Prevention of Cardiorenal Complications with Sodium-Glucose Cotransporter Type 2 Inhibitors: A Narrative Review.

Heart failure (HF) and chronic kidney disease (CKD) are the most frequent first cardiorenal conditions in patients with type 2 diabetes (T2D), which can be exacerbated by other comorbidities, such as hypertension, dyslipidemia, and obesity. To improve their clinical outcomes, patients with T2D need to achieve and maintain glycemic targets, as well as prevent cardiorenal disease onset and progression. Several clinical trials evaluating the sodium-glucose cotransporter type 2 inhibitors (SGLT2i) dapagliflozin, empagliflozin, canagliflozin, and ertugliflozin have shown consistent risk reduction in major adverse cardiovascular events and/or hospitalization for HF, together with lower risk of kidney disease progression. The benefits associated with SGLT2i in T2D are distinct from other antihyperglycemic drugs since they have been proposed to exert pleiotropic metabolic and direct effects on the kidney and the heart. In this review, we summarize and discuss the evidence regarding the mechanisms of action, the efficacy and safety profiles, and the clinical guidelines on the use of the therapeutic class of SGLT2i, highlighting their role in cardiorenal prevention beyond glycemic control.

Clinical value of Flash glucose monitoring in patients with type 1 diabetes treated with continuous subcutaneous insulin infusion / Utilidad clínica de la monitorización Flash de glucosa en pacientes con diabetes mellitus tipo 1 tratados con infusión subcutánea de insulina

Aim: To analyze the clinical impact of the Flash glucose monitoring system in patients with type 1 diabetes mellitus (T1DM) treated with continuous subcutaneous insulin infusion (CSII). Methods: A 24-week retrospective cohort study in CSII-treated T1DM patients exposed (1:1) to the Flash glucose monitoring system vs. self-monitoring of capillary blood glucose (SMBG). The primary outcome was the difference in hemoglobin A1c (HbA1c) levels between both groups at the end of the study. Results: Thirty-six patients with a mean age of 38.2 years (range 22-55) and a mean T1DM duration of 20.9±7.8 years, treated with CSII for 7.1±5.4 years, were enrolled into the study. At the end of the study, mean HbA1c levels improved in patients in the Flash group (7.1±0.7 vs. 7.8±1.0, p=0.04). Only the Flash group showed a significant decrease in HbA1c levels of −0.4% (95% CI, −0.6, −0.2; p=0.004) during follow-up. Flash patients captured 93.9% of data through 17.8±9.9 scans daily. In fact, the Flash cohort showed a three-fold increase in daily self-monitoring of glucose, while daily frequency of SMBG decreased during the study (−1.8 tests/24h (95% CI −3, −0.7; p=0.01). No safety issues related to Flash use were recorded. Conclusions: The Flash glucose monitoring system is a novel approach to improve blood glucose control in CSII-treated T1DM patients. Randomized controlled trials are needed to assess the effectiveness of this system in CSII-treated T1DM patients

Objetivo: Analizar el efecto clínico de la monitorización Flash de glucosa intersticial en pacientes con diabetes mellitus tipo 1 (DM1) tratados con infusión subcutánea continúa de insulina (ISCI). Método: Estudio de cohortes de 24 semanas de duración de sujetos con DM1 tratados con ISCI expuestos (1:1) a monitorización Flash de glucosa intersticial vs. autodeterminación de la glucemia capilar (AGC). El objetivo principal fueron las diferencias en los valores de hemoglobina glucosilada (HbA1c) entre ambos grupos. Resultados: Treinta y seis pacientes fueron incluidos con edad media de 38,2 años (rango: 22-55 años), duración media de la DM1 de 20,9±7,8 años y tratados con ISCI durante 7,1±5,4 años. Detectamos una mejora al final del estudio en las cifras de HbA1c entre los pacientes del grupo Flash (7,1±0,7 vs. 7,8±1,0; p=0,04). Solo los pacientes del grupo Flash mostraron durante el seguimiento un descenso significativo en los valores de HbA1c de −0,4% (IC 95%: −0,6, −0,2; p=0,004). Los pacientes que usaron Flash capturaron el 93,9% de los datos mediante 17,8±9,9 escaneos diarios. De hecho, los pacientes de la cohorte Flash triplicaron la frecuencia de comprobación de su glucosa aunque la frecuencia diaria de AGC descendió a lo largo del estudio (−1,8 test/24h; IC 95%: −3, −0,7; p=0,01). No se detectaron eventos de seguridad relacionados con el uso de Flash. Conclusiones: La monitorización Flash de glucosa supone un abordaje novedoso para mejorar el control glucémico en pacientes con DM1 tratados con ISCI. Resultan necesarios ensayos clínicos randomizados en el futuro para valorar con mayor consistencia la efectividad de esta terapia en este subgrupo de pacientes

