Body composition and sexual hormones for the glucose control of autoimmune diabetes in males: are they necessary to predict diabetes-related complications?

Background: Glucose control in diabetes is essential for avoiding diabetes-related complications. Aim: To determine the impact of body composition and sexual hormones in glucose control and diabetes-related complications, in males with autoimmune diabetes. Patients and methods: Thirty-nine patients with autoimmune diabetes and flash glucose monitoring were included. A morphofunctional nutritional evaluation with bioelectrical impedance vector analysis (BIVA), abdominal adipose tissue ultrasound, rectus femoris ultrasound and biochemical parameters, was performed. Results: Strong, positive correlations were observed between body composition parameters, biochemical variables and sexual hormones (p<0.05). Adipose tissue measured by BIVA and ultrasound was more significantly associated with glucose control (including time in range >70%, glucose variability <36% determined by flash glucose monitoring; p<0.05) and the presence of microvascular/macrovascular complications (p<0.05) than lean mass. After adjusting by the duration of diabetes, BMI, abdominal circumference, fat mass and phase angle increased the risk for microvascular complications (OR 1.32(1.00 - 1.73), OR 1.06(1.00 - 1.12), OR 1.14(1.01 - 1.20), 0R 0.3(0.10 - 0.91) respectively; for macrovascular complications: BMI OR 1.38(1.04 - 1.84) and fat mass OR 1.26(1.00 - 1.58)]. Sexual hormone levels did not influence on glucose control or the development of diabetes-related complications. Conclusion: Anthrpometric parameters, especially adipose tissue, were associated with glucose control and variability determined by flash glucose monitoring. Furthermore, changes in fat and lean mass were associated with the presence of microvascular and macrovascular complications. Thus, a comprehensive nutritional evaluation might be useful for the evaluation of males with autoimmune diabetes, in order to identify patients with increased risk of complications.

Hyperlipidemia during gestational diabetes and its relation with maternal and offspring complications.

INTRODUCTION: lipid profile suffers adaptive changes during pregnancy due to estrogen stimulation and insulin resistance. Several relations have been suggested between maternal lipid profile, glucose tolerance, endothelial cell dysfunction and long-term cardiovascular risk; the effects of maternal lipid profile metabolism in fetal growth are also inconclusive. Since a regular evaluation and follow-up of lipid profile during pregnancy has not been established yet, we aimed to evaluate the incidence of dyslipidemia in patients with gestational diabetes (GDM) and analyze some putative relations with pregnancy, offspring complications and maternal metabolic syndrome parameters determined three and twelve months after delivery. PATIENTS AND METHODS: two hundred and fifty patients with GDM were included. Full medical history, offspring characteristics, lipid profile and maternal variables of metabolic syndrome were evaluated during pregnancy and three- and twelve-months after delivery. The incidence of dyslipidemia during pregnancy was determined using two different classifications. RESULTS: lower plasma HDL and hypertriglyceridemia were the most current disorders; prematurity or birth weight were not correlated with dyslipidemia. During pregnancy, the lipid-related parameter that better predicted the risk of offspring macrosomia was triglycerides (TG). High TG three months after delivery were correlated to macrosomia and metabolic syndrome variables before and after pregnancy (three and twelve months). CONCLUSIONS: TG during pregnancy is the parameter that best predicts the risk of macrosomia and is related to increased metabolic risk after delivery. The evaluation of lipid profile and other metabolic variables during pregnancy and after delivery is required to early diagnose cardiovascular risk factors, especially in high risk population.

Hyperlipidemia during gestational diabetes and its relation with maternal and offspring complications / Hiperlipidemia durante la diabetes gestacional, complicaciones maternas y para la descendencia

Introduction: lipid profile suffers adaptive changes during pregnancy due to estrogen stimulation and insulin resistance. Several relations have been suggested between maternal lipid profile, glucose tolerance, endothelial cell dysfunction and long-term cardiovascular risk; the effects of maternal lipid profile metabolism in fetal growth are also inconclusive. Since a regular evaluation and follow-up of lipid profile during pregnancy has not been established yet, we aimed to evaluate the incidence of dyslipidemia in patients with gestational diabetes (GDM) and analyze some putative relations with pregnancy, offspring complications and maternal metabolic syndrome parameters determined three and twelve months after delivery. Patients and methods: two hundred and fifty patients with GDM were included. Full medical history, offspring characteristics, lipid profile and maternal variables of metabolic syndrome were evaluated during pregnancy and three- and twelve-months after delivery. The incidence of dyslipidemia during pregnancy was determined using two different classifications. Results: lower plasma HDL and hypertriglyceridemia were the most current disorders; prematurity or birth weight were not correlated with dyslipidemia. During pregnancy, the lipid-related parameter that better predicted the risk of offspring macrosomia was triglycerides (TG). High TG three months after delivery were correlated to macrosomia and metabolic syndrome variables before and after pregnancy (three and twelve months).Conclusions: TG during pregnancy is the parameter that best predicts the risk of macrosomia and is related to increased metabolic risk after delivery. The evaluation of lipid profile and other metabolic variables during pregnancy and after delivery is required to early diagnose cardiovascular risk factors, especially in high risk population

