Which people with diabetes are treated with a disposable, half-unit insulin pen? A real-world, retrospective, database study in Spain.

INTRODUCTION: Insulin lispro 100 units/mL Jr KwikPen is the first prefilled, disposable, half-unit insulin pen that delivers 0.5-30 units in increments of 0.5 units for the treatment of patients with diabetes. This study describes the profile of patients in Spain who initiated insulin therapy with Jr KwikPen in a real-world setting. METHODS: This retrospective, observational study based on IQVIA's electronic medical records database included patients with Type 1 (T1D) or Type 2 (T2D) diabetes who initiated therapy with Jr KwikPen between May 2018 and December 2020. Sociodemographic, clinical, and treatment characteristics at treatment initiation were analysed descriptively. RESULTS: A total of 416 patients were included. The main characteristics of the T1D/T2D groups (N = 326/90), respectively were as follows: female sex, 61.7%/65.6%; mean age (standard deviation [SD]), 32.5 (20.7)/55.5 (16.6) years; body mass index, 20.9 (4.2)/25.2 (4.6) kg/m2 (N = 239/77); HbA1c, 7.8 (1.7)%/8.0 (1.5)% (N = 141/64); and presence of diabetes-associated comorbidities, 27.9%/64.4%. Only 32.8% of patients with T1D were < 18 years old. Among Jr KwikPen users, 12.3% (T1D/T2D, 7.7%/28.9%) were ≥ 65 years old, 17.1% patients were newly diagnosed, and 3.8% were pregnant women. The mean (SD) total insulin dose pre-index for T1D/T2D was 43.1 (23.6) and 40.7 (21.6) UI/day, respectively. The mean (SD) insulin dose at the start of Jr KwikPen use was 26.63 (16.56) and 22.58 (13.59) UI/day for T1D/T2D, respectively. Jr KwikPen was first prescribed mainly by endocrinologists (58.7%) or paediatricians (22.6%). CONCLUSIONS: The profile of patients who initiated therapy with Jr KwikPen in routine practice was broad with many patients being adults. Most of these patients had T1D, inadequate glycemic control, and multiple associated comorbidities. These results suggest that Jr KwikPen is prescribed in patients who may benefit from finer insulin dose adjustments, namely children, adolescents, adults, older individuals, or pregnant women with T1D or T2D.

The relationship between glycosylated hemoglobin, time-in-range and glycemic variability in type 1 diabetes patients under flash glucose monitoring.

OBJECTIVES: Flash glucose monitoring in patients with type 1 diabetes provides new glucometric data that allow for the assessment of glycemic control beyond HbA1c. The objective of the study was to evaluate the relationship between HbA1c, time-in-range (TIR) and glycemic variability in a cohort of paediatric and adult patients with type 1 diabetes and treatment with flash glucose monitoring. MATERIAL AND METHODS: This was a cross-sectional study in 195 patients with type 1 diabetes (42.6% females, 70 paediatric, 26.2% continuous subcutaneous insulin infusion, 28.7% coefficient of variation [CV]≤36%) in intensive treatment and flash glucose monitoring. Clinical, analytical and glucometric data were evaluated. RESULTS: The relationship between the TIR and HbA1c showed a strong negative linear correlation (R=-0.746; R2=0.557; P<.001), modified in those patients with CV≤36% (R=-0.852; R2=0.836) compared to CV>36% (R=-0.703; R2=0.551). A similar correlation was found when evaluating the TIR and the Glucose Management Indicator (R=-0.846; R2=0.715; P<.001); in patients with CV≤36% (R=-0.980; R2=0.960) versus CV>36% (R=-0.837; R2=0.701); P<.001. Both correlations remained stable in the paediatric population (R=-0.724; R2=0.525; P<.001) and adults (R=-0.706; R2=0.498; P<.001) and by type of treatment: multiple doses of insulin (R=-0.747; R2=0.558; P<.001) and continuous subcutaneous insulin infusion (R=-0.711; R2=0.506; P<.001). In a multiple regression analysis evaluating HbA1c as dependent variable, the only parameters that maintained statistical significance were the TIR (ß=-0,031; P<.001), CV (ß=0.843; P<.05) and TIR-CV interaction (ß=-0.017; P<.01). CONCLUSIONS: The glycemic variability defined by the CV modifies the relationship between the TIR and HbA1c/Glucose Management Indicator and should be taken into account when individualising TIR targets, regardless of age or the type of treatment used.

