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    "titulo" => "Real-world evaluation of vascular complications and comorbidities in Portuguese patients with type 2 diabetes&#58; Results from the cMORE study"
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          "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Diabetes presentation from an epidemiological cardiovascular risk point-of-view&#46; Intermediate hyperglycemia refers to fasting hyperglycemia and&#47;or glucose intolerance&#44; not meeting the accepted criteria for the diagnosis of diabetes&#46; Intermediate hyperglycemia is estimated in Portugal&#44; between ages 20 and 79 years old&#44; is as follows&#58; fasting hyperglycemia 10&#46;8&#37;&#59; decreased glucose tolerance 14&#46;9&#37;&#59; both traits 2&#46;9&#37; of the population&#46; Total prevalence for clinical relevant hyperglycemia is 42&#46;7&#37;&#46;<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">2</span></a></p>"
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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">The study presented by Silva<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">1</span></a> et al&#46;&#44; in the current issue of the Portuguese Journal of Cardiology&#44; is&#44; in my view&#44; very important&#46; There are several reasons to acknowledge its value&#46; Firstly&#44; it was designed by family doctors &#8211; a wide-ranging designation for what are widely known as primary care physicians&#46; Arguably&#44; these doctors are often misunderstood&#44; buried in a multitude of patients&#44; with a wide variety of diagnoses to be managed and ever-increasing bureaucracy&#46; The present study&#44; in this context&#44; is a victory&#46; Secondly&#44; this study tries to bridge the gap between doctors who usually treat diabetes and the vascular procedure &#8220;hospital folk&#8221; &#8211; cardiologists&#44; vascular and heart surgeons among others&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">Type 2 diabetes &#40;DM&#41; is an important piece of the vascular risk puzzle and&#44; yes&#44; it is on the rise&#44; with an estimated prevalence in Portugal of 14&#46;1&#37; &#40;1&#46;1 million people&#44; between 20 and 79 years old&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">2</span></a> It is usually wrapped in a bundle with other very common risk increasing comorbidities&#44; such as hypertension<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">3</span></a> and&#44; often&#44; as this work clearly shows&#44; is the harbinger of vascular complications&#46; Therefore&#44; in a broad interpretation&#44; diabetes can be viewed as a vascular disease&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">However&#44; for the community interested in reducing global cardiovascular risk&#44; two phenotypes for hyperglycemia are relevant in the general population&#58; type 2 DM and what is known as intermediate hyperglycemia &#40;IH&#41;&#44; which is very common and also associated with high cardiovascular risk&#46;<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">4</span></a> IH refers to fasting hyperglycemia or glycemic intolerance &#40;some patients have one of these traits or both&#44; without meeting the criteria for a diabetes diagnosis&#41; &#8211; see <a class="elsevierStyleCrossRef" href="#fig0005">Figure 1</a>&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0020" class="elsevierStylePara elsevierViewall">Intermediate hyperglycemia is not addressed in this study &#40;probably because its existence is less valued&#41;&#44; however&#44; one could even speculate that it is the commonest of &#8220;civilizational&#8221; hyperglycemia&#46; There are several reasons for the increase in &#8220;civilizational&#8221; hyperglycemia in our midst&#46; The most important factors are related to changes in lifestyle&#44; including lack of physical activity and diet&#44; as societies have changed from agricultural production or physical demanding industries to services in an ever growing digital environment&#44; topped by major urbanization&#46; This trend is now also present in less developed countries&#46;<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">5</span></a> Other risk factors&#44; which are gaining increasing importance in the cardiovascular realm are environmental factors&#44; mainly related to increasing oxidative stress and social anxiety&#44; both connected to vascular inflammation and endothelial dysfunction &#8211; the cornerstone for the development of atherosclerosis&#46;<a class="elsevierStyleCrossRefs" href="#bib0075"><span class="elsevierStyleSup">6&#44;7</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">cMORE was a non-interventional&#44; cross-sectional&#44; multicenter study conducted in 32 Portuguese primary healthcare units between October 2020 and 2022&#44; which is truthfully the basis for solid real-world work&#46; The data collected&#44; including sociodemographic&#44; anthropometric and clinical information&#44; cardiometabolic comorbidities&#44; HbA1c levels&#44; lipid parameters and medication&#44; stem from electronic medical records&#46; Portugal has in place a set of indicators for public primary practice&#44; known as &#8220;BI-CSP&#8221;&#46; These data have also been used successfully in an ongoing country wide hypertension intervention&#46;<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">8</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">In the 780 patients selected&#44; the long duration of disease &#40;10&#46;5 years average&#41;&#44; the heavy multimorbidity burden&#44; including obesity&#44; dyslipidemia and&#44; as expected&#44; hypertension are noteworthy&#44; yet no surprise&#46; Age