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no solo por su alta prevalencia&#44; sino tambi&#233;n por las complicaciones agudas y cr&#243;nicas que produce&#44; por su elevada tasa de morbimortalidad y sus repercusiones en la calidad de vida&#44; ocasionando un elevado consumo de los recursos sanitarios<a class="elsevierStyleCrossRefs" href="#bib0075"><span class="elsevierStyleSup">15&#8211;17&#44;21&#8211;24</span></a>&#46; Algunas estimaciones muestran que el coste anual de la diabetes solo en Espa&#241;a oscilar&#237;a entre 710-2&#46;873 millones de euros&#44; lo que representar&#237;a un 1&#44;5-6&#44;2&#37; del gasto sanitario p&#250;blico espa&#241;ol<a class="elsevierStyleCrossRef" href="#bib0115"><span class="elsevierStyleSup">23</span></a>&#46; Aunque estas cantidades podr&#237;an estar muy subestimadas&#44; ya que solo la DM2 tendr&#237;a un coste anual de 2&#46;403 millones de euros&#44; seg&#250;n el estudio CODE-2<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">22</span></a>&#46; En nuestro medio&#44; el coste medio anual por paciente con DM2 var&#237;a entre los 1&#46;088-5&#46;279&#8364;<a class="elsevierStyleCrossRefs" href="#bib0105"><span class="elsevierStyleSup">21&#8211;24</span></a>&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">A pesar de las numerosas evidencias disponibles de la enfermedad<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1&#44;2&#44;15&#8211;17</span></a>&#44; no conocemos estudios que hayan determinado los costes asociados a las comorbilidades como sobrepeso &#40;SP&#41;&#44; obesidad &#40;OBE&#41; o hipertensi&#243;n arterial &#40;HTA&#41;&#44; y el efecto de sus complicaciones &#40;micro y macrovasculares&#41;&#46; El objetivo del estudio fue evaluar las caracter&#237;sticas cl&#237;nicas &#40;comorbilidades&#44; s&#237;ndrome metab&#243;lico &#91;SM&#93;&#44; control terap&#233;utico&#44; hipoglucemias y ECV&#41; y econ&#243;micas &#40;uso de recursos y costes&#41; asociadas a la DM2 seg&#250;n determinados patrones de comorbilidad&#44; en situaci&#243;n de pr&#225;ctica cl&#237;nica habitual en un &#225;mbito poblacional&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Pacientes y m&#233;todos</span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Dise&#241;o y poblaci&#243;n de estudio</span><p id="par0040" class="elsevierStylePara elsevierViewall">Se realiz&#243; un estudio observacional&#44; multic&#233;ntrico longitudinal&#44; a partir de la revisi&#243;n de los registros m&#233;dicos de pacientes seguidos en r&#233;gimen ambulatorio y hospitalario&#46; La poblaci&#243;n de estudio estuvo formada por personas pertenecientes a 6 centros reformados de atenci&#243;n primaria &#40;AP&#41; gestionados por Badalona Serveis Assistencials SA&#46; Se obtuvo informaci&#243;n de los recursos consumidos de 2 centros hospitalarios&#58; Hospital Municipal de Badalona y Hospital Germans Tr&#237;as i Pujol &#40;ingresos hospitalarios&#41;&#46; La poblaci&#243;n asignada a los centros fue en su mayor&#237;a urbana&#44; de nivel socioecon&#243;mico medio-bajo&#44; con predominio industrial&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Criterios de inclusi&#243;n y exclusi&#243;n</span><p id="par0045" class="elsevierStylePara elsevierViewall">Se incluyeron a todos los pacientes que demandaron atenci&#243;n &#40;a&#241;o 2010&#41; y que reunieron las siguientes caracter&#237;sticas&#58; a&#41; edad entre 40-99 a&#241;os&#59; b&#41; ambos sexos&#59; c&#41; estar diagnosticados de DM2 un m&#237;nimo de 12 meses antes del inicio del estudio&#59; d&#41; seguir de forma regular el protocolo&#47;gu&#237;a de riesgo cardiovascular establecido &#40;con el objetivo de mejorar la calidad de los registros&#41;&#59; e&#41; estar en el programa de prescripciones cr&#243;nicas para la obtenci&#243;n de las recetas m&#233;dicas &#40;con registro constatado de la dosis diaria&#44; el intervalo de tiempo y la duraci&#243;n de cada tratamiento administrado&#41;&#44; y f&#41; que se pudiera garantizar el seguimiento regular de los pacientes&#46; Fueron excluidos los sujetos trasladados a otros centros&#44; los desplazados y los que fueron perdidos durante el periodo de seguimiento &#40;24 meses&#59; durante los a&#241;os 2011 y 2012&#41;&#46; Tambi&#233;n se excluyeron los sujetos que desarrollaron la DM2 antes de los 40 a&#241;os y los de tipo 1&#46;</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Diagn&#243;stico de diabetes mellitus tipo 2 y de las complicaciones</span><p id="par0050" class="elsevierStylePara elsevierViewall">El diagn&#243;stico de DM2 se obtuvo a partir de la Clasificaci&#243;n Internacional de la AP &#40;CIAP-2&#41;<a class="elsevierStyleCrossRef" href="#bib0125"><span class="elsevierStyleSup">25</span></a> &#40;T90&#41;&#44; y de la codificaci&#243;n de las altas hospitalarias y urgencias&#44; seg&#250;n la Clasificaci&#243;n Internacional de Enfermedades&#44; 9&#46;<span class="elsevierStyleSup">a</span> Revisi&#243;n&#44; Modificaci&#243;n Cl&#237;nica&#59; CIE-9-MC &#91;250&#93;&#41;&#46; Durante el periodo de seguimiento se registraron&#58; a&#41; las hipoglucemias &#40;a criterio m&#233;dico&#59; el registro de las hipoglucemias se obtuvo en las visitas habituales de seguimiento&#41;&#59; b&#41; las complicaciones microvasculares &#40;retinopat&#237;a diab&#233;tica&#44; nefropat&#237;a diab&#233;tica y neuropat&#237;a diab&#233;tica&#41;&#44; y c&#41; las infecciones genitourinarias&#46; Los registros se obtuvieron de los motivos de consulta en los centros asistenciales&#44; y&#47;o de los protocolos cl&#237;nicos informatizados durante el seguimiento&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">Tambi&#233;n se contabilizaron los casos nuevos de ECV o renal establecida &#40;complicaciones macrovasculares&#41;&#46; Estos incluyeron&#58; a&#41; cardiopat&#237;as&#44; como la isquemia cardiaca &#40;c&#243;digos&#58; K74&#44; K76&#59; estable&#44; inestable y otras&#41;&#44; el infarto agudo de miocardio &#40;K75&#41; y la insuficiencia cardiaca &#40;K77&#41;&#44; seg&#250;n la definici&#243;n de los criterios diagn&#243;sticos de la Organizaci&#243;n Mundial de la Salud&#59; b&#41; enfermedad cerebrovascular&#44; como el ictus &#40;isqu&#233;mico o hemorr&#225;gico&#59; seg&#250;n la <span class="elsevierStyleItalic">American Heart Association</span>&#41; y el accidente isqu&#233;mico transitorio &#40;K90&#44; K91&#41;&#59; c&#41; la enfermedad arterial perif&#233;rica&#44; y d&#41; la enfermedad renal &#40;nefropat&#237;a diab&#233;tica o deterioro de la funci&#243;n renal &#91;creatinina s&#233;rica&#58; varones<span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>133&#93;&#41;&#59; mujeres<span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>124<span class="elsevierStyleHsp" style=""></span>mmol o filtrado glomerular &#60;<span class="elsevierStyleHsp" style=""></span>60<span class="elsevierStyleHsp" style=""></span>ml&#47;min&#46; No se estandarizaron los resultados puesto que la pir&#225;mide poblacional distribuida por edad y g&#233;nero de los pacientes estudiados es parecida a la de la poblaci&#243;n de Catalu&#241;a&#46; El seguimiento de los pacientes fue de 24 meses&#44; por considerarse un periodo de tiempo suficiente&#44; m&#225;s robusto y homog&#233;neo en la detecci&#243;n de episodios &#40;complicaciones&#41; y sus costes&#46;</p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Descripci&#243;n del tratamiento</span><p id="par0060" class="elsevierStylePara elsevierViewall">Estudio no intervencionista&#44; en el que se obtuvo la informaci&#243;n de los pacientes tratados en el pasado con antidiab&#233;ticos seg&#250;n la <span class="elsevierStyleItalic">Anatomical Therapeutic Chemical Classification System</span> &#40;ATC&#41;<a class="elsevierStyleCrossRef" href="#bib0130"><span class="elsevierStyleSup">26</span></a> a criterio del m&#233;dico&#46; Se obtuvo la informaci&#243;n de los siguientes antidiab&#233;ticos orales&#58; a&#41; metformina &#40;A10BA&#41;&#59; b&#41; estimulantes de la liberaci&#243;n de insulinas&#58; sulfonilureas &#40;A10BB&#42;&#41; y glinidas &#40;A10BX&#41;&#59; c&#41; glitazonas &#40;A10BG&#42;&#41;&#59; d&#41; inhibidores alfaglicosidasas&#58; acarbosa &#40;A10BF&#42;&#41; y miglitol &#40;A10BF&#42;&#41;&#44; IDPP4 &#40;A10BH&#42;&#41; e insulinas &#40;todos los tipos&#41; en monoterapia o en combinaci&#243;n &#40;A10BD&#42;&#41;&#46;</p></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Grupos de estudio</span><p id="par0065" class="elsevierStylePara elsevierViewall">Se establecieron 2 grupos &#40;presencia y ausencia de DM2 &#91;grupo control o de referencia&#93;&#41; y 6 subgrupos&#58; a&#41; DM2 solo&#59; b&#41; DM2 y HTA&#59; c&#41; DM2 y SP&#59; d&#41; DM2 y OBE&#59; e&#41; DM2&#44; HTA y SP&#44; y f&#41; DM2&#44; HTA y OBE&#46;</p></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Variables sociodemogr&#225;ficas y de comorbilidad</span><p id="par0070" class="elsevierStylePara elsevierViewall">Las principales variables de estudio fueron&#58; edad &#40;continua y por rangos&#41;&#44; sexo y el tiempo de evoluci&#243;n de la DM2&#44; as&#237; como los antecedentes personales obtenidos a partir de la CIAP-2<a class="elsevierStyleCrossRef" href="#bib0125"><span class="elsevierStyleSup">25</span></a>&#58; HTA&#44; dislipemia &#40;hipertrigliceridemia y&#47;o hipercolesterolemia&#41;&#44; OBE&#44; SP&#44; tabaquismo&#44; alcoholismo&#44; todos los tipos de fallos org&#225;nicos &#40;cardiaco&#44; hep&#225;tico y renal&#41;&#44; cardiopat&#237;a isqu&#233;mica&#44; accidente vasculocerebral&#44; enfermedad pulmonar obstructiva cr&#243;nica&#44; asma bronquial&#44; demencias o trastornos de la memoria&#44; enfermedades neurol&#243;gicas&#58; enfermedad de Parkinson&#44; epilepsia&#44; esclerosis m&#250;ltiple y otras enfermedades neurol&#243;gicas&#59; s&#237;ndrome depresivo y neoplasias malignas&#46; Como variable resumen de la comorbilidad general&#44; para cada paciente atendido&#44; se utiliz&#243;&#58; a&#41; el n&#250;mero de diagn&#243;sticos&#59; b&#41; el &#237;ndice de comorbilidad de Charlson<a class="elsevierStyleCrossRef" href="#bib0135"><span class="elsevierStyleSup">27</span></a> como una aproximaci&#243;n a la gravedad del paciente&#44; y c&#41; el &#237;ndice de casu&#237;stica individual&#44; obtenido a partir de los <span class="elsevierStyleItalic">Adjusted Clinical Groups</span> &#40;ACG&#41;&#59; un sistema de clasificaci&#243;n de pacientes por iso-consumo de recursos<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">28</span></a>&#46; El aplicativo ACG proporciona las bandas de utilizaci&#243;n de recursos &#40;BUR&#41;&#44; con lo que cada paciente en funci&#243;n de su morbilidad general queda agrupado en una de las 5 categor&#237;as mutuamente excluyentes &#40;1&#58; usuarios sanos o de morbilidad muy baja&#44; 2&#58; morbilidad baja&#44; 3&#58; morbilidad moderada&#44; 4&#58; morbilidad elevada&#44; y 5&#58; morbilidad muy elevada&#41;&#46;</p></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0115">Par&#225;metros bioqu&#237;micos y antropom&#233;tricos&#44; y definici&#243;n de s&#237;ndrome metab&#243;lico</span><p id="par0075" class="elsevierStylePara elsevierViewall">Los par&#225;metros bioqu&#237;micos y&#47;o objetivos terap&#233;uticos de control fueron&#58; presi&#243;n