Excess fat in the liver is a frequent event in people with diabetes.The truth is that the vast majority of people with fatty liver have overweight or obesity, diabetes mellitus and/or dyslipidemia (high levels of cholesterol or triglycerides).

In the XXIX National Congress of the Spanish Society of Diabetes there is the presence of one of the most reputed world experts in the clinical management of non -alcoholic fatty liver (HGNA), Dr. Kenneth Cusi, head of the Endocrinology Division,Diabetes and Metabolism of the University of Florida (USA)

“The fatty liver is one of the most common complications of diabetes.70% of people with type 2 diabetes have a fatty liver, which increases the risk of cirrhosis, liver cancer and cardiovascular disease, among other diseases, ”says Prof. Cusi, which is especially satisfied by participating in thisCongress, "one of the most important in Spanish speech in the field of diabetes and has an unquestionable international prestige."

But not only 7 out of 10 diabetics have an HGNA disorder, but it is also estimated that 2 out of 10 people with diabetes show a very important liver fibrosis, with a high risk of developing cirrhosis.The close link between fatty liver and diabetes, according to Prof. Cusi, "is explained above all by the association between diabetes and disorders such as obesity, insulin resistance and other metabolic risks."Therefore, "logically the best solution to avoid this correlation between fatty liver and diabetes is to adopt healthy habits to reduce obesity and sedentary lifestyle," says this expert.

Therapeutic advances in HGNA

But, apart from a good lifestyle, in recent years, positive evidence has been accumulated on the effect that some pharmacological therapies can have on HGNA approach.Thus, for example, "Pioglitazona reverts HGNA in 60-70% of patients," says Prof. Kenneth Cusi, who also highlights an important economic advantage of this drug, and that is that "in many countries it has a costvery low for being a generic (in the US $ 5-15/month). ”

Making a parallel with a key drug in diabetes, the Argentine -origin expert considers that "pioglitazone is going to be for HGNA as metformin for type 2 diabetes: a" base "medication, which can be associatedother drugs in research ”.Among its main adverse effects, it has been documented that the administration of pioglitazone causes weight gain (2-4 kg) and edema (in 5-8%);These are generally reversible secondary events, if the dose is reduced or the treatment is discontinued.

For its part, the liraglutida has also shown positive effects on the management of fatty liver in diabetics.And vitamin E has positive results in HGNA of people without diabetes.

glycemic variability and complications in diabetes

Another of the international reference experts who participate in this Congress is Dr. Irl B. Hirsch, a professor at the Washington Med Ctr-Roosevelt (Seattle) University, who admits that “this meeting is a unique opportunity to learn about how differentCultures handle diabetes, how they use available technology and how differences in people's lifestyle with diabetes impact the results of treatments. ”

At the closing conference the American expert will reveal the implications of glycemic variability in the appearance of certain complications of diabetes.In this sense, it advances, “although there are already provocative data that support the idea that glycemic variability contributes to theAppearance of micro and macrovascular complications, we do not yet have definitive data in this regard due to the difficulty in designing specific studies in this area ”.The exception is the consistent available evidence on the impact of glycemic variability in the complications of pregnancy, "where the data is convincing," he says.

In any case, Prof. Hirsch is especially optimistic about the advances recorded in the study and control of the usual variations that occur in the blood glucose levels of people with diabetes.In his opinion, "every day we know better why, when and how they occur, in large part due to the use of continuous glucose monitoring";However, he warns, "This technology is used in only 29% of our population, as can be seen from the T1D Exchange Clinic Registry."And, at least in the United States, "hypoglycemia has become a somewhat more visible event, especially thanks to the information that seeks continuous glucose monitoring technology."

Education in Diabetes

Another of the stellar conferences of Congress has been the one pronounced by Mercè Vidal, an expert in diabetes and therapeutic education of the Hospital Clínic de Barcelona, ​​making a synthesis of more than 20 years of therapeutic care and education programs aimed at young people with diabetes mellitus type1 (DM1) Pediatrics transferred to adult centers.

“Working with therapeutic care and education programs allows to standardize the basis and educational care care to be able to customize and agree on objectives at the individual level.But, in addition, evaluating these programs allows to objectify results and modify certain aspects susceptible to improvement, ”says this expert, who recognizes the particular difficulties he presents to deal with the DM1 at such a crucial moment of life as adolescence.

In the program aimed at young people transferred from pediatric centers to adult centers, conception is similar as to the concern of the young man and parents before the change of center and professionals."What changes, fundamentally, is that some young people begin to use more common technology in the treatment of their disease," says Mercé Vidal.In these cases, adolescents begin to use insulin infuses and/or glucose monitoring sensors, use apps to visualize the downloads of capillary glycemia meters, have the possibility of performing telematic visits with the care equipment ...

The challenge is to get the best health results for young people with DM1.In Mercè Vidal's words, "health professionals must be able to seek the motivation and involvement of the young man in the self -management of treatment."In this sense, he informs, “in our clinical practice we have recently introduced a new aspect, which is to try to know the experience of the patient and family prior to the transfer and a year after carrying out the therapeutic care and education program in the new center ofadults ”.

In all this process the role played by the nursing professional is basic."We work with people who have a chronic disease where the daily self -management of treatment and associated adhesion is fundamental," says Mercè Vidal;However, he adds, "success is the result of teamwork."

All members of the professional health team must be involved in the education of the patient and the family, although “the expert nurses in diabetes and education have more weight in the educational process, as well as the responsibility of evaluating the programs and raising with the teamimprovement strategies, ”concludes the nurse of the Clinic Hospital ofBarcelona.