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Prevalencia de diabetes y diabetes oculta en adultos de Castilla-La Mancha
Prevalence of known diabetes mellitus and unknown diabetes in adults from Castilla-La Mancha, Spain
Patricio Giralt Muiñaa,b, Gonzalo Gutiérrez Ávilac, María José Ballester Herrerab,
Autor para correspondencia
Kochebh@hotmail.com

Autor para correspondencia.
, Francisco Botella Romerod, José Javier Angulo Donadoa, el Grupo de Epidemiología de Diabetes de Castilla-La Mancha (GEDCAM)
a Fundación para la Diabetes de Castilla La-Mancha (FUCAMDI), Ciudad Real, España
b Servicio de Endocrinología Pediátrica, Hospital General de Ciudad Real,Ciudad Real, España
c Servicio de Epidemiología, Consejería de Salud y Bienestar Social de Castilla-La Mancha, Toledo, España
d Servicio de Endocrinología, Hospital Universitario de Albacete, Albacete España
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          "es" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Cintura media seg&#250;n categor&#237;a diagn&#243;stica de diabetes y sexo&#46; DM&#58; diabetes mellitus conocida&#59; DO&#58; diabetes oculta&#59; GBA&#58; glucosa basal alterada&#59; ITG&#58; intolerancia a la glucosa&#46;</p>"
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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Introducci&#243;n</span><p id="par0005" class="elsevierStylePara elsevierViewall">La diabetes mellitus es uno de los principales problemas de salud a nivel mundial por su elevada prevalencia&#44; el importante coste personal y social que supone&#44; y el gasto econ&#243;mico que provoca&#46; Seg&#250;n las estimaciones de la Organizaci&#243;n Mundial de la Salud &#40;OMS&#41;&#44; en el a&#241;o 2002 el 3&#37; de la poblaci&#243;n padec&#237;a diabetes&#44; y se prev&#233; que para el a&#241;o 2030 habr&#225; 366 millones de afectados&#44; alcanzando dimensiones de epidemia en los pa&#237;ses desarrollados<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a>&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">La declaraci&#243;n de Sant Vicent se&#241;al&#243; la necesidad urgente de actualizar los conocimientos epidemiol&#243;gicos sobre la diabetes para establecer estrategias de prevenci&#243;n y tratamiento<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a>&#46; En Espa&#241;a&#44; los estudios epidemiol&#243;gicos sobre diabetes han sido escasos&#44; aislados y con metodolog&#237;a muy dispar<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a>&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">En Castilla-La Mancha se ha elaborado el Plan Integral de Diabetes 2007-2010&#44; que contempla&#44; entre sus objetivos generales&#44; impulsar la investigaci&#243;n en diabetes y&#44; como objetivo espec&#237;fico&#44; realizar estudios epidemiol&#243;gicos relacionados con la prevalencia e incidencia en la Comunidad<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a>&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">Este estudio se dise&#241;&#243; con el objetivo de conocer la prevalencia de diabetes y alteraciones en el metabolismo de los hidratos de carbono en Castilla-La Mancha&#44; as&#237; como estimar el porcentaje de diabetes no diagnosticada y la relaci&#243;n con los factores de riesgo cardiovascular asociados a la enfermedad&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Material y m&#233;todo</span><p id="par0025" class="elsevierStylePara elsevierViewall">Castilla-La Mancha tiene una poblaci&#243;n de 1&#46;894&#46;667 habitantes &#40;Padr&#243;n Municipal de Habitantes 1&#47;1&#47;2005&#41;&#46; Se trata de una poblaci&#243;n en una fase de envejecimiento muy avanzado &#40;&#237;ndice de Rosset 23&#44;4&#37;&#41; y con un peso importante del medio rural &#40;48&#44;6&#37; de la poblaci&#243;n vive en municipios con menos de 10&#46;000 habitantes&#41;&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">El marco del estudio para la prevalencia fue constituido por toda la poblaci&#243;n de Castilla-La Mancha con edad &#8805; 30 a&#241;os&#58; 1&#46;211&#46;913 individuos &#40;64&#37; de la poblaci&#243;n&#41;&#46; El tama&#241;o muestral se calcul&#243; para una prevalencia esperada de diabetes del 10&#37;&#44; un error absoluto de &#177; 1&#44;5 y un nivel de confianza del 95&#37;&#46; Se aplic&#243; un coeficiente de efecto dise&#241;o igual a 1&#44;5&#44; lo que dio un tama&#241;o muestral final de 3&#46;092 sujetos&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">Se realiz&#243; un muestreo estratificado poliet&#225;pico&#44; dividiendo la poblaci&#243;n en cinco estratos correspondientes a cada una de las provincias de la regi&#243;n&#46; Cada provincia se dividi&#243; en tres estratos seg&#250;n su nivel de ruralidad&#44; tomando como unidades de primera etapa las zonas de salud definidas en el mapa sanitario de Castilla-La Mancha de la siguiente manera&#58; nivel I&#44; zonas de salud cuyo municipio de cabecera tiene menos de 10&#46;000 habitantes&#59; nivel II&#44; municipio de cabecera con &#8805; 10&#46;000 y &#60; 30&#46;000 habitantes&#59; y nivel III&#44; municipio de cabecera con &#8805; 30&#46;000 habitantes&#46; En cada estrato intraprovincial se seleccionaron las zonas de salud mediante un m&#233;todo aleatorio proporcional al tama&#241;o de la zona&#46; En cada una de &#233;stas se eligi&#243; un cupo de medicina general y en los cupos seleccionados se eligieron 50 personas de forma aleatoria&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">El trabajo de campo se realiz&#243; a lo largo del a&#241;o 2007 &#40;fecha de prevalencia 01-06-2007&#41; por equipos de enfermeros y m&#233;dicos entrenados previamente&#46; A cada sujeto incluido en el estudio se le remiti&#243; una carta personalizada&#46; Con unos d&#237;as de antelaci&#243;n se realiz&#243; una llamada telef&#243;nica para confirmar su asistencia&#46; Se les cit&#243; en ayunas de 12 horas&#44; realizando a cada uno un breve cuestionario que inclu&#237;a datos de filiaci&#243;n&#44; antecedentes familiares y personales y consumo de f&#225;rmacos&#46; La exploraci&#243;n f&#237;sica consist&#237;a en medici&#243;n de peso y talla &#40;ambas con ropa ligera y sin zapatos&#41;&#44; per&#237;metro de la cintura y toma de presi&#243;n arterial con un esfigm&#243;grafo digital &#40;Omrom M6 Comfort&#41;&#46; Los criterios de exclusi&#243;n adoptados fueron haber sido hospitalizados o sometidos a cirug&#237;a en el &#250;ltimo mes&#44; padecer determinadas enfermedades o consumir ciertos