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Ribas A, Chillarón JJ, Vázquez S, Carrera MJ, Martínez-Ruiz N, Galcerán I, Lorente L, Pascagaza A, Sánchez-Parrilla J, Frances A, Sancho JJ, Zugazaga A, Clarà A, Crespo M, Oliveras A. Indication, performance and outcomes of adrenal vein sampling in patients with primary hyperaldosteronism. Nefrologia 2024; 44:61-68. [PMID: 37150672 DOI: 10.1016/j.nefroe.2023.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Accepted: 10/10/2022] [Indexed: 05/09/2023] Open
Abstract
Primary hyperaldosteronism (PAH) is an important cause of secondary hypertension (HTN). The study of the same requires a high clinical suspicion in addition to a hormonal study that confirms hormonal hypersecretion. It is important to start the appropriate treatment once the diagnosis is confirmed, and for this is necessary to demonstrate whether the hormonal hypersecretion is unilateral (patients who could be candidates for surgical treatment) or bilateral (patients who are candidates for pharmacological treatment only). At the Hospital del Mar since 2016 there has been a multidisciplinary work team in which Nephrologists, Endocrinologists, Radiologists and Surgeons participate to evaluate cases with suspected hyperaldosteronism and agree on the best diagnostic-therapeutic approach for these patients, including the need for adrenal vein sampling, which is a technique that in recent years has become the gold standard for the study of PAH. In the present study we collect the experience of our centre in performing AVC and its usefulness for the management of these patients.
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Affiliation(s)
- Andrés Ribas
- Unidad de Hipertensión arterial y Riesgo Vascular, Servicio de Nefrología, Hospital del Mar, Barcelona, Spain.
| | - Juan J Chillarón
- Servicio de Endocrinología y Nutrición, Hospital del Mar, Barcelona, Spain
| | - Susana Vázquez
- Unidad de Hipertensión arterial y Riesgo Vascular, Servicio de Nefrología, Hospital del Mar, Barcelona, Spain
| | - M José Carrera
- Servicio de Endocrinología y Nutrición, Hospital del Mar, Barcelona, Spain
| | | | - Isabel Galcerán
- Unidad de Hipertensión arterial y Riesgo Vascular, Servicio de Nefrología, Hospital del Mar, Barcelona, Spain
| | - Leyre Lorente
- Cirugía Endocrina, Servicio de Cirugía General, Hospital del Mar, Barcelona, Spain
| | - Alejandro Pascagaza
- Radiología Vascular e Intervencionista, Servicio de Radiología, Hospital del Mar, Barcelona, Spain
| | | | - Albert Frances
- Servicio de Urología, Hospital del Mar, Barcelona, Spain
| | - Joan J Sancho
- Cirugía Endocrina, Servicio de Cirugía General, Hospital del Mar, Barcelona, Spain
| | - Ander Zugazaga
- Radiología Vascular e Intervencionista, Servicio de Radiología, Hospital del Mar, Barcelona, Spain
| | - Albert Clarà
- Servicio de Angiología y Cirugía Vascular, Hospital del Mar, Barcelona, Spain
| | - Marta Crespo
- Unidad de Hipertensión arterial y Riesgo Vascular, Servicio de Nefrología, Hospital del Mar, Barcelona, Spain
| | - Anna Oliveras
- Unidad de Hipertensión arterial y Riesgo Vascular, Servicio de Nefrología, Hospital del Mar, Barcelona, Spain
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2
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Ballesta S, Chillarón JJ, Inglada Y, Climent E, Llauradó G, Pedro-Botet J, Cots F, Camell H, Flores JA, Benaiges D. Telehealth model versus in-person standard care for persons with type 1 diabetes treated with multiple daily injections: an open-label randomized controlled trial. Front Endocrinol (Lausanne) 2023; 14:1176765. [PMID: 37441496 PMCID: PMC10333924 DOI: 10.3389/fendo.2023.1176765] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Accepted: 06/06/2023] [Indexed: 07/15/2023] Open
Abstract
Objective Increasing evidence indicates that the telehealth (TH) model is noninferior to the in-person approach regarding metabolic control in type 1 diabetes (T1D) and offers advantages such as a decrease in travel time and increased accessibility for shorter/frequent visits. The primary aim of this study was to compare the change in glycated hemoglobin (HbA1c) at 6 months in T1D care in a rural area between TH and in-person visits. Research design and methods Randomized controlled, open-label, parallel-arm study among adults with T1D. Participants were submitted to in-person visits at baseline and at months 3 and 6 (conventional group) or teleconsultation in months 1 to 4 plus 2 in-person visits (baseline and 6 months) (TH group). Mixed effects models estimated differences in HbA1c changes. Results Fifty-five participants were included (29 conventional/26 TH). No significant differences in HbA1c between groups were found. Significant improvement in time in range (5.40, 95% confidence interval (CI): 0.43-10.38; p < 0.05) and in time above range (-6.34, 95% CI: -12.13- -0.55;p < 0.05) in the TH group and an improvement in the Diabetes Quality of Life questionnaire (EsDQoL) score (-7.65, 95% CI: -14.67 - -0.63; p < 0.05) were observed. In TH, the costs for the participants were lower. Conclusions The TH model is comparable to in-person visits regarding HbA1c levels at the 6-month follow-up, with significant improvement in some glucose metrics and health-related quality of life. Further studies are necessary to evaluate a more efficient timing of the TH visits.
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Affiliation(s)
- Sílvia Ballesta
- Endocrinology and Nutrition, Consorci Sanitari de l’Alt Penedès Garraf, Vilafranca del Penedès, Spain
- Endocrinology and Nutrition, Hospital del Mar, Barcelona, Spain
- Department of Medicine, Universitat Autònoma de Barcelona, Universitari Mar, Barcelona, Spain
| | - Juan J. Chillarón
- Endocrinology and Nutrition, Consorci Sanitari de l’Alt Penedès Garraf, Vilafranca del Penedès, Spain
- Endocrinology and Nutrition, Hospital del Mar, Barcelona, Spain
- Cardiovascular Risk and Nutrition Research Group (CARIN-ULEC), Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain
- Barcelona Biomedical Research Park (PRBB), Barcelona, Spain
- Department of Medicine, Universitat Pompeu Fabra, Barcelona, Spain
| | - Yolanda Inglada
- Endocrinology and Nutrition, Consorci Sanitari de l’Alt Penedès Garraf, Vilafranca del Penedès, Spain
| | - Elisenda Climent
- Endocrinology and Nutrition, Hospital del Mar, Barcelona, Spain
- Department of Medicine, Universitat Pompeu Fabra, Barcelona, Spain
| | - Gemma Llauradó
- Endocrinology and Nutrition, Hospital del Mar, Barcelona, Spain
- Cardiovascular Risk and Nutrition Research Group (CARIN-ULEC), Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain
- Barcelona Biomedical Research Park (PRBB), Barcelona, Spain
- Department of Medicine, Universitat Pompeu Fabra, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Instituto de Salud Carlos III, Madrid, Spain
| | - Juan Pedro-Botet
- Endocrinology and Nutrition, Hospital del Mar, Barcelona, Spain
- Department of Medicine, Universitat Autònoma de Barcelona, Universitari Mar, Barcelona, Spain
| | - Francesc Cots
- Management Control Department, Hospital del Mar, Barcelona, Spain
| | - Helena Camell
- Internal Medicine, Hospital Comarcal de l´Alt Penedès, Vilafranca del Penedès, Spain
| | - Juana A. Flores
- Endocrinology and Nutrition, Consorci Sanitari de l’Alt Penedès Garraf, Vilafranca del Penedès, Spain
- Endocrinology and Nutrition, Hospital del Mar, Barcelona, Spain
- Cardiovascular Risk and Nutrition Research Group (CARIN-ULEC), Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain
- Barcelona Biomedical Research Park (PRBB), Barcelona, Spain
- Department of Medicine, Universitat Pompeu Fabra, Barcelona, Spain
| | - David Benaiges
- Endocrinology and Nutrition, Consorci Sanitari de l’Alt Penedès Garraf, Vilafranca del Penedès, Spain
- Endocrinology and Nutrition, Hospital del Mar, Barcelona, Spain
- Cardiovascular Risk and Nutrition Research Group (CARIN-ULEC), Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain
- Barcelona Biomedical Research Park (PRBB), Barcelona, Spain
- Department of Medicine, Universitat Pompeu Fabra, Barcelona, Spain
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3
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Flores-LE Roux JA, Mañé L, Gabara C, Gortazar L, Pedro-Botet J, Chillarón JJ, Pay À A, Benaiges D. Ethnic differences in the impact of gestational diabetes on macrosomia. Minerva Endocrinol (Torino) 2022; 47:403-412. [PMID: 33435645 DOI: 10.23736/s2724-6507.20.03301-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
BACKGROUND Previous studies reported an ethnic disparity in gestational diabetes mellitus-associated birth outcomes, with some suggesting that macrosomia increases to a lesser extent in groups at high risk, the opposite of the pattern observed by others. Our aim was to evaluate ethnic variation in the impact of gestational diabetes mellitus (GDM). METHODS A case-control study evaluating pregnancy outcomes was conducted in women with and without GDM from five ethnic groups. Data on GDM were collected between January 2004 and July 2017. Women giving birth between May 2013 and July 2017 in whom pre-existing diabetes had been ruled out served as controls. A multivariate logistic regression analysis was performed to determine factors independently associated with macrosomia. RESULTS Overall, 852 GDM women and 3,803 controls were included. In Caucasian and East-Asian women excessive gestational weight gain (OR 2.273, 95% CI 1.364-3.788 and OR 3.776, 95% CI 0.958-14.886) was an independent predictor of macrosomia. In Latin-American and Moroccan women, obesity (OR 1.774, 95% CI 1.219-2.581 and OR 1.656, 95% CI 1.054-2.601), GDM (OR 2.440; 95% CI 1.048-5.679 and OR 3.249, 95% CI 1.269-8.321) and gestational weight gain but only for Latin-American women (OR 2.365, 95% CI 1.039-5.384) were associated with macrosomia. In South-Central Asian women, only GDM was associated with macrosomia (OR 3.701, 95% CI 1.437-9.532). CONCLUSIONS GDM is an independent predictor of macrosomia in Latin-American, South-Central Asian and Moroccan women but not in Caucasian or East-Asian women in whom other factors play a more important role.
