Insulina degludec en pacientes diabéticos tipo 1: observación a 18 meses / Degludec insulin in type 1 diabetic patients: 18 months of observation

Antecedentes: En el tratamiento de la diabetes se buscan insulinas de acción más prolongada y con menores tasas de hipoglicemias. Objetivo. Uso del análogo de insulina de acción ultralenta degludec en diabéticos tipo 1 (DM1) tratados previamente con glargina. Pacientes y método: Se observaron 230 DM1 durante 18 meses, promedio de edad 34 años y de diagnóstico 14 años, registrándose parámetros clínicos, bioquímicos, hipoglicemias y requerimientos de insulina (U/kg/peso), en régimen basal/bolo, con degludec y ultra-rápida precomidas. Degludec se ajustó quincenalmente. Resultados: A los 3 meses, la glicemia de ayunas disminuyó de 253mg/dl (243-270) a 180 mg/dl (172- 240), (p< 0,05); a los 6 meses a 156 mg/dl (137-180) (p< 0,05), a los 12 meses a 151 mg/dl (50-328) (p< 0,001) y a los 18 meses 150 (50-321) (p<0,001). La HbA1c, inicialmente de 10,6% (10,3-12,2) bajó a los 3 meses a 8,7% (8,2-11,1) (p< 0,05), a 6 meses a 8,3% (8,0-9,6) (p<0,05), a los 12 meses subió 9,0% (5,9-14,5) (p<0,001) y a los 18 meses 9,0% (5,9-14,6) (p<0,001). La dosis de degludec fue 0,5 U/kg/peso a los 18 meses. Hubo reducción de hipoglicemias: a los 3 meses 14 leves, 4 moderados 1 grave; a los 6 meses 8 leves, 2 moderados y ninguna grave; a los 12 meses 1 leve, y a los 18 meses 2 leves, 1 moderado y ninguna grave. Un 7,8% no presentó hipoglicemias. Conclusión: Degludec en DM1 mostró reducir las glicemias de ayunas y HbA1c, y menor número de hipoglicemias.

Background: In the treatment of diabetes, longer-acting insulins with lower rates of hypoglycaemia are sought. Objective. Use of ultralow-acting insulin analog degludec in type 1 diabetic patients (T1D) previously treated with glargine. Patients and method: 230 T1D patients were observed during 18 months, average of age 34 years and of diagnosis 14 years, registering clinical, biochemical, hypoglycemia and insulin requirements (U / kg / weight), in basal / bolus regimen, with degludec and ultra-fast pre-meals. Degludec adjusted himself fortnightly. Results: At 3 months, the fasting glycemia decreased from 253 mg / dl (243-270) to 180 mg / dl (172 - 240), (p <0.05); at 6 months at 156 mg / dl (137-180) (p <0.05), at 12 months at 151 mg / dl (50-328) (p <0.001) and at 18 months 150 (50-321) ;(p <0.001). HbA1c, initially of 10.6% (10.3-12.2), decreased after 3 months to 8.7% (8.2 - 11.1) (p <0.05), to 6 months to 8 months, 3% (8.0-9.6) (p <0.05), at 12 months it rose 9.0% (5.9-14.5) (p <0.001) and at 18 months 9.0 % (5.9-14.6) (p <0.001). The dose of degludec was 0.5 U / kg / weight at 18 months. There was reduction of hypoglycemia: at 3 months, 14 mild, 4 moderate, 1 severe; at 6 months 8 mild, 2 moderate and none serious; at 12 months 1 mild, and at 18 months 2 mild, 1 moderate and none serious. 7.8% did not present hypoglycemia. Conclusion: Degludec in T1D patients showed to reduce fasting glycemia and HbA1c, and lower number of hypoglycemia.

[Natural history of diabetic retinopathy in a retrospective cohort of type 1 diabetics]. / Historia natural de retinopatía diabética en un estudio a largo plazo en pacientes con diabetes tipo 1. Factores de riesgo para progresión a enfermedad proliferante.