f&#225;rmacos&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">A todos los que cumplieron los criterios de inclusi&#243;n se les realiz&#243; determinaci&#243;n de glucemia basal capilar y venosa&#59; la sobrecarga oral de glucosa &#40;SOG&#41; s&#243;lo se realiz&#243; en aquellos individuos en los que la glucemia capilar basal fue &#60; 126<span class="elsevierStyleHsp" style=""></span>mg&#47;dl&#46; En aquellos en los que la determinaci&#243;n basal capilar fue &#8805; 126<span class="elsevierStyleHsp" style=""></span>mg&#47;dl se esper&#243; al resultado de la extracci&#243;n basal venosa&#58; si &#233;sta result&#243; &#8805; 126<span class="elsevierStyleHsp" style=""></span>mg&#47;dl se consider&#243; confirmado el diagn&#243;stico de diabetes mellitus y se incluy&#243; como un caso de diabetes oculta &#40;DO&#41;&#46; Sin embargo&#44; si la venosa result&#243; &#60; 126<span class="elsevierStyleHsp" style=""></span>mg&#47;dl&#44; se indic&#243; realizar SOG&#44; por lo que fueron pacientes recapturados para realizar la sobrecarga&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">Las determinaciones de las glucemias capilares se realizaron con varios modelos de gluc&#243;metros&#44; no encontrando diferencias significativas entre los mismos al comparar los resultados con los valores de las glucemias venosas&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">La SOG se realiz&#243; con 75<span class="elsevierStyleHsp" style=""></span>g de glucosa&#44; con extracci&#243;n venosa basal y a las dos horas siguiendo las recomendaciones del informe t&#233;cnico de la OMS de 1985<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a>&#46; La recogida de las muestras las realiz&#243; un &#250;nico servicio de mensajer&#237;a&#44; asegurando su transporte refrigerado en un plazo no superior a 48 horas&#46; Las determinaciones anal&#237;ticas se hicieron en un &#250;nico laboratorio &#40;Fundaci&#243;n Jim&#233;nez D&#237;az-Unilabs&#44; Madrid&#41;&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">Los criterios diagn&#243;sticos de glucemia normal &#40;GN&#41;&#44; diabetes conocida &#40;DM&#41;&#44; DO&#44; intolerancia a la glucosa &#40;ITG&#41; y glucemia basal alterada &#40;GBA&#41; utilizados fueron los establecidos por la Asociaci&#243;n Americana de Diabetes &#40;ADA&#41; en 2003<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a>&#46; Se consider&#243; DM la referida por el paciente&#59; DO la glucemia basal &#8805; 126<span class="elsevierStyleHsp" style=""></span>mg&#47;dl y&#47;o glucemia a las dos horas &#8805; 200<span class="elsevierStyleHsp" style=""></span>mg&#47;dl&#59; ITG la glucemia a las dos horas entre 140<span class="elsevierStyleHsp" style=""></span>mg&#47;dl y 200<span class="elsevierStyleHsp" style=""></span>mg&#47;dl&#59; y GBA la glucemia basal &#8805; 100<span class="elsevierStyleHsp" style=""></span>mg&#47;dl&#46; Los resultados de GBA se compararon con los establecidos por la OMS &#40;GBA &#8805; 110<span class="elsevierStyleHsp" style=""></span>mg&#47;dl&#41;&#46;</p><p id="par0065" class="elsevierStylePara elsevierViewall">Se consideraron obesos los sujetos con &#237;ndice de masa corporal &#8805; 30<span class="elsevierStyleHsp" style=""></span>kg&#47;m<span class="elsevierStyleSup">2</span>&#59; se catalog&#243; como hipertensi&#243;n arterial &#40;HTA&#41; la presi&#243;n arterial sist&#243;lica &#8805; 140 mmHg y&#47;o presi&#243;n arterial diast&#243;lica &#8805; 90 mmHg y&#47;o referir tratamiento antihipertensivo&#59; el h&#225;bito de fumar se evalu&#243; seg&#250;n la autodeclaraci&#243;n de los sujetos&#59; se consider&#243; tener antecedentes familiares si padres&#44; hermanos o hijos padec&#237;an la enfermedad&#46; El dise&#241;o del estudio fue revisado y aprobado por el comit&#233; &#233;tico del Hospital General de Ciudad Real&#46;</p><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">An&#225;lisis estad&#237;stico</span><p id="par0070" class="elsevierStylePara elsevierViewall">Se calcularon el n&#250;mero y porcentaje de sujetos con cada uno de los distintos tipos de alteraciones del metabolismo de la glucosa y las prevalencias seg&#250;n sexo y grupo de edad&#46; Los intervalos de confianza se obtuvieron aplicando la aproximaci&#243;n de Poisson&#46; Mediante un modelo de regresi&#243;n log&#237;stica multivariante se estim&#243; la odds ratio &#40;OR&#41; asociada a cada uno de los factores considerados&#46; Para estimar la OR asociada a los diferentes estadios de la enfermedad se obtuvo un modelo de regresi&#243;n log&#237;stica multinomial&#46;</p><p id="par0075" class="elsevierStylePara elsevierViewall">Se analiz&#243; la posible asociaci&#243;n de la cintura corporal con los diferentes estadios de la enfermedad mediante un an&#225;lisis de la varianza&#44; previa comprobaci&#243;n de las hip&#243;tesis de normalidad y homogeneidad de varianzas&#46; Se realiz&#243; un test de comparaciones m&#250;ltiples &#40;Student-Newman-Keules&#41; para identificar las medias diferentes entre s&#237;&#46;</p><p id="par0080" class="elsevierStylePara elsevierViewall">Para el almacenamiento y grabaci&#243;n de la informaci&#243;n se dise&#241;&#243; una base de datos con el programa Acces de Microsoft Office&#46; El an&#225;lisis de los datos se llev&#243; a cabo con los programas SPSS PC&#43; &#40;versi&#243;n 13&#46;0&#41; y Stata &#40;versi&#243;n 11&#46;0&#41;&#46;</p></span></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Resultados</span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Caracter&#237;sticas de la muestra</span><p id="par0085" class="elsevierStylePara elsevierViewall">Se seleccionaron 3&#46;092 sujetos&#44; de los cuales 1&#46;181 participaron &#40;38&#44;1&#37; del total&#41;&#58; 43&#37; eran varones&#46; Los sujetos v&#225;lidos en el estudio fueron 1&#46;102 &#40;79 cumpl&#237;an criterios de exclusi&#243;n&#41;&#46; La edad media &#40;DE&#41; de los sujetos de la muestra era 57&#44;2 &#40;15&#44;3&#41; a&#241;os&#44; en varones 59&#44;2 &#40;15&#44;2&#41; a&#241;os y en mujeres 55&#44;6 &#40;15&#44;1&#41; a&#241;os&#46; S&#243;lo el 34&#37; de los varones seleccionados decidieron participar frente al 42&#37; de las mujeres&#46; La participaci&#243;n por grupos de edad para ambos sexos fue menor en el grupo de 30-44 a&#241;os y la m&#225;xima correspondi&#243; al grupo de 60-74 a&#241;os&#46; La estructura de la muestra seleccionada es muy similar a la de la poblaci&#243;n de Castilla-La Mancha&#44; aunque se aprecia una