Prediabetes and Cardiometabolic Risk: The Need for Improved Diagnostic Strategies and Treatment to Prevent Diabetes and Cardiovascular Disease.

The progression from prediabetes to type-2 diabetes depends on multiple pathophysiological, clinical, and epidemiological factors that generally overlap. Both insulin resistance and decreased insulin secretion are considered to be the main causes. The diagnosis and approach to the prediabetic patient are heterogeneous. There is no agreement on the diagnostic criteria to identify prediabetic subjects or the approach to those with insufficient responses to treatment, with respect to regression to normal glycemic values or the prevention of complications. The stratification of prediabetic patients, considering the indicators of impaired fasting glucose, impaired glucose tolerance, or HbA1c, can help to identify the sub-phenotypes of subjects at risk for T2DM. However, considering other associated risk factors, such as impaired lipid profiles, or risk scores, such as the Finnish Diabetes Risk Score, may improve classification. Nevertheless, we still do not have enough information regarding cardiovascular risk reduction. The sub-phenotyping of subjects with prediabetes may provide an opportunity to improve the screening and management of cardiometabolic risk in subjects with prediabetes.

Difficult diagnosis in the clinical evaluation of a patient with squamous cell carcinoma of the sigmoid colon: a case report.

BACKGROUND: Squamous cell carcinoma (SCC) of the sigmoid colon is an exceedingly rare subtype of colorectal cancer (CRC) associated with chronic inflammatory conditions. Due to its variable clinical presentation ranging from subclinical to fully symptomatic and limited available information, it poses a diagnostic challenge. We aim to provide a review of the current literature and raise awareness about the importance of a thorough clinical analysis for an early diagnosis. CASE PRESENTATION: We describe the case of a 59-year-old Peruvian woman with a medical history of diverticular disease and irritable bowel syndrome. The patient presented with nonspecific symptoms such as abdominal discomfort, constipation, and bloating. Diagnostic tests and biopsy revealed a rare case of squamous cell carcinoma of the sigmoid colon. The patient underwent surgical resection and adjuvant chemotherapy. CONCLUSION: Despite the rarity of this type of cancer in the colon, the patient's clinical course highlights the importance of considering it as a potential diagnosis in patients with nonspecific symptoms and a history of gastrointestinal disorders. Surgical treatment followed by radiotherapy is the preferred management. Factors such as lack of postoperative complications and the stage of the neoplasia can augur a positive. PROGNOSIS: A prompt diagnosis is crucial, as detecting a neoplasia in its early stages can make surgery more effective.

Paciente adulto con diabetes mellitus tipo 1: múltiples factores para lograr un control adecuado. Reporte de caso / Adult patient with type 1 diabetes mellitus: multiple factors to achieve an adequate control

RESUMEN La diabetes mellitus tipo 1 (DM1) es una de las enfermedades crónicas más comunes de la infancia; sin embargo, un gran número de pacientes adultos viven con esta condición. La terapia con insulina es el pilar del tratamiento. Otros aspectos importantes son fomentar un estilo de vida saludable y lograr la adherencia a la medicación. Se presenta el caso de una mujer de 29 años con diagnóstico de diabetes mellitus tipo 1 hace 15 años. Describimos el manejo y evolución de los últimos 5 años y destacamos la importancia de las nuevas tecnologías, como el monitoreo continuo de glucosa, además de factores como la adherencia al tratamiento y el soporte familiar, los cuales fueron particularmente importantes para el control de la enfermedad de la paciente.

ABSTRACT Type 1 diabetes mellitus (T1DM) is one of the most common chronic childhood diseases. However, a large number of adult patients live with this condition. Insulin therapy is the cornerstone of diabetes treatment. Other important aspects are the promotion of a healthy lifestyle and the adhesion to medications. This is the case of a 29-year-old woman with a fifteen- year diagnosis of T1DM. Medical treatment and evolution over the last five years are described. The importance of new technologies such as continuous glucose monitoring and other factors such as adherence to treatment and family support were particularly important for the patient's adequate disease control.

Correction to: Atypical hyperglycemia presentation suggests considering a diagnostic of other types of diabetes: first reported GCK-MODY in Perú.

[This corrects the article DOI: 10.1186/s40842-019-0091-x.].

