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1.
Endocrinol. diabetes nutr. (Ed. impr.) ; 66(7): 443-458, ago.-sept. 2019. graf, tab
Artigo em Espanhol | IBECS | ID: ibc-182864

RESUMO

Objetivo: El tratamiento de la diabetes tipo 2 (DM2) es complejo y su propósito es reducir la morbimortalidad, por lo que su manejo tiene que incluir: un control glucémico individualizado precoz (mediante una adecuada educación diabetológica, modificaciones del estilo de vida y tratamiento farmacológico), el control de los factores de riesgo cardiovascular (CV), la detección y tratamiento precoz de las complicaciones y la evaluación de las comorbilidades asociadas. El objetivo fue elaborar un documento para unificar los aspectos necesarios para el abordaje integral de las personas con DM2. Participantes: Miembros del Grupo de trabajo de Diabetes Mellitus de la Sociedad Española de Endocrinología y Nutrición. Métodos: Se realizó una revisión de la evidencia disponible relativa a cada aspecto del manejo de la diabetes: objetivos de control glucémico, dieta y ejercicio, tratamiento farmacológico, tratamiento y control de factores de riesgo, detección de complicaciones y manejo del paciente frágil con DM2. Las recomendaciones se formularon según los grados de evidencia recogidos en los Standards of Medical Care in Diabetes 2018. Tras la formulación de las recomendaciones el documento fue consensuado por los miembros del Grupo de trabajo de Diabetes Mellitus de la Sociedad Española de Endocrinología y Nutrición. Conclusiones: El objetivo de este documento es proporcionar, desde el punto de vista del endocrinólogo clínico, unas recomendaciones prácticas basadas en la evidencia acerca de todos los aspectos necesarios para el abordaje integral de la DM2


Objective: Treatment of type 2 diabetes mellitus (T2DM) is complex and is intended to decrease morbidity and mortality. Management should therefore include adequate diabetes education, lifestyle changes, drug treatment to achieve early blood glucose control and reduction of cardiovascular (CV) risk factors, early detection and treatment of complications, and assessment of associated comorbidities. The objective was to prepare a document including all aspects required for a comprehensive approach to T2DM. Participants: Members of the Diabetes Mellitus Working Group of the Spanish Society of Endocrinology. Methods: The available evidence regarding each aspect of diabetes management (blood glucose control goals, diet and exercise, drug treatment, risk factor management and control, detection of complications, and management of frail patients) was reviewed. Recommendations were formulated based on the grades of evidence stated in the 2018 Standards of Medical Care in Diabetes. Recommendations were discussed and agreed by the working group members. Conclusions: This document is intended to provide evidence-based practical recommendations for comprehensive management of T2DM by clinical endocrinologists


Assuntos
Humanos , Diabetes Mellitus Tipo 2/terapia , Diabetes Mellitus Tipo 2/complicações , Fatores de Risco , Sociedades Médicas/normas , Documentos , Índice Glicêmico , Estilo de Vida , Sociedades Médicas/organização & administração , Estratégias de eSaúde , Exercício/fisiologia
2.
Endocrinol Diabetes Nutr ; 66(7): 443-458, 2019.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-30827909

RESUMO

OBJECTIVE: Treatment of type 2 diabetes mellitus (T2DM) is complex and is intended to decrease morbidity and mortality. Management should therefore include adequate diabetes education, lifestyle changes, drug treatment to achieve early blood glucose control and reduction of cardiovascular (CV) risk factors, early detection and treatment of complications, and assessment of associated comorbidities. The objective was to prepare a document including all aspects required for a comprehensive approach to T2DM. PARTICIPANTS: Members of the Diabetes Mellitus Working Group of the Spanish Society of Endocrinology. METHODS: The available evidence regarding each aspect of diabetes management (blood glucose control goals, diet and exercise, drug treatment, risk factor management and control, detection of complications, and management of frail patients) was reviewed. Recommendations were formulated based on the grades of evidence stated in the 2018 Standards of Medical Care in Diabetes. Recommendations were discussed and agreed by the working group members. CONCLUSIONS: This document is intended to provide evidence-based practical recommendations for comprehensive management of T2DM by clinical endocrinologists.

