RESUMO
BACKGROUND: Patients with type 2 diabetes mellitus and heart failure have adverse clinical outcomes, but the characteristics and prognosis of those with undiagnosed diabetes in this setting has not been established. METHODS: In total, 400 patients admitted consecutively with acute heart failure were grouped in three glycaemic categories: no diabetes, clinical diabetes (previously reported or with hypoglycaemic treatment) and undiagnosed diabetes. The latter was defined by the presence of at least two measurements of fasting plasma glycaemia ≥ 7 mmol/L before or after the acute episode.Group differences were tested by proportional hazards models in all-cause and cardiovascular mortality during a 7-year follow-up. RESULTS: There were 188 (47%) patients without diabetes, 149 (37%) with clinical diabetes and 63 (16%) with undiagnosed diabetes. Patients with undiagnosed diabetes had a lower prevalence of hypertension, dyslipidaemia, peripheral vascular disease and previous myocardial infarction than those with clinical diabetes and similar to that of those without diabetes. The adjusted hazards ratios for 7-year total and cardiovascular mortality compared with the group of subjects without diabetes were 1.69 (95% CI: 1.17-2.46) and 2.45 (95% CI: 1.58-3.81) for those with undiagnosed diabetes, and 1.48 (95% CI: 1.10-1.99) and 2.01 (95% CI: 1.40-2.89) for those with clinical diabetes. CONCLUSIONS: Undiagnosed diabetes is common in patients requiring hospitalization for acute heart failure. Patients with undiagnosed diabetes, despite having a lower cardiovascular risk profile than those with clinical diabetes, show a similar increased mortality.
Assuntos
Glicemia/metabolismo , Diabetes Mellitus Tipo 2/diagnóstico , Diabetes Mellitus Tipo 2/mortalidade , Insuficiência Cardíaca/mortalidade , Doença Aguda , Idoso , Idoso de 80 Anos ou mais , Distribuição de Qui-Quadrado , Diabetes Mellitus Tipo 2/sangue , Feminino , Hospitalização , Humanos , Estimativa de Kaplan-Meier , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Prevalência , Prognóstico , Modelos de Riscos Proporcionais , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Espanha/epidemiologia , Fatores de TempoRESUMO
A 30-year-old man was hospitalized with edema, polyuria, and abnormalities in taste. ACTH and cortisol levels at admission were markedly elevated, even after attempted suppression with 8 mg dexamethasone. A thoracic-abdominal CT revealed an anterior mediastinal lesion and hyperplasia of both adrenal glands. After excision of the mediastinal mass, which confirmed the presence of a carcinoid thymic tumor, the patient became totally asymptomatic, with normal ACTH and cortisol levels. A carcinoid thymic tumor has a poor prognosis, especially when it is associated with Cushing's syndrome. Most patients will present recidivism or metastasis within 5 years after surgery. However, the low number of cases available for analysis makes it difficult to establish optimum therapeutic approaches.
Assuntos
Tumor Carcinoide/complicações , Síndrome de Cushing/complicações , Disgeusia/complicações , Neoplasias do Timo/complicações , Adulto , Tumor Carcinoide/patologia , Tumor Carcinoide/cirurgia , Humanos , Masculino , Neoplasias do Timo/patologia , Neoplasias do Timo/cirurgia , Resultado do TratamentoRESUMO
INTRODUCTION AND OBJECTIVES: Numerous clinical and epidemiological studies have highlighted the fact that metabolic syndrome is an important precursor of cardiovascular disease. Metabolic syndrome is generally associated with type-2 diabetes, and few data exist on its occurrence in type-1 diabetes. The aims of this study were to determine the prevalence of metabolic syndrome in patients with type-1 diabetes and to identify associated factors. METHODS: This cross-sectional study included consecutive patients aged over 18 years with autoimmune type-1 diabetes of more than 6 months' duration who were treated during 2008 at the Outpatient Endocrinology Clinic of the Hospital del Mar, Barcelona, Spain. The presence of metabolic syndrome was determined using the modified criteria proposed by the National Cholesterol Education Program-Adult Treatment Panel III. RESULTS: Overall, 31.9% (95% confidence interval [CI], 22.3%-41.5%) of patients with type-1 diabetes had metabolic syndrome. The following factors were significantly and independently associated with the presence of metabolic syndrome in patients with type-1 diabetes: age (odds ratio [OR]=1.09; 95% CI, 1.029-1.154), body mass index (OR=1.389; 95% CI, 1.134-1.702) and glycosylated hemoglobin level (OR=1.745; 95% CI, 1.081-2.815). In addition, there was a direct relationship between the number of components of metabolic syndrome present and prevalence of microangiopathy, which reached 100% in patients who satisfied all diagnostic criteria. CONCLUSIONS: Metabolic syndrome was common in patients with type-1 diabetes and was associated with microvascular complications.
