Endocrinologia Y Nutricion最新文献

Objective

The aim of the study was to examine the prevalence of protein-energy wasting (PEW) in hemodialysis (HD) and peritoneal dialysis (PD) patients in our center and determine whether adiponectin and leptin are involved in the development of PEW.

Design

Prospective (18 months).

Setting

University Hospital of Heraklion, Crete, Greece.

Subjects

Seventy-four end-stage-renal-disease patients, 47 on HD and 27 on PD.

Main outcome measures

At three sequential time points (baseline, 6 and 18 months) anthropometric, nutritional and inflammatory status data were collected. Serum adiponectin and leptin were also assessed at each time point. Patients were allocated to 3 strata according to PEW severity (0, 1–2 and ≥3 criteria for PEW).

Results

Adiponectin and leptin levels were greater among PD compared to HD patients (p ≤ 0.035). Adiponectin levels were incrementally greater across increasing strata of PEW (p ≤ 0.002). Leptin showed the opposite trend, with lower levels in malnourished patients and higher levels in patients with zero PEW criteria (p ≤ 0.042). Alterations of adiponectin levels during the observation period were dependent on PEW stratum (p ≤ 0.021) and mode of dialysis (p ≤ 0.002), after adjustment for age, dialysis vintage, gender and fat mass index. Particularly, adiponectin levels increased over time in HD patients with ≥3 criteria for PEW, whereas adiponectin levels decreased in PD patients with ≥3 criteria for PEW throughout the study. Leptin alterations over time were not affected by dialysis mode or PEW stratification.

Conclusions

Our study provides evidence that increased adiponectin and decreased leptin levels are independently associated with PEW and thus, poor prognosis.

Objective

To assess the long-term clinical and economic impact of integrated pump/CGM technology therapy as compared to multiple daily injections (MDI), for the treatment of type 1 diabetes (T1D) in Colombia.

Methods

The CORE Diabetes Model was used to simulate a hypothetical cohort of patients with T1D. Mean baseline characteristics were taken from a clinical study conducted in Colombia and a healthcare payer perspective was adopted, with a 5% annual discount rate applied to both costs and outcomes.

Results

The integrated pump/CGM improved mean life expectancy by 3.51 years compared with MDI. A similar increase occurred in mean quality-adjusted life expectancy with an additional 3.81 quality-adjusted life years (QALYs). Onset of diabetes-related complications was also delayed as compared to MDI, and mean survival time free of complication increased by 1.74 years with integrated pump/CGM. Although this increased treatment costs of diabetes as compared to MDI, savings were achieved thanks to reduced expenditure on diabetes-related complications. The estimated incremental cost-effectiveness ratio (ICER) for SAP was Colombian Pesos (COP) 44,893,950 (approximately USD$23,200) per QALY gained.

Conclusions

Improved blood glucose control associated to integrated pump/CGM results in a decreased incidence of diabetes-related complications and improves life expectancy as compared to MDI. Using recommended thresholds from the World Health Organization and previous coverage decisions about health technologies in Colombia, it is a cost-effective alternative to MDI for the treatment of type 1 diabetes in Colombia.

Background and aim

Although the prevalence of MNG is widespread throughout the world, its pathogenesis is poorly understood, and the complex interactions of both genetic predisposition and the individuals’ environment are likely. However, to the best of our knowledge, it remains unknown whether there is a relationship between vitamin D status and prevalence or pathogenesis of euthyroid MNG. Therefore, the goal of the present study was determination of vitamin D status in euthyroid MNG as well as exploration of the correlation between vitamin D status & TSH levels.

Methods

A total of 77 patients diagnosed with euthyroid MNG and 50 subjects without goiter were matched according to age, weight and BMI as control group in this case control study.

Results

We found that patients with euthyroid MNG had statistically significant lower mean of [25(OH)D] (24.21 ± 8.68 ng/mL) in comparison with its mean in control subjects (28.37 ± 10.91 ng/mL, P value = 0.019). The 28 sufficient vitamin D MNG patients had statistically significant lower level of TSH than 49 insufficient vitamin D MNG patients. Vitamin D and TSH levels correlate with vitamin D levels in MNG patients in Pearson correlation. Also 25 OH vitamin D was a significant independent predictor for TSH levels among euthyroid MNG patients in regression analysis.

