GALIPDIA study: Reaching lipid targets in a population with type 2 diabetes (T2DM) from the Northwest of Spain.

AIM: To assess the degree of compliance with the European ESC/EAS 2016 and 2019 dyslipidaemia guidelines in patients with type 2 diabetes mellitus (T2DM). METHODS: Multicentre retrospective cross-sectional study, conducted in 380 adults with T2DM and dyslipidaemia in 7 Spanish health areas. INCLUSION CRITERIA: minimum follow-up of one year in Endocrinology Units, at least one visit in 2020 and a lipid profile measurement in the last 3 months. EXCLUSION CRITERIA: familial hypercholesterolaemia, recent hospitalisation, active oncological pathology and dialysis. RESULTS: According to the 2016 and 2019 guidelines the majority of patients were classified as being at very high cardiovascular risk (86.8% vs. 72.1%, respectively). LDL-c compliance was adequate in 62.1% of patients according to the 2016 guidelines and 39.7% according to the 2019 guidelines (p<0.001). Clinical conditions such as history of cardiovascular disease and therapy-related aspects (use of statins, especially high-potency statins, combination therapies and good adherence) were significantly associated with greater achievement of lipid targets. CONCLUSION: There is a discrepancy between dyslipidaemia guideline recommendations and the reality of lipid control in patients with T2DM, despite most of these patients being at very high cardiovascular risk. Strategies to optimise lipid-lowering treatments need to be implemented.

The challenge of diabetes home control in COVID-19 times: Proof is in the pudding.

SARS-CoV-2 pandemic had changed self-care in diabetes. The aim of this work is to analyze the effect of lockdown on glycemic control in people with type 1 diabetes on multiple daily insulin injections using FGM. During lockdown no deleterious effect on glycemic control measured by FGM.

Intestinal absorption and pancreatic function are preserved in anorexia nervosa patients in both a severely malnourished state and after recovery.

INTRODUCTION: Anorexia nervosa (AN) is characterised by a refusal to normal body weight accompanied by a marked restriction of food intake, frequently leading to severe malnutrition. In severe malnutrition and wasting syndromes, mucosal atrophy, altered gastrointestinal motility and pancreatic atrophy, which alter digestive function and can exacerbate malnutrition, have been described. The objective of this work was to determine intestinal absorption and pancreatic function in severely malnourished AN patients before and after recovery. METHODS: Ten severely malnourished AN women were studied at hospital admittance (body mass index = 11.44-16.16 kg/m(2)) and after weight recovery with artificial nutrition (body mass index ≥ 20 kg/m(2)). A (13)C-labelled triglycerides digestion test, faecal elastase test and d-xylose absorption test were performed. RESULTS: In nine patients, (13)C-labelled triglycerides digestion tests and the faecal elastase and d-xylose tests were normal both before and after weight recovery. In one patient, the results were abnormal, and they led to the detection of a previously undiagnosed celiac disease in addition to her AN. CONCLUSION: In this series, there was neither intestinal absorption nor pancreatic function disturbances in severely malnourished AN patients either before or after weight recovery. The usefulness of these tests in the differentiation of functional versus structural changes needs further studies.

Should the amounts of fat and protein be taken into consideration to calculate the lunch prandial insulin bolus? Results from a randomized crossover trial.

BACKGROUND: Concerning continuous subcutaneous insulin infusion (CSII), there are controversial results related to changes in glycemic response according to the meal composition and bolus design. Our aim is to determine whether the presence of protein and fat in a meal could involve a different postprandial glycemic response than that obtained with only carbohydrates (CHs). SUBJECTS AND METHODS: This was a crossover, randomized clinical trial. Seventeen type 1 diabetes (T1D) patients on CSII wore a blinded continuous glucose monitoring system sensor for 3 days. They ingested two meals (meal 1 vs. meal 2) with the same CH content (50 g) but different fat (8.9 g vs. 37.4 g) and protein (3.3 g vs. 28.9 g) contents. A single-wave insulin bolus was used, and the interstitial glucose values were measured every 30 min for 3 h. We evaluated the different postprandial glycemic response between meal 1 and meal 2 by using mixed-effects models. RESULTS: The postmeal glucose increase was 22 mg/dL for meal 1 and 31 mg/dL for meal 2. In univariate analysis, at different times not statistically significant differences in glucose levels between meals occurred. In mixed-model analysis, a time×meal interaction was found, indicating a different response between treatments along the time. However, most of the patients remained in the normoglycemic range (70-180 mg/dL) during the 3-h postmeal period (84.4% for meal 1 and 93.1% for meal 2). CONCLUSIONS: The presence of balanced amounts of protein and fat determined a different glycemic response from that obtained with only CH up to 3 h after eating. The clinical relevance of this finding remains to be elucidated.

