Physicians' and Pharmacists' Clinical Considerations for Elderly Patients with Type 2 Diabetes Mellitus: The IMPLICA2 Study.

BACKGROUND: Management of elderly patients with type 2 diabetes mellitus (T2DM) is complex due to their age-related conditions. Several clinical guidelines provide specific recommendations for management of these patients but little is known about their implementation in clinical practice. OBJECTIVE: To describe physician and community pharmacist perceptions and routine clinical practice in the management of elderly T2DM patients. METHODS: Cross-sectional study. RESULTS: A total of 993 physicians and 999 community pharmacists completed the questionnaire. More physicians than pharmacists agreed on the need to establish more flexible HbA1c targets for elderly (79.4% vs. 30.6%; p < 0.001) and frail (92.6% vs. 31.4%; p < 0.001) patients than for the general diabetic population. HbA1c targets < 7.5% for elderly patients and < 8.5% for frail patients (as recommended by the principle guidelines) were set by 38.9% and 28.7% of physicians, respectively. Furthermore, 62.8% of physicians stated they follow guideline recommendations but, based on their prescription decisions for hypothetical patients, less than 50% were aligned with them. In addition, 73.1% of physicians monitor treatment adherence, mainly by using dispensing control (59.1%). Specific nutritional approaches for elderly patients are provided by 62.9% of physicians and 56.0% of pharmacists, whilst 57.4% and 21.7%, respectively, deliver specific physical exercise programs. CONCLUSIONS: Low adherence to guideline recommendations (i.e. setting more stringent HbA1c targets or delaying treatment intensification) may lead to suboptimal glycaemic control in elderly patients. The standardization of processes, extensive monitoring of patient treatment adherence and providing advice regarding specific personal lifestyle habits may improve the management of elderly T2DM patients.

[Treatment of epistaxes in hereditary haemorrhagic telangiectasia (Rendu-Osler-Weber disease) with tranexamic acid]. / Tratamiento de las epistaxis en la telangiectasia hemorrágica hereditaria (enfermedad de Rendu-Osler-Weber) con ácido tranexámico.

OBJECTIVE: Recurrent epistaxis is the most frequent clinical manifestation of hereditary haemorrhagic telangiectasia (HHT). Its treatment occasionally presents difficulties as there is no consensus on the appropriate therapeutic protocol. Our objective was to explore the utility of oral tranexamic acid for the treatment of epistaxes in HHT patients. PATIENTS AND METHOD: A 3-year prospective study was carried on HHT patients with epistaxis treated with oral tranexamic acid in the HHT unit at our hospital. RESULTS: Ten patients with HHT were treated with oral tranexamic acid during the study. Most of them improved both the frequency and severity of their epistaxis and were satisfied with the treatment. No treatment-related complications were recorded. Two patients needed more aggressive treatments to control epistaxis. CONCLUSIONS: Oral tranexamic acid is useful for achieving significant reductions in epistaxis frequency and intensity in selected patients with HHT. In those presenting severe epistaxis, however, it may need to be combined with more aggressive therapies.

Tratamiento de las epistaxis en la telangiectasia hemorrágica hereditaria (enfermedad de Rendu-Osler-Weber) con ácido tranexámico / Treatment of epistaxes in hereditary haemorrhagic telangiectasia (Rendu-Osler-Weber disease) with tranexamic acid

Introducción: Las epistaxis son la manifestación clínica más frecuente en los enfermos con telangiectasia hemorrágica hereditaria (HHT). Su tratamiento es en ocasiones muy complejo, y no hay consenso sobre el protocolo terapéutico que se ha de aplicar. El objetivo de nuestro estudio fue valorar la utilidad del ácido tranexámico oral en las epistaxis secundarias a HHT. Pacientes y método: Se realizó un estudio prospectivo de pacientes con HHT tratados por epistaxis en la unidad de HHT de nuestro hospital mediante ácido tranexámico durante 3 años. Resultados: Se trató a 10 pacientes con HHT mediante ácido tranexámico oral durante el período de estudio. Todos ellos presentaron una disminución tanto en la intensidad como la frecuencia de las epistaxis. En su mayoría estaban satisfechos con los resultados del tratamiento. Ninguno presentó complicaciones relacionadas con él y 2 pacientes siguieron precisando otros tratamientos para control de las epistaxis. Conclusiones: El ácido tranexámico oral es útil en el tratamiento de las epistaxis en algunos pacientes con HHT, pues reduce de forma significativa tanto la intensidad como la frecuencia. Sin embargo, en los que presentan epistaxis severas no impide la necesidad de seguir realizando otros tratamientos agresivos

