Prevalence and control of type 2 diabetes mellitus among primary care physicians in Spain. PRISMA Study. / Prevalencia y control de la diabetes mellitus tipo 2 entre los médicos de Atención Primaria de España. Estudio PRISMA.

OBJECTIVE: To describe the prevalence of known and ignored type 2 diabetes mellitus (T2DM) among primary care physicians (PCP), as well as the treatment used and the degree of metabolic control reached. MATERIAL AND METHODS: Descriptive cross-sectional study on national level. The participants were randomly selected PCPs, members of the redGDPS Foundation. A total of 495 PCP were enrolled. Capillary HbA1c measurement was done with a A1CNow+® device and a diabetes-related survey specifically designed for the study was administered to the participants. RESULTS: The total prevalence of T2DM was 11.1% (95% CI 8.33-13.9) (known disease 8,1% and ignored disease 3.0%). The prevalence of prediabetes was 16.2% (95% CI 13.0-19.4). A total of 62.5% of PCPs with known T2DM reached HbA1c<7% and 15% had HbA1c>8.5%. Control of blood pressure (BP<140/90mmHg) was reached in 87.5% and control of LDL cholesterol<130mg/dl with no history of cardiovascular disease was reached in 88.6% of cases of known T2DM. In the PCPs with a history of macrovascular disease, good control of LDL was reached in 42.9% of the cases. A total of 12.5% were active smokers. A total of 71.4% of PCPs with known T2DM self-treated their own disease, usually with 2 or more drugs (51.4%). The most commonly used drug was metformin (74.3%) followed by iDPP4 (48.6%). CONCLUSIONS: PCPs with T2DM have better metabolic control than the general population. It is necessary to study whether PCPs with T2DM may have greater adherence to treatment and do they achieve a better metabolic control.

Prevalencia y control de la diabetes mellitus tipo 2 entre los médicos de Atención Primaria de España. Estudio PRISMA / Prevalence and control of type 2 diabetes mellitus among primary care physicians in Spain. PRISMA Study

Objetivo: Describir la prevalencia de la diabetes mellitus tipo 2 (DM2) conocida e ignorada entre los médicos de Atención Primaria (MAP), así como el tratamiento utilizado y el grado de control metabólico. Material y métodos: Estudio descriptivo transversal de ámbito nacional. Fueron elegidos 495 MAP aleatoriamente entre los médicos afiliados a la Fundación redGDPS. A todos se les determinó la HbA1ccapilar con dispositivo A1CNow+(R) y se les aplicó una encuesta específicamente diseñada para el estudio. Resultados: La prevalencia total de DM2 fue del 11,1% (IC 95% 8,33-13,9) (8,1% con DM2 conocida y 3,0% con DM2 ignorada) y del 16,2% para la prediabetes (IC 95% 13,0-19,4). El 62,5% de los MAP con DM2 conocida alcanzan cifras de control de la HbA1c<7% y el 15% tienen cifras superiores a HbA1c>8,5%. El control tensional (PA<140/90mmHg) se alcanza en el 87,5% y el control del colesterol LDL<130mg/dl sin antecedentes de enfermedad cardiovascular es alcanzado por el 88,6% de los casos de DM conocida, y si existen antecedentes de enfermedad macrovascular, el LDL<100mg/dl solo se alcanza en el 42,9% de los casos. El 12,5% son fumadores activos. El 71,4% de los MAP con DM conocida se autotrataban su propia enfermedad, habitualmente con 2 o más fármacos (el 51,4%). El fármaco más utilizado era la metformina (74,3%), seguido por los iDPP4 (el 48,6%). Conclusiones: Los MAP con DM2 tienen un control metabólico algo mejor que la población general. Es necesario estudiar si los pacientes de MAP con DM2 pueden tener una mayor adherencia al tratamiento y alcanzar un mejor control metabólico (AU)

