Pancreas transplantation: differences in activity between Europe and the United States

Background. Although pancreas transplantation (PT) is the treatment of choice in selected diabetic patients, the International Pancreas Transplant Registry (IPTR) has reported important differences in activity between USA and Europe. Of all cases reported, 75% are from USA and only 23% from Europe. Therefore, an analysis of PT activity in selected European countries (SEC) and USA was performed

Chronic Losartan Administration Reduces Mortality and Preserves Cardiac but Not Skeletal Muscle Function in Dystrophic Mice

Duchenne muscular dystrophy (DMD) is a degenerative disorder affecting skeletal and cardiac muscle for which there is no effective therapy. Angiotension receptor blockade (ARB) has excellent therapeutic potential in DMD based on recent data demonstrating attenuation of skeletal muscle disease progression during 6–9 months of therapy in the mdx mouse model of DMD. Since cardiac-related death is major cause of mortality in DMD, it is important to evaluate the effect of any novel treatment on the heart. Therefore, we evaluated the long-term impact of ARB on both the skeletal muscle and cardiac phenotype of the mdx mouse. Mdx mice received either losartan (0.6 g/L) (n = 8) or standard drinking water (n = 9) for two years, after which echocardiography was performed to assess cardiac function. Skeletal muscle weight, morphology, and function were assessed. Fibrosis was evaluated in the diaphragm and heart by Trichrome stain and by determination of tissue hydroxyproline content. By the study endpoint, 88% of treated mice were alive compared to only 44% of untreated (p = 0.05). No difference in skeletal muscle morphology, function, or fibrosis was noted in losartan-treated animals. Cardiac function was significantly preserved with losartan treatment, with a trend towards reduction in cardiac fibrosis. We saw no impact on the skeletal muscle disease progression, suggesting that other pathways that trigger fibrosis dominate over angiotensin II in skeletal muscle long term, unlike the situation in the heart. Our study suggests that ARB may be an important prophylactic treatment for DMD-associated cardiomyopathy, but will not impact skeletal muscle disease

Use of aspirin for primary and secondary prevention of cardiovascular disease in diabetic patients in an ambulatory care setting in Spain

<p>Abstract</p> <p>Background</p> <p>This study was conducted in order to determine the use of aspirin and to assess the achievement of therapeutic targets in diabetic patients according to primary (PP) or secondary prevention (SP).</p> <p>Methods</p> <p>This is a retrospective, observational study including patients ≥18 years with diabetes mellitus followed in four primary care centers. Measurements included demographics, use of aspirin and/or anticoagulant drugs, co-morbidities, clinical parameters and proportion of patient at therapeutic target (TT). Descriptive statistics, chi-square test and logistic regression model were used for significance.</p> <p>Results</p> <p>A total of 4,140 patients were analyzed, 79.1% (95% confidence intervals [CI]: 77.7–80.5%) in PP and 20.9% (95% CI: 18.2–23.7%) in SP. Mean age was 64.1 (13.8) years, and 49.3% of patient were men (PP: 46.3, SP: 60.7, p = 0.001). Aspirin was prescribed routinely in 20.8% (95% CI: 19.4–22.2%) in PP and 60.8% (95% CI: 57.6–64.0%) in SP. Proportion of patient at TT was 48.0% for blood pressure and 59.8% for cholesterol. Use of aspirin was associated to increased age [OR = 1.01 (95% CI: 1.00–1.02); p = 0.011], cardiovascular-risk factors [OR = 1.14 (95% CI: 1.03–1.27); p = 0.013], LDL-C [OR = 1.42 (95% CI: 1.06–1.88); p = 0.017] and higher glycated hemoglobin [OR = 1.51 (95% CI: 1.22–1.89); p = 0.000] were covariates associated to the use of aspirin in PP.</p> <p>Conclusion</p> <p>Treatment with aspirin is underused for PP in patients with diabetes mellitus in Primary Care. Achievement of TT should be improved.</p

Diabetes y trasplante de páncreas Diabetes and pancreas transplantation

La nefropatía es una grave y frecuente complicación de la diabetes, cuyo tratamiento, en una fase terminal, implica la necesidad de efectuar diálisis, y de ser posible, un trasplante renal. El trasplante simultáneo de riñón y páncreas se considera en la actualidad como el tratamiento de elección en los pacientes con diabetes mellitus tipo 1 e insuficiencia renal terminal si no existe una contraindicación. El trasplante de páncreas es un procedimiento complejo, inicialmente asociado a una mayor morbilidad que el trasplante de riñón aislado, pero con el que hoy en día se obtiene una buena supervivencia del paciente y de los injertos. Esto implica una total normalización del control metabólico, permitiendo que el paciente desarrolle una vida normal sin necesidad de administrarse insulina, con los consiguientes beneficios que todo ello tiene para su calidad de vida y para la evolución de las complicaciones de la enfermedad. El trasplante de páncreas aislado, ofrece unos resultados algo peores a los del trasplante combinado de páncreas y riñón. No obstante, son lo suficientemente satisfactorios como para que se considere como una buena opción de tratamiento en pacientes portadores de un trasplante de riñón previo. Otra cuestión, es el trasplante de páncreas aislado en pacientes diabéticos sin insuficiencia renal y no trasplantados de riñón previamente. A pesar que sería el trasplante ideal, hoy en día, quedaría restringido a pacientes con una diabetes lábil, que precisan de repetidos ingresos hospitalarios por descompensación metabólica y/o episodios hipoglicémicos severos que se acompañan de pérdida de conciencia.Kidney disease is a severe and frequent complication in diabetes. In the terminal phase, treatment requires dialysis and, if possible, kidney transplantation. Provided that there are no contraindications, simultaneous kidney/pancreas transplantation is currently considered the treatment of choice in patients with type 1 diabetes mellitus and terminal kidney disease. Pancreas transplantation is a complex process initially associated with a greater morbidity than kidney transplant alone. At present, however, patient and graft survival is good thereby leading to total normalization of metabolic control and allowing the patient to carry out a normal life without the need to administer insulin and with the consequent benefits in quality of life and the evolution of the complications of the disease. The results of pancreas transplant alone are somewhat worse than those with combined kidney/pancreas transplantation. They are, however, sufficiently satisfactory to be considered a good therapeutic option in patients who have previously received a kidney. Nonetheless, the transplantation of the pancreas alone in diabetic patients without renal insufficiency or previous kidney transplant is another question. Although this type of transplantation would be ideal, it currently remains restricted to patients with a labile diabetes who require repeated hospital admission due to metabolic decompensation and/or severe hypoglycemic episodes accompanied by loss of consciousness

