Document resource
Background and Importance Recent guidelines for type 2 diabetes (T2D) have shifted from HbA1c-centred targets to drug selection based on the patient’s predominant clinical condition to reduce morbidity and mortality. Nevertheless, many patients still receive outdated regimens not aligned with current recommendations.Aim and Objectives To evaluate the appropriateness of chronic antidiabetic treatment in adults with T2DM according to the most recent national guidelines, based on their predominant clinical condition.To analyse whether differences in appropriateness exist depending on the predominant clinical condition.Material and Methods A three-month prospective observational study was conducted in a tertiary care hospital. Inclusion criteria: adults with T2DM and a prescribed home antidiabetic treatment at admission. Variables: age, sex, BMI, history of cardiovascular disease (CVD), high cardiovascular risk (CVR), stroke, heart failure (HF), chronic kidney disease (CKD), frailty, estimated glomerular filtration rate, last HbA1c value, and prescribed antidiabetic drugs. High CVR was defined as ≥3 of: hypertension, hypercholesterolaemia, smoking, albuminuria, or family history of CVD.Patients were randomly selected from inpatients with T2DM under treatment. Clinical data and prescription drugs were retrieved from electronic health records.Patients were classified into six groups according to their predominant condition: CVD/high CVR, HF, CKD, frailty, obesity, or none. Appropriateness was defined as concordance between prescribed drugs and recommendations of the 2023 Spanish redGDPS and the 2025 Spanish Society of Internal Medicine.Data collection and analysis were performed using Excel. Categorical variables were statistically analysed with absolute frequencies; quantitative variables with mean or median depending on distribution (Kolmogorov–Smirnov test). Differences in appropriateness among groups were assessed with the Chi-squared test.Results Among 124 patients (62.3% male, mean age 74.2 years ±11.4), overall appropriateness of antidiabetic treatment was 64/124 (51.6%).Appropriateness by group was: CVD or high CVR 15/36, HF 6/10, CKD 10/21, frailty 10/21, obesity 6/10, and 17/20 for patients without any predominant condition. Significant differences (p = 0.0324; p < 0.05) between groups.Conclusion and Relevance Antidiabetic treatment showed a moderate degree of appropriateness to national guidelines, with particularly low rates in patients with comorbidities, especially CVD/high CVR, HF, and CKD. Significant differences between groups highlight the need to prioritise optimisation strategies in patients with lower adherence to recommendations to improve clinical outcomes.Conflict of Interest No conflict of interest