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Bellido V, Duque N, Newson RS, Artime E, Spaepen E, Rubio de Santos M, Redondo-Antón J, Díaz-Cerezo S, Navarro J. The Burden of Suboptimal Insulin Dosing in People with Diabetes in Spain: Barriers and Solutions from the Physician Perspective. Patient Prefer Adherence 2024; 18:151-164. [PMID: 38259955 PMCID: PMC10800280 DOI: 10.2147/ppa.s439814] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Accepted: 01/09/2024] [Indexed: 01/24/2024] Open
Abstract
Background This study aimed to determine physicians' perceptions of the extent of suboptimal insulin dosing and the barriers and solutions to optimal dosing in people with diabetes (PwD) treated with insulin. Methods A cross-sectional online survey was conducted in four countries with primary care physicians and endocrinologists treating PwD using insulin pens, which included 53 questions on physicians' characteristics and their perceptions of the behaviors of PwD in relation to insulin dosing routines, unmet needs and potential solutions. Analyses were descriptive. Results Of the 160 physicians (80 primary care physicians, 80 specialists) surveyed in Spain, 58.1% were male and 88.8% had been qualified to practice for more than five years. Most physicians (>65%) indicated that 0-30% of PwD missed or skipped, mistimed, or miscalculated an insulin dose in the last 30 days. Common reasons for these actions were that PwD forgot, were out of their normal routine, were too busy or distracted, or were unsure of how much insulin to take. To optimize insulin dosing, over 75% of physicians considered it very helpful for PwD to have real-time insulin dosing calculation guidance, mobile app reminders, a device automatically recording glucose measurements and/or insulin, having insulin and glucose data in one place, and having the time for more meaningful conversations about insulin dosing routines. Conclusion According to physicians' perspectives, suboptimal insulin dosing remains common among PwD. This survey highlights the need for integrated and automated insulin dosing support to manage the complexity of insulin treatment, improve communications between PwD and physicians, and ultimately improve outcomes for PwD.
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Affiliation(s)
- Virginia Bellido
- Unidad de Gestión Clínica de Endocrinología y Nutrición, Hospital Universitario Virgen del Rocío, Sevilla, Spain
| | - Natalia Duque
- Medical Department, Medical Affairs, Eli Lilly and Company, Madrid, Spain
| | - Rachel S Newson
- NAPAC Real World Evidence, Medical Affairs, Eli Lilly and Company, Sydney, NSW, Australia
| | - Esther Artime
- Medical Department, Medical Affairs, Eli Lilly and Company, Madrid, Spain
| | | | | | | | - Silvia Díaz-Cerezo
- Medical Department, Medical Affairs, Eli Lilly and Company, Madrid, Spain
| | - Jorge Navarro
- Department of Medicine, University of Valencia, Valencia, Spain
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Bellido V, Freckman G, Pérez A, Galindo RJ. Accuracy and Potential Interferences of Continuous Glucose Monitoring Sensors in the Hospital. Endocr Pract 2023; 29:919-927. [PMID: 37369291 DOI: 10.1016/j.eprac.2023.06.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Revised: 06/15/2023] [Accepted: 06/19/2023] [Indexed: 06/29/2023]
Abstract
For years, the standard of care for monitoring dysglycemia in hospitalized patients was capillary blood glucose (CBG) testing with point-of-care glucose meters. Recently, there has been a revolution in novel factory-calibrated continuous glucose monitoring (CGM) systems. Newer CGMs are smaller and less expensive, have improved accuracy and longer wear time, and do not require fingerstick CBG for calibration, resulting in increased utilization in ambulatory settings. Consequently, hospitals have noticed increased usability of CGMs among hospitalized patients and expect a progressive continued increase. During the COVID-19 pandemic, there was a critical need for innovative approaches to glycemic monitoring, with several pilot implementation projects using CGM in the intensive care unit and non-intensive care unit settings, further boosting the evidence in this area. Hence, recent guidelines have provided recommendations for the use of CGM in specific hospital scenarios and highlighted the potential of CGM to overcome CBG limitations for glucose monitoring in the inpatient setting. In this review, we provide the following: 1) an up-to-date review of the accuracy of the newer CGMs in hospitalized patients, 2) a discussion of standards for CGM accuracy metrics, 3) a contemporary overview of potential interferences that may cause inaccuracies or poor CGM performance, and 4) required steps for full regulatory approval of CGMs in the hospital and future research steps to advance the field forward.
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Affiliation(s)
- Virginia Bellido
- Unidad de Gestión Clínica de Endocrinología y Nutrición, Hospital Universitario Virgen del Rocío, Sevilla, Spain, Instituto de Biomedicina de Sevilla (IBiS), Hospital Universitario Virgen del Rocío/CSIC/Universidad de Sevilla, Sevilla, Spain
| | - Guido Freckman
- Institut für Diabetes-Technologie, Forschungs- und Entwicklungsgesellschaft mbH an der Universität Ulm, Ulm, Germany
| | - Antonio Pérez
- Servicio de Endocrinología y Nutrición. Hospital de la Santa Creu i Sant Pau, IIB Sant Pau, Universitat Autònoma de Barcelona. CIBER de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Barcelona, España
| | - Rodolfo J Galindo
- University of Miami Miller School of Medicine, Division of Endocrinology, Diabetes and Metabolism, Miami, Florida.
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3
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Bellido V, Aguilera E, Cardona-Hernandez R, Diaz-Soto G, González Pérez de Villar N, Picón-César MJ, Ampudia-Blasco FJ. Expert Recommendations for Using Time-in-Range and Other Continuous Glucose Monitoring Metrics to Achieve Patient-Centered Glycemic Control in People With Diabetes. J Diabetes Sci Technol 2023; 17:1326-1336. [PMID: 35470692 PMCID: PMC10563535 DOI: 10.1177/19322968221088601] [Citation(s) in RCA: 4] [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] [Indexed: 11/16/2022]
Abstract
New metrics for assessing glycemic control beyond HbA1c have recently emerged due to the increasing use of continuous glucose monitoring (CGM) in diabetes clinical practice. Among them, time in range (TIR) has appeared as a simple and intuitive metric that correlates inversely with HbA1c and has also been newly linked to the risk of long-term diabetes complications. The International Consensus on Time in Range established a series of target glucose ranges (TIR, time below range and time above range) and recommendations for time spent within these ranges for different diabetes populations. These parameters should be evaluated together with the ambulatory glucose profile (AGP). Using standardized visual reporting may help people with diabetes and healthcare professionals in the evaluation of glucose control in frequent clinical situations. The objective of the present review is to provide practical insights to quick interpretation of patient-centered metrics based on flash glucose monitoring data, as well as showing some visual examples of common clinical situations and giving practical recommendations for their management.
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Affiliation(s)
- Virginia Bellido
- Unidad de Gestión Clínica de Endocrinología y Nutrición, Hospital Universitario Virgen del Rocío, Sevilla, Spain
| | - Eva Aguilera
- Endocrinology and Nutrition Department, Health Sciences Research Institute and University, Hospital Germans Trias i Pujol, Badalona, Spain
| | | | - Gonzalo Diaz-Soto
- Endocrinology and Nutrition Department, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
- Universidad de Valladolid, Valladolid, Spain
| | | | - María J. Picón-César
- Endocrinology and Nutrition Department, Hospital Universitario Virgen de la Victoria, Málaga, Spain
- Instituto de Investigación Biomédica de Málaga, Málaga, Spain
- Centro de Investigación Biomédica en Red de Fisiopatología de la Obesidad y Nutrición, Instituto de Salud Carlos III, Madrid, Spain
| | - Francisco Javier Ampudia-Blasco
- Endocrinology and Nutrition Department, Hospital Clínico Universitario de Valencia, Valencia, Spain
- INCLIVA Research Foundation, Valencia, Spain
- CIBERDEM, Madrid, Spain
- Universitat de Valencia, Valencia, Spain
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4
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Bellido V, Morales C, Garach AM, Almeida JMG, Morera JLF, Aguilera BG, de la Torre ML, Bellido D. Descriptive study of a clinical and educational telemedicine intervention in patients with diabetes receiving glargine 300 U/ml (Toujeo) in Spain: results of the T-Coach programme. Drugs Context 2023; 12:dic-2023-1-1. [PMID: 37261244 PMCID: PMC10228333 DOI: 10.7573/dic.2023-1-1] [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] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2023] [Accepted: 03/29/2023] [Indexed: 06/02/2023] Open
Abstract
Background Diabetes is one of the most prevalent chronic diseases worldwide, and innovative patient support programmes can help and inform patients about their disease and improve their quality of life. The purpose of this study was to evaluate the effect of the T-Coach programme in terms of improvement of disease knowledge, self-management and adherence to treatment in a real-world setting in Spain between July 2016 and October 2018. Methods We analyzed data from the T-Coach programme, a telephone platform that gives support to patients with type 2 diabetes mellitus treated with insulin glargine 300 U/ml (Gla-300). Support was provided by diabetes care nurses. Patients followed their treatment and aimed to achieve fasting blood glucose targets through diabetes education. Results A total of 479 patients were included in the programme. The mean (SD) dose of Gla-300 was 28.5 (16.3) U at baseline and 31.8 (16.1) U, 31.4 (16.4) U and 32.2 (16.3) U, respectively, at 3, 6 and 12 months. A satisfaction survey was completed by 240 (50.1%) patients, who, on average, were very highly satisfied with the programme, general assistance provided, recommendations received, and calls from nurses. Conclusions T-Coach could be an effective tool to help patients achieve their optimal dose of Gla-300 insulin and manage their blood glucose levels. It could also act as an effective support for diabetes education.