Clinical value of Flash glucose monitoring in patients with type 1 diabetes treated with continuous subcutaneous insulin infusion.

AIM: To analyze the clinical impact of the Flash glucose monitoring system in patients with type 1 diabetes mellitus (T1DM) treated with continuous subcutaneous insulin infusion (CSII). METHODS: A 24-week retrospective cohort study in CSII-treated T1DM patients exposed (1:1) to the Flash glucose monitoring system vs. self-monitoring of capillary blood glucose (SMBG). The primary outcome was the difference in hemoglobin A1c (HbA1c) levels between both groups at the end of the study. RESULTS: Thirty-six patients with a mean age of 38.2 years (range 22-55) and a mean T1DM duration of 20.9±7.8 years, treated with CSII for 7.1±5.4 years, were enrolled into the study. At the end of the study, mean HbA1c levels improved in patients in the Flash group (7.1±0.7 vs. 7.8±1.0, p=0.04). Only the Flash group showed a significant decrease in HbA1c levels of -0.4% (95% CI, -0.6, -0.2; p=0.004) during follow-up. Flash patients captured 93.9% of data through 17.8±9.9 scans daily. In fact, the Flash cohort showed a three-fold increase in daily self-monitoring of glucose, while daily frequency of SMBG decreased during the study (-1.8 tests/24h (95% CI -3, -0.7; p=0.01). No safety issues related to Flash use were recorded. CONCLUSIONS: The Flash glucose monitoring system is a novel approach to improve blood glucose control in CSII-treated T1DM patients. Randomized controlled trials are needed to assess the effectiveness of this system in CSII-treated T1DM patients.

Reclamaciones en el servicio de urgencias. Oportunidad de mejora / Claims at the Emergency Unit. Opportunity for improvement

OBJETIVO: averiguar los motivos más recurrentes en las reclamaciones realizadas por todos los usuarios que acudieron a los servicios de urgencias hospitalarios (SUH) del Hospital General de Granollers, Barcelona. MÉTODO: estudio descriptivo transversal sobre todas las personas que acudieron a los SUH y que realizaron una reclamación. Como instrumento de recogida de los datos se utilizó un formulario de la institución que incluye: lugar, fecha y hora de la reclamación, datos sobre quién la realiza, sobre el afectado y sobre los motivos, los cuales fueron categorizados en seis tipos: asistenciales, trato, información, organización y trámites, documentación, hostelería y confort. RESULTADOS: se recibieron 176 reclamaciones, una por cada 612 pacientes atendidos. El 67% (n= 116) de los afectados era mujer. Respecto al motivo de la reclamación, en primer lugar se encontraba "organización y trámites" con un 57,9% (n= 102), seguido de "asistenciales" con un 28,4% (n= 50). En el 73,8% (n= 130) de los casos, la reclamación fue interpuesta por el propio paciente. CONCLUSIONES: la mayoría de las quejas realizadas por los usuarios y sus familiares en el SUH fueron por motivos organizativos y por insatisfacción con la asistencia. Los hallazgos del presente estudio proporcionan una oportunidad de mejora, fundamentalmente, a través de cambios organizativos en el servicio

