Testing a new approach to translate research achievements into improved quality of care worldwide

The aim of the BRIDGES Research net is within the BRIDGES main scope: a) to improve the control and treatment of diabetes in a concerted effort to reduce the development and progression of chronic complications, thus decreasing the cost of its care and improving the quality of life of people with diabetes worldwide, b) to promote the early diagnosis of the disease and prevent its development, and c) to increase the critical mass of translational researchers worldwide. Better access of health providers and authorities to evidence-based practice, replicability and self-sustainability would be the central aim of this new initiative.Fil: Gagliardino, Juan Jose. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Cientifico Tecnológico La Plata. Centro de Endocrinologia Experimental y Aplicada (i); Argentin

Physiological endocrine control of energy homeostasis and postprandial blood glucose levels

The aim of this review is to analyze the different components and the feedback mechanisms involved in the normal control of energy homeostasis and postprandial blood glucose levels. Such control involves exogenous and endogenous factors: while the former include quantity and quality of food intake, the latter involve the balance of glucose intestinal absorption (postprandial period), glucose production and release by the liver and its consumption by peripheral tissues. Adequate secretion and peripheral metabolic effects of insulin play a key role in the control of both processes. Insulin secretion is controlled by the level of circulating substrates and by gastrointestinal hormones. The mechanism for the immediate control of blood glucose levels is modulated by energy homeostasis, with the participation of the above mentioned hormones and others produced at the classical endocrine system and adipose tissue, whose actions integrate at the central nervous system. The alteration of such delicate mechanism of control causes diseases such as diabetes; therefore, identification of the multiple components of this mechanism and comprehension of its normal function would facilitate the selection of effective strategies for diabetes prevention and treatment.Fil: Gagliardino, Juan Jose. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - La Plata. Centro de Endocrinología Experimental y Aplicada. Universidad Nacional de La Plata. Facultad de Ciencias Médicas. Centro de Endocrinología Experimental y Aplicada; Argentin

Relation between cost of drug treatment and body mass index in people with type 2 diabetes in Latin America

Aims Despite the frequent association of obesity with type 2 diabetes (T2D), the effect of the former on the cost of drug treatment of the latest has not been specifically addressed. We studied the association of overweight/obesity on the cost of drug treatment of hyperglycemia, hypertension and dyslipidemia in a population with T2D. Methods This observational study utilized data from the QUALIDIAB database on 3,099 T2D patients seen in Diabetes Centers in Argentina, Chile, Colombia, Peru, and Venezuela. Data were grouped according to body mass index (BMI) as Normal (18.5BMI<25), Overweight (25BMI<30), and Obese (BMI30). Thereafter, we assessed clinical and metabolic data and cost of drug treatment in each category. Statistical analyses included group comparisons for continuous variables (parametric or non-parametric tests), Chi-square tests for differences between proportions, and multivariable regression analysis to assess the association between BMI and monthly cost of drug treatment. Results Although all groups showed comparable degree of glycometabolic control (FBG, HbA1c), we found significant differences in other metabolic control indicators. Total cost of drug treatment of hyperglycemia and associated cardiovascular risk factors (CVRF) increased significantly (p<0.001) with increment of BMI. Hyperglycemia treatment cost showed a significant increase concordant with BMI whereas hypertension and dyslipidemia did not. Despite different values and percentages of increase, this growing cost profile was reproduced in every participating country. BMI significantly and independently affected hyperglycemia treatment cost. Conclusions Our study shows for the first time that BMI significantly increases total expenditure on drugs for T2D and its associated CVRF treatment in Latin America.Fil: Elgart, Jorge Federico. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - la Plata. Centro de Endocrinología Experimental y Aplicada. Universidad Nacional de la Plata. Facultad de Ciencias Médicas. Centro de Endocrinología Experimental y Aplicada; ArgentinaFil: Prestes, Mariana. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - la Plata. Centro de Endocrinología Experimental y Aplicada. Universidad Nacional de la Plata. Facultad de Ciencias Médicas. Centro de Endocrinología Experimental y Aplicada; ArgentinaFil: Gonzalez, Lorena. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - la Plata. Centro de Endocrinología Experimental y Aplicada. Universidad Nacional de la Plata. Facultad de Ciencias Médicas. Centro de Endocrinología Experimental y Aplicada; ArgentinaFil: Rucci, Enzo. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - la Plata. Centro de Endocrinología Experimental y Aplicada. Universidad Nacional de la Plata. Facultad de Ciencias Médicas. Centro de Endocrinología Experimental y Aplicada; ArgentinaFil: Gagliardino, Juan Jose. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - la Plata. Centro de Endocrinología Experimental y Aplicada. Universidad Nacional de la Plata. Facultad de Ciencias Médicas. Centro de Endocrinología Experimental y Aplicada; Argentin

