Control glucémico en el panciente anciano con diabetes mellitus tipo 2 tratado con antidiabéticos / Glycemic control in the elderly patient with type 2 diabetes mellitus treated with antidiabetics

El objetivo de este trabajo es evaluar el tratamiento antidiabético y la concordancia con los valores de hemoglobina glicosilada (HbA1c) recomendados por la guías en pacientes ancianos: entre 7,5 y 8,5% para el control de la diabetes mellitus tipo II (DMII) en el paciente anciano frágil, relacionándose HbA1c <6,5% con mayor morbi-mortalidad, riesgo de hipoglucemias y caídas.Se trata de un estudio retrospectivo realizado en enero 2020. Se incluyeron pacientes diagnosticados de DMII, mayores de 75 años, que llevaran tratamiento con cualquier combinación de antidiabéticos orales (ADO). Se registró el último valor de HbA1c disponible durante el año previo. Se analizó la relación entre el valor de HbA1c y el número de ADOs prescritos (+ insulina), edad del paciente y/o fragilidad. Se incluyeron 936 pacientes, edad media 81,3 años. El 15,8% de los pacientes no tenía ninguna determinación de HbA1c disponible en el último año. El resto de pacientes, tenían una media de HbA1c de 6,6%. Sólo el 13,2% de los pacientes se situaron en el intervalo terapéutico objetivo (7,5-8,5%). Un 39,9% tuvo una HbA1c <6,5% y solamente un 5,0% tenía un HbA1c ≥8,5%, (mal control). De los 617 pacientes con una HbA1c <7,5%, el 25,4% eran mayores de 85 años, el 32,1% estaban clasificados como paciente crónico complejo (PCC), lo que suponía una mayor fragilidad, el 38,6% llevaban más de un fármaco ADO y el 8,6% llevaba asociada insulina.Los valores de HbA1c en los pacientes ancianos analizados son inferiores a los recomendados por las principales guías. Los resultados de este trabajo hacen patente la necesidad de implementar estrategias que permitan establecer el tratamiento óptimo de manera individualizada. (AU)

The objective of this work is to evaluate antidiabetic treatment and concordance with the glycosylated hemoglobin (HbA1c) values recommended by the guidelines in elderly patients: between 7.5 and 8.5% for the control of type II diabetes mellitus (DMII) in frail elderly patients. HbA1c <6.5% is being associated with higher morbidity and mortality, risk of hypoglycemia and falls.This is a retrospective study conducted in January 2020. Patients diagnosed with DMII, older than 75 years, who had been treated with any combination of oral antidiabetic drugs (ADO) were included. The last HbA1c value available during the previous year was recorded. The relationship between the HbA1c value and the number of prescribed ADOs (+ insulin), age of the patient and/or frailty was analyzed.936 patients were included, mean age 81.3 years. 15.8% of the patients had no HbA1c determination available in the last year. The rest of the patients had a mean HbA1c of 6.6%. Only 13.2% of the patients were in the target therapeutic range (7.5-8.5%). 39.9% had an HbA1c <6.5% and only 5.0% had an HbA1c ≥8.5%, (poor control). Of the 617 patients with an HbA1c <7.5%, 25.4% were older than 85 years, 32.1% were classified as complex chronic patient (PCC), which meant greater frailty, 38.6% had more than one ADO drug and 8.6% had associated insulin.The HbA1c values in the analyzed elderly patients are lower than those recommended by the main guidelines. The results of this work make clear the need to implement strategies that establish the optimal treatment individually. (AU)

Adecuación de los botiquines de antídotos de los servicios de farmacia en hospitales públicos de la comunidad autónoma de Les Illes Balears / Adequacy of poisoning antidote stocks in the pharmacies of public health service hospitals in the Spanish autonomous community of the Balearic Islands

