We estimated healthcare costs associated with patients with type 2 diabetes compared with non-dia... more We estimated healthcare costs associated with patients with type 2 diabetes compared with non-diabetic subjects in a population-based primary care database through a retrospective analysis of economic impact during 2011, including 126,811 patients with type 2 diabetes in Catalonia, Spain. Total annual costs included primary care visits, hospitalizations, referrals, diagnostic tests, self-monitoring test strips, medication, and dialysis. For each patient, one control matched for age, gender and managing physician was randomly selected from a population database. The annual average cost per patient was €3110.1 and €1803.6 for diabetic and non-diabetic subjects, respectively (difference €1306.6; i.e., 72.4 % increased cost). The costs of hospitalizations were €1303.1 and €801.6 (62.0 % increase), and medication costs were €925.0 and €489.2 (89.1 % increase) in diabetic and non-diabetic subjects, respectively. In type 2 diabetic patients, hospitalizations and medications had the greatest impact on the overall cost (41.9 and 29.7 %, respectively), generating approximately 70 % of the difference between diabetic and non-diabetic subjects. Patients with poor glycaemic control (glycated haemoglobin >7 %; >53 mmol/mol) had average costs of €3296.5 versus €2848.5 for patients with good control. In the absence of macrovascular complications, average costs were €3008.1 for diabetic and €1612.4 for non-diabetic subjects, while its presence increased costs to €4814.6 and €3306.8, respectively. In conclusion, the estimated higher costs for type 2 diabetes patients compared with non-diabetic subjects are due mainly to hospitalizations and medications, and are higher among diabetic patients with poor glycaemic control and macrovascular complications.
Endocrinologia y nutricion : organo de la Sociedad Espanola de Endocrinologia y Nutricion, Jan 18, 2015
The self-determination of blood glucose is relevant for diabetes mellitus (DM) insulin-treated pa... more The self-determination of blood glucose is relevant for diabetes mellitus (DM) insulin-treated patients. The use of glucometers with advanced features and measuring glycated haemoglobin (HbA1c) may help improve metabolic control. The main objective of this study was to determine the percentage of insulin treated patients who reduced HbA1c by at least 0.4% after 6 months of using Contour and A1CNow+. Observational, prospective, multicentre study in adult DM insulin treated patients, with HbA1c> 8%. Of the 454 recruited patients analysed, a total of 333 were evaluable. After 6 months the HbA1c decreased (P<.05) in both groups [-0.89 (95% CI -1.01 to -0.76) and -0.98 (95% CI: -1.21 to -0.76), in type 1 and 2 DM, respectively]. An HbA1c reduction of 0.4% was observed in 73% of patients after 6 months of device use. A decrease in the number of patients with HbA1c > 8% was observed, with this reaching: 41% for all, 45% in type 1 DM, and 25% in type 2 DM. In the glycaemic profile,...
Aim: To analyse glycaemic control and antihyperglycaemic treatment in patients with varying durat... more Aim: To analyse glycaemic control and antihyperglycaemic treatment in patients with varying duration of type 2 diabetes in a population-based database. Methods: A cross-sectional survey of 286,791 patients with type 2 diabetes registered in the primary care centres of the Catalan Health Institute (Catalonia, Spain) in 2009. We analysed the effects of types of treatment, diabetes duration and renal function on glycaemic control, adjusting for other clinical variables. Results: Twenty-four percent of patients were treated with lifestyle changes only, 35.5% with oral glucoselowering monotherapy, 21% with oral combinations and 17.7% with insulin (alone or in combination). Insulin was more frequently used in patients with longer duration of diabetes or severe renal impairment. Fifty-six percent of patients achieved the optimal target of HbA1c ≤ 7% (≤ 53 mmol/mol), a result more frequently observed in patients older than 65, early in the course of the disease and at the lower steps of tre...
To analyse glycaemic control and antihyperglycaemic treatment in patients with varying duration o... more To analyse glycaemic control and antihyperglycaemic treatment in patients with varying duration of type 2 diabetes in a population-based database.
