Survey of Spanish hospitals on diabetes care resources.

INTRODUCTION: The quality of diabetes care varies from region to region. The objective of this study is to analyze the characteristics of care in different hospitals in Spain through a specific survey assessing different aspects of care for both children and adults. MATERIALS AND METHODS: Cross-sectional observational voluntary survey study, sent to the heads of the Endocrinology and Pediatric Endocrinology Departments or Units in public hospitals with more than 150 beds, during the first semester of 2021. A total of 105 responses were obtained, 55.5% of the 189 requested, which corresponded to a population served of 31,782,409 people, representing almost 80% of the total population served. RESULTS: Patients with diabetes under 15 years of age are cared for by Pediatric Departments, but only 58% of them have a specific Diabetes Education Unit for children, and in 72% of the cases, there is one single nurse dedicated to these tasks, and not always full-time. Those over 15 years of age are attended by specialists in Endocrinology and Nutrition in 94.3 % of hospitals. There are Therapeutic Education Units in Diabetes in practically all hospitals (94.3%). However, Diabetes Day Hospitals exist in only 32 centres and cover 40.3% of the population, since in 22 provinces there are none. Virtual and telematic consultations, as well as retinography, are available in more than 70% of cases, but access to a Diabetic Foot Unit only in 54% of centres. Monographic technological consultations on diabetes have become widespread, but access to mental health specialists with diabetes training remains limited (24% of centres), and interdisciplinary (32%) or interlevel (12%) committees are very scarce. CONCLUSION: Diabetes care in Spain shows great variability from one region to another, and some deficiencies have been detected that affect a large part of the population, such as access to Diabetic Foot Units, as well as mental health specialists with specific training. The presence of multidisciplinary and mixed committees between levels of care remains scarce.

Correlation between glucose measurement parameters of continuous flash monitoring and HbA1c. Real life experience in Asturias.

INTRODUCTION: Despite continuous glucose monitoring having been proven useful in patients with type 1 diabetes mellitus, A1C remains the gold standard for assessing disease management. MATERIAL AND METHODS: Descriptive, retrospective study which included 252 patients, 40.5% male, mean age 44.91±14.57 years, mean duration of diabetes 22.21±13.12 years, 88.1% on basal-bolus insulin therapy and 11.9% users of continuous subcutaneous insulin infusion. Glucose measurement, analytical and anthropometric data were obtained. RESULTS: The mean time in range was 60.18±15.60% and was associated with A1C after adjusting for age, gender, duration of diabetes, BMI, insulin regimen, %CV and time below range (ß: -0.548; p<0.01). The glucose management indicator (GMI) was 7.19±0.69% and was also associated with A1C (ß: 0.957; p<0.01) regardless of age, gender, duration of diabetes, BMI, insulin treatment, %CV and time in range. The average difference between A1C and GMI was 0.17±0.65% (-2.70-3.40%), being higher as A1C increased, in a linear and significant manner, without being influenced by the duration of diabetes or CV. CONCLUSIONS: Although we found a positive correlation between continuous glucose monitoring glucose measurement parameters and A1C, there is still not enough evidence to replace one parameter with another.

Classification of follicular-patterned thyroid lesions using a minimal set of epigenetic biomarkers.

