Evaluación de la satisfacción del paciente diabético con la utilización del glucómetro portátil BGSTAR(c) mediante el cuestionario SATIGLU / Assessment of satisfaction of diabetic patients with the use of the portable glucometer BGSTAR© using the SATIGLU questionnaire

OBJETIVOS: Evaluar la satisfacción con el glucómetro portátil BGStar(c) del paciente diagnosticado de diabetes mellitus (DM) tipo 1 (DM1) y 2 (DM2), mediante el cuestionario SATIGLU, previamente validado, y analizar la asociación de la satisfacción con la adherencia a la monitorización y al tratamiento insulínico y con el grado de control de la glucemia (%HbA1c). MATERIAL Y MÉTODO: Estudio epidemiológico, multicéntrico y transversal. Participaron 221 pacientes con DM, mayores de edad, insulinizados y usuarios del BGStar(c). Se recogieron datos socio-demográficos, clínicos, de tratamiento y adherencia. Los pacientes cumplimentaron el SATIGLU y el Morisky-Green (M-G). Se realizó un análisis descriptivo de las puntuaciones del cuestionario SATIGLU y del resto de las variables. Se evaluó la asociación de la satisfacción con el número de inyecciones de insulina/número de controles de glucemia (rho de Spearman), con la clasificación de adherencia al tratamiento según M-G y con la clasificación de control de glucemia según la cifra de %HbA1c (U de Mann-Whitney). Se ajustó un modelo de regresión lineal múltiple para identificar las variables asociadas a la puntuación del SATIGLU. RESULTADOS: Edad media ± DE 57,96 (15,60) años; 56,60% varones; 80,82% DM2; 65,30% bien controlados (%HbA1c≤ 7). Media ± DE de inyecciones de insulina/día, 2,35 ± 1,34, y de controles glucemia/día 2,56 ± 1,29. Un 75,57% de los pacientes fueron adherentes al tratamiento (M-G). Se encontró correlación positiva del SATIGLU con los controles realizados (rho = 0,251; p = 0,001), y con las inyecciones de insulina (rho = 0,235; p = 0,001). Las puntuaciones del SATIGLU fueron mayores en los pacientes adherentes y con mejor control (p < 0,0001). El modelo de regresión mostró que las variables asociadas a la satisfacción fueron: adherencia (B = 7,006; p < 0,0001), y número de controles de glucemia (B = 3,214; p = 0,014). CONCLUSIONES: Los pacientes analizados muestran elevada satisfacción con el BGStar(c) son adherentes al tratamiento, realizan mayor número de inyecciones de insulina, más controles de glucemia y tienen un mejor control de la DM

OBJECTIVES: To assess satisfaction of patients diagnosed with Diabetes Mellitus (DM), type 1 and 2, with use of the portable glucometer BGStar(c) using the previously validated SATIGLU questionnaire. The relationships between satisfaction level and adherence to continuous glucose monitoring, insulin therapy, and with the level of glycemic control (% HbA1c), were also studied. MATERIAL AND METHOD: Epidemiological, multicenter, cross-sectional study that included 221 diabetic patients aged over 18 years, receiving treatment with insulin and using the BGStar(c) glucometer. Socio-demographic and clinical data were collected, as well as treatment and adherence data. Patients self-completed the SATIGLU questionnaire and Morisky-Green (M-G). A descriptive analysis was carried out on the SATIGLU scores and other study variables. An analysis was performed to calculate the association between satisfaction scores and the number of insulin injections and the number of glucose controls (Spearman rho), and with the adherence to treatment classification according to M-G, and with the glycemic control classification according to % HbA1c. Multiple Linear Regression analysis was conducted to identify the variables associated with SATIGLU scores. RESULTS: Mean age (SD) 57.96 (15.60) years; 56.60% male; 80.82% T2DM; good glycemic control (% HbA1c≤7), 65.30%. Mean (SD) insulin injections/day, 2.35 (1.34), and blood glucose/day controls 2.56 (1.29), with 75.57% showing adherence to therapy (M-G). A positive correlation was found between the SATIGLU and the number of glycemic controls (rho = 0.251; P=.001) and of insulin injections (rho = 0.235; P=.001). SATIGLU scores were higher in adherent patients and in those with better glycemic control (P<.0001). The regression model showed that the variables associated with satisfaction were: adherence (B= 7.006;P<.0001), and the number of glycemic controls (B= 3,214; P=.014). CONCLUSIONS: The patients studied showed high satisfaction with the BGStar(c) glucometer, with a high level of adherence to insulin therapy. They also had more insulin injections, a higher number of glycemic controls, and a better DM control

