El projecte predice anàlisi de la relació entre el cost I l’efectivitat d’un programa per a la prevenció de la diabetis tipus 2 en l’atenció primària de catalunya.

JUSTIFICACIÓ: La diabetis tipus 2 consumeix aproximadament un 15% del pressupost del sistema nacional de salut. La rendibilitat econòmica dels programes dirigits a la seva prevenció se sol avaluar en escenaris informàtics virtuals i es dubta sobre la seva eficiència real en la pràctica clínica. OBJECTIU: Avaluar l'eficiència i la rendibilitat econòmica d'un programa de prevenció de la diabetis denominat DE-PLAN-CAT. MATERIAL I MÈTODE: Disseny d'un estudi prospectiu de cohorts en atenció primària amb dues fases. A la primera (n=2054), doble cribratge entre participants de 45-75 anys lliures de diabetis mitjançant el qüestionari FINDRISC (Finnish Diabetes Risk Score) –el rendiment va ser avaluat– i una sobrecàrrega oral amb glucosa. A la segona fase, els subjectes amb risc (n=552) es van assignar consecutivament a una intervenció estandarditzada (n=219) o bé a una intensiva sobre l'estil de vida (n=333): en grup (n=230) o individualment (n=103). L'indicador primari d'efectivitat va ser la incidència de diabetis (norma OMS). Es va relacionar el cost directe per grup amb l'efectivitat i la qualitat de vida (qüestionari 15D). RESULTATS: L'índex de participació fou 80,6% en la primera fase i 88,5% en la segona. L'escala FINDRISC va maximitzar fins 0,71 l'àrea sota la corba ROC (Receiver Operating Characteristic). Després de 4,2 anys, la incidència acumulada de diabetis va ser 18,3% (IC95%: 14,3-22,9%) en intervenció intensiva i 28,8% (22,9-35,3%) en estandarditzada (36,5% reducció-risc-relatiu) i la taxa de risc 0,64 (0,47-0,87,p<0,004). L'increment del cost en intervenció intensiva va ser 106 € per participant en modalitat individual i 10 € en la grupal, representant 746 € i 108 € per cas evitat de diabetis, respectivament. La intervenció intensiva va comportar un sobrecost de 3243 € per any de vida guanyat, ajustat per qualitat. CONCLUSIÓ: La intervenció intensiva fou factible, efectiva reduint la incidència de diabetis i també eficient en termes econòmics.JUSTIFICACIÓN: La diabetes tipo 2 consume aproximadamente un 15% del presupuesto del sistema nacional de salud. La rentabilidad económica de los programas dirigidos a su prevención se suele evaluar en escenarios informáticos virtuales y se duda sobre su eficiencia real en la práctica clínica. OBJETIVO: Evaluar la eficiencia y la rentabilidad económica de un programa de prevención de la diabetes denominado DE-PLAN-CAT. MATERIAL Y MÉTODO: Diseño de un estudio prospectivo de cohortes en atención primaria con dos fases. En la primera (n=2054), doble cribado entre participantes de 45-75 años libres de diabetes mediante el cuestionario FINDRISC (Finnish Diabetes Risk Score) –cuyo rendimiento fue evaluado– y una sobrecarga oral con glucosa. En la segunda fase, los sujetos con riesgo (n=552) se asignaron consecutivamente a una intervención estandarizada (n=219) o a una intensiva sobre el estilo de vida (n=333): en grupo (n=230) o individualmente (n=103). El indicador primario de efectividad fue la incidencia de diabetes (norma OMS). Se relacionó el coste directo por grupo con la efectividad y la calidad de vida (cuestionario 15D). RESULTADOS: El índice de participación fue 80,6% en la primera fase y 88,5% en la segunda. La escala FINDRISC maximizó hasta 0,71 el área bajo la curva ROC (Receiver Operating Characteristic). Tras 4,2 años, la incidencia acumulada de diabetes fue 18,3% (IC95%: 14,3-22,9%) en intervención intensiva y 28,8% (22,9-35,3%) en estandarizada (36,5% reducción-riesgo-relativo), siendo la tasa de riesgo 0,64 (0,47-0,87;p<0,004). El incremento del coste en intervención intensiva fue 106 € por participante en modalidad individual y 10 € en la grupal, representando 746 € y 108 € por caso evitado de diabetes, respectivamente. La intervención intensiva comportó un sobrecoste de 3243 € por año de vida ganado, ajustado por calidad. CONCLUSIÓN: La intervención intensiva fue factible, efectiva reduciendo la incidencia de diabetes y también eficiente en términos económicos.RATIONALE: Type 2 diabetes consumes about 15% of the national health budget. The cost-effectiveness of programmes aimed at preventing diabetes is usually evaluated by virtual computer models and there are reasonable doubts about real efficiency during clinical practice. AIM: To evaluate efficiency and cost-effectiveness of a diabetes prevention programme called DE-PLAN-CAT. MATERIAL AND METHOD: A prospective cohort study was designed and performed in primary care with two phases. The first one (n=2054) involved individuals without diagnosed diabetes aged 45-75 years screened by FINDRISC (Finnish Diabetes Risk Score) questionnaire –whose performance was also assessed– and a subsequent oral glucose tolerance test. In the second phase, high-risk individuals who were identified (n=552) were allocated sequentially to standard care (n=219), a group-based (n=230) or an individual-level (n=103) intensive lifestyle intervention (n=333). The primary outcome was the development of diabetes (WHO). We evaluated the cost of resources used with comparison of standard care and the intervention groups in terms of effectiveness and quality of life (15D questionnaire). RESULTS: The participation rate was 80.6% in the first phase and 88.5% in the second one. The FINDRISC scale maximized to 0.71 the area under the ROC (Receiver Operating Characteristic) curve. After 4.2-year median follow-up, the cumulative incidences were 18.3% (95%CI:14.3-22.9%) in the intensive intervention group and 28.8% (22.9-35.3%) in the standard care group (36.5% relative-risk-reduction). The corresponding 4-year Hazard Ratio was 0.64 (0.47-0.87;p<.004). The incremental cost induced by intensive intervention compared with the standard was 106€ per participant in the individual level and 10€ in the group-based intervention representing 746€ and 108€ per averted case of diabetes, respectively. The estimated incremental cost-utility ratio was 3243€ per quality-adjusted life-years gained. CONCLUSION: The intensive lifestyle intervention was feasible, delayed the development of diabetes and was also efficient in economic analysis

