Alberto Goday

Epidemiología de la diabetes y sus complicaciones no coronaries

Diabetes mellitus is among the diseases with great impact on health and society, not only for its high prevalence but also for its chronic complications and high mortality. The most precise method to investigate the prevalence of diabetes is by oral glucose tolerance testing. In Spain, the prevalence of diabetes in the 30-65 year-old population is estimated to be 6.5% among 30-to-65- year old, and 10.3% among the 30-to-89 year-old population. The ratio of known to unknown diabetes ranges from 1:3 to 2:3. The incidence of diabetes mellitus type 2 in Spain is 8/1000 persons per year, and the incidence of type 1 is 11 to 12 cases per 100,000 persons per year. The prevalence of chronic complications varies according to type of diabetes, time since onset and degree of metabolic control: neuropathy 25%, retinopathy 32% and nephropathy 23%. Diabetes is one of the most important causes of death in Spain, occupying third place for women and seventh for men.La diabetes mellitus (DM) es una de las enfermedades con mayor impacto sociosanitario, no solo por su alta prevalencia, sino tambien por las complicaciones cronicas que produce y por su elevada tasa de mortalidad. La forma mas exacta de estimar la prevalencia de la DM es la practica de un test de tolerancia oral a la glucosa. En Espana, la prevalencia de la DM se estima en un 6,2% para los grupos de edad 30–65 anos, y del 10% para 30–89 anos. La proporcion de DM conocida frente a la ignorada oscila entre 1:3 y 2:3 del total. Los factores de riesgo de las DM mas importantes son la edad, la obesidad y la historia familiar de DM. La incidencia de la DM tipo 2 se estima en 8/1.000 habitantes ano, y la de DM tipo 1 en 11–12 casos por 100.000 habitantes y ano. La prevalencia de las distintas complicaciones cronicas varia en funcion del tipo de DM, tiempo de evolucion y grado de control meta-bolico, estimandose globalmente en la siguiente: neuropatia, un 25%; retinopatia, un 32%, y nefropatia, un 23%. La DM es una de las principales causas de mortalidad en Espana, ocupando el tercer lugar en mujeres y el septimo en varones.

Socioeconomic inequalities in the incidence and prevalence of type 2 diabetes mellitus in Europe

OBJECTIVE The aim of this study was to analyze socioeconomic position (SEP) inequalities in the prevalence and incidence of type 2 diabetes mellitus (T2DM) in people aged 50 years and over in Europe and to describe the contribution of body mass index (BMI) and other possible mediators. METHODS This was a cross-sectional and longitudinal study including men and women ≥ 50 years old in 11 European countries in 2004 and 2006 (n = 21,323). The prevalence and cumulative incidence of T2DM were calculated with self-reported T2DM or when the individual took drugs for diabetes. Prevalence ratio (PR) and relative risk (RR) of prevalent and incident T2DM were calculated according to educational level and adjusted by BMI and other possible mediators. RESULTS The age-adjusted and country-adjusted prevalence of T2DM in 2004 was 10.2% in men and 8.5% in women. Compared to those with higher education, men and women with lower education had a PR [95% CI] of T2DM of 1.29 [1.12-1.50] and 1.61 [1.39-1.86], respectively. SEP-related inequalities in incidence (RR [95%CI]) were 1.88 [1.35-2.62] in women and 1.04 [0.78-1.40] in men. Adjusting for potential mediators reduced inequalities in the prevalence and incidence of T2DM among women by 26.2% and 21.6%, respectively, and inequalities in prevalence among men by 44.8%. CONCLUSIONS We observed significant inequalities in the prevalence and incidence (women only) of T2DM as a function of socioeconomic position. These inequalities were mediated by BMI.

Iodine intake in the adult population. Di@bet.es study

BACKGROUND & AIMS To date no nation-wide study has yet been undertaken in Spain to estimate the iodine deficiency. The aim was to evaluate iodine intake and its conditioning factors in a representative sample of the whole adult population. METHODS The Di@bet.es Study is a national, cross-sectional, population-based survey conducted in 2009-2010 in Spain. RESULTS The median urinary iodine (UI) was 117.2 μg/L. Iodized salt (IS) was consumed by 43.9% of the population. The median UI in those who consumed IS and in those who did not consume IS was 131.1 and 110.8 μg/L respectively (p<0.0001). The likelihood of having UI levels above 100 μg/L was significantly associated with the intake of IS (OR=1.47) and milk at least once a day (OR=1.22). Within each individual autonomous communities, the median UI levels in those who consumed IS correlated significantly with the median levels of those who did not consume IS (r=0.76, p=0.001). CONCLUSIONS Though strictly speaking, Spain should be considered within the category of a country having an adequate iodine intake, the current value is too close to the cut point and does not guarantee that those groups with a greater need for iodine will have the required intake of iodine.

