Effects of a Digital Patient Empowerment and Communication Tool on Metabolic Control in People With Type 2 Diabetes: The DeMpower Multicenter Ambispective Study.

BACKGROUND: Diabetes is a major health care problem, reaching epidemic numbers worldwide. Reducing hemoglobin A1c (HbA1c) levels to recommended targets is associated with a marked decrease in the risk of type 2 diabetes mellitus (T2DM)-related complications. The implementation of new technologies, particularly telemedicine, may be helpful to facilitate self-care and empower people with T2DM, leading to improved metabolic control of the disease. OBJECTIVE: This study aimed to analyze the effect of a home digital patient empowerment and communication tool (DeMpower App) on metabolic control in people with inadequately controlled T2DM. METHODS: The DeMpower study was multicenter with a retrospective (observational: 52 weeks of follow-up) and prospective (interventional: 52 weeks of follow-up) design that included people with T2DM, aged ≥18 and ≤80 years, with HbA1c levels ≥7.5% to ≤9.5%, receiving treatment with noninsulin antihyperglycemic agents, and able to use a smartphone app. Individuals were randomly assigned (2:1) to the DeMpower app-empowered group or control group. We describe the effect of empowerment on the proportion of patients achieving the study glycemic target, defined as HbA1c≤7.5% with a ≥0.5% reduction in HbA1c at week 24. RESULTS: Due to the COVID-19 pandemic, the study was stopped prematurely, and 50 patients (33 in the DeMpower app-empowered group and 17 in the control group) were analyzed. There was a trend toward a higher proportion of patients achieving the study glycemic target (46% vs 18%; P=.07) in the DeMpower app group that was statistically significant when the target was HbA1c≤7.5% (64% vs 24%; P=.02) or HbA1c≤8% (85% vs 53%; P=.02). The mean HbA1c was significantly reduced at week 24 (-0.81, SD 0.89 vs -0.15, SD 1.03; P=.03); trends for improvement in other cardiovascular risk factors, medication adherence, and satisfaction were observed. CONCLUSIONS: The results suggest that patient empowerment through home digital tools has a potential effect on metabolic control, which might be even more relevant during the COVID-19 pandemic and in a digital health scenario.

Impact of Advanced Diabetes Centers on the healthcare experience of patients with type 2 diabetes using the IEXPAC tool.

AIMS: To determine the experience with healthcare among patients with type 2 diabetes according to the assistance model provided in their primary care centers, and to determine factors related with their experience. METHODS: This was a cross-sectional study performed in patients with type 2 diabetes with cardiovascular or renal complications. The patients were divided in two groups according to whether they had been attended in Advanced Diabetes centers (ADC) or the traditional assistance centers. Patient's healthcare experience was assessed with the "Instrument for Evaluation of the Experience of Chronic Patients" (IEXPAC) questionnaire, with possible scores ranging from 0 (worst experience) to 10 (best experience). RESULTS: A total of 451 patients (215 from ADC and 236 from traditional assistance centers) were included. The mean overall IEXPAC scores were 5.9 ±â€¯1.7 (ADC) and 6.0 ±â€¯1.9 (traditional assistance centers; p = 0.82). In the multivariant analyses, in ADC, the regular follow-up by the same physician (p = 0.01) and follow-up by a nurse (p = 0.01), were associated with a better patient experience, whereas receiving a higher number of medications with a worse patient experience (p = 0.04). In the traditional assistance centers, only the regular follow-up by the same physician was associated with a better experience (p = 0.02). Patients from ADC centers reported a higher score in the quality of life scale (69.1 ±â€¯16.5 vs 64.6 ±â€¯17.5; p = 0.008). CONCLUSIONS: In general, the healthcare experience of type 2 diabetic patients with their sanitary assistance can be improved. Patients from ADC centers report a higher score in the quality of life scale.

Healthcare experience among patients with type 2 diabetes: A cross-sectional survey using the IEXPAC tool.

