Incidence of T2DM and the role of baseline glycaemic status as a determinant in a metropolitan population in northern Madrid (Spain).

AIM: To estimate the incidence of T2DM and assess the effect of pre-T2DM (isolated impaired fasting glucose [iIFG], isolated impaired glucose tolerance [iIGT] or both) on progress to T2DM in the adult population of Madrid. METHODS: Population-based cohort comprising 1,219 participants (560 normoglycaemic and 659 preT2DM [418 iIFG, 70 iIGT or 171 IFG-IGT]). T2DM was defined based on fasting plasma glucose or HbA1c or use of glucose-lowering medication. We used a Cox model with normoglycaemia as reference category. RESULTS: During 7.26 years of follow-up, the unadjusted incidence of T2DM was 11.21 per 1000 person-years (95 %CI, 9.09-13.68) for the whole population, 5.60 (3.55-8.41) for normoglycaemic participants and 16.28 (12.78-20.43) for pre-T2DM participants. After controlling for potential confounding factors, the baseline glycaemic status was associated with higher primary effect on developing T2DM was iIGT (HR = 3.96 [95 %CI, 1.93-8.10]) and IFG-IGT (3.42 [1.92-6.08]). The HR for iIFG was 1.67 (0.96-2.90). Obesity, as secondary effect, was strongly significantly associated (HR = 2.50 [1.30-4.86]). CONCLUSIONS: Our incidence of T2DM is consistent with that reported elsewhere in Spain. While baseline iIGT and IFG-IGT behaved a primary effect for progression to T2DM, iIFG showed a trend in this direction.

Real-world data in primary care: validation of diagnosis of atrial fibrillation in primary care electronic medical records and estimated prevalence among consulting patients'.

BACKGROUND: Primary care electronic medical records contain clinical-administrative information on a high percentage of the population. Before this information can be used for epidemiological purposes, its quality must be verified. This study aims to validate diagnoses of atrial fibrillation (AF) recorded in primary care electronic medical records and to estimate the prevalence of AF in the population attending primary care consultations. METHODS: We performed a cross-sectional validation study of all diagnoses of AF recorded in primary care electronic medical records in Madrid (Spain). We also performed simple random sampling of diagnoses of AF (ICPC-2 code K78) registered by 55 physicians and random age- and sex-matched sampling of the records that included a diagnosis of AF. Electrocardiograms, echocardiograms, and hospital discharge or cardiology clinic reports were matched. Sensitivity, specificity, positive and negative predictive values (PPV and NPV), and overall agreement were calculated using the kappa statistic (κ). The prevalence of AF in the community of Madrid was estimated considering the sensitivity and specificity obtained in the validation. All calculations were performed overall and by sex and age groups. RESULTS: The degree of agreement was very high (κ = 0.952), with a sensitivity of 97.84%, specificity of 97.39%, PPV of 97.37%, and NPV of 97.85%. The prevalence of AF in the population aged over 18 years was 2.41% (95%CI 2.39-2.42% [2.25% in women and 2.58% in men]). This increased progressively with age, reaching 16.95% in those over 80 years of age (15.5% in women and 19.44% in men). CONCLUSIONS: The validation results obtained enable diagnosis of AF recorded in primary care to be used as a tool for epidemiological studies. A high prevalence of AF was found, especially in older patients.

Factores asociados con la mortalidad por SARS-CoV-2 en la población mayor de 75 años de la Comunidad de Madrid / Factors associated with mortality due to SARS-CoV-2 in the population over 75 years of age in the Community of Madrid

