Outcome of COVID-19 infection in people with diabetes mellitus or obesity in the primary care setting in Catalonia, Spain: A retrospective cohort study of the initial three waves.

AIM: We estimate the incidence and risk factors for fatal and non-fatal events among the COVID-19 infected subjects based on the presence of obesity or diabetes during the initial three epidemiological waves in our region. METHODS: This was a retrospective cohort study. A primary care database was used to identify persons with COVID-19. We stratified for subjects who either had diabetes mellitus or obesity. The follow-up period for study events was up to 90 days from inclusion. RESULTS: In total, 1238,710 subjects were analysed. Subjects with diabetes mellitus or obesity were older and had a worse comorbidity profile compared with groups without these conditions. Fatal events were more frequent among people with diabetes and during the first wave. In the second and third waves, the number of study events decreased. Diabetes was a risk factor for fatal events in all models, while obesity was only in the model adjusted for age, sex, diabetes and COVID-19 waves. HIV, cancer, or autoimmune diseases were risk factors for mortality among subjects with COVID-19 in the fully-adjusted model. CONCLUSIONS: Diabetes was an independent risk factor for mortality among people with COVID-19. The number of fatal events decreased during the second and third waves in our region, both in those with diabetes or obesity.

Checklist para pacientes con diabetes mellitus tipo 2 en consulta telemática / Checklist for patients with type 2 diabetes mellitus for remote consultation

Las circunstancias actuales provocadas por la COVID-19 nos obligan a los profesionales de atención primaria a idear nuevas formas de garantizar la atención sanitaria de nuestros pacientes con diabetes tipo 2 (DM2). Existen evidencias que respaldan la eficacia de la telemedicina en el control glucémico de los pacientes con DM2. Ante la rápida adaptación de la práctica clínica al uso de la telemedicina, el Grupo de Trabajo de Diabetes de la Sociedad Española de Medicina Familiar y Comunitaria (SemFyC) optó por elaborar un documento de consenso plasmado en un algoritmo de actuación/seguimiento telemático en la atención de los pacientes con DM2.(AU)

The current circumstances cause by the COVID-19 force primary care doctors to find out new ways to guarantee the health care of our type 2 diabetes patients. There is evidence that supports the remote consultation efficacy in the glycemic control in patients with type 2 diabetes. Facing the rapid adaptation of clinical practice to the remote consultation use, from de Diabetes Group of the Spanish Society of Family and Community Medicine (SemFyC), we have prepared a document embodied in a telematic action / monitoring algorithm in the care of patients with type 2 diabetes.(AU)

[Checklist for patients with type 2 diabetes mellitus for remote consultation]. / Checklist para pacientes con diabetes mellitus tipo 2 en consulta telemática.

The current circumstances cause by the COVID-19 force primary care doctors to find out new ways to guarantee the health care of our type 2 diabetes patients. There is evidence that supports the remote consultation efficacy in the glycemic control in patients with type 2 diabetes. Facing the rapid adaptation of clinical practice to the remote consultation use, from de Diabetes Group of the Spanish Society of Family and Community Medicine (SemFyC), we have prepared a document embodied in a telematic action / monitoring algorithm in the care of patients with type 2 diabetes.

The effectiveness of a community-based, type 2 diabetes prevention programme on health-related quality of life. The DE-PLAN study.

