Nuestros investigadores

Francisco Javier Escalada San Martín

Publicaciones científicas más recientes (desde 2010)

Autores: Rodríguez, José Antonio; Fernández-Seara, M. A.; et al.
ISSN 2045-2322  2020 
Matrix metalloproteinases have been implicated in diabetic microvascular complications. However, little is known about the pathophysiological links between MMP-10 and the renin-angiotensin system (RAS) in diabetic kidney disease (DKD). We tested the hypothesis that MMP-10 may be up-regulated in early stage DKD, and could be down-regulated by angiotensin II receptor blockade (telmisartan). Serum MMP-10 and TIMP-1 levels were measured in 268 type 2 diabetic subjects and 111 controls. Furthermore, histological and molecular analyses were performed to evaluate the renal expression of Mmp10 and Timp1 in a murine model of early type 2 DKD (db/db) after telmisartan treatment. MMP-10 (473¿±¿274¿pg/ml vs. 332¿±¿151; p¿=¿0.02) and TIMP-1 (573¿±¿296¿ng/ml vs. 375¿±¿317; p¿<¿0.001) levels were significantly increased in diabetic patients as compared to controls. An early increase in MMP-10 and TIMP-1 was observed and a further progressive elevation was found as DKD progressed to end-stage renal disease. Diabetic mice had 4-fold greater glomerular Mmp10 expression and significant albuminuria compared to wild-type, which was prevented by telmisartan. MMP-10 and TIMP-1 are increased from the early stages of type 2 diabetes. Prevention of MMP-10 upregulation observed in diabetic mice could be another protective mechanism of RAS blockade in DKD.
Autores: Frühbeck, Gema; Escalada, J, (Autor de correspondencia)
ISSN 2072-6643  Vol. 11  Nº 3  2019  págs. 677
Non-alcoholic fatty liver disease (NAFLD) is a major global health threat due to its growing incidence and prevalence. It is becoming the leading cause of liver disease in addition to its strong association with cardio-metabolic disease. Therefore, its prevention and treatment are of strong public interest. Therapeutic approaches emphasize lifestyle modifications including physical activity and the adoption of healthy eating habits that intend to mainly control body weight and cardio-metabolic risk factors associated with the metabolic syndrome. Lifestyle interventions may be reinforced by pharmacological treatment in advanced stages, though there is still no registered drug for the specific treatment of NAFLD. The purpose of this review is to assess the evidence available regarding the impact of dietary recommendations against NAFLD, highlighting the effect of macronutrient diet composition and dietary patterns in the management of NAFLD.
Autores: Martinez, S. B., (Autor de correspondencia); Jauregui, E. P.; Escalada, J;
ISSN 2530-0180  Vol. 66  Nº 1  2019  págs. 62 - 68
The important prevalence and morbidity of obesity has generated an increase in bariatric surgery. It has a positive effect in obesity-related comorbidities. However, it's detrimental to bone health. The underline pathophysiological mechanisms are complex and heterogeneous. The knowledge of these factors may lead us to develop an adequate therapeutic intervention.
Autores: Pérez-Pevida, Belén, (Autor de correspondencia); Núñez, Jorge María; Romero, S.; et al.
ISSN 1479-5876  Vol. 17  2019  págs. 48
Background and aims: Obesity is associated with impaired glucose tolerance which is a risk factor for cardiovascular risk. However, the oral glucose tolerance test (OGTT) is not usually performed in patients with normal fasting glycaemia, thus offering false reassurance to patients with overweight or obesity who may have post-prandial hyperglycaemia. As an alternative to resource demanding OGTTs, we aimed to examine the predictive value of anthropometric measures of total and central fat distribution for post-prandial hyperglycaemia in patients with overweight and obesity with normal fasting glycaemia enrolled in the DICAMANO study. Methods: We studied 447 subjects with overweight/obesity with a fasting glucose value <= 5.5 mmol l(-1) (99 mg dl(-1)) and BMI >= 25 kg/m(2) who underwent a 75-g OGTT. Post-prandial hyperglycaemia was defined as a glucose level >= 7.8 mmol l(-1) (140 mg dl(-1)) 2-h after the OGTT. The anthropometric measurements included body mass index, body adiposity index, waist circumference, neck circumference, waist-to-hip ratio and waist-to-height ratio. Results: The prevalence of post-prandial hyperglycaemia was 26%. Mean 1-h OGTT glucose levels, insulin resistance and beta cell dysfunction was higher in those subjects in the highest tertile for each anthropometric measurement, irrespective of fasting glucose level. Central fat depot anthropometric measurements were strongly and independently associated with an increased risk of post-prandial hyperglycaemia. After multivariable-adjustment for fasting plasma glucose level, smoking, and physical activity level, the odds ratio (95% confidence intervals) for the presence of post-prandial hyperglycaemia for neck circumference, waist circumference and waist-to-height ratio were 3.3 (1.4, 7.7), 2.4 (1.4, 4.4) and 2.5 (1.4, 4.5), respectively. Conclusions: In this large and comprehensively phenotyped cohort, one in four subjects had post-prandial hyperglycaemia despite normal fasting glycaemia. Anthropometric indices of central fat distribution were strongly and independently associated with an increased risk of post-prandial hyperglycaemia. These results support the association between central adiposity and glucose derangements and demonstrate the clinical usefulness of anthropometric measurements as screening tools for the selection of patients who are most likely to benefit from an OGTT.
Autores: Morillas, C. , (Autor de correspondencia); Escalada, J; Palomares, R.; et al.
ISSN 1869-6953  Vol. 10  Nº 5  2019  págs. 1893 - 1907
Introduction The aim of this Delphi study is to unveil the management of patients with type 2 diabetes (T2D) and different levels of complexity in the clinical practice in Spain. Methods Based on the common management practices of T2D profiles reported by Spanish endocrinologists, a Delphi questionnaire of 55 statements was developed and responded to by a national panel (n = 101). Results A consensus was reached for 30 of the 55 statements. Regarding overweight patients inadequately controlled with metformin, treatment with a sodium-glucose transport protein 2 inhibitor (SGLT2-I) is preferred over treatment with a dipeptidyl peptidase-4 inhibitor (DPP4-I). If the patient is already being treated with a DPP4-I, an SGLT2-I is added on to the treatment regimen rather than replacing the DPP4-I. Conversely, if the treatment regimen includes a sulfonylurea, it is usually replaced by other antihyperglycemic agents. Current treatment trends in uncontrolled obese patients include the addition of an SGLT2-I or a glucagon-like peptide-1 receptor agonist (GLP1-RA) to background therapy. When the glycated hemoglobin target is not reached, triple therapy with metformin + GLP1-RA + SGLT2-I is initiated. Although SGLT2-Is are the treatment of choice in patients with T2D and heart failure or uncontrolled hypertension, no consensus was reached regarding the preferential use of SGLT2-Is or GLP1-RAs in patients with established cardiovascular disease. Conclusion Consensus has been reached for a variety of statements regarding the management of several T2D profiles. Achieving a more homogeneous management of complex patients with T2D may require further evidence and a better understanding of the key drivers for treatment choice. Funding Logistic support was provided by ESTEVE Pharmaceuticals S.A Spain.
