Prevention and Management of Hormonal Crisis during Theragnosis with LU-DOTA-TATE in Neuroendocrine Tumors. A Systematic Review and Approach Proposal.

Neuroendocrine tumors (NETs) frequently overexpress somatostatin receptors (SSTR) on their cell surface. The first-line pharmacological treatment for inoperable metastatic functioning well-differentiated NETs are somatostatin analogs. On second line, Lu-DOTA-TATE (177Lu-DOTA0 Tyr 3 octreotate) has shown stabilization of the disease and an increase in progression free survival, as well as effectiveness in controlling symptoms and increasing quality of life. The management of functional NETs before and during LU-DOTA-TATE treatment is specially challenging, as several complications such as severe carcinoid and catecholamine crisis have been described. The aim of this review is to establish practical guidance for the management and prevention of the most common hormonal crises during radionuclide treatment with Lu-DOTA-TATE: carcinoid syndrome (CS) and catecholamine hypersecretion, as well as to provide a brief commentary on other infrequent metabolic complications. To establish a practical approach, a systematic review was performed. This systematic review was developed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement and conducted using MEDLINE (accessed from PubMed), Google Scholar and ClinicalTrials.gov. Literature searches found 449 citations, and finally nine were considered for this systematic review.

Effect of Telephone-Delivered Interventions on Glycemic Control in Type 2 Diabetes Treated with Glargine Insulin.

Background:Telephone-delivered intervention can provide support in diabetes self-management to improve glycemic control. "eStar® program" is a telephone support platform for type 2 diabetes on glargine insulin treatment. Its objective is to help patients to perform insulin titration to reach target fasting blood glucose levels. Patients are contacted by trained nurses on a regular basis to adjust the basal insulin dose and reinforce the diabetes education. This study aimed to evaluate if eStar program was effective in helping patients reach their optimal insulin glargine dose within 6 months.Materials and Methods:An observational prospective study was conducted with type 2 diabetes patients who were initiating insulin glargine or requiring dose titration and were eligible to be included in the eStar program. Those participants who followed the program comprised the intervention group, while those who discontinued, the control group. The primary outcome was to evaluate if this program was effective in helping patients reach their optimal insulin glargine dose within 6 months. Secondary outcomes included changes in glycosylated hemoglobin (HbA1C), fasting plasma glucose (FPG), insulin dose, and body mass index after 6 months.Results:A total of 228 subjects [intervention group, 143 (62.7%); control group, 85 (37.3%)] were included in the study. A significantly greater percentage of patients in the intervention group reached their optimal glargine dose than in the control group (83.8% vs. 31.5%; p < 0.001). After 6 months, significant reductions in mean HbA1C levels were observed in both groups: 1.49% (p < 0.001) for the intervention group and 1.08% (p < 0.001) for the control group. Furthermore, a mean reduction in FPG between group was achieved (34.96 mg/dL; p < 0.001).Conclusions:The eStar program is an effective way to help patients reach their optimal insulin glargine dose, besides improving their glycemic control.

Desarrollo y validación de un cuestionario específico de evaluación de la satisfacción del paciente diabético con glucómetros / Development and validation of a specific questionnaire to evaluate diabetic patient satisfaction with the use of glucometers

OBJETIVO: Desarrollar un cuestionario específico de evaluación de la satisfacción del paciente diabético con el uso del glucómetro y evaluar sus propiedades psicométricas (factibilidad, fiabilidad y validez). MATERIAL Y MÉTODOS: 1) Tras una revisión bibliográfica se construyó un banco de 53 ítems inicial. Un panel de 6 expertos y 50 pacientes concluyeron una versión del cuestionario de 25 ítems (dimensiones: satisfacción, molestias, valor añadido y aspecto). 2) Para la validación del instrumento se diseñó un estudio epidemiológico, multicéntrico y transversal de 2 meses de duración en el que participaron 283 pacientes mayores de edad con diabetes mellitus (DM) (tipo 1 y tipo 2) que usaban un glucómetro portátil. Se recogieron las respuestas al cuestionario SATIGLU, junto con variables complementarias en visita única. Para evaluar la fiabilidad Test-Retest, 51 pacientes han respondido al cuestionario tras 15 días de la primera visita. RESULTADOS: El cuestionario demuestra tener alta consistencia interna (α de Cronbach de 0,88). Además muestra correlación positiva y estadísticamente significativa con los cuestionarios de medida de la satisfacción del paciente con el tratamiento en general (SAT-Q) y con el tratamiento para la DM (DTSQs(c)). Se observaron diferencias estadísticamente significativas en la puntuación total del cuestionario en función del tipo de DM a favor de los DMT1 (z = 6,69; p = 0,000), y en hemoglobina glucosilada a favor de los pacientes con HbA1c < 7 (z = -3,13; p = 0,002). CONCLUSIONES: El cuestionario SATIGLU muestra unas adecuadas propiedades psicométricas como instrumento de evaluación de la satisfacción de los pacientes diabéticos con el uso del glucómetro

