Pauta óptima de administración de insulina detemir en sujetos diabéticos tipo 1 con mal control metabólico / Optimal timing of insulin detemir injection in patients with type 1 diabetes and poor metabolic control

Objetivo El objetivo de este estudio fue comparar diversos regímenes de administración de la insulina detemir (IDet) en pacientes con diabetes tipo I y mal control metabólico.Material y métodosEstudio abierto aleatorizado de 24 semanas de duración. Se incluyeron 39 pacientes con diabetes mellitus (DM) tipo I aleatorizados a una inyección de IDet antes de la comida (14,24±00,36[±SD]h) o IDet antes de acostarse (23,19±0,42h). Si no se alcanzaban los objetivos de glucemia, se cambió a la pauta con 2 inyecciones (IDet-12h). En las comidas se administró insulina aspart.ResultadosEn la semana 24 solamente un 12,2% de los pacientes permanecían en el grupo IDet antes de acostarse y un 30,3% en el grupo IDet antes de la comida. El 57,5% restantes pasaron al grupo de IDet-12h. No hubo diferencias entre el grupo de IDet antes de la comida e IDet antes de acostarse. Un subanálisis incluyendo los 3 grupos demostró un mejor control metabólico en el grupo IDet antes de la comida (hemoglobina glicosilada (HbA1c) 7,1±0,2 vs. 7,6±0,4 y 8,1±0,2%, en IDet antes de la comida, IDet antes de acostarse e IDet-12h, respectivamente; p<0,05). El valor de HbA1c inferior a 7%, fue alcanzado en un 30,3% de los pacientes, un 15,2% en el grupo IDet antes de la comida, un 3,3% en el grupo IDet antes de acostarse y 11,5% en grupo IDet-12h. No se encontraron diferencias entre los grupos del tratamiento respecto a la calidad de vida.ConclusiónUna inyección de IDet administrada antes de la comida podría mejorar el control metabólico. Sin embargo, la mayoría de pacientes requiere 2 inyecciones de IDet (AU)

Aim To compare different administration times of insulin detemir (IDet) in patients with type 1 diabetes and poor metabolic control.Material and MethodsThis 24-week open study included 39 people with type 1 diabetes mellitus (DM) randomized to one injection of IDet before lunch (mean 14.24±00.36 (±SD) h) or at bedtime (23.19±0.42h). Whenever target glycemia levels were not reached, the regimen was switched to insulin therapy with two injections (IDet-12h). Insulin aspart was used before main meals.ResultsAt week 24, only 12.2% of patients remained in the IDet bedtime group and 30.3% in the IDet before lunch group. The remaining 57.5% joined the IDet-12h group. There were no differences between the IDet before lunch and IDet bedtime groups. A subanalysis including the three groups demonstrated better metabolic control in the IDet before lunch group (glycosylated hemoglobin (HbA1c) 7.1±0.2 vs. 7.6±0.4 and 8.1±0.2% in IDet before-lunch, IDet bedtime and IDet-12h, respectively; p<0.05). An HbA1c value below 7% was achieved in 30.3% of the patients: 15.2% in the IDet before-lunch group, 3.3% in the IDet bedtime group and 12.2% in IDet-12h group. Quality of life did not differ among treatment groups.ConclusionsOne injection of IDet administered before lunch could improve metabolic control. However, most patients required two injections of IDet(AU)

[Optimal timing of insulin detemir injection in patients with type 1 diabetes and poor metabolic control]. / Pauta óptima de administración de insulina detemir en sujetos diabéticos tipo 1 con mal control metabólico.

