[New glucose-lowering drugs for reducing cardiovascular risk in patients with type2 diabetes mellitus]. / Nuevos fármacos para la reducción del riesgo cardiovascular en pacientes con diabetes mellitus tipo 2.

Cardiovascular (CV) disease is the most common cause of mortality in patients with type2 diabetes (T2DM). In recent years, several glucose-lowering drugs from two therapeutic families, GLP-1 receptor agonists (GLP-1 RAs) and sodium-glucose co-transporter type 2 inhibitors (SGLT-2i), have shown a reduction in CV morbidity and mortality in patients with T2DM and high CV risk. SGLT-2i, unlike GLP-1 RAs, also reduce the risk of hospital admission due to heart failure. Both therapeutic groups reduce the progression of diabetic kidney disease (DKD). The cardioprotective mechanism of SGLT-2i appears to be predominantly haemodynamic and shows an early onset, while that of GLP-1 RAs is mostly anti-atherosclerotic with a slow and progressive onset. At present, several scientific societies recommend the preferential use of GLP-1 RAs and SGLT-2i, with demonstrated CV benefit in patients with T2DM and cardiovascular disease or DKD.

Real-world effectiveness and safety of dapagliflozin therapy added to a GLP1 receptor agonist in patients with type 2 diabetes.

BACKGROUND AND AIM: To evaluate the effectiveness and safety of a sodium-glucose cotransporter-2 (SGLT-2) inhibitor, dapagliflozin, in patients with type 2 diabetes mellitus (T2DM) and background glucagon-like peptide-1 receptor agonist (GLP1-RA) therapy. METHODS AND RESULTS: This is a 12-month, real-world observational study, which assessed the effectiveness and safety of dapagliflozin in patients with T2DM and background GLP1-RA therapy. The main outcome measures were changes in A1C and weight at 6 and 12 months from baseline. Secondary outcomes were differences in A1C and weight reduction between this cohort and another group of patients with T2DM treated with dapagliflozin but without background GLP1-RA therapy. In total, 109 patients with GLP1-RA and 104 patients without GLP1-RA were included. Baseline mean A1C and weight in the GLP1-RA and non-GLP1-RA groups were 7.4% vs. 7.3% and 96.2 kg vs. 95.1 kg, respectively. A significant reduction in A1C was seen with dapagliflozin in both cohorts at 6 and 12 months (GLP1-RA: -0.51% and -0.34%, non-GLP1-RA: -0.69% and -0.62%, respectively, p < 0.0001 in all analyses). Weight was significantly reduced in both groups at 6 and 12 months (GLP1-RA: -2.3 kg and -2.4 kg, non-GLP1-RA: -3.9 kg and -4.8 kg, respectively, p < 0.0001 in all analyses). A1C reduction and weight loss were significantly lower in patients with GLP1-RA than in patients without GLP1-RAs. Drug discontinuation rates were similar in both cohorts. CONCLUSIONS: Dapagliflozin, when added in real life to patients with T2DM treated with GLP1-RAs, induced a further significant, albeit modest improvement in A1C and a further weight loss.

Diferencias clínicas entre pacientes obesos mórbidos con y sin atracones / Clinical differences between morbid obese patients with and without binge eating

Introducción. Nuestro objetivo fue evaluar las diferencias clínicas de pacientes obesos con y sin alteraciones de la conducta alimentaria. Material y métodos. Se estudiaron a 210 pacientes con obesidad mórbida derivados de forma consecutiva a una consulta de psiquiatría en un hospital general por diferentes motivos. Se realizó una entrevista clínica, se valoró la presencia de comorbilidad psiquiátrica y se aplicaron una serie de escalas de psicopatología y de conducta alimentaria: Escala de Depresión de Beck (BDI), Escala de Ansiedad de Beck (BAI), Inventario de Obsesiones-Compulsiones de Maudsley (MOCI), Escala de Impulsividad de Barrat (BIS), Inventario de Trastornos de la Alimentación (EDI), Test de Actitudes hacia la Comida (EAT), Test de Bulimia de Edimburgo (BITE) y Cuestionario sobre la Figura Corporal (BSQ). La muestra se dividió en dos grupos: pacientes con conductas de atracones según las definiciones de la CIE-10 y el DSM-IV y aquellos sin estas conductas. En el primer grupo se incluyeron 14 pacientes con bulimia nerviosa, 32 con criterios de trastorno por atracón y 15 pacientes con atracones sin criterios para uno de los dos trastornos citados (total, 61 pacientes con atracones frente a 145 sin atracones). Resultados. Los pacientes con atracones tenían más psicopatología, fundamentalmente mayor prevalencia de distimia, eran más impulsivos según la BIS y obtenían puntuaciones más elevadas en algunas escalas que valoraban la alteración de la conducta alimentaria. Estos pacientes tenían más antecedentes familiares de trastornos de la conducta alimentaria (TCA) y presentaban mayor insatisfacción corporal a pesar de un menor índice de masa corporal (IMC). Este grupo refería mayores limitaciones funcionales debidas a su obesidad y presentaba mayor obsesividad sobre el peso y la comida. Conclusiones. Por tanto, los obesos mórbidos con atracones forman un grupo posiblemente homogéneo (independientemente del diagnóstico de trastorno de la conducta alimentaria presente) y diferenciado del resto de los obesos mórbidos por la existencia de mayor psicopatología fundamentalmente de tipo afectivo, mayor impulsividad y mayor severidad en las escalas que evalúan síntomas nucleares de los trastornos de la conducta alimentaria e insatisfacción corporal

