Spanish translation, adaptation and validation of the Hypoglycemia Fear Survey in adults with type 1 diabetes in the Community of Madrid. / Traducción al español, adaptación y validación del Cuestionario de miedo a la hipoglucemia en adultos con diabetes tipo 1 de la Comunidad de Madrid.

BACKGROUND AND OBJECTIVE: The negative impact of hypoglycemia on patients with type 1 diabetes mellitus (T1DM) may lead to development of fear of hypoglycemia. In this study, the original Hypoglycemia Fear Survey (HFS) questionnaire was translated into Spanish, adapted and validated, and variables associated to fear of hypoglycemia in T1DM were analyzed. MATERIAL AND METHODS: The HFS was translated and adapted to Spanish using the forward-backward translation method. The resulting questionnaire, EsHFS, was administrated to a population with T1DM. The following parameters of the questionnaire were analyzed: feasibility, reliability (Cronbach's alpha), content validity (correlating EsHFS and EsDQOL [Diabetes Quality of Life] questionnaire), and stability (by means of test-retest correlation). RESULTS: The EsHFS questionnaire consists of 24 items and three subscales including: subscale 1 on worry; subscale 2 on hypoglycemia-avoidant behavior, and subscale 3 on hyperglycemia-influenced behavior. STUDY POPULATION: 163 subjects, with a mean aged (SD) of 36 (10.5) years, 24% on continuous subcutaneous insulin infusion. Of these, 99.8% completed the EsHFS questionnaire in less than 10minutes. Cronbach's alpha for global EsHFS was 0.92. EsHFS and its subscales correlated with EsDQOL. Test-retest correlation (Pearson) was r=0.92. Age, female sex, lower educational level, living alone, frequency of daily self-monitoring and non-severe hypoglycemia, and history of severe and/or asymptomatic hypoglycemia were independently associated to the result of EsHFS. CONCLUSIONS: The Spanish version of the HFS, EsHFS, has good psychometric properties and may be a useful tool to assess fear of hypoglycemia in Spanish-speaking patients with T1DM.

Traducción al español, adaptación y validación del Cuestionario de miedo a la hipoglucemia en adultos con diabetes tipo 1 de la Comunidad de Madrid / Spanish translation, adaptation and validation of the Hypoglycemia Fear Survey in adults with type 1 diabetes in the Community of Madrid

Antecedentes y objetivo: Las consecuencias negativas de la hipoglucemia en las personas con diabetes mellitus tipo 1 (DM1) pueden resultar en el desarrollo de miedo a la hipoglucemia. Este estudio traduce al español, adapta y valida, el cuestionario original Hypoglycemia Fear Survey (HFS) y analiza qué variables se asocian con el miedo a la hipoglucemia en DM1. Material y métodos: El HFS fue traducido y adaptado mediante el proceso de traducción-retrotraducción y el nuevo cuestionario obtenido, EsHFS, fue administrado a una población con DM1. Se analizó: factibilidad, confiabilidad (alpha de Cronbach), validez de contenido (mediante correlación del EsHFS y el cuestionario de calidad de vida, EsDQOL) y estabilidad (correlación test-retest) del cuestionario. Resultados: El EsHFS consta de 24 ítems, identificándose 3 subescalas: subescala 1, de preocupación; subescala 2, de comportamiento asociado a evitación y la subescala 3, de comportamiento que produce hiperglucemia. Población incluida: 163 sujetos, M (DE) 36(10,5) años, 24% tratados mediante infusión subcutánea continua de insulina. El 99,8% autocumplimentó el EsHFS en<10min. El alpha de Cronbach para el EsHFS global fue de 0,92. El EsHFs y las subescalas se correlacionaron con el EsDQOL. La correlación test-retest (Pearson) obtuvo una r=0,92. Edad, sexo femenino, menor nivel formativo/estudios, convivencia sin pareja, frecuencia de autoanálisis y de hipoglucemia no grave, antecedentes de hipoglucemia grave y/o asintomática, se asociaron independientemente al resultado del EsHFS. Conclusiones: La versión española, EsHFS, posee unas buenas propiedades psicométricas y podría ser útil para evaluar el miedo a la hipoglucemia en población con DM1 que hable español en nuestro entorno

Background and objective: The negative impact of hypoglycemia on patients with type 1 diabetes mellitus (T1DM) may lead to development of fear of hypoglycemia. In this study, the original Hypoglycemia Fear Survey (HFS) questionnaire was translated into Spanish, adapted and validated, and variables associated to fear of hypoglycemia in T1DM were analyzed. Material and methods: The HFS was translated and adapted to Spanish using the forward-backward translation method. The resulting questionnaire, EsHFS, was administrated to a population with T1DM. The following parameters of the questionnaire were analyzed: feasibility, reliability (Cronbach's alpha), content validity (correlating EsHFS and EsDQOL [Diabetes Quality of Life] questionnaire), and stability (by means of test-retest correlation). Results: The EsHFS questionnaire consists of 24 items and three subscales including: subscale 1 on worry; subscale 2 on hypoglycemia-avoidant behavior, and subscale 3 on hyperglycemia-influenced behavior. Study population: 163 subjects, with a mean aged (SD) of 36 (10.5) years, 24% on continuous subcutaneous insulin infusion. Of these, 99.8% completed the EsHFS questionnaire in less than 10minutes. Cronbach's alpha for global EsHFS was 0.92. EsHFS and its subscales correlated with EsDQOL. Test-retest correlation (Pearson) was r=0.92. Age, female sex, lower educational level, living alone, frequency of daily self-monitoring and non-severe hypoglycemia, and history of severe and/or asymptomatic hypoglycemia were independently associated to the result of EsHFS. Conclusions: The Spanish version of the HFS, EsHFS, has good psychometric properties and may be a useful tool to assess fear of hypoglycemia in Spanish-speaking patients with T1DM

[Glycemic control in non-critical hospitalized patients]. / Control glucémico en pacientes hospitalizados no críticos.