Glomerular Filtration Rate and/or Ratio of Urine Albumin to Creatinine as Markers for Diabetic Retinopathy : A Ten-Year Follow-Up Study

To determine the relationship between diabetic nephropathy and diabetic retinopathy on a population of type 2 diabetes mellitus patients. A prospective ten-year follow-up population-based study. We determined differences between estimated glomerular filtration rate (eGFR) using the chronic kidney disease epidemiology collaboration equation and urine albumin to creatinine ratio. Annual incidence of any-DR was 8.21 ± 0.60% (7.06%-8.92%), sight-threatening diabetic retinopathy (STDR) was 2.65 ± 0.14% (2.48%-2.88%), and diabetic macular edema (DME) was 2.21 ± 0.18% (2%-2.49%). Renal study results were as follows: UACR > 30 mg/g had an annual incidence of 7.02 ± 0.05% (6.97%-7.09%), eGFR < 60 ml/min/1.73 m 2 incidence was 5.89 ± 0.12% (5.70%-6.13%). Cox's proportional regression analysis of DR incidence shows that renal function studied by eGFR < 60 ml/min/1.73 m 2 was less significant (p = 0.04, HR 1.223, 1.098-1.201) than UACR ≥ 300 mg/g (p < 0.001, HR 1.485, 1.103-1.548). The study of STDR shows that eGFR < 60 ml/min/1.73 m 2 was significant (p = 0.02, HR 1.890, 1.267-2.820), UACR ≥ 300 mg/g (p < 0.001, HR 2.448, 1.595-3.757), and DME shows that eGFR < 60 ml/min/1.73 m 2 was significant (p = 0.02, HR 1.920, 1.287-2.864) and UACR ≥ 300 mg/g (p < 0.001, HR 2.432, 1.584-3.732). The UACR has a better association with diabetic retinopathy than the eGFR, although both are important risk factors for diabetic retinopathy

Rationale and design of the PREDICE project : cost-effectiveness of type 2 diabetes prevention among high-risk Spanish individuals following lifestyle intervention in real-life primary care setting

Peer reviewe

Metabolic Syndrome as a Cardiovascular Disease Risk Factor: Patients Evaluated in Primary Care

To estimate the prevalence of metabolic syndrome (MS) in a population receiving attention in primary care centers (PCC) we selected a random cohort of ostensibly normal subjects from the registers of 5 basic-health area (BHA) PCC. Diagnosis of MS was with the WHO, NCEP and IDF criteria. Variables recorded were: socio-demographic data, CVD risk factors including lipids, obesity, diabetes, blood pressure and smoking habit and a glucose tolerance test outcome. Of the 720 individuals selected (age 60.3 ± 11.5 years), 431 were female, 352 hypertensive, 142 diabetic, 233 pre-diabetic, 285 obese, 209 dyslipemic and 106 smokers. CVD risk according to the Framingham and REGICOR calculation was 13.8 ± 10% and 8.8 ± 9.8%, respectively. Using the WHO, NCEP and IDF criteria, MS was diagnosed in 166, 210 and 252 subjects, respectively and the relative risk of CVD complications in MS subjects was 2.56. Logistic regression analysis indicated that the MS components (WHO set), the MS components (IDF set) and the female gender had an increased odds ratio for CVD of 3.48 (95CI%: 2.26–5.37), 2.28 (95%CI: 1.84–4.90) and 2.26 (95%CI: 1.48–3.47), respectively. We conclude that MS and concomitant CVD risk is high in ostensibly normal population attending primary care clinics, and this would necessarily impinge on resource allocation in primary care

