Prevalence, impact and management of hypertension-mediated organ damage in type 2 diabetes patients.

OBJECTIVE: To determine the prevalence, impact and management of hypertension-mediated organ damage (HMOD) according to the presence of type 2 diabetes (T2DM). METHODS: IBERICAN is an ongoing multicenter, observational and prospective study, including outpatients aged 18-85 years who attended the Primary Care setting in Spain. In this study, the prevalence, impact and management of HMOD according to the presence of T2DM at baseline were analyzed. RESULTS: At baseline, 8066 patients (20.2% T2DM, 28.6% HMOD) were analyzed. Among patients with T2DM, 31.7% had hypertension, 29.8% dyslipidemia and 29.4% obesity and 49.3% had ≥1 HMOD, mainly high pulse pressure (29.6%), albuminuria (16.2%) and moderate renal impairment (13.6%). The presence of T2DM significantly increased the risk of having CV risk factors and HMOD. Among T2DM population, patients with HMOD had more dyslipidemia (78.2% vs 70.5%; P=0.001), hypertension (75.4% vs 66.4%; P=0.001), any CV disease (39.6% vs 16.1%; P=0.001) and received more drugs. Despite the majority of types of glucose-lowering agents were more frequently taken by those patients with HMOD, compared to the total T2DM population, the use of SGLT2 inhibitors and GLP-1 receptor agonists was marginal. CONCLUSIONS: In patients daily attended in primary care setting in Spain, one in five patients had T2DM and nearly half of these patients had HMOD. In patients with T2DM, the presence of HMOD was associated with a higher risk of CV risk factors and CV disease. Despite the very high CV risk, the use of glucose-lowering agents with proven CV benefit was markedly low.

Glycaemic control of elderly patients with type 2 diabetes mellitus in Spain (2015) and its relationship with functional capacity and comorbidity. The Escadiane study. / Control glucémico de los pacientes ancianos con diabetes mellitus tipo 2 en España (2015) y su relación con la capacidad funcional y la comorbilidad. Estudio Escadiane.

OBJECTIVES: To understand the state of glycaemic control of elderly patients with type 2 diabetes mellitus in Spain and its relationship with functional capacity and comorbidity. METHODS: Cross-sectional, observational, multicentre national study on patients with diabetes mellitus aged 65 years or older. The study analysed demographic and anthropometric variables, cardiovascular risk factors, clinical and laboratory data, associated comorbidity and treatments. We analysed the functional capacity using the Barthel index and the comorbidity with Charlson index. RESULTS: The study included 939 patients with a mean age of 76.4±6.7 years. The mean glycated haemoglobin (HbA1c) level was 7.0%±1.2%, and the mean basal blood glucose level was 137±39.6mg/dL. The HbA1c level showed statistically significant differences depending on the degree of disability. In the patients who were totally, severely, moderately or slightly dependent or who were independent, the mean HbA1c levels were 7.0%, 7.9%, 7.4% and 7.0%, respectively (P<.028). HbA1c levels were 7.3%, 7.1% and 6.9% in the patients with very high, high and medium comorbidity, respectively (P<.001). CONCLUSIONS: Mean HbA1c levels in elderly patients with type 2 diabetes analysed in Spain are below those recommended by the main clinical practice guidelines. The levels are higher in patients who have more functional disability and a higher level of comorbidity.

Egg consumption and cardiovascular disease according to diabetic status: The PREDIMED study.

