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1.
Nutr Metab Cardiovasc Dis ; 31(6): 1845-1850, 2021 06 07.
Artículo en Inglés | MEDLINE | ID: mdl-33838993

RESUMEN

BACKGROUND AND AIMS: Several treatment modalities are available for type 1 diabetes (T1D), including continuous glucose monitoring (CGM) and flash glucose monitoring (FGM) with MDI, sensor-augmented pumps with predictive low-glucose suspend function (SAP-PLGS) and hybrid closed-loop systems (HCL). The aim of the study was to evaluate the real-world benefits obtained with these treatment modalities. METHODS AND RESULTS: A cross-sectional study was performed, selecting 4 groups of T1D subjects, regarding their treatment modalities, paired by age, sex and diabetes duration. A comparison was performed, concerning time in different glucose ranges in 2-week sensor downloads. Estimated HbA1c, glycaemic variability measures and sensor use were also compared. 302 T1D people were included (age: 39 ± 12 years, 47% male, diabetes duration: 21 ± 10 years, estimated HbA1c: 7.28 ± 0.84% (56 ± 9 mmol/mol), baseline HbA1c: 7.4 ± 1.0% (57 ± 11 mmol/mol), length of use of the device 8 [3-21] months). Group 1 (CGM + MDI) and 2 (FGM + MDI) showed no differences in time in different glucose ranges. Group 4 (HCL) showed a higher time 70-180 mg/dl and a lower time in hypoglycaemia than group 3 (SAP-PLGS). Group 1 and 2 showed lower time 70-180 mg/dl, higher time in hyperglycaemia and higher glycaemic variability measures than group 3. Group 4 was superior to groups 1 and 2 in all the outcomes. CONCLUSION: Real-life achievements in glycaemic control and glycaemic variability are described. HCL offer the maximum benefit in terms of time in range and hypoglycaemia protection, compared to CGM + MDI, FGM + MDI and SAP-PLGS.


Asunto(s)
Automonitorización de la Glucosa Sanguínea/instrumentación , Glucemia/efectos de los fármacos , Diabetes Mellitus Tipo 1/tratamiento farmacológico , Control Glucémico/instrumentación , Hipoglucemiantes/uso terapéutico , Sistemas de Infusión de Insulina , Insulina/uso terapéutico , Adulto , Biomarcadores/sangre , Glucemia/metabolismo , Automonitorización de la Glucosa Sanguínea/efectos adversos , Estudios Transversales , Diabetes Mellitus Tipo 1/sangre , Diabetes Mellitus Tipo 1/diagnóstico , Diseño de Equipo , Femenino , Hemoglobina Glucada/metabolismo , Control Glucémico/efectos adversos , Humanos , Hipoglucemiantes/efectos adversos , Insulina/efectos adversos , Masculino , Persona de Mediana Edad , Valor Predictivo de las Pruebas , Resultado del Tratamiento
2.
Endocr Res ; 39(2): 86-90, 2014.
Artículo en Inglés | MEDLINE | ID: mdl-24152206

RESUMEN

INTRODUCTION: The long-term prognosis of type 1 diabetes (T1DM) was evaluated in relation to the clinical characteristics at the time of diabetes onset. PATIENTS AND METHODS: We examined retrospectively the clinical and laboratory characteristics present at the time of diagnosis in 301 adult patients (187 men) consecutively admitted to hospital with T1DM onset and evaluated the clinical outcome of T1DM during 6 ± 4.8 years following diagnosis. RESULTS: Women needed a greater insulin dose per kg of body weight over the first 2 years following diagnosis. Younger patients at diagnosis had greater insulin requirements during follow-up. Patients with at least one positive pancreatic antibody needed a greater insulin dose 2 years after diagnosis and developed poorer glycemic control during follow-up than patients with no detectable pancreatic antibodies at onset. Diabetic ketoacidosis at onset was associated with greater insulin requirements over the first 2 years of follow-up and with poorer glycemic control during the course of the illness. C-peptide levels at diagnosis correlated with insulin requirements during the first 2 years of follow-up. Patients with higher HbA1c levels at diagnosis had greater insulin requirements in the first year of follow-up. A correlation was found between the HbA1c levels at the consecutive years of follow-up. CONCLUSIONS: Female sex, younger age, humoral pancreatic autoimmunity, diabetic ketoacidosis, lower pancreatic reserve and higher HbA1c levels at onset could predict a poor long-term clinical outcome of T1DM in terms of insulin requirements and glycemic control.