BACKGROUND: Diabetic retinopathy is one of the most common causes of blindness among adults. AIM: To report the natural history of diabetic retinopathy among Chilean patients with type 1 diabetes followed for a mean of 18 years. MATERIAL AND METHODS: Retrospective review of medical records of 39 patients aged 26 to 70 years, (20 females, 78 eyes) with type 1 diabetes controlled by the same ophthalmologist from 1971 to 2008. A questionnaire was sent to each patient and their treating physician to request information about the evolution of the disease and metabolic control. RESULTS: The questionnaire was answered by 24 patients (62%) and 21 attending physicians (54%). Small hard drusen were observed in 25 patients (64%). In 12 cases the drusen were detected before the development of any type of retinopathy. Eleven women became pregnant and retinopathy progressed in four of them. Twenty three patients (59%) developed proliferative diabetic retinopathy (PDR). Patients with PDR had a significantly longer duration of diabetes and worse glycemic control. There was a higher frequency of diabetic nephropathy in the PDR group, but only 13 patients out of 23 with PDR had nephropathy. The retinopathy progressed to high risk PDR two years after successful kidney-pancreas transplantation in one patient. CONCLUSIONS: In patients with type 1 diabetes mellitus, small hard drusen may be the initial manifestation of diabetic retinopathy. Risk factors for progression to PDR were duration of diabetic and poor glycemic control. Nephropathy was more prevalent in patients with PDR, but a significant group of PDR patients did not have demonstrable nephropathy.

Historia natural de retinopatía diabética en un estudio a largo plazo en pacientes con diabetes tipo 1. Factores de riesgo para progresión a enfermedad proliferante / Natural history of diabetic retinopathy in a retrospective cohort of type 1 diabetics

Background: Diabetic retinopathy is one of the most common causes of blindness among adults. Aim: To report the natural history of diabetic retinopathy among Chilean patients with type 1 diabetes followed for a mean of 18 years. Material and methods: Retrospective review of medical records of 39 patients aged 26 to 70 years, (20 females, 78 eyes) with type 1 diabetes controlled by the same ophthalmologist from 1971 to 2008. A questionnaire was sent to each patient and their treating physician to request information about the evolution of the disease and metabolic control. Results: The questionnaire was answered by 24 patients (62 percent) and 21 attending physicians (54 percent). Small hard drusen were observed in 25 patients (64 percent). In 12 cases the drusen were detected before the development of any type of retinopathy. Eleven women became pregnant and retinopathy progressed in four of them. Twently three patients (59 percent) developed proliferative diabetic retinopathy (PDR). Patients with PDR had a significantly longer duration of diabetes and worse glycemic control. There was a higher frequency of diabetic nephropathy in the PDR group, but only 13 patients out of 23 with PDR had nephropathy. The retinopathy progressed to high risk PDR two years after successful kidney-pancreas transplantation in one patient. Conclusions. In patients with type 1 diabetes mellitus, small hard drusen may be the initial manifestation of diabetic retinopathy. Risk factors for progression to PDR were duration of diabetic and poor glycemic control. Nephropathy was more prevalent in patients with PDR, but a significant group of PDR patients did not have demonstrable nephropathy (RevMéd Chile 2009; 137:1145-52).

Tratamiento con insulina aspártica bifásica en pacientes con diabetes en mal control metabólico: Experiencia clínica programada / Biphasic insulin aspart for the management of diabetic patients with unsatisfactory metabolic control

Background: Biophasic insulin aspart (InAsBi) is a mixture of 30 percent of rapid acting soluble aspart insulin and 70 percent aspart insulin retarded with protamine. The soluble portion reduces postprandial serum glucose rises and the retarded portion reduces basal glucose levels. Aim: To assess the efficacy of biphasic insulin aspart in diabetics with a bad metabolic control. Material and methods: Multicentríc study that included diabetic patients with a glycosilated hemoglobin over 7 percent that were transferred to treatment with InAsBi, given in one to three daily doses, according to glycemic control and followed for 12 weeks. At the end of follow up, glycosilated hemoglobin levels (HbA1c) were measured again. Results: One hundred ninety six patients were enrolled and 154, age 59± 12 (84 females), completed the follow up. HbA 1 c levels decreased in at íeast 1 percent in 96 and increased in eight cases. In the total group HbA1c decreased from 10.1± 1.7 to 8.4±1.4 percent (p <0.01). Those with higher initial values and with oral therapy, had the greatest reductions. At the end of the observation period, 29 patients received one daily dose of InAsBi, 114 two doses and 11 three doses. Two patients had allergy, one systemic and one in the injection site. Conclusions: In this group of diabetic patients with a bad metabolic control, the use of InAsBi was associated with a significant reduction of glycosilated hemoglobin levels.

