Multicausal analysis of mortality due to diabetes mellitus in Spain, 2016-2018.

OBJECTIVES: This study aimed to assess multicausal mortality due to diabetes from 2016-2018 in Spain. Specific objectives were to quantify the occurrence of diabetes as an underlying cause or as any registered cause on the death certificate. MATERIALS AND METHODS: A cross-sectional descriptive study taking a multicausal approach. RESULTS: Diabetes appears as an underlying cause of 2.3% of total deaths in Spain, and as any cause in 6.2%. In patients in whom Diabetes appears as an underlying cause on the death certificates, the 15 most frequent immediate causes are cardiovascular diseases in men(prevalence ratio 1,59)and women (PR1,31). In men, the causes associated with diabetes as any cause were skin diseases(prevalence ratio 1.33), followed by endocrine diseases(prevalence ratio 1.26)and genitourinary diseases (prevalence ratio1.14). In women, the causes associated with the presence of diabetes as any cause were endocrine (prevalence ratio 1.13)and genitourinary (prevalence ratio 1.04)diseases. CONCLUSIONS: In patients in whom diabetes appears as an underlying cause on the death certificates, the 15 most frequent immediate causes are cardiovascular diseases. In men, the causes associated with the presence of diabetes as any cause of death are skin, endocrine and genitourinary diseases. In women, the causes associated with diabetes as any cause are endocrine and genitourinary.

Diabetes Does Not Increase the Risk of Hospitalization Due to COVID-19 in Patients Aged 50 Years or Older in Primary Care-APHOSDIAB-COVID-19 Multicenter Study.

The purpose of this study was to identify clinical, analytical, and sociodemographic variables associated with the need for hospital admission in people over 50 years infected with SARS-CoV-2 and to assess whether diabetes mellitus conditions the risk of hospitalization. A multicenter case-control study analyzing electronic medical records in patients with COVID-19 from 1 March 2020 to 30 April 2021 was conducted. We included 790 patients: 295 cases admitted to the hospital and 495 controls. Under half (n = 386, 48.8%) were women, and 8.5% were active smokers. The main comorbidities were hypertension (50.5%), dyslipidemia, obesity, and diabetes (37.5%). Multivariable logistic regression showed that hospital admission was associated with age above 65 years (OR from 2.45 to 3.89, ascending with age group); male sex (OR 2.15, 95% CI 1.47-3.15), fever (OR 4.31, 95% CI 2.87-6.47), cough (OR 1.89, 95% CI 1.28-2.80), asthenia/malaise (OR 2.04, 95% CI 1.38-3.03), dyspnea (4.69, 95% CI 3.00-7.33), confusion (OR 8.87, 95% CI 1.68-46.78), and a history of hypertension (OR 1.61, 95% CI 1.08-2.41) or immunosuppression (OR 4.97, 95% CI 1.45-17.09). Diabetes was not associated with increased risk of hospital admission (OR 1.18, 95% CI 0.80-1.72; p = 0.38). Diabetes did not increase the risk of hospital admission in people over 50 years old, but advanced age, male sex, fever, cough, asthenia, dyspnea/confusion, and hypertension or immunosuppression did.

The influence of hemoglobin A1c levels on cardiovascular events and all-cause mortality in people with diabetes over 70 years of age. A prospective study.

AIM: Glycated hemoglobin A1c (HbA1c) is a reliable risk factor of cardiovascular diseases in diabetic patients, but information about this relationship in elderly patients is scarce. The aim of this study is to analyze, the relationship between HbA1c levels and the risk of mayor adverse cardiovascular events (MACE) in patients with diabetes over 70 years. METHODS: Prospective study of subjects with diabetes using electronic health records from the universal public health system in the Valencian Community, Spain, 2008-2012. We included men and women aged≥70 years with diabetes who underwent routine health examinations in primary care. Primary endpoint was the incidence of MACE: all-cause mortality and/or hospital admission due to coronary heart disease or stroke. A standard Cox and Cox-Aalen models were adjusted. RESULTS: 5016 subjects were included whit a mean age of 75.1 years (46.7% men). During an average follow-up of 49 months (4.1 years), 807 (16.1%) MACE were recorded. The incidence of MACE was 20.6 per 1000-person-years. Variables significantly associated to the incidence of MACE were male gender (HR: 1.61), heart failure (HR: 2.26), antiplatelet therapy (HR: 1.39), oral antidiabetic treatment (HR: 0.74), antithrombotics (HR: 1.79), while age, creatinine, HbA1c and peripheral arterial disease were time-depend associated variables. CONCLUSION: These results highlights the importance of HbA1c level in the incidence of cardiovascular events in older diabetic patients.

