Blood glucose control and quality of health care in non-insulin-treated patients with Type 2 diabetes in Spain: a retrospective and cross-sectional observational study.

AIMS: To assess blood glucose control and quality of health care provided to non-insulin-treated patients with Type 2 diabetes mellitus in routine clinical practice in Spain. METHODS: In this observational, retrospective, cross-sectional study, patients were grouped as either having good or suboptimal blood glucose control according to International Diabetes Federation or American Diabetes Association HbA(1c) goals. Clinical and socio-demographic data and compliance with the main standard level of care recommendations of the International Diabetes Federation were recorded during a routine visit. Correlates of glucose control were analysed by logistic regression. RESULTS: Many patients were grouped as having suboptimal control under International Diabetes Federation (61.9%) or American Diabetes Association (45.0%) criteria. The mean number of accomplished International Diabetes Federation recommendations (7.3 out of 11) was higher for endocrinologists (than for internists or primary care physicians), and significantly more patients under their care were in the good glucose control group (than with primary care physicians). More recommendations were associated with blood glucose control using International Diabetes Federation than American Diabetes Association criteria, demanding higher quality of health care for achieving stricter goals. Some recommendations were poorly observed, particularly those concerning patients' education on diabetes, the prompt prescription of effective treatments and monitoring of complications. Diabetes complications were associated with being in the suboptimal control group. Patients' education on diabetes and HbA(1c) monitoring were associated with being in the good control group. CONCLUSIONS: These results demonstrate the need for improvement in the management of patients with non-insulin-treated Type 2 diabetes in actual clinical practice in Spain. Such improvement would entail a stricter adherence to International Diabetes Federation recommendations.

[The impact of obesity in the management and evolution of diabetes mellitus]. / El impacto de la obesidad en el manejo y evolución de la diabetes mellitus.

OBJECTIVES: To assess both management and evolution of diabetes mellitus type 2 (DM2) in Primary Care centers in Spain and the related factors, especially obesity. METHODOLOGY: Epidemiological, cross-sectional, multicenter, retrospective study. PATIENTS: Patients suffering from DM2, over 20 years of age, were consecutively enrolled from 30 Primary Care centers in 16 autonomous communities. Métodos. Data was collected on age, gender, educational level, DM2 duration, HbA1c, treatment and body measurement index (BMI). RESULTS: A total of 294 patients, 50% male, with a mean age (SD) of 67.5 years (10.2) and BMI 28.9 (4.5) kg/m(2) were included. Of them, 58.16% had HbA1c levels >6.5%, 38% being obese or severely obese. A total of 93.9% were under drug treatment for DM2. Significant differences in the mean value of HbA1c were shown between the over-weight and severely obese groups (Tukey-Kramer test). Differences were observed in the presence of macrovascular complications between patients with normal weight and patients with obesity (p=0.006). Patients with low educational level had 3.39 more probability of being obese or severely obese than patients with secondary school or university studies (p=0.0041; 95% CI 1.47-7.80), and patients with primary school 2.22 more probability (p= 0.038; 95% CI 1.04-4.73). A total of 47.8% reported high compliance. Obese and severely obese patients showed 2.2 more probability of having low or mild compliance than non-obese patients (p=0.002; 95% CI 1.31-3.74). CONCLUSIONS: Results obtained in this population suggest that obesity is related with more macro-vascular complications, worst metabolic control and worst compliance.

