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Papers by José Manuel Ramiro Lozano

Research paper thumbnail of Vitamin D Levels in Patients with Type 2 Diabetes Mellitus

Journal of Investigative Medicine, 2015

Background Vitamin D may influence many diseases, including type 2 diabetes mellitus. Patients an... more Background Vitamin D may influence many diseases, including type 2 diabetes mellitus. Patients and Methods We studied serum levels of 25-hydroxyvitamin D (25(OH)D) and associated characteristics in type 2 diabetic outpatients with pharmacologic treatment attended in internal medicine offices in a first-level hospital from Extremadura (Southern Spain). Results We included a total of 103 patients. Seventy-two patients (69.9%) had serum levels of 25(OH)D lower than 20 ng/mL. There was inverse correlation between serum levels of 25(OH)D and glycosylated hemoglobin ( r = −0.74, P = 0.01). In 78 patients without insulin therapy, we found inverse correlation between serum levels of 25(OH)D and fasting serum insulin ( r = −0.82, P = 0.001) and Homeostasis Model Assessment–Insulin Resistance ( r = −0.51, P < 0.001). Conclusions Vitamin D deficiency is common in type 2 diabetic patients. There are inverse correlations between vitamin D and metabolic control and insulin resistance.

Research paper thumbnail of WITHDRAWN: Effects on lipid profile of supplementation with vitamin D in type 2 diabetic patients with vitamin D deficiency

Diabetes & Metabolic Syndrome: Clinical Research & Reviews, 2015

Research paper thumbnail of Vitamin B12 in type 2 diabetic patients treated with metformin

Endocrinología y Nutrición (English Edition), 2012

Objective: To test vitamin B 12 plasma levels in type 2 diabetic patients treated with metformin ... more Objective: To test vitamin B 12 plasma levels in type 2 diabetic patients treated with metformin in our area. Methods: A cross-sectional, observational study of consecutive type 2 diabetic patients on drug treatment attending an internal medicine outpatient clinic. Results: One hundred and nine patients (81 treated with metformin) were enrolled into the study. Mean time on metformin treatment was 43.5 months and mean drug dose was 1779 mg/day. Patients treated with metformin had significantly lower vitamin B 12 plasma levels (393.5 vs 509 pg/mL, p = 0.0008). Seven (8.6%) of 81 patients treated with metformin and none of the 28 patients not treated with the drug had vitamin B 12 plasma levels lower than 197 pg/mL. No correlation was found between vitamin B 12 plasma levels and metformin treatment time or dosage. Conclusions: In type 2 diabetic patients, treatment with metformin is associated to lower vitamin B 12 plasma levels. Vitamin B 12 deficiency associated with metformin is relatively common in our area.

Research paper thumbnail of Effects on lipid profile of supplementation with vitamin D in type 2 diabetic patients with vitamin D deficiency

Therapeutic Advances in Endocrinology and Metabolism, 2015

Background: Epidemiological studies suggest that vitamin D status may have an influence on lipid ... more Background: Epidemiological studies suggest that vitamin D status may have an influence on lipid profile. Patients and methods: We studied consecutive type 2 diabetic patients with vitamin D deficiency (serum 25-hydroxyvitamin D (25(OH)D) lower than 20 ng/ml). They were treated with 16,000 IU of calcifediol orally once a week for a minimum of 8 weeks. Results: A total of 28 patients were treated for a mean time of 84.1 days (range 56-120 days). All patients achieved serum levels of 25(OH)D higher than 20 ng/ml. There was significant reduction in total cholesterol (172.1 ± 32.4 versus 164.4 ± 27.3 mg/dl, p = 0.04). There were nonsignificant reductions in low-density lipoprotein (LDL) cholesterol, non-high-density lipoprotein (non-HDL) cholesterol and triglycerides. There was no change in HDL cholesterol. Conclusions: Correction of vitamin D deficiency in type 2 diabetic patients decreases total cholesterol. Our results do not rule out reductions in LDL cholesterol, non-HDL cholestero...

Research paper thumbnail of Agotamiento Por Calor Asociado a Trastornos Del Lenguaje

Emergencias, Feb 1, 2014

El golpe de calor ( heat stroke ), es una emergencia medica que se define como forma de hiperterm... more El golpe de calor ( heat stroke ), es una emergencia medica que se define como forma de hipertermia asociada a respuesta inflamatoria sistemica y el consecuente desarrollo final de fracaso multiorganico en el cual predomina la encefalopatia. El agotamiento por calor ( heat exhaustion ), es una entidad clinica de menor gravedad en la cual la temperatura corporal esta usualmente dentro de los limites normales y el sistema nervioso central no suele estar afectado. Sin embargo, presentamos un caso de agotamiento por calor que se asocio a trastornos del lenguaje.

