Background
Diabetic kidney disease is the leading cause of chronic kidney disease (CKD) and end‐stage kidney disease (ESKD) worldwide. ESKD has a high prevalence in patients with diabetes mellitus ...(DM). CKD increases the chances of hypoglycaemia by different mechanisms, causes insulin resistance and a decrease in insulin metabolism. Both the “Kidney Disease: Improving Global Outcomes” (KDIGO) and “American Diabetes Association” (ADA) guidelines recommend the use of insulin as part of treatment, but the type of basal insulin is not specified.
Methods
We reviewed the literature to determine whether first‐ and second‐generation basal insulins are effective and safe in CKD patients. We reviewed specific pivotal studies conducted by pharmaceutical laboratories, as well as independent studies.
Conclusions
Basal insulins are safe and effective in patients with CKD and diabetes mellitus but we do not have specific studies. Given that CKD is one of the main complications of type 2 DM, and insulin specific treatment in the final stages, the absence of studies is striking. Real‐life data are also important since trials such as pivotal studies do not fully represent actual patients. Treatment should be individualized until we have specific trials in this type of population.
Which intensity of physical activity (PA) is associated with type 2 diabetes (T2D) prevention remains unclear. Isotemporal substitution models assess the relationship of replacing the amount of time ...spent in one activity for another. We aimed to assess T2D incidence associated with light-to-moderate physical activity (LMPA) and vigorous physical activity (VPA) using isotemporal substitution models of one hour (1 h) sitting by 1 h of LMPA or VPA. Furthermore, we evaluated the effect on T2D of an isotemporal substitution of 1 h sitting by 1 h of slow (light physical activity) or brisk–very brisk walking (moderate physical activity). In total, 20,060 participants (both sexes) of the SUN cohort (Spain) initially free of T2D followed-up during a median of 12 years were included. Cox regression models were fitted to assess the association between the substitution of 1 h LMPA, VPA, slow and brisk–very brisk pace by 1 h sitting and T2D. The replacement of 1 h sitting time by 1 h of VPA was associated with an adjusted HR of 0.52 (95% CI: 0.34–0.80), not observed for the substitution by 1 h of LMPA (HR 0.93; 95% CI: 0.73–1.20). An apparent inverse association was observed for the replacement of 1 h sitting time by 1 h of brisk/very brisk walking (HR: 0.69; 95% CI: 0.46–1.04), not observed by 1 h of slow pace. From equal conditions of duration and frequency of PA, the higher the intensity of PA, the greater the T2D prevention.
The association between ultra-processed foods (UPF) consumption and the risk of type 2 diabetes (T2D) has not been much explored. We aimed to evaluate the association between consumption of UPF and ...the incidence of T2D.
We assessed 20,060 participants (61.5% women) from the SUN project (Seguimiento Universidad de Navarra) followed-up every two years (median follow-up 12 years). Food and drink consumption were evaluated through a validated 136-item food frequency questionnaire and grouped according to their degree of processing by the NOVA classification. Participants were categorized into tertiles of UPF consumption adjusted for total energy intake. We fitted Cox proportional hazard models with repeated dietary measurements at baseline and updating information on food consumption after 10 years of follow-up to minimise the potential effect of diet variation.
During 215,149 person-years of follow-up, 175 new-onset T2D cases were confirmed. Participants in the highest baseline tertile (high consumption) of UPF consumption had a higher risk of T2D as compared to those in the lowest tertile (multivariable adjusted hazard ratio HR 1.53, 95% confidence interval CI: 1.06 to 2.22) with a significant dose–response relationship (p for linear trend = 0.024). The multivariable adjusted HR using repeated measurements of UPF intake was 1.65 (95% CI 1.14–2.38) when comparing extreme tertiles.
In a highly-educated Mediterranean cohort with a low absolute risk, a higher intake of UPF was independently associated with a higher risk for T2D. These results provide more evidence to encourage the limitation of UPF consumption to reduce the population burden of T2D.
Both physical activity (PA) and sedentary behaviors have demonstrated independent associations with the development of type 2 diabetes mellitus (T2DM). However, the combination of both, has been less ...explored. We aimed to compare the associations of PA-only versus the simultaneous effect of PA and sedentary behaviors on T2DM in a Mediterranean cohort.