El impacto de la obesidad en el manejo y evolución de la diabetes mellitus / The impact of obesity in the management and evolution of diabetes mellitus

Objetivo. Estudiar el manejo y evolución de ladiabetes mellitus tipo 2 (DM2) en Atención Primaria(AP) en España y los factores implicados,especialmente la obesidad.Diseño. Estudio epidemiológico, transversal,multicéntrico, retrospectivo.Participantes. Se incluyeron pacientes con DM2mayores de 20 años seleccionadosconsecutivamente en 30 centros de AP, en16 comunidades autónomas (CCAA).Métodos. Se recogió información sobre edad, sexo,nivel educativo, duración de DM2, HbA1c,tratamiento e índice de masa corporal (IMC).Resultados. De un total de 294 pacientes, 50%hombres, con edad media (DE) 67,5 años (10,2) eIMC 28,9 (4,5) kg/m2, el 58,16% presentabanniveles de HbA1c >6,5%, el 38% era obeso oseveramente obeso. El 93,9% seguía tratamientofarmacológico para su diabetes. Se mostrarondiferencias significativas en el valor medio deHbA1c entre el grupo con sobrepeso y el grupocon obesidad severa (test de Tukey-Kramer).Se observaron diferencias en la presencia decomplicaciones macrovasculares entrepacientes con peso normal y pacientes obesos(p=0,006). Pacientes con menor grado dealfabetización mostraron 3,39 más probabilidad deser obesos o severamente obesos que pacientescon estudios secundarios o universitarios(p=0,0041; 95% intervalo de confianza [IC] 1,47-7,80), y los pacientes con estudios primarios 2,22veces más (p=0,038; 95% IC 1,04-4,73). Un47,8% refirieron un cumplimiento elevado. Losobesos y severamente obesos presentaron 2,2veces más probabilidad de presentar cumplimientobajo o moderado que los no obesos (p=0,002;95% IC 1,31-3,74 ).Conclusiones. Los resultados obtenidos en estapoblación sugieren que la variable obesidad serelaciona con más complicaciones macrovasculares,peor control metabólico y peor cumplimiento

Objectives. To assess both management andevolution of diabetes mellitus type 2 (DM2) inPrimary Care centers in Spain and the relatedfactors, especially obesity.Methodology. Epidemiological, cross-sectional,multicenter, retrospective study.Patients. Patients suffering from DM2, over 20years of age, were consecutively enrolled from 30Primary Care centers in 16 autonomouscommunities.Métodos. Data was collected on age, gender,educational level, DM2 duration, HbA1c, treatmentand body measurement index (BMI).Results. A total of 294 patients, 50% male, with amean age (SD) of 67.5 years (10.2) and BMI 28.9(4.5) kg/m2 were included. Of them, 58.16% hadHbA1c levels >6.5%, 38% being obese or severelyobese. A total of 93.9% were under drug treatmentfor DM2. Significant differences in the mean valueof HbA1c were shown between the over-weight andseverely obese groups (Tukey-Kramer test).Differences were observed in the presence ofmacrovascular complications between patients withnormal weight and patients with obesity (p=0.006).Patients with low educational level had 3.39 moreprobability of being obese or severely obese thanpatients with secondary school or university studies(p=0.0041; 95% CI 1.47-7.80), and patients withprimary school 2.22 more probability (p= 0.038;95% CI 1.04-4.73). A total of 47.8% reported highcompliance. Obese and severely obese patientsshowed 2.2 more probability of having low or mildcompliance than non-obese patients (p=0.002; 95%CI 1.31-3.74).Conclusions. Results obtained in this populationsuggest that obesity is related with more macrovascularcomplications, worst metabolic control andworst compliance

Cost of severe hypoglycaemia in patients with type 1 diabetes in Spain and the cost-effectiveness of insulin lispro compared with regular human insulin in preventing severe hypoglycaemia.