Objective: To describe the prevalence of known and ignored type 2 diabetes mellitus (T2DM) among primary care physicians (PCP), as well as the treatment used and the degree of metabolic control reached. Material and methods: Descriptive cross-sectional study on national level. The participants were randomly selected PCPs, members of the redGDPS Foundation. A total of 495 PCP were enrolled. Capillary HbA1c measurement was done with a A1CNow+(R) device and a diabetes-related survey specifically designed for the study was administered to the participants. Results: The total prevalence of T2DM was 11.1% (95% CI 8.33-13.9) (known disease 8,1% and ignored disease 3.0%). The prevalence of prediabetes was 16.2% (95% CI 13.0-19.4). A total of 62.5% of PCPs with known T2DM reached HbA1c<7% and 15% had HbA1c>8.5%. Control of blood pressure (BP<140/90mmHg) was reached in 87.5% and control of LDL cholesterol<130mg/dl with no history of cardiovascular disease was reached in 88.6% of cases of known T2DM. In the PCPs with a history of macrovascular disease, good control of LDL was reached in 42.9% of the cases. A total of 12.5% were active smokers. A total of 71.4% of PCPs with known T2DM self-treated their own disease, usually with 2 or more drugs (51.4%). The most commonly used drug was metformin (74.3%) followed by iDPP4 (48.6%). Conclusions: PCPs with T2DM have better metabolic control than the general population. It is necessary to study whether PCPs with T2DM may have greater adherence to treatment and do they achieve a better metabolic control (AU)

[Cardiovascular disease prevalence in recent diagnosed type 2 diabetic patients]. / Prevalencia de enfermedad cardiovascular en personas recién diagnosticadas de diabetes mellitus tipo 2.

OBJECTIVE: To determine the prevalence of cardiovascular disease at diagnosis of type 2 diabetes mellitus. METHODS: Retrospective observational study in an urban primary health care centre between 1991 and 2000. Review of clinical patient characteristics, cardiovascular disease and risk factors, in the year of diabetes diagnosis. Patients without any glycaemia recorded before diagnostic were excluded. Logistic regression was done to identify the variables associated to cardiovascular events. RESULTS: From 598 cases of diabetes diagnosed, 487 with previous glycaemia were included for the analysis (mean age [SD], 60.4 [10.9]; 53% women). The prevalence of cardiovascular risk factors was: obesity 61.1%, hypertension 71.9%, hypercholesterolemia 52%, hypertriglyceridemia 35.3% and present or previous smoking habit (24 and 16,6%). 96.9% of them presented at least one of the studied cardiovascular risk factors and 53.4% three or more. 78 patients (16%; CI95%: 12.8-19.3) had cardiovascular disease before or during the first year of diagnosis (men 21.4% and women 11.2%). The prevalence of cardiovascular disease increased progressively with the number of cardiovascular risk factors. The significant predictive variables of cardiovascular disease (logistic regression) were: age 55 years (OR = 2.91; CI95%: 1.46-5.80), smoking habit (OR = 2.28; CI95%: 1.15-4.51) and HbA1c 7% (OR = 1.8; CI95%: 1.1-3.1). CONCLUSIONS: A high prevalence of cardiovascular disease and cardiovascular risk factors at diabetes diagnosis was observed. Age, smoking habit and elevated glycated haemoglobin were the variables related to cardiovascular disease.

Prevalencia de enfermedad cardiovascular en personas recién diagnosticadas de diabetes mellitus tipo 2 / Cardiovascular disease prevalence in recent diagnosed type 2 diabetic patients

Objetivo: Conocer la prevalencia de la enfermedad cardiovascular en el momento del diagnóstico de la diabetes mellitus tipo 2.MétodosEstudio observacional retrospectivo realizado en un centro de atención primaria urbano entre 1991 y 2000. Revisión de las características clínicas, factores de riesgo y enfermedad cardiovascular el año del diagnóstico de diabetes. Se excluyeron los pacientes sin glucemias previas al diagnóstico. Se realizó un análisis de regresión logística para identificar las variables asociadas a la presencia de eventos cardiovasculares.Resultados: De los 598 nuevos casos de diabetes diagnosticados se analizaron los 487 que tenían valores previos de glucemia (media de edad [desviación estándar]: 60,4 [10,9] años; un 53% eran mujeres). La prevalencia de factores de riesgo cardiovascular fue: obesidad 61,1%, hipertensión arterial 71,9%, hipercolesterolemia 52%, hipertrigliceridemia 35,3% y tabaquismo actual 24% o previo 16,6%. El 96,9% tenía algún factor de riesgo cardiovascular y el 53,4% tres o más. Un total de 78 pacientes presentaron enfermedad cardiovascular anterior o detectada durante el primer año de diagnóstico (16%; intervalo de confianza del 95%[IC95%]: 12,8–19,3; varones 21,4% y mujeres 11,2%). La prevalencia de enfermedad cardiovascular aumentó con el número de factores de riesgo cardiovascular. El análisis de regresión logística mostró una asociación de la enfermedad cardiovascular y la edad ≥55 años (odds ratio [OR]=2,91; IC95%: 1,46–5,80), el tabaquismo (OR=2,28; IC95%: 1,15–4,51) y los valores de hemoglobina glucosilada (HbA1c) ≥7% (OR=1,85; IC95%: 1,10–3,1).Conclusiones: Se observa una elevada prevalencia de factores de riesgo y enfermedad cardiovascular en el momento del diagnóstico de la diabetes; la edad, el tabaquismo y la HbA1c son las variables relacionadas con la enfermedad cardiovascular (AU)

