Resumen El presente documento actualiza las recomendaciones de práctica clínica del manejo de los factores de riesgo cardiovascular (FRCV) en la diabetes mellitus (DM). Es un consenso médico ...realizado por un panel de expertos independiente de la Sociedad Española de Diabetes (SED). Se han propuesto y actualizado varios consensos de diferentes sociedades científicas o médicas con el fin de mejorar los resultados terapéuticos. La valoración del RCV en la población general puede carecer de sensibilidad para la evaluación individual en determinados grupos de riesgo como los diabéticos. Se revisan los factores de riesgo tradicionales y no tradicionales, así como las estrategias de intervención para el control de los FRCV en los pacientes diabéticos como la dieta, el control ponderal, el ejercicio físico, los hábitos tóxicos, el control glucémico, tensional y lipídico, así como la antiagregación plaquetaria. Confiamos en que estas pautas ayuden a los médicos en la toma de decisiones en su actividad asistencial. Se expone una actualización de los conceptos más relevantes y de mayor interés clínico-práctico y, a su vez realista, para reducir el RCV de los diabéticos como se venía haciendo regularmente por parte del Grupo de Enfermedad Cardiovascular de la SED.
OBJECTIVES The pathogenic role of the decline in serum concentrations of IGF‐I in postmenopausal osteoporosis is not fully elucidated. We investigated the associations among IGF‐I, bone mineral ...density (BMD), ultrasound parameters and prevalence of vertebral fractures in postmenopausal women.
DESIGN A cross‐sectional study.
PATIENTS One hundred and fifty‐four ambulatory postmenopausal women (61 ± 7 years) referred for osteoporosis screening.
MEASUREMENTS IGF‐I was measured by radioimmunoassay and BMD using dual‐energy X‐ray absorptiometry. Broadband ultrasound attenuation (BUA) and speed of sound (SOS) at calcaneus were measured by a quantitative ultrasound system.
RESULTS IGF‐I was significantly lower in osteoporotic subjects and correlated positively with BMD, BUA and SOS. After adjusting for age, years since menopause and body mass index, IGF‐I accounted for 8·5% of the variance at lumbar spine BMD, 4·6% at femoral neck and 7·1% at calcaneal BUA. BUA was associated with IGF‐I independently of BMD. IGF‐I was lower in women with vertebral fractures (91 ± 39 µg/l vs. 114 ± 44 µg/l; P = 0·003). The osteoporosis densitometric criteria (t‐score ≤ −2·5 SD) was the most strongly independent associated variable with prevalent vertebral fractures odds ratio (OR): 3·3 (1·4–7·6), followed by IGF‐I levels below 75th percentile OR: 3 (1–8·8).
CONCLUSIONS Our study shows that IGF‐I is strongly associated with bone mineral density and reflects aspects of bone quality. The contribution of IGF‐I to skeletal integrity in postmenopausal women is clinically relevant.
OBJECTIVE
The effect of hyperthyroidism on osteoporosis risk and its reversal after control of hyperthyroidism remains somewhat controversial. We assessed the values of bone mineral density in ...hyperthyroid patients and in former hyperthyroid patients euthyroid on medical therapy, as well as the influence of aetiology and menopause upon bone mass.
DESIGN
The values of bone mineral density in hyperthyroid patients (active) and former hyperthyroid patients euthyroid on medical therapy (controlled), were compared, together with data from our control group and from the Spanish reference population. We also compared the values of bone mineral density in patients with Graves' disease with those in patients with toxic nodular goitre and assessed the influence of the menopause.
PATIENTS
We studied 127 consecutive hyperthyroid patients (age 41 ± 16 years; 110 females, 17 males; 102 Graves' disease and 25 toxic nodular goitre); 78 were active (group A) and 49 controlled on medical therapy (carbimazole, mean time of euthyroidism 7.5 ± 9.1 months; group B). We also studied 43 healthy subjects (age 40 ± 14 years; 41 females, two males; group C).
