Seven-year mortality in heart failure patients with undiagnosed diabetes: an observational study.

BACKGROUND: Patients with type 2 diabetes mellitus and heart failure have adverse clinical outcomes, but the characteristics and prognosis of those with undiagnosed diabetes in this setting has not been established. METHODS: In total, 400 patients admitted consecutively with acute heart failure were grouped in three glycaemic categories: no diabetes, clinical diabetes (previously reported or with hypoglycaemic treatment) and undiagnosed diabetes. The latter was defined by the presence of at least two measurements of fasting plasma glycaemia ≥ 7 mmol/L before or after the acute episode.Group differences were tested by proportional hazards models in all-cause and cardiovascular mortality during a 7-year follow-up. RESULTS: There were 188 (47%) patients without diabetes, 149 (37%) with clinical diabetes and 63 (16%) with undiagnosed diabetes. Patients with undiagnosed diabetes had a lower prevalence of hypertension, dyslipidaemia, peripheral vascular disease and previous myocardial infarction than those with clinical diabetes and similar to that of those without diabetes. The adjusted hazards ratios for 7-year total and cardiovascular mortality compared with the group of subjects without diabetes were 1.69 (95% CI: 1.17-2.46) and 2.45 (95% CI: 1.58-3.81) for those with undiagnosed diabetes, and 1.48 (95% CI: 1.10-1.99) and 2.01 (95% CI: 1.40-2.89) for those with clinical diabetes. CONCLUSIONS: Undiagnosed diabetes is common in patients requiring hospitalization for acute heart failure. Patients with undiagnosed diabetes, despite having a lower cardiovascular risk profile than those with clinical diabetes, show a similar increased mortality.

[Metabolic syndrome and type-1 diabetes mellitus: prevalence and associated factors]. / Síndrome metabólico y diabetes mellitus tipo 1: prevalencia y factores relacionados.

INTRODUCTION AND OBJECTIVES: Numerous clinical and epidemiological studies have highlighted the fact that metabolic syndrome is an important precursor of cardiovascular disease. Metabolic syndrome is generally associated with type-2 diabetes, and few data exist on its occurrence in type-1 diabetes. The aims of this study were to determine the prevalence of metabolic syndrome in patients with type-1 diabetes and to identify associated factors. METHODS: This cross-sectional study included consecutive patients aged over 18 years with autoimmune type-1 diabetes of more than 6 months' duration who were treated during 2008 at the Outpatient Endocrinology Clinic of the Hospital del Mar, Barcelona, Spain. The presence of metabolic syndrome was determined using the modified criteria proposed by the National Cholesterol Education Program-Adult Treatment Panel III. RESULTS: Overall, 31.9% (95% confidence interval [CI], 22.3%-41.5%) of patients with type-1 diabetes had metabolic syndrome. The following factors were significantly and independently associated with the presence of metabolic syndrome in patients with type-1 diabetes: age (odds ratio [OR]=1.09; 95% CI, 1.029-1.154), body mass index (OR=1.389; 95% CI, 1.134-1.702) and glycosylated hemoglobin level (OR=1.745; 95% CI, 1.081-2.815). In addition, there was a direct relationship between the number of components of metabolic syndrome present and prevalence of microangiopathy, which reached 100% in patients who satisfied all diagnostic criteria. CONCLUSIONS: Metabolic syndrome was common in patients with type-1 diabetes and was associated with microvascular complications.

Carcinoid tumor of the thymus associated with Cushing's syndrome and dysgeusia: case report and review of the literature.

A 30-year-old man was hospitalized with edema, polyuria, and abnormalities in taste. ACTH and cortisol levels at admission were markedly elevated, even after attempted suppression with 8 mg dexamethasone. A thoracic-abdominal CT revealed an anterior mediastinal lesion and hyperplasia of both adrenal glands. After excision of the mediastinal mass, which confirmed the presence of a carcinoid thymic tumor, the patient became totally asymptomatic, with normal ACTH and cortisol levels. A carcinoid thymic tumor has a poor prognosis, especially when it is associated with Cushing's syndrome. Most patients will present recidivism or metastasis within 5 years after surgery. However, the low number of cases available for analysis makes it difficult to establish optimum therapeutic approaches.

Estimated glucose disposal rate in assessment of the metabolic syndrome and microvascular complications in patients with type 1 diabetes.

OBJECTIVE: The objective of the study was to quantify insulin resistance in type 1 diabetes patients by estimated glucose disposal rate (eGDR), according to the presence or absence of the metabolic syndrome, and its relationship with chronic complications. DESIGN: This was a cross-sectional study in 91 patients with type 1 immune-mediated diabetes managed at an outpatient endocrinology clinic. All participants were Caucasians aged 18 yr or older with type 1 diabetes duration of more than 6 months who had completed the study protocol. RESULTS: Twenty-nine patients met metabolic syndrome criteria, yielding a prevalence of 31.9%. Although no differences in insulin requirements were found between diabetic patients with and without metabolic syndrome, lower eGDR levels, indicating greater insulin resistance, were observed in metabolic syndrome patients compared with those without (6.19 +/- 1.5 mg/kg(-1) x min(-1) vs. 9.93 +/- 1.6 mg/kg(-1) x min(-1)) (P < 0.001). An eGDR level less than 8.77 mg/kg(-1) x min(-1) showed 100% sensitivity and 85.2% specificity for metabolic syndrome diagnosis. All patients with diabetes complications had eGDR values below 8.16 mg/kg(-1) x min(-1). eGDR level was significantly lower in patients with diabetic retinopathy (5.97 +/- 1.2 mg/kg(-1) x min(-1)), diabetic neuropathy (5.06 +/- 0.4 mg/kg(-1) x min(-1)), or diabetic nephropathy (5.79 +/- 1.5 mg/kg(-1) x min(-1)) compared with those without (9.38 +/- 2.0 mg/kg(-1) x min(-1), P < 0.001; 9.26 +/- 2.0 mg/kg(-1) x min(-1), P < 0.001; and 9.19 +/- 2.2 mg/kg(-1) x min(-1), P < 0.001). CONCLUSIONS: Insulin resistance is common in type 1 diabetes patients and is associated with microvascular complications. eGDR, as an insulin resistance marker, provides more useful information than other classical variables such as insulin requirements.