Introducción: los cambios del perfil lipídico durante el embarazo se relacionan probablemente con la estimulación estrogénica y la resistencia a la insulina. Diversas relaciones se han planteado entre el perfil lipídico gestacional, la intolerancia a la glucosa, la disfunción endotelial y el riesgo cardiovascular a largo plazo; sus efectos sobre el crecimiento fetal no son concluyentes. Dado que no existe un protocolo de diagnóstico y seguimiento de la dislipemia durante el embarazo, el objetivo del presente estudio fue evaluar la incidencia de dislipemia en pacientes con diabetes gestacional (DMG) y analizar su relación con complicaciones maternas, fetales y variables de síndrome metabólico 3 y 12 meses tras el parto. Pacientes y métodos: fueron incluidos 250 pacientes con DMG. Se analizaron variables clínicas maternas y del recién nacido y se determinó el perfil lipídico durante el embarazo, 3 y 12 meses tras el parto. La incidencia de dislipemia se realizó utilizando dos clasificaciones diferentes. Resultados: las alteraciones más frecuentes fueron bajos niveles de HDL y altos de triglicéridos (TG). La prematuridad o el peso al nacer no se relacionaron con la presencia de dislipemia. El parámetro lipídico que mejor predijo el riesgo de macrosomía fueron los TG. Altos niveles de TG tres meses después del parto se relacionaron con macrosomía y variables de síndrome metabólico pregestacional, así como 3 y 12 meses después del parto. Conclusiones: los niveles de TG durante el embarazo representan el parámetro que mejor predice el riesgo de macrosomía y se relacionan con un mayor riesgo metabólico después del parto. La evaluación del perfil lipídico durante el embarazo y después del parto permite un diagnóstico precoz de factores de riesgo cardiovascular, especialmente en poblaciones de alto riesgo

¿A quién y cuándo plantear el tratamiento con liraglutida? / Liraglutide therapy: when and in whom?

Liraglutida es un agonista del receptor de GLP-1 aprobado para el tratamiento de la diabetes mellitus tipo 2 (DM2), que mejora el control glucémico con bajo riesgo de hipoglucemias, reduce el peso corporal, mejora otros factores de riesgo cardiovascular y presenta un potencial efecto protector sobre la función de la célula beta. Todo ello pudiera traducirse a largo plazo en una reducción de las complicaciones propias de esta enfermedad. Estas ventajas sitúan a liraglutida como opción preferente de tratamiento tras fracaso de monoterapia frente a otros fármacos disponibles en la actualidad, dado que la probabilidad de conseguir un objetivo compuesto de HbA1c < 7%, sin hipoglucemias y sin ganancia ponderal es significativamente superior a la de sus comparadores. En la actualidad, liraglutida está aprobada para alcanzar el control glucémico en adultos con DM2, en combinación dual con metformina o una sulfonilurea, o en combinación triple con metformina más sulfonilurea o metformina más tiazolidindiona. El fármaco ha mostrado mayores beneficios en diabéticos con una corta evolución de la enfermedad, que presentan obesidad, síndrome metabólico y/u otras comorbilidades que pudieran mejorar con la pérdida de peso (AU)

Liraglutide is a GLP-1 receptor agonist approved for the treatment of type 2 diabetes mellitus. This drug improves glycemic control with a low risk of hypoglycemias, reduces body weight, improves other cardiovascular risk factors and has a potential protective effect on beta cell function. In the long term, these effects could translate into a reduction in the complications of this disease. These advantages make liraglutide the preferred treatment option after failure of mono-therapy compared with other currently available drugs, given that its probability of achieving a composite outcome of HbA1c<7% with no hypoglycemia and no weight gain is significantly higher than that of its comparators. Currently, liraglutide is approved in adults with type 2 diabetes not achieving glucose control, in dual combination therapy with metformin or a sulfonylurea, or in triple combination with metformin plus sulfonylurea, or metformin plus thiazolidinedione. The benefits of this drug are greater in patients with recent onset of the disease, with obesity, metabolic syndrome and/or other comorbidities that could improve with weight loss (AU)