sobrerrepresentaci&#243;n de mujeres en la muestra y una subrepresentaci&#243;n de los varones a expensas fundamentalmente del grupo de edad de 30 a 44 a&#241;os &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">tabla 1</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Prevalencia de diabetes&#44; intolerancia a la glucosa y glucemia basal alterada</span><p id="par0090" class="elsevierStylePara elsevierViewall">La prevalencia de DM en los individuos encuestados result&#243; del 10&#44;7&#37; &#40;intervalo de confianza del 95&#37; &#91;IC 95&#37;&#93; 8&#44;9-12&#44;8&#37;&#41;&#58; en varones 12&#44;5&#37; &#40;IC 95&#37; 9&#44;5-16&#44;1&#37;&#41; y en mujeres 9&#44;3&#37; &#40;IC 95&#37; 7&#44;16-12&#44;1&#37;&#41;&#46; La prevalencia se incrementa con la edad y es mayor en varones que en mujeres hasta los 74 a&#241;os&#44; a partir de los cuales se invierte esta relaci&#243;n&#46; Se diagnostic&#243; de DO a un 7&#44;2&#37; de los participantes &#40;IC 95&#37; 5&#44;7-8&#44;9&#37;&#41;&#44; 9&#44;1&#37; de varones &#40;IC 95&#37; 6&#44;6-12&#44;3&#37;&#41; y 5&#44;6&#37; de mujeres &#40;IC 95&#37; 3&#44;9-7&#44;8&#37;&#41;&#44; con mayor porcentaje en varones que en mujeres hasta los mayores de 74 a&#241;os&#44; a partir de donde se igualan&#46; La m&#225;xima prevalencia de DO &#40;11&#44;4&#37;&#41; se encontr&#243; en el grupo de 60 a 74 a&#241;os &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">tabla 2</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0095" class="elsevierStylePara elsevierViewall">La raz&#243;n global de DO&#47;DM fue de 0&#44;7&#46; En el grupo de edad de 30-44 a&#241;os fue 0&#44;9&#59; de 45-59 a&#241;os la raz&#243;n fue 1&#59; de 60 a 74 a&#241;os 0&#44;7 y para los mayores de 74 a&#241;os de 0&#44;5&#46; En un 5&#44;6&#37; &#40;IC 95&#37; 4&#44;3-7&#44;2&#37;&#41; de la poblaci&#243;n seleccionada se encontr&#243; ITG&#44; 5&#44;3&#37; &#40;IC 95&#37; 3&#44;7-7&#44;5&#37;&#41; en mujeres y 6&#44;0&#37; &#40;IC 95&#37; 4&#44;0-8&#44;7&#37;&#41; en varones&#46; La prevalencia de GBA fue mayor en varones que en mujeres en todos los grupos de edad excepto en 60-74 a&#241;os &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">tabla 2</a>&#41;&#46; Seg&#250;n los criterios diagn&#243;sticos de la ADA<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a>&#44; la GBA fue tres veces mayor que aplicando los criterios de la OMS<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> &#40;22&#44;3 frente a 7&#37;&#41;&#46;</p><p id="par0100" class="elsevierStylePara elsevierViewall">Por tanto&#44; globalmente&#44; se observa que el 17&#44;9&#37; &#40;IC 95&#37; 15&#44;5-20&#44;6&#37;&#41; de la poblaci&#243;n de Castilla-La Mancha &#8805; 30 a&#241;os padece alg&#250;n tipo de diabetes&#46; La prevalencia global de diabetes es mayor en varones&#44; 21&#44;6&#37; &#40;IC 95&#37; 17&#44;7-26&#44;2&#37;&#41;&#44; que en mujeres&#44; 15&#44;0&#37; &#40;IC 95&#37; 12&#44;1-18&#44;3&#37;&#41;&#44; y aumenta con la edad&#46; Seg&#250;n los criterios de la ADA<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a>&#44; el 27&#44;9&#37; de las personas &#8805; 30 a&#241;os tienen lo que se ha denominado cl&#225;sicamente como un estado de prediabetes&#58; 5&#44;6&#37; ITG y 22&#44;3&#37; GBA&#46;</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Factores asociados con alteraciones del metabolismo de la glucosa</span><p id="par0105" class="elsevierStylePara elsevierViewall">El 34&#44;3&#37; de los individuos eran obesos &#40;33&#44;6&#37; de los varones y 34&#44;8&#37; de las mujeres&#41;&#46; Las mayores prevalencias de obesidad se observaron en varones de 45-59 a&#241;os &#40;38&#44;8&#37;&#41; y en mujeres de 60-74 a&#241;os &#40;42&#44;4&#37;&#41; y &#62; 74 a&#241;os &#40;41&#44;3&#37;&#41;&#46; Las menores correspondieron al grupo con GN &#40;<a class="elsevierStyleCrossRefs" href="#tbl0015">tablas 3 y 4</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia><elsevierMultimedia ident="tbl0020"></elsevierMultimedia><p id="par0110" class="elsevierStylePara elsevierViewall">El 29&#44;6&#37; de los sujetos tienen alg&#250;n familiar de primer grado diab&#233;tico&#46; Los sujetos con ITG y con GN son los que tienen menor porcentaje de familiares diab&#233;ticos &#40;<a class="elsevierStyleCrossRef" href="#tbl0015">tabla 3</a>&#41;&#46;</p><p id="par0115" class="elsevierStylePara elsevierViewall">Se observ&#243; HTA en 37&#44;3&#37; de la poblaci&#243;n de la muestra &#40;40&#44;5&#37; en varones y 34&#44;9&#37; en mujeres&#41;&#46; Esta aumenta con la edad&#46; La mayor prevalencia se observa en los sujetos con DO y DM y&#44; en especial&#44; en las mujeres&#44; con una muy elevada prevalencia en estas categor&#237;as diagn&#243;sticas &#40;<a class="elsevierStyleCrossRefs" href="#tbl0015">tablas 3 y 4</a>&#41;&#46;</p><p id="par0120" class="elsevierStylePara elsevierViewall">El 20&#44;4&#37; de los sujetos declararon tener h&#225;bito de fumar&#44; siendo m&#225;s prevalente en varones que en mujeres en todos los grupos de edad&#46; En las mujeres de m&#225;s de 59 a&#241;os fue pr&#225;cticamente nulo&#46; La mayor prevalencia para ambos sexos correspondi&#243; a los sujetos de 30-44 a&#241;os y 45-59 a&#241;os &#40;<a class="elsevierStyleCrossRefs" href="#tbl0015">tablas 3 y 4</a>&#41;&#46;</p><p id="par0125" class="elsevierStylePara elsevierViewall">La cintura media &#40;CM&#41; de los sujetos de la muestra fue de 96&#44;4<span class="elsevierStyleHsp" style=""></span>cm &#40;IC 95&#37; 95&#44;6-97&#44;2&#41;&#46; La mayor CM correspondi&#243; a los que ten&#237;an DM &#40;104&#44;6<span class="elsevierStyleHsp" style=""></span>cm&#44; IC 95&#37; 101&#44;1-108&#44;1&#41; y DO &#40;103&#44;9<span class="elsevierStyleHsp" style=""></span>cm&#44; IC 95&#37; 100&#44;8-107&#44;0&#41;&#44; mayor que la de los sujetos con ITG &#40;97&#44;4<span class="elsevierStyleHsp" style=""></span>cm&#44; IC 95&#37; 94&#44;5-100&#44;4&#41; y GBA &#40;99&#44;8<span class="elsevierStyleHsp" style=""></span>cm&#44; IC 95&#37; 98&#44;3-101&#44;2&#41;&#44; mientras que los que ten&#237;an GN tuvieron menor CM &#40;93&#44;1<span class="elsevierStyleHsp" style=""></span>cm&#44; IC 95&#37; 92&#44;0-94&#44;1&#41;&#46; Las diferencias de medias entre las diferentes categor&#237;as de valores de glucemia fueron estad&#237;sticamente significativas &#40;F<span class="elsevierStyleInf">4</span>&#44; <span class="elsevierStyleInf">1&#46;024</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>28&#44;1&#59; p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;0001&#41;&#46; Con