Asunto(s)
Diabetes Mellitus Tipo 1/tratamiento farmacológico , Diabetes Mellitus Tipo 1/metabolismo , Hiperglucemia/tratamiento farmacológico , Hiperglucemia/metabolismo , Insulina/administración & dosificación , Adolescente , Adulto , Factores de Edad , Glucemia/efectos de los fármacos , Glucemia/metabolismo , Niño , Cetoacidosis Diabética/tratamiento farmacológico , Cetoacidosis Diabética/metabolismo , Relación Dosis-Respuesta a Droga , Femenino , Estudios de Seguimiento , Hemoglobina Glucada/metabolismo , Humanos , Hipoglucemiantes/administración & dosificación , Masculino , Persona de Mediana Edad , Pronóstico , Estudios Retrospectivos , Factores Sexuales , Adulto Joven
3.
Diabetes Care ; 47(2): 216-224, 2024 Feb 01.
Artículo en Inglés | MEDLINE | ID: mdl-37948469

RESUMEN

OBJECTIVE: Advanced hybrid closed-loop systems (AHCL) have been shown to improve glycemic control and patient-reported outcomes in type 1 diabetes. The aim was to analyze the outcomes of two commercially available AHCL in real life. RESEARCH DESIGN AND METHODS: A prospective study was performed, including adolescents and adults with type 1 diabetes, AHCL naïve, from 14 centers, who initiated the use of MM780G with SmartGuard or Tandem t:slimX2 with Control-IQ. Baseline and 3-month evaluations were performed, assessing HbA1c, time in different glycemic ranges, and patient-reported outcomes. The primary outcome was the between-group time in range 70-180 mg/dL difference from beginning to end of follow-up. RESULTS: One hundred fifty participants were included, with 75 initiating each system (age: 39.9 ± 11.4 years [16-72]; 64% female; diabetes duration: 21.6 ± 11.9 years). Time in range increased from 61.53 ± 14.01% to 76.17 ± 9.48% (P < 0.001), with no between-group differences (P = 0.591). HbA1c decreased by 0.56% (95% CI 0.44%, 0.68%) (6 mmol/mol, 95% CI 5, 7) (P < 0.001), from 7.43 ± 1.07% to 6.88 ± 0.60% (58 ± 12 to 52 ± 7 mmol/mol) in the MM780G group, and from 7.14 ± 0.70% to 6.56 ± 0.53% (55 ± 8 to 48 ± 6 mmol/mol) in the Control-IQ group (both P < 0.001 to baseline, P = 0.819 between groups). No superiority of one AHCL over the other regarding fear of hypoglycemia or quality of life was found. Improvement in diabetes-related distress was higher in Control-IQ users (P = 0.012). Sleep quality was improved (PSQI: from 6.94 ± 4.06 to 6.06 ± 4.05, P = 0.004), without differences between systems. Experience with AHCL, evaluated by the INSPIRE measures, exceeded the expectations. CONCLUSIONS: The two AHCL provide significant improvement in glucose control and satisfaction, with no superiority of one AHCL over the other.


Asunto(s)
Diabetes Mellitus Tipo 1 , Adolescente , Adulto , Humanos , Femenino , Persona de Mediana Edad , Masculino , Diabetes Mellitus Tipo 1/tratamiento farmacológico , Glucemia , Hemoglobina Glucada , Estudios Prospectivos , Calidad de Vida , Medición de Resultados Informados por el Paciente , Insulina , Hipoglucemiantes/uso terapéutico , Sistemas de Infusión de Insulina , Automonitorización de la Glucosa Sanguínea
4.
Artículo en Inglés | MEDLINE | ID: mdl-38417014