OBJECTIVE: The aim of the study was to develop a specific questionnaire to assess patient satisfaction with the use of glucometers, and to evaluate their psychometric properties (feasibility, reliability and validity). MATERIAL AND METHODS: (I) An initial 53 item bank was constructed from a systematic review of literature. A panel composed of 6 experts and 50 patients concluded a 25 item version of the questionnaire (dimensions: Satisfaction, inconveniences, added value and appearance). (II) In order to evaluate the psychometric properties, an epidemiological multi-centred, crosssectional and 2 month long study was designed, for which 283 patients 18 years or older who were suffering from DM (type 1 and 2) and using a portable glucometer were recruited. Responses to the questionnaire that was the purpose of the study were gathered, together with complementary variables in a single visit. To evaluate test-retest reliability, 51 patients responded again 15 days after initial visit. RESULTS: There was high internal consistency (Cronbach alpha = 0.88). Moreover, it showed a positive and statistically significant correlation with patient overall satisfaction (SAT-Q), and with patient treatment-satisfaction (DTSQs(c)) questionnaires. Statistically significant differences were found in SATIGLU total score depending on the type of DM, in favour of type 1 DM patients (z = 6.69; P = 0.000), and glycated haemoglobin favouring patients who observe a good control of their disease, HbA1c < 7 (z = -3.13; P = 0.002). CONCLUSION: The SATIGLU Questionnaire showed adequate psychometric properties as an evaluation tool of patient satisfaction with the use of glucometers

[Anthropometric measures of central abdominal fat and discriminant capacity for metabolic syndrome in a Spanish population]. / Índices antropométricos estimadores de la distribución adiposa abdominal y capacidad discriminante para el síndrome metabólico en población española.

INTRODUCTION: The metabolic syndrome (MS) carries an increased risk of cardiovascular disease and diabetes mellitus. Insulin resistance is probably the mechanism underlying the changes detected in lipid and carbohydrate metabolism in these patients, who have, as a common anthropometric feature, a predominantly increased abdominal fat distribution. PATIENTS AND METHODS: A total of 3316 patients were studied, of whom 63.40% were female and 36.60 male, with a mean age of 42.36±14.63 years, and a body mass index (BMI) of 32.76±6.81kg/m(2). Weight, height and waist circumference (CC) were measured using standard techniques. The waist/height (ICA) was calculated using two indicators, expressed as waist in cm divided by height in m(2), and as waist divided by height, both in cm. The prevalence of metabolic syndrome in the sample was 33.70%. In order to assess the predictive ability of BMI, ICA and CC to detect the existence of MS, receiver operating curves (ROC) were constructed and the areas under the curve (AUC) calculated for each anthropometric parameter. RESULTS: An AUC of 0.724 (95%CI: 0.706 to 0.742), P<.001, was obtained for CC, 0.709 (95%CI: 0.691 to 0.728), P<.001 for ICA with height in m(2), and 0.729 (95%CI: 0.711 to 0.747), P<.001 for ICA with height in cm, and for the BMI it was 0.680 (95%CI 0.661-0.699), P<.001. CONCLUSIONS: Anthropometric indices that assess abdominal fat distribution have a better predictive capacity for detecting MS, compared to total adiposity indicators such as BMI.

Índices antropométricos estimadores de la distribución adiposa abdominal y capacidad discriminante para el síndrome metabólico en población española / Anthropometric measures of central abdominal fat and discriminant capacity for metabolic syndrome in a Spanish population

