Validating prediction scales of type 2 diabetes mellitus in Spain: the SPREDIA-2 population-based prospective cohort study protocol.

INTRODUCTION: The incidence of type 2 diabetes mellitus (T2DM) is increasing worldwide. When diagnosed, many patients already have organ damage or advance subclinical atherosclerosis. An early diagnosis could allow the implementation of lifestyle changes and treatment options aimed at delaying the progression of the disease and to avoid cardiovascular complications. Different scores for identifying undiagnosed diabetes have been reported, however, their performance in populations of southern Europe has not been sufficiently evaluated. The main objectives of our study are: to evaluate the screening performance and cut-off points of the main scores that identify the risk of undiagnosed T2DM and prediabetes in a Spanish population, and to develop and validate our own predictive models of undiagnosed T2DM (screening model), and future T2DM (prediction risk model) after 5-year follow-up. As a secondary objective, we will evaluate the atherosclerotic burden of the population with undiagnosed T2DM. METHODS AND ANALYSIS: Population-based prospective cohort study with baseline screening, to evaluate the performance of the FINDRISC, DANISH, DESIR, ARIC and QDScore, against the gold standard tests: Fasting plasma glucose, oral glucose tolerance and/or HbA1c. The sample size will include 1352 participants between the ages of 45 and 74 years. ANALYSIS: sensitivity, specificity, positive predictive value, negative predictive value, likelihood ratio positive, likelihood ratio negative and receiver operating characteristic curves and area under curve. Binary logistic regression for the first 700 individuals (derivation) and last 652 (validation) will be performed. All analyses will be calculated with their 95% CI; statistical significance will be p<0.05. ETHICS AND DISSEMINATION: The study protocol has been approved by the Research Ethics Committee of the Carlos III Hospital (Madrid). The score performance and predictive model will be presented in medical conferences, workshops, seminars and round table discussions. Furthermore, the predictive model will be published in a peer-reviewed medical journal to further increase the exposure of the scores.

[Patients' understanding of the dietetic and pharmacological treatment of hypercholesterolaemia and its relationship with the achievement of objectives in patients receiving statins: OPINA study]. / Conocimiento sobre el tratamiento dietético y farmacológico de la hipercolesterolemia y su relación con el control de objetivos en pacientes que reciben estatinas: estudio OPINA.

OBJECTIVE: To evaluate the understanding of patients receiving statins about the dietary and therapeutic measures taken to control their cholesterol and to relate this to the achievement of therapy objectives. DESIGN: Transversal, multi-centre study, conducted between March and November, 2004. SETTING: Three-hundred seventy six primary care and specialist doctors from all over the country. PARTICIPANTS: A total of 2347 patients, with an average age of 59 (12) and 48% women, being treated with statins. METHOD: Survey to evaluate understanding of lipid-lowering diet and pharmacological treatment. The percentage of patients achieving therapy objectives in line with ATP III guidelines was determined. RESULTS: Understanding of diet was adequate only for foods with negative effects on the concentration of cholesterol. Overall, understanding was better in the young, those with a higher level of education, those with hyperlipaemia originating in the family, those under treatment for longer, and in those attended in primary care or internal medicine clinics; it was worse in diabetic patients and in those with cardiovascular disease. Patients with more understanding of their treatment reached their therapy objectives to a greater extent. CONCLUSION: Patients receiving statins treatment have an adequate understanding of diet, but little information on pharmacological treatment. This understanding is associated with the achievement of therapy objectives.

Conocimiento sobre el tratamiento dietético y farmacológico de la hipercolesterolemia y su relación con el control de objetivos en pacientes que reciben estatinas: estudio OPINA / Patients’ understanding of the dietetic and pharmacological treatment of hypercholesterolaemia and its relationship with the achievement of objectives in patients receiving statins: OPINA study

