Alteraciones lipídicas y su relación con los niveles de vitamina D en menores de 18 años con diabetes tipo 1 / Lipid changes and their relationship with vitamin D levels in children under 18 years with type 1 diabetes

Objetivo: Analizar en menores de 18 años con diabetes mellitus tipo 1 (DM1) las alteraciones lipídicas y su relación con los niveles de 25 hidroxi vitamina D3 (25-OH-D). Material y métodos: Estudio transversal y descriptivo. Se incluyen menores de 18 años con DM1 mediante un muestreo no aleatorizado consecutivo. Determinaciones: sexo, edad, estadio puberal, tiempo de evolución de la DM1, peso, talla, índice de masa corporal, perímetro abdominal, hemoglobina glucosilada (HbA1c) 25-OH-D, colesterol total, LDL-colesterol, HDL-colesterol y triglicéridos (TG). Se estratifican los resultados para sexo, edad y estadio puberal. Se analizan los datos con el programa SPSS®. Resultados: Se recogen 90 pacientes: edad media de 11,7 ± 3,6 años, predominio masculino (51,1%) y HbA1c media de 7,5 ± 1,3%. El 26,6% presentan 25-OH-D < 20 ng/ml y el 13,3% 25-OH-D ≤ 15 ng/ml. No se observan diferencias en la 25-OH-D en pacientes con sobrepeso-obesidad respecto al resto. El 1,1% presentan HDL-colesterol < 40 ng/ml, el 34,4% LDL-colesterol ≥ 100 mg/dl y el 2,2% TG ≥ 150 mg/dl. Los pacientes con 25-OH-D < 20 ng/ml presentan valores superiores de TG que el resto (76,80 ± 45,62 vs 57,55 ± 26,08; p = 0,04) en el análisis multivariante para índice de masa corporal, perímetro abdominal y HbA1c. Se observa correlación entre los niveles de 25-OH-D y los TG (–0,230; p = 0,029). Conclusión: En nuestra población los pacientes con insuficiencia de vitamina D muestran valores de TG superiores. Debe realizarse un seguimiento a largo plazo para conocer las repercusiones sobre las complicaciones relacionadas con la diabetes (AU)

Objective: To analyze lipid changes and their relationship with 25-hydroxy vitamin D3 (25-OH-D) levels in patients under 18 years old with type 1 diabetes mellitus (T1DM). Material and methods: A cross-sectional, descriptive study. Patients under 18 years with T1DM were enrolled by consecutive, nonrandomized sampling. Data collected included sex, age, pubertal stage, time since T1DM onset, weight, height, body mass index (BMI), waist circumference, glycosylated hemoglobin (HbA1c), 25-OH-D, total cholesterol (TC), LDL cholesterol (LDL-C), HDL cholesterol (HDL-C), and triglycerides (TG). Results were stratified by sex, age, and pubertal stage. Data were analyzed using SPSS®. Results: Ninety patients with a mean age of 11.7 ± 3.6 years (51.1% males) and mean HbA1c levels of 7.5 ± 1.3% were enrolled. Of these, 26.6% had 25-OH-D levels < 20 ng/mL and 13.3% 25-OH-D levels ≤ 15 ng/mL. No differences were found in 25-OH-D between patients with overweight or obesity and the rest. HDL-C levels < 40 ng/mL were found in 1.1%, 34.4% had LDL-C levels ≥ 100 mg/dL, and 2.2% had TG levels ≥ 150 mg/dL. Patients with 25-OH-D < 20 ng/mL had higher TG levels than the rest (76.80 ± 45.62 vs 57.55 ± 26.08; P = .04) in the multivariate analysis controlled for BMI, waist circumference, and HbA1c. A correlation was found between 25-OH-D and TG levels (-0.230;P = .029). Conclusions: Patients in our population with vitamin D deficiency had higher TG levels. Long-term follow-up should be performed to understand the potential impact of such levels on diabetes-related complications (AU)

Lipid changes and their relationship with vitamin D levels in children under 18 years with type 1 diabetes.

