Comparison of baseline clinical characteristics among people with type 2 diabetes on second-line therapy previously added with dapagliflozin or another oral glucose-lowering drug: AGORA study.

INTRODUCTION: Type 2 diabetes mellitus (T2D) has acquired epidemic proportions worldwide. In recent years, new oral glucose-lowering drugs (OGLD) have emerged that improve the cardiovascular-kidney-metabolic control in T2D people. OBJECTIVES: To compare the baseline clinical-biological characteristics among T2D people to whom had added-on dapagliflozin (DAPA group) or another OGLD (SOC group) second-line hypoglycaemic therapies among the AGORA study population. METHODS: This is a multicentre cross-sectional observational study of the baseline characteristics of T2D people recruited through competitive sampling among 46 primary care health centres in Spain for the AGORA study. The inclusion and exclusion criteria of participants, and justification of the sample size are reported. After verifying the data necessary to be evaluated and informed consent, 317 subjects were included to the DAPA group and 288 to the SOC group. Both categorical and continuous variables were analysed and compared with the usual statistics. Cohen's d was used to assess the standardised difference in means. RESULTS: Six hundred and five patients with T2D were assessed (mean age 63.5 [SD±8.1] years, 61.8% men), whom 17.4% were smokers, 47.6% had obesity, 74.8% hypertension, 87.3% dyslipidaemia, and 41.7% reported physical inactivity, with no significant differences between both comparison groups. The mean (SD) evolution time of T2D was 10.1 (5.6) years. Most baseline clinical-biological characteristics at recruitment were similar in both groups. However, DAPA group was younger (2.9 years), and had lower systolic blood pressure (SBP) (2.8mmHg), higher body weight (BW) (3.7kg), and higher glycated haemoglobin A1c (HbA1c) (0.3%) than SOC group. Only 11.5% of participants had poor glycaemic control (HbA1c>8%) at recruitment, 54.9% had good glycaemic control (HbA1c<7%), being significantly lower in the DAPA group (47.3%) than in the SOC group (63.4%). The percentage of T2D patients with high vascular risk (VR) was 46.3%, and 53.7% with very high VR, being significantly higher in the DAPA group (57.4%) than in the SOC group (49.6%). CONCLUSIONS: Most baseline cardiovascular-kidney-metabolic characteristics were similar in T2D patients whom had added dapagliflozin on second-line hypoglycaemic therapy as those whom had added-on another OGLD. However, patients whom had added-on dapagliflozin had higher VR, lower SBP, higher BW, and slightly worse HbA1c control. Future research is necessary to explain the causes of these differences in cardiometabolic control.

Inpatient management of diabetes and hyperglycaemia: an audit of Spanish hospitals.

OBJECTIVES: Evaluation of quality of care for patients with diabetes mellitus admitted to hospitals in Spain. METHODS: Cross-sectional study in one day that included 1193 (26.7%) patients with type 2 diabetes or hyperglycaemia out of a total of 4468 patients admitted to the internal medicine departments of 53 hospitals in Spain. We collected demographic data, adequacy of capillary glycaemic monitoring, treatment administered during admission, and recommended therapy at discharge. RESULTS: The median age of the patients was 80 years [74-87], of which 561 (47%) were women, with a Charlson index of 4 points [2-6], and 742 (65%) were fragile. Median blood glucose on admission was 155 mg/dl [119-213]. On the third day, the number of capillary blood glucose levels in target (80-180 mg/dl) at pre-breakfast was 792/1126 (70.3%), pre-lunch 601/1083 (55.4%), pre-dinner 591/1073 (55.0%), and at night 317/529 (59.9%). A total of 35 patients (0.9%) were suffering from hypoglycemia. Treatment during hospitalization was performed with sliding scale insulin in 352 (40.5%) patients, with basal insulin and rapid insulin analogues in 434 (50%), or with diet exclusively in 101 (9.1%). A total of 735 (61.6%) patients had a recent HbA1c value. At discharge, the use of SGLT2i increased significantly (30.1% vs. 21.6%; p < 0.001), as did the use of basal insulin (25.3% vs. 10.1%; p < 0.001). CONCLUSIONS: There is an excessive use of sliding scale insulin as well as insufficient information on HbA1c values and prescription upon discharge of treatments with cardiovascular benefit.

[Risk factors associated with emergency service re-visits in frailty diabetic patients who consult for hypoglycaemia]. / Factores asociados a reconsultas a urgencias en pacientes frágiles con diabetes tipo 2 que consultan por hipoglucemia.

INTRODUCTION AND OBJECTIVES: Emergency department (ED) visits due to hypoglycaemia are frequent in elderly patients. The main objective of the study is to evaluate the risk factors associated to ED re-visits at 90days in elderly patients who visited ED with an episode of hypoglycaemia. MATERIAL AND METHODS: A retrospective observational study was designed, including elderly diabetic patients (>65years) attended in a fragility area of an ED for an episode of hypoglycaemia. To evaluate the risk factors associated to ED re-visits at 90days a multivariate analysis with logistic regression was performed, including those variables related to comorbidity and antidiabetic treatment with a P<0.2 in a previous univariate analysis. RESULTS: 106 patients were included. %HbA1c value was available in 87 (82.1%) patients. Ten (11.5%) patients presented a value of HbA1c ≤5.5%. Antidiabetic treatment was changed to 63 (59.4%) patients at discharge. Thirty-eight (36.1%) patients re-visited the ED at 90days, 9 for glycaemic alterations. The risk factors associated to 90days ED re-visit were: being man (OR: 3.62 [95%CI: 1.24-10.51)), treatment modified at discharge (OR: 0.31 [0.11-0.91]) and to present an HbA1c value ≤5.5% (OR: 5.33 [1.16-14.51]). CONCLUSIONS: Fragile patients with diabetes who visit ED for hypoglycaemia present, in high frequency, HbA1c values lower than those recommended, being associated to an increase of ED re-visit risk at 90days.

