Effect of an educational intervention in primary care physicians on the compliance of indicators of good clinical practice in the treatment of type 2 diabetes mellitus [OBTEDIGA project]

[Abstract] Aim. To evaluate the effect of an educational intervention among primary care physicians on several indicators of good clinical practice in diabetes care. Methods. Two groups of physicians were randomly assigned to the intervention or control group (IG and CG). Every physician randomly selected two samples of patients from all type 2 diabetic patients aged 40 years and above and diagnosed more than a year ago. Baseline and final information were collected cross-sectionally 12 months apart, in two independent samples of 30 patients per physician. The educational intervention comprised: distribution of educational materials and physicians' specific bench-marking information, an on-line course and three on-site educational workshops on diabetes. External observers collected information directly from the physicians and from the medical records of the patients on personal and family history of disease and on the evolution and treatment of their disease. Baseline information was collected retrospectively in the control group. Results. Intervention group comprised 53 physicians who included a total of 3018 patients in the baseline and final evaluations. CG comprised 50 physicians who included 2868 patients in the same evaluations. Measurement of micro-albuminuria in the last 12 months (OR = 1.6, 95% CI: 1.1–2.4) and foot examination in the last year (OR = 2.0, 95% CI: 1.1–3.6) were the indicators for which greater improvement was found in the IG. No other indicator considered showed statistically significant improvement between groups. Conclusions. The identification of indicators with very low level of compliance and the implementation of a simple intervention in physicians to correct them is effective in improving the quality of care of diabetic patients

Chronic renal disease in Spain: Prevalence and related factors in persons with diabetes mellitus older than 64 years

Introducción La diabetes mellitus tipo 2 y la enfermedad renal crónica (ERC) son afecciones de elevada prevalencia en personas = 65 años y constituyen un importante problema de salud pública. Objetivos Conocer la prevalencia de la ERC, sus categorías y su relación con diversos factores demográficos y clínicos, en pacientes ancianos con diabetes mellitus tipo 2 en España. Métodos Estudio epidemiológico, observacional, transversal, multicéntrico, ámbito nacional. Se incluyeron pacientes con diabetes mellitus tipo 2 conocida, edad = 65 años atendidos en Atención Primaria. Se recogieron variables demográficas, antropométricas y analíticas de los últimos 12 meses, incluyendo el cociente albúmina-creatinina y el filtrado glomerular estimado para evaluar la función renal. Resultados La prevalencia de ERC fue del 37, 2% (IC95%, 34, 1-40, 3%), de insuficiencia renal del 29, 7% (IC95%, 26, 8-32, 6%) y de elevación de la albuminuria del 20, 6% (IC95%, 17, 3-23, 9%), moderadamente elevada 17, 8% (IC95%, 14, 7-20, 9%), severamente elevada 2, 8% (IC95%, 1, 4-4, 2%). La prevalencia de las categorías de ERC fueron: G1 1, 3% (IC95%, 0, 6-2%), G2 6, 2% (IC95%, 4, 6-7, 8%), G3a 17, 2% (IC95%, 14, 8-19, 6%), G3b 9, 8% (IC95%, 7, 9-11, 7%), G4 2% (IC95%, 1, 1-2, 9%) y G5 0, 7% (IC95%, 0, 2-1, 2%). En el análisis multivariante, después de ajustar por el resto de variables, la ERC se asoció a mayor edad OR 5, 13, (IC95%, 3, 15-8, 35), alta comorbilidad OR 3, 36 (IC95%, 2, 2-5, 12) y la presencia de tratamiento antihipertensivo OR 2, 43 (IC95%, 1, 48-4, 02). Conclusiones La ERC es frecuente en la población diabética = 65 años y se asocia con mayor edad, alta comorbilidad e hipertensión tratada. No se ha encontrado asociación con el género y años de evolución de la diabetes. Introduction: Type 2 diabetes mellitus and chronic kidney disease (CKD) are conditions which have a high prevalence in individuals =65 years of age and represent a major public health problem. Objectives: To determine the prevalence of CKD, its categories and its relationship with various demographic and clinical factors in elderly patients with type 2 diabetes mellitus in Spain. Methods: Observational, cross-sectional, multicenter, Spanish epidemiological study. Patients with known type 2 diabetes mellitus, age =65 years of age treated in Primary Care were included. We collected demographic, anthropometric and analytical variables from the previous 12 months, including the albumin-to-creatinine ratio and estimated glomerular filtration rate to evaluate renal function. Results: The prevalence of CKD was 37.2% (95% CI, 34.1–40.3%), renal failure was 29.7% (95% CI, 26.8–32.6%) and increased albuminuria was 20.6% (95% CI, 17.3–23.9%), moderately increased albuminuria was 17.8% (95% CI, 14.7–20.9%) and severely increased albuminuria was 2.8% (95% CI, 1.4–4.2%). In turn, the prevalence of CKD categories were: G1 1.3% (95% CI, 0.6–2%), G2 6.2% (95% CI, 4.6–7.8%), G3a 17.2% (95% CI, 14.8–19.6%), G3b 9.8% (95% CI, 7.9–11.7%), G4 2% (95% CI, 1.1–2.9%) and G5 0.7% (95% CI, 0.2–1.2%). In the multivariate analysis, after adjusting for the remaining variables, CKD was associated with elderly age (OR 5.13, 95% CI, 3.15–8.35), high comorbidity (OR 3.36, 95% CI, 2.2–5.12) and presence of antihypertensive treatment (OR 2.43, 95% CI, 1.48–4.02). Conclusions: CKD is frequent in the diabetic population =65 years of age and is associated with elderly age, high comorbidity and with treated hypertension. No relationship has been found with gender and time in years since onset of diabetes

