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Ena J, Carretero-Gómez J, Manuel-Casas J, Casado P, Vázquez-Rodríguez P, Martínez-García F, González-González P, de Escalante-Yagüela B, Gandullo-Moro M, Carrasco-Sánchez FJ. Inpatient management of diabetes and hyperglycaemia: an audit of Spanish hospitals. Rev Clin Esp 2023:S2254-8874(23)00069-3. [PMID: 37295647 DOI: 10.1016/j.rceng.2023.04.011] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Accepted: 04/17/2023] [Indexed: 06/12/2023]
Abstract
OBJECTIVES Evaluation of quality of care for patients with diabetes mellitus admitted to hospitals in Spain. METHODS Cross-sectional study in one day that included 1193 (26.7%) patients with type 2 diabetes or hyperglycaemia out of a total of 4468 patients admitted to the internal medicine departments of 53 hospitals in Spain. We collected demographic data, adequacy of capillary glycaemic monitoring, treatment administered during admission, and recommended therapy at discharge. RESULTS The median age of the patients was 80 years [74-87], of which 561 (47%) were women, with a Charlson index of 4 points [2-6], and 742 (65%) were fragile. Median blood glucose on admission was 155 mg/dL [119-213]. On the third day, the number of capillary blood glucose levels in target (80-180 mg/dL) at pre-breakfast was 792/1126 (70.3%), pre-lunch 601/1083 (55.4%), pre-dinner 591/1073 (55.0%), and at night 317/529 (59.9%). A total of 35 (0.9%) patients suffered from hypoglycaemia. Treatment during hospitalization was performed with sliding scale insulin in 352 (40.5) patients, with basal insulin and rapid insulin analogues in 434 (50%), or with diet exclusively in 101 (9.1%). A total of 735 (61.6%) patients had a recent HbA1c value. At discharge, the use of SGLT2i increased significantly (30.1% vs. 21.6%; p < 0.001), as did the use of basal insulin (25.3% vs. 10.1%; p < 0.001). CONCLUSIONS There is an excessive use of sliding scale insulin as well as insufficient information on HbA1c values and prescription upon discharge of treatments with cardiovascular benefit.
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Affiliation(s)
- Javier Ena
- Servicio de Medicina Interna, Hospital Marina Baixa, Alicante, Spain.
| | | | - José Manuel-Casas
- Servicio de Medicina Interna, Hospital Infanta Cristina, Parla, Madrid, Spain
| | - Pedro Casado
- Servicio de Medicina Interna, Hospital La Princesa, Madrid, Spain
| | | | | | | | | | - María Gandullo-Moro
- Servicio de Medicina Interna, Hospital Universitario Virgen Macarena, Sevilla, Spain
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Gutiérrez-Zúñiga R, Alonso de Leciñana M, Delgado-Mederos R, Gállego-Cullere J, Rodríguez-Yáñez M, Martínez-Zabaleta M, Freijo M, Portilla JC, Gil-Núñez A, Díez Sebastián J, Lisbona A, Díez-Tejedor E, Fuentes B. Beyond hyperglycemia: glycaemic variability as a prognostic factor after acute ischemic stroke. Neurologia 2023; 38:150-158. [PMID: 37059570 DOI: 10.1016/j.nrleng.2020.06.017] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2020] [Accepted: 06/14/2020] [Indexed: 04/16/2023] Open
Abstract
INTRODUCTION Glycaemic variability (GV) refers to variations in blood glucose levels, and may affect stroke outcomes. This study aims to assess the effect of GV on acute ischaemic stroke progression. METHODS We performed an exploratory analysis of the multicentre, prospective, observational GLIAS-II study. Capillary glucose levels were measured every 4 hours during the first 48 hours after stroke, and GV was defined as the standard deviation of the mean glucose values. The primary outcomes were mortality and death or dependency at 3 months. Secondary outcomes were in-hospital complications, stroke recurrence, and the impact of the route of insulin administration on GV. RESULTS A total of 213 patients were included. Higher GV values were observed in patients who died (n = 16; 7.8%; 30.9 mg/dL vs 23.3 mg/dL; p = 0.05). In a logistic regression analysis adjusted for age and comorbidity, both GV (OR = 1.03; 95% CI, 1.003-1.06; p = 0.03) and stroke severity (OR = 1.12; 95% CI, 1.04-1.2; p = 0.004) were independently associated with mortality at 3 months. No association was found between GV and the other outcomes. Patients receiving subcutaneous insulin showed higher GV than those treated with intravenous insulin (38.95 mg/dL vs 21.34 mg/dL; p < 0.001). CONCLUSIONS High GV values during the first 48 hours after ischaemic stroke were independently associated with mortality. Subcutaneous insulin may be associated with higher VG levels than intravenous administration.
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Affiliation(s)
- R Gutiérrez-Zúñiga
- Servicio de Neurología, Hospital Universitario La Paz, Universidad Autónoma de Madrid, Madrid, España
| | - M Alonso de Leciñana
- Servicio de Neurología, Hospital Universitario La Paz, Universidad Autónoma de Madrid, Madrid, España
| | - R Delgado-Mederos
- Servicio de Neurología, Hospital de la Santa Creu i Sant Pau, Barcelona, España
| | - J Gállego-Cullere
- Servicio de Neurología, Complejo Hospitalario de Navarra, Pamplona, España
| | - M Rodríguez-Yáñez
- Servicio de Neurología, Hospital Clínico Universitario, Santiago de Compostela, España
| | - M Martínez-Zabaleta
- Servicio de Neurología, Hospital Universitario Donostia, San Sebastián, España
| | - M Freijo
- Servicio de Neurología, IIS Biocruces-Bizkaia, Bilbao, España
| | - J C Portilla
- Servicio de Neurología, Hospital San Pedro de Alcántara, Cáceres, España
| | - A Gil-Núñez
- Servicio de Neurología, Hospital Universitario Gregorio Marañón, Madrid, España
| | - J Díez Sebastián
- Servicio de Bioestadística, Hospital Universitario La Paz, Universidad Autónoma de Madrid, Madrid, España
| | - A Lisbona
- Servicio de Endocrinología, Hospital Universitario La Paz, Universidad Autónoma de Madrid, Madrid, España
| | - E Díez-Tejedor
- Servicio de Neurología, Hospital Universitario La Paz, Universidad Autónoma de Madrid, Madrid, España
| | - B Fuentes
- Servicio de Neurología, Hospital Universitario La Paz, Universidad Autónoma de Madrid, Madrid, España.
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García-Arnés JA, García-Casares N. Doping and sports endocrinology: growth hormone, IGF-1, insulin, and erythropoietin. Rev Clin Esp 2023; 223:181-187. [PMID: 36736729 DOI: 10.1016/j.rceng.2023.01.005] [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] [Indexed: 02/04/2023]
Abstract
Among the substances prohibited by the World Anti-Doping Agency, "peptide hormones, growth factors, related substances, and mimetics" are classified as prohibited both in- and out-of-competition in section S2. This work reviews growth hormone and its releasing peptides, insulin-like growth factor 1 as the main growth factor, insulin, and erythropoietin and other agents that affect erythropoiesis. This review analyzes the prevalence of use among professional athletes and gym clients, the forms of use, dosing, ergogenic effects and effects on physical performance, as well as side effects and anti-doping detection methods.
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Affiliation(s)
- J A García-Arnés
- Departamento de Farmacología, Facultad de Medicina, Universidad de Málaga, Málaga, Spain.
| | - N García-Casares
- Departamento de Medicina, Facultad de Medicina, Universidad de Málaga, Málaga, Spain; Centro de Investigaciones Médico-Sanitarias (CIMES), Universidad de Málaga, Málaga, Spain; Instituto de Investigación Biomédica de Málaga (IBIMA), Málaga, Spain
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Palomo Atance E, Caballero Mora FJ, Espadas Maciá D, Marbán Calzón M, Sevilla Ramos P, García Villaescusa L, Dabad Moreno MJ, Muñoz-Rodríguez JR, Ruiz Cano R. Triponderal mass index and markers of metabolic risk in children and adolescents with obesity. Med Clin (Barc) 2023; 160:379-384. [PMID: 36631326 DOI: 10.1016/j.medcli.2022.09.024] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Revised: 09/19/2022] [Accepted: 09/22/2022] [Indexed: 01/11/2023]
Abstract
BACKGROUND AND OBJECTIVE Triponderal mass index (TMI) would estimate excess adiposity better than body mass index (BMI), maintaining stable values during childhood. This work aims to determine the correlation between TMI and markers of metabolic risk as well as set values of TMI that are related to an increase of metabolic risk. MATERIAL AND METHODS Multicenter, observational, cross-sectional and prospective study in children under 14 years of age with obesity. VARIABLES age, sex, pubertal stage, weight, height, abdominal circumference, BMI, TMI, basal glucose and insulin, HOMA index, blood pressure, lipoprotein profile, transaminases and uric acid. BMI and TMI were expressed according to the values of the Barcelona longitudinal study. Statistical analysis was performed with the SPSS* program. RESULTS One hundred and ninety-nine patients (50.3% male), age 11.08 (2.48) years, TMI 19.68 (2.36)kg/m3. Correlation between TMI and abdominal circumference (r=0.571; p=0), insulin (r=0.198; p=0.005), HOMA index (r=0.189; p=0.008) and HDL-c (r=-0.188; p=0.008) was observed. IMT>20.15kg/m3 was associated with insulin≥15mIU/ml (p=0.029) and IMT>20.36kg/m3 with HDL-c<40mg/dl (p=0.023). CONCLUSIONS TMI was correlated with increase of abdominal circumference, insulin and HOMA index and decrease of HDL-c. IMT>20kg/m3 can be associated with increased insulin and decreased HDL-c. Therefore, the IMT seems to be a useful parameter in the assessment of pediatric patients with obesity.
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Affiliation(s)
- Enrique Palomo Atance
- Endocrinología Pediátrica, Servicio de Pediatría, Hospital General Universitario de Ciudad Real, Grupo de Endocrinología Pediátrica de Castilla-La Mancha (GEPCAM), Ciudad Real, España.
| | - Francisco Javier Caballero Mora
- Endocrinología Pediátrica, Servicio de Pediatría, Hospital Santa Bárbara, Grupo de Endocrinología Pediátrica de Castilla-La Mancha (GEPCAM), Puertollano, Ciudad Real, España
| | - David Espadas Maciá
- Endocrinología Pediátrica, Servicio de Pediatría, Hospital Virgen de la Luz, Grupo de Endocrinología Pediátrica de Castilla-La Mancha (GEPCAM), Cuenca, España
| | - Mercedes Marbán Calzón
- Endocrinología Pediátrica, Servicio de Pediatría, Hospital General La Mancha Centro, Grupo de Endocrinología Pediátrica de Castilla-La Mancha (GEPCAM), Alcázar de San Juan, Ciudad Real, España
| | - Pilar Sevilla Ramos
- Endocrinología Pediátrica, Servicio de Pediatría, Hospital Universitario de Guadalajara, Grupo de Endocrinología Pediátrica de Castilla-La Mancha (GEPCAM), Guadalajara, España
| | - Lourdes García Villaescusa
- Endocrinología Pediátrica, Servicio de Pediatría, Hospital General de Almansa, Grupo de Endocrinología Pediátrica de Castilla-La Mancha (GEPCAM), Almansa, Albacete, España
| | - María Jesús Dabad Moreno
- Endocrinología Pediátrica, Servicio de Pediatría, Hospital General Universitario de Albacete, Grupo de Endocrinología Pediátrica de Castilla-La Mancha (GEPCAM), Albacete, España
| | - José Ramón Muñoz-Rodríguez
- Unidad de Investigación Traslacional, Hospital General Universitario de Ciudad Real, Ciudad Real, España
| | - Rafael Ruiz Cano
- Endocrinología Pediátrica, Servicio de Pediatría, Hospital General Universitario de Albacete, Grupo de Endocrinología Pediátrica de Castilla-La Mancha (GEPCAM), Albacete, España
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Hernández-García F, González-Velázquez VE, Pérez García ER, Lazo Herrera LA, Pedraza-Rodríguez EM, Pupo Pérez A, González Quintana P, Casanovas Figueroa J. Validation and application of the Insulin Treatment Appraisal Scale in Cuban patients with type 2 diabetes mellitus. ENDOCRINOL DIAB NUTR 2022; 69:791-801. [PMID: 36443192 DOI: 10.1016/j.endien.2021.11.036] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Accepted: 11/08/2021] [Indexed: 06/16/2023]
Abstract
INTRODUCTION The purpose of this study was to validate the Insulin Treatment Appraisal Scale (ITAS) in the Cuban population with type 2 diabetes mellitus. MATERIAL AND METHODS A cross-sectional, multicentre analytical study was performed in Cuba from February 2020 to April 2021; 199 patients were surveyed in a hospital institution and in primary healthcare. We used the Insulin Treatment Appraisal Scale, consisting of 20 items, with a minimum score of 20 points and a maximum of 100, where the higher the score, the worse the perception of insulin therapy. The validity of the instrument was determined by means of an exploratory factor analysis. The internal consistency and reliability of the scale were calculated by means of Cronbach's alpha coefficient. A K-means cluster analysis was performed to establish a cut-off point for poor perception of insulin therapy. RESULTS The exploratory factor analysis supported the validity of the instrument, with a Cronbach's alpha of 0.747. There were statistically significant differences between patients under insulin and non-insulin treatment in terms of the answers given in all items of the scale. The total mean score obtained was 51.96 ± 10.78, and it was lower in insulin users compared to those who used other drugs (49.79 ± 10.07 vs 55.09 ± 11.12). A score ≥65 was proposed as a cut-off point for poor perception of insulin therapy. A positive relationship was found between the body mass index values and the total score of the scale. Being female and current treatment not involving insulin were factors associated with low perception of insulin therapy. CONCLUSIONS The instrument proved to be valid for the population in which it was applied. Insulin users turned out to be the ones with the best perception about its use. A cut-off point of ≥65 points for poor perception of insulin treatment was proposed for evaluation and comparison in future studies in other patient populations.
