Switching from Premixed Insulin To Basal Insulin Analogue For Type 2 Diabetes and Role of Dipeptidyl Peptidase-4 Inhibitors.

INTRODUCTION: This study aimed to confirm the usefulness of basal insulin analogue plus oral antidiabetic drugs (OADs) for type 2 diabetes (T2D) patients inadequately controlled with premixed insulin with/without OADs and assess the role of dipeptidyl peptidase-4 (DPP-4) inhibitors within this regimen in clinical practice. METHODS: Spanish retrospective observational study that included 186 T2D patients with glycosylated hemoglobin (HbA1c) >7% (53 mmol/mol) despite premixed insulin with/without OADs who had been switched to basal insulin analogue plus OADs. Study data describing the situation before the treatment switch and 6 months later was retrospectively retrieved from patients' medical charts. RESULTS: Switching to a basal insulin plus OADs decreased HbA1c (-1.0%, p<0.001), fasting (-38.1 mg/dl, p<0.001) and postprandial glycemia (-36.1 mg/dl, p<0.001), with reduced body weight (-1.1 kg, p<0.001) and hypoglycemic episodes (-17.5%, p<0.001). 68 (36.6%) patients received a basal insulin plus DPP-4 inhibitor±metformin and 74 (39.8%) plus metformin only. The DPP-4 inhibitor±metformin group showed a greater HbA1c reduction than the metformin group (1.3±1.4% vs. 0.9±1.0%, p=0.022), with no significant differences between groups in hypoglycemic episodes. CONCLUSIONS: Basal insulin analogue plus OADs may be a useful treatment for type 2 diabetes patients inadequately controlled with premixed insulin. Administering DPP-4 inhibitors within this regimen may contribute to improve patients' glycemia, with a favorable weight-change profile and without increasing hypoglycemia risk.

[Incidence of postpartum thyroiditis and study of possible associated factors]. / Tiroiditis posparto: incidencia y estudio de los posibles factores asociados en las embarazadas de una zona de salud.

BACKGROUND AND OBJECTIVE: Our objective was to evaluate the presence of postpartum thyroiditis (PPT) in a group of pregnant euthyroid women. MATERIAL AND METHOD: This study was prospective and descriptive in nature and was carried out over the course of three years in an urban Health District in Toledo, Spain. Information recorded included height and weight, tobacco use, previous consumption of oral contraceptives, and numbers of pregnancies and abortions prior to the current gestation. Levels of Thyroid Stimulating Hormone (TSH), free Thyroxin (FT4) and thyroid peroxidase antibodies (TPOAb) were determined during the first trimester and 3 and 6 months postpartum. A urine sample was collected for determination of iodine levels. Thyroid ultrasonography was performed on all pregnant subjects concurrently with analytical sample collection at 3 months of pregnancy and 3 months postpartum. RESULTS: The sample contained 157 pregnant women, of whom 25 (15.9%) developed PPT. Of these, 44.0% were positive for TPO antibodies in the first trimester, compared to 4.5% of the subjects who did not develop PPT (P<.001). At the end of the first year, 5 (20%) were still afflicted with hypothyroidism. The complete study group of pregnant women displayed a median urinary iodine level of 135 microg/L. A minor BMI was found in the PPT subjects when compared with the rest of the study group (21.7 vs 24.5; P=.000). A greater frequency of PPT was found in Rh-negative women (33.3 vs 12.2%; P=.015). CONCLUSIONS: The incidence of PPT exceeded that previously reported. We have only found a significant correlation between PPT and BMI and Rh factor. Based on the high incidence rate detected in our Health District, an active search for cases of PPT might be justified.

Enfermedad tiroidea y estado de yodación en el primer trimestre del embarazo / Thyroid disorders and iodine nutritional status in the first trimester of pregnancy

Fundamento y objetivos: Las alteraciones tiroideas son frecuentes en la gestación y pueden ser nocivas para el desarrollo del recién nacido. El objetivo del presente estudio fue valorar la prevalencia de enfermedad tiroidea y el estado nutricional de yodo de un grupo de mujeres en su primer trimestre de embarazo. Pacientes y método: Estudio observacional descriptivo, realizado en una zona de salud de Toledo. La población del estudio estaba formada por las embarazadas de dicha zona y un grupo control de mujeres no gestantes de edad similar. En ambos grupos se realizó una ecografía tiroidea y se determinó la yoduria; en embarazadas, además, tirotropina (TSH), T4 libre y anticuerpos antiperoxidasa (TPO). Resultados: Participaron 199 embarazadas y 169 controles. La mediana de yoduria fue 135 (rango intercuartílico [RI], 240-65) mg/l en embarazadas y 150 (RI, 200-90) mg/l en controles. Las medias ± desviación estándar de TSH y T4 en embarazadas fueron 1,95 ± 1,62 y 1,03 ± 0,15 mU/ml, respectivamente. La prevalencia de hipotiroidismo en embarazadas fue del 9,5% (intervalo de confianza del 95%, 6,0-14,7). El volumen tiroideo resultó mayor en embarazadas (12,2 ± 5,6 ml) que en controles (10,7 ± 4,0 ml) (p = 0,005). Se encontraron nódulos tiroideos en el 38,5% de los controles y en el 33,2% de las embarazadas (p = 0,290). Conclusiones: Existe un deficiente estado de yodación en nuestras embarazadas. La prevalencia de hipotiroidismo es alta y similar a la de otros trabajos españoles. Debería valorarse la determinación de hormonas tiroideas y anticuerpos anti-TPO en el primer control gestacional. La prevalencia de nódulos es similar en controles y embarazadas en el primer trimestre. Debería solicitarse una ecografía tiroidea en las gestantes que presenten en la exploración física bocio y/o nódulos tiroideos (AU)

