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array:25 [ "pii" => "S2254887419300037" "issn" => "22548874" "doi" => "10.1016/j.rceng.2019.01.002" "estado" => "S300" "fechaPublicacion" => "2019-05-01" "aid" => "1599" "copyright" => "Elsevier España, S.L.U. and Sociedad Española de Medicina Interna (SEMI)" "copyrightAnyo" => "2018" "documento" => "article" "crossmark" => 1 "subdocumento" => "fla" "cita" => "Rev Clin Esp. 2019;219:177-83" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:2 [ "total" => 1 "HTML" => 1 ] "Traduccion" => array:1 [ "es" => array:19 [ "pii" => "S0014256518303084" "issn" => "00142565" "doi" => "10.1016/j.rce.2018.10.005" "estado" => "S300" "fechaPublicacion" => "2019-05-01" "aid" => "1599" "copyright" => "Elsevier España, S.L.U. and Sociedad Española de Medicina Interna (SEMI)" "documento" => "article" "crossmark" => 1 "subdocumento" => "fla" "cita" => "Rev Clin Esp. 2019;219:177-83" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:2 [ "total" => 31 "formatos" => array:2 [ "HTML" => 20 "PDF" => 11 ] ] "es" => array:13 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Original</span>" "titulo" => "Prevalencia de diabetes, utilización de antidiabéticos y grado de control glucémico en la provincia de Cádiz (2014-2016): un estudio de base poblacional" "tienePdf" => "es" "tieneTextoCompleto" => "es" "tieneResumen" => array:2 [ 0 => "es" 1 => "en" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "177" "paginaFinal" => "183" ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "Prevalence of diabetes, use of antidiabetic drugs and degree of glycaemic control in the province of Cadiz (2014-2016): A population-based study" ] ] "contieneResumen" => array:2 [ "es" => true "en" => true ] "contieneTextoCompleto" => array:1 [ "es" => true ] "contienePdf" => array:1 [ "es" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0015" "etiqueta" => "Figura 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 1248 "Ancho" => 2093 "Tamanyo" => 159839 ] ] "descripcion" => array:1 [ "es" => "<p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">Pacientes con diabetes tratada sin prueba de HbA1c en el año y pacientes controlados por escalón terapéutico en 2016.</p> <p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">Todas las cifras de control están calculadas respecto a los pacientes de los que se disponía de evaluación de la HbA1c.</p> <p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">Controlados ADA1: en ≤<span class="elsevierStyleHsp" style=""></span>75 años HbA1c<span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>7% y en<span class="elsevierStyleHsp" style=""></span>><span class="elsevierStyleHsp" style=""></span>75 años HbA1c<span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>7,5%; controlados ADA2: en ≤<span class="elsevierStyleHsp" style=""></span>75 años HbA1c<span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>7% y en<span class="elsevierStyleHsp" style=""></span>><span class="elsevierStyleHsp" style=""></span>75 años HbA1c<span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>8,0%; controlados RedGDPS: en ≤<span class="elsevierStyleHsp" style=""></span>75 años HbA1c<span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>7% y en<span class="elsevierStyleHsp" style=""></span>><span class="elsevierStyleHsp" style=""></span>75 años HbA1c<span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>8,5%.</p> <p id="spar0075" class="elsevierStyleSimplePara elsevierViewall">ADA: <span class="elsevierStyleItalic">American Diabetes Association</span>; RedGDPS: Red de grupos de estudio de diabetes en atención primaria de salud.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "J. Escribano Serrano, M.I. Méndez-Esteban, A. García-Bonilla, M. Márquez-Ferrando, C. Casto-Jarillo, E. Berruguilla Pérez, M.M. Calero Ruiz, M.L. Gonzalez Borrachero, J.D. Santotoribio, A. Michán-Doña" "autores" => array:10 [ 0 => array:2 [ "nombre" => "J." "apellidos" => "Escribano Serrano" ] 1 => array:2 [ "nombre" => "M.I." "apellidos" => "Méndez-Esteban" ] 2 => array:2 [ "nombre" => "A." "apellidos" => "García-Bonilla" ] 3 => array:2 [ "nombre" => "M." "apellidos" => "Márquez-Ferrando" ] 4 => array:2 [ "nombre" => "C." "apellidos" => "Casto-Jarillo" ] 5 => array:2 [ "nombre" => "E." "apellidos" => "Berruguilla Pérez" ] 6 => array:2 [ "nombre" => "M.M." "apellidos" => "Calero Ruiz" ] 7 => array:2 [ "nombre" => "M.L." "apellidos" => "Gonzalez Borrachero" ] 8 => array:2 [ "nombre" => "J.D." "apellidos" => "Santotoribio" ] 9 => array:2 [ "nombre" => "A." "apellidos" => "Michán-Doña" ] ] ] ] ] "idiomaDefecto" => "es" "Traduccion" => array:1 [ "en" => array:9 [ "pii" => "S2254887419300037" "doi" => "10.1016/j.rceng.2019.01.002" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2254887419300037?idApp=WRCEE" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0014256518303084?idApp=WRCEE" "url" => "/00142565/0000021900000004/v1_201904260611/S0014256518303084/v1_201904260611/es/main.assets" ] ] "itemSiguiente" => array:19 [ "pii" => "S2254887419300207" "issn" => "22548874" "doi" => "10.1016/j.rceng.2018.11.011" "estado" => "S300" "fechaPublicacion" => "2019-05-01" "aid" => "1605" "copyright" => "Elsevier España, S.L.U. and Sociedad Española de Medicina Interna (SEMI)" "documento" => "article" "crossmark" => 1 "subdocumento" => "fla" "cita" => "Rev Clin Esp. 2019;219:184-8" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "en" => array:12 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Original article</span>" "titulo" => "Series of 12 cases of wheat-dependent exercise-induced allergy in Aragon, Spain" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => array:2 [ 0 => "en" 1 => "es" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "184" "paginaFinal" => "188" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Serie de 12 casos de alergia al trigo dependiente de ejercicio físico en Aragón, España" ] ] "contieneResumen" => array:2 [ "en" => true "es" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "A. Agulló-García, J.L. Cubero Saldaña, C. Colás Sanz" "autores" => array:3 [ 0 => array:2 [ "nombre" => "A." "apellidos" => "Agulló-García" ] 1 => array:2 [ "nombre" => "J.L." "apellidos" => "Cubero Saldaña" ] 2 => array:2 [ "nombre" => "C." "apellidos" => "Colás Sanz" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S0014256518303266" "doi" => "10.1016/j.rce.2018.11.004" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0014256518303266?idApp=WRCEE" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2254887419300207?idApp=WRCEE" "url" => "/22548874/0000021900000004/v1_201904260621/S2254887419300207/v1_201904260621/en/main.assets" ] "itemAnterior" => array:19 [ "pii" => "S2254887419300554" "issn" => "22548874" "doi" => "10.1016/j.rceng.2019.03.004" "estado" => "S300" "fechaPublicacion" => "2019-05-01" "aid" => "1606" "copyright" => "Elsevier España, S.L.U. and Sociedad Española de Medicina Interna (SEMI)" "documento" => "article" "crossmark" => 1 "subdocumento" => "fla" "cita" => "Rev Clin Esp. 2019;219:171-6" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "en" => array:13 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Original article</span>" "titulo" => "RECALMIN. Four years of growth of the internal medicine units of the Spanish National Health System (2013–2016)" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => array:2 [ 0 => "en" 1 => "es" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "171" "paginaFinal" => "176" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "RECALMIN. Cuatro años de evolución de las Unidades de Medicina Interna del Sistema Nacional de Salud (2013-2016)" ] ] "contieneResumen" => array:2 [ "en" => true "es" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 922 "Ancho" => 1528 "Tamanyo" => 81538 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Correlation between the number of discharges by internal medicine units recorded using the survey (RECALMIN) and minimum basic data set.</p> <p id="spar0050" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleItalic">Abbreviation</span>: MBDS, minimum basic data set.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "A. Zapatero-Gaviria, R. Gomez-Huelgas, J. Diez-Manglano, R. Barba-Martín, J. Carretero-Gomez, A. Maestre-Peiró, J.L. Bernal-Sobrino, J. Marco-Martinez, C. Fernandez-Perez, F.J. Elola-Somoza" "autores" => array:10 [ 0 => array:2 [ "nombre" => "A." "apellidos" => "Zapatero-Gaviria" ] 1 => array:2 [ "nombre" => "R." "apellidos" => "Gomez-Huelgas" ] 2 => array:2 [ "nombre" => "J." "apellidos" => "Diez-Manglano" ] 3 => array:2 [ "nombre" => "R." "apellidos" => "Barba-Martín" ] 4 => array:2 [ "nombre" => "J." "apellidos" => "Carretero-Gomez" ] 5 => array:2 [ "nombre" => "A." "apellidos" => "Maestre-Peiró" ] 6 => array:2 [ "nombre" => "J.L." "apellidos" => "Bernal-Sobrino" ] 7 => array:2 [ "nombre" => "J." "apellidos" => "Marco-Martinez" ] 8 => array:2 [ "nombre" => "C." "apellidos" => "Fernandez-Perez" ] 9 => array:2 [ "nombre" => "F.J." "apellidos" => "Elola-Somoza" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S0014256518303278" "doi" => "10.1016/j.rce.2018.11.005" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0014256518303278?idApp=WRCEE" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2254887419300554?idApp=WRCEE" "url" => "/22548874/0000021900000004/v1_201904260621/S2254887419300554/v1_201904260621/en/main.assets" ] "asociados" => array:1 [ 0 => array:19 [ "pii" => "S225488741930089X" "issn" => "22548874" "doi" => "10.1016/j.rceng.2019.03.017" "estado" => "S300" "fechaPublicacion" => "2019-05-01" "aid" => "1652" "copyright" => "Elsevier España, S.L.U. and Sociedad Española de Medicina Interna (SEMI)" "documento" => "simple-article" "crossmark" => 1 "subdocumento" => "edi" "cita" => "Rev Clin Esp. 2019;219:196-7" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "en" => array:10 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Editorial</span>" "titulo" => "The consumption of antidiabetic agents in large populations: a new tool for understanding diabetes mellitus" "tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "196" "paginaFinal" => "197" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "El consumo de antidiabéticos en grandes poblaciones: una nueva herramienta para el conocimiento de la diabetes mellitus" ] ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "J.F. Gómez Cerezo" "autores" => array:1 [ 0 => array:2 [ "nombre" => "J.F. Gómez" "apellidos" => "Cerezo" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S0014256519300888" "doi" => "10.1016/j.rce.2019.03.003" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0014256519300888?idApp=WRCEE" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S225488741930089X?idApp=WRCEE" "url" => "/22548874/0000021900000004/v1_201904260621/S225488741930089X/v1_201904260621/en/main.assets" ] ] "en" => array:21 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Original article</span>" "titulo" => "Prevalence of diabetes, use of antidiabetic drugs and degree of glycemic control in the province of Cadiz (2014–2016): A population-based study" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "177" "paginaFinal" => "183" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "J. Escribano Serrano, M.I. Méndez-Esteban, A. García-Bonilla, M. Márquez-Ferrando, C. Casto-Jarillo, E. Berruguilla Pérez, M.M. Calero Ruiz, M.L. Gonzalez Borrachero, J.D. Santotoribio, A. Michán-Doña" "autores" => array:10 [ 0 => array:4 [ "nombre" => "J." "apellidos" => "Escribano Serrano" "email" => array:1 [ 0 => "Jescribanos@semergen.es" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "M.I." "apellidos" => "Méndez-Esteban" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 2 => array:3 [ "nombre" => "A." "apellidos" => "García-Bonilla" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff0015" ] ] ] 3 => array:3 [ "nombre" => "M." "apellidos" => "Márquez-Ferrando" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">d</span>" "identificador" => "aff0020" ] ] ] 4 => array:3 [ "nombre" => "C." "apellidos" => "Casto-Jarillo" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">e</span>" "identificador" => "aff0025" ] ] ] 5 => array:3 [ "nombre" => "E." "apellidos" => "Berruguilla Pérez" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">f</span>" "identificador" => "aff0030" ] ] ] 6 => array:3 [ "nombre" => "M.M." "apellidos" => "Calero Ruiz" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">g</span>" "identificador" => "aff0035" ] ] ] 7 => array:3 [ "nombre" => "M.L." "apellidos" => "Gonzalez Borrachero" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">h</span>" "identificador" => "aff0040" ] ] ] 8 => array:3 [ "nombre" => "J.D." "apellidos" => "Santotoribio" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">i</span>" "identificador" => "aff0045" ] ] ] 9 => array:3 [ "nombre" => "A." "apellidos" => "Michán-Doña" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">j</span>" "identificador" => "aff0050" ] ] ] ] "afiliaciones" => array:10 [ 0 => array:3 [ "entidad" => "Unidad de Gestión Clínica de San Roque, Área de Gestión Sanitaria Campo de Gibraltar, Cádiz, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Farmacia de Atención Primaria, Área de Gestión Sanitaria Campo de Gibraltar, Cádiz, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "Unidad de Gestión Clínica Farmacia, Distrito Jerez-Costa, Área de Gestión Sanitaria Norte de Cádiz, Cádiz, Spain" "etiqueta" => "c" "identificador" => "aff0015" ] 3 => array:3 [ "entidad" => "Servicio de Farmacia, Distrito