Research paper thumbnail of Propiedades hipoglucemiantes de la hoja de higuera (ficus carica)

EL EXTRACTO DE HOJAS DE HIGUERA (FICUS CARICA) ADMINISTRADO VIA ORAL POSEE UNA CLARA ACCION HIPOG... more EL EXTRACTO DE HOJAS DE HIGUERA (FICUS CARICA) ADMINISTRADO VIA ORAL POSEE UNA CLARA ACCION HIPOGLUCEMIANTE EN RATAS DIABETICAS PERO NO EN RATAS NORMALES, SU MECANISMO DE ACCION NO PARECE SER EFECTO FIBRA, NI UN EFECTO INSULINOTROPICO TIPO SULFONILUREAS, SINO QUE SOBRE LOS DATOS OBTENIDOS, SE APROXIMA MAS AL MECANISMO DE ACCION PERIFERICO DE LA INSULINA, BIEN POTENCIANDOLA O MIMETIZANDOLA.

Research paper thumbnail of Vitamin D and thyrotropin in type 2 diabetic patients

Diabetes & Metabolic Syndrome: Clinical Research & Reviews, 2016

Vitamin D status and thyroid function may be related. Using our data from two previous studies in... more Vitamin D status and thyroid function may be related. Using our data from two previous studies in type 2 diabetic patients, we found slightly higher serum thyrotropin levels in patients with vitamin D deficiency (at the limit of statistical significance) and no effect of correction of vitamin D deficiency in serum thyrotropin levels.

Research paper thumbnail of Secondary hyperparathyroidism prevalence and profile, between diabetic and non-diabetic patients with stage 3 to 4 chronic kidney disease attended in internal medicine wards. MiPTH study

Diabetes & Metabolic Syndrome: Clinical Research & Reviews, 2016

Secondary hyperparathyroidism (SHPTH) is a leading cause of renal osteodystrophy, and an independ... more Secondary hyperparathyroidism (SHPTH) is a leading cause of renal osteodystrophy, and an independent risk factor for all-cause and cardiovascular mortality. Our aim is to establish differences in prevalence and profile of SHPTH, regarding diabetics or non-diabetics with chronic kidney disease (CKD). Cross-sectional multicenter study which included patients with stages 3 to 4 CKD. SHPTH was considered when the intact PTH levels (iPTH) were equal or higher than 70pg/ml. We divided the sample into two groups (diabetics and non-diabetics). We used robust statistical methods. 409 patients (214 diabetics) were studied. HPTH was found in 60.4% of diabetics vs 65% of non-diabetics (P=0.42). Diabetics with HPTH were younger (79.5 vs 82.3 years-old, P=0.005), and had more hypertension (P=0.0014), dyslipidemia (P=0.0001) and comorbidities. In multivariate analysis, we found a significant relationship in case of diabetics, with age (OR: 1.04, 95%CI 1.005-1.09 P=0.02 ), and with statins treatment (OR 2.3, 95%CI 1.17-4.54, P=0.01). The prevalence of SHPTH between the groups was similar, however, diabetics had more presence of hypertension and dyslipidemia, and SHPTH in this case was also related with moderate microalbuminuria and lower levels of vitamin D. An association with statins was also found in this group.

Research paper thumbnail of Metabolic effects of supplementation with vitamin D in type 2 diabetic patients with vitamin D deficiency

Diabetes & Metabolic Syndrome: Clinical Research & Reviews, 2015

Epidemiological studies suggest that vitamin D status influences type 2 diabetes mellitus. We inv... more Epidemiological studies suggest that vitamin D status influences type 2 diabetes mellitus. We investigate the metabolic effects of vitamin D. We studied consecutive type 2 diabetic patients without insulin therapy with vitamin D deficiency (serum 25-hydroxyvitamin D (25(OH)D) lower than 20ng/ml). They were treated with 16,000IU of calcifediol orally once a week for a minimum of 8 weeks. Twenty eight patients were treated for a mean time of 84.1 days (range 56 to 120 days). All patients achieved serum levels of 25(OH)D higher than 20ng/ml. There was a significant reduction in fasting glucose (145.6±35.5 vs. 131.7±30.4mg/dl, p&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;0.001). There were small non-significant reductions in HbA1c, fasting insulin and Homeostasis Model Assesment (HOMA)-insulin resistance (IR). There were small non-significant increases in HOMA-insulin sensitivity (S) and HOMA-beta cell function (B) and a small significant increase in Quantitative Insulin Sensitivity Check Index (QUICKI). Correction of vitamin D deficiency in type 2 diabetic patients decreases fasting glucose. Our results do not rule out improvements in metabolic control, insulin-resistance and function of the beta cell.