Participants (n = 19,524) initially free of T2DM from the SUN Project were followed-up for a median of 10.4 years. Analyses were conducted in 2018. PA and sedentary parameters (TV viewing time and sitting time) were assessed through a validated questionnaire. The amount of each PA was expressed in METs-h/wk. After that, a previously developed 8-item active + sedentary lifestyle score was computed. T2DM was defined according to ADA criteria. To adjust for potential confounders, Cox regression models were adjusted. Among 19,524 participants, 175 cases of new-onset T2DM were observed during follow-up. After multivariable adjustment, higher PA was strongly inversely associated with T2DM, showing highly significant differences between extreme quartiles (HR = 0.51; 95% CI 0.32–0.79 p for trend<0.001). When considering not only PA, but also the more comprehensive active + sedentary lifestyle combined score, even stronger differences were found between the lowest and the highest categories (HR = 0.40; 95%CI 0.20–0.80; p for trend<0.001).
Sedentary lifestyles, in addition to PA patterns, should be included in the assessment of T2DM risk. Promoting PA should be coupled with the avoidance of a sedentary lifestyle to lower the risk of T2DM.
•The research supports that sedentary lifestyles, may be an independent risk factor in the evaluation of T2DM risk.•When considering sedentary behaviours, in addition to physical activity, stronger differences were found in the risk of T2DM development.•Effective public health measures promoting an active lifestyle are required.
Previous studies have shown that there is decreasing interest in E&N among medical students. The aim of our study was to evaluate the perception of E&N among a sample of medical students.
We surveyed ...2252 students prior to taking the exam that allows access to specialised training in Spain.
Overall, 9.9% (222 participants) would probably choose E&N. The most positive aspects in includes of the specialty are its logical pathophysiological basis (54%) and that the work is dynamic and varied (27%), while the least attractive aspects are the few interventional techniques. The parts of the specialty that most attract students are hypothalamic–pituitary disease and diabetes mellitus.
The proportion of candidates who want to study E&N as their first choice is adequate in relation to the number of places available.
Estudios previos han mostrado que el interés por la Endocrinología y Nutrición está disminuyendo entre los estudiantes de medicina. El objetivo de nuestro estudio es evaluar la percepción de la Endocrinología y Nutrición en una muestra de estudiantes de medicina.
Encuestamos a 2252 estudiantes antes de hacer el examen MIR.
El 9,9% (222 participantes) elegirían probablemente Endocrinología y Nutrición. Los aspectos más positivos de la especialidad son sus bases fisiopatológicas lógicas (54%) y que el trabajo es dinámico y variado (27%), mientras que los aspectos menos atractivos son las pocas técnicas intervencionistas. Las partes de la especialidad que más les atraen son la patología hipotálamo-hipofisaria y la diabetes mellitus.
La proporción de candidatos que quieren estudiar Endocrinología y Nutrición como su primera opción es adecuada con relación al número de plazas ofertadas.
Prediabetes: what are we talking about? Escalada San Martín, Javier
Advances in Laboratory Medicine / Avances en Medicina de Laboratorio,
09/2021, Letnik:
2, Številka:
3
Journal Article
Prediabetes ¿de qué estamos hablando? Escalada San Martín, Javier
Advances in Laboratory Medicine / Avances en Medicina de Laboratorio,
09/2021, Letnik:
2, Številka:
3
Journal Article
Treatment of type 2 diabetes mellitus (T2DM) is complex and is intended to decrease morbidity and mortality. Management should therefore include adequate diabetes education, lifestyle changes, drug ...treatment to achieve early blood glucose control and reduction of cardiovascular (CV) risk factors, early detection and treatment of complications, and assessment of associated comorbidities. The objective was to prepare a document including all aspects required for a comprehensive approach to T2DM.
Members of the Diabetes Mellitus Working Group of the Spanish Society of Endocrinology.
The available evidence regarding each aspect of diabetes management (blood glucose control goals, diet and exercise, drug treatment, risk factor management and control, detection of complications, and management of frail patients) was reviewed. Recommendations were formulated based on the grades of evidence stated in the 2018 Standards of Medical Care in Diabetes. Recommendations were discussed and agreed by the working group members.
This document is intended to provide evidence-based practical recommendations for comprehensive management of T2DM by clinical endocrinologists.
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