title: Management of patients with type 2 diabetes and multiple chronic conditions: A Delphi consensus of the Spanish Society of Internal Medicine.
abstract: OBJECTIVE
  To develop consensus-based recommendations for the management of chronic complex patients with type 2 diabetes mellitus using a two round Delphi technique.
  
  
  METHODS
  Experts from the Diabetes and Obesity Working Group (DOWG) of the Spanish Society of Internal Medicine (SEMI) reviewed MEDLINE, PubMed, SCOPUS and Cochrane Library databases up to September 2014 to gather information on organization and health care management, stratification of therapeutic targets and therapeutic approach for glucose control in chronic complex patients with type 2 diabetes mellitus. A list of 6 recommendations was created and rated by a panel of 75 experts from the DOWG by email (first round) and by open discussion (second round). A written document was produced and sent back to DOWG experts for clarification purposes.
  
  
  RESULTS
  A high degree of consensus was achieved for all recommendations summarized as 1) there is a need to redesign and test new health care programs for chronic complex patients with type 2 diabetes mellitus; 2) therapeutic targets in patients with short life expectancy should be individualized in accordance to their personal, clinical and social characteristics; 3) patients with chronic complex conditions and type 2 diabetes mellitus should be stratified by hypoglycemia risk; 4) age and specific comorbidities should guide the objectives for glucose control; 5) the risk of hypoglycemia should be a key factor when choosing a treatment; and 6) basal insulin analogs compared to human insulin are cost-effective options.
  
  
  CONCLUSIONS
  The assessment and recommendations provided herein represent our best professional judgment based on current data and clinical experience.
authors.affiliation: Internal Medicine Department, Hospital Marina Baixa, Alicante, Spain. Electronic address: ena_jav@gva.es.
authors.forename: Javier
authors.initials: J
authors.lastname: Ena
authors.affiliation: Internal Medicine Department, Hospital Regional Universitario, FIMABIS, Málaga, Spain.
authors.forename: Ricardo
authors.initials: R
authors.lastname: Gómez-Huelgas
authors.affiliation: Internal Medicine Department, Hospital Nuestra Señora de Sonsoles, Ávila, Spain.
authors.forename: Demetrio
authors.initials: D
authors.lastname: Sánchez-Fuentes
authors.affiliation: Geriatric Unit, Internal Medicine Department, Hospital Clínic, University of Barcelona, "August Pi i Sunyer" Biomedical Research Institute (IDIBAPS), Barcelona, Spain.
authors.forename: Miguel
authors.initials: M
authors.lastname: Camafort-Babkowsk
authors.affiliation: Geriatric Unit, Internal Medicine Department, Hospital Universitari Bellvitge, IDIBELL, Barcelona, Spain.
authors.forename: Francesc
authors.initials: F
authors.lastname: Formiga
authors.affiliation: Internal Medicina Deparment, Hospital de Jerez de la Frontera, Universidad de Cádiz, Cádiz, Spain.
authors.forename: Alfredo
authors.initials: A
authors.lastname: Michán-Doña
authors.affiliation: Internal Medicine Department, Hospital Lucus Augustis, Lugo, Spain.
authors.forename: Emilio
authors.initials: E
authors.lastname: Casariego
mesh_terms: D002908:Chronic Disease; D015897:Comorbidity; D003697:Delphi Technique; D003924:Diabetes Mellitus, Type 2 / Q000150:complications* / Q000188:drug therapy* / Q000191:economics; D019468:Disease Management; D006801:Humans; D007003:Hypoglycemia / Q000453:epidemiology*; D017410:Practice Guidelines as Topic; D018570:Risk Assessment; D012955:Societies, Medical; D013030:Spain
keywords: Glycated hemoglobin; Institutionalization; Long-term care; Nursing home; Risk assessment; Terminal care