[Intervention study on subacute and chronic pain in primary care: an approach to the effectiveness of neural therapy]. / Estudio de intervención sobre el dolor subagudo y crónico en atención primaria: una aproximación a la efectividad de la terapia neural.

OBJECTIVE: To evaluate the effectiveness of NT in reducing pain and minimising use of analgesics in patients. DESIGN: Before and after intervention study. SETTING: Llefià Primary Health Care centre in Badalona (Barcelona). PARTICIPANTS: Eighty-two patients between the ages of 25 and 85 years old, who suffered pain that did not disappear after a month. MAIN MEASUREMENTS: Data was collected to evaluate any change in pain and the use of analgesics in patients before intervention and then afterwards, at 2 weeks, 3 months and 6 months. This was conducted by means of interviews and use of the Visual Analogue Pain Scale (VAS). RESULTS: Mean VAS pre-treatment: 7.94 (SD: 1.68), mean VAS after two weeks 4.63 (SD: 2.79), after 3 months 3.73 (SD: 3.17), and after 6 months 3.48 (SD: 3,27) (P<.001 in the 3 comparisons, using the Wilcoxon-test for matched data). As regards analgesic use after treatment, 74.4% of patients reduced it after 2 weeks, 76.8% after 3 months and 80% after 6 months. CONCLUSIONS: Neural therapy can be effective in reducing pain, as well as the use of analgesics. Further clinical trials would be needed to confirm this assertion.

[Detection of LADA-type diabetes in overweight diabetic patients. Is treatment with metformin suitable?]. / Detección de diabetes tipo LADA en pacientes diabéticos con exceso ponderal. 'Es adecuado el tratamiento con metformina?

OBJECTIVES: To detect type-1 LADA (latent auto-immune diabetes in adults) in adults with overweight. To describe the metabolic variations in these patients after metformin treatment. DESIGN: Observational, multi-centre study based on a series of cases. SETTING: Health centres in Barcelona province, Spain. PARTICIPANTS: Diabetic patients with overweight or obesity, diagnosed with diabetes for <2 years, aged between 35 and 65, and without clinical micro-macrovascular complications and without initial glycaemia-lowering drug treatment. INTERVENTION: Metformin administration (1700 mg/day). MEASUREMENTS: The metabolic control variable was HbA1c. Other variables measured were: body mass index (BMI), glucose in fast, insulinaemia, C-peptide, and insulin resistance (HOMA-IR). We determined ICA, GADAb and IA2Ab antibodies to diagnose LADA-type diabetes. RESULTS: In our sample of diabetics (N=103), we detected 3 type-1 LADA cases. These patients had higher levels of HbA1c, insulin and, especially, HOMA-IR. Metformin treatment for one year improved HbA1c in both groups (with and without type-1 LADA). However, the decrease in insulin one year afterwards was greater in type-1 LADA patients. CONCLUSIONS: The percentage of type-1 LADA in our sample made us wonder whether we should search for pancreatic antibodies more often in primary care. More studies on the prevalence of type-1 LADA in our country are needed, especially in diabetic patients with overweight. Type-1 LADA patients improved their metabolic control after metformin treatment and showed a drastic decrease in insulin levels. Further studies are needed to evaluate whether metformin improves metabolic control, even though it may not protect insulin reserves, and to contrast metformin with other drugs.