Publications by authors named "Mercè Fernández Miró"

10 Publications

  • Page 1 of 1

Autoinmune polyendocrinopathy.

Med Clin (Barc) 2021 May 3. Epub 2021 May 3.

Departamento de Medicina Interna y Especialidades Médicas, Centre d'Atenció Integral Dos de Maig, Consorci Sanitari Integral, Barcelona, España.

Pluriglandular autoimmune syndrome (APS) can affect multiple endocrine glands and is associated with other autoimmune diseases. APS type 1 presents with hypoparathyroidism, mucocutaneous candidiasis and Addison's disease. It is caused by AutoImmune Regulator (AIRE) gene mutation. The diagnosis includes clinical manifestations in addition to AIRE gene sequencing. SPA type 2 presents with Addison's disease, type 1 diabetes, or autoimmune thyroid disease. Multiple genes have been implicated, including those of the class II major histocompatibility complex. SPA type 3 is characterized by autoimmune thyroid disease and other autoimmune disease, excluding Addison's disease and hypoparathyroidism, 4 genes have been implicated and confer susceptibility. The diagnosis of APS type 2 and type 3 includes clinical manifestations, nevertheless, the determination of autoantibodies can be useful to predict the risk of disease manifestation and to confirm the autoimmune disease in some cases.
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http://dx.doi.org/10.1016/j.medcli.2021.02.004DOI Listing
May 2021

Syndrome of inappropriate antidiuretic hormone secretion associated with a SARS-CoV-2 pneumonia.

Med Clin (Engl Ed) 2021 Feb 16;156(4):195-196. Epub 2021 Feb 16.

Internal Medicine Department, Centre d'Atenció Integral Dos de Maig, Consorci Sanitari Integral, Barcelona, Spain.

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http://dx.doi.org/10.1016/j.medcle.2020.10.009DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7885693PMC
February 2021

[Syndrome of inappropriate antidiuretic hormone secretion associated with a SARS-CoV-2 pneumonia].

Med Clin (Barc) 2021 02 19;156(4):195-196. Epub 2020 Nov 19.

Internal Medicine Department, Centre d'Atenció Integral Dos de Maig, Consorci Sanitari Integral, Barcelona, Spain.

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http://dx.doi.org/10.1016/j.medcli.2020.10.003DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7674133PMC
February 2021

Hypertriglyceridemic waist in type 1 diabetes patients: prevalence and related factors.

Minerva Endocrinol 2017 Mar 8;42(1):1-7. Epub 2016 Nov 8.

Department of Medicine, Universitat Autònoma de Barcelona, Cerdanyola del Vallès, Spain; Department of Endocrinology and Nutrition, Hospital del Mar, Barcelona, Spain; IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain.

Background: The hypertriglyceridemic waist has been linked to a higher number of cardiovascular risk factors and a greater probability of developing diabetes and cardiovascular disease. Around 50% of individuals with type 1 diabetes (T1D) are overweight or obese and triglyceridemia is associated with the onset of micro- and macrovascular complications.

Methods: A cross-sectional study was conducted in men with T1D to assess the association between the prevalence of hypertriglyceridemic waist and cardiovascular risk factors and hypogonadism. Triglyceride levels + abdominal circumference taken together were stratified into quartiles to identify the hypertriglyceridemic waist phenotype.

Results: One hundred and eighty-one male patients were included. An increased prevalence of hypogonadism and hypertension in parallel to increased triglyceride + waist circumference quartile was observed. Patients in the highest quartile had higher insulin resistance measured by estimated glucose disposal rate (eGDR 7.8±2.1 mg/kg-1.min-1 in 1st quartile vs. 5.8±1.8 mg/kg-1.min-1 in 4th quartile, P=0.000), insulin requirements, hip circumference, percentage of fat mass, glycosilated hemoglobin and total and LDL cholesterol as well as lower levels of total testosterone (27.24±9.3 nmol/L in 1st quartile vs. 17.4±8 nmol/L in 4th quartile, P=0.000) and HDL cholesterol. An inverse relationship was found between triglycerides + waist circumference and total testosterone levels (R=-0.367, P<0.0001).

Conclusions: The hypertriglyceridemic waist in men with T1D is associated with an atherogenic lipid profile, hypertension, worse metabolic diabetes control, increased insulin resistance and a higher prevalence of hypogonadism.
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http://dx.doi.org/10.23736/S0391-1977.16.02561-XDOI Listing
March 2017

Testosterone undecanoate improves lipid profile in patients with type 1 diabetes and hypogonadotrophic hypogonadism.