Atypical hyperglycemia presentation suggests considering a diagnostic of other types of diabetes: first reported GCK-MODY in Perú.

BACKGROUND: Prevalence of maturity-onset diabetes of the young (MODY) is estimated between 1 and 2% of all diabetes cases. In Latin-America little information has been described about the frequency of the disease, perhaps due to limited access to genetic studies. CASE PRESENTATION: We present the case of a male patient with a history of two years of fatigue, mild hyperglycemia and intermittent polyuria, accompanied by a recent history of weight loss. He was diagnosed initially as type 2 diabetes, but in the follow-up as a patient with type 1 diabetes. He required relatively low doses of insulin and was evaluated in the endocrinology service at a hospital in Lima. The results of glucose, insulin and C-peptide in the oral glucose tolerance test (OGTT) performed were not consistent with a type 1 diabetes. Moreover, the age of the patient and the clinical characteristics did not strongly suggest a diagnosis of type 2 diabetes either. These clinical features had prompted us to carry out the genetic study. The genetic test performed with a genetic MODY panel through a massive sequencing. Heterozygous pathogenic for a variant in GCK gene was found (c.629 T > C, p.Met210Thr.). His parents were negative for this variant after performed the genetic test. CONCLUSIONS: This is the first case of MODY for a pathogenic variant in the GCK gene reported in Perú. The genetic evaluation of a clinical suspicion of MODY is important to confirm the diagnosis and establish an adequate treatment in patients.

A CROSS-SECTIONAL STUDY OF THE ASSOCIATION BETWEEN THE 1-HOUR ORAL GLUCOSE TOLERANCE TEST AND THE METABOLIC SYNDROME IN A HIGH-RISK SAMPLE WITH IMPAIRED FASTING GLUCOSE.

Objective: The aim of this study was to evaluate the association between the 1-hour oral glucose tolerance test (OGTT) (≥155 mg/dL) and metabolic syndrome (MS) in a sample with previous impaired fasting glucose (IFG). Methods: Three hundred and twenty four Peruvian subjects with a history of IFG ≥100 mg/dL were selected for a cross-sectional study. They underwent a 75 g OGTT and were assigned to different groups according to the result. We evaluated the association between 1-hour OGTT and MS. Results: The mean age was 56.5 ± 12.6 years and 191 (61.5%) were female. During the OGTT, we found 28 (8.6%) subjects with diabetes, 74 (22.8%) with IGT, and 222 (68.5%) with a normal glucose tolerance test with a 2-hour glucose <140 mg/dL (NGT). In the NGT group, 124 (38.3%) had 1-hour glucose levels <155 mg/dL, while 98 (30.2%) had 1-hour glucose levels ≥155 mg/dL. Evaluating the association between the 1-hour value in the OGTT and MS, we found that subjects with a 1-hour glucose ≥155 mg/dL were more than twice as likely to have MS as those with a 1-hour glucose <155 mg/dL (odds ratio = 2.64, 95% confidence interval: 1.52 to 4.57). In addition, body mass index, fasting glycemia, triglycerides, and waist circumferences were significantly higher in subjects with 1-hour glucose levels ≥155 mg/dL compared to those with 1-hour glucose levels <155 mg/dL (P<.05). Conclusion: Among subjects with IFG, performing an OGTT was helpful to identify subjects with 1-hour glucose levels ≥155 mg/dL and NGT who were significantly more likely to have MS and a worse cardiometabolic risk profile. Abbreviations: AST = aspartate aminotransferase; BMI = body mass index; CI = confidence interval; IFG = impaired fasting glucose; IGT = impaired glucose tolerance; LDL = low-density lipoprotein; MS = metabolic syndrome; NGT = normal glucose tolerance; OGTT = oral glucose tolerance test; OR = odds ratio; T2DM = type 2 diabetes; TG = triglycerides.

