GLP-1 RAs in Spain: A Short Narrative Review of Their Use in Real Clinical Practice.

Glucagon-like peptide 1 receptor agonists (GLP-1 RAs) are a class of drugs with potent glucose-lowering activity. Additionally, some GLP-1 RAs have demonstrated cardiovascular and renal benefits. Current guidelines recommend their use in patients with type 2 diabetes (T2D) at high risk of or with established cardiovascular disease (CVD), regardless of glycaemic control, with lifestyle modification and metformin. However, several studies have recently highlighted the limited number of patients with T2D benefiting from these medications worldwide. Given the huge burden of CVD among patients with T2D, efforts should be made to bring clinical practice closer to expert guidelines. This review describes the current situation of GLP-1 RA use in Spain and the reasons behind the gap between guidelines and real-world practice and suggests possible solutions. Administrative issues, lack of awareness of the cardiovascular benefits, clinical inertia, rejection of injectable medication and costs could be some of the reasons for the current situation. Possible strategies that could help to close the gap include encouraging a multidisciplinary approach to the treatment of diabetes which involves cardiologists, endocrinologists, nephrologists, primary care providers and pharmacists; improved awareness of comorbidities and earlier evaluation and treatment or risks; and better education of healthcare providers regarding the cardioprotective benefits of these drugs.

The glucagon-like peptide 1 receptor agonists (GLP-1 RAs) are a class of drugs that can be beneficial for patients with type 2 diabetes who are at high risk of cardiovascular complications, such as heart attacks. For this reason, the current clinical guidelines strongly recommend their use in these patients. Unfortunately, many patients with type 2 diabetes and high cardiovascular risk still do not benefit from these drugs. This review analyses the reasons for this situation in Spain, and proposes some possible solutions. The reasons for the low use of GLP-1 RAs could be related to doctors not updating a patient's diabetes medicine as often as they should, lack of awareness about the cardiovascular benefits of these drugs, fear of medicines that involve needles, administrative issues, and costs. Some of the possible strategies to improve the use of GLP-1 RAs among patients with type 2 diabetes with high cardiovascular risk could be to foster greater cooperation among specialists, increase awareness of the need to treat cardiovascular risk in patients with diabetes, and better education of doctors regarding the benefits of these drugs.

Changes in the Epidemiology of Diabetic Retinopathy in Spain: A Systematic Review and Meta-Analysis.

BACKGROUND: The aim of the present study was to determine the prevalence and incidence of diabetic retinopathy (DR) and its changes in the last 20 years in type 2 diabetes mellitus (T2DM) patients in Spain. METHODS: A systematic review with a meta-analysis was carried out on the studies published between 2001-2020 on the prevalence and incidence of DR and sight-threatening diabetic retinopathy (STDR) in Spain. The articles included were selected from four databases and publications of the Spanish Ministry of Health and Regional Health Care System (RHCS). The meta-analysis to determine heterogeneity and bias between studies was carried out with the MetaXL 4.0. RESULTS: Since 2001, we have observed an increase in the detection of patients with DM, and at the same time, screening programs for RD have been launched; thus, we can deduce that the increase in the detection of patients with DM, many of them in the initial phases, far exceeds the increased detection of patients with DR. The prevalence of DR was higher between 2001 and 2008 with values of 28.85%. These values decreased over the following period between 2009 and 2020 with a mean of 15.28%. Similarly the STDR prevalence decrease from 3.67% to 1.92% after 2008. The analysis of the longitudinal studies determined that the annual DR incidence was 3.83%, and the STDR annual incidence was 0.41%. CONCLUSION: In Spain, for T2DM, the current prevalence of DR is 15.28% and 1.92% forSTDR. The annual incidence of DR is 3.83% and is 0.41% for STDR.

Classifying and communicating risks in prediabetes according to fasting glucose and/or glycated hemoglobin: PREDAPS cohort study.

