El diabético inmigrante: factores de riesgo cardiovascular y su control. Aportaciones del estudio IDIME / The diabetic immigrant: cardiovascular risk factors and control. Contributions of the IDIME study

Introducción y objetivos. El objetivo del estudio es conocer las características clínicas de la diabetes mellitus y los factores de riesgo cardiovascular asociados en los diabéticos inmigrados a España. Métodos. Estudio multicéntrico, observacional, transversal con una cohorte de 605 diabéticos inmigrados y 307 diabéticos autóctonos, realizado en pacientes diagnosticados de diabetes mellitus atendidos en consultas de atención primaria y especializada en España. El muestreo se realizó a partir de casos sucesivos por orden de llegada a la consulta. Se estudian variables epidemiológicas, clínicas y analíticas relacionadas con la diabetes mellitus, así como la presencia de factores de riesgo clásicos. Resultados. El paciente diabético inmigrado es más joven (50,4 ± 11,5 frente a 62,7 ± 13 años) y con menos años de evolución de la enfermedad (5,8 ± 6,4 frente a 10,5 ± 8,3 años) (p<0,001) que el diabético autóctono. Los diabéticos inmigrados de Hispanoamérica tienen mayor obesidad. No hay diferencias estadísticamente significativas con respecto a la obesidad abdominal o el índice cintura/estatura. El control glucémico era peor que en los autóctonos (glucohemoglobina, el 7,8 ± 2,2 frente al 7,1 ± 1,5%), especialmente entre los indostaníes (8,1 ± 2,5%) (p<0,001), que además utilizan menos insulina (el 12,8 frente al 30,7% de otros inmigrantes) (p<0,001). Sin embargo, la prevalencia de las complicaciones crónicas de la diabetes mellitus es menor entre los inmigrados, especialmente las macrovasculares (el 7,7 frente al 24,4%) (p<0,01). Conclusiones. En nuestro estudio, el perfil de los diabéticos inmigrados a España es el de un diabético joven y sin complicaciones, pero con peor control metabólico. Todo ello nos proporciona una excelente oportunidad preventiva(AU)

Introduction and objectives. The aim of this study was to determine the clinical characteristics of diabetes and associated cardiovascular risk factors in immigrants with diabetes in Spain. Methods. A multicenter, observational, cross-sectional study including a cohort of 605 diabetic immigrants and 307 native diabetics was conducted in patients diagnosed with diabetes and treated in primary and specialized care in Spain. A consecutive sampling method was followed. We studied epidemiological, clinical and laboratory variables related to diabetes and the presence of classical risk factors. Results. The immigrant diabetic patient was younger (50.4 [11.5] vs 62.7 [13] years) and had fewer years of diabetes progression (5.8 [6.4] vs 10.5 [8.3] years) (P<.001) compared with native diabetic patients. Immigrants from South America with diabetes were more obese. No statistically significant differences were found in abdominal obesity or the waist/height ratio. Glycemic control was worse in immigrants than in the native Spaniards group (glycosylated hemoglobin, 7.8 [2.2] vs 7.1 [1.5%]), especially among South Asians (8.1[2.5%]) (P<.001), in whom insulin use was lower (12.8% vs 30.7% in other immigrants) (P<.001). However, the prevalence of chronic complications of diabetes was lower among immigrants, particularly that of macrovascular complications (7.7% vs 24.4%) (P<.01). Conclusions. In our study the profile of immigrant diabetics in Spain is one of a young diabetic without complications, but with worse metabolic control. These findings provide an excellent opportunity to implement preventive measures(AU)

The diabetic immigrant: cardiovascular risk factors and control. Contributions of the IDIME study.

INTRODUCTION AND OBJECTIVES: The aim of this study was to determine the clinical characteristics of diabetes and associated cardiovascular risk factors in immigrants with diabetes in Spain. METHODS: A multicenter, observational, cross-sectional study including a cohort of 605 diabetic immigrants and 307 native diabetics was conducted in patients diagnosed with diabetes and treated in primary and specialized care in Spain. A consecutive sampling method was followed. We studied epidemiological, clinical and laboratory variables related to diabetes and the presence of classical risk factors. RESULTS: The immigrant diabetic patient was younger (50.4 [11.5] vs 62.7 [13] years) and had fewer years of diabetes progression (5.8 [6.4] vs 10.5 [8.3] years) (P<.001) compared with native diabetic patients. Immigrants from South America with diabetes were more obese. No statistically significant differences were found in abdominal obesity or the waist/height ratio. Glycemic control was worse in immigrants than in the native Spaniard group (glycosylated hemoglobin, 7.8 [2.2] vs 7.1 [1.5%]), especially among South Asians (8.1[2.5%]) (P<.001), in whom insulin use was lower (12.8% vs 30.7% in other immigrants) (P<.001). However, the prevalence of chronic complications of diabetes was lower among immigrants, particularly that of macrovascular complications (7.7% vs 24.4%) (P<.01). CONCLUSIONS: In our study the profile of immigrant diabetics in Spain is one of a young diabetic without complications, but with worse metabolic control. These findings provide an excellent opportunity to implement preventive measures.

Ecografía Doppler renal y su relación con la función renal en pacientes con cirrosis hepática / Renal Doppler ultrasonography and its relationship with the renal function in patients with liver cirrhosis

FUNDAMENTO: Relacionar los cambios hemodinámicos renales, valorados por ecografía Doppler, con el desarrollo de ascitis, función renal y sistemas vasoactivos endógenos en pacientes con cirrosis hepática. PACIENTES Y MÉTODO: Se estudiaron de formas prospectiva 60 pacientes cirróticos, 31 compensados y 29 con ascitis. Se determinaron el índice de resistencia renal, la función renal y los valores plasmáticos de actividad de renina, aldosterona, noradrenalina y hormona antidiurética. RESULTADOS: El índice de resistencia renal fue significativamente superior en los pacientes cirróticos con ascitis (0,68) que en los cirróticos compensados (0,63) y se correlacionó significativamente con las concentraciones séricas de creatinina, excreción urinaria de sodio, actividad de renina plasmática y concentración plasmática de aldosterona. CONCLUSIONES: El índice de resistencia renal, determinado por ecografía Doppler, se eleva progresivamente con la evolución de la cirrosis hepática, con el empeoramiento de la función renal y con la activación de los sistemas vasoactivos endógenos (AU)