Approach to patients with diabetes and obesity in primary care / Abordaje de pacientes con diabetes y obesidad en atención primaria

Aims:The aim of this study is to analyse the effect of pharmacological and non-pharmacological treatment on weight control in patients with diabetes and obesity. Design: Epidemiological, descriptive, cross-sectional study. Site: Primary care. In 11 health centres in Málaga and Cádiz during April and October 2022. Participants: 281 patients over 18 years old with type 2 diabetes and obesity are included. Main measurements: Socio-demographics, clinical, treatment and lifestyle habits variables were obtained from medical records and personal interview. Descriptive statistics were obtained for continuous variables. Statistical tests were performed based on the nature of the variables. Results: Variables like marital status, level of education and occupation, and smoking habit, shows differences regarding the sex (p<0.05). 82.3% of those who received education lost weight, compared to 67.5% of lost weight who received no health education (p=0.004). GLP1 and SGLT2 were more commonly prescribed for women (p=0.048), and SGLT2 more commonly prescribed for men (p=0.047). Patients taking GLP1, SGLT2 or both, regardless of sex, weight loss during the study period was −3.1kg (SE: 0.60), while the loss of those who took other medications was −1.33kg (SE: 0.62). The mean difference was 1.75kg (p=0.046). Conclusions: In terms of weight loss, obese diabetics who took GLP1, SGLT2 or both were 2.5 times more likely to lose weight than those who did not. Healthy lifestyle choices are key to weight loss in obese diabetic patients.(AU)

Objetivo: Analizar el efecto del tratamiento farmacológico y no farmacológico en el control del peso en pacientes diabéticos obesos. Diseño: Estudio epidemiológico, descriptivo y transversal. Emplazamiento: Atención primaria: 11 centros de salud en Málaga y Cádiz durante abril y octubre de 2022. Participantes: Fueron incluidos 281 pacientes mayores de 18 años con diabetes tipo 2 y obesidad. Mediciones principales: Se obtuvieron variables sociodemográficas, clínicas, de tratamiento y de hábitos de vida a partir de registros médicos de entrevistas personales. Se obtuvieron estadísticos descriptivos para variables continuas. Se realizaron pruebas estadísticas en función de la naturaleza de las variables. Resultados: Variables como el estado civil, el nivel educativo, la ocupación y el hábito de fumar mostraron diferencias dependiendo del sexo (p<0,05). El 82,3% de los que recibieron educación sobre salud perdieron peso en comparación con el 67,5% de los que perdieron peso y no la recibieron (p=0,004). Los medicamentos GLP1 y SGLT2 se recetaron con mayor frecuencia a las mujeres (p=0,048), mientras que los SGLT2 se prescribieron más en hombres (p=0,047). Los pacientes que tomaron GLP1, SGLT2 o ambos, independientemente del sexo, perdieron 3,1kg durante el estudio (EE: 0,60), mientras que aquellos que tomaron otros medicamentos perdieron 1,33kg (EE: 0,62). La diferencia media fue de 1,75kg (p=0,046). Conclusiones: Los diabéticos obesos que tomaron GLP1, SGLT2 o ambos tenían 2,5 veces más probabilidades de perder peso que aquellos que no los tomaron. Un estilo de vida saludable es fundamental para la pérdida de peso en pacientes diabéticos obesos.(AU)

Approach to patients with diabetes and obesity in primary care.

AIMS: The aim of this study is to analyse the effect of pharmacological and non-pharmacological treatment on weight control in patients with diabetes and obesity. DESIGN: Epidemiological, descriptive, cross-sectional study. SITE: Primary care. In 11 health centres in Málaga and Cádiz during April and October 2022. PARTICIPANTS: 281 patients over 18 years old with type 2 diabetes and obesity are included. MAIN MEASUREMENTS: Socio-demographics, clinical, treatment and lifestyle habits variables were obtained from medical records and personal interview. Descriptive statistics were obtained for continuous variables. Statistical tests were performed based on the nature of the variables. RESULTS: Variables like marital status, level of education and occupation, and smoking habit, shows differences regarding the sex (p<0.05). 82.3% of those who received education lost weight, compared to 67.5% of lost weight who received no health education (p=0.004). GLP1 and SGLT2 were more commonly prescribed for women (p=0.048), and SGLT2 more commonly prescribed for men (p=0.047). Patients taking GLP1, SGLT2 or both, regardless of sex, weight loss during the study period was -3.1kg (SE: 0.60), while the loss of those who took other medications was -1.33kg (SE: 0.62). The mean difference was 1.75kg (p=0.046). CONCLUSIONS: In terms of weight loss, obese diabetics who took GLP1, SGLT2 or both were 2.5 times more likely to lose weight than those who did not. Healthy lifestyle choices are key to weight loss in obese diabetic patients.