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Affiliation(s)
- Juana A Flores-LE Roux
- Department of Endocrinology and Nutrition, Hospital del Mar, Barcelona, Spain - .,Department of Medicine, Autonomous University of Barcelona, Barcelona, Spain -
| | - Laura Mañé
- Department of Endocrinology and Nutrition, Hospital del Mar, Barcelona, Spain.,Department of Medicine, Autonomous University of Barcelona, Barcelona, Spain
| | - Cristina Gabara
- Department of Medicine, Autonomous University of Barcelona, Barcelona, Spain
| | - Lucia Gortazar
- Department of Endocrinology and Nutrition, Hospital del Mar, Barcelona, Spain.,Department of Medicine, Autonomous University of Barcelona, Barcelona, Spain
| | - Juan Pedro-Botet
- Department of Endocrinology and Nutrition, Hospital del Mar, Barcelona, Spain.,Department of Medicine, Autonomous University of Barcelona, Barcelona, Spain
| | - Juan J Chillarón
- Department of Endocrinology and Nutrition, Hospital del Mar, Barcelona, Spain.,Department of Medicine, Autonomous University of Barcelona, Barcelona, Spain
| | - Antonio Pay À
- Department of Medicine, Autonomous University of Barcelona, Barcelona, Spain.,Department of Gynecology and Obstetrics, Hospital del Mar, Barcelona, Spain
| | - David Benaiges
- Department of Endocrinology and Nutrition, Hospital del Mar, Barcelona, Spain.,Department of Medicine, Autonomous University of Barcelona, Barcelona, Spain
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4
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Ribas A, Chillarón JJ, Vázquez S, Carrera MJ, Galcerán I, Lorente L, Pascagaza A, Frances A, Sancho JJ, Zugazaga A, Clarà A, Crespo M, Oliveras A. Indicación, realización y resultado del cateterismo de venas adrenales en pacientes con hiperaldosteronismo primario. Nefrologia 2022. [DOI: 10.1016/j.nefro.2022.10.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
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5
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Martín-Peláez S, Serra-Majem L, Cano-Ibáñez N, Martínez-González MÁ, Salas-Salvadó J, Corella D, Lassale C, Martínez JA, Alonso-Gómez ÁM, Wärnberg J, Vioque J, Romaguera D, López-Miranda J, Estruch R, Tinahones FJ, Lapetra J, Fernández-Aranda F, Bueno-Cavanillas A, Tur JA, Martín V, Pintó X, Delgado-Rodríguez M, Matía P, Vidal J, Vázquez C, Daimiel L, Ros E, Toledo E, Nishi SK, Sorli JV, Malcampo M, Zulet MÁ, Moreno-Rodríguez A, Cueto-Galán R, Vivancos-Aparicio D, Colom A, García-Ríos A, Casas R, Bernal-López MR, Santos-Lozano JM, Vázquez Z, Gómez-Martínez C, Ortega-Azorín C, del Val JL, Abete I, Goikoetxea-Bahon A, Pascual E, Becerra-Tomás N, Chillarón JJ, Sánchez-Villegas A. Contribution of cardio-vascular risk factors to depressive status in the PREDIMED-PLUS Trial. A cross-sectional and a 2-year longitudinal study. PLoS One 2022; 17:e0265079. [PMID: 35417452 PMCID: PMC9007355 DOI: 10.1371/journal.pone.0265079] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Accepted: 02/13/2022] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Cardio-vascular disease and depression are thought to be closely related, due to shared risk factors. The aim of the study was to determine the association between cardio-vascular risk (CVR) factors and depressive status in a population (55-75 years) with metabolic syndrome (MetS) from the PREDIMED-Plus trial. METHODS AND FINDINGS Participants were classified into three groups of CVR according to the Framingham-based REGICOR function: (1) low (LR), (2) medium (MR) or (3) high/very high (HR). The Beck Depression Inventory-II (BDI-II) was used to assess depressive symptoms at baseline and after 2 years. The association between CVR and depressive status at baseline (n = 6545), and their changes after 2 years (n = 4566) were evaluated through multivariable regression models (logistic and linear models). HR women showed higher odds of depressive status than LR [OR (95% CI) = 1.78 (1.26, 2.50)]. MR and HR participants with total cholesterol <160 mg/mL showed higher odds of depression than LR [OR (95% CI) = 1.77 (1.13, 2.77) and 2.83 (1.25, 6.42) respectively)] but those with total cholesterol ≥280 mg/mL showed lower odds of depression than LR [OR (95% CI) = 0.26 (0.07, 0.98) and 0.23 (0.05, 0.95), respectively]. All participants decreased their BDI-II score after 2 years, being the decrease smaller in MR and HR diabetic compared to LR [adjusted mean±SE = -0.52±0.20, -0.41±0.27 and -1.25±0.31 respectively). MR and HR participants with total cholesterol between 240-279 mg/mL showed greater decreases in the BDI-II score compared to LR (adjusted mean±SE = -0.83±0.37, -0.77±0.64 and 0.97±0.52 respectively). CONCLUSIONS Improving cardiovascular health could prevent the onset of depression in the elderly. Diabetes and total cholesterol in individuals at high CVR, may play a specific role in the precise response. International Standard Randomized Controlled Trial (ISRCTN89898870).
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Affiliation(s)
- Sandra Martín-Peláez
- Department of Preventive Medicine and Public Health, University of Granada, Granada, Spain
- Instituto de Investigación Biosanitaria de Granada (ibs.GRANADA), Granada, Spain
- * E-mail:
| | - Lluis Serra-Majem
- Centro de Investigación Biomédica en Red Fisiopatología de la Obesidad y la Nutrición (CIBEROBN), Institute of Health Carlos III, Madrid, Spain
- Research Institute of Biomedical and Health Sciences (IUIBS), University of Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, Spain
| | - Naomi Cano-Ibáñez
- Department of Preventive Medicine and Public Health, University of Granada, Granada, Spain
- Instituto de Investigación Biosanitaria de Granada (ibs.GRANADA), Granada, Spain
- Centro de Investigación Biomédica en Red Epidemiología y Salud Pública (CIBERESP), Institute of Health Carlos III, Madrid, Spain
| | - Miguel Ángel Martínez-González
- Centro de Investigación Biomédica en Red Fisiopatología de la Obesidad y la Nutrición (CIBEROBN), Institute of Health Carlos III, Madrid, Spain
- Department of Preventive Medicine and Public Health, IdiSNA, University of Navarre, Pamplona, Spain
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America
| | - Jordi Salas-Salvadó
- Centro de Investigación Biomédica en Red Fisiopatología de la Obesidad y la Nutrición (CIBEROBN), Institute of Health Carlos III, Madrid, Spain
- Universitat Rovira i Virgili, Departament de Bioquímica i Biotecnologia, Unitat de Nutrició Humana. Reus, Spain
- University Hospital of Sant Joan de Reus, Nutrition Unit, Reus, Spain
- Institut d’Investigació Sanitària Pere Virgili (IISPV), Reus, Spain
| | - Dolores Corella
- Centro de Investigación Biomédica en Red Fisiopatología de la Obesidad y la Nutrición (CIBEROBN), Institute of Health Carlos III, Madrid, Spain
- Department of Preventive Medicine, University of Valencia, Valencia, Spain
| | - Camille Lassale
- Centro de Investigación Biomédica en Red Fisiopatología de la Obesidad y la Nutrición (CIBEROBN), Institute of Health Carlos III, Madrid, Spain
- Unit of Cardiovascular Risk and Nutrition, Institut Hospital del mar de Investigaciones Médicas Municipal d’Investigació Médica (IMIM), Barcelona, Spain
| | - Jose Alfredo Martínez
- Centro de Investigación Biomédica en Red Fisiopatología de la Obesidad y la Nutrición (CIBEROBN), Institute of Health Carlos III, Madrid, Spain
- Department of Nutrition, Food Sciences and Physiology, University of Navarra, Pamplona, Spain
- Precision Nutrition Program, IMDEA Food, CEI UAM + CSIC, Madrid, Spain
| | - Ángel M. Alonso-Gómez
- Centro de Investigación Biomédica en Red Fisiopatología de la Obesidad y la Nutrición (CIBEROBN), Institute of Health Carlos III, Madrid, Spain
- Bioaraba Health Research Institute, Cardiovascular, Respiratory and Metabolic Area; Osakidetza Basque Health Service, Araba University Hospital; University of the Basque Country UPV/EHU, Vitoria-Gasteiz, Spain
| | - Julia Wärnberg
- Centro de Investigación Biomédica en Red Fisiopatología de la Obesidad y la Nutrición (CIBEROBN), Institute of Health Carlos III, Madrid, Spain
- Department of Nursing, School of Health Sciences. University of Malaga- Instituto de Investigación Biomédica de Málaga (IBIMA), Málaga, Spain
| | - Jesús Vioque
- Centro de Investigación Biomédica en Red Epidemiología y Salud Pública (CIBERESP), Institute of Health Carlos III, Madrid, Spain
- Instituto de Investigación Sanitaria y Biomédica de Alicante, ISABIAL-UMH. Alicante, Spain
| | - Dora Romaguera
- Centro de Investigación Biomédica en Red Fisiopatología de la Obesidad y la Nutrición (CIBEROBN), Institute of Health Carlos III, Madrid, Spain
- Health Research Institute of the Balearic Islands (IdISBa), Palma de Mallorca, Spain
| | - José López-Miranda
- Centro de Investigación Biomédica en Red Fisiopatología de la Obesidad y la Nutrición (CIBEROBN), Institute of Health Carlos III, Madrid, Spain
- Lipids and Atherosclerosis Unit, Department of Internal Medicine, Maimonides Biomedical Research Institute of Córdoba (IMIBIC), Reina Sofía University Hospital, University of Córdoba, Córdoba, Spain
| | - Ramón Estruch
- Centro de Investigación Biomédica en Red Fisiopatología de la Obesidad y la Nutrición (CIBEROBN), Institute of Health Carlos III, Madrid, Spain
- Department of Internal Medicine, Institut dÌnvestigacions Biomèdiques August Pi Sunyer (IDIBAPS), Hospital Clinic, University of Barcelona, Barcelona, Spain
| | - Francisco J. Tinahones
- Centro de Investigación Biomédica en Red Fisiopatología de la Obesidad y la Nutrición (CIBEROBN), Institute of Health Carlos III, Madrid, Spain
- Virgen de la Victoria Hospital, Department of Endocrinology, Instituto de Investigación Biomédica de Málaga (IBIMA). University of Málaga, Málaga, Spain
| | - José Lapetra
- Centro de Investigación Biomédica en Red Fisiopatología de la Obesidad y la Nutrición (CIBEROBN), Institute of Health Carlos III, Madrid, Spain
- Department of Family Medicine, Research Unit, Distrito Sanitario Atención Primaria Sevilla, Sevilla, Spain
| | - Fernando Fernández-Aranda
- Centro de Investigación Biomédica en Red Fisiopatología de la Obesidad y la Nutrición (CIBEROBN), Institute of Health Carlos III, Madrid, Spain
- Research Institute of Biomedical and Health Sciences (IUIBS), University of Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, Spain
| | - Aurora Bueno-Cavanillas
- Department of Preventive Medicine and Public Health, University of Granada, Granada, Spain
- Instituto de Investigación Biosanitaria de Granada (ibs.GRANADA), Granada, Spain
- Centro de Investigación Biomédica en Red Epidemiología y Salud Pública (CIBERESP), Institute of Health Carlos III, Madrid, Spain
| | - Josep A. Tur
- Centro de Investigación Biomédica en Red Fisiopatología de la Obesidad y la Nutrición (CIBEROBN), Institute of Health Carlos III, Madrid, Spain
- Health Research Institute of the Balearic Islands (IdISBa), Palma de Mallorca, Spain
- Research Group on Community Nutrition & Oxidative Stress, University of Balearic Islands, Palma de Mallorca, Spain
| | - Vicente Martín
- Centro de Investigación Biomédica en Red Epidemiología y Salud Pública (CIBERESP), Institute of Health Carlos III, Madrid, Spain
- Institute of Biomedicine (IBIOMED), University of León, León, Spain
| | - Xavier Pintó
- Centro de Investigación Biomédica en Red Fisiopatología de la Obesidad y la Nutrición (CIBEROBN), Institute of Health Carlos III, Madrid, Spain
- Lipids and Vascular Risk Unit, Internal Medicine, Hospital Universitario de Bellvitge, Hospitalet de Llobregat, Barcelona, Spain
| | - Miguel Delgado-Rodríguez
- Instituto de Investigación Biosanitaria de Granada (ibs.GRANADA), Granada, Spain
- Center for Advanced Studies in Olive Grove and Olive Oils, University of Jaén, Jaén, Spain
| | - Pilar Matía
- Department of Endocrinology and Nutrition, Instituto de Investigación Sanitaria Hospital Clínico San Carlos (IdISSC), Madrid, Spain
| | - Josep Vidal
- CIBER Diabetes y Enfermedades Metabólicas (CIBERDEM), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
- Department of Endocrinology, Institut dÌnvestigacions Biomèdiques August Pi Sunyer (IDIBAPS), Hospital Clinic, University of Barcelona, Barcelona, Spain
| | - Clotilde Vázquez
- Department of Endocrinology and Nutrition, Hospital Fundación Jiménez-Díaz, Instituto de Investigaciones Biomédicas IISFJD. University Autónoma, Madrid, Spain
| | - Lidia Daimiel
- Nutritional Genomics and Epigenomics Group, IMDEA Food, CEI UAM + CSIC, Madrid, Spain
