[Follow-up of patients with type 2 diabetes during the COVID-19 pandemic: A multicentre study in Primary Care]. / Seguimiento de los pacientes con diabetes tipo 2 durante la pandemia por COVID-19: un estudio multicéntrico en Atención Primaria.

BACKGROUND: The COVID-19 pandemic meant measures had to be taken that implied the neglect of patients with type 2 diabetes (T2D). OBJECTIVES: to explore the impact of care discontinuity on patients with T2D in Primary Care (PC) centres, who did not have a specific action protocol for them, during 2020 and 2021. DESIGN: Multicenter retrospective observational study. PARTICIPANTS: Patients with T2D in Tenerife, Canary Islands, Spain. MAIN MEASUREMENTS: Sex and age, follow-up variables of atherosclerotic vascular disease detection and control programme (pEVA), compliance with the control objectives and visits to the family practitioner and community nurse were extracted from their medical records. RESULTS: 3,543 participants took part in the study, 1,772 (50%) women, 2,204 (62%) of whom were older than 65 years of age. The vast majority of registered activities and control objectives decreased in 2020, recovering in 2021 without reaching 2019 levels. In 2020, telephone consultations increased and in-person consultations decreased, a trend that remained unchanged in 2021 for telephone consultations. Women and those over 65 years of age presented higher frequentation, more activity records and achievement of control objectives in most of the parameters. CONCLUSIONS: The pandemic caused an overload in the PCs that affected the care of patients with T2D, which has not returned to pre-pandemic levels. Young men are the target for prioritization of this care. Anti-pandemic measures have led to an increase in telephone consultations, a resource that should be strengthened.

[Impact of the alteration of the continuity of care in diabetes type 2 patients during the COVID-19 pandemic]. / Impacto de la alteración de la continuidad asistencial en los pacientes con diabetes tipo 2 durante la pandemia de COVID-19.

AIM: To assess the impact of the alteration of the continuity of care in patients with type 2 diabetes during the COVID-19 pandemic. MATERIAL AND METHOD: Follow-up study with 587 primary care patients with DM2, and control according to the redGDPS-2018 criteria in 2018 and 2020. Activities carried out and control status of patients were compared using statistical tests appropriate to type and distribution of each variable, for a significance level P≤.05. RESULTS: Sample was made up of 587 patients with glycosylated hemoglobin (A1c) in 2018 (54% men), age of 66±11, in range of 29-91 years. All the care indicators decreased in 2020: A1c was determined in 68% of patients (382/558 after 29 deaths); 59% remained with good control, 17% with poor control, 10% improved and 14% worsened (P<.001). Those who had ECG and retinography performed in 2018 and not in 2020 show a lower degree of worsening than those who did not have them done in 2018 but they did in 2020 (16% vs 25%, P<.001 and 13% vs 42%, P=.002). Those who decrease their visits to family doctor and nurse show less deterioration than those who increase them (14% vs 26%; P<.001 and 17% vs 23%; P<.001). CONCLUSIONS: Inattention impeded control of 32% of the patients. Poor control in 2020 was lower in those who were controlled in 2018, and who decreased their attendance at the health center in 2020. Possibly adequate pre-pandemic training in self-care has led to the empowerment of the patient during a pandemic period.

[Effectiveness of the TG/HDL-C ratio to improve GLP-1 prescription in patients with type 2 diabetes in primary care]. / Efectividad de la ratio TG/c-HDL en la mejora de la prescripción de GLP-1 en pacientes con diabetes tipo 2 en atención primaria.

