Beneficios de un programa ambulatorio de ejercicio físico en sujetos mayores con diabetes mellitus tipo 2 / Benefits of a home-based physical exercise program in elderly subjects with type 2

Objetivo: Analizar los efectos de un programa ambulatorio de ejercicio físico (PEFA) sobre la calidad de vida, el control metabólico y variables antropométricas y bioquímicas en diabéticos tipo 2 mayores de 60 años. Pacientes y métodos Ochenta y cuatro pacientes mayores de 60 años fueron finalmente randomizados a realizar un programa ambulatorio de ejercicio físico combinado (aeróbico y anaeróbico) o a recibir tratamiento convencional para su diabetes, incluyendo dieta y ejercicio. A los seis meses, se evaluó el efecto sobre la calidad de vida (test EuroQol), HbA1c, glucemia en ayunas, frecuencia de hipoglucemias, peso, IMC, perímetro cintura, presión arterial y otros parámetros bioquímicos. Resultados La edad media de los pacientes que participaron en el estudio fue de 66,7 (8,0) años. Los pacientes incluidos en el grupo de ejercicio mejoraron su calidad de vida a los 6 meses: EuroQol 0,67 (0,37) vs 0,76 (0,26) y escala analógica 67,97 (18,92) vs 76,26 (20,14). Además se demostró una mejoría del control metabólico con HbA1c 6,35 vs 6,0%, glucosa en ayunas 151,2 (36,7) vs 137,6 (23,5) mg/dL y una reducción de peso de 1,7kg. Ninguno de estos beneficios se observó en el grupo control. No se demostró un incremento en la prevalencia de hipoglucemias. 10 pacientes abandonaron el estudio antes de los 6 meses. Conclusiones Un programa ambulatorio de ejercicio físico mejora la calidad de vida, el control metabólico y el peso en sujetos mayores de 60 años con diabetes mellitus tipo 2(AU)

Objective: To analyze the effects of a home-based physical exercise program on quality of life, metabolic control, and anthropometric and biochemical parameters in people over 60 years of age with type 2 diabetes mellitus. Methods: Eighty-four Spanish patients aged over 60 years were finally randomized to participatein a home-based, combined physical exercise program (aerobic and anaerobic exercises) or to receive conventional treatment for diabetes. At 6 months, effects on quality of life (EuroQoL questionnaire). HbA1c, fasting glucose, hypoglycemic events, weight, BMI, waist circumference, blood pressure, and biochemical parameters were assessed. Results: Mean age of study participants was 66.7 (8.0) years. Patients in the exercise group showed an improved quality of life at six months based on EuroQol: 0.48 (0.38) vs 0.66 (0.35)and analogic scale 67.97 (18.92) vs 76.26 (20.14). An improved glycemic control was also seen:HbA1c 6.35 vs 6.0% and fasting glucose 151.2 (36.7) vs 137.6 (23.5) mg/dL, as well as a weigh treduction by 1.7 kg. Hypoglycemic events did not increase. No benefits were seen in the control group. Ten subjects withdrew from the study before 6 months. Conclusions: A home-based physical exercise program improves quality of life, glycemic control, and weight in type 2 diabetic patients older than 60 years (AU)

[Benefits of a home-based physical exercise program in elderly subjects with type 2 diabetes mellitus]. / Beneficios de un programa ambulatorio de ejercicio físico en sujetos mayores con diabetes mellitus tipo 2.

OBJECTIVE: To analyze the effects of a home-based physical exercise program on quality of life, metabolic control, and anthropometric and biochemical parameters in people over 60 years of age with type 2 diabetes mellitus. METHODS: Eighty-four Spanish patients aged over 60 years were finally randomized to participate in a home-based, combined physical exercise program (aerobic and anaerobic exercises) or to receive conventional treatment for diabetes. At 6 months, effects on quality of life (EuroQoL questionnaire). HbA1c, fasting glucose, hypoglycemic events, weight, BMI, waist circumference, blood pressure, and biochemical parameters were assessed. RESULTS: Mean age of study participants was 66.7 (8.0) years. Patients in the exercise group showed an improved quality of life at six months based on EuroQol: 0.48 (0.38) vs 0.66 (0.35) and analogic scale 67.97 (18.92) vs 76.26 (20.14). An improved glycemic control was also seen: HbA1c 6.35 vs 6.0% and fasting glucose 151.2 (36.7) vs 137.6 (23.5) mg/dL, as well as a weight reduction by 1.7 kg. Hypoglycemic events did not increase. No benefits were seen in the control group. Ten subjects withdrew from the study before 6 months. CONCLUSIONS: A home-based physical exercise program improves quality of life, glycemic control, and weight in type 2 diabetic patients older than 60 years.