[Analysis of patients with type 2 diabetes in an urban Primary Healthcare centre. DESENROQUE Study]. / Análisis de pacientes con diabetes tipo 2 en un centro de salud urbano. Estudio DESENROQUE.

OBJECTIVES: To determine the health status of patients with type 2 diabetes (T2D) in an urban Primary Healthcare centre, and to assess the follow-up carried out by health professionals. To analyse the pharmacological treatment in patients with T2D, as well as to assess the individualisation according to their comorbidities. MATERIAL AND METHODS: Descriptive and cross-sectional analysis conducted on patients with DM2. Out of a total of 920 patients, a randomised and simple sample of 460 individuals was obtained, from which the parameters related to associated comorbidities and the integral treatment of T2D were collected. RESULTS: The study included 460 patients (42.4% women) with a mean age of 67.1 years (SD=13.07). The mean value of their last HbA1c was 6.75% (SD=1.24). The large majority (83.7%) fulfilled the proposed individualised HbA1c objectives according to their age and comorbidities. Approximately two-thirds (65.43%) of patients had a suboptimal follow-up by health professionals. As regards the suitability of the treatment, 19.8% had non-recommended pharmacological combinations or drugs applied outside the indications of the data sheet. A comprehensive T2D treatment that could be improved was observed in 74.3%. CONCLUSIONS: Although 83.7% of patients had good control of HbA1c, the treatment is centred on blood glucose and improvable in a high percentage of patients (74.3%). Given that the therapy must be adjusted to the needs of each patient, and since the BMI (body mass index) is a determining factor for the selection of treatment, it is striking that it is not recorded in the clinical histories of 44.13% of the patients.

Standards for global cardiovascular risk management arteriosclerosis. / Estándares SEA 2019 para el control global del riesgo cardiovascular.

One of the main goals of the Spanish Society of Arteriosclerosis is to contribute to a wider and greater knowledge of vascular disease, its prevention and treatment. Cardiovascular diseases are the leading cause of death in our country and also lead to a high degree of disability and health expenditure. Arteriosclerosis is a multifactorial disease, this is why its prevention requires a global approach that takes into account the different risk factors with which it is associated. Thus, this document summarizes the current level of knowledge and integrates recommendations and procedures to be followed for patients with established cardiovascular disease or high vascular risk. Specifically, this document reviews the main symptoms and signs to be evaluated during the clinical visit, the laboratory and imaging procedures to be routinely requested or those in special situations. It also includes the estimation of vascular risk, the diagnostic criteria of the different entities that are cardiovascular risk factors, and presents general and specific recommendations for the treatment of the different cardiovascular risk factors and their final objectives. Finally, the document includes aspects that are not often mentioned in the literature, such as the organisation of a vascular risk consultation.

Revisión exploratoria sobre la evidencia de cultivos andinos con efecto hipoglucemiante y de sus componentes bioactivos / Exploratory review on the evidence of Andean crops with hypoglycemic effect and their bioactive components

RESUMEN La diabetes es una enfermedad crónica que afecta a varias personas en todo el mundo. Algunos cultivos domesticados y compartidos en el continente sudamericano se han reportado como una fuente prometedora de componentes bioactivos con posibles efectos hipoglucemiantes. En esta revisión se tuvo como objetivo explorar y sintetizar la evidencia existente en la literatura científica sobre el efecto hipoglucemiante de los cultivos andinos y sus componentes bioactivos. Se incluyó distintos tipos de estudios primarios de tres bases de datos (Scopus, Pubmed y Web of Science) durante junio de 2023, sin restricciones, por medio del lenguaje controlado y no controlado, según la estrategia PICO. Se encontró 30 estudios realizados entre 2005 y 2022 que demostraron tener efecto hipoglucemiante, mediante la inhibición enzimática en estudios in vitro y reducción significativa de la glucosa en estudios preclínicos y ensayos clínicos. Dicho efecto fue atribuido a diferentes componentes bioactivos que se identificaron con mecanismos independientes sobre la reducción de la glucosa e inhibición enzimática. Los cultivos más utilizados fueron Smallanthus sonchifolius (9/30), Lupinus mutabilis (5/30) y Solanum tuberosum (4/30). De los cuales se asignó el efecto hipoglucémico a los componentes bioactivos, como polifenoles, flavonoides, subclases de ácidos fenólicos, fructanos, alcaloides, hidrolizados, antocianinas y fibra dietética. A pesar de los resultados alentadores en distintos tipos de estudio, para que estos sean considerados como tratamientos seguros y efectivos, se requiere investigaciones adicionales que profundicen en los mecanismos de acción, comparen su eficacia con los tratamientos convencionales y evalúen su seguridad a largo plazo.

ABSTRACT Diabetes is a chronic disease that affects several people around the world. Some domesticated crops in South America have been reported to be a promising source of bioactive compounds with possible hypoglycemic effects. In this review we aimed to explore and synthesize the existing evidence in the scientific literature on the hypoglycemic effect of Andean crops and their bioactive components. We included different types of primary studies from three databases (Scopus, Pubmed and Web of Science) during June 2023, without restrictions, by means of controlled and uncontrolled language, according to the PICO strategy. We found 30 studies conducted between 2005 and 2022 that reported a hypoglycemic effect, through enzymatic inhibition in in vitro studies and significant glucose reduction in preclinical studies and clinical trials. This effect was attributed to different bioactive components that were identified with independent mechanisms related to glucose reduction and enzymatic inhibition. The most commonly used cultures were Smallanthus sonchifolius (9/30), Lupinus mutabilis (5/30) and Solanum tuberosum (4/30). The hypoglycemic effect was assigned to bioactive components such as polyphenols, flavonoids, phenolic acid subclasses, fructans, alkaloids, hydrolysates, anthocyanins and dietary fiber. Despite encouraging results from different types of studies, further research on their mechanisms of action, their efficacy compared to conventional treatments and their long-term safety is required for these to be considered safe and effective treatments.

