Effectiveness and Tolerability of the Intensification of Canagliflozin Dose from 100 mg to 300 mg Daily in Patients with Type 2 Diabetes in Real Life: The INTENSIFY Study.

Aim: This study aimed to evaluate the effectiveness and tolerability of intensifying the dose of canagliflozin from 100 mg/day (CANA100) to 300 mg/day (CANA300) in patients with type 2 diabetes (T2DM) and suboptimal metabolic control in a real-world setting. Methods: A multicenter observational study was conducted on adult patients with T2DM who initiated treatment with CANA100 and subsequently required intensification to CANA300. The primary outcome measures were changes in HbA1c and weight at 6 months after the switch and at the end of the follow-up period. Results: A total of 317 patients met the inclusion criteria (59.6% male, mean age 62.2 years, baseline HbA1c 7.55%, weight 88.6 kg, median duration of treatment with CANA100 9.9 months). Switching to CANA300 resulted in a significant reduction in HbA1c (6 months: -0.33%; last visit: -0.47%, both p < 0.0001) and weight (6 months: -1.8 kg; last visit: -2.9 kg, both p < 0.0001) over a median follow-up period of 20.8 months. The proportion of patients that achieved HbA1c < 7% increased from 26.7% with CANA100 to 51.6% with CANA300 (p < 0.0001). Among individuals with poor baseline glycemic control (HbA1c > 8%, mean 9.0%), HbA1c was significantly reduced by -1.24% (p < 0.0001). Furthermore, significant improvements were observed in fasting plasma glucose (FPG), blood pressure (BP), liver enzymes, and albuminuria. No unexpected adverse events were reported. Conclusions: Intensifying the treatment to CANA300 in a real-world setting resulted in further significant and clinically relevant reductions in FPG, HbA1c, weight, and BP in patients with T2DM. The switch was particularly effective in patients with higher baseline HbA1c levels.

Effectiveness and tolerability of orlistat and liraglutide in patients with obesity in a real-world setting: The XENSOR Study.

AIMS: To evaluate in a real-world setting the effectiveness of two drugs, orlistat and liraglutide, in patients with overweight or obesity and insufficient weight loss (WL) after a lifestyle modification programme. METHODS: Retrospective, observational cohort study comparing clinical outcomes of orlistat 120 mg three times a day and liraglutide (up to 3 mg daily) in adult patients with BMI ≥30 kg/m2 or ≥27 kg/m2 with at least a weight-related comorbidity who had failed to lose at least 5% of their weight after 6 months of lifestyle modification. The co-primary end-points, assessed at 3-6 months and at the end of the follow-up, were weight change from baseline, proportion of patients who lost at least 5% of their baseline weight and adjusted differences in WL between both drugs. RESULTS: Five hundred patients, 400 in the group of orlistat (age 47.0, weight 107.8 kg) and 100 in the group of liraglutide (age 51.9 years, weight 105.1 kg), were included. Treatment with both drugs significantly reduced weight, fasting plasma glucose, systolic BP, low-density lipoprotein-cholesterol and alanine transaminase over a median follow-up period of 7 months. WL with liraglutide (-7.7 kg) was significantly greater than that observed with orlistat (-3.3 kg), and more individuals lost at least 5% of their baseline weight with liraglutide (64.7%) than with orlistat (27.4%). Rates of prediabetes significantly decreased with liraglutide in comparison to orlistat. CONCLUSIONS: In this real-world study, liraglutide showed a greater effectiveness in WL compared with orlistat and improved several obesity-associated metabolic and cardiovascular risk factors.

Estudio de cohorte retrospectivo de pacientes diagnosticados de cáncer de tiroides del área suroeste de Madrid. Factores pronósticos en el cáncer diferenciado de tiroides / No disponible

