Characterization of the hypertriglyceridemic waist phenotype in patients with type2 diabetes mellitus in Spain: An epidemiological study. / Caracterización del fenotipo de cintura hipertrigliceridémica en pacientes con diabetes mellitus tipo2 en España: un estudio epidemiológico.

BACKGROUND AND OBJECTIVES: In patients with type2 diabetes mellitus (DM2), the presence of increased waist circumference and triglycerides is a reflection of increased visceral fat and insulin resistance. However, information about the prevalence and clinical characteristics of the hypertriglyceridemic waist (HTGW) phenotype in patients with DM2 is scarce. The aim of the present study was to analyze the prevalence and characteristics of DM2 patients with HTGW. METHODS: We analyzed 4214 patients with DM2 in this epidemiological, cross-sectional study conducted in primary care centers across Spain between 2011 and 2012. The HTGW phenotype was defined as increased waist circumference according to the International Diabetes Federation criteria for Europids (≥94cm for men and ≥80cm for women) with the presence of triglyceride levels ≥150mg/dl. We compared demographic, clinical and analytical variables according to the presence or absence of the HTGW phenotype. RESULTS: Thirty-five percent of patients presented the HTGW phenotype. Patients with the HTGW phenotype had a higher body mass index (31.14±4.88 vs. 29.2±4.82kg/m2; P<.001) and glycated hemoglobin levels (7.38±1.2% vs. 7±1.07%; P<.001). The presence of hypertension, peripheral arterial disease, cardiac insufficiency and microvascular complications were higher when compared with patients without the HTGW phenotype. Patients with the HTGW phenotype were less adherent to prescribed diet (69.8 vs. 81%; P<.001), exercise (44.6 vs. 58.2%; P<.001) and presented greater weight increase within the year prior to the study visit (29.4 vs. 22.5%; P<.001). CONCLUSIONS: The HTGW phenotype is prevalent in the Spanish DM2 population and identifies a subgroup of patients with higher cardiometabolic risk and prevalence of diabetic complications.

Meeting individualized glycemic targets in primary care patients with type 2 diabetes in Spain.

BACKGROUND: Information about the achievement of glycemic targets in patients with type 2 diabetes according to different individualization strategies is scarce. Our aim was to analyze the allocation of type 2 diabetic patients into individualized glycemic targets according to different strategies of individualization and to assess the degree of achievement of adequate control. METHODS: Cross-sectional analysis on 5382 type 2 diabetic patients in primary care setting in Spain between 2011 and 2012. Targets of HbA1c were assigned based on different strategies of individualization of glycemic targets: 1) the ADA/EASD consensus 2) The Spanish Diabetes Society (SED) consensus 3) a strategy that accounts for the risk of hypoglycemia (HYPO) considering the presence of a hypoglycemia during the last year and type of hypoglycemic treatment. Concordance between the different strategies was analyzed. RESULTS: A total of 15.9, 17.1 and 67 % applied to ADA/EASD recommendation of HbA1c target of <6.5, < 7 and <8 % (48, 53 and 64 mmol/mol), and 31.9 and 67.4 % applied to the SED glycemic target of <6.5 and <7.5 % (<48 and 58 mmol/mol). Using the HYPO strategy, 53.5 % had a recommended HbA1c target <7 % (53 mmol/mol). There is a 94 % concordance between the ADA/EASD and SED strategies, and a concordance of 41-42 % between these strategies and HYPO strategy. Using the three different strategies, the overall proportion of patients achieving glycemic targets was 56-68 %. CONCLUSIONS: Individualization of glycemic targets increases the number of patients who are considered adequately controlled. The proposed HYPO strategy identifies a similar proportion of patients that achieve adequate glycemic control than ADA/EASD or SED strategies, but its concordance with these strategies in terms of patient classification is bad.

Characterization of the hypertriglyceridemic waist phenotype in patients with type 2 diabetes mellitus in Spain: an epidemiological study.

BACKGROUND AND OBJECTIVES: In patients with type 2 diabetes mellitus (DM2), the presence of increased waist circumference and triglycerides is a reflection of increased visceral fat and insulin resistance. However, information about the prevalence and clinical characteristics of the hypertriglyceridemic waist (HTGW) phenotype in patients with DM2 is scarce. The aim of the present study was to analyze the prevalence and characteristics of DM2 patients with HTGW. METHODS: We analyzed 4214 patients with DM2 in this epidemiological, cross-sectional study conducted in primary care centers across Spain between 2011 and 2012. The HTGW phenotype was defined as increased waist circumference according to the International Diabetes Federation criteria for Europids (≥ 94 cm for men and ≥ 80 cm for women) with the presence of triglyceride levels ≥ 150 mg/dL. We compared the demographic, clinical and analytical variables according to the presence or absence of the HTGW phenotype. RESULTS: Thirty-five percent of patients presented the HTGW phenotype. Patients with the HTGW phenotype had a higher body mass index (31.14 ±â€¯4.88 vs. 29.2 ±â€¯4.82 kg/m2; p < .001) and glycated hemoglobin levels (7.38 ±â€¯1.2% vs. 7 ±â€¯1.07%; p < .001). The presence of hypertension, peripheral arterial disease, cardiac insufficiency and microvascular complications were higher when compared with patients without the HTGW phenotype. Patients with the HTGW phenotype were less adherent to prescribed diet (69.8 vs. 81%; p < .001), exercise (44.6 vs. 58.2%; p < .001) and presented greater weight increase within the year prior to the study visit (29.4 vs. 22.5%; p < .001). CONCLUSIONS: The HTGW phenotype is prevalent in the Spanish DM2 population and identifies a subgroup of patients with higher cardiometabolic risk and prevalence of diabetic complications.

Value of radical cystectomy in bladder cancer with pelvic node involvement.

Of the 241 patients with bladder cancer treated with cystectomy and urinary diversion between January, 1978, and May, 1985, pelvic lymphadenectomy was performed in 150. In 41 of the 150 patients, pelvic node involvement was shown in the pathology study (27%). The preoperative clinical stages showed bladder muscle invasion in all 41 cases. Node invasion was found in 16/77 cases with radiation therapy and in 25/73 cases without radiation therapy (p less than 0.05). Operative mortality was 3 cases (7.3%). Of the 38 patients who survived the operation, 35 (94%) died of cancer within an average of 8 months. Twenty-seven showed 1-3 pelvic nodes involved, 7 showed 4-6, and 4 patients had more than 6 nodes involved. These differences between survival rates are not statistically significant (p = 0.35). Two patients died of a disease not related to the tumor, and only 1 is alive 4 years after operation (2%).

Place of cystectomy in superficial bladder cancer.

Between January 1978 and June 1985, 44 patients underwent cystectomy for clinically diagnosed superficial bladder cancer. Operative mortality was 13.6%. Early and late complications were observed in 34 and 55% patients, respectively. Clinical understaging was seen in 23%, and stage reduction in 18% of the patients. Clinical staging was correct in 59% of the patients. The mean follow-up was 40 months (range, 24-84 months). Five patients presented local recurrence (13%) of the tumor and 10 patients showed distant metastases (26%). Urethral and upper urinary tract recurrences were observed in 7 and 4 patients, respectively. Fourteen patients (39%) died of cancer after a mean follow-up of 24 months. The actuarial 5-year survival was achieved by 77% of the patients with PTo-PTa-PTis and by 67% of the patients with PT1 (p, not significant).