que aquellos que no tienen diabetes, sugiriendo que la pared de las grandes arterias se puede considerar también una diana de la microangiopatía diabética. No se ha podido demostrar una asociación entre la señal de vasa vasorum y la presencia de retinopatía diabéticaThis thesis is composed of 4 articles published in journals of international impact and the main conclusions are discussed below. Patients with diabetes mellitus type 2 have a higher prevalence of subclinical atheromatous disease that subjects without diabetes mellitus. The role of nursing professionals is essential in prevention and health promotion, through the realization of ultrasound procedures, identification of cardiovascular risk factors and the education for health. It has been developed a standardized ultrasound method for quantifying the signal of vasa vasorum in the adventitious common carotid which is valid, reliable, and reproducible. The signal evaluation of vasa vasorum in the adventitia carotid may be a new marker for exploration and monitoring of the atherosclerotic process. Patients with type 1 diabetes have greater vasa vasorum signal that those without diabetes, suggesting that the wall of the large arteries can also be considered a target of diabetic microangiopathy. It was unable to demonstrate an association between VV signal and the presence of diabetic retinopath

A prospective cross-sectional study on quality of life and treatment satisfaction in type 2 diabetic patients with retinopathy without other major late diabetic complications

Background: To assess quality of life and treatment satisfaction in patients with type 2 diabetes mellitus with diabetic retinopathy (DR) using validated instruments, with comparison to patients without DR. Methods: A prospective cross-sectional study was designed to assess the influence of retinopathy on quality of life and treatment satisfaction in patients with type 2 diabetes mellitus who do not have any other advanced late complications that could interfere with these outcomes. We included 148 patients with DR and 149 without DR, all without other advanced diabetic complications. Quality of life was assessed using the Audit of Diabetes Dependent Quality of Life (ADDQoL) questionnaire, and treatment satisfaction was assessed using the Diabetes Treatment Satisfaction Questionnaire (DTSQ). Clinical and treatment variables related to diabetes were also collected. The degree of DR was classified according to the International Clinical Classification System. Multivariate linear regression models were used to model the ADDQoL and DTSQ scores according to sociodemographical and clinical characteristics, and to model the adjusted relationship of DTSQ with ADDQoL. In DR patients, a subanalysis assessed the relationship of these scores with the degree of retinopathy, severity of macular edema, and previous photocoagulation treatment. Results: DR was associated with significantly lower quality of life (p < 0.001), when examining the two general quality of life items and most of the specific domains. Concerning DTSQ, no difference was found in the total score, and only two domains that assess the perception of glycemic control (hyper- and hypoglycemia) showed a worse score in DR (p < 0.001 and p = 0.008, respectively). Quality of life was significantly affected by the severity of DR, and treatment satisfaction was significantly affected by the severity of macular edema. In the multivariate analysis, a significant effect of the interaction between diabetes duration, insulin therapy, and the presence of DR was found for both, ADDQoL and DTSQ. Conclusion: In the absence of other major complications, DR has a negative impact on quality of life in patients with type 2 diabetes. Further, treatment satisfaction was not affected by the presence of DR.This study was supported by grant PS09/01035 from Instituto de Salud Carlos III

Understanding the physical, social, and emotional experiences of people with uncontrolled Type 2 diabetes: a qualitative study

The purpose of this study was to identify the perceptions, barriers, and facilitators of self-management of Type 2 diabetes mellitus (T2DM) to determine the factors to consider when developing and implementing a person-centered intervention in patients with poor glycemic control attending primary care.CIBER of Diabetes and Associated Metabolic Diseases (CIBERDEM) is an initiative included in Plan Nacional de I+D+I and cofinanced by Instituto de Salud Carlos III-Subdireccion General de Evaluación and Fondo Europeo de Desarrollo Regional (FEDER)

INTEGRA study protocol: primary care intervention in type 2 diabetes patients with poor glycaemic control

Background The management of hyperglycaemia and associated cardiovascular risk factors in patients with type 2 diabetes mellitus (T2DM) may reduce diabetes-related complications. The strategy to broaden the knowledge base of primary care professionals to improve health care has mainly been prompted by the current reality of limited resources and access to specialized care. The main objective of this study is to assess the effectiveness of comprehensive interventions focused on treatment intensification, decrease clinical inertia and reduce possible barriers to treatment adherence in patients with poorly controlled diabetes in a primary care setting. Methods This is a two-phase mixed method study, whose aims are the development of complex interventions and the assessment of their effectiveness. The main study outcome is a change in glycated haemoglobin (HbA1c) levels. The INTEGRA study is divided into two phases. Phase 1: A qualitative study with a phenomenological approach using semi-structured interviews with the objective of determining the factors related to the participants and health care professionals that influence the development and implementation of a specific intervention strategy aimed at patients with poor glycaemic control of T2DM in primary care. Phase 2: Exploratory intervention study to be conducted in Primary Health Care Centres in Catalonia (Spain), including 3 specific health care areas. The intervention study has two arms: Intervention Group 1 and 2. Each intervention group will recruit 216 participants (the same as in the control group) between the ages of 30 and 80 years with deficient glycaemic control (HbA1c > 9%). The control group will be established based on a randomized selection from the large SIDIAP (Sistema d’Informació per al desenvolupament de la Investigació en Atenció Primària) database of patients with comparable socio-demographic and clinical characteristics from the three provinces. Discussion This study is a comprehensive, pragmatic intervention based on glycaemic treatment intensification and the control of other cardiovascular risk factors. It is also aimed at improving treatment adherence and reducing clinical inertia, which could lead to improved glycaemic control and could likewise be feasible for implementation in the actual clinical practice of primary care.The study is partially supported by unrestricted grant from Sanofi. The study has also intramural support from Institut Universitari d’Investigació en Atenció Primària Jordi Gol. The funder does not have any role in writing the study protocol. This funding source will not have any role during its execution, analyses, interpretation of the data, or decision to submit results