Fatty liver index as a predictor for type 2 diabetes in subjects with normoglycemia in a nationwide cohort study.

Our aim was to evaluate whether fatty liver index (FLI) is associated with the risk of type 2 diabetes (T2DM) development within the Spanish adult population and according to their prediabetes status; additionally, to examine its incremental predictive value regarding traditional risk factors. A total of 2260 subjects (Prediabetes: 641 subjects, normoglycemia: 1619 subjects) from the Di@bet.es cohort study were studied. Socio-demographic, anthropometric, clinical data and survey on habits were recorded. An oral glucose tolerance test was performed and fasting determinations of glucose, lipids and insulin were made. FLI was calculated and classified into three categories: Low (< 30), intermediate (30-60) and high (> 60). In total, 143 people developed diabetes at follow-up. The presence of a high FLI category was in all cases a significant independent risk factor for the development of diabetes. The inclusion of FLI categories in prediction models based on different conventional T2DM risk factors significantly increase the prediction power of the models when all the population was considered. According to our results, FLI might be considered an early indicator of T2DM development even under normoglycemic condition. The data also suggest that FLI could provide additional information for the prediction of T2DM in models based on conventional risk factors.

Incidence of diabetes mellitus in Spain as results of the nation-wide cohort di@bet.es study.

Our aim was to determine the incidence of type 2 diabetes mellitus in a nation-wide population based cohort from Spain (di@bet.es study). The target was the Spanish population. In total 5072 people older than 18 years,were randomly selected from all over Spain). Socio-demographic and clinical data, survey on habits (physical activity and food consumption) and weight, height, waist, hip and blood pressure were recorder. A fasting blood draw and an oral glucose tolerance test were performed. Determinations of serum glucose were made. In the follow-up the same variables were collected and HbA1c was determined. A total of 2408 subjects participated in the follow-up. In total, 154 people developed diabetes (6.4% cumulative incidence in 7.5 years of follow-up). The incidence of diabetes adjusted for the structure of age and sex of the Spanish population was 11.6 cases/1000 person-years (IC95% = 11.1-12.1). The incidence of known diabetes was 3.7 cases/1000 person-years (IC95% = 2.8-4.6). The main risk factors for developing diabetes were the presence of prediabetes in cross-sectional study, age, male sex, obesity, central obesity, increase in weight, and family history of diabetes. This work provides data about population-based incidence rates of diabetes and associated risk factors in a nation-wide cohort of Spanish population.

Predictors of failure to respond to fluid restriction in SIAD in clinical practice; time to re-evaluate clinical guidelines?

BACKGROUND: Fluid restriction is recommended as first line therapy for Syndrome of Inappropriate Antidiuresis (SIAD), despite of lack of good evidence base to support its use, and poor efficacy in clinical practice and in the literature. AIM: We set out to determine how many patients with well-defined SIAD had pre-treatment criteria which would predict failure to fluid restriction. DESIGN AND METHODS: This was a consecutive, prospective evaluation of 183 patients with a diagnosis of SIAD in two different hospitals. Full ascertainment of the diagnostic criteria for SIAD was obtained in all patients. RESULTS: About 47% of patients had a urine volume <1500 ml in 24 h, 41% had initial urine osmolality > 500 mOsm/kg, 26% a Furst-equation ratio > 1. About 59% had one criterion predicting failure to respond to fluid restriction, 37% two criteria, and 3% three criteria. CONCLUSIONS: Our data suggest that up to 60% of patients with SIAD had criteria which recent clinical guidelines suggest would predict nonresponse to fluid restriction. This may explain why the recommended first line therapy for SIAD has been shown to be ineffective.

Olive oil has a beneficial effect on impaired glucose regulation and other cardiometabolic risk factors. Di@bet.es study.

