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1.
East Mediterr Health J ; 26(2): 182-188, 2020 Feb 24.
Artículo en Inglés | MEDLINE | ID: mdl-32141596

RESUMEN

Background: Diabetes mellitus in all its forms has been rapidly increasing worldwide, especially in the Eastern Mediterranean Region. Aims: This national study aimed to assess the prevalence and clinical aspects of diabetes mellitus in Lebanon with special focus on type 1 (T1DM). Methods: A national multistage, random household sample survey was conducted, using face-to-face interviews with 1 questionnaire per household. A total of 4500 households were selected from all areas based on a pre-existing sampling frame of the Lebanese population. Results: The prevalence of previously diagnosed diabetes mellitus in the surveyed population of 17 832 persons (mean age ~36 years) was 7.95%. The prevalence of T1DM in particular was estimated at 0.1%, or almost 1% of all detected cases of diabetes mellitus. Most persons with diabetes mellitus reported obtaining their usual care from endocrinologists rather than primary healthcare physicians. Delayed performance of haemoglobin A1c test was reported in 25% of 1418 patients. Hypoglycaemic episodes recently occurred in 30% of patients; of whom, at least one third required medical attention, including hospital admission. Diagnosed complications were reported in 22% of cases, with retinopathy being the most common. Conclusions: Prevalence of T1DM in this population was lower than international estimates. Diabetes mellitus management appears to be deficient, based on delays in standard control testing, hypoglycaemic episodes and diabetes mellitus-related complications. Coordination of diabetic care management should be devolved to primary healthcare physicians, who can keep track of the need for referral to various types of diabetes mellitus care.


Asunto(s)
Diabetes Mellitus Tipo 1/epidemiología , Diabetes Mellitus/epidemiología , Manejo de la Enfermedad , Adulto , Complicaciones de la Diabetes/epidemiología , Complicaciones de la Diabetes/prevención & control , Diabetes Mellitus/terapia , Diabetes Mellitus Tipo 1/terapia , Femenino , Humanos , Líbano/epidemiología , Masculino , Prevalencia , Encuestas y Cuestionarios
2.
Bratisl Lek Listy ; 121(2): 129-132, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32115965

RESUMEN

OBJECTIVES: We aimed to study the prevalence of the early onset Type 1 diabetes in Slovakia during the years 1996-2017. BACKGROUND: Prevalence of Type 1 diabetes in young children is increasing worldwide. However, recent data from Slovakia are missing. METHODS: All children with newly diagnosed Type 1 diabetes included in the study were diagnosed in the Children Diabetes Centre in Bratislava during the years 1996-2017. The incidence of T1D in children aged below 3 and below 5 years was calculated and compared to the T1D incidence in older children. Incidence trends were calculated with the Poissed regression. RESULTS: Gender-adjusted incidence of T1D annually increased by 5.4 % (CI: 3.9-6.8; p < 0.001) in children <3 years, and by 3.4 % (95 % CI 2.2-4.6; p<0.001) in children <5 years during the last two decades. Moreover, the proportion of young children <3 years of age among all newly diagnosed children and adolescents increased over time (4.2±2.8 % in years 1996-1998; 12.2±5.8 % in years 2004-2008, and 13.7±7.4 % during the years 2013-2017). CONCLUSION: We found a significant increase in the incidence and proportion of T1D in young children during the last two decades. Similar data were also found in other European countries. This could be explained by changing environmental conditions (Fig. 1, Ref. 32).


Asunto(s)
Diabetes Mellitus Tipo 1 , Adolescente , Anciano , Niño , Preescolar , Diabetes Mellitus Tipo 1/epidemiología , Europa (Continente) , Humanos , Incidencia , Lactante , Prevalencia , Eslovaquia/epidemiología
3.
MMWR Morb Mortal Wkly Rep ; 69(6): 161-165, 2020 Feb 14.
Artículo en Inglés | MEDLINE | ID: mdl-32053581

RESUMEN

Diabetes is one of the most common chronic diseases among persons aged <20 years (1). Onset of diabetes in childhood and adolescence is associated with numerous complications, including diabetic kidney disease, retinopathy, and peripheral neuropathy, and has a substantial impact on public health resources (2,3). From 2002 to 2012, type 1 and type 2 diabetes incidence increased 1.4% and 7.1%, respectively, among U.S. youths (4). To assess recent trends in incidence of diabetes in youths (defined for this report as persons aged <20 years), researchers analyzed 2002-2015 data from the SEARCH for Diabetes in Youth Study (SEARCH), a U.S. population-based registry study with clinical sites located in five states. The incidence of both type 1 and type 2 diabetes in U.S. youths continued to rise at constant rates throughout this period. Among all youths, the incidence of type 1 diabetes increased from 19.5 per 100,000 in 2002-2003 to 22.3 in 2014-2015 (annual percent change [APC] = 1.9%). Among persons aged 10-19 years, type 2 diabetes incidence increased from 9.0 per 100,000 in 2002-2003 to 13.8 in 2014-2015 (APC = 4.8%). For both type 1 and type 2 diabetes, the rates of increase were generally higher among racial/ethnic minority populations than those among whites. These findings highlight the need for continued surveillance for diabetes among youths to monitor overall and group-specific trends, identify factors driving these trends, and inform health care planning.


