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Objectives Determine the incidence and risk factors of type 2 diabetes in the adult population of Madrid (Spain) and compare the predictive models of type 2 diabetes based on the prediabetes criteria of the American Diabetes Association (ADA) and the World Health Organisation (WHO). Material and methods A prospective study was conducted on a population cohort composed of 2048 individuals between 30 and 74 years of age with no diabetes. At the start of the study, an epidemiological survey was performed, and baseline glycaemia, HbA1c, body mass index and waist circumference were measured. A follow-up of 6.4 years was conducted. New cases of type 2 diabetes were identified using the electronic primary care medical history. Results The incidence of type 2 diabetes was 3.5 cases/1000 person-years. In the multivariate analysis, the variables that were associated with the onset of type 2 diabetes were age, family history of diabetes, baseline glycaemia (100–125 mg/dL), HbA1c (5.7–6.4%) and waist circumference (≥94 cm for men and ≥80 cm for women). Of these, the most significantly associated variables were baseline glycaemia and HbA1c. The ADA and WHO criteria for defining prediabetes had the same predictive capacity. Conclusion The incidence of type 2 diabetes measured in Madrid was lower than that found in other population studies, with the glucometabolic state the main factor associated with progression to type 2 diabetes. There were no differences between the prediabetes defined by the ADA and the WHO for predicting the onset of the disease.

Tesis Doctoral leida en la Universidad Rey Juan Carlos de Madrid en 2015. Director de la Tesis: Ana Lopez de Andres y Ma Dolores Martin Rios

Resumen Introduccion La relacion entre depresion y diabetes ha sido ampliamente documentada pero con limitaciones metodologicas como la no realizacion de una entrevista diagnostica del cuadro depresivo. Hemos estimado la prevalencia de depresion en pacientes con diabetes tipo 2 (DM2) y su relacion con variables sociodemograficas, estilos de vida y clinicas. Pacientes y metodos Estudio transversal, de una muestra aleatoria, estratificada por sexo y edad, de pacientes con DM2 atendidos en un area sanitaria con unos 3.000 enfermos elegibles. Los sintomas depresivos fueron evaluados mediante el Inventario de Depresion de Beck (depresion definida como BDI > 16) y una entrevista psiquiatrica. Se utilizo un modelo de regresion logistica multivariante para evaluar la asociacion de la depresion con la DM2, tras ajustar por factores de riesgo conocidos. Resultados Estudiamos a 275 enfermos con DM2 (edad media: 64,5 anos; hombres: 56,4%). La prevalencia de depresion se estimo en un 32,7% (IC 95%: 27,4-38,5) y aumentaba con la edad. Se encontro una mayor prevalencia en mujeres, en viudos, en obesos, en los malos cumplidores de la prescripcion, en los que no mantenian un buen control glucemico y en los que habian desarrollado complicaciones de la diabetes. El 35% (IC 95%: 26,4-45,8) de los pacientes que obtuvieron una puntuacion en la escala BDI > 16 no habian sido diagnosticados de depresion. Conclusiones La depresion es muy prevalente en los pacientes con DM2, especialmente en mujeres. En cerca de un tercio de los enfermos, el diagnostico de depresion no se habia formulado.

Background The relationship between depression and diabetes has been widely documented but there have been methodological limitations such as the failure to conduct a diagnostic interview of the depressive condition. We have estimated the prevalence of depression in patients with type 2 diabetes mellitus (DM2) and its relationship with sociodemographic, lifestyle and clinical variables. Patients and methods This was a cross-sectional, randomized study (stratified by sex and age) of patients with DM2 treated in a healthcare area with approximately 3000 eligible patients. The depressive symptoms were assessed using the Beck Depression Inventory (depression defined as a BDI score ≥16) and a psychiatric interview. We used a multivariate logistic regression model to evaluate the association between depression and DM2, after adjusting for known risk factors. Results We examined 275 patients with DM2 (mean age, 64.5 years; men, 56.4%). The prevalence of depression was calculated at 32.7% (95% CI 27.4–38.5) and increased with age. A greater prevalence of depression was found in women, widowers, patients with obesity, those with poor compliance with the prescription, those with poor glycemic control and those who developed complications from diabetes. Thirty-five percent (95% CI 26.4–45.8) of the patients who scored ≥16 on the BDI scale had not been diagnosed with depression. Conclusions Depression is highly prevalent in patients with DM2, especially in women. For approximately one-third of the patients, a diagnosis of depression had not been reached.

ObjetivoConocer las representaciones sociales que sobre la oficina de farmacia tiene la población más frecuentadora.DiseñoEstudio cualitativo. Análisis del discurso producido por 2 grupos de discusión.ParticipantesMujeres de 30-60 años, residentes urbanas de la Comunidad de Madrid.Mediciones y resultados principalesLas oficinas de farmacia son identificadas por el usuario como un recurso de atención primaria accesible –tanto por su cercanía como por sus horarios– y de confianza. En ellas se realiza una actividad asistencial de apoyo para el tratamiento de dolencias menores («automedicación asistida»), y por otro lado se aconseja sobre tecnicismos médicos y sobre el uso de la medicación. Desde la farmacia se deriva al médico a los usuarios con cuadros potencialmente graves. Las imágenes asociadas a «ir al médico» carecen de la cercanía y familiaridad que se asocia a «bajar a la farmacia».ConclusionesLa integración de los farmacéuticos de la oficina de farmacia dentro de un marco global de atención primaria supondría una mejora para la salud de la población.ObjectiveTo find what the pharmacy office represents socially to the population that uses it most.DesignQualitative study. Analysis of the contents of two discussion groups.Participants.Women from 30 to 60 years old, urban residents of the Community of Madrid.Measurements and main resultsThe pharmacy offices were identified by the user as a primary care resource which was accessible –both because of its closeness and opening hours– and trustworthy. They provided health care support for treating minor ailments («assisted self-medication») and also advised on medical technicalities and use of medication. Users with potentially serious clinical pictures were referred from the pharmacy to the doctor. The images associated with «going to the doctor» lacked the nearness and familiarity of «dropping round to the pharmacy».ConclusionsIntegrating pharmacy office pharmacists into a general primary care framework would improve the health of the general population.