Hypoglycemia during hyperosmolar hyperglycemic crises is associated with long-term mortality.

BACKGROUND: Previous research has indicated that hypoglycemia during hospitalization is a predictor of unfavorable outcomes in patients with diabetes. However, no studies have examined the long-term impact of hypoglycemia in adults admitted for hyperglycemic crises. The study was aimed to investigate the long-term implications of hypoglycemia during hyperosmolar hyperglycemic crises, particularly in terms of all-cause mortality. METHODS: This retrospective cohort study included 170 patients (82 men [48.2%], median age 72 years) admitted to a university hospital for hyperosmolar hyperglycemic crises, including pure hyperosmolar hyperglycemic states and hyperosmolar diabetic ketoacidoses. We separately investigated the prognostic significance of hypoglycemia on mortality during the initial intravenous insulin therapy phase and during the later subcutaneous insulin therapy phase, both during hospitalization and in the long term (median follow-up, 652 days; range 2-3460 days). RESULTS: Both hypoglycemia during the initial intravenous insulin therapy phase (observed in 26.5% of patients) and hypoglycemia during the later subcutaneous insulin therapy phase (observed in 52.7% of patients) were associated with long-term mortality. After adjusting for potential confounders, hypoglycemia during the initial intravenous insulin therapy phase remained associated with mortality (hazard ratio 2.10, 95% CI 1.27-3.46, p = 0.004). CONCLUSIONS: Hypoglycemia during hyperosmolar hyperglycemic crises is a marker of long-term mortality, especially when it occurs during the initial intravenous insulin therapy phase.

Hypoglycemia in patients with type 2 diabetes mellitus during hospitalization: associated factors and prognostic value.

BACKGROUND: The risk factors for hypoglycemia during hospital admission and its consequences in patients with diabetes are not entirely known. The present study aimed to investigate the risk factors for hypoglycemia, as well as the potential implications of hypoglycemia in patients with type 2 diabetes mellitus admitted to the hospital. METHODS: This retrospective cohort study included 324 patients (214 [66.0%] men; median age 70 years, range 34-95 years) with type 2 diabetes admitted to a university hospital who were consulted the Endocrinology Department for glycemic control during a 12-month period. We investigated the potential role of demographic factors, metabolic factors, therapy, and comorbidities on the development of in-hospital hypoglycemia. We explored the prognostic value of hypoglycemia on mortality (both in-hospital and in the long-term), hospital readmission in the following year, and metabolic control (HbA1c value) after discharge (median follow-up, 886 days; range 19-1255 days). RESULTS: Hypoglycemia occurred in 154 (47.5%) patients during their hospitalization and was associated with advanced age, previous insulin therapy, higher Charlson Comorbidity Index, lower body mass index and lower baseline HbA1c values. Hypoglycemia was associated with greater in-hospital and long-term mortality, longer hospital stays, higher readmission rates, and poorer metabolic control after discharge. These negative consequences of hypoglycemia were more frequent in patients with severe (≤ 55 mg/dL) hypoglycemia and in patients who had hypoglycemia during a greater percentage of hospitalization days. CONCLUSIONS: Hypoglycemia during hospital admission is a marker of a poor prognosis in patients with type 2 diabetes.

[Cetoacidosis diabética al diagnóstico de diabetes mellitus tipo 1 en Asturias entre 2011 y 2020: influencia de la duración de los síntomas en la prevalencia de cetoacidosis y en la pérdida de peso.] / Diabetic ketoacidosis at diagnosis of type 1 diabetes in Asturias (Spain) between 2011 and 2020: influence of symptom duration on prevalence of ketoacidosis and weight loss.

OBJECTIVE: Diabetic ketoacidosis (DKA) is a serious complication that usually occurs at diagnosis of type 1 diabetes mellitus (T1D). However, the prevalence of DKA at diagnosis of T1D is heterogeneous in different regions of the world. The aim of this study was to determine the prevalence of DKA at diagnosis of T1D in Asturias. METHODS: This study included all patients under nineteen years of age diagnosed with T1D in Asturias between 2011 and 2020. Retrospective review of medical records was performed to analyse DKA and other characteristics at diagnosis. A log binary regression model was constructed to obtain an estimate of the prevalence ratio of DKA to diagnosis in the years studied. RESULTS: A total of 267 people were diagnosed with a mean age of 9.85±4.46 years. The prevalence of DKA at diagnosis during this period was 38.63%. There was an increasing trend, with a prevalence ratio over the years studied of 1.015 (95%CI: 0.96-1.07; p=0.61). Duration of symptoms before diagnosis was 4.57±7.64 weeks. Weight loss was 7.56±7.26%, being more than 10% of previous weight in almost half of the patients who loosed weight. There was a positive relationship between symptoms duration and prevalence of DKA and between time to diagnosis and weight loss. CONCLUSIONS: Asturias has a high prevalence of DKA at diagnosis of T1D, slightly higher than observed in other studies at national level and higher than in other similar countries, with a tendency to increase. Delayed diagnosis is a key factor in the prevalence of DKA and weight loss. Thus, health actions are needed for the early detection of T1D to avoid DKA at diagnosis.

