Diabetes y mujer, ¿por qué somos diferentes? / Diabetes and women, why are we different?

La diabetes afecta de manera diferente a hombres y a mujeres, y la presunción equivocada de igualdad en su expresividad clínica puede tener como consecuencia errores y demoras en el proceso diagnóstico y en la estrategia terapéutica que se adopte. El objetivo del artículo es mostrar las diferencias de género que influyen en el abordaje de esta patología y cuál es el papel del médico de familia en el seguimiento de la mujer con diabetes. Es una revisión sobre el impacto de la diabetes en las distintas etapas de la vida de la mujer, cómo los cambios hormonales afectan al control glucémico, la diabetes gestacional, cómo afecta la diabetes al desarrollo de las complicaciones crónicas en la mujer y sus consecuencias, las diferencias existentes en el control de los factores de riesgo cardiovascular y los aspectos diferenciales por sexo de las distintas familias de fármacos utilizados en el tratamiento de la diabetes. (AU)

Diabetes affects men and women differently and the mistaken assumption of equality in its clinical expression can lead to errors and delays in the diagnostic process and the therapeutic strategy adopted. The objective is to show the gender differences that influence the approach to this pathology and what the role of the family doctor is in the monitoring of women with diabetes. It is a review of the impact of diabetes at different stages of a woman's life, how hormonal changes affect glycemic control, gestational diabetes, how diabetes affects the development of chronic complications in women and their consequences, the existing differences in the control of cardiovascular risk factors and the differential aspects by sex of the different families of drugs used in the treatment of diabetes. (AU)

[Diabetes and women, why are we different?] / Diabetes y mujer, ¿por qué somos diferentes?

Diabetes affects men and women differently and the mistaken assumption of equality in its clinical expression can lead to errors and delays in the diagnostic process and the therapeutic strategy adopted. The objective is to show the gender differences that influence the approach to this pathology and what the role of the family doctor is in the monitoring of women with diabetes. It is a review of the impact of diabetes at different stages of a woman's life, how hormonal changes affect glycemic control, gestational diabetes, how diabetes affects the development of chronic complications in women and their consequences, the existing differences in the control of cardiovascular risk factors and the differential aspects by sex of the different families of drugs used in the treatment of diabetes.

La diabetes tipo 3c. Abordaje desde el médico del primer nivel / Type 3 c diabetes: Approach from the first level doctor

La diabetes mellitus tipo 3c (DM3c) es una diabetes (DM) del páncreas exocrino que habrá que sospechar siempre que existan antecedentes de pancreatitis crónica (PC), pancreatitis aguda (PA) o recidivante (PAR) (80% de los casos) o una DM de nueva aparición en individuos a partir de los 50 años sin otra justificación (pruebas de autoinmunidad negativas, anticuerpos contra la descarboxilasa del ácido glutámico). Se trata de una entidad mal diagnosticada como diabetes tipo 2 (DM2) (90%) y, por ello, de no sospecharla puede pasar inadvertida. Para su diagnóstico son de utilidad la ecografía abdominal, la determinación del antígeno tumoral carbohydrate antigen 19-9 (CA 19.9), la resonancia magnética nuclear (RMN) o la tomografía axial computarizada (TAC). El tratamiento es el mismo de la DM2, aunque con ciertas especificaciones según el tipo de fármacos y con la particularidad de que al tratarse de una «diabetes frágil» habrá que tener mayor precaución con las hipoglucemias (monitorización). Asimismo, al ser una enfermedad del páncreas exocrino habrá que tratar específicamente esta para evitar las alteraciones metabólicas, malabsortivas y/o nutricionales (AU)

DM3c is diabetes (DM) of the exocrine pancreas that must be suspected whenever there is a history of chronic pancreatitis (CP), acute pancreatitis (AP) or recurrence (80% of cases) or new-onset DM in individuals from over 50 years of age without any other justification (negative autoimmunity tests, Glutamic Acid Decarboxylase antibodies). It is an entity misdiagnosed as type 2 diabetes (DM2) (90%) and therefore, if it is not suspected, it can go unnoticed. For its diagnosis, abdominal ultrasound, determination of the CA 19.9 tumor antigen (carbohydrate antigen 19-9), nuclear magnetic resonance (NMR) or computerized axial tomography (CT) are useful. The treatment is the same as DM2, although certain specifications depend on the type of drugs and with the particularity that in dealing with «fragile diabetes» greater caution must be taken with hypoglycemia (monitoring). Likewise, as it is a disease of the exocrine pancreas, it will have to be specifically treated to avoid metabolic, malabsorptive and/or nutritional alterations (AU)

[Type 3 c diabetes: Approach from the first level doctor]. / La diabetes tipo 3c. Abordaje desde el médico del primer nivel.