Objetivo Diversos estudios han identificado factores asociados con el riesgo de muerte en pacientes infectados por SARS-CoV-2. Sin embargo, su tamaño muestral ha sido muchas veces limitado, y sus resultados parcialmente contradictorios. Este estudio ha evaluado los factores asociados con la mortalidad por COVID-19 en la población madrileña mayor de 75 años, en los pacientes infectados y en los hospitalizados hasta enero de 2021. Pacientes y métodos Estudio de cohortes de base poblacional con todos los residentes de la Comunidad de Madrid nacidos antes del 1 de enero de 1945 y vivos a 31 de diciembre de 2019. Se obtuvieron variables demográficas y clínicas de la historia clínica electrónica de atención primaria (AP-Madrid), de los ingresos hospitalarios a través del Conjunto Mínimo Básico de Datos (CMBD) y de la mortalidad a través del Índice Nacional de Defunciones (INDEF). Se recogieron los datos de infección, hospitalización y muerte por SARS-CoV-2 entre el 1 de marzo e 2020 y el 31 de enero de 2021. Resultados De los 587.603 sujetos incluidos en la cohorte, 41.603 (7,1%) desarrollaron una infección confirmada por SARS-CoV-2. De ellos, 22.362 (53,7% de los infectados) se hospitalizaron y 11.251 (27%) murieron. El sexo masculino y la edad fueron los factores más asociados con la mortalidad, si bien también contribuyeron numerosas comorbilidades. La asociación fue de mayor magnitud en los análisis poblacionales que en los análisis con pacientes infectados u hospitalizados. La mortalidad en los hospitalizados fue menor en la segunda ola (33,4%) que en la primera ola (41,2%) de la pandemia Conclusión La edad, el sexo y las numerosas comorbilidades se asocian con el riesgo de muerte por COVID-19. La mortalidad en los pacientes hospitalizados se redujo apreciablemente después de la primera ola de la pandemia (AU)

Objective Various studies have identified factors associated with risk of mortality in patients with SARS-CoV-2 infection. However, their sample size has often been limited and their results partially contradictory. This study evaluated factors associated with COVID-19 mortality in the population of Madrid over 75 years of age, in infected patients, and in hospitalized patients up to January 2021. Patients and Methods This population-based cohort study analyzed all residents of the Community of Madrid born before January 1, 1945 who were alive as of December 31, 2019. Demographic and clinical data were obtained from primary care electronic medical records (PC-Madrid), data on hospital admissions from the Conjunto Mínimo Básico de Datos (CMBD, Minimum Data Set), and data on mortality from the Índice Nacional de Defunciones (INDEF, National Death Index). Data on SARS-CoV-2 infection, hospitalization, and death were collected from March 1, 2020 to January 31, 2021. Results A total of 587,603 subjects were included in the cohort. Of them, 41,603 (7.1%) had confirmed SARS-CoV-2 infection, of which 22,362 (53.7% of the infected individuals) were hospitalized and 11,251 (27%) died. Male sex and age were the factors most closely associated with mortality, though many comorbidities also had an influence. The associations were stronger in the analysis of the total population than in the analysis of infected or hospitalized patients. Mortality among hospitalized patients was lower during the second wave (33.4%) than during the first wave (41.2%) of the pandemic. Conclusion Age, sex, and numerous comorbidities are associated with risk of death due to COVID-19. Mortality in hospitalized patients declined notably after the first wave of the pandemic (AU)

Factors associated with mortality due to SARS-CoV-2 in the population over 75 years of age in the Community of Madrid.