de Atención Primaria, Bahía de Cádiz-La Janda, Cádiz, Spain" "etiqueta" => "d" "identificador" => "aff0020" ] 4 => array:3 [ "entidad" => "Unidad de Gestión Clínica Laboratorio, Hospital de la Línea, Cádiz, Spain" "etiqueta" => "e" "identificador" => "aff0025" ] 5 => array:3 [ "entidad" => "Unidad de Gestión Clínica, Análisis Clínicos, Hospital Punta Europa, Algeciras, Cádiz, Spain" "etiqueta" => "f" "identificador" => "aff0030" ] 6 => array:3 [ "entidad" => "Unidad de Gestión Clínica Intercentros, Laboratorio Clínico, Hospital Universitario Puerta del Mar, Cádiz, Spain" "etiqueta" => "g" "identificador" => "aff0035" ] 7 => array:3 [ "entidad" => "Unidad de Gestión Clínica Laboratorio Clínico, Hospital Universitario Jerez de la Frontera, Cádiz, Spain" "etiqueta" => "h" "identificador" => "aff0040" ] 8 => array:3 [ "entidad" => "Unidad de Gestión Clínica, Laboratorios, Hospital Universitario Puerto Real, Departamento de Biomedicina, Biotecnología y Salud Pública, Cádiz, Spain" "etiqueta" => "i" "identificador" => "aff0045" ] 9 => array:3 [ "entidad" => "Departamento de Medicina Interna, Hospital de Jerez, Universidad de Cádiz, Cádiz, Spain" "etiqueta" => "j" "identificador" => "aff0050" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Prevalencia de diabetes, utilización de antidiabéticos y grado de control glucémico en la provincia de Cádiz (2014-2016): un estudio de base poblacional" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0015" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 1248 "Ancho" => 2093 "Tamanyo" => 152928 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">Patients with treated diabetes with no HbA1c test in a year and patients controlled with step therapy in 2016</p> <p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">All control readings were calculated for patients for whom an HbA1c assessment was available.</p> <p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">Controlled ADA1: in ≤75 years HbA1c <7% and in >75 years HbA1c <7.5%; controlled ADA2: in ≤75 years HbA1c <7% and in >75 years HbA1c <8.0%; controlled RedGDPS: in ≤75 years HbA1c <7% and in >75 years HbA1c <8.5%.</p> <p id="spar0075" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleItalic">Abbreviations</span>: ADA: American Diabetes Association; RedGDPS: Network of Study Groups for Diabetes in Primary Health Care.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Background</span><p id="par0005" class="elsevierStylePara elsevierViewall">Diabetes constitutes a public health problem of the greatest magnitude due to the burden it represents for individuals and society.<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">1</span></a> To properly plan healthcare policies, epidemiological data need to be collected that reflect the disease burden in terms of prevalence and incidence, and we need to determine whether the disease is being properly managed and whether the objectives established by clinical practice guidelines are being achieved. Prevalence studies based on the populational consumption of drugs have advantages compared with those conducted with other administrative databases or cross-sectional surveys.<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">2</span></a> Prevalence estimates can be performed easily and inexpensively and are not affected by sampling problems. The use of internationally accepted codes such as the Anatomical Therapeutic Chemical (ATC) classification helps compare the results of these studies with other studies in other settings and can be frequently updated. These types of studies have been used in Spain to estimate the prevalence of other diseases such as hypothyroidism<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">3</span></a> and have shown how the burden of diabetes, in terms of the prevalence of treated diabetes, has increased in Andalusia, with significant variations among provinces.<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">4</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">This strategy can also include the implementation of studies on the use of drugs, which enable, among other objectives, the description of drug use patterns, the early detection of signs of irrational use, the study of interventions aimed at improving the application of drugs and, in general, controlling the quality of their use.<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">5</span></a> Within the context of diabetes, the few studies conducted in Spain have suggested, for example, a delay in the introduction of insulin (therapeutic inertia)<a class="elsevierStyleCrossRef" href="#bib0115"><span class="elsevierStyleSup">6</span></a> and potentially inadequate prescription of antidiabetic drugs in some patient subgroups, such as those with renal failure.<a class="elsevierStyleCrossRef" href="#bib0120"><span class="elsevierStyleSup">7</span></a> Additionally, these drug consumption studies have revealed differences among the Spanish autonomous communities and even among provinces within the same autonomous community.<a class="elsevierStyleCrossRefs" href="#bib0105"><span class="elsevierStyleSup">4,6,8,9</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">The aim of this study was to assess the prevalence of diabetes mellitus treated pharmacologically, analyze the prescription patterns of antidiabetic drugs and assess the degree of control over the disease in the province of Cadiz.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Patients and methods</span><p id="par0020" class="elsevierStylePara elsevierViewall">An observational retrospective study was conducted with the databases of the public health system of the Andalusian Health Service between 2014 and 2016, inclusive. The study was authorized by the Research Ethics Committee of the province of Cadiz.</p><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Data sources</span><p id="par0025" class="elsevierStylePara elsevierViewall">In Andalusia, all individuals with the right to healthcare from Spain's public health system (SPHS) are identified by the Unique Health Record Number of Andalusia (<span class="elsevierStyleItalic">Número Único de Historia de Salud de Andalucía</span>, NUHSA). Each individual/NUHSA is assigned to a family medicine or pediatric quota. The quotas are grouped into primary care clinical management units (PCCMUs), and these in turn are grouped into a healthcare management area (HMA). In this study, we used data from the 3 HMAs of the province of Cadiz (Gibraltar Field, North Cadiz and Bay of Cadiz-La Janda), which cover 56 PCCMUs and a total population with the right to SPHS healthcare of 1,189,320 to the 31st of May 2015. The PCCMUs of Olvera (North Cadiz HMA) (17,441 patients with NUHSA) could not provide laboratory data because their measurements are performed in another province.