Alterations in arterial pressure in patients with Type 1 diabetes are associated with long-term poor metabolic control and a more atherogenic lipid profile.

AIM: To determine the prevalence of alterations in blood pressure (BP) in patients with Type 1 diabetes who are normoalbuminuric and normotensive; and to evaluate the association with genetic, clinical and metabolic factors. MATERIAL/ METHODS: Normoalbuminuric, normotensive Type 1 diabetic patients (no.=85) had their ambulatory blood pressure monitoring (ABPM) performed over 24 h, together with measurement of HbA1c and lipid profile, polymorphisms of the ACE gene, non-midriatic retinography, and the "historical HbA1c" calculated (mean of all the determinations available on the patient). RESULTS: Of the 85 patients, a mean of 18.8% had pathologic values of BP over the 24 h, 31.8% during active periods and 22.4% during rest periods; in 42% there was a non-dipper pattern in BP. The patients with alterations of BP had higher body mass index (BMI), higher levels of glycemia and of triglycerides, and decreased levels of HDL cholesterol. The "historical HbA1c" was significantly higher in the patients with the non-dipper pattern (8.6 ± 1.4% vs 7.9 ± 1.4%; p=0.046). Pulse pressure was directly associated with male gender (p=0.006) and with BMI (p=0.001). No differences were detected in the distribution of the polymorphisms of the ACE gene as a function of the BP alterations. CONCLUSIONS: An elevated number normoalbuminuric, normotensive, Type 1 diabetic patients have alterations in BP detected with ABPM over 24 h, and these are associated with a greater BMI, poor long-term metabolic control and a more atherogenic lipid profile.

Alteraciones de la presión arterial en pacientes con diabetes tipo 1 / Blood pressure alterations in patients with type 1 diabetes

La hipertensión arterial (HTA) incrementa de forma significativa elriesgo de complicaciones crónicas de la diabetes. Mediante la monitorizaciónambulatoria de presión arterial (MAPA) es posible detectaralteraciones subclínicas de la presión arterial (PA), como elpatrón no dipper, que pasan desapercibidas con la toma aislada, yque son más prevalentes en pacientes con diabetes que en la poblacióngeneral. A pesar de su relevancia, son escasos los datosdisponibles a este respecto en pacientes con diabetes tipo 1 (DM1).Por este motivo, se ha realizado un exhaustivo análisis de la bibliografía(PubMed, Ovid). La prevalencia de HTA y de patrón no dipperdifieren según la metodología del estudio y las características de lapoblación analizada (HTA: 8-58%; patrón no dipper: 18-78%). Lapresencia de patrón no dipper incrementa significativamente el riesgode microalbuminuria y retinopatía. Aunque el control estricto dela HTA disminuye la aparición de complicaciones crónicas de ladiabetes, no hay evidencias de que el tratamiento de las alteracionessubclínicas de la PA, detectadas mediante MAPA en pacientesnormotensos, disminuya la tasa de complicaciones, por lo que esnecesario llevar a cabo estudios prospectivos para aclarar estacuestión(AU)

Hypertension and subclinical alterations of blood pressure (non dipperpattern) increase the risk of chronic diabetes complications. In spiteof this risk, there are few studies that analize this problem in type 1diabetic patients. Because of this, we have made an exhaustive searchabout this item in bibliographic databases (PubMed, Ovid). Prevalenceof hypertension and non-dipper pattern are different depending onthe methodology and population charactheristics (hypertension: 8-58%; non dipper pattern: 18-78%). Non dipper pattern increasessignifi cantively the risk of microalbuminuria and retinopathy. Althoughthere is evidence about the benefi cial effect of tigh control of hypertension,at the moment we do not know exactly the benefi cial effectof treating subclinical alterations of blood pressure in patient with valuesat normal range during standard measurement(AU)

[Dietary-therapeutic product supply in unitary doses at a university hospital: effect on consumption and costs]. / Dispensación de los productos dietoterapéuticos mediante dosis unitarias en un hospital universitario: efectos sobre el consumo y costes.

GOALS: To analyze the consumption and costs of the Enteral Nutrition products (diets and dietary supplements) dispensed from the Nutrition unit in a 735-bed general hospital during two six-month periods, before and after the implementation of a unit-dose (UD) distribution system. MATERIALS AND METHODS: The defined daily dose (DDD) methodology was used. A DDD of 1,500 Kcal/day was defined for complete diets in adults, with 1,000 Kcal/day for complete diets in children, 1,200 Kcal/day for "start-up" diets, 500 Kcal/day for normocaloric supplements and 600 Kcal/day for hypercaloric supplements and 450 Kcal for very low caloire diets. RESULTS: The total consumption in the hospital fell from 10.21 DDD per 100 stays/day (DED in its Spanish acronym), representing generated costs of 8,640,130 pesetas between November, 1997, and April, 1998, to 6.25 DED in the same period for 1998-99, with costs amounting to 6,674,775 pesetas (-23%). In the services handled using UD, the total consumption declined from 9.3 DED between November, 1997, and April, 1998, to 5.2 DED in the same period for 1998-99. The consumption of standard/special diets and dietary supplements went from 1.38/0.76/7.16 DED to 1.48/0.53/3.19 DED during the two periods under study, with an accompanying drop in costs of -1,806,598 pesetas (-30%). In percentage terms, the standard diets varied from 26% to 41% (of the total cost generated in the services with UD), special diets from 28% to 22% and dietary supplements from 54% to 37%. In those services where the UD was not applied (ICU and reanimation), the total consumption of diets remained stable with a slight drop from 25.3 DED to 24.3 DED. CONCLUSIONS: The unit dose system has improved the prescription of therapeutic dietary products in our hospital and has reduced the costs, mainly through the notable decrease in the dispensation of supplements.