Consenso sobre tratamiento con insulina en la diabetes tipo 2 / Consensus on insulin treatment in type 2 diabetes

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Remission of type 2 diabetes mellitus after bariatric surgery - comparison between procedures.

INTRODUCTION: We aimed to assess the mid-term type 2 diabetes mellitus recovery patterns in morbidly obese patients by comparing some relevant physiological parameters of patients of bariatric surgery between two types of surgical procedures: mixed (roux-en-Y gastric bypass and biliopancreatic diversion) and restrictive (sleeve gastrectomy). MATERIAL AND METHODS: This is a prospective and observational study of co-morbid, type 2 diabetes mellitus evolution in 49 morbidly obese patients: 37 underwent mixed surgery procedures and 12 a restrictive surgery procedure. We recorded weight, height, body mass index, and glycaemic, lipid, and nutritional blood parameters, prior to procedure, as well as six and twelve months post-operatively. In addition, we tested for differences in patient recovery and investigated predictive factors in diabetes remission. RESULTS: Both glycaemic and lipid profiles diminished significantly to healthy levels by 6 and 12 months post intervention. Type 2 diabetes mellitus showed remission in more than 80% of patients of both types of surgical procedures, with no difference between them. Baseline body mass index, glycated haemoglobin, and insulin intake, among others, were shown to be valuable predictors of diabetes remission one year after the intervention. CONCLUSIONS: The choice of the type of surgical procedure did not significantly affect the remission rate of type 2 diabetes mellitus in morbidly obese patients. (Endokrynol Pol 2017; 68 (1): 18-25).

Diabetes mellitus y riesgo cardiovascular: recomendaciones del Grupo de Trabajo Diabetes y Enfermedad Cardiovascular de la Sociedad Española de Diabetes (SED, 2015) / Diabetes mellitus and cardiovascular risk: Working group recommendations of Diabetes and Cardiovascular Disease of the Spanish Society of Diabetes (SED, 2015)

El presente documento actualiza las recomendaciones de práctica clínica del manejo de los factores de riesgo cardiovascular (FRCV) en la diabetes mellitus (DM). Es un consenso médico realizado por un panel de expertos independiente de la Sociedad Española de Diabetes (SED). Se han propuesto y actualizado varios consensos de diferentes sociedades científicas o médicas con el fin de mejorar los resultados terapéuticos. La valoración del RCV en la población general puede carecer de sensibilidad para la evaluación individual en determinados grupos de riesgo como los diabéticos. Se revisan los factores de riesgo tradicionales y no tradicionales, así como las estrategias de intervención para el control de los FRCV en los pacientes diabéticos como la dieta, el control ponderal, el ejercicio físico, los hábitos tóxicos, el control glucémico, tensional y lipídico, así como la antiagregación plaquetaria. Confiamos en que estas pautas ayuden a los médicos en la toma de decisiones en su actividad asistencial. Se expone una actualización de los conceptos más relevantes y de mayor interés clínico-práctico y, a su vez realista, para reducir el RCV de los diabéticos como se venía haciendo regularmente por parte del Grupo de Enfermedad Cardiovascular de la SED

The present paper updates the Clinical Practice Recommendations for the management of cardiovascular risk factors (CVRF) in diabetes mellitus. This is a medical consensus agreed by an independent panel of experts from the Spanish Society of Diabetes (SED). Several consensuses have been proposed by scientific and medical Societies to achieve clinical goals. However, the risk score for general population may lack sensitivity for individual assessment or for particular groups at risk, such as diabetics. Traditional risk factors together with non-traditional factors are reviewed throughout this paper. Intervention strategies for managing CVRF in the diabetic patient are reviewed in detail: balanced food intake, weight reduction, physical exercise, smoking cessation, reduction in HbA1c, therapy for high blood pressure, obesity, lipid disorders, and platelet anti-aggregation. It is hoped that these guidelines can help clinicians in the decisions of their clinical activity. This regular update by the SED Cardiovascular Disease Group of the most relevant concepts, and of greater practical and realistic clinical interest, is presented in order to reduce CVR of diabetics

Metabolic syndrome, glucose tolerance categories and the cardiovascular risk in Spanish population.

