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Is there anything to improve?" "tieneTextoCompleto" => true "saludo" => "Dear Editor:" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "308" "paginaFinal" => "309" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Pedro J. Pinés-Corrales, Pilar Ibáñez-Navarro, Ángela Vicente-Albiñana, Gema Sáez-Valencia" "autores" => array:4 [ 0 => array:4 [ "nombre" => "Pedro J." "apellidos" => "Pinés-Corrales" "email" => array:1 [ 0 => "pjpines@sescam.jccm.es" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "Pilar" "apellidos" => "Ibáñez-Navarro" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 2 => array:3 [ "nombre" => "Ángela" "apellidos" => "Vicente-Albiñana" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 3 => array:3 [ "nombre" => "Gema" "apellidos" => "Sáez-Valencia" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Department of Endocrinology, Diabetes and Nutrition, Hospital General de Almansa, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Department of Pharmacy, Complejo Hospitalario Universitario de Albacete, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Tratamiento de la diabetes en el anciano. ¿Hay algo que mejorar?" ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Diabetes in elderly people is one of the main problems for our Public Health System today. Aging is causing a marked increase in the pandemic of diabetes and its prevalence in Spain for men and women older than 75 years-old is greater than 20%.<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">1</span></a> We know that the therapeutic strategies and targets should be individualized in these patients but scientific evidence to support the most appropriate treatment is scarce.<a class="elsevierStyleCrossRefs" href="#bib0040"><span class="elsevierStyleSup">2–3</span></a> Metformin is the first-line agent and recent studies have indicated that it may be used safely in patients with estimated glomerular filtration rate (eGFR) ≥30<span class="elsevierStyleHsp" style=""></span>ml/min/1.73<span class="elsevierStyleHsp" style=""></span>m<span class="elsevierStyleSup">2</span>. However, metformin is contraindicated in patients with advanced renal insufficiency. Sulfonylureas are associated with hypoglycemia and should be used with caution in patients with increased susceptibility.<a class="elsevierStyleCrossRefs" href="#bib0050"><span class="elsevierStyleSup">4–5</span></a> Ruiz-Tamallo et al. observed that a significant proportion of patients with eGFR <30<span class="elsevierStyleHsp" style=""></span>ml/min/1.73<span class="elsevierStyleHsp" style=""></span>m<span class="elsevierStyleSup">2</span> were on metformin or sulfonylureas treatment.<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">6</span></a> The aim of our study was to know if the use of metformin and sulfonylureas were lower in patients ≥75 years-old with eGFR <45<span class="elsevierStyleHsp" style=""></span>ml/min/1.73<span class="elsevierStyleHsp" style=""></span>m<span class="elsevierStyleSup">2</span> and determine the prevalence of patients ≥75 years-old who are in treatment with metformin or sulfonylureas that have had eGFR <30<span class="elsevierStyleHsp" style=""></span>ml/min/1.73<span class="elsevierStyleHsp" style=""></span>m<span class="elsevierStyleSup">2</span> or without eGFR within the last year.</p><p id="par0010" class="elsevierStylePara elsevierViewall">From January 2017 to April 2017, we identified in our pharmacological prescription program, 1183 patients ≥75 years-old who were taking pharmacological treatment for diabetes (insulin and no insulin). These patients live among the three basic health areas located in the southeast of Castilla-La Mancha which attend a total of 41992 inhabitants. 70.4% of them were treated with metformin and 14% with sulfonylureas (13 patients were on gliblenclamide treatment). We analyzed a randomly selected sample of 295 patients (calculated to have enough statistical power) and the following variables were collected: age (years), sex (male or female), pharmacological treatment for diabetes (metformin, sulfonylureas, glinides, thiazolidinediones, DPP-4 inhibitors, GLP-1 receptor agonist, SGLT-2 inhibitors and insulin), and the last blood analysis with A1c and eGFR in the previous year.</p><p id="par0015" class="elsevierStylePara elsevierViewall">Data were analyzed with the use of G-Stat 2.0 software. Qualitative variables were expressed as an absolute and relative frequency. Quantitative variables were expressed as a mean and standard deviation (SD). The Chi-square test was used to compare proportions of use of metformin or sulfonylureas between two groups (eGFR <45<span class="elsevierStyleHsp" style=""></span>ml/min/1.73<span class="elsevierStyleHsp" style=""></span>m<span class="elsevierStyleSup">2</span> vs. eGFR ≥45<span class="elsevierStyleHsp" style=""></span>ml/min/1.73<span class="elsevierStyleHsp" style=""></span>m<span class="elsevierStyleSup">2</span>). A <span class="elsevierStyleItalic">p</span> value <0.05 was considered statistically significant.</p><p id="par0020" class="elsevierStylePara elsevierViewall">The mean age was 82.7 years (SD: 5.1) and 106 patients (35.9%) were 85 years of age or older. 173 patients (58.6%) were women. 220 patients (74.6%) were on metformin, 39 (13.2%) on sulfonylureas, 18 (6.1%) on glinides and 99 (33.6%) on DPP-4 inhibitors. Only 1 patient was treated with GLP-1 receptor agonist and 9 with SGLT-2 inhibitors. 45 patients (15.2%) were on basal insulin analogs and 18 (6.1%) on premixed insulin. Only 3 patients were treated with intermediate acting insulin (Human NPH or NPL insulin) and only 5 with basal-acting insulin more rapid-acting insulin.