Type 1 diabetes in pediatrics during the COVID-19 pandemic: Time from symptom onset and forms of presentation at a referral hospital. / Diabetes tipo 1 en pediatría durante la pandemia por COVID-19: tiempo de evolución de síntomas y formas de presentación en un centro de referencia.

Introduction. The COVID-19 pandemic impacted on the health care of patients with type 1 diabetes mellitus (DM1). An increase in diabetic ketoacidosis (DKA) as a form of diagnosis was reported. Objectives. To assess whether there were changes in the time from symptom onset, the causes of hospitalization due to DM1, and the proportion of severe forms, and to describe SARS-CoV-2 infection in these patients. Population and methods. Cross-sectional study in patients younger than 19 years hospitalized due to DM1 from March 2018 to August 2019 (pre-pandemic) and from March 2020 to August 2021 (pandemic). Results. The assessment included 135 hospitalizations in the pre-pandemic period and 96 during the pandemic. The time from symptom onset during the pandemic in those with debut of diabetes was shorter than in the pre-pandemic period (18.8 ± 10.2 versus 52.1 ± 12.1 days, respectively; p < 0.001). Hospitalizations due to all forms of diabetes debut and debut with DKA were more common during the pandemic than before it (59.4% versus 39.3%; odds ratio [OR]: 2.3; 95% confidence interval [CI]: 1.3-3.8; p = 0.003 and 40.6% versus 20.7%; OR: 2.6; 95% CI: 1.4-5.2; p = 0.006, respectively). Severe forms of DKA did not change between both periods (48.1% versus 59.9%; p = 0.3). Only 6 patients developed SARS-CoV-2 infection; 3 were severe. Conclusion. During the pandemic, the time from symptom onset decreased and the frequency of hospitalizations due to debut of DM1 increased. The proportion of severe forms of DKA did not change.

Introducción. La pandemia por COVID-19 afectó la atención de pacientes con diabetes mellitus tipo 1 (DM1). Además, se reportó un aumento de cetoacidosis diabética (CAD) como forma de diagnóstico. Objetivos. Evaluar si durante la pandemia por COVID-19 se modificaron el tiempo de evolución de síntomas, las causas de hospitalización por DM1 y la proporción de formas graves, y describir la infección por SARS-CoV-2 en estos pacientes. Población y métodos. Estudio transversal que incluyó pacientes menores de 19 años hospitalizados por DM1 en un centro pediátrico de referencia de marzo de 2018 a agosto de 2019 (prepandemia) y de marzo de 2020 a agosto de 2021 (pandemia). Resultados. Se analizaron 231 internaciones, 135 prepandemia y 96 en pandemia. Los pacientes con debut diabético presentaron menor tiempo de evolución de síntomas en pandemia que en prepandemia (18,8 ± 10,2 vs. 52,1 ±12,1 días, respectivamente; p <0,001). Las hospitalizaciones por todas las formas de debut diabético y el debut con CAD fueron más frecuentes en pandemia que en prepandemia (59,4 % vs. 39,3 %; OR 2,3; IC95% 1,3-3,8; p = 0,003); y (40,6 % vs. 20,7 %; OR 2,6; IC95% 1,4-5,2; p = 0,006) respectivamente. La proporción de formas graves de CAD no se modificó entre ambos períodos (48,1 % vs. 59,9 %; p = 0,3). Solo 6 pacientes presentaron infección por SARS-CoV-2; 3 fueron formas graves. Conclusión. Durante la pandemia, disminuyó el tiempo de evolución de síntomas y aumentó la frecuencia de hospitalizaciones por debut de DM1, con mayor proporción de CAD. No se modificó la proporción de formas graves de CAD.

[Type 2 diabetes. Is it possible to achieve the glycemic goal in real life?] / Diabetes Tipo 2 ¿en la vida real es posible lograr la meta glucémica?

