Glycemic control and use of A1c in primary care patients with type 2 diabetes mellitus.

AIMS: To evaluate the degree of glycemic control and its relationship with disease characteristics and antidiabetic treatment in patients with type 2 diabetes mellitus (DM), as well as the frequency of A1c use. METHODS: For this purpose, an observational, cross-sectorial, and multicenter study was performed. A total of 443 patients were monitored in 17 Spanish primary healthcare centers. Demographic and clinical variables were recorded from the clinical history of patients. RESULTS: Mean age was 68.9±12.0 years. Time of evolution of DM was 9.2±6.4 years. Mean A1c was 7.38±1.34% and 45% of patients achieved A1c <7%. There was a no significant relationship between the degree of control and time of evolution of DM. In 16% of patients no A1c determination was performed in the previous twelve months. In those patients in whom A1c was determined, 95% received pharmacologic treatment, and 31% insulin therapy. 66% of patients on monotherapy attained A1C <7%, compared with 39% and 23% of those receiving double- and triple-oral therapy, respectively (p<0.001). Only 21% of patients on insulin therapy achieved A1c <7%. The worst-controlled patients were those receiving oral antidiabetic agents and insulin (24% had A1c levels ≥9%). CONCLUSIONS: A large proportion of patients are poorly controlled. Poor control increases according to complexity of treatment. A1c is underdetermined in many patients, likely related to clinical inertia.

Evaluación de la realización del cribado del pie diabético en Atención Primaria / Evaluation of diabetic foot screening in Primary Care

OBJETIVO: Conocer si se realiza el cribado del pie diabético en pacientes con diabetes tipo 2 atendidos en Atención Primaria y analizar qué factores relacionados con el paciente y el centro de salud se asocian a la cumplimentación de dicho cribado. MATERIAL Y MÉTODO: Estudio epidemiológico, transversal y multicéntrico. Se revisaron las historias clínicas de una muestra representativa (n = 443) de pacientes con diabetes tipo 2 que habían sido seguidos en Atención Primaria como mínimo en los 12 meses previos. Se registraron variables demográficas, de proceso asistencial y características del centro. RESULTADOS: El 51,2% de los pacientes recibieron educación sanitaria sobre el autocuidado del pie, al 56,4% se le realizó inspección de los pies, el 39,5% fueron explorados con monofilamento, y en el 45,8 y 10,1% se realizó palpación de pulsos periféricos e índice tobillo-brazo, respectivamente. El cribado del pie diabético (inspección, exploración de sensibilidad con monofilamento y palpación de pulsos periféricos) fue efectuado al 37% de los pacientes estudiados, y la estratificación del riesgo de úlceras se determinó en el 12,4% de los casos. Existe asociación entre realización del cribado y presencia de deformidades en el pie (p < 0,001), antecedentes de neuropatía (p = 0,005) y arteriopatía periférica (p < 0,05). También se asocia a algunas características del centro: recibir información sobre consecución de objetivos (p < 0,001), y percepción de incentivos económicos por cumplimiento de los mismos (p < 0,001). CONCLUSIONES: Se constata una deficiente atención a las personas con diabetes tipo 2 respecto a la prevención del pie diabético, pues no se realiza de forma rutinaria cribado y estratificación de riesgo

AIM: To ascertain whether patients with type 2 diabetes are screened for diabetic foot, and to analyze the factors related to patients and centers associated to performance of such screening. MATERIAL AND METHODS: A multicenter, epidemiological, cross-sectional study was conducted. The clinical records of 443 patients with type 2 diabetes monitored at Primary Care for at least 12 months were reviewed. Demographic and healthcare variables and characteristics of the primary care center were recorded. RESULTS: In the previous year, 51.2% of patients had been trained on foot self-care, 56.4% had undergone foot inspection, 39.5% had been examined with a monofilament, and palpation of peripheral pulses and measurement of the ankle-brachial index were performed in 45.8 and 10.1% of patients, respectively. Diabetic foot screening (inspection, monofilament testing, and palpation of peripheral pulses) was performed in 37% of study patients. Ulcer risk stratification was done in 12.4% of patients. A significant association was found between diabetic foot screening and presence of foot deformities (P < .001), history of neuropathy (P = .005), and history of peripheral artery disease (P < .05). Screening was also associated to some characteristics of the center, such as reception of information about goal achievement (P < .001) and economic incentives for goal attainment (P < .001). CONCLUSIONS: Compliance with diabetic foot screening and ulcer risk stratification in patients with type 2 diabetes in Primary Care was poor

Evaluation of diabetic foot screening in Primary Care.

