Diabetes y mujer, ¿por qué somos diferentes? / Diabetes and women, why are we different?

La diabetes afecta de manera diferente a hombres y a mujeres, y la presunción equivocada de igualdad en su expresividad clínica puede tener como consecuencia errores y demoras en el proceso diagnóstico y en la estrategia terapéutica que se adopte. El objetivo del artículo es mostrar las diferencias de género que influyen en el abordaje de esta patología y cuál es el papel del médico de familia en el seguimiento de la mujer con diabetes. Es una revisión sobre el impacto de la diabetes en las distintas etapas de la vida de la mujer, cómo los cambios hormonales afectan al control glucémico, la diabetes gestacional, cómo afecta la diabetes al desarrollo de las complicaciones crónicas en la mujer y sus consecuencias, las diferencias existentes en el control de los factores de riesgo cardiovascular y los aspectos diferenciales por sexo de las distintas familias de fármacos utilizados en el tratamiento de la diabetes. (AU)

Diabetes affects men and women differently and the mistaken assumption of equality in its clinical expression can lead to errors and delays in the diagnostic process and the therapeutic strategy adopted. The objective is to show the gender differences that influence the approach to this pathology and what the role of the family doctor is in the monitoring of women with diabetes. It is a review of the impact of diabetes at different stages of a woman's life, how hormonal changes affect glycemic control, gestational diabetes, how diabetes affects the development of chronic complications in women and their consequences, the existing differences in the control of cardiovascular risk factors and the differential aspects by sex of the different families of drugs used in the treatment of diabetes. (AU)

[Diabetes and women, why are we different?] / Diabetes y mujer, ¿por qué somos diferentes?

Diabetes affects men and women differently and the mistaken assumption of equality in its clinical expression can lead to errors and delays in the diagnostic process and the therapeutic strategy adopted. The objective is to show the gender differences that influence the approach to this pathology and what the role of the family doctor is in the monitoring of women with diabetes. It is a review of the impact of diabetes at different stages of a woman's life, how hormonal changes affect glycemic control, gestational diabetes, how diabetes affects the development of chronic complications in women and their consequences, the existing differences in the control of cardiovascular risk factors and the differential aspects by sex of the different families of drugs used in the treatment of diabetes.

Vulnerabilidad y determinantes sociales en diabetes / Vulnerability and social determinants in diabetes

Los determinantes sociales de la salud influyen significativamente en el desarrollo y en la progresión de enfermedades crónicas como la diabetes tipo2 (DM2). Este artículo examina los determinantes sociales clave, incluidos la educación, la estabilidad económica, el vecindario, así como la procedencia, la raza o la religión, que afectan a las personas con DM2. También se explora el papel del género como determinante social, enfatizando la necesidad de consideraciones específicas de género en la gestión y en la investigación de la DM2. Además, se analiza el impacto de la pobreza en los resultados de salud, destacando la relación bidireccional entre pobreza y enfermedad. Las medidas integrales que abordan estos determinantes son cruciales para mejorar la salud y el bienestar de las personas con DM2. Abordar las desigualdades sociales a través de intervenciones específicas puede contribuir a mejores resultados de tratamiento y a una atención médica equitativa (AU)

Social determinants of health significantly influence the development and progression of chronic diseases such as type2 diabetes (T2DM). This article examines key social determinants including education, economic stability, neighborhood, and factors such as ethnicity, race, or religion that impact individuals with T2DM. The role of gender as a social determinant is also explored, emphasizing the need for gender-specific considerations in T2DM management and research. Additionally, the impact of poverty on health outcomes is analyzed, highlighting the bidirectional relationship between poverty and disease. Comprehensive measures addressing these determinants are crucial to improving the health and well-being of individuals with T2DM. Addressing social inequalities through targeted interventions can contribute to better treatment outcomes and equitable healthcare (AU)

Adherencia terapéutica de pacientes con riesgo cardiovascular en atención primaria. Proyecto REAAP / Therapeutic adherence of patients with cardiovascular risk in primary care. REAAP project

