RESUMO
OBJETIVO: Evaluar el control glucémico de pacientes de edad avanzada, con diabetes mellitus tipo 2 (DM2), en tratamiento con varios antidiabéticos, y analizar el efecto de una intervención. MATERIAL Y MÉTODOS: Estudio descriptivo transversal y observacional de prevalencia que incluyó a pacientes ≥75 años con DM2, en tratamiento con 2 o más hipoglucemiantes. Se analizó la adecuación de los tratamientos siguiendo las recomendaciones actuales para este grupo poblacional, la prevalencia de complicaciones macro y microvasculares, demencia e hipoglucemias, los tratamientos empleados y la adherencia. Se realizó una intervención para optimizar la prescripción. RESULTADOS: Se incluyeron 215 pacientes. El 54,4% fueron mujeres, con edad media de 82,0±4,1 años, el 77,2% tenía complicaciones macro y/o microvasculares y el 7,4% demencia. En el 67,9% se detectó inadecuación por control glucémico demasiado intensivo (55,6% HbA1c<7,5%) o no estar ajustada la posología a su filtrado glomerular (51,0%). El 81,4% estaba en tratamiento con fármacos con riesgo de producir hipoglucemias; el 2,3% tenía algún episodio registrado. La HbA1c media fue mayor en los no adherentes (8,1±1,6% vs. 7,5±1,3%, p < 0,05). Tras la intervención disminuyó la intensidad del tratamiento hipoglucemiante en el 36,2% de los pacientes, y se adecuó la posología en el 23,1% de los fármacos que precisaban ajuste. El porcentaje de sobretratamiento se redujo al 40,0% (p < 0,01). CONCLUSIONES: Más de la mitad de los pacientes mayores, con DM2 e importantes comorbilidades, tenía un control glucémico demasiado estricto. La puesta en marcha de un programa de intervención ha permitido mejorar la seguridad y la adecuación de los tratamientos
OBJECTIVE: To evaluate blood-glucose control in elderly patients with type 2 diabetes mellitus (T2DM), who are receiving various anti-diabetic treatments, and to analyse the effect of an intervention. MATERIAL AND METHODS: Cross-sectional, descriptive, and observational study of prevalence that included patients who were ≥75 years old with T2DM and being treated with two or more antidiabetic drugs. The adequacy of treatments following current recommendations for this population group was analysed, together with the prevalence of macro- and micro-vascular complications, dementia, and hypoglycaemia, the treatments used, and adherence. An intervention was carried out to optimise prescription. RESULTS: A total of 215 patients were included, of which 54.4% were women. The mean age was 82.0±4.1, and 77.2% had micro- and/or macrovascular complications, and 7.4% had dementia. Inadequacy was detected in 67.9% due to an overly intensive blood glucose control (55.6% HbA1c<7.5%), or that the dosage was not adapted to glomerular filtration (51.0%). The large majority (81.4%) were being treated with drugs with a risk of producing hypoglycaemia (2.3% had recorded episodes). The HbA1c mean was higher in non-adherent patients (8.1±1.6% vs 7.5±1.3%, P<.05). After the intervention, the intensity of hypoglycaemic treatment was reduced in 36.2% of patients, and the dosage of drugs that required adjustment was corrected in 23.1%. The percentage of overtreatment decreased to 40.0% (P<.01). CONCLUSIONS: More than half of the elderly patients with T2DM and important comorbidities had an overly strict glycaemic control. The launch of an intervention programme has allowed for an improvement in safety and for the optimisation of treatments
Assuntos
Humanos , Masculino , Feminino , Idoso de 80 Anos ou mais , Diabetes Mellitus Tipo 2/tratamento farmacológico , Diabetes Mellitus Tipo 2/sangue , Glicemia/análise , Glicemia/efeitos dos fármacos , Hipoglicemiantes/administração & dosagem , Cooperação e Adesão ao Tratamento , Estudos Transversais , PrevalênciaRESUMO
OBJECTIVE: To evaluate blood-glucose control in elderly patients with type 2 diabetes mellitus (T2DM), who are receiving various anti-diabetic treatments, and to analyse the effect of an intervention. MATERIAL AND METHODS: Cross-sectional, descriptive, and observational study of prevalence that included patients who were ≥75 years old with T2DM and being treated with two or more antidiabetic drugs. The adequacy of treatments following current recommendations for this population group was analysed, together with the prevalence of macro- and micro-vascular complications, dementia, and hypoglycaemia, the treatments used, and adherence. An intervention was carried out to optimise prescription. RESULTS: A total of 215 patients were included, of which 54.4% were women. The mean age was 82.0±4.1, and 77.2% had micro- and/or macrovascular complications, and 7.4% had dementia. Inadequacy was detected in 67.9% due to an overly intensive blood glucose control (55.6% HbA1c<7.5%), or that the dosage was not adapted to glomerular filtration (51.0%). The large majority (81.4%) were being treated with drugs with a risk of producing hypoglycaemia (2.3% had recorded episodes). The HbA1c mean was higher in non-adherent patients (8.1±1.6% vs 7.5±1.3%, P<.05). After the intervention, the intensity of hypoglycaemic treatment was reduced in 36.2% of patients, and the dosage of drugs that required adjustment was corrected in 23.1%. The percentage of overtreatment decreased to 40.0% (P<.01). CONCLUSIONS: More than half of the elderly patients with T2DM and important comorbidities had an overly strict glycaemic control. The launch of an intervention programme has allowed for an improvement in safety and for the optimisation of treatments.
Assuntos
Diabetes Mellitus Tipo 2 , Idoso , Idoso de 80 Anos ou mais , Glicemia , Estudos Transversais , Feminino , Hemoglobinas Glicadas/análise , Humanos , Hipoglicemiantes , Masculino , Fatores de RiscoRESUMO
BACKGROUND: Today, advances in technology provide the best success rates in the reproductive medicine field. One of the biggest concerns about it, is the high risk of achieving multiple pregnancies, which may carry greater health risks for both; the mother and fetuses. Besides that, multiple pregnancies are considered a complication or an adverse effect of assisted reproduction treatments. OBJECTIVES: To compare the factors associated with multiple pregnancy in patients who underwent complex assisted reproduction techniques. MATERIAL AND METHODS: A retrospective and transversal case control study was rolled to compare the factors associated with multiple pregnancy rates, these results were correlated using a logistic regression model. RESULTS: a total of 1063 cases were reviewed, we obtained a pregnancy rate of 35.9%, and a multiple pregnancy rate of 31.5%. We found positive statistical association between patient age, total number of oocytes obtained, total embryos transferred, total vitrified embryos per cycle, total serum cuantitative B-GCH level, endometrial thickness in milimeters, and the Honest of a multiple pregnancy. In the logistic regression model, we found statistical association between the number of embryos transferred, number of embryos obtained, embryo quality, total vitrified embryos and the risk for multiple pregnancies. CONCLUSIONS: The total number of embryos transferred in a cycle of a complex assisted reproduction, is the most important factor for the onset of multiple pregnancies. The age of patients, the number of oocytes, total number of embryos obtained, the number of embryos transferred, the quality of embryos transferred and the number of frozen embryos per cycle, correlate significantly with more risk for multiple pregnancies.
