Estrés psicológico y angustia por diabetes en adultos con diabetes mellitus tipo 2: una revisión sistemática / Psychological Stress and Diabetes Distress in Adults with Type 2 Diabetes Mellitus: A Systematic Review / Estresse psicológico e angústia causada por diabetes em adultos com diabetes mellitus tipo 2: uma revisão sistemática

Introducción: la diabetes mellitus tipo 2 es una enfermedad crónica que puede causar estrés psicológico en el desarrollo de la enfermedad y como suceso estresante, mientras que la angustia por la diabetes se asocia con estresores como el descontrol de las concentraciones de glucosa, presencia de complicaciones agudas o crónicas, disciplina y apego en el tratamiento integral. El objetivo del estudio fue analizar la literatura científica disponible sobre el estrés psicológico y angustia por diabetes en relación con el con- trol glucémico en adultos con diabetes mellitus tipo 2. Materiales y métodos: para la búsqueda de literatura se utilizaron las bases de datos Pubmed, Medline, Biblioteca Virtual en Salud, CINAHL, EBSCO, Wiley y Google Académico. Se incluyeron artículos indexados en bases de datos con idioma inglés, español y portugués, de diseños descriptivos, correlacionales y experimentales publicados en el periodo 2010-2020. Los artículos se evaluaron a través de la lista de revisión del Joanna Briggs Institute. Resultados: se encontró que el estrés psicológico ocurre mayormente en mujeres y que la angustia por diabetes es predictora del control glucémico pobre, provoca un manejo inadecuado de la glucosa, aumenta la hemoglobina glucosilada y también es una de las causas de mortalidad en hombres. Conclusiones: los hallazgos muestran que existe mayor relación entre la angustia por diabetes y el control glucémico en estos pacientes

Introduction: type 2 diabetes mellitus is a chronic disease that can cause psychological stress in the development of the disease and as a stressful event, while diabetes distress is associated to stressors such as uncontrolled diabetes, presence of acute or chronic complications, discipline and adherence in comprehensive treatment. The aim of the study is to analyze the available scientific literature on psychological stress and diabetes distress in relation to glycemic control in adults with type 2 diabetes mellitus. Materials and methods: For the literature search, Pubmed, Medline, Virtual Health Library, CINAHL, EBSCO, Wiley and Google databases were used. Articles indexed with English, Spanish and Portuguese languages, with descriptive, correlational and experimental designs published in the period 2010 to 2020. The articles were evaluated through the Joanna Briggs Institute Check list. Results: 10 articles that met the inclusion criteria were analyzed, some studies showed an associated of psychological stress and diabetes distress with glycated hemoglobin, in addition, it was found that psychological stress is mostly in women and diabetes distress is a predictor of poor glycemic control, it causes inadequate glucose management, increases glycated hemoglobin and is also one of the causes of mortality in men. Conclusions: The findings show that there is a relationship mainly between diabetes distress and glycemic control in these patients.

Introdução: A diabetes mellitus tipo 2 é uma doença crônica que pode causar estresse psicológico no surgimento da doença e ser um evento estressante, enquanto que a angústia por diabetes está associada a estressores como os níveis glicose descontrolados, presença de complicações agudas ou crônicas, disciplina e aderência a um tratamento integral. O objetivo do estudo foi analisar a literatura científica disponível sobre o estresse psicológico e a angústia por diabetes em relação ao controle glicêmico em adultos com diabetes mellitus tipo 2. Materiais e métodos: As bases de dados Pubmed, Medline, Biblioteca Virtual en Salud, CINAHL, EBSCO, Wiley e Google foram utilizadas para a pesquisa bibliográfica. Foram incluídos artigos indexados em bases de dados em inglês, espanhol e português, com desenhos descritivos, correlacionais e experimentais publicados no período de 2010 a 2020. Os artigos foram avaliados através do Check List do Instituto Joanna Briggs. Resultados: Foram analisados 10 artigos que cumpriram com os critérios de inclusão, alguns estudos mostraram associação do estresse psicológico e angústia por diabetes com a hemoglobina glicosilada, além disso, descobriu-se que o estresse psicológico apresenta principalmente nas mulheres e a angústia por diabetes é um preditor de controle glicêmico deficiente, provocando manejo inadequado da glicose, aumentando a hemoglobina glicosilada e também, é uma das causas de mortalidade nos homens. Conclusões: Os resultados mostraram que existe uma maior relação entre a angustia por diabetes e o controle glicêmico nestes pacientes

Calidad del sueño en personas con diabetes tipo 2 controladas en el nivel primario y su asociación con características sociodemográficas y clínicas / Sleep quality in people with type 2 diabetes controlled at the primary level and its association with sociodemographic and clinical characteristics

La diabetes tipo 2 (DM2) es una de las enfermedades que causa mayor mortalidad prematura y discapacidad a nivel mundial. Las alteraciones del sueño se han asociado a la aparición de trastornos metabólicos y a mayores niveles de hemoglobina glucosilada en personas diabéticas.Objetivo:Evaluar la calidad del sueño de personas con DM2 y su asociación con características sociodemográficas, clínicas y metabólicas.Métodos:Estudio observacional, transversal, analítico en 223 personas con DM2 entre 20 y 64 años controladas en un centro de atención primaria de salud.Resultados:La mayoría eran mujeres (66,4%), edad promedio 54,7 años y solo el 33% duerme las horas necesarias (7 a 9 horas). Un 57,7% se encontraba metabólicamente descompensado (Hb1Ac>7%). Un 75,2% de los participantes presentó problemas de sueño de diversa gravedad, que se asoció a ser mujer, dolor nocturno, nicturia, tiempo de diagnóstico de la diabetes y síntomas depresivos. Las personas con mala calidad de sueño tuvieron 73% más probabilidad de estar descompensados metabólicamente, sin embargo, este resultado no fue estadísticamente significativo OR=1,73 (IC: 0,78-3,87).Conclusiones:Destaca la alta frecuencia de mala calidad de sueño y descompensación metabólica en la muestra, lo que podría complicar la DM2. No es concluyente la asociación entre mala calidad de sueño y descompensación de la DM2. Futuras investigaciones contribuirán a dilucidar el papel del sueño en la compensación metabólica y en la prevención de trastornos metabólicos.

Type 2 diabetes (DM2) is one of the diseases that cause the highest premature mortality and disability worldwide. Sleep disturbances have been associated with the onset of metabolic disorders and increased levels of glycated haemoglobin in diabetics.Objective:To evaluate the quality of sleep of people with type 2 diabetes and its association with sociodemographic, clinical, and metabolic characteristics.Methods:Observational, cross-sectional, analytical study of 223 patients with DM2 between 20 and 64 years old, controlled in a primary health care centre in Chile.Results:Most were women (66.4%), average age 54.7 years. Only 33% slept the required number of hours (7 to 9hours) to maintain health. Fifty-seven point seven percent were metabolically unbalanced (Hb1Ac>7%). Seventy-five point two percent presented sleep problems of varying severity, which were associated with being a woman, night pain, nocturia, time of diagnosis of diabetes, and depressive symptoms. Persons with poor sleep quality were 73% more likely to be metabolically decompensated, however, this result was not statistically significant: OR=1.73 (CI:78-3.87).Conclusions:The high frequency of poor sleep quality and metabolic decompensation in the sample stands out, which could complicate DM2. The association between poor sleep quality and DM2 decompensation is inconclusive. Future research will contribute to elucidating the role of sleep in metabolic compensation and in the prevention of metabolic disorders.