</p><p id="par0030" class="elsevierStylePara elsevierViewall">We obtained the necessary information from 3 databases through the NUHSA:<ul class="elsevierStyleList" id="lis0005"><li class="elsevierStyleListItem" id="lsti0005"><span class="elsevierStyleLabel">-</span><p id="par0035" class="elsevierStylePara elsevierViewall">Pharmacy database: collects data on the consumption of prescribed drugs funded by the SPHS. We obtained information about the individuals who had consumed some drug from group A10 of the ATC (hypoglycemic treatment).</p></li><li class="elsevierStyleListItem" id="lsti0010"><span class="elsevierStyleLabel">-</span><p id="par0040" class="elsevierStylePara elsevierViewall">Database of users: contains the demographic data of individuals with the right to healthcare from SPHS. From this database, we obtained the patients’ demographic data and healthcare origin.</p></li><li class="elsevierStyleListItem" id="lsti0015"><span class="elsevierStyleLabel">-</span><p id="par0045" class="elsevierStylePara elsevierViewall">Laboratory information system database: collects information on the results of analyses performed in primary care and hospital settings. We obtained data on HbA1c and fasting plasma glucose levels.</p></li></ul></p><p id="par0050" class="elsevierStylePara elsevierViewall">This study included NUHSAs from individuals 15 years of age or older (i.e., those assigned to the family medicine quota) of the 3 HMAs of the province corresponding to 2014 to 2016.</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Statistical analysis</span><p id="par0055" class="elsevierStylePara elsevierViewall">Adults with treated diabetes (ATD) were considered those older than 14 years who had consumed at least 1 package of medication from the A10 group during one of the years covered by the study. The patient's treatment was categorized according to the ATC classification system. If the patient had withdrawn containers of 2 different drugs over the course of the year, we considered the patient as having undergone treatment with the 2 drugs. To categorize the therapeutic burden, we grouped the patients based on whether they were treated with 1, 2 or 3 or more noninsulin antidiabetic drugs (NIADs), whether basal insulin was employed and whether the therapy was intensified with prandial insulin. The degree of diabetes control was assessed based on HbA1c levels and age, simplifying the control criteria published by the Network of Study Groups of Diabetes in Primary Care (<span class="elsevierStyleItalic">Red de Grupos de Estudio de Diabetes en Atención Primaria de Salud</span>, redGDPS), which considers patients to be well-controlled if they have an HbA1c level <7% and are 75 years of age or younger or if they have a level <8.5% and are older than 75 years. We also assessed the degree of control according to 2 criteria based on those of the American Diabetes Association: HbA1c levels <7% for patients 75 years of age or younger or <7.5% for patients older than 75 years (ADA1), and HbA1c levels <7% for patients 75 years of age or younger or<span class="elsevierStyleHsp" style=""></span><8.0% for patients older than 75 years (ADA2). If the patient had more than one analysis during the year, we considered the most favorable value.</p><p id="par0060" class="elsevierStylePara elsevierViewall">To calculate the prevalence rate, we employed the total number of individuals with NUHSAs who had consumed a drug from the A10 group over the course of the year as the numerator and the total number of individuals with NUHSAs in December 2015 as the denominator. For all other demographic and clinical variables, we described the quantitative variables using mean and standard deviation or median and interquartile range and described the qualitative variables with absolute and relative frequencies.</p><p id="par0065" class="elsevierStylePara elsevierViewall">All analyses were performed with the MedCalc Statistical Software, version 14.12.0 (MedCalc bvba, Ostend, Belgium; <a id="intr0010" class="elsevierStyleInterRef" href="https://www.medcalc.org/">https://www.medcalc.org/</a>).</p></span></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Results</span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Prevalence and characteristics of patients with treated diabetes</span><p id="par0070" class="elsevierStylePara elsevierViewall">Of the 1,189,320 individuals with NUHSAs surveyed in the province of Cadiz in 2015, 993,082 were 15 years of age or older. The prevalence of ATD ranged from 8.65% to 8.83% from 2014 to 2016, respectively (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>). There were no relevant differences between the 3 HMAs. This prevalence rate was higher for the men and increased with age; in those older than 60 years, the rate increased from 24.2% to 24.9% between 2014 and 2016 (<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>).</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="tbl0005"></elsevierMultimedia></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Treatment of adults with treated diabetes</span><p id="par0075" class="elsevierStylePara elsevierViewall">The pattern of treatment was similar throughout the 3-year period. Seventy-one percent of the ATD were treated with only NIADs (groups 1, 2 and 3), 11% were treated with insulin, and 18% were treated with a combination of both (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>).</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0080" class="elsevierStylePara elsevierViewall">When we analyzed by ATC therapeutic group (<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>), regardless of the year studied, 2/3 of the patients were treated with metformin, and 1/4 were treated with sulfonylureas. For the rest of the therapeutic groups, the most commonly used drugs were fixed-dose combinations (15–17%) and dipeptidyl peptidase-4 inhibitors (DPP-4i) (8–11%). When the A10BD group with fixed-dose combinations was disaggregated, 80% of the ATD were treated with metformin in 2016, 26.3% were treated with DPP-4i, 25.2% were treated with sulfonylureas, 5.7% were treated with sodium–glucose cotransporter-2 inhibitors, and 4.6% were treated with repaglinide. The drugs that had the most relevant change in prescription were sodium–glucose cotransporter-2 inhibitors, which increased from 0.4% in 2014 to 5.7% in 2016, and DPP4i, which went from 23.2% to 26.3%.</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0085" class="elsevierStylePara elsevierViewall">Most of the patients (42%) were undergoing treatment with a single NIAD, 20% were taking 2 NIADs (a quarter in a fixed-dose combination), 14.7% were taking some type of basal insulin (combined with NIADs for 11.4% of the patients), and 15% were undergoing a regimen of basal-prandial insulin (in combination with NIADs for 7.3% of the patients). There were no variations in the 3 years studied (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>).