Determinants of adherence to hypoglycemic agents and medical visits in patients with type 2 diabetes mellitus. / Determinantes de la adherencia a los hipoglucemiantes y a las visitas médicas en pacientes con diabetes mellitus tipo 2.

AIM: To assess glycemic control in diabetic patients, to measure the impact on such control of adherence to hypoglycemic agents and to medical visits, and to explore factors that allow for predicting adherence. METHODS: Study of historical cohorts of diabetic patients. The proportion of patients who achieved the target HbA1c levels was estimated. Adherence was assessed using the Haynes-Sackett test. Change in HbA1c from the first to the last visit, adherence, and attendance to visits were analyzed according to comorbidities, cardiovascular risk factors, and treatments used. RESULTS: The study simple consisted of 639 patients (mean follow-up time, 11.1±11.2 months), of whom 66.6% achieved target HbA1c levels. Change in HbA1c from the first to the last visit was explained in 54.2% of patients by baseline HbA1c (P<0.001), in 13% by treatment adherence (P<0.001), and in 9.6% by visit adherence (P<0.001). Non-insulinization (P=0.011) and smoking cessation (P=0.032) predisposed to greater adherence. Insulinization (P=0.019) and lack of diabetes education (P=0.033) predisposed to visit non-compliance. CONCLUSIONS: Improvement in HbA1c is determined by baseline HbA1c, treatment adherence, and attendance to visits. Patients on insulin have poorer adherence and are more likely to miss the appointments, those who stop smoking adhere more to hypoglycemic agents, and those given therapeutic education are more likely to keep the appointments.

Interacciones en el tratamiento antitrombótico e hipoglucemiante / Interactions in antithrombotic and hypoglycemic therapy

Resumen Esta revisión consiste en una puesta al día del tratamiento antiplaquetario y la interacción que presenta con los hipoglucemiantes orales en pacientes diabéticos con cardiopatía isquémica. Re sumimos los principales mecanismos fisiopatológicos que intervienen en el aumento del riesgo cardiovascular en este grupo, los efectos de la combinación entre los hipoglucemiantes orales, sus efectos antitrombóticos y su interacción con los antiplaquetarios y, por último, los trabajos que estudiaron los beneficios de los antiplaque tarios en pacientes diabéticos en diferentes escenarios de la cardiopatía isquémica. Los variados mecanismos de acción implican una mejora del control de la glucemia, del aumento de la biodisponibilidad del óxido nítrico, reducción del estrés oxidativo y, para ciertas moléculas, una inhibición directa de la activación y de la agregación plaquetaria.

Abstract This review is an update on antiplatelet therapy and its interaction with oral hypoglycemic agents in diabetic patients with ischemic heart disease. We summarize the main pathophysiological mechanisms that intervene in diabetic patients and that increase the ischemic risk, the effects of the combination of oral hypoglycemic agents, their antithrombotic ef fects and their interaction with antiplatelet, and finally the studies that demonstrated the benefits of antiplatelet in diabetic patients in different scenarios of ischemic heart disease. The different mechanisms of action involve improved glycemic control, increased bioavailability of nitric oxide, reduced oxidative stress and, for certain mol ecules, direct inhibition of platelet activation and aggregation.

Factores de riesgo que influyen en el desarrollo de la retinopatía diabética / Factors of risk that bear upon the development of diabetic retinopathy

RESUMEN Introducción: La retinopatía diabética es una microangiopatía retiniana. Provoca cambios anatómicos progresivos en la retina de pacientes diabéticos de larga evolución, es la tercera causa de ceguera a nivel mundial y primera en personas de edad productiva en países en vías de desarrollo, que conlleva a pérdida irreversible de la visión si no se diagnostica y se trata a tiempo. Objetivo: Describir el comportamiento de los factores de riesgo en los pacientes con retinopatía diabética que asistieron a la consulta de retina. Métodos: Se realizó un estudio observacional, descriptivo, transversal en 115 pacientes que acudieron a la consulta de retina con diagnóstico de retinopatía diabética en el periodo de octubre 2020 a febrero 2021 y cumplieron con los criterios de inclusión, se aplicó un formulario para recoger los datos. Los resultados se relacionaron con las variables: tipo de diabetes (tipo I, tipo II), tratamiento actual, control glucémico, factores de riesgo de retinopatía diabética y severidad de esta. Resultados: Fueron más frecuente los pacientes con diabetes tipo II y la retinopatía diabética proliferativa, en pacientes con diabetes tipo I. El tratamiento con hipoglucemiantes orales fue más frecuente seguido de la insulina, la mayor cantidad de pacientes presentaron control glucémico deficiente, el mayor número de pacientes tenían más de 15 años de enfermedad como factor de riesgo, seguida de la hipertensión arterial. Solo la nefropatía no se comportó como factor de riesgo. Conclusiones: La diabetes tipo II fue más prevalente. La retinopatía diabética proliferativa fue más frecuente en pacientes con diabetes tipo I. Los hipoglucemiantes orales constituyen el tratamiento más utilizado. La insulina se utilizó en pacientes con retinopatía diabética no proliferativa severa y retinopatía diabética proliferativa. Predominó el deficiente control glucémico. A mejor control glucémico menos severidad de la retinopatía diabética. Existió asociación estadística entre retinopatía diabética y la mayoría de los factores de riesgo.