la prueba de Student-Newman-Keules &#40;&#945;<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;05&#41; se identificaron tres subconjuntos homog&#233;neos&#58; GN&#44; ITG-GBA y DM-DO con medias diferentes entre ellos&#46; En general la CM de los varones es mayor que la de las mujeres&#44; pero en los individuos con DM y DO esta diferencia entre g&#233;neros se iguala &#40;<a class="elsevierStyleCrossRef" href="#fig0005">fig&#46; 1</a>&#41;&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0130" class="elsevierStylePara elsevierViewall">Se obtuvo un modelo de regresi&#243;n log&#237;stica multinomial tomando como categor&#237;a basal a los sujetos con GN&#59; el resto de categor&#237;as fueron DM&#44; DO&#44; ITG y GBA&#46; El modelo final incluye las variables&#58; sexo&#44; grupo de edad&#44; obesidad y antecedentes familiares &#40;<a class="elsevierStyleCrossRef" href="#tbl0025">tabla 5</a>&#41;&#46; Mediante la raz&#243;n de verosimilitudes se excluyeron del modelo las variables HTA y h&#225;bito de fumar&#46; La OR en los varones es &#62; 1 en todas las categor&#237;as&#44; con diferencia estad&#237;sticamente significativa en todas ellas excepto en los sujetos con ITG&#44; en los cuales la diferencia no es estad&#237;sticamente significativa&#46; Asimismo&#44; la OR de obesidad es &#62; 1 en todas las categor&#237;as &#40;significativa en todas&#41;&#46; Las OR m&#225;s elevadas de la obesidad se observan en DM &#40;OR 5&#44;68&#59; IC 95&#37; 3&#44;62-8&#44;91&#41; y DO &#40;OR 2&#44;87&#44; IC 95&#37; 1&#44;76-4&#44;70&#41;&#46; La OR de antecedentes familiares tambi&#233;n es &#62; 1 en todas las categor&#237;as&#44; aunque con diferencia significativa tan s&#243;lo en el caso de GBA y DM&#46; En todas las categor&#237;as diagn&#243;sticas se observa un incremento de la OR en funci&#243;n de la edad&#46; La OR de cada uno de los grupos de edad es &#62; 1 respecto a la edad de referencia &#40;30-44 a&#241;os&#41;&#44; excepto la OR de los sujetos de 45-59 a&#241;os con ITG &#40;no significativa&#41;&#46; Las OR m&#225;s elevadas en relaci&#243;n a la edad se observan en los grupos de edad de 60-74 y de mayores de 74 a&#241;os&#44; especialmente en los sujetos con DM y DO&#46;</p><elsevierMultimedia ident="tbl0025"></elsevierMultimedia></span></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Discusi&#243;n</span><p id="par0135" class="elsevierStylePara elsevierViewall">El resultado del estudio muestra que el 17&#44;9&#37; de la poblaci&#243;n de Castilla-La Mancha &#8805; 30 a&#241;os tiene diabetes&#46; De ellos el 7&#44;2&#37; desconoce que padece la enfermedad&#46; La participaci&#243;n inferior al 50&#37; de los individuos seleccionados fue prevista en el dise&#241;o del estudio para minimizar la variaci&#243;n en los resultados<span class="elsevierStyleBold">&#46;</span> La comparaci&#243;n con otros trabajos es dif&#237;cil debido a la distinta metodolog&#237;a y a los diferentes grupos de edad incluidos&#44; pero en general&#44; seg&#250;n estudios previos realizados en nuestro pa&#237;s&#44; la prevalencia de DM se sit&#250;a en torno a un 6&#44;5&#37; para la poblaci&#243;n entre los 30 y 65 a&#241;os&#44; oscilando entre el 4&#44;8&#37; y el 18&#44;7&#37; para la DM tipo 2 &#40;DM2&#41;<a class="elsevierStyleCrossRefs" href="#bib0035"><span class="elsevierStyleSup">7&#8211;20</span></a>&#46; En algunos de estos estudios&#44; la DO puede suponer m&#225;s de la mitad de la poblaci&#243;n que padece diabetes&#46; Encontramos que la raz&#243;n DO&#47;DM disminuye con la edad&#44; coincidiendo con otros autores&#59; la mayor&#237;a de ellos resaltan la importancia de realizar un diagn&#243;stico precoz de diabetes&#44; ya que en edades m&#225;s j&#243;venes es donde hay m&#225;s DO proporcionalmente&#44; lo que conlleva mayor morbimortalidad asociada a la enfermedad no tratada&#46;</p><p id="par0140" class="elsevierStylePara elsevierViewall">Los resultados muestran cifras de prevalencia de diabetes similares a las encontradas en EE&#46;UU&#46;&#44; donde seg&#250;n la encuesta nacional NAHNES III<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">21</span></a>&#44; la prevalencia global de DM2 en la poblaci&#243;n de 40-74 a&#241;os&#44; aplicando los criterios diagn&#243;sticos de la OMS&#44; fue de 14&#44;3&#37;&#44; sin diferencias de g&#233;nero&#46;</p><p id="par0145" class="elsevierStylePara elsevierViewall">Encontramos que 5&#44;6&#37; de los sujetos &#8805; 30 a&#241;os tienen ITG y el 22&#44;3&#37; GBA&#44; seg&#250;n criterios de la ADA de 2003<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a>&#44; frente a un 7&#37; aplicando los criterios de la OMS de 1985<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a>&#46; En los distintos estudios realizados en nuestro pa&#237;s se encuentran unas prevalencias de ITG entre 10 y 17&#37; y de GBA entre 6 y 12&#37;&#46; Tambi&#233;n en &#233;stos&#44; al aplicar los criterios de ADA&#44; la prevalencia de GBA se triplica hasta 20-30&#37;&#46; Estos resultados aparentemente se han mantenido estables en la &#250;ltima d&#233;cada<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">22</span></a>&#46; En la poblaci&#243;n europea la prevalencia de ITG y de GBA es del 11&#44;9 y 10&#44;0&#37;&#44; respectivamente&#44; seg&#250;n el estudio DECODE<a class="elsevierStyleCrossRef" href="#bib0115"><span class="elsevierStyleSup">23</span></a>&#44; y en EE&#46;UU&#46; la prevalencia de ITG es del 15&#44;8&#37; y la de GBA del 8&#44;3&#37; seg&#250;n la encuesta nacional NHANES III<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">21</span></a>&#46;</p><p id="par0150" class="elsevierStylePara elsevierViewall">Objetivamos un incremento progresivo de la prevalencia de diabetes con la edad&#46; Lo mismo ocurre con las prevalencias de ITG y GBA&#44; ambas asociadas superan a la de diabetes en todos los grupos de edad&#46; El modelo log&#237;stico obtenido&#44; con mayores OR seg&#250;n aumenta la edad en pr&#225;cticamente todas las categor&#237;as diagn&#243;sticas&#44; apoya la hip&#243;tesis de la asociaci&#243;n de la diabetes y alteraciones del metabolismo de la glucosa&#44; algo que no por ser ya conocido deja de ser interesante&#44; ya que diferentes estudios prospectivos han demostrado que tanto la ITG como la GBA son altamente predictivas de diabetes y su efecto es&#44; adem&#225;s&#44; acumulativo&#44; siendo el riesgo m&#225;ximo en los individuos con GBA e ITG combinadas<a