A Multicenter Prospective Evaluation of the Benefits of Two Advanced Hybrid Closed-Loop Systems in Glucose Control and Patient-Reported Outcomes in a Real-world Setting.

OBJECTIVE: Advanced hybrid closed-loop systems (AHCL) have been shown to improve glycemic control and patient-reported outcomes in type 1 diabetes. The aim was to analyze the outcomes of two commercially available AHCL in real life. RESEARCH DESIGN AND METHODS: A prospective study was performed, including adolescents and adults with type 1 diabetes, AHCL naïve, from 14 centers, who initiated the use of MM780G with SmartGuard or Tandem t:slimX2 with Control-IQ. Baseline and 3-month evaluations were performed, assessing HbA1c, time in different glycemic ranges, and patient-reported outcomes. The primary outcome was the between-group time in range 70-180 mg/dL difference from beginning to end of follow-up. RESULTS: One hundred fifty participants were included, with 75 initiating each system (age: 39.9 ± 11.4 years [16-72]; 64% female; diabetes duration: 21.6 ± 11.9 years). Time in range increased from 61.53 ± 14.01% to 76.17 ± 9.48% (P < 0.001), with no between-group differences (P = 0.591). HbA1c decreased by 0.56% (95% CI 0.44%, 0.68%) (6 mmol/mol, 95% CI 5, 7) (P < 0.001), from 7.43 ± 1.07% to 6.88 ± 0.60% (58 ± 12 to 52 ± 7 mmol/mol) in the MM780G group, and from 7.14 ± 0.70% to 6.56 ± 0.53% (55 ± 8 to 48 ± 6 mmol/mol) in the Control-IQ group (both P < 0.001 to baseline, P = 0.819 between groups). No superiority of one AHCL over the other regarding fear of hypoglycemia or quality of life was found. Improvement in diabetes-related distress was higher in Control-IQ users (P = 0.012). Sleep quality was improved (PSQI: from 6.94 ± 4.06 to 6.06 ± 4.05, P = 0.004), without differences between systems. Experience with AHCL, evaluated by the INSPIRE measures, exceeded the expectations. CONCLUSIONS: The two AHCL provide significant improvement in glucose control and satisfaction, with no superiority of one AHCL over the other.

Morphofunctional assessment of patient's nutritional status: a global approach / Evaluación morfofuncional del estado nutricional de los pacientes: un nuevo enfoque

Disease-related malnutrition represents an imbalance between the intake and the requirements of energy and nutrients. It produces a series of metabolic and functional changes in the body. There are multiple limitations in the classic parameters for nutrition assessment including body mass index, weight loss, food intake, or standard laboratory parameters such as albumin or lymphocytes. We can establish some points of interest in this new approach to nutrition focused on the assessment of nutritional status by evaluating changes in composition and function using parameters such as PhA and other electrical measurements of bioimpedance, dynamometry, functional tests, muscle ultrasound, or laboratory parameters such as CRP/prealbumin.Each of these parameters has a number of uses and limitations that should be understood when evaluating its ability to diagnose malnutrition as related to disease, its concordance with other tests, and its prognostic value. Emerging nutritional param­eters for future use should be sensitive, specific, and interrelated to allow a better understanding of each patient's status at different time points during their disease. (AU)

La malnutrición relacionada con la enfermedad representa un disbalance entre el aporte y los requerimientos de energía y nutrientes, que produce una serie de cambios metabólicos y funcionales a nivel corporal. Existen múltiples limitaciones de los parámetros clásicos de valoración nutricional, como el índice de masa corporal, la pérdida de peso, la ingesta o los parámetros analíticos clásicos, como es el caso de la albúmina o los linfocitos. Sugerimos un nuevo enfoque de la nutrición clínica centrado en la valoración del estado nutricional del paciente evaluando los cambios de composición y función con nuevos parámetros como el ángulo de fase y otras medidas eléctricas de la bioimpedanciometría, la ecografía nutricional©, los nuevos parámetros analíticos como el cociente PCR/prealbúmina, la dinamometría o los test funcionales.Cada uno de estos parámetros tiene una serie de utilidades y limitaciones que es importante conocer a la hora de evaluar su capacidad de diagnosticar la desnutrición relacionada con la enfermedad, la concordancia con otros tests y su valor pronóstico. La nueva visión global de la nutrición clínica debería integrar diferentes aspectos de composición y función del organismo para poder establecer un diagnóstico más preciso de la situación nutricional y un plan terapéutico individualizado. Los parámetros nutricionales emergentes deben ser sensibles y específicos, y estar relacionados entre sí, de forma que permitan un mejor conocimiento de la situación particular de cada paciente en los diferentes momentos evolutivos de su proceso patológico. (AU)

Morphofunctional assessment of patient´s nutritional status: a global approach.

