[Profile of glucose lowering drug use in outpatients with type 2 diabetes mellitus]. / Perfiles de hipoglicemiantes e insulinas en pacientes con diabetes mellitus tipo 2 y su efecto en control metabólico, hipoglicemia y otros efectos adversos.

BACKGROUND: The use of glucose lowering agents with favorable weight profile is a growing practice in Diabetology. AIM: To characterize medication combinations in patients with type 2 Diabetes (T2D) and their effect on metabolic control. MATERIAL AND METHODS: Review of medical records of 249 outpatients with T2D with a median age of 66 years, cared for at a medical network. Clinical characteristics, glycated hemoglobin (HbA1c), details of Diabetes treatment (types of drugs or insulin), renal function, lipids and B12 vitamin levels were registered. RESULTS: The median disease duration was 16 years. The most recent HbA1c was 7.4%. No patient was using sulfonylureas, 45 were using Dipeptidyl peptidase 4 inhibitors, 113 were using Sodium-glucose Cotransporter-2 (SGLT2i) Inhibitors, 21 used Glucagon-like Peptide-1 Receptor Agonists (GLP1ra), 158 used basal insulin and 61 on basal plus bolus insulin. The use of SGLT2i or GLP1ra was associated with a metabolic control similar to those patients not using them, while patients on rapid insulin had a significantly worse metabolic control and a tendency to greater body mass index. The use of basal insulin and rapid insulin was significantly associated with more hypoglycemia events. CONCLUSIONS: The use of SGLT2i and GLP1ra in patients with T2D is associated with better metabolic control than rapid insulin with less risk of hypoglycemia. The use of these therapies should be prioritized in the future.

Perfiles de hipoglicemiantes e insulinas en pacientes con diabetes mellitus tipo 2 y su efecto en control metabólico, hipoglicemia y otros efectos adversos / Profile of glucose lowering drug use in outpatients with type 2 diabetes mellitus

BACKGROUND: The use of glucose lowering agents with favorable weight profile is a growing practice in Diabetology. AIM: To characterize medication combinations in patients with type 2 Diabetes (T2D) and their effect on metabolic control. MATERIAL AND METHODS: Review of medical records of 249 outpatients with T2D with a median age of 66 years, cared for at a medical network. Clinical characteristics, glycated hemoglobin (HbA1c), details of Diabetes treatment (types of drugs or insulin), renal function, lipids and B12 vitamin levels were registered. RESULTS: The median disease duration was 16 years. The most recent HbA1c was 7.4%. No patient was using sulfonylureas, 45 were using Dipeptidyl peptidase 4 inhibitors, 113 were using Sodium-glucose Cotransporter-2 (SGLT2i) Inhibitors, 21 used Glucagon-like Peptide-1 Receptor Agonists (GLP1ra), 158 used basal insulin and 61 on basal plus bolus insulin. The use of SGLT2i or GLP1ra was associated with a metabolic control similar to those patients not using them, while patients on rapid insulin had a significantly worse metabolic control and a tendency to greater body mass index. The use of basal insulin and rapid insulin was significantly associated with more hypoglycemia events. CONCLUSIONS: The use of SGLT2i and GLP1ra in patients with T2D is associated with better metabolic control than rapid insulin with less risk of hypoglycemia. The use of these therapies should be prioritized in the future.

[Periodontal disease among patients with acute coronary syndrome]. / Enfermedad periodontal en pacientes con síndrome coronario agudo.

BACKGROUND: Epidemiological studies suggest an association between periodontal disease and coronary heart disease. It is possible that periodontal disease may contribute to plaque destabilization in patients with acute coronary syndrome. AIM: To assess the association between severity of periodontal disease, the number of acute plaques and extension of coronary artery disease in patients with acute coronary syndrome. PATIENTS AND METHODS: The severity of periodontal disease was assessed by skilled independent observers in patients with acute coronary syndrome subjected to coronary angiography. The periodental disease was classified as mild or severe. Acute plaques were defined on angiography as those with thrombi, ulcers or flow alterations. The extension of coronary disease was analyzed using the Sullivan score. RESULTS: Forty three patients (35 males) aged 41 to 83 years, were studied. Mild and severe periodontal disease was present in 18 (42%) and 25 (58%) patients respectively. Seventy six percent of those with severe disease had two or more acute plaques, compared with 17% of those with mild disease (p<0.001). Median Sullivan score was 80.6 and 57.2 in patients with severe or mild periodontal disease respectively (p=0.001). CONCLUSIONS: Severe periodontal disease was associated with a higher number of acute coronary plasques and a higher extension of coronary artery disease, in patients with acute coronary syndromes.