Objetivo Describir las percepciones y las experiencias cotidianas de los médicos de atención primaria (AP) en el abordaje de la falta de adherencia terapéutica en pacientes con riesgo cardiovascular, así como sus expectativas y las posibles áreas de mejora. Material y métodos Estudio cualitativo (en el marco del proyecto REAAP: Red de Expertos en Adherencia de Atención Primaria) realizado en varias comunidades autónomas de España a partir de un cuestionario de respuesta abierta completado por médicos de AP. Los escritos se analizaron mediante el método marco o Framework Analysis para orientar la codificación de los temas. Resultados Participaron 18 médicos, de cuyas respuestas se identificaron tres temas principales: abordaje de la adherencia durante la práctica clínica, barreras que dificultan una correcta adherencia e intervenciones para mejorar la adherencia. Las estrategias más señaladas para facilitar la adherencia terapéutica de los pacientes fueron: mejorar la comunicación médico-paciente y la continuidad asistencial, involucrar a las farmacias comunitarias y simplificar el tratamiento prescribiendo fármacos a combinaciones fijas. Conclusiones Los médicos asistenciales de AP apuntan a que no existe una estrategia ideal que por sí sola facilite la adherencia terapéutica, siendo necesario combinar varias intervenciones para optimizarla. Conocer la problemática y las herramientas disponibles y ausentes en la práctica habitual permitirá un mejor abordaje de la adherencia de los pacientes. En esta línea, iniciativas como el proyecto REAAP son un medio importante para que el personal sanitario, y el resto de actores implicados reconozcan la importancia que merece esta cuestión (AU)

Objective To describe the perceptions and daily experiences of primary care (PC) physicians in dealing with the lack of therapeutic adherence in patients with cardiovascular risk, as well as their expectations and possible areas for improvement. Material and methods A qualitative study (within the framework of the REAAP project: Network of Experts in Adherence in Primary Care) carried out in several autonomous communities in Spain using an open-ended questionnaire completed by PC physicians and analyzed using the framework analysis method to guide the coding of the topics. Results Eighteen physicians participated, and three main themes were identified from their responses: an approach to adherence during clinical practice, barriers that hinder the appropriate adherence, and interventions to improve it. The strategies most frequently mentioned to facilitate patients’ therapeutic adherence were improving physician-patient communication and continuity of care, involving community pharmacies, and simplifying treatment by prescribing drugs in fixed combinations. Conclusions There is no single ideal strategy to facilitate therapeutic adherence, and it is necessary to combine several interventions to optimize it. The first step is to understand the problems and the tools available. Initiatives such as the REAAP project are an important means to improve patient adherence, and for healthcare personnel to recognize the importance that this issue deserves (AU)

[Vulnerability and social determinants in diabetes]. / Vulnerabilidad y determinantes sociales en diabetes.

Social determinants of health significantly influence the development and progression of chronic diseases such as type2 diabetes (T2DM). This article examines key social determinants including education, economic stability, neighborhood, and factors such as ethnicity, race, or religion that impact individuals with T2DM. The role of gender as a social determinant is also explored, emphasizing the need for gender-specific considerations in T2DM management and research. Additionally, the impact of poverty on health outcomes is analyzed, highlighting the bidirectional relationship between poverty and disease. Comprehensive measures addressing these determinants are crucial to improving the health and well-being of individuals with T2DM. Addressing social inequalities through targeted interventions can contribute to better treatment outcomes and equitable healthcare.

[Therapeutic adherence of patients with cardiovascular risk in primary care. REAAP project]. / Adherencia terapéutica de pacientes con riesgo cardiovascular en atención primaria. Proyecto REAAP.

OBJECTIVE: To describe the perceptions and daily experiences of primary care (PC) physicians in dealing with the lack of therapeutic adherence in patients with cardiovascular risk, as well as their expectations and possible areas for improvement. MATERIAL AND METHODS: A qualitative study (within the framework of the REAAP project: Network of Experts in Adherence in Primary Care) carried out in several autonomous communities in Spain using an open-ended questionnaire completed by PC physicians and analyzed using the framework analysis method to guide the coding of the topics. RESULTS: Eighteen physicians participated, and three main themes were identified from their responses: an approach to adherence during clinical practice, barriers that hinder the appropriate adherence, and interventions to improve it. The strategies most frequently mentioned to facilitate patients' therapeutic adherence were improving physician-patient communication and continuity of care, involving community pharmacies, and simplifying treatment by prescribing drugs in fixed combinations. CONCLUSIONS: There is no single ideal strategy to facilitate therapeutic adherence, and it is necessary to combine several interventions to optimize it. The first step is to understand the problems and the tools available. Initiatives such as the REAAP project are an important means to improve patient adherence, and for healthcare personnel to recognize the importance that this issue deserves.

