Impact of sensor-augmented pump therapy with predictive low-glucose management on hypoglycemia and glycemic control in patients with type 1 diabetes mellitus: 1-year follow-up.

AIMS: To describe real-life experience with sensor-augmented pump therapy with predictive low-glucose management (SAPT-PLGM), in terms of hypoglycemia and glycemic control after one year of follow-up in T1D patients with hypoglycemia as the main indication of therapy. METHODS: Retrospective cohort study under real life conditions. Baseline and one-year follow-up variables of glycemic control, hypoglycemia and glycemic variability were compared. RESULTS: Fifty patients were included, 31 on prior treatment with SAPT with low-glucose suspend (LGS) feature and 19 on multiple dose insulin injections (MDI). Mean HbA1c decreased in the MDI group (8.24%-7.08%; p = 0.0001). HbA1c change was not significant in the SAPT-LGS group. Area under the curve (AUC) below 70 mg/dl improved in both SAPT-LGS and MDI groups while AUC, %time and events below 54 mg/dl decreased in SAPT-LGS group. Glycemic variability improved in the MDI group. Less patients presented severe hypoglycemia with SAPT-PLGM in both groups, however the change was non-significant. CONCLUSIONS: Under real life conditions, SAPT-PLGM reduced metrics of hypoglycemia in patients previously treaded with MDI and SAPT-LGS without deteriorating glycemic control in SAPT-LGS patients, while improving it in patients treated with MDI.

Defining High Glycemic Variability in Type 1 Diabetes: Comparison of Multiple Indexes to Identify Patients at Risk of Hypoglycemia.

Background: International consensus on the use of continuous glucose monitoring (CGM) recommends coefficient of variation (CV) as the metric of choice to express glycemic variability (GV) with a cutoff of 36% to define unstable diabetes. Even though, CV is associated with hypoglycemia in type 2 diabetes patients, the evidence on the use of one particular measure of GV in type 1 diabetes (T1DM) patients as a predictor of hypoglycemia is limited. Methods: A cohort of T1DM ambulatory patients was evaluated using CGM. Number and incidence rate of events <54 and <70 mg/dL were calculated. Bivariate and multivariate analysis of different glycemic indexes and clinical variables were performed to identify those associated with hypoglycemia. Receiver operating characteristic (ROC) curve analysis for each of the glycemic indexes was performed to define the best index and its optimal cutoff threshold to discriminate patients with events of hypoglycemia. Results: Seventy-three patients were included. A total of 128 events <54 mg/dL were recorded in 34 patients, and 350 events <70 mg/dL were registered in 51 patients. CV was the only variable significantly associated with hypoglycemia <54 mg/dL in the multivariate analysis (adjusted relative risk [aRR] 1.44, 95% confidence interval [CI]: 1.10-1.88, P = 0.008). CV, HbA1c (glycated hemoglobin), and mean glucose were associated with events <70 mg/dL. ROC curve analysis showed that, among GV metrics, CV had the best performance to discriminate patients with events <54 mg/dL (area under the curve [AUC] 0.87, 95% CI: 0.79-0.95) and events <70 mg/dL (AUC 0.79, 95% CI: 0.68-0.90) with optimal cutoff thresholds values of 34% and 31%, respectively. Among glycemic risk (GR) indexes, low blood glucose index (LBGI) showed the best performance. Conclusions: This analysis shows that CV is the best GV index, and LBGI the best GR index, to identify patients at risk of clinically significant hypoglycemia and hypoglycemia alert events in T1DM patients.

Malformaciones de la vena cava inferior y tromboembolismo venoso / Inferior vena cava malformations and venous thromboembolism

Presentamos el caso de una paciente de 30 años con tromboembolismo pulmonar de riesgo alto por PESI, en quien se confirmó la presencia de una anomalía congénita de la vena cava inferior, dada por ausencia de su porción intrahepática y subsecuente drenaje por el sistema ácigos. Como factor de riesgo adicional coexistía el consumo de anticonceptivos orales. Las malformaciones congénitas de la vena cava inferior constituyen una entidad poco frecuente y la mayoría cursan de forma indolente identificándose como hallazgo incidental. Pueden considerarse como factor de riesgo para tromboembolismo venoso especialmente en pacientes menores de 30 años con trombosis venosa profunda de miembros inferiores con compromiso de las venas iliacas, cuando hay resistencia a anticoagulantes o trombosis venosa profunda recurrente. No existe una recomendación clara respecto a la duración de la anticoagulación por lo que se debe individualizar cada caso teniendo en cuenta el perfil de riesgo de cada paciente. (Acta Med Colomb 2015; 40: 54-57).

The case of a 30 year old female patient with high-risk pulmonary embolism by PESI, in whom the presence of a congenital anomaly of the inferior vena cava due to the absence of its intrahepatic portion and subsequent drainage through the azygos system was confirmed, is presented. An additional risk factor was the consumption of oral contraceptives. Congenital malformations of the inferior vena cava are a rare entity and most follow an indolent course being identified as an incidental finding. They can be considered as a risk factor for venous thromboembolism especially in patients younger than 30 years with deep venous thrombosis of lower limbs with involvement of the iliac veins, when there is resistance to anticoagulants or recurrent deep vein thrombosis. There is no clear recommendation regarding the duration of anticoagulation so each case must be individualized taking into account the risk profile of each patient. (Acta Med Colomb 2015; 40: 54-57).

