Control hospitalario de la diabetes y de la hiperglucemia: una auditoría en hospitales españoles / Inpatient management of diabetes and hyperglycemia: an audit of Spanish hospitals

Objetivos Evaluación de la calidad de la asistencia a los pacientes con diabetes mellitus ingresados en España. Métodos Estudio transversal que incluyó a 1.193 (26,7%) pacientes con diabetes tipo 2 o hiperglucemia de un total de 4.468 pacientes ingresados en los servicios de medicina interna de 53 hospitales (España). Se recogieron datos demográficos, adecuación de la monitorización de la glucemia capilar, tratamiento administrado durante el ingreso y terapia recomendada al alta. Resultados La edad mediana fue de 80 años (74-87), 561 (47%) pacientes eran mujeres, con un índice de Charlson de 4 (2-6) puntos, siendo clasificados frágiles 742 (65%). La mediana de glucemia al ingreso fue de 155 (119-213) mg/dL. Al tercer día de ingreso el número de glucemias capilares en objetivo (80-180mg/dL) fue de 792/1.126 (70,3%) en el predesayuno, 601/1.083 (55,4%) en la precomida, 591/1.073 (55,0%) en la precena y 317/529 (59,9%) durante la noche. Se observó hipoglucemia en 35 (0,9%) pacientes. El tratamiento durante el ingreso fue realizado con insulina en escala móvil en 352 (40,5%) pacientes, insulina basal y análogos de insulina rápida en 434 (50%) y dieta exclusivamente en 101 (9,1%). Un total de 735 (61,6%) pacientes disponían de un valor reciente de HbA1c. En el alta se incrementó el uso de iSGLT2 (30,1 vs. 21,6%; p<0,001) y el uso de insulina basal (25,3 vs. 10,1%; p<0,001). Conclusiones Existe un excesivo uso de insulina en escala móvil, una deficiente información de los valores de HbA1c y una prescripción aún deficiente de tratamientos con beneficio cardiovascular al alta (AU)

Objectives Evaluation of the 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 hyperglycemia out of 4468 patients admitted to the internal medicine departments of 53 hospitals in Spain. We collected demographic data, adequacy of capillary glycemic 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 155mg/dL (119-213). On the third day, the number of capillary blood glucose levels in target (80-180mg/dL) was pre-breakfast 792/1126 (70.3%), pre-lunch 601/1083 (55.4%), pre-dinner 591/1073 (55.0%) and night 317/529 (59.9%). A total of 35 patients (0.9%) were suffering from hypoglycemia. Treatment during hospitalization was performed with sliding scale insulin in 352 (40.5%) patients, with basal insulin and rapid insulin analogs in 434 (50%), or with diet exclusively in 101 (9.1%). A total of 735 (61.6%) patients had a recent HbA1c value. At the time of discharge, the use of iSGLT2 increased significantly (30.1% vs. 21.6%; p<0.001), as well as the use of basal insulin (25.3% vs. 10.1%; p<0.001). Conclusions There is an excessive use of insulin on a sliding scale as well as deficient information on HbA1c values and an even deficient prescription at the discharge of treatments with cardiovascular benefit (AU)

Identification of Drug-Related Problems (DRPS) of drugs with special dosage forms in geriatric patients (study at the outpatient pharmacy unit, Airlangga University Hospital, Surabaya)

Background: Geriatric syndrome is a condition of decreased organ function that causes DRPs, especially drugs with special dosage forms, such as an inhaler, insulin pens, and modified release drugs. Objective: To identify DRPs of drugs with special dosage forms in geriatric patients at the Outpatient Pharmacy Unit of RSUA Surabaya. Methods: It was an observational and prospective study with the interview method. Each problem identified was given a score to be analyzed descriptively and statistically. Data collection was carried out from April to June 2022. Results: The sample is 82 special dosage forms, there are drug delivery devices including inhaler (26%) and insulin pen (29%), and drug delivery systems including OROS (33%), retard (6%), and sustained-release (6%). DRPs were found in 40% of them. In inhaler form, the DRPs of DPI are failure to load the dose, shaking after the dose was loaded, and not checking the remaining dose after using the device. While in MDI, no DRPs were found. The DRPs of insulin pens are errors in device storage (25%), injection position (8%), and repeated use of blunt/broken needles (38%). While in modified release drugs is an error in drug storage (5%). The percentages of nonadherence are Turbuhaler 33%, Breezhaler 60%, Diskus 25%, MDI 0%, insulin pen 29%, and modified release drugs 24%. The solution is given by using verbal education such as leaflets. Statistical analysis showed a significant difference in the insulin pen and the modified release drug, while there was no significant difference in the inhaler. Conclusion: Each type of drug with a special dosage form has its problems and problem-solving in the form of interventions has not given maximum results. (AU)

Glycaemic and insulinaemic impact of a diabetes-specific oral nutritional supplement with extra-virgin olive oil in patients with type 2 diabetes mellitus at nutritional risk: a randomized, double-blind, crossover, multicentre clinical trial (DiACARE) / Impacto glucémico e insulinémico de un suplemento nutricional oral con AOVE específico para diabetes en pacientes en riesgo nutricional y con diabetes mellitus tipo 2: ensayo clínico, aleatorizado, doble ciego, cruzado y multicéntrico (DIACARE)

