Journal of the Argentine Society of Diabetes

Carmen Sylvia Mazza

Gabriela Krochik — Mon, 16 Jun 2025 00:00:00 -0300

I sit down to write these words, and I can't help but feel deeply honored by the life that made Carmen my teacher and professional guide.

I met her when I was 20, when my friend Irina invited me to spend Christmas with her family. Carmen welcomed me with her turkey, her unforgettable gazpacho, and an enormous affection and warmth that she shared with sensitivity and generosity with her friends, her friends' friends, and her children's friends.

BERNARDO HOUSSAY CONFERENCE: Topics of immunity and diabetes mellitus reviewed in the light of basic science and current technologies

Edgardo Poskus — Mon, 16 Jun 2025 00:00:00 -0300

Conventional methods for measuring autoantibodies, called markers, in diabetes mellitus with an autoimmune component (type 1 diabetes and LADA), have been radiometric or enzymatic (ELISA). Anti-insulin autoantibodies (IAA) were among the first to be studied. Antibodies with the same specificity have also been detected in diabetic patients treated with insulin (AI) and in other rare diseases. In all these cases, the aforementioned tests were shown to be very sensitive, but they had the limitation of expressing relative results because they could not distinguish the two constituent parameters of the analytical signals, such as affinities and concentrations. The so-called absolute methods can discriminate these parameters and are appropriate to study in depth the cases in which very high levels of IAA or IA appear through conventional preliminary analyses.

We have selected three work models requested from our laboratory at the Institute of Humoral Immunity Studies (IDEHU, CONICET-UBA), required from different medical groups or by the biotechnology pharmaceutical industry. The common problem of these special studies was to overcome the limitations of the usual methods for measuring high-level specific anti-insulin antibodies and move to a higher level of complexity that would allow defining the real absolute levels of these antibodies. The objectives of the works published in these lines were diverse, such as providing more precise diagnostic support, or reorienting therapeutic administration in favor of insulin analogues. For the latter, the concepts of cross-reactivity and specificity in immunology were also reviewed in order to introduce the selectivity parameter (S), which allows the most precise quantitative expression of the interaction of antibodies against a panel of antigens with structural homologies. Finally, contributions were made to quality control required by official regulatory authorities for recombinant insulins produced by the biotechnology industry.

For all these approaches, the theoretical and practical scientific bases of radiometry were presented, which historically allowed the weighting of antibodies based on their absolute parameters, and the principles of current biosensors were incorporated, based on surface plasmonic resonance, which includes the determination of the kinetic parameters.

PEDRO ESCUDERO CONFERENCE: A person with type 2 diabetes and metabolic-renal-cardiovascular syndrome. Evidence, doubts, omissions

Isaac Sinay — Mon, 16 Jun 2025 00:00:00 -0300

This presentation will review the mechanisms involved in the syndrome, its treatment based on evidence interpreted by the attending physician, and finally, its interaction with other specialized physicians.

Based on a patient with class 2 obesity, type 2 diabetes mellitus (DM2), dyslipidemia and hypertension, with evidence of fatty liver disease associated with metabolic disease, chronic kidney disease, and a history of transient ischemic attack and angioplasty for unstable angina (stage 4 cardiovascular-renal-metabolic syndrome [CKMS]), we hypothesize about the possible evolutionary history of the syndrome (reclassifying it as metabolic-renal-cerebro-cardiovascular) and the evidence on little-explored interactions within it (hepato-renal, renal/hepato-cerebral, and cerebrovascular-heart).

Evidence is also mentioned regarding missed opportunities with interventions prior to the current stage and those available (nonpharmacological and with antihyperglycemic cardiorenal protective medications and their combinations) at this advanced stage to improve the quality and duration of survival. Likewise, new lipid-lowering and renal protective drugs available in our setting are explored, which could be used in interaction with other specialists.

This inevitably leads to an evaluation of how the diabetologist plays a fundamental role in managing the evidence and existing doubts so that, without losing fidelity to them, they can implement their translation to the patient.

And this can be done through their training and transdisciplinary access, which involves multiple actors. For example, the large group of specialists convened by the American Heart Association (AHA) for the aforementioned document should have included hepatologists, lipidologists, nutritionists, and physical trainers, who were not included.

