La diabetes tipo 3c. Abordaje desde el médico del primer nivel / Type 3 c diabetes: Approach from the first level doctor

La diabetes mellitus tipo 3c (DM3c) es una diabetes (DM) del páncreas exocrino que habrá que sospechar siempre que existan antecedentes de pancreatitis crónica (PC), pancreatitis aguda (PA) o recidivante (PAR) (80% de los casos) o una DM de nueva aparición en individuos a partir de los 50 años sin otra justificación (pruebas de autoinmunidad negativas, anticuerpos contra la descarboxilasa del ácido glutámico). Se trata de una entidad mal diagnosticada como diabetes tipo 2 (DM2) (90%) y, por ello, de no sospecharla puede pasar inadvertida. Para su diagnóstico son de utilidad la ecografía abdominal, la determinación del antígeno tumoral carbohydrate antigen 19-9 (CA 19.9), la resonancia magnética nuclear (RMN) o la tomografía axial computarizada (TAC). El tratamiento es el mismo de la DM2, aunque con ciertas especificaciones según el tipo de fármacos y con la particularidad de que al tratarse de una «diabetes frágil» habrá que tener mayor precaución con las hipoglucemias (monitorización). Asimismo, al ser una enfermedad del páncreas exocrino habrá que tratar específicamente esta para evitar las alteraciones metabólicas, malabsortivas y/o nutricionales (AU)

DM3c is diabetes (DM) of the exocrine pancreas that must be suspected whenever there is a history of chronic pancreatitis (CP), acute pancreatitis (AP) or recurrence (80% of cases) or new-onset DM in individuals from over 50 years of age without any other justification (negative autoimmunity tests, Glutamic Acid Decarboxylase antibodies). It is an entity misdiagnosed as type 2 diabetes (DM2) (90%) and therefore, if it is not suspected, it can go unnoticed. For its diagnosis, abdominal ultrasound, determination of the CA 19.9 tumor antigen (carbohydrate antigen 19-9), nuclear magnetic resonance (NMR) or computerized axial tomography (CT) are useful. The treatment is the same as DM2, although certain specifications depend on the type of drugs and with the particularity that in dealing with «fragile diabetes» greater caution must be taken with hypoglycemia (monitoring). Likewise, as it is a disease of the exocrine pancreas, it will have to be specifically treated to avoid metabolic, malabsorptive and/or nutritional alterations (AU)

Diabetes tipo 2 en Andalucía: uso de recursos y coste económico / Type 2 diabetes in Andalusia: Resources use and economic cost

Antecedentes y objetivos Estudios previos que cuantifican el coste de la diabetes tipo 2 (DM2) muestran resultados muy dispares. Nos planteamos definir el perfil del paciente con DM2 en Andalucía, analizar el uso de recursos sanitarios y, cuantificar su coste económico en el año 2022. Pacientes y métodos Estudio multicéntrico, transversal y descriptivo; 385 pacientes con DM2 de toda Andalucía (IC 95%; error: 5%). Datos analizados: edad, sexo, asistencia a consultas de Atención Primaria (AP), de enfermería, de urgencias y de especialidades hospitalarias; consumo de fármacos en general y antidiabéticos en particular, tiras de glucemia, pruebas complementarias y días de ingreso hospitalario. Resultados Edad media: 70,7 ± 12,44 años; 53,6% hombres. Contactos asistenciales: médico de AP: 8,36 ± 4,69; enfermería: 7,17 ± 12; consultas hospitalarias: 2,31 ± 2,38; urgencias: 1,71 ± 2,89. Días de ingreso hospitalario: 2,26 ± 6,46. Analíticas: 3,79 ± 5,45 y 2,17 ± 3,47 Rx. Fármacos consumidos: 9,20 ± 3,94 (1,76 ± 0,90 antidiabéticos). Tiras glucemia: 184 ± 488. Coste anual: 5.171,05 €/paciente/año (2.228,36 € por ingresos hospitalarios, 1.702,87 € por fármacos y 1.239,82 € por asistencias y pruebas complementarias). Conclusiones El andaluz con DM2 tiene 71 años de edad, consume 10 fármacos diferentes y trata su DM2 con doble terapia. Tiene 20 asistencias/año (75% en AP), cuatro análisis, dos Rx y precisa dos días de ingreso hospitalario. Los costes sanitarios directos superan los 5.000 €/año. Lo que supone 41,66% del presupuesto de la Consejería de Salud y triplica el gasto medio por habitante (AU)

