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Resumen Objetivo Evaluar el uso de la terapia con beneficio cardiovascular en pacientes con DM tipo 2 previo al ingreso en servicios de medicina interna. Metodos Estudio transversal en un dia de los pacientes con DM tipo 2 hospitalizados en servicios de medicina interna. Se recogieron variables demograficas y antropometricas, datos de laboratorio y utilizacion de farmacos antihiperglucemiantes. La variable desenlace fue la proporcion y los determinantes de uso de inhibidores del cotransportador sodio-glucosa 2 (iSGLT2) y de agonistas del receptor del peptido similar al glucagon tipo 1 (AR-GLP1). Resultados Se incluyeron 928 pacientes pertenecientes a 74 hospitales. La edad media fue 78,9 anos (DE: 10,86), un 50% varones. Un total de 557 (60%) presentaba cardiopatia isquemica, 189 (20,4%) enfermedad cerebrovascular, 293 (31,6%) insuficiencia cardiaca, 274 (29,5%) enfermedad renal cronica y 129 (13,9%) enfermedad arterial periferica. Los antihiperglucemiantes utilizados previo al ingreso fueron: sulfonilureas (5.7%), biguanidas (49.1%), inhibidores de la alfa-glucosidasa (0,2%), pioglitazona (0%), iDPP4 (39%), iSGLT2 (5,8%), AR-GLP1 (2,6%) y analogos de insulina basal (24%). La edad mayor de 75 anos fue el factor determinante principal para no utilizar iSGLT2 (OR ajustada 0,28; intervalo de confianza al 95%: 0,10-0,74; p = 0,039) o AR-GLP1 (OR ajustada 0,09; intervalo de confianza al 95%: 0,02-0,46; p = 0,006). Discusion Una gran proporcion de pacientes ancianos con DM tipo 2 de muy alto riesgo cardiovascular no recibe terapia antihiperglucemiante con farmacos de probado beneficio cardiovascular. El tratamiento mas frecuentemente utilizado fue metformina e iDPP4. Existe un margen de mejora en el tratamiento en esta poblacion de muy alto riesgo.

espanolLa esclerosis sistemica es una conectivopatia con unas manifestaciones clinicas muy heterogeneas, relacionandose en un pequeno porcentaje con enfermedades oculares inflamatorias. En el caso concreto de las uveitis, unicamente se han descrito casos aislados en la literatura, sobre todo con relacion al sindrome de CREST. Presentamos el caso de una mujer de 53 anos, con sindrome de CREST y uveitis anterior cronica, que consideramos de relevancia clinica dada su baja prevalencia. EnglishSystemic sclerosis is a connective tissue pathology with very heterogeneous clinical manifestations, associated in a small percentage with inflammatory eye diseases. In the specific case of uveitis, only isolated cases have been reported in the literature, especially in relation to the CREST syndrome. We present the case of a 53-year-old woman with CREST syndrome and chronic anterior uveitis, which we consider of clinical relevance given its low prevalence.

Systemic sclerosis is a connective tissue pathology with very heterogeneous clinical manifestations, associated in a small percentage with inflammatory eye diseases. In the specific case of uveitis, only isolated cases have been reported in the literature, especially in relation to the CREST syndrome. We present the case of a 53-year-old woman with CREST syndrome and chronic anterior uveitis, which we consider of clinical relevance given its low prevalence.

Exponemos el caso de un varón joven con hábitos de vida poco saludables con obesidad e hipertrigliceridemia grave que además está diagnosticado de diabetes mellitus tipo 2. El paciente presenta pancreatitis agudas de repetición, con dos episodios en el pasado que se resolvieron sin dejar secuelas y que, en una tercera ocasión, le lleva a un desenlace fatal. Tratamos de estudiar con este caso una posible complicación relacionada con la diabetes mellitus. A la vez, reflejamos la importancia que puede tener en el desarrollo de una enfermedad crónica seguir unos hábitos de vida poco recomendables.