Aim: To assess the experience with health care among patients with type 2 diabetes (T2DM) and to evaluate patients' demographic variables and healthcare-related characteristics which may affect their experience. Methods: A cross-sectional survey was delivered to T2DM adults. Patient experiences were assessed with the 'Instrument for Evaluation of the Experience of Chronic Patients' (IEXPAC) questionnaire, a validated 12-item survey, which describes patient experience within the last 6 months (items 1-11) and hospitalization in the last 3 years (item 12), with possible scores ranging from 0 (worst) to 10 (best experience). Results: A total of 451 T2DM patients responded to the survey (response rate 72.3%; mean age 69.5 ± 10.1 years, 67.8% men). The mean overall IEXPAC score was 5.92 ± 1.80. Mean scores were higher for productive interactions (7.92 ± 2.15) and self-management (7.08 ± 2.27) than for new relational model (1.72 ± 2.01). Only 32.8% of patients who had been hospitalized in the past 3 years reported having received a follow-up call or visit after discharge. Multivariate analyses identified that regular follow-up by the same physician and follow-up by a nurse were associated with a better patient experience. Continuity of healthcare score was higher only in those patients requiring help from others. Conclusions: The areas of T2DM care which may need to be addressed to ensure better patient experience are use of the Internet, new technologies and social resources for patient information and interaction with healthcare professionals, closer follow-up after hospitalization, and a comprehensive multidisciplinary approach with regular follow-up by the same physician and a nurse.

Spanish Diabetes Society (SED) recommendations for the pharmacologic treatment of hyperglycemia in type 2 diabetes: 2018 Update. / Recomendaciones de la Sociedad Española de Diabetes (SED) para el tratamiento farmacológico de la hiperglucemia en la diabetes tipo 2: Actualización 2018.

Type 2 diabetes mellitus (DM2) has become a problem of global dimensions by their high and growing prevalence worldwide and the personal and economic costs associated with it. Correct treatment can reduce mortality and associated complications. New concepts have recently been included in routine clinical practice and have changed the algorithm of DM2 pharmacological therapy. Therefore, the Spanish Society of Diabetes (SED) entrusted to the Working Group of Consensus and Clinical Guidelines an update of the 2010 document Recommendations for Pharmacological Treatment of Hyperglycemia in Diabetes type2. Novel aspects include nine characteristics to describe each drug group: efficiency, the risk of hypoglycemia, effects on body weight, the demonstrated effect in cardiovascular risk, nephroprotection, limitation of use in renal insufficiency, the rate of secondary effects, complexity and costs. Additionally, the document details combination options, and develop the start and adjustment of available injectable therapies.

[Managing the discharge of diabetic patients from the emergency department: a consensus paper]. / Documento de consenso sobre el manejo al alta desde urgencias del paciente diabético.

EN: Eighty to 90% of patients attended in emergency departments are discharged to home. Emergency department physicians are therefore responsible for specifying how these patients are treated afterwards. An estimated 30% to 40% of emergency patients have diabetes mellitus that was often decompensated or poorly controlled prior to the emergency. It is therefore necessary to establish antidiabetic treatment protocols that contribute to adequate metabolic control for these patients in the interest of improving the short-term prognosis after discharge. The protocols should also maintain continuity of outpatient care from other specialists and contribute to improving the long-term prognosis. This consensus paper presents the consensus of experts from 3 medical associations whose members are directly involved with treating patients with diabetes. The aim of the paper is to facilitate the assessment of antidiabetic treatment when the patient is discharged from the emergency department and referred to outpatient care teams.

ES: El 80-90% de los pacientes atendidos en los servicios de urgencias son dados de alta desde los mismos, y por tanto los facultativos de urgencias son los responsables del tratamiento al alta en dichos pacientes. Se estima que la frecuencia de diabetes mellitus en urgencias es de un 30-40% y en muchos casos dicha diabetes está descompensada o con un mal control metabólico previo, por lo que es necesario establecer pautas de tratamiento antidiabético adecuadas de cara al alta que contribuyan a un adecuado control metabólico de dichos pacientes y favorezca un mejor pronóstico a corto plazo tras el alta, así como mantener una continuidad con la atención ambulatoria por parte de otras especialidades y contribuir a una mejoría del pronóstico a largo plazo. El presente documento es por tanto un consenso de expertos de tres sociedades científicas implicadas directamente en la atención del paciente diabético, que pretende facilitar la valoración del tratamiento al alta desde urgencias en cuanto a la diabetes se refiere y su continuidad asistencial ambulatoria.

[Prospective observational study of insulin detemir in patients with poorly controlled type 2 diabetes mellitus initiating insulin therapy for the first time (SOLVE Study)]. / Estudio observacional prospectivo con insulina detemir en pacientes con diabetes mellitus tipo 2 mal controlados que inician por primer vez tratamiento con insulina (estudio SOLVE).