Hipernatremia grave en relación con un tratamiento con litio / Severe hypernatraemia associated with lithium treatment

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Beneficios de la terapia con infusión subcutánea continua de insulina en pacientes diabéticos tipo 1 que presentan gran variabilidad glucémica / Benefits of subcutaneous continuous insulin infusion in type 1 diabetic patients with high glycemic variability

Introducción La hipoglucemia limita la eficacia de la terapia insulínica intensiva, principalmente en pacientes con gran variabilidad glucémica. Nuestro objetivo fue determinar si la terapia con infusión subcutánea contínua de insulina (ISCI) es útil y si logra disminuir la variabilidad glucémica e hipoglucemias, principalmente en los pacientes con mayor variabilidad. Método Se realizó una monitorización continua de glucosa de 3 días de duración a 24 pacientes con diabetes mellitus tipo 1 (DM1) en 2 ocasiones diferentes: antes de iniciar la terapia con ISCI y 6 meses después de su implantación. Se comparó la variabilidad glucémica con distintas medidas de variabilidad (desviación estándar [SD], amplitud media de las excursiones glucémicas [MAGE], valor M) y el área bajo la curva (AUC) <70mg/dl de forma global en todos los pacientes y en aquellos con mayor variabilidad inicial (MAGE en mayor cuartil) Resultados A los 6 meses, se observó un descenso de la variabilidad glucémica medida como MAGE (mediana:-28mg/dl [rango interquartílico {RI}, -48 a 1], p=0,03); valor M (-22 [-40 a 0], p=0,04) y SD (-11[-23 a 0], p=0,009) en todos los pacientes. Los pacientes con mayor variabilidad glucémica inicial (MAGE cuartil 4) mostraron un mayor descenso de MAGE (-47mg/dl [-103 a -34] vs -20 [-36 a 17], p=0,01) y de AUC<70 (-10,7mg/dlxdía [-15 a 0] vs -1,1[-4,7 a 3,8], p=0,03), que el resto. Los pacientes con más tiempo en hipoglucemia inicial (AUC cuartil 4) lograron una mayor reducción del AUC<70 (-9,7mg/dlxdía [-15 a -6,5] vs -0,08 [-2,9 a 3,8], p=0,003]. Se halló una correlación entre ΔMAGE-ΔAUC [r 0,4, p=0,03].Conclusiones Durante el tratamiento con ISCI, la variabilidad glucémica descendió significativamente, principalmente en aquellos pacientes con mayor variabilidad inicial. El tiempo en hipoglucemia también fue menor en aquellos con una mayor variabilidad. Los pacientes con más hipoglucemias iniciales experimentaron un mayor descenso de estas con ISCI (AU)

Background Hypoglycemia limits the efficacy of intensive insulin therapy, especially in patients with great glucose variability. The extent to which continuous subcutaneous insulin infusion (CSII) overcomes this limitation is unclear. Our aim was to determine whether CSII is helpful for decreasing glucose variability and hypoglycemia, mainly in patients with the greatest variability .Method Twenty-four patients with type 1 diabetes wore a continuous glucose monitoring system sensor for 3 days before starting therapy with CSII and 6 months later. Glucose variability (SD, MAGE, M) and hypoglycemia duration (area under the curve (AUC) <70mg/dL) were compared in all patients and in those with the greatest MAGE (highest quartile).Results At 6 months, a decreased glucose variability was seen, as measured by MAGE, M, and SD (median: −28mg/dL (interquartile range, −48 to 1), p=0.03; −22 (−40 to 0), p=0.04; −11 (−23 to 0), p=0.009; respectively). Patients with the greatest initial glucose variability (MAGE quartile 4) showed a greater decrease in both MAGE (−47mg/dL (−103 to −34) vs −20 (−36 to 17), p=0.01) and AUC <70 (−10.7mg/dL×day (−15 to 0) vs −1.1 (−4.7 to 3.8), p=0.03) as compared to all others. Patients with longer initial hypoglycemia (AUC quartile 4) achieved a greater reduction in AUC <70 (−9.7mg/dL×day (−15 to −6.5) vs −0.08 (−2.9 to 3.8), p=0.003). A correlation was found between ΔMAGE-ΔAUC (r 0.4, p=0.03).Conclusions During CSII, glucose variability significantly decreased, especially in patients with the greatest initial variability. Hypoglycemia was also markedly less in patients with greater variability, with the greatest reduction occurring in those who experienced more marked hypoglycemia with CSII (AU)

[Benefits of subcutaneous continuous insulin infusion in type 1 diabetic patients with high glycemic variability]. / Beneficios de la terapia con infusión subcutánea continua de insulina en pacientes diabéticos tipo 1 que presentan gran variabilidad glucémica.

