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Piñar-Gutiérrez A, Romero-Lluch AR, Dueñas-Disotuar S, de Lara-Rodríguez I, Gálvez-Moreno MÁ, Martín-Hernández T, García-Alemán J, Martínez-de Pinillos G, Navarro-González E. Bone metastases from differentiated thyroid cancer: characteristics and prognostic factors in a multicenter series. Eur Thyroid J 2023; 12:e230086. [PMID: 37493475 PMCID: PMC10448562 DOI: 10.1530/etj-23-0086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Accepted: 07/26/2023] [Indexed: 07/27/2023] Open
Abstract
Objective The aim of this study is to describe the characteristics, survival and prognostic factors of a cohort of patients with bone metastases (BMs) from differentiated thyroid carcinoma (DTC). Methods This was a multicenter retrospective observational study including patients diagnosed with BMs from DTC between 1980 and 2021. A Cox regression was performed to study prognostic factors for 5- and 10-year survival. Kaplan-Meier and log-rank tests were performed for the survival analysis and comparison between groups. Results Sixty-three patients were evaluated. Median follow-up from BM diagnosis was 35 (15-68) months. About 30 (48.4%) patients presented with synchronous BMs. Regarding histology, 38 (60.3%) had the papillary variant. BMs were multiple in 32 (50.8%) patients. The most frequent location was the spine (60.3%). Other metastases were present in 77.8%, mainly pulmonary (69.8%). Concerning treatment, 54 (85.9%) patients received I131, with BM uptake in 31 (49.2%) and 25 (39.7%) received treatment with multikinase inhibitors. Regarding complications, 34 (54%) patients had skeletal-related events, 34 (54%) died and 5- and 10-year overall survival was 42.4% and 20.4%, respectively. Significant prognostic factors in the multivariate analysis were the presence of lymph node involvement (hazard ratio (HR): 2.916; 95% confidence interval (CI): 1.013-8.391; P = 0.047) and treatment with I131 (HR 0.214 (95% CI 0.069-0.665); P = 0.008) at 5 years, the presence of other metastases (HR 6.844. 95% CI 1.017-46.05; P = 0.048) and treatment with I131 (HR 0.23 (95% CI 0.058-0.913); P = 0.037) at 10 years. Conclusions Our study reflects the management of patients with bone metastases from differentiated thyroid carcinoma in real clinical practice in several centers in southern Spain. Overall survival at 5 and 10 years was lower in patients who were not treated with I131, had nodal involvement and/or had other metastases.
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Affiliation(s)
- Ana Piñar-Gutiérrez
- UGC Endocrinología y Nutrición, Hospital Universitario Virgen del Rocío, Sevilla, España
| | - Ana R Romero-Lluch
- UGC Endocrinología y Nutrición, Hospital Universitario Virgen del Rocío, Sevilla, España
| | - Suset Dueñas-Disotuar
- UGC Endocrinología y Nutrición, Hospital Universitario Virgen del Rocío, Sevilla, España
| | | | | | | | - Jorge García-Alemán
- Servicio de Endocrinología, Hospital Universitario Virgen de la Victoria, Málaga, España
| | | | - Elena Navarro-González
- UGC Endocrinología y Nutrición, Hospital Universitario Virgen del Rocío, Sevilla, España
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2
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Ampudia-Blasco FJ, Ugarte-Abasolo E, Chico A, García-Alemán J, Galan-Barroso M. Spanish Consensus on the Use of Intermittently Scanned Continuous Glucose Monitoring in the Management of Patients With Insulin Therapy: The MONITOR Project. J Diabetes Sci Technol 2023; 17:1256-1264. [PMID: 35466722 PMCID: PMC10563520 DOI: 10.1177/19322968221087270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Continuous glucose monitoring (CGM) systems are increasingly being adopted as an alternative or adjunct to self-monitoring of blood glucose (SMBG) by patients receiving insulin therapy. However, the available evidence on the role of intermittently scanned CGM or flash CGM (isCGM) remains limited. This consensus aims to evaluate the degree of agreement among Spanish experts on the role of isCGM in the evaluation of glycemic variability, reduction of glycosylated hemoglobin (HbA1c) levels, and selection and adjustment of insulin therapy. METHODS Delphi methodology was used to achieve consensus in two survey rounds. A total of 431 Spanish endocrinologists participated in the first round of a 34-item questionnaire survey on isCGM and 427 participated in the second round. Any disagreement was resolved in round 2. RESULTS Consensus was reached for 32 statements, and four items were ultimately agreed upon SMBG after round 2. There was a high degree of consensus that isCGM helps to evaluate glycemic variability, improves HbA1c levels, and can guide therapeutic changes in type 1 diabetes patients. However, there was no consensus on the routine use of the interquartile range to evaluate glycemic variability or the selection of HbA1c as the main parameter for monitoring glycemic control. CONCLUSIONS Most Spanish experts believe that the isCGM system is appropriate for: (1) identifying glycemic variability and facilitating its management, (2) evaluating hyperglycemia as a complement of HbA1c levels, and (3) guiding therapeutic decisions on insulin selection and dosing. The isCGM system is a useful tool for patients and health care professionals to improve glycemic control in insulin-dependent diabetes.