</p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Glycated hemoglobin measurement and degree of diabetes control</span><p id="par0090" class="elsevierStylePara elsevierViewall">For approximately 1/3 of the ATD, an HbA1c reading was not performed during each year, and there were no relevant differences between the analyzed years. Except for a smaller proportion of patients with no HbA1c readings among those who were taking 3 drugs (26%), there were practically no differences according to the patients’ current therapeutic step (<a class="elsevierStyleCrossRef" href="#fig0015">Fig. 3</a>). A total of 6102 ATD (6%) lacked an HbA1c reading over the course of the 3 years, while 94% of the ATD studied did not reach the minimum 6 HbA1c readings during the full 3-year period.</p><elsevierMultimedia ident="fig0015"></elsevierMultimedia><p id="par0095" class="elsevierStylePara elsevierViewall">If we assess the ATD with HbA1c readings according to RedGDPS criteria (according to HbA1c and age), 69% of the evaluated ATD had an appropriate degree of control in 2016. Additionally, this reading ranged from 86%, among those who were treated with a single drug, to 48%, among those who were already being treated with a basal-prandial insulin regimen (<a class="elsevierStyleCrossRef" href="#fig0015">Fig. 3</a>). The results with the 2 ADA criteria followed the same tendency, although with lower readings (<a class="elsevierStyleCrossRef" href="#fig0015">Fig. 3</a>). Ninety-two percent of the patients older than 75 years were controlled according to RedGDPS criteria. The proportion of patients older than 75 years who were controlled was 87% when we considered an HbA1c level <8% and 78% when the criterion was an HbA1c level <7.5%.</p></span></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0115">Discussion</span><p id="par0100" class="elsevierStylePara elsevierViewall">The prevalence of pharmacologically treated diabetes in the province of Cadiz in 2014–2016 was approximately 9%, with a greater incidence in men, and increased with increasing age, reaching 1 of every 4 patients over the age of 60 years. The most common oral treatment employed is metformin as monotherapy, and up to 30% of ATD took some type of insulin. Overall, more than 2/3 of the patients had adequate diabetes control according to the RedGDPS criteria.</p><p id="par0105" class="elsevierStylePara elsevierViewall">The prevalence of treated diabetes in our study (8.8% in 2016), identified through the prescription of hypoglycemic agents, was greater than the prevalence of “known diabetes” described in the Di@bet.es study (7.8%) conducted between 2009 and 2010.<a class="elsevierStyleCrossRef" href="#bib0135"><span class="elsevierStyleSup">10</span></a> This difference could be partly due to the increase in prevalence in the 5–7 years between the two studies and the inclusion in our study of all types of treated diabetes. Interestingly, Torrecilla et al., in a study that employed a similar criterion (pharmaceutical invoices for the A10 therapeutic group obtained from the pharmacy information system of the Andalusian Health Service), found a prevalence rate of treated diabetes in the province of Cadiz of 4.18% in 2000.<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">4</span></a> If we consider our methods and those of Torrecilla et al. as sufficiently comparable, we can assume that the prevalence of diabetes in the province of Cadiz has doubled in only 15 years. It is possible that an earlier start of drug treatment for individuals with diabetes could have contributed to this increase in prevalence. This hypothesis is strengthened by the fact that a population study conducted in Catalonia found that the proportion of patients treated only with nonpharmacological measures decreased from 28% to 19% in 7 years.<a class="elsevierStyleCrossRef" href="#bib0125"><span class="elsevierStyleSup">8</span></a> Nevertheless, the increase in prevalence would be highly significant and would once again highlight the severity of the problem we are facing, which has already been reported in other countries<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">11</span></a> and repeatedly signaled by international organizations.<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">1</span></a></p><p id="par0110" class="elsevierStylePara elsevierViewall">The treatment data show that 42% of ATD take a single NIAD and that only 30% of the patients are treated with an insulin. In the Catalonian population study, the rate of oral monotherapy (36%) was very similar but not the consumption of insulin (20%).<a class="elsevierStyleCrossRef" href="#bib0125"><span class="elsevierStyleSup">8</span></a> However, we need to consider that the Catalonian study performed their calculations based on the total number of patients, and 19% of these in 2013 were undergoing treatment with diet alone.<a class="elsevierStyleCrossRef" href="#bib0125"><span class="elsevierStyleSup">8</span></a> The prescription data for the classical drug groups are practically identical between these 2 studies, with more than 2/3 of the patients treated with metformin, 1/4 treated with sulfonylureas and an insignificant proportion treated with other drugs. The largest differences were the consolidation of DPP-4i, which already exceeded sulfonylureas in 2016, and the emergence in our series of sodium–glucose cotransporter-2 inhibitors, which were introduced to the market in 2013 and had a greater relevant variation (in this case, growth) in our series.</p><p id="par0115" class="elsevierStylePara elsevierViewall">Furthermore, our diabetes control figure (69%) is consistent with that reported in a European study,<a class="elsevierStyleCrossRef" href="#bib0145"><span class="elsevierStyleSup">12</span></a> with the specific data for Spain from this study<a class="elsevierStyleCrossRef" href="#bib0150"><span class="elsevierStyleSup">13</span></a> and close to that reported in the Catalonian population study (76% in 2013, according to RedGDPS criteria).<a class="elsevierStyleCrossRef" href="#bib0125"><span class="elsevierStyleSup">8</span></a> Nevertheless, it is important to consider that 30% of the patients did not have an HbA1c assessment, and therefore these readings might vary. The fact that almost 1/3 of the patients did not undergo any HbA1c reading in 1 year (a very similar figure to that obtained in the Catalonian study<a class="elsevierStyleCrossRef" href="#bib0125"><span class="elsevierStyleSup">8</span></a>) suggests the presence of clinical inertia, a phenomenon that is broader than therapeutic inertia and that includes all the various actions to be performed for patients with diabetes.