Regional differences in the degree of glycaemic diabetes control in Spain and associated factors. IBERICAN study.

BACKGROUND AND OBJECTIVE: The prevalence of type 2 diabetes (T2D) is high, it is increasing and its degree of control seems to be improvable with important social and health consequences. The objective of this study is to determine the regional differences in the degree of glycaemic control of T2D in Spain and its associated factors. MATERIAL AND METHODS: Cross-sectional, multicentre, observational study in patients with T2D between 18 and 85 years of age selected by consecutive sampling between 2014 and 2018. The population was divided into four regions: north, centre, Mediterranean and south-east. The main variable was the value of glycated haemoglobin (HbA1c). Sociodemographic and clinical variables, presence or absence of other risk factors and treatment were recorded. RESULTS: A total of 1587 patients with T2D were analysed, with a mean age of 65.93 years (standard deviation [SD] 10.14); 54.5% were men; the mean duration of T2D was 8.63 years (SD 6.64) and the mean HbA1c value was 7.05%. Of the total, 59.8% had an HbA1c value ≤ 7% (north 59.5%, centre 59.5%, Mediterranean 60.6% and south-east 59.8%; P=.99). The factors for poor control were: in the north, duration of T2D and being sedentary; in the centre, duration of T2D and having a low income; in the Mediterranean, duration of T2D; and in the south-east, duration of T2D and having a low level of education or income. Overall, 76.2% of the subjects had hypertension, 75.1% dyslipidaemia, and 51.7% obesity, with significant differences between regions only being observed in the case of dyslipidaemia (P<.001). CONCLUSIONS: No differences were observed in the degree of diabetes control in the different regions, with the percentage of patients needing intensification in their control being high in all of them. The factors associated with poor control were the duration of the disease, a low level of education or income, and a sedentary lifestyle.

Evaluación formativa mediante el portafolio de 4 promociones de residentes de medicina de familia y comunitaria de la Unidad Docente de Murcia / Training evaluation using the four courses portfolio in primary care residents of a Teaching Unit in Murcia

Objetivo: Evaluar el cumplimiento y la calidad de los 10 grupos de tareas formativas previstas en el modelo de portafolio formativo que realizan todos los residentes de la Unidad Docente de Medicina de Familia y Comunitaria de Murcia. Diseño: Estudio transversal realizado con los portafolios cumplimentados y entregados por todos los residentes en mayo de 2011. Participantes: Todos los residentes que en ese momento se estaban formando en la unidad docente (131). Método: Se establecen 10 grupos de tareas formativas de las recomendadas por la comisión nacional de la especialidad. Se evalúa el cumplimiento de cada una de ellas en cada uno de los portafolios. Se calcula la frecuencia de cumplimiento para cada tarea formativa. Se califica la calidad de la realización de cada una de las tareas, de 0 (muy deficiente) a 10 puntos (excelente). Resultados: Respecto al grado de cumplimiento, las tareas que más se cumplen: cumplimentar correctamente el libro del residente y utilizar la guía de competencias, ambas con un99,24%; seguidas de la elaboración de informes de reflexión sobre las estancias formativas. Todas las tareas obtienen un porcentaje de cumplimiento superior al 67%. El porcentaje medio de cumplimiento es del 86,49%. Todas las tareas obtienen una nota media superior a 7 (notable).La calificación media global fue de 7,80 puntos. Conclusiones: El grado de cumplimiento de las tareas previstas en el portafolio por los residentes es muy satisfactorio. Es necesario seguir insistiendo en la mejora de la realización del portafolio (AU)

Objective: To evaluate the performance and quality of the 10 groups of training tasks envisaged in the portfolio training model undertaken by all residents of the Primary Care Teaching Unit in Murcia. Design: A cross-sectional study was conducted on the portfolios provided and completed by all residents in May 2011.ParticipantsAll residents who were in training at that time (131). Method: Ten groups of training tasks were established from those recommended by the National Commission for the specialty. The performance of each one in each of the portfolios was evaluated, and the compliance for each training task was calculated. The quality of the performance of each of the tasks was given a score, 0 points (very poor) to 10 points (excellent). Results: As regards compliance, the tasks that were most performed were: filling in the Resident book correctly and using the resident skills guide, both with 99.24%, followed by reflection reports on the training visits. All tasks had a compliance rate higher than 67%. The mean percentage of compliance was 86.49%. All tasks obtained an average score greater than 7 (outstanding). The overall mean score was 7,8 points. Conclusions: The level of perfomance of the tasks set out in the portfolio by the residents was very satisfying. It is necessary to continue working on improving the performance of the portfolio (AU)

