Diabetic Patients In Spain Research Articles

Control of Cardiovascular Risk Factors in Revascularized Patients with Diabetes: Algerian experience

Patients with type 2 diabetes and revascularized coronary disease are a group with very high cardiovascular risk that has been rarely studied. This Algerian study analyzes the clinical characteristics and risk factor control of these patients. The analysis selected patients with type 2 diabetes who had participated in an a multicenter, observational study (military hospitals of Algeria) conducted in 978 patients > 18 years of age who had undergone coronary surgery or percutaneous coronary intervention. Demographic and therapeutic variables, as well as clinical and analytical parameters, were collected and comparatively analyzed. The mean age (standard deviation) of the 371 diabetic patients included in the analysis was 67.7 (9.6) years (71.3% men; mean time since revascularization, 3.5 years). Most (57.6%) were receiving treatment with oral hypoglycemics alone, where as 30.4% were receiving insulin alone or in combination. The mean glycohemoglobin figure was 7.3% (in 72%, < 7.5%); 73.9% had been diagnosed with dyslipidemia. Mean low-density lipoprotein cholesterol was 93.5 mg/dL (in 73%, > 70 mg/dL). Among these patients, 93.5% were receiving statins. A total of 76.4% had been diagnosed with hypertension; systolic/diastolic blood pressure was < 130/80 mmHg in 56% and < 140/90 mmHg in 93%. Cardiovascular risk and prevention may be improved in revascularized diabetic patients in Spain through further control of risk factors, particularly dyslipidemia. Patients with glycohemoglobin > 7.5% should be individually assessed in terms of glycemic targets.

Higher Accuracy Of Blood Glucose Monitoring Systems In Type 2 Insulin Treated Diabetic Patients In Spain: Clinical And Economic Impact

Higher Accuracy Of Blood Glucose Monitoring Systems In Type 2 Insulin Treated Diabetic Patients In Spain: Clinical And Economic Impact

Control de factores de riesgo cardiovascular en pacientes diabéticos revascularizados: un subanálisis del estudio ICP-Bypass

Introduction and objectivesPatients with type 2 diabetes and revascularized coronary disease are a group with very high cardiovascular risk that has been rarely studied. This ICP-Bypass substudy analyzes the clinical characteristics and risk factor control of these patients. MethodsThe analysis selected patients with type 2 diabetes who had participated in an earlier multicenter, observational, cross-sectional study (ICP-Bypass) conducted in 2293 patients > 18 years of age who had undergone coronary surgery or percutaneous coronary intervention. Demographic and therapeutic variables, as well as clinical and analytical parameters, were collected and comparatively analyzed. ResultsThe mean age standard deviation of the 771 diabetic patients included in the analysis was 67.7 (9.6) years (71.4% men; mean time since revascularization, 3.5 years). Most (57.8%) were receiving treatment with oral hypoglycemics alone, whereas 30.4% were receiving insulin alone or in combination. The mean glycohemoglobin figure was 7.1% (in 70%,<7.5%); 74.8% had been diagnosed with dyslipidemia. Mean low-density lipoprotein cholesterol was 93.5mg/dL (in 73%, > 70mg/dL). Among these patients, 93.6% were receiving statins and 18.7% a statin combined with ezetimib. A total of 78.1% had been diagnosed with hypertension; systolic/diastolic blood pressure was < 130/80mmHg in 52% and < 140/90mmHg in 93%. ConclusionsCardiovascular risk and prevention may be improved in revascularized diabetic patients in Spain through further control of risk factors, particularly dyslipidemia. Patients with glycohemoglobin > 7.5% should be individually assessed in terms of glycemic targets.Full English text available from: www.revespcardiol.org/en

Control of Cardiovascular Risk Factors in Revascularized Patients With Diabetes: A Subanalysis of the ICP-Bypass Study

