Effects of the COVID-19 pandemic on gestational diabetes in Castilla-La Mancha (Spain).

SUBJECT-MATTER: To assess the effect of the 2019 coronavirus (COVID-19) pandemic on gestational diabetes (GDM). MATERIAL AND METHODS: In this retrospective, multicentre, non-interventional study carried out in Castilla-La Mancha, Spain, we compared 663 women with GDM exposed to the pandemic (pandemic group), with 622 women with GDM seen one year earlier (pre-pandemic group). The primary endpoint was a Large for Gestational Age (LGA) newborn as an indicator of poor GDM control. Secondary endpoints included obstetric and neonatal complications. RESULTS: During the pandemic, the gestational week at diagnosis (24.2 ±â€¯7.4 vs 22.9 ±â€¯7.7, p = 0.0016) and first visit to Endocrinology (26.6 ±â€¯7.2 vs 25.3 ±â€¯7.6, p = 0.0014) were earlier. Face-to-face consultations were maintained in most cases (80.3%). The new diagnostic criteria for GDM were used in only 3% of cases. However, in the pandemic group, the final HbA1c was higher (5.2 ±â€¯0.48 vs 5.29 ±â€¯0.44%, p = 0.047) and there were more LGA newborns (8.5% vs 12.8%, p = 0.015). There were no differences in perinatal complications. CONCLUSIONS: Care for GDM in our Public Health System did not significantly deteriorate during the COVID-19 pandemic. However, this did not prevent a higher number of LGA newborns.

All-cause mortality and risk factors in patients with type 1 diabetes in Castilla-La Mancha, Spain. DIACAM1 2010-2020 study.

INTRODUCTION: Despite better treatments and care for patients with type 1 diabetes (T1DM), all-cause and cardiovascular mortality still remains higher compared to the general population. We evaluated mortality and risk factors for mortality in a representative cohort of patients with T1DM. METHODS: DIACAM1 was a cross-sectional, multicenter study on adult patients (≥ 16 years old) and diabetes with at least 5 years since diabetes diagnosis conducted between 2009 and 2010. DIACAM1 2010-2020 study was a follow-up study, extension of DIACAM1, where vital status of patients was evaluated between June 2019 and June 2020. RESULTS: 4.03% [CI95%, 2.53-5.62) of the 1465 patients with T1DM included in the cohort of the DIACAM1 in 2010 had died. Survival was lower than in the sex- and age-matched general population in the same region. 40.7% of deaths were due to cardiovascular disease. HbA1c levels < 7% and triglyceride levels < 150 mg/dL were associated with lower mortality, whereas retinopathy and plasma creatinine were associated with increased mortality. CONCLUSIONS: We confirmed a lower survival in people with T1DM, with cardiovascular disease being the main cause of mortality. High HbA1c, high triglycerides, retinopathy, and high creatinine are factors associated with mortality.

Prevalencia de enfermedades autoinmunes en pacientes con diabetes mellitus tipo 1. Estudio DIACAM 1 2010-2020 / Prevalence of autoimmune diseases in patients with type 1 diabetes mellitus. DIACAM 1 study 2010-2020

Objective: To evaluate the prevalence of autoimmune diseases (AD) associated with type 1 diabetes mellitus (T1DM).Patients and methodsAnalytical cross-sectional study, nested in a multicenter prospective cohort of 1121 adults with DM1 with active follow-up in endocrinology clinics. Sociodemographic and clinical variables and the presence of AD were analysed in 2010 and 2020.ResultsIn this second analysis, 49,5% were male, mean age was 49.4 ± 12.8 years, median T1DM duration was 27,1 years (20,7-35,1) and mean glycated hemoglobin was 7.66 ± 1.06%. There is an absolute increase of 13% (95% CI 11-15) (p < 0.001) of patients with at least one AE and an absolute increase of 11.6% (95% CI 9.7-13.5) (p < 0.0001) of any type of autoimmune thyroid disease (ATD) after 10 years of follow-up. Likewise, the prevalence of celiac disease, autoimmune gastritis and other AD increased statistically significantly. In the multivariate logistic regression analysis, the factors that were independently associated with the presence of ATD were female gender [OR 2.9 (95% CI 2.3-3.7); p < 0.0001] and the presence of type 1 b diabetes (OR 0.5 [95% CI 0.3-0.9]; p = 0.041).ConclusionsAfter 10 years of follow-up, there is a substantial increase in other types of AE in patients with DM1. It seems necessary to carry out a systematic screening of these AD to optimize the follow-up of patients with 1 TDM, mainly of the ATD. (AU)