OBJECTIVE: Information about prognostic outcomes can be of great help for people with prediabetes and for physicians in the face of scientific controversy about the cutoff point for defining prediabetes. We aimed to estimate different prognostic outcomes in people with prediabetes. DESIGN: Prospective cohort of subjects with prediabetes according to American Diabetes Association guidelines. MAIN OUTCOME MEASURES: The probabilities of diabetes onset versus non-onset, the odds against diabetes onset, and the probability of reverting to normoglycemia according to different prediabetes categories were calculated. RESULTS: The odds against diabetes onset ranged from 29:1 in individuals with isolated FPG of 100-109 mg/dL to 1:1 in individuals with FPG 110-125 mg/dL plus HbA1c 6.0-6.4%. The probability of reversion to normoglycemia was 31.2% (95% CI 24.0-39.6) in those with isolated FPG 100-109 mg/dL and 6.2% (95% CI 1.4-10.0) in those with FPG 110-125 mg/dL plus HbA1c 6.0-6.4%. Of every 100 participants in the first group, 97 did not develop diabetes and 31 reverted to normoglycemia, while in the second group those figures were 52 and 6. CONCLUSIONS: Using odds of probabilities and absolute numbers might be useful for people with prediabetes and physicians to share decisions on potential interventions.Key pointsCommunicating knowledge on the course of the disease to make clinical decisions is not always done appropriately.Prediabetes is an example where risk communication is important because the prognosis of subjects with prediabetes is very heterogeneous.Depending on fasting plasma glucose and HbA1c levels, the odds of probabilities against diabetes onset ranged from 29: 1 to 1: 1.Depending on fasting plasma glucose and HbA1c levels, the number of subjects in 100 who revert to normoglycemia ranged from 31 to 6.Using probabilities and number absolutes on the prognosis of prediabetes may be useful for people with prediabetes and physicians to share decisions on potential interventions.

The heterogeneity of reversion to normoglycemia according to prediabetes type is not explained by lifestyle factors.

Healthy lifestyle interventions and drug therapies are proven to have a positive preventative influence on normal glucose regulation in prediabetes. However, little is known on the specific role that these factors play on reversion to normal glycemia according to type of prediabetes. We used data from the Observational prospective cohort study, The Cohort study in Primary Health Care on the Evolution of Patients with Prediabetes from 2012 to 2015. A total of 1184 individuals aged 30-74 years old were included and classified based on the ADA in three mutually exclusive groups using either fasting plasma glucose (FPG) levels (from 100 to 125 mg/dl, FPG group), HbA1c (5.7-6.4%, HbA1c group) or both impaired parameters. Information on lifestyle factors and biochemical parameters were collected at baseline. Reversion to normal glucose regulation was calculated at third year of follow-up. Relationship of lifestyle factor and type of prediabetes with reversion were estimated using odds ratios (ORs) with 95% confidence intervals (95% CIs) adjusting by different groups of confounders. Proportion of reversion rates were 31% for FPG group, 31% for HbA1c group and 7.9% for both altered parameters group, respectively. Optimal life style factors such as BMI < 25 kg/m2[OR (95% CI): 1.90 (1.20-3.01)], high adherence to Mediterranean diet 1.78 (1.21-2.63) and absence of abdominal obesity 1.70 (1.19-2.43) were the strongest predictors for reversion to normal glucose. However, those did not modify the ORs of reversion to normal glucose. Taking as reference those with both impaired parameters, subjects with FPG impairment (FPG group) had an OR of 4.87 (3.10-7.65) and 3.72 (2.39-5.78) for HbA1c group. These estimates remained almost the same after further adjustment for biochemical parameters and lifestyle factors (4.55(2.84-7.28) and 3.09 (1.92-4.97), respectively). Optimal lifestyle factors showed to be a positive predictor for reversion to normal glucose regulation however, the differences of reversion risk according type of prediabetes are not explained by lifestyle factors.

Cost Analysis of FreeStyle Libre® 2 System in Type 2 Diabetes Mellitus Population.

INTRODUCTION: FreeStyle Libre® 2 system is a sensor-based flash-monitoring system that measures interstitial fluid glucose. The study aimed to compare cost of FreeStyle Libre 2 system and self-monitoring of blood glucose (SMBG) in the type 2 diabetes mellitus (T2DM) population from the Spanish Health System perspective. METHODS: On the basis of data collected from a literature review, the cost of glucose monitoring was modelled for patients with T2DM on a basal-bolus insulin regimen. The cost estimate included annual consumption for glucose monitoring (strips, lancets and sensors) and severe hypoglycaemic events (SHE) management. A published rate of SHE (2.5 episodes/patient-year) was considered. A reduction of SHE (- 48.8%) associated with FreeStyle Libre 2 system, derived from the REPLACE trial, was applied. Hospital attendance for 20.5% of SHEs (with subsequent hospitalization in 16.0%) was applied. Consumption of strips and lancets was set at 6/day for SMBG (derived from national monitoring recommendations), and 0.2/day for FreeStyle Libre 2 system users, with 26 FreeStyle Libre 2 sensors/year. Unitary costs (€, year 2020 excluding VAT) were derived from literature (€0.28/strip; €0.09/lancet; €3.09/daily FM sensor; €3804/hospitalized SHE; €1794/hospital-attended non-admitted SHE; €389/community-attended SHE). RESULTS: Costs were €2700 and €2120/year/patient using SMBG or FreeStyle Libre 2 system, respectively. For 1000 patients with T2DM using basal-bolus insulin, 1220 SHEs/year (with 48 hospitalizations) could be prevented and FreeSytle Libre 2 system could generate cost savings of up to €580,953/year versus SMBG (- 21.5%). CONCLUSION: FreeStyle Libre 2 system is a potential cost-saving strategy in patients with T2DM in Spain on a basal-bolus insulin regimen.

