[Prevalence of occult chronic kidney disease and associated variables in a population of patients with type 2 diabetes]. / Prevalencia de insuficiencia renal oculta y variables asociadas en una población de pacientes con diabetes tipo 2.

BACKGROUND AND OBJECTIVE: To determine the prevalence of occult chronic kidney disease (CKD) and the associated clinical variables in patients with type 2 diabetes mellitus (DM-2). PATIENTS AND METHOD: Observational, laboratory and cross-sectional study of patients with DM-2 from primary care settings. Demographic and anthropometric data, previous illnesses and measures of cardiovascular risk and kidney function were collected from electronic medical records. We determined the prevalence of occult CKD defined as patients with normal values of plasma creatinine (Cr) and reduced glomerular filtration rate (GFr) (< 60 ml/min/1,73 m(2)). The GFr was determined by the Modification of Diet in Renal Disease (MDRD) equation. RESULTS: The sample consisted of 3,197 patients, the mean age was 67.7 years (SD = 11.7) and 53.9% were men. The prevalence of CKD according to the MDMR values was 16.6% (n = 532), of which 60.3% (n = 321) corresponded to occult CKD. 6.6% (n = 211) of the participants had CKD with high Cr values. Multivariate analysis showed an association of occult CKD with female sex (OR = 2.7; CI 95% = 1,83-3,99). Occult CKD was associated with age, blood pressure higher than 150/100 mm/Hg and with a history of ischemic heart disease, heart failure, peripheral arterial disease and dyslipemia. CONCLUSIONS: The prevalence of CKD is 16.6%, of which 60.3% (n = 321) corresponds to occult CKD. Female sex is associated with the presence of occult CKD.

[Withdrawal of a specialised diabetes education program in primary care: long term impact on the metabolic control outcomes]. / La supresión de la educación especializada empeora el control metabólico en diabetes tipo 2.

AIMS: To evaluate the possible relationships between a health policy decision, in relation to the diabetes education strategies and the metabolic control outcomes. DESIGN: Longitudinal prospective cohort study. PARTICIPANTS: A random cohort sample of 276 type II diabetes mellitus subjects. LOCATION: All primary care centres in three regions of Catalonia. PRINCIPAL MEASUREMENTS: Patients were classified as specialised (n=59) or non-specialised (n=217) groups, as regards whether having received previous diabetes education before the start of the study. HbA1c values were evaluated in all subjects at baseline and after 5 years after receiving only conventional education. RESULTS: Baseline evaluation showed a better metabolic control in the specialised group (P=0.009). The final evaluation showed no significant differences in outcomes between the two groups (P=0.679). When baseline and outcomes values were compared, significant differences were observed in all subjects (P=0.001), the specialised group showed significantly poorer metabolic control (P<0.001), but in the group with previous conventional education no significant differences were observed (P=0.058). CONCLUSIONS: Our results suggest that the withdrawal of higher levels of diabetes education may play a major role in poor metabolic control, and that conventional diabetes education does not improve outcomes. Health policy in Primary Care should consider improving the level of diabetes education.

Prevalencia de insuficiencia renal oculta y variables asociadas en una población de pacientes con diabetes tipo 2 / Prevalence of occult chronic kidney disease and associated variables in a population of patients with type 2 diabetes

Fundamento y objetivo: Determinar la prevalencia de insuficiencia renal crónica (IRC) oculta y las variables clínicas asociadas en pacientes con diabetes mellitus de tipo 2 (DM2). Pacientes y método: Estudio observacional, analítico y transversal en pacientes con DM2 ambulatorios de atención primaria. De la historia clínica electrónica se registraron datos demográficos y antropométricos, antecedentes patológicos y medidas de riesgo cardiovascular y de función renal. Se determinó la prevalencia de IRC oculta, definida en pacientes con valores de creatinina (Cr) plasmática normales (Cr ≤1,4mg/dl en las mujeres y Cr ≤1,5mg/dl en los varones), y la estimación del filtrado glomerular (eFG) reducida (<60ml/min/1,73m2). La eFG se determinó mediante la fórmula Modification of Diet in Renal Disease (MDRD). Resultados: La muestra estuvo formada por 3.197 pacientes, con una media (DE) de edad de 67,7 años (11,7); el 53,9% eran varones. La prevalencia de IRC según los valores de la MDRD fue del 16,6% (n=532), de los que el 60,3% (n=321) fue IRC oculta. El 6,6% (n=211) de los sujetos presentó IRC con valores de Cr elevados. El análisis multivariante mostró una asociación del sexo femenino con la IRC oculta (odds ratio: 2,7; intervalo de confianza del 95%: 1,83–3,99). La IRC se asoció a la edad, a la presión arterial superior a 150/100mmHg, a la dislipidemia y a los antecedentes de cardiopatía isquémica, insuficiencia cardíaca y arteriopatía periférica. Conclusión: La prevalencia de IRC según la fórmula MDRD fue del 16,6%, del que el 60,3% presentaba IRC oculta. El sexo femenino se asoció directamente a la presencia de IRC oculta (AU)

