ABSTRACT
Las disglicemias, objetivadas en el test de tolerancia a la glucosa de 2 horas y en el monitoreo continuo de glicemia, son el factor de riesgo principal para el desarrollo de la diabetes relacionada a fibrosis quística (FQ) (DRFQ), la que constituiría la etapa final de un continuo de alteraciones del metabolismo de la glucosa en los pacientes con FQ. Estas disglicemias se deben tanto al daño directo de las células de los islotes pancreáticos productores de insulina, como al aumento de la resistencia a la insulina asociada al estado inflamatorio sistémico de la FQ. El uso cada vez más precoz de los moduladores del CFTR debiera contribuir a evitar el desarrollo de DRFQ y sus complicaciones. La siguiente revisión se enfoca en los efectos de los moduladores del CFTR en la tolerancia a la glucosa en pacientes con FQ.
Dysglycemia, observed in the 2-hour glucose tolerance test and in the continuous monitoring of glycemia, are the main risk factor for the development of diabetes related to cystic fibrosis (CF), which constitutes the final stage of a continuum of impaired glucose metabolism in people with CF. These dysglycemias are due both to direct damage to insulin-producing pancreatic islet cells, and to increased insulin resistance associated with the systemic inflammatory state of CF. The increasingly early use of CFTR modulators should help prevent the development of CRFD and its complications. The following review focuses on the effects of regulador de transmembrana de fibrosis quística (CFTR) modulators on glucose tolerance in people with CF.
Subject(s)
Humans , Cystic Fibrosis Transmembrane Conductance Regulator , Cystic Fibrosis/complications , Diabetes Complications , Glucose Tolerance Test , InsulinABSTRACT
El objetivo de este estudio fue caracterizar a los pacientes con sospecha de diabetes mellitus tipo 2 con glicemia en ayunas previa menor a 126 mg/dl diagnosticados precozmente a través del test de tolerancia a la glucosa. Se realizó un estudio descriptivo transversal, en el Centro de Salud Familiar Violeta Parra de Chillán-Chile. La población estudiada fueron los pacientes con glicemias en ayuno menores de 126 mg/dl, que ingresaron al monitoreo de sospecha de diabetes mellitus tipo 2, a los cuales se les realizó el test de tolerancia oral a la glucosa. Se realizó la revisión de los registros de pacientes que ingresaron entre julio y diciembre de 2011 a monitoreo para diagnóstico de diabetes mellitus tipo 2. Las principales medidas del estudio fueron la frecuencia de diagnóstico de diabetes mellitus tipo 2 y de los estadios pre-diabéticos. Se usó estadística descriptiva para el análisis de los datos, de 364 registros de pacientes en monitoreo, se excluyeron 61 por haber sido ingresados al monitoreo sin test de glicemia en ayunas, de los 303 pacientes con registros adecuados, a 49 (16, 1%) se les diagnosticó diabetes mellitus tipo 2, de éstos 14(4,6%) habían presentado glicemia en ayunas de 110 mg/dl o menos, 176 (58%) pacientes presentaron alteraciones pre-diabéticas y 89 (29,3%) pacientes no presentaron alteraciones. Un alto porcentaje que no sería diagnosticado como diabetes mellitus tipo 2 logra serlo a través del test de tolerancia a la glucosa, lo que justifica la realización del mismo.
The Objective of this study was to characterize patients with suspected diabetes mellitus type 2 with fasting glucose less prior to 126mg/dl diagnosed early through the test of glucose tolerance.We did a cross sectio-nal study in the Family Health Center Violeta Parra de Chillan, Chile. The populations studied were patients with fasting blood glucose less than 126mg/dl, who entered the monitoring of suspected diabetes mellitus 2, to which test they performed oral glucose tolerance. A revision of the records of patients admitted from July to December 2011 monitoring for diagnosis of type 2 diabetes mellitus.The main measures of the study were the frequency of diagnosis of type 2 diabetes mellitus and other pre diabetic stage. Descriptive statistics were used to analyze the data. Of 364 patient records 61 were exclused for being admitted to monitoring blood glucose test without fasting. Of the 303 patients with adequate records, 49 (16.1%) were diagnosed with type 2 diabetes mellitus, of these 14 (4.6%) had fasting glucose of 110mg/dL or less. Pre-diabetes abnormalities had 176 (58%) patients. Only 89 (29.3%) patients showed no abnormalities. A high percentage would not be diagnosed as type 2 diabetes mellitus be achieved through the test of glucose tolerance, which justifies the realization.