Research paper thumbnail of Vitamin D Levels in Patients with Type 2 Diabetes Mellitus

Journal of Investigative Medicine, 2015

Background Vitamin D may influence many diseases, including type 2 diabetes mellitus. Patients an... more Background Vitamin D may influence many diseases, including type 2 diabetes mellitus. Patients and Methods We studied serum levels of 25-hydroxyvitamin D (25(OH)D) and associated characteristics in type 2 diabetic outpatients with pharmacologic treatment attended in internal medicine offices in a first-level hospital from Extremadura (Southern Spain). Results We included a total of 103 patients. Seventy-two patients (69.9%) had serum levels of 25(OH)D lower than 20 ng/mL. There was inverse correlation between serum levels of 25(OH)D and glycosylated hemoglobin ( r = −0.74, P = 0.01). In 78 patients without insulin therapy, we found inverse correlation between serum levels of 25(OH)D and fasting serum insulin ( r = −0.82, P = 0.001) and Homeostasis Model Assessment–Insulin Resistance ( r = −0.51, P < 0.001). Conclusions Vitamin D deficiency is common in type 2 diabetic patients. There are inverse correlations between vitamin D and metabolic control and insulin resistance.

Research paper thumbnail of WITHDRAWN: Effects on lipid profile of supplementation with vitamin D in type 2 diabetic patients with vitamin D deficiency

Diabetes & Metabolic Syndrome: Clinical Research & Reviews, 2015

Research paper thumbnail of Vitamin B12 in type 2 diabetic patients treated with metformin

Endocrinología y Nutrición (English Edition), 2012

Objective: To test vitamin B 12 plasma levels in type 2 diabetic patients treated with metformin ... more Objective: To test vitamin B 12 plasma levels in type 2 diabetic patients treated with metformin in our area. Methods: A cross-sectional, observational study of consecutive type 2 diabetic patients on drug treatment attending an internal medicine outpatient clinic. Results: One hundred and nine patients (81 treated with metformin) were enrolled into the study. Mean time on metformin treatment was 43.5 months and mean drug dose was 1779 mg/day. Patients treated with metformin had significantly lower vitamin B 12 plasma levels (393.5 vs 509 pg/mL, p = 0.0008). Seven (8.6%) of 81 patients treated with metformin and none of the 28 patients not treated with the drug had vitamin B 12 plasma levels lower than 197 pg/mL. No correlation was found between vitamin B 12 plasma levels and metformin treatment time or dosage. Conclusions: In type 2 diabetic patients, treatment with metformin is associated to lower vitamin B 12 plasma levels. Vitamin B 12 deficiency associated with metformin is relatively common in our area.

Research paper thumbnail of Effects on lipid profile of supplementation with vitamin D in type 2 diabetic patients with vitamin D deficiency

Therapeutic Advances in Endocrinology and Metabolism, 2015

Background: Epidemiological studies suggest that vitamin D status may have an influence on lipid ... more Background: Epidemiological studies suggest that vitamin D status may have an influence on lipid profile. Patients and methods: We studied consecutive type 2 diabetic patients with vitamin D deficiency (serum 25-hydroxyvitamin D (25(OH)D) lower than 20 ng/ml). They were treated with 16,000 IU of calcifediol orally once a week for a minimum of 8 weeks. Results: A total of 28 patients were treated for a mean time of 84.1 days (range 56-120 days). All patients achieved serum levels of 25(OH)D higher than 20 ng/ml. There was significant reduction in total cholesterol (172.1 ± 32.4 versus 164.4 ± 27.3 mg/dl, p = 0.04). There were nonsignificant reductions in low-density lipoprotein (LDL) cholesterol, non-high-density lipoprotein (non-HDL) cholesterol and triglycerides. There was no change in HDL cholesterol. Conclusions: Correction of vitamin D deficiency in type 2 diabetic patients decreases total cholesterol. Our results do not rule out reductions in LDL cholesterol, non-HDL cholestero...

Research paper thumbnail of Agotamiento Por Calor Asociado a Trastornos Del Lenguaje

Emergencias, Feb 1, 2014

El golpe de calor ( heat stroke ), es una emergencia medica que se define como forma de hiperterm... more El golpe de calor ( heat stroke ), es una emergencia medica que se define como forma de hipertermia asociada a respuesta inflamatoria sistemica y el consecuente desarrollo final de fracaso multiorganico en el cual predomina la encefalopatia. El agotamiento por calor ( heat exhaustion ), es una entidad clinica de menor gravedad en la cual la temperatura corporal esta usualmente dentro de los limites normales y el sistema nervioso central no suele estar afectado. Sin embargo, presentamos un caso de agotamiento por calor que se asocio a trastornos del lenguaje.

