Concordance between two methods in measuring treatment adherence in patients with type 2 diabetes.

OBJECTIVE: We analyzed the concordance between two methods for measuring treatment adherence (TA) and studied the determinants of TA in patients with type 2 diabetes mellitus. METHODS: We conducted a cross-sectional descriptive study in a primary care center, involving 320 diabetic patients. TA was measured using the Haynes-Sackett (H-S) adherence test during the patient interview and based on pharmacy refill data. TA was calculated globally and by drug groups (antihypertensive, lipid-lowering, and antidiabetic drugs). RESULTS: Poor TA as measured by the H-S test was observed in 11.2% of the patients. Based on pharmacy refill data, there was a poor global TA rate of 30.3%, which was 33.3%, 26.6%, and 34.2% for oral antidiabetic, antihypertensive, and lipid-lowering drugs, respectively. Concordance between the two methods was poor. There was no relationship between the degree of disease control and TA as measured by the H-S test. Good TA measured based on pharmacy refill data for antidiabetic and antihypertensive drugs was associated with lower glycosylated hemoglobin and diastolic blood pressure values, respectively. Patients with good global TA showed lower glycosylated hemoglobin, diastolic blood pressure, and low-density lipoprotein cholesterol values. The multivariate analysis found good oral antidiabetic adherence to be associated to free pharmacy service; good antihypertensive drug adherence to the existence of comorbidities; and good lipid-lowering drug adherence to a history of ischemic heart disease, and a more experienced physician and/or female physician. CONCLUSION: Concordance between the two methods in assessing TA was low. Approximately one-third of the patients with type 2 diabetes mellitus presented poor TA in relation to antihypertensive, lipid-lowering, and antidiabetic medication. An improved TA was associated with a better control of the studied parameters. Comorbidities, such as ischemic heart disease and access to free pharmacy service, were identified as determinants of good TA.

Prevalence of depression in patients with type 2 diabetes attended in primary care in Spain.

OBJECTIVES: To estimate the prevalence of known and undiagnosed depression in patients with type 2 diabetes attended in primary care setting in Spain, and to determine the factors associated with the presence of depression. METHODS: This was a cross-sectional and multicenter study performed in a random sample of patients with type 2 diabetes attended in 21 primary care centers. Depressive symptoms were measured with the self-administered Patient Health Questionnaire (PHQ-9). RESULTS: A total of 411 patients were analyzed (mean age 70.8 (SD 10.3) years; 53.8% women). 29.2% of patients met the diagnostic criteria of depression, of whom 17% had known depression and 12.2% undiagnosed depression (PHQ-9 score ≥10, without a previous diagnosis of depression). Depression was more common in women (43.4%; 95% confidence interval [CI] 34.5-52.3%), widow (33.3%; 95% CI 27.9-38.7%), and hypothyroidism (12.5%; 95% CI 8.7-16.3%). Cardiovascular risk factors, the degree of control, complications related to diabetes, antidiabetic therapy and the number of drugs were not associated with the presence of depression. CONCLUSIONS: The prevalence of depression was high in patients with type 2 diabetes. However, in approximately 40% of patients depression was undiagnosed. The complications related to diabetes and antidiabetic therapy were not associated with the presence of depression.

Chronic Kidney Disease and Diabetic Retinopathy in Patients with Type 2 Diabetes.

PURPOSE: To explore the relationship between chronic kidney disease (CKD) and diabetic retinopathy (DR) in a representative population of type 2 diabetes mellitus (DM2) patients in Catalonia (Spain). METHODS: This was a population-based, cross-sectional study. A total of 28,344 patients diagnosed with DM2 who had recorded ophthalmologic and renal functional examinations were evaluated. Data were obtained from a primary healthcare electronic database of medical records. CKD was defined as an estimated glomerular filtration ratio (eGFR) of <60 ml/min/1.73 m2 and/or urine albumin to creatinine ratio (UACR) ≥30 mg/g. DR was categorized as non-vision threatening diabetic retinopathy and vision threatening diabetic retinopathy. RESULTS: CKD was associated with a higher rate of DR [OR], 95% confidence interval [CI], 1.5 (1.4-1.7). When we analyzed the association between different levels of UACR and DR prevalence observed that DR prevalence rose with the increase of UACR levels, and this association was significant from UACR values ≥10 mg/g, and increased considerably with UACR values ≥300 mg/g (Odds ratio [OR], 95% confidence interval [CI], 2.0 (1.6-2.5). This association was lower in patients with eGFR levels 44 to 30 mL/min/1.73 m2 [OR], 95% confidence interval [CI], 1.3 (1.1-1.6). CONCLUSIONS: These results show that CKD, high UACR and/or low eGFR, appear to be associated with DR in this DM2 population.

Prevalence of diabetic retinopathy in individuals with type 2 diabetes who had recorded diabetic retinopathy from retinal photographs in Catalonia (Spain).

BACKGROUND/AIMS: Retinal photography with a non-mydriatic camera is the method currently employed for diabetic retinography (DR) screening. We designed this study in order to evaluate the prevalence and severity of DR, and associated risk factors, in patients with type 2 diabetes (T2DM) screened in Catalan Primary Health Care. METHODS: Retrospective, cross-sectional, population based study performed in Catalonia (Spain) with patients with T2DM, aged between 30 years and 90 years (on 31 December 2012) screened with retinal photography and whose DR category was recorded in their medical records. DR was classified as: no apparent retinopathy (no DR), mild non-proliferative DR (mild NPDR), moderate NPDR, severe NPDR, proliferative DR (PDR) and diabetic macular oedema (DMO). Non-vision threatening DR (non-VTDR) included mild and moderate NPDR; VTDR included severe NPDR, PDR and DMO. Clinical data were obtained retrospectively from the SIDIAP database (System for Research and Development in Primary Care). RESULTS: 108 723 patients with T2DM had been screened with retinal photography. The prevalence of any kind of DR was 12.3% (95% CI 12.1% to 12.5%). Non-VTDR and VTDR were present in 10.8% (mild 7.5% and moderate NPDR 3.3%) and 1.4% (severe NPDR 0.86%, PDR 0.36% and DMO 0.18%) of the study patients, respectively. CONCLUSIONS: The prevalence of any type of DR in patients with T2DM screened with retinal photography was lower when compared with earlier studies.

