A cross-sectional survey among patients and prescribers on insulin dosing irregularities and impact of mild (self-treated) hypoglycemia episodes in Spanish patients with type 2 diabetes as compared to other European patients | Endocrinología y Nutrición (English Edition)

array:24 ["pii" => "S2173509314001445" "issn" => "21735093" "doi" => "10.1016/j.endoen.2014.07.003" "estado" => "S300" "fechaPublicacion" => "2014-10-01" "aid" => "593" "copyright" => "SEEN" "copyrightAnyo" => "2014" "documento" => "article" "crossmark" => 0 "subdocumento" => "fla" "cita" => "Endocrinol Nutr. 2014;61:426-33" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:2 [ "total" => 962 "formatos" => array:3 [ "EPUB" => 10 "HTML" => 687 "PDF" => 265 ] ] "Traduccion" => array:1 [ "en" => array:19 [ "pii" => "S1575092214001284" "issn" => "15750922" "doi" => "10.1016/j.endonu.2014.03.008" "estado" => "S300" "fechaPublicacion" => "2014-10-01" "aid" => "593" "copyright" => "SEEN" "documento" => "article" "crossmark" => 0 "subdocumento" => "fla" "cita" => "Endocrinol Nutr. 2014;61:426-33" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:2 [ "total" => 1344 "formatos" => array:3 [ "EPUB" => 10 "HTML" => 901 "PDF" => 433 ] ] "en" => array:13 [ "idiomaDefecto" => true "cabecera" => "Original article" "titulo" => "A cross-sectional survey among patients and prescribers on insulin dosing irregularities and impact of mild (self-treated) hypoglycemia episodes in Spanish patients with type 2 diabetes as compared to other European patients" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => array:2 [ 0 => "en" 1 => "es" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "426" "paginaFinal" => "433" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Estudio transversal mediante encuesta entre pacientes y médicos prescriptores sobre irregularidades en dosificación de la insulina e impacto de los episodios de hipoglucemia leve (auto-tratadas) en pacientes con diabetes tipo 2 en España en comparación con otros países europeos" ] ] "contieneResumen" => array:2 [ "en" => true "es" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1660 "Ancho" => 2290 "Tamanyo" => 194240 ] ] "descripcion" => array:1 [ "en" => "Worry reported by Spanish and OEC patients in different daily situations." ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Francisco J. Ampudia-Blasco, Manuel Galán, Meryl Brod" "autores" => array:3 [ 0 => array:2 [ "nombre" => "Francisco J." "apellidos" => "Ampudia-Blasco" ] 1 => array:2 [ "nombre" => "Manuel" "apellidos" => "Galán" ] 2 => array:2 [ "nombre" => "Meryl" "apellidos" => "Brod" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "en" => array:9 [ "pii" => "S2173509314001445" "doi" => "10.1016/j.endoen.2014.07.003" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173509314001445?idApp=UINPBA00004N" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1575092214001284?idApp=UINPBA00004N" "url" => "/15750922/0000006100000008/v1_201409200130/S1575092214001284/v1_201409200130/en/main.assets" ] ] "itemSiguiente" => array:19 [ "pii" => "S2173509314001421" "issn" => "21735093" "doi" => "10.1016/j.endoen.2014.07.001" "estado" => "S300" "fechaPublicacion" => "2014-10-01" "aid" => "599" "copyright" => "SEEN" "documento" => "simple-article" "crossmark" => 0 "subdocumento" => "cor" "cita" => "Endocrinol Nutr. 2014;61:434-6" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:2 [ "total" => 1852 "formatos" => array:3 [ "EPUB" => 17 "HTML" => 1450 "PDF" => 385 ] ] "en" => array:11 [ "idiomaDefecto" => true "cabecera" => "Scientific letter" "titulo" => "Carcinoid tumor on cystic ovarian teratoma" "tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "434" "paginaFinal" => "436" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Tumor carcinoide sobre teratoma ovárico quístico" ] ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 766 "Ancho" => 1600 "Tamanyo" => 83248 ] ] "descripcion" => array:1 [ "en" => "Whole body Octreoscan®/abdominal SPECT-CT." ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Mariana Tomé Fernández-Ladreda, Guillermo Martínez de Pinillos Gordillo, Francisco Pichardo López de Haro, María Victoria Cózar León" "autores" => array:4 [ 0 => array:2 [ "nombre" => "Mariana" "apellidos" => "Tomé Fernández-Ladreda" ] 1 => array:2 [ "nombre" => "Guillermo" "apellidos" => "Martínez de Pinillos Gordillo" ] 2 => array:2 [ "nombre" => "Francisco" "apellidos" => "Pichardo López de Haro" ] 3 => array:2 [ "nombre" => "María Victoria" "apellidos" => "Cózar León" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S157509221400134X" "doi" => "10.1016/j.endonu.2014.04.003" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S157509221400134X?idApp=UINPBA00004N" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173509314001421?idApp=UINPBA00004N" "url" => "/21735093/0000006100000008/v1_201410080024/S2173509314001421/v1_201410080024/en/main.assets" ] "itemAnterior" => array:19 [ "pii" => "S2173509314001470" "issn" => "21735093" "doi" => "10.1016/j.endoen.2014.07.005" "estado" => "S300" "fechaPublicacion" => "2014-10-01" "aid" => "579" "copyright" => "SEEN" "documento" => "article" "crossmark" => 0 "subdocumento" => "fla" "cita" => "Endocrinol Nutr. 2014;61:419-25" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:2 [ "total" => 1964 "formatos" => array:3 [ "EPUB" => 9 "HTML" => 1532 "PDF" => 423 ] ] "en" => array:13 [ "idiomaDefecto" => true "cabecera" => "Original Article" "titulo" => "Serum cholesterol and triglyceride levels in diabetic patients with subclinical hypothyroidism" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => array:2 [ 0 => "en" 1 => "es" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "419" "paginaFinal" => "425" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Concentraciones séricas de colesterol y triglicéridos en pacientes diabéticos con hipotiroidismo subclínico" ] ] "contieneResumen" => array:2 [ "en" => true "es" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 3351 "Ancho" => 2524 "Tamanyo" => 250221 ] ] "descripcion" => array:1 [ "en" => "Flow chart showing the origin of the sample of euthyroid diabetic patients who acted as controls (group C), and diabetic patients with incident or prevalent, untreated hypothyroidism (group SH)." ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Juan J. Díez, Pedro Iglesias" "autores" => array:2 [ 0 => array:2 [ "nombre" => "Juan J." "apellidos" => "Díez" ] 1 => array:2 [ "nombre" => "Pedro" "apellidos" => "Iglesias" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S1575092214000680" "doi" => "10.1016/j.endonu.2014.01.012" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1575092214000680?idApp=UINPBA00004N" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173509314001470?idApp=UINPBA00004N" "url" => "/21735093/0000006100000008/v1_201410080024/S2173509314001470/v1_201410080024/en/main.assets" ] "en" => array:20 [ "idiomaDefecto" => true "cabecera" => "Original article" "titulo" => "A cross-sectional survey among patients and prescribers on insulin dosing irregularities and impact of mild (self-treated) hypoglycemia episodes in Spanish patients with type 2 diabetes as compared to other European patients" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "426" "paginaFinal" => "433" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Francisco J. Ampudia-Blasco, Manuel Galán, Meryl Brod" "autores" => array:3 [ 0 => array:4 [ "nombre" => "Francisco J." "apellidos" => "Ampudia-Blasco" "email" => array:1 [ 0 => "francisco.j.ampudia@uv.es" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "*" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "Manuel" "apellidos" => "Galán" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "b" "identificador" => "aff0010" ] ] ] 2 => array:3 [ "nombre" => "Meryl" "apellidos" => "Brod" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "c" "identificador" => "aff0015" ] ] ] ] "afiliaciones" => array:3 [ 0 => array:3 [ "entidad" => "Diabetes Reference Unit, Endocrinology and Nutrition Department, Clinic University Hospital, Valencia, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Novo Nordisk, Madrid, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "The Brod Group, Mill Valley, CA, USA" "etiqueta" => "c" "identificador" => "aff0015" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Estudio transversal mediante encuesta entre pacientes y médicos prescriptores sobre irregularidades en dosificación de la insulina e impacto de los episodios de hipoglucemia leve (auto-tratadas) en pacientes con diabetes tipo 2 en España en comparación con otros países europeos" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1690 "Ancho" => 2290 "Tamanyo" => 205399 ] ] "descripcion" => array:1 [ "en" => "Worry reported by Spanish and OEC patients in different daily situations." ] ] ] "textoCompleto" => "IntroductionEuropean data from 2011 showed that 35 million adults had type 1 or type 2 diabetes and €89 billion were spent in treating and managing diabetes and its complications. This is projected to increase by approximately 23%, to €43 million by 2030.<a class="elsevierStyleCrossRef" href="#bib0005">1</a> In Spain, data suggest that 13.8% of the adult population has diabetes.<a class="elsevierStyleCrossRef" href="#bib0010">2</a> Diabetes, particularly type 2 diabetes, is an increasingly important public health problem,<a class="elsevierStyleCrossRef" href="#bib0015">3</a> from which the estimated costs per patient per year are approximately €1708.<a class="elsevierStyleCrossRef" href="#bib0020">4</a>Type 2 diabetes can cause significant impairment in health-related quality of life.<a class="elsevierStyleCrossRef" href="#bib0025">5</a> Disease complications (e.g. hypoglycaemia, stroke) have been shown to decrease quality of life in patients with type 2 diabetes.<a class="elsevierStyleCrossRef" href="#bib0030">6</a> Finally, there is a strong link between diabetes and depression which is associated with significant morbidity, mortality, and increased healthcare costs.<a class="elsevierStyleCrossRef" href="#bib0035">7</a>Self-treated hypoglycaemia, often referred to as mild hypoglycaemia, remains a key aspect of diabetes management.<a class="elsevierStyleCrossRefs" href="#bib0040">8,9</a> Mild hypoglycaemia is common, affecting approximately a third of patients using insulin analogues. They are associated with a reduction in patient well-being and functioning<a class="elsevierStyleCrossRef" href="#bib0050">10</a> and have substantial economic consequences, with lost productivity estimated to cost from $15.26 to $93.47 per episode.<a class="elsevierStyleCrossRef" href="#bib0050">10</a> Mild hypoglycaemic episodes may precede or predispose to severe episodes where patients cannot treat themselves.<a class="elsevierStyleCrossRefs" href="#bib0055">11,12</a>There is also growing evidence poor adherence to insulin in type 2 diabetes patients results in inadequate glucose control<a class="elsevierStyleCrossRefs" href="#bib0065">13,14</a> and increased mortality.<a class="elsevierStyleCrossRef" href="#bib0075">15</a> Dosing irregularities (including missed, mistimed by >2h and reduced doses) of basal insulin have been shown to be common in type 2 diabetes patients and may negatively impact diabetes management.<a class="elsevierStyleCrossRef" href="#bib0080">16</a>Therefore, the impact of self-treated hypoglycaemia and dosing irregularities in type 2 diabetes patients requires further investigation. The GAPP2 (Global Attitude of Patients and Physicians) survey was designed to improve our understanding of these two issues. This survey was initially conducted in six countries (USA, Canada, Japan, Germany, UK and Denmark),<a class="elsevierStyleCrossRefs" href="#bib0060">12,16</a> and was extended to a total of 17 countries in Europe (including Spain), North America, Asia, Africa and Australasia.MethodsStudy design, setting and data handlingThe GAPP2 survey was a multinational online, cross-sectional study of type 2 diabetes patients using insulin analogues and of healthcare professionals (HCPs) managing type 2 diabetes. The survey was conducted in 17 countries in Europe, North America, Asia, Africa and Australasia. This manuscript reports data from Spain, with comparisons against pooled data from eight other European countries (Czech Republic, Denmark, France, Germany, Israel, Russia, Sweden and UK), which will be referred to as ‘Other European Countries’ (OECs).The methodology was implemented across all countries. Further details of the global methodology have been previously published.<a class="elsevierStyleCrossRefs" href="#bib0060">12,16</a> Questions were generated from multiple data sources: an international steering committee of clinical experts, current literature and key concepts raised from transcripts of nine previously conducted focus groups and interviews with diabetes patients.Patient and HCP questionnaires were structured to allow between-population comparisons. Questionnaires contain demographics and background information on diabetes management, self-treated hypoglycaemia, patient functioning and well-being. To minimise recall bias on patient responses, reporting was focused on events occurring during the 30 days prior to participation in the survey. Respondents were offered an “I don’t know” answer where applicable to avoid generating inaccurate responses, all data were logic tested to ensure respondents did not provide contradictory answers. Data identified electronically as being incomplete were collected but not processed to be included in the analyses. Response data were stored in compliance with the UK Data Protection Act (1998) on secure servers that could be accessed only by relevant researchers. Each respondent was issued with a unique Uniform Resource Locator (URL) that could be used once to access the questionnaire.Pilot testPrior to the full launch, both surveys were pilot tested in a two-step process. First, they were cognitively debriefed to ensure comprehension and readability by three HCPs and five patients in each country. A limited number of respondents were also invited to complete each survey (50–100 per country) and after the first 10 completed surveys, the data and survey mechanism logic were tested.ParticipantsHealthcare professionals and patients were recruited from pre-existing online research panels where members had registered to participate in research surveys. Panels were composed of a representative sample of the online population so as not to bias the sample, and were recruited from a broad array of online and offline approaches that best represented the country's online community.HCP respondents were initially targeted by specialty, incentives ranging from £25 to £45 were offered. Participants were required to see a minimum number of type 2 diabetes patients in a typical month: in Spain, this was 20 patients per month for general practitioners (GPs) or 40 patients per month for specialists. For OEC, France, Sweden and UK required GPs to see 20 patients/month or 40 patients/month for specialists. Denmark and Germany required GPs to see five patients/month or 40 patients/month for specialists. Israeli GPs were required to see 40 patients/month and specialists 60 patients/month. Czech Republic and Russia specialists were required to see 40 patients/month and GPs were excluded.Patient respondents were recruited from general population research panels and were initially contacted on the basis of having type 2 diabetes and being aged ≥40 years. Incentives were offered (often non-monetary) in line with terms and conditions of the panels. Participants were required to be on long-acting basal insulin (alone) or a combination of long-acting basal and short-acting bolus insulin taken separately (basal-bolus), with or without oral agents. Those on bolus only, premix or using insulin pumps were excluded.Statistical analysisData were initially descriptively analysed using paired t-tests and Pearson's Chi square test as appropriate. Where notable numbers of outliers were seen to be affecting the results for a given question, that question was assessed subjectively, and responses outside the statistically acceptable range not deemed plausible in the context of the question were removed.ResultsParticipantsIn Spain, 39,250 patients were invited to participate, 9685 responded and were screened, producing 305 eligible responders who completed the survey. The response rate was higher in Spain than in the global response rate as previously reported (24.6% vs 9.8%).<a class="elsevierStyleCrossRefs" href="#bib0060">12,16</a> For the HCP survey 1515 were invited to participate, 431 responded and were screened, producing 211 eligible respondents who completed the survey. Data are presented for 305 Spanish type 2 diabetes patients taking insulin analogues and 211 Spanish HCPs who prescribe insulin treatment (prescribers) for type 2 diabetes patients.Where applicable, the Spanish data are compared with a pooled data from OEC (Other European Countries data from Czech Republic, Denmark, France, Germany, Israel, Russia, Sweden and UK). OEC data are based on 1424 completed surveys from type 2 diabetes patients taking insulin analogues and 1261 completed surveys from prescribers.Patient demographicsThe mean age of the Spanish cohort was significantly older compared to OEC (62.9 years vs 59 years; P<0.05; <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>). Compared to OEC, Spanish respondents had been a shorter duration of diabetes (6.7 vs 9.8 years; P<0.05); significantly lower BMI (P<0.05); most used prefilled pens to deliver their insulin (P<0.001) and felt they had good control of their diabetes (P<0.001). The Spanish cohort was similar in most other respects to the OEC population.<elsevierMultimedia ident="tbl0005"></elsevierMultimedia>Prescriber demographicsThere were significantly fewer Spanish specialists compared to OEC (P<0.001; <a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>) and but Spanish prescribers saw significantly more patients with type 2 diabetes per month (76% vs 66%; P<0.001). Compared to OEC, Spanish prescribers also saw patients on fewer occasions per year (P<0.001). The Spanish cohort was similar in most other respects to the OEC population.