Abordaje de la desnutrición en pacientes hospitalizados con diabetes/hiperglucemia y cirrosis hepática / Malnutrition management of hospitalized patients with diabetes/hyperglycemia and liver cirrhosis

La cirrosis hepática es una enfermedad progresiva y crónica del hígado, de etiología diversa, que se asocia frecuentemente con intolerancia a la glucosa y en algunos casos concurre con diabetes tipo 2 (DM2). La DM2 se asocia con resultados adversos en pacientes con cirrosis, incluyendo una mayor tasa de ingresos hospitalarios, una mayor prevalencia de carcinoma hepatocelular y un mayor riesgo de mortalidad. La desnutrición es otra complicación frecuente en la cirrosis, cuya prevalencia aumenta con el grado de disfunción hepática, empeorando el pronóstico. El presente artículo describe los resultados del consenso de expertos y las respuestas de los panelistas sobre el manejo nutricional en la práctica clínica habitual de los pacientes con diabetes/hiperglucemia hospitalizados en planta (no críticos) con cirrosis hepática. (AU)

Liver cirrhosis is a progressive and chronic disease of the liver, of diverse etiology, which is frequently associated with glucose intolerance and in some cases concurs with type 2 diabetes (DM2). DM2 is associated with adverse outcomes in patients with cirrhosis, including a higher rate of hospitalizations, a higher prevalence of hepatocellular carcinoma, and an increased risk of mortality. Malnutrition is another frequent complication of cirrhosis, the prevalence of which increases with the degree of liver dysfunction, worsening the prognosis. This article describes the results of the expert consensus and the responses of the panelists on the nutritional management in routine clinical practice of patients with diabetes/hyperglycemia hospitalized (non-critically ill) with liver cirrhosis. (AU)

La respuesta monofásica a la sobrecarga oral de glucosa como factor predictivo del riesgo de diabetes tipo 2 en pacientes pediátricos con obesidad / The monophasic pattern in oral glucose tolerance test as a predictive risk factor of type 2 diabetes in obese paediatric patients

Introducción: El aumento en la prevalencia de obesidad en la edad pediátrica se asocia a mayor incidencia de diabetes mellitus tipo2 (DM2). El tipo de respuesta de la glucemia y de la insulina a la sobrecarga oral de glucosa (SOG) podría predecir el riesgo de DM2 en pacientes con obesidad. Objetivo: Valorar la respuesta a la SOG y relacionar con factores de riesgo de DM2 en niños y adolescentes obesos. Métodos: Estudio observacional retrospectivo sobre 588 pacientes (309 varones, 279 mujeres); 90,3% caucásicos; edad media 11,1 ± 2,8 años. Según el tipo de respuesta en la SOG se establecieron dos grupos: monofásico y bifásico. Se analizaron parámetros antropométricos, bioquímicos e índices relacionados con sensibilidad a la insulina y la función de la célula Beta. Resultados: El 50,2% de los pacientes tuvieron un patrón de glucosa monofásico (50,8% varones), el 48,5% bifásico (47,6% varones) y el 1,3% indeterminado. La respuesta monofásica mostró menor sensibilidad a la insulina y peor función de la célula Beta; los pacientes con patrón bifásico presentaron mayor índice de masa corporal, perímetro de cintura y presión arterial, sin ser estos resultados estadísticamente significativos. Los pacientes latinos tuvieron glucemias significativamente menores en la SOG a expensas de una mayor insulinemia. Conclusiones: El patrón de respuesta de la SOG refleja fenotipos metabólicos diferentes. Los pacientes pediátricos con un patrón bifásico tienen un perfil con menor riesgo de desarrollar DM2. Una SOG en niños y adolescentes obesos podría ser útil para implementar estrategias de intervención precoz y prevenir la aparición de prediabetes o DM2 en esta población (AU)