Diabetes in Argentina: cost and management of diabetes and its complications and challenges for health policy

Diabetes is an expensive disease in Argentina as well as worldwide, and its prevalence is continuously rising affecting the quality of life of people with the disease and their life expectancy. It also imposes a heavy burden to the national health care budget and on the economy in the form of productivity losses. Aims: To review and discuss a) the reported evidence on diabetes prevalence, the degree of control, the cost of care and outcomes, b) available strategies to decrease the health and economic disease burden, and c) how the disease fits in the Argentinian health care system and policy. Finally, to propose evidence-based policy options to reduce the burden of diabetes, both from an epidemiological as well as an economic perspective, on the Argentinian society. The evidence presented is expected to help the local authorities to develop and implement effective diabetes care programmes. Methodology: A comprehensive literature review was performed using databases such as MEDLINE, EMBASE and LILACS (Latin American and Caribbean Health Sciences). Literature published from 1980 to 2011 was included. This information was complemented with grey literature, including data from national and provincial official sources, personal communications and contacts with health authorities and diabetes experts in Argentina. Results: Overall diabetes prevalence increased from 8.4% in 2005 to 9.6% 2009 at national level. In 2009, diabetes was the seventh leading cause of death with a mortality rate of 19.2 per 100,000 inhabitants, and it accounted for 1,328,802 DALYs lost in the adult population, mainly affecting women aged over fifty. The per capita hospitalisation cost for people with diabetes was significantly higher than for people without the disease, US$1,628 vs. US$ 833 in 2004. Evidence shows that implementation of combined educative interventions improved quality of care and outcomes, decreased treatment costs and optimised the use of economic resources. Conclusions: Based on the evidence reviewed, we believe that the implementation of structured health care programmes including diabetes education at every level, could improve quality of care as well as its clinical, metabolic and economic outcomes. If implemented across the country, these programmes could decrease the disease burden and optimise the use of human and economic resources.Fil: Caporale, Joaquin E.. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Cientifico Tecnológico La Plata. Centro de Endocrinologia Experimental y Aplicada (i); Argentina. Universidad Nacional de la Plata. Facultad de Ciencias Médicas; ArgentinaFil: Elgart, Jorge Elgart. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Cientifico Tecnológico La Plata. Centro de Endocrinologia Experimental y Aplicada (i); Argentina. Universidad Nacional de la Plata. Facultad de Ciencias Médicas; ArgentinaFil: Gagliardino, Juan Jose. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Cientifico Tecnológico La Plata. Centro de Endocrinologia Experimental y Aplicada (i); Argentina. Universidad Nacional de la Plata. Facultad de Ciencias Médicas; Argentin

Changes in quality of care and costs induced by implementation of a diabetes program in a social security entity of Argentina

Purpose: To measure the impact of a Diabetes and Cardiovascular Risk Factors Program implemented in a social security institution (OSPERYH) upon short- and long-term clinical/metabolic outcomes and costs of care. Methods: Observational longitudinal cohort analysis of clinical/metabolic data and resource use of 300 adult male and female OSPERYH affiliates with diabetes before (Baseline) and one and three years after implementation of the program. Data were obtained from clinical records (Qualidiab) and the administration´s database. Results: The implementation of the program in "real world" conditions resulted in an immediate and sustainable improvement of the quality of care provided to people with diabetes incorporated therein. We also recorded a more appropriate oral therapy prescription for hyperglycemia and cardiovascular risk factors (CVRF) as well as a decrease of events related to chronic complications. This improvement was associated to an increased use of diagnostic and therapeutic resources, particularly those related to pharmacy prescriptions, not specifically used for the control of hyperglycemia and other CVRF. Conclusion: The implementation of a diabetes program in "real world" conditions results in a significant short- and long-term improvement of the quality of care provided to people with diabetes and other CVRF, but simultaneously increased the use of resources and the cost of diagnostic and therapeutic practices. Since controlled studies have shown improvement in quality of care without increasing its costs, our results suggest the need to include management control strategies in these programs for an appropriate medical and administrative feedback to ensure the simultaneous improvement of clinical outcomes and optimization of the use of resources.Fil: Gagliardino, Juan Jose. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Cientifico Tecnológico La Plata. Centro de Endocrinologia Experimental y Aplicada (i); Argentina. Universidad Nacional de la Plata; ArgentinaFil: Calvo, Héctor. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Cientifico Tecnológico La Plata. Centro de Endocrinologia Experimental y Aplicada (i); Argentina. Universidad Nacional de la Plata; ArgentinaFil: Elgart, Jorge. Universidad Nacional de la Plata; ArgentinaFil: Gonzalez, Lorena. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Cientifico Tecnológico La Plata. Centro de Endocrinologia Experimental y Aplicada (i); Argentina. Universidad Nacional de la Plata; Argentin