Objetivo: Analizar la adecuación del botiquín de antídotos en los servicios de farmacia de los hospitales de la red pública de la comunidad autónoma de Les Illes Balears. Método: Estudio descriptivo y transversal que revisa la composición del botiquín de antídotos y otros fármacos para el tratamiento de intoxicaciones agudas disponible en los servicios de farmacia de los diversos hospitales públicos de la Comunidad Autónoma, mediante cumplimentación de un formulario específico por un responsable de cada centro. Los resultados obtenidos se compararon con las recomendaciones CALITOX-2006 y las recomendaciones Antidote Stocking Guidelines (ASG-2009), se analizó la disponibilidad, cantidad y ubicación. Resultados: En los 7 hospitales, la disponibilidad supera el 85% según CALITOX y el68% según ASG. Las carencias principales fueron el sulfato sódico, la apomorfina, la cianida kit oral y el suero anticrotálide. La adecuación cuantitativa media es del 83%, y lapiridoxina es el que más veces está infradotado. Hay un exceso de carbón activado y de N-acetilcisteína. Se detectó una infradotación de glucagón y de fomepizol en el hospital de referencia. Los criterios de ubicación en el servicio de urgencias se siguieron en más del 80% (hospital de nivel I), 68% (hospital de nivel II) y 94% (hospital de referencia).Conclusiones: El grado de cumplimiento de las recomendaciones consultadas en cuanto a composición, accesibilidad y dotación del botiquín de antídotos y otros fármacos para el tratamiento de intoxicaciones agudas en los hospitales públicos de Les Illes Balears es alto, con una distribución en cada una de las islas segura para garantizar su disponibilidad. La situación geográfica del hospital y su proximidad al centro de referencia más dotado de antídotos predominan sobre el grado de complejidad del hospital en los de nivel 2

Objective: To analyze whether pharmacies in public health service hospitals in the Spanish autonomous community of the Balearic Islands are stocking sufficient amounts of poison antidotes. Methods: Descriptive cross-sectional study of public hospital pharmacy stocks of antidotes and other medicines for treating acute poisoning. The head of each hospital pharmacy completed a questionnaire about stocks. The results on which antidotes were in stock, the amounts, and the storage locations were assessed for compliance with recommended quality indicators for emergency care in acute poisonings (CALITOX-2006) and the Antidote Stocking Guidelines (ASG-2009).Results: The 7 hospitals met the CALITOX-2006 availability criteria for over 85% of items and the ASG-2009 criteria for68%. Inadequate stocking mainly involved sodium sulfate, apomorphine, oral cyanide antidote kits, and crotaline snake antivenom. An average of 83% of the stocks were adequate; pyridoxine was the substance most often found to be understocked. Activated charcoal and N-acetylcysteine were the items most often overstocked. Glucagon and fomepizole were understocked in the referral hospital. Over 80% of items were stored in appropriate ocations in the emergency departments of level 1 hospitals (68% in level 2 hospitals; 94% in the referral hospital). Conclusions: Public health system hospitals are highly compliant with recommendations on stocking antidotes and other medicines to treat acute poisoning (what to stock, where, and in what amounts); the distribution of stocks safely guarantees they will be available when needed. Among level 2 hospitals, a facility's location (proximity to the best-equipped referral hospital for poisonings) had greater influence on compliance than the hospital's level of complexity

Evaluación retrospectiva de la efectividad y seguridad de cinacalcet para el tratamiento de hiperparatiroidismo secundario dependiendo del valor basal de paratohormona intacta / Retrospective assessment of effective and safety of cinacalcet for the treatment of secondary hyperparathyroidism depending on basal iPTH level

Objetivo Cinacalcet es un calcimimético recomendado para el tratamiento del hiperparatiroidismo secundario en pacientes en diálisis. El objetivo del estudio fue evaluar la eficacia y seguridad de cinacalcet comparando pacientes con PTHi basal > 300 pg/ml vs. PTHi < 300 pg/ml. Métodos Estudio observacional retrospectivo de pacientes en tratamiento con cinacalcet 30mg/día desde enero de 2008 a enero de 2009.Estudiamos 26 pacientes, 15 PTHi > 300 pg/ml y 11 PTHi < 300 pg/ml.La variable principal de eficacia fue la reducción entre el valor basal y final de PTHi (4 meses).Como variables secundarias se registró la reducción entre valor basal y final de calcio, fósforo, CaxP, y porcentaje de pacientes con reducción de PTHi superior al 30%.La seguridad se evaluó por los efectos secundarios más frecuentes y nivel de calcio < 8,6mg/dl. Resultados Los pacientes con PTHi > 300 presentaron diferencias estadísticamente significativas entre valor basal y final de PTH (563,49+286,88 pg/ml vs. 315,15+201,948 pg/ml; p=0,017) y calcio (9,1+1,77mg/dl vs. 8,15+1,2mg/dl; p=0,02). No hubo diferencias en los pacientes con PTHi < 300 pg/ml. Se observó reducción de más del 30% de la PTHi basal en el 60% de pacientes con PTHi basal > 300 pg/ml, y en el 27,3% de los que tenían PTHi basal < 300 pg/ml (p=0,098). No se reportó intolerancia gastrointestinal. Conclusión Cinacalcet es un fármaco efectivo y seguro en el tratamiento del hiperpartiroidismo secundario en pacientes dializados, con valores basales de PTHi > 300 pg/ml (AU)

