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Fundamento: Valorar la adecuación de la prescripción de fármacos antirresortivos según la Guía de Osteoporosis de la Sociedad Española de Medicina Familiar y Comunitaria (SEMFYC). Material y métodos: Estudio descriptivo transversal realizado en dos centros de Atención Primaria de ámbito urbano. Se estudió una muestra de 411 pacientes entre todos los que tomaban un fármaco antirresortivo y/o en los que constaba diagnóstico de osteoporosis. Se excluyeron los que lo tomaban por otro motivo (13), errores diagnósticos (8), exitus (3) y falta de historia clínica (16). Se recogieron las variables: edad, sexo, antecedentes personal y familiar de fractura, T y Z scores densitométricas, tipo de fármaco antirresortivo, suplementos de calcio y vitamina D, y especialista que indicó inicialmente el tratamiento. Se valoró la adecuación de la prescripción según si cumplía o no criterios de la Guía SEMFYC. Resultados: 371 cumplían criterios de inclusión. De ellos, el 96,5% eran mujeres. La edad media fue de 68 años (desviación estándar -DE-: 9,4). En 288 (77,6%) pacientes se valoró el antecedente personal de fractura, y en 21 (5,7%), el familiar. En el 65,5% constaba la realización de densitometría. El 65,2% tomaban bifosfonatos, y el 14,8% raloxifeno. El 72,8% recibían suplementos de vitamina D y el 76% de calcio. En el 30,5% el médico de familia inició el tratamiento, en el 21% fue el reumatólogo y en el 14,3% el ginecólogo. En 204 pacientes (55%) la prescripción del antirresortivo era adecuada, en 113 (30,5%) no se pudo determinar y en 51 (13,7%) fue inadecuada. Conclusiones: En menos del 15% la prescripción de antirresortivos fue inadecuada, siendo los bifosfonatos los más utilizados. En un tercio de los pacientes no constaba la realización de densitometría.

Background: Our study aimed to evaluate the performance of primary healthcare physicians (PCPs) in managing glycemia, lipids, and blood pressure in people with type 2 diabetes mellitus (T2DM) in Catalonia, Spain. Methods: We included 3267 PCPs with 367,132 T2DM subjects in a cross-sectional analysis of the SIDIAP (Sistema d'Informació per al Desenvolupament de la Investigació en Atenció Primària) database for the year 2017. Results : 63.1% of PCPs were female, with an average practice size of 1512 subjects. T2DM individuals had a mean (standard deviation) age of 70 (±12.2) years old, a mean body mass index (BMI) of 30.2 (±5.21) kg/m 2 , and a median diabetes duration of 8.8 years. Overall, 42.6% of subjects achieved target glycemic control (glycated hemoglobin < 7%). Notably, 59.2% maintained blood pressure < 140/90 mmHg during the 12-month study period. The multivariable analysis identified positive associations between glycemic control and female PCPs, practice sizes (1000-1500 people), a higher proportion of patients aged ≥ 65 years, and rural practices. Combined glycemic, lipid, and blood pressure target attainment was associated with medium-sized practices and those with a higher proportion of patients aged ≥ 65 years. Conclusions: Practice size, patient age distribution, and rurality are factors associated with the performance of PCPs in the control of glycemia, lipids, and blood pressure in T2DM subjects in primary health care centers in our region.