MEASUREMENTS
Bone mineral density was assessed by dual X‐ray absorptiometry at lumbar spine (L2–L4), femoral neck and Ward's triangle. Data were expressed as g/cm2 and as a Z score (SD vs Spanish reference population adjusted by age and sex). Blood was obtained to measure the levels of free T4, TSH and TSH receptor antibody.
RESULTS
Patients with active hyperthyroidism showed a generalized reduction in axial bone mineral density in comparison with both the control group and the reference population, whereas former hyperthyroid patients showed partial recovery of bone mass in lumbar spine and Ward's triangle. Mean Z scores at lumbar spine, femoral neck and Ward's triangle were: −0.92, −0.79 and −0.89 in group A; −0.74, −0.23 and −0.44 in group B and 0.18, 0.09 and 0.36 in group C, respectively. No differences were found between bone mineral density values from patients with Graves' disease and those with toxic nodular goitre, nor between pre‐ and postmenopausal hyperthyroid women once adjusted by age and sex.
CONCLUSIONS
Our data suggest that hyperthyroid patients show a generalized reduction of bone mass in the axial skeleton and that only partial recovery is present in former hyperthyroid patients after a mean of 7.5 months of biochemical euthyroidism. This recovery is insufficient to normalize the bone density in lumbar spine and Ward's triangle, although femoral bone mass was not different from that of the control group. The extent and degree of hyperthyroid bone disease surpass the effects of the menopause on the bone mass. The aetiology of hyperthyroidism does not seem to play any role in the severity of hyperthyroid bone disease.
Although previous studies have established the importance of genetic, hormonal and lifestyle factors separately, the integral role of these factors on bone mass in postmenopausal women is still ...controversial. We examined the association of the collagen 1-alpha-1 gene (COLIA1) and vitamin D receptor gene (VDR) polymorphisms, s-IGF-I, s-25OHD and lifestyle factors with bone mineral density (BMD) in postmenopausal women. We determined anthropometric parameters, lifestyle factors, serum levels of IGF-I and 25OHD, the COLIA1 Sp1 (Mscl) and VDR (Bsml, Taql) polymorphisms by PCR and BMD by dual X-ray absorptiometry in 141 ambulatory postmenopausal Spanish women. There were significant linear correlations between S-25OHD and BMD and between s-IGF-I and BMD. BMD was statistically higher in active subjects. Of the three different polymorphisms, only the COLIA1 Sp1 polymorphism was significantly associated with BMD. In the logistic regression model, the COLIA1 Sp1 polymorphism, S-25OHD, s-IGF-I and physical activity variables were independently associated with osteoporosis. Our study shows that COLIA1 Sp1 polymorphism, S-25OHD and s-IGF-I serum levels and physical activity are independently associated with BMD in postmenopausal Spanish women.
Increased plasma pancreastatin-like levels in gestational diabetes: correlation with catecholamine levels.
V Sánchez-Margalet ,
J A Lobón ,
A González ,
M L Fernández-Soto ,
F Escobar-Jiménez and
R ...Goberna
Department of Clinical Biochemistry, University Hospital Virgen Macarena, Seville, Spain. vsandhez@asterix.cica.es
Abstract
OBJECTIVE: To investigate plasma pancreastatin (a chromogranin A-derived peptide) and catecholamine levels (counterregulatory
hormones) in subjects with gestational diabetes compared with normal pregnant subjects. RESEARCH DESIGN AND METHODS: Fasting
blood samples were obtained from 11 normal pregnant and 12 nonobese gestational diabetic subjects at late pregnancy (30+/-1
weeks). Selection criteria were those recommended by the National Diabetes Data Group (modified from O'Sullivan original criteria).