Introduction: there is controversy about the usefulness of specific enteral nutrition formulas in malnourished patients with diabetes. The effects on blood glucose and other aspects of metabolic control are not fully understood in the scientific literature. Objective: the aim of the study was to compare the glycaemic and insulinaemic response of patients with type 2 diabetes at risk of malnutrition after oral feed between a diabetes-specific formula with AOVE (DSF) and a standard one (STF). Methods: A randomized, double-blind, crossover, multicentre clinical trial was conducted in patients with type 2 diabetes at risk of malnutrition (SGA). The patients were randomized to receive either DSF or STF, a week apart. A glycaemia and insulinaemia curve was made at times 0 minutes, 30 min, 60 min, 90 min, 120 min, and 180 min after the patients drank 200 ml of the oral nutritional supplement (ONS). The principal variables were the area under the curve (AUC0-t) of glucose and insulin. Results: 29 patients (51 % women) were included, who were on average 68.84 (SD 11.37) years old. Regarding the degree of malnutrition, 86.2 % presented moderate malnutrition (B) and 13.8 % severe (C). When the patients received the DSF, they had a lower mean of glucose AUC0-t (-3,325.34 mg/min/dl [95 % CI: -4,3608.34 to -2,290.07]; p = 0.016) and also a lower mean of insulin AUC0-t (-451.14 uU/min/ml [95 % CI: -875,10 to -27.17]; p = 0.038). There were no differences in the degree of malnutrition. Conclusion: compared with STF, DSF with AOVE showed a better glycaemic and insulinaemic response in patients with type 2 diabetes at risk of malnutrition.(AU)

Introducción: la utilidad de las fórmulas específicas de nutrición enteral en el paciente desnutrido con diabetes resulta controvertida. Sus efectossobre la glucosa en sangre y otros aspectos del control metabólico no se conocen del todo en la literatura científica.Objetivo: el objetivo del estudio fue comparar la respuesta glucémica e insulinémica de los pacientes con diabetes de tipo 2 (DM2) en riesgode desnutrición tras la ingesta oral de una fórmula específica para diabetes (DSF) con aceite de oliva virgen extra (AOVE) y una estándar (STF).Métodos: ensayo clínico aleatorizado, doble ciego, cruzado y multicéntrico enpacientes con DM2 en riesgo de desnutrición (SGA). Los pacientes seasignaron aleatoriamente para recibir DSF o STF con una semana de diferencia. Se realizó una curva de glucemia e insulinemia en los siguientestiempos: 0 minutos, 30 min, 60 min, 90 min, 120 min y 180 min tras la ingesta de 200 ml del suplemento nutricional oral (SNO). Las variablesprincipales fueron el área bajo la curva (AUC0-t) de glucosa e insulina.Resultados: se incluyeron 29 pacientes (51 % mujeres), con una edad media de 68,84 años (DE 11,37). En cuanto al grado de desnutrición,el 86,2 % presentaba desnutrición moderada (B) y el 13,8 %, severa (C). Cuando los pacientes recibieron DSF tuvieron una media más bajade AUC0-t de glucosa (-3325,34 mg/min/dl [IC 95 %: de -4.3608,34 a -2.290,07]; p = 0,016) y también una media más baja de AUC0-t deinsulina (-451,14 μU/min/ml [IC 95 %: de -875,10 a -27,17]; p = 0,038) respecto a cuando recibieron STF. No hubo diferencias por el gradode desnutrición.Conclusión: la fórmula con AOVE específica para diabetes mostró una mejor respuesta glucémica e insulinémica en pacientes con diabetes detipo 2 en riesgo de desnutrición respecto a una fórmula estándar.(AU)

Glucometrics in the first week of critical illness and its association with mortality / Glucometría en la primera semana de enfermedad crítica y su asociación con la mortalidad

Objective Evaluation of glucometrics in the first week of ICU stay and its association with outcomes. Design Prospective observational study. Setting Mixed ICU of teaching hospital. Patients Adults initiated on insulin infusion for 2 consecutive blood glucose (BG) readings ≥180mg/dL. Main variables of interest Glucometrics calculated from the BG of first week of admission: hyperglycemia (BG>180mg/dL) and hypoglycemia (BG<70mg/dL) episodes; median, standard deviation (SD) and coefficient of variation (CV) of BG, glycemic lability index (GLI), time in target BG range (TIR). Factors influencing glucometrics and the association of glucometrics to patient outcomes analyzed. Results A total of 5762 BG measurements in 100 patients of median age 55 years included. Glucometrics: hyperglycemia: 2253 (39%), hypoglycemia: 28 (0.48%), median BG: 169mg/dL (162–178.75), SD 31mg/dL (26–38.75), CV 18.6% (17.1–22.5), GLI: 718.5 [(mg/dL)2/h]/week (540.5–1131.5) and TIR 57% (50–67). Diabetes and higher APACHE II score were associated with higher SD and CV, and lower TIR. On multivariate regression, diabetes (p=0.009) and APACHE II score (p=0.016) were independently associated with higher SD. Higher SD and CV were associated with less vasopressor-free days; lower TIR with more blood-stream infections (BSI). Patients with higher SD, CV and GLI had a higher 28-day mortality. On multivariate analysis, GLI alone was associated with a higher mortality (OR 2.99, p=0.04). Conclusions Glycemic lability in the first week in ICU patients receiving insulin infusion is associated with higher mortality. Lower TIR is associated with more blood stream infections (AU)

Objetivo Evaluación de la glucometría en la primera semana de estancia en la UCI y su asociación con los resultados. Diseño Estudio observacional prospectivo. Ámbito UCI mixta de hospital docente. Pacientes Adultos que iniciaron una infusión de insulina para dos lecturas consecutivas de glucosa en sangre (GS) ≥180mg/dl. Principales variables de interés Glucometría calculada a partir de la GS de la primera semana de ingreso: episodios de hiperglucemia (GS >180mg/dl) e hipoglucemia (GS <70mg/dl); mediana, desviación estándar (DE) y coeficiente de variación (CV) de GS, índice de labilidad glucémica (ILG), tiempo en el rango objetivo de GS (TIR). Resultados Se incluyeron un total de 5.762 GS en 100 pacientes con una mediana de edad de 55años. Glucometría: hiperglucemia: 2.253 (39%), hipoglucemia: 28 (0,48%), mediana GS: 169mg/dl, DE 31mg/dl, CV 18,6%, ILG: 718,5 [(mg/dl)2/h]/semana, TIR 57%. La diabetes y una puntuación APACHEII más alta se asociaron con una DE y un CV más altos y una TIR más baja. En la regresión multivariada, la diabetes (p=0,009) y la puntuación APACHEII (p=0,016) se asociaron de forma independiente con una DE más alta. La DE y el CV más altos se asociaron con menos días sin vasopresores; menor TIR, con más infecciones del torrente sanguíneo (ITS). En el análisis multivariado, el ILG solo se asoció con una mayor mortalidad (OR: 2,99, p=0,04). Conclusiones La labilidad glucémica en la primera semana en pacientes de UCI que reciben infusión de insulina se asocia con mayor mortalidad. Una TIR más baja se asocia con más ITS (AU)

