RESUMEN
Diets involving a reduction in caloric intake are frequently prescribed for the treatment of obesity, but their long-term efficacy is questionable. We considered a calorie restricted diet successful if the weight loss was ≥ 5% after at least 3 years follow up. From published data, calculating a definitive percentage of successful cases is difficult because of the way data are presented and because loss to follow-up is not corrected for in many studies. Judging by the best data available, the success rate is very low. Most individuals will regain weight and sometimes even more than they lost in the first place. The mechanisms driving this weight increase are a decrease in energy expenditure and an increased appetite which is mediated by factors such as leptin. If the first attempt to lose weight fails, the advice to go on a diet should not be endlessly repeated; stabilizing the individual's weight would probably be a more realistic goal.
Asunto(s)
Restricción Calórica , Metabolismo Energético/fisiología , Obesidad/terapia , Pérdida de Peso/fisiología , Ingestión de Energía/fisiología , Humanos , Leptina/fisiología , Insuficiencia del Tratamiento , Resultado del Tratamiento , Aumento de PesoRESUMEN
Strict glucose control is important for patients with diabetes mellitus in order to prevent complications. However, many patients find it difficult to achieve the recommended HbA1c level. The possibility of hypoglycaemia plays an important role in this. The artificial pancreas automates glucose control, improving glucose levels without increasing hypoglycaemic events. The required insulin dose is calculated and administered on the basis of continuous glucose measurements, taking over a large part of the treatment from the patient. Several research groups are working on making this technique suitable for home use. It is expected that the artificial pancreas will become available in the near future. However, effectiveness and safety will have to be investigated in long-term studies. A large number of insulin-dependent patients with diabetes could be eligible for this treatment.
Asunto(s)
Diabetes Mellitus/terapia , Glucosa/metabolismo , Páncreas Artificial , HumanosRESUMEN
The treatment of diabetes mellitus is focused on the prevention of micro- and macrovascular complications. The target HbA(1c) should therefore be 7% or lower. However, a recent study advised a HbA(1c) of 7.5%, since it was found that mortality increased with an HbA(1c) below 7.5%. This was probably caused by hypoglycaemia. A higher mortality in patients with a low HbA(1c) has been described before, but the causes were never understood. It is true that a lower HbA(1c) leads to more hypoglycaemia, but there are no indications that this is the cause of the increased mortality. Changing the target HbA(1c) based on one epidemiological retrospective study is unwise. Taking into account historic prospective studies such as the United Kingdom Prospective Diabetes Study, we think the target HbA(1c) should remain 7% or lower in the treatment of diabetes mellitus.