Role of therapeutic inertia in glycemic control according to individualized objectives in a cohort of patients with type 2 diabetes. Results from CONCARDIA2.

BACKGROUND AND OBJECTIVE: Therapeutic inertia (TI) is the lack of initiation or intensification of treatment when indicated. It contributes to the fact that more than a third of people with type 2 diabetes mellitus (T2D) do not have adequate metabolic control. We set out to analyze the impact of TI during 4 years of follow-up in a cohort of T2D and its possible variables. MATERIALS AND METHODS: Prospective cohort study of a cohort of 297 TD2 patients. We considered TI when treatment was not modified during the 4 years, despite poor control. We contemplate uncontrolled those that did not meet their individualized HbA1c target. RESULTS: Uncontrolled patients: 87; age: 62.2 ±â€¯9.2; 58.7% men. We consider TI in 41.6% of the patients. Average HbA1c 8.22% in patients with treatment intensification of which 43.1% achieved their HbA1c goal, 29.8% were on monotherapy at the beginning, 29.8% double, 36.2% triple and 2,1% in quadruple therapy. There was more change in treatment in people with obesity (67.6 vs. 34.6%; P < 0.01) and the 6 of the study patients with cardiovascular events (P < 0.05). Metformin was part of the treatment in 97.1% of IT cases (vs. 76.6%; P < 0.01). Achievement of the HbA1c target was higher in patients receiving iSGLT2 (0 vs. 68.4%; P < 0.001). CONCLUSIONS: In 2 out of 5 uncontrolled T2D patients, the treatment was not changed; this was more evident in those patients treated with metformin. Patients with obesity and presence of cardiovascular events seem to protect against IT. Those who were on iSGLT2 have an advantage in meeting their HbA1c target.

Aplicación de los objetivos individualizados definidos por la guía europea 2019 de lípidos en pacientes con diabetes tipo 2 / Application of the individualized objectives defined by the European 2019 lipid guidelines in patients with type 2 diabetes

ANTECEDENTES Y OBJETIVO: La enfermedad cardiovascular supone una de las principales complicaciones de las personas con diabetes tipo 2 (DM2). La guía ESC/ESA 2019 de lípidos ha supuesto un cambio en el control de la dislipidemia. Analizamos la evolución del perfil lipídico, el cumplimiento de los objetivos de colesterol ligado a lipoproteínas de baja densidad (c-LDL), cómo clasifica a los pacientes y el impacto de esta guía en el control lipídico en pacientes con DM2. MATERIALES Y MÉTODOS: Estudio de cohortes prospectivo de 2017 a 2020 de una cohorte de 297 DM2 de un total de 1.229 (nivel de confianza del 95%). Clasificamos a los pacientes en función de su riesgo cardiovascular y si cumplían o no su objetivo de LDL. RESULTADOS: Edad 62,58±10,68 años; 52,79% varones. Niveles de c-LDL medio 116,2 al inicio y 100,2mg/dl a los 4 años (p<0,001). Cumplían su objetivo individualizado de c-LDL después de la publicación de la guía 57 (21,67%) pacientes. Hubo más controlados que eran menores de 65 años (57,9 vs. 36,9%; p<0,01; RR 0,83), varones (66,7 vs. 49,5%; p<0,05; RR 0,86) y fumadores (17,5 vs. 7,8%; p<0,05). El 74,23% tenía un riesgo cardiovascular alto y un objetivo c-LDL<70mg/dl. CONCLUSIONES: Desde la publicación de la guía de lípidos ESC/ESA 2019 se observa un descenso en los niveles de c-LDL. Aun así, solo uno de cada 5 pacientes cumple su objetivo individualizado de c-LDL. Presentaron ventajas por cumplir su objetivo los pacientes de sexo masculino, menores de 65 años y fumadores. La mayoría de los pacientes con DM2 tienen un riesgo cardiovascular alto y el objetivo de c-LDL predominante es inferior a 70mg/dl.

