Comprehensive approach to people with type 2 diabetes. Diabetes Knowledge Area of the Spanish Society of Endocrinology and Nutrition

[ES] Objetivo: Proporcionar recomendaciones prácticas para el abordaje integral de las personas con diabetes tipo 2 según la medicina basada en la evidencia. Participantes: Miembros del Área de Conocimiento de Diabetes de la Sociedad Española de Endocrinología y Nutrición. Métodos: Las recomendaciones se formularon según los grados de evidencia de los Standards of Medical Care in Diabetes—2022. Tras la revisión de la evidencia disponible y la formulación de recomendaciones por los autores de cada apartado, se desarrollaron varias rondas de comentarios con incorporación de las aportaciones y votación de los puntos controvertidos. Por último, el documento final se remitió al resto de los miembros del área para revisión e incorporación de aportaciones, para, finalmente, realizar el mismo proceso con los miembros de la Junta Directiva de la Sociedad Española de Endocrinología y Nutrición. Conclusiones: El documento establece unas recomendaciones prácticas basadas en la última evidencia disponible para el manejo de las personas con diabetes tipo 2.[EN] Objective. To provide practical recommendations for the comprehensive approach of people with type 2 diabetes according to evidence-based medicine. Participants. Members of the Diabetes Knowledge Area of the Spanish Society of Endocrinology and Nutrition. Methods. The recommendations were formulated according to the degrees of evidence of the Standards of Medical Care in Diabetes—2022. After reviewing the available evidence and formulating recommendations by the authors of each section, several rounds of comments were developed incorporating the contributions and voting on controversial points. Finally, the final document was sent to the rest of the members of the area for review and incorporation of contributions, to finally carry out the same process with the members of the Spanish Society of Endocrinology and Nutrition Board of Directors. Conclusions. The document establishes practical recommendations based on the latest available evidence for the management of people with type 2 diabetes.Peer reviewe

Secondary osteoporosis

Las osteoporosis secundarias se deben a diversas causas relacionadas con enfermedades, medicaciones y hábitos que reducen la masa ósea y aumentan el riesgo de fractura osteoporótica con independencia de la edad y del déficit estrogénico. Están presentes en una de cada cinco de las mujeres diagnosticadas de osteoporosis y hasta en la mitad de los varones con fracturas osteoporóticas. Una importante cantidad de enfermedades endocrinológicas, digestivas, hematológicas, reumatológicas, infecciosas y tumorales, así como el uso de múltiples fármacos, se ha asociado a pérdida de masa ósea y a un riesgo incrementado de fractura. En la presente actualización se revisan sus causas, fisiopatología, evaluación y tratamiento recomendado.0.103 SJR (2014) Q4, 1647/1811 Medicine (miscellaneous)UE

Characteristics and types of GLP-1 receptor agonists. An opportunity for individualized therapy

El péptido similar al glucagón-1 (GLP-1) es secretado por células L entero-endocrinas tras la ingestión oral de nutrientes y potencia la secreción de insulina estimulada por glucosa mientras suprime la secreción de glucagón. Además, retrasa el vaciamiento gástrico –reduciendo la hiperglucemia posprandial–, reduce el peso corporal, la presión arterial sistólica y tiene otros beneficios tanto en el sistema nervioso central como en el cardiovascular. Desde la década de 1990 se conoce su efecto hipoglucemiante en la diabetes mellitus tipo 2 (DM2), aunque precisa de infusión subcutánea continua por su corta vida media por efecto de la enzima dipeptidil-peptidasa 4 (DPP-4). Además de los inhibidores de la DPP-4 que elevan pseudofisiológicamente el GLP-1 endógeno, se han desarrollado diversos agonistas del receptor de GLP-1 de acción corta, larga y prolongada con diferencias estructurales, farmacodinámicas y clínicas que pueden administrarse en diferentes combinaciones terapéuticas. Estas diferencias pueden permitir individualizar el tratamiento en la DM2.1.417 JCR (2014) Q2, 70/153 medicine, general & internalUE

Coexistence of dyschondrosteosis associated to SHOX deficiency, pseudohypoparathyroidism 1B, and chronic autoimmune thyroiditis: a case report