Introduction and objectivesPatients with type 2 diabetes and revascularized coronary disease are a group with very high cardiovascular risk that has been rarely studied. This ICP-Bypass substudy analyzes the clinical characteristics and risk factor control of these patients. MethodsThe analysis selected patients with type 2 diabetes who had participated in an earlier multicenter, observational, cross-sectional study (ICP-Bypass) conducted in 2293 patients > 18 years of age who had undergone coronary surgery or percutaneous coronary intervention. Demographic and therapeutic variables, as well as clinical and analytical parameters, were collected and comparatively analyzed. ResultsThe mean age (standard deviation) of the 771 diabetic patients included in the analysis was 67.7 (9.6) years (71.4% men; mean time since revascularization, 3.5 years). Most (57.8%) were receiving treatment with oral hypoglycemics alone, whereas 30.4% were receiving insulin alone or in combination. The mean glycohemoglobin figure was 7.1% (in 70%,<7.5%); 74.8% had been diagnosed with dyslipidemia. Mean low-density lipoprotein cholesterol was 93.5mg/dL (in 73%, > 70mg/dL). Among these patients, 93.6% were receiving statins and 18.7% a statin combined with ezetimib. A total of 78.1% had been diagnosed with hypertension; systolic/diastolic blood pressure was < 130/80mmHg in 52% and < 140/90mmHg in 93%. ConclusionsCardiovascular risk and prevention may be improved in revascularized diabetic patients in Spain through further control of risk factors, particularly dyslipidemia. Patients with glycohemoglobin > 7.5% should be individually assessed in terms of glycemic targets.

PDB85 - Diabetic Patients in Primary Care: Self-Perception and Satisfaction. Comparative Study Spain Versus Europe

EUprimecare is an European Union project aimed at analyzing the costs and quality of the different models of primary care (PC) in Europe. The aim of this study is to analyze the management of diabetic patients in PC services in Spain compared to other European countries, the satisfaction of these patients with PC services and their self-perceived health status. We conducted a population survey by telephone among PC users in each of the consortium countries (Germany, Spain, Estonia, Finland, Hungary, Italy and Lithuania). The questionnaire included information on sociodemographic characteristics, health status, satisfaction, utilization of PC services, and frequency of some interventions carried out by PC professionals. The survey was conducted to 431-432 PC users in each country (Ntotal = 3020). The percentage of diabetic patients in Spain was 6.7% (N = 29), lower than the overall average (9.1%). Eighty three percent of patients living in Spain were diagnosed by their PC physicians compared with 73% of the European average. Eighty six percent of patients in Spain said that they were being treated for diabetes (EU average = 84%) and in 88% of these cases the treatment was prescribed by their PC doctor (EU average = 70%). Only 6.9% of patients said their health was poor or very poor, the lowest proportion of all countries assessed. The overall satisfaction with PC services among diabetic patients was 4.10 points on a scale of 1 to 5. Satisfaction in Spain was below the global average for all the items measured. Diabetic patients in Spain are more frequently controlled by PC professionals than in other European countries. These patients have a better self-perceived health status and the results of this study suggest a lower level of dissatisfaction with the services provided by PC.

Achievement of cardiometabolic goals among diabetic patients in Spain. A nationwide population-based study.

BackgroundNo previous study has reported a comprehensive assessment of the attainment of cardiometabolic goals in the diabetic population of a European country. We examined the achievement of cardiometabolic goals among diabetics in Spain.Methods and FindingsA cross-sectional survey was performed in 2008–2010 among 12,077 individuals representative of the Spanish population aged ≥18 years. Information on cardiometabolic characteristics was collected at the participants’ homes through structured questionnaires, physical examination, and fasting blood samples. Attainment of cardiometabolic goals was evaluated according to the most well-known guidelines. A total of 834 individuals had diabetes (fasting serum glucose ≥126 mg/dl, or glycosylated hemoglobin ≥6.5%,) or were being treated with oral antidiabetic drugs or insulin). Among diabetic patients, 661 (79.2%) were aware of their condition. Among the aware diabetic patients, only 11.4% had neither general (body mass index <25 kg/m2) nor abdominal obesity (waist circumference ≤102 cm in men and ≤88 cm in women), 8.6% consumed <7% of calories daily from saturated fats, and 41.1% achieved the recommendation on weekly physical activity. About 71% had glycosylated hemoglobin <7%, 22% had blood pressure <130/80 mmHg, and 36% reached the LDL-cholesterol goal of <100 mg/dl. Although a large proportion of aware diabetic individuals received lifestyle medical advice, only 38% of overweight individuals and 20% of daily smokers were offered a specific strategy for weight loss or quitting smoking, respectively.ConclusionsIn a European country with universal healthcare coverage, achievement of many cardiometabolic goals, in particular lifestyle, among aware diabetic individuals is poor. This suggests a need for improvement in both clinical guidelines' implementation and patients’ adherence.

