Manuel García de los Ríos

Historia natural de retinopatía diabética en un estudio a largo plazo en pacientes con diabetes tipo 1. Factores de riesgo para progresión a enfermedad proliferante

BACKGROUND Diabetic retinopathy is one of the most common causes of blindness among adults. AIM To report the natural history of diabetic retinopathy among Chilean patients with type 1 diabetes followed for a mean of 18 years. MATERIAL AND METHODS Retrospective review of medical records of 39 patients aged 26 to 70 years, (20 females, 78 eyes) with type 1 diabetes controlled by the same ophthalmologist from 1971 to 2008. A questionnaire was sent to each patient and their treating physician to request information about the evolution of the disease and metabolic control. RESULTS The questionnaire was answered by 24 patients (62%) and 21 attending physicians (54%). Small hard drusen were observed in 25 patients (64%). In 12 cases the drusen were detected before the development of any type of retinopathy. Eleven women became pregnant and retinopathy progressed in four of them. Twenty three patients (59%) developed proliferative diabetic retinopathy (PDR). Patients with PDR had a significantly longer duration of diabetes and worse glycemic control. There was a higher frequency of diabetic nephropathy in the PDR group, but only 13 patients out of 23 with PDR had nephropathy. The retinopathy progressed to high risk PDR two years after successful kidney-pancreas transplantation in one patient. CONCLUSIONS In patients with type 1 diabetes mellitus, small hard drusen may be the initial manifestation of diabetic retinopathy. Risk factors for progression to PDR were duration of diabetic and poor glycemic control. Nephropathy was more prevalent in patients with PDR, but a significant group of PDR patients did not have demonstrable nephropathy.

Tratamiento con insulina aspártica bifásica en pacientes con diabetes en mal control metabólico: Experiencia clínica programada

BACKGROUND Biophasic insulin aspart (InAsBi) is a mixture of 30% of rapid acting soluble aspart insulin and 70% aspart insulin retarded with protamine. The soluble portion reduces postprandial serum glucose rises and the retarded portion reduces basal glucose levels. AIM To assess the efficacy of biphasic insulin aspart in diabetics with a bad metabolic control. MATERIAL AND METHODS Multicentríc study that included diabetic patients with a glycosilated hemoglobin over 7% that were transferred to treatment with InAsBi, given in one to three daily doses, according to glycemic control and followed for 12 weeks. At the end of follow up, glycosilated hemoglobin levels (HbA1c) were measured again. RESULTS One hundred ninety six patients were enrolled and 154, age 59+/- 12 (84 females), completed the follow up. HbA 1 c levels decreased in at least 1% in 96 and increased in eight cases. In the total group HbA1c decreased from 10.1+/- 1.7 to 8.4+/-1.4% (p <0.01). Those with higher initial values and with oral therapy, had the greatest reductions. At the end of the observation period, 29 patients received one daily dose of InAsBi, 114 two doses and 11 three doses. Two patients had allergy, one systemic and one in the injection site. CONCLUSIONS In this group of diabetic patients with a bad metabolic control, the use of InAsBi was associated with a significant reduction of glycosilated hemoglobin levels.