Evaluation of the assessment of diabetic patients and the diabetology education at the Servicio Andalud de Salud in Malaga (Spain)

Cada vez es mayor el nº de pacientes diabéticos en el mundo, según estimaciones de la O.M.S. tenemos 180 millones de personas en el mundo que la padecen. En España asumimos en torno a un 6,5% de la población afectada.El pie diabético es una de las complicaciones que con mayor frecuencia sufren los pacientes diabéticos. La angiopatía y neuropatía que conlleva la diabetes, es más acusada en las zonas distales de nuestro cuerpo en especial el pie. El aumento de la prevalencia de diabéticos provoca que exista también un aumento en el número de casos de pie diabético.El Plan integral de Diabetes de Andalucía 2003-2007 señala lo siguiente: “el pie diabético es fundamentalmente un problema de prevención”.En el presente trabajo se analiza la exploración del pie diabético y la educación diabetológica en los centros del S.A.S. de la provincia de Málaga.Se observan deficiencias tanto en equipamiento material como humano.Por último queremos hacer hincapié en la necesidad de la inclusión del podólogo en los programas de salud del pie diabético. El pie diabético es una patología grave, compleja, de un altísimo coste económico y humano, y que requiere un abordaje multidisciplinar.Every time nº of diabetic patients in the world is greater, according to estimations of the O.M.S. we have 180 million people in the world who suffer it. In Spain we have around a 6.5% of the affected population. The diabetic foot is one of the complications that most frequently undergo the diabetic patients. The angiopathy and neuropathy that the diabetes entails, are more accusing in the distad zones of our special body in the foot. The increase of the prevalence of diabetics causes that an increase in nº of cases of diabetic foot also exists. In Andalusia one settled down in the integral Plan of Diabetes in Andalusia 2003-2007 and as it indicates the own plan: “the diabetic foot is fundamental a prevention problem”. In the present work we expose, as it is carried out the exploration of the diabetic foot and the diabetes education within the medicine consultations of the S.A.S. in the province of Malaga. We have observed that exists deficiencies in the material and human resources as much. Finally we want to insist on the necessity of the inclusion of the podiatry in the programs of health of the diabetic foot. The diabetic foot is a serious, complex pathology, of a highest economic and human cost, and that requires a boarding to multidiscipline

Simultaneous Pancreas Kidney Transplantation Improves Cardiovascular Autonomic Neuropathy with Improved Valsalva Ratio as the Most Precocious Test

[EN] Background. Simultaneous pancreas-kidney (SPK) transplantation is a proven option of treatment for patients with type 1 diabetes mellitus (T1DM) and related end-stage renal disease. There is discrepancy between the results of different studies about the impact of prolonged normalization of glucose metabolism achieved by SPK on the course of diabetic complications including severe forms of diabetic neuropathy. The objective of the study was to evaluate the prevalence of cardiovascular autonomic neuropathy (CAN) in patients undergoing SPK transplantation and its evolution 10 years after transplantation. Methods. Prospective study of 81 patients transplanted in a single center from year 2002 to 2015. Autonomic function was assessed using cardiovascular autonomic reflex tests (CARTs). CARTs were made before SPK transplantation and during the follow-up. Evolution of tests after SPK transplantation was evaluated by contrasting hypotheses (paired tests). Multiple testing was adjusted with the Benjamini-Hochberg procedure with a false discovery rate of 10%. Results. 