Changes in physical activity habits in subjects with type 1 diabetes: A comparative study 10 years apart

Physical activity (PA) is highly recommended in type 1 diabetes (T1D). Few studies have reported the amount of PA performed by individuals with T1D in their daily life, and there is no information about changes over time.Cross-sectional study in patients with T1D from a referral hospital recruited in two different periods: data from the Biobank registers from 2009 and data from patients attending visits at the hospital in 2019, on a consecutive basis. Data included clinical characteristics and the PA assessment through the International Physical Activity Questionnaire-short form (IPAQ-SF).In 2019, participants with T1D (n=135) reported a lower sedentary lifestyle and greater levels of high PA compared to subjects with T1D (n=355) from 10 years earlier (6.7% vs. 14.1% sedentariness, p=0.015; and 52.6% vs. 25.4% of high PA, p0.05 for all comparisons). Sex and age groups were not determinant for sedentary lifestyle in the different years studied. Analysing all the 490 participants, there was an inverse correlation of age with sitting hours (p=0.024, r=-0.102), total METs (p<0.001, r=-0.146) and HbA1c (p=0.038, r=-0.097). No correlations were found between PA and HbA1c or BMI.The findings indicate that PA has significantly increased in subjects with T1D over the last 10 years. Future studies are needed to assess whether these healthier habits translate into better outcomes in this high-risk population.Copyright © 2022 SEEN and SED. Published by Elsevier España, S.L.U. All rights reserved

Psychometric analysis of the Spanish and Catalan versions of the Diabetes Self-Care Inventory-Revised version questionnaire

Margarida Jans&agrave;,1 Merc&egrave; Vidal,1 Marga Gim&eacute;nez,1 Ignacio Conget,1 Mercedes Galindo,2 Daria Roca,1 Cristina Colungo,3 Enric Esmatjes,1 Manel Salamero4 1Diabetes Unit, Endocrinology and Nutrition, Hospital Clinic, Barcelona, 2Endocrinology and Nutrition Department, Hospital Clinico, Madrid, 3Primary Care Centre, Hospital Clinic, Barcelona, 4Psychology Department, Hospital Clinic, Barcelona, Spain Background: The purpose of this study was to validate the Spanish and Catalan versions of the Diabetes Self-Care Inventory-Revised Version (SCI-R) questionnaire to assess the degree of adherence to self-care among adults with diabetes. Methods: We validated the Spanish and Catalan translation from, and back translation to, English and cultural adaptation of the SCI-R in type 1 diabetes patients on multiple insulin doses or continuous subcutaneous insulin infusion and in type 2 diabetes patients on oral agents and/or insulin. Internal reliability, structural validity, and external validity (correlation with glycated hemoglobin) were evaluated. Responsiveness to change was assessed in patients 1 year after onset of type 1 diabetes and following a structured education program. Results: The SCI-R presented good internal reliability Cronbach&#39;s &alpha;: 0.75, test-retest reliability (r = 0.82) and structural validity (r > 0.40). The external validity was also good; the SCI-R correlated with HbA1c in patients with type 1 diabetes on multiple insulin doses (r = -0.50) or continuous subcutaneous insulin infusion (r = -0.66) and in patients with type 2 diabetes on multiple insulin doses (r = -0.62). However, it was not satisfactory in patients on oral agents (r = -0.20) and/or bedtime insulin (r = -0.35). Responsiveness to change was analyzed in 54 patients (age 27.3&plusmn;7.4 years, 26% men, HbA1c 6.8% &plusmn;1.1%); the SCI-R score was 72.3% &plusmn;13.7% and correlated negatively with glycated hemoglobin (r = -0.42) and 3 scales of the Diabetes Quality of Life questionnaire (lower score indicating better perception): Impact (r = -0.37), Social Worry (r = -0.36) and Diabetes Worry (r = -0.38), all at P < 0.05. Conclusion: The Spanish and Catalan versions of the SCI-R questionnaire show good psychometric properties and both could be considered as useful tools for evaluating self-care behavior in patients with type 1 or type 2 diabetes. However, there are still some subgroups of patients with type 2 diabetes in which the validity of this questionnaire needs further evaluation. Keywords: diabetes, self-care, questionnaire, adherence, validation, patient educatio