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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.

4.
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
5.
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
6.
Endocrinol. nutr. (Ed. impr.) ; 59(2): 117-124, feb. 2012. ilus, tab
Artigo em Espanhol | IBECS | ID: ibc-97388

RESUMO

Objetivos Valorar el grado de control glucémico y del resto de factores de riesgo cardiovascular en una cohorte de pacientes diabéticos seguidos en consultas externas durante 4 años. Conocer el patrón de tratamiento utilizado y su evolución. Material y métodos Estudio de 424 pacientes diabéticos tanto tipo 1 (DM1) como tipo 2 (DM2), seleccionados aleatoriamente en 2004 y seguidos hasta 2008. La cohorte final fue de 343 pacientes. Se recogieron datos epidemiológicos, factores de riesgo cardiovascular, complicaciones crónicas, datos de control glucémico, lipídico y tensional, así como de tratamiento al inicio y a los 4 años. Resultados Tras los 4 años, el porcentaje de pacientes que conseguían una hemoglobina glicada inferior a 7% se mantuvo estable (DM1 18,5 en 2004 frente a 21,7% en 2008 y DM2 26,6 frente a 26,5%). En ambos tipos de diabetes se incrementó de forma significativa el grado de consecución de objetivos de control lipídico y tensional. Para conseguir estos resultados las pautas de tratamiento se complicaron de manera significativa. Conclusiones La estabilización del control glucémico objetivada tras 4 años de seguimiento es un resultado positivo, considerando el largo tiempo de evolución de la enfermedad, el deterioro progresivo de la función pancreática y la complejidad de esta cohorte. Gracias a la optimización de los tratamientos utilizados, han mejorado de forma significativa el control tensional y lipídico del grupo estudiado(AU)


Objectives To assess control of blood glucose and other cardiovascular risk factors in diabetic patients monitored at an outpatient endocrinology clinic. To ascertain treatment used and its changes over time. Patients and methods A cohort of 424 randomly selected diabetic patients (both type 1 and type 2) was monitored from 2004 to 2008. Final cohort size was 343 patients. Data were collected about epidemiological characteristics, cardiovascular risk factors, chronic complications, glycemic, lipid and blood pressure control, and treatment at baseline and 4 years. Results After 4 years, the proportion of patients achieving glycosylated hemoglobin levels less than 7% remained stable (type 1: 18.5% in 2004 vs 21.7% in 2008, type 2: 26.6% vs 26.5%). The degree of achievement of lipid and blood pressure (BP) control levels increased in both groups. The complexity of treatment schemes used to achieve these results significantly increased. Conclusions Stabilization of glycemic control after 4 years of follow-up was a positive result, considering the long course of diabetes, progressive pancreatic function impairment, and complexity of our cohort. Treatment optimization significantly improved BP and lipid control in the study group(AU)


Assuntos
Humanos , Diabetes Mellitus/epidemiologia , Doenças Cardiovasculares/prevenção & controle , Doenças Metabólicas/prevenção & controle , Fatores de Risco , Hipertensão/prevenção & controle , Hiperlipidemias/prevenção & controle , Complicações do Diabetes/epidemiologia
7.
Endocrinol Nutr ; 59(2): 117-24, 2012 Feb.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-22265763

RESUMO

OBJECTIVES: To assess control of blood glucose and other cardiovascular risk factors in diabetic patients monitored at an outpatient endocrinology clinic. To ascertain treatment used and its changes over time. PATIENTS AND METHODS: A cohort of 424 randomly selected diabetic patients (both type 1 and type 2) was monitored from 2004 to 2008. Final cohort size was 343 patients. Data were collected about epidemiological characteristics, cardiovascular risk factors, chronic complications, glycemic, lipid and blood pressure control, and treatment at baseline and 4 years. RESULTS: After 4 years, the proportion of patients achieving glycosylated hemoglobin levels less than 7% remained stable (type 1: 18.5% in 2004 vs 21.7% in 2008, type 2: 26.6% vs 26.5%). The degree of achievement of lipid and blood pressure (BP) control levels increased in both groups. The complexity of treatment schemes used to achieve these results significantly increased. CONCLUSIONS: Stabilization of glycemic control after 4 years of follow-up was a positive result, considering the long course of diabetes, progressive pancreatic function impairment, and complexity of our cohort. Treatment optimization significantly improved BP and lipid control in the study group.