<elsevierMultimedia ident="tbl0010"></elsevierMultimedia>Dosing irregularitiesSpanish dosing irregularitiesWhen asked about the last time they dosed their insulin irregularly, the percentage of Spanish patients who missed, mistimed and reduced doses in the past 30 days was 1% (mean occasions 1.0), 3% (mean 2.3) and 1% (mean 1.0) respectively. Of those who had dosed irregularly the percentage of intentional dosing irregularities were reported as 31% missed, 40% mistimed and 64% reduced. The last time they intentionally missed, mistimed or reduced a dose the main reasons were reducing risk of hypoglycaemia (91%, 67% and 60% respectively) or because their blood sugar was too low (80%, 67% and 60% respectively). Seventy one per cent recognised that missing basal doses would negatively impact their health and 73% discussed dosing irregularities with their doctors.The frequency of insulin dosing irregularities with clinical impact was reported by Spanish prescribers as 4.3, 6.2 and 5.5 for missed, mistimed and reduced doses.OEC dosing irregularitiesCompared to Spanish patients a higher proportion of OEC patients reported dosing irregularities in the past 30 days missed (16% (P<0.001); mean 2.3 (P<0.001); mistimed 24% (P<0.001); mean 3.6; reduced 15% (P<0.001); mean 3.6 (P<0.001)). A smaller proportion reported intentional missed (10%; P<0.001) and mistimed (26%; P<0.001) doses and a similar proportion reported intentional reduced doses (67%) compared to Spanish patients. A smaller proportion also reported intentionally missing or mistiming a dose to reduce their risk of hypoglycaemia (missing 37% P<0.001; mistimed 26% P<0.001) or because their blood sugar was too low (missed 28% P<0.001; mis-timed 24%; P<0.001) compared to Spanish patients. A smaller proportion of OEC patients both recognised missing basal doses would negatively impact their health (65%; P<0.05) and discussed dosing irregularities with their doctors (66%; P<0.05) compared to Spanish patients.OEC prescribers reported the frequency of insulin dosing irregularities with clinical impact at a similar level (missed 4.1; mis-timed 5.8; reduced 5.2).Self-treated hypoglycaemiaSpanish self-treated hypoglycaemiaIn the past 30 days, 10% of Spanish patients reported self-treated hypoglycaemia, of which 12% were nocturnal episodes and none reporting five or more episodes in that time. In response to a self-treated hypoglycaemic episode, 26% missed, 22% mistimed and 22% reduced a dose. Thirteen per cent reported they intentionally let their blood sugar go high to avoid a self-treated hypoglycaemic episode.Nineteen per cent of Spanish prescribers reported discussing hypoglycaemia most or all of the time with patients, and 13% reported patients do not see hypoglycaemia as an important issue.OEC self-treated hypoglycaemiaIn the past 30 days, a higher proportion of OEC patients (33%; P<0.001) reported self-treated hypoglycaemia and a similar proportion (11%) were nocturnal episodes, 14% (P<0.001) reported having five or more episodes in that time. A smaller proportion reported after the last time they had a self-treated hypoglycaemic episode they missed (5%; P<0.001), mistimed (6%; P<0.001) and reduced a dose (8%; P<0.001). A higher proportion (21%; P<0.05) reported they intentionally let their blood sugar go high to avoid a self-treated hypoglycaemic episode.A similar proportion of OEC prescribers reported discussing hypoglycaemia most or all of the time (23%), but a higher proportion reported patients do not see hypoglycaemia as an important issue (25%; P<0.05).Patient guilt and worrySpanish guilt and worrySeventy-seven per cent of Spanish patients would worry and 59% would feel guilty about missing a dose of basal insulin. Twenty four per cent reported being very worried about nocturnal self-treated hypoglycaemia. In everyday situations, Spanish patients reported worry about self-treated hypoglycaemia (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>).<elsevierMultimedia ident="fig0005"></elsevierMultimedia>When asked about the convenience of their insulin regime, 48% of Spanish patients find it convenient to take their insulin at the same time every day. Patients reported taking their basal insulin at the same time inconvenient because they ‘can’t remember to take it with them’ (13%).OEC guilt and worryA smaller proportion of OEC patients reported being worried (47%; P<0.001) and feeling guilty (37%; P<0.001) about missing a dose of basal insulin and being worried about nocturnal self-treated hypoglycaemia (12%; P<0.05). In everyday situations, OEC patients also reported less worry about self-treated hypoglycaemia (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>).A larger proportion finds it convenient to take their insulin at the same time every day (60%; P<0.05). A larger proportion report they find taking their basal insulin at the same time inconvenient because they ‘can’t remember to take it with them’ (43%; P<0.001).DiscussionDosing irregularitiesSpanish patients reported significantly lower proportion of dosing irregularities (missed, mistimed, reduced) compared to OEC patients in the previous 30 days. The low numbers of dosing irregularities by Spanish patients is encouraging and an important finding for diabetes management in Spain as insulin non-adherence is a significant predictor of elevated HbA1c<a class="elsevierStyleCrossRef" href="#bib0070">14</a> and an independent risk factor for mortality.<a class="elsevierStyleCrossRef" href="#bib0075">15</a> One possible reason may be that Spanish patients had significantly shorter disease duration (6.7 years vs. 9.8 years OEC; P<0.05, <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>) indicating less advanced disease and a greater desire for tighter control.While fewer dosing irregularities were reported in Spain, reports of intentional missed and mistimed doses are significantly higher. The consistent reporting of reasons for intentional dosing irregularities (reducing hypoglycaemia risk or blood sugar being too low) indicates room for improvement. Patients reporting missing or mistiming a dose largely because of concerns about blood sugar suggest that glycaemic control may be suboptimal. Reports of dosing irregularities occurring to reduce the risk of hypoglycaemia indicate a possible fear of hypoglycaemia.It is positive that more Spanish patients discussed dosing irregularities with their doctor compared to OEC and that more Spanish patients recognised that missing doses would negatively impact their health. Physician communication and awareness of the negative effects of dosing irregularities by Spanish patients suggest a possible link between communication and dosing irregularities, and physicians should be aware of this aspect of treatment.Self-treated hypoglycaemiaAs with dosing irregularities a significantly lower proportion of Spanish patients reported self-treated hypoglycaemia in the past 30 days compared to OEC, with similar levels of dosing irregularities being nocturnal. Interestingly, no Spanish patients reported having five or more events in the past 30 days, which was significantly lower than OEC patients, indicating that insulin titration may be more progressive in Spanish patients. However, of those Spanish patients who suffered a hypoglycaemic event, approximately a quarter reported a subsequent dosing irregularity, indicating that while self-treated hypoglycaemia is less frequent it may have higher negative effects on Spanish patients.As discussed above, the intentional dosing irregularities were often to reduce the risk of hypoglycaemia indicating a persistent fear of hypoglycaemia. Fear of hypoglycaemia can limit the ability of diabetes medications to achieve and maintain optimal glycaemic control.<a class="elsevierStyleCrossRef" href="#bib0085">17</a> Patients should therefore be encouraged to discuss hypoglycaemia with their prescriber.Patient guilt and worryThe proportion of dosing irregularities reported by Spanish patients are consistent with the levels of worry and guilt reported, indicating they are concerned with potential dosing irregularities. A higher proportion of Spanish patients also worry about self-treated hypoglycaemia in daily situations, particularly nocturnal hypoglycaemia. These data demonstrate while it is positive that dosing irregularities are low in Spanish patients, they may be paying a high cost for them. Prescribers should seek to alleviate patient concerns by increasing communication as well as discussing the worries patients have about all aspects of their disease.LimitationsThis survey focused on insulin analogue users rather than NPH insulin, therefore removing a significant proportion of patients from consideration. However, among the healthcare professionals surveyed in GAPP2, when asked about their views on these two different types of insulin there was general consensus on the benefits of insulin analogues particularly in terms of reduction of hypoglycaemia risk. Participants (both healthcare professionals and patients) were recruited from pre-existing online research panels where members had registered to participate in research surveys. This is a potential bias to the survey as it selects only those who are currently registered with the panels. However, the panels are designed to be a representative sample to limit any potential bias, and were recruited from a broad array of online and offline approaches that best represented the country's online community. While the response rate may initially be perceived as low and may be a limiting factor in the survey they are higher than the global GAPP2 response rates which have previously been reported.<a class="elsevierStyleCrossRefs" href="#bib0060">12,16</a>GAPP2 was a web-based survey and hence selected for respondents with internet access. Although the internet is widely available in Spain, this may have led to over-representation of younger patients, those in employment and those living in non-isolated situations. The study was based on self-reports of relevant dosing irregularities and self-treated hypoglycaemic events. Hence, recall bias and between-country differences in under- or over-reporting cannot be ruled out.ConclusionsSpanish patients appear to have fewer dosing irregularities and hypoglycaemia episodes compared to patients from OEC explained at least in part by their shorter disease duration. However, Spanish patients report increased worry and guilt related to dosing irregularities. While prescribers must keep up basic diabetes education and discuss the importance of insulin adherence for reducing adverse outcomes, they must also help alleviate the worry and guilt of their patients when insulin is initiated, including the fear of hypoglycaemia, which may be significant. Patients must be encouraged to freely discuss their fears and concerns with their prescribers. Finally, prescribers should help patients in reducing insulin dosing irregularities that may result in improving glycaemic control while avoiding excessive hypoglycaemia episodes.Conflicts of interestF. Javier Ampudia-Blasco is a member of a Novo Nordisk national advisory board. Manual Galan is an employee of Novo Nordisk who funded this study. Meryl Brod has consulted for Forest, Genetech, Bayer, Novo Nordisk and Abbvie." "textoCompletoSecciones" => array:1 [ "secciones" => array:12 [ 0 => array:2 [ "identificador" => "xres374668" "titulo" => array:5 [ 0 => "Abstract" 1 => "Background and objective" 2 => "Materials and methods" 3 => "Results" 4 => "Conclusions" ] ] 1 => array:2 [ "identificador" => "xpalclavsec353782" "titulo" => "Keywords" ] 2 => array:2 [ "identificador" => "xres374669" "titulo" => array:5 [ 0 => "Resumen" 1 => "Antecedentes y objetivo" 2 => "Materiales y métodos" 3 => "Resultados" 4 => "Conclusiones" ] ] 3 => array:2 [ "identificador" => "xpalclavsec353781" "titulo" => "Palabras clave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 5 => array:3 [ "identificador" => "sec0010" "titulo" => "Methods" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "sec0015" "titulo" => "Study design, setting and data handling" ] 1 => array:2 [ "identificador" => "sec0020" "titulo" => "Pilot test" ] 2 => array:2 [ "identificador" => "sec0025" "titulo" => "Participants" ] 3 => array:2 [ "identificador" => "sec0030" "titulo" => "Statistical analysis" ] ] ] 6 => array:3 [ "identificador" => "sec0035" "titulo" => "Results" "secciones" => array:4 [ 0 => array:3 [ "identificador" => "sec0040" "titulo" => "Participants" "secciones" => array:2 [ 0 => array:2 [ "identificador" => "sec0045" "titulo" => "Patient demographics" ] 1 => array:2 [ "identificador" => "sec0050" "titulo" => "Prescriber demographics" ] ] ] 1 => array:3 [ "identificador" => "sec0055" "titulo" => "Dosing irregularities" "secciones" => array:2 [ 0 => array:2 [ "identificador" => "sec0060" "titulo" => "Spanish dosing irregularities" ] 1 => array:2 [ "identificador" => "sec0065" "titulo" => "OEC dosing irregularities" ] ] ] 2 => array:3 [ "identificador" => "sec0070" "titulo" => "Self-treated hypoglycaemia" "secciones" => array:2 [ 0 => array:2 [ "identificador" => "sec0075" "titulo" => "Spanish self-treated hypoglycaemia" ] 1 => array:2 [ "identificador" => "sec0080" "titulo" => "OEC self-treated hypoglycaemia" ] ] ] 3 => array:3 [ "identificador" => "sec0085" "titulo" => "Patient guilt and worry" "secciones" => array:2 [ 0 => array:2 [ "identificador" => "sec0090" "titulo" => "Spanish guilt and worry" ] 1 => array:2 [ "identificador" => "sec0095" "titulo" => "OEC guilt and worry" ] ] ] ] ] 7 => array:3 [ "identificador" => "sec0100" "titulo" => "Discussion" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "sec0105" "titulo" => "Dosing irregularities" ] 1 => array:2 [ "identificador" => "sec0110" "titulo" => "Self-treated hypoglycaemia" ] 2 => array:2 [ "identificador" => "sec0115" "titulo" => "Patient guilt and worry" ] 3 => array:2 [ "identificador" => "sec0120" "titulo" => "Limitations" ] ] ] 8 => array:2 [ "identificador" => "sec0125" "titulo" => "Conclusions" ] 9 => array:2 [ "identificador" => "sec0130" "titulo" => "Conflicts of interest" ] 10 => array:2 [ "identificador" => "xack96082" "titulo" => "Acknowledgements" ] 11 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2014-01-29" "fechaAceptado" => "2014-03-24" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec353782" "palabras" => array:5 [ 0 => "Type 2 diabetes" 1 => "Hypoglycemia" 2 => "Insulin" 3 => "Dosing irregularities" 4 => "GAPP 2 survey" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec353781" "palabras" => array:5 [ 0 => "Diabetes tipo 2" 1 => "Hipoglucemia" 2 => "Insulina" 3 => "Irregularidades en dosificación" 4 => "Encuesta GAPP2" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:2 [ "titulo" => "Abstract" "resumen" => "Background and objectiveIn Spain, data suggest that 13.8% of adults have diabetes. Two important aspects in diabetes management are mild hypoglycemic episodes and poor treatment adherence. This study assesses the impact of missed insulin doses and prevalence of mistimed and reduced insulin doses and mild hypoglycemia in patients with type 2 diabetes treated with basal insulin analogues in Spain, and compares the data collected to pooled data from 8 other European countries (OECs). Materials and methodsGAPP2 was an international, online, cross-sectional study of diabetic patients aged ≥40 years treated with long-acting insulin analogues and their healthcare professionals. Patients and healthcare professionals were recruited from online research panels. Data reported in Spain are compared to pooled data from 8 OECs. ResultsIn Spain, 1–3% of patients reported they had reduced, missed, or mistimed at least one insulin does in the previous month. Significantly more OEC patients reported dosing irregularities (15–23%; all P<0.01). In Spain, 77% of patients were worried and 59% felt guilty for missing a dose of basal insulin, while 24% reported that they were very worried about nocturnal hypoglycemia. Significantly fewer OEC patients reported worrying (47%; P<0.01) and feeling guilty (37%; P<0.01) about missing an insulin dose, or worry about nocturnal hypoglycemia (12%; P<0.01). ConclusionsIn Spain, patients with type 2 diabetes report fewer dosing irregularities and hypoglycemic episodes as compared to patients from OECs. However, Spanish patients appear to have a reduced quality of life related to hypoglycemia as well as worry and guilt related to insulin dosing irregularities." ] "es" => array:2 [ "titulo" => "Resumen" "resumen" => "Antecedentes y objetivoEn España, los datos indican que el 13,8% de los adultos tienen diabetes. Dos aspectos importantes del tratamiento de la diabetes son las hipoglucemias leves y la baja adherencia al tratamiento. En este trabajo se evalúa el impacto de las irregularidades de dosificación de insulina (dosis omitidas, administradas fuera de tiempo, y anormalmente reducidas) y de las hipoglucemias leves en los pacientes con diabetes tipo 2 tratados con análogos de la insulina basal en España, en comparación con los datos agrupados de otros 8 países europeos (OEC). Materiales y métodosGAPP2 fue diseñado como un estudio transversal, internacional, online, para pacientes con diabetes tipo 2 y edad ≥40 años, en tratamiento con análogos de insulina de acción prolongada, y sus profesionales de la salud. Pacientes y profesionales de la salud fueron reclutados a partir de diversos paneles de investigación online. Los datos reportados en España se comparan con los datos agrupados de otros 8 OEC. ResultadosEn España, el 1–3% de los pacientes informaron que redujeron, olvidaron o se administraron fuera de tiempo al menos una dosis de la insulina en el mes anterior. En comparación, más pacientes OEC denunciaron significativamente irregularidades de dosificación (15–23%). En España, el 77% de los pacientes manifestaron su preocupación y el 59% se sintieron culpables por olvidar una dosis de insulina basal, mientras que el 24% manifestó estar muy preocupado por las hipoglucemias nocturnas. En relación con los pacientes OEC, menos pacientes manifestaron significativamente preocupación (47%) y sentimiento de culpabilidad (37%) sobre la omisión de una dosis de insulina, o inquietud por las hipoglucemias nocturnas (12%). ConclusionesEn España, los pacientes con diabetes tipo 2 reportan menos irregularidades de dosificación e hipoglucemias en comparación con los pacientes de la OEC. Sin embargo, los pacientes españoles parecen sufrir una reducción de la calidad de vida relacionada con la hipoglucemia, así como preocupación y culpa en relación con las irregularidades en la dosificación de insulina." ] ] "multimedia" => array:3 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1690 "Ancho" => 2290 "Tamanyo" => 205399 ] ] "descripcion" => array:1 [ "en" => "Worry reported by Spanish and OEC patients in different daily situations." ] ] 1 => array:7 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:2 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Spain \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">OEC \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">P value \t\t\t\t\t\t\n \t\t\t\t</td></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">N \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">305 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1729 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Mean age, years (range) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">62.9 (42–86) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">59.0 (41–99) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><0.05 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Male \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">51% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">58% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">>0.05 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Duration of diabetes, years (range) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">6.7 (1–27) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">9.8 (<1–50) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><0.05 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">BMI (kg/m2) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><0.001 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><27 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">58% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">33% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">27–33 