OBJECTIVE: Various studies have identified factors associated with risk of mortality in patients with SARS-CoV-2 infection. However, their sample size has often been limited and their results partially contradictory. This study evaluated factors associated with COVID-19 mortality in the population of Madrid over 75 years of age, in infected patients, and in hospitalized patients up to January 2021. PATIENTS AND METHODS: This population-based cohort study analyzed all residents of the Community of Madrid born before January 1, 1945 who were alive as of December 31, 2019. Demographic and clinical data were obtained from primary care electronic medical records (PC-Madrid), data on hospital admissions from the Conjunto Mínimo Básico de Datos (CMBD, Minimum Data Set), and data on mortality from the Índice Nacional de Defunciones (INDEF, National Death Index). Data on SARS-CoV-2 infection, hospitalization, and death were collected from March 1, 2020 to January 31, 2021. RESULTS: A total of 587,603 subjects were included in the cohort. Of them, 41,603 (7.1%) had confirmed SARS-CoV-2 infection, of which 22,362 (53.7% of the infected individuals) were hospitalized and 11,251 (27%) died. Male sex and age were the factors most closely associated with mortality, though many comorbidities also had an influence. The associations were stronger in the analysis of the total population than in the analysis of infected or hospitalized patients. Mortality among hospitalized patients was lower during the second wave (33.4%) than during the first wave (41.2%) of the pandemic. CONCLUSION: Age, sex, and numerous comorbidities are associated with risk of death due to COVID-19. Mortality in hospitalized patients declined notably after the first wave of the pandemic.

[Factors associated with mortality due to SARS-CoV-2 in the population over 75 years of age in the Community of Madrid]. / Factores asociados con la mortalidad por SARS-CoV-2 en la población mayor de 75 años de la Comunidad de Madrid.

Objective: Various studies have identified factors associated with risk of mortality in patients with SARS-CoV-2 infection. However, their sample size has often been limited and their results partially contradictory. This study evaluated factors associated with COVID-19 mortality in the population of Madrid over 75 years of age, in infected patients, and in hospitalized patients up to January 2021. Patients and methods: This population-based cohort study analyzed all residents of the Community of Madrid born before January 1, 1945 who were alive as of December 31, 2019. Demographic and clinical data were obtained from primary care electronic medical records (PC-Madrid), data on hospital admissions from the Conjunto Mínimo Básico de Datos (CMBD, Minimum Data Set), and data on mortality from the Índice Nacional de Defunciones (INDEF, National Death Index). Data on SARS-CoV-2 infection, hospitalization, and death were collected from March 1, 2020 to January 31, 2021. Results: A total of 587,603 subjects were included in the cohort. Of them, 41,603 (7.1%) had confirmed SARS-CoV-2 infection, of which 22,362 (53.7% of the infected individuals) were hospitalized and 11,251 (27%) died. Male sex and age were the factors most closely associated with mortality, though many comorbidities also had an influence. The associations were stronger in the analysis of the total population than in the analysis of infected or hospitalized patients. Mortality among hospitalized patients was lower during the second wave (33.4%) than during the first wave (41.2%) of the pandemic. Conclusion: Age, sex, and numerous comorbidities are associated with risk of death due to COVID-19. Mortality in hospitalized patients declined notably after the first wave of the pandemic.

All-cause mortality and cardiovascular events in a Spanish nonagenarian cohort according to type 2 diabetes mellitus status and established cardiovascular disease.

