Determinantes de la inercia en el tratamiento hipolipidemiante de pacientes con diabetes mellitus tipo 2 / Determinants of inertia with lipid-lowering treatment in patients with type 2 diabetes mellitus

Objetivo: Valorar el control del cLDL de pacientes con diabetes, medir la influencia en este control de la inercia con los hipolipidemiantes y explorar sus factores predictores. Métodos: Estudio de cohortes históricas de pacientes con diabetes. Se midió el porcentaje que alcanzó un cLDL dentro de objetivo. Se consideró inercia terapéutica cuando no se ajustó la dosis de los hipolipidemiantes, ni se cambió ni añadió ningún nuevo hipolipidemiante en los pacientes con cLDL inicial fuera de objetivo. Se estudiaron el cambio experimentado en el cLDL entre la primera y la última visita y la inercia con los hipolipidemiantes en función de las comorbilidades, factores de riesgo cardiovascular asociados y tratamientos utilizados. Resultados: Se incluyó a 639 pacientes (tiempo medio de seguimiento 11,1±11,2 meses). El 27,5% alcanzó un cLDL dentro de objetivo. Se produjo inercia en el 43,6% de los pacientes con un cLDL inicial fuera de objetivo. Resultaron predictores independientes de la inercia el cLDL inicial (p<0,001), la polineuropatía (p=0,014), el ajuste de los antihipertensivos (p=0,002), la adecuación de los hipolipidemiantes (p<0,001), el uso de ezetimiba (p=0,001) y la adherencia a los hipolipidemiantes (p=0,015). Conclusiones: La inercia en el tratamiento hipolipidemiante de un paciente con diabetes es menos frecuente ante valores iniciales de cLDL más altos, en los casos de polineuropatía, cuando se ajustan o cambian los antihipertensivos y cuando se detecta falta de adherencia. La prescripción inicial adecuada de estatinas y la asociación con ezetimiba disminuyen la probabilidad de caer en la inercia

Objective: To assess the control of cLDL in diabetic patients, to measure the impact on such control of inertia with lipid-lowering agents and to explore factors that allow for predicting this inertia. Methods: Study of historical cohorts of diabetic patients. The proportion of patients who achieved the target cLDL levels was estimated. Therapeutic inertia was considered when the dose of the lipid-lowering agents was not adjusted, or a lipid-lowering agent was not changed or added in patients with initial cLDL outside the target. Change in cLDL from the first to the last visit and inertia with lipid-lowering drugs were analyzed according to comorbidities, cardiovascular risk factors and treatments used. Results: The study simple consisted of 639 patients (mean follow-up time 11.1±11.2 months), of whom 27.5% achieved target cLDL levels. Inertia occurred in 43,6% of patients with initial cLDL outside the target. Independent predictors of inertia were the initial cLDL (P<0.001), polyneuropathy (P=0.014), adjustment of antihypertensive agents (P=0.002), adequacy of lipid-lowering agents (P<0.001), use of ezetimibe (P=0.001) and adherence to lipid-lowering drugs (P=0.015). Conclusions: Inertia with lipid-lowering agents in a diabetic patient is less frequent in the presence of higher cLDL values, in cases of polyneuropathy, when antihypertensive agents are adjusted or changed, and when non-adherence is detected. The adequate initial prescription of statins and the association with ezetimibe decrease the likelihood of committing inertia

Determinants of inertia with lipid-lowering treatment in patients with type 2 diabetes mellitus. / Determinantes de la inercia en el tratamiento hipolipidemiante de pacientes con diabetes mellitus tipo 2.

OBJECTIVE: To assess the control of cLDL in diabetic patients, to measure the impact on such control of inertia with lipid-lowering agents and to explore factors that allow for predicting this inertia. METHODS: Study of historical cohorts of diabetic patients. The proportion of patients who achieved the target cLDL levels was estimated. Therapeutic inertia was considered when the dose of the lipid-lowering agents was not adjusted, or a lipid-lowering agent was not changed or added in patients with initial cLDL outside the target. Change in cLDL from the first to the last visit and inertia with lipid-lowering drugs were analyzed according to comorbidities, cardiovascular risk factors and treatments used. RESULTS: The study simple consisted of 639 patients (mean follow-up time 11.1±11.2 months), of whom 27.5% achieved target cLDL levels. Inertia occurred in 43,6% of patients with initial cLDL outside the target. Independent predictors of inertia were the initial cLDL (P<0.001), polyneuropathy (P=0.014), adjustment of antihypertensive agents (P=0.002), adequacy of lipid-lowering agents (P<0.001), use of ezetimibe (P=0.001) and adherence to lipid-lowering drugs (P=0.015). CONCLUSIONS: Inertia with lipid-lowering agents in a diabetic patient is less frequent in the presence of higher cLDL values, in cases of polyneuropathy, when antihypertensive agents are adjusted or changed, and when non-adherence is detected. The adequate initial prescription of statins and the association with ezetimibe decrease the likelihood of committing inertia.