OBJETIVO: La cetoacidosis diabética (CAD) es una complicación grave que puede producirse al diagnóstico de la diabetes mellitus tipo 1 (DM1). La prevalencia de CAD al diagnóstico de DM1 es desigual en las distintas regiones del mundo. El objetivo de este estudio fue conocer la prevalencia de CAD al diagnóstico de DM1 en Asturias. METODOS: Se incluyeron los pacientes menores de diecinueve años diagnosticados de DM1 en Asturias entre 2011 y 2020. Mediante revisión de historia clínica se analizó la prevalencia de CAD así como otras características al diagnóstico. Se construyó un modelo de regresión log binaria para obtener una estimación de la razón de prevalencia de CAD al diagnóstico en los años estudiados. RESULTADOS: Se diagnosticaron 267 personas con edad media de 9,85±4,46 años. La prevalencia de CAD al diagnóstico fue del 38,63%. Se apreció una tendencia al aumento, con una razón de prevalencia en los años estudiados de 1,015 (IC95%:0,96-1,07; p=0,61). La duración de los síntomas hasta el diagnóstico fue de 4,57±7,64 semanas. La pérdida de peso fue de 7,56±7,26%, siendo superior al 10% en casi la mitad de los pacientes que perdieron peso. Se apreció relación entre la duración de los síntomas y la prevalencia de CAD, y entre el tiempo de evolución y la pérdida de peso. CONCLUSIONES: Asturias presenta una alta prevalencia de CAD al diagnóstico de DM1, levemente superior a otros estudios a nivel nacional y superior a otros países de nuestro entorno, con tendencia al aumento. El retraso diagnóstico es clave en la prevalencia de CAD y en la pérdida de peso. Son necesarias actuaciones sanitarias para la detección precoz de la DM1.

Cetoacidosis diabética al diagnóstico de diabetes mellitus tipo 1 en Asturias entre 2011 y 2020: influencia de la duración de los síntomas en la prevalencia de cetoacidosis y en la pérdida de peso / Diabetic ketoacidosis at diagnosis of type 1 diabetes in Asturias (Spain) between 2011 and 2020: influence of symptom duration on prevalence of ketoacidosis and weight loss

Fundamentos: La cetoacidosis diabética (CAD) es una complicación grave que puede producirse al diagnóstico de la diabetes mellitus tipo 1 (DM1). La prevalencia de CAD al diagnóstico de DM1 es desigual en las distintas regiones del mundo. El objetivo de este estudio fue conocer la prevalencia de CAD al diagnóstico de DM1 en Asturias. Métodos: Se incluyeron los pacientes menores de diecinueve años diagnosticados de DM1 en Asturias entre 2011 y 2020. Mediante revisión de historia clínica se analizó la prevalencia de CAD así como otras características al diagnóstico. Se construyó un modelo de regresión logbinaria para obtener una estimación de la razón de prevalencia de CAD al diagnóstico en los años estudiados. Resultados: Se diagnosticaron 267 personas con edad media de 9,85±4,46 años. La prevalencia de CAD al diagnóstico fue del 38,63%. Se apreció una tendencia al aumento, con una razón de prevalencia en los años estudiados de 1,015 (IC95%:0,96-1,07; p=0,61). La duración de los síntomas hasta el diagnóstico fue de 4,57±7,64 semanas. La pérdida de peso fue de 7,56±7,26%, siendo superior al 10% en casi la mitad de los pacientes que perdieron peso. Se apreció relación entre la duración de los síntomas y la prevalencia de CAD, y entre el tiempo de evolución y la pérdida de peso. Conclusiones: Asturias presenta una alta prevalencia de CAD al diagnóstico de DM1, levemente superior a otros estudios a nivel nacional y superior a otros países de nuestro entorno, con tendencia al aumento. El retraso diagnóstico es clave en la prevalencia de CAD y en la pérdida de peso. Son necesarias actuaciones sanitarias para la detección precoz de la DM1.(AU)