BACKGROUND: Despite the progressive aging of the population in industrialized countries, few studies have focused on the natural history of cardiovascular disease in the very old, and recommendations on prevention of cardiovascular disease in this population are lacking. We aimed to analyze all-cause mortality and cardiovascular events according to prevalent type 2 diabetes mellitus and established cardiovascular disease in nonagenarians from a Mediterranean population. METHODS: We analyzed the primary health records of all nonagenarians living in the Community of Madrid (N = 59,423) and collected data for 4 groups: Group 1, individuals without T2DM or established CVD (T2DM-, CVD-); Group 2, individuals without T2DM but with established CVD (T2DM-, CVD +); Group 3, individuals with T2DM but without established CVD (T2DM + , CVD-); and Group 4, individuals with both T2DM and established CVD (T2DM + , CVD +), taking into account the influence of sex on the outcomes. Follow-up was 2.5 years. The primary outcomes were cumulative incidence and incidence density rates for all-cause mortality, non-fatal myocardial infarction, non-fatal stroke (the first composite primary outcome [CPO1]), combined with heart failure (CPO2). We evaluated the adjusted effect of each group on all-cause mortality (Cox regression). RESULTS: Mean age was 93.3 ± 2.8 years (74.2% women). Hypertension, dyslipidemia, heart failure, albuminuria, and estimated glomerular filtration rate < 60 mL/min/1.73 m2 were significantly more prevalent in G4 than in the other groups (all p values < 0.001). We observed significantly higher cumulative incidence rates for all-cause mortality, CPO1, and CPO2 in participants belonging to G4 (all p values ≤ 0.001). People in G2 presented higher rates of all-cause mortality, heart failure, CPO1, and CPO2 than people in G3 (all p values ≤ 0.001). In the fully adjusted model, G4 independently predicted all-cause mortality (HR = 1.48 [95% CI, 1.40 to 1.57] vs reference G1 [p < 0.01]). In addition, significant HRs were recorded for cardiovascular disease alone (G2) and type 2 diabetes mellitus alone (G3) (1.13 and 1.14, respectively; both p values < 0.01). CONCLUSIONS: In Spanish nonagenarians, established cardiovascular disease and type 2 diabetes mellitus conferred a modest risk of all-cause mortality. However, the simultaneous presence of both conditions conferred the highest risk of all-cause mortality.

Cardiovascular risk factors associated with acute myocardial infarction and stroke in the MADIABETES cohort.

We aimed to develop two models to estimate first AMI and stroke/TIA, respectively, in type 2 diabetes mellitus patients, by applying backward elimination to the following variables: age, sex, duration of diabetes, smoking, BMI, and use of antihyperglycemic drugs, statins, and aspirin. As time-varying covariates, we analyzed blood pressure, albuminuria, lipid profile, HbA1c, retinopathy, neuropathy, and atrial fibrillation (only in stroke/TIA model). Both models were stratified by antihypertensive drugs. We evaluated 2980 patients (52.8% women; 67.3 ± 11.2 years) with 24,159 person-years of follow-up. We recorded 114 cases of AMI and 185 cases of stroke/TIA. The factors that were independently associated with first AMI were age (≥ 75 years vs. < 75 years) (p = 0.019), higher HbA1c (> 64 mmol/mol vs. < 53 mmol/mol) (p = 0.003), HDL-cholesterol (0.90-1.81 mmol/L vs. < 0.90 mmol/L) (p = 0.002), and diastolic blood pressure (65-85 mmHg vs. < 65 mmHg) (p < 0.001). The factors that were independently associated with first stroke/TIA were age (≥ 75 years vs. < 60 years) (p < 0.001), atrial fibrillation (first year after the diagnosis vs. more than one year) (p = 0.001), glomerular filtration rate (per each 15 mL/min/1.73 m2 decrease) (p < 0.001), total cholesterol (3.88-6.46 mmol/L vs. < 3.88 mmol/L) (p < 0.001), triglycerides (per each increment of 1.13 mmol/L) (p = 0.031), albuminuria (p < 0.001), neuropathy (p = 0.01), and retinopathy (p = 0.023).

Effect of depression on mortality in type 2 diabetes mellitus after 8 years of follow-up. The DIADEMA study.

AIM: To assess the effect of depression on all-cause mortality in patients with type 2 diabetes mellitus (T2DM) followed up during 8 years in primary care in Spain. METHODS: Depression was diagnosed according to MINI 5.0.0 questionnaire, physician-diagnosis or following antidepressant therapy for at least two months in 3923 people with T2DM. We analyzed mortality-rates/10,000 person-years. We compared survival according to baseline depression with Kaplan-Meier estimates and the log-rank test. We performed Cox proportional hazard model analyses. RESULTS: Baseline depression was diagnosed in 22.1% of participants. Mortality was higher in patients with depression (31.9% vs. 26.9%; p = 0.003), who had a significantly poorer survival (median survival = 7.4 vs. 7.8 years, respectively; Log Rank = 15.83; p < 0.001). Depression showed an adjusted mortality hazard ratio (HR) = 1.40 (95%CI:1.20-1.65; p < 0.001). The strongest predictive factors were: age >75 years (HR = 6.04; 95%CI:4.62-7.91; p < 0.001), insulin use (HR = 2.37; 95%CI:1.86-3.00; p < 0.001), lower limb amputation (HR = 1.99; 95%CI:1.28-3.11; p = 0.002), heart failure (HR = 1.94; 95%CI:1.63-2.30; p < 0.001), and male gender (HR = 1.90; 95%CI:1.59-2.27). CONCLUSION: In a Spanish cohort of older T2DM patients, depression was associated with a higher mortality risk. More efforts are needed to minimize the influence of depression on mortality in people with T2DM and to implement measures that allow its early diagnosis and effective treatment.

