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Ortega Millan C.,Medico de Familia | Fornos Perez J.A.,Grupo Berbes de Investigacion | Garcia Mayor R.V.,Hospital Xeral Cies | Menendez Torre E.,Servicio de Endocrinologia y Nutricion
Avances en Diabetologia | Year: 2010

Current guidelines differ in their recommendations for triple therapy when targets are not achieved with a combined treatment of two oral agents. In addition, they diverge also in the type of association and the name given for the triple therapy. In the present manuscript we review the available scientific evidence to determine whether triple therapy is effective and safe, as well as the more favorable association in patients with type 2 diabetes. Reviewing available literature, we have noticed that triple therapy improves glycemic control. However, available randomized control trials do not extend more than one year of follow-up and they don't have data over endpoint variables as morbidity and mortality. Therefore, the long-term safety of triple therapy has not been demonstrated until now. In conclusion, with the currently available data there is no reason to delay introduction of insulin in the treatment of patients with type 2 diabetes after failure of dual combination therapy, except in cases of patients' resistance to initiate insulin therapy.


Aims: To study the level of control of cardiovascular risk factors, and prevalence of chronic complications in type 2 diabetic (T2D) patients in daily practice in the Community of Madrid. Design: An epidemiological cross-sectional study in T2D patients attending 51 general practitioner clinics, with the participation of 134 health professionals from all the health areas in the Madrid Community. The sample was obtained by systematic sampling. Measurements: Sociodemographic, biological/biochemical processes and outcomes of the clinical care were recorded. For the statistical analysis the software SPSS 15.0 was used. Results: A total of 3268 T2D patients were studied, 50.3% men and 49.7% women, mean age 68.8 ± 10.9 years, and with a mean duration of diabetes of 7.9 ± 7.4 years and a median of 6 years. High blood pressure was observed in 70.4% of T2D patients, and 48.4% were obese. Mean systolic blood pressure was 131.7 ± 14.5 mmHg, and 35.3% of patients had a systolic pressure less than 130 mmHg. Mean diastolic pressure was 76.1 ± 9 mmHg, and in 51.4% of the patients it was below 80 mmHg. A systolic/diastolic blood pressure below 130/80 mmHg was found in 25.3% of T2D patients. A high prevalence of macrovascular complications (18.3%) was found in our study. No differences in the prevalence was found for chronic complications of diabetes compared with that previously published, except for retinopathy, with a prevalence of 8% in our study, probably reflecting a low case register. Conclusions: The level of integrated control in T2D (HbA1C < 7%, LDL < 100 and BP < 130/80 mmHg), was only observed in 4.5% of the patients. The study shows the difficulty of achieving integral control of T2D patients. © 2010 Sociedad Española de Diabetes. Published by Elsevier España, S.L. All rights reserved.


Lopez M.T.F.,Servicio de Endocrinologia y Nutricion | Baamil O.F.,Servicio de Endocrinologia y Nutricion | Doldan C.L.,Servicio Of Farmacia Hospitalaria | Alonso M.L.B.,Servicio de Endocrinologia y Nutricion | And 2 more authors.
Nutricion Hospitalaria | Year: 2014

Background: Malnutrition is a frequent issue in our hospitals, and it is associated with an increase in morbi-mortality and financial costs, together with a decline in the patients’ quality of life. This study is aimed at establishing the prevalence of malnutrition in our health centre, as much at admission as at discharge.Methods: Transversal observational study assessing 277 adult patients, who were admitted consecutively, and applying the Nutritional Risk Screening 2002 (NRS-2002) in the first 48 hours from admission and then again at discharge. Cancer patients were also submitted the Patient Generated Subjective Global Assessment (PG-SGA) and the Mini Nutritional Assessment Short Form (MNA-SF) was applied to the population of 65 and over.Results: 32.49% of patients were at malnutrition risk according to the results of NRS-2002 at admission. This percentage increased up to 40.98% at discharge. The NRS-2002 showed that 31.15% of cancer patients presented with nutritional risk; however, according to VGS-GP, 52.54% of the cases presented with nutritional risk to a certain extent (38.98% with moderate malnutrition and 13.56% with serious malnutrition). Among patients aged 65 and over, 29.31% were considered at risk according to the NRS-2002; the MNA-SF revealed nutritional alteration in 70.35% (54.65% with malnutrition risk, 15.7% with malnutrition). There are different groups of patients: 65 years old and over, transferred from the emergency department, multi-medicated, cancer patients and patients with heart failure, who present with a higher risk of nutritional deterioration at admission (p<0.05).Conclusions: There is a very high percentage of patients at nutritional risk in our centre, as much at admission as at discharge. It is therefore necessary to install a systematic screening of the nutritional status for all inpatients. © 2014, Grupo Aula Medica S.A. All rights reserved.