48 males and 33 females, mean age 37.4 +/- 5.7 years, mean BMI 24.0 +/- 3.4 kg/m2, and mean duration of diabetes 25.5 +/- 6.5 years, received SPK transplantation. Ten years after SPK transplantation, 56 patients re tained the pancreatic graft (42 of them with normofunctioning pancreas and 14 with low doses of insulin therapy). These 42 patients were selected for the autonomic study. Before transplant procedure, all CART results were abnormal. After SPK transplantation, paired test analysis showed an improvement of systolic blood pressure (SBP) response to orthostasis at the 5(th) year after SPK (p=0.03), as well as improvement of the Valsalva ratio at the 3(rd) (p<0.001) and 5(th) (p=0.001) year after SPK. After correcting for the false discovery rate, all the variables of autonomic study reached significance at different time points. Conclusions. Prevalence of CAN in patients who are candidates for SPK transplantation is high and is generally advanced. SPK transplantation improves CAN with improved Valsalva ratio as the most precocious test.Argente-Pla, M.; Pérez-Lázaro, A.; Martinez-Millana, A.; Del Olmo-García, MI.; Espí-Reig, J.; Beneyto-Castello, I.; López-Andújar, R.... (2020). Simultaneous Pancreas Kidney Transplantation Improves Cardiovascular Autonomic Neuropathy with Improved Valsalva Ratio as the Most Precocious Test. Journal of Diabetes Research. 2020:1-10. https://doi.org/10.1155/2020/7574628S1102020Freeman, R. (2014). Diabetic autonomic neuropathy. Handbook of Clinical Neurology, 63-79. doi:10.1016/b978-0-444-53480-4.00006-0Maser, R. E., Mitchell, B. D., Vinik, A. I., & Freeman, R. (2003). The Association Between Cardiovascular Autonomic Neuropathy and Mortality in Individuals With Diabetes: A meta-analysis. Diabetes Care, 26(6), 1895-1901. doi:10.2337/diacare.26.6.1895Dimitropoulos, G. (2014). Cardiac autonomic neuropathy in patients with diabetes mellitus. World J Diabetes, 5(1), 17. doi:10.4239/wjd.v5.i1.17Vinik, A. I., & Ziegler, D. (2007). Diabetic Cardiovascular Autonomic Neuropathy. Circulation, 115(3), 387-397. doi:10.1161/circulationaha.106.634949Kennedy, W. R., Navarro, X., & Sutherland, D. E. R. (1995). Neuropathy profile of diabetic patients in a pancreas transplantation program. Neurology, 45(4), 773-780. doi:10.1212/wnl.45.4.773Pop-Busui, R., Boulton, A. J. M., Feldman, E. L., Bril, V., Freeman, R., Malik, R. A., … Ziegler, D. (2016). Diabetic Neuropathy: A Position Statement by the American Diabetes Association. Diabetes Care, 40(1), 136-154. doi:10.2337/dc16-2042Balcıoğlu, A. S. (2015). Diabetes and cardiac autonomic neuropathy: Clinical manifestations, cardiovascular consequences, diagnosis and treatment. World Journal of Diabetes, 6(1), 80. doi:10.4239/wjd.v6.i1.80Pop-Busui, R., Low, P. A., Waberski, B. H., Martin, C. L., Albers, J. W., Feldman, E. L., … Herman, W. H. (2009). Effects of Prior Intensive Insulin Therapy on Cardiac Autonomic Nervous System Function in Type 1 Diabetes Mellitus. Circulation, 119(22), 2886-2893. doi:10.1161/circulationaha.108.837369Maser, R. E., Lenhard, J. M., & DeCherney, S. G. (2000). Cardiovascular Autonomic Neuropathy. The Endocrinologist, 10(1), 27-33. doi:10.1097/00019616-200010010-00006Vinik, A. I., Erbas, T., & Casellini, C. M. (2013). Diabetic cardiac autonomic neuropathy, inflammation and cardiovascular disease. Journal of Diabetes Investigation, 4(1), 4-18. doi:10.1111/jdi.12042Ewing, D. J., Campbell, I. W., Murray, A., Neilson, J. M., & Clarke, B. F. (1978). Immediate heart-rate response to standing: simple test for autonomic neuropathy in diabetes. BMJ, 1(6106), 145-147. doi:10.1136/bmj.1.6106.145In This Issue of Diabetes Care. (2019). Diabetes Care, 43(1), 1-2. doi:10.2337/dc20-ti01Gremizzi, C., Vergani, A., Paloschi, V., & Secchi, A. (2010). Impact of pancreas transplantation on type 1 