BackgroundLimited evidence exists on the role of glucose-lowering drugs in patients with COVID-19. Our main objective was to examine the association between in-hospital death and each routine at-home glucose-lowering drug both individually and in combination with metformin in patients with type 2 diabetes mellitus admitted for COVID-19. We also evaluated their association with the composite outcome of the need for ICU admission, invasive and non-invasive mechanical ventilation, or in-hospital death as well as on the development of in-hospital complications and a long-time hospital stay.MethodsWe selected all patients with type 2 diabetes mellitus in the Spanish Society of Internal Medicine’s registry of COVID-19 patients (SEMI-COVID-19 Registry). It is an ongoing, observational, multicenter, nationwide cohort of patients admitted for COVID-19 in Spain from March 1, 2020. Each glucose-lowering drug user was matched with a user of other glucose-lowering drugs in a 1:1 manner by propensity scores. In order to assess the adequacy of propensity score matching, we used the standardized mean difference found in patient characteristics after matching. There was considered to be a significant imbalance in the group if a standardized mean difference > 10% was found. To evaluate the association between treatment and study outcomes, both conditional logit and mixed effect logistic regressions were used when the sample size was ≥ 100.ResultsA total of 2666 patients were found in the SEMI-COVID-19 Registry, 1297 on glucose-lowering drugs in monotherapy and 465 in combination with metformin. After propensity matching, 249 patients on metformin, 105 on dipeptidyl peptidase-4 inhibitors, 129 on insulin, 127 on metformin/dipeptidyl peptidase-4 inhibitors, 34 on metformin/sodium-glucose cotransporter 2 inhibitor, and 67 on metformin/insulin were selected. No at-home glucose-lowering drugs showed a significant association with in-hospital death; the composite outcome of the need of intensive care unit admission, mechanical ventilation, or in-hospital death; in-hospital complications; or long-time hospital stays.ConclusionsIn patients with type 2 diabetes mellitus admitted for COVID-19, at-home glucose-lowering drugs showed no significant association with mortality and adverse outcomes. Given the close relationship between diabetes and COVID-19 and the limited evidence on the role of glucose-lowering drugs, prospective studies are needed.

Background: Limited evidence exists on the role of glucose-lowering drugs in patients with COVID-19 This work examines the impact of each at-home glucose-lowering drugs individually or in combination with metformin on mortality and other adverse outcomes in patients with type 2 diabetes hospitalized for COVID-19 Methods: We selected all patients with type 2 diabetes in the Spanish Society of Internal Medicine’s SEMI-COVID-19 Registry, an observational, multicenter, nationwide registry of patients admitted for COVID-19 in Spain from March 1, 2020 Each glucose-lowering drug user was matched with a user of other glucose-lowering drugs by propensity scores To evaluate treatment effect on study outcomes, both conditional logit and mixed effect logistic regression were used when simple size ≥100 Findings: A total of 2,666 patients were found in the SEMI-COVID-19 Registry, 1297 on glucose-lowering drugs in monotherapy and 465 in combination with metformin After propensity matching, 249 patients on metformin, 105 on dipeptidyl peptidase-4 inhibitors, 129 on insulin, 127 on metformin/dipeptidyl peptidase-4 inhibitors, 34 on metformin/sodium-glucose cotransporter 2 inhibitor, and 67 on metformin/insulin were selected No at-home glucose-lowering drugs showed a significant association with in-hospital death;the composite outcome of need of intensive care unit admission, mechanical ventilation, or in-hospital death;in-hospital complications;or long-time hospital stays Interpretation: In patients with type 2 diabetes admitted for COVID-19, at-home glucose-lowering drugs had a neutral effects on mortality and adverse outcomes Given the close relationship between diabetes and COVID-19 and the limited evidence on the role of glucose-lowering drugs, prospective studies are needed

La diabetes mellitus (DM) tipo 1 es una enfermedad caracterizada por la destrucción de islotes pancreáticos de células beta que lleva a presentar niveles bajos o indetectables de insulina endógena. El buen control glucémico es el patrón oro para prevenir complicaciones micro y macrovasculares. En el caso clínico descrito a continuación nos encontramos una paciente joven con diagnóstico de DM tipo 1 con múltiples complicaciones secundarias a un mal control glucémico. Además, la paciente presenta un síndrome de Addison, que se relaciona en ocasiones con la diabetes pero no es una complicación de la misma.