Despite similar clinical features metabolomics reveals distinct signatures in insulin resistant and progressively obese minipigs

Obesity is a major contributor to the silent and progressive development of type 2 diabetes (T2D) whose prevention could be improved if individuals at risk were identified earlier. Our aim is to identify early phenotypes that precede T2D in diet-induced obese minipigs. We fed four groups of minipigs (n = 5–10) either normal-fat or high-fat high-sugar diet during 2, 4, or 6 months. Morphometric features were recorded, and metabolomics and clinical parameters were assessed on fasting plasma samples. Multivariate statistical analysis on 46 morphometrical and clinical parameters allowed to differentiate 4 distinct phenotypes: NFC (control group) and three others (HF2M, HF4M, HF6M) corresponding to the different stages of the obesity progression. Compared to NFC, we observed a rapid progression of body weight and fat mass (4-, 7-, and tenfold) in obese phenotypes. Insulin resistance (IR; 2.5-fold increase of HOMA-IR) and mild dyslipidemia (1.2- and twofold increase in total cholesterol and HDL) were already present in the HF2M and remained stable in HF4M and HF6M. Plasma metabolome revealed subtle changes of 23 metabolites among the obese groups, including a progressive switch in energy metabolism from amino acids to lipids, and a transient increase in de novo lipogenesis and TCA-related metabolites in HF2M. Low anti-oxidative capacities and anti-inflammatory response metabolites were found in the HF4M, and a perturbed hexose metabolism was observed in HF6M. Overall, we show that IR and progressively obese minipigs reveal phenotype-specific metabolomic signatures for which some of the identified metabolites could be considered as potential biomarkers of early progression to TD2. (AU)

The anxiolytic drug opipramol inhibits insulin-induced lipogenesis in fat cells and insulin secretion in pancreatic islets

The antidepressant drug opipramol has been reported to exert antilipolytic effect in human adipocytes, suggesting that alongside its neuropharmacological properties, this agent might modulate lipid utilization by peripheral tissues. However, patients treated for depression or anxiety disorders by this tricyclic compound do not exhibit the body weight gain or the glucose tolerance alterations observed with various other antidepressant or antipsychotic agents such as amitriptyline and olanzapine, respectively. To examine whether opipramol reproduces or impairs other actions of insulin, its direct effects on glucose transport, lipogenesis and lipolysis were investigated in adipocytes while its influence on insulin secretion was studied in pancreatic islets. In mouse and rat adipocytes, opipramol did not activate triglyceride breakdown, but partially inhibited the lipolytic action of isoprenaline or forskolin, especially in the 10–100 μM range. At 100 μM, opipramol also inhibited the glucose incorporation into lipids without limiting the glucose transport in mouse adipocytes. In pancreatic islets, opipramol acutely impaired the stimulation of insulin secretion by various activators (high glucose, high potassium, forskolin...). Similar inhibitory effects were observed in mouse and rat pancreatic islets and were reproduced with 100 μM haloperidol, in a manner that was independent from alpha2-adrenoceptor activation but sensitive to Ca2+ release. All these results indicated that the anxiolytic drug opipramol is not only active in central nervous system but also in multiple peripheral tissues and endocrine organs. Due to its capacity to modulate the lipid and carbohydrate metabolisms, opipramol deserves further studies in order to explore its therapeutic potential for the treatment of obese and diabetic states. (AU)

Aerobic exercise and insulin resistance indicators in sedentary woman / Ejercicio aeróbico e indicadores de resistencia a la insulina en sedentarios mujer

The aim of this study is to determine the concordance between the insulin resistance indicators, HOMA and TyG, because ofa moderate intensity aerobic exercise session in sedentary young women. Methods: A total of 22 sedentary women between 18 and 35 years of age participated in this research. HOMA and TyG indiceswere determined before and after a moderate intensity aerobic exercise (MIAE), based on Heart Rate reserve. Spearman andKendall’s Tau-b were used to evaluate the association between those variables. Values were compared using the Bland &Altman graphs: Kappa Coefficient was used to estimate the proportion of concordance observed between both indicators. Significant differences were considered at a p≤0.01.Results: Spearman's Rho correlation and Kendall's Tau-b before MIAE were significant and direct (r=0.634, p<0.001 andr=0.480, p<0.01; respectively) with a Cohen's Kappa index of k=0.585. After MIAE, Spearman's Rho correlation and Kendall'sTau-b were also significant and direct r=0.650, p<0.001 and r=0.504, p<0.001, respectively, with a lower Cohen's Kappa index(k=0.390). Conclusions: TyG index is a good indicator to evaluate insulin resistance at baseline situations. However, this index doesn’tproperly determine insulin resistance after a MIAE.(AU)

Más allá de la hiperglucemia: la variabilidad glucémica como factor pronóstico en el infarto cerebral agudo / Beyond hyperglycemia: glycaemic variability as a prognostic factor after acute ischemic stroke

