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Estudien la relació entre el virus de l'hepatits C i la diabetis mellitus

S'ha detectat un increment de la prevalença de diabetis en els pacients infectats pel VHC, així com una major prevalença d'infecció pel VHC entre els diabètics. Investigadors de la UAB a la secció d'Endocrinologia de l'Hospital de la Vall d'Hebron revisen la informació disponible i estudien els mecanismes pels quals el VHC desencadena la diabetis.Se ha detectado un incremento de la prevalencia de diabetes en los pacientes infectados por el VHC, así como una mayor prevalencia de infección por el VHC entre los diabéticos. Investigadores de la UAB en la sección de Endocrinología del Hospital del Vall d'Hebron revisan la información disponible y estudian los mecanismos por los que el VHC desencadena la diabetes

Alteraciones hidrocarbonadas en los pacientes con infección crónica por el virus de la hepatitis C : estudio de prevalencia y de los mecanismos etiopatogénicos /

Consultable des del TDXTítol obtingut de la portada digitalitzadaExisten cada vez más evidencias de que el virus de la hepatitis C favorece el desarrollo de diabetes. Objetivos: 1.- Analizar la prevalencia de las alteraciones del metabolismo hidrocarbonado (diabetes y glucemia anómala en ayunas) en los pacientes con infección crónica por el VHC (n=498) y compararla con la que presentan los pacientes con otras enfermedades hepáticas (n=144), considerando el grado de lesión hepática (hepatitis crónica o cirrosis) y los genotipos del VHC en el análisis de los resultados. 2.- Evaluar los mecanismos etiopatogénicos por los que el VHC puede favorecer el desarrollo de diabetes (citocinas proinflamatorias, resistencia a la insulina, disfunción célula beta) mediante un estudio caso control en pacientes con hepatitis crónica no diabéticos (14 VHC (-) y 28 (+)) estrictamente equiparados por los factores relacionados con la aparición de diabetes. 3.- Analizar si el aumento de ferritina que existe en los pacientes infectados por el VHC es debido a la propia infección o, si por el contrario, puede atribuirse a la mayor prevalencia de diabetes (enfermedad que también cursa con ferritina elevada) en estos pacientes. 4.- Complementando al último objetivo, determinar mediante el análisis de los receptores solubles de la transferrina (sTfR), si la concentración de ferritina en los pacientes diabéticos tipo 2 es un buen indicador de los depósitos de hierro. Conclusiones: 1.- Los pacientes con infección por el VHC presentan una elevada prevalencia tanto de glucemia anómala en ayunas como de diabetes en comparación con los pacientes con otras enfermedades hepáticas no atribuibles al VHC (17% vs. 7% y 15% vs. 5%, respectivamente). Este aumento de prevalencia se produce fundamentalmente en los pacientes con hepatitis crónica e incluso se objetiva en sujetos con transaminasas normales. 2.- El análisis del genotipo no parece útil para identificar una población de pacientes infectados por el VHC con mayor riesgo para desarrollar alteraciones hidrocarbonadas. 3.- La infección por el VHC debe consideradarse un factor de riesgo para el desarrollo de diabetes. Por tanto, es recomendable realizar un cribado sistemático de las alteraciones hidrocarbonadas en los pacientes infectados por el VHC. 4.- En los pacientes infectados por el VHC la prueba de la sobrecarga oral de glucosa es el método de elección para realizar el diagnóstico de la diabetes. 5.- En los pacientes infectados por el VHC que aún no han desarrollado una diabetes existe un hiperinsulinismo, tanto en situación basal como tras la estimulación con glucagón endovenoso o la ingesta de una comida estándar, lo que traduce un estado de insulinresistencia. 6.- El aumento de resistencia a la insulina en los pacientes infectados por el VHC se asocia a un incremento de citocinas proinflamatorias. 7.- Los pacientes infectados por el VHC no diabéticos presentan concentraciones similares de ferritina que la población general. De ello puede deducirse que el aumento de los depósitos de hierro, evaluados mediante los niveles séricos de ferritina, no parece un elemento fundamental en la etiopatogenia de la diabetes asociada al VHC. 8.- La diabetes mellitus es el principal factor relacionado con el aumento de las concentraciones séricas de ferritina observado en los pacientes con infección crónica por el VHC. Por tanto, la diabetes mellitus debe ser tenida en cuenta al evaluar el metabolismo del hierro en los pacientes infectados por el VHC. 9.- El aumento de la ferritina en los pacientes diabéticos no se acompaña de un descenso recíproco de los niveles de sTfR, lo que sugiere que es un reflejo del estado inflamatorio crónico de baja intensidad característico de la DM tipo 2. 10.- La determinación de la concentración sérica de ferritina no es un marcador útil de los depósitos de hierro en los pacientes con DM tipo 2.There is growing evidence to suggest an association between hepatitis C virus infection and type 2 diabetes mellitus. Objetives: 1.- To compare the prevalence of both diabetes and impaired fasting glucose between hepatitis C virus (HCV)-infected patients (n=498) and patients with other liver diseases but not HCV (n=144), taking into account the degree of liver damage (chronic hepatitis and cirrhosis) and the different HCV genotypes. 2.- To explore the specific mechanisms responsible for the development of diabetes in HCV infected patients (proinflammatory cytokines, insulin resistance and beta-cell function) in a case-control study with nondiabetic noncirrhotic patients (14 anti-HCV negative and 28 anti-HCV positive) carefully matched for the main items related with diabetes development. 3.- To investigate if the high ferritin levels observed in HCV-infected patients are related with HCV infection itself or could be associated with the higher prevalence of diabetes (also related with hyperferritinemia) in HCV infected patients. 4.- To determine circulating transferrin receptor levels (sTfR) to evaluate if serum ferritin reflects iron body stores in type 2 diabetic patients. Conclusions: 1.- Both impaired fasting glucose and diabetes were more prevalent among patients with HCV infection than among anti-HCV negative patients. This finding was mainly due to the group of patients with chronic hepatitis, and it was also present among patients with normal transaminases. 2.- No differences in the prevalence of either impaired fasting glucose or diabetes among HCV genotypes were observed. 3.- HCV infected patients must be considered as a high risk group for type 2 diabetes development, and testing for glucose abnormalities should be mandatory in these patients. 4.- The high percentage of new cases of diabetes detected using postload hyperglycemia in the subset of patients with chronic hepatitis suggests that the oral glucose tolerance test (OGTT) should be recommended as the primary screening test for diabetes in these patients. 5.- In HCV nondiabetic noncirrhotic patients an hyperinsulinemia is detected, both basal and after stimulation tests (intravenous administration of 1 mg of glucagon and the standard food intake test), suggesting an insulin resistance state. 6.- This state of insulin resistance, before the development of glucose abnormalities, is accompanied with a marked increase of proinflammatory cytokines. 7.- Serum ferritin levels in anti-HCV positive nondiabetic patients were similar to those in the control group, suggesting that iron deposition is not one of the main mechanisms linking HCV infection and diabetes. 8.- The increase in ferritin levels detected in HCV patients was closely related to the presence of diabetes. So, diabetes should be taken into consideration when evaluating iron metabolism in HCV-infected patients. 9.- Serum ferritin levels are increased in Type 2 diabetic patients in the absence of a reciprocal decrease of sTfR. This finding suggest that elevated ferritin levels in Type 2 diabetic patients are mainly as a result of inflammatory mechanisms rather than iron overload. 10.- Serum ferritin levels may not be a reliable tool for evaluating iron deficiency anaemia in Type 2 diabetes

