Control de diabetes y consultas al médico de familia durante la pandemia de COVID-19: estudio multicéntrico en atención primaria / Diabetes control and visits to the family doctor during the COVID-19 pandemic: a multicenter study in primary care

Objetivos: Determinar los cambios de frecuentación de consultas presenciales (CP) y telemáticas (CT) a su médico de familia en pacientes con diabetes tipo 2 (DM2) durante la pandemia de COVID-19 y su relación con el control de su enfermedad. Diseño: Estudio multicéntrico de seguimiento retrospectivo. Emplazamiento: Siete centros de salud en Tenerife, España. Participantes: Un total de 3.543 pacientes con DM2. Mediciones: Sexo, edad, CP, CT y control de DM2 mediante hemoglobina glicosilada (A1c) durante el periodo 2019-2021. Se ajustaron modelos de regresión logística con el control de DM2 como efecto, y con las demás mediciones como variables independientes. Resultados: El 50% eran mujeres. El 38% tenía 65 años o menos. Se midió la A1c al 84% de los pacientes en 2019, 68% en 2020, y 77% en 2021. Presentaron buen control el 58,4% en 2019, 46,1% en 2020 y 50,3% en 2021. Las CP fueron 7 en 2019, 4 en 2020 y 5 en 2021 (p<0,001). Las razones de ventaja (IC95%) de buen control en 2019 fueron 1,04 (1,04-1,05) por cada año más de edad y 1,03 (1,01-1,04) por cada CP más; en 2020 fueron 1,04 (1,03-1,05) por cada año más de edad, 1,05 (1,04-1,07) por cada CP más y 1,04 (1,02-1,07) por cada CT más; en 2021 fueron 1,04 (1,04-1,05) por cada año más de edad, 1,05 (1,03-1,06) por cada CP más y 1,02 (1,00-1,04) por cada CT más. Conclusiones: El control de pacientes con DM2 durante 2019-2021 tuvo una relación directa con el cambio de frecuentación al centro de salud, con diferencias según el tipo de consulta y la edad.(AU)

Objectives: To determine whether in patients with type 2 diabetes (DM2) the changes in their relationship with family doctors during the COVID-19 pandemic, in-person (iPC) and telematic (TC) consultations, were associated with control of their disease. Design: Multicentric study of retrospective follow-up. Setting: Seven health centers in Tenerife, Spain. Participants: 3543 patients with DM2. Main measurements: Sex, age, iPC, TC and DM2 control using glycosylated hemoglobin (A1c) during the period 2019-2021. Logistic regression models were fitted with DM2 control as an effect, and with the other measurements as independent variables. Results: 50% were women. 38% were less than 65 years old. A1c was measured in 84% of patients in 2019, 68% in 2020, and 77% in 2021. 58.4% had good control in 2019, 46.1% in 2020, and 50.3% in 2021. Median iPC were 7 in 2019, 4 in 2020 and 5 in 2021 (p<0.001). The OR(95%CI) of good control in 2019 were 1.04(1.04-1.05) per year of age and 1.03(1.01-1.04) for each iPC; In 2020 they were 1.04 (1.03-1.05) per year of age, 1.05 (1.04-1.07) for each iPC and 1.04 (1.02-1.07) for each TC; in 2021 they were 1.04 (1.04-1.05) per year of age, 1.05 (1.03-1.06) for each iPC and 1.02 (1.00-1.04) for each TC. Conclusions: The control of patients with DM2 during the period 2019-2021 had a direct relationship with the change in the frequency of consultations at the health center, with differences depending on the type of consultation and the age of the patient.(AU)

[Diabetes control and visits to the family doctor during the COVID-19 pandemic: a multicenter study in primary care]. / Control de diabetes y consultas al médico de familia durante la pandemia de COVID-19: estudio multicéntrico en atención primaria.