Incidence and costs of cardiovascular events in Spanish patients with type 2 diabetes mellitus: a comparison with general population, 2015.

INTRODUCTION: Cardiovascular (CV) disease affects a high percentage of patients with type 2 diabetes mellitus (T2DM), especially in the hospital setting, impacting on mortality, complications, quality of life and use of health resources. The aim of this study was to estimate the incidence, mean length of hospital stay (LOHS) and costs attributable to hospital admissions due to CV events in patients with T2DM versus patients without diabetes mellitus (non-DM) in Spain. RESEARCH DESIGN AND METHODS: Retrospective observational study based on the Spanish National Hospital Discharge Database for 2015. Hospital admissions for patients aged ≥35 years with a diagnosis of CV death, non-fatal acute myocardial infarction (AMI), non-fatal stroke, unstable angina, heart failure and revascularization were evaluated. The International Classification of Diseases, Ninth Revision (250.x0 or 250.x2) coding was used to classify records of patients with T2DM. For each CV complication, the hospital discharges of the two groups, T2DM and non-DM, were precisely matched and the number of hospital discharges, patients, LOHS and mean cost were quantified. Additional analyses assessed the robustness of the results. RESULTS: Of the 276 925 hospital discharges analyzed, 34.71% corresponded to patients with T2DM. A higher incidence was observed in all the CV complications studied in the T2DM population, with a relative risk exceeding 2 in all cases. The mean LOHS (days) was longer in the T2DM versus the non-DM group for: non-fatal AMI (7.63 vs 7.02, p<0.001), unstable angina (5.11 vs 4.78, p=0.009) and revascularization (7.96 vs 7.57, p<0.001). The mean cost per hospital discharge was higher in the T2DM versus the non-DM group for non-fatal AMI (€6891 vs €6876, p=0.029) and unstable angina (€3386 vs €3304, p<0.001). CONCLUSIONS: Patients with T2DM had a higher incidence and number of hospital admissions per patient due to CV events versus the non-DM population. This generates a significant clinical and economic burden given the longer admission stay and higher costs associated with some of these complications.

[Recommendations for clinical practice in diabetes and obesity. The Madrid Agreements. Document agreed by the working groups of the scientific societies: SENDIMAD, SOMAMFYC, SEMG Madrid, SEMERGEN Madrid and RedGDPS]. / Recomendaciones para la práctica clínica en diabetes y obesidad. Los acuerdos de Madrid. Documento consensuado por los grupos de trabajo de las sociedades científicas: SENDIMAD, SOMAMFYC, SEMG Madrid, SEMERGEN Madrid y RedGDPS.

The increase in the prevalence of type 2 diabetes and the worldwide expansion of overweight and obesity are intrinsically linked. The percentage of diabetes attributable to weight gain amounts to more than 80% in many countries. This relationship is addressed in a Spanish Consensus Document from SEMI, SED, redGDPS, SEC, SEEDO, SEEN, SEMERGEN and SEMFYC published in 2015 and which gathers best available evidences. Based on the statements of this consensus document, we propose five recommendations for clinical practice to establish a diagnosis of precision and the most appropriate treatment for joint diabetes and obesity. These recommendations have been agreed by the SENDIMAD, SOMAMFYC, SEMG Madrid and RedGDPS Working Groups: 1. For every patient with diabetes and obesity, in addition to the calculation of the body mass index, the percentage of body fat and the approximation to the assessment of body composition should be evaluated throughout the whole process (both at the beginning and follow up). 2. The approximation to the degree and distribution of body fat requires the measurement and recording of the waist circumference of these patients. 3. The integrated assessment of the patient with type 2 diabetes-obesity requires the evaluation of the degree of physical activity and/or characterization of the sedentary condition. 4. The prescription of lifestyle changes should be incorporated into therapeutic education (individualized, flexible, autonomous and sustainable diet and physical activity plan. 5. The pharmacological approach in the treatment of type 2 diabetes-obesity implies the choice of anti-diabetic drugs that facilitate the loss of fat.

