Control glucémico en pacientes con diabetes mellitus tipo 2 en España

doi:10.1016/j.rce.2014.05.028

Revista Clínica Española

Volume 214, Issue 8, November 2014, Pages 429-436

https://doi.org/10.1016/j.rce.2014.05.028 Get rights and content

Resumen

Objetivo

Evaluar el grado de control glucémico en los pacientes con diabetes tipo 2 (DM2) en España, e identificar los factores asociados con el nivel de control glucémico.

Pacientes y métodos

Estudio epidemiológico transversal, multicéntrico realizado en consultas de atención primaria en España. Se incluyeron 5.591 pacientes con DM2 (> 1 año evolución) y con tratamiento farmacológico (> 3 meses). En una única visita, se determinó la HbA1c (sistema A1cNow + ) y se registraron las variables relacionadas con la diabetes y su tratamiento, los factores de riesgo cardiovascular (FRCV), la presencia de lesiones de órgano diana (LOD), y la presencia de hipoglucemia y modificación del peso en el año previo.

Resultados

Se analizaron los datos de 5.382 pacientes (edad media 66,7 años; 8,8 años de evolución); el 43,6% presentaban alguna LOD y el 59,1% recibían ≥ 2 fármacos. La HbA1c media fue de 7,1 (1,1)% y el 48,6% tenían HbA1c < 7,0%. Los pacientes con HbA1c ≥ 7,0% presentaban mayor duración de la diabetes, mayor prevalencia de LOD y FRCV, usaban terapias más complejas y en el año previo presentaron más hipoglucemias y mayor aumento de peso. En el análisis multivariante, la ausencia de tratamiento con insulina, la ausencia de obesidad abdominal y dislipemia aterogénica, el tiempo de evolución de DM2 < 10 años y la edad > 70 años se asociaron con mejor control glucémico.

Conclusiones

la proporción de DM2 con deficiente control en España es elevada. Los factores que reflejan la complejidad de la enfermedad y del tratamiento hipoglucemiante, así como el antecedente de hipoglucemia y aumento de peso, se asocian con peor control glucémico.

Abstract

Objective

To evaluate the degree of glycemic control in patients with type 2 diabetes in Spain and identify factors associated with glycemic control.

Patients and methods

This was a cross-sectional, multicenter, epidemiological study that used consecutive sampling and was conducted in primary care practices in Spain. A total of 5591 patients with type 2 diabetes mellitus lasting more than 1 year and who were treated with hypoglycemic agents for more than 3 months were included in the study. At a single visit, HbA1c levels were measured (A1cNow+ system) and demographic and clinical variables related to diabetes and its treatment were recorded. During the visit, CV risk factors (CVRF), the presence of target-organ damage (TOD), the presence of hypoglycemia and body weight changes within the previous year were recorded.

Results

We analyzed data from 5382 patients (mean age 66.7 [10.8] years, mean duration of the diabetes 8.8 [6.3] years). TOD was present in 43.6% of the patients and 59.1% were taking 2 or more drugs. The patients’ mean HbA1c was 7.1 (1.1)%, and 48.6% had HbA1c levels <7.0%. The patients with HbA1c levels ≥ 7.0% had longer-standing diabetes, a higher prevalence of TOD and CVRF, used more complex therapies, experienced more hypoglycemic episodes in the previous year and had more weight gain. In the multivariate analysis, the absence of insulin treatment, the absence of abdominal obesity and atherogenic dyslipidemia, a duration of the diabetes <10 years and an age >70 years were associated with improved glycemic control.

Conclusions

Patients with poorly controlled type 2 diabetes mellitus are highly prevalent in Spain. Factors associated with poorer glycemic control include the complexity of both the disease and the hypoglycemic therapy, a history of hypoglycemia and weight gain.

