Effectiveness of a primary care nurse delivered educational intervention for patients with type 2 diabetes mellitus in promoting metabolic control and compliance with long-term therapeutic targets: Randomised controlled trial.

BACKGROUND: Systematic reviews and meta-analyses have shown very different values for the effectiveness of education in type 2 diabetes mellitus. However, the achievement of therapeutic targets after educational programs has been poorly evaluated. OBJECTIVE: Evaluate the effectiveness of a structured and individualised education program for type 2 diabetes, provided by a primary care nurse, which featured educational reinforcements and family support to achieve metabolic control, and long-term therapeutic targets. METHODS: Randomised controlled clinical trial with two arms: Intervention and control group. The intervention consisted of six face-to-face sessions of 30 min and follow-ups after 12 and 24 months for 236 participants with type 2 diabetes mellitus in a primary care setting in Andalusia (Spain). The primary outcome variables were the values and achievement of the type 2 diabetes mellitus control targets established by the American Diabetes Association: Glycated haemoglobin, fasting blood glucose, total cholesterol, low-density lipoprotein-cholesterol, high-density lipoprotein-cholesterol, triglycerides, systolic and diastolic blood pressure. The secondary outcome variable was body mass index. RESULTS: From an overall total of 236 participants, 54.2% were male and the average age was 65.1 ±â€¯9.5. After 12 months, the glycated haemoglobin level and systolic blood pressure decreased in the intervention group. After 24 months, the following variables significantly improved among the intervention group participants: basal glycemia, glycated haemoglobin, total cholesterol low-density lipoprotein cholesterol, and diastolic blood pressure. The glycated haemoglobin target (<7%) was better achieved in the intervention group than in the control group (35.2% vs 24.7%, p < 0.003). The rest of the targets were not met. CONCLUSION: Continual diabetes education with reinforcement sessions provided by a nurse achieved reductions in glycated haemoglobin, basal glycaemia, total cholesterol, low-density lipoprotein-cholesterol and systolic blood pressure in both the medium and long term. It also increased the proportion of participants who achieved the therapeutic target of glycated haemoglobin.

Sex disparity persists in the prevention of cardiovascular disease in women on statin therapy compared to that in men.

BACKGROUND AND AIMS: The aim of this study was to assess whether women differ from men with regard to lowering lipid levels, achieving target of optimal lipid levels, and analyzing evidence-based dose and intensity of statin prescription in primary care patients. METHODS AND RESULTS: A multicenter cross-sectional survey was conducted among 1046 patients with dyslipidemia (554 women) who were receiving statin therapy from the Primary Health Care of Andalucía (Spain). A random sample was obtained using data from the electronic health record system. The primary outcomes were the prescription of statin therapy (intensity and dose), lowering lipid levels, and achieving target of optimal lipid levels. Women were less likely to be treated with a more potent statin than men (9.2% vs. 14.4%, p = 0.009), and they received lower doses (45 ± 59 mg/day vs. 56 ± 71 mg/day, p = 0.004) than men. Total cholesterol and LDL-C levels were higher in women than in men (5.7 ± 1.3 mmol/l vs. 5.2 ± 1.2 mmol/l, p < 0.0001 and 3.5 ± 1.2 mmol/l vs. 3.1 ± 1.0 mmol/l, p < 0.0001, respectively). Compliance with established goals for total cholesterol (47.7% vs. 31.3%, p < 0.0001) and LDL-C (39.7% vs. 25.4%, p < 0.0001) was superior in men than in women. In multivariate analysis, adjusted for age, the variables male gender and CVD were associated with a higher compliance with total cholesterol and LDL-C target levels, and the variable diabetes mellitus 2 was associated with a lower compliance with HDL-C and triglycerides target levels. CONCLUSIONS: Women were less likely to be prescribed high-intensity statin to achieve total cholesterol and LDL-C target levels, and mean doses of statin were lower in women than in men. Dyslipidemia is less closely controlled in women than in men.

Development and Evaluation of an Automated, Home-Based, Electronic Questionnaire for Detecting COPD Exacerbations.