Introduction. Our objective was to evaluate clinical differences between morbid obese patients with and without binge eating. Methods. We evaluated 210 morbid obese patients who were referred consecutively to a psychiatric evaluation in a general hospital for different reasons. We used a clinical interview, evaluated psychiatric comorbidity and applied a series of psychopathology and eating behavior scales: Beck Depression Inventory (BDI), Beck Anxiety Inventory (BAI), Maudsley Obsessive-Compulsive Interview (MOCI), Barrat Impulsiveness Scale (BIS), Eating Disorder Inventory (EDI), Eating Attitudes Test (EAT), Bulimic Investigatory Test Edinburgh (BITE) and Body Shape Questionnaire (BSQ). The sample was divided in two subgroups: patients with binge eating according to ICD-10 and DSM-IV criteria, and patients without binge eating. The first subgroup was composed of 14 patients with bulimia nervosa, 32 with binge eating disorder, and 15 patients with binge eating who did not fulfill criteria for bulimia or binge eating disorder (subgroup was composed by 61 patients vs 145 patients without binge eating). Results. Binge eating patients showed more psychopathology, more prevalence of dysthymia, higher score in impulsiveness, and scales that evaluated eating disorder. Binge eating patients showed more familial background of eating disorders; more body dissatisfaction in spite of a lower Body Mass Index (BMI). This group showed more functional disability induced by obesity and more weight and shape overconcern. Conclusions. The findings suggest that the morbid obese with binge eating constitute a distinct subgroup (independently of eating disorder diagnosis) among the obese population, with more psychopathology severity, especially affective disorder, more impulsivity, and more severity in core items of eating disorder scales and body dissatisfaction

Comorbilidad psiquiátrica y alteraciones de la conducta alimentaria en pacientes con obesidad mórbida candidatos a cirugía bariátrica / Tittle

Nuestros objetivos fueron evaluar las alteraciones psicopatológicas y de la conducta alimentaria de pacientes con obesidad mórbida derivados para evaluación previa a cirugía bariátrica. Se incluyeron 145 pacientes derivados de forma consecutiva para valoración psiquiátrica previa a la realización de cirugía bariátrica. Como grupo control se valoraron 65 pacientes con obesidad, igualmente derivados desde endocrinología de forma consecutiva por otros motivos de consulta (alteraciones de la conducta alimentaria y trastornos mentales comórbidos). Se realizó una entrevista clínica y se aplicaron varias escalas de psicopatología y de evaluación de la conducta alimentaria: escala de depresión de Beck (BDI), escala de ansiedad de Beck (BAI), inventario de obsesiones-compulsiones de Maudsley (MOCI), escala de impulsividad de Barrat (BIS), inventario de trastornos de la alimentación (EDI), test de actitudes hacia la comida (EAT), test de bulimia de Edimburgo (BITE) y cuestionario sobre la figura corporal (BSQ). Un 44,4% de los pacientes valorados para cirugía presentaba un diagnóstico psiquiátrico comórbido en el eje I del DSM-IV, fundamentalmente distimia (19,4%). Un 15,3% presentó un diagnóstico de trastorno de personalidad. Un 40% requirió el uso de psicofármacos, habitualmente antidepresivos. Respecto a la conducta alimentaria, un 16,6% presentaba atracones, un 4% criterios de bulimia nerviosa y casi un 14% criterios de trastorno de la conducta alimentaria no especificado, fundamentalmente el denominado trastorno por atracones. Aunque el grupo control presentaba mayor comorbilidad psiquiátrica y más trastornos de la ideación autolítica o en la mayoría de las escalas que medían psicopatología, insatisfacción corporal o conducta alimentaria. Los pacientes candidatos a un programa de cirugía bariátrica presentan una elevada comorbilidad psiquiátrica, fundamentalmente trastornos del humor, y severas alteraciones de la conducta alimentaria e insatisfacción corporal que justifican la presencia de una evaluación psiquiátrica previa a la cirugía

