Scientific Letter
Prevalence of undiagnosed type 2 diabetes mellitus in the Sahrawi population of the Sahrawi refugee camps of Tindouf, Algeria
Prevalencia de la diabetes mellitus tipo 2 no diagnosticada en la población saharaui de los campamentos de refugiados saharauis de Tinduf, Argelia
Enrique Carretero-Anibarro
, Mansur Hamud-Uedha
Corresponding author
Medicina Familiar y Comunitaria, Unidad de Gestión Clínica Estepa, Sevilla, Spain
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(B) Overall survival according to disease extent at diagnosis.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Paloma Peinado, Cristina Díaz del Arco, María Jesús Fernández-Aceñero" "autores" => array:3 [ 0 => array:2 [ "nombre" => "Paloma" "apellidos" => "Peinado" ] 1 => array:2 [ "nombre" => "Cristina Díaz del" "apellidos" => "Arco" ] 2 => array:2 [ "nombre" => "María Jesús" "apellidos" => "Fernández-Aceñero" ] ] ] ] ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2387020620305015?idApp=UINPBA00004N" "url" => "/23870206/0000015500000010/v1_202011260800/S2387020620305015/v1_202011260800/en/main.assets" ] "en" => array:15 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Scientific Letter</span>" "titulo" => "Prevalence of undiagnosed type 2 diabetes mellitus in the Sahrawi population of the Sahrawi refugee camps of Tindouf, Algeria" "tieneTextoCompleto" => true "saludo" => "Dear Editor," "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "461" "paginaFinal" => "462" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Enrique Carretero-Anibarro, Mansur Hamud-Uedha" "autores" => array:2 [ 0 => array:4 [ "nombre" => "Enrique" "apellidos" => "Carretero-Anibarro" "email" => array:1 [ 0 => "almudenayenrique@yahoo.es" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:2 [ "nombre" => "Mansur" "apellidos" => "Hamud-Uedha" ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Medicina Familiar y Comunitaria, Unidad de Gestión Clínica Estepa, Sevilla, Spain" "identificador" => "aff0005" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Prevalencia de la diabetes mellitus tipo 2 no diagnosticada en la población saharaui de los campamentos de refugiados saharauis de Tinduf, Argelia" ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Around 200,000 Sahrawi refugees live in refugee camps in Tindouf, Algeria.<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">1</span></a> It has been calculated that there is a high prevalence of type 2 diabetes mellitus (DM2) in these camps.<a class="elsevierStyleCrossRefs" href="#bib0035"><span class="elsevierStyleSup">2,3</span></a> Given the healthcare limitations, it is difficult to assess the real situation and it is suspected that there may be an even higher prevalence in the form of undiagnosed DM2.<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">4</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">In order to describe the prevalence of undiagnosed DM2, a 15-day screening programme was carried out in March 2018.</p><p id="par0015" class="elsevierStylePara elsevierViewall">The population sample was collected in an opportunistic study in citizens between the ages of 20 and 90 who attended the local dispensaries in the Smara camp. A single visit was made to each dispensary and the patients were evaluated in a single clinical act. The variables recorded were: age, sex, body mass index (BMI), baseline plasma glucose, glycated haemoglobin (HbA1c), glucosuria and ketonuria.</p><p id="par0020" class="elsevierStylePara elsevierViewall">According to the recommendations of the Standard of the American Diabetes Association (ADA) 2019<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">5</span></a> regarding screening for prediabetes and DM2 in asymptomatic adults, the test should be considered in adults who are overweight or obese and who also present a risk factor. Weight was used as a criterion for screening and physical inactivity as a risk factor.</p><p id="par0025" class="elsevierStylePara elsevierViewall">No clinical prediction rules were used since none are validated in this population.</p><p id="par0030" class="elsevierStylePara elsevierViewall">First, all patients were questioned about physical activity. Those who reported habitual physical inactivity were weighed and measured, and if the BMI was ≥25 a fasting plasma glucose level was performed and if the value was >100<span class="elsevierStyleHsp" style=""></span>mg/dl, an HbA1c test was performed in the same medical act.</p><p id="par0035" class="elsevierStylePara elsevierViewall">The diagnostic criteria used for DM2 and prediabetes were those published in the 2019 ADA Standards.<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">5</span></a> Once the 2 determinations had been made, if both met the diagnostic criteria of the ADA (plasma glucose >126<span class="elsevierStyleHsp" style=""></span>mg/dl and HbA1c<span class="elsevierStyleHsp" style=""></span>><span class="elsevierStyleHsp" style=""></span>6.5%) patients were categorised as DM2, if HbA1c was between 5.7–6.4% they were classified as prediabetes. If HbA1c was <5.7% they were categorised as high blood glucose. Following the WHO criteria, obesity was defined as BMI<span class="elsevierStyleHsp" style=""></span>≥<span class="elsevierStyleHsp" style=""></span>30 and overweight as BMI<span class="elsevierStyleHsp" style=""></span>≥<span class="elsevierStyleHsp" style=""></span>25.</p><p id="par0040" class="elsevierStylePara elsevierViewall">A baseline plasma glucose level ≥200<span class="elsevierStyleHsp" style=""></span>mg/dl was detected in 23 patients, with negative glycosuria and ketonuria.</p><p id="par0045" class="elsevierStylePara elsevierViewall">The mean age of patients diagnosed with DM2 and prediabetes did not differ between the sexes 68.05<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>1 and the same occurred with respect to the average age of obesity and overweight.