Conclusions

Patients with euthyroid MNG have lower levels of vitamin D and TSH levels correlate with vitamin D levels in euthyroid MNG patients. In addition, 25 OH vitamin D was a significant independent predictor for TSH levels among euthyroid MNG patients. We recommend hypovitaminosis D evaluation and correction in patients with MNG.

Purpose

To describe real-world use of lanreotide combination therapy for acromegaly.

Patients and methods

ACROCOMB is a retrospective observational Spanish study of patients with active acromegaly treated with lanreotide combination therapy between 2006 and 2011. 108 patients treated at 44 Spanish Endocrinology Departments were analyzed separately: 61 patients received lanreotide/cabergoline (cabergoline cohort) and 47 lanreotide/pegvisomant (pegvisomant cohort).

Results

Patient median age was 50.8 years in the cabergoline cohort and 42.7 years in the pegvisomant cohort. Prior medical treatments were somatostatin analogue (SSA) monotherapy (40 [66%] patients) or dopamine agonists (7 [11%] patients) in the cabergoline cohort and SSA (29 [62%] patients) or pegvisomant monotherapy (16 [34%] patients) in the pegvisomant cohort. Across both cohorts 12 patients were previously untreated, and prior therapy was unknown/missing in 4 patients. Median duration of combined treatment was 1.6 years (0.1–6) and 2.1 years (0.4–6.3) in the cabergoline and pegvisomant cohorts, respectively. At baseline, median insulin growth factor (IGF)-I values were 149% upper limit of normal (ULN) (15–505%) in the cabergoline cohort and 156% ULN (15–534%) in the pegvisomant cohort, and decreased to 104% ULN (13–557%) p < 0.001 and 86% ULN (23–345%) p < 0.0001, respectively, at end of study (EOS). Normal age-adjusted values of IGF-I were obtained in 48% of lanreotide/cabergoline-treated patients and 70% of lanreotide/pegvisomant-treated patients at EOS. There were no significant changes in hepatic, cardiac or glycaemic parameters in either cohort.

Conclusion

In clinical practice lanreotide treatment combinations are useful options for patients with acromegaly when monotherapy is insufficient; particularly, the combination of lanreotide and pegvisomant in patients not controlled with either SSA or pegvisomant alone has high efficacy and is well-tolerated.

Objective

The aim of this study was to detect people at risk of suffering diabetes or changes in carbohydrate metabolism and to refer them for possible diagnosis to health care centers. The number of diagnoses and costs for the pharmacy were recorded.

Methods

A cross-sectional, observational study was conducted in community pharmacies in Pontevedra in September–October of 2014. The Findrisc questionnaire was completed by pharmacy users over 18 years old. If Findrisc score was ≥15, capillary blood glucose was measured, and the participant was referred to a physician if the value was ≥110 mg/dL. The main variables included score in the Findrisc questionnaire, number of diabetes diagnosed, and cost of the service.

Differences between the groups were calculated using a Chi-squared test, a Student's t test, and/or a Wilcoxon test.

Results

This study was conducted in 180 pharmacies on a sample of 4222 users, including 992 (23.5%) with a high or very high risk of diabetes (F ≥ 15). In the 1060 basal capillary blood glucose tests performed, mean glucose level was 110.2 (SD = 20.4) mg/dL (56–254). The Galician Health Service sent information about 83 of the 384 (9.1%) subjects referred to a physician: 28 (33.7%) of them were diagnosed with diabetes (3.1% of the sample), and 26 (31.3%) were diagnosed with prediabetes (2.8% of the sample).

Cost per diagnosed subject was €184.22 per subject with diabetes and €96.86 per subject with prediabetes.

Conclusions

The proportion of subjects with new diagnosis of diabetes (3.1%) shows the high efficiency of a screening program for hidden diabetics implemented at community pharmacies as the one presented here.