BACKGROUND: Eggs are a major source of dietary cholesterol and their consumption has been sometimes discouraged. A relationship between egg consumption and the incidence of cardiovascular disease (CVD) has been suggested to be present exclusively among patients with type2 diabetes. AIMS: To assess the association between egg consumption and CVD in a large Mediterranean cohort where approximately 50% of participants had type 2 diabetes. METHODS: We prospectively followed 7216 participants (55-80 years old) at high cardiovascular risk from the PREDIMED (PREvención con DIeta MEDiterránea) study for a mean of 5.8 years. All participants were initially free of CVD. Yearly repeated measurements of dietary information with a validated 137-item food-frequency questionnaire were used to assess egg consumption and other dietary exposures. The endpoint was the rate of major cardiovascular events (myocardial infarction, stroke or death from cardiovascular causes). RESULTS: A major cardiovascular event occurred in 342 participants. Baseline egg consumption was not significantly associated with cardiovascular events in the total population. Non-diabetic participants who ate on average >4 eggs/week had a hazard ratio (HR) of 0.96 (95% confidence interval, 0.33-2.76) in the fully adjusted multivariable model when compared with non-diabetic participants who reported the lowest egg consumption (<2 eggs/week). Among diabetic participants, the HR was 1.33 (0.72-2.46). There was no evidence of interaction by diabetic status. HRs per 500 eggs of cumulative consumption during follow-up were 0.94 (0.66-1.33) in non-diabetics and 1.18 (0.90-1.55) in diabetics. CONCLUSIONS: Low to moderated egg consumption was not associated with an increased CVD risk in diabetic or non-diabetic individuals at high cardiovascular risk. This trial was registered at controlled-trials.com as ISRCTN35739639.

Dietary fibre intake is inversely associated with carotid intima-media thickness: a cross-sectional assessment in the PREDIMED study.

OBJECTIVE: To assess the association between the intake of dietary fibre and carotid intima-media thickness (IMT) in a Mediterranean population at high cardiovascular risk. METHODS: Baseline cross-sectional assessment of 457 men and women (average age 67 years) from two different Spanish centres of the PREDIMED trial. A previously validated food frequency questionnaire (137 food items) was administered by trained dieticians in a face-to-face interview. Mean common carotid IMT was measured using B-mode ultrasound imaging of the right and left carotid arteries by four certified sonographers who used a common protocol. Anthropometric and blood pressure measurements were performed and samples of fasting blood were obtained. Participants were categorized into four groups (roughly quartiles: < or =21; >21 to < or =25; >25 to < or =31 and >31 g/day) of energy-adjusted intake of dietary fibre. Multiple linear regression models were used to adjust for age, sex, centre, smoking, body mass index, diabetes, blood pressure, lipid levels and statin use. RESULTS: In the crude analyses, energy-adjusted fibre intake showed a significant inverse correlation with IMT (r=-0.27, P<0.001). In multivariate analyses, a modest, though statistically significant (P=0.03) inverse association between energy-adjusted fibre intake and IMT was also found. The multivariate-adjusted difference in average IMT was -0.051 mm (95% confidence interval: -0.094 to-0.009, P=0.02) for participants whose intake was >35 g/day, (n=47) when compared with those whose intake was <25 g/day (n=224). CONCLUSIONS: Our results suggest that high fibre intake is inversely associated with carotid atherosclerosis.

Effects of dietary fibre intake on risk factors for cardiovascular disease in subjects at high risk.

BACKGROUND: Epidemiological studies and feeding trials with supplements suggest that fibre intake is associated with a reduction in cardiovascular risk. However, the effects of changes in dietary fibre on risk factor levels have not been evaluated in free-living individuals. Thus, the effects of changes in dietary fibre intake on cardiovascular risk factors were assessed over 3 months in free-living high-risk subjects. METHODS: 772 high-risk subjects (age 69+/-5 years) were assigned to a low-fat diet or two Mediterranean-style diets. All participants received behavioural and nutritional education, including recommendations for increasing the consumption of vegetables, fruits, and legumes. Changes in food and nutrient intake, body weight, blood pressure, lipid profiles, glucose control and inflammatory markers were evaluated. RESULTS: Most participants increased consumption of vegetable products, but the increase in dietary fibre exhibited wide between-subject variability (6-65 g/day). Body weight, waist circumference, and mean systolic and diastolic blood pressure decreased across quintiles of fibre intake (p<0.005; all). Reductions in fasting glucose and total cholesterol levels, and increments in HDL cholesterol were highest among participants in the upper 20% of fibre intake (p = 0.04 and 0.02 respectively). Plasma concentrations of C-reactive protein, but not those of inflammatory cytokines, decreased in parallel with increasing dietary fibre (p = 0.04). Significant reductions in LDL cholesterol were observed only among participants with the greatest increases in soluble fibre intake (p = 0.04). CONCLUSIONS: Increasing dietary fibre intake with natural foods is associated with reductions in classical and novel cardiovascular risk factors in a high-risk cohort.