Introduction: The onset of obesity at young ages is strongly associated with the early development of type 2 diabetes (T2D). The shape of the curves of glucose and insulin curves during an oral glucose tolerance test (OGTT) could predict the risk of developing T2D. Objective: To analyse the morphology of the OGTT and determine T2D risk factors in a mainly Caucasian population of children and adolescents. Methods: Observational retrospective study including 588 patients (309 males, 279 females) with a mean age of 11.1 ± 2years, and of whom 90.3% were Caucasian. Risk factors for T2D were compared in patients with a monophasic or biphasic pattern during the performance of an OGTT, as well as anthropometric and biochemical variables, insulin resistance, and beta-cell function. Results: The shape of the glucose curve was monophasic in 50.2% of patients (50.8% male), biphasic in 48.5% (47.6% males), and indeterminate in 1.3%. The monophasic pattern showed lower insulin-sensitivity and worse beta-cell function. Patients with a biphasic pattern had a higher BMI, waist circumference, and blood pressure, although the results were not significant. Latin-American patients had significantly lower serum glucose levels with higher insulin levels during the OGTT. Conclusions: The pattern of response to an OGTT reflects different metabolic phenotypes. Paediatric patients with a biphasic pattern have lower risk-profiling for T2D. The performing of an OGTT could be useful to implement early intervention strategies in children and adolescents with obesity, in order to prevent the development of pre-diabetes or T2D (AU)

Fine particulate matter potentiates type 2 diabetes development in high-fat diet-treated mice: stress response and extracellular to intracellular HSP70 ratio analysis

Exposure to fine particulate matter (PM2.5) air pollution is a risk factor for type 2 diabetes (T2DM). We argue whether the potentiating effect of PM2.5 over the development of T2DM in high-fat diet (HFD)-fed mice would be related to modification in cell stress response, particularly in antioxidant defenses and 70-kDa heat shock proteins (HSP70) status. Male mice were fed standard chow or HFD for 12 weeks and then randomly exposed to daily nasotropic instillation of PM2.5 for additional 12 weeks under the same diet schedule, divided into four groups (n = 14-15 each): Control, PM2.5, HFD, and HFD + PM2.5 were evaluated biometric and metabolic profiles of mice, and cellular stress response (antioxidant defense and HSP70 status) of metabolic tissues. Extracellular to intracellular HSP70 ratio ([eHSP72]/[iHSP70]), viz. H-index, was then calculated. HFD + PM2.5 mice presented a positive correlation between adiposity, increased body weight and glucose intolerance, and increased glucose and triacylglycerol plasma levels. Pancreas exhibited lower iHSP70 expression, accompanied by 3.7-fold increase in the plasma to pancreas [eHSP72]/[iHSP70] ratio. Exposure to PM2.5 markedly potentiated metabolic dysfunction in HFD-treated mice and promoted relevant alteration in cell stress response assessed by [eHSP72]/[iHSP70], a relevant biomarker of chronic low-grade inflammatory state and T2DM risk (AU)

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Epidemiología de la diabetes mellitus en Sudamérica: la experiencia de Colombia / Epidemiology of diabetes mellitus in South America: The experience of Colombia

Para la Federación Internacional de Diabetes, el 8,3% de la población mundial padece diabetes mellitus, y se espera que el número de individuos con la enfermedad se incremente a más de 592 millones. Para Sudamérica y Centroamérica se calcula que el aumento en el número de casos diagnosticados en el periodo de tiempo desde el año 2013 al año 2035 sea del 59,8% (pasando de 24 a 38,5 millones). Para la Organización Mundial de la Salud, en el año 2014 y para la región de las Américas la prevalencia de hiperglucemia en ayunas fue del 9,3% en hombres y del 8,1% en mujeres, y los países con mayor prevalencia de diabetes mellitus en adultos ≥18años fueron: Guyana, Surinam, Chile y Argentina. En Colombia, la prevalencia de diabetes mellitus tipo2 es variable, dependiendo del rango poblacional evaluado y del criterio diagnóstico empleado

According to the International Diabetes Federation, 8.3% of the world population suffers from diabetes mellitus, and it is expected that the number of individuals with the disease will increase to over 592 million. In South and Central America, it is estimated that the increase in the number of cases diagnosed in the period from 2013 to 2035 will be 59.8% (from 24 to 38.5 millions). According to the World Health Organisation, the prevalence of fasting hyperglycaemia in the region of the Americas in 2014 was 9.3% in men and 8.1% in women. The countries with the highest prevalence of diabetes mellitus in adults ≥18years were: Guyana, Surinam, Chile, and Argentina. In Colombia, the prevalence of type 2 diabetes mellitus is variable, depending on the population range assessed and the diagnostic criteria used