Objective: The minimally invasive fine-needle aspiration cytology (FNAC) is the current gold standard for the diagnosis of thyroid nodule malignancy. However, the correct discrimination of follicular neoplasia often requires more invasive diagnostic techniques. The lack of suitable immunohistochemical markers to distinguish between follicular thyroid carcinoma and other types of follicular-derived lesions complicates diagnosis, and despite most of these tumours being surgically resected, only a small number will test positive for malignancy. As such, the development of new orthogonal diagnostic approaches may improve the accuracy of diagnosing thyroid nodules. Design: This study includes a retrospective, multi-centre training cohort including 54 fresh-frozen follicular-patterned thyroid samples and two independent, multi-centre validation cohorts of 103 snap-frozen biopsies and 33 FNAC samples, respectively. Methods: We performed a genome-wide genetic and epigenetic profiling of 54 fresh-frozen follicular-patterned thyroid samples using exome sequencing and the Illumina Human DNA Methylation EPIC platform. An extensive validation was performed using the bisulfite pyrosequencing technique. Results: Using a random forest approach, we developed a three-CpG marker-based diagnostic model that was subsequently validated using bisulfite pyrosequencing experiments. According to the validation cohort, this cost-effective method discriminates between benign and malignant nodules with a sensitivity and specificity of 97 and 88%, respectively (positive predictive value (PPV): 0.85, negative predictive value (NPV): 0.98). Conclusions: Our classification system based on a minimal set of epigenetic biomarkers can complement the potential of the diagnostic techniques currently available and would prioritize a considerable number of surgical interventions that are often performed due to uncertain cytology. Significance statement: In recent years, there has been a significant increase in the number of people diagnosed with thyroid nodules. The current challenge is their etiological diagnosis to discount malignancy without resorting to thyroidectomy. The method proposed here, based on DNA pyrosequencing assays, has high sensitivity (0.97) and specificity (0.88) for the identification of malignant thyroid nodules. This simple and cost-effective approach can complement expert pathologist evaluation to prioritize the classification of difficult-to-diagnose follicular-patterned thyroid lesions and track tumor evolution, including real-time monitoring of treatment efficacy, thereby stimulating adherence to health promotion programs.

Enfermedades cardiovasculares en personas con diabetes mellitus en España según la Base de Datos Clínicos de Atención Primaria (BDCAP) en 2017 / Cardiovascular diseases in people with diabetes mellitus in Spain according to the Primary Care Clinical Database (BDCAP) in 2017

Introducción y objetivosLa enfermedad cardiovascular ateroesclerótica y la insuficiencia cardiaca (IC) son la principal causa de morbimortalidad en los pacientes con diabetes. El objetivo de este trabajo es conocer la prevalencia de enfermedades cardiovasculares ateroscleróticas y de insuficiencia cardiaca en personas diagnosticadas de diabetes en España durante el año 2017, y compararlas con las de las personas no diagnosticadas de diabetes en función de la edad y el sexo.MétodosLos datos correspondientes a los diagnósticos de diabetes mellitus (DM), infarto agudo de miocardio (IAM), accidente cerebrovascular (ACV), arteriopatía periférica (AP) o IC del año 2017 se obtuvieron de la Base de Datos Clínicos de Atención Primaria (BDCAP) del Sistema Nacional de Salud.ResultadosComparando personas con diabetes y sin diabetes mayores de 35 años, la odds ratio (OR) de estar diagnosticado de IAM, ACV, AP o IC es de alrededor de 2 en el caso de los mayores de 64 años y superior a 4 en los menores de esa edad. Esta OR es mayor en las mujeres respecto a los varones para todos los diagnósticos con excepción de la AP.ConclusionesEste estudio muestra la elevada comorbilidad cardiovascular de los pacientes con diabetes en España, objetivando un mayor de riesgo en los menores de 65 años, más acentuado en mujeres, lo que hace necesario un tratamiento más intensivo en este colectivo de pacientes.

Introduction and objectives:Atherosclerotic cardiovascular disease and heart failure are the leading cause of morbidity and mortality in patients with diabetes. The objective of this work is to know the prevalence of atherosclerotic cardiovascular diseases and heart failure in people diagnosed with diabetes in Spain during 2017 and compare them with those not diagnosed with diabetes according to age and sex.Methods:Data for diagnoses of diabetes mellitus (DM), acute myocardial infarction (AMI), stroke, peripheral artery disease (PAD) or heart failure (HF) for 2017 were obtained from the National Health System's Primary Care Clinical Database (BDCAP).Results:Comparing people with diabetes and people without diabetes over 35 years of age, the Odds Ratio (OR) for being diagnosed with acute myocardial infarction, stroke, peripheral artery disease or heart failure is about 2 in those over 64 years of age and more than 4 in patients under that age. This OR is superior in females versus males for all diagnoses apart from peripheral artery disease.Conclusions:This study shows the high cardiovascular comorbidity of patients with diabetes in Spain, with a greater excess of risk in patients under 65 years of age, more pronounced in women. We should offer more intensive treatment for DM2 in women. (AU)

[Cardiovascular diseases in people with diabetes mellitus in Spain according to the Primary Care Clinical Database (BDCAP) in 2017]. / Enfermedades cardiovasculares en personas con diabetes mellitus en España según la Base de Datos Clínicos de Atención Primaria (BDCAP) en 2017.