AIM: To compare different administration times of insulin detemir (IDet) in patients with type 1 diabetes and poor metabolic control. MATERIAL AND METHODS: This 24-week open study included 39 people with type 1 diabetes mellitus (DM) randomized to one injection of IDet before lunch (mean 14.24 + or - 00.36 (+ or - SD) h) or at bedtime (23.19 + or - 0.42 h). Whenever target glycemia levels were not reached, the regimen was switched to insulin therapy with two injections (IDet-12h). Insulin aspart was used before main meals. RESULTS: At week 24, only 12.2% of patients remained in the IDet bedtime group and 30.3% in the IDet before lunch group. The remaining 57.5% joined the IDet-12h group. There were no differences between the IDet before lunch and IDet bedtime groups. A subanalysis including the three groups demonstrated better metabolic control in the IDet before lunch group (glycosylated hemoglobin (HbA1c) 7.1 + or - 0.2 vs. 7.6 + or - 0.4 and 8.1 + or - 0.2% in IDet before-lunch, IDet bedtime and IDet-12h, respectively; p<0.05). An HbA1c value below 7% was achieved in 30.3% of the patients: 15.2% in the IDet before-lunch group, 3.3% in the IDet bedtime group and 12.2% in IDet-12h group. Quality of life did not differ among treatment groups. CONCLUSIONS: One injection of IDet administered before lunch could improve metabolic control. However, most patients required two injections of IDet.

[Pegylated-interferon alpha plus ribavirin-induced subacute thyroiditis in chronic hepatitis C]. / Tiroiditis subaguda inducida por el tratamiento con interferón alfa pegilado y ribavirina en un caso de hepatitis crónica por virus C.

Chronic hepatitis C virus infection may be associated with extrahepatic manifestations. Thyroid disease related to chronic hepatitis C virus infection has been associated with interferon-alpha treatment. We present the case of a 40-year-old woman with chronic hepatitis C virus infection, who developed subacute thyroiditis during treatment with pegylated interferon-alpha plus ribavirin.

Tiroiditis subaguda inducida por el tratamiento con interferón alfa pegilado y ribavirina en un caso de hepatitis crónica por virus C / Pegylated-interferon alpha plus ribavirin-induced subacute thyroiditis in chronic hepatitis C

La infección crónica por el virus de la hepatitis C puede acompañarse de manifestaciones extrahepáticas. En especial se ha relacionado la enfermedad tiroidea con el tratamiento con interferón alfa. Se presenta el caso de una mujer de 40 años con infección por el virus de la hepatitis C, que desarrolló un cuadro de tiroiditis subaguda durante el tratamiento con interferón alfa pegilado y ribavirina (AU)

Chronic hepatitis C virus infection may be associated with extrahepatic manifestations. Thyroid disease related to chronic hepatitis C virus infection has been associated with interferon-alpha treatment. We present the case of a 40-year-old woman with chronic hepatitis C virus infection, who developed subacute thyroiditis during treatment with pegylated interferon-alpha plus ribavirin (AU)

Desnutrición caloricoproteínica grave tras bypass gástrico / Severe protein-calorie malnutrition after gastric bypass

La cirugía bariátrica da lugar a una pérdida de peso que perdura y mejora las comorbilidades de la obesidad mórbida. Pueden darse complicaciones tras ella, la mayoría nutricionales y de carácter leve, pero en algunos casos pueden ser graves y comprometer la vida del paciente. Se presenta el caso de una mujer de 50 años en quien se desarrolló desnutrición caloricoproteínica grave tras cirugía bariátrica y que precisó que se revirtiera la intervención. Se discuten los factores que dieron lugar a la desnutrición y las opciones de tratamiento (AU)

Bariatric surgery achieves lasting weight loss and improves the comorbidities associated with morbid obesity. After surgery, patients can develop complications, mainly mild nutritional alterations. However, in some patients, complications can be serious and life-threatening. We present the case of a 50-year-old woman who developed severe protein-calorie malnutrition after bariatric surgery, which required surgical reversion. The factors leading to malnutrition in this patient and the treatment options are discussed (AU)

Severe protein-calorie malnutrition after gastric bypass.

Bariatric surgery achieves lasting weight loss and improves the comorbidities associated with morbid obesity. After surgery, patients can develop complications, mainly mild nutritional alterations. However, in some patients, complications can be serious and lifethreatening. We present the case of a 50-year-old woman who developed severe protein-calorie malnutrition after bariatric surgery, which required surgical reversion. The factors leading to malnutrition in this patient and the treatment options are discussed.