arterial sist&#243;lica y diast&#243;lica &#40;mmHg&#41;&#44; &#237;ndice de masa corporal &#40;IMC&#44; kg&#47;m<span class="elsevierStyleSup">2</span>&#41;&#44; glucemia basal &#40;mg&#47;dl&#41;&#44; hemoglobina glucosilada &#40;porcentaje&#44; control metab&#243;lico&#58; HbA1c<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>7&#37;&#41;&#59; triglic&#233;ridos s&#233;ricos&#44; colesterol total&#44; colesterol ligado a lipoprote&#237;nas de alta densidad &#40;cHDL&#41; y colesterol ligado a lipoprote&#237;nas de baja densidad &#40;cLDL&#41; en mg&#47;dl&#46; Estos par&#225;metros se obtuvieron al inicio y final del estudio &#40;seguimiento de 2 a&#241;os&#41;&#46; Se defini&#243; como SP un IMC entre 25-29&#44;9<span class="elsevierStyleHsp" style=""></span>kg&#47;m<span class="elsevierStyleSup">2</span> y como OBE un IMC<span class="elsevierStyleHsp" style=""></span>&#8805;<span class="elsevierStyleHsp" style=""></span>30<span class="elsevierStyleHsp" style=""></span>kg&#47;m<span class="elsevierStyleSup">2</span>&#46;</p><p id="par0080" class="elsevierStylePara elsevierViewall">La definici&#243;n del SM se estableci&#243; cuando en un mismo individuo se cumpl&#237;an 3 de los 5 criterios siguientes&#44; modificados del Adult Treatment Panel &#40;ATP&#41; III<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">28</span></a>&#58; a&#41; triglic&#233;ridos de 150<span class="elsevierStyleHsp" style=""></span>mg&#47;dl o mayor&#59; b&#41; cHDL menor de 40<span class="elsevierStyleHsp" style=""></span>mg&#47;dl en varones o menor de 50<span class="elsevierStyleHsp" style=""></span>mg&#47;dl en mujeres&#59; c&#41; presi&#243;n arterial sist&#243;lica&#47;diast&#243;lica de 130&#47;85<span class="elsevierStyleHsp" style=""></span>mmHg o mayor o en tratamiento antihipertensivo&#59; d&#41; glucemia basal en ayunas de 110<span class="elsevierStyleHsp" style=""></span>mg&#47;dl o m&#225;s&#59; o en tratamiento hipogluc&#233;mico o diabetes previamente diagnosticada&#59; y&#47;o e&#41; IMC de 28&#44;8<span class="elsevierStyleHsp" style=""></span>kg&#47;m<span class="elsevierStyleSup">2</span> o superior&#46; En este estudio se ha reemplazado uno de los componentes habituales de SM&#44; la medici&#243;n de la circunferencia de la cintura&#44; por la determinaci&#243;n del IMC&#44; lo que constituye uno de los criterios modificados del NCEP-ATP III<a class="elsevierStyleCrossRef" href="#bib0145"><span class="elsevierStyleSup">29</span></a>&#46; Se consider&#243; que cumpl&#237;a el criterio de componente individual de SM&#44; un IMC superior o igual a 28&#44;8<span class="elsevierStyleHsp" style=""></span>kg&#47;m<span class="elsevierStyleSup">2</span>&#46; Este valor ha sido considerado equivalente al de adiposidad abdominal &#40;per&#237;metro de cintura &#62;<span class="elsevierStyleHsp" style=""></span>102<span class="elsevierStyleHsp" style=""></span>cm en varones y &#62;<span class="elsevierStyleHsp" style=""></span>88<span class="elsevierStyleHsp" style=""></span>cm en mujeres&#41;&#44; criterio original seguido por diferentes autores<a class="elsevierStyleCrossRef" href="#bib0150"><span class="elsevierStyleSup">30</span></a>&#46;</p></span><span id="sec0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0120">Uso de recursos y modelo de costes</span><p id="par0085" class="elsevierStylePara elsevierViewall">Se consideraron como costes directos sanitarios &#40;costes directos&#41; los relacionados con la actividad asistencial &#40;visitas m&#233;dicas&#44; d&#237;as de hospitalizaci&#243;n&#44; urgencias&#44; solicitudes diagn&#243;sticas o terap&#233;uticas&#44; etc&#46;&#41;&#44; efectuadas por los profesionales&#59; y como indirectos&#44; los relativos a las p&#233;rdidas de productividad laboral &#40;d&#237;as de incapacidad laboral&#41;&#46; El coste fue expresado en coste medio por paciente durante los 2 a&#241;os de seguimiento del estudio &#40;coste&#47;unitario&#41;&#46; Los diferentes conceptos de estudio y su valoraci&#243;n econ&#243;mica se obtuvieron de un estudio recientemente publicado<a class="elsevierStyleCrossRef" href="#bib0155"><span class="elsevierStyleSup">31</span></a>&#46;</p></span><span id="sec0065" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0125">An&#225;lisis estad&#237;stico</span><p id="par0090" class="elsevierStylePara elsevierViewall">Se efectu&#243; un an&#225;lisis estad&#237;stico descriptivo-univariante e intervalos de confianza &#40;IC&#41; del 95&#37;&#59; y se comprob&#243; la normalidad de la distribuci&#243;n con la prueba de Kolmog&#243;rov-Smirnov&#46; En el an&#225;lisis bivariante se utilizaron las pruebas de ANOVA&#44; Chi-cuadrado&#44; correlaci&#243;n lineal de Pearson y comparaci&#243;n de medias para grupos apareados&#46; Se efectu&#243; un an&#225;lisis de regresi&#243;n log&#237;stica para obtener las variables asociadas al perfil de paciente &#40;variable dependiente&#41;&#44; con procedimiento <span class="elsevierStyleItalic">enter</span> &#40;estad&#237;stico&#58; Wald&#41;&#46; Se realiz&#243; un modelo de regresi&#243;n lineal m&#250;ltiple &#40;pasos consecutivos&#41; para valorar las variables asociadas al coste sanitario&#46; La comparaci&#243;n del coste ambulatorio y hospitalario se realiz&#243; seg&#250;n las recomendaciones de Thompson y Barber<a class="elsevierStyleCrossRef" href="#bib0160"><span class="elsevierStyleSup">32</span></a>&#59; mediante el an&#225;lisis de la covarianza &#40;ANCOVA&#41;&#44; con el sexo&#44; la edad&#44; las BUR&#44; el &#237;ndice de Charlson y el tiempo de evoluci&#243;n de la enfermedad como covariables &#40;procedimiento&#58; estimaci&#243;n de medias marginales&#59; ajuste de Bonferroni&#41;&#46; Se utiliz&#243; el programa SPSS<span class="elsevierStyleSup">&#174;</span> versi&#243;n 17&#44; estableci&#233;ndose una significaci&#243;n estad&#237;stica para valores de p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;05&#46;</p></span></span><span id="sec0070" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0130">Resultados</span><p id="par0095" class="elsevierStylePara elsevierViewall">La poblaci&#243;n de estudio estuvo formada por 52&#46;370 sujetos<span class="elsevierStyleHsp" style=""></span>&#8805;<span class="elsevierStyleHsp" style=""></span>40 a&#241;os&#46; De estos&#44; 38&#46;295 demandaron atenci&#243;n y&#44; finalmente&#44; se seleccionaron 26&#46;845 pacientes&#46; Por grupos de estudio un 14&#44;0&#37; &#40;N<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>3&#46;760&#59; IC 95&#37;&#58; 13&#44;7-14&#44;2&#37;&#41; pertenecieron al grupo con diagn&#243;stico de DM2&#44; y un 86&#44;0&#37; &#40;N<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>23&#46;085&#41; al grupo de referencia&#47;control &#40;<a class="elsevierStyleCrossRef" href="#fig0005">fig&#46; 1</a>&#41;&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0100" class="elsevierStylePara elsevierViewall">En la <a class="elsevierStyleCrossRef" href="#tbl0005">tabla 1</a> se describen las caracter&#237;sticas basales de la serie estudiada seg&#250;n los grupos&#47;subgrupos de pacientes&#46; En el modelo de regresi&#243;n log&#237;stica&#44; la DM2 se asoci&#243; mayoritariamente con la OBE OR<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>2&#44;8 &#40;IC 95&#37;&#58; 2&#44;4-3&#44;1&#41;&#44; la HTA OR<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>2&#44;4 &#40;IC 95&#37;&#58; 2&#44;2-2&#44;6&#41;&#44; y el SP OR<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>1&#44;9 &#40;IC 95&#37;&#58; 1&#44;7-2&#44;2&#41;&#59; y en menor probabilidad con la dislipemia OR<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>1&#44;5 &#40;IC 95&#37;&#58; 1&#44;4-1&#44;7&#41;&#44; la cardiopat&#237;a isqu&#233;mica OR<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>1&#44;5 &#40;IC 95&#37;&#58; 1&#44;1-2&#44;0&#41;&#44; el accidente cerebrovascular OR<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>1&#44;4 &#40;IC 95&#37;&#58; 1&#44;1-1&#44;8&#41;&#44; los varones OR<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>1&#44;2 &#40;IC 95&#37;&#58; 1&#44;1-1&#44;3&#41; y la edad OR<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>1&#44;2 &#40;IC 95&#37;&#58; 1&#44;1-1&#44;3&#41;&#44; p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;05&#46; La distribuci&#243;n del grupo de DM2 por subgrupos de factores fue la siguiente&#58; 6&#44;7&#37; con DM2 solo &#40;N<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>253&#59; IC 95&#37;&#58; 5&#44;9-7&#44;5&#37;&#41;&#44; 7&#44;0&#37; con DM2-HTA &#40;N<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>263&#59; IC 95&#37;&#58; 6&#44;2-7&#44;8&#37;&#41;&#44; 15&#44;4&#37; con DM2-SP &#40;N<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>579&#59; IC 95&#37;&#58; 14&#44;2-16&#44;6&#37;&#41;&#44; 10&#44;7&#37; con DM2-OBE &#40;N<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>403&#59; IC 95&#37;&#58; 9&#44;7-11&#44;7&#37;&#41;&#44; 26&#44;1&#37; con DM2-HTA-SP &#40;N<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>980&#59; IC 95&#37;&#58; 24&#44;7-27&#44;5&#37;&#41; y 34&#44;1&#37; con DM2-HTA-OBE &#40;N<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>1&#46;282&#59; IC 95&#37;&#58; 32&#44;6-35&#44;6&#37;&#41;&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0105" class="elsevierStylePara elsevierViewall">La distribuci&#243;n de las complicaciones microvasculares&#44; la prevalencia del SM&#44; la medicaci&#243;n farmacol&#243;gica antidiab&#233;tica y las hipoglucemias de los pacientes con DM2 se detallan en la <a class="elsevierStyleCrossRef" href="#tbl0010">tabla 2</a>&#46; La prevalencia del SM en la DM2 fue del 75&#44;4&#37; &#40;IC 95&#37;&#58; 74&#44;0-75&#44;8&#37;&#41;&#44; siendo mayor en los subgrupos DM2-OBE &#40;75&#44;8&#37;&#41;&#44; DM2-HTA-SP &#40;78&#44;7&#37;&#41; y&#44; sobre todo&#44; en DM2-HTA-OBE &#40;98&#44;7&#37;&#41;&#44; p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;01&#44; respectivamente&#46; El consumo de antidiab&#233;ticos fue del 85&#44;3&#37; y el de hipoglucemias del 37&#44;5&#37; &#40;en AP&#58; 41&#44;3&#37;&#41;&#46; En el grupo control cabe destacar una reducci&#243;n de los niveles de triglic&#233;ridos &#40;118&#44;6 vs&#46; 115&#44;2<span class="elsevierStyleHsp" style=""></span>mg&#47;dl&#59; p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41; y de colesterol total &#40;209&#44;8 vs&#46; 207&#44;3<span class="elsevierStyleHsp" style=""></span>mmHg&#59; p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41;&#59; mientras que el grupo con DM2 muestra unas reducciones superiores &#40;150&#44;8 vs&#46; 141&#44;8<span class="elsevierStyleHsp" style=""></span>mg&#47;dl&#59; p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41; y de colesterol total &#40;191&#44;1 vs&#46; 182&#44;0<span class="elsevierStyleHsp" style=""></span>mmHg&#59; p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41;&#46; Estas diferencias tambi&#233;n se mostraron en todos los subgrupos analizados&#46; El 60&#44;0&#37; de los pacientes con DM2 mostraron un adecuado control metab&#243;lico &#40;IC 95&#37;&#58; 58&#44;4-61&#44;6&#37;&#41;&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0110" class="elsevierStylePara elsevierViewall">Los sujetos con DM2 en comparaci&#243;n con los del grupo control&#47;referencia utilizaron m&#225;s