Lifestyle factors do not explain the difference on diabetes progression according to type of prediabetes: Results from a Spanish prospective cohort of prediabetic patients.

AIMS: We studied the role of lifestyle factors associated to type 2 diabetes (T2DM) onset according to type of prediabetes. METHODS: We used data from the observational prospective cohort study in Primary Health Care on the Evolution of Patients with Prediabetes in Spain (PREDAPS). Participants were classified by American Diabetes Association criteria using either fasting plasma glucose levels (100-125 mg/dL) (group 1), HbA1c (5.7%-6.4%) (group 2) or both impaired parameters (group 3). Relationship between lifestyles and diabetes onset according to prediabetes at third year of follow up were estimated by Hazard Ratios (HRs) using three sequential models. RESULTS: Incidence rate of diabetes was 2.27 cases per 1000 person-years (95% CI: 1.4-3.6) for group 1, 1.18 (95% CI: 0.65-2.13) for group 2 and 6.68 (95% CI: 5.71-8.23) for group 3. The most important risk factors were: abdominal obesity (HR: 2.29 (95% CI: 1.49-3.52)) and hypertension (HR: 2.16 (95% CI: 1.41-3.30)). Using as reference group 2, group 3 had a HR of 5.82 (3.13-10.82) and 1.83 (95% CI: 0.85-3.93) for group 1, estimates remained constant when adjusting by lifestyle and metabolic factors. CONCLUSIONS: Lifestyle and metabolic do not seem to explain the differences on T2DM onset by type of prediabetes.

Metabolic control and chronic complications during a 3-year follow-up period in a cohort of type 2 diabetic patients attended in primary care in the Community of Madrid (Spain).

BACKGROUND: Our aim was to analyze both metabolic control and chronic complications of type 2 diabetes mellitus (T2D) patients regularly attended in primary care during a 3 years of follow-up in the Community of Madrid (Spain). METHODS: From 2007 to 2010 we prospectively included 3268 patients with T2D attended by 153 primary care physicians from 51 family health centers. An prospective cohort study with annual evaluation over 3 years to the same population was performed. We measured the goals of control in diabetic patients and the incidence of chronic complications of diabetes during the study period. RESULTS: A significant decrease in serum glucose levels (143±42mg/dl vs 137±43mg/dl, p<0.00), HbA1c (7.09±1.2% vs 7.02±1.2%, p<0.00), total cholesterol (191.4±38mg/dl vs 181.5±36mg/dl, p<0.00), LDL cholesterol (114.7±31mg/dl vs 105.5±30mg/dl, p<0.00) and triglyceride levels (144.5±93mg/dl vs 138±84mg/dl, p<0.00) during study period was documented. On the contrary, a significant elevation in HDL cholesterol levels was observed (49.2±14mg/dl vs 49.9±16mg/dl, p<0.00). The incidence of diabetic complications throughout the study period was low, with a incidence of coronary heart disease of 6.2%, peripheral arterial disease 3%, ischemic stroke 2.8%, diabetic foot 11.2%, nephropathy 5.9%, retinopathy 4.5%, and neuropathy 3%. CONCLUSION: Metabolic control in T2D patients attended in primary care in the Community of Madrid throughout 3 years is adequate and is accompanied by low percent of chronic diabetic complications during this period of follow-up.

Estimation of the economic and health impact of complications of type 2 diabetes mellitus in the autonomous community of Madrid (Spain).

OBJECTIVE: To estimate the economic and health impact of chronic complications (macrovascular and microvascular) of type 2 diabetes mellitus (T2DM) in the autonomous community of Madrid (Spain) (ACM). METHODS: The number of expected complications was obtained from a descriptive, cross-sectional study on a cohort of 3,268 patients with T2DM from the ACM. Cost of complications (€, 2012) was assessed both at hospitals and in primary care. The number of medical visits in primary care and drug treatment for complications were collected by a panel of 21 physicians experienced in treatment of T2DM. Population and epidemiological data and healthcare costs were obtained from Spanish sources. Univariate sensitivity analyses were performed. RESULTS: It is estimated that there are 390,944 patients with T2DM in the ACM, and that they experience 172,406 and 212,283 macrovascular and microvascular complications respectively during their lifetimes. Mean cost of T2DM complications per patient is estimated at € 4,121.54 (66% due to macrovascular complications). The economic impact of T2DM complications in the ACM would be € 1,611 million (1,065 and 545 millions from macrovascular and microvascular complications respectively). The economic impact would range from € 1,249 and 2.509 million euro depending on T2DM prevalence. CONCLUSIONS: Complications of T2DM have a great health and economic impact in ACM.