Assuntos
Glicemia/metabolismo , Doenças Cardiovasculares/prevenção & controle , Diabetes Mellitus Tipo 1/metabolismo , Diabetes Mellitus Tipo 1/terapia , Diabetes Mellitus Tipo 2/metabolismo , Diabetes Mellitus Tipo 2/terapia , Doenças Cardiovasculares/etiologia , Estudos de Coortes , Diabetes Mellitus Tipo 1/complicações , Diabetes Mellitus Tipo 2/complicações , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Fatores de Risco
8.
Endocrinol. nutr. (Ed. impr.) ; 58(4): 157-162, abr. 2011. ilus, tab
Artigo em Espanhol | IBECS | ID: ibc-94152

RESUMO

Antecedentes y objetivo El cáncer diferenciado de tiroides (CDT) es el tumor endocrino más frecuente, con buen pronóstico y supervivencias superiores al 85%. El objetivo de nuestro trabajo es conocer la supervivencia actual de nuestra serie de CDT y analizar los factores relacionados. Pacientes y métodos Realizamos un estudio retrospectivo de una cohorte de pacientes con CDT (n: 308), 93,5% eran papilares, el 78,2% eran mujeres con una edad media al diagnóstico de 45,4±15,8 años y un tiempo de seguimiento de 8,9 ± 6,8 años. Han sido tratados y seguidos de forma homogénea en nuestro centro hospitalario. Para cada paciente se ha recogido edad al diagnóstico, sexo, histología, estadio TNM, tratamientos empleados y fecha y causa de la muerte. La probabilidad de supervivencia fue calculada por el método de Kaplan Meier. Para analizar los factores relacionados con la supervivencia se realizó un análisis univariante (Log Rank test) y multivariante (Riesgos proporcionales de Cox).Resultados Se produjeron 26 casos de muerte, de ellos 15 pacientes (4,9%) murieron como consecuencia del CDT. La probabilidad de supervivencia acumulada del grupo total fue del 92,7%. En el análisis multivariante las variables asociadas de forma independiente con mortalidad por CDT fueron: metástasis a distancia, tipo histológico folicular, edad al diagnóstico más de 60 años y afectación extratiroidea. Discusión La probabilidad de supervivencia de nuestra serie es equiparable a la de la literatura. El conocimiento de los factores relacionados con peor supervivencia en el medio que trabajamos, es importante para establecer estrategias más activas de tratamiento en pacientes de alto riesgo (AU)


Background and aims Differentiated thyroid carcinoma (DTC) is the most common endocrine tumor. DTC has a good prognosis and survival rates higher than 85%. The aim of our study was to assess our current survival rate and to analyze prognostic factors. Patients and methods A retrospective analysis was conducted of 308 patients with DTC (93.5% with papillary tumors, 78.8% women). Mean age at diagnosis was 45.4±15.8years, and mean follow-up time was 8.9±6.8 years. The whole group was treated and followed up using the same protocol at our hospital. The following data were collected: age at diagnosis, sex, histology, TNM stage, treatments, and date and cause of death. Survival probability was calculated using Kaplan-Meier analyses. Prognostic factors were analyzed using a univariate log rank test and a multivariate Cox regression analysis model. Results Twenty-six patients died during follow-up, 15 of them (4.9%) from DTC. Thyroid carcinoma-related survival was 92.7% for the whole group. In multivariate analyses, the following parameters were associated to a significantly increased risk of death from DTC: presence of distant metastases, follicular histology, age at diagnosis older than 60 years, and extrathyroid invasion. Discussion Our survival rate is similar to that reported in literature. Assessment of prognostic factors related to an increased risk of death in our patient group, is essential to establish active therapeutic approaches in high risk patients (AU)


Assuntos
Humanos , Carcinoma/epidemiologia , Neoplasias da Glândula Tireoide/epidemiologia , Estudos Retrospectivos , Carcinoma/patologia , Neoplasias da Glândula Tireoide/patologia , Fatores de Risco , Taxa de Sobrevida
9.
Endocrinol Nutr ; 58(4): 157-62, 2011 Apr.
Artigo em Espanhol | MEDLINE | ID: mdl-21419724

RESUMO

BACKGROUND AND AIMS: Differentiated thyroid carcinoma (DTC) is the most common endocrine tumor. DTC has a good prognosis and survival rates higher than 85%. The aim of our study was to assess our current survival rate and to analyze prognostic factors. PATIENTS AND METHODS: A retrospective analysis was conducted of 308 patients with DTC (93.5% with papillary tumors, 78.8% women). Mean age at diagnosis was 45.4±15.8years, and mean follow-up time was 8.9±6.8years. The whole group was treated and followed up using the same protocol at our hospital. The following data were collected: age at diagnosis, sex, histology, TNM stage, treatments, and date and cause of death. Survival probability was calculated using Kaplan-Meier analyses. Prognostic factors were analyzed using a univariate log rank test and a multivariate Cox regression analysis model. RESULTS: Twenty-six patients died during follow-up, 15 of them (4.9%) from DTC. Thyroid carcinoma-related survival was 92.7% for the whole group. In multivariate analyses, the following parameters were associated to a significantly increased risk of death from DTC: presence of distant metastases, follicular histology, age at diagnosis older than 60years, and extrathyroid invasion. DISCUSSION: Our survival rate is similar to that reported in literature. Assessment of prognostic factors related to an increased risk of death in our patient group, is essential to establish active therapeutic approaches in high risk patients.


