Age and Red Blood Cell Parameters Mainly Explain the Differences Between HbA1c and Glycemic Management Indicator Among Patients With Type 1 Diabetes Using Intermittent Continuous Glucose Monitoring.

BACKGROUND: Glycated hemoglobin (HbA1c) is the gold standard to assess glycemic control in patients with diabetes. Glucose management indicator (GMI), a metric generated by continuous glucose monitoring (CGM), has been proposed as an alternative to HbA1c, but the two values may differ, complicating clinical decision-making. This study aimed to identify the factors that may explain the discrepancy between them. METHODS: Subjects were patients with type 1 diabetes, with one or more HbA1c measurements after starting the use of the Freestyle Libre 2 intermittent CGM, who shared their data with the center on the Libreview platform. The 14-day glucometric reports were retrieved, with the end date coinciding with the date of each HbA1c measurement, and those with sensor use ≥70% were selected. Clinical data prior to the start of CGM use, glucometric data from each report, and other simultaneous laboratory measurements with HbA1c were collected. RESULTS: A total of 646 HbA1c values and their corresponding glucometric reports were obtained from 339 patients. The absolute difference between HbA1c and GMI was <0.3% in only 38.7% of cases. Univariate analysis showed that the HbA1c-GMI value was associated with age, diabetes duration, estimated glomerular filtration rate, mean corpuscular volume (MCV), red cell distribution width (RDW), and time with glucose between 180 and 250 mg/dL. In a multilevel model, only age and RDW, positively, and MCV, negatively, were correlated to HbA1c-GMI. CONCLUSION: The difference between HbA1c and GMI is clinically relevant in a high percentage of cases. Age and easily accessible hematological parameters (MCV and RDW) can help to interpret these differences.

Successful outcome of pregnancy in a patient with Cushing's disease under treatment with ketoconazole during the first trimester of gestation.

BACKGROUND: Ketoconazole is the most widely used medical treatment for Cushing's syndrome, but, because of its potential to cause birth defects, it is not recommended during pregnancy. Specifically, due to its antiandrogenic effects, ketoconazole entails theoretical risks of interfering with the development of external genitalia in male fetuses. CASE: A pregnancy was diagnosed at 13 weeks of gestation in a 26-year-old woman with Cushing's disease under treatment with ketoconazole. The drug was withdrawn and the patient underwent transsphenoidal surgery at 16 weeks of pregnancy. She did not develop postsurgical adrenal insufficiency and was treated with metyrapone during the second and third trimesters of gestation. Partum was induced at 34 weeks of pregnancy. The patient delivered a healthy male infant with normal external genitalia. CONCLUSION: Treatment with ketoconazole during the critical period of organogenesis did not cause congenital birth defects to the male fetus of a woman with Cushing's disease. This report should be taken into account for future cases of unplanned pregnancies in women with Cushing's syndrome treated with ketoconazole, as well in those cases in which other therapeutic options are not feasible.

Combined treatment with GH and anastrozole in a pubertal boy with Cushing's disease and postsurgical GH deficiency.

Growth failure is a characteristic manifestation of pediatric Cushing's disease. Catch-up growth is usually incomplete after cure of the disease, and final height is often compromised. Possible mechanisms for this phenomenon include postoperative persistence of GH hyposecretion and absence of retardation of bone maturation in spite of GH deficiency. This report describes the outcome in the case of a boy with Cushing's disease for whom GH replacement therapy was combined with anastrozole, an aromatase inhibitor, in order to delay skeletal maturation and extend the available time for linear growth. The case of a 14 years 4-months-old pubertal male (Tanner stage III) with GH deficiency after successful surgical treatment of Cushing's disease is presented. His height was 147.2 cm (-2.34 SDS), and his midparental target height 171.2 cm (-0.95 SDS). Bone age was 13.5 years and predicted adult height 163.2 cm (-2.2 SDS). Combined treatment was administered for 2.5 years. GH was maintained up to age 18 years. Anastrozole induced a substantial deceleration of bone age. Near-final height at 18 years was 169.5 cm (-1.07 SDS). Puberty progressed normally. Compared with population reference data, bone mineral density before GH plus anastrozole treatment was -4.07 SDS in the lumbar spine and -1.85 SDS in the femoral neck. These measures increased to -1.95 and -0.89 SDSs respectively, at 18 years, when GH was discontinued. Combined treatment with GH and aromatase inhibitors could be a therapeutic alternative to improve the stature of pubertal boys with Cushing's disease and postsurgical GH deficiency.