RESUMEN

Aims: To compare glycemic control and maternal-fetal outcomes of women with type 1 diabetes (T1D) using hybrid closed loop (HCL) versus multiple daily insulin injections (MDI) plus continuous glucose monitoring. Methods: Multicenter prospective cohort study of pregnant women with T1D in Spain. We evaluated HbA1c and time spent within (TIR), below (TBR), and above (TAR) the pregnancy-specific glucose range of 3.5-7.8 mmol/L. Adjusted models were performed for adverse pregnancy outcomes, including baseline maternal characteristics and center. Results: One hundred twelve women were included (HCL n = 59). Women in the HCL group had a longer duration of diabetes and higher rates of prepregnancy care. There was no between-group difference in HbA1c in any trimester. However, in the second trimester, MDI users had a greater decrease in HbA1c (-6.12 ± 9.06 vs. -2.16 ± 7.42 mmol/mol, P = 0.031). No difference in TIR (3.5-7.8 mmol/L) and TAR was observed between HCL and MDI users, but with a higher total insulin dose in the second trimester [+0.13 IU/kg·day)]. HCL therapy was associated with increased maternal weight gain during pregnancy (ßadjusted = 3.20 kg, 95% confidence interval [CI] 0.90-5.50). Regarding neonatal outcomes, newborns of HCL users were more likely to have higher birthweight (ßadjusted = 279.0 g, 95% CI 39.5-518.5) and macrosomia (ORadjusted = 3.18, 95% CI 1.05-9.67) compared to MDI users. These associations disappeared when maternal weight gain or third trimester HbA1c was included in the models. Conclusions: In a real-world setting, HCL users gained more weight during pregnancy and had larger newborns than MDI users, while achieving similar glycemic control in terms of HbA1c and TIR.

5.
J Diabetes Sci Technol ; 16(4): 934-938, 2022 07.
Artículo en Inglés | MEDLINE | ID: mdl-33596681

RESUMEN

BACKGROUND AND AIMS: The use of continuous glucose monitoring (CGM) has become standard practice in people with type 1 diabetes. The evaluation of user satisfaction is crucial. The Glucose Monitoring Experiences questionnaire (GME-Q) includes 23 items with a 5-point Likert scale to produce a total satisfaction score and three subscale scores. The study aimed to translate the GME-Q from English into Spanish and to validate its use in Spanish-speaking CGM users with type 1 diabetes. METHODS: The linguistic translation and validation process of the GME-Q was established. T1D CGM users were asked to complete the produced Spanish version of the GME-Q and interviewed about difficulties or misunderstandings. Total satisfaction, effectiveness, convenience and intrusiveness subscales and internal consistency reliability were computed. RESULTS: Forward and backward translations and cognitive debriefing produced a final version of the GME-Q in Spanish. Ninety-eight subjects with type 1 diabetes were selected (age: 40 ± 12 years, 63% females, Hb1c: 7.2 ± 0.9% (55 ± 10 mmol/l), pump users: 78%, CGM use: 3.7 ± 2.6 years). The completion rate was 99% and the Cronbach's alpha coefficient was 0.8. The total satisfaction score was 3.9 ± 0.4 (effectiveness: 4.1 ± 0.6, convenience: 3.8 ± 0.6, intrusiveness: 2.2 ± 0.7). CONCLUSION: The GME-Q was translated into Spanish and validated for Spanish-speaking CGM users with type 1 diabetes.


Asunto(s)
Automonitorización de la Glucosa Sanguínea , Diabetes Mellitus Tipo 1 , Adulto , Glucemia , Automonitorización de la Glucosa Sanguínea/psicología , Diabetes Mellitus Tipo 1/psicología , Femenino , Humanos , Lingüística , Masculino , Persona de Mediana Edad , Reproducibilidad de los Resultados , Encuestas y Cuestionarios
6.
Diabetes Res Clin Pract ; 191: 110052, 2022 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-36030902

RESUMEN

BACKGROUND: The long-term benefit provided by advanced hybrid closed-loop (AHCL) systems needs to be assessed in general populations and specific subpopulations. METHODS: A prospective evaluation of subjects initiating the AHCL system 780G was performed. Time in range (70-180 mg/dl) (TIR), <70 mg/dl, <54 mg/dl, >180 mg/dl and >250 mg/dl were compared, at baseline and after one year, in different subpopulations, according to previous treatment (pump vs MDI), age (> or ≤25 years old) and hypoglycaemia risk at baseline. RESULTS: 135 subjects were included (age: 35 ± 15 years, 64 % females, diabetes duration: 21 ± 12 years). An increase in TIR was found, from 67.26 ± 11.80 % at baseline to 77.41 ± 8.85 % after one year (p < 0.001). All the subgroups showed a significant improvement in TIR, time > 180 mg/dl and >250 mg/dl. At the 1-year evaluation, no significant differences were found, between previous pump users and MDI subjects. Children and young adults had a lower time < 70 mg/dl than adults. Subjects with a high risk of hypoglycaemia at baseline had a higher time spent at <70 mg/dl and <54 mg/dl than low-risk individuals. CONCLUSION: The initial benefit provided by the AHCL system is sustained in the long term. MDI subjects obtain the same outcomes as subjects with pump experience.