Estudio de cohortes en atención primaria sobre la evolución de sujetos con prediabetes (PREDAPS). Fundamentos y metodología

El estudio PREDAPS pretende determinar el riesgo de desarrollo de diabetes y aparición de complicaciones vasculares en sujetos con prediabetes e identificar los factores asociados. Se trata de un estudio observacional de seguimiento de una cohorte de 1.184 sujetos con prediabetes y otra cohorte de 838 sujetos sin alteraciones en el metabolismo de la glucosa. Los datos de la etapa basal se obtuvieron de pacientes que acudieron a centros de Atención Primaria en España a lo largo del año 2012. Los sujetos con prediabetes fueron clasificados en tres grupos: aquellos que sólo tenían alteradas las cifras de glucemia en ayunas -entre 100 y 125 mg/dl-, aquellos que sólo tenían alterado el nivel de HbA1c -entre 5,7 y 6,4%- y aquellos que tenían alterados ambos parámetros. La información sobre sus características sociodemográficas, antecedentes familiares y personales, estilos de vida y tratamiento farmacológico se obtuvo de la historia clínica y de la entrevista realizada en la consulta por el médico. Se realizó un examen físico para determinar peso, talla, perímetro de la cintura y presión arterial y se realizaron análisis de sangre y orina. El estudio PREDAPS puede contribuir a disminuir la incertidumbre en las estrategias individuales de prevención en los sujetos con prediabetes. El seguimiento anual durante cinco años de los participantes posibilitará conocer el riesgo de desarrollo de diabetes mellitus tipo 2 y el de complicaciones macro y microvasculares en los tres grupos de sujetos con prediabetes, así como averiguar los posibles factores asociados a esos riesgos. The PREDAPS study aims to determine the risk of developing diabetes and the risk of vascular complications in patients with prediabetes and identify factors associated with those risks. It is a prospective observational study of a cohort of 1184 subjects with prediabetes and another cohort of 838 subjects with no alterations in glucose metabolism. The data at baseline were obtained from patients attending primary care centers in Spain throughout 2012. Subjects with prediabetes were classified into three groups: those who had only altered the fasting blood glucose levels -between 100 and 125mg/dl-, those who had only altered the HbA1c level -between 5.7 and 6.4% - and those who had altered both parameters. Information on sociodemographic characteristics, personal and family history, lifestyle and drug therapy was obtained from medical records and the interview with the doctor in the consultation. It was also performed a physical examination to determine weight, height, waist circumference and blood pressure were performed and blood and urine analysis. The PREDAPS study may help to reduce uncertainty in individual prevention strategies in subjects with prediabetes. Annual monitoring of patients recruited for five years will enable to know the risk of developing diabetes type 2 and the risk of macro-and microvascular complications in the three groups of subjects with prediabetes and determine the factors associated with those risks

Modifiable risk factors associated with prediabetes in men and women: A cross-sectional analysis of the cohort study in primary health care on the evolution of patients with prediabetes

Background: Prediabetes is a high-risk state for diabetes development, but little is known about the factors associated with this state. The aim of the study was to identify modifiable risk factors associated with the presence of prediabetes in men and women. Methods: Cohort Study in Primary Health Care on the Evolution of Patients with Prediabetes (PREDAPS-Study) is a prospective study on a cohort of 1184 subjects with prediabetes and another cohort of 838 subjects without glucose metabolism disorders. It is being conducted by 125 general practitioners in Spain. Data for this analysis were collected during the baseline stage in 2012. The modifiable risk factors included were: smoking habit, alcohol consumption, low physical activity, inadequate diet, hypertension, dyslipidemia, and obesity. To assess independent association between each factor and prediabetes, odds ratios (ORs) were estimated using logistic regression models. Results: Abdominal obesity, low plasma levels of high-density lipoprotein cholesterol (HDL-cholesterol), and hypertension were independently associated with the presence of prediabetes in both men and women. After adjusting for all factors, the respective ORs (95% Confidence Intervals) were 1.98 (1.41-2.79), 1.88 (1.23-2.88) and 1.86 (1.39-2.51) for men, and 1.89 (1.36-2.62), 1.58 (1.12-2.23) and 1.44 (1.07-1.92) for women. Also, general obesity was a risk factor in both sexes but did not reach statistical significance among men, after adjusting for all factors. Risky alcohol consumption was a risk factor for prediabetes in men, OR 1.49 (1.00-2.24). Conclusions: Obesity, low HDL-cholesterol levels, and hypertension were modifiable risk factors independently related to the presence of prediabetes in both sexes. The magnitudes of the associations were stronger for men than women. Abdominal obesity in both men and women displayed the strongest association with prediabetes. The findings suggest that there are some differences between men and women, which should be taken into account when implementing specific recommendations to prevent or delay the onset of diabetes in adult population

