Asociación entre Glucemia inestable, tiempo de estancia y mortalidad de pacientes en estado críticos: Estudio de cohorte / Associação Entre Glicemia Instável, Tempo de Permanência e Mortalidade de Pacientes Críticos: Estudo de Coorte / Relationships between unstable Glycemia, Hospital Length Of Stay, and mortality In Critically Ill patients: A cohort study

Resumen Introducción: El control y la evaluación de los niveles glucémicos de pacientes en estado críticos es un desafío y una competencia del equipo de enfermería. Por lo que, determinar las consecuencias de esta durante la hospitalización es clave para evidenciar la importancia del oportuno manejo. Objetivo: Determinar la asociación entre la glucemia inestable (hiperglucemia e hipoglucemia), el resultado de la hospitalización y la duración de la estancia de los pacientes en una unidad de cuidados intensivos. Metodología: Estudio de cohorte prospectivo realizado con 62 pacientes a conveniencia en estado crítico entre marzo y julio de 2017. Se recogieron muestras diarias de sangre para medir la glucemia. Se evaluó la asociación de la glucemia inestable con la duración de la estancia y el resultado de la hospitalización mediante ji al cuadrado de Pearson. El valor de p<0.05 fue considerado significativo. Resultados: De las 62 personas participantes, 50 % eran hombres y 50 % mujeres. La edad media fue de 63.3 años (±21.4 años). La incidencia de glucemia inestable fue del 45.2 % y se asoció con una mayor duración de la estancia en la UCI (p<0.001) y una progresión a la muerte como resultado de la hospitalización (p=0.03). Conclusión: Entre quienes participaron, la glucemia inestable se asoció con una mayor duración de la estancia más prolongada y con progresión hacia la muerte, lo que refuerza la importancia de la actuación de enfermería para prevenir su aparición.

Resumo Introdução: O controle e avaliação dos níveis glicêmicos em pacientes críticos é um desafio e uma competência da equipe de enfermagem. Portanto, determinar as consequências da glicemia instável durante a hospitalização é chave para evidenciar a importância da gestão oportuna. Objetivo: Determinar a associação entre glicemia instável (hiperglicemia e hipoglicemia), os desfechos hospitalares e o tempo de permanência dos pacientes em uma unidade de terapia intensiva. Métodos: Um estudo de coorte prospectivo realizado com 62 pacientes a conveniência em estado crítico entre março e julho de 2017. Foram coletadas amostras diariamente de sangue para medir a glicemia. A associação entre a glicemia instável com o tempo de permanência e o desfecho da hospitalização foi avaliada pelo teste qui-quadrado de Pearson. O valor de p <0,05 foi considerado significativo. Resultados: Das 62 pessoas participantes, 50% eram homens e 50% mulheres. A idade média foi de 63,3 anos (±21,4 anos). A incidência de glicemia instável foi de 45,2% e se associou a um tempo de permanência mais prolongado na UTI (p <0,001) e uma progressão para óbito como desfecho da hospitalização (p = 0,03). Conclusão: Entre os participantes, a glicemia instável se associou a um tempo mais longo de permanência e com progressão para óbito, enfatizando a importância da actuação da equipe de enfermagem para prevenir sua ocorrência.

Abstract Introduction: The control and evaluation of glycemic levels in critically ill patients is a challenge and a responsibility of the nursing team; therefore, determining the consequences of this during hospitalization is key to demonstrate the importance of timely management. Objective: To determine the relationship between unstable glycemia (hyperglycemia and hypoglycemia), hospital length of stay, and the hospitalization outcome of patients in an Intensive Care Unit (ICU). Methods: A prospective cohort study conducted with 62 critically ill patients by convenience sampling between March and July 2017. Daily blood samples were collected to measure glycemia. The correlation of unstable glycemia with the hospital length of stay and the hospitalization outcome was assessed using Pearson's chi-square. A p-value <0.05 was considered significant. Results: Among the 62 patients, 50% were male and 50% were female. The mean age was 63.3 years (±21.4 years). The incidence of unstable glycemia was 45.2% and was associated with a longer ICU stay (p<0.001) and a progression to death as a hospitalization outcome (p=0.03). Conclusion: Among critically ill patients, unstable glycemia was associated with an extended hospital length of stay and a progression to death, emphasizing the importance of nursing intervention to prevent its occurrence.

Análisis retrospectivo de las hipoglucemias inducidas por venlafaxina en pacientes con sobredosis / Retrospective analysis of venlafaxine-induced hypoglycemia in patients with overdose

Introducción: Estudios recientes en intoxicaciones por venlafaxina (VLF) relacionan la presencia de hipoglucemia con la dosis. Nuestro objetivo fue analizar las características clínicas de los pacientes que presentaron hipoglucemia inducida por sobredosis de VLF.Pacientes y métodosEstudio retrospectivo realizado en las Islas Baleares (2020-2023). Como criterios de inclusión se tomaron en cuenta las concentraciones séricas de VLF + ortodesmetilvenlafaxina (O-VLF) > 800 ng/mL. Se compararon las características de los pacientes con y sin hipoglucemia.ResultadosSe incluyeron 21 pacientes, ocho (38,1%) con hipoglucemia. No se hallaron diferencias en las dosis referidas en ambos grupos. Las concentraciones máximas de VLF + O-VLF (ng/mL) fueron 9.783 (4.459-17.976) en sujetos con hipoglucemia y 1.413 (930-1.769) en aquellos sin esta enfermedad (p<0,0001). La presencia de hipoglucemia se asoció con: menor edad y nivel de conciencia; y mayor frecuencia de tentativas suicidas, convulsiones, midriasis, taquicardia y síndrome serotoninérgico, soporte respiratorio invasivo, sueroterapia e ingreso en la Unidad de Cuidados Intensivos (UCI) (p < 0,05).ConclusionesLa detección de hipoglucemia en individuos intoxicados por VLF es un marcador fácilmente disponible para sospechar la gravedad del paciente. En cualquier caso, las concentraciones séricas, cuando se disponen, permiten confirmar la intoxicación. (AU)

