Carcinoma medular de tiroides estadio IV y gestación / Medullary thyroid carcinoma stage IV and pregnancy

El carcinoma medular de tiroides (CMT) es un tumor maligno poco frecuente, con relativa agresividad debido a la existencia de metástasis a distancia en el momento del diagnóstico. Se considera como tratamiento de primera línea la cirugía, aunque existen otras opciones de tratamiento en los casos de recurrencia o enfermedad persistente, como los inhibidores de la tirosin-kinasa. El impacto del embarazo en mujeres con CMT es desconocido. Presentamos un caso inédito de una paciente diagnosticada de CMT con gestación posterior exitosa

Medullary thyroid carcinoma is an uncommon malignant tumour that behaves aggressively due to frequent distant metastases at the time of diagnosis. Surgery is considered as first-line treatment, although other treatment options are available for patients with recurrent or residual disease, such as a tyrosine kinase inhibitors. The impact of pregnancy on women with medullary thyroid carcinoma is unknown. We present the case of a woman with medullary thyroid carcinoma whose subsequent pregnancy was successful

Early blood pressure alterations are associated with pro-inflammatory markers in type 1 diabetes mellitus.

The aim of this study was to evaluate the relationship between early blood pressure (BP) changes (detected using ambulatory BP monitoring; ABPM) with different markers of inflammation and endothelial dysfunction in patients with type 1 diabetes mellitus (T1DM). The study design was observational cross-sectional in 85 T1DM patients, clinically normotensive and with normo-albuminuria. We analyzed the relationships between ABPM-measured BP alterations over 24 h with the inflammatory cytokines (interleukin-6 (IL-6), tumor necrosis factor-α and vascular endothelial growth factor (VEGF)) and the markers of endothelial damage (vascular adhesion molecule, intercellular adhesion molecule and plasminogen activator inhibitor-1 (PAI)). Despite being recorded as normotensive, 27 (31.8%) subjects presented with an average of pathological BP. VEGF levels were significantly elevated in the patients with an altered mean diurnal values compared with normotensives (112.33 (72.87-213.53) pg ml-1 vs 71.03 (37.71-107.92) pg ml-1; P=0.007). Further, VEGF levels correlated significantly with the parameters of diurnal BP and of 24 h values. IL-6 concentration was a risk factor in the patients with hypertension (OR=1.406; P=0.027). There were no modifications in the levels of markers of endothelial damage. Summarizing, there is an increase in pro-inflammatory cytokines, but not the endothelial adhesion molecules, in early stages of arterial hypertension in patients with T1DM.

[Effect of gastric bypass on the cardiovascular risk and quality of life in morbid obese patients]. / Efecto del bypass gástrico sobre el riesgo cardiovascular y la calidad de vida en pacientes con obesidad mórbida.

OBJECTIVES: To determine the prevalence of major comorbidities of morbidity obese patients and to evaluate the gastric bypass effect on the weight status, cardiovascular risk and quality of life in these patients. METHODS: The evolution of weight, comorbidity, 10- year follow-up of cardiovascular risk (estimated by the Framingham risk score) and quality of life using the test BAROS (Bariatric Analysis and Reporting Outcome System) was analyzed in 162 patients with morbid obesity before and 2 years after gastric bypass. RESULTS: Body mass index (BMI) was reduced from 51.12 ± 7.22 to 29.94 ± 4.86 kg/m2 (72.85% loss of excess weight). Hypertension (HT), dyslipidemia and type 2 diabetes mellitus (T2DM) were resolved in 71.93%, 91.38% and 82.93% respectively (p < 0.001). Cardiovascular risk greater than 10% was reduced from 25.91% to 4.32% (p < 0.001). According to BAROS scale, surgery was positive in 95% of cases. CONCLUSIONS: Gastric bypass is very effective in weight loss; benefits in comorbidities, cardiovascular risk and quality of life.

