Analysis of hospitalizations by cardiovascular disease in the population with diabetes in Spain

Zapatero-Gaviria, Antonio; Gómez‐Huelgas, Ricardo; Canora-Lebrato, Jesús; Ena-Muñoz, J.; Romero-Sánchez, M.; Méndez‐Bailón, Manuel; Marco-Martínez, Javier; Barba-Martín, R.

doi:10.1016/j.rceng.2018.09.006

Cited by 6 publications

(12 citation statements)

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“…This study assessed the efficacy and safety of insulin Gla-300 during hospitalization and therapy intensification at discharge in people with type 2 diabetes insufficiently controlled with basal insulin and/or non-insulin antidiabetic drugs. It was mostly conducted in general internal medicine wards, which have a relevant role in diabetes management and often includes more clinically compromised patients, 31 and demonstrated that using basal–bolus regimens with Gla-300 as basal insulin is effective during the hospital stay. The study results also indicate that restarting oral agents in combination with 80% of hospital daily insulin dose as Gla-300 at discharge is an effective strategy for therapy intensification when admission HbA1c ranges between 8% and 10% (1.6% HbA1c reduction at months 3 and 6 postdischarge).…”

Section: Discussionmentioning

confidence: 99%

Efficacy and safety of insulin glargine 300 U/mL (Gla-300) during hospitalization and therapy intensification at discharge in patients with insufficiently controlled type 2 diabetes: results of the phase IV COBALTA trial

Pérez

Carrasco-Sánchez

González

et al. 2020

BMJ Open Diab Res Care

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IntroductionThis study assessed the efficacy and safety of insulin glargine 300 U/mL (Gla-300) during hospitalization and therapy intensification at discharge in insufficiently controlled people with type 2 diabetes.Research design and methodsCOBALTA (for its acronym in Spanish, COntrol Basal durante la hospitalizacion y al ALTA) was a multicenter, open-label, single-arm, phase IV trial including 112 evaluable inpatients with type 2 diabetes insufficiently controlled (glycosylated hemoglobin (HbA1c) 8%–10%) with basal insulin and/or non-insulin antidiabetic drugs. Patients were treated with a basal–bolus–correction insulin regimen with Gla-300 during the hospitalization and with Gla-300 and/or non-insulin antidiabetics for 6 months after discharge. The primary endpoint was the HbA1c change from baseline to month 6 postdischarge.ResultsHbA1c levels decreased from 8.8%±0.6% at baseline to 7.2%±1.1% at month 6 postdischarge (p<0.001, mean change 1.6%±1.1%). All 7-point blood glucose levels decreased from baseline to 24 hours predischarge (p≤0.001, mean changes from 25.1±66.6 to 63.0±85.4 mg/dL). Fasting plasma glucose also decreased from baseline to 24 hours predischarge (p<0.001), month 3 (p<0.001) and month 6 (p<0.001) postdischarge (mean changes 51.5±90.9, 68.2±96.0 and 77.6±86.4 mg/dL, respectively). Satisfaction was high and hyperglycemia/hypoglycemia perception was low according to the Diabetes Treatment Satisfaction Questionnaire at month 6 postdischarge. The incidence of confirmed (glucose<70 mg/dL)/severe hypoglycemia was 25.0% during hospitalization and 59.1% 6 months after discharge. No safety concerns were reported.ConclusionsInpatient and intensification therapy at discharge with Gla-300 improved significantly glycemic control of patients with type 2 diabetes insufficiently controlled with other basal insulin and/or non-insulin antidiabetic medication, with high treatment satisfaction. Gla-300 could therefore be a treatment choice for hospital and postdischarge diabetes management.

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Section: Discussionmentioning

confidence: 99%

Efficacy and safety of insulin glargine 300 U/mL (Gla-300) during hospitalization and therapy intensification at discharge in patients with insufficiently controlled type 2 diabetes: results of the phase IV COBALTA trial

Pérez

Carrasco-Sánchez

González

et al. 2020

BMJ Open Diab Res Care

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“… 2 In Spain, 7.8% of the adult population are diagnosed with T2DM 3 and about 23.2% of these have CVD, 4 with this figure reaching 40.8% in hospitalized patients with T2DM. 5 …”

Section: Introductionmentioning

confidence: 99%

Incidence and costs of cardiovascular events in Spanish patients with type 2 diabetes mellitus: a comparison with general population, 2015

