RESUMO
Antecedentes y objetivo:La enfermedad microvascular (EMV) diabética ha sido asociada con una fragilidad ósea incrementada. El objetivo fue analizar la relación entre la EMV y la microestructura trabecular -evaluada mediante el índice trabecular óseo (trabecular bone score, TBS)- en pacientes diabéticos tipo 2 (DM2). Adicionalmente, conocer la relación entre la vitamina D y la EMV.Pacientes y métodos:Diseño transversal analítico, que incluyó varones > 50 años y mujeres postmenopáusicas con DM2, participantes en una cohorte poblacional. Se clasificó como EMV+ la presencia de nefropatía, neuropatía y/o retinopatía. Fueron analizadas variables clínicas, de laboratorio, el TBS, la 25-hidroxivitamina D [25(OH)D] y la densidad mineral ósea (DMO). Se realizaron análisis bivariable y multivariable.Resultados:Fueron evaluados 361 pacientes (51,1% mujeres), de 63,8 (9) años. De ellos, 92 tenían EMV, con un peor control metabólico, mayor duración de la DM2, menor TBS (1,235 [0,1] vs. 1,287 [0,1]; p=0,003) y menores niveles de 25(OH)D (18,3 [7] vs. 21,6 [8] ng/mL; p=0,0001). No hubo diferencias entre EMV+ y EMV- en la DMO ni en los marcadores P1NP y β-CTX. Tras ajustar por confusores, incluyendo HbA1c y duración de la DM2, el TBS en EMV+ fue 1,252 (IC 95% 1,230-1,274) vs. 1,281 (IC 95% 1,267-1,295) en EMV- (p=0,034). La EMV se asoció a un nivel de 25(OH)D < 20 ng/mL con una OR ajustada=1,88 (IC 95% 1,06-3,31; p=0,028).Conclusiones:Los pacientes con EMV presentaron un TBS significativamente menor, tras ajustar por confusores. El análisis multivariable mostró asimismo una asociación significativa entre un nivel bajo de 25(OH)D y la EMV prevalente. (AU)
Background and objective:Diabetic microvascular disease (MVD) has been associated with increased bone fragility. The objective was to analyse the relationship between MVD and trabecular microstructure -assessed by the trabecular bone score (TBS)- in type 2 diabetic (T2D) patients. A second aim was to know the relationship between vitamin D and MVD.Patients and methods:Cross-sectional study, which included men >50 years and postmenopausal women participating in a population-based cohort, diagnosed with T2D. The presence of nephropathy, neuropathy and/or retinopathy was classified as MVD+. Clinical and laboratory variables, TBS, 25(OH)D and BMD by DXA, were evaluated. Bivariate and multivariate analysis were performed.Results:We evaluated 361 patients (51.1% women), 63.8 (9) years old. Of them, 92 were MVD+ and presented poorer metabolic control, longer duration of T2D, lower TBS [1.235 (.1) vs. 1.287 (.1); p=.007] and lower levels of 25(OH)D [18.3 (7) vs. 21.6 (8) ng/ml; p=.0001). There were no differences between MVD+ and MVD- with regard to BMD or P1NP and β-CTX markers. After adjusting for confounders, including HbA1c and duration of T2D, the TBS value in MVD+ was 1.252 (95% CI 1.230-1.274) vs. 1.281 (95% CI 1.267-1.295) in MVD- (p=.034). MVD was associated with a 25(OH)D level <20 ng ml with an adjusted OR of 1.88 (95% CI 1.06-3.31; p=.028).Conclusions:The MVD+ patients presented a significantly lower TBS, after adjusting for confounders. Furthermore, multivariable analysis showed a significant relationship between a low 25(OH)D level and a prevalent MVD. (AU)
Assuntos
Humanos , Absorciometria de Fóton , Densidade Óssea , Osso Esponjoso , Diabetes Mellitus Tipo 2/complicações , Vitamina D , Estudos Retrospectivos , CalcifediolRESUMO
BACKGROUND AND OBJECTIVE: Diabetic microvascular disease (MVD) has been associated with increased bone fragility. The objective was to analyse the relationship between MVD and trabecular microstructure -assessed by the trabecular bone score (TBS)- in type 2 diabetic (T2D) patients. A second aim was to know the relationship between vitamin D and MVD. PATIENTS AND METHODS: Cross-sectional study, which included men >50 years and postmenopausal women participating in a population-based cohort, diagnosed with T2D. The presence of nephropathy, neuropathy and/or retinopathy was classified as MVD+. Clinical and laboratory variables, TBS, 25(OH)D and BMD by DXA, were evaluated. Bivariate and multivariate analysis were performed. RESULTS: We evaluated 361 patients (51.1% women), 63.8 (9) years old. Of them, 92 were MVD+ and presented poorer metabolic control, longer duration of T2D, lower TBS [1.235 (.1) vs. 1.287 (.1); p=.007] and lower levels of 25(OH)D [18.3 (7) vs. 21.6 (8) ng/ml; p=.0001). There were no differences between MVD+ and MVD- with regard to BMD or P1NP and ß-CTX markers. After adjusting for confounders, including HbA1c and duration of T2D, the TBS value in MVD+ was 1.252 (95% CI 1.230-1.274) vs. 1.281 (95% CI 1.267-1.295) in MVD- (p=.034). MVD was associated with a 25(OH)D level <20 ng ml with an adjusted OR of 1.88 (95% CI 1.06-3.31; p=.028). CONCLUSIONS: The MVD+ patients presented a significantly lower TBS, after adjusting for confounders. Furthermore, multivariable analysis showed a significant relationship between a low 25(OH)D level and a prevalent MVD.
