Switching to an advanced hybrid closed-loop system in real-world practice improves hypoglycemia awareness and metabolic control in adults with type 1 diabetes, particularly in those with impaired perception of hypoglycemia symptoms.

AIMS: To evaluate the efficacy of an advance closed-loop (AHCL) system in restoring awareness of hypoglycemia in patients with type 1 diabetes (T1D). METHODS: We conducted a prospective study including 46 subjects with T1D flash glucose monitoring (FGM) or continuous glucose monitoring (CGM) switching to a Minimed 780G® system. Patients were classified in three groups according to the therapy used before switching to Minimed® 780G: multiple dose insulin (MDI) therapy + FGM (n = 6), continuous subcutaneous insulin infusion + FGM (n = 21), and sensor-augmented pump with predictive low-glucose suspend (n = 19). FGM/CGM data were analyzed at baseline, after 2 and 6 months on AHCL. Clarke's score of hypoglycemia awareness was compared at baseline and 6 months recordings. We also compared the efficacy of the AHCL system in improving A1c among patients with appropriate perception of symptoms of hypoglycemia compared to those presenting with impaired awareness of hypoglycemia (IAH). RESULTS: Participants had a mean age of 37 ± 15 and a diabetes duration of 20 ± 10 years. At baseline, 12 patients (27%) showed IAH as defined by a Clarke's score ≥ 3. Patients with IAH were older and had lower estimated glomerular filtration rate (eGFR) compared with those who did not have IAH; with no differences in baseline CGM metrics or A1c. An overall decrease in A1c was observed after 6 months on AHCL system (from 6.9 ± 0.5% to 6.7 ± 0.6%, P < 0.001), regardless of prior insulin therapy. The improvement in metabolic control was greater in patients with IAH, showing a reduction in A1c from 6.9 ± 0.5 to 6.4 ± 0.4% vs 6.9 ± 0.5 to 6.8 ± 0.6% (P = 0.003), showing a parallel increase in total daily boluses of insulin and automatic bolus correction administered by the AHCL system. In patients with IAH Clarke's score decreased from 3.6 ± 0.8 at baseline to 1.9 ± 1.6 after 6 months (P < 0.001). After 6 months on AHCL system, only 3 patients (7%) presented with a Clarke's score ≥ 3, resulting in an absolute risk reduction of 20% (95% confidence interval: 7-32) of having IAH. CONCLUSIONS: Switching from any type of insulin administration to AHCL system improves restoration of hypoglycemia awareness and metabolic control in patients with T1D, particularly in adults with impaired perception of hypoglycemia symptoms. TRIAL REGISTRATION: ClinicalTrial.gov ID NCT04900636.

Psychometric properties of the Clarke questionnaire for hypoglycemia awareness in the Spanish population with type 2 diabetes.

OBJECTIVES: The Clarke questionnaire, validated in Spanish language, assesses hypoglycemia awareness in patients with type 1 diabetes. This study aimed to analyze its psychometric properties in patients with type 2 diabetes (T2DM). METHODS: This was a questionnaire validation study. Patients with T2DM and treated with insulin, sulfonylureas or glinides were consecutively recruited from six endocrinology consultations and six primary care centers. The internal structure of the 8-item Clarke questionnaire was analyzed by exploratory (training sample) and confirmatory (testing sample) factor analysis; the internal consistency using Omega's McDonald coefficient; and goodness of fit with comparative fit index (CFI, cutoff >0.9), Goodness of Fit Index (GFI, cutoff >0.9), and root mean-square error of approximation (RMSEA, cutoff <0.09), as well as unidimensionality indicators. RESULTS: The 265 participants (56.8% men) had a mean age of 67.8 years. Confirmatory factor analysis for one dimension obtained poor indicators: fit test (p < 0.001); CFI = 0.748; RMSEA = 0.122 and SRMR = 0.134. Exploratory factor analysis showed 2 or 3 dimensions with poor adjustment indicators. Omega's McDonald was 0.739. CONCLUSIONS: The Spanish version of the Clarke questionnaire was not valid or reliable for assessing hypoglycemia awareness in people with T2DM in Spanish population.

Executive summary of the consensus statement of: Clinical recommendations for sport practice in people with diabetes (RECORD Guide). Update 2021. Diabetes Mellitus Area of the Spanish Society of Endocrinology and Nutrition (SEEN).