Actualización en el uso de insulinas para el médico de familia / Update on the use of insulins for the primary care physician

El tratamiento con insulina en personas con diabetes mellitus tipo 2 (DM2) continúa siendo fundamental y su consumo ha aumentado en los últimos años. A pesar de ello, el grado de control para esta patología continúa siendo muy deficiente. El inicio del tratamiento con insulina se realiza con cifras muy por encima de las recomendaciones de las Guías de Práctica Clínica (GPC) y los pacientes están sometidos a cifras de glucemia muy elevadas durante largos periodos de tiempo. En este artículo se revisa el papel de la insulina siguiendo las diferentes GPC, los criterios para el inicio y la intensificación con dicha terapia, los diferentes tipos de insulina comercializados en nuestro país, la insulinización en situaciones especiales (tratamiento con corticoides, en el anciano frágil, personas en situación de cuidados paliativos, enfermedad renal crónica y personas que cumplen el Ramadán) y finalmente se aborda el problema de la inercia terapéutica en la insulinización (AU)

Insulin treatment in type 2 diabetes mellitus patients is still essential and its usage has increased during recent years. Despite this, the level of control continues to be very poor. Insulin treatment is initiated with control levels above the recommendations set by the Clinical Practice Guidelines (CPG) and patients are exposed to very high blood glucose levels during long periods of time. This paper reviews the role of insulin in the different CPG, the criteria for therapy initiation and intensification, the beginning of the intensification and the different types of insulin which are commercialized in our country. Moreover, we discuss insulinization in special situations such as corticosteroid treatment, fragile elderly patients, palliative care situations, chronic kidney disease or during Ramadan. Finally, the problem of therapeutic inertia in insulinization is also addressed (AU)

[Adherence to healthy lifestyle behaviours in patients with type 2 diabetes in Spain]. / Adherencia a un estilo de vida saludable en pacientes con diabetes mellitus tipo 2 en España.

OBJECTIVES: The aim of this study was to report on the main lifestyle components and related factors in adults with diabetes type 2 treated in Primary Care clinics in Spain. MATERIAL AND METHODS: A cross-sectional and multicentre study was performed on a consecutive sample of patients with type 2 diabetes attending 25 Primary Care clinics between April 2018 and April 2019. Data were collected by auditing the computerised medical records, and an interview. An analysis was carried out on adherence to 4 healthy lifestyle trends (Mediterranean diet, regular exercise, not smoking, and emotional well-being). RESULTS: A total of 412 patients were included in the analysis (mean age 69 (SD 8.65) years; 50.2% men). Only a minority was highly adherent to the Mediterranean diet, 92 (22.3%). Regular physical activity was carried out by 189 (45.8%). A total of 361 (87.6%) were non-smoking, and 259 (62.8%) felt emotional well-being. A small number (9, 2.1%) of patients had not followed any of the healthy lifestyle recommendations, with 87 (21.1%) following one, 145 (35.1%) two, 128 (31%) three, and 43 (10.4%) all 4 healthy habits: diet, exercise, not smoking, and emotional well-being. Healthy lifestyle adherence was related to gender. Obesity is poorly associated with adherence to diet and physical activity. The results for age, time with the disease, socioeconomic status, and treatment regimen were not consistent. CONCLUSIONS: This study suggest that adherence to a healthy lifestyle pattern in DM2 is low. Less than a quarter follow a healthy diet, and less than a half practice regular exercise. Gender is the variable that most influences a healthy lifestyle in DM2, but not age, time with the disease, or treatment regimen.

Prevención y tratamiento de la enfermedad infecciosa en personas con diabetes / Prevention and treatment of infectious diseases in diabetic patients

Es conocida la relación bidireccional entre enfermedades infecciosas y diabetes. Las personas con diabetes tienen mayor riesgo de presentar enfermedades infecciosas, pudiendo ser estas de mayor severidad; y por otro lado, las enfermedades infecciosas desestabilizan el control metabólico de las personas con diabetes. El envejecimiento importante de la población es debido en parte al aumento de la supervivencia de pacientes con enfermedades crónicas, entre ellas la diabetes. Mejorar la prevención de enfermedades infecciosas en este grupo de población podría disminuir las complicaciones de estas enfermedades, así como las consecuencias de la desestabilización de la enfermedad de base (morbilidad, discapacidad, ingresos hospitalarios, costes sanitarios, tasas de mortalidad), mejorando además la calidad de vida de las personas con diabetes. La presente revisión expone el tratamiento de las enfermedades infecciosas en personas con diabetes y el abordaje de las enfermedades inmunoprevenibles con las vacunas recomendadas en la actualidad

