Mal control de la diabetes tipo 2 en un centro de salud de atención primaria: factores modificables y población diana / Uncontrolled type 2 diabetes in primary care health center: Modifiable factors and target population

Objetivos: Detectar factores modificables y poblaciones diana asociados al mal control de la diabetes tipo 2 (DM2) en atención primaria. Diseño: Estudio descriptivo transversal restrospectivo. Emplazamiento: Centro de salud de Barranco Grande, Tenerife. Participantes: selección aleatoria de pacientes con DM2 atendidos por 12 médicos de familia y 12 enfermeras. Mediciones principales: Además del control de la DM2, se obtuvieron datos sociodemográficos, clínicos, hábitos de vida y seguimiento de medidas preventivas y terapéuticas. Tras análisis bivariado, se ajustó un modelo multivariado multinivel tomando el cupo médico-enfermero como efecto mixto de segundo nivel y el resto como variables de primer nivel. Resultados: Fueron reclutados 587 pacientes (46,5% mujeres), tratados con 1,9±1,1 fármacos antidiabéticos, con 4,1% de incumplimiento terapéutico, y padeciendo un 13,8% inercia terapéutica. El 23,7% mostraba mal control de DM2, siendo peor (p<0,05) en sexo masculino, edad <65 años, evolución DM2 ≥5 años, dieta inadecuada, síndrome metabólico, ratio triglicéridos/HDL≥3, complicaciones de la DM2, índice Charlson<5, visitas a enfermera<3/año, sin ECG en el último año y mayor número de fármacos prescritos para DM2. El cupo médico-enfermero se asoció al mal control con un coeficiente intraclase de 0,01. Conclusiones: Los hombres menores de 65 años con larga evolución de DM2 son población diana para intensificar intervenciones. El incumplimiento terapéutico, dieta inadecuada, falta de adhesión a los protocolos de seguimiento y ratio triglicéridos/HDL>3 son factores sobre los que intervenir. La asociación del cupo médico-enfermero con el control de la DM2 es débil, probablemente por adecuado seguimiento de los programas preventivos.(AU)

Aims: To detect modifiable factors and target populations associated with uncontrolled type 2 diabetes in primary care. Design: Retrospective cross-sectional descriptive study. Location: Health center of Barranco Grande, Tenerife. Participants: Random selection of patients with DM2 attended by 12 family doctors and 12 nurses. Main Measurements: In addition to the control of DM2, sociodemographic, clinical data, lifestyle and follow-up of preventive and therapeutic measures were obtained. After bivariate analysis, a multilevel multivariate model was adjusted by taking the quota of patients assisted by each physician as a second-level mixed-effect variable and the rest as first-level variables. Results: 587 patients were recruited (46.5% female), treated with 1.9-1.1 antidiabetic drugs, with 4.1% therapeutic non-compliance, and suffering 13.8% therapeutic inertia. 23.7% showed poor DM2 control, being significantly worse (p<0.05) in male sex, age <65 years, evolution DM2 -5 years, work-active, upper-middle studies, inadequate diet, metabolic syndrome, ratio TG/HDL-3, complications of DM2, Charlson index<5, nursing visits <3/year, without ECG in the last year, and more drugs prescribed for DM2. The doctor-nurse quota was associated with poor control with an intraclass coefficient of 0.01. Conclusions: Men under 65 years of age with DM2 evolution longer than 5 years are a target population to intensify interventions. Therapeutic non-compliance, inadequate diet, lack of adherence protocols and ratio TG/HDL>3 are the main modifiable factors on which to intervene. The association of the doctor-nurse quota with the control of DM2 is weak, probably due to adequate follow-up of preventive programs.(AU)

[Uncontrolled type 2 diabetes in primary care health center: Modifiable factors and target population]. / Mal control de la diabetes tipo 2 en un centro de salud de atención primaria: factores modificables y población diana.