OBJECTIVE: To guide professionals involved in the care of people with diabetes mellitus who practice sport. PARTICIPANTS: Members of the Diabetes Mellitus Working Group of the Spanish Society of Endocrinology and Nutrition. METHODS: A group of experts in each area covered by the statement carried out a bibliographic review of the available evidence for each topic, based on which recommendations were subsequently agreed upon within the Diabetes Mellitus Working Group. CONCLUSIONS: The statement provides practical recommendations for the management of diabetes mellitus during sports practice.

How often patients on insulin therapy measure postprandial glycemia and modify insulin doses accordingly? From an on-line survey in insulin-treated diabetes patients in Spain.

INTRODUCTION: Controlling postprandial glycemia (PPG) is important to achieve optimal glycemic control, but few studies have evaluated how often is measured and evaluated. OBJECTIVES: To evaluate how often patients on insulin therapy measure PPG and modify insulin doses accordantly. As secondary objectives, we evaluated the factors conditioning elevated PPG and associated issues. MATERIAL AND METHODS: Cross-sectional observational study based on a web-based survey from an unselected sample of adult insulin-treated patients. A p-value of < 0.05 was significant. RESULTS: 1251 patients (68% women, 38.9 ±â€¯13 years [mean ±â€¯SD], body mass index (BMI) 24.2 ±â€¯4.2 kg/m2, diabetes duration 17.4 ±â€¯12.8 years, insulin dose 38 ±â€¯18 IU) participated, 1104 with autoinmmune disease (AD) and 147 with non-autoinmmune diabetes (NAD). 59% of patients had HbA1c ≤ 7%, 92.7% of patients with AD and 55.8% with NAD were attended by specialists (p < 0.001). People with AD did more often blood glucose monitoring (BGM) (p < 0.0001) and used continuous glucose monitoring systems (CGMS) (p < 0.0001). 90.1% with AD and 68.0% with NAD received instructions on measuring PPG (p < 0.001), and more with AD received specific training to change the treatment (87% vs. 61.2%, p < 0.0001) and were more proactive. However, more with NAD discussed their postprandial glucose levels with their healthcare team during clinical visits (92.5% vs. 74.1%, p < 0.0001). Regarding bolus administration, 88.6% with AD and 68.7% with NAD injected the insulin bolus before meals (p < 0.001). CONCLUSIONS: Patients with AD determine PPG more frequently. Diabetes type, follow-up setting, number of injections and CGMS use were the most important predictive factors for PPG measurement. Diabetes education programs should address how to best monitor PPG and appropriate corrective actions.

Clinical and metabolic profile of patients with latent autoimmune diabetes in adults in specialized care in Madrid. / Perfil clínico y metabólico de pacientes con diabetes tipo LADA atendidos en atención especializada en la comunidad de Madrid.

OBJECTIVE: To report the clinical characteristics of patients with latent autoimmune diabetes in adults (LADA), and to ascertain their metabolic control and associated chronic complications. METHODS: Patients with DM attending specialized medical care in Madrid who met the following criteria: age at diagnosis of DM >30years, initial insulin independence for at least 6months and positive GAD antibodies were enrolled. Clinical profiles, data on LADA diagnosis, associated autoimmunity, C-peptide levels, therapeutic regimen, metabolic control, and presence of chronic complications were analyzed. RESULTS: Number of patients; 193; 56% females. Family history of DM: 62%. Age at DM diagnosis: 49years. Delay in confirmation of LADA: 3.5years. Insulin-independence time: 12months. Baseline serum C-peptide levels: 0.66ng/ml. Basal-bolus regimen: 76.7%. Total daily dose: 35.1U/day, corresponding to 0.51U/Kg. With no associated oral antidiabetic drugs: 33.5%. Other autoimmune diseases: 57%. Fasting plasma glucose: 160.5mg/dL. HbA1c: 7.7%. BMI: 25.4kg/m2 (overweight, 31.5%; obesity, 8%). Blood pressure: 128/75. HDL cholesterol: 65mg/dL. LDL cholesterol: 96mg/dL. Triglycerides: 89mg/dL. Known chronic complications: 28%. CONCLUSIONS: Recognition of LADA may be delayed by several years. There is a heterogeneous pancreatic insulin reserve which is negative related to glycemic parameters. Most patients are poorly controlled despite intensive insulin therapy. They often have overweight, but have adequate control of BP and lipid profile and a low incidence of macrovascular complications.