INTRODUCCIÓN: El síndrome metabólico conlleva un aumento del riesgo de aparición de enfermedad cardiovascular y diabetes mellitus. La existencia de un estado de resistencia a la insulina es, probablemente, el mecanismo subyacente a las alteraciones del metabolismo lipídico e hidrocarbonado detectado en estos pacientes, que presentan, como característica antropométrica frecuente, una distribución adiposa de predominio abdominal. Pacientes y métodos Se estudia una muestra de 3.316 pacientes (63,40% mujeres y 36,60 varones) de 42,36 ± 14,63 años y un índice de masa corporal (IMC) de 32,76 ± 6,81 kg/m2; en todos los pacientes se determinaron peso, talla y circunferencia de cintura ( CC ) según técnicas estandarizadas; se calculó el índice cintura/altura (ICA) mediante 2 indicadores, expresado como cintura en cm dividido por la talla en m2, y como cintura dividido por la talla, ambos en cm. La prevalencia de síndrome metabólico en la muestra fue del 33,70%. Con objeto de valorar la capacidad predictiva de IMC, ICA y CC para la detección de la existencia de SM, se construyeron las curvas operador-receptor (COR) y se calcularon las áreas bajo la curva (ABC) para cada parámetro antropométrico. RESULTADOS: Se obtuvo un ABC de 0,724 (IC 95%: 0,706-0,742), p < 0,001 para CC, de 0,709 (IC 95%: 0,691-0,728), p < 0,001 para ICA, con talla en m2, y de 0,729 (IC 95%: 0,711-0,747), p < 0,001 para ICA, con talla en cm; el ABC para IMC fue de 0,680 (IC 95%: 0,661-0,699), p < 0,001. CONCLUSIONES: Los índices antropométricos que valoran la distribución adiposa abdominal presentan mejor capacidad predictiva para la detección de SM respecto a indicadores de adiposidad total como el IMC

INTRODUCTION: The metabolic syndrome (MS) carries an increased risk of cardiovascular disease and diabetes mellitus. Insulin resistance is probably the mechanism underlying the changes detected in lipid and carbohydrate metabolism in these patients, who have, as a common anthropometric feature, a predominantly increased abdominal fat distribution. PATIENTS AND METHODS: A total of 3316 patients were studied, of whom 63.40% were female and 36.60 male, with a mean age of 42.36 ± 14.63 years, and a body mass index (BMI) of 32.76 ± 6.81 kg/m2. Weight, height and waist circumference (CC) were measured using standard techniques. The waist/height (ICA) was calculated using two indicators, expressed as waist in cm divided by height in m2, and as waist divided by height, both in cm. The prevalence of metabolic syndrome in the sample was 33.70%. In order to assess the predictive ability of BMI, ICA and CC to detect the existence of MS, receiver operating curves (ROC) were constructed and the areas under the curve (AUC) calculated for each anthropometric parameter. RESULTS: An AUC of 0.724 (95%CI: 0.706 to 0.742), P < .001, was obtained for CC, 0.709 (95% CI: 0.691 to 0.728), P < .001 for ICA with height in m2, and 0.729 (95% CI: 0.711 to 0.747), P < .001 for ICA with height in cm, and for the BMI it was 0.680 (95% CI 0.661-0.699), P < .001. CONCLUSIONS: Anthropometric indices that assess abdominal fat distribution have a better predictive capacity for detecting MS, compared to total adiposity indicators such as BMI

Distribución de la circunferencia de la cintura y de la relación circunferencia de la cintura con respecto a la talla según la categoría del índice de masa corporal en los pacientes atendidos en consultas de endocrinología y nutrición / Distribution of waist circumference and waist-to-height ratio by categories of body mass index in patients attended in endocrinology and nutrition units

Introducción La circunferencia de cintura (CC) y la relación circunferencia de cintura/talla (CT) son medidas antropométricas muy utilizadas en la práctica clínica para valorar la grasa visceral y por tanto el riesgo cardiovascular. Sin embargo, los umbrales de riesgo para diferentes rangos de índice de masa corporal (IMC) no han sido suficientemente validados.ObjetivoDeterminar la distribución de CC y CT en función de los puntos de corte de IMC actualmente vigentes para definir el sobrepeso y la obesidad.Material y métodosSe determinó la CC, la CT y el IMC en 3521 pacientes adultos (mayores de 18 años) atendidos en las consultas de endocrinología y nutrición.ResultadosEl 20,8% (734) de los pacientes eran diabéticos. El 82,1% de los pacientes diabéticos eran obesos, así como el 75% de los no diabéticos. Los umbrales de riesgo (..) (AU)

Introduction Waist circumference (WC) and the waist-to-height ratio (WHtR) are anthropometric measures widely used in clinical practice to evaluate visceral fat and the consequent cardiovascular risk. However, risk thresholds should be standardized according to body mass index (BMI).ObjectiveTo determine the distribution of WC and WHtR according to the BMI cut-points currently used to describe overweight and obesity.Materials and methodsWC, WHtR and BMI were measured in 3521 adult patients (>18 years) attended in Endocrinology and Nutrition units.ResultsA total of 20.8% (734 patients) were diabetic. Obesity was found in 82.1% of diabetic patients and in 75% of non-diabetic patients. The WC thresholds proposed by the National Institute of Health (..) (AU)

[Distribution of waist circumference and waist-to-height ratio by categories of body mass index in patients attended in endocrinology and nutrition units]. / Distribución de la circunferencia de la cintura y de la relación circunferencia de la cintura con respecto a la talla según la categoría del índice de masa corporal en los pacientes atendidos en consultas de endocrinología y nutrición.