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Affiliation(s)
- Virginia Bellido
- Endocrinology and Nutrition Department, Hospital Universitario Virgen del Rocío, Sevilla, Spain
| | - Cristóbal Morales
- Endocrinology Department, Hospital Clínico Universitario Virgen Macarena, Sevilla, Spain
| | - Araceli Muñoz Garach
- Endocrinology Department, Hospital Universitario Virgen de las Nieves, Granada, Spain
| | | | | | | | | | - Diego Bellido
- Endocrinology Department, Complejo Hospitalario Universitario de Ferrol, La Coruña, Spain
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Reyes-García R, Moreno-Pérez Ó, Bellido V, Botana-López M, Duran Rodríguez-Hervada A, Fernández-García D, Fernández-García JC, Gargallo-Fernández M, González-Clemente JM, Jódar-Gimeno E, López de la Torre Casares M, López-Fernández J, Marco Martínez A, Mezquita-Raya P, Rozas-Moreno P, Tejera-Pérez C, Escalada-San Martín J. Comprehensive approach to people with type 2 diabetes. Diabetes Knowledge Area of the Spanish Society of Endocrinology and Nutrition. ENDOCRINOL DIAB NUTR 2023; 70 Suppl 1:95-102. [PMID: 36906509 DOI: 10.1016/j.endien.2023.03.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [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: 06/23/2022] [Accepted: 07/26/2022] [Indexed: 03/11/2023]
Abstract
OBJECTIVE To provide practical recommendations for the comprehensive approach of people with type 2 diabetes according to evidence-based medicine. PARTICIPANTS Members of the Diabetes Knowledge Area of the Spanish Society of Endocrinology and Nutrition. METHODS The recommendations were formulated according to the degrees of evidence of the Standards of Medical Care in Diabetes-2022. After reviewing the available evidence and formulating recommendations by the authors of each section, several rounds of comments were developed incorporating the contributions and voting on controversial points. Finally, the final document was sent to the rest of the members of the area for review and incorporation of contributions, to finally carry out the same process with the members of the Spanish Society of Endocrinology and Nutrition Board of Directors. CONCLUSIONS The document establishes practical recommendations based on the latest available evidence for the management of people with type 2 diabetes.
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Affiliation(s)
- Rebeca Reyes-García
- Unidad de Endocrinología, Hospital Universitario Torrecárdenas, Almería, Spain.
| | - Óscar Moreno-Pérez
- Servicio de Endocrinología, Hospital Universitario Doctor Balmis, Alicante, Spain
| | - Virginia Bellido
- Unidad de Gestión Clínica de Endocrinología y Nutrición, Instituto de Biomedicina de Sevilla (IBiS), Hospital Universitario Virgen del Rocío, Consejo Superior de Investigaciones Científicas (CSIC), Universidad de Sevilla, Sevilla, Spain
| | - Manuel Botana-López
- Sección de Endocrinología, Hospital Universitario Lucus Augusti, Lugo, Spain
| | - Alejandra Duran Rodríguez-Hervada
- Servicio de Endocrinología, Metabolismo y Nutrición, Hospital Clínico Universitario de San Carlos, Universidad Complutense de Madrid, Madrid, Spain
| | - Diego Fernández-García
- Unidad de Gestión Clínica de Endocrinología y Nutrición, Hospital Universitario Virgen de la Victoria, Málaga, Spain; Servicio de Endocrinología y Nutrición, Hospital Vithas Xanit, Benalmádena, Málaga, Spain
| | - José Carlos Fernández-García
- Servicio de Endocrinología y Nutrición, Hospital Regional Universitario de Málaga, Instituto de Investigación Biomédica de Málaga (IBIMA), Universidad de Málaga, Málaga, Spain
| | - Manuel Gargallo-Fernández
- Endocrinología y Nutrición, Hospital Universitario Infanta Leonor, Madrid, Spain; Fundación Jiménez Díaz, Madrid, Spain
| | - Jose Miguel González-Clemente
- Servicio de Endocrinología y Nutrición, Hospital Universitario Parc Taulí, Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Sabadell, Barcelona, Spain; CIBER de Diabetes y Enfermedades Metabólicas asociadas (CIBERDEM), Spain
| | - Esteban Jódar-Gimeno
- Departamento de Endocrinología y Nutrición, Hospital Universitario QuirónSalud, Universidad Europea, Madrid, Spain
| | | | - Judith López-Fernández
- Servicio de Endocrinología y Nutrición, Hospital Universitario de Canarias, La Laguna, Santa Cruz de Tenerife, Spain; Departamento de Medicina, Universidad de La Laguna, La Laguna, Santa Cruz de Tenerife, Spain
| | - Amparo Marco Martínez
- Complejo Hospitalario Universitario de Toledo (CHUT), Toledo, Spain; Hospital QuirónSalud Madrid, Universidad Europea de Madrid, Madrid, Spain
| | - Pedro Mezquita-Raya
- Unidad de Endocrinología, Hospital Universitario Torrecárdenas, Almería, Spain
| | - Pedro Rozas-Moreno
- Servicio de Endocrinología y Nutrición, Hospital General Universitario de Ciudad Real, Ciudad Real, Spain
| | - Cristina Tejera-Pérez
- Servicio de Endocrinología y Nutrición, Complejo Hospitalario Universitario de Ferrol (CHUF), Ferrol, A Coruña, Spain
| | - Javier Escalada-San Martín
- Departamento de Endocrinología y Nutrición, Clínica Universidad de Navarra, Pamplona, Navarra, Spain; CIBER Fisiopatología de la Obesidad y Nutrición (CIBERobn), Spain; Grupo de Diabetes & Enfermedades Metabólicas, Instituto de Investigación Sanitaria de Navarra (IdiSNA), Pamplona, Navarra, Spain
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Amuedo S, Bellido V, Mangas Cruz MÁ, Gros Herguido N, López Gallardo G, Pérez Morales A, Soto Moreno A. Successful Use of an Advanced Hybrid Closed-loop System in a Patient With Type 3c Pancreatogenic Diabetes Secondary to Nesidioblastosis. Can J Diabetes 2023; 47:193-196. [PMID: 36207270 DOI: 10.1016/j.jcjd.2022.09.117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Revised: 08/22/2022] [Accepted: 09/12/2022] [Indexed: 11/25/2022]
Affiliation(s)
- Sandra Amuedo
- Unidad de Gestión Clínica de Endocrinología y Nutrición, Hospital Universitario Virgen del Rocío, Sevilla, Spain
| | - Virginia Bellido
- Unidad de Gestión Clínica de Endocrinología y Nutrición, Hospital Universitario Virgen del Rocío, Sevilla, Spain; Instituto de Biomedicina de Sevilla, Hospital Universitario Virgen del Rocío/CSIC/Universidad de Sevilla, Sevilla, Spain.
| | - Miguel Ángel Mangas Cruz
- Unidad de Gestión Clínica de Endocrinología y Nutrición, Hospital Universitario Virgen del Rocío, Sevilla, Spain; Instituto de Biomedicina de Sevilla, Hospital Universitario Virgen del Rocío/CSIC/Universidad de Sevilla, Sevilla, Spain
| | - Noelia Gros Herguido
- Unidad de Gestión Clínica de Endocrinología y Nutrición, Hospital Universitario Virgen del Rocío, Sevilla, Spain; Instituto de Biomedicina de Sevilla, Hospital Universitario Virgen del Rocío/CSIC/Universidad de Sevilla, Sevilla, Spain
| | - Gema López Gallardo
- Unidad de Gestión Clínica de Endocrinología y Nutrición, Hospital Universitario Virgen del Rocío, Sevilla, Spain
| | - Ana Pérez Morales
- Unidad de Gestión Clínica de Endocrinología y Nutrición, Hospital Universitario Virgen del Rocío, Sevilla, Spain
| | - Alfonso Soto Moreno
- Unidad de Gestión Clínica de Endocrinología y Nutrición, Hospital Universitario Virgen del Rocío, Sevilla, Spain; Instituto de Biomedicina de Sevilla, Hospital Universitario Virgen del Rocío/CSIC/Universidad de Sevilla, Sevilla, Spain; Facultad de Medicina, Departamento de Medicina, Universidad de Sevilla, Sevilla, Spain
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7
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Gros Herguido N, Amuedo S, Bellido V, López Gallardo G, Losada F, Pérez Morales A, Ruiz Trillo CA, Soto Moreno A. Effectiveness and Safety of an Advanced Hybrid Closed-Loop System in Adolescents and Adults with Type 1 Diabetes Previously Treated with Continuous Subcutaneous Insulin Infusion and Flash Glucose Monitoring. Diabetes Technol Ther 2023; 25:151-156. [PMID: 36108305 DOI: 10.1089/dia.2022.0287] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [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] [Indexed: 02/04/2023]
Abstract
This study aimed to evaluate the effectiveness and safety of the MiniMed™ 780G advanced hybrid closed-loop (AHCL) system in people with type 1 diabetes (T1D) previously treated with continuous subcutaneous insulin infusion combined with flash glucose monitoring in a real-life setting. A total of 47 subjects (mean age 41 ± 13.6 years, 60% females, diabetes duration 28 ± 11 years) were included and switched to an AHCL system. Baseline and 6-month data were analyzed. Time in range 70-180 mg/dL increased from 65.3% at baseline to 73.8% at 6 months. Time in hyperglycemia >180 mg/dL decreased from 26.6% to 19.3%. Time in hypoglycemia <70 mg/dL decreased from 4.6% to 2.3%. The coefficient of variation also decreased from 36% to 31.6%. No episodes of severe hypoglycemia, diabetes ketoacidosis, or diabetes-related hospital admissions occurred. In conclusion, the MiniMed 780G AHCL system enables the safe achievement of recommended glycemic targets in people with T1D after 6 months of use.