OBJECTIVE: to find out the most frequent reasons for claims presented by all users attending the Hospital Emergency Unit (ER) in the Hospital General de Granollers, Barcelona. METHOD: transversal descriptive study on all persons who atended the ER and presented a claim. A centre form was used as a tool for data collection, including place, date and time of the claim, data of the claimant, of the person affected, and about the reasons, which were classified into six types: care, personal treatment, information, organization and paperwork, documentation, accommodation and comfort. RESULTS: 176 claims were received, one per each 612 patients seen. A 67% (n= 116) of those affected were women. Regarding the reason for the claim, "organization and paperwork" was in the first place, with 57.9% (n= 102), followed by "care", with 28.4% (n= 50). In 73.8% (n= 130) of cases, patients themselves were the claimants. CONCLUSIONS: The majority of claims filed by users and their relatives in the ER were due to organization reasons and lack of satisfaction with care. The findings of the present study will provide an opportunity for improvement, mostly through changes in the organization of the unit

Utilidad de las escalas de evaluación del riesgo de fractura en el paciente con diabetes tipo 2 / Usefulness of fracture risk assessment scales in the patient with type 2 diabetes mellitus

Introducción: Nuestro objetivo fue evaluar la utilidad de las herramientas FRAX y QFracture en la predicción del riesgo de fractura en un grupo de pacientes con diabetes tipo 2. Material y métodos: Estudio transversal con 78 pacientes. Se evaluó la densidad mineral ósea (DMO) por absorciometría dual por rayos X (DXA). El riesgo a 10 años de presentar cualquier fractura osteoporótica y fractura de cadera se calculó usando las escalas FRAX y QFracture. Los resultados se analizaron con el programa SPSS 15.0. Resultados: La edad media ± desviación estándar de los pacientes fue 57,8 ± 6,4 años; el 22,4% de los pacientes tenía criterios densitométricos de osteoporosis y el 9% tenía fractura previa por fragilidad. Se detectaron fracturas vertebrales radiográficas en un 27,7% de los pacientes. Aplicando la escala FRAX, los pacientes que cumplieron criterios de tratamiento para prevención de fractura mayor osteoporótica fueron el 2,6%, sin tener en cuenta la DMO, y el 5,1% tras introducir la DMO en cadera (p = 0,002). El 2,6% de los pacientes presentaron criterios de intervención para fractura de cadera tras añadir los datos de DMO. Según la escala QFracture, el 3,8% de los pacientes tenía alta probabilidad de cualquier fractura osteoporótica y el 1,3% de fractura de cadera. Conclusiones: En nuestro grupo de pacientes con diabetes tipo 2 la aplicación de la escalas FRAX y QFracture clasifica a un bajo porcentaje de pacientes como candidatos a tratamiento para la osteoporosis, a pesar del alto riesgo de fractura que presentan estos pacientes como refleja la alta prevalencia de fracturas vertebrales(AU)

Objective: To evaluate the performance of the FRAX and QFracture tools in a group of type 2 diabetes mellitus (T2DM) patients. Material and methods: A cross-sectional study including 78 patients with type 2 diabetes. Lumbar spine and femoral bone mineral density (BMD) were measured by dual X-Ray absorptiometry (Hologic QDR 4500). Ten-year major osteoporotic fracture risk and hip fracture risk were calculated using the FRAX and QFracture tools. Results were analysed using the SPSS 15.0 program. Results: Mean age was 57.8 years (57.8 ± 6.4). It was found that 22.4% of patients had densitometric criteria for osteoporosis, and 9% had a previous fracture. Prevalent radiographic vertebral fractures were detected in 27.7%. Few patients were selected for treatment according to FRAX: 2.6% for major osteoporotic fracture, 5.1% after introducing hip BMD (p.002) and 2.6% for hip fracture risk only if hip BMD was added. Using QFracture, 3.8% of patients had a high probability of osteoporotic fracture, and 1.3% a hip fracture. Conclusions: In our group of type 2 diabetes mellitus patients, a low percentage were selected for treatment using the FRAX tool or QFracture tool despite the high risk of fracture demonstrated by high vertebral fracture rate(AU)