Introducción: La variabilidad glucémica (VG) hace referencia a las oscilaciones en los niveles de glucosa en sangre y podría influir en el pronóstico del ictus. Objetivo: Analizar el efecto de la VG en la evolución del infarto cerebral agudo (IC).MétodosAnálisis exploratorio del estudio GLIAS-II (multicéntrico, prospectivo y observacional). Se midieron los niveles de glucemia capilar cada cuatro horas durante las primeras 48 horas y la VG se definió como la desviación estándar de los valores medios. Variables principales: mortalidad y muerte o dependencia a los tres meses. Variables secundarias: porcentaje de complicaciones intrahospitalarias y de recurrencia de ictus, e influencia de la vía de administración de insulina sobre la VG.ResultadosSe incluyeron 213 pacientes. Los pacientes que fallecieron (N = 16;7,8%) presentaron mayores valores de VG (30,9 mg/dL vs. 23,3 mg/dL; p = 0,05). En el análisis de regresión logística ajustado por edad y comorbilidad, tanto la VG (OR = 1,03; IC del 95%: 1,003-1,06: p = 0,03) como la gravedad del IC (OR = 1,12; IC del 95%: 1,04-1,2; p = 0,004) se asociaron de forma independiente con la mortalidad a los tres meses. No se encontró asociación entre la VG y las demás variables de estudio. Los pacientes que recibieron tratamiento con insulina subcutánea mostraron una mayor VG que los tratados con insulina intravenosa (38,9 mg/dL vs. 21,3 mg/dL; p < 0,001).ConclusionesValores elevados de VG durante las primeras 48 horas tras el IC se asociaron de forma independiente con la mortalidad. La administración subcutánea de insulina podría condicionar una mayor VG que la vía intravenosa. (AU)

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.MethodsWe 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.ResultsA 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).ConclusionsHigh 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. (AU)

Efectividad de la insulina tópica en el tratamiento de patologías de la superficie corneal / Effectiveness of topical insulin for the treatment of surface corneal pathologies

El propósito es identificar a través de una revisión sistemática de la literatura, la evidencia actual frente a la eficacia del tratamiento de la insulina tópica en patologías de la superficie ocular. Se implementó una búsqueda de literatura en bases de datos de indexación médica Medline (Pubmed), Embase y Web Of Science a través de palabras claves como «insulin» AND «córnea» OR «corneal» OR «dry eye» artículos publicados en inglés o español en los últimos once años (2011-2022). Se identificaron nueve artículos con 180 participantes provenientes de Estados Unidos, España, Irlanda, Canadá, Portugal y Malasia, con defectos epiteliales persistentes refractarios y secundarios a vitrectomía, cuya extensión de la lesión fue de 3,75 mm2 hasta 65,47 mm2. La preparación fue disuelta con lágrimas artificiales y la concentración de insulina fue desde 1 UI/ml hasta 100 UI/ml. En todos los casos la resolución del cuadro clínico fue completa con un tiempo de curación desde 2,5 días hasta 60,9 días siendo este último un caso secundario a una quemadura por cáusticos de difícil control. La insulina tópica ha sido efectiva para el tratamiento de defectos epiteliales persistentes; la de acción intermedia y en bajas concentraciones demostró menor tiempo de resolución, en úlceras neurotróficas y secundarias a vitrectomías (AU)

The purpose is to identify, through a systematic literature review, the current evidence regarding the effectiveness of topical insulin treatment in ocular surface pathologies. A literature search was implemented in Medline (Pubmed), Embase and Web Of Science medical indexing databases by using keywords such as “insulin” AND “cornea” OR “corneal” OR “dry eye” in published papers in English or Spanish within the last eleven years (2011-2022). Nine papers were identified with 180 participants from the United States, Spain, Ireland, Canada, Portugal and Malaysia, with persistent refractory epithelial defects and secondary to vitrectomy, whose extension of the lesion was from 3.75 mm2 to 65.47 mm2. The preparation was dissolved with artificial tears and the insulin concentration ranged from 1 IU/ml to 100 IU/ml. In all cases, the resolution of the clinical picture was complete with a healing time from 2.5 days to 60.9 days, the latter being a secondary case to a difficult-to-control caustic burn. Topical insulin has been effective for the treatment of persistent epithelial defects. The intermediate action and low concentrations showed a shorter resolution time in neurotrophic ulcers and induced during vitreoretinal surgery (AU)

Responsabilidades de autocuidado acordes a la edad en población pediátrica con diabetes tratada con ISCI / Age-appropriate self-care responsibilities in the pediatric population with diabetes treated with CSII

Objetivo: Determinar en población infantil con Diabetes tipo 1 (DT1) en tratamiento con infusión subcutánea continua de insulina (ISCI), si asumir responsabilidades de autocuidado tras recibir un programa estructurado de educación terapéutica (PEET) se relaciona con el control metabólico y la calidad de vida (CV). Métodos: Estudio observacional, transversal. Se realizó un sub-análisis retrospectivo. Se incluyeron sujetos con DT1 (edad 9-17 años) en terapia ISCI (>1año) que habían recibido el mismo PEET al inicio de ISCI. Se registraron: grado en que asumían responsabilidades de autocuidado acordes a su edad, control metabólico, CV, nivel de conocimientos sobre diabetes y uso de funciones específicas del dispositivo. Resultados: Se incluyeron 44 pacientes. Los niños que asumieron responsabilidades de autocuidado acordes a su edad presentaron valores de hemoglobina glicada (HbA1c) significativamente menores que los niños que no las asumieron (8,0±0,7% vs. 9,2±1,1%, respectivamente, p<0,001), así como una mayor puntuación en los cuestionarios de CV y de conocimientos (CV 84,3±9,3 vs. 79,4±10,6, p<0,01; conocimientos 27,9±4,2 vs. 26,5±4,3, respectivamente, n.s). El uso de las funciones específicas de la bomba se observó principalmente en aquellos que asumieron esas responsabilidades de autocuidado presentando valores más bajos de HbA1c que aquellos niños que no las utilizaron (7,9±1,0% vs. 8,4±0,8%, p<0,05). Conclusiones: Los pacientes con DT1 en tratamiento con ISCI que asumieron responsabilidades de autocuidado de su diabetes acorde a su edad, mostraron mejor control de HbA1c y mejor CV que aquellos que no lo hicieron. Se necesitan más estudios para profundizar en el conocimiento de estos aspectos. (AU)