Assuntos
Diabetes Mellitus Tipo 1/complicações , Síndrome Metabólica/complicações , Síndrome Metabólica/epidemiologia , Adulto , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência , Fatores de RiscoRESUMO
OBJECTIVE: The objective of the study was to quantify insulin resistance in type 1 diabetes patients by estimated glucose disposal rate (eGDR), according to the presence or absence of the metabolic syndrome, and its relationship with chronic complications. DESIGN: This was a cross-sectional study in 91 patients with type 1 immune-mediated diabetes managed at an outpatient endocrinology clinic. All participants were Caucasians aged 18 yr or older with type 1 diabetes duration of more than 6 months who had completed the study protocol. RESULTS: Twenty-nine patients met metabolic syndrome criteria, yielding a prevalence of 31.9%. Although no differences in insulin requirements were found between diabetic patients with and without metabolic syndrome, lower eGDR levels, indicating greater insulin resistance, were observed in metabolic syndrome patients compared with those without (6.19 +/- 1.5 mg/kg(-1) x min(-1) vs. 9.93 +/- 1.6 mg/kg(-1) x min(-1)) (P < 0.001). An eGDR level less than 8.77 mg/kg(-1) x min(-1) showed 100% sensitivity and 85.2% specificity for metabolic syndrome diagnosis. All patients with diabetes complications had eGDR values below 8.16 mg/kg(-1) x min(-1). eGDR level was significantly lower in patients with diabetic retinopathy (5.97 +/- 1.2 mg/kg(-1) x min(-1)), diabetic neuropathy (5.06 +/- 0.4 mg/kg(-1) x min(-1)), or diabetic nephropathy (5.79 +/- 1.5 mg/kg(-1) x min(-1)) compared with those without (9.38 +/- 2.0 mg/kg(-1) x min(-1), P < 0.001; 9.26 +/- 2.0 mg/kg(-1) x min(-1), P < 0.001; and 9.19 +/- 2.2 mg/kg(-1) x min(-1), P < 0.001). CONCLUSIONS: Insulin resistance is common in type 1 diabetes patients and is associated with microvascular complications. eGDR, as an insulin resistance marker, provides more useful information than other classical variables such as insulin requirements.
Assuntos
Diabetes Mellitus Tipo 1/metabolismo , Glucose/metabolismo , Síndrome Metabólica/metabolismo , Adulto , Estudos Transversais , Diabetes Mellitus Tipo 1/complicações , Angiopatias Diabéticas/metabolismo , Feminino , Hemoglobinas Glicadas/análise , Humanos , Resistência à Insulina , Masculino , Pessoa de Meia-IdadeRESUMO
Introducción y objetivos. Numerosas evidencias han puesto de relieve la importancia clínica y epidemiológica del síndrome metabólico como precursor de la enfermedad cardiovascular. El síndrome metabólico se asocia en general a la diabetes tipo 2, pero son escasos los datos en la diabetes tipo 1. En el presente estudio se evalúa la prevalencia de síndrome metabólico en pacientes con diabetes tipo 1 y los factores relacionados. Métodos. Estudio transversal que incluyó a los pacientes mayores de 18 años de edad con diabetes tipo 1 autoinmune de más de 6 meses de evolución atendidos consecutivamente en la Consulta Externa de Endocrinología del Hospital del Mar de Barcelona durante el año 2008. La identificación del síndrome metabólico se estableció según los criterios modificados del Panel III del National Cholesterol Education Program. Resultados. Tenía síndrome metabólico el 31,9% (intervalo de confianza [IC] del 95%, 22,3%-41,5%) de los pacientes con diabetes tipo 1. La edad (odds ratio [OR] = 1,09; IC del 95%, 1,029-1,154), el índice de masa corporal (OR = 1,389; IC del 95%, 1,134-1,702) y la glucohemoglobina (OR = 1,745; IC del 95%, 1,081-2,815) fueron los factores que se asociaron de forma independiente y significativa con la presencia de síndrome metabólico en los pacientes con diabetes tipo 1. Se constató una relación directa entre el número de componentes de síndrome metabólico y la prevalencia de microangiopatía, que llegó a ser del 100% en los pacientes que cumplían todos los criterios diagnósticos. Conclusiones. El síndrome metabólico es frecuente en los pacientes con diabetes tipo 1 y se asocia con las complicaciones microvasculares (AU)
Introduction and objectives. Numerous clinical and epidemiological studies have highlighted the fact that metabolic syndrome is an important precursor of cardiovascular disease. Metabolic syndrome is generally associated with type-2 diabetes, and few data exist on its occurrence in type-1 diabetes. The aims of this study were to determine the prevalence of metabolic syndrome in patients with type-1 diabetes and to identify associated factors. Methods. This cross-sectional study included consecutive patients aged over 18 years with autoimmune type-1 diabetes of more than 6 months duration who were treated during 2008 at the Outpatient Endocrinology Clinic of the Hospital del Mar, Barcelona, Spain. The presence of metabolic syndrome was determined using the modified criteria proposed by the National Cholesterol Education Program-Adult Treatment Panel III. Results. Overall, 31.9% (95% confidence interval [CI], 22.3%-41.5%) of patients with type-1 diabetes had metabolic syndrome. The following factors were significantly and independently associated with the presence of metabolic syndrome in patients with type-1 diabetes: age (odds ratio [OR]=1.09; 95% CI, 1.029-1.154), body mass index (OR=1.389; 95% CI, 1.134-1.702) and glycosylated hemoglobin level (OR=1.745; 95% CI, 1.081-2.815). In addition, there was a direct relationship between the number of components of metabolic syndrome present and prevalence of microangiopathy, which reached 100% in patients who satisfied all diagnostic criteria. Conclusions. Metabolic syndrome was common in patients with type-1 diabetes and was associated with microvascular complications (AU)