Objetivos: Determinar la prevalencia de las principales comorbilidades asociadas a la obesidad mórbida y evaluar el efecto del bypass gástrico sobre el estado ponderal, riesgo cardiovascular y calidad de vida en estos pacientes. Métodos: Estudio descriptivo con medidas del cambio intrasujeto (antes-después) en una muestra de 162 pacientes de los resultados del bypass gástrico sobre la evolución ponderal, comorbilidades asociadas, riesgo cardiovascular a 10 años (estimado mediante las tablas de Framingham) y calidad de vida mediante el test BAROS (Bariatric Analysis and Reporting Outcome System). Resultados: El índice de masa corporal (IMC) se reduce de 51,12 ± 7,22 kg/m2 a 29,94 ± 4,86 kg/m2 (72,85% de sobrepeso perdido) y se resuelven la hipertensión arterial (HTA), la dislipemia y la diabetes mellitus tipo 2 (DMT2) en el 71,93%, 91,38% y 82,93% respectivamente (p < 0,001). El riesgo cardiovascular mayor del 10% se reduce del 25,91% al 4,32% (p < 0,001). Según la escala BAROS, el resultado de la cirugía fue favorable en el 95% de los casos. Conclusiones: La cirugía bariátrica mediante bypass gástrico demuestra ser muy efectiva para la reducción ponderal y comorbilidades asociadas, mejorando notablemente la calidad de vida.

Postpartum development of endothelial dysfunction and oxidative stress markers in women with previous gestational diabetes mellitus.

BACKGROUND: Relationships between adhesion molecules (AM), oxidative stress, gestational diabetes mellitus (GDM) and future development of type 2 diabetes mellitus are unclear. AIM: We investigated AM and oxidant/antioxidant markers in women with previous history of GDM. SUBJECTS AND METHODS: Postpartum women with GDM (cases; n = 41) and healthy women (controls; n = 21) had clinical and laboratory variables measured, including indicators of vascular damage (ICAM-1, VCAM-1 and E-selectin), oxidative stress (LPO, GSH and GST) and antioxidant markers (catalase, SOD, GPX and TAC). RESULTS: Previous GDM versus control women presented higher body mass index: 27.4 ± 5.6 versus 23.9 ± 3.6 (p = 0.013); waist circumference: 85.2 ± 12.9 versus 77.5 ± 9.0 (p = 0.017); MetS (WHO definition): 14.6 versus 0 % (p = 0.012); MetS (NCEP-ATPIII definition): 22 versus 0 % (p = 0.002); low HDL: 36.6 versus 9.5 % (p = 0.024); fasting glucose (mmol/L): 5.4 ± 0.6 versus 4.9 ± 0.2 (p < 0.001); glucose 120 min (mg/dL): 105.0 ± 30.2 versus 85.1 ± 14.2 (p = 0.007); fasting insulin (µU/mL): 13.4 ± 8.1 versus 8.4 ± 4.3 (p = 0.004); HOMA index: 3.3 ± 2.3 versus 1.8 ± 1.0 (p = 0.002); HbA1c (%/mmol/mol): 5.4 ± 0.2 versus 5.2 ± 0.2/36 ± 1.4 versus 33 ± 1.4 (p = 0.021); uric acid (mg/dL): 4.1 ± 1 versus 3.5 ± 0.6 (p = 0.009); catalase (nmol/min/mL): 38.7 ± 15.6 versus 28.9 ± 11.1 (p = 0.013). There were no significant differences in hypertension prevalence, lipid fractions, albumin/creatinine ratio and AM. CONCLUSIONS: Women with previous GDM have high catalase levels which correlate positively with glucose intolerance, indicating the potential effect of oxidative stress on postpartum dysglycemic status.

Efecto del bypass gástrico sobre el riesgo cardiovascular y la calidad de vida en pacientes con obesidad mórbida / Effect of gastric bypass on the cardiovascular risk and quality of life in morbid obese patients

Objetivos: Determinar la prevalencia de las principales comorbilidades asociadas a la obesidad mórbida y evaluar el efecto del bypass gástrico sobre el estado ponderal, riesgo cardiovascular y calidad de vida en estospacientes. Métodos: Estudio descriptivo con medidas del cambio intrasujeto (antes-después) en una muestra de 162 pacientes de los resultados del bypass gástrico sobre la evolución ponderal, comorbilidades asociadas, riesgo cardiovascular a 10 años (estimado mediante las tablas de Framingham) y calidad de vida mediante el test BAROS (Bariatric Analysis and Reporting Outcome System).Resultados: El índice de masa corporal (IMC) se reduce de 51,12 ± 7,22 kg/m2 a 29,94 ± 4,86 kg/m2 (72,85% de sobrepeso perdido) y se resuelven la hipertensión arterial(HTA), la dislipemia y la diabetes mellitus tipo 2 (DMT2)en el 71,93%, 91,38% y 82,93% respectivamente (p <0,001). El riesgo cardiovascular mayor del 10% se reduce del 25,91% al 4,32% (p < 0,001). Según la escala BAROS, el resultado de la cirugía fue favorable en el 95% de los casos. Conclusiones: La cirugía bariátrica mediante bypass gástrico demuestra ser muy efectiva para la reducción ponderal y comorbilidades asociadas, mejorando notablemente la calidad de vida (AU)