Síndrome metabólico: concepto y aplicación práctica / Metabolic syndrome: concept and practical application

El síndrome metabólico (SM) es un conjunto de anormalidades metabólicas consideradas como un factor de riesgo para desarrollar enfermedad cardiovascular y diabetes. Los componentes del SM se han definido según diferentes guías y consensos. Las definiciones propuestas por el National Cholesterol Education Program Adult Treatment Panel III (ATP III) y la International Diabetes Federation (IDF) son las más utilizadas en las diferentes publicaciones; sin embargo, se han realizado actualizaciones para diferentes poblaciones según la etnia y ubicación geográfica, como es el caso de la Asociación Latinoamericana de Diabetes (ALAD), que define un perímetro abdominal determinado para la región América Latina. En el año 2009, la publicación Harmonizing the Metabolic Syndrome sugirió un consenso para el diagnóstico de SM tratando de unificar los criterios de las diferentes organizaciones. Respecto a la fisiopatología del SM, la resistencia a insulina ha sido considerada como base del desarrollo del conjunto de anormalidades que lo conforman, sugiriendo a la obesidad abdominal o central como responsable del desarrollo de la insulino resistencia. Las adipoquinas producidas por el tejido adiposo abdominal actuarían directa o indirectamente en el desarrollo de los componentes del síndrome. Es importante mencionar que el síndrome metabólico ha sido considerado un equivalente diagnóstico de prediabetes, por ser predictor de diabetes. El incremento en la prevalencia del SM a nivel mundial le ha otorgado una gran importancia en la prevención y control de riesgo de la enfermedad cardiovascular y la diabetes. En el presente artículo revisaremos importantes aspectos sobre la definición y diagnóstico del síndrome metabólico.

The metabolic syndrome (MS) is a cluster of metabolic abnormalities considered risk factors for developing cardiovascular disease and diabetes. MS components are defined according to different guidelines and consensus. The definition proposed by the National Cholesterol Education Program Adult Treatment Panel III (ATPIII) and the International Diabetes Federation (IDF) are the most commonly used in the different publications. These definitions have been updated in some populations according to ethnicity and geographical location, such as the Latin American Diabetes Association (ALAD) that defines a specific abdominal perimeter for Latin-Americans. In 2009 the publication Harmonizing the Metabolic Syndrome suggested a consensus on the application of unified diagnostic criteria for MS. Regarding the pathophysiology of MS, insulin resistance has been considered the main factor for development of the abnormalities associated with this syndrome; the abdominal or central obesity would be responsible for the development of insulin resistance. Adipokines produced in the abdominal fat would play a direct or indirect role in the development of MS components. It is important to consider the metabolic syndrome as equivalent to prediabetes because is also predicts diabetes. The rise in MS prevalence worldwide has increased the importance of this syndrome in the prevention and control of cardiovascular disease risk and diabetes. In the present article we review important aspects of the metabolic syndrome.

Hipotiroidismo subclínico y estimación de su frecuencia en síndrome metabólico y obesidad en un grupo poblacional urbano de Lima, Perú / Subclinical hypothyroidism and estimation of its prevalence in metabolic syndrome and obesity in an urban population group in Lima, Peru

El hipotiroidismo subclínico (HSC) es una condición relativamente frecuente en la población adulta, siendo escasos los reportes al respecto en nuestro medio. El síndrome metabólico (SM) y la obesidad han incrementado su prevalencia en la población mundial, habiendo sido descrita en algunos reportes su coexistencia con el HSC. Objetivo: Evaluar la prevalencia de HSC, además de estimar su frecuencia en SM y obesidad en un grupo poblacional. Métodos: Estudio descriptivo transversal. Un total de 69 trabajadores del Hospital Municipal del distrito de Comas en Lima-Perú, sin antecedente de enfermedad cardiovascular, enfermedad tiroidea o gestantes y sin medicación que altere los valores de hormonas tiroideas fueron incluidos en el estudio. Variables: HSC, SM, obesidad, además del índice de masa corporal (IMC), colesterol total, colesterol LDL e hipotiroidismo subclínico límite superior elevado (HSC-Lse) fueron evaluados. El diagnóstico de HSC fue definido como una condición de elevación de hormona estimulante de la tiroides (TSH) y niveles normales de tiroxina Libre (T4L). Resultados: La edad promedio fue de 32ñ11,7 años, 54 fueron mujeres y 15 varones. La prevalencia de HSC fue de 14,5% (10 mujeres y 3 varones). La prevalencia de SM fue de 18,8% y de obesidad 8,6%. La frecuencia de HSC en SM fue de 10% y de 16% en los que no tenían SM, mientras que la frecuencia de HSC en obesidad fue de 16,7% y de 14,3% en sujetos no obesos. No se encontró diferencia significativa al evaluar la media de los componentes de SM, IMC, colesterol total y colesterol LDL en los grupos con y sin HSC. Conclusiones: La prevalencia de HSC fue elevada. La prevalencia de SM y obesidad fue similar a la descrita en otras series. La frecuencia de sujetos con HSC en los grupos con SM y obesidad fue baja, adem s de no existir una variación significativa en la media de los componentes de SM, IMC y lípidos entre los grupos con y sin HSC.

