Delphi-based recommendations for the management of cardiovascular comorbidities in patients with psoriatic arthritis and moderate-to-severe psoriasis.

The aim of this study was to generate practical recommendations to assist rheumatologists and dermatologists in the management of cardiovascular (CV) comorbidities in patients with moderate-to-severe psoriasis (MS-PSO) and psoriatic arthritis (PsA). A two-round Delphi study was conducted. A panel of experts rated their agreement with a set of statements (n = 52) on a nine-point Likert scale (1 = totally disagree; 9 = totally agree). Statements were classified as inappropriate (median 1-3), irrelevant (median 4-6) or appropriate (median 7-9). Consensus was established when at least two-thirds of the panel responded with a score within any one range. A total of 25 experts, 60% rheumatologists and 40% dermatologists, participated in two consultation rounds. There was overall unanimity on the appropriateness of an initial assessment for CV risk factors in all patients with MS-PSO and PsA. Most panelists (88.0%) also supported the evaluation of patients' psychological and physical status. Additionally, most panelists (72.2%) agreed on a novel sequential approach for the management of CV comorbidities. This sequence starts with the assessment of hypertension, diabetes and dyslipidemia along with the identification of depression and anxiety disorders. Once these factors are under control, smoking cessation programs might be initiated. Finally, if patients have not met weight loss goals with lifestyle modifications, they should receive specialized treatment for obesity. This study has drawn up a set of practical recommendations that will facilitate the management of CV comorbidities in patients with MS-PSO and PsA.

GLP-1 Receptor Agonists and Diabetic Kidney Disease: A Call of Attention to Nephrologists.

Type 2 diabetes mellitus (T2DM) represents the main cause of chronic kidney disease (CKD) and end-stage renal disease (ESKD), and diabetic kidney disease (DKD) is a major cause of morbidity and mortality in diabetes. Despite advances in the nephroprotective treatment of T2DM, DKD remains the most common complication, driving the need for renal replacement therapies (RRT) worldwide, and its incidence is increasing. Until recently, prevention of DKD progression was based around strict blood pressure (BP) control, using renin-angiotensin system blockers that simultaneously reduce BP and proteinuria, adequate glycemic control and control of cardiovascular risk factors. Glucagon-like peptide-1 receptor agonists (GLP-1RA) are a new class of anti-hyperglycemic drugs shown to improve cardiovascular and renal events in DKD. In this regard, GLP-1RA offer the potential for adequate glycemic control in multiple stages of DKD without an increased risk of hypoglycemia, preventing the onset of macroalbuminuria and slowing the decline of glomerular filtration rate (GFR) in diabetic patients, also bringing additional benefit in weight reduction, cardiovascular and other kidney outcomes. Results from ongoing trials are pending to assess the impact of GLP-1RA treatments on primary kidney endpoints in DKD.

Assessing the cost-effectiveness of a once-weekly GLP-1 analogue versus an SGLT-2 inhibitor in the Spanish setting: Once-weekly semaglutide versus empagliflozin.

Aims: Controlling costs while maximizing healthcare gains is the predominant challenge for healthcare providers, and therefore cost-effectiveness analysis is playing an ever-increasing role in healthcare decision making. The aim of the present analysis was to assess the long-term cost-effectiveness of subcutaneous once-weekly semaglutide (0.5 mg and 1 mg) versus empagliflozin (10 mg and 25 mg) in the Spanish setting for the treatment of patients with type 2 diabetes (T2D) with inadequate glycemic control on oral anti-hyperglycemic medications.Material and methods: The IQVIA CORE Diabetes Model was used to project outcomes over patient lifetimes with once-weekly semaglutide versus empagliflozin, with treatment effects based on a network meta-analysis. The analysis captured treatment costs, costs of diabetes-related complications, and the impact of complications on quality of life, based on published sources. Outcomes were discounted at 3.0% per annum.Results: Once-weekly semaglutide 0.5 mg and 1 mg were associated with improvements in discounted quality-adjusted life expectancy of 0.12 and 0.15 quality-adjusted life years (QALYs), respectively, versus empagliflozin 10 mg and improvements of 0.11 and 0.14 QALYs, respectively, versus empagliflozin 25 mg. Treatment costs were higher with once-weekly semaglutide compared with empagliflozin, but this was partially offset by cost savings due to avoidance of diabetes-related complications. Once-weekly semaglutide 0.5 mg and 1 mg were associated with incremental cost-effectiveness ratios of EUR 2,285 and EUR 161 per QALY gained, respectively, versus empagliflozin 10 mg, and EUR 3,090 and EUR 625 per QALY gained, respectively, versus empagliflozin 25 mg.Conclusions: Based on a willingness-to-pay threshold of EUR 30,000 per QALY gained, once-weekly semaglutide 0.5 mg and 1 mg were projected to be cost-effective versus empagliflozin 10 mg and 25 mg for the treatment of patients with T2D with inadequate glycemic control on oral anti-hyperglycemic medications in the Spanish setting, irrespective of patients' BMI at baseline.