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">40% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">42% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">33–39 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">16% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">>39 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">– \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">– \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="4" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"></td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Number of diabetes complications<a class="elsevierStyleCrossRef" href="#tblfn0005">a</a>(range) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1.7 (0–7) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2.3 (1–11) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">>0.05 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Duration of insulin therapy, years (range) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">4 (<1–12) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">5 (<1–90) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">>0.05 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="4" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"></td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Insulin regimen \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><0.05 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Basal only \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">61% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">51% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Basal bolus \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">39% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">49% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="4" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"></td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Mean number of basal insulin injections/day \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1.8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1.5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">>0.05 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="4" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"></td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Injection device for basal insulin \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><0.001 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Prefilled pens \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">85% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">66% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">A vial and syringe \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">16% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">12% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Refillable pens \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">- \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">31% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Employed \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">40% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">41% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">>0.05 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="4" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"></td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Perceived Diabetes Control \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><0.001 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Poor \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">– \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">6% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Moderate \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">20% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">48% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Good \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">80% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">46% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab568004.png" ] ] ] "notaPie" => array:1 [ 0 => array:3 [ "identificador" => "tblfn0005" "etiqueta" => "a" "nota" => "Selected from 13 complications offered: amputation, anxiety, cataracts or eyesight damage, depression, foot ulcers, glaucoma, high cholesterol, impotence/reduced sexual functioning, nerve damage, reduced kidney function, sleeping problems, stroke." ] ] ] "descripcion" => array:1 [ "en" => "Patient demographics." ] ] 2 => array:7 [ "identificador" => "tbl0010" "etiqueta" => "Table 2" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:1 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Spain \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">OEC \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">P value \t\t\t\t\t\t\n \t\t\t\t</td></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">N \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">211 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1472 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Mean time since qualified, years \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">18 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">16 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">>0.05 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Specialty \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><0.001 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Primary care \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">48% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">48% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Specialist \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">28% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">48% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Other \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">24% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">4% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="4" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"></td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Mean insulin treated patients with type 2 diabetes aged 40+ \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">99 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">94 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">>0.05 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Mean percentage of insulin treated patients with type 2 diabetes using analogue insulin \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">76% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">66% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><0.001 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="4" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"></td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Type of insulin analogues used by patients \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><0.05 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Basal bolus taken separately \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">26% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">30% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Premix \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">19% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">21% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Bolus only \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">6% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">8% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Basal only \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">49% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">41% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="4" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"></td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Frequency of seeing patients (visits/year) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><0.001 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Patients with good control (HbA1c 6–7%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">5.9 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">7.1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Patients with moderate control (HbA1c 7–8%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">7.7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">8.4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Patients with poor control (HbA1c >8%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">8.3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">9.5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab568005.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Prescriber demographics." ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:17 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "IDF Diabetes Atlas" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "International Diabetes Federation" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Libro" => array:4 [ "edicion" => "5th ed." "fecha" => "2011" "editorial" => "International Diabetes Federation" "editorialLocalizacion" => "Brussels, Belgium" ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0010" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Prevalence of diabetes mellitus and impaired glucose regulation in Spain: the Di@bet.es Study" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "F. Soriguer" 1 => "A. Goday" 2 => "A. Bosch-Comas" 3 => "E. Bordiú" 4 => "A. Calle-Pascual" 5 => "R. Carmena" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1007/s00125-011-2336-9" "Revista" => array:6 [ "tituloSerie" => "Diabetologia" "fecha" => "2012" "volumen" => "55" "paginaInicial" => "88" "paginaFinal" => "93" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21987347" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0015" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "La diabetes mellitus en España: mortalidad, prevalencia, incidencia, costes económicos y desigualdades" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "M. Ruiz-Ramos" 1 => "A. Escolar-Pujolar" 2 => "E. Mayoral-Sánchez" 3 => "F. Corral-San Laureano" 4 => "I. Fernández-Fernández" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Gac Sanit" "fecha" => "2006" "volumen" => "20" "paginaInicial" => "15" "paginaFinal" => "24" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16539961" "web" => "Medline" ] ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0020" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:1 [ "referenciaCompleta" => "Diabetes expenditure, burden of disease and management in 5 EU countries 2012. Available from <a id="intr0010" class="elsevierStyleInterRef" href="http://www2.lse.ac.uk/LSEHealthAndSocialCare/research/LSEHealth/MTRG/ResearchReportOnDiabetes.aspx">http://www2.lse.ac.uk/LSEHealthAndSocialCare/research/LSEHealth/MTRG/ResearchReportOnDiabetes.aspx</a>) (accessed 01.09.13)." ] ] ] 4 => array:3 [ "identificador" => "bib0025" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Health-related quality of life and type 2 diabetes: a study of people living in the Bella Coola Valley" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "H. Thommason" 1 => "W. Zhang" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "BCMJ" "fecha" => "2006" "volumen" => "48" "paginaInicial" => "272" "paginaFinal" => "278" ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib0030" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Quality of life in type 2 diabetic patients is affected by complications but not by intensive policies to improve blood glucose or blood pressure control" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "UKPDS" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Diabetes Care" "fecha" => "1999" "volumen" => "22" "paginaInicial" => "1125" "paginaFinal" => "1136" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/10388978" "web" => "Medline" ] ] ] ] ] ] ] ] 6 => array:3 [ "identificador" => "bib0035" "etiqueta" => "7" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Diabetes and depression: global perspectives" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "L. Egede" 1 => "C. Ellis" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Diabetes Res. Clin. Prac." "fecha" => "2010" "volumen" => "87" "paginaInicial" => "302" "paginaFinal" => "312" "itemHostRev" => array:3 [ "pii" => "S0090825813001005" "estado" => "S300" "issn" => "00908258" ] ] ] ] ] ] ] 7 => array:3 [ "identificador" => "bib0040" "etiqueta" => "8" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Barriers to insulin initiation: the translating research into action for diabetes insulin starts project" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "A. Karter" 1 => "U. Subramanian" 2 => "C. Saha" 3 => "J. Crosson" 4 => "M. Parker" 5 => "B. Swain" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.2337/dc09-1184" "Revista" => array:5 [ "tituloSerie" => "Diabetes Care" "fecha" => "2010" "volumen" => "33" "paginaInicial" => "733" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20086256" "web" => "Medline" ] ] ] ] ] ] ] ] 8 => array:3 [ "identificador" => "bib0045" "etiqueta" => "9" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Primary care physician beliefs about insulin initiation in patients with type 2 diabetes" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "R. Hayes" 1 => "J. Fitzgerald" 2 => "S. Jacober" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/j.1742-1241.2008.01742.x" "Revista" => array:6 [ "tituloSerie" => "Int J Clin Pract" "fecha" => "2008" "volumen" => "62" "paginaInicial" => "860" "paginaFinal" => "868" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18393965" "web" => "Medline" ] ] ] ] ] ] ] ] 9 => array:3 [ "identificador" => "bib0050" "etiqueta" => "10" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The impact of non-severe hypoglycemic events on work productivity and diabetes management" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "M. Brod" 1 => "T. Christensen" 2 => "T. Thomsen" 3 => "D. Bushnell" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.jval.2011.02.001" "Revista" => array:6 [ "tituloSerie" => "Value Health" "fecha" => "2011" "volumen" => "14" "paginaInicial" => "665" "paginaFinal" => "671" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21839404" "web" => "Medline" ] ] ] ] ] ] ] ] 10 => array:3 [ "identificador" => "bib0055" "etiqueta" => "11" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Defining and reporting hypoglycemia in diabetes" "autores" => array:1 [ 0 => array:2 [ "colaboracion" => "American Diabetes Association Workgroup on Hypoglycemia" "etal" => false ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Diabetes Care" "fecha" => "2005" "volumen" => "28" "paginaInicial" => "1245" "paginaFinal" => "1249" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15855602" "web" => "Medline" ] ] ] ] ] ] ] ] 11 => array:3 [ "identificador" => "bib0060" "etiqueta" => "12" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Impact of self-treated hypoglycaemia in type 2 diabetes: a multinational survey in patients and physicians" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "M. Brod" 1 => "A. Rana" 2 => "A. Barnett" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1185/03007995.2012.743458" "Revista" => array:6 [ "tituloSerie" => "Curr Med Res Opin" "fecha" => "2012" "volumen" => "28" "paginaInicial" => "1933" "paginaFinal" => "1946" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23150949" "web" => "Medline" ] ] ] ] ] ] ] ] 12 => array:3 [ "identificador" => "bib0065" "etiqueta" => "13" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Insulin adherence behaviours and barriers in the multinational Global Attitudes of Patients and Physicians in Insulin Therapy study" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "M. Peyrot" 1 => "A. Barnett" 2 => "L. Meneghini" 3 => "P. Schumm-Draeger" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/j.1464-5491.2012.03605.x" "Revista" => array:5 [ "tituloSerie" => "Diabet Med" "fecha" => "2012" "volumen" => "29" "paginaInicial" => "682" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22313123" "web" => "Medline" ] ] ] ] ] ] ] ] 13 => array:3 [ "identificador" => "bib0070" "etiqueta" => "14" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Adherence to insulin and its association with glycaemic control in patients with type 2 diabetes" "autores" => array:1 [ 0 => array:3 [ "colaboracion" => "for the DARTS/MEMO collaboration" "etal" => false "autores" => array:3 [ 0 => "L. Donnelly" 1 => "A. Morris" 2 => "J. Evans" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1093/qjmed/hcm031" "Revista" => array:6 [ "tituloSerie" => "QJM" "fecha" => "2007" "volumen" => "100" "paginaInicial" => "345" "paginaFinal" => "350" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17504861" "web" => "Medline" ] ] ] ] ] ] ] ] 14 => array:3 [ "identificador" => "bib0075" "etiqueta" => "15" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The impact of treatment noncompliance on mortality in people with type 2 diabetes" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "C. Currie" 1 => "M. Peyrot" 2 => "C. Morgan" 3 => "C. Poole" 4 => "S. Jenkins-Jones" 5 => "R. Rubin" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.2337/dc11-1277" "Revista" => array:6 [ "tituloSerie" => "Diabetes Care" "fecha" => "2012" "volumen" => "35" "paginaInicial" => "1279" "paginaFinal" => "1284" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22511257" "web" => "Medline" ] ] ] ] ] ] ] ] 15 => array:3 [ "identificador" => "bib0080" "etiqueta" => "16" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Adherence patterns in patients with type 2 diabetes on basal insulin analogues: missed, mistimed and reduced doses" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "M. Brod" 1 => "A. Rana" 2 => "A. Barnett" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "CMRO" "fecha" => "2012" "volumen" => "28" "paginaInicial" => "1947" "paginaFinal" => "1958" ] ] ] ] ] ] 16 => array:3 [ "identificador" => "bib0085" "etiqueta" => "17" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Hypoglycaemia in Type 2 diabetes" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "S. Amiel" 1 => "T. Dixon" 2 => "R. Mann" 3 => "K. Jameson" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/j.1464-5491.2007.02341.x" "Revista" => array:6 [ "tituloSerie" => "Diabet Med" "fecha" => "2008" "volumen" => "25" "paginaInicial" => "245" "paginaFinal" => "254" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18215172" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] "agradecimientos" => array:1 [ 0 => array:4 [ "identificador" => "xack96082" "titulo" => "Acknowledgements" "texto" => "The GAPP2 study was funded by Novo Nordisk A/S. The sponsor's role was to appoint an independent medical communications company (FTI Consulting) and research company (Bryter Research)." "vista" => "all" ] ] ] "idiomaDefecto" => "en" "url" => "/21735093/0000006100000008/v1_201410080024/S2173509314001445/v1_201410080024/en/main.assets" "Apartado" => array:4 [ "identificador" => "5824" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Original articles" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/21735093/0000006100000008/v1_201410080024/S2173509314001445/v1_201410080024/en/main.pdf?idApp=UINPBA00004N&text.app=https://www.elsevier.es/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173509314001445?idApp=UINPBA00004N"]

