Actividad física y factores de riesgo cardiovascular: evidencia de su interrelación a nivel nacional / Physical activity and cardiovascular risk factors: evidence of their interrelation nationwide

RESUMEN Antecedentes: En nuestro país la prevalencia de diabetes tipo 2 (DT2) y de factores de riesgo cardiovascular (FRCV) aumenta continuamente. Aunque el fenómeno se acompaña de adopción de estilos de vida no saludable que facilitan dicho crecimiento, es escasa la implementación de estrategias que puedan modificar la situación. Objetivo: Revisar la evidencia disponible sobre la magnitud del problema de la diabetes y los FRCV en nuestro país, su posible relación con la práctica de actividad física y potencial mecanismo de acción. Metodología: Evaluación de datos de la tercera Encuesta Nacional de Factores de Riesgo (ENFR) e información referida a factores que contribuyen al crecimiento de la prevalencia de DT2. Igualmente estrategias exitosas utilizadas a nivel mundial para su prevención. Resultados: El índice de masa corporal registrado en la población estudiada muestra un aumento del porcentaje de personas con sobrepeso/obesidad inverso a la práctica de actividad física. Igualmente los resultados de las pruebas de tolerancia a la glucosa oral muestran que sus alteraciones (prediabetes/diabetes) son menores entre quienes realizaban actividad física. El porcentaje de personas con valores de presión arterial dentro del rango normal al igual que de colesterol circulante (según valores meta de guías internacionales), es también significativamente menor entre quienes practicaban actividad física. Conclusión: La evidencia presentada demuestra objetivamente la necesidad/ventajas de implementar un programa de prevención primaria de diabetes a gran escala a nivel nacional para disminuir su crecimiento y la pertinencia de incluir la práctica de actividad física como estrategia de prevención tal como propone el PPDBA.

ABSTRACT Background: In our country, the prevalence of type 2 diabetes (DT2) and cardiovascular risk factors (CVRF) increases continuously. Although the phenomenon is accompanied by the adoption of unhealthy lifestyles that facilitate such growth, there is little implementation of strategies that can modify the situation. Objective: To review the available evidence on the magnitude of the problem of diabetes and CVRF in our country, its possible relationship with the practice of physical activity and potential mechanism of action. Methodology: Evaluation of data from the Third National Survey of Risk Factors (ENFR) and information referred to factors that promote the prevalence growth of T2D. Additionally, successful strategies have been used worldwide for its prevention. Results: The body mass index registered in the studied population shows an increase in the percentage of people with overweight/obesity inverse to the practice of physical activity. Likewise, the results of the oral glucose tolerance tests show that their alterations (prediabetes/ diabetes) are lower among those who performed physical activity. The percentage of people with blood pressure values within the normal range as well as circulating cholesterol (according to target values of international guidelines), is also significantly lower among those who practiced physical activity. Conclusion: The presented evidence objectively demonstrates the need/advantages of implementing a large-scale diabetes primary prevention program at the national level to.

Quality indicators for the prevention of type 2 diabetes in Europe--IMAGE.

BACKGROUND: The marked increase of type 2 diabetes necessitates active development and implementation of efficient prevention programs. A European level action has been taken by launching the IMAGE project to unify and improve the various prevention management concepts, which currently exist within the EU. This report describes the background and the methods used in the development of the IMAGE project quality indicators for diabetes primary prevention programs. It is targeted to the persons responsible for diabetes prevention at different levels of the health care systems. METHODS: Development of the quality indicators was conducted by a group of specialists representing different professional groups from several European countries. Indicators and measurement recommendations were produced by the expert group in consensus meetings and further developed by combining evidence and expert opinion. RESULTS: The quality indicators were developed for different prevention strategies: population level prevention strategy, screening for high risk, and high risk prevention strategy. Totally, 22 quality indicators were generated. They constitute the minimum level of quality assurance recommended for diabetes prevention programs. In addition, 20 scientific evaluation indicators with measurement standards were produced. These micro level indicators describe measurements, which should be used if evaluation, reporting, and scientific analysis are planned. CONCLUSIONS: We hope that these quality tools together with the IMAGE guidelines will provide a useful tool for improving the quality of diabetes prevention in Europe and make different prevention approaches comparable.

