Evaluation of clinical and antidiabetic treatment characteristics of different sub-groups of patients with type 2 diabetes : Data from a Mediterranean population database

Altres ajuts: Institut Universitari d'Investigació en Atenció Primària Jordi GolAltres ajuts: MSD Spain 4R16/062-1Aims: To describe the characteristics and antidiabetic treatment among type 2 diabetes patients according to the clinical conditions prioritized in the Spanish 2020 RedGDPS (Primary Care Diabetes Study Groups Network) therapeutic algorithm: obesity, older than 75 years, chronic kidney disease, cardiovascular disease, and heart failure. Methods: Retrospective, cross-sectional study. Clinical characteristics, the use of antidiabetic drugs and the KDIGO renal risk categories at 31.12.2016 were retrieved from the SIDIAP (Information System for Research in Primary Care) database (Catalonia, Spain). Results: From a total of 373,185 type 2 diabetes patients, 37% were older than 75 years, 45% obese, 33% had chronic kidney disease, 23.2% cardiovascular disease and 6.9% heart failure. Insulin was more frequently prescribed in chronic kidney disease, cardiovascular disease and heart failure whereas Sodium-Glucose cotransporter 2 inhibitors and Glucagon Like Peptide 1 receptor agonists were scarcely prescribed (2.6% and 1.4%, respectively). Among patients with severe renal failure, contraindicated drugs like metformin (16%) and sulfonylureas (6.1%) were still in use. The 2012 KDIGO renal risk categories distribution was: Low: 60.9%, Moderate: 21.6%, High: 9.8% and Very high: 7.7%. Conclusions: Almost 80% of our T2DM patients meet one of the five clinical conditions that should be considered for treatment individualization. Importantly, a relevant number of patients with severe renal failure were found to use contraindicated drugs

Prevalence of pre-diabetes and undiagnosed diabetes in the Mollerussa prospective observational cohort study in a semi-rural area of Catalonia

Objectives: To assess the prevalence of undiagnosed diabetes and pre-diabetes in the healthy population in the Mollerussa cohort. As a secondary objective, to identify the variables associated with these conditions and to describe the changes in glycaemic status after 1 year of follow-up in subjects with pre-diabetes. Design: Prospective observational cohort study. Setting: General population from a semi-rural area. Participants: The study included 583 participants without a diagnosis of diabetes recruited between March 2011 and July 2014. Results: The prevalence of undiagnosed diabetes was 20, 3.4% (95% CI 2.6 to 4.2) and that of pre-diabetes was 229, 39.3% (37.3 to 41.3). Among those with pre-diabetes, 18.3% had isolated impaired fasting plasma glucose (FPG) (FPG: 100 to <126 mg/dL), 58.1% had isolated impaired glycated haemoglobin (HbA1c) (HbA1c 5.7 to <6.5) and 23.6% fulfilled both criteria. Follow-up data were available for 166 subjects; 41.6%(37.8 to 45.4) returned to normoglycaemia, 57.6% (57.8 to 61.4) persisted in pre-diabetes and 0.6% (0 to 1.2) progressed to diabetes. Individuals with pre-diabetes had worse cardiometabolic risk profiles and sociodemographic features than normoglycaemic subjects. In the logistic regression model, variables significantly associated with pre-diabetes were older age (OR; 95% CI) (1.033; 1.011 to 1.056), higher physical activity (0.546; 0.360 to 0.827), body mass index (1.121; 1.029 to 1.222) and a family history of diabetes (1.543; 1.025 to 2.323). The variables significantly associated with glycaemic normalisation were older age (0.948; 0.916 to 0.982) and body mass index (0.779; 0.651 to 0.931). Conclusions: Among adults in our region, the estimated prevalence of undiagnosed diabetes was 3.4% and that of pre-diabetes was 39.3%. After a 1-year follow-up, a small proportion of subjects (0.6%) with pre-diabetes progressed to diabetes, while a high proportion (41.6%) returned to normoglycaemia. Individuals with pre-diabetes who returned to normoglycaemia were younger and had a lower body mass inde

Three decades of deep water mass investigation in the Weddell Sea (1984–2014): Temporal variability and changes

The role of Antarctic Bottom Water (AABW) in changing the ocean circulation and controlling climate variability is widely known. However, a comprehensive understanding of the relative contribution and variability of Antarctic regional deep water mass varieties that form AABW is still lacking. Using a high-quality dataset comprising three decades of observational shipboard surveys in the Weddell Sea (1984–2014), we updated the structure, composition and hydrographic properties variability of the Weddell Sea deep-layer, and quantified the contribution of the source waters composing Weddell Sea Bottom Water (WSBW) in its main formation zone. Shifts in WSBW hydrographic properties towards less dense varieties likely equate to less WSBW being produced over time. WSBW is primarily composed of 71±4% of modified-Warm Deep Water (mWDW) and 29±4% of Dense Shelf Waters, with the latter composed by ~two-thirds (19±2%) of High Salinity Shelf Water and ~one-third (10±6%) of Ice Shelf Water. Further, we show evidence that WSBW variability in the eastern Weddell Sea is driven by changes in the inflow of Dense Shelf Waters and bottom water from the Indian Sector of the Southern Ocean. This was observed through the rise of the WSBW contribution to the total mixture after 2005, following a twenty-year period (1984–2004) of decreasing contribution