Healthcare experience among patients with type 2 diabetes: A cross-sectional survey using the IEXPAC tool.

Aim: To assess the experience with health care among patients with type 2 diabetes (T2DM) and to evaluate patients' demographic variables and healthcare-related characteristics which may affect their experience. Methods: A cross-sectional survey was delivered to T2DM adults. Patient experiences were assessed with the 'Instrument for Evaluation of the Experience of Chronic Patients' (IEXPAC) questionnaire, a validated 12-item survey, which describes patient experience within the last 6 months (items 1-11) and hospitalization in the last 3 years (item 12), with possible scores ranging from 0 (worst) to 10 (best experience). Results: A total of 451 T2DM patients responded to the survey (response rate 72.3%; mean age 69.5 ± 10.1 years, 67.8% men). The mean overall IEXPAC score was 5.92 ± 1.80. Mean scores were higher for productive interactions (7.92 ± 2.15) and self-management (7.08 ± 2.27) than for new relational model (1.72 ± 2.01). Only 32.8% of patients who had been hospitalized in the past 3 years reported having received a follow-up call or visit after discharge. Multivariate analyses identified that regular follow-up by the same physician and follow-up by a nurse were associated with a better patient experience. Continuity of healthcare score was higher only in those patients requiring help from others. Conclusions: The areas of T2DM care which may need to be addressed to ensure better patient experience are use of the Internet, new technologies and social resources for patient information and interaction with healthcare professionals, closer follow-up after hospitalization, and a comprehensive multidisciplinary approach with regular follow-up by the same physician and a nurse.

Healthcare Experience and their Relationship with Demographic, Disease and Healthcare-Related Variables: A Cross-Sectional Survey of Patients with Chronic Diseases Using the IEXPAC Scale.

BACKGROUND: Patient experience is acknowledged as a principal aspect of quality healthcare delivery, and it has implications with regard to outcomes. OBJECTIVES: Our objective was to evaluate the healthcare experience of patients with chronic diseases to identify patient-perceived healthcare gaps and to assess the influence of demographic and healthcare-related variables on patient experiences. METHODS: A cross-sectional survey was delivered to adult patients with chronic diseases: diabetes mellitus (DM), human immunodeficiency virus (HIV) infection, inflammatory bowel disease (IBD) or rheumatic diseases. Patient experiences were assessed with the Instrument for Evaluation of the Experience of Chronic Patients (IEXPAC) questionnaire, with possible scores ranging from 0 (worst) to 10 (best experience). RESULTS: Of the 2474 patients handed the survey, 1618 returned it (response rate 65.4%). Patients identified gaps in healthcare related mainly to access to reliable information and services, interaction with other patients and continuity of healthcare after hospital discharge. The mean ± standard deviation (SD) IEXPAC score was 6.0 ± 1.9 and was higher for patients with HIV (6.6 ± 1.7) than for those with rheumatic disease (5.5 ± 2.0), IBD (5.9 ± 2.0) or DM (5.9 ± 1.9) (p < 0.001). In multivariate models, better overall IEXPAC experience was associated with follow-up by the same physician, follow-up by a nurse, receiving healthcare support from others and treatment with subcutaneous or intravenous drugs. The multivariate model that confirmed patients with HIV or DM had better experience than did those with rheumatic diseases. CONCLUSIONS: Through IEXPAC, patients identified aspects for healthcare quality improvements and circumstances associated with better experience, which may permit greater redirection of healthcare toward patient-centered goals while facilitating improvements in social care and long-term healthcare quality.

[Prevalence of Hypothyroidism in Andalusia, Spain, Determined by Thyroid Hormone Comsumption]. / Prevalencia de hipotiroidismo en Andalucía según el consumo de hormona tiroidea en 2014.