BACKGROUND: Despite the marked increase in cardiovascular risk factors in Spain in recent years, the prevalence and incidence of cardiovascular diseases have not risen as expected. Our objective is to examine the association between consumption of olive oil and the presence of cardiometabolic risk factors in the context of a large study representative of the Spanish population. SUBJECTS AND METHODS: A population-based, cross-sectional, cluster sampling study was conducted. The target population was the whole Spanish population. A total of 4572 individuals aged ≥ 18 years in 100 clusters (health centers) were randomly selected with a probability proportional to population size. The main outcome measures were clinical and demographic structured survey, lifestyle survey, physical examination (weight, height, body mass index, waist, hip and blood pressure) and oral glucose tolerance test (OGTT) (75 g). RESULTS: Around 90% of the Spanish population use olive oil, at least for dressing, and slightly fewer for cooking or frying. The preference for olive oil is related to age, educational level, alcohol intake, body mass index and serum glucose, insulin and lipids. People who consume olive oil (vs sunflower oil) had a lower risk of obesity (odds ratio (OR)=0.62 (95% confidence interval (CI)=0.41-0.93, P=0.02)), impaired glucose regulation (OR=0.49 (95% CI=0.28-0.86, P=0.04)), hypertriglyceridemia (OR=0.53 (95% CI=0.33-0.84, P=0.03)) and low HDL cholesterol levels (OR=0.40 (95% CI=0.26-0.59, P=0.0001)). CONCLUSIONS: The results show that consumption of olive oil has a beneficial effect on different cardiovascular risk factors, particularly in the presence of obesity, impaired glucose tolerance or a sedentary lifestyle.

Mediterranean diet adherence in individuals with prediabetes and unknown diabetes: the Di@bet.es Study.

BACKGROUND AND AIMS: Mediterranean diet (MedDiet) is causally related to diabetes and is a dietary pattern recommended to individuals with diabetes. We investigated MedDiet adherence in individuals with prediabetes and unknown (PREDM/UKDM) or known diabetes (KDM) compared to those with normal glucose metabolism (NORMAL). METHODS: This was a national, population-based, cross-sectional, cluster-sampling study. MedDiet adherence was scored (MedScore, mean ± SD 24 ± 5) using a qualitative food frequency questionnaire. Logistic regression was used to examine the association between MedScore and PREDM/UKDM or KDM versus control subjects. RESULTS: We evaluated 5,076 individuals. Mean age was 50 years, 57% were female, 826 (582/244) were PREDM/UKDM, 478 were KDM and 3,772 were NORMAL. Mean age increased across MedScore tertiles (46, 51 and 56 years, p < 0.0001). Higher age-adjusted adherence to MedDiet (5-unit increment in the MedScore) was associated with lower and nondifferent odds (OR, 95% CI) of prevalent PREDM/UKDM (0.88, 0.81-0.96, p = 0.001) and KDM (0.97, 0.87-1.07, p = 0.279), respectively, compared to individuals in the NORMAL group. CONCLUSIONS: In a representative sample of the whole Spanish population, MedDiet adherence is independently associated with PREDM/UKDM. Therapeutic intervention may be, in part, responsible for the lack of differences in adherence observed between the KDM and NORMAL groups. However, reverse causation bias cannot be ruled out in cross-sectional studies.

Evaluation of Health-Related Quality of Life according to Carbohydrate Metabolism Status: A Spanish Population-Based Study (Di@bet.es Study).

Objective. To evaluate the association between diabetes mellitus and health-related quality of life (HRQOL) controlled for several sociodemographic and anthropometric variables, in a representative sample of the Spanish population. Methods. A population-based, cross-sectional, and cluster sampling study, with the entire Spanish population as the target population. Five thousand and forty-seven participants (2162/2885 men/women) answered the HRQOL short form 12-questionnaire (SF-12). The physical (PCS-12) and the mental component summary (MCS-12) scores were assessed. Subjects were divided into four groups according to carbohydrate metabolism status: normal, prediabetes, unknown diabetes (UNKDM), and known diabetes (KDM). Logistic regression analyses were conducted. Results. Mean PCS-12/MCS-12 values were 50.9 ± 8.5/ 47.6 ± 10.2, respectively. Men had higher scores than women in both PCS-12 (51.8 ± 7.2 versus 50.3 ± 9.2; P < 0.001) and MCS-12 (50.2 ± 8.5 versus 45.5 ± 10.8; P < 0.001). Increasing age and obesity were associated with a poorer PCS-12 score. In women lower PCS-12 and MCS-12 scores were associated with a higher level of glucose metabolism abnormality (prediabetes and diabetes), (P < 0.0001 for trend), but only the PCS-12 score was associated with altered glucose levels in men (P < 0.001 for trend). The Odds Ratio adjusted for age, body mass index (BMI) and educational level, for a PCS-12 score below the median was 1.62 (CI 95%: 1.2-2.19; P < 0.002) for men with KDM and 1.75 for women with KDM (CI 95%: 1.26-2.43; P < 0.001), respectively. Conclusion. Current study indicates that increasing levels of altered carbohydrate metabolism are accompanied by a trend towards decreasing quality of life, mainly in women, in a representative sample of Spanish population.

