José Antonio Balsa

Estudio descriptivo de la evolución clínico-asistencial de la población con diabetes tipo 2 en la Comunidad de Madrid. Estudio de seguimiento diabético tipo 2 (ESD-2)

Resumen Objetivos El objetivo del estudio es conocer el grado de control de los factores de riesgo cardiovascular y la prevalencia de complicaciones cronicas de la poblacion con diabetes mellitus tipo 2 (DM2) en la Comunidad de Madrid, en condiciones habituales de practica asistencial diaria durante 3 anos de seguimiento. Materiales y metodos Para ello, hemos realizado un estudio epidemiologico, transversal y descriptivo, de los pacientes con DM2 seguidos en 51 centros de salud, con la participacion de 134 profesionales sanitarios de todas las areas sanitarias de la Comunidad de Madrid. La muestra se obtuvo mediante muestreo sistematico. Analizamos variables sociodemograficas, biologicas/bioquimicas, de resultado y de procesos asistenciales. El tratamiento estadistico de los datos se realizo mediante el programa de analisis estadistico SPSS 15.0. Resultados La muestra de pacientes estudiados estuvo constituida por 3.268 pacientes. El 50,3% eran varones y el 49,7%, mujeres, con una edad media de 68,8xa0±xa010,9 anos, y un tiempo medio de evolucion de diabetes mellitus de 7,9xa0±xa07,4 anos y mediana de 6 anos. Los resultados de comorbilidad mostraron principalmente que el 70,4% tenia la presion arterial elevada, y el 48,4%, obesidad. La presion arterial sistolica media fue de 131,7xa0±xa014,5xa0mmHg, y en el 35,3% de los diabeticos fue menor de 130xa0mmHg. La presion arterial diastolica media fue de 76,1±xa09xa0mmHg, y en el 51,4% de los pacientes estaba por debajo de los 80xa0mmHg. El 25,3% tenia unapresion arterial sistolica/diastolica por debajo de 130/80xa0mmHg. Es de destacar la elevada prevalencia de complicaciones macrovasculares con un 18,3%, sin diferencias en la prevalencia de complicaciones cronicas de la diabetes mellitus senaladas por la bibliografia, salvo en la retinopatia con una prevalencia del 8%, probablemente por ser el proceso asistencial de registro mas bajo. Conclusiones El grado de control integral (hemoglobina glucosilada

Influencia de la pérdida de peso en la evolución clínica, metabólica y psicológica de los pacientes con sobrepeso u obesidad

INTRODUCTION AND OBJECTIVEnThe clinical evolution and psychological well-being of patients with overweight or obesity is still a matter of controversy. The aim of this study is to know the impact of the loss of weight on the evolution of the alterations both clinical and metabolic as psychological in patients with overweight or obesity.nnnPATIENTS AND METHODnWe studied a cohort of 192 patients randomly chosen. All of them were characterized clinically and biochemically. Autoadministered questionnaires were used which were already validated in the Spanish population:the General Health Questionnaire (GHQ-28), and bulimia subescale, the Eating Disorder Inventary (EDI). For the statistical analysis using the statistical program SPSS 15.0. Data are expressed as mean (standard deviation).nnnRESULTSnThe weight loss was 3.77 (4.85) kilograms, equivalent to a 3.8 (4.86)% of the total weight, the diameter of the waist was reduced by 3.78 (5.89) centimeters, systolic blood pressure was reduced by 3.36 (15.61) mmHg and diastolic in 2.15 (11.26) mmHg. We also found a decreased significantly of glucose levels 7.37(21.23) mg/dl, insulin levels 2.773 (8.749) IU/ml, HOMA-IR index 0.925 (2.728), triglycerides 12.59 (82.95) mg/dl and uric acid 0.172 (1.13) mg/dl. The basal score of the GHQ-28 was pathological in 44,8% of the studied patients, and after six months of treatment, it improved in 20,8% of the patients (p < 0,001). The EDI bulimia subscale score at the beginning of the treatment was 1,02 (SD 1,91), improving after six months of treatment to 0,65 (SD 1,49) p < 0,002.nnnCONCLUSIONnThe decrease in weight improves not only clinical parameters and biochemical cardiovascular risk and insulin resistance, but also improves the scale score Goldberg, with higher impact on those with worse baseline GHQ-28 scores.