Beneficios de la clínica de anticoagulación / Benefits of anticoagulation clinic

Resumen Introducción: son claros los beneficios de la terapia anticoagulante con warfarina en diversas patologías, sin embargo ésta requiere un cuidadoso monitoreo para evitar complicaciones. Las clínicas de anticoagulación han mostrado mejorar la calidad del control al incrementar el tiempo en rango terapéutico, entre otros beneficios. Objetivo: se describe la población atendida y la calidad de la anticoagulación alcanzada en la clínica del Hospital Universitario Fundación Santa Fe de Bogotá desde su creación. Material y métodos: se realizó un estudio descriptivo retrospectivo. Se incluyeron la totalidad de pacientes atendidos por la clínica desde su creación. Se describieron las características demográficas, la calidad de la anticoagulación medida con el tiempo en el rango terapéutico y la aparición de complicaciones. Resultados: se incluyeron 159 pacientes, el promedio de edad fue 61.5 años y el tromboembolismo venoso fue la indicación más frecuente. El tiempo en el rango terapéutico fue 53.7% con rango de 2-3 y 67.2% con rango de 1.8-3.2. El porcentaje de INR de alto riesgo fue 7.1% para INR menor a 1.5 y 7.4% para INR mayor a 4. La tasa de sangrado mayor fue 1.1% y de eventos trombóticos 2.2% en 100 pacientes-años. Conclusiones: este estudio es consistente con lo reportado en la literatura y a pesar de un mejor control con las clínicas de anticoagulación, los pacientes pasan una cantidad considerable de tiempo con INR fuera del rango. Faltan estudios comparativos para evaluar la costo-efectividad de la implementación rutinaria de las clínicas en el país. (Acta Med Colomb 2013; 38: 239-243).

Abstract Introduction: the benefits of anticoagulant therapy with warfarin in various pathologies are evident; however, this requires careful monitoring to avoid complications. Anticoagulation clinics have shown to improve the quality of control by increasing the time in therapeutic range, among other benefits. Objective: the population served and the quality of anticoagulation obtained in the University Hospital Fundación Santa Fe de Bogotá since its creation, is described. Materials and methods: we performed a retrospective study, and included all patients served by the clinic since its creation. We described demographic characteristics , quality of anticoagulation as measured by time in therapeutic range, and the occurrence of complications. Results: 159 patients were included; the average age was 61.5 years and venous thromboembolism was the most frequent indication. The time in the therapeutic range was 53.7 % with a range of 2-3 and 67.2% with a range 1.8 to 3.2. Percentage of high-risk INRs was 7.1% for INR < 1.5 and 7.4% for INR > 4. The rate of major bleeding was 1.1% and of thrombotic events 2.2% in 100 patient-years. Conclusions: this study is consistent with the reported in the literature, and despite a better control with anticoagulation clinics, patients spend a considerable amount of time with INRs out of range. Comparative studies are lacking to evaluate the cost -effectiveness of routine implementation of clinics in the country. (Acta Med Colomb 2013; 38: 239-243).

Mutación del gen de la menina: desde el hiperparatiroidismo familiar aislado a la neoplasia endocrina múltiple de tipo 1: [revisión] / Mutation of the menin gen: from isolated familial hyperparathyroidism to the multiple endocrine neoplasia syndrome type 1: [review]

La menina es una proteína supresora de tumor codificada por el gen MEN1, cuya mutación produce procesos neoplásicos en múltiples tejidos del organismo que pueden manifestarse por generaciones como síndromes familiares. La mutación genera un espectro de enfermedad que va desde el hiperparatiroidismo familiar aislado hasta la neoplasia endocrina múltiple de tipo 1, caracterizada por neoplasias de paratiroides, hipófisis anterior, páncreas endocrino y duodeno, entre otras. Como ejemplo, se presentan dos casos de pacientes con neoplasias endocrinas secundarias a la mutación del gen MEN1. Se revisa la información actual sobre la etiopatogenia y carcinogénesis entendidos apenas recientemente, al igual que otras mutaciones involucradas en los síndromes neoplásicos expuestos y se dan unas recomendaciones finales.

Menin is a tumor suppressor protein, encoded by the MEN1 gene, whose mutation can generate neoplastic disease in multiple tissues of the human body, which for generations can manifest as familial syndromes. The mutation generates a spectrum of diseases ranging from familial isolated hyperparathyroidism to multiple endocrine neoplasia type 1, characterized by neoplasm of parathyroid glands, anterior pituitary, endocrine pancreas and duodenum, among others. We present two cases of patients with endocrine neoplastic disease secondary to menin’s mutation. We review current information regarding its ethiopathogeny and its mechanism of carcinogenesis just recently understood. Additionally we review other mutations involved in the neoplastic syndromes exposed and present some final recommendations.