Impact of endometrial compaction on reproductive outcomes after cryotransfer of euploid embryos in a modified natural cycle: protocol for a prospective cohort study.

Introduction: Embryo implantation is a complex and poorly understood process. Most studies to date have focused on the analysis of the endometrium at the end of the estrogenic phase, while the available data on its importance after secretory transformation are limited and inconsistent. Current evidence does not allow for a conclusive interpretation of the changes observed in the pre-implantation endometrium, whether in the natural or replacement cycle, and their relevance in the development of a pregnancy or the implications for clinical practice. Methods: Multicenter prospective observational cohort study. Based on our sample size calculation, the study group will consist of 206 women (exposed or "compaction" group: 103 women with a decrease of ≥ 5% in endometrial thickness between the estrogenic phase and the day of embryo transfer; non-exposed "non-compaction" group: 103 women with similar or greater endometrial thickness between these time points). The main objective of this study is to compare the ongoing pregnancy rates in natural cycles for euploid embryo transfer in patients who present endometrial compaction at the time of transfer versus those who with a stable or greater endometrial thickness with respect to the estrogenic phase. The estimated duration of the study is 30 months. Inclusion criteria are: 18 to 50 years of age, with primary or secondary infertility, subjected to endometrial preparation in a modified natural cycle for transfer of a genetically euploid blastocyst, from their own oocyte or oocyte donation, with a normal uterine cavity. Exclusion criteria are: uterine or endometrial disease (e.g., multiple myomatosis, severe adenomyosis, Asherman syndrome, refractory endometrium), conditions that prevent correct ultrasound assessment (tilted uterus), or a history of recurrent implantation failure or repeated miscarriages. Discussion: The findings from this study will provide valuable insights into the potential influence of the "endometrial compaction" phenomenon on reproductive outcomes during natural cycle endometrial preparation. By examining this aspect, we aim to contribute to a better understanding of the factors that may impact successful outcomes in fertility treatments.

Impact of adherence to Mediterranean diet and/or drug treatment on glycaemic control in type 2 diabetes mellitus patients: DM2-CUMCYL study.

AIMS: This study aimed to analyse the association between adherence to treatment and glycaemic control in people with type 2 diabetes mellitus. METHODS: Multicentre, cross-sectional study in patients with type 2 diabetes mellitus recruited by primary care professionals in Castilla y León (Spain). Sociodemographic and clinical characteristics were reflected in self-reported questionnaire, which included the Morisky-Green Medication Adherence Scale and the 14-point Mediterranean Diet Adherence Screener. Medication non-adherence and poor glycaemic control were analysed by bivariable and multivariable analyses. RESULTS: Of 3536 included patients, the 33.8% reported non-adherence to pharmacological treatment, and the 33.7% had poor glycaemic control (HbA1c ≥58 mmol/mol [7.5%]); 50.6% of patients reported moderate-high adherence to the Mediterranean diet (≥9 points). The multivariable logistic regression model showed that educational level (OR 0.73; 95% CI 0.61-0.87; p < 0.001) and sedentarism (OR 1.64; 95% CI 1.36-1.98; p < 0.001) were associate with low adherence. Younger age, rural residence, smoking, time since diagnosis (OR 1.04; 95% CI 1.03-1.05; p < 0.001) and polypharmacy were associated with poor glycaemic control. CONCLUSION: Lower educational level and sedentarism were associated with low adherence. Younger age, rural residence, smoking, time since diagnosis and polypharmacy, increased risk of poor glycaemic control.

Clinical applicability and cost-effectiveness of DIABSCORE in screening for type 2 diabetes in primary care.

AIMS: To evaluate the applicability and cost-effectiveness of a clinical risk score (DIABSCORE) to screen for type 2 diabetes in primary care patients. METHODS: Multicenter cross-sectional study of 10,508 adult no previously diagnosed with diabetes, in 2 Spanish regions (Canary Islands and Valencian Community). The variables comprising DIABSCORE were age, waist to height ratio, family history of diabetes and gestational diabetes. ROC curves were obtained; the diabetes prevalences odds ratios (HbA1c ≥6.5%) between patients exposed and not exposed to DIABSCORE ≥100, and to fasting blood glucose ≥126mg/dL were calculated. The opinions of both the professionals and the patients concerning DIABSCORE were collected, and a cost-effectiveness analysis was performed. RESULTS: In both regions, the valid cut-off point for diabetes (DIABSCORE=100), showed an area under the curve >0.80. The prevalences odds ratio of diabetes for DIABSCORE ≥100 was 9.5 (3.7-31.5) in Canarian and 18.3 (8.0-51.1) in Valencian; and for glucose ≥126mg/dL it was, respectively, 123.0 (58.8-259.2) and 303.1 (162.5-583.8). However, glucose ≥126mg/dL showed a low sensitivity (below 48% in both communities) as opposed to DIABSCORE ≥100 (above 90% in both regions). Professionals (100%) and patients (75%) satisfaction was greater when using DIABSCORE rather than glucose measurement for diabetes screening. The cost of each case of diabetes identified was lower with DIABSCORE ≥100 (7.6 € in Canarian and 8.3 € in Valencian) than glucose ≥126mg/dL (10.8 € and 10.5 €, respectively). CONCLUSIONS: DIABSCORE is an applicable and cost-effective screening method for type 2 diabetes in primary care.