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Affiliation(s)
- Noelia Gros Herguido
- Unidad de Gestión Clínica de Endocrinología y Nutrición, Hospital Universitario Virgen del Rocío, Sevilla, Spain
- Instituto de Biomedicina de Sevilla (IBiS), Hospital Universitario Virgen del Rocío/CSIC/Universidad de Sevilla, Sevilla, Spain
| | - Sandra Amuedo
- Unidad de Gestión Clínica de Endocrinología y Nutrición, Hospital Universitario Virgen del Rocío, Sevilla, Spain
| | - Virginia Bellido
- Unidad de Gestión Clínica de Endocrinología y Nutrición, Hospital Universitario Virgen del Rocío, Sevilla, Spain
- Instituto de Biomedicina de Sevilla (IBiS), Hospital Universitario Virgen del Rocío/CSIC/Universidad de Sevilla, Sevilla, Spain
| | - Gema López Gallardo
- Unidad de Gestión Clínica de Endocrinología y Nutrición, Hospital Universitario Virgen del Rocío, Sevilla, Spain
| | - Fernando Losada
- Unidad de Gestión Clínica de Endocrinología y Nutrición, Hospital Universitario Virgen del Rocío, Sevilla, Spain
| | - Ana Pérez Morales
- Unidad de Gestión Clínica de Endocrinología y Nutrición, Hospital Universitario Virgen del Rocío, Sevilla, Spain
| | - Carmen Amelia Ruiz Trillo
- Unidad de Gestión Clínica de Endocrinología y Nutrición, Hospital Universitario Virgen del Rocío, Sevilla, Spain
| | - Alfonso Soto Moreno
- Unidad de Gestión Clínica de Endocrinología y Nutrición, Hospital Universitario Virgen del Rocío, Sevilla, Spain
- Instituto de Biomedicina de Sevilla (IBiS), Hospital Universitario Virgen del Rocío/CSIC/Universidad de Sevilla, Sevilla, Spain
- Departamento de Medicina, Facultad de Medicina, Universidad de Sevilla, Sevilla, Spain
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González Fernández P, Grau Bolado G, Fernández López C, Ponce de León Saenz de Navarrete S, Guadilla Fernández ML, Vázquez San Miguel F, Bellido V, Rica Echevarria I. Changing trends in transgender demographics and morbidity: baseline data from a Spanish cohort. Sex Health 2023; 20:96-98. [PMID: 36653020 DOI: 10.1071/sh22171] [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] [Subscribe] [Scholar Register] [Received: 10/15/2022] [Accepted: 12/15/2022] [Indexed: 01/20/2023]
Abstract
The number of transgender people who request hormone treatment is increasing worldwide. We obtained base clinical and demographic information from transgender people treated at a specialised clinic in Spain (n =484) and studied changes over time. Transgender women treated in 2009-14 were older than those treated in 2015-20 (29years vs 17years), had a lower academic level and had higher anxiolytics consumption. Transgender men treated in 2009-14 were older than those treated later (27years vs 17years) and had a lower academic level. These trends reflect favourable changes in how the transgender population is treated by society and health services.
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Affiliation(s)
- Pedro González Fernández
- Endocrinology Department, Cruces University Hospital, Cruces s/n 48903, Barakaldo, Spain; and Biocruces Bizkaia Health Research Institute, Barakaldo, Spain; and Grupo GIDSEEN, Sociedad Española de Endocrinología y Nutrición, Madrid, Spain
| | - Gema Grau Bolado
- Endocrinology Department, Cruces University Hospital, Cruces s/n 48903, Barakaldo, Spain; and Biocruces Bizkaia Health Research Institute, Barakaldo, Spain; and Grupo GIDSEEN, Sociedad Española de Endocrinología y Nutrición, Madrid, Spain
| | - Carmen Fernández López
- Endocrinology Department, Cruces University Hospital, Cruces s/n 48903, Barakaldo, Spain; and Grupo GIDSEEN, Sociedad Española de Endocrinología y Nutrición, Madrid, Spain
| | - Susana Ponce de León Saenz de Navarrete
- Endocrinology Department, Cruces University Hospital, Cruces s/n 48903, Barakaldo, Spain; and Grupo GIDSEEN, Sociedad Española de Endocrinología y Nutrición, Madrid, Spain
| | - María Luisa Guadilla Fernández
- Endocrinology Department, Cruces University Hospital, Cruces s/n 48903, Barakaldo, Spain; and Grupo GIDSEEN, Sociedad Española de Endocrinología y Nutrición, Madrid, Spain
| | | | - Virginia Bellido
- Unidad de Gestión Clínica de Endocrinología y Nutrición, Hospital Universitario Virgen del Rocío, Sevilla, Spain; and Instituto de Biomedicina de Sevilla (IBiS), Sevilla, Spain; and Hospital Universitario Virgen del Rocío/CSIC/Universidad de Sevilla, Sevilla, Spain
| | - Itxaso Rica Echevarria
- Endocrinology Department, Cruces University Hospital, Cruces s/n 48903, Barakaldo, Spain; and Biocruces Bizkaia Health Research Institute, Barakaldo, Spain; and Grupo GIDSEEN, Sociedad Española de Endocrinología y Nutrición, Madrid, Spain; and CIBERER, Madrid, Spain
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9
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García-Almeida JM, García-García C, Ballesteros-Pomar MD, Olveira G, Lopez-Gomez JJ, Bellido V, Bretón Lesmes I, Burgos R, Sanz-Paris A, Matia-Martin P, Botella Romero F, Ocon Breton J, Zugasti Murillo A, Bellido D. Expert Consensus on Morphofunctional Assessment in Disease-Related Malnutrition. Grade Review and Delphi Study. Nutrients 2023; 15:nu15030612. [PMID: 36771319 PMCID: PMC9920608 DOI: 10.3390/nu15030612] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Revised: 01/13/2023] [Accepted: 01/18/2023] [Indexed: 01/27/2023] Open
Abstract
Disease-related malnutrition (DRM) affects approximately a third of hospitalized patients and is associated with an increased risk of morbimortality. However, DRM is often underdiagnosed and undertreated. Our aim is to evaluate the prognostic value of morphofunctional tools and tests for nutritional assessment in clinical practice. A systematic literature review was conducted to identify studies relating to the morphofunctional assessment of nutritional status and mortality or complications. Evidence was evaluated using the GRADE (Grading of Recommendations, Assessment, Development, and Evaluations) method. Twelve GRADE recommendations were made and divided into seven topics: food intake and nutrient assimilation, anthropometry, biochemical analysis, hand grip strength, phase angle, muscle imaging, and functional status and quality of life. From these recommendations, 37 statements were developed and scored in a two-survey Delphi method by 183 experts. A consensus was reached on accepting 26/37 statements. Surveys had high internal consistency and high inter-rater reliability. In conclusion, evidence-based recommendations were made on the prognostic value of morphofunctional assessment tools and tests to assess malnutrition, most of which were found to be feasible in routine clinical practice, according to expert opinions.
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Affiliation(s)
- José Manuel García-Almeida
- Department of Endocrinology and Nutrition, Hospital Clínico Universitario Virgen de la Victoria, 29010 Málaga, Spain
- IBIMA, Instituto de Investigación Biomédica y Plataforma en Nanomedicina, BIONAND, 29590 Málaga, Spain
- CIBEROBN, Centro de Investigación Biomédica en Red, Fisiopatología de la Obesidad y Nutrición, 28029 Madrid, Spain
- Department of Endocrinology and Nutrition, Hospital Quirónsalud, 29004 Málaga, Spain
- Facultad de Medicina, University of Málaga, 29010 Málaga, Spain
| | - Cristina García-García
- PhD Program in Biomedicine, Translational Research and New Health Technologies, Faculty of Medicine, University of Málaga, 29071 Málaga, Spain
- Medical Director, Persan Farma, 35007 Las Palmas de Gran Canaria, Spain
- Correspondence: ; Tel.: +34-670326887
| | - María D. Ballesteros-Pomar
- Department of Endocrinology and Nutrition, Complejo Asistencial Universitario de León, 24071 León, Spain
| | - Gabriel Olveira
- IBIMA, Instituto de Investigación Biomédica y Plataforma en Nanomedicina, BIONAND, 29590 Málaga, Spain
- Facultad de Medicina, University of Málaga, 29010 Málaga, Spain
- Department of Endocrinology and Nutrition, Hospital Regional Universitario de Málaga, 29010 Málaga, Spain
- CIBERDEM, Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas, Instituto de Salud Carlos III, 29010 Málaga, Spain
- Department of Medicine and Dermatology, University of Málaga, 29016 Málaga, Spain
| | - Juan J. Lopez-Gomez
- Department of Endocrinology and Nutrition, Hospital Clínico Universitario de Valladolid, 47003 Valladolid, Spain
| | - Virginia Bellido
- Department of Endocrinology and Nutrition, Hospital Universitario Virgen del Rocío, 41013 Sevilla, Spain
| | - Irene Bretón Lesmes
- Department of Endocrinology and Nutrition, Hospital General Universitario Gregorio Marañón, 28007 Madrid, Spain
| | - Rosa Burgos
- Nutritional Support Unit, Vall d’Hebron Barcelona Hospital Campus, 08035 Barcelona, Spain
| | - Alejandro Sanz-Paris
- Department of Endocrinology and Nutrition, University Hospital Miguel Servet, 50009 Zaragoza, Spain
- Instituto de Investigación Sanitaria (IIS) Aragón, 50009 Zaragoza, Spain
| | - Pilar Matia-Martin
- Department of Endocrinology and Nutrition, Hospital Clínico San Carlos, 28040 Madrid, Spain
- Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), 28040 Madrid, Spain
- Medicine Department, Universidad Complutense, 28040 Madrid, Spain
| | - Francisco Botella Romero
- Department of Endocrinology and Nutrition, Complejo Hospitalario de Albacete, 02006 Albacete, Spain
| | - Julia Ocon Breton
- Department of Endocrinology and Nutrition, Hospital Clínico Universitario Lozano Blesa, 50009 Zaragoza, Spain
| | - Ana Zugasti Murillo
- Nutrition Department, Hospital Universitario de Navarra, 31008 Pamplona, Spain
| | - Diego Bellido
- Department of Endocrinology and Nutrition, Complejo Hospitalario de Ferrol, 15405 Ferrol, Spain
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10
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Reyes-García R, Moreno-Pérez Ó, Bellido V, Botana-López M, Duran Rodríguez-Hervada A, Fernández-García D, Fernández-García JC, Gargallo-Fernández M, González-Clemente JM, Jódar-Gimeno E, López de la Torre Casares M, López-Fernández J, Marco Martínez A, Mezquita-Raya P, Rozas-Moreno P, Tejera-Pérez C, Escalada-San Martín J. Abordaje integral de las personas con diabetes tipo 2. Área de Conocimiento de Diabetes de la Sociedad Española de Endocrinología y Nutrición. ENDOCRINOL DIAB NUTR 2022. [DOI: 10.1016/j.endinu.2022.07.006] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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11
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Bellido V, Martínez J, Calvo F, Villarroel A, Lecumberri E, Moreno J, Morillas C, Rodrigo S, Izarra A, Lecube A. Beyond the Glycaemic Control of Dapagliflozin: Microangiopathy and Non-classical Complications. Diabetes Ther 2022; 13:873-888. [PMID: 35338446 PMCID: PMC9076778 DOI: 10.1007/s13300-022-01237-9] [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] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Accepted: 02/21/2022] [Indexed: 11/23/2022] Open
Abstract
Dapagliflozin is a selective sodium-glucose cotransporter 2 inhibitor (SGLT2i) indicated for the treatment of type 2 diabetes mellitus (T2DM), heart failure (HF) with reduced ejection fraction (EF) and chronic kidney disease (CKD). In monotherapy or as an additive therapy, dapagliflozin aids glycaemic control, is associated with reductions in blood pressure and weight, and promotes a favourable lipid profile. In this review, we address the impact of dapagliflozin on cardiovascular risk factors and common microangiopathic complications such as kidney disease and retinopathy in patients with T2DM. Furthermore, we evaluate its potential beneficial effects on other less frequent complications of diabetes, such as macular oedema, cognitive impairment, non-alcoholic fatty liver disease and respiratory disorders during sleep. Moreover, the underuse of SGLT2i in clinical practice is discussed. Our goal is to help translate this evidence into clinical practice.