Asunto(s)
Diabetes Mellitus Tipo 1 , Hipoglucemia , Adulto , Glucemia , Automonitorización de la Glucosa Sanguínea , Niño , Diabetes Mellitus Tipo 1/tratamiento farmacológico , Femenino , Humanos , Hipoglucemia/prevención & control , Hipoglucemiantes/uso terapéutico , Insulina/uso terapéutico , Sistemas de Infusión de Insulina , Masculino , Persona de Mediana Edad , Riesgo , Adulto Joven
7.
Diabetes Technol Ther ; 24(12): 898-906, 2022 12.
Artículo en Inglés | MEDLINE | ID: mdl-35947087

RESUMEN

Aim: To analyze the clinical effect of continuous subcutaneous insulin infusion (CSII) in type 1 diabetes mellitus (T1D) patients in the Spanish real-world scenario. Methods: All T1D patients on CSII registered in the SPAnish Insulin Pump (SPAIP) registry were included. The primary efficacy outcome was change in HbA1c during follow-up. Secondary efficacy outcomes included: insulin pump indications, diabetes complication rates, insulin and pump use, and continuous glucose monitoring (CGM) glycometrics. Patient data were typed through the web-based SPAIP registry. Results: Data from 2979 T1D patients treated with CSII were analyzed. The median age was 44 years (interquartile range [IQR] 34-52 years), and T1D duration was 27 years (IQR 18-35 years). The median duration of CSII therapy was 6 years (IQR 3-10 years). The main indications for treatment were suboptimal glycemic control (33.8%), hypoglycemia (22.1%), and increased glycemic variability (18.8%). Glycated hemoglobin decreased by 6 mmol/mol (95% CI, -5 to -6 mmol/mol, P < 0.001) [-0.5%, 95% CI, -0.4 to -0.5, P < 0.001] during the follow-up. The percentage of patients with severe hypoglycemia decreased from 14.9% to 0.9% (P < 0.001). We observed an inverse correlation between final HbA1c levels and CGM adherence (R = -0.24, P < 0.001) or percentage of time with active hybrid closed-loop functions (R = -0.25, P < 0.001). Conclusions: CSII treatment was associated with a sustained improvement in glycemic control in the Spanish population. This benefit was greater among patients with higher CGM or active hybrid closed-loop functions adherence. The protocol was publicly registered at ClinicalTrials.gov (NCT04761094).


Asunto(s)
Diabetes Mellitus Tipo 1 , Hipoglucemia , Humanos , Adulto , Persona de Mediana Edad , Diabetes Mellitus Tipo 1/tratamiento farmacológico , Automonitorización de la Glucosa Sanguínea , Hemoglobina Glucada/análisis , Hipoglucemiantes , Glucemia , Sistemas de Infusión de Insulina , Insulina , Hipoglucemia/inducido químicamente , Hipoglucemia/epidemiología , Hipoglucemia/prevención & control , Sistema de Registros
8.
Diabetes Res Clin Pract ; 178: 108986, 2021 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-34329691