BACKGROUND AND AIMS: The DE-PLAN was a European multicenter study, with the primary objective of testing whether a community-based lifestyle modification programme could serve as a means of primary prevention for type 2 diabetes (T2D) in high-risk individuals (based on the FINDRISC questionnaire). The aim of this study was to examine the impact of a 1-year community-based lifestyle intervention on health-related quality of life (HRQOL) in individuals from four participating European centers (Athens, Barcelona, Krakow, Kaunas), through a post-hoc analysis. MATERIALS AND METHODS: Each center was allowed to implement different intervention strategies specifically tailored to the needs of their corresponding population sample. Before and after the intervention, participants underwent clinical evaluation, anthropometric measurements, an oral glucose tolerance test and lipid profile measurements. Health-related quality of life was assessed using the validated HRQOL-15D questionnaire. A difference of ±0.015 in the 15D questionnaire score was set as the threshold of clinically meaningful change. RESULTS: Data from 786 participants (67% females, mean age 59.7±9.4 years, BMI 31.5±4.5 kg/m2) with complete data regarding the HRQOL were analyzed (Athens: 104, Barcelona: 434, Krakow: 175, Kaunas: 70). After 1 year, a significant overall improvement in HRQOL was shown, as depicted by a change of 15D score from baseline value (0.88±0.9) to post-intervention (0.90±0.87, P<0.001), achieving the threshold of clinically meaningful change. A significant weight reduction was also observed (-0.8±4.0 kg, P<0.001). In multivariate analysis, improvement in HRQOL was independently associated with lower 15D score at baseline (P<0.001) and self-reported increase in overall exercise time (P<0.001) as assessed through specifically designed trial questionnaires. CONCLUSION: A community-based lifestyle intervention programme aiming at T2D prevention, applied on a heterogeneous population and with varied methods, was shown to improve overall health-related quality of life to a clinically meaningful degree.

Metabolic syndrome and risk of cancer: a study protocol of case-control study using data from the Information System for the Development of Research in Primary Care (SIDIAP) in Catalonia.

BACKGROUND: Metabolic syndrome (MS) is defined by the clustering of specific metabolic disorders in one subject. MS is highly prevalent globally and currently considered a growing public health concern. MS comprises obesity, hypertension, dyslipidaemia and insulin resistance. Mechanisms linking MS with cancer are poorly understood, and it is as yet unknown if MS confers a greater risk than the risk entailed by each of its separate components. The main objective of this study is to compare the association between MS and 14 site-specific cancer against the association between one or two individual components of MS and cancer. The secondary objective is to evaluate the time elapsed since the diagnosis of MS and the subsequent onset of cancer within the 2006-2017 period by sex. METHODS AND ANALYSIS: A case-control study will be conducted for the main objective and a cohort of patients with MS will be followed for the evaluation of the second objective. Incident cases of fourteen types of cancer in patients ≥40 years of age diagnosed prospectively will be selected from electronic primary care records in the Information System for Research in Primary Care (SIDIAP database; www.sidiap.org). The SIDIAP database includes anonymous data from 6 million people (80% of the Catalan population) registered in 286 primary healthcare centres. Each matched control (four controls for each case) will have the same inclusion date, the same sex and age (±1 year) than the paired case. Logistic regression and a descriptive analysis and Kaplan-Meier analysis will be performed, in accordance with the objectives. ETHICS AND DISSEMINATION: The protocol of the study was approved by the IDIAP Jordi Gol Clinical Research Ethics Committee (protocol P17/212). The study's findings will be published in a peer-reviewed journal and disseminated at national and international conferences and oral presentations to researchers, clinicians and policy makers.

Implementation of the DP-TRANSFERS project in Catalonia: A translational method to improve diabetes screening and prevention in primary care.

BACKGROUND: The DE-PLAN-CAT project (Diabetes in Europe-Prevention using lifestyle, physical activity and nutritional intervention-Catalonia) has shown that an intensive lifestyle intervention is feasible in the primary care setting and substantially reduces the incidence of diabetes among high-risk Mediterranean participants. The DP-TRANSFERS project (Diabetes Prevention-Transferring findings from European research to society) is a large-scale national programme aimed at implementing this intervention in primary care centres whenever feasible. METHODS: A multidisciplinary committee first evaluated the programme in health professionals and then participants without diabetes aged 45-75 years identified as being at risk of developing diabetes: FINDRISC (Finnish Diabetes Risk Score)>11 and/or pre-diabetes diagnosis. Implementation was supported by a 4-channel transfer approach (institutional relationships, facilitator workshops, collaborative groupware, programme website) and built upon a 3-step (screening, intervention, follow-up) real-life strategy. The 2-year lifestyle intervention included a 9-hour basic module (6 sessions) and a subsequent 15-hour continuity module (10 sessions) delivered by trained primary healthcare professionals. A 3-level (centre, professionals and participants) descriptive analysis was conducted using cluster sampling to assess results and barriers identified one year after implementation. RESULTS: The programme was started in June-2016 and evaluated in July-2017. In all, 103 centres covering all the primary care services for 1.4 million inhabitants (27.9% of all centres in Catalonia) and 506 professionals agreed to develop the programme. At the end of the first year, 83 centres (80.6%) remained active and 305 professionals (60.3%) maintained regular web-based activities. Implementation was not feasible in 20 centres (19.4%), and 5 main barriers were prioritized: lack of healthcare manager commitment; discontinuity of the initial effort; substantial increase in staff workload; shift in professional status and lack of acceptance. Overall, 1819 people were screened and 1458 (80.1%) followed the lifestyle intervention, with 1190 (81.6% or 65.4% of those screened) participating in the basic module and 912 in the continuity module (62.5% or 50.1%, respectively). CONCLUSIONS: A large-scale lifestyle intervention in primary care can be properly implemented within a reasonably short time using existing public healthcare resources. Regrettably, one fifth of the centres and more than one third of the professionals showed substantial resistance to performing these additional activities.

