Dietary program and physical activity impact on biochemical markers in patients with type 2 diabetes: A systematic review

Objectives

Evaluate the effectiveness of the implementation of independently or combined dietary and physical activity programs on the blood glucose values and lipid profile in patients with type 2 diabetes, including participants aged 60 years and over.

不同血液透析液生物相容性的研究进展

血液透析在提高慢性肾衰竭患者生存率的同时,也因其出现的脂质代谢紊乱、微炎症状态和营养不良,导致多种远期并发症,严重影响患者的生存时间。近年来,研究发现使用超纯血液透析液可以改善患者的脂质代谢、炎症水平和营养不良等,血液透析液的纯度与血透质量密切相关。现就国内外不同纯度血透液对慢性肾衰竭患者血脂代谢、炎症水平及营养等研究进展进行综述。     

2型糖尿病患者合并代谢综合征不同组分血脂谱分析

目的观察2型糖尿病患者合并代谢综合征组分数目对血脂谱的影响。方法回顾性分析3 750例2型糖尿病患者的代谢综合征患病率及合并不同代谢综合征组分的血脂谱进行分析。结果 2型糖尿病患者代谢综合征患病率为63%,其中男性1 268人(54%),女性1 087人(46%)。2型糖尿病患者合并代谢综合征常见组合中均包括血脂异常。血脂异常发生率为58%,其中男性1 322人(60%),女性864(40%)。并且随着代谢综合征组分数目的增加,均显示总胆固醇、甘油三酯、低密度脂蛋白水平逐渐升高,高密度脂蛋白水平下降。结论对于2型糖尿病患者尤其合并代谢综合征时不仅要控制血糖达标,还要重视其他代谢组分异常如血脂达标,从而减少患者心血管疾病的发生风险。     

Management of dyslipidemia in diabetic patients: The situation in primary health care units

IntroductionCardiovascular disease is one of the main causes of morbidity and mortality worldwide. Control of its risk factors, particularly diabetes and dyslipidemia, through reduction of LDL cholesterol, is crucial to reduce cardiovascular risk. This work aims to assess and improve the medical approach to dyslipidemia in diabetic patients.MethodsThis is a quality improvement study aimed at family doctors. It included patients with diabetics and dyslipidemia enrolled in the primary health care units of Além D’Ouro, S. Miguel and Oceanos. A quality standard was defined for each of the criteria assessed, and the results were compared using the chi-square test with p-value<0.05. Data analysis was performed using Microsoft Excel 2010® and IBM SPSS®.ResultsComparing the first and second assessments, 14.6% vs. 22.2% (p=0.016) of the patients, respectively, achieved the LDL cholesterol target level of <70 mg/dl. Of those who did not meet the target level, 11.0% vs. 13.6% (p=0.395) had their pharmacological therapy changed and 4.6% vs. 3.3% (p=0.448) had their lipid profile reassessed within three months.ConclusionsControl of dyslipidemia in patients with diabetes continues to be a major factor in the health of these patients, but it is carried out in an unsatisfactory way in the three health units studied. It is essential to increase the literacy of family doctors and to encourage the search for the best possible lipid control, in order to reduce cardiovascular risk, as well as to raise awareness among patients to increase adherence to therapy.     

血液透析患者脂代谢紊乱的临床研究

目的探讨血液透析患者脂代谢紊乱的临床特征及原因。方法检测106例维持性血液透析患者空腹血脂，并对影响血脂水平及有关因素进行分析。结果血液透析患者脂代谢紊乱主要表现为血清甘油三脂（TG）、载脂蛋白B（Apo-LB）水平显著增高，高密度脂蛋白胆固醇（HDLC）显著降低。TG与血清白蛋白（Alb）、透析时体外循环血流量显著负相关（r=-0．398，r=-0．219）；HDLC水平与Kt／V显著相关（r=-0．305）。血液透析患者高血压的发生率为73．6％，心血管病变为25％。伴心血管疾病的血液透析患者TG水平显著高于无心血管疾病者。结论血液透析患者脂代谢紊乱主要表现为TG、Apo-LB水平增高，HDLC水平降低。透析充分及透析时体外循环血流量及血清白蛋白水平影响血脂水平。     