Prevalence of diabetes mellitus and impaired glucose regulation in Spain: the Di@bet.es Study.

AIMS/HYPOTHESIS: The Di@bet.es Study is the first national study in Spain to examine the prevalence of diabetes and impaired glucose regulation. METHODS: A population-based, cross-sectional, cluster sampling study was carried out, with target population being the entire Spanish population. Five thousand and seventy-two participants in 100 clusters (health centres or the equivalent in each region) were randomly selected with a probability proportional to population size. Participation rate was 55.8%. Study variables were a clinical and demographic structured survey, lifestyle survey, physical examination (weight, height, BMI, waist and hip circumference, blood pressure) and OGTT (75 g). RESULTS: Almost 30% of the study population had some carbohydrate disturbance. The overall prevalence of diabetes mellitus adjusted for age and sex was 13.8% (95% CI 12.8, 14.7%), of which about half had unknown diabetes: 6.0% (95% CI 5.4, 6.7%). The age- and sex-adjusted prevalence rates of isolated impaired fasting glucose (IFG), isolated impaired glucose tolerance (IGT) and combined IFG-IGT were 3.4% (95% CI 2.9, 4.0%), 9.2% (95% CI 8.2, 10.2%) and 2.2% (95% CI 1.7, 2.7%), respectively. The prevalence of diabetes and impaired glucose regulation increased significantly with age (p < 0.0001), and was higher in men than in women (p < 0.001). CONCLUSIONS/INTERPRETATION: The Di@bet.es Study shows, for the first time, the prevalence rates of diabetes and impaired glucose regulation in a representative sample of the Spanish population.

Efficacy and safety of vildagliptin monotherapy during 2-year treatment of drug-naïve patients with type 2 diabetes: comparison with metformin.

The present study was a 52-week extension of a previously published, multi-center, randomized, parallel-group study. The aim of this extension study was to compare the efficacy and tolerability of vildagliptin and metformin in drug-naïve patients with type 2 diabetes over 104 weeks. The extension population comprised 305 patients randomized to vildagliptin (100 mg daily) and 158 patients randomized to metformin (2 000 mg daily). Pioglitazone was added as rescue medication if fasting glucose was >10 mmol/l; data from patients receiving rescue medication were excluded from the primary analysis. Baseline HbA (1c) averaged 8.4+/-0.1% in patients randomized to vildagliptin and 8.8+/-0.1% in those randomized to metformin. The adjusted mean change from baseline to study endpoint was -1.0+/-0.1% in vildagliptin-treated patients and -1.5+/-0.1% in those receiving metformin (p<0.001 vs. vildagliptin). These results were similar to those reported after the 1-year core phase of the study. The adjusted mean changes in body weight from baseline to endpoint were 0.5+/-0.4 kg and -2.5+/-0.5 kg in the vildagliptin and metformin groups, respectively. One or more adverse event (AE) was reported by 82.2% of patients receiving vildagliptin and by 87.3% of those receiving metformin (p<0.001). Gastrointestinal AEs were more common in patients receiving metformin (45.6%) than in those receiving vildagliptin (25.0%, p<0.001 vs. metformin). One hypoglycemic event occurred after strenuous exercise in a single patient receiving vildagliptin (0.3%). In conclusion, both vildagliptin and metformin monotherapy provided clinically meaningful decreases in HbA (1c) over 2 years in drug-naïve patients with type 2 diabetes. Vildagliptin was weight neutral, while weight loss was observed with metformin; however, metformin was associated with significantly worse gastrointestinal tolerability.

Cardiovascular risk factor management is poorer in diabetic patients with undiagnosed peripheral arterial disease than in those with known coronary heart disease or cerebrovascular disease. Results of a nationwide study in tertiary diabetes centres.