Autores: Reyes-Garcia, R., (Autor de correspondencia); Moreno-Perez, O. ; Tejera-Perez, C. ; et al.
ISSN 2530-0180  Vol. 66  Nº 7  2019  págs. 443 - 458
Objective: Treatment of type 2 diabetes mellitus (T2DM) is complex and is intended to decrease morbidity and mortality. Management should therefore include adequate diabetes education, lifestyle changes, drug treatment to achieve early blood glucose control and reduction of cardiovascular (CV) risk factors, early detection and treatment of complications, and assessment of associated comorbidities. The objective was to prepare a document including all aspects required for a comprehensive approach to T2DM. Participants: Members of the Diabetes Mellitus Working Group of the Spanish Society of Endo-crinology. Methods: The available evidence regarding each aspect of diabetes management (blood glucose control goals, diet and exercise, drug treatment, risk factor management and control, detection of complications, and management of frail patients) was reviewed. Recommendations were formulated based on the grades of evidence stated in the 2018 Standards of Medical Care in Diabetes. Recommendations were discussed and agreed by the working group members. Conclusions: This document is intended to provide evidence-based practical recommendations for comprehensive management of T2DM by clinical endocrinologists.
Autores: Pedro-Botet, J., (Autor de correspondencia); Ascaso, J. F.; Barrios, V. ; et al.
ISSN 1178-7007  Vol. 11  2018  págs. 683 - 697
Metabolic syndrome (MetS), a disorder with a high and growing prevalence, is a recognized risk factor for cardiovascular disease (CVD) and type 2 diabetes. It is a constellation of clinical and metabolic risk factors that include abdominal obesity, dyslipidemia, glucose intolerance, and hypertension. Unfortunately, MetS is typically underrecognized, and there is great heterogeneity in its management, which can hamper clinical decision-making and be a barrier to achieving the therapeutic goals of CVD and diabetes prevention. Although no single treatment for MetS as a whole currently exists, management should be targeted at treating the conditions contributing to it and possibly reversing the risk factors. All this justifies the need to develop recommendations that adapt existing knowledge to clinical practice in our healthcare system. In this regard, professionals from different scientific societies who are involved in the management of the different MetS components reviewed the available scientific evidence focused basically on therapeutic aspects of MetS and developed a consensus document to establish recommendations on therapeutic goals that facilitate their homogenization in clinical decision-making.
Autores: Pérez-Pevida, Belén; Diaz-Gutierrez, J.; Miras, A. D.; et al.
Revista: OBESITY
ISSN 1930-7381  Vol. 26  Nº 4  2018  págs. 672 - 682
ObjectiveThe objective of this study was to assess the utility of the 2-hour oral glucose tolerance test (OGTT) value to discriminate between different cardiometabolic profiles and examine the role of body composition in predicting the associated increased risk for glucose impairment, beta-cell dysfunction, and cardiovascular disease (CVD). MethodsSubjects with normal fasting glucose completed a 2-hour OGTT and were categorized to the carbohydrate metabolism alterations (CMAs) or the control group based on a 2-hour glucose threshold of 7.8 mmol/L. Body composition, visceral adipose tissue, OGTT-based parameters, and cardiovascular risk factors (CVRFs) such as hypertension, dyslipidemia, obstructive sleep apnea, nonalcoholic fatty liver disease, and smoking status were measured. ResultsSubjects with CMAs exhibited a significantly higher 1-hour postload glucose level and a greater decline in beta-cell function and CVRF profiles. After multivariate adjustment, an excess of total body and visceral fat was associated with an increased risk of CMAs, beta-cell dysfunction, CVRFs, and lower whole-body insulin sensitivity. ConclusionsThese data support the etiopathogenic role of body and visceral fat in the development of glucose derangements and CVRFs early on in the metabolic dysregulation process. Thus, body composition analysis and OGTT assessment performed in individuals with normal fasting glucose enable a better identification of patients at risk of developing type 2 diabetes and CVD.
Autores: Twigg, S. M., (Autor de correspondencia); Escalada, J; Stella, P. ; et al.
ISSN 1869-6953  Vol. 9  Nº 5  2018  págs. 2043 - 2053
To examine the association of baseline patient characteristics with study outcomes in people with type 2 diabetes receiving insulin glargine 300 U/mL (Gla-300) versus glargine 100 U/mL (Gla-100), over a 6-month period. A post hoc patient-level meta-analysis using data from three multicenter, randomized, open-label, parallel-group, phase 3a studies of similar design, in people previously receiving either basal and prandial insulin, basal insulin + oral antihyperglycemic drugs, or no prior insulin (EDITION 1, 2 and 3, respectively). The endpoints, glycated hemoglobin (HbA(1c)), hypoglycemia, body weight change, and insulin dose were investigated by subgroups: age (< 65 and 65 years), body mass index (BMI; < 30 and 30 kg/m(2)), age at onset (< 40, 40-50, and > 50 years), and diabetes duration (< 10 and 10 years). Reduction in HbA(1c) was comparable between insulins, regardless of subgroup. The lower risk of 1 nocturnal (00:00-05:59 h) confirmed ( 3.9 mmol/L [ 70 mg/dL]) or severe hypoglycemic event with Gla-300 versus Gla-100 was also unaffected by participant characteristics. While heterogeneity of treatment effect between diabetes duration subgroups was seen for the risk of 1 confirmed ( 3.9 mmol/L [ 70 mg/dL]) or severe hypoglycemic event at any time (24 h), treatment effect consistently favored Gla-300; no evidence of heterogeneity was observed for the other subgroups. Annualized rates of confirmed ( 3.9 mmol/L [ 70 mg/dL]) or severe hypoglycemia and body weight change were not influenced by participant characteristics; a similar pattern was observed with insulin dose. Comparable glycemic control was observed with Gla-300 versus Gla-100, with less hypoglycemia, regardless of age, BMI, age at onset or diabetes duration. Sanofi. Plain language summary available for this article.