INTRODUCTION AND OBJECTIVES: Atherosclerotic cardiovascular disease and heart failure are the leading cause of morbidity and mortality in patients with diabetes. The objective of this work is to know the prevalence of atherosclerotic cardiovascular diseases and heart failure in people diagnosed with diabetes in Spain during 2017 and compare them with those not diagnosed with diabetes according to age and sex. METHODS: Data for diagnoses of diabetes mellitus (DM), acute myocardial infarction (AMI), stroke, peripheral artery disease (PAD) or heart failure (HF) for 2017 were obtained from the National Health System's Primary Care Clinical Database (BDCAP). RESULTS: Comparing people with diabetes and people without diabetes over 35 years of age, the Odds Ratio (OR) for being diagnosed with acute myocardial infarction, stroke, peripheral artery disease or heart failure is about 2 in those over 64 years of age and more than 4 in patients under that age. This OR is superior in females versus males for all diagnoses apart from peripheral artery disease. CONCLUSIONS: This study shows the high cardiovascular comorbidity of patients with diabetes in Spain, with a greater excess of risk in patients under 65 years of age, more pronounced in women. We should offer more intensive treatment for DM2 in women.

Estimación de grasa corporal según ecuación CUN-BAE e IMC y riesgo de mortalidad por sexos en la cohorte del Estudio Asturias / Estimation of body fat mass using the CUN-BAE index and mortality risk by sex in the Asturias Study cohort

Introducción y objetivos: Conocemos que el exceso de grasa corporal (GC) se asocia con factores de riesgo cardiovascular, algunos tipos de cáncer y otras causas principales de muerte. Se ha definido un nuevo método antropométrico: el índice CUN-BAE (Clínica Universidad de Navarra-Estimador de Adiposidad Corporal), que se basa en el IMC, el sexo y la edad. Hemos utilizado IMC y CUN-BAE para evaluar su contribución en la asociación con mortalidad en la cohorte del Estudio Asturias. Material y métodos: El Estudio Asturias se trata de un estudio de cohortes que incluyó a 1.034 individuos de 30-75 años de edad que participaron en la primera fase del estudio (1998-1999), realizando encuesta, exploración física y sobrecarga oral de glucosa. Se registraron los fallecimientos en la cohorte tras 18 años de seguimiento. Resultados: 204 personas fallecieron: 93 mujeres y 111 varones (16,6% de las mujeres y 23,5% de los varones). Valores basales tanto de IMC como de %GC determinantes de obesidad (> 30 kg/m2 para IMC; > 25% en hombres y > 35% en mujeres para CUN-BAE) fueron mayoritarios en los datos de individuos fallecidos. Tras ajuste por DM2, HTA, ECV y tabaco, el riesgo de mortalidad por todas las causas y cardiovascular es significativamente mayor según se incrementa el CUN-BAE, sobre todo en mujeres. Conclusiones: La ecuación CUN-BAE es una herramienta útil en mujeres para detectar las que van a presentar un mayor riesgo de mortalidad, independientemente de factores de riesgo

Introduction and objectives: In epidemiological studies, excess body fat (BF) has been associated with cardiometabolic risk factors, some types of cancer, and other causes of death. A new anthropometric method has been defined: The CUN-BAE index (University of Navarra Clinic-Body Fat Estimator), which is based on BMI, sex, and age. BMI and CUN-BAE index were used to assess their contribution to mortality risk from any cause in the Asturias Study cohort. Material and methods: The Asturias study is a cohort study including 1.034 individuals aged 30-75 years who participated in the first study phase (1998-1999). The study included a clinical survey, physical examination, and an oral glucose tolerance test. Vital status was determined in the cohort after 18years of follow-up. Results: Two hundred and four subjects died: 93 females and 111 males (16.6% and 23.5% respectively men). Baseline values of both BMI and %BF suggesting obesity (BMI > 30 kg/m2 and CUN-BAE > 25% in males and >35% in females) were found in most subjects. After adjusting for T2DM, HBP, CVD, and tobacco, the risk of all-cause and cardiovascular mortality was significantly higher as CUN-BAE increased, especially in females. Conclusions: The CUN-BAE equation is a useful tool, especially in females, to detect those who will have a greater risk of mortality, regardless of cardiovascular risk factors

Estimation of body fat mass using the CUN-BAE index and mortality risk by sex in the Asturias Study cohort. / Estimación de grasa corporal según ecuación CUN-BAE e IMC y riesgo de mortalidad por sexos en la cohorte del Estudio Asturias.