Evaluation of the effectiveness of an ambulatory teaching/treatment programme for non-insulin dependent (type 2) diabetic patients.

The aim of this study was to evaluate the effect of a structured teaching/treatment programme on the clinical and metabolic control of non-insulin-dependent (type 2) diabetic patients. The programme was aimed at improving the overall treatment quality in these patients through measures involving self-care, diet, exercise and weight reduction. Four theoretical-practical teaching units were given once a week to group of 5-8 ambulatory patients by previously trained general practitioners. Clinical and biochemical parameters were recorded at the beginning of the course and 1 year after its completion in 40 patients attending the programme and in 39 patients of similar clinical characteristics under conventional diabetes treatment, but receiving no structured teaching before or during the survey period (control group). The drop-out percentage in the intervention group (25%) was significantly lower than in the control group (45%, P < 0.05), suggesting an incentive toward greater compliance in the former. At the end of the 1-year follow-up, the mean differences observed in the control and in the intervention groups were: body weight loss -2.4 +/- 0.5 kg vs -0.4 +/- 0.5 (P < 0.001); haemoglobin HbA1 -0.2% +/- 0.4% vs +0.8% +/- 0.4% (NS); number of daily oral hypoglycaemic agent intake -1.4 +/- 0.2 vs +0.9 +/- 0.2 tablets (P < 0.001). Our results strongly suggest that this programme, applied through family doctors, may constitute an efficient tool to improve the compliance and clinico-metabolic control of type 2 patients at the primary health care level.

Evaluación de la efectividad de un programa de educación para diabéticos no insulinodependientes / Evaluation of effectiveness of an education program for non-insulin-dependent diabetic patients

En este trabajo se evaluó durante un año el impacto prospectivo de un programa educativo para diabéticos no insulinodependientes (PEDNID), sobre parámetros clínicos, bioquímicos y terapéuticos. El programa, de modalidad grupal, constaba de 4 módulos teórico-prácticos dictados semanalmente por el médico de cabecera, entrenado previamente para su desarrollo. El objetivo general fue mejorar el control metabólico del DNID por medios no farmacológicos, suprimiro atenuar los síntomas clásicos de la enfermedad y entrenar a los pacientes parala implementación de acciones de prevención y de diagnóstico precoz de las complicaciones crónicas de la enfermedad. Los objetivos particulares fueron capacitaral paciente para efectuar monitoreos glucosúricos, un plan de alimentación con reemplazos, autocuidado en piernas y pies, incremento en su actividad física y controles médicos y de laboratorio periódicos. La población consistió en pacientesasistidos en los subsectores estatal y privado en las ciudades de La Plata, Berisso, Ensenada y Magdalena. Al cabo del año se evaluaron 40 pacientes del PEDNID y 39 controles apareados por edad, sexo y antig³edad de diabetes, encontrándose estos últimos bajo tratamiento convencional de su enfermedad y sin haber recibido educación diabetológica estructurada antes o durante del período de estudio. El área congnoscitiva se evaluó en el grupo PEDNID mediante un cuestionario relevado antes y al año del curso de educación...(AU)

Evaluación de la efectividad de un programa de educación para diabéticos no insulinodependientes / Evaluation of effectiveness of an education program for non-insulin-dependent diabetic patients

