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)

Cardiometabolic Risk Profiles in Patients With Impaired Fasting Glucose and/or Hemoglobin A1c 5.7% to 6.4%: Evidence for a Gradient According to Diagnostic Criteria: The PREDAPS Study.

It has been suggested that the early detection of individuals with prediabetes can help prevent cardiovascular diseases. The purpose of the current study was to examine the cardiometabolic risk profile in patients with prediabetes according to fasting plasma glucose (FPG) and/or hemoglobin A1c (HbA1c) criteria.Cross-sectional analysis from the 2022 patients in the Cohort study in Primary Health Care on the Evolution of Patients with Prediabetes (PREDAPS Study) was developed. Four glycemic status groups were defined based on American Diabetes Association criteria. Information about cardiovascular risk factors-body mass index, waist circumference, blood pressure, cholesterol, triglycerides, uric acid, gamma-glutamyltransferase, glomerular filtration-and metabolic syndrome components were analyzed. Mean values of clinical and biochemical characteristics and frequencies of metabolic syndrome were estimated adjusting by age, sex, educational level, and family history of diabetes.A linear trend (P < 0.001) was observed in most of the cardiovascular risk factors and in all components of metabolic syndrome. Normoglycemic individuals had the best values, individuals with both criteria of prediabetes had the worst, and individuals with only one-HbA1c or FPG-criterion had an intermediate position. Metabolic syndrome was present in 15.0% (95% confidence interval: 12.6-17.4), 59.5% (54.0-64.9), 62.0% (56.0-68.0), and 76.2% (72.8-79.6) of individuals classified in normoglycemia, isolated HbA1c, isolated FPG, and both criteria groups, respectively.In conclusion, individuals with prediabetes, especially those with both criteria, have worse cardiometabolic risk profile than normoglycemic individuals. These results suggest the need to use both criteria in the clinical practice to identify those individuals with the highest cardiovascular risk, in order to offer them special attention with intensive lifestyle intervention programs.

Modifiable risk factors associated with prediabetes in men and women: a cross-sectional analysis of the cohort study in primary health care on the evolution of patients with prediabetes (PREDAPS-Study).

BACKGROUND: Prediabetes is a high-risk state for diabetes development, but little is known about the factors associated with this state. The aim of the study was to identify modifiable risk factors associated with the presence of prediabetes in men and women. METHODS: Cohort Study in Primary Health Care on the Evolution of Patients with Prediabetes (PREDAPS-Study) is a prospective study on a cohort of 1184 subjects with prediabetes and another cohort of 838 subjects without glucose metabolism disorders. It is being conducted by 125 general practitioners in Spain. Data for this analysis were collected during the baseline stage in 2012. The modifiable risk factors included were: smoking habit, alcohol consumption, low physical activity, inadequate diet, hypertension, dyslipidemia, and obesity. To assess independent association between each factor and prediabetes, odds ratios (ORs) were estimated using logistic regression models. RESULTS: Abdominal obesity, low plasma levels of high-density lipoprotein cholesterol (HDL-cholesterol), and hypertension were independently associated with the presence of prediabetes in both men and women. After adjusting for all factors, the respective ORs (95% Confidence Intervals) were 1.98 (1.41-2.79), 1.88 (1.23-2.88) and 1.86 (1.39-2.51) for men, and 1.89 (1.36-2.62), 1.58 (1.12-2.23) and 1.44 (1.07-1.92) for women. Also, general obesity was a risk factor in both sexes but did not reach statistical significance among men, after adjusting for all factors. Risky alcohol consumption was a risk factor for prediabetes in men, OR 1.49 (1.00-2.24). CONCLUSIONS: Obesity, low HDL-cholesterol levels, and hypertension were modifiable risk factors independently related to the presence of prediabetes in both sexes. The magnitudes of the associations were stronger for men than women. Abdominal obesity in both men and women displayed the strongest association with prediabetes. The findings suggest that there are some differences between men and women, which should be taken into account when implementing specific recommendations to prevent or delay the onset of diabetes in adult population.

[Cohort Study in Primary Health Care on the Evolution of Patients with Prediabetes (PREDAPS): basis and methodology].