Section snippets

Introducción

La diabetes mellitus es una enfermedad crónica con una prevalencia del 13,8% en nuestro medio¹. Las complicaciones micro y macrovasculares de la diabetes, así como la elevada mortalidad cardiovascular, hacen de la diabetes una enfermedad con gran repercusión sanitaria y social, que precisa de unos cuidados continuos y supone un importante consumo de recursos sanitarios². El tratamiento de acuerdo con las guías de práctica clínica ha demostrado una disminución en la morbimortalidad y mejoras en

Diseño del estudio

Se trata de un estudio epidemiológico, transversal y multicéntrico, con muestreo secuencial realizado en consultas de atención primaria de todo el territorio nacional en condiciones de práctica clínica habitual entre el año 2011 y 2012. Participaron un total de 1.797 investigadores, distribuidos de forma no aleatorizada en 13 Comunidades Autónomas del territorio español, que reclutaron los 3 primeros pacientes con diabetes mellitus 2 (DM2) que acudieron a la consulta y cumplían los criterios de

Resultados

Se reclutaron un total de 5.591 pacientes, de los que se excluyeron 209 pacientes (3,7%) al presentar alguno de los criterios de exclusión, por lo que se analizaron un total de 5.382 pacientes, que permitió una precisión del 1,35%. La HbA1c media determinada por el sistema A1cNow+ fue del 7,1(1,1)% y el 48,6% (IC 95% 47,3-50) tenían una HbA1c < 7,0%. Las principales características clínicas de la población estudiada y las diferencias entre los pacientes con HbA1c < 7,0% y HbA1c≥7,0% se resumen en

Discusión

Este estudio realizado en condiciones de práctica clínica habitual en la atención primaria en España, confirma la dificultad para conseguir el objetivo de HbA1c < 7%10, 11, 12, 13 en muchos pacientes con DM2 tratados con fármacos hipoglucemiantes y el deterioro del control a medida que aumenta la complejidad de la diabetes6, 7, 8, 14, 15, 16, 17, 18, 19, 20. Las causas son múltiples e incluyen, tal como se demuestra en este estudio, factores relacionados con la fisiopatología de la enfermedad, la

Financiación

Este trabajo ha sido realizado con financiación de Laboratorios Almirall S.A. (Barcelona, España).

Conflicto de intereses

Los Dres. A. Pérez y J.J. Mediavilla recibieron honorarios de Almirall S.A. por la coordinación del estudio. D. González-Segura es empleado de Almirall.

Agradecimientos

Los autores quieren expresar su agradecimiento a todos los médicos que han participado en el estudio, pero desafortunadamente la lista es muy larga y no podemos transcribirla al completo. También queremos agradecer a Almirall, S.A. su apoyo en la financiación, y a Adknoma Health Research su apoyo en la gestión logística y el trabajo estadístico. También agradecemos a Content Ed Net Madrid su colaboración en la redacción y submission del manuscrito.

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Cited by (30)

