Drug treatment of type 2 diabetes: Its cost is significantly associated with HbA1c levels.

AIMS: To examine the relationship between costs of hyperglycaemia drug treatment and glycemic control amongst people with type 2 diabetes (T2D). METHODS: This observational study utilised data from the QUALIDIAB database on 3,452 T2D patients seen in Diabetes Centers in Argentina. Patients were classified according to their HbA1c value into two groups: on target (OT; HbA1c ≤ 7%), and not on target (NOT; HbA1c > 7%); within each category we considered clinical and metabolic indicators, as well as type of hyperglycaemia treatment. Monthly expenditure on drugs was estimated by micro-costing. Multivariable regression analysis was used to evaluate the association between cost of hyperglycaemia treatment and HbA1c values. RESULTS: In total, 48.9% of the participants have HbA1c OT values. Overall monthly per capita costs of this treatment increased significantly (134%) in the NOT group. Multivariable regression analysis showed that expenditure for hyperglycaemia drugs treatment was significant associated with glycemic control (OR: 0.705), diabetes duration (OR: 1.017), systolic blood pressure (OR: 1.006) and treatment of T2D (OR: 2.622). CONCLUSIONS: HbA1c NOT significantly increases drugs monthly cost of hyperglycaemia treatment in people with T2D in a country with an emerging market economy.

Self-administered structured food record for measuring individual energy and nutrient intake in large cohorts: Design and validation / Registro alimentario estructurado y autoadministrado para estimar la ingesta individual de energía y nutrientes en grandes cohortes: diseño y validación

Introduction: Several instruments developed to assess dietary intake of groups or populations have strengths and weaknesses that affect their specific application. No self-administered, closed-ended dietary survey was previously used in Argentina to assess current food and nutrient intake on a daily basis. Objective: To design and validate a self-administered, structured food record (NutriQuid, NQ) representative of the adult Argentine population's food consumption pattern to measure individual energy and nutrient intake. Materials and methods: Records were loaded onto a database using software that checks a regional nutrition information system (SARA program), automatically quantifying energy and nutrient intake. NQ validation included two phases: (1) NQ construct validity comparing records kept simultaneously by healthy volunteers (45-75 years) and a nutritionist who provided meals (reference), and (2) verification of whether NQ reflected target population consumption (calories and nutrients), week consumption differences, respondent acceptability, and ease of data entry/analysis. Data analysis included descriptive statistics, repeated measures ANOVA, intraclass correlation coefficient, nonparametric regression, and cross-classification into quintiles. Results: The first validation (study group vs. reference) showed an underestimation (10%) of carbohydrate, fat, and energy intake. Second validation: 109 volunteers (91% response) completed the NQ for seven consecutive days. Record completion took about 9min/day, and data entry 3-6min. Mean calorie intake was 2240±119kcal/day (42% carbohydrates, 17% protein, and 41% fat). Intake significantly increased in the weekend. Conclusion: NQ is a simple and efficient tool to assess dietary intake in large samples

Introducción: Diferentes instrumentos para evaluar la ingesta alimentaria grupal o poblacional tienen fortalezas y debilidades que afectan a su aplicación. No existe experiencia nacional con un registro dietético auto-administrado cerrado para evaluar la ingesta actual de alimentos y nutrientes diaria de alimentos. Objetivo: Diseñar y validar un registro de alimentos estructurado, auto-administrado (NutriQuid [NQ]), representativo del patrón de consumo alimentario de la población argentina adulta para medir la ingesta individual de energía y nutrientes. Materiales y métodos: Desarrollamos un software para incorporar registros en una base de datos y verificar información nutricional (programa SARA), cuantificando automáticamente la ingesta de energía y nutrientes. La validación de NQ incluyó 2 fases: 1) comparación simultánea de registros del NQ completado por voluntarios sanos (45-75 años) y de una nutricionista que preparó las comidas ofrecidas (referencia), y 2) verificación si el NQ reflejó el consumo diferencial de población objetivo (calorías y nutrientes) durante la semana, aceptabilidad por los encuestados y facilidad de ingreso/análisis de datos. Análisis estadístico: incluyó estadística descriptiva, ANOVA de medidas repetidas, coeficiente de correlación intraclase, regresión no paramétrica y clasificación cruzada en quintilos. Resultados: La primera validación (voluntarios vs. referencia): mostró una subestimación del 10% de la ingesta de carbohidratos, grasas y energía. Segunda validación: 109 voluntarios (91% de respuesta) completaron el NQ durante 7 días consecutivos. Completar los registros requirió 9min/día y la carga de datos 3-6min. La ingesta calórica promedio fue de 2.240±119kcal/día (42% carbohidratos, 17% proteína y 41% grasa) y aumentó significativamente durante el fin de semana. Conclusión: El NQ es una herramienta simple y eficiente para evaluar la ingesta alimentaria en grandes grupos

Self-administered structured food record for measuring individual energy and nutrient intake in large cohorts: Design and validation.