class="elsevierStyleCrossRefs" href="#bib0120"><span class="elsevierStyleSup">24&#8211;27</span></a>&#46; Aunque existe controversia respecto a si el g&#233;nero juega alg&#250;n papel en la etiopatogenia de la diabetes&#44; en nuestro estudio se ha encontrado mayor prevalencia de diabetes en varones &#40;21&#44;6&#37;&#41; que en mujeres &#40;15&#44;0&#37;&#41;&#44; manteni&#233;ndose esta relaci&#243;n en todos los grupos de edad excepto en los mayores de 74 a&#241;os&#46; En el estudio realizado por Botas Cervero et al<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">14</span></a> en Asturias&#44; en el estudio de Arag&#243;n<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">12</span></a> y otros pa&#237;ses europeos<a class="elsevierStyleCrossRefs" href="#bib0140"><span class="elsevierStyleSup">28&#44;29</span></a> se encuentran cifras de prevalencia de DM discretamente superiores en el sexo masculino&#46; Sin embargo&#44; en el estudio realizado en Le&#243;n<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a> encontraron mayor prevalencia de diabetes en las mujeres &#40;7&#37;&#41; que en los varones &#40;4&#37;&#41;&#44; con tendencia a aumentar esta diferencia con la edad&#46; En el modelo log&#237;stico obtenido se observa una OR var&#243;n&#47;mujer &#62; 1 en todas las categor&#237;as diagn&#243;sticas&#44; con diferencias significativas en todas ellas excepto en ITG&#46; La obesidad es uno de los factores que se encuentra m&#225;s consistentemente asociado&#44; destacando en algunos estudios sobre todo la variaci&#243;n porcentual media del IMC<a class="elsevierStyleCrossRefs" href="#bib0150"><span class="elsevierStyleSup">30&#44;31</span></a>&#46; Est&#225; descrita la asociaci&#243;n lineal entre el IMC y la incidencia de DM2&#44; comenzando desde niveles de IMC que cl&#225;sicamente se hab&#237;an considerado como normales &#40;IMC 22-25<span class="elsevierStyleHsp" style=""></span>kg&#47;m<span class="elsevierStyleSup">2</span>&#41;<a class="elsevierStyleCrossRef" href="#bib0160"><span class="elsevierStyleSup">32</span></a>&#46; En este an&#225;lisis&#44; la OR de obesidad en todas las categor&#237;as diagn&#243;sticas es &#62; 1&#44; con diferencias significativas en todas ellas&#46; La mayor OR se observa en los sujetos con DM&#44; algo que no deja de ser un hallazgo relevante ya que pudiera estar hablando de un control deficiente de los sujetos con diabetes diagnosticada&#46;</p><p id="par0155" class="elsevierStylePara elsevierViewall">La Federaci&#243;n Internacional de Diabetes considera el per&#237;metro de la cintura &#40;PC&#41;&#44; marcador de obesidad central&#44; como un elemento imprescindible en el diagn&#243;stico de s&#237;ndrome metab&#243;lico e incorpora diferentes valores umbrales referido a los distintos grupos &#233;tnicos&#44; definiendo como riesgo&#44; en la poblaci&#243;n europea&#44; valores de PC &#8805; 94<span class="elsevierStyleHsp" style=""></span>cm en varones y &#8805; 80<span class="elsevierStyleHsp" style=""></span>cm en mujeres<a class="elsevierStyleCrossRef" href="#bib0165"><span class="elsevierStyleSup">33</span></a>&#46; En nuestro estudio se observa una clara asociaci&#243;n entre la CM en cent&#237;metros &#40;an&#225;lisis de la varianza&#41; y la alteraci&#243;n del metabolismo de los hidratos de carbono&#46; No se trata de una mera asociaci&#243;n aleatoria&#44; ya que con la prueba de Student-Newman-Keules &#40;contrastes a posteriori&#41; se aprecia un aumento secuencial de la CM seg&#250;n las diferentes categor&#237;as diagn&#243;sticas&#46;</p><p id="par0160" class="elsevierStylePara elsevierViewall">Se ha demostrado que existe una predisposici&#243;n gen&#233;tica&#46; Tener un familiar de primer grado con DM2 confiere hasta un 40&#37; de riesgo&#44; y en gemelos id&#233;nticos la concordancia es casi del 100&#37; para DM2&#44; mucho mayor que para DM1<a class="elsevierStyleCrossRef" href="#bib0170"><span class="elsevierStyleSup">34</span></a>&#46; Se sugiere que en la agregaci&#243;n familiar pueden estar implicados factores ambientales&#44; describiendo en los c&#243;nyuges que conviven con pacientes con DM2 mayor riesgo de desarrollar alteraciones en el metabolismo hidrocarbonado<a class="elsevierStyleCrossRef" href="#bib0175"><span class="elsevierStyleSup">35</span></a>&#46; En el modelo log&#237;stico obtenido&#44; se observa una OR &#62; 1 para la variable antecedentes familiares en todas las categor&#237;as diagn&#243;sticas&#44; con diferencias significativas en DM y GBA&#46; Con el modelo log&#237;stico que agrupa ITG y GBA&#44; se observan diferencias significativas en todas las categor&#237;as diagn&#243;sticas excepto en la DO&#46;</p><p id="par0165" class="elsevierStylePara elsevierViewall">Se puede concluir que el presente estudio&#44; el primero realizado en Castilla-La Mancha&#44; muestra la situaci&#243;n real de la diabetes en nuestra comunidad&#44; siendo los resultados comparables a los de otros estudios realizados en Espa&#241;a&#44; Europa y EE&#46;UU&#46;&#44; no por ello menos alarmantes&#44; ya que revelan prevalencias muy elevadas de alteraci&#243;n en el metabolismo de los hidratos de carbono y factores asociados&#46;</p></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Conflicto de intereses</span><p id="par0170" class="elsevierStylePara elsevierViewall">Los autores declaran no tener ning&#250;n conflicto de intereses con las empresas que han colaborado en el desarrollo del estudio&#46;</p></span></span>"
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          "titulo" => array:5 [
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              "titulo" => "Caracter&#237;sticas de la muestra"
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              "identificador" => "sec0030"
              "titulo" => "Prevalencia de diabetes&#44; intolerancia a la glucosa y glucemia basal alterada"
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              "titulo" => "Factores asociados con alteraciones del metabolismo de la glucosa"
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          "titulo" => "Agradecimientos"
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          "titulo" => "Bibliograf&#237;a"
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    "pdfFichero" => "main.pdf"
    "tienePdf" => true
    "fechaRecibido" => "2010-04-30"
    "fechaAceptado" => "2010-11-04"
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        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Palabras clave"