AIMS: To assess whether patients with Type 2 diabetes mellitus and unrecognized peripheral arterial disease (PAD), detected by the ankle-brachial index (ABI), have poorer cardiovascular risk factor management (CVRFs) and receive fewer medications than patients previously diagnosed with coronary heart disease (CHD) or cerebrovascular disease (CVD). METHODS: In 31 diabetes centres throughout Spain, 1303 patients with Type 2 diabetes mellitus were screened for PAD using the ABI. Patient history of CHD and CVD and treatment and control of CVRFs were recorded. RESULTS: Forty-one patients had an ABI > 1.30 and were excluded, leaving 1262 patients (age 65.3 +/- 7.7 years) for the study. Of those screened, 790 patients had a normal ABI (ABI > 0.9) and no known history of CHD or CVD (no CHD/CVD/PAD group), 194 had unrecognized PAD (ABI < or = 0.9) with no known history of CHD or CVD (undiagnosed PAD group) and 278 had a known history of CHD and/or CVD (CHD/CVD group). The undiagnosed PAD group had higher low-density lipoprotein (LDL) cholesterol (2.9 +/- 0.83 vs. 2.4 +/- 0.84 mmol/l; P < 0.001) and systolic blood pressure (150 +/- 20 vs. 145 +/- 21 mmHg; P < 0.001) compared with the CHD/CVD group. They were less likely to take statins (56.9 vs. 71.6%; P < 0.001), anti-hypertensive agents (75.9 vs. 90.1%, P = 0.001), and anti-platelet agents (aspirin, 28.7 vs. 57.2%; P < 0.001; clopidogrel, 5.6 vs. 20.9%; P < 0.001) and more likely to smoke (21.0 vs. 9.2%; P < 0.001). Higher LDL in the undiagnosed PAD group was associated with the underutilization of statins. CONCLUSIONS: Measurement of ABI detected a significant number of patients with PAD, who did not have CHD or CVD, but whose CVRFs were under treated and poorly controlled compared with subjects with CHD and/or CVD.

Tratamiento de las complicaciones neuropáticas de la diabetes mellitus / Treatment of the neuropathic complications of diabetes mellitus

La polineuropatía diabética (DPN) es una de las complicaciones crónicas más frecuentes en los pacientes con diabetes, sinónimo de neuropatíadiabética, y representa una de las causas principales para presentar úlceras en los pies y amputaciones de miembros inferiores (LEA).La DPN comienza de forma habitual con una disfunción de los nervios, con la presencia de signos, pero de forma asintomática. En la prevención es prioritario el estricto control glucémico y de otros factores de riesgo cardiovascular, que incluyen la dislipemia, la hipertensión arterial, el tabaco, la circunferencia de la cintura y el consumo de grasa. Las estrategias preventivas para reducir la aparición de úlceras en los piesy LEA están dirigidas al diagnóstico temprano de DPN con el diapasón de 128 Hz, el palillo puntiagudo y los reflejos aquíleos, el neurotensiómetro y el monofilamento de 10 g, y la intervención basada en el desarrollo de un programa estructurado y continuado de educación y tratamiento (AU)

Diabetic polyneuropathy (DPN), also called diabetic neuropathy, is one of the most frequent complications of diabetes mellitus and remains a major cause of foot ulcers and lower extremity amputations (LEAs).DPN often begins with silent nerve dysfunction and abnormal signs but with few or no symptoms. Factors crucial to prevention are control of blood glucose levels and other cardiovascular risk factors such as dyslipidemia, hypertension, smoking, waist circumference, and fat consumption. Prevention strategies to reduce foot ulcers and LEAS focus on the early detection of DPN, involving the use of the 128 Hz turning fork, pin-prick and Achilles reflex testing, tensometer and 10-gmonofilament, and intervention based on continuing and well-structured education and treatment programs (AU)

Técnicas de exploración de la sensibilidad en la patología del pie / Exploration techniques of sensibility in foot pathology

La polineuropatía en pacientes con diabetes puede ser detectada realizando una exploración neurológica básica de los pies utilizando el diapasón de 128 Hz, el palillo y valorando el reflejo aquíleo. Con ello se obtiene una puntuación en cuestionarios como el Neuropathy Disability Score, ó semejantes. La utilización de un neurotensiómetro que permite la evaluación del umbral de sensibilidad vibratoria, ó el monofilamento de 10 g, que predicen la aparición de úlceras en los pies de una forma mas precisa. En los pacientes con diabetes se podría alcanzar una reducción importante en la tasa de amputaciones de miembros inferiores con un programa de cribaje precoz de la polineuropatía, así como con programas de intervención basados en una educación continuada y en la instauración de un tratamiento adecuado

