Search

Long-term studies comparing the mechanisms of different bariatric techniques for T2DM remission are scarce. We aimed to compare type 2 diabetes (T2DM) remission after a gastric bypass with a 200-cm biliopancreatic limb (mRYGB), sleeve gastrectomy (SG), and greater curvature plication (GCP), and to assess if the initial secretion of gastrointestinal hormones may predict metabolic outcomes at 5 years. Forty-five patients with mean BMI of 39.4(1.9)kg/m2 and T2DM with HbA1c of 7.7(1.9)% were randomized to mRYGB, SG, or GCP. Anthropometric and biochemical parameters, fasting concentrations of PYY, ghrelin, glucagon, and AUC of GLP-1 after SMT were determined prior to and at months 1 and 12 after surgery. At 5-year follow-up, anthropometrical and biochemical parameters were determined. Total weight loss percentage (TWL%) at year 1 and GLP-1 AUC at months 1 and 12 were higher in the mRYGB than in the SG and GCP. TWL% remained greater at 5 years in mRYGB group − 27.32 (7.8) vs. SG − 18.00 (10.6) and GCP − 14.83 (7.8), p = 0.001. At 5 years, complete T2DM remission was observed in 46.7% after mRYGB vs. 20.0% after SG and 6.6% after GCP, p

Medullary thyroid carcinoma (MTC) is a rare malignancy. Location of residual, recurrent, or metastatic disease is crucial to treatment management and outcome. We aimed to evaluate the use of F-FDG PET/CT in localizing MTC foci in patients with biochemical relapse.This is a retrospective cohort study. Review of 51 FDG PET/CT studies of 45 patients referred to restage MTC due to increased calcitonin (Ctn) and carcinoembryonic antigen (CEA) values at follow-up. FDG PET/CT diagnostic accuracy was determined through a patient-based analysis, using histology as criterion standard when available, or other imaging studies and clinical follow-up otherwise (mean, 4 years).There were 25 positive scans. Sensitivity, specificity, positive and negative predictive values, diagnostic accuracy, and positive likelihood ratio were 66.7%, 83.3%, 88.0%, 57.7%, 72.5%, and 4.0, respectively. Using a Ctn cutoff of 1000 pg/mL, sensitivity increased to 76.9%. There were significant differences of Ctn and CEA values between positive and negative FDG PET/CT (P0.05). Regarding true-positive studies, average SUVmax comparing locoregional and metastatic disease was at the limit of significance (P = 0.046).PET/CT can be useful to restage patients with biochemical relapse of MTC, with a better performance in higher Ctn levels. Its high positive predictive value (88%) may impact in the therapeutic management, although its low negative predictive value (57.7%) makes strict follow-up mandatory in examinations without pathologic findings.

Resumen Introduccion y objetivos La hipoglucemia asociada a insulina u otros hipoglucemiantes es una de las principales causas de consulta a urgencias por efectos secundarios de medicamentos. El objetivo del estudio es analizar las caracteristicas de los pacientes con diabetes mellitus (DM) que consultan a urgencias hospitalarias por un episodio de hipoglucemia. Pacientes y metodos Se realizo un analisis retrospectivo de los pacientes con DM que fueron atendidos en el Servicio de Urgencias del Hospital Universitari de Bellvitge con el diagnostico de hipoglucemia durante un periodo de 3 anos. Se analizaron las caracteristicas epidemiologicas, las relacionadas con la DM, sus complicaciones y otras comorbilidades, el tratamiento hipoglucemiante de base y el resultado del episodio de hipoglucemia. Resultados Se analizaron 149 episodios de hipoglucemia. El 81,9% de los casos eran pacientes con DM tipo 2. La edad media de los pacientes con DM tipo 2 fue de 75,4 anos. La duracion de la DM era superior a los 10 anos en el 69,4% de los casos. La prevalencia de insuficiencia renal cronica y deterioro cognitivo fue del 38,5 y del 19,7%, respectivamente, en los pacientes con DM tipo 2. El 78,7% de los pacientes con DM tipo 2 estaban tratados con insulina con o sin otros hipoglucemiantes asociados. El 21,3% restante se trataban con agentes orales, principalmente glibenclamida. El 13,4% de los casos requirieron ingreso hospitalario y, en el 36,8% de ellos, la hipoglucemia estaba asociada al uso de glibenclamida. Conclusiones La mayoria de episodios de hipoglucemia se produjeron en pacientes con DM tipo 2 de edad avanzada, con elevada prevalencia de enfermedades asociadas y en tratamiento con insulina y sulfonilureas, especialmente glibenclamida.

