[The impact of obesity in the management and evolution of diabetes mellitus]. / El impacto de la obesidad en el manejo y evolución de la diabetes mellitus.

OBJECTIVES: To assess both management and evolution of diabetes mellitus type 2 (DM2) in Primary Care centers in Spain and the related factors, especially obesity. METHODOLOGY: Epidemiological, cross-sectional, multicenter, retrospective study. PATIENTS: Patients suffering from DM2, over 20 years of age, were consecutively enrolled from 30 Primary Care centers in 16 autonomous communities. Métodos. Data was collected on age, gender, educational level, DM2 duration, HbA1c, treatment and body measurement index (BMI). RESULTS: A total of 294 patients, 50% male, with a mean age (SD) of 67.5 years (10.2) and BMI 28.9 (4.5) kg/m(2) were included. Of them, 58.16% had HbA1c levels >6.5%, 38% being obese or severely obese. A total of 93.9% were under drug treatment for DM2. Significant differences in the mean value of HbA1c were shown between the over-weight and severely obese groups (Tukey-Kramer test). Differences were observed in the presence of macrovascular complications between patients with normal weight and patients with obesity (p=0.006). Patients with low educational level had 3.39 more probability of being obese or severely obese than patients with secondary school or university studies (p=0.0041; 95% CI 1.47-7.80), and patients with primary school 2.22 more probability (p= 0.038; 95% CI 1.04-4.73). A total of 47.8% reported high compliance. Obese and severely obese patients showed 2.2 more probability of having low or mild compliance than non-obese patients (p=0.002; 95% CI 1.31-3.74). CONCLUSIONS: Results obtained in this population suggest that obesity is related with more macro-vascular complications, worst metabolic control and worst compliance.

El impacto de la obesidad en el manejo y evolución de la diabetes mellitus / The impact of obesity in the management and evolution of diabetes mellitus

Objetivo. Estudiar el manejo y evolución de ladiabetes mellitus tipo 2 (DM2) en Atención Primaria(AP) en España y los factores implicados,especialmente la obesidad.Diseño. Estudio epidemiológico, transversal,multicéntrico, retrospectivo.Participantes. Se incluyeron pacientes con DM2mayores de 20 años seleccionadosconsecutivamente en 30 centros de AP, en16 comunidades autónomas (CCAA).Métodos. Se recogió información sobre edad, sexo,nivel educativo, duración de DM2, HbA1c,tratamiento e índice de masa corporal (IMC).Resultados. De un total de 294 pacientes, 50%hombres, con edad media (DE) 67,5 años (10,2) eIMC 28,9 (4,5) kg/m2, el 58,16% presentabanniveles de HbA1c >6,5%, el 38% era obeso oseveramente obeso. El 93,9% seguía tratamientofarmacológico para su diabetes. Se mostrarondiferencias significativas en el valor medio deHbA1c entre el grupo con sobrepeso y el grupocon obesidad severa (test de Tukey-Kramer).Se observaron diferencias en la presencia decomplicaciones macrovasculares entrepacientes con peso normal y pacientes obesos(p=0,006). Pacientes con menor grado dealfabetización mostraron 3,39 más probabilidad deser obesos o severamente obesos que pacientescon estudios secundarios o universitarios(p=0,0041; 95% intervalo de confianza [IC] 1,47-7,80), y los pacientes con estudios primarios 2,22veces más (p=0,038; 95% IC 1,04-4,73). Un47,8% refirieron un cumplimiento elevado. Losobesos y severamente obesos presentaron 2,2veces más probabilidad de presentar cumplimientobajo o moderado que los no obesos (p=0,002;95% IC 1,31-3,74 ).Conclusiones. Los resultados obtenidos en estapoblación sugieren que la variable obesidad serelaciona con más complicaciones macrovasculares,peor control metabólico y peor cumplimiento

