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Diagnóstico de la diabetes mellitus tipo 2. Situación epidemiológica, características de los pacientes, factores de riesgo y pronóstico 2 型糖尿病的诊断。流行病学情况、患者特征、风险因素和预后。
Medicine - Programa de Formación Médica Continuada Acreditado Pub Date : 2024-10-01 DOI: 10.1016/j.med.2024.10.018
J.B. Quiñones Silva , A. Bayona Cebada , H.F. Escobar-Morreale , L. Nattero Chávez
{"title":"Diagnóstico de la diabetes mellitus tipo 2. Situación epidemiológica, características de los pacientes, factores de riesgo y pronóstico","authors":"J.B. Quiñones Silva ,&nbsp;A. Bayona Cebada ,&nbsp;H.F. Escobar-Morreale ,&nbsp;L. Nattero Chávez","doi":"10.1016/j.med.2024.10.018","DOIUrl":"10.1016/j.med.2024.10.018","url":null,"abstract":"<div><div>Type 2 diabetes mellitus (DM2) is one of the most prevalent chronic diseases. It accounts for approximately 90% of diabetes cases worldwide. This disease is characterized by insulin resistance and the progressive dysfunction of pancreatic beta cells, resulting in chronic hyperglycemia. In recent decades, the prevalence of DM2 has increased considerably due to changes in lifestyles, population aging, and urbanization. The complications associated with DM2, such as retinopathy, nephropathy, neuropathy, cardiovascular diseases, and lower extremity amputations, are a significant burden in terms of both healthcare and the economy. Intensive control of blood glucose and cardiovascular risk factors is crucial for preventing these complications. Early detection and effective interventions, such as lifestyle changes and pharmacological treatments, are essential in order to reduce the incidence of DM2 and its comorbidities.</div></div>","PeriodicalId":100912,"journal":{"name":"Medicine - Programa de Formación Médica Continuada Acreditado","volume":"14 19","pages":"Pages 1099-1106"},"PeriodicalIF":0.0,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142432375","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Paciente con diabetes tipo 1 con hipoglucemias desapercibidas y de repetición 1 型糖尿病患者反复出现低血糖而未被察觉
Medicine - Programa de Formación Médica Continuada Acreditado Pub Date : 2024-10-01 DOI: 10.1016/j.med.2024.10.009
A. Bayona Cebada , J.B. Quiñones Silva , H.F. Escobar-Morreale , L. Nattero Chávez
{"title":"Paciente con diabetes tipo 1 con hipoglucemias desapercibidas y de repetición","authors":"A. Bayona Cebada ,&nbsp;J.B. Quiñones Silva ,&nbsp;H.F. Escobar-Morreale ,&nbsp;L. Nattero Chávez","doi":"10.1016/j.med.2024.10.009","DOIUrl":"10.1016/j.med.2024.10.009","url":null,"abstract":"","PeriodicalId":100912,"journal":{"name":"Medicine - Programa de Formación Médica Continuada Acreditado","volume":"14 18","pages":"Pages 1097.e1-1097.e4"},"PeriodicalIF":0.0,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142426502","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Tratamiento no farmacológico de la diabetes mellitus tipo 2. Cirugía de la obesidad. Nuevas estrategias terapéuticas 2 型糖尿病的非药物治疗。肥胖症手术。新的治疗策略
Medicine - Programa de Formación Médica Continuada Acreditado Pub Date : 2024-10-01 DOI: 10.1016/j.med.2024.10.012
J.B. Quiñones Silva , A. Bayona Cebada , H.F. Escobar-Morreale , L. Nattero Chávez
{"title":"Tratamiento no farmacológico de la diabetes mellitus tipo 2. Cirugía de la obesidad. Nuevas estrategias terapéuticas","authors":"J.B. Quiñones Silva ,&nbsp;A. Bayona Cebada ,&nbsp;H.F. Escobar-Morreale ,&nbsp;L. Nattero Chávez","doi":"10.1016/j.med.2024.10.012","DOIUrl":"10.1016/j.med.2024.10.012","url":null,"abstract":"<div><div>The incidence and prevalence of type 2 diabetes mellitus (DM2) and obesity are increasing globally and are closely interrelated. Obesity surgery (metabolic surgery) is a valid, effective tool for weight reduction and remission of DM2. This update describes the different surgical techniques in obesity surgery. It also lists the available evidence on the observational studies and clinical trials that have supported recommendations for this intervention in patients with DM2 and obesity. Lastly, emerging treatment strategies related to peptides involved with the incretin effect (GLP-1, GIP, and glucagon) and glucose receptor inhibitors (SGLT) are described.</div></div>","PeriodicalId":100912,"journal":{"name":"Medicine - Programa de Formación Médica Continuada Acreditado","volume":"14 19","pages":"Pages 1125-1130"},"PeriodicalIF":0.0,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142432378","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Objetivos del tratamiento de la diabetes mellitus tipo 1 1 型糖尿病的治疗目标