Fitness, adiposopathy, and adiposity are independent predictors of insulin sensitivity in middle-aged men without diabetes

Adiposopathy, or sick fat, refers to adipose tissue dysfunction that can lead to several complications such as dyslipidemia, insulin resistance, and hyperglycemia. The relative contribution of adiposopathy in predicting insulin resistance remains unclear. We investigated the relationship between adiposopathy, as assessed as a low plasma adiponectin/leptin ratio, with anthropometry, body composition (hydrostatic weighing), insulin sensitivity (hyperinsulinemic-euglycemic clamp), inflammation, and fitness level (ergocycle VO2max, mL/kgFFM/min) in 53 men (aged 34-53 years) from four groups: sedentary controls without obesity (body mass index [BMI] <25 kg/m2), sedentary with obesity (BMI > 30 kg/m2), sedentary with obesity and glucose intolerance, and endurance trained active without obesity. The adiponectin/leptin ratio was the highest in trained men (4.75 ± 0.82) and the lowest in glucose intolerant subjects with obesity (0.27 ± 0.06; ANOVA p < 0.0001) indicating increased adiposopathy in those with obesity. The ratio was negatively associated with adiposity (e.g., waist circumference, r = −0.59, p < 0.01) and positively associated with VO2max (r = 0.67, p < 0.01) and insulin sensitivity (M/I, r = 0.73, p < 0.01). Multiple regression analysis revealed fitness as the strongest independent predictor of insulin sensitivity (partial R2 = 0.61). While adiposopathy was also an independent and significant contributor (partial R2 = 0.10), waist circumference added little power to the model (partial R2 = 0.024). All three variables remained significant independent predictors when trained subjects were excluded from the model. Plasma lipids were not retained in the model. We conclude that low fitness, adiposopathy, as well as adiposity (and in particular abdominal obesity) are independent contributors to insulin resistance in men without diabetes (AU)

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High intake of dietary tyramine does not deteriorate glucose handling and does not cause adverse cardiovascular effects in mice

Tyramine is naturally occurring in food and induces pressor responses. Low-tyramine diets are recommended for patients treated with MAO inhibitors to avoid the fatal hypertensive crisis sadly known as "cheese effect". Hence, tyramine intake is suspected to have toxicological consequences in humans, while its administration to type 1 diabetic rodents has been reported to improve glucose tolerance. We investigated in mice whether prolonged tyramine ingestion could alter glucose homeostasis, insulin sensitivity, adipose tissue physiology or cardiovascular functions. Tyramine was added at 0.04 or 0.14 % in the drinking water since this was estimated to increase by 10- to 40-fold the spontaneous tyramine intake of control mice fed a standard diet. Ten to 12 weeks of such tyramine supplementation did not influence body weight gain, adiposity or food consumption. Both doses (reaching approx. 300 and 1100 μmol tyramine/kg bw/day) decreased nonfasting blood glucose but did not modify glucose tolerance or fasting levels of glucose, insulin or circulating lipids. Blood pressure was not increased in tyramine-drinking mice, while only the higher tested dose moderately increased heart rate without change in its variability. Markers of cardiac tissue injury or oxidative stress remained unaltered, except an increased hydrogen peroxide production in heart preparations. In isolated adipocytes, tyramine inhibited lipolysis similarly in treated and control groups, as did insulin. The lack of serious adverse cardiovascular effects of prolonged tyramine supplementation in normoglycemic mice together with the somewhat insulin-like effects found on adipose cells should lead to reconsider favourably the risk/benefit ratio of the intake of this dietary amine (AU)

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Development and assessment of the disposition index based on the oral glucose tolerance test in subjects with different glycaemic status