| | - Emili Ros
- Centro de Investigación Biomédica en Red Fisiopatología de la Obesidad y la Nutrición (CIBEROBN), Institute of Health Carlos III, Madrid, Spain
- Lipid Clinic, Department of Endocrinology and Nutrition, Institut d’Investigació Biomédiques August Pi Sunyer (IDIBAPS), Hospital Clinic, Barcelona, Spain
| | - Estefanía Toledo
- Centro de Investigación Biomédica en Red Fisiopatología de la Obesidad y la Nutrición (CIBEROBN), Institute of Health Carlos III, Madrid, Spain
- Department of Preventive Medicine and Public Health, IdiSNA, University of Navarre, Pamplona, Spain
| | - Stephanie K. Nishi
- Centro de Investigación Biomédica en Red Fisiopatología de la Obesidad y la Nutrición (CIBEROBN), Institute of Health Carlos III, Madrid, Spain
- Universitat Rovira i Virgili, Departament de Bioquímica i Biotecnologia, Unitat de Nutrició Humana. Reus, Spain
- University Hospital of Sant Joan de Reus, Nutrition Unit, Reus, Spain
- Institut d’Investigació Sanitària Pere Virgili (IISPV), Reus, Spain
| | - Jose V. Sorli
- Department of Preventive Medicine, University of Valencia, Valencia, Spain
| | - Mireia Malcampo
- Unit of Cardiovascular Risk and Nutrition, Institut Hospital del mar de Investigaciones Médicas Municipal d’Investigació Médica (IMIM), Barcelona, Spain
| | - M. Ángeles Zulet
- Department of Nutrition, Food Sciences and Physiology, University of Navarra, Pamplona, Spain
| | - Anaí Moreno-Rodríguez
- Centro de Investigación Biomédica en Red Fisiopatología de la Obesidad y la Nutrición (CIBEROBN), Institute of Health Carlos III, Madrid, Spain
- Bioaraba Health Research Institute, Cardiovascular, Respiratory and Metabolic Area; Osakidetza Basque Health Service, Araba University Hospital; University of the Basque Country UPV/EHU, Vitoria-Gasteiz, Spain
| | - Raquel Cueto-Galán
- Department of Nursing, School of Health Sciences. University of Malaga- Instituto de Investigación Biomédica de Málaga (IBIMA), Málaga, Spain
| | | | - Antoni Colom
- Centro de Investigación Biomédica en Red Fisiopatología de la Obesidad y la Nutrición (CIBEROBN), Institute of Health Carlos III, Madrid, Spain
- Health Research Institute of the Balearic Islands (IdISBa), Palma de Mallorca, Spain
| | - Antonio García-Ríos
- Centro de Investigación Biomédica en Red Fisiopatología de la Obesidad y la Nutrición (CIBEROBN), Institute of Health Carlos III, Madrid, Spain
- Lipids and Atherosclerosis Unit, Department of Internal Medicine, Maimonides Biomedical Research Institute of Córdoba (IMIBIC), Reina Sofía University Hospital, University of Córdoba, Córdoba, Spain
| | - Rosa Casas
- Department of Internal Medicine, Institut dÌnvestigacions Biomèdiques August Pi Sunyer (IDIBAPS), Hospital Clinic, University of Barcelona, Barcelona, Spain
| | - M Rosa Bernal-López
- Centro de Investigación Biomédica en Red Fisiopatología de la Obesidad y la Nutrición (CIBEROBN), Institute of Health Carlos III, Madrid, Spain
- Virgen de la Victoria Hospital, Department of Endocrinology, Instituto de Investigación Biomédica de Málaga (IBIMA). University of Málaga, Málaga, Spain
| | - Jose Manuel Santos-Lozano
- Centro de Investigación Biomédica en Red Fisiopatología de la Obesidad y la Nutrición (CIBEROBN), Institute of Health Carlos III, Madrid, Spain
- Department of Family Medicine, Research Unit, Distrito Sanitario Atención Primaria Sevilla, Sevilla, Spain
| | - Zenaida Vázquez
- Centro de Investigación Biomédica en Red Fisiopatología de la Obesidad y la Nutrición (CIBEROBN), Institute of Health Carlos III, Madrid, Spain
- Department of Preventive Medicine and Public Health, IdiSNA, University of Navarre, Pamplona, Spain
| | - Carlos Gómez-Martínez
- Centro de Investigación Biomédica en Red Fisiopatología de la Obesidad y la Nutrición (CIBEROBN), Institute of Health Carlos III, Madrid, Spain
- Universitat Rovira i Virgili, Departament de Bioquímica i Biotecnologia, Unitat de Nutrició Humana. Reus, Spain
- University Hospital of Sant Joan de Reus, Nutrition Unit, Reus, Spain
- Institut d’Investigació Sanitària Pere Virgili (IISPV), Reus, Spain
| | | | - Jose Luís del Val
- Centro de Investigación Biomédica en Red Fisiopatología de la Obesidad y la Nutrición (CIBEROBN), Institute of Health Carlos III, Madrid, Spain
- Unit of Cardiovascular Risk and Nutrition, Institut Hospital del mar de Investigaciones Médicas Municipal d’Investigació Médica (IMIM), Barcelona, Spain
| | - Itziar Abete
- Department of Nutrition, Food Sciences and Physiology, University of Navarra, Pamplona, Spain
| | - Amaia Goikoetxea-Bahon
- Centro de Investigación Biomédica en Red Fisiopatología de la Obesidad y la Nutrición (CIBEROBN), Institute of Health Carlos III, Madrid, Spain
- Bioaraba Health Research Institute, Cardiovascular, Respiratory and Metabolic Area; Osakidetza Basque Health Service, Araba University Hospital; University of the Basque Country UPV/EHU, Vitoria-Gasteiz, Spain
| | - Elena Pascual
- Centro de Investigación Biomédica en Red Fisiopatología de la Obesidad y la Nutrición (CIBEROBN), Institute of Health Carlos III, Madrid, Spain
- Department of Preventive Medicine and Public Health, IdiSNA, University of Navarre, Pamplona, Spain
| | - Nerea Becerra-Tomás
- Centro de Investigación Biomédica en Red Fisiopatología de la Obesidad y la Nutrición (CIBEROBN), Institute of Health Carlos III, Madrid, Spain
- Universitat Rovira i Virgili, Departament de Bioquímica i Biotecnologia, Unitat de Nutrició Humana. Reus, Spain
- University Hospital of Sant Joan de Reus, Nutrition Unit, Reus, Spain
- Institut d’Investigació Sanitària Pere Virgili (IISPV), Reus, Spain
| | - Juan J. Chillarón
- Centro de Investigación Biomédica en Red Fisiopatología de la Obesidad y la Nutrición (CIBEROBN), Institute of Health Carlos III, Madrid, Spain
- Unit of Cardiovascular Risk and Nutrition, Institut Hospital del mar de Investigaciones Médicas Municipal d’Investigació Médica (IMIM), Barcelona, Spain
| | - Almudena Sánchez-Villegas
- Centro de Investigación Biomédica en Red Fisiopatología de la Obesidad y la Nutrición (CIBEROBN), Institute of Health Carlos III, Madrid, Spain
- Research Institute of Biomedical and Health Sciences (IUIBS), University of Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, Spain
- Institute for Innovation & Sustainable Development in Food Chain. Universidad Pública de Navarra (UPNA), IdisNA, Pamplona, Spain
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Flores-Le Roux JA, Mañé L, Gabara C, Gortazar L, Pedro-Botet J, Chillarón JJ, Payà A, Benaiges D. Ethnic differences in the impact of gestational diabetes on macrosomia. MINERVA ENDOCRINOL 2021:S0391-1977.20.03301-5. [PMID: 33435645 DOI: 10.23736/s0391-1977.20.03301-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Previous studies reported an ethnic disparity in gestational diabetes mellitus-associated birth outcomes, with some suggesting that macrosomia increases to a lesser extent in groups at high risk, the opposite of the pattern observed by others. Our aim was to evaluate ethnic variation in the impact of gestational diabetes mellitus (GDM). METHODS A case-control study evaluating pregnancy outcomes was conducted in women with and without GDM from 5 ethnic groups. Data on GDM were collected between January 2004 and July 2017. Women giving birth between May 2013 and July 2017 in whom pre-existing diabetes had been ruled out served as controls. A multivariate logistic regression analysis was performed to determine factors independently associated with macrosomia. RESULTS 852 GDM women and 3,803 controls were included. In Caucasian and East-Asian women excessive gestational weight gain (OR 2.273, 95% CI 1.364-3.788 and OR 3.776, 95% CI 0.958-14.886) was an independent predictor of macrosomia. In Latin-American and Moroccan women, obesity (OR 1.774, 95% CI 1.219-2.581 and OR 1.656, 95% CI 1.054-2.601), GDM (OR 2.440; 95% CI 1.048-5.679 and OR 3.249, 95% CI 1.269-8.321) and gestational weight gain but only for Latin-American women (OR 2.365, 95% CI 1.039-5.384) were associated with macrosomia. In South-Central Asian women, only GDM was associated with macrosomia (OR 3.701, 95% CI 1.437-9.532). CONCLUSIONS GDM is an independent predictor of macrosomia in Latin-American, South-Central Asian and Moroccan women but not in Caucasian or East-Asian women in whom other factors play a more important role.
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Affiliation(s)
- Juana A Flores-Le Roux
- Department of Endocrinology and Nutrition, Hospital del Mar, Barcelona, Spain - .,Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain -
| | - Laura Mañé
- Department of Endocrinology and Nutrition, Hospital del Mar, Barcelona, Spain.,Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Cristina Gabara
- Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Lucía Gortazar
- Department of Endocrinology and Nutrition, Hospital del Mar, Barcelona, Spain.,Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Juan Pedro-Botet
- Department of Endocrinology and Nutrition, Hospital del Mar, Barcelona, Spain.,Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Juan J Chillarón
- Department of Endocrinology and Nutrition, Hospital del Mar, Barcelona, Spain.,Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Antonio Payà
- Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain.,Department of Gynaecology and Obstetrics, Hospital del Mar, Barcelona, Spain
| | - David Benaiges
- Department of Endocrinology and Nutrition, Hospital del Mar, Barcelona, Spain.,Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
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7
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Ballesta S, Güerri-Fernández RC, Chillarón JJ, Güell A, Herrera S, Torres E, Ascoeta NG, Flores Le-Roux JA, Díez A. The use of microindentation for the study of bone properties in type 1 diabetes mellitus patients. Osteoporos Int 2020; 31:175-180. [PMID: 31641800 DOI: 10.1007/s00198-019-05178-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2019] [Accepted: 09/24/2019] [Indexed: 11/27/2022]
Abstract
UNLABELLED Diabetes mellitus is associated with a higher risk of fracture. In this study, we analysed the bone quality of premenopausal women with type 1 diabetes mellitus by microindentation. No differences in bone quality were identified between patients and healthy controls, suggesting that intensive insulin therapy can preserve bone health. PURPOSE To compare the bone quality of women with type 1 diabetes mellitus (T1DM) and healthy controls, and to determine the relationship with bone mineral density (BMD). METHODS This was a cross-sectional study of 45 premenopausal women with T1DM and 21 healthy controls, matched according to age and BMI. Clinical parameters, BMD and bone tissue mechanical properties (assessed using the bone material strength index [BMSi]) were evaluated in each group using microindentation. In T1DM patients, glycosylated haemoglobin (HbA1c), the number of hypoglycaemic events and the status of chronic complications were also analysed. RESULTS No differences in BMSi or BMD between T1DM patients and healthy controls were identified. In the T1DM patients, the mean HbA1c was 7.52% ± 1.00% and the mean time elapsed since diagnosis was 22.6 ± 12.2 years. Eight patients (17.7%) met the criteria for metabolic syndrome (MetS), and microvascular complications were present in 12 patients (26.7%). Neither the number of features of MetS present nor the presence of microangiopathy was found to be associated with BMSi. CONCLUSIONS T1DM premenopausal patients showed bone tissue properties comparable to those shown by controls. Further larger-scale studies should be conducted to confirm these results.
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Affiliation(s)
- S Ballesta
- Department of Endocrinology and Nutrition, Hospital del Mar, PasseigMarítim, 25-29, 08003, Barcelona, Spain
- Department of Medicine, Universitat Autònoma de Barcelona, Cerdanyola del Vallès, Spain
| | - R C Güerri-Fernández
- Department of Medicine, Universitat Autònoma de Barcelona, Cerdanyola del Vallès, Spain
- Department of Internal Medicine, Hospital del Mar, Barcelona, Spain
- IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
| | - J J Chillarón
- Department of Endocrinology and Nutrition, Hospital del Mar, PasseigMarítim, 25-29, 08003, Barcelona, Spain.
- Department of Medicine, Universitat Autònoma de Barcelona, Cerdanyola del Vallès, Spain.
- IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain.
| | - A Güell
- Department of Medicine, Universitat Autònoma de Barcelona, Cerdanyola del Vallès, Spain
- Department of Medicine, Universitat Pompeu Fabra, Barcelona, Spain
| | - S Herrera
- Department of Medicine, Universitat Autònoma de Barcelona, Cerdanyola del Vallès, Spain
- Department of Internal Medicine, Hospital del Mar, Barcelona, Spain
| | - E Torres
- Department of Internal Medicine, Hospital del Mar, Barcelona, Spain
| | - N G Ascoeta
- Department of Endocrinology and Nutrition, Hospital del Mar, PasseigMarítim, 25-29, 08003, Barcelona, Spain
| | - J A Flores Le-Roux
- Department of Endocrinology and Nutrition, Hospital del Mar, PasseigMarítim, 25-29, 08003, Barcelona, Spain
- Department of Medicine, Universitat Autònoma de Barcelona, Cerdanyola del Vallès, Spain
- IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
| | - A Díez
- Department of Medicine, Universitat Autònoma de Barcelona, Cerdanyola del Vallès, Spain
- Department of Internal Medicine, Hospital del Mar, Barcelona, Spain
- IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
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8
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Mañé L, Flores-Le Roux JA, Pedro-Botet J, Gortazar L, Chillarón JJ, Llauradó G, Payà A, Benaiges D. Is fasting plasma glucose in early pregnancy a better predictor of adverse obstetric outcomes than glycated haemoglobin? Eur J Obstet Gynecol Reprod Biol 2019; 234:79-84. [PMID: 30665080 DOI: 10.1016/j.ejogrb.2018.12.036] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2018] [Revised: 12/18/2018] [Accepted: 12/27/2018] [Indexed: 11/15/2022]
Abstract
OBJECTIVES To determine, in a multi-ethnic cohort, the suitability of first-trimester fasting plasma glucose and HbA1c levels in non-diabetic range to identify women without diabetes at increased pregnancy risk. STUDY DESIGN A retrospective analysis of a prospective cohort between April 2013 and September 2015. Universal testing for fasting plasma glucose and HbA1c levels at the first antenatal blood sampling was performed and women were screened for gestational diabetes mellitus at 24-28 weeks' gestation. Primary outcomes were macrosomia and pre-eclampsia, and secondary outcomes preterm delivery, Caesarean section and large-for-gestational age. Different fasting plasma glucose and HbA1c cut-off levels were assessed for associations with outcomes. RESULTS 1,228 pregnancies were included for outcome analysis. After adjustment for potential confounders, no association was found between fasting plasma glucose levels and pregnancy outcomes. Women with an HbA1c ≥5.8% (39.9 mmol/mol) showed an increased risk of macrosomia (OR 2.69, 95% CI 1.16-6.24); an HbA1c ≥5.9% (41 mmol/mol) threshold was independently associated with a three-fold risk of pre-eclampsia (95% CI 1.03-9.9) and an HbA1c ≥6.0% (42.1 mmol/mol) with a four-fold risk of large-for-gestational age (95% CI 1.49-11.07). CONCLUSIONS In a multi-ethnic population, first-trimester fasting plasma glucose levels were not a better predictor of pregnancy complications than HbA1c. Further, an early HbA1c ≥5.8% (39.9 mmol/mol) threshold is already associated with an increased risk of macrosomia.
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Affiliation(s)
- Laura Mañé
- Department of Endocrinology and Nutrition, Hospital del Mar, E-08003, Barcelona, Spain; Department of Medicine, Universitat Autònoma de Barcelona, Campus del Mar, E-08003, Barcelona, Spain.
| | - Juana A Flores-Le Roux
- Department of Endocrinology and Nutrition, Hospital del Mar, E-08003, Barcelona, Spain; Department of Medicine, Universitat Autònoma de Barcelona, Campus del Mar, E-08003, Barcelona, Spain.
| | - Juan Pedro-Botet
- Department of Endocrinology and Nutrition, Hospital del Mar, E-08003, Barcelona, Spain; Department of Medicine, Universitat Autònoma de Barcelona, Campus del Mar, E-08003, Barcelona, Spain.
| | - Lucía Gortazar
- Department of Endocrinology and Nutrition, Hospital del Mar, E-08003, Barcelona, Spain.
| | - Juan J Chillarón
- Department of Endocrinology and Nutrition, Hospital del Mar, E-08003, Barcelona, Spain; Department of Medicine, Universitat Autònoma de Barcelona, Campus del Mar, E-08003, Barcelona, Spain.
| | - Gemma Llauradó
- Department of Endocrinology and Nutrition, Hospital del Mar, E-08003, Barcelona, Spain; Department of Medicine, Universitat Autònoma de Barcelona, Campus del Mar, E-08003, Barcelona, Spain.
| | - Antonio Payà
- Department of Medicine, Universitat Autònoma de Barcelona, Campus del Mar, E-08003, Barcelona, Spain; Department of Gynaecology and Obstetrics, Hospital del Mar, E-08003, Barcelona, Spain.
| | - David Benaiges
- Department of Endocrinology and Nutrition, Hospital del Mar, E-08003, Barcelona, Spain; Department of Medicine, Universitat Autònoma de Barcelona, Campus del Mar, E-08003, Barcelona, Spain.
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9
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Prados M, Flores-Le Roux JA, Benaiges D, Llauradó G, Chillarón JJ, Paya A, Pedro-Botet J. Previous Gestational Diabetes Increases Atherogenic Dyslipidemia in Subsequent Pregnancy and Postpartum. Lipids 2018; 53:387-392. [PMID: 29732563 DOI: 10.1002/lipd.12040] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2017] [Revised: 02/08/2018] [Accepted: 03/14/2018] [Indexed: 11/10/2022]
Abstract
In a cohort of women with previous gestational diabetes mellitus (GDM), we aimed to ascertain whether women with abnormal glucose tolerance 1-year postdelivery had a more atherogenic lipid profile during and after pregnancy than those with normal glucose tolerance. A prospective cohort study with longitudinal design between January 2004 and March 2016 was conducted. Three hundred and six (56.8%) of 537 women diagnosed with GDM during the studied period attended a control visit during the first year after delivery. Of these, 112 (36.6%) had prediabetes and 16 (5.2%) had type 2 diabetes mellitus. No significant differences during pregnancy were found in total, low-density lipoprotein, high-density lipoprotein (HDL) cholesterol, and triacylglycerol (TAG) concentrations among the three groups. Only HDL cholesterol and TAG levels differed significantly among groups at 2 and 12 months after delivery. Logistic regression analysis revealed pregnancy HDL and glucose metabolism status to be associated with the HDL cholesterol concentration 1-year postdelivery. Furthermore, the only independent factor associated with TAG levels 1 year after delivery was the gestational TAG concentration. In summary, an overweight multiethnic group of women with prior GDM presented a high incidence of postpartum dysglycemia (41.8%). HDL-cholesterol and TAG levels, both components of the metabolic syndrome, differed significantly among the three study groups in the glucose-metabolism status at 2 and 12 months after delivery. Women with previous GDM must be followed up in the postpartum period for early detection and management of lipid and glucose disorders.
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Affiliation(s)
- Montserrat Prados
- Department of Internal Medicine, Hospital Sant Joan de Deu de Martorell, Mancomunitats Comarcals Avenue 1-3, Martorell, 08760 Barcelona, Spain.,Department of Medicine, Universitat Autònoma de Barcelona, Passeig Vall d'Hebron 119-129, 08035 Barcelona, Spain
| | - Juana A Flores-Le Roux
- Department of Medicine, Universitat Autònoma de Barcelona, Passeig Vall d'Hebron 119-129, 08035 Barcelona, Spain.,Endocrinology and Nutrition Department, Hospital del Mar Barcelona, Passeig Marítim 25-29, 08003 Barcelona, Spain
| | - David Benaiges
- Department of Medicine, Universitat Autònoma de Barcelona, Passeig Vall d'Hebron 119-129, 08035 Barcelona, Spain.,Endocrinology and Nutrition Department, Hospital del Mar Barcelona, Passeig Marítim 25-29, 08003 Barcelona, Spain
| | - Gemma Llauradó
- Endocrinology and Nutrition Department, Hospital del Mar Barcelona, Passeig Marítim 25-29, 08003 Barcelona, Spain
| | - Juan J Chillarón
- Department of Medicine, Universitat Autònoma de Barcelona, Passeig Vall d'Hebron 119-129, 08035 Barcelona, Spain.,Endocrinology and Nutrition Department, Hospital del Mar Barcelona, Passeig Marítim 25-29, 08003 Barcelona, Spain
| | - Antoni Paya
- Obstetrics and Gynaecology Department, Hospital del Mar Barcelona, Passeig Marítim 25-29, 08003 Barcelona, Spain
| | - Juan Pedro-Botet
- Department of Medicine, Universitat Autònoma de Barcelona, Passeig Vall d'Hebron 119-129, 08035 Barcelona, Spain.,Endocrinology and Nutrition Department, Hospital del Mar Barcelona, Passeig Marítim 25-29, 08003 Barcelona, Spain
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10
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Benaiges D, Flores-Le Roux JA, Marcelo I, Mañé L, Rodríguez M, Navarro X, Chillarón JJ, Llauradó G, Gortazar L, Pedro-Botet J, Payà A. Is first-trimester HbA1c useful in the diagnosis of gestational diabetes? Diabetes Res Clin Pract 2017; 133:85-91. [PMID: 28918341 DOI: 10.1016/j.diabres.2017.08.019] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2017] [Revised: 07/17/2017] [Accepted: 08/22/2017] [Indexed: 10/19/2022]
Abstract
AIMS To evaluate the usefulness and efficacy of first-trimester HbA1c in the diagnosis of gestational diabetes (GDM). METHODS Prospective observational of consecutive pregnant women. All women had a first-trimester HbA1c determination and GDM screening at 24-28weeks of pregnancy using a two-step approach. A ROC curve was drawn to determine the sensitivity and specificity of HbA1c in detecting GDM and a rule-in rule-out diagnostic algorithm was proposed. The cost of the proposed algorithm was calculated. RESULTS 152 (13.1%) of 1195 women were diagnosed of GDM. The area under the ROC curve for HbA1c to detect GDM was 0.679 (95%CI 0.631-0.727). A rule-out threshold for HbA1c of 4.8% (29mmol/mol) had 96.7% sensitivity (95%CI 93.9-99.5), 10.1% specificity (95%CI 8.3-12.0) and a negative predictive value of 95.3% (95%CI 91.3-99.3). A rule-in value of 5.6% (38mmol/mol) had a positive predictive value of 31.6% (95%CI 24.4-38.9), 89.3% specificity (95%CI 87.4-91.2) and 32.9% sensitivity (95%CI 25.4-40.4). The low positive predictive value of the rule-in threshold precludes its use for GDM diagnosis, but could be used to identify women at high risk of GDM in whom the diagnosis can be established using a one-step approach. The overall saving of the proposed algorithm would be 6.5% of the total cost with the standard strategy. CONCLUSIONS A first-trimester HbA1c does not have sufficient sensitivity or specificity to diagnose GDM, although the use of a higher and lower threshold could simplify the diagnostic process by reducing the number of oral glucose tolerance test, associated costs and patient inconvenience.
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Affiliation(s)
- David Benaiges
- Department of Endocrinology and Nutrition, Hospital del Mar, Passeig Marítim, 25-29, 08003 Barcelona, Spain; Department of Medicine, Universitat Pompeu Fabra, Campus del Mar, Passeig Marítim, 25-29, 08003 Barcelona, Spain; Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Passeig Marítim, 25-29, 08003 Barcelona, Spain.