Asunto(s)
Diabetes Mellitus Tipo 1/epidemiología , Diabetes Mellitus Tipo 2/epidemiología , Adolescente , Niño , Preescolar , Diabetes Mellitus Tipo 1/etnología , Diabetes Mellitus Tipo 2/etnología , Femenino , Humanos , Incidencia , Indios Norteamericanos/estadística & datos numéricos , Lactante , Recién Nacido , Masculino , Estados Unidos/epidemiología , Adulto Joven
5.
JAMA ; 323(4): 339-351, 2020 Jan 28.
Artículo en Inglés | MEDLINE | ID: mdl-31990315

RESUMEN

Importance: Public health screening for type 1 diabetes in its presymptomatic stages may reduce disease severity and burden on a population level. Objective: To determine the prevalence of presymptomatic type 1 diabetes in children participating in a public health screening program for islet autoantibodies and the risk for progression to clinical diabetes. Design, Setting, and Participants: Screening for islet autoantibodies was offered to children aged 1.75 to 5.99 years in Bavaria, Germany, between 2015 and 2019 by primary care pediatricians during well-baby visits. Families of children with multiple islet autoantibodies (presymptomatic type 1 diabetes) were invited to participate in a program of diabetes education, metabolic staging, assessment of psychological stress associated with diagnosis, and prospective follow-up for progression to clinical diabetes until July 31, 2019. Exposures: Measurement of islet autoantibodies. Main Outcomes and Measures: The primary outcome was presymptomatic type 1 diabetes, defined by 2 or more islet autoantibodies, with categorization into stages 1 (normoglycemia), 2 (dysglycemia), or 3 (clinical) type 1 diabetes. Secondary outcomes were the frequency of diabetic ketoacidosis and parental psychological stress, assessed by the Patient Health Questionnaire-9 (range, 0-27; higher scores indicate worse depression; ≤4 indicates no to minimal depression; >20 indicates severe depression). Results: Of 90 632 children screened (median [interquartile range {IQR}] age, 3.1 [2.1-4.2] years; 48.5% girls), 280 (0.31%; 95% CI, 0.27-0.35) had presymptomatic type 1 diabetes, including 196 (0.22%) with stage 1, 17 (0.02%) with stage 2, 26 (0.03%) with stage 3, and 41 who were not staged. After a median (IQR) follow-up of 2.4 (1.0-3.2) years, another 36 children developed stage 3 type 1 diabetes. The 3-year cumulative risk for stage 3 type 1 diabetes in the 280 children with presymptomatic type 1 diabetes was 24.9% ([95% CI, 18.5%-30.7%]; 54 cases; annualized rate, 9.0%). Two children had diabetic ketoacidosis. Median (IQR) psychological stress scores were significantly increased at the time of metabolic staging in mothers of children with presymptomatic type 1 diabetes (3 [1-7]) compared with mothers of children without islet autoantibodies (2 [1-4]) (P = .002), but declined after 12 months of follow-up (2 [0-4]) (P < .001). Conclusions and Relevance: Among children aged 2 to 5 years in Bavaria, Germany, a program of primary care-based screening showed an islet autoantibody prevalence of 0.31%. These findings may inform considerations of population-based screening of children for islet autoantibodies.


Asunto(s)
Autoanticuerpos/sangre , Diabetes Mellitus Tipo 1/epidemiología , Islotes Pancreáticos/inmunología , Tamizaje Masivo , Enfermedades Asintomáticas/epidemiología , Enfermedades Asintomáticas/psicología , Preescolar , Diabetes Mellitus Tipo 1/diagnóstico , Diabetes Mellitus Tipo 1/psicología , Femenino , Estudios de Seguimiento , Alemania/epidemiología , Humanos , Masculino , Padres , Encuestas y Cuestionarios
6.
Medicine (Baltimore) ; 99(2): e18679, 2020 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-31914062

RESUMEN

This study aimed to correlate hypoglycemic risk exposures (HREs) with low blood glucose value (BGV) in ambulatory patients to inform selection of a glucose critical action value (CAV).This was a retrospective study of ambulatory patients with at least 1 serum glucose ≤70 mg/dL obtained at 2 laboratories within the Johns Hopkins Health System over 3.8 years. Multivariable logistic regression was used to evaluate association of BGV cut-offs of <60, <54, <50, and <45 mg/dL with HREs. HREs were classified as "high hypoglycemic risk" (HHR), "moderate hypoglycemic risk" (MHR), "low hypoglycemic risk" (LHR), and "no hypoglycemic risk" (NHR).A total of 5404 patient samples of BG ≤70 mg/dL were analyzed, of which 30.3%, 23.2%, 28.5%, 18.0% occurred in NHR, LHR, MHR, and HHR groups, respectively. An inverse relationship was noted between BGV cut-offs and HHR, but no association was observed for LHR or MHR. After adjusting for age, sex, and race, there was an inverse association between BG thresholds and the odds of HHR. For classification of HHR, BGV cut-offs of <60, <54, <50, and <45 mg/dL correctly classified 71.2%, 69.8%, 68.8%, and 67.2% of BG samples, achieved false-positive rates of 13.6%, 4.7%, 1.7%, and 0.5% and positive likelihood ratios of 3.3, 6.0, 11.2, and 23.4, respectively.Nearly 70% of low BGVs occurred in patients with at least 1 HRE, but only ∼20% occurred in HHR patients. Given their high positive likelihood ratios, BGVs <54 or <50 mg/dL are reasonable candidates for CAVs that would allow sufficient clinician response time while minimizing false-positive alerts.


