BackgroundObesity is known to be related to the development of type 2 diabetes mellitus (T2D). The most commonly used anthropometric indicator (body mass index [BMI]) presents several limitations such as the lack of possibility to distinguish adipose tissue distribution. Thus, this study examines the suitability of a body shape index (ABSI) for prediction of body composition and sarcopenic obesity in obese or overweight T2D subjects.MethodsCross-sectional study in 199 overweight/obese T2D adults. Anthropometric (BMI, ABSI) and body composition (fat mass [FM], fat-free mass [FFM], fat mass index [FMI] and fat-free mass index, and the ratio FM/FFM as an index of sarcopenic obesity) data was collected, as well as metabolic parameters (glycated haemoglobin [HbA1c], mean blood glucose, fasting plasma glucose [FPG], high-density-lipoprotein cholesterol [HDL], low-density-lipoprotein cholesterol, total cholesterol, and triglycerides [TG] levels; the ratio TG/HDL was also calculated as a surrogate marker for insulin resistance).ResultsABSI was significantly associated with age and waist circumference. It showed a statistically significant correlation with BMI exclusively in women. Regarding body composition, in men, ABSI was associated with FM (%), while in women it was associated with both FM and FFM. Both males and females groups with high ABSI scores were significantly older (men: 59.3 ± 10.8 vs 54.6 ± 10.1, p ≤ 0.05; women: 65.1 ± 9.8 vs 58.1 ± 13.3, p ≤ 0.005) and showed lower FFM values (men: 62.3 ± 9.0 vs 66.2 ± 9.3, p ≤ 0.05; women: 48.7 ± 5.6 vs 54.5 ± 8.9, p ≤ 0.001) compared with low-ABSI groups. Multiple linear regression revealed that ABSI independently predict FMI and the FM/FFM ratio in women. Sarcopenic obesity was identified in 70 (36.5%) individuals according to the FM/FFM ratio. The AUROC of ABSI was 63.1% (95% CI 54.6–71.6%; p = 0.003) and an ABSI value of 0.083 m11/6 kg−2/3 was the optimal threshold in discriminating patients with sarcopenic obesity (sensitivity: 48%, specificity: 73%). Moreover, a significant association between ABSI and FPG was found in men.ConclusionsABSI could be useful to identify visceral and sarcopenic obesity in overweight/obese adults with T2D, adding some relevant clinical information to traditional anthropometric measures.Electronic supplementary materialThe online version of this article (10.1186/s13098-018-0323-8) contains supplementary material, which is available to authorized users.

Background/Aims: Obesity has been associated with hypothyroidism and impaired insulin sensitivity. However, few studies have specifically addressed the association between insulin sensitivity and thyroid function. Our aim was to look for a relation between these 2 factors in a sample of obese males. Methods: One hundred and forty-four euthyroid male obese patients – mean age 42.6 years, mean body mass index (BMI) 41.8 – were enrolled in this cross-sectional study. The hospital study protocol at entrance included baseline serum thyroid-stimulating hormone (TSH), insulin and glucose concentrations. Data were studied using an age-adjusted simple and multivariate linear regression analysis with TSH as the dependent and insulin and BMI as the independent variables. Results: Mean TSH and insulin were 1.6 and 21.2 mU/l, respectively. It was found that their relationship follows a regression model: TSH = 1.725–0.019 (age) + 0.003 (insulin) + 0.017 (BMI). Further data showed a positive correlation between BMI and TSH (r = 0.22; p < 0.05), as well as between serum baseline insulin (>10 mU/l) and TSH concentration (r = 0.27; p < 0.05). This association was stronger in patients with higher insulin values (>21.2 mU/l; r = 0.40; p < 0.01). However, negative correlations between age and insulin (r = –0.14; not significant) and age and TSH (r = –0.35; p < 0.05) were observed. Conclusions: In obese males, insulin resistance is significantly related with impairment of thyroid function, and this situation seems to be attenuated with age.

AimsHypoglycaemia is a serious medical emergency. The need for emergency medical service care and the costs of hypoglycaemic emergencies are not completely known.MethodsThis was a retrospective observational study using Public Company for Health Emergencies (EPES) data for hypoglycaemia in 2012. The EPES provides emergency medical services to the entire population of Andalusia, Spain (8.5 million people). Data on event type, onsite treatments, emergency room visits or hospitalization were collected. Medical costs were estimated using the public rates for healthcare services.ResultsFrom a total of 1 137 738 emergency calls that requested medical assistance, 8683 had a primary diagnosis of hypoglycaemia (10.34 per 10 000 person‐years). The incidence of severe hypoglycaemic episodes requiring emergency treatment in the estimated population with diabetes was 810 episodes per 10 000 person‐years. A total of 7479 episodes (86%) required an emergency team to visit the patient's residence. The majority of cases (64%) were addressed in the residence, although 1784 (21%) cases were transferred to hospital. A total of 5564 events (65%) involved patients aged > 65 years. Overall mortality was 0.32% (28 cases). The total annual cost of attending a hypoglycaemic episode was €6 093 507, leading to an estimated mean direct cost per episode of €702 ± 565. Episodes that required hospital treatment accounted for 49% of the total costs.ConclusionsHypoglycaemia is a common medical emergency that is associated with high emergency medical service utilization, resulting in a significant economic impact on the health system.

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.

Sodium-glucose co-transporter 2 (SGLT2) inhibitors are an attractive novel therapeutic option for the treatment of type 2 diabetes. They block the reabsorption of filtered glucose in kidneys, mainly in proximal renal tubules, resulting in increased urinary glucose excretion and correction of the diabetes-related hyperglycemia. Beyond improving glucose control, SGLT2 inhibitors offer potential benefits by reducing body weight and blood pressure. On the basis of the efficacy demonstrated in clinical trials, SGLT2 inhibitors are recommended as second- or third-line agents for the management of patients with type 2 diabetes. Beneficial effects on kidney disease progression, cardiovascular and all-cause mortality, and hospitalization for heart failure have also been demonstrated with one SGLT2 inhibitor (empagliflozin). Potential adverse events resulting from their mechanism of action or related to concomitant therapies are reviewed. A treatment algorithm for the adjustment of concomitant therapies after initiating SGLT2 inhibitors is also proposed.