GLP1 Receptor Agonist and SGLT2 Inhibitor Combination: An Effective Approach in Real-world Clinical Practice.

PURPOSE: The aim of this study was to evaluate the effectiveness and safety of combination therapy with a sodium-glucose cotransporter-2 (SGLT2) inhibitor and a glucagon-like peptide-1 receptor agonist (GLP1RA) in patients with inadequately controlled type 2 diabetes. METHODS: A retrospective search of electronic prescriptions of patients undergoing GLP1RA and SGLT2 inhibitor combination therapy was conducted. Once the patients had been identified, demographic data, blood and urine analyses (glycosylated hemoglobin [HbA1c], glucose, renal function, albuminuria, lipid profile, liver enzymes, and uric acid), physical examination (weight, body mass index, and blood pressure), and adverse effects were obtained from their electronic clinical records according to each of the following 3 periods: before the initiation of the combination, the first visit after initiation, and the last available visit. The influence of the duration of diabetes and the drug combination sequence on the effectiveness of the treatment was also analyzed. Statistical analysis was performed with SPSS version 21.0 (IBM SPSS Statistics, IBM Corporation, Armonk, New York). Quantitative variables are presented as mean and SD and were compared by using the Student t test, one-way ANOVA, or repeated measures ANOVA with Bonferroni correction. Categorical variables are expressed as percentages and were compared by using the χ2 test. RESULTS: A total of 212 patients were included, with women accounting for 52.4%. The mean age (SD) of the population was 61.5 (9.6) years. A significant reduction in HbA1c (-12 mmol/mol [-1.1%]) was observed with combined therapy (P < 0.001). The target of HbA1c <53 mmol/mol (<7%) was achieved in 42% of the participants. Mean weight loss was -3.5 kg, and almost 40% of the patients attained the weight loss goal of ≥5% (P < 0.001 in all analyses). Transaminase levels and renal parameters also improved. These benefits persisted over time and bore no relation to the evolution of diabetes. Simultaneous initiation of a combination of a GLP1RA and SGLT2 inhibitor led to faster weight loss and a greater decrease in HbA1c than when they are used sequentially; however, the long-term benefits in terms of metabolic control were similar. Adverse events were rare, and a tendency for a reduced insulin dose was observed. IMPLICATIONS: The findings of this study reveal the combined benefits of a GLP1RA and SGLT2 inhibitor in real-world clinical practice. In general, the combined treatment was well tolerated, and few adverse events were detected.

Novel TMEM127 Variant Associated to Bilateral Phaeochromocytoma with an Uncommon Clinical Presentation.

Phaeochromocytomas and paragangliomas are rare catecholamine-secreting tumours arising from the adrenal medulla or sympathetic paraganglia. It is known that 20-30% of all cases occur as a result of germline variants in several well known genes. The TMEM127 gene was recently identified as a new phaeochromocytoma susceptibility gene. However, until a larger sample of cases is available, the prevalence, genotype-phenotype correlation, and a clear predominant biochemical pattern of TMEM127-related PCC, remain to be defined. We present a woman with the pathogenic variant c.86delG (p.Arg29Leufs∗52) in the TMEM127 gene, which has not been previously reported, associated to a bilateral phaeochromocytoma, with an uncommon initial clinical presentation and a biochemical profile that is distinctly adrenergic. Her two young children carry the same variant and are, at present, disease-free. Physicians should be aware that phaeochromocytoma can manifest in an atypical manner, as with episodic hypotension, mainly if the symptoms have no obvious aetiology and they worsen over time. This case also supports the presence of a predominant adrenaline secreting pattern in TMEM127-positive tumours, as well as the need to consider multigene panel testing in patients with bilateral phaeochromocytomas.

Epidemiology of home enteral nutrition: an approximation to reality.