ABSTRACT
Background: The prevalence obesity, type 2 diabetes (DM2) and glucose intolerance among children is increasing worldwide. Aim: To assess the frequency of DM2 and GI among severely obese children and adolescents. Patients and methods: Cross sectional study of 69 children and adolescents aged 12 +/- 3 years with a mean body mass index (BMI) z score of 2.9 +/- 0.6. An oral glucose tolerance test (OGTT) was performed, measuring fasting and 120 minutes blood glucose and insulin. According to these results two patients had diabetes mellitus and 4 had glucose intolerance. Previously studied patients, five with diabetes mellitus and two with glucose intolerance were incorporated to the present study. These 13 participants were compared with the remaining 63 children without abnormalities in glucose metabolism, considered as controls. Results: Body mass index among children with glucose intolerance, diabetes mellitus and controls was 33.8 +/- 6.4, 26.7 +/- 5.1 and 29.4 +/- 4.5 kg/m2, respectively, p = 0.03. Basal and 120 min insulin levels were also significantly higher among children with glucose intolerance compared with diabetics and controls. Homeostasis model assessment for insulin resistance was significantly lower in controls than in children with diabetes or glucose intolerance. Conclusions: Eight percent of this group of obese children and adolescents had DM2 or glucose intolerance. Oral glucose tolerance test should be included in the routine assessment of obese children to diagnose abnormalities of glucose metabolism.
Subject(s)
Humans , Male , Female , Child , Adolescent , /epidemiology , Glucose Intolerance/epidemiology , Obesity/epidemiology , Analysis of Variance , Body Mass Index , Cross-Sectional Studies , Chile/epidemiology , Prediabetic State/epidemiology , Glucose Tolerance Test , Incidence , Insulin Resistance , Insulin/blood , Lipids/bloodABSTRACT
El test de tolerancia oral a la glucosa (TTOG) es el más frecuentemente utilizado en la práctica clínica para el diagnóstico de resistencia insulínica (RI). El objetivo del presente trabajo fue la evaluación de la utilidad de los índices basales e índices TTOG, en mujeres con síndrome de ovario poliquístico (SOP) y del valor predictivo de los índices basales sobre la glucemia a los 120 minutos postprandial (G 120). Se estudiaron 114 pacientes con diagnóstico de SOP y 29 mujeres normales. A todas se les realizó un TTOG. Se dosó insulina y glucosa séricas cada 30 min durante las 2 horas del test y se determinaron los siguientes índices: Indices basales: GLU/lNS (glucemia en ayunas / insulinemia en ayunas), HOMA (modelo homeostático) y QUICKI (índice cuantitativo de sensibilidad insulínica) e índices TTOG: AI (área bajo la curva de insulina) e ISI composite (índice de sensibilidad insulínica). Se observaron correlaciones significativas entre los índices basales y los índices TTOG. Hubo 9 pruebas con índices basales normales que presentaban índice TTOG patológicos. Ninguna paciente con niveles de insulina menores a 9.9 Ul/ml presentó RI, mientras que todas las pacientes con niveles de insulina mayores a 18.4 Ul/ml tuvieron RI. Catorce pacientes (10.5%) presentaron G 120 ³ a 140 mg%. En 4 de los 14 casos (12.2%), los valores basales no hicieron sospechar la posibilidad del diagnóstico de hiperglucemia post prandial. En conclusión, en pacientes con SOP, los índices basales son útiles para diagnosticar RI. Proponemos realizar TTOG para diagnóstico de RI en aquellas pacientes que presenten insulinemias en ayunas entre 9.9 y 18.4 Ul/ml. En pacientes con SOP, se recomienda la evaluación periódica de la G 120.