Hemoglobina glucosilada en el diagnóstico de diabetes gestacional en mujeres mexicanas durante el tercer trimestre / Glycosylated hemoglobin in the diagnosis of gestational diabetes in Mexican women during the third trimester

Resumen El objetivo del trabajo fue analizar los valores de hemoglobina glucosilada en el tercer trimestre de embarazo como predictores alternativos de la diabetes gestacional en pacientes del Noreste de México. Se trata de un estudio retrospectivo de casos y controles a partir de 121 expedientes de pacientes embarazadas, divididos en dos grupos, pacientes con diabetes gestacional (casos) y gestantes con valores glucémicos normales (controles). Se analizaron los factores de riesgo asociados a la diabetes gestacional y se obtuvo un punto de corte para la hemoglobina glucosilada. Se encontró que la obesidad materna, la edad y el antecedente del padecimiento fueron asociados significativamente con la diabetes gestacional. Valores de hemoglobina glucosilada ≥5% incrementaron el riesgo de padecer diabetes mellitus gestacional 4 veces y, aunado a un factor de riesgo, la probabilidad se incrementó 7 veces. Se concluye que los valores de hemoglobina glucosilada en el tercer trimestre de embarazo podrían emplearse como prueba diagnóstica de la diabetes gestacional en pacientes del Noreste de México. Sin embargo, aunque las diferencias encontradas fueron estadísticamente significativas, los resultados se deben interpretar con cautela y requieren su confirmación con estudios que incluyan una muestra mayor.

Abstract The objective of this study was to analise glycosylated hemoglobin values in the third trimester of pregnancy as an alternative predictor of gestational diabetes in North East Mexican cohort patients. This is a retrospective case-control study based on 121 records of pregnant patients, divided into two groups, patients with gestational diabetes (cases) and pregnant women with normal glycemic values (control). The risk factors associated with gestational diabetes were analised and a cut-off point for glycosylated hemogestaglobin was obtained. It was found that maternal obesity, age and a history of the condition were significantly associated with gestational diabetes. Values of glycosylated hemoglobin ≥5% increased the risk of suffering from gestational diabetes 4 times, and coupled with a risk factor, the risk increased 7 times. It is concluded that glycosylated hemoglobin values in the third trimester of pregnancy could be used as a diagnostic test for gestational diabetes in patients from the North East of Mexico. Although the differences found were statistically significant, our results must be interpreted with caution and require confirmation by studies with a larger sample.

Resumo O objetivo deste estudo foi analisar os valores da hemoglobina glicada no terceiro trimestre de gestação como preditores alternativos do diabetes gestacional em pacientes na região nordeste do México. Trata-se de um estudo retrospectivo de casos e controles utilizando 121 prontuários de gestantes divididas em dois grupos; pacientes com diabetes gestacional (casos) e gestantes com valores de glicemia normais (controles). Foram analisados os fatores de risco associados a diabetes gestacional obtendo-se um ponto de corte para a hemoglobina glicada. Descobriu-se que a obesidade materna, idade e antecedentes da doença foram associados significativamente ao diabetes gestacional. Valores da hemoglobina glicada ≥ 5% aumentaram o risco de padecer diabetes mellitus gestacional 4 vezes, e juntamente a um fator de risco, a probabilidade aumentou 7 vezes. Conclui-se que os valores da hemoglobina glicada no terceiro trimestre de gestação poderiam ser usados como teste diagnóstico do diabetes gestacional em pacientes da região nordeste do México. Embora as diferenças encontradas tenham sido estatisticamente significativas, os resultados devem ser interpretados com cautela e requerem confirmação através de estudos que incluam uma amostra maior.

Asociación entre sentido de coherencia y control glucémico en personas con Diabetes Mellitus tipo 2 / Associação entre Senso de Coerência e controle glicêmico em pessoas com Diabetes Mellitus Tipo 2 / Association between Sense of Coherence and glycemic control in people with Type 2 Mellitus Diabetes

Objetivo: Evaluar la asociación entre sentido de coherencia y control glucémico en adultos con Diabetes Mellitus tipo 2. Métodos: Estudio de tipo transversal desarrollado durante el año 2018 en el cual fueron encuestados 220 diabéticos de tres unidades de Salud de la Secretaría de Salud del Estado de Jalisco en Ciudad Guzmán, México. Se les aplicó el instrumento SOC-13 para sentido de coherencia y el control glucémico se evaluó por medio del nivel de hemoglobina glucosilada que se obtuvo del expediente médico. Los datos se analizaron por medio del análisis de regresión logística. Resultados: Se obtuvieron resultados con un total de 220 participantes en un rango de edad entre 23 y 69 años de los que el 67% presentó control glucémico inadecuado y el 33% control glucémico adecuado; de los encuestados con control glucémico inadecuado el 24% refirió puntuaciones bajas de sentido de coherencia, mientras que el 96% de quienes tienen control glucémico adecuado obtuvo puntuaciones medio/alta de sentido de coherencia. Los análisis de regresión logística arrojan que el sentido de coherencia se asocia significativamente con el control glucémico (OR = 7.2; 95% C.I: 2.0-24.7; p = 0.002) después de ajustar los análisis por diversas variables confusoras como sexo, apego al plan alimenticio, actividad física, ausencia de complicaciones y ausencia de tabaquismo. Conclusión: Los diabéticos con puntuaciones medio/altas de sentido de coherencia tienen hasta 7 veces más probabilidad de tener control glucémico adecuado que diabéticos con puntuaciones bajas de sentido de coherencia independientemente de variables intervinientes.

Objetivo: Avaliar a associação entre senso de coerência e controle glicêmico em adultos com diabetes mellitus tipo 2. Métodos: Estudo transversal desenvolvido durante 2018, com 220 diabéticos de três unidades de saúde da Secretaria de Saúde do Estado de Jalisco na cidade de Guzmán, México. Aplicou-se o instrumento SOC-13 para senso de coerência, e avaliou-se o controle glicêmico por meio do nível de hemoglobina glicosada obtido nos prontuários. Assim, obtiveram-se os dados por análise de regressão logística. Resultados: Os 220 participantes tinham faixa etária de 23 a 69 anos, dos quais 148 (67%) apresentavam controle glicêmico inadequado e 72 (33%) controle glicêmico adequado; 24% dos pesquisados com controle glicêmico inadequado relataram escores baixos para senso de coerência, enquanto 96% daqueles com controle glicêmico adequado obtiveram escores médios/ altos para senso de coerência. As análises de regressão logística mostram que o senso de coerência está significativamente associado ao controle glicêmico (OR=7,2; IC 95%: 2,0-24,7; p=0,002) após ajustar as análises para variáveis de confusão, como sexo, adesão ao plano alimentar, atividade física, ausência de complicações e ausência de tabagismo. Conclusão: Diabéticos, com escores médios/altos de senso de coerência, têm até 7 vezes mais chances de apresentar controle glicêmico adequado do que diabéticos com baixos escores de senso de coerência, independentemente das variáveis intervenientes.