INTRODUCTION: home enteral nutrition (HEN) has undergone an important development; however, there is a notable lack of information with regard to its incidence and characteristics. OBJECTIVES: our aim was to assess the state of HEN in our area. METHODS: an observational, prospective study, involving all patients who had initiated HEN in the Nutrition Unit during a year. Epidemiological, functional, and nutritional evolution of the patients was described and incidence of HEN was calculated. RESULTS: HEN incidences totalled 229/100,000 inhabitants/year. The HEN population in our area was characterized by the aged and a high frequency of comorbidity and functional limitations. Neurological and oncological diseases accounted for 50% of indications. The remaining cases were malnourished patients who had received short periods of HEN after hospitalization or a hip fracture. Oral supplements (60%) with standard and hypercaloric formulas were used the most. At baseline, 75% of the patients suffered from malnutrition. During the follow-up, patients showed weight gain (1.6%), an increase in the percentage of normal weight and overweight (from 74% to 82.7%, p = 0.001) and a reduction in pressure ulcers (15.7% vs10.3%, p < 0.001). The median duration of HEN was 8.5 months. Only a quarter of the patients experienced complications (mostly mild gastrointestinal complications); 43.1% had died at the end of the follow-up. CONCLUSIONS: in our area, the HEN incidence was much higher than those described in the literature. HEN appears to be a safe therapy with few complications that improves the nutritional status of the patients, even with short periods of administration.

Epidemiology of home enteral nutrition: an approximation to reality / Epidemiología de la nutrición enteral domiciliaria: una aproximación a la realidad

Introduction: home enteral nutrition (HEN) has undergone an important development; however, there is a notable lack of information with regard to its incidence and characteristics. Objectives: our aim was to assess the state of HEN in our area. Methods: an observational, prospective study, involving all patients who had initiated HEN in the Nutrition Unit during a year. Epidemiological, functional, and nutritional evolution of the patients was described and incidence of HEN was calculated. Results: HEN incidences totalled 229/100,000 inhabitants/year. The HEN population in our area was characterized by the aged and a high frequency of comorbidity and functional limitations. Neurological and oncological diseases accounted for 50% of indications. The remaining cases were malnourished patients who had received short periods of HEN after hospitalization or a hip fracture. Oral supplements (60%) with standard and hypercaloric formulas were used the most. At baseline, 75% of the patients suffered from malnutrition. During the follow-up, patients showed weight gain (1.6%), an increase in the percentage of normal weight and overweight (from 74% to 82.7%, p = 0.001) and a reduction in pressure ulcers (15.7% vs10.3%, p < 0.001). The median duration of HEN was 8.5 months. Only a quarter of the patients experienced complications (mostly mild gastrointestinal complications); 43.1% had died at the end of the follow-up. Conclusions: in our area, the HEN incidence was much higher than those described in the literature. HEN appears to be a safe therapy with few complications that improves the nutritional status of the patients, even with short periods of administration

Introducción: la nutrición enteral domiciliaria (NED) ha experimentado un importante desarrollo, aunque aún existe una notable carencia de información acerca de su incidencia y características. Objetivos: evaluar el estado de la NED en nuestra área. Métodos: estudio observacional y prospectivo que incluyó a todos los pacientes que iniciaron NED en el periodo de un año. Describimos su evolución epidemiológica, funcional y nutricional y calculamos la incidencia de NED. Resultados: la incidencia de NED alcanzó los 229/100.000 habitantes/año. La población con NED se caracterizó por ser añosa, con una elevada frecuencia de comorbilidad y limitación funcional. Las enfermedades neurológicas y oncológicas representaron el 50% de las indicaciones. El resto fueron pacientes malnutridos que recibieron periodos cortos de NED tras una hospitalización o fractura de cadera. Los suplementos orales con fórmulas estándar o hipercalóricas fueron los más utilizados (60%). Al inicio, el 75% de los pacientes tenía malnutrición. En el seguimiento, los pacientes lograron aumento de peso (1,6%) y mayor porcentaje de normopeso o sobrepeso (de 74% a 82,7%, p = 0,001). Las úlceras por presión se redujeron (15,7% vs. 10,3%, p < 0,001). La duración mediana de NED fue 8,5 meses. Solo una cuarta parte de los pacientes experimentaron complicaciones, la mayoría de ellas gastrointestinales y leves. El 43,1% había fallecido al final del seguimiento. Conclusiones: en nuestra área, la incidencia de NED es más elevada respecto a lo descrito en la literatura. La NED es un tratamiento seguro con pocas complicaciones que mejora el estado nutricional de los pacientes, incluso con periodos cortos de administración

ECONOMIC BURDEN OF HOME ARTIFICIAL NUTRITION IN THE HEALTH AREA OF SANTIAGO DE COMPOSTELA.