Public–private partnership in FTTX passive infrastructure deployment: the 22@BCN case

The paper analyses municipal active involvement in deploying passive telecommunication infrastructure oriented to support New Generation Access (NGAs) networks. This analysis is illustrated using a case study based on the 22@Barcelona council initiative, consisting on the deployment of a whole passive network infrastructure under a shared investment agreement with the incumbent operator. Part of this municipal passive infrastructure is used to rent dark fibre and spaces in order to lower entry cost for alternative operators and encourage competition on the FTTX market. The analysis is centred on benefits, risks, costs and opportunities for municipal passive infrastructure deployment.NGA networks; new generation access; passive infrastructure; municipal involvement; FTTH; fibre-to-the-home; FTTX; business models; competition; fibre deployment; public–private partnerships; PPP; Spain; fibre networks; shared investment; broadband services.

Impact of the COVID-19 Pandemic on the Metabolic Control of Diabetic Patients in Diabetic Retinopathy and Its Screening

(1) Background: Diabetic retinopathy (DR) is a complication of diabetes mellitus (DM), screening programs of which have been affected by the COVID-19 pandemic. The aim of the present study was to determine the impact of the COVID-19 pandemic on the screening of diabetes patients in our healthcare area (HCA). (2) Methods: We carried out a retrospective study of patients with DM who had attended the DR screening program between January 2015 and June 2022. We studied attendance, DM metabolic control and DR incidence. (3) Results: Screening for DR decreased in the first few months of the pandemic. The incidence of mild and moderate DR remained stable throughout the study, and we observed little increase in severe DR, proliferative DR and neovascular glaucoma during 2021 and 2022. (4) Conclusions: The current study shows that during the COVID-19 pandemic, screening program attendance decreased during the year 2020, which then recovered in 2021. Regarding the most severe forms of DR, a slight increase in cases was observed, beginning in the year 2021. Nevertheless, we aimed to improve the telemedicine systems, since the conditions of a significant proportion of the studied patients worsened during the pandemic; these patients are likely those who were already poorly monitored

Shifting from glucose diagnosis to the new HbA1c diagnosis reduces the capability of the Finnish Diabetes Risk Score (FINDRISC) to screen for glucose abnormalities within a real-life primary healthcare preventive strategy.

BACKGROUND: To investigate differences in the performance of the Finnish Diabetes Risk Score (FINDRISC) as a screening tool for glucose abnormalities after shifting from glucose-based diagnostic criteria to the proposed new hemoglobin (Hb)A1c-based criteria. METHODS: A cross-sectional primary-care study was conducted as the first part of an active real-life lifestyle intervention to prevent type 2 diabetes within a high-risk Spanish Mediterranean population. Individuals without diabetes aged 45-75 years (n = 3,120) were screened using the FINDRISC. Where feasible, a subsequent 2-hour oral glucose tolerance test and HbA1c test were also carried out (n = 1,712). The performance of the risk score was calculated by applying the area under the curve (AUC) for the receiver operating characteristic, using three sets of criteria (2-hour glucose, fasting glucose, HbA1c) and three diagnostic categories (normal, pre-diabetes, diabetes). RESULTS: Defining diabetes by a single HbA1c measurement resulted in a significantly lower diabetes prevalence (3.6%) compared with diabetes defined by 2-hour plasma glucose (9.2%), but was not significantly lower than that obtained using fasting plasma glucose (3.1%). The FINDRISC at a cut-off of 14 had a reasonably high ability to predict diabetes using the diagnostic criteria of 2-hour or fasting glucose (AUC = 0.71) or all glucose abnormalities (AUC = 0.67 and 0.69, respectively). When HbA1c was used as the primary diagnostic criterion, the AUC for diabetes detection dropped to 0.67 (5.6% reduction in comparison with either 2-hour or fasting glucose) and fell to 0.55 for detection of all glucose abnormalities (17.9% and 20.3% reduction, respectively), with a relevant decrease in sensitivity of the risk score. CONCLUSIONS: A shift from glucose-based diagnosis to HbA1c-based diagnosis substantially reduces the ability of the FINDRISC to screen for glucose abnormalities when applied in this real-life primary-care preventive strategy