Autores: Escalada, J, (Autor de correspondencia); Halimi, S.; Senior, P. A. ; et al.
ISSN 1462-8902  Vol. 20  Nº 12  2018  págs. 2860 - 2868
Aim Materials and Methods To investigate the impact of renal function on the safety and efficacy of insulin glargine 300 U/mL (Gla-300) and insulin glargine 100 U/mL (Gla-100). A meta-analysis was performed using pooled 6-month data from the EDITION 1, 2 and 3 trials (N = 2496). Eligible participants, aged >= 18 years with a diagnosis of type 2 diabetes (T2DM), were randomized to receive once-daily evening injections of Gla-300 or Gla-100. Pooled results were assessed by two renal function subgroups: estimated glomerular filtration rate (eGFR) Results Conclusions The decrease in glycated haemoglobin (HbA1c) after 6 months and the proportion of individuals with T2DM achieving HbA1c targets were similar in the Gla-300 and Gla-100 groups, for both renal function subgroups. There was a reduced risk of nocturnal (12:00-5:59 am) confirmed (<= 3.9 mmol/L [<= 70 mg/dL]) or severe hypoglycaemia with Gla-300 in both renal function subgroups (eGFR <60 mL/min/1.73 m(2): relative risk [RR] 0.76 [95% confidence interval {CI} 0.62-0.94] and eGFR >= 60 mL/min/1.73 m(2): RR 0.75 [95% CI 0.67-0.85]). For confirmed (<= 70 mg/dL [<= 3.9 mmol/L]) or severe hypoglycaemia at any time of day (24 hours) the hypoglycaemia risk was lower with Gla-300 vs Gla-100 in both the lower (RR 0.94 [95% CI 0.86-1.03]) and higher (RR 0.90 [95% CI 0.85-0.95]) eGFR subgroups. Gla-300 provided similar glycaemic control to Gla-100, while indicating a reduced overall risk of confirmed (<= 3.9 and <3.0 mmol/L [<= 70 and <54 mg/dL]) or severe hypoglycaemia, with no significant difference between renal function subgroups.
Autores: Gomez-Peralta, F. , (Autor de correspondencia); Escalada, J; Torre, E. M.; et al.
ISSN 2530-0180  Vol. 65  Nº 10  2018  págs. 611 - 624
Type 2 diabetes mellitus (DM2) has become a problem of global dimensions by their high and growing prevalence worldwide and the personal and economic costs associated with it. Correct treatment can reduce mortality and associated complications. New concepts have recently been included in routine clinical practice and have changed the algorithm of DM2 pharmacological therapy. Therefore, the Spanish Society of Diabetes (SED) entrusted to the Working Group of Consensus and Clinical Guidelines an update of the 2010 document Recommendations for Pharmacological Treatment of Hyperglycemia in Diabetes type 2. Novel aspects include nine characteristics to describe each drug group: efficiency, the risk of hypoglycemia, effects on body weight, the demonstrated effect in cardiovascular risk, nephroprotection, limitation of use in renal insufficiency, the rate of secondary effects, complexity and costs. Additionally, the document details combination options, and develop the start and adjustment of available injectable therapies. (C) 2018 SEEN y SED. Published by Elsevier Espana, S.L.U. All rights reserved.
Autores: Borras, J. G., (Autor de correspondencia); Escalada, J; Cases, M. M. ; et al.
ISSN 2530-0180  Vol. 65  Nº Supl.1  2018  págs. 1 - 8
Autores: Fernández-Seara, M. A.; et al.
ISSN 0931-0509  Vol. 33  Nº Supl. 1  2018  págs. SP453
Autores: Escalada, J; Bonnet, F.; Wu, J. ; et al.
ISSN 1098-3015  Vol. 21  Nº Supl. 3  2018  págs. S120 - S120
Autores: Raccah, D; Huet, D ; Dib, A; et al.
ISSN 0742-3071  Vol. 34  Nº 9  2017  págs. 1193-1204
AIMS: To identify simple insulin regimens for people with Type 2 diabetes mellitus that can be accepted and implemented earlier in primary and specialist care, taking into consideration each individual's needs and capabilities. METHODS: Using randomized clinical trials identified by a search of the PubMed database, as well as systematic reviews, meta-analyses and proof-of-concept studies, this review addresses topics of interest related to the progressive intensification of a basal insulin regimen to a basal-plus regimen (one basal insulin injection plus stepwise addition of one to three preprandial short-acting insulin injections/day) vs a basal-bolus regimen (basal insulin plus three short-acting insulin injections per day) in people with Type 2 diabetes. The review explores approaches that can be used to define the meal for first prandial injection with basal-plus regimens, differences among insulin titration algorithms, and the importance of self-motivation and autonomy in achieving optimum glycaemic control. RESULTS: A basal-plus regimen can provide glycaemic control equivalent to that obtained with a full basal-bolus regimen, with fewer injections of prandial insulin. The first critical step is to optimize basal insulin dosing to reach a fasting glucose concentration of ~6.7 mmol/l; this allows ~40% of patients with baseline HbA1c >75 mmol/mol (9%) to be controlled with only one basal insulin injection per day. CONCLUSIONS: Compared with a basal-bolus regimen, a basal-plus insulin regimen is as effective but more practical, and has the best chance of acceptance and success in the real world.
Autores: Collantes M; Quincoces, Gemma; et al.
ISSN 1824-4785  Vol. 61  Nº 4  2017  págs. 447 - 455
Background: The feasibility of beta cell mass (BCM) imaging and quantification with positron emission tomography (PET) in the pancreas is controversial. In an effort to shed some light on this topic, we have used a xenograft model of rat insulinoma (RIN) in mice, mimicking an intramuscular islet transplantation situation. Methods: A total of 105 RIN cells were subcutaneously implanted in nude mice (N.=8). Tumor size and glycaemia levels were determined daily. Rat C-peptide was measured to demonstrate rat insulin production. PET imaging with 11C-(+)-¿-dihydrotetrabenazine (11C-DTBZ) was done at 3 and 4 weeks and compared with 18F-FDG and 18F-DOPA studies in the same mice. Ex-vivo autoradiography with 11C-DTBZ was carried out in frozen sections of tumors. VMAT2 expression was measured by Western-blot and immunohistochemistry in tumors and RIN cells. Results: Functional rat insulin production in mice was demonstrated by substantial decrease in glycaemia (<50 mg/dL by week 4) and rat C-peptide levels (7.2±2.6 ng/mL) similar to those measured in control rats. PET studies showed that tumor imaging with 11C-DTBZ at four (N.=8) and five (N.=5) weeks was negative; only bigger tumors could be seen with 18F-DOPA. In explanted tumors 11C-DTBZ autoradiography was negative, albeit VMAT2 expression measured by Western-blot and immunohistochemistry was lower than in cultured RIN cells. Conclusions: Although insulinomas are fully functional it does not seem feasible to use 11C-DTBZ for in-vivo measuring of BCM. This might either be due to inherent technical limitations of PET, decrease in VMAT2 expression in the tumors due to unknown reasons, or other biological limiting facts.