Insulin secretion and insulin sensitivity indexes are related by hyperbolic functions, allowing the calculation of the disposition index (DI) as the product of the acute insulin response (AIR) and the insulin sensitivity index (Si) from intravenous glucose tolerance test (IVGTT). Our objective was to develop an oral-DI based on the oral glucose tolerance test (OGTT) and to assess its association with glucose tolerance status. This research is structured in three studies. Study 1: OGTT were performed in 833 non-diabetic Chilean women (18-60 years) without family history of diabetes mellitus. Study 2: an independent group of n = 57 non-diabetic (18-46 years) without family history of diabetes mellitus carried out an OGTT and an abbreviated IVGTT. Study 3: a sample of 1674 Chilean adults (18-60 years) with different glycaemic status performed an OGTT. An adequate statistical fit for a rectangular hyperbola was found between the area under the curve of insulin-to-glucose ratio (AUCI/G-R) and the Matsuda ISI-COMP index (study 1). The oral-DI derived as AUCI/G-R × ISI-COMP was previously termed insulin-secretion-sensitivity index-2 (ISSI-2). ISSI-2 significantly correlated with DI from IVGTT (rho = 0.34; p = 0.009) (study 2). ISSI-2 shows important differences across groups of subjects with different glycaemic status (study 3). We have confirmed that ISSI-2 replicates the mathematical properties of DI, showing significant correlations with DI from the abbreviated MM-IVGTT. These results indicate that ISSI-2 constitutes a surrogate measure of insulin secretion relative to insulin sensitivity and emphasizes the pivotal role of impaired insulin secretion in the development of glucose homeostasis dysregulation (AU)

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Chronic liquid nutrition intake induces obesity and considerable but reversible metabolic alterations in Wistar rats

We have previously described the development of substantial, but reversible obesity in Wistar rats fed with palatable liquid nutrition (Fresubin). In this study, we investigated changes in serum hormone levels, glycemia, fat mass, adipocyte size, and gene expression of adipokines and inflammatory markers in adipose tissue of Wistar rats fed by Fresubin (i) for 5 months, (ii) up to 90 days of age, or (iii) after 90 days of age to characterize metabolic alterations and their reversibility in rats fed with Fresubin. An intra-peritoneal glucose tolerance test was also performed to determine levels of serum leptin, adiponectin, insulin, and C-peptide in 2- and 4-month-old animals. In addition, mesenteric and epididymal adipose tissue weight, adipocyte diameter, and gene expression of pro- and anti-inflammatory adipokines and other markers were determined at the end of the study. Chronic Fresubin intake significantly increased adipocyte diameter, reduced glucose tolerance, and increased serum leptin, adiponectin, insulin, and C-peptide levels. Moreover, gene expression of leptin, adiponectin, CD68, and nuclear factor kappa B was significantly increased in mesenteric adipose tissue of Fresubin fed rats. Monocyte chemotactic protein 1 messenger RNA (mRNA) levels increased in mesenteric adipose tissue only in the group fed Fresubin during the entire experiment. In epididymal adipose tissue, fatty acid binding protein 4 mRNA levels were significantly increased in rats fed by Fresubin during adulthood. In conclusion, chronic Fresubin intake induced complex metabolic alterations in Wistar rats characteristic of metabolic syndrome. However, transition of rats from Fresubin to standard diet reversed these alterations (AU)

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Diabetes-induced perturbations are subject to intergenerational transmission through maternal line

The hypothesis of fetal origins of adult disease states that early life events program the occurrence of significant adult diseases, including diabetes and obesity. Maternal diabetes is associated with general stress environment for developing fetus, and gestational diabetes is an independent risk factor for type 2 diabetes and metabolic syndrome in offspring. Intra-uterine fetal programming of fetal tissues exposes the offspring to increased risk of impaired glucose tolerance, type 2 diabetes, and cardiovascular disease. Here, we examined the transmission of maternal diabetes-induced fetal programming in second generation and compared maternal and paternal routes of intergenerational effects. We organized 40 Wistar rats into three groups, male offspring of diabetic mothers, female offspring of diabetic mothers, and offspring of control mothers. These groups were mated with normal healthy rats to assess the effect of grand-maternal diabetes on pregnancy outcome in F2 rats, as well as glucose-sensing parameters, insulin resistance, and glucose tolerance prenatally and postnatally. We found that F2 offspring of diabetic mothers had impaired glucose sensing, increased oxidative stress, insulin resistance, and impaired glucose tolerance, and these effects were more prominent in the F2 offspring of F1 female rats (F2-DF1F). We deduce that fetal programming of maternal diabetes is mostly transmitted through maternal line across two generations (AU)