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Affiliation(s)
- Frank Hernández-García
- Centro Provincial de Atención y Educación al Paciente Diabético, Hospital Provincial General Docente Dr. Antonio Luaces Iraola, Facultad de Ciencias Médicas Dr. José Assef Yara, Universidad de Ciencias Médicas de Ciego de Ávila, Ciego de Ávila, Cuba.
| | | | - Enrique Rolando Pérez García
- Policlínico Universitario Área Norte, Facultad de Ciencias Médicas Dr. José Assef Yara, Universidad de Ciencias Médicas de Ciego de Ávila, Ciego de Ávila, Cuba
| | - Luis Alberto Lazo Herrera
- Facultad de Ciencias Médicas Dr. Ernesto Che Guevara de la Serna, Universidad de Ciencias Médicas de Pinar del Río, Pinar del Río, Cuba
| | | | - Antonio Pupo Pérez
- Facultad de Ciencias Médicas General Calixto García, Universidad de Ciencias Médicas de La Habana, La Habana, Cuba
| | | | - Jany Casanovas Figueroa
- Centro Provincial de Atención y Educación al Paciente Diabético, Hospital Provincial General Docente Dr. Antonio Luaces Iraola, Facultad de Ciencias Médicas Dr. José Assef Yara, Universidad de Ciencias Médicas de Ciego de Ávila, Ciego de Ávila, Cuba
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Gargallo-Fernández M, Escalada-San Martín J, Chico-Ballesteros A, Lecumberri-Pascual E, Tejera-Pérez C, Fernández-García JC, Rozas-Moreno P, Marco-Martínez A, Gómez-Peralta F, López-Fernández J. Executive summary of the consensus statement of: Clinical recommendations for sport practice in people with diabetes (RECORD Guide). Update 2021. Diabetes Mellitus Area of the Spanish Society of Endocrinology and Nutrition (SEEN). ENDOCRINOL DIAB NUTR 2022; 69:732-743. [PMID: 36404267 DOI: 10.1016/j.endien.2022.11.001] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Accepted: 06/23/2021] [Indexed: 06/16/2023]
Abstract
OBJECTIVE To guide professionals involved in the care of people with diabetes mellitus who practice sport. PARTICIPANTS Members of the Diabetes Mellitus Working Group of the Spanish Society of Endocrinology and Nutrition. METHODS A group of experts in each area covered by the statement carried out a bibliographic review of the available evidence for each topic, based on which recommendations were subsequently agreed upon within the Diabetes Mellitus Working Group. CONCLUSIONS The statement provides practical recommendations for the management of diabetes mellitus during sports practice.
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Affiliation(s)
- Manuel Gargallo-Fernández
- Sección de Endocrinología y Nutrición, Hospital Universitario Infanta Leonor, Fundación Jiménez Díaz, Madrid, Spain.
| | - Javier Escalada-San Martín
- Departamento de Endocrinología y Nutrición, Clínica Universidad de Navarra, Centro de Investigación Biomédica en Red Fisiopatología de la Obesidad y Nutrición (CIBEROBN), ISCIII, Instituto de Investigación Sanitaria de Navarra (IdiSNA), Grupo de Nefrología clínica, Pamplona, Spain
| | - Ana Chico-Ballesteros
- Servicio de Endocrinología y Nutrición, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Edurne Lecumberri-Pascual
- Unidad de Diabetes, Servicio de Endocrinología y Nutrición, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - Cristina Tejera-Pérez
- Servicio de Endocrinología y Nutrición, Complejo Hospitalario Universitario de Ferrol, Ferrol, La Coruña, Spain
| | - José Carlos Fernández-García
- Servicio de Endocrinología y Nutrición, Hospital Regional Universitario de Málaga, Instituto de Investigación Biomédica de Málaga (IBIMA), Málaga, Spain
| | - Pedro Rozas-Moreno
- Sección de Endocrinología y Nutrición, Hospital General Universitario, Ciudad Real, Spain
| | - Amparo Marco-Martínez
- Sección de Endocrinología y Nutrición, Complejo hospitalario de Toledo, Toledo, Hospital Quirón Salud Madrid, Madrid, Spain
| | | | - Judith López-Fernández
- Servicio de Endocrinología y Nutrición, Hospital Universitario de Canarias, Santa Cruz de Tenerife, Spain
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Amigó J, Corcoy R. Type 1 diabetes and pregnancy: An update on glucose monitoring and insulin treatment. ENDOCRINOL DIAB NUTR 2022; 69:433-441. [PMID: 35787359 DOI: 10.1016/j.endien.2022.06.008] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Accepted: 09/15/2021] [Indexed: 06/15/2023]
Abstract
The relevance of type 1 diabetes during pregnancy stems from its impact on the health of mother and offspring and its increasing prevalence. Glycemic control during pregnancy is one of the main risk factors for adverse events. Besides, treatment becomes a major challenge not only due to the modifications in insulin requirements due to changes in hormones and cytokines but also to the stricter control targets. Given the recent appearance of new ultra-rapid and basal insulin analogues and the constant evolution of technology to treat people with diabetes, we review these aspects in relation to the treatment of women with type 1 diabetes during pregnancy.
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Affiliation(s)
- Judit Amigó
- Servei d'Endocrinologia i Nutrició, Hospital Vall d'Hebron, Barcelona, Spain.
| | - Rosa Corcoy
- Servei d'Endocrinologia i Nutrició, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain; Institut de Recerca, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain; Centro de Investigación Biomédica en Red de Bioingeniería, Biomateriales y Nanomedicina, Instituto de Salud Carlos III, CIBER-BBN, Madrid, Spain
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Manjarrez-Gutiérrez G, Mondragón-Herrera JA, Hernández-Rodríguez J. Diabetes mellitus causes changes in the activity and expression of brain tryptophan-5-hydroxylases and in the number of serotonergic neurons, which do not return to normal with insulin treatment. GAC MED MEX 2022; 158:182-189. [PMID: 36256550 DOI: 10.24875/gmm.m22000675] [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: 03/28/2022] [Accepted: 07/14/2022] [Indexed: 06/16/2023] Open
Abstract
INTRODUCTION Diabetes mellitus (DM) inhibits brain serotonin biosynthesis through changes in tryptophan-5-hydroxylase (TPH) activity and expression. OBJECTIVES To determine whether DM-induced changes in brain TPH1 or TPH2 expression and in the number of serotonergic neurons return to normal in diabetic rats treated with insulin. METHODS Rats with streptozotocin-induced diabetes were divided in two groups: one treated with insulin and the other without treatment. On day 14, brain stems were obtained in order to quantify L-tryptophan and 5-hydroxytryptamine levels, as well as to determine TPH activity. The expression of TPH1 and TPH2 by West-ern blot, and the number of serotonergic neurons by immunohistochemistry. RESULTS In diabetic rats, a decrease in the levels of L-tryptophan, 5-hydroxytryptamine, and TPH activity was confirmed, as well as lower TPH1 and TPH2 expression and lower numbers of serotonergic neurons. When diabetic rats were treated with insulin, L-tryptophan returned to normal, but not 5-hy-droxytryptamine, TPH expression, or the number of serotonergic neurons. CONCLUSIONS DM chronically inhibits the synthesis of brain 5-hydroxytryptamine through changes in TPH1 and TPH2 expression and a decrease in the number of serotonergic neurons, which persist despite insulin treatment.
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Affiliation(s)
- Gabriel Manjarrez-Gutiérrez
- Neurological Disorders Research Unit, Specialty Hospital, Centro Médico Nacional Siglo XXI (CMN-SXXI), Instituto Mexicano del Seguro Social (IMSS), Mexico City
- Cardiology Biomolecular Research Unit, Cardiology Hospital, Centro Médico Nacional Siglo XXI, IMSS, Mexico City
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Gracia-Ramos AE, Cruz-Domínguez MP, Madrigal-Santillán EO. Incretin-based therapy for glycemic control of hospitalized patients with type 2 diabetes: a systematic review. Rev Clin Esp 2021; 222:180-189. [PMID: 34872879 DOI: 10.1016/j.rceng.2021.09.003] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Accepted: 09/02/2021] [Indexed: 11/26/2022]
Abstract
Incretin-based therapy leads to glycemic control in a glucose-dependent manner with a low risk of hypoglycemia, making it appealing for use in the hospital. The aim of this systematic review was to assess the benefits of incretin-based therapy in patients with type 2 diabetes hospitalized outside of the intensive care unit. We searched for studies published up to August 2021 in the PubMed and Scopus databases. Clinical trials comparing incretin-based therapy (alone or in combination with insulin) versus an insulin regimen were selected. The results of the included studies showed that incretin-based therapy showed mean blood glucose values, a percentage of records within the therapeutic target, and a percentage of treatment failure similar to insulin management, particularly in patients with mild to moderate hyperglycemia. Furthermore, incretin-based treatment was associated with a lower total insulin dose and a lower incidence of hypoglycemia. In conclusion, incretin-based therapy achieved glycemic control similar to insulin treatment in patients with type 2 diabetes hospitalized outside the intensive care unit and has the advantages of reducing the insulin requirement and a lower risk of hypoglycemia.
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Affiliation(s)
- A E Gracia-Ramos
- Departamento de Medicina Interna, Hospital General, Centro Médico Nacional "La Raza", Instituto Mexicano del Seguro Social, Ciudad de México, Mexico; Sección de Estudios de Posgrado e Investigación, Escuela Superior de Medicina, Instituto Politécnico Nacional, Ciudad de México, Mexico.
| | - M P Cruz-Domínguez
- División de Investigación en Salud, Hospital de Especialidades, Centro Médico Nacional "La Raza", Instituto Mexicano del Seguro Social, Ciudad de México, Mexico
| | - E O Madrigal-Santillán
- Laboratorio de Medicina de Conservación, Escuela Superior de Medicina, Instituto Politécnico Nacional, Ciudad de México, Mexico
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Cabré Font C, Colungo Francia C, Vinagre Torres I, Jansà I Morató M, Conget Donlo I. A therapeutic education program with a diabetes specialist nurse for type 2 diabetes patients using insulin in a primary care setting. A diabetes education program with a diabetes specialist nurse in a primary care setting. ENDOCRINOL DIAB NUTR 2021; 68:628-635. [PMID: 34906343 DOI: 10.1016/j.endien.2021.11.022] [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] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Accepted: 10/30/2020] [Indexed: 06/14/2023]
Abstract
INTRODUCTION Therapeutic education is an essential part in the management of type 2 diabetes mellitus (T2D). Implementing a therapeutic education program with the participation of a diabetes specialist nurse (DSN) addressed to patients with T2D using more than 2 insulin injections and sub-optimal metabolic control in primary care (PC) could improve health care and clinical outcomes. Our purpose was to evaluate the clinical, educational and patient satisfaction outcomes of this program. MATERIAL AND METHODS A prospective, longitudinal study was performed with an evaluation before and after the intervention. The program had a duration of 6 months and included individual on-site, phone and group visits. RESULTS 184 subjects were included and 161 were finally evaluated. 89.4% were included due to sub-optimal metabolic control and 10.6% because of repeated hypoglycemia. In the first group, the mean reduction in HbA1c was -1.34%±1.45% without any increase in hypoglycemia episodes. In the second group, a significant reduction in hypoglycemia episodes/week was observed (2.52±1.66 vs. 0.53±1.06; p<0.05) without any increase in HbA1c. Learning skills, lifestyle, adherence to care, and the perception of quality of life had significantly improved at 6 months (p<0.05). The overall program was positively evaluated by patients, the role of DSN being considered essential by 98% of the responders. CONCLUSION A structured therapeutic education program, including a DSN, addressed to insulin treated T2D patients attending primary care facilities and with sub-optimal metabolic control is associated with beneficial effects in terms of clinical, educational and patient satisfaction endpoints.
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Affiliation(s)
- Carla Cabré Font
- Unidad de Diabetes, Endocrinología y Nutrición, Hospital Clínic i Universitari, Barcelona, Spain
| | - Cristina Colungo Francia
- Centro de Atención Primaria Comte Borrell, Consorci d'Atenció Primària de Salut de Barcelona Esquerre (CAPSBE), Barcelona, Spain
| | - Irene Vinagre Torres
- Unidad de Diabetes, Endocrinología y Nutrición, Hospital Clínic i Universitari, Barcelona, Spain.
| | - Marga Jansà I Morató
- Unidad de Diabetes, Endocrinología y Nutrición, Hospital Clínic i Universitari, Barcelona, Spain
| | - Ignacio Conget Donlo
- Unidad de Diabetes, Endocrinología y Nutrición, Hospital Clínic i Universitari, Barcelona, Spain; IDIBAPS, Institut d'investigacions Biomèdiques August Pi i Sunyer, Barcelona, Spain; CIBERDEM, Centro de Investigación Biomédica en Red de Diabetes y Enfermedades metabólicas, Barcelona, Spain
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11
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Ampudia-Blasco FJ, Artime E, Díaz S, Rubio M, Reviriego J, Mitchell B, Osumili B, Peyrot M, Pokrzywinski R, Spaepen E, Snoek F. Conversations and Reactions Around Severe Hypoglycaemia (CRASH): Spanish results of a global survey of people with type 1 diabetes or insulin-treated type 2 diabetes and caregivers. Endocrinol Diabetes Nutr (Engl Ed) 2021; 68:557-66. [PMID: 34872639 DOI: 10.1016/j.endien.2021.11.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Accepted: 10/14/2020] [Indexed: 11/20/2022]
Abstract
INTRODUCTION Information on experience/management of severe hypoglycaemic events (SHEs) among people with insulin-treated diabetes (PWD) and caregivers (CGs) providing care to PWD was sought. MATERIALS AND METHODS An online cross-sectional survey was conducted in eight countries. INCLUSION CRITERIA PWD (aged≥18 years; self-reported type 1 [T1D] or insulin-treated type 2 [T2D] diabetes; experienced ≥1 SHE [hypoglycaemia requiring external assistance] in past 3 years); CGs (layperson aged ≥18 years; caring for PWD meeting all criteria above except age [≥4 years]). This descriptive analysis provides data from Spain. SHE-associated data relate to the most recent SHE. RESULTS Across all groups (T1D PWD, n=106; T2D PWD, n=88, T1D CG, n=87; T2D CG, n=96), 76-89% reported that the SHE occurred at home; most common cause was eating less than planned (38-53%). Most usual action during the SHE was to intake carbohydrates (67-84%); glucagon use was low (9-36%). Discussion of the SHE with their healthcare provider (HCP) was reported by 70-75% of PWD. During the SHE, 35-69% of PWD/CGs reported feeling scared, unprepared and/or helpless. CONCLUSIONS Most SHEs occurred outside the healthcare setting; treatment therefore depends greatly on CGs. SHEs have a negative emotional impact on PWD/CGs, underscoring the need for HCPs to discuss SHEs with PWD/CGs, and to provide tools and strategies to prevent and effectively manage SHEs.
