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Hemos comparado la consecuci&#243;n de objetivos terap&#233;uticos en la unidad de riesgo vascular &#40;URV&#41;&#44; del Hospital Universitario La Paz&#44; con los referidos por D&#237;ez Porres et al<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a>&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">Seleccionamos pacientes diagnosticados de DM2 &#40;criterios diagn&#243;sticos ADA&#41;<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> atendidos durante el a&#241;o 2009 en la URV&#46; Incluimos pacientes con edad&#44; sexo e IMC equiparables a los de la poblaci&#243;n de D&#237;ez Porres et al<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a>&#46; De un total de 192 enfermos&#44; 67 pacientes &#40;36 hombres&#44; 54&#37;&#41; mostraron unas caracter&#237;sticas semejantes a los de la poblaci&#243;n de D&#237;ez Porres et al<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a><span class="elsevierStyleItalic">&#46;</span> La edad &#40;media<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>DE&#41; 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12&#47;63 en varones &#40;74&#37;&#41; y 26&#47;63 en mujeres &#40;46&#37;&#41;&#59; HbA1c&#44; 39&#47;59 &#40;68&#37;&#41;&#59; triglic&#233;ridos&#44; 39&#47;62 &#40;63&#37;&#41;&#59; presi&#243;n arterial diast&#243;lica&#44; 36&#47;66 &#40;54&#37;&#41;&#59; LDL colesterol&#44; 30&#47;63 &#40;46&#37;&#41;&#59; y presi&#243;n arterial sist&#243;lica&#44; 25&#47;66 &#40;38&#37;&#41;&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">Al comparar nuestros resultados con los de D&#237;ez Porres et al<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">tabla 1</a>&#41;<span class="elsevierStyleItalic">&#44;</span> observamos una diferencia relevante en la proporci&#243;n de pacientes con evento cardiovascular previo &#40;URV 28&#37; versus medio rural 19&#37;&#59; p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;01&#41;&#46; Adem&#225;s&#44; entre los pacientes de la URV hubo una mayor proporci&#243;n de enfermos con sobrepeso y obesidad &#40;IMC &#8805; 27<span class="elsevierStyleHsp" style=""></span>kg&#47;m<span class="elsevierStyleSup">2</span>&#41; &#40;84&#37; versus 75&#37;&#59; p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;01&#41;&#44; y de tabaquismo &#40;37&#37; versus 18&#37;&#59; p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;01&#41;&#46; Es posible&#44; por tanto&#44; que los enfermos con DM2 atendidos en la URV tuvieran un mayor riesgo vascular&#46; Una mayor proporci&#243;n de los pacientes atendidos en la URV ten&#237;an controlado el metabolismo hidrocarbonado &#40;HbA1c&#44; 68&#37; versus 41&#37;&#59; p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;05&#41;&#44; y lip&#237;dico &#40;colesterol total&#44; 78&#37; versus 54&#37;&#59; 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                  \t\t\t\t\ttop\n
                  \t\t\t\t">8&#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">37&#37;<a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">b</span></a>&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">IMC &#40;kg&#47;m<span class="elsevierStyleSup">2</span>&#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">30&#44;0<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>4&#44;6&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">29&#44;8<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>2&#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">IMC &#8805; 27 kg&#47;m<span class="elsevierStyleSup">2</span>&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">75&#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">84&#37;<a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">b</span></a>&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">36&#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  " align="left" valign="\n
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                  \t\t\t\t">54&#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&#37;<a class="elsevierStyleCrossRef" href="#tblfn0020"><span class="elsevierStyleSup">d</span></a>&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</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  " align="left" valign="\n
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                  \t\t\t\t  " align="left" valign="\n
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Correspondencia
Objetivos terapéuticos en diabetes mellitus tipo 2: ¿influye el lugar de atención al paciente?
Therapeutic objectives in type 2 diabetes mellitus: Does the site play in role in the patient's care?
R. Bailén Almorox
Autor para correspondencia
rebeca.bailen@gmail.com

Autor para correspondencia.