Statistics

Original article

A cross-sectional survey among patients and prescribers on insulin dosing irregularities and impact of mild (self-treated) hypoglycemia episodes in Spanish patients with type 2 diabetes as compared to other European patients

Estudio transversal mediante encuesta entre pacientes y médicos prescriptores sobre irregularidades en dosificación de la insulina e impacto de los episodios de hipoglucemia leve (auto-tratadas) en pacientes con diabetes tipo 2 en España en comparación con otros países europeos

Francisco J. Ampudia-Blascoa,

Corresponding author

francisco.j.ampudia@uv.es

Corresponding author.

, Manuel Galánb, Meryl Brodc

a Diabetes Reference Unit, Endocrinology and Nutrition Department, Clinic University Hospital, Valencia, Spain

b Novo Nordisk, Madrid, Spain

c The Brod Group, Mill Valley, CA, USA

Read

2418

Times
was read the article

723

Total PDF

1695

Total HTML

Share statistics

 array:24 [
  "pii" => "S2173509314001445"
  "issn" => "21735093"
  "doi" => "10.1016/j.endoen.2014.07.003"
  "estado" => "S300"
  "fechaPublicacion" => "2014-10-01"
  "aid" => "593"
  "copyright" => "SEEN"
  "copyrightAnyo" => "2014"
  "documento" => "article"
  "crossmark" => 0
  "subdocumento" => "fla"
  "cita" => "Endocrinol Nutr. 2014;61:426-33"
  "abierto" => array:3 [
    "ES" => false
    "ES2" => false
    "LATM" => false
  ]
  "gratuito" => false
  "lecturas" => array:2 [
    "total" => 962
    "formatos" => array:3 [
      "EPUB" => 10
      "HTML" => 687
      "PDF" => 265
    ]
  ]
  "Traduccion" => array:1 [
    "en" => array:19 [
      "pii" => "S1575092214001284"
      "issn" => "15750922"
      "doi" => "10.1016/j.endonu.2014.03.008"
      "estado" => "S300"
      "fechaPublicacion" => "2014-10-01"
      "aid" => "593"
      "copyright" => "SEEN"
      "documento" => "article"
      "crossmark" => 0
      "subdocumento" => "fla"
      "cita" => "Endocrinol Nutr. 2014;61:426-33"
      "abierto" => array:3 [
        "ES" => false
        "ES2" => false
        "LATM" => false
      ]
      "gratuito" => false
      "lecturas" => array:2 [
        "total" => 1344
        "formatos" => array:3 [
          "EPUB" => 10
          "HTML" => 901
          "PDF" => 433
        ]
      ]
      "en" => array:13 [
        "idiomaDefecto" => true
        "cabecera" => "<span class="elsevierStyleTextfn">Original article</span>"
        "titulo" => "A cross-sectional survey among patients and prescribers on insulin dosing irregularities and impact of mild &#40;self-treated&#41; hypoglycemia episodes in Spanish patients with type 2 diabetes as compared to other European patients"
        "tienePdf" => "en"
        "tieneTextoCompleto" => "en"
        "tieneResumen" => array:2 [
          0 => "en"
          1 => "es"
        ]
        "paginas" => array:1 [
          0 => array:2 [
            "paginaInicial" => "426"
            "paginaFinal" => "433"
          ]
        ]
        "titulosAlternativos" => array:1 [
          "es" => array:1 [
            "titulo" => "Estudio transversal mediante encuesta entre pacientes y m&#233;dicos prescriptores sobre irregularidades en dosificaci&#243;n de la insulina e impacto de los episodios de hipoglucemia leve &#40;auto-tratadas&#41; en pacientes con diabetes tipo 2 en Espa&#241;a en comparaci&#243;n con otros pa&#237;ses europeos"
          ]
        ]
        "contieneResumen" => array:2 [
          "en" => true
          "es" => true
        ]
        "contieneTextoCompleto" => array:1 [
          "en" => true
        ]
        "contienePdf" => array:1 [
          "en" => true
        ]
        "resumenGrafico" => array:2 [
          "original" => 0
          "multimedia" => array:7 [
            "identificador" => "fig0005"
            "etiqueta" => "Figure 1"
            "tipo" => "MULTIMEDIAFIGURA"
            "mostrarFloat" => true
            "mostrarDisplay" => false
            "figura" => array:1 [
              0 => array:4 [
                "imagen" => "gr1.jpeg"
                "Alto" => 1660
                "Ancho" => 2290
                "Tamanyo" => 194240
              ]
            ]
            "descripcion" => array:1 [
              "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Worry reported by Spanish and OEC patients in different daily situations&#46;</p>"
            ]
          ]
        ]
        "autores" => array:1 [
          0 => array:2 [
            "autoresLista" => "Francisco J&#46; Ampudia-Blasco, Manuel Gal&#225;n, Meryl Brod"
            "autores" => array:3 [
              0 => array:2 [
                "nombre" => "Francisco J&#46;"
                "apellidos" => "Ampudia-Blasco"
              ]
              1 => array:2 [
                "nombre" => "Manuel"
                "apellidos" => "Gal&#225;n"
              ]
              2 => array:2 [
                "nombre" => "Meryl"
                "apellidos" => "Brod"
              ]
            ]
          ]
        ]
      ]
      "idiomaDefecto" => "en"
      "Traduccion" => array:1 [
        "en" => array:9 [
          "pii" => "S2173509314001445"
          "doi" => "10.1016/j.endoen.2014.07.003"
          "estado" => "S300"
          "subdocumento" => ""
          "abierto" => array:3 [
            "ES" => false
            "ES2" => false
            "LATM" => false
          ]
          "gratuito" => false
          "lecturas" => array:1 [
            "total" => 0
          ]
          "idiomaDefecto" => "en"
          "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173509314001445?idApp=UINPBA00004N"
        ]
      ]
      "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1575092214001284?idApp=UINPBA00004N"
      "url" => "/15750922/0000006100000008/v1_201409200130/S1575092214001284/v1_201409200130/en/main.assets"
    ]
  ]
  "itemSiguiente" => array:19 [
    "pii" => "S2173509314001421"
    "issn" => "21735093"
    "doi" => "10.1016/j.endoen.2014.07.001"
    "estado" => "S300"
    "fechaPublicacion" => "2014-10-01"
    "aid" => "599"
    "copyright" => "SEEN"
    "documento" => "simple-article"
    "crossmark" => 0
    "subdocumento" => "cor"
    "cita" => "Endocrinol Nutr. 2014;61:434-6"
    "abierto" => array:3 [
      "ES" => false
      "ES2" => false
      "LATM" => false
    ]
    "gratuito" => false
    "lecturas" => array:2 [
      "total" => 1852
      "formatos" => array:3 [
        "EPUB" => 17
        "HTML" => 1450
        "PDF" => 385
      ]
    ]
    "en" => array:11 [
      "idiomaDefecto" => true
      "cabecera" => "<span class="elsevierStyleTextfn">Scientific letter</span>"
      "titulo" => "Carcinoid tumor on cystic ovarian teratoma"
      "tienePdf" => "en"
      "tieneTextoCompleto" => "en"
      "paginas" => array:1 [
        0 => array:2 [
          "paginaInicial" => "434"
          "paginaFinal" => "436"
        ]
      ]
      "titulosAlternativos" => array:1 [
        "es" => array:1 [
          "titulo" => "Tumor carcinoide sobre teratoma ov&#225;rico qu&#237;stico"
        ]
      ]
      "contieneTextoCompleto" => array:1 [
        "en" => true
      ]
      "contienePdf" => array:1 [
        "en" => true
      ]
      "resumenGrafico" => array:2 [
        "original" => 0
        "multimedia" => array:7 [
          "identificador" => "fig0005"
          "etiqueta" => "Figure 1"
          "tipo" => "MULTIMEDIAFIGURA"
          "mostrarFloat" => true
          "mostrarDisplay" => false
          "figura" => array:1 [
            0 => array:4 [
              "imagen" => "gr1.jpeg"
              "Alto" => 766
              "Ancho" => 1600
              "Tamanyo" => 83248
            ]
          ]
          "descripcion" => array:1 [
            "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Whole body Octreoscan<span class="elsevierStyleSup">&#174;</span>&#47;abdominal SPECT-CT&#46;</p>"
          ]
        ]
      ]
      "autores" => array:1 [
        0 => array:2 [
          "autoresLista" => "Mariana Tom&#233; Fern&#225;ndez-Ladreda, Guillermo Mart&#237;nez de Pinillos Gordillo, Francisco Pichardo L&#243;pez de Haro, Mar&#237;a Victoria C&#243;zar Le&#243;n"
          "autores" => array:4 [
            0 => array:2 [
              "nombre" => "Mariana"
              "apellidos" => "Tom&#233; Fern&#225;ndez-Ladreda"
            ]
            1 => array:2 [
              "nombre" => "Guillermo"
              "apellidos" => "Mart&#237;nez de Pinillos Gordillo"
            ]
            2 => array:2 [
              "nombre" => "Francisco"
              "apellidos" => "Pichardo L&#243;pez de Haro"
            ]
            3 => array:2 [
              "nombre" => "Mar&#237;a Victoria"
              "apellidos" => "C&#243;zar Le&#243;n"
            ]
          ]
        ]
      ]
    ]
    "idiomaDefecto" => "en"
    "Traduccion" => array:1 [
      "es" => array:9 [
        "pii" => "S157509221400134X"
        "doi" => "10.1016/j.endonu.2014.04.003"
        "estado" => "S300"
        "subdocumento" => ""
        "abierto" => array:3 [
          "ES" => false
          "ES2" => false
          "LATM" => false
        ]
        "gratuito" => false
        "lecturas" => array:1 [
          "total" => 0
        ]
        "idiomaDefecto" => "es"
        "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S157509221400134X?idApp=UINPBA00004N"
      ]
    ]
    "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173509314001421?idApp=UINPBA00004N"
    "url" => "/21735093/0000006100000008/v1_201410080024/S2173509314001421/v1_201410080024/en/main.assets"
  ]
  "itemAnterior" => array:19 [
    "pii" => "S2173509314001470"
    "issn" => "21735093"
    "doi" => "10.1016/j.endoen.2014.07.005"
    "estado" => "S300"
    "fechaPublicacion" => "2014-10-01"
    "aid" => "579"
    "copyright" => "SEEN"
    "documento" => "article"
    "crossmark" => 0
    "subdocumento" => "fla"
    "cita" => "Endocrinol Nutr. 2014;61:419-25"
    "abierto" => array:3 [
      "ES" => false
      "ES2" => false
      "LATM" => false
    ]
    "gratuito" => false
    "lecturas" => array:2 [
      "total" => 1964
      "formatos" => array:3 [
        "EPUB" => 9
        "HTML" => 1532
        "PDF" => 423
      ]
    ]
    "en" => array:13 [
      "idiomaDefecto" => true
      "cabecera" => "<span class="elsevierStyleTextfn">Original Article</span>"
      "titulo" => "Serum cholesterol and triglyceride levels in diabetic patients with subclinical hypothyroidism"
      "tienePdf" => "en"
      "tieneTextoCompleto" => "en"
      "tieneResumen" => array:2 [
        0 => "en"
        1 => "es"
      ]
      "paginas" => array:1 [
        0 => array:2 [
          "paginaInicial" => "419"
          "paginaFinal" => "425"
        ]
      ]
      "titulosAlternativos" => array:1 [
        "es" => array:1 [
          "titulo" => "Concentraciones s&#233;ricas de colesterol y triglic&#233;ridos en pacientes diab&#233;ticos con hipotiroidismo subcl&#237;nico"
        ]
      ]
      "contieneResumen" => array:2 [
        "en" => true
        "es" => true
      ]
      "contieneTextoCompleto" => array:1 [
        "en" => true
      ]
      "contienePdf" => array:1 [
        "en" => true
      ]
      "resumenGrafico" => array:2 [
        "original" => 0
        "multimedia" => array:7 [
          "identificador" => "fig0005"
          "etiqueta" => "Figure 1"
          "tipo" => "MULTIMEDIAFIGURA"
          "mostrarFloat" => true
          "mostrarDisplay" => false
          "figura" => array:1 [
            0 => array:4 [
              "imagen" => "gr1.jpeg"
              "Alto" => 3351
              "Ancho" => 2524
              "Tamanyo" => 250221
            ]
          ]
          "descripcion" => array:1 [
            "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Flow chart showing the origin of the sample of euthyroid diabetic patients who acted as controls &#40;group C&#41;&#44; and diabetic patients with incident or prevalent&#44; untreated hypothyroidism &#40;group SH&#41;&#46;</p>"
          ]
        ]
      ]
      "autores" => array:1 [
        0 => array:2 [
          "autoresLista" => "Juan J&#46; D&#237;ez, Pedro Iglesias"
          "autores" => array:2 [
            0 => array:2 [
              "nombre" => "Juan J&#46;"
              "apellidos" => "D&#237;ez"
            ]
            1 => array:2 [
              "nombre" => "Pedro"
              "apellidos" => "Iglesias"
            ]
          ]
        ]
      ]
    ]
    "idiomaDefecto" => "en"
    "Traduccion" => array:1 [
      "es" => array:9 [
        "pii" => "S1575092214000680"
        "doi" => "10.1016/j.endonu.2014.01.012"
        "estado" => "S300"
        "subdocumento" => ""
        "abierto" => array:3 [
          "ES" => false
          "ES2" => false
          "LATM" => false
        ]
        "gratuito" => false
        "lecturas" => array:1 [
          "total" => 0
        ]
        "idiomaDefecto" => "es"
        "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1575092214000680?idApp=UINPBA00004N"
      ]
    ]
    "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173509314001470?idApp=UINPBA00004N"
    "url" => "/21735093/0000006100000008/v1_201410080024/S2173509314001470/v1_201410080024/en/main.assets"
  ]
  "en" => array:20 [
    "idiomaDefecto" => true
    "cabecera" => "<span class="elsevierStyleTextfn">Original article</span>"
    "titulo" => "A cross-sectional survey among patients and prescribers on insulin dosing irregularities and impact of mild &#40;self-treated&#41; hypoglycemia episodes in Spanish patients with type 2 diabetes as compared to other European patients"
    "tieneTextoCompleto" => true
    "paginas" => array:1 [
      0 => array:2 [
        "paginaInicial" => "426"
        "paginaFinal" => "433"
      ]
    ]
    "autores" => array:1 [
      0 => array:4 [
        "autoresLista" => "Francisco J&#46; Ampudia-Blasco, Manuel Gal&#225;n, Meryl Brod"
        "autores" => array:3 [
          0 => array:4 [
            "nombre" => "Francisco J&#46;"
            "apellidos" => "Ampudia-Blasco"
            "email" => array:1 [
              0 => "francisco&#46;j&#46;ampudia&#64;uv&#46;es"
            ]
            "referencia" => array:2 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">a</span>"
                "identificador" => "aff0005"
              ]
              1 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">&#42;</span>"
                "identificador" => "cor0005"
              ]
            ]
          ]
          1 => array:3 [
            "nombre" => "Manuel"
            "apellidos" => "Gal&#225;n"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">b</span>"
                "identificador" => "aff0010"
              ]
            ]
          ]
          2 => array:3 [
            "nombre" => "Meryl"
            "apellidos" => "Brod"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">c</span>"
                "identificador" => "aff0015"
              ]
            ]
          ]
        ]
        "afiliaciones" => array:3 [
          0 => array:3 [
            "entidad" => "Diabetes Reference Unit&#44; Endocrinology and Nutrition Department&#44; Clinic University Hospital&#44; Valencia&#44; Spain"
            "etiqueta" => "a"
            "identificador" => "aff0005"
          ]
          1 => array:3 [
            "entidad" => "Novo Nordisk&#44; Madrid&#44; Spain"
            "etiqueta" => "b"
            "identificador" => "aff0010"
          ]
          2 => array:3 [
            "entidad" => "The Brod Group&#44; Mill Valley&#44; CA&#44; USA"
            "etiqueta" => "c"
            "identificador" => "aff0015"
          ]
        ]
        "correspondencia" => array:1 [
          0 => array:3 [
            "identificador" => "cor0005"
            "etiqueta" => "&#8270;"
            "correspondencia" => "Corresponding author&#46;"
          ]
        ]
      ]
    ]
    "titulosAlternativos" => array:1 [
      "es" => array:1 [
        "titulo" => "Estudio transversal mediante encuesta entre pacientes y m&#233;dicos prescriptores sobre irregularidades en dosificaci&#243;n de la insulina e impacto de los episodios de hipoglucemia leve &#40;auto-tratadas&#41; en pacientes con diabetes tipo 2 en Espa&#241;a en comparaci&#243;n con otros pa&#237;ses europeos"
      ]
    ]
    "resumenGrafico" => array:2 [
      "original" => 0
      "multimedia" => array:7 [
        "identificador" => "fig0005"
        "etiqueta" => "Figure 1"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr1.jpeg"
            "Alto" => 1690
            "Ancho" => 2290
            "Tamanyo" => 205399
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Worry reported by Spanish and OEC patients in different daily situations&#46;</p>"
        ]
      ]
    ]
    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">European data from 2011 showed that 35 million adults had type 1 or type 2 diabetes and &#8364;89 billion were spent in treating and managing diabetes and its complications&#46; This is projected to increase by approximately 23&#37;&#44; to &#8364;43 million by 2030&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> In Spain&#44; data suggest that 13&#46;8&#37; of the adult population has diabetes&#46;<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> Diabetes&#44; particularly type 2 diabetes&#44; is an increasingly important public health problem&#44;<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> from which the estimated costs per patient per year are approximately &#8364;1708&#46;<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">Type 2 diabetes can cause significant impairment in health-related quality of life&#46;<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> Disease complications &#40;e&#46;g&#46; hypoglycaemia&#44; stroke&#41; have been shown to decrease quality of life in patients with type 2 diabetes&#46;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> Finally&#44; there is a strong link between diabetes and depression which is associated with significant morbidity&#44; mortality&#44; and increased healthcare costs&#46;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">Self-treated hypoglycaemia&#44; often referred to as mild hypoglycaemia&#44; remains a key aspect of diabetes management&#46;<a class="elsevierStyleCrossRefs" href="#bib0040"><span class="elsevierStyleSup">8&#44;9</span></a> Mild hypoglycaemia is common&#44; affecting approximately a third of patients using insulin analogues&#46; They are associated with a reduction in patient well-being and functioning<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a> and have substantial economic consequences&#44; with lost productivity estimated to cost from &#36;15&#46;26 to &#36;93&#46;47 per episode&#46;<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a> Mild hypoglycaemic episodes may precede or predispose to severe episodes where patients cannot treat themselves&#46;<a class="elsevierStyleCrossRefs" href="#bib0055"><span class="elsevierStyleSup">11&#44;12</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">There is also growing evidence poor adherence to insulin in type 2 diabetes patients results in inadequate glucose control<a class="elsevierStyleCrossRefs" href="#bib0065"><span class="elsevierStyleSup">13&#44;14</span></a> and increased mortality&#46;<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">15</span></a> Dosing irregularities &#40;including missed&#44; mistimed by &#62;2<span class="elsevierStyleHsp" style=""></span>h and reduced doses&#41; of basal insulin have been shown to be common in type 2 diabetes patients and may negatively impact diabetes management&#46;<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">16</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">Therefore&#44; the impact of self-treated hypoglycaemia and dosing irregularities in type 2 diabetes patients requires further investigation&#46; The GAPP2 &#40;Global Attitude of Patients and Physicians&#41; survey was designed to improve our understanding of these two issues&#46; This survey was initially conducted in six countries &#40;USA&#44; Canada&#44; Japan&#44; Germany&#44; UK and Denmark&#41;&#44;<a class="elsevierStyleCrossRefs" href="#bib0060"><span class="elsevierStyleSup">12&#44;16</span></a> and was extended to a total of 17 countries in Europe &#40;including Spain&#41;&#44; North America&#44; Asia&#44; Africa and Australasia&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Methods</span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Study design&#44; setting and data handling</span><p id="par0030" class="elsevierStylePara elsevierViewall">The GAPP2 survey was a multinational online&#44; cross-sectional study of type 2 diabetes patients using insulin analogues and of healthcare professionals &#40;HCPs&#41; managing type 2 diabetes&#46; The survey was conducted in 17 countries in Europe&#44; North America&#44; Asia&#44; Africa and Australasia&#46; This manuscript reports data from Spain&#44; with comparisons against pooled data from eight other European countries &#40;Czech