We present an unusual case of SHOX deficiency associated with Léri-Weill dyschondrosteosis (LWD), Hashimoto’s thyroiditis and pseudohypoparathyroidism 1B in a young woman. To our knowledge, this is the first ever report of these disorders coexisting. At the age of nine years, the proband was diagnosed of hypothyroidism due to Hashimoto’s thyroiditis, and developed biochemical abnormalities consistent with hyperphosphatemia, mild hypocalcemia and elevated parathyroid hormone without any clinical symptoms except short stature. Replacement therapy with levothyroxine, calcium and alphacalcidol was initiated. The diagnosis of pseudohypoparathyroidism 1B was confirmed at the age of 17.5 years with the demonstration of methylation alteration at the GNAS locus. At the age of 16 years, 3.5 years after her menarche, she presented clear features of LWD. A large deletion of the SHOX gene was confirmed. Family genetic tests were not doable since she was adopted. We discuss the diagnostic challenges of these coexisting rare endocrinopathies.Sin financiación1.634 JCR (2020) Q3, 95/129 Pediatrics0.411 SJR (2021) Q2, 149/320 Pediatrics, Perinatology and Child HealthUE

Fasting plasmatic glucose changes during the menopausal transition

OBJETIVO: Evaluar los cambios en la glucemia en ayunas en mujeres en transición a la menopausia. MATERIALES Y MÉTODOS: Estudio observacional, retrospectivo, de una cohorte de mujeres atendidas en el Hospital Quirón Salud de Madrid entre 2007 y 2018. Criterios de inclusión: diagnóstico del ginecólogo y al menos una medición en ayunas de la glucemia y perfil lipídico. Los reportes del laboratorio se clasificaron en perimenopáu-sicos o posmenopáusicos, según la fecha de la última menstruación. Para el análisis estadístico se utilizaron las siguientes pruebas: χ2, t de Student, U-Mann Whitney (dependiendo del comportamiento paramétrico) y ANOVA. RESULTADOS: Se incluyeron 1949 reportes de glucemia en ayunas: 459 (23.6%) en pacientes en la perimenopausia y 1490 (76.4%) en la posmenopausia (n = 275). La glucemia en ayunas fue significativamente mayor en las mujeres en la posmenopausia (p < 0.001). En el cambio de la glucemia en ayunas a lo largo del tiempo, según la fecha de la última menstruación, se observó un aumento continuo de la glucemia, sin diferencias significativas entre la peri y posmenopausia. La edad al momento de los estudios, la diabetes gestacional, los antecedentes familiares de diabetes y las con-centraciones de triglicéridos se asociaron, de forma independiente, con la glucemia en ayunas (p < 0.001 en todos los casos). CONCLUSIONES: Las diferencias en la glucemia en ayunas entre los periodos de pe-rimenopausia y posmenopausia son significativas; sin embargo, los datos del cambio de la glucemia ajustados por edad y tratamiento sugieren que el estado menopáusico no actúa de forma independiente en la glucemia en ayunas. Los que sí influyeron fue-ron: la edad al momento de las mediciones, la diabetes gestacional, los antecedentes familiares de diabetes y las concentraciones de triglicéridosOBJECTIVE: To evaluate the fasting plasmatic glucose changes during the menopausal transition. MATERIALS ANDMETHODS: This is a retrospective observational study of laboratory studies from women visited in hospital Quirón Salud de Madrid from 2007-2018 years. The inclusion criteria were one or more laboratory studies of fasting plasmatic glucose and lipid profile from women visited because of irregular menstruation, menopausal symptoms and/or amenorrhea. Laboratory studies values were classified as perimeno-pausal or posmenopausal based on their date of last menstruation. For quantitative variables, Student's T or Mann-Whitney U tests (depending on the normality distribu-tion) were applied to analyze differences between perimenopausal and posmenopausal values. Chi-square or Fisher's exact test were used for qualitative variables. ANOVA test was performed to compare the glucose quartiles. RESULTS: 1949 laboratory reports of fasting glucose were included: 459 (23.6%) were perimenopausal and 1490 (76.4%) were posmenopausal, from 275 women with 7.3 laboratory report-women. Fasting plasmatic glucose was higher at the posmenopausal samples (p < 0.001). The evolution of the fasting plasmatic glucose showed a continuous increase that starts during perimenopause. There were no significant differences in the evolution trend between perimenopause and posmenopause. Age in the moment of the blood sample, gestational diabetes, family history of diabetes and triglycerides levels were independently associated with fasting plasmatic glucose (p < 0.001 in all cases). CONCLUSION: The differences in fasting blood glucose between periods of perimeno-pause and posmenopause are significant; however, data on age-adjusted blood glucose change and treatment suggest that menopausal status does not act independently on fasting blood glucose. Those that did influence were: age at the time of the measure-ments, gestational diabetes, family history of diabetes and triglyceride concentrationsSin financiaciónNo data JCR 20200.126 SJR (2020) Q4, 2219/2447 Medicine (miscellaneous)No data IDR 2020UE