Introduction: Recent publications relate the presence of hypoglycemia in venlafaxine (VLX) poisoning depending on the dose. Our aim was to analyze the clinical characteristics of patients who presented hypoglycemia induced by VLF overdose.Patients and methodsRetrospective study carried out in the Balearic Islands (2020–2023). Inclusion criteria: serum concentrations of VLX + O-desmethyl-venlafaxine (O-VLX)>800 ng/mL. The characteristics of patients with and without hypoglycemia were compared.ResultsTwenty-one patients were included, 8 (38.1%) with hypoglycemia. No differences were found in the doses referred to in both groups. Peak concentrations of VLX + O-VLX (ng/mL) were 9,783 [4,459–17,976] in patients with hypoglycemia and 1,413 [930–1,719] in patients without hypoglycemia (p<0.0001). The presence of hypoglycemia was associated with: lower age and level of consciousness; and higher frequency of suicide attempts, seizures, mydriasis, tachycardia and serotonin syndrome, invasive respiratory support, fluid therapy and ICU admission (p<0.05).ConclusionsThe detection of hypoglycemia in a VLX overdose case is a readily available marker to suspect the severity of the patient. In any case, serum concentrations when available allow us to confirm intoxication. (AU)

[Retrospective analysis of venlafaxine-induced hypoglycemia in patients with overdose]. / Análisis retrospectivo de las hipoglucemias inducidas por venlafaxina en pacientes con sobredosis.

INTRODUCTION: Recent publications relate the presence of hypoglycemia in venlafaxine (VLX) poisoning depending on the dose. Our aim was to analyze the clinical characteristics of patients who presented hypoglycemia induced by VLF overdose. PATIENTS AND METHODS: Retrospective study carried out in the Balearic Islands (2020-2023). INCLUSION CRITERIA: serum concentrations of VLX + O-desmethyl-venlafaxine (O-VLX)>800 ng/mL. The characteristics of patients with and without hypoglycemia were compared. RESULTS: Twenty-one patients were included, 8 (38.1%) with hypoglycemia. No differences were found in the doses referred to in both groups. Peak concentrations of VLX + O-VLX (ng/mL) were 9,783 [4,459-17,976] in patients with hypoglycemia and 1,413 [930-1,719] in patients without hypoglycemia (p<0.0001). The presence of hypoglycemia was associated with: lower age and level of consciousness; and higher frequency of suicide attempts, seizures, mydriasis, tachycardia and serotonin syndrome, invasive respiratory support, fluid therapy and ICU admission (p<0.05). CONCLUSIONS: The detection of hypoglycemia in a VLX overdose case is a readily available marker to suspect the severity of the patient. In any case, serum concentrations when available allow us to confirm intoxication.

Impacto del PET/CT en el diagnóstico de insulinoma

Introducción: La tomografía de emisión de positrones es una técnica diagnóstica no invasiva que permite tomar imágenes del organismo que muestra el metabolismo de los órganos del cuerpo. Objetivo: Destacar el valor de la PET/CT en el diagnóstico imagenológico prequirúrgico del enfermo. Presentación de caso: Se presentó un paciente masculino de 39 años sin antecedentes de importancia, con un cuadro de hipoglucemias severas de 5 años de evolución, a pesar de los múltiples estudios imagenológicos se incluyó la ecoendoscopía digestiva, lo que no fue posible evidenciar la lesión tumoral. Se le realiza PET/CT cuyo resultado fue crucial para localizar el tumor, se le dio al paciente la oportunidad de un tratamiento quirúrgico y la demostración anatomopatológica de insulinoma. Conclusiones: Los insulinomas son tumores pancreáticos poco frecuentes que provocan hiperinsulinismo endógeno y son difíciles de visualizar debido a su tamaño por las técnicas de imágenes convencionales, por lo que el PET/CT es un estudio bastante efectivo para localizar la lesión tumoral, y así realizar un procedimiento quirúrgico.

Introduction: Positron emission tomography is a non-invasive diagnostic technique, allowing images of the body to be taken that show the metabolism of the body's organs. Objective: To highlight the value of PET/CT in the pre-surgical imaging diagnosis of the patient. Case presentation: We report the case of a 39-year-old male patient with no significant medical history, but a 5-year history of severe hypoglycemia. Despite multiple imaging studies, digestive ultrasound endoscopy was included, which was not possible to demonstrate the tumor lesion. PET/CT was performed, the result of which was crucial in locating the tumor. The patient was given the opportunity for surgical treatment and the pathological demonstration of insulinoma. Conclusions: Insulinomas are rare pancreatic tumors that cause endogenous hyperinsulinism and are difficult to visualize due to their size using conventional imaging techniques, therefore PET/CT is a fairly effective study to locate the tumor lesion, and thus perform a surgical procedure.

Hipoglicemia hipocetósica por deficiencia de carnitina en un niño

Durante el ayuno, la oxidación de ácidos grasos y la formación de cuerpos cetónicos son necesarios para la producción de energía. La carnitina es esencial para que los ácidos grasos de cadena larga se transfieran a la mitocondria para la oxidación de ácidos grasos. La deficiencia primaria de carnitina es un defecto recesivo que se expresa con un espectro clínico amplio que incluye descompensación metabólica, hipoglicemia hipocetósica o cardiomiopatía en la niñez, fatigabilidad en la adultez o ausencia de síntomas. En nuestro país no hay publicaciones sobre el tema, por lo que en el presente artículo se reporta el caso de un niño que presentó una deficiencia de carnitina expresada como hipoglicemia hipocetósica y se analiza sus hallazgos clínicos, bioquímicos e histopatológicos.