Considering this, and considering that it is a stage that goes beyond multidisciplinary and interdisciplinary approaches, and that there is little transdisciplinary information in our area of activity (which for now can be enriched with a few experiences from similar topics), I believe that its realization is a future challenge, probably supported by advances in computer science that can be transferred to the clinical practice.

Cardio-renal-metabolic profile in first hospitalization for heart failure. Evaluation of 541 patients

Mon, 16 Jun 2025 00:00:00 -0300

Introduction: heart failure (HF) and diabetes mellitus (DM). often coexist, and each condition independently increases the risk of developing the other. Patients with DM have higher mortality rates compared to normoglycemic individuals.

Objectives: to evaluate cardiorenal metabolic factors in the first hospitalization for heart failure and to estimate predictors of mortality.

Materials and methods: this was a retrospective study. Digitized medical records of patients hospitalized for their first episode of HF between 2013 and 2019 were analyzed. Data collected included personal history, habits, regular medications, physical examination, laboratory tests at admission and discharge, and complementary studies. The sample was divided into groups of patients with and without DM. For the comparison of numerical variables, the Student's test or Mann-Whitney test was used, and for the comparison of frequencies, the chi-square test or Fisher's exact test was used. Statistical significance was set at p < 0.05. A predictive model for mortality was constructed using logistic regression with stepwise variables automatically selected.

Results: a total of 541 patients (297 without DM and 244 with DM) were inclued. Patients with DM were younger, had a higher prevalence of dyslipidemia and myocardial infarction (MI) and systolic blood pressure (SBP) at discharge. At admission, they had higher glucose levels, HbA1c albuminuria, and creatinine, and lower glomerular filtration rate. On echocardiography, left ventricular ejection fraction was lower in patients with DM. The multivariable model for mortality prediction included: age, discharge SBP, creatinine and HbA1c; with a sensitivity of 96.88%, specificity of 34.04%, and an area under the ROC curve (AUC) of 0.82.

Conclusions: consistent with the literature, patients with DM presented a higher severity and quantity of cardiorenal metabolic risk factors, which independently behave as predictors of mortality.

Diabetes, dysglycemia and obesity: their relationship with mortality and demand for health resources during the COVID-19 pandemic (2020-2021) in a community hospital

Mon, 16 Jun 2025 00:00:00 -0300

Introduction: the COVID-19 pandemic led to an increase in global morbidity and mortality that affected the community served at our Hospital, particularly vulnerable individuals with underlying comorbidities.

Objectives: to analyze whether patients with known diabetes mellitus (DM) and dysglycemia at the time of hospital admission and/or during their stay, and those with obesity, had higher mortality compared to patients without these conditions during hospitalizations due to COVID-19 infection (2020-2021). Likewise, to evaluate whether these same patients required increased demand for intensive care unit (ICU) admission and/or mechanical ventilation (MVA).

Materials and methods: a retrospective study was made of 594 patients admitted with a confirmed diagnosis of SARS-CoV-2 virus infection (SARS-CoV-2 TCR antigen immunochromatographic test and/or polymerase chain reaction, PCR) to the Hospital del Carmen de Chacabuco from May 20, 2020, to August 15, 2021. Patients were classified as: a) patients with DM: with a known diagnosis of DM with two previous fasting blood glucose levels >126 mg/dl, HbA1c >6.5%, and/or receiving oral hypoglycemic agents and/or insulin upon admission; b) dysglycemic patients: patients with previously unknown DM who were admitted and/or maintained fasting plasma glucose levels >100 mg/dl and/or postprandial blood glucose levels >180 mg/dl during their hospitalization, requiring insulin for control; (c) normoglycemic patients: those with normal blood glucose levels during their hospitalization; (d) obese patients: those admitted with a body mass index [BMI] >30; (e) normo and/or overweight patients: those with a BMI <30. Mortality rates were compared between groups. Statistical methods: Student t test, chi-square, correlation (Pearson and Spearman), Cox regression.

