Acute-to-chronic glycemic ratio as an outcome predictor in ischemic stroke in patients with and without diabetes mellitus.

OBJECTIVE: Elevated plasma glucose levels are common in patients suffering acute ischemic stroke (AIS), and acute hyperglycemia has been defined as an independent determinant of adverse outcomes. The impact of acute-to-chronic glycemic ratio (ACR) has been analyzed in other diseases, but its impact on AIS prognosis remains unclear. The main aim of this study was to assess whether the ACR was associated with a 3-month poor prognosis in patients with AIS. RESEARCH, DESIGN AND METHODS: Retrospective analysis of patients admitted for AIS in Hospital del Mar, Barcelona. To estimate the chronic glucose levels (CGL) we used the formula eCGL= [28.7xHbA1c (%)]-46.7. The ACR (glycemic at admission / eCGL) was calculated for all subjects. Tertile 1 was defined as: 0.28-0.92, tertile 2: 0.92-1.13 and tertile 3: > 1.13. Poor prognosis at 3 months after stroke was defined as mRS score 3-6. RESULTS: 2.774 subjects with AIS diagnosis were included. Age, presence of diabetes, previous disability (mRS), initial severity (NIHSS) and revascularization therapy were associated with poor prognosis (p values < 0.05). For each 0.1 increase in ACR, there was a 7% increase in the risk of presenting a poor outcome. The 3rd ACR tertile was independently associated with a poor prognosis and mortality. In the ROC curves, adding the ACR variable to the classical clinical model did not increase the prediction of AIS prognosis (0.786 vs. 0.781). CONCLUSIONS: ACR was positively associated with a poor prognosis and mortality at 3-months follow-up after AIS. Subjects included in the 3rd ACR tertile presented a higher risk of poor prognosis and mortality. Baseline glucose or ACR did not add predictive value in comparison to only using classical clinical variables.

Testosterone undecanoate improves lipid profile in patients with type 1 diabetes and hypogonadotrophic hypogonadism.

Testosterone deficiency (Td) has been associated with the metabolic syndrome. Few studies have evaluated this condition in type 1 diabetes (T1D). The primary aim of this study was to evaluate the effectiveness of testosterone undecanoate (TU) on insulin sensitivity, glycemic control, anthropometric parameters, blood pressure and lipid profile in patients with Td and T1D. We performed a randomized placebo-controlled multicenter study. INCLUSION CRITERIA: a) age ≥ 18 years; b) autoimmune diabetes; c) Td (total testosterone <10 nmol/L or calculated free testosterone <225 pmol/L and low/normal LH; d) ability to sign informed consent; e) comply with the study protocol. EXCLUSION CRITERIA: a) pituitary tumor, empty sella, hyperprolactinemia, panhypopituitarism or secondary hypogonadism; b) contraindications for treatment with testosterone undecanoate (TU); c) patients who did not agree to sign their informed consent. Six patients were randomly assigned to testosterone undecanoate (TU) treatment and 7 to placebo with the following dosing schedule: baseline, 6 weeks and 16 weeks. Blood test, anthropometric parameters, blood pressure and insulin sensitivity were determined at baseline, 6, 16 and 22 weeks. No differences were observed regarding insulin sensitivity, HbA1c or basal glucose, anthropometric parameters or blood pressure. At 22 weeks, the decrease in total cholesterol was 37.4 ± 27.5 mg/dL in the TU group compared with an increase of 13.2 ± 17.8 mg/dL in the placebo group (P<0.005), and LDL cholesterol concentration decreased 30.2 ± 22.1 mg/dL, compared with an increase of 10.5 ± 13.4 mg/dL in the placebo group (P=0.004). We conclude that treatment with TU in patients with T1D and Td improves lipid profile, with no effects on metabolic control or anthropometric parameters.

Age, insulin requirements, waist circumference, and triglycerides predict hypogonadotropic hypogonadism in patients with type 1 diabetes.