is&#44; of course&#44; an important factor in diabetes&#44; increasing the risk for retinopathy and CV disease procedures&#46; In contrast&#44; the findings of such a good HgA1c average level &#40;7&#37;&#41; are worthy of comment&#58; &#40;1&#41; hospital experience&#44; with cardiovascular diabetes patients is not so good&#44; and clearly present much higher HgbA1c values&#59; &#40;2&#41; this might be due to the added severity of hospital diabetic patients&#44; or to the data collecting&#44; since there are critics of the &#8220;BI-CSP&#8221; data collection pitfalls&#44; as the authors duly mention&#46; Importantly&#44; this work reports what most doctors have witnessed&#58; longer duration of disease and higher HgbA1c are related to an increase in vascular disease&#46; Finally&#44; this study also points to the therapeutic trends&#44; addressing the need to move from classic antidiabetic medications&#44; to the newer SGLT2 inhibitors&#58; 34&#46;2&#37; usage in the population studied&#46; Insulin therapy was associated with an increase in vascular interventions&#44; most likely due to the late introduction of insulin in tipe 2 DM&#46; In truth&#44; reducing therapeutic inertia and easy hospital referral may also be the key to future improvements in the management of these patients&#46;<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">9</span></a></p><p id="par0035" class="elsevierStylePara elsevierViewall">This study demonstrates the substantial burden of vascular complications&#47;comorbidities among Portuguese diabetes patients&#46; Microvascular complications&#44; including chronic kidney disease&#44; micro and macroalbuminuria&#44; diabetic neuropathy&#44; diabetic retinopathy&#44; and diabetic foot infections&#44; were observed in 38&#46;1&#37; of patients&#44; while macrovascular complications&#44; such as CV diseases and procedures&#44; were present in 19&#46;6&#37; of the included patients&#46; Nevertheless&#44; we do believe that larger scale studies with extended follow-up periods could provide further understanding of the long-term outcomes of these management strategies and their impact on patient health &#8211; as the authors stressed&#46; A future study should address IH&#44; the diagnosis of which is easily overlooked&#44; and adds to the burden of hyperglycemic-related vascular events&#46;</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Conflicts of interest</span><p id="par0040" class="elsevierStylePara elsevierViewall">The author has no conflicts of interest to declare&#46;</p></span></span>"
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Real-world evaluation of vascular complications and comorbidities in Portuguese patients with type 2 diabetes: Results from the cMORE study
Avaliação no mundo real das complicações vasculares e comorbilidades em doentes portugueses com diabetes tipo 2: resultados do estudo cMORE
Luís Bronzea,b
a Senior Cardiologist, Portuguese Navy, Portugal
b Cardiovascular Medicine, Beira Interior University, Covilhã, Portugal
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    "titulo" => "Real-world evaluation of vascular complications and comorbidities in Portuguese patients with type 2 diabetes&#58; Results from the cMORE study"
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          "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Diabetes presentation from an epidemiological cardiovascular risk point-of-view&#46; Intermediate hyperglycemia refers to fasting hyperglycemia and&#47;or glucose intolerance&#44; not meeting the accepted criteria for the diagnosis of diabetes&#46; Intermediate hyperglycemia is estimated in Portugal&#44; between ages 20 and 79 years old&#44; is as follows&#58; fasting hyperglycemia 10&#46;8&#37;&#59; decreased glucose tolerance 14&#46;9&#37;&#59; both traits 2&#46;9&#37; of the population&#46; Total prevalence for clinical relevant hyperglycemia is 42&#46;7&#37;&#46;<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">2</span></a></p>"
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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">The study presented by Silva<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">1</span></a> et al&#46;&#44; in the current issue of the Portuguese Journal of Cardiology&#44; is&#44; in my view&#44; very important&#46; There are several reasons to acknowledge its value&#46; Firstly&#44; it was designed by family doctors &#8211; a wide-ranging designation for what are widely known as primary care physicians&#46; Arguably&#44; these doctors are often misunderstood&#44; buried in a multitude of patients&#44; with a wide variety of diagnoses to be managed and ever-increasing bureaucracy&#46; The present study&#44; in this context&#44; is a victory&#46; Secondly&#44; this study tries to bridge the gap between doctors who usually treat diabetes and the vascular procedure &#8220;hospital folk&#8221; &#8211; cardiologists&#44; vascular and heart surgeons among others&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">Type 2 diabetes &#40;DM&#41; is an important piece of the vascular risk puzzle and&#44; yes&#44; it is on the rise&#44; with an estimated prevalence in Portugal of 14&#46;1&#37; &#40;1&#46;1 million people&#44; between 20 and 79 years old&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">2</span></a> It is usually wrapped in a bundle with other very common risk increasing comorbidities&#44; such as hypertension<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">3</span></a> and&#44; often&#44; as this work clearly shows&#44; is the harbinger of vascular complications&#46; Therefore&#44; in a broad interpretation&#44; diabetes can be viewed as a vascular disease&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">However&#44; for