Medicine - Programa de Formación Médica Continuada Acreditado Pub Date : 2024-10-01 DOI: 10.1016/j.med.2024.10.002
A. Bayona Cebada , J.B. Quiñones Silva , H.F. Escobar-Morreale , L. Nattero Chávez
{"title":"Objetivos del tratamiento de la diabetes mellitus tipo 1","authors":"A. Bayona Cebada ,&nbsp;J.B. Quiñones Silva ,&nbsp;H.F. Escobar-Morreale ,&nbsp;L. Nattero Chávez","doi":"10.1016/j.med.2024.10.002","DOIUrl":"10.1016/j.med.2024.10.002","url":null,"abstract":"<div><div>There are three ways to assess blood glucose control in type 1 diabetes (DM1): glycated hemoglobin (HbA<sub>1c</sub>, general target less than or equal to 7%), time in the 70–180<!--> <!-->mg/dl range (general target 70% or higher), and capillary blood glucose. Diabetes education is a fundamental element in achieving self-management of the disease. It is based on three fundamental pillars: nutrition, insulin therapy, and management of diabetes technology (sensors, insulin pumps, smart insulin pens, and mobile applications). Drug treatment for DM1 consists of intensive insulin therapy using multiple dose injection (MDI) or continuous subcutaneous insulin infusion (CSII). The choice of treatment regimen should be based on patient characteristics and other clinical considerations (e.g., pregnancy, presence of undetected hypoglycemia, or variable insulin requirements). There are currently no other insulin adjuvant therapies approved for use in DM1, although DM2 drugs such as GLP-1 analogs or SGLT2 inhibitors that may provide benefits in blood glucose control or weight loss have been used. Kidney-pancreas or pancreatic islet transplantation is considered a final option in patients with end-stage chronic kidney disease together with or following renal transplantation or in individuals with undetected or severe recurrent hypoglycemia that does not respond to optimized management.</div></div>","PeriodicalId":100912,"journal":{"name":"Medicine - Programa de Formación Médica Continuada Acreditado","volume":"14 18","pages":"Pages 1055-1063"},"PeriodicalIF":0.0,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142426433","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Paciente varón de 58 años con obesidad, hipertensión, dislipidemia y diabetes mellitus tipo 2 mal controlada con fármacos orales 58 岁的男性患者，患有肥胖症、高血压、血脂异常和口服药物控制不佳的 2 型糖尿病。
Medicine - Programa de Formación Médica Continuada Acreditado Pub Date : 2024-10-01 DOI: 10.1016/j.med.2024.10.017
A. Bayona Cebada , J.B. Quiñones Silva , H.F. Escobar-Morreale , L. Nattero Chávez
{"title":"Paciente varón de 58 años con obesidad, hipertensión, dislipidemia y diabetes mellitus tipo 2 mal controlada con fármacos orales","authors":"A. Bayona Cebada ,&nbsp;J.B. Quiñones Silva ,&nbsp;H.F. Escobar-Morreale ,&nbsp;L. Nattero Chávez","doi":"10.1016/j.med.2024.10.017","DOIUrl":"10.1016/j.med.2024.10.017","url":null,"abstract":"","PeriodicalId":100912,"journal":{"name":"Medicine - Programa de Formación Médica Continuada Acreditado","volume":"14 19","pages":"Pages 1147.e1-1147.e4"},"PeriodicalIF":0.0,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142432261","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Estrategia terapéutica en el paciente diabético (II). Tratamiento farmacológico del paciente con diabetes mellitus tipo 2. Criterios de selección y evidencia actual de los fármacos antidiabéticos no insulínicos 糖尿病患者的治疗策略（II）。2 型糖尿病患者的药物治疗。非胰岛素抗糖尿病药物的选择标准和现有证据。
Medicine - Programa de Formación Médica Continuada Acreditado Pub Date : 2024-10-01 DOI: 10.1016/j.med.2024.10.011
J.B. Quiñones Silva , A. Bayona Cebada , H.F. Escobar-Morreale , L. Nattero Chávez