Manejo de la hiperglucemia con fármacos no insulínicos en pacientes adultos con diabetes tipo 2 / Management of hyperglycaemia with non-insulin drugs in adult patients with type 2 diabetes

El adecuado tratamiento de la diabetes mellitus tipo 2 (DM2) incluye la alimentación saludable y el ejercicio (150 min/semana) como pilares básicos. Para el tratamiento farmacológico, la metformina es el fármaco de elección inicial, salvo contraindicación o intolerancia; en caso de mal control, se dispone de 8 familias terapéuticas (6 orales y 2 inyectables) como posibles combinaciones. Se presenta un algoritmo y unas recomendaciones para el tratamiento de la DM2. En prevención secundaria cardiovascular se recomienda asociar un inhibidor del cotransportador sodio-glucosa tipo2 (iSGLT2) o un agonista del receptor de glucagon-like peptide-1 (arGLP1) en pacientes con obesidad. En prevención primaria, si el paciente presenta obesidad o sobrepeso la metformina deberá combinarse con iSGLT2, arGLP1 o inhibidores de la dipeptidilpeptidasa tipo 4 (iDPP4). Si el paciente no presenta obesidad, podrán emplearse los iDPP4, los iSGLT2 o la gliclazida, sulfonilurea recomendada por su menor tendencia a la hipoglucemia

Treatment of diabetes mellitus type 2 (DM2) includes healthy eating and exercise (150 minutes/week) as basic pillars. For pharmacological treatment, metformin is the initial drug except contraindication or intolerance; in case of poor control, 8 therapeutic families are available (6 oral and 2 injectable) as possible combinations. An algorithm and some recommendations for the treatment of DM2 are presented. In secondary cardiovascular prevention, it is recommended to associate an inhibitor of the sodium-glucose cotransporter type 2 (iSGLT2) or a glucagon-like peptide-1 receptor agonist (arGLP1) in patients with obesity. In primary prevention if the patient is obese or overweight metformin should be combined with iSGLT2, arGLP1, or inhibitors of type 4 dipeptidylpeptidase (iDPP4). If the patient does not present obesity, iDPP4, iSGLT2 or gliclazide, sulfonylurea, recommended due to its lower tendency to hypoglycaemia, may be used

[Management of hyperglycaemia with non-insulin drugs in adult patients with type 2 diabetes]. / Manejo de la hiperglucemia con fármacos no insulínicos en pacientes adultos con diabetes tipo 2.

Treatment of diabetes mellitus type2 (DM2) includes healthy eating and exercise (150minutes/week) as basic pillars. For pharmacological treatment, metformin is the initial drug except contraindication or intolerance; in case of poor control, 8 therapeutic families are available (6 oral and 2 injectable) as possible combinations. An algorithm and some recommendations for the treatment of DM2 are presented. In secondary cardiovascular prevention, it is recommended to associate an inhibitor of the sodium-glucose cotransporter type 2 (iSGLT2) or a glucagon-like peptide-1 receptor agonist (arGLP1) in patients with obesity. In primary prevention if the patient is obese or overweight metformin should be combined with iSGLT2, arGLP1, or inhibitors of type4 dipeptidylpeptidase (iDPP4). If the patient does not present obesity, iDPP4, iSGLT2 or gliclazide, sulfonylurea, recommended due to its lower tendency to hypoglycaemia, may be used.

A Review of Practical Issues on the Use of Glucagon-Like Peptide-1 Receptor Agonists for the Management of Type 2 Diabetes.

Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) are well established as effective treatments for patients with type 2 diabetes. GLP-1 RAs augment insulin secretion and suppress glucagon release via the stimulation of GLP-1 receptors. Although all GLP-1 RAs share the same underlying mechanism of action, they differ in terms of formulations, administration, injection devices and dosages. With six GLP-1 RAs currently available in Europe (namely, immediate-release exenatide, lixisenatide, liraglutide; prolonged-release exenatide, dulaglutide and semaglutide), each with its own characteristics and administration requirements, physicians caring for patients in their routine practice face the challenge of being cognizant of all this information so they are able to select the agent that is most suitable for their patient and use it in an efficient and optimal way. The objective of this review is to bring together practical information on the use of these GLP-1 RAs that reflects their approved use.Funding: Eli Lilly and Company.Plain Language Summary: Plain language summary available for this article.

Recomendaciones de la Sociedad Española de Diabetes (SED) para el tratamiento farmacológico de la hiperglucemia en la diabetes tipo 2: Actualización 2018 / Spanish Diabetes Society (SED) recommendations for the pharmacologic treatment of hyperglycemia in type 2 diabetes: 2018 Update

La diabetes mellitus tipo 2 (DM2) es un problema de dimensiones globales por su alta y creciente prevalencia en todo el mundo y por los costes personales y económicos asociados a ella. Un tratamiento adecuado ha demostrado reducir la mortalidad y las complicaciones asociadas. Recientemente se han incluido nuevos conceptos en la práctica clínica habitual y en el árbol de decisión de la terapia farmacológica de la DM2. Por ello, la Sociedad Española de Diabetes (SED) encargó al Grupo de Trabajo de Consensos y Guías Clínicas actualizar el documento de 2010 «Recomendaciones para el tratamiento farmacológico de la hiperglucemia en la diabetes tipo2». Entre los aspectos novedosos se incluyen nueve características para describir a cada grupo farmacológico: eficacia, riesgo de hipoglucemia, efectos en el peso corporal, efecto demostrado en el riesgo cardiovascular, nefroprotección, limitación de uso en la insuficiencia renal, frecuencia de los efectos secundarios, complejidad y coste. Así mismo, se detallan las opciones de combinación y se desarrollan el inicio y el ajuste de las terapias inyectables disponibles

Type 2 diabetes mellitus (DM2) has become a problem of global dimensions by their high and growing prevalence worldwide and the personal and economic costs associated with it. Correct treatment can reduce mortality and associated complications. New concepts have recently been included in routine clinical practice and have changed the algorithm of DM2 pharmacological therapy. Therefore, the Spanish Society of Diabetes (SED) entrusted to the Working Group of Consensus and Clinical Guidelines an update of the 2010 document Recommendations for Pharmacological Treatment of Hyperglycemia in Diabetes type2. Novel aspects include nine characteristics to describe each drug group: efficiency, the risk of hypoglycemia, effects on body weight, the demonstrated effect in cardiovascular risk, nephroprotection, limitation of use in renal insufficiency, the rate of secondary effects, complexity and costs. Additionally, the document details combination options, and develop the start and adjustment of available injectable therapies

Spanish Diabetes Society (SED) recommendations for the pharmacologic treatment of hyperglycemia in type 2 diabetes: 2018 Update. / Recomendaciones de la Sociedad Española de Diabetes (SED) para el tratamiento farmacológico de la hiperglucemia en la diabetes tipo 2: Actualización 2018.

Type 2 diabetes mellitus (DM2) has become a problem of global dimensions by their high and growing prevalence worldwide and the personal and economic costs associated with it. Correct treatment can reduce mortality and associated complications. New concepts have recently been included in routine clinical practice and have changed the algorithm of DM2 pharmacological therapy. Therefore, the Spanish Society of Diabetes (SED) entrusted to the Working Group of Consensus and Clinical Guidelines an update of the 2010 document Recommendations for Pharmacological Treatment of Hyperglycemia in Diabetes type2. Novel aspects include nine characteristics to describe each drug group: efficiency, the risk of hypoglycemia, effects on body weight, the demonstrated effect in cardiovascular risk, nephroprotection, limitation of use in renal insufficiency, the rate of secondary effects, complexity and costs. Additionally, the document details combination options, and develop the start and adjustment of available injectable therapies.

Consenso sobre tratamiento con insulina en la diabetes tipo 2 / Consensus on insulin treatment in type 2 diabetes

No disponible

Calculating individualized glycaemic targets using an algorithm based on expert worldwide diabetologists: Implications in real-life clinical practice.