OBJECTIVES: To determine the costs of severe hypoglycaemia (SH) in a population of patients with type 1 diabetes mellitus in the Spanish healthcare system and the cost-effectiveness of insulin lispro over regular insulin in preventing SH episodes. METHODS: A retrospective study of 100 patients in three Spanish health centres was performed. Resource utilisation data were collected only for interventions specifically relating to the hypoglycaemic episode. The direct medical costs determined in the analyses were: costs of hospitalisation, diagnostic tests carried out, costs of treatment administered and other associated costs such as visits to the endocrinologist and re-training in glucose control, transportation and assistance of a care-giver. In addition, indirect costs such as days of lost productivity were measured. The incidence rates of SH for insulin lispro and regular insulin were obtained from the literature. The incremental cost-effectiveness of insulin lispro over regular insulin was calculated. RESULTS: The overall mean cost per episode of SH was 366 euro, comprised of 65.4% direct costs and 35.6% indirect costs. The largest cost was for hospitalisation at 183 euro per episode. The SH episodes incidence rates for 100 patients per year were 33 and 73 for insulin lispro and 48 (p < 0.05) and 117 (p < 0.01) for regular insulin, in the two clinical trials found in the literature. The additional cost to prevent one episode of SH with insulin lispro over regular insulin ranged from 277 euro to insulin lispro dominance. CONCLUSIONS: Severe hypoglycaemia has a significant impact on the total cost of diabetes. The use of insulin lispro is associated with reductions in annual costs because of SH and, possibly, the overall effect may be cost neutral or cost saving when total costs are considered. The cost of SH should be included in the analysis of total socio-economic burden of diabetes.

[Understanding and awareness of malaria among 103 French individuals traveling to endemic areas, having consulted the Bordeaux university hospital travel clinic, France]. / Connaissances et perceptions du paludisme chez 103 voyageurs à destination intertropicale consultant le centre de conseil aux voyageurs du centre hospitalier universitaire de Bordeaux, France.

OBJECTIVE: Malaria is increasing worldwide due to the emergence and spread of drug resistant strains. As globalization in business and commerce and appetites for more adventurous travel increase, more people from non-endemic countries are being exposed to malaria. The management of travelers before departure or returning from visiting endemic countries with malaria is a challenge, both for exposed individuals and for physicians, considering the weak knowledge of the disease. METHODS: A survey was conducted among French individuals traveling to endemic areas to evaluate their knowledge and perception of malaria. An observational study using guided questionnaires was made on 103 travelers recruited in the Bordeaux University Hospital travel clinic, France. RESULTS: The findings of the survey were consistent with previously reported data concerning the knowledge of signs and symptoms of malaria, as well as with the global level of knowledge on the disease, and with the number of travelers not understanding the mode of infection appropriately. Irrelevant data was reported concerning the typical pattern of the disease, the objectives of malaria management for travelers, and the attention given to the most susceptible groups: children, pregnant women, and immuno-compromised individuals. CONCLUSION: Our findings show a link between gender and adhesion to prophylactic measures, and an inverse gradient in the subgroup of frequent overseas travelers, between knowledge and risk perception of illness.

[Incretins as new therapeutic targets of type 2 diabetes]. / Las incretinas como nuevas dianas terapéuticas de la diabetes tipo 2.

The epidemic characteristics of type 2 diabetes mellitus (DM) pose a formidable challenge in terms of healthcare, given the tremendous impact it has on the healthcare resources needed not only to treat it, but also to prevent and treat the associated cardiovascular complications. This makes up the number 1 cause of DM-associated morbidity-mortality in addition to its social and personal impact. We currently have a growing number of available treatment tools that make it possible to achieve the target glycemic control in most of our patients, albeit unfortunately, only temporarily in a good many of them, because of the progressive nature of the disease. Furthermore, current therapy often entails undesirable effects, such as weight gain or the emergence of hypoglycemias that limit their optimization. Recently, a new class of drugs has been incorporated into the treatment of DM - incretin mimetics. These new drugs act in very much the same way as the intestinal hormones that are naturally secreted following the intake of nutrients, called incretins (e.g., glucagon like peptide-1 [GLP-1]), with the added advantage that these molecules are resistant to enzymatic degradation by the DPP-IV enzyme. This provides them with a half-life that makes ambulatory treatment possible, unlike natural incretins whose half-life is too short to make them viable as treatment. The incretin mimetics bind to GLP-1 receptors, increasing glucose-dependent secretion of insulin and decreasing glucose-dependent posprandial secretion of glucagon, slowing gastric emptying, and reducing food intake. All these mechanisms have a significant impact on glucose homeostasis and a beneficial effect on body weight. Moreover, studies in experimental models suggest that these new molecules might have a promising effect on pancreatic beta cell function and mass. Exenatide is the first incretin mimetic available to date. Efficacy and safety data of this drug show it as a therapeutic option for the treatment of type 2 DM.