Effectiveness of standardized nursing care plans to achieve A1C, blood pressure, and LDL-C goals among people with poorly controlled type 2 diabetes mellitus at baseline: four-year follow-up study.

BACKGROUND: No studies that have measured the role of nursing care plans in patients with poorly controlled type 2 diabetes mellitus. Our objectives were firstly, to evaluate the effectiveness of implementing Standardized languages in Nursing Care Plans (SNCP) for improving A1C, blood pressure and low density lipoprotein cholesterol (ABC goals) in patients with poorly controlled type 2 diabetes mellitus at baseline (A1C ≥7%, blood pressure ≥ 130/80 mmHg, and low-density lipoprotein cholesterol≥100 mg/dl) compared with Usual Nursing Care (UNC). Secondly, to evaluate the factors associated with these goals. METHODS: A four-year prospective follow-up study among outpatients with type 2 diabetes mellitus: We analyzed outpatients of 31 primary health centers (Madrid, Spain), with at least two A1C values (at baseline and at the end of the study) who did not meet their ABC goals at baseline. A total of 1916 had A1C ≥7% (881 UNC versus 1035 SNCP). Two thousand four hundred seventy-one had systolic blood pressure ≥ 130 mmHg (1204 UNC versus 1267 SNCP). One thousand one hundred seventy had diastolic blood pressure ≥ 80 mmHg (618 UNC versus 552 SNCP); and 2473 had low-density lipoprotein cholesterol ≥100 mg/dl (1257 UNC versus 1216 SNCP). Data were collected from computerized clinical records; SNCP were identified using NANDA and NIC taxonomies. RESULTS: More patients cared for using SNCP achieved in blood pressure goals compared with patients who received UNC (systolic blood pressure: 29.4% versus 28.7%, p = 0.699; diastolic blood pressure: 58.3% versus 53.2%, p = 0.08), but the differences did not reach statistical significance. For A1C and low-density lipoprotein cholesterol goals, there were no significant differences between the groups. Coronary artery disease was a significant predictor of blood pressure and low-density lipoprotein cholesterol goals. CONCLUSIONS: In patients with poorly controlled type 2 diabetes mellitus, there is not enough evidence to support the use of SNCP instead of with UNC with the aim of helping patients to achieve their ABC goals. However, the use of SNCP is associated with a clear trend of a achievement of diastolic blood pressure goals.

Body mass index and all-cause mortality among type 2 diabetes mellitus patients: Findings from the 5-year follow-up of the MADIABETES cohort.