Perfil clínico y metabólico de pacientes con diabetes tipo LADA atendidos en atención especializada en la comunidad de Madrid / Clinical and metabolic profile of patients with latent autoimmune diabetes in adults in specialized care in Madrid

Objetivo: Definir las características clínicas de los pacientes con diabetes autoinmune latente del adulto (LADA), conocer su control metabólico y las complicaciones crónicas asociadas que presentan. Métodos: Seleccionamos pacientes con DM seguidos en las consultas de endocrinología de hospitales públicos de la Comunidad de Madrid que reunían los siguientes criterios: edad al diagnóstico de DM >30años, independencia inicial de insulina durante al menos 6meses y positividad de anticuerpos antiGAD. Analizamos datos clínicos relativos al diagnóstico de LADA, autoinmunidad asociada, niveles de péptidoC, pauta terapéutica, control metabólico y presencia de complicaciones crónicas. Resultados: Número de pacientes: 193. Mujeres: 56%. Antecedentes familiares de DM: 62%. Edad al diagnóstico de DM: 49años. Retraso en confirmación LADA: 3,5años. Tiempo de insulino-independencia: 12meses. PéptidoC basal suero: 0,66ng/ml (0,22nmol/l). Pauta de insulina basal-bolus: 76,7%. Dosis total diaria: 35,1U/día, correspondiente a 0,51U/kg. Sin fármacos orales asociados: 33,5%. Presencia de otras patologías autoinmunes: 57%. Glucemia en ayunas: 160,5mg/dl (8,91mmol/l). HbA1c: 7,7%. IMC: 25,4kg/m2 (sobrepeso: 31,5%; obesidad: 8%). Presión arterial: 128/75. Colesterol HDL: 65mg/dl (16,9mmol/l). Colesterol LDL: 96mg/dl (24,96mmol/l). Triglicéridos: 89mg/dl (1,01mmol/l). Complicaciones crónicas: 28%; microangiopatía: 23,1%; macroangiopatía: 4,9%. Conclusiones: El reconocimiento de LADA puede retrasarse varios años. La reserva pancreática de insulina de los pacientes es heterogénea y el grado medio de control glucémico deficiente a pesar de utilizar mayoritariamente insulinoterapia intensiva. Con frecuencia presentan sobrepeso, aunque tienen un control adecuado de la presión arterial y perfil lipídico y baja incidencia de complicaciones macroangiopáticas (AU)

Objective: To report the clinical characteristics of patients with latent autoimmune diabetes in adults (LADA), and to ascertain their metabolic control and associated chronic complications. Methods: Patients with DM attending specialized medical care in Madrid who met the following criteria: age at diagnosis of DM >30years, initial insulin independence for at least 6months and positive GAD antibodies were enrolled. Clinical profiles, data on LADA diagnosis, associated autoimmunity, C-peptide levels, therapeutic regimen, metabolic control, and presence of chronic complications were analyzed. Results: Number of patients; 193; 56% females. Family history of DM: 62%. Age at DM diagnosis: 49years. Delay in confirmation of LADA: 3.5years. Insulin-independence time: 12months. Baseline serum C-peptide levels: 0.66ng/ml. Basal-bolus regimen: 76.7%. Total daily dose: 35.1U/day, corresponding to 0.51U/Kg. With no associated oral antidiabetic drugs: 33.5%. Other autoimmune diseases: 57%. Fasting plasma glucose: 160.5mg/dL. HbA1c: 7.7%. BMI: 25.4kg/m2 (overweight, 31.5%; obesity, 8%). Blood pressure: 128/75. HDL cholesterol: 65mg/dL. LDL cholesterol: 96mg/dL. Triglycerides: 89mg/dL. Known chronic complications: 28%. Conclusions: Recognition of LADA may be delayed by several years. There is a heterogeneous pancreatic insulin reserve which is negative related to glycemic parameters. Most patients are poorly controlled despite intensive insulin therapy. They often have overweight, but have adequate control of BP and lipid profile and a low incidence of macrovascular complications (AU)

[Associated gastroenteropancreatic neuroendocrine tumours to familiar syndromes]. / Tumores neuroendocrinos gastroenteropancreáticos asociados a síndromes familiares.

Aproximately 5-10% of neuroendocrine tumours (NETs) of the gastroenteropancreatic system (GEP) have an hereditary background. The known hereditary syndromes include: multiple endocrine neoplasia type 1 (MEN 1), von Hippel Lindau disease (VHL), neurofibromatosis type 1 (NF 1) and tuberous sclerosis complex (TSC). This review discusses for each of these syndromes the: genes involved and specifics types of mutations, disease prevalence, affected neuroendocrine tissues and related clinical syndromes, and special morphological features of NETs on each of these syndromes.

