Family physician and endocrinologist coordination as the basis for diabetes care in clinical practice

<p>Abstract</p> <p>Background</p> <p>To estimate the proportion of diabetic patients (DPts) with peripheral vascular disease treated at a primary health care site after an endocrinologist-based intervention, who meet ATP III and Steno targets of metabolic control, as well as to compare the outcome with the results of the patients treated by endocrinologists.</p> <p>Methods</p> <p>A controlled, prospective over 30-months period study was conducted in area 7 of Madrid. One hundred twenty six eligible diabetic patients diagnosed as having peripheral vascular disease between January 2003 and June 2004 were included in the study. After a treatment period of three months by the Diabetes team at St Carlos Hospital, 63 patients were randomly assigned to continue their follow up by diabetes team (Group A) and other 63 to be treated by the family physicians (FP) at primary care level with continuous diabetes team coordination (Group B). 57 DPts from Group A and 59 from Group B, completed the 30 months follow-up period. At baseline both groups were similar in age, weight, time from diagnosis and metabolic control. The main outcomes of this study were the proportion of patients meeting ATP III and Steno goals for HbA1c (%), Cholesterol, HDL cholesterol, LDL cholesterol, triglycerides, blood pressure, albumine-to-creatinine excretion ratio (ACR), body mass index (BMI), waist circumference (WC), anti-aggregation treatment and smoking status.</p> <p>Results</p> <p>At the end of the follow up, no differences were found between the groups. More than 37% of diabetic patients assigned to be treated by FP achieved a HbA1c < 6.5%, more than 50% a ACR < 30 mg/g, and more than 80% reached low risk values for cholesterol, LDL cholesterol, triglycerides, diastolic blood pressure and were anti-aggregated, and 12% remained smokers. In contrast, less than 45% achieved a systolic blood pressure < 130 mm Hg, less than 12% had a BMI < 25 Kg.m-2 (versus 23% in group A; p < 0.05) and 49%/30% (men/women) had a waist circumference of low risk.</p> <p>Conclusion</p> <p>Improvements in metabolic control among diabetic patients with peripheral vascular disease treated at a primary health care setting is possible, reaching similar results to the patients treated at a specialized level. Despite such an improvement, body weight control remains more than poor in both levels, mainly at primary care level. General practitioner and endocrinologist coordination care may be important to enhance diabetes management in primary care settings.</p> <p>Trial registration</p> <p>Clinical Trial number ISRCTN75037597</p

Quality Aspects of Pork Meat and Its Nutritional Impact

Pork meat production in Europe has followed a steady increase over the last decade, with about 19,000,000 tons produced in 1,999, and is expected to remain fairly stable or even experiment a small increase over the next few years. Spain constitutes the second largest producer of pig meat in the European Union. The production has risen to about 2,900,000 tons in 1,999. Pork meat is recognised as an important part of the European diet. However, consumers perception in recent years is not so good because they believe pork meat contains a high amount of visible fat with a high content in saturated fatty acids and cholesterol.Grants 1FD97-1864 from the Comisión Interministerial de Ciencia y Tecnología (CICYT-FEDER, Madrid, Spain) and FIS 0279/98 from Ministerio de Sanidad y Consumo (Madrid, Spain) are acknowledged. Financial support from Vaquero Foundation for R+D on Pork Meat and Vaquero Meat Industries (Madrid, Spain) is also fully acknowledged.N

Interfacial Activity and Contact Angle of Homogeneous, Functionalized, and Janus Nanoparticles at the Water/Decane Interface

Surface heterogeneity affects the behavior of nanoparticles at liquid interfaces. To gain a deeper understanding on the details of these phenomena, we have measured the interfacial activity and contact angle at water/decane interfaces for three different types of nanoparticles: homogeneous poly­(methyl methacrylate) (PMMA), silica functionalized with a capping ligand containing a methacrylate terminal group, and Ag-based Janus colloids with two capping ligands of different hydrophobicity. The interfacial activity was analyzed by pendant drop tensiometry, and the contact angle was measured directly by freeze-fracture shadow-casting cryo-scanning electron microscopy. The silver Janus nanoparticles presented the highest interfacial activity, compared to the silica nanoparticles and the homogeneous PMMA nanoparticles. Additionally, increasing the bulk concentration of the PMMA and silica nanoparticles up to 100-fold compared to the Janus nanoparticles led to silica particles forming fractal-like structures at the interface, contrary to the PMMA particles that did not show any spontaneous adsorption

Flavin-containing monooxygenase 3 as a potential player in diabetes-associated atherosclerosis

Despite the well-documented association between insulin resistance and cardiovascular disease, the key targets of insulin relevant to the development of cardiovascular disease are not known. Here, using non-biased profiling methods, we identify the enzyme flavin-containing monooxygenase 3 (Fmo3) to be a target of insulin. FMO3 produces trimethylamine N-oxide (TMAO), which has recently been suggested to promote atherosclerosis in mice and humans. We show that FMO3 is suppressed by insulin in vitro, increased in obese/insulin resistant male mice and increased in obese/insulin-resistant humans. Knockdown of FMO3 in insulin-resistant mice suppresses FoxO1, a central node for metabolic control, and entirely prevents the development of hyperglycaemia, hyperlipidemia and atherosclerosis. Taken together, these data indicate that FMO3 is required for FoxO1 expression and the development of metabolic dysfunction