Real-world clinical outcomes and predictors of glycaemic and weight response to exenatide once weekly in patients with type 2 diabetes: The CIBELES project.

AIMS: To evaluate in a real-world setting the effectiveness of exenatide once-weekly (ExQW) in patients with T2D and to determine predictors of glycaemic and weight response to this drug at 6 months. METHODS: Observational, retrospective, multicenter study in adult patients with T2D and BMI ≥30 kg/m2 from 4 tertiary Spanish hospitals who started ExQW therapy at least 6 months before the inclusion and had not achieved adequate glycaemic control on oral therapies or other GLP-1 receptor agonists. Glycaemic response was defined as an A1C reduction ≥1.0% and weight response as a weight loss ≥3% 6 months after ExQW. The best predictive models of glycaemic and weight response were estimated by binary logistic regression. RESULTS: One hundred and forty eight patients were included, mean age 58.0 years, A1C 7.7%, weight 105.9 kg and BMI 38.4 kg/m2 . A1C (-1.1%), weight (-3.9 kg), systolic blood pressure (-4.0 mm Hg), diastolic blood pressure (-2.9 mm Hg), LDL-cholesterol (-14.2 mg/dL) and triglycerides (-31.0 mg/dL) significantly decreased 6 months after ExQW. 41.5% of patients had an A1C reduction ≥1.0% and 53.1% lost ≥3% of baseline weight. Glycaemic and weight reductions were sustained in patients completing 1 and 2 years of follow-up. The best predictive model of glycaemic response only included higher A1C levels (OR 3.9), whereas higher BMI (OR 1.1) and prior DPP-4i therapy (OR 3.1) were associated to weight response in the multivariate analysis. CONCLUSIONS: In a real-world setting, ExQW significantly decreased A1C, weight, blood pressure and lipids at 6 months. Our study identified higher baseline A1C as the sole independent predictor of glycaemic response to ExQW and higher BMI and previous DDP4i treatment as predictive factors of meaningful weight response.

Mi experiencia con liraglutida en pacientes con diabetes mellitus de tipo 2 frente a otros agonistas del receptor del GLP-1 / My experience with liraglutide vs. other GLP-1 receptor agonists in patients with DM2

Liraglutida es un agonista del receptor del péptido similar al glucagón de tipo 1 (ARGLP-1) aprobado para el tratamiento de la diabetes mellitus de tipo 2 (DM2), que mejora el control glucémico con bajo riesgo de hipoglucemias, reducción del peso corporal, un efecto favorable sobre otros factores de riesgo cardiovascular y un potencial efecto protector sobre la función de la célula b. En este artículo se revisan los ensayos clínicos comparativos directos con otros ARGLP-1, en los cuales liraglutida ha mostrado superioridad o no inferioridad en el descenso de HbA1c y un efecto similar o superior en términos de reducción del peso, con un buen perfil de seguridad. Además, se presentan varios estudios del autor con liraglutida en la vida real que corroboran los resultados de los ensayos clínicos y amplían el espectro de posibilidades de indicación, como la nefroprotección o el tratamiento de la DM2 tras cirugía bariátrica

Liraglutide is a GLP-1 receptor agonist (GLP-1-RA) approved for the treatment of type 2 diabetes mellitus (T2DM), which improves glycemic control with a low risk of hypoglycaemia, aids weight reduction, and has a favourable effect on other cardiovascular risk factors and a potential protective effect on beta cell function. This article reviews head-to-head comparisons with other GLP-1-RAs. In those trials, liraglutide has been shown to be superior or non-inferior in reducing HbA1c and to have a similar or greater effect in terms of weight reduction, with a good safety profile. In addition, several real-life studies with liraglutide undertaken by the author of this article are presented which corroborate the results of clinical trials and broaden the spectrum of possibilities of indication, such as renal protection or management of type 2 diabetes after bariatric surgery

Importancia del peso en el control del paciente con diabetes mellitus tipo 2: hacia una visión adipocéntrica del abordaje de la diabetes / Relevance of weight in the management of patients with type 2 diabetes mellitus: towards an adipocentric approach to diabetes