AIMS: Check the usefulness of ratio TG/HDL-C≥2.5 to improve the effectiveness of GLP-1 prescribing in patients with type 2 diabetes (DM2) in primary care, and determine whether any patient profile would higher benefit. DESIGN: Descriptive cross-sectional study. LOCATION: Barranco Grande Health Center, Tenerife. PARTICIPANTS: Random selection of patients with DM2 attended by 12 family doctors and 12 nurses. MAIN MEASUREMENTS: Poor control according to the current criteria was compared to poor control according to the proposed rule. To determine who would benefit, the sociodemographic, clinical, therapeutic and follow-up characteristics were analyzed. Descriptive, bivariate and multivariate statistical analysis was performed. RESULTS: No predominant characteristics were found in the patients who would be prescribed GLP-1 according to the proposed rule, but those that reached a significance P<.20 were included as potential explanatory factors in a multivariate binary logistic regression model. The adjustment of the model retained the factors of therapeutic non-compliance (OR 3.40 [1.58-5.02]; P=.003), evolution of DM2 less than 15 years (OR 2.74 [1.10-4.89]; P=.031), number of prescribed anti-diabetes drugs (OR 2.30 [1.88-2.81]; P<.001) and age under 65 years (OR 1.67 [1.08-2.58]; P=.021). CONCLUSIONS: The use of the rule that we propose for the prescription of GLP-1 (2018 recommendations of the GDPS network combined with the TG/HDL-C ratio≥2.5 or BMI≥30kg/m2), instead of the current criterion adopted by the National Health System, would allow to broaden the spectrum of application of the drug in patients with poor control of their DM2.

[Application of the Smoking Scale for Primary Care (ETAP) in clinical practice]. / Aplicación de la Escala de Tabaquismo para Atención Primaria (ETAP) en la práctica clínica.

OBJECTIVE: To determine if the ETAP smoking scale, which measures accumulated exposure to tobacco, both actively and passively, is applicable and effective in the clinical practice of Primary Care for the prevention of acute myocardial infarction (AMI). Location Barranco Grande Health Centre in Tenerife, Spain. DESIGN: A study of 61 cases (AMI) and 144 controls. Sampling with random start, without matching. COR-II curves were analysed, and effectiveness was estimated using sensitivity and negative predictive value (NPV). A questionnaire was provided to participating family physicians on the applicability of ETAP in the clinic. RESULTS: The opinion of the participating physicians was unanimously favourable. ETAP was easy to use in the clinic, required less than 3min per patient, and was useful to reinforce the preventive intervention. The ETAP COR-II curve showed that 20years of exposure was the best cut-off point, with an area under the curve of 0.70 (95%CI: 0.62-0.78), and a combination of sensitivity (98%) and NPV (96%) for AMI. When stratifying age and gender, all groups achieved sensitivities and NPVs close to 100%, except for men aged ≥55years, in whom the NPV fell to 75%. CONCLUSIONS: The results indicate that ETAP is a valid tool that can be applied and be effective in the clinical practice of Primary Care for the prevention of AMI related to smoking exposure.

Is there an association between physical exercise and the quality of life of hypertensive patients?

CONTEXT: Quality of life of hypertensive patients (QOLHP) is associated with factors that are not always taken into account in the recommendations made by doctors. OBJECTIVE: To evaluate the association between QOLHP and physical exercise in an effectiveness approach, i.e. under the actual conditions of application of these treatments. METHODOLOGY: In a sample of 361 hypertensive patients registered in a primary care center in Tenerife, Spain, the QOLHP is measured using the PECVEC questionnaire. The main factor considered is physical exercise. In addition, we compiled a set of control variables: pharmacological and dietetic treatments, pathological, clinical, functional, psychological, social, lifestyle and demographic characteristic of the patients. We explored the association between all these factors and the QOLHP by adjusting multiple linear regression models. RESULTS: The PECVEC results were between 2.0 and 3.5, with an overall Cronbach's alpha reliability statistic of 0.88. From the sample, 58% of the patients engage in physical exercise, 75% maintain a anti-hypertension diet and 89% take hypertension medication. From all the treatments evaluated, only physical exercise is associated directly with all PECVEC scales, especially for women and patients over 65. CONCLUSIONS: Recommending the practice of physical exercise may be a useful tool for doctors to improve the QOLHP.