OBJECTIVE: To analyze lipid changes and their relationship with 25-hydroxy vitamin D3 (25-OH-D) levels in patients under 18 years old with type 1 diabetes mellitus (T1DM). MATERIAL AND METHODS: A cross-sectional, descriptive study. Patients under 18 years with T1DM were enrolled by consecutive, nonrandomized sampling. Data collected included sex, age, pubertal stage, time since T1DM onset, weight, height, body mass index (BMI), waist circumference, glycosylated hemoglobin (HbA1c), 25-OH-D, total cholesterol (TC), LDL cholesterol (LDL-C), HDL cholesterol (HDL-C), and triglycerides (TG). Results were stratified by sex, age, and pubertal stage. Data were analyzed using SPSS(®). RESULTS: Ninety patients with a mean age of 11.7 ± 3.6 years (51.1% males) and mean HbA1c levels of 7.5 ± 1.3% were enrolled. Of these, 26.6% had 25-OH-D levels<20 ng/mL and 13.3% 25-OH-D levels ≤ 15 ng/mL. No differences were found in 25-OH-D between patients with overweight or obesity and the rest. HDL-C levels<40 ng/mL were found in 1.1%, 34.4% had LDL-C levels ≥ 100 mg/dL, and 2.2% had TG levels ≥ 150 mg/dL. Patients with 25-OH-D<20 ng/mL had higher TG levels than the rest (76.80 ± 45.62 vs 57.55 ± 26.08; P=.04) in the multivariate analysis controlled for BMI, waist circumference, and HbA1c. A correlation was found between 25-OH-D and TG levels (-0.230; P=.029). CONCLUSIONS: Patients in our population with vitamin D deficiency had higher TG levels. Long-term follow-up should be performed to understand the potential impact of such levels on diabetes-related complications.

Rabdomiólisis hiponatrémica en enfermedad de Addison en niño con síndrome poliglandular autoinmune tipo 2 / Hyponatremic rhabdomyolysis in Addison's disease in a child with autoimmune polyglandular syndrome type 2

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Tasa estimada de disposición de glucosa en pacientes menores de 18 años con diabetes mellitus tipo 1 y sobrepeso-obesidad / Estimated glucose disposal rate in patients under 18 years of age with type 1 diabetes mellitus and overweight or obesity

Objetivo Comparar la tasa estimada de disposición de glucosa (TeDG), la dosis de insulina y el perfil lipoproteico en niños con diabetes mellitus tipo 1 (DM1) y sobrepeso-obesidad frente a niños con DM1 de peso normal. Métodos Se seleccionaron 115 pacientes (5-16 años) con DM1 e insulinoterapia intensiva. Se determinaron: peso, talla, índice de masa corporal, perímetro abdominal y de cadera, dosis de insulina, hemoglobina glucosilada, presión arterial y perfil lipoproteico. Los resultados se estratificaron por sexo y edad. Resultados No se encontraron diferencias en la TeDG entre los pacientes con peso normal, sobrepeso y obesidad. No obstante, los niños obesos mayores de 11 años mostraron valores inferiores en la TeDG (9,3 ± 1,3 vs 10,1 ± 0,8 mg kg-1min; p < 0,01). Los niños con obesidad y sobrepeso precisaban dosis de insulina superiores a aquellos con peso normal, especialmente en UI/m2/día (37,7 vs 36,1 vs 29,4, respectivamente; p < 0,007). Los niños con obesidad presentaban concentraciones de colesterol de las lipoproteínas de baja densidad superiores a aquellos con sobrepeso y peso normal (106,5 vs 91,7 vs 91,5 mg/dl, respectivamente; p < 0,01). Asimismo, no se encontró correlación entre el perímetro abdominal y los distintos marcadores de resistencia a la insulina. Conclusiones La TeDG es inferior en niños obesos mayores de 11 años con DM1, por lo que podría considerarse como un marcador de resistencia a la insulina. Las necesidades de insulina son mayores en pacientes con sobrepeso-obesidad, especialmente cuando se cuantifican en UI/m2/día. Los pacientes obesos con DM1 presentan un perfil lipoproteico de riesgo cardiovascular (AU)