{"title":"Estrategia terapéutica en el paciente diabético (II). Tratamiento farmacológico del paciente con diabetes mellitus tipo 2. Criterios de selección y evidencia actual de los fármacos antidiabéticos no insulínicos","authors":"J.B. Quiñones Silva ,&nbsp;A. Bayona Cebada ,&nbsp;H.F. Escobar-Morreale ,&nbsp;L. Nattero Chávez","doi":"10.1016/j.med.2024.10.011","DOIUrl":"10.1016/j.med.2024.10.011","url":null,"abstract":"<div><div>The management of type 2 diabetes mellitus is complex and requires a multifaceted approach that combines nonpharmacological interventions with pharmacological treatments. Non-insulin antidiabetics (NIA) have evolved considerably, progressing from traditional agents such as biguanides and sulfonylureas to newer ones such as SGLT-2 inhibitors and GLP-1 agonists and from a glucocentric approach to management based on comorbidities. Metformin continues to be the first-line treatment due to its efficacy and safety profile. However, the variety of NIAs allows for personalizing treatment according to each patient's specific needs, considering factors such as the presence of comorbidities, cardiovascular risk, and patient preference. This document reviews the different pharmacological groups of NIAs and their mechanisms of action, efficacy, and side effects. It also addresses the selection criteria for these drugs, emphasizing the importance of an informed decision based on the most recent evidence and individual patient characteristics, in addition to updated evidence on these pharmacological groups.</div></div>","PeriodicalId":100912,"journal":{"name":"Medicine - Programa de Formación Médica Continuada Acreditado","volume":"14 19","pages":"Pages 1116-1124"},"PeriodicalIF":0.0,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142432377","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Protocolo terapéutico de la diabetes mellitus tipo 2 con obesidad y riesgo cardiovascular 2 型糖尿病合并肥胖和心血管风险的治疗方案
Medicine - Programa de Formación Médica Continuada Acreditado Pub Date : 2024-10-01 DOI: 10.1016/j.med.2024.10.014
A. Bayona Cebada , J.B. Quiñones Silva , H.F. Escobar-Morreale , L. Nattero Chávez
{"title":"Protocolo terapéutico de la diabetes mellitus tipo 2 con obesidad y riesgo cardiovascular","authors":"A. Bayona Cebada ,&nbsp;J.B. Quiñones Silva ,&nbsp;H.F. Escobar-Morreale ,&nbsp;L. Nattero Chávez","doi":"10.1016/j.med.2024.10.014","DOIUrl":"10.1016/j.med.2024.10.014","url":null,"abstract":"<div><div>The management of type 2 diabetes mellitus (DM2) with obesity and cardiovascular risk is a growing challenge due to the high prevalence of both conditions. This protocol describes therapeutic recommendations based on glycemic control and the cardiovascular benefits of certain drugs. Two classes of drugs with weight and cardiometabolic efficacy stand out: glucagon-like peptide-1 agonists (GLP-1a) and sodium-glucose cotransporter-2 inhibitors (SGLT-2i). This document suggests the joint use of both to reduce cardiovascular risk and promote weight loss. It also describes the role of metabolic surgery as an effective option for the management of DM2 and obesity, as it significantly improves glycemic outcomes and reduces cardiovascular risk. Continuous follow-up is recommended to adjust treatment according to the patient's clinical response and to avoid therapeutic inertia.</div></div>","PeriodicalId":100912,"journal":{"name":"Medicine - Programa de Formación Médica Continuada Acreditado","volume":"14 19","pages":"Pages 1135-1138"},"PeriodicalIF":0.0,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142432380","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Protocolo diagnóstico de la poliuria 多尿症诊断方案
Medicine - Programa de Formación Médica Continuada Acreditado Pub Date : 2024-09-24 DOI: 10.1016/j.med.2024.09.005
A. Rivas Montenegro, L. González Fernández, A. López Guerra, O. González Albarrán
{"title":"Protocolo diagnóstico de la poliuria","authors":"A. Rivas Montenegro,&nbsp;L. González Fernández,&nbsp;A. López Guerra,&nbsp;O. González Albarrán","doi":"10.1016/j.med.2024.09.005","DOIUrl":"10.1016/j.med.2024.09.005","url":null,"abstract":"<div><div>Polyuria is defined as a urinary excretion volume &gt; 3 l/24<!--> <!-->h or &gt; 40-50<!--> <!-->ml/kg/24<!--> <!-->h. It is essential to differentiate it from symptoms such as nocturia and pollakiuria that are related to urologic pathology. To guide the diagnosis it is important to differentiate whether it is an osmotic or aqueous polyuria. The most frequent cause of osmotic diuresis is decompensated diabetes mellitus. The main causes of aqueous polyuria are primary polydipsia (PP), vasopressin deficiency (AVP-D) and vasopressin resistance (AVP-R). Making an accurate diagnosis of the different causes of polyuria is essential because the therapeutic plan varies. Once aqueous polyuria is confirmed, the cause of the polyuria-polydipsia syndrome must be established. Currently, it is recommended to start the study with a basal copeptin measurement to differentiate AVP-D from AVP-R and to differentiate AVP-D from PP to measure stimulated copeptin after infusion of arginine or hypertonic saline.</div></div>","PeriodicalId":100912,"journal":{"name":"Medicine - Programa de Formación Médica Continuada Acreditado","volume":"14 17","pages":"Pages 1026-1029"},"PeriodicalIF":0.0,"publicationDate":"2024-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142315918","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Protocolo diagnóstico endocrinológico de la infertilidad 不孕症的内分泌诊断方案