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Affiliation(s)
- Virginia Bellido
- Endocrinology and Nutrition Department, Virgen del Rocío University Hospital, Sevilla, Spain
| | | | - Fernando Calvo
- Endocrinology and Nutrition Department, "Lozano Blesa" Clinical Hospital, Zaragoza, Spain
| | | | - Edurne Lecumberri
- Endocrinology and Nutrition Department, Ramón y Cajal University Hospital, Madrid, Spain
| | - Juan Moreno
- Medical Department, AstraZeneca Spain, Madrid, Spain
| | - Carlos Morillas
- Endocrinology and Nutrition Department, Dr Peset University Hospital of Valencia, Valencia, Spain
| | | | | | - Albert Lecube
- Research Group On Obesity, Diabetes and Metabolism (ODIM), Institute of Biomedical Research of Lleida (IRBLleida), Endocrinology and Nutrition Department, Arnau de Vilanova University Hospital, Lleida, University of Lleida, Avda. Rovira Roure 80, 25198, Lleida, Spain.
- Biomedical Research Networking Center in Diabetes and Associated Metabolic Disorders (CIBERDEM), Carlos III Health Institute, Madrid, Spain.
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12
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Morales C, Merino-Torres JF, Moreno-Moreno P, Lainez M, Tejado I, Yoldi A, Gutiérrez Medina S, Soto A, Botana MA, Bellido V, Caballero I. Effectiveness and safety of dapagliflozin in real-life patients: data from the DAPA-RWE Spanish multicentre study. Drugs Context 2022; 11:dic-2021-11-5. [PMID: 35251200 PMCID: PMC8855933 DOI: 10.7573/dic.2021-11-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Accepted: 01/17/2022] [Indexed: 11/21/2022] Open
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13
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Rodríguez de Vera-Gómez P, Piñar-Gutiérrez A, Guerrero-Vázquez R, Bellido V, Morales-Portillo C, Sancho-Márquez MP, Espejo-García P, Gros-Herguido N, López-Gallardo G, Martínez-Brocca MA, Soto-Moreno A. Flash Glucose Monitoring and Diabetes Mellitus Induced by Immune Checkpoint Inhibitors: An Approach to Clinical Practice. J Diabetes Res 2022; 2022:4508633. [PMID: 36387939 PMCID: PMC9652069 DOI: 10.1155/2022/4508633] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Revised: 09/01/2022] [Accepted: 10/19/2022] [Indexed: 11/06/2022] Open
Abstract
OBJECTIVES The aim of this study is to investigate in depth diabetes mellitus associated with immune checkpoint inhibitors (DM-ICIs) by analysing a case series. We also evaluated the clinical impact of flash glucose monitoring (FGM) systems in the management of this entity. METHODS We conducted an observational cohort study of DM-ICIs diagnosed in two hospitals in Seville (Spain). Patients with a new diagnosis of diabetes mellitus (DM) or with sudden worsening of preexisting DM after starting treatment with ICIs, with a random 5 hour-postprandial C-peptide value of <0.6 nmol/L and without possibility of subsequent withdrawal of insulin treatment, were included. RESULTS A total of 7 cases were identified, mostly males (n = 6; 85.7%), with a mean age of 64.9 years. The mean glycated hemoglobin (HbA1c) upon diagnosis was 8.1%, with diabetic ketoacidosis (DKA) observed in 6 cases (85.7%). Subcutaneous flash glucose monitoring (FGM) systems were used in six cases, with a mean follow-up period of 42.7 weeks. During the first 90 days of use, mean average glucose was 167.5 mg/dL, with a coefficient of variation (CV) of 34.6%. The mean time in the range 70-180 mg/dL (TIR) was 59.7%, with a mean time above range (TAR) 181-250 mg/dL of 27.8% and a mean TAR > 250 mg/dL of 10.2%. The mean time below range (TBR) 54-69 mg/dL was 2%, while the mean TBR < 54 mg/dL was 0.3%. The mean glucose management indicator (GMI) was 7.3%. No significant differences were observed in FGM values for the following 90 days of follow-up. A progressive improvement in all parameters of glycaemic control was observed between the first month of FGM use and the sixth month of FGM use. Of note, there was a decrease in mean CV (40.6% to 34.1%, p = 0.25), mean TAR 181-250 (30.3% to 26%, p = 0.49), mean TAR > 250 mg/dL (16.3% to 7.7%, p = 0.09), mean TBR 54-69 mg/dL (5.2% to 2%, p = 0.16), and mean TBR < 54 mg/dL (1.8% to 0.2%, p = 0.31), along with an increase in mean values of TIR 70-180 mg/dL (46.5% to 60.5%, p = 0.09). The lack of statistical significance in the differences observed in the mean FGM values over the follow-up period may be related to the small sample size. CONCLUSION DM-ICI is recognised by a state of sudden-onset insulinopenia, often associated with DKA. The use of FGM systems may be a valid option for the effective management of DM-ICIs and for the prevention of severe hyperglycaemic and hypoglycaemic episodes in this condition.
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Affiliation(s)
| | - Ana Piñar-Gutiérrez
- Endocrinology and Nutrition Department, Hospital Universitario Virgen del Rocío, Seville, Spain
| | - Raquel Guerrero-Vázquez
- Endocrinology and Nutrition Department, Hospital Universitario Virgen Macarena, Seville, Spain
| | - Virginia Bellido
- Endocrinology and Nutrition Department, Hospital Universitario Virgen del Rocío, Seville, Spain
| | | | | | | | - Noelia Gros-Herguido
- Endocrinology and Nutrition Department, Hospital Universitario Virgen del Rocío, Seville, Spain
| | - Gema López-Gallardo
- Endocrinology and Nutrition Department, Hospital Universitario Virgen del Rocío, Seville, Spain
| | | | - Alfonso Soto-Moreno
- Endocrinology and Nutrition Department, Hospital Universitario Virgen del Rocío, Seville, Spain
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14
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Choudhary P, Bellido V, Graner M, Altpeter B, Cicchetti A, Durand-Zaleski I, Kristensen FB. The Challenge of Sustainable Access to Telemonitoring Tools for People with Diabetes in Europe: Lessons from COVID-19 and Beyond. Diabetes Ther 2021; 12:2311-2327. [PMID: 34390477 PMCID: PMC8363869 DOI: 10.1007/s13300-021-01132-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Accepted: 07/26/2021] [Indexed: 01/08/2023] Open
Abstract
Telemedicine in diabetes care has been evolving over several years, particularly since the advent of cloud-connected technologies for diabetes management, such as glucose monitoring devices, including continuous glucose monitoring (CGM) systems, that facilitate sharing of glucose data between people with diabetes and their healthcare professionals in near-real time. Extreme social distancing and shielding in place for vulnerable patients during the COVID-19 pandemic has created both the challenge and the opportunity to provide care at a distance on a large scale. Available evidence suggests that glucose control has in fact improved during this period for people with diabetes who are able to use CGM devices for remote glucose monitoring. The development of telemedicine as part of the standard of care in diabetes faces significant challenges in the European context, particularly in terms of providing consistent and effective care at a distance to large populations of patients while using robust systems that can be supported by large regional and national healthcare services. These challenges include a fragmented approach to healthcare technology assessment and reimbursement, lack of eHealth education and literacy, particularly amongst healthcare professionals, lack of data integration, as well as concerns about electronic health records, patient consent and privacy. Here we review the benefits of and challenges to wider application of telemedicine and telemonitoring in the post-pandemic future, with the aim to ensure that the value of these eHealth services is provided to patients, healthcare providers and health systems.
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Affiliation(s)
- Pratik Choudhary
- Leicester Diabetes Centre (Bloom), Leicester General Hospital, University of Leicester, Leicester, UK.
| | - Virginia Bellido
- Department of Endocrinology and Nutrition, Virgen del Rocío University Hospital, Seville, Spain
| | | | - Bernd Altpeter
- Digital Health Groupe and German Institute of Telemedicine, Frankfurt, Germany
| | - Americo Cicchetti
- School of Healthcare Systems, Economics and Management, Universita Cattolica del Sacro Cuore, Rome, Italy
| | | | - Finn Børlum Kristensen
- Danish Centre for Health Economics (DaCHE), Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
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15
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Chacón P, Vega-Rioja A, Doukkali B, Del Valle Rodríguez A, Bellido V, Puente Y, Alcañiz L, Rodríguez D, Palacios R, Cornejo-García JA, Monteseirín J, Rivas-Pérez D. Targeted inhibition of allergen-induced histamine production by neutrophils. FASEB J 2021; 35:e21483. [PMID: 33788304 DOI: 10.1096/fj.202001912r] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Revised: 02/12/2021] [Accepted: 02/15/2021] [Indexed: 11/11/2022]
Abstract
Histamine is a critical inflammatory mediator in allergic diseases. We showed in a previous work that neutrophils from allergic patients produce histamine in response to allergens to which the patients were sensitized. Here, we investigate the molecular mechanisms involved in this process using peripheral blood neutrophils. We challenged these cells in vitro with allergens and analyzed histamine release in the culture supernatants. We also explored the effect of common therapeutic drugs that ameliorate allergic symptoms, as well as allergen-specific immunotherapy. Additionally, we examined the expression of histidine decarboxylase and diamine oxidase, critical enzymes in the metabolism of histamine, under allergen challenge. We show that allergen-induced histamine release is dependent on the activation of the phosphoinositide 3-kinase, mitogen-activated protein kinase p38, and extracellular signal-regulated kinase 1/2 signaling pathways. We also found a contribution of the phosphatase calcineurin to lesser extent. Anti-histamines, glucocorticoids, anti-M3-muscarinic receptor antagonists, and mainly β2 -receptor agonists abolished the allergen-dependent histamine release. Interestingly, allergen-specific immunotherapy canceled the histamine release through the downregulation of histidine decarboxylase expression. Our observations describe novel molecular mechanisms involved in the allergen-dependent histamine release by human neutrophils and provide new targets to inhibit histamine production.
