Executive summary: Updates to the dietary treatment of prediabetes and type 2 diabetes mellitus.

Adequate lifestyle changes significantly reduce the cardiovascular risk factors associated with prediabetes and type 2 diabetes mellitus. Therefore, healthy eating habits, regular physical activity, abstaining from using tobacco, and good sleep hygiene are recommended for managing these conditions. There is solid evidence that diets that are plant-based; low in saturated fatty acids, cholesterol, and sodium; and high in fiber, potassium, and unsaturated fatty acids are beneficial and reduce the expression of cardiovascular risk factors in these subjects. In view of the foregoing, the Mediterranean diet, the DASH diet, a low-carbohydrate diet, and a vegan-vegetarian diet are of note. Additionally, the relationship between nutrition and these metabolic pathologies is fundamental in targeting efforts to prevent weight gain, reducing excess weight in the case of individuals with overweight or obesity, and personalizing treatment to promote patient empowerment. This document is the executive summary of an updated review that includes the main recommendations for improving dietary nutritional quality in people with prediabetes or type 2 diabetes mellitus. The full review is available on the webpages of the Spanish Society of Arteriosclerosis, the Spanish Diabetes Society, and the Spanish Society of Internal Medicine.

Executive summary: Updates to the dietary treatment of prediabetes and type 2 diabetes mellitus. / Resumen ejecutivo: actualización en el tratamiento dietético de la prediabetes y la diabetes mellitus tipo 2.

Adequate lifestyle changes significantly reduce the cardiovascular risk factors associated with prediabetes and type 2 diabetes mellitus. Therefore, healthy eating habits, regular physical activity, abstaining from using tobacco, and good sleep hygiene are recommended for managing these conditions. There is solid evidence that diets that are plant-based; low in saturated fatty acids, cholesterol, and sodium; and high in fiber, potassium, and unsaturated fatty acids are beneficial and reduce the expression of cardiovascular risk factors in these subjects. In view of the foregoing, the Mediterranean diet, the DASH diet, a low-carbohydrate diet, and a vegan-vegetarian diet are of note. Additionally, the relationship between nutrition and these metabolic pathologies is fundamental in targeting efforts to prevent weight gain, reducing excess weight in the case of individuals with overweight or obesity, and personalizing treatment to promote patient empowerment. This document is the executive summary of an updated review that includes the main recommendations for improving dietary nutritional quality in people with prediabetes or type 2 diabetes mellitus. The full review is available on the webpages of the Spanish Society of Arteriosclerosis, the Spanish Diabetes Society, and the Spanish Society of Internal Medicine.

Genetic contribution to lipid target achievement with statin therapy: a prospective study.

Statin therapy response is highly variable. Variants of lipid metabolism genes and statin pharmacokinetic modulators could play a role, however, the impact of most of these variants remains unconfirmed. A prospective and multicenter study included 252 patients was carried out in order to assess, according to achievement of LDL-C or non-HDL-C therapeutic targets and quantitative changes in lipid profiles, the impact of CETP, ABCA1, CYP2D6, and CYP2C9 gene candidate variants on the simvastatin, atorvastatin, and rosuvastatin response. Patients carrier ABCA1 rs2230806 and CYP2D6*3 variants are less likely to achieve therapeutic lipid targets (p = 0.020, OR = 0.59 [0.37, 0.93]; p = 0.040, OR = 0.23 [0.05, 0.93], respectively). Among CETP variants, rs708272 was linked to a 10.56% smaller reduction in LDL-C with rosuvastatin (95% CI = [1.27, 19.86] %; p = 0.028). In contrast, carriers of rs5882 had a 13.33% greater reduction in LDL-C (95% CI = [25.38, 1.28]; p = 0.032). If these findings are confirmed, ABCA1, CYP2D6, and CETP genotyping could be used to help predict which statin and dosage is appropriate in order to improve personalized medicine.

KIF6 gene as a pharmacogenetic marker for lipid-lowering effect in statin treatment.

INTRODUCTION: The therapeutic response to statins has a high interindividual variability with respect to reductions in plasma LDL-cholesterol (c-LDL) and increases in HDL cholesterol (c-HDL). Many studies suggest that there is a relationship between the rs20455 KIF6 gene variant (c.2155T> C, Trp719Arg) and a lower risk of cardiovascular disease in patients being treated with statins. AIM: The aim of this study was to investigate whether or not the c.2155T> C KIF6 gene variant modulates the hypercholesteremic effects of treatment with simvastatin, atorvastatin, or rosuvastatin. MATERIALS AND METHODS: This was a prospective, observational and multicenter study. Three hundred and forty-four patients who had not undergone prior lipid-lowering treatment were recruited. Simvastatin, atorvastatin or rosuvastatin were administered. Lipid profiles and multiple clinical and biochemical variables were assessed before and after treatment. RESULTS: The c.2155T> C variant of the KIF6 gene was shown to influence physiological responses to treatment with simvastatin and atorvastatin. Patients who were homozygous for the c.2155T> C variant (CC genotype, ArgArg) had a 7.0% smaller reduction of LDL cholesterol levels (p = 0.015) in response to hypolipidemic treatment compared to patients with the TT (TrpTrp) or CT (TrpArg) genotype. After pharmacological treatment with rosuvastatin, patients carrying the genetic variant had an increase in c-HDL that was 21.9% lower compared to patients who did not carry the variant (p = 0.008). CONCLUSION: Being a carrier of the c.2155T> C variant of the KIF6 gene negatively impacts patient responses to simvastatin, atorvastatin or rosuvastatin in terms of lipid lowering effect. Increasing the intensity of hypolipidemic therapy may be advisable for patients who are positive for the c.2155T> C variant.