CODAP: um consenso multidisciplinar sobre a definição,diagnóstico e tratamento da dislipidemia aterogénica em Portugal

Introduction and aimsAtherogenic dyslipidemia is an important contributor to residual cardiovascular (CV) risk, but it is underdiagnosed and undertreated. This study aimed to assess the opinion of Portuguese experts to generate a consensus concerning the diagnosis and treatment of atherogenic dyslipidemia, as well as to contribute toward standardization of clinical practice in this disorder.MethodsThe study consisted in the application of a questionnaire to an expert panel, following a modified Delphi methodology.ResultsThe majority (88.4%) of the proposed items were found to be consensual. The expert panel recognized the importance of the atherogenic dyslipidemia phenotype, the role played by low‐density lipoprotein cholesterol and non‐high‐density lipoprotein cholesterol as risk markers and therapeutic targets, the choice of statins as first‐line lipid‐lowering drugs, and the value of associating statins with fenofibrate as a means to reduce residual CV risk. However, the role played by triglycerides in CV risk and the therapeutic value of fibrates lacked consensus. Taking into consideration the state of the art and the opinions expressed in this study, the scientific committee developed a treatment algorithm aimed to improve the perception and treatment of atherogenic dyslipidemia.ConclusionsThe experts involved in this study were shown to be familiar with the concept and the importance of atherogenic dyslipidemia. The few situations in which a consensus could not be found were mainly related to the interpretation and/or relevance of the available evidence.     

Suboptimal lipid levels in clinical practice among Portuguese adults with dyslipidemia under lipid-lowering therapy: Data from the DISGEN-LIPID study

IntroductionCardiovascular disease (CVD) is the leading cause of morbidity and mortality in Portugal. Hypercholesterolemia has a causal role in atherosclerotic CVD. Guidelines recommend that cardiovascular (CV) risk reduction should be individualized and treatment goals identified. Low-density lipoprotein cholesterol (LDL-C) is the primary treatment target.MethodsDISGEN-LIPID was a cross-sectional observational study conducted in 24 centers in Portugal in dyslipidemic patients aged ≥40 years, on lipid-lowering therapy (LLT) for at least three months and with an available lipid profile in the previous six months.ResultsA total of 368 patients were analyzed: 48.9% men and 51.1% women (93.9% postmenopausal), of whom 73% had a SCORE of high or very high CV risk. One quarter had a family history of premature CVD; 31% had diabetes; 26% coronary heart disease; 9.5% cerebrovascular disease; and 4.1% peripheral arterial disease. Mean baseline lipid values were total cholesterol (TC) 189 mg/dl, LDL-C 116 mg/dl, high-density lipoprotein cholesterol (HDL-C) 53.5 mg/dl, and triglycerides (TG) 135 mg/dl. Women had higher TC (p<0.001), LDL-C (non-significant) and HDL-C (p<0.001), and lower TG (p=0.002); 57% of men and 63% of women had LDL-C>100 mg/dl (p=0.28), and 58% of men and 47% of women had LDL-C>70 mg/dl (p=0.933).ConclusionThese observational data show that, despite their high-risk profile, more than half of patients under LLT, both men and women, did not achieve the recommended target levels for LDL-C, and a large proportion also had abnormal HDL-C and/or TG. This is a renewed opportunity to improve clinical practice in CV prevention.     

Consenso mexicano sobre el diagnóstico de la deficiencia de lipasa ácida lisosomal

Introduction

Lysosomal acid lipase deficiency (LAL-D) causes progressive cholesteryl ester and triglyceride accumulation in the lysosomes of hepatocytes and monocyte-macrophage system cells, resulting in a systemic disease with various manifestations that may go unnoticed. It is indispensable to recognize the deficiency, which can present in patients at any age, so that specific treatment can be given. The aim of the present review was to offer a guide for physicians in understanding the fundamental diagnostic aspects of LAL-D, to successfully aid in its identification.