Seven-year mortality in heart failure patients with undiagnosed diabetes: an observational study

BackgroundPatients with type 2 diabetes mellitus and heart failure have adverse clinical outcomes, but the characteristics and prognosis of those with undiagnosed diabetes in this setting has not been established.MethodsIn total, 400 patients admitted consecutively with acute heart failure were grouped in three glycaemic categories: no diabetes, clinical diabetes (previously reported or with hypoglycaemic treatment) and undiagnosed diabetes. The latter was defined by the presence of at least two measurements of fasting plasma glycaemia ≥ 7 mmol/L before or after the acute episode.Group differences were tested by proportional hazards models in all-cause and cardiovascular mortality during a 7-year follow-up.ResultsThere were 188 (47%) patients without diabetes, 149 (37%) with clinical diabetes and 63 (16%) with undiagnosed diabetes. Patients with undiagnosed diabetes had a lower prevalence of hypertension, dyslipidaemia, peripheral vascular disease and previous myocardial infarction than those with clinical diabetes and similar to that of those without diabetes. The adjusted hazards ratios for 7-year total and cardiovascular mortality compared with the group of subjects without diabetes were 1.69 (95% CI: 1.17-2.46) and 2.45 (95% CI: 1.58-3.81) for those with undiagnosed diabetes, and 1.48 (95% CI: 1.10-1.99) and 2.01 (95% CI: 1.40-2.89) for those with clinical diabetes.ConclusionsUndiagnosed diabetes is common in patients requiring hospitalization for acute heart failure. Patients with undiagnosed diabetes, despite having a lower cardiovascular risk profile than those with clinical diabetes, show a similar increased mortality.

Validity of self-reported diabetes in health interview surveys for measuring social inequalities in the prevalence of diabetes

Background To analyse the validity of diabetes declarations in a health interview survey in order to evaluate the appropriateness of using health interview surveys to understand the relationship between diabetes and social groups. Methods People with self-reported diabetes are those who report to have diabetes in the health survey. People with diabetes (gold standard) are those who were identified with fasting blood glucose level ≥126 mg/dl or those who were treated with oral antidiabetic drugs or insulin. Independent variables were educational level, social class and gender. The authors calculated sensitivity, specificity and κ coefficient. Results The majority of indicators for evaluating the adequacy of using health interviews surveys to analyse inequalities in self-reported diabetes by social groups are good. The worst indicator was sensitivity, although it did not vary according to social groups. Conclusion Health surveys are a good instrument to evaluate the social inequalities in the prevalence of diabetes.

Síndrome metabólico y diabetes mellitus tipo 1: prevalencia y factores relacionados

Introduccion y objetivos. Numerosas evidencias han puesto de relieve la importancia clinica y epidemiologica del sindrome metabolico como precursor de la enfermedad cardiovascular. El sindrome metabolico se asocia en general a la diabetes tipo 2, pero son escasos los datos en la diabetes tipo 1. En el presente estudio se evalua la prevalencia de sindrome metabolico en pacientes con diabetes tipo 1 y los factores relacionados. Metodos. Estudio transversal que incluyo a los pacientes mayores de 18 anos de edad con diabetes tipo 1 autoinmune de mas de 6 meses de evolucion atendidos consecutivamente en la Consulta Externa de Endocrinologia del Hospital del Mar de Barcelona durante el ano 2008. La identificacion del sindrome metabolico se establecio segun los criterios modificados del Panel III del National Cholesterol Education Program. Resultados. Tenia sindrome metabolico el 31,9% (intervalo de confianza [IC] del 95%, 22,3%-41,5%) de los pacientes con diabetes tipo 1. La edad (odds ratio [OR] = 1,09; IC del 95%, 1,029-1,154), el indice de masa corporal (OR = 1,389; IC del 95%, 1,134-1,702) y la glucohemoglobina (OR = 1,745; IC del 95%, 1,081-2,815) fueron los factores que se asociaron de forma independiente y significativa con la presencia de sindrome metabolico en los pacientes con diabetes tipo 1. Se constato una relacion directa entre el numero de componentes de sindrome metabolico y la prevalencia de microangiopatia, que llego a ser del 100% en los pacientes que cumplian todos los criterios diagnosticos. Conclusiones. El sindrome metabolico es frecuente en los pacientes con diabetes tipo 1 y se asocia con las complicaciones microvasculares

Olive oil has a beneficial effect on impaired glucose regulation and other cardiometabolic risk factors. Di@bet.es study.

