[Management of type 2 diabetic patients in primary care in Spain]. / Tratamiento de los pacientes con diabetes mellitus tipo 2 en atención primaria en España.

BACKGROUND AND OBJECTIVE: We assess the metabolic control, complications, quality of life related to health (QLRH) and the type and amount of medical resource consumption (MRC) in type 2 diabetic patients (2DMp) followed by primary care physicians (PCP) in Spain. PATIENTS AND METHOD: We studied 628 2DMp divided in 4 cohorts: 1. Either newly diagnosed 2DMp who required pharmacological treatment or failed to non-pharmacological measures; 2. Patients pharmacologically treated for less than 1 year; 3. Patients with pharmacological treatment for more than 1 year; 4. Patients with impaired fasting glucose (control group). RESULTS: Eighty percent of the subjects were overweight. At baseline, 27.9, 23.5 and 36.9% of patients from cohorts 1, 2 and 3, respectively, had HbA1C < 8%. After 6 months of follow-up, 14.6, 21.3 and 22.8% of patients from cohorts 1, 2 and 3, respectively, still had "bad control". At baseline, 38.0%, 21.2% and 20.7% of patients from cohorts 1, 2, and 3, respectively, had "bad lipid profile". After 6 months, 57.4%, 54.2% and 45.3% of cohorts 1, 2 and 3, respectively, still had plasma cLDL levels > 130 mg/dl. Complications were more frequent in cohort 3. During the 6-month period, MRC was higher among 2DMp than controls (p < 0.05) and higher among patients from cohort 3 (p < 0.05) compared with all the other patients. More diabetic than control patients and more patients from cohort 3 than patients from cohort 1 and 2 reported that their expected quality of life would be better without diabetes. CONCLUSIONS: One out of four of diabetic patients studied had HbA1C and lipids higher than the limits suggested by guidelines. Type 2 diabetes is associated with higher MRC and worse QLRH. This situation is worse among long-term diabetic patients.

Tratamiento de los pacientes con diabetes mellitus tipo 2 en atención primaria en España / Management of type 2 diabetic patients in primary care in Spain

Fundamento y objetivo: Evaluar el control metabólico y las complicaciones, la calidad de vida relacionada con la salud (CVRS) y el uso de recursos sanitarios (URS) en pacientes con diabetes mellitus tipo 2 (DM2) en centros de atención primaria en España. Pacientes y método: Estudiamos a 628 pacientes divididos en 4 cohortes: 1. Pacientes con DM2 que iniciaban tratamiento farmacológico. 2. Pacientes con DM2 que habían recibido fármacos antidiabéticos durante menos de un año. 3. Pacientes con DM2 que habían recibido tratamiento farmacológico durante más de un año. 4. Pacientes con glucemia basal alterada (controles). Resultados: Un 80% de los pacientes presentaba sobrepeso. Inicialmente presentaron un valor de hemoglobina glucosilada (HbA1C) inferior al 8%, el 27,9, el 23,5 y el 36,9% de las cohortes 1, 2 y 3, respectivamente, y el 14,6, el 21,3 y el 22,8% tras 6 meses. Presentaron inicialmente un deficiente control lipídico, el 38,0, el 21,2 y el 20,7% de las cohortes 1, 2 y 3, respectivamente. Tras 6 meses, el 57,4, el 54,2 y el 45,3% de los mismos grupos de pacientes presentaban aún concentraciones de colesterol unido a lipoproteínas de baja densidad superiores a 130 mg/dl. Las complicaciones fueron más frecuentes en la cohorte 3. El URS fue mayor entre los diabéticos que en los controles (p < 0,05) y mayor en la cohorte 3 (p < 0,05) que en los otros grupos. Significativamente más diabéticos que controles informaron que su CVRS sería mejor sin diabetes, así como más pacientes de la cohorte 3 que de las cohortes 1 y 2. Conclusiones: Aproximadamente 1 de cada 4 pacientes diabéticos presenta valores de control glucémico y lipídico superiores a los establecidos por las guías. El control es peor en el grupo de pacientes diabéticos de larga evolución. El URS y la alteración de la CVRS es también superior en este grupo

Background and objective: We assess the metabolic control, complications, quality of life related to health (QLRH) and the type and amount of medical resource consumption (MRC) in type 2 diabetic patients (2DMp) followed by primary care physicians (PCP) in Spain. Patients and method: We studied 628 2DMp divided in 4 cohorts: 1. Either newly diagnosed 2DMp who required pharmacological treatment or failed to non-pharmacological measures; 2. Patients pharmacologically treated for less than 1 year; 3. Patients with pharmacological treatment for more than 1 year; 4. Patients with impaired fasting glucose (control group). Results: Eighty percent of the subjects were overweight. At baseline, 27.9, 23.5 and 36.9% of patients from cohorts 1, 2 and 3, respectively, had HbA1C 130 mg/dl. Complications were more frequent in cohort 3. During the 6-month period, MRC was higher among 2DMp than controls (p < 0.05) and higher among patients from cohort 3 (p < 0.05) compared with all the other patients. More diabetic than control patients and more patients from cohort 3 than patients from cohort 1 and 2 reported that their expected quality of life would be better without diabetes. Conclusions: One out of four of diabetic patients studied had HbA1C and lipids higher than the limits suggested by guidelines. Type 2 diabetes is associated with higher MRC and worse QLRH. This situation is worse among long-term diabetic patients

Epidemiology, clinical characteristics, outcome, morbidity and mortality in acromegaly based on the Spanish Acromegaly Registry (Registro Espanol de Acromegalia, REA).

OBJECTIVE: To undertake a multicentre epidemiological study reflecting acromegaly in Spain. DESIGN: Voluntary reporting of data on patients with acromegaly to an online database, by the managing physician. METHODS: Data on demographics, diagnosis, estimated date of initial symptoms and diagnosis, pituitary imaging, visual fields, GH and IGF-I concentrations (requested locally), medical, radiotherapy and neurosurgical treatments, morbidity and mortality were collected. RESULTS: Data were included for 1219 patients (60.8% women) with a mean age at diagnosis of 45 years (s.d. 14 years). Reporting was maximal in 1997 (2.1 cases per million inhabitants (c.p.m.) per year); prevalence was globally 36 c.p.m., but varied between 15.7 and 75.8 c.p.m. in different regions. Of 1196 pituitary tumours, most were macroadenomas (73%); 81% of these patients underwent surgery, 45% received radiotherapy and 65% were given medical treatment (somatostatin analogues in 68.3% and dopamine agonists in 31.4%). Cures (GH values (basal or after an oral glucose tolerance test) <2 ng/ml, normal IGF-I, or both) were observed in 40.3% after surgery and 28.2% after radiotherapy. Hypertension (39.1%), diabetes mellitus (37.6%), hypopituitarism (25.7%), goitre (22.4%), carpal tunnel syndrome (18.7%) and sleep apnoea (13.2%) were reported as most frequent morbidities; 6.8% of the patients had cancer (breast in 3.1% of the women and colon in 1.2% of the cohort). Fifty-six patients died at a mean age of 60 years (s.d. 14 years), most commonly of a cardiovascular cause (39.4%); mortality was greater in patients given radiotherapy (hazard ratio 2.29; 95% confidence interval 1.03 to 5.08; P=0.026), and in those in whom GH and IGF-I concentrations were never normal (P<0.001). CONCLUSIONS: This acromegaly registry offers a realistic overview of the epidemiological characteristics, treatment outcome and morbidity of acromegaly in Spain. As active disease and treatment with radiotherapy are associated with an increase in mortality, efforts to control the disease early are desirable.