Importance of exercise in the control of metabolic and inflammatory parameters at the moment of onset in type 1 diabetic subjects.

The onset of type 1 diabetes coincides with the final phase of ß-cell destruction. In some cases, this period is characterized by the presence of a functional reserve of ß-cells, favouring an adequate metabolic control (honeymoon phase). Therefore, the extension of this situation could have evident benefits in subsequent diabetes management. We aimed to study the influence of regular physical activity before and after the onset of the disease. We did an observational study of 2 groups of type 1 diabetic patients from onset to a 2-year period. One group (n = 8) exercised regularly (5 or more hours/week) before onset and continued doing so with the same regularity. The second group (n = 11) either did not perform physical activity or did so sporadically. Circulating glycated haemoglobin (HbA1c), C-peptide, protein carbonyls and basal cytokine levels were determined at the beginning and at the end of the 1(st) and 2(nd) year. The more active group debuted with and maintained significantly lower HbA(1c) levels and insulin requirements compared to the more sedentary group. C-peptide levels were only significantly higher in the active group at the moment of onset compared to the sedentary group. In addition, determination of basal circulating cytokines revealed a large variability between individuals but no significant differences when comparing the groups. Altogether, the obtained results seem to indicate that physical activity allows a better control at the moment of onset regarding glycaemic control, residual endocrine pancreatic mass and subsequent insulin requirements.

Growth hormone, ghrelin and peptide YY secretion after oral glucose administration in healthy and obese women.

The mechanism of the altered GH secretion in obesity is unclear. There is evidence that oral glucose (OG) administration initially decreases and subsequently stimulates GH secretion. Ghrelin is a peptide that displays strong growth hormone-releasing activity. Its physiological importance on GH regulation is unclear. Our aim was to study fasting GH concentrations and their response to OG administration in relation with ghrelin secretion in obese and healthy women, in order to elucidate the hypothetical participation of ghrelin on post-oral glucose GH secretion. 36 women were included in the study. After an overnight fast, 75 g of oral glucose was administered; glucose, insulin, ghrelin, and PYY (1-36) were obtained at baseline and during 300 min. The area under the curve between 0 and 300 min (AUC) of GH µ/l·min) was lower in obese patients than in controls; 262.5±57.5 vs. 534.9±95.6, p=0.01, for obese and controls respectively. GH peak (µg/l) was lower in obese patients than in controls; 3.7±0.7 vs. 7.1±1.0, p=0.012, for obese and controls, respectively. The AUC of total ghrelin (pg/ml·min) was lower in obese patients than in controls; 233,032±12,641 vs. 333,697±29,877, p=0.004, for the obese patients and controls respectively. PYY (1-36) was similar in obese and healthy women after OG. There were significant correlations between the different indices of post-oral glucose GH and ghrelin secretion. These data suggest that ghrelin is a physiological regulator of GH in the post-oral glucose state, and the decreased ghrelin secretion could be one of the mechanisms responsible for the altered GH secretion in obesity.

Eficacia y seguridad de ezetimiba en unidades de riesgo vascular / Efficacy and safety of ezetimibe in vascular risk units