The PREDAPS study aims to determine the risk of developing diabetes and the risk of vascular complications in patients with prediabetes and identify factors associated with those risks. It is a prospective observational study of a cohort of 1184 subjects with prediabetes and another cohort of 838 subjects with no alterations in glucose metabolism. The data at baseline were obtained from patients attending primary care centers in Spain throughout 2012. Subjects with prediabetes were classified into three groups: those who had only altered the fasting blood glucose levels -between 100 and 125mg/dl-, those who had only altered the HbA1c level -between 5.7 and 6.4% - and those who had altered both parameters. Information on sociodemographic characteristics, personal and family history, lifestyle and drug therapy was obtained from medical records and the interview with the doctor in the consultation. It was also performed a physical examination to determine weight, height, waist circumference and blood pressure were performed and blood and urine analysis. The PREDAPS study may help to reduce uncertainty in individual prevention strategies in subjects with prediabetes. Annual monitoring of patients recruited for five years will enable to know the risk of developing diabetes type 2 and the risk of macro-and microvascular complications in the three groups of subjects with prediabetes and determine the factors associated with those risks.

Análisis sobre los motivos de derivación de pacientes con diabetes mellitus tipo 2 entre atención primaria y atención especializada. Estudio Pathways / Analysis of criteria for referral of type 2 diabetes patients from primary care to specialized care in spain. A Pathways Study

OBJETIVOS: Conocer los motivos de derivación de pacientes con diabetes tipo 2 (DM2) entre atención primaria (AP) y atención especializada (AE). Analizar el grado de cumplimiento de las recomendaciones nacionales sobre motivos de derivación de pacientes con DM2. MATERIAL Y MÉTODOS: Estudio observacional, transversal, multicéntrico nacional en AP y AE. Cada investigador debía aportar, mediante un cuaderno de recogida de datos estructurado, información sobre su práctica habitual en derivación de pacientes con DM2 y datos sobre derivación de 6 pacientes concretos. Los documentos de referencia para el análisis del cumplimiento fueron: Recomendaciones de la Sociedad Española de Endocrinología y Nutrición (SEEN) y Guía de Práctica Clínica del Ministerio de Sanidad y Consumo (MSC). Se analizaron datos sobre práctica habitual de 143 médicos de AE y 641 de AP y sobre derivaciones de 805 pacientes de AE y 3.624 de AP. RESULTADOS: El 31,8% de los profesionales de AP y el 46,2% de AE declaran existencia de un protocolo de coordinación con el otro nivel asistencial. El método de comunicación más frecuentemente declarado para derivaciones hacia AE fue el parte interconsulta (89,2%) y hacia AP la historia clínica (53,5%). El criterio de derivación hacia AE más manejado en la práctica habitual fue «inestabilidad metabólica» (80,5%), y hacia AP, «consecución de objetivos» (96,5%). El motivo más frecuente en derivaciones concretas hacia AE fue «re-evaluación» (48,4%) y hacia AP «consecución de objetivos» (91,6%). El 46,8% de los profesionales de AP aplicaban todos los criterios MSC y el 3,9% todos los criterios SEEN. CONCLUSIONES: Se observa una escasa implementación de protocolos de coordinación entre niveles asistenciales y un bajo grado de cumplimiento de las recomendaciones nacionales

OBJECTIVES: To assess the reasons for referral of type 2 diabetes (T2DM) patients from primary care (PC) to specialized care (SC) in Spain. To assess the level of compliance with referral criteria established in national recommendations. METHODS: Observational, cross-sectional, multi-centre national study, in PC and SC. Each physician provided, using a structured case report form, data on usual practice for T2DM patient referral and data about referral of 6 patients. Recommendations of the Spanish Society for Endocrinology and Nutrition (SEEN) and the National Health System (NHS) were used as reference documents to assess compliance. Data from clinical practice of 143 professionals of SC/641 general practitioners (GPs) and from referrals of 805 patients to PC/3,624 to SC are presented. RESULTS: Almost one-third (31.8%) of GPs and 46.2% of SC professionals reported the existence of a coordination protocol with the other healthcare level. The most frequent communication tool for referrals to SC was a Consultation Report (89.2%), and the Medical History for referrals to PC. The referral criterion to SC most frequently declared was Metabolic Instability (80.5%) and to PC was Goal Achievement (96.5%). The most frequent cause for referral to SC among the patients studied was Reassessment (48.4%) and to PC Goal Achievement (91.6%). Almost half (46.8%) of GPs applied all NHS criteria in usual practice, and 3.9% all SEEN referral criteria. CONCLUSIONS: The number of reported coordination protocols is low, and the compliance with national guidelines is poor