Biomarkers of Pre-eclampsia in Pregnant Women With Gestational Diabetes and Pre-existing Type 2 Diabetes: A Systematic Review.

Pre-eclampsia (PE) is one of the leading causes of maternal and perinatal health morbidity, producing more than 4.6% of complications in pregnancy worldwide. This systematic review was conducted to determine the significance of specific biomarkers in predicting PE in gestational diabetes mellitus (GDM) and type 2 diabetes mellitus (DM). The review measured and explained the significant abnormalities in lipids, blood glucose, cytokines, inflammatory markers, placental proteins, urinary proteins, and other serum biomarkers that contribute to the development of PE in GDM and type 2 DM populations. We searched CINAHL, EMBASE, Medline, Maternity and Infant care, Scopus, and Web of Science. Studies were included if they had a measurable component in the blood serum or urine of women who developed PE and suffered from GDM or pre-existing type 2 DM. A narrative synthesis was conducted instead of a meta-analysis due to the high heterogeneity of data from the studies. A total of 2,593 studies were screened, producing eight relevant studies. Twenty-seven different biomarkers were investigated from the study group of 40 to 1,344 participants. No single biomarker was identified; however, there is a need for further research on specific biomarkers of PE, especially in CRP, FABP4, and microalbuminuria in the GDM-PE group and calprotectin in the type 2 DM population. Many biomarkers were identified as practical in predicting PE when combined with other biomarkers and more data are required to verify the predictability of the diagnostic markers in pregnant women.

Mulheres com síndrome do ovário policísticos que desenvolveram diabetes melitus 2 antes dos 35 anos: ansiedade, má qualidade do sono e não controle glicêmico / Women with polycystic ovarian syndrome who developed diabetes mellitus 2 before the age of 35: anxiety, poor sleep quality and lack of glycemic control / Mujeres con síndrome de ovario poliquístico que desarrollaron diabetes melitus 2 antes de los 35 años: ansiedad, mala calidad del sueño y sin control glucémico

Introdução: A síndrome dos ovários policísticos (SOP) consiste em uma desordem de origem endocrinológica de grande prevalência nas mulheres em idade fértil, sendo acometidas por ela aproximadamente de 6 a 16% da população feminina - em consonância com diversos critérios diagnósticos 1-4. Essa síndrome é associada ao hiperandrogenismo e à resistência insulínica (RI), com manifestações clínicas relacionadas a alterações reprodutivas 4, desenvolvimento de diabetes mellitus (DM2) e obesidade. Esta pesquisa objetiva compreender o perfil das mulheres com DM 2 antes dos 35 anos e os fatores que podem levar a esta condição. Metodologia: Este estudo se deu por meio de inquérito on-line feito a mulheres diagnosticadas com SOP, e com menos de 35 anos de idade. Foi desenvolvido de maneira virtualizada via plataforma GoogleForms® em função da pandemia do COVID-19. Tratou-se de um levantamento sobre presença de fatores de risco para DM 2, como sobrepeso e alimentação, sedentarismo e qualidade do sono; em grupos de mulheres com SOP diabéticas e não diabéticas, para efeito de comparação. Resultados e discussão: Um total de 198 mulheres responderam ao questionário, sendo divididas em Diabéticas (DM) e não diabéticas (NDM). O grupo DM foi o que mais apresentou IMC elevado (acima de 30), e o que mais se declarou seguir orientações nutricionais. Atividade física não diferenciou entre os grupos. O grupo DM foi o que declarou dormir mais tarde (pós 23:00) quando comparado com o grupo NDM. O sobrepeso indica ser um fator importante para o advento da DM 2 neste grupo, sendo as orientações nutricionais não tão efetivas, devido muito a dificuldade de aderir às orientações. O hábito de dormir tarde implica em alterações que levam a aumento da RI via estresse oxidativo, contribuindo para obesidade e DM 2. Conclusões: A obesidade é um fator decisivo para a precocidade da DM 2 em mulheres com SOP, e sua condição é multifatorial, associada a seguimento de orientações nutricionais, atividade física e qualidade do sono. O evitar da precocidade da DM 2 neste grupo passa por esta compreensão.

Introduction: Polycystic ovary syndrome (PCOS) is an endocrinological disorder with high prevalence in women of childbearing age, affected by approximately 6 to 16% of the female population - in line with several diagnostic criteria 1-4. This syndrome is associated with hyperandrogenism and insulin resistance (IR), with clinical manifestations related to reproductive changes 4, development of diabetes mellitus (DM2) and obesity. This research aims to understand the profile of women with DM 2 before the age of 35 and the factors that can lead to this condition. Methodology: This study was carried out through an online survey made to women diagnosed with PCOS, and under 35 years of age. It was developed in a virtualized way via the GoogleForms® platform due to the COVID-19 pandemic. This was a survey on the presence of risk factors for DM 2, such as overweight and diet, sedentary lifestyle and sleep quality; in groups of women with diabetic and non-diabetic PCOS for comparison purposes. Results and discussion: A total of 198 women answered the questionnaire, divided into Diabetic (DM) and non-diabetic (NDM). The DM group was the one with the highest BMI (above 30), and the one that most declared to follow nutritional guidelines. Physical activity did not differ between groups. The DM group was the one who reported sleeping later (after 11 pm) when compared to the NDM group. Overweight is an important factor for the advent of DM 2 in this group, and nutritional guidelines are not so effective, due to the difficulty in adhering to the guidelines. The habit of sleeping late implies changes that lead to increased IR via oxidative stress, contributing to obesity and DM 2. Conclusions: Obesity is a decisive factor for the precocity of DM 2 in women with PCOS, and its condition is multifactorial, associated with following nutritional guidelines, physical activity and sleep quality. Avoiding the precocity of DM 2 in this group involves this understanding.

