Prevenció de la diabetis tipus 2 en atenció primària. Estudi del perfil de risc a Europa, anàlisi d'una intervenció sobre l'estil de vida a Catalunya i ressenya de la seva contribució internacional

La diabetis és una malaltia de gran impacte malgrat disposar d’eines predictives i programes de prevenció teòricament eficaços. Els objectius d’aquesta tesi són avaluar el rendiment de l’escala FINDRISC en població europea; la factibilitat i efectivitat d’un programa d’intervenció sobre l’estil de vida i, finalment, incloure’l com a referència internacional. Es presenta un estudi transversal de cribratge derivat del projecte europeu DE-PLAN, un estudi multicèntric de cohorts (DE-PLAN-CAT) i la seva aportació conjunta a la Declaració de Berlín. Es va comparar la prevalença de trastorns glucídics (1621 homes/2483 dones) segons interval de risc de l’escala FINDRISC. Puntuacions entre 15-19 es corresponien amb prevalences del 50-60% (20-30%, diabetis). Amb valors >20 augmentava al 80% (50%, diabetis). La intervenció intensiva sobre l’estil de vida DE-PLAN-CAT va ser factible (n=333) en atenció primària durant 4,2 anys amb una reducció significativa en la incidència de diabetis respecte al grup (n=219) d’intervenció estàndard (4,6/7,2 casos/100 persones/any; RRR=36%) i aquest programa va aconseguir una clara difusió internacional. Per tant, FINDRISC té un bon rendiment com a eina de cribratge i la intervenció intensiva subsegüent no només és factible sinó que redueix la incidència de diabetis en persones de risc. L’aportació a la Declaració de Berlín palesa una proposta formal a nivell europeu.La diabetes es una enfermedad de gran impacto mundial a pesar del acceso a instrumentos predictivos i programas de prevención teóricamente eficaces. Los objetivos de esta tesis son evaluar el rendimiento del cuestionario FINDRISC en población europea; la factibilidad y efectividad a de un programa de intervención sobre los estilos de vida y, finalmente, incluir el programa como referencia internacional. Se presenta un estudio transversal de cribado del proyecto europeo DE-PLAN, un estudio multicéntrico de cohortes (DE-PLAN-CAT) i su contribución conjunta a la Declaración de Berlín. Se comparó la prevalencia de trastornos de glucémicos (1621 hombres/2483 mujeres) en función del intervalo de la escala FINDRISC. Puntuaciones entre 15-19 puntos se correspondían con la prevalencias del 50-60% (20-30%, diabetes). Con valores > 20 aumentaba al 80% (50%, diabetes). La intervención intensiva sobre los estilos de vida DE-PLAN-CAT fué factible (n=333) en atención primaria durante 4,2 años con una reducción significativa en la incidencia de diabetes respecto al grupo (n=219) de intervención estándar (4,6/7,2 casos/100 personas/año; RRR= 36%) y este programa consiguió una clara difusión internacional. Por lo tanto, FINDRISC tiene un buen rendimiento como herramienta de cribado y la intervención intensiva subsiguiente no solo es factible sino que reduce la incidencia de diabetes en personas de riesgo. La aportación a la Declaración de Berlín evidencia una propuesta formal a nivel europeo.Diabetes is a high-impact disease despite having theoretically effective predictive tools and prevention programs. The objectives of this thesis are to evaluate the performance of the FINDRISC scale in the European population; the feasibility and effectiveness of a lifestyle intervention program and, finally, to include it as an international reference. A cross-sectional screening study derived from the European DE-PLAN project, a multicenter cohort study (DE-PLANCAT) and its joint contribution to the Berlin Declaration are presented. The prevalence of glucose disorders (1621 men / 2483 women) was compared according to the risk interval of the FINDRISC scale. Scores between 15-19 corresponded to prevalences of 50-60% (20-30%, diabetes). With values > 20 it increased to 80% (50%, diabetes). Intensive lifestyle intervention DE-PLAN-CAT was feasible (n = 333) in primary care for 4.2 years with a significant reduction in the incidence of diabetes compared to the intervention group (n = 219) standard (4.6 / 7.2 cases / 100 people / year; RRR = 36%) and this program achieved a clear international dissemination. Therefore, FINDRISC performs well as a screening tool and subsequent intensive intervention is not only feasible but reduces the incidence of diabetes in people at risk. The contribution to the Berlin Declaration is a formal proposal at European level