Research paper thumbnail of Propiedades hipoglucemiantes de la hoja de higuera (ficus carica)

EL EXTRACTO DE HOJAS DE HIGUERA (FICUS CARICA) ADMINISTRADO VIA ORAL POSEE UNA CLARA ACCION HIPOG... more EL EXTRACTO DE HOJAS DE HIGUERA (FICUS CARICA) ADMINISTRADO VIA ORAL POSEE UNA CLARA ACCION HIPOGLUCEMIANTE EN RATAS DIABETICAS PERO NO EN RATAS NORMALES, SU MECANISMO DE ACCION NO PARECE SER EFECTO FIBRA, NI UN EFECTO INSULINOTROPICO TIPO SULFONILUREAS, SINO QUE SOBRE LOS DATOS OBTENIDOS, SE APROXIMA MAS AL MECANISMO DE ACCION PERIFERICO DE LA INSULINA, BIEN POTENCIANDOLA O MIMETIZANDOLA.

Research paper thumbnail of Vitamin D and thyrotropin in type 2 diabetic patients

Diabetes & Metabolic Syndrome: Clinical Research & Reviews, 2016

Vitamin D status and thyroid function may be related. Using our data from two previous studies in... more Vitamin D status and thyroid function may be related. Using our data from two previous studies in type 2 diabetic patients, we found slightly higher serum thyrotropin levels in patients with vitamin D deficiency (at the limit of statistical significance) and no effect of correction of vitamin D deficiency in serum thyrotropin levels.

Research paper thumbnail of Secondary hyperparathyroidism prevalence and profile, between diabetic and non-diabetic patients with stage 3 to 4 chronic kidney disease attended in internal medicine wards. MiPTH study

Diabetes & Metabolic Syndrome: Clinical Research & Reviews, 2016

Secondary hyperparathyroidism (SHPTH) is a leading cause of renal osteodystrophy, and an independ... more Secondary hyperparathyroidism (SHPTH) is a leading cause of renal osteodystrophy, and an independent risk factor for all-cause and cardiovascular mortality. Our aim is to establish differences in prevalence and profile of SHPTH, regarding diabetics or non-diabetics with chronic kidney disease (CKD). Cross-sectional multicenter study which included patients with stages 3 to 4 CKD. SHPTH was considered when the intact PTH levels (iPTH) were equal or higher than 70pg/ml. We divided the sample into two groups (diabetics and non-diabetics). We used robust statistical methods. 409 patients (214 diabetics) were studied. HPTH was found in 60.4% of diabetics vs 65% of non-diabetics (P=0.42). Diabetics with HPTH were younger (79.5 vs 82.3 years-old, P=0.005), and had more hypertension (P=0.0014), dyslipidemia (P=0.0001) and comorbidities. In multivariate analysis, we found a significant relationship in case of diabetics, with age (OR: 1.04, 95%CI 1.005-1.09 P=0.02 ), and with statins treatment (OR 2.3, 95%CI 1.17-4.54, P=0.01). The prevalence of SHPTH between the groups was similar, however, diabetics had more presence of hypertension and dyslipidemia, and SHPTH in this case was also related with moderate microalbuminuria and lower levels of vitamin D. An association with statins was also found in this group.

Research paper thumbnail of Metabolic effects of supplementation with vitamin D in type 2 diabetic patients with vitamin D deficiency

Diabetes & Metabolic Syndrome: Clinical Research & Reviews, 2015

Epidemiological studies suggest that vitamin D status influences type 2 diabetes mellitus. We inv... more Epidemiological studies suggest that vitamin D status influences type 2 diabetes mellitus. We investigate the metabolic effects of vitamin D. We studied consecutive type 2 diabetic patients without insulin therapy with vitamin D deficiency (serum 25-hydroxyvitamin D (25(OH)D) lower than 20ng/ml). They were treated with 16,000IU of calcifediol orally once a week for a minimum of 8 weeks. Twenty eight patients were treated for a mean time of 84.1 days (range 56 to 120 days). All patients achieved serum levels of 25(OH)D higher than 20ng/ml. There was a significant reduction in fasting glucose (145.6±35.5 vs. 131.7±30.4mg/dl, p&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;0.001). There were small non-significant reductions in HbA1c, fasting insulin and Homeostasis Model Assesment (HOMA)-insulin resistance (IR). There were small non-significant increases in HOMA-insulin sensitivity (S) and HOMA-beta cell function (B) and a small significant increase in Quantitative Insulin Sensitivity Check Index (QUICKI). Correction of vitamin D deficiency in type 2 diabetic patients decreases fasting glucose. Our results do not rule out improvements in metabolic control, insulin-resistance and function of the beta cell.