Objective Cinacalcet is a calcimimetic agent, recommended for treating refractory secondary hyperparathyroidism in patients undergoing dialysis. The aim of this study was to evaluate the efficacy and safety of cinacalcet, comparing patients with baseline iPTH > 300 pg/ml with those with iPTH < 300 pg/ml. Method Observational retrospective study of patients being treated with cinacalcet 30mg/day from January 2008 to January 2009.We studied 26 patients, 15 with iPTH > 300 pg/ml and 11 with iPTH < 300pg/ml. The primary efficacy outcome was that there was a reduction between baseline and final iPTH (4 month). The secondary efficacy outcome were the reduction between basal and final calcium, phosphorus, Ca x P, and the percentage of patients with an iPTH decrease > 30%. The safety was evaluated based on the most frequent adverse effects and the levels of serum calcium < 8.6mg/dl. Results Patients with initial iPTH > 300 had significant differences before and after cinacalcet treatment in iPTH (563.49+286.88 pg/ml vs 315.15+201.948 pg/ml; P=.017) and serum calcium (9.1+1.77mg/dl vs 8.15+1.2mg/dl; P=.02). There were no significant differences in patients with initial iPTH < 300 pg/ml. A decrease greater than 30% from baseline iPTH was observed in 60% of patients with baseline iPTH > 300pg/ml, and only in 27.3% of those with basal iPTH < 300 pg/ml (P=.098). Patients did not show gastric intolerance. Conclusions Cinacalcet is an effective and safe drug for controlling secondary hyperparathyroidism in dialysis, mainly when it is used in patients with baseline iPTH > 300 pg/ml. (AU)

[Retrospective assessment of effective and safety of cinacalcet for the treatment of secondary hyperparathyroidism depending on basal iPTH level]. / Evaluación retrospectiva de la efectividad y seguridad de cinacalcet para el tratamiento de hiperparatiroidismo secundario dependiendo del valor basal de paratohormona intacta.

OBJECTIVE: Cinacalcet is a calcimimetic agent, recommended for treating refractory secondary hyperparathyroidism in patients undergoing dialysis. The aim of this study was to evaluate the efficacy and safety of cinacalcet, comparing patients with baseline iPTH > 300 pg/ml with those with iPTH < 300 pg/ml. METHOD: Observational retrospective study of patients being treated with cinacalcet 30 mg/day from January 2008 to January 2009. We studied 26 patients, 15 with iPTH > 300 pg/ml and 11 with iPTH < 300 pg/ml. The primary efficacy outcome was that there was a reduction between baseline and final iPTH (4 month). The secondary efficacy outcome were the reduction between basal and final calcium, phosphorus, Ca x P, and the percentage of patients with an iPTH decrease > 30%. The safety was evaluated based on the most frequent adverse effects and the levels of serum calcium < 8.6 mg/dl. RESULTS: Patients with initial iPTH > 300 had significant differences before and after cinacalcet treatment in iPTH (563.49+286.88 pg/ml vs 315.15+201.948 pg/ml; P=.017) and serum calcium (9.1+1.77 mg/dl vs 8.15+1.2mg/dl; P=.02). There were no significant differences in patients with initial iPTH < 300 pg/ml. A decrease greater than 30% from baseline iPTH was observed in 60% of patients with baseline iPTH > 300 pg/ml, and only in 27.3% of those with basal iPTH < 300 pg/ml (P=.098). Patients did not show gastric intolerance. CONCLUSIONS: Cinacalcet is an effective and safe drug for controlling secondary hyperparathyroidism in dialysis, mainly when it is used in patients with baseline iPTH > 300 pg/ml.