RESUMEN

AIMS: Automation in diabetes technology is rapidly evolving. The aim was to evaluate the real-world glycemic outcomes and user acceptance after 3 months of using the Medtronic 780G Advanced Hybrid Closed-Loop (AHCL) system. METHODS: A prospective analysis was performed. A glucose target of 100 mg/dl and an active insulin time of 2 h were set. Capillary HbA1c, 2-week of pump and sensor data and several satisfaction questionnaire scores were compared at baseline and after 3 months of using the AHCL system. RESULTS: 52 subjects were selected (age: 43 ±â€¯12 years, sex: 73% female, diabetes duration: 27 ±â€¯11 years, higher education: 31%). Time in range (TIR) 70-180 mg/dl increased from 67.3 ±â€¯13.6% to 80.1 ±â€¯7.5% and time >180 mg/dl and >250 mg/dl were reduced (16.8 ±â€¯8.4 vs 29.4 ±â€¯15.1%, 2.7 ±â€¯3.0% vs 6.9 ±â€¯7.8%, respectively) (all p < 0.001), while time in hypoglycaemia remained below recommended targets. Time in Auto-Mode and sensor use were 94 ±â€¯10% and 90 ±â€¯11%, respectively. Auto-correction boluses represented 29 ±â€¯12% of bolus insulin. Fear of hypoglycaemia, diabetes quality of life, sleep quality and satisfaction with the monitoring system improved after 3 months. CONCLUSION: The real-world use of the AHCL system Medtronic 780G provides an 80.1% TIR 70-180 mg/dl with minimal hypoglycaemia and an increased level of patient satisfaction.


Asunto(s)
Diabetes Mellitus Tipo 1 , Calidad de Vida , Adulto , Glucemia , Diabetes Mellitus Tipo 1/tratamiento farmacológico , Femenino , Humanos , Hipoglucemiantes/uso terapéutico , Insulina/uso terapéutico , Sistemas de Infusión de Insulina , Masculino , Persona de Mediana Edad
9.
Diabetes Technol Ther ; 23(9): 609-615, 2021 09.
Artículo en Inglés | MEDLINE | ID: mdl-33784187

RESUMEN

Background: Advanced hybrid closed-loop (AHCL) systems represent the next step of automation intended to maximize normoglycemia in people with type 1 diabetes (T1D). In the AHCL MiniMed 780G system, different algorithm glucose targets for insulin infusion are available and autocorrection boluses are delivered. The aim was to prospectively evaluate the impact of the implementation of this AHCL system in a clinical setting. Materials and Methods: T1D subjects using a sensor-augmented pump with predictive low-glucose suspend (SAP-PLGS) were upgraded to AHCL. Baseline, every 3 days, 2-week and 1-month sensor and pump data were downloaded. Glucose target was set to 100 mg/dL and active insulin time to 2 h for all the subjects. Time in different glucose ranges was compared. Results: Fifty-two T1D subjects were included (age: 43 ± 12 years, 73% females, diabetes duration: 27 ± 11 years, HbA1c: 7.2% ± 0.9%, time in SAP-PLGS: 5 ± 2 years). Time in range (TIR) 70-180 mg/dL increased from 67.3% ± 13.6% at baseline to 79.6% ± 7.9% at 1 month (P = 0.001). Time in hyperglycemia >180 and >250 mg/dL decreased from 29.4% ± 15.1% to 17.3% ± 8.6% and from 6.9% ± 7.8% to 2.5% ± 2.4%, respectively (P = 0.001). No differences in time in hypoglycemia <70 or <54 mg/dL were found. Time in Auto Mode was 97% ± 4%, and autocorrection insulin was 31% ± 14% of bolus insulin. Four hours postprandial glucose was improved from 162 ± 26 mg/dL at baseline to 142 ± 16 mg/dL at 1 month (P = 0.001). No severe hypoglycemia or diabetic ketoacidosis episodes occurred. Conclusion: AHCL systems allow well-controlled T1D patients to rapidly increase their TIR. The most aggressive settings allow optimal outcomes in TIR, without increasing hypoglycemia frequency.


Asunto(s)
Diabetes Mellitus Tipo 1 , Adolescente , Adulto , Glucemia , Automonitorización de la Glucosa Sanguínea , Diabetes Mellitus Tipo 1/tratamiento farmacológico , Femenino , Humanos , Hipoglucemiantes/uso terapéutico , Insulina/uso terapéutico , Sistemas de Infusión de Insulina , Masculino , Persona de Mediana Edad
10.
Artículo en Inglés | MEDLINE | ID: mdl-32396400

