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In 2010, the American Diabetes Association included glycosylated hemoglobin (HbA1c) as a criterion for the diagnosis of diabetes with a cut-off point of ≥ 6.5%. However, there may be a substantial percentage of false negative results. Other scientific societies have accepted this approach but with slight differences. HbA1c complements, but does not substitute, basal glycemia as a screening and diagnostic test or the 2-hour oral glucose tolerance test. HbA1c should not be used for the diagnosis of gestational diabetes. Interpretation of HbA1c is limited in persons with anemia and hemoglobinopathies. Therefore, in addition to its sensitivity and specificity, its costs and the epidemiological situation should also be evaluated. An important question is whether almost normal HbA1c levels are safe in patients with type 2 diabetes. The results of the ACCORD, ADVANCE and VADT trials are contradictory and have aroused considerable controversy. However, the extensions of the UKPDS and STENO-2 studies have shown the benefits of good glycemic control in the long term. As a general rule, a target of HbA1c < 7% seems appropriate. In patients at low risk of hypoglycemic episodes, short disease duration and young persons, HbA1c < 6.5% can be considered. In patients with frequent hypoglycemic episodes, the elderly and persons with short life expectancy, values of more than 7% are acceptable. This target should be achieved through individualized, early, intensive and safe treatment, without risk of hypoglycemia, and should be integrated in an overall program of cardiovascular risk prevention., (Copyright © 2010 Elsevier España, S.L. All rights reserved.)

Objectives: To measure two functional dimensions (vitality and physical function) involved in the quality of life of the over-65s and to find what relationship they maintain with the commonest reasons for consultation., Design: Cross-sectional, descriptive study., Setting: Primary care., Participants: Randomised sample of 179 patients over 65 from 14 primary care clinics in Navarra., Methods: SF-36 quality-of-life questionnaire and most common reasons for consultation. Personal and family details and ongoing drug prescription were also recorded., Results: The most common reasons for consultation were insomnia (31.8%), arthrosis (48%), and urinary symptoms (16.2%). The greatest differences in the SF-36 scales occurred in patients with insomnia. In the multiple regression models, inverse associations were found for each of the reasons for consultation with the vitality and physical function dimensions. Vitality was associated with urinary symptoms, with an adjusted beta coefficient of -11.2 points (95% CI, -18.6 to -3.7). Insomnia was associated with significant decline in vitality and physical function, with beta of -7.7 points (95% CI, -13.9 to -1.5) and -10.3 points (95% CI, -19.1 to -1.6), respectively. Arthrosis symptoms behaved in a similar way., Conclusions: The most common pathologies or symptoms causing primary care consultations in the over-65s affect significantly the quality-of-life dimensions relating to the pursuit of normal daily life.

Objectives: The main objective of this study was to determine the degree of similarity between large primary prevention trials of hypercholesterolemia and our population of patients with dyslipidemia, in order to evaluate the external validity of these studies and their applicability to the general population., Design: Descriptive retrospective study., Setting: Tafalla Health Center in Navarra (Northern Spain), serving a population of 11 500 inhabitants.Participants. All patients older than 18 years assigned to our health center who had dyslipidemia with no antecedents of ischemic heart disease., Results: The percentage of patients in our sample who satisfied the inclusion criteria used in large clinical trials ranged from 2.4% to 46%, depending on the study: AFCAPS/TexCAPS 1998, 46.2%; HPS 2002, 46.1%; WOSCOPS 1995, 10.9%; HHS 1987, 10.6%; LRC-CPPT 1984, 2.4%., Conclusions: Many of our patients (54%-97%) with dyslipidemia would not have been eligible for inclusion in earlier studies of hyperlipidemia and primary prevention. The external validity (applicability to the general population) of these studies is questionable. Decision-making in clinical practice for the primary prevention of hypercholesterolemia should be based on the risk/benefit ratio of pharmacological treatment.

Objectives: To find the degree of control, the prevalence of complications and cardiovascular risk factors (CVRF), and the drugs treatment used for type II diabetics., Design: A descriptive crossover study., Setting: Rekaldeberri Health Centre, Bilbao., Patients: 202 diabetes II patients selected at random., Interventions: Data were gathered by interviews, physical examinations and further tests., Main Results: 52.2% of the sample were women. Average age was 66.6 50% of the diabetics had been diagnosed for 8 years or more. Microalbuminuria was detected in 21.9% of the patients, Microangiopathy in 24.8%, Neuropathy in 11.4% and diabetic foot in 10.4%. The years of evolution and appearance of complications had a significant connection. 64.4% of patients had a good or acceptable metabolic control. Worse metabolic control of diabetes was connected with the appearance of retinopathy and neuropathy. 47.5% were hypertensive. 21.3% smoked, 35.6% had cholesterol figures over 250 mgr/dl. Their mean Body mass index was 28.1. 40.6% were treated exclusively by diet, 9.9% with insulin and 35.6% with medicines taken orally., Conclusions: A high percentage of diabetics had a good or acceptable control of their disease. Prevalence of complications was less than in other studies, whereas CVRFs were similar. We do not discount the presence of bias in the comparison because of different diagnostic methods.

Objective: To find the utilization of the health center medical services in Navarra and how it relates to characteristics of both doctors and population., Design: Descriptive study., Setting: Primary Health Care., Participants: 167 family doctors (GP) from 31 PCTs. The daily on-demand, administrative and pre-programmed consultation in the records of the PCTs from 1/5/90 to 30/3/91 were analysed for each doctor., Measurements and Results: Indicators: frequentation (interviews/inhabitant/year), pressure of attendance (interviews/doctor/day), programmed pressure (pre-programmed interviews/doctor/day) and administrative pressure (administrative interviews/doctor/day). Average frequency in Navarra is 5.26 (SD = 2.58); average pressure of attendance, 32.13 (SD = 11.88); average pre-programmed pressure, 2.68 (SD = 1.81) and average administrative pressure, 7.9 (SD = 7.11). Frequency is inversely determined by the size of the allotted population list (p < 0.01). On studying doctors with an allotted list of &#95; 1,500 people, GPs with residential training have lower frequency of interviews than the rest (p < 0.01), whereas rural GPs have higher frequency and higher pressure of attendance (p < 0.001). Rural areas in the North of Navarra have a lower frequency of interviews and pressure of attendance than rural areas in the South (p < 0.02)., Conclusion: Values of frequency in Navarra are comparable with other countries.