A novel hydrographic gridded data set for the northern Antarctic Peninsula

The northern Antarctic Peninsula (NAP) is a highly dynamic transitional zone between the subpolarpolar and oceanic-coastal environments, and it is located in an area affected by intense climate change, including intensification and spatial shifts of the westerlies as well as atmospheric and oceanic warming. In the NAP area, the water masses originate mainly from the Bellingshausen and Weddell seas, which create a marked regional dichotomy thermohaline characteristic. Although the NAP area has relatively easy access when compared to other Southern Ocean environments, our understanding of the water masses distribution and the dynamical processes affecting the variability of the region is still limited. That limitation is closely linked to the sparse data coverage, as is commonly the case in most Southern Ocean environments. This work provides a novel seasonal three-dimensional high-resolution hydrographic gridded data set for the NAP (version 1), namely the NAPv1.0. Hydrographic measurements from 1990 to 2019 comprising data collected by conductivity, temperature, depth (CTD) casts; sensors from the Marine Mammals Exploring the Oceans Pole to Pole (MEOP) consortium; and Argo floats have been optimally interpolated to produce maps of in situ temperature, practical salinity, and dissolved oxygen at 10 km spatial resolution and 90 depth levels. The water masses and oceanographic features in this regional gridded product are more accurate than other climatologies and state estimate products currently available. The data sets are available in netCDF format at https://doi.org/10.5281/zenodo.4420006 (Dotto et al., 2021). The novel and comprehensive data sets presented here for the NAPv1.0 product are a valuable tool to be used in studies addressing climatological changes in the unique NAP region since they provide accurate initial conditions for ocean models and improve the end of the 20th-And early 21st-century ocean mean-state representation for that area

Analysis of the Adherence and Safety of Second Oral Glucose-Lowering Therapy in Routine Practice From the Mediterranean Area : A Retrospective Cohort Study

Altres ajuts: AstraZeneca/ESR-16-12628Altres ajuts: Applied Research Collaboration East Midlands (ARC EM)Altres ajuts: National Institute for Health Research (NIHR)Altres ajuts: Imperial Biomedical Research Centre (NIHR)The aims of our study was compare adherence measured by the medical possession ratio (MPR), time until discontinuation and describe adverse events after adding a DPP-4i, SGLT-2i, or sulfonylureas (SU) to metformin in a primary care population with insufficient glycemic control. We used routinely-collected health data from the SIDIAP database. The included subjects were matched by propensity score. The follow-up period was up to 24 months or premature discontinuation. The primary outcomes were the percentage of subjects with good adherence, treatment discontinuation and adverse events among treatment groups. The proportion of patients with good adherence (MPR> 0.8) after the addition of DPP-4i, SGLT-2i or SU was 53.6%, 68.7%, and 43.0%, respectively. SGLT-2i users were 1.7 times more likely to achieve good adherence compared with DPP-4i users (odds ratio [OR]:1.72, 98% confidence interval [CI]:1.51, 1.96), and 2.8 times more likely compared with SU users (OR: 0.35, 98% CI: 0.07, 0.29). The discontinuation hazard ratios were 1.43 (98%CI: 1.26; 1.62) and 1.60 (98%CI: 1.42; 1.81) times higher among SGLT-2i and SU users than DPP-4i users during the follow-up period. No differences were observed for adverse events among the treatment groups. In conclusion, in our real-world setting, the combination of SGLT-2i with metformin was associated with better adherence. The mean time until discontinuation was longer in the SGLT-2i group in comparison with the DPP-4i or SU groups

Subpolar Southern Ocean response to changes in the surface momentum, heat, and freshwater fluxes under 2xCO2

The Antarctic subpolar Southern Ocean (sSO) has fundamental climate importance. Antarctic Bottom Water (AABW) originates in the sSO and supplies the lower limb of the meridional overturning circulation (MOC), occupying 36% of ocean volume. Climate models struggle to represent continental shelf processes that form AABW. We explore sources of persistent model biases by examining response of the sSO to perturbations in surface forcing in a global ocean–sea ice model (ACCESS-OM2) that forms AABW both on shelf and in open ocean. The sSO response to individual and combined perturbations of surface heat, freshwater, and momentum fluxes follows the WCRP CMIP6 FAFMIP-protocol. Wind perturbation (i.e., a poleward shift and intensification of the westerlies) is dominant, enhancing AABW formation and accelerating the global MOC. This occurs through upwelling of warm waters and inhibition of sea ice growth during winter, which triggers large open water polynya (OWP) events with associated deep convection. These events occur in the Weddell and Ross Seas and their variability is associated with availability of heat at midocean depths. These OWPs cease when the heat reservoir is depleted. Effects of surface warming and freshening only partially compensate changes from increasing winds on ocean stratification and depletion of AABW formation. These results indicate that overly convective models, such ACCESS-OM2, can respond to CO2-perturbed scenarios by forming too much AABW in OWP, which might not hold in models without OWPs. This might contribute to the large intermodel spread thermosteric sea level projections, being relevant to the interpretation of future projections by current climate models.Peer reviewe