OBJECTIVE: Hypothyroidism is the most common condition linked to a hormone deficiency, nevertheless data on its prevalence are scarce in Spain. For that reason, we have estimated its prevalence through the registration of patients who had used thyroid hormones in Andalusia (South Spain). METHODS: Data of patients who had withdrawn levothyroxine under the public system during 2014 from the base of the Andalusian Health Service were considered. Prevalence were calculated with confidence intervals of 95% for each management area, stratified by sex and age groups, and differences between them were evaluated. RESULTS: 321,368 people (98% older than 18 years and 83% female) were identified as levothyroxine users and a prevalence of hypothyroidism of 3.95% (95%CI:3.94-3.96) was estimated for the general population. The condition was more common in females, in the older 18 years 7.81% (95%CI:7.80 to 7.82) compared to males 1.75% (95%CI:1.73-1.77) with a ratio of 4.5-fold. It increases in the population of women older than 45 years, 10.32% (95%CI:10.30-0.32) and in the over 60 years 11.37% (95%CI: 11.35-11.40). The prevalence in adult women in the western provinces is 7.38% (95%CI:7.36-7.40), in the eastern provinces 8.59% (95%CI:8.57-8.62) and in coastal areas 6.70% (95%CI: 6.68-6.72) compared to the mountainous ones, which is 8.91% (95%CI:8.88-8.94). CONCLUSIONS: The results denote a high prevalence of hypothyroidism in the adult population of Andalusia compared to the nearby countries, with a clear increased associated with females and age. Furthermore, the prevalence of the illness presents also a geographically-related variability.

Prevalencia de hipotiroidismo en Andalucía según el consumo de hormona tiroidea en 2014 / Prevalence of hypothyroidism in Andalusia, Sapin, determined by thyroid hormone comsumption

Fundamento: El hipotiroidismo es la condición más común ligada a un déficit hormonal. A pesar de ello existe una escasez de datos en España sobre su su prevalencia. El objetivo fue estimar la prevalencia en Andalucía a través del registro de pacientes que consumieron hormona tiroidea durante el año 2014. Método: Se recuperaron los datos de las personas que habían retirado de la farmacia levotiroxina con cargo al sistema público durante 2014 de la base de datos del Servicio Andaluz de Salud. Se calcularon las prevalencias con sus intervalos de confianza del 95% para cada Área de Gestión, estratificadas por sexo y grupos etarios. Resultados: Se identificaron 321.368 personas (98% mayores de 18 años y 83% mujeres) consumidoras de levotiroxina y se estimó una prevalencia de hipotiroidismo del 3,95% (IC95%: 3,943,96) para población general. La condición era más común en la mujer, en mayores de 18 años un 7,81% (IC95 7,80 a 7,82) comparada con el hombre 1,75% (IC95 1,73 a 1,77) con una razón de 4,5. Aumenta en la población de mujeres mayores de 45 años, 10,32% (IC95 10,30 a 10,32) y más en las mayores de 60 años 11,37% (IC95%: 11,35 a 11,40). La prevalencia en mujer adulta de las provincias occidentales fue 7,38% (IC95%: 7,36-7,40), en las orientales de 8,59% (IC95%: 8,57-8,62) y en las áreas costeras fue de 6,70% (IC95%: 6,68-6,72) frente a las montañosas que fue 8,91% (IC95%: 8,88-8,94). Conclusión: Los resultados indican una elevada prevalencia de hipotiroidismo en la población adulta de Andalucía, con un claro predominio de la mujer y un incremento con la edad. Además, la prevalencia de la enfermedad también presenta una importante variabilidad geográfica (AU)

Background: Hypothyroidism is the most common condition linked to a hormone deficiency, nevertheless data on its prevalence are scarce in Spain. For that reason, we have estimated its prevalence through the registration of patients who had used thyroid hormones in Andalusia (South Spain). Method: data of patients who had withdrawn levothyroxine under the public system during 2014 from the base of the Andalusian Health Service were considered. Prevalence were calculated with confidence intervals of 95% for each management area, stratified by sex and age groups, and differences between them were evaluated. Results: 321,368 people (98% older than 18 years and 83% female) were identified as levothyroxine users and a prevalence of hypothyroidism of 3.95% (95%CI:3.94-3.96) was estimated for the general population. The condition was more common in females, in the older 18 years 7.81% (95%CI:7.80 to 7.82) compared to males 1.75% (95%CI:1.73-1.77) with a ratio of 4.5-fold. It increases in the population of women older than 45 years, 10.32% (95%CI:10.30- 0.32) and in the over 60 years 11.37% (95%CI: 11.35-11.40). The prevalence in adult women in the western provinces is 7.38% (95%CI:7.36-7.40), in the eastern provinces 8.59% (95%CI:8.57-8.62) and in coastal areas 6.70% (95%CI: 6.68-6.72) compared to the mountainous ones, which is 8.91% (95%CI:8.88- 8.94). Conclusion: The results denote a high prevalence of hypothyroidism in the adult population of Andalusia compared to the nearby countries, with a clear increased associated with females and age. Furthermore, the prevalence of the illness presents also a geographically-related variability (AU)

Mejora de la efectividad en el manejo del riesgo cardiovascular de pacientes diabéticos tipo 2 en atención primaria / Improved effectiveness in the management of cardiovascular risk among type 2 diabetic patients in primary health care