Asociación de obesidad general y abdominal con hipertensión, dislipemia y presencia de prediabetes en el estudio PREDAPS / Association of general and abdominal obesity with hypertension, dyslipidemia and prediabetes in the PREDAPS study

Introducción y objetivos: Algunas medidas antropométricas muestran mayor capacidad que otras para discriminar la presencia de factores de riesgo cardiovascular. Este trabajo estima la magnitud de la asociación de diversos indicadores antropométricos de obesidad con hipertensión, dislipemia y prediabetes (glucemia basal o glucohemoglobina alteradas). Métodos: Análisis transversal de la información recogida en 2.022 sujetos del estudio PREDAPS (etapa basal). Se definió obesidad general como índice de masa corporal ≥ 30 kg/m2 y obesidad abdominal con 2 criterios: a) perímetro de cintura (PC) ≥ 102 cm en varones/PC ≥ 88 cm en mujeres, y b) índice cintura/estatura (ICE) ≥ 0,55. La magnitud de la asociación se estimó mediante regresión logística. Resultados: La hipertensión arterial mostró la asociación más alta con la obesidad general en mujeres (OR = 3,01; IC95%, 2,24-4,04) y con la obesidad abdominal según el criterio del ICE en varones (OR = 3,65; IC95%, 2,66-5,01). La hipertrigliceridemia y los valores bajos de colesterol unido a lipoproteínas de alta densidad mostraron la asociación más alta con obesidad abdominal según el criterio del ICE en mujeres (OR = 2,49; IC95%, 1,68-3,67 y OR = 2,70; IC95%, 1,89-3,86) y la obesidad general en varones (OR = 2,06; IC95%, 1,56-2,73 y OR = 1,68; IC95%, 1,21-2,33). La prediabetes mostró la asociación más alta con obesidad abdominal según el criterio del ICE en mujeres (OR = 2,48; IC95%, 1,85-3,33) y con obesidad abdominal según el criterio del PC en varones (OR = 2,33; IC95%, 1,75-3,08). Conclusiones: Los indicadores de obesidad abdominal mostraron la mayor asociación con la presencia de prediabetes. La relación de los indicadores antropométricos con hipertensión y con dislipemia mostró resultados heterogéneos (AU)

Introduction and objectives: Some anthropometric measurements show a greater capacity than others to identify the presence of cardiovascular risk factors. This study estimated the magnitude of the association of different anthropometric indicators of obesity with hypertension, dyslipidemia, and prediabetes (altered fasting plasma glucose and/or glycosylated hemoglobin). Methods: Cross-sectional analysis of information collected from 2022 participants in the PREDAPS study (baseline phase). General obesity was defined as body mass index ≥ 30 kg/m2 and abdominal obesity was defined with 2 criteria: a) waist circumference (WC) ≥ 102 cm in men/WC ≥ 88 cm in women, and b) waist-height ratio (WHtR) ≥ 0.55. The magnitude of the association was estimated by logistic regression. Results: Hypertension showed the strongest association with general obesity in women (OR, 3.01; 95%CI, 2.24-4.04) and with abdominal obesity based on the WHtR criterion in men (OR, 3.65; 95%CI, 2.66-5.01). Hypertriglyceridemia and low levels of high-density lipoprotein cholesterol showed the strongest association with abdominal obesity based on the WHtR criterion in women (OR, 2.49; 95%CI, 1.68-3.67 and OR, 2.70; 95%CI, 1.89-3.86) and with general obesity in men (OR, 2.06; 95%CI, 1.56-2.73 and OR, 1.68; 95%CI, 1.21-2.33). Prediabetes showed the strongest association with abdominal obesity based on the WHtR criterion in women (OR, 2.48; 95%CI, 1.85-3.33) and with abdominal obesity based on the WC criterion in men (OR, 2.33; 95%CI, 1.75-3.08). Conclusions: Abdominal obesity indicators showed the strongest association with the presence of prediabetes. The association of anthropometric indicators with hypertension and dyslipidemia showed heterogeneous results (AU)