[Training evaluation using the four courses portfolio in primary care residents of a Teaching Unit in Murcia]. / Evaluación formativa mediante el portafolio de 4 promociones de residentes de medicina de familia y comunitaria de la Unidad Docente de Murcia.

OBJECTIVE: To evaluate the performance and quality of the 10 groups of training tasks envisaged in the portfolio training model undertaken by all residents of the Primary Care Teaching Unit in Murcia. DESIGN: A cross-sectional study was conducted on the portfolios provided and completed by all residents in May 2011. PARTICIPANTS: All residents who were in training at that time (131). METHOD: Ten groups of training tasks were established from those recommended by the National Commission for the specialty. The performance of each one in each of the portfolios was evaluated, and the compliance for each training task was calculated. The quality of the performance of each of the tasks was given a score, 0 points (very poor) to 10 points (excellent). RESULTS: As regards compliance, the tasks that were most performed were: filling in the Resident book correctly and using the resident skills guide, both with 99.24%, followed by reflection reports on the training visits. All tasks had a compliance rate higher than 67%. The mean percentage of compliance was 86.49%. All tasks obtained an average score greater than 7 (outstanding). The overall mean score was 7,8 points. CONCLUSIONS: The level of perfomance of the tasks set out in the portfolio by the residents was very satisfying. It is necessary to continue working on improving the performance of the portfolio.

[Effects of a revision program on the control of type 2 diabetics followed at the primary care level. Diabetes First program]. / Efectos de un programa de revisión en el control de los diabéticos tipo 2 seguidos en atención primaria. Programa Diabetes First.

BACKGROUND AND OBJECTIVE: To analyze the evolution of the glycosylated hemoglobin and other parameters after performing a control program and follow-up by nurses to improve the control of the patients with type 2 diabetes mellitus (Diabetes First). PATIENTS AND METHOD: Intervention study in type 2 diabetes mellitus patients from Murcia. The inclusion criterium was to be a type 2 diabetes mellitus patient badly controlled on diabetes parameters (glycosylated haemoglobin > or = 7%). We included 831 patients from 8 primary care centers. The program consisted of three visits (first one, after three months and after six months), where the patients received diabetic education. RESULTS: The mean initial glycosylated haemoglobin value was 8.1% +/- 1.3%, after 3 months it decreased to 7.5% +/- 1.1%, and after 6 months from the first visit its value was 7.5% +/- 2.6%. There was a statistically significant (p < 0.001) difference between the initial glycosylated haemoglobin and the values three months later. There was not such a difference between the second and third visit. Total and low-density liporpotein cholesterol decreased significantly after 3 months (p < 0.05). High-density lipoprotein cholesterol and triglycerides showed no difference. Systolic and diastolic blood pressure significantly decreased after three months (p < 0.0001 and p < 0.005). CONCLUSIONS: A simple nursing intervention program performed in primary care centers has a very positive impact on the control and treatment of patients with type 2 diabetes mellitus.

Efectos de un programa de revisión en el control de los diabéticos tipo 2 seguidos en atención primaria. Programa Diabetes First / Effects of a revision program on the control of type 2 diabetics followed at the primary care level. Diabetes First program