Background: Diabetic ketoacidosis (DKA) is a serious complication that usually occurs at diagnosis of type 1 diabetes mellitus (T1D). However, the prevalence of DKA at diagnosis of T1D is heterogeneous in different regions of the world. The aim of this study was to determine the prevalence of DKA at diagnosis of T1D in Asturias. Methods: This study included all patients under nineteen years of age diagnosed with T1D in Asturias between 2011 and 2020. Retrospective review of medical records was performed to analyse DKA and other characteristics at diagnosis. A log binary regression model was constructed to obtain an estimate of the prevalence ratio of DKA to diagnosis in the years studied. Results: A total of 267 people were diagnosed with a mean age of 9.85±4.46 years. The prevalence of DKA at diagnosis during this period was 38.63%. There was an increasing trend, with a prevalence ratio over the years studied of 1.015 (95%CI: 0.96-1.07; p=0.61). Duration of symptoms before diagnosis was 4.57±7.64 weeks. Weight loss was 7.56±7.26%, being more than 10% of previous weight in almost half of the patients who loosed weight. There was a positive relationship between symptoms duration and prevalence of DKA and between time to diagnosis and weight loss. Conclusions: Asturias has a high prevalence of DKA at diagnosis of T1D, slightly higher than observed in other studies at national level and higher than in other similar countries, with a tendency to increase. Delayed diagnosis is a key factor in the prevalence of DKA and weight loss. Thus, health actions are needed for the early detection of T1D to avoid DKA at diagnosis.(AU)

Reclassification of type 2 diabetes to type 1 diabetes in Asturias (Spain) between 2011 and 2020.

BACKGROUND: Differentiating between type 1 diabetes (T1D) and type 2 diabetes (T2D) can be difficult in adults. The aim of this study was to determine the frequency of diagnostic reclassification from T2D to T1D, the characteristics of the patients and the impact on the management of the disease. METHODS: Observational and descriptive study including patients diagnosed with T1D in Asturias (Spain) between 2011 and 2020 who had been considered as T2D for at least 12 months. RESULTS: A total of 205 patients were included, representing 45.3% of those diagnosed with T1D over 30 years of age. Median time of evolution as T2D was 7,8 years. The age was 59.1 ± 12.9 years. BMI was > 25 kg/m2 in 46.8% of patients. HbA1c was 9.1 ± 2.1%, 77 ± 22 mmol/mol, and 56.5% were using insulin. Pancreatic antibodies were present in 95.5%, the most frequent being GAD, 82.6%. At 6 months, basal insulin use increased from 46.9 to 86.3%, and HbA1c decreased, 9.2 ± 2.0%vs7.7 ± 1.2%, 77 ± 22vs60 ± 13 mmol/mol; p < 0.0001. CONCLUSIONS: Diagnosis as T2D in patients with T1D in adults is common. Age, BMI, insulin use and other clinical features are not definitely discriminatory. GAD is the antibody of choice in case of diagnostic suspect. Reclassification has important implications for metabolic control.

Iodine status in pregnant women in northern Spain. Effect of iodised salt and iodine supplements on thyroid function.

INTRODUCTION: Iodine deficiency is linked to thyroid dysfunction, particularly in pregnant women. The objective of this study was to ascertain the iodine levels of women in the second trimester of pregnancy, analysing the influence of iodine ingestion on urinary iodine concentration (UIC) and maternal thyroid function. METHODS: A prospective observational study of pregnant women from Health Area IV of Asturias (northern Spain) recruited before 13 weeks of gestation between May and June 2017. A questionnaire on iodine intake was completed at the first visit, and urine and serum samples were collected at baseline and again during the second trimester. UIC, thyroid stimulating hormone (TSH) and free thyroxine (FT4) obtained in the second trimester of gestation were analysed and related to iodine intake. Thyroid autoimmunity was also analysed in half of the pregnant women at baseline. RESULTS: A total of 241 pregnant women were studied. Of these, 56.7% used iodised salt, 46.7% consumed ≥2 servings of dairy products daily and 88.1% took iodine supplements. Median UIC was 191µg/l (135.3-294µg/l), with 68.1% of the women having UIC ≥150µg/l. Only iodised salt consumption provided protection against iodine deficiency (odds ratio 0.35 [0.20-0.63], p=0.001). In women with no autoimmune thyroid disease (n=88), mean levels of TSH were lower in those that consumed iodised salt than in those that did not (respectively, 2.08±0.89mIU/l vs. 2.56±1.02mIU/l, p=0.025). In women with autoimmune thyroid disease (n=30), mean levels of TSH were higher in those that took iodine supplements than in those that did not (respectively, 2.97±1.25mIU/l vs. 1.16±0.41mIU/l, p=0.002). CONCLUSIONS: The pregnant women studied from Health Area IV in Asturias maintain adequate nutritional iodine status in the second trimester of gestation. In our sample, only the consumption of iodised salt was associated with adequate iodine nutrition, without affecting maternal thyroid function. Most of the women used iodine supplements, which was linked to higher levels of TSH in pregnant women with autoimmune thyroid disease.