Introducción: El síndrome de ovario poliquístico (SOP) es un trastorno de origen endocrinológico de alta prevalencia en mujeres en edad fértil, afectando aproximadamente entre el 6 y el 16% de la población femenina, de acuerdo con diversos criterios diagnósticos 1- 4 . Este síndrome se asocia con hiperandrogenismo y resistencia a la insulina (RI), con manifestaciones clínicas relacionadas con cambios reproductivos 4, desarrollo de diabetes mellitus (DM2) y obesidad. Esta investigación tiene como objetivo conocer el perfil de las mujeres con DM 2 antes de los 35 años y los factores que pueden conducir a esta condición. Metodología: Este estudio se realizó a través de una encuesta online realizada entre mujeres diagnosticadas con SOP y menores de 35 años. Fue desarrollado de manera virtualizada a través de la plataforma GoogleForms® debido a la pandemia de COVID-19. Se realizó una encuesta sobre la presencia de factores de riesgo para DM 2, como sobrepeso y alimentación, sedentarismo y calidad del sueño; en grupos de mujeres diabéticas y no diabéticas con síndrome de ovario poliquístico, con fines de comparación. Resultados y discusión: Respondieron al cuestionario un total de 198 mujeres, divididas en diabéticas (DM) y no diabéticas (NDM). El grupo DM fue el que presentó un IMC más elevado (superior a 30), y el que más declaró seguir las pautas nutricionales. La actividad física no difirió entre los grupos. El grupo DM fue el que reportó dormir más tarde (después de las 11:00 pm) en comparación con el grupo NDM. El sobrepeso indica que es un factor importante en la aparición de DM 2 en este grupo, siendo las pautas nutricionales no tan efectivas, en gran parte por la dificultad para cumplirlas. El hábito de dormir tarde implica cambios que conducen a un aumento de la RI vía estrés oxidativo, contribuyendo a la obesidad y la DM 2. Conclusiones: La obesidad es un factor decisivo en la aparición temprana de la DM 2 en mujeres con SOP, y su condición es multifactorial, asociado con el seguimiento de pautas nutricionales, actividad física y calidad del sueño. Evitar la precocidad de la DM 2 en este grupo requiere esta comprensión.

Validación del test FLI (Fatty Liver Index) para el diagnóstico de esteatosis hepática en pacientes con obesidad y/o diabetes mellitus para su utilización en Atención Primaria. Estudio FLIAP / Validation of the FLI (Fatty Liver Index) test to diagnose hepatic steatosis in patients with obesity and/or diabetes mellitus for use in primary care. FLIAP study

Objetivo: validación de la prueba diagnóstica Fatty Liver Index (FLI) mediante un diseño transversal. Métodos: se incluyeron pacientes con diagnóstico previo de obesidad y/o diabetes en los que estaría indicado hacer una ecografía para descartar esteatosis. Se les realizó el FLI y la prueba Gold Estándar (ecografía). Tamaño muestral: se incluyeron 135 individuos. Se calculó curva ROC, el área bajo la curva y el punto de corte del FLI para la clasificación como esteatosis. Se estimó sensibilidad, especificidad, los valores predictivos positivos y negativos del FLI. Se utilizó el programa SPSS para el análisis. A todos los pacientes se les entregó una hoja informativa del estudio y se pidió consentimiento informado. Resultados: prevalencia de esteatosis del 60,7%, predominando esteatosis leve y moderada. Hubo relación significativa entre esteatosis y triglicéridos, no así para índice de masa corporal (IMC), gamma-glutamil transferasa (GGT) y perímetro abdominal. La curva ROC del FLI se mostró muy cercana a la línea media, y el área bajo la curva fue 0,666 (0,571-0,759; intervalo de confianza [IC] del 95%), que indica una capacidad predictiva del FLI baja. Considerando un punto de corte de 76 para el FLI, la sensibilidad fue del 75,6%, la especificidad del 50,94%, el valor predictivo positivo (VPP) del 70,45% y el valor predictivo negativo (VPN) del 57,45%. Los coeficientes de probabilidad positivo y negativo fueron 1,53 y 0,49, respectivamente, que indican que el FLI no puede considerarse una buena prueba para el diagnóstico de esteatosis. Conclusiones: el test FLI no predice de forma adecuada qué pacientes con diabetes y/o obesidad tendrían esteatosis asociada. Por ello, no se puede recomendar de forma generalizada el uso del FLI para el diagnóstico de esteatosis ni tampoco para sustituir la ecografía. (AU)

Aim: Validation of the FLI (Fatty Liver Index) diagnostic test by means of a cross-sectional design. Methods: Patients with a prior diagnosis of obesity and/or diabetes in whom an ultrasound would be indicated to rule out steatosis were included. The FLI and the Gold Standard test (ultrasound) were performed. Sample size: 135 individuals were included. ROC curve, area under the curve and the FLI threshold for classification as steatosis were all calculated. Sensitivity, specificity and the positive and negative predictive values for FLI were estimated. The SPSS programme was used for the analysis. All patients were given a study information sheet and informed consent was requested. Results: Prevalence of steatosis of 60.7%, with mild and moderate steatosis predominating. There was a statistically significant relationship between steatosis and triglycerides, but not for BMI (body mass index), GGT (gamma-glutamyl transferase) and abdominal perimeter. The FLI ROC curve was very close to the midline, and the area under the curve was 0.666. This reveals a low predictive capacity for FLI. Considering a threshold of 76 for the FLI, the sensitivity, specificity, positive and negative predictive values (PPV and NPV) were 75.6%, 50.94%, 70.45% and 57.45%, respectively. The Positive and Negative Likelihood Ratios were 1.53 and 0.49, respectively. This reveals that FLI cannot be deemed a good test to diagnose steatosis. Conclusions: The Fatty Liver Index test does not adequately predict patients with diabetes and/or obesity who would have associated steatosis. Therefore, the use of FLI to diagnose steatosis or to replace ultrasound cannot be recommended in general. (AU)

APPLICATION OF PROBIOTIC ANTISEPSIS FOR PURULENT COMPLICATIONS IN PATIENTS WITH TYPE 2 DIABETES MELLITUS.

