Introduction and objectives Patients with type 2 diabetes (T2D) and stable coronary artery disease (CAD) previously revascularized with percutaneous coronary intervention (PCI) are at high risk of recurrent ischemic events. We aimed to provide real-world insights into the clinical characteristics and management of this clinical population, excluding patients with a history of myocardial infarction (MI) or stroke, using Natural Language Processing (NLP) technology. Methods This is a multicenter, retrospective study based on the secondary use of 2014–2018 real-world data captured in the Electronic Health Records (EHRs) of 1,579 patients (0.72% of the T2D population analyzed; n = 217,632 patients) from 12 representative hospitals in Spain. To access the unstructured clinical information in EHRs, we used the EHRead® technology, based on NLP and machine learning. Major adverse cardiovascular events (MACE) were considered: MI, ischemic stroke, urgent coronary revascularization, and hospitalization due to unstable angina. The association between MACE rates and the variables included in this study was evaluated following univariate and multivariate approaches. Results Most patients were male (72.13%), with a mean age of 70.5±10 years. Regarding T2D, most patients were non-insulin-dependent T2D (61.75%) with high prevalence of comorbidities. The median (Q1-Q3) duration of follow-up was 1.2 (0.3–4.5) years. Overall, 35.66% of patients suffered from at least one MACE during follow up. Using a Cox Proportional Hazards regression model analysis, several independent factors were associated with MACE during follow up: CAD duration (p < 0.001), COPD/Asthma (p = 0.021), heart valve disease (p = 0.031), multivessel disease (p = 0.005), insulin treatment (p < 0.001), statins treatment (p < 0.001), and clopidogrel treatment (p = 0.039). Conclusions Our results showed high rates of MACE in a large real-world series of PCI-revascularized patients with T2D and CAD with no history of MI or stroke. These data represent a potential opportunity to improve the clinical management of these patients.

Assessment of medical management in Coronary Type 2 Diabetic patients with previous percutaneous coronary intervention in Spain: A retrospective analysis of electronic health records using Natural Language Processing

Introduccion: Revisar la prescripcion representa una oportunidad para corregir errores y optimizar la farmacoterapia en grupos vulnerables. Objetivos: Analizar la complejidad farmacoterapeutica que se presenta en el paciente polimedicado del medio residencial. Material y Metodos: Estudio descriptivo, retrospectivo, transversal; de esquema terapeutico con elementos de indicacion-prescripcion. Universo: 117 historias clinicas de pacientes polimedicados con 60 anos y mas que residen en los hogares de anciano. Periodo: junio-julio del 2020. Escenario: todos los hogares de ancianos en Cienfuegos, Cuba. Variable dependiente: complejidad farmacoterapeutica definida por la presencia de tres o mas de los indicadores de calidad de vida medidos por la evaluacion geriatrica exhaustiva, Escala de Puntuacion Acumulativa de Enfermedad en Geriatria y criterios STOPP/START. Variables independientes: edad, sexo, enfermedad relacionada al mayor consumo de medicamentos, validismo, comorbilidad, tipo de prescripcion, medicamentos inadecuados. Fuente: historia clinica individual. Resultados: La complejidad farmacoterapeutica en los polimedicados se detecto en el 76.9% de los prescritos inadecuadamente, multimorbidos (OR=17,3; IC95%:16-18,6), dependientes funcionalmente (OR=9,9; IC95%:6,8-13) y ancianos ≥75 anos (OR=5,1; IC95%:4-6,2). Las benzodiacepinas fue el grupo mas prescrito inadecuadamente. Los antiagregantes plaquetarios y estatinas son los medicamentos indicados no prescritos. Conclusiones: Los ancianos polimedicados del medio residencial tienen prescripciones de grupos/farmacos de uso frecuente que se relacionan con errores de prescripcion, que expone polifarmacia inadecuada y complejidad farmacoterapeutica con posible amenaza a la calidad de vida del geronte institucionalizado.

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Polifarmacia y complejidad farmacoterapéutica en pacientes de hogares de ancianos en Cienfuegos

Glucagon-like peptide 1 receptor agonists (GLP-1 RAs) are a class of drugs with potent glucose-lowering activity. Additionally, some GLP-1 RAs have demonstrated cardiovascular and renal benefits. Current guidelines recommend their use in patients with type 2 diabetes (T2D) at high risk of or with established cardiovascular disease (CVD), regardless of glycaemic control, with lifestyle modification and metformin. However, several studies have recently highlighted the limited number of patients with T2D benefiting from these medications worldwide. Given the huge burden of CVD among patients with T2D, efforts should be made to bring clinical practice closer to expert guidelines. This review describes the current situation of GLP-1 RA use in Spain and the reasons behind the gap between guidelines and real-world practice and suggests possible solutions. Administrative issues, lack of awareness of the cardiovascular benefits, clinical inertia, rejection of injectable medication and costs could be some of the reasons for the current situation. Possible strategies that could help to close the gap include encouraging a multidisciplinary approach to the treatment of diabetes which involves cardiologists, endocrinologists, nephrologists, primary care providers and pharmacists; improved awareness of comorbidities and earlier evaluation and treatment or risks; and better education of healthcare providers regarding the cardioprotective benefits of these drugs. The glucagon-like peptide 1 receptor agonists (GLP-1 RAs) are a class of drugs that can be beneficial for patients with type 2 diabetes who are at high risk of cardiovascular complications, such as heart attacks. For this reason, the current clinical guidelines strongly recommend their use in these patients. Unfortunately, many patients with type 2 diabetes and high cardiovascular risk still do not benefit from these drugs. This review analyses the reasons for this situation in Spain, and proposes some possible solutions. The reasons for the low use of GLP-1 RAs could be related to doctors not updating a patient’s diabetes medicine as often as they should, lack of awareness about the cardiovascular benefits of these drugs, fear of medicines that involve needles, administrative issues, and costs. Some of the possible strategies to improve the use of GLP-1 RAs among patients with type 2 diabetes with high cardiovascular risk could be to foster greater cooperation among specialists, increase awareness of the need to treat cardiovascular risk in patients with diabetes, and better education of doctors regarding the benefits of these drugs. 

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GLP-1 RAs in Spain: A Short Narrative Review of Their Use in Real Clinical Practice

Una las patologías más frecuentes en nuestro país Ecuador, como en todo el mundo, es la diabetes miellitus, que pertenece al grupo de las Enfermedades Crónicas no Transmisibles tales como hipertensión Arterial (HTA), enfermedad pulmonar obstructiva crónica (EPOC), cardiovasculares, artritis, artrosis, cáncer, dislipidemias, obesidad, entre otras, las cuales en conjunto están consideradas como un problema de salud pública, las mismas pertenecen a estadísticas importantes que determina que cada año aumentan en número las personas que las adquieren y cada vez la media de edad de presentación va disminuyendo. Alrededor de los 56 millones de defunciones ocurridas en el 2012, 38 millones son ocasionadas por enfermedades no transmisibles, de estos 28 millones ocurrieron en países de bajos recursos. Las causas más frecuentes son por: EPOC, cáncer, patologías cardiovasculares, diabetes, las mismas que se podrían evitar si se trabaja conjuntamente con prevención y promoción de la salud.

Diabetes mellitus

Prevención y tratamiento de los factores de riesgo cardiovascular

Guía ESC 2019 sobre diabetes, prediabetes y enfermedades cardiovasculares, en colaboración con la European Association for the Study of Diabetes (EASD)

Isabelle Johansson

Papers

Guía ESC 2019 sobre diabetes, prediabetes y enfermedades cardiovasculares, en colaboración con la European Association for the Study of Diabetes (EASD)