There is scant evidence of the long-term effects of bariatric surgery on bone mineral density (BMD). We compared BMD changes in patients with severe obesity and type 2 diabetes (T2D) 5 years after randomization to metabolic gastric bypass (mRYGB), sleeve gastrectomy (SG) and greater curvature plication (GCP). We studied the influence of first year gastrointestinal hormone changes on final bone outcomes. Forty-five patients, averaging 49.4 (7.8) years old and body mass index (BMI) 39.4 (1.9) kg/m2, were included. BMD at lumbar spine (LS) was lower after mRYGB compared to SG and GCP: 0.89 [0.82, 0.94] vs. 1.04 [0.91, 1.16] vs. 0.99 [0.89, 1.12], p = 0.020. A higher percentage of LS osteopenia was present after mRYGB 78.6% vs. 33.3% vs. 50.0%, respectively. BMD reduction was greater in T2D remitters vs. non-remitters. Weight at fifth year predicted BMD changes at the femoral neck (FN) (adjusted R2: 0.3218, p = 0.002), and type of surgery (mRYGB) and menopause predicted BMD changes at LS (adjusted R2: 0.2507, p &lt, 0.015). In conclusion, mRYGB produces higher deleterious effects on bone at LS compared to SG and GCP in the long-term. Women in menopause undergoing mRYGB are at highest risk of bone deterioration. Gastrointestinal hormone changes after surgery do not play a major role in BMD outcomes.

International audience; Objective: To compare real-world outcomes with newer (insulin glargine 300 U/mL; Gla-300) versus standard of care (SoC) basal insulins (BIs) in the REACH (insulin-naïve; NCT02967224) and REGAIN (basal insulin-treated; NCT02967211) studies in participants with uncontrolled type 2 diabetes (T2DM) in Europe and Brazil.Methods: In these open-label, parallel-group, pragmatic studies, patients (HbA1c > 7.0%) were randomized to Gla-300 or SoC BI for a 6-month treatment period (to demonstrate non-inferiority of Gla-300 vs SoC BIs for HbA1c change [non-inferiority margin 0.3%]) and a 6-month extension period (continuing with their assigned treatment). Insulin titration/other medication changes were at investigator/patient discretion post-randomization.Results: Overall, 703 patients were randomized to treatment in REACH (Gla-300, n = 352; SoC, n = 351) and 609 (Gla-300, n = 305, SoC, n = 304) in REGAIN. The primary outcome, non-inferiority of Gla-300 versus SoC for HbA1c change from baseline to month 6, was met in REACH (least squares [LS] mean difference 0.12% [95% CI –0.046 to 0.281]) but not REGAIN (LS mean difference 0.17% [0.015–0.329]); no between-treatment difference in HbA1c change was shown after 12 months in either study. BI dose increased minimally from baseline to 12 months in REACH (Gla-300, +0.17 U/kg; SoC, +0.15 U/kg) and REGAIN (Gla-300, +0.11 U/kg; SoC, +0.07 U/kg). Hypoglycemia incidence was low and similar between treatment arms in both studies.Conclusions: In both REACH and REGAIN, no differences in glycemic control or hypoglycemia outcomes with Gla-300 versus SoC BIs were seen over 12 months. However, the suboptimal insulin titration in REACH and REGAIN limits comparisons of outcomes between treatment arms and suggests that more titration instruction/support may be required for patients to fully derive the benefits from newer basal insulin formulations.