The bidirectional relationship between infectious diseases and diabetes is well-known. On the one hand, diabetes patients are at a higher risk of presenting with infectious diseases, possibly with more severity, and on the other hand, infectious diseases impair metabolic control in patients with diabetes. Population ageing arises partly due to an increased survival rate in chronic diseases, of which diabetes is amongst them. Improving infectious disease prevention could reduce complications arising from the former diseases, consequences of decompensated diabetes condition (morbidity, incapacity, hospital admissions, healthcare costs, and mortality rates) and result in improved quality of life in patients with diabetes. The current review presents the treatment of infectious diseases in patients with diabetes and the dealing with immuno-preventable diseases with the currently advised vaccinations

[Prevention and treatment of infectious diseases in diabetic patients]. / Prevención y tratamiento de la enfermedad infecciosa en personas con diabetes.

The bidirectional relationship between infectious diseases and diabetes is well-known. On the one hand, diabetes patients are at a higher risk of presenting with infectious diseases, possibly with more severity, and on the other hand, infectious diseases impair metabolic control in patients with diabetes. Population ageing arises partly due to an increased survival rate in chronic diseases, of which diabetes is amongst them. Improving infectious disease prevention could reduce complications arising from the former diseases, consequences of decompensated diabetes condition (morbidity, incapacity, hospital admissions, healthcare costs, and mortality rates) and result in improved quality of life in patients with diabetes. The current review presents the treatment of infectious diseases in patients with diabetes and the dealing with immuno-preventable diseases with the currently advised vaccinations.

Impacto de la inercia terapéutica y del grado de adherencia al tratamiento en los objetivos de control en personas con diabetes / The impact of therapeutic inertia and the degree of the medication adherence on the control goals for patients with diabetes

Objetivo: El objetivo de este estudio fue analizar el impacto de la baja adherencia terapéutica (AT) y la inercia terapéutica de los profesionales (IT) sobre el mal control glucémico y de los factores de riesgo cardiovasculares en personas con DM2. Material y métodos: Estudio transversal realizado en atención primaria. Se incluyeron 320 personas con DM2. Se valoró si cumplían los objetivos de control (HbA1c≤7%, PA≤130/80mmHg, LDL≤100mg/dl). Se consideró falta de AT la retirada de farmacia <80% de las recetas prescritas e IT la no modificación del tratamiento en personas mal controladas. Resultados: Presentaron buen control de HbA1c, PA y cLDL el 62,5, el 40,9 y el 35,9%, respectivamente. Las personas mal controladas presentaron cifras de AT menores y la IT no se relacionó con la AT. En sujetos mal controlados para HbA1c, presentaban IT el 25,8%, el 24,8% mala AT y el 11,9% estaban afectados por ambos comportamientos. Para cLDL, el 3,6% presentaban mala AT, el 70,4% IT y el 16,0% mala AT e IT (p<0,001). Respecto a la PA, el 3,5% tenían mala AT, el 54,6% IT y el 21,5% presentaban mala AT e IT (p<0,01). Conclusiones: La falta de AT y la IT han estado implicadas en un porcentaje elevado de personas con DM2 mal controladas. La IT ha resultado de gran relevancia en el presente estudio

Objective: The purpose of this study was to analyse both the impact of low therapeutic adherence (TA) and therapeutic inertia (TI) on poor blood glucose control and on risk factors for heart disease in patients with DM2. Material and methods: A cross-sectional study was conducted in a Primary Halth Care centre. A total of 320 patients with DM2 were included and an assessment was made of control goals (HbA1c≤7%, blood pressure ≤130/80mmHg, and LDL-cholesterol≤100mg/dl). A pharmacy retrieval <80% was considered as a lack of TA and the non-modification of treatment in badly controlled patient as TI. Results: The percentage of patients with good control of HbA1c, blood pressure and LDL-cholesterol was 62.5%, 40.9%, and 35.9%, respectively. Lower figures of TA were present in poorly controlled patients, and TI was not found to be related to TA. In the patients with poor HbA1c control, 25.8% had TI, 24.8% poor TA, and 11.9% had both of them. As regards LDL-cholesterol, 3.6% presented poor TA, 70.4% showed TI, and 16% with poor TA and TI (P<.001). As for blood pressure, 3.5% of patients had poor TA, 54.6% had TI, and 21.5% of them had poor TA as well as TI (P<.01). Conclusions: Lack of therapeutic adherence and therapeutic inertia were found in a high percentage of poorly-controlled DM2 patients with bad control. Therapeutic inertia was found to be of great relevance in this study

[The impact of therapeutic inertia and the degree of the medication adherence on the control goals for patients with diabetes]. / Impacto de la inercia terapéutica y del grado de adherencia al tratamiento en los objetivos de control en personas con diabetes.