BACLGROUND AND OBJETIVE: Cardiovascular disease is one of the main complications of people with type 2 diabetes (T2D). The ESC/ESA 2019 lipid guide has led to a change in dyslipidemia control. We analyze the evolution of the lipid profile, the fulfillment of the low-density cholesterol (LDL-C) targets, how patients are classified and the impact of this guide on lipid control in T2D patients. MATERIALS AND METHODS: A prospective cohort study from 2017 to 2020 from a cohort of 297 T2D out of a total of 1229 (95% confidence level). We classified patients according to their cardiovascular risk and whether they met or not their LDL-C goal. RESULTS: Age 62.58±10.68 years; 52.79% men. Mean LDL-C levels 116.2 at baseline and 100.2mg/dL at 4 years (P<.001). They met their individualized LDL-C target after publication of the guide: 57 (21.67%). There were more controls who were under 65 years (57.9 vs. 36.9%; P<.01; RR 0.83), men (66.7 vs. 49.5%; P<.05; RR 0.86) and smokers (17.5 vs. 7.8%; P<.05). A percentage of 74.23 had a high cardiovascular risk and a target LDL-C<70mg/dL. CONCLUSIONS: Since the publication of the ESC/ESA 2019 lipid guide, a decrease in LDL-C levels has been observed. Only one in 5 patients fulfill their individualized LDL-C target. Male patients, under 65 years of age and smokers presented an advantage in meeting their goal. Most T2D patients have a high cardiovascular risk, and the predominant LDL-C target is less than 70mg/dL.

Application of the individualized objectives defined by the European 2019 lipid guidelines in patients with type 2 diabetes. / Aplicación de los objetivos individualizados definidos por la guía europea 2019 de lípidos en pacientes con diabetes tipo 2.

BACKGROUND AND OBJECTIVE: Cardiovascular disease is one of the main complications of people with type 2 diabetes (T2D). The ESC/ESA 2019 lipid guide has led to a change in dyslipidemia control. We analyze the evolution of the lipid profile, the fulfillment of the low-density cholesterol (LDL-C) targets, how patients are classified and the impact of this guide on lipid control in T2D patients. MATERIALS AND METHODS: A prospective cohort study from 2017 to 2020 from a cohort of 297 T2D out of a total of 1229 (95% confidence level). We classified patients according to their cardiovascular risk and whether they met or not their LDL-C goal. RESULTS: Age 62.58±10.68 years; 52.79% men. Mean LDL-C levels 116.2 at baseline and 100.2mg/dL at 4 years (P<.001). They met their individualized LDL-C target after publication of the guide: 57 (21.67%). There were more controls who were under 65 years (57.9 vs. 36.9%; P<.01; RR 0.83), men (66.7 vs. 49.5%; P<.05; RR 0.86) and smokers (17.5 vs. 7.8%; P<.05). A percentage of 74.23 had a high cardiovascular risk and a target LDL-C<70mg/dL. CONCLUSIONS: Since the publication of the ESC/ESA 2019 lipid guide, a decrease in LDL-C levels has been observed. Only one in 5 patients fulfill their individualized LDL-C target. Male patients, under 65 years of age and smokers presented an advantage in meeting their goal. Most T2D patients have a high cardiovascular risk, and the predominant LDL-C target is less than 70mg/dL.

Evolución del grado de control de una cohorte de pacientes anticoagulados de Atención Primaria / Evolution of the degree of control in a cohort of anticoagulated patients in Primary Care