Subclinical hypotiroidism (SCH) is a relatively common condition among the adult population, but there are insufficient studies in Peru. Metabolic syndrome (MS) and obesity have increased their prevalence in the world, and many times coexists with SCH. Objective: To study the prevalence of SCH, and its frequency in MS and obesity in a specific population. Methods: Descriptive cross-sectional study. A total of 69 workers from “Hospital Municipal” at Comas district in Lima- Peru, with no past history of cardiovascular disease, thyroid disease or pregnacy, and on no medication that could change thyroid hormone profile were included in our study. Variables: SCH, MS, obesity and also body mass index (BMI), total cholesterol, LDL cholesterol and elevated upper limit subclinical hypothyroidism were evaluated. The diagnosis of SCH was defined as a condition of high thyroid stimulating hormone (TSH) with normal levels of free thyroxin (Ft4). Results: The mean age was 32ñ11.67, with 54 females and 15 males. The prevalence of SCH was 14% (10 females and 3 males). The prevalence of MS was 18,8% and of obesity 8,6%. The frequencies of SCH in MS were 10% and 16% in the group without MS. We did not find significant differences in the mean levels of the MS components: BMI, total cholesterol and LDL cholesterol in groups with and without SCH. Conclusion: The prevalence of SCH was high. The prevalence of MS and obesity were similar as in other reports. The frequency of subjects with SCH in the group with MS and obesity were low, also we did not find significant variation in the mean of the components of MS, BMI and lipids in the groups with and without SCH.

Prevalencia de síndrome metabólico en una población de estudiantes de Lima / Prevalence of metabolic syndrome in a population of students in Lima

El objetivo del presente trabajo es describir la prevalencia de síndrome metabólico (SM) y la relación de los componentes de SM con el índice de masa corporal (IMC) y la talla, en una población de estudiantes de Lima. La muestra fue de 185 estudiantes de un instituto superior tecnológico, en quienes se evaluó índice de masa corporal, perímetro abdominal, control de glucosa en ayunas, colesterol HDL y triglicéridos. Los criterios utilizados para el diagnóstico de SM fueron los de la federación Internacional de Diabetes. El criterio de talla baja se basó en la descripción del documento Norma Oficial Mexicana NOM-174-SSA1-1998, para el manejo integral de la obesidad. El IMC se basó en los parámetros de sobrepeso y obesidad regidos por la OMS. La prevalencia de SM fue de 4% en la población estudiada. La prevalencia de glucosa de ayuno alterada (mayor de 100 mg%) fue de 3,8%. Respecto a los componentes de SM, promedio de obesidad central, triglicéridos y presión arterial, no se hallaron valores alterados. Sin embargo, el promedio de valor de HDL hallado, resultó inferior al valor mínimo normal descrito. Las personas de talla baja presentaron un prevalencia de HDL bajo, a pesar de presentar un IMC normal, a diferencia del grupo de la talla no baja.

The objective of the following paper is to describe the prevalence of Metabolic Syndrome (MS), and the relation of its components with Body Mass Index (BMI), and with height a student population in Lima. The sample consisted of 185 students of a Superior Institute of Technology who were measured for BMI, abdominal perimeter, fasting glucose control, HDL cholesterol. And triglycerides. The implemented criteria for the diagnose of MS was that used by the International Diabetes Federation (IDF). The height criterion was based on the description of the document Norma Oficial Mexicana NOM-174-SSA1-1998, para el manejo integral de la obesidad. The BMI was based on parameters of overweight and obesity dictated by the WHO. The prevalence of MS was of 4% in the sample population. The prevalence of altered fasting glucose (greater than 100 mg%) was 3,8%. In respect to the MS components, the average of central obesity, triglycerides, and arterial pressure; no altered values were found. Nevertheless, the average value of the HDL found was lower than the minimum value described. People of a lower height showed a low prevalence of HDL even though they showed a normal BMI as opposed to the group of a taller height.