Maria Lopes Pereira

Universal vs. risk-factor-based screening for gestational diabetes—an analysis from a 5-Year Portuguese Cohort

PurposeThe criteria to screen for Gestational Diabetes Mellitus are not internationally consensual. In opposition to the universal screening performed in Portugal, certain countries advocate a risk-factor-based screening. We aim to compare obstetric and neonatal outcomes in pregnant women with and without risk factors treated for Gestational Diabetes Mellitus.MethodsRetrospective and multicentric study of 12,006 pregnant women diagnosed with Gestational Diabetes Mellitus between 2011 and 2015, in Portugal. Gestational Diabetes Mellitus was diagnosed according to the International Association of the Diabetes and Pregnancy Study Groups criteria. Risk factors: body mass index > 30kg/m2, history of Gestational Diabetes Mellitus, history of macrossomic newborn (birth weight > 4000 g) or first-degree relatives with Type 2 Diabetes Mellitus. Exclusion criteria: lack of data concerning risk factors (n = 1563).ResultsAt least one risk factor was found in 68.2% (n = 7123) pregnant women. Pregnant women with risk factors were more frequently medicated with insulin (p < 0.001), caesarean section was more commonly performed (p < 0.001), their newborns were more frequently large-for-gestational-age (p < 0.001) and neonatal morbidity was higher (p = 0.040) in comparison to pregnant women without risk factors. The Diabetes Mellitus reclassification test showed an increased frequency of intermediate hyperglycaemia and Diabetes Mellitus in women with risk factors (p < 0.001).ConclusionAlmost one-third of pregnant women would have remained undiagnosed if risk-based-factor screening were implemented in Portugal. Women without risk factors presented fewer obstetric and neonatal complications. However, more than one third required insulin therapy.

Primary adrenal insufficiency in adult population: a Portuguese multicentre study by the Adrenal Tumours Study Group

Introduction Primary adrenal insufficiency (PAI) is a rare but severe and potentially life-threatening condition. No previous studies have characterized Portuguese patients with PAI. Aims To characterize the clinical presentation, diagnostic workup, treatment and follow‐up of Portuguese patients with confirmed PAI. Methods This multicentre retrospective study examined PAI patients in 12 Portuguese hospitals. Results We investigated 278 patients with PAI (55.8% were females), with a mean age of 33.6 ± 19.3 years at diagnosis. The most frequent presenting clinical features were asthenia (60.1%), mucocutaneous hyperpigmentation (55.0%) and weight loss (43.2%); 29.1% of the patients presented with adrenal crisis. Diagnosis was established by high plasma ACTH and low serum cortisol in most patients (43.9%). The most common aetiology of PAI was autoimmune adrenalitis (61.0%). There were 38 idiopathic cases. Autoimmune comorbidities were found in 70% of the patients, the most frequent being autoimmune thyroiditis (60.7%) and type 1 diabetes mellitus (17.3%). Seventy-nine percent were treated with hydrocortisone (mean dose 26.3 ± 8.3 mg/day) mostly in three (57.5%) or two (37.4%) daily doses. The remaining patients were treated with prednisolone (10.1%), dexamethasone (6.2%) and methylprednisolone (0.7%); 66.2% were also on fludrocortisone (median dose of 100 µg/day). Since diagnosis, 33.5% of patients were hospitalized for disease decompensation. In the last appointment, 17.2% of patients had complaints (7.6% asthenia and 6.5% depression) and 9.7% had electrolyte disturbances. Conclusion This is the first multicentre Portuguese study regarding PAI. The results emphasize the need for standardization in diagnostic tests and etiological investigation and provide a framework for improving treatment.

CO014. DIABETES E HIPERGLICEMIA: FACTORES DE PROGNÓSTICO NA PNEUMONIA ADQUIRIDA NA COMUNIDADE – ESTUDO RETROSPECTIVO EM DOENTES ADMITIDOS NO HOSPITAL DE BRAGA

Introducao: A Pneumonia Adquirida na Comunidade (PAC) e uma patologia frequente e com uma importante morbimortalidade. A Diabetes Mellitus (DM) aumenta o risco e complicacoes de doencas infecciosas. Todavia, carece estabelecer se a DM e a glicemia na admissao sao factores de prognostico em doentes com PAC. Objetivo: Avaliar a relacao entre DM/glicemia na admissao e desenvolvimento de complicacoes, duracao do internamento e mortalidade em doentes com PAC; e a relacao entre controlo glicemico e existencia de complicacoes em diabeticos. Metodos: Estudo observacional, analitico e retrospectivo dos adultos admitidos no Hospital de Braga entre Outubro/2011 e Marco/2012, com PAC. Consultaram-se os processos clinicos electronicos e para avaliacao da mortalidade aos 30 e 90 dias efectuaram-se, adicionalmente, chamadas telefonicas. Utilizaram-se os testes Qui-quadrado, Mann-Whitney, Kruskal-Wallis e regressao logistica. Resultados: Dos 440 doentes incluidos, 51,1% eram mulheres, 83,1% idosos e 29,3% diabeticos. Destes, 48,8% tinham HbA1c doseada no internamento (mediana de 6,8%, percentil 25: 6,3%, percentil 75: 7,8%). A mediana da glicose na admissao foi 134 mg/dL (P25: 111 mg/ dL, P75: 176 mg/dL). Os diabeticos pertenciam a faixas etarias mais elevadas (p = 0,002), apresentaram maior gravidade da pneumonia, avaliada pelo CRB-65 (p = 0,025), mais complicacoes (p = 0,001) e mais dias de internamento (p = 0,001). A DM revelou-se um preditor de complicacoes (p = 0,008). Nao se demonstrou relacao entre a DM e a mortalidade, nem entre os niveis de HbA1c e complicacoes, tempo de internamento e mortalidade. Por outro lado, verificou-se um aumento gradual dos dias de internamento para niveis mais elevados de glicose na admissao (p = 0,016) e uma tendencia para complicacoes nos doentes hiperglicemicos. Porem, nao houve diferencas estatisticamente significativas entre niveis de glicose e mortalidade. Conclusao: A DM e a hiperglicemia na admissao sao factores de mau prognostico em doentes admitidos com PAC, associando-se a prolongamento do tempo de internamento e, nos diabeticos, a aumento das complicacoes.