Síndrome de Prader-Willi e hiperfagia: un reto a investigar / Prader-Willi syndrome and hyperphagia: A challenge to investigate

No disponible

Hipotiroidismo primario: consideraciones para una buena utilización del tratamiento con levotiroxina / Primary hypothyroidism: Considerations for a rational use of levothyroxine therapy

No disponible

[Treatment of type 2 diabetes: revision of current therapeutical options and priorities]. / Tratamiento de la diabetes tipo 2: revisión de las opciones y prioridades terapéuticas actuales.

The paradigm of type 2 diabetes mellitus treatment is based in an adequate meal plan and the regular practice of physical exercise. The benefits of these measures are of evident as it is the perseverance in their compliance. In the daily practice, this reality favours the early implementation of a pharmacological therapy that, in the opinion of different experts, would be simultaneous to the introduction of life style changes. In the last years, new drugs have been developed. On the one hand, there are agents with beneficial effects not only on blood glucose control but also on the components of metabolic syndrome. Other drugs, according to different experts, have doubtful therapeutical contribution. The appearance of new drugs to treat obesity, associated with diabetes or not, extends other possibilities of choice to take into account. The great variety of options makes the decision of the adequate therapy more difficult. In the last decade, many therapeutic guidelines have been developed, with convergences and divergences that may mislead the inexpert practitioners. In this review we propose some practical advise in diet and exercise, and an evaluation of the different drugs and rules of intervention proposed in the different therapeutic guidelines. The ultimate goal is to facilitate and direct type 2 diabetes management.

Tratamiento de la diabetes tipo 2: revisión de las opciones y prioridades terapéuticas actuales / Treatment of type 2 diabetes: revision of current therapeutical options and priorities

El paradigma del tratamiento de la diabetes mellitus tipo 2 se fundamenta en una dieta adecuada y la práctica de ejercicio físico regular. Los beneficios de estas medidas higiénico-dietéticas son evidentes, como también lo es la falta de perseverancia en su cumplimiento. En la práctica diaria esta realidad favorece la instauración precoz de un tratamiento farmacológico que, en opinión de distintos expertos, debería ser simultánea a la introducción de los cambios en el estilo de vida. En los últimos años se han desarrollado nuevos principios activos, algunos con efectos beneficiosos tanto sobre el control metabólico como sobre determinados componentes del denominado síndrome metabólico; otros, según diversos expertos, de dudosa aportación terapéutica. La aparición de fármacos para tratar la obesidad, asociada o no a la diabetes, amplía el abanico de posibilidades de tratamiento. La gran diversidad de opciones hace que cada vez resulte más difícil saber cuál es la decisión terapéutica adecuada. Durante esta última década han visto la luz varias guías de práctica clínica, con convergencias y divergencias en algunas de sus recomendaciones, que pueden confundir y desorientar a los menos expertos. En esta revisión proponemos algunos consejos prácticos sobre dieta y ejercicio, así como una valoración de los principios activos y de las normas de intervención propuestas por distintas guías de práctica clínica; todo ello sin desestimar la experiencia propia, con el objetivo final de facilitar y orientar el abordaje terapéutico de la diabetes mellitus tipo 2

The paradigm of type 2 diabetes mellitus treatment is based in an adequate meal plan and the regular practice of physical exercice. The benefits of these measures are of evident as it is the perseverance in their compliance. In the daily practice, this reality favours the early implementation of a pharmacological therapy that, in the opinion of different experts, would be simoultaneous to the introduction of life style changes. In the last years, new drugs have been developed. On the one hand, there are agents with beneficial effects not only on blood glucose control but also on the components of metabolic syndrome. Other drugs, according to different experts, have doubtful therapeutical contribution. The appearance of new drugs to treat obesity, associated with diabetes or not, extends other possibilities of choice to take into account. The great variety of options makes the decision of the adequate therapy more difficult. In the last decade, many therapeutic guidelines have been developed, with convergences and divergences that may mislead the inexpert practitioners. In this review we propose some practical advise in diet and exercise, and an evaluation of the different drugs and rules of intervention proposed in the different therapeutic guidelines. The ultimate goal is to facilitate and direct type 2 diabetes management (AU)