ABSTRACT Introduction: Diabetic retinopathy is a retinal microangiopathy that provokes anatomical progressive changes in the retina of the patients with diabetes mellitus of long evolution, it is the third worldwide cause of blindness but the first in old fellows productive in developing countries, that it entails an irreversible loss of vision if one does not diagnose and he talks to each other in good timing. Objective: To describe the behavior of the risk factors in the patients with diabetic retinopathy that attended the retinal consultation of the Hospital Universitario Manuel Ascunce Domenech. Methods: A descriptive transverse study, in diabetic patients that attended the retinal consultation with the diagnosis of diabetic retinopathy was carried out in the period understood of October from 2020 to February 2021. The population was composed of 115 diabetic patients that attended the consultation, and they fulfilled the criteria of inclusion, they were applied a fill-out form to pick up data. The results related with the following variables: Type of diabetes (type 1, type 2), present-day treatment, glycemic control and risk factors of diabetic retinopathy and severity of the same. Results: It was more frequent the patients with diabetes type 2, and the proliferative diabetic retinopathy in patients with diabetes type 1. The treatment with hypoglycemic pray to them it was more frequent in frequent users of insulin, the most patients presented glycemic deficient control, the bigger number of patients they had more of 15 years of disease as risk factor, followed of high blood pressure. Only nephropathy did not entail itself as risk factor. Conclusions: Diabetes type 2 was more frequent than diabetes type 1. The proliferative diabetic retinopathy was frequent in the patients with diabetes type 1. The treatment more used was the oral hypoglycemic ones. Insulin was the treatment used in patients with diabetic retinopathy not proliferative severe and proliferative diabetic retinopathy. The bigger group presented deficient glycemic control. To better glycemic control less severity of her diabetic retinopathies. There was statistical association between diabetic retinopathy and most of the risk factors.

Prescription of DPP4 inhibitors: Indication and effect on glycosylated hemoglobin in a primary care institution of Colombia / Prescripción de inhibidores de la DPP-4: indicación y efecto sobre la hemoglobina glicosilada en un primer nivel de Colombia

Abstract Introduction and objective: In Colombia, Dipeptidyl-Peptidase IV (DPP4) inhibitors are recommended as second-best choice for type 2 diabetes mellitus treatment. However, no evaluation of the accomplishment or impact of this recommendation was performed. The objective was to determine the prescription of the DPP4 inhibitor according to the Colombian Clinicial Practice Guide regarding type 2 diabetes mellitus treatment, and its effects on glycosylated hemoglobin (HbAlc). Materials and methods: A descriptive study that included patients with type 2 diabetes mellitus who attended a first level between 2016 and 2018, had a prescription for DPP4 inhibitor and at least two control appointments. Variables included were sociodemographic, clinics, treatment and comorbidities. The unadjusted prescription was defined as the lack of accomplishment of Colombian guidelines. Descriptive statistics and X2 test were used for the comparison of categorical variables. A binary logistic regression model was applied. Results: 112 out of 207 patients accomplished inclusion criteria, of which 77 were women (68.8%). Also, 68.8% of the patients had an unadjusted prescription of the iDPP4. There was a 0.21% total reduction in HbA1c levels, with a mean of 198.2 ± 124 days between the first and second control measurement (reduction of 0.55% when the prescription was adjusted to the guidelines and 0.05% if it was unadjusted). Conclusion: There is a limited impact of DPP4 inhibitors regarding the reduction of HbA1c and metabolic control, and there is a slight follow-up to the Colombian guidelines in patients who attend a first level.

Resumen Introducción y Objetivo: En Colombia se recomiendan los inhibidores de la Dipeptidil Peptidasa-IV (iDPP4) como segunda opción para el manejo de la diabetes mellitus tipo 2. No se ha evaluado el cumplimiento e impacto de esta recomendación. Como objetivo se buscó determinar la prescripción de los iDPP4 según las recomendaciones de la Guía de Práctica Clínica colombiana, y su efecto sobre la hemoglobina glicosilada (HbA1c). Materiales y métodos: Estudio descriptivo que incluyó pacientes con diabetes mellitus tipo 2 que consultaron a un primer nivel entre 2016 y 2018, y tenían formulado un iDPP4, con al menos dos consultas de seguimiento. Se incluyeron variables sociodemográficas, clínicas, tratamiento y comorbilidades. La prescripción no ajustada se definió como la falta de cumplimento de la recomendación de la guía colombiana. Se empleó estadística descriptiva y pruebas X2 para la comparación de variables categóricas. Se aplicó un modelo de regresión logística binaria. Resultados: Hubo 207 pacientes de los cuales 112 cumplieron criterios de inclusión, 77 eran mujeres (68,8%). El 68,8% de los pacientes presentaron una prescripción no ajustada del iDPP4. Hubo una reducción total de 0,21%, con una media de 198,2±124 días entre la primera y segunda medición de HbA1c de control (reducción de 0,55% cuando la prescripción se ajustaba a la guía colombiana y 0,05% cuando no). Conclusión: Hay un limitado impacto de los iDPP4 frente a la reducción de HbA1c y poco seguimiento de la guía colombiana en pacientes de primer nivel de atención.

Control glicémico perioperatorio / Perioperatory glycemic control

Diabetes is the most common endocrinopathy, in 2014, 8.6% of the population suffered from diabetes, and it was responsible for at least 3.7 million deaths per year. It is estimated that by that by 2050 more than 30% of the population will have this disease. In cardiovascular surgery, it is described that 5.2% of patients are undiagnosed diabetics and this rises to 10% -28% in non-cardiac surgeries. The adverse results are markedly high in those patients with poor glycemic control including an increase of more than 50% in mortality, as well as an increase in respiratory infections, surgical site infection, urinary infection, heart attack and acute kidney injury among others. During the preoperative period of patients with diabetes, it is important to review glycemic control and its current treatment, in addition to providing the patient instructions on how to adjust medications. Intraoperatively, any condition that leads to an uncontrolled increase in surgical stress must be controlled, since this in turn generates hyperglycemia. Knowledge of insulins, their pharmacology and schedules is essential to maintain blood glucose intraoperatively in normal ranges. Different practical algorithms are proposed for the correct and safe management of hyperglycemia in the perioperative period. All care should be continued in the postoperative period defining the continuity of the insulin therapies established and the postoperative care of the patient.

