Publications by authors named "Gabriel Olveira-Fuster"

10 Publications

  • Page 1 of 1

MeDiGes Study. Metformin versus insulin in gestational diabetes: Glycemic control, and obstetrical and perinatal outcomes. Randomized prospective trial.

Am J Obstet Gynecol 2021 Apr 19. Epub 2021 Apr 19.

Department of Endocrinology and Nutrition, Hospital Regional Universitario de Málaga. IBIMA; CIBER de Diabetes y Enfermedades Metabólicas (CIBERDEM).

Background: Gestational diabetes not properly controlled with diet has been commonly treated with insulin. In recent years several studies have published that metformin can lead to, at least, similar obstetrical and perinatal outcomes as insulin. Nevertheless, not all clinical guidelines endorse its use, and clinical practice is heterogeneous.

Objectives: The aim of this study was to test if metformin could achieve the same glycemic control as insulin and similar obstetrical and perinatal results, with a good safety profile, in women with gestational diabetes not properly controlled with lifestyle changes.

Study Design: The MeDiGes study was a multicenter, open-label, parallel arms, randomized clinical trial performed at two hospitals in Málaga (Spain), enrolling women with GDM who needed pharmacological treatment. Women aged 18-45 years, in the second or third trimesters of pregnancy, were randomized to receive metformin or insulin (Detemir and/or Aspart). The main outcomes were: 1. glycemic control (mean glycemia, pre-prandial and postprandial) and hypoglycemic episodes, and 2. obstetrical and perinatal outcomes and complications (hypertensive disorders, type of labor, prematurity, macrosomia, large for gestational age, neonatal care unit admissions, respiratory distress syndrome, hypoglycemia, jaundice). Outcomes were analyzed on an intention-to-treat basis.

Results: Between 2016-October and 2019-June 200 women were randomized, 100 to the insulin-treated group and 100 to the metformin-treated group. Mean fasting and postprandial glycemia did not differ between groups, but postprandial glycemia was significantly better after lunch and/or dinner in the metformin-treated-group. Hypoglycemic episodes were significantly more common in the insulin-treated group (55.9% vs 17.7% on metformin, OR 6.118, 95% CI 3.134-11.944, p 0.000). Women treated with metformin gained less weight from the enrollment to the prepartum visit (36-37 gestational weeks) (1.35±3.21 vs 3.87±3.50 Kg, p 0.000). Labor inductions (MET 45.7% vs INS 62.5%, OR 0.506, 95% CI 0.283-0.903, p 0.029) and cesarean deliveries (MET 27.6% vs INS 52.6%, OR 0.345, 95% CI 0.187-0.625, p 0.001) were significantly lower in the MET-group. Mean birth weight, macrosomia and large for gestational age were not different between treatment groups, as well as babies' complications. The lower cesarean delivery rate for women treated with metformin was not associated with macrosomia, large or small for gestational age, or other complications of pregnancy.

Conclusions: Metformin treatment was associated with a better postprandial glycemic control than insulin for some meals, a lower risk of hypoglycemic episodes, less maternal weight gain, and a low rate of failure as an isolated treatment. Most obstetrical and perinatal outcomes were similar between groups.
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http://dx.doi.org/10.1016/j.ajog.2021.04.229DOI Listing
April 2021

Care of people with Cystic Fibrosis: what is the role of specialists in Endocrinology and Nutrition?

Endocrinol Diabetes Nutr 2021 04;68(4):215-217

Servicio de Neumología. Hospital Regional Universitario de Málaga/ Universidad de Málaga. Instituto de Investigación Biomédica de Málaga (IBIMA), Spain; Unidad de Fibrosis quística. Hospital Regional Universitario de Málaga.

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http://dx.doi.org/10.1016/j.endinu.2021.01.003DOI Listing
April 2021

[Pillars for excellence in nutrition units - research].

Nutr Hosp 2021 Apr;38(Spec No1):19-28

U.G.C. de Endocrinología y Nutrición. Hospital Regional Universitario de Málaga. Universidad de Málaga. Instituto de Investigación Biomédica de Málaga. Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM).

Introduction: Research in clinical nutrition and dietetics consists of "carrying out intellectual and experimental activities in a systematic way with the purpose of increasing knowledge on this topic." The biomedical research carried out in clinical nutrition and dietetics units (UNCyDs) must be clinical-translational, which is understood as the fastest way to ensure that new scientific knowledge is transferred not only to clinical research but also to clinical practice. When UNCyDs conduct research, regardless of type and extent, they achieve higher quality standards in the health care they provide to their users. Clinical practice and scientific research are activities that constitute a continuous, indissoluble action. For this reason, both those responsible for health management and nutrition units and all their members have an obligation to promote research. In this article, a brief historical review of the birth of clinical nutrition as a scientific discipline is made, the legislation that supports biomedical research is briefly mentioned, the main keys to promote research in UNCyD are proposed, and finally orientation is offered on the main funding for biomedical research programs, and how to transfer and disseminate results.
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http://dx.doi.org/10.20960/nh.03557DOI Listing
April 2021

[Editor's corner: 2020, the year of the pandemic COVID-19].