INTRODUCTION: Achieving glycemic control in type 2 diabetes(T2D) prevents or delays chronic complications and extends survival. AIM: to analyze metabolic control goals in adults with T2DM, treated by specialists in their usual practice in Argentina, and their relationship with adherence to prescribed medications, different treatment strategies, time of diagnosis, quality of life variables and presence of chronic complications of T2DM. METHODS: cross-sectional design; multicenter study conducted in 28 centers in Argentina during 2018. The sample was selected randomly and systematically. Morisky-Green-Levine and WHO-5 adherence questionnaire for quality of life was applied. History of disease and laboratory markers were analyzed. RESULTS: of 1329 DMT2 cases included, 60.2% achieved the goal. Regarding pharmacological treatment in diabetes: 5.1% were without medication, 47.5% with 1 drug, 34.5% with 2, 12.9% with 3 or more; in turn, with insulin (alone or combined) 38.1%. According to the questionnaire, 68.4% adhered to treatment and 72.6% reached A1C <7%. Among the non-adherents, 27.4% reached the goal. Achieving the glycemic goal was associated with age = 65 years (p < 0.0001), higher adherence score (p < 0.0001), private health insurance (p < 0.0001), and physical activity (p < 0.02). The worst metabolic control was associated with time of DMT2 diagnosis (p <0.0001), insulin therapy (p < 0.0001) and symptoms of depression (p < 0.002) Conclusions: The youngest and most vulnerable presented lower values for adherence; intervening and intensifying the treatment earlier in them would allow better results.

Lograr control glucémico en diabetes tipo 2 (DMT2) previene, o enlentece las complicaciones crónicas y prolonga la supervivencia. Objetivo: analizar metas de control metabólico en adultos con DMT2 tratados por especialistas en Argentina y su relación con la adherencia a la medicación prescrita, las diferentes estrategias de tratamiento, la antigüedad de la enfermedad, las variables de calidad de vida y presencia de complicaciones crónicas de DMT2. Métodos: diseño transversal; estudio multicéntrico realizado en 28 centros de Argentina durante 2018. La muestra se seleccionó en forma aleatoria y sistemática. Se aplicó cuestionario de adherencia Morisky-Green-Levine y OMS-5 para calidad de vida. Se analizaron antecedentes de enfermedad y marcadores de laboratorio. Resultados: de 1329 casos de DMT2 incluidos, el 60.2% logró la meta. Respecto al tratamiento farmacológico en diabetes: el 5.1% estaba sin medicación, 47.5% con 1 fármaco, el 34.5% con 2, el 12.9% con 3 o más; a su vez, con insulina (sola o combinada) el 38.1%. Según cuestionario, adhería al tratamiento el 68.4% y el 72.6% alcanzó A1C < 7%. Entre los no adherentes, alcanzó la meta glucémica el 27.4%. Lograr esta meta se asoció con edad mayor de 65 años (p < 0.0001), mayor score de adherencia (p < 0.0001), tener medicina prepaga (p < 0.0001), y realizar actividad física (p < 0.02). El peor control metabólico se asoció con antigüedad de DMT2 (p < 0.0001), insulinoterapia (p < 0.0001) y síntomas de depresión (p < 0.002) Conclusiones: Los más jóvenes y los más vulnerables presentaron menor adherencia; en ellos intervenir e intensificar tratamiento más tempranamente permitiría mejores resultados.

Diabetes tipo 2 ¿En la vida real es posible lograr la meta glucémica? / Type 2 Diabetes. Is it possible to achieve the glycemic goal in real life?

Resumen Lograr control glucémico en diabetes tipo 2 (DMT2) previene, o enlentece las complicaciones crónicas y prolonga la supervivencia. Objetivo: analizar metas de control metabólico en adultos con DMT2 tratados por especialistas en Argentina y su relación con la adherencia a la medicación prescrita, las diferentes estrategias de tratamiento, la antigüedad de la enfermedad, las variables de calidad de vida y pre sencia de complicaciones crónicas de DMT2. Métodos: diseño transversal; estudio multicéntrico realizado en 28 centros de Argentina durante 2018. La muestra se seleccionó en forma aleatoria y sistemática. Se aplicó cuestionario de adherencia Morisky-Green-Levine y OMS-5 para calidad de vida. Se analizaron antecedentes de enfermedad y marcadores de laboratorio. Resultados: de 1329 casos de DMT2 incluidos, el 60.2% logró la meta. Respecto al tratamiento farmacológico en diabetes: el 5.1% estaba sin medicación, 47.5% con 1 fármaco, el 34.5% con 2, el 12.9% con 3 o más; a su vez, con insulina (sola o combinada) el 38.1%. Según cuestionario, adhería al tratamiento el 68.4% y el 72.6% alcanzó A1C < 7%. Entre los no adherentes, alcan zó la meta glucémica el 27.4%. Lograr esta meta se asoció con edad mayor de 65 años (p < 0.0001), mayor score de adherencia (p < 0.0001), tener medicina prepaga (p < 0.0001), y realizar actividad física (p < 0.02). El peor control metabólico se asoció con antigüedad de DMT2 (p < 0.0001), insulinoterapia (p < 0.0001) y síntomas de depresión (p < 0.002) Conclusiones: Los más jóvenes y los más vulnerables presentaron menor adherencia; en ellos intervenir e intensificar tratamiento más tempranamente permitiría mejores resultados.