We aimed to explore the relationship between GLP-1 receptor (GLP-1R) expression in adipose tissue (AT) and incretin secretion, glucose homeostasis and weight loss, in patients with morbid obesity and type 2 diabetes undergoing bariatric surgery. RNA was extracted from subcutaneous (SAT) and visceral (VAT) AT biopsies from 40 patients randomized to metabolic gastric bypass, sleeve gastrectomy or greater curvature plication. Biochemical parameters, fasting plasma insulin, glucagon and area under the curve (AUC) of GLP-1 following a standard meal test were determined before and 1 year after bariatric surgery. GLP-1R expression was higher in VAT than in SAT. GLP-1R expression in VAT correlated with weight (r = −0.453, p = 0.008), waist circumference (r = −0.494, p = 0.004), plasma insulin (r = −0.466, p = 0.007), and systolic blood pressure (BP) (r = −0.410, p = 0.018). At 1 year, GLP-1R expression in VAT was negatively associated with diastolic BP (r = −0.361, p = 0.039) and, following metabolic gastric bypass, with the increase of GLP-1 AUC, (R2 = 0.46, p = 0.038). Finally, GLP-1R in AT was similar independently of diabetes outcomes and was not associated with weight loss after surgery. Thus, GLP-1R expression in AT is of limited value to predict incretin response and does not play a role in metabolic outcomes after bariatric surgery.

Resumen Objetivos Determinar la prevalencia de pacientes de origen no caucasico en los ingresos hospitalarios por inicio de diabetes mellitus durante el periodo 2003-2010 y analizar las caracteristicas diferenciales respecto a la poblacion caucasica en el momento del inicio y a los 2 anos. Material y metodos Estudio observacional retrospectivo. Criterios de inclusion: pacientes ingresados por inicio sintomatico de diabetes entre enero de 2003 y octubre de 2010, con edad entre 18 y 40 anos. Se analizo la prevalencia de pacientes de origen no caucasico, se compararon ambas poblaciones respecto a datos clinicos, bioquimicos, de reserva pancreatica e inmunologicos en el momento del inicio y se analizo la evolucion a los 2 anos. Resultados De los ingresos por inicio sintomatico de diabetes, el 19% fueron pacientes no caucasicos, con un aumento progresivo en los ultimos anos. Estos presentaban un grado de descompensacion mas leve (3,0% de cetoacidosis respecto al 15,2% en el grupo caucasico, p Conclusiones El grupo de pacientes no caucasicos presenta menor prevalencia de autoinmunidad, mejor funcionalismo celular beta al diagnostico, sobre todo a expensas del subgrupo de pacientes con autoinmunidad negativa, y menor necesidad de tratamiento intensivo a los 2 anos del diagnostico, comportamiento mas caracteristico de la diabetes mellitus tipo 2.

Introduction and objective Hypoglycemia associated to insulin or other glucose-lowering agents is one of the most common causes of visits to the emergency department for adverse drug reactions. The study objective was to analyze the characteristics of patients with diabetes mellitus (DM) who attend a tertiary hospital emergency department for a hypoglycemic event. Patients and methods A 3-year retrospective analysis was conducted of patients with DM who attended the emergency department of Hospital Universitari de Bellvitge for a hypoglycemic event. An analysis was made of epidemiological and diabetes-related characteristics, prevalence of chronic diabetic complications and other comorbidities, the glucose-lowering treatment and the result of the hypoglycemic episode. Results Of the 149 hypoglycemic events analyzed, 81.9% occurred in patients with type 2 DM. Mean age of patients with type 2 DM was 75.4 years. DM duration was longer than 10 years in 69.4% of patients. The prevalence rates of chronic kidney disease and cognitive decline were 38.5% and 19.7% respectively in patients with type 2 DM. Insulin with or without other concomitant glucose-lowering agents was associated to 78.7% of episodes in type 2 DM patients. The remaining 21.3% were associated to oral hypoglycemic agents, mainly glibenclamide. After the event, 13.4% of patients required hospital admission, and in 36.8% of these hypoglycemia was associated to use of glibenclamide. Conclusions A majority of hypoglycemic events occurred in elderly patients with type 2 DM, with a high prevalence of associated comorbidities and treated with insulin and sulfonylureas, particularly glibenclamide.

Resumen Objetivo Evaluar la eficacia y seguridad de una estrategia basal plus usando insulina glargina (GLA) como insulina basal e insulina glulisina (GLU) como insulina prandial en pacientes con diabetes mellitus tipo 2 (DM2) en la practica clinica habitual. Material y metodos Estudio observacional retrospectivo realizado entre noviembre de 2010 y diciembre de 2011 (periodo de observacion entre enero y julio de 2010) en 65 servicios de endocrinologia en Espana. Consecutivamente se incluyeron pacientes con DM2 tratados previamente con GLA mas una inyeccion de GLU con la comida principal. La variable principal fue el cambio en la HbA1c desde antes de introducir GLU (visita basal) y a los 3 meses como minimo (visita basal plus). Resultados Se incluyeron 363 pacientes (edad 65 ± 10 anos, 54% hombres). Despues de 6 meses la HbA1c descendio de 8,5 a 7,4% (–1,1 ± 0,8% [IC 95%: 1,0-1,2]; p Conclusiones Una estrategia basal plus con GLA en monodosis diaria mas GLU en la comida principal es eficaz y segura para mejorar el control glucemico en la practica clinica en pacientes con DM2 que previamente no cumplian criterios de buen control metabolico.