En este trabajo se evaluó durante un año el impacto prospectivo de un programa educativo para diabéticos no insulinodependientes (PEDNID), sobre parámetros clínicos, bioquímicos y terapéuticos. El programa, de modalidad grupal, constaba de 4 módulos teórico-prácticos dictados semanalmente por el médico de cabecera, entrenado previamente para su desarrollo. El objetivo general fue mejorar el control metabólico del DNID por medios no farmacológicos, suprimiro atenuar los síntomas clásicos de la enfermedad y entrenar a los pacientes parala implementación de acciones de prevención y de diagnóstico precoz de las complicaciones crónicas de la enfermedad. Los objetivos particulares fueron capacitaral paciente para efectuar monitoreos glucosúricos, un plan de alimentación con reemplazos, autocuidado en piernas y pies, incremento en su actividad física y controles médicos y de laboratorio periódicos. La población consistió en pacientesasistidos en los subsectores estatal y privado en las ciudades de La Plata, Berisso, Ensenada y Magdalena. Al cabo del año se evaluaron 40 pacientes del PEDNID y 39 controles apareados por edad, sexo y antigüedad de diabetes, encontrándose estos últimos bajo tratamiento convencional de su enfermedad y sin haber recibido educación diabetológica estructurada antes o durante del período de estudio. El área congnoscitiva se evaluó en el grupo PEDNID mediante un cuestionario relevado antes y al año del curso de educación...

Evaluation of a structured treatment and teaching program for non-insulin-treated type II diabetic outpatients in Germany after the nationwide introduction of reimbursement policy for physicians.

OBJECTIVE: To evaluate the practicability and efficacy of a structured treatment and teaching program for non-insulin-treated type II diabetic patients in routine primary health care. RESEARCH DESIGN AND METHODS: All physicians (n = 139) and their office staffs in Hamburg, Germany, who had participated in a special training course from 1 April 1991 to 31 December 1991 were contacted for a standardized interview. A random sample of 17 of these offices was selected for office visits during which the documented data of all patients who had received the standardized treatment and teaching in the same period were collected and evaluated. RESULTS: The program was well received by the physicians, and the data collected on 179 patients (5.1 mo median after the intervention) demonstrated the efficacy of the program at the treatment level: reduction of body weight (mean 2.8 kg, P < 0.0001) and HbA1c levels (from 8.11 +/- 1.68 to 7.47 +/- 1.64%, P < 0.0001) was substantial. The individual prescribed volume of oral antidiabetic agents was approximately 50% lower after patient attendance of the program (significant decrease from 1.41 +/- 1.42 to 0.76 +/- 1.11 tablets/patient/day, P < 0.0001). The proportion of patients treated with oral antidiabetic drugs decreased from 63 to 42% (P < 0.0001). CONCLUSIONS: Subsequent to the introduction of nationwide remuneration of outpatient education for type II diabetic patients by office-based physicians, a relevant improvement was observed in the quality of care, comparable with the effects of the program in a previous prospective controlled trial.

Evaluation of a structured treatment and teaching programme on non-insulin-dependent diabetes.

A structured treatment and teaching programme for non-insulin-treated non-insulin-dependent (type 2) diabetes was evaluated prospectively in general practice. The four group sessions were mainly conducted by paramedical personnel. 65 patients from five general practices were assessed at the start of the programme and 50 (mean age 65 years, diabetes duration 7 years) completed the 1 year follow-up (intervention group). The control group consisted of 49 patients (mean age 63 years, diabetes duration 7 years) from three other general practices without the programme. In the intervention group the percentage of patients receiving sulfonylureas fell from 68% at the start of the study to 38% after 1 year (mean difference 30%, 95% confidence interval [CI] 16-44%); the mean weight loss was 2.7 kg (95% CI 1.6-3.8 kg), and non-fasting triglycerides were reduced by 0.77 mmol/1 (95% CI 0.35-1.19 mmol/l); and glycosylated haemoglobin remained unchanged (7.1% of total haemoglobin). In the control group none of these indices was changed during the study year, and 10% of patients started insulin treatment. The structured treatment and teaching programme improved the overall quality of patient care in elderly non-insulin-dependent diabetic patients treated by general practitioners.