Diabetes mellitus: ¿subdiagnosticada o sobrediagnosticada? / Diabetes mellitus: underdiagnosed or overdiagnosed?

De los grandes tipos de DM, la de tipo 1, de comienzo agudo y muy sintomática debe ser siempre sospechada y confirmada por el laboratorio; la de tipo 2 poco sintomática, es generalmente un hallazgo en exámenes de rutina. La intolerancia a la glucosa no es una patología en si misma, sino un estado intermedio entre la normalidad y la diabetes clínica. Actualmente se reconocen dos tipos de intolerancia a la glucosa, la llamada de ayunas y la post carga de glucosa a las 2 horas. Ambas asintomáticas, se diagnostican por exámenes de laboratorio. Los individuos normales presentan glicemias de ayunas menor de 100 mg/dl; los intolerantes a la glucosa de ayunas, mayor de 100 mg/dl pero menor de 126 mg/dl. Los intolerantes a la glucosa de post carga registran valores entre 140 mg/dl y 200 mg/dl. Los diabéticos en ayunas tienen cifras de 126 mg/dl o más y a las 2 horas mayor de 200 mg/dl. Todos estos exámenes deben repetirse en más de una oportunidad.

[Biphasic insulin aspart for the management of diabetic patients with unsatisfactory metabolic control]. / Tratamiento con insulina aspártica bifásica en pacientes con diabetes en mal control metabólico: experiencia clínica programada.

BACKGROUND: Biophasic insulin aspart (InAsBi) is a mixture of 30% of rapid acting soluble aspart insulin and 70% aspart insulin retarded with protamine. The soluble portion reduces postprandial serum glucose rises and the retarded portion reduces basal glucose levels. AIM: To assess the efficacy of biphasic insulin aspart in diabetics with a bad metabolic control. MATERIAL AND METHODS: Multicentríc study that included diabetic patients with a glycosilated hemoglobin over 7% that were transferred to treatment with InAsBi, given in one to three daily doses, according to glycemic control and followed for 12 weeks. At the end of follow up, glycosilated hemoglobin levels (HbA1c) were measured again. RESULTS: One hundred ninety six patients were enrolled and 154, age 59+/- 12 (84 females), completed the follow up. HbA 1 c levels decreased in at least 1% in 96 and increased in eight cases. In the total group HbA1c decreased from 10.1+/- 1.7 to 8.4+/-1.4% (p <0.01). Those with higher initial values and with oral therapy, had the greatest reductions. At the end of the observation period, 29 patients received one daily dose of InAsBi, 114 two doses and 11 three doses. Two patients had allergy, one systemic and one in the injection site. CONCLUSIONS: In this group of diabetic patients with a bad metabolic control, the use of InAsBi was associated with a significant reduction of glycosilated hemoglobin levels.

[Asymptomatic bacteriuria in type 2 diabetics women ]. / Bacteriología urinaria asintomática en mujeres diabéticas tipo 2.

BACKGROUND: Urinary tract infection (UTI) is frequent among diabetics, especially women. It may be preceded by asymptomatic bacteriuria. AIM: To study the frequency of asymptomatic bacteriuria in type 2 diabetic women. PATIENTS AND METHODS: Fifty women with type 2 diabetes and 50 non diabetic women were studied. In aseptic conditions, morning midstream urine specimens were obtained for microbiological analysis. The test was repeated in similar conditions during consecutive days. Urine samples were cultured in blood agar, Mac Conkey agar and CPS ID 2. Colony forming units were counted. Asymptomatic bacteriuria was defined as the presence of 100,000 or more colony forming units per ml. Leukocyturia was also quantified. RESULTS: There was microbial growth in 40% of samples from diabetic women and 6% of samples from controls (p < 0.01). Asymptomatic bacteriuria was present in 32% of diabetics and 4% of controls (p < 0.01). E Coli was the most frequently isolated strain, in 55% of patients and 100% of controls. Klebsiella pneumoniae was isolated in 10% of diabetics, coagulase negative Staphylococcus in 10%, Enterococcus spp in 10% and Pseudomonas aeruginosa in 5%. Leukocyturia of more than 10 cells per field, was present in 80% of diabetic women with positive culture. Women with positive cultures had a longer lasting diabetes than those with negative cultures. There was no association between urine microbiological results and glycosilated hemoglobin, fasting blood glucose, chronic complications of diabetes and treatment received. CONCLUSIONS: This study shows a high prevalence of asymptomatic bacteriuria among diabetic women.