Inercia y cumplimiento terapéutico en pacientes con diabetes mellitus tipo 2 en atención primaria / Inertia and treatment compliance in patients with type 2 diabetes in primary care

Fundamento y objetivo: La inercia terapéutica (IT) y el cumplimiento terapéutico (CT) limitan alcanzar los objetivos de control recomendados para los pacientes. Este estudio valora la IT y el CT en pacientes con diabetes mellitus 2 (DM2) en relación al control glucémico, la presión arterial (PA) y el colesterol unido a lipoproteínas de baja densidad (colesterol LDL), valorando la relación entre IT y CT. Pacientes y método: Estudio transversal realizado en atención primaria. Se incluyeron 320 pacientes diabéticos. Se valoró si cumplían los objetivos de control (hemoglobina glucosilada [HbA1c]≤7%, presión arterial [PA]≤130/80mmHg, colesterol LDL≤100mg/dl), si se incurrió en IT (ausencia de modificaciones en el tratamiento en caso de no cumplir los objetivos de control) y el CT (recuento de recetas retiradas de farmacia). Resultados: Un 66,4% de los pacientes alcanzaron el objetivo de control para la HbA1c, un 43,2% para la PA y un 40,5% para el colesterol LDL. Se incurrió en IT en un 86,4% para el colesterol LDL, en un 76,7% para la PA y en un 40,6% para la HbA1c. El porcentaje de incumplimiento terapéutico fue del 36,1, 37,5 y 32,0% para los antidiabéticos, antihipertensivos e hipolipidemiantes, respectivamente. Los pacientes con mayor edad fueron mejor cumplidores. La IT no se relacionó con el CT. No hubo diferencias según sexo en cuanto al grado de control, la IT, la utilización de fármacos, ni el CT. Conclusiones: La IT y el CT tienen un papel importante en la no consecución de los objetivos de control en los pacientes diabéticos, especialmente en la PA y los lípidos. El CT no se relaciona con la IT (AU)

Background and objectives: Therapeutic inertia (TI) and therapeutic compliance (TC) are 2 important barriers in achieving the therapeutic objectives recommended for patients with diabetes mellitus type 2 (DM2). This study analyzes the TI in patients with DM2 who do not achieve the glycemic, blood pressure (BP) and LDL-cholesterol (c-LDL) control goals, the patients’ TC and the relationship between TI and TC. Patients and methods: This is a descriptive study conducted in a Primary Health Care center. We included 320 diabetic patients. Objectives of control were HbA1c≤7%, blood pressure (BP)≤130/80 mmHg , c-LDL≤100mg/dl, TI (when the objectives of control were not reached and the professional did not change the treatment) and TC (by counting withdrawals of pharmacy prescriptions).Results: The objectives of control for HbA1c, BP and c-LDL were reached by 66.4, 43.2 and 40.5% of patients, respectively. There was TI in the 86.4% of patients for c-LDL, in 76.7% for BP and in 40.6% for HbA1c. The percentage of therapeutic non-compliance was of 36.1, 37.5 and 32.0% for antidiabetic, antihypertensive and lipid lowering drugs, respectively. Elderly patients were better compliants. TI and TC were not associated. We did not find differences in the level of control, TI, use of drugs and TC by sex. Conclusions: TI and TC play an important role in the non-consecution of the control objectives in diabetic patients, especially regarding BP and lipids. TC is not related to TI (AU)

[Inertia and treatment compliance in patients with type 2 diabetes in primary care]. / Inercia y cumplimiento terapéutico en pacientes con diabetes mellitus tipo 2 en atención primaria.

BACKGROUND AND OBJECTIVES: Therapeutic inertia (TI) and therapeutic compliance (TC) are 2 important barriers in achieving the therapeutic objectives recommended for patients with diabetes mellitus type 2 (DM2). This study analyzes the TI in patients with DM2 who do not achieve the glycemic, blood pressure (BP) and LDL-cholesterol (c-LDL) control goals, the patients' TC and the relationship between TI and TC. PATIENTS AND METHODS: This is a descriptive study conducted in a Primary Health Care center. We included 320 diabetic patients. Objectives of control were HbA1c ≤ 7%, blood pressure (BP) ≤ 130/80 mm Hg, c-LDL ≤ 100 mg/dl, TI (when the objectives of control were not reached and the professional did not change the treatment) and TC (by counting withdrawals of pharmacy prescriptions). RESULTS: The objectives of control for HbA1c, BP and c-LDL were reached by 66.4, 43.2 and 40.5% of patients, respectively. There was TI in the 86.4% of patients for c-LDL, in 76.7% for BP and in 40.6% for HbA1c. The percentage of therapeutic non-compliance was of 36.1, 37.5 and 32.0% for antidiabetic, antihypertensive and lipid lowering drugs, respectively. Elderly patients were better compliants. TI and TC were not associated. We did not find differences in the level of control, TI, use of drugs and TC by sex. CONCLUSIONS: TI and TC play an important role in the non-consecution of the control objectives in diabetic patients, especially regarding BP and lipids. TC is not related to TI.