Republic&#44; Denmark&#44; France&#44; Germany&#44; Israel&#44; Russia&#44; Sweden and UK&#41;&#44; which will be referred to as &#8216;Other European Countries&#8217; &#40;OECs&#41;&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">The methodology was implemented across all countries&#46; Further details of the global methodology have been previously published&#46;<a class="elsevierStyleCrossRefs" href="#bib0060"><span class="elsevierStyleSup">12&#44;16</span></a> Questions were generated from multiple data sources&#58; an international steering committee of clinical experts&#44; current literature and key concepts raised from transcripts of nine previously conducted focus groups and interviews with diabetes patients&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">Patient and HCP questionnaires were structured to allow between-population comparisons&#46; Questionnaires contain demographics and background information on diabetes management&#44; self-treated hypoglycaemia&#44; patient functioning and well-being&#46; To minimise recall bias on patient responses&#44; reporting was focused on events occurring during the 30 days prior to participation in the survey&#46; Respondents were offered an &#8220;I don&#8217;t know&#8221; answer where applicable to avoid generating inaccurate responses&#44; all data were logic tested to ensure respondents did not provide contradictory answers&#46; Data identified electronically as being incomplete were collected but not processed to be included in the analyses&#46; Response data were stored in compliance with the UK Data Protection Act &#40;1998&#41; on secure servers that could be accessed only by relevant researchers&#46; Each respondent was issued with a unique Uniform Resource Locator &#40;URL&#41; that could be used once to access the questionnaire&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Pilot test</span><p id="par0045" class="elsevierStylePara elsevierViewall">Prior to the full launch&#44; both surveys were pilot tested in a two-step process&#46; First&#44; they were cognitively debriefed to ensure comprehension and readability by three HCPs and five patients in each country&#46; A limited number of respondents were also invited to complete each survey &#40;50&#8211;100 per country&#41; and after the first 10 completed surveys&#44; the data and survey mechanism logic were tested&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Participants</span><p id="par0050" class="elsevierStylePara elsevierViewall">Healthcare professionals and patients were recruited from pre-existing online research panels where members had registered to participate in research surveys&#46; Panels were composed of a representative sample of the online population so as not to bias the sample&#44; and were recruited from a broad array of online and offline approaches that best represented the country&#39;s online community&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">HCP respondents were initially targeted by specialty&#44; incentives ranging from &#163;25 to &#163;45 were offered&#46; Participants were required to see a minimum number of type 2 diabetes patients in a typical month&#58; in Spain&#44; this was 20 patients per month for general practitioners &#40;GPs&#41; or 40 patients per month for specialists&#46; For OEC&#44; France&#44; Sweden and UK required GPs to see 20 patients&#47;month or 40 patients&#47;month for specialists&#46; Denmark and Germany required GPs to see five patients&#47;month or 40 patients&#47;month for specialists&#46; Israeli GPs were required to see 40 patients&#47;month and specialists 60 patients&#47;month&#46; Czech Republic and Russia specialists were required to see 40 patients&#47;month and GPs were excluded&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">Patient respondents were recruited from general population research panels and were initially contacted on the basis of having type 2 diabetes and being aged &#8805;40 years&#46; Incentives were offered &#40;often non-monetary&#41; in line with terms and conditions of the panels&#46; Participants were required to be on long-acting basal insulin &#40;alone&#41; or a combination of long-acting basal and short-acting bolus insulin taken separately &#40;basal-bolus&#41;&#44; with or without oral agents&#46; Those on bolus only&#44; premix or using insulin pumps were excluded&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Statistical analysis</span><p id="par0065" class="elsevierStylePara elsevierViewall">Data were initially descriptively analysed using paired <span class="elsevierStyleItalic">t</span>-tests and Pearson&#39;s Chi square test as appropriate&#46; Where notable numbers of outliers were seen to be affecting the results for a given question&#44; that question was assessed subjectively&#44; and responses outside the statistically acceptable range not deemed plausible in the context of the question were removed&#46;</p></span></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Results</span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Participants</span><p id="par0070" class="elsevierStylePara elsevierViewall">In Spain&#44; 39&#44;250 patients were invited to participate&#44; 9685 responded and were screened&#44; producing 305 eligible responders who completed the survey&#46; The response rate was higher in Spain than in the global response rate as previously reported &#40;24&#46;6&#37; vs 9&#46;8&#37;&#41;&#46;<a class="elsevierStyleCrossRefs" href="#bib0060"><span class="elsevierStyleSup">12&#44;16</span></a> For the HCP survey 1515 were invited to participate&#44; 431 responded and were screened&#44; producing 211 eligible respondents who completed the survey&#46; Data are presented for 305 Spanish type 2 diabetes patients taking insulin analogues and 211 Spanish HCPs who prescribe insulin treatment &#40;prescribers&#41; for type 2 diabetes patients&#46;</p><p id="par0075" class="elsevierStylePara elsevierViewall">Where applicable&#44; the Spanish data are compared with a pooled data from OEC &#40;Other European Countries data from Czech Republic&#44; Denmark&#44; France&#44; Germany&#44; Israel&#44; Russia&#44; Sweden and UK&#41;&#46; OEC data are based on 1424 completed surveys from type 2 diabetes patients taking insulin analogues and 1261 completed surveys from prescribers&#46;</p><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Patient demographics</span><p id="par0080" class="elsevierStylePara elsevierViewall">The mean age of the Spanish cohort was significantly older compared to OEC &#40;62&#46;9 years vs 59 years&#59; <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;05&#59; <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#41;&#46; Compared to OEC&#44; Spanish respondents had been a shorter duration of diabetes &#40;6&#46;7 vs 9&#46;8 years&#59; <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;05&#41;&#59; significantly lower BMI &#40;<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;05&#41;&#59; most used prefilled pens to deliver their insulin &#40;<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;001&#41; and felt they had good control of their diabetes &#40;<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;001&#41;&#46; The Spanish cohort was similar in most other respects to the OEC population&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Prescriber demographics</span><p id="par0085" class="elsevierStylePara elsevierViewall">There were significantly fewer Spanish specialists compared to OEC &#40;<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;001&#59; <a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>&#41; and but Spanish prescribers saw significantly more patients with type 2 diabetes per month &#40;76&#37; vs 66&#37;&#59; <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;001&#41;&#46; Compared to OEC&#44; Spanish prescribers also saw patients on fewer occasions per year &#40;<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;001&#41;&#46; The Spanish cohort was similar in most other respects to the OEC population&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia></span></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0115">Dosing irregularities</span><span id="sec0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0120">Spanish dosing irregularities</span><p id="par0090" class="elsevierStylePara elsevierViewall">When asked about the last time they dosed their insulin irregularly&#44; the percentage of Spanish patients who missed&#44; mistimed and reduced doses in the past 30 days was 1&#37; &#40;mean occasions 1&#46;0&#41;&#44; 3&#37; &#40;mean 2&#46;3&#41; and 1&#37; &#40;mean 1&#46;0&#41; respectively&#46; Of those who had dosed irregularly the percentage of intentional dosing irregularities were reported as 31&#37; missed&#44; 40&#37; mistimed and 64&#37; reduced&#46; The last time they intentionally missed&#44; mistimed or reduced a dose the main reasons were reducing risk of hypoglycaemia &#40;91&#37;&#44; 67&#37; and 60&#37; respectively&#41; or because their blood sugar was too low &#40;80&#37;&#44; 67&#37; and 60&#37; respectively&#41;&#46; Seventy one per cent recognised that missing basal doses would negatively impact their health and 73&#37; discussed dosing irregularities with their doctors&#46;</p><p id="par0095" class="elsevierStylePara elsevierViewall">The frequency of insulin dosing irregularities with clinical impact was reported by Spanish prescribers as 4&#46;3&#44; 6&#46;2 and 5&#46;5 for missed&#44; mistimed and reduced doses&#46;</p></span><span id="sec0065" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0125">OEC dosing irregularities</span><p id="par0100" class="elsevierStylePara elsevierViewall">Compared to Spanish patients a higher proportion of OEC patients reported dosing irregularities in the past 30 days missed &#40;16&#37; &#40;<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;001&#41;&#59; mean 2&#46;3 &#40;<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;001&#41;&#59; mistimed 24&#37; &#40;<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;001&#41;&#59; mean 3&#46;6&#59; reduced 15&#37; &#40;<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;001&#41;&#59; mean 3&#46;6 &#40;<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;001&#41;&#41;&#46; A smaller proportion reported intentional missed &#40;10&#37;&#59; <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;001&#41; and mistimed &#40;26&#37;&#59; <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;001&#41; doses and a similar proportion reported intentional reduced doses &#40;67&#37;&#41; compared to Spanish patients&#46; A smaller proportion also reported intentionally missing or mistiming a dose to reduce their risk of hypoglycaemia &#40;missing 37&#37; <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;001&#59; mistimed 26&#37; <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;001&#41; or because their blood sugar was too low &#40;missed 28&#37; <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;001&#59; mis-timed 24&#37;&#59; <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;001&#41; compared to Spanish patients&#46; A smaller proportion of OEC patients both recognised missing basal doses would negatively impact their health &#40;65&#37;&#59; <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;05&#41; and discussed dosing irregularities with their doctors &#40;66&#37;&#59; <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;05&#41; compared to Spanish patients&#46;</p><p id="par0105" class="elsevierStylePara elsevierViewall">OEC prescribers reported the frequency of insulin dosing irregularities with clinical impact at a similar level &#40;missed 4&#46;1&#59; mis-timed 5&#46;8&#59; reduced 5&#46;2&#41;&#46;</p></span></span><span id="sec0070" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0130">Self-treated hypoglycaemia</span><span id="sec0075" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0135">Spanish self-treated hypoglycaemia</span><p id="par0110" class="elsevierStylePara elsevierViewall">In the past 30 days&#44; 10&#37; of Spanish patients reported self-treated hypoglycaemia&#44; of which 12&#37; were nocturnal episodes and none reporting five or more episodes in that time&#46; In response to a self-treated hypoglycaemic episode&#44; 26&#37; missed&#44; 22&#37; mistimed and 22&#37; reduced a dose&#46; Thirteen per cent reported they intentionally let their blood sugar go high to avoid a self-treated hypoglycaemic episode&#46;</p><p id="par0115" class="elsevierStylePara elsevierViewall">Nineteen per cent of Spanish prescribers reported discussing hypoglycaemia most or all of the time with patients&#44; and 13&#37; reported patients do not see hypoglycaemia as an important issue&#46;</p></span><span id="sec0080" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0140">OEC self-treated hypoglycaemia</span><p id="par0120" class="elsevierStylePara elsevierViewall">In the past 30 days&#44; a higher proportion of OEC patients &#40;33&#37;&#59; <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;001&#41; reported self-treated hypoglycaemia and a similar proportion &#40;11&#37;&#41; were nocturnal episodes&#44; 14&#37; &#40;<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;001&#41; reported having five or more episodes in that time&#46; A smaller proportion reported after the last time they had a self-treated hypoglycaemic episode they missed &#40;5&#37;&#59; <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;001&#41;&#44; mistimed &#40;6&#37;&#59; <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;001&#41; and reduced a dose &#40;8&#37;&#59; <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;001&#41;&#46; A higher proportion &#40;21&#37;&#59; <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;05&#41; reported they intentionally let their blood sugar go high to avoid a self-treated hypoglycaemic episode&#46;</p><p id="par0125" class="elsevierStylePara elsevierViewall">A similar proportion of OEC prescribers reported discussing hypoglycaemia most or all of the time &#40;23&#37;&#41;&#44; but a higher proportion reported patients do not see hypoglycaemia as an important issue &#40;25&#37;&#59; <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;05&#41;&#46;</p></span></span><span id="sec0085" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0145">Patient guilt and worry</span><span id="sec0090" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0150">Spanish guilt and worry</span><p id="par0130" class="elsevierStylePara elsevierViewall">Seventy-seven per cent of Spanish patients would worry and 59&#37; would feel guilty about missing a dose of basal insulin&#46; Twenty four per cent reported being very worried about nocturnal self-treated hypoglycaemia&#46; In everyday situations&#44; Spanish patients reported worry about self-treated hypoglycaemia &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0135" class="elsevierStylePara elsevierViewall">When asked about the convenience of their insulin regime&#44; 48&#37; of Spanish patients find it convenient to take their insulin at the same time every day&#46; Patients reported taking their basal insulin at the same time inconvenient because they &#8216;can&#8217;t remember to take it with them&#8217; &#40;13&#37;&#41;&#46;</p></span><span id="sec0095" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0155">OEC guilt and worry</span><p id="par0140" class="elsevierStylePara elsevierViewall">A smaller proportion of OEC patients reported being worried &#40;47&#37;&#59; <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;001&#41; and feeling guilty &#40;37&#37;&#59; <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;001&#41; about missing a dose of basal insulin and being worried about nocturnal self-treated hypoglycaemia &#40;12&#37;&#59; <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;05&#41;&#46; In everyday situations&#44; OEC patients also reported less worry about self-treated hypoglycaemia &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;&#46;</p><p id="par0145" class="elsevierStylePara elsevierViewall">A larger proportion finds it convenient to take their insulin at the same time every day &#40;60&#37;&#59; <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;05&#41;&#46; A larger proportion report they find taking their basal insulin at the same time inconvenient because they &#8216;can&#8217;t remember to take it with them&#8217; &#40;43&#37;&#59; <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;001&#41;&#46;</p></span></span></span><span id="sec0100" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0160">Discussion</span><span id="sec0105" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0165">Dosing irregularities</span><p id="par0150" class="elsevierStylePara elsevierViewall">Spanish patients reported significantly lower proportion of dosing irregularities &#40;missed&#44; mistimed&#44; reduced&#41; compared to OEC patients in the previous 30 days&#46; The low numbers of dosing irregularities by Spanish patients is encouraging and an important finding for diabetes management in Spain as insulin non-adherence is a significant predictor of elevated HbA1c<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">14</span></a> and an independent risk factor for mortality&#46;<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">15</span></a> One possible reason may be that Spanish patients had significantly shorter disease duration &#40;6&#46;7 years vs&#46; 9&#46;8 years OEC&#59; <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;05&#44; <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#41; indicating less advanced disease and a greater desire for tighter control&#46;</p><p id="par0155" class="elsevierStylePara elsevierViewall">While fewer dosing irregularities were reported in Spain&#44; reports of intentional missed and mistimed doses are significantly higher&#46; The consistent reporting of reasons for intentional dosing irregularities &#40;reducing hypoglycaemia risk or blood sugar being too low&#41; indicates room for improvement&#46; Patients reporting missing or mistiming a dose largely because of concerns about blood sugar suggest that glycaemic control may be suboptimal&#46; Reports of dosing irregularities occurring to reduce the risk of hypoglycaemia indicate a possible fear of hypoglycaemia&#46;</p><p id="par0160" class="elsevierStylePara elsevierViewall">It is positive that more Spanish patients discussed dosing irregularities with their doctor compared to OEC and that more Spanish patients recognised that missing doses would negatively impact their health&#46; Physician communication and awareness of the negative effects of dosing irregularities by Spanish patients suggest a possible link between communication and dosing irregularities&#44; and physicians should be aware of this aspect of treatment&#46;</p></span><span id="sec0110" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0170">Self-treated hypoglycaemia</span><p id="par0165" class="elsevierStylePara elsevierViewall">As with dosing irregularities a significantly lower proportion of Spanish patients reported self-treated hypoglycaemia in the past 30 days compared to OEC&#44; with similar levels of dosing irregularities being nocturnal&#46; Interestingly&#44; no Spanish patients reported having five or more events in the past 30 days&#44; which was significantly lower than OEC patients&#44; indicating that insulin titration may be more progressive in Spanish patients&#46; However&#44; of those Spanish patients who suffered a hypoglycaemic event&#44; approximately a quarter reported a subsequent dosing irregularity&#44; indicating that while self-treated hypoglycaemia is less frequent it may have higher negative effects on Spanish patients&#46;</p><p id="par0170" class="elsevierStylePara elsevierViewall">As discussed above&#44; the intentional dosing irregularities were often to reduce the risk of hypoglycaemia indicating a persistent fear of hypoglycaemia&#46; Fear of hypoglycaemia can limit the ability of diabetes medications to achieve and maintain optimal glycaemic control&#46;<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">17</span></a> Patients should therefore be encouraged to discuss hypoglycaemia with their prescriber&#46;</p></span><span id="sec0115" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0175">Patient guilt and worry</span><p id="par0175" class="elsevierStylePara elsevierViewall">The proportion of dosing irregularities reported by Spanish patients are consistent with the levels of worry and guilt reported&#44; indicating they are concerned with potential dosing irregularities&#46; A higher proportion of Spanish patients also worry about self-treated hypoglycaemia in daily situations&#44; particularly nocturnal hypoglycaemia&#46; These data demonstrate while it is positive that dosing irregularities are low in Spanish patients&#44; they may be paying a high cost for them&#46; Prescribers should seek to alleviate