XI. STRATEGIES FOR IMPROVING DIABETES CARE D iabetes is a chronic illness that requires continuing medical care and patient self-management education to prevent acute complications and to reduce the risk of long-term complications. Diabetes care is complex and requires that many issues, beyond glycemic control, be addressed. A large body of evidence exists that supports a range of interventions to improve diabetes outcomes. These standards of care are intended to provide clinicians, patients, researchers, payors, and other interested individuals with the components of diabetes care, treatment goals, and tools to evaluate the quality of care. While individual preferences, comorbidities, and other patient factors may require modification of goals, targets that are desirable for most patients with diabetes are provided. These standards are not intended to preclude more extensive evaluation and management of the patient by other specialists as needed. For more detailed information, refer to Bode (Ed.): Medical Management of Type 1 Diabetes (1), Burant (Ed): Medical Management of Type 2 Diabetes (2), and Klingensmith (Ed): Intensive Diabetes Management (3). The recommendations included are diagnostic and therapeutic actions that are known or believed to favorably affect health outcomes of patients with diabetes. A grading system (Table 1), developed by the American Diabetes Association (ADA) and modeled after existing methods, was utilized to clarify and codify the evidence that forms the basis for the recommendations. The level of evidence that supports each recommendation is listed after each recommendation using the letters A, B, C, or E.

Standards of Medical Care in Diabetes

Corticosteroid-induced hyperglycemia is a common medical problem that can lead to frequent emergency room visits, hospital admissions and prolonged hospital stay, in addition to the well known morbidity associated with hyperglycemia. However, the diagnosis and treatment of corticosteroid-induced hyperglycemia is surprisingly undervalued by most professionals, probably because of the lack of quality studies to determine specific strategies of action. In the present review, we discuss the pathophysiology of corticosteroid-induced hyperglycemia, focusing on diverse patterns of hyperglycemia induced by the different formulations, and provide clues for diagnosis based on the duration of treatment and the administration schedule of corticosteroids. We propose a treatment strategy based on both the pathophysiology of the process and the mechanism of action of different corticosteroids, and take into account dosing and administration timing to predict the duration of therapy. Finally, we propose treatment goals that differ slightly between the transient and continuous use of corticosteroids based on evidence from clinical practice guidelines of diabetes care both in ambulatory and hospital settings.

Glucocorticoid-induced hyperglycemia.

Ultrasound-based differentiation of malignant and benign thyroid Nodules: An extreme learning machine approach

COVID-19 infection has tremendously impacted our daily clinical practice as well as our social living organization. Virtually all organs and biological systems suffer from this new coronavirus infection, either because the virus targets directly specific tissues or because of indirect effects. Endocrine diseases are not an exception and some of endocrine organs are at risk of direct or indirect lesion by COVID-19. Although there is still no evidence of higher predisposition to contract the infection in patients with diabetes and/or obesity, the coexistence of these conditions contributes to a worse prognosis because both conditions confer an impaired immunologic system. Cytokines storm can be amplified by these two latter conditions thereby leading to multisystemic failure and death. Glycaemic control has been demonstrated to be crucial to avoiding long hospital stays, ICU requirement and also prevention of excessive mortality. Endocrine treatment modifications as a consequence of COVID-19 infection are required in a proactive manner, in order to avoid decompensation and eventual hospital admission. This is the case of diabetes and adrenal insufficiency in which prompt increase of insulin dosage and substitutive adrenal steroids through adoption of the sick day's rules should be warranted, as well as easy contact with the health care provider through telematic different modalities. New possible endocrinological targets of COVID-19 have been recently described and warrant a full study in the next future.

/pdf/endocrine-and-metabolic-aspects-of-the-covid-19-pandemic-2o3ur2dwzv.pdf

Endocrine and metabolic aspects of the COVID-19 pandemic.

Non-invasive automated 3D thyroid lesion classification in ultrasound: A class of ThyroScan™ systems

aSociedad Española de Diabetes (SED). Servicio de Endocrinología y Nutrición. Hospital de la Santa Creu i Sant Pau. Barcelona. CIBER de Diabetes y Enfermedades Metabólicas Asociadas. CIBERDEM. España. bSociedad Española de Medicina Interna (SEMI). Servicio de Medicina Interna. Hospital General Universitario Gregorio Marañón. Madrid. España. cSociedad Española de Cardiología (SEC). Madrid. España. dSociedad Española de Medicina Intensiva, Crítica y Unidades Coronarias (SEMICYUC). España. eGrupo de Urgencias de la SEMI. Madrid. España. fSociedad Española de Endocrinología y Nutrición (SEEN). Madrid. España.

Tratamiento de la hiperglucemia en el hospital

Recomendaciones para el tratamiento farmacológico de la hiperglucemia en la diabetes tipo 2

Servicio de Endocrinologίa, Hospital Clίnico Universitario de Valladolid, Centro de Investigaciόn en Endocrinologίa y Nutriciόn Clίnica (IEN), Valladolid, Servei d’Endocrinologia, Servei Radiodiagnostic, Centre diagnostic per la imatge (CDI), Servei de Medicina Nuclear, Centre diagnostic per la imatge (CDI) Hospital Clίnic, Universitat de Barcelona, Barcelona, Spain Review HORMONES 2010, 9(4):287-298

/pdf/update-in-thyroid-imaging-the-expanding-world-of-thyroid-2edovbqfw1.pdf

Update in thyroid imaging. The expanding world of thyroid imaging and its translation to clinical practice.

E. Menéndez Torre, J. Lafita Tejedor, S. Artola Menéndez, J. Millán NúñezCortés, Á. Alonso García, M. Puig Domingo, J.R. García Solans, F. Álvarez Guisasola, J. García Alegría, J. Mediavilla Bravo, C. Miranda Fernández-Santos, R. Romero González En representación del Grupo de Trabajo de Consensos y Guías Clínicas de la Sociedad Española de Diabetes. Sociedad Española de Arteriosclerosis (SEA). Sociedad Española de Cardiología (SEC). Sociedad Española de Endocrinología y Nutrición (SEEN). Sociedad Española de Farmacia Comunitaria (SEFAC). Sociedad Española de Medicina Familiar y Comunitaria (SEMFYC). Sociedad Española de Medicina Interna (SEMI). Sociedad Española de Médicos de Atención Primaria (SEMERGEN). Sociedad Española de Médicos Generales (SEMG). Sociedad Española de Nefrología (SEN).

Manuel Puig Domingo

Papers

Tratamiento de la hiperglucemia en el hospital

Recomendaciones para el tratamiento farmacológico de la hiperglucemia en la diabetes tipo 2

Update in thyroid imaging. The expanding world of thyroid imaging and its translation to clinical practice.

Recomendaciones para el tratamiento farmacológico de la hiperglucemia en la diabetes tipo 2

Recomendaciones para el tratamiento farmacológico de la hiperglucemia en la diabetes tipo 2