Metabolic syndrome and risk of cancer : A study protocol of case-control study using data from the Information System for the Development of Research in Primary Care (SIDIAP) in Catalonia

Funding The project received a research grant from the Carlos III Institute of Health, Ministry of Economy and Competitiveness (Spain), awarded on the 2017 call under the Health Strategy Action 2013-2016 of the National Research Program oriented to Societal Challenges, within the Technical, Scientific and Innovation Research National Plan 2013-2016 (reference PI17/00914), cofunded with European Union ERDF funds (European Regional Development Fund). TD-S is funded by the Department of Health of the Generalitat de Catalunya, awarded on the 2016 call under the Strategic Plan for Research and Innovation in Health (PERIS) 2016-2020, modality incorporation of scientists and technologists, with reference SLT002/16/00308.Background Metabolic 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 analysis A 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 dissemination The 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

Comorbid autoimmune diseases and burden of diabetes-related complications in patients with type 1 diabetes from a Mediterranean area

Autoimmunity; Glycemic control; Type 1 diabetes mellitus;Autoinmunidad; Control Glicémico; Diabetes mellitus tipo 1Autoimmunitat; Control glucèmic; Diabetis mellitus tipus 1Aim: To assess the prevalence of autoimmune diseases (AID) in patients with type 1 diabetes (T1D) and to evaluate whether the rate of diabetes-related complications differs depending on the presence of AID. Methods: Cross-sectional analysis of 13,570 T1D patients aged ≥ 18 years registered in the SIDIAP database. The association between AID and diabetes-related complications was assessed by multivariable logistic regression models. Results: The prevalence of AID was 18.3% with thyroid AID being the most common. Patients with T1D and AID were more often female and their current age, age of diabetes onset and diabetes duration were higher. Patients with only thyroid AID experienced a lower risk of peripheral artery disease (odds ratio [OR] = 0.51, 95%; confidence interval [CI] 0.31 to 0.81) and kidney disease (OR = 0.68, 95%; 95% CI 0.54 to 0.85), whereas patients with other AID had an increased risk of ischemic heart disease (OR = 1.48, 95%; 95% CI 1.04 to 2.06). Conclusions: The burden of diabetes-related complications in patients with T1D differs according to the type of additional AID. The presence of diabetes complications is lower in those with autoimmune thyroid disease while the presence of other AID is associated with higher rates of ischemic heart disease

Sodium-glucose co-transporter-2 inhibitors in patients with type 2 diabetes : Barriers and solutions for improving uptake in routine clinical practice

Recent advances in type 2 diabetes (T2D) research have highlighted the benefits of sodium-glucose co-transporter-2 (SGLT-2) inhibitors, including cardiovascular and renal protection. However, uptake rates of these drugs remain low in patients with T2D, particularly in subpopulations most likely to benefit from them. This review considers the potential barriers to prescribing SGLT-2 inhibitors in T2D in clinical practice and outlines potential multidisciplinary recommendations to overcome these barriers. Safety concerns and a lack of clarity in and divergence of guidelines around the introduction of SGLT-2 inhibitors into treatment regimens may represent a barrier to uptake from the clinicians' perspective, including a general lack of understanding of the benefits associated with SGLT-2 inhibitors. Patient characteristics, such as socioeconomic status, may influence uptake because of the cost of SGLT-2 inhibitors, especially in the United States, where health insurance coverage could be a concern. SGLT-2 inhibitor prescription rates vary between clinical specialty (endocrinology, primary care, cardiology, and nephrology) and country, with cardiologists the lowest prescribers, and endocrinologists the highest. Primary care practitioners may experience more challenges in following SGLT-2 inhibitor-related guidelines than diabetes specialists as there may be fewer opportunities for education on how this drug class improves cardiovascular and renal outcomes in patients with T2D. Uptake rates appear to vary between countries because of differences in guidelines and health insurance systems. The amendment of SGLT-2 inhibitor-related guidelines for more multidisciplinary use and the implementation of patient and clinician education may encourage uptake of these drugs, potentially improving long-term health outcomes among patients with T2D