visitas m&#233;dicas en AP &#40;26&#44;9 vs&#46; 15&#44;4&#59; p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41;&#44; d&#237;as de hospitalizaci&#243;n &#40;0&#44;6 vs&#46; 0&#44;2&#59; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41; y visitas en atenci&#243;n especializada &#40;1&#44;2 vs&#46; 0&#44;2&#59; p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41;&#46; No hubo diferencias en los d&#237;as de incapacidad laboral&#46; Por subgrupos de DM2&#44; el uso de recursos fue m&#225;s destacado en los pacientes con DM2-HTA-SP y DM2-HTA-OBE&#46; El modelo de costes brutos y corregidos &#40;por covariables&#41; seg&#250;n los grupos de estudio&#44; se describe en la <a class="elsevierStyleCrossRef" href="#tbl0015">tabla 3</a>&#46; En los costes sanitarios&#44; el 89&#44;0&#37; correspondieron a costes en AP &#40;medicaci&#243;n&#58; 60&#44;5&#37;&#44; visitas m&#233;dicas&#58; 15&#44;8&#37;&#41; y el 11&#44;0&#37; en atenci&#243;n especializada &#40;visitas m&#233;dicas&#58; 3&#44;2&#37;&#41;&#46; El promedio&#47;unitario de los costes totales de los sujetos con DM2 en comparaci&#243;n con el de control&#47;referencia fueron superiores &#40;4&#46;908&#8364; frente a 2&#46;645&#8364;&#59; p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41;&#46; En el modelo corregido &#40;ANCOVA&#41; fueron de 4&#46;458&#8364; &#40;IC 95&#37;&#58; 4&#46;269-4&#46;647&#8364;&#41; vs&#46; 2&#46;784&#8364;&#59; &#40;IC 95&#37;&#58; 2&#46;710-2&#46;858&#8364;&#41;&#59; p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#46; Adem&#225;s&#44; los costes sanitarios de los pacientes con DM2 fueron superiores en los sujetos con mal control metab&#243;lico &#40;HbA1c<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>7&#37;&#59; 4&#46;118 vs&#46; 3&#46;406&#8364;&#44; p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41;&#44; la presencia de SM &#40;4&#46;128 vs&#46; 3&#46;048&#8364;&#44; p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41; y&#47;o presentar antecedentes de ECV previo &#40;5&#46;448 vs&#46; 3&#46;418&#8364;&#44; p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41;&#46;</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia><p id="par0115" class="elsevierStylePara elsevierViewall">Los pacientes con DM2 en comparaci&#243;n con el grupo control mostraron mayores tasas en todos los episodios&#59; destacando los ECV &#40;4&#44;7 vs&#46; 1&#44;7&#37;&#44; p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41;&#44; insuficiencia renal &#40;1&#44;8 vs&#46; 0&#44;6&#37;&#44; p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41; e infecciones genitourinarias &#40;11&#44;2 vs&#46; 8&#44;6&#37;&#44; p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41;&#46; Por subgrupos &#40;DM2 solo&#44; DM2-HTA&#44; DM2-SP&#44; DM2-OBE&#44; DM2-HTA-SP y DM2-HTA-OBE&#41;&#44; las tasas de ECV fueron del 4&#44;7&#59; 4&#44;6&#59; 2&#44;1&#59; 5&#44;0&#59; 4&#44;8 y 5&#44;6&#37;&#44; respectivamente &#40;p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41;&#44; las de insuficiencia card&#237;aca del 1&#44;6&#59; 0&#44;8&#59; 1&#44;2&#59; 1&#44;5&#59; 1&#44;8 y 2&#44;6&#37;&#44; respectivamente &#40;p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41;&#44; las de insuficiencia renal del 0&#44;1&#59; 1&#44;9&#59; 0&#44;3&#59; 1&#44;0&#59; 3&#44;4 y 1&#44;9&#37;&#44; respectivamente &#40;p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41;&#44; y las de infecci&#243;n genito-urinaria del 10&#44;7&#59; 13&#44;7&#59; 8&#44;3&#59; 9&#44;2&#59; 11&#44;1 y 12&#44;7&#37;&#44; respectivamente &#40;p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41;&#46; Las diferencias fueron estad&#237;sticamente significativas en los subgrupos DM2-HTA-SP y DM2-HTA-OBE &#40;en todos los episodios&#41;&#46;</p><p id="par0120" class="elsevierStylePara elsevierViewall">En el modelo de regresi&#243;n log&#237;stica &#40;corregido por covariables&#41;&#44; la presencia de ECV en los pacientes diab&#233;ticos se asoci&#243; al bajo control metab&#243;lico de la DM2 &#40;OR<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>2&#44;8&#41;&#59; al sexo masculino &#40;OR<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>2&#44;3&#41;&#59; OBE &#40;OR<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>1&#44;8&#41;&#59; dislipemia &#40;OR<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>1&#44;7&#41;&#59; HTA &#40;OR<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>1&#44;5&#41;&#44; y SP &#40;OR<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>1&#44;4&#41;&#46; Mientras que las hipoglucemias se asociaron con dislipemia &#40;OR<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>1&#44;5&#41;&#44; OBE &#40;OR<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>1&#44;7&#41; y la comorbilidad general &#40;&#237;ndice de Charlson&#44; OR<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>1&#44;3&#41;&#46; A su vez&#44; los costes sanitarios &#40;corregido por covariables&#41; se asociaron a los reingresos hospitalarios &#40;&#223;<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;432&#41;&#44; la edad &#40;&#223;<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;196&#41;&#44; la OBE &#40;&#223;<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;117&#41;&#44; el mal control metab&#243;lico &#40;&#223;<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;093&#41; y la hipoglucemia &#40;&#223;<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;052&#41;&#46;</p></span><span id="sec0075" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0135">Discusi&#243;n</span><p id="par0125" class="elsevierStylePara elsevierViewall">Este estudio demuestra que los pacientes con DM2 presentan una elevada asociaci&#243;n con la OBE&#44; HTA y SP&#44; circunstancia que puede ocasionar mayores tasas de ECV &#40;complicaciones&#41; y costes sanitarios durante la progresi&#243;n de la enfermedad&#46; La singularidad del estudio reside en la medida conjunta de las variables analizadas &#40;control metab&#243;lico&#44; complicaciones y costes&#41;&#44; por lo que puede considerarse como una fortaleza del estudio&#46;</p><p id="par0130" class="elsevierStylePara elsevierViewall">Los resultados del estudio resaltan la asociaci&#243;n de la DM2 con el SP&#44; la OBE y la HTA<a class="elsevierStyleCrossRefs" href="#bib0040"><span class="elsevierStyleSup">8&#8211;11&#44;13&#44;14&#44;17</span></a>&#46; Llama la atenci&#243;n que el grupo con DM2-HTA-OBE fue m&#225;s prevalente que el de DM2-HTA-SP&#59; esta circunstancia podr&#237;a ser debida a un efecto casual&#44; aunque la explicaci&#243;n m&#225;s plausible consistir&#237;a en que en el subgrupo con SP son pacientes de mayor edad&#44; y podr&#237;an presentar una reducci&#243;n del tejido adiposo<a class="elsevierStyleCrossRefs" href="#bib0060"><span class="elsevierStyleSup">12&#44;13</span></a>&#46; Los resultados observados de la prevalencia del SM son consistentes con otros estudios publicados<a class="elsevierStyleCrossRefs" href="#bib0165"><span class="elsevierStyleSup">33&#44;34</span></a>&#59; mientras que los del control metab&#243;lico son parecidos o ligeramente superiores a los datos consultados en la literatura<a class="elsevierStyleCrossRefs" href="#bib0065"><span class="elsevierStyleSup">13&#44;14&#44;35&#44;36</span></a>&#46; Esta circunstancia puede ser debida a que nuestros datos son de m&#225;s reciente aparici&#243;n&#59; no obstante&#44; aun queda un cierto margen de mejora&#44; tal como se indica en las sociedades cient&#237;ficas<a class="elsevierStyleCrossRefs" href="#bib0075"><span class="elsevierStyleSup">15&#44;16</span></a>&#46; La DM2 es una de las enfermedades con mayor impacto sociosanitario&#44; por las complicaciones que produce y un elevado consumo de los recursos sanitarios que genera<a class="elsevierStyleCrossRefs" href="#bib0075"><span class="elsevierStyleSup">15&#44;16</span></a>&#46; La tasas de hipoglucemias fueron del 37&#44;5&#37;&#59; y no hubo diferencias entre los subgrupos estudiados&#44; por lo que podr&#237;a suponerse que el perfil de tolerancia y seguridad &#40;propiedades farmacocin&#233;ticas y farmacodin&#225;micas&#41; de los pacientes&#44; junto a la distribuci&#243;n de los IDPP4 fue parecido entre los subgrupos analizados&#46;</p><p id="par0135" class="elsevierStylePara elsevierViewall">El an&#225;lisis de los costes debe ser interpretado como una fortaleza del estudio&#46; Estos se asociaron a los reingresos &#40;ECV&#41;&#44; la edad&#44; la OBE&#44; el mal control metab&#243;lico y la hipoglucemia&#46; En este sentido&#44; los limitados estudios existentes muestran que cuanto mayor sea el cumplimiento y el control metab&#243;lico de estos pacientes&#44; menor es el riesgo de hospitalizaci&#243;n<a class="elsevierStyleCrossRef" href="#bib0185"><span class="elsevierStyleSup">37</span></a>&#46; No obstante&#44; la variabilidad en los estudios revisados fue alta&#44; circunstancia que dificulta la comparaci&#243;n de los resultados&#46; En general&#44; nuestros resultados son consistentes con estos estudios<a class="elsevierStyleCrossRefs" href="#bib0110"><span class="elsevierStyleSup">22&#44;23</span></a>&#44; destacando la asociaci&#243;n de la hipoglucemia con los costes<a class="elsevierStyleCrossRefs" href="#bib0190"><span class="elsevierStyleSup">38&#8211;40</span></a>&#46; Ballesta et al&#46;<a class="elsevierStyleCrossRef" href="#bib0205"><span class="elsevierStyleSup">41</span></a> en una muestra de 517 pacientes con DM2&#44; estimaron un coste anual directo asociado a la diabetes de 2&#46;504&#8364;&#46; Los autores encontraron una asociaci&#243;n significativa entre los costes totales asociados a la DM2 y las variables tiempo de evoluci&#243;n de la diabetes&#44; valor promedio de la HbA1c y presencia de complicaciones&#46; Giorda et al&#46;<a class="elsevierStyleCrossRef" href="#bib0210"><span class="elsevierStyleSup">42</span></a>&#44; reafirman la tesitura que una terapia eficaz con un buen control metab&#243;lico puede reducir el riesgo de complicaciones y representa una estrategia v&#225;lida desde un punto de vista econ&#243;mico&#46; Con las limitaciones comentadas con anterioridad&#44; nuestros resultados estar&#237;an en consonancia con los datos revisados<a class="elsevierStyleCrossRef" href="#bib0215"><span class="elsevierStyleSup">43</span></a>&#46;</p><p id="par0140" class="elsevierStylePara elsevierViewall">Las posibles limitaciones del estudio inciden en el diagn&#243;stico preciso de la DM2&#44; el posible sesgo de clasificaci&#243;n de los pacientes y en la medida operativa de los costes&#44; atribuibles al sistema de informaci&#243;n desarrollado&#46; Otras limitaciones del estudio consisten en la falta de medida de algunas variables &#40;cumplimiento terap&#233;utico&#44; nivel socioecon&#243;mico&#44; etc&#46;&#41;&#44; aunque su distribuci&#243;n tambi&#233;n deber&#237;a de ser parecido en los grupos de estudio &#40;variables cl&#237;nicas&#41; analizados&#46; Otra limitaci&#243;n del estudio se refiere a la medida de la hipoglucemia&#44; puesto que solo se identificaron los episodios en los que el paciente requiri&#243; asistencia sanitaria y esta qued&#243; documentada&#44; por lo que podr&#237;a hacer un infradiagn&#243;stico de los casos&#46; Desde un punto de vista estrictamente farmacoecon&#243;mico parece mucho m&#225;s