Adherence to antidiabetic treatment and impaired hypoglycemia awareness in type 2 diabetes mellitus assessed in Spanish community pharmacies: the ADHIFAC study.

INTRODUCTION: Adherence to treatment and hypoglycemia awareness are strongly linked to glycemic control and hypoglycemia risk in people with type 2 diabetes mellitus (T2DM). Community pharmacies are suitable facilities to detect these conditions, and should be involved in the strategies to minimize the associated risks and burden. RESEARCH DESIGN AND METHODS: This cross-sectional study conducted at community pharmacies across Spain assessed the prevalence of low adherence to antidiabetic treatments, the frequency of impaired hypoglycemia awareness, and their predictive factors. Adherence was measured with the 8-item Morisky Medication Adherence Scale (MMAS-8) and electronic records of dispensed treatments. The Clarke questionnaire was used to assess impaired hypoglycemia awareness. Healthcare counseling provided in the pharmacy was collected. RESULTS: Seventy-nine pharmacists and 618 subjects with T2DM participated in the study. Mean age in the overall T2DM population was 67 years, being the majority (69%) pensioners. Adherence was high in 41% of participants, medium in 35%, and low in 24% according to the MMAS-8. Impaired hypoglycemia awareness was observed in 25% of participants. Main determinants of low adherence were the level of education, the number of treatments per patient, hypoglycemia awareness, and the type of pharmacy. Predictive factors of impaired hypoglycemia awareness were the level of education, information on diabetes-related complications, adherence levels, and the type of pharmacy. The proportion of participants who had healthcare counseling was 71% in the overall population and 100% in subjects with impaired hypoglycemia awareness and low adherence. Healthcare counseling comprised diabetes education (69%), pharmacotherapeutic assessment (20%), and physician referrals (11%). CONCLUSION: Lack of adherence to antidiabetic treatments and impaired hypoglycemia awareness are frequent and correlate in T2DM. Community pharmacies can detect these conditions and should have an active role in the design of strategies to minimize them.

Cumplimiento de las Recomendaciones de la Guía SEH/SEC 2007 en población Hipertensa en un Centro de Salud / Compliance to the 2007 ESH/ESC guideline in a hypertensive population at a primary health care centre

Objetivo. Evaluar la proporción de hipertensos con y sin factores de riesgo cardiovascular añadido que tienen presión arterial controlada, y el seguimiento de la Guía SEH/SEC 2007 por los médicos de un Centro de Salud. Diseño. Estudio observacional descriptivo transversal. Emplazamiento. Zona de Salud Manzanares II. Participantes. Pacientes adultos con Hipertensión Arterial documentada en la historia clínica informatizada, reclutados mediante muestreo sistemático. Mediciones. Antecedentes familiares y personales de factores de riesgo cardiovascular, biometría(edad, sexo, peso, talla, índice de masa corporal), presión arterial, datos analíticos, electrocardiograma y fármacos empelados. Resultados. La proporción de pacientes hipertensos con cifras controladas (<140/90 mmHg) fue de50,35% (IC 95%: 48,17-52,54%), siendo significativamente inferior en hombres (47,46%, IC 95%:44,03-50,89) que en mujeres (52,44%, IC 95%: 49,60-55,28%) (p = 0,01). La proporción de controlados entre los que tienen riesgo añadido fue mayor (56,52 ± 14,40%) que la de aquéllos sin riesgo añadido (49,15 ± 6,41%), sin diferencias entre sexos. El 36,86% de los pacientes con riesgo tomaba estatinas y, de ellos, el 60,92% tenía LDL > 130 mgr/dl. El 32,05% de los hipertensos diabéticos tomaba estatina y antiagregante y, de éstos, el 40% tenía LDL < 100 mgr/dl y el 24,36% HBA1C <6,5%.Conclusiones. La proporción de hipertensos con cifras de presión arterial controladas fue elevada en relación a otros estudios de nuestro ámbito. Debemos mejorar el seguimiento de la Guía SEH/SEC para el abordaje integral y la calidad de la asistencia a nuestros hipertensos (AU)

Objective. To determine the proportion of controlled hypertensive patients with and without added cardiovascular risks factors and to evaluate compliance to the 2007 SHE/SEC guidelines by doctors at a Primary Health Care Centre. Design. Observational, descriptive, cross-sectional study. Setting. Primary Health Care Centre at Manzanares II (Ciudad Real). Subjects. Adult patients with documented hypertension in their computerised medical record. Patients were recruited by systematic sampling Main measurement. Family and personal history of cardiovascular risk factors, biometric (age, sex, weight, height, body mass index), blood pressure, analytical data, electrocardiogram and medication. Results. The percentage of patients with controlled hypertension (< 140/90 mm Hg) was 50.35%(48.17 – 52.54%) being lower in males 47.46% (44.03 – 50.89%) than in females 52.44 (49.6 – 55.28%)with statistical signifi cance (p = 0.01). The percentage of well controlled patients with added risks factor was greater (56.52 +/- 14.4 %) than those without added risk factors (49.15 +/- 6.41%), with no differences between sexes. 36.86 % of the patients with risk factors were taking statins and of this group 60.92 % had LDL levels of > 130 mg/dl. 32.05% of the diabetic patients with high blood pressure were taking statins and antiaplatelets and 40 % of them had LDL < 100 mgr/dl and 24.36%had HBA1C < 6.5 %.Conclusions: The percentage of patients with controlled hypertension was high compared to other studies in the same setting. We should improve compliance to the ESH/ESC guidelines in order to provide complete, high quality care to our hypertensive patients (AU)