En las últimas décadas se ha producido en el mundo un incremento paralelo en la prevalencia de obesidad y diabetes mellitus tipo 2, dato no sorprendente si tenemos en cuenta que el aumento de grasa visceral es el principal factor de riesgo para el desarrollo de diabetes mellitus tipo 2 en individuos genéticamente predispuestos. La intervención centrada en el control intensivo de la glucemia en la diabetes mellitus tipo 2 con los tratamientos clásicos aumenta el riesgo de ganancia de peso y aparición de hipoglucemias. Por el contrario, la pérdida de peso mediante cambios en el estilo de vida, fármacos y/o cirugía mejora simultáneamente la mayoríade factores de riesgo cardiovascular, incluida la hiperglucemia. La intervención intensiva sobre el estilo de vida induce un beneficio global en el paciente con diabetes mellitus tipo 2, pero la pérdida ponderal a largo plazo es modesta y no ha demostrado reducir la morbimortalidad cardiovascular. La aparición de nuevos grupos terapéuticos para la diabetes mellitus tipo 2 o la obesidad, que consiguen mejorar simultáneamente la HbA1c, el peso y otros factores de riesgo cardiovascular sin producir hipoglucemias, representa un salto cualitativo en el manejo de los pacientes con diabesidad. Un inhibidor del cotransportador sodio-glucosa tipo 2 y un agonista del receptor de GLP1 recientemente han demostrado reducir la mortalidad cardiovascular y total en la diabetes mellitus tipo 2 con enfermedad cardiovascular. Además, la cirugía bariátrica ha mostrado una rápida remisión de la diabetes mellitus tipo 2 en un gran porcentaje de pacientes y reduce la mortalidad específica para diabetes. La aparición de nuevos tratamientos plantea la posibilidad de cambiar la estrategia terapéutica glucocéntrica actual por una estrategia adipocéntrica (AU)

In recent decades, there has been a worldwide parallel increase in the prevalence of obesity and type 2 diabetes mellitus (T2DM), which is not surprising, given that increased visceral fat is the main risk factor for the development of T2DM in genetically predisposed individuals. An intervention focused on intensive blood glucose control in T2DM with classic drugs increases the risk of weight gain and the rate of hypoglycaemia. In contrast, weight loss through lifestyle changes, drugs and/or surgery simultaneously improves most cardiovascular (CV) risk factors, including hyperglycemia. Intensive intervention on lifestyle induces an overall benefit in patients with T2DM, but long-term weight loss is modest and has not been shown to reduce CV morbidity and mortality. The emergence of new therapeutic classes for T2DM and obesity, which simultaneously improve HbA1c, weight and other CV risk factors without inducing hypoglycaemia, represents a major change in the management of patients with diabesity. A sodium-glucose cotransporter-2 inhibitor and a GLP-1 receptor agonist have recently been shown to decrease CV and total mortality in type 2 diabetic patients with CV disease. Furthermore, bariatric surgery rapidly inducesremission or improvement of T2DM in a large percentage of patients and reduces diabetes-relatedmortality. The emergence of new therapies raises the possibility of changing the current glucose-centred therapeutic strategy for a weight-centred approach (AU)

Relevance of weight in the management of patients with type 2 diabetes mellitus: towards an adipocentric approach to diabetes. / Importancia del peso en el control del paciente con diabetes mellitus tipo 2: hacia una visión adipocéntrica del abordaje de la diabetes.

In recent decades, there has been a worldwide parallel increase in the prevalence of obesity and type 2 diabetes mellitus (T2DM), which is not surprising, given that increased visceral fat is the main risk factor for the development of T2DM in genetically predisposed individuals. An intervention focused on intensive blood glucose control in T2DM with classic drugs increases the risk of weight gain and the rate of hypoglycaemia. In contrast, weight loss through lifestyle changes, drugs and/or surgery simultaneously improves most cardiovascular (CV) risk factors, including hyperglycemia. Intensive intervention on lifestyle induces an overall benefit in patients with T2DM, but long-term weight loss is modest and has not been shown to reduce CV morbidity and mortality. The emergence of new therapeutic classes for T2DM and obesity, which simultaneously improve HbA1c, weight and other CV risk factors without inducing hypoglycaemia, represents a major change in the management of patients with diabesity. A sodium-glucose cotransporter-2 inhibitor and a GLP-1 receptor agonist have recently been shown to decrease CV and total mortality in type 2 diabetic patients with CV disease. Furthermore, bariatric surgery rapidly induces remission or improvement of T2DM in a large percentage of patients and reduces diabetes-related mortality. The emergence of new therapies raises the possibility of changing the current glucose-centred therapeutic strategy for a weight-centred approach.

