Diabetes mellitus tipo 2 crónica / Type 2 diabetes mellitus. Chronic complications

La diabetes mellitus tipo 2 es una enfermedad con una elevada prevalencia en nuestro medio, y con un gran impacto socioeconómico por constituir un factor de riesgo cardiovascular. Además, la diabetes mellitus tipo 2 presenta complicaciones crónicas que redundan en una mayor morbimortalidad. En el ámbito hospitalario, es una enfermedad altamente prevalente, motivo de ingreso o que empeora la evolución de enfermedades concomitantes. Dentro de las complicaciones crónicas de la diabetes, distinguimos las complicaciones microvasculares y macrovasculares. En ambas, el estricto control glicémico puede disminuir el riesgo de presentarlas, y además en las complicaciones microvasculares puede disminuir el riesgo de progresión de las mismas. Para reducir el riesgo de evolución de las complicaciones macrovasculares es necesario un abordaje integral que incluya el control de la hiperglucemia, la dislipemia, la hipertensión y el tabaquismo. El abordaje dietético en la diabetes mellitus tipo 2 va dirigido a controlar la hiperglucemia, a disminuir la hiperglicemia y la hipertrigliceridemia postprandial, a mejorar el perfil lipídico y a controlar la hipertensión arterial. En las situaciones en las que el paciente diabético precisa nutrición enteral deben considerarse los mismos objetivos de control metabólico que en el paciente que sigue dieta oral. Por ello, se han desarrollado fórmulas de nutrición enteral que ayuden a mejorar el perfil metabó- lico de los pacientes diabéticos, modificando el contenido y la fuente de carbohidratos, lípidos y fibra. Los pacientes con nefropatía diabética se benefician de una dieta baja en proteínas para retrasar la evolución a insuficiencia renal terminal. Los pacientes que presentan gastroparesia o enteropatía diabética deben considerarse de forma individual, y el tratamiento nutricional debe plantearse conjuntamente con otros tratamientos que ayuden a sincronizar el tratamiento hipoglucemiante con la absorción de nutrientes (AU)

Type 2 diabetes mellitus is a high prevalent disease in our area, with a great socioeconomic impact for constituting an important cardiovascular risk factor. In addition, type 2 diabetes mellitus produce chronic complications that redound in a major morbidity and mortality. In the hospital area, it is a highly prevalent disease, that motivate the hospital income or that worsens the evolution of concomitant diseases. Considering the chronic complications of diabetes, we distinguish the microvascular and macrovascular complications. In both, the strict glycemic control can diminish the risk of develop them, and in addition in case of microvascular complications it can diminish the risk of progression of the same ones. To reduce the risk of progression of macrovascular complications is necessary an integral boarding that includes the control of the hyperglycemia, the dislipemia, the hypertension and the smoking habit. The dietetic treatment in type 2 diabetes mellitus is focused to control the hyperglycemia, to diminish the postprandial hyperglycemia and hipertriglyceridemia, to improve the lipid profile and to control hypertension. In the situations in which the diabetic patient needs enteral nutrition we must be considered the same aims of metabolic control that in the patient who are on oral diet. For these reason, enteral nutrition formula have been developed to improve the metabolic profile of the diabetic patients, modifying the content and the source of carbohydrates, lipids and fiber. The patients with diabetic nephropathy benefits from a low diet for delay the evolution to renal terminal insufficiency. The patients who present gastroparesis or diabetic enteropathy must be considered of individual form and the nutritional treatment must appear together with other treatments that help to synchronize the hypoglycemic treatment with the absorption of nutrients (AU)

[Head and neck cancer patients included at home enteral nutrition by tube]. / Pacientes afectos de neoplasia de cabeza-cuello con nutrición enteral domiciliaria por sonda.