Metabolic control and chronic complications during a 3-year follow-up period in a cohort of type 2 diabetic patients attended in primary care in the Community of Madrid (Spain) / Control metabólico y complicaciones crónicas durante un período de 3 años en una cohorte de pacientes diabéticos tipo 2 atendidos en asistencia primaria en la Comunidad de Madrid (España)

BACKGROUND: Our aim was to analyze both metabolic control and chronic complications of type 2 diabetes mellitus (T2D) patients regularly attended in primary care during a 3 years of follow-up in the Community of Madrid (Spain). METHODS: From 2007 to 2010 we prospectively included 3268 patients with T2D attended by 153 primary care physicians from 51 family health centers. An prospective cohort study with annual evaluation over 3 years to the same population was performed. We measured the goals of control in diabetic patients and the incidence of chronic complications of diabetes during the study period. RESULTS: A significant decrease in serum glucose levels (143 ± 42 mg/dl vs 137 ± 43 mg/dl, p < 0.00), HbA1c (7.09 ± 1.2% vs 7.02 ± 1.2%, p < 0.00), total cholesterol (191.4 ± 38 mg/dl vs 181.5 ± 36 mg/dl, p < 0.00), LDL cholesterol (114.7 ± 31 mg/dl vs 105.5 ±30 mg/dl, p < 0.00) and triglyceride levels (144.5 ± 93 mg/dl vs 138 ± 84 mg/dl, p < 0.00) during study period was documented. On the contrary, a significant elevation in HDL cholesterol levels was observed (49.2 ± 14 mg/dl vs 49.9 ± 16 mg/dl, p < 0.00). The incidence of diabetic complications throughout the study period was low, with a incidence of coronary heart disease of 6.2%, peripheral arterial disease 3%, ischemic stroke 2.8%, diabetic foot 11.2%, nephropathy 5.9%, retinopathy 4.5%, and neuropathy 3%. CONCLUSION: Metabolic control in T2D patients attended in primary care in the Community of Madrid throughout 3 years is adequate and is accompanied by low percent of chronic diabetic complications during this period of follow-up

ANTECEDENTES: Nuestro objetivo ha sido analizar el control metabólico y las complicaciones crónicas de pacientes con diabetes mellitus tipo 2 (DM2) que acudían regularmente a consultas de asistencia primaria durante 3 años de seguimiento en la Comunidad de Madrid (España). MÉTODOS: Desde 2007 a 2010, 153 médicos de asistencia primaria de 51 centros de salud familiares incluyeron prospectivamente 3268 pacientes con DM2. Se realizó un estudio de cohorte prospectivo con evaluación anual de la misma población durante 3 años. Se determinaron los objetivos de control y la incidencia de complicaciones crónicas de la diabetes. RESULTADOS: Se comprobaron descensos significativos de los niveles séricos de glucosa (143 ± 42 mg/dl frente a 137 ± 43 mg/dl, p < 0,00), HbA1c (7,09 ± 1,2% frente a 7,02 ± 1,2%, p < 0,00), colesterol total (191,4 ± 38 mg/dl frente a 181,5 ± 36 mg/dl, p < 0,00), colesterol LDL (114,7 ±31 mg/dl frente a 105,5 ± 30 mg/dl, p < 0,00) y triglicéridos (144,5 ± 93 mg/dl frente a 138 ± 84 mg/dl, p < 0,00) durante el período del estudio. Por el contrario, se observó una elevación significativa de los niveles de colesterol HDL (49,2 ± 14 mg/dl frente a 49,9 ± 16 mg/dl, p < 0,00). La incidencia de complicaciones diabéticas durante el período del estudio fue baja: enfermedad coronaria 6,2%, enfermedad arterial periférica 3%, ictus isquémico 2,8%, pie diabético 11,2%, nefropatía 5,9%, retinopatía 4,5% y neuropatía 3%. CONCLUSIÓN: El control metabólico de los pacientes con DM2 atendidos en asistencia primaria en la Comunidad de Madrid durante 3 años era adecuado e iba acompañado de un porcentaje bajo de complicaciones crónicas durante este período de seguimiento