atrayente analizar el gasto en funci&#243;n de los par&#225;metros que potencialmente pudieran ser modificables como la presencia o no de hipoglucemias&#44; el control metab&#243;lico o incluso el control de otros factores de riesgo asociados&#44; por lo que esta circunstancia podr&#237;a interpretarse como una limitaci&#243;n del estudio&#46; Otra de las limitaciones del estudio est&#225; en relaci&#243;n con el control metab&#243;lico&#59; de forma general se considera un buen control metab&#243;lico A1c<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>7&#37;&#44; pero esto est&#225; en discusi&#243;n hoy en d&#237;a en funci&#243;n de la actual recomendaci&#243;n de individualizar los objetivos&#46; Otra limitaci&#243;n del estudio podr&#237;a deberse a no haber incluido a los pacientes con DM2 y a los de edad inferior a 40 a&#241;os&#44; aunque su repercusi&#243;n es escasa&#46;</p><p id="par0145" class="elsevierStylePara elsevierViewall">Las perspectivas futuras que nos ofrece este estudio se centran en replicarlo en otras instituciones sanitarias&#44; as&#237; como mejorar las estrategias realizadas por equipos pluridisciplinares que promuevan intervenciones efectivas en la reducci&#243;n de la OBE&#44; en las que los pacientes est&#233;n altamente comprometidos en su autocuidado&#46; En conclusi&#243;n&#44; la DM2 tiene una asociaci&#243;n importante con la OBE&#44; HTA y SP&#46; La DM2-OBES origina m&#225;s coste que la DM2-HTA&#46; La presencia de estos factores en la DM2 puede ocasionar mayores tasas de ECV y costes sanitarios en el sistema nacional de salud&#46;</p></span><span id="sec0080" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0140">Financiaci&#243;n</span><p id="par0150" class="elsevierStylePara elsevierViewall">Trabajo financiado por Bristol-Myers Squibb y Astra-Zeneca&#46;</p></span><span id="sec0085" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0145">Conflicto de intereses</span><p id="par0155" class="elsevierStylePara elsevierViewall">Los autores manifiestan no tener ning&#250;n conflicto de intereses&#46;</p></span><span id="sec0090" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0150">Contribuci&#243;n de los autores</span><p id="par0160" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">Concepci&#243;n y dise&#241;o del manuscrito&#58;</span> A&#46; Sicras&#44; R&#46; Navarro y J&#46; Ib&#225;&#241;ez&#46;</p><p id="par0165" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">Recogida de los datos&#58;</span> A&#46; Sicras&#46;</p><p id="par0170" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">An&#225;lisis e interpretaci&#243;n de los datos&#58;</span> A&#46; Sicras&#46;</p><p id="par0175" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">La redacci&#243;n&#44; revisi&#243;n y aprobaci&#243;n del manuscrito remitido&#58;</span> A&#46; Sicras&#44; R&#46; Navarro y J&#46; Ib&#225;&#241;ez&#46;</p></span></span>"
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          "titulo" => "Discusi&#243;n"
        ]
        8 => array:2 [
          "identificador" => "sec0080"
          "titulo" => "Financiaci&#243;n"
        ]
        9 => array:2 [
          "identificador" => "sec0085"
          "titulo" => "Conflicto de intereses"
        ]
        10 => array:2 [
          "identificador" => "sec0090"
          "titulo" => "Contribuci&#243;n de los autores"
        ]
        11 => array:1 [
          "titulo" => "Bibliograf&#237;a"
        ]
      ]
    ]
    "pdfFichero" => "main.pdf"
    "tienePdf" => true
    "fechaRecibido" => "2013-09-21"
    "fechaAceptado" => "2013-11-03"
    "PalabrasClave" => array:2 [
      "es" => array:1 [
        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Palabras clave"
          "identificador" => "xpalclavsec311409"
          "palabras" => array:5 [
            0 => "Diabetes"
            1 => "S&#237;ndrome metab&#243;lico"
            2 => "Hipoglucemias"
            3 => "Enfermedad cardiovascular"
            4 => "Costes sanitarios"
          ]
        ]
      ]
      "en" => array:1 [
        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Keywords"
          "identificador" => "xpalclavsec311410"
          "palabras" => array:5 [
            0 => "Diabetes"
            1 => "Metabolic syndrome"
            2 => "Hypoglycemia"
            3 => "Cardiovascular disease"
            4 => "Health care costs"
          ]
        ]
      ]
    ]
    "tieneResumen" => true
    "resumen" => array:2 [
      "es" => array:2 [
        "titulo" => "Resumen"
        "resumen" => "<span class="elsevierStyleSectionTitle" id="sect0010">Objetivos</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">La diabetes mellitus tipo 2 &#40;DM2&#41; suele acompa&#241;arse de diversas comorbilidades que pueden incrementar el coste de su tratamiento&#46; No conocemos estudios que hayan determinado los costes asociados al tratamiento de los enfermos con DM2 que&#44; adem&#225;s padecen sobrepeso &#40;SP&#41;&#44; obesidad &#40;OBE&#41; o hipertensi&#243;n arterial &#40;HTA&#41;&#46; Hemos examinado el gasto sanitario y la incidencia de enfermedad cardiovascular &#40;ECV&#41; en estos enfermos&#46;</p> <span class="elsevierStyleSectionTitle" id="sect0015">Pacientes y m&#233;todos</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Dise&#241;o observacional-multic&#233;ntrico de car&#225;cter retrospectivo&#46; Se incluyeron pacientes entre 40-99 a&#241;os que demandaron atenci&#243;n durante 2010 en Badalona &#40;Barcelona&#44; Espa&#241;a&#41;&#46; Se establecieron 2 grupos de estudio&#58; presencia-DM2 y ausencia-DM2 &#40;referencia&#47;control&#41;&#44; y 6 subgrupos&#58; DM2-solo&#44; DM2-HTA&#44; DM2-SP&#44; DM2-OBE&#59; DM2-HTA-SP y DM2-HTA-OBE&#46; Las principales medidas fueron&#58; comorbilidad&#44; s&#237;ndrome metab&#243;lico &#40;SM&#41;&#44; complicaciones &#40;hipoglucemias&#44; ECV&#41; y costes &#40;sanitarios&#59; no-sanitarios&#41;&#46; El seguimiento se realiz&#243; durante 2 a&#241;os&#46;</p> <span class="elsevierStyleSectionTitle" id="sect0020">Resultados</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Se reclutaron 26&#46;845 pacientes&#46; La prevalencia de DM2 fue del 14&#44;0&#37;&#46; Los sujetos con DM2 mostraron mayor edad &#40;67&#44;8 vs&#46; 59&#44;7 a&#241;os&#41; y porcentaje de varones &#40;51&#44;3 vs&#46; 43&#44;0&#37;&#41;&#44; p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#46; La DM2 se asoci&#243; principalmente a OBE &#40;OR&#58;<span class="elsevierStyleHsp" style=""></span>2&#44;8&#59; IC 95&#37;&#58; 2&#44;4-3&#44;1&#41;&#44; HTA &#40;OR&#58;<span class="elsevierStyleHsp" style=""></span>2&#44;4&#59; IC 95&#37;&#58; 2&#44;2-2&#44;6&#41; y SP &#40;OR&#58;<span class="elsevierStyleHsp" style=""></span>1&#44;9&#59; IC 95&#37;&#58; 1&#44;7-2&#44;2&#41;&#46; La distribuci&#243;n por subgrupos oscil&#243; entre el 6&#44;7&#37; para los enfermos que solo presentaban DM2&#44; y el 26&#44;1&#37; para los diagnosticados de DM2-HTA-SP y el 34&#44;1&#37; para los que ten&#237;an DM2-HTA-OBE&#46; El SM se identific&#243; en el 75&#44;4&#37; y un 37&#44;5&#37; refiri&#243; alg&#250;n episodio de hipoglucemia&#46; El coste-total&#47;paciente con DM2 al cabo de 2 a&#241;os fue de 4&#46;458&#8364;&#46; Por subgrupos fue de DM2&#58; 3&#46;431&#8364;&#59; DM2-HTA&#58; 4&#46;075&#8364;&#59; DM2-SP&#58; 4&#46;057&#8364;&#59; DM2-OBE&#58; 4&#46;915&#8364;&#59; DM2-HTA-SP&#58; 4&#46;203&#8364; y DM2-HTA-OBE&#58; 5&#46;02&#8364; &#40;p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41;&#46; La tasa de ECV en los enfermos con DM2 fue del 4&#44;7&#37;&#44; y del 1&#44;7&#37; en los que no padec&#237;an esta condici&#243;n &#40;p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41;&#46;</p> <span class="elsevierStyleSectionTitle" id="sect0025">Conclusiones</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">La OBE es una comorbilidad asociada a la DM2 que origina un mayor gasto sanitario que la HTA&#46; La presencia de estas comorbilidades ocasiona mayores tasas de ECV&#46;</p>"
      ]
      "en" => array:2 [
        "titulo" => "Abstract"
        "resumen" => "<span class="elsevierStyleSectionTitle" id="sect0035">Objectives</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Type 2 diabetes mellitus &#40;DM2&#41; is usually accompanied by various comorbidities that can increase the cost of treatment&#46; We are not aware of studies that have determined the costs associated with treating DM2 patients with co-morbidities such as overweight &#40;OW&#41;&#44; obesity &#40;OBE&#41; or arterial hypertension &#40;AHT&#41;&#46; The aim of the study was to examine the health-related costs and the incidence of cardiovascular disease &#40;CVD&#41; in these patients&#46;</p> <span class="elsevierStyleSectionTitle" id="sect0040">Patients and methods</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Multicenter&#44; observational retrospective design&#46; We included patients 40-99 years of age who requested medical attention in 2010 in Badalona &#40;Barcelona&#44; Spain&#41;&#46; There were two study groups&#58; those with DM2 and without DM2 &#40;reference group&#47;control&#41;&#44; and six subgroups&#58; DM2-only&#44; DM2-AHT&#44; DM2-OW&#44; DM2-OBE&#59; DM2-AHT-OW and DM2-AHT-OBE&#46; The main outcome measures were&#58; co-morbidity&#44; metabolic syndrome &#40;MS&#41;&#44; complications &#40;hypoglycemia&#44; CVD&#41; and costs &#40;health and non-health&#41;&#46; Follow-up was carried out for two years&#46;</p> <span class="elsevierStyleSectionTitle" id="sect0045">Results</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">A total of 26&#44;845 patients were recruited&#46; The prevalence of DM2 was 14&#46;0&#37;&#46; Subjects with DM2 were older &#40;67&#46;8 vs&#46; 59&#46;7 years&#41; and more were men &#40;51&#46;3 vs&#46; 43&#46;0&#37;&#41;&#44; <span class="elsevierStyleItalic">P</span>&#60;&#46;001&#46; DM2 status was associated primarily with OBE &#40;OR&#61;2&#46;8&#44; <span class="elsevierStyleSmallCaps">CI</span>&#61;2&#46;4-3&#46;1&#41;&#44; AHT &#40;OR&#61;2&#46;4&#44; CI&#61;2&#46;2-2&#46;6&#41; and OW &#40;OR&#61;1&#46;9&#44; CI&#61;1&#46;7-2&#46;2&#41;&#46; The distribution by subgroups was&#58; 6&#46;7&#37; of patients had only DM2&#44; 26&#46;1&#37; had DM2&#44; AHT and OW&#44; and 34&#46;1&#37; had DM2&#44; AHT&#44; and OBE&#46; Some 75&#46;4&#37; had MS and 37&#46;5&#37; reported an episode of hypoglycemia&#46; The total cost&#47;patient with DM2 was &#8364;4&#44;458&#46; By subgroups the costs were as follows&#58; DM2&#58; &#8364;3&#44;431&#59; DM2-AHT&#58; &#8364;4&#44;075&#59; DM2-OW&#58; &#8364;4&#44;057&#59; DM2-OBE&#58; &#8364;4&#44;915&#59; DM2-AHT-OW&#58; &#8364;4&#44;203 and DM2-AHT-OBE&#58; &#8364;5&#44;021&#44; <span class="elsevierStyleItalic">P</span>&#60;&#46;001&#46; The CVD rate among patients with DM2 was 4&#46;7 vs&#46; 1&#46;7&#37; in those without DM2 <span class="elsevierStyleItalic">P</span>&#60;&#46;001&#46;</p> <span class="elsevierStyleSectionTitle" id="sect0050">Conclusions</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Obesity is a comorbidity associated with DM2 that leads to greater healthcare costs than AHT&#46; The presence of these comorbidities causes increased rates of CVD&#46;</p>"
      ]
    ]
    "multimedia" => array:5 [
      0 => array:7 [
        "identificador" => "fig0005"
