RESUMEN Fundamento. Determinar en una muestra poblacional la prevalencia de los factores de riesgo y del síndrome metabólico, su asociación con las lesiones arterioscleróticas subclínicas y su impacto sobre la enfermedad cardiovascular y cerebrovascular a los 10 años. Material y métodos. (Fase I) Estudio transversal en una muestra aleatoria estratificada por edad y sexo de la población de Navarra entre 35 y 84 años, por encuesta sobre antecedentes vasculares, factores de riesgo, exploración física y analítica. (Fase II) Estudio de cohortes de 10 años de seguimiento, en 500 expuestos y 500 no expuestos al SM, entre 45 y 74 años seleccionados para una razón de riesgo de 2, y una potencia del 82,25%, con exploración de marcadores de arteriosclerosis subclínica por imagen y analíticos. (Fase III) Seguimiento de eventos de enfermedad vascular a los 10 años de la muestra poblacional y de la cohorte prospectiva. Resultados. (Fase 1) Los sujetos requeridos fueron 6.553; excluidos y no localizados 871; la muestra efectiva 5.682 (2.644 hombres y 3.038 mujeres) y completaron el estudio 4.168 sujetos, (73,4%). La prevalencia del síndrome metabólico entre 35 y 84 años fue de 22,1 por 100 (IC95% 20,5-23,7) en hombres y de 17,2% (IC95% 15,8-18,5) en mujeres. Los factores mayores de riesgo vascular presentan prevalencias altas esperadas respecto a otras áreas geográficas excepto la del HDL colesterol bajo que lo fue de 8,5 por 100 (IC95% 7,4-9,6) en hombres y de 1,7% (IC95% 1,3-2,2). Conclusiones. Existen diferencias importantes de riesgo entre sexos en detrimento de los hombres. Las altas cifras promedio de HDL colesterol y la baja prevalencia de síndrome metabólico pueden justificar el menor riesgo de eventos vasculares en Navarra. Palabras clave. Factores de riesgo vascular. Lesiones subclínicas. Navarra (España). Prevalencia. Síndrome metabólico.
La malnutrición puede considerarse un disbalance entre el aporte y los requerimientos de energía y nutrientes que produce una serie de cambios metabólicos y funcionales a nivel corporal. Existen múltiples limitaciones en los parámetros clásicos de valoración nutricional como IMC, pérdida de peso, ingesta o parámetros analíticos clásicos como albúmina o linfocitos. Podemos establecer algunos puntos básicos de interés en este nuevo enfoque de la nutrición centrado en la valoración del estado nutricional del paciente evaluando los cambios de composición y función con nuevos parámetros como el ángulo de fase y otras medidas eléctricas de la bioimpedanciometría, dinamometría, test funcionales, ecografía muscular o nuevos parámetros analíticos como PCR/prealbúmina. Cada uno de estos parámetros tiene una serie de utilidades y limitaciones que es importante conocer a la hora de evaluar los resultados de los mismos. La nueva visión global de la nutrición debe integrar diferentes aspectos de composición y función del organismo para poder establecer un diagnóstico más preciso de la situación nutricional y un plan terapéutico individualizado. Los parámetros nutricionales avanzados del futuro deben ser sensibles y específicos, relacionados entre sí, de forma que permitan un mejor conocimiento de la situación particular de cada paciente en diferentes momentos evolutivos de su proceso patológico.
Background and Aims: “T-Coach® program” is a telephone support platform for type 2 diabetes (T2D) on glargine U300 insulin. This study aimed to evaluate whether this program was effective in helping patients reach their optimal insulin dose. Materials and Methods: Both T2D patients who were initiating glargine U300 or requiring dose titration, enrolled in T-Coach® program, were included in the study. Telephone intervention was delivered by diabetes nurse educators and consisted of regular telephone sessions, aimed at achievement of target fasting blood glucose (FBG) and reinforce diabetes education. The optimal insulin dose (OID) was defined as the dose of Glargine U300 required to achieve target FBG. The primary outcome was whether a patient reached the OID dose within 6 months. Results: A total of 589 patients consented and were included in TCoach program®. Median age was 65.4±11.2 years; 51.8% men; BMI 30.3±6 kg/m2. Of them, 65.9% were already on basal insulin (17.7% on Glargine U300). Mean glargine U300 dose was 27.4±15.9 UI. Mean baseline HbA1c was 9.4±1.8%, and basal FBG was 215.2±66.2 mg/dL. Mean FBG target was 88.7-132.3 mg/dl. Of them, 77.6% reached their OID at 6 months (75.7% at 3 months, and 41.2% at 1 month), and they did so in an average of 2.2±1.8 months. Mean FBG levels fell from 215.2 mg/dL to 137.9 mg/dL, 117.9 mg/dL and 115.9 mg/dL at months 1,3 and 6, respectively. Mean glargine U300 dose increased from 27.4 UI to 30.4 UI at month 6. Knowledge and adherence questionnaires were given to the patients. Mean score in knowledge questionnaire increased from 4.8 to 7.6 after the program. Moreover, a satisfaction survey was completed by 208 patients. The program was very well graded, with an average score of 9.1 out of 10. Conclusion: The T-Coach® program is an effective way to help patients reach their optimal insulin glargine U300 dose, improves glycemic control and can be an effective support for diabetes education. Disclosure D. Bellido Guerrero: None. V. Bellido: None. C. Morales: Other Relationship; Self; AstraZeneca, Janssen Pharmaceuticals, Inc., Lilly Diabetes, Merck Sharp & Dohme Corp., Novo Nordisk A/S, Sanofi. J. García: None. A. Muñoz-Garach: Speaker's Bureau; Self; Lilly Diabetes, Novo Nordisk A/S, Sanofi-Aventis. J.L. Fernandez Morera: None. B. Gonzalez Aguilera: None. M. López de la Torre: None. P. Fuentealba: Employee; Self; Sanofi.