INTRODUCTION: The prevalence of hypogonadotropic hypogonadism (HH) in patients with type 2 diabetes mellitus is higher than in the general population and leads to detrimental effects on metabolic control, lipid profile, and body composition. Few studies have examined its role in type 1 diabetes mellitus. AIM: To determine the prevalence of HH in patients with type 1 diabetes and associated risk factors. MAIN OUTCOME MEASURES: Clinical and biochemical parameters were gathered on initial evaluation. An HH score creating different experimental models was devised to calculate the risk of HH for an individual with type 1 diabetes. METHODS: Cross-sectional study of 181 male patients with type 1 diabetes consecutively admitted to the Diabetes outpatient clinics of three urban hospitals. All participants were Caucasians aged ≥ 18 years with type 1 diabetes duration of more than 6 months. RESULTS: One hundred and eighty-one male patients with a mean age of 44.2 ± 13.2 years and a type 1 diabetes duration of 18.9 ± 12.7 years were included. Fifteen patients had HH, representing a prevalence of 8.3% (95% confidence interval [CI]: 4.3-12.3%). Age (odds ratio [OR] 1.066 [95% CI: 1.002-1.134]), waist circumference (OR 1.112 [95% CI: 1028-1203]), and insulin requirements ([IU/Kg] ×10 [OR 1.486 {95% CI: 1052-2.098}]) were independently associated with the presence of HH. The model that best predicted HH generated this formula: HH-score = (1.060 × age) + (1.084 × waist circumference) + (14.00 × insulin requirements) + triglycerides, where age was expressed in years, waist circumference in cm, insulin requirements in IU/kg/d, and triglycerides in mg/dL. An HH score > 242.4 showed 100% sensitivity and 53.2% specificity for HH diagnosis; positive and negative predictive values were 17.0 % and 100%, respectively. CONCLUSIONS: One in 10 men with type 1 diabetes presents HH. This condition is associated with age, waist circumference, and insulin requirements. A simple formula based on clinical parameters can rule out its presence.

Malnutrition is associated with postoperative complications in elderly patients undergoing total hip arthroplasty.

INTRODUCTION: Malnutrition in elderly patients with hip fracture has been described as a factor associated with poor outcomes. This evidence for elderly patients undergoing elective total hip arthroplasty (THA) for osteoarthritis is not well-established. METHODS: We retrospectively studied a cohort of patients with an age ≥65 years admitted to the hospital for THA between January 2018 and December 2020. Demographic characteristics were collected. Albumin and total lymphocyte count were included in the pre-operative analysis and 24h postoperatively. Nutritional screening was carried out 24h postoperatively. GLIM criteria were applied for the diagnosis of malnutrition. RESULTS: 25 patients out of the total cohort of 65 (38.4%) were malnourished. Five out of six patients (83.3%) with postoperative complications presented malnutrition compared with 20 of 59 patients (33.8%) without postoperative complications (P=0.028). Mean length of stay (LOS) was 3.49±0.88 days. Five out of six (83.3%) patients with postoperative complications presented LOS >3 days compared with one out of six patients (16.6%) with LOS ≤3 days (P=0.009). 26 patients (40%) were referred to a community health centre, no differences in diagnosis of malnutrition were detected compared with patients who were discharged home. Patients with a diagnosis of malnutrition were significantly older, had a lower body mass index (BMI), a lower preoperative and postoperative albumin and worse anthropometric parameters. CONCLUSIONS: Malnutrition is associated with postoperative complications and longer LOS in elderly patients with elective THA. Risk factors for malnutrition are older age and low BMI.

[Autoinmune polyendocrinopathy]. / Síndromes pluriglandulares autoinmunes.

Pluriglandular autoimmune syndrome (APS) can affect multiple endocrine glands and is associated with other autoimmune diseases. APS type 1 presents with hypoparathyroidism, mucocutaneous candidiasis and Addison's disease. It is caused by AutoImmune Regulator (AIRE) gene mutation. The diagnosis includes clinical manifestations in addition to AIRE gene sequencing. SPA type 2 presents with Addison's disease, type 1 diabetes, or autoimmune thyroid disease. Multiple genes have been implicated, including those of the class II major histocompatibility complex. SPA type 3 is characterized by autoimmune thyroid disease and other autoimmune disease, excluding Addison's disease and hypoparathyroidism, 4 genes have been implicated and confer susceptibility. The diagnosis of APS type 2 and type 3 includes clinical manifestations, nevertheless, the determination of autoantibodies can be useful to predict the risk of disease manifestation and to confirm the autoimmune disease in some cases.