Evaluación de la satisfacción del paciente diabético con la utilización del glucómetro portátil BGSTAR(c) mediante el cuestionario SATIGLU / Assessment of satisfaction of diabetic patients with the use of the portable glucometer BGSTAR© using the SATIGLU questionnaire

OBJETIVOS: Evaluar la satisfacción con el glucómetro portátil BGStar(c) del paciente diagnosticado de diabetes mellitus (DM) tipo 1 (DM1) y 2 (DM2), mediante el cuestionario SATIGLU, previamente validado, y analizar la asociación de la satisfacción con la adherencia a la monitorización y al tratamiento insulínico y con el grado de control de la glucemia (%HbA1c). MATERIAL Y MÉTODO: Estudio epidemiológico, multicéntrico y transversal. Participaron 221 pacientes con DM, mayores de edad, insulinizados y usuarios del BGStar(c). Se recogieron datos socio-demográficos, clínicos, de tratamiento y adherencia. Los pacientes cumplimentaron el SATIGLU y el Morisky-Green (M-G). Se realizó un análisis descriptivo de las puntuaciones del cuestionario SATIGLU y del resto de las variables. Se evaluó la asociación de la satisfacción con el número de inyecciones de insulina/número de controles de glucemia (rho de Spearman), con la clasificación de adherencia al tratamiento según M-G y con la clasificación de control de glucemia según la cifra de %HbA1c (U de Mann-Whitney). Se ajustó un modelo de regresión lineal múltiple para identificar las variables asociadas a la puntuación del SATIGLU. RESULTADOS: Edad media ± DE 57,96 (15,60) años; 56,60% varones; 80,82% DM2; 65,30% bien controlados (%HbA1c≤ 7). Media ± DE de inyecciones de insulina/día, 2,35 ± 1,34, y de controles glucemia/día 2,56 ± 1,29. Un 75,57% de los pacientes fueron adherentes al tratamiento (M-G). Se encontró correlación positiva del SATIGLU con los controles realizados (rho = 0,251; p = 0,001), y con las inyecciones de insulina (rho = 0,235; p = 0,001). Las puntuaciones del SATIGLU fueron mayores en los pacientes adherentes y con mejor control (p < 0,0001). El modelo de regresión mostró que las variables asociadas a la satisfacción fueron: adherencia (B = 7,006; p < 0,0001), y número de controles de glucemia (B = 3,214; p = 0,014). CONCLUSIONES: Los pacientes analizados muestran elevada satisfacción con el BGStar(c) son adherentes al tratamiento, realizan mayor número de inyecciones de insulina, más controles de glucemia y tienen un mejor control de la DM

OBJECTIVES: To assess satisfaction of patients diagnosed with Diabetes Mellitus (DM), type 1 and 2, with use of the portable glucometer BGStar(c) using the previously validated SATIGLU questionnaire. The relationships between satisfaction level and adherence to continuous glucose monitoring, insulin therapy, and with the level of glycemic control (% HbA1c), were also studied. MATERIAL AND METHOD: Epidemiological, multicenter, cross-sectional study that included 221 diabetic patients aged over 18 years, receiving treatment with insulin and using the BGStar(c) glucometer. Socio-demographic and clinical data were collected, as well as treatment and adherence data. Patients self-completed the SATIGLU questionnaire and Morisky-Green (M-G). A descriptive analysis was carried out on the SATIGLU scores and other study variables. An analysis was performed to calculate the association between satisfaction scores and the number of insulin injections and the number of glucose controls (Spearman rho), and with the adherence to treatment classification according to M-G, and with the glycemic control classification according to % HbA1c. Multiple Linear Regression analysis was conducted to identify the variables associated with SATIGLU scores. RESULTS: Mean age (SD) 57.96 (15.60) years; 56.60% male; 80.82% T2DM; good glycemic control (% HbA1c≤7), 65.30%. Mean (SD) insulin injections/day, 2.35 (1.34), and blood glucose/day controls 2.56 (1.29), with 75.57% showing adherence to therapy (M-G). A positive correlation was found between the SATIGLU and the number of glycemic controls (rho = 0.251; P=.001) and of insulin injections (rho = 0.235; P=.001). SATIGLU scores were higher in adherent patients and in those with better glycemic control (P<.0001). The regression model showed that the variables associated with satisfaction were: adherence (B= 7.006;P<.0001), and the number of glycemic controls (B= 3,214; P=.014). CONCLUSIONS: The patients studied showed high satisfaction with the BGStar(c) glucometer, with a high level of adherence to insulin therapy. They also had more insulin injections, a higher number of glycemic controls, and a better DM control