AIM: To ascertain whether patients with type 2 diabetes are screened for diabetic foot, and to analyze the factors related to patients and centers associated to performance of such screening. MATERIAL AND METHODS: A multicenter, epidemiological, cross-sectional study was conducted. The clinical records of 443 patients with type 2 diabetes monitored at Primary Care for at least 12 months were reviewed. Demographic and healthcare variables and characteristics of the primary care center were recorded. RESULTS: In the previous year, 51.2% of patients had been trained on foot self-care, 56.4% had undergone foot inspection, 39.5% had been examined with a monofilament, and palpation of peripheral pulses and measurement of the ankle-brachial index were performed in 45.8 and 10.1% of patients, respectively. Diabetic foot screening (inspection, monofilament testing, and palpation of peripheral pulses) was performed in 37% of study patients. Ulcer risk stratification was done in 12.4% of patients. A significant association was found between diabetic foot screening and presence of foot deformities (P<.001), history of neuropathy (P=.005), and history of peripheral artery disease (P<.05). Screening was also associated to some characteristics of the center, such as reception of information about goal achievement (P<.001) and economic incentives for goal attainment (P<.001). CONCLUSIONS: Compliance with diabetic foot screening and ulcer risk stratification in patients with type 2 diabetes in Primary Care was poor.

Cumplimiento terapéutico y calidad de vida en pacientes crónicos / Therapeutic compliance and quality of life in chronic patients

Objetivo. Conocer el cumplimiento terapéutico y percepción de salud en dos Centros de Salud, en los que se utilizó un documento normalizado de tratamiento. Diseño. Ensayo clínico. Emplazamiento. Zonas de Salud de Sillería y Ocaña (Toledo). Participantes. Pacientes, de edad ≥ 18 años, en cartera de servicios que siguen tratamiento para la hipertensión, dislipemia y Diabetes Mellitus. Se realizó un muestreo aleatorio simple de los listados de estos pacientes. Mediciones principales. En los dos grupos se entregó un documento sobre medidas higiénico-dietéticas y consejos de cumplimentación farmacológica. En el grupo de intervención además del documento anterior se entregó una hoja de tratamientos crónicos. Se realizaron cuatro visitas bimensuales en un periodo de seguimiento de ocho meses. Para el estudio del cumplimento terapéutico se utilizó el recuento de comprimidos. En la primera y última visita se pasó la versión española del EuroQol-5D. Resultados. Se incluyeron en el estudio 309 pacientes con una edad media de 69,2 ± 10,7 años (55,3% eran mujeres). Un total de 156 pacientes fueron aleatorizados al grupo de intervención y 153 al grupo control. En la última visita 173 pacientes cumplieron adecuadamente el tratamiento (63,1%; IC 95%: 57,4 - 68,8), frente a 152 en la visita basal del estudio (55,5%; IC 95%: 49,6 - 61,4), Chi-cuadrado = 96,7 y p < 0,0001. Al analizar el número de pacientes cumplidores por grupo de estudio, en la visita fi nal, no se encontraron diferencias signifi cativas entre ambos grupos. Los grupos del estudio no mostraron diferencias en la percepción de su propia salud. Conclusiones. El documento normalizado de tratamiento no aportó una mejora en el cumplimiento terapéutico del grupo de intervención. La intervención realizada en ambos grupos y el seguimiento mejoró el cumplimiento terapéutico en ambos grupos (AU)

Objective. To determine treatment compliance and health perception at two Primary Health Centres, in which a standardized treatment protocol was used. Design. Clinical trial. Setting. Primary Health Centres at Sillería and Ocaña (Toledo). Subjects. Patients aged ≥ 18 years, in the portfolio services being treated for hypertension, dyslipidaemia and diabetes. A simple random sampling from the lists of these patients was made. Main measurement. Patients in both groups were given a sheet setting out health-dietary measures and advice on treatment compliance. The intervention group were also given a sheet of chronic treatments.. There were four two-monthly visits over a follow-up period of eight months. Pill count was used to determine treatment compliance. At the fi rst and last visit the Spanish version of the EuroQol- 5D was performed. Results. A total of 309 patients with an average age of 69.2 ± 10.7 years were included in the study (55.3% were women). Of these patients, 156 patients were randomised to the intervention group and 153 to the control group. At the final visit, 173 patients had good treatment compliance (63.1%; CI 95%, 57.4 - 68.8), as opposed to 152 at the baseline visit (55.5%; CI 95%, 49.6 - 61.4), Chi-square = 96.7 and p < 0,0001. At the final visit, no significant differences were found between the two groups as regards treatment compliance. There were no differences in health perception between the two study groups. Conclusions. The standardized treatment document did not contribute to an improvement in treatment compliance in the intervention group. Interventionand follow-up improved treatment compliance in both groups (AU)

[Prevalence of tuberculosis infection among immigrants in the Toledo Health District, Spain]. / Prevalencia de infección tuberculosa en las personas inmigrantes del Area de Salud de Toledo.

