Screening of undiagnosed hyperglycaemia in the dental setting: The DiabetRisk study. A field trial.

AIM: To evaluate the efficacy of different screening protocols for undiagnosed hyperglycaemia in a Research Network of Dental Clinics coordinated by the Spanish Society of Periodontology (SEPA). MATERIAL AND METHODS: A total of 1143 patients were included in the study. Participants filled a questionnaire considering diabetes risk factors (FINDRISC) and received a periodontal screening examination. Patients with a slightly elevated score according to the Findrisc (≥7), received a point-of-care HbA1c and were eventually referred to their physician for confirmatory diagnosis. Receiver Operating Characteristic (ROC) curves were used to assess the performance of various predictive models with confirmed hyperglycaemia as outcome. RESULTS: From this population, 97 (8.5%) were finally diagnosed of diabetes (n = 28; 2.5%) or prediabetes (n = 69; 6.0%). When only including the results from the FINDRISC questionnaire, the model reported an area under the curve (AUC) of 0.866 (95% confidence interval - CI [0.833; 0.900]). This model significantly improved when a basic periodontal examination (EPB Code; AUC = 0.876; 95% CI [0.845: 0.906]; p = .042) or a point-of-care HbA1c were added (AUC = 0.961; 95% CI [0.941; 0.980]; p < .001). CONCLUSIONS: The tested protocol, combining the FINDRISC questionnaire and a point-of-care HbA1c, showed to be feasible when carried out in a dental clinic setting and was efficient to identify subjects with undiagnosed diabetes or prediabetes.

May Measurement Month 2018: an analysis of blood pressure screening results from Mexico.

In 2015, arterial hypertension was responsible for 18.1% of the total deaths in Mexico and its mortality rate has increased to 29.9% in the last 6 years. It is currently the main risk factor for preventable premature deaths of adults in the country. Good quality epidemiological information is the first step to improve health services. May Measurement Month 2018 (MMM18) in Mexico is an opportunistic survey, which follows the previously published methodology. MMM18 included screening 10 139 participants, 2187 (21.6%) of whom were classified as having hypertension. Of these, 42.0% were aware of the condition before measurement, and 38.0% were on medication, of which 66.5% were controlled. Hence, of all hypertensive patients, 25.3% were controlled (<140/90 mmHg). MMM18 in Mexico provides complementary data to the existing information on arterial hypertension in the country and helps to increase the visibility of hypertension: a priority health problem.

I Workshop ibérico sobre la asociación entre diabetes y enfermedades periodontales. Documento de consenso / 1st Iberian Workshop on the relationship between diabetes and periodontal diseases. Consensus Document

Este consenso se ha realizado por expertos de las Fundaciones de las Sociedades Españolas de Diabetes y de Periodoncia. La evidencia revisada presenta datos relevantes que avalan la importancia tanto de la diabetes como de las enfermedades periodontales, así como de la relación bidireccional entre las mismas:- La diabetes tiene una alta prevalencia en las poblaciones de España y Portugal con elevada prevalencia de diabetes no conocida y con cifras en continuo incremento. Además, es muy relevante la importancia, frecuencia y severidad de sus complicaciones.- Las enfermedades periodontales tienen una alta prevalencia, cercana al 90% de la población adulta. La capacidad destructiva de la periodontitis conduce a la pérdida de dientes, lo que provoca importantes alteraciones para el paciente. También la periodontitis se ha asociado a un incremento en el riesgo de enfermedades cardiovasculares, de resultados adversos del embarazo, y de enfermedades pulmonares, entre otras.- Numerosos estudios han señalado que la diabetes es un importante factor de riesgo para sufrir periodontitis, especialmente si el control de la glucemia no es adecuado.- Las enfermedades periodontales han demostrado un efecto negativo sobre el control de la glucemia, tanto en pacientes con diabetes como en sujetos sanos, y se ha demostrado que las complicaciones de la diabetes son más frecuentes en pacientes con periodontitis.- El tratamiento periodontal es capaz de mejorar el control de la glucemia, con un valor de reducción de la hemoglobina glucosilada de 0.4%.Basados en estas evidencias, se proponen distintas implicaciones para los profesionales sanitarios involucrados en el cuidado de estos pacientes