Background and objectives Previous studies that quantify the cost of type 2 diabetes (DM2) show very different results. We set out to define the profile of the patient with DM2 in Andalusia, analyze the use of health resources and quantify their economic cost during 2022. Patients and methods Multicenter, cross-sectional and descriptive study. Three hundred and eighty-five patients with DM2 from Andalusia (confidence level: 95%; error: 5%). Data analyzed: age, sex, attendance at primary care (PC), nursing, emergency and hospital specialty consultations; consumption of drugs in general and antidiabetics in particular, blood glucose strips, complementary tests and hospitalization days. Results Mean age: 70.7 ± 12.44 years; 53.6% men. Care contacts: PC physician: 8.36 ± 4.69; nursing: 7.17 ± 12; hospital visits: 2.31 ± 2.38; emergencies: 1.71 ± 2.89; hospitalization days: 2.26 ± 6.46. Laboratory tests: 3.79 ± 5.45 and 2.17 ± 3.47 Rx. Drugs consumed: 9.20 ± 3.94 (1.76 ± 0.90 antidiabetics). Blood glucose strips: 184 ± 488. Annual cost: 5171.05 €/patient/year (2228.36 € for hospital admissions, 1702.87 € for drugs and 1239.82 € for assistance and complementary tests). Conclusions The DM2 Andalusian is 71 years old, consumes 10 different drugs and treats DM2 with double therapy. He has been 20 attendances/year (75% in PC), 4 analyses, 2 X-rays and requires 2 days of hospitalization. Direct healthcare costs goes over 5000 €/year. This represents 41.66% of the budget of the Andalusian Ministry of Health and triples the average cost per habitant (AU)

[Type 3 c diabetes: Approach from the first level doctor]. / La diabetes tipo 3c. Abordaje desde el médico del primer nivel.

DM3c is diabetes (DM) of the exocrine pancreas that must be suspected whenever there is a history of chronic pancreatitis (CP), acute pancreatitis (AP) or recurrence (80% of cases) or new-onset DM in individuals from over 50 years of age without any other justification (negative autoimmunity tests, Glutamic Acid Decarboxylase antibodies). It is an entity misdiagnosed as type 2 diabetes (DM2) (90%) and therefore, if it is not suspected, it can go unnoticed. For its diagnosis, abdominal ultrasound, determination of the CA 19.9 tumor antigen (carbohydrate antigen 19-9), nuclear magnetic resonance (NMR) or computerized axial tomography (CT) are useful. The treatment is the same as DM2, although certain specifications depend on the type of drugs and with the particularity that in dealing with «fragile diabetes¼ greater caution must be taken with hypoglycemia (monitoring). Likewise, as it is a disease of the exocrine pancreas, it will have to be specifically treated to avoid metabolic, malabsorptive and/or nutritional alterations.

[Type 2 diabetes in Andalusia: Resources use and economic cost]. / Diabetes tipo 2 en Andalucía: uso de recursos y coste económico.

