DIRECT HEALTHCARE COSTS OF DIABETES MELLITUS PATIENTS IN SPAIN

Objectives. To estimate the healthcare resources spent by diabetic patients in Spain during the year 2002. Methods. The present work is a cost-of-illness study. Direct healthcare costs were estimated using rates of DM, based on primary and secondary sources of information. A range of prevalence from 5% to 6% of the adult population was determined. The total cost was composed of six items: insulin and oral hypoglycemic agents; other drugs; disposable and consumable goods (glucose test strips, needles and syringes); hospitalization; primary care visits; visits to specialists. Results. The estimated direct cost of DM during the year 2002 ranges from € 2.4 billion to € 2.67 billion. Hospital costs had the highest weight (€ 933 million) in the total, followed by non-insulin, non-hypoglycemic-agent drugs (€ 777-932 million). Much lower are the costs of insulin and oral hypoglycemic agents (€ 311 million), primary care visits (€ 181-272 million), specialized visits (€ 127-145 million) and disposable elements (€ 70-81 million). The per-diabetic, per-year cost ranges between € 1,290 to € 1,476. Discussion. Despite our rather conservative approach to the issue, our findings demonstrate the high direct healthcare costs of diabetic patients. Likewise, they illustrate the magnitude of the costs of treatment of DM-related complications.

Direct healthcare costs of diabetes mellitus patients in Spain

Objectives. To estimate the healthcare resources spent by diabetic patients in Spain during the year 2002. Methods. The present work is a cost-of-illness study. Direct healthcare costs were estimated using rates of DM, based on primary and secondary sources of information. A range of prevalence from 5% to 6% of the adult population was determined. The total cost was composed of six items: insulin and oral hypoglycemic agents; other drugs; disposable and consumable goods (glucose test strips, needles and syringes); hospitalization; primary care visits; visits to specialists. Results. The estimated direct cost of DM during the year 2002 ranges from (euros)2.4 billion to (euros)2.67 billion. Hospital costs had the highest weight ((euros)933 million) in the total, followed by non-insulin, non-hypoglycemic-agent drugs ((euros)777-932 million). Much lower are the costs of insulin and oral hypoglycemic agents ((euros)311 million), primary care visits ((euros)181-272 million), specialized visits ((euros)127-145 million) and disposable elements ((euros)70-81 million). The per-diabetic, per-year cost ranges between (euros)1,290 to 1,476. Discussion. Despite our rather conservative approach to the issue, our findings demonstrate the high direct healthcare costs of diabetic patients. Likewise, they illustrate the magnitude of the costs of treatment of DM-related complications

ESTUDIO DE LOS COSTES DIRECTOS SANITARIOS DE LOS PACIENTES CON DIABETES MELLITUS EN ESPAÑA

Objetivo. Estimar el consumo de recursos sanitarios empleados en prevención y el tratamiento de pacientes con Diabetes Mellitus (DM) en España en el año 2002. Métodos. Estudio de coste de la enfermedad. Los costes directos sanitarios se estimaron mediante un enfoque de prevalencia recurriendo a fuentes tanto primarias como secundarias. Se estableció un arco de prevalencia que oscila entre el 5% y el 6% de la población adulta española. El coste total se desagregó en seis partidas: coste de insulinas y antidiabéticos orales; coste de otros fármacos; coste de consumibles (tiras reactivas más agujas y jeringuillas); coste de las hospitalizaciones; consultas de las consultas de Atención Primaria; coste de las consultas de Atención Especializada. Resultados. El coste directo estimado de los pacientes con DM oscila entre los 2.400 y los 2.675 millones de euros. Las partidas de mayor peso fueron los gastos hospitalarios (933 millones de euros) seguidos del coste de otros fármacos distintos de insulina y antidiabéticos orales (777-932 millones de euros). A continuación figura el coste de insulina y antidiabéticos orales (311 millones de euros), consultas de Atención Primaria (181-272 millones de euros), consultas de Atención Especializada (127-145 millones de euros) y consumibles (70-81 millones de euros). El coste por paciente y año varía, en función de los supuestos asumidos, entre los 1.289 y los 1.476 euros anuales. Discusión. A pesar de haber sido adoptado un enfoque conservador, se demuestra que en torno a los pacientes diabéticos se concentra un elevado coste directo sanitario. Asimismo, se pone de manifiesto la importancia del coste de la prevención y el tratamiento de las complicaciones crónicas asociadas a la diabetes.