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Consenso sobre la detección y el manejo de la prediabetes. Grupo de Trabajo de Consensos y Guías Clínicas de la Sociedad Española de Diabetes / Consensus on the detection and management of prediabetes. Consensus and Clinical Guidelines Working Group of the Spanish Diabetes Society

En España, según datos del estudio Di@bet. es, un 13,8% de la población adulta padece diabetes y un 14,8% algún tipo de prediabetes (intolerancia a la glucosa, glucemia basal alterada o ambas). Puesto que la detección precoz de la prediabetes puede facilitar la puesta en marcha de medidas terapéuticas que eviten su progresión a diabetes, consideramos que las estrategias de prevención en las consultas de atención primaria y especializada deberían consensuarse. La detección de diabetes y prediabetes mediante un cuestionario específico (test de FINDRISC) y/o la determinación de la glucemia basal en pacientes de riesgo permiten detectar los pacientes con riesgo de desarrollar la enfermedad y es necesario considerar cómo debe ser su manejo clínico. La intervención sobre los estilos de vida puede reducir la progresión a diabetes o hacer retroceder un estado prediabético a la normalidad y es una intervención coste-efectiva. Algunos fármacos, como la metformina, también se han mostrado eficaces en reducir la progresión a diabetes aunque no son superiores a las intervenciones no farmacológicas. Finalmente, aunque no hay pruebas sólidas que apoyen la eficacia del cribado en términos de morbimortalidad, sí que se ha observado una mejora de los factores de riesgo cardiovascular. El Grupo de Trabajo de Consensos y Guías Clínicas de la Sociedad Española de Diabetes, ha elaborado unas recomendaciones que han sido consensuadas con la Sociedad Española de Endocrinología y Nutrición, la Sociedad Española de Endocrinología Pediátrica, la Sociedad Española de Farmacia Comunitaria, la Sociedad Española de Medicina Familiar y Comunitaria, la Sociedad Española de Médicos Generales, la Sociedad Española de Médicos de Atención Primaria, la Sociedad Española de Medicina Interna y la Asociación de Enfermería Comunitaria y la Red de Grupos de Estudio de la Diabetes en Atención Primaria

In Spain, according to the Di@bet. es study, 13.8% of the adult population suffers from diabetes and 14.8% from some form of prediabetes (impaired glucose tolerance, impaired fasting glucose or both). Since early detection of prediabetes can facilitate the implementation of therapeutic measures to prevent its progression to diabetes, we believe that preventive strategies in primary care and specialized clinical settings should be agreed. Screening for diabetes and prediabetes using a specific questionnaire (FINDRISC) and/or the measurement of fasting plasma glucose in high risk patients leads to detecting patients at risk of developing diabetes and it is necessary to consider how they should be managed. The intervention in lifestyle can reduce the progression to diabetes and reverse a prediabetic state to normal and is a cost-effective intervention. Some drugs, such as metformin, have also been shown effective in reducing the progression to diabetes but are not superior to non-pharmacological INTERVENTIONS: Finally, an improvement in some cardiovascular risk factors has been observed although there is no strong evidence supporting the effectiveness of screening in terms of morbility and mortality. The Consensus and Clinical Guidelines Working Group of the Spanish Diabetes Society has issued some recommendations that have been agreed by the Sociedad Española de Endocrinología y Nutrición, Sociedad Española de Endocrinología Pediátrica, Sociedad Española de Farmacia Comunitaria, Sociedad Española de Medicina Familiar y Comunitaria, Sociedad Española de Médicos Generales, Sociedad Española de Médicos de Atención Primaria, Sociedad Española de Medicina Interna, Asociación de Enfermería Comunitaria and Red de Grupos de Estudio de la Diabetes en Atención Primaria

Síndrome de apneas-hipopneas del sueño y diabetes tipo 2. ¿Una relación de ida y vuelta? / Sleep Apnea-Hypopnea Syndrome and Type 2 Diabetes. A Reciprocal Relationship?