Introducción: Solo el 60 por ciento de los pacientes en tratamiento con antagonistas de la vitamina K (AVK) están controlados. Objetivos: A nalizar una cohorte de pacientes anticoagulados para valorar su grado de control y su evolución a los 2 años, tras una intervención formativa breve. Métodos: Estudio longitudinal, observacional, retrospectivo de 157 anticoagulados con AVK. Se recogieron datos sociodemográficos, comorbilidades, motivo de prescripción del AVK y grado de control basal y tras 2 años de seguimiento. Utilizamos 2 métodos de valoración diferentes: Rosendaal y método directo (porcentaje de INR-Razón Normalizada Internacional- en rango). Asimismo, establecimos correlaciones temporales intramétodo. Resultados: El grado de control pasó del 47,3 por ciento al 53,5 por ciento a los 2 años, según Rosendaal (p= 0,52), y del 39,5 por ciento al 53,5 por ciento según el método directo (p< 0,05). El tiempo en rango terapéutico fue del 63,1 ±19,9 por ciento al inicio y 65 ±19,2 por ciento al final del seguimiento. La correlación entre los 2 controles fue positiva para ambos métodos (Rosendaal: 0,23; método directo: 0,33). El análisis multivariante fue significativo para el sexo masculino y para un objetivo diferente de 2,5-3,5 (odds ratio: 2,22 y 2,73, respectivamente). Conclusiones: El control del INR mejoró a los 2 años de seguimiento tras la actividad formativa. La evolución del grado de control de cada paciente es parcialmente predecible. El peor control se asoció al sexo femenino y al objetivo de INR de 2,5-3,5. El control mejora 2,22 veces en los varones y 2,73 veces en quienes no tienen un INR objetivo de 2,5-3,5(AU)

Introduction: Only 60 percent of patients on treatment with vitamin K antagonists (AVK) are controlled. Objectives: We proposed to analyze a cohort of anticoagulated patients to assess their degree of control and their evolution at 2 years, after a brief training intervention. Methods: Longitudinal, observational, retrospective study of 157 anticoagulated with AVK. Sociodemographic data, comorbidities, reason for VKA prescription and degree of baseline control were collected and after 2 years of follow-up. We use 2 different valuation methods: Rosendaal and direct method (INR percentage -International Normalized Ratio- in range). Likewise, we established intra-method temporal correlations. Results: The degree of control went from 47.3 percent to 53.5 percent at 2 years, according to Rosendaal (p = 0.52), and from 39.5 percent to 53.5 percent according to the direct method (p<0.05). The time in the therapeutic range was 63.1±19.9 percent at the start and 65±19.2 percent at the end of the follow-up. The correlation between the 2 controls was positive for both methods (Rosendaal: 0.23; direct method:0.33). The multivariate analysis was significant for males and for a target other than 2.5-3.5(odds ratio: 2.22 and 2.73, respectively). Conclusions: INR control improved after 2 years of follow-up after training activity. The evolution of the degree of control of each patient is partially predictable. The worst control was associated with female sex and the INR goal of 2.5-3.5. Control improves 2.22 times in males and 2.73 times in those without a target INR of 2.5-3.5(AU)

Mortalidad en una cohorte de pacientes de Atención Primaria tratados con anticoagulantes antagonistas de la vitamina K / Mortality in a cohort of primary care patients treated with vitamin K antagonist anticoagulants

Introducción y objetivos: El uso de anticoagulantes para prevenir eventos embólicos en España es muy elevado, tendiendo a un aumento progresivo. Por ello pretendemos analizar la mortalidad de los pacientes tratados con anticoagulantes antagonistas de la vitamina K (AVK) de un área metropolitana de Granada, en 2 años no consecutivos.Pacientes y métodos: Estudio longitudinal, observacional, retrospectivo de 205 pacientes tratados con AVK. Se recogieron datos sociodemográficos, condiciones clínicas previas, patología causante del tratamiento AVK, grado de control y la mortalidad a 2 años del inicio del estudio.ResultadosEdad media, 76±11,8años (57,56% mujeres). La mortalidad a los 2 años fue del 22,4%, con un aumento significativo en función de la edad (p<0,001) y los años de tratamiento (p<0,001). Los pacientes con demencia (p<0,05), con enfermedad renal crónica (p<0,01) o con enfermedad pulmonar obstructiva crónica (p<0,01) presentaron también mayor mortalidad. El análisis multivariante demostró efecto significativo de la enfermedad renal crónica (odds ratio=4,075), la enfermedad pulmonar obstructiva crónica (odds ratio=3,694) y los años de tratamiento (odds ratio=1,236).ConclusionesA los 2 años de seguimiento, fallecieron uno de cada 5 pacientes tratados con AVK y se asociaron independientemente a este aumento la presencia de enfermedad renal crónica, enfermedad pulmonar obstructiva crónica y un mayor tiempo de tratamiento. La mayoría de los pacientes estaban anticoagulados por una fibrilación auricular, tenían una edad avanzada y una alta prevalencia de comorbilidades. (AU)