Objectives. To assess both management andevolution of diabetes mellitus type 2 (DM2) inPrimary Care centers in Spain and the relatedfactors, especially obesity.Methodology. Epidemiological, cross-sectional,multicenter, retrospective study.Patients. Patients suffering from DM2, over 20years of age, were consecutively enrolled from 30Primary Care centers in 16 autonomouscommunities.Métodos. Data was collected on age, gender,educational level, DM2 duration, HbA1c, treatmentand body measurement index (BMI).Results. A total of 294 patients, 50% male, with amean age (SD) of 67.5 years (10.2) and BMI 28.9(4.5) kg/m2 were included. Of them, 58.16% hadHbA1c levels >6.5%, 38% being obese or severelyobese. A total of 93.9% were under drug treatmentfor DM2. Significant differences in the mean valueof HbA1c were shown between the over-weight andseverely obese groups (Tukey-Kramer test).Differences were observed in the presence ofmacrovascular complications between patients withnormal weight and patients with obesity (p=0.006).Patients with low educational level had 3.39 moreprobability of being obese or severely obese thanpatients with secondary school or university studies(p=0.0041; 95% CI 1.47-7.80), and patients withprimary school 2.22 more probability (p= 0.038;95% CI 1.04-4.73). A total of 47.8% reported highcompliance. Obese and severely obese patientsshowed 2.2 more probability of having low or mildcompliance than non-obese patients (p=0.002; 95%CI 1.31-3.74).Conclusions. Results obtained in this populationsuggest that obesity is related with more macrovascularcomplications, worst metabolic control andworst compliance

Estudio para el establecimiento de un sistema de priorización de pacientes en lista de espera para cirugía de varices / Study to establish a system for arranging patients in order of priority on a waiting list for varicose vein surgery

Introducción y objetivos. Las listas de espera gestionadas mediante el criterio first in-first served puede generarinequidades clínicas, sociales o éticas. Pretendemos establecer un sistema objetivo y equitativo de priorización de cirugíade varices. Sujetos y métodos. Basándonos en la metodología del ‘análisis de conjuntos’, se organizó un grupo focalcon pacientes estratificados por edad y afectación clínica, y otro con especialistas en Angiología y Cirugía Vasculary gestores del hospital promotor. Se determinaron las opiniones de cada colectivo y se elaboró un sistema preliminar conlos criterios seleccionados. Se ponderaron las categorías mediante entrevistas personales a 104 sujetos de la poblacióngeneral, seleccionados al azar. Las preferencias se estimaron mediante la técnica paramétrica de regresión multivariantedel logit ordenado. Se normalizaron los valores de los parámetros en una escala del 0 al 100. Resultados. El sistemade priorización final fue: gravedad de la patología (según la escala CEAP) leve (C2) 0 puntos, moderada (C3-C4) 18puntos, severa (C5-C6) 42 puntos; afectación de la calidad de vida (cuestionario CIVIQ-2) leve (CIVIQ-2 > 65) 0 puntos,moderada (CIVIQ-2 ≥ 30 y ≤ 65) 9 puntos, severa (CIVIQ-2 < 30) 19 puntos; sin circunstancias laborales agravantes0 puntos y con 17 puntos; tamaño de las varices pequeño (< 10 mm) 0 puntos y grande (≥ 10 mm) 9 puntos. Conclusión.El sistema de priorización de la lista de espera resultante contempla una visión integral de especialistas, gestores,pacientes y población general, e incluye criterios de gravedad de la patología, calidad de vida, presencia de complicaciones,circunstancias laborales agravantes y tamaño de las varices