BACKGROUND AND OBJECTIVES: Previous studies that quantify the cost of type 2 diabetes (DM2) show very different results. We set out to define the profile of the patient with DM2 in Andalusia, analyze the use of health resources and quantify their economic cost during 2022. PATIENTS AND METHODS: Multicenter, cross-sectional and descriptive study. Three hundred and eighty-five patients with DM2 from Andalusia (confidence level: 95%; error: 5%). DATA ANALYZED: age, sex, attendance at primary care (PC), nursing, emergency and hospital specialty consultations; consumption of drugs in general and antidiabetics in particular, blood glucose strips, complementary tests and hospitalization days. RESULTS: Mean age: 70.7 ± 12.44 years; 53.6% men. Care contacts: PC physician: 8.36 ± 4.69; nursing: 7.17 ± 12; hospital visits: 2.31 ± 2.38; emergencies: 1.71 ± 2.89; hospitalization days: 2.26 ± 6.46. LABORATORY TESTS: 3.79 ± 5.45 and 2.17 ± 3.47 Rx. Drugs consumed: 9.20 ± 3.94 (1.76 ± 0.90 antidiabetics). Blood glucose strips: 184 ± 488. Annual cost: 5171.05 €/patient/year (2228.36 € for hospital admissions, 1702.87 € for drugs and 1239.82 € for assistance and complementary tests). CONCLUSIONS: The DM2 Andalusian is 71 years old, consumes 10 different drugs and treats DM2 with double therapy. He has been 20 attendances/year (75% in PC), 4 analyses, 2 X-rays and requires 2 days of hospitalization. Direct healthcare costs goes over 5000 €/year. This represents 41.66% of the budget of the Andalusian Ministry of Health and triples the average cost per habitant.

Programa CASERIA (Cuestionario hábitos Saludables en Primaria). Respuestas de escolares de 6 a 10 años de edad / CASERIA Program (Healthy Habits in Primary School Questionnaire). Responses of 6 to 10 year-old children

En los reconocimientos escolares, realizados de forma periódica, detectamos un continuo aumento de la obesidad y del sedentarismo en nuestros escolares; con este trabajo pretendemos contrastar, con datos objetivos, la situación real de la población infantil de nuestro entorno respecto a sus hábitos alimenticios, su actividad física e higiene. Material y métodos. Se entregaron cuestionarios sobre hábitos alimenticios, preferencias en cuanto a la dieta, práctica de ejercicio e higiene dental a 430 escolares de entre 6 y 10 años. Fueron válidos para su estudio 366. Resultados. El 85,8% de los encuestados vivía en el seno de una familia «tradicional»; el 22% tenía familiares con sobrepeso; el 96,7% desayunaba antes de ir al colegio, siendo los lácteos el producto más consumido; la bollería industrial era muy utilizada tanto en el desayuno (7,4%) como en el recreo (16,9%). La comida favorita era la pasta en el 29,8% de los casos, seguida de las patatas, sobre todo fritas (10,4%). Los alimentos que menos gustaban eran las verduras (26,2%) y el pescado (8,2%). El 70% veía diariamente la televisión más de 2 h; el 34% pasaba 2 h o más al día jugando con las videoconsolas o similares, por otra parte, los deberes y el estudio ocupaban más de 2 h diarias al 50% de los alumnos. El 55% de los encuestados consumía chucherías 2 o más veces al día, y comer y ver la televisión de forma simultánea era un hábito casi constante en más del 60%. El 9,29% de los participantes en el estudio no se limpiaba los dientes nunca. Conclusiones. El conocimiento teórico de lo que debe de ser una correcta alimentación parece ser adecuado, pero su puesta en práctica no. La población estudiada tiene hábitos bastante sedentarios, come poca fruta y no le agradan ni las legumbres, ni las verduras, ni el pescado. Todos estos factores disminuyen la protección cardiovascular asociada a su práctica y consumo, y comprobamos que ya están presentes desde la infancia, en nuestra población, lo que sin duda repercutirá en su futuro estado de salud y bienestar, en caso de no modificarse (AU)