| | - Juana A Flores-Le Roux
- Department of Endocrinology and Nutrition, Hospital del Mar, Passeig Marítim, 25-29, 08003 Barcelona, Spain; Department of Medicine, Universitat Pompeu Fabra, Campus del Mar, Passeig Marítim, 25-29, 08003 Barcelona, Spain; Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Passeig Marítim, 25-29, 08003 Barcelona, Spain
| | - Irene Marcelo
- Department of Medicine, Universitat Pompeu Fabra, Campus del Mar, Passeig Marítim, 25-29, 08003 Barcelona, Spain
| | - Laura Mañé
- Department of Endocrinology and Nutrition, Hospital del Mar, Passeig Marítim, 25-29, 08003 Barcelona, Spain; Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Passeig Marítim, 25-29, 08003 Barcelona, Spain
| | - Marta Rodríguez
- Department of Medicine, Universitat Pompeu Fabra, Campus del Mar, Passeig Marítim, 25-29, 08003 Barcelona, Spain
| | - Xavier Navarro
- Laboratori de Referència de Catalunya, Carrer de la Selva, 10, 08820 Prat de Llobregat, Spain
| | - Juan J Chillarón
- Department of Endocrinology and Nutrition, Hospital del Mar, Passeig Marítim, 25-29, 08003 Barcelona, Spain; Department of Medicine, Universitat Pompeu Fabra, Campus del Mar, Passeig Marítim, 25-29, 08003 Barcelona, Spain; Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Passeig Marítim, 25-29, 08003 Barcelona, Spain
| | - Gemma Llauradó
- Department of Endocrinology and Nutrition, Hospital del Mar, Passeig Marítim, 25-29, 08003 Barcelona, Spain; Department of Medicine, Universitat Pompeu Fabra, Campus del Mar, Passeig Marítim, 25-29, 08003 Barcelona, Spain; Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Passeig Marítim, 25-29, 08003 Barcelona, Spain
| | - Lucia Gortazar
- Department of Endocrinology and Nutrition, Hospital del Mar, Passeig Marítim, 25-29, 08003 Barcelona, Spain; Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Passeig Marítim, 25-29, 08003 Barcelona, Spain
| | - Juan Pedro-Botet
- Department of Endocrinology and Nutrition, Hospital del Mar, Passeig Marítim, 25-29, 08003 Barcelona, Spain; Department of Medicine, Universitat Pompeu Fabra, Campus del Mar, Passeig Marítim, 25-29, 08003 Barcelona, Spain; Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Passeig Marítim, 25-29, 08003 Barcelona, Spain
| | - Antonio Payà
- Department of Medicine, Universitat Pompeu Fabra, Campus del Mar, Passeig Marítim, 25-29, 08003 Barcelona, Spain; Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Passeig Marítim, 25-29, 08003 Barcelona, Spain; Department of Gynecology and Obstetrics, Hospital del Mar, Passeig Marítim, 25-29, 08003 Barcelona, Spain
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11
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Climent E, Benaiges D, Pedro-Botet J, Flores-Le Roux JA, Ramón JM, Villatoro M, Fontané L, Chillarón JJ, Goday A. Atherogenic Dyslipidemia Remission 1 Year After Bariatric Surgery. Obes Surg 2016; 27:1548-1553. [DOI: 10.1007/s11695-016-2504-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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12
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Fernández-Miró M, Chillarón JJ, Albareda M, Fontserè S, Colom C, Vila L, Pedro-Botet J, Flores LE-Roux JA. Hypertriglyceridemic waist in type 1 diabetes patients: prevalence and related factors. MINERVA ENDOCRINOL 2016; 42:1-7. [PMID: 27824243 DOI: 10.23736/s0391-1977.16.02561-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND The hypertriglyceridemic waist has been linked to a higher number of cardiovascular risk factors and a greater probability of developing diabetes and cardiovascular disease. Around 50% of individuals with type 1 diabetes (T1D) are overweight or obese and triglyceridemia is associated with the onset of micro- and macrovascular complications. METHODS A cross-sectional study was conducted in men with T1D to assess the association between the prevalence of hypertriglyceridemic waist and cardiovascular risk factors and hypogonadism. Triglyceride levels + abdominal circumference taken together were stratified into quartiles to identify the hypertriglyceridemic waist phenotype. RESULTS One hundred and eighty-one male patients were included. An increased prevalence of hypogonadism and hypertension in parallel to increased triglyceride + waist circumference quartile was observed. Patients in the highest quartile had higher insulin resistance measured by estimated glucose disposal rate (eGDR 7.8±2.1 mg/kg-1.min-1 in 1st quartile vs. 5.8±1.8 mg/kg-1.min-1 in 4th quartile, P=0.000), insulin requirements, hip circumference, percentage of fat mass, glycosilated hemoglobin and total and LDL cholesterol as well as lower levels of total testosterone (27.24±9.3 nmol/L in 1st quartile vs. 17.4±8 nmol/L in 4th quartile, P=0.000) and HDL cholesterol. An inverse relationship was found between triglycerides + waist circumference and total testosterone levels (R=-0.367, P<0.0001). CONCLUSIONS The hypertriglyceridemic waist in men with T1D is associated with an atherogenic lipid profile, hypertension, worse metabolic diabetes control, increased insulin resistance and a higher prevalence of hypogonadism.
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Affiliation(s)
- Mercè Fernández-Miró
- Department of Internal Medicine-Endocrinology and Nutrition, Centre d'Atenció Integral Dos de Maig, Barcelona, Spain.,Department of Medicine, Universitat Autònoma de Barcelona, Cerdanyola del Vallès, Spain
| | - Juan J Chillarón
- Department of Medicine, Universitat Autònoma de Barcelona, Cerdanyola del Vallès, Spain - ; Department of Endocrinology and Nutrition, Hospital del Mar, Barcelona, Spain; IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
| | - Mercè Albareda
- Department of Endocrinology and Nutrition, Hospital de Sant Joan Despí Moisès Broggi, Sant Joan Despí, Spain
| | - Sara Fontserè
- Department of Medicine, Universitat Autònoma de Barcelona, Cerdanyola del Vallès, Spain.,Department of Medicine, Universitat Pompeu Fabra, Barcelona, Spain
| | - Cristina Colom
- Department of Internal Medicine-Endocrinology and Nutrition, Centre d'Atenció Integral Dos de Maig, Barcelona, Spain
| | - Lluís Vila
- Department of Endocrinology and Nutrition, Hospital de Sant Joan Despí Moisès Broggi, Sant Joan Despí, Spain
| | - Juan Pedro-Botet
- Department of Medicine, Universitat Autònoma de Barcelona, Cerdanyola del Vallès, Spain; Department of Endocrinology and Nutrition, Hospital del Mar, Barcelona, Spain; IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
| | - Juana A Flores LE-Roux
- Department of Medicine, Universitat Autònoma de Barcelona, Cerdanyola del Vallès, Spain; Department of Endocrinology and Nutrition, Hospital del Mar, Barcelona, Spain; IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
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13
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Pedro-Botet J, Millán Núñez-Cortés J, Chillarón JJ, Flores-Le Roux JA, Rius J. Severity of statin-induced adverse effects on muscle and associated conditions: data from the DAMA study. Expert Opin Drug Saf 2016; 15:1583-1587. [PMID: 27645494 DOI: 10.1080/14740338.2016.1238068] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
BACKGROUND Statins are generally well tolerated, but muscular adverse effects appear to be the most common obstacle limiting their use. Our objective was to describe the severity of muscle injury (myalgia, myositis and rhabdomyolysis) and associated conditions related to statin therapy that may be clinically significant. METHODS A cross-sectional one-visit, non-interventional, national multicenter study including patients of both sexes over 18 years of age referred for past or present muscle symptoms associated with statin therapy was conducted. Clinical, biochemical and drug therapy characteristics were obtained at the initial evaluation. RESULTS 3,845 patients were recruited from a one-day record from 2,001 physicians. Myalgia was present in 78.2% of patients, myositis in 19.3% and rhabdomyolysis in 2.5%. The prevalence of different comorbidities such as diabetes, hypertension, atrial fibrillation, and coronary heart disease increased as the severity of myopathy rose. High-intensity statin therapy was used in 33.4% of patients. Concomitant drugs metabolized by the CYP450 3A4 pathway were taken by 9.3% of patients, and statins with this metabolic route by 75%. Independent variables associated with myositis or rhabdomyolysis compared with myalgia alone in the multivariate model were excessive alcohol consumption and pravastatin therapy. CONCLUSION Myalgia was the most common muscle adverse effect associated with statin therapy. Excessive alcohol consumption and pravastatin were independently associated with myositis or rhabdomyolysis.
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Affiliation(s)
- Juan Pedro-Botet
- a Unidad de Lípidos y Riesgo Vascular. Endocrinology and Nutrition Department , Hospital del Mar, Universidad Autónoma de Barcelona , Barcelona , Spain
| | - Jesús Millán Núñez-Cortés
- b Unidad de Lípidos , Hospital Universitario Gregorio Marañón, Universidad Complutense , Madrid , Spain
| | - Juan J Chillarón
- a Unidad de Lípidos y Riesgo Vascular. Endocrinology and Nutrition Department , Hospital del Mar, Universidad Autónoma de Barcelona , Barcelona , Spain
| | - Juana A Flores-Le Roux
- a Unidad de Lípidos y Riesgo Vascular. Endocrinology and Nutrition Department , Hospital del Mar, Universidad Autónoma de Barcelona , Barcelona , Spain
| | - Joan Rius
- c Medical Department , Medicina Familiar y Comunitaria , Barcelona , Spain
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Chillarón JJ, Fernández-Miró M, Albareda M, Fontserè S, Colom C, Vila L, Pedro-Botet J, Flores Le-Roux JA. Testosterone undecanoate improves lipid profile in patients with type 1 diabetes and hypogonadotrophic hypogonadism. Endocr J 2016; 63:849-855. [PMID: 27452372 DOI: 10.1507/endocrj.ej16-0195] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
UNLABELLED Testosterone deficiency (Td) has been associated with the metabolic syndrome. Few studies have evaluated this condition in type 1 diabetes (T1D). The primary aim of this study was to evaluate the effectiveness of testosterone undecanoate (TU) on insulin sensitivity, glycemic control, anthropometric parameters, blood pressure and lipid profile in patients with Td and T1D. We performed a randomized placebo-controlled multicenter study. INCLUSION CRITERIA a) age ≥ 18 years; b) autoimmune diabetes; c) Td (total testosterone <10 nmol/L or calculated free testosterone <225 pmol/L and low/normal LH; d) ability to sign informed consent; e) comply with the study protocol. EXCLUSION CRITERIA a) pituitary tumor, empty sella, hyperprolactinemia, panhypopituitarism or secondary hypogonadism; b) contraindications for treatment with testosterone undecanoate (TU); c) patients who did not agree to sign their informed consent. Six patients were randomly assigned to testosterone undecanoate (TU) treatment and 7 to placebo with the following dosing schedule: baseline, 6 weeks and 16 weeks. Blood test, anthropometric parameters, blood pressure and insulin sensitivity were determined at baseline, 6, 16 and 22 weeks. No differences were observed regarding insulin sensitivity, HbA1c or basal glucose, anthropometric parameters or blood pressure. At 22 weeks, the decrease in total cholesterol was 37.4 ± 27.5 mg/dL in the TU group compared with an increase of 13.2 ± 17.8 mg/dL in the placebo group (P<0.005), and LDL cholesterol concentration decreased 30.2 ± 22.1 mg/dL, compared with an increase of 10.5 ± 13.4 mg/dL in the placebo group (P=0.004). We conclude that treatment with TU in patients with T1D and Td improves lipid profile, with no effects on metabolic control or anthropometric parameters.
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Affiliation(s)
- Juan J Chillarón
- Department of Endocrinology and Nutrition, Hospital del Mar, Barcelona, Spain
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15
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Benaiges D, Sagué M, Flores-Le Roux JA, Pedro-Botet J, Ramón JM, Villatoro M, Chillarón JJ, Pera M, Más A, Grande L, Goday A. Response to "When will physical activity be routinely measured in the clinical setting? The case for bariatric surgery". Am J Hypertens 2016; 29:e2. [PMID: 27507079 DOI: 10.1093/ajh/hpw064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2016] [Accepted: 05/31/2016] [Indexed: 11/13/2022] Open
Affiliation(s)
| | - María Sagué
- Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
| | | | | | - José M Ramón
- Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Barcelona, Spain; Department of General Surgery, Hospital del Mar, Barcelona, Spain
| | | | | | - Manuel Pera
- Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Barcelona, Spain; Department of General Surgery, Hospital del Mar, Barcelona, Spain
| | - Antonio Más
- Department of Endocrinology and Nutrition, Hospital del Mar, Barcelona, Spain
| | - Luis Grande
- Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Barcelona, Spain; Department of General Surgery, Hospital del Mar, Barcelona, Spain
| | - Albert Goday
- CiberOBN, Instituto de Salud Carlos III, Santiago de Compostela, Spain
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Benaiges D, Sagué M, Flores-Le Roux JA, Pedro-Botet J, Ramón JM, Villatoro M, Chillarón JJ, Pera M, Más A, Grande L, Goday A. Predictors of Hypertension Remission and Recurrence After Bariatric Surgery. Am J Hypertens 2016; 29:653-9. [PMID: 26350297 DOI: 10.1093/ajh/hpv153] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2015] [Accepted: 08/11/2015] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Few data exist on factors associated with hypertension (HTN) remission post-bariatric surgery. No information on factors that may predict HTN relapse is available. The aims were to assess the HTN remission and relapse rates at 1 and 3 years, respectively, post-bariatric surgery, and determine predictive factors. METHODS A nonrandomized prospective cohort study on severely obese patients undergoing laparoscopic Roux-en-Y gastric bypass (LRYGB) or laparoscopic sleeve gastrectomy (LSG) with a follow-up of 36 months was conducted between 2005 and 2011. Criteria for HTN diagnosis were current treatment with antihypertensive agents and/or systolic blood pressure (BP) >140 mm Hg and/or diastolic BP >90 mm Hg. HTN remission was defined as normalization of BP maintained after discontinuation of medical treatment. RESULTS A total of 197 patients were included in the study. HTN was present in 47.7%; 68.1% of hypertensive patients showed HTN remission 1 year after the surgical procedure, 21.9% of whom had relapsed at 3 years. The number of antihypertensive drugs prior to surgery was associated with a lower remission rate at the first year and a higher recurrence at 3 years. However, a smaller weight loss during the first year was associated with increased HTN recurrence at 3 years. CONCLUSION HTN relapses in 1 of 5 hypertensives who have achieved remission at the first year of follow-up. Weight loss during the first postoperative year should be encouraged to avoid HTN relapse at 3 years.