[Cardiovascular disease prevalence in recent diagnosed type 2 diabetic patients]. / Prevalencia de enfermedad cardiovascular en personas recién diagnosticadas de diabetes mellitus tipo 2.

OBJECTIVE: To determine the prevalence of cardiovascular disease at diagnosis of type 2 diabetes mellitus. METHODS: Retrospective observational study in an urban primary health care centre between 1991 and 2000. Review of clinical patient characteristics, cardiovascular disease and risk factors, in the year of diabetes diagnosis. Patients without any glycaemia recorded before diagnostic were excluded. Logistic regression was done to identify the variables associated to cardiovascular events. RESULTS: From 598 cases of diabetes diagnosed, 487 with previous glycaemia were included for the analysis (mean age [SD], 60.4 [10.9]; 53% women). The prevalence of cardiovascular risk factors was: obesity 61.1%, hypertension 71.9%, hypercholesterolemia 52%, hypertriglyceridemia 35.3% and present or previous smoking habit (24 and 16,6%). 96.9% of them presented at least one of the studied cardiovascular risk factors and 53.4% three or more. 78 patients (16%; CI95%: 12.8-19.3) had cardiovascular disease before or during the first year of diagnosis (men 21.4% and women 11.2%). The prevalence of cardiovascular disease increased progressively with the number of cardiovascular risk factors. The significant predictive variables of cardiovascular disease (logistic regression) were: age 55 years (OR = 2.91; CI95%: 1.46-5.80), smoking habit (OR = 2.28; CI95%: 1.15-4.51) and HbA1c 7% (OR = 1.8; CI95%: 1.1-3.1). CONCLUSIONS: A high prevalence of cardiovascular disease and cardiovascular risk factors at diabetes diagnosis was observed. Age, smoking habit and elevated glycated haemoglobin were the variables related to cardiovascular disease.

Prevalencia de enfermedad cardiovascular en personas recién diagnosticadas de diabetes mellitus tipo 2 / Cardiovascular disease prevalence in recent diagnosed type 2 diabetic patients

Objetivo: Conocer la prevalencia de la enfermedad cardiovascular en el momento del diagnóstico de la diabetes mellitus tipo 2.MétodosEstudio observacional retrospectivo realizado en un centro de atención primaria urbano entre 1991 y 2000. Revisión de las características clínicas, factores de riesgo y enfermedad cardiovascular el año del diagnóstico de diabetes. Se excluyeron los pacientes sin glucemias previas al diagnóstico. Se realizó un análisis de regresión logística para identificar las variables asociadas a la presencia de eventos cardiovasculares.Resultados: De los 598 nuevos casos de diabetes diagnosticados se analizaron los 487 que tenían valores previos de glucemia (media de edad [desviación estándar]: 60,4 [10,9] años; un 53% eran mujeres). La prevalencia de factores de riesgo cardiovascular fue: obesidad 61,1%, hipertensión arterial 71,9%, hipercolesterolemia 52%, hipertrigliceridemia 35,3% y tabaquismo actual 24% o previo 16,6%. El 96,9% tenía algún factor de riesgo cardiovascular y el 53,4% tres o más. Un total de 78 pacientes presentaron enfermedad cardiovascular anterior o detectada durante el primer año de diagnóstico (16%; intervalo de confianza del 95%[IC95%]: 12,8–19,3; varones 21,4% y mujeres 11,2%). La prevalencia de enfermedad cardiovascular aumentó con el número de factores de riesgo cardiovascular. El análisis de regresión logística mostró una asociación de la enfermedad cardiovascular y la edad ≥55 años (odds ratio [OR]=2,91; IC95%: 1,46–5,80), el tabaquismo (OR=2,28; IC95%: 1,15–4,51) y los valores de hemoglobina glucosilada (HbA1c) ≥7% (OR=1,85; IC95%: 1,10–3,1).Conclusiones: Se observa una elevada prevalencia de factores de riesgo y enfermedad cardiovascular en el momento del diagnóstico de la diabetes; la edad, el tabaquismo y la HbA1c son las variables relacionadas con la enfermedad cardiovascular (AU)