Pauta óptima de administración de insulina detemir en sujetos diabéticos tipo 1 con mal control metabólico / Optimal timing of insulin detemir injection in patients with type 1 diabetes and poor metabolic control

Objetivo El objetivo de este estudio fue comparar diversos regímenes de administración de la insulina detemir (IDet) en pacientes con diabetes tipo I y mal control metabólico.Material y métodosEstudio abierto aleatorizado de 24 semanas de duración. Se incluyeron 39 pacientes con diabetes mellitus (DM) tipo I aleatorizados a una inyección de IDet antes de la comida (14,24±00,36[±SD]h) o IDet antes de acostarse (23,19±0,42h). Si no se alcanzaban los objetivos de glucemia, se cambió a la pauta con 2 inyecciones (IDet-12h). En las comidas se administró insulina aspart.ResultadosEn la semana 24 solamente un 12,2% de los pacientes permanecían en el grupo IDet antes de acostarse y un 30,3% en el grupo IDet antes de la comida. El 57,5% restantes pasaron al grupo de IDet-12h. No hubo diferencias entre el grupo de IDet antes de la comida e IDet antes de acostarse. Un subanálisis incluyendo los 3 grupos demostró un mejor control metabólico en el grupo IDet antes de la comida (hemoglobina glicosilada (HbA1c) 7,1±0,2 vs. 7,6±0,4 y 8,1±0,2%, en IDet antes de la comida, IDet antes de acostarse e IDet-12h, respectivamente; p<0,05). El valor de HbA1c inferior a 7%, fue alcanzado en un 30,3% de los pacientes, un 15,2% en el grupo IDet antes de la comida, un 3,3% en el grupo IDet antes de acostarse y 11,5% en grupo IDet-12h. No se encontraron diferencias entre los grupos del tratamiento respecto a la calidad de vida.ConclusiónUna inyección de IDet administrada antes de la comida podría mejorar el control metabólico. Sin embargo, la mayoría de pacientes requiere 2 inyecciones de IDet (AU)

Aim To compare different administration times of insulin detemir (IDet) in patients with type 1 diabetes and poor metabolic control.Material and MethodsThis 24-week open study included 39 people with type 1 diabetes mellitus (DM) randomized to one injection of IDet before lunch (mean 14.24±00.36 (±SD) h) or at bedtime (23.19±0.42h). Whenever target glycemia levels were not reached, the regimen was switched to insulin therapy with two injections (IDet-12h). Insulin aspart was used before main meals.ResultsAt week 24, only 12.2% of patients remained in the IDet bedtime group and 30.3% in the IDet before lunch group. The remaining 57.5% joined the IDet-12h group. There were no differences between the IDet before lunch and IDet bedtime groups. A subanalysis including the three groups demonstrated better metabolic control in the IDet before lunch group (glycosylated hemoglobin (HbA1c) 7.1±0.2 vs. 7.6±0.4 and 8.1±0.2% in IDet before-lunch, IDet bedtime and IDet-12h, respectively; p<0.05). An HbA1c value below 7% was achieved in 30.3% of the patients: 15.2% in the IDet before-lunch group, 3.3% in the IDet bedtime group and 12.2% in IDet-12h group. Quality of life did not differ among treatment groups.ConclusionsOne injection of IDet administered before lunch could improve metabolic control. However, most patients required two injections of IDet(AU)

[Optimal timing of insulin detemir injection in patients with type 1 diabetes and poor metabolic control]. / Pauta óptima de administración de insulina detemir en sujetos diabéticos tipo 1 con mal control metabólico.