Incidence of type 1 diabetes mellitus in Asturias (Spain) between 2011 and 2020.

INTRODUCTION: Type 1 diabetes mellitus (DM1) is a chronic disease with important socio-health repercussions that requires epidemiological information for proper health management. The aim of this study was to determine the incidence of DM1 in Asturias between 2011-2020. METHODS: Descriptive study which included diagnoses of DM1 in Asturias between 2011-2020 captured as a primary source by reviewing the register of pancreatic autoimmunity analysis. Incidence rates were estimated, expressed per 100,000 population-years of risk by age group, sex, and health area. RESULTS: A total of 815 patients were diagnosed, 53.13% men. The mean age was 34.32±22.07 years; 9.85±4.46 in children under 19 years of age (10.48±4.45 in males and 9.00±4.36 in females). Of the diagnoses, 55.34% occurred at an age over 30 years. The incidence was 7.82 (7.29-8.37); 19.65 (17.17-22.39) in under 15s and 12.84 (11.73-14.03) in under 40s. The maximum incidence peak was between 10-14 years, both in males 31.16 (23.89-39.95) and in females 21.72 (15.59-29.47). There was no significant increase in incidence over the years studied. CONCLUSIONS: Asturias has a high incidence of DM1. In our study no earlier age at diagnosis was observed or an increase in incidence. Compared to previous studies, the increase in incidence is most likely due to an improvement in data capture, not to a real increase in incidence. A high percentage of diagnoses occur in adulthood.

TSH neonatal como marcador del estado de nutrición de yodo. Influencia de la yoduria y la función tiroidea maternas sobre la TSH neonatal / Neonatal TSH as a marker of iodine nutrition status. Effect of maternal ioduria and thyroid function on neonatal TSH

Introducción: La TSH neonatal (TSHn) es un marcador de nutrición de yodo en la población. La OMS relaciona una prevalencia<3% de TSHn>5mUI/L, obtenida a partir de las 72h del nacimiento, con un adecuado estado nutricional de yodo. El objetivo de este estudio es conocer la prevalencia de TSHn>5mUI/L en una población yodosuficiente y su relación con factores maternos, neonatales y obstétricos. Materiales y métodos: Se reclutaron 243 gestantes entre mayo-junio de 2017 en nuestra área sanitaria. Se realizó un cuestionario sobre consumo de yodo y determinación de yoduria, función y autoinmunidad tiroideas en el primer trimestre de gestación. Se analizó la TSHn entre 48-72h del nacimiento, así como otros factores obstétricos y neonatales. Resultados: La TSHn media fue 2,43±1,68mUI/L, con un 7,8% de neonatos con TSHn>5mUI/L. La TSHn más elevada pertenecía a los neonatos de madres con yodurias insuficientes (p=0,021) o con TSH>2,5mUI/L, tanto en autoinmunidad tiroidea negativa (p=0,049) como positiva (p=0,006). La yoduria materna<150μg/L fue un factor de riesgo de TSHn>5mUI/L (3,70 [1,06-14,60], p=0,046), mientras que el peso neonatal ≥2500g fue un factor protector (0,14 [0,02-1,00], p=0,038). Conclusiones: La prevalencia de TSHn>5mUI/L en nuestra área sanitaria fue elevada, según las recomendaciones de la OMS. Se asoció el déficit de yodo materno con mayor riesgo de TSHn>5mUI/L. Dado que en la actualidad la determinación de la TSHn se realiza antes de las 72h del nacimiento, precisamos de nuevos puntos de corte para continuar empleando la TSHn como marcador de nutrición de yodo. (AU)

Introduction: Neonatal thyroid stimulating hormone (nTSH) is a marker of iodine nutrition status in the population. The WHO considers a prevalence of less than 3% of nTSH levels greater than 5mIU/L in samples obtained within 72h from birth indicative of iodine sufficiency. The aim of this study was to determine the prevalence of nTSH levels greater than 5mIU/L in an iodine-sufficient population and its association with maternal, neonatal and obstetric factors. Materials and methods: A total of 243 pregnant women were recruited between May and June 2017 in our health area. A questionnaire of iodine intake was administered, in addition to determination of ioduria, thyroid function and autoimmunity in the first trimester of gestation. We analysed nTSH levels in samples collected between 48 and 72h post birth and other obstetric and neonatal factors. Results: The mean nTSH level (standard deviation) was 2.43 (1.68mIU/L), with 7.8% of neonates having levels greater than 5mIU/L. The highest nTSH levels corresponded to neonates of mothers with insufficient ioduria (p=.021) or TSH levels greater than 2.5mIU/L, in both the case of negative (p=0.049) and positive (p=0.006) thyroid autoimmunity results. Maternal ioduria greater than 150μg/L was a risk factor for nTSH levels greater than 5mIU/L (3.70 [1.06–14.60]; p=0.046), while a neonatal weight of 2500g or greater was a protective factor (0.14 [0.02–1.00]; p=0.038). Conclusions: The prevalence of nTSH levels greater than 5mIU/L in our health area was high based on the WHO recommendations. Maternal iodine deficiency was associated with a higher risk of nTSH levels less than 5mIU/L. Given that nTSH is currently measured before 72h post birth, we need new cut-off points to keep on using nTSH as a marker of iodine nutritional status. (AU)

