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Durante mucho tiempo se asoció fenotípicamente la diabetes mellitus tipo 1 (DM1) con pacientes de aspecto delgado y, en algunos casos, subnutridos. Sin embargo, este fenotipo fue cambiando dado que, en las últimas décadas, el sobrepeso y la obesidad aumentaron significativamente en dichos pacientes paralelamente a la población general. El incremento del índice de masa corporal (IMC) en personas con DM1 estaría influenciado por factores genéticos y medioambientales. Los primeros se estudiaron mediante la determinación del gen asociado a obesidad (FTO) que no mostraron por ahora resultados convincentes. Sin embargo, los factores medioambientales tendrían un impacto directo y se asocian significativamente. Podemos describirlos de la siguiente manera: 1) aumento significativo en la ingesta de grasas saturadas, hidratos de carbono (por temor a las hipoglucemias), alcohol y comidas hipercalóricas (sobre todo adolescentes y adultos jóvenes); 2) falta de actividad física por temor a las hipoglucemias, por falta de indicación médica y por aumento de las horas frente a las pantallas; 3) no adecuar el valor calórico total al IMC de cada paciente generando una sobreinsulinización, tanto basal (sobrebasalización) como prandial, con la preocupación de lograr solamente el control glucémico; 4) presencia de hipoglucemias que llevan a ingerir colaciones fuera del plan alimentario; 5) tener antecedentes familiares de obesidad, DM2 o síndrome metabólico. Por otra parte, la presencia de obesidad acelera la aparición de DM1 en pacientes predispuestos a padecerla. Consecuentemente, debido al aumento de la grasa abdominal, se genera insulinorresistencia (incrementada por el hiperinsulinismo debido a la administración periférica de insulina) que sobrecarga a las células beta potenciando la autoinmunidad y su mayor inflamación. Se agrega, además, el riesgo de padecer dislipidemia, hipertensión arterial, esteatosis hepática, cáncer e incremento del riesgo de enfermedades cardiovasculares. Concluimos que los pacientes con DM1 están expuestos a padecer no solo complicaciones micro, sino además macroangiopáticas requiriendo, además de la insulinoterapia adecuada, un enfoque terapéutico más amplio y complementario.

Abstract Background Although there is a strong association between obesity and obstructive sleep apnoea (OSA), the effects of OSA and CPAP therapy on weight loss are less well known. The aim of this study in adults with class 3 obesity attending a multidisciplinary weight management program was to assess the relationship between OSA and CPAP usage, and 12-month weight change. Methods A retrospective cohort study of all patients commencing an intensive multidisciplinary publicly funded weight management program in Sydney, Australia, between March 2018 and March 2019. OSA was diagnosed using laboratory overnight sleep studies. Demographic and clinical data, and use of CPAP therapy was collected at baseline and 12 months. CPAP use was confirmed if used ≥4 h on average per night on download. Results Of the 178 patients who joined the program, 111 (62.4 %) completed 12 months in the program. At baseline, 63.1 % (n=70) of patients had OSA, of whom 54.3 % (n=38) were using CPAP. The non-OSA group had more females compared to the OSA with CPAP group and OSA without CPAP group (90.2 % vs. 57.9 % and 62.5 %, respectively; p=0.003), but there were no significant baseline differences in BMI (50.4±9.3 vs. 52.1±8.7 and 50.3±9.5 kg/m2, respectively; p=0.636). There was significant weight loss across all three groups at 12 months. However, there were no statistically significant differences across groups in the percentage of body weight loss (OSA with CPAP: 6.3±5.6 %, OSA without CPAP: 6.8±6.9 %, non-OSA: 7.2±6.5 %; p=0.844), or the proportion of patients who achieved ≥5 % body weight loss (OSA with CPAP: 57.9 %, OSA without CPAP: 59.4 %, non-OSA: 65.9 %; p=0.743). In patients with T2DM, there was a significant reduction in HbA1c from baseline to 12 months (7.8±1.7 % to 7.3±1.4 %, p=0.03), with no difference between groups (p=0.997). Conclusions This multidisciplinary weight management program resulted in significant weight loss at 12 months, regardless of OSA diagnosis or CPAP use in adults with class 3 obesity. Larger studies are needed to further investigate the effects of severity of OSA status and CPAP use in weight management programs. Until completed, this study suggests that the focus should remain on implementing lifestyle changes and weight management regardless of OSA status.