Aim: This study's objective was to assess the risk of severe in-hospital complications of patients admitted for COVID-19 and diabetes mellitus (DM)., Design: This was a cross-sectional study., Settings: We used pseudonymised medical record data provided by six general hospitals from the HM Hospitales group in Spain., Outcome Measures: Multiple logistic regression analyses were used to identify variables associated with mortality and the composite of mortality or invasive mechanical ventilation (IMV) in the overall population, and stratified for the presence or absence of DM. Spline analysis was conducted on the entire population to investigate the relationship between glucose levels at admission and outcomes., Results: Overall, 1621 individuals without DM and 448 with DM were identified in the database. Patients with DM were on average 5.1 years older than those without. The overall in-hospital mortality was 18.6% (N=301), and was higher among patients with DM than those without (26.3% vs 11.3%; p<0.001). DM was independently associated with death, and death or IMV (OR=2.33, 95% CI: 1.7 to 3.1 and OR=2.11, 95% CI: 1.6 to 2.8, respectively; p<0.001). In subjects with DM, the only variables independently associated with both outcomes were age >65 years, male sex and pre-existing chronic kidney disease. We observed a non-linear relationship between blood glucose levels at admission and risk of in-hospital mortality and death or IMV. The highest probability for each outcome (around 50%) was at random glucose of around 550 mg/dL (30.6 mmol/L), and the risks flattened above this value., Conclusion: The results confirm the high burden associated with DM in patients hospitalised with COVID-19 infection, particularly among men, the elderly and those with impaired kidney function. Moreover, hyperglycaemia on admission was strongly associated with poor outcomes, suggesting that personalised optimisation could help to improve outcome during the hospital stay., Competing Interests: Competing interests: EO has received advisory and or speaking fees from AstraZeneca, Boehringer Ingelheim, Lilly, MSD, Novo Nordisk, Sanofi and Amgen; he received research grants to the institution from MSD and Amgen. RC has received advisory and/or speaking fees from Abbott, Ascensia, Lilly, MSD, Novo Nordisk and Sanofi. MM-C has received advisory honorarium from AstraZeneca, Bayer, Boehringer Ingelheim, GSK, Lilly, MSD, Novartis, Novo Nordisk and Sanofi; he received speaker honoraria from AstraZeneca, Bayer, Boehringer Ingelheim, GSK, Lilly, Menarini, MSD, Novartis, Novo Nordisk and Sanofi; he received research grants to the institution from AstraZeneca, GSK, Lilly, MSD, Novartis, Novo Nordisk and Sanofi. JF-N has received advisory and or speaking fees from AstraZeneca, Ascensia, Boehringer Ingelheim, GSK, Lilly, MSD, Novartis, Novo Nordisk and Sanofi; he received research grants to the institution from AstraZeneca, GSK, Lilly, MSD, Novartis, Novo Nordisk, Sanofi and Boehringer. KK has acted as a consultant, speaker or received grants for investigator-initiated studies for AstraZeneca, Novartis, Novo Nordisk, Sanofi-Aventis, Lilly and Merck Sharp & Dohme, Boehringer Ingelheim, Bayer, Berlin-Chemie AG/Menarini Group, Janssen and Napp. DM has received advisory and/or speaking fees from AstraZeneca, Ascensia, Boehringer Ingelheim, GSK, Lilly, MSD, Novartis, Novo Nordisk and Sanofi; he received research grants to the institution from AstraZeneca, GSK, Lilly, MSD, Novartis, Novo Nordisk, Sanofi and Boehringer. PD has received lecture and Advisory Board fees from Gilead Sciences, Roche, Merck, Sharp & Dohme, ViiV Healthcare, Janssen & Cilag, Theratechnologies, Boehringer Ingelheim and Ferrer International. PD has received research grants from Gilead Sciences, ViiV Healthcare, GSK, Janssen & Cilag and Boehringer Ingelheim. BV, FXCC, JR, RP-T, MG and EC have no conflict of interest to declare., (© Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Background and Objectives: Diabetes is a significant risk factor for the development of cardiovascular disease, which is the main cause of death. The purpose of this study was to determine the level of glycaemic control in patients with type 2 diabetes without cardiovascular disease in Spain. The data used includes the most recent determination of glycosylated haemoglobin, as well as the pattern of antidiabetic treatment, the incidence of episodes of severe hypoglycaemia in the last 6 months, and the level of control of cardiovascular risk factors, and gender., Patients and Methods: A national, multicentre, and cross-sectional epidemiological study in which 800 doctors associated with the GDPS network participated., Results: Of the total of 1,059 patients, 57% male, with a mean age of 62.7 years in men vs. 65.2 in women (P<.001). The mean onset of diabetes was 9.4±7.5 years. The mean HbA1C was 7.0% in men vs. 7.1% in women (P=.039), with the control objective of <7% being observed in 47.2%. There were 65% patients on treatment with metformin, and 62.4% on DPP-4 inhibitors, and basal insulin: 14.2%. Incidence of severe hypoglycemias in the last 6 months was 1.9%. The women had worse glycaemic control, total cholesterol, LDL cholesterol, abdominal obesity, and glomerular filtration levels., Conclusions: The glycaemic control is worse in women even if adjusted for age and time of onset of diabetes (P=.043), and for the number of hypoglycaemic agents (P=.015). The level of control is also worse in women for dyslipidaemia, abdominal obesity, and glomerular filtration. A preventive strategy promoted from Primary care on healthy lifestyles and controlling all vascular risk factors is essential., (Copyright © 2019 Sociedad Española de Médicos de Atención Primaria (SEMERGEN). Publicado por Elsevier España, S.L.U. All rights reserved.)

