Identifying advanced MAFLD in a cohort of T2DM and clinical features.

Background: MAFLD is the most common cause of chronic liver disease, affecting 25% of the global population. Patients with T2DM have an increased risk of developing MAFLD. In addition, patients with T2DM have a higher risk of advanced forms of steatohepatitis and fibrosis. Identifying those patients is critical in order to refer them to specialist and appropriate management of their disease. Aims and Objectives: To estimate advanced fibrosis prevalence in a cohort of patients with T2DM and to identify possible predictors. Methods: subjects with T2DM during regular health check-up were enrolled. Demographic and general characteristics were measured, including metabolic parameters and homeostasis model assessment of insulin resistance (HOMA2-IR). Four non-invasive fibrosis scores (NAFLD fibrosis scores, FIB-4, APRI, Hepamet fibrosis score) were measure and compared with transient elastography (TE). Results: 96 patients (21%) presented risk of significant fibrosis (≥F2) measured by TE and 45 patients (10%) presented with risk of advanced fibrosis F3-F4. Liver fibrosis was related to BMI, AC, HOMA2-IR. The results of the non-invasive fibrosis scores have been validated with the results obtained in the TE. It is observed that the index with the greatest area under the curve (AUC) is APRI (AUC=0.729), with a sensitivity of 62.2% and a specificity of 76.1%. However, the test with better positive likelihood ratio (LR+) in our study is NAFLD fibrosis score. Conclusions: Our results show that in a general T2DM follow up, 10% of patients were at risk of advanced fibrosis. We found a positive correlation between liver fibrosis and BMI, AC and HOMA2-IR. Non-invasive fibrosis markers can be useful for screening, showing NAFLD Fibrosis score a better LHR+ compared to TE. Further studies are needed to validate these results and elucidate the best screening approach to identify those patients at risk of advanced MAFLD.

Executive summary: Position document: Evaluation and management of hypoglycemia in the patient with diabetes mellitus 2020. Diabetes Mellitus Working Group of the Spanish Society of Endocrinology and Nutrition.

OBJECTIVE: To provide practical recommendations for the evaluation and management of hypoglycemia in patients with diabetes mellitus. PARTICIPANTS: Members of the Diabetes Mellitus Working Group of the Spanish Society of Endocrinology and Nutrition (SEEN). METHODS: The recommendations were made based on the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) system to establish both the strength of the recommendations and the level of evidence. A systematic search was made in MEDLINE (PubMed) for the available evidence on each subject, and articles written in English and Spanish with an inclusion date up to 30 November 2019 were reviewed. This executive summary takes account of the evidence incorporated since 2013. CONCLUSIONS: The document establishes practical evidence-based recommendations regarding the evaluation and management of hypoglycemia in patients with diabetes mellitus.

Executive summary: Position document: Evaluation and management of hypoglycemia in the patient with diabetes mellitus 2020. Diabetes Mellitus Working Group of the Spanish Society of Endocrinology and Nutrition. / Resumen ejecutivo: Documento de posicionamiento: evaluación y manejo de la hipoglucemia en el paciente con diabetes mellitus 2020. Grupo de Trabajo de Diabetes Mellitus de la Sociedad Española de Endocrinología y Nutrición.

OBJECTIVE: To provide practical recommendations for the evaluation and management of hypoglycemia in patients with diabetes mellitus. PARTICIPANTS: Members of the Diabetes Mellitus Working Group of the Spanish Society of Endocrinology and Nutrition (SEEN). METHODS: The recommendations were made based on the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) system to establish both the strength of the recommendations and the level of evidence. A systematic search was made in MEDLINE (PubMed) for the available evidence on each subject, and articles written in English and Spanish with an inclusion date up to 28 February 2020 were reviewed. This executive summary takes account of the evidence incorporated since 2013. CONCLUSIONS: The document establishes practical evidence-based recommendations regarding the evaluation and management of hypoglycemia in patients with diabetes mellitus.

A Randomized Trial Evaluating the Efficacy and Safety of Fast-Acting Insulin Aspart Compared With Insulin Aspart, Both in Combination With Insulin Degludec With or Without Metformin, in Adults With Type 2 Diabetes (ONSET 9).