Type 2 diabetes mellitus (DM2) is the paradigm of chronic disease. DM2 is a process that affects various organs and systems, is accompanied by other diseases and reduces patients' quality of life. Patients with diabetes show microvascular complications and an increased risk of cardiovascular morbidity and mortality related to the quality of the healthcare received, among other factors. The quality of the management of the healthcare process is intimately connected to the degree of diabetes control, the quality of the care received, quality of life and the degree to which the diabetic patient feels empowered to manage his or her disease. In Spain, several projects to coordinate specialized and primary care - shared care - have been developed to improve the management of patients with DM2. Among others, the UDEN project, in Gerona (UDENTG), is providing highly promising results. UDENTG is an intervention aimed at improving the organization of the care of endocrinological patients, especially those with DM2. Despite its complexity, this project is demonstrating its effectiveness and equitableness in DM2 and is improving professional development in all those involved. Copyright © 2010 Elsevier España, S.L. All rights reserved.


PubMed | Servicio de Endocrinologia y Nutricion and Servicio de Radiodiagnostico
Type: Journal Article | Journal: Nutricion hospitalaria | Year: 2015

To evaluate anthropometric characteristics and satisfaction with self body image in a group of university students.64 university students from 21 to 25 years old, 36 females and 28 males, were studied. Body composition was evaluated by anthropometric data and bioimpedance. Satisfaction with body image was self evaluated by a score from 0 to 10.Mean BMI was 21.95 and fat mass 12.15 5.27 Kg, greater in women. Satisfaction level was high, with a mean score of 7.15 + 1.15, only 3 participants rated themselves below 5 points. There were no differences between sexes and there was not correlation between self evaluation and anthropometric data in the whole group but, in women, an inverse correlation (r=-0.52) between self evaluation and BMI was observed. This correlation was lesser (r=-0.30) between self evaluation and fat mass percent.Anthropometric characteristics in the study population were appropriate, as reflected by the high level of satisfaction with their body images. Nevertheless, there is a trend towards a lower self evaluation at greater BMI in women. This trend is not so strong with greater fat mass percent, despite this parameter would represent more exactly the real body image.


Santacruz Cerda E.,Hospital Universitario Ramon y Cajal | Arcano K.,Hospital Universitario Ramon y Cajal | Arrieta Blanco F.,Hospital Universitario Ramon y Cajal | Ortiz Flores A.,Hospital Universitario Ramon y Cajal | And 4 more authors.
Nutricion Hospitalaria | Year: 2016

The use of home parenteral nutrition (HPN) in patients who can not obtain their nutritional requirements by the enteral route is increasing in recent years, allowing normalization lifestyle of patients. Neoplasm and mesenteric ischaemia are some of the diseases that most frequently require HPN in Spain. However, HPN is one of the cornerstones of the treatment of much less frequent illnesses as in the case of encapsulating peritoneal sclerosis. We present the case of a patient with encapsulating peritoneal sclerosis and HPN support for more than 7 years with a peripherally inserted central catheter (PICC) for over 6 years without complications and the autonomy to perform his normal business activity. Given the exceptional nature of the case we refer it to its publication. © 2016, Grupo Aula Medica S.A. All rights reserved.


