[Evaluation of a follow-up program for diabetes after hospital discharge]. / Evaluación de un protocolo de seguimiento para diabetes tras el alta hospitalaria.

BACKGROUND: Given the higher rate of hospital admissions among diabetic patients, discharge should be used to optimize outpatient treatment. We evaluate a follow-up program for diabetic patients after hospital discharge to determine the evolution of glycemic control. METHOD: Retrospective collection of data on 375 diabetic patients enrolled in the follow-up program for optimization treatment: telephonic follow-up where treatment was adjusted if needed; and three months after discharge an in-person consultation was scheduled. Factors potentially associated with a 1% improvement in HbA1c were studied by multivariate logistic regression. RESULTS: Seventy-three percent of enrolled patients completed the follow-up program; each patient received an average of 4.6 phone calls. Globally, basal mean HbA1c was significantly lower three months later regarding the initial value (8.6 vs. 7.2%); the most relevant lowering was found in the group of hyper-glycemia by poor metabolic control (from 9.9 to 7.7%), combined hyperglycemia (from 9.3 to 7.3%) and debut (from 8.3 to 6.4%). Twenty percent of patients reported capillary hypoglycemia, with two severe events. A shorter duration of diabetes, absence of corticotherapy and absence of hypoglycemia during the follow-up period were independent predictors for a 1% reduction in three-months HbA1c. CONCLUSION: In patients whose treatment is changed on hospital discharge, a program allowing frequent treatment adjustment would improve HbA1c levels. These results could help to organize health resources more rationally.

Evaluación de un protocolo de seguimiento para diabetes tras el alta hospitalaria / Evaluation of a follow-up program for diabetes after hospital discharge

FUNDAMENTO: Ante la mayor tasa de hospitalizaciones de los pacientes con diabetes (DM), se recomienda aprovechar el momento del alta hospitalaria para optimizar su tratamiento ambulatorio. Evaluamos un protocolo de seguimiento tras el alta hospitalaria de pacientes con DM para conocer la evolución del control glucémico. MATERIAL Y MÉTODOS: Se recogieron de forma retrospectiva datos de los 375 pacientes diabéticos incluidos en el protocolo, basado en optimización del tratamiento previo, seguimiento telefónico con ajuste terapéutico intermedio durante tres meses y consulta presencial al final del periodo. Se estudiaron factores potencialmente relacionados con una disminución del 1% en la HbA1c final mediante regresión logística. RESULTADOS: El 73% de los pacientes incluidos completaron el seguimiento, recibiendo una media de 4,6 llamadas. Globalmente, la HbA1c se redujo significativamente a los tres meses respecto a la inicial (de 8,62 a 7,19%); los mayores descensos se observaron en pacientes con hiperglucemia por mal control metabólico previo (de 9,85 a 7,65%), hiperglucemia combinada (de 9,32 a 7,31%) y debut (de 8,29 a 6,36%). El 20,5 % de los pacientes presentaron hipoglucemia capilar, en dos casos grave. Un menor tiempo de evolución de la DM, la no necesidad de corticoterapia y la ausencia de hipoglucemias en el seguimiento fueron predictores independientes de una reducción de 1% en la HbA1c a los tres meses. CONCLUSIÓN: Un protocolo de seguimiento mediante contacto telefónico de pacientes con DM con cambios de tratamiento al alta hospitalaria, permite el ajuste frecuente de la dosis y mejora los niveles de HbA1c, lo que podría ayudar a distribuir los recursos asistenciales de forma más racional

BACKGROUND: Given the higher rate of hospital admissions among diabetic patients, discharge should be used to optimize outpatient treatment. We evaluate a follow-up program for diabetic patients after hospital discharge to determine the evolution of glycemic control. METHOD: Retrospective collection of data on 375 diabetic patients enrolled in the follow-up program for optimization treatment: telephonic follow-up where treatment was adjusted if needed; and three months after discharge an in-person consultation was scheduled. Factors potentially associated with a 1% improvement in HbA1c were studied by multivariate logistic regression. RESULTS: Seventy-three percent of enrolled patients completed the follow-up program; each patient received an average of 4.6 phone calls. Globally, basal mean HbA1c was significantly lower three months later regarding the initial value (8.6 vs. 7.2%); the most relevant lowering was found in the group of hyper-glycemia by poor metabolic control (from 9.9 to 7.7%), combined hyperglycemia (from 9.3 to 7.3%) and debut (from 8.3 to 6.4%). Twenty percent of patients reported capillary hypoglycemia, with two severe events. A shorter duration of diabetes, absence of corticotherapy and absence of hypoglycemia during the follow-up period were independent predictors for a 1% reduction in three-months HbA1c. CONCLUSION: In patients whose treatment is changed on hospital discharge, a program allowing frequent treatment adjustment would improve HbA1c levels. These results could help to organize health resources more rationally

Encuesta nacional sobre la cantidad y estabilidad de las plazas de endocrinología y nutrición en los sistemas públicos de salud españoles / National survey on the number and estability of endocrinology and nutrition positions in the Spanish public health system