Antecedentes y objetivo: Analizar la evolución de la glucohemoglobina y otros parámetros tras aplicar un programa de revisión y seguimiento de enfermería (Diabetes First) para mejorar el control de sujetos con diabetes mellitus tipo 2. Pacientes y método: Estudio de intervención, realizado con pacientes diabéticos tipo 2 de la Región de Murcia. El criterio de inclusión era ser diabético tipo 2 no controlado (glucohemoglobina ¡Ý 7%). Se obtuvo una muestra final de 831 pacientes pertenecientes a ocho centros de salud. El programa constaba de tres visitas (inicial, a los 3 y a los 6 meses) en las que se daba educación diabetológica. Resultados: La glucohemoglobina inicial fue una media del 8,1% ¡À 1,3%; a los 3 meses descendió al 7,5% ¡À 1,1%, y a los 6 meses de la visita inicial era del 7,5% ¡À 2,6%. La comparación de los valores de la visita inicial y a los 3 meses mostró significación estadística (p < 0,001). Entre la segunda visita (3 meses) y la tercera (6 meses) no hubo diferencias significativas. Las cifras de colesterol total y colesterol de las lipoproteínas de baja densidad disminuyeron significativamente entre el inicio y los 3 meses (p < 0,05). El colesterol de las lipoproteínas de alta densidad y los triglicéridos no mostraron diferencias. Respecto a la presión arterial sistólica y diastólica, disminuyeron significativamente las cifras entre el inicio y los 3 meses (p < 0,0001 y p < 0,005 respectivamente). Conclusiones: Un programa de intervención enfermera sencillo realizado en las consultas de atención primaria tiene un impacto muy favorable en el control y el tratamiento de los pacientes diabéticos tipo 2 (AU)

Background and objective: To analyze the evolution of the glycosylated hemoglobin and other parameters after performing a control program and follow-up by nurses to improve the control of the patients with type 2 diabetes mellitus (Diabetes First). Patients and method: Intervention study in type 2 diabetes mellitus patients from Murcia. The inclusion criterium was to be a type 2 diabetes mellitus patient badly controlled on diabetes parameters (glycosylated haemoglobin ¡Ý 7%). We included 831 patients from 8 primary care centers. The program consisted of three visits (first one, after three months and after six months), where the patients received diabetic education. Results: The mean initial glycosylated haemoglobin value was 8.1% ¡À 1.3%, after 3 months it decreased to 7.5% ¡À 1.1%, and after 6 months from the first visit its value was 7.5% ¡À 2.6%. There was a statistically significant (p < 0.001) difference between the initial glycosylated haemoglobin and the values three months later. There was not such a difference between the second and third visit. Total and low-density liporpotein cholesterol decreased significantly after 3 months (p < 0.05). High-density lipoprotein cholesterol and triglycerides showed no difference. Systolic and diastolic blood pressure significantly decreased after three months (p < 0.0001 and p < 0.005). Conclusions: A simple nursing intervention program performed in primary care centers has a very positive impact on the control and treatment of patients with type 2 diabetes mellitus (AU)

Relación entre el consumo de tabaco y alcohol y el ejercicio físico con el paso por la universidad / Association between the consumption of tobacco and alcohol and physical exercise while at university

ObjetivosAveriguar la influencia que tiene el paso por la universidad en la modificación de los hábitos de consumo de tabaco y alcohol y el ejercicio físico en los estudiantes universitarios.DiseñoEstudio descriptivo, transversal.EmplazamientoÁmbito universitario de Murcia.ParticipantesSe selecciona una muestra de 1.179 alumnos.IntervencionesSe utiliza un cuestionario autocumplimentado y anónimo. Consta de 36 preguntas con 4 escalas de medida: grado de información sanitaria sobre RCV, consumo de tabaco, consumo de alcohol y realización de ejercicio físico.ResultadosLos estudiantes universitarios (EU) del último curso se declaran fumadores: el 39,2 frente al 36,4% de los de primer curso (NS). El 81,6% de los de primer curso consumen alcohol durante los fines de semana, frente al 81,1% de los del último curso (NS). En la valoración general del consumo de alcohol el 13% deja de consumir o consume menos y el 10% consume más, aunque la mayoría (55,2%) no modifica su hábito de consumo. Respecto al ejercicio físico, la frecuencia de EU que refieren practicar más ejercicio es de un 21,2% en los del primer curso frente al 20% en los del último curso (NS).ConclusionesEl paso por la universidad no parece tener influencia positiva en los hábitos y estilos de vida de los jóvenes. Es necesario aplicar medidas para potenciar estilos de vida saludables entre los universitarios(AU)