INTRODUCTION: Waist circumference (WC) and the waist-to-height ratio (WHtR) are anthropometric measures widely used in clinical practice to evaluate visceral fat and the consequent cardiovascular risk. However, risk thresholds should be standardized according to body mass index (BMI). OBJECTIVE: To determine the distribution of WC and WHtR according to the BMI cut-points currently used to describe overweight and obesity. MATERIALS AND METHODS: WC, WHtR and BMI were measured in 3521 adult patients (>18 years) attended in Endocrinology and Nutrition units. RESULTS: A total of 20.8% (734 patients) were diabetic. Obesity was found in 82.1% of diabetic patients and in 75% of non-diabetic patients. The WC thresholds proposed by the National Institute of Health (102 cm in men, 88 cm in women), Bray (100 cm in men, 90 cm in women) and the International Diabetes Federation (94 cm in men, 80 cm in women) were exceeded by 92.9%, 94.8% and 98.4% of obese men, 96.8%, 95.5% and 99.7% of obese women, 79.1%, 83.1% and 90% of diabetic men and 95.5%, 81.5% and 97.4% of diabetic women, respectively. Thresholds adapted to the degree of obesity (90, 100, 110 and 125 cm in men and 80, 90, 105 and 115cm in women for normal BMI, overweight, obesity I and obesity greater than I) were exceeded by 58.4% of obese men, 54.2% of obese women, 57.5% of diabetic men and 60.7% of diabetic women. WC was higher in men, and BMI and the WHtR were higher in women. The WC of diabetic women equalled that of men, and WC, WHtR and BMI were higher in diabetic than in non-diabetic women (p<0.001). WC (p<0.005), WHtR (p<0.001) and BMI (p<0.5) were also higher in diabetic than in non-diabetic men. CONCLUSION: WC and WHtR thresholds by BMI discriminated diabetic and obese patients better than single thresholds, and can be represented graphically by the distribution of percentile ranks of WC and WHtR by BMI.ik.

Losartan titration versus diuretic combination in type 2 diabetic patients.

METHODS: We compared the effects of Losartan dose titration to 100 mg versus the addition of 12.5 mg of hydrochlorothiazide, in 90 type 2 diabetic patients with microalbuminuria and blood pressure > 130/85 mmHg, receiving losartan 50 mg as initial treatment during 4 weeks. RESULTS: With the first dose of losartan, systolic (SBP) and diastolic blood pressure (DBP) decreased from 154.5 (152.1-157.5) to 144.4 (141.3-147.5) mmHg (P < 0.001) and from 91.1 (89.4-92.8) to 84.6 (82.8-86.4) mmHg (P < 0.001), with 20 patients attaining the expected goal blood pressure (< 130/85 mmHg); albuminuria decreased from 109.8 (90.5-133.3) to 83.5 (63.6-109.5) mg per 24 h (P = 0.006). Patients not attaining the target blood pressure were randomly allocated to titration or to the combination arm. After an additional 4 weeks, patients titrated exhibited a fall in SBP and DBP from 157.1 (152.7-161.5) to 142.1 (136.4-147.8) mmHg (P < 0.001) and from 92.4 (89.5-95.3) to 83.6 (81.1-86.1) mmHg (P < 0.001); albuminuria decreased from 136.3 (97.8-189.9) to 99.7 (69.3-143.4) mg per 24 h (P = 0.002). In the combination arm, there were similar reductions in SBP and DBP from 155.3 (151.5-159.1) to 139.1 (132.1-146.1) mmHg (P < 0.001) and from 92.1 (89.3-94.9) to 80.9 (77.4-84.4) mmHg (P < 0.001); while albuminuria fell from 107.7 (82.2-141.0) to 64.2 (45.9-89.9) mg per 24 h (P = 0.001). CONCLUSIONS: Losartan 50 mg was effective in reducing blood pressure and albuminuria in type 2 diabetic patients. When the blood pressure target was not reached, the two strategies tested seem to contribute similarly to further reductions in blood pressure and albuminuria.