"Hypothyroidism screening during first trimester of pregnancy".

BACKGROUND: Subclinical hypothyroidism is defined as an elevated thyroid-stimulating hormone level with a normal thyroxin level without signs or symptoms of hypothyroidism. Although it is well accepted that overt hypothyroidism has a deleterious impact on pregnancy, recent studies indicate that subclinical hypothyroidism may affect maternal and fetal health. Studies suggest an association between miscarriage and preterm delivery in euthyroid women positive for anti-peroxidase antibodies and/or anti-thyroglobulin antibodies. A proposal of a new set-point to diagnose SCH was recently published. The aim of this research was to determine the optimal thyroid-stimulating hormone cut-off point to screen for subclinical hypothyroidism in the first trimester of gestation in a population of our clinical area and to determine the diagnostic value of this screening test for detecting anti-thyroid peroxidase antibodies. METHODS: This cross-sectional study determines the cutoff point for SCH screening and evaluates its usefulness to detect TPO Ab using the Receiver Operating Characteristics (ROC) curve. Prevalence of SCH was calculated using as cut-off 2.5 mIU/L, 4 mIU/L, and our TSH 97.5th percentile. The ability to detect positive anti-thyroglobulin antibodies (TG Ab) and anti-thyroid peroxidase antibodies (TPO Ab) in patients with levels of TSH >97.5th percentile was determined by ROC curves. RESULTS: The mean, range and standard deviation of TSH was 2.15 ± 1.34 mIU/L (range 0.03-8.82); FT4 was 1.18 ± 0.13 ng/dL (range 0.94-1.3); TG Ab was 89.87 ± 413.56 IU/mL (range 0.10-4000); and TPO Ab was 21.61 ± 46.27 IU/mL(range 0.10-412.4). The ROC. analysis of the ability of the TSH level to predict the presence of positive TPO Ab found an AUC of 0.563. CONCLUSION: In our population, the TSH cutoff value for gestational SCH screening is 4.7 mIU/L. Using the SEGO recommended 2.5 mIU/L TSH cut-off point, the prevalence of SCH is 37%. Applying the ATA 2017 recommended cutoff point of 4 mIU/L, the prevalence of SCH is 9.6%. Finally, when the cut-off of 4.7 mIU/L (our 97.5th centile) was used, the SCH prevalence is 5%. TSH levels in the first trimester of pregnancy are not useful to detect TPO Ab.

Apoyo telefónico, control glucémico y visitas a la unidad de diabetes en pacientes insulinizados / Phone coaching, glycemic control and diabetes unit visits in patients treated with insulin

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High prevalence of inactivity among young patients with type 1 diabetes in south Spain.

OBJECTIVES: To describe usual physical activity level and analyze its association with metabolic control and presence of microvascular complications in a cohort of patients with type 1 diabetes (DM-1) in south Spain. METHODS: Observational, cross-sectional study that included one hundred thirty patients, aged 33.9 ± 11.5 years-old with disease duration of 16.5 ± 9.5 years that consecutively were recruited among patients attending the Endocrinology Service of Puerta del Mar University Hospital (Cádiz, Spain). Usual physical activity level was assessed using the "General Practice Physical Activity Questionnaire" (GPPAQ) together with clinical, anthropometric, metabolic parameters and microvascular complications. RESULTS: DM-1 patients were grouped in four categories of physical activity level: inactive (n = 33; 25.3%), moderately inactive (n = 31; 23.8%), moderately active (n = 26; 20.0%) and active (n = 40; 30.9%). We observed no significant differences in glycated haemoglobin (HbA1c) level between the different physical activity groups analyzed. Patients classified as moderately active and active were more often men, significantly younger and presented lower plasmatic levels of triglycerides than patients classified as inactive or moderately inactive, with no differences in other clinical or anthropometric variables. In addition, active and moderately active patients had a lower prevalence of diabetic retinopathy and microvascular complications in general compared to inactive or moderately inactive patients. CONCLUSIONS: Half of patients with type 1 diabetes evaluated were classified as inactive and these patients had a higher prevalence of diabetic retinopathy than active patients. No difference in HbA1c levels was documented among different groups of physical activity.