Objetivos: Determinar el impacto de la implementación de una guía en la valoración del riesgo cardiovascular de pacientes en alto riesgo (diabéticos tipo 2), y en la adecuación del tratamiento antihipertensivo y antiagregante.Diseño: Estudio semiexperimental, no aleatorizado, prospectivo, con grupo control concurrente.EmplazamientoDos centros de salud de Málaga.Participantes: Médicos de familia.Intervenciones: Implementación de la guía mediante intervenciones multicomponentes sobre los médicos de familia del centro experimental.Mediciones principales: Variable principal de resultado: grado de estimación del riesgo cardiovascular en población con elevado riesgo (diabéticos). Variables secundarias: adecuación del tratamiento antihipertensivo y antiagregante.Resultados: Se detectaron importantes diferencias en la estimación del riesgo cardiovascular a favor del grupo experimental (el 74,36 frente al 7,63%; riesgo relativo [RR]=9,74; intervalo de confianza [IC] del 95%, 5,15–18,43; p=0,0001). Las pautas de antiagregación se ajustaron más a las recomendaciones de la evidencia en el grupo intervención (el 51,28 frente al 36,44%; RR=1,407; IC del 95%, 1,04–1,89; p=0,026), al igual que en antihipertensivos, aunque sin significación (el 80 frente al 66,27%; RR=1,207; IC del 95%, 0,99–1,46.Conclusiones: Una estrategia de implementación multicomponente de una guía para el manejo de pacientes con elevado riesgo cardiovascular mejora la adherencia a intervenciones efectivas por parte de médicos de familia(AU)

Objectives: To determine the impact of the implementation of a guidelines in theassessment of cardiovascular risk in high-risk patients (type2diabetes) in health centres, and to analyse the appropriateness of antihypertensive and antiplatelet treatment in diabetic patients.Design: Quasi-experimental, non-randomised, prospective study with concurrent control group.Placement: Two health centres in Málaga.Participants: General practitioners of the two centres.Interventions: The guideline was implemented through a multifaceted intervention in family physicians in the experimental centre.Main outcomes: Rate of cardiovascular risk assessment in high risk population. Secondary: appropriateness of antihypertensive and antiplatelet treatment.Results: Large differences were detected in the cardiovascular risk assessment, improving in the experimental group (74.36% vs. 7.63%; RR ¼ 9.74; 95%CI, 5.15–18.43; P ¼.0001). Similarly, the antiplatelet use was more in line with the guidelines recommendations in theintervention group (51.28% vs. 36.44%; RR ¼ 1.407; 95%CI, 1.04–1.89; P ¼.026), andin antihypertensive drugs, although with no statistical significance (80% vs. 66.27%;RR ¼ 1.207; 95%CI, 0.99–1.46).Conclusions: A multifaceted intervention for the implementation of a guideline for the management of high risk cardiovascular patients, improves the adherence to effectiveinterventions by family physicians(AU)

[Improved effectiveness in the management of cardiovascular risk among type 2 diabetic patients in primary health care]. / Mejora de la efectividad en el manejo del riesgo cardiovascular de pacientes diabéticos tipo 2 en atención primaria.

OBJECTIVES: To determine the impact of the implementation of a guidelines in the assessment of cardiovascular risk in high-risk patients (type 2 diabetes) in health centres, and to analyse the appropriateness of antihypertensive and antiplatelet treatment in diabetic patients. DESIGN: Quasi-experimental, non-randomised, prospective study with concurrent control group. PLACEMENT: Two health centres in Málaga. PARTICIPANTS: General practitioners of the two centres. INTERVENTIONS: The guideline was implemented through a multifaceted intervention in family physicians in the experimental centre. MAIN OUTCOMES: Rate of cardiovascular risk assessment in high risk population. Secondary: appropriateness of antihypertensive and antiplatelet treatment. RESULTS: Large differences were detected in the cardiovascular risk assessment, improving in the experimental group (74.36% vs. 7.63%; RR = 9.74; 95% CI, 5.15-18.43; P = .0001). Similarly, the antiplatelet use was more in line with the guidelines recommendations in the intervention group (51.28% vs. 36.44%; RR = 1.407; 95% CI, 1.04-1.89; P = .026), and in antihypertensive drugs, although with no statistical significance (80% vs. 66.27%; RR = 1.207; 95% CI, 0.99-1.46). CONCLUSIONS: A multifaceted intervention for the implementation of a guideline for the management of high risk cardiovascular patients, improves the adherence to effective interventions by family physicians.