Hypogonadotropic hypogonadism in a patient with morbid obesity.

Obesity has recently become one of the most important public health problems. It is associated with a high rate of mortality, mainly because of cardiovascular disease, and can cause hormonal abnormalities such as hypogonadotropic hypogonadism. Weight loss is very beneficial for obese patients, because it results in improvement or even normalization of these conditions. In this report, we describe a morbidly obese patient with hypogonadotropic hypogonadism, which was probably caused by hyperprolactinemia and exacerbated by obesity-induced hormonal imbalances. After medical treatment for hyperprolactinemia and bariatric surgery, the patient's hormonal status became normal. Although morbid obesity can cause hypogonadotropic hypogonadism in men, the differential diagnosis should include other potential causes of hypogonadism if free testosterone levels are below normal.

[Lung transplantation and the development of diabetes mellitus in adult patients with cystic fibrosis]. / Importancia del trasplante pulmonar en la aparición de diabetes mellitus en pacientes adultos con fibrosis quística.

OBJECTIVE: The prevalence of diabetes mellitus is higher in patients with cystic fibrosis than in the general population. Solid organ transplantation is a significant risk factor for diabetes mellitus, which has been linked to type of immunosuppression. The aim of this study was to analyze whether lung transplantation represents a significant risk factor for the onset of abnormal carbohydrate metabolism in cystic fibrosis, whether it affects severity of alterations, and whether there is a relation to type of immunosuppression. PATIENTS AND METHODS: The following data were extracted retrospectively for 54 patients with cystic fibrosis: type of carbohydrate metabolism alteration and treatment received, whether or not transplantation took place, and type of immunosuppression used. RESULTS: Twenty of the 54 patients (37%) underwent lung transplantation; 18 of them (89%) developed diabetes mellitus. Eight of the patients (24%) who did not receive a lung developed diabetes and 10 (29%) displayed carbohydrate intolerance (P< .01, chi(2) test). Insulin was administered to 36.3% of nontransplanted patients and 78.6% of transplanted patients. The influence of immunosuppressant used was analyzed in 15 patients. Nine out of 10 patients (90%) treated with cyclosporine and 4 out of 5 (80%) of those treated with tacrolimus developed diabetes mellitus. All received the same regimen of corticosteroid therapy. CONCLUSIONS: For cystic fibrosis patients, lung trans-plantation is a significant risk factor for developing abnormal carbohydrate metabolism and it influences severity and treatment. No significant differences in the frequency of development of diabetes mellitus were found in relation to type of immunosuppression.

Importancia del trasplante pulmonar en la aparición de diabetes mellitus en pacientes adultos con fibrosis quística / Lung transplantation and the development of diabetes mellitus in adult patients with cystic fibrosis

Objetivo: La prevalencia de diabetes mellitus (DM) en pacientes con fibrosis quística (FQ) es mayor que en la población general. El trasplante de órganos sólidos es un factor de riesgo importante para el desarrollo de DM y se ha relacionado con el tipo de inmunodepresión. El objetivo del estudio ha sido analizar si el trasplante pulmonar (TP) es un factor de riesgo importante para desarrollar alteración hidrocarbonada en la FQ, si influye en su gravedad y tratamiento, y si existe relación con el tipo de inmunodepresión. Pacientes y métodos: Se estudió retrospectivamente a 54 pacientes adultos con FQ, sobre los que se recogieron los siguientes datos: tipo de alteración hidrocarbonada y su tratamiento, existencia o no de TP y tipo de inmunodepresión. Resultados: De los 54 pacientes, 20 recibieron TP (37%). De éstos, el 89% (n = 18) presentó DM. Entre aquellos que no recibieron TP, el 24% (n = 8) presentó DM y el 29% (n = 10) intolerancia hidrocarbonada (p < 0,01; prueba de χ²). Se pautó insulina al 36,3% de los pacientes sin TP y al 78,6% de los trasplantados. La influencia de la inmunodepresión se analizó en 15 pacientes. Desarrollaron DM el 90% (9/10) de los tratados con ciclosporina y el 80% (4/5) de los tratados con tacrolimus. Todos llevaban la misma pauta de corticoterapia. Conclusiones: El TP es un factor de riesgo importante para el desarrollo de alteración hidrocarbonada en pacientes con FQ e influye en su gravedad y tratamiento. No hemos encontrado diferencia significativa entre el tipo de inmunodepresión y la aparición de DM