Objective: To evaluate the association between a sense of coherence and glycemic control in adults with type 2 Mellitus Diabetes. Methods: Cross-sectional study, developed during 2018, 220 diabetics from three health units of the Secretaria de Salud del Estado de Jalisco in Ciudad Guzmán, Mexico, the SOC-13 instrument was applied for a sense of coherence, glycemic control was evaluated through the level of glycosylated hemoglobin obtained from the medical record, the data was analyzed through logistic regression analysis. Results: Results were obtained with a total of 220 participants in an age range of 23 to 69 years of which 67% presented inadequate glycemic control and 33% adequate glycemic control; 24% of those surveyed with inadequate glycemic control reported low scores for a sense of coherence, while 96% of those with adequate glycemic control obtained medium/high scores for a sense of coherence. The logistic regression analyzes show that the sense of coherence is significantly associated with glycemic control (OR=7.2; 95% CI: 2.0-24.7; p=0.002) after adjusting the analyzes for various confounding variables such as sex, adherence to eating plan, physical activity, absence of complications and absence of smoking. Conclusion: Diabetics with medium/high scores of coherence sense are up to 7 times more likely to have adequate glycemic control than diabetics with low scores of coherence sense regardless of intervening variables.

[Diabetic patient control in Primary Care: Influence of service portfolio and other factors]. / Control del paciente diabético en Atención Primaria: influencia de cartera de servicios y otros factores.

OBJECTIVE: To study the effect of the type of follow-up according to Service Portfolio and other associated factors, in the reduction of HbA1c levels in people with a new diagnosis of type 2 diabetes and poor initial control. DESIGN: Analytical observational study of a cohort under routine clinical practice conditions. LOCATION: 262 Primary Health Care Centres in Madrid. PARTICIPANTS: 1,838 individuals older than 18 years with a new diagnosis of type 2 DM and initial HbA1c levels ≥ 7%, or ≥ 8.5% if older than 75 years. INTERVENTIONS: The exposure variable was the type of follow-up according to Portfolio, categorised as minimum, medium, and optimal, according to the number of interventions performed and periodicity of type of therapeutic-pharmacological plan. MAIN MEASUREMENTS: A study was made of the comorbidity, therapeutic-pharmacological plan, diet - exercise advice and deprivation index. The main outcome was the difference between the final and initial HbA1c. RESULTS: After 2 years of follow-up there was a mean decrease in HbA1c by -1.7 percentage points (95% CI: -1.6;-1.8), which was 0.36 points higher in patients with optimal follow-up: -2.1 (95% CI: -1.7;-2.4). The factors associated with a decrease in HbA1c were the optimal follow-up -0.29 (95% CI: -0.5;-0.1), the medium follow-up -0.26 (95% CI: -0.5; -0.0), and the initial HbA1c value -0.9 (95% CI: -0.9; -0.9. The factors associated with the increase were insulin treatment and living in socially disadvantaged areas. CONCLUSIONS: Glycaemic control was improved in patients with a new diagnosis of diabetes in which optimal follow-up is performed as proposed in the Service Portfolio.

Glycosylated hemoglobin level in patients with and without surgical site infection after hysterectomy.

BACKGROUND: Surgical site infection (SSI) occurs in 11-12% of surgeries. The glycosylated hemoglobin (HbA1c) has been found to be significantly elevated in those who presented infection. OBJECTIVE: To compare the concentration of HbA1c between patients with and without SSI after hysterectomy. METHOD: In healthy, postoperative women with total abdominal (open) hysterectomy, the HbA1c serum concentration was measured (normal <5.7%) and the difference between those who presented SSI and other risk factors for SSI were compared with Mann Whitney U test was used. The HbA1c values were stratified as normal or abnormal and were contrasted with the presence or absence of SSI by means of X2. RESULTS: 27 women without SSI and 20 with SSI were studied. The preoperative glucose was and 88 (70-99) mg/dl and 86 (70-99) mg/dl for the groups with and without SSI respectively. The HbA1c was significantly higher in the group with ISQ 5.6% (5-8) vs. 6.5% (5.2-8.2). The sensitivity of HbA1c with cut point <5.7 was 80% and the specificity was 51.9%. CONCLUSION: HbA1c can serve as a prognostic criterion of ISQ.

ANTECEDENTES: La infección del sitio quirúrgico (ISQ) se presenta en el 11-12% de las cirugías. La hemoglobina glucosilada (HbA1c) se ha encontrado significativamente elevada en los pacientes que presentan infección. OBJETIVO: Comparar la concentración de HbA1c entre pacientes con y sin ISQ posterior a una histerectomía. MÉTODO: En mujeres sanas posoperadas de histerectomía total abdominal (abierta) se midió la concentración sérica de HbA1c (normal < 5.7%) y se comparó la diferencia entre las que presentaron ISQ y las que no. Se investigaron también otros factores de riesgo para ISQ. Se utilizó la prueba U de Mann Whitney. Los valores de HbA1c se estratificaron como normales o anormales, y se contrastaron con la presencia o no de ISQ por medio de la prueba ji al cuadrado. RESULTADOS: Se estudiaron 27 mujeres sin ISQ y 20 con ISQ. La glucosa preoperatoria fue de 88 (70-99) y 86 (70-99) mg/dl para los grupos con y sin ISQ, respectivamente. La HbA1c fue significativamente mayor en el grupo con ISQ (5.6%; 5-8) que en el grupo sin ISQ (6.5%; 5.2-8.2). La sensibilidad de la HbA1c con un punto de corte < 5.7 fue del 80% y la especificidad fue del 51.9%. CONCLUSIÓN: La HbA1c puede servir como criterio pronóstico de ISQ.

Cetoacidosis por empagliflozina post histerectomía / Post hysterectomy ketoacidosis due to empagliflozin

RESUMEN Paciente de sexo femenino de 42 años, con diagnóstico de diabetes mellitus tipo 2, de 3 años de evolución, era tratada con empagliflozina/metformina. Intervenida quirúrgicamente por miomatosis uterina, presentó en el postoperatorio inmediato deterioro neurológico y acidosis metabólica, sin hiperglicemia, pero con desequilibrio hidroelectrolítico. Fue ingresada a terapia intensiva, requiriendo manejo invasivo con hemodiálisis y diálisis peritoneal por acidosis refractaria. Egresó luego de 17 días de estancia intrahospitalaria, en buenas condiciones generales.

ABSTRACT A 42-year-old female patient received a diagnosis of type 2 diabetes mellitus 3 years ago, and was treated with empagliflozin/metformin. She had a surgical intervention for uterine myomatosis, and presented immediately after the surgery neurological deterioration, metabolic acidosis without hyperglycemia, and hydroelectrolytic imbalance. She was admitted to the intensive care unit and required treatment with hemodialysis and peritoneal dialysis due to refractory acidosis. She was discharged in good condition after 17 days of hospitalization.

