[Metabolic syndrome and insulin resistance: prevalence in women with prior gestational diabetes, using two different classifications]. / Síndrome metabólico y resistencia insulínica: prevalencia según distintas clasificaciones en mujeres con diabetes gestacional previa.

OBJECTIVE: To determine the metabolic syndrome prevalence using the ATPIII and the IDF definitions and that of each criterion and to study the differences. To relate the presence of insulin resistance with metabolic syndrome diagnostic. MATERIALS AND METHODS: A total of 1,080 women diagnosed of gestational diabetes who came to follow up were studied. Prevalence of the metabolic syndrome was determined using the ATPIII and the IDF classification and prevalence of each criterion independently. The HOMA insulin resistance index was determined in 575 patients. RESULTS: Metabolic syndrome prevalence was 9.3% according to the ATPIII classification and 17.4% according to the IDF, this coinciding in 94 cases. Only the IDF classification criteria were fulfilled in 94 cases due to abdominal obesity in 13.8%, to fasting glucose in 17% and to both criteria in 69.8%. Six cases only met the ATPIII classification due to absence of abdominal obesity. The HOMA index value was 4.9 (+/- 3.5) and 4.0 (+/- 3) for women diagnosed of metabolic syndrome using the ATPIII or the IDF classification, respectively. Insulin resistance prevalence was 13.7%. The Kappa index of agreement was 0.411 between metabolic syndrome diagnostic by ATPIII and insulin resistance and 0.352 for IDF. CONCLUSIONS: Metabolic syndrome prevalence is almost double when the IDF classification is used than with the ATPIII due to the more strict value of fasting glucose and abdominal obesity. The ATPIII classification better identifies insulin resistance presence than that of IDF.

[Diabetic foot and risk factors]. / Factores de riesgo y pie diabético.

OBJECTIVE: To identify clinic and metabolic risk factors for diabetic neuropathy and peripheral arterial disease in patients evaluated in a diabetic foot unit care. METHOD: From 2000 to 2005 we evaluated the presence of diabetic neuropathy (monofilament, tuning fork and Boulton's clinic scale) and peripheral arterial disease (ankle-brachial index and toe-brachial index) in 304 diabetic patients. We classified patients in four groups: patients without pathology (normal group), with neuropathy (neuropathic group), with peripheral arterial disease (vascular group) and with both pathologies (mixed group) and we compared the characteristics of each group. We analysed other poblational characteristics: age, gender, type of diabetes, duration, microvascular and macrovascular complications, hypertension, smoking habit, antiagregation and mean HbA1c in the last year. RESULTS: Age, frequency of hypertension and coronary disease were significantly higher (p < 0.005) in vascular and mixed group than in normal group (63 +/- 13 and 65 +/- 10 vs. 55 +/- 14; 69.2 and 70.3 vs. 45.5%; 46,2% and 39.2% vs 23.8%, respectively). Frequency of retinopathy, nephropathy and HbA1c were significantly higher (p < 0.05) in neuropathic and mix group than in normal group (62.5 and 66.2 vs. 32.7%; 45.3 and 47.3 vs. 24.8%; 8.1 +/- 1.6 and 8.0 +/- 1.3 vs 7.4 +/- 1.2 respectively). CONCLUSION: This study indicates that the development of diabetic neuropathy is related with worse metabolic control and the presence of other microvascular complications; while age, hypertension and coronary disease are risk factors for peripheral arterial disease.

[Imaging advances in the diagnosis of neuroendocrine tumors]. / Avances en la localización de los tumores neuroendocrinos con las ténicas de imagen.

We present two cases of neuroendocrine tumors: insulinoma and glucagonoma. Several diagnostic procedures are analysed including those useful to localize the tumor and its possible metastasis, as ultrasound, computed tomography, magnetic resonance imaging, angiography, endoscopic ultrasonography and somatostatin receptor scintigraphy. We suggest that the work up should begin with lesser invasive procedures such as CT and In111-labelled pentetreotide scan.

[Pathological characteristics of patients with diabetes mellitus type 2, in Spanish Primary Care]. / Perfil de los pacientes con diabetes mellitus tipo 2, en la Atención Primaria española.