Autores: Gómez-Ambrosi, J; Valentí, Víctor; et al.
ISSN 0307-0565  Vol. 41  Nº 9  2017  págs. 1379 - 1387
BACKGROUND/OBJECTIVES: Body weight, body mass index (BMI) and excess weight loss (EWL) are the most frequently used measures to analyse bariatric surgery outcomes. However, these measurements do not provide accurate information on body composition (BC) with body fat (BF), importantly determining the levels of cardiometabolic risk factors. Our aim was to analyse the evolution of BC after Roux-en-Y Gastric Bypass (RYGB) and its influence on the changes of cardiometabolic risk factors in comparison to BMI and EWL. SUBJECTS/METHODS: A group of 81 obese Caucasian patients (19 males/62 females) aged 44.9 +/- 1.3 years undergoing RYGB between January 2006 and December 2011 was prospectively followed up for a period of 3 years. BC was determined by air-displacement plethysmography. Visceral adiposity, physical activity and cardiometabolic risk factors were measured. RESULTS: BF was markedly (P < 0.001) reduced after the first year, increasing progressively during the second and third years after RYGB, following a different trajectory than body weight, BMI and EWL that decreased up to the second year post surgery. Markers of glucose homeostasis decreased during the first month and continued to decrease during the first year (P < 0.05), remaining stabilised or slightly increased between the second and third years following RYGB. However, markers of lipid metabolism decreased (P < 0.05) markedly during the first 12 months, increasing thereafter in parallel to the changes observed in BC, with the exception of high-density lipoprotein-cholesterol, which increased progressively throughout the whole period analysed. CONCLUSIONS: The adverse switch in the changes in BC between the first and the second years after RYGB may underlie the changes observed in cardiometabolic risk factors. Tracking of adiposity during the follow-up of bariatric/metabolic surgery yields clinically relevant information to better identify patients in need of increased lifestyle advice or treatment intensification.
Autores: Pérez-Pevida, Belén, (Autor de correspondencia); Varela, N.; et al.
ISSN 1137-6627  Vol. 40  Nº 3  2017  págs. 413 - 420
Background. Achieving an adequate control of glycaemic and cardiovascular risk factors (CVRFs) is essential in patients with type 2 diabetes mellitus (T2DM). However, several studies have shown that the percentage of patients achieving these goals is scarce. We evaluated the degree of control of CVRFs target goals in T2DM patients who regularly attend a specialized diabetic clinic. Methods. We studied T2DM patients who attended the specialized Diabetic Unit at the Department of Endocrinology of Clinica Universidad de Navarra with a minimum follow-up of one year. Clinical characteristics, chronic complications and treatments were collected and patients were classified into groups according to the fulfilment of target glycated haemoglobin (HbA1c), LDL cholesterol and blood pressure (BP) levels, predefined according to the presence of different comorbidities and the duration of T2DM. Results. We analysed 137 patients (75% men) with T2DM, with an average age of 67 years and a 12.7 year duration of diabetes. During follow-up, 83.9% of the patients were within the individualized HbA1c target, 76.6% considering BP and 67.2% in terms of LDL-cholesterol. In addition, 68% had concomitantly the three main variables within the target. Conclusions. In our population of T2DM, HbA1c, LDL cholesterol and BP targets were achieved in a substantial proportion of patients (67-91%). Perhaps the intense and individualized care offered through a specialized diabetes unit may explain these results.
Autores: Garcia-Fernandez, N; et al.
ISSN 1053-1807  Vol. 46  Nº 6  2017  págs. 1810-1817
To investigate whether arterial spin labeling (ASL) MRI could detect renal hemodynamic impairment in diabetes mellitus (DM) along different stages of chronic kidney disease (CKD).
Autores: Pérez-Pevida, B. ; Romero, S.; Silva, Camilo; et al.
ISSN 0012-186X  Vol. 60  Nº Supl 1  2017  págs. S571
Autores: Varo, N; Escalada, J; et al.
ISSN 1575-0922  Vol. 63  Nº 9  2016  págs. 495 - 501
La diabetes mellitus tipo 2 es una patología con una enorme prevalencia y morbilidad, que van en aumento. La fractura osteoporótica se encuentra entre las denominadas complicaciones «no clásicas» de la diabetes y ha sido durante tiempo ignorada, tal vez por su complejo abordaje tanto diagnóstico como terapéutico. Las herramientas habituales para la prevención de la fractura por fragilidad, como el FRAX y la densitometría ósea, no han demostrado la suficiente eficacia en estos pacientes, ya que infraestiman el riesgo. Nuevas técnicas de evaluación ósea, como el trabecular bone score o los marcadores de remodelado óseo, podrían ser de utilidad, aunque requieren una mayor evidencia científica para recomendar su uso en la práctica clínica habitual. Las características especiales de su fisiopatología condicionan la aparición de fracturas sin existir alteraciones densitométricas, en lo que podemos calificar de «paradoja diabética».
Autores: Pons-Villanueva, Juan; Escalada, J;
ISSN 1756-1841  Vol. 19  Nº 12  2016  págs. 1226-36
Shoulder stiffness is associated with diabetes mellitus. It is characterized by pain and restriction of active and passive range of motion. Like other complications of diabetes (e.g., arterial stiffness, pancreatic or renal fibrosis), shoulder stiffness is due to a fibrotic process. The clinical course is generally benign, but it can last for months, with remaining disabilities in the long term. Several possibilities of treatment are being used. The practitioner should be aware of this complication, its natural history, and the current treatments available in order to adequately tailor the best treatment to the patient, sometimes combining more than one option.
Autores: Pérez-Pevida, Belén; Idoate, Miguel Ángel; Fernández, Sara; et al.