Control of diabetes and cardiovascular risk factors in patients with type 2 diabetes in primary care. The gap between guidelines and reality in Spain.

To evaluate the level and factors affecting control of diabetes and cardiovascular risk factors in type 2 diabetes (TYPE 2 DM) patients. Multicentre cross-sectional study: a sample of 430 primary care practices across Spain selected 1907 type 2 diabetic patients. The first five consecutive ambulatory patients with TYPE 2 DM were eligible for the inclusion into the survey. Patients were free of known cardiovascular disease (CVD). Control criteria were defined based on 2002 American Diabetes Association (ADA) clinical practice recommendations. A total of 1907 patients (51% women) aged 63 +/- 9 years. Smoking prevalence was 22.6%, 50.6% had levels of A1c < 7%. Mean blood pressure (BP) was 148 +/- 17/86 +/- 10 mmHg. Only 7.8% have achieved the target of BP < 130/80 mmHg. Among the 1180 patients (65%) treated for hypertension, this target was attained in only 4.4% of patients. A measurement for low-density lipoprotein (LDL) cholesterol was available in 1669 patients (88%). Only 5.9% of patients achieved the target of LDL < 100 mg/dl. Among the 638 patients (41.6%) on drug treatment for dyslipidaemia, this target was attained in only 5.6% of patients. Among type 2 diabetic patients in Spain the prevalence of cardiovascular risk factors is high. Control of glycaemia, smoking, BP and LDL are far from optimal despite the widespread use of guidelines for the management of diabetes and CVD. The application of published recommendations needs to be reinforced.

[Impact of common reasons for consultation on the feeling of vitality and the physical performance of the over-65s]. / Impacto de los motivos comunes de consulta en el sentimiento de vitalidad y en el rendimiento físico de personas mayores de 65 años.

OBJECTIVES: To measure two functional dimensions (vitality and physical function) involved in the quality of life of the over-65s and to find what relationship they maintain with the commonest reasons for consultation. DESIGN: Cross-sectional, descriptive study. SETTING: Primary care. PARTICIPANTS: Randomised sample of 179 patients over 65 from 14 primary care clinics in Navarra. METHODS: SF-36 quality-of-life questionnaire and most common reasons for consultation. Personal and family details and ongoing drug prescription were also recorded. RESULTS: The most common reasons for consultation were insomnia (31.8%), arthrosis (48%), and urinary symptoms (16.2%). The greatest differences in the SF-36 scales occurred in patients with insomnia. In the multiple regression models, inverse associations were found for each of the reasons for consultation with the vitality and physical function dimensions. Vitality was associated with urinary symptoms, with an adjusted beta coefficient of -11.2 points (95% CI, -18.6 to -3.7). Insomnia was associated with significant decline in vitality and physical function, with beta of -7.7 points (95% CI, -13.9 to -1.5) and -10.3 points (95% CI, -19.1 to -1.6), respectively. Arthrosis symptoms behaved in a similar way. CONCLUSIONS: The most common pathologies or symptoms causing primary care consultations in the over-65s affect significantly the quality-of-life dimensions relating to the pursuit of normal daily life.

[Validity in a community (with outside verification) of primary prevention studies on hypercholesterolemia]. / Aplicabilidad en una comunidad (validez externa) de los estudios de prevención primaria de hipercolesterolemia.