Oral glucose tolerance test (OGTT) is the most commonly used method to evaluate insulin resistance (IR) in the clinical practice. Our objective was to evaluate the diagnostic utility of fasting tests compared with OGTT tests in women with PCO, and the ability of fasting tests to detect postprandial hyperglycemia. One hundred fourteen women with PCO and 29 normal women were evaluated by a 2 hours OGTT. Fasting plasma insulin (INS) and glucose were measured during the test. GLU:INS ratio (r) (fasting glucose/fasting insulin), HOMA (homeostatic model assessment), QUICKI (quantitative insulin sensitivity check index) (fasting tests), as well as the AUCI (area under the curve of INS) and ISI composite (ISI) (insulin sensitivity index) (OGTT tests), were determined. A significant correlation between fasting tests and OGTT tests was found. Normal fasting tests with abnormal OGTT tests were found in 9 patients. No patient with fasting insulin levels less than 9.9 UI/ml were IR, and all women with fasting insulin levels over 18.4 UI/ml were classified as having IR. We found glucose levels 120 min post glucose load (G 120) ³ 140 mg/dl in 14 patients (12.2%). Fasting glucose and insulin levels and the fasting tests, were poor predictors of impaired glucose tolerance (IGT) and type 2 diabetes (DBT 2). Thus, fasting tests are useful in the diagnostic of IR in PCO patients. OGTT is necessary when the fasting insulin levels range between 9.9 and 18.4 UI/ml. Women with PCO should undergo periodic screening for abnormal glucose tolerance.
Subject(s)
Humans , Female , Adolescent , Adult , Blood Glucose/analysis , Fasting/physiology , Glucose Tolerance Test/standards , Insulin Resistance/physiology , Insulin/blood , Polycystic Ovary Syndrome/blood , /blood , /diagnosis , Glucose Clamp Technique , Glucose Intolerance/blood , Glucose Intolerance/diagnosis , Homeostasis/physiology , Predictive Value of Tests , Reference ValuesABSTRACT
Se realizó un estudio transversal para conocer la morbilidad oculta por diabetes mellitus no insulinodependiente y tolerancia alterada a la glucosa en el consultorio No. 17 del Policlínico Comunitario Docente Centro durante el año 1998. El universo de estudio lo representaron 196 personas a las que se les realizó una primera glicemia en ayunas, y de acuerdo con sus resultados una segunda determinación o una prueba de tolerancia a la glucosa oral, recogiéndose los resultados en una encuesta que contenía variables tales como: sexo, grupos de edades, factores de riesgo y resultados de ambas pruebas anteriores. Todo ello se procesó de una forma computadorizada. Los antecedentes patológicos familiares y la obesidad fueron los factores de riesgo más frecuentes, con mayor incidencia del sexo femenino, detectándose una morbilidad oculta de 1,53 % por diabetes mellitus no insulinodependiente, y de 2,04 % por tolerancia alterada a la glucosa.
A cross-sectional study was carried out to know the hidden morbidity from non-insulin-dependent diabetes mellitus and impaired glucose tolerance at the family physician?s office No 17 of the Central Community Teaching Polyclinic during 1998. The universe of study was composed of 196 subjects who underwent a first fasting glycaemia and according to its results a second determination or an oral glucose tolerance test. The results were collected in a survey containing containing variables such as: sex, age groups, risk factors and the results of both previous tests. All this information was processed by computer. Family pathological history and obesity were the commonest risk factors, with a higher incidence of females. It was detected an hidden morbidity of 1,53 % from non-insulin-dependent diabetes mellitus and of 2,04 % from impaired glucose tolerance.