Psychometric properties of the Clarke questionnaire for hypoglycemia awareness in the Spanish population with type 2 diabetes.

OBJECTIVES: The Clarke questionnaire, validated in Spanish language, assesses hypoglycemia awareness in patients with type 1 diabetes. This study aimed to analyze its psychometric properties in patients with type 2 diabetes (T2DM). METHODS: This was a questionnaire validation study. Patients with T2DM and treated with insulin, sulfonylureas or glinides were consecutively recruited from six endocrinology consultations and six primary care centers. The internal structure of the 8-item Clarke questionnaire was analyzed by exploratory (training sample) and confirmatory (testing sample) factor analysis; the internal consistency using Omega's McDonald coefficient; and goodness of fit with comparative fit index (CFI, cutoff >0.9), Goodness of Fit Index (GFI, cutoff >0.9), and root mean-square error of approximation (RMSEA, cutoff <0.09), as well as unidimensionality indicators. RESULTS: The 265 participants (56.8% men) had a mean age of 67.8 years. Confirmatory factor analysis for one dimension obtained poor indicators: fit test (p < 0.001); CFI = 0.748; RMSEA = 0.122 and SRMR = 0.134. Exploratory factor analysis showed 2 or 3 dimensions with poor adjustment indicators. Omega's McDonald was 0.739. CONCLUSIONS: The Spanish version of the Clarke questionnaire was not valid or reliable for assessing hypoglycemia awareness in people with T2DM in Spanish population.

[Lung transplantation and the development of diabetes mellitus in adult patients with cystic fibrosis]. / Importancia del trasplante pulmonar en la aparición de diabetes mellitus en pacientes adultos con fibrosis quística.

OBJECTIVE: The prevalence of diabetes mellitus is higher in patients with cystic fibrosis than in the general population. Solid organ transplantation is a significant risk factor for diabetes mellitus, which has been linked to type of immunosuppression. The aim of this study was to analyze whether lung transplantation represents a significant risk factor for the onset of abnormal carbohydrate metabolism in cystic fibrosis, whether it affects severity of alterations, and whether there is a relation to type of immunosuppression. PATIENTS AND METHODS: The following data were extracted retrospectively for 54 patients with cystic fibrosis: type of carbohydrate metabolism alteration and treatment received, whether or not transplantation took place, and type of immunosuppression used. RESULTS: Twenty of the 54 patients (37%) underwent lung transplantation; 18 of them (89%) developed diabetes mellitus. Eight of the patients (24%) who did not receive a lung developed diabetes and 10 (29%) displayed carbohydrate intolerance (P< .01, chi(2) test). Insulin was administered to 36.3% of nontransplanted patients and 78.6% of transplanted patients. The influence of immunosuppressant used was analyzed in 15 patients. Nine out of 10 patients (90%) treated with cyclosporine and 4 out of 5 (80%) of those treated with tacrolimus developed diabetes mellitus. All received the same regimen of corticosteroid therapy. CONCLUSIONS: For cystic fibrosis patients, lung trans-plantation is a significant risk factor for developing abnormal carbohydrate metabolism and it influences severity and treatment. No significant differences in the frequency of development of diabetes mellitus were found in relation to type of immunosuppression.

Importancia del trasplante pulmonar en la aparición de diabetes mellitus en pacientes adultos con fibrosis quística / Lung transplantation and the development of diabetes mellitus in adult patients with cystic fibrosis

Objetivo: La prevalencia de diabetes mellitus (DM) en pacientes con fibrosis quística (FQ) es mayor que en la población general. El trasplante de órganos sólidos es un factor de riesgo importante para el desarrollo de DM y se ha relacionado con el tipo de inmunodepresión. El objetivo del estudio ha sido analizar si el trasplante pulmonar (TP) es un factor de riesgo importante para desarrollar alteración hidrocarbonada en la FQ, si influye en su gravedad y tratamiento, y si existe relación con el tipo de inmunodepresión. Pacientes y métodos: Se estudió retrospectivamente a 54 pacientes adultos con FQ, sobre los que se recogieron los siguientes datos: tipo de alteración hidrocarbonada y su tratamiento, existencia o no de TP y tipo de inmunodepresión. Resultados: De los 54 pacientes, 20 recibieron TP (37%). De éstos, el 89% (n = 18) presentó DM. Entre aquellos que no recibieron TP, el 24% (n = 8) presentó DM y el 29% (n = 10) intolerancia hidrocarbonada (p < 0,01; prueba de χ²). Se pautó insulina al 36,3% de los pacientes sin TP y al 78,6% de los trasplantados. La influencia de la inmunodepresión se analizó en 15 pacientes. Desarrollaron DM el 90% (9/10) de los tratados con ciclosporina y el 80% (4/5) de los tratados con tacrolimus. Todos llevaban la misma pauta de corticoterapia. Conclusiones: El TP es un factor de riesgo importante para el desarrollo de alteración hidrocarbonada en pacientes con FQ e influye en su gravedad y tratamiento. No hemos encontrado diferencia significativa entre el tipo de inmunodepresión y la aparición de DM

Objective: The prevalence of diabetes mellitus is higher in patients with cystic fibrosis than in the general population. Solid organ transplantation is a significant risk factor for diabetes mellitus, which has been linked to type of immunosuppression. The aim of this study was to analyze whether lung transplantation represents a significant risk factor for the onset of abnormal carbohydrate metabolism in cystic fibrosis, whether it affects severity of alterations, and whether there is a relation to type of immunosuppression. Patients and methods: The following data were extracted retrospectively for 54 patients with cystic fibrosis: type of carbohydrate metabolism alteration and treatment received, whether or not transplantation took place, and type of immunosuppression used. Results: Twenty of the 54 patients (37%) underwent lung transplantation; 18 of them (89%) developed diabetes mellitus. Eight of the patients (24%) who did not receive a lung developed diabetes and 10 (29%) displayed carbohydrate intolerance (P<.01, χ² test). Insulin was administered to 36.3% of nontransplanted patients and 78.6% of transplanted patients. The influence of immunosuppressant used was analyzed in 15 patients. Nine out of 10 patients (90%) treated with cyclosporine and 4 out of 5 (80%) of those treated with tacrolimus developed diabetes mellitus. All received the same regimen of corticosteroid therapy. Conclusions: For cystic fibrosis patients, lung trans-plantation is a significant risk factor for developing abnormal carbohydrate metabolism and it influences severity and treatment. No significant differences in the frequency of development of diabetes mellitus were found in relation to type of immunosuppression