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Resumen Objetivo Examinar el patron de prescripcion de los distintos inhibidores de la dipeptidil-peptidasa 4 (iDPP4) en funcion del filtrado glomerular estimado (FGe) en condiciones de practica clinica real. Metodologia Estudio descriptivo observacional con base de datos poblacional (SIDIAP Catalunya). Se incluyeron sujetos diagnosticados de diabetes mellitus tipo 2 (DM2) con evaluacion de su funcion renal y tratamiento activo con iDPP4. Se incluyeron pacientes en el momento de la determinacion del FGe (CKD-EPI), con un periodo de observacion de 6 meses posterior a su inclusion. Para cada sujeto se estimo la dosis diaria prescrita (DDP) de iDPP4, su dosis teorica segun su nivel de insuficiencia renal que establecen las recomendaciones de la ficha tecnica (DDD-aj) y el ratio RDP (DDP/DDD-aj). Se considero que un sujeto estaba sobretratado si su RDP era superior a 1,2 (> 20%). Resultados La muestra estudiada fue de 72.135 sujetos con una edad media de 69,7 (± 11,6) anos y un 55,9% de varones. El porcentaje de pacientes con sobretratamiento varia segun el tipo de farmaco iDPP4 y el estadio de la funcion renal. Globalmente la sobredosificacion se registro en el 7,15% de todos los tratamientos con iDPP4. En estadios avanzados (IIIb, IV y V) la sobredosificacion fue muy superior (del 36,8% para todos los iDPP4 y si excluimos la linagliptina del 58,7%). Discusion En condiciones de practica clinica real, mas de un tercio de los pacientes con DM2 con insuficiencia renal avanzada presentaban una sobredosificacion de los iDPP4, puesto que no se ajustan correctamente las dosis al filtrado glomerular de cada paciente.

Background Evidence from prospective cardiovascular (CV) outcome trials in type 2 diabetes (T2DM) patients supports the use of sodium–glucose co-transporter-2 inhibitors (SGLT2i) to reduce the risk of CV events. In this study, we compared the risk of several CV outcomes between new users of SGLT2i and other glucose-lowering drugs (oGLDs) in Catalonia, Spain. Methods CVD-REAL Catalonia was a retrospective cohort study using real-world data routinely collected between 2013 and 2016. The cohorts of new users of SGLT2i and oGLDs were matched by propensity score on a 1:1 ratio. We compared the incidence rates and hazard ratio (HR) for all-cause death, hospitalization for heart failure, chronic kidney disease, and modified major adverse CV event (MACE; all-cause mortality, myocardial infarction, or stroke). Results After propensity score matching, 12,917 new users were included in each group. About 27% of users had a previous history of CV disease. In the SGLT2i group, the exposure time was 60% for dapagliflozin, 26% for empagliflozin and 14% for canagliflozin. The use of SGLT2i was associated with a lower risk of heart failure (HR: 0.59; 95% confidence interval [CI] 0.47–0.74; p Conclusions In this large, retrospective observational study of patients with T2DM from a Catalonia, initiation of SGLT-2i was associated with lower risk of mortality, as well as heart failure and CKD.

To assess the clinical characteristics, the prescription pattern of GLP-1 receptor agonists (GLP-1RA) users, and HbA1c and weight change, we retrospectively assessed patients with type 2 diabetes by initiating GLP-1RA as an add-on to the standard of care in Catalonia. The mean change from the baseline in glycated hemoglobin (HbA1c) and weight at 6 and 12 months of therapy was calculated, and we assessed the predictors of the HbA1c reduction of &ge, 1% and/or the weight reduction of &ge, 3% as recommended by the Catalan Health Service. In 2854 patients who initiated a GLP-1RA during 2014 and 2015, the overall mean HbA1c values were reduced from the baseline by &minus, 0.84% (SD = 1.66) (&minus, 9.2 mmol/mol) and lost on average 2.73 kg (SD = 6.2). About 44% percent of patients decreased their HbA1c by &ge, 1%, 44% decreased their weight by &ge, 3%, and only 22% met both of them together. The odds of achieving a reduction of &ge, 1% in initial HbA1c were two-fold higher for patients with higher baseline levels, and the likelihood of a reduction of &ge, 3% in the initial weight was associated with a higher BMI at the baseline, but they were independent of each other. The composite outcome (target 1% HbA1c reduction and 3% weight loss) to evaluate both the GLP-1RA clinical benefit and treatment withdrawal should be judged from a patient-centered approach.

The value of heparin in the prevention of venous thromboembolism has been shown effective and safe by controlled studies. However, how these studies have influenced physicians' decisions in thrombo-prophylaxis is not known. With the aim of evaluating the frequency and the appropriateness of prophylaxis for venous thromboembolism in our centre, we performed a cross-sectional study on a specific day. Among 667 patients who were admitted to hospital on this day, 134 (20 per cent) were receiving heparin. This had been prescribed for the prophylaxis of venous thromboembolism to 82 (12 per cent) patients. Immobilization was the risk factor most strongly associated with prophylaxis. Prophylaxis with heparin was only used in 79 out of 444 high-risk patients (21.6 per cent). One hundred and eighty-three patients had been subject to major surgery and heparin was being given only to 34 of them (18.6 per cent). A wide variability in the use of prophylaxis, depending on the hospital ward, was also recorded. We conclude that prophylaxis with heparin is underused in our milieu.