Different Indexes of Glycemic Variability as Identifiers of Patients with Risk of Hypoglycemia in Type 2 Diabetes Mellitus.

INTRODUCTION: Recent publications frequently introduce new indexes to measure glycemic variability (GV), quality of glycemic control, or glycemic risk; however, there is a lack of evidence supporting the use of one particular parameter, especially in clinical practice. METHODS: A cohort of type 2 diabetes mellitus (T2DM) patients in ambulatory care were followed using continuous glucose monitoring sensors (CGM). Mean glucose (MG), standard deviation, coefficient of variation (CV), interquartile range, CONGA1, 2, and 4, MAGE, M value, J index, high blood glucose index, and low blood glucose index (LBGI) were estimated. Hypoglycemia incidence (<54 mg/dl) was calculated. Area under the curve (AUC) was determined for different indexes as identifiers of patients with risk of hypoglycemia (IRH). Optimal cutoff thresholds were determined from analysis of the receiver operating characteristic curves. RESULTS: CGM data for 657 days from 140 T2DM patients (4.69 average days per patient) were analyzed. Hypoglycemia was present in 50 patients with 144 hypoglycemic events in total (incidence rate of 0.22 events per patient/day). In the multivariate analysis, both CV (OR 1.20, 95% CI 1.12-1.28, P < .001) and LBGI (OR 4.83, 95% CI 2.41-9.71, P < .001) were shown to have a statistically significant association with hypoglycemia. The highest AUC were for CV (0.84; 95% CI 0.77-0.91) and LBGI (0.95; 95% CI 0.92-0.98). The optimal cutoff threshold for CV as IRH was 34%, and 3.4 for LBGI. CONCLUSION: This analysis shows that CV can be recommended as the preferred parameter of GV to be used in clinical practice for T2DM patients. LBGI is the preferred IRH between glycemic risk indexes.

Comparación de dos ángulos para el diagnóstico del tipo de perfil / Comparison of two angles for diagnosing facial profile

Se realizó un estudio comparativo, no experimental, cuyo objetivo fue evaluar la concordancia del diagnóstico dado por los ángulos de Viazis y de la convexidad, con la clínica, para la clasificación de un tipo de perfil de tejidos blandos. El universo estudio conformado por pacientes de consulta privada de ortodoncia, 50 mujeres y 50 hombres, entre los 18 y 29 años, sin asimetrías aparentes, dentición completa y línea de sonrisa normal. Se tomaron 100 radiografías de perfil en posición natural de la cabeza, se realizaron los trazos de tejidos blandos y se evaluaron los ángulos de Viazis y de la convexidad para posteriormente clasificar en perfil I, II o III, según los rangos establecidos. Cinco evaluadores clasificaron cada perfil según su criterio clínico. Se observó la concordancia entre los ángulos y la clínica, concluyendo que se deben combinar las medidas cefalométricas con el criterio clínico al diagnosticar y tratar un paciente