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Gargallo-Fernández M, Escalada-San Martín J, Chico-Ballesteros A, Lecumberri-Pascual E, Tejera-Pérez C, Fernández-García JC, Rozas-Moreno P, Marco-Martínez A, Gómez-Peralta F, López-Fernández J. Executive summary of the consensus statement of: Clinical recommendations for sport practice in people with diabetes (RECORD Guide). Update 2021. Diabetes Mellitus Area of the Spanish Society of Endocrinology and Nutrition (SEEN). ENDOCRINOL DIAB NUTR 2021; 69:S2530-0164(21)00187-7. [PMID: 34489216 DOI: 10.1016/j.endinu.2021.06.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Accepted: 06/23/2021] [Indexed: 11/17/2022]
Affiliation(s)
- Manuel Gargallo-Fernández
- Sección de Endocrinología y Nutrición, Hospital Universitario Infanta Leonor, Fundación Jiménez Díaz, Madrid, España.
| | - Javier Escalada-San Martín
- Departamento de Endocrinología y Nutrición, Clínica Universidad de Navarra, Centro de Investigación Biomédica en Red Fisiopatología de la Obesidad y Nutrición (CIBEROBN), ISCIII, Instituto de Investigación Sanitaria de Navarra (IdiSNA), Grupo de Nefrología clínica, Pamplona, España
| | - Ana Chico-Ballesteros
- Servicio de Endocrinología y Nutrición, Hospital de la Santa Creu i Sant Pau, Barcelona, España
| | - Edurne Lecumberri-Pascual
- Unidad de Diabetes, Servicio de Endocrinología y Nutrición, Hospital Universitario Ramón y Cajal, Madrid, España
| | - Cristina Tejera-Pérez
- Servicio de Endocrinología y Nutrición, Complejo Hospitalario Universitario de Ferrol, Ferrol, La Coruña, España
| | - José Carlos Fernández-García
- Servicio de Endocrinología y Nutrición, Hospital Regional Universitario de Málaga, Instituto de Investigación Biomédica de Málaga (IBIMA), Málaga, España
| | - Pedro Rozas-Moreno
- Sección de Endocrinología y Nutrición, Hospital General Universitario, Ciudad Real, España
| | - Amparo Marco-Martínez
- Sección de Endocrinología y Nutrición, Complejo hospitalario de Toledo, Toledo, Hospital Quirón Salud Madrid, Madrid, España
| | | | - Judith López-Fernández
- Servicio de Endocrinología y Nutrición, Hospital Universitario de Canarias, Santa Cruz de Tenerife, España
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13
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López-Simarro F, Cols-Sagarra C, Mediavilla Bravo JJ, Cañís-Olivé J, Hernández-Teixidó C, González Mohíno Loro MB. [Update on the use of insulins for the primary care physician]. Semergen 2021; 48:54-62. [PMID: 34266759 DOI: 10.1016/j.semerg.2021.04.011] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2021] [Revised: 04/23/2021] [Accepted: 04/28/2021] [Indexed: 11/25/2022]
Abstract
Insulin treatment in type 2 diabetes mellitus patients is still essential and its usage has increased during recent years. Despite this, the level of control continues to be very poor. Insulin treatment is initiated with control levels above the recommendations set by the Clinical Practice Guidelines (CPG) and patients are exposed to very high blood glucose levels during long periods of time. This paper reviews the role of insulin in the different CPG, the criteria for therapy initiation and intensification, the beginning of the intensification and the different types of insulin which are commercialized in our country. Moreover, we discuss insulinization in special situations such as corticosteroid treatment, fragile elderly patients, palliative care situations, chronic kidney disease or during Ramadan. Finally, the problem of therapeutic inertia in insulinization is also addressed.
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Affiliation(s)
- Flora López-Simarro
- Médico de Familia. CAP Martorell Urbano, Barcelona, España; Miembro del grupo de trabajo de diabetes, Semergen España.
| | - Celia Cols-Sagarra
- Miembro del grupo de trabajo de diabetes, Semergen España; Médico de Familia. CAP Martorell Rural, Barcelona, España
| | - José Javier Mediavilla Bravo
- Miembro del grupo de trabajo de diabetes, Semergen España; Médico de Familia. Centro de Salud Burgos Rural, Burgos, España
| | - Judit Cañís-Olivé
- Miembro del grupo de trabajo de diabetes, Semergen España; Médico de Familia. EAP Vilafranca Nord. Vilafranca del Penedès. Barcelona, España
| | - Carlos Hernández-Teixidó
- Miembro del grupo de trabajo de diabetes, Semergen España; Médico de Familia. CS San Roque, Badajoz, España
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Jordán-Domingo M, Gimeno-Orna JA, Lahoza-Pérez MC, Ilundain-González AI, Agudo-Tabuenca A, Sáenz-Abad D. Effect of in-hospital glycemic variability on mortality in patients with diabetes. Rev Clin Esp 2021; 221:323-330. [PMID: 32646753 DOI: 10.1016/j.rce.2019.12.014] [Citation(s) in RCA: 3] [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] [Received: 10/02/2019] [Revised: 12/03/2019] [Accepted: 12/22/2019] [Indexed: 01/04/2023]
Abstract
INTRODUCTION The aim of this study was to evaluate the impact of mean blood glucose (MBG) and glycaemic variability (GV) during hospitalisation on mortality after discharge. MATERIAL AND METHODS We conducted a retrospective longitudinal analytical cohort study that included patients discharged form a department of internal medicine with a diabetes-related diagnosis The evaluated prognosis was mortality. During hospitalisation, the patients' clinical, laboratory and glycaemic control-related variables were recorded (MBG, GV and hypoglycaemia). The GV was measured with the coefficient of variation (CV). We calculated the mortality rates for every 1000 patient-years and compared them with Kaplan-Meier curves. We determined the predictors of mortality by performing a Cox regression. RESULTS The study included 276 patients with a mean age of 77.6 (SD, 10.2) years. The median outpatient follow-up duration was 2.7 years. In the multivariate analysis, an MBG >140mg/dl (HR, 1.72; 95% CI 1.14-2.61; p=.01) and a CV >0.29 (HR, 1.52; 95% CI 1.12-2.06; p=.006) but not the presence of hypoglycaemia were additively and independently associated with an increased risk of mortality. An MBG >140mg/dl with a CV >0.29 increased the mortality rates (123 vs. 317 per 1000 patient-year; p <.001) and the adjusted mortality risk (HR, 2.70; 95% CI 1.71-4.27; p<.001) compared with having an MBG ≤140mg/dl. CONCLUSION The simultaneous presence of a high MBG level and CV constitutes a powerful tool for stratifying mortality risk after hospital discharge.
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Affiliation(s)
- M Jordán-Domingo
- Instituto de Investigación Sanitaria Aragón (IIS Aragón), Zaragoza, España; Servicio de Urgencias, Hospital Clínico Universitario Lozano Blesa, Zaragoza, España
| | - J A Gimeno-Orna
- Servicio de Urgencias, Hospital Clínico Universitario Lozano Blesa, Zaragoza, España; Servicio de Endocrinología, Hospital Clínico Universitario Lozano Blesa, Zaragoza, España
| | - M C Lahoza-Pérez
- Instituto de Investigación Sanitaria Aragón (IIS Aragón), Zaragoza, España; Servicio de Urgencias, Hospital Clínico Universitario Lozano Blesa, Zaragoza, España
| | - A I Ilundain-González
- Servicio de Urgencias, Hospital Clínico Universitario Lozano Blesa, Zaragoza, España; Servicio de Endocrinología, Hospital Clínico Universitario Lozano Blesa, Zaragoza, España
| | - A Agudo-Tabuenca
- Servicio de Urgencias, Hospital Clínico Universitario Lozano Blesa, Zaragoza, España; Servicio de Endocrinología, Hospital Clínico Universitario Lozano Blesa, Zaragoza, España
| | - D Sáenz-Abad
- Instituto de Investigación Sanitaria Aragón (IIS Aragón), Zaragoza, España; Servicio de Urgencias, Hospital Clínico Universitario Lozano Blesa, Zaragoza, España.
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Jordán-Domingo M, Gimeno-Orna JA, Lahoza-Pérez MC, Ilundain-González AI, Agudo-Tabuenca A, Sáenz-Abad D. Effect of in-hospital glycemic variability on mortality in patients with diabetes. Rev Clin Esp 2021; 221:323-330. [PMID: 34059229 DOI: 10.1016/j.rceng.2019.12.014] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2019] [Accepted: 12/22/2019] [Indexed: 10/21/2022]
Abstract
INTRODUCTION The aim of this study was to evaluate the impact of mean blood glucose (MBG) and glycaemic variability (GV) during hospitalisation on mortality after discharge. MATERIAL AND METHODS We conducted a retrospective longitudinal analytical cohort study that included patients discharged form a department of internal medicine with a diabetes-related diagnosis. The evaluated prognosis was mortality. During hospitalisation, the patients' clinical, laboratory and glycaemic control-related variables were recorded (MBG, GV and hypoglycaemia). The GV was measured with the coefficient of variation (CV). We calculated the mortality rates for every 1000 patient-years and compared them with Kaplan-Meier curves. We determined the predictors of mortality by performing a Cox regression. RESULTS The study included 276 patients with a mean age of 77.6 (SD, 10.2) years. The median outpatient follow-up duration was 2.7 years. In the multivariate analysis, an MBG > 140 mg/dL (HR = 1.72; 95% CI 1.14-2.61; p = .01) and a CV > 0.29 (HR = 1.52; 95% CI 1.12-2.06; p = .006), but not the presence of hypoglycaemia, were additively and independently associated with an increased risk of mortality. An MG > 140 mg/dL with a CV > 0.29 increased the mortality rates (123 vs. 317 per 1000 patient-year; p < .001) and the adjusted mortality risk (HR = 2.70; 95% CI 1.71-4.27; p < .001) compared with having an MBG ≤ 140 mg/dL. CONCLUSION The simultaneous presence of a high MBG level and CV constitutes a powerful tool for stratifying mortality risk after hospital discharge.
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Affiliation(s)
- M Jordán-Domingo
- Instituto de Investigación Sanitaria Aragón (IIS Aragón), Zaragoza, Spain; Servicio de Urgencias, Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain
| | - J A Gimeno-Orna
- Servicio de Urgencias, Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain; Servicio de Endocrinología, Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain
| | - M C Lahoza-Pérez
- Instituto de Investigación Sanitaria Aragón (IIS Aragón), Zaragoza, Spain; Servicio de Urgencias, Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain
| | - A I Ilundain-González
- Servicio de Urgencias, Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain; Servicio de Endocrinología, Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain
| | - A Agudo-Tabuenca
- Servicio de Urgencias, Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain; Servicio de Endocrinología, Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain
| | - D Sáenz-Abad
- Instituto de Investigación Sanitaria Aragón (IIS Aragón), Zaragoza, Spain; Servicio de Urgencias, Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain.
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Cabré Font C, Colungo Francia C, Vinagre Torres I, Jansà I Morató M, Conget Donlo I. A Therapeutic Education Program with a Diabetes Specialist Nurse for Type 2 Diabetes Patients Using Insulin in a Primary Care Setting. A Diabetes Education Program with a Diabetes Specialist Nurse in a Primary Care Setting. ENDOCRINOL DIAB NUTR 2021; 68:S2530-0164(21)00053-7. [PMID: 33771504 DOI: 10.1016/j.endinu.2020.10.015] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Revised: 10/28/2020] [Accepted: 10/30/2020] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Therapeutic education is an essential part in the management of type 2 diabetes mellitus (T2D). Implementing a therapeutic education program with the participation of a diabetes specialist nurse (DSN) addressed to patients with T2D using more than 2insulin injections and sub-optimal metabolic control in primary care (PC) could improve health care and clinical outcomes. Our purpose was to evaluate the clinical, educational and patient satisfaction outcomes of this program. MATERIAL AND METHODS A prospective, longitudinal study was performed with an evaluation before and after the intervention. The program had a duration of 6 months and included individual on-site, phone and group visits. RESULTS 184 subjects were included and 161 were finally evaluated. 89.4% were included due to sub-optimal metabolic control and 10.6% because of repeated hypoglycemia. In the first group, the mean reduction in HbA1c was -1.34±1.45% without any increase in hypoglycemia episodes. In the second group, a significant reduction in hypoglycemia episodes/week was observed (2.52±1.66 vs. 0.53±1.06; P<.05) without any increase in HbA1c. Learning skills, lifestyle, adherence to care, and the perception of quality of life had significantly improved at 6 months (P<.05). The overall program was positively evaluated by patients, the role of DSN being considered essential by 98% of the responders. CONCLUSION A structured therapeutic education program, including a DSN, addressed to insulin treated T2D patients attending primary care facilities and with sub-optimal metabolic control is associated with beneficial effects in terms of clinical, educational and patient satisfaction endpoints.
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Affiliation(s)
- Carla Cabré Font
- Unidad de Diabetes, Endocrinología y Nutrición, Hospital Clínic i Universitari, Barcelona, España
| | - Cristina Colungo Francia
- Centro de Atención Primaria Comte Borrell, Consorci d'Atenció Primària de Salut de Barcelona Esquerre (CAPSBE), Barcelona, España
| | - Irene Vinagre Torres
- Unidad de Diabetes, Endocrinología y Nutrición, Hospital Clínic i Universitari, Barcelona, España.
| | - Marga Jansà I Morató
- Unidad de Diabetes, Endocrinología y Nutrición, Hospital Clínic i Universitari, Barcelona, España
| | - Ignacio Conget Donlo
- Unidad de Diabetes, Endocrinología y Nutrición, Hospital Clínic i Universitari, Barcelona, España; IDIBAPS, Institut d'investigacions Biomèdiques August Pi i Sunyer, Barcelona, España; CIBERDEM. Centro de Investigación Biomédica en Red de Diabetes y Enfermedades metabólicas, Barcelona, España
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Gutiérrez-Zúñiga R, Alonso de Leciñana M, Delgado-Mederos R, Gállego-Cullere J, Rodríguez-Yáñez M, Martínez-Zabaleta M, Freijo M, Portilla JC, Gil-Núñez A, Díez Sebastián J, Lisbona A, Díez-Tejedor E, Fuentes B. Beyond hyperglycemia: glycaemic variability as a prognostic factor after acute ischemic stroke. Neurologia 2020; 38:S0213-4853(20)30272-3. [PMID: 33069448 DOI: 10.1016/j.nrl.2020.06.018] [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] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2020] [Revised: 05/10/2020] [Accepted: 06/14/2020] [Indexed: 01/10/2023] Open
Abstract
INTRODUCTION Glycaemic variability (GV) refers to variations in blood glucose levels, and may affect stroke outcomes. This study aims to assess the effect of GV on acute ischaemic stroke progression. METHODS We performed an exploratory analysis of the multicentre, prospective, observational GLIAS-II study. Capillary glucose levels were measured every 4 hours during the first 48 hours after stroke, and GV was defined as the standard deviation of the mean glucose values. The primary outcomes were mortality and death or dependency at 3 months. Secondary outcomes were in-hospital complications, stroke recurrence, and the impact of the route of insulin administration on GV. RESULTS A total of 213 patients were included. Higher GV values were observed in patients who died (n = 16; 7.8%; 30.9 mg/dL vs 23.3 mg/dL; p = 0.05). In a logistic regression analysis adjusted for age and comorbidity, both GV (OR = 1.03; 95% CI, 1.003-1.06; p = 0.03) and stroke severity (OR = 1.12; 95% CI, 1.04-1.2; p = 0.004) were independently associated with mortality at 3 months. No association was found between GV and the other outcomes. Patients receiving subcutaneous insulin showed higher GV than those treated with intravenous insulin (38.95 mg/dL vs 21.34 mg/dL; p < 0.001). CONCLUSIONS High GV values during the first 48 hours after ischaemic stroke were independently associated with mortality. Subcutaneous insulin may be associated with higher VG levels than intravenous administration.
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Affiliation(s)
- R Gutiérrez-Zúñiga
- Servicio de Neurología, Hospital Universitario La Paz, Universidad Autónoma de Madrid, Madrid, España
| | - M Alonso de Leciñana
- Servicio de Neurología, Hospital Universitario La Paz, Universidad Autónoma de Madrid, Madrid, España
| | - R Delgado-Mederos
- Servicio de Neurología, Hospital de la Santa Creu i Sant Pau, Barcelona, España
| | - J Gállego-Cullere
- Servicio de Neurología, Complejo Hospitalario de Navarra, Pamplona, España
| | - M Rodríguez-Yáñez
- Servicio de Neurología, Hospital Clínico Universitario, Santiago de Compostela, España
| | - M Martínez-Zabaleta
- Servicio de Neurología, Hospital Universitario Donostia, San Sebastián, España
| | - M Freijo
- Servicio de Neurología, IIS Biocruces-Bizkaia, Bilbao, España
| | - J C Portilla
- Servicio de Neurología, Hospital San Pedro de Alcántara, Cáceres, España
| | - A Gil-Núñez
- Servicio de Neurología, Hospital Universitario Gregorio Marañón, Madrid, España
| | - J Díez Sebastián
- Servicio de Bioestadística, Hospital Universitario La Paz, Universidad Autónoma de Madrid, Madrid, España
| | - A Lisbona
- Servicio de Endocrinología, Hospital Universitario La Paz, Universidad Autónoma de Madrid, Madrid, España
| | - E Díez-Tejedor
- Servicio de Neurología, Hospital Universitario La Paz, Universidad Autónoma de Madrid, Madrid, España
| | - B Fuentes
- Servicio de Neurología, Hospital Universitario La Paz, Universidad Autónoma de Madrid, Madrid, España.