Objectives: To determine the prevalence of majorcomorbidities of morbidity obese patients and to evaluate the gastric bypass effect on the weight status, cardiovascular risk and quality of life in these patients. Methods: The evolution of weight, comorbidity, 10-year follow-up of cardiovascular risk (estimated by the Framingham risk score) and quality of life using the test B AROS (Bariatric Analysis and Reporting Outcome System) was analyzed in 162 patients with morbid obesity before and 2 years after gastric bypass. Results: Body mass index (BMI) was reduced from 51.12± 7.22 to 29.94 ± 4.86 kg/m2 (72.85% loss of excess weight).Hypertension (HT), dyslipidemia and type 2 diabetes mellitus (T2DM) were resolved in 71.93%, 91.38% and82.93% respectively (p < 0.001). Cardiovascular risk greater than 10% was reduced from 25.91% to 4.32% (p< 0.001). According to BAROS scale, surgery was positive in 95% of cases. Conclusions: Gastric bypass is very effective in weightless; benefits in comorbidities, cardiovascular risk and quality of life (AU)

Cytokine profile, metabolic syndrome and cardiovascular disease risk in women with late-onset gestational diabetes mellitus.

Inflammation is an important component of the metabolic syndrome (MetS) which could be the link between the metabolic and the cardiovascular consequences of this condition. Gestational diabetes mellitus (GDM) has been recognized as a significant risk factor for MetS and an inflammation component has been described in this disease. The aim of the study was to evaluate the relationships between cytokine concentrations, components of MetS and cardiovascular risk markers in women with late-onset GDM. Women (n=63) with late-onset GDM and 63 controls were enrolled. Clinical variables, and obstetrics and perinatal outcomes were recorded. Relationships between cytokines (TNF-α, leptin, IL6, adiponectin) and endothelial injury markers (VCAM, ICAM and selectine) were analyzed. Control vs. patient data indicated: pre-gestational body mass index (BMI) 23.46±3.73 vs. 26.97±5.07kg/m(2) (p=0.001); TNF-α 2.2±0.8 vs. 3.1±1.5pg/mL (p=0.002); leptin 18714.78±8859.08 vs. 27365.79±16209.67pg/mL (p=0.001); adiponectin 162.42±34.19 vs. 141.54±41.33ng/mL (p=0.04). Multivariate analyses showed that adiponectin had a protective effect (OR=0.9; p=0.02) and BMI carried a significant risk (OR=8.4; p=0.01) for GDM. No differences were found in endothelial injury markers. In conclusion, the cytokine profile in women with late-onset GDM is characterized by high concentrations of TNF-α and leptin and low adiponectin. This profile is related, in large extent, to an increased pregravid BMI which, potentially, may be linked to the future development of both metabolic and cardiovascular disease.

Alterations in arterial pressure in patients with Type 1 diabetes are associated with long-term poor metabolic control and a more atherogenic lipid profile.

AIM: To determine the prevalence of alterations in blood pressure (BP) in patients with Type 1 diabetes who are normoalbuminuric and normotensive; and to evaluate the association with genetic, clinical and metabolic factors. MATERIAL/ METHODS: Normoalbuminuric, normotensive Type 1 diabetic patients (no.=85) had their ambulatory blood pressure monitoring (ABPM) performed over 24 h, together with measurement of HbA1c and lipid profile, polymorphisms of the ACE gene, non-midriatic retinography, and the "historical HbA1c" calculated (mean of all the determinations available on the patient). RESULTS: Of the 85 patients, a mean of 18.8% had pathologic values of BP over the 24 h, 31.8% during active periods and 22.4% during rest periods; in 42% there was a non-dipper pattern in BP. The patients with alterations of BP had higher body mass index (BMI), higher levels of glycemia and of triglycerides, and decreased levels of HDL cholesterol. The "historical HbA1c" was significantly higher in the patients with the non-dipper pattern (8.6 ± 1.4% vs 7.9 ± 1.4%; p=0.046). Pulse pressure was directly associated with male gender (p=0.006) and with BMI (p=0.001). No differences were detected in the distribution of the polymorphisms of the ACE gene as a function of the BP alterations. CONCLUSIONS: An elevated number normoalbuminuric, normotensive, Type 1 diabetic patients have alterations in BP detected with ABPM over 24 h, and these are associated with a greater BMI, poor long-term metabolic control and a more atherogenic lipid profile.