Parámetros de control glucémico en pacientes con diabetes tipo 2 no insulinizados derivados a consulta de Endocrinología, y grado de implementación del consenso nacional sobre el tratamiento de la hiperglucemia / Glycemic control parameters in insulin-naïve patients with uncontrolled type 2 diabetes referred to endocrinologists, and degree of implementation of the national Spanish consensus for the management of hyperglycemia

OBJETIVO: Evaluar el control glucémico en pacientes con diabetes tipo 2 que son remitidos a Endocrinología desde Atención Primaria (AP) por no estar controlados con antidiabéticos orales sin insulinoterapia; y el grado de implementación del consenso nacional de la Sociedad Española de Diabetes, valorando los sucesivos escalones, primero (Pe), segundo (Se) y tercero (Te), del abordaje terapéutico. MATERIAL Y MÉTODOS: Estudio observacional retrospectivo en el que 81 endocrinólogos evaluaron los pacientes mayores de 40 años remitidos por AP entre julio de 2012 y julio de 2013, tratados con 1-2 antidiabéticos orales, no insulinizados, con una hemoglobina glucosilada (HbA1c) ≥ 6,5%, y en los que se disponía en los 3 meses previos de Hb1Ac, glucosa capilar en ayunas y glucosa capilar posprandial. RESULTADOS: Fueron evaluables 285 pacientes (57,6% varones), con una edad media (DE) de 63,1 (9,7) años, HbA1c media de 8,5 (1,2) %, glucosa capilar en ayunas 171,7 (43) mg/dl y glucosa capilar posprandial 206,8 (50) mg/dl. En AP el 26,0% de los pacientes se situaban en Pe terapéutico y el 74,0% en el Se. En atención especializada solo el 9,8% de la cohorte está en el Pe, el 42,8% en el Se y el 47,4% en el Te. Los fármacos más prescritos en AP fueron metformina (90,2%), inhibidores DPP-4 (34,4%) y sulfonilureas (30,5%), mientras que en Endocrinología fueron metformina (86%), insulina (56,8%) e inhibidores DPP-4 (49,8%). Las guías clínicas más seguidas fueron las de la American Diabetes Association y el consenso de la Sociedad Española de Diabetes, en un 77 y 45% respectivamente. CONCLUSIONES: Aproximadamente la mitad de los pacientes con diabetes mellitus 2 no insulinizados y tratados con antidiabéticos orales en AP, son tratados con insulina en Endocrinología. La guía clínica más seguida por el especialista es la de la American Diabetes Association

OBJECTIVE: To assess blood glucose in patients with uncontrolled type 2 diabetes mellitus treated with oral antidiabetic drugs in primary care at the time of referral to specialized endocrinologists, and the degree of implementation of the national consensus guidelines of the Spanish Society of Diabetes by evaluating steps one (S1), two (S2), and three (S3) of the escalating therapy. MATERIAL AND METHODS: Retrospective, observational study where 81 endocrinologists evaluated patients ≥ 40 years of age referred from primary care between July 2012 and July 2013, treated with 1 to 2 oral antidiabetic drugs but no insulin therapy, and with glycosylated hemoglobin (HbA1c) levels ≥ 6.5%. Patients also had to have HbA1c levels and both fasting and postprandial plasma glucose measurements from the previous three months. RESULTS: A total of 285 patients (57.6% males) were assessed. Mean (SD) age was 63.1 (9.7) years, mean HbA1c was 8.5 (1.2) %, mean FPG was 171.7 (43) mg/dL, and mean postprandial plasma glucose was 206.8 (50) mg/dL. In primary care, 26.0% of patients were at S1 and 74.0% were at S2. After referral to the endocrinologist, 9.8% of patients moved onto S1, 42.8% onto S2, and 47.4% onto S3. Oral antidiabetic drugs most commonly prescribed in primary care were metformin (90.2%), DPP-4 inhibitors (34.4%), and sulfonylureas (30.5%), while drugs most commonly used in the specialized endocrinology setting were metformin (86%), insulin (56.8%), and DPP-4 inhibitors (49.8%). The most commonly followed guidelines were those of the American Diabetes Association and the consensus guidelines of the Spanish Society of Diabetes, in 77% and 45% of cases respectively. CONCLUSIONS: Approximately half the patients treated with oral antidiabetic drugs in primary care are prescribed insulin after referral to an endocrinology specialist. The most commonly followed guidelines in specialized care are the American Diabetes Association guidelines