BACKGROUND: The aim of this study was to assess the clinical implications of calculating an individualized HbA1c target using a recently published algorithm in a real-life clinical setting. METHODS: General practitioners (GPs) from the Spanish Society of Family Medicine Diabetes Expert Group were invited to participate in the study. Each GP selected a random sample of patients with diabetes from his or her practice and submitted their demographic and clinical data for analysis. Individualized glycaemic targets were calculated according to the algorithm. Predictors of good glycaemic control were studied. The rate of patients attaining their individualized glycaemic target or the uniform target of HbA1c  < 7.0% was calculated. RESULTS: Forty GPs included 408 patients in the study. Of the 8 parameters included in the algorithm, "comorbidities," "risk of hypoglycaemia from treatment," and "diabetes duration" had the greatest impact on determining the individualized glycaemic target. Number of glucose-lowering agents and adherence were independently associated with glycaemic control. Overall, 60.5% of patients had good glycaemic control per individualized target, and 56.1% were well controlled per the uniform target of HbA1c  < 7.0% (P = .20). However, 12.8% (23 of 246) of the patients with HbA1c  ≥ 7.0% were adequately controlled per individualized target, and 2.6% (6 of 162) of the patients with HbA1c  < 7.0% were uncontrolled since their individualized target was lower. CONCLUSIONS: In a real-life clinical setting, applying individualized targets did not change the overall rate of patients with good glycaemic control yet led to reclassification of 7.1% (29 of 408) of the patients. More studies are needed to validate these results in different populations.

Saxagliptina e insuficiencia cardiaca en el estudio SAVOR-TIMI 53: bajo la lupa de Bradford Hill / Saxagliptin and heart failure in the SAVOR-TIMI 53 Trial: reflections on the Bradford Hill criteria

No disponible

Prevalence of diabetic retinopathy and its relationship with glomerular filtration rate and other risk factors in patients with type 2 diabetes mellitus in Spain. DM2 HOPE study.

AIM: Diabetic retinopathy (DR) is the leading cause of blindness in working age population in developed countries. Albuminuria and estimated glomerular filtration rate (eGFR) have been considered biomarkers for DR. This study aimed to investigate the prevalence of DR and its relationship with eGFR and other risk factors in type 2 diabetic patients (T2DM) in Spain. METHODS: A cross-sectional and descriptive study has been performed in 14,266 patients. Clinical records were reviewed. Demographic data, clinical diagnoses, clinical variables, and results from laboratory tests were recorded. Prevalence rates of DR were calculated. Logistic regression analysis was applied to assess predictors of the DR presence/absence. RESULTS: DR prevalence was 14.9%, being more prevalent in women (p = 0.0087) and in older patients (p < 0.0001). Duration of disease (OR = 5.3, IC95% = 3.8-7.4; p < 0.0001), eGFR < 60 ml/min/1.73 m2 (OR = 2.0, IC95% 1.6-2.4; p < 0.0001), levels of HbA1c ≥ 7% (OR = 1.9, IC95% = 1.5-2.3; p < 0.0001) and high blood pressure (OR = 1.6, IC95% = 1.2-2.1; p = 0.0032) were associated with higher risk of DR. DR was also more frequent in patients taking insulin (32,6% vs. 10,2%; p < 0.0001). CONCLUSION: Around one in seven patients with T2DM has DR after nine years since diagnosis. Time since diagnosis, insulin therapy, cardiovascular profile, and renal dysfunction are associated with DR in patients with T2DM in Spain.

Attitudes towards insulin initiation in type 2 diabetes patients among healthcare providers: A survey research.

AIMS: To describe the views of healthcare providers about starting insulin in patients with type 2 diabetes and to determine the specific factors that contribute to delay insulin initiation. METHODS: Two-phases observational descriptive study. In the quantitative phase we conducted a cross-sectional survey of a sample of 380 healthcare professionals (general practitioners (GPs), endocrinologists, internists and nurses). In the qualitative phase, a discussion group reviewed the results of the survey to propose solutions. RESULTS: In poorly controlled patients, 46% of GPs vs. 43.2% of internists and 31.3% of endocrinologists waited 3-6months before starting insulin, and 71.4% of GPs vs. 66.7% of internists vs. 58.8% of endocrinologists need to confirm twice the HbA1c levels. The upper level of basal glucose more frequently considered as good control is 130mg/dL for GPs (35.7%), and 120mg/dL for internists (35.8%) and endocrinologists (37.5%). In patients without comorbidities, 32.5% of endocrinologists vs. 27.2% of internists vs. 17.9% of GPs initiated insulin when HbA1c was >7% while 26.3% of endocrinologists vs. 28.4% of internists vs. 38.4% of GPs initiated insulin when HbA1c was >8%. The interference of the therapy with the patient' social life and the need for time management were the most accepted barriers to initiate insulin. CONCLUSIONS: There are significant differences between GPs and endocrinologists regarding the insulin initiation and GPs and internists felt less empowered to manage patients with diabetes. Specific training for professionals and joint work with patients could improve the glycemic control.