INTRODUCTION: home artificial nutrition (HAN) is a growing therapy, but the absence of obligatory registries complicates the calculation of its real economic burden. The aim of this study was to assess the state and economic impact of HAN in our health area. METHODS: an observational, prospective study was designed to calculate the cost of nutritional formulas and materials in patients who initiated HAN in the nutrition unit during a year. RESULTS: we included 573 new patients with HAN during the study period, 60% of whom were treated with oral supplements. The median daily cost of oral HAN was 3.65 (IQR 18.63) euros compared to a cost of 8.86 (IQR 20.02) euros for enteral-access HAN. The daily expenditure per 1 000 kcal of diet was higher for patients on oral HAN than for patients with tubes (5.13 vs. 4.52 euros, p < 0.001). The median cost of the complete HAN treatments during the study period was also calculated (186.60 euros and 531.99 euros for oral and tube HAN, respectively). The total estimated cost for all patients who initiated HAN in the study period was around one million euros. CONCLUSIONS: HAN represented an important economic burden in our health area, but the estimated daily cost of HAN was moderate, probably because of the high frequency of oral HAN, the adjusted treatments, and the centralized dispensation by the hospital pharmacy.

Introducción: la nutrición artificial domiciliaria (NAD) es una terapia en creciente desarrollo, pero la ausencia de registros obligatorios hace difícil calcular la carga económica que implica. Nuestro objetivo es evaluar el estado y el impacto económico de la NAD en nuestra área sanitaria. Métodos: estudio observacional y prospectivo diseñado para estimar el gasto en fórmulas y materiales nutricionales en los pacientes que iniciaron NAD durante 1 año. Resultados: se incluyeron 573 pacientes que iniciaron NAD en el período de estudio. El 60% recibieron suplementos orales. La mediana de gasto diario fue de 3,65 (RIC 18,63) euros en la NAD oral y de 8,86 (RIC 20,02) euros en la NAD por acceso enteral. El gasto por 1.000 kcal de dieta fue superior en los pacientes con NAD oral respecto a los pacientes con NAD enteral (5,13 vs. 4,52 euros, p < 0.001). Asimismo se calculó la mediana de gasto completo de los tratamientos durante todo el período de estudio (186,60 euros y 531,99 euros en NAD oral y enteral, respectivamente). Considerando el gasto conjunto de todos los pacientes que iniciaron NAD en el período de estudio, el gasto estimado estaría en torno a un millón de euros. Conclusiones: la NAD representa una importante carga económica en nuestra área sanitaria. Sin embargo, el gasto diario estimado fue moderado, probablemente por la elevada proporción de NAD oral en nuestra muestra, la revisión frecuente de la indicación y la centralización de la dispensación desde el servicio de Farmacia Hospitalaria.

Economic burden of home artificial nutrition in the health area of Santiago de Compostela / Impacto económico de la nutrición artificial domiciliaria en el área sanitaria de Santiago de Compostela

Introduction: home artificial nutrition (HAN) is a growing therapy, but the absence of obligatory registries complicates the calculation of its real economic burden. The aim of this study was to assess the state and economic impact of HAN in our health area. Methods: an observational, prospective study was designed to calculate the cost of nutritional formulas and materials in patients who initiated HAN in the nutrition unit during a year. Results: we included 573 new patients with HAN during the study period, 60% of whom were treated with oral supplements. The median daily cost of oral HAN was 3.65 (IQR 18.63) euros compared to a cost of 8.86 (IQR 20.02) euros for enteral-access HAN. The daily expenditure per 1 000 kcal of diet was higher for patients on oral HAN than for patients with tubes (5.13 vs. 4.52 euros, p <0.001). The median cost of the complete HAN treatments during the study period was also calculated (186.60 euros and 531.99 euros for oral and tube HAN, respectively). The total estimated cost for all patients who initiated HAN in the study period was around one million euros. Conclusions: HAN represented an important economic burden in our health area, but the estimated daily cost of HAN was moderate, probably because of the high frequency of oral HAN, the adjusted treatments, and the centralized dispensation by the hospital pharmacy (AU)

