Efectos en vida real de la adición de semaglutida subcutánea semanal al tratamiento con insulina en diabetes mellitus tipo 2 / Real-life effects of adding weekly subcutaneous semaglutide to insulin for the treatment of type 2 diabetes mellitus

Objetivos: Determinar en la vida real los beneficios antropométricos y analíticos de la adición de semaglutida por vía subcutánea al tratamiento previo con insulina en pacientes con diabetes tipo 2.Métodos: Estudio descriptivo, retrospectivo y abierto en el que se describen características clínicas y antropométricas de 117 pacientes diagnosticados de diabetes tipo 2 seguidos en las consultas externas de Endocrinología y Nutrición del Hospital Universitario Central de Asturias a lo largo de 53 semanas tras el inicio de tratamiento con semaglutida subcutánea (octubre-diciembre 2019). Todos los pacientes estaban en tratamiento previo con insulina, con o sin antidiabéticos orales.Resultados: De los 117 pacientes iniciales, 17 no completaron el estudio debido a efectos adversos (náuseas, vómitos), decisión clínica y pérdida de seguimiento.A los 12 meses (semana 53) del inicio de la semaglutida se obtuvo un descenso de HbA1c de 0,74% (IC 95% 0,59-1,14, p<0,05), así como de 3,61kg de peso (IC 95% 2,30-4,92, p<0,05), y de 15,88 UI de insulina total (IC 95% 10,98-20,74, p<0,05) respecto a las cifras basales. En pacientes sin análogo del receptor de GLP-1 (arGLP-1) previo, el efecto en la disminución de HbA1c, el peso y la dosis total de insulina fue estadísticamente significativo; sin embargo, los pacientes pretratados con arGLP-1 solo tuvieron mejoría en la reducción de peso. No se observaron eventos adversos graves.Conclusiones: La adición de semaglutida subcutánea al tratamiento previo con insulina con o sin antidiabéticos orales induce una disminución de HbA1c, peso y dosis de insulina de forma segura. Este efecto es mayor en pacientes naïve para tratamiento con arGLP-1. (AU)

Objectives: This work aims to determine the real-life anthropometric and analytical benefits of adding subcutaneous semaglutide to previous insulin treatment in patients with type 2 diabetes.Methods: This is a descriptive, retrospective, open-label study describing the clinical and anthropometric characteristics of 117 patients diagnosed with type 2 diabetes followed-up on in the Endocrinology and Nutrition outpatient clinic of the Hospital Universitario Central de Asturias for 53 weeks after starting treatment with subcutaneous semaglutide (October-December 2019). All patients were on previous insulin treatment with or without oral antidiabetics.Results: Of the 117 initial patients, 17 did not complete the study due to adverse effects (nausea, vomiting), the physician's decision, or loss to follow-up.Twelve months (week 53) after starting semaglutide, there was a decrease in HbA1c of 0.74% (95% CI 0.59-1.14, p<0.05) as well as 3.61kg of weight loss (95% CI 2.30-4.92, p<0.05) and a decline in total insulin of 15.88 IU (95% CI 10.98-20.74, p<0.05) from baseline figures. In patients without prior GLP-1 receptor analogs (GLP-1ra), the effect in terms of a reduction in HbA1c, weight, and the total insulin dose was statistically significant. However, in patients pre-treated with GLP-1ra only had improvements in terms of weight loss. No serious adverse events were observed.Conclusions: The addition of subcutaneous semaglutide to prior insulin treatment with or without oral antidiabetics safely led to a decrease in HbA1c, weight, and the insulin dose. This effect is greater in GLP-1ra naive patients. (AU)

Real-life effects of adding weekly subcutaneous semaglutide to insulin for the treatment of type 2 diabetes mellitus.