El aumento en la prevalencia de diabetes tipo 2 y la expansión a nivel mundial de los estados de sobrepeso y obesidad están intrínsecamente vinculados, de forma que el porcentaje de diabetes atribuible al aumento de peso llega a ser superior al 80% en muchos países. En 2015 se publica un Documento de Consenso español de SEMI, SED, redGDPS, SEC, SEEDO, SEEN, SEMERGEN y SEMFYC que aborda esta doble condición de acuerdo con las mejores evidencias. Desde las afirmaciones de dicho consenso proponemos cinco recomendaciones para la práctica clínica consensuadas por los Grupos de trabajo de SENDIMAD, SOMAMFYC, SEMG Madrid y RedGDPS, con el fin de establecer un diagnóstico de precisión y el tratamiento más adecuado:1. En todo paciente con diabetes y obesidad debe abordarse, tanto al inicio como en el seguimiento, además del cálculo del índice de masa corporal (IMC), el porcentaje de grasa corporal y la valoración de la composición corporal.2. La aproximación al grado y distribución de la grasa corporal requiere incluir la medición y registro del perímetro de cintura de estos pacientes.3. La valoración integral del paciente con diabetes tipo 2-obesidad exige la evaluación del grado de actividad física y/o caracterizar la condición de sedentarismo.4. La prescripción de cambios del estilo de vida debe ser incorporada a la educación terapéutica (plan dietético y de actividad física individualizado, flexible, autónomo y sostenible).5. El abordaje farmacológico en el tratamiento de la diabetes-obesidad implica la elección de fármacos antidiabéticos que faciliten la pérdida de grasa.

Recomendaciones para la práctica clínica en diabetes y obesidad. los acuerdos de madrid. documento consensuado por los grupos de trabajo de las sociedades científicas: sendimad, somamfyc, semg madrid, semergen madrid y redgdps / Recommendations for clinical practice in diabetes and obesity. The Madrid Agreements. Document agreed by the working groups of the scientific societies: SENDIMAD, SOMAMFYC, SEMG Madrid, SEMERGEN Madrid and RedGDPS

El aumento en la prevalencia de diabetes tipo 2 y la expansión a nivel mundial de los estados de sobrepeso y obesidad están intrínsecamente vinculados, de forma que el porcentaje de diabetes atribuible al aumento de peso llega a ser superior al 80% en muchos países. En 2015 se publica un Documento de Consenso español de SEMI, SED, redGDPS, SEC, SEEDO, SEEN, SEMERGEN y SEMFYC que aborda esta doble condición de acuerdo con las mejores evidencias. Desde las afirmaciones de dicho consenso proponemos cinco recomendaciones para la práctica clínica consensuadas por los Grupos de trabajo de SENDIMAD, SOMAMFYC, SEMG Madrid y RedGDPS, con el fi n de establecer un diagnóstico de precisión y el tratamiento más adecuado: 1. En todo paciente con diabetes y obesidad debe abordarse, tanto al inicio como en el seguimiento, además del cálculo del índice de masa corporal (IMC), el porcentaje de grasa corporal y la valoración de la composición corporal. 2. La aproximación al grado y distribución de la grasa corporal requiere incluir la medición y registro del perímetro de cintura de estos pacientes. 3. La valoración integral del paciente con diabetes tipo 2-obesidad exige la evaluación del grado de actividad física y/o caracterizar la condición de sedentarismo. 4. La prescripción de cambios del estilo de vida debe ser incorporada a la educación terapéutica (plan dietético y de actividad física individualizado, flexible, autónomo y sostenible). 5. El abordaje farmacológico en el tratamiento de la diabetes-obesidad implica la elección de fármacos antidiabéticos que faciliten la pérdida de grasa