Tratamiento insulínico, requerimientos de insulina y resultados perinatales en una cohorte de embarazadas con diabetes tipo 1 / Insulin treatment, insulin requirements and perinatal outcomes in a pregnancy cohort with type 1 diabetes

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Diabetes insípida central familiar / Familial central diabetes insipidus

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Relevancia de las nuevas pruebas genéticas en el diagnóstico de la talla baja con dismorfias / Relevance of new genetic tests in the diagnosis of short stature with dysmorphic features

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Síndrome de Turner: análisis de 42 casos / Turner syndrome: Study of 42 cases

Antecedentes y objetivo: El síndrome de Turner (ST) se asocia con talla baja, disgenesia gonadal y monosomía parcial o total del cromosoma X. Pacientes y métodos: Se realizó un estudio de cohortes histórico de las pacientes con ST≤18 años seguidas en los hospitales públicos de Castilla y León. Resultados: Se registraron 42 pacientes (diagnóstico prenatal 11,9%, neonatal 14,3%) con una edad media actual de 11,9±4,2 años. La talla baja fue el motivo de consulta en el 87,1%. El 40,5% presentaban monosomía total del cromosoma X. La enfermedad asociada más frecuente fue la oftalmológica (50%), con problemas cardiacos en el 23,8%. El 93% reciben tratamiento congrowth hormone (GH, «hormona de crecimiento»), con una edad media al inicio de 7,43±3,4 años y una DE media de talla de −2,84±1,08. Solamente 10 pacientes han alcanzado talla final (talla media 151,47±6,09cm). La edad cronológica media de inducción puberal fue 13,2 años±0,94 años (edad ósea 12,47±1,17). Conclusiones: Uno de los datos clave para el diagnóstico fue la talla baja acompañada en algunos casos de otros hallazgos, siendo el tratamiento con GH efectivo (AU)

Background and objective: Turner syndrome (TS) is characterized by short stature, gonadal dysgenesis, and total or partial loss of X chromosome. Patients and methods: A historical cohorts study of patients with TS≤18 years old followed up in public hospitals in Castilla y Leon was undertaken. Results: Forty-two female patients were included (prenatal diagnosis 11.9%, neonatal diagnosis 14.3%) with current median age 11.9±4.2 years. Short stature was the reason for consultation in 87.1%. Total monosomy of X chromosome was present in 40.5%. The most frequently associated comorbidity was opthalmological (50%), with heart defects in 23.8%. Ninety-three percent were treated with growth hormone (GH), mean age at the beginning of treatment was 7.43±3.4 years and mean height standard deviation was −2.84±1.08. Final height was reached in 10 patients only (mean final height 151.47±6.09cm). Chronological age of puberty induction was 13.2±0.94 years (bone age 12.47±1.17 years) (AU)

[Turner syndrome: Study of 42 cases]. / Síndrome de Turner: análisis de 42 casos.

BACKGROUND AND OBJECTIVE: Turner syndrome (TS) is characterized by short stature, gonadal dysgenesis, and total or partial loss of X chromosome. PATIENTS AND METHODS: A historical cohorts study of patients with TS≤18 years old followed up in public hospitals in Castilla y Leon was undertaken. RESULTS: Forty-two female patients were included (prenatal diagnosis 11.9%, neonatal diagnosis 14.3%) with current median age 11.9±4.2 years. Short stature was the reason for consultation in 87.1%. Total monosomy of X chromosome was present in 40.5%. The most frequently associated comorbidity was opthalmological (50%), with heart defects in 23.8%. Ninety-three percent were treated with growth hormone (GH), mean age at the beginning of treatment was 7.43±3.4 years and mean height standard deviation was -2.84±1.08. Final height was reached in 10 patients only (mean final height 151.47±6.09cm). Chronological age of puberty induction was 13.2±0.94 years (bone age 12.47±1.17 years). CONCLUSIONS: Short stature was an important clinical sign for the diagnosis of TS, accompanied in some cases by other findings, with good response to GH treatment.

Tratamiento con hormona de crecimiento en 2 pacientes con deleción 22q11.21 / Growth hormone treatment in 2 patients with 22q11.21 deletion syndrome

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Deficiencia parcial de 3B-hidroxiesteroide deshidrogenasa tipo 2: diagnóstico de una nueva mutación tras cribado neonatal positivo de deficiencia de 21-hidroxilasa / Partial 3ß-hydroxysteroid dehydrogenase type 2 deficiency: Diagnosis of a novel mutation after positive newborn screening for 21-hydroxylase deficiency

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