diabetes-related complications. Current Opinion in Organ Transplantation, 15(1), 119-123. doi:10.1097/mot.0b013e32833552bcKennedy, W. R., Navarro, X., Goetz, F. C., Sutherland, D. E. R., & Najarian, J. S. (1990). Effects of Pancreatic Transplantation on Diabetic Neuropathy. New England Journal of Medicine, 322(15), 1031-1037. doi:10.1056/nejm199004123221503Bouček, P., Bartoš, V., Vaněk, I., Hýža, Z., & Skibová, J. (1991). Diabetic autonomic neuropathy after pancreas and kidney transplantation. Diabetologia, 34(S1), S121-S124. doi:10.1007/bf00587636Navarro, X., Sutherland, D. E. R., & Kennedy, W. R. (1997). Long-term effects of pancreatic transplantation on diabetic neuropathy. Annals of Neurology, 42(5), 727-736. doi:10.1002/ana.410420509Solders, G., Tyden, G., Persson, A., & Groth, C.-G. (1992). Improvement of Nerve Conduction in Diabetic Neuropathy: A Follow-up Study 4 Yr After Combined Pancreatic and Renal Transplantation. Diabetes, 41(8), 946-951. doi:10.2337/diab.41.8.946Argente-Pla, M., Martínez-Millana, A., Del Olmo-García, M. I., Espí-Reig, J., Pérez-Rojas, J., Traver-Salcedo, V., & Merino-Torres, J. F. (2019). Autoimmune Diabetes Recurrence After Pancreas Transplantation: Diagnosis, Management, and Literature Review. Annals of Transplantation, 24, 608-616. doi:10.12659/aot.920106Sundkvist, G., & Lilja, B. (1985). Autonomic Neuropathy in Diabetes Mellitus: A Follow-up Study. Diabetes Care, 8(2), 129-133. doi:10.2337/diacare.8.2.129Boulton, A. J. M., Vinik, A. I., Arezzo, J. C., Bril, V., Feldman, E. L., Freeman, R., … Ziegler, D. (2005). Diabetic Neuropathies: A statement by the American Diabetes Association. Diabetes Care, 28(4), 956-962. doi:10.2337/diacare.28.4.956Ewing, D. J., Martyn, C. N., Young, R. J., & Clarke, B. F. (1985). The Value of Cardiovascular Autonomic Function Tests: 10 Years Experience in Diabetes. Diabetes Care, 8(5), 491-498. doi:10.2337/diacare.8.5.491Spallone, V., Bellavere, F., Scionti, L., Maule, S., Quadri, R., Bax, G., … Morganti, R. (2011). Recommendations for the use of cardiovascular tests in diagnosing diabetic autonomic neuropathy☆. Nutrition, Metabolism and Cardiovascular Diseases, 21(1), 69-78. doi:10.1016/j.numecd.2010.07.005Agashe, S., & Petak, S. (2018). Cardiac Autonomic Neuropathy in Diabetes Mellitus. Methodist DeBakey Cardiovascular Journal, 14(4), 251. doi:10.14797/mdcj-14-4-251Valensi, P., Pariès, J., & Attali, J. . (2003). Cardiac autonomic neuropathy in diabetic patients: influence of diabetes duration, obesity, and microangiopathic complications—the french multicenter study. Metabolism, 52(7), 815-820. doi:10.1016/s0026-0495(03)00095-7Tesfaye, S., Boulton, A. J. M., Dyck, P. J., Freeman, R., Horowitz, M., … Kempler, P. (2010). Diabetic Neuropathies: Update on Definitions, Diagnostic Criteria, Estimation of Severity, and Treatments. Diabetes Care, 33(10), 2285-2293. doi:10.2337/dc10-1303Benjamini, Y., & Hochberg, Y. (1995). Controlling the False Discovery Rate: A Practical and Powerful Approach to Multiple Testing. Journal of the Royal Statistical Society: Series B (Methodological), 57(1), 289-300. doi:10.1111/j.2517-6161.1995.tb02031.xAdler, G. K., Bonyhay, I., Failing, H., Waring, E., Dotson, S., & Freeman, R. (2008). Antecedent Hypoglycemia Impairs Autonomic Cardiovascular Function: Implications for Rigorous Glycemic Control. Diabetes, 58(2), 360-366. doi:10.2337/db08-1153HATHAWAY, D. K., ABELL, T., CARDOSO, S., HARTWIG, M. S., GEBELY, S. E., & Gaber, A. O. (1994). IMPROVEMENT IN AUTONOMIC AND GASTRIC FUNCTION FOLLOWING PANCREAS-KIDNEY VERSUS KIDNEY-ALONE TRANSPLANTATION AND THE CORRELATION WITH QUALITY OF LIFE1,2. Transplantation, 57(6), 816-822. doi:10.1097/00007890-199403270-00008Arnold, R., Pussell, B. A., Pianta, T. J., Lin, C. S.