The increase in the prevalence of type 2 diabetes and the worldwide expansion of overweight and obesity are intrinsically linked. The percentage of diabetes attributable to weight gain amounts to more than 80% in many countries. This relationship is addressed in a Spanish Consensus Document from SEMI, SED, redGDPS, SEC, SEEDO, SEEN, SEMERGEN and SEMFYC published in 2015 and which gathers best available evidences. Based on the statements of this consensus document, we propose five recommendations for clinical practice to establish a diagnosis of precision and the most appropriate treatment for joint diabetes and obesity. These recommendations have been agreed by the SENDIMAD, SOMAMFYC, SEMG Madrid and RedGDPS Working Groups: 1. For every patient with diabetes and obesity, in addition to the calculation of the body mass index, the percentage of body fat and the approximation to the assessment of body composition should be evaluated throughout the whole process (both at the beginning and follow up). 2. The approximation to the degree and distribution of body fat requires the measurement and recording of the waist circumference of these patients. 3. The integrated assessment of the patient with type 2 diabetes-obesity requires the evaluation of the degree of physical activity and/or characterization of the sedentary condition. 4. The prescription of lifestyle changes should be incorporated into therapeutic education (individualized, fl exible, autonomous and sustainable diet and physical activity plan. 5. The pharmacological approach in the treatment of type 2 diabetes-obesity implies the choice of anti-diabetic drugs that facilitate the loss of fat

Impact of hypoglycemic episodes on health-related quality of life of type-2 diabetes mellitus patients: development and validation of a specific QoLHYPO© questionnaire.

BACKGROUND: Hypoglycemia is a limiting factor to achieving optimal glycemic control in patients with type-2 diabetes mellitus (T2DM), increasing risk of death and complications, reducing health-related quality of life (HRQoL) and work productivity and increasing healthcare costs. The study's primary objective was to develop and validate a specific questionnaire to assess the impact of hypoglycemia on the HRQoL of T2DM patients (QoLHYPO© questionnaire). METHODS: A two-phase multicenter prospective, longitudinal, observational, epidemiologic study of consecutively enrolled patients, not involving any drug, was conducted: In phase 1 (questionnaire development), patients who had given their written informed consent, who were at least 30 years of age, had been diagnosed with T2DM at least 5 years prior, had an HbA1c test in the previous 3 months, and a hypoglycemic episode in the previous 6 months were included. To validate the questionnaire and assess reliability and responsiveness, phase 2 included two cohorts of patients. Patients in the reliability cohort would likely have stable clinical course during the 3 weeks following inclusion in the study and patients in the responsiveness cohort would likely experience changes in their clinical course in the 3 months after enrollment. RESULTS: Phase 1 included 168 patients: 10 attended semi-structured interviews, 18 for face validity, and 140 for the pilot test (Rasch analysis). Phase 2 included 227 patients: 142 in the reliability cohort and 85 in the responsiveness cohort. Of the 37 items initially included in Phase 1, 11 (floor/ceiling effect analysis) and 13 (Rasch analysis) were discarded. The final version of the questionnaire consisted of 13 items. Phase 2 results showed the questionnaire was unidimensional and able to accurately assess HRQoL. Intra-observer reproducibility (ICC = 0.920) and internal consistency (Cronbach's alpha: visit 1 = 0.912; visit 2 = 0.901) were high, showing high reliability. Internal responsiveness was moderate (standardized effect size 0.5-0.8) and external responsiveness was lower (AUC > 0.5; not statistically significant). Minimal clinically important difference (MCID) was estimated to be 3.2 points. CONCLUSIONS: The QoLHYPO© questionnaire is a tool that can be used in routine clinical practice to assess the impact of hypoglycemia on the HRQoL of T2DM patients.

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)

Abordaje de la adherencia en diabetes mellitus tipo 2: situación actual y propuesta de posibles soluciones / Adherence of Type 2 Diabetes Mellitus approach: Current situation and possible solutions

OBJETIVOS: Definir el impacto y las causas de la falta de adherencia terapéutica en los pacientes con diabetes mellitus tipo 2 (DM2), las posibles intervenciones para mejorarla y el papel de las distintas partes implicadas. DISEÑO: Valoración de cuestionario estructurado mediante método Delphi aplicado en 2 rondas. Emplazamiento: Estudio realizado en el ámbito de atención primaria. PARTICIPANTES: Panel formado por profesionales médicos de reconocido prestigio y con amplia experiencia en diabetes. MEDICIONES PRINCIPALES: Valoración a través de una escala Likert de 9 puntos del grado de acuerdo o desacuerdo de 131 ítems agrupados en 4 bloques: impacto; causas de incumplimiento; diagnóstico de la falta de adherencia y de sus posibles causas, y mejores intervenciones y papel de los distintos roles implicados en la mejora de la adherencia. RESULTADOS: Con una tasa de participación del 76,31%, los profesionales sanitarios de atención primaria consensuaron 110 de las 131 aseveraciones propuestas (84%), mostrando acuerdo en 102 ítems (77,9%) y desacuerdo en 8 (6,1%). No se logró consenso en 21 ítems. CONCLUSIONES: La falta de adherencia en los pacientes con DM2 dificulta lograr el control terapéutico. La formación específica y disponer de los recursos necesarios en la consulta son esenciales para minimizar el impacto de la falta de adherencia terapéutica

