Consenso sobre tratamiento con insulina en la diabetes tipo 2 / Consensus on insulin treatment in type 2 diabetes

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Factores asociados a la adherencia al autoanálisis de la glucemia capilar en personas con diabetes en tratamiento con insulina. Estudio dapa / Factors associated to adherence to blood glucose self-monitoring in patients with diabetes treated with insulin. The dapa study

Objetivo: El objetivo principal del estudio fue determinar la adherencia al autoanálisis de la glucemia capilar y los principales factores que influyen en ella, con especial atención a los relacionados con la percepción glucémica, en personas con diabetes tipo 1 o 2 en tratamiento con insulina. Material y métodos: Estudio epidemiológico, observacional, prospectivo y multicéntrico realizado en condiciones de práctica clínica habitual en centros de Atención Primaria, ambulatorios y hospitalarios de distintas comunidades autónomas. Se recogieron datos sociodemográficos, clínicos y de tratamiento. Las personas fueron consideradas adherentes si realizaban el número mínimo de controles recomendado por la Sociedad Española de Diabetes. Resultados: El 61,6% de los pacientes demostraron ser adherentes. Los factores asociados a la adherencia fueron tratamiento con insulina de menos de 3 inyecciones diarias (OR: 2,678; IC 95%: 2,048-3,5029; p<0,001), presentar enfermedad vascular periférica (OR: 1,529; IC 95%: 1,077-2,171; p=0,018), no tomar alcohol (OR: 1,442; IC 95%: 1,118-1,858; p=0,005) y recoger las tiras reactivas en la farmacia (OR: 1,275; IC 95%: 1,026-1,584; p=0,028). El 21,4% de los pacientes presentaron una autopercepción glucémica correcta. Conclusiones: Los resultados encontrados demuestran una adherencia al autoanálisis subóptima con respecto a las recomendaciones establecidas por la Sociedad Española de Diabetes en las personas con diabetes en tratamiento con insulina. Las variables independientes asociadas con una buena adherencia fueron tratamiento con menos de 3 inyecciones de insulina al día, presentar enfermedad vascular periférica, no tomar alcohol y retirar las tiras reactivas en la farmacia (AU)

Objective: To assess adherence to self-monitoring of blood glucose and the main factors associated with it, particularly those related to self-perception of glycemia, in patients with diabetes on insulin therapy. Patients and methods: An epidemiological, observational, prospective, multicenter study conducted in standard clinical practice in primary care, outpatient centers, and hospitals from different Spanish regions. Sociodemographic, clinical and treatment data were collected. Patients were considered adherent to self-monitoring if they performed the minimum number of controls recommended by the Spanish Society of Diabetes (SED). Results: Adherence was shown in 61.6% of patients. Factors associated to adherence included treatment with less than three insulin injections daily (OR 2.678; 95% CI 2.048- 3.5029; p <0.001), presence of peripheral vascular disease (OR 1.529; 95% CI 1.077 - 2.171; p=0.018), alcohol abstinence (OR 1.442; 95% CI 1.118 - 1.858; p=0.005), and collection of the glucose test strips from the pharmacy (OR 1.275; 95% CI 1.026 - 1.584; p=0.028). Adequate self-perception of glycemia was found in 21.4% of patients. Conclusions Our results show a suboptimal adherence to the recommended protocol for blood glucose self-monitoring in patients with diabetes on insulin therapy. Independent variables associated to good adherence were treatment with less than three insulin injections dailyu, presence of peripheral vascular disease, alcohol abstinence, and collection of glucose test strips from the pharmacy (AU)

Factors associated to adherence to blood glucose self-monitoring in patients with diabetes treated with insulin. The dapa study. / Factores asociados a la adherencia al autoanálisis de la glucemia capilar en personas con diabetes en tratamiento con insulina. Estudio dapa.