3.
Endocrinol. diabetes nutr. (Ed. impr.) ; 66(1): 62-68, ene. 2019. graf
Artigo em Espanhol | IBECS | ID: ibc-175795

RESUMO

La importante prevalencia y morbimortalidad de la obesidad ha ocasionado un aumento de pacientes sometidos a cirugía bariátrica. Son numerosos los beneficios reportados de la cirugía de la obesidad en distintas esferas de la salud. Sin embargo, no ocurre lo mismo sobre el hueso, donde tiene un impacto negativo. Los mecanismos fisiopatológicos que subyacen en el deterioro del tejido óseo de estos pacientes son complejos y requieren de un estudio en profundidad. El adecuado conocimiento de estos factores permitirá adoptar las herramientas más oportunas para un adecuado abordaje terapéutico


The important prevalence and morbidity of obesity has generated an increase in bariatric surgery. It has a positive effect in obesity-related comorbidities. However, it's detrimental to bone health. The underline pathophysiological mechanisms are complex and heterogeneous. The knowledge of these factors may lead us to develop an adequate therapeutic intervention


Assuntos
Humanos , Cirurgia Bariátrica/métodos , Osso e Ossos/fisiopatologia , Obesidade/cirurgia , Cirurgia Bariátrica , Cirurgia Bariátrica/efeitos adversos , Obesidade/epidemiologia , Obesidade/complicações , Fraturas Ósseas , Suplementos Nutricionais , Terapia Combinada/métodos , Densitometria , Osteoporose/tratamento farmacológico
4.
Endocrinol Diabetes Nutr ; 66(1): 62-68, 2019 Jan.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-30266592

RESUMO

The important prevalence and morbidity of obesity has generated an increase in bariatric surgery. It has a positive effect in obesity-related comorbidities. However, it's detrimental to bone health. The underline pathophysiological mechanisms are complex and heterogeneous. The knowledge of these factors may lead us to develop an adequate therapeutic intervention.


Assuntos
Cirurgia Bariátrica/efeitos adversos , Doenças Ósseas/etiologia , Complicações Pós-Operatórias/etiologia , Doenças Ósseas/fisiopatologia , Doenças Ósseas/terapia , Humanos , Complicações Pós-Operatórias/fisiopatologia , Complicações Pós-Operatórias/terapia
7.
Endocrinol. nutr. (Ed. impr.) ; 63(9): 495-501, nov. 2016. graf
Artigo em Espanhol | IBECS | ID: ibc-156951

RESUMO

La diabetes mellitus tipo 2 es una patología con una enorme prevalencia y morbilidad, que van en aumento. La fractura osteoporótica se encuentra entre las denominadas complicaciones «no clásicas» de la diabetes y ha sido durante tiempo ignorada, tal vez por su complejo abordaje tanto diagnóstico como terapéutico. Las herramientas habituales para la prevención de la fractura por fragilidad, como el FRAX y la densitometría ósea, no han demostrado la suficiente eficacia en estos pacientes, ya que infraestiman el riesgo. Nuevas técnicas de evaluación ósea, como el trabecular bone score o los marcadores de remodelado óseo, podrían ser de utilidad, aunque requieren una mayor evidencia científica para recomendar su uso en la práctica clínica habitual. Las características especiales de su fisiopatología condicionan la aparición de fracturas sin existir alteraciones densitométricas, en lo que podemos calificar de «paradoja diabética» (AU)


Type 2 diabetes mellitus prevalence and morbidity are increasing. Osteoporotic fractures are among the ‘non-classical’ complications of diabetes and been overlooked for a long time, maybe because of their complex diagnostic and therapeutic approach. The usual tools for preventing fragility fractures (such as the fracture risk assessment tool and bone densitometry) underestimate risk of fractures in type2 diabetic patients. New techniques, such as trabecular bone score or bone turnover markers, could be useful, but greater scientific evidence is required to recommend their use in clinical practice. The special characteristics of their pathophysiology result in decreased bone remodeling with normal or even increased bone mineral density, but with low quality. These changes lead to the occurrence of osteoporotic fractures without evidence of densitometric changes, which could be called ‘the diabetic paradox’ (AU)


Assuntos
Humanos , Diabetes Mellitus Tipo 2/complicações , Osteoporose/epidemiologia , Doenças Ósseas Metabólicas/epidemiologia , Fraturas por Osteoporose/epidemiologia , Fatores de Risco , Qualidade de Vida , Perfil de Impacto da Doença , Hiperglicemia/fisiopatologia
8.
Endocrinol Nutr ; 63(9): 495-501, 2016 Nov.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-27481443

RESUMO

Type 2 diabetes mellitus prevalence and morbidity are increasing. Osteoporotic fractures are among the 'non-classical' complications of diabetes and been overlooked for a long time, maybe because of their complex diagnostic and therapeutic approach. The usual tools for preventing fragility fractures (such as the fracture risk assessment tool and bone densitometry) underestimate risk of fractures in type2 diabetic patients. New techniques, such as trabecular bone score or bone turnover markers, could be useful, but greater scientific evidence is required to recommend their use in clinical practice. The special characteristics of their pathophysiology result in decreased bone remodeling with normal or even increased bone mineral density, but with low quality. These changes lead to the occurrence of osteoporotic fractures without evidence of densitometric changes, which could be called 'the diabetic paradox'.