RESUMEN

The Editor of Diabetes Technology & Therapeutics is officially retracting the article entitled, "No Deleterious Effect of Lockdown Due to COVID-19 Pandemic on Glycaemic Control, Measured by Glucose Monitoring, in Adults with Type 1 Diabetes," by Beato-Vibora PI. Diabetes Technol Ther 2020; epub DOI: 10.1089/dia.2020.0184. After the Instant Online publication of the article, the journal editor received correspondence indicating that some portions of the paper may have been plagiarized. An internal investigation was launched into the accusation, and though the charge of plagiarism was not found to be compelling, it was discovered that the author's Institutional Review Board approval statements for the paper were secured after submission and publication of the article, and only after the publisher requested said documentation. The author explained that IRB approval was not secured due to her institution's closure because of the COVID-19 pandemic. Despite these unusual circumstances, it is a clear violation of proper and standard protocols for studies containing human subjects, and therefore the Journal officially retracts the paper. Diabetes Technology & Therapeutics, its editors, and its publisher are committed to upholding the strictest standards of the scientific record and the community it serves and will not tolerate any improprieties or violations of proper scientific publishing conventions.

11.
Diabetes Technol Ther ; 22(12): 912-919, 2020 12.
Artículo en Inglés | MEDLINE | ID: mdl-31855446

RESUMEN

Background: Automatization of insulin delivery by closed-loop systems represents a major step in type 1 diabetes management. The aim of this study was to analyze the effect of the commercialized hybrid closed-loop system, the MiniMed 670G system, on glycemic control, glycemic variability, and patient satisfaction. Methods: A prospective study, including type 1 diabetes patients consecutively starting on the 670G system in one adult and two pediatric hospitals, was performed. Baseline and 3-month visits were documented. Two weeks of data from the system were downloaded. Glycemic variability measures were calculated. Adults and adolescents completed a set of questionnaires (Gold and Clarke scores, Hypoglycemia Fear Survey, Diabetes Quality of Life [DQoL], Diabetes Treatment Satisfaction [DTS], Diabetes Distress Scale, Pittsburgh Sleep Quality Index). Results: Fifty-eight patients were included (age: 28 ± 15 years [7-63], <18 years old: 38% [n = 22], 59% [n = 34] females, previous use of SAP-PLGS [predictive low-glucose suspend]: 60% [n = 35]). HbA1c was reduced from 57 ± 10 to 53 ± 7 mmol/L (7.4% ± 0.9% to 7.0% ± 0.6%) (P < 0.001) and time in range 70-180 mg/dL was increased from 63.0% ± 11.4% to 72.7% ± 8.7% (P < 0.001). In patients with high baseline hypoglycemia risk, time <54 and <70 mg/dL were reduced from 0.9% ± 1.1% to 0.45% ± 0.7% (P = 0.021) and from 3.3% ± 2.8% to 2.1% ± 2.1% (P = 0.019), respectively. Glycemic variability measures improved. Time in auto mode was 85% ± 17%, the number of auto mode exits was 0.6 ± 0.3 per day, and the number of alarms was 8.5 ± 3.7 per day. Fear of hypoglycemia, DQoL, DTS, and diabetes distress improved, while the percentage of patients with poor sleep quality was reduced. The discontinuation rate was 3%. Conclusion: The commercialized hybrid closed-loop system improves glycemic control and glycemic variability in children and adults, reducing the burden of living with type 1 diabetes.


Asunto(s)
Diabetes Mellitus Tipo 1 , Control Glucémico , Sistemas de Infusión de Insulina , Adolescente , Adulto , Glucemia , Automonitorización de la Glucosa Sanguínea , Niño , Diabetes Mellitus Tipo 1/tratamiento farmacológico , Femenino , Humanos , Hipoglucemiantes/uso terapéutico , Insulina/uso terapéutico , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Calidad de Vida , Tecnología , Adulto Joven
12.
Drugs Context ; 8: 212599, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31402931

RESUMEN

Hypoglycaemia is the more frequent complication of insulin therapy and the main barrier to tight glycaemic control. Injectable glucagon and oral intake of carbohydrates are the recommended treatments for severe and non-severe hypoglycaemia episodes, respectively. Nasal glucagon is currently being developed as a ready-to-use device, to simplify severe hypoglycaemia rescue. Stable forms of liquid glucagon could open the field for different approaches for mild to moderate hypoglycaemia treatment, such as mini-doses of glucagon or continuous subcutaneous glucagon infusion as a part of dual-hormone closed-loop systems. Pharmaceutical companies are developing stable forms of native glucagon or glucagon analogues for that purpose.