Antecedentes: En gestantes con diabetes mellitus gestacional (DMG) se han descrito diferencias en... more Antecedentes: En gestantes con diabetes mellitus gestacional (DMG) se han descrito diferencias en los resultados perinatales según la etnia materna.
Aim: To assess the association of hypovitaminosis D with clinical and biochemical characteristics... more Aim: To assess the association of hypovitaminosis D with clinical and biochemical characteristics of type 2 diabetic patients and to determine the effect of glycemic control optimization on 25-hydroxyvitamin D (25(OH)D) concentrations. Methods: Cross-sectional study of 63 patients with type 2 diabetes (mean age 60 ± 9.8 years, 69.8% men). Twenty of the 63 patients were also studied before and after glycemic control optimization. Results: Mean 25(OH)D concentrations were 63.64 ± 25.51 nmol/L and 74.6% of patients had hypovitaminosis D. Compared with patients with vitamin D sufficiency, patients with hypovitaminosis D had higher prevalence of overweight or obesity (72.3% versus 37.5%; p = 0.012) and higher VLDL cholesterol (VLDL-c) (0.71 (0.24-3.59) versus 0.45 (0.13-1.6) mmol/L; p = 0.011) and C-reactive protein (3.28 (0.36-17.69) versus 1.87 (0.18-17.47) mg/L; p = 0.033) concentrations. The composition of HDL particles also differed in both groups, with higher relative content of tr...
Bariatric surgery (BS) has become more frequent among women of child-bearing age. Data regarding ... more Bariatric surgery (BS) has become more frequent among women of child-bearing age. Data regarding the underlying maternal and perinatal risks are scarce. The objective of this nationwide study is to evaluate maternal and perinatal outcomes after BS. We performed a retrospective observational study of 168 pregnancies in 112 women who underwent BS in 10 tertiary hospitals in Spain over a 15-year period. Maternal and perinatal outcomes, including gestational diabetes mellitus (GDM), pregnancy-associated hypertensive disorders (PAHD), pre-term birth cesarean deliveries, small and large for gestational age births (SGA, LGA), still births, and neonatal deaths, were evaluated. Results were further compared according to the type of BS performed: restrictive techniques (vertical-banded gastroplasty, sleeve gastrectomy, and gastric banding), Roux-en-Y gastric bypass (RYGB), and biliopancreatic diversion (BPD). GDM occurred in five (3 %) pregnancies and there were no cases of PAHD. Women whose ...
Struma ovarii is an uncommon teratoma of the ovary that contains over 50% of thyroid tissue. This... more Struma ovarii is an uncommon teratoma of the ovary that contains over 50% of thyroid tissue. This tumor accounts for 0.2-1.3% of all ovarian tumors and for 2-4% of all teratomas. Malignancy is reported in 5% to 37% of patients with struma ovarii, with metastases occurring in few cases. 1-3 This article reports a patient with some unusual features, including malignancy, metastases, hormone production, and a fatal outcome. Literature is reviewed, and significance of appropriate treatment and follow-up of these patients is emphasized.
Patients with type 1 diabetes (T1DM) treated with continuous subcutaneous insulin infusion (CSII)... more Patients with type 1 diabetes (T1DM) treated with continuous subcutaneous insulin infusion (CSII) have available several specific features of these devices. The aim of this study was to evaluate the relationship between real use of them and the degree of glycemic control in patients using this therapy. Forty-four T1DM patients on CSII therapy with or without real-time continuous glucose monitoring (CGM) were included. Data from 14 consecutive days were retrospectively collected using the therapy management software CareLink Personal/Pro(®) and HbA1c measurement performed at that period. The relationship between the frequency of usie of specific features of insulin pumps (non-sensor augmented or sensor-augmented) and glycemic control was analyzed. Mean HbA1c in the group was 7.5 ± .8%. Mean daily number of boluses administered was 5.1 ± 1.8, with 75.4% of them being bolus wizards (BW). Daily number of boluses was significantly greater in patients with HbA1c &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;7.5% than in those with HbA1c&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt;7.5% (5.3 ± 1.6 vs. 4.3 ± 1.6, P=.056). There was a trend to greater use of BW in patients with better control (82.8 ± 21.4% vs. 69.9 ± 29.1%, P=.106). HbA1c was lower in patients using CGM (n=8) as compared to those not using sensor-augmented pumps (7.6 ± .8 vs 7.1 ± .7, P=.067), but the difference was not statistically significant. More frequent use of BW appears to be associated to better metabolic control in patients with T1DM using pump therapy. In standard clinical practice, augmentation of insulin pump with CGM may be associated to improved glycemic control.