Neonatal TSH as a marker of iodine nutrition status. Effect of maternal ioduria and thyroid function on neonatal TSH.

INTRODUCTION: Neonatal thyroid stimulating hormone (nTSH) is a marker of iodine nutrition status in the population. The WHO considers a prevalence of less than 3% of nTSH levels greater than 5 mIU/L in samples obtained within 72h from birth indicative of iodine sufficiency. The aim of this study was to determine the prevalence of nTSH levels greater than 5 mIU/L in an iodine-sufficient population and its association with maternal, neonatal and obstetric factors. MATERIALS AND METHODS: A total of 243 pregnant women were recruited between May and June 2017 in our health area. A questionnaire of iodine intake was administered, in addition to determination of ioduria, thyroid function and autoimmunity in the first trimester of gestation. We analysed nTSH levels in samples collected between 48 and 72h post birth and other obstetric and neonatal factors. RESULTS: The mean nTSH level (standard deviation) was 2.43 (1.68 mIU/L), with 7.8% of neonates having levels greater than 5 mIU/L. The highest nTSH levels corresponded to neonates of mothers with insufficient ioduria (P = 0.021) or TSH levels greater than 2.5 mIU/L, in both the case of negative (P = 0.049) and positive (P = 0.006) thyroid autoimmunity results. Maternal ioduria less than 150 µg/L was a risk factor for nTSH levels greater than 5 mIU/L (3.70 [1.06-14.60]; P = 0.046), while a neonatal weight of 2500 g or greater was a protective factor (0.14 [0.02-1.00]; P = 0.038). CONCLUSIONS: The prevalence of nTSH levels greater than 5 mIU/L in our health area was high based on the WHO recommendations. Maternal iodine deficiency was associated with a higher risk of nTSH levels greater than 5 mIU/L. Given that nTSH is currently measured before 72h post birth, we need new cut-off points to keep on using nTSH as a marker of iodine nutritional status.

Correlation between glucose measurement parameters of continuous flash monitoring and HbA1c. Real life experience in Asturias.

INTRODUCTION: Despite continuous glucose monitoring having been proven useful in patients with type 1 diabetes mellitus, A1C remains the gold standard for assessing disease management. MATERIAL AND METHODS: Descriptive, retrospective study which included 252 patients, 40.5% male, mean age 44.91±14.57 years, mean duration of diabetes 22.21±13.12 years, 88.1% on basal-bolus insulin therapy and 11.9% users of continuous subcutaneous insulin infusion. Glucose measurement, analytical and anthropometric data were obtained. RESULTS: The mean time in range was 60.18±15.60% and was associated with A1C after adjusting for age, gender, duration of diabetes, BMI, insulin regimen, %CV and time below range (ß: -0.548; p<0.01). The glucose management indicator (GMI) was 7.19±0.69% and was also associated with A1C (ß: 0.957; p<0.01) regardless of age, gender, duration of diabetes, BMI, insulin treatment, %CV and time in range. The average difference between A1C and GMI was 0.17±0.65% (-2.70-3.40%), being higher as A1C increased, in a linear and significant manner, without being influenced by the duration of diabetes or CV. CONCLUSIONS: Although we found a positive correlation between continuous glucose monitoring glucose measurement parameters and A1C, there is still not enough evidence to replace one parameter with another.

Enfermedades cardiovasculares en personas con diabetes mellitus en España según la Base de Datos Clínicos de Atención Primaria (BDCAP) en 2017 / Cardiovascular diseases in people with diabetes mellitus in Spain according to the Primary Care Clinical Database (BDCAP) in 2017