Objective: The aim of this study was to determine if children and adolescents with type 1 diabetes (DT1) managed with continuous subcutaneous insulin infusion (ISCI) who assume self-care responsibilities tailored to the age after a specific structured education program (PEET), present better metabolic control and quality of life (CV). Methods: A observational, cross-sectional study was conducted. A retrospective sub-analysis was performed. Subjects with DT1 (aged 9-17 years) who have been using ISCI (>1year) were included. All patients received the same structured PEET when initiating ISCI treatment. The degree of self-care age-appropriate responsibilities assumed by children was registered. Data related to metabolic control, diabetes knowledge, use of different pump features, and quality of life were also collected. Results: Forty-four patients were included. Children assuming age-appropriate self-care responsibilities had a significantly lower glycated hemoglobin (HbA1c) value compared to those children who did not take on these responsibilities (8,0±0,7% vs. 9,2±1,1%, p<0,001). as well as higher scores in the CV and knowledge questionnaires (84,3±9,3 vs. 79,4±10,6 respectively, p<0,01; knowledge 27,9±4,2 vs. 26,5±4,3, respectively, n.s). The use of specific pump features was mainly observed in those who assumed age-appropriate self-care responsibilities and showed lower HbA1c values than those children who did not take on these responsibilities (7,9±1,0% vs. 8,4±0,8%, p<0,05). Conclusion: Patients with DT1 managed with ISCI, who assumed age-appropriate responsibilities on disease self- management, showed better HbAc1 and better CV than those who did not. More studies are needed to deepen the knowledge of these topics. (AU)

Efecto de una dieta de bajo índice glucémico en mujeres obesas con hiperinsulinemia / Effect of a low glycemic index diet in obese women with hyperinsulinemia

Introducción: La obesidad en los últimos años ha incrementado su prevalencia a nivel nacional e internacional. Las dietas bajas en índice glicémico disminuyen el peso y regula los niveles de insulina en pacientes obesos.Objetivos: Determinar el efecto de una dieta de bajo índice glicémico en mujeres obesas con hiperinsulinemia.Métodos: Estudio analítico, comparativo y longitudinal. El muestreo fue no probabilístico de 102 mujeres; 42 pacientes con dieta normocalórica de 2000 calorías y 60 pacientes con dieta de bajo índice glicémico de 1300-1500 calorías, durante 4 meses. Se calculó el índice de masa corporal (IMC), peso, la circunferencia abdominal valores < 88cm, los triglicéridos <150 mg/dL en ayunas con estuches de reactivos colorimétricos de Trinder y la insulina plasmática basal entre 6-27 uUI/ml. Se realizó la prueba t de Student para las variables peso, circunferencia abdominal e IMC y la prueba de Signos de Wilcoxon, para la variable insulina y triglicéridos.Resultados: En ambas dietas hubo un efecto significativo de pérdida de peso (Δ-1,20; Δ-5,56), IMC (Δ-0,96; Δ-2,29) y circunferencia abdominal (Δ-4,88, Δ-5,03) (p<0,001). Los triglicéridos redujeron sus valores (Δ-5,76; Δ-14) pero no fue significativo en ninguna de las dietas y la dieta con bajo índice glicémico presentó una mejor reducción de la insulina (Δ-1.54) (p<0,001).Conclusiones: Ambas dietas reducen los indicadores antropométricos, la dieta de bajo índice glicémico tuvo un mejor efecto en reducir los niveles de insulina y ninguna de las dietas fue efectivas en la reducción de triglicéridos.(AU)

Introduction: Obesity in recent years has increased itsprevalence nationally and internationally. Low glycemic indexdiets decrease weight and regulate insulin levels in obese pa-tients.Objectives: To determine the effect of a low glycemic in-dex diet in obese women with hyperinsulinemia.Methods: Descriptive, comparative, longitudinal study.The sampling was non-probabilistic of 102 women; 42 patients with a normocaloric diet of 2000 calories and 60 pa-tients with a low glycemic index diet of 1300-1500 caloriesand was conducted for fourth months. Weight was meas-ured, body mass index (BMI) is calculated and waist circum-ference (<82 cm), triglycerides (<150 mg/dL), and basalplasma insulin (5-25 uU/ml) were measured. Student’s t-testwas performed for paired samples on the variables weight,waist circumference, and BMI to compare the effect of a lowglycemic and normocaloric diet before and after treatment.For the variable insulin and triglycerides, the Wilcoxon Signstest is applied.Results: In both diets there was a significant effect ofweight loss (Δ-1,20 kg; Δ-5,56 kg), BMI (Δ-0,96 kg/m2; Δ-2,29 kg/m2) and abdominal circumference (Δ-4,88 cm; Δ-5,03 cm)(p<0,001). Triglycerides decreased their values (Δ-5,76 mg/dL; Δ-14 mg/dL) but it was not significant in anyof the diets and the low glycemic index diet presented a bet-ter insulin reduction (Δ-1,64 uU/ml) (p<0,001).Conclusions: Both diets reduced anthropometric indica-tors, the low glycemic index diet had a better effect in reduc-ing insulin levels and none of the diets was effective in re-ducing triglycerides.(AU)

Factores nutricionales relacionados con la resistencia a la insulina en escolares y adolescentes