[Treatment of diabetes mellitus during Ramadan]. / Tratamiento de la diabetes mellitus durante el Ramadán.

In the treatment of patients with diabetes mellitus it is fundamental that the therapeutic schemes are adapted to each's patient characteristics such as age, associated diseases and diabetes complications. This therapeutic individualization must also include lifestyles and socio-cultural and religious factors as the celebration of Ramadan. Although Muslin diabetics are theoretically free from Ramadan, they commonly wish to fast in practice. It is therefore needed a right approach of the patient during this period. In this Review, we analyze the prevalence of diabetes among different ethnicities, the possible complications of the disease in relation to fasting's pathophysiology, and the studies performed to rightly manage type 1 and 2 diabetic patients during Ramadan. It is necessary to adapt the therapeutic scheme both for patients treated with dietetic measures or oral drugs and for patients receiving insulin. It is also important the involvement of health professionals in the advice, orientation and adaptation of the therapeutic regimen of Muslin people with diabetes.

Hypertriglyceridemic waist in type 1 diabetes patients: prevalence and related factors.

BACKGROUND: The hypertriglyceridemic waist has been linked to a higher number of cardiovascular risk factors and a greater probability of developing diabetes and cardiovascular disease. Around 50% of individuals with type 1 diabetes (T1D) are overweight or obese and triglyceridemia is associated with the onset of micro- and macrovascular complications. METHODS: A cross-sectional study was conducted in men with T1D to assess the association between the prevalence of hypertriglyceridemic waist and cardiovascular risk factors and hypogonadism. Triglyceride levels + abdominal circumference taken together were stratified into quartiles to identify the hypertriglyceridemic waist phenotype. RESULTS: One hundred and eighty-one male patients were included. An increased prevalence of hypogonadism and hypertension in parallel to increased triglyceride + waist circumference quartile was observed. Patients in the highest quartile had higher insulin resistance measured by estimated glucose disposal rate (eGDR 7.8±2.1 mg/kg-1.min-1 in 1st quartile vs. 5.8±1.8 mg/kg-1.min-1 in 4th quartile, P=0.000), insulin requirements, hip circumference, percentage of fat mass, glycosilated hemoglobin and total and LDL cholesterol as well as lower levels of total testosterone (27.24±9.3 nmol/L in 1st quartile vs. 17.4±8 nmol/L in 4th quartile, P=0.000) and HDL cholesterol. An inverse relationship was found between triglycerides + waist circumference and total testosterone levels (R=-0.367, P<0.0001). CONCLUSIONS: The hypertriglyceridemic waist in men with T1D is associated with an atherogenic lipid profile, hypertension, worse metabolic diabetes control, increased insulin resistance and a higher prevalence of hypogonadism.

[Testosterone deficiency, metabolic syndrome and diabetes mellitus]. / Déficit de testosterona, síndrome metabólico y diabetes mellitus.

Testosterone deficiency in adult age is associated with a decrease in libido, energy, hematocrit, muscle mass and bone mineral density, as well as with depression. More recently, testosterone deficiency has also been associated with various components of the metabolic syndrome, which in turn is associated with a five-fold increase in the risk of cardiovascular disease. Low testosterone levels are associated with increased insulin resistance, increase in fat mass, low HDL cholesterol, higher triglyceride levels and hypertension. Testosterone replacement therapy in patients with testosterone deficiency and type 2 diabetes mellitus and/or metabolic syndrome has shown reductions in insulin resistance, total cholesterol, LDL cholesterol and triglycerides and improvement in glycemic control and anthropometric parameters.

