Evolución clínica de una cohorte de pacientes con diabetes mellitus tipo 2 tras su valoración en endocrinología. Estudio a 26 semanas

Abstract

Introduction and objetives: type 2 diabetes mellitus (T2DM) has become one of the biggest public health problems of our time and has a great health and social impact due to the associated chronic complications and the high cardiovascular mortality that it entails. There is evidence of the importance of metabolic control in the appearance and progression of complications related to DM. However, reaching and maintaining glycemic control goals is a challenge in dailyclinical practice. The main objective of this work is to evaluate if there is an improvement in the metabolic control in a cohort of patients with T2DM after their assessment in endocrinology clinics. Secondary objectives are to evaluate, on one hand, the changes in hypoglycaemic treatment and, on the other hand, the prevalence of associated complications. Material and methods: prospective cohort study. 465 patients with T2DM who did not do the follow up in an endocrinology clinic were included. Control data (glycemic, lipid and blood pressure) and treatments received in an initial visit and after 26 weeks of follow-up were evaluated. The prevalence of chronic complications as well as the associated factors were also evaluated. Results: the initial glycosylated hemoglobin (HbA1c) was 8.3 ± 1.8%, while after 26 weeks of follow-up it was 6.6 ± 0.9% (p <0.0001). The percentage of patients with HbA1c <7% increased from 33.1 to 71.3% (p <0.0001). In 59.9% of the patients a decrease of HbA1c ≥ 0.8% was observed. In the multivariate analysis, the variables that predicted an improvement in the metabolic control were an older age (OR 1.038, 95% CI 1-1.07, p = 0.041), higher initial HbA1c (OR 5.51, 95 % CI 3,4-9, p <0,0001), time of evolution of T2DM <5 years (OR 4.63, 95% CI 1.6-13.3, p = 0.005) and change of hypoglycaemic treatment (OR 2.77, 95% CI 1.1-6.9, p = 0.03). There was also a statistically significant improvement in the systolic and diastolic blood pressure, body mass index, cholesterol associated with low density lipoproteins and triglycerides. In 75.1% of the subjects with T2DM included in the study, the hypoglycaemictreatment was modified. The percentage of patients who did not receive treatment, decreased from 7 to 0.3% after 26 weeks of follow-up (p <0.0001), as well as the percentage of patients receiving oral antidiabetic drugs (OAD) (60.9 vs 55, 5%) (p = 0.003) and insulin (10.5 vs. 6.2%) (p = 0.021). However, the percentage of patients receiving treatment with combined insulin with OAD increased from 21.1 to 38% (p <0.0001). In this study, 27.1% of the patients included, had some type of macrovascular complication, 33.6% of the patients had some type of microvascular complication and 6.9% had a diabetic foot. 25.1% had diabetic nephropathy and 21.9% had ocular manifestations. Regarding macrovascular complications, the most prevalent was coronary disease (19.8%), while 7.1% and 4.9% had peripheral arterial disease and cerebral vascular disease respectively. Conclusions: there is an improvement in metabolic control in this cohort of patients with T2DM after their assessment in an endocrinology clinic. However, HbA1c <7% is not reached in 28.7%, which shows the difficulty of achieving good metabolic control in daily clinical practice. Besides that, there is a change in the hypoglycaemic treatment in the majority of patients included in the study, which also has an influence in the improvement of glycemic control. Finally, the prevalence of complications associated with T2DM is relevant