Regional differences in the degree of glycaemic diabetes control in Spain and associated factors. IBERICAN study
2023, Endocrinologia, Diabetes y Nutricion
La prevalencia de diabetes tipo 2 (DM2) es elevada, está aumentando y su grado de control parece mejorable, con importantes consecuencias sociosanitarias. El objetivo de este estudio es conocer las diferencias regionales en el grado de control glucémico de la DM2 en España y sus factores asociados.
Estudio transversal, multicéntrico, observacional en pacientes con DM2 entre 18 y 85 años seleccionados por muestreo consecutivo entre 2014 y 2018. Se dividió la población en cuatro regiones: Norte, Centro, Mediterráneo y Sureste. La variable principal fue el valor de la hemoglobina glucosilada (HbA1c). Se registraron variables sociodemográficas, clínicas, presencia o no de otros factores de riesgo y tratamiento.
Fueron analizados 1.587 pacientes con DM2, con una edad de 65,93 (desviación estándar [DE] 10,14) años, el 54,5% eran hombres, la antigüedad media de la DM2 era de 8,63 (DE 6,64) años y la HbA1c media era del 7,05%. El 59,8% tenían una HbA1c ≤ 7% (Norte 59,5%, Centro 59,5%, Mediterráneo 60,6% y Sureste 59,8%; p = 0,99). Los factores de mal control fueron en el Norte la antigüedad de la DM2 y ser sedentario; en el Centro, la antigüedad de la DM2 y tener un bajo nivel de renta; en el Mediterráneo, la antigüedad de la DM2, y en el Sureste, la antigüedad de la DM2 y tener un bajo nivel de estudios o renta. El 76,2% de los sujetos presentaban hipertensión; el 75,1%, dislipemia, y el 51,7%, obesidad, observándose solo diferencias significativas entre regiones en el caso de la dislipemia (p < 0,001).
No se observaron diferencias en el grado de control de la diabetes en las diferentes regiones, siendo el porcentaje de pacientes con necesidad de intensificación en su control elevado en todas ellas. Los factores asociados al mal control fueron la antigüedad de la enfermedad, un bajo nivel de estudios y de renta, y el sedentarismo.
The prevalence of type 2 diabetes (T2D) is high, it is increasing and its degree of control seems to be improvable with important social and health consequences. The objective of this study is to determine the regional differences in the degree of glycaemic control of T2D in Spain and its associated factors.
Cross-sectional, multicentre, observational study in patients with T2D between 18 and 85 years of age selected by consecutive sampling between 2014 and 2018. The population was divided into four regions: north, centre, Mediterranean and south-east. The main variable was the value of glycated haemoglobin (HbA1c). Sociodemographic and clinical variables, presence or absence of other risk factors and treatment were recorded.
A total of 1,587 patients with T2D were analysed, with a mean age of 65.93 years (standard deviation [SD] 10.14); 54.5% were men; the mean duration of T2D was 8.63 years (SD 6.64) and the mean HbA1c value was 7.05%. Of the total, 59.8% had an HbA1c value ≤ 7% (north 59.5%, centre 59.5%, Mediterranean 60.6% and south-east 59.8%; P = .99). The factors for poor control were: in the north, duration of T2D and being sedentary; in the centre, duration of T2D and having a low income; in the Mediterranean, duration of T2D; and in the south-east, duration of T2D and having a low level of education or income. Overall, 76.2% of the subjects had hypertension, 75.1% dyslipidaemia, and 51.7% obesity, with significant differences between regions only being observed in the case of dyslipidaemia (P < .001).
No differences were observed in the degree of diabetes control in the different regions, with the percentage of patients needing intensification in their control being high in all of them. The factors associated with poor control were the duration of the disease, a low level of education or income, and a sedentary lifestyle.
Characterization of the hypertriglyceridemic waist phenotype in patients with type 2 diabetes mellitus in Spain: An epidemiological study
2021, Revista Clinica Espanola
En los pacientes con diabetes mellitus tipo 2 (DM2) la presencia de aumento de la circunferencia de la cintura y de los triglicéridos es un reflejo del aumento de la grasa visceral y de la resistencia a la insulina. Sin embargo, es escasa la información acerca de la prevalencia y de las características clínicas del fenotipo de cintura hipertrigliceridémica (CHTG) en pacientes con DM2. El objetivo del presente estudio fue analizar la prevalencia y las características de los pacientes de DM2 con CHTG.
En este estudio epidemiológico transversal, llevado a cabo en centros de atención primaria de toda España entre los años 2011 y 2012, analizamos a 4.214 pacientes con DM2. El fenotipo CHTG fue definido como un aumento de la circunferencia de la cintura conforme a los criterios de la Federación Internacional de Diabetes para caucásicos (≥ 94 cm para hombres y ≥ 80 cm para mujeres) acompañado de niveles de triglicéridos ≥ 150 mg/dl. Comparamos las variables demográficas, clínicas y analíticas según la presencia o ausencia del fenotipo CHTG.
