RESUMEN
Type 2 diabetes (T2D) exists in 25-40% of hospitalized patients. Therapeutic inertia is the delay in the intensification of a treatment and it is frequent in T2D. The objectives of this study were to detect patients admitted to surgical wards with hyperglycaemia (HH; fasting glycaemia > 140 mg/dL) as well as those with T2D and suboptimal chronic glycaemic control (SCGC) and to assess the midterm impact of treatment modifications indicated at discharge. A total of 412 HH patients were detected in a period of 18 months; 86.6% (357) had a diagnosed T2D. Their preadmittance HbA1c was 7.7 ± 1.5%; 47% (189) had HbA1c ≥ 7.4% (SCGC) and were moved to the upper step in the therapeutic algorithm at discharge. Another 15 subjects (3.6% of the cohort) had T2D according to their current HbA1c. Ninety-four of the 189 SCGC patients were evaluated 3-6 months later. Their HbA1c before in-hospital-intervention was 8.6 ± 1.2% and 7.5 ± 1.2% at follow-up (P < 0.004). Active detection of hyperglycaemia in patients admitted in conventional surgical beds permits the identification of T2D patients with SCGC as well as previously unknown cases. A shift to the upper step in the therapeutic algorithm at discharge improves this control. Hospitalization is an opportunity to break therapeutic inertia.
RESUMEN
OBJECTIVES: IGF1 is decreased in morbidly obese (MO) patients and its changes after bariatric surgery weight loss (WL) are not well known. The aim of this study was to analyse IGF1 modifications in MO patients after WL and its relationship to ghrelin and to different types of surgeries. DESIGN: Retrospective follow-up study at the University Medical Center. METHODS: One hundred and nine MO patients (age 44.19.3, BMI 51.748.75KG/M(2)) were evaluated at baseline and 1 year after surgery: 28 sleeve gastrectomy (SG), 31 distal modified (m), and 50 ringed (r) Roux-en-Y gastric bypass (RYGBP) surgery. Changes in IGF1, IGFBP3, ratio IGF1:IGFBP3, and ghrelin were evaluated 1 year after surgery. RESULTS: Baseline prevalence of low IGF1 (defined by s.d. IGF1<-2) was 22%, and %WL 1 year after surgery was 34.9±8.9%. There was a significant decrease in IGFBP3 in all the procedures, an increase in IGF1:IGFBP3 ratio in rRYGBP and SG, but total IGF1 only increased significantly in SG. Albumin concentrations decreased in mRYGBP, did not change in rRYGBP, but increased in SG after surgery. Total ghrelin concentrations increased after both RYGBPs and decreased after SG (P<0.05 in all cases). The prevalence of low IGF1 decreased in SG (28.6 vs 10.1%, P=0.03) and did not change in RYGPBP techniques. The %albumin change was the only dependent variable associated with the % total IGF1 change. CONCLUSIONS: Recovery of low IGF1 after bariatric surgery was specifically related to the albumin modifications induced by surgery and was not related to ghrelin modifications.
Asunto(s)
Cirugía Bariátrica/métodos , Factor I del Crecimiento Similar a la Insulina/metabolismo , Estado Nutricional , Obesidad Mórbida/sangre , Obesidad Mórbida/cirugía , Adulto , Índice de Masa Corporal , Femenino , Ghrelina/sangre , Homeostasis , Humanos , Hipertensión/sangre , Hipertensión/complicaciones , Insulina/sangre , Resistencia a la Insulina , Proteína 3 de Unión a Factor de Crecimiento Similar a la Insulina/sangre , Lípidos/sangre , Masculino , Persona de Mediana Edad , Oportunidad Relativa , Estudios Prospectivos , Análisis de Regresión , Albúmina Sérica/metabolismoRESUMEN
La diabetes tipo1 (DM1) es una enfermedad autoinmune crónica en la que se produce una destrucción progresiva de las células β pancreáticas que conduce a una deficiencia absoluta de insulina.El manejo al principio incluye educación diabetológica básica (administración de insulina, determinación de glucemia capilar y cetonuria, prevención y manejo de la hipoglicemia...). Mediante la instauración de un tratamiento intensivo con insulina se persigue el objetivo de mantener los niveles de glucemia lo más próximos a la normalidad de forma segura, evitando la aparición de hipoglucemias. Se recomienda el cribado de la enfermedad tiroidea y celíaca al inicio, pero no la determinación de los anticuerpos antipancreáticos. La prueba de la tolerancia oral a la comida mixta es la de elección para valorar la función pancreática, pero no se utiliza de forma rutinaria en la práctica clínica habitual y suele reservarse para estudios de intervención al inicio de la DM1
Type 1 diabetes mellitus is a chronic, autoimmune disease, where specific pancreatic β-cell destruction leads to complete insulin deficiency.Management of the patient at diagnosis includes patient education (training in insulin self-injection, self-monitoring of glucose and ketone levels, prevention and management of hypoglycaemia ) and intensive insulin treatment, aimed at achieving glucose concentrations as close to normal as safely possible and avoiding hypoglycaemia. Screening for associated thyroid and coeliac diseases is recommended at the onset of type1 diabetes. Pancreatic auto-antibody measurement, however, is only recommended in case of diagnostic uncertainly. The measurement of stimulated C-peptide after a mixed meal is the reference method to assess endogenous insulin production, although its use is currently limited to intervention trials