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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Background</span><p id="par0005" class="elsevierStylePara elsevierViewall">In studies conducted in the national setting using administrative data&#44; the prevalence of diabetes in patients hospitalized in the departments of internal medicine between 2005 and 2010 was 27&#37;&#46;<a class="elsevierStyleCrossRef" href="#bib0150"><span class="elsevierStyleSup">1</span></a> The presence of diabetes is one of the main determinants of increased costs due to hospitalization&#44; hospital readmissions and mortality&#46;<a class="elsevierStyleCrossRefs" href="#bib0155"><span class="elsevierStyleSup">2&#8211;4</span></a> High glucose levels promote the onset of nosocomial infections and ischemic-thrombotic phenomena because hyperglycemia affects the granulocytic function and boosts the activation of proinflammatory and procoagulant factors&#46;<a class="elsevierStyleCrossRef" href="#bib0170"><span class="elsevierStyleSup">5</span></a> Hyperglycemia during hospitalization&#44; both in patients with known diabetes and those without diabetes&#44; is associated with increased mortality&#46;<a class="elsevierStyleCrossRef" href="#bib0175"><span class="elsevierStyleSup">6</span></a> The clinical practice guidelines recommend monitoring capillary blood glucose in all patients with hyperglycemia and using subcutaneous insulin&#44; administered in a basal-bolus regimen&#44; in order to maintain preprandial glucose levels below 140<span class="elsevierStyleHsp" style=""></span>mg&#47;dL and randomly measured glucose levels below 180<span class="elsevierStyleHsp" style=""></span>mg&#47;dL&#46;<a class="elsevierStyleCrossRef" href="#bib0180"><span class="elsevierStyleSup">7</span></a> Studies conducted on hyperglycemia control in hospitals show that although this is an issue of growing importance&#44; the physicians&#8217;&#44; nurses&#8217; and pharmacists&#8217; knowledge is often insufficient&#46;<a class="elsevierStyleCrossRef" href="#bib0185"><span class="elsevierStyleSup">8</span></a> Benchmarking strategies&#44; defined as a systematic and continuous process of assessing study processes&#44; services and outcomes in organizations that exhibit best practices&#44; are directed at achieving continuous improvement and are mainly aimed at customers&#46; These strategies have been employed to improve quality indicators for patients with diabetes treated in primary care&#46;<a class="elsevierStyleCrossRef" href="#bib0190"><span class="elsevierStyleSup">9</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">One of the lines of interest of the Diabetes and Obesity Study Group of the Spanish Society of Internal Medicine is improving glycemic control in hospitalized patients&#46; In 2014&#44; the Environmental Triggers of Type 1 Diabetes &#40;MIDIA-1&#41; study evaluated the extent of the problem&#44; the patient characteristics&#44; the degree of glycemic control and the methods employed to reach optimal blood glucose levels&#46;<a class="elsevierStyleCrossRef" href="#bib0195"><span class="elsevierStyleSup">10</span></a> Based on the findings of the MIDIA-1 study&#44; we employed the benchmarking strategy to disseminate the results of the MIDIA-1 study &#40;baseline period&#41; and publish specific recommendations for improving 3 quality indicators for treating hyperglycemia in hospitalized patients&#46; The present study &#40;MIDIA-2&#41; evaluated the impact of this strategy of disseminating results and recommendations on the adherence to the clinical practice guidelines and glycemic control&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Material and method</span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Study design</span><p id="par0015" class="elsevierStylePara elsevierViewall">The study employed a comparative assessment with a preintervention-postintervention design&#46; In 2014&#44; an email was sent to the members of the Diabetes and Obesity Study Group of the Spanish Society of Internal Medicine inviting them to participate in the study&#46; The preintervention study consisted of data collected &#40;on a specified day between June 23 and July 8&#44; 2014&#41; from patients hospitalized in the internal medicine departments who presented hyperglycemia or known diabetes &#40;MIDIA-1 study&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0195"><span class="elsevierStyleSup">10</span></a> The study recorded demographic and clinical data and adherence to the clinical practice guidelines published by The Endocrine Society for treating hyperglycemia in patients hospitalized in noncritical areas&#46;<a class="elsevierStyleCrossRef" href="#bib0180"><span class="elsevierStyleSup">7</span></a> The intervention consisted of the dissemination of the results of the MIDIA-1 study&#44; whose outcomes were presented at the Annual Workgroup Meeting&#44; on the website of the Spanish Society of Internal Medicine and in the corresponding publication&#46;<a class="elsevierStyleCrossRef" href="#bib0195"><span class="elsevierStyleSup">10</span></a> The data collection for the postintervention study &#40;MIDIA-2 study&#41; was conducted in the hospitals that participated in the MIDIA-1 study on a day between June 22 and July 3&#44; 2015&#46; The changes in the rate of adherence to 3 critical indicators in the care of hospitalized patients with hyperglycemia were assessed&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Patient selection</span><p id="par0020" class="elsevierStylePara elsevierViewall">The study included patients older than 15 years of age&#44; with known diabetes&#44; stress hyperglycemia or diabetes diagnosed in the hospital&#44; who were hospitalized in the internal medicine departments of acute care hospitals and who were treated in hospitals that participated in the MIDIA-1 study conducted in 2014&#46; Patients hospitalized in emergency departments or treated in consultations were excluded&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Data collection</span><p id="par0025" class="elsevierStylePara elsevierViewall">Data was collected on the hospital size&#44; geographical location&#44; number of beds and number of patients hospitalized in the department of internal medicine on the day of the study&#46; The patient data included age&#44; sex&#44; smoking habit&#44; type of diabetes&#44; time since the diabetes diagnosis&#44; date of the most recent hemoglobin &#40;Hb&#41; A1c measurement&#44; glomerular filtration rate calculated using the Modification of Diet in Renal Disease-4 &#40;MDRD-4&#41; formula&#44; degree of disability measured by the Rankin scale&#44; Charlson comorbidity index&#44; type of diabetes treatment before the hospital admission&#44; reason for hospitalization&#44; length of hospital stay to the study day&#44; diabetes treatment administered during hospitalization&#44; use of enteral or parenteral nutrition&#44; use of systemic glucocorticoids&#44; capillary blood glucose levels measured at different times of the day and the presence of hypoglycemia during the hospitalization&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">Hyperglycemia was defined as glucose values &#8805;140<span class="elsevierStyleHsp" style=""></span>mg&#47;dL &#40;7&#46;7<span class="elsevierStyleHsp" style=""></span>mol&#47;L&#41; on more than 2 occasions or an isolated blood glucose level higher than 200<span class="elsevierStyleHsp" style=""></span>mg&#47;dL &#40;11&#46;1<span class="elsevierStyleHsp" style=""></span>mmol&#47;L&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0180"><span class="elsevierStyleSup">7</span></a></p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Quality indicators</span><p id="par0035" class="elsevierStylePara elsevierViewall">The measured quality indicators were the percentage of patients with glucose monitoring adapted to the dietary intake and medication&#44; the use of insulin administered as basal-bolus or basal-bolus-correction versus insulin administered on a sliding scale and the availability of a recent HbA1c measurement&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">During both periods&#44; we assessed the changes in capillary blood glucose levels at various times of the day and the proportion of patients who