Documento de posicionamiento: evaluación y manejo de la hipoglucemia en el paciente concon diabetes mellitus. Grupo de Trabajo de Diabetes Mellitus de la Sociedad Española de Endocrinología y Nutrición / Position statement: Hypoglycemia management in patients with diabetes mellitus. Diabetes Mellitus Working Group of the Spanish Society of Endocrinology and Nutrition

Objetivo Proporcionar unas recomendaciones prácticas para la evaluación y el manejo de la hipoglucemia en pacientes con diabetes mellitus. Participantes Miembros del Grupo de Trabajo de Diabetes Mellitus de la Sociedad Española de Endocrinología y Nutrición (SEEN).Métodos Las recomendaciones se formularon de acuerdo al sistema Grading of Recommendations, Assessment, Development, and Evaluation para establecer tanto la fuerza de las recomendaciones como el grado de evidencia. Se realizó una búsqueda sistemática en MEDLINE (PubMed) de la evidencia disponible para cada tema, y se revisaron artículos escritos en inglés y castellano con fecha de inclusión hasta el 15 de febrero de 2013. Para las recomendaciones acerca del uso de fármacos, se consideraron tratamientos aprobados por la Agencia Europea de Medicamentos con esa misma fecha. Tras la formulación de las recomendaciones estas se discutieron conjuntamente por el Grupo de trabajo. Conclusiones El documento establece unas recomendaciones prácticas basadas en la evidencia acerca de la evaluación y manejo de la hipoglucemia en pacientes con diabetes mellitus (AU)

Objective To provide practical recommendations for evaluation and management of hypoglycemia in patients with diabetes mellitus. Participants Members of the Diabetes Mellitus Working Group of the Spanish Society of Endocrinology and Nutrition. Methods Recommendations were formulated according to the Grading of Recommendations, Assessment, Development, and Evaluation system to describe both the strength of recommendations and the quality of evidence. A systematic search was made in MEDLINE (PubMed). Papers in English and Spanish with publication date before 15 February 2013 were included. For recommendations about drugs only those approved by the European Medicines Agency were included. After formulation of recommendations, they were discussed by the Working Group. Conclusions The document provides evidence-based practical recommendations for evaluation and management of hypoglycemia in patients with diabetes mellitus (AU)

¿A quién y cuándo plantear el tratamiento con liraglutida? / Liraglutide therapy: when and in whom?

Liraglutida es un agonista del receptor de GLP-1 aprobado para el tratamiento de la diabetes mellitus tipo 2 (DM2), que mejora el control glucémico con bajo riesgo de hipoglucemias, reduce el peso corporal, mejora otros factores de riesgo cardiovascular y presenta un potencial efecto protector sobre la función de la célula beta. Todo ello pudiera traducirse a largo plazo en una reducción de las complicaciones propias de esta enfermedad. Estas ventajas sitúan a liraglutida como opción preferente de tratamiento tras fracaso de monoterapia frente a otros fármacos disponibles en la actualidad, dado que la probabilidad de conseguir un objetivo compuesto de HbA1c < 7%, sin hipoglucemias y sin ganancia ponderal es significativamente superior a la de sus comparadores. En la actualidad, liraglutida está aprobada para alcanzar el control glucémico en adultos con DM2, en combinación dual con metformina o una sulfonilurea, o en combinación triple con metformina más sulfonilurea o metformina más tiazolidindiona. El fármaco ha mostrado mayores beneficios en diabéticos con una corta evolución de la enfermedad, que presentan obesidad, síndrome metabólico y/u otras comorbilidades que pudieran mejorar con la pérdida de peso (AU)

Liraglutide is a GLP-1 receptor agonist approved for the treatment of type 2 diabetes mellitus. This drug improves glycemic control with a low risk of hypoglycemias, reduces body weight, improves other cardiovascular risk factors and has a potential protective effect on beta cell function. In the long term, these effects could translate into a reduction in the complications of this disease. These advantages make liraglutide the preferred treatment option after failure of mono-therapy compared with other currently available drugs, given that its probability of achieving a composite outcome of HbA1c<7% with no hypoglycemia and no weight gain is significantly higher than that of its comparators. Currently, liraglutide is approved in adults with type 2 diabetes not achieving glucose control, in dual combination therapy with metformin or a sulfonylurea, or in triple combination with metformin plus sulfonylurea, or metformin plus thiazolidinedione. The benefits of this drug are greater in patients with recent onset of the disease, with obesity, metabolic syndrome and/or other comorbidities that could improve with weight loss (AU)

Position statement: hypoglycemia management in patients with diabetes mellitus. Diabetes Mellitus Working Group of the Spanish Society of Endocrinology and Nutrition.

OBJECTIVE: To provide practical recommendations for evaluation and management of hypoglycemia in patients with diabetes mellitus. PARTICIPANTS: Members of the Diabetes Mellitus Working Group of the Spanish Society of Endocrinology and Nutrition. METHODS: Recommendations were formulated according to the Grading of Recommendations, Assessment, Development, and Evaluation system to describe both the strength of recommendations and the quality of evidence. A systematic search was made in MEDLINE (PubMed). Papers in English and Spanish with publication date before 15 February 2013 were included. For recommendations about drugs only those approved by the European Medicines Agency were included. After formulation of recommendations, they were discussed by the Working Group. CONCLUSIONS: The document provides evidence-based practical recommendations for evaluation and management of hypoglycemia in patients with diabetes mellitus.