La resistencia a la insulina se explica como un defecto en la unión de la insulina con su receptor y está asociada con numerosas enfermedades,como la obesidad o la diabetes tipo 2, entre otras. La resistencia a la insulina se ha relacionado con la deficiencia de vitaminas y minerales,especialmente de aquellos involucrados en el estrés oxidativo. La dieta mediterránea, una dieta basada en el Healthy Eating Index o la dietaDietary Approaches to Stop Hypertension (DASH) son patrones dietéticos que se han asociado con un menor riesgo de presentar resistencia a lainsulina en edad infantil. Por tanto, una dieta rica en vitaminas y minerales antioxidantes, fibra, calcio y ácidos grasos poliinsaturados y baja enazucares libres, sodio y ácidos grasos saturados puede disminuir el riesgo de presentar resistencia a la insulina en este grupo de edad. Además,otros factores nutricionales, como evitar la comida rápida, cenar en familia, no comer mientras se ve la televisión o el consumo regular de undesayuno suficiente y saludable son hábitos que parecen estar relacionados con menor riesgo de presentar resistencia a la insulina. Por tanto,es importante establecer hábitos alimentarios diarios equilibrados para prevenir y tratar la resistencia a la insulina en escolares y adolescentes. (AU)

Insulin resistance is described as a defect in the binding of insulin to its receptor and is associated with several diseases, including obesity andtype 2 diabetes. Insulin resistance has been linked to vitamin and mineral deficiencies, especially those involved in oxidative stress. The Mediterranean diet, a diet based on the Healthy Eating Index or the Dietary Approaches to Stop Hypertension (DASH) diet are dietary patterns that havebeen associated with a lower risk of developing insulin resistance in children. Therefore, a diet rich in antioxidant vitamins and minerals, fiber,calcium, and polyunsaturated fatty acids and low in free sugars, sodium and saturated fatty acids may decrease the risk of insulin resistancein this age group. In addition, other nutritional factors, such as avoiding fast food, eating dinner with the family, not eating while watching TV oreating a sufficient and healthy breakfast on a regular basis seem to be associated with a lower risk of insulin resistance. Therefore, it is importantto establish balanced daily eating habits to prevent and treat insulin resistance in schoolchildren and adolescents. (AU)

Estabilidad del colirio de insulina para el tratamiento de úlceras corneales refractarias / Stability of insulin eye drops in the treatment of refractory corneal ulcers

Objetivo: Determinar y comparar la estabilidad físico-química y microbiológica de dos colirios de insulina 25 UI/ml elaborados con suerofisiológico o balanced salt solution bajo diferentes condiciones de conservación durante 120 días.Método: Los colirios se elaboraron por triplicado con insulina Actrapid®100 Ul/ml y balanced salt solution o suero fisiológico como vehículo, yfueron conservados a temperatura ambiente (25 °C), en nevera (2-8 °C)o congelador (–20 °C) durante 120 días. Se determinó la concentraciónde insulina mediante cromatografía liquida de ultra alta resolución, laosmolalidad y el pH a días 0, 3, 7, 15, 30, 60, 90 y 120. Asimismo, seextrajeron muestras para estudios microbiológicos en los días 0, 15, 30,60, 90 y 120.Resultados: La formulación elaborada con suero fisiológico mantuvola concentración de insulina por encima del 90% con respecto a la inicialtras 120 días de estudio en todas las condiciones de temperatura. En elcaso del colirio elaborado con balanced salt solution, la concentraciónse mantuvo estable en ambiente y congelador tras 120 días, aunque ennevera descendió por debajo del 90% a día 90 de estudio. Los valoresde osmolalidad y pH se mantuvieron constantes en ambas formulacionesy condiciones de conservación. No se observó crecimiento microbiológico en ninguna de las muestras retiradas.Conclusiones: El colirio de insulina 25 UI/ml elaborado con suerofisiológico es estable 120 días, conservado tanto a temperatura ambientecomo en nevera o congelador, protegido de la luz. Con balanced saltsolution permanece estable 120 días a temperatura ambiente y congelador, reduciéndose el periodo de validez a 90 días en el caso de laconservación en nevera. (AU)

Objective: To determine and compare the physicochemical and microbiological stability of two 25 IU/mL insulin eye drop formulations madewith normal saline and a balanced salt solution, respectively, stored for120 days under various conditions.Method: Eye drops were compounded in triplicate with 100 IU/mLActrapid® insulin and either normal saline or a balanced salt solution asvehicles, and they were stored alternatively at room temperature (25 °C),in a refrigerator (2-8 °C) or in a freezer (–20 °C) for 120 days. Insulinconcentrations were determined by ultra-high resolution liquid chromatography, and osmolality and pH values were measured at days 0, 3, 7,15, 30, 60, 90 and 120. Likewise, samples were extracted for microbiological studies on days 0, 30, 60, 90 and 120.Results: The formulation made with normal saline maintained insulinconcentrations above 90% of the baseline level after 120 days acrossall temperature conditions. In the case of the balanced salt solution-basedeye drops, insulin concentration when stored at room temperature or inthe freezer remained stable after 120 days, although insulin concentrationwhen stored in the refrigerator fell below 90% on day 90 of the study.Osmolality and pH values remained constant in both formulations andacross all storage conditions. No microbiological growth was observedin any of the samples. Conclusions: 25 IU/mL insulin eye drops made with normal salineremain stable for 120 days whether they are stored at room temperature,in a refrigerator or in a freezer, provided that they are protected fromlight. When made with a balanced salt solution, they remain stable for120 days at room temperature and in a freezer, their shelf life being reduced to 90 days in the case of storage in a refrigerator. (AU)

Efectos en vida real de la adición de semaglutida subcutánea semanal al tratamiento con insulina en diabetes mellitus tipo 2 / Real-life effects of adding weekly subcutaneous semaglutide to insulin for the treatment of type 2 diabetes mellitus