Objective: To determine the prevalence of cardiovascular disease at diagnosis of type 2 diabetes mellitus.Methods: Retrospective observational study in an urban primary health care centre between 1991 and 2000. Review of clinical patient characteristics, cardiovascular disease and risk factors, in the year of diabetes diagnosis. Patients without any glycaemia recorded before diagnostic were excluded. Logistic regression was done to identify the variables associated to cardiovascular events.Results: From 598 cases of diabetes diagnosed, 487 with previous glycaemia were included for the analysis (mean age [SD], 60.4 [10.9]; 53% women). The prevalence of cardiovascular risk factors was: obesity 61.1%, hypertension 71.9%, hypercholesterolemia 52%, hypertriglyceridemia 35.3% and present or previous smoking habit (24 and 16,6%). 96.9% of them presented at least one of the studied cardiovascular risk factors and 53.4% three or more. 78 patients (16%; CI95%: 12.8–19.3) had cardiovascular disease before or during the first year of diagnosis (men 21.4% and women 11.2%). The prevalence of cardiovascular disease increased progressively with the number of cardiovascular risk factors. The significant predictive variables of cardiovascular disease (logistic regression) were: age ≥55 years (OR=2.91; CI95%: 1.46–5.80), smoking habit (OR=2.28; CI95%: 1.15–4.51) and HbA1c ≥7% (OR=1.8; CI95%: 1.1–3.1).Conclusions: A high prevalence of cardiovascular disease and cardiovascular risk factors at diabetes diagnosis was observed. Age, smoking habit and elevated glycated haemoglobin were the variables related to cardiovascular disease (AU)

[Incidence of type 2 diabetes and its diagnosis process in the decade 1991-2000 in a primary health care centre]. / Incidencia de diabetes tipo 2 y análisis del proceso diagnóstico en un centro de atención primaria durante la década de los noventa.

BACKGROUND AND OBJECTIVE: To determine the annual incidence and reasons for diagnosing type 2 diabetes mellitus (T2DM) from 1991 to 2000. PATIENTS AND METHOD: We performed a retrospective, longitudinal study. The clinical records of all new cases of T2DM registered in an urban primary care center over a 10-year period were reviewed. The annual incidence and prevalence in the population aged more than 14 years old were calculated. Statistical analyses of temporal trends and periodicity (monthly, seasonal and annual) were performed with ARIMA models (Box-Jenkins), Poisson parametrical regression and semiparametrical (GAM) models. RESULTS: There were 598 true new cases of T2DM (mean age [SD]: 59.7 [11.4] years; 51.3% women). The most frequent associated cardiovascular risk factors were obesity (58.5%) and hypertension (68.2%). The main reasons for diagnosing T2DM were the presence of previous hyperglycemia (64.7%) and the application of protocols for other cardiovascular risk factors (12.4%).The annual incidence was 37.9 per 10,000 persons (95% CI, 34.9-40.9) with no differences between sexes. The prevalence of T2DM at the beginning and end of the study period was 4.4 (95% CI, 2.0-4.8) and 5.5% (95% CI, 5.2-5.9) (25% relative increase). There was no significant temporal trend in the incidence of T2DM over the years. CONCLUSIONS: The observed incidence of T2DM is high compared with that reported in other studies. The increase in prevalence was not related to a progressive increase in the incidence. The most frequent reasons for diagnosing T2DM were previous hyperglycemia and the application of protocols for other cardiovascular risk factors. This finding seems to be related to an early diagnosis and could benefit these patients.