We examined the prevalence of metabolic syndrome (MetS), glucose tolerance categories and risk factors of cardiovascular-disease (CVD) in the general Spanish population. We studied 3844 randomly sampled subjects (46% males) aged 35-74 years. Glucose tolerance categories were defined according to the 2003 ADA and MetS according to the Harmonized Consensus Criteria with waist circumference (WC) cut-off-points previously reported in Spanish population (≥94.5/≥89.5cm for males/females). The prevalences of normoglycemia (NG), impaired fasting glucose (IFG), impaired glucose tolerance (IGT), IFG and IGT considered together (IFG/IGT), and diabetes mellitus (DM) were 67.6/16.6/5.0/3.3, and 7.5%, respectively. The overall prevalence of MetS was 31.2%. In subjects with NG, IFG, IGT, IFG/IGT, and DM the MetS prevalence's were 16.3/57.1/31.5/66.1, and 74.4% (p<0.001), respectively. MetS was more common in males, older subjects, smokers, and/or individuals with obesity, IFG, IFG/IGT, DM, or insulin resistance (HOMA-IR ≥3.8). MetS was less prevalent in individuals with low alcohol intake and/or high education level. Regarding the risk level of CVD estimated by Framingham and SCORE risk charts, IGT had higher estimated CVD-risk than IFG and IFG/IGT. The presence of MetS increases the risk 4.85 times by Framingham and 2.43 times by SCORE. Prevalence of prediabetes (IFG/IGT) and MetS were 25% and 31.2% respectively. Prevalence of MetS has not changed in the past decade in Spanish females, but has slightly increased in males. We found that subjects with IGT showed a higher risk of CVD than IFG and IFG/IGT according to the Framingham and SCORE. MetS increased the CVD-risk previously estimated by Framingham and SCORE.

[Diabetes mellitus and cardiovascular risk: Working group recommendations of Diabetes and Cardiovascular Disease of the Spanish Society of Diabetes (SED, 2015)]. / Diabetes mellitus y riesgo cardiovascular: recomendaciones del Grupo de Trabajo Diabetes y Enfermedad Cardiovascular de la Sociedad Española de Diabetes (SED, 2015).

The present paper updates the Clinical Practice Recommendations for the management of cardiovascular risk factors (CVRF) in diabetes mellitus. This is a medical consensus agreed by an independent panel of experts from the Spanish Society of Diabetes (SED). Several consensuses have been proposed by scientific and medical Societies to achieve clinical goals. However, the risk score for general population may lack sensitivity for individual assessment or for particular groups at risk, such as diabetics. Traditional risk factors together with non-traditional factors are reviewed throughout this paper. Intervention strategies for managing CVRF in the diabetic patient are reviewed in detail: balanced food intake, weight reduction, physical exercise, smoking cessation, reduction in HbA1c, therapy for high blood pressure, obesity, lipid disorders, and platelet anti-aggregation. It is hoped that these guidelines can help clinicians in the decisions of their clinical activity. This regular update by the SED Cardiovascular Disease Group of the most relevant concepts, and of greater practical and realistic clinical interest, is presented in order to reduce CVR of diabetics.

Diabetes mellitus y riesgo cardiovascular: recomendaciones del Grupo de Trabajo Diabetes y Enfermedad Cardiovascular de la Sociedad Española de Diabetes (SED, 2015) / Diabetes mellitus and cardiovascular risk: Working group recommendations of Diabetes and Cardiovascular Disease of the Spanish Society of Diabetes (SED, 2015)

El presente documento actualiza las recomendaciones de práctica clínica del manejo de los factores de riesgo cardiovascular (FRCV) en la diabetes mellitus (DM). Es un consenso médico realizado por un panel de expertos independiente de la Sociedad Española de Diabetes (SED). Se han propuesto y actualizado varios consensos de diferentes sociedades científicas o médicas con el fin de mejorar los resultados terapéuticos. La valoración del RCV en la población general puede carecer de sensibilidad para la evaluación individual en determinados grupos de riesgo como los diabéticos. Se revisan los factores de riesgo tradicionales y no tradicionales, así como las estrategias de intervención para el control de los FRCV en los pacientes diabéticos como la dieta, el control ponderal, el ejercicio físico, los hábitos tóxicos, el control glucémico, tensional y lipídico, así como la antiagregación plaquetaria. Confiamos en que estas pautas ayuden a los médicos en la toma de decisiones en su actividad asistencial. Se expone una actualización de los conceptos más relevantes y de mayor interés clínico-práctico y, a su vez realista, para reducir el RCV de los diabéticos como se venía haciendo regularmente por parte del Grupo de Enfermedad Cardiovascular de la SED