OBJECTIVES: Define the impact and causes of non-adherent type-2 diabetes mellitus (DM2) patients, possible solutions and the role of the different health care professionals involved in the treatment. DESIGN: Structured questionnaire rating by a two-round Delphi method. LOCATION: The study was conducted in the Primary Care settings. PARTICIPANTS: The expert panel consisted of renowned medical professionals with extensive experience in diabetes. MAIN MEASUREMENTS: Assessment through a 9-point Likert scale, of the degree of agreement or disagreement on 131 items grouped into 4 blocks: impact; causes of nonadherence; diagnosis of non-adherence, and possible causes, solutions and role of the different professionals involved in adherence. RESULTS: The participation rate was 76.31%. The primary care health professionals agreed on 110 of the 131 proposals statements (84%), showing agreement on 102 items (77.9%) and disagreement in 8 (6.1%). Consensus was not reached on 21 items. CONCLUSIONS: The lack of adherence of DM2 patients makes the achievement of therapeutic control difficult. The medical practice needs to have specific training and enough resources to reduce the impact of the lack of therapeutic compliance

[Adherence of Type 2 Diabetes Mellitus approach: Current situation and possible solutions]. / Abordaje de la adherencia en diabetes mellitus tipo2: situación actual y propuesta de posibles soluciones.

OBJECTIVES: Define the impact and causes of non-adherent type-2 diabetes mellitus (DM2) patients, possible solutions and the role of the different health care professionals involved in the treatment. DESIGN: Structured questionnaire rating by a two-round Delphi method. LOCATION: The study was conducted in the Primary Care settings. PARTICIPANTS: The expert panel consisted of renowned medical professionals with extensive experience in diabetes. MAIN MEASUREMENTS: Assessment through a 9-point Likert scale, of the degree of agreement or disagreement on 131 items grouped into 4 blocks: impact; causes of nonadherence; diagnosis of non-adherence, and possible causes, solutions and role of the different professionals involved in adherence. RESULTS: The participation rate was 76.31%. The primary care health professionals agreed on 110 of the 131 proposals statements (84%), showing agreement on 102 items (77.9%) and disagreement in 8 (6.1%). Consensus was not reached on 21 items. CONCLUSIONS: The lack of adherence of DM2 patients makes the achievement of therapeutic control difficult. The medical practice needs to have specific training and enough resources to reduce the impact of the lack of therapeutic compliance.

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.

Consenso sobre la detección y el manejo de la prediabetes. Grupo de Trabajo de Consensos y Guías Clínicas de la Sociedad Española de Diabetes / Consensus on the detection and management of prediabetes. Consensus and Clinical Guidelines Working Group of the Spanish Diabetes Society

En España, según datos del estudio Di@bet.es, un 13,8% de la población adulta padece diabetes y un 14,8% algún tipo de prediabetes (intolerancia a la glucosa, glucemia basal alterada o ambas). Puesto que la detección precoz de la prediabetes puede facilitar la puesta en marcha de medidas terapéuticas que eviten su progresión a diabetes, consideramos que las estrategias de prevención en las consultas de atención primaria y especializada deberían consensuarse. La detección de diabetes y prediabetes mediante un cuestionario específico (test de FINDRISC) y/o la determinación de la glucemia basal en pacientes de riesgo permiten detectar los pacientes con riesgo de desarrollar la enfermedad y es necesario considerar cómo debe ser su manejo clínico. La intervención sobre los estilos de vida puede reducir la progresión a diabetes o hacer retroceder un estado prediabético a la normalidad y es una intervención coste-efectiva. Algunos fármacos, como la metformina, también se han mostrado eficaces en reducir la progresión a diabetes aunque no son superiores a las intervenciones no farmacológicas. Finalmente, aunque no hay pruebas sólidas que apoyen la eficacia del cribado en términos de morbimortalidad, sí que se ha observado una mejora de los factores de riesgo cardiovascular. El Grupo de Trabajo de Consensos y Guías Clínicas de la Sociedad Española de Diabetes, ha elaborado unas recomendaciones que han sido consensuadas con la Sociedad Española de Endocrinología y Nutrición, la Sociedad Española de Endocrinología Pediátrica, la Sociedad Española de Farmacia Comunitaria, la Sociedad Española de Medicina Familiar y Comunitaria, la Sociedad Española de Médicos Generales, la Sociedad Española de Médicos de Atención Primaria, la Sociedad Española de Medicina Interna y la Asociación de Enfermería Comunitaria y la Red de Grupos de Estudio de la Diabetes en Atención Primaria