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Affiliation(s)
- David Benaiges
- Department of Endocrinology and Nutrition, Hospital del Mar, Barcelona, Spain; Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain; Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Barcelona, Spain;
| | - María Sagué
- Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Juana A Flores-Le Roux
- Department of Endocrinology and Nutrition, Hospital del Mar, Barcelona, Spain; Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain; Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Barcelona, Spain
| | - Juan Pedro-Botet
- Department of Endocrinology and Nutrition, Hospital del Mar, Barcelona, Spain; Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain; Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Barcelona, Spain
| | - José M Ramón
- Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Barcelona, Spain; Department of General Surgery, Hospital del Mar, Barcelona, Spain
| | | | - Juan J Chillarón
- Department of Endocrinology and Nutrition, Hospital del Mar, Barcelona, Spain; Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain; Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Barcelona, Spain
| | - Manuel Pera
- Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Barcelona, Spain; Department of General Surgery, Hospital del Mar, Barcelona, Spain
| | - Antonio Más
- Department of Endocrinology and Nutrition, Hospital del Mar, Barcelona, Spain
| | - Luis Grande
- Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Barcelona, Spain; Department of General Surgery, Hospital del Mar, Barcelona, Spain
| | - Albert Goday
- Department of Endocrinology and Nutrition, Hospital del Mar, Barcelona, Spain; Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain; Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Barcelona, Spain; CiberOBN, Instituto de Salud Carlos III, Santiago de Compostela, Spain
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Pedro-Botet J, Chillarón JJ, Benaiges D, Flores-Le Roux JA. [Cardiovascular prevention in diabetes mellitus: A multifactorial challenge]. Clin Investig Arterioscler 2015; 28:154-63. [PMID: 26655375 DOI: 10.1016/j.arteri.2015.10.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/01/2015] [Accepted: 10/07/2015] [Indexed: 12/21/2022]
Abstract
Patients with type2 diabetes mellitus have a high to very high cardiovascular risk, and often have other associated risk factors, such as hypertension, obesity and dyslipidaemia. Cardiovascular disease is the leading cause of morbidity and mortality in this population. An integrated control of all risk factors in patients with diabetes is essential for minimising the risk of macrovascular complications. Given the benefits of the multifactorial intervention strategies for cardiovascular prevention in diabetic patients, a review is presented on the therapeutic goals established for each risk factor in diabetes and the benefits of their control.
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Affiliation(s)
- Juan Pedro-Botet
- Servicio de Endocrinología y Nutrición, Hospital del Mar, Departament de Medicina, Universitat Autònoma de Barcelona, Barcelona, España.
| | - Juan J Chillarón
- Servicio de Endocrinología y Nutrición, Hospital del Mar, Departament de Medicina, Universitat Autònoma de Barcelona, Barcelona, España
| | - David Benaiges
- Servicio de Endocrinología y Nutrición, Hospital del Mar, Departament de Medicina, Universitat Autònoma de Barcelona, Barcelona, España
| | - Juana A Flores-Le Roux
- Servicio de Endocrinología y Nutrición, Hospital del Mar, Departament de Medicina, Universitat Autònoma de Barcelona, Barcelona, España
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Benaiges D, Garcia-Retortillo M, Mas A, Cañete N, Broquetas T, Puigvehi M, Chillarón JJ, Flores-Le Roux JA, Sagarra E, Cabrero B, Zaffalon D, Solà R, Pedro-Botet J, Carrión JA. Clinical Value of Thyrotropin Receptor Antibodies for the Differential Diagnosis of Interferon Induced Thyroiditis. Exp Clin Endocrinol Diabetes 2015; 124:39-44. [PMID: 26575116 DOI: 10.1055/s-0035-1565071] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
OBJECTIVE The clinical value of thyrotropin receptor antibodies for the differential diagnosis of thyrotoxicosis induced by pegylated interferon-alpha remains unknown. We analyzed the diagnostic accuracy of thyrotropin receptor antibodies in the differential diagnosis of thyrotoxicosis in patients with chronic hepatitis C (CHC) receiving pegylated interferon-alpha plus ribavirin. METHODS Retrospective analysis of 274 patients with CHC receiving pegylated interferon-alpha plus ribavirin. Interferon-induced thyrotoxicosis was classified according to clinical guidelines as Graves disease, autoimmune and non- autoimmune destructive thyroiditis. RESULTS 48 (17.5%) patients developed hypothyroidism, 17 (6.2%) thyrotoxicosis (6 non- autoimmune destructive thyroiditis, 8 autoimmune destructive thyroiditis and 3 Graves disease) and 22 "de novo" thyrotropin receptor antibodies (all Graves disease, 2 of the 8 autoimmune destructive thyroiditis and 17 with normal thyroid function). The sensitivity and specificity of thyrotropin receptor antibodies for Graves disease diagnosis in patients with thyrotoxicosis were 100 and 85%, respectively. Patients with destructive thyroiditis developed hypothyroidism in 87.5% of autoimmune cases and in none of those with a non- autoimmune etiology (p<0.001). CONCLUSION Thyrotropin receptor antibodies determination cannot replace thyroid scintigraphy for the differential diagnosis of thyrotoxicosis in CHC patients treated with pegylated interferon.
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Affiliation(s)
- D Benaiges
- Department of Endocrinology and Nutrition, Hospital del Mar
| | | | - A Mas
- Department of Endocrinology and Nutrition, Hospital del Mar
| | - N Cañete
- Department of Medicine, Universitat Autònoma de Barcelona
| | - T Broquetas
- Department of Medicine, Universitat Autònoma de Barcelona
| | - M Puigvehi
- Department of Medicine, Universitat Autònoma de Barcelona
| | - J J Chillarón
- Department of Endocrinology and Nutrition, Hospital del Mar
| | | | - E Sagarra
- Department of Endocrinology and Nutrition, Hospital del Mar
| | - B Cabrero
- Department of Medicine, Universitat Autònoma de Barcelona
| | - D Zaffalon
- Department of Medicine, Universitat Autònoma de Barcelona
| | - R Solà
- Department of Medicine, Universitat Autònoma de Barcelona
| | - J Pedro-Botet
- Department of Endocrinology and Nutrition, Hospital del Mar
| | - J A Carrión
- Department of Medicine, Universitat Autònoma de Barcelona
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Calvet J, Orellana C, Larrosa M, Navarro N, Chillarón JJ, Pedro-Botet J, Galisteo C, García-Manrique M, Gratacós J. High prevalence of cardiovascular co-morbidities in patients with symptomatic knee or hand osteoarthritis. Scand J Rheumatol 2015; 45:41-44. [DOI: 10.3109/03009742.2015.1054875] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Pedro-Botet J, Climent E, Chillarón JJ, Toro R, Benaiges D, Flores-Le Roux JA. Statins for primary cardiovascular prevention in the elderly. J Geriatr Cardiol 2015; 12:431-8. [PMID: 26345308 PMCID: PMC4554788 DOI: 10.11909/j.issn.1671-5411.2015.04.016] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2015] [Revised: 04/22/2015] [Accepted: 05/29/2015] [Indexed: 04/08/2023] Open
Abstract
The elderly population is increasing worldwide, with subjects > 65 years of age constituting the fastest-growing age group. Furthermore, the elderly face the greatest risk and burden of cardiovascular disease mortality and morbidity. Although elderly patients, particularly those older > 75, have not been well represented in randomized clinical trials evaluating lipid-lowering therapy, the available evidence supporting the use of statin therapy in primary prevention in older individuals is derived mainly from subgroup analyses and post-hoc data. On the other hand, elderly patients often have multiple co-morbidities that require a high number of concurrent medications; this may increase the risk for drug-drug interactions, thereby reducing the potential benefits of statin therapy. The aim of this review was to present the relevant literature regarding statin use in the elderly for their primary cardiovascular disease, with the associated risks and benefits of treatment.
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Affiliation(s)
- Juan Pedro-Botet
- Lipid and Vascular Risk Unit, Endocrinology department, Hospital del Mar. Spain
| | - Elisenda Climent
- Lipid and Vascular Risk Unit, Endocrinology department, Hospital del Mar. Spain
| | - Juan J Chillarón
- Lipid and Vascular Risk Unit, Endocrinology department, Hospital del Mar. Spain
| | - Rocio Toro
- Department of Medicine, School of Medicine. Cádiz University, Cádiz, Spain
| | - David Benaiges
- Lipid and Vascular Risk Unit, Endocrinology department, Hospital del Mar. Spain
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Benaiges D, Goday A, Pedro-Botet J, Más A, Chillarón JJ, Flores-Le Roux JA. Bariatric surgery: to whom and when? MINERVA ENDOCRINOL 2015; 40:119-128. [PMID: 25665592] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Bariatric surgery is the most effective treatment for obesity. Its effects go beyond weight loss, in a high percentage of cases achieving remission of comorbidities associated with obesity and reducing mortality. However, not all patients achieve satisfactory weight loss or resolution of comorbidities and perioperative complications are a constant risk. Correct preoperative evaluation is essential to predict the likelihood of success and choose the most appropriate surgical technique for this purpose. The aim of this review was to ascertain which obese subjects will benefit from bariatric surgery taking into account body mass index, age, comorbidities, risk of complications and the impact of different bariatric surgery techniques.
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Affiliation(s)
- D Benaiges
- Department of Endocrinology and Nutrition Hospital del Mar, Barcelona, Spain -
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Chillarón JJ, Benaiges D, Mañé L, Pedro-Botet J, Flores Le-Roux JA. Obesity and type 1 diabetes mellitus management. MINERVA ENDOCRINOL 2015; 40:53-60. [PMID: 25413942] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Patients with type 1 diabetes mellitus (T1DM) traditionally had a low body mass index and microangiopathic complications were common. The Diabetes Control and Complications Trial, published in 1993, demonstrated that therapy aimed at maintaining HbA1c levels as close to normal as feasible reduced the incidence of microangiopathy. Since then, the use of intensive insulin therapy to optimise metabolic control became generalised, with two main side effects: a higher rate of severe hypoglycaemia and increased weight gain. Approximately 50% of patients with T1DM are currently obese or overweight, which reduces or nullifies the benefits of good metabolic control, and which has other negative consequences; therefore, strategies to achieve weight control in patients with T1DM are necessary. At present, treatment with GLP-1 and SGLT-2 inhibitors has yielded promising short-term results that need to be confirmed in studies with larger numbers of patients and long-term follow-up. It is possible that, in coming years, the applicability of bariatric surgery in obese patients with T1DM will be similar to that of the general population or T2DM.
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Affiliation(s)
- J J Chillarón
- Department of Endocrinology and Nutrition Hospital del Mar, Barcelona, Spain, Institut Municipal d´Investigacions Mèdiques Departament de Medicina Universitat Autònoma de Barcelona, Barcelona, Spain -
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Sanz-Serra P, Pedro-Botet J, Flores-Le Roux JA, Benaiges D, Chillarón JJ. [Dapagliflozin: Beyond glycemic control in the treatment of type 2 diabetes mellitus]. Clin Investig Arterioscler 2015; 27:205-11. [PMID: 25648671 DOI: 10.1016/j.arteri.2014.11.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/19/2014] [Accepted: 11/19/2014] [Indexed: 02/06/2023]
Abstract
Patients with type 2 diabetes mellitus (T2DM) have a high or very high cardiovascular risk. The clinical practice guidelines focus on the need to achieve optimal glycemic control, and strategies for a multifactorial therapeutic approach have shown significant cardiovascular benefits in these patients. Inhibitors of sodium-glucose co-transporter 2 (SGLT-2) are a new class of orally administered drugs in the treatment of T2DM, which act by inhibiting reabsorption of glucose in the renal proximal tubule with consequent glycosuric effect and lowering of blood glucose. Dapagliflozin, SGLT-2 inhibitor marketed in Europe and Australia, has been shown to achieve glycosylated hemoglobin reductions similar to other oral agents, as well as beneficial effects on major comorbidities associated with T2DM. Therefore, it is considered of interest to review the clinical efficacy of this new oral hypoglycemic on glycemic control, risk of hypoglycemia, and its impact on body weight, blood pressure, lipid profile and renal function.