Nutr Hosp 2021 Feb;38(1):1-2

Endocrinología y Nutrición. Hospital Regional Universitario de Málaga.

Introduction:
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http://dx.doi.org/10.20960/nh.03508DOI Listing
February 2021

Vitamin D deficiency in outpatients with inflammatory bowel disease: prevalence and association with clinical-biological activity.

Rev Esp Enferm Dig 2019 Jan;111(1):46-54

UGC Aparato Digestivo, Hospital Regional Universitario de Málaga, España.

Introduction: there are few data on the prevalence of vitamin D deficiency in patients with inflammatory bowel disease (IBD) in Spain. A deficiency could be associated with a worse course of the disease.

Aim: to determine the prevalence of 25-hydroxyvitamin D (25OHD) deficiency in a cohort of outpatients with IBD and assess its association with clinical and biological activity, quality of life and psychological symptoms.

Methods: a cross-sectional, single-center observational study was performed. The study variables were obtained via clinical interviews, medical chart review and validated questionnaires (Hospital Anxiety and Depression Scale and Short Quality of Life in Inflammatory Bowel Disease Questionnaire). 25OHD was measured in the same laboratory by an electro-chemiluminescence immunoassay.

Results: the study included 224 patients. The prevalence of vitamin D deficiency in Crohn's disease and ulcerative colitis was 33.3% and 20.3%, respectively. In Crohn's disease, vitamin D deficiency was associated with a higher clinical activity (p < 0.001) and a higher concentration of fecal calprotectin (p = 0.01). In ulcerative colitis, it was associated with clinical activity (p < 0.001), the use of steroids during the last six months (p = 0.001) and hospital admission during the previous year (p = 0.003). A sub-analysis of 149 patients failed to detect an association between vitamin D and quality of life or the scores of the Hospital Anxiety and Depression Scale.

Conclusions: vitamin D deficiency is common in patients with inflammatory bowel disease. An association was found between vitamin D concentration and clinical activity indexes, as well as fecal calprotectin levels in Crohn's disease.
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http://dx.doi.org/10.17235/reed.2018.5714/2018DOI Listing
January 2019

Terms, concepts and definitions in clinical artificial nutrition. The ConT-SEEN Project.

Endocrinol Diabetes Nutr 2018 Jan 8;65(1):5-16. Epub 2017 Dec 8.

Grupo de trabajo ConTSEEN del Área de Nutrición de la SEEN.

Background: Imprecision in terms used in the field of clinical nutrition may lead to misinterpretations among professionals.

Objective: For this reason, the Spanish Society of Endocrinology and Nutrition (SEEN) promoted this document on the terms and definitions used in clinical artificial nutrition (enteral and parenteral), establishing an agreement between Spanish experts of this specialty.

Methods: Forty-seven specialists in endocrinology and nutrition, members of the Nutrition Area of the SEEN, participated between April and September 2016. After a systematic literature review, 52 concepts were proposed. The coordinators included two additional concepts, and 57were finally selected by the working group: 13 of a general nature, 30 referring to enteral nutrition and 14 to parenteral nutrition. The degree of agreement was subsequently determined using a two-round Delphi process. It was finally ratified by consistency and concordance analysis.

Results: Fifty-four of the 57 terms had a very consistent agreement and were concordant. Only three showed no concordance, of whom two were very consistent and one inconsistent. In conclusion, there was consensus in the definition of 54 basic terms in the practice of clinical nutrition.
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http://dx.doi.org/10.1016/j.endinu.2017.10.008DOI Listing
January 2018

Nutrición Hospitalaria 2016-2017: achivements and challenges

Nutr Hosp 2017 02 22;34(1):1-3. Epub 2017 Feb 22.

Hospital Universitario 12 de Octubre.

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http://dx.doi.org/10.20960/nh.903DOI Listing
February 2017

Night-time sleep duration and the incidence of obesity and type 2 diabetes. Findings from the prospective Pizarra study.

Sleep Med 2014 Nov 11;15(11):1398-404. Epub 2014 Aug 11.

Spanish Biomedical Research Centre in Diabetes and Associated Metabolic Disorders (CIBERDEM), Spain; UGCI de Endocrinología y Nutrición, Hospital Regional Universitario, Málaga, Spain; Instituto de Investigación Biomédica de Málaga (IBIMA), Málaga, Spain.

Background: Several recent studies have related short sleep duration with different health problems, though the results related with the risk of obesity and type 2 diabetes (T2D) are far from conclusive. The aim of this study was to investigate the association between night-time sleep duration and the incidence of obesity and T2D in a prospective study with a follow-up of 11 years.

Material And Methods: The study comprised 1145 people evaluated in 1997-1998 and re-evaluated after 6 years and 11 years. At the three study points, subjects without known diabetes mellitus (KDM) were given an oral glucose tolerance test (OGTT). Anthropometric and biochemical variables were measured. The subjects were asked about their number of hours of night-time sleep.

