Rendimiento de los indicadores tras la implementación del Documento de consenso español para el control de la hiperglucemia en el hospital y al alta / Indicator performance after the implementation of the Spanish Consensus Document for the control of hyperglycemia in the hospital and at discharge

Antecedentes y objetivos: la información sobre el manejo de los pacientes diabéticos en el momento del alta hospitalaria es reducida. El objetivo del estudio fue evaluar el impacto de la implementación de las recomendaciones del Consenso español para el manejo del alta hospitalaria en pacientes con diabetes tipo 2 (DM2) o hiperglucemia durante la hospitalización. Métodos: estudio observacional con un grupo de recogida prospectiva y otra retrospectiva de pacientes con DM2/hiperglucemia (> 140mg/dl) durante la hospitalización de 19 hospitales españoles. Se recopilaron indicadores de calidad en el informe de alta, terapia hipoglucémica, HbA1c y eventos adversos al ingreso, en el momento del alta y a los 3 meses del alta. Resultados: se incluyó a 199 pacientes en el grupo prospectivo y 75 en el retrospectivo. Los indicadores de calidad del informe de alta hospitalaria fueron mayores en el grupo prospectivo (p<0,001). La proporción de pacientes con tratamiento de insulina, fármacos antidiabéticos orales (ADO) e insulina+ADO sufrió modificaciones en el momento del alta hospitalaria de los pacientes del grupo prospectivo con HbA1c<7,5% (p<0,005) y ≥ 7,5% (p<0,001), y en los pacientes del grupo retrospectivo con HbA1c ≥ 7,5% (p<0,001). En el mes 3 tras el alta, los niveles de HbA1c descendieron de 8,2± 1,9% a 7,3±1,2% (p<0,001) en el grupo prospectivo y desde 8,2±1,9% a 7,3±1,2% (p<0,001) en el retrospectivo. Los episodios de hipoglucemia e hiperglucemia así como los de reingreso fueron semejantes en ambos grupos. Conclusiones: la aplicación del documento español de consenso de las recomendaciones para el manejo del alta hospitalaria en pacientes con DM2 o hiperglucemia mejora de forma considerable el registro de indicadores de calidad en el informe de alta. La conciliación de la medicación antidiabética en el momento del alta hospitalaria mejora el control glucémico después del alta

Background and aims: information for the adequate management of diabetic patients at hospital discharge is limited. We aimed to evaluate the impact of implementation of recommendations of the Spanish consensus for the management hospital discharge in patients with type 2 diabetes or hyperglycaemia during hospitalization. Methods: observational multicentric study with a prospective and a retrospective colection of patients with type 2 diabetes /hyperglycaemia (>140mg/dl) during hospitalization from 19 Spanish hospitals. Quality indicators in discharge report, antidiabetic therapy, HbA1c and adverse events were gathered at hospital admission, hospital discharge and 3 month post-discharge. Results: 199 and 75 subjects in the prospective and retrospective group respectively were included. The indicators of quality in the hospital discharge reports was higher in the prospective group (P<.001). The proportion of patients with insulin, oral antidiabetic drugs (OADs), and insulin+OADs was modified at discharge in patients with HbA1c<7.5% (P<.005) and ≥7.5% (P<.001) in the prospective group and in patients with HbA 1c ≥7.5% (P<.001) in the retrospective group. At 3 month post-discharge HbA1c levels decreased from 8.2±1.9% to 7.3±1.2% (P<.001) in the prospective group, and from 8.3±1.5% to 7.2±1.2% (P<.001) in the retrospective group. Hypoglycaemic and hyperglycaemic episodes and hospital readmissions were similar in both groups. Conclusions: implementation of Spanish consensus recommendations for the management of hospital discharge in patients with diabetes type 2 or hyperglycaemia considerably improved the registration of quality indicators in the discharge report. Reconciliation of antidiabetic medication at the time of hospital discharge, improves glycaemic control after hospital discharge

Indicator performance after the implementation of the Spanish Consensus Document for the control of hyperglycemia in the hospital and at discharge. / Rendimiento de los indicadores tras la implementación del Documento de consenso español para el control de la hiperglucemia en el hospital y al alta.