Costos de atención de la diabetes tipo 2 en Argentina: un análisis de sensibilidad probabilístico

Estimar el costo incremental de atención de diabetes tipo 2 sin complicaciones en la Argentina. Utilizamos las guías ALAD y el UKPDS para identificar recursos por aplicar en Córdoba y Misiones, provincias de características socioeconómicas opuestas. La estimación de costos se hizo por microcosteo desde la perspectiva del financiador público y asumiendo como escenario comparador la situación de una provincia sin programa de diabetes. Se incluyó un análisis de sensibilidad probabilístico mediante simulación de Montecarlo para el número de consultas y prácticas, probabilidad de usar insulina, terapia combinada de hipertensión, cantidad anual de tiras reactivas y costos unitarios de todos los recursos.To estimate the incremental healthcare cost of type 2 diabetes without complications in Argentina. UKPDS and ALAD guidelines were used to identify resources to be applied in Córdoba and Misiones, two Argentinean provinces with opposite socioeconomic characteristics. Microcosting techniques were employed to estimate this cost from a public payer perspective, taking a province without diabetes program as a comparative scenario. Probabilistic sensitivity analysis following Monte Carlo simulation was used to determine number of visits and practices, probability of insulin treatment, combination therapy for hypertension, annual number of test strips and unit cost of all resources. Results: The main component of the annual incremental cost per patient in both provinces was self-monitoring blood glucose (~50%), followed by treatment of hypertension, dyslipidemia and diabetes. The lowest corresponded to human resources ( 90%).Fil: Caporale, Joaquín. Sociedad Argentina de Diabetes; ArgentinaFil: Gagliardino, Juan Jose. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - La Plata. Centro de Endocrinología Experimental y Aplicada. Universidad Nacional de La Plata. Facultad de Ciencias Médicas. Centro de Endocrinología Experimental y Aplicada; Argentin

Implementing a post-graduate degree course for diabetes educators in Argentina.

One reason for poor diabetes outcomes – the development of disabling, potentially life-threatening complications – is the lack of effective participation by people with diabetes in the management of their own condition. This participation is the key to successfully achieving therapeutic goals. To be able to follow a difficult and complex life-long regimen requires high levels of motivation and knowledge. Yet although extensive evidence supports this concept, only a minority of people receive appropriate diabetes education. Thus, many people with diabetes are handicapped in their self-care by limited knowledge and skills. The authors describe an initiative in La Plata, Argentina, which aims to promote and diffuse high-quality diabetes education by training healthcare providers to become expert educators.Fil: Gagliardino, Juan Jose. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - La Plata. Centro de Endocrinología Experimental y Aplicada. Universidad Nacional de La Plata. Facultad de Ciencias Médicas. Centro de Endocrinología Experimental y Aplicada; ArgentinaFil: Malbran, Maria del Carmen. Universidad Nacional de La Plata; ArgentinaFil: Clark, Charles. Indiana University; Estados Unido

Development and implementation of advanced training course for diabetes educators in Argentina

Preliminary report on the development and evaluation of a university-based master's degree program in diabetes education in Latin America. The program, based on reported international standards, was developed through the Department of Postgraduate Studies of the National University of La Plata, Argentina, with funds provided by the American Association of Diabetes Educators. This highly interactive program combines pedagogical, psychological, and communication-based education specifically related to diabetes. Consequently, its graduates will be prepared to communicate effectively with their patients about their self-care needs and work with them to overcome the day-to-day barriers that prevent them from integrating self-care effectively into their lives.Fil: Gagliardino, Juan Jose. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - La Plata. Centro de Endocrinología Experimental y Aplicada. Universidad Nacional de La Plata. Facultad de Ciencias Médicas. Centro de Endocrinología Experimental y Aplicada; ArgentinaFil: Malbran, Maria del Carmen. Universidad Nacional de La Plata; ArgentinaFil: Clark, Carmen. Indiana University; Estados Unido

Lipoic acid prevents fructose-induced changes in liver carbohydrate metabolism: Role of oxidative stress

