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

Evaluation of clinical and antidiabetic treatment characteristics of different sub-groups of patients with type 2 diabetes : Data from a Mediterranean population database

Altres ajuts: Institut Universitari d'Investigació en Atenció Primària Jordi GolAltres ajuts: MSD Spain 4R16/062-1Aims: To describe the characteristics and antidiabetic treatment among type 2 diabetes patients according to the clinical conditions prioritized in the Spanish 2020 RedGDPS (Primary Care Diabetes Study Groups Network) therapeutic algorithm: obesity, older than 75 years, chronic kidney disease, cardiovascular disease, and heart failure. Methods: Retrospective, cross-sectional study. Clinical characteristics, the use of antidiabetic drugs and the KDIGO renal risk categories at 31.12.2016 were retrieved from the SIDIAP (Information System for Research in Primary Care) database (Catalonia, Spain). Results: From a total of 373,185 type 2 diabetes patients, 37% were older than 75 years, 45% obese, 33% had chronic kidney disease, 23.2% cardiovascular disease and 6.9% heart failure. Insulin was more frequently prescribed in chronic kidney disease, cardiovascular disease and heart failure whereas Sodium-Glucose cotransporter 2 inhibitors and Glucagon Like Peptide 1 receptor agonists were scarcely prescribed (2.6% and 1.4%, respectively). Among patients with severe renal failure, contraindicated drugs like metformin (16%) and sulfonylureas (6.1%) were still in use. The 2012 KDIGO renal risk categories distribution was: Low: 60.9%, Moderate: 21.6%, High: 9.8% and Very high: 7.7%. Conclusions: Almost 80% of our T2DM patients meet one of the five clinical conditions that should be considered for treatment individualization. Importantly, a relevant number of patients with severe renal failure were found to use contraindicated drugs

Trends in the Degree of Control and Treatment of Cardiovascular Risk Factors in People With Type 2 Diabetes in a Primary Care Setting in Catalonia During 2007-2018

Objective: To assess the trends in cardiovascular risk factor control and drug therapy from 2007 to 2018 in subjects with type 2 diabetes mellitus (T2DM). Materials and Methods: Cross-sectional analysis using yearly clinical data and treatment obtained from the SIDIAP database. Patients aged ≥18 years with a diagnosis of T2DM seen in primary care in Catalonia, Spain. Results: The number of T2DM patients increased from 299,855 in 2007 to 394,266 in 2018. We also found an increasing prevalence of cardiovascular disease, heart failure, and chronic kidney disease (from 18.4 to 24.4%, from 4.5 to 7.3%, and from 20.2 to 31.3%, respectively). The achievement of glycemic targets (HbA1c<7%) scarcely changed (54.9% to 55.9%). Major improvements were seen in blood pressure (≤140/90 mmHg: from 55% to 71.8%), and in lipid control (low-density lipoprotein cholesterol <100 mg/dl: 33.4% to 48.4%), especially in people with established cardiovascular disease (48.8 to 69.7%). Simultaneous achievement of all three targets improved from 12.5% to 20.1% in the overall population and from 24.5% to 32.2% in those with cardiovascular disease but plateaued after 2013. There was an increase in the percentage of patients treated with any antidiabetic drug (70.1% to 81.0%), especially metformin (47.7% to 67.7%), and DPP4i (0 to 22.6%). The use of SGLT-2 and GLP-1ra increased over the years, but remained very low in 2018 (5.5% and 2.1% of subjects, respectively). There were also relevant increases in the use of statins (38.0% to 49.2%), renin-angiotensin system (RAS) drugs (52.5% to 57.2%), and beta-blockers (14.3% to 22.7%). Conclusions: During the 2007-2018 period, relevant improvements in blood pressure and lipid control occurred, especially in people with cardiovascular disease. Despite the increase in the use of antidiabetic and cardiovascular drugs, the proportion of patients in which the three objectives were simultaneously achieved is still insufficient and plateaued after 2013. The use of antidiabetic drugs with demonstrated cardio renal benefits (SGLT-2 and GLP-1ra) increased over the years, but their use remained quite low

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

Prevalence of chronic kidney disease in patients with type 2 diabetes in Spain: PERCEDIME2 study