INTRODUCTION AND OBJECTIVES: In epidemiological studies, excess body fat (BF) has been associated with cardiometabolic risk factors, some types of cancer, and other causes of death. A new anthropometric method has been defined: The CUN-BAE index (University of Navarra Clinic-Body Fat Estimator), which is based on BMI, sex, and age. BMI and CUN-BAE index were used to assess their contribution to mortality risk from any cause in the Asturias Study cohort. MATERIAL AND METHODS: The Asturias study is a cohort study including 1.034 individuals aged 30-75years who participated in the first study phase (1998-1999). The study included a clinical survey, physical examination, and an oral glucose tolerance test. Vital status was determined in the cohort after 18years of follow-up. RESULTS: Two hundred and four subjects died: 93 females and 111 males (16.6% and 23.5% respectively men). Baseline values of both BMI and %BF suggesting obesity (BMI>30kg/m2 and CUN-BAE >25% in males and >35% in females) were found in most subjects. After adjusting for T2DM, HBP, CVD, and tobacco, the risk of all-cause and cardiovascular mortality was significantly higher as CUN-BAE increased, especially in females. CONCLUSIONS: The CUN-BAE equation is a useful tool, especially in females, to detect those who will have a greater risk of mortality, regardless of cardiovascular risk factors.

Experiencia tras el cambio de insulina glargina U100 a glargina U300 en pacientes con diabetes tipo 1. Estudio tras un año de tratamiento en vida real / Experience after switching from insulin glargine U100 to glargine U300 in patients with type 1 diabetes mellitus. A study after one year of treatment in real life

Introducción: Los tratamientos insulínicos actuales para diabetes tipo 1 (DM1) no siempre consiguen los objetivos de control metabólico debido, entre otros aspectos, a la aparición de episodios de hipoglucemia asociados al uso de insulina. Material y métodos: Estudio descriptivo en la vida real con 247 pacientes DM1, el 55,5% varones, de 46,53 ± 16,23 años, con un tiempo de evolución de 21,89 ± 11,99 años, a los que se sustituyó su insulina basal, glargina U100, por glargina U300. Los objetivos primarios fueron los cambios en la HbA1c y en el número de hipoglucemias y los secundarios fueron los cambios en el peso y en la dosis de insulina trascurridos 6 y 12 meses. Resultados: Tras un año, no se observaron cambios en la HbA1c en el total de los pacientes, si bien se comprobó un descenso significativo en los pacientes mal controlados. Sin embargo, aumentó el porcentaje de pacientes con HbA1c < 7,5% a los 6 meses (33,5 vs. 40,5%; p < 0,05), que se mantuvo al año. El número de hipoglucemias leves se redujo tras los 12 meses de tratamiento en aquellos pacientes con antecedentes de hipoglucemias leves. En cuanto al peso, no observamos cambios. La dosis total de insulina/kg se incrementó significativamente en un 7,24% a los 6 meses y en un 8,69% al año por el aumento de la insulina basal. Las diferencias en las dosis a los 6 meses y al año no fueron significativas. Este aumento fue similar entre los grupos según el control metabólico, la presencia de hipoglucemias y no se relacionó con la insulina basal inicial, la HbA1c inicial, el número de hipoglucemias leves ni con el peso inicial. Discusión: En la vida real glargina U300 muestra un mejor control glucémico en pacientes mal controlados, al reducir las hipoglucemias en pacientes con antecedentes de hipoglucemias sin incrementar el peso corporal