AIMS: To detect modifiable factors and target populations associated with uncontrolled type 2 diabetes in primary care. DESIGN: Retrospective cross-sectional descriptive study. LOCATION: Health center of Barranco Grande, Tenerife. PARTICIPANTS: Random selection of patients with DM2 attended by 12 family doctors and 12 nurses. MAIN MEASUREMENTS: In addition to the control of DM2, sociodemographic, clinical data, lifestyle and follow-up of preventive and therapeutic measures were obtained. After bivariate analysis, a multilevel multivariate model was adjusted by taking the quota of patients assisted by each physician as a second-level mixed-effect variable and the rest as first-level variables. RESULTS: 587 patients were recruited (46.5% female), treated with 1.9-1.1 antidiabetic drugs, with 4.1% therapeutic non-compliance, and suffering 13.8% therapeutic inertia. 23.7% showed poor DM2 control, being significantly worse (p<0.05) in male sex, age <65 years, evolution DM2 -5 years, work-active, upper-middle studies, inadequate diet, metabolic syndrome, ratio TG/HDL-3, complications of DM2, Charlson index<5, nursing visits <3/year, without ECG in the last year, and more drugs prescribed for DM2. The doctor-nurse quota was associated with poor control with an intraclass coefficient of 0.01. CONCLUSIONS: Men under 65 years of age with DM2 evolution longer than 5 years are a target population to intensify interventions. Therapeutic non-compliance, inadequate diet, lack of adherence protocols and ratio TG/HDL>3 are the main modifiable factors on which to intervene. The association of the doctor-nurse quota with the control of DM2 is weak, probably due to adequate follow-up of preventive programs.

Evolución del tabaquismo según clase social en la población adulta de las Islas Canarias durante el periodo 2000-2015: seguimiento de la cohorte CDC-Canarias / Evolution of Smoking According to Social Class in the Adult Population of the Canary Islands During 2000-2015: Follow-up of the CDC-Canary Cohort

OBJETIVO: Conocer la evolución del consumo de tabaco en Canarias durante 2000-2015 según clase social. Emplazamiento: Comunidad Autónoma de Canarias. PARTICIPANTES: Cohorte CDC-Canarias con cortes en 2000 (n = 6.729), 2008 (n = 6.171) y 2015 (n = 4.705). Mediciones principales: Tabaquismo, sexo, edad y clase social. RESULTADOS: El consumo disminuyó un 6% (5-7%, p < 0,001) en general, siendo más acentuado en el periodo 2000-2008 (5%). La disminución fue mayor en hombres, aunque siguieron fumando más que las mujeres, con una prevalencia del 25% (24-26%) frente al 18% (17-19%, p < 0,001). Solo hubo una disminución del consumo en los grupos jóvenes (6% [3-5%]; p = 0,011) y de edades intermedias (7% [6-8%]; p < 0,001). En todas las clases sociales se observó una disminución similar, con mayor prevalencia de tabaquismo en la clase alta: 24% (23-25%) en 2015 (p < 0,001). Al valorar conjuntamente sexo, edad y clase social, los hombres más jóvenes y de edad intermedia presentaron los mayores descensos de consumo: 8% (7-9%) clase baja y alta, 10% (9-11%) clase media. En la clase social baja, las mujeres más jóvenes continúan fumando más (27%) aunque abandonaron más el consumo (14%), fenómeno que en las de clase media se produjo en edades intermedias. CONCLUSIONES: La evolución del consumo de tabaco en Canarias sigue un patrón similar al conjunto de España. El abandono del consumo de tabaco se ha frenado en el periodo 2008-2015, especialmente en hombres y en clases sociales medias y altas