<a class="elsevierStyleCrossRef" href="#bib0155"><span class="elsevierStyleSup">14</span></a></p><p id="par0120" class="elsevierStylePara elsevierViewall">The limitations of our results include the fact that studies based on drug prescription can underestimate the prevalence of diabetes. Among other reasons, there might be patients with diabetes who are exclusively treated with diet. Therefore, these drug prescription data should be considered supplementary for monitoring the prevalence of chronic diseases.<a class="elsevierStyleCrossRef" href="#bib0160"><span class="elsevierStyleSup">15</span></a> Our study only included patients with the right to drug prescriptions from the public health system. We therefore used the total number of individuals with NUHSA as the denominator and not the surveyed population. However, we do not believe that this approach should have a relevant impact on our results given that the proportion of patients excluded from this system is very low. In terms of the proportion of patients without an HbA1c reading, it is possible that our readings somehow overestimate the problem, given that the HbA1c reading could have been performed on capillary blood for some patients, a reading that would not be reflected in the laboratory data employed in our analysis. Given the lack of any public program that supports this practice, however, this situation would be uncommon and would therefore have a small impact on our results. Finally, we have already discussed the variations in the prevalence results and prescription patterns among the autonomous communities of Spain and even within provinces of a single autonomous community.<a class="elsevierStyleCrossRefs" href="#bib0115"><span class="elsevierStyleSup">6,8</span></a> Our results might not therefore seem directly extrapolatable to other geographical settings; however, studies that cover the most recent years, although based on intent to prescribe, indicate a very similar therapeutic profile in Europe and the United States.<a class="elsevierStyleCrossRefs" href="#bib0165"><span class="elsevierStyleSup">16,17</span></a></p></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0120">Conclusions</span><p id="par0125" class="elsevierStylePara elsevierViewall">Our results show a high prevalence of pharmacologically treated diabetes in the province of Cadiz, a rate that appears to be increasing, as well as limited glycemic control, which could be mainly due to inadequate follow-up in almost a third of patients. Educational and administrative measures directed at improving this follow-up of patients with diabetes are needed. Globally, we need to reinforce the public health policies aimed at halting this increase in diabetes.</p></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0125">Funding</span><p id="par0130" class="elsevierStylePara elsevierViewall">The collaboration of a medical writer was financed by <span class="elsevierStyleGrantSponsor" id="gs1">Merck Sharp and Dohme of Spain</span>, S.A.</p></span><span id="sec0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0130">Conflicts of interest</span><p id="par0135" class="elsevierStylePara elsevierViewall">The authors declare that they have no conflicts of interest.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:15 [ 0 => array:3 [ "identificador" => "xres1183863" "titulo" => "Abstract" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Background and objective" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Patients and methods" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusion" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec1104284" "titulo" => "Keywords" ] 2 => array:2 [ "identificador" => "xpalclavsec1104282" "titulo" => "Abbreviations" ] 3 => array:2 [ "identificador" => "xpalclavsec1104283" "titulo" => "Abreviaturas" ] 4 => array:3 [ "identificador" => "xres1183862" "titulo" => "Resumen" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0025" "titulo" => "Antecedentes y objetivo" ] 1 => array:2 [ "identificador" => "abst0030" "titulo" => "Pacientes y métodos" ] 2 => array:2 [ "identificador" => "abst0035" "titulo" => "Resultados" ] 3 => array:2 [ "identificador" => "abst0040" "titulo" => "Conclusión" ] ] ] 5 => array:2 [ "identificador" => "xpalclavsec1104281" "titulo" => "Palabras clave" ] 6 => array:2 [ "identificador" => "sec0005" "titulo" => "Background" ] 7 => array:3 [ "identificador" => "sec0010" "titulo" => "Patients and methods" "secciones" => array:2 [ 0 => array:2 [ "identificador" => "sec0015" "titulo" => "Data sources" ] 1 => array:2 [ "identificador" => "sec0020" "titulo" => "Statistical analysis" ] ] ] 8 => array:3 [ "identificador" => "sec0025" "titulo" => "Results" "secciones" => array:3 [ 0 => array:2 [ "identificador" => "sec0030" "titulo" => "Prevalence and characteristics of patients with treated diabetes" ] 1 => array:2 [ "identificador" => "sec0035" "titulo" => "Treatment of adults with treated diabetes" ] 2 => array:2 [ "identificador" => "sec0040" "titulo" => "Glycated hemoglobin measurement and degree of diabetes control" ] ] ] 9 => array:2 [ "identificador" => "sec0045" "titulo" => "Discussion" ] 10 => array:2 [ "identificador" => "sec0050" "titulo" => "Conclusions" ] 11 => array:2 [ "identificador" => "sec0055" "titulo" => "Funding" ] 12 => array:2 [ "identificador" => "sec0060" "titulo" => "Conflicts of interest" ] 13 => array:2 [ "identificador" => "xack404221" "titulo" => "Acknowledgements" ] 14 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2018-09-04" "fechaAceptado" => "2018-10-30" "PalabrasClave" => array:2 [ "en" => array:3 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec1104284" "palabras" => array:4 [ 0 => "Diabetes" 1 => "Prevalence" 2 => "Use of medication" 3 => "Glycaemic control" ] ] 1 => array:4 [ "clase" => "abr" "titulo" => "Abbreviations" "identificador" => "xpalclavsec1104282" "palabras" => array:6 [ 0 => "ADA" 1 => "NIADs" 2 => "HMA" 3 => "ATD" 4 => "RedGDPS" 5 => "PCCMUs" ] ] 2 => array:4 [ "clase" => "abr" "titulo" => "Abreviaturas" "identificador" => "xpalclavsec1104283" "palabras" => array:6 [ 0 => "ADA" 1 => "ADNI" 2 => "AGS" 3 => "PADT" 4 => "RedGDPS" 5 => "UGCAP" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec1104281" "palabras" => array:4 [ 0 => "Diabetes" 1 => "Prevalencia" 2 => "Utilización de medicamentos" 3 => "Control glucémico" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:3 [ "titulo" => "Abstract" "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Background and objective</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">The aim of the study was to assess the prevalence of diabetes mellitus treated pharmacologically, analyze the prescription patterns of antidiabetic drugs and assess the degree of control over the disease in the province of Cadiz.