OBJECTIVE: Evaluation of quality of care for patients with diabetes mellitus admitted to hospitals in Spain.
METHODS: Cross-sectional study in one day that included 1193 (26.7%) patients with type 2 diabetes or hyperglycaemia out of a total of 4468 patients admitted to the internal medicine departments of 53 hospitals in Spain. We collected demographic data, adequacy of capillary glycaemic monitoring, treatment administered during admission, and recommended therapy at discharge.
RESULTS: The median age of the patients was 80 years [74-87], of which 561 (47%) were women, with a Charlson index of 4 points [2-6], and 742 (65%) were fragile. Median blood glucose on admission was 155 mg/dl [119-213]. On the third day, the number of capillary blood glucose levels in target (80-180 mg/dl) at pre-breakfast was 792/1126 (70.3%), pre-lunch 601/1083 (55.4%), pre-dinner 591/1073 (55.0%), and at night 317/529 (59.9%). A total of 35 patients (0.9%) were suffering from hypoglycemia. Treatment during hospitalization was performed with sliding scale insulin in 352 (40.5%) patients, with basal insulin and rapid insulin analogues in 434 (50%), or with diet exclusively in 101 (9.1%). A total of 735 (61.6%) patients had a recent HbA1c value. At discharge, the use of SGLT2i increased significantly (30.1% vs. 21.6%; p < 0.001), as did the use of basal insulin (25.3% vs. 10.1%; p < 0.001).
CONCLUSIONS: There is an excessive use of sliding scale insulin as well as insufficient information on HbA1c values and prescription upon discharge of treatments with cardiovascular benefit.

BACKGROUND: Glycaemic variability (GV) refers to variations in blood glucose levels, and may affect stroke outcomes. This study aims to assess the effect of GV on acute ischaemic stroke progression.
METHODS: We performed an exploratory analysis of the multicentre, prospective, observational GLIAS-II study. Capillary glucose levels were measured every 4 hours during the first 48 hours after stroke, and GV was defined as the standard deviation of the mean glucose values. The primary outcomes were mortality and death or dependency at 3 months. Secondary outcomes were in-hospital complications, stroke recurrence, and the impact of the route of insulin administration on GV.
RESULTS: A total of 213 patients were included. Higher GV values were observed in patients who died (n = 16; 7.8%; 30.9 mg/dL vs 23.3 mg/dL; p = 0.05). In a logistic regression analysis adjusted for age and comorbidity, both GV (OR = 1.03; 95% CI, 1.003-1.06; p = 0.03) and stroke severity (OR = 1.12; 95% CI, 1.04-1.2; p = 0.004) were independently associated with mortality at 3 months. No association was found between GV and the other outcomes. Patients receiving subcutaneous insulin showed higher GV than those treated with intravenous insulin (38.95 mg/dL vs 21.34 mg/dL; p < 0.001).
CONCLUSIONS: High GV values during the first 48 hours after ischaemic stroke were independently associated with mortality. Subcutaneous insulin may be associated with higher VG levels than intravenous administration.

Among the substances prohibited by the World Anti-Doping Agency, \"peptide hormones, growth factors, related substances, and mimetics\" are classified as prohibited both in- and out-of-competition in section S2. This work reviews growth hormone and its releasing peptides, insulin-like growth factor 1 as the main growth factor, insulin, and erythropoietin and other agents that affect erythropoiesis. This review analyzes the prevalence of use among professional athletes and gym clients, the forms of use, dosing, ergogenic effects and effects on physical performance, as well as side effects and anti-doping detection methods.

Triponderal mass index (TMI) would estimate excess adiposity better than body mass index (BMI), maintaining stable values during childhood. This work aims to determine the correlation between TMI and markers of metabolic risk as well as set values of TMI that are related to an increase of metabolic risk.
Multicenter, observational, cross-sectional and prospective study in children under 14 years of age with obesity.
age, sex, pubertal stage, weight, height, abdominal circumference, BMI, TMI, basal glucose and insulin, HOMA index, blood pressure, lipoprotein profile, transaminases and uric acid. BMI and TMI were expressed according to the values of the Barcelona longitudinal study. Statistical analysis was performed with the SPSS* program.
One hundred and ninety-nine patients (50.3% male), age 11.08 (2.48) years, TMI 19.68 (2.36)kg/m3. Correlation between TMI and abdominal circumference (r=0.571; p=0), insulin (r=0.198; p=0.005), HOMA index (r=0.189; p=0.008) and HDL-c (r=-0.188; p=0.008) was observed. IMT>20.15kg/m3 was associated with insulin≥15mIU/ml (p=0.029) and IMT>20.36kg/m3 with HDL-c<40mg/dl (p=0.023).
TMI was correlated with increase of abdominal circumference, insulin and HOMA index and decrease of HDL-c. IMT>20kg/m3 can be associated with increased insulin and decreased HDL-c. Therefore, the IMT seems to be a useful parameter in the assessment of pediatric patients with obesity.