Introduction and objectives: The use of anticoagulants to prevent embolic events in Spain is very high, tending to a progressive increase. For this reason, we intend to analyse the mortality of patients from a metropolitan area of Granada treated with vitamin K antagonist anticoagulants (VKA), over 2 non-consecutive years.Patients and methods: Longitudinal, observational, retrospective study of 205 patients treated with VKA. Sociodemographic data, previous clinical conditions, pathology causing VKA treatment, degree of control and mortality were collected 2 years after the start of the study.ResultsAverage age, 76±11.8 years (57.56% women). Two-year mortality was 22.4%, with a significant increase depending on age (p<.001) and years of treatment (p<.001). Patients with dementia (p<.05), with chronic kidney disease (p<.01) or with chronic obstructive pulmonary disease (p<.01) also presented higher mortality. Multivariate analysis showed significant effect of chronic kidney disease (odds ratio=4.075), chronic obstructive pulmonary disease (odds ratio=3.694), and years of treatment (odds ratio=1.236).ConclusionsAt 2 years of follow-up, 1 in 5 patients treated with VKA died. The presence of chronic kidney disease, chronic obstructive pulmonary disease and a longer treatment time were independently associated with this increase of mortality. Most of the patients were anticoagulated by atrial fibrillation, they were elderly and had a high prevalence of comorbidities. (AU)

Mortality in a cohort of primary care patients treated with vitamin K antagonist anticoagulants. / Mortalidad en una cohorte de pacientes de Atención Primaria tratados con anticoagulantes antagonistas de la vitamina K.

INTRODUCTION AND OBJECTIVES: The use of anticoagulants to prevent embolic events in Spain is very high, tending to a progressive increase. For this reason, we intend to analyse the mortality of patients from a metropolitan area of Granada treated with vitamin K antagonist anticoagulants (VKA), over 2 non-consecutive years. PATIENTS AND METHODS: Longitudinal, observational, retrospective study of 205 patients treated with VKA. Sociodemographic data, previous clinical conditions, pathology causing VKA treatment, degree of control and mortality were collected 2 years after the start of the study. RESULTS: Average age, 76±11.8 years (57.56% women). Two-year mortality was 22.4%, with a significant increase depending on age (p<.001) and years of treatment (p<.001). Patients with dementia (p<.05), with chronic kidney disease (p<.01) or with chronic obstructive pulmonary disease (p<.01) also presented higher mortality. Multivariate analysis showed significant effect of chronic kidney disease (odds ratio=4.075), chronic obstructive pulmonary disease (odds ratio=3.694), and years of treatment (odds ratio=1.236). CONCLUSIONS: At 2 years of follow-up, 1 in 5 patients treated with VKA died. The presence of chronic kidney disease, chronic obstructive pulmonary disease and a longer treatment time were independently associated with this increase of mortality. Most of the patients were anticoagulated by atrial fibrillation, they were elderly and had a high prevalence of comorbidities.

PCR para COVID-19 positiva, luego negativa y otra vez positiva ¿Reinfección a los 55 días? / PCR for COVID-19 positive, then negative and again positive Reinfection at 55 days?

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¿116? ¿Hasta cuánto hay que bajar el cLDL de la población catalogada como en «bajo riesgo»? / 116? How much should LDL-C be lowered in the «low risk» population?

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Grado de control de la Anticoagulación con Antagonistas de la vitamina K en Atención primaria. Estudio GRANADA / Anticoagulation quality control in Primary Care with vitamin K antagonists

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