[Early diabetic nephropathy and cardiovascular disease in a Mediterranean population: risk factors and treatment intensity]. / Nefropatía diabética inicial y enfermedad cardiovascular en una población mediterránea: factores de riesgo y grado de tratamiento.

The objective of this cross-sectional study was to evaluate the impact of early diabetic nephropathy on the presence of cardiovascular disease (CVD) in a Mediterranean population, as well as the prevalence in these patients of traditional cardiovascular risk factors and its treatment intensity in accordance with international recommendations. In 123 patients with type 2 diabetes and incipient nephropathy the presence of CVD, smoking, hypertension, dyslipemia, and their treatment was recorded. CVD prevalence was 34%. Age, nephropathy stage (micro/macroalbuminuria), and smoking were associated with the presence of CVD. Hypertension, dyslipemia, and smoking were present in 83%, 81%, and 59%, respectively. Coexistence of several risk factors was frequent and was associated with a higher incidence of CVD. 79% hypertensive patients and 43% dyslipemic patients received pharmacological treatment but only 17% and 9%, respectively, reached a good control of their disease. Patients with known CVD showed also a deficient control. Accordingly, early diabetic nephropathy induces a multiplier effect on the cardiovascular risk of a Mediterranean population. Higher prevalence and association with cardiovascular risk factors, with smoking in a predominant role, are associated with this higher risk. Despite this, the intensity of treatment and control of these risk factors is deficient, which means that a better and more intensive treatment should reduce the morbidity and mortality in these patients.

[Outpatient insulin therapy in type II diabetes: program evaluation and calculation of cost saving]. / La insulinización ambulatoria en la diabetes tipo II: evaluación de un programa y cálculo del ahorro económico.

BACKGROUND: Evaluation of the results of a program of outpatient insulinization in type II diabetes and the resulting saving in cost. METHODS: Data from 39 patients with that disease (mean age 62 years) were evaluated four months after the beginning of insulin therapy and diabetic education. The economic cost of the outpatient program was calculated and compared with the cost if patients had been admitted. RESULTS: A good metabolic control was achieved with a significant reduction (p less than 0.001) of the glycemic levels from 281 +/- 43 mg/dl (15.6 +/- 2.4 mmol/l) to 156 +/- 22 mg/dl (8.6 +/- 1.5 mmol/l). Fructose levels were reduced from 4.7 +/- 0.54 mmol/l to 3.29 +/- 0.51 mmol/l. Seventeen patients had some episode of mild hypoglycemia. The insulin dose was increased from 0.27 +/- 0.06 U per kg and day to 0.42 +/- 0.1 (11 patients required two insulin doses). At onset, no patient controlled the glycemia at home, while at the end of the program 46% did so. The evaluation of each educational end-point showed a mean of 4.8 +/- 0.3 (from 0 to 5); the end-point with the best score were the technical aspects. The economic cost of the program was 230.39 ptas per patient and day, versus 1351.75 ptas per patient and day if the patients had been admitted. CONCLUSIONS: Outpatient insulinization in type II diabetes has very good results and is economically effective provided the adequate equipment and facilities are available.

[Newborn infants of diabetic mothers. Clinical study in the period 1980-1985]. / Recién nacido de madre diabética. Estudio clínico del período 1980-1985.

An statistical analysis is reported on specific problems of the infant of diabetic mother during the period 1980-1985, with a total of 287 newborns. Complications in this sample are exposed, and significant differences demonstrated in gestational age, fetal distress, hypocalcemia, polycythemia, jaundice, respiratory distress syndrome and associated problems according to clinical type of diabetes mellitus. High percentage of congenital malformations is pointed-out with a predominance of cardiac septal defects. Diabetological control was closer in insulin-dependent group, therefore, its effect has been studied separately. A lower rate of hypoglycemia was found in those under control, while infant of insulin-dependent diabetic mother showed a better compliance between weight and gestational age and a lower rate of respiratory distress syndrome.