Our objectives were to evaluate psychopathological and eating disorders in morbid obese candidates to bariatric surgery. We evaluated 145 out-patients who were admitted to a psychiatric evaluation consecutively previous to surgical procedure. The control group was constituted by 65 out-patients with diagnosis of obesity referred from unit of endocrinology who were admitted to a psychiatric evaluation because mental or eating disorders. We used a clinical interview, we evaluated psychiatric comorbidity, and we applied the next scales: Beck depression inventory (BDI), Beck anxiety inventory (BAI), Maudsley obssesive-compulsive interview (MOCI), Barrat impulsiveness scale (BIS), eating disorder inventory (EDI), eating attitudes test (EAT), bulimic investigation test Edinburg (BITE), and body shape questionnaire (BSQ). Between morbid obese candidates to surgery, 44.4% had a diagnosis of mental disorder, mainly dysthimia (19.4%), additionaly 15.3% had a personality disorder. Between candidates to surgery, 16.6% had binge eating, 4% fulfilled criteria of bulimia nervosa and about 14% fulfilled criteria of eating disorders not otherwise specified, mainly the binge eating disorder. Control group had more pychiatric comorbidity and eating disorders, but they showed similar scores in majority of scales to evaluate psychopathology and eating disorders. The patients candidates to bariatric surgery had a elevated psychiatric comorbidity, mainly mood disorders, and elevated scores in core items of eating disorders scales and body dissatisfaction. These findings provide evidence to the need of a psychiatric evaluation among bariatric surgery candidates

[Clinical differences between morbid obese patients with and without binge eating]. / Deferencias clinicas entre pacientes obesos mórbidos con y sin atracones.

INTRODUCTION: Our objective was to evaluate clinical differences between morbid obese patients with and without binge eating. METHODS: We evaluated 210 morbid obese patients who were referred consecutively to a psychiatric evaluation in a general hospital for different reasons. We used a clinical interview, evaluated psychiatric comorbidity and applied a series of psychopathology and eating behavior scales: Beck Depression Inventory (BDI), Beck Anxiety Inventory (BAI), Maudsley Obsessive-Compulsive Interview (MOCI), Barrat Impulsiveness Scale (BIS), Eating Disorder Inventory (EDI), Eating Attitudes Test (EAT), Bulimic Investigatory Test Edinburgh (BITE) and Body Shape Questionnaire (BSQ). The sample was divided in two subgroups: patients with binge eating according to ICD-10 and DSM-IV criteria, and patients without binge eating. The first subgroup was composed of 14 patients with bulimia nervosa, 32 with binge eating disorder, and 15 patients with binge eating who did not fulfill criteria for bulimia or binge eating disorder (subgroup was composed by 61 patients vs 145 patients without binge eating). RESULTS: Binge eating patients showed more psychopathology, more prevalence of dysthymia, higher score in impulsiveness, and scales that evaluated eating disorder. Binge eating patients showed more familial background of eating disorders; more body dissatisfaction in spite of a lower Body Mass Index (BMI). This group showed more functional disability induced by obesity and more weight and shape overconcern. CONCLUSIONS. The findings suggest that the morbid obese with binge eating constitute a distinct subgroup (independently of eating disorder diagnosis) among the obese population, with more psychopathology severity, especially affective disorder, more impulsivity, and more severity in core items of eating disorder scales and body dissatisfaction.