Introducción y objetivosLa enfermedad cardiovascular ateroesclerótica y la insuficiencia cardiaca (IC) son la principal causa de morbimortalidad en los pacientes con diabetes. El objetivo de este trabajo es conocer la prevalencia de enfermedades cardiovasculares ateroscleróticas y de insuficiencia cardiaca en personas diagnosticadas de diabetes en España durante el año 2017, y compararlas con las de las personas no diagnosticadas de diabetes en función de la edad y el sexo.MétodosLos datos correspondientes a los diagnósticos de diabetes mellitus (DM), infarto agudo de miocardio (IAM), accidente cerebrovascular (ACV), arteriopatía periférica (AP) o IC del año 2017 se obtuvieron de la Base de Datos Clínicos de Atención Primaria (BDCAP) del Sistema Nacional de Salud.ResultadosComparando personas con diabetes y sin diabetes mayores de 35 años, la odds ratio (OR) de estar diagnosticado de IAM, ACV, AP o IC es de alrededor de 2 en el caso de los mayores de 64 años y superior a 4 en los menores de esa edad. Esta OR es mayor en las mujeres respecto a los varones para todos los diagnósticos con excepción de la AP.ConclusionesEste estudio muestra la elevada comorbilidad cardiovascular de los pacientes con diabetes en España, objetivando un mayor de riesgo en los menores de 65 años, más acentuado en mujeres, lo que hace necesario un tratamiento más intensivo en este colectivo de pacientes.

Introduction and objectives:Atherosclerotic cardiovascular disease and heart failure are the leading cause of morbidity and mortality in patients with diabetes. The objective of this work is to know the prevalence of atherosclerotic cardiovascular diseases and heart failure in people diagnosed with diabetes in Spain during 2017 and compare them with those not diagnosed with diabetes according to age and sex.Methods:Data for diagnoses of diabetes mellitus (DM), acute myocardial infarction (AMI), stroke, peripheral artery disease (PAD) or heart failure (HF) for 2017 were obtained from the National Health System's Primary Care Clinical Database (BDCAP).Results:Comparing people with diabetes and people without diabetes over 35 years of age, the Odds Ratio (OR) for being diagnosed with acute myocardial infarction, stroke, peripheral artery disease or heart failure is about 2 in those over 64 years of age and more than 4 in patients under that age. This OR is superior in females versus males for all diagnoses apart from peripheral artery disease.Conclusions:This study shows the high cardiovascular comorbidity of patients with diabetes in Spain, with a greater excess of risk in patients under 65 years of age, more pronounced in women. We should offer more intensive treatment for DM2 in women. (AU)

[Cardiovascular diseases in people with diabetes mellitus in Spain according to the Primary Care Clinical Database (BDCAP) in 2017]. / Enfermedades cardiovasculares en personas con diabetes mellitus en España según la Base de Datos Clínicos de Atención Primaria (BDCAP) en 2017.

INTRODUCTION AND OBJECTIVES: Atherosclerotic cardiovascular disease and heart failure are the leading cause of morbidity and mortality in patients with diabetes. The objective of this work is to know the prevalence of atherosclerotic cardiovascular diseases and heart failure in people diagnosed with diabetes in Spain during 2017 and compare them with those not diagnosed with diabetes according to age and sex. METHODS: Data for diagnoses of diabetes mellitus (DM), acute myocardial infarction (AMI), stroke, peripheral artery disease (PAD) or heart failure (HF) for 2017 were obtained from the National Health System's Primary Care Clinical Database (BDCAP). RESULTS: Comparing people with diabetes and people without diabetes over 35 years of age, the Odds Ratio (OR) for being diagnosed with acute myocardial infarction, stroke, peripheral artery disease or heart failure is about 2 in those over 64 years of age and more than 4 in patients under that age. This OR is superior in females versus males for all diagnoses apart from peripheral artery disease. CONCLUSIONS: This study shows the high cardiovascular comorbidity of patients with diabetes in Spain, with a greater excess of risk in patients under 65 years of age, more pronounced in women. We should offer more intensive treatment for DM2 in women.

Nutritional Iodine Status in Pregnant Women from Health Area IV in Asturias (Spain): Iodised Salt Is Enough.

BACKGROUND: Iodine deficiency during pregnancy may have adverse effects on the neurodevelopment of the foetus. Recent studies of pregnant women in Asturias (Spain) indicate that nutritional iodine levels are sufficient. The objective of this study was to confirm the appropriate nutritional iodine status and to analyse the influence of the ingestion of iodine on maternal urinary iodine concentration (UIC) and thyroid function. METHODS: An observational study was carried out between May and June 2017 on women in the first trimester of pregnancy from Health Area IV in Asturias. The women completed a questionnaire related to their consumption of iodine and samples were taken to analyse UIC and thyroid function. RESULTS: Three hundred and eighteen pregnant women were involved. Of these, 51.10% used iodised salt, 48.90% consumed ≥ 2 servings of dairy products daily and 87.08% took iodine supplements. The median UIC was 171.5 µg/L (116-265 µg/L) and 60.41% of women had UIC ≥ 150 µg/L. Multivariate logistic regression analysis demonstrated that iodised salt had a protective effect on UIC < 150 µg/L (odds ratio (OR) 0.404 (0.237-0.683), p = 0.001), but not iodine supplements (OR 0.512 (0.240-1.085), p = 0.080). The average level of thyroid stimulating hormone (TSH) was 2.26 ± 0.94 mIU/L; 68.40% of pregnant women taking iodine supplements had TSH < 2.5 mIU/L compared to 30.00% of those who were not taking supplements (p = 0.031). CONCLUSIONS: The pregnant women in our health area are maintaining appropriate nutritional iodine levels. The consumption of iodised salt protects against iodine deficiency; thus, iodine supplements should be taken on an individualised basis.