During fasting, the oxidation of fatty acids and the formation of ketone bodies are necessary for energy production. Carnitine is essential for long-chain fatty acids to be transferred to the mitochondria for fatty acid oxidation. Primary carnitine deficiency is a recessive defect that is expressed with a broad clinical spectrum that includes metabolic decompensation, hypoketotic hypoglycemia or cardiomyopathy in childhood, fatiguability in adulthood or absence of symptoms. In our country there are no publications on the subject, so this article reports the case of a child who had carnitine deficiency expressed as hypoketotic hypoglycemia and its clinical, biochemical and histopathological findings are analyzed.

¿Existe correlación metabólica hipoglucémica y el síndrome de Percheron? Reporte de caso

Introducción: El síndrome de Percheron es causa de lesiones isquémicas talamicas bilaterales ocasionando una serie de anomalías clínicas como: alteración del estado de conciencia, oftalmoplejias, y alteraciones de la memoria. Caso clínico: Presentamos el caso de una mujer de 49 años con diabetes mellitus, mal control metabólico, episodios hipoglucémicos e hiperglucemicos repetitivos, quien cursa con sintomatologia inespecífica, se realizan estudios imagenológicos no invasivos documentado lesiones talamica bilaterales. Conclusiones: Los cuadros subagudos e isquémicos parciales que involucran la región paramediana del Talamo bilateral podrían tener alguna relación con episodios hipoglucémicos e hiperglucemicos repetitivos, que pueden llegar a cursar con sintomatología leve e inespecífica, lo cual lo convierte un reto diagnóstico para este síndrome.

Introduction: Percheron syndrome is the cause of bilateral thalamic ischemic lesions, causing a series of clinical abnormalities such as an altered state of consciousness, ophthalmoplegia, and memory alterations. Clinical case: We present the case of 49-year-old woman with diabetes mellitus, poor metabolic control, and repetitive hypoglycemic and hyperglycemic episodes with nonspecific symptoms, non-invasive imaging studies were performed, which documented bilateral thalamic lesions. Conclusions: Subacute and partial ischemic symptoms that involve the paramedian region of the bilateral thalamus could have some relationship with repetitive hypoglycemic and hyperglycemic episodes, and can lead to mild and nonspecific symptoms, which makes it a diagnostic challenge for this syndrome.

Evaluation of plasma cortisol during fasting test in patients with endogenous hyperinsulinemic hypoglycemia. Fifteen years experience.

BACKGROUND: Endogenous hyperinsulinemic hypoglycemia (EHH) is a rare clinical condition. The aim of this study was to evaluate baseline plasma cortisol concentration and its concentration during hypoglycemic crisis in fasting tests (FT) performed in our center. Secondarily, the aim was to establish the relationship between baseline cortisol and the time of evolution of EHH. MATERIAL AND METHODS: A retrospective, observational, descriptive study was carried out which included patients with hypoglycemic disorder with positive FT. RESULTS: Of a total of 21 patients, 16 presented insulinoma, 1 nesidioblastosis, 2 malignant insulinoma and 2 EHH without pathological diagnosis. The time from the onset of symptoms to diagnosis was 2 years (Q1=1.5-Q2=5.5). The comparison between median baseline cortisol (BC)=11.8 mcg/dl (nmol/L 340.68) (Q1=9-Q3=14.1) and median cortisol during hypoglycemic episode (HC)=11.6 mcg/dl (nmol/L: 303.44) (Q1=7.8-Q3=16.1) showed no differences (Z=-0.08; P>.05). When correlating BC with HC, no significant relationship was observed (r=0.16; P>.05). When correlating the glycemic value in the crisis and the HC, a slight negative trend was found (r=-0.53; P=.01). In addition, we found that recurrent hypoglycemic disorder is associated with lower baseline cortisol values ​​the longer the time of its evolution. CONCLUSION: We confirmed that cortisol values ​​remain low during hypoglycemic episodes, reinforcing the hypothesis of lack of response of this counterregulatory hormone in cases of recurrent hypoglycemia.

Biochemical and haematological abnormalities in severe acute organophosphorus poisoning / Anomalías bioquímicas y hematológicas en la intoxicación grave por organofosforados. Estudio prospectivo en un solo centro

Background: Organophosphorus insecticides are considered one of the commonest causes of morbidity and mortality due to poisoning worldwide. Severe organophosphorus poisoning can lead to multiple sometimes lethal metabolic and haematological abnormalities. Methods: A total of 141 OP poisoning patients were admitted during the study period and their blood samples were collected on admission and analysed for the biochemical abnormalities. Results: Out of 141 patients 76 were males (53.9%) and 65 were females (46.1%). Bradycardia with Pulse rate of less than 60 was seen in in 21 patients (14.7). Hypoxemia with oxygen saturation of less than 94% was seen in 32 (22.7%). leucocytosis with TLC o 11000 or more was seen in 19 patients (13.5%).101 patients (83.5%) had low serum choline esterase levels less than 1.5kU/L. Hypokalaemia with K+ of less than 3.5 was seen in 16 patients (9.9%). Five patients died out of 141 (3.5%). Hypoxemia Spo2 of less than 90% was seen in 3 (60%) patients who died and hypoglycaemia with blood glucose of less than 70mg/dl was seen in 2 out of 5 Patients (40%). Conclusions: low choline esterase levels less than 1.5kU/L was the most common abnormality indicating severe poisoning followed by hypoxemia. Both Hypoxemia and low acetylcholine esterase levels are bad prognostic signs and result in high mortality in organophosphorus poisoning. (AU)