The tools to assess the degree of glycemic control were modified lately. Glycosylated Hemoglobin (HbA1c), the gold standard, reflects the glycemic control of the last 3 months retrospectively, without expressing glycemic variability. It can be modified in the presence of hemoglobinopathies and/or alterations of erythropoiesis, inducing inappropriate and late therapeutic decisions. Self-blood glucose monitoring (SBGM) provides immediate and prospective information, but has little glycemic data to generate representative averages and standard deviations. It does not detect trends and has limitations to obtain nocturnal data or during physical activity. It is invasive and often rejected. On the contrary, continuous glucose monitoring (CGM), allows to measure glucose instantly, shows your trends and variability continuously, incorporating new control metrics. The CGM would be indicated in adults, adolescents and children (> 4 years for FreeStyle Libre and > 2 years for Dexcom), with diabetes mellitus type 1 (DM1) without adequate glycemic control or with adequate control presenting mild hypoglycemia/moderated. It is also indicated in pregnant patients with DM1 or with type 2 diabetes mellitus (DM2). For DM2, except under intensified insulin therapeutics (IIT), the evidence at the moment is scarce, although recent studies show its effectiveness in these patients. The ambulatory glucose profile (AGP) analyzes the patterns of glycemic control during sleep, prolonged fasting, physical activity and intercurrences, expressing them as curves with their standard deviations during periods of hours (8 to 24 hours) or days (7, 14, 30 and 90 days). The AGP contains the following metrics: percentage time in range (70-180 mg/dl=TIR), percentage time above range (>180 mg/dl TAR), percentage time below range or hypoglycemia (70% of the day, a TAR > 180 mg/dl < 25% of the day and a TBR < 70 mg/dl at < 5% of the day. In labile patients, a TIR only 50% of the day. In pregnant women with DM1 a TIR of 63-140 mg/dl in > 70% of the day. The continuous information allows immediate decisions to be taken by ingesting carbohydrates or by applying insulin. CGM with IIT or continuous subcutaneous insulin infusion (CSII), is a very useful and complementary tool for the treatment of DM1 and DM2 in insulin therapy. Its use was associated with significant decreases in HbA1c, decreased glycemic variability, reduction of total and nocturnal hypoglycemia and improvement of the quality of life in these patients. Finally a very important advantage of this tool is the chance to achieve all the information on line.

This Consensus comes to light in the midst of one of the worst global health crises in the last 100 years. SARS-CoV-2 and its clinical manifestation, COVID-19, have caused a disruption in how doctors and patients interact. Although it is an infectious disease, one of the most notable characteristics is that its mortality increases in patients with chronic non-communicable diseases and, in particular, with a history of diabetes and cardiovascular disease. In this context, then, we believe that the recommendations made in this document, which aim to identify and protect these patients, become more relevant, while the implementation, beyond the statements, of specific cardiometabolic prevention policies becomes a priority.

The tools to assess the degree of glycemic control were modified lately. Glycosylated Hemoglobin (HbA1c), the gold standard, reflects the glycemic control of the last 3 months retrospectively, without expressing glycemic variability. Self-blood glucose monitoring (SBGM) provides immediate and prospective information, but has little glycemic data to generate representative averages and standard deviations. It does not detect trends and has limitations to obtain nocturnal data or during physical activity. It is invasive and often rejected. On the contrary, continuous glucose monitoring (CGM), allows to measure glucose instantly, shows your trends and variability continuously, incorporating new control metrics.

Introduction: obesity is a serious growing medical problem in type 1 diabetes mellitus (DM1). Insulin replacement is the only available therapy for these patients with DM1 and the main problems associated with it are hypoglycemia and weight gain. Bariatric surgery (BS) showed improvement in glycemic control in type 2 but only few cases of DM1 have been reported. Objectives: to evaluate changes in metabolic parameters in obese DM1 patients who underwent BS.

An adequate glycemic control prevents and/or delays the development and/or progression of chronic complications in patients with Diabetes Mellitus (DM). To achieve this control, it is necessary to adjust insulin doses, in type 1 or insulinized type 2 DM patients, based on traditional capillary glucose self-monitoring (GSM), which has limitations to generate an adequate data record, is invasive and has low adherence. In contrast, new continuous glucose monitoring (CGM) systems provide more complete and dynamic information, and better compliance. In these systems, a subcutaneous sensor continuously sends glucose values which are captured and stocked by a receptor module. Real-time models (CGM-RT) allow continuous and real-time readings of interstitial glucose, whereas CGM-Flash/EI systems require lector approach to sensor module performing intermittent scanning. CGM shows if glycemic levels are increasing or decreasing and how fast it´s happening (tendency). CGM decreases A1C between 0.53% and 1% in patients with high adherence, as well as time in hypoglycemia by 38%, increasing the time in range of glucose levels.