Objective: The prevalence of diabetes mellitus is higher in patients with cystic fibrosis than in the general population. Solid organ transplantation is a significant risk factor for diabetes mellitus, which has been linked to type of immunosuppression. The aim of this study was to analyze whether lung transplantation represents a significant risk factor for the onset of abnormal carbohydrate metabolism in cystic fibrosis, whether it affects severity of alterations, and whether there is a relation to type of immunosuppression. Patients and methods: The following data were extracted retrospectively for 54 patients with cystic fibrosis: type of carbohydrate metabolism alteration and treatment received, whether or not transplantation took place, and type of immunosuppression used. Results: Twenty of the 54 patients (37%) underwent lung transplantation; 18 of them (89%) developed diabetes mellitus. Eight of the patients (24%) who did not receive a lung developed diabetes and 10 (29%) displayed carbohydrate intolerance (P<.01, χ² test). Insulin was administered to 36.3% of nontransplanted patients and 78.6% of transplanted patients. The influence of immunosuppressant used was analyzed in 15 patients. Nine out of 10 patients (90%) treated with cyclosporine and 4 out of 5 (80%) of those treated with tacrolimus developed diabetes mellitus. All received the same regimen of corticosteroid therapy. Conclusions: For cystic fibrosis patients, lung trans-plantation is a significant risk factor for developing abnormal carbohydrate metabolism and it influences severity and treatment. No significant differences in the frequency of development of diabetes mellitus were found in relation to type of immunosuppression

Glucemia basal frente a sobrecarga oral de glucosa en el diagnóstico de diabetes mellitus / Fasting glucose versus oral glucose tolerance testing in the diagnosis of diabetes mellitus

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Hemoglobin Glycosylation Index is not related with blood glucose.

OBJECTIVE: Accurate assessment of blood glucose control is essential to prevent chronic complications in diabetes. Hemoglobin Glycosylation Index (HGI) quantifies the degree to which individuals demonstrate a HbA(1C) higher or lower than average for the population. This study has aimed to assess the relationship between HGI and blood glucose. METHODS: 25 type 1 diabetes subjects (12 men and 13 women), 22.0+/-5.2 (17-34) years old, were instructed to self-monitor glucose with the One Touch Profile capillary glucose meter. HbA(1C) was determined and self-monitored blood glucose levels were studied every 3 months. Diabetic patients were monitored for 3-9 months and 62 measurements of HbA(1C) were included. HbA(1C) was measured by HPLC. Mean blood glucose (MBG) was calculated from self-monitored blood glucose records. A linear regression was calculated between HbA(1C) and MBG during the 60 days before sampling to determine HbA(1C). For each diabetic patient's MBG, a predicted HbA(1C) was calculated from the population regression equation. HGI was then calculated as HGI=observed HbA(1C)-predicted HbA(1C). Blood glucose was analyzed within target range (WTR), below target range (BTR) and above target range (ATR) according to The European Diabetes Policy Group Consensus for type 1 diabetes. RESULTS: A good linear regression between HbA(1C) and MBG was observed (r=.71, r(2)=.497, P=.000). No correlation was found between HGI and the percentage of WTR, BTR or ATR values. Moreover, the percentage of self-monitored blood glucose ATR and BTR was the same for high glycosylators (HGI<0 and ATR: 56.2+/-20.9%; HGI<0 and BTR: 34.5+/-17.5%) as for low glycosylators (HGI>0 and ATR: 52.8+/-25.5%; HGI>0 and BTR: 25.1+/-15.0%). CONCLUSIONS: HGI is determined for both physiological factors and blood glucose. A prospective study is necessary to assess whether HGI, together with HbA(1C), can predict the incidence and severity of chronic complications in diabetic patients.