Introduction and aims. Waiting lists that are managed by the ‘first in-first served’ criterion may give rise toclinical, social or ethical inequalities. Our aim is to establish an objective, fair system of prioritising varicose veinsurgery. Subjects and methods. Based on the 'conjoint analysis’methodology, one focus group patients were arranged instrata according to age and clinical disorder, and another was organised with specialists in Angiology and VascularSurgery and managers from the sponsoring hospital. The opinions of each collective were determined and a preliminarysystem was set up with the selected criteria. The categories were weighted with personal interviews held with 104randomly-chosen subjects from the general population. The preferences were estimated by means of the ordered logitmultivariate parametric regression technique. The values of the parameters were normalised on a scale from 0 to 100.Results. The final prioritisation system was: severity of the pathology (according to the CEAP scale): mild (C2) 0 points,moderate (C3-C4) 18 points, severe (C5-C6) 42 points; compromise of quality of life (CIVIQ-2 survey): mild (CIVIQ-2> 65) 0 points, moderate (CIVIQ-2 ≥ 30 and ≤ 65) 9 points, severe (CIVIQ-2 < 30) 19 points; with no aggravatingoccupational circumstances 0 points and 17 points with such circumstances; size of the varicose veins: small (< 10 mm)0 points and large (≥ 10 mm) 9 points. Conclusions. The resulting system for arranging a waiting list in order of prioritytakes into account an integrated vision by specialists, managers, patients and the general population, and includescriteria such as the severity of the pathology, quality of life, the presence of complications, aggravating occupationalcircumstances and the size of the varicose veins

[Quality of life, time commitment and burden perceived by the principal informal caregiver of Alzheimer's patients]. / Calidad de vida, tiempo de dedicación y carga percibida por el cuidador principal informal del enfermo de Alzheimer.

OBJECTIVE: To evaluate the impact in Health Related Quality of Life (HRQoL), the time commitment and the burden perceived by the principal informal caregiver (PIC) of Alzheimer's patients (AP) in Spain, as well as the type and amount of external help received. DESIGN: Multicentric descriptive cross-sectional study. PATIENTS: A randomised sample of 268 PIC were included from 19 Alzheimer's Patient Family Associations (APFA) randomly selected from all Spanish regions. MEASURES: Data were collected using a structured telephone interview with the CATI system. HRQoL was measured using the questionnaire EuroQoL-5D. Information was also collected on the health problems of the PIC, the burden perceived (using the specific Zarit scale), the time commitment of PICs (hours per day), type of activity, as well as the amount and type of external help received. RESULTS: The HRQoL of the PIC showed to be worse than the general population in the EQ-5D, except in the self-care dimension. A total of 84% of PIC had physical problems related to the care given to the AP and 94.4% had psychological problems. The Zarit scale showed that 46.5% of caregivers had a level of burden between severe and moderated, while in 34.7% was severe. Time commitment was more than 8 hours per day in 72.1% of them and more than 20 hours per day in 39.6%. Only 26.9% of the PIC received some sort of socio-sanitary help and 76.5% received help from the APFA. CONCLUSIONS: Caregivers of AP suffer a negative impact on their health state and HRQoL; the time they dedicate to the patient is very high.

[Dyslipemia in type-2 diabetes. A risk factor for macroangiopathy?]. / La dislipemia en la diabetes tipo II. Un factor de riesgo para la macroangiopatía?

OBJECTIVE: To study the association of dyslipemia with macroangiopathy in patients with type II diabetes mellitus. DESIGN: Descriptive crossover study. SETTING: An urban health district with a socially and economically depressed elderly population. PATIENTS: A randomised sample among the diabetics registered in the health district (n = 449). MEASUREMENTS AND MAIN RESULTS: Different factors in the lipidic profile were studied, as was the presence of diabetic macroangiopathy and some of the associated risk factors. The following were considered cut-off figures with a predictive value of cardiovascular risk: overall cholesterol >or= 240 mg/dl (40% of the sample), HDL < 35 mg/dl (27%), LDL >or= 160 mg/dl (43%), triglycerides >or= 200 mg/dl (25%), atherogenic index >or= 4.5 (73%) and HDL/LDL balance >or= 0.2 (83%). 85.5% of the diabetics in the sample presented one of the lipidic disorders mentioned above. In the multivariant analysis only hypertriglyceridaemia was associated with a higher prevalence of peripheral vasculopathy. CONCLUSIONS: A high percentage of patients with type II DM presented disorders in their lipidic profile. But, unlike the norm in the general population, only hypertriglyceridaemia displayed a statistically significant association with diabetic macroangiopathy. The role of the other dyslipemic factors was limited.