Objetivo. Evaluar el conocimiento de los sujetos que reciben tratamiento con estatinas sobre las medidas dietéticas y terapéuticas dirigidas a su control, relacionándolo con la consecución de objetivos terapéuticos. Diseño. Estudio transversal, multicéntrico, realizado entre marzo y noviembre de 2004. Emplazamiento. En total, 376 médicos de atención primaria y especializada distribuidos por toda la geografía nacional. Participantes. Se incluyó a 2.347 sujetos, con una edad media de 59 ± 12 años, el 48%, mujeres, y en tratamiento con estatinas. Método. Encuesta dirigida a evaluar el conocimiento sobre la dieta hipolipidemiante y el tratamiento farmacológico. Se determinó el porcentaje de sujetos que alcanzó los objetivos terapéuticos según el ATP III. Resultados. El conocimiento de la dieta era adecuado sólo para los alimentos con efectos negativos sobre la concentración de colesterol. Globalmente, el conocimiento fue mejor en los sujetos jóvenes, con un superior nivel de educación, con una hiperlipidemia de origen familiar, con más tiempo en tratamiento y que eran atendidos en consultas de atención primaria o medicina interna, y peor en los pacientes diabéticos y con enfermedad cardiovascular. Los sujetos con un mayor nivel de conocimientos sobre el tratamiento alcanzaron en mayor proporción los objetivos terapéuticos. Conclusión. Los pacientes que reciben tratamiento con estatinas tienen un adecuado conocimiento de la dieta y escasa información sobre el tratamiento farmacológico. Este conocimiento se asocia con la consecución de objetivos terapéuticos

Objective. To evaluate the understanding of patients receiving statins about the dietary and therapeutic measures taken to control their cholesterol and to relate this to the achievement of therapy objectives. Design. Transversal, multi-centre study, conducted between March and November, 2004. Setting. Three-hundred seventy six primary care and specialist doctors from all over the country. Participants. A total of 2347 patients, with an average age of 59 (12) and 48% women, being treated with statins. Method. Survey to evaluate understanding of lipid-lowering diet and pharmacological treatment. The percentage of patients achieving therapy objectives in line with ATP III guidelines was determined. Results. Understanding of diet was adequate only for foods with negative effects on the concentration of cholesterol. Overall, understanding was better in the young, those with a higher level of education, those with hyperlipaemia originating in the family, those under treatment for longer, and in those attended in primary care or internal medicine clinics; it was worse in diabetic patients and in those with cardiovascular disease. Patients with more understanding of their treatment reached their therapy objectives to a greater extent. Conclusion. Patients receiving statins treatment have an adequate understanding of diet, but little information on pharmacological treatment. This understanding is associated with the achievement of therapy objectives

Tratamiento de la infección por VIH en pacientes con problemática psicosocial / Treatment of HIV infection in patients with psychosocial problems

El talón de Aquiles del tratamiento antirretroviral de gran actividad (TARGA) es la adherencia. Es necesario trabajar en mejorar la adherencia, sobre todo en pacientes con otros problemas o patologías que pudieran favorecer el incumplimiento terapéutico. Además de conocer las posibles interacciones farmacológicas, se precisa un trabajo multidisciplinario para el tratamiento integral del paciente, sobre todo en condiciones extremas (AU)

The Achilles heel of hight activity antiretroviral treatment (HAART) is adherence. Improvement of adherence needs to be worked on, especially in patients with other problems or pathologies that may favour non-compliance with therapy. As well as the search for possible drug interactions, multidisciplinary work for integrated treatment, especially under extreme conditions, is required (AU)

Hipertensión pulmonar en los pacientes con infección por el virus de la inmunodeficiencia humana. Estudio de 14 casos / Pulmonary hypertension in patients with human immunodeficiency virus infection. Study of 14 patients

Fundamento: En pacientes positivos para el virus de la inmunodeficiencia humana (VIH) se han descrito casos de hipertensión arterial pulmonar y cor pulmonale con hallazgos similares a los observados en la hipertensión arterial pulmonar primaria. Población y métodos: Se analizaron retrospectivamente 14 enfermos positivos para el VIH con datos ecocardiográficos de hipertensión arterial pulmonar diagnosticados durante 9 años (1991-1999). Resultados: El tiempo medio hasta el diagnóstico fue de 4 meses (límites, 1 semana-1 año). La hipertensión arterial pulmonar se consideró leve en 3 casos (23 por ciento), moderada en siete (54 por ciento) y grave en cuatro, con un valor medio del gradiente VD-AD de 57,96 mmHg (límites, 35-87). Se realizó terapia convencional en 10 casos, con progresión de la enfermedad en cinco. En éstos se empleó carvedilol con respuesta favorable en cuatro. Tres enfermos no requirieron tratamiento farmacológico. La evolución a largo plazo fue buena con mejoría clínica y ecocardiográfica en 11 casos (78 por ciento). El tiempo medio de seguimiento fue de 2 años (límites, 1-8 años) y fallecieron 3 pacientes (22 por ciento). Conclusiones: La hipertensión arterial pulmonar en los pacientes con infección por el VIH suele ser de grado moderado-grave y, sin un alto índice de sospecha, se produce un acusado retraso en el diagnóstico. El carvedilol podría ser una buena alternativa terapéutica en los casos de hipertensión arterial pulmonar refractaria a otros tratamientos. (AU)