experienced hypoglycemia&#46;</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Sample size</span><p id="par0045" class="elsevierStylePara elsevierViewall">A sample size of 404 patients per group was calculated based on the following assumptions&#58; an <span class="elsevierStyleItalic">&#945;</span> error &#40;type 1&#41; of 0&#46;05 &#40;2-tailed test&#41;&#44; a <span class="elsevierStyleItalic">&#946;</span> error &#40;type 2&#41; of 0&#46;2 and a statistical value &#40;1<span class="elsevierStyleHsp" style=""></span>&#8722;<span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">&#946;</span>&#41; of 0&#46;8 to detect a difference of at least 10&#37; in the achievement of objectives with respect to the baseline period&#46;</p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Statistical analysis</span><p id="par0050" class="elsevierStylePara elsevierViewall">The descriptive statistical analysis included the measurements of frequency and percentages for categorical variables and mean and standard deviation for continuous variables&#46; To compare the continuous variables between the 2 study periods&#44; we employed Student&#39;s <span class="elsevierStyleItalic">t</span>-test&#46; The comparison of categorical variables between the 2 periods was performed using the chi-squared test and Fisher&#39;s test when the number of observations was below 5&#46; Values of <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>&#46;05 calculated for 2 tails were considered statistically significant&#46;</p></span></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Results</span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Participating hospitals and patients</span><p id="par0055" class="elsevierStylePara elsevierViewall">The hospitals included in the postintervention study were those that participated in the MIDIA-1 study &#40;baseline period&#41;&#46; There were 44 hospitals with the following distribution&#58; 9 with fewer than 200 beds&#44; 20 with between 200 and 500 beds and 15 with more than 500 beds&#46; A total of 506 patients were included in the baseline period&#44; and 562 were included in the postintervention period&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">The patient characteristics for the 2 periods are listed in <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#46; There were no differences in the mean age&#44; the proportion of men&#44; the length of stay up to the study or the proportion of patients who smoked&#46; The patients in the intervention group had greater comorbidity&#44; a higher degree of disability and a significantly longer disease period than the baseline group&#46; The number of patients who presented a reduction in the MDRD score was higher in the intervention group&#46; However&#44; the proportion of patients with readings below 60<span class="elsevierStyleHsp" style=""></span>mL&#47;min&#47;1&#46;73<span class="elsevierStyleHsp" style=""></span>m<span class="elsevierStyleSup">2</span> was similar in the postintervention and baseline groups &#40;50&#46;0&#37; vs&#46; 47&#46;4&#37;&#44; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;40&#41;&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0065" class="elsevierStylePara elsevierViewall">Prior to admission&#44; the use of oral hypoglycemic therapy was similar in the 2 groups &#40;57&#46;9&#37; baseline group vs&#46; 61&#46;4&#37; postintervention group&#44; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;24&#41;&#44; while the use of subcutaneous therapy was greater in the first group than in the second &#40;42&#46;9&#37; vs&#46; 29&#46;7&#37;&#44; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>&#46;001&#41;&#46; The most frequently used drugs in oral therapy were metformin and dipeptidyl-peptidase 4 inhibitors&#46; The most frequently used drug in the subcutaneous therapy group was insulin glargine&#46;</p></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0115">Impact of the minimal intervention on hyperglycemia management in hospitalized patients</span><p id="par0070" class="elsevierStylePara elsevierViewall">During the hospital stay&#44; blood glucose monitoring adapted to the nutritional and therapeutic requirements was achieved in the baseline period in 71&#46;5&#37; compared with 74&#46;1&#37; in the postintervention period &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;33&#41;&#46; The use of insulin in a baseline-correction regimen was used in a similar proportion of patients &#40;32&#37; vs&#46; 32&#46;6&#37;&#41;&#44; as well as the use of insulin in a basal-bolus-correction regimen &#40;20&#46;7&#37; vs&#46; 24&#44; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;20&#41; in the 2 baseline and post-intervention periods&#44; respectively&#46; The use of insulin in a sliding-scale regimen was maintained constant in the baseline and postintervention period &#40;22&#46;7&#37; vs&#46; 24&#37;&#44; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;61&#41;&#46; In terms of the availability of a recent HbA1c reading&#44; this indicator was met in 54&#46;1&#37; of the patients during the baseline period&#44; while the percentage rose to 66&#46;3&#37; in the postintervention period &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>&#46;001&#41; &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia></span><span id="sec0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0120">Impact of the minimal intervention on hyperglycemia control</span><p id="par0075" class="elsevierStylePara elsevierViewall">We observed no clinically relevant differences in the mean capillary blood glucose values between the baseline and postintervention periods&#44; measured 24<span class="elsevierStyleHsp" style=""></span>h prior to the study&#46; In particular&#44; these values were measured before breakfast &#40;154&#46;7<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>62&#46;3<span class="elsevierStyleHsp" style=""></span>mg&#47;dL vs&#46; 160&#46;7<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>70&#46;4<span class="elsevierStyleHsp" style=""></span>mg&#47;dL&#59; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;14&#41;&#44; before lunch &#40;181&#46;3<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>71&#46;2<span class="elsevierStyleHsp" style=""></span>mg&#47;dL vs&#46; 187&#46;2<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>76&#46;8<span class="elsevierStyleHsp" style=""></span>mg&#47;dL&#59; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;18&#41;&#44; before dinner &#40;190&#46;6<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>72&#46;3<span class="elsevierStyleHsp" style=""></span>mg&#47;dL vs&#46; 194&#46;1<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>73&#46;4<span class="elsevierStyleHsp" style=""></span>mg&#47;dL&#59; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;36&#41; and at midnight &#40;169&#46;1<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>78&#46;7<span class="elsevierStyleHsp" style=""></span>mg&#47;dL vs&#46; 162&#46;6<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>79&#46;8<span class="elsevierStyleHsp" style=""></span>mg&#47;dL&#59; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;14&#41; &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;&#46; The proportion of capillary blood glucose readings in the optimal range &#40;between 70 and 180<span class="elsevierStyleHsp" style=""></span>mg&#47;dL&#41; during the baseline and postintervention periods was similar before breakfast&#44; before lunch&#44; before dinner and at midnight &#40;<a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a>&#41;&#46; The proportion of patients with hypoglycemia during their hospital stay did not change in the baseline or postintervention periods &#40;10&#46;3&#37; vs&#46; 6&#46;3&#37;&#59; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;31&#41;&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="tbl0015"></elsevierMultimedia></span></span><span id="sec0065" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0125">Discussion</span><p id="par0080" class="elsevierStylePara elsevierViewall">We employed 3 important indicators of quality included in the clinical practice guidelines for managing hyperglycemia in hospitalized patients in order to observe differences between 