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Affiliation(s)
| | | | - Ana Chico
- Department of Endocrinology and Nutrition, Hospital de la Santa Creu i Sant Pau, Barcelona, CIBER-BBN, Spain
| | - Jorge García-Alemán
- Department of Endocrinology and Nutrition, Hospital Clínico Universitario Virgen de la Victoria, Malaga, Spain
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3
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Martínez-Montoro JI, Picón-César MJ, Simón-Frapolli VJ, Pinzón-Martín JL, García-Alemán J, Durán-Martínez M, Tinahones FJ. Evaluation of the Clinical Impact of Dapagliflozin Discontinuation as Adjunctive Therapy for Patients With Type 1 Diabetes After Indication Withdrawal: A Two-Center Retrospective Study. Diabetes Care 2023; 46:e101-e102. [PMID: 36884283 PMCID: PMC10154648 DOI: 10.2337/dc23-0083] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2023] [Accepted: 02/01/2023] [Indexed: 03/09/2023]
Affiliation(s)
- José Ignacio Martínez-Montoro
- Department of Endocrinology and Nutrition, Virgen de la Victoria University Hospital, Málaga, Spain.,Instituto de Investigación Biomédica de Málaga-Plataforma Bionand, Málaga, Spain.,Faculty of Medicine, University of Málaga, Málaga, Spain
| | - María José Picón-César
- Department of Endocrinology and Nutrition, Virgen de la Victoria University Hospital, Málaga, Spain.,Instituto de Investigación Biomédica de Málaga-Plataforma Bionand, Málaga, Spain.,Centro de Investigación Biomédica en Red de la Fisiopatología de la Obesidad y la Nutrición, Instituto de Salud Carlos III, Madrid, Spain
| | | | - José Luis Pinzón-Martín
- Department of Endocrinology and Nutrition, Virgen de la Victoria University Hospital, Málaga, Spain.,Faculty of Medicine, University of Málaga, Málaga, Spain
| | - Jorge García-Alemán
- Department of Endocrinology and Nutrition, Virgen de la Victoria University Hospital, Málaga, Spain
| | - María Durán-Martínez
- Department of Endocrinology and Nutrition, Getafe University Hospital, Madrid, Spain
| | - Francisco J Tinahones
- Department of Endocrinology and Nutrition, Virgen de la Victoria University Hospital, Málaga, Spain.,Instituto de Investigación Biomédica de Málaga-Plataforma Bionand, Málaga, Spain.,Faculty of Medicine, University of Málaga, Málaga, Spain.,Centro de Investigación Biomédica en Red de la Fisiopatología de la Obesidad y la Nutrición, Instituto de Salud Carlos III, Madrid, Spain
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4
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Martínez-Montoro JI, Gómez-Pérez AM, Gallego E, García-Alemán J, Sebastián-Ochoa A, Damas-Fuentes M, Mancha-Doblas I, Tinahones FJ. "Triple-negative" non-secretory medullary thyroid cancer: uncommon pathological findings in a rare disease. Arch Med Sci 2022; 18:825-828. [PMID: 35591839 PMCID: PMC9103519 DOI: 10.5114/aoms/147431] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Accepted: 03/16/2022] [Indexed: 11/17/2022] Open
Affiliation(s)
- José Ignacio Martínez-Montoro
- Department of Endocrinology and Nutrition, Virgen de la Victoria University Hospital, Málaga, Spain
- Instituto de Investigación Biomédica de Málaga (IBIMA), Málaga, Spain
- Faculty of Medicine, University of Málaga, Málaga, Spain
| | - Ana María Gómez-Pérez
- Department of Endocrinology and Nutrition, Virgen de la Victoria University Hospital, Málaga, Spain
- Instituto de Investigación Biomédica de Málaga (IBIMA), Málaga, Spain
| | - Elena Gallego
- Department of Pathological Anatomy, Virgen de la Victoria University Hospital, Málaga, Spain