Estimación del impacto económico y sanitario de las complicaciones de la diabetes mellitus tipo 2 en la Comunidad de Madrid / Estimation of the economic and health impact of complications of type 2 diabetes mellitus in the autonomous community of Madrid (Spain)

OBJETIVO: Estimar el impacto económico y sanitario de las complicaciones crónicas macro y microvasculares de la diabetes mellitus tipo 2 (DM2) en la Comunidad de Madrid (CM). MÉTODOS: El número de complicaciones esperadas se obtuvo de un estudio descriptivo transversal que incluyó una cohorte de 3.268 pacientes con DM2 de la CM. El coste de las complicaciones (Euros de 2012) se valoró tanto a nivel hospitalario como en la atención primaria. El número de consultas médicas en atención primaria y el tratamiento farmacológico de las complicaciones se obtuvo mediante un panel de 21 médicos con experiencia en el tratamiento de la DM2. Los datos poblacionales, epidemiológicos y los costes sanitarios se consiguieron de fuentes españolas. Se hicieron análisis de sensibilidad univariantes. RESULTADOS: Se estima que la población con DM2 en la CM asciende a 390.944 pacientes y que estos sufren a lo largo de su vida 172.406 y 212.283 complicaciones macro y microvasculares, respectivamente. El coste promedio de las complicaciones de la DM2 por paciente se calcula en 4.121,54 € (el 66% debido a las complicaciones macrovasculares). El impacto económico de las complicaciones de la DM2 en la CM sería de 1.611 millones de euros (1.065 en las complicaciones crónicas de tipo macrovascular y 545 en las complicaciones de tipo microvascular). El impacto económico oscilaría entre los 1.249 y los 2.509 millones de euros, según la prevalencia de DM2. CONCLUSIONES: Las complicaciones de la DM2 tienen un gran impacto, tanto sanitario como económico en la CM

OBJECTIVE: To estimate the economic and health impact of chronic complications (macrovascular and microvascular) of type 2 diabetes mellitus (T2DM) in the autonomous community of Madrid (Spain) (ACM). METHODS: The number of expected complications was obtained from a descriptive, cross-sectional study on a cohort of 3,268 patients with T2DM from the ACM. Cost of complications (Euros, 2012) was assessed both at hospitals and in primary care. The number of medical visits in primary care and drug treatment for complications were collected by a panel of 21 physicians experienced in treatment of T2DM. Population and epidemiological data and healthcare costs were obtained from Spanish sources. Univariate sensitivity analyses were performed. RESULTS: It is estimated that there are 390,944 patients with T2DM in the ACM, and that they experience 172,406 and 212,283 macrovascular and microvascular complications respectively during their lifetimes. Mean cost of T2DM complications per patient is estimated at Euros 4,121.54 (66% due to macrovascular complications). The economic impact of T2DM complications in the ACM would be € 1,611 million (1,065 and 545 millions from macrovascular and microvascular complications respectively). The economic impact would range from Euros 1,249 and 2.509 million euro depending on T2DM prevalence. CONCLUSIONS: Complications of T2DM have a great health and economic impact in ACM

Fe de errores de «Estudio descriptivo de la evolución clínico-asistencial de la población con diabetes tipo 2 en la Comunidad de Madrid. Estudio de seguimiento diabético tipo 2» / Erratum to “Descriptive study on the outcome of clinical care of the type 2 diabetes population in the Community of Madrid. Type 2 diabetes follow-up (ESD-2)”