INTRODUCTION: Disease-related malnutrition represents an imbalance between the intake and the requirements of energy and nutrients. It produces a series of metabolic and functional changes in the body. There are multiple limitations in the classic parameters for nutrition assessment including body mass index, weight loss, food intake, or standard laboratory parameters such as albumin or lymphocytes. We can establish some points of interest in this new approach to nutrition focused on the assessment of nutritional status by evaluating changes in composition and function using parameters such as PhA and other electrical measurements of bioimpedance, dynamometry, functional tests, muscle ultrasound, or laboratory parameters such as CRP/prealbumin. Each of these parameters has a number of uses and limitations that should be understood when evaluating its ability to diagnose malnutrition as related to disease, its concordance with other tests, and its prognostic value. Emerging nutritional parameters for future use should be sensitive, specific, and interrelated to allow a better understanding of each patient's status at different time points during their disease.

INTRODUCCIÓN: La malnutrición relacionada con la enfermedad representa un disbalance entre el aporte y los requerimientos de energía y nutrientes, que produce una serie de cambios metabólicos y funcionales a nivel corporal. Existen múltiples limitaciones de los parámetros clásicos de valoración nutricional, como el índice de masa corporal, la pérdida de peso, la ingesta o los parámetros analíticos clásicos, como es el caso de la albúmina o los linfocitos. Sugerimos un nuevo enfoque de la nutrición clínica centrado en la valoración del estado nutricional del paciente evaluando los cambios de composición y función con nuevos parámetros como el ángulo de fase y otras medidas eléctricas de la bioimpedanciometría, la ecografía nutricional©, los nuevos parámetros analíticos como el cociente PCR/prealbúmina, la dinamometría o los test funcionales. Cada uno de estos parámetros tiene una serie de utilidades y limitaciones que es importante conocer a la hora de evaluar su capacidad de diagnosticar la desnutrición relacionada con la enfermedad, la concordancia con otros tests y su valor pronóstico. La nueva visión global de la nutrición clínica debería integrar diferentes aspectos de composición y función del organismo para poder establecer un diagnóstico más preciso de la situación nutricional y un plan terapéutico individualizado. Los parámetros nutricionales emergentes deben ser sensibles y específicos, y estar relacionados entre sí, de forma que permitan un mejor conocimiento de la situación particular de cada paciente en los diferentes momentos evolutivos de su proceso patológico.

Efectividad del tratamiento con sulfonilureas en paciente con mutación en el gen ABCC8 (MODY12) / Effectiveness of sulfonylurea treatment in a patient with a mutation in ABCC8 (MODY12)

No disponible

A Multinational Real-World Study on the Clinical Characteristics of Patients with Type 2 Diabetes Initiating Dapagliflozin in Southern Europe.

INTRODUCTION: A real-world study was performed to describe the clinical characteristics of patients who received dapagliflozin to better understand differences when initiating dapagliflozin in various countries and different prescribing settings. METHODS: We assessed pooled data from observational studies carried out in Italy (n = 2484), Spain (n = 564) and Greece (n = 87). The primary objective was to compare the clinical profile of patients initiating dapagliflozin in the three countries. We also evaluated the percentage of patients who received dapagliflozin in clinical practice who satisfied DECLARE-TIMI 58 enrolment criteria. RESULTS: In Italy and Spain, around 90% of patients were receiving metformin vs. 66% in Greece (p < 0.0001). Patients in Greece had lower levels of estimated glomerular filtration rate and lower prevalence rates of retinopathy, prior stroke, acute myocardial infarction, peripheral arterial disease and atherosclerotic cardiovascular disease. Grouping the cohorts by prescribing setting (primary vs. specialist care), baseline HbA1c was lower in primary care (8.4 ± 1.7 vs. 8.7 ± 1.5, respectively; p < 0.0001). Significantly more patients were receiving other medications for concomitant conditions in specialist care. A total of 1416 patients (48%) did not meet DECLARE inclusion criteria, while 1561 (52%) patients met the criteria (Greece 41.05%, Italy 53.19%, Spain 51.35%). CONCLUSIONS: Significant differences were seen among patients initiating dapagliflozin in southern Europe. Our results suggest that dapagliflozin was being initiated at different stages of the disease according to the country and prescribing settings. Such geographic heterogeneity may have an impact upon effectiveness of dapagliflozin on glucose lowering, as well as cardiovascular and renal outcomes.

Documento de abordaje integral de la diabetes tipo 2 / Document on a comprehensive approach to type 2 diabetes mellitus

Objetivo: El tratamiento de la diabetes tipo 2 (DM2) es complejo y su propósito es reducir la morbimortalidad, por lo que su manejo tiene que incluir: un control glucémico individualizado precoz (mediante una adecuada educación diabetológica, modificaciones del estilo de vida y tratamiento farmacológico), el control de los factores de riesgo cardiovascular (CV), la detección y tratamiento precoz de las complicaciones y la evaluación de las comorbilidades asociadas. El objetivo fue elaborar un documento para unificar los aspectos necesarios para el abordaje integral de las personas con DM2. Participantes: Miembros del Grupo de trabajo de Diabetes Mellitus de la Sociedad Española de Endocrinología y Nutrición. Métodos: Se realizó una revisión de la evidencia disponible relativa a cada aspecto del manejo de la diabetes: objetivos de control glucémico, dieta y ejercicio, tratamiento farmacológico, tratamiento y control de factores de riesgo, detección de complicaciones y manejo del paciente frágil con DM2. Las recomendaciones se formularon según los grados de evidencia recogidos en los Standards of Medical Care in Diabetes 2018. Tras la formulación de las recomendaciones el documento fue consensuado por los miembros del Grupo de trabajo de Diabetes Mellitus de la Sociedad Española de Endocrinología y Nutrición. Conclusiones: El objetivo de este documento es proporcionar, desde el punto de vista del endocrinólogo clínico, unas recomendaciones prácticas basadas en la evidencia acerca de todos los aspectos necesarios para el abordaje integral de la DM2