| | - Jorge García-Alemán
- Department of Endocrinology and Nutrition, Virgen de la Victoria University Hospital, Málaga, Spain
| | | | - Miguel Damas-Fuentes
- Department of Endocrinology and Nutrition, Virgen de la Victoria University Hospital, Málaga, Spain
- Instituto de Investigación Biomédica de Málaga (IBIMA), Málaga, Spain
| | - Isabel Mancha-Doblas
- Department of Endocrinology and Nutrition, Virgen de la Victoria University Hospital, Málaga, Spain
| | - Francisco J. Tinahones
- Department of Endocrinology and Nutrition, Virgen de la Victoria University Hospital, Málaga, Spain
- Instituto de Investigación Biomédica de Málaga (IBIMA), Málaga, Spain
- Faculty of Medicine, University of Málaga, Málaga, Spain
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5
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Molina-Vega M, García-Alemán J, Sebastián-Ochoa A, Mancha-Doblas I, Trigo-Pérez JM, Tinahones-Madueño F. Tyrosine kinase inhibitors in iodine-refractory differentiated thyroid cancer: experience in clinical practice. Endocrine 2018; 59:395-401. [PMID: 29275532 DOI: 10.1007/s12020-017-1499-7] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2017] [Accepted: 12/11/2017] [Indexed: 01/30/2023]
Abstract
PURPOSE The aim of this study is to describe our clinical experience with tyrosine kinase inhibitors (TKIs) and to evaluate their efficacy and tolerability in patients with iodine-refractory differentiated thyroid cancer (DTC). METHODS There were 17 patients (47.1% women, mean age: 65.7) with DTC iodine-refractory (9 papillary, 2 follicular and 3 Hürthle cell), treated with TKIs: 16 with sorafenib and 1 with lenvatinib as first-line treatment; 7 required second-line treatment (4 lenvatinib and 3 axitinib). Primary endpoints were progression-free survival (PFS) and radiographic response (determinate at 3, 6, 12, 18, and 24 months after the initiation of treatment) and second endpoints were determining differences in baseline characteristics depending on clinical course and describing toxicities and tolerability. RESULTS Median PFS was 18 months. During the first 24 months of treatment with TKIs PR rate was 35.3% (only 5.8% ≥ 6 months) and SD ≥ 6 months was observed in 58.8%. There were no significant differences in baseline characteristics between patients with good and poor evolution. Adverse events (AEs) were present in 100% of patients, but most of them were grade 1 and 2. CONCLUSIONS In our population of patients with iodine-refractory DTC, treatment with sorafenib, lenvatinib, and axitinib allows the stabilization of the disease in a high percentage of cases, with acceptable tolerability.
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Affiliation(s)
- M Molina-Vega
- Department of Endocrinology, Virgen de la Victoria University Hospital, Malaga, Spain
| | - J García-Alemán
- Department of Endocrinology, Virgen de la Victoria University Hospital, Malaga, Spain
| | - A Sebastián-Ochoa
- Department of Endocrinology, Virgen de la Victoria University Hospital, Malaga, Spain
| | - I Mancha-Doblas
- Department of Endocrinology, Virgen de la Victoria University Hospital, Malaga, Spain
| | - J M Trigo-Pérez
- Department of Medical Oncology, Virgen de la Victoria University Hospital, Malaga, Spain
| | - F Tinahones-Madueño
- Department of Endocrinology, Virgen de la Victoria University Hospital, Malaga, Spain.
- Instituto de Investigación Biomédica de Málaga (IBIMA), Virgen de la Victoria University Hospital, Malaga, Spain.
