Incidencia de diabetes tipo 2 y factores asociados en la población adulta de la Comunidad de Madrid. Cohorte PREDIMERC / Incidence of type 2 diabetes and associated factors in the adult population of the Community of Madrid. PREDIMERC cohort

Objetivos. Estimar la incidencia y los factores de riesgo de diabetes tipo2 en la población adulta de Madrid (España) y comparar los modelos predictivos de diabetes tipo2 basados en los criterios de prediabetes de la American Diabetes Association (ADA) y la Organización Mundial de la Salud (OMS). Material y métodos. Estudio prospectivo de una cohorte poblacional formada por 2048 individuos de entre 30 y 74años sin diabetes. Al inicio del estudio se realizó una encuesta epidemiológica y se midió la glucemia basal, la HbA1c, el índice de masa corporal y el perímetro de la cintura. Se realizó un seguimiento de 6,4años. Los casos nuevos de diabetes tipo2 se identificaron a través de la historia clínica electrónica de atención primaria. Resultados. La incidencia de diabetes tipo2 fue 3,5 casos/1.000 personas-año. En el análisis multivariante las variables que se asociaron con la aparición de diabetes tipo2 fueron la edad, los antecedentes familiares de diabetes, la glucemia basal (100-125mg/dl), la HbA1c (5,7-6,4%) y el perímetro de la cintura (≥94cm en hombres y ≥80cm en mujeres). De estas, las más significativamente asociadas fueron la glucemia basal y la HbA1c. Los criterios de la ADA y la OMS para definir prediabetes tuvieron la misma capacidad predictiva. Conclusión. La incidencia de diabetes tipo2 estimada en Madrid fue inferior a la encontrada en otros estudios poblacionales, siendo el estado glucometabólico el principal factor asociado a la progresión a diabetes tipo2. No se han detectado diferencias entre la prediabetes definida por la ADA y la OMS para predecir la aparición de la enfermedad (AU)

Objectives. Determine the incidence and risk factors of type2 diabetes in the adult population of Madrid (Spain) and compare the predictive models of type2 diabetes based on the prediabetes criteria of the American Diabetes Association (ADA) and the World Health Organisation (WHO). Material and methods. A prospective study was conducted on a population cohort composed of 2048 individuals between 30 and 74years of age with no diabetes. At the start of the study, an epidemiological survey was performed, and baseline glycaemia, HbA1c, body mass index and waist circumference were measured. A follow-up of 6.4years was conducted. New cases of type2 diabetes were identified using the electronic primary care medical history. Results. The incidence of type2 diabetes was 3.5 cases/1000 person-years. In the multivariate analysis, the variables that were associated with the onset of type2 diabetes were age, family history of diabetes, baseline glycaemia (100-125mg/dL), HbA1c (5.7-6.4%) and waist circumference (≥94cm for men and ≥80cm for women). Of these, the most significantly associated variables were baseline glycaemia and HbA1c. The ADA and WHO criteria for defining prediabetes had the same predictive capacity. Conclusion. The incidence of type2 diabetes measured in Madrid was lower than that found in other population studies, with the glucometabolic state the main factor associated with progression to type2 diabetes. There were no differences between the prediabetes defined by the ADA and the WHO for predicting the onset of the disease (AU)

Incidence of type 2 diabetes and associated factors in the adult population of the Community of Madrid. PREDIMERC cohort.