Diabetic neuropathy can be detected with a simple feet neurologic examination involving the use of the 128-Hz tuning fork, the pin-prick testing and the achilles reflex. Using these techniques it is possible to obtain a composite score such the modified Neuropathy Disability Score. A semiquantitative assessment of the vibration-perception threshold assessed by the neurothensiometer, and the 10 g-monofilament can be used in order to predict the risk of foot ulcers. A substantial reduction in lower extremity amputation rate in diabetic patients might be achieved with an earlier neuropathy screening and intervention based on a continuing and well structured treatment and education programmes

Implantación de los sistemas de infusión subcutánea continua de insulina (ISCI) en la Comunidad de Madrid / Continuous subcutaneous insulin infusion (CSII) implementation in Madrid Autonomous Community

Objetivo: Conocer la implantación de los sistemas de infusión subcutánea continua de insulina (ISCI) en la Comunidad de Madrid (CM) y observar la evolución desde que dichos sistemas son cubiertos por los Servicios Públicos de Salud (SPS). Método: Estudio transversal descriptivo mediante encuesta enviada por correo electrónico a los médicos responsables de la utilización de los sistemas ISCI de los Servicios de Endocrinologíao Pediatría en cada Área Sanitaria (AS) de la CM entre 2004-2005. Resultados: Todos los representantes de las AS madrileñas remitieron el cuestionario contestado: 11 Áreas de Salud con su hospital de referencia y 2 centros hospitalarios que no tienen AS propia. En una de las Áreas, se han considerado por separado las respuestas de pediatría y de adultos, por lo que en total fueron 14 los encuestados. En el año 2004 había 109 dispositivos ISCI seguidos en nuestra Comunidad, y 213 en el 2005. Actualmente esla gerencia de cada Centro Hospitalario (CH) quien soporta el 72% del gasto subyacente a los sistemas ISCI. En 5 CH se abona la bomba de insulina y el fungible a pacientes diabéticos de otras AS de la Comunidad, pero no es así si los pacientes pertenecen a otra Comunidad Autónoma. El número de médicos involucrados en el año 2005 ascendía a 24 (20 endocrinólogos y 4 pediatras). Sólo en una de las AS se ha logrado un nuevo endocrinólogo en la plantilla y no ha habido aumentos en el personal de enfermería. En 10 de los 13 CH el fungible de los sistemas ISCI es dispensado por el propio Servicio de Endocrinología. Sólo 1 de ellos está dotado de hospital de día, teléfono de 24 horas, personal de enfermería educador, lugar específico y remuneración por ese concepto, mientrasque 2 CH no disponen de ninguno de estos requisitos. Siete de los 14 encuestados creen que debería existir un "Comité de Endocrinólogos" que marcase las pautas a seguir en materia de sistemas ISCI. Sin embargo, sólo 3 creen que "ese Comité" debería tener capacidad ejecutiva para acreditar o no a los distintos centros en materia de bombas de infusión. En 4 de los 13 CH no existe aún un protocolo de aplicación y seguimiento de ISCI. Conclusión: La dispensación de sistemas ISCI es poco homogénea entre las diferentes AS de la CM. Este hecho probablemente sea debido a diferencias en las infraestructuras de los CH, y en la capacitación y motivación de los profesionales involucrados

Objective: To assess the implementation of continuous subcutaneous insulin infusion (ISCI) in the Madrid Autonomous Community (MAC) and to evaluate the evolution since the coverage by the Public Health System. Methods: Descriptive cross-sectional study using questionnaires sending by e-mail to the physicians responsible for CSII therapy in Departments of Endocrinology or Pediatrics in each Heath Area of MAC between 2004-2005. Results: All the contacted physicians sent back the questionnaires: 11 health areas with a reference hospital, 2 centers without a self health area and two centers of pediatrics or endocrinology from the same area, making a total of 14 centers to be evaluated. During 2004, 109 devices were followed in MAC, increasing to 213 in 2005. Nowadays, each management center sustained at least 72% of the expenses related to CSII therapy. In 5 centers, pump and fungible material were covered for diabetic patients coming from other health areas but no from other autonomous communities. In 2005, 24 health personnel (20 endocrinologists and 4 pediatricians) were involved in the therapy. Only one center incorporated a new staff physician but no changes occurred in the number of diabetic educators. In 10 centers, fungible material are dispensed by the endocrinology department. Finally, only one center had a day-care clinic, 24 h assistance phone, diabetes educator, an appropriate area for therapy and a budget for CSII therapy. Two centers didn’t have any of the above requirements. Seven of 14 interviewed physicians suggest that a committee of endocrinologists will be necessary to establish the rules for CSII. However, only 3 were in accordance to give executive faculties to the committee to give accreditation for CSII therapy. Finally, in 4 out of 13 centers there are still no pump therapy protocols and followup. Conclusions: The implementation of CSII therapy is no homogeneous between different health areas of MAC. This fact is probably due to differences in the resources and personal motivated enough with pump therapy