ABSTRACT The procurement of pumps/supplies through a tender process is common practice among publ... more ABSTRACT The procurement of pumps/supplies through a tender process is common practice among public services. A report is presented on the feasibility and safety of the transition from one continuous subcutaneous insulin infusion (CSII) system to another within a very short time frame (4-weeks) as the consequence of a public tender.Methods The program consisted of: Session-1 was a system start-up training session. Patient satisfaction was evaluated. Session-2 consisted of a call from technical staff 72 h after Session-1 to provide support regarding the programming or the change of infusion set. Session-3 was a training session regarding the use of therapy management software. During and 2 months after Session-2, clinical events, technical issues, and training reinforcement incidents were registered. HbA1c data were collected retrospectively.ResultsA total of 219 patients were enrolled. During the second week, 81% of patients were transferred to the new system. Patient overall satisfaction scored 9.4/10 (none &lt;7). There were 30 training reinforcement events and 7 technical issues, with all 37 of them being were sorted out over the telephone. There were 31 additional clinical events (infusion set issues). Twenty-four were considered mild, and were solved by phone technical support. Medical assistance was needed in six (five unexpected hyperglycemia, one ketosis). There was only one severe event (ketoacidosis requiring hospitalization). HbA1c did not deteriorate during the transition process. One hundred twenty-eight patients attended the therapy management software training.Conclusions With the assistance of a specific program, a complete switch to a new insulin pump in a large population of patients with T1D in the context of a public tender in a very short time was carried out safely and without deterioration of metabolic control.
The objective of this cross-sectional study was to assess differences in the control and treatmen... more The objective of this cross-sectional study was to assess differences in the control and treatment of modifiable cardiovascular risk factors (CVRF: HbA1c, blood pressure [BP], LDL-cholesterol, body mass index, and smoking habit) according to gender and the presence of cardiovascular disease (CVD) in patients with type 2 diabetes mellitus (T2DM) in Catalonia, Spain. The study included available data from electronic medical records for a total of 286,791 patients. After controlling for sex, age, diabetes duration, and treatment received, both men and women with prior CVD had worse cardiometabolic control than patients without previous CVD; women with prior CVD had worse overall control of CVRFs than men except for smoking; and women without prior CVD were only better than men at controlling smoking and BP, with no significant differences in glycemic control. Finally, although the proportion of women treated with lipid-lowering medications was similar to (with prior CVD) or even higher...
OBJECTIVEdThe objective of this study was to analyze the clinical characteristics and levels of g... more OBJECTIVEdThe objective of this study was to analyze the clinical characteristics and levels of glycemic and cardiovascular risk factor control in patients with type 2 diabetes that are in primary health care centers in Catalonia (Spain).
We describe a 37-year-old man with a 4-month history of episodic muscular weakness, involving mai... more We describe a 37-year-old man with a 4-month history of episodic muscular weakness, involving mainly lower-limbs. Hypokalemia was documented in one episode and managed with intravenous potassium chloride. Hyperthyroidism was diagnosed 4 months after onset of attacks because of mild symptoms. The patient was subsequently diagnosed as having thyrotoxic periodic paralysis associated with Graves´ disease. Treatment with propranolol and methimazol was initiated and 1 year later he remains euthyroid and symptoms free.