Valoración del programa de formación de médicos residentes en Endocrinología y Nutrición por facultativos: resultados de una encuesta / Assessment of a residency training program in endocrinology and nutrition by physicians: Results of a survey

Background and objective The current training program for resident physicians in endocrinology and nutrition (EN) organizes their medical learning. Program evaluation by physicians was assessed using a survey. Material and method The survey asked about demographic variables, EN training methods, working time and center, and opinion on training program contents. Results Fifty-one members of Sociedad Castellano-Manchega de Endocrinología, Nutrición y Diabetes, and Sociedad Andaluza de Endocrinología y Nutrición completed the survey. Forty-percent of them disagreed with the compulsory nature of internal medicine, cardiology, nephrology and, especially, neurology rotations (60%); a majority (>50%) were against several recommended rotations included in the program. The fourth year of residence was considered by 37.8% of respondents as the optimum time for outpatient and inpatient control and monitoring without direct supervision. The recommended monthly number of on-call duties was 3.8±1.2. We detected a positive opinion about extension of residence duration to 4.4±0.5 years. Doctoral thesis development during the residence period was not considered convenient by 66.7% of physicians. Finally, 97.8% of resident physicians would recommend residency in EN to other colleagues. Conclusions Endocrinologists surveyed disagreed with different training program aspects such as the rotation system, skill acquisition timing, and on-call duties. Therefore, an adaptation of the current training program in EN would be required( AU)

Antecedentes y objetivos El programa de formación MIR regula el aprendizaje de los médicos residentes en Endocrinología y Nutrición (EYN). Evaluamos la valoración que realizan los facultativos en EYN sobre dicho programa mediante una encuesta. Material y método La encuesta incluía: variables demográficas, vía y hospital de formación, tiempo trabajado, centro de trabajo actual, y la opinión sobre el contenido del programa de formación: sistema de rotaciones, competencias, guardias, y otras preguntas. Resultados Se encuestó a 51 endocrinólogos asistentes a las Jornadas de Casos Clínicos de las Sociedades Castellano-Manchega y Andaluza de EYN (SCAMEND, SAEN). Los entrevistados mostraron su desacuerdo con las rotaciones obligatorias durante el primer año de residencia en Neurología y Protección Radiológica, y con las recomendables por Digestivo, Neumología, Hematología y Unidad de Cuidados Intensivos. Sin embargo, creyeron convenientes las obligatorias a partir del segundo año de residencia dentro del propio Servicio de EYN (Hospital de Día, Consultas Externas y Nutrición). El 37,8% de los encuestados consideraron el cuarto año de residencia como el momento en que el residente puede realizar sin tutorización el control y seguimiento de pacientes ambulatorios y hospitalizados (nivel 1 de responsabilidad). La mayoría de los (..) (AU)

Valoración del programa de formación MIR en endocrinología y nutrición: resultados de una encuesta dirigida a residentes / Assessment of a residency training program in endocrinology and nutrition: Results of a resident survey

Introducción En 2006 se aprobó un nuevo programa formativo para la especialidad endocrinología y nutrición (EYN). Con la realización de una encuesta a los residentes de la especialidad tratamos de evaluar cómo es la formación de nuestros residentes, el grado de conocimiento y cumplimiento del nuevo programa y posibles cambios en la formación de especialistas de EYN derivados de ello comparando los resultados con los de encuestas previas. Material y métodos Se utilizó la misma encuesta ya distribuida en 2000 y 2005. La encuesta incluye variables demográficas, y preguntas sobre las distintas rotaciones, formación práctica y científica, evaluación de los distintos servicios de origen y otros aspectos. Se compararon los resultados con los de 2005.Resultados La encuesta fue completada por 40 residentes. Las rotaciones obligatorias se cumplen en su mayoría a excepción de neurología. Existen rotaciones que han quedado fuera del programa como radiología y medicina nuclear que aún son frecuentes y que los residentes incluirían de nuevo. Existe poco cumplimiento en los aspectos de formación práctica del área de endocrinología. Un 40% de los residentes desconoce aún el programa, aunque un 60% considera que se cumple. El 82,5% considera que sus servicios consiguen los objetivos formativos. Conclusiones Existen pocas diferencias respecto a las rotaciones respecto a los datos obtenidos en 2005 a pesar del cambio de programa y sigue habiendo carencias en aspectos prácticos de la especialidad. Por el contrario, se percibe una mejoría de la valoración de los residentes de la formación recibida por sus servicios y facultativos adjuntos con respecto a encuestas previas(AU)