Prevalencia de la enfermedad tiroidea autoinmune en pacientes con diabetes mellitus tipo 1 / Prevalence of autoimmune thyroid disease in patients with type 1 diabetes

Objetivo: Evaluar la prevalencia de enfermedad tiroidea autoinmune (ETA) enpacientes con diabetes tipo 1 (DM1) y su relación con variables clínicas y analíticas.Material y métodos: Estudio observacional descriptivo en pacientescon DM1 en el que se analiza la prevalencia de ETA y los factores relacionados.Resultados: Se estudiaron 507 pacientes con DM1 (50,4% mujeres)de 33,5 ± 11,8 años de edad y 16,1 ± 9,5 años de evolución de la DM1, ycon un nivel medio de HbA1c del 7,8 ± 1,4%. El 17,8% de los pacientes presentabaETA (9,9% hipotiroidismo primario, 7,1% hipotiroidismo subclínico y0,8% enfermedad de Graves). Los pacientes DM1 y ETA eran, con mayor frecuencia,mujeres (24,6 frente a 10,8%; p <0,001) y fumadores (15,6 frentea 2,2%; p= 0,039) y presentaban niveles séricos de colesterol LDL (c-LDL)más elevados (110,1 ± 31,4 frente a 102,9 ± 28,8 mg/dL; p <0,043).Conclusión: Observamos una elevada prevalencia de ETA en pacientes conDM1, asociándose a sexo femenino, tabaquismo activo y niveles elevados dec-LDL. Recomendamos el cribado sistemático de ETA en pacientes con DM1,que permita un precoz diagnóstico y tratamiento(AU)

Objective: To evaluate the prevalence of autoimmune thyroid disease in type1 diabetes patients and their association to clinical and analytical parameters.Methodology: A retrospective observational study of type 1 diabetes patientswas designed to analyze the prevalence of autoimmune thyroid disease andrelated factors. Results: The study included 507 patients with type 1 diabetes(50.4% women), aged 33.5 ± 11.8 years with an average duration of diabetesof 16.1 ± 9.5 years. The average level of HbA1c was 7.8 ± 1.4%.Theprevalence of autoimmune thyroid function disorder was 17.8% (9.9% primaryhypothyroidism, 7.1% subclinical hypothyroidism, and 0.8% Graves disease).There was a positive association between thyroid disease and femalegender (24.6% versus 10.8% in men, p <0.001), smoking (15.6% versus2.2%, p= 0.039) and serum LDL levels (110.1 ± 31.4 mg/dL versus 102.9± 28.8 mg/dL; p <0.043). Conclusion: Prevalence of autoimmune thyroiddisease in type 1 diabetes patients is high and it is associated with femalegender, smoking and increased LDL levels. We suggest a systematic screeningfor autoimmune thyroid disease in type 1 diabetes to establish an early diagnoseand treatment(AU)

Alteraciones de la presión arterial en pacientes con diabetes tipo 1 / Blood pressure alterations in patients with type 1 diabetes

La hipertensión arterial (HTA) incrementa de forma significativa elriesgo de complicaciones crónicas de la diabetes. Mediante la monitorizaciónambulatoria de presión arterial (MAPA) es posible detectaralteraciones subclínicas de la presión arterial (PA), como elpatrón no dipper, que pasan desapercibidas con la toma aislada, yque son más prevalentes en pacientes con diabetes que en la poblacióngeneral. A pesar de su relevancia, son escasos los datosdisponibles a este respecto en pacientes con diabetes tipo 1 (DM1).Por este motivo, se ha realizado un exhaustivo análisis de la bibliografía(PubMed, Ovid). La prevalencia de HTA y de patrón no dipperdifieren según la metodología del estudio y las características de lapoblación analizada (HTA: 8-58%; patrón no dipper: 18-78%). Lapresencia de patrón no dipper incrementa significativamente el riesgode microalbuminuria y retinopatía. Aunque el control estricto dela HTA disminuye la aparición de complicaciones crónicas de ladiabetes, no hay evidencias de que el tratamiento de las alteracionessubclínicas de la PA, detectadas mediante MAPA en pacientesnormotensos, disminuya la tasa de complicaciones, por lo que esnecesario llevar a cabo estudios prospectivos para aclarar estacuestión(AU)