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Affiliation(s)
- Pedro Chacón
- UGC de Alergología, Hospital Universitario Virgen Macarena, Sevilla, Spain
| | - Antonio Vega-Rioja
- UGC de Alergología, Hospital Universitario Virgen Macarena, Sevilla, Spain
| | - Bouchra Doukkali
- UGC de Alergología, Hospital Universitario Virgen Macarena, Sevilla, Spain
| | | | - Virginia Bellido
- UGC de Alergología, Hospital Universitario Virgen Macarena, Sevilla, Spain
| | - Yolanda Puente
- UGC de Alergología, Hospital Universitario Virgen Macarena, Sevilla, Spain
| | - Lorena Alcañiz
- UGC de Dermatología, Hospital Universitario Virgen Macarena, Sevilla, Spain
| | | | | | | | - Javier Monteseirín
- UGC de Alergología, Hospital Universitario Virgen Macarena, Sevilla, Spain.,Departamento de Medicina, Facultad de Medicina, Universidad de Sevilla, Sevilla, Spain
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16
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Bellido V, Pinés-Corrales PJ, Villar-Taibo R, Ampudia-Blasco FJ. Time-in-range for monitoring glucose control: Is it time for a change? Diabetes Res Clin Pract 2021; 177:108917. [PMID: 34126129 DOI: 10.1016/j.diabres.2021.108917] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [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: 04/04/2021] [Revised: 06/02/2021] [Accepted: 06/09/2021] [Indexed: 11/30/2022]
Abstract
The HbA1c value has been the gold standard for evaluating glucose control for decades. However, it has limitations such as the lack of information on glycemic variability or the risk of hypoglycemia. The increasing use of continuous glucose monitoring has provided patients and healthcare professionals with a range of useful metrics for the management of diabetes. Among them, Time in Range (TIR) is a simple and intuitive metric that gives information regarding the quality of glucose control. It is defined as the time spent in an individual's target glucose range. TIR is strongly correlated with HbA1c, and it has been linked to the risk of developing microvascular and macrovascular complications. The International Consensus on Time in Range has recently set targets for different diabetes populations. For the majority of people with type 1 or type 2 diabetes, a TIR (70-180 mg/dL or 3.9-10.0 mmol/L) of >70%, a time below range (TBR) <70 mg/dL (<3.9 mmol/L) of <4% and a TBR <54 (<3.0 mmol/L) of <1% are recommended. In this review, we address the latest evidence for the use of TIR as an essential parameter in the management of diabetes.
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Affiliation(s)
- Virginia Bellido
- Endocrinology and Nutrition Department, Virgen del Rocío University Hospital, Sevilla, Spain.
| | | | - Rocío Villar-Taibo
- Endocrinology and Nutrition Department, Santiago de Compostela University Hospital, A Coruña, Spain.
| | - Francisco Javier Ampudia-Blasco
- Endocrinology and Nutrition Department, Clinic University Hospital Valencia, Valencia, Spain; INCLIVA Research Foundation, Spain; CIBERDEM, Spain; Universitat de Valencia, Valencia, Spain
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17
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Morales C, Bellido V, Tejera C, Goñi F, Palomares R, Sevillano C, Bellido D, Soto A, Mangas MÁ, Botana MA, Caballero I. DAPA-RWE: a retrospective multicenter study comparing dapagliflozin and sitagliptin in patients with Type 2 diabetes treated under routine clinical practice in Spain. J Comp Eff Res 2021; 10:815-821. [PMID: 33955233 DOI: 10.2217/cer-2020-0264] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 12/14/2022] Open
Abstract
Background: Weight reduction and glycemic control are key goals during Type 2 diabetes management. However, there are few country-specific, real-world data on cotransporter 2 inhibitors. Materials & methods: DAPA-RWE was a retrospective, multicenter study comparing the efficacy of dapagliflozin versus sitagliptin in Type 2 diabetes patients in Spain. Results: The study population comprised 1046 patients (594 with dapagliflozin, 452 with sitagliptin). Age was 61.8 ± 10.0 and 66.2 ± 11.4 years and glycosylated hemoglobin (HbA1c) 8.9 and 8.8%, respectively. The main end point (reduction in weight and HbA1c) was reached by 24.4 and 56.1% of patients, respectively; p < 0.05. This was confirmed with a propensity score matching analysis balanced for obesity-related variables at baseline. Conclusion: DAPA-RWE confirmed dapagliflozin to be more effective than sitagliptin in reducing HbA1c and weight.
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Affiliation(s)
- Cristobal Morales
- Departamento de endocrinología y Nutrición, Hospital Universitario Virgen Macarena, Seville, Spain
| | - Virginia Bellido
- Departamento de endocrinología y Nutrición, Hospital Universitario de Cruces, Bilbao, Spain
| | - Cristina Tejera
- Departamento de endocrinología y Nutrición, Complejo Hospitalario Universitario de Ferrol, Ferrol, Spain
| | - Fernando Goñi
- Departamento de endocrinología y Nutrición, Hospital de Basurto, Bilbao, Spain
| | - Rafael Palomares
- Departamento de endocrinología y Nutrición, Hospital Reina Sofía de Córdoba, Cordoba, Spain
| | - Cristina Sevillano
- Departamento de endocrinología y Nutrición, Hospital Intanta Leonor de Madrid, Madrid, Spain
| | - Diego Bellido
- Departamento de endocrinología y Nutrición, Clínica Privada ENDOFER, La Coruña, Spain
| | - Alfonso Soto
- Departamento de endocrinología y Nutrición, Complejo Hospitalario Universitario de A Coruña, La Coruña, Spain
| | - Miguel Ángel Mangas
- Departamento de endocrinología y Nutrición, Hospital Universitario Virgen del Rocio de Sevilla, Seville, Spain
| | - Manuel A Botana
- Departamento de endocrinología y Nutrición, Hospital Universitario Lucus Augusti de Lugo, Lugo, Spain
| | - Irene Caballero
- Departamento de endocrinología y Nutrición, Hospital Universitario Virgen Macarena, Seville, Spain
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Abstract
Diabetes is one of the most common comorbidities in hospitalized patients with coronavirus disease 2019 (COVID-19). Inpatient hyperglycemia during this pandemic has been associated with worse outcomes, so it is mandatory to implement effective glycemic control treatment approaches for inpatients with COVID-19. The shortage of personal protective equipment, the need to prevent staff exposure, or the fact that many of the healthcare professionals might be relatively unfamiliar with the management of hyperglycemia may lead to worse glycemic control and, consequently, a worse prognosis. In order to reduce these barriers, we intend to adapt established recommendations to manage hyperglycemia during this pandemic in critical and noncritical care settings.
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Affiliation(s)
- Virginia Bellido
- Department of Endocrinology and Nutrition, Cruces University Hospital, Vizcaya, Spain
- Biocruces Bizkaia Health Research Institute, Vizcaya, Spain
- University of the Basque Country (UPV/EHU), Vizcaya, Spain
| | - Antonio Pérez
- Department of Endocrinology and Nutrition, Santa Creu I Sant Pau Hospital, Barcelona, Spain.
- Sant Pau Institute of Biomedical Research, Barcelona, Spain.
- Autonomous University of Barcelona, Barcelona, Spain.
- CIBER de Diabetes Y Enfermedades Metabólicas Asociadas (CIBERDEM), Barcelona, Spain.
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19
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Fernández E, Cortazar A, Bellido V. Impact of COVID-19 lockdown on glycemic control in patients with type 1 diabetes. Diabetes Res Clin Pract 2020; 166:108348. [PMID: 32711000 PMCID: PMC7375311 DOI: 10.1016/j.diabres.2020.108348] [Citation(s) in RCA: 93] [Impact Index Per Article: 23.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2020] [Revised: 06/19/2020] [Accepted: 07/01/2020] [Indexed: 11/20/2022]
Abstract
INTRODUCTION The COVID-19 pandemic has forced governments to take exceptional measures to minimize its spread, imposing lockdown policies. The aim of this study was to evaluate the impact of lockdown on type 1 diabetes (T1D) glycemic control. MATERIAL AND METHODS People with T1D using flash glucose monitoring were included. Data from the 14 days before lockdown were compared with data from the last 14 days after 8 weeks of lockdown. RESULTS A total of 307 patients were included (age 45.8 ± 12.6 years, 50.2% male, diabetes duration 21.1 ± 12.3 years). Only one patient had COVID-19 infection. Mean glucose decreased from 166.89 ± 29.4 to 158.0 ± 29.0 mg/dL and estimated HbA1c declined from 7.4 ± 1.0 to 7.1 ± 1.0% (54 ± 10.9 vs 57 ± 10.9 mmol/mol; p < 0.001). Time in range increased from 57.8 ± 15.8 to 62.46 ± 16.1%. Time in hyperglycemia > 180 mg/dL and >250 mg/dL decreased from 37.3 ± 1.9% to 32.0 ± 17.1% and from 13.0 ± 11.3 to 10.3 ± 10.6%, respectively; (p < 0.001). Time in hypoglycaemia <70 mg/dL increased from 4.9 ± 4.0% to 5.5 ± 4.4% (p < 0.001). No differences in time <54 mg/dl, coefficient of variation (CV%) or number of scans per day were found. CONCLUSION Despite the limitations of lockdown, glycemic control improved in patients with T1D. These results suggest that having more time for self-management may help improve glycemic control in the short term.