OBJECTIVE: To know characteristics and the patients' evolution with head and neck cancer who received radiotherapy treatment and they were included at a home enteral nutrition (HEN) by feeding tube programme. To analyse the weight evolution according to the start of HEN before or after radiotherapy. METHODS: Observational study of tube feeding patients with head and neck cancer who were included in HEN programme in our hospital for two years. Variables analysed: gender, age, Body Mass Index (BMI), Karnofsky Index (KI), reason for nutritional support, type of feeding tube, formula used and prescribed caloric contribution, necessity to change access device and HEN days. RESULTS: 62 patients were studied (77.4% men; 22.6% women). Age 64 +/- 10.1 years (rang: 39-90). The dysphagia was the main cause to begin enteral nutrition by feeding tube in these patients. Naso-gastric tube was prevalence (67.7%). The most used formula was polymeric hypercaloric diet with a mean of caloric contribution of 1,629 +/- 267.09 kcal/day. Overall, there was a weight loss in all patients during the study period time. However, patients who began the HEN by feeding tube before the radiotherapy treatment, the BMI did not decrease. CONCLUSION: All patients who began feeding tube before oncological treatment didn't lose weight for the period of study.

Pacientes afectos de neoplasia de cabeza-cuello con nutrición enteral domiciliaria por sonda / Head and neck cancer patients included at home enteral nutrition by tube

Objetivo: Conocer las características y la evolución de los pacientes diagnosticados de neoplasia de cabeza y cuello (NCC) que precisaron recibir tratamiento de radioterapia y que fueron atendidos en un programa de nutrición enteral por sonda a domicilio (NESD). Análisis del peso en función de administrar la nutrición enteral antes o después del inicio de la radioterapia. Material y métodos: Estudio observacional de pacientes con NCC incluidos en el programa de NESD de nuestro hospital durante 2 años. Variables analizadas: sexo, edad, índice de masa corporal (IMC), índice de Karnofsky (IK), motivo del inicio de soporte nutricional, tipo de sonda para la administración de la nutrición, tipo de fórmula nutricional y aporte calórico prescrito, necesidad de cambio de vía y días de NESD. Resultados: Se incluyeron 62 pacientes (77,4% varones y 22,6% hembras) con una edad media de 64 años ± 10,1 (rango entre 39 y 90). La disfagia fue el motivo principal de colocación de sonda en estos pacientes. Predominio de sonda nasogástrica (67,7%). La fórmula más utilizada fue la polimérica hipercalórica con un aporte calórico de 1.629 ± 267,09 kcal/día. Globalmente, se observó una pérdida de peso en todos los pacientes durante el período de estudio. Sin embargo, aquellos en los que se inició la NESD antes de la radioterapia el IMC no disminuyó. Conclusión: Los pacientes que iniciaron nutrición por sonda con anterioridad al tratamiento oncológico no perdieron peso durante el periodo de estudio (AU)

Objective: To know characteristics and the patients' evolution with head and neck cancer who received radiotherapy treatment and they were included at a home enteral nutrition (HEN) by feeding tube programme. To analyse the weight evolution according to the start of HEN before or after radiotherapy. Methods: Observational study of tube feeding patients with head and neck cancer who were included in HEN programme in our hospital for two years. Variables analysed: gender, age, Body Mass Index (BMI), Karnofsky Index (KI), reason for nutritional support, type of feeding tube, formula used and prescribed caloric contribution, necessity to change access device and HEN days. Results: 62 patients were studied (77.4% men; 22.6% women). Age 64 ± 10.1 years (rang: 39-90). The dysphagia was the main cause to begin enteral nutrition by feeding tube in these patients. Naso-gastric tube was prevalence (67.7%). The most used formula was polymeric hypercaloric diet with a mean of caloric contribution of 1,629 ± 267.09 kcal/day. Overall, there was a weight loss in all patients during the study period time. However, patients who began the HEN by feeding tube before the radiotherapy treatment, the BMI did not decrease. Conclusion: All patients who began feeding tube before oncological treatment didn't lose weight for the period of study (AU)