Several studies have reported the existence of an epidemiological association between diabetes mellitus (DM) and dementia. Although this association is more evident for vascular dementia, it is also described in Alzheimer's disease (AD). In this review we evaluate the different hypotheses that may explain the association between DM and dementia. We can consider the existence of a diabetes type 3 as the situation that occurs when hyperinsulinemia in response to insulin resistance leads to a decrease of the brain insulin and a poor regulation of insulin-degrading enzyme; thus, beta-amyloid accumulates, among other mechanisms, by the decline of its degradation by insulin-degrading enzyme. Consequently, AD may be related, at least in part, to a brain insulin resistance. There are several studies that prove the concept that a better metabolic control, especially in not very old people, is associated with an increased cognitive performance. It is not known whether the use of any specific drug for the treatment of DM is better than any other. It is important for physicians responsible for the metabolic control of diabetic patients to know this possible association, and to explore cognition in the control visits of patients with DM.

Several studies have reported the existence of an epidemiological association between diabetes mellitus (DM) and dementia. Although this association is more evident for vascular dementia, it is also described in Alzheimer's disease (AD). In this review we evaluate the different hypotheses that may explain the association between DM and dementia. We can consider the existence of a diabetes type 3 as the situation that occurs when hyperinsulinemia in response to insulin resistance leads to a decrease of the brain insulin and a poor regulation of insulin-degrading enzyme; thus, beta-amyloid accumulates, among other mechanisms, by the decline of its degradation by insulin-degrading enzyme. Consequently, AD may be related, at least in part, to a brain insulin resistance. There are several studies that prove the concept that a better metabolic control, especially in not very old people, is associated with an increased cognitive performance. It is not known whether the use of any specific drug for the treatment of DM is better than any other. It is important for physicians responsible for the metabolic control of diabetic patients to know this possible association, and to explore cognition in the control visits of patients with DM.

Resumen El tratamiento con insulina puede ser necesario en la diabetes tipo 2, dado que muchos pacientes, con el tiempo, no consiguen alcanzar o mantener los objetivos glucemicos para prevenir las complicaciones cronicas asociadas a la hiperglucemia sostenida. Inicialmente, la adicion de insulina basal al tratamiento previo con agentes orales suele ser la pauta mas habitual. Esta estrategia se basa en el control optimo de la glucemia en ayunas. Sin embargo, un porcentaje significativo de pacientes no consiguen alcanzar o mantener el objetivo de HbA 1c ≤ 7%, debido a que presentan elevaciones excesivas de la glucemia posprandial. En consecuencia, el paso siguiente en la intensificacion del tratamiento podria ser la adicion de una dosis unica de insulina prandial antes de la comida que provoca la mayor excursion posprandial (estrategia basal plus), manteniendo el tratamiento previo con insulina basal y agentes orales. Este regimen ha demostrado ser sencillo, eficaz y adecuado para un gran numero de pacientes. Ademas, en caso necesario, facilita la introduccion progresiva de inyecciones adicionales de insulina prandial hasta una estrategia bolo basal. En este articulo se resumen las recomendaciones de un grupo de trabajo multidisciplinar para una adecuada implementacion de la estrategia basal plus en la practica clinica habitual.