ObjectiveTo find out the influence that going to University has on changing smoking and alcohol habits, and on physical exercise in students in the EU.DesignCross-sectional descriptive study.SettingUniversity of Murcia.ParticipantsA sample of 1179 students was selected.InterventionsA self-filled and anonymous questionnaire was used. It consisted of 36 questions using 4 measurement scales: level of health information on cardiovascular risks (CVR), smoking, alcohol consumption and doing physical exercise.ResultsA total of 39.2% of university students in their last academic year said they were smokers, compared to 36.4% in the first year (NS). A total of 81.6% of first year students had consumed alcohol at weekends, compared to 81.1% of those in their last year (NS). In the overall assessment of alcohol consumption, 13% «stopped drinking or drank less» and 10% «drank more», although the majority (55%), did not change their drinking habits. As regards physical exercise, the number of students who did more physical exercise was 21.2% in the first academic year, compared to 20% of students in their last year (NS).ConclusionsGoing to University does not seem to exercise a positive influence on the habits and lifestyles of young people. Measures should be taken to encourage healthy lifestyles in Universities(AU)

Nivel de información sobre el riesgo cardiovascular en estudiantes universitarios / Level of information on cardiovascular risk in university students

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[Current situation of hypertensive patients over 75 years old: the DISEHTAE study]. / Situación actual del paciente hipertenso y mayor de 75 años en España. Estudio DISEHTAE.

OBJECTIVE: To assess in patients over 75 years old the degree of their compliance with recommendations on follow-up, control and treatment of hypertension. DESIGN: Descriptive, multi-centre study, covering the whole of Spain. SETTING: A total of 107 health centres from 14 autonomous communities. PARTICIPANTS: Hypertensive patients over 75: 1,369 clinical charts. INTERVENTIONS AND MAIN MEASUREMENTS: The variables studied were: age and sex, place monitored, blood pressure figures, screening for, and diagnosis of diabetes, hypercholesterolaemia, smoking, left ventricular hypertrophy (LVH) and obesity. Blood creatinine, proteinuria, prescribed medication, and infrastructure variables were also included. RESULTS: The most often screened cardiovascular risk factor (CRF) was obesity (76.1%), whilst the most prevalent was hypercholesterolaemia (31.3%). Of the patients, 25.5% had associated diabetes and 48.5% had a body mass index (BMI) >25. Low microalbuminuria (8.4%) was found. The proportion of patients with their blood pressure controlled was higher among those monitored in primary care (32.8%) than out of primary care (23.2%). No drug treatment was prescribed for 7.9%, only hygiene-dietary measures. The most common pharmacological group was that of the diuretics, followed by IECAS and ARA II. CONCLUSIONS: Though we can say that the degree of control of hypertension in elderly patients is steadily increasing, it is still far from optimal in most of our patients.

Situación actual del paciente hipertenso y mayor de 75 años en España. Estudio DISEHTAE / Current situation of hypertensive patients over 75 years old. The DISEHTAE study

Objetivo. Valorar, en el paciente mayor de 75 años, el grado de cumplimiento de las recomendaciones de seguimiento, control y tratamiento de la hipertensión arterial. Diseño. Estudio descriptivo, multicéntrico, de ámbito nacional. Emplazamiento. Ciento siete centros de salud de 14 comunidades autónomas de España. Participantes. Un total de 1.369 historias clínicas de pacientes hipertensos mayores de 75 años. Intervenciones y mediciones principales. Las variables estudiadas fueron edad y sexo, lugar de seguimiento, cifras de presión arterial, cribado y diagnóstico de diabetes, hipercolesterolemia, hábito tabáquico, hipertrofia ventricular izquierda y obesidad. También se estudiaron la creatinina plasmática, proteinuria, tratamiento farmacológico prescrito y variables de infraestructura. Resultados: El factor de riesgo cardiovascular más cribado fue la obesidad (76,1%), mientras que el más prevalente fue la hipercolesterolemia (31,3%). El 25,5% de los pacientes presentaba diabetes asociada, y el 48,5% de la muestra presentaba un índice de masa corporal (IMC) superior a 25. Se observó un bajo cribado de la microalbuminuria (8,4%). La proporción de pacientes con la presión arterial controlada es mayor entre los que se siguen en atención primaria, con un 32,8%, respecto a los seguidos fuera del ámbito de la atención primaria, con un 23,2%. A un 7,9% no se le había prescrito tratamiento farmacológico alguno, únicamente medidas higiénico-dietéticas. El grupo farmacológico más utilizado fueron los diuréticos, seguidos de inhibidores de la enzima conversiva de la angiotensina (IECA) y antagonistas de los receptores de la angiotensina II (ARA II). Conclusiones: Se puede llegar a la conclusión de que el grado de control de la hipertensión arterial en el paciente anciano va aumentando de forma progresiva, pero aún está muy lejos de lograrse un control óptimo en la mayoría de los pacientes