Hypertension and subclinical alterations of blood pressure (non dipperpattern) increase the risk of chronic diabetes complications. In spiteof this risk, there are few studies that analize this problem in type 1diabetic patients. Because of this, we have made an exhaustive searchabout this item in bibliographic databases (PubMed, Ovid). Prevalenceof hypertension and non-dipper pattern are different depending onthe methodology and population charactheristics (hypertension: 8-58%; non dipper pattern: 18-78%). Non dipper pattern increasessignifi cantively the risk of microalbuminuria and retinopathy. Althoughthere is evidence about the benefi cial effect of tigh control of hypertension,at the moment we do not know exactly the benefi cial effectof treating subclinical alterations of blood pressure in patient with valuesat normal range during standard measurement(AU)

Benefits of continuous subcutaneous insulin infusion in type 1 diabetes previously treated with multiple daily injections with once-daily glargine and pre-meal analogues.

BACKGROUND/AIMS: There is insufficient information about the use of continuous subcutaneous insulin infusion (CSII) versus multiple daily injections (MDI) using long-acting insulin analogs in relation to possible metabolic consequences and, as well, on the grade of patient satisfaction. The aim of the study was to evaluate the usefulness of CSII treatment in patients with type 1 diabetes in achieving glycemic objectives using continuous glucose monitoring system (CGMS) and in improving patient's satisfaction with treatment. METHODS: We have studied 45 type 1 diabetic patients treated with MDI with once-daily glargine and pre-meal rapid-acting insulin analogues, and 20 patients who commenced CSII because they had not achieved a good glycemic control. RESULTS: With CSII, there were significant reductions in insulin requirements (0.75+/-0.21 vs. 0.64+/-0.21 UI/kg/day; p=0.001), HbA (1c) (7.99+/-0.76 vs. 7.19+/-0.51%; p=0.001) and hypoglycemic episodes (4.60+/-1.82 vs. 3.05+/-1.88 events/patient/week; p=0.031) and improved patient satisfaction with treatment. CSII reduced hyperglycemic episodes in 04:00-08 h period (131.65+/-113.49 vs. 69.70+/-101.52 min; p=0.049), 24 h period area-under-the-curve (AUC) (4521.60+/-3689.23 vs. 3000.36+/-493.96 mmol/L x min; p=0.025) and AUC before dinner (217.36+/-181.46 vs. 136.22+/-202.88 mmol/L x min; p=0.048). CONCLUSIONS: In selected patients with poor metabolic control with once-daily glargine and pre-meal rapid-acting insulin analogues, CSII is a good alternative since it reduces hypoglycemic episodes and insulin requirement and improves glycemic control and patient's satisfaction.

Armonización de resultados de HbA1c en España / Harmonization oftheresultsofHbA1c in Spain

No disponible

No disponible

Tratamiento insulínico en régimen basal-bolos con insulina glargina en pacientes con diabetes tipo 1 con inadecuado control metabólico / Insulin treatment in basal-bolus regimen using a insulin glargine in patients with type 1 diabetes and inadequate metabolic control

El objetivo de este trabajo era evaluar la eficacia del tratamiento con múltiples dosis de insulina (MDI) utilizando insulina glargina como insulina basal y lispro como insulina prandial. Cuarenta y cinco pacientes con diabetes tipo 1 (DM1) y un control metabólico inadecuado con terapia intensiva con insulina protamina neutra de Hagedorn (NPH) e insulina rápida, fueron tratados con una dosis de insulina glargina asociada a 3 o más dosis de insulina lispro preprandial durante 5 meses. Antes y después del tratamiento, se analizaron variables clínicas, analíticas y grado de satisfacción con el tratamiento, y se efectuó una monitorización continua de glucosa durante 48 horas al final del estudio. Los resultados fueron los siguientes: con la terapia basal-bolos se observó un aumento del índice de masa corporal (24,0 ± 3,5 frente a 24,4 ± 3,4 kg/m2; p <0,05), una reducción de las necesidades de insulina (0,86 ± 0,28 frente a 0,72 ± 0,20 UI/kg/día; p <0,001) y una disminución de los episodios de hipoglucemia grave. Al mismo tiempo, un descenso significativo tanto de la glucemia basal (189 ± 78 frente a 145 ± 58 mg/dL; p= 0,005) como de los niveles de hemoglobina glucosilada (HbA1c) (8,5 ± 1,1 frente a 7,8 ± 0,8%; p= 0,001), así como una evidente mejora en el grado de satisfacción con el tratamiento. En conclusión, el tratamiento con MDI en régimen bolos-basal con insulina glargina como insulina basal reduce la glucemia basal y el nivel de HbA1c, con menores requerimientos de insulina, e induce un ligero incremento ponderal. Además, esta terapia consigue una reducción significativa de los episodios de hipoglucemia grave, con una mejora importante en el grado de satisfacción del paciente con el tratamiento (AU)