Coste del tratamiento farmacológico de los factores de riesgo cardiovascular en población diabética anciana según género (Estudio ESCADIANE)

Objetivo Estudiar el coste del tratamiento farmacológico utilizado para el control de los factores de riesgo cardiovascular en pacientes con diabetes mellitus tipo 2 > 65 años y la prevalencia de complicaciones cardiovasculares en función del género. Diseño Estudio transversal, observacional, multicéntrico. Emplazamiento Ámbito nacional. Participantes Pacientes con diabetes mellitus tipo 2 > 65 años. Mediciones principales Prevalencia de factores de riesgo cardiovascular y su coste en pacientes con diabetes mellitus tipo 2. Resultados Se estudiaron 947 pacientes (53% mujeres) con una edad media de 76, 2 ± 7, 3 años. El 14% habían sufrido un infarto agudo de miocardio (17, 8% varones vs. 10, 7% mujeres; p = 0, 001), el 11, 9% un accidente cerebrovascular (13, 7% varones vs. 10, 5% mujeres; p = ns), el 11, 3% insuficiencia cardíaca (10, 9% varones vs. 11, 7% mujeres; p = ns) y el 9% enfermedad arterial periférica (12, 1% varones vs. 6, 3% mujeres; p = 0, 001). El mayor coste en el tratamiento fue para los antidiabéticos orales (414, 76 ± 210, 18 € paciente/año), debido fundamentalmente a los inhibidores DPP-4 (49, 9% del coste de los antidiabéticos), seguidos de la insulina basal (29, 95%) y sin diferencias significativas entre género. El gasto anual de antihipertensivos por paciente/año fue mayor en mujeres que en varones (86, 80 € ± 32, 84 vs. 78, 24 € ± 26, 86; p = 0, 0001). El de antiagregantes significativamente menor (20, 87 € ± 7, 25 en mujeres vs. 30, 21 € ± 13, 68; p = 0, 0001). Conclusiones Los antidiabéticos supusieron el mayor coste en el control de los factores de riesgo cardiovascular del paciente diabético > 65 años, seguido de los hipotensores, hipolipemientes y por último los antiagregantes. Las mujeres presentaron mayor gasto en hipotensores y los hombres en antiagregantes. En varones, las complicaciones macrovasculares más frecuentes fueron infarto IAM, arritmias y ACV. Solo hubo diferencias con respecto al género para infarto. Aims To study the cost of pharmacological treatment used for the control of cardiovascular risk factors in patients with type 2 diabetes mellitus (DM2) > 65 years and the prevalence of cardiovascular complications according to gender. Design Cross-sectional, observational, multicentric study. Location National study. Participants Patients with diabetes mellitus 2 > 65 years. Main measurements prevalence of cardiovascular risk factors and their cost in patients with diabetes mellitus 2. Results We studied 947 patients (53% females) with a mean age of 76.2 ± 7.3 years. 14% had suffered acute myocardial infarction (17.8% men vs. 10.7% women, p = .001), 11.9% had stroke (13.7% men vs. 10.5% women; p = ns), 11.3% heart failure (10.9% men vs. 11.7% women, p = ns) and 9% peripheral arterial disease (12.1% men vs. 6.3% women; p = .001). Oral antidiabetic drugs accounted for the highest cost (414.76 ± 210.18 € patient / year), mainly due to DPP-4 inhibitors (49.9% of the cost of antidiabetics), followed by basal insulin (29.95%) and without significant differences between gender. The annual expenditure of antihypertensive drugs per patient/year was higher in women than in men (86.80 ± 32.84 € vs. 78.24 € ± 26.86, p = 0.0001). The antiaggregants significantly lower in women (20.87 ± 7.25 € vs. € 30.21 ± 13.68, p = 0.0001). Conclusions Antidiabetic drugs represented the highest cost in controlling cardiovascular risk factors in diabetic patients > 65 years of age, followed by hypotensives, hypolipements and antiaggregants. Women had higher spending on anti-hypertensives and men on antiaggregants. The most frequent macrovascular complications in men were AMI, arrhythmias and stroke. There were only gender differences for infarction