El 35% de los pacientes presentaron el fenotipo CHTG. Los pacientes con fenotipo CHTG tenían mayor índice de masa corporal (31,14 ± 4,88 vs. 29,2 ± 4,82 kg/m²; p < 0,001) y hemoglobina glucosilada más alta (7,38 ± 1,2% vs. 7 ± 1,07%; p < 0,001). La presencia de hipertensión, enfermedad arterial periférica, insuficiencia cardíaca y complicaciones microvasculares fueron más frecuentes en los pacientes con fenotipo CHTG que los que no lo tenían. Los pacientes con fenotipo CHTG tenían una menor adherencia a la dieta prescrita (69,8 vs. 81%; p < 0,001), al ejercicio (44,6 vs. 58,2%; p < 0,001), y el aumento de peso en el año previo al estudio fue mayor (29,4 vs. 22,5%; p < 0,001).
El fenotipo CHTG es prevalente en la población DM2 española e identifica a un subgrupo de pacientes con un elevado riesgo cardiometabólico y mayor prevalencia de complicaciones diabéticas.
In patients with type 2 diabetes mellitus (DM2), the presence of increased waist circumference and triglycerides is a reflection of increased visceral fat and insulin resistance. However, information about the prevalence and clinical characteristics of the hypertriglyceridemic waist (HTGW) phenotype in patients with DM2 is scarce. The aim of the present study was to analyze the prevalence and characteristics of DM2 patients with HTGW.
We analyzed 4214 patients with DM2 in this epidemiological, cross-sectional study conducted in primary care centers across Spain between 2011 and 2012. The HTGW phenotype was defined as increased waist circumference according to the International Diabetes Federation criteria for Europids (≥ 94 cm for men and ≥ 80 cm for women) with the presence of triglyceride levels ≥ 150 mg/dl. We compared demographic, clinical and analytical variables according to the presence or absence of the HTGW phenotype.
Thirty-five percent of patients presented the HTGW phenotype. Patients with the HTGW phenotype had a higher body mass index (31.14 ± 4.88 vs. 29.2 ± 4.82 kg/m²; P < .001) and glycated hemoglobin levels (7.38 ± 1.2% vs. 7 ± 1.07%; P < .001). The presence of hypertension, peripheral arterial disease, cardiac insufficiency and microvascular complications were higher when compared with patients without the HTGW phenotype. Patients with the HTGW phenotype were less adherent to prescribed diet (69.8 vs. 81%; P < .001), exercise (44.6 vs. 58.2%; P < .001) and presented greater weight increase within the year prior to the study visit (29.4 vs. 22.5%; P < .001).
The HTGW phenotype is prevalent in the Spanish DM2 population and identifies a subgroup of patients with higher cardiometabolic risk and prevalence of diabetic complications.
Transcutaneous application of the gaseous CO<inf>2</inf> for improvement of the microvascular function in patients with diabetic foot ulcers
2021, Microvascular Research
Citation Excerpt :
In Type 2 DM, which is the predominant type of DM, various multifactorial risk-reduction strategies (Gæde et al., 2003) are applied to prevent diabetic microvascular complications by introducing lifestyle modification and pharmacological interventions. However, the results of various studies indicate that even the glycaemic control improvement, which is the main therapeutic intervention, is poor in the majority of the diabetic patients (Ji et al., 2013; Pérez et al., 2014; Yousefzadeh et al., 2015; Fekadu et al., 2019). Therefore, various potential microvascular-supporting interventions have been investigated, e.g. re-vascularization (Arora et al., 2002), traditional Chinese blood-circulation-activating drugs (He et al., 2016), phototherapy (Wang et al., 2017; Frangez et al., 2017), and CO2 therapies (Finzgar et al., 2015; Matsumoto et al., 2019).
Microvascular function is impaired in patients with diabetes mellitus (DM) and is involved in numerous DM complications. Several microvascular-supporting interventions have been proposed of which the transcutaneous application of gaseous CO₂ (hereinafter CO₂ therapy) is one of the most promising. The aim of present study was to determine the effect of repeated CO₂ therapies on the cutaneous microvascular function in DM patients with diabetic foot ulcers.
A total of 42 subjects with at least one chronic diabetic foot ulcer were enrolled in the study. They were divided into the experimental group (21 subjects aged 64.6 ± 11.6 years) that underwent 4-week-long treatment with transcutaneous application of gaseous CO₂ (hereinafter CO₂ therapies), and the placebo group (21 subjects aged 65.0 ± 10.7 years) that underwent 4-week-long placebo treatment with transcutaneous application of air. Before the first and after the last treatment in both groups, laser Doppler (LD) flux in foot cutaneous microcirculation, heart rate, and arterial blood pressure measurements were carried out during rest and local thermal hyperaemia (LTH) provocation test.