2 periods separated by a minimal intervention&#44; consisting of disseminating the results of the baseline study &#40;benchmarking&#41;&#46;<a class="elsevierStyleCrossRefs" href="#bib0180"><span class="elsevierStyleSup">7&#44;11&#44;12</span></a> Specifically&#44; the evaluated indicators were the percentage of patients with glucose monitoring adapted to their nutritional and therapeutic needs&#44; the use of insulin in basal-bolus or basal-bolus-correction regimen and the availability of a recent HbA1c reading&#46; Although there are no established recommendations&#44; the above-mentioned indicators should be met in at least 80&#37; of the treated patients&#46; In the rest of the cases&#44; the lack of compliance with the indicators could be justified for terminal patients&#44; for scheduled admissions for diagnostic tests or for patients with mild hyperglycemia without treatment&#46;</p><p id="par0085" class="elsevierStylePara elsevierViewall">The clinical practice guidelines state that blood glucose monitoring should be adapted to the patients&#8217; nutritional and medication requirements&#44; which means performing at least 3 capillary blood glucose checks adjusted to dietary intake and 4 capillary blood glucose checks&#44; 1 every 6<span class="elsevierStyleHsp" style=""></span>h&#44; for those patients who are in fasting conditions&#46; Although the clinical practice guidelines recommend the use of supplementary doses of insulin after dinner for hospitalized patients who are fed&#44; the efficacy of this recommendation has been questioned&#46; A recently published clinical trial showed that the rapid administration of insulin after dinner did not improve blood glucose control&#46;<a class="elsevierStyleCrossRef" href="#bib0210"><span class="elsevierStyleSup">13</span></a></p><p id="par0090" class="elsevierStylePara elsevierViewall">In our study&#44; the number of capillary blood glucose checks adjusted to the nutritional and medication needs remained stable in both periods&#44; with readings slightly lower than 80&#37;&#46; It is worth noting that the patients in the postintervention period had a greater degree of frailty due to higher comorbidity&#44; higher dependence and greater glomerular filtration impairment&#46; These aspects should have induced the physicians to a greater degree of adherence to the clinical practice guidelines for reducing adverse events&#46;</p><p id="par0095" class="elsevierStylePara elsevierViewall">The clinical practice guidelines also state that insulin treatment in a basal-bolus-correction regimen is the method of choice for blood glucose control&#46; Various clinical trials have shown that the sliding scale has a greater risk of hypoglycemia and does not allow for strict blood glucose control&#46;<a class="elsevierStyleCrossRefs" href="#bib0215"><span class="elsevierStyleSup">14&#8211;17</span></a> In our study&#44; the administration of insulin in a sliding scale remained at unacceptably high percentages in both periods&#44; with values of approximately 22-24&#37;&#46; Although a number of recent studies conducted in Spain have shown that it is possible to introduce changes in the insulin treatment schemes employed in hospitals&#44;<a class="elsevierStyleCrossRefs" href="#bib0235"><span class="elsevierStyleSup">18&#8211;20</span></a> therapeutic inertia represents a highly significant impediment to incorporating new strategies and could explain the excessive use of insulin in sliding-scale regimens&#46;<a class="elsevierStyleCrossRef" href="#bib0250"><span class="elsevierStyleSup">21</span></a></p><p id="par0100" class="elsevierStylePara elsevierViewall">Lastly&#44; we recorded the availability of a recent HbA1c reading as a prognostic and healthcare quality indicator&#46; HbA1c readings help stratify patients into stress hyperglycemia&#44; recently diagnosed diabetes&#44; known diabetes with good blood glucose control and known diabetes with poor blood glucose control&#46; Stress hyperglycemia is an independent marker of hospital mortality<a class="elsevierStyleCrossRef" href="#bib0255"><span class="elsevierStyleSup">22</span></a> and can worsen the progression of acute coronary syndrome&#44;<a class="elsevierStyleCrossRef" href="#bib0260"><span class="elsevierStyleSup">23</span></a> pneumonia<a class="elsevierStyleCrossRef" href="#bib0265"><span class="elsevierStyleSup">24</span></a> and the postoperative period of orthopedic surgery&#46;<a class="elsevierStyleCrossRef" href="#bib0270"><span class="elsevierStyleSup">25</span></a> In the hospitalized patients with previous diabetes&#44; the presence of HbA1c readings outside the therapeutic objective should induce physicians to increase the intensity of the treatment&#46; Algorithms for treatment prior to discharge have recently been published&#46; The treatment is based on the control range and the treatment prior to hospitalization&#46;<a class="elsevierStyleCrossRef" href="#bib0275"><span class="elsevierStyleSup">26</span></a></p><p id="par0105" class="elsevierStylePara elsevierViewall">The results of the present study show that the impact of the minimal intervention was relatively low&#46; A significant improvement was only achieved by the patients who had a recent assessment of their HbA1c levels&#46; In the setting of diabetes mellitus and primary care&#44; there have been other studies that have evaluated the efficacy of using benchmarking to improve the therapeutic objectives&#46; In particular&#44; the OPTIMISE clinical trial&#44; which was conducted in 6 countries in Europe&#44; assessed the impact of benchmarking on controlling blood pressure&#44; low-density lipoprotein cholesterol and hemoglobin A1c levels of patients with type 2 diabetes&#46;<a class="elsevierStyleCrossRef" href="#bib0280"><span class="elsevierStyleSup">27</span></a> The patients in the intervention group had significant increases &#40;13&#37;&#41; in the achievement of objectives in the analyzed quality indicators&#44; while the control group&#44; which received no information&#44; also had increases &#40;approximately 7&#37;&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0280"><span class="elsevierStyleSup">27</span></a> Educational strategies&#44; such as online courses directed to specialist physicians in hospital practice&#44; could be added as a method of increasing the effect of benchmarking&#46;<a class="elsevierStyleCrossRefs" href="#bib0285"><span class="elsevierStyleSup">28&#44;29</span></a></p><p id="par0110" class="elsevierStylePara elsevierViewall">This study has a strengths and limitations&#46; One of its strengths is the sample size&#44; which helped identify increases of 10&#37; in the improvement of the indicators&#46; However&#44; it is possible that the results show a bias related to the better care of patients with hyperglycemia&#44; because the physicians who participated in the study could have had increased motivation and expertise in treating hyperglycemia in hospitalized patients&#46;</p><p id="par0115" class="elsevierStylePara elsevierViewall">In summary&#44; our results show that a minimal benchmarking intervention was insufficient for improving critical aspects of the care of patients hospitalized with diabetes&#46; The selected indicators summarize critical aspects in the care during hospitalization and help monitor the progress in blood glucose control&#46; However&#44; to achieve improvement to optimal limits&#44; we need multimodal strategies that not only include benchmarking but also educational strategies&#46;</p></span><span id="sec0070" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0130">Diabetes and obesity workgroup</span><p id="par0120" class="elsevierStylePara elsevierViewall">Adelaida Rey Ferrin&#44; University Hospital Son Espases&#59; Palma de Mallorca&#46;</p><p id="par0125" class="elsevierStylePara elsevierViewall">Alejandro Garc&#237;a Mor&#225;n&#44; Hospital of Cabue&#241;es&#59; Gij&#243;n&#44; Asturias&#46;</p><p id="par0130" class="elsevierStylePara elsevierViewall">Alfonso Garc&#237;a Aranda&#44; University Hospital Miguel Servet&#59; Zaragoza&#46;</p><p id="par0135" class="elsevierStylePara elsevierViewall">Alfredo Luis Mich&#225;n Do&#241;a&#44; Specialties Hospital&#59; Jerez de la Frontera&#44; C&#225;diz&#46;</p><p id="par0140" class="elsevierStylePara