Asunto(s)
Instituciones de Atención Ambulatoria/estadística & datos numéricos , Glucemia/análisis , Hipoglucemia/epidemiología , Adulto , Anciano , Comorbilidad , Diabetes Mellitus Tipo 1/sangre , Diabetes Mellitus Tipo 1/epidemiología , Reacciones Falso Positivas , Femenino , Humanos , Modelos Logísticos , Masculino , Persona de Mediana Edad , Valores de Referencia , Estudios Retrospectivos , Factores de Riesgo
7.
Tidsskr Nor Laegeforen ; 139(18)2019 Dec 10.
Artículo en Noruego | MEDLINE | ID: mdl-31823575

RESUMEN

BACKGROUND: The aim was to investigate the prevalence of gestational diabetes and pregnancy outcomes in women with gestational diabetes in Nordland and Troms counties. MATERIAL AND METHOD: We included all 1 067 women with type 1 diabetes, type 2 diabetes and gestational diabetes among 34 915 births at four hospitals in Nordland and Troms counties from 2004 to 2015. Prevalence of diabetes was calculated based on ICD-10 codes in patient records for women with diabetes in Nordland and Troms counties, and compared with national prevalence figures from the Medical Birth Registry of Norway. Prevalence of pre-eclampsia, macrosomia (birth weight > 4 500 grams) and caesarian section was calculated for all women with diabetes and all those giving birth in the same region. RESULTS: Prevalence of type 1 diabetes and type 2 diabetes remained stable. Prevalence of gestational diabetes increased from 1.0 % to 4.0 % in Nordland and Troms counties and from 1.0 % to 3.8 % nationally. Prevalence of pre-eclampsia among all women with diabetes fell from 18.8 % in 2004-06 to 12.4 % in 2013-15. In women with diabetes, the prevalence of pre-eclampsia was 4.6 times higher, that of macrosomia was 3.5 times higher, and the proportion of caesarian sections was 2.3 times higher than in the background population. INTERPRETATION: Prevalence of gestational diabetes increased in Nordland and Troms counties, as it did nationally. Prevalence of pre-eclampsia among pregnant women with diabetes fell, but prevalence of pre-eclampsia, macrosomia and caesarean section was higher than in the background population.


Asunto(s)
Diabetes Mellitus Tipo 2 , Diabetes Gestacional , Cesárea , Diabetes Mellitus Tipo 1/epidemiología , Diabetes Mellitus Tipo 2/epidemiología , Diabetes Gestacional/epidemiología , Femenino , Humanos , Noruega/epidemiología , Embarazo , Resultado del Embarazo , Prevalencia
9.
Pan Afr Med J ; 33: 322, 2019.
Artículo en Francés | MEDLINE | ID: mdl-31692874

RESUMEN

Introduction: Diabetic ketoacidosis (DKA) is a severe metabolic complication of diabetes. Recent years have seen a marked increase in prevalence of diabetic ketoacidosis, but mortality is low. This study aimed to describe the epidemiological, clinical, therapeutic and prognostic features of patients with severe or moderate DKA admitted to the Emergency Department. Methods: He conducted a prospective, descriptive study including patients with moderate or severe DKA. Standardized care protocol. We studied the epidemiological, clinical, therapeutic and prognostic features of these patients. Results: The study involved 185 patients with moderate or severe DKA. The average age of patients was 38+/-18 years, with a sex ratio of 0.94. Known diabetes was reported in 159 patients (85%) of whom 116 had type 1 diabetes. The most common factors of decompensation were treatment discontinuation in 42% and infection in 32%. Average blood glucose was 32.7+/-12 mmol/L, pH =7.14+/-0.13, HCO3- =7.2+/-3.56 mmol/L. The mean duration of intravenous insulin was 17.3 +/- 16 hours. Hypoglycaemia was reported in 26 patients (14%), hypokalemia in 80 (43%) patients and hyperchloraemic mineral acidosis in 43 patients (23%). Intrahospital mortality was 2.1%. Conclusion: Diabetic ketoacidosis occurs in young subjects treated with insulin therapy. Treatment is based on intravenous insulin associated with correction of fluid deficit. Complications mainly include hypokalemia and hypoglycemia and mortality is low.