BACKGROUND: The purpose of this study was to validate the Insulin Treatment Appraisal Scale (ITAS) in the Cuban population with type 2 diabetes mellitus.
METHODS: A cross-sectional, multicentre analytical study was performed in Cuba from February 2020 to April 2021; 199 patients were surveyed in a hospital institution and in primary healthcare. We used the Insulin Treatment Appraisal Scale, consisting of 20 items, with a minimum score of 20 points and a maximum of 100, where the higher the score, the worse the perception of insulin therapy. The validity of the instrument was determined by means of an exploratory factor analysis. The internal consistency and reliability of the scale were calculated by means of Cronbach\'s alpha coefficient. A K-means cluster analysis was performed to establish a cut-off point for poor perception of insulin therapy.
RESULTS: The exploratory factor analysis supported the validity of the instrument, with a Cronbach\'s alpha of 0.747. There were statistically significant differences between patients under insulin and non-insulin treatment in terms of the answers given in all items of the scale. The total mean score obtained was 51.96 ± 10.78, and it was lower in insulin users compared to those who used other drugs (49.79 ± 10.07 vs 55.09 ± 11.12). A score ≥65 was proposed as a cut-off point for poor perception of insulin therapy. A positive relationship was found between the body mass index values and the total score of the scale. Being female and current treatment not involving insulin were factors associated with low perception of insulin therapy.
CONCLUSIONS: The instrument proved to be valid for the population in which it was applied. Insulin users turned out to be the ones with the best perception about its use. A cut-off point of ≥65 points for poor perception of insulin treatment was proposed for evaluation and comparison in future studies in other patient populations.

OBJECTIVE: To guide professionals involved in the care of people with diabetes mellitus who practice sport.
METHODS: Members of the Diabetes Mellitus Working Group of the Spanish Society of Endocrinology and Nutrition.
METHODS: A group of experts in each area covered by the statement carried out a bibliographic review of the available evidence for each topic, based on which recommendations were subsequently agreed upon within the Diabetes Mellitus Working Group.
CONCLUSIONS: The statement provides practical recommendations for the management of diabetes mellitus during sports practice.

BACKGROUND: Diabetes mellitus (DM) inhibits brain serotonin biosynthesis through changes in tryptophan-5-hydroxylase (TPH) activity and expression.
OBJECTIVE: To determine whether DM-induced changes in brain TPH1 or TPH2 expression and in the number of serotonergic neurons return to normal in diabetic rats treated with insulin.
METHODS: Rats with streptozotocin-induced diabetes were divided in two groups: one treated with insulin and the other without treatment. On day 14, brain stems were obtained in order to quantify L-tryptophan and 5-hydroxytryptamine levels, as well as to determine TPH activity. The expression of TPH1 and TPH2 by West-ern blot, and the number of serotonergic neurons by immunohistochemistry.
RESULTS: In diabetic rats, a decrease in the levels of L-tryptophan, 5-hydroxytryptamine, and TPH activity was confirmed, as well as lower TPH1 and TPH2 expression and lower numbers of serotonergic neurons. When diabetic rats were treated with insulin, L-tryptophan returned to normal, but not 5-hy-droxytryptamine, TPH expression, or the number of serotonergic neurons.
CONCLUSIONS: DM chronically inhibits the synthesis of brain 5-hydroxytryptamine through changes in TPH1 and TPH2 expression and a decrease in the number of serotonergic neurons, which persist despite insulin treatment.
UNASSIGNED: La diabetes mellitus (DM) inhibe la biosíntesis de serotonina cerebral mediante cambios en la actividad y expresión de la triptófano-5-hidroxilasa (TPH).
OBJECTIVE: Determinar si los cambios en la expresión de TPH1 o TPH2 cerebral y en el número de neuronas serotoninérgicas causados por la DM retornan a la normalidad en las ratas con diabetes tratadas con insulina.
UNASSIGNED: Ratas con diabetes inducida con estreptozotocina se dividieron en dos grupos: uno tratado con insulina y otro sin tratamiento. En el día 14, se obtuvieron tallos cerebrales para cuantificar niveles de L-triptófano, 5-hidroxitriptamina y la actividad de la TPH. La expresión de TPH1 y TPH2 fue mediante Western blot y el número de neuronas serotoninérgicas por inmu­nohistoquímica.
RESULTS: En las ratas con diabetes se confirmó disminución de los niveles de L-triptófano, 5-hidroxitriptamina y la actividad de la TPH, así como una menor expresión de TPH1 y 2 y un menor número de neuronas serotoninérgicas. Cuando las ratas diabéticas fueron tratadas con insulina, el L-triptófano regreso a la normalidad, no así la 5-hidroxitriptamina, la expresión de TPH y el número de neuronas serotoninérgicas.
CONCLUSIONS: La DM inhibe crónicamente la síntesis de 5-hidroxitriptamina cerebral mediante modificaciones en la expresión de TPH1 y TPH2 y disminución de las neuronas seroto­ninérgicas, que persisten a pesar del tratamiento con insulina.