Estudi transversal; Malaltia renal crònica; Diabetis mellitus tipus 2Estudio transversal; Enfermedad renal crónica; Diabetes mellitus tipo 2Cross-sectional study; Chronic kidney disease; Type 2 diabetes mellitusBackground: The objective of this study was to determinate the prevalence of chronic kidney disease (CKD) and the different stages of CKD in patients with type 2 diabetes mellitus (DM2) treated in primary care consults in Spain.Methods: A national cross-sectional study was performed in primary care consults. The following data were collected: demographic and anthropometric information; list of present cardiovascular risk factors (CVRF); previous macrovascular and microvascular disease history; physical examination and analytical data from the previous 12 months, including the urine albumin-creatinine ratio (UACR) and estimated glomerular filtration rate (eGFR) to evaluate renal function.Results: With regard to the patients, 27.9% presented some degree of CKD as follows: 3.5% with stage 1; 6.4% with stage 2; 16.8% with stage 3 (11.6% with stage 3A and 5.2% with stage 3B); and 1.2% with stages 4 and 5. The prevalence of patients with UACR ≥ 30 mg/g was 15.4% (13% microalbuminuria and 2.4% macroalbuminuria). Renal impairment (RI) was found in 206 patients (18%) of whom 133 patients (64.6%) was stage 3A, 60 patients (29.1%) was stage 3B and 13 patients (6.3%) stages 4 and 5. Among patients with RI, 143 patients (69.4%) had normoalbuminuria. The following variables were significantly associated with CKD: age; sex (women); systolic arterial blood pressure (SABP) ≥ 150 mmHg; and a previous history of cardiovascular disease.Conclusions: The results showed that the prevalence for any type of CKD was 27.9%. A systematic determination of UACR and eGFR may contribute to an early diagnosis, thus allowing intervention during the initial stages of the disease when treatment is more efficient

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

Epidemiology of the first-ever cardiovascular event in people with type 1 diabetes: a retrospective cohort population-based study in Catalonia

Cardiovascular disease; Type-1 diabetes; Heart failureEnfermedad cardiovascular; Diabetes tipo 1; Insuficiencia cardiacaMalaltia cardiovascular; Diabetis tipus 1; Atac de corBackground: Knowledge of the characteristics of first-ever cardiovascular events in type 1 diabetes may impact primary prevention strategies. This study describes the first-ever manifestation of cardiovascular disease (CVD) in patients with type 1 diabetes (T1D) in Catalonia (Spain) and evaluates differences according to age and sex. Methods: Retrospective cohort study of patients with T1D > 30 years without CVD before 2010 registered in the SIDIAP database. The occurrence of a first cardiovascular event up to the end of 2016, the type of CV event and associations with baseline characteristics were analysed. Results: Of 8412 patients, 884 suffered a first CV event (incidence rate 1.62 per 100 persons-years). Overall, peripheral vascular disease (39.5%) was the most frequent event. We observed a higher proportion of heart failure in women (21.7%) than in men (10.1%). In women, heart failure was the most frequent event in those > 65 years (40.5%). Decreased glomerular filtration rate (hazard ratio [HR] 5.42 [95% CI 4.32;6.80]), elevated albumin/creatinine ratio (HR 3.39 [95% CI [2.47;4.66], microvascular complications (HR 3.27 [95% CI 2.85;3.75]), and hypertension (HR 3.21 [95% CI [2.80;3.67]) were most strongly associated with a first CV event. HbA1c > 7.0% was associated with incident CVD only in patients aged < 55/60 years. Conclusions: Peripheral artery disease in the whole cohort, and heart failure in elder subjects are the most frequent first-ever CVD events in T1D in our region. These findings deserve to be taken into account when considering primary prevention measures and when estimating CV risk in people with T1D

How Many Patients with Type 2 Diabetes Meet the Inclusion Criteria of the Cardiovascular Outcome Trials with SGLT2 Inhibitors? Estimations from a Population Database in a Mediterranean Area

Altres ajuts: This study was funded by the Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol). CIBER of Diabetes and Associated Metabolic Diseases (CIBERDEM) is an initiative from Instituto de Salud Carlos III, Madrid, Spain.Objective. Regulatory agencies require the assessment of cardiovascular (CV) safety for new type 2 diabetes (T2D) therapies through CV outcome trials (CVOTs). However, patients included in CVOTs assessing sodium-glucose cotransporter-2 inhibitors (SGLT2i) might not be representative of those seen in clinical practice. This study examined the proportion of patients that would have been enrolled into three main SGLT2i CVOTs to determine whether these trials' eligibility criteria can be applied to a real-world Mediterranean T2D population. Methods. Cross-sectional, retrospective, cohort study of T2D patients registered in primary care centres of the Catalan Institute of Health using medical records from a population database (SIDIAP) that includes approximately 74% of the population in Catalonia (Spain). Eligibility criteria were according to those of three SGLT2i CVOTs: EMPA-REG OUTCOME (empagliflozin), CANVAS (canagliflozin), and DECLARE-TIMI 58 (dapagliflozin). Results. By the end of 2016, the database included 373,185 patients with T2D with a mean age of 70±12 years, 54.9% male, with a mean duration of T2D of 9±6 years, and a mean glycated haemoglobin (HbA1c) of 7.12%±1.32 (59% with HbA1c<7%). Of these, 86,534 (23%) had established CV disease and 28% chronic renal failure (estimated glomerular filtration<60 ml/min/1.73m2). Among all included patients, only 8.2% would have qualified for enrolment into the EMPA-REG OUTCOME trial, 29.6% into the CANVAS program, and 38% into the DECLARE-TIMI 58 trial. The main limiting factors for inclusion would have been a previous history of CV disease and the baseline HbA1c value. Conclusion. The external validity of the analysed CVOTs is clearly limited when applying the same eligibility criteria to a T2D Mediterranean population