Our aim was to evaluate the efficacy of treatment with multiple daily injections (MDI) using insulin glargine as basal insulin and insulin lispro as prandial insulin. Forty-five patients with type 1 diabetes and inadequate metabolic control with intensive therapy based on NPH insulin and rapid-acting insulin were treated with insulin glargine once daily associated with 3 or more doses of preprandial lispro insulin during 5 months. Clinical and analytical variables and satisfaction with treatment were analyzed before and after treatment, and a continuous glucose monitoring was performed during 48 hours at the end of the study. An increase in body mass index (24.01 ± 3.55 versus 24.42 ± 3.38 kg/m2, p <0.05), a reduction in insulin requirements (0.86 ± 0.28 versus 0.72 ± 0.20 IU/kg/day, p <0.001) and diminution of severe hypoglycemia episodes were observed with the basal-bolus therapy. At the same time, a significant decrease of fasting plasma glucose levels (189 ± 78 versus 145 ± 58 mg/dl, p= 0.005) and HbA1c levels (8.5 ± 1.1 versus 7.8 ± 0.8%, p= 0001), as well as an improvement in the degree of satisfaction with treatment were observed. In conclusion, treatment with MDI in basalbolus regimen with insulin glargine as basal insulin reduces fasting plasma glucose and HbA1c levels, with lower insulin requirements and a slight weight increase. Furthermore, this therapy achieves a significant reduction of episodes of severe hypoglycemia with an important improvement in the degree of treatment patient satisfaction (AU)

Anti-proliferative effect of pro-inflammatory cytokines in cultured beta cells is associated with extracellular signal-regulated kinase 1/2 pathway inhibition: protective role of glucagon-like peptide -1.

Pancreatic beta-cell homeostasis is a balance between programmed cell death (apoptosis) and regeneration. Although autoimmune diabetes mellitus type 1 (DM1) is the most-studied cause of beta-cell mass loss by pro-inflammatory cytokine-induced apoptosis, influences of a pro-inflammatory environment on beta-cell regenerative response have been poorly studied. In this study, we assess the anti-proliferative effect of pro-inflammatory cytokines and glucose concentration on rat pancreatic beta cells and the potential protective role of glucagon-like peptide (GLP-1). Apoptotic and proliferating islet cells were stained using the DeadEnd Fluorimetric TUNEL System and 5-bromo-2'-deoxyuridine label respectively, in the presence-absence of varying concentrations of glucose, pro-inflammatory cytokines, and GLP-1. The potential signaling pathways involved were evaluated by western blot. Considerable anti-proliferative effects of pro-inflammatory cytokines interleukin (IL)-1beta, interferon (IFN)-gamma, and tumour necrosis factor-alpha (TNF-alpha) were observed. The effects were synergistic and independent of glucose concentration, and appeared to be mediated by the inhibition of extracellular signal-regulated kinase 1/2 (ERK1/2) activation, the signaling pathway involved in beta-cell replication. GLP-1 completely reversed the cytokine-induced inhibition of ERK phosphorylation and increased beta-cell proliferation threefold in cytokine-treated cultures. While pro-inflammatory cytokines reduced islet cell ERK1/2 activation and beta-cell proliferation in pancreatic islet culture, GLP-1 was capable of reversing this effect. These data suggest a possible pharmacological application of GLP-1 in the treatment of early stage DM1, to prevent the loss of pancreatic beta cells as well as to delay the development of overt diabetes.

[Economic costs associated to type 1 diabetes]. / Costes económicos asociados a la diabetes tipo 1.