Objetivo: Conocer la prevalencia de las enfermedades autoinmunes (EA) asociadas a la diabetes mellitus tipo 1 (DM1).Pacientes y métodosEstudio transversal analítico, anidado en una cohorte prospectiva multicéntrica de 1.121 adultos con DM1 con seguimiento activo en consultas de endocrinología. Se analizaron variables sociodemográficas, clínicas y la presencia de EA en el año 2010 y en el año 2020.ResultadosEn este segundo análisis, la edad media fue de 49,4 ± 12,8 años, siendo el 49,5% varones, con una mediana de tiempo de evolución de la DM1 de 27,1 años (20,7-35,1) y una media de hemoglobina glicosilada de 7,66 ± 1,06%. Existe un incremento absoluto del 13% (IC 95% 11-15) (p < 0,001) de pacientes con al menos una EA y un incremento absoluto de 11,6% (IC 95% 9,7-13,5) (p < 0,0001) de cualquier tipo de enfermedad tiroidea autoinmune (ETA) tras 10 años de seguimiento. Así mismo, aumentó la prevalencia de manera estadísticamente significativa de la gastritis autoinmune, enfermedad celiaca y otras EA. En el análisis de regresión logística multivariante, los factores que se asociaron de manera independiente a la presencia de ETA fueron el género femenino (OR 2,9 [IC 95% 2,3-3,7]; p < 0,0001) y la DM1 tipo b (OR 0,5 [IC 95% 0,3-0,9]; p = 0,041).ConclusionesTras 10 años de seguimiento activo se produce un incremento sustancial de otro tipo de EA en pacientes con DM1. Parece necesario realizar un cribado sistemático de dichas EA para optimizar el seguimiento de los pacientes con DM1, fundamentalmente de la ETA. (AU)

Prevalence of autoimmune diseases in patients with type 1 diabetes mellitus. DIACAM 1 study 2010-2020. / Prevalencia de enfermedades autoinmunes en pacientes con diabetes mellitus tipo 1. Estudio DIACAM 1 2010-2020.

OBJECTIVE: To evaluate the prevalence of autoimmune diseases (AD) associated with type 1 diabetes mellitus (T1DM). PATIENTS AND METHODS: Analytical cross-sectional study, nested in a multicenter prospective cohort of 1121 adults with DM1 with active follow-up in endocrinology clinics. Sociodemographic and clinical variables and the presence of AD were analysed in 2010 and 2020. RESULTS: In this second analysis, 49,5% were male, mean age was 49.4 ± 12.8 years, median T1DM duration was 27,1 years (20,7-35,1) and mean glycated hemoglobin was 7.66 ± 1.06%. There is an absolute increase of 13% (95% CI 11-15) (p < 0.001) of patients with at least one AE and an absolute increase of 11.6% (95% CI 9.7-13.5) (p < 0.0001) of any type of autoimmune thyroid disease (ATD) after 10 years of follow-up. Likewise, the prevalence of celiac disease, autoimmune gastritis and other AD increased statistically significantly. In the multivariate logistic regression analysis, the factors that were independently associated with the presence of ATD were female gender [OR 2.9 (95% CI 2.3-3.7); p < 0.0001] and the presence of type 1 b diabetes (OR 0.5 [95% CI 0.3-0.9]; p = 0.041). CONCLUSIONS: After 10 years of follow-up, there is a substantial increase in other types of AE in patients with DM1. It seems necessary to carry out a systematic screening of these AD to optimize the follow-up of patients with 1 TDM, mainly of the ATD.