Plasma glucose, insulin, glucagon, pancreastatin-like, epinephrine, and norepinephrine were measured. RESULTS: Gestational
diabetic subjects had significantly higher insulin levels than control pregnant subjects (18+/-1 vs. 15+/-1 microU/ml), whereas
glucose and glucagon levels where comparable in the two groups. However, increased catecholamine levels (epinephrine and norepinephrine)
were found in the gestational diabetic group. We also found increased pancreastatin-like levels in these patients compared
with the pregnant control group (46+/-2 vs. 30+/-2 pmol/l). Actually, pancreastatin levels positively correlated with both
epinephrine (r = 0.34) and norepinephrine (r = 0.80) levels. CONCLUSIONS: Catecholamine and pancreastatin-like levels were
found elevated in gestational diabetic subjects. These counterregulatory hormones may play a role in the insulin resistance
syndrome of gestational diabetes.
The present paper updates the Clinical Practice Recommendations for the management of cardiovascular risk factors (CVRF) in diabetes mellitus. This is a medical consensus agreed by an independent ...panel of experts from the Spanish Society of Diabetes (SED). Several consensuses have been proposed by scientific and medical Societies to achieve clinical goals. However, the risk score for general population may lack sensitivity for individual assessment or for particular groups at risk, such as diabetics. Traditional risk factors together with non-traditional factors are reviewed throughout this paper. Intervention strategies for managing CVRF in the diabetic patient are reviewed in detail: balanced food intake, weight reduction, physical exercise, smoking cessation, reduction in HbA1c, therapy for high blood pressure, obesity, lipid disorders, and platelet anti-aggregation. It is hoped that these guidelines can help clinicians in the decisions of their clinical activity. This regular update by the SED Cardiovascular Disease Group of the most relevant concepts, and of greater practical and realistic clinical interest, is presented in order to reduce CVR of diabetics.
Erectile dysfunction is a common complication in patients with diabetes mellitus, which impairs quality of life, decreases self-esteem and can affect partners relationships. Sildenafil improves ...nitric oxide-dependent relaxation of smooth muscle in corpora cavernosa--induced by an increase in cGMP via inhibition of phosphodiesterase 5.
Multicenter, randomized, double-blind, placebo-controlled study with flexible doses of sildenafil. The study was performed in 16 centers and recruited a total of 112 subjects with diabetes mellitus who had erectile dysfunction. At the start and end of the study, the following questionnaires were administered: International Index of Erectile Function (IIEF), Global Efficacy Assessment Question and Quality of Life Questionnaire (Fugl-Meyer). Of the 112 initially recruited patients, 92 received treatment, sildenafil in 44 and placebo in 48.
A clear improvement was observed in the capacity to achieve and maintain an erection; 55.3% diabetic patients receiving sildenafil had at least one successful sexual intercourse (15.6% in the placebo group). In addition, significant improvements were seen in other aspects of the sexual activity of treated subjects. Among those treated with sildenafil, 46.3% reported a clear improvement of erections as compared to their baseline conditions (i.e, prior to treatment) vs only 14.9% in the placebo group. The percentage of a successful intercourse clearly increased, from 6 to 49%. Sildenafil was well-tolerated. Side effects were mild and transient.
Sildenafil is an effective, safe treatment for erectile dysfunction in diabetic patients.
Las patologías tromboembólicas se encuentran entre las enfermedades vasculares más frecuentes en la mayoría de los países. La piedra angular del tratamiento ETV actualmente es la anticoagulación, ...entre los fármacos más utilizados está la warfarina. La Warfarina ha sido utilizada tradicionalmente como anticoagulante oral para la profilaxis y el tratamiento de ETV; sin embargo, tiene limitaciones como la hipersensibilidad a este fármaco, lento inicio de acción, riesgo de hemorragia, necrosis de piel, alopecia, y necesidad de monitoreo riguroso. Pese a sus efectos adversos, la warfarina es un anticoagulante que evita la actividad de los factores de coagulación dependientes de la vitamina K, es por ello que la desensibilización a la warfarina representa un desafío clínico significativo en pacientes con patologías tromboembólicas, particularmente cuando se enfrentan a complicaciones hemorrágicas o intolerancia a la terapia anticoagulante convencional. El objetivo de este artículo es reconocer la desensibilización a la warfarina en pacientes con patologías tromboembólicas.
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