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Comellas MJ, Albiñana E, Artes M, Corcoy R, Fernández-García D, García-Alemán J, García-Cuartero B, González C, Rivero MT, Casamira N, Weissmann J. Evaluation of a New Digital Automated Glycemic Pattern Detection Tool. Diabetes Technol Ther 2017; 19:633-640. [PMID: 29091477 PMCID: PMC5689116 DOI: 10.1089/dia.2017.0180] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
BACKGROUND Blood glucose meters are reliable devices for data collection, providing electronic logs of historical data easier to interpret than handwritten logbooks. Automated tools to analyze these data are necessary to facilitate glucose pattern detection and support treatment adjustment. These tools emerge in a broad variety in a more or less nonevaluated manner. The aim of this study was to compare eDetecta, a new automated pattern detection tool, to nonautomated pattern analysis in terms of time investment, data interpretation, and clinical utility, with the overarching goal to identify early in development and implementation of tool areas of improvement and potential safety risks. METHODS Multicenter web-based evaluation in which 37 endocrinologists were asked to assess glycemic patterns of 4 real reports (2 continuous subcutaneous insulin infusion [CSII] and 2 multiple daily injection [MDI]). Endocrinologist and eDetecta analyses were compared on time spent to analyze each report and agreement on the presence or absence of defined patterns. RESULTS eDetecta module markedly reduced the time taken to analyze each case on the basis of the emminens eConecta reports (CSII: 18 min; MDI: 12.5), compared to the automatic eDetecta analysis. Agreement between endocrinologists and eDetecta varied depending on the patterns, with high level of agreement in patterns of glycemic variability. Further analysis of low level of agreement led to identifying areas where algorithms used could be improved to optimize trend pattern identification. CONCLUSION eDetecta was a useful tool for glycemic pattern detection, helping clinicians to reduce time required to review emminens eConecta glycemic reports. No safety risks were identified during the study.
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Affiliation(s)
| | - Emma Albiñana
- Vithas Hospital Internacional Medimar, Paediatrics Unit, Alicante, Spain
| | | | - Rosa Corcoy
- Hospital de la Santa Creu i Sant Pau, Endocrinology and Nutrition Department, Medicine Department, Universitat Autònoma de Barcelona, Barcelona, Spain
- CIBER-BBN, Zaragoza, Spain
| | - Diego Fernández-García
- Hospital Universitario Virgen de la Victoria, Endocrinology and Nutrition Unit, Málaga, Spain
| | - Jorge García-Alemán
- Hospital Universitario Virgen de la Victoria, Endocrinology and Nutrition Unit, Málaga, Spain
| | - Beatriz García-Cuartero
- Hospital Universitario Ramón y Cajal, Pediatric Endocrinology and Diabetes Unit, Madrid, Spain
| | - Cintia González
- Hospital de la Santa Creu i Sant Pau, Endocrinology and Nutrition Department, Medicine Department, Universitat Autònoma de Barcelona, Barcelona, Spain
- CIBER-BBN, Zaragoza, Spain
| | - María Teresa Rivero
- Complejo Hospitalario Universitario de Ourense, Endocrinology and Nutrition Unit, Ourense, Spain
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del Carmen Crespillo M, Olveira G, de Adana MSR, Rojo-Martínez G, García-Alemán J, Olvera P, Soriguer F, Muñoz A. Metabolic effects of an enteral nutrition formula for diabetes: comparison with standard formulas in patients with type 1 diabetes. Clin Nutr 2003; 22:483-7. [PMID: 14512036 DOI: 10.1016/s0261-5614(03)00047-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
AIM To evaluate the metabolic response (glucose, cholesterol, triglycerides and beta-hydroxy-butyrate) in patients with type 1 diabetes after a trial breakfast with an enteral nutrition formula designed for patients with diabetes and compare it with standard formulas (with and without fibre). MATERIAL AND METHODS Each of 11 patients with type 1 diabetes consumed three types of liquid breakfast with a 1 week interval between each. (1). A standard diet (SD) with 49% carbohydrates, 35% lipids, 16% proteins-casein-and without fibre; (2). A fibre-enriched diet (FD): with 49% carbohydrates, 35% lipids, 16% casein and 15 g/1000 ml fibre; (3). A diet designed for patients with diabetes (DD) with 45% carbohydrates, 38% lipids, 16% soy protein and 15 g/1000 ml fibre. Each subject consumed 250 ml of each preparation at 9.00 AM after having administered their usual insulin dose, which was the same for each diet. Blood samples were taken at baseline and each 30 min, up to 150 min. RESULTS The increase in postprandial glycaemia was lower with DD than with the standard preparations, reaching statistical significance at 60 min. There were no significant variations in the levels of cholesterol, triglycerides or beta-hydroxy-butyrate between the three preparations. CONCLUSIONS After a trial breakfast, a diet designed for patients with diabetes provoked lower increases in postprandial glycaemia (with no changes in lipid or beta-hydroxy-butyrate levels) compared to the standard diets evaluated (with and without fibre).
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