DM3c is diabetes (DM) of the exocrine pancreas that must be suspected whenever there is a history of chronic pancreatitis (CP), acute pancreatitis (AP) or recurrence (80% of cases) or new-onset DM in individuals from over 50 years of age without any other justification (negative autoimmunity tests, Glutamic Acid Decarboxylase antibodies). It is an entity misdiagnosed as type 2 diabetes (DM2) (90%) and therefore, if it is not suspected, it can go unnoticed. For its diagnosis, abdominal ultrasound, determination of the CA 19.9 tumor antigen (carbohydrate antigen 19-9), nuclear magnetic resonance (NMR) or computerized axial tomography (CT) are useful. The treatment is the same as DM2, although certain specifications depend on the type of drugs and with the particularity that in dealing with «fragile diabetes¼ greater caution must be taken with hypoglycemia (monitoring). Likewise, as it is a disease of the exocrine pancreas, it will have to be specifically treated to avoid metabolic, malabsorptive and/or nutritional alterations.

[Adherence to healthy lifestyle behaviours in patients with type 2 diabetes in Spain]. / Adherencia a un estilo de vida saludable en pacientes con diabetes mellitus tipo 2 en España.

OBJECTIVES: The aim of this study was to report on the main lifestyle components and related factors in adults with diabetes type 2 treated in Primary Care clinics in Spain. MATERIAL AND METHODS: A cross-sectional and multicentre study was performed on a consecutive sample of patients with type 2 diabetes attending 25 Primary Care clinics between April 2018 and April 2019. Data were collected by auditing the computerised medical records, and an interview. An analysis was carried out on adherence to 4 healthy lifestyle trends (Mediterranean diet, regular exercise, not smoking, and emotional well-being). RESULTS: A total of 412 patients were included in the analysis (mean age 69 (SD 8.65) years; 50.2% men). Only a minority was highly adherent to the Mediterranean diet, 92 (22.3%). Regular physical activity was carried out by 189 (45.8%). A total of 361 (87.6%) were non-smoking, and 259 (62.8%) felt emotional well-being. A small number (9, 2.1%) of patients had not followed any of the healthy lifestyle recommendations, with 87 (21.1%) following one, 145 (35.1%) two, 128 (31%) three, and 43 (10.4%) all 4 healthy habits: diet, exercise, not smoking, and emotional well-being. Healthy lifestyle adherence was related to gender. Obesity is poorly associated with adherence to diet and physical activity. The results for age, time with the disease, socioeconomic status, and treatment regimen were not consistent. CONCLUSIONS: This study suggest that adherence to a healthy lifestyle pattern in DM2 is low. Less than a quarter follow a healthy diet, and less than a half practice regular exercise. Gender is the variable that most influences a healthy lifestyle in DM2, but not age, time with the disease, or treatment regimen.

[Management of type 2 diabetes mellitus in adolescents and young adults in primary care]. / Manejo de la diabetes mellitus tipo 2 en adolescentes y adultos jóvenes en atención primaria.

The prevalence of type 2 diabetes (DM2) diagnosed in childhood and adolescence is currently increasing, and is characterised by a rapidly progressive decline in beta-cells and insulin resistance. Physical inactivity and obesity are the main risk factors for its development. Diagnostic criteria are similar to those used in adults, although HbA1c as a diagnostic method is questioned. Diabetes-related complications are more aggressive than in adults. Diabetic nephropathy is the most frequent complication in the young population and macrovascular complications appear early, leading to high mortality rates. Healthy lifestyles are the basis of the treatment, and metformin, insulin and liraglutide (approved by FDA for its use in the United States) are the pharmacological options indicated in this population. It is important to establish models of health care transition from paediatric to adult care to ensure continuity of care and avoid patient disengagements.

[Consensus document on the treatment of dyslipidemia in diabetes]. / Recomendaciones de buena práctica en el tratamiento de la dislipemia en la diabetes.

People with type 2 diabetes mellitus have a 2 to 4 times higher risk of developing cardiovascular diseases when compared to general population of similar age and sex. This risk remains after adjustment of other traditional cardiovascular risk factors. The dyslipidemia associated with type 2 diabetes mellitus is present in up to 60% of people with diabetes and contributes greatly to increased cardiovascular, morbidity and mortality risk in these patients. Diabetic dyslipidemia is a disorder of lipid metabolism characterized by an excess of triglycerides, a decrease in HDL-cholesterol and altered lipoprotein composition, consisting mainly in an excess of small, dense LDL particles. Multiple clinical trials have demonstrated the benefits of drug treatment of dyslipidemia (mainly statins) to prevent cardiovascular events and mortality in people with diabetes, both in primary and secondary prevention. This consensus document, developed by general practitioners, members of the Diabetes Group of the Spanish Society of Primary Care Physicians (SEMERGEN), aims to assist in the management of patients with diabetes and dyslipidemia in accordance with the most recent recommendations.

[Diabetic ketoacidosis in patients with soft-tissue necrotizing infections]. / Cetoacidosis diabética en pacientes con infecciones necrosantes de tejidos blandos.

Necrotizing soft tissue infection is an uncommon and severe infection of the skin, subcutaneous tissue and superficial fascia which is usually accompanied by severe systemic toxicity. These infections occur more frequently in diabetics and are associated with higher morbidity and mortality rate. The prognosis of necrotizing fasciitis is known to be dependent on early recognition and treatment. Therefore, clinical awareness is important to avoid fatal outcome in patients with diabetes mellffus. We present three patients with undiagnosed type 2 diabetes in whom hyperglycaemia may have facilffated me development of necrotizing tissue infection, which in tum may have precipitated diabetic ketoacidosis in patients who rarely develop this metabolic complication.