OBJECTIVES: This work aims to determine the real-life anthropometric and analytical benefits of adding subcutaneous semaglutide to previous insulin treatment in patients with type 2 diabetes. METHODS: This is a descriptive, retrospective, open-label study describing the clinical and anthropometric characteristics of 117 patients diagnosed with type 2 diabetes followed-up on in the Endocrinology and Nutrition outpatient clinic of the Hospital Universitario Central de Asturias for 53 weeks after starting treatment with subcutaneous semaglutide (October-December 2019). All patients were on previous insulin treatment with or without oral antidiabetics. RESULTS: Of the 117 initial patients, 17 did not complete the study due to adverse effects (nausea, vomiting), the physician's decision, or loss to follow-up. Twelve months (week 53) after starting semaglutide, there was a decrease in HbA1c of 0.74% (95% CI 0.59-1.14, p < 0.05) as well as 3.61 kg of weight loss (95% CI 2.30-4.92, p < 0.05) and a decline in total insulin of 15.88 IU (95% CI 10.98-20.74, p < 0.05) from baseline figures. In patients without prior GLP-1 receptor analogs (GLP-1ra), the effect in terms of a reduction in HbA1c, weight, and the total insulin dose was statistically significant. However, in patients pre-treated with GLP-1ra only had improvements in terms of weight loss. No serious adverse events were observed. CONCLUSIONS: The addition of subcutaneous semaglutide to prior insulin treatment with or without oral antidiabetics safely led to a decrease in HbA1c, weight, and the insulin dose. This effect is greater in GLP-1ra naive patients.

Estrategia de detección de disfunción tiroidea en la gestación: cribado universal o selectivo / Universal vs. selective screening for thyroid dysfunction in pregnancy

Objetivo: Estimar la efectividad del cribado selectivo frente al universal en la detección de disfunción tiroidea (DT) en el embarazo en condiciones de práctica clínica. Material y métodos: Estudio de diseño transversal basado en la identificación de gestantes con factores de riesgo (FR) de DT en una cohorte de 220 mujeres con cribado poblacional positivo. El estudio se desarrolló en el Área Sanitaria de Oviedo entre abril del 2010 y marzo del 2011. Resultados: Se identificaron FR en el 83,6% de las gestantes con DT. Los FR más prevalentes fueron la edad ≥ 30 años (70,5%), la historia de abortos previos (21,8%) y la historia familiar de patología tiroidea (20,9%). Sin tener en cuenta la edad, solo el 51,8% de las gestantes presentaba FR. Conclusiones: El cribado selectivo logra identificar una elevada proporción de gestantes con DT pero a expensas de incluir en el cribado a un gran número de mujeres, por lo que no parece una estrategia efectiva

Objective: To estimate the effectiveness of selective versus universal screening for thyroid dysfunction (TD) during pregnancy. Material and methods: Cross-sectional study applying a selective screening protocol, based on the presence of TD risk factors (RF), in a cohort of pregnant women with a positive universal screening result in the Oviedo Healthcare District. Two hundred and twenty pregnant women with TD were studied between April 2010 and March 2011. Results: Selective screening identified 83.6% of pregnant women with TD. The most prevalent RF were maternal age ≥ 30 years (70.5%), history of miscarriage (21.8%) and family history of thyroid disease (20.9%). Excluding the age factor, only 51.8% of the pregnant women included in the group had risk factors. Conclusions: Selective screening identifies a high proportion of pregnant women with TD but at the expense of screening a large number of women, so it does not appear to be an effective strategy

Functional analysis of human glucokinase gene mutations causing MODY2: exploring the regulatory mechanisms of glucokinase activity.

