Jose Manuel Millaruelo Trillo

Centro de Salud Torrero La Paz

Zaragoza

“Sombras en las luces y luces en la sombras en

2016”

Agenda

•LUCES: Constatación de la importancia de lo “biopsicosocial” y del problema de su abordaje desde la sanidad exclusivamente, pero “si se puede”

•SOMBRAS: Falta de eficacia del abordaje tradicional: mortalidad prematura, peor pronostico tras un evento. Un año de “malas noticias”

•Una sorprendente apuesta de futuro: la prevención y la desdramatizacion

• ¿Lo hacemos? ¿Con que instrumentos? ¿Cómo?

Association Between Socioeconomic Status and Mortality,Cardiovascular Disease, and Cancer in Patients

With Type 2 Diabetes

JAMA Intern Med. 2016;176(8):1146-1154.

Socioeconomic Deprivation and the Incidence of 12Cardiovascular Diseases in 1.9 Million Women and Men: Implications for Risk Prediction and Prevention

•August 2014 | Volume 9 | Issue 8 | e104671

Repercusiones de la pobreza sobre lasalud de los individuos y las poblaciones

FMC. 2016;23(2):50-60

Treatment beliefs, health behaviors and theirassociation with treatment outcome in type 2

diabetes

BMJ Open Diabetes Research and Care 2016;4:e000166

Neighbourhood Walkability and DailySteps in Adults with Type 2 Diabetes

• PLOS ONE | DOI:10.1371/journal.pone.0151544 March 18, 2016

Association of Neighborhood Walkability WithChange in Overweight, Obesity, and Diabetes

• JAMA. 2016;315(20):2211-2220

Relationship Between Health Literacy and Unintentionaland Intentional Medication Non adherence in Medically

Underserved Patients With Type 2 Diabetes

• The Diabetes Educator OnlineFirst, published on January 13, 2016

Interaction between functional health literacy, patient activation, and glycemic control

Patient Preference and Adherence 2014:8 1019–1024

Relative Contributions of Socioeconomic, Local Environmental, Psychosocial, Lifestyle/Behavioral, Biophysiological, and Ancestral Factors to Racial/Ethnic Disparities in Type 2 Diabetes

Diabetes Care 2016;39:1208–1217

Loneliness and social isolation as risk factors for CVD: implications for patient care and scientific inquiry

• Holt-Lunstad J, Smith TB. Heart Month 2016 Vol 0 No 0

Loneliness and social isolation as risk factors forcoronary heart disease and stroke: systematicreview and meta-analysis

• Valtorta NK, et al. Heart 2016;0:1–8.

Study results suggest that adults with a larger anddenser social network have a healthier lifestyle.Underlying mechanisms for these associations shouldbe further explore

The relationship between diabetes-related distressand clinical variables and perceived support amongadults with type 2 diabetes

• International Journal of Nursing Studies 51 (2014) 438–447

Systematic review and meta-analysis of randomisedcontrolled trials of psychological interventions to improveglycaemic control in patients with type 2 diabetes

Lancet 2004; 363: 1589–97

What We Don’t Talk About When We Talk AboutPreventing (and managing) Type 2 Diabetes—Addressing Socioeconomic Disadvantage

•Familia•Red social. Soledad•Entorno. Habitabilidad •Trabajo•Economía (fin de mes)•Estado de animo•Vivencia de la diabetes

JAMA Internal Medicine August 2016 Volume 176, Number 8 1053

El problema de la mortalidad en edades medias de la vida

N Engl J Med 2015;373:1720-32

N Engl J Med 2015;373:1720-32

Excess Mortality among Persons with Type 2 Diabetes

¿Año de malas noticias?

•9-Year Effects of 3.7 Years of Intensive Glycemic Control on Cardiovascular Outcomes

Diabetes Care Publish Ahead of Print, published online January 28, 2016

Effect of early intensive multifactorial therapy on 5-year cardiovascular outcomes in individuals with type 2 diabetes detected by screening (ADDITION-Europe)

Lancet 2011; 378: 156–67

¿Año de malas noticias?

Diabet. Med. 33, 324–331 (2016)

Comparison of Long-Term Mortality for CardiacDiseases in Patients With Versus Without Diabetes Mellitus

Long-term excess mortality associated withdiabetes following acute myocardial infarction

Alabas OA, et al. J Epidemiol Community Health 2016;0:1–8.

¿Año de malas noticias?

JAMA Intern Med. Published on line June 20, 2016.

• Am J Cardiol 2016;-:-e-)

Conclusions— In a post hoc analysis from 10ODYSSEY trials greater percentage reductions inLDL-C and lower on-treatment LDL-C wereassociated with a lower incidence of MACE,including very low levels of LDL-C (<50 mg/dL).These findings require further validation in theongoing prospective ODYSSEY OUTCOMES trial

Y de hallazgos extraños…

Diabetes Care 2016;39:1424–1430

Discordance of Low-Density Lipoprotein and High-Density LipoproteinCholesterol Particle Versus Cholesterol Concentration for the Predictionof Cardiovascular Disease in Patients With Metabolic Syndrome and Diabetes Mellitus

¿Año de malas noticias?Comparison of Clinical Outcomes and Adverse Events Associated With Glucose-

Lowering Drugs in Patients With Type 2 Diabetes A Meta-analysis

JAMA. 2016;316(3):313-324.