        "etiqueta" => "Figura 1"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr1.jpeg"
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        ]
        "descripcion" => array:1 [
          "es" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Esquema general del estudio&#46;</p>"
        ]
      ]
      1 => array:7 [
        "identificador" => "tbl0005"
        "etiqueta" => "Tabla 1"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "tabla" => array:2 [
          "leyenda" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">BUR&#58; bandas de utilizaci&#243;n de recursos&#59; DM2&#58; diabetes mellitus tipo 2&#59; EPOC&#58; enfermedad pulmonar obstructiva cr&#243;nica&#59; HTA&#58; hipertensi&#243;n arterial&#59; OBE&#58; obesidad&#59; SP&#58; sobrepeso&#46;</p><p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">Valores expresados en porcentaje o media &#40;desviaci&#243;n est&#225;ndar&#41;&#46;</p><p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">Valor p global en la comparaci&#243;n general entre grupos&#58; <span class="elsevierStyleSup">a</span>p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;05&#59; &#42;&#42;p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;01&#59; &#42;&#42;&#42;p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001 en la comparaci&#243;n por pares&#46;</p><p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">En los subgrupos&#44; diferencias estad&#237;sticamente significativas respecto al grupo control&#46;</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"><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Grupos de estudio&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " colspan="3" align="center" valign="\n
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                  \t\t\t\t" style="border-bottom: 2px solid black">Grupos generales</td><td class="td" title="\n
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                  \t\t\t\t  " colspan="6" align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">Subgrupos de estudio &#40;comorbilidad asociada a la diabetes&#41;</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">Total&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">Control&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">Diabetes&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">DM2 solo&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">DM2-HTA&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">DM2-SP&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">DM2-OBE&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">DM2-HTA-SP&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">DM2-HTA-OBE&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t" style="border-bottom: 2px solid black">N&#250;mero de pacientes&#44; &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
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                  \t\t\t\t" style="border-bottom: 2px solid black">N<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>26&#46;845 &#40;100&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
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                  \t\t\t\t" style="border-bottom: 2px solid black">N<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>23&#46;085 &#40;86&#44;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleBold">Caracter&#237;sticas sociodemogr&#225;ficas</span></td></tr><tr title="table-row"><td class="td" title="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Promedio de edad&#44; a&#241;os</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">60&#44;9 &#40;13&#44;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">67&#44;8 &#40;11&#44;3&#41;&#42;&#42;&#42;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">71&#44;7 &#40;10&#44;4&#41;<span class="elsevierStyleSup">a</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">64&#44;2 &#40;12&#44;1&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">R&#233;gimen de pensionista&#44; &#37;</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Promedio de BUR</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleBold">Comorbilidades asociadas</span></td></tr><tr title="table-row"><td class="td" title="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Hipertensi&#243;n arterial&#44; &#37;</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Dislipemia&#44; &#37;</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Sobrepeso&#44; &#37;</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Obesidad&#44; &#37;</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">&#8211;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">&#8211;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Fumadores activos&#44; &#37;</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">22&#44;5&#42;&#42;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">33&#44;6<span class="elsevierStyleSup">a</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">17&#44;1&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">29&#44;7<span class="elsevierStyleSup">a</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">26&#44;3<span class="elsevierStyleSup">a</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Alcoholismo&#44; &#37;</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">3&#44;6&#42;&#42;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">8&#44;3<span class="elsevierStyleSup">a</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">3&#44;0&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">4&#44;3&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">3&#44;2&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">3&#44;1&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">3&#44;0&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Cardiopat&#237;a isqu&#233;mica&#44; &#37;</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">14&#44;1&#42;&#42;&#42;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Accidente cerebrovascular&#44; &#37;</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Evento cardiovascular&#44; &#37;</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Insuficiencias org&#225;nicas&#44; &#37;</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Asma bronquial&#44; &#37;</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Neoplasias malignas&#44; &#37;</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">DM2-HTA-OBE&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">N&#250;mero de pacientes&#44; &#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">N<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>3&#46;760&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">N<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>253&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">N<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>263&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">N<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>579&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">N<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>403&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">N<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>980&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">N<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>1&#46;282&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">Tiempo desde el diagn&#243;stico&#44; a&#241;os</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">8&#44;5 &#40;3&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6&#44;5 &#40;3&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">8&#44;7 &#40;3&#44;2&#41;<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6&#44;1 &#40;2&#44;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6&#44;0 &#40;3&#44;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">8&#44;8 &#40;2&#44;9&#41;<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">8&#44;9 &#40;3&#44;5&#41;<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="8" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Complicaciones microvasculares</span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Retinopat&#237;a diab&#233;tica&#44; &#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">22&#44;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">15&#44;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">19&#44;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">14&#44;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">13&#44;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">19&#44;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">23&#44;2<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Neuropat&#237;a diab&#233;tica&#44; &#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&#44;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&#44;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&#44;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&#44;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&#44;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&#44;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&#44;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Nefropat&#237;a diab&#233;tica&#44; &#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&#44;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#44;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#44;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#44;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#44;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#44;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&#44;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Microalbuminuria&#44; &#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">25&#44;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">20&#44;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">23&#44;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">20&#44;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">19&#44;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">26&#44;0<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">26&#44;3<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="8" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Componentes del s&#237;ndrome metab&#243;lico</span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>IMC<span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>28&#44;8<span class="elsevierStyleHsp" style=""></span>kg&#47;m<span class="elsevierStyleSup">2</span>&#44; &#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">63&#44;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">11&#44;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">14&#44;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">49&#44;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">100&#44;0<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">51&#44;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">100&#44;0<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Presi&#243;n arterial<span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>130&#47;85<span class="elsevierStyleHsp" style=""></span>mmHg o