the community interested in reducing global cardiovascular risk&#44; two phenotypes for hyperglycemia are relevant in the general population&#58; type 2 DM and what is known as intermediate hyperglycemia &#40;IH&#41;&#44; which is very common and also associated with high cardiovascular risk&#46;<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">4</span></a> IH refers to fasting hyperglycemia or glycemic intolerance &#40;some patients have one of these traits or both&#44; without meeting the criteria for a diabetes diagnosis&#41; &#8211; see <a class="elsevierStyleCrossRef" href="#fig0005">Figure 1</a>&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0020" class="elsevierStylePara elsevierViewall">Intermediate hyperglycemia is not addressed in this study &#40;probably because its existence is less valued&#41;&#44; however&#44; one could even speculate that it is the commonest of &#8220;civilizational&#8221; hyperglycemia&#46; There are several reasons for the increase in &#8220;civilizational&#8221; hyperglycemia in our midst&#46; The most important factors are related to changes in lifestyle&#44; including lack of physical activity and diet&#44; as societies have changed from agricultural production or physical demanding industries to services in an ever growing digital environment&#44; topped by major urbanization&#46; This trend is now also present in less developed countries&#46;<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">5</span></a> Other risk factors&#44; which are gaining increasing importance in the cardiovascular realm are environmental factors&#44; mainly related to increasing oxidative stress and social anxiety&#44; both connected to vascular inflammation and endothelial dysfunction &#8211; the cornerstone for the development of atherosclerosis&#46;<a class="elsevierStyleCrossRefs" href="#bib0075"><span class="elsevierStyleSup">6&#44;7</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">cMORE was a non-interventional&#44; cross-sectional&#44; multicenter study conducted in 32 Portuguese primary healthcare units between October 2020 and 2022&#44; which is truthfully the basis for solid real-world work&#46; The data collected&#44; including sociodemographic&#44; anthropometric and clinical information&#44; cardiometabolic comorbidities&#44; HbA1c levels&#44; lipid parameters and medication&#44; stem from electronic medical records&#46; Portugal has in place a set of indicators for public primary practice&#44; known as &#8220;BI-CSP&#8221;&#46; These data have also been used successfully in an ongoing country wide hypertension intervention&#46;<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">8</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">In the 780 patients selected&#44; the long duration of disease &#40;10&#46;5 years average&#41;&#44; the heavy multimorbidity burden&#44; including obesity&#44; dyslipidemia and&#44; as expected&#44; hypertension are noteworthy&#44; yet no surprise&#46; Age is&#44; of course&#44; an important factor in diabetes&#44; increasing the risk for retinopathy and CV disease procedures&#46; In contrast&#44; the findings of such a good HgA1c average level &#40;7&#37;&#41; are worthy of comment&#58; &#40;1&#41; hospital experience&#44; with cardiovascular diabetes patients is not so good&#44; and clearly present much higher HgbA1c values&#59; &#40;2&#41; this might be due to the added severity of hospital diabetic patients&#44; or to the data collecting&#44; since there are critics of the &#8220;BI-CSP&#8221; data collection pitfalls&#44; as the authors duly mention&#46; Importantly&#44; this work reports what most doctors have witnessed&#58; longer duration of disease and higher HgbA1c are related to an increase in vascular disease&#46; Finally&#44; this study also points to the therapeutic trends&#44; addressing the need to move from classic antidiabetic medications&#44; to the newer SGLT2 inhibitors&#58; 34&#46;2&#37; usage in the population studied&#46; Insulin therapy was associated with an increase in vascular interventions&#44; most likely due to the late introduction of insulin in tipe 2 DM&#46; In truth&#44; reducing therapeutic inertia and easy hospital referral may also be the key to future improvements in the management of these patients&#46;<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">9</span></a></p><p id="par0035" class="elsevierStylePara elsevierViewall">This study demonstrates the substantial burden of vascular complications&#47;comorbidities among Portuguese diabetes patients&#46; Microvascular complications&#44; including chronic kidney disease&#44; micro and macroalbuminuria&#44; diabetic neuropathy&#44; diabetic retinopathy&#44; and diabetic foot infections&#44; were observed in 38&#46;1&#37; of patients&#44; while macrovascular complications&#44; such as CV diseases and procedures&#44; were present in 19&#46;6&#37; of the included patients&#46; Nevertheless&#44; we do believe that larger scale studies with extended follow-up periods could provide further understanding of the long-term outcomes of these management strategies and their impact on patient health &#8211; as the authors stressed&#46; A future study should address IH&#44; the diagnosis of which is easily overlooked&#44; and adds to the burden of hyperglycemic-related vascular events&#46;</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Conflicts of interest</span><p id="par0040" class="elsevierStylePara elsevierViewall">The author has no conflicts of interest to declare&#46;</p></span></span>"
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Informação do artigo
ISSN: 08702551
Idioma original: Inglês
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