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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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