Changes in glomerular filtration rate in patients with body mass index ≥35 kg/m2 treated with metabolic and bariatric surgery versus GLP-1 agonist at 1-year follow-up.

Background: Metabolic and bariatric surgery (MBS) reduces glomerular hyperfiltration. The renoprotective effects of GLP-1 analogs were derived from clinical studies in type 2 diabetes (T2D). The objective of this study was to evaluate the changes in glomerular filtration rate (GFR) over time associated with weight loss in patients with a BMI ≥ 35 kg/m2 treated with liraglutide compared with patients treated with MBS. Methods: A longitudinal study derived from a retrospective cohort of patients with BMI ≥ 35 kg/m2 treated with either MBS or liraglutide 3 mg/day, with follow-up ≥1 year. Clinical variables, baseline GFR, and 1-year GFR were analyzed. A generalized estimating equation (GEE) model was used to compare changes in GFR between both groups while controlling for confounding variables. Results: A total of 159 patients were included in the analysis. Of these, 129 patients underwent MBS (median age 60.5 years [IQR 51.8-66.6], body mass index (BMI) 40.9 kg/m2 [IQR 0.68-0.89]), and 30 patients were treated with liraglutide (median age 56 years [IQR 46-62], BMI 37.4 kg/m2 [IQR 0.69-0.93]). No difference in baseline GFR or at 12 months of follow-up was found between the two interventions. GEE analysis revealed an increase of 0.32 mL/min/1.73 m2 per month of follow-up. Factors associated with a greater increase in GFR were the percentage total weight loss (%TWL) (0.12 mL/min/1.73 m2, p = 0.023) and baseline GFR (0.69 mL/min/1.73 m2, p > 0.001) for both interventions, independent of a history of T2D. Conclusion: In patients with BMI ≥ 35 kg/m2, changes in GFR are related to %TWL and baseline GFR, regardless of the presence of diabetes or the type of intervention used.

Recommendations on the use of the flash continuous glucose monitoring system in hospitalized patients with diabetes in Latin America.

BACKGROUND: Continuous glucose monitoring can improve glycemic control for hospitalized patients with diabetes, according to current evidence. However, there is a lack of consensus-established recommendations for the management of hospitalized patients with diabetes using flash continuous glucose monitoring system (fCGM) in Latin America. Therefore, this expert consensus exercise aimed to establish guidelines on the implementation of fCGM in the management of hospitalized patients with diabetes in Latin America. METHODS: The modified Delphi method was applied on a panel of nine specialists, establishing consensus at 80%. A twenty-two-question instrument was developed to establish recommendations on the use of fCGM in hospitalized patients living with diabetes. RESULTS: Based on consensus, experts recommend the use of fCGM in hospitalized patients with diabetes starting at admission or whenever hyperglycemia (> 180 mg/dl) is confirmed and continue monitoring throughout the entire hospital stay. The recommended frequency of fCGM scans varies depending on the patient's age and diabetes type: ten scans per day for pediatric patients with type 1 and 2 diabetes, adult patients with type 1 diabetes and pregnant patients, and seven scans for adult patients with type 2 diabetes. Different hospital services can benefit from fCGM, including the emergency room, internal medicine departments, intensive care units, surgery rooms, and surgery wards. CONCLUSIONS: The use of fCGM is recommended for patients with diabetes starting at the time of admission in hospitals in Latin America, whenever the necessary resources (devices, education, personnel) are available.

Adherencia al automonitoreo en diabetes tipo 2: plataforma "ClouDi" vs. Educación presencial. / Adherence to self-monitoring in type 2 diabetes: "ClouDi" platform vs. Face-to-face follow-up / Adesão à automonitorização na diabetes tipo 2: plataforma "ClouDi" vs. acompanha-mento presencial