BACKGROUND AND AIMS: Information for the adequate management of diabetic patients at hospital discharge is limited. We aimed to evaluate the impact of implementation of recommendations of the Spanish consensus for the management hospital discharge in patients with type 2 diabetes or hyperglycaemia during hospitalization. METHODS: Observational multicentric study with a prospective and a retrospective colection of patients with type 2 diabetes /hyperglycaemia (>140mg/dl) during hospitalization from 19 Spanish hospitals. Quality indicators in discharge report, antidiabetic therapy, HbA1c and adverse events were gathered at hospital admission, hospital discharge and 3 month post-discharge. RESULTS: 199 and 75 subjects in the prospective and retrospective group respectively were included. The indicators of quality in the hospital discharge reports was higher in the prospective group (P<.001). The proportion of patients with insulin, oral antidiabetic drugs (OADs), and insulin+OADs was modified at discharge in patients with HbA1c<7.5% (P<.005) and ≥7.5% (P<.001) in the prospective group and in patients with HbA 1c ≥7.5% (P<.001) in the retrospective group. At 3 month post-discharge HbA1c levels decreased from 8.2±1.9% to 7.3±1.2% (P<.001) in the prospective group, and from 8.3±1.5% to 7.2±1.2% (P<.001) in the retrospective group. Hypoglycaemic and hyperglycaemic episodes and hospital readmissions were similar in both groups. CONCLUSIONS: Implementation of Spanish consensus recommendations for the management of hospital discharge in patients with diabetes type 2 or hyperglycaemia considerably improved the registration of quality indicators in the discharge report. Reconciliation of antidiabetic medication at the time of hospital discharge, improves glycaemic control after hospital discharge.

[A comparative study of nisoldipine and alpha-methyldopa in aged patients with isolated systolic hypertension]. / Estudio comparativo entre nisoldipino y alfa-metildopa en pacientes ancianos con hipertensión sistólica aislada.

A comparative, randomized and cross clinical trial between nisoldipine and alpha-methyldopa in 50 aged patients with isolated systolic hypertension during 12 weeks. The therapeutic aim (SAP less than or equal to 160 mmHg) was reached after the first period in the 60% of the patients treated with nisoldipine and the 63% of those who took alpha-methyldopa (ns), and after the second period: 77% in nisoldipine group and 82% for alpha-methyldopa (ns). Adverse effects were experienced in the 21.7% of the patients treated with nisoldipine and in the 60.8% of the patients who received alpha-methyldopa (p less than 0.001. Nisoldipine had a lower effect that alpha-methyldopa over the diastolic arterial pressure. It was not any change in the biochemical parameters related to both antihypertensive drugs.

[A multicenter study comparing nitrendipine and chlorthalidone in elderly hypertensive patients]. / Estudio multicéntrico comparativo entre nitrendipino y clortalidona en pacientes ancianos hipertensos.

One hundred and eleven low-moderate hypertense elderly patients treated with nitrenpidine or chlortalidone were studied during 4 months either on monotherapy or in combination according to the therapeutic response observed. The therapeutic goal (diastolic arterial pressure less than 95 mmHg) was obtained in 92.4% of patients on nintrenpidine and in 49.1% on chlortidone, both on monotherapy (2 months) (p less than 0.001). At the end of the study 96.3% of patients reaches the therapeutic goal. Secondary effects were observed in 8.3% of patients on nitrenpidine and 6.1% on chlortalidone and in 11.1% of patients on combined treatment. No abnormalities were observed in blood biochemistry studied nor was there evidence of a significant influence of any of the two drugs on the patients quality of life which was evaluated through a specific questionnaire specially designed.