Las incretinas como nuevas dianas terapéuticas de la diabetes tipo 2 / Incretins as new therapeutic targets of type 2 diabetes

Las características epidémicas de la diabetes mellitus (DM) tipo 2 suponen un importante reto asistencial, por el elevado impacto en el uso de los recursos sanitarios requeridos en su tratamiento, así como en la prevención y tratamiento de las complicaciones cardiovasculares asociadas, causa principal de la morbimortalidad relacionada con la DM, sin olvidar su impacto social y personal. En la actualidad disponemos de un número creciente de herramientas terapéuticas que nos permiten alcanzar el control glucémico deseable en la mayoría de nuestros pacientes, aunque sólo de forma transitoria en buena parte de los mismos, debido a la progresión de esta enfermedad; además con frecuencia la terapéutica actual se asocia a efectos no deseados, tales como el incremento de peso o la aparición de hipoglucemias, que limitan la optimización. Recientemente se ha incorporado al tratamiento de la DM un nuevo grupo de fármacos: los incretín-miméticos. Estos nuevos agentes tienen un efecto similar a las hormonas intestinales secretadas de forma natural tras la ingesta de nutrientes, denominadas incretinas (como por ejemplo el péptido 1 similar al glucagón [GLP-1]), con la ventaja añadida de ser moléculas resistentes a la degradación enzimática de la enzima dipeptidil peptidasa IV (DPP-IV), ofreciendo una semivida que permite un tratamiento de carácter ambulatorio, a diferencia de las incretinas naturales que exhiben una semivida demasiado corta para poder ser utilizadas. Los incretín-miméticos se unen a receptores de GLP-1, incrementando la secreción de la insulina y reduciendo la secreción posprandial de glucagón, en ambos casos de forma glucosa-dependiente, ralentizando el vaciamiento gástrico y reduciendo la ingesta de alimentos, mecanismos, todos ellos con un importante impacto sobre la homeostasis de la glucosa y un efecto beneficioso sobre el peso corporal. Además, estudios en modelos experimentales sugieren que estas nuevas moléculas podrían tener un prometedor efecto sobre la función y masa de la célula β del islote pancreático. Exenatida es el primer incretín-mimético disponible hasta la fecha. Los datos sobre eficacia y seguridad del fármaco lo convierten en una alternativa terapéutica para el tratamiento de la DM tipo 2 (AU)

The epidemic characteristics of type 2 diabetes mellitus (DM) pose a formidable challenge in terms of healthcare, given the tremendous impact it has on the healthcare resources needed not only to treat it, but also to prevent and treat the associated cardiovascular complications. This makes up the number 1 cause of DM-associated morbidity-mortality in addition to its social and personal impact. We currently have a growing number of available treatment tools that make it possible to achieve the target glycemic control in most of our patients, albeit unfortunately, only temporarily in a good many of them, because of the progressive nature of the disease. Furthermore, current therapy often entails undesirable effects, such as weight gain or the emergence of hypoglycemias that limit their optimization. Recently, a new class of drugs has been incorporated into the treatment of DM ­ incretin mimetics. These new drugs act in very much the same way as the intestinal hormones that are naturally secreted following the intake of nutrients, called incretins (e.g., glucagon like peptide-1 [GLP-1]), with the added advantage that these molecules are resistant to enzymatic degradation by the DPP-IV enzyme. This provides them with a half-life that makes ambulatory treatment possible, unlike natural incretins whose half-life is too short to make them viable as treatment. The incretin mimetics bind to GLP-1 receptors, increasing glucose-dependent secretion of insulin and decreasing glucose-dependent posprandial secretion of glucagon, slowing gastric emptying, and reducing food intake. All these mechanisms have a significant impact on glucose homeostasis and a beneficial effect on body weight. Moreover, studies in experimental models suggest that these new molecules might have a promising effect on pancreatic β cell function and mass. Exenatide is the first incretin mimetic available to date. Efficacy and safety data of this drug show it as a therapeutic option for the treatment of type 2 DM (AU)

Twice-daily pre-mixed insulin rather than basal insulin therapy alone results in better overall glycaemic control in patients with Type 2 diabetes.