Background: Qualitative alterations of lipoproteins underlie the high incidence of atherosclerosi... more Background: Qualitative alterations of lipoproteins underlie the high incidence of atherosclerosis in diabetes. The objective of this study was to assess the impact of low-density lipoprotein (LDL) subfraction phenotype on the qualitative characteristics of LDL and high-density lipoprotein (HDL) in patients with type 2 diabetes. Methods: One hundred twenty two patients with type 2 diabetes in poor glycemic control and 54 healthy subjects were included in the study. Patients were classified according to their LDL subfraction phenotype. Seventy-seven patients presented phenotype A whereas 45 had phenotype B. All control subjects showed phenotype A. Several forms of modified LDL, HDL composition and the activity and distribution of lipoprotein-associated phospholipase A2 (Lp-PLA2) were analyzed. Results: Oxidized LDL, glycated LDL and electronegative LDL were increased in both groups of patients compared with the control group. Patients with phenotype B had increased oxidized LDL and glycated LDL concentration than patients with phenotype A. HDL composition was abnormal in patients with diabetes, being these abnormalities more marked in patients with phenotype B. Total Lp-PLA2 activity was higher in phenotype B than in phenotype A or in control subjects. The distribution of Lp-PLA2 between HDL and apoB-containing lipoproteins differed in patients with phenotype A and phenotype B, with higher activity associated to apoB-containing lipoproteins in the latter.
The aim of this study was to determine the effect of intensified hypoglycemic therapy in patients... more The aim of this study was to determine the effect of intensified hypoglycemic therapy in patients with type 2 diabetes mellitus on the distribution of lipoprotein-associated phospholipase A2 (Lp-PLA2) activity between high-density lipoprotein and low-density lipoprotein (LDL) and its relation with the lipid profile and other qualitative properties of LDL. Forty-two patients with type 2 diabetes on the basis of poor glycemic control and normal or near normal LDL cholesterol were recruited. Lifestyle counseling and pharmacologic hypoglycemic therapy were intensified to improve glycemic control, but lipid-lowering therapy was unchanged. At 4 ؎ 2 months, glycosylated hemoglobin had decreased by a mean of 2.1%, but the only effect on the lipid profile were statistically significant decreases in nonesterified fatty acids and apolipoprotein B concentration. LDL size increased and the proportion of electronegative LDL decreased significantly. In parallel, total Lp-PLA2 activity decreased significantly, promoting a redistribution of Lp-PLA2 activity toward a higher proportion in high-density lipoprotein. Improvements in glycemic control led to more marked changes in Lp-PLA2 activity and distribution in patients with diabetes who had not received previous lipid-lowering therapy. In conclusion, optimizing glycemic control in patients with type 2 diabetes promotes atheroprotective changes, including larger LDL size, decreased electronegative LDL, and a higher proportion of Lp-PLA2 activity in high-density lipoprotein.
Endocrinología y nutrición : órgano de la Sociedad Española de Endocrinología y Nutrición, 2013
To assess in standard clinical practice the feasibility, efficacy, and safety of switching patien... more To assess in standard clinical practice the feasibility, efficacy, and safety of switching patients with long-standing type 2 diabetes (T2DM) and poor or unstable blood glucose control to basal-bolus insulin therapy. This was a prospective, single center study including 37 patients with T2DM (age 65±8 years, 62.2% men, body mass index 28.8±6.2 kg/m2, diabetes duration 18±8 years) with poor or unstable glycemic control, who were switched to a basal-bolus insulin regimen with glargine and rapid-acting insulin analogue at the discretion of their physicians. After a group-structured outpatient diabetes training program, patients were followed in a clinical practice setting for 6 months. Clinical and biochemical variables were collected before switching and at 3 and 6 months. After switching to basal-bolus therapy, glycosylated hemoglobin (HbA1c) decreased from 9±1.2% to 8.1±1.2% (p<0.001) at 3 months and to 8.0±1.2% at 6 months (p<0.001) without changing total daily insulin dose. ...