Diversos datos epidemiológicos muestran que el síndrome de apneas-hipopneas del sueño (SAHS) se relaciona independientemente con el desarrollo de resistencia a la insulina e intolerancia a la glucosa. Además, y pese a la existencia de notables limitaciones metodológicas, algunos estudios refieren una elevada prevalencia de SAHS en pacientes con diabetes tipo 2 (DM2). Un reciente metaanálisis muestra que el SAHS moderado-grave se asocia a un mayor riesgo de DM2 (riesgo relativo = 1,63 [1,09-2,45]), en relación con la ausencia de apneas-hipopneas. La existencia de alteraciones comunes de diversas vías patogénicas le proporciona plausibilidad bioló- gica a esta relación. La hipoxia intermitente y la fragmentación del sueño, originadas por la sucesión de episodios de apneas-hipopneas, inducen diversos trastornos intermedios, como la activación del sistemanervioso simpático, el estrés oxidativo, la inflamación sistémica, alteraciones en las hormonas reguladoras del apetito y activación del eje hipotálamo-hipófiso-suprarrenal, que favorecen el desarrollo de resistencia a la insulina, así como su progresión a intolerancia a la glucosa y, en última instancia, a DM2. La coexistencia del SAHS parece agravar la evolución de la DM2, al empeorar el control glucémico y potenciar el efecto de la aterosclerosis en el desarrollo de complicaciones macrovasculares. Además, el SAHS podría asociarse al desarrollo de complicaciones microvasculares, particularmente la retinopatía, nefropatía o neuropatía diabéticas. Aunque todavía escasos, algunos datos sugieren que la DM2 también podría empeorar la evolución del SAHS, al favorecer la colapsabilidad de la vía aérea superior y potenciar la aparición de apneas-hipopneas centrales

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 hypothalamicpituitary-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, butit seems that DM2 may also worsen SAHS progression, by increasing the collapsibility of the upper airway and the development of central apneas and hypopneas

Improved metabolic response after 16 weeks of calorie-restricted low-glycaemic index diet and metformin in impaired glucose tolerance subjects / Mejora de la respuesta metabólica después de 16 semanas de dieta con restricción calórica y bajo índice glucémico junto con metformina en sujetos con intolerancia a glucosa

Aim: This study analyzed the metabolic effects of dietary advice to follow calorie-restricted low-glycaemic index diet with metformin in overweight / obese impaired glucose tolerance subjects. Methods: Sixteen subjects with body mass index between 27-38 kg/m² were followed monthly for 16 weeks and treated with metformin (1 g/day) and dietary prescription for low-glycaemic index diet with energy reduction of 25-30% their total energy expenditure. Glucose metabolism, lipid profile, anthropometric and body composition, and food intake parameters were measured before and after the treatment. Paired t-tests/Wilcoxon tests were used to compare differences from baseline, with a statistical significance criterion of p ≤ 0.05. Results: There were significant reductions in anthropometric and body composition parameters, decrease in HOMA2-%β and triglycerides concentrations, and in - crease in Cederholm index. These results show enhanced peripheral insulin sensitivity and preservation of pan - creatic beta-cell function. Conclusion: Calorie-restricted low-glycaemic index diet and metformin was benefit to metabolic and anthropometric parameters in overweight/obese subjects with impaired glucose tolerance (AU)

Objetivo: Este estudio analizaba los efectos metabólicos del consejo dietético de seguir una dieta con restricción calórica y un índice glucémico bajo junto con Metformina en individuos con sobrepeso / obesidad y tolerancia alterada a la glucosa. Métodos: Se siguió mensualmente durante 16 semanas a 16 individuos con un índice de masa corporal entre 27-38 kg/m² y se les trató con Metformina (1 g/día) y una prescripción dietética con un índice glucémico bajo y una reducción del energía del 25-30 % de su gasto energético total. Se midieron el metabolismo de la glucosa, el perfil lipídico, la composición antropométrica y corporal y los parámetros de consumo de alimentos antes y después del tratamiento. Se emplearon las pruebas t pareadas y de Wilcoxon para comparar las diferencias con respecto al basal, con un criterio de significación estadística de p ≤ 0,05. Resultados: Hubo reducciones significativas en los parámetros de composición corporal y antropométricos, una disminución en las concentraciones de HOMA2-% y e triglicéridos y un aumento del índice de Cederholm. Estos resultados muestran una mejora de la sensibilidad periférica a la insulina y una conservación de la función de las células beta pancreáticas. Conclusión: la dieta con restricción calórica y un índice glucémico bajo junto con Metformina fueron beneficiosas para los parámetros metabólicos y antropométricos en individuos con sobrepeso/obesidad y una tolerancia a la glucosa alterada (AU)