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Yagoglu AI, Dizdar OS, Erdem S, Akcakaya B, Gunal AI. The effect of linagliptin on renal progression in type-2 diabetes mellitus patients with chronic kidney disease: A prospective randomized controlled study. Nefrologia 2020; 40:664-671. [PMID: 32736891 DOI: 10.1016/j.nefro.2020.04.023] [Citation(s) in RCA: 2] [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] [Received: 07/29/2019] [Revised: 04/03/2020] [Accepted: 04/21/2020] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Linagliptin does not require dose adjustment in diabetes mellitus patients with chronic kidney disease (CKD). But, renal effects of linagliptin are not clear. Our aim was to examine the effect of linagliptin on renal disease progression in only insulin dependent type 2 diabetes mellitus (DM) patients with CKD. METHODS Stage 3-4 CKD patients were randomized into 2 groups in this prospective randomized controlled study. In the first group, linagliptin 5mg was added in addition to the background insulin therapy. In the second group, patients continued their insulin therapy. Patients were followed up at 3-month intervals for one year. RESULTS The study population consisted of 164 patients (90 patients in linagliptin group, 74 patients in other group) with a mean age of 67.5±8.8 years. eGFR significantly increased in linagliptin group (p=0.033), but decreased in other group (p=0.003). No significant change was observed in total insulin dose in linagliptin group (p=0.111), but in other group, total insulin dose significantly increased (p<0.001). Proteinuria levels decreased in both groups, but there was no significant change. In the multiple logistic regression analysis, male gender and proteinuria emerged as variables that showed significant association with increased risk and the use of linagliptin emerged as variable that showed significant association with decreased risk for CKD progression. CONCLUSION Linagliptin in DM patients with CKD was able to improve renal progression without significant effect on proteinuria and glucose control. With regard to treating diabetic nephropathy, linagliptin may offer a new therapeutic approach.
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Affiliation(s)
- Ali Ihsan Yagoglu
- Department of Internal Medicine, Kayseri City Training and Research Hospital, Kayseri, Turkey.
| | - Oguzhan Sıtkı Dizdar
- Department of Internal Medicine and Clinical Nutrition, Kayseri City Training and Research Hospital, Kayseri, Turkey
| | - Selahattin Erdem
- Department of Internal Medicine, Kayseri City Training and Research Hospital, Kayseri, Turkey
| | - Berkan Akcakaya
- Department of Internal Medicine, Kayseri City Training and Research Hospital, Kayseri, Turkey
| | - Ali Ihsan Gunal
- Department of Internal Medicine Division of Nephrology, Kayseri City Training and Research Hospital, Kayseri, Turkey
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Pinés Corrales PJ, Arias Lozano C, Jiménez Martínez C, López Jiménez LM, Sirvent Segovia AE, García Blasco L, Botella Romero F. Prevalence of severe hypoglycemia in a cohort of patients with type 1 diabetes. ACTA ACUST UNITED AC 2021; 68:47-52. [PMID: 32349942 DOI: 10.1016/j.endinu.2020.01.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2019] [Revised: 01/06/2020] [Accepted: 01/09/2020] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Hypoglycemia is the major limiting factor in the glycemic management of type 1 diabetes. Severe hypoglycemia puts patients at risk of injury and death. Recurrent hypoglycemia leads to impaired awareness of hypoglycemia and this increases the risk of severe hypoglycemia. Recent studies have reported rates for severe hypoglycemia of 35% in type 1 diabetic patients. OBJECTIVES To assess the prevalence of severe hypoglycemia in type 1 diabetes mellitus patients and to evaluate the relationship between this and impaired awareness of hypoglycemia according to the Clarke test. PATIENTS AND METHODS The following data were collected from a cohort of type 1 diabetic patients: age, gender, duration of type 1 diabetes, treatment (multiple daily insulin injection or continuous subcutaneous insulin infusion), glycemia self-control, HbA1c, episodes of severe hypoglycemia and impaired awareness of hypoglycemia. RESULTS Of the participants, 39.8% had had at least one episode of severe hypoglycemia (in the previous 6 months), 11.4% with loss of consciousness (in the previous 12 months). According to the Clark test, 40.9% had impaired awareness of hypoglycemia. Older age and longer duration of diabetes were associated with a higher prevalence of severe hypoglycemia with unconsciousness; older age and a lower level of HbA1c were associated with impaired awareness of hypoglycemia. CONCLUSIONS Our study allows us to confirm the high rate of severe hypoglycemia and impaired awareness of hypoglycemia in patients with type 1 diabetes.
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Pedraza-Flechas PV, Pereira-Ospina RP, Molinares-Mejía JS, Suescún-Vargas JM, Pinzón-Salamanca JY. Congenital hyperinsulinism: characterization of patients treated in a pediatric university hospital in Colombia. Bol Med Hosp Infant Mex 2020; 77:94-99. [PMID: 32226004 DOI: 10.24875/bmhim.19000133] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background Congenital hyperinsulinism is a disease of the glucose metabolism, relevant in pediatric endocrinology because of the elevated production of insulin according to blood glucose level, which leads to persistent severe hypoglycemia. This condition can produce important neurological sequelae in the patient due to the irreversible damage that occurs in the neuron caused by the exposure to hypoglycemia for short periods of time. Congenital hyperinsulinism diagnosis is not simple and it requires a high index of suspicion. The treatment should be established sequentially, in several steps, noticing the response to each possible medication used. If the pharmacological management fails, surgical procedures are required occasionally. Case series report Seven cases of congenital hyperinsulinism diagnosed in the last seven years at the Instituto Roosevelt in Bogotá, Colombia are presented. In this country, the radiotracer used internationally during positron emission tomography/computed tomography (PET/CT) is not available. However, was possible to use an alternative radiotracer in one of the cases, which led to an adequate diagnosis and a successful surgical treatment. Conclusions Congenital hyperinsulinism is a complex clinical condition, which requires proper diagnosis and treatment, with the aim of avoiding any neurological damage caused by persistent hypoglycemia. PET/CT can be used with an appropriate radiotracer for a timely diagnosis and to provide the best available therapeutic option.
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Affiliation(s)
- Paola V Pedraza-Flechas
- Instituto Roosevelt, Bogotá, Colombia.,Universidades del Rosario, Bogotá, Colombia.,Universidad de los Andes, Bogotá, Colombia.,Universidad de La Sabana, Bogotá, Colombia
| | | | | | - José M Suescún-Vargas
- Instituto Roosevelt, Bogotá, Colombia.,Universidades del Rosario, Bogotá, Colombia.,Universidad de los Andes, Bogotá, Colombia.,Universidad de La Sabana, Bogotá, Colombia
| | - Javier Y Pinzón-Salamanca
- Instituto Roosevelt, Bogotá, Colombia.,Universidades del Rosario, Bogotá, Colombia.,Universidad de los Andes, Bogotá, Colombia.,Universidad de La Sabana, Bogotá, Colombia.,Universidad Militar Nueva Granada. Bogotá, Colombia
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21
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Abstract
OBJECTIVE The association between diabetes mellitus and infections is very common. These infections, even when mild, interfere with blood glucose control. The aim of this review is to describe infections that occur in children and adolescents with DM, as well as to provide recommendations on glycemia management during these episodes. SOURCE OF DATA A non-systematic review was carried out in the PubMed database, using the terms "diabetes mellitus," "infection," "children," and "adolescents." The most relevant publications were selected. SYNTHESIS OF DATA In addition to the usual community diseases, some infections may occur predominantly in diabetic patients, especially when there is inadequate glycemic control, and common infections can be more severe in these patients. Alterations caused by the disease itself and the immune response are responsible for the risk of higher frequency and severity of infections. During infections, an increase in blood glucose occurs and usually an increase in insulin dose is required. CONCLUSIONS Pediatric patients with diabetes have some immune system disorders that, when associated with high glycemia, increase the risk of infections and their severity, and should be promptly identified and treated. The presence of an infectious condition, in turn, raises blood glucose and increases the risk of decompensation, and pediatricians should be cautioned to intensify monitoring and insulin therapy, and to avoid the risk of DKA. It should also be noted that many infections are preventable and can be avoided with adequate vaccine coverage.
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Affiliation(s)
- Luis Eduardo Calliari
- Faculdade de Ciências Médicas da Santa Casa de São Paulo, Departamento de Pediatria, Unidade de Endocrinologia Pediátrica e Ambulatório de Diabetes Pediátrico, São Paulo, SP, Brasil.
| | - Flávia J Almeida
- Faculdade de Ciências Médicas da Santa Casa de São Paulo, Departamento de Pediatria, Unidade de Infectologia Pediátrica, São Paulo, SP, Brasil
| | - Renata Maria Noronha
- Faculdade de Ciências Médicas da Santa Casa de São Paulo, Departamento de Pediatria, Ambulatório de Diabetes Pediátrico, São Paulo, SP, Brasil
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22
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Gómez-Peralta F, Abreu C, Cos X, Gómez-Huelgas R. When does diabetes start? Early detection and intervention in type2 diabetes mellitus. Rev Clin Esp 2020; 220:305-314. [PMID: 32107016 DOI: 10.1016/j.rce.2019.12.003] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2019] [Revised: 12/12/2019] [Accepted: 12/14/2019] [Indexed: 01/09/2023]
Abstract
Type 2 diabetes mellitus (DM2) is a progressive disease whose pathophysiological changes occur several years before its detection. An approach based on the pathophysiological development of DM2 and its complications emphasises the importance of early and intensive intervention, not only to prevent beta-cell dysfunction but also to act on the potential associated cardiovascular risk factors before reaching the blood glucose thresholds currently set for diagnosing DM2. In the field of recently diagnosed DM2, the VERIFY study has shown that early treatment combined with metformin-vildagliptin provides relevant improvements in long-term glycaemic control and can positively affect the disease's progression.
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Affiliation(s)
- F Gómez-Peralta
- Unidad de Endocrinología y Nutrición, Hospital General de Segovia, Segovia, España.
| | - C Abreu
- Unidad de Endocrinología y Nutrición, Hospital General de Segovia, Segovia, España
| | - X Cos
- Innovation and Health in Primary Care Barcelona City, Gerència Barcelona Ciutat, Institut Català de la Salut, Barcelona, España; Fundació Institut Universitari d'Investigació en Atenció Primària Jordi Gol i Gurina (IDIAPJGol), Barcelona, España
| | - R Gómez-Huelgas
- Departamento de Medicina Interna, Hospital Regional Universitario, Instituto de Investigación Biomédica de Málaga (IBIMA), Universidad de Málaga (UMA), Málaga, España
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23
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Carretero-Anibarro E, López-Tello A, Hamud-Uedha M, Roldan-Reguera B. [Level of knowledge about insulinization by Primary Care physicians and its impact on diabetes control]. Semergen 2020; 46:379-91. [PMID: 32057633 DOI: 10.1016/j.semerg.2019.11.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2019] [Revised: 11/21/2019] [Accepted: 11/26/2019] [Indexed: 01/14/2023]
Abstract
OBJECTIVE To determine the level of knowledge and current management of starting insulin treatment by Primary Care physicians, and its impact on metabolic control. MATERIALS AND METHODS A mainly qualitative exploratory sequential study, with a phenomenological approach, followed by a quantitative phase. The study included 37 primary care physicians from the Andalusian Health Service. Socio-demographic and clinical care variables were analysed. Univariate and bivariate analyses were performed. RESULTS There was a wide variability between Primary Care physicians in the level of knowledge of treatment with insulins (low knowledge: 13.5%; medium knowledge: 59.5%; high knowledge: 27.0%). There was a direct relationship between the level of knowledge and the attainment of HbA1c goals (as the level of knowledge increased, the metabolic control improved). The most common basal insulins prescribed were insulin glargine U-100 (56.8%), followed by insulin glargine U-300 (29.7%), and neutral protamine hagedorn (NPH) insulin (8.1%). There was a trend to show a different prescription pattern with basal insulins (as the level of knowledge decreased, the prescription of mixed and NPH insulins increased). More than one-third (35.1%) of primary care physicians did not know more complex patterns of treatment with insulins. CONCLUSIONS Only 27% of Primary Care physicians had a high knowledge about treatment with insulins. There was a direct relationship between the level of knowledge about insulins and glycaemic control. It is necessary to improve the knowledge about insulin therapy in order to optimise metabolic control and reduce the risk of complications.
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24
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Oliveira SC, Neves JS, Pérez A, Carvalho D. Maturity-onset diabetes of the young: From a molecular basis perspective toward the clinical phenotype and proper management. ACTA ACUST UNITED AC 2019; 67:137-147. [PMID: 31718996 DOI: 10.1016/j.endinu.2019.07.012] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [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: 03/01/2019] [Revised: 07/04/2019] [Accepted: 07/09/2019] [Indexed: 12/28/2022]
Abstract
Maturity-onset diabetes of the young (MODY) comprises a heterogeneous group of monogenic disorders characterized by primary defect in pancreatic β-cell function, early onset and autosomal dominant inheritance, accounting for about 1-5% of all diabetes diagnoses. Mutations in 14 genes are responsible for the majority of all MODY cases described so far. The clinical phenotype relies on genetic defects, with important implications in the optimal treatment and prognosis definition. MODY's early diagnosis remains a challenge, since this group of inherited disorders comprises a large clinical spectrum and it usually overlaps with other types of diabetes, requiring a high index of suspicion even if the definitive statement demands a molecular genetic study. Recent advances on the genetic determinants and pathophysiology of MODY have allowed a better understanding of its underlying molecular mechanisms, providing a proper genetic counseling and early diagnosis. These new management insights will make possible to set up new therapeutic strategies, with drugs able to prevent, correct or at least delay the decline of pancreatic β-cell function, thus affording for a more personalized treatment and, ultimately, for a better patient care.