Introduction: Current treatment of type 1 diabetes mellitus (T1DM) does not always achieve metabolic control because, among other things, the ocurrence of hypoglycemic events associated to insulin use. Material and methods: A descriptive real life study of 247 T1DM patients, 55.5% male, aged 46.53 ± 16.23 years, and with a mean diabetes duration of 21.89 ± 11.99 years, who were switched from basal insulin glargine U100 to glargine U300. The primary endpoints were changes in Hba1c and number of hypoglycemic events, while secondary endpoints included changes in weight and insulin dose after 6 and 12 months. Results: After one year, no changes were seen in HbA1c, but the proportion of patients with HbA1c values <7.5% increased at 6 months (33.5 vs. 40.5%; P<0.05) and remained stable during one year of follow-up. Hypoglycemic events significantly decreased after one year of treatment in patients with previous hypoglycemic events. No changes were seen in body weight. Total insulin dose (U/kg) increased 7.24% at 6 months of treatment and by 8.69% at one year, mainly due to basal insulin. No changes were seen between the doses given at 6 and 12 months. These changes were similar in the different metabolic control groups and in patients with or without hypoglycemia. This increase was not related with prior basal insulin dose, baseline HbA1c level, number of hypoglycemic events or baseline weight. Discussion: Glargine U300 is a good basal insulin alternative to treat T1DM, improving metabolic control in patients with HbA1c levels >7,5 and decreasing hypoglycemic events in patients with history of hypoglycemia without increasing body weight

Experience after switching from insulin glargine U100 to glargine U300 in patients with type 1 diabetes mellitus. A study after one year of treatment in real life. / Experiencia tras el cambio de insulina glargina U100 a glargina U300 en pacientes con diabetes tipo 1. Estudio tras un año de tratamiento en vida real.

INTRODUCTION: Current treatment of type 1 diabetes mellitus (T1DM) does not always achieve metabolic control because, among other things, the ocurrence of hypoglycemic events associated to insulin use. MATERIAL AND METHODS: A descriptive real life study of 247 T1DM patients, 55.5% male, aged 46.53 ± 16.23 years, and with a mean diabetes duration of 21.89 ± 11.99 years, who were switched from basal insulin glargine U100 to glargine U300. The primary endpoints were changes in Hba1c and number of hypoglycemic events, while secondary endpoints included changes in weight and insulin dose after 6 and 12 months. RESULTS: After one year, no changes were seen in HbA1c, but the proportion of patients with HbA1c values <7.5% increased at 6 months (33.5 vs. 40.5%; P<0.05) and remained stable during one year of follow-up. Hypoglycemic events significantly decreased after one year of treatment in patients with previous hypoglycemic events. No changes were seen in body weight. Total insulin dose (U/kg) increased 7.24% at 6 months of treatment and by 8.69% at one year, mainly due to basal insulin. No changes were seen between the doses given at 6 and 12 months. These changes were similar in the different metabolic control groups and in patients with or without hypoglycemia. This increase was not related with prior basal insulin dose, baseline HbA1c level, number of hypoglycemic events or baseline weight. DISCUSSION: Glargine U300 is a good basal insulin alternative to treat T1DM, improving metabolic control in patients with HbA1c levels >7,5 and decreasing hypoglycemic events in patients with history of hypoglycemia without increasing body weight.

Control metabólico y pérdida de peso en pacientes con obesidad y diabetes mellitus tipo 2 tratados con exenatida / Metabolic control and weight loss in patients with obesity and type 2 diabetes mellitus, treated with exenatide