Fructose administration rapidly induces oxidative stress that triggers compensatory hepatic metabolic changes. We evaluated the effect of an antioxidant, R/S-α-lipoic acid on fructose-induced oxidative stress and carbohydrate metabolism changes. METHODS: Wistar rats were fed a standard commercial diet, the same diet plus 10% fructose in drinking water, or injected with R/S-α-lipoic acid (35mg/kg, i.p.) (control+L and fructose+L). Three weeks thereafter, blood samples were drawn to measure glucose, triglycerides, insulin, and the homeostasis model assessment-insulin resistance (HOMA-IR) and Matsuda indices. In the liver, we measured gene expression, protein content and activity of several enzymes, and metabolite concentration. RESULTS: Comparable body weight changes and calorie intake were recorded in all groups after the treatments. Fructose fed rats had hyperinsulinemia, hypertriglyceridemia, higher HOMA-IR and lower Matsuda indices compared to control animals. Fructose fed rats showed increased fructokinase gene expression, protein content and activity, glucokinase and glucose-6-phosphatase gene expression and activity, glycogen storage, glucose-6-phosphate dehydrogenase mRNA and enzyme activity, NAD(P)H oxidase subunits (gp91phox and p22phox) gene expression and protein concentration and phosphofructokinase-2 protein content than control rats. All these changes were prevented by R/S-α-lipoic acid co-administration. CONCLUSIONS: Fructose induces hepatic metabolic changes that presumably begin with increased fructose phosphorylation by fructokinase, followed by adaptive changes that attempt to switch the substrate flow from mitochondrial metabolism to energy storage. These changes can be effectively prevented by R/S-α-lipoic acid co-administration. GENERAL SIGNIFICANCE: Control of oxidative stress could be a useful strategy to prevent the transition from impaired glucose tolerance to type 2 diabetes.Fil: Castro, María Cecilia. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico. Centro de Endocrinologia Experimental y Aplicada (i); ArgentinaFil: Massa, Maria Laura. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico. Centro de Endocrinologia Experimental y Aplicada (i); ArgentinaFil: Gagliardino, Juan Jose. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico. Centro de Endocrinologia Experimental y Aplicada (i); ArgentinaFil: Francini, Flavio. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico. Centro de Endocrinologia Experimental y Aplicada (i); Argentin

Treat-to-target HbA1c and lipid profile to prolong β-cell mass/function and optimize treatment goal attainment

Background: To evaluate the relation between different serum lipid fractions and other known barriers to attain the HbA1c ≤ 7.0% (53 mmol/mol) target. Methods: Data on 2719 patients with type 2 diabetes were collected from the five waves of the International Diabetes Mellitus Practice Study implemented in Argentina (2006 to 2012) including demographic/socioeconomic profile, clinical, metabolic (HbA1c and serum lipids) data, and treatment type and also, percentage of treatment goal attainment. Descriptive statistical analyses included ANOVA, χ2 test, and Fisher exact test and univariate and multivariate logistic regression analyses, which identified predictive factors for HbA1c ≤ 7% (53 mmol/mol). Results: The average age was 63 years, primary/secondary education, health insurance, 10‐year type 2 diabetes duration, most associated with cardiovascular risk factors and some microvascular/macrovascular complications; 94.5% received antihyperglycaemic drugs. Percentage of people on target: HbA1c 51.2%, blood pressure 23.5%, total cholesterol 62.6%, low‐density lipoprotein (LDL) cholesterol 38.9%, and triglycerides 61.1%. HbA1c on target depended markedly on treatment type: more of those treated with lifestyle changes and significantly fewer of those receiving insulin. Only 4.1% had all parameters simultaneously on target. Multivariate logistic regression analyses showed that achieving HbA1c ≤ 7.0% (53 mmol/mol) was associated with higher educational level, shorter diabetes duration, and having reached goals for LDL cholesterol and triglycerides, whereas opposite results were obtained with insulin treatment and longer diabetes duration. Conclusions: High LDL cholesterol and triglyceride levels simultaneously potentiate development/progression of chronic complications, exerting this effect in the long term by decreasing β‐cell mass/function, thereby making it more difficult to reach HbA1c values able to prevent complications.Fil: Gagliardino, Juan Jose. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - La Plata. Centro de Endocrinología Experimental y Aplicada. Universidad Nacional de La Plata. Facultad de Ciencias Médicas. Centro de Endocrinología Experimental y Aplicada; ArgentinaFil: Elgart, Jorge Federico. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - La Plata. Centro de Endocrinología Experimental y Aplicada. Universidad Nacional de La Plata. Facultad de Ciencias Médicas. Centro de Endocrinología Experimental y Aplicada; ArgentinaFil: Forti, Luján. Sanofi Aventis Argentina Sociedad Anonima.; ArgentinaFil: Guaita, María Silvina. Sanofi Aventis Argentina Sociedad Anonima.; ArgentinaFil: Chantelot, Jean M.. Sanofi; Franci