The diet of diabetic patients in Spain in 2008-2010: accordance with the main dietary recommendations--a cross-sectional study.

BackgroundNo previous study has assessed the diet of the diabetic patients in the general population of an entire country in Europe. This study evaluates accordance of the diet of diabetic adults in Spain with nutritional recommendations of the European Association for the Study of Diabetes (EASD), American Diabetes Association (ADA), and the Mediterranean diet (MD).Methods and FindingsCross-sectional study conducted in 2008–2010 among 12,948 persons representative of the population aged ≥18 years in Spain. Usual food consumption was assessed with a dietary history. EASD accordance was defined as ≥6 points on a score of 12 nutritional goals, ADA accordance as ≥3 points on a score of 6 goals, and MD accordance as ≥7 points on the Mediterranean Diet Adherence Screener. In the 609 diagnosed diabetic individuals, the diet was rich in saturated fat (11.2% of total energy), but trans fat intake was relatively low (1.1% energy) and monounsaturated fat intake was high (16.1% energy). Carbohydrate intake was relatively low (41.1% energy), but sugar intake was high (16.9% energy). Intake of cholesterol (322 mg/day) and sodium (3.1 g/day) was also high, while fiber intake was insufficient (23.8 g/day). EASD accordance was observed in 48.7% diabetic patients, ADA accordance in 46.3%, and MD accordance in 57.4%. The frequency of EASD, ADA and MD accordance was not statistically different between diagnosed and undiagnosed diabetic individuals.ConclusionsOnly about half of diabetic patients in Spain have a diet that is consistent with the major dietary recommendations. The lack of dietary differences between diagnosed and undiagnosed diabetic individuals reflects deficiencies in diabetes management.

PMD14 Budget Impact analysis of Two Drug-Eluting Stents for Diabetic Patients in Spain

PMD14 Budget Impact analysis of Two Drug-Eluting Stents for Diabetic Patients in Spain

Adding questions about cardiovascular risk factors improve the ability of the ADA questionnaire to identify unknown diabetic patients in Spain

Introduction:Currently, there are not specific questionnaires for Spanish population to identify people at risk of undiagnosed diabetes. When American Diabetes Association (ADA) test is validated in the Spanish population, the sensitivity and specificity values obtained are lower than those found in the USA. Objectives:To develop a screening tool based on the ADA questionnaire, to prospectively identify undiagnosed type 2 diabetes in Spanish ambulatory patients. Methods:Epidemiological, transversal, multicentre study, including 2,662 ambulatory patients of Primary Care centres, mean age (SD) 61.7 (10.2) years (53% women), needing a blood test and attending follow-up protocols for chronic pathologies or periodic screening programs. Classification tree construction was achieved through classical and Artificial Intelligence (AI) methods. The sensitivity, specificity, and the positive and negative predictive values were described and compared with the ADA questionnaire. Results:The final selected classification tree included the following variables: previous impaired fasting glucose or glucose intolerance; recent weight gain; parents, siblings or children with diabetes; smoking habit and pharmacologic treatment for lipid disorders (sensitivity: 80.7%; specificity: 70.9%; positive predictive value: 45.3%; negative predictive value: 92.5%). This tree showed a better Receiver Operating Characteristic curve than that of the ADA test (sensitivity: 84.3%; specificity: 20.9%). Conclusions:The inclusion of questions regarding lipid disorders, smoking habit and weight gain increase the specificity of the ADA test to identify undiagnosed type 2 diabetes in Spanish patients older than 45 years.