An adequate glycemic control prevents and/or delays the development and/or progression of chronic complications in patients with Diabetes Mellitus (DM). In order to adjust insulin doses, in type 1 or insulinized type 2 DM patients, with multiple insulin injections and or insulin pumps the traditional capillary glucose self-monitoring (GSM) showed a lot of limitations to generate an ade-quate data record, is invasive and has low adherence. New continuous glucose monitoring (CGM) systems provide not only more complete and dynamic information nor allows as to know continuous and real-time readings of interstitial glucose. CGM had built new glucose metrics like Time in Range, Time above the Range and Time Below the Rage and also the Glucose management indicator giving us a more wide information about glycaemic variability and glucose tendencies. Yes, there are robust data showing us that it is the time to change and design new glycemic metrics in order to look for a better glucose control.

Faced with the significant and rapid changes in knowledge related to the pathophysiology of diabetes mellitus (DM) and the mechanisms involved in the development of cardiovascular diseases (CVD), on the one hand, and, on the other, with the development of different drugs with unexpected effects at the cardiovascular level, we set out to develop an updated consensus between the Argentine Society of Cardiology and the Argentine Society of Diabetes, two societies with recognized trajectory in the preparation of guidelines and consensus that, ultimately, have the objective of providing a material updated and practical for the management of patients with DM and CVD. Although our joint task had begun some time ago, this Consensus comes to light in the middle of one of the worst health crises in the world with the emergence of SARS-CoV2 and its clinical manifestation, COVID-19.

Objectives: 1) update the Guidelines for the Treatment of the Diabetes Mellitus Type 2 of the Argentine Society of Diabetes, published in 2010; 2) provide to the health team updated guidance for the therapeutic management of people with this disease. Material and methods: a group of experts, full members of the Argentine Society of Diabetes, was convened to analyze the papers available from different sources, classifying them according to their level of evidence (Table 2), written in bold at the end of the paragraph; on this basis the 2010 guideline was modified to update contents. A drafting committee responsable for the final layout of the document was appointed. Conclusions: changes in lifestyle remain the first therapeutic option, metformin is the drug of first line, if there are no contraindications for use or intolerance, any of the other families of antidiabetic drugs, insulin and insulin analogs, can be used as monotherapy or associated, taking into account their contraindicationsand not using together those with similar action mechanisms. Algorithms 1 and 2 can be considered the synthesis of the current proposal.

There are approximately 25 million patients with type 1 diabetes mellitus (DM1) in the world, a figure that would triple in 2050. Although the optimum is to reach A1c levels

Introduction: the worldwide pandemic increase of obesity and type 2 diabetes push us to choose therapeutic options to control metabolic parameters and decrease cardiovascular risk in this group of patients. Metabolic surgery became a useful tool added to lifestyle change and pharmacologic therapy. Objetives: the aim of the recommendations was to treat patients with y Roux bypass surgery (BPGYR), with BMI between 30-35 kg/m2 and alter metabolic parameters after been treated with the best medical therapy. Conclusions: the first Argentinean metabolic surgery consensus was done by the Argentinean Diabetes Society (SAD), Argentinean Nutrition Society (SAN) and Argentinean Society of Obesity Surgery (SACO) and the proposal was to consider metabolic surgery in type 2 diabetic patients with BMI between 30-35 kg/m2 after been treated with the best medical therapy. We describe selection criteria of patients, the important role of the interdisciplinary approach, evaluation, and preparation before surgery and the follow up.

Optimal glycemic control is important for reducing the risks of chronic complications in type 2 diabetic patients. However there are a high percentage of patients treated with insulin and /or oral diabetic drugs that do not achieve their glycated haemoglobin goals, particularly for elevated postprandial glucose. Traditionally the management of patients with type 2 diabetes has focused on the therapeutic control of fasting plasma glucose, given the high correlation of it with glycosylated hemoglobin. There is currently extensive evidence to support that the postprandial glucose has a fundamental role in the sub-optimal glycemic control, with the complications that this entails. The glycemic homeostasis is complex to achieve in patients with diabetes, and the therapy should be aimed at reset it. The principal objective of this review is to emphasize the importance of managing postprandial glucose in Type 2 diabetic patients, establish the current treatment and evaluate what would be the new therapeutics available.