OBJECTIVE: The aim: To improve the results of surgical treatment of patients with type 2 diabetes and purulent-necrotic wounds by using probiotic antiseptics. PATIENTS AND METHODS: Materials and methods: 66 patients with type 2 diabetes and purulent-necrotic complications took part in this study. Probiotic antiseptics were used for local treatment in the experimental group (n=31), and traditional antiseptics were used in the control group (n=35). The levels of pro-inflammatory markers in the blood (IL-6, TNF-a, CRP) were studied; microscopic material was taken to study the type of cytogram during bandaging, before wound treatment with antiseptics or debridement on admission to the hospital (1st day), on the 3rd day and on the 7th day. RESULTS: Results: Analysis of dynamic changes in pro-inflammatory markers between the first and seventh days proved that only in the experimental group there was a statistically significant difference (IL-6 (Р=0.004), TNF-a (Р=0.001), CRP (Р=0.018)). Detection of regenerative-inflammatory and regenerative cytogram types on the 7th day in the experimental group had a statistically significant difference compared to the control group (p=0.002 and p<0.001, respectively). CONCLUSION: Conclusions: the use of probiotic antisepsis accelerates wound healing in patients with type 2 diabetes and purulent-necrotic complications.

Predictive value of TCM clinical index for diabetic peripheral neuropathy among the type 2 diabetes mellitus population: A new observation and insight.

Aims: The objectives of this study were to identify clinical predictors of the Traditional Chinese medicine (TCM) clinical index for diabetic peripheral neuropathy (DPN) in type 2 diabetes mellitus (T2DM) patients, develop a clinical prediction model, and construct a nomogram. Methods: We collected the TCM clinical index from 3590 T2DM recruited at the Second Affiliated Hospital of Tianjin University of Traditional Chinese Medicine from January 2019 to October 2020. The participants were randomly assigned to either the training group (n = 3297) or the validation group (n = 1426). TCM symptoms and tongue characteristics were used to assess the risk of developing DPN in T2DM patients. Through 5-fold cross-validation in the training group, the least absolute shrinkage and selection operator (LASSO) regression analysis method was used to optimize variable selection. In addition, using multifactor logistic regression analysis, a predictive model and nomogram were developed. Results: A total of eight independent predictors were found to be associated with the DPN in multivariate logistic regression analyses: advanced age of grading (odds ratio/OR 1.575), smoke (OR 2.815), insomnia (OR 0.557), sweating (OR 0.535), loose teeth (OR 1.713), dry skin (OR 1.831), purple tongue (OR 2.278). And dark red tongue (OR 0.139). The model was constructed using these eight predictor's medium discriminative capabilities. The area under the curve (AUC) of the training set is 0.727, and the AUC of the validation set is 0.744 on the ROC curve. The calibration plot revealed that the model's goodness-of-fit is satisfactory. Conclusions: We established a TCM prediction model for DPN in patients with T2DM based on the TCM clinical index.

Participation in a multicomponent lifestyle intervention for people with obesity improves glycated hemoglobin (HbA1c).

Introduction: Obesity is associated with compromised glucose metabolism. Hence, it is of interest to investigate if the lifestyle interventions used in the LIBRA-cohort, which aimed at not only weight loss, but also patient well-being, could also help obese patients improve glucose metabolism by evidence of reduced HbA1c. The aim of the study was to retrospectively investigate if patients who were referred to a lifestyle intervention for obesity, were able to alter HbA1c. Research design and methods: Patients with a BMI≥30 undergoing a 6-month lifestyle intervention, who also completed physical and mental health surveys and whose baseline and 6-month blood samples were available, were included in the analysis. For changes in HbA1c and body weight a clinically relevant change of 5≥mmom/mol and 5%≥, respectively, was chosen. Participants were divided into groups according to their baseline HbA1c level: "Diabetes": HbA1c of ≥6.5% (≥48 mmol/mol), "Prediabetes": HbA1c of 5.7% to 6.4% (39-47.99 mmol/mol) or "Normal" HbA1c <5.7% (<39 mmol/mol). Results: 180 patients met the stated inclusion criteria and these patients were divided into groups (median age (25th;75th quartile): Diabetes: n=47, age 54 (43;60), 51% women, Prediabetes: n=68, age 60 (50;66), 71% women and Normal: n=65, median age 61 (50;66), 85% women. Significant reductions were found in all three groups and specifically in the diabetes group HbA1c was reduced (mean [95%CI]) -5[-8;-2] mmol/mol from baseline to the end of the intervention. Furthermore, 35% of patients with prediabetes normalized their HbA1c (<39) and 30% patients with diabetes reduced their HbA1c <48. All groups had clinically relevant (≥5%) reductions in body weight (p<0.01). There was an association between body weight reduction and HbA1c reduction in the diabetes group (p<0.01). All groups reported improvements in physical health (p<0.01). Conclusion: In this retrospective cohort study, all patients achieved clinically relevant weight loss after participation in the lifestyle intervention and obese patients with diabetes achieved clinically relevant reductions in HbA1c after 6-months. More than 1/3 of patients with prediabetes normalized their HbA1c.