Objetivos: Describir el nivel de actividad física habitual y analizar su asociación con el control metabólico y la presencia de complicaciones microvasculares en una cohorte de pacientes con diabetes tipo 1 (DM-1) del sur de España. Métodos: Estudio transversal observacional que incluyó ciento treinta pacientes de 33,9 ± 11,5 años de edad y una duración de la enfermedad de 16,5 ± 9,5 años que fueron reclutados consecutivamente en el Servicio de Endocrinología del Hospital Universitario Puerta del Mar (Cádiz, España). El nivel de actividad física habitual fue evaluado utilizando el "General Practice Physical Activity Questionnaire" (GPPAQ) conjuntamente con diversos parámetros clínicos, antropométricos, metabólicos y de complicaciones microvasculares. Resultados: Los pacientes con DM-1 fueron agrupados en cuatro categorías de nivel de actividad física: inactivo (n = 33; 25,3%), moderadamente inactivo (n = 31; 23,8%), moderadamente activo (n = 26; 20,0%) y activo (n = 40; 30,9%). No observamos diferencias significativas en el nivel de hemoglobina glucosilada (HbA1c) entre los diferentes grupos de actividad física analizados. Los pacientes clasificados como moderadamente activos y activos fueron con mayor probabilidad hombres, más jóvenes y con menores niveles plasmáticos de triglicéridos que los pacientes clasificados como inactivos o moderadamente inactivos, sin encontrarse diferencias en otras variables clínicas o antropométricas. Adicionalmente, los pacientes activos y moderadamente activos tenían una menor prevalencia de retinopatía diabética y de complicaciones microvasculares en general comparados con los pacientes inactivos o moderadamente inactivos. Conclusiones: La mitad de los pacientes con DM-1 evaluados fueron clasificados como inactivos y estos pacientes tenían mayor prevalencia de retinopatía diabética que los pacientes activos. No fueron documentadas diferencias en los niveles de HbA1c entre los diferentes grupos de actividad física.

High prevalence of inactivity among young patients with type 1 diabetes in south Spain / Elevada prevalencia de inactividad física en pacientes jóvenes con diabetes tipo 1 del sur de España

Objectives: To describe usual physical activity level and analyze its association with metabolic control and presence of microvascular complications in a cohort of patients with type 1 diabetes (DM-1) in south Spain. Methods: Observational, cross-sectional study that included one hundred thirty patients, aged 33.9 ± 11.5 years-old with disease duration of 16.5 ± 9.5 years that consecutively were recruited among patients attending the Endocrinology Service of Puerta del Mar University Hospital (Cádiz, Spain). Usual physical activity level was assessed using the «General Practice Physical Activity Questionnaire» (GPPAQ) together with clinical, anthropometric, metabolic parameters and microvascular complications. Results: DM-1 patients were grouped in four categories of physical activity level: inactive (n = 33; 25.3%), moderately inactive (n = 31; 23.8%), moderately active (n = 26; 20.0%) and active (n = 40; 30.9%). We observed no significant differences in glycated haemoglobin (HbA1c) level between the different physical activity groups analyzed. Patients classified as moderately active and active were more often men, significantly younger and presented lower plasmatic levels of triglycerides than patients classified as inactive or moderately inactive, with no differences in other clinical or anthropometric variables. In addition, active and moderately active patients had a lower prevalence of diabetic retinopathy and microvascular complications in general compared to inactive or moderately inactive patients. Conclusions: Half of patients with type 1 diabetes evaluated were classified as inactive and these patients had a higher prevalence of diabetic retinopathy than active patients. No difference in HbA1c levels was documented among different groups of physical activity (AU)