Assuntos
Densidade Óssea , Diabetes Mellitus Tipo 2/complicações , Fraturas Espontâneas/etiologia , Osteoporose/etiologia , Acidentes por Quedas , Remodelação Óssea , Diabetes Mellitus Tipo 2/metabolismo , Diabetes Mellitus Tipo 2/fisiopatologia , Fraturas Espontâneas/prevenção & controle , Humanos , Hiperinsulinismo/fisiopatologia , Hipoglicemiantes/uso terapêutico , Obesidade/complicações , Obesidade/fisiopatologia , Osteoporose/diagnóstico , Osteoporose/metabolismo , Osteoporose/prevenção & controle , Deficiência de Vitamina D/complicações , Deficiência de Vitamina D/fisiopatologia
9.
Int J Rheum Dis ; 19(12): 1226-1236, 2016 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-27306701

RESUMO

Shoulder stiffness is associated with diabetes mellitus. It is characterized by pain and restriction of active and passive range of motion. Like other complications of diabetes (e.g., arterial stiffness, pancreatic or renal fibrosis), shoulder stiffness is due to a fibrotic process. The clinical course is generally benign, but it can last for months, with remaining disabilities in the long term. Several possibilities of treatment are being used. The practitioner should be aware of this complication, its natural history, and the current treatments available in order to adequately tailor the best treatment to the patient, sometimes combining more than one option.


Assuntos
Complicações do Diabetes/fisiopatologia , Artropatias/fisiopatologia , Articulação do Ombro/fisiopatologia , Dor de Ombro/fisiopatologia , Fenômenos Biomecânicos , Complicações do Diabetes/diagnóstico , Complicações do Diabetes/etiologia , Complicações do Diabetes/terapia , Avaliação da Deficiência , Feminino , Fibrose , Humanos , Artropatias/diagnóstico , Artropatias/etiologia , Artropatias/terapia , Masculino , Pessoa de Meia-Idade , Amplitude de Movimento Articular , Recuperação de Função Fisiológica , Fatores de Risco , Articulação do Ombro/patologia , Dor de Ombro/diagnóstico , Dor de Ombro/etiologia , Dor de Ombro/terapia , Resultado do Tratamento
11.
Endocrinol. nutr. (Ed. impr.) ; 62(6): e73-e93, jun.-jul. 2015. tab
Artigo em Espanhol | IBECS | ID: ibc-140174

RESUMO

La práctica de deporte con un nivel de exigencia alto es cada vez más habitual en pacientes con diabetes mellitus (DM). Esta situación aconseja realizar tanto una valoración previa como una amplia serie de modificaciones en el tratamiento, escasamente referidas en la literatura médica habitual. Objetivo: Elaborar una guía clínica que oriente sobre la actitud médica a seguir ante un paciente con DM que realiza deporte de forma habitual. Métodos: Un grupo de expertos del Grupo de Trabajo de DM de la Sociedad Española de Endocrinología y Nutrición (SEEN) ha revisado la literatura médica relevante en cada uno de los apartados. En base a esta revisión, y con los datos aportados por la experiencia de una serie de deportistas con DM, se han consensuado una serie de recomendaciones dentro de cada apartado. Tras la formulación de las recomendaciones, estas se han discutido conjuntamente por el Grupo de Trabajo y por representantes de la SEEN. Conclusión: La guía ofrece unas pautas que abarcan desde la valoración previa a la práctica deportiva en paciente con DM, como a la actuación durante y después del deporte, pasando por aspectos como la repercusión del deporte en el control de la DM, pautas de entrenamiento o situaciones de especial riesgo (AU)


Sporting activity is becoming a common practice in patients with diabetes mellitus (DM). This situation requires both a preliminary medical assessment and a wide range of changes in treatment which have scarcely been addressed in medical literature. Objective: To prepare a clinical guideline on the medical approach to patients with diabetes who practice sport regularly. Methods: An expert panel from the Diabetes Mellitus Working Group of the Spanish Society of Endocrinology and Nutrition (SEEN) reviewed the most relevant literature in each of the sections. Based both on this review and on data from the experience of a number of athletes with DM, a number of recommendations were agreed within each section. Finally, the Working Group and representatives of the SEEN jointly discussed all these recommendations. Conclusion: The guideline provides recommendations ranging from medical assessment before patients with DM start to practice sport to actions during and after physical activity. Recommendations are also given on aspects such as the impact of sport on blood glucose control, training schemes, or special risk situations (AU)