OBJECTIVES: To assess in hospitalized patients the prevalence of hyperglycemia, degree of glycemic control, rate of hypoglycemia, and treatment used. PATIENTS AND METHODS: A prospective, observational study. RESULTS: Hyperglycemia was found in 185 (26.7%) of 691 patients, of whom 85% had been diagnosed with diabetes and 15% had no diabetes. Preprandial mean blood glucose was 169 mg/dL (95% CI 160-177). Control goals were achieved by 34.5% of patients (blood glucose ≤140 mg/dL). In 121 patients only sliding-scale regular insulin was used, while 64 patients received both basal and regular insulin. The mean daily insulin dose used was 19.5 units. Oral antidiabetics were given to 11.4% of patients. Thirteen patients (7%) experienced hypoglycemia (< 70 mg/dL), none of them severe. CONCLUSIONS: Glycemic control is not adequate in hospitalized patients, probably because of overuse of sliding scales and the low insulin doses used.

Resultados a medio-largo plazo de pacientes con diabetes tipo 1 remitidos a una consulta monográfica de bombas de insulina / Mid-long term results on the evaluation of type 1 diabetes patients referred to an insulin pump clinic

OBJETIVO: Analizar la evolución a largo plazo de los primeros 69 pacientes con diabetes mellitus tipo 1 remitidos a una consulta monográfica de bombas de insulina durante el periodo 2005-2012, para valorar la iniciación de terapia con infusión subcutánea continua de insulina (ISCI). MATERIAL Y MÉTODOS: Estudio retrospectivo, observacional y unicéntrico de 69 pacientes candidatos a ISCI. Se analizaron los pacientes que no iniciaron ISCI (n = 18) y los que sí lo hicieron (n = 51). Se analizaron las siguientes variables: edad, sexo, duración de la enfermedad, indicación de ISCI, HbA1c, frecuencia de episodios de hipoglucemias severas, cetoacidosis diabética y tasa de retirada de la ISCI. RESULTADOS: El motivo principal para no iniciar ISCI fue el rechazo del paciente (49%), seguido por mejoría de control glucémico tras optimizar tratamiento con múltiples dosis de insulina (MDI) (33%). Las principales indicaciones de ISCI fueron: mal control (49%), seguido de mal control asociado a hipoglucemias no graves (27,5%). La HbA1c previa al inicio de ISCI fue de 8,6 ± 1,5%, con una reducción media de un 1% mantenida durante 5 años (p < 0,001), siendo el descenso superior si la HbA1c basal > 8%. Cinco (10%) pacientes interrumpieron el uso de ISCI tras 1-6 años de la terapia. CONCLUSIÓN: En nuestra práctica clínica uno de cada 4 pacientes remitidos para comenzar ISCI no inician finalmente la terapia. El cambio de MDI a ISCI se asoció con una reducción del 1% de la HbA1c durante los primeros 5 años, siendo mayor en los pacientes con peor control glucémico

OBJECTIVE: To analyse the first 69 type 1 diabetes patients referred to a specialist team between 2005 and 2012 in order to evaluate the indication for continuous subcutaneous insulin infusion (CSII). METHODS: Retrospective, observational, single centre study conducted on 69 adult patients evaluated for CSII. An analysis was made on patients who did not initiate CSII (n = 18) and patients who were treated with CSII (n = 51). Variables included: age, gender, duration of disease, indication for CSII, HbA1c, frequency of severe hypoglycaemia events, episodes of diabetic ketoacidosis, and pump discontinuation. RESULTS: The main reason for not initiating CSII was patient refusal (49%), followed by improving of glycaemic control (33%) after optimising with multiple daily injections (MDI) therapy. The most common CSII indications were: suboptimal glycaemic control (49%), and suboptimal glycaemic control with frequent non-severe hypoglycaemia (27.5%). Baseline HbA1c was 8.6 ± 1.5%, and there was a significant and sustained decrease of 1% over a 5 year period (P < .001), with this reduction being greater in patients with HbA1c > 8%. The use of CSII was stopped by 5 patients (10%) after 1 to 6 years. CONCLUSION: In our clinical practice one in four patients evaluated for CSII did not initiate it. The switch from MDI to CSII was associated with a 1% reduction in HbA1c over 5 years, being greater in patients with poor glycaemic control

Control glucemico en pacientes hospitalizados no criticos / Glycemic control in non-critial hospitalized patients

Conocer la prevalencia de hiperglucemia en pacientes ingresados, el grado de control glucemico, la tasa de hipoglucemias y el tratamiento utilizado. Material y métodos Estudio observacional de corte transversal. Resultados De 691 pacientes, 185 (26,7%) tenían (..) (AU)

Objectives: To assess in hospitalized patients the prevalence of hyperglycemia, degree of glycemiccontrol, rate of hypoglycemia, and treatment used. Patients and (..) (AU)