Characteristics of people with type 1 diabetes who use technology in their treatment and who use frequently the technical assistance teleconsultation service.

INTRODUCTION: Technical issues related to continuous subcutaneous insulin infusion (CSII), associated or not with continuous glucose monitoring (SAP), are handled by tele-technical assistance from the manufacturer. We analyze the characteristics of the most demanding patients of technical teleassistance. MATERIAL AND METHODS: Patients with type 1 diabetes (T1D) in treatment with CSII or SAP, who made use of technical teleassistance from 01/01/2017 to 02/28/2021 (2298 consultations) were included. We selected the group of patients who made ≥10 calls (90th percentile, P90) and the one who made a single call (10th percentile, P10). The number and most frequent reasons for consultation, clinical characteristics and HbA1c were collected and both groups were compared. RESULTS: 51 patients (P90) made a total of 876 calls (38.1% of calls), 32 used SAP. The most frequent reason for consultation was related to continuous glucose monitoring (36.8%). 51 (P10) made 51 calls (2.2%), 3 used SAP. The most frequent reason for consultation was related to device damage (25.5%). The most demanding patients used SAP more frequently (62.7 vs. 5.9%, P < .001), had been in advanced treatment for less time (7.1 ±â€¯5.5 vs. 12.1 ±â€¯6.2 years, P < .001) and their HbA1c was lower (7.2 ±â€¯0.9 vs 7.6 ±â€¯0.8%). CONCLUSIONS: Most of the calls to the technical teleassistance service for ISCI/SAP devices come from a more demanding group of people with T1D. The greatest demand is concentrated in patients who use SAP, with a shorter time of use of advanced therapy and a better degree of glucose control.

Effectiveness and Safety of Insulin Glargine 300 U/ml in Comparison with Insulin Degludec 100 U/ml Evaluated with Continuous Glucose Monitoring in Adults with Type 1 Diabetes and Suboptimal Glycemic Control in Routine Clinical Practice: The OneCARE Study.

INTRODUCTION: Data regarding efficacy of second-generation basal insulins (BI) using continuous glucose monitoring (CGM) come from clinical trials. We evaluated the effectiveness of insulin glargine 300 U/ml (Gla-300) compared to insulin degludec 100 U/ml (IDeg-100) in terms of percentage of time in range (TIR); 70-180 mg/dl was obtained from CGM in sub-optimally controlled patients with type 1 diabetes (T1D) in routine clinical practice. METHODS: This observational, multicenter, cross-sectional study included patients with T1D (> 3 years diabetes duration, HbA1c ≥ 7.5%) who had switched from first-generation BI to Gla-300/IDeg-100 within the past 24 months according to physician discretion. Clinical and laboratory data were obtained from clinical records and during study visit, and CGM data were collected prior to the visit. RESULTS: One hundred ninety-nine people with T1D were included [42.6 ± 13.4 (mean ± SD) years, 18.4 ± 10.4 years diabetes duration]; 104 received Gla-300, 95 IDeg-100. TIR 70-180 throughout whole day was similar in both groups, 52.4 ± 14.0 vs. 49.3 ± 13.9% Gla-300/IDeg-100, respectively. At night, TIR 70-180 and TIR 70-140 were significantly higher in the Gla-300 group compared to the IDeg-100 (52.4 vs. 46.2 and 31.8 vs. 26.9%, respectively, p = 0.0209 and p = 0.0182), and time above range (180) was significantly lower in the Gla-300 group (40.1% vs. 47.2%, p = 0.0199). Additional CGM glucometric data were comparable in both groups. Patient treatment satisfaction score assessed through the Diabetes Treatment Satisfaction Questionnaire (DTSQ) was high and similar for both insulins. CONCLUSION: This real-world study shows the effectiveness and safety of Gla-300 are more similar to than different from IDeg-100, with a slightly better nocturnal glucose profile, in sub-optimally controlled T1D patients switching from a first-generation BI.

Educación terapéutica ante la Diabetes Tipo 1(DM1). Iniciación con infusión subcutánea continua de insulina (ISCI) / Therapeutic education regarding type 1 diabetes (DM1)

Este artículo presenta una introducción sobre la diabetes, sus problemas asociados y la evidencia científica de prevenir y/o atrasar las complicaciones crónicas a través de la optimización del control metabólico. Se referencia uno de los estudios «The Diabetes Control and Complications Trial-DCCT» más importantes que ha marcado un antes y un después en el tratamiento de la diabetes mellitus tipo 1 (DM1). Centrado en el tratamiento con ISCI se describe: 1) Pacientes candidatos según las sociedades científicas. 2) Características y funcionamiento de los infusores de insulina, así como los diferentes modelos de infusores, catéteres, agujas e insertadores comercializados actualmente en España. Se aporta la experiencia del equipo de diabetes del Hospital Clínic de Barcelona en la terapia ISCI (en inglés, CSII). Se describe la estructura, el proceso que sigue el paciente y los resultados (evaluados a los dos años de seguimiento) del programa de Educación Terapéutica dirigido a las personas con DM1 candidatas a terapia ISCI(AU)