BACKGROUND: The rise in the frequency of tuberculosis is due to several factors: resistance to treatment, human immunodeficiency virus infection, unemployment, poverty and migratory movements. This study is aimed at ascertaining the prevalence of tuberculosis infection among the immigrant population in the Toledo Health District. METHODS: Descriptive, cross-sectional, multi-center study conducted at the Primary Care level. The immigrants were attracted and recruited on the based of their health cards within the December 2002-September 2003 period. Mantoux intradermal reaction test was performed with 0.1 ml (2UT) of PPD RT-23, following informed consent. Other variables were collected: age, sex, weight, country of origin, work situation, BCG vaccination, number of individuals living with them, length of time residing in Europe. RESULTS: A total of 344 immigrants were included in the study, averaging 28.8 +/- 12.7 years of age. Fifty percent were females (172). They had been living in Europe for an average of 3.4 +/- 3.7 years. A total 78.8% (271) of the immigrants completed the study. The intradermal reaction was positive in 75 of them [27.7% (CI 95%: 23-32.5)]. Those immigrants showing a positive Mantoux were older (age 32.5 +/- 8.5 years) than those showing a negative result (age 27.7 +/- 13.8 years), p=0.006. Originally being from the sub-Saharan area increased the probability of showing a positive intradermal reaction. CONCLUSIONS: The immigrant population of the Toledo Health District shows a high prevalence of tuberculosis infection, which is higher than the general Spanish population. Differences exist depending upon the country of origin. These results indicate the importance of considering the Mantoux test among the preventive activities addressed toward this immigrant population.

Prevalencia de infección tuberculosa en las personas inmigrantes del área de salud de Toledo / Prevalence of tuberculosis infection among immigrants in the Toledo Health District, Spain

Fundamento: El aumento en la frecuencia de tuberculosis (TB) se produce por varios factores: resistencias al tratamiento, la infección por el virus de la inmunodeficiencia humana, el paro, la pobreza y los movimientos migratorios. El objetivo del estudio fue conocer la prevalencia de infección tuberculosa en población inmigrante del Área de Salud de Toledo. Métodos: Estudio descriptivo, transversal y multicéntrico con emplazamiento en Atención Primaria. La captación y reclutamiento de las personas inmigrantes se realizó sobre base de tarjeta sanitaria, entre diciembre de 2002 y septiembre de 2003. Se realizó intradermorreacción de Mantoux (IDRM), con 0,1 ml (2UT) de PPD RT-23, previa firma del consentimiento informado. Otras variables recogidas fueron: edad, sexo, peso, país de origen, situación laboral, vacunación BCG, número de convivientes, tiempo de residencia en Europa. Resultados: Fueron incluidos 344 inmigrantes, con una edad media de 28,8±12,7 años. El 50% (172) eran mujeres. Llevaban un promedio de 3,4±3,7 años de residencia en Europa. El 78,8% (271) de las personas inmigrantes completaron el estudio. La IDRM fue positiva en 75 de ellos [27,7% (IC 95%: 23,1-32,5)]. Los inmigrantes con Mantoux positivo tenían más edad (32,5± 8,5 años) frente a (27,7 ± 13,8 años) en los que el resultado fue negativo, p=0,006. El origen subsahariano aumentaba la probabilidad de presentar IDRM positiva. Conclusiones: La población inmigrante del Área de Salud de Toledo presenta una prevalencia alta de infección tuberculosa, superior a la población general española. Existen diferencias según el país de origen. Estos resultados indican la importancia de considerar la prueba de Mantoux (AU)

Background: The rise in the frequency of tuberculosis is due to several factors: resistance to treatment, human immunodeficiency virus infection, unemployment, poverty and migratory movements. This study is aimed at ascertaining the prevalence of tuberculosis infection among the immigrant population in the Toledo Health District. Methods: Descriptive, cross-sectional, multicenter study conducted at the Primary Care level. The immigrants were attracted and recruited on the based of their health cards within the December 2002-September 2003 period. Mantoux intradermal reaction test was performed with 0.1 ml (2UT) of PPD RT-23, following informed consent. Other variables were collected: age, sex, weight, country of origin, work situation, BCG vaccination, number of individuals living with them, length of time residing in Europe. Results: A total of 344 immigrants were included in the study, averaging 28.8 ± 12.7 years of age. Fifty percent were females (172). They had been living in Europe for an average of 3.4±3.7 years. A total 78.8% (271) of the immigrants completed the study. The intradermal reaction was positive in 75 of them [27.7% (CI 95%: 23.- 32.5)]. Those immigrants showing a positive Mantoux were older (age 32.5 ± 8.5 years) than those showing a negative result (age 27.7 ± 13.8 years), p=0.006. Originally being from the sub-Saharan area increased the probability of showing a positive intradermal reaction. Conclusions: The immigrant population of the Toledo Health District shows a high prevalence of tuberculosis infection, which is higher than the general Spanish population. Differences exist depending upon the country of origin. These results indicate the importance of considering the Mantoux test among the preventive activities addressed toward this immigrant population (AU)