La diabetes es la endocrinopatía más común, en 2014, el 8,6% de la población padecía diabetes siendo responsable de 3,7 millones de muertes por año. Se estima que para el 2050 más del 30% de la población tendrá diabetes. En cirugía cardiovascular el 5,2% de los pacientes son diabéticos no diagnosticados, cifra que aumenta hasta 10%-28% en cirugías no cardíacas. Los resultados adversos son marcadamente elevados en aquellos pacientes con mal control incluyendo un aumento del 50% en la mortalidad, así mismo, incremento de infecciones respiratorias, infección del sitio quirúrgico, infección urinaria, infarto agudo de miocardio y lesión renal aguda, entre otros. Durante el preoperatorio de pacientes con diabetes, es importante revisar el control glucémico y su tratamiento, además de proporcionar al paciente instrucciones por escrito sobre cómo ajustarlo. En el intraoperatorio se debe controlar cualquier condición que lleve a un aumento del estrés quirúrgico pues este a su vez genera hiperglucemia. Es fundamental el conocimiento de las insulinas, su farmacología y esquemas para mantener glucemias en el intraoperatorio en rangos normales. Se proponen diferentes algoritmos prácticos para el correcto y seguro manejo de la hiperglucemia en el perioperatorio. La atención debe continuarse en el posoperatorio definiendo continuidad de terapias insulínicas instauradas y el adecuado cuidado del paciente.

Evaluación de la prescripción de hipoglucemiantes orales en población adulta con Diabetes Mellitus Tipo 2 / Evaluation of the prescription of oral hypoglycemic agents in the adult population with type 2 diabetes mellitus

En el nivel primario de atención se detectan errores en la prescripción del tratamiento farmacológico de la diabetes tipo 2. El objetivo de este estudio fue evaluar la calidad de la prescripción de hipoglucemiantes orales en pacientes atendidos en consultorios del médico de la familia del Policlínico Universitario Hermanos Cruz, municipio Pinar del Río, Cuba. Se realizó un estudio de utilización de medicamentos de tipo descriptivo y transversal clasificado dentro de estos como de indicación-prescripción con elementos de esquema terapéutico y de factores que condicionan los hábitos de prescripción. El universo estuvo conformado por 1575 pacientes con diagnóstico de diabetes mellitus tipo 2 tratados con hipoglucemiantes orales que pertenecían a los 20 consultorios médicos de la familia.La muestra de estudio se obtuvo por el método de muestreo no probabilístico (por conveniencia) (n=846). La información se obtuvo de la historia clínica y tarjeta control de los pacientes para adquirir estos medicamentos. Predominó la edad de 40-49 años, el sexo femenino y entre 5-10 años de evolución de la enfermedad. No se usó la primera línea de tratamiento en el 43,6 % de los casos, ningún caso tenía estudios de laboratorio para el uso de la Metformina. La prescripción y dosis fue adecuada no así su uso racional. Las interacciones más frecuentes fueron las farmacocinéticas.El uso racional de hipoglucemiantes orales fue deficiente lo que hace necesario ampliar la divulgación de un protocolo de tratamiento para mejorar el uso de estos fármacos en el nivel primario de atención.

Errors in the prescription of drug treatment for type 2 diabetes are detected at the primary level of care. the purpose of this study was to evaluate the quality of the prescription of oral hypoglycemic agents in patients attended in the family doctor's offices of the Hermanos Cruz University Polyclinic, Pinar del Río distrit, Cuba. A descriptive and cross-sectional study of the use of medications was carried out, classified within these as indication-prescription with elements of the therapeutic scheme and factors that condition prescription habits. The universe was made up of 1575 patients diagnosed with type 2 diabetes mellitus treated with oral hypoglycemic agents who belonged to the 20 family medical offices. The study sample was carried out by the non-probabilistic sampling method (for convenience) (n = 846). The information was obtained from the clinical history and control card of the patients to acquire these medications. The age of 40-49 years, the female sex and between 5-10 years of evolution of the disease predominated. The first line of treatment was not used in 43.6% of the cases; no case had laboratory studies for the use of Metformin. The prescription and dose was adequate, but not its rational use. The most frequent interactions were pharmacokinetic ones.The rational use of oral hypoglycemic agents was deficient, which makes it necessary to expand the dissemination of a treatment protocol to improve the use of these drugs at the primary level of care.

Diabetes mellitus tipo 2: Consideraciones sobre riesgo y rehabilitación cardiovasculares. Segunda parte

RESUMEN La diabetes mellitus tipo 2 se asocia a un incremento del riesgo de mortalidad por enfermedad cardiovascular y es una afección frecuente dentro de los pacientes con enfermedad cardiovascular establecida. El tratamiento adecuado permite mejorar la calidad de vida del paciente y disminuir la morbilidad y la mortalidad por esta y otras causas. La rehabilitación cardiovascular ha demostrado ser una terapéutica eficaz y beneficiosa en los pacientes con diabetes mellitus tipo 2. Por eso, se revisaron 70 referencias bibliográficas con el objetivo de describir elementos importantes sobre su tratamiento, que incluye estrategias farmacológicas, no farmacológicas y la rehabilitación cardiovascular.

ABSTACT Type 2 diabetes mellitus is associated with an increased risk of mortality from cardiovascular disease and it is a common condition within patients with established cardiovascular disease. Appropriate treatment can improve the patient's quality of life and decrease morbidity and mortality from this and other causes. Cardiovascular rehabilitation has been shown to be an effective and beneficial therapy in patients with type 2 diabetes mellitus. For this reason, 70 bibliographic references were reviewed with the aim of describing important elements of its treatment, which includes pharmacological and non-pharmacological strategies and cardiovascular rehabilitation.