Introducción: De entre todos los procesos de intoxicación, el envenenamiento por organofósforados se considera una de las causas más comunes de morbilidad y mortalidad en todo el mundo. La intoxicación grave por organofósforo puede provocar múltiples anomalías metabólicas y hematológicas, a veces letales. Métodos: Un total de 141 pacientes intoxicados por organofósforados fueron ingresados durante el periodo de estudio y sus muestras e sangre fueron recogidas al ingreso y analizadas para detectar las anomalías bioquímicas. Resultados: De los 141 pacientes, 76 eran varones (53,9%) y 65 mujeres (46,1%). Se observó bradicardia con una frecuencia de pulso inferior a 60 en 21 pacientes (14,7). Se observó hipoxemia con una saturación de oxígeno inferior al 94% en 32 (22,7%). Leucocitosis con un recuento total de leucocitos de 11.000 o más en 19 pacientes (13,5%). 101 pacientes (83,5%) tenían niveles bajos de colina esterasa sérica inferiores a 1,5 kU/L. Se observó hipopotasemia con K+ inferior a 3,5 en 16 pacientes (9,9%). Cinco pacientes fallecieron de un total de 141 (3,5%). Se observó hipoxemia Spo2 inferior al 90% en 3 (60%) pacientes que fallecieron e hipoglucemia con glucemia inferior a 70 mg/dl en 2 de 5 pacientes (40%). Conclusiones: Los niveles bajos de colinesterasa inferiores a 1,5 kU/L fueron la anomalía más frecuente que indicaba intoxicación grave, seguida de hipoxemia. La hipoxemia, la hipoglucemia y los niveles bajos de acetilcolinesterasa son signos de mal pronóstico y dan lugar a una elevada mortalidad en la intoxicación por organofosforados. (AU)

Monitorización flash en pacientes con diabetes mellitus tipo 1: adherencia, complicaciones y parámetros clínicos / Flash monitoring in patients with type 1 diabetes mellitus: treatment adherence, complications and clinical parameters

Objetivos: describir el perfil sociodemográfico y clínico de las personas con diabetes mellitus tipo 1 (DM1), así como el uso del dispositivo de monitorización flash Freestyle Libre (FL) en quienes se lo habían costeado por cuenta propia, y analizar las diferencias (parámetros analíticos, complicaciones de la enfermedad y adherencia al tratamiento) frente a pacientes con DM1 que utilizaban los controles glucémicos tradicionales mediante punción capilar.Método: estudio descriptivo transversal en 206 pacientes con DM1 de un área de salud en la región de Castilla-La Mancha. Variables de estudio: tener dispositivo FL por cuenta propia, variables sociodemográficas y clínicas (incluyendo parámetros analíticos) y el cuestionario validado Self Care Inventory Revised (SCI-R). Se realizaron análisis univariante y bivariante, así como un análisis multivariante de regresión logística (variable dependiente: tener el dispositivo FL por cuenta propia).Resultados: el análisis multivariante mostró que no tener el dispositivo FL era más probable en quienes tenían estudios primarios/sin estudios (OR 4,86 (IC95%: 1,03-22,88); Referencia (Ref): estudios secundarios/universitarios), dislipemia (OR 3,18 (IC95% 1,39-7,26); Ref: no dislipemia), 6 o más hipoglucemias/semana (OR 3,21 (IC95%: 1,44-7,16); Ref: menos de 6) y 4 o más punciones/día (OR: 17,56 (IC95%: 6,09-50,64); Ref: menos de 4). Tanto le media de glucosa basal como la HBA1c eran más bajas (p< 0,001) en quienes tenían el dispositivo, así como mejores puntuaciones en el SCI-R (p< 0,001).Conclusión: el uso de los dispositivos de control glucémico permite un mejor manejo de las complicaciones de la DM1: menor número de hiper e hipoglucemias, punciones y mejor adherencia al tratamiento.(AU)

Objectives: to describe the sociodemographic and clinical profile of persons with Type 1 Diabetes Mellitus (T1D), as well as the use of the FreeStyle Libre (FL) flash monitoring device in those who had paid for it out of their own pocket, and to analyse the differences (lab test parameters, disease complications and treatment adherence) vs. T1D patients using traditional glycemic monitoring through finger prick.Method: a descriptive cross-sectional study in 206 patients with T1D from a health area in the Castilla-La Mancha region. Study variables: to have a FL device purchased out of pocket, sociodemographic and clinical variables (including lab test parameters) and the validated Self Care Inventory Revised (SCI-R) questionnaire. Univariate and bivariate analyses were conducted, as well as multivariate logistical regression analysis (dependent variable: to have purchased the FL out of pocket).Results: the multivariate analysis showed that not having the FL device was more likely among those with primary education / no education (OR 4.86 (CI95%: 1.03-22.88); Reference (Ref): secondary / university education, dyslipidemias (OR 3.18 (CI95% 1.39-7.26); Ref: no dyslipidemia, 6 or more hypoglycaemias/ week (OR 3.21 (CI95%: 1.44-7.16); Ref: less than 4, or more finger pricks/day (OR: 17.56 (CI95%: 6.09-50.64); Ref: less than 4. Both the mean baseline glucose and the HBA1c were lower (p< 0.001) among those who had the device, who also had better scores in the SCI-R questionnaire (p< 0.001).Conclusion: the use of the glycemic control devices allows better management of TDI complications: a lower number of hyper and hypoglycaemias and finger pricks, and better treatment adherence.(AU)

Impaired hypoglycaemia awareness in early pregnancy increases risk of severe hypoglycaemia in the mid-long term postpartum irrespective of breastfeeding status in women with type 1 diabetes.

INTRODUCTION: Information regarding the postpartum period in women with type 1 diabetes (T1D) is scarce. We aim to evaluate the relation of impaired hypoglycaemia awareness (IAH) in early pregnancy and breastfeeding status (its presence and duration) with severe postpartum hypoglycaemia (SH). MATERIALS AND METHODS: Retrospective cohort study of women with T1D followed during pregnancy between 2012 and 2019. Data on SH were recorded before and during pregnancy. IAH was evaluated at the first antenatal visit. Data on breastfeeding and the long-term postpartum period were collected by questionnaire and from medical records. RESULTS: A total of 89 women with T1D were included with a median follow-up after pregnancy of 19.2 [8.7-30.5] months. Twenty-eight (32%) women had IAH at the first antenatal visit. At discharge, 74 (83%) started breastfeeding during a median of 8 [4.4-15] months. A total of 18 (22%) women experienced ≥1 SH during postpartum. The incidence of SH significantly increased from pregestational to the gestational and post-partum period (0.09, 0.15 and 0.25 episodes/patient-year, respectively). Postpartum SH rates were comparable in breastfeeding and non-breastfeeding women (21.4% vs. 25%, respectively, p>0.05). Clarke test score at the first antenatal visit was associated with postpartum SH (for each 1-point increase: OR 1.53; 95% CI, 1.06-2.21) adjusted for confounders. No other diabetes and pregnancy-related variables were identified as predictors of SH in this period. CONCLUSIONS: SH are common in the long-term postpartum period independently of breastfeeding. Assessing IAH in early pregnancy could identify those at an increased risk of SH in the postpartum period.