BACKGROUND: Hypoglycemia limits the efficacy of intensive insulin therapy, especially in patients with great glucose variability. The extent to which continuous subcutaneous insulin infusion (CSII) overcomes this limitation is unclear. Our aim was to determine whether CSII is helpful for decreasing glucose variability and hypoglycemia, mainly in patients with the greatest variability. METHOD: Twenty-four patients with type 1 diabetes wore a continuous glucose monitoring system sensor for three days before starting therapy with CSII and 6 months later. Glucose variability (SD, MAGE, M) and hypoglycemia duration (area under the curve (AUC) <70mg/dL) were compared in all patients and in those with the greatest MAGE (highest quartile). RESULTS: At 6 months, a decreased glucose variability was seen, as measured by MAGE, M, and SD (median: -28mg/dL (interquartile range, -48 to 1), p=0.03; -22(-40 to 0), p=0.04; -11(-23 to 0), p=0.009; respectively). Patients with the greatest initial glucose variability (MAGE quartile 4) showed a greater decrease in both MAGE (-47mg/dL (-103 to -34) vs -20 (-36 to 17), p=0.01) and AUC <70 (-10.7mg/dL x day (-15 to 0) vs -1.1 (-4.7 to 3.8), p=0.03) as compared to all others. Patients with longer initial hypoglycemia (AUC quartile 4) achieved a greater reduction in AUC <70 (-9.7mg/dL x day(-15 to -6.5) vs -0.08 (-2.9 to 3.8), p=0.003). A correlation was found between ΔMAGE-ΔAUC (r 0.4, p=0.03). CONCLUSIONS: During CSII, glucose variability significantly decreased, especially in patients with the greatest initial variability. Hypoglycemia was also markedly less in patients with greater variability, with the greatest reduction occurring in those who experienced more marked hypoglycemia with CSII.

Cetoacidosis diabética como manifestación inicial de un somatostatinoma metastásico / Diabetic ketoacidosis as first manifestation of a metastasic somatostatinoma

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Absceso hipofisario primario: una causa poco frecuente de cefalea y fiebre / Primary pituitary abscess: An unusual cause of headache and fever

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Long term treatment of a thyrotropin-secreting microadenoma with somatostatin analogues.

Thyrotropin (TSH) secreting pituitary adenomas (TSH-omas) account for < 1% of all pituitary adenomas and are a rare cause of hyperthyroidism. The diagnosis is often made at the stage of macroadenoma because of the aggressive nature of the tumor and due to the fact that patients are mistakenly treated for more common primary hyperthyroidism for a long time. First line therapy is transsphenoidal resection of the tumor, which can cure one-third of the patients completely. However, if surgery is not possible or curative, pituitary radiotherapy and/or somatostatin analogs (SSA) can be useful. We report the case of a 54-year-old woman treated 20 years earlier for a mistakenly suspected primary hyperthyroidism. Given the persistence of symptoms she was studied further and was diagnosed with a thyrotropinoma. Despite the delay in diagnosis and prior thyroid ablation, a microadenoma was found. As transsphenoidal surgery was not considered effective, medical therapy with a somatostatin analogue was initiated. Currently, at four years of follow-up, the patient continues on this treatment and remains euthyroid and asymptomatic. We report a case of successful long-term treatment with SSA, after unsuccessful surgery.

Isolated idiopathic central hypothyroidism in an adult, possibly caused by thyrotropin releasing hormone (TRH) deficiency.

Central hypothyroidism (Central H) is mainly due to acquired lesions, either in the pituitary, the hypothalamus or both, and in such cases it is usually associated with deficient secretion of ther pituitary hormones. Isolated central hypothyroidism (I Central H) remains a very rare disease. By the use of the serum thyroid stimulating hormone (TSH) assay as an initial screening test for thyroid disease, the diagnosis of I, Central H can be missed or delayed, since most of these patients have normal or even slightly high serum TSH concentrations. We present a 54-year-old woman with intense tiredness, in whom hypothyroidism was initially and persistently excluded because of normal TSH levels. Further investigations showed again a normal TSH with slightly low free thyroxine (FT4), and Central H was suspected. A thyrotropin releasing hormone (TRH) stimulation test confirmed the diagnosis. No lesion was found by magnetic resonance imaging (MRI). No other pituitary hormone insufficiency was detected. Finally, after excluding, the intake of any drug affecting the hypothalamo-pituitary-thyroid axis and the presence of critical systemic illness, the unusual diagnosis of idiopathic isolated Central H was made. When suspecting Central H, both FT4 and TSH should be measured and if these values are low, TSH response to TRH is recommended to reach specific diagnosis.