Meeting individualized glycemic targets in primary care patients with type 2 diabetes in Spain

• Published in: BMC endocrine disorders Vol. 16; no. 10; p. 10
• Main Authors: Miñambres, I, Mediavilla, J J, Sarroca, J, Pérez, A
• Format: Journal Article
• Language: English
• Published: England BioMed Central Ltd 17-02-2016; BioMed Central
• Subjects: Aged; Blood Glucose - metabolism; Care and treatment; Comorbidity; Complications and side effects; Cross-Sectional Studies; Diabetes Mellitus, Type 2 - blood; Diabetes Mellitus, Type 2 - drug therapy; Diabetes Mellitus, Type 2 - epidemiology; Diabetes therapy; Female; Guideline Adherence - statistics & numerical data; Health aspects; Humans; Male; Middle Aged; Patient Care Planning; Precision Medicine - methods; Precision Medicine - standards; Primary Health Care - standards; Primary Health Care - statistics & numerical data; Risk factors; Spain - epidemiology; Type 2 diabetes; Spain
• ISSN: 1472-6823; 1472-6823
• DOI: 10.1186/s12902-016-0090-1

Information about the achievement of glycemic targets in patients with type 2 diabetes according to different individualization strategies is scarce. Our aim was to analyze the allocation of type 2 diabetic patients into individualized glycemic targets according to different strategies of individualization and to assess the degree of achievement of adequate control.
Cross-sectional analysis on 5382 type 2 diabetic patients in primary care setting in Spain between 2011 and 2012. Targets of HbA1c were assigned based on different strategies of individualization of glycemic targets: 1) the ADA/EASD consensus 2) The Spanish Diabetes Society (SED) consensus 3) a strategy that accounts for the risk of hypoglycemia (HYPO) considering the presence of a hypoglycemia during the last year and type of hypoglycemic treatment. Concordance between the different strategies was analyzed.
A total of 15.9, 17.1 and 67 % applied to ADA/EASD recommendation of HbA1c target of <6.5, < 7 and <8 % (48, 53 and 64 mmol/mol), and 31.9 and 67.4 % applied to the SED glycemic target of <6.5 and <7.5 % (<48 and 58 mmol/mol). Using the HYPO strategy, 53.5 % had a recommended HbA1c target <7 % (53 mmol/mol). There is a 94 % concordance between the ADA/EASD and SED strategies, and a concordance of 41-42 % between these strategies and HYPO strategy. Using the three different strategies, the overall proportion of patients achieving glycemic targets was 56-68 %.
Individualization of glycemic targets increases the number of patients who are considered adequately controlled. The proposed HYPO strategy identifies a similar proportion of patients that achieve adequate glycemic control than ADA/EASD or SED strategies, but its concordance with these strategies in terms of patient classification is bad.