</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Patients and methods</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">An observational retrospective study was conducted with the databases of the public health system of the Andalusian Health Service between 2014 and 2016, inclusive. Adults with treated diabetes (ATD) were considered those older than 14 years who had consumed at least 1 package of medication from the A10 group during the corresponding year covered by the study.</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">The prevalence of ATD varied between 8.65% and 8.83% from 2014 to 2016, respectively. Seventy-one percent of the ATD were treated with only noninsulin drugs, 11% were treated with insulin, and 18% were treated with a combination of both. For approximately one-third of the ATD, an HbA1c reading was not performed during each year. Sixty-nine percent of the assessed ATD in 2016 had an appropriate degree of control according to RedGDPS criteria (based on HbA1c and age).</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusion</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">The prevalence of pharmacologically treated diabetes in the province of Cadiz is high and appears to be increasing. The patients presented limited glycemic control, to which inadequate follow-up in almost a third of the patients could be the major contributor.</p></span>" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Background and objective" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Patients and methods" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusion" ] ] ] "es" => array:3 [ "titulo" => "Resumen" "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Antecedentes y objetivo</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Los objetivos de este estudio fueron evaluar la prevalencia de diabetes mellitus tratada farmacológicamente, analizar los patrones de prescripción de los fármacos antidiabéticos y evaluar el grado de control de la enfermedad en la provincia de Cádiz.</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Pacientes y métodos</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Estudio observacional retrospectivo utilizando las bases de datos del Sistema Público de Salud del Servicio Andaluz de Salud entre los años 2014 a 2016, ambos inclusive. Se consideró persona adulta con diabetes tratada (PADT) aquella persona mayor de 14 años que había consumido al menos un envase de medicación del grupo A10 a lo largo de cada uno de los años correspondientes de estudio.</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Resultados</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">La prevalencia de PADT varió entre el 8,65% y el 8,83% de 2014 a 2016, respectivamente. Un 71% de PADT estaban tratadas solo con fármacos no insulínicos, un 11% con insulinas y un 18% con una combinación de ambos. En aproximadamente un tercio de las PADT no se había realizado una determinación de HbA1c a lo largo de cada año. El 69% de las PADT evaluadas tenía en 2016 un adecuado grado de control de acuerdo a los criterios de la RedGDPS (según HbA1c y edad).</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclusión</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">La prevalencia de diabetes tratada farmacológicamente en la provincia de Cádiz es elevada y parece ir en aumento. Los pacientes presentan un limitado control glucémico, al que puede contribuir de forma predominante el seguimiento inadecuado en casi una tercera parte de los mismos.</p></span>" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0025" "titulo" => "Antecedentes y objetivo" ] 1 => array:2 [ "identificador" => "abst0030" "titulo" => "Pacientes y métodos" ] 2 => array:2 [ "identificador" => "abst0035" "titulo" => "Resultados" ] 3 => array:2 [ "identificador" => "abst0040" "titulo" => "Conclusión" ] ] ] ] "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Escribano Serrano J, Méndez-Esteban MI, García-Bonilla A, Márquez-Ferrando M, Casto-Jarillo C, Berruguilla Pérez E, et al. Prevalencia de diabetes, utilización de antidiabéticos y grado de control glucémico en la provincia de Cádiz (2014-2016): un estudio de base poblacional. Rev Clin Esp. 2019;219:177–183.</p>" ] ] "multimedia" => array:5 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1310 "Ancho" => 2041 "Tamanyo" => 123251 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Prevalence of treated diabetes in the province of Cadiz (2014–2016).</p> <p id="spar0050" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleItalic">Abbreviations</span>: BCJ: Bay of Cadiz-La Janda; CG: Campo de Gibraltar; Norte: Norte de Cádiz.</p>" ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1219 "Ancho" => 2079 "Tamanyo" => 116378 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Step therapy for the patients with treated diabetes. gr2.</p>" ] ] 2 => array:7 [ "identificador" => "fig0015" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 1248 "Ancho" => 2093 "Tamanyo" => 152928 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">Patients with treated diabetes with no HbA1c test in a year and patients controlled with step therapy in 2016</p> <p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">All control readings were calculated for patients for whom an HbA1c assessment was available.</p> <p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">Controlled ADA1: in ≤75 years HbA1c <7% and in >75 years HbA1c <7.5%; controlled ADA2: in ≤75 years HbA1c <7% and in >75 years HbA1c <8.0%; controlled RedGDPS: in ≤75 years HbA1c <7% and in >75 years HbA1c <8.5%.</p> <p id="spar0075" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleItalic">Abbreviations</span>: ADA: American Diabetes Association; RedGDPS: Network of Study Groups for Diabetes in Primary Health Care.</p>" ] ] 3 => array:8 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at1" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:2 [ "leyenda" => "<p id="spar0085" class="elsevierStyleSimplePara elsevierViewall">All readings are in percentages.