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Affiliation(s)
- Sofia Castro Oliveira
- Department of Endocrinology, Diabetes and Metabolism, Centro Hospitalar Universitário de São João, Porto, Portugal; Faculty of Medicine of the Universidade do Porto, Porto, Portugal; Instituto de Investigação e Inovação em Saúde, Universidade do Porto, Porto, Portugal.
| | - João Sérgio Neves
- Department of Endocrinology, Diabetes and Metabolism, Centro Hospitalar Universitário de São João, Porto, Portugal; Faculty of Medicine of the Universidade do Porto, Porto, Portugal; Instituto de Investigação e Inovação em Saúde, Universidade do Porto, Porto, Portugal
| | - Antonio Pérez
- Department of Endocrinology and Nutrition, Hospital Santa Creu i Sant Pau, Barcelona, Spain; Department of Medicine, Universitat Autònoma de Barcelona, Bellaterra, Spain; CIBER de Diabetes y Enfermidades Metabólicas Asociadas (CIBERDEM), Madrid, Spain
| | - Davide Carvalho
- Department of Endocrinology, Diabetes and Metabolism, Centro Hospitalar Universitário de São João, Porto, Portugal; Faculty of Medicine of the Universidade do Porto, Porto, Portugal; Instituto de Investigação e Inovação em Saúde, Universidade do Porto, Porto, Portugal
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25
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María María MA, Ramos A, Martínez Roldán MJ, Pujol Giménez I, Pérez A. Implementation of an inpatient hyperglycemia management program incorporating a nurse consultant. ACTA ACUST UNITED AC 2019; 67:461-468. [PMID: 31706975 DOI: 10.1016/j.endinu.2019.07.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [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: 05/05/2019] [Revised: 07/23/2019] [Accepted: 07/25/2019] [Indexed: 10/25/2022]
Abstract
BACKGROUND AND AIMS The efficacy and safety of inpatient hyperglycemia management protocols using basal-bolus regimens have been widely demonstrated, but their implementation is insufficient. The aim of the study was to assess implementation and to establish the efficacy and safety of inpatient hyperglycemia management protocol based on a basal-bolus regimen and the incorporation of a nurse consultant. MATERIAL AND METHODS Evaluation was performed at 10 hospital units. Data were retrospectively reviewed during hospital stay and 90 days after discharge in 400 patients after protocol implementation and 200 patients before implementation. The degree of satisfaction of professionals was assessed using a questionnaire 12 months after implementation. RESULTS The proportion of patients with basal-bolus regimens upon admission was higher in the postimplementation group (58% vs. 9%, P<0.001). Mean pre-prandial and bedtime blood glucose levels during admission were lower in the postimplementation group (164±41mg/L vs. 196±50mg/dL, P<0.001). After implementation, there were less patients with blood glucose levels >300mg/dL (36.3% vs. 50.5%, P<0.001) and more patients with values <70mg/dL (15% vs. 9%, P=0.040). Insulin addition and intensification was the main change in treatment at discharge, and a significant HbA1c reduction was seen three months after discharge in the postimplementation phase (P=0.04). The professionals assigned the protocol a score of 4.5 on a 1 to 5 scale. CONCLUSIONS Incorporation of a nurse consultant expert in diabetes as key component of a hyperglycemia management program ensures that a majority of patients admitted to hospital for hyperglycemia receive treatment with a basal-bolus regimen and improves blood glucose control during hospital stay and after discharge.
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Affiliation(s)
- Miguel A María María
- Servicio de Endocrinología y Nutrición, Hospital de la Santa Creu i Sant Pau, Barcelona, España
| | - Analía Ramos
- Servicio de Endocrinología y Nutrición, Hospital de la Santa Creu i Sant Pau, Barcelona, España
| | - M José Martínez Roldán
- Servicio de Endocrinología y Nutrición, Hospital de la Santa Creu i Sant Pau, Barcelona, España
| | - Isabel Pujol Giménez
- Servicio de Endocrinología y Nutrición, Hospital de la Santa Creu i Sant Pau, Barcelona, España
| | - Antonio Pérez
- Servicio de Endocrinología y Nutrición, Hospital de la Santa Creu i Sant Pau, Barcelona, España; Departamento de Medicina, Universitat Autònoma de Barcelona, Bellaterra, España; CIBER de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), España.
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26
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Pujante P, Ares J, Maciá C, Rodriguez Escobedo R, Menéndez E, Delgado E. Efficacy of sodium glucose cotransporter 2 inhibitors as an adjunct treatment for patients with diabetes type 2. Med Clin (Barc) 2019; 152:438-441. [PMID: 30503071 DOI: 10.1016/j.medcli.2018.09.019] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2018] [Revised: 09/18/2018] [Accepted: 09/27/2018] [Indexed: 10/27/2022]
Abstract
OBJECTIVE To analyze the effect of sodium glucose cotransporter 2 (SGLT2) inhibitors in a group of insulin-dependent type 2 diabetes mellitus (T2D) patients. PATIENTS AND METHODS One hundred and five insulin treated T2D patients were enrolled. Primary endpoints were: fasting plasma glucose, HbA1c, weight, total insulin doses (TDI), total basal insulin (TDB) and total rapid insulin (TDR). Secondary variables were: total cholesterol, LDL cholesterol (cLDL), HDL cholesterol (cHDL), triglycerides and systolic (SBP) and diastolic (DBP) blood pressure. Safety and tolerance were evaluated through the appearance of severe hypoglycemia, ketoacidosis and infections. RESULTS After 4 months follow-up, a 0.7 (1.0)% HbA1c reduction was found, accompanied by a -2.8 (11.5) UI/day TDI decrease. Weight dropped for 73.7% of patients, with an average -2.0 (2.7) kg reduction. A global cHDL increase was noted after treatment, while no differences were observed for total cholesterol, triglycerides or cLDL. SBP dropped significantly, but no change in DBP was observed. CONCLUSION The use of SGLT2 inhibitors in insulin treated T2D patients resulted in reduction of HbA1c, which was associated to weight loss, cHDL increase and SBP decrease.
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Affiliation(s)
- Pedro Pujante
- Hospital Central de Asturias, Servicio de Endocrinología y Nutrición, Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), Oviedo, Spain.
| | - Jessica Ares
- Hospital Central de Asturias, Servicio de Endocrinología y Nutrición, Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), Oviedo, Spain
| | - Carmen Maciá
- Hospital San Agustín, Servicio de Endocrinología y Nutrición, Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), Avilés, Asturias, Spain
| | - Raúl Rodriguez Escobedo
- Hospital Central de Asturias, Servicio de Endocrinología y Nutrición, Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), Oviedo, Spain
| | - Edelmiro Menéndez
- Hospital Central de Asturias, Servicio de Endocrinología y Nutrición, Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), Oviedo, Spain
| | - Elías Delgado
- Hospital Central de Asturias, Servicio de Endocrinología y Nutrición, Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), Oviedo, Spain
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Galvis V, Niño CA, Tello A, Grice JM, Gómez MA. Topical insulin in neurotrophic keratopathy after resection of acoustic neuroma. ACTA ACUST UNITED AC 2018; 94:100-104. [PMID: 30025986 DOI: 10.1016/j.oftal.2018.06.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [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: 03/07/2018] [Revised: 05/30/2018] [Accepted: 06/04/2018] [Indexed: 11/18/2022]
Abstract
CASE REPORT A patient with a history of surgical resection of an acoustic neuroma presented with involvement of both the left facial nerve and the left trigeminal nerve. She initially consulted for exposure keratitis, but two weeks later presented with an infectious keratitis. After taking the corneal sample, she presented with persistent epithelial defect, which did not respond to medical management. Topical insulin was indicated, and a decrease in the area of the lesion was seen in the following 5 days. A therapeutic contact lens was also placed at that time and finally, two weeks after the initiation of insulin, the epithelial defect completely closed. DISCUSSION This was a complex case due to the confluence of facial paralysis, neurotrophic keratitis, and infectious keratitis, which finally had a successful outcome. Topical insulin can be an effective adjuvant therapy in cases of neurotrophic ulcers that do not respond to standard therapy.
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Affiliation(s)
- V Galvis
- Centro Oftalmológico Virgilio Galvis, Floridablanca, Santander, Colombia; Departamento de Oftalmología, Facultad de Ciencias de la Salud, Universidad Autónoma de Bucaramanga, Bucaramanga, Santander, Colombia
| | - C A Niño
- Centro Oftalmológico Virgilio Galvis, Floridablanca, Santander, Colombia; Departamento de Oftalmología, Fundación Oftalmológica de Santander FOSCAL, Floridablanca, Santander, Colombia
| | - A Tello
- Centro Oftalmológico Virgilio Galvis, Floridablanca, Santander, Colombia; Departamento de Oftalmología, Facultad de Ciencias de la Salud, Universidad Autónoma de Bucaramanga, Bucaramanga, Santander, Colombia.
| | - J M Grice
- Centro Oftalmológico Virgilio Galvis, Floridablanca, Santander, Colombia
| | - M A Gómez
- Centro Oftalmológico Virgilio Galvis, Floridablanca, Santander, Colombia
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Rodriguez-Calero MA, Barceló Llodrá E, Cruces Cuberos M, Blanco-Mavillard I, Pérez Axartell MA. Effectiveness of an evidence-based protocol for the control of stress-induced hyperglycaemia in critical care. Enferm Intensiva (Engl Ed) 2018; 30:4-12. [PMID: 29935968 DOI: 10.1016/j.enfi.2018.01.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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: 08/09/2017] [Revised: 01/19/2018] [Accepted: 01/22/2018] [Indexed: 11/17/2022]
Abstract
AIM To assess the effectiveness of the implementation of a protocol for glycaemic control in critical care, in terms of maintenance of a pre-established target of blood glucose level, reduction of hyperglycaemia and prevention of severe hypoglycaemia. METHOD Prospective "pre-post" quasi-experimental study carried out in a general critical care unit. Adult patients treated with intravenous insulin were included. We recorded all glycaemic tests performed from November 2014 to August 2015 (pre-intervention) and from November 2015 to August 2016 (post-intervention). The intervention consisted of the implementation of an evidence-based glycaemic control protocol to achieve glycaemic levels in a range of 140-180mg/dl. Main variables analysed were: proportion of glycaemic tests in the target range, proportions of severe hypoglycaemia (under 40mg/dl) and hyperglycaemia over 200mg/dl. RESULTS We analysed 7864 glycaemic tests from 125 patients, 66 pre-intervention and 59 post-intervention. Average age was 66.24±13.99 years, 64% of patients were male. The proportion of tests within the target range was higher in the intervention group (38.82 vs. 44.34 p<.001). Only one case of severe hypoglycaemia was identified, which happened in the pre-intervention period. The rate of severe hyperglycaemia was lower in the post-intervention group (19.19 vs. 16.28 p=.001). CONCLUSIONS Our experience shows that implementation of evidence-based interventions can improve glycaemic control during critical illness. We found higher glycaemia levels in the target range. The protocol proved useful in the prevention of severe hypoglycaemia. Nurse-led interventions based on clinical data improved health results in our patients.
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Affiliation(s)
- M A Rodriguez-Calero
- Unidad de Calidad, Docencia e Investigación, Hospital de Manacor, Manacor, Mallorca, España.
| | - E Barceló Llodrá
- Área del Paciente Crítico, Hospital de Manacor, Manacor, Mallorca, España
| | - M Cruces Cuberos
- Unidad de Cuidados Intensivos, Hospital de Manacor, Manacor, Mallorca, España
| | - I Blanco-Mavillard
- Unidad de Calidad, Docencia e Investigación, Hospital de Manacor, Manacor, Mallorca, España
| | - M A Pérez Axartell
- Unidad de Cuidados Intensivos, Hospital de Manacor, Manacor, Mallorca, España
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Fernández Viadero C, Verduga Vélez R, Crespo Santiago D. [Patterns of brain ageing]. Rev Esp Geriatr Gerontol 2018; 52 Suppl 1:7-14. [PMID: 29628040 DOI: 10.1016/s0211-139x(18)30073-8] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Neuroplasticity lends the brain a strong ability to adapt to changes in the environment that occur during ageing. Animal models have shown alterations in neurotransmission and imbalances in the expression of neural growth factor. Changes at the morphometric level are not constant. Volume loss is related to alterations in neuroplasticity and involvement of the cerebral neuropil. Although there are no conclusive data, physical exercise improves the molecular, biological, functional and behavioural-cognitive changes associated with brain ageing. The aged human brain has been described as showing weight and volume loss and increased ventricular size. However, neuroimaging shows significant variation and many healthy elderly individuals show no significant macroscopic changes. In most brain regions, the number of neurons remains stable throughout life. Neuroplasticity does not disappear with ageing, and changes in dendritic arborization and the density of spines and synapses are more closely related to brain activity than to age. At the molecular level, although the presence of altered Tau and β-amyloid proteins is used as a biomarker of neurodegenerative disease, postmortem studies show that these abnormal proteins are common in the brains of elderly people without dementia. Finally, due to the relationship between neurodegenerative diseases and metabolic alterations, this article analyses the influence of insulin-like growth factor and ageing, both in animal models and in humans, and the possible neuroprotective effect of insulin.
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Affiliation(s)
- Carlos Fernández Viadero
- Servicio de Psiquiatría, Hospital Universitario Marqués de Valdecilla, Servicio Cántabro de Salud, Santander, España; Biogerontología, Departamento de Anatomía y Biología Celular, Universidad de Cantabria, Santander, España.
| | | | - Dámaso Crespo Santiago
- Biogerontología, Departamento de Anatomía y Biología Celular, Universidad de Cantabria, Santander, España
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Pontes JPJ, Mendes FF, Vasconcelos MM, Batista NR. [Evaluation and perioperative management of patients with diabetes mellitus. A challenge for the anesthesiologist]. Braz J Anesthesiol 2018; 68:75-86. [PMID: 28571661 PMCID: PMC9391782 DOI: 10.1016/j.bjan.2017.04.017] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [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: 09/06/2016] [Revised: 01/04/2017] [Accepted: 04/12/2017] [Indexed: 11/27/2022]
Abstract
Diabetes mellitus (DM) is characterized by alteration in carbohydrate metabolism, leading to hyperglycemia and increased perioperative morbidity and mortality. It evolves with diverse and progressive physiological changes, and the anesthetic management requires attention regarding this disease interference in multiple organ systems and their respective complications. Patient's history, physical examination, and complementary exams are important in the preoperative management, particularly glycosylated hemoglobin (HbA1c), which has a strong predictive value for complications associated with diabetes. The goal of surgical planning is to reduce the fasting time and maintain the patient's routine. Patients with Type 1 DM must receive insulin (even during the preoperative fast) to meet the basal physiological demands and avoid ketoacidosis. Whereas patients with Type 2 DM treated with multiple injectable and/or oral drugs are susceptible to develop a hyperglycemic hyperosmolar state (HHS). Therefore, the management of hypoglycemic agents and different types of insulin is fundamental, as well as determining the surgical schedule and, consequently, the number of lost meals for dose adjustment and drug suspension. Current evidence suggests the safe target to maintain glycemic control in surgical patients, but does not conclude whether it should be obtained with either moderate or severe glycemic control.