Estudio de cohorte retrospectivo de pacientes diagnosticados de cáncer de tiroides del área suroeste de Madrid. Factores pronósticos en el cáncer diferenciado de tiroides / No disponible

Objetivos Análisis de las características clínicas e histopatológicas de los pacientes con cáncer de tiroides en el área suroeste de Madrid e identificación de los factores de mal pronóstico en el subgrupo de carcinoma diferenciado de tiroides (CDT) del epitelio folicular. Pacientes y métodos .Estudio retrospectivo de una cohorte de cáncer de tiroides de nuestro hospital entre 1998-2009. Las variables clínicas, quirúrgicas e histopatológicas significativas se incluyeron en modelos de regresión de Cox y logística para la identificación de factores pronósticos de muerte, recidiva y persistencia de enfermedad. Resultados Se incluyeron 150 pacientes con mediana de edad 49 años y mediana de seguimiento de 5,4 años. Los subtipos histológicos fueron: carcinoma papilar (86%), carcinoma folicular (6,6%), carcinoma medular (4%), carcinoma pobremente diferenciado (2,7%) y carcinoma anaplásico (0,7%).Al final del estudio: 68% curación, 3,3% muertos (mortalidad por cáncer tiroideo 1,3%), 1,3% pérdida de seguimiento, 6,7% con enfermedad bioquímica persistente, 2,7% con enfermedad clínica persistente y 18% pendiente de evaluación. El mejor modelo pronóstico para recidiva de CDT fue el estadiaje TNM (estadio ii-iv frente a i: HR 5,9, 95% IC 1,3-26,6) y para persistencia de enfermedad o muerte el estadiaje clínico de la ETA (alto riesgo frente a bajo/muy bajo riesgo: OR 9,2, 95% IC 2,6-33,2)Conclusiones En nuestro estudio la mortalidad y persistencia clínica de enfermedad fueron bajas. La clasificación de pacientes con CDT según estadiaje de la ETA fue un buen factor predictor de enfermedad persistente o muerte (AU)

Objectives To analyze the clinical and histopathological features of patients with thyroid cancer in the southwest Madrid area and to identify poor prognostic factors in the subgroup with differentiated thyroid carcinoma (DTC) of the follicular epitelium. Patients and methods A retrospective cohort study of patients diagnosed with thyroid cancer at our hospital from 1998 to 2009. Significant clinical, surgical, and histopathological variables were included in Cox proportional hazard and logistic regression models to identify baseline factors predicting for death, recurrence, and persistent disease in DTC. Results A total of 150 patients with a median age of 49 years and a median follow-up of 5.4 years were enrolled. Histological subtypes were: papillary carcinoma (86%), follicular carcinoma (6.6%), medullary carcinoma (4%), poorly differentiated carcinoma (2.7%), and anaplastic carcinoma (0.7%). At the end of the study, 68% of patients were cured, 3.3% had died (disease-specific mortality, 1.3%), 1.3% were lost to follow-up, 6.7% had persistent biochemical disease, and 2.7% persistent clinical disease, while 18% of patients were pending assessment. The best prognostic model for DTC recurrence was TNM staging (stage II-IV vs. I: HR 5.9, 95% CI 1.3-26.6), while the best model for persistent disease or death was ETA clinical staging (high risk vs. low or very low risk: OR 9.2, 95% CI 2.6-33.2).Conclusions In our study, disease-specific mortality and persistent clinical disease were low. Classification of DTC patients based on ETA staging after initial treatment was a good predictor of persistent disease or death (AU)

[A retrospective cohort study of patients diagnosed of thyroid cancer in the southwest Madrid area. Predictive factors in differentiated thyroid cancer]. / Estudio de cohorte retrospectivo de pacientes diagnosticados de cáncer de tiroides del área suroeste de Madrid. Factores pronósticos en el cáncer diferenciado de tiroides.