Objetivos Análisis de las características clínicas e histopatológicas de los pacientes con cáncer de tiroides en el área suroeste de Madrid e identificación de los factores de mal pronóstico en el subgrupo de carcinoma diferenciado de tiroides (CDT) del epitelio folicular. Pacientes y métodos .Estudio retrospectivo de una cohorte de cáncer de tiroides de nuestro hospital entre 1998-2009. Las variables clínicas, quirúrgicas e histopatológicas significativas se incluyeron en modelos de regresión de Cox y logística para la identificación de factores pronósticos de muerte, recidiva y persistencia de enfermedad. Resultados Se incluyeron 150 pacientes con mediana de edad 49 años y mediana de seguimiento de 5,4 años. Los subtipos histológicos fueron: carcinoma papilar (86%), carcinoma folicular (6,6%), carcinoma medular (4%), carcinoma pobremente diferenciado (2,7%) y carcinoma anaplásico (0,7%).Al final del estudio: 68% curación, 3,3% muertos (mortalidad por cáncer tiroideo 1,3%), 1,3% pérdida de seguimiento, 6,7% con enfermedad bioquímica persistente, 2,7% con enfermedad clínica persistente y 18% pendiente de evaluación. El mejor modelo pronóstico para recidiva de CDT fue el estadiaje TNM (estadio ii-iv frente a i: HR 5,9, 95% IC 1,3-26,6) y para persistencia de enfermedad o muerte el estadiaje clínico de la ETA (alto riesgo frente a bajo/muy bajo riesgo: OR 9,2, 95% IC 2,6-33,2)Conclusiones En nuestro estudio la mortalidad y persistencia clínica de enfermedad fueron bajas. La clasificación de pacientes con CDT según estadiaje de la ETA fue un buen factor predictor de enfermedad persistente o muerte (AU)

Objectives To analyze the clinical and histopathological features of patients with thyroid cancer in the southwest Madrid area and to identify poor prognostic factors in the subgroup with differentiated thyroid carcinoma (DTC) of the follicular epitelium. Patients and methods A retrospective cohort study of patients diagnosed with thyroid cancer at our hospital from 1998 to 2009. Significant clinical, surgical, and histopathological variables were included in Cox proportional hazard and logistic regression models to identify baseline factors predicting for death, recurrence, and persistent disease in DTC. Results A total of 150 patients with a median age of 49 years and a median follow-up of 5.4 years were enrolled. Histological subtypes were: papillary carcinoma (86%), follicular carcinoma (6.6%), medullary carcinoma (4%), poorly differentiated carcinoma (2.7%), and anaplastic carcinoma (0.7%). At the end of the study, 68% of patients were cured, 3.3% had died (disease-specific mortality, 1.3%), 1.3% were lost to follow-up, 6.7% had persistent biochemical disease, and 2.7% persistent clinical disease, while 18% of patients were pending assessment. The best prognostic model for DTC recurrence was TNM staging (stage II-IV vs. I: HR 5.9, 95% CI 1.3-26.6), while the best model for persistent disease or death was ETA clinical staging (high risk vs. low or very low risk: OR 9.2, 95% CI 2.6-33.2).Conclusions In our study, disease-specific mortality and persistent clinical disease were low. Classification of DTC patients based on ETA staging after initial treatment was a good predictor of persistent disease or death (AU)

[A retrospective cohort study of patients diagnosed of thyroid cancer in the southwest Madrid area. Predictive factors in differentiated thyroid cancer]. / Estudio de cohorte retrospectivo de pacientes diagnosticados de cáncer de tiroides del área suroeste de Madrid. Factores pronósticos en el cáncer diferenciado de tiroides.

OBJECTIVES: To analyze the clinical and histopathological features of patients with thyroid cancer in the southwest Madrid area and to identify poor prognostic factors in the subgroup with differentiated thyroid carcinoma (DTC) of the follicular epitelium. PATIENTS AND METHODS: A retrospective cohort study of patients diagnosed with thyroid cancer at our hospital from 1998 to 2009. Significant clinical, surgical, and histopathological variables were included in Cox proportional hazard and logistic regression models to identify baseline factors predicting for death, recurrence, and persistent disease in DTC. RESULTS: A total of 150 patients with a median age of 49 years and a median follow-up of 5.4 years were enrolled. Histological subtypes were: papillary carcinoma (86%), follicular carcinoma (6.6%), medullary carcinoma (4%), poorly differentiated carcinoma (2.7%), and anaplastic carcinoma (0.7%). At the end of the study, 68% of patients were cured, 3.3% had died (disease-specific mortality, 1.3%), 1.3% were lost to follow-up, 6.7% had persistent biochemical disease, and 2.7% persistent clinical disease, while 18% of patients were pending assessment. The best prognostic model for DTC recurrence was TNM staging (stage II-IV vs. I: HR 5.9, 95% CI 1.3-26.6), while the best model for persistent disease or death was ETA clinical staging (high risk vs. low or very low risk: OR 9.2, 95% CI 2.6-33.2). CONCLUSIONS: In our study, disease-specific mortality and persistent clinical disease were low. Classification of DTC patients based on ETA staging after initial treatment was a good predictor of persistent disease or death.

