Clinical Approach to Flash Glucose Monitoring: An Expert Recommendation.

The flash glucose monitoring (FGM) system FreeStyle Libre® is a device that measures interstitial glucose in a very simple way and indicates direction and speed of glucose change. This allows persons with diabetes to prevent hypoglycemic and hyperglycemic events. Scientific evidence indicates that the system can improve glycemic control and quality of life. To obtain the maximum benefit, it is necessary to properly handle glucose values and trends. Due to the generalization of the system use, the purpose of the document is to provide recommendations for the optimal use of the device, not only in the management of glucose values and trends but also in the prevention of hypoglycemia, actuation in exercise, special situations, and retrospective analysis of the glucose data, among others.

Tablas y bases de datos de composición de alimentos españolas: necesidad de un referente para los profesionales de la salud / Spanish food composition tables and databases: need for a gold standard for healthcare professionals

Las tablas y las bases de datos de composición de alimentos (TCA o BDCA) proporcionan la información necesaria para estimar la ingesta de nutrientes y otros componentes alimentarios. En España la falta de una base de datos de referencia ha propiciado el uso de diferentes TCA/BDCA en encuestas nutricionales y estudios de investigación, así como en el desarrollo de programas dietéticos para el análisis de dietas. En consecuencia, se obtienen resultados sesgados y no comparables, y pocas veces el profesional sanitario es consciente de estas limitaciones. La AECOSAN y la asociación BEDCA desarrollaron una BDCA siguiendo estándares europeos, la Red Española de Bases de Datos de Composición de Alimentos (RedBEDCA). La base de datos actual tiene un número reducido de alimentos y componentes de alimentos y apenas contiene productos procesados, lo que limita su utilización en estudios epidemiológicos y en la práctica diaria del profesional de la salud

Food composition tables and databases (FCTs or FCDBs) provide the necessary information to estimate intake of nutrients and other food components. In Spain, the lack of a reference database has resulted in use of different FCTs/FCDBs in nutritional surveys and research studies, as well as for development of dietetic for diet analysis. As a result, biased, non-comparable results are obtained, and healthcare professionals are rarely aware of these limitations. AECOSAN and the BEDCA association developed a FCDB following European standards, the Spanish Food Composition Database Network (RedBEDCA).The current database has a limited number of foods and food components and barely contains processed foods, which limits its use in epidemiological studies and in the daily practice of healthcare professionals

Spanish food composition tables and databases: need for a gold standard for healthcare professionals. / Tablas y bases de datos de composición de alimentos españolas: necesidad de un referente para los profesionales de la salud.

Food composition tables and databases (FCTs or FCDBs) provide the necessary information to estimate intake of nutrients and other food components. In Spain, the lack of a reference database has resulted in use of different FCTs/FCDBs in nutritional surveys and research studies, as well as for development of dietetic for diet analysis. As a result, biased, non-comparable results are obtained, and healthcare professionals are rarely aware of these limitations. AECOSAN and the BEDCA association developed a FCDB following European standards, the Spanish Food Composition Database Network (RedBEDCA).The current database has a limited number of foods and food components and barely contains processed foods, which limits its use in epidemiological studies and in the daily practice of healthcare professionals.

Documento de consenso sobre el tratamiento con infusión subcutánea continua de insulina en el medio hospitalario / Position statement on continuous subcutaneous insulin infusion in the hospital setting

En España hay un número creciente de personas con diabetes tipo 1 tratadas con la terapia de infusión subcutánea continua de insulina (ISCI), pero no hay directrices nacionales sobre cómo manejar la terapia con bomba de insulina en el ámbito hospitalario. El Grupo de Nuevas Tecnologías de la Sociedad Española de Diabetes ha revisado la literatura y varias directrices internacionales y propone un documento de consenso sobre el manejo de la terapia con bomba de insulina para los pacientes hospitalizados. El documento contiene recomendaciones sobre las indicaciones, las contraindicaciones y los requisitos necesarios para el mantenimiento de la terapia con ISCI en el hospital. Esta revisión proporciona una guía para el manejo de pacientes ISCI en entornos especiales, tales como la sala de urgencias, cirugía, parto y para pacientes pediátricos. Por último, el grupo propone un conjunto de documentos necesarios para establecer una política ISCI en el hospital. En conclusión, la terapia con ISCI se puede utilizar con seguridad en el hospital en pacientes seleccionados después de haberse implementado un protocolo estandarizado

There is an increasing number of people with type 1 diabetes treated with continuous subcutaneous insulin infusion therapy (CSII) in Spain, but there are no national guidelines on how to manage insulin pump therapy in the hospital setting. The Group on New Technologies in Diabetes of the Spanish Diabetes Society has reviewed the literature and several international guidelines, and proposes a consensus document on the management of insulin pump therapy for inpatients. The document contains recommendations on indications, contraindications and the requirements needed to maintaining CSII therapy. This review provides a guide for the management of CSII patients in special settings such as the emergency room, surgery, delivery, and for pediatric patients. Finally, the group proposes a set of documents needed to establish a CSII policy in the hospital. In conclusion, CSII therapy can safely be used in the hospital in selected patients after the implementation of a standardized protocol