The present paper updates the Clinical Practice Recommendations for the management of cardiovascular risk factors (CVRF) in diabetes mellitus. This is a medical consensus agreed by an independent panel of experts from the Spanish Society of Diabetes (SED). Several consensuses have been proposed by scientific and medical Societies to achieve clinical goals. However, the risk score for general population may lack sensitivity for individual assessment or for particular groups at risk, such as diabetics. Traditional risk factors together with non-traditional factors are reviewed throughout this paper. Intervention strategies for managing CVRF in the diabetic patient are reviewed in detail: balanced food intake, weight reduction, physical exercise, smoking cessation, reduction in HbA1c, therapy for high blood pressure, obesity, lipid disorders, and platelet anti-aggregation. It is hoped that these guidelines can help clinicians in the decisions of their clinical activity. This regular update by the SED Cardiovascular Disease Group of the most relevant concepts, and of greater practical and realistic clinical interest, is presented in order to reduce CVR of diabetics

[Diabetes mellitus and cardiovascular risk: Working group recommendations of Diabetes and Cardiovascular Disease of the Spanish Society of Diabetes (SED, 2015)]. / Diabetes mellitus y riesgo cardiovascular: recomendaciones del Grupo de Trabajo Diabetes y Enfermedad Cardiovascular de la Sociedad Española de Diabetes (SED, 2015).

The present paper updates the Clinical Practice Recommendations for the management of cardiovascular risk factors (CVRF) in diabetes mellitus. This is a medical consensus agreed by an independent panel of experts from the Spanish Society of Diabetes (SED). Several consensuses have been proposed by scientific and medical Societies to achieve clinical goals. However, the risk score for general population may lack sensitivity for individual assessment or for particular groups at risk, such as diabetics. Traditional risk factors together with non-traditional factors are reviewed throughout this paper. Intervention strategies for managing CVRF in the diabetic patient are reviewed in detail: balanced food intake, weight reduction, physical exercise, smoking cessation, reduction in HbA1c, therapy for high blood pressure, obesity, lipid disorders, and platelet anti-aggregation. It is hoped that these guidelines can help clinicians in the decisions of their clinical activity. This regular update by the SED Cardiovascular Disease Group of the most relevant concepts, and of greater practical and realistic clinical interest, is presented in order to reduce CVR of diabetics.

Relationship between serum concentrations of persistent organic pollutants and markers of insulin resistance in a cohort of women with a history of gestational diabetes mellitus.

The aim of the present study was to assess the relationship between serum concentrations of several persistent organic pollutants and insulin resistance markers in a cohort of women with a history of gestational diabetes mellitus. ∑POPs was computed as the sum of individual serum POP concentrations. No statistically significant associations were found between levels of any POP and fasting glucose. However, polychlorinated biphenyl (PCB) congeners 138 and 180 were positively associated with 2-h glucose levels and PCB 180 also with fasting immunoreactive insulin (IRI). We also found a positive association of p,p'- dichlorodiphenyldichloroethylene (p,p'- DDE), PCBs (138, 153, and 180), hexachlorobenzene, and ∑POPs with 2-h IRI. Serum concentrations of PCBs (138, 153, and 180), hexachlorobenzene, and ∑POPs were also positively associated with homeostasis model assessment (HOMA2-IR) levels. Moreover, p,p'- DDE, PCBs (138, 153 and 180), hexachlorobenzene, and ∑POPs were negatively associated with Insulin Sensitivity Index (ISI-gly) levels. No significant association was found between glycated hemoglobin and the concentrations of any POP. The removal of women under blood glucose lowering treatment from the models strengthened most of the associations previously found for the whole population. Our findings suggest that exposure to certain POPs is a modifiable risk factor contributing to insulin resistance.

Factores de riesgo cardiovascular en pacientes con hiperparatiroidismo primario asintomático / Cardiovascular risk factors in patients with asymptomatic primary hyperparathyroidism