Introduction In 2006, a new training program was approved for resident physicians in endocrinology and nutrition (EN). A survey was conducted to EN residents to assess their training, their depth of knowledge, and compliance with the new program, as well as potential changes in training, and the results obtained were compared to those from previous surveys. Material and methods A survey previously conducted in 2000 and 2005 was used for this study. The survey included demographic factors, questions about the different rotations, scientific and practical training, assessment of their training departments and other aspects. Results of the current survey were compared to those of the 2005 survey. Results The survey was completed by 40 residents. Mandatory rotations are mainly fulfilled, except for neurology. Some rotations removed from the program, such as radiology and nuclear medicine, still are frequently performed and popular among residents, who would include them back into the program. There was a low compliance with practical training in the endocrinology area. Forty percent of residents were not aware of the new program, but 60% thought that it was fulfilled. A total of 82.5% of residents thought that their departments fulfilled the training objectives. Conclusions Few differences were found in rotations as compared to the data collected in 2005 despite changes in the training program, and there was still a lack of practical training. By contrast, rating of training received from departments and senior physicians was improved as compared to prior surveys (AU)

[Assessment of a residency training program in endocrinology and nutrition by physicians: results of a survey]. / Valoración del programa de formación de médicos residentes en Endocrinología y Nutrición por facultativos: resultados de una encuesta.

BACKGROUND AND OBJECTIVE: The current training program for resident physicians in endocrinology and nutrition (EN) organizes their medical learning. Program evaluation by physicians was assessed using a survey. MATERIAL AND METHOD: The survey asked about demographic variables, EN training methods, working time and center, and opinion on training program contents. RESULTS: Fifty-one members of Sociedad Castellano-Manchega de Endocrinología, Nutrición y Diabetes, and Sociedad Andaluza de Endocrinología y Nutrición completed the survey. Forty-percent of them disagreed with the compulsory nature of internal medicine, cardiology, nephrology and, especially, neurology rotations (60%); a majority (>50%) were against several recommended rotations included in the program. The fourth year of residence was considered by 37.8% of respondents as the optimum time for outpatient and inpatient control and monitoring without direct supervision. The recommended monthly number of on-call duties was 3.8±1.2. We detected a positive opinion about extension of residence duration to 4.4±0.5 years. Doctoral thesis development during the residence period was not considered convenient by 66.7% of physicians. Finally, 97.8% of resident physicians would recommend residency in EN to other colleagues. CONCLUSIONS: Endocrinologists surveyed disagreed with different training program aspects such as the rotation system, skill acquisition timing, and on-call duties. Therefore, an adaptation of the current training program in EN would be required.

[Assessment of a residency training program in endocrinology and nutrition: results of a resident survey]. / Valoración del programa de formación MIR en endocrinología y nutrición: resultados de una encuesta dirigida a residentes.

INTRODUCTION: In 2006, a new training program was approved for resident physicians in endocrinology and nutrition (EN). A survey was conducted to EN residents to assess their training, their depth of knowledge, and compliance with the new program, as well as potential changes in training, and the results obtained were compared to those from previous surveys. MATERIAL AND METHODS: A survey previously conducted in 2000 and 2005 was used for this study. The survey included demographic factors, questions about the different rotations, scientific and practical training, assessment of their training departments and other aspects. Results of the current survey were compared to those of the 2005 survey. RESULTS: The survey was completed by 40 residents. Mandatory rotations are mainly fulfilled, except for neurology. Some rotations removed from the program, such as radiology and nuclear medicine, still are frequently performed and popular among residents, who would include them back into the program. There was a low compliance with practical training in the endocrinology area. Forty percent of residents were not aware of the new program, but 60% thought that it was fulfilled. A total of 82.5% of residents thought that their departments fulfilled the training objectives. CONCLUSIONS: Few differences were found in rotations as compared to the data collected in 2005 despite changes in the training program, and there was still a lack of practical training. By contrast, rating of training received from departments and senior physicians was improved as compared to prior surveys.