Objetivos: Determinar en la vida real los beneficios antropométricos y analíticos de la adición de semaglutida por vía subcutánea al tratamiento previo con insulina en pacientes con diabetes tipo 2.Métodos: Estudio descriptivo, retrospectivo y abierto en el que se describen características clínicas y antropométricas de 117 pacientes diagnosticados de diabetes tipo 2 seguidos en las consultas externas de Endocrinología y Nutrición del Hospital Universitario Central de Asturias a lo largo de 53 semanas tras el inicio de tratamiento con semaglutida subcutánea (octubre-diciembre 2019). Todos los pacientes estaban en tratamiento previo con insulina, con o sin antidiabéticos orales.Resultados: De los 117 pacientes iniciales, 17 no completaron el estudio debido a efectos adversos (náuseas, vómitos), decisión clínica y pérdida de seguimiento.A los 12 meses (semana 53) del inicio de la semaglutida se obtuvo un descenso de HbA1c de 0,74% (IC 95% 0,59-1,14, p<0,05), así como de 3,61kg de peso (IC 95% 2,30-4,92, p<0,05), y de 15,88 UI de insulina total (IC 95% 10,98-20,74, p<0,05) respecto a las cifras basales. En pacientes sin análogo del receptor de GLP-1 (arGLP-1) previo, el efecto en la disminución de HbA1c, el peso y la dosis total de insulina fue estadísticamente significativo; sin embargo, los pacientes pretratados con arGLP-1 solo tuvieron mejoría en la reducción de peso. No se observaron eventos adversos graves.Conclusiones: La adición de semaglutida subcutánea al tratamiento previo con insulina con o sin antidiabéticos orales induce una disminución de HbA1c, peso y dosis de insulina de forma segura. Este efecto es mayor en pacientes naïve para tratamiento con arGLP-1. (AU)

Objectives: This work aims to determine the real-life anthropometric and analytical benefits of adding subcutaneous semaglutide to previous insulin treatment in patients with type 2 diabetes.Methods: This is a descriptive, retrospective, open-label study describing the clinical and anthropometric characteristics of 117 patients diagnosed with type 2 diabetes followed-up on in the Endocrinology and Nutrition outpatient clinic of the Hospital Universitario Central de Asturias for 53 weeks after starting treatment with subcutaneous semaglutide (October-December 2019). All patients were on previous insulin treatment with or without oral antidiabetics.Results: Of the 117 initial patients, 17 did not complete the study due to adverse effects (nausea, vomiting), the physician's decision, or loss to follow-up.Twelve months (week 53) after starting semaglutide, there was a decrease in HbA1c of 0.74% (95% CI 0.59-1.14, p<0.05) as well as 3.61kg of weight loss (95% CI 2.30-4.92, p<0.05) and a decline in total insulin of 15.88 IU (95% CI 10.98-20.74, p<0.05) from baseline figures. In patients without prior GLP-1 receptor analogs (GLP-1ra), the effect in terms of a reduction in HbA1c, weight, and the total insulin dose was statistically significant. However, in patients pre-treated with GLP-1ra only had improvements in terms of weight loss. No serious adverse events were observed.Conclusions: The addition of subcutaneous semaglutide to prior insulin treatment with or without oral antidiabetics safely led to a decrease in HbA1c, weight, and the insulin dose. This effect is greater in GLP-1ra naive patients. (AU)

Anti-diabetic effects of Inonotus obliquus extract in high fat diet combined streptozotocin-induced type 2 diabetic mice / Efectos antidiabéticos del extracto de Inonotus obliquus en ratones diabéticos tipo 2 inducidos por estreptozotocina combinada con una dieta rica en grasas

Introduction: type 2 diabetes (T2DM) is a complex disease affected by lifestyle and genetic factors. Although the drugs currently used to treat T2DM have certain curative effects, they still have some adverse side effects. Therefore, it is urgent to find new effective drugs with few side effects to cure T2DM. Objective: to study the role of Inonotus obliquus (IO) in diabetic model mice. Methods: we used high-fat diet (HFD) combined with streptozocin (STZ) to establish a diabetic mouse model. Mice were divided into non-high-fat diet group (ND), diabetes model group (HFD + STZ) and IO-treated diabetes model group (IO). The mice in the IO group were orally treated with IO (150 mg/kg) at 10 ml/kg for five weeks. Body weight, glucose level, food intake and water consumption, glucose tolerance and insulin tolerance were evaluated in all mice. The pathological sections of liver, kidney and pancreas were observed by hematoxylin-eosin staining. Results: after IO administration, the blood glucose level, water consumption, low-density lipoprotein (LDL) and triacylglycerol (TG) levels of mice decreased. Compared with the HFD + STZ group, the number of normal islet iiiiiiii cells increased and focal necrosis of the liver was significantly reduced in the IO administration group. Conclusions: IO reduced the levels of blood glucose, restored body weight, and enhanced insulin sensitivity along with insulin tolerance and glucose tolerance in diabetic mice. Additionally, IO also reversed HFD and STZ-induced organ injury. (AU)

Introducción: la diabetes mellitus tipo 2 (T2DM) es una enfermedad compleja influenciada por el estilo de vida y los factores genéticos. En la actualidad, aunque los medicamentos para la diabetes tipo 2 tienen cierto efecto curativo, todavía tienen algunos efectos secundarios. Por lo tanto, es urgente encontrar nuevos medicamentos para la diabetes tipo 2 que tengan un buen efecto curativo y menos efectos secundarios. Objetivo: estudiar el papel del Inonotus obliquus (IO) en ratones diabéticos. Métodos: se estableció un modelo de ratón diabético con dieta de alto contenido en grasas (HFD) y estreptozocina (STZ). Los ratones se dividieron en el grupo de dieta no alta en grasas (ND), el grupo modelo de diabetes mellitus (HFD + STZ) y el grupo modelo de diabetes mellitus tratado con IO. Los ratones del grupo IO recibieron 10 ml/kg de IO (150 mg/kg) durante cinco semanas. Se observaron el peso corporal, el nivel de azúcar en sangre, la ingesta de alimentos, la ingesta de agua potable, la tolerancia a la glucosa y la tolerancia a la insulina de los ratones de cada grupo, y se estudiaron muestras de biopsias hepáticas, renales y pancreáticas mediante tinción de hematoxilina eosina. Resultados: los niveles de glucosa en sangre, el consumo de agua, la lipoproteína de baja densidad (LDL) y los triglicéridos (TG) disminuyeron después de la administración de IO. En comparación con el grupo HFD+STZ, el número de células β pancreáticas normales y la necrosis focal hepática disminuyeron significativamente en el grupo IO. Conclusiones: el IO redujo el nivel de glucosa en sangre, ayudó a recuperar el peso corporal y mejorar la sensibilidad a la insulina, la tolerancia a la insulina y la tolerancia a la glucosa en ratones diabéticos. Además, el IO revirtió el daño orgánico inducido por HFD y STZ. (AU)

