Ricardo Gómez-Huelgas

Hemoglobin A1c Versus Oral Glucose Tolerance Test in Postpartum Diabetes Screening

OBJECTIVE To determine the usefulness of measuring hemoglobin A1c (A1C), alone or combined with the fasting glucose test, compared with the oral glucose tolerance test (OGTT) for the reassessment of the carbohydrate metabolism status in postpartum women with a history of gestational diabetes mellitus (GDM). RESEARCH DESIGN AND METHODS We evaluated the status of carbohydrate metabolism by performing the OGTT and fasting glucose and A1C tests in 231 postpartum women with prior GDM 1 year after delivery. RESULTS The prevalence of abnormal carbohydrate metabolism was 45.89% by the OGTT criterion, 19.05% by the A1C test criterion, 38.10% by the fasting glucose test criterion, and 46.75% by the A1C-fasting glucose test criteria. Using the OGTT as the gold standard, abnormal carbohydrate metabolism according to the A1C test criterion had 22.64% sensitivity and 54.55% positive predictive value; abnormal carbohydrate metabolism by the fasting glucose criterion had 83.02% sensitivity and 100% positive predictive value. The A1C-fasting glucose test criteria classified 18 women with normal carbohydrate metabolism as having abnormal carbohydrate metabolism. Abnormal carbohydrate metabolism by the A1C-fasting glucose test criteria had 83.02% sensitivity and 81.48% positive predictive value. CONCLUSIONS Our results seem to indicate that the A1C test criterion alone or in combination with fasting glucose test criterion does not provide a sensitive and specific diagnosis of abnormal carbohydrate metabolism in women who have had GDM.

Impact of Dementia on Hospitalization

Background: The purpose of this study was to analyze and determine the prevalence and clinical characteristics of hospitalized dementia patients compared with nondemented patients. Methods: We examined hospital discharge database records dated 1998–2003 from public hospitals in Andalusia, Spain. We used ICD-9-CM codes to identify patients with dementia. The variables examined included age, length of stay, discharge diagnosis, diagnostic-related groups, and mortality of both dementia and nondementia patients over 65 years of age. Results: A diagnosis of dementia was documented for 40,482 cases. The prevalence of dementia increased from 3.43% to 4.64% between 1998 and 2003 and was higher among older patients and women. Dementia was the reason for admission in 5.6% of cases. Medical reasons constituted 82.4% of admittances. Dementia patients had hip surgery more frequently than patients without dementia, and other procedures (orthopedic surgery, cataracts, or hernia repair) were less frequent (p < 0.001). The mean duration of the hospital stay was longer (13.4 vs. 10.7 days) and the intra-hospital mortality rate was greater (19.3% vs. 8.7%) for patients with dementia compared to those without dementia. Dementia was an independent predictor of mortality (OR 1.77; 95% CI 1.72–1.82). Conclusions: Dementia is increasing among hospitalized patients. Dementia patients have different reasons for hospitalization and higher mortality. It is necessary to identify these differences and to improve the hospital care of dementia patients.

Frequency of hypoglycemia and its impact on length of stay, mortality, and short-term readmission in patients with diabetes hospitalized in internal medicine wards.

OBJECTIVE To evaluate whether hypoglycemia is associated with increases in length of stay (LOS), inpatient mortality, and readmission among patients with diabetes hospitalized in internal medicine wards. METHODS A retrospective cohort study was carried out using the Basic Minimum Data Set registry of the Spanish National Health System, which contains clinical and administrative information for every patient discharged from system hospitals. The analysis included patients discharged between January 2005 and December 2010 and had a primary (i.e., reason for the admission) or secondary diagnosis of diabetes and a secondary diagnosis of hypoglycemia. The associations between hypoglycemia and the study outcomes (mortality, readmission, and LOS) were evaluated using multivariate and multilinear regression models that included age, sex, and the Charlson index as covariates. RESULTS During the study period, 3,361,104 patients were admitted to internal medicine wards in the National Health System. Of these, 921,306 (27.4%) had diagnoses of diabetes, and among these patients, 46,408 (5%) had secondary hypoglycemia. A total of 4,754 (10.2%) patients with secondary hypoglycemia died during their hospital stays, compared with 83,508 (9.5%) patients without hypoglycemia. The multivariate/multilinear regression models demonstrated significant associations between the presence of secondary hypoglycemia and greater inpatient mortality (odds ratio [OR] 1.24, 95% confidence interval [CI] 1.20-1.28), a greater likelihood of readmission (OR 1.20, 95% CI 1.17-1.23), and an increased LOS (β 1.24, 95% CI 1.15-1.35). CONCLUSION Hypoglycemia in patients with diabetes hospitalized in internal medicine wards is associated with increases in the LOS, inpatient mortality, and early readmission.

Raoultella planticola bacteraemia secondary to gastroenteritis.

We present the first case of Raoultella planticola bacteria in human infections with a direct relationship between fish intake and enteric infection. The patient was treated with antibiotherapy (cefotaxime). It is important to consider this organism in the differential diagnosis of enteric fever and even more with previous ingestion of fish.

Metformin-Induced Hepatotoxicity

Metformin is the first choice oral antidiabetic drug for type 2 diabetes and currently the most consumed. Although gastrointestinal intolerance is frequent, metformin-induced hepatotoxicity is rare. Fewer than 10 cases have been reported (1). In all of those cases, metformin was associated with concomitant intake of other potentially hepatotoxic drugs. We present what we feel may be the first documented case of hepatotoxicity due to metformin with no other drug interference. A 61-year-old man was admitted to the hospital with a 3-day history of painless jaundice. He had no history of liver disease or toxic habits and denied previous consumption of drugs or herbal products, but had been taking metformin (1,700 mg/day for 6 weeks) after being diagnosed with type 2 diabetes. Laboratory tests showed a mixed …

Inverse relation between FASN expression in human adipose tissue and the insulin resistance level.