Medicine - Programa de Formación Médica Continuada Acreditado Pub Date : 2024-09-24 DOI: 10.1016/j.med.2024.09.008
A. Galdón Sanz-Pastor, M. Gómez Gordo, G. Pérez Bennet, O. González Albarrán
{"title":"Protocolo diagnóstico endocrinológico de la infertilidad","authors":"A. Galdón Sanz-Pastor,&nbsp;M. Gómez Gordo,&nbsp;G. Pérez Bennet,&nbsp;O. González Albarrán","doi":"10.1016/j.med.2024.09.008","DOIUrl":"10.1016/j.med.2024.09.008","url":null,"abstract":"<div><div>Infertility affects approximately 15% to 20% of couples. Factors can include both females and males as well as mixed factors and its causes may be idiopathic or unknown. The main causes of female infertility include ovulatory dysfunctions; uterine or cervical abnormalities; fallopian tube problems; and endocrinological causes such as polycystic ovary syndrome, hyperprolactinemia, hypothyroidism, hyperthyroidism, and obesity. The evaluation begins with a complete medical history and physical examination followed by tests to assess ovulatory function as well as a biochemical and hormonal analysis. Male infertility, which affects a significant proportion of couples, may be caused by testicular dysfunction, endocrinopathies, lifestyle factors, congenital anatomical anomalies, exposure to gonadotoxic drugs, and aging. The evaluation includes a detailed medical history and complete physical examination followed by semen analysis to assess sperm concentration, motility, and morphology. Imaging tests and molecular and chromosomal studies are also performed in specific cases.</div><div>In both sexes, a biochemical and hormonal evaluation is crucial to identify possible endocrinological causes of infertility. Levels of hormones such as FSH, LH, testosterone, and prolactin must be measured to determine gonadal function and detect possible underlying hormonal disorders. The interpretation of these results helps guide the diagnosis and treatment of infertility.</div></div>","PeriodicalId":100912,"journal":{"name":"Medicine - Programa de Formación Médica Continuada Acreditado","volume":"14 17","pages":"Pages 1038-1042"},"PeriodicalIF":0.0,"publicationDate":"2024-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142315921","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Protocolo diagnóstico del hirsutismo 多毛症诊断方案
Medicine - Programa de Formación Médica Continuada Acreditado Pub Date : 2024-09-24 DOI: 10.1016/j.med.2024.09.006
A. López Guerra, R. García-Centeno, J. Atencia Goñi, O. González Albarrán
{"title":"Protocolo diagnóstico del hirsutismo","authors":"A. López Guerra,&nbsp;R. García-Centeno,&nbsp;J. Atencia Goñi,&nbsp;O. González Albarrán","doi":"10.1016/j.med.2024.09.006","DOIUrl":"10.1016/j.med.2024.09.006","url":null,"abstract":"<div><div>Hirsutism is defined as the appearance of excess hair in women in androgen-dependent areas. It has different degrees of severity. The Ferriman-Gallwey scale is used to diagnose hirsutism and quantify its severity. A score equal to or greater than eight indicates the presence of this disease. Hirsutism is usually secondary to a state of hyperandrogenism. Polycystic ovary syndrome is the most common cause of hyperandrogenism in women of childbearing age. Other possible causes include congenital adrenal hyperplasia, androgen-secreting tumors, and use of drugs with androgenic effect, among others. The medical record, together with laboratory tests, helps to clearly guide the diagnosis and be able to choose the best treatment in each case.</div></div>","PeriodicalId":100912,"journal":{"name":"Medicine - Programa de Formación Médica Continuada Acreditado","volume":"14 17","pages":"Pages 1030-1033"},"PeriodicalIF":0.0,"publicationDate":"2024-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142315919","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
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