Asunto(s)
Diabetes Mellitus Tipo 1/epidemiología , Diabetes Mellitus Tipo 2/epidemiología , Cetoacidosis Diabética/epidemiología , Insulina/administración & dosificación , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Glucemia/metabolismo , Diabetes Mellitus Tipo 1/complicaciones , Diabetes Mellitus Tipo 2/complicaciones , Cetoacidosis Diabética/tratamiento farmacológico , Servicio de Urgencia en Hospital , Femenino , Humanos , Hipoglucemia/epidemiología , Hipoglucemia/etiología , Hipoglucemiantes/administración & dosificación , Hipopotasemia/epidemiología , Hipopotasemia/etiología , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Adulto Joven
10.
Georgian Med News ; (294): 72-76, 2019 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-31687953

RESUMEN

Dysbacteriosis of the oral cavity is known to complicate the course of chronic catarrhal gingivitis resulting from functional disorders of the macroorganism ecosystem, decreased amount of probiotic and increased amount of opportunistic and pathogenic microflora. And natural immune response is activated first in this case. It differentiates pathogens by TLR. The aim - to enhance the efficacy of treatment of chronic catarrhal gingivitis in children suffering from type 1 diabetes mellitus by means of improving the methods of pharmacological correction on the basis of investigation of the indices of local natural immune response and microbiological properties of the disease. We formed 2 group of the study. Children received basic insulin therapy. The treatment of chronic catarrhal gingivitis in children from the main group were suggested the antiseptic solution "Decasan"; pill of a probiotic action "BioGaia ProDentis" and the immune modulator "Imupret". Children from the comparative group were treated according to the common scheme. Oral microflora of children after treatment was decreased by 69,42% of general microbial number in children from the main group. Natural immunity state was also indicative of the improved protective mechanisms of the oral cavity in children from the main subgroup in the dynamics of treatment: twice as less level of mRNA TLR-2 expression was found in the main subgroup and mRNA TLR-4 - 45,44%. Therefore, the initiated course of treatment concerning chronic catarrhal gingivitis promoted a considerable improvement of the periodontal tissue state in children.


Asunto(s)
Diabetes Mellitus Tipo 1/complicaciones , Gingivitis/inmunología , Gingivitis/microbiología , Enfermedades Periodontales/patología , Antiinfecciosos Locales/uso terapéutico , Niño , Comorbilidad , Diabetes Mellitus Tipo 1/tratamiento farmacológico , Diabetes Mellitus Tipo 1/epidemiología , Ecosistema , Gingivitis/tratamiento farmacológico , Gingivitis/epidemiología , Humanos , Insulina/administración & dosificación , Enfermedades Periodontales/complicaciones , Enfermedades Periodontales/epidemiología , Probióticos/administración & dosificación
11.
Zhonghua Nei Ke Za Zhi ; 58(12): 889-893, 2019 Dec 01.
Artículo en Chino | MEDLINE | ID: mdl-31775451

RESUMEN

Objective: To evaluate the effect of mobile application (APP) based interactive peer support on glycemic control in patients with type 1 diabetes mellitus (T1DM). Methods: The data of the present study were from the largest mobile APP platform for patients with T1DM in China, Tangtangquan. Patients with T1DM who has registered in the APP for at least 1 year and had completed data entry were recruited. According to the monthly interaction index during the first year of APP registration (including four indicators: praise, comment, posting and collection), the eligible patients were divided into the high-interaction group and the low-interaction group. The changes from baseline of self-blood glucose monitoring frequency (SMBG), glycosylated hemoglobin (HbA1c), incidence of hyperglycemia and incidence of hypoglycemia were compared between the two groups after one year of using the APP. Results: A total of 238 patients with T1DM with an age of (27±8) years were included. Among them, 77.3% (184/238) were female. The baseline SMBG [the low-interaction group (1.71±1.14) times/day vs. the high-interaction group (1.82±1.15) times/day] and HbA1c [the low-interaction group (6.72±0.99)% vs. the high-interaction group (6.76±1.04)%] were comparable between the two groups. After one year use of the APP, the frequency of SMBG in the high-interaction group was significantly higher than that in the low-interaction group [ΔSMBG (0.59+2.06) times/d vs. (0.08+1.69) times/d, t=4.280, P=0.04), and the reduction of HbA1c was more obvious in the high-interaction group [ΔHbA1c (-0.40+1.10)% vs. (-0.06+1.13)%, t=5.651, P=0.018] than in the lower-interaction group. The incidence of hyperglycemia in the high-interaction group was significantly lower than that in the low-interaction group [13.19(6.22,23.19)% vs. 17.69(10.56,30.49)%, Z=2.850, P=0.005]. There was no significant difference in the incidence of hypoglycemia between the two groups [4.62(2.14, 8.03)% vs. 4.83(2.06, 8.87)%, Z=1.276, P=0.204]. The correlation analysis showed that interaction index was significantly associated with the reduction of HbA1c and incidence of hyperglycemia. Conclusion: Participation in interactive peer education via mobile APP may be beneficent for glycemic control in patients with T1DM.


Asunto(s)
Automonitorización de la Glucosa Sanguínea/métodos , Diabetes Mellitus Tipo 1/sangre , Aplicaciones Móviles , Grupo Paritario , Adulto , Glucemia , China , Diabetes Mellitus Tipo 1/epidemiología , Femenino , Hemoglobina A Glucada , Humanos , Hiperglucemia/epidemiología , Incidencia , Persona de Mediana Edad , Cooperación del Paciente
12.
PLoS Med ; 16(10): e1002926, 2019 10.
Artículo en Inglés | MEDLINE | ID: mdl-31574092