OBJECTIVE: The purpose of this study was to analyse both the impact of low therapeutic adherence (TA) and therapeutic inertia (TI) on poor blood glucose control and on risk factors for heart disease in patients with DM2. MATERIAL AND METHODS: A cross-sectional study was conducted in a Primary Halth Care centre. A total of 320 patients with DM2 were included and an assessment was made of control goals (HbA1c≤7%, blood pressure ≤130/80mmHg, and LDL-cholesterol≤100mg/dl). A pharmacy retrieval <80% was considered as a lack of TA and the non-modification of treatment in badly controlled patient as TI. RESULTS: The percentage of patients with good control of HbA1c, blood pressure and LDL-cholesterol was 62.5%, 40.9%, and 35.9%, respectively. Lower figures of TA were present in poorly controlled patients, and TI was not found to be related to TA. In the patients with poor HbA1c control, 25.8% had TI, 24.8% poor TA, and 11.9% had both of them. As regards LDL-cholesterol, 3.6% presented poor TA, 70.4% showed TI, and 16% with poor TA and TI (P<.001). As for blood pressure, 3.5% of patients had poor TA, 54.6% had TI, and 21.5% of them had poor TA as well as TI (P<.01). CONCLUSIONS: Lack of therapeutic adherence and therapeutic inertia were found in a high percentage of poorly-controlled DM2 patients with bad control. Therapeutic inertia was found to be of great relevance in this study.

Hacia un manejo integral del paciente con diabetes y obesidad. Posicionamiento de la SEMI, SED, redGDPS, SEC, SEEDO, SEEN, SEMERGEN y SEMFYC / Position statement of the SEMI, SED, redGDPS, SEC, SEEDO, SEEN, SEMERGEN y SEMFYC

La obesidad y el sobrepeso constituyen la principal causa modificable de diabetes tipo 2 (DM2). En el momento del diagnóstico de la diabetes tipo 2 se debe establecer el grado de obesidad según el índice de masa corporal y, en los pacientes con sobrepeso, determinar el perímetro de la cintura. El adecuado tratamiento de la DM2 requiere un abordaje simultáneo del sobrepeso/obesidad y el resto de factores de riesgo cardiovascular, como la hipertensión, la dislipemia o el tabaquismo. Las intervenciones no farmacológicas (dieta, ejercicio) con beneficio demostrado en la prevención y tratamiento del paciente con DM2 y sobrepeso/obesidad deben seguir un enfoque individualizado y multidisciplinario, con programas estructurados dotados de recursos específicos. La ganancia de peso asociada al tratamiento antidiabético puede dificultar el control glucémico, comprometer la adherencia al tratamiento, empeorar el perfil de riesgo vascular de los pacientes y limitar los beneficios cardiovasculares del tratamiento. Por ello, es importante evitarla; una medida que resulta coste-efectiva. Los fármacos antidiabéticos con beneficios sobre el peso corporal también han demostrado su beneficio en pacientes con un índice de masa corporal<30kg/m2. Globalmente, el tratamiento del paciente con DM2 y obesidad dependerá tanto del grado de obesidad como de la comorbilidad asociada. Los ensayos clínicos de intervención en DM2 deben contemplar objetivos combinados que incluyan no solo el control glucémico, sino otras variables como el riesgo de hipoglucemia y el efecto del tratamiento sobre el peso corporal (AU)