Introducción: El uso de mHealth puede mejorar la adherencia a el automonitoreo con glucometría capilar (GC) en la transición del ámbito hospitalario al ambulatorio. Objetivo: evaluar la adherencia al automonitoreo con GC de los pacientes con Diabetes Tipo 2 (DM2) vinculados a un programa de educación usuarios de mHealth (ClouDi) comparado con el programa de educación y seguimiento presencial usual. Materiales y métodos: Estudio longitudinal prospectivo. Se analizaron pacientes con DM2 valorados por consulta de educación de diabetes con indicación de tratamiento con insulina al egreso hospitalario. Se analizaron dos grupos: uno con seguimiento presencial y otro vinculado a un programa educativo y uso de ClouDi. Resultados: De los 86 pacientes (44% de sexo femenino, 41 usuarios ClouDi, edad promedio 58.8 ± 11.2 años, con una media de duración de la diabetes de 7.8 ± 7.4 años), 53.6% se encontraban en estrato 2, el 92.9% pertenecían al régimen contributivo, el 42.9% con educación básica primaria y 51.2% empleados. Fue considerada la adherencia a la GC al realizar y registrar 3 o más mediciones por día en los pacientes de ClouDi fue mayor comparado con los pacientes en cuidado usual (64.4% vs 28.2%, p <0.001), independiente de las variables sociodemográficas. Conclusión: El uso de ClouDi se asoció a mayor adherencia a automonitoreo con GC comparado con seguimiento presencial independiente de variables sociodemográficas. El uso de esta tecnología podría ser útil en el seguimiento de pacientes usuarios de insulina al egreso hospitalario

Introduction: The use of mHealth can improve adherence to self-monitoring blood Glucose (SMBG) in the transition from hospital to outpatient setting. Objective: To evaluate adherence to self-monitoring with GC in patients with type 2 diabetes (T2DM) linked to an mHealth user education program (ClouDi) compared with the usual face-to-face education and follow-up program. Materials and Methods: Prospective longitudinal study. Patients with T2D assessed by diabetes education counseling with an indication for insulin treatment at hospital discharge were analyzed. Two groups were analyzed: one with face-to-face follow-up and another linked to an educational program and use of ClouDi. Results: Of the 86 patients (44% female, 41 ClouDi users, mean age 58.8 ± 11.2 years, with a mean duration of diabetes of 7.8 ± 7.4 years), 53.6% were in stratum 2, 92.9% belonged to the contributory system, 42.9% with basic pri-mary education and 51.2% were employed. Compliance with the SMBG was considered if 3 or more measurements per day were taken and recorded, was higher in ClouDi patients com-pared to usual care patients (64.4% vs. 28.2%, p <0.001), independent of sociodemographic variables.Conclusions: The use of ClouDi was associated with greater adherence to SMBG compared to in-person follow-up, independent of sociodemographic variables. The use of this technology may be useful in monitoring insulin-using patients after hospital discharge

Introdução: A utilização do mHealth pode melhorar a adesão à automonitorização com glico-metria capilar (GC) na transição do hospital para o ambulatório. Objetivo: avaliar a adesão ao automonitoramento com GC de pacientes com Diabetes Tipo 2 (DM2) vinculados a um progra-ma de educação de usuários de mHealth (ClouDi) em comparação com o programa habitual de educação e acompanhamento presencial. Materiais e métodos: Estudo prospectivo longitudi-nal. Foram analisados pacientes com DM2 avaliados por consulta de educação em diabetes com indicação de tratamento insulínico na alta hospitalar. Foram analisados dois grupos: um com acompanhamento presencial e outro vinculado a um programa educativo e uso do ClouDi. Re-sultados: Dos 86 doentes (44% do sexo feminino, 41 utilizadores do ClouDi, idade média 58,8 ± 11,2 anos, com duração média da diabetes de 7,8 ± 7,4 anos), 53,6% encontravam-se no estra-to 2, 92,9% pertenciam ao regime contributivo, 42,9% com ensino fundamental básico e 51,2% empregados. A adesão ao GC foi considerada quando realizada e registrada 3 ou mais medidas por dia em pacientes ClouDi foi maior em comparação aos pacientes em cuidados habituais (64,4% vs 28,2%, p <0,001), independente das variáveis sociodemográficas. Conclusão: O uso do ClouDi esteve associado à maior adesão ao automonitoramento com GC em comparação ao acompanhamento presencial independente das variáveis sociodemográficas. O uso dessa tecnologia pode ser útil no monitoramento de pacientes usuários de insulina na alta hospitalar

Factors associated with different patterns of weight change after bariatric surgery: A longitudinal study.