To evaluate the use and clinical effect of intermittently scanned continuous glucose monitoring in adults with type 1 diabetes: Results of a multicentre study.

AIM: To evaluate the use and clinical effect of intermittently scanned continuous glucose monitoring (isCGM) in adults with type 1 diabetes (T1D) in a public health service scenario. METHOD: Cross-sectional retrospective analysis of all patients with T1D and medical indication for isCGM use from a cohort followed since 2010 at Castilla-La Mancha Public Health Service (Spain). Primary outcome was HbA1c change during the first year of follow-up after isCGM initiation. Secondary outcomes included evaluation of self-monitoring of blood glucose (SMBG), isCGM and insulin use, along with glycometric indexes. RESULTS: A total of 945 T1D patients were analyzed. Median age was 49.5 years (IQ range 19.0 years) and T1D duration of 28.9 years (IQ range 14.0 years). The most frequent insulin therapy alternatives were multiple daily injections (85%) followed by insulin pump (11%). Eighty percent of the patients were active isCGM users with a 90% of adherence to the device. Patients showed a mean daily scan frequency of 10.1±6.4scans/day. Daily SMBG reduced by -3.5 test/day [95% CI -3.7, -3.2; P<0.001]. We detected an HbA1c reduction of -0.3% (-4mmol/mol) [95% CI -0.2, -0.4 (-3, -5); P<0.001] at the end of the follow-up. An inverse correlation between HbA1c levels at the end of the follow-up and daily frequency of isCGM scanning (R=-0.34, P<0.001) was observed. Dropout rate was 4%, and 4% of patients were not willing to use isCGM. CONCLUSIONS: Adult patients with T1D improved glycaemic control after isCGM initiation in a public health service scenario. Despite described clinical benefits, a higher than expected percentage of patients were not using isCGM technology. NCT05095610.

Valor pronóstico de la hipoglucemia hospitalaria / Prognostic value of hospital hypoglycemia

Resumen Introducción: La hipoglucemia hospitalaria (HH) es un problema importante ya que se vincula a muerte hospitalaria, estadía prolongada y mayores costos, en personas con y sin diabetes, en área crítica y sala general, sobre todo en los casos de hipoglucemia grave. El objetivo de nuestro trabajo fue comparar la mortalidad hospitalaria, pase a área crítica y tiempo de internación en adultos con HH, según la gravedad de la misma. Métodos: Se realizó un estudio de cohorte retrospectiva en pacientes adultos interna dos con hipoglucemia en el Hospital Italiano de Buenos Aires entre 2013 y 2018. Se definieron tres grupos de hipoglucemia: leve (glucemia entre 70 y 54 mg/dl), grave (glucemia < 54 mg/dl ≥ 40 mg/dl) y crítica (glucemia < 40mg/dl). Resultados: Un total de 5994 pacientes tuvieron HH, la mayoría presentó hipoglucemia leve (72%). La hipoglucemia grave y la crítica, comparadas con la hipoglucemia leve se asociaron a una mayor mortalidad: OR 2.6 (IC95% 2.2-3.1) y 4.2 (IC95% 3.5-5.0) respectivamente; y a mayor internación en áreas de cuidados críticos: OR 1.6 (IC95% 1.4-1.9) y 3.2 (IC95% 2.6-4.0) respectivamente. No hubo diferencias en el tiempo de internación. Discusión: Esta información aporta evidencia en nuestro país, sobre el valor pronóstico de la hipo glucemia, cuya mayor gravedad se asocia a mayor internación en áreas críticas y mayor mortalidad hospitalaria.

Abstract Background: Hospital hypoglycemia (HH) is an important problem since it is linked to hospital death, prolonged stay and higher costs, both in people with and without diabetes, in the critical area and general ward, especially in cases of severe hypoglycemia. The objective of our work was to compare hospital mortality, transfer to the critical area and hospitalization periods in adults with HH according to its severity. Methods: We conducted a retrospective cohort of adults hospitalized with hypoglycemia at the Hospital Italiano de Buenos Aires between 2013 and 2018. Three groups of hypoglycemia were defined: mild (glycemia between 70 and 54 mg/dl), severe (glycemia < 54 mg/dl and ≥ 40 mg/dl) and critical (glycemia<40mg/dl). Results: A total of 5994 patients had HH, the majority presented mild hypoglycemia (72%). Severe and critical hypoglycemia, compared with mild hypo glycemia, were associated with higher mortality: OR 2.6 (95%CI 2.2-3.1) and 4.2 (95%CI 3.5-5.0) respectively; and increased hospitalization in critical care areas: OR 1.6 (95%CI 1.4-1.9) and 3.2 (95%CI 2.6-4.0) respectively. There were no differences in length of stay. Discussion: This information provides, in our country, evidence on the prognostic value of hypoglycemia, whose greater severity is associated with increased hospitalization in critical areas and higher hospital mortality.

Numerical and clinical precision in hypoglycemia of the intermittent FreeStyle Libre glucose monitoring through an NFC-Bluetooth transmitter associated with the xDrip+ algorithm in diabetic patients under insulin therapy.