Efeito do uso de probióticos e simbióticos no controle metabólico em pacientes com diabetes Mellitus tipo 2 e pré-diabetes: uma revisão sistemática de literatura / Effect of probiotics and symbotics on metabolic control in patients with type 2 diabetes Mellitus and pre-diabetes: a systematic literature review / Efecto del uso de probióticos y simbióticos sobre el control metabólico en pacientes con diabetes Mellitus tipo 2 y prediabetes: una revisión sistemática de la literatura

O diabetes mellitus constitui um distúrbio clínico heterogêneo, apresentando comumente hiperglicemia e estado inflamatório crônico. Tais condições se relacionam com a microbiota intestinal, compreendida como um conjunto de microrganismos que interagem com o hospedeiro de maneira benéfica ou maléfica. Nos pacientes diabéticos, a modulação microbiológica do intestino é bastante intrigante, pois o uso de probióticos tem auxiliado na redução da endotoxemia metabólica e de mediadores inflamatórios. Dessa forma, o objetivo deste trabalho é realizar uma revisão sistemática de literatura, buscando verificar a relação entre o uso de probióticos e simbióticos e a melhora metabólica em indivíduos diabéticos ou em risco de desenvolver tal patologia. Para tanto, foi realizada uma revisão sistemática, com coleta de dados realizada nas bases de dados PubMed, LILACS e ScienceDirect, com o objetivo de localizar ensaios clínicos que contemplassem a relação entre o uso de probióticos e simbióticos e a melhora metabólica (glicêmica e no tocante aos marcadores inflamatórios) na população-alvo. Os artigos coletados foram publicados entre janeiro de 2017 e fevereiro de 2022, e os estudos incluídos na revisão se restringiram ao idioma inglês. Foram avaliados quatro estudos, a maioria demonstrando uma redução significativa na glicemia em jejum e melhora metabólica geral, com redução dos níveis de marcadores inflamatórios após introdução de probióticos e simbióticos. Dessa forma, foi possível concluir que, apesar de muitos estudos serem inconclusivos em relação ao efeito dos probióticos sobre o controle glicêmico, pode haver espaço para tais suplementos no tratamento do diabetes mellitus tipo 2 e pré-diabetes. Entretanto, mais estudos são necessários para confirmar esses resultados.

Diabetes mellitus is a heterogeneous clinical disorder, commonly presenting hyperglycemia and chronic inflammatory state. These conditions are related to the intestinal microbiota, understood as a set of microorganisms that interact with the host in a beneficial or harmful way. Microbiological modulation of the intestine in diabetic patients is quite interesting, as probiotics have helped reduce metabolic endotoxemia and inflammatory mediators. Thus, this systematic literature review sought to verify the relationship between use of probiotics and symbiotics and glycemic/metabolic control in patients with type 2 Diabetes Mellitus and pre-diabetes. Bibliographic search was conducted in the PubMed, LILACS and ScienceDirect databases to identify clinical trials on the effect of probiotics and symbiotics on glycemic/metabolic improvement/control in the targeted patients. Retrieved articles were published between January 2017 and February 2022, but only papers in English were included in the review, resulting in four articles evaluated. Most studies showed a significant reduction in fasting blood glucose and general metabolic improvement, with reduced levels of inflammatory markers, after introduction of probiotics and symbiotics. Although many studies are inconclusive regarding the effect of probiotics and symbiotics on glycemic control, such supplements may have space in DM2 and pre-DM treatment. Further studies are needed to confirm these results.

La diabetes mellitus es un trastorno clínico heterogéneo, caracterizada comúnmente por la hiperglucemia y un estado inflamatorio crónico. Esta condición está relacionada con la microbiota intestinal, que abarca un conjunto de microorganismos que viven con el huésped benéfica o maléficamente. En pacientes diabéticos, la modulación microbiológica del intestino es muy intrigante, puesto que el uso de probióticos ha ayudado a reducir la endotoxemia metabólica y los mediadores inflamatorios. Así, el objetivo de este trabajo es realizar una revisión sistemática de la literatura para verificar la relación entre el uso de probióticos y simbióticos y la mejoría metabólica en diabéticos y prediabéticos. Por lo tanto, se realizó una revisión sistemática, con recolección de datos en las bases de datos PubMed, LILACS y ScienceDirect, con el objetivo de localizar ensayos clínicos que contemplaran la relación entre el uso de probióticos y simbióticos y la mejora metabólica (glucémica y en cuanto a marcadores inflamatorios) en el público objetivo. Los artículos habían sido publicados entre enero de 2017 y febrero de 2022 y  se restringieron al idioma inglés. Se evaluaron cuatro estudios, la mayoría demostró una reducción significativa en la glucosa en sangre en ayunas y una mejora metabólica general, con niveles reducidos de marcadores inflamatorios, después de la introducción de probióticos y simbióticos. Así, fue posible concluir que, aunque muchos estudios no son concluyentes en cuanto al efecto de los probióticos en el control glucémico, hay espacio para tales suplementos en el tratamiento de la diabetes mellitus y la prediabetes. Sin embargo, se necesitan más estudios para confirmar estos resultados.