Valoracion de la utilidad del test de estimulacion intraarterial con calcio en el diagnostico de localizacion del hiperinsulinismo endogeno / Usefulness of arterial calcium stimulation with hepatic venous sampling in the localization diagnosis of endogenous hyperinsulinism

Antecedentes y objetivo El objetivo de este estudio fue valorar la utilidad del test de estimulación intraarterial con calcio (TEIC) en el diagnostico de localización del hiperinsulinismo endogeno no detectado por otros métodos. Pacientes y métodos Estudio retrospectivo de 26 pacientes ingresados por hipoglucemias en los que se realizo un TEIC, ya que la localización del hiperinsulinismo no fue claramente establecida con otras técnicas de imagen. En los pacientes que recibieron cirugía se pudo establecer el diagnostico anatomopatologico, y este se considero el patrón de referencia para la validación del TEIC. El análisis estadístico se realizo mediante la comparación de proporciones por el test chi-cuadrado con corrección de Yates para tablas de contingencia y el coeficiente (..) (AU)

Background and objective The aim of this study was to assess the utility of arterial calcium stimulation with hepatic venous sampling (ASVS) in the localization of tumors in patients with endogenous hyperinsulinism not detected with other methods. Patients and methods We performed a retrospective study of 26 patients admitted to our hospital for hypoglycemia who underwent ASVS because the source of hyperinsulinism was not clearly identified by other imaging techniques. The histopathological result in patients who underwent a surgical procedure was considered the reference for statistical study of the accuracy of this technique. Statistical analysis was performed by comparing proportions with the chi-squared test with Yates¡¯ correction for contingency tables, and Cohen¡äs kappa coefficient as a measure of interrater agreement between two observations. Results Surgery was performed in 17 patients, 13 with positive ASVS and the remaining four with negative results. An insulinoma was removed in 12 patients, and 10 of these were detected in the ASVS. A total of 76.9 % of positive ASVS tests corresponded to a histological diagnosis of insulinoma, and 83% of these insulinomas were positive in ASVS. This association was statistically significant (chi cuadrado=7.340; p=0.012). Two of three patients with nesidioblastosis had a positive response in the ASVS. A good and statistically significant agreement was obtained between histopathologic diagnosis and ASVS results (¦Ê=0.556, p = 0.007).Conclusions ASVS is a useful procedure in the localization diagnosis of endogenous hyperinsulinism not detected by other imaging tests. This technique allows tumors in the pancreatic gland to be identified and may be useful in the choice of the surgical technique to be used (AU)

Programa de formación MIR en endocrinología y nutrición: resultados de una encuesta nacional / Residency training program (MIR) in Endocrinology and Nutrition: results of a national questionnaire

Introducción: El actual programa de formación MIR de endocrinología y nutrición está regulado según lo propuesto por la Comisión Nacional de la Especialidad. Evaluamos su cumplimiento en el período 2000-2005 mediante una encuesta a los residentes de tercer y cuarto año. Material y método: La encuesta incluía: datos del residente, rotaciones, guardias, formación teórica y práctica, actividad científica e investigadora y otros aspectos relacionados con la especialidad. Resultados: Se encuestó a 46 residentes (63%), un 73,9% mujeres, con una edad de 27,8 años. Todos habían pasado por el área de hospitalización y nutrición durante 10,7 ± 5 y 5,7 ± 2,2 meses, respectivamente. Las rotaciones obligatorias fuera de endocrinología y nutrición no las habían llevado todos y su duración era inferior a la recomendada. El 97,8% realiza una comisión de servicio. La formación práctica no se cumple en más del 50%. El 40% no cree que sus servicios cumplan los objetivos formativos. La endocrinología y nutrición fue su primera opción en la elección de la especialidad en el 97,8%. El 95,5% se encuentra capacitado para trabajar al terminar la residencia, con preferencia en endocrinología y nutrición. Conclusiones: Los MIR de endocrinología y nutrición valoran positivamente la formación teórica y el grado de supervisión recibidos, aunque los objetivos del programa no se cumplen en todos los aspectos, lo que les permite estar preparados para trabajar al concluir la residencia

Introduction: The current training program for resident physicians in endocrinology is regulated by the National Specialty Commission. We evaluated compliance with the program between 2000 and 2005 through a questionnaire completed by 3rd- and 4th-year residents. Material and method: The questionnaire included residents' personal data, rotations, theoretical and practical training, scientific and research activity, and other items related to the specialty. Results: Forty-six residents (63%) completed the questionnaire. Of these, 73.9% were women. Age was 27.8 years. All the residents had worked in in-patient and nutrition services for 10.7 ± 5.0 and 5.7 ± 2.2 months, respectively. Not all residents had completed compulsory rotations outside endocrinology and nutrition and the duration of these rotations was lower than recommended. A total of 97.8% had performed the Service Commission. Forty percent of the residents believed that their service did not comply with training objectives. Endocrinology and nutrition was the first-choice specialty in 97.8%. Most of the residents (95.5%) felt adequately trained for work at the end of the training program, preferring endocrinology and nutrition. Conclusions: Resident physicians in endocrinology and nutrition positively evaluated the theoretical training and supervision received, although not all the program's objectives were achieved. The residents felt qualified for work at the end of their training program