Objetivos: Describir el nivel de actividad física habitual y analizar su asociación con el control metabólico y la presencia de complicaciones microvasculares en una cohorte de pacientes con diabetes tipo 1 (DM-1) del sur de España. Métodos: Estudio transversal observacional que incluyó ciento treinta pacientes de 33,9 ± 11,5 años de edad y una duración de la enfermedad de 16,5 ± 9,5 años que fueron reclutados consecutivamente en el Servicio de Endocrinología del Hospital Universitario Puerta del Mar (Cádiz, España). El nivel de actividad física habitual fue evaluado utilizando el «General Practice Physical Activity Questionnaire» (GPPAQ) conjuntamente con diversos parámetros clínicos, antropométricos, metabólicos y de complicaciones microvasculares. Resultados: Los pacientes con DM-1 fueron agrupados en cuatro categorías de nivel de actividad física: inactivo (n = 33; 25,3%), moderadamente inactivo (n = 31; 23,8%), moderadamente activo (n = 26; 20,0%) y activo (n = 40; 30,9%). No observamos diferencias significativas en el nivel de hemoglobina glucosilada (HbA1c) entre los diferentes grupos de actividad física analizados. Los pacientes clasificados como moderadamente activos y activos fueron con mayor probabilidad hombres, más jóvenes y con menores niveles plasmáticos de triglicéridos que los pacientes clasificados como inactivos o moderadamente inactivos, sin encontrarse diferencias en otras variables clínicas o antropométricas. Adicionalmente, los pacientes activos y moderadamente activos tenían una menor prevalencia de retinopatía diabética y de complicaciones microvasculares en general comparados con los pacientes inactivos o moderadamente inactivos. Conclusiones: La mitad de los pacientes con DM-1 evaluados fueron clasificados como inactivos y estos pacientes tenían mayor prevalencia de retinopatía diabética que los pacientes activos. No fueron documentadas diferencias en los niveles de HbA1c entre los diferentes grupos de actividad física (AU)

¿Qué variables se asocian con un buen control metabólico en pacientes con diabetes tipo 1? / Which variables are associated with a good metabolic control in patients with type 1 diabetes?

OBJETIVOS: Evaluar las variables epidemiológicas, clínicas y de adherencia a estilos de vida saludable que se asocian con una HbA1c ≤ 7% en pacientes con diabetes tipo 1 (DM1). MATERIAL Y MÉTODOS: Estudio transversal realizado en 130 pacientes de 33,7 ± 11,7 años de edad media. Se analizaron diversas variables clínicas, antropométricas, analíticas y de estilo de vida mediante la autocumplimentación de los cuestionarios «Minnesota Leisure Time Physical Activity Questionnaire» y «Adherencia a la Dieta Mediterránea». RESULTADOS: Los pacientes con HbA1c ≤ 7% (n = 39) dedicaron mayor tiempo a realizar actividad física (AF) (999,7 ± 538,6 versus 719,5 ± 386,0 versus 834,2 ± 512,7 min/AF/semana; p = 0,010) y AF intensa (180,6 ± 259,3 versus 80,4 ± 125,5 versus 104,3 ± 139,9 min/AF intensa/semana; p = 0,037), en comparación con pacientes con HbA1c entre 7-8% (n = 41) y superior al 8% (n = 50). Los pacientes con HbA1c ≤ 7% eran más frecuentemente licenciados (77%) en comparación con los otros grupos. No se detectaron diferencias significativas en los niveles de HbA1c en función de la edad, el sexo, el tiempo de evolución, el índice de masa corporal, el número de hipoglucemias, la presencia de complicaciones o la adherencia a la dieta mediterránea. En el análisis multivariante las variables independientemente asociadas con una HbA1c ≤ 7% fueron ser licenciado y realizar más de 150 min de actividad física intensa semanal. CONCLUSIONES: Los pacientes con DM1 y HbA1c ≤ 7% de nuestro estudio son más frecuentemente licenciados y dedican más tiempo a realizar actividad física intensa que los pacientes con peor control metabólico (AU)