Abstract Introduction: Achieving glycemic control in type 2 diabetes(T2D) prevents or delays chronic complications and extends survival. Aim: to analyze metabolic control goals in adults with T2DM, treated by specialists in their usual practice in Argentina, and their relationship with adherence to prescribed medications, different treatment strategies, time of diagnosis, quality of life variables and presence of chronic complications of T2DM. Methods: cross-sectional design; multicenter study conducted in 28 centers in Argentina during 2018. The sample was selected randomly and systematically. Morisky-Green-Levine and WHO-5 adherence questionnaire for quality of life was applied. History of disease and laboratory markers were analyzed. Results: of 1329 DMT2 cases included, 60.2% achieved the goal. Regarding pharmacological treatment in diabetes: 5.1% were without medication, 47.5% with 1 drug, 34.5% with 2, 12.9% with 3 or more; in turn, with insulin (alone or combined) 38.1%. According to the questionnaire, 68.4% adhered to treatment and 72.6% reached A1C <7%. Among the non-adherents, 27.4% reached the goal. Achieving the glycemic goal was associated with age ≥ 65 years (p < 0.0001), higher adherence score (p < 0.0001), private health insurance (p < 0.0001), and physical activity (p < 0.02). The worst metabolic control was associated with time of DMT2 diagnosis (p<0.0001), insulin therapy (p < 0.0001) and symptoms of depression (p < 0.002) Conclusions: The youngest and most vulnerable presented lower values for adherence; intervening and intensifying the treatment earlier in them would allow better results.

[Hypoglycaemia in patients with type 1 and type 2 diabetes mellitus on insulin therapy. Results of the global HAT study in Argentina]. / Hipoglucemia en pacientes con diabetes tipo 1 y tipo 2 en tratamiento con insulina. Resultados del estudio HAT en Argentina.

We describe the results of the HAT study in 433 Argentinean patients with type 1 diabetes (T1D) and 823 with type 2 diabetes (T2D). HAT was an international non-interventional study assessing severe and non-severe hypoglycaemia in patients with T1D and T2D under insulin treatment through a two-part self-assessment questionnaire (retrospective and prospective). The annual incidence of at least one hypoglycaemic episode was 46 episode/patient/year in T1D and 14.2 in T2D (retrospective), 96.5 and 24.6 episode/patient/year in T1D and T2D, respectively (prospective). Hypoglycaemia affected quality of life (on a scale of 0-10 for fear of hypoglycaemia: 60% in T1D and 37.6% in T2D scored 5 to 10), daily life, occupational or academic performance (2.1% with T1D and 3.2% with T2D did not attend to their work after hypoglycaemia), and induced an increased use of health resources (T1D: 66.1% increased glucose monitoring, 60.5% food intake, 51% consultations, 3.5% hospital admissions; 60.5% reduced insulin and 20.9% exercises; T2D increased 46.2% glucose monitoring, 43.8% consultations, 38.6% food intake, 24.1% reduced and 13.9% skipped the insulin dose and 14.3% suspended exercises). Greater numbers of episodes were recorded in the prospective period. An instrument to assess hypoglycaemia in clinical practice and strategies to reduce their risk are required. It is also important to ask about the episodes and reinforce the education of patients and close relatives on hypoglycaemia prevention and treatment.

Hipoglucemia en pacientes con diabetes tipo 1 y tipo 2 en tratamiento con insulina. Resultados del estudio HAT en argentina / Hypoglycaemia in patients with type 1 and type 2 diabetes mellitus on insulin therapy. Results of the global HAT study in Argentina