14.
Diabetes Technol Ther ; 20(11): 738-743, 2018 11.
Artículo en Inglés | MEDLINE | ID: mdl-30256132

RESUMEN

AIMS: The aim was to evaluate the effectiveness of sensor-augmented pump therapy with predictive low-glucose suspend function (SAP-PLGS) in real-world use in children and adults with type 1 diabetes (T1D). METHODS: Patients with T1D treated with the MiniMed 640G® pump with PLGS function at three referral hospitals were retrospectively evaluated. HbA1c at baseline and at 6, 12, 18, and 24 months was analyzed. Two weeks of data from pumps, sensors, and/or glucose meters were downloaded. Patients completed satisfaction questionnaires at the last follow-up visit. RESULTS: A total of 162 patients were included. Mean age was 32 ± 17 years, 28% were (n = 46) children, and 29% (n = 47) were with a history of severe hypoglycemia. Median follow-up was 12 months (6-18). HbA1c was reduced from 55 ± 9 to 54 ± 8 mmol/mol (7.2% ± 0.8% to 7.1% ± 0.7%) at 12 months (P < 0.03, n = 100). In patients with suboptimal control, there was a reduction in HbA1c from 66% ± 7% to 61 ± 10 mmol/mol (8.2% ± 0.6% to 7.7% ± 0.9%) at the end of follow-up (n = 26, P < 0.01). Three percent (n = 5) of the patients experienced severe hypoglycemia during follow-up. A reduction in the percentage of self-monitoring of blood glucose values <70 mg/dL was achieved (10% ± 7% to 6% ± 5%, P = 0.001, n = 144). Time in range 70-180 mg/dL was 67% ± 13% at the end of follow-up and predictors of a higher time in range were identified. The use of sensors was high (86%) and 73% of the patients showed high satisfaction. In patients using sensors at baseline (n = 54), the time spent at <54 and <70 mg/dL was reduced. CONCLUSION: SAP-PLGS reduces hypoglycemia frequency while maintaining glycemic control in adults and children under real-life conditions.


Asunto(s)
Automonitorización de la Glucosa Sanguínea/instrumentación , Glucemia/análisis , Diabetes Mellitus Tipo 1/tratamiento farmacológico , Hipoglucemiantes/administración & dosificación , Sistemas de Infusión de Insulina , Insulina/administración & dosificación , Adolescente , Adulto , Automonitorización de la Glucosa Sanguínea/métodos , Automonitorización de la Glucosa Sanguínea/psicología , Niño , Diabetes Mellitus Tipo 1/sangre , Diabetes Mellitus Tipo 1/complicaciones , Femenino , Humanos , Hipoglucemia/etiología , Hipoglucemia/prevención & control , Sistemas de Infusión de Insulina/psicología , Masculino , Satisfacción del Paciente , Estudios Retrospectivos , Resultado del Tratamiento , Adulto Joven
15.
Diabetes Res Clin Pract ; 137: 56-63, 2018 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-29278712

RESUMEN

AIMS: To assess safety and benefits of continuous subcutaneous insulin infusion (CSII) therapy in a cohort of type 1 diabetes patients in Spain. METHODS: A web-based national registry was created by the Working Group of the Spanish Diabetes Association. All patients on CSII being followed at selected referral centers were included. A cross-sectional analysis was performed. RESULTS: A total of 1275 patients were included. Data completion for patients on CSII was 67 ±â€¯32%. Indications for treatment were suboptimal glycemic control (32%), high glucose variability (24%), preconception care (14%) and hypoglycemia (11%). In the patients on CSII for ≥1 year (n = 843, mean CSII duration of 5 years), HbA1c decreased by 5 mmol/mol (0.5%) in the whole population and by 8 mmol/mol (0.7%) in subjects with suboptimal glycemic control as CSII indication. Percentage of patients achieving HbA1c ≤ 53 mmol/mol (7%) increased from 20% before CSII to 34% at the end of follow-up. Severe hypoglycemia decreased from 29% to 5%. The rate of discontinuation was 9.5%. HbA1c was lower in patients using bolus advisor and temporary basal rates. CONCLUSIONS: CSII was associated with a sustained improvement in glycemic control and a reduction in severe hypoglycemia. The use of advanced CSII settings was related to better glycemic control.