RESUMEN

BACKGROUND: Diabetes mellitus (DM) increases the risk of adverse maternal and neonatal outcomes, and optimization of glycemic control during pregnancy can help mitigate risks associated with diabetes. However, studies seldom focus precisely on maternal blood glucose level prior to pregnancy. We aimed to evaluate the associations between preconception blood fasting plasma glucose (FPG) level and subsequent pregnancy outcomes. METHODS AND FINDINGS: We conducted a population-based retrospective cohort study among 6,447,339 women aged 20-49 years old who participated in National Free Pre-Pregnancy Checkups Project and completed pregnancy outcomes follow-up between 2010 and 2016 in China. During the preconception health examination, serum FPG concentration was measured, and self-reported history of DM was collected. Women were classified into three groups (normal FPG group: FPG < 5.6 mmol/L and no self-reported history of DM; impaired fasting glucose [IFG]: FPG 5.6-6.9 mmol/L and no self-reported history of DM; and DM: FPG ≥ 7.0 mmol/L or self-reported history of DM). The primary outcomes were adverse pregnancy outcomes, including spontaneous abortion, preterm birth (PTB), macrosomia, small for gestational age infant (SGA), birth defect, and perinatal infant death. Logistic regression model was used to calculate odds ratio (OR) and 95% confidence interval (CI) after adjusting for confounding variables. The mean age of women was 25.24 years, 91.47% were of Han nationality, and 92.85% were from rural areas. The incidence of DM and IFG was 1.18% (76,297) and 13.15% (847,737), respectively. Only 917 (1.20%) women reported a history of DM (awareness of their DM status), of whom 37.28% (337) had an elevated preconception FPG level (≥ 5.6 mmol/L), regarded as noncontrolled DM. A total of 1,005,568 (15.60%) women had adverse pregnancy outcomes. Compared with women with normal FPG, women with IFG had higher risks of spontaneous abortion (OR 1.08; 95% CI 1.06-1.09; P < 0.001), PTB (1.02; 1.01-1.03; P < 0.001), macrosomia (1.07; 1.06-1.08; P < 0.001), SGA (1.06; 1.02-1.10; P = 0.007), and perinatal infant death (1.08; 1.03-1.12; P < 0.001); the corresponding ORs for women with DM were 1.11 (95% CI 1.07-1.15; P < 0.001), 1.17 (1.14-1.20; P < 0.001), 1.13 (1.09-1.16; P < 0.001), 1.17 (1.04-1.32; P = 0.008), and 1.59 (1.44-1.76; P < 0.001). Women with DM also had a higher risk of birth defect (OR 1.42; 95% CI 1.15-1.91; P = 0.002). Among women without self-reported history of DM, there was a positive linear association between FPG levels and spontaneous abortion, PTB, macrosomia, SGA, and perinatal infant death (P for trend <0.001, <0.001, <0.001, 0.001, <0.001). Information about hypoglycemic medication before or during pregnancy was not collected, and we cannot adjust it in the analysis, which could result in underestimation of risks. Data on 2-hour plasma glucose level and HbA1c concentration were not available, and the glycemic control status was evaluated according to FPG value in women with DM. CONCLUSIONS: Women with preconception IFG or DM had higher risk of adverse pregnancy outcomes, including spontaneous abortion, PTB, macrosomia, SGA, and perinatal infant death. Preconception glycemic control through appropriate methods is one of the most important aspects of preconception care and should not be ignored by policy makers.


Asunto(s)
Diabetes Mellitus Tipo 1/complicaciones , Diabetes Mellitus Tipo 2/complicaciones , Resultado del Embarazo , Embarazo en Diabéticas/epidemiología , Adulto , Glucemia , China/epidemiología , Estudios de Cohortes , Diabetes Mellitus Tipo 1/epidemiología , Diabetes Mellitus Tipo 2/epidemiología , Femenino , Estudios de Seguimiento , Política de Salud , Humanos , Hiperglucemia/complicaciones , Hipoglucemia/complicaciones , Tamizaje Masivo , Edad Materna , Persona de Mediana Edad , Atención Preconceptiva , Embarazo , Complicaciones del Embarazo/diagnóstico , Complicaciones del Embarazo/epidemiología , Embarazo en Diabéticas/terapia , Nacimiento Prematuro/epidemiología , Estudios Retrospectivos , Adulto Joven
14.
Sensors (Basel) ; 19(20)2019 Oct 16.
Artículo en Inglés | MEDLINE | ID: mdl-31623111

RESUMEN

Machine learning techniques combined with wearable electronics can deliver accurate short-term blood glucose level prediction models. These models can learn personalized glucose-insulin dynamics based on the sensor data collected by monitoring several aspects of the physiological condition and daily activity of an individual. Until now, the prevalent approach for developing data-driven prediction models was to collect as much data as possible to help physicians and patients optimally adjust therapy. The objective of this work was to investigate the minimum data variety, volume, and velocity required to create accurate person-centric short-term prediction models. We developed a series of these models using different machine learning time series forecasting techniques suitable for execution within a wearable processor. We conducted an extensive passive patient monitoring study in real-world conditions to build an appropriate data set. The study involved a subset of type 1 diabetic subjects wearing a flash glucose monitoring system. We comparatively and quantitatively evaluated the performance of the developed data-driven prediction models and the corresponding machine learning techniques. Our results indicate that very accurate short-term prediction can be achieved by only monitoring interstitial glucose data over a very short time period and using a low sampling frequency. The models developed can predict glucose levels within a 15-min horizon with an average error as low as 15.43 mg/dL using only 24 historic values collected within a period of sex hours, and by increasing the sampling frequency to include 72 values, the average error is reduced to 10.15 mg/dL. Our prediction models are suitable for execution within a wearable device, requiring the minimum hardware requirements while at simultaneously achieving very high prediction accuracy.


