Grado de conocimiento de insulinización por los médicos de atención primaria y su repercusión en el control de la diabetes / Level of knowledge about insulinization by Primary Care physicians and its impact on diabetes control

OBJETIVO: Analizar el grado de conocimiento y manejo actual de la insulinización por los médicos de atención primaria (AP), así como su impacto sobre el grado de control metabólico. MATERIALES Y MÉTODOS: Estudio secuencial exploratorio, principalmente cualitativo con un enfoque fenomenológico y posterior fase cuantitativa. Participaron 37 médicos de AP del Servicio Andaluz de Salud. Se realizó análisis univariado y bivariado de variables sociodemográficas y clínico-asistenciales. RESULTADOS: Existió una gran variabilidad entre los médicos de AP acerca del conocimiento sobre el tratamiento con insulinas (conocimiento bajo: 13,5%; medio: 59,5%; alto: 27,0%). Hubo una relación directa entre el conocimiento sobre insulinización y el grado de consecución de objetivos de HbA1c: a mayor grado de conocimiento, mejor control metabólico. Las insulinas basales más prescritas fueron la insulina glargina100 (56,8%), seguida de la insulina glargina300 (29,7%) y después la insulina NPH (8,1%). Hubo tendencia a presentar un diferente perfil de prescripción respecto a las insulinas basales, de tal forma que la prescripción de insulina NPH y de insulinas mixtas coincidía con el nivel más bajo de conocimiento. El 35,1% de los médicos de AP desconocían patrones de insulinización más complejos. CONCLUSIONES: Solo el 27% de los médicos de AP tienen un conocimiento elevado sobre el tratamiento con insulinas. Existe una relación directa entre el nivel de conocimiento sobre las insulinas y el grado de control glucémico. Es necesario mejorar el conocimiento sobre el tratamiento con insulinas para optimizar el control metabólico y disminuir el riesgo de complicaciones

OBJECTIVE: To determine the level of knowledge and current management of starting insulin treatment by Primary Care physicians, and its impact on metabolic control. MATERIALS AND METHODS: A mainly qualitative exploratory sequential study, with a phenomenological approach, followed by a quantitative phase. The study included 37 primary care physicians from the Andalusian Health Service. Socio-demographic and clinical care variables were analysed. Univariate and bivariate analyses were performed. RESULTS: There was a wide variability between Primary Care physicians in the level of knowledge of treatment with insulins (low knowledge: 13.5%; medium knowledge: 59.5%; high knowledge: 27.0%). There was a direct relationship between the level of knowledge and the attainment of HbA1c goals (as the level of knowledge increased, the metabolic control improved). The most common basal insulins prescribed were insulin glargine U-100 (56.8%), followed by insulin glargine U-300 (29.7%), and neutral protamine hagedorn (NPH) insulin (8.1%). There was a trend to show a different prescription pattern with basal insulins (as the level of knowledge decreased, the prescription of mixed and NPH insulins increased). More than one-third (35.1%) of primary care physicians did not know more complex patterns of treatment with insulins. CONCLUSIONS: Only 27% of Primary Care physicians had a high knowledge about treatment with insulins. There was a direct relationship between the level of knowledge about insulins and glycaemic control. It is necessary to improve the knowledge about insulin therapy in order to optimise metabolic control and reduce the risk of complications

[Level of knowledge about insulinization by Primary Care physicians and its impact on diabetes control]. / Grado de conocimiento de insulinización por los médicos de atención primaria y su repercusión en el control de la diabetes.

OBJECTIVE: To determine the level of knowledge and current management of starting insulin treatment by Primary Care physicians, and its impact on metabolic control. MATERIALS AND METHODS: A mainly qualitative exploratory sequential study, with a phenomenological approach, followed by a quantitative phase. The study included 37 primary care physicians from the Andalusian Health Service. Socio-demographic and clinical care variables were analysed. Univariate and bivariate analyses were performed. RESULTS: There was a wide variability between Primary Care physicians in the level of knowledge of treatment with insulins (low knowledge: 13.5%; medium knowledge: 59.5%; high knowledge: 27.0%). There was a direct relationship between the level of knowledge and the attainment of HbA1c goals (as the level of knowledge increased, the metabolic control improved). The most common basal insulins prescribed were insulin glargine U-100 (56.8%), followed by insulin glargine U-300 (29.7%), and neutral protamine hagedorn (NPH) insulin (8.1%). There was a trend to show a different prescription pattern with basal insulins (as the level of knowledge decreased, the prescription of mixed and NPH insulins increased). More than one-third (35.1%) of primary care physicians did not know more complex patterns of treatment with insulins. CONCLUSIONS: Only 27% of Primary Care physicians had a high knowledge about treatment with insulins. There was a direct relationship between the level of knowledge about insulins and glycaemic control. It is necessary to improve the knowledge about insulin therapy in order to optimise metabolic control and reduce the risk of complications.