OBJECTIVE: To evaluate the efficacy and safety of fast-acting insulin aspart (faster aspart) compared with insulin aspart (IAsp), both with insulin degludec with or without metformin, in adults with type 2 diabetes not optimally controlled with a basal-bolus regimen. RESEARCH DESIGN AND METHODS: This multicenter, double-blind, treat-to-target trial randomized participants to faster aspart (n = 546) or IAsp (n = 545). All available information, regardless of treatment discontinuation or use of ancillary treatment, was used for evaluation of effect. RESULTS: Noninferiority for the change from baseline in HbA1c 16 weeks after randomization (primary end point) was confirmed for faster aspart versus IAsp (estimated treatment difference [ETD] -0.04% [95% CI -0.11; 0.03]; -0.39 mmol/mol [-1.15; 0.37]; P < 0.001). Faster aspart was superior to IAsp for change from baseline in 1-h postprandial glucose (PPG) increment using a meal test (ETD -0.40 mmol/L [-0.66; -0.14]; -7.23 mg/dL [-11.92; -2.55]; P = 0.001 for superiority). Change from baseline in self-measured 1-h PPG increment for the mean over all meals favored faster aspart (ETD -0.25 mmol/L [-0.42; -0.09]); -4.58 mg/dL [-7.59; -1.57]; P = 0.003). The overall rate of treatment-emergent severe or blood glucose (BG)-confirmed hypoglycemia was statistically significantly lower for faster aspart versus IAsp (estimated treatment ratio 0.81 [95% CI 0.68; 0.97]). CONCLUSIONS: In combination with insulin degludec, faster aspart provided effective overall glycemic control, superior PPG control, and a lower rate of severe or BG-confirmed hypoglycemia versus IAsp in adults with type 2 diabetes not optimally controlled with a basal-bolus regimen.

Structural, Dermal and Ungual Characteristics of the Foot in Patients with Type II Diabetes.

Background and Objectives: Diabetes is a chronic and metabolic disease, considered as an important public health problem. The objective of this study was to determine the prevalence of podiatric pathology in type II diabetic patients. Materials and Methods: An observational descriptive study of prevalence in the endocrinology service of Complexo Hospitalario Universitario A Coruña (CHUAC) (A Coruña-Spain) was carried out (n = 153). Type II diabetic patients included, of legal age who signed the informed consent. Sociodemographic variables were studied (age, sex, body mass index (BMI), smoking habit, alcohol consumption, family history), disease variables (time of evolution of diabetes, treatments, low-density lipoprotein (LDL), high-density lipoprotein (HDL), glucose), podiatric variables: measurement of the footprint, metatarsal and digital formula, nail, skin, hindfoot and forefoot alterations. The data collection was done in 2018 and the data analysis was carried out in 2019. Results: The patients with type II diabetes had greater age, obesity and arterial hypertension it compared to the general population. Diabetic patients had a higher prevalence of flat feet than the general population (71.2% vs. 20.7%, p < 0.001), with a predominance of normal foot according to the podoscope. The predominant podological pathology was the presence of claw toes (94.8%), followed by dermal (78.4%) and nail (71.9%) alterations, and the Hallux Valgus (66.0%). The Clarke angle and the Chippaux index showed a Kappa concordance index of 0.26 with the type of footprint measured with the podoscope. The Staheli index showed a Kappa index of 0.27 associated with an observed agreement of 54%. Conclusions: This study shows that foot problems continue to be prevalent in subjects with type II diabetes mellitus and for this reason, podiatry is essential in its treatment.

ZODIAC: Consenso para la prevención del herpes zóster en personas con diabetes mellitus / ZODIAC: Consensus on herpes zoster prevention in persons with diabetes mellitus

No disponible

Relación entre el control metabólico y la automonitorización de la glucemia capilar en pacientes con diabetes mellitus tratados con insulina / Relationship between metabolic control and self-monitoring of blood glucose in insulin-treated patients with diabetes mellitus