patient concerns by increasing communication as well as discussing the worries patients have about all aspects of their disease&#46;</p></span><span id="sec0120" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0180">Limitations</span><p id="par0180" class="elsevierStylePara elsevierViewall">This survey focused on insulin analogue users rather than NPH insulin&#44; therefore removing a significant proportion of patients from consideration&#46; However&#44; among the healthcare professionals surveyed in GAPP2&#44; when asked about their views on these two different types of insulin there was general consensus on the benefits of insulin analogues particularly in terms of reduction of hypoglycaemia risk&#46; Participants &#40;both healthcare professionals and patients&#41; were recruited from pre-existing online research panels where members had registered to participate in research surveys&#46; This is a potential bias to the survey as it selects only those who are currently registered with the panels&#46; However&#44; the panels are designed to be a representative sample to limit any potential bias&#44; and were recruited from a broad array of online and offline approaches that best represented the country&#39;s online community&#46; While the response rate may initially be perceived as low and may be a limiting factor in the survey they are higher than the global GAPP2 response rates which have previously been reported&#46;<a class="elsevierStyleCrossRefs" href="#bib0060"><span class="elsevierStyleSup">12&#44;16</span></a></p><p id="par0185" class="elsevierStylePara elsevierViewall">GAPP2 was a web-based survey and hence selected for respondents with internet access&#46; Although the internet is widely available in Spain&#44; this may have led to over-representation of younger patients&#44; those in employment and those living in non-isolated situations&#46; The study was based on self-reports of relevant dosing irregularities and self-treated hypoglycaemic events&#46; Hence&#44; recall bias and between-country differences in under- or over-reporting cannot be ruled out&#46;</p></span></span><span id="sec0125" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0185">Conclusions</span><p id="par0190" class="elsevierStylePara elsevierViewall">Spanish patients appear to have fewer dosing irregularities and hypoglycaemia episodes compared to patients from OEC explained at least in part by their shorter disease duration&#46; However&#44; Spanish patients report increased worry and guilt related to dosing irregularities&#46; While prescribers must keep up basic diabetes education and discuss the importance of insulin adherence for reducing adverse outcomes&#44; they must also help alleviate the worry and guilt of their patients when insulin is initiated&#44; including the fear of hypoglycaemia&#44; which may be significant&#46; Patients must be encouraged to freely discuss their fears and concerns with their prescribers&#46; Finally&#44; prescribers should help patients in reducing insulin dosing irregularities that may result in improving glycaemic control while avoiding excessive hypoglycaemia episodes&#46;</p></span><span id="sec0130" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0190">Conflicts of interest</span><p id="par0195" class="elsevierStylePara elsevierViewall">F&#46; Javier Ampudia-Blasco is a member of a Novo Nordisk national advisory board&#46; Manual Galan is an employee of Novo Nordisk who funded this study&#46; Meryl Brod has consulted for Forest&#44; Genetech&#44; Bayer&#44; Novo Nordisk and Abbvie&#46;</p></span></span>"
    "textoCompletoSecciones" => array:1 [
      "secciones" => array:12 [
        0 => array:2 [
          "identificador" => "xres374668"
          "titulo" => array:5 [
            0 => "Abstract"
            1 => "Background and objective"
            2 => "Materials and methods"
            3 => "Results"
            4 => "Conclusions"
          ]
        ]
        1 => array:2 [
          "identificador" => "xpalclavsec353782"
          "titulo" => "Keywords"
        ]
        2 => array:2 [
          "identificador" => "xres374669"
          "titulo" => array:5 [
            0 => "Resumen"
            1 => "Antecedentes y objetivo"
            2 => "Materiales y m&#233;todos"
            3 => "Resultados"
            4 => "Conclusiones"
          ]
        ]
        3 => array:2 [
          "identificador" => "xpalclavsec353781"
          "titulo" => "Palabras clave"
        ]
        4 => array:2 [
          "identificador" => "sec0005"
          "titulo" => "Introduction"
        ]
        5 => array:3 [
          "identificador" => "sec0010"
          "titulo" => "Methods"
          "secciones" => array:4 [
            0 => array:2 [
              "identificador" => "sec0015"
              "titulo" => "Study design&#44; setting and data handling"
            ]
            1 => array:2 [
              "identificador" => "sec0020"
              "titulo" => "Pilot test"
            ]
            2 => array:2 [
              "identificador" => "sec0025"
              "titulo" => "Participants"
            ]
            3 => array:2 [
              "identificador" => "sec0030"
              "titulo" => "Statistical analysis"
            ]
          ]
        ]
        6 => array:3 [
          "identificador" => "sec0035"
          "titulo" => "Results"
          "secciones" => array:4 [
            0 => array:3 [
              "identificador" => "sec0040"
              "titulo" => "Participants"
              "secciones" => array:2 [
                0 => array:2 [
                  "identificador" => "sec0045"
                  "titulo" => "Patient demographics"
                ]
                1 => array:2 [
                  "identificador" => "sec0050"
                  "titulo" => "Prescriber demographics"
                ]
              ]
            ]
            1 => array:3 [
              "identificador" => "sec0055"
              "titulo" => "Dosing irregularities"
              "secciones" => array:2 [
                0 => array:2 [
                  "identificador" => "sec0060"
                  "titulo" => "Spanish dosing irregularities"
                ]
                1 => array:2 [
                  "identificador" => "sec0065"
                  "titulo" => "OEC dosing irregularities"
                ]
              ]
            ]
            2 => array:3 [
              "identificador" => "sec0070"
              "titulo" => "Self-treated hypoglycaemia"
              "secciones" => array:2 [
                0 => array:2 [
                  "identificador" => "sec0075"
                  "titulo" => "Spanish self-treated hypoglycaemia"
                ]
                1 => array:2 [
                  "identificador" => "sec0080"
                  "titulo" => "OEC self-treated hypoglycaemia"
                ]
              ]
            ]
            3 => array:3 [
              "identificador" => "sec0085"
              "titulo" => "Patient guilt and worry"
              "secciones" => array:2 [
                0 => array:2 [
                  "identificador" => "sec0090"
                  "titulo" => "Spanish guilt and worry"
                ]
                1 => array:2 [
                  "identificador" => "sec0095"
                  "titulo" => "OEC guilt and worry"
                ]
              ]
            ]
          ]
        ]
        7 => array:3 [
          "identificador" => "sec0100"
          "titulo" => "Discussion"
          "secciones" => array:4 [
            0 => array:2 [
              "identificador" => "sec0105"
              "titulo" => "Dosing irregularities"
            ]
            1 => array:2 [
              "identificador" => "sec0110"
              "titulo" => "Self-treated hypoglycaemia"
            ]
            2 => array:2 [
              "identificador" => "sec0115"
              "titulo" => "Patient guilt and worry"
            ]
            3 => array:2 [
              "identificador" => "sec0120"
              "titulo" => "Limitations"
            ]
          ]
        ]
        8 => array:2 [
          "identificador" => "sec0125"
          "titulo" => "Conclusions"
        ]
        9 => array:2 [
          "identificador" => "sec0130"
          "titulo" => "Conflicts of interest"
        ]
        10 => array:2 [
          "identificador" => "xack96082"
          "titulo" => "Acknowledgements"
        ]
        11 => array:1 [
          "titulo" => "References"
        ]
      ]
    ]
    "pdfFichero" => "main.pdf"
    "tienePdf" => true
    "fechaRecibido" => "2014-01-29"
    "fechaAceptado" => "2014-03-24"
    "PalabrasClave" => array:2 [
      "en" => array:1 [
        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Keywords"
          "identificador" => "xpalclavsec353782"
          "palabras" => array:5 [
            0 => "Type 2 diabetes"
            1 => "Hypoglycemia"
            2 => "Insulin"
            3 => "Dosing irregularities"
            4 => "GAPP 2 survey"
          ]
        ]
      ]
      "es" => array:1 [
        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Palabras clave"
          "identificador" => "xpalclavsec353781"
          "palabras" => array:5 [
            0 => "Diabetes tipo 2"
            1 => "Hipoglucemia"
            2 => "Insulina"
            3 => "Irregularidades en dosificaci&#243;n"
            4 => "Encuesta GAPP2"
          ]
        ]
      ]
    ]
    "tieneResumen" => true
    "resumen" => array:2 [
      "en" => array:2 [
        "titulo" => "Abstract"
        "resumen" => "<span class="elsevierStyleSectionTitle" id="sect0010">Background and objective</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">In Spain&#44; data suggest that 13&#46;8&#37; of adults have diabetes&#46; Two important aspects in diabetes management are mild hypoglycemic episodes and poor treatment adherence&#46; This study assesses the impact of missed insulin doses and prevalence of mistimed and reduced insulin doses and mild hypoglycemia in patients with type 2 diabetes treated with basal insulin analogues in Spain&#44; and compares the data collected to pooled data from 8 other European countries &#40;OECs&#41;&#46;</p> <span class="elsevierStyleSectionTitle" id="sect0015">Materials and methods</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">GAPP2 was an international&#44; online&#44; cross-sectional study of diabetic patients aged &#8805;40 years treated with long-acting insulin analogues and their healthcare professionals&#46; Patients and healthcare professionals were recruited from online research panels&#46; Data reported in Spain are compared to pooled data from 8 OECs&#46;</p> <span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">In Spain&#44; 1&#8211;3&#37; of patients reported they had reduced&#44; missed&#44; or mistimed at least one insulin does in the previous month&#46; Significantly more OEC patients reported dosing irregularities &#40;15&#8211;23&#37;&#59; all <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;01&#41;&#46; In Spain&#44; 77&#37; of patients were worried and 59&#37; felt guilty for missing a dose of basal insulin&#44; while 24&#37; reported that they were very worried about nocturnal hypoglycemia&#46; Significantly fewer OEC patients reported worrying &#40;47&#37;&#59; <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;01&#41; and feeling guilty &#40;37&#37;&#59; <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;01&#41; about missing an insulin dose&#44; or worry about nocturnal hypoglycemia &#40;12&#37;&#59; <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;01&#41;&#46;</p> <span class="elsevierStyleSectionTitle" id="sect0025">Conclusions</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">In Spain&#44; patients with type 2 diabetes report fewer dosing irregularities and hypoglycemic episodes as compared to patients from OECs&#46; However&#44; Spanish patients appear to have a reduced quality of life related to hypoglycemia as well as worry and guilt related to insulin dosing irregularities&#46;</p>"
      ]
      "es" => array:2 [
        "titulo" => "Resumen"
        "resumen" => "<span class="elsevierStyleSectionTitle" id="sect0035">Antecedentes y objetivo</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">En Espa&#241;a&#44; los datos indican que el 13&#44;8&#37; de los adultos tienen diabetes&#46; Dos aspectos importantes del tratamiento de la diabetes son las hipoglucemias leves y la baja adherencia al tratamiento&#46; En este trabajo se eval&#250;a el impacto de las irregularidades de dosificaci&#243;n de insulina &#40;dosis omitidas&#44; administradas fuera de tiempo&#44; y anormalmente reducidas&#41; y de las hipoglucemias leves en los pacientes con diabetes tipo 2 tratados con an&#225;logos de la insulina basal en Espa&#241;a&#44; en comparaci&#243;n con los datos agrupados de otros 8 pa&#237;ses europeos &#40;OEC&#41;&#46;</p> <span class="elsevierStyleSectionTitle" id="sect0040">Materiales y m&#233;todos</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">GAPP2 fue dise&#241;ado como un estudio transversal&#44; internacional&#44; online&#44; para pacientes con diabetes tipo 2 y edad &#8805;40 a&#241;os&#44; en tratamiento con an&#225;logos de insulina de acci&#243;n prolongada&#44; y sus profesionales de la salud&#46; Pacientes y profesionales de la salud fueron reclutados a partir de diversos paneles de investigaci&#243;n online&#46; Los datos reportados en Espa&#241;a se comparan con los datos agrupados de otros 8 OEC&#46;</p> <span class="elsevierStyleSectionTitle" id="sect0045">Resultados</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">En Espa&#241;a&#44; el 1&#8211;3&#37; de los pacientes informaron que redujeron&#44; olvidaron o se administraron fuera de tiempo al menos una dosis de la insulina en el mes anterior&#46; En comparaci&#243;n&#44; m&#225;s pacientes OEC denunciaron significativamente irregularidades de dosificaci&#243;n &#40;15&#8211;23&#37;&#41;&#46; En Espa&#241;a&#44; el 77&#37; de los pacientes manifestaron su preocupaci&#243;n y el 59&#37; se sintieron culpables por olvidar una dosis de insulina basal&#44; mientras que el 24&#37; manifest&#243; estar muy preocupado por las hipoglucemias nocturnas&#46; En relaci&#243;n con los pacientes OEC&#44; menos pacientes manifestaron significativamente preocupaci&#243;n &#40;47&#37;&#41; y sentimiento de culpabilidad &#40;37&#37;&#41; sobre la omisi&#243;n de una dosis de insulina&#44; o inquietud por las hipoglucemias nocturnas &#40;12&#37;&#41;&#46;</p> <span class="elsevierStyleSectionTitle" id="sect0050">Conclusiones</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">En Espa&#241;a&#44; los pacientes con diabetes tipo 2 reportan menos irregularidades de dosificaci&#243;n e hipoglucemias en comparaci&#243;n con los pacientes de la OEC&#46; Sin embargo&#44; los pacientes espa&#241;oles parecen sufrir una reducci&#243;n de la calidad de vida relacionada con la hipoglucemia&#44; as&#237; como preocupaci&#243;n y culpa en relaci&#243;n con las irregularidades en la dosificaci&#243;n de insulina&#46;</p>"
      ]
    ]
    "multimedia" => array:3 [
      0 => array:7 [
        "identificador" => "fig0005"
        "etiqueta" => "Figure 1"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr1.jpeg"
            "Alto" => 1690
            "Ancho" => 2290
            "Tamanyo" => 205399
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Worry reported by Spanish and OEC patients in different daily situations&#46;</p>"
        ]
      ]
      1 => array:7 [
        "identificador" => "tbl0005"
        "etiqueta" => "Table 1"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "tabla" => array:2 [
          "tablatextoimagen" => array:1 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">Spain&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">OEC&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black"><span class="elsevierStyleItalic">P</span> value&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">N</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">305&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1729&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Mean age&#44; years &#40;range&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">62&#46;9 &#40;42&#8211;86&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">59&#46;0 &#40;41&#8211;99&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#60;0&#46;05&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Male</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">51&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">58&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#62;0&#46;05&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Duration of diabetes&#44; years &#40;range&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6&#46;7 &#40;1&#8211;27&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">9&#46;8 &#40;&#60;1&#8211;50&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#60;0&#46;05&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">BMI &#40;kg&#47;m</span><span class="elsevierStyleSup"><span class="elsevierStyleItalic">2</span></span><span class="elsevierStyleItalic">&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#60;0&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>&#60;27&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">58&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">33&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>27&#8211;33&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">40&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">42&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>33&#8211;39&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">16&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>&#62;39&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="4" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Number of diabetes complications</span><a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a><span class="elsevierStyleItalic">&#40;range&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#46;7 &#40;0&#8211;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&#46;3 &#40;1&#8211;11&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#62;0&#46;05&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Duration of insulin therapy&#44; years &#40;range&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4 &#40;&#60;1&#8211;12&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5 &#40;&#60;1&#8211;90&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#62;0&#46;05&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="4" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Insulin regimen</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#60;0&#46;05&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Basal only&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">61&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">51&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Basal bolus&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">39&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">49&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="4" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Mean number of basal insulin injections&#47;day</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#46;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#46;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#62;0&#46;05&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="4" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Injection device for basal insulin</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#60;0&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Prefilled pens&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">85&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">66&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>A vial and syringe&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">16&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">12&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Refillable pens&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">-&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">31&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Employed&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">40&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">41&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#62;0&#46;05&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="4" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Perceived Diabetes Control</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#60;0&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Poor&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Moderate&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">20&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">48&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Good&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">80&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">46&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab568004.png"