Prevalence of diabetes mellitus in Spain in 2016 according to the Primary Care Clinical Database (BDCAP). / Prevalencia de diabetes mellitus en 2016 en España según la Base de Datos Clínicos de Atención Primaria (BDCAP).

The prevalence of type 2 diabetes mellitus is increasing worldwide, including in Spain, and this disease has become a major challenge for health care. In Spain, the computerization of medical records in primary care, in the Primary Care Clinical Database (BDCAP), has made possible the diagnoses of diabetes in a representative sample of the nation as a whole. This article analyzes the prevalence of diabetes recorded in this database and compares the data of the different autonomous communities. The prevalence of diabetes in Spain is 6.66% of the total population assigned to primary care in the National Health System, is higher in men than in women (7.27% vs. 6.06%), and increases with age up to 80 years. There are significant differences in the adjusted prevalence of diabetes between autonomous communities, with lower prevalence rates in North and Central Spain and higher rates in the South and East, as well as the islands. The lowest prevalence is seen in Castile and Leon (4.51%), and the highest in the Canary Islands (9.72%).

DNA Methylomes and Epigenetic Age Acceleration Associations with Poor Metabolic Control in T1D.

Type 1 diabetes (T1D) is an autoimmune disease that leads to insulin deficiency and hyperglycemia. Little is known about how this metabolic dysfunction, which substantially alters the internal environment, forces cells to adapt through epigenetic mechanisms. Consequently, the purpose of this work was to study what changes occur in the epigenome of T1D patients after the onset of disease and in the context of poor metabolic control. We performed a genome-wide analysis of DNA methylation patterns in blood samples from 18 T1D patients with varying levels of metabolic control. We identified T1D-associated DNA methylation differences on more than 100 genes when compared with healthy controls. Interestingly, only T1D patients displaying poor glycemic control showed epigenetic age acceleration compared to healthy controls. The epigenetic alterations identified in this work make a valuable contribution to improving our understanding of T1D and to ensuring the appropriate management of the disease in relation to maintaining healthy aging.

Incidence and regression of metabolic syndrome in a representative sample of the Spanish population: results of the cohort di@bet.es study.

INTRODUCTION: Metabolic syndrome (MetS) is an important predictor of cardiovascular mortality. Identification of occurrence and regression trends of MetS could permit elaboration of preventive strategies with new targets. The objective of this study was to analyze the occurrence and regression rates of MetS and its associated factors in the representative cohort of Spain of the di@bet.es study. RESEARCH DESIGN AND METHODS: The di@bet.es study is a prospective cohort where 5072 people representative of the Spanish population over 18 years of age were randomly selected between 2009 and 2010. Follow-up was a median of 7.5 (IQR 7.2-7.9) years, with 2408 (47%) participating subjects. A total of 1881 (78%) subjects had all the pertinent data available and were included in this study. RESULTS: Of the 1146 subjects without baseline criteria for MetS, 294 (25.7%) developed MetS during follow-up, while of the 735 patients with prior MetS, 148 (20.1%) presented regression. Adjusted MetS incidence per 1000 person-years was 38 (95% CI 32 to 44), while regression incidence was 36 (95% CI 31 to 41). Regression rate was independently higher than incidence rate in the following: women, subjects aged 18-45, university-degree holders, patients without central obesity, without hypertension, as well as those with body mass index of <25 kg/m2. Lower progression and higher regression rates were observed with an adapted 14-point Mediterranean Diet adherence screener questionnaire score of >11 in both groups and with >500 and>2000 MET-min/week of physical activity, respectively. CONCLUSIONS: This study provides MetS incidence and regression rates, and identifies the target population for intervention strategies in Spain and possibly in other countries.

Performance of the Eversense versus the Free Style Libre Flash glucose monitor during exercise and normal daily activities in subjects with type 1 diabetes mellitus.