Respuestas glicémicas e insulinémicas a una fórmula líquida polimérica en diabéticos no insulino dependientes / Glycemic and insulinemic response to a polymeric liquid formula in non insulin dependent diabetic patient

Se ha publicado que las fórmulas clásicas de alimentación enteral pueden provocar hiperglicemia. Objetivo: estudiar en diabéticos las respuestas glicémicas e insulinémicas de una fórmula enteral diseñada para estos pacientes (GLUCERNA). Material y método: el estudio se realizó en 11 diabéticos no insulino dependientes, 10 mujeres, 1 hombre, edad promedio 56,5 años, evolución 9,7 años, IMC= 27 kg/m2 (20-32), sin patologías renales, digestivas o cardiovasculares. En forma aleatoria se dio a ingerir 68 g de carbohidratos, aportados por la fórmula Glucerna o Ensure. Se midió glicemia e insulinemia, basal y post-ingesta a los 30, 60, 90 y 120 min. Dos días después se repitió la prueba con la otra fórmula. Se interrogó respecto a aceptabilidad y tolerancia de los productos. Las glicemias se determinaron por glucosaoxidasa y las insulinemias por ELISA. El análisis estadístico se hizo con Anova. Resultados: en la prueba con Glucerna, los niveles de glicemia (MA ñ DS) fueron 136ñ50, 138ñ45, 134ñ40, 143ñ49 y 146ñ55 mg/d; y los de insulinemia 19ñ10, 36ñ19, 37ñ17, 37ñ14, y 40ñ24 uU/mL. Con Ensure las glicemias fueron 117ñ28, 162ñ44, 171ñ56, 191ñ71 y 193ñ71 mg/dL; las insulinemias 21ñ11, 53ñ38, 66ñ34, 67ñ37 y 60 38 uU/mL. Para las dos variables se encontró una respuesta mayor con Ensure en toda la prueba, p<0,05 (minuto 60 y 90). Cuociente de insulinemia/glicemia con glucerna: 0,12ñ0,06, 0,20ñ0,11, 0,23ñ0,11, 0,23ñ0,08 y 0,24ñ0,17; con Ensure: 0,19ñ0,12, 0,22ñ0,09, 0,29ñ0,10, 0,27ñ0,15 y 0,22ñ0,22ñ0,10 (NS entre las fórmulas). La aceptabilidad fue buena para las dos fórmulas. Conclusión: con Glucerna se observó menor respuesta glicémica e insulinémica que con Ensure, fórmula clásica; su aceptabilidad y tolerancia fue buena, su uso sería recomendable en la asistencia nutricional de los diabéticos

Frecuencia de diabetes gestacional en embarazadas en riesgo diabético de Santiago, Chile / Frequency of gestational diabetes in women at risk for diabetes in Santiago, Chile

Frecuencia de diabetes gestacional en embarazadas en riesgo diabético de Santiago, Chile

Frecuencia de diabetes gestacional en embarazadas en riesgo diabetico de Santiago, Chile / Frequency of gestational diabetes in women at risk for diabetes in Santiago, Chile

Frecuencia de diabetes gestacional en embarazadas en riesgo diabetico de Santiago, Chile

Aspartame: un nuevo edulcorante / Aspartame: a new sweetener

El Aspartame es un potente edulcorante producido en forma sintética a partir del ácido aspártico y de la fenilanina. Es considerado como un edulcorante no calórico, por las pequeñas cantidades que se utilizan para obtener el sabor dulce deseado. El Aspartame es hidrolizado en el lumen intestinal y en las vellosidades de la mucosa y absorbido al estado de aspartato, fenilanina y metanol y también como el dipéptido aspartil-fenilanina. El edulcorante y los productos de su degradación no han demostrado toxicidad en el ser humano, aún a dosis muy superiores a las habitualmente empleadas. Sin embargo, no es recomendable el uso de Aspartame en niños portadores de fenilquetonuria, por las elevadas concentraciones sanguíneas de feneilanina que en ellos se puede alcanzar. El Aspartame puede ser consumido en forma segura por individuos obesos y pacientes diabéticos, por cuanto no modifica los niveles glicémicos, insulinémicos, glucagonémicos, ni interfiere con la hemoglobina glicosilada. Su uso está practicamente libre de efectos colaterales adverso