Glycemic control parameters in insulin-naïve patients with uncontrolled type 2 diabetes referred to endocrinologists, and degree of implementation of the national Spanish consensus for the management of hyperglycemia.

OBJECTIVE: To assess blood glucose in patients with uncontrolled type 2 diabetes mellitus treated with oral antidiabetic drugs in primary care at the time of referral to specialized endocrinologists, and the degree of implementation of the national consensus guidelines of the Spanish Society of Diabetes by evaluating steps one (S1), two (S2), and three (S3) of the escalating therapy. MATERIAL AND METHODS: Retrospective, observational study where 81 endocrinologists evaluated patients ≥40 years of age referred from primary care between July 2012 and July 2013, treated with 1 to 2 oral antidiabetic drugs but no insulin therapy, and with glycosylated hemoglobin (HbA(1c)) levels ≥6.5%. Patients also had to have HbA(1c) levels and both fasting and postprandial plasma glucose measurements from the previous three months. RESULTS: A total of 285 patients (57.6% males) were assessed. Mean (SD) age was 63.1 (9.7) years, mean HbA1c was 8.5 (1.2) %, mean FPG was 171.7 (43) mg/dL, and mean postprandial plasma glucose was 206.8 (50) mg/dL. In primary care, 26.0% of patients were at S1 and 74.0% were at S2. After referral to the endocrinologist, 9.8% of patients moved onto S1, 42.8% onto S2, and 47.4% onto S3. Oral antidiabetic drugs most commonly prescribed in primary care were metformin (90.2%), DPP-4 inhibitors (34.4%), and sulfonylureas (30.5%), while drugs most commonly used in the specialized endocrinology setting were metformin (86%), insulin (56.8%), and DPP-4 inhibitors (49.8%). The most commonly followed guidelines were those of the American Diabetes Association and the consensus guidelines of the Spanish Society of Diabetes, in 77% and 45% of cases respectively. CONCLUSIONS: Approximately half the patients treated with oral antidiabetic drugs in primary care are prescribed insulin after referral to an endocrinology specialist. The most commonly followed guidelines in specialized care are the American Diabetes Association guidelines.

Prevalence and clinical profile and management of peripheral arterial disease in elderly patients with diabetes.

INTRODUCTION: Peripheral arterial disease (PAD) increases with age and diabetes. The aim of this study was to assess the prevalence of PAD in an elderly population with diabetes. METHODS: This multicenter and cross-sectional study included patients >70 years, with an established diagnosis of diabetes. PAD was defined as those patients with a history of revascularization or amputation due to ischemia, or a pathological ankle-brachial index (ABI). Adequate blood pressure (BP), LDL cholesterol and HbA1c control were considered as <130/80 mm Hg, <100 mg/dL and <7.0%, respectively. RESULTS: A total of 1462 patients were included. The most frequent cardiovascular risk factor and cardiovascular disease were hypertension (80.37%) and PAD (60.60% overall; 83.2% of those assisted by vascular surgeons vs 31.9% of those attended by other medical specialists; p<0.001), respectively. However, when ABI was measured, 70.99% of the study population had PAD (80.2% of those assisted by vascular surgeons vs 59.6% of those attended by other medical specialists; p<0.001). The predictors for a pathological ABI included male gender, smoking, dyslipidemia, family history of premature cardiovascular disease, sedentary lifestyle, diabetic-related complications, heart and cerebrovascular diseases. Although risk factors control was very poor, it was even lower in patients with PAD. CONCLUSIONS: The prevalence of PAD is high in diabetic elderly patients. The concomitance with other risk factors and cardiovascular diseases was very high. The ABI allowed increasing the diagnosis of PAD.