Estudio de los costes directos sanitarios de los pacientes con diabetes mellitus en España

Objetivo. Estimar el consumo de recursos sanitarios empleados en prevención y el tratamiento de pacientes con Diabetes Mellitus (DM) en España en el año 2002. Métodos. Estudio de coste de la enfermedad. Los costes directos sanitarios se estimaron mediante un enfoque de prevalencia recurriendo a fuentes tanto primarias como secundarias. Se estableció un arco de prevalencia que oscila entre el 5% y el 6% de la población adulta española. El coste total se desagregó en seis partidas: coste de insulinas y antidiabéticos orales; coste de otros fármacos; coste de consumibles (tiras reactivas más agujas y jeringuillas); coste de las hospitalizaciones; consultas de las consultas de Atención Primaria; coste de las consultas de Atención Especializada. Resultados. El coste directo estimado de los pacientes con DM oscila entre los 2.400 y los 2.675 millones de euros. Las partidas de mayor peso fueron los gastos hospitalarios (933 millones de euros) seguidos del coste de otros fármacos distintos de insulina y antidiabéticos orales (777-932 millones de euros). A continuación figura el coste de insulina y antidiabéticos orales (311 millones de euros), consultas de Atención Primaria (181-272 millones de euros), consultas de Atención Especializada (127-145 millones de euros) y consumibles (70-81 millones de euros). El coste por paciente y año varía, en función de los supuestos asumidos, entre los 1.289 y los 1.476 euros anuales. Discusión. A pesar de haber sido adoptado un enfoque conservador, se demuestra que en torno a los pacientes diabéticos se concentra un elevado coste directo sanitario. Asimismo, se pone de manifiesto la importancia del coste de la prevención y el tratamiento de las complicaciones crónicas asociadas a la diabetes

Leading Factors for Weight Gain during COVID-19 Lockdown in a Spanish Population: A Cross-Sectional Study

The increase in sedentary behaviors during the COVID-19-induced lockdown may have led to a significant weight gain. To investigate this hypothesis, a representative sample of the Spanish adult population comprising 1000 subjects was enrolled in a cross-sectional study between 26 May and 10 June 2020. Computer-assisted telephone interviews were conducted consisting of 29 questions on the topic of lifestyle habits during the lockdown. The cohort comprised 51.5% women and 51% overweight or obese subjects and had a mean age of 50 ± 18 years. Of the respondents, 44.5% self-reported weight gain during the lockdown; of these, 58.0% were women, 69.9% had previous excess weight, 44.7% lived with a relative who also gained weight, and 73.5 experienced increased appetite. Further, an increased consumption of energy-dense products was found relative to respondents who did not gain weight (p ≤ 0.016 for all). Additionally, respondents were unaware that obesity is a poor prognostic factor for COVID-19 infection, lived in smaller flats, and had a lower level of education and lower monthly income. The factors independently associated with weight gain were female gender, previous overweight or obesity, lack of food care, increased appetite, and increased consumption of sugar-sweetened beverages, alcoholic beverages, and snacks (p ≤ 0.023 for all). Should another lockdown be mandated, extra caution is warranted to prevent weight gain

Weight-related quality of life in spanish obese subjects suitable for bariatric surgery is lower than in their North American counterparts: a case–control study

Multicenter study[Abstract] Background: Obesity impairs quality of life, but the perception of the impairment could be different from one country to another. The purpose was to compare weight-related quality of life (QOL) between cohorts from Spain and North America. Methods: A cross-sectional case-control study was performed between two populations. Four hundred Spanish and 400 North American obese subjects suitable for bariatric surgery closely matched for race, gender, age, and body mass index (BMI) were included. Two non-obese control groups matched for gender, age, and BMI from each population were also evaluated (n = 400 in each group). The participants completed the Impact of Weight on Quality of Life-Lite (IWQOL-Lite) questionnaire, a measure of weight-related QOL. Results: Spanish morbidly obese patients showed poorer QOL than their North American counterparts in physical function, sexual life, work, and total score. By contrast, Spanish non-obese control subjects reported better QOL in all domains than their North American counterparts. Women, both in Spain and North America, reported reduced QOL compared to men on the domain of self-esteem. In addition, North American women reported reduced QOL on the sexual life domain compared to men. BMI correlated negatively with all domains of QOL except for self-esteem in both national groups. Conclusions: Spanish obese subjects suitable for bariatric surgery report poorer weight-related quality of life than their North American counterparts, and obese women, regardless of nationality, perceive a reduced quality of life compared to men

Maternal and perinatal outcomes after bariatric surgery: a spanish multicenter study