OBJECTIVES: To analyze the clinical and histopathological features of patients with thyroid cancer in the southwest Madrid area and to identify poor prognostic factors in the subgroup with differentiated thyroid carcinoma (DTC) of the follicular epitelium. PATIENTS AND METHODS: A retrospective cohort study of patients diagnosed with thyroid cancer at our hospital from 1998 to 2009. Significant clinical, surgical, and histopathological variables were included in Cox proportional hazard and logistic regression models to identify baseline factors predicting for death, recurrence, and persistent disease in DTC. RESULTS: A total of 150 patients with a median age of 49 years and a median follow-up of 5.4 years were enrolled. Histological subtypes were: papillary carcinoma (86%), follicular carcinoma (6.6%), medullary carcinoma (4%), poorly differentiated carcinoma (2.7%), and anaplastic carcinoma (0.7%). At the end of the study, 68% of patients were cured, 3.3% had died (disease-specific mortality, 1.3%), 1.3% were lost to follow-up, 6.7% had persistent biochemical disease, and 2.7% persistent clinical disease, while 18% of patients were pending assessment. The best prognostic model for DTC recurrence was TNM staging (stage II-IV vs. I: HR 5.9, 95% CI 1.3-26.6), while the best model for persistent disease or death was ETA clinical staging (high risk vs. low or very low risk: OR 9.2, 95% CI 2.6-33.2). CONCLUSIONS: In our study, disease-specific mortality and persistent clinical disease were low. Classification of DTC patients based on ETA staging after initial treatment was a good predictor of persistent disease or death.

Glucocentrismo o adipocentrismo: una visión crítica de los consensos y guías clínicas para el tratamiento de la diabetes mellitus tipo 2 / Glucocentricity or adipocentricity: A critical view of consensus and clinical guidelines for the treatment of type 2 diabetes mellitus

El 80% de los pacientes con diabetes mellitus tipo 2 (DM2) tienen sobrepeso u obesidad, lo que se asocia a su vez con otros factores de riesgo cardiovascular y con un riesgo aumentado de cáncer. Los grandes estudios de intervención centrados en el control intensivo de la glucemia no han logrado demostrar una reducción de eventos cardiovasculares en pacientes diabéticos tipo 2. Los dos principales problemas observados en estos estudios son la ganancia de peso y la aparición de hipoglucemias graves en las ramas de intervención intensiva, lo que podría haber mitigado el potencial efecto favorable del control glucémico. Por el contrario, la pérdida de peso en pacientes diabéticos mediante cambios en el estilo de vida, fármacos y/o cirugía mejora simultáneamente todos los factores de riesgo cardiovascular, incluida la hiperglucemia. La cirugía bariátrica ha mostrado una rápida resolución de la DM2 en un gran porcentaje de pacientes y reduce la mortalidad específica para diabetes. A pesar de ello, todos los consensos y recomendaciones para el tratamiento de la DM2 centran la toma de decisiones en el nivel de hemoglobina glucosilada. Este artículo pretende abrir un debate sobre la necesidad de sustituir la estrategia terapéutica glucocéntrica por una estrategia adipocéntrica (AU)

Abstract Eighty percent of patients with type 2 diabetes mellitus (T2DM) are overweight or obese, which in turn is associated with other cardiovascular risk factors and an increased risk of cancer. Large intervention studies that focused on intensive glycemic control have failed to show a reduction of cardiovascular events in T2DM patients. The two major concerns in these studies were weight gain and severe hypoglycemia in the arms of intensive intervention, which could have mitigated the potential beneficial effect of glycemic control. On the contrary, weight loss in diabetic patients through changes in lifestyle, drugs and/or surgery simultaneously improves all cardiovascular risk factors including hyperglycemia. Bariatric surgery has shown an early resolution of T2DM in a large percentage of patients and a decrease of diabetes-specific mortality. Despite this, all consensus and recommendations for the treatment of T2DM focus their decisions on the glycated hemoglobin value. This article aims to open a debate on the need to replace the glucose-centered therapeutic strategy for a weight-centered strategy (AU)

[Glucocentricity or adipocentricity: a critical view of consensus and clinical guidelines for the treatment of type 2 diabetes mellitus]. / Glucocentrismo o adipocentrismo: una visión crítica de los consensos y guías clínicas para el tratamiento de la diabetes mellitus tipo 2.

Eighty percent of patients with type 2 diabetes mellitus (T2DM) are overweight or obese, which in turn is associated with other cardiovascular risk factors and an increased risk of cancer. Large intervention studies focused on intensive glycemic control have failed to show a reduction of cardiovascular events in T2DM patients. The two major concerns in these studies were weight gain and severe hypoglycemia in the arms of intensive intervention, which could have mitigated the potential beneficial effect of glycemic control. On the contrary, weight loss in diabetic patients through changes in lifestyle, drugs and/or surgery simultaneously improves all cardiovascular risk factors including hyperglycemia. Bariatric surgery has shown an early resolution of T2DM in a large percentage of patients and a decrease of diabetes-specific mortality. Despite this, all consensus and recommendations for the treatment of T2DM focus their decisions on the glycated hemoglobin value. This article aims to open a debate on the need to replace the glucose-centered therapeutic strategy for a weight-centered strategy.