Objective To assess the estimated glucose disposal rate (eGDR), insulin dose, and lipoprotein profile in children with type 1 diabetes mellitus (T1DM) and overweight or obesity as compared to children with T1DM and normal weight. Methods A total of 115 patients (aged 5-16 years) with T1DM on intensive insulin therapy were recruited. The following parameters were measured: weight, height, body mass index, waist and hip circumference, insulin dose, eGDR, glycosylated hemoglobin, blood pressure, and lipoprotein profile. Results were stratified by sex and age. Results No significant differences were found in eGDR between children with normal weight, overweight, and obesity. However, obese children older than 11 years had lower eGDR values (9.3 ± 1.3 vs 10.1 ± 0.8 mg kg-1min-1; p < 0.01). Insulin dose was higher in overweight and obese children, especially in IU/m2/day (37.7 vs 36.1 vs 29.4 respectively; p < 0.01). Obese children had higher low-density lipoprotein cholesterol levels than children with overweight and normal weight (106.5 vs 91.7 vs 91.5 mg/dL respectively; p < 0.01). No correlation was found between waist circumference and the different markers of insulin resistance. Conclusions Values of eGDR values were lower in obese children with T1DM older than 11 years, and this may therefore be considered a marker of insulin resistance. Insulin dose was higher in diabetic patients with overweight or obesity, specially in IU/m2/day. Obese children with T1DM had a lipoprotein profile of cardiovascular risk. (AU)

[Estimated glucose disposal rate in patients under 18 years of age with type 1 diabetes mellitus and overweight or obesity]. / Tasa estimada de disposición de glucosa en pacientes menores de 18 años con diabetes mellitus tipo 1 y sobrepeso-obesidad.

OBJECTIVE: To assess the estimated glucose disposal rate (eGDR), insulin dose, and lipoprotein profile in children with type 1 diabetes mellitus (T1DM) and overweight or obesity as compared to children with T1DM and normal weight. METHODS: A total of 115 patients (aged 5-16 years) with T1DM on intensive insulin therapy were recruited. The following parameters were measured: weight, height, body mass index, waist and hip circumference, insulin dose, eGDR, glycosylated hemoglobin, blood pressure, and lipoprotein profile. Results were stratified by sex and age. RESULTS: No significant differences were found in eGDR between children with normal weight, overweight, and obesity. However, obese children older than 11 years had lower eGDR values (9.3±1.3 vs 10.1±0.8 mg kg(-1)min(-1); p<0.01). Insulin dose was higher in overweight and obese children, especially in IU/m2/day (37.7 vs 36.1 vs. 29.4 respectively; p<0.01). Obese children had higher low-density lipoprotein cholesterol levels than children with overweight and normal weight (106.5 vs 91.7 vs 91.5mg/dL respectively; p<0.01). No correlation was found between waist circumference and the different markers of insulin resistance. CONCLUSIONS: Values of eGDR values were lower in obese children with T1DM older than 11 years, and this may therefore be considered a marker of insulin resistance. Insulin dose was higher in diabetic patients with overweight or obesity, specially in IU/m2/day. Obese children with T1DM had a lipoprotein profile of cardiovascular risk.

Análisis del control del paciente diabético en el área de atención primaria Mancha-Centro de Castilla-La Mancha. Barómetro de la diabetes / Analysis of diabetic patient control in the Primary Care Area of La Mancha-Centro, in the Castile-La Mancha region. Diabetes barometer

OBJETIVOS: Evaluar el control del paciente con diabetes mellitus (DM) en atención primaria(AP), analizando el sistema de registro informático del Sevicio de Salud de Castilla-La Mancha(SESCAM). MATERIAL Y MÉTODOS: Muestra de 938 pacientes con diagnóstico de DM sobre 14.733 individuos incluidos en el año 2009 en el registro informático del SESCAM del área Mancha Centro (Turriano), que comprende 25 centros de AP. Se analizaron distintos parámetros clínicos y analíticos: hemoglobina glicosilada (HbA1c), colesterol total (CT), presión arterial (PA) e índice de masa corporal(IMC), así como el número de procesos por paciente/año: análisis de HbA1c y lípidos, controles de PA, monitorizaciones de pie diabético y revisiones oculares. RESULTADOS: La prevalencia de diabetes conocida fue del 6,36% en la población general. El 54%de los pacientes presentaron una HbA1c < 7%, y el 24,1%, > 8%. El 79% asociaban sobrepeso u obesidad. El 38% eran hipertensos. No se realizó control de CT en el 16% de los individuos, obteniendo valores por debajo de 200 mg/dl en el 45%. Se registró menos de una revisión de pie al año, ninguna revisión ocular, ni control de microalbuminuria. CONCLUSIONES: El sistema «Turriano» es eficaz en el registro de pacientes con diabetes. La mayoría de los pacientes de nuestro estudio presentan un buen control metabólico y de los factores de riesgo cardiovascular