CONTEXT: To know the characteristics, related risk factors, and degree of control in patients with diabetes mellitus type 2 (DM2) in our country. METHODS: Observational, unrandom, opened, and multicenter study. Anthropometric characteristics, substance abuse, medication, control of diabetes, cholesterol, and triglycerides were analyzed in 5,395 patients. The patients were classified according to the length of the diagnosis: recent diabetes (RD) and known diabetes (KD). The chi-square test was utilized in order to compare the categorical variables, and the Student's t test for compare the continuous variables. The relationship between these variables was analyzed through the Pearson's correlation coefficient, and an analysis of multiple correspondence was carried out. RESULTS: Median age, 63 years; obese, 34%; smokers, 11%; drinkers, 24%; hypertensives, 44%; lipemic, 42%. Control degree: HbA1c>6.5% in 79%, LDLc>115 mg/dl in 80%. Hypoglycemic treatment: sulfonylureas, 62.8%; antidiabetics combination, 5%; only insulin, 4.3%; insulin combined with antidiabetics, 20.6%. Control of diabetics, of lipids, and of weight was lower in the patients with KD that in the patients with RD (HbA1c, 7.6% versus 7%; LDLc 148 mg/dl versus 136 mg/dl; percentage of obese, 27.2% versus 38.62%). A relationship between the length of evolution of diabetes and the deterioration of the control of blood glucose and of lipids was detected. CONCLUSION: DM2 and its associated risk factors are insufficiently controlled in our country. The drug combination and insulin are utilized scarcely.

Liver transplantation for type Ib glycogenosis with reversal of cyclic neutropenia.

We describe a case of glycogen storage disease type Ib in 32-year old male patient with poor metabolic control in spite of medical and nutritional management and the use of recombinant granulocyte stimulating factor. Because of this, liver transplantation was considered as a definitive treatment. We comment on the metabolic results of liver transplantation performed, with reversal of hypoglycemia, hyperuricemia, hypertriglyceridemia and cyclic neutropenia, all of which persist 4 years post-transplant. In view of this case, we believe that liver transplantation is a feasible option to consider in patients with type Ib glycogenosis as a definitive therapeutic procedure.

[Diabetic ketoacidosis in patients with soft-tissue necrotizing infections]. / Cetoacidosis diabética en pacientes con infecciones necrosantes de tejidos blandos.

Necrotizing soft tissue infection is an uncommon and severe infection of the skin, subcutaneous tissue and superficial fascia which is usually accompanied by severe systemic toxicity. These infections occur more frequently in diabetics and are associated with higher morbidity and mortality rate. The prognosis of necrotizing fasciitis is known to be dependent on early recognition and treatment. Therefore, clinical awareness is important to avoid fatal outcome in patients with diabetes mellffus. We present three patients with undiagnosed type 2 diabetes in whom hyperglycaemia may have facilffated me development of necrotizing tissue infection, which in tum may have precipitated diabetic ketoacidosis in patients who rarely develop this metabolic complication.

[Preconceptional control in diabetic women]. / El control preconcepcional en la gestante diabética.

The experience of the Preconceptional Clinic developed in our hospital from 1992 to 1996 is here reported. Twenty-eight insulin-dependent diabetic patients underwent a preconceptional control (PCC). Pregnancy was obtained in 19 patients (2 miscarriages, 12 full pregnancies, and 5 pregnancies in course). A comparative case-control study was performed between the 12 patients undergoing PCC, who have completed their pregnancy, and other 12 prepregnant diabetic patients, controlled from the 7-12 weeks of pregnancy. HbA1c levels in the PCC group were lower, and no differences regarding fetal morbidity were observed. The presence of a severe congenital malformation in the PCC group, with normal periconceptional HbA1c levels, denotes the teratogenic influence of factors yet to be elucidated.

[Primary empty sella turcica: clinical, radiological and hormonal evaluation]. / Silla turca vacía primaria: evaluación clínica, radiológica y hormonal.

A retrospective study of 33 patients diagnosed of primary empty sella turcica has been done. Main clinical feature was cephalea, which was present in 51.1% of cases. Diagnosis was done based in Neuroradiologic studies (CAT, Cisternography, Pneumocisternography, Nuclear Magnetic Resonance) finding sellar size being significantly smaller in cases studied after 1980. After Hypophyseal function study, 19 patients did not show any endocrinological disorders, in the other 14 (42.4%), hyperprolactinemia was the most frequent finding (7 patients, 23.3%). 17.8% of cases showed a lowered response of Growth Hormone to insulinic Hypoglycemia. In two cases Panhypopituitarism was found and in case Insipidus diabetes was diagnosed.