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Affiliation(s)
- Pol Sanz-Serra
- Unidad de Lípidos y Riesgo Vascular, Servicio de Endocrinología y Nutrición, Hospital del Mar, Barcelona, España; Departamento de Medicina, Universitat de Barcelona, Barcelona, España
| | - Juan Pedro-Botet
- Unidad de Lípidos y Riesgo Vascular, Servicio de Endocrinología y Nutrición, Hospital del Mar, Barcelona, España; Departamento de Medicina, Universitat Autònoma de Barcelona, Barcelona, España.
| | - Juana A Flores-Le Roux
- Unidad de Lípidos y Riesgo Vascular, Servicio de Endocrinología y Nutrición, Hospital del Mar, Barcelona, España; Departamento de Medicina, Universitat Autònoma de Barcelona, Barcelona, España
| | - David Benaiges
- Unidad de Lípidos y Riesgo Vascular, Servicio de Endocrinología y Nutrición, Hospital del Mar, Barcelona, España; Departamento de Medicina, Universitat Autònoma de Barcelona, Barcelona, España
| | - Juan J Chillarón
- Unidad de Lípidos y Riesgo Vascular, Servicio de Endocrinología y Nutrición, Hospital del Mar, Barcelona, España; Departamento de Medicina, Universitat Autònoma de Barcelona, Barcelona, España
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Chillarón JJ, Fernández-Miró M, Albareda M, Vila L, Colom C, Fontserè S, Pedro-Botet J, Flores-Le Roux JA. Age, insulin requirements, waist circumference, and triglycerides predict hypogonadotropic hypogonadism in patients with type 1 diabetes. J Sex Med 2014; 12:76-82. [PMID: 25394376 DOI: 10.1111/jsm.12748] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
INTRODUCTION The prevalence of hypogonadotropic hypogonadism (HH) in patients with type 2 diabetes mellitus is higher than in the general population and leads to detrimental effects on metabolic control, lipid profile, and body composition. Few studies have examined its role in type 1 diabetes mellitus. AIM To determine the prevalence of HH in patients with type 1 diabetes and associated risk factors. MAIN OUTCOME MEASURES Clinical and biochemical parameters were gathered on initial evaluation. An HH score creating different experimental models was devised to calculate the risk of HH for an individual with type 1 diabetes. METHODS Cross-sectional study of 181 male patients with type 1 diabetes consecutively admitted to the Diabetes outpatient clinics of three urban hospitals. All participants were Caucasians aged ≥ 18 years with type 1 diabetes duration of more than 6 months. RESULTS One hundred and eighty-one male patients with a mean age of 44.2 ± 13.2 years and a type 1 diabetes duration of 18.9 ± 12.7 years were included. Fifteen patients had HH, representing a prevalence of 8.3% (95% confidence interval [CI]: 4.3-12.3%). Age (odds ratio [OR] 1.066 [95% CI: 1.002-1.134]), waist circumference (OR 1.112 [95% CI: 1028-1203]), and insulin requirements ([IU/Kg] ×10 [OR 1.486 {95% CI: 1052-2.098}]) were independently associated with the presence of HH. The model that best predicted HH generated this formula: HH-score = (1.060 × age) + (1.084 × waist circumference) + (14.00 × insulin requirements) + triglycerides, where age was expressed in years, waist circumference in cm, insulin requirements in IU/kg/d, and triglycerides in mg/dL. An HH score > 242.4 showed 100% sensitivity and 53.2% specificity for HH diagnosis; positive and negative predictive values were 17.0 % and 100%, respectively. CONCLUSIONS One in 10 men with type 1 diabetes presents HH. This condition is associated with age, waist circumference, and insulin requirements. A simple formula based on clinical parameters can rule out its presence.
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Affiliation(s)
- Juan J Chillarón
- Department of Endocrinology and Nutrition, Hospital del Mar, Barcelona, Spain; Departament de Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain; IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
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Benaiges D, Chillarón JJ, Carrera MJ, Cots F, Puig de Dou J, Corominas E, Pedro-Botet J, Flores-Le Roux JA, Claret C, Goday A, Cano JF. Efficacy of treatment for hyperglycemic crisis in elderly diabetic patients in a day hospital. Clin Interv Aging 2014; 9:843-9. [PMID: 24868152 PMCID: PMC4027922 DOI: 10.2147/cia.s60581] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
Background The purpose of this prospective cohort study was to compare the costs of day hospital (DH) care for hyperglycemic crisis in elderly diabetic patients with those of conventional hospitalization (CH). Secondary objectives were to compare these two clinical scenarios in terms of glycemic control, number of emergency and outpatient visits, readmissions, hypoglycemic episodes, and nosocomial morbidity. Methods The study population comprised diabetic patients aged >74 years consecutively admitted to a tertiary teaching hospital in Spain for hyperglycemic crisis (sustained hyperglycemia [>300 mg/dL] for at least 3 days with or without ketosis). The patients were assigned to DH or CH care according to time of admission and were followed for 6 months after discharge. Exclusion criteria were ketoacidosis, hyperosmolar crisis, hemodynamic instability, severe intercurrent illness, social deprivation, or Katz index >D. Results Sixty-four diabetic patients on DH care and 36 on CH care were included, with no differences in baseline characteristics. The average cost per patient was 1,345.1±793.6 € in the DH group and 2,212.4±982.5 € in the CH group (P<0.001). There were no differences in number of subjects with mild hypoglycemia during follow-up (45.3% DH versus 33.3% CH, P=0.24), nor in the percentage of patients achieving a glycated hemoglobin (HbA1c) <8% (67.2% DH versus 58.3% CH, P=0.375). Readmissions for hyperglycemic crisis and pressure ulcer rates were significantly higher in the CH group. Conclusion DH care for hyperglycemic crises is more cost-effective than CH care, with a net saving of 1,418.4 € per case, lower number of readmissions and pressure ulcer rates, and similar short-term glycemic control and hypoglycemia rates.
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Affiliation(s)
- D Benaiges
- Department of Endocrinology and Nutrition, Hospital del Mar, Barcelona, Spain ; Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain ; Institut Hospital del Mar d'Investigacions Mèdiques, Barcelona, Spain
| | - J J Chillarón
- Department of Endocrinology and Nutrition, Hospital del Mar, Barcelona, Spain ; Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain ; Institut Hospital del Mar d'Investigacions Mèdiques, Barcelona, Spain
| | - M J Carrera
- Department of Endocrinology and Nutrition, Hospital del Mar, Barcelona, Spain ; Institut Hospital del Mar d'Investigacions Mèdiques, Barcelona, Spain
| | - F Cots
- Institut Hospital del Mar d'Investigacions Mèdiques, Barcelona, Spain ; Epidemiology and Evaluation Department, Parc de Salut Mar, Barcelona, Spain
| | - J Puig de Dou
- Department of Endocrinology and Nutrition, Hospital del Mar, Barcelona, Spain
| | - E Corominas
- Department of Endocrinology and Nutrition, Hospital del Mar, Barcelona, Spain
| | - J Pedro-Botet
- Department of Endocrinology and Nutrition, Hospital del Mar, Barcelona, Spain ; Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain ; Institut Hospital del Mar d'Investigacions Mèdiques, Barcelona, Spain
| | - J A Flores-Le Roux
- Department of Endocrinology and Nutrition, Hospital del Mar, Barcelona, Spain ; Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain ; Institut Hospital del Mar d'Investigacions Mèdiques, Barcelona, Spain
| | - C Claret
- Department of Endocrinology and Nutrition, Hospital del Mar, Barcelona, Spain
| | - A Goday
- Department of Endocrinology and Nutrition, Hospital del Mar, Barcelona, Spain ; Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain ; Institut Hospital del Mar d'Investigacions Mèdiques, Barcelona, Spain
| | - J F Cano
- Department of Endocrinology and Nutrition, Hospital del Mar, Barcelona, Spain ; Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain ; Institut Hospital del Mar d'Investigacions Mèdiques, Barcelona, Spain
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Renard MC, Chillarón JJ, Flores-Le-Roux JA. Panhypopituitarism in a pregnant women caused by a cystic sellar lesion. Endocrine 2014; 46:166-8. [PMID: 23963812 DOI: 10.1007/s12020-013-0037-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2013] [Accepted: 08/07/2013] [Indexed: 10/26/2022]
Affiliation(s)
- M C Renard
- Department of Endocrinology, Hospital Del Mar, Passeig Marítim 25-29, 08003, Barcelona, Spain
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Chillarón JJ, Flores Le-Roux JA, Benaiges D, Pedro-Botet J. Type 1 diabetes, metabolic syndrome and cardiovascular risk. Metabolism 2014; 63:181-7. [PMID: 24274980 DOI: 10.1016/j.metabol.2013.10.002] [Citation(s) in RCA: 118] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2013] [Revised: 10/16/2013] [Accepted: 10/16/2013] [Indexed: 11/24/2022]
Abstract
Patients with type 1 diabetes mellitus (T1DM) traditionally had a low body mass index and microangiopathic complications were common, while macroangiopathy and the metabolic syndrome were exceptional. The Diabetes Control and Complications Trial, published in 1993, demonstrated that therapy aimed at maintaining HbA1c levels as close to normal as feasible reduced the incidence of microangiopathy. Since then, the use of intensive insulin therapy to optimize metabolic control became generalized. Improved glycemic control resulted in a lower incidence of microangiopathy; however, its side effects included a higher rate of severe hypoglycemia and increased weight gain. Approximately 50% of patients with T1DM are currently obese or overweight, and between 8% and 40% meet the metabolic syndrome criteria. The components of the metabolic syndrome and insulin resistance have been linked to chronic T1DM complications, and cardiovascular disease is now the leading cause of death in these patients. Therefore, new therapeutic strategies are required in T1DM subjects, not only to intensively lower glycemia, but to control all associated metabolic syndrome traits.
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Affiliation(s)
- Juan J Chillarón
- Department of Endocrinology and Nutrition, Hospital del Mar, Barcelona; Institut Municipal d´Investigacions Mèdiques; Departament de Medicina, Universitat Autònoma de Barcelona.
| | - Juana A Flores Le-Roux
- Department of Endocrinology and Nutrition, Hospital del Mar, Barcelona; Institut Municipal d´Investigacions Mèdiques; Departament de Medicina, Universitat Autònoma de Barcelona
| | - David Benaiges
- Department of Endocrinology and Nutrition, Hospital del Mar, Barcelona; Institut Municipal d´Investigacions Mèdiques; Departament de Medicina, Universitat Autònoma de Barcelona
| | - Juan Pedro-Botet
- Department of Endocrinology and Nutrition, Hospital del Mar, Barcelona; Institut Municipal d´Investigacions Mèdiques; Departament de Medicina, Universitat Autònoma de Barcelona
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Benaiges D, Pedro-Botet J, Hernández E, Tarragón S, Chillarón JJ, Flores Le-Roux JA. Different clinical presentation of Klinefelter's syndrome in monozygotic twins. Andrologia 2014; 47:116-20. [PMID: 24404777 DOI: 10.1111/and.12219] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/19/2013] [Indexed: 11/28/2022] Open
Abstract
There is a wide variability in the clinical presentation of Klinefelter's syndrome. We report the case of a 45-year-old man who was incidentally diagnosed a 47,XXY/46,XY karyotype in a bone marrow aspiration (case 1). He presented hypogonadic features with undetectable testosterone levels and a height in accordance with mid-parental height. He had a monozygous sibling (case 2) who did not show clinical signs of hypogonadism and whose height exceeded mid-parental height. Both patients had presented language disorders since childhood. The karyotype of lymphocytes in peripheral blood of both subjects was compatible with mosaic Klinefelter's syndrome (46,XY/47,XXY). Testosterone replacement was initiated in case 1. Lack of testicular involvement due to mosaicism and the overexpression of the SHOX gene in case 2 could explain the marked differences in phenotype in these homozygous twins.
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Affiliation(s)
- D Benaiges
- Department of Endocrinology and Nutrition, Hospital del Mar, Barcelona, Spain; Department of Internal Medicine, Hospital Comarcal de l'Alt Penedés, Barcelona, Spain; Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain; IMIM (Institut Hospital del Mar d'Investigacions Mèdiques), Barcelona, Spain
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Chillarón JJ, Sales MP, Flores Le-Roux JA, Castells I, Benaiges D, Sagarra E, Pedro-Botet J. Dislipidemia aterogénica en pacientes con diabetes mellitus tipo 1. Med Clin (Barc) 2013; 141:465-70. [DOI: 10.1016/j.medcli.2013.03.016] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2013] [Revised: 03/06/2013] [Accepted: 03/07/2013] [Indexed: 10/26/2022]
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Claret C, Goday A, Benaiges D, Chillarón JJ, Flores JA, Hernandez E, Corretger JM, Cano JF. Subclinical hypothyroidism in the first years of life in patients with Down syndrome. Pediatr Res 2013; 73:674-8. [PMID: 23403803 DOI: 10.1038/pr.2013.26] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Subclinical hypothyroidism (SH), defined as mild thyroid-stimulating hormone (TSH) elevation with normal free thyroxine (FT4) levels and no symptoms, is common during the first few years of life in Down syndrome (DS) and can be self-limiting. Our objective was to confirm that SH is usually a transitory disorder and to identify the factors associated with spontaneous remission. METHODS We reviewed clinical histories of patients from the Catalan Down Syndrome Foundation (CDSF) with DS and SH diagnosed before 5 y of age. SH was defined as TSH 5.5-25 µU/ml (6 mo-4 y) or 4.13-25 µU/ml (4-7 y), with FT4 0.89-1.87 ng/dl (6 mo-4 y) or 0.96-1.86 ng/dl (4-7 y). RESULTS Fifty-three patients with SH were identified, with an average age of 2.4 ± 1.1 y, median (range) TSH at diagnosis 7.1 (4.2-23.9 µU/ml), and median (range) FT4 1.1 (0.9-1.7 ng/dl). SH resolved spontaneously in 39 cases (73.6%), with TSH at the most recent visit (mean age 6.7 ± 1.4 y) 3.9 (1.8-12.7 µU/ml). The rate of remission was significantly higher in patients without goiter (94.9 vs. 28.6%) and in those who were negative for antithyroid antibodies (89.7 vs. 42.9%). CONCLUSION SH in infants and preschool children with DS is usually a transitory disorder, with remission in >70% of cases. The absence of goiter and thyroid autoantibodies was associated with a greater rate of spontaneous remission in our study.