INTRODUCTION: Several instruments developed to assess dietary intake of groups or populations have strengths and weaknesses that affect their specific application. No self-administered, closed-ended dietary survey was previously used in Argentina to assess current food and nutrient intake on a daily basis. OBJECTIVE: To design and validate a self-administered, structured food record (NutriQuid, NQ) representative of the adult Argentine population's food consumption pattern to measure individual energy and nutrient intake. MATERIALS AND METHODS: Records were loaded onto a database using software that checks a regional nutrition information system (SARA program), automatically quantifying energy and nutrient intake. NQ validation included two phases: (1) NQ construct validity comparing records kept simultaneously by healthy volunteers (45-75 years) and a nutritionist who provided meals (reference), and (2) verification of whether NQ reflected target population consumption (calories and nutrients), week consumption differences, respondent acceptability, and ease of data entry/analysis. Data analysis included descriptive statistics, repeated measures ANOVA, intraclass correlation coefficient, nonparametric regression, and cross-classification into quintiles. RESULTS: The first validation (study group vs. reference) showed an underestimation (10%) of carbohydrate, fat, and energy intake. Second validation: 109 volunteers (91% response) completed the NQ for seven consecutive days. Record completion took about 9min/day, and data entry 3-6min. Mean calorie intake was 2240±119kcal/day (42% carbohydrates, 17% protein, and 41% fat). Intake significantly increased in the weekend. CONCLUSION: NQ is a simple and efficient tool to assess dietary intake in large samples.

Ingesta alimentaria en la población adulta de dos ciudades de la Provincia de Buenos Aires: su adecuación a las necesidades nutricionales / FOOD INTAKE OF AN ADULT POPULATION IN TWO CITIES IN THE PROVINCE OF BUENOS AIRES: ITS ADEQUACY TO NUTRITIONAL RECOMMENDATIONS

Introducción: frecuentemente la ingesta alimentaria de las personas no coincide con las recomendaciones de salud. Objetivos: comparar la ingesta alimentaria de la población estudiada con las recomendaciones de las guías nacionales como base para definir los contenidos del plan de educación nutricional de un programa de prevención primaria de diabetes. Materiales y métodos: evaluamos la ingesta alimentaria de personas de 45 a 75 años, atendidas en el sector público de salud de La Plata y Berisso, entre marzo de 2015 y marzo de 2016. Utilizamos una encuesta de ingesta de alimentos estructurada y autoadministrada basada en un listado de alimentos de consumo habitual de nuestra población (NutriQuid). Los participantes completaron la encuesta durante dos días hábiles y un día de fin de semana. Verificamos el porcentaje de adecuación de la ingesta energética y nutrientes a las recomendaciones nutricionales del Ministerio de Salud de la Nación. En un subgrupo analizamos la relación entre el índice de masa corporal e ingesta energética y el consumo de sodio en hipertensos/normotensos. La evaluación estadística incluyó ANOVA y el test de t. Resultados: evaluamos las encuestas realizadas a 142 personas: 50% o más de la población encuestada siguió un plan de alimentación que no cumple con las recomendaciones del Ministerio de Salud de la Nación respecto de energía, proteínas, lípidos, sodio, ácidos grasos saturados, colesterol y azúcares refinados. Más del 80% de los participantes consumió cantidades insuficientes de fibra, potasio, frutas y verduras. Sólo un 27% de los hipertensos y un 14% de los normotensos consumieron las cantidades de sodio recomendadas. El 35% de los hipertensos y el 48% de los normotensos declararon consumir más del doble del valor recomendado. Conclusiones: consideramos que nuestros resultados apoyan la iniciativa de implementar un programa de educación alimentaria basado en las recomendaciones nutricionales.

Relation between cost of drug treatment and body mass index in people with type 2 diabetes in Latin America.

AIMS: Despite the frequent association of obesity with type 2 diabetes (T2D), the effect of the former on the cost of drug treatment of the latest has not been specifically addressed. We studied the association of overweight/obesity on the cost of drug treatment of hyperglycemia, hypertension and dyslipidemia in a population with T2D. METHODS: This observational study utilized data from the QUALIDIAB database on 3,099 T2D patients seen in Diabetes Centers in Argentina, Chile, Colombia, Peru, and Venezuela. Data were grouped according to body mass index (BMI) as Normal (18.5≤BMI<25), Overweight (25≤BMI<30), and Obese (BMI≥30). Thereafter, we assessed clinical and metabolic data and cost of drug treatment in each category. Statistical analyses included group comparisons for continuous variables (parametric or non-parametric tests), Chi-square tests for differences between proportions, and multivariable regression analysis to assess the association between BMI and monthly cost of drug treatment. RESULTS: Although all groups showed comparable degree of glycometabolic control (FBG, HbA1c), we found significant differences in other metabolic control indicators. Total cost of drug treatment of hyperglycemia and associated cardiovascular risk factors (CVRF) increased significantly (p<0.001) with increment of BMI. Hyperglycemia treatment cost showed a significant increase concordant with BMI whereas hypertension and dyslipidemia did not. Despite different values and percentages of increase, this growing cost profile was reproduced in every participating country. BMI significantly and independently affected hyperglycemia treatment cost. CONCLUSIONS: Our study shows for the first time that BMI significantly increases total expenditure on drugs for T2D and its associated CVRF treatment in Latin America.