Importancia de la dieta en el síndrome del intestino irritable / Importance of diet in irritable bowel syndrome

Aproximadamente dos tercios de los pacientes con síndrome del intestino irritable (SII) relacionan sus síntomas con algún alimento. Revisamos aquellos factores dietéticos que pueden influir. La fibra soluble puede mejorar el estreñimiento pero frecuentemente aumenta la distensión y el dolor abdominal. La malabsorción de hidratos de carbono parece más frecuente en los pacientes con SII. Se ha planteado así una dieta exenta de oligosacáridos, disacáridos, monosacáridos y polioles fermentables (FODMAP), obteniéndose una mejoría significativa, lo que la plantea como una opción terapéutica. Se aconseja realizar cribado de la enfermedad celiaca mediante serología en pacientes que no padezcan estreñimiento. También puede existir una sensibilidad al gluten no-celiaca, definida como una forma de intolerancia al gluten cuando se han excluido la enfermedad celiaca y la alergia al trigo. Aunque no existe una dieta específica sí que puede ser beneficioso realizar comidas pequeñas y frecuentes, y evitar alimentos grasos, lácteos, muchos hidratos de carbono, cafeína y alcohol

About two-thirds of irritable bowel syndrome (IBS) patients associate their symptoms with certain foods. We reviewed food-related factors putatively associated with manifestations of IBS. Soluble fiber may improve constipation but frequently increases bloating and abdominal pain. Carbohydrate malabsorption seems to be more frequent in IBS. A low FODMAP (fermentable oligosaccharides, disaccharides, monosaccharides and polyols) diet significantly reduces IBS symptoms and has been suggested as a therapeutic option. Serological screening for celiac disease should be done in patients without constipation. Moreover, non-celiac disease gluten sensitivity, defined as gluten intolerance once celiac disease and wheat allergy have been ruled out, should be considered in these patients. There is no specific diet for IBSpatients but small and frequent meals, avoiding greasy foods, dairy products, many carbohydrates, caffeine and alcohol, is recommended

Sistemas de monitorización continua de la glucosa / Continuous monitoring systems of glucose

La posibilidad de obtener una lectura continua de la glucosa puede representar un gran avance y una herramienta útil para el manejo de la diabetes. Los avances tecnológicos pueden mejorar la calidad de vida y el control metabólico de las personas con diabetes, aunque esto suponga tener que aprender e incorporar nuevos conceptos técnicos, nuevos algoritmos de modificación de pauta y nuevos retos en Educación Terapéutica(AU)

The possibility of obtaining a continuous reading of glucose may represent a breakthrough and a useful tool for the management of diabetes. Technological advances can improve the quality of life and people with diabetes metabolic control, even if this means having to learn and incorporate new technical concepts, new algorithms for pattern modification and new challenges in Therapeutic Education(AU)

Benzylamine antihyperglycemic effect is abolished by AOC3 gene invalidation in mice but not rescued by semicarbazide-sensitive amine oxidase expression under the control of aP2 promoter

Semicarbazide-sensitive amine oxidase (SSAO) is a transmembrane enzyme that metabolizes primary amines from endogenous or dietary origin. SSAO is highly expressed in adipose, smooth muscle and endothelial cells. In each of these cell types, SSAO is implicated in different biological functions, such as glucose transport activation, extracellular matrix maturation and leucocyte extravasation, respectively. However, the physiological functions of SSAO and their involvement in pathogenesis remain uncompletely characterized. To better understand the role of adipose tissue SSAO, we investigated whether it was necessary and/or sufficient to produce the antihyperglycemic effect of the SSAO-substrate benzylamine, already reported in mice. Therefore, we crossed SSAO-deficient mice invalidated for AOC3 gene and transgenic mice expected to express human SSAO in an adipocyte-specific manner, under the control of aP2 promoter. The aP2-human AOC3 construct (aP2-hAOC3) was equally expressed in the adipose tissue of mice expressing or not the native murine form and almost absent in other tissues. However, the corresponding SSAO activity found in adipose tissue represented only 20 % that of control mice. As a consequence, the benzylamine antihyperglycemic effect observed during glucose tolerance test in control was abolished in AOC3-KO mice but not rescued in mice expressing aP2-hAOC3. The capacity of benzylamine or methylamine to activate glucose uptake in adipocytes exhibited parallel variations in the corresponding genotypes. Although the aP2-hAOC3 construct did not allow a total rescue of SSAO activity in adipose tissue, it could be assessed from our observations that adipocyte SSAO plays a pivotal role in the increased glucose tolerance promoted by pharmacological doses of benzylamine (AU)