Asunto(s)
Diabetes Mellitus Tipo 1/tratamiento farmacológico , Hipoglucemiantes/uso terapéutico , Sistemas de Infusión de Insulina/estadística & datos numéricos , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Niño , Preescolar , Estudios de Cohortes , Estudios Transversales , Diabetes Mellitus Tipo 1/patología , Femenino , Humanos , Hipoglucemiantes/farmacología , Masculino , Persona de Mediana Edad , España , Encuestas y Cuestionarios , Adulto Joven
16.
Int J Endocrinol Metab ; 15(1): e37792, 2017 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-28835757

RESUMEN

INTRODUCTION: Interfering antibodies are capable of causing potentially misleading results in automated thyroid hormone immunoassays. CASE PRESENTATION: We report the case of a 46- year-old female patient with autoimmune hypothyroidism in chronic replacement treatment with levothyroxine who was presented 8 years after diagnosis with a thyroid function test showing an increased level of TSH and a very high level of FT4. Interference in the laboratory serum free thyroxin (FT4) test was suspected, due to the lack of symptoms of hyperthyroidism and a different immunoassay platform confirmed a low FT4 result. The discrepancy between the two results was explained by the presence of antiT4-autoantibodies. CONCLUSIONS: Antibody interference with serum free thyroxine must be considered when clinical findings and laboratory results show discrepancies.

17.
Nutr Hosp ; 31(4): 1763-70, 2015 Apr 01.
Artículo en Español | MEDLINE | ID: mdl-25795969

RESUMEN

INTRODUCTION AND OBJECTIVES: Living habits, several nutritional aspects and relationship between them were studied of Hospital de Mérida health professional of the Extremadura Health Service (SES). METHODS: Forty-three employed workers participates voluntary in this project by submitting a questionary about personal details and life style, and a seven-days-food-intake-dietary. Finally, their anthropometric data were also measured. RESULTS: Men tend to play more physical activities than women. They also were more sedentary. They use to smoke less than women, but they do drink more. Normal-weight subjects tried to practice sport during more time than overweight and obese ones. However, they also remained sitting for longer periods on a weekly basis. The average daily intakes of kilocalories were higher in men, but protein intakes were higher in women. Fat intake was increased in both sexes. The average daily intake of kilocalories was lower in obese subjects than over and normal-weights ones. An increase in the body mass index was accompanied by a bigger waist perimeter, waist to hip ratio, fat mass and body fat percentage. CONCLUSION: The majority of people interviewed in the survey have healthy living and dietary habits. Protein and fat daily intake is slightly higher than the values recommended by the WHO. Carbohydrates intake, by contrast, is lower.


INTRODUCCIÓN Y OBJETIVOS: Se estudiaron hábitos de vida y diversos aspectos nutricionales y la relación entre ellos en personal sanitario del Hospital de Mérida del Servicio Extremeño de Salud (SES). MÉTODO: Se contó con la participación voluntaria de 43 trabajadores en activo los cuales autorrealizaron un cuestionario de datos personales, estilos de vida y un registro alimentario de siete días. Además se les midieron una serie de datos antropométricos. RESULTADOS: Los hombres practicaban más actividad física, eran más sedentarios, fumaban menos y bebían más alcohol que las mujeres. Los sujetos con normopeso practicaban más horas de actividad física que los sujetos con sobrepeso y que los obesos y paradójicamente los sujetos con normopeso pasaban más horas sentados a la semana que los obesos. La media de kcal/día fue superior en hombres que en mujeres y en estas se observa un aumento significativo en el consumo de proteínas con respecto a los hombres, así mismo, la ingesta de lípidos y colesterol se encontró elevada en ambos casos. La media de kcal/día fue inferior en los sujetos obesos que en los sujetos con normopeso y sobrepeso. El IMC (índice de masa corporal) se acompañó de un aumento del perímetro cintura, de la cadera, de la masa grasa y del % grasa corporal. CONCLUSIÓN: La mayor parte de los sujetos estudiados presenta hábitos de vida y alimentación saludables. La ingesta de proteínas, lípidos y colesterol está ligeramente elevada mientras que la ingesta de hidratos de carbono esta disminuida con respecto a los valores recomendados.


Asunto(s)
Conducta Alimentaria , Personal de Salud/estadística & datos numéricos , Estilo de Vida , Evaluación Nutricional , Adulto , Antropometría , Ingestión de Alimentos , Femenino , Humanos , Masculino , Factores Sexuales , España , Encuestas y Cuestionarios
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