          "identificador" => "xpalclavsec94144"
          "palabras" => array:5 [
            0 => "Diabetes"
            1 => "Epidemiolog&#237;a"
            2 => "Prevalencia"
            3 => "Intolerancia a la glucosa"
            4 => "Glucemia basal alterada"
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        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Keywords"
          "identificador" => "xpalclavsec94143"
          "palabras" => array:5 [
            0 => "Diabetes"
            1 => "Epidemiology"
            2 => "Prevalence"
            3 => "Impaired glucose tolerance"
            4 => "Impaired fasting glucose"
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    "resumen" => array:2 [
      "es" => array:2 [
        "titulo" => "Resumen"
        "resumen" => "<span class="elsevierStyleSectionTitle">Fundamento y objetivo</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Los objetivos de este estudio fueron estimar la prevalencia de diabetes mellitus &#40;DM&#41; conocida&#44; diabetes oculta &#40;DO&#41; y alteraciones del metabolismo de los hidratos de carbono en la poblaci&#243;n de Castilla-La Mancha de edad &#8805; 30 a&#241;os&#44; y valorar los factores de riesgo cardiovascular asociados con diabetes&#46;</p> <span class="elsevierStyleSectionTitle">Pacientes y m&#233;todo</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Para estimar la prevalencia se realiz&#243; un estudio poblacional trasversal con fecha de referencia del 01-06-2007&#46; Fueron seleccionados 3&#46;092 sujetos&#44; de los que participaron 1&#46;181 &#40;38&#44;1&#37;&#41;&#46; Se realiz&#243; cuestionario&#44; exploraci&#243;n y sobrecarga oral de glucosa &#40;SOG&#41;&#46; Se utilizaron los criterios diagn&#243;sticos establecidos por la Asociaci&#243;n Americana de Diabetes &#40;ADA&#41; y se compararon los resultados con los criterios de la Organizaci&#243;n Mundial de la Salud &#40;OMS&#41;&#46;</p> <span class="elsevierStyleSectionTitle">Resultados</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">La prevalencia de diabetes en sujetos de edad &#8805; 30 a&#241;os fue del 17&#44;9&#37; &#40;DM 10&#44;7&#37;&#44; DO 7&#44;2&#37;&#44; raz&#243;n DO&#47;DM 0&#44;7&#41;&#44; la de intolerancia a la glucosa &#40;ITG&#41; del 5&#44;6&#37; y la de glucosa basal alterada &#40;GBA&#41; del 22&#44;3&#37; seg&#250;n criterios ADA y 7&#44;2&#37; seg&#250;n criterios OMS&#46; La DM&#44; ITG y GBA aumentaron con la edad&#46; Se observ&#243; una mayor prevalencia de diabestes en global en varones &#40;20&#44;9&#37;&#41; frente a mujeres &#40;14&#44;5&#37;&#41;&#44; pero a partir de los 75 a&#241;os es m&#225;s prevalente en sexo femenino&#46; Se encontr&#243; asociaci&#243;n con la obesidad&#44; el g&#233;nero masculino&#44; la edad y la presencia de antecedentes familiares de diabetes&#46;</p> <span class="elsevierStyleSectionTitle">Conclusiones</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">La prevalencia de diabetes en la poblaci&#243;n adulta de Castilla-La Mancha es muy elevada&#44; es mayor en varones y aumenta con la edad&#46; Un alto porcentaje de personas con diabetes o con alteraci&#243;n en el metabolismo de los hidratos de carbono desconoce su condici&#243;n&#44; lo que pone de manifiesto la necesidad de implantar estrategias de detecci&#243;n precoz&#46;</p>"
      ]
      "en" => array:2 [
        "titulo" => "Abstract"
        "resumen" => "<span class="elsevierStyleSectionTitle">Background and objetive</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">To estimate the prevalence of known diabetes mellitus &#40;KD&#41;&#44; unknown diabetes &#40;UD&#41;&#44; and carbohydrate metabolism disturbances in a population of Castilla-La Mancha &#40;CLM&#41; older than 30 years old&#59; To study the cardiovascular risk factors related with diabetes&#46;</p> <span class="elsevierStyleSectionTitle">Patients and methods</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">A transversal study was performed in order to determine these prevalence data&#46; Reference date&#58; 2007&#47;06&#47;01&#46; 3&#44;092 subjects were selected&#44; and 1&#44;181 of them &#40;38&#46;1&#37;&#41; participated in the study&#46; A questionnaire&#44; physical exploration and glucose tolerance test were performed&#46; The diagnostic criteria of diabetes were those established by the American Association of Diabetes &#40;ADA&#41; and were compared with the World Health Organization criteria &#40;WHO&#41;&#46;</p> <span class="elsevierStyleSectionTitle">Results</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Prevalence of diabetes in individuals younger than 30 years&#58; 17&#46;9&#37; &#40;DM 10&#46;7&#37;&#44; DO 7&#46;2&#37;&#41;&#46; Ratio UD&#47;KD&#58; 0&#46;7&#46; Prevalence of impaired glucose tolerance &#40;IGT&#41; 5&#46;6&#37; and impaired fasting glucose &#40;IFG&#41; 22&#46;3&#37; based on ADA criteria and 7&#46;2&#37; if WHO criteria applied&#46; KD&#44; IFT and IFG increased with age&#46; Global prevalence was higher in males &#40;20&#46;9&#37;&#41; than females &#40;14&#46;5&#37;&#41;&#44; but the prevalence was higher in females older than 74 years&#46; A positive relationship was found with obesity&#44; male sex&#44; age and familiar history of diabetes&#46;</p> <span class="elsevierStyleSectionTitle">Conclusions</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Prevalence of diabetes in the adult population of CLM is very high&#44; higher in males and increase with age&#46; A great percentage of diabetic people or with carbohydrate metabolism alterations do not know that condition&#46; This situation makes necessary to create early detection strategies&#46;</p>"
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          "es" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Cintura media seg&#250;n categor&#237;a diagn&#243;stica de diabetes y sexo&#46; DM&#58; diabetes mellitus conocida&#59; DO&#58; diabetes oculta&#59; GBA&#58; glucosa basal alterada&#59; ITG&#58; intolerancia a la glucosa&#46;</p>"
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                  \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="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Grupo de edad&#44; a&#241;os&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  " colspan="3" align="center" valign="\n
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                  \t\t\t\t" style="border-bottom: 2px solid black">Castilla-La Mancha</td><td class="td" title="\n