Introduction: Cardiovascular disease (CVD) is the major cause of mortality in T1D. Lipid-lowering treatment (LLT) with statins prevent major cardiovascular events and dead in a broad spectrum of patients. However, evidence of CVD risks factors and its management are based on subgroup analyses and extrapolations of effects demonstrates in other populations. Objectives: The aim of the study was to analyze the differences between T1D adults on lipid-lowering treatment (T group) and without treatment (No T group). We pay special attention to CVD risk factors, comorbidities and which factors are associated with receiving lipid-lowering treatment. Research design and Methods: A multicentric, cross-sectional study in Spain included 1252 T1D adults who visited Diabetes Clinic from December 2017 to December 2018. Results: Among 1252 patients 344 were on LLT. In terms of lipid profile LDL (131 vs. 100 mg/dL), HDL (57 vs. 60 mg/dL), total cholesterol (213 vs. 178 mg/dL) and triglycerides (125 vs. 85 mg/dL) levels were statistically significant while compared between T and No T groups. T group was older (48 vs. 37 years old) and the median duration of diabetes was higher (25 vs. 18 years)than No T group (p< 0.000). BMI in T group was 27 kg/m2 higher than no T group (25 kg/m2) (p < 0,0001). There was a trend toward higher prevalence of microvascular (57% vs. 23,8%) and macrovascular complications (13,7% vs. 3,6%) in T group than in No T (p < 0,000). A positive association was found between sex (male), smoking, high blood pressure and to be on treatment. There were no differences between the T group and No T group in terms of A1c (A1c 7,90% vs. 7,99%) or fasting glucose (157 vs.161 mg/dl). Conclusions: This multicentric study shows that starting LLT is associated with LDL > 100 mg/dL, aged, sex (male), duration of diabetes, high BMI, comorbidities, smoking and a high blood pressure. Our results show compliance with the recommendations of 2014 AHA/ADA scientific statement type 1 diabetes mellitus and Cardiovascular Disease. Disclosure M. Rodriguez Carnero: None. D. Bellido Guerrero: None. C. Tejera: None. M. López de la Torre: None. A. Soto González: None. F.J. Escalada: Advisory Panel; Self; Merck Sharp & Dohme Corp., Novo Nordisk A/S, Sanofi. Consultant; Self; Esteve, Lilly Diabetes. Speaker's Bureau; Self; Amgen Inc., AstraZeneca, Boehringer Ingelheim Pharmaceuticals, Inc., Janssen Pharmaceuticals, Inc., Merck Sharp & Dohme Corp., Novo Nordisk A/S, Sanofi. A. Hernandez-Mijares: None. L. Suarez Gutierrez: None. C. Morales: Other Relationship; Self; AstraZeneca, Janssen Pharmaceuticals, Inc., Lilly Diabetes, Merck Sharp & Dohme Corp., Novo Nordisk A/S, Sanofi. L. Gutiérrez Carrasqu: None. A. Cadenas: Advisory Panel; Self; Janssen Pharmaceuticals, Inc. O. Díaz Trastoy: None. J. Amigó-Farran: None. I. Gonzalez molero: None. V. Bellido: None. F. Arrieta: None. F. Tinahones: Advisory Panel; Self; Lilly Diabetes, Novo Nordisk A/S, Regeneron Pharmaceuticals, Sanofi-Aventis. Consultant; Self; AstraZeneca. Research Support; Self; AstraZeneca. Speaker's Bureau; Self; Danone Nutricia Research, Lilly Diabetes, Novo Nordisk A/S, Regenerative Medical Solutions, Sanofi-Aventis.
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