Tratamiento farmacológico de la diabetes mellitus tipo 2 dirigido a pacientes con sobrepeso y obesidad / Pharmacological treatment of diabetes mellitus type 2 directed to patients with overweight and obesity

Resumen La diabetes mellitus tipo 2 es una enfermedad multifactorial y de carácter crónico que requiere un tratamiento integral a lo largo de la vida del paciente y con necesidad de ajustes constantes de acuerdo con los requerimientos específicos de cada paciente. Se ha identificado que la disminución de peso en pacientes diabéticos puede retrasar la progresión de la enfermedad e incluso retrasar o evitar su aparición. Además de ser un factor benéfico en las metas de tratamiento de los pacientes diabéticos, la disminución del peso puede lograr cambios clínicamente significativos en las concentraciones totales de glucosa sérica, hemoglobina glucosilada (HbA1C) y en las concentraciones de triglicéridos. En la actualidad las recomendaciones basadas en evidencia están dirigidas a la intervención farmacológica, quirúrgica y cambios en el estilo de vida en el manejo de la obesidad como parte del tratamiento integral de los pacientes con diabetes mellitus tipo 2. Los tratamientos farmacológicos tradicionales contra la diabetes mellitus tipo 2 pueden aumentar aún más el peso y esto puede disminuir los beneficios del control glucémico adecuado. Es importante identificar la injerencia de cada grupo de fármacos en el peso.

Abstract Diabetes mellitus type 2 (DM2) is a chronic and multifactorial disease that requires an integral treatment throughout the life of the patient and in need of constant adjustments according to specific requirements of each patient. It is well established that weight loss in diabetic patients may delay the progression of the disease or even delay its onset. In addition to being a beneficial factor in the treatment goals of diabetic patients, weight reduction can achieve clinically significant changes in serum glucose, glycated hemoglobin (HbA1c) and triglyceride levels. Evidence-based recommendations are currently aimed at pharmacological, surgical and lifestyle changes in the management of obesity as part of the comprehensive treatment of patients with diabetes mellitus type 2. Traditional pharmacological treatments for diabetes mellitus type 2 may further increase weight and this may decrease the benefits of adequate glycemic control. It's important to identify the interference of each drug group on weight.

Impacto del índice de masa corporal en la presión arterial medida con esfigmomanómetro de mercurio en niños y adolescentes con diabetes mellitus tipo 1 / The impact of body mass index on blood pressure measured with mercury sphygmomanometer in children and adolescents with type 1 diabetes mellitus

Resumen Introducción Los pacientes con diabetes mellitus tipo 1 (DM1) y sobrepeso tienen más riesgo de desarrollar cambios en la presión arterial (PA), y esto incrementa su morbilidad y mortalidad cardiovascular. En este estudio se determinó la relación entre la PA y el índice de masa corporal (IMC) y el promedio de las tres últimas mediciones de hemoglobina glucosilada (HbA1c) de pacientes con DM1. Métodos Estudio transversal analítico en niños y adolescentes con DM1 con más de un año de evolución. Las variables dependientes fueron la PA sistólica y diastólica medidas con esfigmomanómetro y las variables independientes, IMC y promedio de las últimas tres mediciones de la HbA1c. Se utilizó regresión lineal múltiple con intervalo de confianza del 95%. Resultados Se estudiaron 75 pacientes con DM1. La mediana del tiempo de evolución de la DM1 fue de 3.5 años (mínimo 1 año-máximo 14.8 años), el IMC 19.5 ± 3.1 kg/cm2 y la HbA1c 8.3 ± 2.4%. De los 75 pacientes, 66 presentaron PA < percentil 90 y 9 PA ≥ percentil 90 (12%). Se construyeron dos modelos de regresión lineal múltiple, con PA sistólica y diastólica como variables dependientes. Las posibles variables predictoras fueron sugeridas por el contexto teórico y el análisis estadístico. El IMC expresado en puntuación zeta (zIMC) fue predictor para PA sistólica/diastólica. Los modelos sugirieron que a cada incremento de unidad del zIMC corresponde un aumento de 5.1 y 3.6 mmHg de PA sistólica y diastólica, respectivamente. Conclusiones Se observó una correlación positiva de la PA sistólica y la diastólica con el zIMC.

Abstract Background Patients with type 1 diabetes mellitus (T1DM) and overweight have more risk to develop changes in blood pressure that increase cardiovascular morbidity and mortality. In this study, the relationship between blood pressure (BP) with the body mass index (BMI) and the average of the last three measurements of glycated hemoglobin (HbA1c) in patients with T1DM was determined. Methods A cross-sectional analytical study was conducted in children and adolescents with T1DM with over a year since diagnosis. The dependent variables were systolic and diastolic BP, measured with a mercury sphygmomanometer. The independent variables were BMI and average of the last three measurements of HbA1. A linear regression with a 95% confidence interval was used. Results Seventy-five patients with T1DM were studied. The median of disease duration was 3.5 years (min 1-max 14.8 years), BMI 19.5 ± 3.1 kg/cm2 and HbA1c 8.3 ± 2.4%. Sixty-six patients showed BP < percentile 90 and 9 BP ≥ percentile 90 (12%). Two models of linear regression were constructed, with systolic and diastolic BP as dependent variables. The possible predictor variables were suggested by theoretical context and statistical analysis. The predictive variable of high BP was zBMI (body mass index expressed in z-score) for systolic and diastolic BP. Also, the models suggested that for an increase of one unit of zBMI, corresponded a rise of 5.1 and 3.6 mmHg in systolic and diastolic BP, respectively. Conclusions A positive correlation between systolic and diastolic BP with zBMI was observed.

Hemoglobina glucosilada como predictor de mortalidad y complicaciones en pacientes con infarto agudo del miocardio con elevación del segmento ST / Glycated hemoglobin as predictor of mortality and complications in patients with acute myocardial infarction with st-segment elevation

Introducción: La hemoglobina glucosilada pudiera convertirse en una herramienta en la estratificación inicial de pacientes infartados según el balance metabólico previo. Objetivo: Determinar el valor pronóstico de la hemoglobina glucosilada para muerte y complicaciones cardíacas mayores en el período intrahospitalario en pacientes con diagnóstico de infarto agudo del miocardio con elevación del segmento ST. Métodos: Se realizó un estudio observacional analítico de cohorte prospectivo en pacientes atendidos en la Unidad de Cuidados Coronarios del Hospital Universitario Arnaldo Milián Castro entre noviembre de 2018 y marzo de 2019 por presentar diagnóstico de infarto del miocardio agudo con elevación del segmento ST (N=73), de los cuales se seleccionó una muestra de 62 pacientes. Se realizó un análisis de conglomerados de K-medias y se valoró el área bajo la curva ROC de la hemoglobina glucosilada para predecir mortalidad y complicaciones mayores. Resultados: Existieron diferencias estadísticamente significativas entre los diferentes cluster en las variables estado al egreso (p=0,001; V=0,489) y ocurrencia de complicaciones cardíacas mayores (p=0,050; V=0,307). El análisis del estadístico C de la hemoglobina glucosilada demostró su capacidad predictiva para mortalidad tanto en diabéticos (C=0,810; p=0,014) como en no diabéticos (C=0,817; p=0,006), así como para complicaciones cardíacas mayores en diabéticos (C=0,799; p=0,015) y no diabéticos (C=0,683; p=0,052). Se estableció el punto de corte en 7,8 por ciento, por encima del cual la hemoglobina glucosilada constituyó un factor pronóstico de mortalidad y complicaciones cardíacas mayores. Conclusiones: Se determinó que la hemoglobina glucosilada posee capacidad para predecir mortalidad y complicaciones cardíacas mayores en el período intrahospitalario. Su valor por encima del punto de corte constituyó un predictor independiente(AU)