[Cardiovascular complications at 1-year of follow-up in patients with atherothrombosis. On behalf of Spain's REACH Registry]. / Complicaciones cardiovasculares a un año de seguimiento en pacientes con aterotrombosis. Registro REACH España.

BACKGROUND AND OBJECTIVE: The REACH Registry is the largest worldwide designed to obtain information on cardiovascular risk factor control and preventive treatment in a population who have, or are at risk of having, symptoms of atherothrombosis. The objective of this study is to show the results of cardiovascular events obtained in a sample of the Spanish population at one year follow-up and intervention. MATERIAL AND METHOD: The REACH Spain registry is a prospective cohort study of subjects with vascular risk factors (ORF) for atherothrombosis or with symptomatic vascular disease (VD): coronary artery disease (CAD) and/or cerebrovascular disease (CVD) and/or peripheral artery disease (PAD). The main outcome measures were rates of all-cause mortality, cardiovascular (CV) death, and the overall combined CV death, myocardial infarction (MI), or stroke and CV hospitalization at one year follow-up. RESULTS: In Spain 2,516 patients were recruited and 2,252 completed one year follow-up, the mean age was 68,1 (73,8% men), 11,6% of subjects with ORF and 88,5% with VD, 55% with CAD, 33% with CVD and 17% with PAD. The annual rate of all-cause mortality in VD and ORF groups were 3,57% and 1,98% (NS) respectively, while for CV death they were 2,69% and 0,62% (P<.05) and for overall combined CV death myocardial infarction (MI), or stroke and CV hospitalization they were 15,34% and 5,47% (P=.0001). The annual rate of CV death for CAD, CVD and PAD groups were 3,47%, 2,78% and 1,46% respectively, and for the overall combined CV death, myocardial infarction (MI) , or stroke and CV hospitalization they were 18,52%, 13,75% and 14,52%. These event rates increased with the number of symptomatic arterial disease locations from 0,1,2 or 3 for CV death (0,62%, 2,46%, 3,55% and 4,32%, respectively P<.05) and for overall combined CV death myocardial infarction (MI), or stroke and CV hospitalization (5,50%, 4,18%, 20,59% y 19,40%, respectively P<.0001). At one year follow-up, 82,8% of the patients were with at least one antiplatelet drug and 86,2% were receiving lipid-lowering agents. CONCLUSIONS: The REACH Spain Registry at one year follow-up in patients with atherothrombotic disease or at risk of having symptoms of atherothrombosis shows a high rate of all-cause mortality and of overall combined major CV events, which is becoming higher as the number of symptomatic arterial disease locations increases.

Complicaciones cardiovasculares a un año de seguimiento en pacientes con aterotrombosis. Registro REACH España / Cardiovascular complications at 1-year of follow-up in patients with atherothrombosis. On behalf of Spain's REACH Registry

Fundamento y objetivo: REACH es el mayor registro mundial diseñado para obtener información sobre el control de factores de riesgo vascular y tratamiento preventivo en una población con aterotrombosis sintomática o de riesgo alto para desarrollarla. El objetivo del presente estudio es conocer la tasa de episodios cardiovasculares en la muestra de la población española incluida en el registro, tras un año de seguimiento e intervención. Material y método: El registro REACH España es un estudio de cohorte prospectivo de sujetos con sólo factores de riesgo vascular (SFR) para aterotrombosis o con enfermedad vascular (EV) sintomática: enfermedad coronaria (EC) y/o cerebrovascular (ECV) y/o arterial periférica (EAP). Las variables principales del estudio fueron la tasa de mortalidad global, cardiovascular y la del conjunto de mortalidad cardiovascular más infarto de miocardio (IM), más accidente cerebrovascular, más hospitalización cardiovascular al año de seguimiento. Resultados: España incluyó a 2.516 sujetos, de los cuales 2.252 completaron el año de seguimiento, con una edad media de 68,1 años (73,8% de varones). El 11,6% presentaban SFR y el 88,5% EV establecida, el 55% EC, el 33% ECV y el 17% EAP. La tasa anual en los grupos EV y SFR fue, respectivamente, para la mortalidad global del 3,57 y el 1,98% (p=NS), para la mortalidad cardiovascular del 2,69% y el 0,62% (p<0,05) y para el conjunto de mortalidad cardiovascular, más IM, más accidente cerebrovascular, más hospitalización cardiovascular del 15,34 y el 5,47% (p=0,0001). La tasa anual para los subgrupos EC, ECV y EAP fue, respectivamente, para la mortalidad cardiovascular del 3,47, el 2,78 y el 1,46%, y para el conjunto de mortalidad cardiovascular más IM, más accidente cerebrovascular, más hospitalización cardiovascular (...) (AU)