Nutrición basada en la evidencia en el cáncer como enfermedad caquectizante / Evidence-based nutrition in cancer as a cachexia-inducing disease

La caquexia es un síndrome caracterizado por una progresiva e involuntaria pérdida de peso. Se habla del cáncer como enfermedad caquectizante por la prevalencia y la importancia de la caquexia en esta enfermedad. Es sabido que la malnutrición contribuye a menudo a la muerte del paciente con cáncer, pero antes de recomendar una terapia nutricional de forma sistemática debemos conocer los beneficios terapéuticos que realmente proporciona. El objetivo de este trabajo es una actualización del papel del soporte nutricional en el paciente oncológico, especialmente ante la caquexia, basándose en la mayor evidencia científica existente. Para ello, se ha realizado una búsqueda bibliográfica exhaustiva utilizando las bases de datos informáticas MEDLINE y EBM Reviews Multifile PubMed. Pocos son los trabajos que evalúan la nutrición como elemento terapéutico en la caquexia por cáncer. La mayoría no diferencian entre el paciente con o sin malnutrición, e incluso utilizan la malnutrición grave como criterio de exclusión. El soporte nutricional tiene un efecto terapéutico beneficioso en enfermos con cáncer, pero está limitado a un pequeño grupo con malnutrición moderadagrave. Los datos disponibles sugieren que el aumento del aporte calórico-proteico a través de la nutrición artificial convencional no mejora el estado nutricional de los pacientes con enfermedad caquectizante y no altera la progresión de la caquexia. Recientes investigaciones están centradas en el efecto anticaquexia del aceite de pescado, pero las evidencias actuales todavía no son definitivas (AU)

Cachexia is characterized by progressive and involuntary weight loss. Cancer is considered to be a cachexia-inducing disease because of the prevalence and importance of cachexia in malignant neoplastic disease. It is well known that malnutrition frequently contributes to the death of cancer patients. However, before routinely recommending nutritional therapy, the real therapeutic benefits it confers should be identified. The present article aims to provide an update on the role of nutritional support in oncological patients, especially in those with cachexia, based on the best scientific evidence available. An exhaustive literature search was performed in Medline and EBM databases (Reviews Multifile PubMed). Few studies have evaluated nutrition as a therapeutic modality in cancer-induced cachexia. Most studies do not differentiate between patients with or without malnutrition, and even use severe malnutrition as an exclusion criterion. Nutritional support has a beneficial effect in cancer patients but is limited to a small group with moderate to severe malnutrition. The available data suggest that the increase in caloric-protein intake through conventional artificial nutrition does not improve the nutritional status of patients with cachexiainducing disease and does not alter the progression of cachexia. Recent investigations center on the anti-cachexia effect of fish oil but current evidence is still not definitive (AU)

[Incidence of gestational diabetes mellitus according to different diagnostic criteria in the southeast Madrid area. Influence of diagnosis on materno-fetal parameters]. / Incidencia de la diabetes mellitus gestacional según distintos criterios diagnósticos en la zona suroeste de Madrid. Influencia del diagnóstico sobre los parámetros maternofetales.

BACKGROUND. In 1997, The Fourth International Workshop-Conference on Gestational Diabetes Mellitus (GDM) recommended the use of Carpenter and Coustan diagnostic criteria instead of those of Sullivan and Mahan used until then. The objective of this work was to study the incidence of GDM in the southeast Madrid area by applying both the classical and new criteria, as well as to determine whether patients diagnosed of GDM by the new criteria present a higher materno-fetal morbidity than treated GDM patients or non diabetic pregnant patients.Methods. Review of a cohort of 1,293 pregnant women from September 1998 to August 1999 who were screened for GDM. The annual cumulated incidence of GDM was estudied by using both diagnostic criteria and materno-fetal evolution of four groups of patients classified according to glucose intolerance degree. RESULTS. The annual cumulated incidence of GDM was 4.8% and 7.3% using the classical criteria and the new criteria, respectively. GDM patients fulfilling only the new criteria and not treated as such had children with a significantly higher birth-weight than the other groups, and a trend towards a higher percentage of macrosomies, instrumental deliveries and cesarean sections in such group was observed, although they were not statistically significant. CONCLUSIONS. The incidence of GDM in the southeast Madrid area was similar to that among other Caucasian populations and increased by 52% when the new diagnostic criteria were used. It is our opinion that a study with a larger number of patients should be conducted before the new diagnostic criteria are applied in our country.

