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

Antecedentes y objetivos En los pacientes con diabetes mellitus tipo2 (DM2) la presencia de aumento de la circunferencia de la cintura y de los triglicéridos es un reflejo del aumento de la grasa visceral y de la resistencia a la insulina. Sin embargo, es escasa la información acerca de la prevalencia y de las características clínicas del fenotipo de cintura hipertrigliceridémica (CHTG) en pacientes con DM2. El objetivo del presente estudio fue analizar la prevalencia y las características de los pacientes de DM2 con CHTG. Métodos En este estudio epidemiológico transversal, llevado a cabo en centros de atención primaria de toda España entre los años 2011 y 2012, analizamos a 4.214 pacientes con DM2. El fenotipo CHTG fue definido como un aumento de la circunferencia de la cintura conforme a los criterios de la Federación Internacional de Diabetes para caucásicos (≥94cm para hombres y ≥80cm para mujeres) acompañado de niveles de triglicéridos ≥150mg/dl. Comparamos las variables demográficas, clínicas y analíticas según la presencia o ausencia del fenotipo CHTG. Resultados El 35% de los pacientes presentaron el fenotipo CHTG. Los pacientes con fenotipo CHTG tenían mayor índice de masa corporal (31,14±4,88 vs. 29,2±4,82kg/m2; p<0,001) y hemoglobina glucosilada más alta (7,38±1,2% vs. 7±1,07%; p<0,001). La presencia de hipertensión, enfermedad arterial periférica, insuficiencia cardíaca y complicaciones microvasculares fueron más frecuentes en los pacientes con fenotipo CHTG que los que no lo tenían. Los pacientes con fenotipo CHTG tenían una menor adherencia a la dieta prescrita (69,8 vs. 81%; p<0,001), al ejercicio (44,6 vs. 58,2%; p<0,001), y el aumento de peso en el año previo al estudio fue mayor (29,4 vs. 22,5%; p<0,001). Conclusiones El fenotipo CHTG es prevalente en la población DM2 española e identifica a un subgrupo de pacientes con un elevado riesgo cardiometabólico y mayor prevalencia de complicaciones diabéticas (AU)

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 (AU)

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.

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.

Control glucémico en pacientes con diabetes mellitus tipo 2 en España / Glycemic control in patients with type 2 diabetes mellitus in Spain

Objetivo. Evaluar el grado de control glucémico en los pacientes con diabetes tipo 2 (DM2) en España, e identificar los factores asociados con el nivel de control glucémico. Pacientes y métodos. Estudio epidemiológico transversal, multicéntrico realizado en consultas de atención primaria en España. Se incluyeron 5.591 pacientes con DM2 (> 1año evolución) y con tratamiento farmacológico (>3 meses). En una única visita, se determinó la HbA1c (sistema A1cNow+) y se registraron las variables relacionadas con la diabetes y su tratamiento, los factores de riesgo cardiovascular (FRCV), la presencia de lesiones de órgano diana (LOD), y la presencia de hipoglucemia y modificación del peso en el año previo. Resultados. Se analizaron los datos de 5.382 pacientes (edad media 66,7 años; 8,8 años de evolución); el 43,6% presentaban alguna LOD y el 59,1% recibían ≥ 2 fármacos. La HbA1c media fue de 7,1 (1,1)% y el 48,6% tenían HbA1c<7,0%. Los pacientes con HbA1c≥7,0% presentaban mayor duración de la diabetes, mayor prevalencia de LOD y FRCV, usaban terapias más complejas y en el año previo presentaron más hipoglucemias y mayor aumento de peso. En el análisis multivariante, la ausencia de tratamiento con insulina, la ausencia de obesidad abdominal y dislipemia aterogénica, el tiempo de evolución de DM2<10 años y la edad>70 años se asociaron con mejor control glucémico. Conclusiones. la proporción de DM2 con deficiente control en España es elevada. Los factores que reflejan la complejidad de la enfermedad y del tratamiento hipoglucemiante, así como el antecedente de hipoglucemia y aumento de peso, se asocian con peor control glucémico (AU)

Objective. To evaluate the degree of glycemic control in patients with type 2 diabetes in Spain and identify factors associated with glycemic control. Patients and methods. This was a cross-sectional, multicenter, epidemiological study that used consecutive sampling and was conducted in primary care practices in Spain. A total of 5591 patients with type 2 diabetes mellitus lasting more than 1 year and who were treated with hypoglycemic agents for more than 3 months were included in the study. At a single visit, HbA1c levels were measured (A1cNow+ system) and demographic and clinical variables related to diabetes and its treatment were recorded. During the visit, CV risk factors (CVRF), the presence of target-organ damage (TOD), the presence of hypoglycemia and body weight changes within the previous year were recorded. Results. We analyzed data from 5382 patients (mean age 66.7 [10.8] years, mean duration of the diabetes 8.8 [6.3] years). TOD was present in 43.6% of the patients and 59.1% were taking 2 or more drugs. The patients’ mean HbA1c was 7.1 (1.1)%, and 48.6% had HbA1c levels <7.0%. The patients with HbA1c levels ≥7.0% had longer-standing diabetes, a higher prevalence of TOD and CVRF, used more complex therapies, experienced more hypoglycemic episodes in the previous year and had more weight gain. In the multivariate analysis, the absence of insulin treatment, the absence of abdominal obesity and atherogenic dyslipidemia, a duration of the diabetes <10 years and an age >70 years were associated with improved glycemic control. Conclusions. Patients with poorly controlled type 2 diabetes mellitus are highly prevalent in Spain. Factors associated with poorer glycemic control include the complexity of both the disease and the hypoglycemic therapy, a history of hypoglycemia and weight gain (AU)

Efficacy and feasibility of basal-bolus insulin regimens and a discharge-strategy in hospitalised patients with type 2 diabetes--the HOSMIDIA study.