Fundamento y objetivo. Exenatida es un análogo de GLP1 diseñado para mejorar el control glucémico en pacientes con obesidad y diabetes mellitus tipo 2 (DM2). Además, presenta otras acciones de control metabólico. El objetivo de este estudio fue valorar si exenatida ayuda a conseguir objetivos de control metabólico en pacientes con obesidad y DM2 tras 24 semanas de tratamiento. Pacientes y método. Ensayo clínico abierto en 102 pacientes, 69 mujeres y 33 varones, con edades comprendidas entre 19-77 años (media [DE] de 53,2 [1,1] años, con DM2 de evolución media de 4,88 [0,5] años (extremos entre 1 y 20 años) en tratamiento con antidiabéticos orales (ADO) y obesidad. Resultados. Se observó una diferencia significativa de la glucosa basal, con reducción promedio de 19,7 (7,1) mg/dl, y de hemoglobina glucosilada (HbA1c) de 0,33 (0,17)%, siendo esta última mayor en pacientes con mal control previo al tratamiento (HbA1c>8,5%), en los que la disminución fue de una media del 2,12 (0,53)%. Se tomó como objetivo establecido respecto a HbA1c < 7%, alcanzado en un 14% más de los pacientes tratados que de los controles (43,6 frente a 57,9; p < 0,05). El peso disminuyó en 4,4 (0,8) kg y el índice de masa corporal en 1,7 (0,3) kg/m2. Se redujeron de forma no significativa el colesterol total (una media de 4,9 [1,5] mg/dl), el colesterol unido a lipoproteínas de baja densidad (colesterol LDL) (una media de 3,2 [3,4] mg/dl, el colesterol unido a lipoproteínas de no alta densidad (de 8,6 [5,6] mg/dl) y el colesterol unido a lipoproteínas de alta densidad (de 2,5 [1,4] mg/dl). En pacientes fuera de objetivo (colesterol LDL>100mg/dl y/o triglicéridos>150mg/dl) sí se observaron diferencias significativas en el colesterol LDL y los triglicéridos. En cuanto a la presión arterial (PA), solo se obtuvieron diferencias significativas en las cifras de PA diastólica (descenso medio de 18,9 [5,7] mmHg), mientras que la PA sistólica se redujo de forma no significativa. Se tomó como objetivo establecido respecto a HbA1c<7%, alcanzado en un 14% más de los pacientes tratados que de los controles (43,6 frente a 57,9; p<0,05). Conclusiones. Exenatida es un fármaco efectivo no solo para el control de la glucemia (HbA1c), sino también para otros parámetros como perfil lipídico, PA y peso corporal(AU)

Background and objective. Exenatide is an analogue of GLP1 designed to improve the glycemic control in patients with obesity and type 2 diabetes. It may control other metabolic processes as well. We aimed to evaluate whether exenatide helps to achieve metabolic control goals in patients with obesity and type 2 diabetes (T2DM) after 24 weeks of treatment. Patients and method. Open clinical trial in 102 obese patients, with age between 19-77 years (mean [ED] 53,2 [1,1] years), T2DM with mean evolution of 4,88 [0,5] years (range 1 to 20 years) with oral antidiabetic treatment. Results. There was a reduction of 19.7±7.1mg/dl in the fasting glucose average and of 0.33±0.17% in glycated hemoglobin (HbA1c). These last values were higher (2.12±0.53%) in patients with bad control prior to treatment (HbA1c>8.5%). The desirable threshold of HbA1c<7% was fulfilled by 14% more treated than control patients (43.6 vs. 57.9, P<.05). Reductions of 4.4±0.8kg average weight and of 1.7±0.3kg/m2 body mass index were recorded. Although there was not a significant reduction in the overall lipid profile, a decrease of 4.9±5.1mg/dl total cholesterol, 3.2±4.3mg/dl LDL-C, 8.6±5.6mg/dl noHDL-C and 2.5±1, 4mg/dl HDL-C was observed. Patients outside target (LDL>100 and/or triglycerides>150mg/dl) showed significant differences in their concentrations of LDL-C and triglycerides. With respect to blood pressure (BP), significant differences were observed in diastolic BP (-18.9±5.7mmHg) but not in systolic BP (P<.05). Conclusions. Exenatide is an effective drug not only for glycemic control but also for the overall metabolic control of HbA1c, lipid profile, BP and body weight(AU)

Planteamientos interdisciplinares para la educación nutricional de pacientes con obesidad mórbida / Interdisciplinary aproach by nutritional education in morbid obesity patients

