title: Glycemic control parameters in insulin-naïve patients with uncontrolled type 2 diabetes referred to endocrinologists, and degree of implementation of the national Spanish consensus for the management of hyperglycemia.
abstract: OBJECTIVE
  To assess blood glucose in patients with uncontrolled type 2 diabetes mellitus treated with oral antidiabetic drugs in primary care at the time of referral to specialized endocrinologists, and the degree of implementation of the national consensus guidelines of the Spanish Society of Diabetes by evaluating steps one (S1), two (S2), and three (S3) of the escalating therapy.
  
  
  METHODS
  Retrospective, observational study where 81 endocrinologists evaluated patients ≥40 years of age referred from primary care between July 2012 and July 2013, treated with 1 to 2 oral antidiabetic drugs but no insulin therapy, and with glycosylated hemoglobin (HbA(1c)) levels ≥6.5%. Patients also had to have HbA(1c) levels and both fasting and postprandial plasma glucose measurements from the previous three months.
  
  
  RESULTS
  A total of 285 patients (57.6% males) were assessed. Mean (SD) age was 63.1 (9.7) years, mean HbA1c was 8.5 (1.2) %, mean FPG was 171.7 (43) mg/dL, and mean postprandial plasma glucose was 206.8 (50) mg/dL. In primary care, 26.0% of patients were at S1 and 74.0% were at S2. After referral to the endocrinologist, 9.8% of patients moved onto S1, 42.8% onto S2, and 47.4% onto S3. Oral antidiabetic drugs most commonly prescribed in primary care were metformin (90.2%), DPP-4 inhibitors (34.4%), and sulfonylureas (30.5%), while drugs most commonly used in the specialized endocrinology setting were metformin (86%), insulin (56.8%), and DPP-4 inhibitors (49.8%). The most commonly followed guidelines were those of the American Diabetes Association and the consensus guidelines of the Spanish Society of Diabetes, in 77% and 45% of cases respectively.
  
  
  CONCLUSIONS
  Approximately half the patients treated with oral antidiabetic drugs in primary care are prescribed insulin after referral to an endocrinology specialist. The most commonly followed guidelines in specialized care are the American Diabetes Association guidelines.
authors.affiliation: Hospital Infanta Sofía, Madrid, España. Electronic address: sharona.azriel@salud.madrid.org.
authors.forename: Sharona
authors.initials: S
authors.lastname: Azriel
authors.affiliation: Hospital Universitario Cabueñes, Gijón, España.
authors.forename: Florentino
authors.initials: F
authors.lastname: Casal
authors.affiliation: Hospital Universitario Valle Hebron, Barcelona, España.
authors.forename: Belén
authors.initials: B
authors.lastname: Dalama
authors.affiliation: Hospital de Fuerteventura, España.
authors.forename: Francisco
authors.initials: F
authors.lastname: Varillas
authors.affiliation: Hospital Universitario La Paz, Madrid, España.
authors.forename: África
authors.initials: Á
authors.lastname: Villarroel
authors.affiliation: Hospital Universitario Coruña (CHUAC), España.
authors.forename: Alfonso
authors.initials: A
authors.lastname: Soto
authors.affiliation: Departamento Médico de Sanofi.
authors.forename: Gloria
authors.initials: G
authors.lastname: Barberá
mesh_terms: D000368:Aged; D006801:Humans; D008875:Middle Aged; D001786:Blood Glucose / Q000032:analysis; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000188:drug therapy; D004704:Endocrinology; D005215:Fasting / Q000097:blood; D006442:Glycated Hemoglobin / Q000032:analysis; D019983:Guideline Adherence; D006943:Hyperglycemia / Q000097:blood / Q000517:prevention & control; D007004:Hypoglycemic Agents / Q000627:therapeutic use; D019518:Postprandial Period; D012017:Referral and Consultation; D012189:Retrospective Studies; D013030:Spain; D003245:Consensus Statements as Topic
chemical_list: D001786:Blood Glucose; D006442:Glycated Hemoglobin; D007004:Hypoglycemic Agents
keywords: Antidiabéticos orales; Asistencia especializada; Asistencia primaria; Blood glucose control; Clinical guidelines; Control glucémico; Diabetes tipo 2; Guías clínicas; Insulin; Insulina; Oral hypoglycemic agents; Primary care; Specialized care; Type 2 diabetes mellitus