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Vol. 214. Issue 8.
Pages 429-436 (November 2014)
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Vol. 214. Issue 8.
Pages 429-436 (November 2014)
Original article
Glycemic control in patients with type 2 diabetes mellitus in Spain
Control glucémico en pacientes con diabetes mellitus tipo 2 en España
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726
A. Péreza,b,
Corresponding author
aperez@santpau.cat

Corresponding author.
, J.J. Mediavillac, I. Miñambresa, D. González-Segurad
a Servicio de Endocrinología y Nutrición, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
b Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM) , Barcelona, Spain
c Centro de Salud Burgos Rural Sur, Burgos, Spain
d Departamento Médico Almirall S.A., Barcelona, Spain
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Figures (1)
Tables (3)
Table 1. Clinical characteristics of the study population and differences between patients with HbA1c levels <7% and those with HbA1c levels ≥7%.
Table 2. Hyperglycemia treatment, glycemic control, hypoglycemia and weight changes in the previous year in the study population. Differences between patients with HbA1c levels <7% and those with HbA1c levels ≥7%.
Table 3. Factors associated with an HbA1c value <7% in the logistic regression analysis.
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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.

Keywords:
Type 2 diabetes
Glycemic control
Duration of diabetes
Atherogenic dyslipidemia
Oral antidiabetic agents
Insulin therapy
Primary care
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.

Palabras clave:
Diabetes tipo 2
Control glucémico
Duración de la diabetes
Dislipemia aterogénica
Antidiabéticos orales
Insulinoterapia
Atención primaria

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