Describimos los resultados del estudio internacional no intervencionista HAT en una muestra de Argentina que evaluó las hipoglucemias graves y no graves en 433 pacientes con diabetes mellitus tipo 1 (DMT1) y 823 con diabetes tipo 2 (DMT2) tratados con insulina, mediante un cuestionario de autoevaluación doble (retrospectivo y prospectivo). La incidencia anual de al menos un evento de hipoglucemia fue 46 episodios/paciente-año en DMT1 y 14.2 en DMT2 (retrospectivo) y 96.5 y 24.6 eventos/paciente/año en DMT1 y DMT2, respectivamente (prospectivo). La hipoglucemia influyó en la calidad de vida (en escala 0-10 de temor a hipoglucemia: 60% en DMT1 y 37.6% en DMT2 puntuó de 5 a 10), en el desempeño cotidiano, laboral o académico (2.1% con DMT1 y el 3.2% con DMT2 no asistieron a su labor por hipoglucemia) y en el mayor consumo de recursos (en DMT1: 66.1% aumentó el monitoreo glucémico, 60.5% la ingesta, 51% las consultas y 60.5% redujo la insulina y el 20.9% el ejercicio, con 3.5% de internación, y en DMT2 aumentó un 46.2% el monitoreo glucémico, 43.8% las consultas, 38.6% la ingesta, el 24.1% redujo y el 13.9% salteó la dosis de insulina, 14.3% suspendió el ejercicio). Se registró mayor número de episodios en el período prospectivo. Es necesario contar con un instrumento para evaluar las hipoglucemias en la práctica clínica y con estrategias para reducir su riesgo. También es importante indagar sobre los episodios y reforzar la educación de pacientes y familiares sobre ajustes de tratamiento ante episodios de hipoglucemia.

We describe the results of the HAT study in 433 Argentinean patients with type 1 diabetes (T1D) and 823 with type 2 diabetes (T2D). HAT was an international non-interventional study assessing severe and non-severe hypoglycaemia in patients with T1D and T2D under insulin treatment through a two-part self-assessment questionnaire (retrospective and prospective). The annual incidence of at least one hypoglycaemic episode was 46 episode/patient/year in T1D and 14.2 in T2D (retrospective), 96.5 and 24.6 episode/patient/year in T1D and T2D, respectively (prospective). Hypoglycaemia affected quality of life (on a scale of 0-10 for fear of hypoglycaemia: 60% in T1D and 37.6% in T2D scored 5 to 10), daily life, occupational or academic performance (2.1% with T1D and 3.2% with T2D did not attend to their work after hypoglycaemia), and induced an increased use of health resources (T1D: 66.1% increased glucose monitoring, 60.5% food intake, 51% consultations, 3.5% hospital admissions; 60.5% reduced insulin and 20.9% exercises; T2D increased 46.2% glucose monitoring, 43.8% consultations, 38.6% food intake, 24.1% reduced and 13.9% skipped the insulin dose and 14.3% suspended exercises). Greater numbers of episodes were recorded in the prospective period. An instrument to assess hypoglycaemia in clinical practice and strategies to reduce their risk are required. It is also important to ask about the episodes and reinforce the education of patients and close relatives on hypoglycaemia prevention and treatment.

NETosis before and after Hyperglycemic Control in Type 2 Diabetes Mellitus Patients.

INTRODUCTION AND OBJECTIVE: Diabetes is characterized by chronic inflammation, endothelial dysfunction, increased risk of infections and early cardiovascular disease. By releasing neutrophil extracellular traps (NETs), neutrophils kill bacteria and exert pro-inflammatory and pro-thrombotic activities. Increased NETosis has been found in cross-sectional studies including treated type 2 diabetes mellitus (T2DM) patients. In this study, we determined whether the ability of neutrophils to form NETs differs in diabetic patients pre- and post-hyperglycemic control versus healthy donors (HD), and the relationship between NETosis with pro-thrombotic, pro-inflammatory biomarkers and thrombotic clinical events. METHODS: Diabetic patients recently diagnosed and after 6 and 12 months of treatment (N = 25) and HD (N = 25) were included. NET formation was studied by microscopy and fluorometry. Nucleosomes, HNE-DNA complexes, von Willebrand factor (vWF), IL6 and TNFα plasma levels were measured by ELISA and P-selectin on the platelet surface was assessed by cytometry. RESULTS: Basal levels of NETs in recently diagnosed T2DM patients were higher compared to HD. While TNFα stimulation of control neutrophils resulted in DNA release, patient neutrophils were not responsive. Although glycemia decreased after 6 months of metformin treatment, basal and TNFα and PMA-stimulated NETs reached normal values after 12 months. Compared to controls, nucleosomes, HNE-DNA complexes, IL-6 and TNFα levels were increased in recently diagnosed patients and decreased after 12 months of treatment. P-selectin and vWF levels were similar in both populations. CONCLUSION: Our data suggest that NETs could represent a biomarker for T2DM. Increased NETosis in T2DM patients does not appear to be the consequence of impaired glycemic control but rather due to pro-inflammatory cytokines and is not related to thrombotic events.