Obesity and excess weight are the main preventable causes of type 2 diabetes (DM2). When diagnosing type 2 diabetes, clinicians should establish the degree of obesity according to the body mass index (BMI) and, for patients with excess weight, measure the waist circumference. The proper treatment of DM2 requires a simultaneous approach to excess weight/obesity and the other cardiovascular risk factors, such as hypertension, dyslipidaemia and smoking. Nondrug interventions (e.g., diet and exercise) have proven benefits in preventing and treating patients with DM2 and excess weight/obesity and should follow an individual and multidisciplinary approach, with structured programs equipped with specific resources. Weight gain associated with antidiabetic treatment can hinder glycaemic control, compromise treatment adherence, worsen the vascular risk profile and limit the cardiovascular benefits of treatment. Therefore, it is significant to avoid weight gain, a measure that can be cost-effective. Antidiabetic drugs with benefits in body weight have also demonstrated their benefit in patients with BMIs <30. In general, the treatment of patients with DM2 and obesity will depend both on the degree of obesity and the associated comorbidity. Clinical trials on DM2 intervention should consider combined objectives that include not only glycaemic control but also other variables such as the risk of hypoglycaemia and the effect of treatment on body weight (AU)

Position statement of the SEMI, SED, redGDPS, SEC, SEEDO, SEEN, SEMERGEN y SEMFYC.

Obesity and excess weight are the main preventable causes of type 2 diabetes (DM2). When diagnosing type 2 diabetes, clinicians should establish the degree of obesity according to the body mass index (BMI) and, for patients with excess weight, measure the waist circumference. The proper treatment of DM2 requires a simultaneous approach to excess weight/obesity and the other cardiovascular risk factors, such as hypertension, dyslipidaemia and smoking. Nondrug interventions (e.g., diet and exercise) have proven benefits in preventing and treating patients with DM2 and excess weight/obesity and should follow an individual and multidisciplinary approach, with structured programs equipped with specific resources. Weight gain associated with antidiabetic treatment can hinder glycaemic control, compromise treatment adherence, worsen the vascular risk profile and limit the cardiovascular benefits of treatment. Therefore, it is significant to avoid weight gain, a measure that can be cost-effective. Antidiabetic drugs with benefits in body weight have also demonstrated their benefit in patients with BMIs <30. In general, the treatment of patients with DM2 and obesity will depend both on the degree of obesity and the associated comorbidity. Clinical trials on DM2 intervention should consider combined objectives that include not only glycaemic control but also other variables such as the risk of hypoglycaemia and the effect of treatment on body weight.

Recomendaciones de buena práctica en el tratamiento de la dislipemia en la diabetes / Consensus document on the treatment of dyslipidemia in diabetes

Las personas con diabetes mellitus tipo 2 tienen un riesgo de desarrollar enfermedad cardiovascular de 2 a 4 veces superior al observado en la población general de similar edad y sexo. Este riesgo se mantiene después de ajustar para otros factores clásicos de riesgo cardiovascular. La dislipidemia asociada a la diabetes mellitus tipo 2 se encuentra presente en hasta un 60% de las personas con diabetes y contribuye en gran medida al incremento de riesgo cardiovascular y de morbimortalidad que presentan estos pacientes. La dislipidemia diabética es una alteración del metabolismo lipídico que se caracteriza por un exceso de triglicéridos, un déficit del colesterol HDL y una alteración de la composición de las lipoproteínas que consiste sobre todo en un exceso de partículas LDL pequeñas y densas. Múltiples ensayos clínicos han demostrado los beneficios del tratamiento farmacológico de la dislipidemia (principalmente estatinas), para prevenir eventos cardiovasculares y mortalidad en personas con diabetes tanto en prevención primaria como secundaria. El presente documento de consenso elaborado por médicos de familia, integrantes del Grupo de Diabetes de la Sociedad Española de Médicos de Atención Primaria (SEMERGEN), pretende servir de ayuda en el manejo de las personas con diabetes y dislipidemia a la vista de las recomendaciones más actualizadas (AU)

People with type 2 diabetes mellitus have a 2 to 4 times higher risk of developing cardiovascular diseases when compared to general population of similar age and sex. This risk remains after adjustment of other traditional cardiovascular risk factors. The dyslipidemia associated with type 2 diabetes mellitus is present in up to 60% of people with diabetes and contributes greatly to increased cardiovascular, morbidity and mortality risk in these patients. Diabetic dyslipidemia is a disorder of lipid metabolism characterized by an excess of triglycerides, a decrease in HDL-cholesterol and altered lipoprotein composition, consisting mainly in an excess of small, dense LDL particles. Multiple clinical trials have demonstrated the benefits of drug treatment of dyslipidemia (mainly statins) to prevent cardiovascular events and mortality in people with diabetes, both in primary and secondary prevention. This consensus document, developed by general practitioners, members of the Diabetes Group of the Spanish Society of Primary Care Physicians (SEMERGEN), aims to assist in the management of patients with diabetes and dyslipidemia in accordance with the most recent recommendations (AU)

[Consensus document on the treatment of dyslipidemia in diabetes]. / Recomendaciones de buena práctica en el tratamiento de la dislipemia en la diabetes.