Objective. To assess in patients over 75 years old the degree of their compliance with recommendations on follow-up, control and treatment of hypertension. Design. Descriptive, multi-centre study, covering the whole of Spain. Setting. A total of 107 health centres from 14 autonomous communities. Participants. Hypertensive patients over 75: 1369 clinical charts. Interventions and main measurements. The variables studied were: age and sex, place monitored, blood pressure figures, screening for, and diagnosis of diabetes, hypercholesterolaemia, smoking, left ventricular hypertrophy (LVH) and obesity. Blood creatinine, proteinuria, prescribed medication, and infrastructure variables were also included. Results. The most often screened cardiovascular risk factor (CRF) was obesity (76.1%), whilst the most prevalent was hypercholesterolaemia (31.3%). Of the patients, 25.5% had associated diabetes and 48.5% had a body mass index (BMI) >25. Low microalbuminuria (8.4%) was found. The proportion of patients with their blood pressure controlled was higher among those monitored in primary care (32.8%) than out of primary care (23.2%). No drug treatment was prescribed for 7.9%, only hygiene-dietary measures. The most common pharmacological group was that of the diuretics, followed by IECAS and ARA II. Conclusions. Though we can say that the degree of control of hypertension in elderly patients is steadily increasing, it is still far from optimal in most of our patients

Guía para la prevención secundaria del ictus : recomendaciones y actividades a realizar

Guía que contiene información sobre lo que tiene que hacerse en el seguimiento de un paciente con Ictus y sobre lo que debe hacerse para el control, de los principales factores de riesgo cardiovascular.

[Level of knowledge and action on lipaemia among Spanish primary and specialist care doctors. Press cholesterol study]. / Nivel de conocimiento y actuación sobre dislipidemias de los médicos de atención primaria y especializada españoles. Estudio Colesterol Press.

OBJECTIVES: To find the level of knowledge, the guidelines for action and the monitoring of lipaemia by Spanish primary care and specialist doctors. DESIGN AND INTERVENTION: A self-defined questionnaire of 12 items was designed. Data on the population treated and the subjective evaluation of objectives, and on the management and monitoring of lipid parameters were filled in. SETTING AND PARTICIPANTS: A total of 1998 doctors from the whole of Spain took part; 68.8% of the doctors interviewed worked in primary health care and 30.2% in specialist centres or hospitals. RESULTS: A 91% of the doctors said they followed international consensus on monitoring lipaemia. The most commonly used objective therapeutic parameter for treating lipaemia was LDL-cholesterol (83%), followed by total cholesterol (62%), HDL-cholesterol (56%) and triglycerides (51%). If the patient's lipaemia was well controlled, then 21.8% of doctors reduced the doses of lipid-lowerers. In general terms, no great differences were appreciated between the criteria followed by PC and by specialist doctors. CONCLUSIONS: The criteria for action on lipaemia could be improved. There are no important differences of view or action in clinical and therapeutic criteria for Lipaemia cases between PC and specialist doctors.

