Control glucémico en pacientes diabéticos tipo 2 de edad avanzada. Intervención para evitar riesgos / Blood-glucose control in eldely patients with type 2 diabetes. Interventions to avoid risks

OBJETIVO: Evaluar el control glucémico de pacientes de edad avanzada, con diabetes mellitus tipo 2 (DM2), en tratamiento con varios antidiabéticos, y analizar el efecto de una intervención. MATERIAL Y MÉTODOS: Estudio descriptivo transversal y observacional de prevalencia que incluyó a pacientes ≥75 años con DM2, en tratamiento con 2 o más hipoglucemiantes. Se analizó la adecuación de los tratamientos siguiendo las recomendaciones actuales para este grupo poblacional, la prevalencia de complicaciones macro y microvasculares, demencia e hipoglucemias, los tratamientos empleados y la adherencia. Se realizó una intervención para optimizar la prescripción. RESULTADOS: Se incluyeron 215 pacientes. El 54,4% fueron mujeres, con edad media de 82,0±4,1 años, el 77,2% tenía complicaciones macro y/o microvasculares y el 7,4% demencia. En el 67,9% se detectó inadecuación por control glucémico demasiado intensivo (55,6% HbA1c<7,5%) o no estar ajustada la posología a su filtrado glomerular (51,0%). El 81,4% estaba en tratamiento con fármacos con riesgo de producir hipoglucemias; el 2,3% tenía algún episodio registrado. La HbA1c media fue mayor en los no adherentes (8,1±1,6% vs. 7,5±1,3%, p < 0,05). Tras la intervención disminuyó la intensidad del tratamiento hipoglucemiante en el 36,2% de los pacientes, y se adecuó la posología en el 23,1% de los fármacos que precisaban ajuste. El porcentaje de sobretratamiento se redujo al 40,0% (p < 0,01). CONCLUSIONES: Más de la mitad de los pacientes mayores, con DM2 e importantes comorbilidades, tenía un control glucémico demasiado estricto. La puesta en marcha de un programa de intervención ha permitido mejorar la seguridad y la adecuación de los tratamientos

OBJECTIVE: To evaluate blood-glucose control in elderly patients with type 2 diabetes mellitus (T2DM), who are receiving various anti-diabetic treatments, and to analyse the effect of an intervention. MATERIAL AND METHODS: Cross-sectional, descriptive, and observational study of prevalence that included patients who were ≥75 years old with T2DM and being treated with two or more antidiabetic drugs. The adequacy of treatments following current recommendations for this population group was analysed, together with the prevalence of macro- and micro-vascular complications, dementia, and hypoglycaemia, the treatments used, and adherence. An intervention was carried out to optimise prescription. RESULTS: A total of 215 patients were included, of which 54.4% were women. The mean age was 82.0±4.1, and 77.2% had micro- and/or macrovascular complications, and 7.4% had dementia. Inadequacy was detected in 67.9% due to an overly intensive blood glucose control (55.6% HbA1c<7.5%), or that the dosage was not adapted to glomerular filtration (51.0%). The large majority (81.4%) were being treated with drugs with a risk of producing hypoglycaemia (2.3% had recorded episodes). The HbA1c mean was higher in non-adherent patients (8.1±1.6% vs 7.5±1.3%, P<.05). After the intervention, the intensity of hypoglycaemic treatment was reduced in 36.2% of patients, and the dosage of drugs that required adjustment was corrected in 23.1%. The percentage of overtreatment decreased to 40.0% (P<.01). CONCLUSIONS: More than half of the elderly patients with T2DM and important comorbidities had an overly strict glycaemic control. The launch of an intervention programme has allowed for an improvement in safety and for the optimisation of treatments

[Blood-glucose control in eldely patients with type 2 diabetes. Interventions to avoid risks]. / Control glucémico en pacientes diabéticos tipo 2 de edad avanzada. Intervención para evitar riesgos.

OBJECTIVE: To evaluate blood-glucose control in elderly patients with type 2 diabetes mellitus (T2DM), who are receiving various anti-diabetic treatments, and to analyse the effect of an intervention. MATERIAL AND METHODS: Cross-sectional, descriptive, and observational study of prevalence that included patients who were ≥75 years old with T2DM and being treated with two or more antidiabetic drugs. The adequacy of treatments following current recommendations for this population group was analysed, together with the prevalence of macro- and micro-vascular complications, dementia, and hypoglycaemia, the treatments used, and adherence. An intervention was carried out to optimise prescription. RESULTS: A total of 215 patients were included, of which 54.4% were women. The mean age was 82.0±4.1, and 77.2% had micro- and/or macrovascular complications, and 7.4% had dementia. Inadequacy was detected in 67.9% due to an overly intensive blood glucose control (55.6% HbA1c<7.5%), or that the dosage was not adapted to glomerular filtration (51.0%). The large majority (81.4%) were being treated with drugs with a risk of producing hypoglycaemia (2.3% had recorded episodes). The HbA1c mean was higher in non-adherent patients (8.1±1.6% vs 7.5±1.3%, P<.05). After the intervention, the intensity of hypoglycaemic treatment was reduced in 36.2% of patients, and the dosage of drugs that required adjustment was corrected in 23.1%. The percentage of overtreatment decreased to 40.0% (P<.01). CONCLUSIONS: More than half of the elderly patients with T2DM and important comorbidities had an overly strict glycaemic control. The launch of an intervention programme has allowed for an improvement in safety and for the optimisation of treatments.

