Distribución de la circunferencia de la cintura y de la relación circunferencia de la cintura con respecto a la talla según la categoría del índice de masa corporal en los pacientes atendidos en consultas de endocrinología y nutrición / Distribution of waist circumference and waist-to-height ratio by categories of body mass index in patients attended in endocrinology and nutrition units

Introducción La circunferencia de cintura (CC) y la relación circunferencia de cintura/talla (CT) son medidas antropométricas muy utilizadas en la práctica clínica para valorar la grasa visceral y por tanto el riesgo cardiovascular. Sin embargo, los umbrales de riesgo para diferentes rangos de índice de masa corporal (IMC) no han sido suficientemente validados.ObjetivoDeterminar la distribución de CC y CT en función de los puntos de corte de IMC actualmente vigentes para definir el sobrepeso y la obesidad.Material y métodosSe determinó la CC, la CT y el IMC en 3521 pacientes adultos (mayores de 18 años) atendidos en las consultas de endocrinología y nutrición.ResultadosEl 20,8% (734) de los pacientes eran diabéticos. El 82,1% de los pacientes diabéticos eran obesos, así como el 75% de los no diabéticos. Los umbrales de riesgo (..) (AU)

Introduction Waist circumference (WC) and the waist-to-height ratio (WHtR) are anthropometric measures widely used in clinical practice to evaluate visceral fat and the consequent cardiovascular risk. However, risk thresholds should be standardized according to body mass index (BMI).ObjectiveTo determine the distribution of WC and WHtR according to the BMI cut-points currently used to describe overweight and obesity.Materials and methodsWC, WHtR and BMI were measured in 3521 adult patients (>18 years) attended in Endocrinology and Nutrition units.ResultsA total of 20.8% (734 patients) were diabetic. Obesity was found in 82.1% of diabetic patients and in 75% of non-diabetic patients. The WC thresholds proposed by the National Institute of Health (..) (AU)

[Distribution of waist circumference and waist-to-height ratio by categories of body mass index in patients attended in endocrinology and nutrition units]. / Distribución de la circunferencia de la cintura y de la relación circunferencia de la cintura con respecto a la talla según la categoría del índice de masa corporal en los pacientes atendidos en consultas de endocrinología y nutrición.

INTRODUCTION: Waist circumference (WC) and the waist-to-height ratio (WHtR) are anthropometric measures widely used in clinical practice to evaluate visceral fat and the consequent cardiovascular risk. However, risk thresholds should be standardized according to body mass index (BMI). OBJECTIVE: To determine the distribution of WC and WHtR according to the BMI cut-points currently used to describe overweight and obesity. MATERIALS AND METHODS: WC, WHtR and BMI were measured in 3521 adult patients (>18 years) attended in Endocrinology and Nutrition units. RESULTS: A total of 20.8% (734 patients) were diabetic. Obesity was found in 82.1% of diabetic patients and in 75% of non-diabetic patients. The WC thresholds proposed by the National Institute of Health (102 cm in men, 88 cm in women), Bray (100 cm in men, 90 cm in women) and the International Diabetes Federation (94 cm in men, 80 cm in women) were exceeded by 92.9%, 94.8% and 98.4% of obese men, 96.8%, 95.5% and 99.7% of obese women, 79.1%, 83.1% and 90% of diabetic men and 95.5%, 81.5% and 97.4% of diabetic women, respectively. Thresholds adapted to the degree of obesity (90, 100, 110 and 125 cm in men and 80, 90, 105 and 115cm in women for normal BMI, overweight, obesity I and obesity greater than I) were exceeded by 58.4% of obese men, 54.2% of obese women, 57.5% of diabetic men and 60.7% of diabetic women. WC was higher in men, and BMI and the WHtR were higher in women. The WC of diabetic women equalled that of men, and WC, WHtR and BMI were higher in diabetic than in non-diabetic women (p<0.001). WC (p<0.005), WHtR (p<0.001) and BMI (p<0.5) were also higher in diabetic than in non-diabetic men. CONCLUSION: WC and WHtR thresholds by BMI discriminated diabetic and obese patients better than single thresholds, and can be represented graphically by the distribution of percentile ranks of WC and WHtR by BMI.ik.

