Aims: To implement a patient registry and collect data related to the care provided to people with type 2 diabetes in six specialized centers of three Latin American countries, measure the quality of such care using a standardized form (QUALIDIAB) that collects information on different quality of care indicators, and analyze the potential of collecting this information for improving quality of care and conducting clinical research. Methods: We collected data on clinical, metabolic and therapeutic indicators, micro-and macrovascular complications, rate of use of diagnostic and therapeutic elements and hospitalization of patients with type 2 diabetes in six diabetes centers, four in Argentina and one each in Colombia and Peru. Results: We analyzed 1157 records from patients with type 2 diabetes (Argentina, 668; Colombia, 220; Peru, 269); 39 records were discarded because of data entry errors or inconsistencies. The data demonstrated frequency performance deficiencies in several procedures, including foot and ocular fundus examination and various cardiovascular screening tests. In contrast, HbA 1c and cardiovascular risk factor assessments were performed with a greater frequency than recommended by international guidelines. Management of insulin therapy was sub-optimal, and deficiencies were also noted among diabetes education indicators. Conclusions: Patient registry was successfully implemented in these clinics following an interactive educational program. The data obtained provide useful information as to deficiencies in care and may be used to guide quality of care improvement efforts. What′s knownWhile many reports describe the quality of care provided to people with diabetes in Europe and the USA, scarce information is available on this issue in Latin America. What′s newThe article provides detailed information regarding the quality of care provided to people with type 2 diabetes in diabetes centers of three Latin American countries.

Background: HbA1c result provide information on metabolic control in diabetes mellitus (DM) and could also be used for its diagnosis. For its determination, the laboratory must be certified by the National Glycohemoglobin Standardization Program (NGSP) or the International Federation of Clinical Chemistry (IFCC) and comply with a strict quality control program. Aims: To determine the correlation and agreement between HbA1c results measured by three analytical methods (enzymatic, turbidimetric, and capillary electrophoresis) versus HPLC. Methods: Method comparison—1245 samples from equal number of subjects at 45 Association of High Complexity Laboratories (Asociación de Laboratorios de Alta Complejidad—ALAC) centers, centralizing sample processing and operator. Statistical analysis—analysis of variance (ANOVA) and nonparametric Friedman ANOVA test for related samples, means, and medians. Correlation and concordance—Pearson’s correlation and linear regression, intraclass correlation coefficient (Passing and Bablock and Bland and Altman). Results: The comparison of mean values obtained by the four methods showed statistically significant, but clinically irrelevant, differences: HbA1c by HPLC versus Electrophoresis 0.06% (0.42 mmol/mol) P = .000 (± 1.96 DS -0.070 -0.047), Enzymatic 0.087% (1 mmol/mol) P = .000 (± 1.96 DS 0.077 0.098), Turbidimetric 0.056% (0.38 mmol/mol) P = 0.000 (± 1.96 DS -0.067 -0.044). Their concordance showed intraclass correlation of single measures of 0.982 P < .001 (95% CI 0.987 - 0.9838). Conclusions: The three methods present low variability and high correlation versus the HPLC.

Introducción: la diabetes mellitus tipo 2 (DM2) es una enfermedad metabólica de alta prevalencia que constituye un importante factor de riesgo cardiovascular, en la cual los pacientes no sólo se diagnostican tardíamente, sino que permanecen por tiempos prolongados con mal control de la glucemia y de los demás factores de riesgo cardiovascular. Se registra una significativa inercia terapéutica en la implementación de drogas antidiabéticas en la segunda línea de tratamiento.Objetivos: el objetivo principal del estudio DISCOVER fue proporcionar datos del mundo real para evaluar la terapéutica antidiabética y los resultados clínicos prospectivos en pacientes con DM2 que inician una terapia farmacológica de segunda línea para la reducción de la glucemia.El objetivo secundario fue informar los datos de referencia de Argentina comparados con pacientes del mundo global, incluyendo variables metabólicas, edad, antigüedad de la enfermedad, y riesgo cardiovascular.

Es un honor dirigirme a Uds. en el marco del XXI Congreso Argentino de Diabetes; agradezco la confianza depositada en la Comisión Directiva que presido, integrada por profesionales que desinteresadamente brindan sus servicios a esta Sociedad que nos nuclea. Este Congreso, que se desarrolla del 24 al 26 de octubre en el Gran Hotel Provincial de la ciudad de Mar del Plata, ha sido planificado con esmero tanto en el aspecto científico como en todo aquello que hace a su adecuada realización.

Simposio 19: Tratamiento farmacológico: ¿qué hay de nuevo?Secretagogos: sulfonilureas e incretinasLas SUs y los iDPP4 tienen un sitio ganado dentro de la terapéutica actual de la diabetes mellitus (DM).Respecto de las SUs, refiriéndonos a glimepirida, gliclazida y glipizida, ya que la glimepirida está últimamente desaconsejada, dejaremos de lado sus cualidades en el tratamiento de la DM neonatal y del MODY3, para enfocarnos en su lugar dentro de los esquemas de abordaje de la DM2, contestando algunas preguntas fundamentales.