-Y., Kiernan, M. C., & Krishnan, A. V. (2013). Association Between Calcineurin Inhibitor Treatment and Peripheral Nerve Dysfunction in Renal Transplant Recipients. American Journal of Transplantation, 13(9), 2426-2432. doi:10.1111/ajt.12324Vinik, A. I., Maser, R. E., Mitchell, B. D., & Freeman, R. (2003). Diabetic Autonomic Neuropathy. Diabetes Care, 26(5), 1553-1579. doi:10.2337/diacare.26.5.1553Suarez, G. A. (2005). Sudden cardiac death in diabetes mellitus: risk factors in the Rochester diabetic neuropathy study. Journal of Neurology, Neurosurgery & Psychiatry, 76(2), 240-245. doi:10.1136/jnnp.2004.039339Dinh, W., Füth, R., Lankisch, M., Bansemir, L., Nickl, W., Scheffold, T., … Ziegler, D. (2010). Cardiovascular autonomic neuropathy contributes to left ventricular diastolic dysfunction in subjects with Type 2 diabetes and impaired glucose tolerance undergoing coronary angiography. Diabetic Medicine, no-no. doi:10.1111/j.1464-5491.2010.03221.xWackers, F. J. T., Young, L. H., Inzucchi, S. E., Chyun, D. A., Davey, J. A., Barrett, E. J., … Iskandrian, A. E. (2004). Detection of Silent Myocardial Ischemia in Asymptomatic Diabetic Subjects: The DIAD study. Diabetes Care, 27(8), 1954-1961. doi:10.2337/diacare.27.8.1954Astrup, A. S., Tarnow, L., Rossing, P., Hansen, B. V., Hilsted, J., & Parving, H.-H. (2006). Cardiac Autonomic Neuropathy Predicts Cardiovascular Morbidity and Mortality in Type 1 Diabetic Patients With Diabetic Nephropathy. Diabetes Care, 29(2), 334-339. doi:10.2337/diacare.29.02.06.dc05-1242Pop-Busui, R., Evans, G. W., Gerstein, H. C., Fonseca, V., Fleg, J. L., … Hoogwerf, B. J. (2010). Effects of Cardiac Autonomic Dysfunction on Mortality Risk in the Action to Control Cardiovascular Risk in Diabetes (ACCORD) Trial. Diabetes Care, 33(7), 1578-1584. doi:10.2337/dc10-0125Kempler, P., Tesfaye, S., Chaturvedi, N., Stevens, L. K., Webb, D. J., … Eaton, S. (2002). Autonomic neuropathy is associated with increased cardiovascular risk factors: the EURODIAB IDDM Complications Study. Diabetic Medicine, 19(11), 900-909. doi:10.1046/j.1464-5491.2002.00821.xPop-Busui, R., Cleary, P. A., Braffett, B. H., Martin, C. L., Herman, W. H., Low, P. A., … Bluemke, D. A. (2013). Association Between Cardiovascular Autonomic Neuropathy and Left Ventricular Dysfunction. Journal of the American College of Cardiology, 61(4), 447-454. doi:10.1016/j.jacc.2012.10.02

Programa de Promoción de Salud en la Escuela : área 1

En esta publicación se expone el Programa de Promoción de Salud en la Escuela llevado a cabo en los colegios madrileños del Área Sanitaria 1, con la colaboración del Ministerio de Educación y Cultura, el Ayuntamiento y la Comunidad de Madrid, y el Instituto Nacional de la Salud. Los objetivos principales son fomentar la adquisición de conocimientos, actitudes y hábitos saludables en la comunidad escolar; contribuir a la prevención de enfermedades; favorecer la detección y atención de patologías; apoyar a los profesores en el desarrollo de la Educación para la Salud como tema transversal; contribuir a la integración de niños en situación de riesgo social y facilitarles una atención socio-sanitaria adecuada; y apoyar la coordinación entre instituciones en este ámbito. El programa contempla varias actividades: prevención y control de enfermedades transmisibles; salud buco dental; detección de desviaciones en la columna vertebral y de alteraciones de la visión; preparación para la atención de urgencias; eliminación de conductas de riesgo; y detección y prevención de las situaciones de riesgo social en la infancia. Se incluye en anexos documentación para el desarrollo del programa, además de una relación de materiales divulgativos y bibliografía de interés.MadridMadrid (Comunidad Autónoma). Servicio de Formación del Profesorado. CRIF Las Acacias; General Ricardos 179 - 28025; Madrid; +34915250893; +34914660991; [email protected]