People with type 2 diabetes mellitus have a 2 to 4 times higher risk of developing cardiovascular diseases when compared to general population of similar age and sex. This risk remains after adjustment of other traditional cardiovascular risk factors. The dyslipidemia associated with type 2 diabetes mellitus is present in up to 60% of people with diabetes and contributes greatly to increased cardiovascular, morbidity and mortality risk in these patients. Diabetic dyslipidemia is a disorder of lipid metabolism characterized by an excess of triglycerides, a decrease in HDL-cholesterol and altered lipoprotein composition, consisting mainly in an excess of small, dense LDL particles. Multiple clinical trials have demonstrated the benefits of drug treatment of dyslipidemia (mainly statins) to prevent cardiovascular events and mortality in people with diabetes, both in primary and secondary prevention. This consensus document, developed by general practitioners, members of the Diabetes Group of the Spanish Society of Primary Care Physicians (SEMERGEN), aims to assist in the management of patients with diabetes and dyslipidemia in accordance with the most recent recommendations.

[Incretin mimetic drugs: therapeutic positioning]. / Fármacos incretín miméticos: posicionamiento terapéutico.

Type 2 diabetes is a chronic and complex disease, due to the differences among affected individuals, which affect choice of treatment. The number of drug families has increased in the last few years, and these families have widely differing mechanisms of action, which contributes greatly to the individualization of treatment according to the patient's characteristics and comorbidities. The present article discusses incretin mimetic drugs. Their development has been based on knowledge of the effects of natural incretin hormones: GLP-1 (glucagon-like peptide 1), GIP (glucose-dependent insulinotropic peptide) and dipeptidyl peptidase enzyme 4 (DPP4), which rapidly degrade them in the systemic circulation. This group is composed of 2 different types of molecules: GLP-1 analogs and DPP4 enzyme inhibitors. The benefits of these molecules include a reduction in plasma glucose without the risk of hypoglycemias or weight gain. There are a series of questions that require new studies to establish a possible association between the use of these drugs and notification of cases of pancreatitis, as well as their relationship with pancreatic and thyroid cancer. Also awaited is the publication of several studies that will provide information on the relationship between these drugs and cardiovascular risk in people with diabetes. All these questions will probably be progressively elucidated with greater experience in the use of these drugs.

Fármacos incretín miméticos: posicionamiento terapéutico / Incretin mimetic drugs: therapeutic positioning

La diabetes tipo 2 es una enfermedad crónica y compleja dadas las diferencias existentes entre las personas que la presentan y que van a influir en el profesional a la hora de seleccionar los tratamientos. En los últimos años han aumentado las familias de fármacos y estas presentan mecanismos de acción muy diferentes entre sí, lo que facilita, de manera importante, la individualización del tratamiento según las características de las personas y sus comorbilidades. En este trabajo se presentan los fármacos incretín miméticos. Su desarrollo se ha basado en el conocimiento de los efectos de las hormonas llamadas incretinas naturales: GLP-1 (glucagón-likepeptid 1) y GIP (polipéptido insulinotrópico dependiente de la glucosa) y el de la enzima dipeptidilpeptidasa 4 (DPP4), que las degrada rápidamente en la circulación sistémica. Este grupo está formado por 2 tipos diferentes de moléculas: los análogos del GLP-1 y los inhibidores de la enzima DPP4. Entre los beneficios que presentan están la reducción de la glucosa plasmática, sin presentar riesgos de hipoglucemias ni aumento de peso. Hay una serie de cuestiones que precisan nuevos estudios para establecer una posible relación entre el uso de estos fármacos y la notificación de casos de pancreatitis, así como la relación con el cáncer de páncreas y tiroides. También se espera la publicación de diferentes trabajos que aporten información sobre la relación existente entre estos fármacos y el riesgo cardiovascular en las personas con diabetes. Todas estas cuestiones probablemente se irán aclarando en el futuro cuando aumente la experiencia de su uso (AU)