AIMS: Guidelines recommend use of basal-bolus insulin in hospitalised patients with hyperglycaemia, but information about implementation and medication reconciliation at discharge is scarce. The HOSMIDIA study evaluated a management program involving basal-bolus insulin and an algorithm for medication reconciliation at discharge in non-critically ill hospitalised patients with type 2 diabetes in clinical practice. METHODS: HOSMIDIA was a prospective, observational study performed during routine clinical practice at 15 Spanish hospitals during hospitalisation, with follow-up 3 months postdischarge. Study patients (n = 134) received a basal-bolus regimen with insulin glargine during hospitalisation and treatment at discharge was adjusted according to a simple algorithm. The control group (n = 62) included patients with similar characteristics hospitalised during the month before study initiation and had no follow-up after discharge. RESULTS: Compared with control subjects, patients in the prospective study achieved lower mean total (167.7 ± 41.1 vs. 190.5 ± 53.3 mg/dl) preprandial (164.2 ± 42.4 vs. 189.6 ± 52.6 mg/dl; p < 0.001) and fasting (137.0 ± 42.2 vs. 165.8 ± 56.5 mg/dl) blood glucose levels while hospitalised, without increased hypoglycaemic episodes (17.7% vs. 19.3% patients). In the prospective study, glycaemic control improved from admission to discharge, with control maintained 3 months after discharge. The main treatment modification at discharge compared with admission was addition of basal insulin, and treatment at discharge was maintained at 3 months in 89% of patients. CONCLUSION: The HOSMIDIA study confirmed that management of hyperglycaemia with basal-bolus insulin is feasible and effective in routine clinical practice, and that a simple strategy facilitating the reconciliation of medication on discharge can improve glycaemic control postdischarge.

Glycemic control in patients with type 2 diabetes mellitus in Spain. / Control glucémico en pacientes con diabetes mellitus tipo 2 en España.

OBJECTIVE: To evaluate the degree of glycemic control in patients with type 2 diabetes in Spain and identify factors associated with glycemic control. PATIENTS AND METHODS: This was a cross-sectional, multicenter, epidemiological study that used consecutive sampling and was conducted in primary care practices in Spain. A total of 5591 patients with type 2 diabetes mellitus lasting more than 1 year and who were treated with hypoglycemic agents for more than 3 months were included in the study. At a single visit, HbA1c levels were measured (A1cNow+ system) and demographic and clinical variables related to diabetes and its treatment were recorded. During the visit, CV risk factors (CVRF), the presence of target-organ damage (TOD), the presence of hypoglycemia and body weight changes within the previous year were recorded. RESULTS: We analyzed data from 5382 patients (mean age 66.7 [10.8] years, mean duration of the diabetes 8.8 [6.3] years). TOD was present in 43.6% of the patients and 59.1% were taking 2 or more drugs. The patients' mean HbA1c was 7.1 (1.1)%, and 48.6% had HbA1c levels <7.0%. The patients with HbA1c levels ≥7.0% had longer-standing diabetes, a higher prevalence of TOD and CVRF, used more complex therapies, experienced more hypoglycemic episodes in the previous year and had more weight gain. In the multivariate analysis, the absence of insulin treatment, the absence of abdominal obesity and atherogenic dyslipidemia, a duration of the diabetes <10 years and an age >70 years were associated with improved glycemic control. CONCLUSIONS: Patients with poorly controlled type 2 diabetes mellitus are highly prevalent in Spain. Factors associated with poorer glycemic control include the complexity of both the disease and the hypoglycemic therapy, a history of hypoglycemia and weight gain.

Severe Hypocalcemia due to Vitamin D Deficiency after Extended Roux-en-Y Gastric Bypass.

Vitamin D deficiency is a well-known comorbidity of obesity that can be exacerbated after bariatric surgery and can predispose the patient for hypocalcemia. Vitamin D and calcium doses to prevent and treat vitamin D deficiency after weight loss surgery are not well defined. We describe a patient who developed severe hypocalcemia due to vitamin D deficiency 5 years after an extended Roux-en-Y gastric bypass for a type II obesity. No precipitating factors were present and malabsorption induced by the bypass was considered to be the main causative factor. High doses of vitamin D and calcium were needed to reach and maintain normal calcium and vitamin D concentrations. This case emphasises the importance of routine screening for vitamin D deficiency in obese individuals and reflects that while consensus does not exist regarding optimal dosage, vitamin D replacement should be tittered based on calcidiol levels.