elsevierViewall">Araceli Jimeno Sainz&#44; University Clinic Hospital Lozano Blesa&#59; Zaragoza&#46;</p><p id="par0145" class="elsevierStylePara elsevierViewall">Ana Barreiro Rivas&#44; University Hospital Complex of Ourense&#59; Orense&#46;</p><p id="par0150" class="elsevierStylePara elsevierViewall">Ana Calzada Valle&#44; University Hospital Virgen del Roc&#237;o&#59; Seville&#46;</p><p id="par0155" class="elsevierStylePara elsevierViewall">Ana Isabel C&#243;rdoba Alonso&#44; University Hospital Marqu&#233;s de Valdecilla&#59; Santander&#46;</p><p id="par0160" class="elsevierStylePara elsevierViewall">Ana Latorre Diez&#44; University Hospital Complex of Ourense&#59; Orense&#46;</p><p id="par0165" class="elsevierStylePara elsevierViewall">Ana Mar&#237;a Garijo Saiz&#44; Hospital Marina Baixa&#59; Villajoyosa&#44; Alicante&#46;</p><p id="par0170" class="elsevierStylePara elsevierViewall">Ana Mar&#237;a Lorenzo Vizcaya&#44; University Hospital Complex of Ourense&#59; Orense&#46;</p><p id="par0175" class="elsevierStylePara elsevierViewall">Arturo Artero Mora&#44; Hospital Doctor Peset&#59; Valencia&#46;</p><p id="par0180" class="elsevierStylePara elsevierViewall">Aurora Villalobos S&#225;nchez&#44; University Regional Hospital of Malaga&#59; Malaga&#46;</p><p id="par0185" class="elsevierStylePara elsevierViewall">B&#225;rbara Rodr&#237;guez Mart&#237;n&#44; Hospital of Hell&#237;n&#59; Hell&#237;n&#44; Albacete&#46;</p><p id="par0190" class="elsevierStylePara elsevierViewall">Bego&#241;a de Escalante Yang&#252;ela&#44; University Clinic Hospital Lozano Blesa&#59; Zaragoza&#46;</p><p id="par0195" class="elsevierStylePara elsevierViewall">Borja del Carmelo Gracia Tello&#44; University Clinic Hospital Lozano Blesa&#59; Zaragoza&#46;</p><p id="par0200" class="elsevierStylePara elsevierViewall">Carlos de Andr&#233;s David&#44; University General Hospital of Valencia&#59; Valencia&#46;</p><p id="par0205" class="elsevierStylePara elsevierViewall">Carlos Moreno Lugr&#237;s&#44; University Hospital Lucus Augusti&#59; Lugo&#46;</p><p id="par0210" class="elsevierStylePara elsevierViewall">Carlos Trescoli Serrano&#44; Hospital of La Ribera&#59; Alcira&#44; Valencia&#46;</p><p id="par0215" class="elsevierStylePara elsevierViewall">Carlota Arg&#252;ello&#44; Central University Hospital of Asturias&#59; Oviedo&#46;</p><p id="par0220" class="elsevierStylePara elsevierViewall">Carmen Mar&#237;n Silvente&#44; University Hospital Morales Meseguer&#59; Murcia&#46;</p><p id="par0225" class="elsevierStylePara elsevierViewall">Carmen Caro Narrillos&#44; Hospital Complex of Pontevedra&#59; Pontevedra&#46;</p><p id="par0230" class="elsevierStylePara elsevierViewall">Concepci&#243;n Gil Anguita&#44; Hospital Marina Baixa&#59; Villajoyosa&#44; Alicante&#46;</p><p id="par0235" class="elsevierStylePara elsevierViewall">Concepci&#243;n Gonz&#225;lez Becerra&#44; Hospital San Juan de Dios del Aljarafe&#59; Seville&#46;</p><p id="par0240" class="elsevierStylePara elsevierViewall">Concepci&#243;n Benito&#44; Hospital Marina Baixa&#59; Villajoyosa&#44; Alicante&#46;</p><p id="par0245" class="elsevierStylePara elsevierViewall">Cristina Soler i Ferrer&#44; Hospital of Santa Caterina&#59; Salt&#44; Gerona&#46;</p><p id="par0250" class="elsevierStylePara elsevierViewall">David Vicente Navarro&#44; Hospital Virgen de los Lirios&#59; Alcoy&#44; Alicante&#46;</p><p id="par0255" class="elsevierStylePara elsevierViewall">Enrique Garc&#237;a Car&#250;s&#44; Central University Hospital of Asturias&#59; Oviedo&#46;</p><p id="par0260" class="elsevierStylePara elsevierViewall">Enrique Gonz&#225;lez Sarmiento&#44; Hospital Clinic of Valladolid&#59; Valladolid&#46;</p><p id="par0265" class="elsevierStylePara elsevierViewall">Estefan&#237;a Pereira D&#237;az&#44; University Hospital Virgen del Roc&#237;o&#59; Seville&#46;</p><p id="par0270" class="elsevierStylePara elsevierViewall">Estela Cobo Garc&#237;a&#44; University Hospital Marqu&#233;s de Valdecilla&#59; Santander&#46;</p><p id="par0275" class="elsevierStylePara elsevierViewall">Eva Calvo Beguer&#237;a&#44; General Hospital San Jorge&#59; Huesca&#46;</p><p id="par0280" class="elsevierStylePara elsevierViewall">Fernando Javier S&#225;nchez Lora&#44; Hospital Virgen de la Victoria&#59; Malaga&#46;</p><p id="par0285" class="elsevierStylePara elsevierViewall">Fernando Mart&#237;nez&#44; University Hospital Clinic of Valencia&#59; Valencia&#46;</p><p id="par0290" class="elsevierStylePara elsevierViewall">Francesc Formiga&#44; Hospital of Bellvitge&#59; Barcelona&#46;</p><p id="par0295" class="elsevierStylePara elsevierViewall">Inmaculada Mej&#237;as Real&#44; Hospital Infanta Margarita&#59; Cabra&#44; C&#243;rdoba&#46;</p><p id="par0300" class="elsevierStylePara elsevierViewall">Isabel Sell&#233;s Sirera&#44; Hospital Marina Baixa&#59; Villajoyosa&#44; Alicante&#46;</p><p id="par0305" class="elsevierStylePara elsevierViewall">Javier Alonso Pe&#241;a&#44; Hospital Virgen del Puerto&#59; Plasencia&#44; C&#225;ceres&#46;</p><p id="par0310" class="elsevierStylePara elsevierViewall">Javier Ena&#44; Hospital Marina Baixa&#59; Villajoyosa&#46; Alicante&#59;</p><p id="par0315" class="elsevierStylePara elsevierViewall">Javier Fern&#225;ndez-Cuervo Lorente&#44; Hospital La Plana Villarreal&#59; Villareal&#44; Castell&#243;n&#46;</p><p id="par0320" class="elsevierStylePara elsevierViewall">Jessica Rugeles Ni&#241;o&#44; Central University Hospital of Asturias&#59; Oviedo&#46;</p><p id="par0325" class="elsevierStylePara elsevierViewall">Joaqu&#237;n Ant&#243;n Mart&#237;nez&#44; Hospital San Pedro de Alc&#225;ntara&#59; C&#225;ceres&#46;</p><p id="par0330" class="elsevierStylePara elsevierViewall">Joaqu&#237;n Bernardo Cofi&#241;o&#44; Hospital of Jarrio&#59; Coa&#241;a&#44; Asturias&#46;</p><p id="par0335" class="elsevierStylePara elsevierViewall">Jos&#233; Manuel Varela Aguilar&#44; Hospital Virgen del Roc&#237;o&#59; Seville&#46;</p><p id="par0340" class="elsevierStylePara elsevierViewall">Jos&#233; Mar&#237;a Fern&#225;ndez Rodr&#237;guez&#44; Hospital Carmen y Severo Ochoa&#59; Cangas de Narcea&#44; Asturias&#46;</p><p id="par0345" class="elsevierStylePara elsevierViewall">Jos&#233; Nicol&#225;s Alcal&#225; Pedradas&#44; Regional Hospital of Pozoblanco&#59; C&#243;rdoba&#46;</p><p id="par0350" class="elsevierStylePara elsevierViewall">Leticia Urbina Soto&#44; University Hospital Marqu&#233;s de Valdecilla&#59; Santander&#46;</p><p id="par0355" class="elsevierStylePara elsevierViewall">Lourdes Mateos Polo&#44; Hospital Virgen de la Vega&#59; Salamanca&#46;</p><p id="par0360" class="elsevierStylePara elsevierViewall">Mar&#237;a Ar&#225;nzazu Caudevilla Mart&#237;nez&#44; Hospital Ernest Lluch Mart&#237;n&#59; Calatayud&#44; Zaragoza&#46;</p><p id="par0365" class="elsevierStylePara elsevierViewall">Mar&#237;a Monserrat Chimeno Vi&#241;as&#44; Hospital Virgen de la Concha&#59; Zamora&#46;</p><p id="par0370" class="elsevierStylePara elsevierViewall">Mar&#237;a Jes&#250;s Ig&#250;zquiza Pellejero&#44; Hospital Royo Villanova&#59; Zaragoza&#46;</p><p id="par0375" class="elsevierStylePara elsevierViewall">Mar&#237;a Luisa Ab&#237;nzano Guill&#233;n&#44; Hospital Garc&#237;a Orcoyen&#59; Estella&#44; Navarra&#46;</p><p id="par0380" class="elsevierStylePara elsevierViewall">Mar&#237;a Soledad Sanz Parras&#44; Regional Hospital of Inca&#59; Inca&#44; Islas Baleares&#46;</p><p id="par0385" class="elsevierStylePara elsevierViewall">Mar&#237;a Victoria Pardo Ortega&#44; Hospital of Terrassa&#59; Barcelona&#46;</p><p id="par0390" class="elsevierStylePara elsevierViewall">Marta Carmen Esles Bolado&#44; Hospital Sierrallana&#59; Torrelavega&#44; Cantabria&#46;</p><p id="par0395" class="elsevierStylePara elsevierViewall">Marta Romero S&#225;nchez&#44; University Hospital of Fuenlabrada&#59; Madrid&#46;</p><p id="par0400" class="elsevierStylePara elsevierViewall">Miriam D&#237;ez Fern&#225;ndez&#44; Hospital of Cabue&#241;es&#59; Gij&#243;n&#44; Asturias&#46;</p><p id="par0405" class="elsevierStylePara elsevierViewall">Mois&#233;s de Vicente Collado&#44; Hospital Nuestra Se&#241;ora del Prado&#59; Talavera de la Reina&#44; Toledo&#46;</p><p id="par0410" class="elsevierStylePara elsevierViewall">Montserrat Garc&#237;a Cors&#44; General Hospital of Catalonia&#59; Sant Cugat del Vall&#232;s&#44; Barcelona&#46;</p><p