INTRODUCTION: There are data capture devices that attach to the FreeStyle Libre sensor and convert its communication from NFC (Near-field communication) to Bluetooth technology, generating real-time continuous glucose monitoring. The accuracy of hypoglycemia measurements displayed by smartphone apps using this device has not been established. METHODS: Study of diagnostic tests. Numerical accuracy was evaluated, utilizing the absolute difference with respect to capillary glucometry (ISO 15197:2015 standard) and clinical accuracy, using the Clarke and Parkes (Consensus) error grids, for glucose measurements less than 70mg/dL performed with the FreeStyle Libre system and with the digital estimation xDrip+ app, in diabetic patients managed with insulin therapy. RESULTS: Twenty-seven patients were included (TIR 73.4%, TBR70 5.6%), who contributed 83 hypoglycemic events. Numerical accuracy was adequate in similar proportions with the FreeStyle Libre system compared to the xDrip+ app (81.92% vs. 68.67%, p=0.0630). The clinical accuracy evaluation showed that 92.8% of the measurements for xDrip+ and 98.8% for FreeStyle libre met the criteria according to the Parkes (Consensus) grid (p=0.0535); and 79.5% and 91.6% of the measurements met the criteria according to the Clarke grid (p=0.0273), being higher with FreeStyle libre. CONCLUSIONS: The use of the NFC-Bluetooth transmitter (Miao-Miao) associated with the xDrip+ app does not improve numerical or clinical accuracy for detecting hypoglycemic events in diabetic patients managed with insulin therapy, compared to the FreeStyle Libre device.

[Factors associated with dissatisfaction with pharmacological treatment in patients with type 2 diabetes mellitus: A cross-sectional study]. / Factores asociados a la insatisfacción con el tratamiento farmacológico en pacientes con diabetes mellitus tipo 2: estudio transversal.

BACKGROUND AND OBJECTIVES: Diabetes is a chronic disease with a high impact on both health and Quality of Life Related to Health (QLRH). To evaluate the satisfaction of treatment in patients with type 2 diabetes mellitus through the Diabetes Treatment Satisfaction Questionnaire (DTSQ) and its relationship with sociodemographic variables, with antidiabetic medication and clinical-analytical variables. MATERIALS AND METHODS: This cross-sectional study was conducted in General University Hospital of San Juan de Alicante between September 2016 and December 2017. Two hundred thirty-two patients diagnosed with type 2 diabetes mellitus at least 1 year before inclusion, treated with antidiabetic medication were included. The Spanish version of the DTSQ scale was used to measure satisfaction with treatment. Factors associated with low satisfaction were analyzed by applying the Chi-square test for qualitative variables and Student-T for quantitative variables. To estimate magnitudes of association, logistic models were adjusted. RESULTS: Two hundred thirty-two patients were included in this study. 21.5% of the patients presented low satisfaction with the treatment. Patients who presented low satisfaction with treatment were associated with medications that could cause hypoglycemia (OR: 2.872 [1.195-6.903]), HbA1c levels higher than 7% (OR: 2.260 [1.005-5.083]) and drugs administered by the route oral (OR: 2.749 [1.233-6.131]). CONCLUSIONS: Patients with type 2 diabetes mellitus who had a lower score on the DTSQ questionnaire were associated with medications that produced hypoglycaemia, and with higher levels of HbA1c higher than 7%, and those who took oral medication.

Uso de inhibidores de sglt 2 en pacientes con nefropatía diabética / Use of SGLT-2 inhibitors in patients with diabetic nephropathy

El tratamiento antidiabético oral ha sido un reto en el manejo de la diabetes mellitus. Los pacientes con algún grado de enfermedad renal crónica corren serios riesgos de hipoglucemia, sin embargo, los inhibidores del transportador de glucosa SGLT2 suponen un nuevo abordaje terapéutico de la diabetes mellitus tipo 2. Estudios en modelos experimentales de diabetes han demostrado que la inducción de glucosuria revierte la glucotoxicidad, restaura la normoglucemia, y mejora el funcionamiento de la célula beta y la sensibilidad a la insulina. Por lo tanto, se constituyen en una alternativa segura en estos pacientes.

Oral antidiabetic treatment has been a challenge in the management of diabetes mellitus in patients with some degree of chronic kidney disease due to the constant risks of hypoglycemia; however, glucose transporter SGLT2 inhibitors represent a new therapeutic approach to diabetes mellitus. Type 2, studies in experimental models of diabetes have shown thatthe induction of glycosuria reverses glucotoxicity, restores normoglycemia, and improves beta cell function and insulin sensitivity.

Frecuencia y factores de riesgo para la hipoglucemia neonatal en un hospital regional, 2021

Introducción: La hipoglucemia que es la reducción en la concentración de glucosa de la sangre en circulación, es un trastorno metabólico común en el recién nacido (RN), sobre todo en aquellos que tienen factores predisponentes como bajo peso al nacer, grande para la edad gestacional, pretérmino, dificultad respiratoria, sepsis, diabetes e hipertensión materna y otros menos frecuentes. Objetivos: analizar la frecuencia de la hipoglucemia y su relación con los factores de riesgo en Recién Nacidos (RN), del Hospital Regional de Encarnación en el año 2021. Metodología: estudio observacional, descriptivo de corte trasversal con componente analítico, en niños del alojamiento conjunto del Servicio de Neonatología del Hospital Regional de Encarnación, de abril a junio del 2021. Fueron incluidos aquellos en los que, por presentar algún factor de riesgo se determinó el nivel de glucosa en sangre capilar con tira reactiva y glucómetro. Resultados: los RN nacieron por cesárea en el 70%, control prenatal insuficiente en el 8,2% sexo masculino el 57%, pretérmino 25%, Apgar bajo 1,18%, dificultad respiratoria 11%, bajo peso al nacer 17%, grande para la edad gestacional 35% Las madres presentaron diabetes gestacional en el 22% e hipertensión materna en el 12%. Los factores de riesgo de riesgo se presentaron en 21,8% e incidencia de hipoglucemia en 4,1%. Conclusión: En los 774 niños que nacieron en ese periodo, la frecuencia de hipoglucemia fue menor a la citada en la literatura. El análisis se realizó mediante las pruebas estadísticas de Fischer y los factores de riesgo relacionados en forma estadísticamente significativa (p=0.05), fueron el control prenatal insuficiente, hipertensión materna, diabetes gestacional, prematuridad y los pequeños para la edad gestacional.

