Intentos para perder peso en una población con sobrepeso y obesidad referida a un centro de endocrinología en Colombia / Attempts to lose weight in an overweight and obese population referred to an endocrinology center in Colombia / Tentativas de perda de peso de uma população com sobrepeso e obesidade encaminhada para um centro de endocrinologia na Colômbia

Introducción. El exceso de peso es una condición prevalente en Colombia. Esto conlleva a realizar múltiples intentos para perder peso, muchos autodirigidos y con riesgos, siendo un motivo de consulta frecuente en atención médica primaria y especializada. Metodología. Estudio de corte transversal con datos secundarios de la consulta de endocrinología de pacientes que consultaron por percepción de aumento de peso. Se indagó por 18 métodos convencionales y populares para perder peso, su duración, peso perdido y posterior re ganancia. Resultados. Se incluyeron 100 personas, 79% mujeres, con un promedio de edad de 41.1 años, índice de masa corporal de 32.9 ± 4.6 kg/m2 y perímetro abdominal de 102.7 ± 12.5 cm. En promedio se registraron entre 4 y 5 intentos para perder peso por persona antes de consultar al endocrinólogo, con una mediana de historia de exceso de peso de 10 años. Todos los intentos lograron alguna pérdida con posterior reganancia del total del peso perdido, excepto liraglutida. No se encontró asociación significativa entre variables antropométricas y el número de intentos para perder peso. Discusión. Los intentos de pérdida de peso más empleados por la población evaluadas son los que no están aprobados o carecen de evidencia científica robusta. Conclusiones. Los pacientes con sobrepeso y obesidad realizan múltiples intentos fallidos para perder peso antes de consultar al médico especialista. La reganancia es muy frecuente, independientemente del tipo de intento. Cómo citar. Wandurraga EA, Marín Carrillo LF, Ardila Gutiérrez MA, Serrano-Gómez SE. Intentos para perder peso en una población con sobrepeso y obesidad referida a un centro de endocrinología en Colombia. MedUNAB. 2019:22(3): 314-321. doi: 10.29375/01237047.3569

Introduction. Excess weight is a prevailing condition in Colombia. This leads to many weight loss attempts, many self-managed and with risks, being a frequent reason for consulting primary and specialized healthcare. Methodology. Cross-sectional study with secondary data from the endocrinology consultation of patients who made the appointment due to a perceived increase in weight. Eighteen conventional and popular ways of losing weight, their duration, the weight lost and the subsequent regained weight were investigated. Results. One hundred people were included, 79% women with an average age of 41.1 years, a body mass index of 32.9 ± 4.6 kg/m2 and a waist circumference of 102.7 ± 12.5 cm. Each person reported an average of four to five attempts to lose weight before consulting the endocrinologist, with a median history of being overweight of ten years. All of the attempts achieved some weight loss with subsequent regain of the total weight lost, except when using liraglutide. A significant association was not found between the anthropometric variables and the number of weight loss attempts. Discussion. The weight loss methods most used by the assessed population are ones that are not approved or that lack strong scientific evidence. Conclusions. Overweight or obese patients make multiple failed attempts to lose weight before consulting a specialist physician. Regain of the lost weight is frequent, regardless of the method used. Cómo citar. Wandurraga EA, Marín Carrillo LF, Ardila Gutiérrez MA, Serrano-Gómez SE. Intentos para perder peso en una población con sobrepeso y obesidad referida a un centro de endocrinología en Colombia. MedUNAB. 2019:22(3): 314-321. doi: 10.29375/01237047.3569

Introdução. Excesso de peso é uma condição prevalecente na Colômbia. Isso leva a várias tentativas de perda de peso, muitas auto-dirigidas e de risco, sendo motivo de consultas frequentes em atendimento médico primário e especializado. Metodologia. Estudo transversal com dados secundários da consulta de endocrinología de pacientes que consultaram para percepção do ganho de peso. Foram investigados 18 métodos convencionais e populares para perder peso, sua duração, peso perdido e subsequente reganho. Resultados. Foram incluídas 100 pessoas, 79% mulheres, com idade média de 41,1 anos, índice de massa corporal de 32,9 ± 4,6 kg / m2 e perímetro abdominal de 102,7 ± 12,5 cm. Em média, foram registradas entre quatro e cinco tentativas de perda de peso por pessoa antes de consultar o endocrinologista, com uma mediana de história de excesso de peso de 10 anos. Todas as tentativas alcançaram alguma perda com subsequente re-ganancia do peso total perdido, exceto o liraglutida. Não foi encontrada associação significativa entre as variáveis antropométricas e o número de tentativas de perda de peso. Discussão. As tentativas de perda de peso mais utilizadas pela população avaliada são aquelas que não são aprovadas ou não possuem evidências científicas robustas. Conclusões. Pacientes com sobrepeso e obesos fazem várias tentativas fracassadas de perder peso antes de consultar o especialista. A re-ganancia de peso é frequente, independentemente do tipo de tentativa. Cómo citar. Wandurraga EA, Marín Carrillo LF, Ardila Gutiérrez MA, Serrano-Gómez SE. Intentos para perder peso en una población con sobrepeso y obesidad referida a un centro de endocrinología en Colombia. MedUNAB. 2019:22(3): 314-321. doi: 10.29375/01237047.3569

Sorafenib-Induced Acute Pancreatitis in a Patient with Differentiated Thyroid Cancer.