Association between metabolic syndrome and 13 types of cancer in Catalonia : A matched case-control study

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. 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. 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. 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

Analysis of the effectiveness of second oral glucose-lowering therapy in routine clinical practice from the mediterranean area : A retrospective cohort study

Altres ajuts: AstraZeneca, Spain [grant number ESR-16-12628]; National Institute for Health Research (NIHR); Applied Research Collaboration East Midlands (ARC EM); NIHR Leicester Biomedical Research Centre (BRC). Instituto de Salud Carlos III (ISCIII); Fondo Investigación sanitaria (FIS); Fondo Europeo de Desarrollo Regional (FEDER).Aim: To compare the changes in HbA1c, the effect on body weight or both combined after the addition of a DPP-4i, SGLT-2i, or sulfonylureas (SU) to metformin in real-world condition. Methods: We used a primary care SIDIAP database. The included subjects were matched by propensity score according to baseline age, sex, HbA1c, weight, inclusion date, diabetes duration, and kidney function. Results: Mean absolute HbA1c reduction was: 1.28% for DPP4i, 1.29% for SGLT2i and 1.26% for SU. Mean weight reduction was: 1.21 kg for DPP4i, 3.47 kg for SGLT2i and 0.04 kg for SU. The proportion of patients who achieved combined target HbA1c (≥0.5%) and weight (≥3%) reductions after the addition of DPP-4i, SGLT-2i or SU, was: 24.2%, 41.3%, and 15.2%, respectively. Small differences in systolic blood pressure reduction (1.07, 3.10 and 0.96 mmHg, respectively) were observed in favour of SGLT-2i. Concerning the lipids, we observed small differences, with an HDL-cholesterol increase with SGLT-2i. Conclusion: Our real-world study showed that the addition of SGLT-2i to metformin was associated with greater reductions in weight and the combination target of weight-HbA1c compared to SU and DPP4 inhibitors. However, similar hypoglycaemic effectiveness was observed among the three-drug classes

Checklist para pacientes con diabetes mellitus tipo 2 en consulta telemática

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

Checklist para pacientes con diabetes mellitus tipo 2 en consulta telemática

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

Manejo de la hiperglucemia con fármacos no insulínicos en pacientes adultos con diabetes tipo 2

Treatment of diabetes mellitus type 2 (DM2) includes healthy eating and exercise (150 minutes/week) as basic pillars. For pharmacological treatment, metformin is the initial drug except contraindication or intolerance; in case of poor control, 8 therapeutic families are available (6 oral and 2 injectable) as possible combinations. An algorithm and some recommendations for the treatment of DM2 are presented. In secondary cardiovascular prevention, it is recommended to associate an inhibitor of the sodium-glucose cotransporter type 2 (iSGLT2) or a glucagon-like peptide-1 receptor agonist (arGLP1) in patients with obesity. In primary prevention if the patient is obese or overweight metformin should be combined with iSGLT2, arGLP1, or inhibitors of type 4 dipeptidylpeptidase (iDPP4). If the patient does not present obesity, iDPP4, iSGLT2 or gliclazide, sulfonylurea, recommended due to its lower tendency to hypoglycaemia, may be used.YesEl 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 hipoglucemi