ISSN 1046-3976  Vol. 27  Nº 1  2016  págs. 50 - 54
The most common cause of organic fasting hypoglycemia in adults is the presence of an insulin-producing pancreatic adenoma, but when high insulin levels are not found, the differential diagnosis is challenging. Misdiagnosis can lead to an unnecessary pancreatectomy. Insulin concentrations may be low in some cases despite a clinical history suggestive of insulinoma. In these cases, a proinsulinoma should be suspected, although the rarity of this condition requires an extensive workup before reaching a final diagnosis. We describe an unusual case of a 38-year-old man with a severe hypoglycemic syndrome due to a proinsulin-secreting pancreatic adenoma. Insulin was measured by the specific assay and suppressed under the lower detection limit during fasting hypoglycemia. Serum proinsulin and C-peptide levels were abnormally elevated, and further tests revealed an islet cell tumor. The tumor was surgically removed, relieving the fasting hypoglycemia. Histopathological study showed a conventional well-differentiated neuroendocrine tumor with high immunoreactivity against proinsulin and with lesser intensity against insulin. Interestingly, GS-9A8 antibody clone used for immunostaining proinsulin did not cross-react with human insulin or C-peptide, providing an unbiased picture of proinsulin secretion. The resolution of symptoms, the fall of proinsulin concentrations after tumor removal and the histopathology study confirmed the diagnosis of proinsulinoma
Autores: Escalada, J; Orozco-Beltran, D.; Morillas, C.; et al.
ISSN 0168-8227  Vol. 122  2016  págs. 46 - 53
Aims: To describe the views of healthcare providers about starting insulin in patients with type 2 diabetes and to determine the specific factors that contribute to delay insulin initiation. Methods: Two-phases observational descriptive study. In the quantitative phase we conducted a cross-sectional survey of a sample of 380 healthcare professionals (general practitioners (GPs), endocrinologists, internists and nurses). In the qualitative phase, a discussion group reviewed the results of the survey to propose solutions. Results: In poorly controlled patients, 46% of GPs vs. 43.2% of internists and 31.3% of endocrinologists waited 3-6 months before starting insulin, and 71.4% of GPs vs. 66.7% of internists vs. 58.8% of endocrinologists need to confirm twice the HbA1c levels. The upper level of basal glucose more frequently considered as good control is 130 mg/dL for GPs (35.7%), and 120 mg/dL for internists (35.8%) and endocrinologists (37.5%). In patients without comorbidities, 32.5% of endocrinologists vs. 27.2% of internists vs. 17.9% of GPs initiated insulin when HbA1c was > 7% while 26.3% of endocrinologists vs. 28.4% of internists vs. 38.4% of GPs initiated insulin when HbA1c was > 8%. The interference of the therapy with the patient' social life and the need for time management were the most accepted barriers to initiate insulin. Conclusions: There are significant differences between GPs and endocrinologists regarding the insulin initiation and GPs and internists felt less empowered to manage patients with diabetes. Specific training for professionals and joint work with patients could improve the glycemic control. (C) 2016 The Authors. Published by Elsevier Ireland Ltd.
Autores: Pérez-Pevida, Belén; Escalada, J; Romero, S. ; et al.
ISSN 0012-186X  Vol. 59  Nº Supl.1  2016  págs. S142
Autores: Gómez-Ambrosi, J; Moncada, Rafael; Valentí, Víctor; et al.
ISSN 0960-8923  Vol. 25  Nº 9  2015  págs. 1594-1603
The present study provides evidence for the existence of an adverse cardiometabolic profile in subjects currently considered to be outside traditional NIH guidelines but exhibiting a highly increased adiposity. It is concluded that body composition analysis yields valuable information to be incorporated into indication criteria for BS and that adiposity may be an independent indicator for BS.
Autores: Pérez-Pevida, Belén; Pascual, Eider; et al.
ISSN 1575-0922  Vol. 62  2015  págs. 106 - 107
Autores: Pérez-Pevida, Belén; et al.
ISSN 1134-3230  Vol. 31  2015  págs. 35
Autores: Sancho, Lidia; Guillen Valderrama, E; Garcia-Velloso, Maria Jose; et al.
ISSN 0161-5505  Vol. 56  Nº Supl.3  2015  págs. 1273
Autores: Pérez-Pevida, Belén; Pascual, Eider; et al.
ISSN 1134-3230  Vol. 31  Nº Especial Congreso  2015  págs. 150-1
Nuestra inercia terapéutica es baja y conseguimos una aceptable mejoría sobre la PA y el PC tras la intervención, aunque quedaría por mejorar el patrón nocturno de la PA. Esto remarca la importancia del Holter en el control global de la PA.
Autores: Pérez-Pevida, Belén; Sancho, Lidia; Guillen Valderrama, E; et al.
ISSN 0012-186X  Vol. 58  Nº Supl. 1  2015  págs. 342
Autores: Sancho, Lidia; Guillen Valderrama, E; Pérez-Pevida, Belén; et al.
ISSN 2253-8070  Vol. 34  Nº Supl.1  2015  págs. 79
Conclusiones: La interrupción de M 48h fue mejor que 24h para la reducción de la CI de 18F-FDG en pacientes con DM2 y mejoró significativamente la calidad de los estudios 18F-FDG-PET/CT. Aunque la glucemia aumentó tras la interrupción de M, permaneció en rangos aceptables.
Autores: Pascual, Eider; Galofre, Juan Carlos; Pérez-Pevida, Belén; et al.
ISSN 1575-0922  Vol. 62  Nº Supl  2015  págs. 20
Autores: Pascual, Eider; Aubá, María; et al.
ISSN 1575-0922  Vol. 61  Nº 7  2014  págs.  377-381
The presence of thyroid autoimmunity in women with TSH above the recommended values at the beginning of pregnancy is not associated to development of GD. However, GD prevalence was higher in these patients as compared to the Spanish general population, suggesting the need for closer monitoring in pregnant women with TSH levels ¿ 2.5 mU/mL.
Autores: Pascual, Eider; Guillén-Grima, F; et al.