AIMS: To compare the glycaemic control of an insulin lispro mixture (25% insulin lispro and 75% NPL) twice daily in combination with metformin to that of once-daily insulin glargine plus metformin in patients with Type 2 diabetes inadequately controlled with intermediate insulin, or insulin plus oral agent(s) combination therapy. RESEARCH DESIGN AND METHODS: Ninety-seven patients were randomized in a multicentre, open-label, 32-week crossover study. Primary variables evaluated: haemoglobin A1c (A1c), 2-h post-prandial blood glucose (BG), hypoglycaemia rate (episodes/patient/30 days), incidence (% patients experiencing > or = 1 episode) of overall and nocturnal hypoglycaemia. RESULTS: At endpoint, A1c was lower with the insulin lispro mixture plus metformin compared with glargine plus metformin (7.54% +/- 0.87% vs. 8.14% +/- 1.03%, P < 0.001). Change in A1c from baseline to endpoint was greater with the insulin lispro mixture plus metformin (-1.00% vs. -0.42%; P < 0.001). Two-hour post-prandial BG was lower after morning, midday, and evening meals (P < 0.001) during treatment with the insulin lispro mixture plus metformin. The fasting BG values were lower with glargine plus metformin (P = 0.007). Despite lower BG at 03.00 hours (P < 0.01), patients treated with the insulin lispro mixture plus metformin had a lower rate of nocturnal hypoglycaemia (0.14 +/- 0.49 vs. 0.34 +/- 0.85 episodes/patient/30 days; P = 0.002), although the overall hypoglycaemia rate was not different between treatments (0.61 +/- 1.41 vs. 0.44 +/- 1.07 episodes/patient/30 days; P = 0.477). CONCLUSION: In patients with Type 2 diabetes and inadequate glucose control while on insulin or insulin and oral agent(s) combination therapy, treatment with a twice-daily insulin lispro mixture plus metformin, which targets both post-prandial and pre-meal BG, provided clinically significant improvements in A1c, significantly reduced post-prandial BG after each meal, and reduced nocturnal hypoglycaemia as compared with once-daily glargine plus metformin, a treatment that targets fasting BG.

Revaluación de la versión española del cuestionario diabetes quality of life (EsDQOL) / Reappraisal of the spanish version of the diabetes quality of life questionnaire (EsDQOL)

A lo largo de varios años hemos adaptado y mejorado1-5 la versión en español del Diabetes Quality of Life Questionnaire (EsDQOL), lo que nos ha permitido conseguir suficiente experiencia en su aplicación. Teniendo en cuenta que este proceso de adaptación ha sido dinámico y, por tanto, sujeto a modificaciones y revisiones, creemos procedente en el momento actual, sobre la base de nuestros resultados, proponer algunas modificaciones que pueden incrementar la fiabilidad y aplicación de la versión española del DQOL (AU)

[Analysis of the experience of diabetes mellitus through case study: an approach to patient's quality of life]. / Análisis de la vivencia de la diabetes mellitus a través del estudio de casos: una aproximación a la calidad de vida del paciente.