In the experimental group the following statistically significant changes were observed after the completed treatment 1) increased mean relative powers of LD flux signals during rest in the frequency bands related to NO-independent endothelial (0.07 ± 0.055 vs. 0.048 ± 0.059, p = 0.0058), NO-mediated endothelial (0.154 ± 0.101 vs. 0.113 ± 0.108, p = 0.015), and neurogenic (0.17 ± 0.107 vs. 0.136 ± 0.098, p = 0.018) activity; 2) decreased resting LD flux (35 ± 29 PU vs. 52 ± 56 PU; p = 0.038); and 3) increased peak LD flux as a function of baseline during LTH (482 ± 474%BL vs. 287 ± 262%BL, p = 0.036); there were no statistically significant changes observed in the placebo group. No systemic effects were observed in none of the two groups by means of mean values of heart rate and arterial blood pressure.
Repeated CO₂ therapies improves the microvasular function in DM patients without any systemic side effects.
Blood glucose control and cardiovascular risk factors in type 2 diabetic patients with cardiovascular disease in Spain, and its treatment pattern, according to gender: CODICE study
2020, Semergen
Con la implementación de la Estrategia de Promoción de la Salud y Prevención en España, el escenario reflejado en estudios previos de infracontrol de los factores de riesgo cardiovascular (FRCV) en pacientes con diabetes tipo 2 (DM2) y enfermedad cardiovascular (ECV) puede haberse modificado, por lo que nos planteamos conocer el grado de control glucémico y de otros FRCV en los pacientes con DM2 y ECV atendidos actualmente en nuestro medio, el patrón de tratamiento antidiabético y las diferencias en función del género.
Estudio epidemiológico, observacional, transversal, de ámbito nacional en pacientes de ambos géneros diagnosticados de DM2 y ECV establecida.
Se incluyeron 3.143 pacientes. Edad media: 69,0 ± 10 años. La HbA1c media fue mayor en mujeres que en varones (7,4 ± 1,1% vs. 7,3 ± 1,2%; p < 0,05), así como el colesterol-LDL (101,5 ± 38,1 mg/dl vs. 91,1 ± 37,5 mg/dl; p < 0,001), la presión arterial sistólica (137,0 mmHg vs. 135,6 mmHg; p < 0,05) y el índice de masa corporal (30,7 ± 5,4 kg/m² vs. 29,6 ± 4,5 kg/m²; p < 0,001). Los tratamientos más utilizados fueron la metformina (68,1%) y/o inhibidores-DPP4 (53,7%), sin diferencias entre géneros.
El grado de control glucémico de los pacientes con DM2 y ECV en España es mejorable. El perfil de tratamiento no se ajusta a las recomendaciones de las guías de práctica clínica en general. Las diferencias en el control de los FRCV son peores en mujeres para lípidos y obesidad.
With the implementation of the Strategy of Health Promotion and Prevention in Spain, the scenario reflected in previous studies of low control of cardiovascular risk factors (CVRF) in patients with type 2 diabetes (DM2) and cardiovascular disease (CVD) can be modified. This study intends to determine the level of blood glucose control and other CVRF in patients with DM2 and CVD currently seen in clinics in Spain, as well as the pattern of antidiabetic treatment, and differences according to gender.
An epidemiological, observational, cross-sectional, nationwide study was conducted in patients of both genders diagnosed with DM2 and established CVD.
The study included 3,143 patients with a mean age 69.0 ± 10 years. The mean HbA1c was 7.4 ± 1.1% in females vs 7.3 ± 1.2% in males (P < .05) and systolic blood pressure was 137 ± 15.0 mmHg in females vs 135.6 ± 14.7 mmHg in males (P < .05). The mean LDL-cholesterol was 101.5 ± 38.1 mg/dl in females vs 91.1 ± 37.5 mg/dl in males; P < .001) and the mean body mass index (30.7 ± 5.4 kg/m² in females vs 29.6 ± 4.5 kg/m² in males; P < .001). The most used treatments were metformin (68.1%) and/or DPP4 inhibitors (53.7%), with no differences between genders.
The level of blood glucose control of DM2 patients with CVD in Spain can be improved. The treatment profile does not conform to the recommendations of clinical practice guidelines in general. The differences in the control of CVRF are worse in women for lipids and obesity.
Liraglutide vs. lixisenatide in obese type 2 diabetes mellitus patients: What effect should we expect in routine clinical practice?
2020, Primary Care Diabetes
Citation Excerpt :
In this process, peripheral insulin action is limited by fatty tissue excess [2]. In fact, current obesity epidemic is the main factor related with T2DM incidence increase [3–5]. Pharmacological T2DM treatment options include glucagon-like peptide-1 receptor (GLP-1R) agonists [6].
Liraglutide and lixisenatide improved glycemic control, weight and cardiovascular risk factors (CVRF) in type 2 diabetes mellitus (T2DM) patients. Our objective was to analyze clinical efficacy and safety differences in routine clinical practice.