ISSN 0163-769X  Vol. 35  Nº 3 Supl.  2014  págs. MON-0493
The relationship between metformin, thyroid function, and thyroid volume has been of interest to many investigators. A number of studies have consistently reported a TSH-lowering effect of metformin in hypothyroid patients. In addition, some previous reports found that metformin, alone or in combination with levothyroxine, shrank thyroid nodules in diabetic individuals with insulin resistance. Furthermore, other authors showed an anti-goitrogenic effect of metformin on subjects with type 2 diabetes (T2DM). Unfortunately, literature on the association between T2DM and thyroid volume is sparse. We designed a two-group retrospective study with euthyroid T2DM patients treated with metformin (Group A) or with other anti-diabetes agents (Group B). Examined were basal TSH (mU/mL), HbA1c (%), BMI (kg/m2), and thyroid nodule size (mm) assessed by sonography. The same examinations were repeated one year later. Exclusion criteria included the following conditions: type 1 diabetes, thyroid dysfunction, levothyroxine or antithyroid treatment, and corticoid therapy. Results from Groups A and B were compared using the Student¿s t and the Mann-Whitney U tests. A total of 63 nodules were analyzed. Group A included 31 nodules from 18 patients. Group B included 32 nodules from 15 patients. Groups A and B pre-TSH levels were 1.62± 1.19 and 2.06± 1.28, respectively; we found no statistically significant differences between them (p=0.164). Groups A and B post-TSH levels were 1.34± 0.87 and 1.99± 1.33, respectively; we observed a statistically significant difference between them (p=0.003). Groups A and B basal nodules mean size were 17.31± 9.97 and 12.45± 8.12, respectively. After one year of treatment, Groups A and B nodules mean size were 17.97± 10.31 and 12.90±7.92, respectively; we did not observe a statistically significant difference between them (p=0.961). We observed no statistically significant difference between Groups A and B in pre- and post-BMI, HbA1c, T2DM duration (data not shown). No patient in Group B was treated with glitazones. Conclusions: Thyroid nodule size in euthyroid patients with T2DM diabetes remained unchanged following treatment with metformin for one year despite changes in TSH levels. Nothing to Disclose: EP, GG, FG, BP, PA, JL, JE, JS, JCG - See more at:
Autores: Pérez-Pevida, Belén; Pascual, Eider; et al.
ISSN 1134-3230  Vol. 30  2014  págs. 61
Introducción: Se ha demostrado que la intervención intensiva sobre factores de riesgo cardiovascular (FRCV) en diabetes mellitus tipo 2 (DM2) reduce y retrasa la aparición de complicaciones micro y macrovasculares. Objetivos: Evaluar el grado de control de los FRCV en pacientes con DM2 que acuden con regularidad a consulta. Material y métodos: Pacientes con DM2 recogidos consecutivamente entre mayo-diciembre de 2013. Los datos estudiados son los de la consulta actual. Tiempo medio de atención/paciente 45 minutos con media de dos revisiones anuales, distribución geográfica nacional y seguimiento mediante telemedicina. Objetivos de hemoglobina glicosilada (HbA1c), perfil lipídico y presión arterial (PA) predefinidos según comorbilidades y años de evolución de DM2: HbA1c < 6,5% (Grupo 1: < 70 años, sin complicaciones y con un tiempo de evolución < 5 años) o < 7,5% (Grupo 2: resto +: MDRD < 60, cardiopatía isquémica (CI) inestable, neuropatía autonómica, arteriopatía periférica significativa, hipoglucemias severas asintomáticas o expectativa corta de vida). Perfil lipídico: HDL > 50 mg/dL (M) o > 40 mg/dL (H), triglicéridos < 150 mg/dL y LDL < 70 o < 100 mg/dL, según presencia o no de enfermedad CV (CI, enfermedad cerebrovascular, arteriopatía periférica, macroalbuminuria o microalbuminuria asociada a hipertensión o tabaquismo). Presión arterial < 140/90 mmHg. Resultados: Características de la población: 137 pacientes (75% hombres/25% mujeres), 67 años de edad media y 12,7 años de evolución de DM2. 12,4% fumadores activos. El 15% con medidas higiénico-dietéticas, 50% antidiabéticos orales (ADO), 35% insulina (54% con ADO, 46% con sólo insulina). Tratamiento antihipertensivo el 80% (15% calcioantagonista, 13% betabloqueante, 12% IECA, 27% ARAII y 33% combinación con diurético), hipolipemiante el 84,6% (72% estatinas/28% estatinas + ezetimibe) y antiagregante en 48%. Variables dentro del objetivo (tabla): Objetivo de HbA1c: 74,5%. PA: el 76,6% presentaba una cifra de PA < 140/90 mmHg. Objetivo de LDL: 67,2%; triglicéridos: 81,3%; colesterol No-HDL: 79%; HDL: 87%. El 68% con tres variables principales dentro del objetivo: HbA1c, PA y LDL colesterol. Función renal y albuminuria: 78% sin albuminuria con MDRD medio de 89 mL/min/1,73 m2, 12,5% microalbuminuria con MDRD medio de 84,3 y 9,5% macroalbuminuria con MDRD medio de 54,5. Dentro del objetivo Si No HbA1c Grupo 1: 8 (media = 5,7%) Grupo 1: 0 Grupo 2: 103 (media = 6,7%) Grupo 2: 26 (media = 8,9%) Presión arterial 105 32 Lípidos (LDL) < 70 mg/dL: 28 (media = 51 mg/dL) < 70 mg/dL: 27 (media = 88,7 mg/dL) < 100 mg/dL: 64 (media = 65,3 mg/dL) < 100 mg/dL: 18 (media = 123 mg/dL) Conclusiones: En nuestra población de DM2 la consecución de objetivos de HbA1c, perfil lipídico y PA se alcanzó en una importante proporción de pacientes (67-87%; media = 77,4%). Quizá la intensa e individualizada atención ofrecida puede explicar estos resultados.
Autores: Pascual, Eider; Pérez-Pevida, Belén; et al.
ISSN 1575-0922  Nº 61  2014  págs. 108
Autores: Pascual, Eider; Pérez-Pevida, Belén; et al.
ISSN 1575-0922  Vol. 61  2014  págs. 112
Autores: Pérez-Pevida, Belén; Pascual, Eider; et al.