Lipid profile changes during the menopausal transition

Objectives:There is evidence that the menopausal transition in women is accompanied by changes in themetabolic profile. We evaluated the lipid profile during the perimenopause to postmenopause transition and itsassociation with menopausal status.Methods:This is a retrospective observational study of laboratory studies from women presenting to thegynecology unit of Hospital Quiro ́ n Salud, Madrid (2007-2018) with irregular menstruation, amenorrhea ormenopausal symptoms. Inclusion criteria were one or more blood samples with determinations of fasting glucoseand lipids (total cholesterol, low-density lipoprotein cholesterol [LDL-c], high-density lipoprotein cholesterol[HDL-c] and triglycerides [TGs]) from women with a menopause diagnosis recorded in the hospital database. Thedeterminations were classified as perimenopausal or postmenopausal based on the date of last menstruation.Results:In total, 13,517 laboratory studies (3,073 perimenopausal and 10,444 postmenopausal) from 275 womenwere analyzed. Total cholesterol, LDL-c, and TG levels were significantly higher in postmenopausal women than inperimenopausal women, whereas HDL-c levels were significantly lower (P<0.05 in all cases). Further adjustmentby age showed differences only in LDL-c levels. Menopausal status, TG levels, and the number of pregnancies wereindependently related with total cholesterol and LDL-c levels. HDL-c levels were independently affected bymenopausal age, TG levels, and number of pregnancies. Finally, TG concentration was independently affected bytotal cholesterol, LDL-c, and HDL-c levels.Conclusion:Our study suggests that significant changes in LDL-c levels occur during the menopausal transition.Total cholesterol and LDL-c changes are independently affected by menopausal status and HDL-c is influenced bymenopausal age.Sin financiación2.953 JCR (2020) Q2, 35/83 Obstetrics & Ginecology1.086 SJR (2020) Q1, 37/181 Obstetrics and GynecologyNo data IDR 2020UE

The impact of repeat fine-needle aspiration in thyroid nodules categorized as atypia of undetermined significance or follicular lesion of undetermined significance: A single center experience

Atypia of undetermined significance (AUS) or follicular lesion of undetermined significance (FLUS) is the most controversial category of the Bethesda System. The present study was conducted to compare the histological findings in a series of thyroid nodules diagnosed with AUS/FLUS after single or repeat fine needle aspiration (FNA) cytology. Methods: Retrospective analysis of our institution's series of 514 patients with an initial diagnosis of AUS/FLUS between 11/2011 and 02/2020. Results: Of 4887 FNA samples, 11.8% were classified as AUS/FLUS. Of patients with an initial AUS/FLUS diagnosis, 11.5% (59/514) underwent surgery after a single FNA, 55.4% (285/514) had a repeat FNA, and 32.7% (168/514) were either observed or lost to follow-up. Surgical pathology was available in 123 cases (23.9%), and malignancy was confirmed in 32.5% (40/123) cases, with similar rates in the single 32.2% (19/59) and repeat FNA 32.8% (21/64) groups. Repeat FNA reclassified 78.9% of the AUS/FLUS cases to a different category: 57.2% were reclassified as benign, 10.5% as follicular neoplasm, and 5.6% as suspicious for malignancy or malignant. The rates of nonneoplastic benign lesions were 52.5% (31/59) and 31.2% (20/64) in the single and repeat FNA groups, respectively (P = .018). The rates of follicular adenomas were higher when repeat FNA was performed (23/64, 35.9%) compared with a single FNA (9/59; 15.2%) (P = .013). Conclusion: In this series, a repeat FNA in cases of AUS/FLUS increased detection of follicular adenomas but not the detection of malignancy. Repeat FNA reduced the rate of benign nonneoplastic lesions by 40% in the surgical samples.Sin financiación1.390 JCR (2021) Q4, 24/29 Medical Laboratory Technology0.415 SJR (2021) Q3, 37/63 HistologyNo data IDR 2020UE

Glycaemic variability in patients with type 2 diabetes mellitus treated with dulaglutide, with and without concomitant insulin: Post hoc analyses of randomized clinical trials