Further Studies on the Physical and Biogeochemical Causes for Large Interannual Changes in the Patagonian Shelf Spring-Summer Phytoplankton Bloom Biomass

A very strong and persistent phytoplankton bloom was observed by ocean color satellites during September - December 2003 along the northern Patagonian shelf. The 2003 bloom had the highest extent and chlorophyll a (Chl-a) concentrations of the entire Sea-viewing Wide Field-of-view Sensor (SeaWiFS) period (1997 to present). SeaWiFS-derived Chl-a exceeded 20 mg/cu m in November at the bloom center. The bloom was most extensive in December when it spanned more than 300 km across the shelf and nearly 900 km north-south (35degS to 43degS). The northward reach and the deep penetration on the shelf of the 2003 bloom were quite anomalous when compared with other years, which showed the bloom more confined to the Patagonian shelf break (PSB). The PSB bloom is a conspicuous austral spring-summer feature detected by ocean color satellites and its timing can be explained using the Sverdrup critical depth theory. Based on high-resolution numerical simulations, in situ and remote sensing data, we provide some suggestions for the probable mechanisms responsible for that large interannual change of biomass as seen by ocean color satellites. Potential sources of macro and micro (e.g., Fe) nutrients that sustain the high phytoplankton productivity of the Patagonian shelf waters are identified, and the most likely physical processes that maintain the nutrient balance in the region are discussed

How Many Patients with Type 2 Diabetes Meet the Inclusion Criteria of the Cardiovascular Outcome Trials with SGLT2 Inhibitors? Estimations from a Population Database in a Mediterranean Area

Altres ajuts: This study was funded by the Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol). CIBER of Diabetes and Associated Metabolic Diseases (CIBERDEM) is an initiative from Instituto de Salud Carlos III, Madrid, Spain.Objective. Regulatory agencies require the assessment of cardiovascular (CV) safety for new type 2 diabetes (T2D) therapies through CV outcome trials (CVOTs). However, patients included in CVOTs assessing sodium-glucose cotransporter-2 inhibitors (SGLT2i) might not be representative of those seen in clinical practice. This study examined the proportion of patients that would have been enrolled into three main SGLT2i CVOTs to determine whether these trials' eligibility criteria can be applied to a real-world Mediterranean T2D population. Methods. Cross-sectional, retrospective, cohort study of T2D patients registered in primary care centres of the Catalan Institute of Health using medical records from a population database (SIDIAP) that includes approximately 74% of the population in Catalonia (Spain). Eligibility criteria were according to those of three SGLT2i CVOTs: EMPA-REG OUTCOME (empagliflozin), CANVAS (canagliflozin), and DECLARE-TIMI 58 (dapagliflozin). Results. By the end of 2016, the database included 373,185 patients with T2D with a mean age of 70±12 years, 54.9% male, with a mean duration of T2D of 9±6 years, and a mean glycated haemoglobin (HbA1c) of 7.12%±1.32 (59% with HbA1c<7%). Of these, 86,534 (23%) had established CV disease and 28% chronic renal failure (estimated glomerular filtration<60 ml/min/1.73m2). Among all included patients, only 8.2% would have qualified for enrolment into the EMPA-REG OUTCOME trial, 29.6% into the CANVAS program, and 38% into the DECLARE-TIMI 58 trial. The main limiting factors for inclusion would have been a previous history of CV disease and the baseline HbA1c value. Conclusion. The external validity of the analysed CVOTs is clearly limited when applying the same eligibility criteria to a T2D Mediterranean population

Prevalence and risk factors of diabetic foot disease among the people with type 2 diabetes using real-world practice data from Catalonia during 2018

Altres ajuts: 8a Convocatòria d'Ajuts a projectes de Institut Català de la Salut with SIDIAP (financing code 4R18/187-1 and file number SIDIAP-18/7).Background: Our study aimed to assess the prevalence of diabetic foot disease (DFD) and its associated risk factors among subjects attending primary care centers in Catalonia (Spain). Methods: We undertook a cross-sectional analysis of data from the primary health care (SIDIAP) database. The presence of comorbidities and concomitant medication were analyzed for subjects with or without DFD. DFD prevalence was estimated from 1st January 2018 to 31st December 2018. Results: During the 12-month observational period, out of 394,266 people with type 2 diabetes, we identified 3,277 (0.83%) active episodes of DFD in the database. The majority of these episodes were foot ulcers (82%). The mean age of patients with DFD was 70.3 (± 12.5) years and 55% were male. In the multivariable descriptive models, male gender, diabetes duration, hypertension, macrovascular, microvascular complications, and insulin and antiplatelet agents were strongly associated with DFD. A previous history of DFD was the stronger risk factor for DFD occurrence in subjects with T2DM (OR: 13.19, 95%CI: 11.81; 14.72). Conclusions: In this real-world primary care practice database, we found a lower prevalence of DFD compared to similar previous studies. Risk factors such as male sex, duration of diabetes, diabetes complications and previous history of DFD were associated with the presence of DFD