Background:Despite the marked increase in cardiovascular risk factors in Spain in recent years, the prevalence and incidence of cardiovascular diseases have not risen as expected. Our objective is to examine the association between consumption of olive oil and the presence of cardiometabolic risk factors in the context of a large study representative of the Spanish population.Subjects and methods:A population-based, cross-sectional, cluster sampling study was conducted. The target population was the whole Spanish population. A total of 4572 individuals aged ⩾18 years in 100 clusters (health centers) were randomly selected with a probability proportional to population size. The main outcome measures were clinical and demographic structured survey, lifestyle survey, physical examination (weight, height, body mass index, waist, hip and blood pressure) and oral glucose tolerance test (OGTT) (75 g).Results:Around 90% of the Spanish population use olive oil, at least for dressing, and slightly fewer for cooking or frying. The preference for olive oil is related to age, educational level, alcohol intake, body mass index and serum glucose, insulin and lipids. People who consume olive oil (vs sunflower oil) had a lower risk of obesity (odds ratio (OR)=0.62 (95% confidence interval (CI)=0.41–0.93, P=0.02)), impaired glucose regulation (OR=0.49 (95% CI=0.28–0.86, P=0.04)), hypertriglyceridemia (OR=0.53 (95% CI=0.33–0.84, P=0.03)) and low HDL cholesterol levels (OR=0.40 (95% CI=0.26–0.59, P=0.0001)).Conclusions:The results show that consumption of olive oil has a beneficial effect on different cardiovascular risk factors, particularly in the presence of obesity, impaired glucose tolerance or a sedentary lifestyle.

Peripartum metabolic control in gestational diabetes

OBJECTIVE We sought to evaluate intrapartum metabolic control in gestational diabetes mellitus (GDM) patients and maternal factors influencing intrapartum glycemic control and neonatal hypoglycemia risk. STUDY DESIGN A prospective observational study included 129 women with GDM admitted for delivery. Data collected included maternal intrapartum capillary blood glucose (CBG) and ketonemia, use of insulin, and neonatal hypoglycemia. RESULTS In all, 86% of maternal intrapartum CBG values fell within target range (3.3-7.2 mmol/L) without need for insulin use. There were no cases of maternal hypoglycemia or severe ketosis. Intrapartum CBG >7.2 mmol/L was associated with third-trimester glycated hemoglobin (P = .02) and lack of endocrinologic follow-up (P = .04). Risk of neonatal hypoglycemia was related with pregnancy insulin use compared with dietary control (60.5% vs 29.5%; P = .02). CONCLUSION Peripartum metabolic control in GDM patients was achieved without insulin in most cases. Intrapartum glycemic control was related with third-trimester glycated hemoglobin and with no endocrinologic follow-up. Neonatal hypoglycemia was associated with insulin use during pregnancy.

Preoperative Predictors of Weight Loss at 4 Years Following Bariatric Surgery

BACKGROUND This study evaluated the influence of patient characteristics, preoperative weight loss, and type of surgical procedure on long-term weight loss after bariatric surgery (BS). METHODS Subjects were a prospective cohort of 95 patients who underwent BS with 4 years of follow-up. Seventy-seven patients (81.1%) underwent laparoscopic Roux-en-Y gastric bypass, and 18 (18.9%) had laparoscopic sleeve gastrectomy. Age, gender, initial body mass index (BMI), preoperative percentage of excess weight loss, presence of type 2 diabetes mellitus, current smoking status, and surgical technique were analyzed via multivariate linear regression analysis to identify predictors of weight loss during the 4 years after the surgery. RESULTS Maximum percentage of excess weight loss was obtained at 18 months. Age and preoperative BMI were negatively associated with percentage of excess weight loss at 1, 2, 3, and 4 years after BS (P < .005). At 4 years, laparoscopic Roux-en-Y gastric bypass was independently associated with a higher weight loss than laparoscopic sleeve gastrectomy (P < .05). CONCLUSIONS Younger age, lower BMI, and laparoscopic Roux-en-Y gastric bypass are independent predictors of long-term weight loss after BS.

Mediterranean diet adherence in individuals with prediabetes and unknown diabetes: the Di@bet.es Study.

Background and Aims: Mediterranean diet (MedDiet) is causally related to diabetes and is a dietary pattern recommended to individuals with diabetes. We investigated MedDiet adherence in individuals with prediabetes and unknown (PREDM/UKDM) or known diabetes (KDM) compared to those with normal glucose metabolism (NORMAL). Methods: This was a national, population-based, cross-sectional, cluster-sampling study. MedDiet adherence was scored (MedScore, mean ± SD 24 ± 5) using a qualitative food frequency questionnaire. Logistic regression was used to examine the association between MedScore and PREDM/UKDM or KDM versus control subjects. Results: We evaluated 5,076 individuals. Mean age was 50 years, 57% were female, 826 (582/244) were PREDM/UKDM, 478 were KDM and 3,772 were NORMAL. Mean age increased across MedScore tertiles (46, 51 and 56 years, p < 0.0001). Higher age-adjusted adherence to MedDiet (5-unit increment in the MedScore) was associated with lower and nondifferent odds (OR, 95% CI) of prevalent PREDM/UKDM (0.88, 0.81-0.96, p = 0.001) and KDM (0.97, 0.87-1.07, p = 0.279), respectively, compared to individuals in the NORMAL group. Conclusions: In a representative sample of the whole Spanish population, MedDiet adherence is independently associated with PREDM/UKDM. Therapeutic intervention may be, in part, responsible for the lack of differences in adherence observed between the KDM and NORMAL groups. However, reverse causation bias cannot be ruled out in cross-sectional studies.