BackgroundAdipose tissue is a key regulator of energy balance playing an active role in lipid storage and may be a dynamic buffer to control fatty acid flux. Just like PPARγ, fatty acid synthesis enzymes such as FASN have been implicated in almost all aspects of human metabolic alterations such as obesity, insulin resistance or dyslipemia. The aim of this work is to investigate how FASN and PPARγ expression in human adipose tissue is related to carbohydrate metabolism dysfunction and obesity.MethodsThe study included eighty-seven patients which were classified according to their BMI and to their glycaemia levels in order to study FASN and PPARγ gene expression levels, anthropometric and biochemical variables.ResultsThe main result of this work is the close relation between FASN expression level and the factors that lead to hyperglycemic state (increased values of glucose levels, HOMA-IR, HbA1c, BMI and triglycerides). The correlation of the enzyme with these parameters is inversely proportional. On the other hand, PPARγ is not related to carbohydrate metabolism.ConclusionsWe can demonstrate that FASN expression is a good candidate to study the pathophysiology of type II diabetes and obesity in humans.

HbA1c in adults without known diabetes from southern Europe. Impact of the new diagnostic criteria in clinical practice

Diabet. Med. 28, 1319–1322 (2011)

Compliance with cardiovascular drug prevention measures in a general population: the Multidisciplinary Intervention in Primary Care (IMAP) study

Aims: To evaluate adherence to guideline-recommended drug therapies for primary and secondary cardiovascular prevention in a general Mediterranean population. Subjects and methods: A cross-sectional study was conducted in a random sample of 2270 individuals (18⊟80 years) assigned to a health centre in Malaga (Spain). The appropriate use was analysed of statins, antithrombotics, beta-blockers, and angiotensin-converting enzyme inhibitors (ACEI) or angiotensin II type 1 receptor blockers (ARB), based on the criteria of the European Guidelines on Cardiovascular Prevention and the European Society of Hypertension-European Society of Cardiology. Results: The prescription rate of statins, antithrombotics, beta-blockers, and ACEI/ARB was 7.8%, 5.1%, 3.3%, and 11%, respectively. The prescription of these drugs was inappropriate in 36.2%, 22.4%, 64.5%, and 0%, respectively. Overtreatment was more frequent in subjects with greater comorbidity or ≥2 vascular risk factors (p < 0.001). The percentage of individuals with prescription criteria but who did not receive the treatment was 19.5%, 4.7%, 2%, and 9.3%, respectively, increasing significantly with age, Charlson index, and the presence of ≥2 risk factors (p < 0.001). Only 11% of patients in secondary prevention received combination therapy with statins, antithrombotics, and ACEI/ARB. Patients with ischaemic heart disease, as compared to non-coronary vascular patients, more frequently received statins (56.1% vs. 25.6%; p = 0.0001) and antithrombotic drugs (66.7% vs. 56.4%; p = 0.02). Conclusions: We detected a low adherence to existing pharmacological guidelines for the prevention of cardiovascular disease. A priority is to establish appropriate training and dissemination of cardiovascular prevention guidelines in the field of primary care.

Effects of a long-term lifestyle intervention program with Mediterranean diet and exercise for the management of patients with metabolic syndrome in a primary care setting.

BACKGROUND The impact of a lifestyle intervention (LSI) program for the long-term management of subjects with metabolic syndrome in a primary care setting is not known. METHODS This 3-year prospective controlled trial randomized adult subjects with metabolic syndrome to receive intensive LSI or to usual care in a community health centre in Malaga, Spain. LSI subjects received instruction on Mediterranean diet and a regular aerobic exercise program by their primary care professionals. Primary outcome included changes from baseline on different components of metabolic syndrome (abdominal circumference, blood pressure, HDL-cholesterol, fasting plasma glucose and triglycerides). RESULTS Among the 2,492 subjects screened, 601 subjects with metabolic syndrome (24.1%) were randomized to LSI (n = 298) or to usual care (n = 303); of them, a 77% and a 58%, respectively, completed the study. At the end of the study period, LSI resulted in significant differences vs. usual care in abdominal circumference (-0.4 ± 6 cm vs. + 2.1 ± 6.7 cm, p < 0.001), systolic blood pressure (-5.5 ± 15 mmHg vs. -0.6 ± 19 mmHg, p = 0.004), diastolic blood pressure (-4.6 ± 10 mmHg vs. -0.2 ± 13 mmHg, p < 0.001) and HDL-cholesterol (+4 ± 12 mg/dL vs. + 2 ± 12 mg/dL, p = 0.05); however, there were no differences in fasting plasma glucose and triglyceride concentration (-4 ± 35 mg/dl vs. -1 ± 32 mg/dl, p = 0.43 and -0.4 ± 83 mg/dl vs. +6 ± 113 mg/dl, p = 0.28). CONCLUSION Intensive LSI counseling provided by primary care professionals resulted in significant improvements in abdominal circumference, blood pressure and HDL-cholesterol but had limited effects on glucose and triglyceride levels in patients with metabolic syndrome.

Prevalence of cardiovascular risk factors in an urban adult population from southern Spain. IMAP Study.

Aims:  To study the prevalence of cardiovascular risk factors in an urban population of Malaga, Spain and its relationship with educational level.