Prevalence and incidence of chronic complications and mortality in a cohort of type 2 diabetic patients in Spain

To evaluate the prevalence, incidence of micro- and macrovascular complications, final events, and mortality in type 2 diabetic patients, followed over a period of 10 years in Spain. Prospective, population-based cohort study. 317 type 2 diabetic patients treated at a Primary Care Centre, followed for 10 years. Variables were described by means of ratios, mean values and standard deviation. The chi(2) test was used to compare ratios and the Student's t test to compare mean values. Mean age in women (61%) was 61.2 years; men 66.7 years. With regard to the prevalence of complications, the following was observed: an increase in nephropathy (12%), in retinopathy (6.2%) and in neuropathy (2.1%), a decrease in ischemic cardiomyopathy (-6.2%), an increase in peripheral vascular disease (5.6%). Cerebrovascular event and diabetic foot remaining unchanged. The highest incidence rates (1000 subjects/year) were: nephropathy 43, neuropathy 39 and ischemic cardiomyopathy 32. The prevalence of cardiovascular risk factors increased over the follow-up; being high blood pressure the most noticeable (30%). Overall mortality was 28/1000 subjects/year, being cardiovascular disease the main cause (31.2%). Our study determines the prevalence and incidence of chronic complications and risk factors in Spain.

Incidence of micro and macrovascular complications and mortality in a 10 years cohort of diabetic patients in Spain

Incidence of micro and macrovascular complications and mortality in a 10 years cohort of diabetic patients in Spain

Control of diabetes and cardiovascular risk factors in patients with type 2 diabetes in primary care. The gap between guidelines and reality in Spain

To evaluate the level and factors affecting control of diabetes and cardiovascular risk factors in type 2 diabetes (TYPE 2 DM) patients. Multicentre cross-sectional study: a sample of 430 primary care practices across Spain selected 1907 type 2 diabetic patients. The first five consecutive ambulatory patients with TYPE 2 DM were eligible for the inclusion into the survey. Patients were free of known cardiovascular disease (CVD). Control criteria were defined based on 2002 American Diabetes Association (ADA) clinical practice recommendations. A total of 1907 patients (51% women) aged 63 +/- 9 years. Smoking prevalence was 22.6%, 50.6% had levels of A1c < 7%. Mean blood pressure (BP) was 148 +/- 17/86 +/- 10 mmHg. Only 7.8% have achieved the target of BP < 130/80 mmHg. Among the 1180 patients (65%) treated for hypertension, this target was attained in only 4.4% of patients. A measurement for low-density lipoprotein (LDL) cholesterol was available in 1669 patients (88%). Only 5.9% of patients achieved the target of LDL < 100 mg/dl. Among the 638 patients (41.6%) on drug treatment for dyslipidaemia, this target was attained in only 5.6% of patients. Among type 2 diabetic patients in Spain the prevalence of cardiovascular risk factors is high. Control of glycaemia, smoking, BP and LDL are far from optimal despite the widespread use of guidelines for the management of diabetes and CVD. The application of published recommendations needs to be reinforced.

Prevalencia de la retinopatía diabética en la población de diabéticos diagnosticados en las comarcas de Girona: Estudio de los factores asociados

To determine of the prevalence of diabetic retinopathy in the general diabetic population in the Girona region and epidemiologic study of the related factors. A population-based cross-sectional study of a randomised sample taken of 401 diabetics in the Girona region. Descriptive statistical analysis of the ocular lesions in relation to diabetic retinopathy and analysis of logistic regression in order to determine the related factors. 30.6% (IC 95%: 26.5-35.5) of the sample presented some degree of diabetic retinopathy, 19.4% (IC 95%: 15.4-24.0) at the initial stage, 8.4% (IC 95%: 5.8-1.9) pre-proliferative and 2.6% (IC 95%: 1.3-5.1) at a proliferative stage. Regarding the type of diabetes, 53% of the patients with type 1 diabetes and 34.2% of those with type 2 diabetes had retinopathy. Retinopathy was observed in 15.7% of diabetics with less than 10 years of diabetes evolution, 51.3% in those between 10 and 20 years and 62.8% in those with more than 20 years. The concentration of HbA1C was significantly associated with the degree of retinopathy. Of those patients with retinopathy, 60.3% were insulin-treated, 30.6% with oral hypoglucemiants and 10.3% on diet only. Patients with family antecedents of retinopathy presented a prevalence three times greater than those without. Approximately one in three diabetic patients exhibited some degree of retinopathy in this study dealing with a population-based cohort of diabetic patients in Spain. The prevalence was greater among type I diabetic patients. As expected, years of evolution of the disease, type of treatment and diabetic metabolic control were the most significant factors influencing the presence of retinopathy.