BACKGROUND: To assess how patients with diabetes experience their condition. PATIENTS AND METHOD: Pilot study conducted in 10 selected patients with type 1 diabetes. A structured interview guide was prepared including physical, social and emotional areas. The information provided was analyzed qualitatively, key statements were coded in analysis units and processed using the computer program Ethnograph. RESULTS: Conceptual maps show that this group of patients: a) Do not feel physically limited but they need a constant planning of every aspect of their lives; b) they avoid openly manifesting their condition, they perceive discrimination at work and little social awareness, and c) except for survival skills, they primarily learn about their disease and its management through their own experience. CONCLUSION: This qualitative research method allows for the application of these observations to different groups within similar problems and contexts.

Patients & health care professionals evaluate a new prefilled insulin pen device

Background El¡ Lilly and Company Nave developed the first 3.0 mL prefilled insulin pen device with single unit incrementa and a dose knob that performs all pen functions. A recent study, conducted in 3 Spanish hospitals, assessed patient acceptance, pen functionality, and adverse events related to the use of this new device in clinical practice.Methods. This was an open-label, multi-centre; non-comparative study in which 42 male and female patients with either type 1 or II diabetes used the 3.0 mL prefilled pen device to inject premixed 30/70 andlor NPH human insulin for 5 to 7 weeks. All enrolled patients had previously used a prefilled pen device with premixed 30/70 and lor NPH human insulin. At the end of the study, patients and health care professionals (HCP) who trained patients how to use the new pen completed questionnaires. Results. The majority of patients (77 por ciento) and HCP (100 por ciento) preferred the new Lilly pen device when compared lo their previous pen device. The highest rated prefilled pen features included ease of dose correction, needle replacement, cartridge visibility, single unit incrementa and increased comfort. HCP also found the new pen easy to teach. One severe hypoglycemia reaction and no device-related adverse events were reported.Conclusion. The new Lilly 3.0 mL prefilled pen delivery device offers patients with diabetes and HCP a simple, convenient and easy to use system, which eliminates cartridge changing and allows for single unit changes in dosage. HCP also considered the new device safe for patient use (AU)

[Complex regional pain syndrome: the need for multidisciplinary approach]. / Síndrome de dolor regional complejo: la necesidad de un planteamiento multidisciplinar.

INTRODUCTION AND DEVELOPMENT: The title complex regional pain syndrome is being introduced to cover the painful syndromes which formerly were described under the headings reflex sympathetic dystrophy and causalgia. The pain may be sympathetically maintained or sympathetically independent. The incidence of disease with respect to age shows a peak at 50 years, but may be present at any moment of live. The clinical picture of an affected extremity is characterized by autonomic (vasomotor, sudomotor, edema), sensory (allodynia, hyperpathia, hyperalgesia, hyper or hypoesthesia) and motor symptoms. The diagnosis is generally made by clinical examination and with the use of diagnostic aids, such as plain film radiographs, three-phase bone scan, thermography, and diagnostic sympathetic blockade with local anesthetics, guanethidine test, phentolamine test or ischemia test. With regard to the pathophysiology of the disease, although some investigators suggest that these patients suffer from a psychogenic problem, research with animals with experimental neuropathies has revealed several phenomena like that seen in human suggesting the organicity of the disease. The mainstay of treatment, specially in severe cases, is a multidisciplinary approach. The goal is restoration of normal function. Treatment includes adequate pain relief, complete physical therapy program and psychiatric evaluation.

Síndrome de dolor regional complejo: la necesidad de un planteamiento multidisciplinar / Complex regional pain syndrome: the need for multidisciplinary approach