Nutrición y síndrome metabólico / Nutrition and metabolic syndrome

Existe suficiente evidencia sobre la asociación de alteraciones enel metabolismo de la glucosa, las lipoproteínas, la acción de la insulina,la hipertensión y la obesidad de distribución central. Esta asociaciónse denomina Síndrome Metabólico. A pesar de que ha sido cuestionadasu existencia por la ADA y la EASD, es una herramienta útilque permite identificar a las personas que tienen un alto riesgo de desarrollarenfermedad cardiovascular. El síndrome metabólico y suscomponentes individuales se asocian a una elevada incidencia deenfermedad cardiovascular. La obesidad y el sedentarismo son factoresde riesgo subyacentes en la ruta patogénica de este síndrome, portanto la modificación de los hábitos de vida es una intervención de primeralínea en la prevención y tratamiento de la resistencia insulínica,la hiperglucemia, la dislipemia aterogénica y la hipertensión arterial.La reducción ponderal y el ejercicio son las claves del plan global, peroentre los tratamientos no farmacológicos la dieta permanece como unade las estrategias de reducción del riesgo cardiovascular más importantes.Estudios epidemiológicos han observado que una ingesta elevadade azúcares simples, de alimentos con alto índice glucémico y de dietascon alta carga glucémica se asocian a resistencia insulínica, diabetesmellitus tipo 2, hipertrigliceridemia y cifras bajas de colesterol-HDL. Un bajo consumo de grasa saturada a favor de ácidos grasospoliinsaturados y monoinsaturados se ha implicado en una reducciónde la incidencia de diabetes mellitus tipo 2 y dislipemia, aunque continúael debate. La fibra dietética de cereales no refinados ha sido beneficiosaen la reducción del riesgo de diabetes...AU)

Sufficient evidence exists in relation to the association inclinical practice between disorders in the metabolism of glucose,lipoproteins, insulin action, arterial hypertension and centrallydistributedobesity. This association is named MetabolicSyndrome. Despite the existence thereof had been questioned bythe ADA and EASD, it is a useful tool affording the possibility ofidentifying individuals at high risk of developing cardiovasculardisease. Metabolic syndrome and/or its individual components areassociated with a high incidence rate of cardiovascular disease.Obesity and a sedentary lifestyle are underlying risk factors alongthis syndrome’s pathway to disease, changes in living habitstherefore being a first-line intervention in the prevention andtreatment of insulin resistance, hyperglycemia, aterogenicdyslipemia and arterial hypertension. Weight loss and exercise arethe keys to the overall plan, one of the most important nonpharmacologicalcardiovascular risk reduction strategies howeverstill being diet. Epidemiological studies have found a high intakeof simple sugars, of foods having a glycemic index and of dietswith a high glycemic load to be associated to insulin resistance,type II diabetes mellitus, hypertriglyceridemia and low HDLcholesterolfigures. Los saturated fat intake in favor ofpolyunsaturated and monounsaturated fatty acids has beenimplied in a reduction of the incidence of type II diabetes mellitusand dyslipemia, although the debate is ongoing. Unrefined grainfiber in the diet has been beneficial in reducing the risk ofdiabetes. Among the diet patterns, the Mediterranean diet hasbeen related to a lower incidence of diabetes and a reduction inthe risk of death. Studies for intervention in the prevention of typeII diabetes have suggested low-fat diets (reducing saturated andtrans-fats), with a high degree of fiber and low glycemic index...(AU)

Neurofibromatosis tipo 1 y feocromocitoma bilateral / Neurofibromatosis tipo 1 y feocromocitoma bilateral

La neurofibromatosis es una enfermedad neurocutánea poco frecuente. Hay 2 tipos, la tipo 1 o enfermedad de Von Recklinghausen y la tipo 2. La neurofibromatosis tipo 1 se asocia a afección endocrinológica, que puede acontecer a lo largo de la vida, y desarrollar diversos tipos de tumores, como el feocromocitoma y tumores carcinoides. Presentamos el caso de una mujer de 50 años, diagnosticada hacía 34 años de neurofibromatosis tipo 1, que había desarrollado feocromocitoma bilateral, y fue intervenida mediante suprarrenalectomía bilateral, por vía laparoscópica, en 2 tiempos. Se discute acerca del amplio espectro clínico de esta enfermedad, de su asociación con múltiples alteraciones endocrinológicas, así como su diagnóstico, tratamiento y seguimiento (AU)