PURPOSE: To analyse the association between body mass index (BMI) and all-cause mortality in a 5-year follow-up study with Spanish type 2 diabetes mellitus (T2DM) patients, seeking gender differences. METHODS: 3443 T2DM outpatients were studied. At baseline and annually, patients were subjected to anamnesis, a physical examination, and biochemical tests. Data about demographic and clinical characteristics was also recorded, as was the treatment each patient had been prescribed. Mortality records were obtained from the Spanish National Institute of Statistics. Survival curves for BMI categories (Gehan-Wilcoxon test) and a multivariate Cox proportional hazard analysis were performed to identify adjusted Hazard Ratios (HRs) of mortality. RESULTS: Mortality rate was 26.38 cases per 1000patient-years (95% CI, 23.92-29.01), with higher rates in men (28.43 per 1000patient-years; 95% CI, 24.87-32.36) than in women (24.31 per 1000patient-years; 95% CI, 21.02-27.98) (p=0.079). Mortality rates according to BMI categories were: 56.7 (95% CI, 40.8-76.6), 28.4 (95% CI, 22.9-34.9), 24.8 (95% CI, 21.5-28.5), 21 (95% CI, 16.3-26.6) and 23.7 (95% CI, 14.3-37) per 1000person-years for participants with a BMI of <23, 23-26.8, 26.9-33.1, 33.2-39.4, and >39.4kg/m2, respectively. The BMI values associated with the highest all-cause mortality were <23kg/m2, but only in males [HR: 2.78 (95% CI, 1.72-4.49; p<0.001)], since in females this association was not significant [HR: 1.14 (95% CI, 0.64-2.04; p=0.666)] (reference category for BMI: 23.0-26.8kg/m2). Higher BMIs were not associated with higher mortality rates. CONCLUSIONS: In an outpatient T2DM Mediterranean population sample, low BMI predicted all-cause mortality only in males.

Proyecto de mejora del Proceso de Atención Continuada domiciliaria en Atención Primaria: rediseño y AMFE / Improving the continuous care process in primary care during weekends and holidays. Redesigning and FMEA

Objetivo. Describir el proyecto de mejora aplicado al proceso de atención continuada (ATC) de sábados y festivos en el Área 4 de Atención Primaria (AP) de Madrid, para garantizar una atención segura y libre de fallos en los cuidados domiciliarios de los fines de semana. Material y método. El proceso de ATC se identificó como de riesgo por la Unidad Funcional de Gestión de Riesgos (UFGR) del Área, además presentaba quejas: de las enfermeras que realizan la atención y de pacientes. En 2009 se realiza un DAFO (debilidades, amenazas, fortalezas y oportunidades) que evidenció problemas. Posteriormente se diseña un proyecto de mejora que se desarrolla en las fases: 1. Rediseño y mejora del proceso. 2. Aplicación AMFE al nuevo proceso. 3. Pilotaje. 4. Formación a las enfermeras. 5. Implantación en todo el Área. 6. Encuesta de satisfacción a las enfermeras de ATC. Resultados. El rediseño del proceso, proporcionó mejoras como la automatización y aumento de la eficiencia. Posteriormente a la implantación de las medidas de mejora, no se han producido nuevas reclamaciones de pacientes y ha mejorado la satisfacción de las enfermeras de ATC medida a través de encuesta. Al aplicar el AMFE se priorizaron fallos y se pusieron en marcha acciones de mejora. Conclusiones. La mejora del proceso y sobre todo su automatización, ha sido un gran avance para mejorar la seguridad. El AMFE nos ha resultado una herramienta útil y práctica que ha permitido implantar importantes acciones, igualmente se ha conseguido mejorar la satisfacción de las enfermeras que realizan la ATC(AU)

Objective. To describe a project carried out in order to improve the process of Continuous Health Care (CHC) on Saturdays and bank holidays in Primary Care, area number 4, Madrid. The aim of this project was to guarantee a safe and error-free service to patients receiving home health care on weekends. Materials and method. The urgent need for improving CHC process was identified by the Risk Management Functional Unit (RMFU) of the area. In addition, some complaints had been received from the nurses involved in the process as well as from their patients. A SWOT (Strengths, Weaknesses, Opportunities and Threats) analysis performed in 2009 highlighted a number of problems with the process. As a result, a project for improvement was drawn up, to be implemented in the following stages: 1. Redesigning and improving the existing process. 2. Application of failure mode and effect analysis (FMEA) to the new process. 3. Follow up, managing and leading the project. 4. Nurse training. 5. Implementing the process in the whole area. 6. CHC nurse satisfaction surveys. Results. After carrying out this project, the efficiency and level of automation improved considerably. Since implementation of the process enhancement measures, no complaints have been received from patients and surveys show that CHC nurse satisfaction has improved. Results. By using FMEA, errors were given priority and enhancement steps were taken in order to: Inform professionals, back-up personnel and patients about the process. Improve the specialist follow-up report. Provide training in ulcer patient care. Conclusion. The process enhancement, and especially its automation, has resulted in a significant step forward toward achieving greater patient safety. FMEA was a useful tool, which helped in taking some important actions. Finally, CHC nurse satisfaction has clearly improved(AU)

