Adherence to the therapeutic guidelines recommendations among the people with type 2 diabetes mellitus and obesity, frailty, or recent diagnosis, attended in primary health care centers in Spain: A cross-sectional study.

Introduction: Clinical practice guidelines are helpful for clinicians, and their proper implementation could improve the quality of care and management of participants with diabetes. This study aimed to evaluate the degree of adherence to the Clinical Practice Guidelines (CPG) recommendations among obese, frail, or recently diagnosed type 2 diabetes mellitus (T2DM) participants in primary care centers in Spain. Methods: We perform a cross-sectional study on a national level in two phases. In the first phase, study participants were recruited, and their clinical data were collected. In the second phase, data related to the participating physicians were collected. Results: In total, 882 participants from 240 physicians were analyzed. According to the study questionnaire, most participants from all three clinical groups had adequate adherence to the CPG. This percentage was highest among the recently diagnosed T2DM (91.6%) and lowest percent of frail T2DM persons (74.7%). The inadequate adherence to the guidelines was observed mainly among the obese and frail participants with T2DM from medical doctors with low CPG knowledge (3.4% and 3.5%, respectively). Regarding the patient's characteristics and degree of adherence to the guidelines, the participants with inadequate adherence were generally older, with higher BMI, poorer HbA1c control, and fewer visits with primary care physicians. Most (57%) primary care physicians had moderate CPG knowledge. In our multivariable logistic model, we did not observe statistically significant odds ratios for different characteristics related to the physicians/consultation and low CPG knowledge. Discussion: The results of our cross-sectional study observe adequate adherence to the clinical guidelines by the primary care physicians for the majority of the participants with obesity, frailty, or newly diagnosed with T2DM.

Potential Risk of Overtreatment in Patients with Type 2 Diabetes Aged 75 Years or Older: Data from a Population Database in Catalonia, Spain.

Aim: To assess the potential risk of overtreatment in patients with type 2 diabetes (T2DM) aged 75 years or older in primary care. Methods: Electronic health records retrieved from the SIDIAP database (Catalonia, Spain) in 2016. Variables: age, gender, body mass index, registered hypoglycemia, last HbA1c and glomerular filtration rates, and prescriptions for antidiabetic drugs. Potential overtreatment was defined as having HbA1c < 7% or HbA1c < 6.5% in older patients treated with insulin, sulfonylureas, or glinides. Results: From a total population of 138,374 T2DM patients aged 75 years or older, 123,515 had at least one HbA1c available. An HbA1c below 7.0% was present in 59.1% of patients, and below 6.5% in 37.7%. Overall, 23.0% of patients were treated with insulin, 17.8% with sulfonylureas, and 6.6% with glinides. Potential overtreatment (HbA1c < 7%) was suspected in 26.6% of patients treated with any high-risk drug, 47.8% with sulfonylureas, 43.5% with glinides, and 28.1% with insulin. Using the threshold of HbA1c < 6.5%, these figures were: 21.6%, 24.4%, 17.9%, and 12.3%, respectively. Conclusion: One in four older adults with T2DM treated with antidiabetic drugs associated with a high risk of hypoglycemia might be at risk of overtreatment. This risk is higher in those treated with sulfonylureas or glinides than with insulin.

Experiencia de Atención Comunitaria en residencias de ancianos durante la primera ola de la pandemia COVID-19 / Experience in Community Care in nursing homes during the first wave of the COVID-19 pandemic