OBJETIVO: Evaluar la relación entre el grado de control metabólico (CM) y la frecuencia de la automonitorización de la glucemia capilar (AGC) en pacientes con diabetes mellitus (DM) tipo 1 (DM1) y 2 (DM2) tratados con insulina, y analizar factores asociados al CM. MATERIAL Y MÉTODOS: Estudio observacional multicéntrico transversal en el que endocrinólogos incluyeron a pacientes con DM tratados con insulina que utilizaban un glucómetro. El punto de corte para definir un CM fue una HbA1c ≤ 7% y no control > 7%. Se valoró en una escala analógica visual (EAV) el grado de aceptación del glucómetro. RESULTADOS: Fueron evaluables 341 pacientes (53,5% varones), con una edad media ± DE de 52,8 ± 16,3 años, HbA1c media de 7,69 ± 1,25%, 128 (37,5%) con DM1 y 211 (61,9%) con DM2. El 86,1% de los pacientes utilizaron el glucómetro al menos una vez en la semana. No se observó ninguna relación entre el CM y la AGC ni en la muestra total (p = 0,678), ni en DM1 (p = 0,940) ni DM2 (p = 0,343). En el modelo de regresión logística, se asociaron a un mal CM en la muestra total y en DM2 los episodios de hiperglucemias (Exp-b [riesgo] 1,794, p = 0,022, y Exp-b 2,538, p = 0,004, respectivamente), las concentraciones de HbA1c falsamente elevadas (Exp-b 3,182 p = 0,005, y Exp-b 3,125, p = 0,012), y la EAV (Exp-b 1,269, p = 0,008, y Exp-b 1,316, p = 0,026), y en la DM1 el índice de masa corporal (Exp-b 1,143, p = 0,046). CONCLUSIONES: En este estudio observacional no controlado en pacientes con DM tratados con insulina que utilizan un glucómetro no se observa ninguna relación entre el grado de CM y la frecuencia de su uso en el último mes

OBJECTIVE: To assess the relationship between metabolic control (MC) and frequency of self-monitoring of blood glucose (SMBG) in insulin-treated patients with type 1 (T1DM) and type 2 (T2DM) diabetes mellitus, and to analyze the factors associated to MC. MATERIAL AND METHODS: A multicenter, cross-sectional, observational study was conducted in which endocrinologists enrolled diabetic patients treated with insulin who used a glucometer. The cut-off value for MC was HbA1c ≤ 7%. Grade of acceptance of the glucometer was assessed using a visual analogue scale (VAS). RESULTS: A total of 341 patients (53.5% males) with a mean age (SD) 52.8 (16.3) years, mean HbA1c of 7.69% (1.25) and 128 (37.5%) with T1DM and 211 (61.9%) with T2DM were evaluable. SMBG was done by 86.1% at least once weekly. No relationship was seen between MC and SMBG (P=.678) in the overall sample or in the T1DM (P=.940) or T2DM (P=.343) subgroups. In the logistic regression model, hyperglycemic episodes (Exp-b [risk] 1.794, P=0.022), falsely elevated HbA1c values (Exp-b 3.182,P=.005), and VAS (Exp-b 1.269, P=.008) were associated to poor MC in the total sample. Hyperglycemic episodes (Exp-b 2.538, P=.004), falsely elevated HbA1c values (Exp-b 3.125, P=.012), and VAS (Exp-b 1.316, P=.026) were associated to poor MC in the T2DM subgroup, while body mass index (Exp-b 1.143, P=.046) was associated to poor MC in the T1DM subgroup. CONCLUSIONS: In this retrospective, non-controlled study on patients with DM treated with insulin who used a glucometer, no relationship was seen between the degree of metabolic control and frequency of use of the glucometer

Relationship between metabolic control and self-monitoring of blood glucose in insulin-treated patients with diabetes mellitus.

