Abstract
Objetivo
Valorar un protocolo de control intensivo de factores de riesgo cardiovascular (FRCV) frente al control habitual en pacientes con diabetes mellitus tipo 2 (DM2) en atención primaria.
Diseño
Estudio aleatorizado de grupos.
Emplazamiento
Consultas de atención primaria.
Participantes
En total participaron 60 médicos de familia.
Intervenciones
Los participantes fueron aleatorizados a seguir un protocolo de tratamiento intensivo de FRCV o a mantener su práctica habitual en pacientes con DM2. El seguimiento fue de 12 meses. Se recogieron datos acerca de la hemoglobina glucosilada, los FRCV y el riesgo cardiovascular al inicio del estudio y a los 12 meses.
Resultados
Se incluyó a 188 pacientes (94 en el grupo de intervención y 94 en el grupo control). El riesgo cardiovascular basal en el grupo control (GC) fue del 36,3% (intervalo de confianza [IC] del 95%, 33,9-38,6%) y en el grupo de intervención (GI), del 35,9% (IC del 95%, 33,5-38,4%), sin diferencias significativas entre grupos. El riesgo cardiovascular a los 12 meses en el GC fue del 33,1% (IC del 95%, 30,0-36,1%) y en el GI del 30,5% (IC del 95%, 27,8-33,2%). La diferencia de riesgo cardiovascular a los 12 meses fue del –2,9% (IC del 95%, 0,2-5,7%) en el GC y del –5,4% (IC del 95%, 2,8-7,1%) en el GI.
Conclusiones
Aunque se observa una disminución mayor del riesgo cardiovascular en el GI, la diferencia entre los grupos no es significativa. Las características de los médicos seleccionados pueden haber condicionado que los pacientes de ambos grupos hayan recibido un tratamiento similar.
Palabras clave: Factores de riesgo cardiovascular, Diabetes mellitus, Atención primaria
Abstract
Objective
To evaluate a primary care protocol for intensive monitoring of cardiovascular risk (CVR) factors in type-2 diabetes patients versus usual care.
Design
Randomised trial with clusters.
Setting
Primary care clinics.
Participants
Sixty family physicians.
Interventions
Participants were randomised between following a protocol of intensive monitoring of CVR factors and maintaining their habitual practice with DM2 patients. Follow-up lasted 12 months. Data on HbA1C, CVR factors and CVR were collected at the start of the study and at 12 months.
Results
In all, 188 patients (94 intervention group and 94 control group) were included. At baseline measurement, CVR in control group (CG) was 36.3% (95% CI, 33.9%-38.6%); and in intervention group (IG), 35.9% (95% CI, 33.5%-38.4%), with no significant differences between groups. At one year, CVR in CG was 33.1% (95% CI, 30%-36.1%) and in IG 30.5% (95% CI, 27.8%-33.2%). The CVR difference between baseline and 1-year measurements was 2.9% (95% CI, 0.2%-5.7%) in CG and 5.4% (95% CI, 2.8%-7.1%) in IG.
Conclusions
Although improvement of CVR is greater in the IG, the difference between the two groups is not significant. The characteristics of the doctors chosen may have meant that the patients of the two groups received similar treatment.
Key words: Cardiovascular risk factors, Diabetes mellitus, Primary care
Footnotes
El Presente estudio fue aprobado por el Comité de Ético de Investigación Clínica de Atención Primaria de Valencia y Castellón. Un resumen de este estudio fue presentado en el congreso de la WONCA de 2004.
El presente estudio ha contado con financiación de ACEMSA. Conselleria de Sanitat de la Generalitat Valenciana, n.° Ev.Tec-011/2001, I Becas REPA n° 22-2201, Merck Sharp and Dohme y Aventis.
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