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Affiliation(s)
- Elsa Fernández
- Department of Endocrinology and Nutrition, Cruces University Hospital, Vizcaya, Spain; Biocruces Bizkaia Health Research Institute, Vizcaya, Spain
| | - Alicia Cortazar
- Department of Endocrinology and Nutrition, Cruces University Hospital, Vizcaya, Spain; Biocruces Bizkaia Health Research Institute, Vizcaya, Spain; CIBERDEM
| | - Virginia Bellido
- Department of Endocrinology and Nutrition, Cruces University Hospital, Vizcaya, Spain; Biocruces Bizkaia Health Research Institute, Vizcaya, Spain; University of the Basque Country (UPV/EHU), Vizcaya, Spain.
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20
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Oyagüez I, Merino-Torres JF, Brito M, Bellido V, Cardona-Hernandez R, Gomez-Peralta F, Morales-Perez F. Cost analysis of the flash monitoring system (FreeStyle Libre 2) in adults with type 1 diabetes mellitus. BMJ Open Diabetes Res Care 2020; 8:e001330. [PMID: 32699114 PMCID: PMC7375427 DOI: 10.1136/bmjdrc-2020-001330] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Revised: 05/21/2020] [Accepted: 05/26/2020] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Compare cost of the interstitial liquid glucose flash monitoring (FM) system (FreeStyle Libre 2) versus self-monitoring of blood glucose (SMBG) in adults with type 1 diabetes mellitus (T1DM) in Spain. RESEARCH DESIGN AND METHODS A model was developed to estimate, with the perspective of the Spanish health system, the annual costs associated with glucose monitoring and hypoglycemic events management in T1DM population, with multiple insulin daily doses (MDI). According to published evidence, rate of severe hypoglycemia (SHE) of 4.90 episodes per patient-year was applied. Reduction of SHE (58.6%) was modeled associated with FM use. Published rates of hospital care (20.2%) and subsequent admission (16%) were assumed for SHE. The daily consumption of strips and lancets was 9 in patients with SMBG (before and after 4 daily intakes and at bedtime) and 0.5 for FM users (according to IMPACT trial findings). Annual consumption of 26 FM sensors was considered (1 every 14 days). Unit costs (in € of 2019, excluding VAT) were obtained from literature and national databases. Sensitivity analyses (SA) were carried out to evaluate the model robustness. RESULTS The total annual cost/patient was €4437 for SMBG and €2526 for FM. The use of FM would be associated with an annual savings in the costs of monitoring and managing hypoglycemic events of €1911 per patient-year. In a hypothetical cohort of 1000 patients with T1DM MDI, FM could avoid in 1 year 4900 SHE, 93 hospitalizations for SHE. In addition, the use of FM would generate total savings of up to €1 910 000 per year. In the SA with alternative hypoglycemia events rates and use of strips and lancets, and including non-SHE episodes, savings from €370 000 to €1 760 000 were observed with FM. CONCLUSIONS The use of the FM system to monitor glucose in adults with T1DM treated with MDI, would reduce hypoglycemic events and would result in cost savings for the health system.
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Affiliation(s)
- Itziar Oyagüez
- Pharmacoeconomics & Outcomes Research Iberia, Pozuelo de Alarcon, Madrid, Spain
| | - Juan Francisco Merino-Torres
- Department of Medicine, Universitat de València Facultat de Medicina i Odontologia, Valencia, Comunitat Valenciana, Spain
- Endocrinology and Nutrition, La Fe University and Polytechnic Hospital, Valencia, Spain
| | - Miguel Brito
- Endocrinology and Nutrition, Puerta de Hierro University Hospital of Majadahonda, Majadahonda, Madrid, Spain
| | - Virginia Bellido
- Endocrinology and Nutrition, Cruces University Hospital, Barakaldo, País Vasco, Spain
| | | | | | - Francisco Morales-Perez
- Department of Endocrinology and Nutrition, University Hospital Complex Badajoz, Badajoz, Extremadura, Spain
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Affiliation(s)
- Virginia Bellido
- Servicio de Endocrinología y Nutrición, Hospital Universitario Cruces, Biocruces, Universidad del País Vasco, Vizcaya, España.
| | - Antonio Pérez
- Servicio de Endocrinología y Nutrición, Hospital de la Santa Creu i Sant Pau, IIB Sant Pau, Universitat Autònoma de Barcelona. CIBER de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Barcelona, España.
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Bellido V, Bellido D, Tejera C, Carral F, Goicolea I, Soto A, García Almeida JM, Morales C, López de la Torre M. Effect of Telephone-Delivered Interventions on Glycemic Control in Type 2 Diabetes Treated with Glargine Insulin. Telemed J E Health 2019; 25:471-476. [DOI: 10.1089/tmj.2018.0014] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Affiliation(s)
- Virginia Bellido
- Department of Endocrinology, Hospital Universitario Cruces, Barakaldo (Vizcaya), Spain
| | - Diego Bellido
- Department of Endocrinology, Complejo Hospitalario Universitario de Ferrol, Ferrol, Spain
| | - Cristina Tejera
- Department of Endocrinology, Complejo Hospitalario Universitario de Ferrol, Ferrol, Spain
| | - Florentino Carral
- Department of Endocrinology, Hospital Universitario Puerto Real, Cádiz, Spain
| | - Ignacio Goicolea
- Department of Endocrinology, Hospital Universitario Cruces, Barakaldo (Vizcaya), Spain
| | - Aflonso Soto
- Department of Endocrinology, Complejo Hospitalario Universitario de A Coruña, A Coruña, Spain
| | | | - Cristobal Morales
- Department of Endocrinology, Hospital Universitario Virgen Macarena, Sevilla, Spain
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Bellido D, Abellán P, Ruiz Palomar JM, Álvarez Sintes R, Nubiolae A, Bellido V, Romero G. Intensification of Basal Insulin Therapy with Lixisenatide in Patients with Type 2 Diabetes in a Real-World Setting: The BASAL-LIXI Study. Curr Ther Res Clin Exp 2018; 89:37-42. [PMID: 30455779 PMCID: PMC6218842 DOI: 10.1016/j.curtheres.2018.09.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [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] [Received: 05/01/2018] [Revised: 09/27/2018] [Accepted: 09/28/2018] [Indexed: 01/02/2023] Open
Abstract
Adding lixisenatide to basal insulin was effective for uncontrolled type 2 diabetes. Glycemic control improved and body weight lowered during 24 weeks of treatment. These benefits were achieved with a low risk of hypoglycemia in clinical practice. These findings in the clinical practice setting support those of clinical trials.
Background Basal insulin reduces fasting blood glucose levels, but postprandial blood glucose levels may remain higher. Traditional strategies with rapid insulin intensification can cause hypoglycemic episodes and weight gain. Glucagon-like peptide-1 receptor agonists, such as the short-acting lixisenatide, are able to control postprandial excursions, without weight gain, and with a low risk of hypoglycemic events. Objective Due to the limited data on the combination of lixisenatide with basal insulin (with or without oral antidiabetes drugs) in clinical practice, this study evaluated changes in parameters associated with glycemic control and anthropometric data after 24 weeks of this therapy intensification. Methods This was a multicenter, retrospective observational study of 129 patients with type 2 diabetes that was uncontrolled by basal insulin. Their treatment was intensified by the addition of lixisenatide at least 24 weeks before being included in the study. Data were retrospectively collected to determine changes in glycated hemoglobin (HbA1c) levels, blood glucose levels, weight, and body mass index. Adverse reactions and hypoglycemic events were also recorded. Results After 24 weeks of therapy intensification with lixisenatide, a significant reduction in HbA1c levels was observed (–1.1%; P < 0.001). An HbA1c <7% was achieved in 30.2% of patients, and 17.1% reached an HbA1c <6.5%. There was a reduction in fasting blood glucose (31.8 [60.3] mg/dL; P < 0.001) and postprandial blood glucose (55.0 [49] mg/dL; P < 0.001) levels, as well as body weight (4.0 [5.4] kg; P < 0.001) and body mass index (1.5 [1.9]; P < 0.001). The most commonly observed adverse reactions were nausea (n = 9), in line with previous studies. Hypoglycemia events were rare; only reported in 2 patients. Conclusions Intensification strategy based on lixisenatide added to basal insulin (with or without oral antidiabetes drugs) can be an effective treatment option in patients with uncontrolled type 2 diabetes. In this small, selected population, glycemic control was significantly improved in terms of HbA1, fasting blood glucose levels, and postprandial glucose levels, with a reduction of body weight and low risk of hypoglycemic events. (Curr Ther Res Clin Exp. 2018; 79:XXX–XXX)
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Affiliation(s)
- Diego Bellido
- Department of Endocrinology and Nutrition, Ferrol Universitary Hospital Complex (CHUF), Ferrol, Spain
| | - Pablo Abellán
- Department of Endocrinology and Nutrition, Castellón General Universitary Hospital, Castellón de la Plana, Spain; Department of Medicine, Universidad Cardenal Herrera-CEU University, CEU Universities, Castellón, Spain.,Department of Endocrinology and Nutrition, Elda Hospital, Elda, Spain
| | - José Manuel Ruiz Palomar
- Department of Endocrinology and Nutrition, Quirón Health, Miguel Domínguez Hospitals Group, Pontevedra, Spain
| | | | - Andreu Nubiolae
- Department of Endocrinology and Nutrition, Cruces Universitary Hospital, Barakaldo, Spain
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Bellido V, Larrañaga I, Guimón M, Martinez-Conde R, Eguia A, Perez de Nanclares G, Castaño L, Gaztambide S. A Novel Mutation in a Patient with Hyperparathyroidism-Jaw Tumour Syndrome. Endocr Pathol 2016; 27:142-6. [PMID: 26995009 DOI: 10.1007/s12022-016-9427-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [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] [Indexed: 10/22/2022]
Abstract
Hyperparathyroidism-jaw tumour syndrome (HPT-JT) is a rare variant of familial hyperparathyroidism, characterized by primary hyperparathyroidism (PHPT) due to one or multiple parathyroid adenomas, and benign tumours of the mandible and maxilla. It has an autosomal dominant pattern of inheritance, and is associated with mutations that deactivate the cell division cycle protein 73 homolog (CDC73) gene, also known as hyperparathyroidism 2 (HRPT2), located on the long arm of chromosome 1, that encodes for the tumour suppressor protein parafibromin. In the majority of cases, PHPT is the presenting symptom, but up to 30 % of HPT-JT cases initially present with an ossifying fibroma of the maxillofacial bones. HPT-JT may result in severe hypercalcemia-related complications and an elevated risk of parathyroid carcinoma. For this reason, early identification of the disease is important. We present the case of a 23-year-old woman who was found to have jaw tumours and was later diagnosed with PHPT. Genetic analysis revealed a novel mutation in exon 1 of CDC73. This report contributes to the understanding of the genetics of this rare syndrome. It also highlights the fact that HPT-JT should be considered and CDC73 mutation analysis should be performed in cases of early-onset PHPT associated with ossifying fibromas of the jaw.