OBJECTIVES: To determine whether in patients with type 2 diabetes (DM2) the changes in their relationship with family doctors during the COVID-19 pandemic, in-person (iPC) and telematic (TC) consultations, were associated with control of their disease. DESIGN: Multicentric study of retrospective follow-up. SETTING: Seven health centers in Tenerife, Spain. PARTICIPANTS: 3543 patients with DM2. MAIN MEASUREMENTS: Sex, age, iPC, TC and DM2 control using glycosylated hemoglobin (A1c) during the period 2019-2021. Logistic regression models were fitted with DM2 control as an effect, and with the other measurements as independent variables. RESULTS: 50% were women. 38% were less than 65 years old. A1c was measured in 84% of patients in 2019, 68% in 2020, and 77% in 2021. 58.4% had good control in 2019, 46.1% in 2020, and 50.3% in 2021. Median iPC were 7 in 2019, 4 in 2020 and 5 in 2021 (p<0.001). The OR(95%CI) of good control in 2019 were 1.04(1.04-1.05) per year of age and 1.03(1.01-1.04) for each iPC; In 2020 they were 1.04 (1.03-1.05) per year of age, 1.05 (1.04-1.07) for each iPC and 1.04 (1.02-1.07) for each TC; in 2021 they were 1.04 (1.04-1.05) per year of age, 1.05 (1.03-1.06) for each iPC and 1.02 (1.00-1.04) for each TC. CONCLUSIONS: The control of patients with DM2 during the period 2019-2021 had a direct relationship with the change in the frequency of consultations at the health center, with differences depending on the type of consultation and the age of the patient.

Irisin, in women and men: blood pressure, heart rate, obesity and insulin resistance.

Background: Irisin is a myokine that increases with leisure time physical activity (LTPA) and for which a cardiovascular protective role has been postulated. Our aim was to assess this role in the general population. Methods: A cross-sectional analysis was performed in a large randomly selected population sample (n=2298 women and 1529 men). Apart from age and sex, we record anthropometrics (blood pressure, heart rate, obesity), lifestyle (LTPA, smoking, alcohol), and biochemical measurements (irisin, lipid profile, insulin resistance). Correlations and regression multivariate models were used to analyze the association of irisin levels with the studied factors. Results: The variables more strongly and directly associated with irisin, adjusting the studied factors separately in women and men, were HOMA-2 (p=0.043 and p=0.001, respectively) and LTPA (p<0.001 and p=0.001, respectively). Also heart rate inversely (p=0.005 and p=0.002, respectively) and DBP directly (p<0.005 and p=0.045, respectively) were associated to irisin in both sexes. The waist/height ratio (p<0.001) was inversely associated to irisin only in women, and the alcohol drinking was directly associated (p=0.029) only in men. Conclusion: We provide new findings for irisin, such as its association with DBP and with heart rate; furthermore, in women irisin is associated to abdominal obesity, and in men is associated to the alcohol intake. We also corroborate the association of irisin with LTPA and insulin resistance. The associations detected point towards a protective role of irisin in the maintenance of cardiometabolic health.

Evolución del tabaquismo según clase social en la población adulta de las Islas Canarias durante el periodo 2000-2015: seguimiento de la cohorte CDC-Canarias / Evolution of Smoking According to Social Class in the Adult Population of the Canary Islands During 2000-2015: Follow-up of the CDC-Canary Cohort

OBJETIVO: Conocer la evolución del consumo de tabaco en Canarias durante 2000-2015 según clase social. Emplazamiento: Comunidad Autónoma de Canarias. PARTICIPANTES: Cohorte CDC-Canarias con cortes en 2000 (n = 6.729), 2008 (n = 6.171) y 2015 (n = 4.705). Mediciones principales: Tabaquismo, sexo, edad y clase social. RESULTADOS: El consumo disminuyó un 6% (5-7%, p < 0,001) en general, siendo más acentuado en el periodo 2000-2008 (5%). La disminución fue mayor en hombres, aunque siguieron fumando más que las mujeres, con una prevalencia del 25% (24-26%) frente al 18% (17-19%, p < 0,001). Solo hubo una disminución del consumo en los grupos jóvenes (6% [3-5%]; p = 0,011) y de edades intermedias (7% [6-8%]; p < 0,001). En todas las clases sociales se observó una disminución similar, con mayor prevalencia de tabaquismo en la clase alta: 24% (23-25%) en 2015 (p < 0,001). Al valorar conjuntamente sexo, edad y clase social, los hombres más jóvenes y de edad intermedia presentaron los mayores descensos de consumo: 8% (7-9%) clase baja y alta, 10% (9-11%) clase media. En la clase social baja, las mujeres más jóvenes continúan fumando más (27%) aunque abandonaron más el consumo (14%), fenómeno que en las de clase media se produjo en edades intermedias. CONCLUSIONES: La evolución del consumo de tabaco en Canarias sigue un patrón similar al conjunto de España. El abandono del consumo de tabaco se ha frenado en el periodo 2008-2015, especialmente en hombres y en clases sociales medias y altas