ISSN 1134-3230  Vol. 30  2014  págs. 64
Introducción: Estudios recientes ponen en duda la efectividad clínica y el coste-efectividad del autoanálisis de glucemia capilar (GC). Evaluamos la utilidad del autoanálisis de GC, para predecir la hemoglobina glicosilada (HbA1c) y detectar hipoglucemias, situación asociada a eventos cardiovasculares. Objetivos: Analizar la utilidad del autocontrol para predecir la cifra de HbA1c. Cuantificar la prevalencia de hipoglucemias en pacientes diabéticos tipo 1 y tipo 2 asociada a los distintos tipos de tratamientos antidiabéticos. Material y métodos: Descargas de glucómetros de pacientes en seguimiento en nuestra consulta. 1. Correlación entre GC y HbA1c. Se han estudiado 123 descargas de diabéticos tipo 1 con > 3.6 controles diarios, con pauta bolo-basal o ISCI. Se ha estudiado la GC media en el 1er, 2º, 3er mes y su asociación con la glucemia media estimada a través de la HbA1c (coeficiente de correlación de Pearson). 2. Detección de hipoglucemias. Se han estudiado 100 pacientes diabéticos tipo 1 y tipo 2, divididos según el tratamiento: antidiabéticos orales (ADO) no hipoglucemiantes e hipoglucemiantes o insulina (premezclada o pauta bolo-basal). Se han recogido de la historia clínica las hipoglucemias severas reportadas (HSR) en la consulta. Se ha estudiado la prevalencia de hipoglucemias según el tratamiento y la correlación con las HSR. Hemos realizado un estudio descriptivo y un estudio de regresión logística. Resultados: Relación entre GC y HbA1c. Observamos asociación positiva y significativa entre la GC media de las descargas y la glucemia media estimada a través de la HbA1c con un coeficiente de correlación de Pearson (r) de 0,588. Esta asociación es más fuerte entre la GC media del tercer mes y la HbA1c (r = 0,599). La media de GC (X) del tercer mes predice la cifra de HbA1c (Y): Y = 71,7 + 0,606 X. Estudio de hipoglucemias. El 4,5% de los diabéticos tipo1 han tenido algún episodio de HSR y según las descargas, el 41,5% ha tenido cifras < 50 mg/dL, 37% cifras 50-70 mg/dL y 21,5% ambas. Ningún diabético tipo 2 tuvo HSR, sin embargo, el 5,4% según el glucómetro ha tenido cifras < 50 mg/dL, en tratamiento con insulina ± ADO y 19,5% cifras de GC entre 51-70 mg/dl (11,7% con ADO no hipoglucemiante, 29% con ADO hipoglucemiante y 59,3% con insulina). Existe una asociación positiva y significativa entre las HSR y las hipoglucemias observadas según glucómetro (r = 0,531). Conclusiones: Nuestro estudio confirma la utilidad del autoanálisis en un doble sentido: como predictor de HbA1c en pacientes que realicen > 3,6 controles/día y para detectar un número importante de hipoglucemias, la mayoría asintomáticas, situación potencialmente relacionada con eventos cardiovasculares. Ambos pueden ayudar a mejorar el control glucémico en nuestros pacientes diabéticos.
Autores: Pascual, Eider; Pérez-Pevida, Belén; et al.
ISSN 1470-3947  Vol. 35  2014 
Obstructive sleep apnoea (OSA) is very common in severe obese patients and has been related to insulin resistance (IR) and hyperleptinemia, and these findings may have effects on food behavior and obesity complications. In order to explore this relationship and the role of sex we have studied 531 patients with morbid obesity (BMI 42.8+6.5 kg/m2). A full polysomnographic study and glucose, insulin and leptin measurements as well as air displacement plethysmography were performed in all of them. Ninety-six obese patients (BMI 45,8+7.3 kg/m2) with OSA were evaluated before and immediately after nocturnal CPAP treatment for 24 h. About 370 out of 531 patients had OSA (AHI 37.7+28/h). OSA patients had higher glucose (108+29 vs 99+26 mg/dl.P<0.001), insulin plasma levels (20+12 vs 16+10 (mu/l.P<0.001) and HOMA index (HOMAi) values (5.5+4.1 vs 4+2.8.P<0.001), but lower leptin levels (45.4+27 vs 55.5+28 ng/ml.P<0.001) and lower fat mass (48.9+7.5 vs 50.5+6.6%.P<0.05) than non-OSA patients. When compared with basal conditions, as a whole group (n=96) CPAP administration was followed by a reduction in glucose (108.3+29.4 vs 115+33.7.P<0.001), and insulin values (21.4+16.4 vs 23.8+16.3 mU/l.P<0.01) without any change in leptin concentrations (49.9+31.3 vs 50+32.3 mU/l. P=NS). Male patients (n=52) showed reductions in glucose values (109.1+22.3 vs 116+26.3 mg/dl.P<0.01) and HOMAi (5.8+3.2 vs 7+4.9.P<0.05). However, no changes either in glucose (PreM: 112+49.7 vs 114+52 mg/dl.P=NS), insulin values or HOMAi (5.1+3.9 vs 6.4+4.8.P=NS) were seen in PreM women following CPAP. In contrast, postmenopausal women (PostM; n=21) showed a reduction in glucose (102.9+17.8 vs 113+28.8 mg/dl.P<0.01), insulin (18.1+11.3 vs 23.5+17.5 mU/L.P<0.05) and HOMAi (4.9+4.2 vs 7.1+8.1.P<0.05) with no variation in leptin values (67+25.3 vs 65+31.9 ng/ml.P=NS) after CPAP. There was no correlation between reduction in apnoea index and decrease in HOMA index after CPAP in any of the subgroups. These data indicate that either OSA in itself or its correction by CPAP has no effects on leptin secretion in patients with morbid obesity. Globally, OSA potentiates IR, but acute correction of OSA by CPAP has more beneficial effects in PostM women and men than in PreM women.
Autores: Veas López, A. B.; Pérez-Pevida, Belén; et al.
ISSN 0033-8338  Vol. 56  2014  págs. 1800
Objetivo docente: Mostrar la utilidad de la extracción de muestras sanguíneas de los senos petrosos en el diagnóstico de la enfermedad de Cushing (EC). Describir la técnica e ilustrar la anatomía de los senos petrosos y sus variantes. Valorar posibles complicaciones durante yposprocedimiento. Analizar la interpretación de los resultados obtenidos ya que son de gran importancia pues condicionan el tratamiento a seguir. Revisión del tema: La toma bilateral de muestras sanguíneas de los senos petrosos antes y después de la estimulación con hormona corticotropa es una técnica que ofrece alta sensibilidad (96%) y especificidad (100%) para diferenciar la EC de un síndrome ACTH-ectópico. El procedimiento se realiza mediante la cateterización de las venas femorales, emplazando los catéteres (calibre 4F) en ambos senos petrosos inferiores y obteniéndose muestras sanguíneas "centrales" y de vena periférica en diferentes fases. Las infrecuentes complicaciones descritas en la literatura incluyen hemorragia subaracnoidea, trombosis del seno cavernoso, embolia pulmonar, parálisis de los nervios craneales o hematomas inguinales. En la presente serie se ha registrado, como hallazgo clínico adverso, un caso con otalgia limitado a la extracción de las muestras. Los resultados orientan a un origen hipofisario si la relación entre los valores de ACTH-central/ACTH-periférica es > 2. Para sugerir lateralización la diferencia debe ser > 1,4. Conclusiones: El muestreo sanguíneo de los senos petrosos es un procedimiento diagnóstico muy útil para diferenciar entre la EC y la secreción de ACTH-ectópica. Resulta imprescindible el conocimiento de la técnica y los materiales, la anatomía y sus variantes para su correcta realización e interpretación.
Autores: Pascual, Eider; Pérez-Pevida, Belén; et al.