Introduction: Glycated hemoglobin could become a tool in the initial stratification of infarcted patients according to the previous metabolic balance. Objective: To determine the prognostic value of death glycated hemoglobin and major cardiac complications in the in-hospital period in patients diagnosed with acute myocardial infarction with ST-segment elevation. Methods: A prospective cohort analytical observational study was conducted in patients treated in the Coronary Care Unit at Arnaldo Milián Castro University Hospital from November 2018 to March 2019. They presented diagnosis of acute myocardial infarction with ST segment elevation ( N = 73); a sample of 62 patients was selected. Cluster analysis of K-means was performed and the area under ROC curve of glycated hemoglobin was assessed to predict mortality and major complications. Results: There were statistically significant differences between the clusters in the variables such as state at discharge (p = 0.001; V = 0.489) and occurrence of major cardiac complications (p = 0.050; V = 0.307). The analysis of C statistic of glycated hemoglobin established the predictive capacity for mortality in both diabetics (C = 0.810; p = 0.014) and non-diabetics (C = 0.817; p = 0.006), as well as for major cardiac complications in diabetics ( C = 0.799; p = 0.015) and non-diabetics (C = 0.683; p = 0.052). The cut-off point was established at 7.8 percent, above which glycated hemoglobin was a prognostic factor for mortality and major c. Conclusions: Glycosylated hemoglobin was stablished to have the ability to predict mortality and major cardiac complications in the in-hospital period. Its value above the cut-off point was an independent predictor(AU)

The impact of body mass index on blood pressure measured with mercury sphygmomanometer in children and adolescents with type 1 diabetes mellitus.

Background: Patients with type 1 diabetes mellitus (T1DM) and overweight have more risk to develop changes in blood pressure that increase cardiovascular morbidity and mortality. In this study, the relationship between blood pressure (BP) with the body mass index (BMI) and the average of the last three measurements of glycated hemoglobin (HbA1c) in patients with T1DM was determined. Methods: A cross-sectional analytical study was conducted in children and adolescents with T1DM with over a year since diagnosis. The dependent variables were systolic and diastolic BP, measured with a mercury sphygmomanometer. The independent variables were BMI and average of the last three measurements of HbA1. A linear regression with a 95% confidence interval was used. Results: Seventy-five patients with T1DM were studied. The median of disease duration was 3.5 years (min 1-max 14.8 years), BMI 19.5 ± 3.1 kg/cm2 and HbA1c 8.3 ± 2.4%. Sixty-six patients showed BP < percentile 90 and 9 BP ≥ percentile 90 (12%). Two models of linear regression were constructed, with systolic and diastolic BP as dependent variables. The possible predictor variables were suggested by theoretical context and statistical analysis. The predictive variable of high BP was zBMI (body mass index expressed in z-score) for systolic and diastolic BP. Also, the models suggested that for an increase of one unit of zBMI, corresponded a rise of 5.1 and 3.6 mmHg in systolic and diastolic BP, respectively. Conclusions: A positive correlation between systolic and diastolic BP with zBMI was observed.

Introducción: Los pacientes con diabetes mellitus tipo 1 (DM1) y sobrepeso tienen más riesgo de desarrollar cambios en la presión arterial (PA), y esto incrementa su morbilidad y mortalidad cardiovascular. En este estudio se determinó la relación entre la PA y el índice de masa corporal (IMC) y el promedio de las tres últimas mediciones de hemoglobina glucosilada (HbA1c) de pacientes con DM1. Métodos: Estudio transversal analítico en niños y adolescentes con DM1 con más de un año de evolución. Las variables dependientes fueron la PA sistólica y diastólica medidas con esfigmomanómetro y las variables independientes, IMC y promedio de las últimas tres mediciones de la HbA1c. Se utilizó regresión lineal múltiple con intervalo de confianza del 95%. Resultados: Se estudiaron 75 pacientes con DM1. La mediana del tiempo de evolución de la DM1 fue de 3.5 años (mínimo 1 año-máximo 14.8 años), el IMC 19.5 ± 3.1 kg/cm2 y la HbA1c 8.3 ± 2.4%. De los 75 pacientes, 66 presentaron PA < percentil 90 y 9 PA ≥ percentil 90 (12%). Se construyeron dos modelos de regresión lineal múltiple, con PA sistólica y diastólica como variables dependientes. Las posibles variables predictoras fueron sugeridas por el contexto teórico y el análisis estadístico. El IMC expresado en puntuación zeta (zIMC) fue predictor para PA sistólica/diastólica. Los modelos sugirieron que a cada incremento de unidad del zIMC corresponde un aumento de 5.1 y 3.6 mmHg de PA sistólica y diastólica, respectivamente. Conclusiones: Se observó una correlación positiva de la PA sistólica y la diastólica con el zIMC.

Caracterización de la hemoglobina glucosilada A1c en embarazas sanas / Characterization of glycosylated hemoglobin A1c in healthy pregnancies

Introducción: en embarazadas con diabetes mellitus pregestacional (tipo 1 o 2) y gestacional la determinación de la hemoglobina glucosilada tiene particular importancia pues se ha visto su valor correlacional con el desarrollo de complicaciones maternas y fetales. Objetivo: caracterizar la hemoglobina glucosilada en los diferentes trimestres del embarazo. Métodos: se realizó estudio observacional analítico transversal en el Hospital Ginecobstétrico Manuel Fajardo durante el segundo semestre del año 2016 a 100 embarazas sanas que asistieron al control prenatal; y un grupo control de 150 mujeres sanas no embarazadas mayores de 17 años en la población correspondiente al municipio Güines las que cumplieron con los criterios de inclusión y exclusión. Se realizó determinaciones de hemoglobina glucosilada y glicemia en ayunas. Resultados: las embarazadas sanas el promedio de hemoglobina glucosilada fue menor que en las no gestante respectivamente 4.50 por ciento (4.41- 4.49) contra 5.21 por ciento (5.16-5.26), P<0,001. En el grupo de embarazada sanas la hemoglobina glucosilada aumentó con el trimestre del embarazo p<0,05, primer trimestre: 4.35 (4.20 4.47), segundo trimestre: 4.58 (4.45 4.70), tercer trimestre: 4.61 (4.14 5.08). Conclusiones: durante el embarazo el porcentaje de Hb A1c aumenta con el trimestre del embarazo, por lo que es importante determinar su valor de referencia para un mejor control metabólico de las gestantes (AU).