Seguridad de los análogos de insulina: qué evaluar, cómo hacerlo y cómo interpretar los resultados / Safety of insulin analogues: What to evaluate, how to do it, and how to interpret the results

La utilización casi generalizada de análogos de insulina está basada no solo en la farmacocinética de estos preparados, mucho más cercana a la fisiología de la secreción de insulina en condiciones normales, sino, además, en su eficacia y seguridad. Se ha publicado una posible asociación entre el uso de un análogo lento de insulina (glargina) y la aparición de cáncer de mama, lo que ha condicionado una inquietud en la comunidad médica sobre la seguridad de estos análogos. Resumen Para explicar el mecanismo del aumento de la actividad tumoral de los análogos de insulina es que actúan a través de los receptores de insulina (IR) y del factor de crecimiento insulínico–1 (IGF-1R) estimulando el crecimiento celular e inhibiendo la apoptosis. En este sentido, existen dos mecanismos principales: el aumento del tiempo de unión de la insulina al IR y la activación aumentada del IGF-1R. Por tanto, para evaluar la seguridad de un análogo hay que descartar su disociación más lenta al IR así como un aumento de su afinidad por el IGF-1. Esto equivale a un índice de actividad mitogénica/metabólica menor a 1. Evaluar estos aspectos sólo es posible mediante el estudio de líneas celulares y la experimentación animal, modelos reduccionistas que no siempre son extrapolables al ser humano. Hasta el momento no existen datos para poner en duda la seguridad de los análogos de insulina en general, si bien la observación de un potencial riesgo de mitogenicidad con la administración de glargina basada en estudios observacionales y en algunos estudios in vitro ha causado cierta alarma en la comunidad médica. A la espera de datos que descarten o confirmen este riesgo, es fundamental poder evaluar los datos existentes de forma crítica con el objeto de proporcionar información objetiva (AU)

The widespread use of insulin analogues is based not only on the pharmacokinetics of these preparations, which is much closer to the physiology of insulin secretion under normal conditions, but also on their safety and effectiveness. The publication of a possible association between the use of a long-acting insulin analogue (glargine) and breast cancer has caused uneasiness among the medical community regarding the safety of these analogues. The mechanism of increased tumor activity of insulin analogues is explained by the fact that they act through insulin receptors (IR) and insulin-like growth factor-1 (IGF-1R), stimulating cell growth and inhibiting apoptosis. There are two major mechanisms: an increase in the binding time of insulin to IR and increased activation of IGF-1R. Therefore, to evaluate the safety of an analogue, the slower dissociation rate from its insulin receptor must be excluded, as well as the increased affinity for the IGF-1 receptor. This is equivalent to an index of mitogenic/metabolic activity of less than 1. These aspects can only be evaluated through study of cell lines and animal testing, which are reductionist models that cannot always be extrapolated to humans. To date, there are no data to question the safety of insulin analogues in general. However, the results of observational studies and some in vitro studies, suggesting a potential risk of mitogenicity with the administration of glargine, have caused some alarm among the medical community. Until now, there are no data to refute or confirm this risk and, therefore, evaluation of the existing data is crucial to obtain objective information (AU)

Mitochondria-targeted antioxidant peptides.