Semaglutida versus agonistas GLP-1. Efectividad, seguridad y calidad de vida en pacientes con diabetes mellitus 2. Estudio SEVERAL / Semaglutide versus GLP-1 agonists. Effectiveness, safety, and quality of life in patients with diabetes mellitus 2. The SEVERAL study

Objetivo: La enfermedad cardiovascular es la causa principal demuerte en pacientes con diabetes mellitus 2. El objetivo principal es evaluar y comparar prospectivamente la pérdida de peso en pacientes condiabetes mellitus 2 tratados por primera vez con los diferentes análogosde la GLP-1. Como variables secundarias se estudiará reducción de lahemoglobina glicosilada, cambios en calidad de vida y actividad física yla seguridad de estos fármacos.Método: Se trata de un estudio postautorización, multicéntrico, no aleatorizado de seguimiento prospectivo. Se reclutarán 360 pacientes queinicien tratamiento por primera vez con análogos de la GLP1 en 10 centros del sistema público durante un período de 6 meses y un seguimientode 44 semanas. La variable principal será la pérdida de peso con los diferentes análogos de la GLP1 y como variable secundaria se valorarán:reducción de hemoglobina glicosilada, cambios en la calidad de vida yactividad física a través del EuroQol-5D y SF-12 y seguridad. Se ha estimado un período de reclutamiento de 6 meses, desde el 1 de Diciembre2021 al 1 de Mayo 2022. El seguimiento finalizará en Diciembre de 2022.Discusión: El estudio intentará aportar información sobre la efectividaden pérdida de peso, cambios en calidad de vida, actividad física y seguridad de los análogos de la GLP1 en pacientes con diabetes mellitus 2que inician tratamiento con estos fármacos en la vida real. Este trabajopretende comparar los diferentes análogos de la GLP1 en términos deeficacia y seguridad para una posterior mejor elección en la prescripciónde estos fármacos en pacientes con diabetes mellitus 2 y obesidad. (AU)

Objective: The cardiovascular disease is the first cause of deaths inpatients with diabetes mellitus 2. The objective is to evaluate and comparethe weight loss in patients with diabetes treated with the different GLP-1receptor agonists for the first time. Secondary endpoints are glycosylatedhemoglobin reduction, changes in quality of life and physical activity andthe safety of these drugs.Method: It is a postauthorization, multicenter, non-randomized and prospective study. 360 Patients that will start treatment for the first time withGLP-1 receptor agonists will be recruited in 10 centers in the NationalHealth System for a period of 6 months and 44 weeks of follow-up. Theprimary endpoint will be weight loss achieved with the different GLP-1receptor agonists and the secondary endpoint will be glycosylated hemoglobin reduction, changes in the quality of life through the EuroQol-5Dand changes physical activity through the SF-12 questionnaire, and alsothe safety of these drugs. The estimate recruitment period will be 6 months,from 1 December 2021 to 1 May 2022. The follow up will finish in December 2022.Discussion: The SEVERAL study will try to provide information aboutweight loss efficacy, changes in quality of life, physical activity and safetyof the GLP-1 receptor agonists in patients with diabetes that start treatmentwith these drugs in the real life. This study try to compare different GLP-1receptor agonists in terms of effectiveness and safety for a better posteriorelection when these drugs are used in patients with diabetes mellitus 2and obesity. (AU)

Uso de empagliflozina en pacientes diabéticos tipo 2 con insuficiencia cardíaca

Resumen: Introducción: La insuficiencia cardíaca es una patología con alta prevalencia y morbimortalidad. Entre las estrategias terapéuticas se debe considerar el abordaje de las comorbilidades, entre ellas la diabetes mellitus tipo 2. Los pacientes con insuficiencia cardíaca que la asocian, tienen 75% más riesgo de hospitalización y mortalidad. La Food and Drug Administration ha enfatizado desde 2008 que todo nuevo hipoglucemiante debe tener un efecto beneficioso o al menos neutro a nivel cardiovascular. Varios estudios han demostrado que los inhibidores del cotransportador sodio glucosa tipo 2 (empagliflozina, canagliflozina y dapagliflozina) cumplen con estos requerimientos. El objetivo de este trabajo es describir la experiencia en "vida real" de la empagliflozina en pacientes con diabetes mellitus 2 e insuficiencia cardíaca con fracción de eyección reducida. Metodología: Se realizó un estudio prospectivo, longitudinal, entre julio 2019 - abril 2021 en una Unidad Multidisciplinaria de Insuficiencia Cardíaca. Resultados: Se incluyeron 25 pacientes Se incluyeron 25 pacientes (13 hombres) con edad media 61 años. La dosis objetivo de empagliflozina se alcanzó en el 95% de los pacientes. Se observó un descenso de peso, hemoglobina glicosilada y glicemia de ayunas. Conclusiones: La empagliflozina presentó buena tolerabilidad, con efectos beneficiosos a nivel cardiovascular y mínimos efectos adversos.

Abstract: Introduction: Heart failure is a pathology with high prevalence and morbidity and mortality. Among the therapeutic strategies, addressing comorbidities should be considered, including type 2 diabetes mellitus. Patients with associated heart failure have a 75% higher risk of hospitalization and mortality. The Food and Drug Administration has emphasized since 2008 that all new hypoglycemic agents must have a beneficial or at least neutral effect at the cardiovascular level. Several studies have shown that sodium-glucose cotransporter 2 inhibitors (empagliflozin, canagliflozin, and dapagliflozin) meet these requirements. The objective of this work is to describe the "real life" experience of empagliflozin in patients with type 2 diabetes mellitus and heart failure with reduced ejection fraction. Methodology: A prospective, longitudinal study was carried out between July 2019 and April 2021 in a Multidisciplinary Heart Failure Unit. Results: Twenty-five patients (13 men) with a mean age of 61 years were included. The target dose of empagliflozin was achieved in 95% of patients. A decrease in weight, glycosylated hemoglobin and fasting blood glucose was observed. Conclusions: Empagliflozin presented good tolerability, with beneficial effects at the cardiovascular level and minimal adverse effects.