Endocr J 2016 Sep 22;63(9):849-855. Epub 2016 Jul 22.

Department of Endocrinology and Nutrition, Hospital del Mar, Barcelona, Spain.

Testosterone deficiency (Td) has been associated with the metabolic syndrome. Few studies have evaluated this condition in type 1 diabetes (T1D). The primary aim of this study was to evaluate the effectiveness of testosterone undecanoate (TU) on insulin sensitivity, glycemic control, anthropometric parameters, blood pressure and lipid profile in patients with Td and T1D. We performed a randomized placebo-controlled multicenter study.

Inclusion Criteria: a) age ≥ 18 years; b) autoimmune diabetes; c) Td (total testosterone <10 nmol/L or calculated free testosterone <225 pmol/L and low/normal LH; d) ability to sign informed consent; e) comply with the study protocol.

Exclusion Criteria: a) pituitary tumor, empty sella, hyperprolactinemia, panhypopituitarism or secondary hypogonadism; b) contraindications for treatment with testosterone undecanoate (TU); c) patients who did not agree to sign their informed consent. Six patients were randomly assigned to testosterone undecanoate (TU) treatment and 7 to placebo with the following dosing schedule: baseline, 6 weeks and 16 weeks. Blood test, anthropometric parameters, blood pressure and insulin sensitivity were determined at baseline, 6, 16 and 22 weeks. No differences were observed regarding insulin sensitivity, HbA or basal glucose, anthropometric parameters or blood pressure. At 22 weeks, the decrease in total cholesterol was 37.4 ± 27.5 mg/dL in the TU group compared with an increase of 13.2 ± 17.8 mg/dL in the placebo group (P<0.005), and LDL cholesterol concentration decreased 30.2 ± 22.1 mg/dL, compared with an increase of 10.5 ± 13.4 mg/dL in the placebo group (P=0.004). We conclude that treatment with TU in patients with T1D and Td improves lipid profile, with no effects on metabolic control or anthropometric parameters.
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http://dx.doi.org/10.1507/endocrj.EJ16-0195DOI Listing
September 2016

[Testosterone deficiency, metabolic syndrome and diabetes mellitus].

Med Clin (Barc) 2016 Jan 1;146(2):69-73. Epub 2015 Oct 1.

Departamento de Medicina, Universitat Autònoma de Barcelona, Barcelona, España; Servicio de Endocrinología y Nutrición, Hospital del Mar, Barcelona, España; Instituto Hospital del Mar de Investigaciones Médicas (IMIM), Barcelona, España.

Testosterone deficiency in adult age is associated with a decrease in libido, energy, hematocrit, muscle mass and bone mineral density, as well as with depression. More recently, testosterone deficiency has also been associated with various components of the metabolic syndrome, which in turn is associated with a five-fold increase in the risk of cardiovascular disease. Low testosterone levels are associated with increased insulin resistance, increase in fat mass, low HDL cholesterol, higher triglyceride levels and hypertension. Testosterone replacement therapy in patients with testosterone deficiency and type 2 diabetes mellitus and/or metabolic syndrome has shown reductions in insulin resistance, total cholesterol, LDL cholesterol and triglycerides and improvement in glycemic control and anthropometric parameters.
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http://dx.doi.org/10.1016/j.medcli.2015.06.020DOI Listing
January 2016

Age, insulin requirements, waist circumference, and triglycerides predict hypogonadotropic hypogonadism in patients with type 1 diabetes.

J Sex Med 2015 Jan 13;12(1):76-82. Epub 2014 Nov 13.

Department of Endocrinology and Nutrition, Hospital del Mar, Barcelona, Spain; Departament de Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain; IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain.

Introduction: The prevalence of hypogonadotropic hypogonadism (HH) in patients with type 2 diabetes mellitus is higher than in the general population and leads to detrimental effects on metabolic control, lipid profile, and body composition. Few studies have examined its role in type 1 diabetes mellitus.

Aim: To determine the prevalence of HH in patients with type 1 diabetes and associated risk factors.

Main Outcome Measures: Clinical and biochemical parameters were gathered on initial evaluation. An HH score creating different experimental models was devised to calculate the risk of HH for an individual with type 1 diabetes.