Construção e validação de cartilha educativa para promoção da adesão a antidiabéticos orais / Construcción y validación de un folleto educativo para promover la adherencia a los antidiabéticos orales / Construction and validation of an educational booklet to promote adherence to oral antidiabetics

RESUMO Objetivo construir e validar cartilha educativa para promover a adesão a antidiabéticos orais em pessoas com Diabetes Mellitus tipo 2. Método estudo metodológico com construção e validação por comitê de 25 juízes, realizado em 2020, em Minas Gerais, Brasil. Foram avaliados conteúdo, linguagem, ilustrações, layout, motivação e cultura. Utilizou-se o Índice de Validade de Conteúdo, considerando válidos resultados iguais ou superiores a 0,80. Resultados a cartilha, intitulada "Planejando a tomada dos medicamentos no tratamento do Diabetes Mellitus tipo 2. Vamos lá?", foi composta por 24 páginas com informações sobre adesão medicamentosa, controle glicêmico, modo de uso dos principais antidiabéticos orais, agravos da não adesão e estratégias comportamentais para a efetivação da tomada destes medicamentos. Na validação de conteúdo, IVC foi de 0,92. Conclusão a cartilha mostrou-se material educativo válido para ser utilizado, a fim de promover a adesão aos antidiabéticos orais.

RESUMEN Objetivo construir y validar un folleto educativo para promover la adherencia a los agentes antidiabéticos orales en personas con Diabetes Mellitus Tipo 2. Método estudio metodológico con construcción y valoración por comité de 25 jueces, realizado en 2020, en Minas Gerais, Brasil. Se evaluó el contenido, el lenguaje, las ilustraciones, el diseño, la motivación y la cultura. Se utilizó el Índice de Validez de Contenido, considerando válidos resultados iguales o superiores a 0,80. Resultados la cartilla, titulada "Planificando la toma de medicamentos en el tratamiento de la Diabetes Mellitus tipo 2. Vamos allá", se compone de 24 páginas con información sobre la adicción a los medicamentos, el control glicémico, el modo de uso de los principales antidiabéticos orales, los efectos de la no adicción y las estrategias de comportamiento para la eficacia de la toma de los medicamentos. En la valoración del contenido, el IVC fue de 0,92. Conclusión el folleto es un material educativo válido para ser utilizado, con el fin de promover la adhesión a los antidiabéticos orales.

ABSTRACT Objective to construct and validate an educational booklet to promote adherence to oral antidiabetic agents in people with Type 2 Diabetes Mellitus. Method methodological study with construction and validation by a committee of 25 judges, conducted in 2020, in Minas Gerais, Brazil. Content, language, illustrations, layout, motivation, and culture were evaluated. The Content Validity Index was used, considering valid results equal to or greater than 0.80. Results The booklet entitled "Planning to take medications in the treatment of type 2 Diabetes Mellitus. Let´s go?", was composed of 24 pages with information on drug adherence, glycemic control, how to use the main oral antidiabetic agents, problems of nonadherence, and behavioral strategies for the effective taking of these medications. In content validation, CVI was 0.92. Conclusion the booklet proved to be a valid educational material to be used to promote adherence to oral antidiabetic drugs.

Nuevos hipoglucemiantes en el cuidado de las personas con diabetes tipo 2: por fin hay un avance / New hypoglycemic agents in the care of people with diabetes: finally, there is a breakthrough

En este artículo, la autora jerarquiza la relevancia de la eficacia documentada de los agonistas del péptido similar alglucagón-1 y los inhibidores del cotransportador sodio-glucosa tipo 2, que ha conducido a recientes modificaciones en el paradigma del cuidado en los pacientes con diabetes tipo 2. (AU)

In this article, the author highlights the relevance of the documented efficacy of glucagon-like peptide-1 agonists and type 2 sodium-glucose cotransporter inhibitors, which has led to recent changes in the paradigm of care in patients with type 2diabetes. (AU)

Construção e validação de cartilha educativa para promoção da adesão a antidiabéticos orais / Construcción y validación de un folleto educativo para promover la adherencia a los antidiabéticos orales / Construction and validation of an educational booklet to promote adherence to oral antidiabetics

RESUMO Objetivo construir e validar cartilha educativa para promover a adesão a antidiabéticos orais em pessoas com Diabetes Mellitus tipo 2. Método estudo metodológico com construção e validação por comitê de 25 juízes, realizado em 2020, em Minas Gerais, Brasil. Foram avaliados conteúdo, linguagem, ilustrações, layout, motivação e cultura. Utilizou-se o Índice de Validade de Conteúdo, considerando válidos resultados iguais ou superiores a 0,80. Resultados a cartilha, intitulada "Planejando a tomada dos medicamentos no tratamento do Diabetes Mellitus tipo 2. Vamos lá?", foi composta por 24 páginas com informações sobre adesão medicamentosa, controle glicêmico, modo de uso dos principais antidiabéticos orais, agravos da não adesão e estratégias comportamentais para a efetivação da tomada destes medicamentos. Na validação de conteúdo, IVC foi de 0,92. Conclusão a cartilha mostrou-se material educativo válido para ser utilizado, a fim de promover a adesão aos antidiabéticos orais.

RESUMEN Objetivo construir y validar un folleto educativo para promover la adherencia a los agentes antidiabéticos orales en personas con Diabetes Mellitus Tipo 2. Método estudio metodológico con construcción y valoración por comité de 25 jueces, realizado en 2020, en Minas Gerais, Brasil. Se evaluó el contenido, el lenguaje, las ilustraciones, el diseño, la motivación y la cultura. Se utilizó el Índice de Validez de Contenido, considerando válidos resultados iguales o superiores a 0,80. Resultados la cartilla, titulada "Planificando la toma de medicamentos en el tratamiento de la Diabetes Mellitus tipo 2. Vamos allá", se compone de 24 páginas con información sobre la adicción a los medicamentos, el control glicémico, el modo de uso de los principales antidiabéticos orales, los efectos de la no adicción y las estrategias de comportamiento para la eficacia de la toma de los medicamentos. En la valoración del contenido, el IVC fue de 0,92. Conclusión el folleto es un material educativo válido para ser utilizado, con el fin de promover la adhesión a los antidiabéticos orales.