Barriers to improved dyslipidemia control: Delphi survey of a multidisciplinary panel.

OBJECTIVE: To assess the barriers that make it difficult for the health care professionals (physicians, nurses and health care managers) to achieve a better control for dyslipidemia in Spain. METHODS: The study has an observational design and was performed using the modified Delphi technique. One hundred and forty-nine panel members from medicine, nursing and health care management fields and from different Spanish regions were selected randomly and were invited to participate. Individual and anonymous opinions were asked by answering a 42-items questionnaire via e-mail (two rounds were done). Level of agreement was assessed using measures of central tendency and dispersion. We analysed commonalities/differences between the three groups (Kappa index and McNemar chi-square). RESULTS: Response rate: 81%. The agreement index was 33.3 (95% CI: 18.9-47.7). Regarding the non-compliance with therapy, it improves with patient education degree in dyslipidemia, patient motivation, the agreement on decisions with the patient and with the use of cardiovascular risk measure and it gets worse with lack of information on the objectives to achieve. Clinical inertia improves with professional's motivation, cardiovascular risk calculation, training on objectives and the use of indicators and it gets worse with lack of treatment goals. CONCLUSION: Different perceptions and attitudes between medicine, nursing and health care management were found. An agreement in interventions in non-compliance and clinical inertia to improve dyslipidemia control was reached.

Impacto económico y sanitario de las hipoglucemias nocturnas asociadas al tratamiento de la diabetes mellitus tipo 2 con insulina glargina o insulina NPH / Economic impact of nocturnal hypoglycemia associated with the treatment of type 2 diabetes with insulin glargine or NPH insulin

OBJETIVO: Estimar el impacto sanitario y económico en España de las hipoglucemias nocturnas ligadas al tratamiento de la diabetes tipo2 (DM2) de insulina glargina (IG) o insulina NPH, administradas al acostarse. MÉTODOS: Se calcularon el coste actual de las hipoglucemias nocturnas graves y sintomáticas y los ahorros que se producirían para el Sistema Nacional de Salud (SNS) por la reducción de estas en el caso de que el tratamiento con NPH fuese parcialmente sustituido por IG. El uso de recursos sanitarios en la práctica clínica y el coste anual de las hipoglucemias se estimó mediante un panel de expertos clínicos de atención primaria y hospitalaria. La reducción en la tasa de hipoglucemias con IG frente a NPH se obtuvo de un metaanálisis publicado. RESULTADOS: Coste anual de las hipoglucemias: 1.121,98 (Euro) (518,90-1.990,19 (Euro)) en el caso de las graves, 473,85 (Euro) (243,22-733,82 (Euro)) las sintomáticas con niveles de glucosa < 36 mg/dl, y 295,83 (Euro) (149,63-406,59 (Euro)) con niveles < 70 mg/dl. Para una sustitución de NPH por IG del 4, del 7, del 10 y y del 11% en 4 años, en España se evitarían 6.772 episodios de hipoglucemia (487, 756 y 5.529, respectivamente, según su gravedad). El ahorro monetario para el SNS de este beneficio sanitario ascendería a 1,6 millones de euros (entre 829.000(Euro) y 2,5 millones de euros). CONCLUSIONES: El tratamiento al acostarse de la DM2 con IG (en comparación con NPH) podría reducir la tasa de hipoglucemias nocturnas y sus costes asociados para el SNS