Déficit de yodo en una población de mujeres embarazadas pertenecientes a un área con leve deficiencia de yodo / Iodine deficiency in pregnant women from a mildly iodine-deficient area

Objetivo: Los estudios realizados en España proponen que la ingesta de yodo de las mujeres embarazadas está por debajo de los requerimientos nutricionales. Con este estudio se pretende conocer el estado nutricional de yodo en una población de mujeres embarazadas de Madrid. Pacientes y método: Estudio prospectivo de una cohorte de 112 mujeres gestantes con enfermedad endocrina entre enero y septiembre de 2004. Resultados: La yoduria fue 101,5 (60,25-176,75) µg/l. Sólo el 30,4% de las mujeres mostraban suficiencia de yodo (yoduria > 160 µg/l). La tirotropina fue 2,1 (1,12-2,95) µU/ml; la tiroxina libre, 0,87 (0,77-1) ng/dl; los anticuerpos antitiroglobulina y los anticuerpos antiperoxidasa, positivos en el 5,4 y el 19,6% respectivamente. En el análisis bivariable, el consumo de sal yodada se asoció con la suficiencia de yodo (odds ratio [OR] = 3,6; intervalo de confianza [IC] del 95%, 1,45-8,93). El 41,3% de las consumidoras de sal yodada presentaron yodurias > 160 µg/l, frente al 16,3% de las no consumidoras (p = 0,004). No hubo asociación entre suficiencia de yodo y antecedentes familiares de enfermedad tiroidea, bocio, tratamiento con levotiroxina, tirotropina, tiroxina libre, anticuerpos antitiroglobulina ni anticuerpos antiperoxidasa. En el análisis multivariable, la OR ajustada del consumo de sal yodada sobre la suficiencia nutricional de yodo fue 3,92 (1,46-10,53; p = 0,008). Conclusiones: En esta muestra, el 69,6% de las gestantes presentaron yodurias < 160 µg/l. El consumo de sal yodada se asoció a suficiencia de yodo. En esta cohorte no encontramos asociación de suficiencia de yodo con positividad de anticuerpos antitiroglobulina y anticuerpos antiperoxidasa ni con concentraciones de tirotropina y tiroxina libre

Objective: Studies performed in Spain suggest that iodine intake in pregnant women is below nutritional requirements. This study was designed to determine the degree of iodine nutrition during pregnancy in women from Madrid. Patients and method: A prospective study of 112 pregnant women with endocrinological disorders was performed between January 2004 and September 2004. Results: The urinary iodine level was 101.5 µg/l (60.25-176.75). Only 30.4% of the women showed adequate urinary iodine levels (higher than 160 µg/l). Serum thyroid-stimulating hormone (TSH) and free thyroxine (FT4) concentrations were 2.1 µU/ml (1.12-2.95) and 0.87 µg/dl (0.77-1), respectively. Antithyroglobulin (TgAb) and antiperoxidase (TPOAb) antibody values were positive in 5.4% and 19.6%, respectively. In the bivariate analysis, iodized salt intake was associated with iodine sufficiency (OR = 3.6; 95% CI, 1.45-8.93). A total of 41.3% of women with iodized salt intake had urinary iodine levels higher than 160 µg/l compared with 16.3% of those not consuming iodized salt (p = 0.004). No association was found between iodine sufficiency and a family history of thyroid disease, the presence of goiter, levothyroxine treatment, TSH, FT3, FT4, TPOAb or TgAb. In the multivariate analysis, the adjusted OR for the association between intake of iodized salt and iodine sufficiency was 3.92 (1.46-10.53; p = 0.008). Conclusions: In this sample, 69.6% of the pregnant women showed urinary iodine levels lower than 160 µg/l. Intake of iodized salt was associated with iodine sufficiency. We found no correlation between urinary iodine levels and TSH, FT4, FT3, or antibody positivity