OBJECTIVE: To determine the status of tobacco consumption in the Canary Islands during 2000-2015, according to social class. LOCATION: Canary Islands. PARTICIPANTS: General population cohort, with contacts in 2000 (n = 6,729), 2008 (n = 6,171) and 2015 (n = 4,705). MAIN MEASUREMENTS: Smoking, gender, age, and social class. RESULTS: Consumption decreased by 6% (5-7%, P < .001) in general, being more accentuated in the period 2000-2008 (5%). The decrease was greater in men, although they continued to smoke more than women, with a prevalence of 25% (24-26%) compared to 18% (17-19%, P < .001). A decrease in consumption was only observed in the younger groups (6% [3-5%], P = .011) and intermediate ages (7% [6-8%], P < .001). A similar decrease was observed in all the social classes, but there was a higher prevalence of smoking in the upper class: 24% (23-25%) in 2015 (P < .001). By jointly assessing gender, age, and social class, younger and middle age men had the greatest decreases in consumption: 8% (7-9%) low and upper classes, 10% (9-11%) middle class. In the lower social class, younger women continue to smoke more (27%) although more of them quit smoking (14%), a phenomenon that occurred in the middle class at intermediate ages. CONCLUSIONS: The evolution of tobacco consumption in the Canary Islands follows a pattern similar to that of mainland Spain. The abandonment of tobacco consumption has slowed down in the period 2008-2015, especially in men, and middle and upper social classes

[Evolution of Smoking According to Social Class in the Adult Population of the Canary Islands During 2000-2015: Follow-up of the CDC-Canary Cohort]. / Evolución del tabaquismo según clase social en la población adulta de las Islas Canarias durante el periodo 2000-2015: seguimiento de la cohorte CDC-Canarias.

OBJECTIVE: To determine the status of tobacco consumption in the Canary Islands during 2000-2015, according to social class. LOCATION: Canary Islands. PARTICIPANTS: General population cohort, with contacts in 2000 (n=6,729), 2008 (n=6,171) and 2015 (n=4,705). MAIN MEASUREMENTS: Smoking, gender, age, and social class. RESULTS: Consumption decreased by 6% (5-7%, P<.001) in general, being more accentuated in the period 2000-2008 (5%). The decrease was greater in men, although they continued to smoke more than women, with a prevalence of 25% (24-26%) compared to 18% (17-19%, P<.001). A decrease in consumption was only observed in the younger groups (6% [3-5%], P=.011) and intermediate ages (7% [6-8%], P<.001). A similar decrease was observed in all the social classes, but there was a higher prevalence of smoking in the upper class: 24% (23-25%) in 2015 (P<.001). By jointly assessing gender, age, and social class, younger and middle age men had the greatest decreases in consumption: 8% (7-9%) low and upper classes, 10% (9-11%) middle class. In the lower social class, younger women continue to smoke more (27%) although more of them quit smoking (14%), a phenomenon that occurred in the middle class at intermediate ages. CONCLUSIONS: The evolution of tobacco consumption in the Canary Islands follows a pattern similar to that of mainland Spain. The abandonment of tobacco consumption has slowed down in the period 2008-2015, especially in men, and middle and upper social classes.

ETAP: una escala de tabaquismo para la atención primaria de salud / ETAP: a smoking scale for Primary Health Care

OBJETIVO: Obtener una escala de exposición al tabaco para abordar la deshabituación. DISEÑO: Seguimiento de una cohorte. Validación de una escala. Emplazamiento: Unidad de investigación de atención primaria. Tenerife. PARTICIPANTES: Seis mil setecientos veintinueve participantes de la cohorte «CDC de Canarias». MÉTODOS: Se construyó una escala bajo la hipótesis de que el tiempo de exposición al tabaco es el factor clave para expresar riego acumulado; su validez discriminante fue probada sobre casos prevalentes de infarto agudo de miocardio (IAM) (n = 171) y se obtuvo su mejor punto de corte para cribado preventivo. Se comprobó su validez predictiva con casos incidentes de IAM (n = 46), comparándose el poder predictivo con factores (hipertensión, diabetes, dislipemia) clásicos de riesgo de IAM, incluido el índice años a paquete diario (APD). RESULTADOS: La escala obtenida fue la suma del triple de años que se había fumado, más los expuestos al tabaco en casa y en el trabajo. La frecuencia de IAM aumentó con los valores de la escala, siendo el valor 20 años de exposición el mejor punto de corte para la actuación preventiva puesto que presentó adecuados valores predictivos para el IAM incidente. La escala superó a APD en la predicción del IAM y compitió con los marcadores y factores de riesgo conocidos. CONCLUSIÓN: La escala propuesta permite una medición válida de exposición al tabaco y proporciona un criterio útil y sencillo que puede ayudar a promover una disposición al cambio y realizar una prevención oportuna. Aún requiere probar su validez tomando como referente otros problemas asociados al tabaco