AIMS: To determine the clinical control of patients with diabetes in Primary Care in the a Mancha Centro area (Castile-La Mancha region).MATERIAL AND METHODS: The computerised records system of the Regional Health Service in Castile-La Mancha (Turriano) included 14,733 patients in 2009, in which 938 patients with diabetes were identified in the 25 centres belonging to La Mancha Centro area. Several parameters were collected: HbA1c, total cholesterol, blood pressure, and body mass index (BMI). The number of process per patient/year also were also collected, including number of: HbA1c, total cholesterol, blood pressure controls, feet controls, and eyes controls. RESULTS: Diabetes prevalence was 6.36% of the general population. The HbA1c was measured on average once a year. An HbA1c under 7 mg/dL was found in 54% of patients, and greater than 8 mg/dL in 24.1% of them. The large majority (79%) of patients with diabetes were overweight or obese. Hypertension was found in 40% of the patients. Total cholesterol was not controlled in 16% of patients; 45% had a total cholesterol under 200 mg/dL. Less than one check-up of the feet was done, and no eye control nor microalbuminuria were registered. CONCLUSIONS: The Turriano system is effective for recording the diabetic population. Most patients in our study showed good metabolic control as well as of cardiovascular risk factors

Prevalencia de diabetes y diabetes oculta en adultos de Castilla-La Mancha / Prevalence of known diabetes mellitus and unknown diabetes in adults from Castilla-La Mancha, Spain

Fundamento y objetivo: Los objetivos de este estudio fueron estimar la prevalencia de diabetes mellitus (DM) conocida, diabetes oculta (DO) y alteraciones del metabolismo de los hidratos de carbono en la población de Castilla-La Mancha de edad ≥ 30 años, y valorar los factores de riesgo cardiovascular asociados con diabetes. Pacientes y método: Para estimar la prevalencia se realizó un estudio poblacional trasversal con fecha de referencia del 01-06-2007. Fueron seleccionados 3.092 sujetos, de los que participaron 1.181 (38,1%). Se realizó cuestionario, exploración y sobrecarga oral de glucosa (SOG). Se utilizaron los criterios diagnósticos establecidos por la Asociación Americana de Diabetes (ADA) y se compararon los resultados con los criterios de la Organización Mundial de la Salud (OMS). Resultados: La prevalencia de diabetes en sujetos de edad ≥ 30 años fue del 17,9% (DM 10,7%, DO 7,2%, razón DO/DM 0,7), la de intolerancia a la glucosa (ITG) del 5,6% y la de glucosa basal alterada (GBA) del 22,3% según criterios ADA y 7,2% según criterios OMS. La DM, ITG y GBA aumentaron con la edad. Se observó una mayor prevalencia de diabestes en global en varones (20,9%) frente a mujeres (14,5%), pero a partir de los 75 años es más prevalente en sexo femenino. Se encontró asociación con la obesidad, el género masculino, la edad y la presencia de antecedentes familiares de diabetes.Conclusiones: La prevalencia de diabetes en la población adulta de Castilla-La Mancha es muy elevada, es mayor en varones y aumenta con la edad. Un alto porcentaje de personas con diabetes o con alteración en el metabolismo de los hidratos de carbono desconoce su condición, lo que pone de manifiesto la necesidad de implantar estrategias de detección precoz (AU)

Background and objetive: To estimate the prevalence of known diabetes mellitus (KD), unknown diabetes (UD), and carbohydrate metabolism disturbances in a population of Castilla-La Mancha (CLM) older than 30 years old; To study the cardiovascular risk factors related with diabetes.Patients and methods: A transversal study was performed in order to determine these prevalence data. Reference date: 2007/06/01. 3,092 subjects were selected, and 1,181 of them (38.1%) participated in the study. A questionnaire, physical exploration and glucose tolerance test were performed. The diagnostic criteria of diabetes were those established by the American Association of Diabetes (ADA) and were compared with the World Health Organization criteria (WHO).Results: Prevalence of diabetes in individuals younger than 30 years: 17.9% (DM 10.7%, DO 7.2%). Ratio UD/KD: 0.7. Prevalence of impaired glucose tolerance (IGT) 5.6% and impaired fasting glucose (IFG) 22.3% based on ADA criteria and 7.2% if WHO criteria applied. KD, IFT and IFG increased with age. Global prevalence was higher in males (20.9%) than females (14.5%), but the prevalence was higher in females older than 74 years. A positive relationship was found with obesity, male sex, age and familiar history of diabetes.Conclusions: Prevalence of diabetes in the adult population of CLM is very high, higher in males and increase with age. A great percentage of diabetic people or with carbohydrate metabolism alterations do not know that condition. This situation makes necessary to create early detection strategies (AU)

[Prevalence of known diabetes mellitus and unknown diabetes in adults from Castilla-La Mancha, Spain]. / Prevalencia de diabetes y diabetes oculta en adultos de Castilla-La Mancha.

