Effect of the historic Spanish heatwave over glycemic control in adult patients with type 1 diabetes.

AIM: To evaluate the effect of the historic Spanish heatwave (9th-26th July 2022) over glycemic control in adults with type 1 diabetes (T1D). METHODS: Cross-sectional retrospective analysis of adult patients with T1D in Castilla-La Mancha (south-central Spanish region) using intermittently scanned continuous glucose monitoring (isCGM) during and after the heatwave. Primary outcome was change in time in range (TIR) 3.0-10 mmol/L (70-180 mg/dL) of interstitial glucose in the two weeks following the heatwave. RESULTS: A total of 2701 T1D patients were analyzed. We detected a TIR reduction of 4.0 % (95 % CI -3.4, -4.6; P < 0.001) in the two weeks following the heatwave. Patients in the highest daily scan frequency quartile (>13 scans/day) during the heatwave showed the greatest deterioration in TIR after it concluded (-5.4 % [95 % CI -6.5, -4.3; P < 0.001]). The percentage of patients meeting all the recommendations of the International Consensus of Time in Range was greater during the heatwave than after it ended (10.6 % vs. 8.4 %, P < 0.001). CONCLUSIONS: Adults with T1D had better glycemic control during the historic Spanish heatwave compared to the following period.

[Adrenal incidentalomas: clinical experience in the hospitals of Castilla-La Mancha (Spain)]. / Incidentalomas suprarrenales: experiencia clínica en los hospitales de Castilla-La Mancha.

OBJECTIVE: The management of incidentally discovered adrenal masses (incidentalomas) remains controversial. Our objective was to describe the demographic and clinical characteristics of a series of patients with adrenal incidentalomas attended in several hospitals of Castilla-La Mancha, and their diagnostic and therapeutic management. MATERIAL AND METHODS: Data were obtained by reviewing the patients' medical charts. RESULTS: A total of 270 patients were included (28.1% from Toledo, 25.9% from Albacete, 24.1% from Ciudad Real, 15.9% from Cuenca and 5.9% from Guadalajara). The mean age was 60.3 +/- 12 and 53.3% were women. Overweight or obesity were found in 80.6%, hypertension in 55.8%, diabetes mellitus in 25.6%, impaired fasting glucose or impaired glucose tolerance in 15.6%, osteopenia in 31.5% and osteoporosis in 20.4%. These percentages were similar in patients with subclinical Cushing's syndrome. Diameter was less than 3 cm in 66% of the tumors, and more than 4 cm in 14.3%. Eighty-five percent of the tumors were detected by computed tomography. After a median follow-up of 28.8 months, 6% of nonfunctioning adenomas progressed to subclinical Cushing's syndrome, tumoral enlargement of more than 1 cm was found in 9.4% and a contralateral mass developed in 8.9%. Surgical adrenalectomy was performed in 14.4% of the patients. CONCLUSIONS: Our study confirms the favorable outcome in most patients with adrenal incidentalomas and contributes to a better understanding of this clinical entity.

Incidentalomas suprarrenales: experiencia clínica en los hospitales de Castilla-La Mancha / Adrenal incidentalomas: clinical experience in the hospitals of Castilla-La Mancha (Spain)

Objetivo: El manejo de las masas suprarrenales descubiertas de manera incidental (incidentalomas) sigue siendo controvertido. El objetivo de este trabajo es describir las características demográficas y clínicas, así como el manejo diagnóstico-terapéutico, de una serie de pacientes conincidentalomas suprarrenales atendidos en los principales hospitales de Castilla-La Mancha. Material y métodos: Los datos se recogieron mediante revisión de historias clínicas. Resultados: Se revisaron las historias clínicas de 270 pacientes(el 28,1% de Toledo, el 25,9% de Albacete, el 24,1% de Ciudad Real, el15,9% de Cuenca y el 5,9% de Guadalajara), con media de edad de60,3 ± 12 años y de los que el 53,3% eran mujeres. El 80,6% presentaba sobrepeso u obesidad; el 55,8%, hipertensión arterial; el 25,6%, diabetes mellitus; el 15,6%, alteración de la glucemia en ayunas o intolerancia hidrocarbonada; el 31,5%, osteopenia, y el 20,4%, osteoporosis; estos porcentajes son similares en los pacientes con síndrome de Cushing subclínico. El 66% de los tumores medían menos de 3 cm y el 14,3% más de 4 cm. El 85% fueron detectados por tomografía computarizada. Tras una mediana de seguimiento de 28,8 meses el 6% de los adenomas no funcionantes evolucionaron a un síndrome de Cushing subclínico, en un9,4% de los casos el diámetro de la masa aumentó más de 1 cm y en un8,9% apareció una masa contralateral. El 14,4% de los pacientes se sometieron a suprarrenalectomía quirúrgica. Conclusiones: Nuestro estudio confirma la evolución favorable de la mayoría de los pacientes con incidentalomas suprarrenales y contribuye a un mejor conocimiento de esta entidad clínica (AU)

Objective: The management of incidentally discovered adrenal masses (incidentalomas) remains controversial. Our objective was to describe the demographic and clinical characteristics of a series of patients with adrenal incidentalomas attended in several hospitals of Castilla-La Mancha, and their diagnostic and therapeutic management. Material and methods: Data were obtained by reviewing the patients’ medical charts. Results: A total of 270 patients were included (28.1% from Toledo, 25.9% from Albacete, 24.1% from Ciudad Real, 15.9% from Cuenca and 5.9% from Guadalajara). The mean age was 60.3 ± 12 and 53.3% were women. Overweight or obesity were found in 80.6%, hypertension in 55.8%, diabetes mellitus in 25.6%, impaired fasting glucose or impaired glucose tolerance in 15.6%, osteopenia in 31.5% and osteoporosis in 20.4%. These percentages were similar in patients with subclinical Cushing’s syndrome. Diameter was less than 3 cm in 66% of the tumors, and more than 4 cm in 14.3%. Eighty-five percent of the tumors were detected by computed tomography. After a median follow-up of 28.8 months, 6% of non-functioning adenomas progressed to subclinical Cushing’s syndrome, tumoral enlargement of more than 1 cm was found in 9.4% and a contralateral mass developed in 8.9%. Surgical adrenalectomy was performed in 14.4% of the patients. Conclusions: Our study confirms the favorable outcome in most patients with adrenal incidentalomas and contributes to a better understanding of this clinical entity (AU)