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Zapatero-Gaviria, R. Gómez-Huelgas, J. Canora-Lebrato, J. Ena-Muñoz, M. Romero-Sánchez, M. Mendez-Bailón, J. Marco-Martínez, R. Barba-Martín" "autores" => array:8 [ 0 => array:2 [ "nombre" => "A." "apellidos" => "Zapatero-Gaviria" ] 1 => array:2 [ "nombre" => "R." "apellidos" => "Gómez-Huelgas" ] 2 => array:2 [ "nombre" => "J." "apellidos" => "Canora-Lebrato" ] 3 => array:2 [ "nombre" => "J." "apellidos" => "Ena-Muñoz" ] 4 => array:2 [ "nombre" => "M." "apellidos" => "Romero-Sánchez" ] 5 => array:2 [ "nombre" => "M." "apellidos" => "Mendez-Bailón" ] 6 => array:2 [ "nombre" => "J." "apellidos" => "Marco-Martínez" ] 7 => array:2 [ "nombre" => "R." 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García Alegría" "autores" => array:1 [ 0 => array:3 [ "nombre" => "J." "apellidos" => "García Alegría" "email" => array:1 [ 0 => "jalegria@hcs.es" ] ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Director Línea de Procesos Médicos, Agencia Sanitaria Costa del Sol, Marbella (Málaga), Consejería de Salud de Andalucía, Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Spain" "identificador" => "aff0005" ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Ingresos cardiovasculares en la diabetes: una ventana de oportunidad" ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Type 2 diabetes mellitus (DM) is a growing problem related to nutritional changes and physical inactivity due to societal changes and is intimately associated with obesity. With a DM prevalence in adults in Spain of approximately 14%, almost half of the patients are unaware that they have the disease.<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">1</span></a> Resolving this diagnostic deficiency, in populations at risk and through early opportunistic inquiries, is a priority health challenge because achieving good control during this period of increased vulnerability is essential. Maintaining an HbA1c level ≥6.5% during the first year after the diagnosis is associated with a higher rate of microvascular and macrovascular complications, as well as a higher rate of total mortality at 10 years. Therefore, after this condition has first been recognized, immediate and intensive treatment is needed to reduce these rates.<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">2</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">Patients with DM who maintain 5 risk factors within objective ranges (HbA1c, low-density lipoprotein cholesterol levels, albuminuria, tobacco use and arterial hypertension) have low or no risk of mortality, myocardial infarction or stroke compared with the general population,<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">3</span></a> which confirms the importance of the comprehensive evaluation and multifactorial control of the disease. An HbA1c level above the objective is the best predictor of stroke and acute myocardial infarction, tobacco use is the best predictor of mortality, and DM increases the risk of hospitalization by 50%.<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">3</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">In recent years, the DM-adjusted mortality in Spain has decreased 25% in men and 41% in women, and there has been a convergence of results among the various autonomous communities and provinces, with greater homogeneity attributable to better overall disease control.<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">4</span></a> Individuals with known and unknown DM or with prediabetes have significantly higher rates of hospitalization for cardiovascular, endocrine, respiratory, gastrointestinal, genitourinary and neurological causes, as well as iatrogenesis, lesions, malignancies and infections.<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">5</span></a> Undoubtedly, hospitalizations for cardiovascular disease (CVD) have the greatest relevance due to their frequency, impact on morbidity and mortality, their complexity and associated costs.</p><p id="par0020" class="elsevierStylePara elsevierViewall">This issue of RCE includes a study conducted through an analysis of the national minimum basic data set that evaluated hospitalizations for CVD in DM.<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">6</span></a> The minimum basic data set is an essential source of information for understanding the reality of care and the seasonal trends, efficiency, costs and quality of hospital care. The study's first conclusion is the high prevalence of DM in numerous medical-surgical specialties that treat CVD. This situation requires that these specialties have the necessary knowledge to address appropriate treatment during the patient's hospitalization to minimize the risks related to hyperglycemia and hypoglycemia, to provide coordination in multidisciplinary care and to have insulinization protocols that facilitate the decision-making process.</p><p id="par0025" class="elsevierStylePara elsevierViewall">The study emphasizes the association between DM and heart failure (HF), which is currently the cardiovascular disease that creates the largest number of hospitalizations by far, accounting for almost 50% of the total. Studies in Spain have reported an annual increase in hospitalization for HF in DM of 7% between 2001 and 2007, with stabilization in the 8 subsequent years.<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">7</span></a> A recent meta-analysis on the impact of DM on HF has shown a 30% increase in risk over a 3-year period in total mortality and 35% in cardiovascular mortality and hospitalization, with a greater impact in chronic HF than in acute HF.<a class="elsevierStyleCrossRef" href="#bib0115"><span class="elsevierStyleSup">8</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">DM can induce HF, with reduced or preserved ventricular function or an overlapping of the two (intermediate ejection fraction), due to coronary artery disease or diabetic cardiomyopathy, with a 2–4-fold increase in risk compared with the general population.<a class="elsevierStyleCrossRef" href="#bib0120"><span class="elsevierStyleSup">9</span></a> The pathophysiological link between the two is better explained by hyperinsulinemia than by hyperglycemia, and the 2 families of hypoglycemic drugs are the ones that reduce insulin (metformin and sodium-glucose co-transporter 2 inhibitors [iSGLT-2] the only ones that reduce the risk of HF).<a class="elsevierStyleCrossRef" href="#bib0125"><span class="elsevierStyleSup">10</span></a></p><p id="par0035" class="elsevierStylePara elsevierViewall">Patients with DM and clinical CVD who do not achieve the glycemic objectives after dieting and taking metformin should be treated with a drug that has demonstrated a reduction in cardiovascular events and mortality, either an iSGLT-2 (empagliflozin or canagliflozin) or a GLP-1 analogue (liraglutide, semaglutide), after considering the patient's factors and the drug's characteristics.<a class="elsevierStyleCrossRef" href="#bib0130"><span class="elsevierStyleSup">11</span></a> Only iSGLT-2 has shown a reduction in hospitalizations for HF.<a class="elsevierStyleCrossRefs" href="#bib0130"><span class="elsevierStyleSup">11,12</span></a> For patients with CVD and DM, the selection of hypoglycemic treatment should consider the cardiovascular safety results of each drug in particular, because there appears to be no class effect in any of the studied families. Although the current HF treatment guidelines do not have a specific section for treatment for patients with coexisting DM, we have information for making an appropriate selection of hypoglycemic drugs in this situation.<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">13</span></a></p><p id="par0040" class="elsevierStylePara elsevierViewall">Hospitalization for DM provides a special opportunity to identify undiagnosed patients, to assess the quality of the comprehensive control, to teach patients and caregivers and to optimize the treatment.<a class="elsevierStyleCrossRef" href="#bib0145"><span class="elsevierStyleSup">14</span></a> An appropriate transition at discharge and a hospital discharge report with defined quality criteria can facilitate this treatment and are essential tools for coordinating primary care.<a class="elsevierStyleCrossRef" href="#bib0150"><span class="elsevierStyleSup">15</span></a></p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: García Alegría J. Ingresos cardiovasculares en la diabetes: una ventana de oportunidad. Rev Clin Esp. 2019;219:147–148.</p>" ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:15 [ 0 => array:3 [ "identificador" => "bib0080" "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@*bet.es Study" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "F. Soriguer" 1 => "A. Goday" 2 => "A. Bosch-Comas" 3 => "E. Bordiú" 4 => "A. Calle-Pascual" 5 => "R. 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