Relationship between metabolic control and self-monitoring of blood glucose in insulin-treated patients with diabetes mellitus.

OBJECTIVE: To assess the relationship between metabolic control (MC) and frequency of self-monitoring of blood glucose (SMBG) in insulin-treated patients with type 1 (T1DM) and type 2 (T2DM) diabetes mellitus, and to analyze the factors associated to MC. MATERIAL AND METHODS: A multicenter, cross-sectional, observational study was conducted in which endocrinologists enrolled diabetic patients treated with insulin who used a glucometer. The cut-off value for MC was HbA1c ≤ 7%. Grade of acceptance of the glucometer was assessed using a visual analogue scale (VAS). RESULTS: A total of 341 patients (53.5% males) with a mean age (SD) 52.8 (16.3) years, mean HbA1c of 7.69% (1.25) and 128 (37.5%) with T1DM and 211 (61.9%) with T2DM were evaluable. SMBG was done by 86.1% at least once weekly. No relationship was seen between MC and SMBG (P=.678) in the overall sample or in the T1DM (P=.940) or T2DM (P=.343) subgroups. In the logistic regression model, hyperglycemic episodes (Exp-b [risk] 1.794, P=0.022), falsely elevated HbA1c values (Exp-b 3.182, P=.005), and VAS (Exp-b 1.269, P=.008) were associated to poor MC in the total sample. Hyperglycemic episodes (Exp-b 2.538, P=.004), falsely elevated HbA1c values (Exp-b 3.125, P=.012), and VAS (Exp-b 1.316, P=.026) were associated to poor MC in the T2DM subgroup, while body mass index (Exp-b 1.143, P=.046) was associated to poor MC in the T1DM subgroup. CONCLUSIONS: In this retrospective, non-controlled study on patients with DM treated with insulin who used a glucometer, no relationship was seen between the degree of metabolic control and frequency of use of the glucometer.

Relación entre el control metabólico y la automonitorización de la glucemia capilar en pacientes con diabetes mellitus tratados con insulina / Relationship between metabolic control and self-monitoring of blood glucose in insulin-treated patients with diabetes mellitus

OBJETIVO: Evaluar la relación entre el grado de control metabólico (CM) y la frecuencia de la automonitorización de la glucemia capilar (AGC) en pacientes con diabetes mellitus (DM) tipo 1 (DM1) y 2 (DM2) tratados con insulina, y analizar factores asociados al CM. MATERIAL Y MÉTODOS: Estudio observacional multicéntrico transversal en el que endocrinólogos incluyeron a pacientes con DM tratados con insulina que utilizaban un glucómetro. El punto de corte para definir un CM fue una HbA1c ≤ 7% y no control > 7%. Se valoró en una escala analógica visual (EAV) el grado de aceptación del glucómetro. RESULTADOS: Fueron evaluables 341 pacientes (53,5% varones), con una edad media ± DE de 52,8 ± 16,3 años, HbA1c media de 7,69 ± 1,25%, 128 (37,5%) con DM1 y 211 (61,9%) con DM2. El 86,1% de los pacientes utilizaron el glucómetro al menos una vez en la semana. No se observó ninguna relación entre el CM y la AGC ni en la muestra total (p = 0,678), ni en DM1 (p = 0,940) ni DM2 (p = 0,343). En el modelo de regresión logística, se asociaron a un mal CM en la muestra total y en DM2 los episodios de hiperglucemias (Exp-b [riesgo] 1,794, p = 0,022, y Exp-b 2,538, p = 0,004, respectivamente), las concentraciones de HbA1c falsamente elevadas (Exp-b 3,182 p = 0,005, y Exp-b 3,125, p = 0,012), y la EAV (Exp-b 1,269, p = 0,008, y Exp-b 1,316, p = 0,026), y en la DM1 el índice de masa corporal (Exp-b 1,143, p = 0,046). CONCLUSIONES: En este estudio observacional no controlado en pacientes con DM tratados con insulina que utilizan un glucómetro no se observa ninguna relación entre el grado de CM y la frecuencia de su uso en el último mes

OBJECTIVE: To assess the relationship between metabolic control (MC) and frequency of self-monitoring of blood glucose (SMBG) in insulin-treated patients with type 1 (T1DM) and type 2 (T2DM) diabetes mellitus, and to analyze the factors associated to MC. MATERIAL AND METHODS: A multicenter, cross-sectional, observational study was conducted in which endocrinologists enrolled diabetic patients treated with insulin who used a glucometer. The cut-off value for MC was HbA1c ≤ 7%. Grade of acceptance of the glucometer was assessed using a visual analogue scale (VAS). RESULTS: A total of 341 patients (53.5% males) with a mean age (SD) 52.8 (16.3) years, mean HbA1c of 7.69% (1.25) and 128 (37.5%) with T1DM and 211 (61.9%) with T2DM were evaluable. SMBG was done by 86.1% at least once weekly. No relationship was seen between MC and SMBG (P=.678) in the overall sample or in the T1DM (P=.940) or T2DM (P=.343) subgroups. In the logistic regression model, hyperglycemic episodes (Exp-b [risk] 1.794, P=0.022), falsely elevated HbA1c values (Exp-b 3.182,P=.005), and VAS (Exp-b 1.269, P=.008) were associated to poor MC in the total sample. Hyperglycemic episodes (Exp-b 2.538, P=.004), falsely elevated HbA1c values (Exp-b 3.125, P=.012), and VAS (Exp-b 1.316, P=.026) were associated to poor MC in the T2DM subgroup, while body mass index (Exp-b 1.143, P=.046) was associated to poor MC in the T1DM subgroup. CONCLUSIONS: In this retrospective, non-controlled study on patients with DM treated with insulin who used a glucometer, no relationship was seen between the degree of metabolic control and frequency of use of the glucometer

Insulina inhalada en la práctica clínica: nuestra experiencia con pacientes diabéticos tipo 2 / Inhaled insulin in clinical practice: our experience in patients with type 2 diabetes

A partir de los datos recogidos en los cuestionarios de satisfacción utilizados en nuestro trabajo se puede concluir que es fácil el aprendizaje y manejo del inhalador de insulina, incluso para pacientes de edad avanzada. Es fácil incorporarlo a la vida diaria. Los pacientes consideran que la insulina en polvo, el inhalador y la vía de absorción son eficaces para conseguir un buen control de la glucemia. Definitivamente, reduce el rechazo a utilizar insulina y les gustaría seguir utilizándolo como dispositivo de administración de la misma. Recomendarían el tratamiento con el inhalador de insulina y con la insulina Exubera® a otros pacientes con diabetes similar a la suya (AU)

Data from the patient satisfaction questionnaires used in our center indicate that the use of inhaled insulin is easy to learn and manage, even in elderly patients. This form of insulin can easily be incorporated into daily life. The patients reported that powder insulin, the inhaler and the route of absorption are effective in achieving good blood glucose control. Inhaled insulin reduces patients’ reluctance to use insulin. The patients would like to continue with this form of insulin administration and would recommend treatment with the Exubera® insulin inhaler to other patients with diabetes similar to their own (AU)