Pituitary irradiation is an effective and well-tolerated treatment for patients with Cushing's disease in whom transsphenoidal surgery is unsuccessful.

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OBJECTIVE -To assess the cardiovascular risk profile, the degree of insulin resistance, and ␤-cell secretion in a cohort of subjects with different categories of impaired glucose regulation (IGR): impaired fasting glucose (IFG), impaired glucose tolerance (IGT), and combined IFG/ IGT.RESEARCH DESIGN AND METHODS -We studied 902 nondiabetic subjects between 30 and 80 years of age, recruited from a cross-sectional population-based study in Telde, Gran Canaria Island, Spain. Categories of glucose tolerance were defined according to 2003 modified American Diabetes Association criteria. Risk factors for cardiovascular disease, the presence of the metabolic syndrome, and indirect measures of both insulin resistance and ␤-cell function were analyzed.RESULTS -A total of 132 (14.6%) participants had isolated IFG, 59 (6.5%) isolated IGT, and 48 (5.3%) combined IFG/IGT. Groups with normal glucose tolerance (NGT) and combined IFG/IGT had, respectively, the most favorable and unfavorable levels of cardiovascular risk factors, metabolic syndrome rates, and measures of insulin resistance. Subjects with IFG and IGT showed an intermediate profile between NGT and IFG/IGT categories. We found no significant differences between IFG and IGT in cardiovascular risk factors, metabolic syndrome prevalence, or insulin resistance. The IFG group exhibited a more impaired insulin secretion than those with IGT or IFG/IGT. I n 1997, the American Diabetes Association (ADA) issued new diagnostic criteria for diabetes and established a new category of impaired glucose regulation (IGR) called impaired fasting glucose (IFG), a fasting category analogous to impaired glucose tolerance (IGT) and defined as a fasting plasma glucose (FPG) between 6.1 and 6.9 mmol/l (1). In 2003, based on epidemiological predictive data from different populations showing that decreasing the lower limit of IFG would optimize its sensitivity and specificity for predicting future diabetes, the ADA established a new cutoff point of 5.6 mmol/l (2). CONCLUSIONSAlthough both IFG and IGT are risk factors for diabetes and cardiovascular disease (CVD) (3), IGT is more consistently associated with an increase in cardiovascular-related and all-cause mortality (4 -9). Moreover, evidence that interventions may reduce progression to diabetes is limited to IGT (10 -12).To explain a different prognostic value of IFG and IGT on the risk of diabetes and CVD, different studies have analyzed the prevalence of cardiovascular risk factors, insulin sensitivity, and ␤-cell function among subjects with different categories of IGR (13-22). However, results have been discordant, and most studies were performed before the introduction of the 2003 ADA criteria.Here, we have compared the cardiovascular risk profile (traditional and new risk factors), the prevalence of the metabolic syndrome, as well as different indexes for the assessment of insulinglucose homeostasis in subjects with normal glucose tolerance (NGT) and IGR that participated in the Telde Study, a population-based survey performed in Gr...

BackgroundDiabetes is becoming of increasing concern in Spain due to rising incidence and prevalence, although little information is known with regards to costs and outcomes. The information on cost of diabetes in Spain is fragmented and outdated. Our objective is to update diabetes costs, and to identify outcomes and quality of care of diabetes in Spain.MethodsWe performed systematic searches from secondary sources, including scientific literature and government data and reports.ResultsDiabetes Type II prevalence is estimated at 7.8%, and an additional 6% of the population is estimated to be undiagnosed. Four Spanish diabetes cost studies were analyzed to create a projection of direct costs in the NHS and productivity losses, estimating €5.1 billion for direct costs along with €1.5 billion for diabetes-related complications (2009) and labour productivity losses represented €2.8 billion. Glycemic control (glycolysated hemoglobin) is considered acceptable in 59% of adult Type II cases, in addition to 85% with HDL cholesterol ≥40mg/dl and 65% with blood pressure <140/90 mmHg, pointing to good intermediate outcomes. However, annual figures indicate that over half of the Type II diabetics are obese (BMI >30), 15% have diabetic retinopathy, 16% with microalbuminuria, and 15% with cardiovascular disease.ConclusionsThe direct health care costs (8% of the total National Health System expenditure) and the loss of labour productivity are high. The importance of a multi-sectoral approach in prevention and improvements in management of diabetes are discussed, along with policy considerations to help modify the disease course.

Only when a significant IPS:P ACTH ratio is present can Cushing's disease be established by IPS sampling. The absence of a significant IPS: P ACTH ratio does not necessarily imply ectopic secretion of ACTH, nor does it exclude Cushing's disease. The results of lateralization by IPS sampling do not remove the need for a thorough transsphenoidal examination of the contents of the sella turcica.