INTRODUCTION: Accurate blood glucose measurements are important in persons with diabetes during normal daily activities (NDA), even more so during exercise. We aimed to investigate the performance of fluorescence sensor-based and glucose oxidase-based interstitial glucose measurement during (intensive) exercise and NDA. RESEARCH DESIGN AND METHODS: Prospective, observational study in 23 persons with type 1 diabetes when mountain biking for 6 days, followed by 6 days of NDA. Readings of the Eversense (fluorescence-based continuous glucose monitoring (CGM); subcutaneously implanted) and of the Free Style Libre (FSL; glucose oxidase-based flash glucose monitoring (FGM); transcutaneously placed) were compared with capillary glucose levels (Free Style Libre Precision NeoPro strip (FSLCstrip)). RESULTS: Mean average differences (MAD) and mean average relative differences (MARD) were significantly different when comparing exercise with NDA (reference FSLCstrip); Eversense MAD 25±19 vs 17±6 mg/dL (p<0.001); MARD 17±6 vs 13%±6% (p<0.01) and FSL MAD 32±17 vs 18±8 mg/dL (p<0.01); MARD 20±7 vs 12%±5% (p<0.001).When analyzing the data according to the Integrated Continuous Glucose Monitoring Approvals (class II-510(K) guidelines), the overall performance of interstitial glucose readings within 20% of the FSLCstrip during exercise compared with NDA was 69% vs 81% for the Eversense and 59% vs 83% for the FSL, respectively. Within 15% of the FSLCstrip was 59% vs 70% for the Eversense and 46% vs 71% for the FSL. CONCLUSIONS: During exercise, both fluorescence and glucose oxidase-based interstitial glucose measurements (using Eversense and FSL sensors) were less accurate compared with measurements during NDA. Even when acknowledging the beneficial effects of CGM or FGM, users should be aware of the risk of diminished accuracy of interstitial glucose readings during (intensive) exercise.

Estimación de grasa corporal según ecuación CUN-BAE e IMC y riesgo de mortalidad por sexos en la cohorte del Estudio Asturias / Estimation of body fat mass using the CUN-BAE index and mortality risk by sex in the Asturias Study cohort

Introducción y objetivos: Conocemos que el exceso de grasa corporal (GC) se asocia con factores de riesgo cardiovascular, algunos tipos de cáncer y otras causas principales de muerte. Se ha definido un nuevo método antropométrico: el índice CUN-BAE (Clínica Universidad de Navarra-Estimador de Adiposidad Corporal), que se basa en el IMC, el sexo y la edad. Hemos utilizado IMC y CUN-BAE para evaluar su contribución en la asociación con mortalidad en la cohorte del Estudio Asturias. Material y métodos: El Estudio Asturias se trata de un estudio de cohortes que incluyó a 1.034 individuos de 30-75 años de edad que participaron en la primera fase del estudio (1998-1999), realizando encuesta, exploración física y sobrecarga oral de glucosa. Se registraron los fallecimientos en la cohorte tras 18 años de seguimiento. Resultados: 204 personas fallecieron: 93 mujeres y 111 varones (16,6% de las mujeres y 23,5% de los varones). Valores basales tanto de IMC como de %GC determinantes de obesidad (> 30 kg/m2 para IMC; > 25% en hombres y > 35% en mujeres para CUN-BAE) fueron mayoritarios en los datos de individuos fallecidos. Tras ajuste por DM2, HTA, ECV y tabaco, el riesgo de mortalidad por todas las causas y cardiovascular es significativamente mayor según se incrementa el CUN-BAE, sobre todo en mujeres. Conclusiones: La ecuación CUN-BAE es una herramienta útil en mujeres para detectar las que van a presentar un mayor riesgo de mortalidad, independientemente de factores de riesgo

Introduction and objectives: In epidemiological studies, excess body fat (BF) has been associated with cardiometabolic risk factors, some types of cancer, and other causes of death. A new anthropometric method has been defined: The CUN-BAE index (University of Navarra Clinic-Body Fat Estimator), which is based on BMI, sex, and age. BMI and CUN-BAE index were used to assess their contribution to mortality risk from any cause in the Asturias Study cohort. Material and methods: The Asturias study is a cohort study including 1.034 individuals aged 30-75 years who participated in the first study phase (1998-1999). The study included a clinical survey, physical examination, and an oral glucose tolerance test. Vital status was determined in the cohort after 18years of follow-up. Results: Two hundred and four subjects died: 93 females and 111 males (16.6% and 23.5% respectively men). Baseline values of both BMI and %BF suggesting obesity (BMI > 30 kg/m2 and CUN-BAE > 25% in males and >35% in females) were found in most subjects. After adjusting for T2DM, HBP, CVD, and tobacco, the risk of all-cause and cardiovascular mortality was significantly higher as CUN-BAE increased, especially in females. Conclusions: The CUN-BAE equation is a useful tool, especially in females, to detect those who will have a greater risk of mortality, regardless of cardiovascular risk factors