OBJECTIVE: To obtain a scale of tobacco exposure to address smoking cessation. DESIGN: Follow-up of a cohort. Scale validation. SETTING: Primary Care Research Unit. Tenerife. PARTICIPANTS: A total of 6729 participants from the 'CDC de Canarias' cohort. METHODS: A scale was constructed under the assumption that the time of exposure to tobacco is the key factor to express accumulated risk. Discriminant validity was tested on prevalent cases of acute myocardial infarction (AMI; n = 171), and its best cut-off for preventive screening was obtained. Its predictive validity was tested with incident cases of AMI (n = 46), comparing the predictive power with markers (age, sex) and classic risk factors of AMI (hypertension, diabetes, dyslipidaemia), including the pack-years index (PYI). RESULTS: The scale obtained was the sum of three times the years that they had smoked plus years exposed to smoking at home and at work. The frequency of AMI increased with the values of the scale, with the value 20 years of exposure being the most appropriate cut-off for preventive action, as it provided adequate predictive values for incident AMI. The scale surpassed PYI in predicting AMI, and competed with the known markers and risk factors. CONCLUSION: The proposed scale allows a valid measurement of exposure to smoking and provides a useful and simple approach that can help promote a willingness to change, as well as prevention. It still needs to demonstrate its validity, taking as reference other problems associated with smoking

[ETAP: A smoking scale for Primary Health Care]. / ETAP: una escala de tabaquismo para la atención primaria de salud.

OBJECTIVE: To obtain a scale of tobacco exposure to address smoking cessation. DESIGN: Follow-up of a cohort. Scale validation. SETTING: Primary Care Research Unit. Tenerife. PARTICIPANTS: A total of 6729 participants from the "CDC de Canarias" cohort. METHODS: A scale was constructed under the assumption that the time of exposure to tobacco is the key factor to express accumulated risk. Discriminant validity was tested on prevalent cases of acute myocardial infarction (AMI; n=171), and its best cut-off for preventive screening was obtained. Its predictive validity was tested with incident cases of AMI (n=46), comparing the predictive power with markers (age, sex) and classic risk factors of AMI (hypertension, diabetes, dyslipidaemia), including the pack-years index (PYI). RESULTS: The scale obtained was the sum of three times the years that they had smoked plus years exposed to smoking at home and at work. The frequency of AMI increased with the values of the scale, with the value 20 years of exposure being the most appropriate cut-off for preventive action, as it provided adequate predictive values for incident AMI. The scale surpassed PYI in predicting AMI, and competed with the known markers and risk factors. CONCLUSION: The proposed scale allows a valid measurement of exposure to smoking and provides a useful and simple approach that can help promote a willingness to change, as well as prevention. It still needs to demonstrate its validity, taking as reference other problems associated with smoking.

[Capillary blood sample for type 2 diabetes screening: fingertip versus forearm]. / Muestra de sangre capilar para el cribado de la diabetes mellitus tipo 2: dedo frente a antebrazo.

BACKGROUND AND OBJECTIVE: In Spain, around 50% of diabetic mellitus cases remain undiagnosed. Capillary blood puncture improves the diabetes screening accessibility. New test strips used in the Blood Glucose Monitoring System allow fingertip and forearm punctures yet they create the dilemma on what is the best anatomic place. PATIENTS AND METHOD: We compared fingertip and forearm capillary blood glucose determinations. RESULTS: In a sample of 107 patients, a 110 mg/dl cut-off point for the fingertip and 125 mg/dl for the forearm were more sensitive. Patient's preferences were as follows: 67% indifferent, 28% forearm and 5% fingertip. CONCLUSIONS: In this study, the best anatomic site for puncture depended on the cut-off point used in diabetes screening.