</p>" "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Group \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">2014 \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">2015 \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">2016 \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">Male \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">8.72 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">8.84 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">9.04 \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">Female \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">8.59 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">8.54 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">8.62 \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">15–30 years \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.64 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.67 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.66 \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">31–60 years \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">4.52 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">4.54 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">4.55 \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">>60 years \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">24.32 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">24.34 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">24.87 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab2017973.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0080" class="elsevierStyleSimplePara elsevierViewall">Prevalence of treated diabetes in the Province of Cadiz by age group and sex.</p>" ] ] 4 => array:8 [ "identificador" => "tbl0010" "etiqueta" => "Table 2" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at2" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:1 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td-with-role" title="table-head ; entry_with_role_rowhead " align="left" valign="top" scope="col">Therapeutic group \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " colspan="3" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Percentage for patients with treated diabetes</th></tr><tr title="table-row"><th class="td" title="table-head " align="" valign="top" scope="col" style="border-bottom: 2px solid black"> \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">2014 \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">2015 \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">2016 \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">A10AB fast-acting insulins and analogs \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">9.9 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">10.0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">10.4 \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">A10AC intermediate-acting insulins and analogs \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">5.8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">5.4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">4.9 \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">A10AD combination of insulins and analogs \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">6.1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">5.8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">5.4 \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">A10AE long-acting insulins and analogs \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">19.5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">19.8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">21.0 \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">Total insulins \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">29.7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">29.5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">29.3 \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">A10BA biguanides (metformin) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">64.4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">63.8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">62.5 \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">A10BB sulfonylureas \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">26.5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">25.7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">24.6 \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">A10BD oral hypoglycemic combinations \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">15.0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">15.6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">17.2 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">A10BF alpha-glucosidase inhibitors \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.7 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">A10BG thiazolidinediones \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.2 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">A10BH dipeptidyl peptidase-4 inhibitors \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">8.4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">9.6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">10.8 \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">A10BJ glucagon-like peptide-1 receptor agonists \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.7 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">A10BK sodium–glucose cotransporter-2 inhibitors \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2.1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">4.0 \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">A10BX other oral hypoglycemic agents (repaglinide) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">5.8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">5.1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">4.6 \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">Total no. of noninsulin drugs \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">88.2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">88.5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">89.2 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab2017972.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0090" class="elsevierStyleSimplePara elsevierViewall">Consumption of hypoglycemic agents in the Province of Cadiz.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:17 [ 0 => array:3 [ "identificador" => "bib0090" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "IDF diabetes atlas" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "International Diabetes Federation" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Libro" => array:4 [ "edicion" => "8th ed." 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This assistance was financed by Merck Sharp and Dohme of Spain, S.A.</p>" "vista" => "all" ] ] ] "idiomaDefecto" => "en" "url" => "/22548874/0000021900000004/v1_201904260621/S2254887419300037/v1_201904260621/en/main.assets" "Apartado" => array:4 [ "identificador" => "1901" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Original Articles" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/22548874/0000021900000004/v1_201904260621/S2254887419300037/v1_201904260621/en/main.pdf?idApp=WRCEE&text.app=https://revclinesp.es/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2254887419300037?idApp=WRCEE" ]