Objective: Recurrent epistaxis is the most frequent clinical manifestation of hereditary haemorrhagic telangiectasia (HHT). Its treatment occasionally presents difficulties as there is no consensus on the appropriate therapeutic protocol. Our objective was to explore the utility of oral tranexamic acid for the treatment of epistaxes in HHT patients. Patients and method: A 3-year prospective study was carried on HHT patients with epistaxis treated with oral tranexamic acid in the HHT unit at our hospital. Results: Ten patients with HHT were treated with oral tranexamic acid during the study. Most of them improved both the frequency and severity of their epistaxis and were satisfied with the treatment. No treatment-related complications were recorded. Two patients needed more aggressive treatments to control epistaxis. Conclusions: Oral tranexamic acid is useful for achieving significant reductions in epistaxis frequency and intensity in selected patients with HHT. In those presenting severe epistaxis, however, it may need to be combined with more aggressive therapies

[Hereditary hemorrhagic telangiectasia]. / Telangiectasia hemorrágica hereditaria.

Hereditary Hemorrhagic Telangiectasia (HHT) or Rendu-Osler-Weber disease is a genetic disorder with a dominant autosomic transmission. Its prevalence is estimated in one in 5-8,000 individuals. Two different mutations have been described involving endoglin and ALK-1 genes, resulting in HHT type 1 and 2 respectively. It is characterized by the occurrence of spontaneous and recurrent episodes of epistaxis, telangiectasias and the presence of visceral arteriovenous malformations (mainly affecting lungs, liver, brain and digestive tract) which are responsible for the clinical manifestations and constitute a basic point in the diagnostic criteria of Curaçao. The aim of this article is to review the pathogenesis, clinical aspects, screening procedures to disclose the visceral involvement and the therapeutic options of this rare disease.

Telangiectasia hemorrágica hereditaria / Hereditary hemorrhagic telangiectasia

La telangiectasia hemorrágica hereditaria (HHT), o síndrome de Rendu-Osler-Weber, es una enfermedad genética con transmisión autosómicadominante. Su prevalencia se estima en un paciente por 5-8.000 habitantes. Se han descrito mutaciones en 2 genes (gen de laendoglina y de ALK-1), y pueden distinguirse 2 tipos según el genmutado: HHT 1 y HHT 2, respectivamente. Se caracteriza por la apariciónde episodios espontáneos y repetidos de epistaxis, telangiectasiasy malformaciones arteriovenosas viscerales (principalmente en elpulmón, el hígado, el cerebro y el aparato digestivo), que son las responsablesde sus manifestaciones clínicas y la base de los criteriosde Curaçao, con los que se realiza el diagnóstico de la HHT.En este artículo se revisan la patogenia y las manifestaciones clínicasde esta rara enfermedad, así como los protocolos de cribado de las lesionesviscerales y las opciones terapéuticas de las que disponemosen la actualidad

Hereditary Hemorrhagic Telangiectasia (HHT) or Rendu-Osler-Weberdisease is a genetic disorder with a dominant autosomic transmission.Its prevelence is estimated in one in 5-8,000 individuals. Two differentmutations have been described involving endoglin and ALK-1 genes,resulting in HHT type 1 and 2 respectively. It is characterized by theocurrence of spontaneus and recurrent episodes of epistaxis,telangiectasias and the presence of visceral arteriovenous malformations(mainly affecting lungs, liver, brain and digestive tract) which areresponsible for the clinical manifestations and constitute a basic point inthe diagnostic criteria of Curaçao.The aim of this article is to review the pathogenesis, clinical aspects,screening procedures to disclose the visceral involvement and thetherapeutic options of this rare disease