AIM: To compare different administration times of insulin detemir (IDet) in patients with type 1 diabetes and poor metabolic control. MATERIAL AND METHODS: This 24-week open study included 39 people with type 1 diabetes mellitus (DM) randomized to one injection of IDet before lunch (mean 14.24 + or - 00.36 (+ or - SD) h) or at bedtime (23.19 + or - 0.42 h). Whenever target glycemia levels were not reached, the regimen was switched to insulin therapy with two injections (IDet-12h). Insulin aspart was used before main meals. RESULTS: At week 24, only 12.2% of patients remained in the IDet bedtime group and 30.3% in the IDet before lunch group. The remaining 57.5% joined the IDet-12h group. There were no differences between the IDet before lunch and IDet bedtime groups. A subanalysis including the three groups demonstrated better metabolic control in the IDet before lunch group (glycosylated hemoglobin (HbA1c) 7.1 + or - 0.2 vs. 7.6 + or - 0.4 and 8.1 + or - 0.2% in IDet before-lunch, IDet bedtime and IDet-12h, respectively; p<0.05). An HbA1c value below 7% was achieved in 30.3% of the patients: 15.2% in the IDet before-lunch group, 3.3% in the IDet bedtime group and 12.2% in IDet-12h group. Quality of life did not differ among treatment groups. CONCLUSIONS: One injection of IDet administered before lunch could improve metabolic control. However, most patients required two injections of IDet.

[An ambulatory physical exercise program improves in the short term weight and quality of life of obese post-menopausal women]. / Mejora a corto plazo del peso y la calidad de vida de mujeres obesas posmenopáusicas mediante un programa ambulatorio de ejercicio físico.

OBJECTIVES: To evaluate the effects of an ambulatory physical exercise program on the quality of life, anthropometric and biochemical parameters in obese post-menopausal women. METHODS: One hundred and six obese post-menopausal women were randomized to take part in an ambulatory program of physical exercise (aerobic and anaerobic), or to receive conventional information about diet and exercise. After three months, effects on quality of life were evaluated (test Euroqol, Rosenberg and subjective evaluation of health), weight, BMI, waist perimeter and fat mass, and biochemical parameters. RESULTS: Mean age was 59.79 (8.02) years and BMI 37.51 (6.03) kg/m(2). Women included in the exercise group improved their quality of life after three months (EuroQol 0.48 (0.38) vs 0.66 (0.35); Rosenberg: 19.21 (5.05) vs 16.86 (4.94); subjective evaluation of health (%): 60.68 (19.99) vs 71.14 (17.28); p<0.01) and lost weight (90.95 (15.51) vs 88.72 (15.17); p<0.001), BMI (37.5 (5.68) vs 36.59 (5.72); p<0.001) and fat mass (46.28 (4.92)% vs 45.47 (4.88)%; p<0.01). No changes were observed in control group. 31 people withdrew the study before 12 weeks. CONCLUSIONS: An ambulatory physical exercise program improves quality of life and reduces weight and fat mass, in a short period of time, in obese post-menopausal women. The high rate of withdrawal should be considered as an inconvenient in this type of programs.

Efficacy of atorvastatin for achieving cholesterol targets after LDL-cholesterol based dose selection in patients with type 2 diabetes.

We analyzed the feasibility of an intensive lipid-lowering strategy based on a starting dose of atorvastatin according to baseline and target low-density lipoprotein cholesterol (LDL-C) level (<2.6 mmol/L) in 202 statin-naïve patients with type 2 diabetes within 24 weeks. They were assigned to receive a daily dosage of atorvastatin based on their initial LDL-C levels. The primary endpoint was the proportion of patients achieving the LDL-C goal after 24 weeks of treatment. No changes were made in prescribed atorvastatin dosage. At the study end, 66.5% of the 188 patients completing the trial reached the LDL-C target (75%, 67%, 58% and 59% with 10, 20, 40 and 80 mg per day of atorvastatin, respectively) reached LDL-C target. Atorvastatin reduced the levels of total cholesterol, LDL-C, high density lipoprotein cholesterol (HDL-C) and triglycerides by 29%, 35%, 3% and 22%, respectively, and all statin doses were well tolerated. Thus, individualizing the starting dose of atorvastatin according to baseline and target LDL-C levels, allowed a high proportion of type 2 diabetic patients to achieve the target within 24 weeks.