Glycaemic control and antidiabetic treatment trends in primary care centres in patients with type 2 diabetes mellitus during 2007-2013 in Catalonia: a population-based study.

OBJECTIVES: To assess trends in prescribing practices of antidiabetic agents and glycaemic control in patients with type 2 diabetes mellitus (T2DM). DESIGN: Cross-sectional analysis using yearly clinical data and antidiabetic treatments prescribed obtained from an electronic population database. SETTING: Primary healthcare centres, including the entire population attended by the Institut Català de la Salut in Catalonia, Spain, from 2007 to 2013. PARTICIPANTS: Patients aged 31-90 years with a diagnosis of T2DM. RESULTS: The number of registered patients with T2DM in the database was 257 072 in 2007, increasing up to 343 969 in 2013. The proportion of patients not pharmacologically treated decreased by 9.7% (95% CI -9.48% to -9.92%), while there was an increase in the percentage of patients on monotherapy (4.4% increase; 95% CI 4.16% to 4.64%), combination therapy (2.8% increase; 95% CI 2.58% to 3.02%), and insulin alone or in combination (increasing 2.5%; 95% CI 2.2% to 2.8%). The use of metformin and dipeptidyl peptidase-IV inhibitors increased gradually, while sulfonylureas, glitazones and α-glucosidase inhibitors decreased. The use of glinides remained stable, and the use of glucagon-like peptide-1 receptor agonists was still marginal. Regarding glycaemic control, there were no relevant differences across years: mean glycated haemoglobin (HbA1c) value was around 7.2%; the percentage of patients reaching an HbA1c≤7% target ranged between 52.2% and 55.6%; and those attaining their individualised target from 72.8% to 75.7%. CONCLUSIONS: Although the proportion of patients under pharmacological treatment increased substantially over time and there was an increase in the use of combination therapies, there have not been relevant changes in glycaemic control during the 2007-2013 period in Catalonia

Central de resultats: Revisió de 20 anys d’atenció a la diabetis a Catalunya

Atenció al pacient; Diabetis; CatalunyaAtención al paciente; Diabetes; CataluñaPatient Care; Diabetes; CataloniaCatalunya es troba entre els països de la Unió Europea amb una menor hospitalització per complicacions de la diabetis. Destaca especialment la baixa hospitalització per amputacions. L’any 1993 es va iniciar a Catalunya el primer programa de “Millora Contínua de la Qualitat assistencial (MCQ)” a partir dels indicadors i de les avaluacions periòdiques realitzades pel “Grup d’estudi de la diabetis a l’atenció primària” (GEDAPS). Des de la primera avaluació feta al 1993 s’ha anat observant una progressiva millora en la major part dels indicadors, no només dels de procés assistencial sinó també dels de resultat. Els bons resultats es deuen al lideratge dels professionals de l’atenció primària, l’establiment de les rutes assistencials, la coordinació dels diferents nivells i serveis assistencials, i la implicació dels pacients en el coneixement i control de la malaltia i de l’Administració.Cataluña se encuentra entre los países de la Unión Europea con una menor hospitalización por complicaciones de la diabetes. Destaca especialmente la baja hospitalización por amputaciones. En 1993 se inició en Cataluña el primer programa de "Mejora Continua de la Calidad asistencial (MCQ)" a partir de los indicadores y de las evaluaciones periódicas realizadas por el "Grupo de estudio de la diabetes en la atención primaria" (GEDAPS). Desde la primera evaluación realizada en 1993 ha ido observando una progresiva mejora en la mayor parte de los indicadores, no sólo los de proceso asistencial sino también de los de resultado. Los buenos resultados se deben al liderazgo de los profesionales de la atención primaria, el establecimiento de las rutas asistenciales, la coordinación de los diferentes niveles y servicios asistenciales, y la implicación de los pacientes en el conocimiento y control de la enfermedad y de la Administración

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

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

AIM: 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

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)

Potential Risk of Overtreatment in Patients with Type 2 Diabetes Aged 75 Years or Older : Data from a Population Database in Catalonia, Spain