OBJECTIVE: The objective of our study was to determinate the health resource utilization and economic cost associated to diabetes in a patient group with type 1 diabetes. PATIENTS AND METHODS: We designed a cross-sectional study that involved 71 type 1 diabetes patients (59.4% women) with 29.2 +/- 12.2 years old mean age and 10.5 +/- 7.9 years of diabetes evolution attended in Endocrinology Service of Puerta del Mar Hospital in Cádiz. Direct and indirect cost associated to diabetes during a year period were determinated by information obtained from patient medical history and hospital, emergency, primary care and medical inspection of social insurance databases. RESULTS: Type 1 diabetes patients presented a total cost associated to diabetes of 3.311 euros/patient/year (95% IC: 2.202-4.420 euros/patient/year). Direct cost (2.104 euros/patient/year; 95% IC: 1.825-2.383 euros/patient/year) was higher than indirect cost (1.250 euros/patient/year; 95% IC: 291-2.225 euros/patient/year). Multiple regression analysis showed an independent association between total cost associated to diabetes (dependent variable) and variables number of hospitalizations related to diabetes (p = 0.006), pensioner situation (p = 0.02) and micro and macrovascular complications (p = 0.001). CONCLUSIONS: We conclude that economic cost associated to type 1 diabetes is important and presents a notable and independent increase with hospitalizations related to diabetes, pensioner situation and micro and macrovascular complications.

Costes económicos asociados a la diabetes tipo 1 / Economic costs associated to type 1 diabetes

Objetivo. Determinar el consumo de recursos sanitarios y los costes económicos asociados a la diabetes en un grupo de pacientes con diabetes tipo 1. Pacientes y métodos. Estudio observacional descriptivo de una muestra de 71 pacientes con diabetes tipo 1 (59,4% mujeres) de 29,2 ± 12,2 años de edad media y 10,5 ± 7,9 años de evolución de la diabetes atendidos en la consulta de Endocrinología del Hospital Puerta del Mar de Cádiz. Se determinan los costes directos e indirectos asociados a la enfermedad durante el período de un año en base a la información obtenida a partir de las historias clínicas y bases de datos de hospitalización, urgencias, atención primaria e inspección médica de la Seguridad Social. Resultados. Los pacientes con diabetes tipo 1 presentaron unos costes asociados a la diabetes de 3.311 e/paciente/año (IC 95%: 2.202-4.420 €/ paciente/año), siendo superior la partida de costes directos (2.104 €/paciente/año; IC 95%: 1.825-2.383 €/paciente/año) que de costes indirectos (1.250 €/paciente/año; IC 95%: 291-2.225 €/ paciente/año). El análisis de regresión múltiple mostró una asociación independiente entre los costes totales (variable dependiente) y las variables número de ingresos relacionados con la diabetes (p = 0,006), situación laboral pensionista (p = 0,02) y presencia de complicaciones micro y macrovasculares (p = 0,001). Conclusiones. El coste económico asociado a la diabetes tipo 1 es importante, incrementándose notablemente y de manera independiente con cada hospitalización relacionada con la diabetes, la situación laboral pensionista y la presencia de complicaciones micro y macrovasculares

Objective. The objective of our study was to determinate the health resource utilization and economic cost associated to diabetes in a patient group with type 1 diabetes. Patients and methods. We designed a cross-sectional study that involved 71 type 1 diabetes patients (59,4% women) with 29,2 ± 12,2 years old mean age and 10,5 ± 7,9 years of diabetes evolution attended in Endocrinology Service of Puerta del Mar Hospital in Cádiz. Direct and indirect cost associated to diabetes during a year period were determinated by information obtained from patient medical history and hospital, emergency, primary care and medical inspection of social insurance databases. Results. Type 1 diabetes patients presented a total cost associated to diabetes of 3.311 €/patient/year (95% IC: 2.202-4.420 €/patient/year). Direct cost (2.104 €/patient/year; 95% IC: 1.825-2.383 €/patient/year) was higher than indirect cost (1.250 €/patient/year; 95% IC: 291-2.225 €/ patient/year). Multiple regression analysis showed an independent association between total cost associated to diabetes (dependent variable) and variables number of hospitalizations related to diabetes (p = 0,006), pensioner situation (p = 0,02) and micro and macrovascular complications (p = 0,001). Conclusions. We conclude that economic cost associated to type 1 diabetes is important and presents a notable and independent increase with hospitalizations related to diabetes, pensioner situation and micro and macrovascular complications