id="par0415" class="elsevierStylePara elsevierViewall">Noelia G&#243;mez Aguirre&#44; Hospital Ernest Lluch Mart&#237;n&#59; Calatayud&#44; Zaragoza&#46;</p><p id="par0420" class="elsevierStylePara elsevierViewall">Patricia Platero Mihi&#44; Hospital of La Ribera&#59; Alcira&#44; Valencia&#46;</p><p id="par0425" class="elsevierStylePara elsevierViewall">Patricia V&#225;zquez Rodr&#237;guez&#44; University Hospital Complex A Coru&#241;a&#59; La Coru&#241;a&#46;</p><p id="par0430" class="elsevierStylePara elsevierViewall">Patxi Huici Polo&#44; Hospital Ernest Lluch Mart&#237;n&#59; Calatayud&#44; Zaragoza&#46;</p><p id="par0435" class="elsevierStylePara elsevierViewall">Pedro Abad Requejo&#44; Hospital del Oriente de Asturias&#59; Arriondas&#44; Parres&#44; Asturias&#46;</p><p id="par0440" class="elsevierStylePara elsevierViewall">Pilar Rom&#225;n S&#225;nchez&#44; General Hospital of Requena&#59; Requena&#44; Valencia&#46;</p><p id="par0445" class="elsevierStylePara elsevierViewall">Rafael Arnal Gracia&#44; Hospital Ernest Lluch Mart&#237;n&#59; Calatayud&#44; Zaragoza&#46;</p><p id="par0450" class="elsevierStylePara elsevierViewall">Rafael Silvari&#241;o Fern&#225;ndez&#44; Hospital San Eloy&#59; Barakaldo&#44; Vizcaya&#46;</p><p id="par0455" class="elsevierStylePara elsevierViewall">Ram&#243;n Baeza Trinidad&#44; Hospital San Pedro&#59; Logro&#241;o&#46;</p><p id="par0460" class="elsevierStylePara elsevierViewall">Roberto P&#233;rez &#193;lvarez&#44; Hospital Meixoeiro&#59; Vigo&#44; Pontevedra&#46;</p><p id="par0465" class="elsevierStylePara elsevierViewall">Rosa Garc&#237;a Contreras&#44; University Hospital Virgen del Roc&#237;o&#59; Seville&#46;</p><p id="par0470" class="elsevierStylePara elsevierViewall">Ruth Brea Aparicio&#44; Hospital Complex of Pontevedra&#59; Pontevedra&#46;</p><p id="par0475" class="elsevierStylePara elsevierViewall">Saioa Eguiluz Casta&#241;&#243;n&#44; University Hospital Araba-Txagorritxu&#59; Vitoria&#46;</p><p id="par0480" class="elsevierStylePara elsevierViewall">Svetlana Zhilina&#44; University Clinic Hospital of Salamanca&#59; Salamanca&#46;</p><p id="par0490" class="elsevierStylePara elsevierViewall">Virginia Herrero Garc&#237;a&#44; Regional Hospital of La Axarqu&#237;a&#59; V&#233;lez-M&#225;laga&#44; Malaga&#46;</p></span><span id="sec0075" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0135">Informed consent</span><p id="par0495" class="elsevierStylePara elsevierViewall">The Spanish Society of Internal Medicine has established that the present study constitutes a research study into health services and for improving the quality of care&#46; Informed consent for participation in the study was therefore not considered necessary&#46;</p></span><span id="sec0080" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0140">Ethical and legal principles</span><p id="par0500" class="elsevierStylePara elsevierViewall">The project complied with the requirements established in Spanish law regarding biomedical research&#44; data protection and bioethics&#46;</p></span><span id="sec0085" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0145">Conflicts of interest</span><p id="par0505" class="elsevierStylePara elsevierViewall">The authors declare that they have no conflicts of interest&#46;</p></span></span>"
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              "titulo" => "Participating hospitals and patients"
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              "titulo" => "Impact of the minimal intervention on hyperglycemia management in hospitalized patients"
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              "titulo" => "Impact of the minimal intervention on hyperglycemia control"
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          "titulo" => "Diabetes and obesity workgroup"
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    "fechaRecibido" => "2016-01-12"
    "fechaAceptado" => "2016-05-08"
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            0 => "Diabetes mellitus"
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        "titulo" => "Abstract"
        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Objectives</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">We evaluated the effect of an intervention on certain quality indicators employed for improving the treatment of hospital hyperglycemia&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Material and methods</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">A multicenter cross-sectional study was conducted on patients with hyperglycemia hospitalized in the internal medicine departments of 44 hospitals evaluated in 2 time periods&#58; 2014 &#40;baseline period&#41; and 2015 &#40;postintervention period&#41;&#46; The intervention consisted of the dissemination of the indicators obtained in 2014 and the objectives for improvement&#46; As indicators&#44; we assessed the frequency of glucose monitoring adapted to the patient&#39;s dietary intake or medication&#44; the use of basal-bolus or basal-bolus-correction insulin therapy as the preferred control method of hyperglycemia and the recent availability of HbA1c prior to hospital discharge&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">A total of 506 and 562 patients were assessed in 2014 and 2015&#44; respectively&#46; The results of the indicators in the baseline and postintervention periods were as follows&#58; blood glucose monitoring adapted to the dietary intake or the medication &#40;71&#46;5 vs&#46; 74&#46;1&#37;&#44; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;33&#41;&#44; use of insulin in basal-correction regimen &#40;32 vs&#46; 32&#46;6&#37;&#44; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;61&#41; or basal-bolo-correction &#40;20&#46;7 vs&#46; 24&#44; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;20&#41; and recent HbA1c value &#40;54&#46;1 vs&#46; 66&#46;3&#37;&#44; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>&#46;001&#41;&#46; The mean glucose values in the 24<span class="elsevierStyleHsp" style=""></span>h prior to the study were similar in the 2 periods&#46; The rate of hypoglycemia was also similar in both periods &#40;3&#46;3 vs&#46; 2&#46;3&#37;&#44; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;31&#41;&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusions</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">There is a need to implement multimodal interventions to improve the treatment of hyperglycemia in patients hospitalized in noncritical areas&#46;</p></span>"
        "secciones" => array:4 [
          0 => array:2 [
            "identificador" => "abst0005"
            "titulo" => "Objectives"
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          1 => array:2 [
            "identificador" => "abst0010"
            "titulo" => "Material and methods"
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          2 => array:2 [
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            "titulo" => "Results"
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        "titulo" => "Resumen"