Background and objective: To determine the prevalence of occult chronic kidney disease (CKD) and the associated clinical variables in patients with type 2 diabetes mellitus (DM-2). Patients and method: Observational, laboratory and cross-sectional study of patients with DM-2 from primary care settings. Demographic and anthropometric data, previous illnesses and measures of cardiovascular risk and kidney function were collected from electronic medical records. We determined the prevalence of occult CKD defined as patients with normal values of plasma creatinine (Cr) and reduced glomerular filtration rate (GFr) (<60ml/min/1,73m2). The GFr was determined by the Modification of Diet in Renal Disease (MDRD) equation. Results: The sample consisted of 3,197 patients, the mean age was 67.7 years (SD=11.7) and 53.9% were men. The prevalence of CKD according to the MDMR values was 16.6% (n=532), of which 60.3% (n=321) corresponded to occult CKD. 6.6% (n=211) of the participants had CKD with high Cr values. Multivariate analysis showed an association of occult CKD with female sex (OR=2.7; CI 95%=1,83–3,99). Occult CKD was associated with age, blood pressure higher than 150/100mm/Hg and with a history of ischemic heart disease, heart failure, peripheral arterial disease and dyslipemia. Conclusions: The prevalence of CKD is 16.6%, of which 60.3% (n=321) corresponds to occult CKD. Female sex is associated with the presence of occult CKD (AU)

La supresión de la educación especializada empeora el control metabólico en diabetes tipo 2 / Withdrawal of a specialised diabetes education program in primary care: Long term impact on the metabolic control outcomes

ObjetivoEvaluar la posible relación entre la supresión de un programa de educación especializada en diabetes y el grado de control metabólico a largo plazo.DiseñoEstudio longitudinal prospectivo en una cohorte.EmplazamientoCentros de atención primaria en 3 comarcas de Cataluña.ParticipantesMuestra aleatorizada de 276 sujetos con diabetes mellitus tipo 2.Mediciones principalesLos pacientes se clasificaron, según el tipo de educación en diabetes (ED) recibida antes del comienzo del estudio, en 2 grupos: especializado (n=59) o convencional (n=217). En todos los sujetos se evaluó la hemoglobina glucosilada (HbA1C) en línea de base y a los 5 años de recibir únicamente educación convencional en diabetes.ResultadosEn la evaluación inicial, el grupo con educación especializada previa mostró mejores concentraciones de HbA1C (p=0,009). La evaluación final no mostró diferencias significativas entre ambos grupos (p=0,679). Comparados con la línea de base, los valores finales de HbA1C en toda la muestra aumentaron de manera significativa (p=0,001). Analizados separadamente, el grupo con educación convencional previa mostró un deterioro no significativo (p=0,058), mientras que el grupo especializado había empeorado significativamente (p=0,001).ConclusionesLos resultados indican que la supresión de niveles especializados de ED puede desempeñar un papel esencial en el deterioro del control metabólico y que la ED convencional no mejora los resultados. La política de salud en atención primaria debería considerar mejorar los niveles de ED mediante una organización más adecuada(AU)

AimsTo evaluate the possible relationships between a health policy decision, in relation to the diabetes education strategies and the metabolic control outcomes.DesignLongitudinal prospective cohort study.ParticipantsA random cohort sample of 276 type II diabetes mellitus subjects.LocationAll primary care centres in three regions of Catalonia.Principal measurementsPatients were classified as specialised (n=59) or non-specialised (n=217) groups, as regards whether having received previous diabetes education before the start of the study. HbA1c values were evaluated in all subjects at baseline and after 5 years after receiving only conventional education.ResultsBaseline evaluation showed a better metabolic control in the specialised group (P=0.009). The final evaluation showed no significant differences in outcomes between the two groups (P=0.679). When baseline and outcomes values were compared, significant differences were observed in all subjects (P=0.001), the specialised group showed significantly poorer metabolic control (P<0.001), but in the group with previous conventional education no significant differences were observed (P=0.058).ConclusionsOur results suggest that the withdrawal of higher levels of diabetes education may play a major role in poor metabolic control, and that conventional diabetes education does not improve outcomes. Health policy in Primary Care should consider improving the level of diabetes education(AU)