Introducción y desarrollo. El término síndrome de dolor regional complejo engloba y sustituye a los clásicos distrofia simpático-refleja y causalgia. El cuadro puede ser o no dependientedel sistema nervioso simpático. La enfermedad, aunque con una máxima incidencia a los 50 años de edad, se presenta en cualquier momento de la vida. La clínica clásica incluye, en la extremidad afectada, trastornos autonómicos (vasomotores, sudomotores y edema), sensitivos (alodinia, hiperpatía, hiperalgesia, hiperohipoestesia) y motores (pérdida de fuerza). Las pruebas diagnósticas aceptadas son pruebas complementarias como la teletermografía, la radiología simple y la gammagrafía de tres fases, y tests diagnósticos como los bloqueos simpáticos con anestésicoslocales, los bloqueos con guanetidina, el test con fentolamina y el test de la isquemia. Respecto de la patogenia del cuadro, aunque algunos autores defienden un origen psicógeno del mismo, estudios experimentales con animales reproducen muchos de los síntomas y signos que se objetivan en estos pacientes así como respuestas similares a los tratamientos, todo ello corrobora la idea de un origen orgánico de la enfermedad. La clave del éxito terapéutico, especialmente en los casos graves, se fundamenta en un abordaje multidisciplinar que persiga la máxima recuperación funcional del paciente. El tratamiento debe incluir analgesia eficaz, un programa de rehabilitación física completa y valoraciónpsiquiátrica, según las necesidades individuales de cada paciente (AU)

Effects of a short-acting insulin analog (Insulin Lispro) versus regular insulin on lipid metabolism in insulin-dependent diabetes mellitus.

Insulin Lispro (IL) is a short-acting insulin analog that better reproduces the physiological postprandial insulin profile. The aim of this study was to compare the effects of intensive insulin therapy on lipid metabolism using preprandial IL and regular insulin (RI) in 10 insulin-dependent diabetes mellitus (IDDM) subjects. The mean hemoglobin A1c (HbA1c) at baseline was 7.13% +/- 1.2% and did not change after both treatments. In IDDM patients, total cholesterol and triglyceride levels appeared lower after RI than after IL. The low-density lipoprotein (LDL) to high-density lipoprotein (HDL) ratio significantly decreased only after RI (baseline, 2.01 +/- 0.6; IL, 1.88 +/- 0.6; RI, 1.71 +/- 0.5, P < .05). Although no very-low-density lipoprotein (VLDL) composition abnormalities were observed at baseline, the protein content was lower (P < .05) after IL (8.13% +/- 2.93%) than after RI (11.93% +/- 3.41%). Intermediate-density lipoprotein (IDL) protein depletion at baseline (6.14% +/- 6.84%) was normalized after both treatments (IL, 11.09% +/- 12.14%; RI, 10.38% +/- 16.68%, P < .05). LDL, HDL, HDL2, and HDL3 composition abnormalities were similar after both treatments and did not normalize. IDDM and control subjects showed similar LDL subfraction distribution at baseline and after both treatments. Two-hour postprandial VLDL composition alterations, although improved after RI, completely normalized after IL (P < .05). Lipoprotein lipase (LPL) and cholesteryl ester transfer protein (CETP) activities were similar to the control group and did not change after both treatments. Hepatic lipase (HL) activity was lower in diabetic patients (39.6 +/- 35.2 v 87.0 +/- 27.1 U/L, P < .01) and remained lower after both treatments. In conclusion, in IDDM patients, IL (injected immediately before the meal) may offer small different effects on lipoprotein metabolism versus RI (injected 30 minutes before the meal) that, taken together, do not seem relevant.

Evaluation of the diabetes quality-of-life questionnaire in a Spanish population. An experience of translation and reliability.

The aim of this study was to evaluate the reliability of a version of the diabetes quality-of-life (DQOL) questionnaire adapted and translated into Spanish. The DQOL questionnaire consists of 46 items and is not sensitive to treatment regimens or self-monitoring; therefore, the instrument might be useful to a wide range of patients with diabetes who use different methods of diabetes management. 105 patients with insulin-dependent diabetes mellitus volunteered to complete the questionnaire. This Spanish version of the DQOL achieved a high global internal consistency (alpha = 0.90), and some outcome similarities, such as more favourable scores among younger patients (up to 21 years of age) and adult male patients compared with the original DQOL. These data show that the Spanish version of the DQOL has a high internal consistency (reliability) and might be a useful comparable tool to evaluate quality of life in Spanish-speaking patients with diabetes mellitus.

Effect of the Ca(2+)-channel agonist Bay K 8644 on the contractile responses in human placental veins.