La COVID-19 ha producido muchas muertes en las residencias geriátricas. El compromiso de las enfermeras/os y médicos de Atención Primaria (AP) con la población que atienden hacía indispensable realizar acciones comunitarias para mejorar la atención de estas personas.El objetivo general fue implementar el “Plan de Acción para la Gestión de Personas en el Ámbito Residencial y la Asistencia Sanitaria en Situación de Pandemia por COVID-19” de la Generalitat de Cataluña y adecuarlo a las necesidades concretas en los centros atendidos. La intervención fue realizada por enfermeras y médicas de AP en dos residencias de ancianos de un núcleo urbano de Barcelona entre marzo y mayo de 2020. Constó de tres etapas: 1) Valoración: las dos residencias atendían 41 residentes (78,6% mujeres; edad media 84,5 años). El 100% tenía patología crónica, el 41,5% presentaba dependencia total, un 21,9% dependencia grave y el 26,8% tenía deterioro cognitivo. Un 63,4% estaba asintomático. Se identificaron carencias de material, infraestructuras y conocimientos. 2) Acciones de coordinación: desinfección de residencias por el servicio de bomberos y toma de muestras PCR que fueron negativas en el 100% de residentes y positivas en cuatro cuidadoras. 3) Taller de educación sanitaria para personal con trato directo a las personas residentes.Las residencias se mantuvieron libres de COVID-19 hasta el momento del inicio de la desescalada a finales de mayo de 2020. Se mantuvo la relación posterior con las residencias. La intervención comunitaria puede haber contribuido a la falta de casos de contagio de trabajadoras y personas residentes.(AU)

COVID-19 has caused many deaths in geriatric homes. The commitment by female Primary Care doctors and nurses with the population they manage made it essential to conduct community actions in order to improve the care for these persons.The general objective was to implement the “Plan of Action for Managing Persons in the Nursing Home Setting and Healthcare during the COVID-19 Pandemic” of the Government of Catalonia, and to adapt it to the specific needs in the centres managed. The intervention was conducted by female Primary Care nurses and doctors, in two nursing homes from an urban area of Barcelona between March and May, 2020. It consisted of three stages: 1) Assessment: Both nursing homes cared for 41 persons (78.6% were female; mean age: 84.5 years). Of these, 100% had a chronic condition, 41.5% presented total dependence, 21.9% presented severe dependence, and 26.8% suffered cognitive deterioration; 63.4% of them were asymptomatic. Lack of materials, infrastructures, and knowledge were detected. 2) Coordination actions: Disinfection of nursing homes by the Fire Department, and extraction of PCR samples, which tested negative in 100% of patients and positive in four caregivers. 3) Health Education Workshop for staff in direct contact with the persons living in the nursing home.Nursing homes stayed free of COVID-19 until the start of de-escalation by the end of May, 2020. Subsequent contact was maintained with nursing homes. Community intervention might have contributed to the lack of infection cases among workers and persons living in the nursing homes.(AU)

Effects of a Primary Care-Based Multifactorial Intervention on Physical and Cognitive Function in Frail, Elderly Individuals: A Randomized Controlled Trial.

Background: Detecting and managing frailty at early stages can prevent disability and other adverse outcomes. The study aim was to evaluate whether a multifactorial intervention program could modify physical and cognitive frailty parameters in elderly individuals. Methods: We conducted a multicenter, randomized, single-blind, parallel-group trial in community-living prefrail/frail elderly individuals in Barcelona. A total of 352 patients, aged ≥65 years old with positive frailty screening, was randomized into two groups to receive a 12-week multidisciplinary intervention or usual care, with concealed allocation. The intervention consisted of: exercise training, intake of hyperproteic nutritional shakes, memory training, and medication review. Main outcome assessments with multivariate analysis were conducted at 3 and 18 months. Results: A total of 347 participants (98.6%) completed the study, mean age 77.3 years, 89 prefrail subjects (25.3%), and 75.3% female (n = 265). Eighteen-month assessments were performed in 76% of the sample. After 3 and 18 months, adjusted means difference between-groups showed significant improvements for the intervention group in all comparisons: Short Physical Performance Battery score improved 1.58 and 1.36 points (p < .001), handgrip strength 2.84 and 2.49 kg (p < .001), functional reach 4.3 and 4.52 cm (p < .001), and number of prescriptions decreased 1.39 and 1.09 (p < .001), respectively. Neurocognitive battery also showed significant improvements across all dimensions at 3 and 18 months. Conclusions: A physical, nutritional, neurocognitive, and pharmacological multifaceted intervention was effective in reversing frailty measures both at short-term and 18 months. Lasting benefits of a multi-intervention program among frail elderly individuals encourage its prioritization.