Asunto(s)
Macrodatos , Glucemia/análisis , Diabetes Mellitus Tipo 1/sangre , Aprendizaje Automático , Adolescente , Adulto , Diabetes Mellitus Tipo 1/epidemiología , Femenino , Humanos , Masculino , Persona de Mediana Edad , Adulto Joven
15.
Endocrinol. diabetes nutr. (Ed. impr.) ; 66(8): 512-519, oct. 2019. tab, graf
Artículo en Inglés | IBECS | ID: ibc-184145

RESUMEN

Introduction: The use of statins in non-selected type 1 diabetes (T1D) populations is low. We assessed the prevalence and factors associated with statin treatment in patients meeting criteria for this therapy for primary prevention of cardiovascular disease (CVD). Material and Methods: From 2015 to 2018, T1D patients from a tertiary hospital were selected. Inclusion criteria were: ≥40 years-old, diabetic nephropathy, or T1D duration ≥10 years with ≥1 cardiovascular risk factor (CVRF). A standardized cardiovascular risk evaluation protocol was performed. Prevalence of statin treatment was evaluated according to presence of several CVRFs, and multivariable models were constructed to assess independent determinants of statin use. Results: We included 241 patients (50% women, age 48.2 ± 9.9 years, T1D duration 26.6 ± 9.0 years). Diabetic retinopathy and nephropathy, active smoking, and hypertension were present in 38%, 12%, 28%, and 27%, respectively. Overall, 43% of patients were on statins and 27% had LDL-cholesterol < 100 mg/dl. Statin users were older, and had higher body mass index (BMI), prevalence of kidney dysfunction, and hypertension (p < 0.05 for all). However, among both T1D-related and classical CVRFs, only hypertension (odds ratio [OR], 2.96; 95% confidence interval [CI] 1.48-5.91) and BMI (OR, 1.08; CI, 1.01-1.16) were independently associated with statin use in multiple regression analysis. Conclusions: Less than half of T1D patients from a tertiary hospital who met criteria for statin use were on treatment. Hypertension and BMI emerged as the only CVRFs independently associated with statin therapy. New strategies are needed to better address CVD prevention in this very high-risk population


Introducción: El uso de estatinas en población con diabetes tipo 1 (DT1) general es bajo. Estudiamos la prevalencia y factores asociados con su uso en pacientes que cumplían los criterios para esta terapia para la prevención primaria de la enfermedad cardiovascular (ECV). Material y métodos: Del 2015-2018 seleccionamos a pacientes con DT1 de un hospital terciario. Los criterios de inclusión fueron: ≥ 40 años, nefropatía diabética, o duración de DT1≥10 años con ≥ 1 factor de riesgo cardiovascular (FRCV). Se realizó un protocolo estandarizado de evaluación del riesgo cardiovascular. Finalmente, estudiamos el uso de estatinas en función de diferentes FRCV y los factores independientemente asociados con su uso (modelos multivariantes). Resultados: Incluimos 241 pacientes (50% mujeres, edad 48,2 ± 9,9 años, duración de diabetes 26,6 ± 9 años). La presencia de retinopatía, nefropatía, tabaquismo e hipertensión fue del 38, 12, 28 y 27%, respectivamente. Un 43% tomaba estatinas y un 27% presentó un colesterol-LDL<100 mg/dL. Los usuarios de estatinas tenían mayor edad, índice de masa corporal (IMC), deterioro de la función renal e hipertensión (p < 0,05). Entre todos los FRCV clásicos y específicos de la DT1, únicamente la hipertensión (odds ratio [OR], 2,96; intervalo de confianza al 95% [IC], 1,48-5,91) y el IMC (OR, 1,08; IC, 1,01-1,16) fueron los que se asociaron independientemente con su uso. Conclusiones: Menos de la mitad de pacientes con DT1 que cumplen criterios para estatinas de un hospital terciario están en tratamiento. Únicamente la hipertensión y el IMC se asociaron independientemente con su uso. Nuevas estrategias son necesarias para la prevención cardiovascular en esta población de alto riesgo


Asunto(s)
Humanos , Femenino , Adulto , Persona de Mediana Edad , Adulto , Diabetes Mellitus Tipo 1/epidemiología , Inhibidores de Hidroximetilglutaril-CoA Reductasas/administración & dosificación , Factores de Riesgo , Análisis Multivariante , Retinopatía Diabética/complicaciones , Oportunidad Relativa , Inhibidores de Hidroximetilglutaril-CoA Reductasas/metabolismo
16.
Diabetes Res Clin Pract ; 157: 107842, 2019 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-31518658

