Experience with cinacalcet in primary hyperparathyroidism: results after 1 year of treatment.

OBJECTIVES: To assess the characteristics of patients with primary hyperparathyroidism (PHPT) treated with cinacalcet and to evaluate its efficacy in reducing serum calcium and parathyroid hormone (PTH) concentrations after 1 year of treatment. METHODS: The study included 20 patients with PHPT who had completed at least 12 months of treatment with cinacalcet (eight patients for refusal of parathyroidectomy, three for surgery not possible due to comorbidities and nine for progressive hypercalcemia prior to surgery). We recorded clinical and biochemical data at baseline, and after 3, 6 and 12 months of treatment. We also monitored adverse events. Cinacalcet was administered in increasing doses until normal serum calcium was reached or side effects preventing a further increase occurred. RESULTS: After 3 months of treatment, serum calcium significantly decreased (11.73 ± 0.85 versus 10.71 ± 1.63 mg/dl, p < 0.001) and serum phosphorus significantly increased (2.41 ± 0.48 versus 2.63 ± 0.70 mg/dl, p = 0.004) while no significant change occurred in PTH (181.91 ± 102.37 versus 195.47 ± 111.71 pg/ml, p = 0.695). No further variation was observed after 6 months compared with 3 months of follow up. However, after 12 months of treatment, there was a significant decrease in PTH concentrations compared with baseline (181.91 ± 102.37 versus 152.47± 70.16 pg/ml, p = 0.028) as well as serum calcium (11.73 ± 0.85 versus 10.20± 0.95 mg/dl, p < 0.001); serum phosphorus significantly increased (2.41 ± 0.48 versus 2.71 ± 0.43 mg/dl, p = 0.01). Normocalcemia (S-Ca < 10.2 mg/dl) was achieved in 55% of patients. The medication was usually well tolerated (83.4%). Most common adverse events were nausea and vomiting, especially at the beginning of therapy. CONCLUSION: Cinacalcet rapidly reduced serum calcium in patients with PHPT and this reduction remained stable after 1 year of treatment. We also observed a decrease in PTH. Cinacalcet is an effective alternative in nonsurgical treatment of PHPT and may be useful in the preoperative hypercalcemia management.

Control metabólico y de factores de riesgo cardiovascular en una cohorte de pacientes con diabetes mellitus. Resultados a los 4 años / Metabolic and cardiovascular risk factor control in a diabetic cohort. Four-year results

Objetivos Valorar el grado de control glucémico y del resto de factores de riesgo cardiovascular en una cohorte de pacientes diabéticos seguidos en consultas externas durante 4 años. Conocer el patrón de tratamiento utilizado y su evolución. Material y métodos Estudio de 424 pacientes diabéticos tanto tipo 1 (DM1) como tipo 2 (DM2), seleccionados aleatoriamente en 2004 y seguidos hasta 2008. La cohorte final fue de 343 pacientes. Se recogieron datos epidemiológicos, factores de riesgo cardiovascular, complicaciones crónicas, datos de control glucémico, lipídico y tensional, así como de tratamiento al inicio y a los 4 años. Resultados Tras los 4 años, el porcentaje de pacientes que conseguían una hemoglobina glicada inferior a 7% se mantuvo estable (DM1 18,5 en 2004 frente a 21,7% en 2008 y DM2 26,6 frente a 26,5%). En ambos tipos de diabetes se incrementó de forma significativa el grado de consecución de objetivos de control lipídico y tensional. Para conseguir estos resultados las pautas de tratamiento se complicaron de manera significativa. Conclusiones La estabilización del control glucémico objetivada tras 4 años de seguimiento es un resultado positivo, considerando el largo tiempo de evolución de la enfermedad, el deterioro progresivo de la función pancreática y la complejidad de esta cohorte. Gracias a la optimización de los tratamientos utilizados, han mejorado de forma significativa el control tensional y lipídico del grupo estudiado(AU)

Objectives To assess control of blood glucose and other cardiovascular risk factors in diabetic patients monitored at an outpatient endocrinology clinic. To ascertain treatment used and its changes over time. Patients and methods A cohort of 424 randomly selected diabetic patients (both type 1 and type 2) was monitored from 2004 to 2008. Final cohort size was 343 patients. Data were collected about epidemiological characteristics, cardiovascular risk factors, chronic complications, glycemic, lipid and blood pressure control, and treatment at baseline and 4 years. Results After 4 years, the proportion of patients achieving glycosylated hemoglobin levels less than 7% remained stable (type 1: 18.5% in 2004 vs 21.7% in 2008, type 2: 26.6% vs 26.5%). The degree of achievement of lipid and blood pressure (BP) control levels increased in both groups. The complexity of treatment schemes used to achieve these results significantly increased. Conclusions Stabilization of glycemic control after 4 years of follow-up was a positive result, considering the long course of diabetes, progressive pancreatic function impairment, and complexity of our cohort. Treatment optimization significantly improved BP and lipid control in the study group(AU)

Metabolic and cardiovascular risk factor control in a diabetic cohort. Four-year results.

OBJECTIVES: To assess control of blood glucose and other cardiovascular risk factors in diabetic patients monitored at an outpatient endocrinology clinic. To ascertain treatment used and its changes over time. PATIENTS AND METHODS: A cohort of 424 randomly selected diabetic patients (both type 1 and type 2) was monitored from 2004 to 2008. Final cohort size was 343 patients. Data were collected about epidemiological characteristics, cardiovascular risk factors, chronic complications, glycemic, lipid and blood pressure control, and treatment at baseline and 4 years. RESULTS: After 4 years, the proportion of patients achieving glycosylated hemoglobin levels less than 7% remained stable (type 1: 18.5% in 2004 vs 21.7% in 2008, type 2: 26.6% vs 26.5%). The degree of achievement of lipid and blood pressure (BP) control levels increased in both groups. The complexity of treatment schemes used to achieve these results significantly increased. CONCLUSIONS: Stabilization of glycemic control after 4 years of follow-up was a positive result, considering the long course of diabetes, progressive pancreatic function impairment, and complexity of our cohort. Treatment optimization significantly improved BP and lipid control in the study group.