Cristina Abreu

Global Assessment of the Impact of Type 2 Diabetes on Sleep through Specific Questionnaires. A Case-Control Study.

Abstract Type 2 diabetes (T2D) is an independent risk factor for sleep breathing disorders. However, it is unknown whether T2D affects daily somnolence and quality of sleep independently of the impairment of polysomnographic parameters. Material and Methods A case-control study including 413 patients with T2D and 413 non-diabetic subjects, matched by age, gender, BMI, and waist and neck circumferences. A polysomnography was performed and daytime sleepiness was evaluated using the Epworth Sleepiness Scale (ESS). In addition, 135 subjects with T2D and 45 controls matched by the same previous parameters were also evaluated through the Pittsburgh Sleep Quality Index (PSQI) to calculate sleep quality. Results Daytime sleepiness was higher in T2D than in control subjects (p = 0.003), with 23.9% of subjects presenting an excessive daytime sleepiness (ESS>10). Patients with fasting plasma glucose (FPG ≥13.1 mmol/l) were identified as the group with a higher risk associated with an ESS>10 (OR 3.9, 95% CI 1.8–7.9, p = 0.0003). A stepwise regression analyses showed that the presence of T2D, baseline glucose levels and gender but not polysomnographic parameters (i.e apnea-hyoapnea index or sleeping time spent with oxigen saturation lower than 90%) independently predicted the ESS score. In addition, subjects with T2D showed higher sleep disturbances [PSQI: 7.0 (1.0–18.0) vs. 4 (0.0–12.0), p<0.001]. Conclusion The presence of T2D and high levels of FPG are independent risk factors for daytime sleepiness and adversely affect sleep quality. Prospective studies addressed to demonstrate whether glycemia optimization could improve the sleep quality in T2D patients seem warranted.

Glycemic Control and Hospital Admission Risk in Type 1 Diabetes is Related to the Use of Carbohydrate Counting and Frequency of Self- Monitoring of Blood Glucose: RSD1 Study

Introduction and objectives: Diabetes mellitus type 1 (DM1) represents 5–10% of the total prevalence of diabetes. Few studies exist to demographically and clinically describe DM1. Subjects and methods: observational, cross-sectional study of patients with DM1 over 14 years of age treated by hospital endocrinologist. Results: 221 patients (104 men, 37.5 ± 12.7 years) from seven hospitals. Caucasian 97%; Education: primary 22.7%, secondary 48.5%, university 25.3%. Anthropometric data (average ± SD): Weight 70.1 ± 13.7 kg; Height 166.5 ± 8.8 cm; BMI: 25 ± 3.8 kg/m2; Waist circumference: 87.3 ± 18 cm. Family history: DM (46.3%, DM1 28.3%, DM2 71.7%), thyroid disease (17.6%), early CVD (6.5%). Active smoker 20%, ex-smoker 18.6%. DM1 duration: 15.8 ± 10.2 years. Treatment: basal + bolus 74.7%; premixed insulin: 5.7%, basal 2.7%, CSII: 17.1%; metformin: 8.5%; Self-monitoring of blood glucose (SMBG) frequency: 3.6 ± 1.4 times/day; Uses insulin/carbohydrates ratio: 38.8%; regular physical activity: 55.6%; Lipid-lowering drugs: 29.1%; antihypertensive agents: 23.5%. Metabolic control: HbA1c = 7.7 ± 1.3% (61 ± 9 mmol/l); Poor adherence to diet (p < 0.001), number of SMBG (p < 0.01) and regular physical activity (p < 0.05) explains 34.2% of the changes in Hb1Ac. Risk of hospital admission is reduced with the use of carbohydrate counting (OR 0.39, p = 0.002) and with the largest number of blood glucose controls (OR 0.65, p = 0.007). Conclusions: More efforts are necessary to improve the overall metabolic control of patients with DM1. Epidemiological studies aimed at DM1 populations are necessary in order to define the necessary resources.

Hepatotoxicity in hyperthyroid patient after consecutive methimazole and propylthiouracil therapies

Summary Methimazole (MMI) and propylthiouracil (PTU) are widely used antithyroid drugs (ATD) that have been approved for the treatment of hyperthyroidism. Hepatotoxicity may be induced by these drugs, though they exert dissimilar incidence rates of hepatotoxicity and, possibly, with different underlying pathogenic mechanisms. We report the case of a 55-year-old woman with no relevant medical history diagnosed with hyperthyroidism due to Graves’ disease, who developed two episodes of acute hepatitis concurrent with the consecutive administration of two different ATDs, first MMI and then PTU. Given the impossibility of administering ATDs, it was decided to perform a total thyroidectomy because the patient was found to be euthyroid at that point. Pathological anatomy showed diffuse hyperplasia and a papillary thyroid microcarcinoma of 2 mm in diameter. Subsequent clinical check-ups were normal. This case suggests the importance of regular monitoring of liver function for hyperthyroid patients. Due to the potential severity of this side effect, it is recommended to determine baseline liver function prior to initiation of treatment. Learning points: We present a rare case of two acute hepatitis episodes concurrent with two different consecutive ATD therapies. Our results highlight the relevance of a liver function monitoring during the treatment with MMI or PTU. A baseline assessment of the liver function before starting an ATD treatment should be recommendable.

Safety and Efficacy of DPP4 Inhibitor and Basal Insulin in Type 2 Diabetes: An Updated Review and Challenging Clinical Scenarios

The safety and efficacy of dipeptidyl peptidase-4 (DPP4) inhibitors as monotherapy or in combination with other oral antidiabetic agents or basal insulin are well established. DPP4 inhibitors stimulate glucose-dependent insulin secretion and inhibit glucagon production. As monotherapy, they reduce the hemoglobin A1c level by about 0.6–0.8%. The addition of a DPP4 inhibitor to basal insulin is an attractive option, because they lower both postprandial and fasting plasma glucose concentrations without increasing the risk of hypoglycemia or weight gain. The present review summarizes the extensive evidence on the combination therapy of DPP4 inhibitors and insulin-based regimens in patients with type 2 diabetes. We focus our discussion on challenging clinical scenarios including patients with chronic renal impairment, elderly persons and hospitalized patients. The evidence indicates that these drugs are highly effective and safe in the elderly and in the presence of mild, moderate and severe renal failure improving glycemic control with low risk of hypoglycemia. In addition, several randomized-controlled trials have shown that the use of DPP4 inhibitors in combination with basal insulin represents an alternative to the basal-bolus insulin regimen in hospitalized patients with type 2 diabetes.

Tratamiento combinado a largo plazo con cinacalcet y bisfosfonatos en el hiperparatiroidismo primario persistente tras cirugía

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