[Improving the continuous care process in primary care during weekends and holidays: redesigning and FMEA]. / Proyecto de mejora del Proceso de Atención Continuada domiciliaria en Atención Primaria: rediseño y AMFE.

OBJECTIVE: To describe a project carried out in order to improve the process of Continuous Health Care (CHC) on Saturdays and bank holidays in Primary Care, area number 4, Madrid. The aim of this project was to guarantee a safe and error-free service to patients receiving home health care on weekends. MATERIALS AND METHOD: The urgent need for improving CHC process was identified by the Risk Management Functional Unit (RMFU) of the area. In addition, some complaints had been received from the nurses involved in the process as well as from their patients. A SWOT (Strengths, Weaknesses, Opportunities and Threats) analysis performed in 2009 highlighted a number of problems with the process. As a result, a project for improvement was drawn up, to be implemented in the following stages: 1. Redesigning and improving the existing process. 2. Application of failure mode and effect analysis (FMEA) to the new process. 3. Follow up, managing and leading the project. 4. Nurse training. 5. Implementing the process in the whole area. 6. CHC nurse satisfaction surveys. RESULTS: After carrying out this project, the efficiency and level of automation improved considerably. Since implementation of the process enhancement measures, no complaints have been received from patients and surveys show that CHC nurse satisfaction has improved. By using FMEA, errors were given priority and enhancement steps were taken in order to: Inform professionals, back-up personnel and patients about the process. Improve the specialist follow-up report. Provide training in ulcer patient care. CONCLUSION: The process enhancement, and especially its automation, has resulted in a significant step forward toward achieving greater patient safety. FMEA was a useful tool, which helped in taking some important actions. Finally, CHC nurse satisfaction has clearly improved.

[Baseline risk of Diabetes Mellitus in Primary Health Care Services by FINDRISC test, associated factors and clinical outcome after 18 months of follow-up]. / Riesgo basal de Diabetes Mellitus en Atención Primaria según cuestionario FINDRISC, factores asociados y evolución clínica tras 18 meses de seguimiento.

OBJECTIVE: To estimate the risk of Diabetes Mellitus in Primary Health Care Services and diabetes incidence after 18 months of follow-up. MATERIAL AND METHODS: A multicenter study, with a first cross-sectional phase, to estimate the risk of Diabetes using the FINRISC test in 261 patients without Diabetes Mellitus treated in Primary Health Care Services. A second phase was carried out to assess Diabetes incidence after 18 months of follow-up. RESULTS: 19.5% had an elevated risk of Diabetes Mellitus (FINDRISC score ≥15). The independent variables after adjusting for gender, which are not included in the FINDRISC test and were associated with increased risk of Diabetes, were low educational level and chronic ischemia of lower limbs. After 18 months of follow-up, 7.8% of patients with FINDRISC score ≥15 developed Diabetes versus 1.9% of patients with FINDRISC score <15. CONCLUSIONS: One out of five patients without Diabetes who are treated in Primary Care Health Services have a FINDRISC score ≥15, this being associated with low educational level and peripheral vascular disease, regardless of gender. The FINDRISC score ≥15 has a short-term association with a high risk of developing Diabetes Mellitus.