Nivel de conocimiento y actuación sobre dislipidemias de los médicos de atención primaria y especializada españoles. Estudio Colesterol Press / Level of knowledge and action on lipaemia among spanish primary and specialist care doctors. Press Cholesterol Study

Objetivos. Determinar el nivel de conocimiento, las pautas de actuación y el control sobre las dislipidemias de los médicos de atención primaria y especializada españoles. Diseño e intervención. Se ha diseñado un cuestionario autodefinido formado por 12 ítems donde se completan datos acerca de la población tratada y la valoración subjetiva sobre los objetivos, el tratamiento y el control de los parámetros lipídicos. Emplazamiento y participantes. Ha participado un total de 1.998 médicos de todo el territorio nacional. El 68,8% de los médicos entrevistados trabaja en atención primaria de salud y el 30,2%, en centros de especialidades o en hospitales. Resultados. Globalmente, el 91% de los médicos declara seguir los consensos internacionales sobre el control de las dislipidemias. El parámetro objetivo terapéutico para tratar las dislipidemias más utilizado es el colesterol unido a lipoproteínas de baja densidad (cLDL) (83%), seguido del colesterol total (62%), el colesterol unido a lipoproteínas de alta densidad (cHDL) (56%) y los triglicéridos (51%). Ante un paciente bien controlado, el 21,8% de los facultativos reduce la dosis del hipolipidemiante. En líneas generales, no se aprecian grandes diferencias entre los criterios que siguen los médicos de atención primaria y los de atención especializada. Conclusiones. Los criterios de actuación ante las dislipidemias son mejorables. No hay diferencias importantes en las opiniones y actuación entre médicos de atención primaria y especialistas en los criterios clínicos y terapéuticos ante las dislipidemias

Objectives. To find the level of knowledge, the guidelines for action and the monitoring of lipaemia by Spanish primary care and specialist doctors. Design and intervention. A self-defined questionnaire of 12 items was designed. Data on the population treated and the subjective evaluation of objectives, and on the management and monitoring of lipid parameters were filled in. Setting and participants. A total of 1998 doctors from the whole of Spain took part; 68.8% of the doctors interviewed worked in primary health care and 30.2% in specialist centres or hospitals. Results. A 91% of the doctors said they followed international consensus on monitoring lipaemia. The most commonly used objective therapeutic parameter for treating lipaemia was LDL-cholesterol (83%), followed by total cholesterol (62%), HDL-cholesterol (56%) and triglycerides (51%). If the patient's lipaemia was well controlled, then 21.8% of doctors reduced the doses of lipid-lowerers. In general terms, no great differences were appreciated between the criteria followed by PC and by specialist doctors. Conclusions. The criteria for action on lipaemia could be improved. There are no important differences of view or action in clinical and therapeutic criteria for Lipaemia cases between PC and specialist doctors

Efficacy of moxonidine in the treatment of hypertension in obese, noncontrolled hypertensive patients.

BACKGROUND: Obesity has become an epidemic problem, contributing to metabolic syndrome, type 2 diabetes, hypertension, and cardiovascular disease. An adequate blood pressure control in this population of obese individuals is extremely difficult to achieve, and in most cases, therapeutic combinations are required. Pharmacologic treatment with moxonidine, a central I(1) imidazole receptor agonist, is a very interesting option because it acts upon the mechanisms implicated in the development of arterial hypertension in these patients. In addition, the drug improves the peripheral insulin resistance often found in obese patents, which contributes to maintain high blood pressure. METHODS: An interventional study has been designed, adding moxonidine to noncontrolled hypertensive, obese subjects in whom a hypocaloric diet was previously recommended. A total of 25 primary care centers participated in the study, with a total of 135 patients recruited. RESULTS: One hundred twelve patients were included in the study; 25 of them had type 2 diabetes. The mean reduction in systolic and diastolic blood pressure after 6 months treatment with moxonidine was 23.0 and 12.9 mm Hg, respectively. The mean systolic and diastolic pressures were 158.5 +/- 10.6 and 95.1 +/- 9 mm Hg, respectively, at baseline, versus 135.5 +/- 11.6 and 82.2 +/- 5.8 mm Hg at the end of the study. Creatinine clearance was significantly decreased in hyperfiltrating obese patients (143.6 +/- 31 vs. 128.2 +/- 27.9, P < 0.0001), without any significant change in patients with normal or slightly decreased renal function (81.9 +/- 18.9 vs. 80.9 +/- 17.5). Only 8 mild adverse reactions in 7 patients were recorded during the study. CONCLUSION: Moxonidine is useful and safe for controlling arterial hypertension in obese patients.