Assuntos
Osso Esponjoso , Diabetes Mellitus Tipo 2 , Absorciometria de Fóton , Densidade Óssea , Calcifediol , Criança , Estudos Transversais , Diabetes Mellitus Tipo 2/complicações , Feminino , Humanos , Vértebras Lombares , Masculino , Vitamina D/análogos & derivadosRESUMO
Objetivo: describir la participación de las enfermeras de Cantabria en el Sistema de Farmacovigilancia Español mediante la notificación de sospechas de reacciones adversas a medicamentos (RAM) y determinar si su ámbito laboral influye en la notificación de las RAM graves. Método: estudio descriptivo longitudinal retrospectivo de las sospechas de RAM notificadas por profesionales enfermeros al Centro de Farmacovigilancia de Cantabria, entre 2010 y 2016. Se estudiaron variables relacionadas con la RAM (medicamento implicado, síntomas y gravedad) y el ámbito profesional de la enfermera que realizó la notificación. Se llevó a cabo estadística descriptiva y prueba de contraste de hipótesis Chi cuadrado de Pearson para determinar la asociación entre la gravedad de las sospechas de RAM y el ámbito profesional del notificador. Resultados: de las 3.008 notificaciones de sospechas de RAM recogidas en el Centro de Farmacovigilancia de Cantabria entre 2010 y 2016, las enfermeras aportaron 34, lo que supuso un 1,1% del total de notificaciones recibidas. El 59% fue clasificada como grave y de ellas el 70% provenía del ámbito hospitalario, sin encontrarse diferencias estadísticamente significativas entre la gravedad de la RAM y el ámbito profesional donde se notificó (p= 0,51). Conclusiones: la participación de las enfermeras cántabras en el Sistema de Farmacovigilancia Español es mínima. La mayoría de notificaciones es grave y proviene del ámbito hospitalario. Es necesario indagar acerca de las razones de la infranotificación, así como establecer medidas formativas e informativas dirigidas al colectivo enfermero en materia de farmacovigilancia
Objective: to describe the participation of Cantabrian nurses in the Spanish Pharmacovigilance System through reporting suspected drug-related adverse events (DRAEs), and to determine if their work setting has an impact on reporting severe DRAEs. Method: a descriptive cross-sectional retrospective study of the suspected DRAEs reported by nursing professionals to the Pharmacovigilance Centre in Cantabria between 2010 and 2016. Variables associated with the DRAE were studied (medication involved, symptoms and severity), and the professional setting of the reporting nurse. Descriptive statistics and Pearsons Chi Square hypothesis contrast test were used to determine any association between the severity of suspected DRAEs and the professional setting of the reporter. Results: nurses contributed 34 out of the 3,008 reports of suspected DRAEs collected at the Pharmacovigilance Centre of Cantabria between 2010 and 2016; this represented 1.1% of the total reports received. Of these, 59% were classified as severe, and 70% of them came from the hospital setting; no statistically significant differences were found between DRAE severity and the professional setting where it was reported (p= 0.51). Conclusions: there is a minimal participation of Cantabrian nurses in the Spanish Pharmacovigilance System. The majority of reports were severe and came from the hospital setting. It is necessary to find out the reasons for this under-reporting, as well as to implement training and informative measures targeted to the nursing community in terms of pharmacovigilance