AIMS/HYPOTHESIS: Glucokinase (GCK) acts as a glucose sensor in the pancreatic beta cell and regulates insulin secretion. In the gene encoding GCK the heterozygous mutations that result in enzyme inactivation cause MODY2. Functional studies of naturally occurring GCK mutations associated with hyperglycaemia provide further insight into the biochemical basis of glucose sensor regulation. MATERIALS AND METHODS: Identification of GCK mutations in selected MODY patients was performed by single-strand conformation polymorphism and direct sequencing. The kinetic parameters and thermal stability of recombinant mutant human GCK were determined, and in pull-down assays the effect of these mutations on the association of GCK with glucokinase (hexokinase 4) regulator (GCKR, also known as glucokinase regulatory protein [GKRP]) and 6-phosphofructo-2-kinase/fructose-2,6-bisphosphatase (PFKFB1, also known as PFK2) was tested. RESULTS: We identified three novel GCK mutations: the insertion of an asparagine residue at position 161 (inserN161) and two missense mutations (M235V and R308W). We also identified a fourth mutation (R397L) reported in a previous work. Functional characterisation of these mutations revealed that insertion of asparagine residue N161 fully inactivates GCK, whereas the M235V and R308W mutations only partially impair enzymatic activity. In contrast, GCK kinetics was almost unaffected by the R397L mutation. Although none of these mutations affected the interaction of GCK with PFKFB1, we found that the R308W mutation caused protein instability and increased the strength of interaction with GCKR. CONCLUSIONS/INTERPRETATION: Our results show that different MODY2 mutations impair GCK function through different mechanisms such as enzymatic activity, protein stability and increased interaction with GCKR, helping further elucidate the regulation of GCK activity.

Implicaciones clinicoterapéuticas de la deficiencia de yodo en España / Clinical and therapeutic implications of iodine deficiency in Spain

El yodo es un nutriente imprescindible para el organismo humano (esencial para la formación de las hormonas tiroideas), cuya principal fuente de abastecimiento son los pescados de mar y los mariscos; se precisa una ingesta diaria mínima de 100 mg en la primera infancia, 120 hasta la pubertad, 150 en la edad adulta y no menos de 250 durante el embarazo y la lactancia. Hoy día, la Organización Mundial de la Salud estima en más de 2.200 millones de personas en riesgo por habitar en áreas yododeficientes, entre las que se incluye una gran parte de Europa. En España, los estudios realizados confirman también este déficit, que es leve en la población escolar de todas las comunidades autónomas estudiadas, salvo en Asturias, donde el programa de profilaxis con sal yodada iniciado en 1983 ha mostrado tener eficacia. Las gestantes, sin embargo, son el segmento de población más vulnerable, y presentan una marcada deficiencia, que se manifiesta también en los recién nacidos, demostrada por los valores de tirotropina (TSH). Aunque sólo hay 2 estudios en preescolares (Mataró y Asturias), ambos sugieren un estado de nutrición aceptable. Se sabe que la reducción de los trastornos por deficiencia de yodo como grave problema de salud pública ha sido posible con el cambio de los hábitos alimentarios de la población mundial, lo que indica la necesidad de lograr que el consumo de sal yodada en España sea una realidad que alcance al 95% de las familias y, además, que las gestantes y las madres en período de lactancia utilicen suplementos farmacológicos de yodo

Iodine is an essential nutrient for the human organism (for the formation of thyroid hormones), and its main sources are fish and shellfish, requiring a daily minimal intake of 100 micrograms in early childhood, 120 until puberty, 150 in adulthood and not less than 250 during pregnancy and breastfeeding. The World Health Organization estimates that currently 2,200 million persons are at risk for iodine deficiency as they live in iodine-deficient areas, which include a large part of Europe. Studies performed in Spain confirm this deficiency in our country, which is mild in the school-aged population of all the autonomous communities studied, except in Asturias, where the prophylaxis program with iodized salt initiated in 1983 has been shown to be effective. Pregnant women, however, are the most vulnerable segment of the population and show marked iodine deficiency. This deficiency is also manifested in newborns, demonstrated by thyroid-stimulating hormone levels. Although only two studies have been performed in preschool children (Mataró and Asturias) both suggest acceptable nutritional status. It is known that a reduction in iodine deficiency disorders as a serious public health problem can be achieved with a change in diet in the world population, indicating the need to make iodine intake a reality in Spain. Such an intervention should include 95% of families; moreover, pregnant and breastfeeding women should use iodine supplements

Déficit de yodo en España: situación actual / Iodine deficiency in Spain: current situation

No disponible

[Prevalence of diabetes mellitus and glucose intolerance in the population aged 30 to 75 years in Asturias, Spain]. / Prevalencia de diabetes mellitus e intolerancia a la glucosa en población entre 30 y 75 años en Asturias, España.