Altres ajuts: Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol); Merck Sharp & Dohme de España S.A.Aim: To assess the potential risk of overtreatment in patients with type 2 diabetes (T2DM) aged 75 years or older in primary care. Methods: Electronic health records retrieved from the SIDIAP database (Catalonia, Spain) in 2016. Variables: age, gender, body mass index, registered hypoglycemia, last HbA1c and glomerular filtration rates, and prescriptions for antidiabetic drugs. Potential overtreatment was defined as having HbA1c < 7% or HbA1c < 6.5% in older patients treated with insulin, sulfonylureas, or glinides. Results: From a total population of 138,374 T2DM patients aged 75 years or older, 123,515 had at least one HbA1c available. An HbA1c below 7.0% was present in 59.1% of patients, and below 6.5% in 37.7%. Overall, 23.0% of patients were treated with insulin, 17.8% with sulfonylureas, and 6.6% with glinides. Potential overtreatment (HbA1c < 7%) was suspected in 26.6% of patients treated with any high-risk drug, 47.8% with sulfonylureas, 43.5% with glinides, and 28.1% with insulin. Using the threshold of HbA1c < 6.5%, these figures were: 21.6%, 24.4%, 17.9%, and 12.3%, respectively. Conclusion: One in four older adults with T2DM treated with antidiabetic drugs associated with a high risk of hypoglycemia might be at risk of overtreatment. This risk is higher in those treated with sulfonylureas or glinides than with insulin

Consenso sobre la detección y el manejo de la prediabetes. Grupo de trabajo de consensos y guías clínicas de la Sociedad Española de Diabetes

En España, según datos del estudio [email protected], un 13,8% de la población adulta padece diabetes y un 14,8% algún tipo de prediabetes (intolerancia a la glucosa, glucemia basal alterada o ambas). Puesto que la detección precoz de la prediabetes puede facilitar la puesta en marcha de medidas terapéuticas que eviten su progresión a diabetes, consideramos que las estrategias de prevención en las consultas de atención primaria y especializada deberían consensuarse. La detección de diabetes y prediabetes mediante un cuestionario específico (test de FINDRISC) y/o la determinación de la glucemia basal en pacientes de riesgo permiten detectar los pacientes con riesgo de desarrollar la enfermedad y es necesario considerar cómo debe ser su manejo clínico. La intervención sobre los estilos de vida puede reducir la progresión a diabetes o hacer retroceder un estado prediabético a la normalidad y es una intervención coste-efectiva. Algunos fármacos, como la metformina, también se han mostrado eficaces en reducir la progresión a diabetes aunque no son superiores a las in tervenciones no farmacológicas. Finalmente, aunque no hay pruebas sólidas que apoyen la eficacia del cribado en términos de morbimortalidad, sí que ha observado una mejora de los factores de riesgo cardiovascular.El Grupo de Trabajo de Consensos y Guías Clínicas de la Sociedad Española de Diabetes (SED) ha elaborado unas recomendaciones que han sido consensuadas con la Sociedad Española de Endocrinología y Nutrición (SEEN), la Sociedad Española de Endocrinología Pediátrica (SEEP), la Sociedad Española de Farmacia Familiar y Comunitaria (SEFAC), la Sociedad Española de Medicina Familiar y Comunitaria (SEMFYC), la Sociedad Española de Médicos Generales (SEMG), la Sociedad Española de Médicos de Atención Primaria (SEMERGEN), la Sociedad Española de Medicina Interna (SEMI), la Asociación de Enfermería Comunitaria (AEC) y la Red de Grupos de Estudio de la Diabetes en Atención Primaria (RedGDPS)

The impact of a programme to improve quality of care for people with type 2 diabetes on hard to reach groups: The GEDAPS study

AIMS: We investigated whether a continuous quality improvement programme in primary care for people with type 2 diabetes led to better care and outcomes in hard to reach groups. METHODS: GEDAPS was implemented in Catalonia, Spain between 1993 (n=2239) and 2002 (n=5819). Process (e.g., education), intermediate (e.g., HbA1c) and final (e.g. retinopathy) outcomes were compared between urban and rural areas, and between younger (≤74 years) and older (≥75 years) individuals as examples of harder to reach groups. RESULTS: In 1993, people in urban areas had significantly better or similar outcomes to rural areas; by 2002, most outcomes improved in urban and rural areas. For all outcomes, the improvement in rural areas was similar to or better than urban areas. Similarly, for most outcomes, the younger and older group improved, with the older group experiencing similar or better improvements than the younger group for all indicators, except coronary artery disease. CONCLUSIONS: A quality improvement programme was associated with equivalent or better outcomes in hard to reach groups, regardless of whether they were specifically targeted. The ability to apply one programme to all populations could save time and money

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