OBJETIVOS: Los pacientes con hiperparatiroidismo primario (HPP), incluso asintomático, presentan un mayor riesgo cardiovascular. Sin embargo, los datos sobre la reversibilidad o mejoría de las alteraciones cardiovasculares con la cirugía son controvertidos. Los objetivos de nuestro estudio fueron evaluar la prevalencia de factores de riesgo cardiovascular clásicos en pacientes con HPP asintomático, examinar su relación con los niveles de calcio y PTH y analizar el efecto de la paratiroidectomía sobre los mismos. PACIENTES Y MÉTODOS: Estudio retrospectivo observacional de 2 grupos de pacientes con HPP asintomático: 40 pacientes en observación y 33 pacientes intervenidos. Se recogieron datos clínicos y bioquímicos relacionados con el HPP y de diversos factores de riesgo cardiovascular en todos los pacientes de forma basal, y al año de la cirugía en el grupo de pacientes intervenidos. RESULTADOS: Encontramos una elevada prevalencia de obesidad (59,9%), diabetes mellitus tipo 2 (25%), hipertensión arterial (47,2%) y dislipidemia (44,4%) en la muestra total, sin diferencias entre los grupos de estudio. En el grupo que se mantuvo en observación las concentraciones séricas de calcio y PTH se relacionaron positivamente con el IMC (r = 0,568, p = 0,011 y r = 0,509, p = 0,026 respectivamente). En los pacientes intervenidos, al año de la cirugía no hubo mejoría de los factores de riesgo cardiovascular considerados. Conclusiones Nuestros resultados confirman la elevada prevalencia de obesidad, diabetes mellitus tipo 2, hipertensión arterial y dislipidemia en pacientes con HPP asintomático. Sin embargo, el tratamiento quirúrgico no supuso una mejoría en estos factores de riesgo cardiovascular

OBJECTIVES: Patients with primary hyperparathyroidism (PHP), even asymptomatic, have an increased cardiovascular risk. However, data on reversibility or improvement of cardiovascular disorders with surgery are controversial. Our aims were to assess the prevalence of classic cardiovascular risk factors in patients with asymptomatic PHP, to explore their relationship with calcium and PTH levels, and analyze the effect of parathyroidectomy on those cardiovascular risk factors. PATIENTS AND METHODS: A retrospective, observational study of two groups of patients with asymptomatic PHP: 40 patients on observation and 33 patients who underwent surgery. Clinical and biochemical data related to PHP and various cardiovascular risk factors were collected from all patients at baseline and one year after surgery in the operated patients. RESULTS: A high prevalence of obesity (59.9%), type 2 diabetes mellitus (25%), high blood pressure (47.2%), and dyslipidemia (44.4%) was found in the total sample, with no difference between the study groups. Serum calcium and PTH levels positively correlated with BMI (r = .568, P = .011, and r = .509, P = .026 respectively) in non-operated patients. One year after parathyroidectomy, no improvement occurred in the cardiovascular risk factors considered. CONCLUSIONS: Our results confirm the high prevalence of obesity, type 2 diabetes mellitus, high blood pressure, and dyslipidemia in patients with asymptomatic PHP. However, parathyroidectomy did not improve these cardiovascular risk factors

Cardiovascular risk factors in patients with asymptomatic primary hyperparathyroidism.

OBJECTIVES: Patients with primary hyperparathyroidism (PHP), even asymptomatic, have an increased cardiovascular risk. However, data on reversibility or improvement of cardiovascular disorders with surgery are controversial. Our aims were to assess the prevalence of classic cardiovascular risk factors in patients with asymptomatic PHP, to explore their relationship with calcium and PTH levels, and analyze the effect of parathyroidectomy on those cardiovascular risk factors. PATIENTS AND METHODS: A retrospective, observational study of two groups of patients with asymptomatic PHP: 40 patients on observation and 33 patients who underwent surgery. Clinical and biochemical data related to PHP and various cardiovascular risk factors were collected from all patients at baseline and one year after surgery in the operated patients. RESULTS: A high prevalence of obesity (59.9%), type 2 diabetes mellitus (25%), high blood pressure (47.2%), and dyslipidemia (44.4%) was found in the total sample, with no difference between the study groups. Serum calcium and PTH levels positively correlated with BMI (r=.568, P=.011, and r=.509, P=.026 respectively) in non-operated patients. One year after parathyroidectomy, no improvement occurred in the cardiovascular risk factors considered. CONCLUSIONS: Our results confirm the high prevalence of obesity, type 2 diabetes mellitus, high blood pressure, and dyslipidemia in patients with asymptomatic PHP. However, parathyroidectomy did not improve these cardiovascular risk factors.

Gonadotropins Are Related to Lean Mass in Healthy Postmenopausal Women.