Introduction: in pregnant women with pregestational diabetes mellitus (type 1 or 2) and gestational diabetes the determination of glycosylated hemoglobin is particularly important because its correlational value has been seen with the development of maternal and fetal complications. Objective: to characterize the glycosylated hemoglobin in the different trimesters of pregnancy. Methods: cross-sectional analytical observational study in the Manuel Fajardo Gyneco-Obstetric Hospital during the second semester of 2016 to 100 healthy pregnancies that attended the prenatal control; and a control group of 150 healthy non-pregnant women older than 17 years in the population corresponding to the municipality of Güines who met the inclusion and exclusion criteria. Determinations of glycosylated hemoglobin and fasting glycemia were made. Results: the healthy pregnant women the average glycosylated hemoglobin was lower than in non-pregnant women, respectively 4.50 por cent (4.41-4.49) versus 5.21 por cent (5.16-5.26), P <0.001. In the healthy pregnant group, glycosylated hemoglobin increased with the trimester of pregnancy p <0.05, first trimester: 4.35 (4.20 - 4.47), second trimester: 4.58 (4.45 - 4.70), third trimester: 4.61 (4.14 - 5.08). Conclusions: during pregnancy the percentage of Hb A1c increases with the trimester of pregnancy, so it is important to determine its reference value for better metabolic control of pregnant women (AU).

Ajuste de la cifra de hemoglobina glucosilada para el diagnóstico de diabetes mellitus en México / Adjustment of the glycated hemoglobin value to diagnose diabetes mellitus in Mexico

Resumen ANTECEDENTES En la actualidad la Asociación Americana de Diabetes (ADA) acepta el uso de tres pruebas para el diagnóstico de diabetes mellitus, que incluyen la determinación de hemoglobina glucosilada (HbA1c). OBJETIVO Evaluar si la cifra establecida de HbA1c de 6.5% para el diagnóstico de diabetes mellitus es válida para la población mexicana. MATERIAL Y MÉTODO Estudio descriptivo, transversal y analítico en el que en octubre de 2016 se incluyeron personas en quienes se determinó HbA1c en sangre capilar y glucemia en sangre venosa. RESULTADOS Se incluyeron 388 pacientes. Se determinó que ni la edad ni el sexo predisponen a la obtención de una cifra determinada de HbA1c. La prueba de HbA1c capilar tendió a diagnosticar mayor número de casos de prediabetes (170 vs 63) y diabetes (27 vs 13) en comparación con la prueba de glucosa sérica, con diferencia en el número de personas sanas entre ambos grupos de 121 (191 personas sanas con HbA1c y 312 personas sanas con glucosa sérica); sin embargo, ambas variables compartieron 90.2% de similitud (p < 0.001). Se obtuvo un nuevo nivel de corte de HbA1c para el diagnóstico de diabetes de 6.65% (con sensibilidad y especificidad de 76 y 97%, respectivamente). CONCLUSIÓN Con el nuevo punto de corte disminuyó la incidencia de casos de diabetes en el grupo de HbA1c, con reducción de 7 a 4.9% (27 a 19 casos).

Abstract BACKGROUND Nowadays, the American Diabetes Association (ADA) recognizes the use of three tests for the diagnosis of diabetes mellitus, including the determination of glycated hemoglobin (HbA1c). OBJECTIVE To evaluate if the established value of 6.5% of glycated hemoglobin for the diagnosis of diabetes mellitus is applicable to the Mexican population. MATERIAL AND METHOD A descriptive, transversal and analytic study was done in October 2016 in persons that were subjected to a capillary test for HbA1c and serum glucose. RESULTS There were included 388 subjects in whom it was determined that the age and the sex did not influence on the obtaining of a determinate level of HbA1c. Capillary HbA1c test tended to diagnose a greater number of cases of prediabetes (170 vs 63) and diabetes (27 vs 13) compared with serum glucose test, with a difference in the number of healthy persons between the two groups of 121 (191 healthy persons with HbA1C and 312 healthy persons with serum glucose); however, both variables shared a 90.2% of similarity (p < 0.001). It was obtained a new threshold of HbA1C for the diagnosis of diabetes of 6.65% (with sensitivity and specificity of 76% and 97%, respectively). CONCLUSION With the new cutoff value the incidence of cases of diabetes decreased in the HbA1c group, with a reduction of 7% to 4.9% (27 to 19 cases).

Clinical course of a cohort with type 2 diabetes mellitus after endocrine assessment. A 26-week study. / Evolución clínica de una cohorte de pacientes con diabetes mellitus tipo 2 tras su valoración en endocrinología. Estudio a 26 semanas.

OBJECTIVE: To assess the degree of metabolic control and hypoglycemic treatments in a cohort of patients with type 2 diabetes mellitus (T2DM) after evaluation in an endocrinology clinic. MATERIAL AND METHODS: A prospective cohort study on 465 patients with T2DM who were not being monitored at an endocrinology clinic. Blood glucose control data and treatments received were recorded at an initial visit and after 26 weeks of follow-up. RESULTS: Baseline glycosylated hemoglobin (HbA1c) level was 8.3±1.8%, as compared to 6.6±0.9% after 26 weeks of follow-up (P<.0001). The proportion of patients with HbA1c levels <7% increased from 33.1% to 71.3% (P<.0001). In 59.9% of patients, a decrease ≥0.8% in HbA1c was seen. In the multivariate analysis, variables predicting for an improvement in the degree of metabolic control were older age (OR 1.038; 95%CI 1-1.07; P=.041), higher baseline HbA1c values (OR 5.51; 95%CI 3.4-9; P<.0001), T2DM duration <5 years (OR 4.63; 95%CI 1.6-13.3; P=.005), and change in hypoglycemic treatment (OR 2.77, 95%CI 1.1-6.9; P=.03). Hypoglycemic therapy was changed in 75.1% of study patients with T2DM. After 26 weeks of follow-up, decreases were seen in both the proportion of patients who receiveding no treatment (from 7% to 0.3%, P<.0001) and the proportions of patients on oral antidiabetic therapy (60.9% vs 55.5%, P=.003) and insulin (10.5% vs 6.2%, P=.021). However, the proportion of patients receiving insulin combined with oral antidiabetic drugs increased from 21.1% to 38% (P<.0001). CONCLUSIONS: An improved metabolic control was seen in this cohort of patients with T2DM after their evaluation in an endocrinology clinic. However, HbA1c levels <7% were not achieved in 28.7% of patients, which shows the difficulty to achieve adequate control in clinical practice.