Direct Health Care Costs of Diabetic Patients in Spain

The goal of this study was to estimate the health care resources spent by type 1 and type 2 diabetic patients in Spain during the year 2002. This is a cost-of-illness study focusing on direct health care costs estimated from primary and secondary sources of information. A prevalence of diabetes ranging from 5 to 6% of the adult population was determined. Total cost is composed of six items: insulin and oral hypoglycemic agents, other drugs, disposable and consumable goods (glucose test strips, needles, and syringes), hospitalization, primary care visits, and visits to endocrinologists and dialysis. The estimated direct cost of diabetes in 2002 ranges from 2.4 to 2.67 billion euro. Hospital costs were the most (933 million euro), followed by noninsulin, nonhypoglycemic agent drugs (777-932 million euro). Much lower are the costs of insulin and oral hypoglycemic agents (311 million euro), primary care visits (181-272 million euro), specialized visits (127-145 million euro), and disposable elements (70-81 million euro). Expenditures for all drugs and consumable goods ranged between 1.16 and 1.3 billion euro, representing 48-49% of total cost, which is 15% higher than hospital costs. The direct health care costs of diabetic patients are high (6.3-7.4% of total National Health System expenditure). Their average annual cost is 1,290-1,476 euro. For individuals without diabetes, the average annual cost is 865 euro.

Incidence of diabetic nephropathy in Type 1 diabetic patients in Spain: ‘Estudio Diamante’

Aims: To determine the prevalence and the incidence of diabetic nephropathy in Type 1 diabetes mellitus in Spain and to investigate the risk factors for the development of microalbuminuria. Methods: One thousand five hundred and two patients with Type 1 diabetes mellitus were prospectively followed in 15 hospital diabetes outpatient clinics in Spain. Blood pressure, body weight, HbA 1c, total cholesterol, HDL-cholesterol, triglycerides, plasma creatinine and urinary albumin excretion (UAE) were determined every 3–5 months. Results: A total of 1225 patients (624 males and 601 females), age 30.7±9.3 years with diabetes duration of 14.1±9.1 years completed 4.3 (4.0–5.1) years of follow-up. At baseline 14.2 (95% CI 12.3–16.3)% of patients had microalbuminuria, 5.1 (3.9–6.4)% macroalbuminuria and 3.4 (2.5–4.6)% kidney failure. During follow-up the annual incidence of microalbuminuria was 2.7 (2.2–3.2)%. In a multiple logistic regression analysis the predictors of progression to microalbuminuria were initial UAE, HbA 1c, diabetes duration, smoking, and HDL-cholesterol <0.9 mmol/l. Conclusions: The prevalence and incidence of diabetic nephropathy in Spain are comparable to data obtained in similar studies carried out in other countries. The development of microalbuminuria is associated not only with glycaemic control and hypertension, but also to the control of other risk factors such as dyslipaemia and smoking.

Diabetes Nutrition and Complications Trial (DNCT): Food Intake and Targets of Diabetes Treatment in a Sample of Spanish People With Diabetes

To know the nutritional pattern of people with diabetes in Spain and that pattern's relationship with targets of metabolic control. The Diabetes Nutrition and Complications Trial (DNCT) is a prospective multicenter study designed to determine the nutritional behavior of diabetic patients in Spain using 7-day food diaries. A total of 337 diabetic patients, 144 (70 men and 74 women) with type I and 193 (81 men and 112 women) with type II diabetes, satisfactorily completed the 7-day food diaries from May 1993 to December 1994. The median energy intake of the Spanish diabetic subjects was between 1,453 and 2,217 kcal/day (6.1-9.3 MJ/day), distributed as follows: 38-40% from carbohydrate, 19-23% from protein, and 36-41.5% from fat (11.1-13.9% saturated fatty acids, 4.6-5.8% polyunsaturated fatty acids, and 19.7-21.9% monounsaturated fatty acids). Of the subjects, 69% had a cholesterol level <5.6 mmol, 97% had an HDL cholesterol level >0.9 mmol, and 85% had a triglyceride level <1.7 mmol, while <36% had an HbA(1c) value >8%. People with diabetes in Spain have near-optimal serum lipid levels and maintain reasonably good blood glucose control and BMI, suggesting that diabetes management that includes the usual Spanish diet, which is low in carbohydrates and high in fat, especially monounsaturated fat, might be adequate.