ABSTRACT Objective to construct and validate an educational booklet to promote adherence to oral antidiabetic agents in people with Type 2 Diabetes Mellitus. Method methodological study with construction and validation by a committee of 25 judges, conducted in 2020, in Minas Gerais, Brazil. Content, language, illustrations, layout, motivation, and culture were evaluated. The Content Validity Index was used, considering valid results equal to or greater than 0.80. Results The booklet entitled "Planning to take medications in the treatment of type 2 Diabetes Mellitus. Let´s go?", was composed of 24 pages with information on drug adherence, glycemic control, how to use the main oral antidiabetic agents, problems of nonadherence, and behavioral strategies for the effective taking of these medications. In content validation, CVI was 0.92. Conclusion the booklet proved to be a valid educational material to be used to promote adherence to oral antidiabetic drugs.

Análise das interações medicamentosas e perfil epidemiológico de indivíduos com diabetes mellitus na atenção primária / Análisis de interacciones farmacológicas y perfil epidemiológico de individuos con diabetes mellitus en atención primaria / Analysis of drug interactions and epidemiological profile of individuals with diabetes mellitus in primary care

Objetivo: analisar as interações medicamentosas e o perfil epidemiológico de indivíduos com diabetes mellitus (DM). Método: estudo quantitativo com aplicação de questionário a 42 pacientes com DM pertencentes a um Centro de Saúde da Família (CSF). Os dados foram coletados em 2018, em três etapas: encontro no CSF, visitas domiciliares e busca em prontuário eletrônico; seguido de análise das interações medicamentosas nas bases Drug Interactions Checker Drug Information e DrugBank. Resultados: a idade média dos pacientes foi de 68,36 anos. O número total de associações entre fármacos foi de 1355 (média de 32,26/paciente). O total de medicações que interagem foi de 479 (11,40 interações/paciente). Em 65% as combinações não interagiram, 4% foram interações leves, 26,05% moderadas e 1,70% graves. Conclusão: a quantidade de interações medicamentosas é expressiva, predominando as de grau moderado. A idade dos pacientes e presença de comorbidades podem estar associadas à

Objetivo: analizar como interacciones medicamentosas y el perfil epidemiológico de individuos con diabetes mellitus (DM). Método: estudio cuantitativo con aplicación de cuestionario a 42 pacientes con DM pertencentes en el Centro de Salud de la Familia (CSF). Os dados foram coletados em 2018, em três etapas: encontro no CSF, visitas domiciliares e busca em prontuário eletrônico; seguido de análise das interações medicamentosas nas bases Comprobador de interacciones de medicamentos Información sobre medicamentos e DrugBank. Resultados: una idade media dos pacientes fe de 68,36 años. Número total de asociaciones entre religiones de 1355 (medios de 32.26/paciente). O total de medicamentos que interagencian la fe de 479 (11.40 interacciones/paciente). Em 65% como combinações não interagiram, 4% foram interações leves, 26.05% moderadas y 1.70% grave. Conclusión: una cantidad de interacõs medicamentosas é expressiva, predominando como de grau moderado. A idade dos pacientes y presença de comorbidades podem estar asociado a polimedicação, contribindo para ocorrência dessas interações.

Aim: to analyze drug interactions and the epidemiological profile of individuals with diabetes mellitus (DM). Method: quantitative study with the application of a questionnaire to 42 patients with DM belonging to a Family Health Center (FHC). Data were collected in 2018, in three stages: meeting at the CSF, home visits and searching electronic medical records; followed by analysis of drug interactions in the Drug Interactions Checker Drug Information and DrugBank databases. Results: the mean age of the patients was 68.36 years. The total number of associations between drugs was 1355 (mean 32.26 / patient). The total number of medications that interact was 479 (11.40 interactions /patient). In 65% the combinations did not interact, 4% were mild interactions, 26.05% moderate and 1.70% severe. Conclusion: the number of drug interactions is significant, with a moderate degree predominating. The age of patients and the presence of comorbidities can be associated with polymedication, contributing to the occurrence of these interactions.

Efecto de terapias farmacológicas para el control glicémico en pacientes con diabetes mellitus tipo 2 en los desenlaces vasculares / Effect of pharmacological therapies for glycemic control in patients with type 2 diabetes mellitus on vascular outcomes

Resumen Introducción: en los últimos 5 años la publicación de conocimiento relacionado con la enfermedad vascular y la diabetes mellitus tipo 2 (DT2) ha ido en aumento. Sin embargo, debido a la ausencia de una revisión que recopilara todos los desenlaces vasculares de la DT2, la presente revisión de literatura tiene como objetivo agrupar todos los desenlaces vasculares relacionados con la DT2 y describir cómo la terapia farmacológica hipoglicemiante puede ser eficaz para lograr el control de estos desenlaces. Los eventos cardiovasculares como desenlace principal demuestran que los medicamentos antidiabéticos innovadores como la empagliflozina y la liraglutida pueden agregar un beneficio significativo para pacientes con DT2. Materiales y métodos: búsqueda sistemática de la literatura, de la cual se obtuvieron 141 referencias, después de eliminar duplicados, para la tamización pareada. Posterior a esto, se identificaron 2l referencias que cumplían con los criterios de inclusión para ser considerados en el análisis. Resultados: el efecto de un buen control glucémico, sobre los resultados clínicos, específicamente en la progresión de la enfermedad renal diabética, ha sido objetivo de múltiples estudios a gran escala, tanto en pacientes diabéticos tipo 1 como en diabéticos tipo 2. Los desenlaces micro y macrovasculares son los principales desenlaces de la DMT2, que incrementan la incidencia de comorbilidades y representan, a su vez, una mayor morbilidad. Conclusiones: dentro de las principales causas de morbilidad y mortalidad de los pacientes con DT2, se encuentran las relacionadas con daño vascular, en especial enfermedad cardiovascular y compromiso renal. En este contexto, el tratamiento farmacológico de la diabetes mellitus se ha enfocado en encontrar medicamentos que reduzcan de manera significativa los eventos cardiovasculares y que al mismo tiempo retrasen la aparición de nefropatía o su progresión. Las tiazolidinedionas, los inhibidores de DPP4 (alogliptina, saxagliptina y sitagliptina), la insulina glargina y degludec han demostrado seguridad cardiovascular, pero no beneficio cardiovascular incremental en pacientes con DT2 que tienen alto riesgo de enfermedad cardiovascular aterosclerótica.