Evolución de alteraciones psicopatológicas en pacientes con obesidad mórbida tras cirugía bariátrica / Evolution of psychopathologycal alterations in patients with morbid obesity after bariatric surgery

Fundamento y objetivo: Los objetivos del presente estudio son conocer la prevalencia de las alteraciones psicopatológicas de los pacientes con obesidad mórbida (OM) y los criterios de cirugía bariátrica atendidos en este centro, analizar el valor pronóstico de estas alteraciones en los resultados de la cirugía y estudiar su evolución tras alcanzar la estabilización ponderal. Pacientes y método: Se incluyó en el estudio un total de 145 pacientes del Hospital Universitario Fundación Alcorcón (122 mujeres) candidatos a cirugía bariátrica (108 finalmente intervenidos). Se realizó una entrevista clínica y se aplicaron varias escalas de psicopatología precirugía y poscirugía: BDI (Beck Depression Inventory escala de depresión de Beck ), BAI (Beck anxiety inventory escala de ansiedad de Beck ), MOCI (Maudsley Obsessional-Compulsive Inventory inventario de obsesiones-compulsiones de Maudsley ), BIS (Barratt Impulsiveness Scale escala de impulsividad de Barrat ), EDI (Eating Disorders Inventory inventario de trastornos de la alimentación ), EAT (Eating Attitudes Test test de actitudes hacia la comida ), BITE (Bulimic Investigatory Test Edimburgh test de bulimia de Edimburgo ) y BSQ (Body Shape Questionnaire cuestionario sobre la figura corporal ). Se realizó una comparación de muestras emparejadas entre las puntuaciones iniciales y finales de las pruebas psicométricas y se llevó a cabo un análisis de regresión logística para valorar las variables predictivas de evolución positiva de la cirugía, definida como porcentaje de sobrepeso perdido superior al 50% e índice de masa corporal final inferior a 35kg/m2. Resultados: Se observó una mejoría en la puntuación de la BDI, la BAI y en las subescalas del EDI: EDI-DT (drive for thinness impulso a la delgadez ) y EDI-BD (body dissatisfaction insatisfacción corporal ). Para el resto de las pruebas psicométricas las diferencias no fueron estadísticamente significativas (AU)

Background and objective: The aims of this study were to know the prevalence of the psychopathological alterations among patients with morbid obesity (MO) candidates for bariatric surgery in our centre, to analyze its predictive value on the surgical outcome and to study the evolution after weight stabilization was achieved. Patients and methods: One hundred and forty five patients of the University Hospital Foundation Alcorcón (122 women) candidates for bariatric surgery (108 finally operated) were included in the study. A clinical interview was carried and several scales of psychopathology were applied before and after surgery: Beck Depression Inventory (BDI), Beck Anxiety Inventory (BAI), Maudsley Obsessive-compulsive Interview (MOCI), Barrat Impulsiveness Scale (BIS), Eating Disorder Inventory (EDI), Eating Attitudes Test (EAT), Bulimic Investigation Test Edinburg (BITE), and Body Shape Questionnaire (BSQ). A comparison of means between the initial and final scores of the psychometric tests and a logistic regression analysis to identify the predictive variables of positive evolution after surgery (defined as percentage of lost overweight> 50% and final IMC <35) were performed. Results: An improvement in the scores of BDI, BAI and in the subscales of EDI, Impulse to the thinness (EDI-DT) and corporal Dissatisfaction (EDI-BD) was observed. The differences were not significant for the rest of the psychometric tests. The multivariate analysis identified 3 predictive factors for postsurgical evolution: BDI (OR 0.91, IC95% 0.82 1.02), BIS (OR 1.08, IC 95% 1.0 1.16) y EDI-DT (OR 1.18, IC 95% 1.0 1.39). Conclusions: In our study, the scales of depression, anxiety, impulse to thinness and corporal dissatisfaction improved in patients with MO after bariatric surgery. Some baseline psychometric variables may predict a favourable postsurgical evolution of these patients (AU)

[Evolution of psychopathological alterations in patients with morbid obesity after bariatric surgery]. / Evolución de alteraciones psicopatológicas en pacientes con obesidad mórbida tras cirugía bariátrica.