Incidencia de la diabetes mellitus gestacional según distintos criterios diagnósticos en la zona suroeste de Madrid. Influencia del diagnóstico sobre los parámetros maternofetales / Incidence of gestational diabetes mellitus according to different diagnostic criteria in the southeast Madrid area. Influence of diagnosis on materno-fetal parameters

Objetivo. En 1997, la Cuarta Conferencia Internacional sobre diabetes mellitus gestacional (DMG) recomendó la aplicación de los criterios diagnósticos de Carpenter y Coustan en lugar de los criterios de O’Sullivan y Mahan utilizados hasta entonces. El objetivo de este trabajo es estudiar la incidencia de DMG en el área suroeste de Madrid aplicando los criterios clásicos y nuevos, así como determinar si las pacientes diagnosticadas de DMG por los nuevos criterios presentan una mayor morbilidad maternofetal que las DMG tratadas o las gestantes no diabéticas. Metodología. Revisión de una cohorte de 1 .2 9 3 gestantes durante el período de septiembre de 1998-agosto de 1999 a las que se les realizó despistaje de DMG. Se estudia la incidencia acumulada anual de DMG utilizando ambos criterios diagnósticos y la evolución maternofetal de cuatro grupos de pacientes clasificadas según el grado de intolerancia a la glucosa. Resultados. La incidencia acumulada anual de DMG fue del 4 ,8 % utilizando los criterios clásicos, y del 7,3% aplicando los nuevos criterios. Las pacientes con DMG que sólo cumplían los nuevos criterios y no fueron tratadas como tales tuvieron hijos con un peso sensiblemente mayor que el resto de grupos, observándose una tendencia a un mayor porcentaje de macrosomías, partos instrumentales y cesáreas en dicho grupo, aunque sin alcanzar significación en la estadística. Conclusiones. La incidencia de DMG en el área suroeste de Madrid es similar a la de otras poblaciones caucásicas, y se incrementa en un 5 2 % al aplicar los nuevos criterios diagnósticos. Creemos necesaria la realización de un estudio con mayor número de pacientes antes de aplicar los nuevos criterios diagnósticos en nuestro país (AU)

Background. In 1997, The Fourth International Workshop-Conference on Gestational Diabetes Mellitus (GDM) recommended the use of Carpenter and Coustan diagnostic criteria instead of those of Sullivan and Mahan used until then. The objective of this work was to study the incidence of GDM in the southeast Madrid area by applying both the classical and new criteria, as well as to determine whether patients diagnosed of GDM by the new criteria present a higher materno-fetal morbidity than treated GDM patients or non diabetic pregnant patients. Methods. Review of a cohort of 1,293 pregnant women from September 1998 to August 1999 who were screened for GDM. The annual cumulated incidence of GDM was estudied by using both diagnostic criteria and materno-fetal evolution of four groups of patients classified according to glucose intolerance degree. Results. The annual cumulated incidence of GDM was 4 .8 % and 7 .3 % using the classical criteria and the new criteria, respectively. GDM patients fulfilling only the new criteria and not treated as such had children with a significantly higher birth- weight than the other groups, and a trend towards a higher percentage of macrosomies, instrumental deliveries and cesarean sections in such group was observed, although they were not statistically significant. Conclusions. The incidence of GDM in the southeast Madrid area was similar to that among other Caucasian populations and increased by 5 2 % when the new diagnostic criteria were used. It is our opinion that a study with a larger number of patients should be conducted before the new diagnostic criteria are applied in our country (AU)

Síndrome de wolfram. Comunicación de una nueva familia y revisión de aspectos clínicos y genéticos de la enfermedad / Wolfram syndrome. Report of a new family and review of clinical and genetic aspects of this disease

El síndrome de Wolfram es un cuadro neurodegenerativo hereditario con transmisión autosómica recesiva, caracterizado por la asociación de diabetes mellitus de inicio en la juventud y atrofia óptica, y presenta con frecuencia otras manifestaciones clínicas como diabetes insípida central y sordera neurosensorial. En el presente artículo se expone el caso índice de una nueva familia con síndrome de Wolfram, cuyo principal hallazgo de interés fue la presencia, en la resonancia magnética, de alteraciones morfológicas encefálicas características y que han sido descritas recientemente en un 18 por ciento de los pacientes con este síndrome (AU)

[Pancreatitis and inappropriate ADH secretion syndrome associated with amiodarone]. / Pancreatitis y síndrome de secreción inadecuada de ADH asociados a amiodarona.

We describe a case of hepatotoxicity, pancreatitis and inappropriate ADH secretion syndrome developed in a patient receiving chronic amiodarone treatment, not related to other causes. Hepatic toxicity is a well known condition. Inappropriate ADH secretion syndrome has not been described yet and there has been a single case-report of pancreatitis in the literature reviewed.