OBJECTIVE: To know the prevalence of type 2 diabetes mellitus (DM2) and glucose intolerance (GIT) in the adult population in Asturias. METHODS: Population based, cross-sectional study. A total of 1,034 individuals (54,1%, women) aged 30-75 years were randomly selected. Individuals responded to a questionnaire, underwent physical examination, and an oral glucose overload test; vein blood was extracted to determine both basal and 2-hour glucose levels. The diagnostic criteria set up by the World Health Organization in 1985 were used. RESULTS: The overall DM2 prevalence was 9.9% (8.2% to 11.7%), known DM 4% (2.8% to 5.1%), unknown DM 5.9% (4.5% to 7.4%). The unknown diabetes/hnown diabetes ratio was 1.5/1. The prevalence of GIT was 13.3 % (11.3% to 15.2%). The prevalence of DM for the Segi population (30-64 years) was 8.2% among men and 5.2% among women. Factors independently associated with DM included age, increased blood pressure, family history of diabetes, obesity, and hypertriglyceridemia. CONCLUSION: The prevalence of DM2 in the adult population of Asturias (9.9%) is moderately high and similar to that observed in our country and other white populations in the world. More than half of patients with DM are unaware of their condition; thus, planning strategies for and early diagnosis would be helpful for the high risk populations.

Prevalencia de diabetes mellitus e intolerancia a la glucosa en población entre 30 y 75 años en Asturias, España / Prevalence of diabetes mellitus and glucose intolerance in the population aged 30 to 75 years in Asturias, Spain

Fundamento. Conocer la prevalencia de diabetes mellitus tipo 2 (DM2) e intolerancia a la glucosa (ITG) en la población adulta de Asturias. Métodos. Estudio poblacional transversal. Mil treinta y cuatro personas (54,1 por ciento mujeres) entre 30 y 75 años que fueron seleccionadas aleatoriamente. Se realizó cuestionario, exploración y sobrecarga oral de glucosa con extracción venosa basal y dos horas. Se utilizaron los criterios diagnósticos establecidos por la Organización Mundial de la Salud en 1985.Resultados. Prevalencia de DM2 global 9,9 por ciento (8,2 por ciento-11,7 por ciento), DM conocida 4 por ciento (2,8 por ciento-5,1 por ciento), DM ignorada 5,9 por ciento (4,5 por ciento-7,4 por ciento)- Ratio diabetes ignorada/conocida: 1,5/1. Prevalencia de ITG 13,3 por ciento (11,3 por ciento-15,2 por ciento). Prevalencia de DM para la población de Segi (30-64 años), 8,2 por ciento en varones y 5,2 por ciento en mujeres. Los factores que se asocian a DM de manera independiente son la edad, la hipertensión arterial, tener antecedentes familiares de diabetes, la obesidad y la hipertrigliceridemia. Conclusión. La prevalencia de DM2 en la población adulta de Asturias (9,9 por ciento) es moderadamente elevada y similar a la observada en nuestro país y en otras poblaciones blancas en el mundo. Más de la mitad de las personas con DM desconocen su condición, por lo que podría ser útil plantear estrategias de diagnóstico precoz en los grupos de población de alto riesgo (AU)

Síndrome de cushing por hiperplasia adrenal macronodular bilateral ACTH-independiente / Cushing's syndrome due to ACTH-independent bilateral macronodular adrenal hyperplasia

La hiperplasia suprarrenal macronodular bilateral ACTH-independiente (HAMAI) se considera hoy día una entidad diferente y separada del resto de causas de síndrome de Cushing. Su etiología es incierta aunque en los últimos años se ha demostrado la existencia de respuesta anormal de glándulas suprarrenales a distintas hormonas que estimulan la secreción de cortisol. En este artículo presentamos un caso de hipercortisolismo no suprimible con dexametasona, cifras de ACTH indetectables, hiperplasia suprarrenal bilateral de aspecto nodular y resonancia magnética nuclear hipofisaria normal. Se realizó suprarrenalectomía bilateral, objetivando cifras detectables de ACTH a los 3 meses (AU)