The relevance of type 1 diabetes during pregnancy stems from its impact on the health of mother and offspring and its increasing prevalence. Glycemic control during pregnancy is one of the main risk factors for adverse events. Besides, treatment becomes a major challenge not only due to the modifications in insulin requirements due to changes in hormones and cytokines but also to the stricter control targets. Given the recent appearance of new ultra-rapid and basal insulin analogues and the constant evolution of technology to treat people with diabetes, we review these aspects in relation to the treatment of women with type 1 diabetes during pregnancy.

BACKGROUND: Therapeutic education is an essential part in the management of type 2 diabetes mellitus (T2D). Implementing a therapeutic education program with the participation of a diabetes specialist nurse (DSN) addressed to patients with T2D using more than 2 insulin injections and sub-optimal metabolic control in primary care (PC) could improve health care and clinical outcomes. Our purpose was to evaluate the clinical, educational and patient satisfaction outcomes of this program.
METHODS: A prospective, longitudinal study was performed with an evaluation before and after the intervention. The program had a duration of 6 months and included individual on-site, phone and group visits.
RESULTS: 184 subjects were included and 161 were finally evaluated. 89.4% were included due to sub-optimal metabolic control and 10.6% because of repeated hypoglycemia. In the first group, the mean reduction in HbA1c was -1.34%±1.45% without any increase in hypoglycemia episodes. In the second group, a significant reduction in hypoglycemia episodes/week was observed (2.52±1.66 vs. 0.53±1.06; p<0.05) without any increase in HbA1c. Learning skills, lifestyle, adherence to care, and the perception of quality of life had significantly improved at 6 months (p<0.05). The overall program was positively evaluated by patients, the role of DSN being considered essential by 98% of the responders.
CONCLUSIONS: A structured therapeutic education program, including a DSN, addressed to insulin treated T2D patients attending primary care facilities and with sub-optimal metabolic control is associated with beneficial effects in terms of clinical, educational and patient satisfaction endpoints.

Incretin-based therapy leads to glycemic control in a glucose-dependent manner with a low risk of hypoglycemia, making it appealing for use in the hospital. The aim of this systematic review was to assess the benefits of incretin-based therapy in patients with type 2 diabetes hospitalized outside of the intensive care unit. We searched for studies published up to August 2021 in the PubMed and Scopus databases. Clinical trials comparing incretin-based therapy (alone or in combination with insulin) versus an insulin regimen were selected. The results of the included studies showed that incretin-based therapy showed mean blood glucose values, a percentage of records within the therapeutic target, and a percentage of treatment failure similar to insulin management, particularly in patients with mild to moderate hyperglycemia. Furthermore, incretin-based treatment was associated with a lower total insulin dose and a lower incidence of hypoglycemia. In conclusion, incretin-based therapy achieved glycemic control similar to insulin treatment in patients with type 2 diabetes hospitalized outside the intensive care unit and has the advantages of reducing the insulin requirement and a lower risk of hypoglycemia.