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Vidal Flor M, Jansà Morató M, Galindo Rubio M, Penalba Martínez M. Factors associated to adherence to blood glucose self-monitoring in patients with diabetes treated with insulin. The dapa study. ACTA ACUST UNITED AC 2017; 65:99-106. [PMID: 29249677 DOI: 10.1016/j.endinu.2017.10.005] [Citation(s) in RCA: 5] [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] [Received: 07/07/2017] [Revised: 10/17/2017] [Accepted: 10/17/2017] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To assess adherence to self-monitoring of blood glucose and the main factors associated with it, particularly those related to self-perception of glycemia, in patients with diabetes on insulin therapy. PATIENTS AND METHODS An epidemiological, observational, prospective, multicenter study conducted in standard clinical practice in primary care, outpatient centers, and hospitals from different Spanish regions. Sociodemographic, clinical and treatment data were collected. Patients were considered adherent to self-monitoring if they performed the minimum number of controls recommended by the Spanish Society of Diabetes (SED). RESULTS Adherence was shown in 61.6% of patients. Factors associated to adherence included treatment with less than three insulin injections daily (OR 2.678; 95% CI 2.048- 3.5029; p <0.001), presence of peripheral vascular disease (OR 1.529; 95% CI 1.077 - 2.171; p=0.018), alcohol abstinence (OR 1.442; 95% CI 1.118 - 1.858; p=0.005), and collection of the glucose test strips from the pharmacy (OR 1.275; 95% CI 1.026 - 1.584; p=0.028). Adequate self-perception of glycemia was found in 21.4% of patients. CONCLUSIONS Our results show a suboptimal adherence to the recommended protocol for blood glucose self-monitoring in patients with diabetes on insulin therapy. Independent variables associated to good adherence were treatment with less than three insulin injections dailyu, presence of peripheral vascular disease, alcohol abstinence, and collection of glucose test strips from the pharmacy.
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Affiliation(s)
- Mercè Vidal Flor
- Servicio de Endocrinología y Nutrición, Unidad de Diabetes, Hospital Clínic i Provincial de Barcelona, Barcelona, España.
| | - Margarita Jansà Morató
- Servicio de Endocrinología y Nutrición, Unidad de Diabetes, Hospital Clínic i Provincial de Barcelona, Barcelona, España
| | | | - Maite Penalba Martínez
- Servicio de Endocrinología y Nutrición, Hospital Universitari i Politècnic La Fe, Valencia, España
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Gómez-Garrido M, Rodilla-Fiz AM, Girón-Lacasa M, Rodríguez-Rubio L, Martínez-Blázquez A, Martínez-López F, Pardo-Ibáñez MD, Núñez-Marín JM. Comparison of 2 intravenous insulin protocols: Glycemia variability in critically ill patients. ACTA ACUST UNITED AC 2017; 64:250-7. [PMID: 28495320 DOI: 10.1016/j.endinu.2017.03.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2016] [Revised: 02/28/2017] [Accepted: 03/02/2017] [Indexed: 11/23/2022]
Abstract
OBJECTIVE Glycemic variability is an independent predictor of mortality in critically ill patients. The objective of this study was to compare two intravenous insulin protocols in critically ill patients regarding the glycemic variability. MATERIAL AND METHODS This was a retrospective observational study performed by reviewing clinical records of patients from a Critical Care Unit for 4 consecutive months. First, a simpler Scale-Based Intravenous Insulin Protocol (SBIIP) was reviewed and later it was compared for the same months of the following year with a Sliding Scale-Based Intravenous Insulin Protocol (SSBIIP). All adult patients admitted to the unit during the referred months were included. Patients in whom the protocol was not adequately followed were excluded. A total of 557 patients were reviewed, of whom they had needed intravenous insulin 73 in the first group and 52 in the second group. Four and two patients were excluded in each group respectively. RESULTS Glycemic variability for both day 1 (DS1) and total stay (DST) was lower in SSBIIP patients compared to SBIIP patients: SD1 34.88 vs 18.16 and SDT 36.45 vs 23.65 (P<.001). CONCLUSION A glycemic management protocol in critically ill patients based on sliding scales decreases glycemic variability.
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Gutiérrez-Salmerón M, Chocarro-Calvo A, García-Martínez JM, de la Vieja A, García-Jiménez C. Epidemiological bases and molecular mechanisms linking obesity, diabetes, and cancer. ACTA ACUST UNITED AC 2017; 64:109-117. [PMID: 28440775 DOI: 10.1016/j.endinu.2016.10.005] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [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: 03/08/2016] [Revised: 09/29/2016] [Accepted: 10/10/2016] [Indexed: 02/07/2023]
Abstract
The association between diabetes and cancer was hypothesized almost one century ago. Today, a vast number of epidemiological studies support that obese and diabetic populations are more likely to experience tissue-specific cancers, but the underlying molecular mechanisms remain unknown. Obesity, diabetes, and cancer share many hormonal, immune, and metabolic changes that may account for the relationship between diabetes and cancer. In addition, antidiabetic treatments may have an impact on the occurrence and course of some cancers. Moreover, some anticancer treatments may induce diabetes. These observations aroused a great controversy because of the ethical implications and the associated commercial interests. We report an epidemiological update from a mechanistic perspective that suggests the existence of many common and differential individual mechanisms linking obesity and type 1 and 2 diabetes mellitus to certain cancers. The challenge today is to identify the molecular links responsible for this association. Classification of cancers by their molecular signatures may facilitate future mechanistic and epidemiological studies.
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Affiliation(s)
- María Gutiérrez-Salmerón
- Departamento de Ciencias Básicas de la Salud, Facultad de Ciencias de la Salud, Universidad Rey Juan Carlos, Alcorcón, Madrid, España
| | - Ana Chocarro-Calvo
- Departamento de Ciencias Básicas de la Salud, Facultad de Ciencias de la Salud, Universidad Rey Juan Carlos, Alcorcón, Madrid, España; Nuffield Department of Clinical Medicine, Ludwig Institute for Cancer Research, Universidad de Oxford, Headington, Oxford, Reino Unido
| | - José Manuel García-Martínez
- Departamento de Ciencias Básicas de la Salud, Facultad de Ciencias de la Salud, Universidad Rey Juan Carlos, Alcorcón, Madrid, España
| | - Antonio de la Vieja
- Unidad de Tumores Endocrinos (UFIEC), Instituto de Salud Carlos III, Majadahonda, Madrid, España.
| | - Custodia García-Jiménez
- Departamento de Ciencias Básicas de la Salud, Facultad de Ciencias de la Salud, Universidad Rey Juan Carlos, Alcorcón, Madrid, España.
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Alonso Martín DE, Roldán Martín MB, Álvarez Gómez MÁ, Yelmo Valverde R, Martín-Frías M, Alonso Blanco M, Barrio Castellanos R. Impact of diabetes education on type 1 diabetes mellitus control in children. ACTA ACUST UNITED AC 2016; 63:536-542. [PMID: 27765490 DOI: 10.1016/j.endonu.2016.08.004] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2016] [Revised: 08/06/2016] [Accepted: 08/09/2016] [Indexed: 10/20/2022]
Abstract
INTRODUCTION Diabetes education is an essential tool to achieve treatment objectives in type1 diabetes mellitus (T1DM). The aim of this study was to determine if understanding of diabetes by caregivers/patients or sociodemographic factors affect blood glucose control in children and adolescents with T1DM. PATIENTS AND METHODS The level of knowledge of 105 caregivers of children and adolescents with T1DM was assessed using a survey adapted to the type of treatment used (multiple dose insulin [MDI] or continuous subcutaneous insulin infusion [CSII]). Mean HbA1c levels in the previous year was considered as metabolic control marker. RESULTS Mean HbA1c levels were similar in both treatment groups, with slightly higher values in children over 12years of age. Patients on CSII had a longer time since disease onset and had poorer results, maybe because the items were more difficult due to the higher level of knowledge required for this treatment modality (P=.005). Caregivers with lower educational levels achieved poorer scores in the survey, but mean HbA1c levels of their children were lower, probably because of their greater involvement in disease care. CONCLUSIONS The level of knowledge of caregivers and/or patients with T1DM was high, and this was associated to good metabolic control. Studies to assess the impact of caregiver knowledge on metabolic control of children are needed.
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Affiliation(s)
- Daniel E Alonso Martín
- Servicio de Pediatría, Unidad de Diabetes Pediátrica, Hospital Universitario Ramón y Cajal, Madrid, España.
| | - M Belén Roldán Martín
- Servicio de Pediatría, Unidad de Diabetes Pediátrica, Hospital Universitario Ramón y Cajal, Madrid, España
| | - M Ángeles Álvarez Gómez
- Servicio de Pediatría, Unidad de Diabetes Pediátrica, Hospital Universitario Ramón y Cajal, Madrid, España
| | - Rosa Yelmo Valverde
- Servicio de Pediatría, Unidad de Diabetes Pediátrica, Hospital Universitario Ramón y Cajal, Madrid, España
| | - María Martín-Frías
- Servicio de Pediatría, Unidad de Diabetes Pediátrica, Hospital Universitario Ramón y Cajal, Madrid, España
| | - Milagros Alonso Blanco
- Servicio de Pediatría, Unidad de Diabetes Pediátrica, Hospital Universitario Ramón y Cajal, Madrid, España
| | - Raquel Barrio Castellanos
- Servicio de Pediatría, Unidad de Diabetes Pediátrica, Hospital Universitario Ramón y Cajal, Madrid, España
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Castilla-Guerra L, Fernández-Moreno MC, Hewitt J. Treatment of hyperglycaemia in patients with acute stroke. Rev Clin Esp 2016; 216:92-8. [PMID: 26189890 DOI: 10.1016/j.rce.2015.06.005] [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] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2015] [Revised: 06/03/2015] [Accepted: 06/14/2015] [Indexed: 01/14/2023]
Abstract
The proportion of diabetic patients who are hospitalised for stroke has been increasing in recent years, currently reaching almost a third of all cases of stroke. In addition, about half of patients with acute stroke present hyperglycaemia in the first hours of the stroke. Although hyperglycaemia in the acute phase of stroke is associated with a poor prognosis, its treatment is currently a topic of debate. There is no evidence that the adminstration of intravenous insulin to these patients offers benefits in terms of the evolution of the stroke. New studies in development, such as the SHINE study (Stroke Hyperglycemia Insulin Network Effort), may contribute to clarifying the role of intensive control of glycaemia during the acute phase of the stroke. Ultimately, patients who have presented with stroke should be screened for diabetes.
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Affiliation(s)
- L Castilla-Guerra
- Servicio de Medicina Interna, Hospital de la Merced, Osuna, Sevilla, España.
| | - M C Fernández-Moreno
- Servicio de Neurología, Hospital de Valme, Universidad de Sevilla, Sevilla, España
| | - J Hewitt
- Institute of Primary Care & Public Health, Cardiff University School of Medicine, WCAT Lead - Geriatric & Stroke Medicine, Cardiff, Reino Unido
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Pu MZMH, Christensen-Adad FC, Gonçalves AC, Minicucci WJ, Ribeiro JD, Ribeiro AF. Insulin therapy in patients with cystic fibrosis in the pre-diabetes stage: a systematic review. Rev Paul Pediatr 2016; 34:367-73. [PMID: 26994743 DOI: 10.1016/j.rpped.2015.12.010] [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] [Subscribe] [Scholar Register] [Received: 08/01/2015] [Revised: 11/14/2015] [Accepted: 12/01/2015] [Indexed: 01/23/2023]
Abstract
OBJECTIVE To elucidate whether insulin is effective or not in patients with cystic fibrosis before the diabetes mellitus phase. DATA SOURCE The study was performed according to the Prisma method between August and September 2014, using the PubMed, Embase, Lilacs and SciELO databases. Prospective studies published in English, Portuguese and Spanish from 2002 to 2014, evaluating the effect of insulin on weight parameters, body mass index and pulmonary function in patients with cystic fibrosis, with a mean age of 17.37 years before the diabetes mellitus phase were included. DATA SYNTHESIS Eight articles were identified that included 180 patients undergoing insulin use. Sample size ranged from 4 to 54 patients, with a mean age ranging from 12.4 to 28 years. The type of follow-up, time of insulin use, the dose and implementation schedule were very heterogeneous between studies. CONCLUSIONS There are theoretical reasons to believe that insulin has a beneficial effect in the studied population. The different methods and populations assessed in the studies do not allow us to state whether early insulin therapy should or should not be carried out in patients with cystic fibrosis prior to the diagnosis of diabetes. Therefore, studies with larger samples and insulin use standardization are required.
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Affiliation(s)
| | | | | | - Walter José Minicucci
- Faculdade de Ciências Médicas, Universidade de Campinas (Unicamp), Campinas, SP, Brasil
| | - José Dirceu Ribeiro
- Faculdade de Ciências Médicas, Universidade de Campinas (Unicamp), Campinas, SP, Brasil
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Ribeiro MEB, Del Roio Liberatore Junior R, Custodio R, Martinelli Junior CE. [Continuous insulin therapy versus multiple insulin injections in the management of type 1 diabetes: a longitutinal study]. Rev Paul Pediatr 2016; 34:86-90. [PMID: 26826879 DOI: 10.1016/j.rpped.2015.06.011] [Citation(s) in RCA: 2] [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] [Subscribe] [Scholar Register] [Received: 01/12/2015] [Revised: 06/08/2015] [Accepted: 06/09/2015] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To compare multiple doses of insulin and continuous insulin infusion therapy as treatment for type 1 diabetes melito. METHODS 40 patients with type 1 diabetes melito (21 female) with ages between 10 and 20 years (mean=14.2) and mean duration of diabetes of 7 years used multiple doses of insulin for at least 6 months and after that, continuous insulin infusion therapy for at least 6 months. Each one of the patients has used multiple doses of insulin and continuous insulin infusion therapy. For analysis of HbA1c, mean glycated hemoglobin levels (mHbA1c) were obtained during each treatment period (multiple doses of insulin and continuous insulin infusion therapy period). RESULTS Although mHbA1c levels were lower during continuous insulin infusion therapy the difference was not statistically significant. During multiple doses of insulin, 14.2% had mHbA1c values below 7.5% vs. 35.71% while on continuous insulin infusion therapy; demonstrating better glycemic control with the use of continuous insulin infusion therapy. During multiple doses of insulin, 15-40 patients have severe hypoglycemic events versus 5-40 continuous insulin infusion therapy. No episodes of ketoacidosis events were recorded. CONCLUSIONS This is the first study with this design comparing multiple doses of insulin and continuous insulin infusion therapy in Brazil showing no significant difference in HbA1c; hypoglycemic events were less frequent during continuous insulin infusion therapy than during multiple doses of insulin and the percentage of patients who achieved a HbA1c less than 7.5% was greater during continuous insulin infusion therapy than multiple doses of insulin therapy.
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Ribeiro MEB, Del Roio Liberatore Junior R, Custodio R, Martinelli Junior CE. [Continuous insulin therapy versus multiple insulin injections in the management of type 1 diabetes: a longitutinal study]. ACTA ACUST UNITED AC 2016. [PMID: 26826879 PMCID: PMC4795726 DOI: 10.1016/j.rppede.2015.06.019] [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] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
OBJECTIVE To compare multiple doses of insulin and continuous insulin infusion therapy as treatment for type 1 diabetes melito. METHODS 40 patients with type 1 diabetes melito (21 female) with ages between 10 and 20 years (mean=14.2) and mean duration of diabetes of 7 years used multiple doses of insulin for at least 6 months and after that, continuous insulin infusion therapy for at least 6 months. Each one of the patients has used multiple doses of insulin and continuous insulin infusion therapy. For analysis of HbA1c, mean glycated hemoglobin levels (mHbA1c) were obtained during each treatment period (multiple doses of insulin and continuous insulin infusion therapy period). RESULTS Although mHbA1c levels were lower during continuous insulin infusion therapy the difference was not statistically significant. During multiple doses of insulin, 14.2% had mHbA1c values below 7.5% vs. 35.71% while on continuous insulin infusion therapy; demonstrating better glycemic control with the use of continuous insulin infusion therapy. During multiple doses of insulin, 15-40 patients have severe hypoglycemic events versus 5-40 continuous insulin infusion therapy. No episodes of ketoacidosis events were recorded. CONCLUSIONS This is the first study with this design comparing multiple doses of insulin and continuous insulin infusion therapy in Brazil showing no significant difference in HbA1c; hypoglycemic events were less frequent during continuous insulin infusion therapy than during multiple doses of insulin and the percentage of patients who achieved a HbA1c less than 7.5% was greater during continuous insulin infusion therapy than multiple doses of insulin therapy.