, A. Sánchez Martín, C. Velasco García, K.J. Lundelin
Unidad de Riesgo Vascular, Servicio de Medicina Interna, Hospital Universitario La Paz, Madrid, España
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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">D&#237;ez Porres et al<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a>&#44; han examinado el cumplimiento de objetivos terap&#233;uticos propuestos por la <span class="elsevierStyleItalic">American Diabetes Association</span><a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> para la diabetes mellitus tipo 2 &#40;DM2&#41; en pacientes que viven en un medio rural y atendidos en el &#225;mbito de la Atenci&#243;n Primaria&#46; Tan s&#243;lo el 2&#37; cumpl&#237;an todos los objetivos<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a>&#46; Se ha comunicado que en unidades especializadas de hospitales extranjeros los enfermos con DM2 consiguen un mayor control de los mismos objetivos terap&#233;uticos<a class="elsevierStyleCrossRefs" href="#bib0015"><span class="elsevierStyleSup">3&#8211;5</span></a>&#46; Hemos comparado la consecuci&#243;n de objetivos terap&#233;uticos en la unidad de riesgo vascular &#40;URV&#41;&#44; del Hospital Universitario La Paz&#44; con los referidos por D&#237;ez Porres et al<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a>&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">Seleccionamos pacientes diagnosticados de DM2 &#40;criterios diagn&#243;sticos ADA&#41;<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> atendidos durante el a&#241;o 2009 en la URV&#46; Incluimos pacientes con edad&#44; sexo e IMC equiparables a los de la poblaci&#243;n de D&#237;ez Porres et al<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a>&#46; De un total de 192 enfermos&#44; 67 pacientes &#40;36 hombres&#44; 54&#37;&#41; mostraron unas caracter&#237;sticas semejantes a los de la poblaci&#243;n de D&#237;ez Porres et al<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a><span class="elsevierStyleItalic">&#46;</span> La edad &#40;media<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>DE&#41; fue de 69&#44;5<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>4&#44;7 a&#241;os&#44; el IMC de 29&#44;8<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>2&#44;2<span class="elsevierStyleHsp" style=""></span>kg&#47;m<span class="elsevierStyleSup">2</span> y el tiempo de evoluci&#243;n de DM2 de 10&#44;3<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>5&#44;2 a&#241;os&#46; Un total de 19&#47;67 &#40;28&#37;&#41; pacientes hab&#237;a sufrido un evento cardiovascular previo y un total de 9&#47;67 &#40;13&#37;&#41; pacientes segu&#237;a tratamiento con insulina&#46; El control de las variables analizadas seg&#250;n los criterios de la ADA<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> &#40;orden decreciente&#41; fue&#58; colesterol total&#44; 49&#47;63 &#40;78&#37;&#41;&#59; HDL colesterol&#44; 12&#47;63 en varones &#40;74&#37;&#41; y 26&#47;63 en mujeres &#40;46&#37;&#41;&#59; HbA1c&#44; 39&#47;59 &#40;68&#37;&#41;&#59; triglic&#233;ridos&#44; 39&#47;62 &#40;63&#37;&#41;&#59; presi&#243;n arterial diast&#243;lica&#44; 36&#47;66 &#40;54&#37;&#41;&#59; LDL colesterol&#44; 30&#47;63 &#40;46&#37;&#41;&#59; y presi&#243;n arterial sist&#243;lica&#44; 25&#47;66 &#40;38&#37;&#41;&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">Al comparar nuestros resultados con los de D&#237;ez Porres et al<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">tabla 1</a>&#41;<span class="elsevierStyleItalic">&#44;</span> observamos una diferencia relevante en la proporci&#243;n de pacientes con evento cardiovascular previo &#40;URV 28&#37; versus medio rural 19&#37;&#59; p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;01&#41;&#46; Adem&#225;s&#44; entre los pacientes de la URV hubo una mayor proporci&#243;n de enfermos con sobrepeso y obesidad &#40;IMC &#8805; 27<span class="elsevierStyleHsp" style=""></span>kg&#47;m<span class="elsevierStyleSup">2</span>&#41; &#40;84&#37; versus 75&#37;&#59; p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;01&#41;&#44; y de tabaquismo &#40;37&#37; versus 18&#37;&#59; p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;01&#41;&#46; Es posible&#44; por tanto&#44; que los enfermos con DM2 atendidos en la URV tuvieran un mayor riesgo vascular&#46; Una mayor proporci&#243;n de los pacientes atendidos en la URV ten&#237;an controlado el metabolismo hidrocarbonado &#40;HbA1c&#44; 68&#37; versus 41&#37;&#59; p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;05&#41;&#44; y lip&#237;dico &#40;colesterol total&#44; 78&#37; versus 54&#37;&#59; p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;01&#44; y LDL-col&#44; 46&#37; versus 30&#37;&#59; p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;01&#41;&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0020" class="elsevierStylePara elsevierViewall">Podemos concluir&#44; que a pesar de que los pacientes atendidos en la URV parecen tener un mayor riesgo vascular la consecuci&#243;n de algunos objetivos como la HbA1c y el colesterol LDL y total es superior en los enfermos atendidos en el hospital por internistas que en los enfermos del &#225;mbito rural&#46; No obstante&#44; en ambas circunstancias existe un amplio margen de mejora para el cumplimiento de estos objetivos terap&#233;uticos&#46;</p></span>"
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                  \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">84&#37;<a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">b</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">PAS &#60; 130 mmHg&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&#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">38&#37;&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">PAD &#60; 80 mmHg&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">53&#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">54&#37;&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">HbA1c &#60; 7&#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">41&#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">68&#37;<a class="elsevierStyleCrossRef" href="#tblfn0020"><span class="elsevierStyleSup">d</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">Col-total &#60; 200 mg&#47;dL&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">54&#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">78&#37;<a class="elsevierStyleCrossRef" href="#tblfn0020"><span class="elsevierStyleSup">d</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">LDL-col &#60; 100 mg&#47;dL&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&#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">46&#37;<a class="elsevierStyleCrossRef" href="#tblfn0020"><span class="elsevierStyleSup">d</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">HDL-col &#62;50 &#40;v&#41;&#47;40 &#40;m&#41; mg&#47;dL<a class="elsevierStyleCrossRef" href="#tblfn0025"><span class="elsevierStyleSup">e</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">75&#37;&#47;55&#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">74&#37;&#47;46&#37;&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">Triglic&#233;ridos &#60; 150 mg&#47;dL&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">75&#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&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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                    0 => array:2 [
                      "doi" => "10.1056/NEJMoa021778"
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ISSN: 00142565
Idioma original: Español
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