</p><p id="par0025" class="elsevierStylePara elsevierViewall">The mean A1c was 7.1% (SD: 1.2) but only 190 patients (64.4%) had this result in the last year. 47 patients (15.9%) did not have eGFR during the last year and 11 (3.7%) had eGFR <30<span class="elsevierStyleHsp" style=""></span>ml/min/1.73<span class="elsevierStyleHsp" style=""></span>m<span class="elsevierStyleSup">2</span>. 153 patients (51.9%) had eGFR ≥60<span class="elsevierStyleHsp" style=""></span>ml/min/1.73<span class="elsevierStyleHsp" style=""></span>m<span class="elsevierStyleSup">2</span>, 43 (14.6%) between 45 and 59<span class="elsevierStyleHsp" style=""></span>ml/min/1.73<span class="elsevierStyleHsp" style=""></span>m<span class="elsevierStyleSup">2</span> and 41 (13.9%) between 30 and 44<span class="elsevierStyleHsp" style=""></span>ml/min/1.73<span class="elsevierStyleHsp" style=""></span>m<span class="elsevierStyleSup">2</span> (<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>). Thirty five patients with eGFR <45<span class="elsevierStyleHsp" style=""></span>ml/min/1.73<span class="elsevierStyleHsp" style=""></span>m<span class="elsevierStyleSup">2</span> (67.3%) were treated with metformin or sulfonylureas vs. 168 patients with eGFR ≥45<span class="elsevierStyleHsp" style=""></span>ml/min/1.73<span class="elsevierStyleHsp" style=""></span>m<span class="elsevierStyleSup">2</span> (85.7%) (<span class="elsevierStyleItalic">p</span>: 0.0079). Forty two patients treated with metformin or sulfonylureas (17.5%; IC 95%, 12.9–22.9%) had eGFR <30<span class="elsevierStyleHsp" style=""></span>ml/min/1.73<span class="elsevierStyleHsp" style=""></span>m<span class="elsevierStyleSup">2</span> or did not have eGFR during the last year.</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0030" class="elsevierStylePara elsevierViewall">Selection of a limited sample of the total elegible population and restriction to a small spanish region were the main limitations of our study. However, others have shown similar results in other geographical areas with larger populations.</p><p id="par0035" class="elsevierStylePara elsevierViewall">In conclusion, the use of metformin and sulfonylureas were lower in patients with eGFR <45<span class="elsevierStyleHsp" style=""></span>ml/min/1.73<span class="elsevierStyleHsp" style=""></span>m<span class="elsevierStyleSup">2</span> vs. patients with eGFR ≥45<span class="elsevierStyleHsp" style=""></span>ml/min/1.73<span class="elsevierStyleHsp" style=""></span>m<span class="elsevierStyleSup">2</span> but 17.5% of patients ≥75 years-old treated with metformin or sulfonylureas had eGFR <30<span class="elsevierStyleHsp" style=""></span>ml/min/1.73<span class="elsevierStyleHsp" style=""></span>m<span class="elsevierStyleSup">2</span> or did not have eGFR during the last year. It is necessary to monitor and help physicians to avoid inappropriate prescription specially in older people.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "multimedia" => array:1 [ 0 => array:8 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at1" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:1 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">eGFR \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Patients \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Metformin or sulfonylureas treatment \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">without eGFR \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">47/295 (15.9%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">37/47 (78.7%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">eGFR ≥60<span class="elsevierStyleHsp" style=""></span>ml/min \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">153/295 (51.9%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">135/153 (88.2%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">eGFR 45–59<span class="elsevierStyleHsp" style=""></span>ml/min \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">43/295 (14.6%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">33/43 (76.7%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">eGFR 30–44<span class="elsevierStyleHsp" style=""></span>ml/min \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">41/295 (13.9%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">30/41 (73.2%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">eGFR <30<span class="elsevierStyleHsp" style=""></span>ml/min \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">11/295 (3.7%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">5/11 (45.4%) \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1783543.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Estimated glomerular filtration rate (eGFR) and metformin or sulfonylureas treatment.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:6 [ 0 => array:3 [ "identificador" => "bib0035" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Prevalence of diabetes mellitus and impaired glucose regulation in Spain: the Di@betes Study" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "F. 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2021 March | 8 | 5 | 13 |
2021 February | 6 | 11 | 17 |
2021 January | 16 | 7 | 23 |
2020 December | 6 | 2 | 8 |
2020 November | 8 | 1 | 9 |
2020 October | 4 | 4 | 8 |
2020 September | 7 | 6 | 13 |
2020 August | 6 | 7 | 13 |
2020 July | 5 | 7 | 12 |
2020 June | 7 | 2 | 9 |
2020 May | 6 | 4 | 10 |
2020 April | 4 | 7 | 11 |
2020 March | 5 | 1 | 6 |
2020 February | 4 | 1 | 5 |
2020 January | 3 | 7 | 10 |
2019 December | 3 | 5 | 8 |
2019 November | 2 | 2 | 4 |
2019 October | 1 | 2 | 3 |
2019 September | 3 | 1 | 4 |
2019 August | 1 | 0 | 1 |
2019 July | 5 | 10 | 15 |
2019 June | 5 | 6 | 11 |
2019 May | 11 | 12 | 23 |
2019 April | 4 | 1 | 5 |
2019 March | 0 | 1 | 1 |
2019 February | 3 | 3 | 6 |
2019 January | 3 | 1 | 4 |
2018 December | 1 | 2 | 3 |
2018 November | 12 | 5 | 17 |