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Background and Objective: The increase in the prevalence of type 2 diabetes mellitus (T2DM) is related to the increase of obesity. We aimed to determine the Spanish prevalence of T2DM in patients with overweight or obesity attended by either family or specialist physicians., Patients and Method: Cross-sectional, multicenter and simultaneous 2-phase design, performed under clinical conditions. Phase A was designed to determine T2DM prevalence: 169,023 patients were recruited. Phase B was designed to define socio-demographic, clinical and metabolic profile of T2DM according to the body mass index (BMI): 7,754 patients were included., Results: T2DM prevalence in overweight or obese patients was 23.6%; 17.8% of overweight patients were diabetic and T2DM was present in 34.8% of obese people. According to sex, 20.2% of men and 16.4% of women had T2DM. Overall, the mean of risk factors related to T2DM was 4.4 (SD 0,8); out of them, 92.6% patients had dyslipidemia, 73.7% hypertension and 62.5% performed a low physical activity. 37.8% of diabetic patients had vascular involvement. Only 43.1% of patients showed a proper metabolic control of T2DM (glycosilated hemoglobin<7%)., Conclusions: T2DM is related to overweight and obesity and higher the BMI is, higher the T2DM prevalence. Dyslipidemia, hypertension and a low physical activity in diabetic patients are more frequent when BMI increases. Patients with inadequate metabolic control have a higher BMI., (Copyright © 2012 Elsevier España, S.L. All rights reserved.)

Background and Objectives: A safety culture is essential to minimize errors and adverse events. Its measurement is needed to design activities in order to improve it. This paper describes the methods and main results of a study on safety climate in a nation-wide representative sample of public hospitals of the Spanish NHS., Material and Method: The Hospital Survey on Patient Safety Culture questionnaire was distributed to a random sample of health professionals in a representative sample of 24 hospitals, proportionally stratified by hospital size. Results are analyzed to provide a description of safety climate, its strengths and weaknesses. Differences by hospital size, type of health professional and service are analyzed using ANOVA., Results: A total of 2503 responses are analyzed (response rate: 40%, (93% from professionals with direct patient contact). A total of 50% gave patient safety a score from 6 to 8 (on a 10-point scale); 95% reported < 2 events last year. Dimensions "Teamwork within hospital units" (71.8 [1.8]) and "Supervisor/Manager expectations and actions promoting safety" (61.8 [1.7]) have the highest percentage of positive answers. "Staffing", "Teamwork across hospital units", "Overall perceptions of safety" and "Hospital management support for patient safety" could be identified as weaknesses. Significant differences by hospital size, type of professional and service suggest a generally more positive attitude in small hospitals and Pharmacy services, and a more negative one in physicians., Conclusions: Strengths and weaknesses of the safety climate in the hospitals of the Spanish NHS have been identified and they are used to design appropriate strategies for improvement.

Background and Objective: To assess the predictive value of some anthropometric parameters of central adiposity for the diagnosis of hyperglycemia and insulin resistance (IR) in the Spanish population., Patients and Method: Multicenter, cross-sectional study carried out in patients visited in primary care and in specialist clinics, of both sexes, between 18 and 79 years of age. IR was estimated in a subsample of patients by the Homeostasis Model Assessment (HOMA-IR). Patients with diagnosis of diabetes were excluded from the study., Results: A total of 3,638 patients were evaluated, 690 out of these participated in the IR substudy. Waist circumference (WC) was the parameter with a better correlation with hyperglycemia and with IR (r = 0.29 and 0.38; p < 0.001). Each increase of 15 cm in the WC was associated with an increase of the risk hyperglycemia and IR (65% and 123%, respectively). The cut-off points that better discriminated men and women, with and without IR, were 105 and 91 cm, with a sensitivity of 62% (95% confidence interval [CI], 46-77%) and 71% (95% CI, 54-85%), and a specificity of 72% (95% CI, 66-78%) and 68 (95% CI, 63-73%), respectively., Conclusions: WC is a useful anthropometric measure for the detection of hyperglycemia and IR, and the optimal cut-off points for the Spanish population from which IR could be detected are 105 cm for men and 91 for women.