Tratamiento de las repercusiones sinérgicas en presencia de enfermedad periodontal en el paciente con diabetes: revisión de la literatura / Treatment of the synergistic effects of periodontaldisease in patients with diabetes. literature review

Introducción: La interacción de las enfermedades periodontales serelacionan con el medio ambiente, huésped, factores microbianos ysusceptibilidad genética. En esta patología la interacción de las bacteriasy el sistema inmunológico dan como resultado una producción elevada de mediadores infl amatorios como las interleucinas IL-1, IL-6 y el TNF-α que destruirán el tejido conectivo y óseo. La diabetes por sí misma ya sea tipo 1 o 2 va a tener repercusiones a nivel de los diferentes órganos de la economía como los riñones, sistema nervioso,ojos, sistema circulatorio y de ahí al periodonto. Cuando el paciente nose encuentra en control sistémico, los efectos adversos van aumentandoy se provoca una sinergia entre la alteración glucémica y la afectaciónperiodontal. Se ha descrito la relación del efecto benéfi co del tratamientoperiodontal en el control glucémico en pacientes diabéticos y no diabéticos. Conclusión: El tratamiento periodontal no quirúrgico demostró reducir los valores de los parámetros periodontales así como los valores séricos de glucosa en ayuno y hemoglobina glucosilada y coadyuvar en el control glucémico.

Introduction: The interaction of periodontal disease is related to theenvironment, host, microbial factors and genetic susceptibility. In thiscondition, the interaction of bacteria and the immune system result inincreased production of infl ammatory mediators such as IL-1, IL-6interleukins, and TNF-α that will destroy connective tissue and bone.Diabetes itself either type 1 or 2 will have repercussions at the levelof the diff erent organs of the economy as it is kidneys, nervous system,eyes, circulatory system and hence the periodontium. When the patientis not in controlling systemic adverse eff ects are increased and synergybetween periodontal health and glycemic involvement provoked. It hasbeen reported regarding the benefi cial eff ect of periodontal treatmenton glycemic control in diabetic and non-diabetic patients. Conclusion:The non-surgical periodontal treatment was shown to reduce the valuesof periodontal parameters and serum fasting glucose and glycatedhemoglobin and assist in glycemic control.

Control glucémico intensivo y sobretratamiento en pacientes mayores de 60 años con diabetes mellitus / Intensive glycemic control and overtreatment in diabetic patients older than 60 years

Resumen ANTECEDENTES: existe incremento de la prevalência de diabetes mellitus 2 y del envejecimiento. Así, los riesgos asociados con control glucémico intensivo en esta población vulnerable se incrementan. Por ello, debe considerarse la posibilidad de un sobretratamiento en estos pacientes. OBJETIVO: determinar la prevalencia de control glucémico intensivo y sobretratamiento en pacientes con diabetes mellitus tipo 2 mayores de 60 años. MATERIAL Y MÉTODO: estudio retrospectivo, transversal, observacional y analítico. De 2013 a 2015 se evaluaron pacientes mayores de 60 años de edad con diabetes mellitus tipo 2, hemoglobina glucosilada (HbAlc) <7% y administración de hipoglucemiantes. Los pacientes se clasificaron en control glucémico intensivo (HbAlc 6.6-7%) y sobretratamiento (HbAlc <6.5%). Los porcentajes de ambos grupos y sus complicaciones cardiovasculares y no cardiovasculares asociadas se compararon utilizando una prueba Z. RESULTADOS: se incluyeron 13,229 pacientes con diabetes mellitus tipo 2 mayores de 60 años; en 2013, fueron 4,381, 16% (n=701) en control glucémico intensivo y 6% (n=256) en sobretratamiento; en 2014 fueron 4,383, 16% (n=697) en control glucémico intensivo y 6% (n=252) en sobretratamiento; en 2015 fueron 4,465, 16% (n=708) en control glucémico intensivo y 6% (n=260) con sobretratamiento. El control glucémico intensivo causó 5, 3 y 1% de complicaciones durante 2013, 2014 y 2015, respectivamente. En el grupo con sobretratamiento el porcentaje de complicaciones fue de 4% en 2013 y de 6% en 2015. Se obtuvo un valor Z de -2.90 (p<0.05), mostrando mayor número en sobretratamiento. CONCLUSIONES: de la población estudiada, 16% estaba en control glucémico intensivo y 6% en sobretratamiento, con incremento significativo de complicaciones en el grupo con sobretratamiento, la hipoglucemia fue la más frecuente.

Abstract BACKGROUND: Due to increasing prevalence of type 2 diabetes mellitus (T2DM) and the overall aging of the population, the number of elderly patients with T2DM is continuously growing. Given the risks associated with intensive glycemic control of those patients, the possibility of overtreatment must be considered. OBJECTIVE: To determine the prevalence of intensive glycemic control and overtreatment in individuals >60 years with T2DM. MATERIAL AND METHOD: An observational, cross-sectional, retrospective and analytical study was done from 2013 to 2015. Individuals >60 years old with T2DM, glycated hemoglobin (HbA1c) <7%, and use of hypoglycemic agents were included. Patients were divided into two groups: intensive glycemic control (HbA1c 6.6-7%) and overtreatment (HbA1c <6.5%). Cardiovascular and non-cardiovascular complications associated with treatment were compared by Z-test. RESULTS: There were included 13,229 patients older than 60 years with T2DM; 4,381 in 2013, 16% (n=701) was classified as intensive glycemic control and 6% (n=256) as overtreatment; 4,383 in 2014, 16% (n=697) as intensive glycemic control and 6% (n=252) as over-treatment; 4,465 in 2015, 16% (n=708) as intensive glycemic control and 6% (n=260) as overtreatment. By this period, adverse outcomes were reported in 5%, 3% and 1% during 2013, 2014 and 2015, respectively; referring to intensive glycemic control group. Likewise, adverse outcomes were reported in 4% and 6% during 2013 and 2015, respectively; referring to overtreatment group. A value of Z-test -2.90 (p<0.05) was obtained, which was increased in overtreatment group. CONCLUSIONS: All data collected during the study highlights a significant increase of cardiovascular and non-cardiovascular adverse outcomes in patients with strict glycemic management, being hypoglycemia the most frequent; 16% are in intensive glycemic control and 6% in overtreatment.

Prognostic value of blood glucose in emergency room and glycosylated hemoglobin in patients who have suffered an acute cerebro-vascular event. / Valor pronóstico de la glucemia en urgencias y la hemoglobina glucosilada en pacientes que han sufrido un accidente cerebrovascular agudo.

BACKGROUND AND OBJECTIVE: Stress hyperglycemia has been associated with a worse prognosis in patients hospitalized in critical care units. The aim of this study is to evaluate the impact of blood glucose and glycosylated hemoglobin (HbA1c) levels on the mortality of patients suffering a acute cerebro-vascular event, and to determine if this relationship depends on the presence of diabetes. MATERIAL AND METHODS: A retrospective analysis of 255 patients admitted to the ER for stroke was performed. Venous plasma glucose levels in the emergency room and HbA1c levels within the first 48hours were analyzed. The presence of diabetes was defined in terms of the patients' medical history, as well as their levels of fasting plasma glucose and HbA1c. Mortality was assessed within the first 30 months after the onset of the acute event. RESULTS: 28.2% of patients had diabetes. Higher mortality was observed in patients who had been admitted with plasma glucose levels≥140mg/dl (hazard ratio [HR]=2.22, 95% CI: 1.18-4.16, P=.013) after adjusting for various factors. This relationship was not confirmed in diabetic patients (HR=2.20, 95% CI: 0.66-7.40, P=.201) and was in non-diabetics (HR=2.55, 95% CI: 1.11-5.85, P=.027). In diabetics, HbA1c≥7% was not associated with poor prognosis (HR=0.68, 95% CI: 0.23-1.98, P=.475), whereas non-diabetics with admission levels of HbA1c falling within the pre-diabetes range (5.7% -6.4%) had a higher mortality (HR=2.62, 95% CI: 1.01-6.79, P=.048). CONCLUSION: Admission hyperglycemia is associated with a worse prognosis in patients without diabetes admitted for stroke, but this relationship was not seen in diabetics. In non-diabetic patients, HbA1c levels in the pre-diabetes range is associated with higher mortality.