RESUMEN

AIMS: This article describes the methods, results and limitations of the International Diabetes Federation (IDF) Diabetes Atlas 9th edition estimates of worldwide numbers of cases of type 1 diabetes in children and adolescents. METHODS: Most information in the published literature is in the form of incidence rates derived from registers of newly-diagnosed cases. After systematic review of the published literature and recent conference abstracts, identified studies were quality graded. If no study was available, extrapolation was used to assign a country the rate from an adjacent country with similar characteristics. Estimates of incident cases were obtained by applying incidence rates to United Nations 2019 population estimates. Estimates of prevalent cases were derived from incidence rates after making allowance for higher mortality rates in less-developed countries. RESULTS: Incidence rates were available for 45% of countries (ranging from 6% in the sub-Saharan Africa region to 77% in the European region). Worldwide annual incidence estimates were 98,200 (128,900) new cases in the under 15 year (under 20 year) age-groups. Corresponding prevalence estimates were 600,900 (1,110,100) existing cases. Compared with estimates in earlier Atlas editions, numbers have increased in most IDF regions, reflecting incidence rate increases, but prevalence estimates have decreased in sub-Saharan Africa because allowance has been made for increased mortality in those with diabetes. CONCLUSIONS: Worldwide estimates of numbers of children and adolescents with type 1 diabetes continue to increase.


Asunto(s)
Diabetes Mellitus Tipo 1/epidemiología , Adolescente , Niño , Diabetes Mellitus Tipo 1/mortalidad , Femenino , Salud Global , Humanos , Incidencia , Lactante , Masculino , Prevalencia , Tasa de Supervivencia
17.
Surgery ; 166(6): 1017-1026, 2019 12.
Artículo en Inglés | MEDLINE | ID: mdl-31500907

RESUMEN

BACKGROUND: The threshold to perform total pancreatectomy is rather high, predominantly because of concerns for long-term consequences of brittle diabetes on patients' quality of life. Contemporary data on postoperative outcomes, diabetes management, and long-term quality of life after total pancreatectomy from large nationwide series are, however, lacking. METHODS: We performed a nationwide, retrospective cohort study among adults who underwent total pancreatectomy in 17 Dutch centers (2006-2016). Morbidity and mortality were analyzed, and long-term quality of life was assessed cross-sectionally using the following generic and disease-specific questionnaires: the 5-level version European quality of life 5-dimension and the European Organization for Research and Treatment in Cancer Quality of Life Questionnaire Cancer. Several questionnaires specifically addressing diabetic quality of life included the Problem Areas in Diabetes Scale 20, the Diabetes Treatment Satisfaction Questionnaire-status version, and the Hypoglycemia Fear Survey-II. Results were compared with the general population and patients with type 1 diabetes. RESULTS: Overall, 148 patients after total pancreatectomy were included. The annual nationwide volume of total pancreatectomy increased from 5 in 2006 to 32 in 2015 (P < .05). The 30-day and 90-day mortality were 5% and 8%, respectively. The major complication rate was 32%. Quality of life questionnaires were completed by 60 patients (85%, median follow-up of 36 months). Participants reported lower global (73 vs 78, P = .03) and daily health status (0.83 vs 0.87, P < .01) compared to the general population. Quality of life did not differ based on time after total pancreatectomy (<3, 3-5, or >5 years). In general, patients were satisfied with their diabetes therapy and experienced similar diabetes-related distress as patients with type 1 diabetes. CONCLUSION: This nationwide study found increased use of total pancreatectomy with a relatively high 90-day mortality. Long-term quality of life was lower compared to the general population, although differences were small. Diabetes-related distress and treatment satisfaction were similar to patients with type 1 diabetes.


Asunto(s)
Diabetes Mellitus Tipo 1/epidemiología , Pancreatectomía/efectos adversos , Neoplasias Pancreáticas/cirugía , Pancreatitis Crónica/cirugía , Complicaciones Posoperatorias/epidemiología , Calidad de Vida , Adulto , Anciano , Anciano de 80 o más Años , Estudios Transversales , Diabetes Mellitus Tipo 1/etiología , Diabetes Mellitus Tipo 1/psicología , Femenino , Mortalidad Hospitalaria/tendencias , Humanos , Masculino , Persona de Mediana Edad , Países Bajos/epidemiología , Pancreatectomía/estadística & datos numéricos , Pancreatectomía/tendencias , Neoplasias Pancreáticas/mortalidad , Pancreatitis Crónica/mortalidad , Satisfacción del Paciente/estadística & datos numéricos , Complicaciones Posoperatorias/etiología , Complicaciones Posoperatorias/psicología , Estudios Retrospectivos , Encuestas y Cuestionarios/estadística & datos numéricos , Factores de Tiempo , Resultado del Tratamiento
18.
BMC Oral Health ; 19(1): 213, 2019 09 14.
Artículo en Inglés | MEDLINE | ID: mdl-31521152

RESUMEN

BACKGROUND: Dental caries and type 1 diabetes are responsible for a large burden of global disease; however, the exact prevalence of dental caries among children and adolescents with type 1 diabetes remains controversial, and no quantitative meta-analysis exists. Thus, we performed a meta-analysis to evaluate the prevalence of dental caries among children and adolescents with type 1 diabetes. METHODS: We performed a systematic search strategy using PubMed, EMBASE and China National Knowledge Infrastructure for relevant studies investigating the prevalence of dental caries in children and adolescents with type 1 diabetes from July 1971 until December 2018. The pooled prevalence with 95% confidence intervals (95%CIs) and subgroup analyses were calculated using a random effects model. RESULTS: After screening 358 non-duplicated articles, a total of 10 articles involving 538 individuals were included. The overall prevalence of dental caries among children and adolescents with type 1 diabetes was 67% (95% CI: 0.56-0.77%; I2 = 83%). The prevalence was highest in South America (84%) and lowest in diabetic patients with good metabolic control (47%). CONCLUSIONS: The prevalence of dental caries was high among children and adolescents with type 1 diabetes. Screening and preventive treatment should be included in dental clinical routines for diabetic children and adolescents, especially in those with poor metabolic control.