ISSN 1134-3230  Vol. 30  2014  págs. 4
Objetivos: La deficiencia de vitamina D es altamente prevalente en todo el mundo. Durante mucho tiempo ha sido conocida por ser una parte esencial del metabolismo óseo; sin embargo, la evidencia reciente sugiere una posible asociación entre los niveles disminuidos de vitamina D y diversas condiciones patológicas incluyendo las enfermedades cardiovasculares y la diabetes mellitus. Por ello, nuestro objetivo fue evaluar la asociación entre los niveles bajos de 25-hidroxivitamina D (25 (OH) D) y la presencia de trastornos cardiometabólicos en pacientes diabéticos tipo 2 (DM2). Material y métodos: Se realizó un estudio transversal en el que se incluyeron de forma aleatoria 108 pacientes con DM2 que realizaron cribado de los niveles de 25 (OH) D entre los años 2007 y 2013. Se excluyeron los pacientes diagnosticados de DM tipo 1, LADA o hiperparatiroidismo primario, aquellos en tratamiento con vitamina D y/o calcio, o con antecedente previo de cirugía bariátrica. Según los niveles de 25 (OH) D, los pacientes fueron divididos en tres grupos: deficiente (< 20 ng/ml), insuficiente (20- < 30 ng/ml) y normal (¿ 30 ng/ml). El análisis se realizó mediante Regresión Lineal Múltiple cuando la variable dependiente era cuantitativa y mediante Regresión Logística en el caso de variables categóricas. Resultados: Del total de la muestra, 69 (63,9%) pacientes presentaron niveles disminuidos de 25 (OH) D, entre ellos 36 (33,3%) deficiencia y 33 (30,6%) insuficiencia, y 39 (36,1%) obtuvieron valores normales. Niveles deficientes e insuficientes de 25 (OH) D fueron inversamente asociados con la cifra de hemoglobina glicosilada (A1c) (p = 0,006 y 0,012, respectivamente), la cardiopatía isquémica (p = 0,011 y 0,022), el infarto agudo de miocardio (p = 0,090 y 0,049) y la retinopatía diabética (p = 0,007 y 0,018), tras ajustar por edad, sexo, índice de masa corporal, hábito tabáquico y enólico, actividad física, estación del año, calcio, paratohormona, años de evolución de la diabetes, función renal y cociente albúmina/creatinina. Únicamente los niveles deficientes de 25 (OH) D obtuvieron una significativa asociación inversa con la glucemia basal (p = 0,008) y la vasculopatía periférica (p = 0,019). No se encontró asociación con las cifras de tensión arterial sistólica o diastólica, los niveles de colesterol total, HDL-colesterol, LDL-colesterol o triglicéridos, el accidente cerebrovascular, la neuropatía o la nefropatía diabética. Conclusiones: Niveles disminuidos de 25 (OH) vitamina D se asocian con un aumento del riesgo cardiovascular, peor control glucémico y mayor prevalencia de complicaciones derivadas de la DM2 en estos pacientes. Se requieren ensayos que permitan evaluar el impacto de la suplementación de la vitamina D sobre estos resultados para confirmar su causalidad.
Autores: Jaques, F.; Rodriguez, S.; et al.
ISSN 0012-186X  Vol. 56  Nº 4  2013  págs. 838 - 846
Cardiotrophin 1 (CT-1) is a recently described cytokine originally isolated from the heart where it has been shown to play an important role in apoptotic protection of cardiomyocytes and heart hypertrophy. Its beneficial properties have also been described in other organs such as liver and neuromuscular tissue. In the present study, we investigated whether CT-1 can confer protection against pro-apoptotic stimuli in pancreatic beta cells, and its role in insulin secretion and diabetes development. The effects of CT-1 on apoptosis and function were studied using MIN6B1 cells and freshly isolated murine pancreatic islets. The impact on the development of diabetes was evaluated in Ct1-null (Ct1 (-/-)) mice (the gene Ct1 is also known as Ctf1) using two streptozotocin (STZ)-induced models of diabetes. CT-1 has a protective effect in MIN6B1 cells and murine islets under the pro-apoptotic stimulus of serum deprivation, which correlates with the expression of B cell lymphoma-extra large, or following exposure to a mixture of cytokines. In addition, CT-1 enhances glucose-stimulated insulin secretion in MIN6B1 cells and this was repressed by inhibitors of phospholipase C. Furthermore, Ct1 (-/-) mice were more prone to develop diabetes, and their glucose tolerance test showed impaired plasma glucose clearance which correlated with decreased pancreatic insulin secretion. The results obtained from both in vitro and in vivo experiments show that CT-1 improves beta cell function and survival, and protects mice against STZ-induced diabetes.
Autores: Pascual, Eider; et al.
ISSN 1575-0922  Vol. 60  2013  págs. 91
Autores: Pascual, Eider; Pérez-Pevida, Belén; et al.
ISSN 1134-3230  Vol. 29  2013  págs. 38
Autores: Gómez-Ambrosi, J; Silva, Camilo; Catalán, V; et al.
ISSN 0149-5992  Vol. 35  Nº 2  2012  págs. 383-88
CUN-BAE is an easy-to-apply predictive equation that may be used as a first screening tool in clinical practice. Furthermore, our equation may be a good tool for identifying patients at cardiovascular and type 2 diabetes risk.
Autores: Gómez-Ambrosi, J; Silva, Camilo; Galofre, Juan Carlos; et al.
ISSN 0307-0565  Vol. 36  Nº 2  2012  págs. 286 - 294
Autores: Cabrera, Paula Karin; Escalada, J; Goikoetxea, María José; et al.
ISSN 1018-9068  Vol. 21  Nº 5  2011  págs. 417-9
The precipitin technique has been used in insulin resistance and immunity studies since the 1940s [7]. In the case described, the technique proved, once again, to be a valid method for choosing the most appropriate insulin. However, whether or not an immunological mechanism was involved in the lipoatrophic process remains uncertain, and further studies with adequate immunological assessment are necessary.
Autores: Gómez-Ambrosi, J; Silva, Camilo; Galofre, Juan Carlos; et al.
Revista: OBESITY
ISSN 1930-7381  Vol. 19  Nº 7  2011  págs. 1439 - 1444
Autores: Salvador, Francisco Javier; Escalada, J; et al.
Libro:  Diabetes tipo 2 surgery
2010  págs. 117 - 124
Autores: Galofre, Juan Carlos; Escalada, J; et al.
Libro:  La clínica y el laboratorio. Interpretación de análisis y pruebas funcionales. Exploración de los síndromes. Cuadro biológico de las enfermedades
2010  págs. 587 - 628