Pie diabético / Diabetic foot

Todos los pacientes a los que se les ha realizado una amputación de miembro inferior (AMI) entre enero de 1989 y diciembre de 2003 en el Área 7 de Madrid se identificaron a través de los partes de quirófano. Los informes de alta del servicio de cirugía vascular y del servicio de endocrinología, así como los médicos de familia (prescriptores), se utilizaron como fuente secundaria. De acuerdo con la Declaración de San Vincent, se observó una reducción en las AMI y un retraso en la edad de presentación, y se relacionó con una mejoría en la asistencia dispensada a las personas con diabetes. A pesar de esta mejoría, se podría alcanzar una reducción más importante en las AMI con un cribado de neuropatía más temprano, con programas de intervención basados en una educación bien estructurada de forma continuada, y facilitando el acceso al podólogo cubierto por la Seguridad Social en pacientes con pie en riesgo. El coste económico ahorrable se ha estimado en más de 100.000 A anuales por cada 100.000 habitantes

All patients who underwent a lower extremity amputation (LEAs) between January 1989 and December 2003 in Area 7, Madrid, were identified through operating theatre records. Vascular surgery department and Endocrinology service discharge records, and prescribing family doctors were used as secondary sources. According to Saint Vincent Declaration, a substantial decrease in LEAs and a later presentation were observed and related to a series of improvements in diabetic treatment. Despite these figures, a more substantial reduction in LEAs in diabetic people could be achieved with an earlier neuropathy screening, and intervention programes based on a continuing and well-structured education. The potential cost saving per 100.000 inhabitants and per year was estimated to be about 100.000 A

Silent peripheral vascular disease is prevalent in people with diabetic neuropathy

El propósito de este estudio ha sido poner en evidencia que la enfermedad vascular periférica (EVP) es prevalente en personas asintomáticas con polineuropatía diabética. Entre Enero y Mayo de 2001 hemos evaluado a 22 personas con diabetes y sin polineuropatía (Grupo A, 12 hombres y 10 mujeres, de 62,5 + 7,8 años de edad y con 12,5 + 10.8 años de evolución) y a 54 personas con diabetes y polineuropatia (Grupo B, 32 hombres y 22 mujeres, de 62,6 + 9,9 años de edad y 17,6 + 13,8 años de evolución) y a un grupo control constituido por 22 personas sin diabetes, 12 hombres y 10 mujeres, de una edad media de 62,6 + 8,7 años de edad, para detectar la presencia de EVP basada en la morfología del pulso arterial y en los índices tobillo brazo (ITB) estimados con un eco doppler bidireccional. Todos los pacientes estaban asintomáticos bajo el punto de vista vascular y tenían los pulsos pedios palpables. La EVP se consideró con un ITB 1,25 y / o con la presencia de ondas monofásicas del pulso arterial. Todos los pacientes del grupo control y del A tuvieron unos ITB entre 0,8 y 1,25 y sus ondas de pulso arterial fueron trifásicas. Sin embargo 5 (9,2 por ciento) y 15 (27,8 por ciento) de las personas con diabetes del grupo B tuvieron un ITB > 1,25 y < 0,8 respectivamente, presentando 17 (31,5 por ciento) ondas monofásicas. La prevalencia de EVO se estimó en 48 por ciento. La presencia de EVP se asoció a unos niveles mas elevados de colesterol LDL y a hipertensión arterial, siendo además fumadores activos con mas frecuencia. En conclusión, nuestros datos ponen en evidencia que una de cada dos personas con polineuropatía tiene EVP asintomática. Si el diagnóstico precoz de la EVP puede ayudar a prevenir la aparición de úlceras en los pies y las amputaciones de miembro inferior debe ser demostrado (AU)