El pasado mes de noviembre de 1999, el Dr. Astorga, presidente de la Sociedad Española de Endocrinología y Nutrición (SEEN), propuso evaluar y dar a conocer a la opinión pública española la falta de especialistas en endocrinología y nutrición, así como la precariedad en el empleo dentro de los diversos servicios públicos de salud de España. Dicha información debía ser recogida por medio de la Comisión Asistencial de la SEEN (órgano de representación de todas y cada una de las 17 comunidades autónomas de España) y hecha pública a través de Inforpress (oficina de prensa contratada por la SEEN).En la reunión de la Comisión Asistencial de noviembre de 1999, en Madrid, se informó a los representantes autonómicos de este proyecto, solicitándose que obtuvieran y facilitaran a su presidente (Dr. Forga), lo antes posible, los siguientes datos: 1. Número aproximado de habitantes de su comunidad en total y de cada una de las provincias que la constituyen en particular.2. Número total de plazas de endocrinología en la red pública de su comunidad y su reparto por provincias. Indicar también cuántos especialistas son fijos y cuántos interinos o temporales.3. Número total de plazas de nutrición en la red pública de su comunidad y su reparto por provincias. Indicar también cuántos especialistas son fijos y cuántos interinos o temporales. A medida que se iban recopilando estos datos, los representantes autonómicos los fueron remitiendo al presidente de la Comisión, de tal manera que, al celebrarse la siguiente reunión de la Comisión Asistencial en Bilbao el 13-5-2000, disponíamos ya de los datos (aunque recogidos con heterogeneidad) de todas las comunidades autónomas. En esa reunión se debatió cómo tratar estos datos y se acordó: 1. Solicitar la publicación de los resultados conjuntos (endocrinología + nutrición), por comunidades autónomas, en la revista ENDOCRINOLOGÍA y NUTRICIÓN.2. Pedir al Dr. Astorga, en su calidad de presidente de la SEEN, que escribiera un "Editorial" que precediera al mencionado artículo.3. Finalmente, facilitar los datos a la prensa (Inforpress) para que se dieran a conocer a la opinión pública a través de los medios de comunicación nacionales y locales. A escala autonómica, los representantes de cada comunidad expondrían también los datos por provincias y por hospitales si lo estimasen oportuno. En cumplimiento de lo acordado por la Asamblea de la Comisión, se ha redactado este escrito que consideramos de interés para los miembros de la SEEN (AU)

Persistent increase of PRL after oral contraceptive treatment. Alterations in dopaminergic regulation as possible etiology.

BACKGROUND: The mechanism involved in estrogen induced hyperprolactinemia is not completely known, although one of the possible theories suggest inhibition of dopaminergic tone. Our objective was to study the mechanism implied in the increment of PRL levels as a consequence of oral contraceptive treatment and possible modifications in TSH levels. MATERIAL AND METHODS: We performed a trial on 21 healthy women, nulliparas. We administered 35 microg of Etinil-Estradiol (EE) and 2 mg of Ciproterone Acetate (CA) for a period of 12 months. Stimulation tests with Metoclopramide and TRH were carried out before treatment, after 3, 6 and 12 months of treatment and finally 6 months after cessation of treatment. RESULTS: Basal levels of PRL (mean=12.62 ng/ml) increased significantly (p<0.05) during the year of treatment (mean12=17.04 ng/ml) and maintained higher levels 6 months after cessation (meanl8=17.53 ng/ml). Maximum values obtained in response to metoclopramide (mean1=154.78) were significantly higher after 12 months (mean12=173.29), persisting 6 months after cessation of treatment (mean18=245.28). We also observed significant differences in the maximum response of TSH to metoclopramide during the same period of study (mean6=2.45), (mean12=2.76) and (mean18=2.07) respectively (p<0.05). We did not find changes in PRL and TSH responses to TRH stimulation after a year of treatment with EE and CA. CONCLUSION: Treatment with EE (35 microg) and CA (2 mg) induces an increase in PRL levels that persist 6 months after cessation of treatment. Our results rule out the possibility that this increase in PRL is due to a decrease in dopaminergic tone or an increase in TRH sensitivity.

[Recurrence of Graves-Basedow disease: the influence of treatment schedule]. / Recidivas en la enfermedad de Graves-Basedow: influencia de la pauta de tratamiento.

BACKGROUND: The aim of the present study was to evaluate the possible influence of 2 different methods of treatment (antithyroid drugs and antithyroid drugs plus levothyroxine) on the number of recurrences in Graves' disease, as well as to study the possible prognostic factors for the evolution of the disease. METHODS: Seventy-six patients allocated in to 2 treatment groups were studied. Group A included those patients treated with decreasing doses of carbimazole and group B included patients treated with high doses of carbimazole plus levothyroxine. The follow-up of these patients was carried out over a minimum of 36 months after discontinuation of treatment. RESULTS: No significant differences were observed in either the clinical characteristics or hormonal or antibody values in both groups on initiation and at the end of treatment. The percentage of recurrence in group A patients during the first 12 months of follow-up was significantly greater (65% vs 23%, p < 0.001) than in group B. The percentage of recurrence equalled (62.8% vs 60.7%, p = NS) on prolongation of follow-up of up to 36 months. Recurrence was not correlated with either the clinical or biochemical parameters evaluated, although it did correlate with goiter size with recurrence observed in 100% of the patients with goiter greater than or equal to II. CONCLUSION: The association of levothyroxine to treatment with carbimazole in Graves' disease delays the appearance of recurrence but does not significantly decrease it in comparison with the treatment with carbimazole in decreasing doses. Only the size of goiter on initiation of treatment may be a prognostic factor for disease evolution.

[ACTH-independent Cushing's syndrome due to bilateral macronodular adrenal hyperplasia with empty sella turcica and anterior panhypopituitarism]. / Síndrome de Cushing ACTH-independiente por hiperplasia adrenal macronodular bilateral con silla turca vacía y panhipopituitarismo anterior.

A case is presented of Cushing's syndrome due to macronodular bilateral adrenal hyperplasia which is ACTH-independent as was demonstrated by the undetectable basal and after stimulation with metoprolol ACTH plasma levels. High cortisol levels is associated in this patient with empty sella turcica and anterior panhypopituitarism with confirm the exclusive adrenal origin of the hormone hypersecretion and the lack of treatment success with hypophysis ablation in this process.