A 24-week prospective observational study to compare the effect of liraglutide versus lixisenatide in obese T2DM patients in routine clinical practice. The main objective was to analyze between-group glycosylated hemoglobin (HbA_1c) differences at the end of the study. Secondary objectives included differences in body weight, other CVRF, changes in medication, side effects, satisfaction and safety.
A total of 100 patients (50 liraglutide, 50 lixisenatide) were included. Both groups experienced a decrease in HbA_1c values (liraglutide, −1.4%, CI 95% −2, −0.8, P < 0.001 vs. lixisenatide, −0.8%, 95% CI −1.2, −0.5, P < 0.001). No differences were found in final HbA_1c values between both groups (liraglutide 7.3 ± 0.9% vs. lixisenatide 7.2 ± 1.5%, P = 0.7). We did not detect between groups differences in anthropometric variables or CVRF at the study end. A lower proportion of patients received treatment with a maximum dose of liraglutide compared with lixisenatide (27% vs. 95%, P < 0.001). In contrast, a greater percentage of patients in the lixisenatide group than in liraglutide group (29% vs. 9%, P = 0.026) intensified treatment by the addition of sodium-glucose transporter type 2 inhibitors. Adverse events were less frequently reported in liraglutide treated patients compared with lixisentatide (80% vs. 96%, P = 0.014). No serious adverse events were detected.
These results confirm the efficacy and safety of liraglutide and lixisenatide in routine clinical practice. Moreover, a different therapeutic effect between liraglutide and lixisenatide was detected.
Observational studies with type 2 diabetes mellitus treatments in Spain: A systematic literature review
2019, Endocrinologia, Diabetes y Nutricion
Citation Excerpt :
In the top five of the most studied variables are those related to effectiveness assessed according to glycaemic control (91%),13–27,29–33 treatment patterns and drug use (82%),13–16,18–22,24–32 safety (only focus on hypoglycaemia) (59%),15,16,18–20,22,23,25,26,29–32 the identification of effectiveness predictive factors or correlations (45%)14,17,20,22,24,25,29–32 and effectiveness according to other control measures such as anthropometric control/lipid profile or cardiovascular risk factors (36%).13,14,16,22,23,25,30,33 Data related to diabetic complications or organ damage was included in 32% of the articles14,25,27,29–32 as complementary information to other effectiveness data. In terms of safety, only two studies showed data apart from hypoglycaemia-related variables: one presented recovered general adverse events information,33 and the other's main aim was to evaluate the impact of glucose-lowering agents in the risk of cancer in a large T2DM population.34
The aim of this systematic literature review (SLR) was to provide an overview of the Spanish research landscape of observational studies conducted with antidiabetic drugs in T2DM patients, published in the last five years, with special focus on the objectives, methodology and main research areas.
Twenty-two articles, corresponding to 20 studies, were included in the analysis. Around 82% of the studies employed a longitudinal study design, collected data retrospectively (72.7%), and were based on secondary data use (63.6%). Pharmacotherapeutical groups most frequently studied were insulin (31.8%) and DPP4i (13.6%). Analytic design was employed most in the studies (68.2%), followed by descriptive analysis (22.7%). In the top five of the most studied variables are those related to effectiveness assessed according to glycaemic control (91%), treatment patterns (82%), safety (hypoglycaemia) (59%), the identification of effectiveness predictive factors (45%) and effectiveness according to other control measures such as anthropometric control or cardiovascular risk factors (36%).
El objetivo de esta revisión sistemática de la literatura (SLR) fue proporcionar una visión general de los estudios observacionales realizados en España con fármacos antidiabéticos en pacientes con DM2, publicados en los últimos cinco años, con especial atención a los objetivos, metodología y principales áreas de investigación.
Veintidós artículos, correspondientes a 20 estudios, se incluyeron en el análisis. Alrededor del 82% de los estudios tenían un diseño longitudinal, recogieron datos retrospectivamente (72.7%) y se basaron en datos secundarios (63.6%). Los grupos farmacoterapéuticos más frecuentemente estudiados fueron las insulinas (31.8%) y los DPP4i (13.6%). Los diseños analíticos fueron los más utilizados (68,2%), seguidos de los análisis descriptivos (22,7%). Entre las variables más estudiadas se encontraron las relacionadas con efectividad según control glucémico (91%), patrones de tratamiento (82%), seguridad (hipoglucemias) (59%), identificación de factores predictores de efectividad (45%) y efectividad según otras medidas, como control antropométrico o factores de riesgo cardiovascular (36%).