Sobrecarga oral de glucosa e identificación de pacientes con riesgo cardiovascular / Oral glucose tolerance test as an identification tool for patients with cardiovascular risk

La sobrecarga oral de glucosa (SOG) es una prueba habitual en los laboratorios clínicos. Determina el estado de diabetes o intolerancia a la glucosa. Pacientes con una SOG alterada, más uno de los dos criterios siguientes: perímetro de cintura patológico (..) (AU)

The oral glucose tolerance test (OGTT) is a standard test in clinical laboratories, in order to asses the status of diabetes or impaired glucose tolerance. Patients with pathological OGTT, plus one of the following two criteria, waist circumference pathological (..) (AU)

Hiperinsulinimso neonatal por nueva mutación del gen ABBCC8 con evolución hacia diabetes hipoinsulínica / Neonatal hyperinsulinism due to new mutation of ABCCS gene with evolution towards hypoinsulinemic diabetes

Recientemente se han descrito mutaciones activadoras de los genes ABCC8 y KCNJ11 causantes de hiperinsulinismo hipoglucémico seguido del desarrollo de una diabetes hipoinsulínica posterior. Se presenta un caso de hiperinsulinismo congénito neonatal por nueva mutación el gen ABCC8 con evolución hacia una diabetes hipoinsulínica al cabo de cuatro caos de evolución. Se trata de una recién nacida macrosómica afecta de hiperinsulinismo con una expresión clínica importante ya que inicialmente presentaba hipoglucemias e hiperinsulinemias severas con buena respuesta al diazóxido. Posteriormente fue estabilizándose la situación metabólica, llegando a retirarse la medicación sin apenas recaídas importantes. A continuación y coincidiendo con procesos infecciosos intercurrentes, se apreciaba tendencia a descender las glucemias sin llegar a presentar hipoglucemias e hiperinsulinemias francas y sin cetosis, que no respondieron a la medicación. Finalmente, a los cinco años de edad aparece una intolerancia a la glucosa con hiperglucemias postprandiales y una sobrecarga oral de glucosa patológica indicativa de una evolución a diabetes mellitus hipoinsulínica. Se detectó la mutación Thr1515Ala en heterocigosis en el exón 37 del gen ABCC8 responsable de la codificación de la proteína SUR1 que no hemos encontrado descrita en la literatura revisada. Se discute el posible mecanismo por la cual se pasa de un estado de hiperinsulinismo hipoglucémico a hipoinsulinismo o diabetes hipoinsulínica (AU)

The have been described recently activating mutations in ABCC8 and KCNJ11 genes that are related wyth hypoglycemic hyperinsulinism that subsequently change to hypoinsulinemic diabetes. We present a case of congenital neonatal hyperinsulinism caused by a new mutation in ABCC8 gene that changed to a hypoinsulinemic diabetes after 4 years of evolution. A macrosomic female newborn with severe hypoglycaemia and hyperinsulinemia with good response to diazoxide was followed in our Unit. Subsequently the patient remains compensated and the medication could be discontinued without symptoms of relapses of hypoglycaemia. Along the period of evolution and when the patient suffered intercurrent infectious episodes she showed tendency to present with low glycemia but without of documented hypoglycaemia, hyperinsulinemia or ketosis that did not respond to medication. When she was 5 years old the patient developed glucose intolerance with postprandial hyperglycaemia nad with an oral glucose tolerance curve compatible with hypoinsulinemic diabetes mellitus. Genetic analysis showed Thr1515Ala mutation in heterozygosis in exon 37 of the ABCC8 gene responsible of coding SUR1 protein that has not been previously described. The possible mechanisms involved in the modification of the clinical phenotype from an state of hyperinsulinemic hypoglicaemia to a state of hypoinsulinemia and diabetes are discussed (AU)