Obesity in Patients with Type 1 Diabetes: Links, Risks and Management Challenges

Obesity affects large numbers of patients with type 1 diabetes (T1D) across their lifetime, with rates ranging between 2.8% and 37.1%. Patients with T1D and obesity are characterized by the presence of insulin resistance, of high insulin requirements, have a greater cardiometabolic risk and an enhanced risk of developing chronic complications when compared to normal-weight persons with T1D. Dual treatment of obesity and T1D is challenging and no specific guidelines for improving outcomes of both glycemic control and weight management have been established for this population. Nevertheless, although evidence is scarce, a comprehensive approach based on a balanced hypocaloric diet, physical activity and cognitive behavioral therapy by a multidisciplinary team, expert in both obesity and diabetes, remains as the best clinical practice. However, weight loss responses with lifestyle changes alone are limited, so in the "roadmap" of the treatment of obesity in T1D, it will be helpful to include anti-obesity pharmacotherapy despite at present there is a lack of evidence since T1D patients have been excluded from anti-obesity drug clinical trials. In case of severe obesity, bariatric surgery has proven to be of benefit in obtaining a substantial and long-term weight loss and reduction in cardiovascular risk. The near future looks promising with the development of new and more effective anti-obesity treatments and strategies to improve insulin resistance and oxidative stress. Advances in precision medicine may help individualize and optimize the medical management and care of these patients. This review, by gathering current evidence, highlights the need of solid knowledge in all facets of the treatment of patients with obesity and T1D that can only be obtained through high quality well-designed studies