OBJECTIVE: Describe the experience in the primary care setting with insulin detemir in patients with poorly controlled type2 diabetes mellitus that need to add-on insulin to their oral antidiabetic drug therapy. METHODS: Prospective observational study of 6 months of follow up, performed in 10 countries. In Spain, participating sites were only from the primary care setting. Eligible patients were those with poorly controlled type2 diabetes mellitus adding-on once-daily insulin detemir to their existing oral antidiabetic therapy in the month prior to their enrollment. The change of Hb1Ac and of weight at the end of the study and the incidence of hypoglycemia and adverse reactions, were analyzed. We report the results obtained in the Spanish cohort. RESULTS: Overall 17,374 patients were included, 973 in Spain [mean age 64.8 years (SE 12); duration of diabetes 9.4 years (SE 6.2); Hb1Ac 8.9% (DE 1.4)]. In the sample analyzed for efficacy (n=474) the mean change of Hb1Ac was -1.6% (95%CI: -1.75 to -1.42; P<.001), mean change of weight was -2.9 kg (95%CI: -3.72 to -2.08; P<.001). Only one episode of severe hypoglycemia was reported, which was also the only serious adverse reaction reported in the study. The incidence rate of non-severe hypoglycemia was 2.44 events/patient-year. CONCLUSIONS: In this cohort of patients with type 2 diabetes mellitus receiving newly initiated insulin therapy, once-daily detemir improved the glycemic control, with low incidence of hypoglycemia and a significant reduction of the weight.

[Glycaemic management in type 1 and 2 diabetes patients undergoing interventional cardiology procedures. Heart and Diabetes Working Group. Sociedad Espan˜ola de Cardiologi´a. Sociedad Espan˜ola de Diabetes]. / Control glucémico de los pacientes con diabetes tipo 1 y 2 tratados mediante procedimientos de cardiología intervencionista.

Despite the growing number of therapeutic alternatives available as well as general reviews and treatment guidelines for the treatment of diabetes, physicians are often left without a clear pathway of therapy to follow in specific clinical contexts such as interventional cardiology. The present document proposes a consensus treatment algorithm, based both on a critical appraisal of evidence from recent clinical trials and on value judgements supported by the authors' collective clinical knowledge and experience, in an attempt to guide practitioners when choosing the most appropriate alternatives in the context of glycemic management in type 1 and 2 diabetic patients scheduled to undergo interventional cardiology procedures in a haemodynamic laboratory.

[Panorama of currently available treatments for patients with type 2 diabetes. The ADA/EASD treatment algorithm. Safety and tolerability]. / Panorama de los tratamientos actuales disponibles para los pacientes con diabetes tipo 2. Algoritmo terapéutico de la ADA/EASD. Seguridad y tolerabilidad.

Type 2 diabetes is defined by chronic hyperglycemia due to at least two pathogenic alterations: resistance to the action of peripheral insulin and insufficient pancreatic insulin secretion. The pharmacological treatment of hyperglycemia in type 2 diabetes should be individualized. The choice of specific oral drug (or combination of drugs) is based on the drug's physiological mechanism, the general recommendations of the clinical practice guidelines, systematic reviews and analysis of data from clinical trials and observational studies. In general terms, clinical practice guidelines recommend starting with lifestyle modifications together with metformin, either from the outset or at 3 months; the combination should be individualized depending on the patient's profile. Therapy may be intensified every 3-6 months until targets (HbA1c 6.5-7.5%) have been reached. To chose the second drug, both its efficacy (mechanism of action) and side effects (hypoglycemic episodes, effect on weight, intestinal effects, edema/cardiac insufficiency and renal or liver insufficiency) should be considered. The controversy on the safety of oral drugs and insulin is constantly reviewed. The cardiovascular safety of intensive hyperglycemia treatment in patients with type 2 diabetes, particularly with certain agents, is an open debate. Finally, the association between insulin and cancer has aroused huge interest but the clinical significance of this association remains uncertain and further analyses are required to clarify this issue.

[Multidisciplinary coordination in the approach to type 2 diabetes mellitus]. / Coordinación multidisciplinaria en el abordaje de la diabetes mellitus tipo 2.

Type 2 diabetes mellitus (DM2) is the paradigm of chronic disease. DM2 is a process that affects various organs and systems, is accompanied by other diseases and reduces patients' quality of life. Patients with diabetes show microvascular complications and an increased risk of cardiovascular morbidity and mortality related to the quality of the healthcare received, among other factors. The quality of the management of the healthcare process is intimately connected to the degree of diabetes control, the quality of the care received, quality of life and the degree to which the diabetic patient feels empowered to manage his or her disease. In Spain, several projects to coordinate specialized and primary care -shared care- have been developed to improve the management of patients with DM2. Among others, the UDEN project, in Gerona (UDENTG), is providing highly promising results. UDENTG is an intervention aimed at improving the organization of the care of endocrinological patients, especially those with DM2. Despite its complexity, this project is demonstrating its effectiveness and equitableness in DM2 and is improving professional development in all those involved.