HIPOALBUMINEMIA Y ASCITIS

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PRESENTADO POR : DR. HAUSTON FERNANDO BECERRA
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SESION ASCITIS
ROTACION PATOLOGIA CLINICA ENERO 2014
PRESENTADO POR : DR. HAUSTON FERNANDO BECERRA
MODULO MEDICINA INTERNA

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Two More Levels to Check for Diabetes Risk?

Fructosamine and glycated albumin levels could help predict risk of diabetes and microvascular complications, particularly when glycated hemoglobin (HbA1c) levels aren't reliable, researchers found.

Having levels above the 95th percentile of each measurement was associated with an increased risk of diabetes, and both tests were predictive of retinopathy and kidney disease,Elizabeth Selvin, PhD, of Johns Hopkins, and colleagues reported online in the Lancet Diabetes & Endocrinology.

In statistical analyses, however, HbA1c maintained the best predictive tool for development of diabetes, they noted.

HbA1c is the standard for monitoring glucose control and for diagnosing diabetes, but it may not be as accurate in all settings, such as anemia, recent transfusion, pregnancy, and kidney disease.

Fructosamine and glycated albumin could serve as alternative markers of short-term glycemic control (about 2 to 4 weeks) or could add complementary prognostic information to HbA1c, the researchers said.

The fructosamine assay is available in the U.S., but has limited use because of a lack of data on long-term outcomes. The glycated albumin panel is used in Japan, but isn't common in the U.S.

To assess the performance of fructosamine and glycated albumin for identifying people at risk of diabetes or other complications, Selvin and colleagues measured levels in blood samples from 11,348 patients without diabetes and 958 patients with the disease who participated in the Atherosclerosis Risk in Communities (ARIC) study.

They found that baseline fructosamine and glycated albumin levels were strongly associated with risk of diabetes, even after adjustment in multivariate analyses. For instance, fructosamine values above 95th percentile (above 264 mcmol/L) were significantly associated with diabetes (HR 2.61, 95% CI), as were glycated albumin values above the 95th (greater than 15.2%) percentile (HR 3.27).

Both measures were also significantly associated with increased risks of retinopathy and chronic kidney disease, they reported.

However, associations between HbA1c and incident diabetes were stronger than those for fructosamine or glycated albumin, Selvin and colleagues noted. And in C-statistic analyses, HbA1c outperformed both fructosamine and glycated albumin for prediction of incident diabetes (0.759 versus 0.706 and 0.703, respectively).

Still, they concluded that their findings "suggest that fructosamine and glycated albumin can be used to predict diabetes, chronic kidney disease, and retinopathy in the community, [can] add complementary information to HbA1c, and ... might be particularly useful in settings where HbA1c testing or interpretation is problematic."

Robert Cohen, MD, of the University of Cincinnati, and William Herman, MD, of the University of Michigan in Ann Arbor, wrote in an accompanying editorial that all three tests seem to work well, but it "remains to be seen how well they perform in individuals, especially for the diagnosis of diabetes."

"Although all three measures might work well for most patients, it will not always be obvious for whom these indirect measures of average glycemia do not work," they wrote.

In the meantime, they said, clinicians should "use multiple sources of information to asses glycemia and maintain a high index of suspicion when an indirect measure does not seem correct."

Tomado de: MedPage Today

Kristina Fiore

Selvin E, et al "Fructosamine and glycated albumin for risk stratification and prediction of incident diabetes and microvascular complications" Lancet Diabetes & Endocrinol 2014; DOI: 10.1016/S2213-8587(13)70199-2.

Intensive lifestyle interventions benefit patients with type 2 diabetes

Lifestyle interventions can have a number of positive effects in the management of type 2 diabetes.

It has been well documented in two landmark clinical trials on the prevention of diabetes that dietary changes and regular physical activity will prevent or delay the development of diabetes in high-risk individuals.

Landmark clinical trials

The Diabetes Prevention Project (DPP), a randomized controlled trial in patients with prediabetes, showed that 7% weight loss, achieved by a lifestyle modification program, reduced the 4-year cumulative incidence of diabetes by 58% vs. a placebo group that made no formal lifestyle changes. The program incorporated individual and group counseling sessions that encouraged a low-fat diet and at least 150 minutes of exercise (brisk walking) per week.

The Finnish Diabetes Prevention Study extended the DPP by looking at the reduction in the incidence of diabetes in high-risk, middle-aged (mean age, 55 years) adults at as much as 5 years post-intervention. The intervention included personal counseling sessions aimed at moderate (5%) weight loss achieved by a low-fat, high-fiber diet and moderate exercise for about 30 minutes per day. The average weight loss at 5 years was only 4.6 lb, but resulted in a lower incidence of diabetes in this population (23%) vs. placebo (11%).

Modest reductions in weight using a combination of dietary modifications and exercise resulted in significant reductions in the incidence of diabetes in high-risk individuals.

Look AHEAD

A more recent analysis of the Action for Health in Diabetes (Look AHEAD) study by Gregg and colleagues examined the association of a long-term intensive weight-loss intervention with the frequency of remission of type 2 diabetes. This was a randomized controlled trial involving more than 4,500 participants followed for 4 years. All participants had type 2 diabetes and a BMI of at least 25 at the beginning of the study. They were randomly assigned to intensive lifestyle intervention or a standard lifestyle intervention.

The intensive intervention involved weekly counseling for the first 6 months, then three sessions per month for 6 months, followed by two sessions per month for remainder of study. The primary aim of the intensive group was a reduction in total caloric intake to 1,200 kcal/day to 1,800 kcal/day, along with 175 minutes/week of exercise.

The standard group received three counseling sessions per year focusing on diet, exercise and social support. The results showed that the intensive intervention group lost significantly more weight and had greater fitness increases. The intensive group also was more likely to achieve remission of their diabetes vs. the control group (7.3% vs. 2%, respectively). It should be noted that more patients achieved partial remission than complete remission. This lends some support to more intensive lifestyle interventions than what is commonly done for many patients with type 2 diabetes. 

Tomado de: Endocrine Today, December 2013 .    James R. Taylor, PharmD, CDE