Background and objectives: Thyroid alterations are frequent during pregnancy and can be harmful to the development of the newborn. The objective of this study was to assess the prevalence of thyroid disorders as well as iodine nutritional status in pregnant women in the first trimester of pregnancy. Patients and method: We performed a descriptive observational survey in a health area of Toledo (Spain). Participants consisted of pregnant women in this area and a control group of non-pregnant women of similar age. Both groups underwent thyroid ultrasonography and urinary iodine concentration test. Thyrotropin, free T4 and anti-thyroid peroxidase antibodies (anti-TPO Ab) levels were also measured in pregnant women. Results: A total of 199 expectant women and a control group of 169 non-pregnant women participated. The median urinary iodine concentration was 135 mg/l (IR, 240-65) in pregnant women and 150 mg/l (IR, 200-90) in the control group. The mean values for TSH and free T4 in pregnant women were 1.95 ± 1.62 and 1.03 ± 0.15 mU/ml, respectively. The prevalence of hypothyroidism in expectant women was 9.5% (95% CI, 6.0-14.7). Thyroid volume was larger in pregnant women (12.2 ± 5.6 mL) than in controls (10.7 ± 4.0 mL) (p = 0.005). Thyroid nodules were found in 38.5% of the women in the control group and in 33.2% of pregnant women (p = 0.290). Conclusions: Iodine status was deficient in our group of pregnant women. In agreement with the results of other studies performed in Spain, the prevalence of hypothyroidism was high. Thyroid hormones and anti-TPO Ab tests should be evaluated in the first prenatal visit. The prevalence of nodules was similar in pregnant women in the first trimester of pregnancy and in controls. Thyroid ultrasonography should be performed in pregnant women whenever a goiter and/or thyroid nodules are detected during clinical examination (AU)

Thyroid disorders and iodine nutritional status in the first trimester of pregnancy.

BACKGROUND AND OBJECTIVES: Thyroid alterations are frequent during pregnancy and can be harmful to the development of the newborn. The objective of this study was to assess the prevalence of thyroid disorders as well as iodine nutritional status in pregnant women in the first trimester of pregnancy. PATIENTS AND METHOD: We performed a descriptive observational survey in a health area of Toledo (Spain). Participants consisted of pregnant women in this area and a control group of non-pregnant women of similar age. Both groups underwent thyroid ultrasonography and urinary iodine concentration test. Thyrotropin, free T4 and anti-thyroid peroxidase antibodies (anti-TPO Ab) levels were also measured in pregnant women. RESULTS: A total of 199 expectant women and a control group of 169 non-pregnant women participated. The median urinary iodine concentration was 135 µg/l (IR, 240-65) in pregnant women and 150µg/l (IR, 200-90) in the control group. The mean values for TSH and free T4 in pregnant women were 1.95±1.62 and 1.03±0.15µU/ml, respectively. The prevalence of hypothyroidism in expectant women was 9.5% (95% CI, 6.0-14.7). Thyroid volume was larger in pregnant women (12.2±5.6mL) than in controls (10.7±4.0mL) (p=0.005). Thyroid nodules were found in 38.5% of the women in the control group and in 33.2% of pregnant women (p = 0.290). CONCLUSIONS: Iodine status was deficient in our group of pregnant women. In agreement with the results of other studies performed in Spain, the prevalence of hypothyroidism was high. Thyroid hormones and anti-TPO Ab tests should be evaluated in the first prenatal visit. The prevalence of nodules was similar in pregnant women in the first trimester of pregnancy and in controls. Thyroid ultrasonography should be performed in pregnant women whenever a goiter and/or thyroid nodules are detected during clinical examination.

[Effectiveness of treatment with tiotropium in patients who suffer from COPD]. / Efectividad del tratamiento con bromuro de tiotropio en pacientes con enfermedad pulmonar obstructiva crónica.