Background and Objective: The PREVENCAT study was designed to estimate the control of the main cardiovascular risk factors (CVRF) and their treatment in a sample of population having the diagnoses of hypertension (HT), type 2 diabetes mellitus (DM2) or hypercholesterolemia (HC) who was attended by primary care physicians in Spain., Patients and Method: Cross-sectional study in patients with HT, DM2 and/or HC, who were consecutively recruited. We describe the treatments for HT, DM2 and HC and analyze and the association between several potential predictors and the control of these CVRF., Results: 2,649 patients were included in the study. 95% of HT patients were under treatment, as were 84% of DM2 and 71.4% of HC patients; most common drugs were diuretics, sulphonylureas and statins, respectively. Monotherapy was more frequent than combined therapy for hypertension treatment. The frequency of HT and DM2 treatment was similar among the subgroups defined by the presence or absence of the other two diagnoses. However, HC treatment was more common in the presence of DM2 (p = 0.001). Age, previous cardiovascular disease (CVD), DM2, obesity and sedentarism were all predictors of poor blood pressure control despite drug treatment. Age, previous CVD, HT and sedentarism were predictors of poor HC control., Conclusions: CVRF treatment was high although heterogeneous and not based on the best available evidence. DM2, previous CVD and obesity were associated with insufficient blood pressure control.

Background and Objective: We assess the metabolic control, complications, quality of life related to health (QLRH) and the type and amount of medical resource consumption (MRC) in type 2 diabetic patients (2DMp) followed by primary care physicians (PCP) in Spain., Patients and Method: We studied 628 2DMp divided in 4 cohorts: 1. Either newly diagnosed 2DMp who required pharmacological treatment or failed to non-pharmacological measures; 2. Patients pharmacologically treated for less than 1 year; 3. Patients with pharmacological treatment for more than 1 year; 4. Patients with impaired fasting glucose (control group)., Results: Eighty percent of the subjects were overweight. At baseline, 27.9, 23.5 and 36.9% of patients from cohorts 1, 2 and 3, respectively, had HbA1C < 8%. After 6 months of follow-up, 14.6, 21.3 and 22.8% of patients from cohorts 1, 2 and 3, respectively, still had "bad control". At baseline, 38.0%, 21.2% and 20.7% of patients from cohorts 1, 2, and 3, respectively, had "bad lipid profile". After 6 months, 57.4%, 54.2% and 45.3% of cohorts 1, 2 and 3, respectively, still had plasma cLDL levels > 130 mg/dl. Complications were more frequent in cohort 3. During the 6-month period, MRC was higher among 2DMp than controls (p < 0.05) and higher among patients from cohort 3 (p < 0.05) compared with all the other patients. More diabetic than control patients and more patients from cohort 3 than patients from cohort 1 and 2 reported that their expected quality of life would be better without diabetes., Conclusions: One out of four of diabetic patients studied had HbA1C and lipids higher than the limits suggested by guidelines. Type 2 diabetes is associated with higher MRC and worse QLRH. This situation is worse among long-term diabetic patients.

Background: Type 2 diabetes mellitus (DM 2) constitutes today one of the most important problems in terms of health. Nowadays, there is special interest to identify those subjects with a high risk for developing the disease. Our study aimed to evaluate fasting glycemia and glycated hemoglobin in the screening of defects in oral glucose tolerance, in relatives of patients with DM 2., Subjects and Methods: 111 relatives of patients with DM 2 were consecutively included in the study. Glycated hemoglobin (HbA1c, DCA 2000) was measured, afterwards an oral glucose tolerance test (OGTT) was performed. 120 min glycemia (G120) classified oral glucose tolerance as: normal (NGT), impaired glucose tolerance (IGT) and DM. In a first subgroup (n = 80) the equation to predict G120 was obtained (G120 estimated) from the basal glycemia (GO) and HbA1c. In a second subgroup (n = 31), G120 observed after the OGTT (G120 observed) and G120 estimated were compared. Finally, sensitivity, specificity and positive predictive value (PPV) for different cutpoints of GO and G120 were estimated, in order to identify those subjects with abnormal glucose tolerance (IGT and DM)., Results: Considering the results from the first subgroup of subjects, G120 was independently related with GO (R2 = 0.64) and with HbA1c (R2 = 0.62). When GO and HbA1c were considered altogether R2 value was 0.73. When data from the second subgroup of subjects was analysed we did not find any differences between observed G120 and G120 estimated by the equation. The sensitivity, specificity and PPV to detect abnormalities in oral glucose tolerance of estimated G120 were 80, 76 and 61%, respectively. Optimal values of these parameters were obtained with GO 98-102 mg/dl and Hba1c 5.6-5.8%., Conclusions: Our results confirm that the measurement of GO and HbA1c in first degree relatives of patients with DM 2 is extremely useful to identify those subjects in which abnormal oral glucose tolerance is highly probable.

