Glucemia capilar en ayunas como prueba de cribaje de la diabetes mellitus tipo 2 en la infancia

La descripción de fenotipos o de marcadores bioquímicos precoces de enfermedades metabólicas ha sido estudiada desde hace algunos años; varias de ellas, tienen su origen en la infancia o en la adolescencia, por lo cual, una intervención precoz podría evitar futuras complicaciones, mejorar la calidad de vida de estas personas y reducir los costos sanitarios. Objetivo: Describir un grupo de niños con alteraciones metabólicas que podrían desarrollar Diabetes Mellitus tipo 2 en la etapa adulta. Métodos: La glucosa capilar en ayunas (GCA) fue evaluada en 2.734 niños de Bailén (Andalucía, España). 51 niños fueron seleccionados en forma randomizada aunque 33 de ellos aceptaron continuar el estudio: 16 niños con GCA>5,55 mmol/l en dos ocasiones fueron considerados como Grupo A; el Grupo B estaba formado por 17 niños con GCA 7 en tres (3) que podrían ser considerados como pacientes diabéticos. La GPA (mmol/l) en el Grupo B fue 4,65 ñ 0,11. La circunferencia de cintura, la ratio proinsulina-insulina y los niveles de triglicéridos fueron significativamente diferentes entre los grupos. Conclusiones: La Diabetes Mellitus tipo 2 al igual que otras alteraciones metabólicas crónicas tendría un origen precoz, tal vez en la infancia o en la adolescencia. Por ello, un método simple y de fácil manejo como la determinación de la glucemia capilar en ayunas podría ser utilizado como prueba de cribaje de una población infantil aunque, a partir de estos datos sería necesario realizar cribajes similiares en otras poblaciones y comprobar la reproducción de los resultados (AU)

Serum ferritin as a component of the insulin resistance syndrome.

OBJECTIVE: In epidemiological studies, serum ferritin was the second-strongest determinant of blood glucose (after BMI) in regression models and the third-strongest determinant of serum insulin (after BMI and age). Its concentration also correlated positively with plasma triglycerides and apolipoprotein B concentrations, and negatively with HDL2 cholesterol. We hypothesized that serum ferritin could be a marker of insulin resistance. RESEARCH DESIGN AND METHODS: Oral glucose tolerance and insulin sensitivity (SI, minimal model method) were prospectively evaluated in 36 healthy subjects. The relationship between serum ferritin and metabolic control (as measured by HbA1c levels) was also studied in 76 consecutive NIDDM patients. RESULTS: In healthy subjects, log-transformed serum ferritin (LOGFER) correlated with basal serum glucose (r = 0.44, P = 0.007), but not with BMI, age, systolic or diastolic blood pressure, total cholesterol, VLDL cholesterol, HDL cholesterol, total triglycerides, VLDL triglycerides, serum insulin, or HbA1c (all P = NS). Identical results were obtained when the two lowest quartiles of serum ferritin were evaluated separately. However, in the two highest quartiles, LOGFER correlated with BMI (0.50, P = 0.02), diastolic blood pressure (r = 0.8, P < 0.0001), serum LDL cholesterol (r = 0.57, P = 0.01), VLDL cholesterol (r = 0.48, P = 0.03), total cholesterol and HDL2 and HDL3 subtractions of HDL cholesterol (r = -0.68, -0.76, -0.55, P = 0.001. < 0.0001, and 0.01, respectively), total triglycerides (r = 0.60, P = 0.006), HDL2/HDL3 quotient (P = -0.71, P = 0.001), VLDL triglycerides (r = 0.65, P = 0.004), and serum uric acid (r = 0.51, P = 0.03), but not with systolic blood pressure (r = 0.38, P = 0.15). After adjusting for BMI, only the correlations between LOGFER and diastolic blood pressure (r = 0.7, P = 0.002) and HDL2/HDL3 quotient (r = -0.63, P = 0.01) remained significant. Strong correlations between LOGFER and glucose area under the curve during oral glucose tolerance test (Pearson's r = 0.73, P = 0.001) and SI (r = -0.68, P = 0.001), which remained significant after controlling for BMI, were observed. LOGFER (beta = -0.44, P = 0.01) and BMI (beta = -0.52, P = 0.004) constituted independent predictors of insulin sensitivity in a multivariate analysis (R2 = 0.68). In 76 consecutive NIDDM outpatients, serum glucose (P < 0.00001) and LOGFER (P = 0.03) independently predicted the value of HbA1c (R2 = 0.40) in a multiple linear regression analysis. CONCLUSIONS: The correlations among serum ferritin and diastolic blood pressure, HDL quotient, glucose area under the curve, and SI suggest that serum ferritin could be a marker of the insulin resistance syndrome. Serum ferritin may also be an independent determinant of poor metabolic control in the diabetic patient.

[Clinical, radiologic, ophthalmologic, and endocrine studies in the primary empty sella turcica syndrome (author's transl)]. / Estudio clínico-radiológico, oftalmológico y endocrino en la silla turca vacía primaria. A propósito de nueve casos.

The clinical, radiologic, ophthalmologic, and endocrine features of nine patients with the syndrome of primary empty sella turcica are described. Pneumoencephalography was diagnostic in the eight patients in whom it was performed, while the remaining case was diagnosed by computerized axial tomography. In two patients alterations of the visual fields were found, while another had a hypertensive eye fundus. Endocrine studies were normal in four patients; the following abnormalities were found in the remaining five cases: one case of partial deficiency of antidiuretic hormone associated to secondary amenorrhea, one case of functional galactorrhea, one case of lack of response of growth hormone to insulin hypoglycemia, one case of hypothalamic deficiency of the hypothalamus-pituitary-thyroid axis, and one case of panhypopituitarism. Pneumoencephalography gave the best diagnostic results but because of its dangers it must be performed only when computerized axial tomography gives negative or equivocal information and the patient is not a typical case (female sex, obese, multiparous, hypertensive, and or diabetid) in the forties.