Aim: To investigate the association between treatment with dulaglutide and glycaemic variability (GV) in adult patients with type 2 diabetes mellitus (T2D). Materials and methods: Post hoc analyses of six randomized, phase 3 studies were conducted to investigate the association between treatment with dulaglutide 1.5 mg once weekly and GV in adult patients with T2D. Using data from seven- and eight-point self-monitored plasma glucose (SMPG) profiles over up to 28 weeks of treatment, GV in within- and between-day SMPG, and between-day fasting glucose from SMPG (FSMPG) was assessed according to standard deviation and coefficient of variation. Results: Pooled data from five studies with dulaglutide as monotherapy or added to oral glucose-lowering medication, without concomitant insulin treatment, revealed clinically meaningful reductions in within- and between-day SMPG, and between-day FSMPG variability from baseline in the dulaglutide group. Comparisons between treatment groups in two studies demonstrated that reductions from baseline in within-day and between-day SMPG, and between-day FSMPG variability were greater for treatment with dulaglutide compared with insulin glargine, as well as for treatment with dulaglutide when added to insulin glargine compared with insulin glargine alone. Conclusions: In patients with T2D, treatment with dulaglutide as monotherapy or added to oral glucose-lowering medication, without concomitant insulin treatment, was potentially associated with a reduction in GV. Treatment with dulaglutide was associated with a reduction in GV to a greater degree than insulin glargine. When added to insulin glargine, treatment with dulaglutide was associated with greater decreases in GV compared with insulin glargine alone. As reduced GV may be associated with better outcomes, these findings may have clinical relevance.Eli Lilly and Company6.410 JCR (2021) Q1, 30/146 Endocrinology & Metabolism2.356 SJR (2021) Q1, 7/128 EndocrinologyNo data IDR 2020UE

Cost of achieving HbA1c and weight loss treatment targets with IDegLira vs insulin glargine U100 plus insulin aspart in the USA

Background: Compared with basal-bolus insulin therapy (insulin glargine U100 plus insulin aspart), IDegLira has been shown to be associated with similar improvements in HbA1c, with superior weight loss and reduced hypoglycemia in patients with type 2 diabetes. The present analysis evaluated the cost per patient with type 2 diabetes achieving HbA1c-focused and composite treatment targets with IDegLira and insulin glargine U100 plus insulin aspart (≤4 times daily). Methods: The proportions of patients achieving treatment targets were obtained from the treat-to-target, non-inferiority DUAL VII study (NCT02420262). The annual cost per patient achieving target (cost of control) was analyzed from a US healthcare payer perspective. The annual cost of control was assessed for eight prespecified endpoints and four post-hoc endpoints. Results: The number needed to treat to bring one patient to targets of HbA1c <7.0% and HbA1c ≤6.5% was similar with IDegLira and insulin glargine U100 plus insulin aspart. However, when weight gain and/or hypoglycemia were included, the number needed to treat was lower with IDegLira. IDegLira and insulin glargine U100 plus insulin aspart had similar costs of control for HbA1c <7.0%. However, cost of control values were substantially lower with IDegLira when the more stringent target of HbA1c ≤6.5% was used, and when patient-centered outcomes of hypoglycemia risk and impact on weight were included. Conclusion: IDegLira was shown to be a cost-effective treatment vs insulin glargine U100 plus insulin aspart for patients with type 2 diabetes not achieving glycemic targets on basal insulin in the USA.Sin financiaciónNo data JCR 20190.544 SJR (2019) Q1, 70/406 Economics, Econometrics and Finance (miscellaneous)No data IDR 2019UE

Sustain 6: A post-hoc analysis of the effect of semaglutide on cardiovascular outcomes over time in subjects with type 2 diabetes

Introduction: Semaglutide is a once weekly glucagon-like peptide-1 analogue in development for treatment of type 2 diabetes (T2D). SUSTAIN 6, a 2-year, cardiovascular (CV) outcomes, randomised, placebo-controlled trial, was conducted in 3297 adults with T2D at high CV risk. Semaglutide (0.5 or 1.0 mg) added to standard care led to a significant 26% reduction (hazard ratio [HR] 0.74; 95% confidence interval [CI] 0.58-0.95) in risk of the primary outcome (CV death, non-fatal myocardial infarction [MI] or non-fatal stroke) vs placebo, driven by reductions in non-fatal MI (26%; HR 0.74; 95% CI 0.51-1.08) and non-fatal stroke (39%; HR 0.61; 95% CI 0.38-0.99). We explored the effect of semaglutide on the primary outcome over time to help support mechanistic understanding by evaluating if there is evidence of a weakened, strengthened or constant treatment effect during the trial.Sin financiación2.350 JCR (2018) Q3, 38/65 Peripheral Vascular Disease0.622 SJR (2018) Q2, 155/369 Cardiology and Cardiovascular MedicineNo data IDR 2018UE