Objective: To determine the prevalence of cardiovascular disease at diagnosis of type 2 diabetes mellitus.Methods: Retrospective observational study in an urban primary health care centre between 1991 and 2000. Review of clinical patient characteristics, cardiovascular disease and risk factors, in the year of diabetes diagnosis. Patients without any glycaemia recorded before diagnostic were excluded. Logistic regression was done to identify the variables associated to cardiovascular events.Results: From 598 cases of diabetes diagnosed, 487 with previous glycaemia were included for the analysis (mean age [SD], 60.4 [10.9]; 53% women). The prevalence of cardiovascular risk factors was: obesity 61.1%, hypertension 71.9%, hypercholesterolemia 52%, hypertriglyceridemia 35.3% and present or previous smoking habit (24 and 16,6%). 96.9% of them presented at least one of the studied cardiovascular risk factors and 53.4% three or more. 78 patients (16%; CI95%: 12.8–19.3) had cardiovascular disease before or during the first year of diagnosis (men 21.4% and women 11.2%). The prevalence of cardiovascular disease increased progressively with the number of cardiovascular risk factors. The significant predictive variables of cardiovascular disease (logistic regression) were: age ≥55 years (OR=2.91; CI95%: 1.46–5.80), smoking habit (OR=2.28; CI95%: 1.15–4.51) and HbA1c ≥7% (OR=1.8; CI95%: 1.1–3.1).Conclusions: A high prevalence of cardiovascular disease and cardiovascular risk factors at diabetes diagnosis was observed. Age, smoking habit and elevated glycated haemoglobin were the variables related to cardiovascular disease (AU)

[Incidence of type 2 diabetes and its diagnosis process in the decade 1991-2000 in a primary health care centre]. / Incidencia de diabetes tipo 2 y análisis del proceso diagnóstico en un centro de atención primaria durante la década de los noventa.

BACKGROUND AND OBJECTIVE: To determine the annual incidence and reasons for diagnosing type 2 diabetes mellitus (T2DM) from 1991 to 2000. PATIENTS AND METHOD: We performed a retrospective, longitudinal study. The clinical records of all new cases of T2DM registered in an urban primary care center over a 10-year period were reviewed. The annual incidence and prevalence in the population aged more than 14 years old were calculated. Statistical analyses of temporal trends and periodicity (monthly, seasonal and annual) were performed with ARIMA models (Box-Jenkins), Poisson parametrical regression and semiparametrical (GAM) models. RESULTS: There were 598 true new cases of T2DM (mean age [SD]: 59.7 [11.4] years; 51.3% women). The most frequent associated cardiovascular risk factors were obesity (58.5%) and hypertension (68.2%). The main reasons for diagnosing T2DM were the presence of previous hyperglycemia (64.7%) and the application of protocols for other cardiovascular risk factors (12.4%).The annual incidence was 37.9 per 10,000 persons (95% CI, 34.9-40.9) with no differences between sexes. The prevalence of T2DM at the beginning and end of the study period was 4.4 (95% CI, 2.0-4.8) and 5.5% (95% CI, 5.2-5.9) (25% relative increase). There was no significant temporal trend in the incidence of T2DM over the years. CONCLUSIONS: The observed incidence of T2DM is high compared with that reported in other studies. The increase in prevalence was not related to a progressive increase in the incidence. The most frequent reasons for diagnosing T2DM were previous hyperglycemia and the application of protocols for other cardiovascular risk factors. This finding seems to be related to an early diagnosis and could benefit these patients.