OBJECTIVE: To assess the relationship between metabolic control (MC) and frequency of self-monitoring of blood glucose (SMBG) in insulin-treated patients with type 1 (T1DM) and type 2 (T2DM) diabetes mellitus, and to analyze the factors associated to MC. MATERIAL AND METHODS: A multicenter, cross-sectional, observational study was conducted in which endocrinologists enrolled diabetic patients treated with insulin who used a glucometer. The cut-off value for MC was HbA1c ≤ 7%. Grade of acceptance of the glucometer was assessed using a visual analogue scale (VAS). RESULTS: A total of 341 patients (53.5% males) with a mean age (SD) 52.8 (16.3) years, mean HbA1c of 7.69% (1.25) and 128 (37.5%) with T1DM and 211 (61.9%) with T2DM were evaluable. SMBG was done by 86.1% at least once weekly. No relationship was seen between MC and SMBG (P=.678) in the overall sample or in the T1DM (P=.940) or T2DM (P=.343) subgroups. In the logistic regression model, hyperglycemic episodes (Exp-b [risk] 1.794, P=0.022), falsely elevated HbA1c values (Exp-b 3.182, P=.005), and VAS (Exp-b 1.269, P=.008) were associated to poor MC in the total sample. Hyperglycemic episodes (Exp-b 2.538, P=.004), falsely elevated HbA1c values (Exp-b 3.125, P=.012), and VAS (Exp-b 1.316, P=.026) were associated to poor MC in the T2DM subgroup, while body mass index (Exp-b 1.143, P=.046) was associated to poor MC in the T1DM subgroup. CONCLUSIONS: In this retrospective, non-controlled study on patients with DM treated with insulin who used a glucometer, no relationship was seen between the degree of metabolic control and frequency of use of the glucometer.

Documento de posicionamiento: evaluación y manejo de la hipoglucemia en el paciente concon diabetes mellitus. Grupo de Trabajo de Diabetes Mellitus de la Sociedad Española de Endocrinología y Nutrición / Position statement: Hypoglycemia management in patients with diabetes mellitus. Diabetes Mellitus Working Group of the Spanish Society of Endocrinology and Nutrition

Objetivo Proporcionar unas recomendaciones prácticas para la evaluación y el manejo de la hipoglucemia en pacientes con diabetes mellitus. Participantes Miembros del Grupo de Trabajo de Diabetes Mellitus de la Sociedad Española de Endocrinología y Nutrición (SEEN).Métodos Las recomendaciones se formularon de acuerdo al sistema Grading of Recommendations, Assessment, Development, and Evaluation para establecer tanto la fuerza de las recomendaciones como el grado de evidencia. Se realizó una búsqueda sistemática en MEDLINE (PubMed) de la evidencia disponible para cada tema, y se revisaron artículos escritos en inglés y castellano con fecha de inclusión hasta el 15 de febrero de 2013. Para las recomendaciones acerca del uso de fármacos, se consideraron tratamientos aprobados por la Agencia Europea de Medicamentos con esa misma fecha. Tras la formulación de las recomendaciones estas se discutieron conjuntamente por el Grupo de trabajo. Conclusiones El documento establece unas recomendaciones prácticas basadas en la evidencia acerca de la evaluación y manejo de la hipoglucemia en pacientes con diabetes mellitus (AU)

Objective To provide practical recommendations for evaluation and management of hypoglycemia in patients with diabetes mellitus. Participants Members of the Diabetes Mellitus Working Group of the Spanish Society of Endocrinology and Nutrition. Methods Recommendations were formulated according to the Grading of Recommendations, Assessment, Development, and Evaluation system to describe both the strength of recommendations and the quality of evidence. A systematic search was made in MEDLINE (PubMed). Papers in English and Spanish with publication date before 15 February 2013 were included. For recommendations about drugs only those approved by the European Medicines Agency were included. After formulation of recommendations, they were discussed by the Working Group. Conclusions The document provides evidence-based practical recommendations for evaluation and management of hypoglycemia in patients with diabetes mellitus (AU)

Position statement: hypoglycemia management in patients with diabetes mellitus. Diabetes Mellitus Working Group of the Spanish Society of Endocrinology and Nutrition.

OBJECTIVE: To provide practical recommendations for evaluation and management of hypoglycemia in patients with diabetes mellitus. PARTICIPANTS: Members of the Diabetes Mellitus Working Group of the Spanish Society of Endocrinology and Nutrition. METHODS: Recommendations were formulated according to the Grading of Recommendations, Assessment, Development, and Evaluation system to describe both the strength of recommendations and the quality of evidence. A systematic search was made in MEDLINE (PubMed). Papers in English and Spanish with publication date before 15 February 2013 were included. For recommendations about drugs only those approved by the European Medicines Agency were included. After formulation of recommendations, they were discussed by the Working Group. CONCLUSIONS: The document provides evidence-based practical recommendations for evaluation and management of hypoglycemia in patients with diabetes mellitus.