Objetivos Desconocemos la eficacia hipolipemiante y la seguridad de ezetimiba en monoterapia o combinada con estatinas en atención especializada y condiciones de práctica clínica. Pacientes y métodos Estudio retrospectivo multicéntrico (unidades hospitalarias de medicina interna y endocrinología) de pacientes tratados con ezetimiba durante al menos 12 semanas. Los pacientes fueron incluidos en tres grupos: a) ezetimiba como único hipolipemiante; b) ezetimiba añadida a estatina, y c) ezetimiba combinada de inicio con estatina. La variable principal fue el porcentaje medio de reducción de colesterol de las lipoproteínas de baja densidad (cLDL) en el último análisis disponible respecto al documentado antes de comenzar el tratamiento con ezetimiba. Resultados Incluimos a 217 pacientes (media de edad, 59 años), 61% mujeres. Un 21% padecía diabetes mellitus tipo 2 y el 20% había sufrido un evento cardovascular previo, por lo que el tratamiento hipolipemiante debía satisfacerr objetivos de prevención secundaria. En el subgrupo de monoterapia (n=92; tratamiento medio, 41 semanas) el cLDL descendió un 28% (p<0,001). En el subgrupo de ezetimiba añadido a estatinas (n=94; tratamiento medio, 73 semanas) el cLDL disminuyó un 34% (p<0,001). En el subgrupo ezetimiba más estatina de inicio (n=31; tratamiento medio, 118 semanas) el cLDL descendió un 53% (p<0,001). En total, un 64% de los pacientes alcanzó el objetivo terapéutico propuesto por el Adult Treatment Panel III (ATPIII) para cLDL. En los pacientes con bajo riesgo (cLDL<160 mg/dl), riesgo moderado (cLDL<130 mg/dl) y riesgo alto-muy alto (cLDL<100-70 mg/dl), los enfermos en objetivo terapéutico fueron el 81%, el 64% y el 44%, respectivamente. Conclusiones En condiciones de práctica clínica habitual, ezetimiba resulta eficaz y segura para reducir el cLDL, permitiendo alcanzar los objetivos terapéuticos propuestos por ATPIII en un elevado número de pacientes, especialmente si se combina con estatinas (AU)

Objectives. This study was intended to assess the efficacy and safety of ezetimibe when taken alone or combined with statins in a specialized care setting and under standard clinical practice conditions. Patients and methods. A multicenter, retrospective study in patients with dyslipidemia seen in a specialized outpatient clinic and treated with ezetimibe for at least 12weeks. Patients were divided into three groups: monotherapy, add-on ezetimibe, and initial coadministration. Results. A total of 217 patients (mean age 59years; 37% ¡Ý65years) were enrolled. Of these, 61% were women, 21% had type 2 diabetes and 20% had had a previous cardiovascular event so that the lipid lower drug treatment should satisfy the objectives of secondary prevention. Mean change in the monotherapy group (n=92; mean 41weeks) included: decrease of LDLc of 28% (P<.001). In the group where ezetimibe was added on to different ongoing statins (n=94, mean 73weeks), mean changes was as follows: LDLc ¨C34%, significant change as compared to monotherapy (P<.001). In the group with initial coadministration of ezetimibe with different statins (n=31; mean 118weeks), mean change included: LDLc ¨C53% (P<.001). Overall, 64% of patients reached the thereapeutic objective proposed for the Adult Treatment Panel III (ATPIII) for cLDL. In patients with low risk (LDLc<160mg/dL), moderate risk (LDLc<130mg/dL) and high-very high risk (LDLc<100-70mg/dL), the percentage of patients who reached the therapeutic objective was 81%, 64% and 44%, respectively. Conclusions. Under standard clinical practice conditions, ezetimibe appears to be effective and safe for the control LDLc, thus making it possible to reach the therapeutic objectives proposed by the ATP-III in a high number of patients, especially when associated to statins(AU)

[Efficacy and safety of ezetimibe in vascular risk units]. / Eficacia y seguridad de ezetimiba en unidades de riesgo vascular.