Results: After adjustment, the OR of becoming obese was significantly higher in subjects who slept ≤ 7 hours per night, at both the 6-year follow-up (OR = 1.99; 95% CI = 1.12-3.55) and the 11-year follow-up (OR = 2.73; 95% CI = 1.47-5.04). The incidence of T2D at the 6-year follow-up in subjects without T2D at baseline was higher in those who slept ≤ 7 hours per night (OR = 1.96; 95% CI = 1.10-3.50). However, this association was not independent of obesity, weight gain or abnormal glucose regulation at baseline. At the 11-year follow-up however there was no association between night-time sleep duration and the incidence of T2D.

Conclusions: The incidence of obesity over the 11-year follow-up increased in subjects with fewer hours of night-time sleep. The incidence of T2D according to the hours of night-time sleep depended on obesity and the carbohydrate metabolism phenotype.
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http://dx.doi.org/10.1016/j.sleep.2014.06.014DOI Listing
November 2014

[Analysis of energy expenditure in adults with cystic fibrosis: comparison of indirect calorimetry and prediction equations].

Arch Bronconeumol 2007 Jul;43(7):366-72

Unidad de Fibrosis Quística de Adultos, Servicio de Neumología, Hospital Universitario Carlos Haya, Málaga, España.

Objective: Undernutrition, which implies an imbalance between energy intake and energy requirements, is common in patients with cystic fibrosis. The aim of this study was to compare resting energy expenditure determined by indirect calorimetry with that obtained with commonly used predictive equations in adults with cystic fibrosis and to assess the influence of clinical variables on the values obtained.

Patients And Methods: We studied 21 patients with clinically stable cystic fibrosis, obtaining data on anthropometric variables, hand grip dynamometry, electrical bioimpedance, and resting energy expenditure by indirect calorimetry. We used the intraclass correlation coefficient (ICC) and the Bland-Altman method to assess agreement between the values obtained for resting energy expenditure measured by indirect calorimetry and those obtained with the World Health Organization (WHO) and Harris-Benedict prediction equations.

Results: The prediction equations underestimated resting energy expenditure in more than 90% of cases. The agreement between the value obtained by indirect calorimetry and that calculated with the prediction equations was poor (ICC for comparisons with the WHO and Harris-Benedict equations, 0.47 and 0.41, respectively). Bland-Altman analysis revealed a variable bias between the results of indirect calorimetry and those obtained with prediction equations, irrespective of the resting energy expenditure. The difference between the values measured by indirect calorimetry and those obtained with the WHO equation was significantly larger in patients homozygous for the DeltaF508 mutation and in those with exocrine pancreatic insufficiency.

Conclusions: The WHO and Harris-Benedict prediction equations underestimate resting energy expenditure in adults with cystic fibrosis. There is poor agreement between the values for resting energy expenditure determined by indirect calorimetry and those estimated with prediction equations. Underestimation was greater in patients with exocrine pancreatic insufficiency and patients who were homozygous for DeltaF508.
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http://dx.doi.org/10.1016/s1579-2129(07)60087-1DOI Listing
July 2007

Excess hospitalizations, hospital days, and inpatient costs among people with diabetes in Andalusia, Spain.

Diabetes Care 2004 Aug;27(8):1904-9

Endocrinology and Nutrition Service, Carlos Haya Universitary Hospital, Malaga, Spain.

Objective: The goal of this study was to estimate the excess hospitalizations, hospital days, and inpatient costs attributable to diabetes in Andalusia, Spain (37 hospitals, 7,236,459 inhabitants), during 1999 compared with those without diabetes.

Research Design And Methods: This study was an analysis of all hospital discharges. Those with an ICD-9-CM code of 250 as either the main or secondary diagnosis were considered to have been admissions of individuals with diabetes. An estimate of costs was applied to each inpatient admission by assigning a cost weight based on the diagnostic-related group (DRG) related to each admission.

Results: A total of 538,580 admissions generated 4,310,654 hospital bed-days and total costs of 940,026,949 euro. People with diabetes accounted for 9.7% of all hospital discharges, 13.8% of total stays, and 14.1% of the total cost. Of the total cost for individuals with diabetes (132,509,217 euro), 58.3% were excess costs, of which 47% was attributable to cardiovascular complications and 43% to admissions for comorbid diseases. Individuals 45-75 years of age accounted for 75% of the excess costs. The rate of admissions during the study year was 145 per 1,000 inhabitants for individuals with diabetes compared with 70 admissions per 1,000 inhabitants for individuals without diabetes.

Conclusions: The costs arising from hospitalization of individuals with diabetes are disproportionate in relation to their prevalence. For those aged >or=45 years, cardiovascular complications were clearly the most important factor determining increased costs from diabetes.
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http://dx.doi.org/10.2337/diacare.27.8.1904DOI Listing
August 2004