BACKGROUND AND OBJECTIVE: The aims of this study were to know the prevalence of the psychopathological alterations among patients with morbid obesity (MO) candidates for bariatric surgery in our centre, to analyze its predictive value on the surgical outcome and to study the evolution after weight stabilization was achieved. PATIENTS AND METHODS: One hundred and forty five patients of the University Hospital Foundation Alcorcón (122 women) candidates for bariatric surgery (108 finally operated) were included in the study. A clinical interview was carried and several scales of psychopathology were applied before and after surgery: Beck Depression Inventory (BDI), Beck Anxiety Inventory (BAI), Maudsley Obsessive-compulsive Interview (MOCI), Barrat Impulsiveness Scale (BIS), Eating Disorder Inventory (EDI), Eating Attitudes Test (EAT), Bulimic Investigation Test Edinburg (BITE), and Body Shape Questionnaire (BSQ). A comparison of means between the initial and final scores of the psychometric tests and a logistic regression analysis to identify the predictive variables of positive evolution after surgery (defined as percentage of lost overweight> 50% and final IMC <35) were performed. RESULTS: An improvement in the scores of BDI, BAI and in the subscales of EDI, Impulse to the thinness (EDI-DT) and corporal Dissatisfaction (EDI-BD) was observed. The differences were not significant for the rest of the psychometric tests. The multivariate analysis identified 3 predictive factors for postsurgical evolution: BDI (OR 0.91, IC95% 0.82-1.02), BIS (OR 1.08, IC 95% 1.0-1.16) y EDI-DT (OR 1.18, IC 95% 1.0-1.39). CONCLUSIONS: In our study, the scales of depression, anxiety, impulse to thinness and corporal dissatisfaction improved in patients with MO after bariatric surgery. Some baseline psychometric variables may predict a favourable postsurgical evolution of these patients.

Déficit de yodo en una población de mujeres embarazadas pertenecientes a un área con leve deficiencia de yodo / Iodine deficiency in pregnant women from a mildly iodine-deficient area

Objetivo: Los estudios realizados en España proponen que la ingesta de yodo de las mujeres embarazadas está por debajo de los requerimientos nutricionales. Con este estudio se pretende conocer el estado nutricional de yodo en una población de mujeres embarazadas de Madrid. Pacientes y método: Estudio prospectivo de una cohorte de 112 mujeres gestantes con enfermedad endocrina entre enero y septiembre de 2004. Resultados: La yoduria fue 101,5 (60,25-176,75) µg/l. Sólo el 30,4% de las mujeres mostraban suficiencia de yodo (yoduria > 160 µg/l). La tirotropina fue 2,1 (1,12-2,95) µU/ml; la tiroxina libre, 0,87 (0,77-1) ng/dl; los anticuerpos antitiroglobulina y los anticuerpos antiperoxidasa, positivos en el 5,4 y el 19,6% respectivamente. En el análisis bivariable, el consumo de sal yodada se asoció con la suficiencia de yodo (odds ratio [OR] = 3,6; intervalo de confianza [IC] del 95%, 1,45-8,93). El 41,3% de las consumidoras de sal yodada presentaron yodurias > 160 µg/l, frente al 16,3% de las no consumidoras (p = 0,004). No hubo asociación entre suficiencia de yodo y antecedentes familiares de enfermedad tiroidea, bocio, tratamiento con levotiroxina, tirotropina, tiroxina libre, anticuerpos antitiroglobulina ni anticuerpos antiperoxidasa. En el análisis multivariable, la OR ajustada del consumo de sal yodada sobre la suficiencia nutricional de yodo fue 3,92 (1,46-10,53; p = 0,008). Conclusiones: En esta muestra, el 69,6% de las gestantes presentaron yodurias < 160 µg/l. El consumo de sal yodada se asoció a suficiencia de yodo. En esta cohorte no encontramos asociación de suficiencia de yodo con positividad de anticuerpos antitiroglobulina y anticuerpos antiperoxidasa ni con concentraciones de tirotropina y tiroxina libre

Objective: Studies performed in Spain suggest that iodine intake in pregnant women is below nutritional requirements. This study was designed to determine the degree of iodine nutrition during pregnancy in women from Madrid. Patients and method: A prospective study of 112 pregnant women with endocrinological disorders was performed between January 2004 and September 2004. Results: The urinary iodine level was 101.5 µg/l (60.25-176.75). Only 30.4% of the women showed adequate urinary iodine levels (higher than 160 µg/l). Serum thyroid-stimulating hormone (TSH) and free thyroxine (FT4) concentrations were 2.1 µU/ml (1.12-2.95) and 0.87 µg/dl (0.77-1), respectively. Antithyroglobulin (TgAb) and antiperoxidase (TPOAb) antibody values were positive in 5.4% and 19.6%, respectively. In the bivariate analysis, iodized salt intake was associated with iodine sufficiency (OR = 3.6; 95% CI, 1.45-8.93). A total of 41.3% of women with iodized salt intake had urinary iodine levels higher than 160 µg/l compared with 16.3% of those not consuming iodized salt (p = 0.004). No association was found between iodine sufficiency and a family history of thyroid disease, the presence of goiter, levothyroxine treatment, TSH, FT3, FT4, TPOAb or TgAb. In the multivariate analysis, the adjusted OR for the association between intake of iodized salt and iodine sufficiency was 3.92 (1.46-10.53; p = 0.008). Conclusions: In this sample, 69.6% of the pregnant women showed urinary iodine levels lower than 160 µg/l. Intake of iodized salt was associated with iodine sufficiency. We found no correlation between urinary iodine levels and TSH, FT4, FT3, or antibody positivity