Garcia-Marirrodriga I.,Centro Laparoscopico Dr Ballesta Clb | Amaya-Romero C.,Centro Laparoscopico Dr Ballesta Clb | Ruiz-Diaz G.P.,Centro Laparoscopico Dr Ballesta Clb | Fernandez S.,Resistencia a la Insulina SL | And 7 more authors.
Obesity Surgery | Year: 2012

Background: The most commonly encountered dyslipidemia in obese individuals is characterized by a cluster of interrelated plasma lipid and lipoprotein abnormalities including hypertriglyceridemia, low HDL cholesterol values, and increased small, dense LDL cholesterol particles. The aim of this study was to assess the changes in lipid profiles at baseline (pre-operatively) and at follow-up (6, 12, and 18 months) after a laparoscopic Roux-en-Y gastric bypass (LRYGBP). A retrospective observational study was performed involving all patients who consecutively underwent a LRYGBP between January 1, 2007 and December 31, 2009. Fasting lipids sub-fractions (total cholesterol, LDL cholesterol, HDL cholesterol, and triglycerides) were measured and HOMA-IR calculated pre-operatively and at follow-up post-LRYGBP. Pearson's correlation coefficients were used to assess the relationship between excess weight loss (EWL) and lipid sub-fractions. ANOVA was used to assess the differences between each lipid sub-fraction at various time-points. Methods: One hundred twenty eight (N=128) medical charts were reviewed, and those containing data on lipid fractions at the three follow-up time-points were analyzed. One hundred fourteen patients (N=114), 84 of whom were women (73.7%), were finally included in the study. Results: Total cholesterol, LDL cholesterol, triglycerides, and HOMA-IR were significantly reduced after LRYGBP (P<0.0005 for all). Inversely, HDL cholesterol disclosed a significant rise (P<0.0005). Noteworthy significant associations between lipid subfractions and EWL were detectedoverall (P<0.0005 for all). A gender effect was found since female patients displayed a milder association than male patients (P<0.0005). Conclusions: LRYGBP-induced weight loss improves the lipid profile while reducing insulin resistance, with male patients showing a better profile than female patients. © Springer Science+Business Media, LLC 2011.


Otero J.L.,Servicio Of Farmacia Hospitalaria | Lopez M.T.F.,Servicio de Endocrinologia y Nutricion | Blanco E.O.,Servicio de Endocrinologia y Nutricion | Vazquez P.A.,Servicio de Endocrinologia y Nutricion | And 2 more authors.
Nutricion Hospitalaria | Year: 2010

Injury to the thoracic duct, leading to chyle leak, oc curs in 1-2,5% of patients who undergo neck dissection. Associated complications include malnutrition, immune compromise, fistula formation and carotid blowout. No definitive treatment algorithm can be deduced from the current literature, but on last reviews, there is an agree ment on the conservative management. Medical man agement is based on that decreasing chyle flow will allow for spontaneous closure of the chyle leak. Conservative treatment includes: closed vacuum drainage, bed-rest, nutrition modification and synthetic somatostatin ana log. Nutrition modification involves a low-fat diet supplemented with medium-chain triglycerides (MCT), enteral nutrition with high percentage of MCT or parenteral nutrition.


Junquera Banares S.,Hospital Of Navarra | Oria Mundin E.,Hospital Of Navarra | Botella-Carretero J.I.,Servicio de Endocrinologia y Nutricion
Nutricion Hospitalaria | Year: 2014

Zinc deficiency is relatively common in certain pathologies, although its clinical manifestation is uncommon. We present the case of a patient who was admitted pre - senting hyponatremic dehydration and pre-renal failure secondary to high-output ileostomy and oral intolerance. Although the ileostomy output was normalized within 3 days of admission and initial zinc plasma levels were normal, after being fed with TPN supplemented with 13 mg/day of zinc, he suffered a severe zinc deficit with enteropathic acrodermatitis that was completely resolved after one week with 26.5 mg/day. However, plasma levels did not return to normal until one month on therapy with high doses of zinc. Zinc plasma levels are not a good indicator of zinc stores in the body and many times their changes are a late indicator of zinc deficit. There is not a correlation between the clinical improvement and normalization of zinc levels, being common the clinical resolution within few days of the supplementation without observing an increase of zinc plasma levels.


PubMed | Servicio de Endocrinologia y Nutricion
Type: Case Reports | Journal: Endocrinologia y nutricion : organo de la Sociedad Espanola de Endocrinologia y Nutricion | Year: 2010

Chylous leak is a rare complication after breast cancer surgery. We present the case of a patient with a chylous leak and discuss the management options.

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