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Affiliation(s)
- Virginia Bellido
- Department of Endocrinology, Cruces University Hospital, Plaza de Cruces s/n, 48903, Barakaldo, Vizcaya, Spain.
- University of the Basque Country, Leioa, Spain.
| | - Ihintza Larrañaga
- Department of Endocrinology, Cruces University Hospital, Plaza de Cruces s/n, 48903, Barakaldo, Vizcaya, Spain
| | - Maite Guimón
- Department of Endocrinology, Cruces University Hospital, Plaza de Cruces s/n, 48903, Barakaldo, Vizcaya, Spain
| | - Rafael Martinez-Conde
- Oral Medicine Unit, Oral and Maxillofacial Pathology Unit, Faculty of Medicine and Dentistry, UFI 11/25, University of the Basque Country, Leioa, Spain
| | - Asier Eguia
- Oral Medicine Unit, Oral and Maxillofacial Pathology Unit, Faculty of Medicine and Dentistry, UFI 11/25, University of the Basque Country, Leioa, Spain
| | - Gustavo Perez de Nanclares
- BioCruces Health Research Institute, Vizcaya, Spain
- CIBERER (Center for Biomedical Research on Rare Diseases), Carlos III Health Institute, Madrid, Spain
| | - Luis Castaño
- University of the Basque Country, Leioa, Spain
- BioCruces Health Research Institute, Vizcaya, Spain
- CIBERER (Center for Biomedical Research on Rare Diseases), Carlos III Health Institute, Madrid, Spain
- CIBERDEM (Spanish Biomedical Research Centre in Diabetes and Associated Metabolic Disorders), Carlos III Health Institute, Madrid, Spain
| | - Sonia Gaztambide
- Department of Endocrinology, Cruces University Hospital, Plaza de Cruces s/n, 48903, Barakaldo, Vizcaya, Spain
- University of the Basque Country, Leioa, Spain
- BioCruces Health Research Institute, Vizcaya, Spain
- CIBERER (Center for Biomedical Research on Rare Diseases), Carlos III Health Institute, Madrid, Spain
- CIBERDEM (Spanish Biomedical Research Centre in Diabetes and Associated Metabolic Disorders), Carlos III Health Institute, Madrid, Spain
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25
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Bellido V, Suarez L, Rodriguez MG, Sanchez C, Dieguez M, Riestra M, Casal F, Delgado E, Menendez E, Umpierrez GE. Comparison of Basal-Bolus and Premixed Insulin Regimens in Hospitalized Patients With Type 2 Diabetes. Diabetes Care 2015; 38:2211-6. [PMID: 26459273 PMCID: PMC4657612 DOI: 10.2337/dc15-0160] [Citation(s) in RCA: 75] [Impact Index Per Article: 8.3] [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: 01/22/2015] [Accepted: 08/31/2015] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Premixed insulin is a commonly prescribed formulation for the outpatient management of patients with type 2 diabetes. The safety and efficacy of premixed insulin formulations in the hospital setting is not known. RESEARCH DESIGN AND METHODS In a prospective, open-label trial, we randomized general medicine and surgery patients to receive a basal-bolus regimen with glargine once daily and glulisine before meals (n = 33) or premixed human insulin (30% regular insulin and 70% NPH insulin) twice daily (n = 39). Major outcomes included differences in daily blood glucose (BG) levels and frequency of hypoglycemic events (<70 mg/dL) between treatment groups. RESULTS At the first prespecified interim analysis, the study was stopped early because of an increased frequency of hypoglycemia >50% in patients treated with premixed human insulin. A total of 64% of patients treated with premixed insulin experienced one or more episodes of hypoglycemia compared with 24% in the basal-bolus group (P < 0.001). There were no differences in mean daily BG level after the first day of insulin treatment (175 ± 32 vs. 179 ± 43 mg/dL, P = 0.64) between groups. A BG target between 80 and 180 mg/dL before meals was achieved in 55.9% of BG readings in the basal-bolus group and 54.3% of BG readings in the premixed insulin group (P = 0.23). There was no difference in the length of hospital stay or mortality between treatment groups. CONCLUSIONS Inpatient treatment with premixed human insulin resulted in similar glycemic control but in significantly higher frequency of hypoglycemia compared with treatment with basal-bolus insulin regimen in hospitalized patients with diabetes.
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Affiliation(s)
- Virginia Bellido
- Hospital Universitario Central de Asturias, Oviedo, Asturias, Spain
| | - Lorena Suarez
- Hospital Universitario Central de Asturias, Oviedo, Asturias, Spain
| | | | - Cecilia Sanchez
- Hospital Universitario Central de Asturias, Oviedo, Asturias, Spain
| | | | | | | | - Elias Delgado
- Hospital Universitario Central de Asturias, Oviedo, Asturias, Spain
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26
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Shamji MH, Bellido V, Scadding GW, Layhadi JA, Cheung DKM, Calderon MA, Asare A, Gao Z, Turka LA, Tchao N, Togias A, Phippard D, Durham SR. Effector cell signature in peripheral blood following nasal allergen challenge in grass pollen allergic individuals. Allergy 2015; 70:171-9. [PMID: 25377909 DOI: 10.1111/all.12543] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [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: 10/31/2014] [Indexed: 11/28/2022]
Abstract
BACKGROUND Several studies have demonstrated the time course of inflammatory mediators in nasal fluids following nasal allergen challenge (NAC), whereas the effects of NAC on cells in the periphery are unknown. We examined the time course of effector cell markers (for basophils, dendritic cells and T cells) in peripheral blood after nasal grass pollen allergen challenge. METHODS Twelve participants with seasonal allergic rhinitis underwent a control (diluent) challenge followed by NAC after an interval of 14 days. Nasal symptoms and peak nasal inspiratory flow (PNIF) were recorded along with peripheral basophil, T-cell and dendritic cell responses (flow cytometry), T-cell proliferative responses (thymidine incorporation), and cytokine expression (FluoroSpot assay). RESULTS Robust increases in nasal symptoms and decreases in PNIF were observed during the early (0-1 h) response and modest significant changes during the late (1-24 h) response. Sequential peaks in peripheral blood basophil activation markers were observed (CD107a at 3 h, CD63 at 6 h, and CD203c(bright) at 24 h). T effector/memory cells (CD4(+) CD25(lo) ) were increased at 6 h and accompanied by increases in CD80(+) and CD86(+) plasmacytoid dendritic cells (pDCs). Ex vivo grass antigen-driven T-cell proliferative responses and the frequency of IL-4(+) CD4(+) T cells were significantly increased at 6 h after NAC when compared to the control day. CONCLUSION Basophil, T-cell, and dendritic cell activation increased the frequency of allergen-driven IL-4(+) CD4(+) T cells, and T-cell proliferative responses are detectable in the periphery after NAC. These data confirm systemic cellular activation following a local nasal provocation.
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Affiliation(s)
- M. H. Shamji
- Immunomodulation and Tolerance Group; National Heart and Lung Institute; Imperial College London; London UK
| | - V. Bellido
- Allergy and Clinical Immunology; Leukocyte Biology; National Heart and Lung Institute; Imperial College London; London UK
| | - G. W. Scadding
- Allergy and Clinical Immunology; Leukocyte Biology; National Heart and Lung Institute; Imperial College London; London UK
| | - J. A. Layhadi
- Immunomodulation and Tolerance Group; National Heart and Lung Institute; Imperial College London; London UK
- Allergy and Clinical Immunology; Leukocyte Biology; National Heart and Lung Institute; Imperial College London; London UK
| | - D. K. M. Cheung
- Immunomodulation and Tolerance Group; National Heart and Lung Institute; Imperial College London; London UK
- Allergy and Clinical Immunology; Leukocyte Biology; National Heart and Lung Institute; Imperial College London; London UK
| | - M. A. Calderon
- Allergy and Clinical Immunology; Leukocyte Biology; National Heart and Lung Institute; Imperial College London; London UK
| | - A. Asare
- Immune Tolerance Network; Bethesda MD USA
| | - Z. Gao
- Immune Tolerance Network; Bethesda MD USA
| | - L. A. Turka
- Immune Tolerance Network; Bethesda MD USA
- Massachusetts General Hospital; Boston MA USA
| | - N. Tchao
- Immune Tolerance Network; Bethesda MD USA
| | - A. Togias
- National Institute of Allergy and Infectious Diseases; Bethesda MD USA
| | | | - S. R. Durham
- Immunomodulation and Tolerance Group; National Heart and Lung Institute; Imperial College London; London UK
- Allergy and Clinical Immunology; Leukocyte Biology; National Heart and Lung Institute; Imperial College London; London UK
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27
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Ventura I, Vega A, Chacón P, Chamorro C, Aroca R, Gómez E, Bellido V, Puente Y, Blanca M, Monteseirín J. Neutrophils from allergic asthmatic patients produce and release metalloproteinase-9 upon direct exposure to allergens. Allergy 2014; 69:898-905. [PMID: 24773508 DOI: 10.1111/all.12414] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [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: 03/19/2014] [Indexed: 01/30/2023]
Abstract
BACKGROUND Asthma is characterized by airway inflammation and remodelling in which matrix metalloproteinases (MMPs) play an important role. MMP-9 is the major MMP found in the bronchoalveolar lavage fluids and bronchial biopsies from patients with allergic asthma after allergen challenge, where it correlates with the count of neutrophils and macrophages. However, the cellular sources of MMP-9 in this inflammatory condition have not yet been clearly identified. This work was undertaken to analyse whether neutrophils may be a source of MMP-9 in the allergic asthma condition upon allergen challenge. METHODS Neutrophils from allergic asthmatic patients were in vitro stimulated, and the levels of MMP-9 release were measured in the cell culture supernatants using enzyme-linked immunosorbent assay (ELISA) and zymography. RESULTS We show that MMP-9 is released by neutrophils, but not by eosinophils from allergic asthmatic patients in response to allergens to which the patients were sensitized. Neutrophils also released MMP-9 in response to anti-IgE Abs, and agonist Abs against FcεRI, FcεRII/CD23 and galectin-3. Inhibitors of transcription and translation, actinomycin D and cycloheximide, partially cancelled this process, suggesting that MMP-9 is also de novo synthesized in response to stimuli. We also show evidence that the MAPKs, p38 and extracellular signal-regulated kinase, as well as the transcription factor NF-κB, are involved, as specific chemical inhibitors of these cell-signalling pathways abolished the anti-IgE/allergen-dependent MMP-9 release. CONCLUSIONS These data demonstrate that the exposure of neutrophils to allergens leads to generation of MMP-9, which may then lead to remodelling in asthma.