Tumor fibroso solitario primario en tiroides: comunicación de un caso y revisión de la literatura / Primary solitary fibrous tumour of the thyroid: a case report and review of the literature

El tumor fibroso solitario es una neoplasia mesenquimal de localización tiroidea muy poco usual. Comunicamos el caso de un varón de 42 años con resección del lóbulo tiroideo derecho tras un diagnóstico citológico de proliferación folicular. Macroscópicamente la lesión correspondía a un nódulo encapsulado de 2,5 cm de diámetro máximo. Histológicamente la lesión estaba constituida por una proliferación de células fusiformes que engloban y atrapan a los folículos tiroideos, positivas para vimentina, CD34 y BCL2. El estudio ultraestructural confirmó la naturaleza miofibroblástica de las células neoplásicas (AU)

The thyroid gland is an unusual location for solitary fibrous tumours. We report a case of a 42 year old male with a cytological diagnosis of follicular proliferation. Macroscopically the lesion corresponded to an encapsulated nodule of 2.5 cm. Histologically, it showed a proliferation of spindle cells encompassing thyroid follicles, positive for vimentin, CD34 and BCL2. The ultrastructural study confirmed the myofibroblastic nature of the proliferative cells (AU)

Enfermedades autoinmunes asociadas a la diabetes mellitus tipo 1 en el estudio DIACAM1 / Relationship between autoimmune disease and type 1 diabetes in the DIACAM1 Study

OBJETIVO: Evaluar las características de las enfermedades autoinmunes (EA) asociadas a la diabetes mellitus tipo 1 (DM1). PACIENTES Y MÉTODOS: Estudio transversal, multicéntrico, que incluyó a pacientes adultos con DM1 valorados en consultas externas de endocrinología durante 12 meses. Se analizaron variables sociodemográficas, clínicas y la presencia de EA (enfermedad tiroidea autoinmune [ETA], gastritis crónica, enfermedad celiaca [EC], vitíligo, insuficiencia suprarrenal primaria [ISR] y otras EA registradas en esta cohorte). RESULTADOS: De un total de 1.465 pacientes, el 51,5% varones, con una mediana de edad de 38,2 años (rango intercuartílico, 28,5-48,3) y una mediana de tiempo de evolución de la DM1 de 17,3 años (11,1-25,6), el 29,2% presentaron alguna EA, siendo la más frecuente la ETA (22% con normofunción o hipofunción y 3,4% con hiperfunción tiroidea). La ETA fue más frecuente en el sexo femenino (70,5% [p < 0,001]) y aumentó con la edad (41,7±14,5 vs 38,6±13,1 años en sujetos con y sin ETA, respectivamente [p < 0,001]). La ETA con normofunción o hipofunción tiroidea aumentó también con el tiempo de evolución de la DM1 (17,1% en <10 años de evolución, 21% en 10-20 años, 24,6% en 20-30 años y 26,3% en >30años [p < 0,05]). Otras EA que se asociaron fueron la gastritis crónica (3,6%), el vitíligo (1,6%), la EC (1,1%), la ISR (0,3%) y otras (3,4%). CONCLUSIONES: La ETA es la EA más prevalente. La EC y la gastritis crónica probablemente se encuentren infradiagnosticadas en este estudio por la falta de consenso en cuanto a su cribado. Parece necesario realizar un cribado sistemático de EA en pacientes con DM1

OBJECTIVE: To assess the characteristics of autoimmune diseases (AD) in patients with type 1 diabetes mellitus (T1DM). PATIENTS AND METHODS: A cross-sectional, multicentre study on adult patients with T1DM seen in outpatient endocrinology clinics over a 12 month period. Sociodemographic and clinical variables and the presence of AD [autoimmune thyroid disease (ATD), chronic gastritis, coeliac disease (CD), vitiligo, primary adrenal insufficiency, and other AD in this cohort] were investigated. RESULTS: The study included a total of 1,465 patients (51.5% male) with a median age of 38.2 years (interquartile range 28,5-48,3) and a median diabetes duration of 17.3 years (11.1-25.6). Just under one-third (29.2%) had AD, with ATD being the most frequent (22% with normal thyroid function or hypothyroidism, and 3.4% with hyperthyroidism). ATD was most frequent in females [70.5% (P<0.001)] and the prevalence increased with age [41.7±14.5 vs 38.6±13.1 years in patients with and without ATD respectively (P<.001)]. ATD with normal thyroid function or hypothyroidism increased also with longer duration of T1DM [17.1% with <10years, 21% with 10-20 years, 24.6% with 20-30 years and 26.3 with >30years (P<.05)]. Other AD were chronic gastritis (3.6%), vitiligo (1.6%), CD (1.1%), primary adrenal insufficiency (0.3%) and others (3.4%). CONCLUSIONS: ATD was the most prevalent AD. CD and chronic gastritis were probably underdiagnosed in our study as there is no consensus for screening. Screening for AD may be necessary in patients with T1DM