BACKGROUND: Sorafenib is a tyrosine kinase inhibitor approved for the treatment of metastatic renal cell carcinoma, hepatocellular carcinoma, and recently for radioactive iodine (RAI)-refractory metastatic differentiated thyroid carcinoma (DTC). Several side effects have been described including alterations in amylase and lipase levels. Nonetheless, only a few cases of pancreatitis during renal carcinoma and hepatocellular carcinoma treatment have been described. OBJECTIVE: To describe the first case report of sorafenib-induced acute pancreatitis during the treatment of thyroid carcinoma. METHODS AND RESULTS: In a 60-year-old Latin woman with RAI-refractory papillary thyroid carcinoma, T4bN1bM1, sorafenib was indicated due to locally recurrent, metastatic, and progressive lung involvement without iodine uptake. Therapy was initiated (200 mg) every 8 h. Three days after starting the medication, abdominal pain, nausea, and emesis appeared. A blood test revealed elevated amylase (343 U/L RV: 28-100) and lipase (1,969 U/L RV: 23-300) levels, but no other findings, confirming acute mild pancreatitis. Hypertriglyceridemia, hypercalcemia, and alcohol and biliary etiologies were ruled out and sorafenib-acute pancreatitis was concluded. Two weeks later, sorafenib was resumed without recurrence. To date, this is the tenth sorafenib-related pancreatitis report and the first in a patient with RAI-refractory metastatic DTC. CONCLUSIONS: Sorafenib-acute pancreatitis may develop in patients with RAI-refractory thyroid cancer. This adverse event seems to be inde-pendent of the treatment duration and administered dose. Resuming the medication with an adjusted dose after pancreatitis resolution may be safe.

Maternal-Fetal Outcomes in 34 Pregnant Women with Type 1 Diabetes in Sensor-Augmented Insulin Pump Therapy.

BACKGROUND: Pregnancy in women with type 1 diabetes (T1D) is associated with increased risk of maternal complications and neonatal morbidity and mortality. Optimizing glycemic control improves these outcomes. OBJECTIVE: To describe the experience of using sensor-augmented insulin pump therapy (SAPT) and SAPT + low-glucose suspension (LGS) on pregnant women with T1D, including neonatal and maternal outcomes. METHODS: A prospective observational study was conducted in women with T1D who started SAPT and SAPT + LGS before or during pregnancy at the San Ignacio University Hospital Diabetes Center in Bogotá, Colombia. The main indication was severe hypoglycemia (SH) and poor glycemic control. Glycated hemoglobin (A1c), hypoglycemia, and maternal and fetal outcomes were assessed. RESULTS: Thirty-four pregnant women with T1D on SAPT and SAPT + LGS were included. Sixteen patients started therapy during pregnancy at a mean gestational age of 17.6 ± 8.3 weeks. Mean preconceptional A1c was 8.24% ± 2.02%. Absolute reduction of A1c level from prepregnancy to third trimester was -1.63% (P < 0.0001), with a significant clinical and statistical reduction in both groups, women who initiated SAPT before or during pregnancy. 52.9% of patients in second trimester and 66.6% in third trimester achieved A1c <6.5%, respectively. 91.1% underwent cesarean section. The main reasons were iterative cesarean (30%), fetal distress (20%), and preeclampsia (16%). The median gestational age at delivery was 37 weeks and 15 pregnancies resulted in preterm delivery. There was neither maternal-fetal mortality nor severe hypoglycemic episodes. Two patients had diabetic ketoacidosis. CONCLUSIONS: In pregnant patients with T1D and high risk of hypoglycemia, SAPT and SAPT + LGS should be considered as a therapeutic alternative for A1c reduction with a low risk of SH. However, additional studies are required to evaluate the efficacy and safety of this therapy during pregnancy.

Long-Term Efficacy and Safety of Sensor Augmented Insulin Pump Therapy with Low-Glucose Suspend Feature in Patients with Type 1 Diabetes.

BACKGROUND: Literature supports short-term efficacy and safety of Sensor Augmented Insulin Pump (SAP) therapy in patients with type 1 diabetes (T1D). However, no data are available showing long-term outcomes. Our study describes the long-term outcomes of SAP therapy with low-glucose suspend feature (SAP+LGS) in hypoglycemia in a Colombian population with T1D and hypoglycemia. METHODS: A cohort study was conducted with T1D patients receiving SAP+LGS therapy who initiated this therapy because of hypoglycemia at San Ignacio University Hospital diabetes center in Bogotá, Colombia. Glycated hemoglobin (A1c) was assessed at least every 6 months, severe hypoglycemia (SH) and hypoglycemia unawareness (HU) incidence yearly. Adherence to therapy was also evaluated. RESULTS: One hundred eleven patients were included in the analysis. Total daily insulin dose was reduced during follow-up (mean difference -0.22 U/kg; 95% confidence interval [CI] -0.18 to -0.26; P < 0.001). A1c levels were reduced from a baseline value of 8.8% ± 1.9% to 7.5% ± 1.0% at 5 months (mean difference -1.3%; 95% CI -1.09 to -1.50; P < 0.001) and 7.1% ± 0.8% (mean difference -1.7%; 95% CI -1.59 to -1.90; P < 0.001) at the end of follow-up (47 months on average). The incidence of SH and HU episodes decreased significantly since the first year, and this effect was maintained over time (P < 0.001). CONCLUSIONS: SAP+LGS therapy in T1D patients with hypoglycemia led to a significant and sustained decrease in A1c during long periods of follow-up, as well as a significant reduction in SH and HU. Future randomized clinical trials are desired.