Neurofibromatosis is an uncommon neurocutaneous disorder. There are two types: neurofibromatosis type 1, also known as von Recklinghausen's disease, and type 2. Neurofibromatosis type 1 is associated with endocrinological disorders that can occur throughout life, such as pheochromocytoma and carcinoid tumors. We report the case of a 50-year-old woman with a diagnosis of NF1 made 34 years previously, who developed bilateral pheochromocytoma, requiring two-stage laparoscopic adrenalectomy. We discuss the wide clinical spectrum of this disease and its association with multiple disorders, as well as its diagnosis, treatment and follow-up (AU)

Prolactinoma ectópico del seno cavernoso. Revisión de la literatura a propósito de un caso / Ectopic prolactinoma in the cavernous sinus. Case report and review of the literature

El adenoma hipofisario ectópico o extraselar es una entidad muy infrecuente que plantea dificultades diagnósticas y terapéuticas por su especial localización anatómica. Presentamos el caso de una paciente de 44 años estudiada por amenorrea e hiperprolactinemia. No refería galactorrea, cefalea ni alteraciones en la visión. En la resonancia magnética se identificó una lesión de 10,5 * 5 mm en el seno cavernoso izquierdo con glándula hipofisaria de características normales. Inicialmente se adoptó una actitud expectante con seguimiento radiológico, y 8 meses después se observó crecimiento de la lesión con persistencia de la hiperprolactinemia. Se inició entonces tratamiento con agonistas dopaminérgicos (cabergolina), con una evolución clínica, hormonal y radiológica favorable. La lesión fue interpretada como un prolactinoma ectópico en el seno cavernoso con buena respuesta al tratamiento médico. A propósito de este caso, realizamos una revisión de la literatura sobre el adenoma hipofisario ectópico, y encontramos que su localización en seno cavernoso es excepcional (AU)

Ectopic pituitary adenomas are a very rare entity. Diagnosis and treatment are difficult in many of these tumors due to their uncommon anatomical location. We report the case of a 44-year-old woman who presented with secondary amenorrhea and hyperprolactinemia. Galactorrhea, headaches and vision impairment were absent. Magnetic resonance imaging showed a 10.5 * 5 mm lesion in the left cavernous sinus with a normal intrasellar anterior pituitary gland. Initially, an expectant attitude with close radiological follow-up was adopted. Therapy with dopaminergic agonists (cabergoline) was initiated 8 months later when radiological growth and persistent hyperprolactinemia were observed. Clinical, biochemical and radiological outcomes were favorable. The lesion was considered to be an ectopic prolactinoma in the cavernous sinus with good response to medical treatment. Location in the cavernous sinus is extremely uncommon. Therefore, we report this case and review additional cases of ectopic adenomas from the literature (AU)

[Nutrition and metabolic syndrome]. / Nutrición y síndrome metabólico.

Sufficient evidence exists in relation to the association in clinical practice between disorders in the metabolism of glucose, lipoproteins, insulin action, arterial hypertension and centrally-distributed obesity. This association is named Metabolic Syndrome. Despite the existence thereof had been questioned by the ADA and EASD, it is a useful tool affording the possibility of identifying individuals at high risk of developing cardiovascular disease. Metabolic syndrome and/or its individual components are associated with a high incidence rate of cardiovascular disease. Obesity and a sedentary lifestyle are underlying risk factors along this syndrome's pathway to disease, changes in living habits therefore being a first-line intervention in the prevention and treatment of insulin resistance, hyperglycemia, aterogenic dyslipemia and arterial hypertension. Weight loss and exercise are the keys to the overall plan, one of the most important non-pharmacological cardiovascular risk reduction strategies however still being diet. Epidemiological studies have found a high intake of simple sugars, of foods having a glycemic index and of diets with a high glycemic load to be associated to insulin resistance, type II diabetes mellitus, hypertriglyceridemia and low HDL-cholesterol figures. Los saturated fat intake in favor of polyunsaturated and monounsaturated fatty acids has been implied in a reduction of the incidence of type II diabetes mellitus and dyslipemia, although the debate is ongoing. Unrefined grain fiber in the diet has been beneficial in reducing the risk of diabetes. Among the diet patterns, the Mediterranean diet has been related to a lower incidence of diabetes and a reduction in the risk of death. Studies for intervention in the prevention of type II diabetes have suggested low-fat diets (reducing saturated and trans-fats), with a high degree of fiber and low glycemic index. Clinical trials have shown diets with small amounts of carbohydrates, low glycemic index and the Mediterranean and DASH diets to be beneficial in reducing aterogenic dyslipemia. There is currently no good evidence for choosing diets with restricted carbohydrates. On the other hand, different guides recommend low-calorie diets with a low content in saturated fats, trans-fats, cholesterol and sugars in favor the eating fruits, green vegetables, unrefined grains and fish.