Methods: Cross-sectional study of 181 male patients with type 1 diabetes consecutively admitted to the Diabetes outpatient clinics of three urban hospitals. All participants were Caucasians aged ≥ 18 years with type 1 diabetes duration of more than 6 months.

Results: One hundred and eighty-one male patients with a mean age of 44.2 ± 13.2 years and a type 1 diabetes duration of 18.9 ± 12.7 years were included. Fifteen patients had HH, representing a prevalence of 8.3% (95% confidence interval [CI]: 4.3-12.3%). Age (odds ratio [OR] 1.066 [95% CI: 1.002-1.134]), waist circumference (OR 1.112 [95% CI: 1028-1203]), and insulin requirements ([IU/Kg] ×10 [OR 1.486 {95% CI: 1052-2.098}]) were independently associated with the presence of HH. The model that best predicted HH generated this formula: HH-score = (1.060 × age) + (1.084 × waist circumference) + (14.00 × insulin requirements) + triglycerides, where age was expressed in years, waist circumference in cm, insulin requirements in IU/kg/d, and triglycerides in mg/dL. An HH score > 242.4 showed 100% sensitivity and 53.2% specificity for HH diagnosis; positive and negative predictive values were 17.0 % and 100%, respectively.

Conclusions: One in 10 men with type 1 diabetes presents HH. This condition is associated with age, waist circumference, and insulin requirements. A simple formula based on clinical parameters can rule out its presence.
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http://dx.doi.org/10.1111/jsm.12748DOI Listing
January 2015

Infradiagnosed complications of chronic diabetes mellitus: the value of systematic review in a single visit.

Endocrinol Nutr 2012 Dec 30;59(10):585-90. Epub 2012 Oct 30.

Servicio de Medicina Interna y Especialidades Médicas, Unidad de Endocrinología y Nutrición, Centre d'Atenció Integral Dos de Maig, Barcelona, España.

Introduction: Early diagnosis of diabetes mellitus complications reduces their progression and therefore improves quality of life and decreases cardiovascular mortality.

Objectives: To evaluate the efficiency of a unit for detection of chronic complications of diabetes, and to analyze the incidence and prevalence of complications in a sample of patients from our area of interest and concern.

Methods: A cross-sectional study performing routine screening of all diabetes complications in patients aged 18-80 years diagnosed with type 1 or type 2 diabetes mellitus at least 6 months before. Anthropometric variables were measured and data on drug treatment and the most recent lipid profile were collected.

Results: 460 patients were included in the study. The prevalence and incidence rates of chronic complications of diabetes were 57% and 35.4% respectively. Glycosylated hemoglobin values ≤ 7% were found in 42% of patients, blood pressure levels below 130/80 mmHg in 20% of patients, and LDL cholesterol levels less than 2.59 mmol/L in 46% of patients. Patients with new complications were older and had higher BMI and hip circumference values, as well as higher systolic blood pressure levels and greater use of antihypertensive drugs.

Conclusion: A unit for routine screening of chronic complications of diabetes would allow for detection of macroangiopathy and microangiopathy in a single annual visit, increasing visit compliance, and for implementation of measures to prevent its progression.
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http://dx.doi.org/10.1016/j.endonu.2012.08.002DOI Listing
December 2012

[Treatment of diabetes mellitus during Ramadan].

Med Clin (Barc) 2007 Sep;129(8):303-8

Servicio de Endocrinología y Nutrición, Hospital Universitario del Mar (IMAS), Barcelona, España.

In the treatment of patients with diabetes mellitus it is fundamental that the therapeutic schemes are adapted to each's patient characteristics such as age, associated diseases and diabetes complications. This therapeutic individualization must also include lifestyles and socio-cultural and religious factors as the celebration of Ramadan. Although Muslin diabetics are theoretically free from Ramadan, they commonly wish to fast in practice. It is therefore needed a right approach of the patient during this period. In this Review, we analyze the prevalence of diabetes among different ethnicities, the possible complications of the disease in relation to fasting's pathophysiology, and the studies performed to rightly manage type 1 and 2 diabetic patients during Ramadan. It is necessary to adapt the therapeutic scheme both for patients treated with dietetic measures or oral drugs and for patients receiving insulin. It is also important the involvement of health professionals in the advice, orientation and adaptation of the therapeutic regimen of Muslin people with diabetes.
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http://dx.doi.org/10.1157/13109119DOI Listing
September 2007