This consensus report has been prepared by a group of experts from the Spanish Foundations of Diabetes and of Periodontology. The reviewed evidence shows relevant data that strongly support the importance of diabetes and periodontal diseases, as well as their bi-directional relationship: - Diabetes has a high prevalence in Spain and Portugal, with a high prevalence of un-diagnosed diabetes, and with continuously increasing rates. In addition, the frequency and severity of their complications is also very important. - Periodontal diseases have high prevalence, close to 90% in adult populations. The destructive capacity of periodontitis leads to tooth loss, which is associated with a profound impact on the patients. Periodontitis have also been related to an increased risk of cardiovascular diseases, adverse pregnancy outcomes, and pulmonary infections, as well as other conditions. - Numerous studies have concluded that diabetes is a significant risk factor for periodontitis, especially in subjects with poor glycemic control. - Periodontal diseases have been shown to have a deleterious effect on glycemic control, both in diabetic patients and healthy subjects, and it has been demonstrated that diabetes complications are more frequent in diabetic patients with periodontitis. - Periodontal treatment has been associated with improvements in glycemic control, with a mean reduction in glycosylated haemoglobin of 0.4%. Based on the above evidence, different challenges are proposed for health professionals involved in diabetic and periodontitis patient care

Efectos de la diabetes sobre las enfermedades periodontales / Effects of diabetes on periodontal diseases

Diferentes revisiones publicadas en los últimos años han demostrado claramente la influencia de la diabetes sobre las enfermedades periodontales, señalando que esta interacción tiene importantes implicaciones para los profesionales de la salud, para los pacientes diabéticos y periodontales, y para la población general. Por ello, es oportuno revisar la evidencia científica sobre esta interacción, con el objeto de establecer implicaciones prácticas para todos los estamentos involucrados. La importancia de la diabetes se basa en sus altos niveles de prevalencia, confirmados recientemente en estudios en España y Portugal, incluida la alta presencia de diabetes no diagnosticada. Diferentes factores explican la influencia de la diabetes sobre las enfermedades periodontales, incluyendo los episodios proinflamatorios, los cambios en la microbiota subgingival o la acumulación de productos de glicación avanzados. Estos factores permiten explicar que la diabetes se comporte como un importante factor de riesgo para sufrir periodontitis. Sin embargo, la diabetes parece no interferir con los resultados del tratamiento, excepto en individuos con mal control de la glucemia. Las implicaciones de esta asociación son variadas, desde la posibilidad de realizar cribado de diabetes en la consulta dental, en sujetos con determinadas características periodontales, hasta la necesidad de llevar a cabo protocolos adecuados de atención odontológica y periodontal en pacientes con diabetes

Different studies, published in the last few years, have clearly demonstrated the effects of diabetes on periodontal diseases, pointing out the relevant implications for health professionals, for diabetic periodontal patients, as well as for the general population. It seems of interest to evaluate the scientific evidence supporting this association, with the main aim of identifying practical implications for all involved groups. The importance of diabetes is based, among other things, in the high levels of prevalence, recently confirmed in Spain and Portugal, and the high proportion of undiagnosed diabetes. Different factors may explain the effects of diabetes on periodontal diseases, including proinflammatory events, changes in the subgingival microbiota, or the accumulation of advanced glycation end-products. These factors provide the basis for diabetes being an important risk factor for periodontitis. However, diabetes may not interfere with periodontal therapy, except in subjects with poor blood glucose control. Many implications can be listed: from the possibility of performing diabetes screening in the dental clinics, to the need of clear dental and periodontal care protocols for patients with diabetes

Is increasing urinary albumin a better marker for microvascular than for macrovascular complication of type 2 diabetes mellitus?