Determinantes de la adherencia a los hipoglucemiantes y a las visitas médicas en pacientes con diabetes mellitus tipo 2 / Determinants of adherence to hypoglycemic agents and medical visits in patients with type 2 diabetes mellitus

Objetivo: Valorar el control glucémico de pacientes diabéticos, medir la influencia en este control de la adherencia a los hipoglucemiantes y a las visitas médicas, y explorar factores que permitan predecir esta adherencia. Métodos: Estudio de cohortes históricas de pacientes diabéticos. Se midió el porcentaje que alcanzó una HbA1c dentro del objetivo. Se valoró la adherencia mediante la pregunta de Haynes-Sacket. Se estudiaron el cambio en la HbA1c entre la primera y la última visita, la adherencia y la asistencia a las consultas en función de las comorbilidades, los factores de riesgo cardiovascular y los tratamientos utilizados. Resultados: Se incluyeron 639 pacientes (tiempo medio de seguimiento 11,1±11,2 meses). El 66,6% alcanzó una HbA1c dentro del objetivo. El cambio en la HbA1c entre la primera y última visita se explicó en un 54,2% por la HbA1c inicial (p<0,001), en un 13% por la adherencia terapéutica (p<0,001) y en un 9,6% por la adherencia a las citas (p<0,001). La no insulinización (p=0,011) y el cese del tabaco (p=0,032) predispusieron a una mayor adherencia. La insulinización (p=0,019) y la falta de educación terapéutica (p=0,033) predispusieron a no acudir a las visitas. Conclusiones: La mejora de la HbA1c está determinada por la HbA1c inicial, la adherencia terapéutica y la asistencia a las citas. Los insulinizados tienen peor adherencia y faltan más a la consulta, los que dejan de fumar se adhieren más a los hipoglucemiantes y los que reciben educación terapéutica acuden más a la consulta (AU)

Aim: To assess glycemic control in diabetic patients, to measure the impact on such control of adherence to hypoglycemic agents and to medical visits, and to explore factors that allow for predicting adherence. Methods: Study of historical cohorts of diabetic patients. The proportion of patients who achieved the target HbA1c levels was estimated. Adherence was assessed using the Haynes-Sackett test. Change in HbA1c from the first to the last visit, adherence, and attendance to visits were analyzed according to comorbidities, cardiovascular risk factors, and treatments used. Results: The study simple consisted of 639 patients (mean follow-up time, 11.1±11.2 months), of whom 66.6% achieved target HbA1c levels. Change in HbA1c from the first to the last visit was explained in 54.2% of patients by baseline HbA1c (P<0.001), in 13% by treatment adherence (P<0.001), and in 9.6% by visit adherence (P<0.001). Non-insulinization (P=0.011) and smoking cessation (P=0.032) predisposed to greater adherence. Insulinization (P=0.019) and lack of diabetes education (P=0.033) predisposed to visit non-compliance. Conclusions: Improvement in HbA1c is determined by baseline HbA1c, treatment adherence, and attendance to visits. Patients on insulin have poorer adherence and are more likely to miss the appointments, those who stop smoking adhere more to hypoglycemic agents, and those given therapeutic education are more likely to keep the appointments (AU)

Determinants of adherence to hypoglycemic agents and medical visits in patients with type 2 diabetes mellitus. / Determinantes de la adherencia a los hipoglucemiantes y a las visitas médicas en pacientes con diabetes mellitus tipo 2.

AIM: To assess glycemic control in diabetic patients, to measure the impact on such control of adherence to hypoglycemic agents and to medical visits, and to explore factors that allow for predicting adherence. METHODS: Study of historical cohorts of diabetic patients. The proportion of patients who achieved the target HbA1c levels was estimated. Adherence was assessed using the Haynes-Sackett test. Change in HbA1c from the first to the last visit, adherence, and attendance to visits were analyzed according to comorbidities, cardiovascular risk factors, and treatments used. RESULTS: The study simple consisted of 639 patients (mean follow-up time, 11.1±11.2 months), of whom 66.6% achieved target HbA1c levels. Change in HbA1c from the first to the last visit was explained in 54.2% of patients by baseline HbA1c (P<0.001), in 13% by treatment adherence (P<0.001), and in 9.6% by visit adherence (P<0.001). Non-insulinization (P=0.011) and smoking cessation (P=0.032) predisposed to greater adherence. Insulinization (P=0.019) and lack of diabetes education (P=0.033) predisposed to visit non-compliance. CONCLUSIONS: Improvement in HbA1c is determined by baseline HbA1c, treatment adherence, and attendance to visits. Patients on insulin have poorer adherence and are more likely to miss the appointments, those who stop smoking adhere more to hypoglycemic agents, and those given therapeutic education are more likely to keep the appointments.

The occurrence or fibrillary glomerulonephritis in patients with diabetes mellitus may not be coincidental: a report of four cases.

Although clinical presentation of fibrillary glomerulonephritis is similar to most forms of glomerulonephritis, it is usually difficult to make the diagnosis. Clinical manifestations include proteinuria, microscopic haematuria, nephrotic syndrome, and impairment of renal function. A diagnosis of fibrillary glomerulonephritis is only confirmed by renal biopsy and it must comprise electronmicroscopy-verified ultrastructural findings. We report four cases between 45-50 years old with documented type 2 diabetes mellitus (T2DM) and arterial hypertension. All patients were found to have fibrils on kidney biopsy. The differential diagnosis of fibrils in the setting of diabetes mellitus is also discussed.