Introduction: Hypoglycemia, which is the reduction in the concentration of glucose in the circulating blood, is a common metabolic disorder in the newborn (NB), especially in those who have predisposing factors such as low birth weight, large for age gestational, preterm, respiratory distress, sepsis, maternal diabetes and hypertension and other less frequent risk factors. Objectives: to analyze the frequency of hypoglycemia and its relationship with risk factors in Newborns (NBs) at the Encarnación Regional Hospital in the year 2021. Methodology: this was an observational, descriptive cross-sectional study with an analytical component, in children admitted to the rooming-in section of the Neonatology Service of the Encarnación Regional Hospital, from April to June 2021. We included infants who, due to presenting some risk factor, had their capillary glucose level measured with a test strip and a glucometer. Results: 70% of newborns were born by cesarean section, 57% were males 8.2% had insufficient prenatal care, 25% were preterm, low Apgar scores were present in 1.18%, respiratory distress in 11%, low birth weight in 17%, large for gestational age in 35%. Maternal gestational diabetes was present in 22% and maternal hypertension in 12%. Risk factors were present in 21.8% and the incidence of hypoglycemia was 4.1%. Conclusion: In the 774 children who were born during this period, the frequency of hypoglycemia was lower than that cited in the literature. The analysis was carried out using Fischer's statistical tests and the related risk factors in a statistically significant way (p=0.05) were insufficient prenatal control, maternal hypertension, gestational diabetes, prematurity and small for gestational age.

Manejo anestésico en hipoglucemia hiperinsulinémica del recién nacido / Anesthetic management of hyperinsulinemic hypoglycemia in the newborn

Resumen: La hipoglucemia hiperinsulinémica del recién nacido es una enfermedad hereditaria que cursa con alteraciones en las células pancreáticas; la incidencia estimada es de 1/50,000 nacidos vivos aumentando en casos de consanguinidad. Patología considerada como causa principal de hipoglucemias en este grupo etario con alto riesgo de daño cerebral y retraso mental que impacta significativamente en el neurodesarrollo. La euglucemia y la prevención de lesión cerebral por neuroglucopenia son los principales objetivos del tratamiento médico. Durante el transanestésico de una pancreatectomía, los niveles de glucosa son de utilidad como marcadores; el objetivo del abordaje perioperatorio es mantener estabilidad hemodinámica y euglucemia a través de un adecuado manejo de líquidos. Se presenta el caso de paciente femenino de dos meses de edad con diagnóstico de hipoglucemia hiperinsulinémica con hipoglucemias severas asociadas a crisis convulsivas, ingresa a quirófano para pancreatectomía subtotal.

Abstract: Hyperinsulinemic hypoglycemia of the newborn is a hereditary disease that presents with alterations in pancreatic cells; the estimated incidence is 1/50,000 newly borns increasing in cases of consanguinity. Pathology considered as the main cause of hypoglycemia in this age group with a high risk of brain damage and mental retardation, significantly impacting neurodevelopment. Euglycemia and the prevention of brain injury from neuroglucopenia are the main objectives of medical treatment. During the transanesthetic of a pancreatectomy, the glucose levels are useful as markers; the objective of the perioperative management is to keep hemodynamic stability and euglycemia through proper fluid handling. In this case report we present a two-month-old female patient with a diagnosis of hyperinsulinemic hypoglycemia with severe hypoglycemia associated with seizures that enters the operating room for subtotal pancreatectomy.

Impact on variables of severe hypoglycaemia and healthcare costs of the use of the FreeStyle system in paediatric population with type 1 diabetes mellitus.

INTRODUCTION: Analysis of the impact on severe hypoglycaemia and direct costs of the introduction of the FreeStyle Libre sensor in paediatric population with type 1 Diabetes Mellitus. MATERIAL AND METHODS: Ambispective single-centre study to assess the impact on severe hypoglycaemia and direct costs, focusing on consumption of materials, in paediatric population with type 1 Diabetes Mellitus before and after introduction of the FreeStyle Libre 1 sensor. RESULTS: A significant decrease was found in episodes of severe hypoglycaemia, with 4.2 episodes of severe hypoglycaemia per 100 patients under follow-up versus 0.25 episodes per 100 patients a year after introduction of the system. This represents a cost difference for severe hypoglycaemia, estimated at €6559.52 before introduction and €409.97 after introduction of the FreeStyle Libre sensor. We found a decrease in the daily consumption of capillary blood glucose strips, which translates as a decrease in the cost of materials and helps mitigate the cost of the sensor. The cost in materials for the patient with FreeStyle Libre was €185.13 per patient and year higher than conventional control with capillary blood glucose strips.

Bauhinia spp. (pata-de-vaca) and its biological potentialities ­ literature review / Bauhinia spp. (pata-de-vaca) e suas potencialidades biológicas ­ revisão da literatura / Bauhinia spp. (pata-de-vaca) y sus potencialidades biológicas - revisión de la literatura

The genus Bauhinia popularly known as "pata-de-vaca", "unha de vaca", "unha de boi", "unha de anta" e "casco de vaca" is widely used in the form of teas and other herbal preparations. The aim of this literature review was to show the diversity and biological potential of Bauhinia species for health promotion. A search was carried out for articles listing some species of medical interest. The pharmacological activities of B. forficata were also highlighted in articles published in the last twenty years using the PubMed database. Research has shown that Bauhinia is used as a hypoglycemic and antidiabetic agent, diuretic, cholesterol reducer, in the treatment of cystitis, intestinal parasites, elephantiasis, tumors and other ailments, including infections and painful processes. In the last eleven years, 86% of the works carried out with B. forficata used the plant collected or acquired in Brazil, predominantly publications from the southern region of the country where almost 60% reported activity on diabetes and its complications and/or antioxidant effect. Despite the literature pointing out the great medicinal potential of Bauhinia in chronic diseases and their complications, there is still a need for more translational research.

