Estudi d'utilització de la digoxina : utilitat de la digoxinèmia com a marcador del seu ús /

Consultable des del TDXTítol obtingut de la portada digitalitzadaPenden

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

Causas específicas de mortalidad en una cohorte de pacientes con diabetes mellitus tipo 2

La diabetis mellitus és un trastorn metabòlic a causa del dèficit de secreció d'insulina i a un augment de la seva resistència perifèrica. En el present estudi es van determinar les causes específiques de mortalitat en pacients amb diabetis mellitus. Es va observar que la mortalitat cardiovascular segueix sent la principal causa de mort en pacients amb diabetis metllitus tipus 2, seguida de la mortalitat per neoplàsies. La mortalitat total i específica per patologia cardiovascular o per neoplàsies va ser significativament superior en els pacients homes.La diabetes mellitus es un trastorno metabólico debido al déficit de secreción de insulina y a un aumento de su resistencia periférica. En el presente estudio se determinó las causas específicas de mortalidad en pacientes con diabetes mellitus. Se observó que la mortalidad cardiovascular sigue siendo la principal causa de muerte en pacientes con diabetes metllitus tipo 2, seguida de mortalidad por neoplasias. La mortalidad total y específica por patología cardiovascular o por neoplasias fue significativamente superior en los pacientes varones

Estudio del riesgo cardiovascular y su manejo en pacientes psicóticos atendidos en 2010 en el centro de atención primaria Raval Sud

Los psicóticos presentan mayor riesgo cardiovascular y peor control de sus factores de reisgo según la bibliografía. Se presenta un estudio de casos y control para comparar psicóticos vs no psicóticos atendidos en un centro de atención primaria durante 2010. El tabaquismo es más prevalente y más frecuentemente interrogado en psicóticos, y el índice de masa corporal más medido en no-psicóticos, aunque no hay otras diferencias significativas en el registro y control de factores de riesgo cardiovascular, por lo que no se puede concluir que la psicosis y su tratamiento supongan un riesgo cardiovascular aumentado.Els pacients psicòtics presenten major risc cardiovascular i pitjor control dels seus factors de risc segons la bibliografia. Es presenta un estudi de casos i controls per comparar psicòtics vs no psicòtics atesos en un centre d'atenció primària durant el 2010. El tabaquisme és més prevalent i més freqüentment interrogat en psicòtics i l'índex de massa corporal més mesurat en no-psicòtics, tot i que no hi ha altres diferències significatives en el registre i control de factors de risc cardiovascular. Per aquest motiu no es pot concloure que la psicosi i el seu tractament suposin un risc cardiovascular augmentat

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

Chronic Kidney Disease and Diabetic Retinopathy in Patients with Type 2 Diabetes

To explore the relationship between chronic kidney disease (CKD) and diabetic retinopathy (DR) in a representative population of type 2 diabetes mellitus (DM2) patients in Catalonia (Spain). This was a population-based, cross-sectional study. A total of 28,344 patients diagnosed with DM2 who had recorded ophthalmologic and renal functional examinations were evaluated. Data were obtained from a primary healthcare electronic database of medical records. CKD was defined as an estimated glomerular filtration ratio (eGFR) of <60 ml/min/1.73m 2 and/or urine albumin to creatinine ratio (UACR) ≥30 mg/g. DR was categorized as non-vision threatening diabetic retinopathy and vision threatening diabetic retinopathy. CKD was associated with a higher rate of DR [OR], 95% confidence interval [CI], 1.5 (1.4-1.7). When we analyzed the association between different levels of UACR and DR prevalence observed that DR prevalence rose with the increase of UACR levels, and this association was significant from UACR values ≥10 mg/g, and increased considerably with UACR values ≥300mg/g (Odds ratio [OR], 95% confidence interval [CI], 2.0 (1.6-2.5). This association was lower in patients with eGFR levels 44 to 30 mL/min/1.73m 2 [OR], 95% confidence interval [CI], 1.3 (1.1-1.6). These results show that CKD, high UACR and/or low eGFR, appear to be associated with DR in this DM2 population

Prevalença de factors de risc cardiovascular i qualitat de vida en pacients amb trastorn mental sever

L'objectiu és descriure els factors de RCV i variables relacionades amb la qualitat de vida de pacients amb TMS