Infradiagnosed complications of chronic diabetes mellitus: the value of systematic review in a single visit.

INTRODUCTION: Early diagnosis of diabetes mellitus complications reduces their progression and therefore improves quality of life and decreases cardiovascular mortality. OBJECTIVES: To evaluate the efficiency of a unit for detection of chronic complications of diabetes, and to analyze the incidence and prevalence of complications in a sample of patients from our area of interest and concern. METHODS: A cross-sectional study performing routine screening of all diabetes complications in patients aged 18-80 years diagnosed with type 1 or type 2 diabetes mellitus at least 6 months before. Anthropometric variables were measured and data on drug treatment and the most recent lipid profile were collected. RESULTS: 460 patients were included in the study. The prevalence and incidence rates of chronic complications of diabetes were 57% and 35.4% respectively. Glycosylated hemoglobin values ≤ 7% were found in 42% of patients, blood pressure levels below 130/80 mmHg in 20% of patients, and LDL cholesterol levels less than 2.59 mmol/L in 46% of patients. Patients with new complications were older and had higher BMI and hip circumference values, as well as higher systolic blood pressure levels and greater use of antihypertensive drugs. CONCLUSION: A unit for routine screening of chronic complications of diabetes would allow for detection of macroangiopathy and microangiopathy in a single annual visit, increasing visit compliance, and for implementation of measures to prevent its progression.

Síndromes pluriglandulares autoinmunes / Autoinmune polyendocrinopathy

Los síndromes pluriglandulares autoinmunes (SPA) afectan a múltiples glándulas endocrinas y asocian otras enfermedades autoinmunes. El SPA tipo 1 se presenta con hipoparatiroidismo, candidiasis mucocutánea y enfermedad de Addison, se debe a una mutación en el gen AutoImmune Regulator (AIRE). El diagnóstico es clínico además de la secuenciación del gen AIRE. El SPA tipo 2 se presenta con enfermedad de Addison, diabetes mellitus tipo1 o enfermedad tiroidea autoinmune, se han implicado múltiples genes, entre ellos los del complejo mayor de histocompatibilidad tipo 2. El SPA tipo 3 se caracteriza por la presencia de enfermedad tiroidea autoinmune y otra enfermedad autoinmune, excluyendo la enfermedad de Addison y el hipoparatiroidismo, se han implicado cuatro genes que pueden conferir susceptibilidad. El diagnóstico del SPA tipo 2 y tipo 3 es clínico, aunque la determinación de autoanticuerpos puede ser útil para la evaluación del riesgo de presentar la enfermedad y para confirmar la enfermedad autoinmune en algunos casos. (AU)

Pluriglandular autoimmune syndrome (APS) can affect multiple endocrine glands and is associated with other autoimmune diseases. APS type 1 presents with hypoparathyroidism, mucocutaneous candidiasis and Addison's disease. It is caused by AutoImmune Regulator (AIRE) gene mutation. The diagnosis includes clinical manifestations in addition to AIRE gene sequencing. SPA type 2 presents with Addison's disease, type 1 diabetes, or autoimmune thyroid disease. Multiple genes have been implicated, including those of the class II major histocompatibility complex. SPA type 3 is characterized by autoimmune thyroid disease and other autoimmune disease, excluding Addison's disease and hypoparathyroidism, 4 genes have been implicated and confer susceptibility. The diagnosis of APS type 2 and type 3 includes clinical manifestations, nevertheless, the determination of autoantibodies can be useful to predict the risk of disease manifestation and to confirm the autoimmune disease in some cases. (AU)

Déficit de testosterona, síndrome metabólico y diabetes mellitus / Testosterone deficiency, metabolic syndrome and diabetes mellitus