Asunto(s)
Caries Dental/epidemiología , Diabetes Mellitus Tipo 1/epidemiología , Adolescente , Niño , China/epidemiología , Humanos , Prevalencia
19.
Nutrients ; 11(9)2019 Sep 11.
Artículo en Inglés | MEDLINE | ID: mdl-31514368

RESUMEN

Type 1 diabetes (T1D) is a chronic autoimmune disease leading to immune-mediated destruction of pancreatic beta cells, resulting in the need for insulin therapy. The incidence of T1D is increasing worldwide, thus prompting researchers to investigate novel immunomodulatory strategies to halt autoimmunity and modify disease progression. T1D is considered as a multifactorial disease, in which genetic predisposition and environmental factors interact to promote the triggering of autoimmune responses against beta cells. Over the last decades, it has become clear that vitamin D exerts anti-inflammatory and immunomodulatory effects, apart from its well-established role in the regulation of calcium homeostasis and bone metabolism. Importantly, the global incidence of vitamin D deficiency is also dramatically increasing and epidemiologic evidence suggests an involvement of vitamin D deficiency in T1D pathogenesis. Polymorphisms in genes critical for vitamin D metabolism have also been shown to modulate the risk of T1D. Moreover, several studies have investigated the role of vitamin D (in different doses and formulations) as a potential adjuvant immunomodulatory therapy in patients with new-onset and established T1D. This review aims to present the current knowledge on the immunomodulatory effects of vitamin D and summarize the clinical interventional studies investigating its use for prevention or treatment of T1D.


Asunto(s)
Autoinmunidad/efectos de los fármacos , Diabetes Mellitus Tipo 1/tratamiento farmacológico , Factores Inmunológicos/uso terapéutico , Células Secretoras de Insulina/efectos de los fármacos , Deficiencia de Vitamina D/tratamiento farmacológico , Vitamina D/uso terapéutico , Adolescente , Adulto , Animales , Niño , Diabetes Mellitus Tipo 1/epidemiología , Diabetes Mellitus Tipo 1/inmunología , Diabetes Mellitus Tipo 1/metabolismo , Femenino , Humanos , Células Secretoras de Insulina/inmunología , Células Secretoras de Insulina/metabolismo , Masculino , Persona de Mediana Edad , Factores de Riesgo , Vitamina D/inmunología , Vitamina D/metabolismo , Deficiencia de Vitamina D/epidemiología , Deficiencia de Vitamina D/inmunología , Deficiencia de Vitamina D/metabolismo
20.
Acta Diabetol ; 56(12): 1315-1321, 2019 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-31493030

RESUMEN

AIM: To assess the association between alcohol consumption and/or cigarette smoking with other unhealthy behaviors and clinical cardiovascular risk factors in youth with type 1 diabetes. METHODS: Two hundred and twenty-eight youth with type 1 diabetes (age 13-19 years) were consecutively enrolled in three Regional Pediatric Diabetes Centers in Italy. Demographic, anthropometric, lifestyle (adherence to the Mediterranean diet pattern and sports participation) and laboratory parameters were compared among youth reporting isolated or combined alcohol consumption and/or cigarette smoking. RESULTS: Ten percent of the youth reported alcohol consumption, 10% cigarette smoking and 6% both alcohol and cigarette use; 74% did not report alcohol or cigarette use. Compared to non-drinker non-smoker youth, smokers showed significantly higher percentages of each of the behavioral and clinical cardiovascular risk factors. Drinkers showed a significantly higher proportion of abdominal adiposity, dyslipidemia and poor adherence to the Mediterranean diet. Alcohol consumption was independently associated with both dyslipidemia and high glycosylated hemoglobin. CONCLUSIONS: Our findings emphasize the need to increase the awareness of youth with T1D about the negative impact of alcohol drinking on cardiovascular risk, since the effects of alcohol might be underestimated with respect to the well-known detrimental effects of smoking. Clustering of unhealthy lifestyle should be discouraged in type 1 diabetes youth in order to promote cardiovascular protection.


Asunto(s)
Consumo de Bebidas Alcohólicas/epidemiología , Enfermedades Cardiovasculares/epidemiología , Fumar Cigarrillos/epidemiología , Diabetes Mellitus Tipo 1/epidemiología , Angiopatías Diabéticas/epidemiología , Adolescente , Adulto , Consumo de Bebidas Alcohólicas/efectos adversos , Enfermedades Cardiovasculares/etiología , Fumar Cigarrillos/efectos adversos , Diabetes Mellitus Tipo 1/sangre , Diabetes Mellitus Tipo 1/complicaciones , Angiopatías Diabéticas/etiología , Femenino , Hemoglobina A Glucada/análisis , Hemoglobina A Glucada/metabolismo , Humanos , Italia/epidemiología , Estilo de Vida , Masculino , Factores de Riesgo , Fumar/efectos adversos , Fumar/epidemiología , Adulto Joven
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