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Mancera-Romero J, Carramiñana-Barrera F, Muñoz-González L, Guillén-Álvarez P, Murillo-García D, Sánchez-Pérez MR. [Satisfaction of patients with type 2 diabetes mellitus after starting treatment with insulin]. Semergen 2015; 42:298-306. [PMID: 26188491 DOI: 10.1016/j.semerg.2015.06.002] [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] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2015] [Revised: 05/15/2015] [Accepted: 06/05/2015] [Indexed: 11/29/2022]
Abstract
OBJECTIVES The objective of this study is to evaluate if overcoming the barrier of starting treatment with insulin can lead to better clinical control and a higher level of patient satisfaction with their treatment. MATERIAL AND METHODS This is an observational, multicentre study of patients diagnosed with DM2 who attended primary care centres with poor glycaemic control (A1c≥8%) under treatment with oral antidiabetic drugs (OADs), and who were given motivational treatment to overcome their fear of injections, and started treatment with insulin. The level of satisfaction with the treatment was evaluated using the Diabetes Treatment Satisfaction Questionnaire (DTSQ). The questionnaire was used before initiating the treatment with insulin and in the follow-up visit (3-4 months from the beginning of treatment with basal insulin). RESULTS A total of 573 patients with a mean age of 64±10 years were recruited. The overall mean score from the DTSQs satisfaction questionnaire was 18.3±6.3, and the change of treatment led to an improvement in patient satisfaction compared to the previous treatment (DTSQc mean score 8.8±5.9). A1c dropped from an initial value of 8.7% (SD 0.8) to 7.5% (SD 0.7) (P<.001). The frequency of hyperglycaemic episodes perceived by the patients was significantly lower after they overcame their fear of injections (35.6% compared to 11.5%; P<.001), but no statistically significant differences were found in the frequency of hypoglycaemic episodes (32% compared to 35%; P=.059). CONCLUSION In patients with DM2 poorly controlled with OADs, overcoming a fear of injections and starting treatment with insulin was associated with an overall improvement in satisfaction with the new treatment, and decreased the perception of hyperglycaemic episodes. Glycaemic control and the metabolic profile of the patients also improved to a statistically significant degree with the change of treatment.
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Affiliation(s)
- J Mancera-Romero
- Centro de Salud Ciudad Jardín, Distrito Sanitario Málaga-Guadalhorce, Málaga, España.
| | | | - L Muñoz-González
- Centro de Salud Ciudad Jardín, Distrito Sanitario Málaga-Guadalhorce, Málaga, España
| | | | | | - M R Sánchez-Pérez
- Centro de Salud Ciudad Jardín, Distrito Sanitario Málaga-Guadalhorce, Málaga, España
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Sáenz-Abad D, Gimeno-Orna JA, Pérez-Calvo JI. Prognostic importance of glycaemic variability on hospital mortality in patients hospitalised in Internal Medicine Departments. Rev Clin Esp 2015; 215:479-85. [PMID: 26163734 DOI: 10.1016/j.rce.2015.06.003] [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] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2015] [Revised: 03/26/2015] [Accepted: 06/07/2015] [Indexed: 10/23/2022]
Abstract
INTRODUCTION The objective was to assess the prognostic importance of various glycaemic control measures on hospital mortality. MATERIAL AND METHODS Retrospective, analytical cohort study that included patients hospitalised in internal medicine departments with a diagnosis related to diabetes mellitus (DM), excluding acute decompensations. The clinical endpoint was hospital mortality. We recorded clinical, analytical and glycaemic control-related variables (scheduled insulin administration, plasma glycaemia at admission, HbA1c, mean glycaemia (MG) and in-hospital glycaemic variability and hypoglycaemia). The measurement of hospital mortality predictors was performed using univariate and multivariate logistic regression. RESULTS A total of 384 patients (50.3% men) were included. The mean age was 78.5 (SD, 10.3) years. The DM-related diagnoses were type 2 diabetes (83.6%) and stress hyperglycaemia (6.8%). Thirty-one (8.1%) patients died while in hospital. In the multivariate analysis, the best model for predicting mortality (R(2)=0.326; P<.0001) consisted, in order of importance, of age (χ(2)=8.19; OR=1.094; 95% CI 1.020-1.174; P=.004), Charlson index (χ(2)=7.28; OR=1.48; 95% CI 1.11-1.99; P=.007), initial glycaemia (χ(2)=6.05; OR=1.007; 95% CI 1.001-1.014; P=.014), HbA1c (χ(2)=5.76; OR=0.59; 95% CI 0.33-1; P=.016), glycaemic variability (χ(2)=4.41; OR=1.031; 95% CI 1-1.062; P=.036), need for corticosteroid treatment (χ(2)=4.03; OR=3.1; 95% CI 1-9.64; P=.045), administration of scheduled insulin (χ(2)=3.98; OR=0.26; 95% CI 0.066-1; P=.046) and systolic blood pressure (χ(2)=2.92; OR=0.985; 95% CI 0.97-1.003; P=.088). CONCLUSION An increase in initial glycaemia and in-hospital glycaemic variability predict the risk of mortality for hospitalised patients with DM.
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Affiliation(s)
- D Sáenz-Abad
- Servicio de Medicina Interna, Hospital Clínico Universitario «Lozano Blesa», Zaragoza, España.
| | - J A Gimeno-Orna
- Servicio de Endocrinología, Hospital Clínico Universitario «Lozano Blesa», Zaragoza, España
| | - J I Pérez-Calvo
- Servicio de Medicina Interna, Hospital Clínico Universitario «Lozano Blesa», Zaragoza, España
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Sáenz-Abad D, Gimeno-Orna JA, Sierra-Bergua B, Pérez-Calvo JI. [Predictors of mean blood glucose control and its variability in diabetic hospitalized patients]. Endocrinol Nutr 2015; 62:257-263. [PMID: 25907976 DOI: 10.1016/j.endonu.2014.06.011] [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] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/17/2014] [Revised: 05/26/2014] [Accepted: 06/05/2014] [Indexed: 06/04/2023]
Abstract
INTRODUCTION This study was intended to assess the effectiveness and predictors factors of inpatient blood glucose control in diabetic patients admitted to medical departments. MATERIAL AND METHODS A retrospective, analytical cohort study was conducted on patients discharged from internal medicine with a diagnosis related to diabetes. Variables collected included demographic characteristics, clinical data and laboratory parameters related to blood glucose control (HbA1c, basal plasma glucose, point-of-care capillary glucose). The cumulative probability of receiving scheduled insulin regimens was evaluated using Kaplan-Meier analysis. Multivariate regression models were used to select predictors of mean inpatient glucose (MHG) and glucose variability (standard deviation [GV]). RESULTS The study sample consisted of 228 patients (mean age 78.4 (SD 10.1) years, 51% women). Of these, 96 patients (42.1%) were treated with sliding-scale regular insulin only. Median time to start of scheduled insulin therapy was 4 (95% CI, 2-6) days. Blood glucose control measures were: MIG 181.4 (SD 41.7) mg/dL, GV 56.3 (SD 22.6). The best model to predict MIG (R(2): .376; P<.0001) included HbA1c (b=4.96; P=.011), baseline plasma glucose (b=.056; P=.084), mean capillary blood glucose in the first 24hours (b=.154; P<.0001), home treatment (versus oral agents) with basal insulin only (b=13.1; P=.016) or more complex (pre-mixed insulin or basal-bolus) regimens (b=19.1; P=.004), corticoid therapy (b=14.9; P=.002), and fasting on admission (b=10.4; P=.098). CONCLUSION Predictors of inpatient blood glucose control which should be considered in the design of DM management protocols include home treatment, HbA1c, basal plasma glucose, mean blood glucose in the first 24hours, fasting, and corticoid therapy.
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Affiliation(s)
- Daniel Sáenz-Abad
- Servicio de Urgencias, Hospital Clínico Universitario Lozano Blesa, Zaragoza, España.
| | | | - Beatriz Sierra-Bergua
- Servicio de Urgencias, Hospital Clínico Universitario Lozano Blesa, Zaragoza, España
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Caimari F, González C, Ramos A, Chico A, Cubero JM, Pérez A. Efficacy of a hyperglycemia treatment program in a Vascular Surgery Department supervised by Endocrinology. Cir Esp 2016; 94:392-8. [PMID: 25882331 DOI: 10.1016/j.ciresp.2015.02.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2014] [Revised: 02/25/2015] [Accepted: 02/27/2015] [Indexed: 11/20/2022]
Abstract
BACKGROUND The aim of this study was to evaluate the strategy and efficacy of a hyperglycemia treatment program supervised by Endocrinology. METHODS All patients with type 2 diabetes hospitalized at the vascular surgery department over a 12 month period were retrospectively reviewed. Clinical characteristics and hyperglycemia treatment during hospitalization, at discharge and 2-6 month after discharge were collected. Glycemic control was assessed using capillary blood glucose profiles and HbA1c at admission and 2-6 months post-discharge. RESULTS A total of 140 hospitalizations of 123 patients were included. The protocol to choose the insulin regimen was applied in 96.4% of patients (22.8% correction dose, 23.6% basal-correction dose and 50% basal-bolus-correction dose [BBC]). Patients with BBC had higher HbA1c (7.7±1.5% vs. 6.7 ±0.8%; P<.001) and mean glycemia on the first day of hospitalization (184.4±59.2 vs. 140.5±31.4mg/dl; P<.001). Mean blood glucose was reduced to 162.1±41.8mg/dl in the middle and 160.8±43.3mg/dl in the last 24h of hospitalization in patients with BBC (P=.007), but did not change in the remaining patients. In 22.1% patients with treatment changes performed at discharge, HbA1c decreased from 8.2±1.6 to 6.8±1.6% at 2-6 months post-discharge (P=.019). CONCLUSIONS The hyperglycemia treatment protocol applied by an endocrinologist in the hospital, allows the identification of the appropriate therapy and the improvement of the glycemic control during hospitalization and discharge, supporting its efficacy in clinical practice.
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Soto González A, Quintela Fernández N, Pumar López A, Darias Garzón R, Rivas Fernández M, Barberá Comes G. Relationship between metabolic control and self-monitoring of blood glucose in insulin-treated patients with diabetes mellitus. ACTA ACUST UNITED AC 2015; 62:233-9. [PMID: 25814324 DOI: 10.1016/j.endonu.2015.01.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2014] [Revised: 01/13/2015] [Accepted: 01/19/2015] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To assess the relationship between metabolic control (MC) and frequency of self-monitoring of blood glucose (SMBG) in insulin-treated patients with type 1 (T1DM) and type 2 (T2DM) diabetes mellitus, and to analyze the factors associated to MC. MATERIAL AND METHODS A multicenter, cross-sectional, observational study was conducted in which endocrinologists enrolled diabetic patients treated with insulin who used a glucometer. The cut-off value for MC was HbA1c ≤ 7%. Grade of acceptance of the glucometer was assessed using a visual analogue scale (VAS). RESULTS A total of 341 patients (53.5% males) with a mean age (SD) 52.8 (16.3) years, mean HbA1c of 7.69% (1.25) and 128 (37.5%) with T1DM and 211 (61.9%) with T2DM were evaluable. SMBG was done by 86.1% at least once weekly. No relationship was seen between MC and SMBG (P=.678) in the overall sample or in the T1DM (P=.940) or T2DM (P=.343) subgroups. In the logistic regression model, hyperglycemic episodes (Exp-b [risk] 1.794, P=0.022), falsely elevated HbA1c values (Exp-b 3.182, P=.005), and VAS (Exp-b 1.269, P=.008) were associated to poor MC in the total sample. Hyperglycemic episodes (Exp-b 2.538, P=.004), falsely elevated HbA1c values (Exp-b 3.125, P=.012), and VAS (Exp-b 1.316, P=.026) were associated to poor MC in the T2DM subgroup, while body mass index (Exp-b 1.143, P=.046) was associated to poor MC in the T1DM subgroup. CONCLUSIONS In this retrospective, non-controlled study on patients with DM treated with insulin who used a glucometer, no relationship was seen between the degree of metabolic control and frequency of use of the glucometer.
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Martínez-Brocca MA, Morales C, Rodríguez-Ortega P, González-Aguilera B, Montes C, Colomo N, Piédrola G, Méndez-Muros M, Serrano I, Ruiz de Adana MS, Moreno A, Fernández I, Aguilar M, Acosta D, Palomares R. Implementation of subcutaneous insulin protocol for non-critically ill hospitalized patients in andalusian tertiary care hospitals. Endocrinol Nutr 2015; 62:64-71. [PMID: 25467634 DOI: 10.1016/j.endonu.2014.09.006] [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] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/23/2014] [Revised: 09/27/2014] [Accepted: 09/29/2014] [Indexed: 06/04/2023]
Abstract
INTRODUCTION In 2009, the Andalusian Society of Endocrinology and Nutrition designed a protocol for subcutaneous insulin treatment in hospitalized non-critically ill patients (HIP). OBJECTIVE To analyze implementation of HIP at tertiary care hospitals from the Andalusian Public Health System. METHOD A descriptive, multicenter study conducted in 8 tertiary care hospitals on a random sample of non-critically ill patients with diabetes/hyperglycemia (n=306) hospitalized for ≥48 hours in 5 non-surgical (SM) and 2 surgical (SQ) departments. Type 1 and other specific types of diabetes, pregnancy and nutritional support were exclusion criteria. RESULTS 288 patients were included for analysis (62.5% males; 70.3±10.3 years; 71.5% SM, 28.5% SQ). A scheduled subcutaneous insulin regimen based on basal-bolus-correction protocol was started in 55.9% (95%CI: 50.5-61.2%) of patients, 63.1% SM vs. 37.8% SQ (P<.05). Alternatives to insulin regimen based on basal-bolus-correction included sliding scale insulin (43.7%), diet (31.3%), oral antidiabetic drugs (17.2%), premixed insulin (1.6%), and others (6.2%). For patients previously on oral antidiabetic drugs, in-hospital insulin dose was 0.32±0.1 IU/kg/day. In patients previously on insulin, in-hospital insulin dose was increased by 17% [-13-53], and in those on insulin plus oral antidiabetic drugs, in-hospital insulin dose was increased by 26.4% [-6-100]. Supplemental insulin doses used for<40 IU/day and 40-80 IU/day were 72.2% and 56.7% respectively. HbA1c was measured in 23.6% of patients (95CI%: 18.8-28.8); 27.7% SM vs. 13.3% SQ (P<.05). CONCLUSIONS Strategies are needed to improve implementation of the inpatient subcutaneous insulin protocol, particularly in surgical departments. Sliding scale insulin is still the most common alternative to insulin regimen based on basal-bolus-correction scheduled insulin. Metabolic control assessment during hospitalization should be encouraged.