Incidence of peripheral arterial disease in the ARTPER population cohort after 5 years of follow-up

To know the epidemiology (prevalence, incidence, progression and morbidity and mortality associated) of peripheral artery disease in general population and the factors associated with this progression is essential to know the evolution of atherosclerosis and develop preventive strategies. The aim of the study was to determine the incidence of PAD after 5 years of follow-up population-based cohort ARTPER, and the evolution of Ankle brachial Index (ABI) in this period. Peripheral artery disease incidence analysis after 5 years of follow-up of 3786 subjects > 50 years old. Peripheral artery disease incident when the second cross section Ankle brachial Index was <0.9 in any of the lower limbs, with normal baseline (0.9 to 1.4). Between 2012 and 2013 2762 individuals (77 % participation) were re-examined. Finally analyzed 2256 subjects (after excluding pathological Ankle brachial Index) followed for 4.9 years (range 3.8 to 5.8 years), totalling 11,106 person-years. Peripheral artery disease 95 new cases were detected, representing an incidence of 4.3 % at 5 years and 8.6 per 1000 person-years (95 % CI 6.9 to 10.5) being higher in men (10.2, 95 % CI 7.4 to 13.5) than in women (7.5, 95 % CI 5.5 to 9.9). Linear correlation between the baseline Ankle brachial Index and the second cross section was low (r = 0.23). The incidence of peripheral artery disease in ARTPER cohort was 8.6 cases per 1000 person-years, being higher in men, especially <65 years. The correlation between two measures Ankle brachial Index after 5 years of follow-up was low. One might consider whether Ankle brachial Index repeated measures could improve the correlation

Caminar més d'una hora al dia redueix a la meitat el risc de patir arteriopatia perifèrica

L'arteriopatia perifèrica és el conjunt de signes i símptomes que es manifesten quan es produeix una disminució del flux sanguini a una extremitat, i és un potent predictor d'episodis cardiovasculars i cerebrovasculars. Un estudi realitzat amb 3.207 persones majors de 49 anys de 28 centres de l'àrea metropolitana de Barcelona i el Barcelonès Nord ha demostrat que caminar una hora al dia redueix a la meitat el risc de patir aquesta malaltia i que l'activitat física en pacients ja malalts s'associa a un menor empitjorament.La arteriopatía periférica es el conjunto de signos y síntomas que se manifiestan cuando se produce una disminución del flujo sanguíneo en una extremidad, y es un potente predictor de episodios cardiovasculares y cerebrovasculares. Un estudio realizado con 3.207 personas mayores de 49 años de 28 centros del área metropolitana de Barcelona y el Barcelonés Norte ha demostrado que caminar una hora al día reduce a la mitad el riesgo de padecer esta enfermedad y que la actividad física en pacientes ya enfermos se asocia a un menor empeoramiento

Noninsulin Antidiabetic Drugs for Patients with Type 2 Diabetes Mellitus: Are We Respecting Their Contraindications?

Aim. To assess prescribing practices of noninsulin antidiabetic drugs (NIADs) in T2DM with several major contraindications according to prescribing information or clinical guidelines: renal failure, heart failure, liver dysfunction, or history of bladder cancer. Methods. Cross-sectional, descriptive, multicenter study. Electronic medical records were retrieved from all T2DM subjects who attended primary care centers pertaining to the Catalan Health Institute in Catalonia in 2013 and were pharmacologically treated with any NIAD alone or in combination. Results. Records were retrieved from a total of 255,499 pharmacologically treated patients. 78% of patients with some degree of renal impairment (glomerular filtration rate (GFR) &lt; 60 mL/min) were treated with metformin and 31.2% with sulfonylureas. Even in the event of severe renal failure (GFR &lt; 30 mL/min), 35.3% and 22.5% of patients were on metformin or sulfonylureas, respectively. Moreover, metformin was prescribed to more than 60% of patients with moderate or severe heart failure. Conclusion. Some NIADs, and in particular metformin, were frequently used in patients at high risk of complications when they were contraindicated. There is a need to increase awareness of potential inappropriate prescribing and to monitor the quality of prescribing patterns in order to help physicians and policymakers to yield better clinical outcomes in T2DM