OBJECTIVE: To assess adherence to self-monitoring of blood glucose and the main factors associated with it, particularly those related to self-perception of glycemia, in patients with diabetes on insulin therapy. PATIENTS AND METHODS: An epidemiological, observational, prospective, multicenter study conducted in standard clinical practice in primary care, outpatient centers, and hospitals from different Spanish regions. Sociodemographic, clinical and treatment data were collected. Patients were considered adherent to self-monitoring if they performed the minimum number of controls recommended by the Spanish Society of Diabetes (SED). RESULTS: Adherence was shown in 61.6% of patients. Factors associated to adherence included treatment with less than three insulin injections daily (OR 2.678; 95% CI 2.048- 3.5029; p <0.001), presence of peripheral vascular disease (OR 1.529; 95% CI 1.077 - 2.171; p=0.018), alcohol abstinence (OR 1.442; 95% CI 1.118 - 1.858; p=0.005), and collection of the glucose test strips from the pharmacy (OR 1.275; 95% CI 1.026 - 1.584; p=0.028). Adequate self-perception of glycemia was found in 21.4% of patients. CONCLUSIONS: Our results show a suboptimal adherence to the recommended protocol for blood glucose self-monitoring in patients with diabetes on insulin therapy. Independent variables associated to good adherence were treatment with less than three insulin injections dailyu, presence of peripheral vascular disease, alcohol abstinence, and collection of glucose test strips from the pharmacy.

[Managing the discharge of diabetic patients from the emergency department: a consensus paper]. / Documento de consenso sobre el manejo al alta desde urgencias del paciente diabético.

EN: Eighty to 90% of patients attended in emergency departments are discharged to home. Emergency department physicians are therefore responsible for specifying how these patients are treated afterwards. An estimated 30% to 40% of emergency patients have diabetes mellitus that was often decompensated or poorly controlled prior to the emergency. It is therefore necessary to establish antidiabetic treatment protocols that contribute to adequate metabolic control for these patients in the interest of improving the short-term prognosis after discharge. The protocols should also maintain continuity of outpatient care from other specialists and contribute to improving the long-term prognosis. This consensus paper presents the consensus of experts from 3 medical associations whose members are directly involved with treating patients with diabetes. The aim of the paper is to facilitate the assessment of antidiabetic treatment when the patient is discharged from the emergency department and referred to outpatient care teams.

ES: El 80-90% de los pacientes atendidos en los servicios de urgencias son dados de alta desde los mismos, y por tanto los facultativos de urgencias son los responsables del tratamiento al alta en dichos pacientes. Se estima que la frecuencia de diabetes mellitus en urgencias es de un 30-40% y en muchos casos dicha diabetes está descompensada o con un mal control metabólico previo, por lo que es necesario establecer pautas de tratamiento antidiabético adecuadas de cara al alta que contribuyan a un adecuado control metabólico de dichos pacientes y favorezca un mejor pronóstico a corto plazo tras el alta, así como mantener una continuidad con la atención ambulatoria por parte de otras especialidades y contribuir a una mejoría del pronóstico a largo plazo. El presente documento es por tanto un consenso de expertos de tres sociedades científicas implicadas directamente en la atención del paciente diabético, que pretende facilitar la valoración del tratamiento al alta desde urgencias en cuanto a la diabetes se refiere y su continuidad asistencial ambulatoria.

Documento de consenso sobre el manejo al alta desde urgencias del paciente diabético / Managing the discharge of diabetic patients from the emergency department: a consensus paper

El 80-90% de los pacientes atendidos en los servicios de urgencias son dados de alta desde los mismos, y por tanto los facultativos de urgencias son los responsables del tratamiento al alta en dichos pacientes. Se estima que la frecuencia de diabetes mellitus en urgencias es de un 30-40% y en muchos casos dicha diabetes está descompensada o con un mal control metabólico previo, por lo que es necesario establecer pautas de tratamiento antidiabético adecuadas de cara al alta que contribuyan a un adecuado control metabólico de dichos pacientes y favorezca un mejor pronóstico a corto plazo tras el alta, así como mantener una continuidad con la atención ambulatoria por parte de otras especialidades y contribuir a una mejoría del pronóstico a largo plazo. El presente documento es por tanto un consenso de expertos de tres sociedades científicas implicadas directamente en la atención del paciente diabético, que pretende facilitar la valoración del tratamiento al alta desde urgencias en cuanto a la diabetes se refiere y su continuidad asistencial ambulatoria (AU)

Eighty to 90% of patients attended in emergency departments are discharged to home. Emergency department physicians are therefore responsible for specifying how these patients are treated afterwards. An estimated 30% to 40% of emergency patients have diabetes mellitus that was often decompensated or poorly controlled prior to the emergency. It is therefore necessary to establish antidiabetic treatment protocols that contribute to adequate metabolic control for these patients in the interest of improving the short-term prognosis after discharge. The protocols should also maintain continuity of outpatient care from other specialists and contribute to improving the long-term prognosis. This consensus paper presents the consensus of experts from 3 medical associations whose members are directly involved with treating patients with diabetes. The aim of the paper is to facilitate the assessment of antidiabetic treatment when the patient is discharged from the emergency department and referred to outpatient care teams (AU)

Therapeutic education and self-care: Results from the cross-sectional study Diabetes, Attitudes, Wishes and Needs 2 (DAWN2) in Spain.