Background: The mean weight loss (WL) after successful bariatric surgery is approximately one third of the initial body weight, which is mainly achieved between the first 2 years of follow-up. However, 15%-35% of patients do not achieve a significant percentage of total WL (%TWL). Information on factors associated with a higher or lower WL after bariatric surgery is limited. This study aimed to assess the change in %TWL and describe the factors associated with greater or lesser WL over time. Methods: This prospective longitudinal study included patients treated with laparoscopic Roux-en-Y gastric bypass or sleeve gastrectomy. Baseline data were recorded before surgery. Follow-up was performed at 3 (n = 141), 6 (n = 208), 9 (n = 115), 12 (n = 216), 24 (n = 166), and 36 months (n = 99). Generalized estimating equation analysis was performed to assess the changes in %TWL over time and factors associated with different patterns of WL. Results: In total, 231 patients were included (women, 82.2%; basal body mass index (BMI) 41.4 ± 5.1 kg/m2). The tendencies to increase %TWL (32 ± 6.5) were evident in the first year and stabilized thereafter. Sustained nutritionist follow-up (2.3%, p = 0.004), baseline BMI >40 kg/m2 (0.4%, p < 0.001), and WL ≥ 10 kg before surgery (0.3%, p = 0.001) were associated with a higher %TWL. Patients who performed physical activity >30 min/day after surgery reduced their %TWL by 0.6% (p = 0.002). Conclusions: Modifiable factors such as nutritional monitoring and WL before surgery are associated with a significant increase in %TWL over time. Basal BMI was associated with a significant decrease in %TWL.

Validación transcultural del HypoA-Q para medir conciencia de hipoglucemia en pacientes diabéticos / Cross-cultural validation of the HypoA-Q to measure hypoglycemic awareness in diabetic patients / Validação transcultural do HypoA-Q para mensurar consciência de hipoglicemia em pacientes diabéticos

Introducción: La hipoglucemia inadvertida incrementa el riesgo de la hipoglucemia severa en pacientes con diabetes. Una medición objetiva de la misma requiere instrumentos como el HypoA-Q, que, a diferencia de otros, mide conciencia de episodios nocturnos; sin embargo, no se dispone de una versión en español. Objetivo: Traducir y adaptar culturalmente la escala HypoA-Q para la medición de conciencia de la hipoglucemia en pacientes colombianos con Diabetes Mellitus. Metodología: Estudio de Adaptación transcultural del instrumento Hy-poA-Q. Se obtuvo la autorización de la autora para su traducción y adaptación a la población colombiana. Se siguió la metodología de la European Organisation for Research and Treat-ment for Cancer (EORTC). Al respecto, se realizaron dos traducciones directas por hablantes nativos del español, una versión reconciliada, dos traducciones inversas por dos hablantes nativos del inglés y una prueba piloto en 15 pacientes con diagnóstico de diabetes. Resulta-dos: Aunque las traducciones directas al español fueron similares, se hicieron ajustes para obtener una versión reconciliada con palabras más fáciles de comprender cambiando las uni-dades de mmol/L a mg/dl. Las traducciones inversas fueron similares al original en inglés. La prueba piloto, realizada en 15 pacientes, no requirió ajustar ningún ítem, pues la frecuencia de ítems con dificultades de comprensión, confusión o palabras ofensivas fue menor al 15%. Conclusiones: Se dispone de la versión en español para Colombia de la escala HypoA-Q. Se aconseja realizar un estudio de evaluación de sus propiedades psicométricas antes de ser usada en investigaciones o en la práctica clínica

Introdução: a hipoglicemia inadvertida incrementa o risco de hipoglicemia severa em pacientes com diabetes. Uma medição da mesma requer instrumentos como o HypoA-Q, que a diferença de outros, mede consciência de episódios noturnos; entretanto, não se dispõe de uma versão em espanhol. Objetivo: traduzir e adaptar culturalmente a escala HypoA-Q para mensurar a consciência de hipoglicemia em pacientes colombianos com Diabetes Mellitus. Materiais e métodos: estudo de adaptação transcultural do instrumento HypoA-Q. Obteve-se a autorização da autora para a sua tradução e adaptação à população colombiana. Seguiu-se a metodologia da European Organization for Research Treatment for Cancer (EORTC). Realizaram-se duas traduções diretas por falantes nativos de língua espanhola e uma versão conciliada, duas traduções inversas por falantes nativos da língua inglesa e uma prova piloto em 15 pacientes com diagnostico de diabetes. Resultados: Embora as traduções diretas ao espanhol foram semelhantes, foram feitos ajustes para obter uma versão conciliada com palavras mais simples de compreender substituindo as unidades de mmol/L para mg/dl. As traduções inversas foram semelhantes ao instrumento original em inglês. A prova piloto realizada não precisou ajustar nenhum item, devido a que os itens com dificuldade de compreensão, confusão ou palavras ofensivas foi inferior ao 15%. Conclusão: Dispõe-se da versão em espanhol para Colômbia da escala HypoA-Q. Aconselha-se realizar um estudo de avaliação das propriedades psicométricas antes de ser usada em pesquisa ou na prática clinica