Artola¹,

García-Moll

Uría

et al. 2020

BMJ Open Diab Res Care

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IntroductionCardiovascular (CV) disease affects a high percentage of patients with type 2 diabetes mellitus (T2DM), especially in the hospital setting, impacting on mortality, complications, quality of life and use of health resources. The aim of this study was to estimate the incidence, mean length of hospital stay (LOHS) and costs attributable to hospital admissions due to CV events in patients with T2DM versus patients without diabetes mellitus (non-DM) in Spain.Research design and methodsRetrospective observational study based on the Spanish National Hospital Discharge Database for 2015. Hospital admissions for patients aged ≥35 years with a diagnosis of CV death, non-fatal acute myocardial infarction (AMI), non-fatal stroke, unstable angina, heart failure and revascularization were evaluated. The International Classification of Diseases, Ninth Revision (250.x0 or 250.x2) coding was used to classify records of patients with T2DM. For each CV complication, the hospital discharges of the two groups, T2DM and non-DM, were precisely matched and the number of hospital discharges, patients, LOHS and mean cost were quantified. Additional analyses assessed the robustness of the results.ResultsOf the 276 925 hospital discharges analyzed, 34.71% corresponded to patients with T2DM. A higher incidence was observed in all the CV complications studied in the T2DM population, with a relative risk exceeding 2 in all cases. The mean LOHS (days) was longer in the T2DM versus the non-DM group for: non-fatal AMI (7.63 vs 7.02, p<0.001), unstable angina (5.11 vs 4.78, p=0.009) and revascularization (7.96 vs 7.57, p<0.001). The mean cost per hospital discharge was higher in the T2DM versus the non-DM group for non-fatal AMI (€6891 vs €6876, p=0.029) and unstable angina (€3386 vs €3304, p<0.001).ConclusionsPatients with T2DM had a higher incidence and number of hospital admissions per patient due to CV events versus the non-DM population. This generates a significant clinical and economic burden given the longer admission stay and higher costs associated with some of these complications.

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“…Tras la Medicina Interna, las especialidades que atienden a más pacientes hospitalizados con diabetes son Cardiología (9% de las altas hospitalarias), Cirugía (9%), Traumatología (7%) y Urología (5%). En conjunto, los servicios de Medicina Interna atienden a más pacientes hospitalizados que todos los demás servicios médicos (27%) y que la globalidad de los servicios quirúrgicos (27%) 8 . Además, como era esperable, los pacientes ingresados en Medicina Interna tienen una mayor edad media (77 años) y una mayor carga de comorbilidad que los hospitalizados en otras unidades 8 .…”

Section: Diabetes En Medicina Internaunclassified

“…En conjunto, los servicios de Medicina Interna atienden a más pacientes hospitalizados que todos los demás servicios médicos (27%) y que la globalidad de los servicios quirúrgicos (27%) 8 . Además, como era esperable, los pacientes ingresados en Medicina Interna tienen una mayor edad media (77 años) y una mayor carga de comorbilidad que los hospitalizados en otras unidades 8 . Igualmente, el protagonismo de la Medicina Interna en el manejo de las complicaciones cardiovasculares de los pacientes con diabetes es indiscutible.…”

Section: Diabetes En Medicina Internaunclassified

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Diabetes en Medicina Interna

2019

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Gregorio Marañón, clínico insigne y pionero de la Endocrinología española, afirmó que “quien quiera aprender Medicina, que estudie la diabetes”. Con ello, quería resaltar el carácter multisistémico de la enfermedad, su heterogeneidad clínica y su gran complejidad fisiopatológica. Dicha aseveración sigue plenamente vigente en la actualidad. Lo que Marañón no pudo pronosticar fue el carácter epidémico que la diabetes ha adquirido en pocas décadas, debido a que la pandemia de obesidad y el envejecimiento de la población han incrementado de forma exponencial la prevalencia mundial de diabetes mellitus tipo 2, convirtiéndola en un problema de salud pública de gran magnitud. Actualmente, la prevalencia de diabetes en España es del 14%1 y se predice que aumentará un 22% en las próximas tres décadas, siendo la población mayor de 70 años la que sufrirá un mayor incremento2. Se estima que cada 6 segundos se produce una muerte por causa de la diabetes, en su mayoría por enfermedad cardiovascular3 . Según cálculos de la Organización Mundial de la Salud (OMS), la diabetes provocará en el futuro próximo mayores pérdidas de años de vida que el tabaquismo o el SIDA4. Actualmente, la diabetes es responsable del 12% de los costes sanitarios globales y su creciente impacto económico puede comprometer la sostenibilidad de los sistemas públicos de salud.

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Analysis of hospitalizations by cardiovascular disease in the population with diabetes in Spain

Cited by 6 publications

References 22 publications

Efficacy and safety of insulin glargine 300 U/mL (Gla-300) during hospitalization and therapy intensification at discharge in patients with insufficiently controlled type 2 diabetes: results of the phase IV COBALTA trial

Efficacy and safety of insulin glargine 300 U/mL (Gla-300) during hospitalization and therapy intensification at discharge in patients with insufficiently controlled type 2 diabetes: results of the phase IV COBALTA trial

Incidence and costs of cardiovascular events in Spanish patients with type 2 diabetes mellitus: a comparison with general population, 2015

Diabetes en Medicina Interna

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