OBJECTIVES: Determine the incidence and risk factors of type2 diabetes in the adult population of Madrid (Spain) and compare the predictive models of type2 diabetes based on the prediabetes criteria of the American Diabetes Association (ADA) and the World Health Organisation (WHO). MATERIAL AND METHODS: A prospective study was conducted on a population cohort composed of 2048 individuals between 30 and 74years of age with no diabetes. At the start of the study, an epidemiological survey was performed, and baseline glycaemia, HbA1c, body mass index and waist circumference were measured. A follow-up of 6.4years was conducted. New cases of type2 diabetes were identified using the electronic primary care medical history. RESULTS: The incidence of type2 diabetes was 3.5 cases/1000 person-years. In the multivariate analysis, the variables that were associated with the onset of type2 diabetes were age, family history of diabetes, baseline glycaemia (100-125mg/dL), HbA1c (5.7-6.4%) and waist circumference (≥94cm for men and ≥80cm for women). Of these, the most significantly associated variables were baseline glycaemia and HbA1c. The ADA and WHO criteria for defining prediabetes had the same predictive capacity. CONCLUSION: The incidence of type2 diabetes measured in Madrid was lower than that found in other population studies, with the glucometabolic state the main factor associated with progression to type2 diabetes. There were no differences between the prediabetes defined by the ADA and the WHO for predicting the onset of the disease.

Organización y funcionamiento de las consultas de tabaquismo en una comunidad autónoma. Experiencia de la Comunidad de Madrid / Organization and functions of the anti-smoking consultations in a regional community. Experience of the Madrid Community

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Epidemiología del tabaquismo: efectos sobre la salud, prevalencia de consumo y actitudes. Estrategias de prevención y control / Epidemiology of the smoking habit: effects on health, consumption prevalence and attitudes. Prevention and control strategies

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Manejo clínico de los fumadores en proceso de reducción hasta dejarlo. Protocolo clínico / Clinical management of smokers in the process of reducing smoking consumption until giving it up. Clinical Protocol

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[Do the complaints of primary care users vary with the care model?]. / Son diferentes las quejas de los usuarios de atención primaria según el modelo de atención?

OBJECTIVES: 1. To compare the traditional model (TM) and Primary Care teams (PCTs) on the index of complaints. 2. To determine whether the reasons for complaints vary with the care model. DESIGN: An observational, cross-sectional study. SETTING: Primary Care Area 4, INSALUD, Madrid, covering 526,987 inhabitants. PARTICIPANTS: The complaints presented at PC Centres during 1993 were included. Those presented for reasons not concerning the centre were excluded. In all, 448 complaints were studied. MEASUREMENTS AND MAIN RESULTS: Significant differences were found in the general index of complaints according to the care model. Statistically significant differences were detected between PCT and the TM for complaints due to disagreement with the treatment and disagreement with the follow-up procedures. CONCLUSIONS: Since the indicators of prescription profiles and the following of procedures are better in PCTs than in the TM, perhaps patients should be encouraged to participate more in the taking of clinical decisions. This would help the introduction of improvements both in the technical quality of treatment and in the follow-up of chronic diseases to be perceived as such by patients. At present, as this study suggests, they are causes of greater dissatisfaction.

[Tobacco addiction in primary health care workers in the health area number 4 of Insalud in Madrid: prevalence of consumption and attitude]. / El tabaquismo en los trabajadores de atención primaria del área sanitaria número 4 del Insalud de Madrid: prevalencia de consumo y actitudes.

BACKGROUND: In developed countries, tobaccoism constitutes the main public health problem capable of prevention. Health professionals comprise the sector with the greatest power of influence in reducing smoking habits. Nevertheless, cooperation is determined by their own personal habits and attitudes to smoking. This study describes the prevalence of smoking and attitudes towards tobaccoism amongst primary medical care personnel within Area 4 of Insalud in Madrid. METHODS: Of the 910 workers surveyed, 803 responded (response rate: 88%). 42.3% were smokers (35.3% on a daily basis and 7% occasionally) and the average smoker consumed 17 cigarrettes per day. 25.9% were ex-smokers and 31.7% non-smokers. 95% of non-smokers and 85% of smokers considered that smoking should be forbidden in medical centres (p << 0.001). 11% of smokers did so in front of patients (10% of doctors and 3.3% of nursing staff). 58.4% of smokers stated that they would participate in an assistance scheme designed to help them give up the habit. CONCLUSIONS: Results indicate that there still exists a large percentage of primary medical care personnel that smoke and that attitudes are not those that would be expected from a group of people seen as an example by others. Priority must be given to intensifying awareness, assisting people to give up smoking and to training courses.