Type 2 diabetes is a chronic and complex disease, due to the differences among affected individuals, which affect choice of treatment. The number of drug families has increased in the last few years, and these families have widely differing mechanisms of action, which contributes greatly to the individualization of treatment according to the patient's characteristics and comorbidities. The present article discusses incretin mimetic drugs. Their development has been based on knowledge of the effects of natural incretin hormones: GLP-1 (glucagon-like peptide 1), GIP (glucose-dependent insulinotropic peptide) and dipeptidyl peptidase enzyme 4 (DPP4), which rapidly degrade them in the systemic circulation. This group is composed of 2 different types of molecules: GLP-1 analogs and DPP4 enzyme inhibitors. The benefits of these molecules include a reduction in plasma glucose without the risk of hypoglycemias or weight gain. There are a series of questions that require new studies to establish a possible association between the use of these drugs and notification of cases of pancreatitis, as well as their relationship with pancreatic and thyroid cancer. Also awaited is the publication of several studies that will provide information on the relationship between these drugs and cardiovascular risk in people with diabetes. All these questions will probably be progressively elucidated with greater experience in the use of these drugs (AU)

Determinaciones analíticas en el paciente diabético / Laboratory tests and the diabetic patient

En el paciente diabético se han de realizar analíticas para conocer su control metabólico, así como los factores de riesgo cardiovascular. En este artículo se analizan las determinaciones analíticas recomendadas y la frecuencia de su realización. La hemoglobina glucosilada es el parámetro que valora el control metabólico; hemos revisado el consenso para la armonización de los resultados y la reciente aceptación de esta determinación para el diagnóstico de diabetes tipo 2. Para el estudio de la dislipemia diabética hemos explicado todos los parámetros que son útiles, aunque el colesterol LDL es el aceptado para el diagnóstico y seguimiento. Para la valoración de la nefropatía diabética se utiliza la excreción urinaria de albúmina y la creatinina sérica para estimar el filtrado glomerular. Debido a que la disfunción tiroidea es común en los pacientes diabéticos, también se recomienda la determinación de TSH (AU)

Laboratory tests must be performed on diabetic patients in order to monitor metabolic control and their cardiovascular risk factors. In this paper, we review the recommended analytical determinations and the frequency of performing them. Glycosylated haemoglobin is the parameter used for assessing metabolic control. We have reviewed the Consensus for result harmonisation and the recent acceptance of this determination for the diagnosis of type 2 diabetes. We have explained all useful parameters for the study of diabetic dyslipidaemia, although LDL cholesterol is the accepted parameter for diagnosis and follow-up. Albumin excretion in urine is used in order to assess diabetic nephropathy and serum creatinine is used in order to assess glomerular filtration. As thyroid dysfunction is common in diabetic patients, TSH determination is recommended (AU)

Hepatocarcinoma en un paciente de 23 años de origen subsahariano portador del virus de la hepatitis B / No disponible

El hepatocarcinoma (HCC) es la tercera causa de muertepor cáncer en el mundo, siendo los factores etiológicos másfrecuentes el virus de la hepatitis B (VHB) y el virus de lahepatitis C (VHC). Presentamos el caso de un varón de 23años natural de Ghana, infectado por el VHB, que consultópor ictericia conjuntival y ascitis. Fue diagnosticado deHCC, siendo candidato para el tratamiento paliativo, y cuyasupervivencia fue inferior al mes desde el momento deldiagnóstico. En la actualidad, en los países desarrolladoslos casos de HCC atribuibles a VHB son escasos, debido ala implantación de programas de vacunación y al tratamientode los portadores del VHB. Dado el número importanteen nuestras consultas de inmigrantes originarios de paísescon alta prevalencia de infección por el VHB, deberíamoshacer una búsqueda activa de los pacientes portadores,para valorar si son candidatos para realizar un tratamientoantivírico (AU)

Hepatocellular carcinoma (HCC) is the third cause ofdeath by cancer in the world. The hepatitis B (HBV) andhepatitis C (HCV) viruses are the most frequent etiologicalfactors. We present the case of a 23-year-old male patientfrom Ghana, infected by HBV, who consulted for conjunctivaljaundice and ascites. He was diagnosed with HCC andthus he became a candidate for palliative treatment. His survivalwas less than one month after diagnosis. Nowadays indeveloped countries, the cases of HCC caused by HBV arescarce, due to implementation of vaccination programs andto treatment of HBV carriers. Given the important number ofpatients who immigrate from countries with a high prevalenceof HBV infection receiving medical care in our HealthSystem, we should carry on active search for HBV carriers inorder to assess whether they are candidates for antiviral treatment (AU)