This article presents an introduction to diabetes and the problems associated with diabetes as well as scientific evidence on how to prevent or retard chronic complications diabetes causes by means of optimizing a diabetes sufferer’s metabolic control. The authors make reference to one of the most important studies by The Diabetes Control and Complications Trial-DCCT which has signified a before and an after in the treatment of type 1 diabetes mellitus (DM1). Focusing on the treatment of diabetes with continuous subcutaneous insulin injection (CSII), the authors describe 1) Patients who are candidates for this treatment according to scientific associations; 2) Characteristics and functioning methods for insulin delivery systems as well as the different models of insulin delivery systems, catheters, needles and commercial inserting mechanisms presently available in Spain. The authors report on the experiences that the diabetes team at the Barcelona «Hospital Clinic» have with CSII therapy. The authors describe the structure of a Therapeutic Educational Program directed at patients suffering from DM1 who are candidates for CSII therapy, the process which these patients follow and the results of this program, evaluated after two years of follow-up study(AU)

[Therapeutic education regarding type 1 diabetes (DM1)]. / Educación terapéutica ante la diabetes tipo 1 (DM1).

This article presents an introduction to diabetes and the problems associated with diabetes as well as scientific evidence on how to prevent or retard chronic complications diabetes causes by means of optimizing a diabetes sufferer's metabolic control. The authors make reference to one of the most important studies by The Diabetes Control and Complications Trial-DCCT which has signified a before and an after in the treatment of type 1 diabetes mellitus (DM1). Focusing on the treatment of diabetes with continuous subcutaneous insulin injection (CSII), the authors describe 1) Patients who are candidates for this treatment according to scientific associations; 2) Characteristics and functioning methods for insulin delivery systems as well as the different models of insulin delivery systems, catheters, needles and commercial inserting mechanisms presently available in Spain. The authors report on the experiences that the diabetes team at the Barcelona "Hospital Clinic" have with CSII therapy The authors describe the structure of a Therapeutic Educational Program directed at patients suffering from DM1 who are candidates for CSII therapy the process which these patients follow and the results of this program, evaluated after two years of follow-up study.

[Young adult onset diabetes mellitus. Clinical differences between MODY-3 and type 2 diabetes mellitus]. / Diabetes mellitus diagnosticada en el adulto joven. Diferencias clínicas entre MODY-3 y diabetes mellitus de tipo 2.

BACKGROUND AND OBJECTIVE: The aim of our study was to evaluate the clinical and metabolic characteristics of type 2 diabetes diagnosed in young adults (T2DYA) and in subjects with mutations in HNF-1* gene. PATIENTS AND METHOD: We included 8 subjects diagnosed of MODY-3 (3 women) at ages 25-45. They were matched (1/2) by gender and age of diagnosis with 16 (6 women) T2DYA. Clinical and metabolic characteristics, as well as C-reactive protein levels, were evaluated. RESULTS: There were not differences in terms of age, disease duration and family history of type 2 diabetes. MODY-3 subjects had a lower body mass index -24 (3) vs. 31 (4) kg/m2; P = .000- and in a lower proportion they had hypertension and required insulin treatment. High density lipoprotein-cholesterol value was higher -50 (4) vs. 43 (2) mg/dl; P = .000) and HbA1c -7.1% (1,0%) vs. 8.2% (1,2%); P = .036-, triglycerides -147 (17) vs. 184 (20) mg/dl; P = .000- and C-reactive protein -0.6 (0,2) vs. 1.7 (0,6) mg/l; P = .000- levels were lower in subjects with MODY-3. CONCLUSIONS: The presence of clinical and metabolic features related to metabolic syndrome could be of help in order to differentiate between T2DYA and diabetes due to mutations in HNF-1*.

Diabetes mellitus diagnosticada en el adulto joven. Diferencias clínicas entre MODY-3 y diabetes mellitus de tipo 2 / Young adult onset diabetes mellitus. Clinical differences between MODY-3 and type 2 diabetes mellitus