Assuntos
Adenocarcinoma Folicular/mortalidade , Carcinoma Papilar/mortalidade , Neoplasias da Glândula Tireoide/mortalidade , Adenocarcinoma Folicular/terapia , Adenoma Oxífilo/mortalidade , Adenoma Oxífilo/terapia , Adulto , Fatores Etários , Idoso , Carcinoma Papilar/terapia , Feminino , Seguimentos , Humanos , Radioisótopos do Iodo/uso terapêutico , Estimativa de Kaplan-Meier , Masculino , Pessoa de Meia-Idade , Invasividade Neoplásica , Prognóstico , Modelos de Riscos Proporcionais , Estudos Retrospectivos , Fatores de Risco , Espanha/epidemiologia , Neoplasias da Glândula Tireoide/terapia , Tireoidectomia
10.
Endocrinol. nutr. (Ed. impr.) ; 54(2): 76-82, feb. 2007. tab, graf
Artigo em Espanhol | IBECS | ID: ibc-052502

RESUMO

Objetivo: Valorar el grado de control glucémico, lipídico y de presión arterial (PA), así como el porcentaje de antiagregación plaquetaria, en pacientes diabéticos asistidos en una consulta de atención especializada. Pacientes y método: Estudio transversal de una cohorte de 424 pacientes vistos en 2 meses de 2004. Se recogieron datos sobre glucohemoglobina (HbA1c), perfil lipídico, PA, antecedentes de microangiopatía y macroangiopatía y tratamientos utilizados. En 296 pacientes se analizaron retrospectivamente los resultados del año 2000. Resultados: En 2004, la HbA1c media fue de 7,8 ± 1,2% (en el 25% de los pacientes era < 7%), la media de colesterol unido a lipoproteínas de baja densidad (cLDL) fueron 104,2 ± 28,7 mg/dl (el 43,4% tenían cLDL < 100 mg/dl) y las PA sistólica y diastólica media fueron 135,3 ± 17,6 y 76,3 ± 10,2 mmHg (el 45,5% tenía PA sistólica < 130 mmHg y el 78,5%, PA diastólica < 80 mmHg). Se produjo una mejoría significativa en todos los parámetros investigados respecto al 2000 (HbA1c, 8,5% ± 1,3%; cLDL, 128,2 ± 28,5 mg/dl; PA sistólica y diastólica media, 140,2 ± 17,9 y 77,9 ± 12,1 mmHg). El 38% de los pacientes (el 84% en prevención secundaria y el 26% en prevención primaria) utilizaban antiagregación plaquetaria, frente a un 17% en el año 2000. Conclusiones: Aunque se ha producido una importante mejora en el control de los factores de riesgo vascular, gracias al abordaje integral de los pacientes, todavía el grado de control de nuestros diabéticos es insuficiente. Hemos evidenciado una mejora en el uso de antiagregación plaquetaria, aunque su utilización es poco frecuente, sobre todo en prevención primaria (AU)


Objective: Our aim was to evaluate the degree of metabolic control in terms of blood glucose, lipids, blood pressure (BP) and to assess antiplatelet agents use among diabetic patients recruited in an endocrinologist clinic. Patients and method: We performed a cross-sectional study of a cohort of 424 outpatients visited in 2004. Data on glycated hemoglobin (HbA1c), lipid profile, BP, micro and macrovascular complications and current treatments were obtained. In a subgroup of 296 patients we analyzed retrospectively the same variables in 2000. Results: In 2004, mean HbA1c was 7.8% ± 1.2% (only 25% of the cohort had < 7%), mean LDLc levels were 104.2 ± 28.7 mg/dl (43.4% of subjects had LDLc < 100 mg/dl). Systolic and diastolic BP levels were 135.3 ± 17.6 and 76.3 ± 10.2 mmHg (45.5% of subjects had systolic BP < 130 and 78.5% diastolic BP < 80). There was a significant improvement of metabolic results since 2000 (HbA1c 8.5 ± 1.3%, LDLc 128.2 ± 28.5 mg/dl, median systolic y diastolic BP 140.2 ± 17.9 and 77.9 ± 12.1 mmHg). Antiplatelet agents use increased from 17% in 2000 to 38% in 2004 (84% as secondary prevention and 26% as primary prevention). Conclusions: Although we have obtained an important improvement in cardiovascular risk factors control, probably due to a multifactorial intervention treatment, overall metabolic and BP control remain unsatisfactory. Antiplatelet agents use has increased but continues to be low in primary prevention (AU)


Assuntos
Masculino , Feminino , Pessoa de Meia-Idade , Humanos , Inibidores da Agregação de Plaquetas/uso terapêutico , Doenças Cardiovasculares/etiologia , Doenças Cardiovasculares/prevenção & controle , Aspirina/uso terapêutico , Prevenção Primária , Lipídeos/sangue , Diabetes Mellitus Tipo 1/complicações , Hemoglobina A Glicada/análise , Estudos Transversais , Estudos Retrospectivos , Estudos de Coortes , Fatores de Risco , Pressão Sanguínea
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