Abstract Introduction: In the last 5 years the publication of knowledge related to vascular disease and diabetes mellitus type 2 (DT2) has been increasing. However, due to the absence of a review that collects all the vascular outcomes of T2D, the current review of the literature aims to group all vascular outcomes related to T2D and describe how hypoglycemic drug therapy can be effective for the control of these outcomes. Cardiovascular events as the main outcome show that innovative antidiabetic drugs such as empagliflozin and liraglutide can add significant benefits for patients with T2D. Materials and methods: Systematic search of the literature, from which 141 references were obtained, after eliminating duplicates, for paired screening. Subsequently, 21 references were identified that met the inclusion criteria to be considered in the analysis. Results: The effect of good glycemic control on clinical outcomes, specifically in the progression of diabetic kidney disease, has been the objective of multiple large-scale studies, both in type 1 diabetic patients and type 2 diabetics and macrovascular outcome of the primary DMT2, increasing the incidence of comorbidities and in turn representing greater morbidity. Conclusions: Among the main causes of morbidity and mortality of patients with T2D, are those with vascular damage, especially cardiovascular disease and renal involvement. In this context, the pharmacological treatment of diabetes mellitus has focused on finding drugs that reduce the importance of cardiovascular events and that at the same time delay the onset of nephropathy or its progression. Thiazolidinediones, DPP4 inhibitors (alogliptin, saxagliptin and sitagliptin), insulin glargine and degludec have demonstrated cardiovascular safety, but not incremental cardiovascular benefits, in patients with T2D who are at high risk of atherosclerotic cardiovascular disease.

Antidiabéticos orales y su interacción con medicamentos modificadores de enfermedad

RESUMEN Los antidiabéticos orales (ADO) en pacientes con diabetes mellitus 2 y con comorbilidades reumatológicas no han demostrado interacción relevante con fármacos modificadores de la enfermedad (DMARDs), se debe recordar que la toma de varios medicamentos eleva el riesgo de interacciones o efectos adversos sobre todo si estos tienen un metabolismo en el mismo órgano. El objetivo es dar a conocer que interacciones existen entre los ADO y los DMARDs, mediante la búsqueda de artículos de revisión, guías farmacológicas y estudios. El resultado más sobresaliente fue el hallazgo de un estudio que abarca el uso de un DPP-4 (inhibidor de la dipeptidil peptidasa-4) especificamente sitagliptina como efecto protector frente a la toxicidad producida por el metotrexato. En pacientes con enfermedades reumatológicas y que padecen de diabetes mellitus 2, el uso de la hidroxicloroquina se ha comprobado que logra disminuir los niveles de lípidos, pero no específicamente como interacción medicamentosa con algún ADO, es una propiedad innata de la hidroxicloroquina. Se encontró evidencia de que existe correlación de hipoglicemia en pacientes que toman fármacos secretagogos y sulfazalacina.

ABSTRACT Oral antidiabetics drugs (OADs) in patients with diabetes mellitus 2 and with rheumatic comorbidities have not demonstrated relevant interaction with disease-modifying drugs (DMARDs). It should be remembered that taking several medications increases the risk of interactions or adverse effects especially if these have their metabolism in the same organ. The objective is to make known what interactions exist between OADs and DMARDs, by searching for review articles, pharmacological guides and studies. The most outstanding result was the finding of a study that covers the use of a DPP-4 (dipeptidyl peptidase-4 inhibitor), specifically sitagliptin as a protective effect against the toxicity produced by methotrexate. In patients with rheumatic diseases who also suffer from diabetes mellitus 2, the use of hydroxychloroquine has been shown to reduce lipid levels, but not specifically as a drug interaction with any OADs, it is an innate property of hydroxychloroquine. Evidence was found that there is a correlation of hypoglycemia in patients taking secretagogue drugs and sulfasalazine.

[Use of glucose-lowering drugs in a primary care setting in Malaga during the years 2008-2012]. / Utilización de fármacos hipoglucemiantes en el ámbito de la atención primaria de Málaga durante los años 2008-2012.

INTRODUCTION: The aim of the study is to describe the pattern of use of hypoglycemic agents in a primary health care district of Málaga between the years 2008-2012. MATERIAL AND METHOD: Cross-sectional descriptive study. Málaga health district. Population of 609,781 inhabitants; 42,060 people in the diabetes process. Therapeutic sub-group A10 (drugs used in diabetes). Data is presented as defined daily dose (DDD). Years 2008-2012. Measures of frequency. RESULTS: The population grew by 0.4% and the people included in the diabetes process, by 19%. The hypoglycemic agents have increased from 12,453,443 to 14,144,817 DDD (13.5%). Oral antidiabetics increased by 13.8% and insulin by 9.7%. Metformin is the most used oral antidiabetic (6,655,923 DDD) and the iDDP4 was the one that had increased more (from 63,882 DDD to 1,482,574). The growth in insulin use was mainly due to the long-acting (38%) and the shorter-acting one (40%). The most used insulin doses are the long-acting ones, followed by the pre-mixed. The proportion of insulin use as regards the use of ADOs has remained stable (31%)., Long-acting (36%) insulin has become the most used, followed by pre-mixed (34%), shorter-acting (16%), and the intermediate-acting (12%). CONCLUSIONS: There is an increase in the use of hypoglycemic agents., Metformin and iDPP4 are the antidiabetics oral with the greatest growth., There is an increase in shorter-acting and long-acting insulins with a decrease in intermediate-acting and pre-mixed., The proportion of oral antidiabetics/insulins has remained stable.