Biomarcadores moleculares implicados en el proceso de desdiferenciación tumoral del carcinoma de tiroides de origen epitelial: perspectivas / Molecular biomarkers involved in the tumor dedifferentiation process of thyroid carcinoma of epithelial origin: perspectives

Aunque el carcinoma diferenciado de tiroides, papilar o folicular, tiene habitualmente un buen pronóstico, existe un porcentaje de casos que presentan un comportamiento más agresivo con recurrencias locales y metastatización, ya sea en el momento del diagnostico (en menos de un 5% de los casos) ya en el seguimiento. A pesar de que existen diferentes sistemas de evaluación del pronóstico del carcinoma diferenciado de tiroides, basados especialmente en datos clínicos y patológicos, no hay en la actualidad un criterio válido que permita definir un tratamiento diferencial entre los pacientes con carcinomas de bajo riesgo y aquellos con carcinomas más agresivos. La identificación de los pacientes de riesgo en el momento del diagnóstico sería clave para desarrollar nuevas estrategias terapéuticas y mejorar el seguimiento, siendo en este sentido los biomarcadores moleculares una herramienta de gran valor (AU)

Abstract Although papillary or follicular well-differentiated thyroid carcinoma usually has a good prognosis, a proportion of well-differentiated thyroid carcinomas show a more aggressive behavior with local recurrence and metastases, either at diagnosis (in less than 5% of cases) or over time. Although there are several scoring systems to assess prognosis of well-differentiated thyroid carcinoma, mainly based on clinical and pathological data, there is currently no valid criterion to define an adequate, differential treatment for patients with low risk carcinomas as compared to those with more aggressive tumors. Identification of patients with a high risk at the time of diagnosis would be essential to develop new therapeutic strategies and to improve follow-up, and molecular biomarkers could be a highly useful tool for this purpose (AU)

[Molecular biomarkers involved in the tumor dedifferentiation process of thyroid carcinoma of epithelial origin: perspectives]. / Biomarcadores moleculares implicados en el proceso de desdiferenciación tumoral del carcinoma de tiroides de origen epitelial: perspectivas.

Although papillary or follicular well-differentiated thyroid carcinoma usually has a good prognosis, a proportion of well-differentiated thyroid carcinomas show a more aggressive behavior with local recurrence and metastases, either at diagnosis (in less than 5% of cases) or over time. Although there are several scoring systems to assess prognosis of well-differentiated thyroid carcinoma, mainly based on clinical and pathological data, there is currently no valid criterion to define an adequate, differential treatment for patients with low risk carcinomas as compared to those with more aggressive tumors. Identification of patients with a high risk at the time of diagnosis would be essential to develop new therapeutic strategies and to improve follow-up, and molecular biomarkers could be a highly useful tool for this purpose.

Glycemic control and pregnancy outcomes in women with type 1 diabetes mellitus using lispro versus regular insulin: a systematic review and meta-analysis.

AIMS: This study performed a systematic review and meta-analysis on glycemic control and pregnancy outcomes in women with type 1 diabetes mellitus (T1DM) treated with lispro (LP) versus regular insulin (RI) since before pregnancy. METHODS: We performed a MEDLINE and EMBASE search. Abstracts (and full articles when appropriate) were reviewed by two independent researchers. Inclusion criteria were patients with T1DM, data on women treated with RI and LP since before pregnancy until delivery in the same article, at least five pregnancies in each group, and information on at least one pregnancy outcome. Quality assessment was performed using the Newcastle-Ottawa Quality Assessment Scale for cohort studies. RESULTS: Outcome data were summarized with Revman version 5.0 (ims.cochrane.org/revman/download [The Nordic Cochrane Centre, The Cochrane Collaboration, Copenhagen, Denmark]), applying a random effects model. Two hundred sixty-seven abstracts were identified, and four full articles fulfilled inclusion criteria, all of them corresponding to observational studies. Baseline characteristics were similar in women treated with LP or RI. Regarding outcome data, no differences between LP and RI groups were observed in hemoglobin A1c, gestational age at birth, birth weight, and rate of diabetic ketoacidosis, pregnancy-induced hypertension, pre-eclampsia, spontaneous miscarriages, interruptions, total abortions, cesarean section, preterm birth, macrosomia, small-for gestational-age newborns, stillbirth, neonatal and perinatal mortality, neonatal hypoglycemia, and major malformations. The rate of large-for-gestational age newborns was higher in the LP group (relative risk 1.38; 95% confidence interval 1.14-1.68). CONCLUSIONS: In relation to women with T1DM treated with RI, those treated with LP display similar baseline characteristics and no differences in metabolic control or perinatal outcome with the exception of a higher rate of large-for-gestational-age newborns.