BACKGROUND AND OBJECTIVE: To estimate the prevalence of known diabetes mellitus (KD), unknown diabetes (UD), and carbohydrate metabolism disturbances in a population of Castilla-La Mancha (CLM) older than 30 years old; To study the cardiovascular risk factors related with diabetes. PATIENTS AND METHODS: A transversal study was performed in order to determine these prevalence data. Reference date: 2007/06/01. 3,092 subjects were selected, and 1,181 of them (38.1%) participated in the study. A questionnaire, physical exploration and glucose tolerance test were performed. The diagnostic criteria of diabetes were those established by the American Association of Diabetes (ADA) and were compared with the World Health Organization criteria (WHO). RESULTS: Prevalence of diabetes in individuals younger than 30 years: 17.9% (DM 10.7%, DO 7.2%). Ratio UD/KD: 0.7. Prevalence of impaired glucose tolerance (IGT) 5.6% and impaired fasting glucose (IFG) 22.3% based on ADA criteria and 7.2% if WHO criteria applied. KD, IFT and IFG increased with age. Global prevalence was higher in males (20.9%) than females (14.5%), but the prevalence was higher in females older than 74 years. A positive relationship was found with obesity, male sex, age and familiar history of diabetes. CONCLUSIONS: Prevalence of diabetes in the adult population of CLM is very high, higher in males and increase with age. A great percentage of diabetic people or with carbohydrate metabolism alterations do not know that condition. This situation makes necessary to create early detection strategies.

Diferencias evolutivas en pacientes pediátricos con diabetes mellitus de tipo 1 en función de su grupo genético HLA-DQ / Outcome differences in pediatric patients with type 1 diabetes mellitus depending on their HLA-DQ genotypes

Fundamento y objetivo: En nuestro estudio se plantea la hipótesis de que existe relación entre la evolución a corto plazo de los pacientes pediátricos con diabetes mellitus de tipo 1 y el grupo genético HLA-DQ. Pacientes y método: Se realizó un estudio epidemiológico descriptivo sobre 129 niños y adolescentes menores de 16 años con diabetes mellitus de tipo 1. Se estudió el grupo genético HLA-DQ y se clasificaron por grupos de riesgo diabetógeno. Se estudiaron parámetros generales, clínicos y analíticos al inicio, y su evolución durante el período de seguimiento de 3 años, además de la búsqueda de aparición de complicaciones crónicas asociadas. Resultados: El 93,8% de nuestros pacientes presenta un grupo de riesgo genético HLA-DQ. Cuando se produce el inicio de la enfermedad, los pacientes heterocigóticos del grupo de riesgo iii inician con una edad más precoz y presentan una menor reserva pancreática. Durante el seguimiento, los pacientes del grupo de riesgo iii presentan diferencias significativas en las medidas de presión arterial sistólica y diastólica, también los pacientes del grupo de riesgo i en las medidas de presión arterial diastólica. Conclusiones: Los pacientes del grupo de riesgo iii inician con menor edad y presentan diferencias significativas en las cifras de presión arterial sistólica y diastólica durante su seguimiento (AU)

Background and Objetive: Our hypothesis is that there is a relationship between the short term outcomes of pediatric patients with type I diabetes mellitus and their HLA-DQ genotypes. Patients and Method: We performed a descriptive epidemiologic study of 129 children and adolescents under 16 years old with type 1 diabetes mellitus. We studied their HLA DQ genotypes and classified them into groups of diabetogenic risk. We studied general clinic and analytic parameters at onset of the disease and during a period of 3 years, and the development of associated chronic complications. Results: In total, 93.8% of our patients had diabetes-risk HLA-DQ genotypes. Onset of the disease occurred earlier in patients who belonged to risk group III, and they had less pancreatic reserve. During the follow-up period, significant differences in systolic and diastolic blood pressure were found in patients in risk group III, and in diastolic blood pressure in patients in risk group I. Conclusions: Patients in risk group III have an onset at a lower age and present significant differences in systolic and diastolic blood pressure during the follow up period (AU)

[Outcome differences in pediatric patients with type 1 diabetes mellitus depending on their HLA-DQ genotypes]. / Diferencias evolutivas en pacientes pediátricos con diabetes mellitus de tipo 1 en función de su grupo genético HLA-DQ.

