Athrogenic indexes: Useful markers for predicting metabolic syndrome in axial spondyloarthritis / Índices aterogénicos: marcadores útiles para predecir el síndrome metabólico en la espondiloartritis axial

Introduction: Metabolic syndrome is a pathological entity associated with a high risk of cardiovascular disease. Data regarding the frequency of this syndrome, lipid profile, and atherogenic index of plasma in patients with radiographic axial spondyloarthritis are scarce. We aim: to determine the prevalence of metabolic syndrome in patients with spondyloarthritis. We also aim to determine discriminative values of atherogenic indexes between patients with and without metabolic syndrome. Methods: We conducted a cross-sectional study including 51 patients meeting the ASAS 2009 criteria for radiographic axial spondyloarthritis. We measured the following parameters: triglyceride (TG), high-density lipoproteins (HDLc), low-density lipoprotein cholesterol (LDLc), and total cholesterol (TC). We calculated TC/HDLc, TG/HDLc, LDLc/HDLc ratios, and atherogenic index of plasma (LogTG/HDLc). Results: Metabolic syndrome was noted in 33% of cases. Patients with active disease had a higher body mass index (26.89±5.88 versus 23.63±4.47kg/m2, p=0.03), higher TG (1.41±0.64 versus 0.89±0.5mmol/L, p=0.05) and a lower HDLc level (1±0.28 versus 1.31±0.22mmol/L, p=0.01). However, the LogTG/HDLc and TG/HDLc were higher in patients under TNFα inhibitors. The ability of the TG/HDLc ratio and LogTG/HDLc to distinguish patients with or without metabolic syndrome were good at cut-offs of 1.33 and 0.22, respectively (specificity: 91.2% and sensitivity 70.6% for both ratios). Conclusion: Our study showed that metabolic syndrome is frequent in patients with axial spondyloarthritis. Atherogenic indexes can be used for predicting metabolic syndrome in these patients.(AU)

Introducción: El síndrome metabólico es una entidad patológica asociada a un alto riesgo de enfermedad cardiovascular. Los datos sobre la frecuencia de este síndrome, el perfil lipídico y el índice aterogénico del plasma en pacientes con espondiloartritis axial radiográfica son escasos. Nuestro objetivo es determinar la prevalencia del síndrome metabólico en pacientes con espondiloartritis. También pretendemos determinar valores discriminativos de índices aterogénicos entre pacientes con y sin síndrome metabólico. Métodos: Realizamos un estudio transversal que incluyó a 51 pacientes que cumplían los criterios ASAS 2009 para espondiloartritis axial radiográfica. Medimos los siguientes parámetros: triglicéridos (TG), lipoproteínas de alta densidad (HDLc), colesterol de lipoproteínas de baja densidad (LDLc) y colesterol total (CT). Calculamos las relaciones CT/HDLc, TG/HDLc, LDLc/HDLc y el índice aterogénico del plasma (LogTG/HDLc). Resultados: El síndrome metabólico se observó en el 33% de los casos. Los pacientes con enfermedad activa tenían un índice de masa corporal más alto (26,89±5,88 versus 23,63±4,47kg/m2; p=0,03), TG más altos (1,41±0,64 versus 0,89±0,5 mmol/L; p=0,05) y un nivel de HDLc más bajo (1±0,28 versus 1,31±0,22mmol/L; p=0,01). Sin embargo, el LogTG/HDLc y TG/HDLc fueron mayores en pacientes bajo inhibidores del TNFα. La capacidad de la relación TG/HDLc y LogTG/HDLc para distinguir pacientes con o sin síndrome metabólico fue buena en puntos de corte de 1,33 y 0,22, respectivamente (especificidad: 91,2% y sensibilidad: 70,6% para ambas relaciones). Conclusión: Nuestro estudio mostró que el síndrome metabólico es frecuente en pacientes con espondiloartritis axial. Los índices aterogénicos se pueden utilizar para predecir el síndrome metabólico en estos pacientes.(AU)

Athrogenic indexes: Useful markers for predicting metabolic syndrome in axial spondyloarthritis.