Results: a total of 594 patients hospitalized with COVID-19 were studied. Age X̄ 61.9 (SD 16.9 years), 56% male, and 44% female. One hundred twenty-seven (127, 21%) were patients with known DM, 309 (52%) had dysglycemia, and 205 were obese (34%). Twenty-nine of 127 patients with known DM (22.8%) died versus 67 of 309 patients with dysglycemia (21.7%), whereas in the group of patients without previous DM and with normal blood glucose during hospitalization, 18 of 158 individuals died (11.4%; p=0.01). Comparing patients with known DM and without DM (considering overall dysglycemic and/or normoglycemic) no significant difference in mortality was observed (22/127 diabetics: 22.8% versus 85/467: 18.5% non-diabetics; p=0.29). Among non-diabetics, 67/309 patients with dysglycemia died (21.7%) versus 18/158 with normoglycemia (11.4%; p=0.009). Of the obese patients, 48/205 (23.4%) versus 22/389 (5.7%) of those with normal weight/overweight required ICU admission (p=0.0001). Adjusting for comorbidities, multivariate analysis found that age (HR: 1.06/year, CI 1.04-1.08; p=0.001) and the presence of obesity (HR: 1.5, CI 1.5-2.0; p=0.004) were associated with higher mortality.

Conclusions: patients with dysglycemia had higher mortality rates during COVID-19 hospitalization compared to those with normoglycemia, a difference similar to that reported by patients with known DM. Obese patients required more ICU admission and needed RMA.

Reliability and validity analysis of the Spanish version of the Diabetes Quality of Life (EsDQoL) questionnaire in adults with diabetes mellitus undergoing insulin treatment at a General Acute Care Hospital in the Autonomous City of Buenos Aires

Fernanda Averna, Luciana Belén Scolaro, Natalia Elorriaga — Mon, 16 Jun 2025 00:00:00 -0300

Introduction: diabetes mellitus (DM) is a chronic disease that affects health-related quality of life (HRQoL). The “Diabetes Quality of Life” (DQoL) questionnaire has been widely used to assess this impact. Its Spanish version (EsDQoL) has demonstrated satisfactory psychometric properties, although it is necessary to verify its validity in the local context.

Objectives: to analyze the reliability and validity of the Spanish version of the EsDQoL in adults with DM undergoing insulin treatment, attended at a general acute care hospital in the Autonomous City of Buenos Aires (CABA), Argentina.

Materials and methods: an observational, prospective, and validation study was conducted on individuals over 18 years of age with DM on insulin treatment, without associated complications. Two quality of life measurement instruments were administered: the EsDQoL and the Short Form-12 (SF-12), in a specialized clinic of a general acute care hospital in CABA, Argentina, during 2022–2024. HRQoL was measured using the EsDQoL and compared with the SF-12 for criterion validity. Correlations, internal consistency (Cronbach’s alpha), and test-retest reliability (intraclass correlation coefficient, ICC) were analyzed. Construct validity was evaluated by comparing EsDQoL scores according to age, health coverage, HbA1c, type of treatment, and physical activity.

Results: 83 individuals participated, of which 52 were women (62.6%) and 31 men (34.7%), with an average age of 52.8 years (14.2). Regarding the type of DM, 59 participants (71%) had DM2, with a mean disease duration of 12.7 years (8.9). Regarding the treatment regimen, 57 patients (68.7%) were treated conventionally, with an average duration of 8.2 years (6.3). In the reliability analysis, positive correlations were found for the dimensions and the total score of the EsDQoL (rho=0.43-0.79) and internal consistency coefficients from acceptable to excellent (0.64-0.90). A moderate correlation was observed between the total scores of the EsDQoL and the SF-12 (rho=0.64; p<0.001). Regarding construct validity, statistically significant differences were found in age, health coverage, HbA1c, type of treatment and physical activity (p<0.05).

Conclusions: the EsDQoL demonstrated adequate reliability and validity for measuring quality of life in people with DM undergoing insulin treatment. The Social/Vocational Concern dimension exhibited lower stability, attributable to its subjective nature. These findings reinforce the utility of the EsDQoL in clinical practice and future research, highlighting the influence of individual and contextual factors.

From the sum of factors to the synergy of damage: towards a redefinition of the cardio-renal-metabolic syndrome

Florencia Aranguren — Mon, 16 Jun 2025 00:00:00 -0300

The increasing prevalence of type 2 diabetes mellitus (T2DM), heart failure (HF), chronic kidney disease (CKD), obesity, and metabolic liver disease (MASLD) has given rise to a network of pathophysiological interactions that transcends the boundaries of organ-specific medicine. What was once considered a cluster of comorbidities is now better understood as an integrated entity: cardiorenal-metabolic (CRM) syndrome. However, current evidence suggests that this definition is insufficient to capture the complexity of multisystem damage resulting from metabolic dysfunction.