¿Un año de malas noticias?

•Diabetes treatments and risk of amputation, blindness, severe kidney failure, hyperglycaemia, and hypoglycaemia: open cohort study in primary care

•Conclusión: Con SU mas hipoglucemias, menos ceguera…

BMJ 2016;352:i1450

The Association between Sulfonylurea Use and All-Cause and Cardiovascular Mortality: A Meta-Analysis with Trial Sequential Analysis of Randomized Clinical Trials

• PLOS Medicine | April 12, 2016

¿Un año de malas noticias?• Effect of antihypertensive treatment at different blood pressure

levels in patients with diabetes mellitus: systematic review and meta-analyses

BMJ 2016;352:i717

Cardiovascular Risk Factor Targets and Cardiovasc. Disease Event Risk in Diabetes

Diabetes Care Publish Ahead of Print, published online March 29, 2016

HbA1c and all-cause mortality riskamong patients with type 2 diabetes

• International Journal of Cardiology 202 (2016) 490–496

La propuesta inaplazable…

PLOS Medicine July 26, 2016

Evidencias prevención a largo plazo

• Li G, Zhang P, Wang J, Gregg EW, Yang W, Gong Q, et al. The long-term effect oflifestyle interventions to prevent diabetes in the China Da Qing Diabetes PreventionStudy: a 20-year follow-up study. Lancet. 2008; 371:1783–1789. doi: 10.1016/S0140-6736(08)60766-7 PMID: 18502303

• Lindstrom J, Ilanne-Parikka P, Peltonen M, Eriksson JG, Hemiö K, et al. Sustainedreduction in the incidence of type 2 diabetes by lifestyle intervention: follow-up ofthe Finnish DM Prevention Study. Lancet. 2006; 368:1673–1679. PMID: 17098085

• Diabetes Prevention Program Research Group. 10-year follow-up of diabetesincidence and weight loss in the Diabetes Prevention Program Outcomes Study.Lancet. 2009; 374:1677–1686

• Lindstrom J, Peltonen M, Eriksson JG, Ilanne-Parikka P, Aunola S, Keinänen-Kiukaanniemi S, et al. Improved lifestyle and decreased diabetes risk over 13 years:long-term follow-up of the randomised Finnish (DPS). Diabetologia. 2013; 56:284–293

• Dunkley AJ, Bodicoat DH, Greaves CJ, Russell C, Yates T, Davies MJ, et al. Diabetesprevention in the real world: effectiveness of pragmatic lifestyle interventions for theprevention of type 2 diabetes and of the impact of adherence to guidelinerecommendations: a systematic review and meta-analysis. Diabetes Care. 2014;37:922–933.

• Tuomilehto J, Schwarz P, Lindstrom J. Long-term benefits from lifestyle interventionsfor type 2 diabetes prevention: time to expand the efforts. Diabetes Care 2011; 34Suppl 2:S210–S214.

Cardiometabolic Risk Factor Changes Observed in Diabetes Prevention Programs in US Settings: A Systematic Review and Metaanalysis

PLoS Med 13(7): e1002095. doi:10.1371/journal. pmed.1002095

An Inverse Relationship Between Age of Type 2 Diabetes Onset and Complication Risk and Mortality: The Impactof Youth-Onset Type 2 Diabetes

• Diabetes Care Publish Ahead of Print, published online March 22, 2016

Risk of non-fatal cardiovascular diseases in early-onset versus late-onset type 2 diabetes in China

•The crucial link between intensive risk factor treatment andimproved cardiovascular outcomes in early-onset type 2diabetes remains unproven, and is a focus for future research

Lancet Diabetes Endocrinol 2015

Una razón mas para el cambio de hábitos…

Diabet. Med. 33, 1013–1025 (2016)

HbA1c appears to be associated with cancer incidence and/or cancer mortality, but further studies are needed to fully understand the complex relationship between HbA1c and cancer

The Global Promise of Healthy Lifestyle and Social Connections for Better Health in People With DM

• Am J Kidney Dis. 2016;68(1):1-4

General Practitioners’ Empathy and Health Outcomes: A Prospective Observational Study of Consultations in Areas of High and Low Deprivation

• Ann Fam Med 2016;14:117-124

Consumption of Meals Prepared at Home and Risk of Type 2 Diabetes

PLoS Med 13(7): e1002052. do i:10.1371/journal.pmed.1002052

¿Seria posible (y bueno) otra manerade comunicarnos en diabetes?

¿Podemos pasar de la empatía “personal” a la empatía “comunitaria”?

¿Podemos hacer algo (distinto)para prevenir la diabetes?

Gracias por vuestra atención