Type 2 diabetes mellitus (T2DM) is one of the most prevalent non-communicable diseases, causing approximately 2 million deaths each year.1 It affects around 537 million people, and its prevalence is estimated to reach 783 million by 2045.2

In Spain, the estimated prevalence of T2DM in 2012 was 13.8%, with 6% of cases being undiagnosed.3 The 2007 National Health System Diabetes Strategy states that this disease is primarily diagnosed and managed in primary care (PC), with shared care involving endocrinology or internal medicine depending on the severity and complexity of the case.4

According to the most widely used Clinical Practice Guidelines (CPGs) on the management of T2DM in Spain,5, 6 the goals of T2DM management focus on achieving good glycemic control, individualizing target glycated hemoglobin (HbA1c) levels based on age, disease duration, and patient comorbidities, as well as detecting and preventing complications. Ideally, a diagnosed and stable patient should have biannual appointments with their family doctor and between 2 and 4 appointments with their nurse. Each year, lifestyle habits should be reviewed, microvascular and macrovascular complications should be screened, along with psychosocial and cognitive issues, sleep disorders, toxic habits, and treatment should be reassessed. HbA1c and lipid profiles should be evaluated twice a year, while the albumin/creatinine ratio and glomerular filtration rate should be checked annually. Cardiovascular risk should be calculated once a year, an electrocardiogram should be performed, and the vaccination schedule should be updated. Quarterly, blood pressure, heart rate, weight, and body mass index should be assessed, along with screening for hyperglycemia or hypoglycemia symptoms and reevaluating diabetes education.5 These recommendations should be individualized.

The 2012 update of the National Health System Diabetes Strategy promotes coordination between care levels and specialties, as well as the implementation of specific protocols for T2DM treatment and follow-up in autonomous communities.7

Overall, the referral criteria to endocrinology recommended by the Spanish Ministry of Health and Consumer Affairs CPG include: suspicion of specific types of diabetes (genetic, exocrine pancreatic diseases, and endocrinopathies), patients younger than 40 years with possible type 1 diabetes mellitus (T1DM) at diagnosis, pregnancy in women with diabetes or gestational diabetes, and chronic poor metabolic control despite therapeutic modifications. There are also referral criteria to other specialties in case of disease complications.8

In summary, diabetes care should be multidisciplinary. The approach in PC should be shared between medicine and nursing and should interact with other care levels for comprehensive management. However, in Spain, health care is managed independently in each autonomous community, so protocols may vary depending on available resources and recommendations in each region. The aim of this study is to describe how T2DM care is organized in PC in Spain and analyze the main differences across regions.