Efecto del ejercicio sobre la somnolencia y la calidad de vida en pacientes con apneas del sueño sin indicación de tratamiento con CPAP / Effect of exercise for excessive daily sleepiness and quality of life in obstructive sleep apnea patients without CPAP device indication

OBJETIVO: Determinar el efecto del ejercicio sobre la calidad de vida e impacto en actividades cotidianas de la vida de los pacientes con síndrome de apneas-hipopneas del sueño (SAHS) leve. PACIENTES Y MÉTODOS: Ensayo clínico controlado, aleatorizado y de grupos paralelos. Se incluyeron sujetos con un índice de apneas-hipopneas (IAH) < 20 y escasa actividad física. Los sujetos fueron aleatorizados a un grupo, que realizó un programa aeróbico de ejercicio físico, frente a un grupo que realizó las medidas habituales. Después de 24 semanas, se determinaron nuevamente la calidad de vida (cuestionario Euroqol-5D) y el impacto sobre las actividades de la vida cotidiana (cuestionario FOSQ). RESULTADOS: De los 27 pacientes con SAHS leve, no se analizaron 3 sujetos del grupo intervención (23%), ya que no cumplieron el programa de ejercicio, y 1 sujeto del grupo control (7%). Las características basales fueron similares en ambos grupos. Tras el seguimiento, en el grupo control (n = 13) no se encontraron diferencias respecto a los valores basales, mientras que en grupo intervención (n = 10) se observaron cambios significativos en la calidad de vida (movilidad, puntuación total de salud y autovaloración, p < 0,05) y en la puntuación del cuestionario FOSQ (cálculo total, dimensiones de productividad social, actividad, vigilancia e intimidad; p < 0,05), sin cambio significativo en el cuestionario de Epworth. CONCLUSIONES: En pacientes con SAHS leve, un programa de ejercicio aeróbico produce mejoría en la calidad de vida y en el impacto de la somnolencia diurna sobre su vida cotidiana

OBJECTIVE: To determine the effect of exercise in health-related quality of life and how it impacts on daily activities in mild obstructive sleep apnea (OSA) patients. Patients and METHODS: Controlled clinical trial, randomized and parallel groups. Patients with an apnea-hipopnea index (AHI) < 20 and with mild activity were included. Randomly, patients were undertaken to an aerobic program (intervention group) or to an usual therapeutic measures (control group). We analyzed health-related quality of life (Euroqol-5D questionnaire) and the impact on daily activities (FOSQ questionnaire) after 24 weeks. RESULTS: 27 patients were included. 3 patients in the intervention group (23%) with mild OSA were no analyzed because of lack of exercise adherence, while in the control group 1 patient (7%) was lost. Characteristics were similar in both groups. There were no differences in basal statements in the control group (n =13) after the following period. There were stadistical differences in quality of life (mobility, total score and visual anagogic scale score; p < 0.05) and in FOSQ questionnaire score (total score, social outcomes, activity level, vigilance and intimacy and sexual subscales; p < 0.05) in the interventional group (n = 10). No significant change in the Epworth questionnaire was observed. CONCLUSIONS: An aerobic exercise program in patients with mild OSA improves quality of life and produces a positive impact in daytime sleepiness on activities of daily living

Mujer de 58 años con dolor centrotorácico y alteración en la radiografía de tórax / 58 year old woman with central-thoracic pain and alterations in the thorax X-Ray

La microlitiasis alveolar es una enfermedad pulmonar difusa infrecuente que se caracteriza por el depósito intraalveolar de formaciones esféricas de fosfato cálcico (microlitos). Se puede presentar a cualquier edad diagnosticándose, en gran parte de los casos, de forma incidental. Aunque la etiología no está del todo aclarada, un 30 - 50% de los pacientes presentan un componente familiar, heredándose de forma autosómica recesiva. Se conoce que dichas alteraciones se relacionan con un gen transportador del fosfato sódico en las células alveolares (SLC34A2), localizado en el cromosoma 4. Esta enfermedad suele ser asintomática hasta estadios finales, existiendo una clara disociación clínico-radiológica. No existe ningún tratamiento específico, siendo el trasplante pulmonar una alternativa posible en estados avanzados. Se presenta el caso de una paciente de 58 años, diagnosticada de forma incidental de microlitiasis alveolar y su evaluación como potencial candidata a trasplante pulmonar

Pulmonary alveolar microlithiasis (PAM) is a rare disease of unknown cause, characterized by intra-alveolar spherical deposits of calcium phosphate (microlites). These may appear at any age, and for the most part, are diagnosed incidentally. Although the etiology is not fully understood, between 30 - 50% of the patients seem to have a genetic component, inheriting it in an autosomal recessive pattern. It is known that said alteration is linked to a gene transporting sodium phosphate in the alveolar cells (SLC34A2), located in chromosome 4. This disorder is usually asymptomatic until the final stages, with a clear clinicalradiological dissociation. There is no specific treatment, with lung transplant being the only possible alternative in advanced stages. The case of a 58 year old patient is presented. She was diagnosed with alveolar microlithiasis by chance and assessed as a potential candidate for lung transplant