Avances en Diabetología最新文献

Objective

To estimate the cost, outcome and economic impact, of the use of a Blood Glucose Monitoring System (BGMS) with pattern alert technology compared with standard BGMS, for the prevention of severe hypoglycemia (SH) in the insulin-treated type 1 and type 2 diabetes populations.

Material and methods

A short term model has been constructed from literature data. It has been assumed that the cost of both BGMS and their corresponding strips are identical between alternatives, including only the direct cost of the severe hypoglycemia event caused by poor metabolic control.

Results

BGMS shows low sensitivity and positive predictive value, and high specificity and negative predictive value. With a baseline risk of hypoglycemia of around 9% for the insulin-treated DM1 and DM2 population, and 17% for DM1 population < 17 years, the trend detector algorithm could prevent between 20% and 35% of severe hypoglycemias. Cost saving per patient would be between € 12 and € 39, respectively. Moreover, this monitoring system could save costs of around € 7.7 million € for the Health System in a baseline analysis.

Conclusions

BGMS with pattern alert technology is effective in preventing severe hypoglycemia and can be cost saving for Spanish health system. Nevertheless, empirical data on the probability of reducing Severe Hypoglycemia is necessary in order to reach any firm conclusions.

Currently, pioglitazone is the only thiazolidinedione still available for use in Europe. This compound enhances insulin sensitivity and improves lipid metabolism activating «peroxisome proliferator-activated receptors» (PPAR), these aspects are key factors in the current treatment of diabetes mellitus. This antihyperglycemic effect and its improvements on lipid metabolism, has been confirmed in randomized, comparative clinical trials, which have demonstrated the efficacy of pioglitazone as monotherapy or in combination with other antidiabetic agents. Their impact on cardiovascular risk is particularly important; pioglitazone induces favorable changes in triglyceride and HDL-cholesterol and anti-atherogenic effect. Adverse effects associated with the use of pioglitazone are usually mild and manageable. In susceptible patients, some potentially serious adverse effects may require special precautions. For instance, heart failure or bladder cancer, although the latter has yet to be confirmed. In conclusion, pioglitazone has a clinically significant antihyperglycemic effect without increased risk of hypoglycemia, with greater potential benefit for patients with predominantly insulin resistance, and a potential association to with cardiovascular protection. Taking into account its safety profile with adverse effects generally mild and manageable, confirms that the benefit-risk balance of pioglitazone remains positive.

Objective

The aim of the study was to develop a specific questionnaire to assess patient satisfaction with the use of glucometers, and to evaluate their psychometric properties (feasibility, reliability and validity).

Material and methods

(i) An initial 53 item bank was constructed from a systematic review of literature. A panel composed of 6 experts and 50 patients concluded a 25 item version of the questionnaire (dimensions: Satisfaction, inconveniences, added value and appearance). (ii) In order to evaluate the psychometric properties, an epidemiological multi-centred, cross-sectional and 2 month long study was designed, for which 283 patients 18 years or older who were suffering from DM (type 1 and 2) and using a portable glucometer were recruited. Responses to the questionnaire that was the purpose of the study were gathered, together with complementary variables in a single visit. To evaluate test-retest reliability, 51 patients responded again 15 days after initial visit.

Results

There was high internal consistency (Cronbach alpha = .88). Moreover, it showed a positive and statistically significant correlation with patient overall satisfaction (SAT-Q), and with patient treatment-satisfaction (DTSQs^©) questionnaires. Statistically significant differences were found in SATIGLU total score depending on the type of DM, in favour of type 1 DM patients (z = 6.69; P = .000), and glycated haemoglobin favouring patients who observe a good control of their disease, HbA1c < 7 (z = –3.13; P = .002).

Conclusion

The SATIGLU Questionnaire showed adequate psychometric properties as an evaluation tool of patient satisfaction with the use of glucometers.

The discovery of type 1 diabetes mellitus’ (T1DM) autoimmune etiopathogenesis, as well as the effectiveness of diverse immunotherapeutic strategies in T1DM animal models, opened a scenario of pharmacological immuno-intervention in this disease, more than 30 years ago. The aim of current trials that are evaluating these immune therapies at T1DM onset, is to safely modify the natural history of insulin secretion loss in addition to that obtained with intensive insulin treatment.

After the great expectations arised at the beginning of the present century with the publication of promising pilot studies, the results of phase iii clinical trials have recently been published, with unsatisfactory results. This has again led to a debate on immunological therapies at T1DM onset in the scientific community.

The computerization of medical records in primary care is full of potential for research. In Catalonia, administrative, clinical and pharmaceutical data of patients cared for in Primary Care by the Institut Català de la Salut have been available since 2006. They constitute the Information System Development Research in Primary Care database of the Institut d’Investigació in Atenció Primària Jordi Gol.

In 2012 the first diabetic population data in Catalonia were published, and several observational projects are currently being implemented. Information System Development Research in Primary Care is establishing itself as the best validated primary care Spanish database and may become a reference for the study of diabetes in southern Europe. The launch of prospective studies in the field of diabetes opens new paths for research in the near future.