We estimated healthcare costs associated with patients with type 2 diabetes compared with non-dia... more We estimated healthcare costs associated with patients with type 2 diabetes compared with non-diabetic subjects in a population-based primary care database through a retrospective analysis of economic impact during 2011, including 126,811 patients with type 2 diabetes in Catalonia, Spain. Total annual costs included primary care visits, hospitalizations, referrals, diagnostic tests, self-monitoring test strips, medication, and dialysis. For each patient, one control matched for age, gender and managing physician was randomly selected from a population database. The annual average cost per patient was €3110.1 and €1803.6 for diabetic and non-diabetic subjects, respectively (difference €1306.6; i.e., 72.4 % increased cost). The costs of hospitalizations were €1303.1 and €801.6 (62.0 % increase), and medication costs were €925.0 and €489.2 (89.1 % increase) in diabetic and non-diabetic subjects, respectively. In type 2 diabetic patients, hospitalizations and medications had the greatest impact on the overall cost (41.9 and 29.7 %, respectively), generating approximately 70 % of the difference between diabetic and non-diabetic subjects. Patients with poor glycaemic control (glycated haemoglobin &amp;amp;amp;amp;amp;amp;gt;7 %; &amp;amp;amp;amp;amp;amp;gt;53 mmol/mol) had average costs of €3296.5 versus €2848.5 for patients with good control. In the absence of macrovascular complications, average costs were €3008.1 for diabetic and €1612.4 for non-diabetic subjects, while its presence increased costs to €4814.6 and €3306.8, respectively. In conclusion, the estimated higher costs for type 2 diabetes patients compared with non-diabetic subjects are due mainly to hospitalizations and medications, and are higher among diabetic patients with poor glycaemic control and macrovascular complications.
Endocrinologia y nutricion : organo de la Sociedad Espanola de Endocrinologia y Nutricion, Jan 18, 2015
The self-determination of blood glucose is relevant for diabetes mellitus (DM) insulin-treated pa... more The self-determination of blood glucose is relevant for diabetes mellitus (DM) insulin-treated patients. The use of glucometers with advanced features and measuring glycated haemoglobin (HbA1c) may help improve metabolic control. The main objective of this study was to determine the percentage of insulin treated patients who reduced HbA1c by at least 0.4% after 6 months of using Contour and A1CNow+. Observational, prospective, multicentre study in adult DM insulin treated patients, with HbA1c> 8%. Of the 454 recruited patients analysed, a total of 333 were evaluable. After 6 months the HbA1c decreased (P<.05) in both groups [-0.89 (95% CI -1.01 to -0.76) and -0.98 (95% CI: -1.21 to -0.76), in type 1 and 2 DM, respectively]. An HbA1c reduction of 0.4% was observed in 73% of patients after 6 months of device use. A decrease in the number of patients with HbA1c > 8% was observed, with this reaching: 41% for all, 45% in type 1 DM, and 25% in type 2 DM. In the glycaemic profile,...
Aim: To analyse glycaemic control and antihyperglycaemic treatment in patients with varying durat... more Aim: To analyse glycaemic control and antihyperglycaemic treatment in patients with varying duration of type 2 diabetes in a population-based database. Methods: A cross-sectional survey of 286,791 patients with type 2 diabetes registered in the primary care centres of the Catalan Health Institute (Catalonia, Spain) in 2009. We analysed the effects of types of treatment, diabetes duration and renal function on glycaemic control, adjusting for other clinical variables. Results: Twenty-four percent of patients were treated with lifestyle changes only, 35.5% with oral glucoselowering monotherapy, 21% with oral combinations and 17.7% with insulin (alone or in combination). Insulin was more frequently used in patients with longer duration of diabetes or severe renal impairment. Fifty-six percent of patients achieved the optimal target of HbA1c ≤ 7% (≤ 53 mmol/mol), a result more frequently observed in patients older than 65, early in the course of the disease and at the lower steps of tre...
To analyse glycaemic control and antihyperglycaemic treatment in patients with varying duration o... more To analyse glycaemic control and antihyperglycaemic treatment in patients with varying duration of type 2 diabetes in a population-based database.