Objective

To assess the incidence and perinatal complications of macrosomic infants born to diabetic and non-diabetic mothers.

Patients and methods

A six-year retrospective study of newborns at our hospital. A total of 996 macrosomic newborns were found. Maternal characteristics, mode of delivery, and perinatal outcomes were studied.

Results

Of 18,005 newborns, 996 were macrosomic infants (5.53%). Of these, 103 (10.3%) were born to diabetic mothers. Diabetic mothers had higher parity (1.89 vs. 1.35; p < 0.000), cesarean section rate (52.4 vs. 31.1%; p < 0.05), and resuscitation rate (5.8 vs. 1.8%; p < 0.006; RR: 2.9; 95% CI: 1.42–5.9), and greater need for hospitalization (19.4 vs. 9.6%; p < 0.002; RR: 2; 95% CI: 1.3–3.2) and intensive care (5.8 vs. 0.7%; p < 0.000; RR: 5.3; 95% CI: 2.8–10) mostly for hypoglycemia (7.8 vs. 1%; p < 0.000; RR: 5; 95% CI: 2.8–8.3), jaundice (8.7 vs. 2.1%; p < 0.000; RR: 3.1; 95% CI: 1.9–5.9), respiratory distress (4.9 vs. 1.3%; p < 0.009; RR: 2.9; 95% CI: 1.4–6.7), and asphyxia (2.9 vs. 0.4%; p < 0.005; RR: 4.3; 95% CI: 1.8–11.1). No differences were found in birth trauma.

Conclusions

Macrosomic infants born to diabetic mothers have an increased risk of hospital admission in the neonatal period for hypoglycemia, jaundice, respiratory distress, and asphyxia, and a greater need of intensive care. Obstetric trauma rates were similar in both groups.

Hashimoto's thyroiditis (HT) and Graves’ disease (GD) are two very common organ-specific autoimmune diseases which are characterized by circulating antibodies and lymphocyte infiltration. Although humoral and cellular mechanisms have been classically considered separately in the pathogenesis of autoimmune thyroid diseases (AITD), recent research suggests a close reciprocal relationship between these two immune pathways. Several B- and T-cell activation pathways through antigen-presenting cells (APCs) and cytokine production lead to specific differentiation of T helper (Th) and T regulatory (Treg) cells. This review will focus on the cellular mechanisms involved in the pathogenesis of AITD. Specifically, it will provide reasons for discarding the traditional simplistic dichotomous view of the T helper type 1 and 2 pathways (Th1/Th2) and will focus on the role of the recently characterized T cells, Treg and Th17 lymphocytes, as well as B lymphocytes and APCs, especially dendritic cells (DCs).

Background and objective

No conclusive data exist on the value of a high resolution thyroid nodule clinic for management of nodular thyroid disease. The aim of this study was to evaluate the economic impact of and user satisfaction with a high resolution thyroid nodule clinic (HRTNC) in coordination with primary care.

Patients and method

A prospective, observational, descriptive study was conducted to analyze data from 3726 patients (mean age 61 ± 12 years; 85% women) evaluated at an HRTNC during 2014 and 2015. Demographic data (sex and age), number of ultrasound examinations and fine needle aspiration cytologies (FNAC), referral center and consultation type were assessed.

Results

In 2014 and 2015, 3726 neck ultrasound examinations and 926 FNACs (3.8% rated as non-diagnostic) were performed. Among the 1227 patients evaluated for the first time, 21.5% did not require a second endocrine appointment, which resulted in mean estimated savings of 14,354.55 euros. Of all patients, 41.1% were referred from primary care, 33.4% from endocrinology, and 26.5% from other specialties. As compared to 2013, the number of thyroid ultrasound examinations requested decreased by 65.3% and 59.7% in 2014 and 2015 respectively, with mean estimated savings of 137,563.92 euros. Mean user satisfaction assessed was 4.0 points (95% confidence interval, 3.7–4.3) on a 5-point scale.

Conclusions

HRTNCs at endocrinology departments, coordinated with primary care, are a viable, cost-effective alternative with a positive user perception.