[Introduction of capillary glycosylated haemoglobin determination in a Primary Care Health Area: Multicentre study of the evolution of patients with type 2 diabetes mellitus]. / Implantación de la determinación de hemoglobina glucosilada capilar en un Área de Salud: estudio multicéntrico sobre evolución de pacientes con diabetes mellitus de tipo 2.

PURPOSE: The aim of this study was to evaluate the efficiency of a joint intervention that included educational components, self-assessment, and information to optimise diabetes control through the introduction of instant capillary glycosylated haemoglobin (HbA1c) determination in Primary Care. MATERIALS AND METHODS: A multicentre prospective descriptive study was carried out over 3years in 10Primary Care Centres of the Area VII Murcia East. At the end of the study there were 804 patients with type 2 diabetes (DM2). Patients were divided into 4 groups based on initial values of HbA1c, and if changes in their treatment were needed. HbA1c, body mass index, and blood pressure were monitored. A financial assessment was also performed on the impact of the implementation of a protocol to measure instant capillary RESULTS: A significant reduction was observed in HbA1c values. The initial HbA1c mean value was 7.4±1.4%, which decreased to a final value of 6.9±1.0% (P<.001). At the end of the study, 71.4% of patients included reached diabetic control objectives. In addition, the financial assessment demonstrated that the implementation of this diabetes control system led to a decrease of the 24.7% in spending on glucose strips after the first year of study in Area VII Murcia Health Service. CONCLUSIONS: The introduction of capillary HbA1c determination in Primary Care has demonstrated to improve diabetes control and the efficiency of the health personnel. Furthermore, a reduction in the health costs of patients with DM2 was also shown.

[Delphi consensus on management of dyslipidaemia in patients with impaired glucose metabolism: Diana study]. / Consenso Delphi sobre el manejo de la dislipidemia en pacientes con alteración del metabolismo de la glucosa: estudio Diana.

OBJECTIVES: The aim of the present study was to develop a multidisciplinary consensus based on the Delphi system to establish clinical recommendations for the management of dyslipidaemia when hyperglycaemia is present, and the relevant factors that should be taken into consideration when prescribing and monitoring treatment with statins. METHODS: The questionnaire developed by the scientific committee included four blocks of questions about dyslipidaemia in patients with impaired glucose metabolism. The results of the first two blocks are presented here: a) management of dyslipidaemia; b) relevant factors that should be taken into consideration when prescribing and monitoring treatment with statins. RESULTS: Among the 497 experts who participated in the study, an agreement of over 90% was attained for recommending screening for dyslipidaemia in patients with diabetes or pre-diabetes and/or cardiovascular disease or a family history and/or abdominal obesity and/or hypertension. There was a high degree of agreement that a statin is the lipid-lowering treatment of choice, and that it should be switched when side effects develop. Also, the choice of statin and dose should be made according to baseline LDL cholesterol levels, the target to achieve, and the possible drug-drug interactions. CONCLUSIONS: The screening of dyslipidaemia is primarily conducted in patients with cardiovascular disease, or any major cardiovascular risk factor. When prescribing a statin, physicians mainly focus on the ability to reduce LDL cholesterol and the risk of drug interactions.

Comportamiento de la hemoglobina glucosilada en diabéticos tipo 2 con macroangiopatía diabética de los miembros inferiores / Behavior of glycosylated hemoglobin type 2 in diabetics with diabetic macroangiopathy in the lower members

Introducción: la hemoglobina glucosilada es utilizada para evaluar el grado de control glucémico. Se ha publicado que la disminución de este indicador en el 2 por ciento reduce la aparición o progresión de las complicaciones micro- o macrovasculares.Objetivo: determinar el comportamiento de la hemoglobina glucosilada en pacientes diabéticos tipo 2 con macroangiopatía diabética de los miembros inferiores.Métodos: se estudiaron 100 pacientes diabéticos tipo 2 con o sin macroangiopatía diabética de los miembros inferiores; 36 hombres y 64 mujeres, con una edad promedio de 61,8 años (44-79 años). Se cuantificó el grado de glucosilación de la hemoglobina y se calculó su valor de referencia. Se identificó y describió el tipo de asociación del indicador con diferentes factores de riesgo y con el tipo de macroangiopatía diabética.Resultados: se escogió el valor de 8,6 por ciento de hemoglobina glucosilada por ser el punto de corte con los mayores valores de sensibilidad (73,7 por ciento), especificidad (83,7 por ciento) y razón de probabilidad (4,52). Se constató un mal control glucémico en el 48,3 por ciento de los pacientes, donde la mayor proporción correspondió a la macroangiopatía de tipo ocluido (44,8 por ciento). En los pacientes descompensados fue la dislipidemia el factor de riesgo que más predominó (58,3 por ciento), así como la combinación del tabaquismo con la hipertensión arterial (35,3 por ciento).Conclusión: los pacientes diabéticos de tipo 2 con macroangiopatía diabética de los miembros inferiores de tipo ocluido mostraron valores muy elevados de hemoglobina glucosilada indicativo de un mal control metabólico(AU)

Introduction: glycosylated hemoglobin is used to evaluate the level of glycemic control. It has been reported that its decrease by 2 percent reduces the occurrence or progression of micro or macrovascular complications.Objective: to determine the behavior of glycosylated hemoglobin in type 2 diabetes patients with macroangiopathy in lower limbs.Method: study of one hundred type 2 diabetic patients with/without diabetic macroangiopathy in their lower limbs; 36 were males and 64 females averagely aged 61.8 years (44-74 years). The level of hemoglobin glycosylation was quantitated as well as the reference value was estimated. The kind of association of this indicator with several risk factors and with the type of diabetic macroangiopathy was also established and described.Results: the reference value of 8.6 percent of the glycosylated hemoglobin was chosen because it was the cutoff point with the highest sensitivity (73.7 percent), specificity (83.7 percent) and probability odds (4.52) values. Poor glycemic control was confirmed in 48.3 percent of patients, mainly affected by occluded macroangiopathy (44.8 percent). In decompensated patients, dyslipidemia was the predominant risk factor (58.3 percent) along with the combination of smoking and blood hypertension (35.3 percent).Conclusions: the type 2 diabetic patients with occluded diabetic macroangiopathy of the lower limbs showed very high glycosylated hemoglobin values indicative of poor metabolic control(AU)