1. The aim of the present study was to analyse, in segments of human placental veins, the effect of the Ca2+ channel agonist Bay K 8644 (0.1 microM) and Ca2+ channel antagonists nifedipine (0.1 microM) and diltiazem (1 microM) on vascular contractility and 45Ca2+ uptake. 2. The Ca2+ channel agonist Bay K 8644 (0.1 microM) caused small concentration dependent contractions that were increased by a moderate membrane depolarization with 7.5 mM K+. This increase was reversed by nifedipine and diltiazem. Ca2+ addition to segments previously depolarized with 75 mM K+ and exposed to a Ca(2+)-free medium caused contractile responses that were increased by 0.1 microM Bay K 8644; such an increase was blocked by 0.1 microM nifedipine and 1 microM diltiazem. 3. K+ and 5-HT induced concentration dependent contractile responses which were increased by Bay K 8644 (0.1 microM). Both 0.1 microM nifedipine and 1 microM diltiazem inhibited the increasing effect of Bay K 8644. Bay K 8644 (30 nM and 0.1 microM) caused an enhancement in 45Ca2+ accumulation over the basal value, that was increased by membrane depolarization with K+ (7.5, 15 and 30 nM) and inhibited by nifedipine (0.1 microM). K+ (15 and 30, but not 7.5 mM) and 5-HT (1 microM) induced 45Ca2+ uptake over the basal level that was increased by Bay K 8644 (0.1 microM). Such an increase was antagonized by nifedipine (0.1 microM). 4. These data indicate that: (1) a small depolarization with K+ is needed for Bay K 8644 to be able to produce consistent contractile responses, suggesting that voltage gated Ca2+ channels (VGCCs) are not activated in a basal situation in placental veins; (2) the increase of 5-HT contraction by Bay K 8644 may be produced by either the capability of this amine to depolarize the membrane of smooth muscle cells and subsequent facilitation of Ca2+ influx through VGCCs or direct activation by Bay K 8644 of receptor (5-HT) operated Ca2+ channels (ROCs), and (3) the increasing effect of Bay K 8644 appears to be due to a Ca2+ entry activation through VGCCs.

Effect of Ca2+ agonist Bay K 8644 in human placental arteries.

1. Bay K 8644 (0.1 microM induced weak contractions in human placental artery segments that were increased in the presence of 7.5 mM K+. K+ and serotonin (5-HT) induced contractions that were enhanced by preincubation of segments with Bay K 8644. These enhancements were reduced by nifedipine (0.1 microM) and diltiazem (1 microM). 2. Bay K 8644 induced a 45Ca2+ uptake increase which was potentiated by depolarization with K+ (less than 30 mM) and antagonized by nifedipine. K+ (15 and 30 mM) and 5-HT (1 microM) induced 45Ca2+ uptake that was enhanced by Bay K 8644. 3. These results suggest that Bay K 8644: (1) is unable to activate the quiescent potential-operated Ca2+ channels (POCs) of these arteries, and (2) activates receptor (5-HT)-operated Ca2+ channels or facilitates Ca2+ influx through POCs activated by 5-HT.

[Anesthesiology implications of laparoscopic surgery]. / Implicaciones anestésicas de la cirugía laparoscópica.

Laparoscopic surgery is constantly advancing and has produced a small revolution in how surgery is used in a range of abdominal disease. Against the undisputed advantages laparoscopy brings to surgery (shorter hospital stay, rapid return to normal activity, more comfortable postoperative recovery and so on), we must weight its technical and anesthetic limitations, as well as the possibility of associated complications. At this time, appropriate indications for applying this technique in preference to conventional surgery are still in the process of being established. The solution to this very recently posed problem will come as a result of further developments in laparoscopic procedures, greater experience and larger studies of morbidity and mortality. It seems clear that in spite of their advantages, surgical techniques involving minimal abdominal incisions will be the subject of controversy and debate for some time to come.