OBJECTIVES: The main objective of this study was to determine the degree of similarity between large primary prevention trials of hypercholesterolemia and our population of patients with dyslipidemia, in order to evaluate the external validity of these studies and their applicability to the general population. DESIGN: Descriptive retrospective study. SETTING: Tafalla Health Center in Navarra (Northern Spain), serving a population of 11 500 inhabitants.Participants. All patients older than 18 years assigned to our health center who had dyslipidemia with no antecedents of ischemic heart disease. RESULTS: The percentage of patients in our sample who satisfied the inclusion criteria used in large clinical trials ranged from 2.4% to 46%, depending on the study: AFCAPS/TexCAPS 1998, 46.2%; HPS 2002, 46.1%; WOSCOPS 1995, 10.9%; HHS 1987, 10.6%; LRC-CPPT 1984, 2.4%. CONCLUSIONS: Many of our patients (54%-97%) with dyslipidemia would not have been eligible for inclusion in earlier studies of hyperlipidemia and primary prevention. The external validity (applicability to the general population) of these studies is questionable. Decision-making in clinical practice for the primary prevention of hypercholesterolemia should be based on the risk/benefit ratio of pharmacological treatment.

[The demand for medical consultations in primary health care in Navarre]. / Demanda de consultas médicas de atención primaria en Navarra.

OBJECTIVE: To find the utilization of the health center medical services in Navarra and how it relates to characteristics of both doctors and population. DESIGN: Descriptive study. SETTING: Primary Health Care. PARTICIPANTS: 167 family doctors (GP) from 31 PCTs. The daily on-demand, administrative and pre-programmed consultation in the records of the PCTs from 1/5/90 to 30/3/91 were analysed for each doctor. MEASUREMENTS AND RESULTS: Indicators: frequentation (interviews/inhabitant/year), pressure of attendance (interviews/doctor/day), programmed pressure (pre-programmed interviews/doctor/day) and administrative pressure (administrative interviews/doctor/day). Average frequency in Navarra is 5.26 (SD = 2.58); average pressure of attendance, 32.13 (SD = 11.88); average pre-programmed pressure, 2.68 (SD = 1.81) and average administrative pressure, 7.9 (SD = 7.11). Frequency is inversely determined by the size of the allotted population list (p < 0.01). On studying doctors with an allotted list of _ 1,500 people, GPs with residential training have lower frequency of interviews than the rest (p < 0.01), whereas rural GPs have higher frequency and higher pressure of attendance (p < 0.001). Rural areas in the North of Navarra have a lower frequency of interviews and pressure of attendance than rural areas in the South (p < 0.02). CONCLUSION: Values of frequency in Navarra are comparable with other countries.

[The competence and skills of the family physician in ophthalmology]. / Competencias y destrezas del médico de familia en oftalmología.

BACKGROUND: In order to facilitate interprofessional collaboration and continuing education, it is necessary to define the family doctor (FD) work profile in ophthalmology and that this profile is accepted by FD and specialized doctors. METHODS: A questionnaire with 42 activities and 18 skills, belonging to the scope of ophthalmology was sent to 20 ophthalmologists in the Health Area of Pamplona. They were asked to value each item and to express whether they thought it belonged to the FD activity scope. The answers from 16 specialized doctors are compared with the answers from 16 FD. RESULTS: 30 activities and 12 skills are considered to be a part of the FD scope by 75% of them, compared with 22 activities and 10 skills accepted by the ophthalmologists. More that 75% of these ones express their disagreement with three activities: identification of traumatic wounds in both cameras, surveillance of eye-pressure in patients at risk, surveillance of chronic glaucoma and early care of wounds in the eye globe; and in three skills: valuation of iridocorneal angle, enlargement of the eye pupil and verification of lacrimal conduct permeability. In 9 items, statistically significant differences were found (p 0.05) between both groups answers. Among them, the examinations and surveillance of retinopathies in vascular and metabolic diseases, stands out. CONCLUSIONS: Our study shows a disparity of positions, which may raise difficulties to the interprofessional collaboration between both groups. It is recommended to study the factors, which might have an influence on this disagreement. The elaborated list constitutes a progress in the definition of FD profile in ophthalmology, although it would be necessary to carry out more studies.