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Affiliation(s)
- Cristina Claret
- Department of Endocrinology, Hospital Universitari del Mar, Barcelona, Spain.
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Benaiges D, Flores Le-Roux JA, Pedro-Botet J, Chillarón JJ, Renard M, Parri A, Ramón JM, Pera M, Goday A. Sleeve gastrectomy and Roux-en-Y gastric bypass are equally effective in correcting insulin resistance. Int J Surg 2013; 11:309-13. [PMID: 23462580 DOI: 10.1016/j.ijsu.2013.02.007] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2013] [Revised: 02/07/2013] [Accepted: 02/09/2013] [Indexed: 12/23/2022]
Abstract
BACKGROUND Laparoscopic Roux-en-Y gastric bypass (LRYGB) and laparoscopic sleeve gastrectomy (LSG) are associated with glucose metabolism improvement although data on insulin resistance remission rates after these procedures are lacking. AIMS Primary aim was to compare insulin resistance remission rates achieved after LRYGB and LSG, using population-specific HOMA-IR cut-off points. Secondary objectives were to analyze factors associated with type 2 diabetes mellitus (T2DM) complete remission according to the new American Diabetes Association criteria and to examine changes in HOMA-B during follow-up. METHODS Non-randomized, prospective cohort study of patients undergoing LRYGB or LSG with a minimal follow-up of 24 months. Patients on insulin therapy were excluded. RESULTS At baseline, 56 (48.7%) of the 115 LRYGB group and 48 (61.5%) of the 78 LSG group had insulin resistance, and 29 (25.2%) and 20 (25.6%) T2DM, respectively. No differences were detected in insulin resistance remission rate (92.9% LRYGB and 87.5% LSG, p = 0.355) nor in T2DM complete remission at 2 years (62.1 vs 60% respectively, p = 0.992). Factors independently associated with T2DM complete remission were diabetes treatment and a greater decrease in 3-month HOMA-IR index. The HOMA-B index showed a progressive decline during follow-up. CONCLUSION Both surgical techniques are equally effective in achieving insulin resistance normalization in the majority of severely obese patients. Three-month HOMA-IR reduction after surgery was the main predictor of T2DM complete remission.
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Affiliation(s)
- David Benaiges
- Department of Endocrinology and Nutrition, Hospital del Mar, Barcelona, Spain.
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Chillarón JJ, Sales MP, Flores-Le-Roux JA, Murillo J, Benaiges D, Castells I, Goday A, Cano JF, Pedro-Botet J. Insulin resistance and hypertension in patients with type 1 diabetes. J Diabetes Complications 2011; 25:232-6. [PMID: 21601483 DOI: 10.1016/j.jdiacomp.2011.03.006] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2010] [Revised: 02/01/2011] [Accepted: 03/31/2011] [Indexed: 11/27/2022]
Abstract
AIM The aims of this study were to determine the prevalence of hypertension in type 1 diabetes patients and to analyze its relationship with insulin resistance and other associated factors. DESIGN AND METHODS A cross-sectional study on 291 patients with type 1 immune-mediated diabetes managed at two outpatient endocrinology clinics was performed. All participants were Caucasian, 18 years or older with type 1 diabetes duration of more than 6 months, who had completed the study protocol. Hypertension was defined as blood pressure ≥130/80 mmHg or use of antihypertensive medication, excluding angiotensin-converting enzyme inhibitors or angiotensin II receptor blockers when used as treatment for micro- or macroalbuminuria. RESULTS Hypertension was found in 87 [29.9% (95% confidence interval, or CI): 24.6%-35.2%] patients with type 1 diabetes. Hypertensive patients presented older age, male predominance, higher body mass index and overweight/obesity prevalence, and longer diabetes duration compared with normotensive patients. Insulin sensitivity quantified by estimated glucose disposal rate (eGDR) was lower in patients with hypertension compared with normotensives (5.2±1.4 vs. 9.1±1.2 mg kg(-1) min(-1), P<.001) and showed a negative correlation with systolic blood pressure level (r=-0.612, P<.01). In multivariate logistic regression analysis, eGDR, besides nephropathy, emerged significantly and independently associated with hypertension. An increment of 1 unit in insulin sensitivity assessed by eGDR was associated with a 5.7% decrease in hypertension prevalence (95% CI: 0.018-0.175) and the absence of nephropathy with an 88.2% decrease (95% CI: 0.15-0.92). CONCLUSIONS Hypertension was present in approximately one third of patients with type 1 diabetes, especially in men, those with microangiopathy, overweight or obesity, older age and longer diabetes duration. Hypertension prevalence increased in parallel to the degree of renal impairment and was inversely related to insulin sensitivity.
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Flores-Le Roux JA, Comin J, Pedro-Botet J, Benaiges D, Puig-de Dou J, Chillarón JJ, Goday A, Bruguera J, Cano-Perez JF. Seven-year mortality in heart failure patients with undiagnosed diabetes: an observational study. Cardiovasc Diabetol 2011; 10:39. [PMID: 21569580 PMCID: PMC3125195 DOI: 10.1186/1475-2840-10-39] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2011] [Accepted: 05/14/2011] [Indexed: 12/24/2022] Open
Abstract
Background Patients with type 2 diabetes mellitus and heart failure have adverse clinical outcomes, but the characteristics and prognosis of those with undiagnosed diabetes in this setting has not been established. Methods In total, 400 patients admitted consecutively with acute heart failure were grouped in three glycaemic categories: no diabetes, clinical diabetes (previously reported or with hypoglycaemic treatment) and undiagnosed diabetes. The latter was defined by the presence of at least two measurements of fasting plasma glycaemia ≥ 7 mmol/L before or after the acute episode.Group differences were tested by proportional hazards models in all-cause and cardiovascular mortality during a 7-year follow-up. Results There were 188 (47%) patients without diabetes, 149 (37%) with clinical diabetes and 63 (16%) with undiagnosed diabetes. Patients with undiagnosed diabetes had a lower prevalence of hypertension, dyslipidaemia, peripheral vascular disease and previous myocardial infarction than those with clinical diabetes and similar to that of those without diabetes. The adjusted hazards ratios for 7-year total and cardiovascular mortality compared with the group of subjects without diabetes were 1.69 (95% CI: 1.17-2.46) and 2.45 (95% CI: 1.58-3.81) for those with undiagnosed diabetes, and 1.48 (95% CI: 1.10-1.99) and 2.01 (95% CI: 1.40-2.89) for those with clinical diabetes. Conclusions Undiagnosed diabetes is common in patients requiring hospitalization for acute heart failure. Patients with undiagnosed diabetes, despite having a lower cardiovascular risk profile than those with clinical diabetes, show a similar increased mortality.
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Affiliation(s)
- Juana A Flores-Le Roux
- Department of Endocrinology, Hospital del Mar, Departament de Medicina, Universitat Autónoma de Barcelona, Spain.
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Fernández-Miró M, Isern V, Marín JH, Manresa R, Chillarón JJ. [Panhypopituitarism and cranial nerve IV palsy: pituitary macroadenoma?]. ACTA ACUST UNITED AC 2010; 57:502-4. [PMID: 20961821 DOI: 10.1016/j.endonu.2010.06.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2010] [Accepted: 06/29/2010] [Indexed: 10/18/2022]
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Chillarón JJ, Flores-Le-Roux JA, Goday A, Benaiges D, Carrera MJ, Puig J, Cano-Pérez JF, Pedro-Botet J. Síndrome metabólico y diabetes mellitus tipo 1: prevalencia y factores relacionados. Rev Esp Cardiol 2010. [DOI: 10.1016/s0300-8932(10)70063-4] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Claret C, Chillarón JJ, Flores JA, Benaiges D, Aguiló R, García M, Aguilar G, Goday A, Cano-Pérez JF. Carcinoid tumor of the thymus associated with Cushing's syndrome and dysgeusia: case report and review of the literature. Endocrine 2010; 37:1-5. [PMID: 19859842 DOI: 10.1007/s12020-009-9249-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2009] [Accepted: 09/18/2009] [Indexed: 10/20/2022]
Abstract
A 30-year-old man was hospitalized with edema, polyuria, and abnormalities in taste. ACTH and cortisol levels at admission were markedly elevated, even after attempted suppression with 8 mg dexamethasone. A thoracic-abdominal CT revealed an anterior mediastinal lesion and hyperplasia of both adrenal glands. After excision of the mediastinal mass, which confirmed the presence of a carcinoid thymic tumor, the patient became totally asymptomatic, with normal ACTH and cortisol levels. A carcinoid thymic tumor has a poor prognosis, especially when it is associated with Cushing's syndrome. Most patients will present recidivism or metastasis within 5 years after surgery. However, the low number of cases available for analysis makes it difficult to establish optimum therapeutic approaches.
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Affiliation(s)
- Cristina Claret
- Department of Endocrinology, Hospital Universitari del Mar, Passeig Marítim 25-29, 08003 Barcelona, Spain
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Chillarón JJ, Goday A, Flores-Le-Roux JA, Benaiges D, Carrera MJ, Puig J, Cano-Pérez JF, Pedro-Botet J. Estimated glucose disposal rate in assessment of the metabolic syndrome and microvascular complications in patients with type 1 diabetes. J Clin Endocrinol Metab 2009; 94:3530-4. [PMID: 19584183 DOI: 10.1210/jc.2009-0960] [Citation(s) in RCA: 73] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
OBJECTIVE The objective of the study was to quantify insulin resistance in type 1 diabetes patients by estimated glucose disposal rate (eGDR), according to the presence or absence of the metabolic syndrome, and its relationship with chronic complications. DESIGN This was a cross-sectional study in 91 patients with type 1 immune-mediated diabetes managed at an outpatient endocrinology clinic. All participants were Caucasians aged 18 yr or older with type 1 diabetes duration of more than 6 months who had completed the study protocol. RESULTS Twenty-nine patients met metabolic syndrome criteria, yielding a prevalence of 31.9%. Although no differences in insulin requirements were found between diabetic patients with and without metabolic syndrome, lower eGDR levels, indicating greater insulin resistance, were observed in metabolic syndrome patients compared with those without (6.19 +/- 1.5 mg/kg(-1) x min(-1) vs. 9.93 +/- 1.6 mg/kg(-1) x min(-1)) (P < 0.001). An eGDR level less than 8.77 mg/kg(-1) x min(-1) showed 100% sensitivity and 85.2% specificity for metabolic syndrome diagnosis. All patients with diabetes complications had eGDR values below 8.16 mg/kg(-1) x min(-1). eGDR level was significantly lower in patients with diabetic retinopathy (5.97 +/- 1.2 mg/kg(-1) x min(-1)), diabetic neuropathy (5.06 +/- 0.4 mg/kg(-1) x min(-1)), or diabetic nephropathy (5.79 +/- 1.5 mg/kg(-1) x min(-1)) compared with those without (9.38 +/- 2.0 mg/kg(-1) x min(-1), P < 0.001; 9.26 +/- 2.0 mg/kg(-1) x min(-1), P < 0.001; and 9.19 +/- 2.2 mg/kg(-1) x min(-1), P < 0.001). CONCLUSIONS Insulin resistance is common in type 1 diabetes patients and is associated with microvascular complications. eGDR, as an insulin resistance marker, provides more useful information than other classical variables such as insulin requirements.
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Affiliation(s)
- Juan J Chillarón
- Department of Endocrinology, Hospital del Mar, 08003 Barcelona, Spain
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Chillarón JJ, Goday A, Flores-Le-Roux JA, Benaiges D, Carrera MJ, Puig J, Cano-Pérez JF, Pedro-Botet J. Estimated Glucose Disposal Rate in Assessment of the Metabolic Syndrome and Microvascular Complications in Patients with Type 1 Diabetes. Mol Endocrinol 2009. [DOI: 10.1210/mend.23.9.9996] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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