Incidencia de diabetes tipo 2 y análisis del proceso diagnóstico en un centro de atención primaria durante la década de los noventa / Incidence of type 2 diabetes and its diagnosis process in the decade 1991-2000 in a primary health care centre

Fundamento y objetivo: Conocer la incidencia anual y los motivos de diagnóstico de la diabetes mellitus tipo 2 (DM2) en el período 1991-2000. Pacientes y método: Estudio longitudinal retrospectivo. Revisión de las historias clínicas de todos los nuevos casos de DM2 registrados en un centro de salud urbano durante 10 años. Cálculo de la prevalencia e incidencia anuales en la población mayor de 14 años. Análisis de las tendencias temporales y periodicidad en la incidencia de DM2 (mensual, estacional y anual) mediante modelos ARIMA (Box-Jenkins), modelo paramétrico de regresión de Poisson y modelos semiparamétricos (GAM). Resultados: Se identificaron 598 nuevos casos de DM2 (edad media [DE], 59,7 [11,4] años; 51,3% mujeres). Los factores de riesgo cardiovascular más frecuentes fueron la obesidad (58,5%) y la hipertensión arterial (68,2%). Los principales motivos de diagnóstico fueron: hiperglucemias previas (64,7%) y la aplicación de protocolos de otros factores de riesgo cardiovascular (12,4%). La incidencia anual fue de 37,9 por 10.000 personas (intervalo de confianza [IC] del 95%, 34,9-40,9), sin diferencias significativas entre ambos sexos. La prevalencia de DM2 al principio y al final del estudio fue del 4,4% (IC del 95%, 2,0-4,8) y el 5,5% (IC del 95%, 5,2-5,9) (un 25% de incremento relativo), sin que el análisis de tendencias mostrara un incremento progresivo de la incidencia. Conclusiones: La incidencia observada es superior a la descrita en otros estudios. El incremento de la prevalencia no se relaciona con un incremento progresivo de la incidencia. Los motivos de diagnóstico más frecuentes fueron el seguimiento de hiperglucemias previas y la aplicación de protocolos de otros factores de riesgo cardiovascular. Este hecho parece indicar un diagnóstico precoz que podría beneficiar a estos pacientes

Background and objective: To determine the annual incidence and reasons for diagnosing type 2 diabetes mellitus (T2DM) from 1991 to 2000. Patients and method: We performed a retrospective, longitudinal study. The clinical records of all new cases of T2DM registered in an urban primary care center over a 10-year period were reviewed. The annual incidence and prevalence in the population aged more than 14 years old were calculated. Statistical analyses of temporal trends and periodicity (monthly, seasonal and annual) were performed with ARIMA models (Box-Jenkins), Poisson parametrical regression and semiparametrical (GAM) models. Results: There were 598 true new cases of T2DM (mean age [SD]: 59.7 [11.4] years; 51.3% women). The most frequent associated cardiovascular risk factors were obesity (58.5%) and hypertension (68.2%). The main reasons for diagnosing T2DM were the presence of previous hyperglycemia (64.7%) and the application of protocols for other cardiovascular risk factors (12.4%).The annual incidence was 37.9 per 10,000 persons (95% CI, 34.9-40.9) with no differences between sexes. The prevalence of T2DM at the beginning and end of the study period was 4.4 (95% CI, 2.0-4.8) and 5.5% (95% CI, 5.2-5.9) (25% relative increase). There was no significant temporal trend in the incidence of T2DM over the years. Conclusions: The observed incidence of T2DM is high compared with that reported in other studies. The increase in prevalence was not related to a progressive increase in the incidence. The most frequent reasons for diagnosing T2DM were previous hyperglycemia and the application of protocols for other cardiovascular risk factors. This finding seems to be related to an early diagnosis and could benefit these patients

Criterios de control y pautas de tratamiento combinado en la diabetes tipo 2. Actualización 2004 / Criteria and guidelines for combined therapy of type 2 diabetes. 2004 Consensus document

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COMBO. Actualización 2004. Criterios y pautas de terapia combinada en la diabetes tipo 2

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