BACKGROUND AND OBJECTIVE: Our hypothesis is that there is a relationship between the short term outcomes of pediatric patients with type I diabetes mellitus and their HLA-DQ genotypes. PATIENTS AND METHOD: We performed a descriptive epidemiologic study of 129 children and adolescents under 16 years old with type 1 diabetes mellitus. We studied their HLA DQ genotypes and classified them into groups of diabetogenic risk. We studied general clinic and analytic parameters at onset of the disease and during a period of 3 years, and the development of associated chronic complications. RESULTS: In total, 93.8% of our patients had diabetes-risk HLA-DQ genotypes. Onset of the disease occurred earlier in patients who belonged to risk group III, and they had less pancreatic reserve. During the follow-up period, significant differences in systolic and diastolic blood pressure were found in patients in risk group III, and in diastolic blood pressure in patients in risk group I. CONCLUSIONS: Patients in risk group III have an onset at a lower age and present significant differences in systolic and diastolic blood pressure during the follow up period.

Aproximación a la diabetes mellitus oculta en un servicio de urgencias hospitalario / Estimation of hidden diabetes mellitus in a hospital emergency department

Objetivos. Determinar la prevalencia de diabetes oculta en los pacientes que presentan hiperglucemia en un servicio de urgencias. Diseño del estudio. Estudio descriptivo transversal (de prevalencia).Emplazamiento. El marco de atención sanitaria ha sido el servicio de urgencias hospitalario. Participantes. Pacientes mayores de 20 años que acudieron al Servicio de Urgencias del Hospital General de Ciudad Real durante 2007, y con valores de glucemia plasmática mayor o igual de 140mg/dl. El número total de pacientes con glucemia mayor o igual a 140 fue de 4.559.Mediciones principales: Variables sociodemográficas y causas de hiperglucemia. Resultados. La edad media de los pacientes con glucemia mayor o igual a 140 mg/dl fue de 68,5años ± 13,8 DE. El 50% fueron menores de 71 años. La moda en la muestra fue de 75 años. El 52,2%(2.381) eran hombres. Las causas de hiperglucemia fueron: diabetes mellitus ya conocida (75,1% dela muestra, 3.423 pacientes), diabetes mellitus oculta (5,3% de la muestra, 240 pacientes), hiperglucemia secundaria a otras causas (19,7% de la muestra, 896 pacientes). Por lo tanto, la prevalencia de diabetes oculta en nuestra población fue del 5,3% (IC 95%: 4,3 - 5,6%). De los diabéticos conocidos, el 10,3% eran del tipo 1 (351 pacientes) y el 89,7% del tipo 2 (3.072 pacientes). Entre las hiperglucemias secundarias, el 18% lo fueron por tratamiento con corticoides (165 personas), el 32% por tratamiento oncológico (238 pacientes), el 3% por algún problema biliar-pancreático (28 pacientes),el 32% por hiperglucemias aisladas en relación con el estrés del proceso actual (291 pacientes) y el15% por intolerancia a la glucosa (131 pacientes).Conclusiones. La prevalencia de diabetes oculta es parecida a la encontrada en estudios similares. La diabetes oculta se confirma como un problema sanitario de peso epidemiológico (5,3% de nuestros pacientes) del que podrían derivarse importantes repercusiones sociosanitarias (AU)