Restrained, emotional eating and depression can be a risk factor for metabolic syndrome / La alimentación emocional y restrictiva, junto con la depresión, pueden ser un factor de riesgo para el síndrome metabólico

Introduction: metabolic syndrome (MetS) can have a bidirectional effect on emotional and restrained eating. Objectives: our aims are to find interrelations between MetS and emotional eating, restrained eating, additionally with depression. Methods: cross-sectional study. Participants aged between 18 and 63, and mostly were obese (n = 200). Eating Attitudes Test (EAT-26), Beck Depression Inventory (BDI) and Dutch Eating Behavior Questionnaire (DEBQ) were used to find associations between eating patterns and metabolic syndrome. Results: our study ensured evidences for physiological relations between restrained and emotional eating with MetS. Biochemical parameters showed that restrained eaters were less insulin resistant and participants with MetS had higher emotional eating and lower restrained eating. Besides, restrained eaters had lower triglyceride, homeostasis model assessment-insulin resistance (HOMA-IR), fasting insulin, blood glucose, and higher high-density lipoprotein cholesterol (HDL-C) levels; and emotional eating was parallel with fasting insulin level and HOMA-IR. Conclusions: MetS had strong associations with eating behaviors as restrained, emotional and external. In line with the findings of the study, additionally, women were more susceptible to MetS than men were. In the regulation of restrictive, emotional and external eating behaviors, dietitians and psychology experts should be in cooperation to treat disordered eating patterns. (AU)

Introducción: el síndrome metabólico (MetS) puede tener un efecto bidireccional sobre la alimentación emocional y restrictiva. Objetivos: nuestro objetivo es encontrar interacciones entre el MetS y la alimentación emocional y la alimentación restrictiva, sumado a la depresión. Métodos: se trata de un estudio transversal. un grupo de participantes de entre 18 y 63 años, en su mayoría obesos (n = 200). Para encontrar asociaciones entre los patrones de alimentación y el síndrome metabólico se utilizaron el Test de Actitudes Alimentarias (EAT-26), el Inventario de Depresión de Beck (BDI) y el Cuestionario Holandés de Comportamiento Alimentario (DEBQ). Resultados: nuestro estudio mostró evidencias de relaciones fisiológicas entre la alimentación restrictiva y emocional con el MetS. Los parámetros bioquímicos reflejaron que aquellos que comían contenidamente eran menos resistentes a la insulina y los participantes con MetS presentaban una mayor alimentación emocional y una menor restricción alimenticia. Además, los que comían contenidamente tenían niveles más bajos de triglicéridos, HOMA-IR, insulina en ayunas y glucosa en sangre, frente a niveles más altos de HDL-C. Asimismo, la alimentación emocional reflejó una relación paralela con el nivel de insulina en ayunas y HOMA-IR. Conclusiones se evidenció una notable asociación entre el MetS y los comportamientos alimenticios restrictivos, emocionales y externos. De acuerdo con los hallazgos del estudio, además, las mujeres eran más susceptibles al MetS que los hombres. En la regulación de las conductas alimenticias restrictivas, emocionales y externas, los dietistas y los expertos en psicología deben coadyuvar para tratar patrones de desórdenes alimenticios. (AU)

Metformin induces mitochondrial remodeling and differentiation of pancreatic progenitor cells into beta-cells by a potential mechanism including suppression of the T1R3, PLCB2, cytoplasmic Ca+2, and AKT

The main goal of this study was to investigate the molecular changes in pancreatic progenitor cells subject to high glucose, aspartame, and metformin in vitro. This scope of work glucose, aspartame, and metformin were exposed to pancreatic islet derived progenitor cells (PID-PCs) for 10 days. GLUT1’s role in beta-cell differentiation was examined by using GLUT1 inhibitor WZB117. Insulin+ cell ratio was measured by flow cytometry; the expression of beta-cell differentiation related genes was shown by RT-PCR; mitochondrial mass, mitochondrial ROS level, cytoplasmic Ca2+, glucose uptake, and metabolite analysis were made fluorometrically and spectrophotometrically; and proteins involved in related molecular pathways were determined by western blotting. Findings showed that glucose or aspartame exposed cells had similar metabolic and gene expression profile to control PID-PCs. Furthermore, relatively few insulin+ cells in aspartame treated cells were determined. Aspartame signal is transmitted through PLCβ2, CAMKK2 and LKB1 in PID-PCs. The most obvious finding of this study is that metformin significantly increased beta-cell differentiation. The mechanism involves suppression of the sweet taste signal’s molecules T1R3, PLCβ2, cytoplasmic Ca+2, and AKT in addition to the direct effect of metformin on mitochondria and AMPK, and the energy metabolism of PID-PCs is remodelled in the direction of oxidative phosphorylation. These findings are very important in terms of determining that metformin stimulates the mitochondrial remodeling and the differentiation of PID-PCs to beta-cells and thus it may contribute to the compensation step, which is the first stage of diabetes development. (AU)