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Affiliation(s)
- I. Ventura
- Servicio Regional de Inmunología y Alergia; Hospital Universitario Virgen Macarena; Sevilla Spain
| | - A. Vega
- Servicio Regional de Inmunología y Alergia; Hospital Universitario Virgen Macarena; Sevilla Spain
| | - P. Chacón
- Servicio Regional de Inmunología y Alergia; Hospital Universitario Virgen Macarena; Sevilla Spain
| | - C. Chamorro
- Servicio Regional de Inmunología y Alergia; Hospital Universitario Virgen Macarena; Sevilla Spain
| | - R. Aroca
- Servicio Regional de Inmunología y Alergia; Hospital Universitario Virgen Macarena; Sevilla Spain
| | - E. Gómez
- Servicio Regional de Inmunología y Alergia; Hospital Universitario Virgen Macarena; Sevilla Spain
| | - V. Bellido
- Servicio Regional de Inmunología y Alergia; Hospital Universitario Virgen Macarena; Sevilla Spain
| | - Y. Puente
- Servicio Regional de Inmunología y Alergia; Hospital Universitario Virgen Macarena; Sevilla Spain
| | - M. Blanca
- Research Laboratory; Carlos Haya Hospital-Fundacion IMABIS; Málaga Spain
| | - J. Monteseirín
- Servicio Regional de Inmunología y Alergia; Hospital Universitario Virgen Macarena; Sevilla Spain
- Departamento de Medicina; Facultad de Medicina; Universidad de Sevilla; Sevilla Spain
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Bellido D, López de la Torre M, Carreira J, de Luis D, Bellido V, Soto A, Luengo LM, Hernández A, Vidal J, Becerra A, Ballesteros M. [Anthropometric measures of central abdominal fat and discriminant capacity for metabolic syndrome in a Spanish population]. Clin Investig Arterioscler 2013; 25:105-9. [PMID: 23916262 DOI: 10.1016/j.arteri.2013.05.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [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: 03/04/2013] [Revised: 05/19/2013] [Accepted: 05/27/2013] [Indexed: 11/20/2022]
Abstract
INTRODUCTION The metabolic syndrome (MS) carries an increased risk of cardiovascular disease and diabetes mellitus. Insulin resistance is probably the mechanism underlying the changes detected in lipid and carbohydrate metabolism in these patients, who have, as a common anthropometric feature, a predominantly increased abdominal fat distribution. PATIENTS AND METHODS A total of 3316 patients were studied, of whom 63.40% were female and 36.60 male, with a mean age of 42.36±14.63 years, and a body mass index (BMI) of 32.76±6.81kg/m(2). Weight, height and waist circumference (CC) were measured using standard techniques. The waist/height (ICA) was calculated using two indicators, expressed as waist in cm divided by height in m(2), and as waist divided by height, both in cm. The prevalence of metabolic syndrome in the sample was 33.70%. In order to assess the predictive ability of BMI, ICA and CC to detect the existence of MS, receiver operating curves (ROC) were constructed and the areas under the curve (AUC) calculated for each anthropometric parameter. RESULTS An AUC of 0.724 (95%CI: 0.706 to 0.742), P<.001, was obtained for CC, 0.709 (95%CI: 0.691 to 0.728), P<.001 for ICA with height in m(2), and 0.729 (95%CI: 0.711 to 0.747), P<.001 for ICA with height in cm, and for the BMI it was 0.680 (95%CI 0.661-0.699), P<.001. CONCLUSIONS Anthropometric indices that assess abdominal fat distribution have a better predictive capacity for detecting MS, compared to total adiposity indicators such as BMI.
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Affiliation(s)
- Diego Bellido
- Endocrinología y Nutrición, Complexo Hospitalario Universitario de Ferrol, Chuf, SERGAS, Ferrol, A Coruña, España.
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29
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Shamji M, Bellido V, Scadding G, Leyhadi J, Calderon M, Togias A, Tchao N, Plaut M, Turka L, Phippard D, Durham S. Effects of Nasal Allergen Challenge on T cell signature in Peripheral Blood in Patients with Severe Seasonal Allergic Rhinitis. J Allergy Clin Immunol 2012. [DOI: 10.1016/j.jaci.2011.12.295] [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: 10/14/2022]
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30
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Bellido I, Perez-Bertolez S, Bellido V, Gomez-Luque A. P-118 - Anxiety increased perioperative pain perception in children. Eur Psychiatry 2012. [DOI: 10.1016/s0924-9338(12)74285-2] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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31
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Bellido I, Dominguez M, Bellido V, Gómez-Luque A. Levetiracetam showed lower depression, insomnia and mood instability incidence than phenytoin after supratentorial tumour neurosurgery. Eur Psychiatry 2011. [DOI: 10.1016/s0924-9338(11)72934-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
BackgroundPhenytoin used to prevent seizures linked to brain cancer neurosurgery has shown many undesirable side effects and drug interactions with chemotherapy.AimTo evaluate the incidence of depression, insomnia, mood instability and early post surgery seizures, after Phenytoin (PHE) vs. Levetiracetam (LEV) monotherapy in patients with brain tumour subjected to a supratentorial brain tumour resection.MethodsA prospective study in patients with supratentorial cancer diagnosis subjected to neurosurgery of resection was done. Patients were consecutive randomized to be treated with PHE (n = 26) 15 ml/kg IV-bolus, 125 mg/8 h IV x48 h, 100 mg/8 h O x7 days or with LEV (n = 34) 500 mg/12 h IV x48 h, 500 mg/12 h O x 7 days. Clinical, histological, TAC, EEG, seizures and undesirable side effects were analyzed.Results and discussion60 patients (53% male, aged 52.5 ± 20 years) with glioblastoma multiform 45%, meningioma 43%, Ewing's sarcoma 6.7%, others 5.3% (size between 3–6 cm, in the right brain site-65.2%, in the frontal lobe-56.2%) were subjected to followed for a week after tumour resection. Undesirable side effects (USE) were (%LEV/%PHE): total (7.3%/31.5%), somnolence (0%/32.8%), headache (6.1%/22.3%), dizziness (0%/25.6%), difficulty with coordination (0%/23.5%), depression (6.2%/18.7%), lack of energy/strength (12.5%/33.8%), insomnia (11.3%/37.9%), mood instability (12.5%/22,6%), leukopenia (0%/16.9%) after surgery (p < 0.05). None of the patients taking Levetiracetam vs. 4 of the patients taking Phenytoin (0% vs. 15.3%) had seizures after surgery (p < 0.05).ConclusionLevetiracetam showed lower depression, insomnia, mood instability and seizures incidence than Phenytoin after supratentorial tumour neurosurgery.
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Fácila L, Bertomeu-González V, Sanchís J, Bodí V, Núñez J, Llácer A, Bellido V. Niveles de glucemia en pacientes no diabéticos. ¿Es un factor pronóstico en el síndrome coronario agudo? Rev Clin Esp 2006; 206:271-5. [PMID: 16762290 DOI: 10.1157/13088586] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
INTRODUCTION The role of glucose elevation above levels considered normal in non- diabetic patients with acute coronary syndromes (ACS) is not adequately defined. The aim of this study was to determine the association between serum glucose at admission and 1-year mortality in this type of patients. METHODS We studied 648 non diabetic patients admitted consecutively with ACS. Serum glucose was determined at admission, together with classical risk factors, biochemical and inflammatory markers. The primary endpoint was all cause mortality at one year follow-up. RESULTS Patients with normal glucose had lower mortality than patients with impaired fasting glucose (14.1% vs 5.7% 1-year mortality) or with glucose levels in diabetic range (24.7% vs 5.7% 1-year mortality). CONCLUSIONS In non-ST elevation acute coronary syndromes, elevated levels of glucose in non-diabetic patients are strong predictors of all cause death at one year follow-up. This prognostic value is independent of other risk factors biochemical and inflammatory markers.
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Affiliation(s)
- L Fácila
- Servicio de Cardiología, Consorcio Hospitalario Provincial de Castellón, Castellón, España.
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33
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Llorente L, Bellido V, Pérez Cuadrado S. [In vivo effect of Resistocell on the Phytohemagglutinin Immunocompetence Index (rabbits)]. Rev Esp Oncol 1984; 31:27-33. [PMID: 6545425] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/05/2023]
Abstract
The RST-SAS effect in normal adult albino New Zealand giant male rabbits was studied. A positive individual response in 89% of the animal and no harmful side-effects were observed, after the i.v. administration of a suitable RSTL-SAS dose. The statistical evaluation of group data showed a significative 42% increased of the IIC.PHA above the normal basal level. Thus, the RSTL-SAS could provide an unique immunomodulator agent due to its significant biological effect and the apparent lack of any side effect.
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