OBJECTIVES: This study was intended to assess the efficacy and safety of ezetimibe when taken alone or combined with statins in a specialized care setting and under standard clinical practice conditions. PATIENTS AND METHODS: A multicenter, retrospective study in patients with dyslipidemia seen in a specialized outpatient clinic and treated with ezetimibe for at least 12 weeks. Patients were divided into three groups: monotherapy, add-on ezetimibe, and initial coadministration. RESULTS: A total of 217 patients (mean age 59 years; 37% ≥65 years) were enrolled. Of these, 61% were women, 21% had type 2 diabetes and 20% had had a previous cardiovascular event so that the lipid lower drug treatment should satisfy the objectives of secondary prevention. Mean change in the monotherapy group (n = 92; mean 41 weeks) included: decrease of LDLc of 28% (P <.001). In the group where ezetimibe was added on to different ongoing statins (n = 94, mean 73 weeks), mean changes was as follows: LDLc -34%, significant change as compared to monotherapy (P < .001). In the group with initial coadministration of ezetimibe with different statins (n = 31; mean 118 weeks), mean change included: LDLc -53% (P < .001). Overall, 64% of patients reached the thereapeutic objective proposed for the Adult Treatment Panel III (ATPIII) for cLDL. In patients with low risk (LDLc < 160 mg/dL), moderate risk (LDLc < 130 mg/dL) and high-very high risk (LDLc < 100-70 mg/dL), the percentage of patients who reached the therapeutic objective was 81%, 64% and 44%, respectively. CONCLUSIONS: Under standard clinical practice conditions, ezetimibe appears to be effective and safe for the control LDLc, thus making it possible to reach the therapeutic objectives proposed by the ATP-III in a high number of patients, especially when associated to statins.

[Utility of magnetic resonance in the etiologic diagnosis of hypopituitarism]. / Utilidad de la resonancia magnética en el diagnóstico etiológico del hipopituitarismo.

The diagnosis of hypothalamic-pituitary disorders relies on a combination of clinical and biochemical data and imaging techniques. During the last decade, computed tomography (CT) has been the best technique for the evaluation of the hypothalamuspituitary region, but in recent years magnetic resonance (MR) has improved the diagnostic efficiency of CT. We retrospectively review the clinical records of 40 hypopituitary patients from the endocrinology unit of our hospital. The aim of the present study was to establish the role of MR in the etiologic diagnosis and anatomic definition of hypopituitarism, when compared with CT. Secondarily, we studied the different pituitary hormones in this condition. The diagnoses were: 12 postsurgical hypopituitarism, 10 empty sella turcica, 7 Sheehan's syndrome, 5 idiopathic hypopituitarism, 3 pituitary disgenesis, 2 craniopharyngioma and 1 macroprolactinoma. GH was the most commonly affected hormone, followed by gonadotrophins, corticotrophin and thyrotrophin (100%, 94%, 76% and 68% respectively). In 24 patients both MR and CT studies were performed. MR was diagnostic in 22 patients, and CT in 15 patients (p < 0.05). MR offered improved diagnostic or anatomical data in 16 patients of the 24 in whom both techniques were performed (p < 0.05). We conclude that MR allows a better definition of the hypothalamus-pituitary region than CT, contributing to the etiologic diagnosis and improving the anatomical findings. Empty sella turcica should be considered a common cause of hypopituitarism.

Persistent GHRH-induced PRL secretion in Cushing's syndrome, obesity and exogenous hypercortisolism.

Endogenous Cushing's syndrome, obesity and chronic glucocorticod treatment are characterized by blunted GH secretion. The administration of GHRH is capable of stimulating a small but significant PRL increase in normal subjects. The current study was designed to determine plasma PRL levels in response to GHRH, studied in three different situations characterized by a blunted GH secretion. Obese patients (n = 6) with a weight over 30% of ideal body weight, patients with active Cushing's syndrome, and normal volunteers treated with dexamethasone 22 mg per os over two days before the pituitary challenge were studied. As a control group 18 normal subjects of similar age and sex were studied. GH and PRL was determined at intervals after GHRH (1 microgram/kg). GHRH-induced GH secretion was markedly reduced in patients with obesity, patients with endogenous Cushing's syndrome and volunteers treated with dexamethasone. In contrast, GHRH-induced PRL secretion was not affected in these three clinical situations. In summary, in three situations characterized for an impairment of the somatotroph cell, due to a primary intrinsic defect or to a functional hypothalamic alteration, there is a persistent GHRH-induced PRL secretion, suggesting that prolactin could be released by mammosomatotrophs that function normally in spite of hyposomatotropism.