tratamiento&#44; &#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t">85&#44;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">49&#44;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t">100&#44;0<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t">59&#44;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t">65&#44;4&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">100&#44;0<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">100&#44;0<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Triglic&#233;ridos<span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>150 mg&#47;dl&#44; &#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">35&#44;6&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">19&#44;0&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">26&#44;1&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">33&#44;4&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">38&#44;1&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">34&#44;6&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">41&#44;8<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Glucemia en ayunas<span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>110<span class="elsevierStyleHsp" style=""></span>mg&#47;dl&#44; &#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">88&#44;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">88&#44;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">89&#44;2&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">88&#44;3&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">88&#44;0&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">89&#44;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">89&#44;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>HDLc<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>40 varones o &#60;<span class="elsevierStyleHsp" style=""></span>50 mujeres mg&#47;dl&#44; &#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">66&#44;8&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">42&#44;3&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">63&#44;2&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">60&#44;4&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">62&#44;4&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">71&#44;8<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">72&#44;7<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
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                  \t\t\t\t  " colspan="8" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">Prevalencia del s&#237;ndrome metab&#243;lico&#44; &#37;</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">75&#44;4&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">31&#44;2&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">67&#44;8&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">64&#44;5&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">75&#44;8<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">78&#44;7<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">98&#44;7<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
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                  \t\t\t\t  " colspan="8" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Medicaci&#243;n farmacol&#243;gica</span></td></tr><tr title="table-row"><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Consumo de antidiab&#233;ticos&#44; &#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">85&#44;3&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">75&#44;5&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">86&#44;7&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">81&#44;3&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">79&#44;2&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">86&#44;9<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">89&#44;3<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Metformina&#44; &#37;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">68&#44;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">52&#44;4&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">68&#44;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">65&#44;0&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">71&#44;8<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">73&#44;0<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">74&#44;0<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Sulfonilureas&#44; &#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">29&#44;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">30&#44;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">35&#44;1<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">30&#44;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">30&#44;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">29&#44;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">27&#44;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Glinidas&#44; &#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">5&#44;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">6&#44;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">4&#44;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">4&#44;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&#44;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">5&#44;8&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">6&#44;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Glitazonas&#44; &#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">1&#44;4&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">0&#44;0&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&#44;0&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">1&#44;1&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">1&#44;3&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">1&#44;8&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">1&#44;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Acarbosa&#44; &#37;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&#44;4&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#44;0&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&#44;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&#44;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&#44;0&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&#44;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&#44;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Miglitol&#44; &#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&#44;2&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">1&#44;0&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&#44;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&#44;2&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#44;3&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#44;2&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#44;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>IDDP4&#44; &#37;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">1&#44;9&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">1&#44;0&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">3&#44;1&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">1&#44;3&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">2&#44;5&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">1&#44;2&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">2&#44;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Metformina&#47;glitazonas&#44; &#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">1&#44;8&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#44;5&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&#44;9&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">1&#44;3&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">2&#44;2&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">1&#44;5&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">2&#44;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Metformina&#47;IDDP4&#44; &#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">12&#44;3&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">12&#44;0&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">12&#44;3&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">16&#44;6&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">10&#44;0&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">11&#44;4&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">11&#44;9&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Insulina&#44; &#37;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">22&#44;3&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">23&#44;9&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">22&#44;7&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">24&#44;8&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">20&#44;5&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">25&#44;5<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Terapia farmacol&#243;gica</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">1&#44;4 &#40;0&#44;6&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">1&#44;4 &#40;0&#44;6&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">1&#44;4 &#40;0&#44;6&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">1&#44;4 &#40;0&#44;6&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">1&#44;5 &#40;0&#44;6&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">1&#44;4 &#40;0&#44;6&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">1&#44;5 &#40;0&#44;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Monoterapia&#44; &#37;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">61&#44;5&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">69&#44;6&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">65&#44;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">63&#44;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">59&#44;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">61&#44;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">59&#44;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Doble terapia&#44; &#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">33&#44;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">25&#44;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">30&#44;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">30&#44;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">33&#44;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">34&#44;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">35&#44;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Triple terapia o superior&#44; &#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5&#44;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">47&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&#44;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6&#44;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6&#44;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4&#44;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6&#44;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="8" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Hipoglucemias &#40;durante el seguimiento&#41;</span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Con ingreso hospitalario&#44; &#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#44;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#44;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>En urgencias hospitalarias&#44; &#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#44;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&#44;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&#44;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#44;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>En atenci&#243;n primaria&#44; &#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">34&#44;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">37&#44;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">46&#44;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">35&#44;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">35&#44;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">39&#44;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">33&#44;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Hipoglucemias total&#44; &#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">37&#44;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">39&#44;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">48&#44;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">36&#44;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">35&#44;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">39&#44;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">35&#44;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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            0 => array:3 [