El déficit de testosterona en la edad adulta se relaciona con depresión, disminución de la libido, energía, hematocrito, masa muscular y de la densidad mineral ósea. En los últimos años, también se ha asociado con diversos componentes del síndrome metabólico, que a su vez se relacionan con un aumento de hasta 5 veces en el riesgo de enfermedad cardiovascular. Así, las concentraciones bajas de testosterona se asocian con una mayor resistencia a la insulina, incremento de la masa grasa, colesterol HDL bajo, triglicéridos elevados e hipertensión arterial. Inversamente, el tratamiento sustitutivo en pacientes con déficit de testosterona y diabetes mellitus tipo 2 y/o síndrome metabólico ha demostrado reducciones en la resistencia a la insulina, colesterol total, LDL y triglicéridos, y una mejoría del control glucémico y los parámetros antropométricos (AU)

Testosterone deficiency in adult age is associated with a decrease in libido, energy, hematocrit, muscle mass and bone mineral density, as well as with depression. More recently, testosterone deficiency has also been associated with various components of the metabolic syndrome, which in turn is associated with a five-fold increase in the risk of cardiovascular disease. Low testosterone levels are associated with increased insulin resistance, increase in fat mass, low HDL cholesterol, higher triglyceride levels and hypertension. Testosterone replacement therapy in patients with testosterone deficiency and type 2 diabetes mellitus and/or metabolic syndrome has shown reductions in insulin resistance, total cholesterol, LDL cholesterol and triglycerides and improvement in glycemic control and anthropometric parameters (AU)

Infradiagnóstico de complicaciones crónicas de la diabetes mellitus: utilidad de una revisión sistemática en una sola visita / Infradiagnosed complications of chronic diabetes mellitus: the value of systematic review in a single visit

Antecedentes: El diagnóstico precoz de las complicaciones crónicas de la diabetes mellitus permite reducir la progresión de las mismas y, por tanto, mejorar la calidad de vida y disminuir la mortalidad cardiovascular

Introduction: Early diagnosis of diabetes mellitus complications reduces their progression and therefore improves quality of life and decreases cardiovascular mortality. Objectives To evaluate the efficiency of a unit for detection of chronic complications of diabetes, and to analyze the incidence and prevalence of complications in a sample of patients from our area of interest and concern

Tratamiento de la diabetes mellitus durante el Ramadán / Treatment of diabetes mellitus during Ramadan

En el tratamiento de las personas con diabetes es fundamental adaptar los esquemas terapéuticos a las características de cada paciente, como la edad, las enfermedades asociadas y las complicaciones de la enfermedad. Esta individualización del tratamiento debe contemplar también los estilos de vida y condicionantes socioculturales y religiosos, como la celebración del Ramadán. Las personas diabéticas de religión musulmana, aunque en teoría están exentas del Ramadán, en la práctica frecuentemente desean cumplir el ayuno. En consecuencia, es necesario un correcto abordaje del paciente durante este período. En la siguiente revisión se exponen la prevalencia de la diabetes en las diferentes etnias y las posibles complicaciones de la diabetes relacionadas con la fisiopatología del ayuno, así como los estudios realizados para el manejo adecuado del paciente con diabetes tipo 1 y tipo 2 durante el Ramadán. Es necesario adaptar la pauta terapéutica, tanto para los pacientes tratados con dieta o fármacos orales como para los tratados con insulina. Es también importante la implicación de los profesionales sanitarios en el consejo, orientación y adaptación del régimen terapéutico de las personas musulmanas con diabetes

In the treatment of patients with diabetes mellitus it is fundamental that the therapeutic schemes are adapted to each's patient characteristics such as age, associated diseases and diabetes complications. This therapeutic individualization must also include lifestyles and socio-cultural and religious factors as the celebration of Ramadan. Although Muslin diabetics are theoretically free from Ramadan, they commonly wish to fast in practice. It is therefore needed a right approach of the patient during this period. In this Review, we analyze the prevalence of diabetes among different ethnicities, the possible complications of the disease in relation to fasting's pathophysiology, and the studies performed to rightly manage type 1 and 2 diabetic patients during Ramadan. It is necessary to adapt the therapeutic scheme both for patients treated with dietetic measures or oral drugs and for patients receiving insulin. It is also important the involvement of health professionals in the advice, orientation and adaptation of the therapeutic regimen of Muslin people with diabetes