</p><p id="par0050" class="elsevierStylePara elsevierViewall"><a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a> shows 782 patients were seen, of whom 506 patients (64.7%) met the criteria: they did not know their health status regarding DM, they referred physical inactivity and the BMI<span class="elsevierStyleHsp" style=""></span>≥<span class="elsevierStyleHsp" style=""></span>25<span class="elsevierStyleHsp" style=""></span>kg/m<span class="elsevierStyleSup">2</span>.</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0055" class="elsevierStylePara elsevierViewall">The majority were women i.e. 289 (57.1%) and 48.9% men.</p><p id="par0060" class="elsevierStylePara elsevierViewall">78 patients were detected with previously undiagnosed prediabetes, the majority were women 61.5% (<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>48) versus 38.4% men (<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>30).</p><p id="par0065" class="elsevierStylePara elsevierViewall">211 patients with previously undiagnosed DM2 were detected. The majority were women, representing 58.7% (<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>158) versus 22.3% men (<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>53). These 211 undiagnosed DM2 patients accounted for 41.7% of the sample population and 26.98% of the entire population studied.</p><p id="par0070" class="elsevierStylePara elsevierViewall">The study population had a distribution that was similar for both sexes, so it can be extrapolated that there is a higher prevalence of undiagnosed DM2 and prediabetes among women compared to men.</p><p id="par0075" class="elsevierStylePara elsevierViewall">The mean HbA1c of patients with DM2 was 8.7<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>3.7%, the mean HbA1c of women was significantly higher than that of men (9.4<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>1.4 vs. 8.0<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>5.2; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>0.01).</p><p id="par0080" class="elsevierStylePara elsevierViewall">The mean BMI of patients with DM2 was 34<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>0.1, women show significantly higher figures (37<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>8.7 vs. 32<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>7.0; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>0.01).</p><p id="par0085" class="elsevierStylePara elsevierViewall">In general, long-term DM2 is detected, but in the case of women, they have worse clinical parameters and worse metabolic control.</p><p id="par0090" class="elsevierStylePara elsevierViewall">This study reflects that Sahrawi women have higher percentages of overweight and obesity, which leads to a higher prevalence of undiagnosed DM2 and prediabetes in women compared to men.</p><p id="par0095" class="elsevierStylePara elsevierViewall">As more than 25% of patients with undiagnosed DM2 were detected, a regulated screening programme and educational interventions in the Sahrawi refugee population is justified.</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Funding</span><p id="par0100" class="elsevierStylePara elsevierViewall">The work was funded by the <span class="elsevierStyleGrantSponsor" id="gs1">()?City Council of Utrera</span>, Seville, Spain, thanks to the joint work with the humanitarian association Friends of the Sahrawi people of Utrera.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:2 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Funding" ] 1 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Carretero-Anibarro E, Hamud-Uedha M. Prevalencia de la diabetes mellitus tipo 2 no diagnosticada en la población saharaui de los campamentos de refugiados saharauis de Tinduf, Argelia. Med Clin (Barc). 2020;155:461–462.</p>" ] ] "multimedia" => array:1 [ 0 => array:8 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at1" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:2 [ "leyenda" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">DM2: diabetes mellitus 2; HBG: high blood glucose; BMI: body mass index (kg/m<span class="elsevierStyleSup">2</span>).</p>" "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"><th 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" scope="col" style="border-bottom: 2px solid black">Patients \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th 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" scope="col" style="border-bottom: 2px solid black">Total population \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th 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" scope="col" style="border-bottom: 2px solid black">Total sample (BMI<span class="elsevierStyleHsp" style=""></span>><span class="elsevierStyleHsp" style=""></span>25 and physical inactivity) \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th 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" scope="col" style="border-bottom: 2px solid black">Obesity (BMI<span class="elsevierStyleHsp" style=""></span>><span class="elsevierStyleHsp" style=""></span>30) \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th 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" scope="col" style="border-bottom: 2px solid black">Overweight (BMI<span class="elsevierStyleHsp" style=""></span>><span class="elsevierStyleHsp" style=""></span>25) \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th 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" scope="col" style="border-bottom: 2px solid black">Prediabetes \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th 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" scope="col" style="border-bottom: 2px solid black">DM2 \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th 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" scope="col" style="border-bottom: 2px solid black">HBG \t\t\t\t\t\t\n \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Females \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="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">399 (51.0%) \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="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">289 (57.1%) \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="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">214 (71.0%) \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="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">75 (42.3%) \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="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">48 (61.5%) \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="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">158 (58.7%) \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="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">24 (40.6%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Males \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="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">383 (48.9%) \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="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">217 (42.8%) \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="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">115 (38.2%) \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="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">102 (57.6%) \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="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">30 (38.4%) \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="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">53 (22.3%) \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="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">35 (59.3%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Total \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="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">782 \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="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">506 \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="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">301 \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="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">177 \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="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">78 \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="char" 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="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">59 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab2437765.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Distribution of patients (results are expressed in absolute numbers and percentages [%]).</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:5 [ 0 => array:3 [ "identificador" => "bib0030" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Sahrawi Refugees in Tindouf, Algeria: Total In-Camp Population" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "The United Nations Refugee Agency" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Libro" => array:2 [ "fecha" => "2018" "editorial" => "The Official Report" ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0035" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Programa de Ayuda Sostenida a Personas Diabéticas Saharauis de los Campamentos de Refugiados de Tinduf" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "L. Suárez Gutiérrez" 1 => "M. Riestra Fernández" 2 => "F. Díaz Cadórniga" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Diabetes Práct" "fecha" => "2017" "volumen" => "08" "paginaInicial" => "145" "paginaFinal" => "192" ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0040" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:1 [ "titulo" => "Ministerio de Salud Pública de RASD" ] ] "host" => array:1 [ 0 => array:1 [ "Libro" => array:1 [ "fecha" => "2018" ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0045" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Situación actual de la diabetes mellitus tipo 2 en el Sáhara" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "I. Larrañaga Unanue" 1 => "M. Riestra" 2 => "L. Suárez" 3 => "P. Villaverde" 4 => "C. Santaña" 5 => "C. Rubiera" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Av Diabetol" "fecha" => "2015" "volumen" => "31" "numero" => "Espec Congr" "paginaInicial" => "2263111" ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0050" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Standards of medical care in diabetes-2019" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "American Diabetes Association" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.2337/dc19-Sint01" "Revista" => array:7 [ "tituloSerie" => "Diabetes Care" "fecha" => "2019" "volumen" => "42" "numero" => "Suppl 1" "paginaInicial" => "S1" "paginaFinal" => "S2" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/30559224" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/23870206/0000015500000010/v1_202011260800/S2387020620304873/v1_202011260800/en/main.assets" "Apartado" => array:4 [ "identificador" => "43311" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Scientific letters" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/23870206/0000015500000010/v1_202011260800/S2387020620304873/v1_202011260800/en/main.pdf?idApp=UINPBA00004N&text.app=https://www.elsevier.es/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2387020620304873?idApp=UINPBA00004N" ]
| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 October | 8 | 0 | 8 |
| 2024 September | 12 | 0 | 12 |
| 2024 August | 9 | 0 | 9 |
| 2024 July | 5 | 0 | 5 |
| 2024 June | 6 | 0 | 6 |
| 2024 May | 3 | 0 | 3 |
| 2024 April | 4 | 0 | 4 |
| 2024 March | 5 | 0 | 5 |
| 2024 February | 7 | 1 | 8 |
| 2024 January | 7 | 0 | 7 |
| 2023 December | 6 | 0 | 6 |
| 2023 November | 4 | 0 | 4 |
| 2023 October | 7 | 0 | 7 |
| 2023 September | 5 | 2 | 7 |
| 2023 August | 11 | 0 | 11 |
| 2023 July | 8 | 3 | 11 |
| 2023 June | 1 | 0 | 1 |
| 2023 May | 1 | 0 | 1 |
| 2023 April | 3 | 0 | 3 |
| 2023 March | 2 | 0 | 2 |
| 2023 February | 2 | 0 | 2 |
| 2023 January | 2 | 0 | 2 |
| 2022 December | 3 | 0 | 3 |
| 2022 November | 2 | 0 | 2 |
| 2022 October | 1 | 0 | 1 |
| 2022 September | 9 | 0 | 9 |
| 2022 August | 3 | 0 | 3 |
| 2022 July | 2 | 0 | 2 |
| 2022 June | 3 | 0 | 3 |
| 2022 May | 2 | 0 | 2 |
| 2022 April | 3 | 0 | 3 |
| 2022 March | 2 | 0 | 2 |
| 2022 February | 2 | 0 | 2 |
| 2021 December | 1 | 2 | 3 |
Show all