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ORIGINALControl glucémico en pacientes con diabetes mellitus tipo 2 en EspañaGlycemic control in patients with type 2 diabetes mellitus in Spain

Resumen

Objetivo

Pacientes y métodos

Resultados

Conclusiones

Abstract

Objective

Patients and methods

Results

Conclusions

Section snippets

Introducción

Diseño del estudio

Resultados

Discusión

Financiación

Conflicto de intereses

Agradecimientos

Gac Sanit

Med Clin (Barc)

Estudio DIABES Med Clin (Barc)

Endocrinol Nutr

Rev Clin Esp

Endocrinol Nutr

The Lancet

Med Clin (Barc)

Endocrinol Nutr

Prevalence of diabetes mellitus and impaired glucose regulation in Spain: the [email protected] Study

Diabetologia

Intensive integrated therapy of type 2 diabetes: implications for long-term prognosis

Diabetes

10-year follow-up of intensive glucose control in type 2 diabetes

N Engl J Med

Control of glycemia and cardiovascular risk factors in patients with type 2 diabetes in primary care in Catalonia (Spain)

Diabetes Care

Accuracy and clinical utility of a point-of-care HbA1c testing device

Postgrad Med

Management of hyperglycemia in type 2 diabetes: a patient-centered approach: position statement of the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD)

Diabetes Care

Individualizing glycemic targets in type 2 diabetes mellitus: implications of recent clinical trials

Ann Intern Med

Diabetes Care

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

Int J Clin Pract

ORIGINAL
Control glucémico en pacientes con diabetes mellitus tipo 2 en EspañaGlycemic control in patients with type 2 diabetes mellitus in Spain