Diferencias clínicas entre pacientes obesos mórbidos con y sin atracones / Clinical differences between morbidly obese patients with and without binge eating

Objetivos: Evaluar las diferencias clínicas de pacientes obesos con y sin alteraciones de la conducta alimentaria. Pacientes y método: Se estudió a 210 pacientes con obesidad mórbida derivados de forma consecutiva y por diferentes motivos a una consulta de psiquiatría en un hospital general. Se realizó una entrevista clínica, se valoró la presencia de comorbilidad psiquiátrica y se aplicó una serie de escalas de psicopatología y sobre conducta alimentaria: Escala de Depresión de Beck (BDI), Escala de Ansiedad de Beck (BAI), Inventario de Obsesiones-Compulsiones de Maudsley (MOCI), Escala de Impulsividad de Barrat (BIS), Inventario de Trastornos de la Alimentación (EDI), Test de Actitudes hacia la Comida (EAT), Test de Bulimia de Edimburgo (BITE) y Cuestionario sobre la Figura Corporal (BSQ). La muestra se dividió en 2 grupos: pacientes con conductas de atracones según la definición de la Clasificación Internacional de Enfermedades (CIE-10) y el Manual Diagnóstico y Estadístico de los Trastornos Mentales (DSM-IV) y pacientes sin esas conductas. En el primer grupo se incluyó a 14 pacientes con bulimia nerviosa, 32 con criterios de trastorno por atracón y 15 con atracones sin criterios para uno de los dos trastornos citados (total, 61 pacientes con atracones y 149 sin atracones). Resultados: Los pacientes con atracones tenían más alteraciones psicopatológicas, fundamentalmente mayor prevalencia de distimia, eran más impulsivos según la escala BIS y obtenían puntuaciones más elevadas en algunas escalas que valoraban la alteración de la conducta alimentaria. Estos pacientes tenían más antecedentes familiares de trastornos de la conducta alimentaria (TCA) y presentaban mayor insatisfacción corporal a pesar de un menor índice de masa corporal (IMC). Este grupo refería mayores limitaciones funcionales por su obesidad y presentaba mayor obsesión sobre el peso y la comida. Conclusiones: Por lo tanto, los obesos mórbidos con atracones forman un grupo posiblemente homogéneo (independientemente de que tuvieran diagnóstico del trastorno de la conducta alimentaria) y diferenciado del resto de los obesos mórbidos por tener más alteraciones psicopatológicas, fundamentalmente de tipo afectivo, mayor impulsividad y mayor severidad en las escalas que evalúan los síntomas nucleares de los trastornos de la conducta alimentaria e insatisfacción corporal

Objectives: To evaluate clinical differences between morbidly obese patients with and without binge eating. Patients and method: We evaluated 210 morbidly obese outpatients who were consecutively referred for psychiatric evaluation in a general hospital for distinct reasons. We carried out a clinical interview, evaluated psychiatric comorbidity, and applied the following scales: Beck Depression Inventory (BDI), Beck Anxiety Inventory (BAI), Maudsley Obsessive-Compulsive Interview (MOCI), Barrat Impulsiveness Scale (BIS), Eating Disorder Inventory (EDI), Eating Attitudes Test (EAT), Bulimic Investigation Test Edinburgh (BITE), and Body Shape Questionnaire (BSQ). The sample was divided into two groups: patients with binge eating according to ICD-10 and DSM-IV criteria and those without binge eating. There were 61 patients with binge eating (14 patients with bulimia nervosa, 32 with binge eating disorder, and 15 patients with binge eating who did not fulfill the criteria for bulimia or binge eating disorder) and 149 patients without binge eating. Results: Patients with binge eating showed more psychopathology, a greater prevalence of dysthymia, higher impulsivity scores according to the BIS scale and higher scores on some of the scales that evaluated eating disorders. These patients had a greater number of familial antecedents of eating disorders and showed greater body dissatisfaction, despite having a lower body mass index. Patients with binge eating also showed greater obesity-induced functional disability and greater obsessiveness about weight and body shape. Conclusions: The results of this study suggest that morbidly obese patients with binge eating constitute a distinct subgroup (independently of eating disorder diagnosis) among the obese population. Distinguishing features consist of more severe psychopathology, especially affective disorder, greater impulsivity, and greater severity in scales evaluating core symptoms of eating disorders and body dissatisfaction