Trends in glycemic control, cardiovascular risk factors and chronic complications of type 2 diabetes, 2012-2016, in a healthcare area of Barcelona.

AIMS: This study aimed to analyse the evolution of the metabolic control, cardiovascular risk factors and chronic complications in a Type 2 Diabetes (T2D) population in a healthcare area of Barcelona. METHODS: We carried out a comparative study of T2D patients (20.457) between 2012 and 2016 (data recorded in the "Electronic Clinical-Station in Primary Care") concerning: age, gender, body mass index (BMI), arterial blood pressure (BP), HbA1c, LDL-Cholesterol, smoking, heart failure (HF), micro and macrovascular complications. RESULTS: Average HbA1c was 6.9 % in 2012 and 7 % in 2016 (Non significant differences)(NS). In 2012, 57.9 % of patients presented proper glycaemic control, 42.8 % LDL-Cholesterol < 100 mg/dL and 76.9 % BP < 140/90 while in 2016 it was 61.2 % (NS), 59.2 % (p = 0.001) and 82.9 % (p = 0.016) respectively. No changes were found in BMI or active smoking. Significant increases were found in the prevalence of microvascular complications, HF and peripheral vasculopathy (PV). Patients with vascular diseases (PVD) and adequate metabolic control increased from 57.5 % to 62.7 % (p = 0.006). Albuminuria > 30 mg/g were more frequent among PVD. CONCLUSIONS: Between 2012 and 2016 it was observed that, amongst our study population, glycaemic control was steady and cholesterol and BP levels were improved, while there was a significant increase of diabetic complications, HF and PV.

Respuesta: Utilidad y uso de la ecocardiografía realizada por «no cardiólogos» / Reply: Use and usefulness of echocardiography performed by «non-cardiologists»

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Utilidad diagnóstica de la ecografía de bolsillo practicada por un médico de familia en una población hipertensa / Diagnostic usefulness of pocket echography performed in hypertensive patients by a general practitioner

Fundamento y objetivo: La ecocardiografía convencional es la técnica de elección para el estudio de la afectación cardíaca de la hipertensión arterial, pero su disponibilidad en atención primaria está limitada. El objetivo del estudio ha sido valorar el rendimiento diagnóstico de la ecografía de bolsillo realizada por un médico de familia en la población hipertensa de atención primaria. Pacientes y método: Estudio transversal de 393 pacientes hipertensos de un centro de atención primaria urbano. Un médico de familia adecuadamente formado realizó una exploración con el ecógrafo de bolsillo y valoró de forma semicuantitativa los diferentes hallazgos. Los estudios fueron revalorados de forma ciega por un ecocardiografista experto y analizados de forma cuantitativa mediante un soporte informático. Se valoraron las dimensiones del ventrículo izquierdo, la aurícula izquierda y la aorta ascendente, el grosor del septum interventricular y las lesiones valvulares. Resultados: El estudio duró < 5 min y la calidad fue buena-aceptable en el 98%. La concordancia entre el médico de familia y el experto fue muy buena (kappa ponderado > 0,83) para la hipertrofia ventricular izquierda, la dilatación de la aurícula izquierda, la dilatación de la aorta ascendente, y la esclerosis e insuficiencia aórticas, y buena (kappa ponderado > 0,71) para la calcificación e insuficiencia mitrales. Todas las lesiones significativas fueron diagnosticadas por el médico de familia, excepto 6 (2,6%). Conclusiones: La ecocardiografía de bolsillo realizada en atención primaria por un médico de familia, como extensión de la valoración clínica convencional en una población afectada de hipertensión arterial, permite realizar un diagnóstico precoz de lesiones cardíacas significativas, pudiendo mejorar el tratamiento de estos pacientes (AU)

Background and objective: Conventional echocardiography is the technique of choice for assessing cardiac involvement in arterial hypertension. Nevertheless, its availability in primary care is very limited. This study aimed to define the diagnostic usefulness of pocket echocardiography performed by a general practitioner (GP) in patients with arterial hypertension. Patients and method: Cross-sectional study of a random sample of 393 patients with arterial hypertension. A GP appropriately trained in the technique performed an examination with a pocket echocardiograph and semiquantitatively assessed the different findings. The studies were blindly reassessed by an expert cardiologist and analyzed quantitatively by computer software. Dimensions of the left ventricle, left atrium and ascending aorta were assessed, together with interventricular septum thickness and presence of valve lesions. Results: The study took less than 5 min and the quality was good-acceptable in 98%. Analysis showed very good concordance (weighted kappa > 0,83) in dimensions of the left ventricle, left atrium and ascending aorta, interventricular septum thickness, aortic regurgitation and aortic valve sclerosis, and good concordance (weighted kappa > 0,71) in mitral regurgitation and mitral valve calcification. Only 6 (2.6%) of the significant lesions were diagnosed by the GP. Conclusions: Pocket echocardiography in primary care performed by a GP, as an extension of the clinical assessment of patients with arterial hypertension, provides an early diagnosis of significant cardiac lesions which may improve therapeutic management (AU)

[Diagnostic usefulness of pocket echography performed in hypertensive patients by a general practitioner]. / Utilidad diagnóstica de la ecografía de bolsillo practicada por un médico de familia en una población hipertensa.

BACKGROUND AND OBJECTIVE: Conventional echocardiography is the technique of choice for assessing cardiac involvement in arterial hypertension. Nevertheless, its availability in primary care is very limited. This study aimed to define the diagnostic usefulness of pocket echocardiography performed by a general practitioner (GP) in patients with arterial hypertension. PATIENTS AND METHOD: Cross-sectional study of a random sample of 393 patients with arterial hypertension. A GP appropriately trained in the technique performed an examination with a pocket echocardiograph and semiquantitatively assessed the different findings. The studies were blindly re-assessed by an expert cardiologist and analyzed quantitatively by computer software. Dimensions of the left ventricle, left atrium and ascending aorta were assessed, together with interventricular septum thickness and presence of valve lesions. RESULTS: The study took less than 5min and the quality was good-acceptable in 98%. Analysis showed very good concordance (weighted kappa>0,83) in dimensions of the left ventricle, left atrium and ascending aorta, interventricular septum thickness, aortic regurgitation and aortic valve sclerosis, and good concordance (weighted kappa>0,71) in mitral regurgitation and mitral valve calcification. Only 6 (2.6%) of the significant lesions were diagnosed by the GP. CONCLUSIONS: Pocket echocardiography in primary care performed by a GP, as an extension of the clinical assessment of patients with arterial hypertension, provides an early diagnosis of significant cardiac lesions which may improve therapeutic management.