Objective

To determine the prevalence of undiagnosed peripheral arterial disease in patients with diabetes mellitus.

Method

We conducted a cross-sectional study on 360 patients > 50 years of age with diabetes mellitus, who were able to walk and be treated at our Department of Medicine. We excluded patients with severe oedema or swelling in the lower limbs, amputation or revascularization procedures, and those who were hemodynamically unstable or previously diagnosed with peripheral arterial disease. We evaluated the diagnostic performance of the Edinburgh questionnaire, and the absence of dorsalis pedis pulses. Peripheral arterial disease was defined by an ankle-brachial index measured by Doppler of less than 0.90.

Results

The prevalence of peripheral arterial disease was 27% (95% CI: 22%-32%), distributed into 16% symptomatic peripheral arterial disease and 11% asymptomatic peripheral arterial disease. The prevalence of peripheral arterial disease in the three age strata, 50-60 years, 61-70 years, and over 70 years was 18%, 24% and 36%, respectively (P < .001). There was no difference in the prevalence of peripheral arterial disease between men and women (28% vs. 25%, P = .083). The overall diagnostic yield of the Edinburgh questionnaire and the dorsalis pedis pulses examination had a sensitivity of 77% (95% CI: 68%-84%) and a specificity of 62% (95% CI: 59%-65%)

Conclusions

Patients with diabetes mellitus treated at the hospital showed a high prevalence of undiagnosed peripheral arterial disease. The low diagnostic performance of the Edinburgh questionnaire and dorsalis pedis pulse examination justifies the implementation of the ankle-brachial index routinely.

Objective

The aim of the study was to estimate the direct costs associated with type 1 and 2 diabetes mellitus in Spain taking into account a National Health Service perspective.

Method

A costs of illness study was conducted using the prevalence approach and data from existing databases and bibliographic references related to the use of resources in the treatment of diabetes mellitus. The costs categories analysed were: hospital costs (including outpatient care), primary care costs (including additional tests cost and self monitoring blood glucose strips cost) and drug costs. In calculating the non-related cost, only the extra cost was taken into account. Additionally, we analysed the complications cost independently of where costs were originated. Costs were updated to 2012 euros.

Results

The total direct annual cost of diabetes mellitus was 5,809 million euros, representing 8.2% of the total Spanish health expenditure. Drug costs was the major component of total cost (38%), followed by hospital costs (33%). Drug costs accounted for 2,232 million euros, with antidiabetic drugs costs being 861 million euros (15%). Self monitoring blood glucose strips only contributed 118 million euros (2%) to the total cost. The cost of complications cost was 2,143 million euros, around 37% of the total.

Conclusions

Total direct costs associated with diabetes mellitus represent a high proportion of total Spanish health expenditure. It is crucial to introduce measures and strategies to improve efficiency in the control and treatment of diabetes mellitus, with the final purpose of reducing its complications and the considerable economic impact generated.

Different studies, published in the last few years, have clearly demonstrated the effects of diabetes on periodontal diseases, pointing out the relevant implications for health professionals, for diabetic periodontal patients, as well as for the general population. It seems of interest to evaluate the scientific evidence supporting this association, with the main aim of identifying practical implications for all involved groups. The importance of diabetes is based, among other things, in the high levels of prevalence, recently confirmed in Spain and Portugal, and the high proportion of undiagnosed diabetes.

Different factors may explain the effects of diabetes on periodontal diseases, including pro-inflammatory events, changes in the subgingival microbiota, or the accumulation of advanced glycation end-products. These factors provide the basis for diabetes being an important risk factor for periodontitis. However, diabetes may not interfere with periodontal therapy, except in subjects with poor blood glucose control.

Many implications can be listed: from the possibility of performing diabetes screening in the dental clinics, to the need of clear dental and periodontal care protocols for patients with diabetes.

In the last few years, various studies have shown that diabetes is not only a risk factor for periodontal diseases, but also that periodontal diseases may affect glycaemic control, with the well known consequences in terms of diabetes complications. The aim of the present paper was to review the existing evidence on the impact of periodontal diseases on diabetes, its metabolic control, and its complications, as well as the implications of these findings.

Periodontal diseases are infections, which trigger an immune inflammatory response in the periodontal tissues, responsible for a major proportion of the associated tissue destruction. The prevalence of periodontal diseases is high all over the world, which is confirmed in recent studies, both in Spain and Portugal. The importance of these diseases is based, not only on the local effects, such as tooth loss, but also on their systemic consequences. Among them, periodontal diseases have been shown to affect diabetes and its glycaemic control, due to (among other factors) the associated systemic inflammation.

Different studies have shown that periodontitis is associated with a higher level of glycosylated haemoglobin, both in subjects with and without diabetes. Moreover, it has been suggested that periodontitis may increase the risk of diabetes onset, as well as a higher risk of diabetic complications for diabetes patients. Conversely, periodontal therapy may improve glycaemic control in type 2 diabetic patients and, eventually, decrease diabetes complications.

The implications of these findings are numerous, affecting dentists, other health professionals and patients, among others.