Antecedentes: En gestantes con diabetes mellitus gestacional (DMG) se han descrito diferencias en... more Antecedentes: En gestantes con diabetes mellitus gestacional (DMG) se han descrito diferencias en los resultados perinatales según la etnia materna.
Aim: To assess the association of hypovitaminosis D with clinical and biochemical characteristics... more Aim: To assess the association of hypovitaminosis D with clinical and biochemical characteristics of type 2 diabetic patients and to determine the effect of glycemic control optimization on 25-hydroxyvitamin D (25(OH)D) concentrations. Methods: Cross-sectional study of 63 patients with type 2 diabetes (mean age 60 ± 9.8 years, 69.8% men). Twenty of the 63 patients were also studied before and after glycemic control optimization. Results: Mean 25(OH)D concentrations were 63.64 ± 25.51 nmol/L and 74.6% of patients had hypovitaminosis D. Compared with patients with vitamin D sufficiency, patients with hypovitaminosis D had higher prevalence of overweight or obesity (72.3% versus 37.5%; p = 0.012) and higher VLDL cholesterol (VLDL-c) (0.71 (0.24-3.59) versus 0.45 (0.13-1.6) mmol/L; p = 0.011) and C-reactive protein (3.28 (0.36-17.69) versus 1.87 (0.18-17.47) mg/L; p = 0.033) concentrations. The composition of HDL particles also differed in both groups, with higher relative content of tr...
Bariatric surgery (BS) has become more frequent among women of child-bearing age. Data regarding ... more Bariatric surgery (BS) has become more frequent among women of child-bearing age. Data regarding the underlying maternal and perinatal risks are scarce. The objective of this nationwide study is to evaluate maternal and perinatal outcomes after BS. We performed a retrospective observational study of 168 pregnancies in 112 women who underwent BS in 10 tertiary hospitals in Spain over a 15-year period. Maternal and perinatal outcomes, including gestational diabetes mellitus (GDM), pregnancy-associated hypertensive disorders (PAHD), pre-term birth cesarean deliveries, small and large for gestational age births (SGA, LGA), still births, and neonatal deaths, were evaluated. Results were further compared according to the type of BS performed: restrictive techniques (vertical-banded gastroplasty, sleeve gastrectomy, and gastric banding), Roux-en-Y gastric bypass (RYGB), and biliopancreatic diversion (BPD). GDM occurred in five (3 %) pregnancies and there were no cases of PAHD. Women whose ...
Struma ovarii is an uncommon teratoma of the ovary that contains over 50% of thyroid tissue. This... more Struma ovarii is an uncommon teratoma of the ovary that contains over 50% of thyroid tissue. This tumor accounts for 0.2-1.3% of all ovarian tumors and for 2-4% of all teratomas. Malignancy is reported in 5% to 37% of patients with struma ovarii, with metastases occurring in few cases. 1-3 This article reports a patient with some unusual features, including malignancy, metastases, hormone production, and a fatal outcome. Literature is reviewed, and significance of appropriate treatment and follow-up of these patients is emphasized.
Patients with type 1 diabetes (T1DM) treated with continuous subcutaneous insulin infusion (CSII)... more Patients with type 1 diabetes (T1DM) treated with continuous subcutaneous insulin infusion (CSII) have available several specific features of these devices. The aim of this study was to evaluate the relationship between real use of them and the degree of glycemic control in patients using this therapy. Forty-four T1DM patients on CSII therapy with or without real-time continuous glucose monitoring (CGM) were included. Data from 14 consecutive days were retrospectively collected using the therapy management software CareLink Personal/Pro(®) and HbA1c measurement performed at that period. The relationship between the frequency of usie of specific features of insulin pumps (non-sensor augmented or sensor-augmented) and glycemic control was analyzed. Mean HbA1c in the group was 7.5 ± .8%. Mean daily number of boluses administered was 5.1 ± 1.8, with 75.4% of them being bolus wizards (BW). Daily number of boluses was significantly greater in patients with HbA1c &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;7.5% than in those with HbA1c&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt;7.5% (5.3 ± 1.6 vs. 4.3 ± 1.6, P=.056). There was a trend to greater use of BW in patients with better control (82.8 ± 21.4% vs. 69.9 ± 29.1%, P=.106). HbA1c was lower in patients using CGM (n=8) as compared to those not using sensor-augmented pumps (7.6 ± .8 vs 7.1 ± .7, P=.067), but the difference was not statistically significant. More frequent use of BW appears to be associated to better metabolic control in patients with T1DM using pump therapy. In standard clinical practice, augmentation of insulin pump with CGM may be associated to improved glycemic control.