Fundamento y objetivo: Nuestro propósito ha sido evaluar las características clínicas y metabólicas de la diabetes tipo 2 diagnosticada en el adulto joven (DAJ) y de aquélla debida a mutaciones en el factor nuclear hepático 1* (HNF-1*). Pacientes y método: Se incluyó en el estudio a 8 pacientes (3 mujeres) con MODY-3 diagnosticada entre los 25 y los 45 años. Emparejados por sexo y edad en el momento del diagnóstico, se seleccionó a 16 pacientes (6 mujeres) con DAJ (2 DAJ/1 MODY-3). Se recogieron datos clínicos, antropométricos y analíticos, entre éstos, la determinación de proteína C reactiva. Resultados: No hubo diferencias en la edad, en la duración de la enfermedad ni en la presencia de antecedentes familiares de diabetes entre los 2 grupos. Los pacientes con MODY-3 presentaban un menor índice de masa corporal ­media (desviación estándar) de 24 (3) frente a 31 (4) kg/m2; p = 0,000­ y en menor proporción tenían antecedentes de hipertensión arterial y recibían tratamiento con insulina. Las cifras de colesterol unido a lipoproteínas de alta densidad eran superiores ­50 (4) frente a 43 (2) mg/dl; p = 0,000­ en los pacientes con MODY-3, y las de hemoglobina glucosilada ­7,1% (1,0%) frente a 8,2 (1,2%); p = 0,036­, triglicéridos ­147 (17) frente a 184 (20) mg/dl; p = 0,000­ y proteína C reactiva ­0,6 (0,2) frente a 1,7 (0,6) mg/l; p = 0,000­, inferiores. Conclusiones: La presencia de datos clínicos relacionados con el síndrome metabólico ayuda a diferenciar a los sujetos con diabetes debida a mutaciones en HNF-1* de aquellos con DAJ

Background and objective: The aim of our study was to evaluate the clinical and metabolic characteristics of type 2 diabetes diagnosed in young adults (T2DYA) and in subjects with mutations in HNF-1* gene. Patients and method: We included 8 subjects diagnosed of MODY-3 (3 women) at ages 25-45. They were matched (1/2) by gender and age of diagnosis with 16 (6 women) T2DYA. Clinical and metabolic characteristics, as well as C-reactive protein levels, were evaluated. Results: There were not differences in terms of age, disease duration and family history of type 2 diabetes. MODY-3 subjects had a lower body mass index ­24 (3) vs. 31 (4) kg/m2; P = .000­ and in a lower proportion they had hypertension and required insulin treatment. High density lipoprotein-cholesterol value was higher ­50 (4) vs. 43 (2) mg/dl; P = .000) and HbA1c ­7.1% (1,0%) vs. 8.2% (1,2%); P = .036­, triglycerides ­147 (17) vs. 184 (20) mg/dl; P = .000­ and C-reactive protein ­0.6 (0,2) vs. 1.7 (0,6) mg/l; P = .000­ levels were lower in subjects with MODY-3. Conclusions: The presence of clinical and metabolic features related to metabolic syndrome could be of help in order to differentiate between T2DYA and diabetes due to mutations in HNF-1*

Prognostic significance of the white coat hypertension in patients with type 1 diabetes mellitus.

Despite the high prevalence of white coat hypertension (WCH) in diabetes mellitus and the evidence that hypertension is a clear risk factor for the development of microalbuminuria (MA) in these patients, there is no information on the long-term prognostic significance of this condition in the diabetic population. We studied the evolution of 40 patients with type 1 diabetes mellitus (Type 1 DM). Twenty patients with WCH (office blood pressure> or =140/90mmHg associated with mean daytime blood pressure<135/85mmHg) classified as the WCH group and 20 patients with type 1 DM with a similar age and disease evolution, but who were normotensive, (office blood pressure<140/90mmHg associated with mean daytime blood pressure<135/85mmHg) classified as the normotensive control group. After 5 years of follow-up, MA appeared in four subjects and sustained hypertension in another, with a total of 31% of events in the WCH group, with none in the normotensive group. Kaplan-Meier analysis showed that the relative risk of developing these hypertensive events was 25% higher in the WCH group. At baseline, the night time systolic and diastolic blood pressure levels were significantly higher in patients who further developed MA and sustained hypertension. The findings in this study highlight the clinical importance of careful follow-up of type 1 diabetic patients with WCH.

[Coronary risk assessment in subjects with type 2 diabetes mellitus. General population-based scores or specific scores?]. / Estimación del riesgo coronario en pacientes con diabetes mellitus tip 2. Escalas de población general o escales específicas?

Coronary risk in patients with type 2 diabetes mellitus can be calculated using population-based scores or diabetes-specific scores. Our objective was to compare the results with both scores in a group of patients with type 2 diabetes and no history of cardiovascular disease. We analyzed the results for 101 patients aged 40 to 65 years with type 2 diabetes and no prior cardiovascular disease. Two scales were used, one based on the general population (Framingham function adapted from the REGICOR study), and the other based on the population with type 2 diabetes mellitus (UKPDS risk engine). The average 10-year likelihood of coronary events was 5.8 (2.5)% and 15.7 (8.4)% for the REGICOR risk score and the UKPDS risk score, respectively (P<.001), with a Pearson correlation coefficient of 0.525 (P<.01). Risk was higher in men (19.2 [8.7]% based on the UKPDS score, and 5.6 [2.8]% based on the REGICOR score, P<.001). The figures for women were 11.3 [5.9]% and 5.9 [2.1]% with the UKPDS and REGICOR scores, respectively (P<.001). Our results suggest that substantially different findings are obtained when general population-based scores or specific scores are used to assess cardiovascular risk in subjects with type 2 diabetes.