Insulin-induced normoglycemia reduces islet number needed to achieve normoglycemia after allogeneic islet transplantation in diabetic mice.

The Edmonton protocol established that insulin independence could be reached with the transplantation of an appropriate number of islet cells. However, to effect a cure, islets from two or three pancreases are needed. The aim of this study was to examine whether normoglycemia, with insulin treatment before and after transplantation, reduces the islet number needed to achieve normoglycemia in allogeneic islet transplantation. Swiss mice were used as donors and recipients. Diabetes was induced by i.p. administration of streptozotocin (180 mg/kg BW). Diabetic mice were transplanted with 300 (n = 16), 400 (n = 16), or 500 (n = 16) islets under the left kidney capsule. For every group, half the animals were kept normoglycemic with insulin treatment from day 4 before transplantation to day 10 after transplantation. At the end of the study, all normoglycemic mice were given an i.p. glucose tolerance test (IPGTT). For statistical analysis, paired or unpaired Student's t-test or ANOVA was used. Only insulin-treated mice achieved normoglycemia by the end of the study (37.5% of animals transplanted with 400 islets and 50% transplanted with 300 or 500 islets). At the end of the study, normoglycemic mice transplanted with 300 allogeneic islets showed better glycosylated hemoglobin (HbA1C) than did normoglycemic mice transplanted with 500 islets (300 islets: 2.7 +/- 0.2%; 500 islets: 3.6 +/- 0.2%; p < 0.05). After the IPGTT, insulin-treated mice transplanted with 500 islets showed abnormal glucose tolerance; however, insulin-treated mice transplanted with 300 or 400 islets showed normal glucose tolerance. Insulin treatment reduced the islet number needed to achieve normoglycemia in allogeneic islet transplantation. The HbA1C and IPGTT results suggest that transplanting smaller numbers of allogeneic islets improves beta-cell function; some studies suggest that this may be due to lower immunogenicity, hypoxia, and inflammation.

Insulin-Induced Normoglycemia Reduces Islet Number Needed to Achieve Normoglycemia after Allogeneic Islet Transplantation in Diabetic Mice.

The Edmonton protocol established that insulin independence could be reached with the transplantation of an appropriate number of islet cells. However, to effect a cure, islets from two or three pancreases are needed. The aim of this study was to examine whether normoglycemia, with insulin treatment before and after transplantation, reduces the islet number needed to achieve normoglycemia in allogeneic islet transplantation. Swiss mice were used as donors and recipients. Diabetes was induced by IP administration of streptozotocin (180 mg/kg BW). Diabetic mice were transplanted with 300 (n = 16), 400 (n = 16), or 500 (n = 16) islets under the left kidney capsule. For every group, half the animals were kept normoglycemic with insulin treatment from day 4 before transplantation to day 10 after transplantation. At the end of the study, all normoglycemic mice were given an IP glucose tolerance test (IPGTT). For statistical analysis, paired or unpaired Student's t-test or ANOVA was used. Only insulin-treated mice achieved normoglycemia by the end of the study (37.5% of animals transplanted with 400 islets and 50% transplanted with 300 or 500 islets). At the end of the study, normoglycemic mice transplanted with 300 allogeneic islets showed better glycosylated hemoglobin (HbA1C) than did normoglycemic mice transplanted with 500 islets (300 islets: 2.7 ± 0.2%; 500 islets: 3.6 ± 0.2%; p < 0.05). After the IPGTT, insulin-treated mice transplanted with 500 islets showed abnormal glucose tolerance; however, insulin-treated mice transplanted with 300 or 400 islets showed normal glucose tolerance. Insulin treatment reduced the islet number needed to achieve normoglycemia in allogeneic islet transplantation. The HbA1C and IPGTT results suggest that transplanting smaller numbers of allogeneic islets improves ß-cell function; some studies suggest that this may be due to lower immunogenicity, hypoxia, and inflammation.