OBJECTIVE: To estimate the health and economic impact in Spain of nocturnal hypoglycemia linked to the treatment of type2 diabetes with insulin glargine (IG) or NPH insulin, both administered before bedtime. METHODS: The current cost of severe and symptomatic nocturnal hypoglycemia and the savings for the National Health Service (NHS) as a result of the reduction in the rate of occurrence of nocturnal hypoglycemia was calculated in the hypothetical case that the treatment with NPH was partially replace by IG. The use of health resources in clinical practice and the annual cost of hypoglycemic events were estimated by an expert panel of primary care and hospital clinicians. The reduction in the rate of hypoglycemic events with IG versus NPH was obtained from a published meta-analysis. RESULTS: The annual cost of hypoglycemia was estimated at 1,121.98 (Euro) (518.90-1,990.19 (Euro)) in the case of severe hypoglycemia, 473.85 (Euro) (243.22-733.82 (Euro)) in case of symptomatic hypoglycemia with plasma glucose levels < 36 mg/dl, and 295.83 (Euro) (149.63-406.59 (Euro)) with levels < 70 mg/dl. For an estimated replacement of NPH by IG of 4%, 7%, 10%, and 11% in four years, in Spain 6,772 hypoglycemic events would be avoided (487, 756, and 5,529, respectively, depending on its severity). The savings for the NHS would correspond to 1.6 million (Euro) (ranging from (Euro) 829,000 to 2.5 million(Euro)). CONCLUSIONS: The treatment of diabetes type2 with IG (vs. NPH), both administered at bedtime, could reduce the rate of nocturnal hypoglycemia and the associated costs for the NHS

Documento de consenso sobre el tratamiento al alta hospitalaria del paciente con hiperglucemia / Consensus document on the management after hospital discharge of patient with hyperglycaemia

En el presente documento se pretende adaptar las recomendaciones generales establecidas en un consenso para la elaboración del informe de alta hospitalaria en especialidades médicas a las necesidades específicas de la población diabética hospitalizada. La diabetes es una enfermedad con un coste sanitario muy elevado, siendo el riesgo global de muerte entre personas con diabetes casi el doble que entre personas sin diabetes, lo que justifica que esta patología constituya uno de los diagnósticos más frecuentes en los pacientes hospitalizados y el creciente interés sobre el tratamiento de la hiperglucemia durante la hospitalización y al alta. Para establecer un plan de tratamiento al alta adecuado a cada paciente, los elementos más importantes a tener en cuenta son la etiología y el tratamiento previo de la hiperglucemia, la situación clínica del paciente y el grado de control glucémico. Debido a la inestabilidad del control glucémico también es necesario prever las necesidades educativas de cada paciente, así como establecer las pautas de monitorización y seguimiento al alta, y un adecuado plan de tratamiento al alta (AU)

The present document intends to adapt the general recommendations set up in a consensus to elaborate the hospital discharge report in medical specialties to the specific needs of the hospitalized diabetic population. Diabetes is an illness with a very high health cost, being the global risk of death in people with diabetes almost double than in non-diabetes people, justifying the fact that diabetes constitutes one of the most frequent diagnoses in hospitalized patients and the growing interest upon hyperglycaemia management during hospitalization and at discharge. To set up an adequate treatment plan at discharge suitable for each patient, the most important elements to take into account are the etiology and prior hyperglycaemia treatment, the patient's clinical situation and the degree of glycaemia control. Due to instability of glycaemia control, it is also needed to anticipate the educational needs for each patient, as well as to set up the monitoring schedule and follow-up at discharge, and an adequate treatment plan at discharge (AU)

[Consensus document on the management after hospital discharge of patient with hyperglycaemia]. / Documento de consenso sobre el tratamiento al alta hospitalaria del paciente con hiperglucemia.

The present document intends to adapt the general recommendations set up in a consensus to elaborate the hospital discharge report in medical specialties to the specific needs of the hospitalized diabetic population. Diabetes is an illness with a very high health cost, being the global risk of death in people with diabetes almost double than in non-diabetes people, justifying the fact that diabetes constitutes one of the most frequent diagnoses in hospitalized patients and the growing interest upon hyperglycaemia management during hospitalization and at discharge. To set up an adequate treatment plan at discharge suitable for each patient, the most important elements to take into account are the etiology and prior hyperglycaemia treatment, the patient's clinical situation and the degree of glycaemia control. Due to instability of glycaemia control, it is also needed to anticipate the educational needs for each patient, as well as to set up the monitoring schedule and follow-up at discharge, and an adequate treatment plan at discharge.