BACKGROUND AND OBJECTIVE: We assessed the clinical and functional changes taking place in patients diagnosed of chronic obstructive pulmonary disease (COPD) who have been treated with ipratropium bromide, three months after this medicament was replaced by the new tiotropium bromide. PATIENTS AND METHOD: A prospective intervention survey was carried out in a primary health-care area in patients who suffered from COPD who fulfilled the inclusion criteria. Before changing the treatment and three months after changing it, we carried out the following procedures: spirometry, 6 minutes walking test (6MWT) with pulsioximetry before and after the exercise, St. George Respiratory Questionnaire (SGRQ) and assessment of: patient's chronic dyspnea, degree of patient's compliance, adverse effects and degree of satisfaction with the new drug. RESULTS: 24 patients (22 males and 2 females) with a mean age of 68.54 years participated in the survey. The FVC improved a 4.92% (120 ml) [p = .27] and the FEV1, 14.16% (170 ml) [p < .001]. The degree of compliance arose from 67.54% to 96.73% (p < .001), the degree of dyspnea decreased from 4.63 to 3.89 (p = .141), the 6MWT increased in 23.79 m (p = .027) and the global mark of the SGRQ reduced (improved) in 13.35 points. There were adverse effects in 5 cases (mouth dryness in 4 patients and headache in 1 of them) and 15 patients (62.5%) said the new drug was better. CONCLUSIONS: Most analyzed parameters had positive changes three months after changing the treatment. Tiotropium may be a valid alternative in the treatment of patients suffering from COPD in a stable stage.

Efectividad del tratamiento con bromuro de tiotropio en pacientes con enfermedad pulmonar obstructiva crónica / Effectiveness of treatment with tiotropium in patients who suffer from COPD

FUNDAMENTO Y OBJETIVO: Valorar los cambios clínicos y funcionales que se producen en pacientes diagnosticados de enfermedad pulmonar obstructiva crónica (EPOC) y tratados con bromuro de ipratropio a los 3 meses de cambiar este fármaco por el nuevo anticolinérgico bromuro de tiotropio. PACIENTES Y MÉTODO: El estudio, prospectivo, de intervención «antes-después», se realizó en el ámbito de la atención primaria en pacientes con EPOC que cumplían los criterios de inclusión. Antes de cambiar el tratamiento y a los 3 meses del cambio se realizaron: espirometría, prueba de la marcha de 6 min con pulsioximetría antes y después del ejercicio, cuestionario respiratorio de St. George (SGRQ), valoración de la disnea crónica del paciente (mediante escala analógica),del grado de cumplimiento terapéutico (mediante autocomunicación), de los efectos secundarios y del grado de satisfacción con el nuevo fármaco. RESULTADOS: Participaron en el estudio 24 pacientes (22 varones y 2 mujeres) con una edad media de 68,54 años. La capacidad vital forzada mejoró un 4,92% (120 ml) (p = 0,27) y el volumen espiratorio máximo en el primer segundo un 14,16% (170 ml) (p < 0,001). El grado de cumplimiento pasó del 67,54 al 96,73% (p < 0,001), el grado de disnea se redujo de 4,63a 3,89 puntos (p = 0,141), la prueba de la marcha de 6 min aumentó en 23,79 m (p = 0,027)y la puntuación global del SGRQ se redujo (mejoró) en 13,35 puntos. En 5 casos se presentaron efectos adversos (sequedad de boca en 4 y cefalea en 1) y 15 pacientes (62,5%) consideraron mejor el nuevo fármaco. CONCLUSIONES: La mayoría de los parámetros analizados experimentan cambios favorables a los 3 meses del cambio de tratamiento. El tiotropio puede ser una opción válida en el tratamiento del paciente con EPOC en fase estable

BACKGROUND AND OBJECTIVE: We assessed the clinical and functional changes taking place in patients diagnosed of chronic obstructive pulmonary disease (COPD) who have been treated with ipratropium bromide, three months after this medicament was replaced by the new tiotropium bromide. PATIENTS AND METHOD: A prospective intervention survey was carried out in a primary health-carearea in patients who suffered from COPD who fulfilled the inclusion criteria. Before changing the treatment and three months after changing it, we carried out the following procedures:spirometry, 6 minutes walking test (6MWT) with pulsioximetry before and after the exercise, St.George Respiratory Questionnaire (SGRQ) and assessment of: patient’s chronic dyspnea, degreeof patient’s compliance, adverse effects and degree of satisfaction with the new drug. RESULTS: 24 patients (22 males and 2 females) with a mean age of 68.54 years participated in the survey. The FVC improved a 4.92% (120 ml) [p = .27] and the FEV1, 14.16% (170 ml) [p< .001]. The degree of compliance a rose from 67.54% to 96.73% (p < .001), the degree of dyspnea decreased from 4.63 to 3.89 (p = .141), the 6MWT increased in 23.79 m (p = .027)and the global mark of the SGRQ reduced (improved) in 13.35 points. There were adverse effects in 5 cases (mouth dryness in 4 patients and headache in 1 of them) and 15 patients(62.5%) said the new drug was better. CONCLUSIONS: Most analyzed parameters had positive changes three months after changing the treatment. Tiotropium may be a valid alternative in the treatment of patients suffering from COPD in a stable stage