Análisis de la utilización de inhibidores de la bomba de protones en Atención Primaria / Analysis of the use of proton pump inhibitors in primary health care

Objetivo: El incremento en el consumo de antiulcerosos se acompaña de una elevada tasa de utilización incorrecta. Los objetivos del estudio fueron analizar la adecuación de la prescripción crónica de inhibidores de la bomba de protones (IBP) en un centro de salud, así como la eficacia de una intervención de mejora. Material y métodos: Estudio descriptivo transversal y observacional de prevalencia que incluyó a pacientes de un centro de salud en tratamiento con IBP durante, al menos, 3meses consecutivos (de noviembre de 2016 a enero de 2017). Se analizó la indicación, posología y duración de tratamiento del IBP, interacciones farmacológicas y posibles riesgos que pudieran relacionarse con el uso continuado de IBP. Se realizó una intervención para optimizar la prescripción racional y eficiente de estos fármacos. Resultados: Se incluyó a 703 pacientes, lo que supone el 5,4% sobre el total de los pacientes mayores de edad adscritos al centro. De ellos, 436 (62,0%) no presentaban criterios de adecuación; el 52,5% eran mujeres, el 70,0% mayores de 65 años y llevaban una media de 2,7 ± 1,9 años en tratamiento. El 48,1% presentaban interacciones y el 29,0%, algún factor de riesgo. Tras la intervención se corrigió la prescripción inadecuada a 112 pacientes (25,7%), que se redujo al 46,1% (p < 0,001). Conclusiones: Existe una elevada prevalencia de prescripción e inadecuación de IBP a largo plazo, por lo que resulta necesario mejorar la formación de los profesionales para potenciar su uso racional y reducir los riesgos. La puesta en marcha de un programa de intervención ha permitido revisar y optimizar los tratamientos

Objective: The increase in the consumption of anti-ulcer drugs is accompanied by a high rate of incorrect use. The objectives of this study were to analyse the adequacy of repeat prescriptions of proton pump inhibitors (PPIs) in a Medical Centre, and to evaluate the efficacy of an improvement intervention. Material and method: A cross-sectional, descriptive and observational study of prevalence was conducted on patients in a medical centre under treatment with PPIs for at least 3consecutive months (November 2016-January 2017). An analysis was performed that included the indication, dosage and time of treatment with PPIs, drug interactions, and possible risks that could be related with their use. An intervention was carried out to optimise rational and efficient prescribing of these medicines. Results: A total of 703 patients were included in the study, which is 5.4% of the total adult patients that are assigned to the centre. Adequacy criteria were not met by 436 (62.0%). Of these, 52.5% were women, 70.0% were over 65 years old, and had been on treatment for a mean of 2.7 ± 1.9 years. Interactions were observed in 48.1%, and 29.0% had some risk factors. After the intervention, the inadequate prescribing was corrected in 112 (25.7%) patients, which was a reduction of 46.1% (P<.001). Conclusions: There is a high prevalence of prescription and inadequacy of PPIs in the long term. This suggests that it is necessary to improve training of professionals to strengthen rational use and to reduce risks. The launch of an intervention programme has led to the revision and optimisation of treatments

[Analysis of the use of proton pump inhibitors in primary health care]. / Análisis de la utilización de inhibidores de la bomba de protones en Atención Primaria.

OBJECTIVE: The increase in the consumption of anti-ulcer drugs is accompanied by a high rate of incorrect use. The objectives of this study were to analyse the adequacy of repeat prescriptions of proton pump inhibitors (PPIs) in a Medical Centre, and to evaluate the efficacy of an improvement intervention. MATERIAL AND METHOD: A cross-sectional, descriptive and observational study of prevalence was conducted on patients in a medical centre under treatment with PPIs for at least 3consecutive months (November 2016-January 2017). An analysis was performed that included the indication, dosage and time of treatment with PPIs, drug interactions, and possible risks that could be related with their use. An intervention was carried out to optimise rational and efficient prescribing of these medicines. RESULTS: A total of 703 patients were included in the study, which is 5.4% of the total adult patients that are assigned to the centre. Adequacy criteria were not met by 436 (62.0%). Of these, 52.5% were women, 70.0% were over 65 years old, and had been on treatment for a mean of 2.7 ± 1.9 years. Interactions were observed in 48.1%, and 29.0% had some risk factors. After the intervention, the inadequate prescribing was corrected in 112 (25.7%) patients, which was a reduction of 46.1% (P<.001). CONCLUSIONS: There is a high prevalence of prescription and inadequacy of PPIs in the long term. This suggests that it is necessary to improve training of professionals to strengthen rational use and to reduce risks. The launch of an intervention programme has led to the revision and optimisation of treatments.