Distribución de la circunferencia de la cintura y de la relación circunferencia de la cintura con respecto a la talla según la categoría del índice de masa corporal en los pacientes atendidos en consultas de endocrinología y nutrición / Distribution of waist circumference and waist-to-height ratio by categories of body mass index in patients attended in endocrinology and nutrition units

Introducción La circunferencia de cintura (CC) y la relación circunferencia de cintura/talla (CT) son medidas antropométricas muy utilizadas en la práctica clínica para valorar la grasa visceral y por tanto el riesgo cardiovascular. Sin embargo, los umbrales de riesgo para diferentes rangos de índice de masa corporal (IMC) no han sido suficientemente validados.ObjetivoDeterminar la distribución de CC y CT en función de los puntos de corte de IMC actualmente vigentes para definir el sobrepeso y la obesidad.Material y métodosSe determinó la CC, la CT y el IMC en 3521 pacientes adultos (mayores de 18 años) atendidos en las consultas de endocrinología y nutrición.ResultadosEl 20,8% (734) de los pacientes eran diabéticos. El 82,1% de los pacientes diabéticos eran obesos, así como el 75% de los no diabéticos. Los umbrales de riesgo (..) (AU)

Introduction Waist circumference (WC) and the waist-to-height ratio (WHtR) are anthropometric measures widely used in clinical practice to evaluate visceral fat and the consequent cardiovascular risk. However, risk thresholds should be standardized according to body mass index (BMI).ObjectiveTo determine the distribution of WC and WHtR according to the BMI cut-points currently used to describe overweight and obesity.Materials and methodsWC, WHtR and BMI were measured in 3521 adult patients (>18 years) attended in Endocrinology and Nutrition units.ResultsA total of 20.8% (734 patients) were diabetic. Obesity was found in 82.1% of diabetic patients and in 75% of non-diabetic patients. The WC thresholds proposed by the National Institute of Health (..) (AU)

[Distribution of waist circumference and waist-to-height ratio by categories of body mass index in patients attended in endocrinology and nutrition units]. / Distribución de la circunferencia de la cintura y de la relación circunferencia de la cintura con respecto a la talla según la categoría del índice de masa corporal en los pacientes atendidos en consultas de endocrinología y nutrición.

INTRODUCTION: Waist circumference (WC) and the waist-to-height ratio (WHtR) are anthropometric measures widely used in clinical practice to evaluate visceral fat and the consequent cardiovascular risk. However, risk thresholds should be standardized according to body mass index (BMI). OBJECTIVE: To determine the distribution of WC and WHtR according to the BMI cut-points currently used to describe overweight and obesity. MATERIALS AND METHODS: WC, WHtR and BMI were measured in 3521 adult patients (>18 years) attended in Endocrinology and Nutrition units. RESULTS: A total of 20.8% (734 patients) were diabetic. Obesity was found in 82.1% of diabetic patients and in 75% of non-diabetic patients. The WC thresholds proposed by the National Institute of Health (102 cm in men, 88 cm in women), Bray (100 cm in men, 90 cm in women) and the International Diabetes Federation (94 cm in men, 80 cm in women) were exceeded by 92.9%, 94.8% and 98.4% of obese men, 96.8%, 95.5% and 99.7% of obese women, 79.1%, 83.1% and 90% of diabetic men and 95.5%, 81.5% and 97.4% of diabetic women, respectively. Thresholds adapted to the degree of obesity (90, 100, 110 and 125 cm in men and 80, 90, 105 and 115cm in women for normal BMI, overweight, obesity I and obesity greater than I) were exceeded by 58.4% of obese men, 54.2% of obese women, 57.5% of diabetic men and 60.7% of diabetic women. WC was higher in men, and BMI and the WHtR were higher in women. The WC of diabetic women equalled that of men, and WC, WHtR and BMI were higher in diabetic than in non-diabetic women (p<0.001). WC (p<0.005), WHtR (p<0.001) and BMI (p<0.5) were also higher in diabetic than in non-diabetic men. CONCLUSION: WC and WHtR thresholds by BMI discriminated diabetic and obese patients better than single thresholds, and can be represented graphically by the distribution of percentile ranks of WC and WHtR by BMI.ik.