Overproduction of reactive oxygen species (ROS) under pathophysiologic conditions is part of the disease process. These ROS are released from different sources, and in particular from mitochondria. Although the molecular mechanisms responsible for mitochondria-mediated disease processes are unclear, oxidative stress seems to play an important role. ROS are essential to cell function, but adequate levels of antioxidant defenses are required in order to avoid the harmful effects that excessive ROS production can produce. Mitochondrial oxidative stress damage and dysfunction contribute to a number of cell pathologies that manifest themselves through a range of conditions. The antioxidants available until now have not proved to be particularly effective against many of these disorders. It is possible that these antioxidants do not reach the sites of free radical generation, especially when mitochondria are the primary source of ROS. Recent developments in mitochondria-targeted antioxidants have moved closer to providing protection against mitochondrial oxidative damage. The SS (Szeto-Schiller) peptide antioxidants represent a novel approach that employs the targeted delivery of antioxidants to the inner mitochondrial membrane. These SS peptides scavenge hydrogen peroxide and peroxynitrite and inhibit lipid peroxidation. By reducing mitochondrial ROS, they inhibit mitochondrial permeability transition and cytochrome c release, thus preventing oxidant-induced cell death. Preclinical studies support the use of these peptides for ischemia-reperfusion injury and neurodegenerative disorders. Although peptides have often been considered to be poor drug candidates, the few that have been studied are promising agents for the treatment of diseases.

[Safety of insulin analogues: what to evaluate, how to do it, and how to interpret the results]. / Seguridad de los análogos de insulina: qué evaluar, cómo hacerlo y cómo interpretar los resultados.

The widespread use of insulin analogues is based not only on the pharmacokinetics of these preparations, which is much closer to the physiology of insulin secretion under normal conditions, but also on their safety and effectiveness. The publication of a possible association between the use of a long-acting insulin analogue (glargine) and breast cancer has caused uneasiness among the medical community regarding the safety of these analogues. The mechanism of increased tumor activity of insulin analogues is explained by the fact that they act through insulin receptors (IR) and insulin-like growth factor-1 (IGF-1R), stimulating cell growth and inhibiting apoptosis. There are two major mechanisms: an increase in the binding time of insulin to IR and increased activation of IGF-1R. Therefore, to evaluate the safety of an analogue, the slower dissociation rate from its insulin receptor must be excluded, as well as the increased affinity for the IGF-1 receptor. This is equivalent to an index of mitogenic/metabolic activity of less than 1. These aspects can only be evaluated through study of cell lines and animal testing, which are reductionist models that cannot always be extrapolated to humans. To date, there are no data to question the safety of insulin analogues in general. However, the results of observational studies and some in vitro studies, suggesting a potential risk of mitogenicity with the administration of glargine, have caused some alarm among the medical community. Until now, there are no data to refute or confirm this risk and, therefore, evaluation of the existing data is crucial to obtain objective information.

Cetoacidosis derivada del mal empleo de la pluma precargada de insulina detemir / Diabetic ketoacidosis due to incorrect use of insulin detemir precharged pen

Los problemas técnicos en el manejo de dispositivos subcutáneos de administración de insulina han disminuido su frecuencia desde la introducción en el mercado de las plumas precargadas de insulina. Sin embargo, todavía se deben tener presentes en el caso de pacientes con diabetes inestable o cetoacidosis diabética aparentemente idiopática. Se presenta el caso de una paciente de 37 años con diabetes mellitus tipo 1 de 12 años de evolución, con mal control metabólico por la inestabilidad de sus glucemias, que ingresó por una cetoacidosis diabética aparentemente idiopática, tras cambiar el análogo de acción retardada glargina por detemir. Posteriormente se comprobó que la paciente desconocía el sistema de aplicación de la pluma precargada de insulina detemir, lo que causó la cetoacidosis. Siempre se debe tener en cuenta esta posibilidad ante un mal control metabólico a pesar de tratamiento insulínico intensivo o ante una cetoacidosis diabética aparentemente idiopática

Technical problems associated with subcutaneous insulin administration devices have become much less frequent since the introduction of precharged insulin systems. Nevertheless, they remain a cause of unstable diabetes or idiopathic diabetic ketoacidosis. We report the case of a 37-year-old woman with type 1 diabetes mellitus of 12 years' duration and unstable metabolic control. The patient was admitted for apparent idiopathic diabetic ketoacidosis after being switched from the long-acting insulin analogue, glargine, to detemir. The patient's insulin administration technique was subsequently discovered to be incorrect, causing the diabetic ketoacidosis. This possibility should always be kept in mind in patients with unstable diabetes despite intensive insulin treatment, as well as in those with idiopathic diabetic ketoacidosis