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Estudio descriptivo de la evolución clínico-asistencial de la población con diabetes tipo 2 en la Comunidad de Madrid. Estudio de seguimiento diabético tipo 2 (ESD-2) / Descriptive study on the outcome of clinical care of the type 2 diabetes population in the Community of Madrid. Type 2 diabetes follow-up (ESD-2)

Objetivos. El objetivo del estudio es conocer el grado de control de los factores de riesgo cardiovascular y la prevalencia de complicaciones crónicas de la población con diabetes mellitus tipo 2 (DM2) en la Comunidad de Madrid, en condiciones habituales de práctica asistencial diaria durante 3 años de seguimiento. Materiales y métodos. Para ello, hemos realizado un estudio epidemiológico, transversal y descriptivo, de los pacientes con DM2 seguidos en 51 centros de salud, con la participación de 134 profesionales sanitarios de todas las áreas sanitarias de la Comunidad de Madrid. La muestra se obtuvo mediante muestreo sistemático. Analizamos variables sociodemográficas, biológicas/ bioquímicas, de resultado y de procesos asistenciales. El tratamiento estadístico de los datos se realizó mediante el programa de análisis estadístico SPSS 15.0. Resultados. La muestra de pacientes estudiados estuvo constituida por 3.268 pacientes. El 50,3% eran varones y el 49,7%, mujeres, con una edad media de 68,8 ± 10,9 años, y un tiempo medio de evolución de diabetes mellitus de 7,9 ± 7,4 años y mediana de 6 años. Los resultados de comorbilidad mostraron principalmente que el 70,4% tenía la presión arterial elevada, y el 48,4%, obesidad. La presión arterial sistólica media fue de 131,7 ± 14,5 mmHg, y en el 35,3% de los diabéticos fue menor de 130 mmHg. La presión arterial diastólica media fue de 76,1± 9 mmHg, y en el 51,4% de los pacientes estaba por debajo de los 80 mmHg. El 25,3% tenía una presión arterial sistólica/diastólica por debajo de 130/80 mmHg. Es de destacar la elevada prevalencia de complicaciones macrovasculares con un 18,3%, sin diferencias en la prevalencia de complicaciones crónicas de la diabetes mellitus señaladas por la bibliografía, salvo en la retinopatía con una prevalencia del 8%, probablemente por ser el proceso asistencial de registro más bajo(AU)

Conclusiones. El grado de control integral (hemoglobina glucosilada < 7%, lipoproteínas de baja densidad < 100 y presión arterial < 130/80 mmHg) sólo lo alcanza el 4,5% de la población. En nuestro estudio son evidentes las dificultades de alcanzar un control integral del paciente con DM2(AU)

Aims. To study the level of control of cardiovascular risk factors, and prevalence of chronic complications in type 2 diabetic (T2D) patients in daily practice in the Community of Madrid. Design. An epidemiological cross-sectional study in T2D patients attending 51 general practitioner clinics, with the participation of 134 health professionals from all the health areas in the Madrid Community. The sample was obtained by systematic sampling. Measurements. Sociodemographic, biological/biochemical processes and outcomes of the clinical care were recorded. For the statistical analysis the software SPSS 15.0 was used. Results. A total of 3268 T2D patients were studied, 50.3% men and 49.7% women, mean age 68.8±10.9 years, and with a mean duration of diabetes of 7.9±7.4 years and a median of 6 years. High blood pressure was observed in 70.4% of T2D patients, and 48.4% were obese. Mean systolic blood pressure was 131.7±14.5 mmHg, and 35.3% of patients had a systolic pressure less than 130 mmHg. Mean diastolic pressure was 76.1±9 mmHg, and in 51.4% of the patients it was below 80 mmHg. A systolic/diastolic blood pressure below 130/80 mmHg was found in 25.3% of T2D patients. A high prevalence of macrovascular complications (18.3%) was found in our study. No differences in the prevalence was found for chronic complications of diabetes compared with that previously published, except for retinopathy, with a prevalence of 8% in our study, probably reflecting a low case register. Conclusions. The level of integrated control in T2D (HbA1C < 7%, LDL < 100 and BP < 130/80 mmHg), was only observed in 4.5% of the patients. The study shows the difficulty of achieving integral control of T2D patients(AU)