Introducción: la nutrición artificial domiciliaria (NAD) es una terapia en creciente desarrollo, pero la ausencia de registros obligatorios hace difícil calcular la carga econó- mica que implica. Nuestro objetivo es evaluar el estado y el impacto económico de la NAD en nuestra área sanitaria. Métodos: estudio observacional y prospectivo diseñado para estimar el gasto en fórmulas y materiales nutricionales en los pacientes que iniciaron NAD durante 1 año. Resultados: se incluyeron 573 pacientes que iniciaron NAD en el período de estudio. El 60% recibieron suplementos orales. La mediana de gasto diario fue de 3,65 (RIC 18,63) euros en la NAD oral y de 8,86 (RIC 20,02) euros en la NAD por acceso enteral. El gasto por 1.000 kcal de dieta fue superior en los pacientes con NAD oral respecto a los pacientes con NAD enteral (5,13 vs. 4,52 euros, p<0.001). Asimismo se calculó la mediana de gasto completo de los tratamientos durante todo el período de estudio (186,60 euros y 531,99 euros en NAD oral y enteral, respectivamente). Considerando el gasto conjunto de todos los pacientes que iniciaron NAD en el período de estudio, el gasto estimado estaría en torno a un millón de euros. Conclusiones: la NAD representa una importante carga económica en nuestra área sanitaria. Sin embargo, el gasto diario estimado fue moderado, probablemente por la elevada proporción de NAD oral en nuestra muestra, la revisión frecuente de la indicación y la centralización de la dispensación desde el servicio de Farmacia Hospitalaria (AU)

Incidentaloma suprarrenal unilateral como presentación de tuberculosis adrenal / Unilateral adrenal incidentaloma as a presentation adrenal tuberculosis

Los incidentalomas suprarrenales son tumores que se detectan durante una prueba radiológica realizada por motivos distintos del estudio de la glándula suprarrenal. El uso extenso de la ecografía, la tomografía computarizada (TC) y la resonancia magnética ha dado lugar a un aumento en el diagnóstico de estas masas. Presentamos el caso de una mujer de 69 años con un incidentaloma suprarrenal izquierdo, que simulaba un adenoma no funcionante, y con atrofia en la adrenal derecha. Los resultados de la TC con contraste y, posteriormente, el estudio histopatológico confirmaron el diagnóstico de tuberculosis suprarrenal. El estudio hormonal reveló una insuficiencia suprarrenal parcial como resultado de la afección bilateral característica de la tuberculosis suprarrenal (AU)

Adrenal incidentalomas are adrenal masses detected during radiologic examination performed for an indication other than evaluation of adrenal disease. Diagnosis of these masses has increased due to the widespread use of ultrasonography, computed tomography (CT) and magnetic resonance imaging. We report the case of a 69-year-old woman with a left adrenal incidentaloma simulating a non-functioning adenoma and right adrenal atrophy. The results of contrast-enhanced CT and subsequent histopathological study confirmed the diagnosis of adrenal tuberculosis. Hormonal study revealed partial adrenal insufficiency as a result of bilateral involvement of the adrenal tuberculosis (AU)

Unilateral adrenal incidentaloma as a presentation of adrenal tuberculosis.

Adrenal incidentalomas are adrenal masses detected during radiologic examination performed for an indication otherthan evaluation of adrenal disease. Diagnosis of these masses has increased due to the widespread use of ultrasonography, computed tomography (CT) and magnetic resonance imaging. We report the case of a 69-year-old woman with a left adrenal incidentaloma simulating a non-functioning adenoma and right adrenal atrophy. The results of contrast-enhanced CT and subsequent histopathological study confirmed the diagnosis of adrenal tuberculosis. Hormonal study revealed partial adrenal insufficiency as a result of bilateral involvement of the adrenal tuberculosis.