Avances en Diabetología最新文献

Introduction

The estimated average glucose (eAG) level is an approximate calculation in mg/dL of the plasma concentration of glucose over the previous 60-90 days.

Objective

To determine the role of venous blood glucose during fasting and post-prandial levels in the calculation of eAG.

Material and methods

We included 413 patients with diabetes mellitus that were being treated between January and July 2012. We considered any condition that could modify the values of A1c as exclusion criteria. We measured the fasting venous blood glucose levels and A1c in the same samples. We calculated the eAG level of each A1c measurement, and the difference between each venous blood glucose level and the eAG of 909 pairs of values.

Results

The mean age of the patients was 64 ± 13.5 years old. From our sample, 53% were male, and 95% of these cases were suffering from type 2 diabetes. The average A1c in the sample was 8.1% ± 1.6%. The eAG level for this percentage was 186 mg/dL. The fasting venous blood glucose was 172 ± 69 mg/dL. The difference between the eAG and the average of the fasting venous glucose levels was 14 mg/dL. This was found to be significant with P < .01.

Conclusion

The eAG level is significantly higher than the mean of the levels in fasting in patients with diabetes. We can assume that this difference is due to the influence of the post-prandial glucose levels in the calculation of eAG; and that the contribution of fasting blood glucose to this calculation is approximately 92%, and that of post-prandial blood glucose only 8%.

Objective

To assess the efficacy and safety of insulin Glargine in the Primary Care setting for patients with type 2 diabetes mellitus (DM2) previously treated with NPH insulin.

Material and methods

This was an observational retrospective study, with 46 participating Primary Care physicians, who recorded the clinical information of patients treated with NPH insulin and who switched to insulin Glargine or continued on NPH for 3-9 months (inclusion design 2 Glargine:1 NPH).

Results

A total of 122 patients in the Glargine group, and 57 patients in the NPH insulin group were evaluated; the patients had a mean age of 67.0 (9.8) years, and 51.4% were males. A difference in HbA1c reduction was seen when comparing the Glargine and NPH groups: 1.07 (0.93)% vs. 0.28 (0.67)%, respectively (P < .001); fasting plasma glucose reductions were 38.4 (37.0) mg/dl vs. 15.7 (28.6) mg/dl, respectively (P < .001). Inadequate control (HbA1c ≥ 7%) at final visit was noted in 61.3% vs. 76.8% of patients (P = .028), respectively. Total hypoglycemic and nocturnal hypoglycemic episodes within one month prior to final visit were 6.6% vs. 43.9%, and 2.5% vs. 21.1%, respectively (P < .0001). The variables associated with better glycemic control were lower baseline HbA1c and fasting plasma glucose values, and the switch to Glargine. The main reason for change was the advantage of one injection a day.

Conclusion

Patients with DM2 who are treated with NPH insulin in Primary Care and switch to Glargine show better glycemic control and experience fewer total and nocturnal hypoglycemic episodes.

Monogenic forms represent a rare form (about 1%) of diabetes. Most cases are clinically mislabeled as type 1 or type 2 diabetes mellitus. Although they constitute a very heterogeneous group, their most common forms, such as neonatal diabetes or those called MODY (Maturity Onset Diabetes of the Young) share common characteristics as the absence of signs of autoimmunity or insulin resistance and the persistence of insulin secretion in over time. Reasons for the low rate of diagnosis may be a low awareness about the importance of diagnosis by health professionals and the need to perform tests in specific genetic units. In recent years there has been significant progress in the description of new forms and validation of clinical serum markers that facilitate their diagnosis.

Objective

To assess the relationship between maternal glycaemic control and final newborn (NB) birth weight in patients with gestational diabetes (GD).

Methods

A retrospective study was conducted on 214 singleton pregnancies with GD. Maternal characteristics, newborn outcomes and glycaemic control during pregnancy were analysed. GD was assessed by measurements of glycated haemoglobin (HbA1c) at different times during the third trimester (3T), fasting, pre-prandial, and 1 and 2 hour post-prandial capillary blood glucose (1hPP-2hPP).

Results

The percentage of NB large for gestational age (LGA) was 9.9% (macrosomia 5.4%), with no differences between genders. Mothers with LGA NB had a higher weight and percentage of body fat before pregnancy (P < .05), more weight gain during pregnancy (P < .01), and required more insulin. In pregnancies with LGA NB, the mean third trimester HbA1c and mean HbA1c (P < .01), were higher, as well as 1hPP (P < .05), 2hPP (P < .01) blood glucose and mean capillary blood glucose (P < .05). The mean third trimester HbA1c and 2hPP blood glucoses were correlated with the fetal weight index (r = 0.22, P < .01, and r = 0.17, P < .05, respectively).

Conclusions

Mothers with LGA NB have worse glycaemic control, despite having received a more intensive treatment. Treatment strategies should be implemented early during pregnancy, not forgetting maternal overweight treatment. HbA1c and 2hPP blood glucose are the only control parameters that correlated with NB weight in our group.

Based on the two main frameworks for evaluating scientific evidence (SEC and GRADE) European cardiovascular prevention guidelines recommend interventions across all life stages using a combination of population-based and high-risk strategies with diet as the cornerstone of prevention. The evaluation of cardiovascular risk (CVR) incorporates HDL levels and psychosocial factors, a very high risk category, and the concept of age-risk. They also recommend cognitive-behavioural methods (e.g., motivational interviewing, psychological interventions) led by health professionals and with the participation of the patient's family, to counterbalance psychosocial stress and reduce CVR through the institution of positive habits such as a healthy diet, physical activity, smoking cessation, and adherence to treatment. Additionally, public health interventions — such as smoking ban in public areas or the elimination of trans fatty acids from the food chain — are also essential. Other innovations include abandoning antiplatelet therapy in primary prevention and the recommendation of maintaining blood pressure within the 130-139/80-85 mmHg range in diabetic patients and individuals with high CVR. Finally, due to the significant impact on patient progress and medical costs, special emphasis is given to the low therapeutic adherence levels observed. In sum, improving cardiovascular prevention requires a true partnership among the political class, public administrations, scientific and professional associations, health foundations, consumer associations, patients and their families. Such partnership would promote population-based and individual strategies by taking advantage of the broad spectrum of scientific evidence available, from clinical trials to observational studies and mathematical models to evaluate population-based interventions, including cost-effectiveness analyses.

Several observational cohort studies and a secondary prevention trial have shown a protective effect of a Mediterranean diet on cardiovascular disease. The latest results of the PREDIMED study (PREvención con DIeta MEDiterránea), which included 7,447 high cardiovascular risk participants followed up for a mean of 5 years, have confirmed that a Mediterranean diet supplemented with extra-virgin olive oil or nuts reduced the incidence of cardiovascular events by 30%. This protective effect of the Mediterranean diet has been attributed to their actions on insulin sensitivity, blood pressure, lipid profile, oxidative stress, and inflammatory biomarkers related to atherosclerosis. These effects are independent of polymorphisms related to lipid changes or inflammatory response, a fact that confirms that Mediterranean diet is a useful tool in the prevention of cardiovascular disease and its main risk factors, including diabetes.