BACKGROUND: It has been suggested that the changes in hormone levels that occur with menopause and aging are related to loss of muscle mass. However, the role of gonadotropins in this process is unknown. OBJECTIVES: To analyze the relationship between follicle-stimulating hormone (FSH) and luteinizing hormone (LH) and lean mass in a cohort of healthy women. METHODS: This is a cross-sectional study including 91 postmenopausal women (48-65 years old). Serum FSH, LH, and estradiol (E2) were measured. Lean mass was estimated by bioelectrical impedance analysis and expressed as appendicular skeletal muscle mass (AMM) index. RESULTS: AMM index was negatively correlated with FSH levels (r = -0.33, p = 0.001) and LH (r = -0.293, p = 0.005), while there was no association with E2. When muscle mass expressed as AMM index was stratified into tertiles, there were significant differences between the lowest and the highest tertile for both FSH (82.4 ± 30, vs. 67.9 ± 25.8 mIU/mL, p = 0.04) and LH (40.9 ± 15.2 vs. 36.1 ± 12.3 mIU/mL, p = 0.03). In logistic regression analysis adjusted for age and E2 levels, high concentrations of FSH (OR = 1.03, 95% CI = 1.01-1.05, p = 0.008) and LH (OR = 1.06, 95% CI = 1.01-1.1, p = 0.01) were risk factors for having lower lean mass expressed as AMM index. CONCLUSIONS: Menopausal women with high levels of gonadotropins have lower levels of lean mass than those with lower gonadotropins levels.

Role of serum FSH measurement on bone resorption in postmenopausal women.

In vitro and animals models have shown follicle-stimulating hormone (FSH) effects on osteoclastic function, and FSH levels seem to influence bone loss independently of estrogen concentrations in humans. Our aim was to evaluate the role of serum FSH measurement in the assessment of bone resorption in postmenopausal women. We conducted a cross-sectional study including 92 postmenopausal healthy women aged 56.2 (3.6) and 7.2 (4) years since menopause. Serum FSH, luteinizing hormone (LH), estradiol (E2) and bone turnover markers as osteocalcin (OC) and C-terminal telopeptide of type I collagen (CTX) were measured. We analyzed the relationship between serum levels of gonadotropins, E2, and bone turnover markers. Serum levels of OC and CTX were positively related to FSH (r = 0.234, P = 0.047 and r = 0.384, P = 0.003) and LH (r = 0.319, P = 0.012 and r = 0.273, P = 0.038). There was no relationship with E2 levels. When gonadotropins levels were divided into quartiles, we found significant differences in bone turnover markers between the first and the fourth quartile. OC levels were higher in the highest quartile of FSH (P = 0.024) and LH (P = 0.001). Serum CTX was also higher in the highest quartile of FSH (P = 0.004) and LH (P = 0.039). FSH levels could explain approximately 14.7% of the chances in CTX. In summary, gonadotropins were related to bone turnover in postmenopausal healthy women. Moreover, the rise in FSH appears to contribute to higher bone resorption. Our results suggest that the measurement of FSH could be usefulness to perform a more comprehensive assessment of bone loss in these women.

Guías clínicas en diabetes mellitus tipo 1 / No disponible

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Serum cathepsin K as a marker of bone metabolism in postmenopausal women treated with alendronate.

CONTEXT: Cathepsin K is a member of the cysteine protease family that cleaves both helical and telopeptide regions of collagen I, the major type of collagen in bone. Measurement of circulating levels of cathepsin K may be useful to assay the number or function of osteoclasts. OBJECTIVE: The aim of the study was to evaluate the role of serum cathepsin K as a biochemical marker of bone metabolism in patients with postmenopausal osteoporosis before and after treatment with alendronate. DESIGN, SETTING AND PARTICIPANTS: The study was a case-control and prospective study with postmenopausal osteoporotic women including a total number of 86 subjects. Serum cathepsin K was determined in 46 women with postmenopausal osteoporosis before and after 3, 6 and 12 months of treatment with alendronate. Basal serum cathepsin K levels were also compared between premenopausal healthy women (n=20), postmenopausal women without osteoporosis (n=20) and osteoporotic women. In addition, serum carboxyterminal cross-linked telopeptide of type I collagen (CTX), osteocalcin (OC) and bone-specific alkaline phosphatase (bALP) were measured. MAIN OUTCOME MEASURE: Changes in cathepsin K serum levels after alendronate treatment. RESULTS: Serum cathepsin K levels were higher in postmenopausal women with osteoporosis (9.4+/-11pmol/L) compared with healthy postmenopausal women (6.8+/-8.1pmol/L; p<0.01) and premenopausal women (6.3+/-5.0pmol/L, p<0.01). Serum cathepsin K decreases gradually after alendronate treatment (17% at 3 months, 22% at 6 months and 41% at 12 months, p<0.01). In contrast, the treatment resulted in early and sustained reductions in serum CTX. CONCLUSION: We conclude that serum cathepsin K seems to provide additional information on bone metabolism in postmenopausal women treated with alendronate.