              ]
            ]
          ]
          "notaPie" => array:1 [
            0 => array:3 [
              "identificador" => "tblfn0005"
              "etiqueta" => "a"
              "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Selected from 13 complications offered&#58; amputation&#44; anxiety&#44; cataracts or eyesight damage&#44; depression&#44; foot ulcers&#44; glaucoma&#44; high cholesterol&#44; impotence&#47;reduced sexual functioning&#44; nerve damage&#44; reduced kidney function&#44; sleeping problems&#44; stroke&#46;</p>"
            ]
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Patient demographics&#46;</p>"
        ]
      ]
      2 => array:7 [
        "identificador" => "tbl0010"
        "etiqueta" => "Table 2"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "tabla" => array:1 [
          "tablatextoimagen" => array:1 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">Spain&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">OEC&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black"><span class="elsevierStyleItalic">P</span> value&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">N</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">211&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1472&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Mean time since qualified&#44; years</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">18&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">16&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#62;0&#46;05&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Specialty</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#60;0&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Primary care&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">48&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">48&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Specialist&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">28&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">48&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Other&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">24&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="4" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Mean insulin treated patients with type 2 diabetes aged 40&#43;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">99&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">94&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#62;0&#46;05&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Mean percentage of insulin treated patients with type 2 diabetes using analogue insulin</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">76&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">66&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#60;0&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="4" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Type of insulin analogues used by patients</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#60;0&#46;05&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Basal bolus taken separately&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">26&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">30&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Premix&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">19&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">21&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Bolus only&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">8&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Basal only&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">49&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">41&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="4" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Frequency of seeing patients &#40;visits&#47;year&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#60;0&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Patients with good control &#40;HbA1c 6&#8211;7&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5&#46;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">7&#46;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Patients with moderate control &#40;HbA1c 7&#8211;8&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">7&#46;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">8&#46;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Patients with poor control &#40;HbA1c &#62;8&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">8&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">9&#46;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab568005.png"
              ]
            ]
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Prescriber demographics&#46;</p>"
        ]
      ]
    ]
    "bibliografia" => array:2 [
      "titulo" => "References"
      "seccion" => array:1 [
        0 => array:2 [
          "identificador" => "bibs0005"
          "bibliografiaReferencia" => array:17 [
            0 => array:3 [
              "identificador" => "bib0005"
              "etiqueta" => "1"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "IDF Diabetes Atlas"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "International Diabetes Federation"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Libro" => array:4 [
                        "edicion" => "5th ed&#46;"
                        "fecha" => "2011"
                        "editorial" => "International Diabetes Federation"
                        "editorialLocalizacion" => "Brussels&#44; Belgium"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            1 => array:3 [
              "identificador" => "bib0010"
              "etiqueta" => "2"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Prevalence of diabetes mellitus and impaired glucose regulation in Spain&#58; the Di&#64;bet&#46;es Study"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "F&#46; Soriguer"
                            1 => "A&#46; Goday"
                            2 => "A&#46; Bosch-Comas"
                            3 => "E&#46; Bordi&#250;"
                            4 => "A&#46; Calle-Pascual"
                            5 => "R&#46; Carmena"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1007/s00125-011-2336-9"
                      "Revista" => array:6 [
                        "tituloSerie" => "Diabetologia"
                        "fecha" => "2012"
                        "volumen" => "55"
                        "paginaInicial" => "88"
                        "paginaFinal" => "93"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21987347"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            2 => array:3 [
              "identificador" => "bib0015"
              "etiqueta" => "3"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "La diabetes mellitus en Espa&#241;a&#58; mortalidad&#44; prevalencia&#44; incidencia&#44; costes econ&#243;micos y desigualdades"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "M&#46; Ruiz-Ramos"
                            1 => "A&#46; Escolar-Pujolar"
                            2 => "E&#46; Mayoral-S&#225;nchez"
                            3 => "F&#46; Corral-San Laureano"
                            4 => "I&#46; Fern&#225;ndez-Fern&#225;ndez"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Gac Sanit"
                        "fecha" => "2006"
                        "volumen" => "20"
                        "paginaInicial" => "15"
                        "paginaFinal" => "24"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16539961"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            3 => array:3 [
              "identificador" => "bib0020"
              "etiqueta" => "4"
              "referencia" => array:1 [
                0 => array:1 [
                  "referenciaCompleta" => "Diabetes expenditure&#44; burden of disease and management in 5 EU countries 2012&#46; Available from <a id="intr0010" class="elsevierStyleInterRef" href="http://www2.lse.ac.uk/LSEHealthAndSocialCare/research/LSEHealth/MTRG/ResearchReportOnDiabetes.aspx">http&#58;&#47;&#47;www2&#46;lse&#46;ac&#46;uk&#47;LSEHealthAndSocialCare&#47;research&#47;LSEHealth&#47;MTRG&#47;ResearchReportOnDiabetes&#46;aspx</a>&#41; &#40;accessed 01&#46;09&#46;13&#41;&#46;"
                ]
              ]
            ]
            4 => array:3 [
              "identificador" => "bib0025"
              "etiqueta" => "5"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Health-related quality of life and type 2 diabetes&#58; a study of people living in the Bella Coola Valley"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "H&#46; Thommason"
                            1 => "W&#46; Zhang"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "BCMJ"
                        "fecha" => "2006"
                        "volumen" => "48"
                        "paginaInicial" => "272"
                        "paginaFinal" => "278"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            5 => array:3 [
              "identificador" => "bib0030"
              "etiqueta" => "6"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Quality of life in type 2 diabetic patients is affected by complications but not by intensive policies to improve blood glucose or blood pressure control"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "UKPDS"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Diabetes Care"
                        "fecha" => "1999"
                        "volumen" => "22"
                        "paginaInicial" => "1125"
                        "paginaFinal" => "1136"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/10388978"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            6 => array:3 [
              "identificador" => "bib0035"
              "etiqueta" => "7"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Diabetes and depression&#58; global perspectives"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "L&#46; Egede"
                            1 => "C&#46; Ellis"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Diabetes Res&#46; Clin&#46; Prac&#46;"
                        "fecha" => "2010"
                        "volumen" => "87"
                        "paginaInicial" => "302"
                        "paginaFinal" => "312"
                        "itemHostRev" => array:3 [
                          "pii" => "S0090825813001005"
                          "estado" => "S300"
                          "issn" => "00908258"
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            7 => array:3 [
              "identificador" => "bib0040"
              "etiqueta" => "8"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Barriers to insulin initiation&#58; the translating research into action for diabetes insulin starts project"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "A&#46; Karter"
                            1 => "U&#46; Subramanian"
                            2 => "C&#46; Saha"
                            3 => "J&#46; Crosson"
                            4 => "M&#46; Parker"
                            5 => "B&#46; Swain"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.2337/dc09-1184"
                      "Revista" => array:5 [
                        "tituloSerie" => "Diabetes Care"
                        "fecha" => "2010"
                        "volumen" => "33"
                        "paginaInicial" => "733"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20086256"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            8 => array:3 [
              "identificador" => "bib0045"
              "etiqueta" => "9"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Primary care physician beliefs about insulin initiation in patients with type 2 diabetes"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "R&#46; Hayes"
                            1 => "J&#46; Fitzgerald"
                            2 => "S&#46; Jacober"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1111/j.1742-1241.2008.01742.x"
                      "Revista" => array:6 [
                        "tituloSerie" => "Int J Clin Pract"
                        "fecha" => "2008"
                        "volumen" => "62"
                        "paginaInicial" => "860"
                        "paginaFinal" => "868"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18393965"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            9 => array:3 [
              "identificador" => "bib0050"
              "etiqueta" => "10"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The impact of non-severe hypoglycemic events on work productivity and diabetes management"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "M&#46; Brod"
                            1 => "T&#46; Christensen"
                            2 => "T&#46; Thomsen"
                            3 => "D&#46; Bushnell"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.jval.2011.02.001"
                      "Revista" => array:6 [
                        "tituloSerie" => "Value Health"
                        "fecha" => "2011"
                        "volumen" => "14"
                        "paginaInicial" => "665"
                        "paginaFinal" => "671"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21839404"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            10 => array:3 [
              "identificador" => "bib0055"
              "etiqueta" => "11"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Defining and reporting hypoglycemia in diabetes"
                      "autores" => array:1 [
                        0 => array:2 [
                          "colaboracion" => "American Diabetes Association Workgroup on Hypoglycemia"
                          "etal" => false
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Diabetes Care"
                        "fecha" => "2005"
                        "volumen" => "28"
                        "paginaInicial" => "1245"
                        "paginaFinal" => "1249"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15855602"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            11 => array:3 [
              "identificador" => "bib0060"
              "etiqueta" => "12"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Impact of self-treated hypoglycaemia in type 2 diabetes&#58; a multinational survey in patients and physicians"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "M&#46; Brod"
                            1 => "A&#46; Rana"
                            2 => "A&#46; Barnett"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1185/03007995.2012.743458"
                      "Revista" => array:6 [
                        "tituloSerie" => "Curr Med Res Opin"
                        "fecha" => "2012"
                        "volumen" => "28"
                        "paginaInicial" => "1933"
                        "paginaFinal" => "1946"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23150949"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            12 => array:3 [
              "identificador" => "bib0065"
              "etiqueta" => "13"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Insulin adherence behaviours and barriers in the multinational Global Attitudes of Patients and Physicians in Insulin Therapy study"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "M&#46; Peyrot"
                            1 => "A&#46; Barnett"
                            2 => "L&#46; Meneghini"
                            3 => "P&#46; Schumm-Draeger"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1111/j.1464-5491.2012.03605.x"
                      "Revista" => array:5 [
                        "tituloSerie" => "Diabet Med"
                        "fecha" => "2012"
                        "volumen" => "29"
                        "paginaInicial" => "682"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22313123"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            13 => array:3 [
              "identificador" => "bib0070"
              "etiqueta" => "14"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Adherence to insulin and its association with glycaemic control in patients with type 2 diabetes"
                      "autores" => array:1 [
                        0 => array:3 [
                          "colaboracion" => "for the DARTS&#47;MEMO collaboration"
                          "etal" => false
                          "autores" => array:3 [
                            0 => "L&#46; Donnelly"
                            1 => "A&#46; Morris"
                            2 => "J&#46; Evans"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1093/qjmed/hcm031"
                      "Revista" => array:6 [
                        "tituloSerie" => "QJM"
                        "fecha" => "2007"
                        "volumen" => "100"
                        "paginaInicial" => "345"
                        "paginaFinal" => "350"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17504861"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            14 => array:3 [
              "identificador" => "bib0075"
              "etiqueta" => "15"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The impact of treatment noncompliance on mortality in people with type 2 diabetes"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "C&#46; Currie"
                            1 => "M&#46; Peyrot"
                            2 => "C&#46; Morgan"
                            3 => "C&#46; Poole"
                            4 => "S&#46; Jenkins-Jones"
                            5 => "R&#46; Rubin"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.2337/dc11-1277"
                      "Revista" => array:6 [
                        "tituloSerie" => "Diabetes Care"
                        "fecha" => "2012"
                        "volumen" => "35"
                        "paginaInicial" => "1279"
                        "paginaFinal" => "1284"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22511257"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            15 => array:3 [
              "identificador" => "bib0080"
              "etiqueta" => "16"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Adherence patterns in patients with type 2 diabetes on basal insulin analogues&#58; missed&#44; mistimed and reduced doses"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "M&#46; Brod"
                            1 => "A&#46; Rana"
                            2 => "A&#46; Barnett"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "CMRO"
                        "fecha" => "2012"
                        "volumen" => "28"
                        "paginaInicial" => "1947"
                        "paginaFinal" => "1958"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            16 => array:3 [
              "identificador" => "bib0085"
              "etiqueta" => "17"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Hypoglycaemia in Type 2 diabetes"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "S&#46; Amiel"
                            1 => "T&#46; Dixon"
                            2 => "R&#46; Mann"
                            3 => "K&#46; Jameson"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1111/j.1464-5491.2007.02341.x"
                      "Revista" => array:6 [
                        "tituloSerie" => "Diabet Med"
                        "fecha" => "2008"
                        "volumen" => "25"
                        "paginaInicial" => "245"
                        "paginaFinal" => "254"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18215172"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
          ]
        ]
      ]
    ]
    "agradecimientos" => array:1 [
      0 => array:4 [
        "identificador" => "xack96082"
        "titulo" => "Acknowledgements"
        "texto" => "<p id="par0200" class="elsevierStylePara elsevierViewall">The GAPP2 study was funded by Novo Nordisk A&#47;S&#46; The sponsor&#39;s role was to appoint an independent medical communications company &#40;FTI Consulting&#41; and research company &#40;Bryter Research&#41;&#46;</p>"
        "vista" => "all"
      ]
    ]
  ]
  "idiomaDefecto" => "en"
  "url" => "/21735093/0000006100000008/v1_201410080024/S2173509314001445/v1_201410080024/en/main.assets"
  "Apartado" => array:4 [
    "identificador" => "5824"
    "tipo" => "SECCION"
    "en" => array:2 [
      "titulo" => "Original articles"
      "idiomaDefecto" => true
    ]
    "idiomaDefecto" => "en"
  ]
  "PDF" => "https://static.elsevier.es/multimedia/21735093/0000006100000008/v1_201410080024/S2173509314001445/v1_201410080024/en/main.pdf?idApp=UINPBA00004N&text.app=https://www.elsevier.es/"
  "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173509314001445?idApp=UINPBA00004N"
]