INTRODUCTION: Metabolic syndrome is a pathological entity associated with a high risk of cardiovascular disease. Data regarding the frequency of this syndrome, lipid profile, and atherogenic index of plasma in patients with radiographic axial spondyloarthritis are scarce. We aim to determine the prevalence of metabolic syndrome in patients with spondyloarthritis. We also aim to determine discriminative values of atherogenic indexes between patients with and without metabolic syndrome. METHODS: We conducted a cross-sectional study including 51 patients meeting the ASAS 2009 criteria for radiographic axial spondyloarthritis. We measured the following parameters: triglyceride (TG), high-density lipoproteins (HDLc), low-density lipoprotein cholesterol (LDLc), and total cholesterol (TC). We calculated TC/HDLc, TG/HDLc, LDLc/HDLc ratios, and atherogenic index of plasma (LogTG/HDLc). RESULTS: Metabolic syndrome was noted in 33% of cases. Patients with active disease had a higher body mass index (26.89±5.88 versus 23.63±4.47kg/m2, p=0.03), higher TG (1.41±0.64 versus 0.89±0.5mmol/L, p=0.05) and a lower HDLc level (1±0.28 versus 1.31±0.22mmol/L, p=0.01). However, the LogTG/HDLc and TG/HDLc were higher in patients under TNFα inhibitors. The ability of the TG/HDLc ratio and LogTG/HDLc to distinguish patients with or without metabolic syndrome were good at cut-offs of 1.33 and 0.22, respectively (specificity: 91.2% and sensitivity 70.6% for both ratios). CONCLUSION: Our study showed that metabolic syndrome is frequent in patients with axial spondyloarthritis. Atherogenic indexes can be used for predicting metabolic syndrome in these patients.

Delay of insulin therapy in type 2 diabetics.

Type 2 diabetes (T2DM) is a progressive disease. Insulin appears early in the therapeutic intensification algorithm, but is still a last resort. This delay is frequent but its duration has been little studied in the Tunisian population. The main objective of this study was to identify and evaluate, in a specialized center, the delay in insulin therapy in type 2 diabetics. This was a retrospective, cross-sectional study of 140 patients. DT2 were included as oral antidiabetic agents, including at least one optimal dose sulfonamide, hospitalized for insulin therapy between January 1, 2014 and December 31, 2015. The delay in insulin therapy was defined by the succession of two HbA1c values ≥8% at least 3 months apart. Its duration, in months, calculated in 90 patients, corresponds to that passed between T0 where HbA1c ≥8% and T1 at the insulin initiation. Our population was 74 women and 66 men, mean age 58.2 ± 11.7 years. The average duration of diabetes was 10.3 ± 6.1 years; mean fasting glucose and HbA1c were 11.9 ± 3.6 mmol / l and 11.3 ± 2%, respectively. The delay in insulin therapy concerned all patients. Its average duration was 39 ± 29 months with extremes of 6 months to 10 years. Mean HbA1c increased significantly from 10 ± 1.5% to 11.2 ± 2% between T0 and T1 (p <10-3). A shift to insulin beyond three years was associated with the duration of diabetes (p = 0.03) and dyslipidemia (p = 0.04). Insulin therapy is late even in a specialized center. This therapeutic inertia is universal. Its causes should be better studied to be better mastered.

[Blood pressure and type 2 diabetes mellitus: impact of the insulin therapy]. / Pression arterielle et diabete de type 2: impact de la mise sous insuline.

BACKGROUND: The incidence of arterial hypertension is by 2-3 times with diabetics than with non-diabetics. Etiopathogenesis of arterial hypertension in type 2 diabetes is multifactorial insulin-resistance, obesity, hyperlipoproteinemia, age, smoking and probably method of treatment (insulin therapy). The aim of this retrospective study is to evaluate, over 5 years period, the level of blood pressure and the frequency's progression of arterial hypertension in 35 type 2 diabetes patients treated with insulin METHODS: comparison of 35 type 2 diabetes patients treated with insulin to 35 controls treated with oral hypoglycemic agents. RESULTS: No significant differences were found over 5 years period in mean systolic blood pressure, mean diastolic blood pressure and frequency of arterial hypertension. However, frequency of arterial hypertension was correlated with mean dose of insulin. CONCLUSION: Our study confirms the long-term results found in the literature reading effects of insulin therapy on blood pressure in diabetic patients.