OBJECTIVES: To evaluate the epidemiological, clinical and healthy lifestyle adherence variables that are associated with HbA1c ≤ 7% in patients with type 1 diabetes (DM-1). METHODS: A descriptive observational study was conducted in 130 patients with DM-1 of 33.7 ± 11.7 years old. Various clinical, anthropometric and analytical variables were analysed, together with the results of the "Minnesota Leisure Time Physical Activity Questionnaire" and "Adherence to the Mediterranean Diet Questionnaire". RESULTS: Patients with HbA1c ≤ 7% (n = 39) spent more time on physical activity (PA) (999.7 ± 538.6 versus 719.5 ± 386.0 versus 834.2 ± 512.7 minutes/PA/week, P =0 .010) and intense PA (180.6 ± 80.4 versus 259.3 ± 125.5 versus 104.3 ± 139.9 minutes/PA intense/week, P = 0.037), compared with patients with HbA1c between 7-8% (n = 41) and higher than 8% (n = 50). Patients with HbA1c ≤ 7% were more likely to be college graduates (77%) than patients of other groups. There were no significant differences in HbA1c levels according to age, sex, diabetes evolution, body mass index, number of hypoglycaemia, presence of chronic complications, or adherence to the Mediterranean diet. In the multivariate analysis, the independent variables "college graduate" and "spent more than 150 minutes of intense physical activity a week" showed a significant association with the dependent variable "HbA1c ≤ 7%". CONCLUSIONS: In our study, patients with DM-1 and HbA1c ≤ 7% were most often college graduates and spent more time practicing intense physical activity than patients with poor metabolic control (AU)

Impacto de la actividad física sobre el control metabólico y el desarrollo de complicaciones crónicas en pacientes con diabetes mellitus tipo 1 / Impact of physical activity on metabolic control and the development of chronic complications in patients with type 1 diabetes mellitus

La realización de actividad física regular constituye, junto con la dieta equilibrada, uno de los pilares básicos del tratamiento de la diabetes mellitus (DM). La práctica de actividad física en personas con DM, teóricamente, ofrece las mismas ventajas que sobre la población general, y además ciertos efectos beneficiosos, en cuanto al control metabólico de la enfermedad, como mejorar los niveles de glucemia y aumentar la acción o sensibilidad a la insulina. En la presente revisión se analizan los principales estudios clínicos publicados hasta la actualidad que evalúan el impacto de la actividad física sobre el control metabólico o el desarrollo de complicaciones crónicas en pacientes con diabetes mellitus tipo 1. A modo de conclusión podemos afirmar que la mayoría de los estudios evaluados evidencian que la práctica de actividad física regular afecta favorablemente al control metabólico de la DM (o al menos no lo empeora), existiendo insuficiente información al respecto del impacto de la actividad física sobre el desarrollo y la progresión de complicaciones crónicas (AU)

Together with a balanced diet, regular physical activity is one of the pillars of diabetes mellitus (DM) management. Physical activity theoretically provides the same advantages in people with DM as in the general population and also has some beneficial effects in controlling metabolic factors, such as improving blood glucose levels and insulin sensitivity. In this article, we analyze the main clinical studies published to date that evaluate the impact of physical activity on metabolic control or the development of chronic complications in patients with type 1 diabetes mellitus. In conclusion, most of the evaluated studies show that regular physical activity favorably affects metabolic control in DM (or at least does not have adverse effects). However, there is insufficient information about the impact of physical activity on the development and progression of chronic complications (AU)

[Impact of physical activity on metabolic control and the development of chronic complications in patients with type 1 diabetes mellitus]. / Impacto de la actividad física sobre el control metabólico y el desarrollo de complicaciones crónicas en pacientes con diabetes mellitus tipo 1.

Together with a balanced diet, regular physical activity is one of the pillars of diabetes mellitus (DM) management. Physical activity theoretically provides the same advantages in people with DM as in the general population and also has some beneficial effects in controlling metabolic factors, such as improving blood glucose levels and insulin sensitivity. In this article, we analyze the main clinical studies published to date that evaluate the impact of physical activity on metabolic control or the development of chronic complications in patients with type 1 diabetes mellitus. In conclusion, most of the evaluated studies show that regular physical activity favorably affects metabolic control in DM (or at least does not have adverse effects). However, there is insufficient information about the impact of physical activity on the development and progression of chronic complications.