The final publication is avaliable at Springer Link[Abstract] Background. Bariatric surgery (BS) has become more frequent among women of child-bearing age. Data regarding the underlying maternal and perinatal risks are scarce. The objective of this nationwide study is to evaluate maternal and perinatal outcomes after BS. Methods. We performed a retrospective observational study of 168 pregnancies in 112 women who underwent BS in 10 tertiary hospitals in Spain over a 15-year period. Maternal and perinatal outcomes, including gestational diabetes mellitus (GDM), pregnancy-associated hypertensive disorders (PAHD), pre-term birth cesarean deliveries, small and large for gestational age births (SGA, LGA), still births, and neonatal deaths, were evaluated. Results were further compared according to the type of BS performed: restrictive techniques (vertical-banded gastroplasty, sleeve gastrectomy, and gastric banding), Roux-en-Y gastric bypass (RYGB), and biliopancreatic diversion (BPD). Results. GDM occurred in five (3 %) pregnancies and there were no cases of PAHD. Women whose pregnancies occurred before 1 year after BS had a higher pre-gestational body mass index (BMI) than those who got pregnant 1 year after BS (34.6 ± 7.7 vs 30.4 ± 5.3 kg/m2, p = 0.007). In pregnancies occurring during the first year after BS, a higher rate of stillbirths was observed compared to pregnancies occurring after this period of time (35.5 vs 16.8 %, p = 0.03). Women who underwent BPD delivered a higher rate of SGA babies than women with RYGB or restrictive procedures (34.8, 12.7, and 8.3 %, respectively). Conclusions. Pregnancy should be scheduled at least 1 year after BS. Malabsorptive procedures are associated to a higher rate of SGA births

Bariatric surgery: evidence-based practical recommendations

[Resumen] La obesidad mórbida es, habitualmente, refractaria a los tratamientos convencionales, por lo que la modificación de hábitos dietéticos y de actividad física y/o el uso de fármacos consiguen pérdidas de peso parciales con habitual recuperación posterior. La cirugía bariátrica constituye una opción terapéutica para los casos de obesidad con elevado índice de masa corporal (IMC) asociada a comorbilidades, con buenos resultados a corto y largo plazo. El Grupo de Trabajo sobre Obesidad de la Sociedad Española de Endocrinología y Nutrición (GOSEEN) ha elaborado un documento con recomendaciones prácticas basadas en la evidencia para el tratamiento quirúrgico de la obesidad. La revisión se estructura en 3 partes. En la primera se definen los conceptos de obesidad y comorbilidades asociadas, los tratamientos médicos y sus resultados, las indicaciones y contraindicaciones para el tratamiento quirúrgico con los criterios de selección de los pacientes, el manejo pre y perioperatorio y la valoración de grupos especiales, como adolescentes y personas de edad avanzada. En la segunda parte se describen las distintas técnicas quirúrgicas, las vías de acceso y los resultados comparativos, las complicaciones tanto a corto como a largo plazo, la repercusión de la pérdida ponderal sobre las comorbilidades y los criterios para evaluar la efectividad de la cirugía. En la tercera parte se desarrolla el seguimiento postoperatorio, el control dietético en fases tempranas y más tardías tras la cirugía, y el calendario de control médico y analítico con la suplementación de los distintos macro y micronutrientes en función de la técnica quirúrgica empleada. Se incluye un apartado final sobre gestación y cirugía bariátrica, así como tablas y gráficos complementarios al texto desarrollado. La cirugía bariátrica sigue siendo un tratamiento discutido para la obesidad, pero los resultados en la corrección del exceso ponderal con mejoría en las patologías asociadas y en la calidad de vida confirman que puede ser el tratamiento de elección en pacientes seleccionados, con la técnica quirúrgica apropiada y con un correcto control pre y postoperatorio.[Abstract] Morbid obesity is usually refractory to conventional treatments. Consequently, weight that is lost by modifying diet and exercise and/or the use of drugs is usually later regained. Bariatric surgery constitutes a therapeutic option in obese patients with a high body mass index associated with comorbidities and achieves good results in both the short and the long term. The Obesity Working Group of the Spanish Society of Endocrinology and Nutrition has produced a document with practical, evidencebased recommendations for the surgical treatment of obesity. The review is structured in three parts. The first part defines the concepts of obesity and associated comorbidities, medical treatments, their results, and the indications and contraindications for surgical treatment, as well as the criteria for patient selection, pre- and perisurgical management, and assessment of special groups such as adolescents and the elderly. The second part discusses the different surgical techniques, approaches and comparative results, short- and long-term complications, the repercussions of weight loss on comorbidities, and the criteria for assessing the effectiveness of surgery. The third part discusses postsurgical follow-up, dietary control in the early and subsequent stages after surgery and the schedule for medical and laboratory follow-up, together with the different macro- and micronutrient supplements that should be used depending on the surgical technique employed. A final section is included on pregnancy and bariatric surgery, as well as tables and figures that complement the text. Although bariatric surgery continues to be a questionable treatment for obesity, the results correcting excess weight, with improvements in associated comorbidities and in quality of life, confirm that this option could be the treatment of choice in selected patients when the appropriate surgical technique and correct preand postoperative follow-up are employed