INTRODUCTION: Therapeutic education (TE) has been gradually introduced progressively into diabetes mellitus care programs with the aim of providing patients and their families or caregivers with the necessary skills for the self-management of the disease. The Diabetes Attitudes, Wishes and Needs 2 (DAWN2) study helps to clarify what are the unmet needs with regards to self-management and the TE offer available to patients and their families. The objective of this paper is to analyse the results of the DAWN2 study regarding self-care habits and participation in TE activities in Spain. METHODS: The DAWN2 is an observational, cross-national study. In this paper, an analysis was performed on the Spanish sample of diabetic patients (502) and family members (123). RESULTS: Patients report taking their medications as recommended by their doctor an average of 6.4 days/week, and self-monitor their blood glucose an average of 3.4 days/week. The large majority (86%) of patients with diabetes mellitus type 1, 59% of patients with diabetes mellitus type 2, and 21% of family members state to have participated in education activities. CONCLUSIONS: Diabetes educators should reinforce the messages about the benefits of self-care, particularly for patients who are in the early stages of the disease. Likewise, access for family members and people with diabetes mellitus type 2 to TE programs should be improved, and these programs for diabetic patients and their families should be included in the services portfolio of health centres.

[Systems of continuous subcutaneous insulin infusion. Therapeutic education program]. / Sistemas de infusión subcutánea continua de insulina. Programa de educación terapéutica.

Insulin replacement therapy in people with diabetes mellitus type 1 (DM1) is to obtain a physiological reproduction as possible, both the pharmacokinetic characteristics of insulin as delivery systems. It has scored two avenues of research: get new insulins and develop new forms of insulin regimen. The advent of insulin analogues has made to the treatment a physiological profile. The most reproducible insulin delivery has been based mainly on the use of a System of Continuous Subcutaneous Insulin Infusion. These two important objectives but not would optimize the treatment for themselves or good glycemic control of the person if they were not attached to a therapeutic education program in diabetes. The usual therapeutic education program conducted by nurses but obviously integrated into the organization and work of a multidisciplinary team, involves the proper selection of the person and the fulfillment of objectives to be aware and know-how, attitudes and skills.

Sistemas de infunsión subcutánea continua de insulina. Programa de educación terapéutica / Systems of continuous subcutaneous insulin infusion. Therapeutic Education Program

El tratamiento sustitutivo de insulina en las personas con diabetes mellitus tipo 1 (DM1) tiene como objetivo obtener una reproducción lo más fisiológica posible, tanto por las características farmacocinéticas de las insulinas como por los sistemas de administración. Esto ha marcado dos vías de investigación: obtener nuevas insulinas y desarrollar nuevas formas de pautarlas. La aparición de los análogos de insulina ha aportado al tratamiento un perfil más fisiológico. La forma más reproductible de administración de insulina se ha basado fundamentalmente en el uso de un Sistema de Infusión Subcutánea Continua de Insulina (ISCI). Estos dos objetivos, aunque importantes, por sí solos no optimizarían el tratamiento ni el buen control glucémico de la persona si no estuvieran unidos a un programa de educación terapéutica en diabetes. Este programa,habitualmente realizado por enfermería aunque obviamente integrado dentro de la organización y el trabajó de un equipo multidisciplinar, presupone la adecuada selección de la persona y el cumplimiento de unos objetivos que debe conocer y saber aplicar, unas actitudes y habilidades(AU)

Insulin replacement therapy in people with diabetes mellitus type 1 (DM1) is to obtain a physiological reproduction as possible, both the pharmacokinetic characteristics of insulin as delivery systems. It has scored two avenues of research: get new insulins and develop new forms of insulin regimen. The advent of insulin analogues has made to the treatment a physiological profile. The most reproducible insulin delivery has been based mainly on the use of a System of Continuous Subcuta-neous Insulin Infusion. These two important objectives but not would optimize the treatment for themselves or good glycemic control of the person if they were not attached to a therapeutic education program in diabetes. The usual therapeutic education program conducted by nurses but obviously integrated into the organization and work of a multidisciplinary team, involves the proper selection of the person and the fulfillment of objectives to be aware and know-how, attitudes and skills (AU)