        "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Objetivos</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Evaluamos el efecto de una intervenci&#243;n sobre determinados indicadores de calidad utilizados para mejorar el tratamiento de la hiperglucemia hospitalaria&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Material y m&#233;todos</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Estudio transversal multic&#233;ntrico de pacientes con hiperglucemia ingresados en servicios de Medicina Interna de 44 hospitales evaluados en 2 periodos&#58; 2014 &#40;periodo basal&#41; y 2015 &#40;periodo postintervenci&#243;n&#41;&#46; La intervenci&#243;n consisti&#243; en la difusi&#243;n de los indicadores obtenidos en el a&#241;o 2014 y de los objetivos de mejora&#46; Como indicadores se evalu&#243; la frecuencia de monitorizaci&#243;n de la glucosa adaptada a la ingesta o la medicaci&#243;n del paciente&#44; el uso de insulina en r&#233;gimen basal-bolo o basal-bolo-correcci&#243;n como m&#233;todo de control de la hiperglucemia y la disponibilidad reciente de HbA1c previa al alta hospitalaria&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Resultados</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">En el a&#241;o 2014 se evalu&#243; a 506 pacientes y en el 2015 a 562&#46; Los resultados de los indicadores en el periodo basal y postintervenci&#243;n fueron los siguientes&#58; monitorizaci&#243;n de la glucemia adaptada a la ingesta o la medicaci&#243;n &#40;71&#44;5 frente a 74&#44;1&#37;&#59; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;33&#41;&#44; uso de insulina en r&#233;gimen basal-correcci&#243;n &#40;32 frente a 32&#44;6&#37;&#59; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;61&#41; o basal-bolo-correcci&#243;n &#40;20&#44;7 frente a 24&#37;&#59; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;20&#41; y valor reciente de HbA1c &#40;54&#44;1 frente a 66&#44;3&#37;&#59; p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41;&#46; Los valores medios de glucosa en las 24<span class="elsevierStyleHsp" style=""></span>h previos al estudio fueron similares en los 2 periodos&#46; El porcentaje de hipoglucemias tambi&#233;n fue similar en ambos periodos &#40;3&#44;3 vs&#46; 2&#44;3&#37;&#59; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;31&#41;&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclusiones</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Es necesario implementar intervenciones multimodales para mejorar el tratamiento de la hiperglucemia en pacientes hospitalizados en &#225;reas no cr&#237;ticas&#46;</p></span>"
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            "titulo" => "Resultados"
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        "etiqueta" => "&#9734;"
        "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as&#58; Ena J&#44; G&#243;mez-Huelgas R&#44; Zapatero-Gaviria A&#44; V&#225;zquez-Rodriguez P&#44; Gonz&#225;lez-Becerra C&#44; Romero-S&#225;nchez M&#44; et al&#46; Efecto de una intervenci&#243;n sobre indicadores de calidad para mejorar el tratamiento de la hiperglucemia en pacientes hospitalizados en &#225;reas no cr&#237;ticas&#46; Rev Clin Esp&#46; 2016&#59;216&#58;352&#8211;360&#46;</p>"
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          "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Capillary blood glucose profile in the baseline and postintervention groups in the 24<span class="elsevierStyleHsp" style=""></span>h prior to the study&#46;</p>"
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                  <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="" valign="top" scope="col" style="border-bottom: 2px solid black">&nbsp;\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">Baseline period &#40;<span class="elsevierStyleItalic">N</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>506&#41;&nbsp;\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">Postintervention period &#40;<span class="elsevierStyleItalic">N</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>562&#41;&nbsp;\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"><span class="elsevierStyleItalic">p</span>&nbsp;\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"><span class="elsevierStyleBold">Mean age&#44; years &#40;SD&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">76 &#40;10&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">76 &#40;11&#46;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#46;99&nbsp;\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"><span class="elsevierStyleBold">Male sex&#44;</span><span class="elsevierStyleItalic"><span class="elsevierStyleBold">n</span></span><span class="elsevierStyleBold">&#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">266 &#40;52&#46;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">294 &#40;52&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#46;93&nbsp;\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"><span class="elsevierStyleBold">Mean hospital stay&#44; days &#40;SD&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">10&#46;0 &#40;16&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">9 &#40;13&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#46;28&nbsp;\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"><span class="elsevierStyleBold">Smoking status&#44;</span><span class="elsevierStyleItalic"><span class="elsevierStyleBold">n</span></span><span class="elsevierStyleBold">&#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">57 &#40;11&#46;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">58 &#40;10&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#46;62&nbsp;\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"><span class="elsevierStyleBold">Mean Charlson comorbidity score &#40;SD&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3&#46;9 &#40;2&#46;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">4&#46;3 &#40;2&#46;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#46;007&nbsp;\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"><span class="elsevierStyleBold">Mean Rankin disability score &#40;SD&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&#46;5 &#40;1&#46;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&#46;3 &#40;1&#46;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#46;070&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="4" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleBold">Type of diabetes&#44;</span><span class="elsevierStyleItalic"><span class="elsevierStyleBold">n</span></span><span class="elsevierStyleBold">&#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#60;&#46;001&nbsp;\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"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Type 1</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">4 &#40;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">4 &#40;0&#46;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\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"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Type 2</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">474 &#40;93&#46;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">478 &#40;85&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\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"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Other</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">22 &#40;4&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">7 &#40;1&#46;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\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"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Lost data</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">6 &#40;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">73 &#40;12&#46;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\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"><span class="elsevierStyleBold">Mean duration of the diabetes&#44; years &#40;SD&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">10&#46;8 &#40;8&#46;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">9&#46;8 &#40;7&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#46;03&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="4" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="4" align="left" valign="top"><span class="elsevierStyleBold">Diabetes treatment prior to admission</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Oral hypoglycemic agents&#44; n &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">293 &#40;57&#46;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">345 &#40;61&#46;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#46;24&nbsp;\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"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Metformin&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">215 &#40;42&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">257 &#40;45&#46;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#46;28&nbsp;\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"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Sulfonylurea&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">55 &#40;10&#46;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">51 &#40;9&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#46;32&nbsp;\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"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Thiazolidinedione&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1 &#40;0&#46;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">7 &#40;1&#46;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#46;05&nbsp;\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"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Glinide&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">40 &#40;7&#46;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">49 &#40;8&#46;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#46;63&nbsp;\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"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>DPP4 inhibitor&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">103 &#40;20&#46;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">120 &#40;21&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#46;69&nbsp;\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"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Alpha-glucosidase inhibitor&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1 &#40;0&#46;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1 &#40;0&#46;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#46;94&nbsp;\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"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>SGLT2 inhibitor&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">4 &#40;0&#46;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1 &#40;0&#46;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#46;31&nbsp;\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"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Subcutaneous therapy&#44; n &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">217 &#40;42&#46;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">167 &#40;29&#46;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#60;&#46;001&nbsp;\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"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>GLP1 agonist&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3 &#40;0&#46;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#46;001&nbsp;\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"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Biphasic insulin&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">50 &#40;9&#46;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#60;&#46;001&nbsp;\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"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Insulin detemir&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">29 &#40;15&#46;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">31 &#40;5&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#46;87&nbsp;\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"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Insulin glargine&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">77 &#40;20&#46;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">125 &#40;22&#46;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#46;003&nbsp;\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"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Insulin NPH&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">16 &#40;3&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">11 &#40;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#46;21&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="4" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleBold">Reason for hospitalization</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#46;79&nbsp;\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"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Diabetes-related</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">12 &#40;2&#46;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">12 &#40;2&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\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"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Not diabetes-related</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">494 &#40;97&#46;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">550 &#40;97&#46;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\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"><span class="elsevierStyleBold">Mean HbA1c&#44; &#37; &#40;SD&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">7&#46;2 &#40;1&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">7&#46;0 &#40;2&#46;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#46;11&nbsp;\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"><span class="elsevierStyleBold">HbA1c &#62;9&#37;&#44;</span><span class="elsevierStyleItalic"><span class="elsevierStyleBold">n</span></span><span class="elsevierStyleBold">&#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">37 &#40;7&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">53 &#40;9&#46;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#46;21&nbsp;\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"><span class="elsevierStyleBold">Mean glomerular filtration rate&#44; mL&#47;min&#47;1&#46;73</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleBold">m</span><span class="elsevierStyleSup"><span class="elsevierStyleBold">2</span></span><span class="elsevierStyleBold">&#40;SD&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">64&#46;7 &#40;29&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">60&#46;1 &#40;25&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#46;006&nbsp;\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"><span class="elsevierStyleBold">Glomerular filtration rate</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleBold">&#60;60</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleBold">mL&#47;min&#47;1&#46;73</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleBold">m</span><span class="elsevierStyleSup"><span class="elsevierStyleBold">2</span></span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">240 &#40;47&#46;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">281 &#40;50&#46;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#46;40&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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          "en" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Characteristics of the patients in the MIDIA-1 &#40;baseline&#41; and MIDIA-2 &#40;postsurgery&#41; studies&#46;</p>"
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        "identificador" => "tbl0010"
        "etiqueta" => "Table 2"
        "tipo" => "MULTIMEDIATABLA"
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          0 => array:3 [
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                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="" valign="top" scope="col" style="border-bottom: 2px solid black">&nbsp;\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">Baseline period &#40;<span class="elsevierStyleItalic">N</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>506&#41;&nbsp;\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">Postintervention period &#40;<span class="elsevierStyleItalic">N</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>562&#41;&nbsp;\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"><span class="elsevierStyleItalic">p</span>&nbsp;\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"><span class="elsevierStyleItalic">Monitoring of capillary glycemia adjusted to dietary intake and medication needs&#44; n &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">362 &#40;71&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">417 &#40;74&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#46;33&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="4" align="left" valign="top"><span class="elsevierStyleItalic">Treatment&#44; n &#40;&#37;&#41;</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Oral hypoglycemic agents&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">38 &#40;7&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">52 &#40;9&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#46;30&nbsp;\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"><span class="elsevierStyleHsp" style=""></span>Insulin&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">398 &#40;78&#46;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">477 &#40;84&#46;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#46;008&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="4" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="4" align="left" valign="top"><span class="elsevierStyleItalic">Insulin therapy regimen&#44; n &#40;&#37;&#41;</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Sliding scale therapy&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">115 &#40;22&#46;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">135 &#40;24&#46;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#46;61&nbsp;\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"><span class="elsevierStyleHsp" style=""></span>Therapy with baseline analog or insulin NPH administered twice a day&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">16 &#40;3&#46;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">24 &#40;4&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#46;34&nbsp;\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"><span class="elsevierStyleHsp" style=""></span>Therapy with baseline analog or insulin NPH administered twice a day and prandial insulin&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">162 &#40;32&#46;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">183 &#40;32&#46;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#46;61&nbsp;\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"><span class="elsevierStyleHsp" style=""></span>Therapy with baseline analog or insulin NPH administered twice a day&#44; prandial insulin and hyperglycemia correction higher than desired level&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">105 &#40;20&#46;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">135 &#40;24&#46;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#46;20&nbsp;\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"><span class="elsevierStyleItalic">Recent HbA1c prior to discharge&#44; n &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">274 &#40;54&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">373 &#40;66&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#60;&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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          "en" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Quality indicators assessed&#46;</p>"
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        "etiqueta" => "Table 3"
        "tipo" => "MULTIMEDIATABLA"
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          0 => array:3 [
            "identificador" => "at3"
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                  <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  " colspan="2" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Before breakfast Glucose between 70 y 180<span class="elsevierStyleHsp" style=""></span>mg&#47;dL&#44; <span class="elsevierStyleItalic">n</span> &#40;&#37;&#41;</th><th class="td" title="table-head  " colspan="2" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Before lunch Glucose between 70 y 180<span class="elsevierStyleHsp" style=""></span>mg&#47;dL&#44; <span class="elsevierStyleItalic">n</span> &#40;&#37;&#41;</th><th class="td" title="table-head  " colspan="2" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Before dinner Glucose between 70 y 180<span class="elsevierStyleHsp" style=""></span>mg&#47;dL&#44; <span class="elsevierStyleItalic">n</span> &#40;&#37;&#41;</th><th class="td" title="table-head  " colspan="2" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">At midnight Glucose between 70 y 180<span class="elsevierStyleHsp" style=""></span>mg&#47;dL&#44; <span class="elsevierStyleItalic">n</span> &#40;&#37;&#41;</th></tr><tr title="table-row"><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Baseline period&nbsp;\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">Postintervention period&nbsp;\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">Baseline period&nbsp;\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">Postintervention period&nbsp;\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">Baseline period&nbsp;\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">Postintervention period&nbsp;\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">Baseline period&nbsp;\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">Postintervention period&nbsp;\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">296 &#40;58&#46;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">305 &#40;54&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">201 &#40;39&#46;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">202 &#40;35&#46;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">170 &#40;33&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">202 &#40;35&#44;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">27 &#40;2&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">7 &#40;1&#44;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="2" align="center" valign="middle"><span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;16</td><td class="td" title="table-entry  " colspan="2" align="center" valign="middle"><span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;02</td><td class="td" title="table-entry  " colspan="2" align="center" valign="middle"><span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;42</td><td class="td" title="table-entry  " colspan="2" align="center" valign="middle"><span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;12</td></tr></tbody></table>
                  """
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          "en" => "<p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">Capillary glycemia and glycemia in the desired range in the 24<span class="elsevierStyleHsp" style=""></span>h prior to the study&#46;</p>"
        ]
      ]
    ]
    "bibliografia" => array:2 [
      "titulo" => "References"
      "seccion" => array:1 [
        0 => array:2 [
          "identificador" => "bibs0005"
          "bibliografiaReferencia" => array:29 [
            0 => array:3 [
              "identificador" => "bib0150"
              "etiqueta" => "1"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Frequency of hypoglycemia and its impact on length of stay&#44; mortality&#44; and short-term readmission in patients with diabetes hospitalized in internal medicine wards"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "A&#46; Zapatero"
                            1 => "R&#46; G&#243;mez-Huelgas"
                            2 => "N&#46; Gonz&#225;lez"
                            3 => "J&#46; Canora"
                            4 => "A&#46; Asenjo"
                            5 => "J&#46; Hinojosa"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
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Original article
DOI: 10.1016/j.rceng.2016.05.004
Effect of an intervention on quality indicators for improving the treatment of hyperglycemia in patients hospitalized in noncritical areas
Efecto de una intervención sobre indicadores de calidad para mejorar el tratamiento de la hiperglucemia en pacientes hospitalizados en áreas no críticas
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J. Enaa,
Corresponding author
ena_jav@gva.es

Corresponding author.
, R. Gómez-Huelgasb, A. Zapatero-Gaviriac, P. Vázquez-Rodriguezd, C. González-Becerrae, M. Romero-Sánchezc, M.J. Igúzquiza-Pellejerof, A. Artero-Morag, J.M. Varela-Aguilarh, On behalf of the Grupo de Estudio de Diabetes y Obesidad de la Sociedad Española de Medicina Interna
a Departamento de Medicina Interna, Hospital Marina Baixa, Villajoyosa, Alicante, Spain
b Departamento de Medicina Interna, Hospital Regional Universitario de Málaga, Málaga, Spain
c Departamento de Medicina Interna, Hospital Universitario de Fuenlabrada, Madrid, Spain
d Departamento de Medicina Interna, Complejo Hospitalario A Coruña, La Coruña, Spain
e Departamento de Medicina Interna, Hospital San Juan de Dios Aljarafe, Sevilla, Spain
f Departamento de Medicina Interna, Hospital Royo Villanova, Zaragoza, Spain
g Departamento de Medicina Interna, Hospital Dr. Peset, Valencia, Spain
h Departamento de Medicina Interna, Hospital Virgen del Rocío, Sevilla, Spain

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