title: Meeting individualized glycemic targets in primary care patients with type 2 diabetes in Spain.
abstract: BACKGROUND
  Information about the achievement of glycemic targets in patients with type 2 diabetes according to different individualization strategies is scarce. Our aim was to analyze the allocation of type 2 diabetic patients into individualized glycemic targets according to different strategies of individualization and to assess the degree of achievement of adequate control.
  
  
  METHODS
  Cross-sectional analysis on 5382 type 2 diabetic patients in primary care setting in Spain between 2011 and 2012. Targets of HbA1c were assigned based on different strategies of individualization of glycemic targets: 1) the ADA/EASD consensus 2) The Spanish Diabetes Society (SED) consensus 3) a strategy that accounts for the risk of hypoglycemia (HYPO) considering the presence of a hypoglycemia during the last year and type of hypoglycemic treatment. Concordance between the different strategies was analyzed.
  
  
  RESULTS
  A total of 15.9, 17.1 and 67 % applied to ADA/EASD recommendation of HbA1c target of <6.5, < 7 and <8 % (48, 53 and 64 mmol/mol), and 31.9 and 67.4 % applied to the SED glycemic target of <6.5 and <7.5 % (<48 and 58 mmol/mol). Using the HYPO strategy, 53.5 % had a recommended HbA1c target <7 % (53 mmol/mol). There is a 94 % concordance between the ADA/EASD and SED strategies, and a concordance of 41-42 % between these strategies and HYPO strategy. Using the three different strategies, the overall proportion of patients achieving glycemic targets was 56-68 %.
  
  
  CONCLUSIONS
  Individualization of glycemic targets increases the number of patients who are considered adequately controlled. The proposed HYPO strategy identifies a similar proportion of patients that achieve adequate glycemic control than ADA/EASD or SED strategies, but its concordance with these strategies in terms of patient classification is bad.
authors.affiliation: Department of Endocrinology and Nutrition Services, Hospital de la Santa Creu i Sant Pau, C/ Sant Quintí, 89, 08026, Barcelona, Spain.|Research Institute, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain.
authors.forename: I
authors.initials: I
authors.lastname: Miñambres
authors.affiliation: Centro de Salud Burgos Rural, Burgos, Spain.
authors.forename: J J
authors.initials: JJ
authors.lastname: Mediavilla
authors.affiliation: Almirall S.A., Barcelona, Spain.
authors.forename: J
authors.initials: J
authors.lastname: Sarroca
authors.affiliation: Department of Endocrinology and Nutrition Services, Hospital de la Santa Creu i Sant Pau, C/ Sant Quintí, 89, 08026, Barcelona, Spain. aperez@santpau.cat.|Research Institute, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain. aperez@santpau.cat.|Department of Medicine, Universitat Autònoma de Barcelona (UAB), Barcelona, Spain. aperez@santpau.cat.|Diabetes and Metabolic Diseases CIBER (CIBERDEM), Barcelona, Spain. aperez@santpau.cat.
authors.forename: A
authors.initials: A
authors.lastname: Pérez
mesh_terms: D000368:Aged; D001786:Blood Glucose / Q000378:metabolism*; D003430:Cross-Sectional Studies; D003924:Diabetes Mellitus, Type 2 / Q000097:blood* / Q000188:drug therapy* / Q000453:epidemiology; D005260:Female; D019983:Guideline Adherence / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008875:Middle Aged; D010347:Patient Care Planning; D057285:Precision Medicine / Q000379:methods / Q000592:standards; D011320:Primary Health Care / Q000592:standards / Q000706:statistics & numerical data; D013030:Spain / Q000453:epidemiology
chemical_list: D001786:Blood Glucose