Predictors of the metabolic syndrome and correlation with computed axial tomography.

OBJECTIVE: We investigated which anthropometric variables or imaging techniques, dual-energy x-ray absorptiometric densitometry (DXA) or bioelectric impedance analysis (BIA), are the most important determinants of the metabolic syndrome. We also evaluated the correlation between anthropometric parameters and DXA and computed axial tomography (CAT) in predicting visceral fat. METHODS: In a series of 399 overweight or obese patients (29.8% male and 70.2% female), anthropometric variables and imaging techniques (DXA or BIA) were measured and correlated with each component of the metabolic syndrome (diagnosed according to the criteria of the Third Report of the Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults of the National Cholesterol Education Program [Adult Treatment Panel III], with the exception of waist circumference). In a subpopulation of 109 patients, CAT was used to assess visceral fat and its correlation with the anthropometric variables and DXA. RESULTS: Applying receiver operating characteristic curves, the waist/height ratio was the best determinant of the metabolic syndrome (0.758, 95% confidence interval 0.634-0.882). The intra-abdominal diameter determined by DXA (r = 0.657, P < 0.001) and the waist/hip ratio (r = 0.603, P < 0.001) had the best correlation with visceral fat as measured by CAT. CONCLUSION: The prediction of visceral fat in overweight and obese patients, as assessed by anthropometric tests and DXA, offers a good alternative to CAT, without significant differences between them.

Síndrome metabólico e inflamación / Metabolic syndrome and inflammation

Introducción. Los pacientes con síndrome metabólico (SM) presentan un incremento del riesgo de presentar ateroesclerosis y enfermedad cardiovascular. La inflamación desempeña un papel crucial en el proceso de la ateroesclerosis. Varios estudios, aunque son escasos, han demostrado la relación entre la elevación de los valores de ferritina, con cada uno de los componentes del SM. Material y métodos. Se realizó un estudio de cohorte, transversal con 598 individuos con sobrepeso u obesidad. Se estudió la composición corporal y los parámetros analíticos: glucosa, insulina, colesterol total, triglicéridos, colesterol unido a lipoproteínas de alta densidad (cHDL) y ferritina. La resistencia a la insulina (RI) se valoró por el método HOMA. Para definir el SM se emplearon los criterios del ATP III. Resultados. Se observaron valores de ferritina significativamente más altos en los pacientes con valores mayores de triglicéridos (124,6 ng/ml frente a 65,0 ng/ml; p = 0,001) o glucosa (105,9 ng/ml frente a 78,6 ng/ml; p = 0,023). El número de criterios del SM se incrementa al aumentar los valores de ferritina. Los pacientes con RI presentan valores superiores de ferritina (119,27 ng/ml frente a 79,05 ng/ml; p = 0,001), con un área bajo la curva ROC (receiver operating characteristic) de 0,678. Conclusiones. El hecho de utilizar parámetros inflamatorios como la ferritina podría resultar útil como marcador temprano del proceso inflamatorio subclínico crónico, en la práctica clínica diaria (AU)

Introduction. Patients with metabolic syndrome (MS) have an increased risk to have atherosclerosis and cardiovascular disease. Inflammation plays a crucial role in the atherosclerosis process. Some studies, even few, have shown the relationship between high levels of ferritin, with each component of the MS. Material and methods. We studied 598 patients with overweight or obesity. We evaluated: the body composition and analytical parameters: glucose, cholesterol, triglycerides, high-density cholesterol and ferritin. Insulin resistance (IR) was defined by HOMA method. ATP III criteria were used to define MS. Results. Higher levels of triglycerides have significant more elevated levels of ferritin (124.6 ng/ml versus 65.0 ng/ml; p = .001) or glucose (105.9 ng/ml versus 78.6 ng/ml; p = .023). The number of components of the MS increases with the values of ferritin. Patients with IR have higher values of ferritin (119.27 ng/ml versus 79.05 ng/ml; p = .001), with an area under the ROC curve of 0.678. Conclusions. An Inflammatory parameter as ferritin could be useful and a precocious marker to evaluate chronic subclinic inflammatory process in daily medical practice (AU)