Resumo: Introdução: A insuficiência cardíaca é uma patologia com alta prevalência e morbidade e mortalidade. Dentre as estratégias terapêuticas, deve-se considerar a abordagem de comorbidades, incluindo diabetes mellitus tipo 2. Pacientes com insuficiência cardíaca associada apresentam risco 75% maior de hospitalização e mortalidade. A Food and Drug Administration tem enfatizado desde 2008 que todos os novos agentes hipoglicemiantes devem ter um efeito benéfico ou pelo menos neutro no nível cardiovascular. Vários estudos mostraram que os inibidores do cotransportador 2 de sódio-glicose (empagliflozina, canagliflozina e dapagliflozina) atendem a esses requisitos. O objetivo deste trabalho é descrever a experiência da "vida real" da empagliflozina em pacientes com diabetes mellitus tipo 2 e insuficiência cardíaca com fração de ejeção reduzida. Metodologia: Foi realizado um estudo prospectivo, longitudinal, entre julho de 2019 e abril de 2021 em uma Unidade Multidisciplinar de Insuficiência Cardíaca. Resultados: Vinte e cinco pacientes (13 homens) com idade média de 61 anos foram incluídos. A dose alvo de empagliflozina foi alcançada em 95% dos pacientes. Observou-se diminuição do peso, da hemoglobina glicosilada e da glicemia de jejum. Conclusões: A empagliflozina apresentou boa tolerabilidade, com efeitos benéficos a nível cardiovascular e efeitos adversos mínimos.

Comparison of Premixed Human Insulin 30/70 to Biphasic Aspart 30 in Well-Controlled Patients with Type 2 Diabetes Using Continuous Glucose Monitoring.

AIM: To compare in terms of glycemic variability two premixed insulins, Premixed Human Insulin 30/70 (PHI) and Biphasic Aspart 30 (BiAsp30), using Continuous Glucose Monitoring (CGM) and to estimate the correlation of Glycated Albumin (GA) and Fructosamine (FA) with CGM data. Patients-Data: A total of 36 well-controlled patients with type 2 Diabetes Mellitus (T2DM) underwent 7-day CGM with PHI and subsequently with BiAsp30. GA and FA were measured at the first and last day of each week of CGM. RESULTS: BiAsp30 was associated with lower Average Blood Glucose (ABG) during the 23:00-03:00 period (PHI: 135.08 ± 28.94 mg/dL, BiAsp30: 117.75 ± 21.24 mg/dL, p < 0.001) and the 00:00-06:00 period (PHI: 120.42 ± 23.13 mg/dL, BiAsp30: 111.17 ± 14.74 mg/dL, p = 0.008), as well as with more time below range (<70 mg/dL) (TBR) during the 23:00-03:00 period in the week (PHI: 3.65 ± 5.93%, BiAsp30: 11.12 ± 16.07%, p = 0.005). PHI was associated with lower ABG before breakfast (PHI: 111.75 ± 23.9 mg/dL, BiAsp30: 128.25 ± 35.9 mg/dL, p = 0.013). There were no differences between the two groups in ABG, Time In Range and Time Below Range during the entire 24-h period for 7 days, p = 0.502, p = 0.534, and p = 0.258 respectively, and in TBR for the 00:00-06:00 period p = 0.253. Total daily insulin requirements were higher for BiAsp30 (PHI: 47.92 ± 12.18 IU, BiAsp30: 49.58 ± 14.12 IU, p = 0.001). GA and FA correlated significantly with ABG (GA: r = 0.512, p = 0.011, FA: r = 0.555, p = 0.005). CONCLUSIONS: In well-controlled patients with T2DM, BiAsp30 is an equally effective alternative to PHI.

Factores de riesgo para desarrollar diabetes mellitus II / Risk factors for developing diabetes mellitus II / Factores de risco para o desenvolvimento da diabetes mellitus II

La diabetes mellitus constituye uno de los problemas de salud más importantes en el mundo por la alta carga de enfermedad en términos de discapacidad y mortalidad prematura que ocasiona, debido a su alta prevalencia e incidencia a nivel mundial se configura como una epidemia. OBJETIVO: determinar el riesgo para desarrollar diabetes mellitus tipo II en las personas de la Cuidad de Cuenca. MATERIALES Y METODOS: se realizó un estudio, descriptivo, correlacional, prospectivo, cuantitativo y de corte transversal, mediante la aplicación del test de FINDRISC, La muestra estuvo compuesta por 379 personas no diabéticas con edades comprendidas entre 18 y 65 años de edad. RESULTADOS: se determinó que las variables sexo, edad, el peso, la talla, el perímetro de cintura, el tiempo diario de actividad física y antecedentes familiares de DM1- 2 presentan una correlación significativa en el nivel 0,01 (bilateral) con el riesgo de desarrollar DM2 según la puntuación del test de FINDRISC. CONCLUSIÓN: los datos obtenidos sugieren la necesidad de programas de intervención multidisciplinar en las unidades de salud asociados a programas educativos, ingesta dietética adecuada y actividad física regular.

Diabetes mellitus is one of the most important health problems in the world due to the high burden of disease in terms of disability and premature mortality it causes, due to its high prevalence and incidence worldwide is configured as an epidemic. OBJECTIVE: to determine the risk of developing type II diabetes mellitus in people from the city of Cuenca. MATERIAL AND METHODS: descriptive, correlational, prospective, quantitative and cross-sectional study was carried out through the application of the FINDRISC test. The sample was composed of 379 non-diabetic persons between 18 and 65 years of age. RESULTS: it was determined that the variables sex, age, weight, height, waist circumference, daily physical activity time and family history of DM1- 2 presented a significant correlation at the 0.01 level (bilateral) with the risk of developing DM2 according to the FINDRISC test score. CONCLUSION: the data obtained suggest the need for multidisciplinary intervention programs in health units associated with educational programs, adequate dietary intake and regular physical activity.