Objective: Treatment of type 2 diabetes mellitus (T2DM) is complex and is intended to decrease morbidity and mortality. Management should therefore include adequate diabetes education, lifestyle changes, drug treatment to achieve early blood glucose control and reduction of cardiovascular (CV) risk factors, early detection and treatment of complications, and assessment of associated comorbidities. The objective was to prepare a document including all aspects required for a comprehensive approach to T2DM. Participants: Members of the Diabetes Mellitus Working Group of the Spanish Society of Endocrinology. Methods: The available evidence regarding each aspect of diabetes management (blood glucose control goals, diet and exercise, drug treatment, risk factor management and control, detection of complications, and management of frail patients) was reviewed. Recommendations were formulated based on the grades of evidence stated in the 2018 Standards of Medical Care in Diabetes. Recommendations were discussed and agreed by the working group members. Conclusions: This document is intended to provide evidence-based practical recommendations for comprehensive management of T2DM by clinical endocrinologists

Document on a comprehensive approach to type 2 diabetes mellitus. / Documento de abordaje integral de la diabetes tipo 2.

OBJECTIVE: Treatment of type 2 diabetes mellitus (T2DM) is complex and is intended to decrease morbidity and mortality. Management should therefore include adequate diabetes education, lifestyle changes, drug treatment to achieve early blood glucose control and reduction of cardiovascular (CV) risk factors, early detection and treatment of complications, and assessment of associated comorbidities. The objective was to prepare a document including all aspects required for a comprehensive approach to T2DM. PARTICIPANTS: Members of the Diabetes Mellitus Working Group of the Spanish Society of Endocrinology. METHODS: The available evidence regarding each aspect of diabetes management (blood glucose control goals, diet and exercise, drug treatment, risk factor management and control, detection of complications, and management of frail patients) was reviewed. Recommendations were formulated based on the grades of evidence stated in the 2018 Standards of Medical Care in Diabetes. Recommendations were discussed and agreed by the working group members. CONCLUSIONS: This document is intended to provide evidence-based practical recommendations for comprehensive management of T2DM by clinical endocrinologists.

Nuevo enfoque de la nutrición. Valoración del estado nutricional del paciente: función y composición corporal / A new nutritional approach. Assessment of the patient's nutritional status: function and body composition

La malnutrición puede considerarse un disbalance entre el aporte y los requerimientos de energía y nutrientes que produce una serie de cambios metabólicos y funcionales a nivel corporal. Existen múltiples limitaciones en los parámetros clásicos de valoración nutricional como índice de masa corporal, pérdida de peso, ingesta o parámetros analíticos clásicos como albúmina o linfocitos. Podemos establecer algunos puntos básicos de interés en este nuevo enfoque de la nutrición centrado en la valoración del estado nutricional del paciente evaluando los cambios de composición y función con nuevos parámetros como el ángulo de fase y otras medidas eléctricas de la bioimpedanciometría, dinamometría, test funcionales, ecografía muscular o nuevos parámetros analíticos como PCR/prealbúmina. Cada uno de estos parámetros tiene una serie de utilidades y limitaciones que es importante conocer a la hora de evaluar los resultados de los mismos. La nueva visión global de la nutrición debe integrar diferentes aspectos de composición y función del organismo para poder establecer un diagnóstico más preciso de la situación nutricional y un plan terapéutico individualizado. Los parámetros nutricionales avanzados del futuro deben ser sensibles y específicos, relacionados entre sí, de forma que permitan un mejor conocimiento de la situación particular de cada paciente en diferentes momentos evolutivos de su proceso patológico

Malnutrition can be considered a mismatch between the intake and the requirements of energy and nutrients. It produces a series of metabolic and functional changes to the body. There are multiple limitations to the classic parameters of nutrition assessment, as body mass index, weight loss, intake or standard analytical parameters, such as albumin or lymphocytes. We can establish some points of interest in this new approach to nutrition focused on the assessment of the nutritional status of the patient by evaluating changes in composition and function with new parameters such the phase angle and other electrical measurements of bioimpedance, dynamometry, functional test, muscle ultrasound or new analytical parameters such as PCR/prealbumin. Each of these parameters has many utilities and limitations that are important to know when evaluating the results. Advanced nutritional parameters of the future must be sensitive and specific, interrelated, so as to allow a better understanding of the particular situation of each patient in different moments of their disease