Objectives. To determine the prevalence of hidden diabetes in patients presenting with hyperglycaemia at a hospital emergency department. Study design. Cross-sectional descriptive study (prevalence) studio. Setting. Hospital emergency department. Participants. Patients over 20 years who attended the Emergency Department of the Hospital General de Ciudad Real during 2007 with plasma glucose levels over 140 mg/dl. The total number of patients with glucose levels higher than 140 mg/dl was 4,559.Main measurements. Socio-demographic variables and cause of hyperglycaemia. Results. The mean age of patients with glucose levels greater than or equal to 140 mg/dl was 68.5years ± 13.8 SD, 50% were less than 71 years. The mean in the sample was 75 years and 52.2%(2.381) were men. The causes of hyperglycaemia were: known diabetes mellitus (75.1% of the sample,3,423 patients), hidden diabetes mellitus (5.3% of the sample, 240 patients), hyperglycaemia secondary to other causes (19.7% of sample, 896 patients). Therefore, the prevalence of hidden diabetes in our population was 5.3% (95% CI: 4.3 – 5.6%). Of those patients with known diabetes,10.3% had type 1 (351 patients) and 89.7% had type 2 (3,072 patients). In 18% of cases, hyperglycaemia was secondary to corticoid treatment (238 patients), in 3% to a biliar-pancreatic problem (28patients), in 32% to isolated hyperglycaemia related to the stress of their current illness (291 patients)and in 15% to glucose intolerance (131 patients).Conclusions. The prevalence of hidden diabetes is comparable to that found in similar studies. Hidden diabetes is confirmed as being a healthcare problem of epidemiological weight (5.3% of our patients) which could have serious socio-healthcare repercussions (AU)

[Biological differences on onset among type 1A diabetics in relation to HLA-DQ genetic markers]. / Diferencias biológicas en la presentación de la diabetes 1A, en relación con los marcadores genéticos HLA-DQ.

BACKGROUND AND OBJECTIVE: The hypothesis that diabetes mellitus presentation partially depends on the genetic characteristics of the patient has been proposed. Up to date this kind of studies have been made by serology, so there are no data about the role played by DQ haplotypes in the presentation and clinical importance of DM1. This fact is analysed in the present study. PATIENTS AND METHOD: We studied DQ haplotypes (molecular biology) in 86 patients affected by DM1. Their relationship with several parameters found on illness debut, such as age, sex, C peptid and clinical importance are analysed. RESULTS: 89% of the patients showed a DQ that increases the risk of diabetes. Average age on onset was 16 years and the median age 9 years. No differences in relation to sex were observed. DQA1*0501, 0301/DQB1*0201, 0302 heterocygotes show an earlier onset (9 years, opposite to 17 in the rest) and the youngest (smaller than 16 years) they have to the onset a smaller pancreatic reservation (peptid C of 0.37 ng/dl in front of 1.4 of those bigger than this age). CONCLUSIONS: DQA1*0501, 0301/DQB1*0201 heterocygocity increases the probability of an earlier and more aggressive debut of the illness, being related this characteristic younger debut to a smaller pancreatic reservation.

Diferencias biológicas en la presentación de la diabetes 1A, en relación con los marcadores genéticos HLA-DQ / Biological differences on onset among type 1A diabetics in relation to HLA-DQ genetic markers

FUNDAMENTO Y OBJETIVO: Se plantea la hipótesis de que la presentación de la diabetes mellitus tipo 1A (DM1) depende en parte de las características genéticas del paciente, ya que determinan la forma de inicio. Analizamos si los haplotipos HLA DQA-DQB son determinantes en la aparición de DM1 y su gravedad, ya que hasta el momento no hay una definición clara en este sentido. PACIENTES Y MÉTODO: Se realizó el estudio de los haplotipos HLA DQA-DQB por técnicas de biología molecular a 86 pacientes con DM1 y se relacionó con distintos parámetros hallados en el inicio de la enfermedad, como edad, sexo, péptido C y gravedad clínica. RESULTADOS: El 89 per cent de los pacientes presentó al menos un haplotipo DQ de riesgo diabetogénico. La edad media de inicio de la enfermedad fue de 16 años, aunque la edad de máxima frecuencia está en los 9 años. No se apreciaron diferencias en función del sexo. Los pacientes heterocigotos DQA1*0501,0301/DQB1*0201,0302 presentaron una mayor precocidad en la aparición de la diabetes (9, frente a los 17 años en el resto), y los más jóvenes (los menores de 16 años) presentaron al inicio una menor reserva pancreática (péptido C de 0,37 frente a 1,4 ng/dl de los mayores de dicha edad). CONCLUSIONES: La heterocigosis HLA DQA1*0501,0301/DQB1*0201,0302 se asocia a una presentación temprana de la DM1, que se relaciona con una menor reserva pancreática (AU)