O gênero Bauhinia conhecido popularmente como "pata-de-vaca", "unha de vaca", "unha de boi", "unha de anta" e "casco de vaca" é amplamente utilizado em forma de chás e outras preparações fitoterápicas. O objetivo desta revisão de literatura foi mostrar a diversidade e potencial biológico das espécies de Bauhinia para a promoção a saúde. Foi realizada a busca de artigos elencando algumas espécies de interesse médico. Destacou-se também as atividades farmacológicas de B. forficata em artigos publicados nos últimos vinte anos utilizando a base de dados PubMed. A pesquisa mostrou que a Bauhinia é utilizada como hipoglicemiante e antidiabética, diurética, redutora de colesterol, no tratamento da cistite, parasitoses intestinais, elefantíase, tumores e outros males, incluindo infecções e processos dolorosos. Nos últimos onze anos, 86% dos trabalhos realizados com B. forficata utilizaram a planta coletada ou adquirida no Brasil sendo predominante publicações oriundas da região sul do país onde quase 60% relataram atividade sobre o diabetes e suas complicações e/ou efeito antioxidante. Apesar da literatura apontar o grande potencial medicinal da Bauhinia em doenças crônicas e suas complicações ainda há a necessidade de mais pesquisas de caráter translacional.

El género Bauhinia, conocido popularmente como "garra de vaca", "garra de ganado", "garra de tapir" y "pezuña de vaca", se utiliza ampliamente como té y otros preparados fitoterapéuticos. El objetivo de esta revisión bibliográfica era mostrar la diversidad y el potencial biológico de las especies de Bauhinia para la promoción de la salud. Se llevó a cabo una búsqueda de artículos que incluyeran algunas especies de interés médico. Las actividades farmacológicas de B. forficata también fueron destacadas en artículos publicados en los últimos veinte años utilizando la base de datos PubMed. La investigación demostró que la Bauhinia se utiliza como hipoglucemiante y antidiabético, diurético, reductor del colesterol, en el tratamiento de la cistitis, la parasitosis intestinal, la elefantiasis, los tumores y otras dolencias, incluyendo infecciones y procesos dolorosos. En los últimos once años, el 86% de los estudios realizados con B. forficata utilizaron la planta recolectada o adquirida en Brasil, siendo predominantes las publicaciones de la región sur del país, donde casi el 60% reportó actividad sobre la diabetes y sus complicaciones y/o efecto antioxidante. Aunque la bibliografía señala el gran potencial medicinal de la Bauhinia en las enfermedades crónicas y sus complicaciones, todavía es necesario realizar más investigaciones traslacionales.

Estrategias para mitigar hipoglucemias y variabilidad glucémica / Strategies to mitigate hypoglycemia and glycemic variability

La última década se ha destacado por los importantes avances en el desarrollo de nuevas tecnologías para pacientes que viven con diabetes mellitus (DM). Las innovaciones han estado orientadas principalmente a: mejorar la calidad de vida, reducir el impacto que genera la ocurrencia de hipoglucemias y reducir la carga de la enfermedad colaborando en la toma diaria de decisiones1. El monitoreo continuo de glucosa (MCG) es una herramienta que ha experimentado un importante avance al aportar información dinámica del estado metabólico en los pacientes y permitir la toma de decisiones, demostrado por un control metabólico estable, menores excursiones glucémicas, y una reducción significativa en la aparición y gravedad de las hipoglucemias2-5. Las presentes recomendaciones tienen como objetivo brindar herramientas rápidas para la interpretación de datos metabólicos y la consiguiente toma de decisiones terapéuticas. A tal fin se realizó una exhaustiva revisión de las principales guías y recomendaciones vigentes; posteriormente, el Grupo de Trabajo adaptó esa información según una serie de preguntas con criterio clínico práctico. El avance de los MCG es innegable, no solo en el desarrollo tecnológico, sino que se han convertido en una herramienta educativa para las personas con DM, su entorno y el equipo de salud al posibilitar un ajuste dinámico del tratamiento, prevenir complicaciones agudas y mejorar la calidad de vida. En esta ecuación enfatizamos la importancia de la educación diabetológica continua de la persona con DM y su entorno, participando activamente en la toma de decisiones para, de esta manera, cumplir con los objetivos propuestos: mejorar la calidad de vida, reducir la carga de la enfermedad y disminuir las excursiones glucémicas agudas.

The last decade has been highlighted by important advances in the development of new technologies for patients living with diabetes. The innovations have been oriented above all to improve the quality of life, reduce the impact generated by the occurrence of hypoglycemia and reduce the burden of the disease by collaborating in daily decision-making1. Continuous glucose monitoring (CGM) is a tool that has undergone significant progress, providing dynamic information on the metabolic status of patients, allowing decision making, demonstrated by stable metabolic control, lower glycemic excursions and a significant reduction in the occurrence and severity of hypoglycemia2-5. The purpose of these recommendations, developed by members of the Innovation Committee of the Argentine Society of Diabetes, is to provide rapid tools for the interpretation of metabolic data and the subsequent therapeutic decisionmaking. To this end, an exhaustive review of the main current guidelines and recommendations has been carried out, later the working group adapted this information according to a series of questions with practical clinical criteria. The progress of CGMs is undeniable, not only in technological development, but it has become an educational tool for people with diabetes, their environment, and the health team, offering the possibility of a dynamic adjustment of treatment, prevention of acute complications and improving quality of life. In this equation, we emphasize the importance of continuous diabetes education for the person with diabetes and their environment, actively participating in decision-making, and in this way, meeting the proposed objectives: improving quality of life, reducing the burden of disease, and decreasing acute glycemic excursions.