Estrategia de tratamiento de la dislipemia y consecución de objetivos en la población española con diabetes tipo 2 sin enfermedad cardiovascular / Therapeutic approach to dyslipidemia and goal achievement in a spanish population with type 2 diabetes without cardiovascular disease

Objetivo: Evaluar la estrategia terapéutica y el grado de consecución de los objetivos lipídicos en la población española con diabetes y alto riesgo cardiovascular. Sujetos y métodos: Estudio descriptivo, transversal y multicéntrico con inclusión mediante muestreo consecutivo de los 10 primeros pacientes que acudieron a consulta de Atención Primaria y que hubieran sido visitados durante los 12 meses previos al estudio. Se incluyeron pacientes con diabetes tipo 2 sin enfermedad cardiovascular, concentraciones de colesterol LDL(cLDL) ≤ 160 mg/dl y triglicéridos ≤ 600 mg/dl, y al menos uno de los siguientes: retinopatía, albuminuria, tabaquismo actual o hipertensión. Resultados: Se evaluaron 2.412 pacientes (edad: 61,3±8,3 años; 46,8% mujeres, duración de la diabetes de 8,6±7,4 años). En comparación con la visita previa (8,1±5 meses antes), en el momento de la evaluación, la proporción de pacientes con cLDL < 100 mg/dl (22,7 vs 28,6%),c-noHDL < 130 mg/dl (27,7 vs 33,8%) y la combinación de ambos (17,6 vs 22,1%) aumentaron significativamente. Las estatinas eran los fármacos hipolipemiantes más prescritos (65,5%) y,desde la visita previa, en el 38,7% de los pacientes se cambió el fármaco hipolipemiante, en el17,3% se aumentó la dosis y en un 5% se añadió otro fármaco. Conclusión: La utilización de estatinas de mayor potencia y el incremento de la dosis es la estrategia terapéutica más utilizada para mejorar el control de la dislipemia en los pacientes con diabetes tipo 2, pero estos cambios resultan claramente insuficientes para alcanzar los objetivos lipídicos en la mayoría de los pacientes con diabetes tipo 2 (AU)

Objective: To assess the therapeutic approach and lipid goal achievement in a spanish diabetic population at high cardiovascular risk. Subjects and methods: A multicenter, descriptive, cross-sectional study consecutively recruited the first 10 patients who attended the primary care office and had been seen in the12 months prior to the study visit. Inclusion criteria were type 2 diabetes without cardiovascular disease, LDL cholesterol levels ≤160 mg/dL, triglyceride levels ≤600 mg/dL, and at least one of the following: retinopathy, albuminuria, current smoking, or hypertension. Results: A total of 2412 patients were evaluated (aged 61.3±8.3 years, 46.8% women, diabetes duration 8.6±7.4 years). As compared to the previous visit (8.1±5 months before), the proportion of patients who achieved LDL-C levels <100 mg/dL (22.7% vs 28.6%), non-HDL-C levels<130 mg/dL (27.7% vs 33.8%) and both goals (17.6% vs 22.1%) significantly increased at the time of assessment. Statins were the most widely prescribed lipid-lowering drugs (65.5%) and the lipid-lowering drug was changed from the previous visit in 38.7% of patients, drug dosage was increased in 17.3%, and another drug was added in 5%.Conclusion: Use of more potent statins and higher statin doses were the most commonly used therapeutic strategies for improving control of dyslipidemia in patients with type2 diabetes, but these changes were clearly inadequate to achieve lipid goals in most patients with type 2 diabetes (AU)

[Therapeutic approach to dyslipidemia and goal achievement in a Spanish population with type 2 diabetes without cardiovascular disease]. / Estrategia de tratamiento de la dislipemia y consecución de objetivos en la población española con diabetes tipo 2 sin enfermedad cardiovascular.

OBJECTIVE: To assess the therapeutic approach and lipid goal achievement in a spanish diabetic population at high cardiovascular risk. SUBJECTS AND METHODS: A multicenter, descriptive, cross-sectional study consecutively recruited the first 10 patients who attended the primary care office and had been seen in the 12 months prior to the study visit. Inclusion criteria were type 2 diabetes without cardiovascular disease, LDL cholesterol levels ≤160mg/dL, triglyceride levels ≤600mg/dL, and at least one of the following: retinopathy, albuminuria, current smoking, or hypertension. RESULTS: A total of 2412 patients were evaluated (aged 61.3±8.3 years, 46.8% women, diabetes duration 8.6±7.4 years). As compared to the previous visit (8.1±5 months before), the proportion of patients who achieved LDL-C levels <100mg/dL (22.7% vs 28.6%), non-HDL-C levels <130mg/dL (27.7% vs 33.8%) and both goals (17.6% vs 22.1%) significantly increased at the time of assessment. Statins were the most widely prescribed lipid-lowering drugs (65.5%) and the lipid-lowering drug was changed from the previous visit in 38.7% of patients, drug dosage was increased in 17.3%, and another drug was added in 5%. CONCLUSION: Use of more potent statins and higher statin doses were the most commonly used therapeutic strategies for improving control of dyslipidemia in patients with type 2 diabetes, but these changes were clearly inadequate to achieve lipid goals in most patients with type 2 diabetes.