OBJECTIVE: To determine the status of tobacco consumption in the Canary Islands during 2000-2015, according to social class. LOCATION: Canary Islands. PARTICIPANTS: General population cohort, with contacts in 2000 (n = 6,729), 2008 (n = 6,171) and 2015 (n = 4,705). MAIN MEASUREMENTS: Smoking, gender, age, and social class. RESULTS: Consumption decreased by 6% (5-7%, P < .001) in general, being more accentuated in the period 2000-2008 (5%). The decrease was greater in men, although they continued to smoke more than women, with a prevalence of 25% (24-26%) compared to 18% (17-19%, P < .001). A decrease in consumption was only observed in the younger groups (6% [3-5%], P = .011) and intermediate ages (7% [6-8%], P < .001). A similar decrease was observed in all the social classes, but there was a higher prevalence of smoking in the upper class: 24% (23-25%) in 2015 (P < .001). By jointly assessing gender, age, and social class, younger and middle age men had the greatest decreases in consumption: 8% (7-9%) low and upper classes, 10% (9-11%) middle class. In the lower social class, younger women continue to smoke more (27%) although more of them quit smoking (14%), a phenomenon that occurred in the middle class at intermediate ages. CONCLUSIONS: The evolution of tobacco consumption in the Canary Islands follows a pattern similar to that of mainland Spain. The abandonment of tobacco consumption has slowed down in the period 2008-2015, especially in men, and middle and upper social classes

[Evolution of Smoking According to Social Class in the Adult Population of the Canary Islands During 2000-2015: Follow-up of the CDC-Canary Cohort]. / Evolución del tabaquismo según clase social en la población adulta de las Islas Canarias durante el periodo 2000-2015: seguimiento de la cohorte CDC-Canarias.

OBJECTIVE: To determine the status of tobacco consumption in the Canary Islands during 2000-2015, according to social class. LOCATION: Canary Islands. PARTICIPANTS: General population cohort, with contacts in 2000 (n=6,729), 2008 (n=6,171) and 2015 (n=4,705). MAIN MEASUREMENTS: Smoking, gender, age, and social class. RESULTS: Consumption decreased by 6% (5-7%, P<.001) in general, being more accentuated in the period 2000-2008 (5%). The decrease was greater in men, although they continued to smoke more than women, with a prevalence of 25% (24-26%) compared to 18% (17-19%, P<.001). A decrease in consumption was only observed in the younger groups (6% [3-5%], P=.011) and intermediate ages (7% [6-8%], P<.001). A similar decrease was observed in all the social classes, but there was a higher prevalence of smoking in the upper class: 24% (23-25%) in 2015 (P<.001). By jointly assessing gender, age, and social class, younger and middle age men had the greatest decreases in consumption: 8% (7-9%) low and upper classes, 10% (9-11%) middle class. In the lower social class, younger women continue to smoke more (27%) although more of them quit smoking (14%), a phenomenon that occurred in the middle class at intermediate ages. CONCLUSIONS: The evolution of tobacco consumption in the Canary Islands follows a pattern similar to that of mainland Spain. The abandonment of tobacco consumption has slowed down in the period 2008-2015, especially in men, and middle and upper social classes.

[Capillary blood sample for type 2 diabetes screening: fingertip versus forearm]. / Muestra de sangre capilar para el cribado de la diabetes mellitus tipo 2: dedo frente a antebrazo.

BACKGROUND AND OBJECTIVE: In Spain, around 50% of diabetic mellitus cases remain undiagnosed. Capillary blood puncture improves the diabetes screening accessibility. New test strips used in the Blood Glucose Monitoring System allow fingertip and forearm punctures yet they create the dilemma on what is the best anatomic place. PATIENTS AND METHOD: We compared fingertip and forearm capillary blood glucose determinations. RESULTS: In a sample of 107 patients, a 110 mg/dl cut-off point for the fingertip and 125 mg/dl for the forearm were more sensitive. Patient's preferences were as follows: 67% indifferent, 28% forearm and 5% fingertip. CONCLUSIONS: In this study, the best anatomic site for puncture depended on the cut-off point used in diabetes screening.