Incidencia de diabetes tipo 2 y análisis del proceso diagnóstico en un centro de atención primaria durante la década de los noventa / Incidence of type 2 diabetes and its diagnosis process in the decade 1991-2000 in a primary health care centre

Fundamento y objetivo: Conocer la incidencia anual y los motivos de diagnóstico de la diabetes mellitus tipo 2 (DM2) en el período 1991-2000. Pacientes y método: Estudio longitudinal retrospectivo. Revisión de las historias clínicas de todos los nuevos casos de DM2 registrados en un centro de salud urbano durante 10 años. Cálculo de la prevalencia e incidencia anuales en la población mayor de 14 años. Análisis de las tendencias temporales y periodicidad en la incidencia de DM2 (mensual, estacional y anual) mediante modelos ARIMA (Box-Jenkins), modelo paramétrico de regresión de Poisson y modelos semiparamétricos (GAM). Resultados: Se identificaron 598 nuevos casos de DM2 (edad media [DE], 59,7 [11,4] años; 51,3% mujeres). Los factores de riesgo cardiovascular más frecuentes fueron la obesidad (58,5%) y la hipertensión arterial (68,2%). Los principales motivos de diagnóstico fueron: hiperglucemias previas (64,7%) y la aplicación de protocolos de otros factores de riesgo cardiovascular (12,4%). La incidencia anual fue de 37,9 por 10.000 personas (intervalo de confianza [IC] del 95%, 34,9-40,9), sin diferencias significativas entre ambos sexos. La prevalencia de DM2 al principio y al final del estudio fue del 4,4% (IC del 95%, 2,0-4,8) y el 5,5% (IC del 95%, 5,2-5,9) (un 25% de incremento relativo), sin que el análisis de tendencias mostrara un incremento progresivo de la incidencia. Conclusiones: La incidencia observada es superior a la descrita en otros estudios. El incremento de la prevalencia no se relaciona con un incremento progresivo de la incidencia. Los motivos de diagnóstico más frecuentes fueron el seguimiento de hiperglucemias previas y la aplicación de protocolos de otros factores de riesgo cardiovascular. Este hecho parece indicar un diagnóstico precoz que podría beneficiar a estos pacientes

Background and objective: To determine the annual incidence and reasons for diagnosing type 2 diabetes mellitus (T2DM) from 1991 to 2000. Patients and method: We performed a retrospective, longitudinal study. The clinical records of all new cases of T2DM registered in an urban primary care center over a 10-year period were reviewed. The annual incidence and prevalence in the population aged more than 14 years old were calculated. Statistical analyses of temporal trends and periodicity (monthly, seasonal and annual) were performed with ARIMA models (Box-Jenkins), Poisson parametrical regression and semiparametrical (GAM) models. Results: There were 598 true new cases of T2DM (mean age [SD]: 59.7 [11.4] years; 51.3% women). The most frequent associated cardiovascular risk factors were obesity (58.5%) and hypertension (68.2%). The main reasons for diagnosing T2DM were the presence of previous hyperglycemia (64.7%) and the application of protocols for other cardiovascular risk factors (12.4%).The annual incidence was 37.9 per 10,000 persons (95% CI, 34.9-40.9) with no differences between sexes. The prevalence of T2DM at the beginning and end of the study period was 4.4 (95% CI, 2.0-4.8) and 5.5% (95% CI, 5.2-5.9) (25% relative increase). There was no significant temporal trend in the incidence of T2DM over the years. Conclusions: The observed incidence of T2DM is high compared with that reported in other studies. The increase in prevalence was not related to a progressive increase in the incidence. The most frequent reasons for diagnosing T2DM were previous hyperglycemia and the application of protocols for other cardiovascular risk factors. This finding seems to be related to an early diagnosis and could benefit these patients