In Spain, according to the Di@bet.es study, 13.8% of the adult population suffers from diabetes and 14.8% from some form of prediabetes (impaired glucose tolerance, impaired fasting glucose or both). Since early detection of prediabetes can facilitate the implementation of therapeutic measures to prevent its progression to diabetes, we believe that preventive strategies in primary care and specialized clinical settings should be agreed. Screening for diabetes and prediabetes using a specific questionnaire (FINDRISC) and/or the measurement of fasting plasma glucose in high risk patients leads to detecting patients at risk of developing diabetes and it is necessary to consider how they should be managed. The intervention in lifestyle can reduce the progression to diabetes and reverse a prediabetic state to normal and is a cost-effective intervention. Some drugs, such as metformin, have also been shown effective in reducing the progression to diabetes but are not superior to non-pharmacological interventions. Finally, an improvement in some cardiovascular risk factors has been observed although there is no strong evidence supporting the effectiveness of screening in terms of morbility and mortality. The Consensus and Clinical Guidelines Working Group of the Spanish Diabetes Society has issued some recommendations that have been agreed by the Sociedad Española de Endocrinología y Nutrición, Sociedad Española de Endocrinología Pediátrica, Sociedad Española de Farmacia Comunitaria, Sociedad Española de Medicina Familiar y Comunitaria, Sociedad Española de Médicos Generales, Sociedad Española de Médicos de Atención Primaria, Sociedad Española de Medicina Interna, Asociación de Enfermería Comunitaria and Red de Grupos de Estudio de la Diabetes en Atención Primaria

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.

Prevalencia de diabetes mellitus tipo 2 en pacientes ambulatorios con sobrepeso u obesidad en España. Estudio OBEDIA / Prevalence of type 2 diabetes mellitus in overweight or obese patients outpatients in Spain. OBEDIA Study

Fundamento y objetivo: El incremento de la prevalencia de diabetes mellitus tipo 2 (DM2) está relacionado con el aumento de la obesidad. El estudio pretendió determinar la prevalencia de DM2 en pacientes con sobrepeso u obesidad que acudían a centros de atención primaria y especializada de España. Pacientes y método: Estudio transversal (con 2 fases simultáneas) y multicéntrico, de ámbito nacional, en condiciones de práctica clínica habitual. En la primera fase, diseñada para el cálculo de la prevalencia de DM2, se incluyeron 169.023 pacientes, y en la segunda, 7.754 pacientes sobre los que definir el perfil sociodemográfico, clínico y metabólico de la DM2 en función del índice de masa corporal (IMC). Resultados: La prevalencia de DM2 en sobrepeso u obesidad fue del 23,6%, en los pacientes con sobrepeso del 17,8% y en los obesos del 34,8%. En función del sexo, la DM2 se constató en el 20,2% de los varones y en el 16,4% de las mujeres. Globalmente, la media (DE) de factores de riesgo asociados a DM2 fue de 4,4 (0,8), destacando dislipidemia (92,6%), hipertensión (73,7%) y sedentarismo (62,5%). El 37,8% presentó complicaciones vasculares de su DM2. El 43,1% se consideró bien controlado metabólicamente (hemoglobina glucosilada < 7%). Conclusiones: La DM2 se asocia a sobrepeso y obesidad y aumenta con el grado de IMC. Dislipidemia, hipertensión y sedentarismo en DM2 se incrementan con el aumento del IMC. Los pacientes con peor control metabólico se asocian a mayor grado de obesidad (AU)