Background and objective: The REACH Registry is the largest worldwide designed to obtain information on cardiovascular risk factor control and preventive treatment in a population who have, or are at risk of having, symptoms of atherothrombosis. The objective of this study is to show the results of cardiovascular events obtained in a sample of the Spanish population at one year follow-up and intervention. Material and method: The REACH Spain registry is a prospective cohort study of subjects with vascular risk factors (ORF) for atherothrombosis or with symptomatic vascular disease (VD): coronary artery disease (CAD) and/or cerebrovascular disease (CVD) and/or peripheral artery disease (PAD). The main outcome measures were rates of all-cause mortality, cardiovascular (CV) death, and the overall combined CV death, myocardial infarction (MI), or stroke and CV hospitalization at one year follow-up. Results: In Spain 2,516 patients were recruited and 2,252 completed one year follow-up, the mean age was 68,1 (73,8% men), 11,6% of subjects with ORF and 88,5% with VD, 55% with CAD, 33% with CVD and 17% with PAD. The annual rate of all-cause mortality in VD and ORF groups were 3,57% and 1,98% (NS) respectively, while for CV death they were 2,69% and 0,62% (P<.05) and for overall combined CV death myocardial infarction (MI), or stroke and CV hospitalization they were 15,34% and 5,47% (P=.0001). The annual rate of CV death for CAD, CVD and PAD groups were 3,47%, 2,78% and 1,46% respectively, and for the overall combined CV death, myocardial infarction (MI) , or stroke and CV hospitalization they were 18,52%, 13,75% and 14,52%. These event rates increased with the number of symptomatic arterial disease locations from 0,1,2 or 3 for CV death (0,62%, 2,46%, 3,55% and 4,32%, respectively P<.05) and for overall combined CV death myocardial infarction (MI), or stroke and CV hospitalization (5,50%, 4,18%, 20,59% y 19,40%, respectively P<.0001). (...) (AU)

Effects of hypolipidemic treatment on serum markers of vascular inflammation in dyslipidemic men.

BACKGROUND: The purpose of our study was to assess the effect of hypolipidemiant drugs on serum markers of vascular inflammation (E-Selectin, VCAM-1 and MCP-1) in dyslipidemic men without cardiovascular disease. MATERIAL/METHODS: 84 dyslipidemic men were consecutively recruited from the Lipid Unit of a tertiary hospital. The patients were placed on statins (n=44) or fibrates (n=22), depending on the lipid profile, for 4 months. In the control group (n=18), a hypolipidemiant diet alone was indicated. RESULTS: Baseline levels of VCAM-1 and MCP-1 were not correlated with the lipid profile. By contrast, baseline E-Selectin levels correlated directly with glucose and triglyceride levels, and negatively with HDL-C. In multiple regression analysis, HDL-C and glucose concentrations independently influenced E-selectin levels. After treatment, we observed a significant decrease of E-Selectin levels in patients treated with statins, and the changes in E-Selectin levels were inversely associated with HDL-C variations. We did not observe any changes in VCAM-1 levels after the treatment regime we used. Regarding MCP-1, a significant increase was detected in the patients receiving fibrates. In addition, the percentage increment of MCP-1 was higher in patients treated with gemfibrozil than in patients who received bezafibrate. CONCLUSIONS: We observed a reduction in E-Selectin levels after statin therapy. This finding was associated with increased HDL-C. Fibrates, especially gemfibrozil, increased MCP-1 concentrations. This deleterious effect was unrelated to changes in lipid profile, and may help explain why fibrates have less impact than statins in reducing cardiovascular disease.