Cetoacidosis diabética: una complicación frecuente de la diabetes tipo 2 en hispanoamericanos

Objetivo: describir las características clínicas y de laboratorio de los casos de cetoacidosis diabética (CAD) identificados en forma prospectiva en un hospital de tercer nivel de atención en Lima - Perú. Material y métodos: se realizó un estudio de serie de casos. Se incluyó a pacientes con diagnóstico de CAD de acuerdo a los criterios de la ADA durante el período de Junio del 2001 a Diciembre del 2002. Se agrupó a los pacientes como diabetes tipo 1 (DM 1), tipo 2 (DM2), tipo no definido (1 ó 2) y otros tipos dependiendo de la causa de la CAD; se utilizó el antecedente de enfermedad y parámetros clínicos como edad, índice de masa corporal (IMC) y se hizo el análisis de las variables de laboratorio: pH inicial, bicarbonato inicial, glucosa inicial, cuerpos cetónicos, creatinina, iones. Resultados: durante el período de estudio se presentaron 110 casos de crisis hiperglicémicas, de los cuales 66 (60 por ciento) casos correspondieron a CAD; la distribución fue la siguiente: el 4,5 por ciento fueron pacientes con diabetes tipo 1, el 54,5 por ciento diabetes tipo 2, el 33,3 por ciento diabetes no definida y el 7,5 por ciento otros tipos (gestacional, corticoides, postpancreatitis y acromegalia). La media de edad de los pacientes con DM 2 fue de 49,69 ñ 12,7 años y el IMC de 29,6 ñ 3,56. El 25 por ciento fueron varones y el 75 por ciento mujeres; se observó que el 52,8 por ciento debutaron con CAD y el factor precipitante en el 35,8 por ciento de los casos fue de causa infecciosa y en el 33,3 por ciento de los casos no se halló factor descompensante; la mortalidad fue del 10,7 por ciento de todo el grupo estudiado. Los valores metabólicos de ingreso tuvieron una media de pH 7,16 (ñ0,106), bicarbonato de 6,9 ñ 3,89 meq/L, osmolaridad de 305 ñ 16,69 mosm/L, glucosa de 583,58 (ñ195,17) en el grupo con DM tipo 2. Conclusiones: la cetoacidosis diabética es más común de lo que se piensa en hispanoamericanos con DM 2 y se produce a edades más avanzadas y sin historia previa de DM 2, su forma de presentación es como CAD moderada o severa de acuerdo a los criterios de la ADA y es una condición frecuente en nuestro Hospital. (AU)

Índice glucémico y tratamiento nutricional de las personas con diabetes mellitus / Glycemic index and nutritional treatment in persons with diabetes

Desde hace más de 20 años ha existido interés en analizar los niveles posprandiales de glucosa después de la ingestión de alimentos ricos en carbohidratos. El objetivo de estos análisis era realizar un listado de alimentos ordenados en función de la respuesta glucémica posprandial. Este parámetro se denominó índice glucémico, que Jenkins definió como la relación entre el área bajo la curva de la respuesta glucémica posprandial producida por la ingestión de 50 g de carbohidratos suministrados por un alimento concreto y un alimento patrón (glucosa o pan), y multiplicado por 100. En teoría, la elección de alimentos con bajo índice glucémico podría ser útil para el tratamiento nutricional de la persona con diabetes. Sin embargo, la utilidad de dicho índice ha sido cuestionada recientemente.Los trabajos disponibles en la actualidad no demuestran ningún beneficio sobre el control de la diabetes en personas con diabetes tipo 1 o tipo 2 cuando reciben alimentos con bajo índice glucémico en comparación con los de alto índice glucémico. El tratamiento nutricional de la persona con diabetes debe basarse en su alimentación habitual y debe utilizarse como la base del tratamiento farmacológico y su estilo de vida. Desde el punto de vista clínico, debe considerarse prioritario seleccionar los alimentos por su contenido en carbohidratos más que por su índice glucémico. En esta revisión analizamos la utilidad del índice glucémico desde la perspectiva de la medicina basada en la evidencia (AU)

Los registros como base para diseñar y evaluar la planificación de la asistencia a las personas con diabetes. El ejemplo de las lesiones en los pies

No disponible