Background: The aim of this study was to analyze the predictive factors of IDDM in first degree relatives of IDDM patients., Subjects and Methods: From 1992 to 1994, 1,053 first degree relatives were screened for measuring islet cell antibodies (ICA) by indirect immunofluorescence (iFl). In all ICA positive subjects, beta cell function was analyzed by intravenous glucose tolerance test (IVGTT) and other immunologic parameters were also studied: anti-insulin antibodies (IAA) by radiobinding and antibodies to glutamic acid decarboxylase (GADAb) by ELISA methods., Results: ICA were found in 3.1% of the first degree relatives. IVGTT showed a significant decrease in acute first phase of insulin response to glucose (IRI 1 minute + 3 minute) in those with ICA > or = 20 JDF units. In patients with ICA > or = 20 JDF units, 20% were found to be positive for IAA and 40% were positive for GAdAb. Thirty-one percent (10/32) of ICA positive first degree relatives fulfilled prediabetes criteria. During follow-up, 40% (4/10) of these prediabetic patients developed IDDM., Conclusion: This study confirms the possibility of identifying among first degree relatives of IDDM patients the subgroup with high risk of developing IDDM thus allowing the initiation of therapy for preventing or delaying IDDM onset.

Background: Insulin treatment in patients with type-II diabetes mellitus (DMII) is normally undertaken by clinical criteria. The aim of the present was to study the efficacy of a standard mixed meal (breakfast test) to predict the need for insulin therapy to thereby evaluate whether it is possible to obtain more objective criteria for the indication of insulin treatment., Methods: Fifty-six patients with DMII were studied to evaluate the need for insulin therapy over a one-year period. Serum glucose and basal C peptide and their maximum values were determined in all the patients following stimulation with the breakfast test. Insulin treatment was initiated according to exclusively clinical criteria during admission. The patients were followed as out patients for a minimum of 3 months. Treatment at the end of follow up (insulin or no insulin) was evaluated and the results of the test were retrospectively analyzed., Results: The basal C peptide (BCP) values were significantly lower in the individuals requiring insulin in comparison to those who did not require insulin (mean +/- SD 0.64 +/- 0.28 versus 1.18 +/- 0.41 nmol/l, p < 0.0001) similar to what was found with the stimulated maximum C peptide values (MCP) (1.48 +/- 0.77 versus 2.49 +/- 0.63 nmol/l, p < 0.0001). On considering a BCP of less than 0.9 nmol/l for the patients with insulin treatment the sensitivity of BCP was 83.6% and the specificity 78.9%. For a BCP value of less than 1.9 nmol/l sensitivity was 77.7% and specificity 78.9%. Using the values together, sensitivity was 66.6% and specificity 84.4%., Conclusions: The breakfast test is useful to indicate the need for insulin therapy in patients with type II diabetes mellitus but is not more useful than a determination of isolated basal C peptide.

Glycosylated hemoglobin ((HbA1c) is formed by structural modification of HbA in a slow and irreversible non-enzymatic reaction. Its concentration is proportional to mean blood glucose levels during approximately four weeks, being therefore a useful index of diabetes mellitus control. The introduction of a microcolumn chromatographic method that measures together the subfractions HbA1a + b + c (fast Hb) and is well correlated to HbA1c has permitted the routine clinical measurement of this parameter. The authors used this method to study the levels of glycosylated hemoglobin in normal subjects, acutely decompensated diabetics, and diabetic outpatients classified according to their degree of control. The highest levels were detected in acutely decompensated patients and in those with chronic poor compensation. It is concluded that HbA1 constitutes a good index of compensation in diabetes, and that it may in the future unify existing criteria on the disease, contributing to clarify the problems about the correlation between the degree of compensation of diabetes and the incidence and evolution of its specific complications.