Article information

ISSN: 21735093
Original language: English

DOI:10.1016/j.endoen.2014.07.003

The statistics are updated each day

Year/Month	Html	Pdf	Total

2024 November	4	1	5
2024 October	18	5	23
2024 September	21	10	31
2024 August	24	7	31
2024 July	16	3	19
2024 June	12	2	14
2024 May	21	2	23
2024 April	17	11	28
2024 March	23	10	33
2024 February	9	11	20
2024 January	12	4	16
2023 December	20	8	28
2023 November	24	5	29
2023 October	24	14	38
2023 September	16	3	19
2023 August	17	5	22
2023 July	20	11	31
2023 June	15	2	17
2023 May	15	4	19
2023 April	8	3	11
2023 March	10	6	16
2023 February	10	6	16
2023 January	8	4	12
2022 December	17	7	24
2022 November	26	6	32
2022 October	21	7	28
2022 September	19	29	48
2022 August	23	14	37
2022 July	15	9	24
2022 June	28	9	37
2022 May	20	12	32
2022 April	34	20	54
2022 March	30	8	38
2022 February	29	4	33
2022 January	20	6	26
2021 December	23	8	31
2021 November	17	9	26
2021 October	22	21	43
2021 September	15	13	28
2021 August	22	4	26
2021 July	26	13	39
2021 June	17	9	26
2021 May	18	12	30
2021 April	35	9	44
2021 March	13	5	18
2021 February	13	8	21
2021 January	13	12	25
2020 December	13	6	19
2020 November	11	6	17
2020 October	11	10	21
2020 September	14	9	23
2020 August	10	5	15
2020 July	11	11	22
2020 June	17	6	23
2020 May	9	5	14
2020 April	12	4	16
2020 March	14	3	17
2020 February	14	10	24
2020 January	11	11	22
2019 December	23	11	34
2019 November	18	7	25
2019 October	11	3	14
2019 September	18	8	26
2019 August	16	5	21
2019 July	19	17	36
2019 June	22	7	29
2019 May	52	17	69
2019 April	11	4	15
2019 March	6	6	12
2019 February	15	9	24
2019 January	8	7	15
2018 December	3	9	12
2018 November	7	0	7
2018 October	4	5	9
2018 September	9	4	13
2018 August	8	7	15
2018 July	10	2	12
2018 June	3	0	3
2018 May	5	2	7
2018 April	4	1	5
2018 March	6	1	7
2018 February	8	1	9
2018 January	3	0	3
2017 December	3	0	3
2017 November	6	0	6
2017 October	16	1	17
2017 September	8	3	11
2017 August	12	3	15
2017 July	8	2	10
2017 June	18	1	19
2017 May	22	2	24
2017 April	20	4	24
2017 March	20	39	59
2017 February	30	3	33
2017 January	7	2	9
2016 December	17	6	23
2016 November	19	2	21
2016 October	30	8	38
2016 September	27	4	31
2016 August	22	2	24
2016 July	16	0	16
2016 June	2	6	8
2016 May	12	0	12
2016 April	12	4	16
2016 March	6	7	13
2016 February	12	4	16
2016 January	9	6	15
2015 December	13	2	15
2015 November	12	2	14

Show all

Now is Endocrinología, Diabetes y Nutrición (English ed.). More information

Indexed in:

Follow us:

Statistics

Now is Endocrinología, Diabetes y Nutrición (English ed.). More information

Indexed in:

Follow us:

Statistics

Subscribe to our newsletter