Avances en Diabetología最新文献

Some aspects of glycemic variability are still not clear. Questions like the role that «short term glycemic variability» could play in the development of diabetic complications is still unanswered. On the other hand, A1C variability, or «long term glycemic variability», emerges as one of the most relevant actors in development and progression of the chronic vascular complications of diabetes. Furthermore, glycemic variability plays a central role in causing dangerous and unnoticed hypoglycemia, and it becomes the limiting factor to achieve an optimal regulation of diabetes. In this review, the most important aspects of glycemic variability are discussed, as well as clarifying, as far as is possible, what we should expect from its control. Some recommendations are also offered on how to evaluate it properly.

The incidence rate of type 1 diabetes varies by up to 576 times between different countries around the world. In Spain, the highest incidence rate is twice that of the lowest between Autonomous Communities. Many studies have been published in the last twenty years on the incidence, prevalence, trends, and characteristics at diagnosis of type 1 diabetes. The age at diagnosis, sex, racial group, familial clustering, and seasonal variation have been the characteristics analysed. These data are the lights that epidemiology provides us, in order to have a better understanding of diabetes aetiopathology. They allow us to create hypotheses to be investigated. The shades are the quality of some registries and the lack of success of trials conducted up until now. In order to improve these results, is necessary to develop more reliable registries to get accurate data in order to combat the environment risk factors.

Chaco Province, Argentina, has a population of 1,055,259 inhabitants, and has one of the largest pediatric and indigenous populations in the country.

The aim of this study was to determine the blood pressure (BP) and nutritional status (NS) in the pediatric population in Chaco Province and to describe the differences between the Caucasian population (CP), and a group of Toba aborigines (AT) less than 10 years old.

This study was conducted on a non-random sample of 678 children of 1-17 years who did not attend medical appointments. The tables developed by WHO 2007 were used to determine NS. BP was taken by adapting the technique described in the Fourth BP Report.

Depending on age and ethnicity, the participating children were divided into four groups. In Group I, 90 (13.3%) AT under 10 years, group II, 52 (7.7%) of CP of the same age range, group III, 190 (28%) CP 11-13 years, and in group IV, 346 (51%) CP 4-17 years. There was a risk of overweight and overweight, in between 24% and 46% of children, and underweight in 2.7% (95% CI; 1.6 to 4.2).

Blood pressure above or equal to the 95 percentile was detected in 42% of Group I, 30% of Group II, 20% of group III, and 16% of group IV (p < .05).

The prevalence of overweight is higher than that that found in other studies from Canada and Buenos Aires, Argentina, and lower than in the United States. The AT had a higher frequency of normal weight and shorter stature.

Objective

To analyze the main factors that influence the health care costs of treating type 2 diabetes mellitus (T2DM) patients, using a literature review.

Methods

National and international electronic data bases were searched to identify articles published between January 2001 and December 2012 that estimated T2DM costs and evaluated cost determining factors.

Results

A total of 26 articles were reviewed out of the 1530 relevant titles identified. In Spain, 71.4% of the direct costs of T2DM is related to T2DM complications. Hypoglycemia and other complications could increase T2DM costs by up to 4-fold. Improving adherence and weight control reduce T2DM costs.

Conclusion

Therapeutic strategies associated to less hypoglycemia events, better adherence, and weight control may lead to lower T2DM costs.

This consensus report has been prepared by a group of experts from the Spanish Foundations of Diabetes and of Periodontology. The reviewed evidence shows relevant data that strongly support the importance of diabetes and periodontal diseases, as well as their bi-directional relationship:

- Diabetes has a high prevalence in Spain and Portugal, with a high prevalence of un-diagnosed diabetes, and with continuously increasing rates. In addition, the frequency and severity of their complications is also very important.

- Periodontal diseases have high prevalence, close to 90% in adult populations. The destructive capacity of periodontitis leads to tooth loss, which is associated with a profound impact on the patients. Periodontitis have also been related to an increased risk of cardiovascular diseases, adverse pregnancy outcomes, and pulmonary infections, as well as other conditions.

- Numerous studies have concluded that diabetes is a significant risk factor for periodontitis, especially in subjects with poor glycemic control.

- Periodontal diseases have been shown to have a deleterious effect on glycemic control, both in diabetic patients and healthy subjects, and it has been demonstrated that diabetes complications are more frequent in diabetic patients with periodontitis.

- Periodontal treatment has been associated with improvements in glycemic control, with a mean reduction in glycosylated haemoglobin of 0.4%.

Based on the above evidence, different challenges are proposed for health professionals involved in diabetic and periodontitis patient care.

Objective

To implement a pharmaceutical care program for hospitalized patients with moderate to severe renal insufficiency treated with metformin and to analyze the impact of pharmaceutical intervention in its prescribing.

Material and method

Prospective intervention study developed in a general hospital of 1,080 beds over a 2.5 month period. An algorithm was designed in order to use metformin depending on creatinine clearance. In patients suffering from severe renal insufficiency the pharmaceutical intervention was to recommend the discontinuation of the drug, while for moderate insufficiency other factors were considered. The degree of acceptance of the pharmaceutical intervention was calculated, and whether there was any episode of metformin-induced lactic acidosis.

Results

Renal insufficiency (16.1-59.8 ml/min creatinine clearance) was observed in 11.5% of the patients taking metformin. Almost two-thirds (65.3%) of them had other comorbidities that also contraindicated the use of metformin. Acceptance of pharmaceutical interventions was 65.7%, reaching 80% if the patient suffered from severe renal impairment.

Conclusions

The implementation of a pharmaceutical care program for diabetic patients with moderate to severe renal insufficiency using metformin resulted in the safe use of the drug. The degree of acceptance of the pharmaceutical interventions was good and there were no episodes of metformin-induced lactic acidosis.

Two aspects particularly relevant for people with diabetes treated with insulin are prevention of hypoglycemia and flexibility in its administration. Both aspects have an important impact in the achievement of blood glucose targets and in the patient quality of life. In the last few years, advances in insulin therapy, with rapid-acting and long-acting insulin analogs, have contributed to reducing the risk of hypoglycemia. Degludec, a new long-acting basal insulin analogue, seems to reduce even more and consistently the risk of nocturnal hypoglycemia, which are particularly inconvenient as they interfere with sleep quality and duration. In addition, due to its duration of action over 42 hours, it may allow higher injection flexibility without compromising glycemic control and safety.