AIMS: The aims of the study were to evaluate the prevalence of increased urinary albumin excretion (UAE) and associated cardiovascular risk factors and vascular diabetes complications in patients with type 2 diabetes mellitus (DM). METHODS: We studied 975 patients in a cross-sectional design from 1998 to 2000. Frequency of micro- and macroalbuminuria, and their associations with cardiovascular risk factors and vascular DM complications, were examined. RESULTS: Prevalence of increased UAE was 28.5% (18.3% micro- and 10.2% macroalbuminuria). Body mass index (BMI) (only females) and hemoglobin (Hb)A1c significantly correlated with macroalbuminuria (p = 0.034, p = 0.027, respectively), while high blood pressure (diastolic) was associated with microalbuminuria (p = 0.008). Diabetes duration, high systolic blood pressure, total cholesterol, high-density lipoprotein (HDL) cholesterol, low-density lipoprotein (LDL) cholesterol and triglycerides were significantly correlated with both micro- and macroalbuminuria. Increased UAE was associated with neuropathy (relative risk (RR) 2.12, confidence interval (CI) 1.07-4.19), retinopathy (RR 2.19, CI 1.76-2.74) and hypertension (RR 2.91, CI 1.77-4.78), but not with cardiovascular disease, high cholesterol and peripheral vascular disease. In the multiple logistic regression analysis, a significant association of albuminuria was found with diabetes duration (odds ratio (OR) 1.59, CI 0.98-2.58; p < 0062), hypertension (OR 3.42, CI 2.22-5.27; p < 0.0001), low HDL cholesterol (OR 1.78, CI 1.31-2.43; p < 0.0003), current smoking status (OR 2.19, CI 1.32-3.64; p < 0.0024), and increased serum creatinine (OR 11.16, CI 5.7-21.7; p < 0.0001). CONCLUSION: Prevalence of increased UAE was similar to that described in other geographically close populations. The stronger association found with microvascular diabetes complications suggests that increased UAE is a better predictor for renal damage than for cardiovascular disease in this type 2 DM population.

Growth hormone release after glucagon as a reliable test of growth hormone assessment in adults.

OBJECTIVE: To investigate the GH response to glucagon in adult patients with GH deficiency and in controls compared with the GH response to the insulin tolerance test (ITT) in patients with GH deficiency and to determine whether the use of glucagon results in a diagnostic utility test. PATIENTS AND DESIGN: Seventy-three patients with adult GH deficiency and organic hypothalamic-pituitary disease were recruited, along with 46 controls. The patients were divided into five groups according to the number of associated hormone deficiencies present. MEASUREMENTS: Hypopituitary subjects underwent assessment of GH secretory status by the ITT, the glucagon test and measurement of serum IGF-I concentration. Controls underwent the glucagon test. After the ITT, glucose and GH levels were measured at baseline, 30, 60 and 90 minutes, and after glucagon at baseline, 90, 120, 150, 180, 210 and 240 minutes. RESULTS: The highest GH value after the ITT in the patient group was 3 microg/l (0.76 +/- 0.82 microg/l), and after the glucagon test the highest GH peak value was 2.9 microg/l (0.64 +/- 0.79 microg/l). A correlation was found between the GH peak and the progressive number of hormone deficiencies. After the glucagon test, the GH peak obtained in the controls at 180 minutes was 9.8 +/- 4.6 microg/l and, on an individual basis, none of the 46 controls failed to achieve peak GH levels higher than 3 microg/l. In the controls, a negative correlation was observed between the GH response to glucagon and age (r = -0.389, P = 0.0075) and body mass index (r = -0.329, P = 0.0254). The accuracy of the glucagon test for differentiating patients from controls, estimated by receiver operating characteristics (ROC) curve methodology, showed that the cut-off of 3 microg/l for the GH peak provides 100% sensitivity and 100% specificity and is a reliable decision threshold. CONCLUSIONS: The glucagon GH test is reliable and provides a clear separation between GH-deficient and normal adults. A single glucagon test with a cut-off of 3 microg/l for the GH peak is diagnostic of GH deficiency in adults and could be considered and studied as an alternative to the ITT.