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              "nota" => "<p class="elsevierStyleNotepara" id="npar0005">En los subgrupos&#44; diferencias estad&#237;sticamente significativas respecto al grupo general de diabetes&#46;</p>"
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          "es" => "<p id="spar0075" class="elsevierStyleSimplePara elsevierViewall">Distribuci&#243;n de las complicaciones microvasculares&#44; s&#237;ndrome metab&#243;lico&#44; medicaci&#243;n farmacol&#243;gica e hipoglucemias de los pacientes con diabetes</p>"
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          "leyenda" => "<p id="spar0095" class="elsevierStyleSimplePara elsevierViewall">Valores expresados en media &#40;DE&#41;&#59; DE&#58; desviaci&#243;n est&#225;ndar&#59; DM2&#58; diabetes mellitus tipo 2&#59; HTA&#58; hipertensi&#243;n arterial&#59; IC&#58; intervalo de confianza&#59; OBE&#58; obesidad&#59; SP&#58; sobrepeso&#46;</p><p id="spar0105" class="elsevierStyleSimplePara elsevierViewall">En los subgrupos existen diferencias significativas respecto al grupo control en todos los componentes&#44; excepto en los d&#237;as de incapacidad laboral&#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"><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">Grupos de estudio&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">Control&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">Diabetes<a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">DM2 solo&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">DM2-HTA&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">DM2-SP&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">DM2-OBE&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">DM2-HTA-SP&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">DM2-HTA-OBE&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="9" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Modelo de costes sin corregir</span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Costes sanitarios&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Costes en atenci&#243;n primaria&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Visitas m&#233;dicas&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Pruebas de laboratorio&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Radiolog&#237;a convencional&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Pruebas complementarias&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Medicamentos &#40;todos&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Antidiab&#233;ticos&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">&#8211;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">625 &#40;821&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">734 &#40;979&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">593 &#40;774&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Costes en atenci&#243;n especializada&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>D&#237;as de hospitalizaci&#243;n&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Visitas m&#233;dicas&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Costes no sanitarios &#40;productividad&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Costes totales&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Modelo de costes corregidos</span><a class="elsevierStyleCrossRef" href="#tblfn0015"><span class="elsevierStyleSup">b</span></a></td></tr><tr title="table-row"><td class="td" title="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Costes sanitarios&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>IC 95&#37;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">2&#46;848-3&#46;313&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">2&#46;387-2&#46;725&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">3&#46;034-3&#46;281&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">3&#46;655-3&#46;876&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Costes en atenci&#243;n primaria&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">2&#46;870&#42;&#42;&#42;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">2&#46;238&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">3&#46;355&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>IC 95&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">1&#46;628-1&#46;672&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">2&#46;814-2&#46;927&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">2&#46;035-2&#46;440&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">2&#46;634-3&#46;026&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">2&#46;167-2&#46;452&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">2&#46;634-2&#46;954&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">2&#46;655-2&#46;863&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">3&#46;261-3&#46;448&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Coste en medicamentos &#40;todos&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">899&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">1&#46;859&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">1&#46;406&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">1&#46;701&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">1&#46;469&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">1&#46;850&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">1&#46;696&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">2&#46;252&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>IC 95&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">868-929&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">1&#46;818-1&#46;899&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">1&#46;305-1&#46;506&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">1&#46;611-1&#46;791&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">1&#46;369-1&#46;569&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">1&#46;780-1&#46;920&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">1&#46;613-1&#46;779&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">2&#46;162-2&#46;342&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Coste en antidiab&#233;ticos&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">563&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t">536&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">363&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">558&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">655&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t">421&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">701&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>IC 95&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">522-603&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">435-636&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">273-453&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">458-658&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">585-725&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">337-504&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">611-791&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Costes en atenci&#243;n especializada&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">133&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">360&#42;&#42;&#42;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">289&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">250&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">246&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">364&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">398&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">411&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>IC 95&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">122-143&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">333-387&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">191-386&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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              "nota" => "<p class="elsevierStyleNotepara" id="npar0015">Modelo de ANCOVA&#58; los contrastes se basan en las comparaciones por pares&#44; linealmente independientes&#44; entre las medias marginales estimadas&#46;</p>"
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          "es" => "<p id="spar0090" class="elsevierStyleSimplePara elsevierViewall">Modelo de costes brutos y corregidos &#40;seguimiento de 24 meses&#41; seg&#250;n los grupos de estudio &#40;en euros&#41;</p>"
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          "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">&#191;Qu&#233; sabemos&#63;</span><p id="par0010" class="elsevierStylePara elsevierViewall">La diabetes mellitus tipo 2 &#40;DM2&#41; es una enfermedad con un elevado riesgo de padecer alguna enfermedad vascular&#44; especialmente si se asocia a otros factores de riesgo cardiovasculares como obesidad e hipertensi&#243;n arterial &#40;HTA&#41;&#46; No conocemos estudios que hayan determinado los costes de la DM2 cuando coexiste sobrepeso&#44; obesidad o HTA&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">&#191;Qu&#233; aporta este estudio&#63;</span><p id="par0015" class="elsevierStylePara elsevierViewall">El an&#225;lisis de 3&#46;760 enfermos con DM2 muestra que los costes asociados a la obesidad son mayores que a la HTA&#46; La incidencia de enfermedad cardiovascular fue m&#225;s de 2&#44;5 veces mayor en los enfermos con DM2 que en los que no padec&#237;an esta condici&#243;n&#46;</p><p id="par0180" class="elsevierStylePara elsevierViewall">Los Editores</p></span></span>"
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Vol. 214. Núm. 3.
Páginas 121-130 (abril 2014)
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Vol. 214. Núm. 3.
Páginas 121-130 (abril 2014)
Original
Características clínicas y económicas asociadas a la diabetes tipo 2
Clinical and economic characteristics associated with type 2 diabetes
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A. Sicras-Mainara,
Autor para correspondencia
asicras@bsa.cat