Background and objective: The increase in the prevalence of type 2 diabetes mellitus (T2DM) is related to the increase of obesity. We aimed to determine the Spanish prevalence of T2DM in patients with overweight or obesity attended by either family or specialist physicians. Patients and method: Cross-sectional, multicenter and simultaneous 2-phase design, performed under clinical conditions. Phase A was designed to determine T2DM prevalence: 169,023 patients were recruited. Phase B was designed to define socio-demographic, clinical and metabolic profile of T2DM according to the body mass index (BMI): 7,754 patients were included. Results: T2DM prevalence in overweight or obese patients was 23.6%; 17.8% of overweight patients were diabetic and T2DM was present in 34.8% of obese people. According to sex, 20.2% of men and 16.4% of women had T2DM. Overall, the mean of risk factors related to T2DM was 4.4 (SD 0,8); out of them, 92.6% patients had dyslipidemia, 73.7% hypertension and 62.5% performed a low physical activity. 37.8% of diabetic patients had vascular involvement. Only 43.1% of patients showed a proper metabolic control of T2DM (glycosilated hemoglobin < 7%). Conclusions: T2DM is related to overweight and obesity and higher the BMI is, higher the T2DM prevalence. Dyslipidemia, hypertension and a low physical activity in diabetic patients are more frequent when BMI increases. Patients with inadequate metabolic control have a higher BMI (AU)

[Consensus document on treatment of type 2 diabetes in patients with chronic kidney disease]. / Documento de Consenso sobre el tratamiento de la diabetes tipo 2 en el paciente con enfermedad renal crónica.

Chronic kidney disease (CKD) and type 2 diabetes mellitus (T2DM) are highly prevalent chronic diseases that represent a significant public health problem and require multidisciplinary management. T2DM is the main cause of CKD in our setting and it is also a major comorbidity of non-diabetic nephropathy. Patients with diabetes and renal failure represent a special risk group as they have higher morbidity and mortality and are at a higher risk of hypoglycaemia than diabetic individuals with normal renal function. Treatment of T2DM in patients with CKD is controversial because of the scarcity of evidence available. This consensus document aims to facilitate the appropriate selection and dosage of anti-diabetic drugs as well as establishing glycaemic control safety targets in patients with CKD.

Tratamiento de la diabetes tipo 2 en el paciente con enfermedad renal crónica / Treatment of type 2 diabetes mellitus in patients with chronic kidney disease

La enfermedad renal crónica (ERC) y la diabetes mellitus tipo 2 (DM2) son afecciones crónicas de elevada prevalencia que representan un importante problema de salud pública y requieren un abordaje interdisciplinario. La DM2 es la principal causa de ERC en nuestro medio y también constituye una importante comorbilidad de la nefropatía no diabética. Los pacientes con diabetes e insuficiencia renal son un grupo de especial riesgo, pues presentan una mayor morbimortalidad y un superior riesgo de hipoglucemias que los sujetos diabéticos con función renal normal. El tratamiento de la DM2 en los pacientes con ERC resulta controvertido dada la escasez de evidencias disponibles. El presente documento de consenso pretende facilitar la adecuada elección y dosificación de los fármacos antidiabéticos y el establecimiento de unos objetivos seguros de control glucémico en los pacientes con ERC (AU)

Chronic kidney disease (CKD) and type 2 diabetes mellitus (T2DM) are highly prevalent chronic diseases, which represent an important public health problem and require a multidisciplinary management. T2DM is the main cause of CKD and it also causes a significant comorbidity with regard to non-diabetic nephropathy. Patients with diabetes and kidney disease represent a special risk group as they have higher morbi-mortality as well as higher risk of hypoglycemia than diabetic individuals with a normal kidney function. Treatment of T2DM in patients with CKD is controversial because of the scarcity of available evidence. The current consensus report aims to ease the appropriate selection and dosage of antidiabetic treatments as well as the establishment of safety objectives of glycemic control in patients with CKD (AU)

[Treatment of type 2 diabetes mellitus in patients with chronic kidney disease. Grupo de Trabajo para el Documento de Consenso sobre el tratamiento de la diabetes tipo 2 en el paciente con enfermedad renal crónica]. / Tratamiento de la diabetes tipo 2 en el paciente con enfermedad renal crónica.

Chronic kidney disease (CKD) and type 2 diabetes mellitus (T2DM) are highly prevalent chronic diseases, which represent an important public health problem and require a multidisciplinary management. T2DM is the main cause of CKD and it also causes a significant comorbidity with regard to non-diabetic nephropathy. Patients with diabetes and kidney disease represent a special risk group as they have higher morbi-mortality as well as higher risk of hypoglycemia than diabetic individuals with a normal kidney function. Treatment of T2DM in patients with CKD is controversial because of the scarcity of available evidence. The current consensus report aims to ease the appropriate selection and dosage of antidiabetic treatments as well as the establishment of safety objectives of glycemic control in patients with CKD.