Improving diabetes care at primary care level with a multistrategic approach: results of the DIAPREM programme.

AIM: To present results, 1 year postimplementation at primary care level, of an integrated diabetes care programme including systemic changes, education, registry (clinical, metabolic, and therapeutic indicators), and disease management (DIAPREM). METHODS: We randomly selected and trained 15 physicians and 15 nurses from primary care units of La Matanza County (intervention-IG) and another 15 physicians/nurses to participate as controls (control-CG). Each physician-nurse team controlled and followed up 10 patients with type 2 diabetes for 1 year; both groups used structured medical records. Patients in IG had quarterly clinical appointments, whereas those in CG received traditional care. Statistical data analysis included parametric/nonparametric tests according to data distribution profile and Chi-squared test for proportions. RESULTS: After 12 months, the dropout rate was significantly lower in IG than in CG. Whereas in IG HbA1c, blood pressure and lipid profile levels significantly decreased, no changes were recorded in CG. Drug prescriptions showed no significant changes in IG except a decrease in oral monotherapy. CONCLUSIONS: DIAPREM is an expedient and simple multistrategic model to implement at the primary care level in order to decrease patient dropout and improve control and treatment adherence, and quality of care of people with diabetes.

Multistrategic approach to improve quality of care of people with diabetes at the primary care level: Study design and baseline data.

AIM: To test the one year-post effect of an integrated diabetes care program that includes system changes, education, registry (clinical, metabolic and therapeutic indicators) and disease management (DIAPREM), implemented at primary care level, on care outcomes and costs. METHODS: We randomly selected 15 physicians and 15 nurses from primary care units of La Matanza County to be trained (Intervention-IG) and another 15 physicians/nurses to use as controls (Control-CG). Each physician-nurse team controlled and followed up 10 patients with type 2 diabetes for one year; both groups use structured medical data registry. Patients in IG had quarterly clinical appointments whereas those in CG received traditional care. DIAPREM includes system changes (use of guidelines, programmed quarterly controls and yearly visits to the specialist) and education (physicians' and nurses' training courses). Statistical data analysis included parametric/nonparametric tests according to data distribution profile and Chi-squared test for proportions. RESULTS: Baseline data from both groups showed comparable values and 20-30% of them did not perform HbA1c and lipid profile measurements. Majority were obese, 59% had HbA1C ≥7%, 86% fasting blood glucose ≥100mg/dL, 45%, total cholesterol ≥200mg/dL, and 92% abnormal HDL- and LDL-cholesterol values. Similarly, micro and macroangiopathic complications had not been detected in the previous year. Most patients received oral antidiabetic agents (monotherapy), and one third was on insulin (mostly a single dose of an intermediate/long-acting formulation). Most people with hypertension received specific drug treatment but only half of them reached target values; dyslipidemia treatment showed similar data. CONCLUSIONS: Baseline data demonstrated the need of implementing an intervention to improve diabetes care and treatment outcomes.

Frequency of self-monitoring blood glucose and attainment of HbA1c target values.

AIMS: Test strips for self-monitoring of blood glucose (SMBG) represent in Argentina, around 50 % of diabetes treatment cost; the frequency of their use is closely associated with hyperglycemia treatment. However, the favorable impact of SMBG on attainment of HbA1c goal in different treatment conditions remains controversial. We therefore attempted to estimate the relationship between use of SMBG test strips and degree of attainment of metabolic control in an institution of our social security subsector (SSS) in which provision is fully covered and submitted to a regular audit system. METHODS: Observational retrospective study using information of 657 patients with T2DM (period 2009-2010) from the database of the Diabetes and Other Cardiovascular Risk Factors Program (DICARO) of one institution of our SSS. DICARO provides-with an audit system-100 % coverage for all drugs and keeps records of clinical, metabolic and treatment data from every patient. RESULTS: The average monthly test strips/patient used for SMBG increased as a function of treatment intensification: Monotherapy with oral antidiabetic drugs (OAD) < combined OAD therapy < insulin treatment. In every condition, the number was larger in people with target HbA1c levels. Test strips represented the larger percentage of total prescription cost. CONCLUSIONS: In our population, the type of hyperglycemia treatment was the main driver of test strip use for SMBG; in every condition tested, targeted HbA1c values were associated with greater strip use. Patient education and prescription audit may optimize its use and treatment outcomes.