Objetivos: analizar nutricional y socioantropológicamente la población con obesidad mórbida y elaborar un programa de educación nutricional significativo a través del uso de la perspectiva antropológica emic. Materiales y métodos: se valoró a 80 pacientes (29 hombres vs 51 mujeres) del Hospital Universitario Virgen Arrixaca Murcia (España) con obesidad mórbida para posterior elaboración de un programa de educación nutricional. La información es extraída a través de las historias dietéticas y la técnica cualitativa historia de vida. Resultados y Discusión: en etapa infantojuvenil predomina el consumo de guiso de legumbres como principal plato de comida diario (67,5%) en comparación con los guisos de carne y de pescado respectivamente (carne 3,8%; pescado 1,3%), recordando un 45% como una gran cantidad de comida. Un 77,5%no recibieron ningún tipo de castigo si no gustaba el plato, en concordancia tampoco cambiaban ese plato por otro (73,8%). Solamente un 1,2% reconoció recibir algún tipo de beneficio si ingería la comida establecida para ese día. De igual modo, un 56,3% reconoció la frecuencia de ir a algún tipo de kiosco, panadería o confitería una vez acabado el horario escolar. Conclusiones: en la elaboración de cualquier programa se debe incluir el análisis de percepciones de los pacientes a través de una perspectiva emic. Aunque esto supone ampliar el tiempo dedicado por paciente, son necesarios planteamientos interdisciplinarios por la confluencia de esta problemática en el contexto familiar y sociocultural (AU)

Objectives: Nutritional and socio-anthropological analysis of morbidly obese people and develop a signi ficant nutritional education program through emic anthropometric technique. Materials and methods: we evaluated 80 patients (29 men vs 51 women) of the Virgen de la Arrixaca Hospital, in Murcia (Spain) with morbid obesity for further development of a nutrition education program. It is used mainly qualitative methodology through the life histories of these patients, supported by information gleaned from the stories relating to dietary nutritional aspect. Avoid presenting comprehensive the nutritional assessment of patients by the extent of the issue. Thus, we show those most representative qualitative data. Results and Discussion: infant-juvenile stage dominated by the consumption of legume stew as the main daily meal (67.5%) compared with meat stews and fish respectively (3.8% meat, fish 1.3 %), recalling 45% as a large amount of food. 77.5% did not receive any punishment, but liked the dish, the dish changed not match the other (73.8%). Only 1.2% reported receiving some benefit if you ate the food set for that day. Similarly, 56.3% said the frequency of going to some sort of kiosk, bakery and confectionery after finishing the school. Conclussions: show that for the preparation of any program should include analysis of patients' persceptions, differing from those contained in the current quality surveys that quantify emotions and have certain information that only the anthropological technique achieved through the perspective emic. Although this means extending the time spent per patient, interdisciplinary approaches are needed by the confluence of these problems in the family context and sociocultura (AU)

[Metabolic control and weight loss in patients with obesity and type 2 diabetes mellitus, treated with exenatide]. / Control metabólico y pérdida de peso en pacientes con obesidad y diabetes mellitus tipo 2 tratados con exenatida.

BACKGROUND AND OBJECTIVE: Exenatide is an analogue of GLP1 designed to improve the glycemic control in patients with obesity and type 2 diabetes. It may control other metabolic processes as well. We aimed to evaluate whether exenatide helps to achieve metabolic control goals in patients with obesity and type 2 diabetes (T2DM) after 24 weeks of treatment. PATIENTS AND METHOD: Open clinical trial in 102 obese patients, with age between 19-77 years (mean [ED] 53,2 [1,1] years), T2DM with mean evolution of 4,88 [0,5] years (range 1 to 20 years) with oral antidiabetic treatment. RESULTS: There was a reduction of 19.7±7.1mg/dl in the fasting glucose average and of 0.33±0.17% in glycated hemoglobin (HbA(1c)). These last values were higher (2.12±0.53%) in patients with bad control prior to treatment (HbA(1c)>8.5%). The desirable threshold of HbA(1c)<7% was fulfilled by 14% more treated than control patients (43.6 vs. 57.9, P<.05). Reductions of 4.4±0.8kg average weight and of 1.7±0.3kg/m(2) body mass index were recorded. Although there was not a significant reduction in the overall lipid profile, a decrease of 4.9±5.1mg/dl total cholesterol, 3.2±4.3mg/dl LDL-C, 8.6±5.6mg/dl noHDL-C and 2.5±1, 4mg/dl HDL-C was observed. Patients outside target (LDL>100 and/or triglycerides>150mg/dl) showed significant differences in their concentrations of LDL-C and triglycerides. With respect to blood pressure (BP), significant differences were observed in diastolic BP (-18.9±5.7mmHg) but not in systolic BP (P<.05). CONCLUSIONS: Exenatide is an effective drug not only for glycemic control but also for the overall metabolic control of HbA(1c), lipid profile, BP and body weight.