ABSTRACT The procurement of pumps/supplies through a tender process is common practice among publ... more ABSTRACT The procurement of pumps/supplies through a tender process is common practice among public services. A report is presented on the feasibility and safety of the transition from one continuous subcutaneous insulin infusion (CSII) system to another within a very short time frame (4-weeks) as the consequence of a public tender.Methods The program consisted of: Session-1 was a system start-up training session. Patient satisfaction was evaluated. Session-2 consisted of a call from technical staff 72 h after Session-1 to provide support regarding the programming or the change of infusion set. Session-3 was a training session regarding the use of therapy management software. During and 2 months after Session-2, clinical events, technical issues, and training reinforcement incidents were registered. HbA1c data were collected retrospectively.ResultsA total of 219 patients were enrolled. During the second week, 81% of patients were transferred to the new system. Patient overall satisfaction scored 9.4/10 (none &lt;7). There were 30 training reinforcement events and 7 technical issues, with all 37 of them being were sorted out over the telephone. There were 31 additional clinical events (infusion set issues). Twenty-four were considered mild, and were solved by phone technical support. Medical assistance was needed in six (five unexpected hyperglycemia, one ketosis). There was only one severe event (ketoacidosis requiring hospitalization). HbA1c did not deteriorate during the transition process. One hundred twenty-eight patients attended the therapy management software training.Conclusions With the assistance of a specific program, a complete switch to a new insulin pump in a large population of patients with T1D in the context of a public tender in a very short time was carried out safely and without deterioration of metabolic control.
The objective of this cross-sectional study was to assess differences in the control and treatmen... more The objective of this cross-sectional study was to assess differences in the control and treatment of modifiable cardiovascular risk factors (CVRF: HbA1c, blood pressure [BP], LDL-cholesterol, body mass index, and smoking habit) according to gender and the presence of cardiovascular disease (CVD) in patients with type 2 diabetes mellitus (T2DM) in Catalonia, Spain. The study included available data from electronic medical records for a total of 286,791 patients. After controlling for sex, age, diabetes duration, and treatment received, both men and women with prior CVD had worse cardiometabolic control than patients without previous CVD; women with prior CVD had worse overall control of CVRFs than men except for smoking; and women without prior CVD were only better than men at controlling smoking and BP, with no significant differences in glycemic control. Finally, although the proportion of women treated with lipid-lowering medications was similar to (with prior CVD) or even higher...
OBJECTIVEdThe objective of this study was to analyze the clinical characteristics and levels of g... more OBJECTIVEdThe objective of this study was to analyze the clinical characteristics and levels of glycemic and cardiovascular risk factor control in patients with type 2 diabetes that are in primary health care centers in Catalonia (Spain).
We describe a 37-year-old man with a 4-month history of episodic muscular weakness, involving mai... more We describe a 37-year-old man with a 4-month history of episodic muscular weakness, involving mainly lower-limbs. Hypokalemia was documented in one episode and managed with intravenous potassium chloride. Hyperthyroidism was diagnosed 4 months after onset of attacks because of mild symptoms. The patient was subsequently diagnosed as having thyrotoxic periodic paralysis associated with Graves´ disease. Treatment with propranolol and methimazol was initiated and 1 year later he remains euthyroid and symptoms free.