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Affiliation(s)
- María Asunción Martínez-Brocca
- Unidad de Gestión Clínica Provincial de Endocrinología y Nutrición, Hospital Universitario Virgen del Rocío, Instituto de Investigación Biomédica de Sevilla (IBiS), Hospital Universitario Virgen del Rocío/CSIC/Universidad de Sevilla, Sevilla, España.
| | - Cristóbal Morales
- Unidad de Gestión Clínica Provincial de Endocrinología y Nutrición, Hospital Universitario Virgen Macarena, Sevilla, España
| | - Pilar Rodríguez-Ortega
- Unidad de Gestión Clínica de Endocrinología y Nutrición, Hospital Juan Ramón Jiménez, Huelva, España
| | - Beatriz González-Aguilera
- Unidad de Gestión Clínica Provincial de Endocrinología y Nutrición, Hospital Universitario Virgen del Rocío, Instituto de Investigación Biomédica de Sevilla (IBiS), Hospital Universitario Virgen del Rocío/CSIC/Universidad de Sevilla, Sevilla, España
| | - Cristina Montes
- Unidad de Gestión Clínica de Endocrinología y Nutrición, Complejo Hospitalario de Jaén, Jaén, España
| | - Natalia Colomo
- Unidad de Gestión Clínica Intercentros, Hospital Regional Universitario de Málaga, Málaga, España
| | - Gonzalo Piédrola
- Unidad de Gestión Clínica de Endocrinología y Nutrición, Hospital Universitario Virgen de las Nieves, Granada, España
| | - Mariola Méndez-Muros
- Unidad de Gestión Clínica Provincial de Endocrinología y Nutrición, Hospital Universitario Virgen de Valme, Sevilla, España
| | - Isabel Serrano
- Unidad de Gestión Clínica Provincial de Endocrinología y Nutrición, Hospital Universitario Virgen Macarena, Sevilla, España
| | | | - Alberto Moreno
- Unidad de Gestión Clínica de Endocrinología y Nutrición, Complejo Hospitalario de Jaén, Jaén, España
| | - Ignacio Fernández
- Unidad de Gestión Clínica Provincial de Endocrinología y Nutrición, Hospital Universitario Virgen de Valme, Sevilla, España
| | - Manuel Aguilar
- Plan Integral de Diabetes, Unidad de Gestión Clínica Intercentros de Endocrinología y Nutrición, Hospital Universitario Puerta del Mar, Cádiz, España
| | - Domingo Acosta
- Unidad de Gestión Clínica Provincial de Endocrinología y Nutrición, Hospital Universitario Virgen del Rocío, Instituto de Investigación Biomédica de Sevilla (IBiS), Hospital Universitario Virgen del Rocío/CSIC/Universidad de Sevilla, Sevilla, España
| | - Rafael Palomares
- Unidad de Gestión Clínica de Endocrinología y Nutrición, Hospital Universitario Reina Sofía, Córdoba, España
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Navarro-Díaz FJ, Amillo M, Rosales M, Panadero A, Ena J. [Opportunities to improve hospital emergency care of patients with diabetic ketoacidosis]. Emergencias 2015; 27:39-42. [PMID: 29077332] [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] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
OBJECTIVES To identify opportunities to improve the care of adult patients with diabetic ketoacidosis in the emergency room. MATERIAL AND METHODS Retrospective observational study of records for 2010 to 2013. Searching for International Classification of Diseases discharge codes 250.1–250.3 we identified patients who met the following 3 criteria: ketonuria of 100 mg/dL or more, diagnosed diabetes or glucose concentration of 250 mg/dL or more, and venous blood pH below 7.30 (or venous bicarbonate concentration less than 18 mEq/L). We reviewed the cases to extract patient and clinical characteristics and time from triage until diagnosis and start of treatment. The findings were compared with recommendations in clinical practice guidelines. RESULTS We identified 49 episodes of diabetic ketoacidosis (4 mild, 32 moderate, and 13 severe) in 43 patients. The median delay between triage until the first blood test results were available was 142 minutes (range, 59-597 minutes). In 50% of the cases fluid therapy was delayed beyond the time recommended in clinical practice guidelines. Intravenous insulin was also delayed (in 66%) and insuficient intravenous potassium was given in 65%. Sodium bicarbonate was overused (in 50%). Half the patients developed hypokalemia in the hospital. CONCLUSION Diagnosis and initiation of treatment were often delayed for patients with diabetic ketoacidosis in our emergency department.
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Affiliation(s)
| | - Mónica Amillo
- Servicio de Urgencias, Hospital Marina Baixa, Villajoyosa, Alicante, España
| | - María Rosales
- Servicio de Urgencias, Hospital Marina Baixa, Villajoyosa, Alicante, España
| | - Ana Panadero
- Servicio de Urgencias, Hospital Marina Baixa, Villajoyosa, Alicante, España
| | - Javier Ena
- Servicio de Medicina Interna, Hospital Marina Baixa, Villajoyosa, Alicante, España
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Abstract
In this study, we review the efficacy and safety limitations of insulin-dependent oral antidiabetic agents. In terms of efficiency, the main drawback of metformin, sulfonylureas, gliptins and -to a lesser extent-glitazones is durability. No drug per se is able to maintain stable blood glucose control for years. Metformin, sulfonylureas and gliptins have demonstrated safety. Experience with the first two drug groups is more extensive. The main adverse effect of metformin is gastrointestinal discomfort. Major concerns related to the use of sulfonylureas are hypoglycemia and weight gain. The use of pioglitazone has been associated with an increased risk of bladder cancer, edema, heart failure, weight gain, and distal bone fractures in postmenopausal women. The most common adverse reactions associated with glucagon-like peptide-1 agonists are gastrointestinal discomfort that sometimes leads to treatment discontinuation.
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Affiliation(s)
- Pino Fuente Valerón
- Servicio de Endocrinología y Nutrición, Hospital Dr. Negrín, Las Palmas de Gran Canaria, España
| | - Pedro L de Pablos-Velasco
- Servicio de Endocrinología y Nutrición, Hospital Dr. Negrín, Las Palmas de Gran Canaria, España; Departamento de Ciencias Médico-Quirúrgicas, Facultad de Ciencias de la Salud, Universidad de Las Palmas, Las Palmas de Gran Canaria, España.
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Azriel S, Casal F, Dalama B, Varillas F, Villarroel Á, Soto A, Barberá G. Glycemic control parameters in insulin-naïve patients with uncontrolled type 2 diabetes referred to endocrinologists, and degree of implementation of the national Spanish consensus for the management of hyperglycemia. ACTA ACUST UNITED AC 2014; 61:541-7. [PMID: 25260336 DOI: 10.1016/j.endonu.2014.06.004] [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] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2014] [Revised: 06/10/2014] [Accepted: 06/16/2014] [Indexed: 10/24/2022]
Abstract
OBJECTIVE To assess blood glucose in patients with uncontrolled type 2 diabetes mellitus treated with oral antidiabetic drugs in primary care at the time of referral to specialized endocrinologists, and the degree of implementation of the national consensus guidelines of the Spanish Society of Diabetes by evaluating steps one (S1), two (S2), and three (S3) of the escalating therapy. MATERIAL AND METHODS Retrospective, observational study where 81 endocrinologists evaluated patients ≥40 years of age referred from primary care between July 2012 and July 2013, treated with 1 to 2 oral antidiabetic drugs but no insulin therapy, and with glycosylated hemoglobin (HbA(1c)) levels ≥6.5%. Patients also had to have HbA(1c) levels and both fasting and postprandial plasma glucose measurements from the previous three months. RESULTS A total of 285 patients (57.6% males) were assessed. Mean (SD) age was 63.1 (9.7) years, mean HbA1c was 8.5 (1.2) %, mean FPG was 171.7 (43) mg/dL, and mean postprandial plasma glucose was 206.8 (50) mg/dL. In primary care, 26.0% of patients were at S1 and 74.0% were at S2. After referral to the endocrinologist, 9.8% of patients moved onto S1, 42.8% onto S2, and 47.4% onto S3. Oral antidiabetic drugs most commonly prescribed in primary care were metformin (90.2%), DPP-4 inhibitors (34.4%), and sulfonylureas (30.5%), while drugs most commonly used in the specialized endocrinology setting were metformin (86%), insulin (56.8%), and DPP-4 inhibitors (49.8%). The most commonly followed guidelines were those of the American Diabetes Association and the consensus guidelines of the Spanish Society of Diabetes, in 77% and 45% of cases respectively. CONCLUSIONS Approximately half the patients treated with oral antidiabetic drugs in primary care are prescribed insulin after referral to an endocrinology specialist. The most commonly followed guidelines in specialized care are the American Diabetes Association guidelines.
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Affiliation(s)
| | | | - Belén Dalama
- Hospital Universitario Valle Hebron, Barcelona, España
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Clemente APG, Santos CDDL, Martins VJB, Albuquerque MP, Fachim MB, Sawaya AL. Lower waist circumference in mildly-stunted adolescents is associated with elevated insulin concentration. J Pediatr (Rio J) 2014; 90:479-85. [PMID: 24973467 DOI: 10.1016/j.jped.2014.01.015] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2013] [Revised: 12/20/2013] [Accepted: 01/03/2014] [Indexed: 10/25/2022] Open
Abstract
OBJECTIVE Augmented waist circumference (WC) is associated with non-communicable diseases and could represent a valuable marker in screening for metabolic dysfunctions in subjects with insufficient linear growth. The objective of the present study was to determine whether biochemical and hemodynamic parameters and waist circumference vary between mildly-stunted and non-stunted adolescents from impoverished communities of São Paulo, Brazil. METHODS The cross-sectional study involved 206 subjects, aged between 9 and 19 years and living in impoverished areas of São Paulo, Brazil. The sample population was divided according to height-for-age Z-score (HAZ) into stunted (-1 > HAZ ≥ -2) and non-stunted (HAZ ≥ -1) groups, and was sub-divided according to gender. Logistic regression analysis was employed to compare individuals with elevated (> 75th percentile) insulin concentrations. The receiver operating characteristic curves were constructed to determine WC cut-off points that could be used to identify stunted and non-stunted individuals with elevated insulin concentrations. RESULTS WC cut-off points of 58.25cm and 67.2cm allowed for correct classification of 90.7% of stunted and 88.7% of non-stunted individuals in the studied population. While the sensitivity of the model was high for stunted and non-stunted subjects (98.8% and 97.2%, respectively), the specificity was modest (57.1% and 41.2%, respectively). CONCLUSION The results presented herein suggest that an increase in plasma insulin is one of the primary metabolic modifications in stunted individuals, and that this alteration could be identified at a lower WC cut-off point than in non-stunted counterparts.
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Affiliation(s)
| | | | - Vinicius J B Martins
- Programa de Pós-Graduação em Endocrinologia Clínica, Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brazil
| | - Maria Paula Albuquerque
- Programa de Pós-Graduação em Endocrinologia Clínica, Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brazil
| | - Mariana B Fachim
- Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brazil
| | - Ana Lydia Sawaya
- Departamento de Fisiologia, Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brazil
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Martínez Cerón E, Casitas Mateos R, García-Río F. Sleep apnea-hypopnea syndrome and type 2 diabetes. A reciprocal relationship? Arch Bronconeumol 2014; 51:128-39. [PMID: 25145320 DOI: 10.1016/j.arbres.2014.06.017] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [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: 05/14/2014] [Revised: 06/15/2014] [Accepted: 06/16/2014] [Indexed: 01/03/2023]
Abstract
Epidemiological data suggest that sleep apnea-hypopnea syndrome (SAHS) is independently associated with the development of insulin resistance and glucose intolerance. Moreover, despite significant methodological limitations, some studies report a high prevalence of SAHS in patients with type 2 diabetes mellitus (DM2). A recent meta-analysis shows that moderate-severe SAHS is associated with an increased risk of DM2 (relative risk=1.63 [1.09 to 2.45]), compared to the absence of apneas and hypopneas. Common alterations in various pathogenic pathways add biological plausibility to this relationship. Intermittent hypoxia and sleep fragmentation, caused by successive apnea-hypopnea episodes, induce several intermediate disorders, such as activation of the sympathetic nervous system, oxidative stress, systemic inflammation, alterations in appetite-regulating hormones and activation of the hypothalamic-pituitary-adrenal axis which, in turn, favor the development of insulin resistance, its progression to glucose intolerance and, ultimately, to DM2. Concomitant SAHS seems to increase DM2 severity, since it worsens glycemic control and enhances the effects of atherosclerosis on the development of macrovascular complications. Furthermore, SAHS may be associated with the development of microvascular complications: retinopathy, nephropathy or diabetic neuropathy in particular. Data are still scant, but it seems that DM2 may also worsen SAHS progression, by increasing the collapsibility of the upper airway and the development of central apneas and hypopneas.
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Affiliation(s)
| | | | - Francisco García-Río
- Servicio de Neumología, Hospital Universitario La Paz, IdiPAZ, Madrid, España; Universidad Autónoma de Madrid, Madrid, España; CIBER de enfermedades respiratorias (CIBERES), Madrid, España.
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Ampudia-Blasco FJ, Galán M, Brod M. A cross-sectional survey among patients and prescribers on insulin dosing irregularities and impact of mild (self-treated) hypoglycemia episodes in Spanish patients with type 2 diabetes as compared to other European patients. ACTA ACUST UNITED AC 2014; 61:426-33. [PMID: 24853553 DOI: 10.1016/j.endonu.2014.03.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [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: 01/29/2014] [Revised: 03/20/2014] [Accepted: 03/24/2014] [Indexed: 11/17/2022]
Abstract
BACKGROUND AND OBJECTIVE In Spain, data suggest that 13.8% of adults have diabetes. Two important aspects in diabetes management are mild hypoglycemic episodes and poor treatment adherence. This study assesses the impact of missed insulin doses and prevalence of mistimed and reduced insulin doses and mild hypoglycemia in patients with type 2 diabetes treated with basal insulin analogues in Spain, and compares the data collected to pooled data from 8 other European countries (OECs). MATERIALS AND METHODS GAPP2 was an international, online, cross-sectional study of diabetic patients aged ≥40 years treated with long-acting insulin analogues and their healthcare professionals. Patients and healthcare professionals were recruited from online research panels. Data reported in Spain are compared to pooled data from 8 OECs. RESULTS In Spain, 1-3% of patients reported they had reduced, missed, or mistimed at least one insulin does in the previous month. Significantly more OEC patients reported dosing irregularities (15-23%; all P<0.01). In Spain, 77% of patients were worried and 59% felt guilty for missing a dose of basal insulin, while 24% reported that they were very worried about nocturnal hypoglycemia. Significantly fewer OEC patients reported worrying (47%; P<0.01) and feeling guilty (37%; P<0.01) about missing an insulin dose, or worry about nocturnal hypoglycemia (12%; P<0.01). CONCLUSIONS In Spain, patients with type 2 diabetes report fewer dosing irregularities and hypoglycemic episodes as compared to patients from OECs. However, Spanish patients appear to have a reduced quality of life related to hypoglycemia as well as worry and guilt related to insulin dosing irregularities.
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Affiliation(s)
- Francisco J Ampudia-Blasco
- Diabetes Reference Unit, Endocrinology and Nutrition Department, Clinic University Hospital, Valencia, Spain.
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