Estimación del impacto económico y sanitario de las complicaciones de la diabetes mellitus tipo 2 en la Comunidad de Madrid

OBJECTIVEnTo estimate the economic and health impact of chronic complications (macrovascular and microvascular) of type 2 diabetes mellitus (T2DM) in the autonomous community of Madrid (Spain) (ACM).nnnMETHODSnThe number of expected complications was obtained from a descriptive, cross-sectional study on a cohort of 3,268 patients with T2DM from the ACM. Cost of complications (€, 2012) was assessed both at hospitals and in primary care. The number of medical visits in primary care and drug treatment for complications were collected by a panel of 21 physicians experienced in treatment of T2DM. Population and epidemiological data and healthcare costs were obtained from Spanish sources. Univariate sensitivity analyses were performed.nnnRESULTSnIt is estimated that there are 390,944 patients with T2DM in the ACM, and that they experience 172,406 and 212,283 macrovascular and microvascular complications respectively during their lifetimes. Mean cost of T2DM complications per patient is estimated at € 4,121.54 (66% due to macrovascular complications). The economic impact of T2DM complications in the ACM would be € 1,611 million (1,065 and 545 millions from macrovascular and microvascular complications respectively). The economic impact would range from € 1,249 and 2.509 million euro depending on T2DM prevalence.nnnCONCLUSIONSnComplications of T2DM have a great health and economic impact in ACM.

Chylous ascytes secondary to acute pancreatitis: a case report and review of literature

Chylous ascites is an uncommon finding which is due to the presence of thoracic or intestinal lymph in the abdominal cavity. It is usually caused by a chronic disruption of the lymphatic system. The present report is one of the rare cases in the literature of chylous ascites secondary to idiopathic acute pancreatitis, which showed a complete resolution with a combination of low fat enteral nutrition with MCT and somatostatin analogs.

Phase IV Prospective Clinical Study to Evaluate the Effect of Taurine on Liver Function in Postsurgical Adult Patients Requiring Parenteral Nutrition

BACKGROUNDnTaurines role in bile acid metabolism and anti-inflammatory activity could exert a protective effect on hepatobiliary complications associated with parenteral nutrition (PN). In this study, the effects of 2 amino acid solutions, with and without taurine, on liver function administered to nonacutely ill postsurgical patients as part of a short-term PN regimen were prospectively compared.nnnMETHODSnAdult patients randomly received (double-blind) Tauramin 10% or a standard PN solution without taurine as the control (1.5 g amino acid/kg body weight [bw]/d; infusion rate of ≤4 mg glucose/kg bw/d) for a period of 5-30 days. γ-Glutamyl transpeptidase (GGT) and other indicators of liver function, glucose metabolism, lipid profile, inflammation markers, and treatment safety data were collected.nnnRESULTSnThirty-five patients receiving taurine PN and 39 receiving control PN were enrolled (intention-to-treat [ITT] population). Most patients (n = 62) discontinued after day 7 of follow-up (per-protocol [PP] population: n = 24 and n = 27, respectively). ITT patients with high GGT values after 5 days of PN comprised 68.6% and 64.1%, respectively. The mean change in GGT values with respect to the baseline values was 167 ± 192 and 157 ± 185 IU/L, respectively. Low-density lipoprotein (LDL) cholesterol levels after 7 days of PN were significantly decreased in the taurine PN group of PP patients (-2.83 ± 30.9 vs 23.9 ± 27.0 mg/dL for control PN; P < .05). None of the adverse events reported (taurine PN: n = 6; control PN: n = 7) were treatment related.nnnCONCLUSIONnPN solutions with and without taurine had similar effects on liver function parameters, except for an LDL reduction in PN with taurine, when administered to nonacutely ill postsurgical patients in the short term (5-7 days).

Calcificación vascular en un paciente con diabetes tipo 2

385 Caso clínico Varón de 72 años de edad, diagnosticado de diabetes tipo 2 hace 10 años y de hipertensión arterial en tratamiento con enalapril (20 mg/día). En los últimos 3 años estaba en tratamiento con antidiabéticos orales, y actualmente con gliclazida (30 mg/3 comprimidos/día) y buen control de la diabetes. No tomaba otra medicación salvo la señalada, y no presentaba alteraciones del metabolismo lipídico. El motivo de consulta fue una disminución progresiva de la función eréctil, pese a estar en tratamiento con citrato de sildenai lo (50 mg a demanda). El paciente no refería síntomas de cardiopatía isquémica, pero sí síntomas de claudicación vascular, tanto en extremidades inferiores como superiores. Tenía un índice de masa corporal de 23,4 kg/m, y presentaba unos valores de presión arterial de 180/100 mmHg. En la analítica practicada se coni rmaba el buen control metabólico con glucemia basal en ayuno de 98 mg/dL y hemoglobina glucosilada (HbA1c) del 6,5%; el peri l lipídico estaba dentro de los límites de la normalidad. En la exploración física destacaba la ausencia de pulsos distales, tanto en extremidades superiores como inferiores. El paciente tenía una calcii cación de la aorta abdominal y de ambas iliacas, como se constató en una radiografía de columna lumbar. Con la sospecha de calcii cación generalizada, se solicitó un estudio radiológico de mano-muñeca para valorar la posible calcii cación de las arterias distales de las extremidades superiores (i gura 1).