Background: Qualitative alterations of lipoproteins underlie the high incidence of atherosclerosi... more Background: Qualitative alterations of lipoproteins underlie the high incidence of atherosclerosis in diabetes. The objective of this study was to assess the impact of low-density lipoprotein (LDL) subfraction phenotype on the qualitative characteristics of LDL and high-density lipoprotein (HDL) in patients with type 2 diabetes. Methods: One hundred twenty two patients with type 2 diabetes in poor glycemic control and 54 healthy subjects were included in the study. Patients were classified according to their LDL subfraction phenotype. Seventy-seven patients presented phenotype A whereas 45 had phenotype B. All control subjects showed phenotype A. Several forms of modified LDL, HDL composition and the activity and distribution of lipoprotein-associated phospholipase A2 (Lp-PLA2) were analyzed. Results: Oxidized LDL, glycated LDL and electronegative LDL were increased in both groups of patients compared with the control group. Patients with phenotype B had increased oxidized LDL and glycated LDL concentration than patients with phenotype A. HDL composition was abnormal in patients with diabetes, being these abnormalities more marked in patients with phenotype B. Total Lp-PLA2 activity was higher in phenotype B than in phenotype A or in control subjects. The distribution of Lp-PLA2 between HDL and apoB-containing lipoproteins differed in patients with phenotype A and phenotype B, with higher activity associated to apoB-containing lipoproteins in the latter.
The aim of this study was to determine the effect of intensified hypoglycemic therapy in patients... more The aim of this study was to determine the effect of intensified hypoglycemic therapy in patients with type 2 diabetes mellitus on the distribution of lipoprotein-associated phospholipase A2 (Lp-PLA2) activity between high-density lipoprotein and low-density lipoprotein (LDL) and its relation with the lipid profile and other qualitative properties of LDL. Forty-two patients with type 2 diabetes on the basis of poor glycemic control and normal or near normal LDL cholesterol were recruited. Lifestyle counseling and pharmacologic hypoglycemic therapy were intensified to improve glycemic control, but lipid-lowering therapy was unchanged. At 4 ؎ 2 months, glycosylated hemoglobin had decreased by a mean of 2.1%, but the only effect on the lipid profile were statistically significant decreases in nonesterified fatty acids and apolipoprotein B concentration. LDL size increased and the proportion of electronegative LDL decreased significantly. In parallel, total Lp-PLA2 activity decreased significantly, promoting a redistribution of Lp-PLA2 activity toward a higher proportion in high-density lipoprotein. Improvements in glycemic control led to more marked changes in Lp-PLA2 activity and distribution in patients with diabetes who had not received previous lipid-lowering therapy. In conclusion, optimizing glycemic control in patients with type 2 diabetes promotes atheroprotective changes, including larger LDL size, decreased electronegative LDL, and a higher proportion of Lp-PLA2 activity in high-density lipoprotein.
Endocrinología y nutrición : órgano de la Sociedad Española de Endocrinología y Nutrición, 2013
To assess in standard clinical practice the feasibility, efficacy, and safety of switching patien... more To assess in standard clinical practice the feasibility, efficacy, and safety of switching patients with long-standing type 2 diabetes (T2DM) and poor or unstable blood glucose control to basal-bolus insulin therapy. This was a prospective, single center study including 37 patients with T2DM (age 65±8 years, 62.2% men, body mass index 28.8±6.2 kg/m2, diabetes duration 18±8 years) with poor or unstable glycemic control, who were switched to a basal-bolus insulin regimen with glargine and rapid-acting insulin analogue at the discretion of their physicians. After a group-structured outpatient diabetes training program, patients were followed in a clinical practice setting for 6 months. Clinical and biochemical variables were collected before switching and at 3 and 6 months. After switching to basal-bolus therapy, glycosylated hemoglobin (HbA1c) decreased from 9±1.2% to 8.1±1.2% (p<0.001) at 3 months and to 8.0±1.2% at 6 months (p<0.001) without changing total daily insulin dose. ...
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