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                  \t\t\t\t  " colspan="3" align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">Participantes</td></tr><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">Varones&nbsp;\t\t\t\t\t\t\n
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                  \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">Mujeres&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">Total&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">Varones&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">Mujeres&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">Total&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
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                  \t\t\t\t">30-44&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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">19&#44;7&#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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">18&#44;0&#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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">37&#44;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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">9&#44;3&#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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">17&#44;3&#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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">26&#44;7&#37;&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">45-59&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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">13&#44;3&#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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">12&#44;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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">25&#44;9&#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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">11&#44;1&#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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">16&#44;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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">27&#44;3&#37;&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">60-74&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="char" valign="\n
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                  """
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                0 => "xTab192691.png"
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        "descripcion" => array:1 [
          "es" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Prevalencia de diabetes mellitus conocida&#44; diabetes oculta&#44; intolerancia a la glucosa y glucemia basal alterada en la poblaci&#243;n de Castilla-La Mancha mayor de 30 a&#241;os&#44; seg&#250;n sexo y grupo de edad&#46;</p>"
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      ]
      3 => array:7 [
        "identificador" => "tbl0015"
        "etiqueta" => "Tabla 3"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "tabla" => array:2 [
          "leyenda" => "<p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">DM&#58; diabetes mellitus conocida&#59; DO&#58; diabetes oculta&#59; GBA&#58; glucosa basal alterada&#59; HTA&#58; hipertensi&#243;n arterial&#59; ITG&#58; intolerancia a la glucosa&#46;</p>"
          "tablatextoimagen" => array:1 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">Diagn&#243;stico&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " colspan="2" align="center" valign="\n
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                  \t\t\t\t" style="border-bottom: 2px solid black">No&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>ITG&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>GBA&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>DO&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>GBA&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>DO&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>DM&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="9" align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Ambos sexos</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
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Normal&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>ITG&nbsp;\t\t\t\t\t\t\n
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                  """
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                  \t\t\t\t\tvoid\n
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                  \t\t\t\t">Grupo de edad&#44; a&#241;os&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">20&#44;4&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
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                0 => "xTab192692.png"
              ]
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        "descripcion" => array:1 [
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      5 => array:7 [
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        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "tabla" => array:1 [
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                0 => """
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                  \t\t\t\t\tvoid\n
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                  \t\t\t\t">Variable&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Varones&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">1&#44;31&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">2&#44;27&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Grupo edad 30-44&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Grupo edad 45-59&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#44;85&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#44;40&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#44;7250&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#44;33&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">2&#44;15&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Grupo edad 60-74&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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&#44;54&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">1&#44;36&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#44;0010&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">1&#44;67&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">7&#44;50&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Grupo edad 75&#43;&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
