[Blood glucose control and cardiovascular risk factors in type 2 diabetic patients with cardiovascular disease in Spain, and its treatment pattern, according to gender: CODICE study]. / Control glucémico y de los factores de riesgo cardiovascular en los pacientes con diabetes tipo 2 con enfermedad cardiovascular en España, y su patrón de tratamiento, en función del género: Estudio CODICE.

INTRODUCTION AND OBJECTIVES: With the implementation of the Strategy of Health Promotion and Prevention in Spain, the scenario reflected in previous studies of low control of cardiovascular risk factors (CVRF) in patients with type 2 diabetes (DM2) and cardiovascular disease (CVD) can be modified. This study intends to determine the level of blood glucose control and other CVRF in patients with DM2 and CVD currently seen in clinics in Spain, as well as the pattern of antidiabetic treatment, and differences according to gender. MATERIALS AND METHODS: An epidemiological, observational, cross-sectional, nationwide study was conducted in patients of both genders diagnosed with DM2 and established CVD. RESULTS: The study included 3,143 patients with a mean age 69.0±10 years. The mean HbA1c was 7.4±1.1% in females vs 7.3±1.2% in males (P<.05) and systolic blood pressure was 137±15.0mmHg in females vs 135.6±14.7mmHg in males (P<.05). The mean LDL-cholesterol was 101.5±38.1mg/dl in females vs 91.1±37.5mg/dl in males; P<.001) and the mean body mass index (30.7±5.4kg/m2 in females vs 29.6±4.5kg/m2 in males; P<.001). The most used treatments were metformin (68.1%) and/or DPP4 inhibitors (53.7%), with no differences between genders. CONCLUSIONS: The level of blood glucose control of DM2 patients with CVD in Spain can be improved. The treatment profile does not conform to the recommendations of clinical practice guidelines in general. The differences in the control of CVRF are worse in women for lipids and obesity.

[ESCRYTO study. Diabetes without cardiovascular disease and level of control]. / Estudio ESCRYTO. Diabetes sin enfermedad cardiovascular y grado de control.

BACKGROUND AND OBJECTIVES: Diabetes is a significant risk factor for the development of cardiovascular disease, which is the main cause of death. The purpose of this study was to determine the level of glycaemic control in patients with type 2 diabetes without cardiovascular disease in Spain. The data used includes the most recent determination of glycosylated haemoglobin, as well as the pattern of antidiabetic treatment, the incidence of episodes of severe hypoglycaemia in the last 6 months, and the level of control of cardiovascular risk factors, and gender. PATIENTS AND METHODS: A national, multicentre, and cross-sectional epidemiological study in which 800 doctors associated with the GDPS network participated. RESULTS: Of the total of 1,059 patients, 57% male, with a mean age of 62.7 years in men vs. 65.2 in women (P<.001). The mean onset of diabetes was 9.4±7.5 years. The mean HbA1C was 7.0% in men vs. 7.1% in women (P=.039), with the control objective of <7% being observed in 47.2%. There were 65% patients on treatment with metformin, and 62.4% on DPP-4 inhibitors, and basal insulin: 14.2%. Incidence of severe hypoglycemias in the last 6 months was 1.9%. The women had worse glycaemic control, total cholesterol, LDL cholesterol, abdominal obesity, and glomerular filtration levels. CONCLUSIONS: The glycaemic control is worse in women even if adjusted for age and time of onset of diabetes (P=.043), and for the number of hypoglycaemic agents (P=.015). The level of control is also worse in women for dyslipidaemia, abdominal obesity, and glomerular filtration. A preventive strategy promoted from Primary care on healthy lifestyles and controlling all vascular risk factors is essential.

Glycaemic control of elderly patients with type 2 diabetes mellitus in Spain (2015) and its relationship with functional capacity and comorbidity. The Escadiane study. / Control glucémico de los pacientes ancianos con diabetes mellitus tipo 2 en España (2015) y su relación con la capacidad funcional y la comorbilidad. Estudio Escadiane.

OBJECTIVES: To understand the state of glycaemic control of elderly patients with type 2 diabetes mellitus in Spain and its relationship with functional capacity and comorbidity. METHODS: Cross-sectional, observational, multicentre national study on patients with diabetes mellitus aged 65 years or older. The study analysed demographic and anthropometric variables, cardiovascular risk factors, clinical and laboratory data, associated comorbidity and treatments. We analysed the functional capacity using the Barthel index and the comorbidity with Charlson index. RESULTS: The study included 939 patients with a mean age of 76.4±6.7 years. The mean glycated haemoglobin (HbA1c) level was 7.0%±1.2%, and the mean basal blood glucose level was 137±39.6mg/dL. The HbA1c level showed statistically significant differences depending on the degree of disability. In the patients who were totally, severely, moderately or slightly dependent or who were independent, the mean HbA1c levels were 7.0%, 7.9%, 7.4% and 7.0%, respectively (P<.028). HbA1c levels were 7.3%, 7.1% and 6.9% in the patients with very high, high and medium comorbidity, respectively (P<.001). CONCLUSIONS: Mean HbA1c levels in elderly patients with type 2 diabetes analysed in Spain are below those recommended by the main clinical practice guidelines. The levels are higher in patients who have more functional disability and a higher level of comorbidity.

¿La diabetes tipo 2 debería diagnosticarse y tratarse como una enfermedad cardiovascular? / Type 2 diabetes mellitus: should be diagnosed and treated as a cardiovascular disease?

Cada vez más estudios clínicos ponen de manifiesto que existe una asociación entre diabetes tipo 2 y enfermedad cardiovascular, y que la mayoría de los pacientes diabéticos fallecen debido a complicaciones macrovasculares. Estudios prospectivos recientes han demostrado que un buen control de la glucemia en ayunas y de la hemoglobina glucosilada, es capaz de prevenir la aparición de las complicaciones microvasculares en los diabéticos. Otros estudios epidemiológicos han resaltado la importancia de la hiperglucemia post-prandial y su papel como factor de riesgo independiente de morbi-mortalidad cardiovascular. Los individuos con el llamado síndrome metabólico (hipertensión arterial, dislipemia, obesidad central, insulin-resistencia e hiperinsulinismo) tienen un riesgo elevado de padecer una enfermedad cardiovascular, sin tener una diabetes manifiesta sino, solamente, una tolerancia alterada a la glucosa. Esto pone de manifiesto que el riesgo cardiovascular aumenta de forma paralela al incremento glucémico global (glucemia basal y post-prandial).Por ello, las opciones terapéuticas actuales, en caminadas a controlar las alteraciones metabólicas de la diabetes, deben tratar, también, de prevenir a largo plazo la aparición de las complicaciones macrovasculares de la enfermedad. La nateglinida, un estimulador de la secreción de insulina de acción rápida y de corta duración, que actúa reduciendo eficazmente los picos post-prandiales de glucosa, puede ofrecer una al ternativa terapéutica válida para el manejo global del paciente con diabetes tipo 2 (AU)