Collaboration between patients and their medical and technical experts enabled the development of an automated questionnaire for the early detection of COPD exacerbations (AQCE). The questionnaire consisted of fourteen questions and was implemented on a computer system for use by patients at home in an un-supervised environment. Psychometric evaluation was conducted after a 6-month field trial. Fifty-two patients were involved in the development of the questionnaire. Reproducibility was studied using 19 patients (ICC = 0.94). Sixteen out of the 19 subjects started the 6 month-field trial with the computer application. Cronbach's alpha of 0.81 was achieved. In the concurrent validity analysis, a correlation of 0.80 (p = 0.002) with the CCQ was reported. The results suggest that AQCE is a valid and reliable questionnaire, showing that an automated home-based electronic questionnaire may enable early detection of exacerbations of COPD.

[Significance of apolipoproteins A and B and the remaining lipid fractions as indicators of protein-calorie malnutrition in the elderly]. / Importancia de las apolipoproteínas A y B y las restantes fracciones lipídicas como indicadoras de desnutrición proteico-calórica en el anciano.

Effects of calorie/protein malnourishment have been studied on plasma concentrations of cholesterol, triglycerides, HDL-C, LDL-C and apolipoproteins A and B, in institutionalized elderly people, 53 males and 62 females, of whom 19 females and 12 males were malnourished. In malnourished patients, total cholesterol and LDL-C were significantly lower both in males and in females, but HDL-C was lower only in females. No significant differences in plasma triglycerides were found between the control and the malnourished groups. Apolipoprotein A showed no significant changes on malnourished males, but did show a significant lowering in malnourished females. On the opposite, apolipoprotein B was lower in males than in females. The lowering in cholesterol in malnourished patients leads us to think that this could be a early predictor of nutritional risk in the elderly.

[The importance of a diet survey in the early detection of malnutrition in the elderly]. / Importancia de la encuesta dietética en la detección temprana de desnutrición en el anciano.

BACKGROUND: The elevated incidence of malnutrition in the elderly and its close relation with the prevalence and evolution of determined diseases raises the need for early identification. Despite the existence of numerous indicators, specificity, sensitivity or occasionally both are lacking. METHODS: One hundred fifteen institutionalized elderly of which 19 females and 12 males had signs of malnutrition were studied. A dietetic survey was carried out on all of those studied by means of a 24 hour recollection-interview, during which triceps fold (TF) and muscular area of the arm (MAA) were measured and serum concentrations of prealbumin (PA) protein bound to retinol (PBR), albumin (ALB), trasferrin (TNF) and complement factor 3 (C3) were determined. RESULTS: Not only caloric but also proteic intake were significantly lower in the undernourished (p less than 0.001) as with ALB (p less than 0.001), TNF (p less than 0.001) and C3 (p less than 0.02 in males and p less than 0.05 in females). However, the sensitivity demonstrated by the dietetic survey (77% in males and 73% in females) was higher to that presented by ALB (44% in males and 53% in females), TNF (33% in males and 53% in females) and C3 (0 in both sexes). CONCLUSIONS: The results obtained demonstrate that the dietetic survey is a valid method for detecting not only the risk but also the subclinical presence of malnutrition, in contrast to ALB, TNF and C3 which, to that end, were of less use.

[Thrombogenic factors in the elderly. Evaluation of the plasma concentrations of thromboxane B2 and antithrombin III]. / Factores trombogénicos en el anciano. Valoración de las concentraciones plasmáticas de tromboxano B2 y antitrombina III.

The aim of this study is to prove the existence of a major tendency of platelet aggregation in elderly patients compared to medium-aged adults and, also, to detect whether it is affected by the presence of diabetes mellitus. Plasmatic concentrations of B2 thromboxane (TXB2) and antithrombin III (AT III) were determined in 73 elderly patients of both sexes; 56 without metabolic disease known (Group a) and 17 diabetic patients, 7 type I (Group bI) and 10 of type II (Group bII); and 12 healthy adults (control group). Medium plasmatic concentration of TXB2 was significantly higher (p less than 0.001) in Group a (55 +/- 14 ng/ml) compared to the control group (37 +/- 9 ng/ml) and there was no difference between Group bI (53 +/- 19 ng/ml) and bII (57 +/- 15 ng/ml). No variations were noted in ATIII concentration between the adults (27.4 +/- 2.3 mg/dl) and elderly patients (a = 29.6 +/- 4.4, bI = 29 +/- 2.6, bII = 31.2 +/- 5.9 mg/dl). In elderly patients, there appears to be a state of platelet pro-aggregation without influence of any risk factor, such as diabetes. This could explain the thrombogenic tendency of this age group.