A diabetes mellitus é um dos problemas de saúde mais importantes do mundo devido ao elevado peso da doença em termos de incapacidade e mortalidade prematura que provoca, devido à sua elevada prevalência e incidência a nível mundial é configurada como uma epidemia. OBJECTIVO: determinar o risco de desenvolvimento da diabetes mellitus tipo II nas pessoas da cidade de Cuenca. MATERIAIS E METODOS: Foi realizado um estudo descritivo, correlativo, prospectivo, quantitativo e transversal utilizando o teste FINDRISC. A amostra consistiu em 379 pessoas não diabéticas entre os 18 e os 65 anos de idade. RESULTADOS: Foi determinado que as variáveis sexo, idade, peso, altura, circunferência da cintura, tempo de atividade física diária e história familiar de DM1- 2 apresentaram uma correlação significativa ao nível 0,01 (bilateral) com o risco de desenvolvimento de DM2 de acordo com a pontuação do teste FINDRISC. CONCLUSÃO: os dados obtidos sugerem a necessidade de programas de intervenção multidisciplinar em unidades de saúde associados a programas educativos, ingestão alimentar adequada e actividade física regular.

Impact of bariatric surgery on the development of diabetic microvascular and macrovascular complications.

BACKGROUND: While bariatric surgery has been shown to improve type 2 diabetes (DM) control in the obese population, the effect on long-term DM complications has been less thoroughly investigated. The purpose of this study was to assess the development of microvascular and macrovascular complications in obese DM patients undergoing bariatric surgery. METHODS: New York patients' records from the SPARCS database in years 2006-2012 were used to identify obese patients with DM. Patients undergoing bariatric surgery were compared with patients managed medically, matched for age and gender. Patients were grouped based on baseline presence of controlled or uncontrolled DM and followed over time for the development of micro- and macrovascular complications. Cumulative incidence of complications was estimated with death treated as a competing risk event. Multivariable proportional sub-distribution hazards models were used to compare the risk of complications among different patient groups after adjusting for possible confounding factors. RESULTS: A total of 88,981 patients were reviewed, including 15,585 (18%) that were treated with bariatric surgery. Surgery patients had significantly lower risk of microvascular complications compared to non-surgery patients (controlled diabetes: HR = 0.40, 95% CI 0.37-0.42; uncontrolled diabetes: HR = 0.51, 95% CI 0.37-0.71). Similarly, the surgical patients were noted to have a significantly lower risk for macrovascular complications compared to non-surgery patients (controlled diabetes: HR = 0.43, 95% CI 0.40-0.46; uncontrolled diabetes: HR = 0.44, 95% CI 0.28-0.69). Cumulative incidence of microvascular complications was lower at 1, 5 and 9 years for the surgical groups for controlled and uncontrolled DM. Similar trends were observed for the macrovascular complications. CONCLUSIONS: Bariatric surgery appears to prevent complications of DM. Bariatric surgery patients with DM experienced significantly lower rates of microvascular and macrovascular complications, compared to non-surgically treated comparison group. Bariatric surgery was noted to offer protective benefits for both complicated and non-complicated DM patients. This reduced rate of complications was sustained in the long term.

Table olives and health: a review.

Table olives, a product of olive tree (Olea europaea L.), is an important fermented product of the Mediterranean Diet. Agronomical factors, particularly the cultivar, the ripening stage and the processing method employed are the main factors influencing the nutritional and non-nutritional composition of table olives and their organoleptic properties. The important nutritional value of this product is due to its richness in monounsaturated fat (MUFA), mainly oleic acid, fibre and vitamin E together with the presence of several phytochemicals. Among these, hydroxytyrosol (HT) is the major phenolic compound present in all types of table olives. There is a scarcity of in vitro, in vivo and human studies of table olives. This review focused comprehensively on the nutrients and bioactive compound content as well as the health benefits assigned to table olives. The possible health benefits associated with their consumption are thought to be primarily related to effects of MUFA on cardiovascular health, the antioxidant (AO) capacity of vitamin E and its role in protecting the body from oxidative damage and the anti-inflammatory and AO activities of HT. The influence of multiple factors on composition of the end product and the potential innovation in the production of table olives through the reduction of its final salt content was also discussed.

Role of HbA1c in diagnosis of gestational diabetes mellitus.

OBJECTIVE: To evaluate glycated haemoglobin as a biomarker for diagnosing gestational diabetes mellitus while keeping the oral glucose tolerance test as the gold standard. METHODS: The cross-sectional study was conducted from Januray, 2016, to January, 2018, at PNS Hafeez Hospital, Islamabad, Pakistan and comprised of pregnant subjects who were first subjected to 2-hour oral glucose tolerance test along with the first evaluation of glycated haemoglobin. Clinical evaluation, including history and measurements of anthropometric indices and blood pressure, were also done. On the basis of the results, the subjects were grouped as those having gestational diabetes mellitus (group A) and those without it (group B). Data was analysed using SPSS 15. RESULTS: Of the 280 subjects, gestational diabetes mellitus was found in 50(17.85%). Differences in glycated haemoglobin between the groups was significant (p<0.002). Glycated haemoglobin test provided sensitivity of 70% and specificity of 84.78%. CONCLUSIONS: With due adjustments, glycated haemoglobin testing can help in reducing the frequency of oral glucose tolerance test.