Autor para correspondencia.
, R. Navarro-Artiedab, J. Ibáñez-Nollac
a Dirección de planificación, Badalona Serveis Assistencials SA, Badalona, Barcelona, España
b Documentación médica, Hospital Germans Trias i Pujol, Badalona, Barcelona, España
c Dirección médica, Badalona Serveis Assistencials SA, Badalona, Barcelona, España
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Tablas (3)
Tabla 1. Características basales de la serie estudiada
Tabla 2. Distribución de las complicaciones microvasculares, síndrome metabólico, medicación farmacológica e hipoglucemias de los pacientes con diabetes
Tabla 3. Modelo de costes brutos y corregidos (seguimiento de 24 meses) según los grupos de estudio (en euros)
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Resumen
Objetivos

La diabetes mellitus tipo 2 (DM2) suele acompañarse de diversas comorbilidades que pueden incrementar el coste de su tratamiento. No conocemos estudios que hayan determinado los costes asociados al tratamiento de los enfermos con DM2 que, además padecen sobrepeso (SP), obesidad (OBE) o hipertensión arterial (HTA). Hemos examinado el gasto sanitario y la incidencia de enfermedad cardiovascular (ECV) en estos enfermos.

Pacientes y métodos

Diseño observacional-multicéntrico de carácter retrospectivo. Se incluyeron pacientes entre 40-99 años que demandaron atención durante 2010 en Badalona (Barcelona, España). Se establecieron 2 grupos de estudio: presencia-DM2 y ausencia-DM2 (referencia/control), y 6 subgrupos: DM2-solo, DM2-HTA, DM2-SP, DM2-OBE; DM2-HTA-SP y DM2-HTA-OBE. Las principales medidas fueron: comorbilidad, síndrome metabólico (SM), complicaciones (hipoglucemias, ECV) y costes (sanitarios; no-sanitarios). El seguimiento se realizó durante 2 años.

Resultados

Se reclutaron 26.845 pacientes. La prevalencia de DM2 fue del 14,0%. Los sujetos con DM2 mostraron mayor edad (67,8 vs. 59,7 años) y porcentaje de varones (51,3 vs. 43,0%), p<0,001. La DM2 se asoció principalmente a OBE (OR:2,8; IC 95%: 2,4-3,1), HTA (OR:2,4; IC 95%: 2,2-2,6) y SP (OR:1,9; IC 95%: 1,7-2,2). La distribución por subgrupos osciló entre el 6,7% para los enfermos que solo presentaban DM2, y el 26,1% para los diagnosticados de DM2-HTA-SP y el 34,1% para los que tenían DM2-HTA-OBE. El SM se identificó en el 75,4% y un 37,5% refirió algún episodio de hipoglucemia. El coste-total/paciente con DM2 al cabo de 2 años fue de 4.458€. Por subgrupos fue de DM2: 3.431€; DM2-HTA: 4.075€; DM2-SP: 4.057€; DM2-OBE: 4.915€; DM2-HTA-SP: 4.203€ y DM2-HTA-OBE: 5.02€ (p<0,001). La tasa de ECV en los enfermos con DM2 fue del 4,7%, y del 1,7% en los que no padecían esta condición (p<0,001).

Conclusiones

La OBE es una comorbilidad asociada a la DM2 que origina un mayor gasto sanitario que la HTA. La presencia de estas comorbilidades ocasiona mayores tasas de ECV.

Palabras clave:
Diabetes
Síndrome metabólico
Hipoglucemias
Enfermedad cardiovascular
Costes sanitarios
Abstract
Objectives

Type 2 diabetes mellitus (DM2) is usually accompanied by various comorbidities that can increase the cost of treatment. We are not aware of studies that have determined the costs associated with treating DM2 patients with co-morbidities such as overweight (OW), obesity (OBE) or arterial hypertension (AHT). The aim of the study was to examine the health-related costs and the incidence of cardiovascular disease (CVD) in these patients.

Patients and methods

Multicenter, observational retrospective design. We included patients 40-99 years of age who requested medical attention in 2010 in Badalona (Barcelona, Spain). There were two study groups: those with DM2 and without DM2 (reference group/control), and six subgroups: DM2-only, DM2-AHT, DM2-OW, DM2-OBE; DM2-AHT-OW and DM2-AHT-OBE. The main outcome measures were: co-morbidity, metabolic syndrome (MS), complications (hypoglycemia, CVD) and costs (health and non-health). Follow-up was carried out for two years.

Results

A total of 26,845 patients were recruited. The prevalence of DM2 was 14.0%. Subjects with DM2 were older (67.8 vs. 59.7 years) and more were men (51.3 vs. 43.0%), P<.001. DM2 status was associated primarily with OBE (OR=2.8, CI=2.4-3.1), AHT (OR=2.4, CI=2.2-2.6) and OW (OR=1.9, CI=1.7-2.2). The distribution by subgroups was: 6.7% of patients had only DM2, 26.1% had DM2, AHT and OW, and 34.1% had DM2, AHT, and OBE. Some 75.4% had MS and 37.5% reported an episode of hypoglycemia. The total cost/patient with DM2 was €4,458. By subgroups the costs were as follows: DM2: €3,431; DM2-AHT: €4,075; DM2-OW: €4,057; DM2-OBE: €4,915; DM2-AHT-OW: €4,203 and DM2-AHT-OBE: €5,021, P<.001. The CVD rate among patients with DM2 was 4.7 vs. 1.7% in those without DM2 P<.001.

Conclusions

Obesity is a comorbidity associated with DM2 that leads to greater healthcare costs than AHT. The presence of these comorbidities causes increased rates of CVD.

Keywords:
Diabetes
Metabolic syndrome
Hypoglycemia
Cardiovascular disease
Health care costs

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