In schoolchildren examinations, carried out periodically, we detect a continuous increase in obesity and sedentarism in our schoolchildren. In this study we attempt to compare, with objective data, the real situation of the childhood population in our area, as regards their eating habits, physical activity and hygiene. Material and methods. Questionnaires on eating habits, preferences as regards diet, doing exercise, and dental hygiene, were handed out to 430 schoolchildren between 6 and 10 years-old. A total of 366 were valid for the study. Results. The majority (85.8%) of those surveyed lived within a "traditional" family; 22% had family members who were overweight; 96.7% had breakfast before going to school, with milk products being the most consumed; the cake and pastry industry was well used, both at breakfast (7.4%) and at playtime (16.9%). The favourite food was pasta in 29.8% of cases, followed by potatoes, particularly fried (10.4%). The least liked foods were vegetables (26.2%) and fish (8.2%). Television was watched for more than 2hours by 70%; 34% exceeded 2hours or more per day playing with video consoles or similar. On the other hand, homework and studying took up more than 2hours daily for 50% of pupils. A majority (55%) of those surveyed ate sweets 2 or more time a day, and to eat and watch television at the same time was an almost constant habit in more than 60%. Of the participants in the study, 9.29% never brushed their teeth. Conclusions. The theoretical knowledge of what should be a correct diet seems adequate, but its putting into practice is not. The population studies had fairly sedentary habits, with little fruit and they did not like pulses or vegetables or fish. All these factors decrease the cardiovascular protection associated with its practice and consumption. We have shown that they are already present since childhood in our population, which without a doubt will have repercussions in their future health status and well-being, if it is not changed (AU)

[CASERIA program (Healthy Habits in Primary School Questionnaire). Responses of 6 to 10 year-old children]. / Programa CASERIA (Cuestionario hábitos Saludables en Primaria). Respuestas de escolares de 6 a 10 años de edad.

UNLABELLED: In schoolchildren examinations, carried out periodically, we detect a continuous increase in obesity and sedentarism in our schoolchildren. In this study we attempt to compare, with objective data, the real situation of the childhood population in our area, as regards their eating habits, physical activity and hygiene. MATERIAL AND METHODS: Questionnaires on eating habits, preferences as regards diet, doing exercise, and dental hygiene, were handed out to 430 schoolchildren between 6 and 10 years-old. A total of 366 were valid for the study. RESULTS: The majority (85.8%) of those surveyed lived within a "traditional" family; 22% had family members who were overweight; 96.7% had breakfast before going to school, with milk products being the most consumed; the cake and pastry industry was well used, both at breakfast (7.4%) and at playtime (16.9%). The favourite food was pasta in 29.8% of cases, followed by potatoes, particularly fried (10.4%). The least liked foods were vegetables (26.2%) and fish (8.2%). Television was watched for more than 2 hours by 70%; 34% exceeded 2 hours or more per day playing with video consoles or similar. On the other hand, homework and studying took up more than 2 hours daily for 50% of pupils. A majority (55%) of those surveyed ate sweets 2 or more time a day, and to eat and watch television at the same time was an almost constant habit in more than 60%. Of the participants in the study, 9.29% never brushed their teeth. CONCLUSIONS: The theoretical knowledge of what should be a correct diet seems adequate, but its putting into practice is not. The population studies had fairly sedentary habits, with little fruit and they did not like pulses or vegetables or fish. All these factors decrease the cardiovascular protection associated with its practice and consumption. We have shown that they are already present since childhood in our population, which without a doubt will have repercussions in their future health status and well-being, if it is not changed.

[Derivatives of pro-opiomelanocortin (ACTH and beta-endorphin) in chronic alcoholics]. / Derivados de la pro-opiomelanocortina (ACTH y beta-endorfina) en alcohólicos crónicos.

The plasmatic concentration of beta-endorphins and ACTH were measured in 31 alcoholic patients and in a control group (N = 16), to test the possible relation between chronic alcohol intake and propiomelanocortin production. There were found a decrease of beta-endorphins plasmatic levels in chronic alcoholic group, apart of clinical manifestations or abstinence period (one month maximum). This decrease can be cause by the chronic alcohol intake, and can be mediated by the tetrahydroisoquinolines (TIQs) or otherwise be the cause and not the consequence of alcoholism. The global plasmatic levels of ACTH were decreased but it was significant in the subgroup of alcoholics with liver disfunction, mental illness and those who carry on drinking.