Introduction and Objectives: 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., Materials and Methods: An epidemiological, observational, cross-sectional, nationwide study was conducted in patients of both genders diagnosed with DM2 and established CVD., Results: 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±15.0mmHg in females vs 135.6±14.7mmHg in males (P<.05). The mean LDL-cholesterol was 101.5±38.1mg/dl in females vs 91.1±37.5mg/dl in males; P<.001) and the mean body mass index (30.7±5.4kg/m 2 in females vs 29.6±4.5kg/m 2 in males; P<.001). The most used treatments were metformin (68.1%) and/or DPP4 inhibitors (53.7%), with no differences between genders., Conclusions: 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., (Copyright © 2019 Sociedad Española de Médicos de Atención Primaria (SEMERGEN). Publicado por Elsevier España, S.L.U. All rights reserved.)

Chronic kidney disease (CKD) is one of the most common complications of type 2 diabetes mellitus (T2DM). Furthermore, CKD confers a considerable increase in the risk of cardiovascular (CV) morbidity and mortality. In line with the need to improve knowledge in this field, this article aims to describe the renal endpoints used in the different cardiovascular outcome trials (CVOTs). The objective is to better know the renal variables used in the different CVOTs in order to optimize the implementation of advances in the prevention of progressive diabetic kidney disease in patients with T2DM in clinical practice., (Copyright © 2019 Primary Care Diabetes Europe. Published by Elsevier Ltd. All rights reserved.)

Treatment of diabetes mellitus type2 (DM2) includes healthy eating and exercise (150minutes/week) as basic pillars. For pharmacological treatment, metformin is the initial drug except contraindication or intolerance; in case of poor control, 8 therapeutic families are available (6 oral and 2 injectable) as possible combinations. An algorithm and some recommendations for the treatment of DM2 are presented. In secondary cardiovascular prevention, it is recommended to associate an inhibitor of the sodium-glucose cotransporter type 2 (iSGLT2) or a glucagon-like peptide-1 receptor agonist (arGLP1) in patients with obesity. In primary prevention if the patient is obese or overweight metformin should be combined with iSGLT2, arGLP1, or inhibitors of type4 dipeptidylpeptidase (iDPP4). If the patient does not present obesity, iDPP4, iSGLT2 or gliclazide, sulfonylurea, recommended due to its lower tendency to hypoglycaemia, may be used., (Copyright © 2019. Publicado por Elsevier España, S.L.U.)

Spain, has a National Health System where Primary and Secondary (outpatient, hospital) care are accessible free of charge for all population. The prevalence of diabetes has risen from 6% in the 1990s to higher than 10% in 2007. In the 1990s, family physicians (FPs) have become the reference physician for diabetic patients. Each FP has on their patients list about 100-150 type 2 diabetic patients that are attended for routine care. In 2006 a National Strategy for Prevention, Diagnosis and Treatment of Diabetes has been initiated. In 2008 the programme will be evaluated.

Objective: To assess the effectiveness of blood pressure self-monitoring at home in front of 24-h blood pressure ambulatory measurement in isolated clinical hypertension diagnosis., Design: Comparative study of repeated measurements of self-monitoring home BP and 24-h ambulatory BP measurement in a hypertensive patients sample. SETTING AND SUBJECTS TO STUDY: Mild-moderate essential hypertensive patients newly diagnosed or previously diagnosed in which suspect isolated clinical hypertension (BP>140/90 mm Hg in clinical setting repeatedly). It needs a sample of 182 hypertensive patients seen at urban primary health care., Principal Measurements: We compute the isolated clinical hypertension prevalence, the sensibility, specificity and positive and negative predictive values, with 95% confidence intervals., Discussion: Prove the effectiveness of blood pressure self-monitoring at home in insolated clinical hypertension diagnosis, can involve an important cost saving for health care system as in hypertensive patient management (medicines and office visits), as in diagnosis equipment.