Assuntos
Feminino , Humanos , Masculino , Diabetes Mellitus/patologia , Diabetes Mellitus/prevenção & controle , Diabetes Mellitus/terapia , Espirometria , Glicemia/análise , Hipoglicemia/prevenção & controle
12.
Diabetes Ther ; 6(2): 173-85, 2015 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-26055216

RESUMO

INTRODUCTION: A limitation with randomized controlled trials is that, while they provide unbiased evidence of the efficacy of interventions, they do so under unreal conditions and in a very limited and highly selected patient population. Our aim was to provide data about the effectiveness of liraglutide treatment in a real-world and clinical practice setting. METHODS: In a retrospective and observational study, data from 753 patients with type 2 diabetes were recorded through an online tool (eDiabetes-Monitor). RESULTS: Mean baseline glycated hemoglobin (HbA1c) was 8.4 ± 1.4% and mean body mass index (BMI) was 38.6 ± 5.4 kg/m(2). After 3-6 months of treatment with liraglutide, we observed a change in HbA1c of -1.1 ± 1.2%, -4.6 ± 5.3 kg in weight and -1.7 ± 2.0 kg/m(2) in BMI (p < 0.001 for all). Compared to baseline, there was a significant reduction in systolic blood pressure (-5.9 mmHg, p < 0.001), diastolic blood pressure (-3.2 mmHg, p < 0.001), LDL cholesterol (-0.189 mmol/l, p < 0.001) and triglycerides (-0.09 mmol/l, p = 0.021). In patients switched from DPP-4 inhibitors, liraglutide induced a decrease of -1.0% in HbA1c (p < 0.001) and a reduction in weight (-4.5 kg, p < 0.001). In patients treated with liraglutide as an add-on therapy to insulin a decrease of -1.08% in HbA1c (p < 0.001) and a weight reduction of -4.15 kg (p < 0.001) were observed. CONCLUSION: Our study confirms the effectiveness of liraglutide in a real-life and clinical practice setting. FUNDING: Spanish Society of Endocrinology and Nutrition.

13.
Endocrinol Nutr ; 62(6): e73-93, 2015.
Artigo em Espanhol | MEDLINE | ID: mdl-25840764

RESUMO

UNLABELLED: Sporting activity is becoming a common practice in patients with diabetes mellitus (DM). This situation requires both a preliminary medical assessment and a wide range of changes in treatment which have scarcely been addressed in medical literature. OBJECTIVE: To prepare a clinical guideline on the medical approach to patients with diabetes who practice sport regularly. METHODS: An expert panel from the Diabetes Mellitus Working Group of the Spanish Society of Endocrinology and Nutrition (SEEN) reviewed the most relevant literature in each of the sections. Based both on this review and on data from the experience of a number of athletes with DM, a number of recommendations were agreed within each section. Finally, the Working Group and representatives of the SEEN jointly discussed all these recommendations. CONCLUSION: The guideline provides recommendations ranging from medical assessment before patients with DM start to practice sport to actions during and after physical activity. Recommendations are also given on aspects such as the impact of sport on blood glucose control, training schemes, or special risk situations.


Assuntos
Diabetes Mellitus , Esportes , Complicações do Diabetes/fisiopatologia , Diabetes Mellitus/fisiopatologia , Humanos , Fatores de Risco , Esportes/fisiologia
14.
Endocrinol. nutr. (Ed. impr.) ; 60(9): 517e1-517e18, nov. 2013. ilus, tab
Artigo em Espanhol | IBECS | ID: ibc-117449

RESUMO

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)


Assuntos
Humanos , Diabetes Mellitus/tratamento farmacológico , Hipoglicemia/prevenção & controle , Hipoglicemiantes/efeitos adversos , Padrões de Prática Médica , Prática Clínica Baseada em Evidências/métodos
15.
Endocrinol Nutr ; 60(9): 517.e1-517.e18, 2013 Nov.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-23916172

RESUMO

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.


Assuntos
Complicações do Diabetes/diagnóstico , Complicações do Diabetes/terapia , Hipoglicemia/diagnóstico , Hipoglicemia/terapia , Árvores de Decisões , Complicações do Diabetes/etiologia , Diabetes Mellitus/terapia , Diabetes Mellitus Tipo 1/complicações , Diabetes Mellitus Tipo 2/complicações , Humanos , Hipoglicemia/etiologia
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