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                  \t\t\t\t">5&#44;56&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">2&#44;31&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">12&#44;56&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
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                  \t\t\t\t  " colspan="6" align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
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                  \t\t\t\t  " colspan="6" align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Glucemia basal alterada</span></td></tr><tr title="table-row"><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Varones&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Obesos&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">2&#44;06&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#44;33&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">1&#44;50&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Familiar diab&#233;tico&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">1&#44;43&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#44;25&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#44;0370&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">1&#44;02&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Grupo edad 30-44&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Grupo edad 45-59&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">1&#44;75&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#44;37&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#44;0080&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">1&#44;16&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">2&#44;64&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Grupo edad 60-74&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">2&#44;26&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">3&#44;46&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Grupo edad 75&#43;&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="char" valign="\n
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                  \t\t\t\t">2&#44;81&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#44;73&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#44;0000&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">1&#44;69&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">4&#44;67&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " colspan="6" align="left" valign="\n
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                  \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  " colspan="6" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Diabetes oculta</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="elsevierStyleHsp" style=""></span>Varones&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">1&#44;94&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">3&#44;18&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Obesos&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="char" valign="\n
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                  \t\t\t\t">2&#44;87&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#44;72&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#44;0000&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">1&#44;76&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">4&#44;70&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>Familiar diab&#233;tico&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="char" valign="\n
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                  \t\t\t\t">1&#44;64&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#44;45&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">0&#44;0720&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#44;96&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">2&#44;80&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>Grupo edad 30-44&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="char" valign="\n
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                  \t\t\t\t">1&#44;00&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Obesos&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#44;0040&nbsp;\t\t\t\t\t\t\n
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                  """
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                      "titulo" => "Global prevalence of diabetes&#58; estimates for the year 2000 and projections for 2030"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
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                            0 => "S&#46; Wild"
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                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15111519"
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                  "referenciaCompleta" => "Diabetes Care and Research in Europe&#58; the Saint Vincent Declaration WHO&#47;IDF Europe&#46; Diabetic Med&#46; 1990&#59;7&#58;360&#46;"
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                      "titulo" => "Los estudios de incidencia de diabetes mellitus tipo I en Espa&#241;a&#46; An&#225;lisis comparativo y consenso de metodolog&#237;a estandarizada"
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    "agradecimientos" => array:1 [
      0 => array:3 [
        "identificador" => "xack36124"
        "titulo" => "Agradecimientos"
        "texto" => "<p id="par0175" class="elsevierStylePara elsevierViewall">Los autores y la Fundaci&#243;n de Castilla-La Mancha para la Diabetes agradecen su colaboraci&#243;n por el apoyo prestado a la Consejer&#237;a de Salud y Bienestar Social&#44; especialmente a la Direcci&#243;n General de Salud P&#250;blica&#44; al Servicio de Salud de Castilla-La Mancha &#40;SESCAM&#41;&#44; a los profesionales sanitarios de Atenci&#243;n Primaria de CLM y al personal de la Fundaci&#243;n de Castilla-La Mancha para la Diabetes&#44; sin cuya colaboraci&#243;n no hubiese sido posible este trabajo&#46; Queremos expresar tambi&#233;n nuestro agradecimiento a las empresas que han colaborado&#58; Abbott&#44; Menarini&#44; Roche y Lifescan&#46;</p>"
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Información del artículo
ISSN: 00257753
Idioma original: Español
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