[The heart and kidney in diabetes: Heart and kidney in diabetes]. / Corazón y riñón en la diabetes: efectos de los glucosúricos.

The diabetic kidney presents excess expression and activity of the SGLT2 transporter of the proximal tubule. This situation increases the renal reabsorption of Na and glucose and reduces their distal supply. In addition to the metabolic effects on the internal environment of this excess reabsorbed glucose, the renal tubule is subjected to glycosylated stress capable of locally activating both apoptosis and inflammasome. The result is a progressive loss of nephron units, activation of transition of mesangial epithelium and collagen deposition. Activation of insulin signalling by the MAP kinase pathway and resistance to the metabolic effects of insulin take place. This is simultaneously combined with afferent vasodilation due to hyperglycaemia, tubuloglomerular feedback inhibition due to reduced distal fluid supply, podocyte dedifferentiation and reduction in their number, the latter effects being due to insulin resistance. The result is self-feeding renal damage, with intraglomerular hyper-pressure, podocyte dedifferentiation, tubular apoptosis, and local and distant activation of inflammasome. All these effects are susceptible to be totally or partially corrected by inhibiting glucose transport via the SGLT transporters.

DYNAMICS OF GASTRIN LEVEL IN PATIENTS WITH DIABETES MELLITUS 2 TYPE AND CHRONIC GASTRITIS AFTER HELICOBACTER PYLORI ERADICATION THERAPY.

OBJECTIVE: The aim: To study the gastrin level dynamics in patients with diabetes mellitus (DM) 2 type and chronic gastritis (CG) on the background of antihelicobacter therapy (AHT). PATIENTS AND METHODS: Materials and methods: 60 patients with DM type 2 and HP-associated CG underwent examination. Patients were divided into two groups of 30 patients each: group 1 included patients who received only standard AHT, group 2 - patients who in addition to standard AHT received the drug SB (Normagut, company Mega) 2 capsules 2 times/day. RESULTS: Results: According to our study results yeast SB, not only increase the HP eradication rate but together with the standard AHT contribute to the serum gastrin reduction, which is a gastric acid stimulator, which in turn leads to an improvement in the CG clinical course. CONCLUSION: Conclusions: Patients with DM type 2 and CG associated with HP should include yeast SB to standard AHT as they reduce side effects from this treatment (by an average of 20%), increase the eradication frequency (by 10%), and also lead to significant decrease in serum gastrin (up to 82.15 ± 2.47 pg/ml).A decrease in serum gastrin levels in patients with HP-associated CG and DM type 2 leads to an improvement in the clinical course of the diseases, namely a decrease in nausea, diarrhea, abdominal pain, and discomfort incidence.

The Beige Adipocyte as a Therapy for Metabolic Diseases.

Adipose tissue is traditionally categorized into white and brown relating to their function and morphology. The classical white adipose tissue builds up energy in the form of triglycerides and is useful for preventing fatigue during periods of low caloric intake and the brown adipose tissue more energetically active, with a greater number of mitochondria and energy production in the form of heat. Since adult humans possess significant amounts of active brown fat depots and its mass inversely correlates with adiposity, brown fat might play an important role in human obesity and energy homeostasis. New evidence suggests two types of thermogenic adipocytes with distinct developmental and anatomical features: classical brown adipocytes and beige adipocytes. Beige adipocyte has recently attracted special interest because of its ability to dissipate energy and the possible ability to differentiate themselves from white adipocytes. The presence of brown and beige adipocyte in human adults has acquired attention as a possible therapeutic intervention for metabolic diseases. Importantly, adult human brown appears to be mainly composed of beige-like adipocytes, making this cell type an attractive therapeutic target for obesity and obesity-related diseases, such as atherosclerosis, arterial hypertension and diabetes mellitus type 2. Because many epigenetics changes can affect beige adipocyte differentiation from adipose progenitor cells, the knowledge of the circumstances that affect the development of beige adipocyte cells may be important to new pathways in the treatment of metabolic diseases. New molecules have emerged as possible therapeutic targets, which through the impulse to develop beige adipocytes can be useful for clinical studies. In this review will discuss some recent observations arising from the unique physiological capacity of these cells and their possible role as ways to treat obesity and diabetes mellitus type 2.

Association between vitamin D status and glycemic profile in postmenopausal women with type 2 diabetes.

The aim of this study is to evaluate the association between vitamin D status and glycemic profile in postmenopausal women with type 2 diabetes. A cross-sectional study was carried out with 70 (59.47 ±â€¯6.47 years; 1.56 ±â€¯0.05 m; 73.56 ±â€¯13.01 kg; 30.30 ±â€¯5.00 BMI kg/m2) postmenopausal women with type 2 diabetes (T2D). The blood samples were collected after fasting for 12 h and the main outcome parameters were serum follicle-stimulating hormone (FSH), estradiol; 25-OH vitamin D; insulin; C-Reactive Protein; cholesterol total (CT), triglycerides (TG), high density lipoprotein (HDL-cholesterol), glucose; calcium, HDL-cholesterol. The average serum 25(OH)D level in this study was 28.45 ±â€¯8.26 ng/mL. The prevalence of hypovitaminosis D was 60%. Table 1 displays mean and standard deviation values for participants' characteristics. The postmenopause status of the women studied was confirmed by FSH and estradiol measurement. All the clinical and anthropometric characteristics did not show difference (p > 0.05) between the groups (Table 2). Triglycerides level was highest (p < 0.0391) in the hypovitaminosis D group. The other serum markers did not show statistical differences (p > 0.05) between the groups. In conclusion, our results suggest that only TG level shows a negative correlation with vitamin D status in postmenopausal women with type 2 diabetes.