To assess the prevalence of non-Caucasian patients in hospital admissions for onset of symptomatic diabetes mellitus during the 2003-2010 period, and to analyze the characteristics differentiating them from the Caucasian population at diagnosis and 2 years later.A retrospective, observational study.Patients aged 18-40 years admitted for de novo symptomatic diabetes from January 2003 to October 2010. Prevalence of patients of non-Caucasian origin was analyzed, and clinical, biochemical, immunological, and beta-cell function of both populations were compared at diagnosis and 2 years later.Nineteen percent of patients admitted to hospital for de novo symptomatic diabetes were non-Caucasian, with a progressive increase in recent years. Non-Caucasian patients had milder decompensation (3.0% had ketoacidosis, as compared to 15.2% in the Caucasian group, P.05), lower presence of autoimmunity (27.2 vs. 73.1%, P.01) and higher stimulated C-peptide levels (0.70±0.56 vs. 0.42±0.39 nmol/l, P.05), mainly because of the subgroup with negative autoimmunity (0.82 vs. 0.25). Two years after diagnosis, less non-Caucasian patients were on intensified treatment (39.1 vs. 93.8%).Non-Caucasian patients had a lower prevalence of autoimmunity, better beta-cell function at diagnosis, particularly due to the subgroup with negative autoimmunity, and less need for intensive treatment 2 years after diagnosis, features which are more characteristic of type 2 diabetes mellitus.

The aim of the study was to evaluate the effects of the non-dihydropyridine calcium antagonist (NDCA) diltiazem on the development of urinary albumin excretion (UAE) in type 2 hypertensive diabetic patients with persistent microalbuminuria despite ACE inhibitor treatment. Thirty-six type 2 diabetic hypertensive patients with microalbuminuria persisting after at least 1 year of treatment with ACE inhibitors were randomized to receive captopril (n=22) or combined therapy with captopril and 120 mg diltiazem (n=14) for 2 years. Captopril dose was individualized according to blood pressure. Changes in UAE, blood pressure, and metabolic control were monitored to analyze the influence of the addition of diltiazem on progression of diabetic nephropathy. In patients treated with captopril and diltiazem, absolute UAE did not change during the study (baseline: 101 mg/24 h, range 39-298; 2 years after randomization: 74 mg/24 h, range 12-665). In contrast, UAE increased in patients treated with captopril monotherapy (baseline: 118 mg/24 h, range 32-282; 2 years after randomization: 164 mg/24 h, range 15-1161, p

El objetivo de este estudio transversal fue evaluar el impacto de la nefropatia diabetica inicial sobre la presencia de enfermedad cardiovascular (ECV) en una poblacion mediterranea, asi como la prevalencia en estos pacientes de factores de riesgo cardiovascular clasicos y su grado de tratamiento de acuerdo con las recomendaciones internacionales. En 123 pacientes con diabetes tipo 2 y nefropatia incipiente se registro la presencia de ECV, tabaquismo, hipertension arterial, dislipidemia y sus tratamientos. La prevalencia de ECV fue del 34%. La edad, fase de la nefropatia (micro/macroalbuminuria) y el tabaquismo se asociaron con la presencia de ECV. La hipertension, dislipidemia y tabaquismo estaban presentes en el 83%, 81% y 59%, respectivamente. La coexistencia de los diferentes factores de riesgo era frecuente y se asocio con una mayor presencia de ECV. El 79% de los pacientes hipertensos y el 43% de los dislipidemicos recibian tratamiento farmacologico, pero solo el 17% y el 9%, respectivamente, obtenian un buen control. Los pacientes con ECV ya conocida mostraban igualmente un deficitario grado de control. Por tanto, la nefropatia diabetica inicial ejerce un efecto multiplicador del riesgo cardiovascular en una poblacion mediterranea. La alta prevalencia y asociacion de factores de riesgo cardiovascular, desempenando el tabaquismo un papel preponderante, se asocian con este riesgo tan aumentado. A pesar de ello, el grado de tratamiento y control de estos factores de riesgo es deficiente, por lo que un mejor y mas intensivo tratamiento deberia reducir la morbimortalidad de estos enfermos.

To evaluate whether treatment with insulin analogues is associated with a lower risk of hypoglycaemia (HYPO score) and less glycaemic variability (Lability Index) than treatment with human insulin in patients with type 1 diabetes. In a 6-month prospective, open-labelled trial, we randomized 47 patients treated with human insulin to receive treatment with human insulin (n = 21) or insulin analogues (n = 26). HYPO score, Lability Index (LI), and hypoglycaemic episode characteristics were assessed at baseline and at the end of follow-up. A 72-h, continuous glucose monitoring was performed at the end in a subgroup of patients. Groups were compared with nonparametric tests. Significance was defined as P < 0.05. HYPO score (71.5 [36.0-162] vs. 260 [52.0-676], P < 0.05), nocturnal hypoglycaemia (0.4 vs. 1.4 events/patient/4-week, P < 0.05), and