Management of Patients with Hernia or Incisional Hernia Undergoing Surgery for Morbid Obesity

Morbidly obese patients (MOPs) are predisposed to developing abdominal wall hernias with the potential complication of small bowel obstruction and other morbidity. We report our experience in treating morbidly obese patients. Hernia prophylaxis has been attempted as a means of decreasing the incisional hernia risk associated with weight loss surgery. The controversy regarding the optimal time and method of repair of abdominal wall hernias in patients undergoing open or laparoscopic gastric bypass is discussed with emphasis placed on either a simultaneous repair or splits of the omentum, and of leaving a plug in the hernia defect, to allow time to perform a delayed repair

Circadian Patterns of Patients with Type 2 Diabetes and Obstructive Sleep Apnea

Índex d’apnea-hipopnea; Circadià; Hemoglobina glicadaÍndice de apnea-hipopnea; Circadiano; Hemoglobina glicadaApnea-hypoapnea index; Circadian; Glycated hemoglobinSleep apnea, a condition that modifies sleep and circadian rhythms, is highly prevalent in patients with diabetes. However, it is not known if there is an association between sleep apnea, circadian alterations and glycemic regulation in this type of patient. Here, a polysomnographic study was carried out on 21 women and 25 men (mean age = 64.3 ± 1.46 years) with diagnoses of type 2 diabetes to detect the presence of sleep apnea. Moreover, patients wore an actigraph and a temperature sensor on the wrist for one week, to study the manifestation of the circadian rhythms. The correlations of circadian and polysomnographic variables with the severity of apnea, measured by the apnea-hypopnea index, and with glycemic dysregulation, measured by the percentage of glycated hemoglobin, were analyzed. The mean apnea-hypoapnea index of all the participants was 39.6 ± 4.3. Apnea-hypoapnea index correlated with % N1, negatively with % N3, and also the stability of the active circadian rhythm. However, no significant correlation was found between the apnea-hypopnea index and wrist temperature rhythm and glycated hemoglobin. Glycated hemoglobin levels were negatively associated with the percentage of variance explained by the wrist temperature circadian rhythm (calculated via 24 and 12 h rhythms). This association was independent of body mass index and was strongest in patients with severe apnea. In conclusion, patients with diabetes showed altered circadian rhythms associated with a poor glycemic control and this association could partially be related to the coexistence of sleep apnea.This research was supported by grants from de Instituto de Salud Carlos III ISCIII (Fondo de Investigación Sanitaria PI12/00803 and PI15/00260). European Union (European Regional Development Fund. Fondo Europeo de Desarrollo Regional. FEDER. “Una manera de hacer Europa”). CIBER de Diabetes y Enfermedades Metabólicas Asociadas and CIBER de Enfermedades Respiratorias are initiatives of the Instituto de Salud Carlos III

Phagocytic Activity Is Impaired in Type 2 Diabetes Mellitus and Increases after Metabolic Improvement

OBJECTIVE: 1) To evaluate whether peripheral blood mononuclear cells (PBMCs) from type 2 diabetic patients present an impairment of phagocytic activity; 2) To determine whether the eventual impairment in phagocytic activity is related to glycemic control and can be reversed by improving blood glucose levels. METHODS: 21 type 2 diabetic patients and 21 healthy volunteers were prospectively recruited for a case-control study. In addition, those patients in whom HbA1c was higher than 8% (n = 12) were hospitalized in order to complete a 5-day intensification treatment of blood glucose. Phagocytic activity was assessed by using a modified flow cytometry procedure developed in our laboratory based on DNA/RNA viable staining to discriminate erythrocytes and debris. This method is simple, highly sensitive and reproducible and it takes advantage of classic methods that are widely used in flow cytometry. RESULTS: Type 2 diabetic patients showed a lower percentage of activated macrophages in comparison with non-diabetic subjects (54.00±18.93 vs 68.53±12.77%; p = 0.006) Significant negative correlations between phagocytic activity and fasting glucose (r = -0.619, p = 0.004) and HbA1c (r = -0.506, p = 0.019) were detected. In addition, multiple linear regression analyses showed that either fasting plasma glucose or HbA1c were independently associated with phagocytic activity. Furthermore, in the subset of patients who underwent metabolic optimization a significant increase in phagocytic activity was observed (p = 0.029). CONCLUSIONS: Glycemic control is related to phagocytic activity in type 2 diabetes. Our results suggest that improvement in phagocytic activity can be added to the beneficial effects of metabolic optimization