Asistencia al niño y adolescente con diabetes. Unidades de referencia en diabetes pediátrica / Treatment of the child and adolescent with type i diabetes: special paediatric diabetes units

El tratamiento intensivo de la diabetes mellitus tipo 1 (DM1) permite retrasar y enlentecer la progresión de las complicaciones crónicas (DCCT 1993). Este tipo de tratamiento en niños y adolescentes con DM1 tiene una complejidad diferente de la de otras etapas de la vida y por ello se necesitan Unidades de Asistencia Especializada en diabetes pediátrica. Se valoran los diferentes documentos y declaraciones sobre los derechos de los pacientes con DM1 y se enfatiza la necesidad de una adecuada asistencia sanitaria. En la última década, se han desarrollado en Europa varios proyectos para establecer una evaluación comparativa del tratamiento de la DM en edad pediátrica con el objetivo de establecer centros hospitalarios con una asistencia muy cualificada en su control. El Grupo de trabajo de Diabetes de la Sociedad Española de Endocrinología Pediátrica ha elaborado este documento con el objetivo de obtener un Consenso Nacional para la asistencia al niño y adolescente con DM1 en «Unidades de Referencia en diabetes pediátrica» y, a su vez, poder asesorar a las administraciones para establecer una Red Nacional dirigida a la asistencia del niño y adolescente con DM y organizar las Unidades de Atención Integral de la diabetes pediátrica en hospitales con nivel de referencia por su calidad asistencial (AU)

Intensive treatment of type 1 diabetes mellitus (DM1) delays and slows down the progression of chronic diabetes complications (DCCT 1993). This type of treatment in children and adolescents with DM1 has a different complexity to other stages of life and therefore, needs specialized care units. Various documents and declarations of diabetic patient's rights are evaluated, and the need for an adequate health care is emphasized. In the last decade, several projects have been developed in Europe to create a benchmark treatment of pediatric diabetes, with the aim of establishing hospitals with highly qualified healthcare to control it. The Diabetes Working Group of the Spanish Society for Pediatric Endocrinology (SEEP) has prepared this document in order to obtain a national consensus for the care of children and adolescents with type 1 diabetes in specialist Pediatric Diabetes Units, and at the same time advise Health Care Administrators to establish a national healthcare network for children and adolescents with diabetes mellitus, and organize comprehensive pediatric diabetes care units in hospitals with a reference level in quality of care (AU)

[Treatment of the child and adolescent with type 1 diabetes: special paediatric diabetes units]. / Asistencia al niño y adolescente con diabetes. Unidades de referencia en diabetes pediátrica.

Intensive treatment of type 1 diabetes mellitus (DM1) delays and slows down the progression of chronic diabetes complications (DCCT 1993). This type of treatment in children and adolescents with DM1 has a different complexity to other stages of life and therefore, needs specialized care units. Various documents and declarations of diabetic patient's rights are evaluated, and the need for an adequate health care is emphasized. In the last decade, several projects have been developed in Europe to create a benchmark treatment of pediatric diabetes, with the aim of establishing hospitals with highly qualified healthcare to control it. The Diabetes Working Group of the Spanish Society for Pediatric Endocrinology (SEEP) has prepared this document in order to obtain a national consensus for the care of children and adolescents with type 1 diabetes in specialist Pediatric Diabetes Units, and at the same time advise Health Care Administrators to establish a national healthcare network for children and adolescents with diabetes mellitus, and organize comprehensive pediatric diabetes care units in hospitals with a reference level in quality of care.

Documento consenso del Grupo de Diabetes de la SEEP: Programa de formación para la implantación del tratamiento con infusión subcutánea continua de insulina (ISCI) en pacientes pediátricos con diabetes tipo 1 / Consensus document of the Diabetes Group of the Spanish Society of Pediatric Endocrinology (SEEP): A training program to carry out treatment with continuous subcutaneous insulin infusion (CSII) in pediatric patients with type 1 diabetes

Los avances tecnológicos en los últimos años en el campo de la diabetes han permitido la aplicación de nuevas terapias para nuestros pacientes con el objetivo fundamental de mejorar su control metabólico, la calidad de vida y evitar las hipoglucemias. Esto obliga a establecer protocolos de consenso en el empleo de estas nuevas tecnologías para ser utilizadas por los distintos profesionales implicados en esta enfermedad. Este programa de formación incluye los conocimientos básicos y avanzados, para la utilización de la ISCI (AU)

Recently new technologies for the management of diabetes allow new therapeutic strategies for diabetes patients with the object of improve metabolic control, queality of life and avoid hypoglycaemias. Because physicians must be familiar with new diabetic are devices, new protocols must be establish. This article reports on the Spanish Position Statement for the Diabetes Pediatric Group for the Spanish Pediatric Endocrinology Society (SEEP) on educational program for the treatment of children and adolescent with type 1 diabetes with continuous subcutaneous insulin infusion (AU)

Ketoacidosis at onset of type 1 diabetes mellitus in pediatric age in Spain and review of the literature.

UNLABELLED: DKA at diagnosis of T1DM is a life-threatening situation that represents the main cause of morbidity and mortality in pediatric patients with T1DM. OBJECTIVE: To determine whether the occurrence and severity of DKA at diagnosis of T1DM has suffered any changes in recent years in the Spanish paediatric population. PATIENTS AND METHODS: Data from 1169 patients with T1DM under 15 years of age was retrospectively studied (2004 -2008) for the presence and severity of DKA at the onset of T1DM, and compared to previous available studies in Spain. This study is multicentric, nationwide with eleven major Paediatric Diabetes Units involved. RESULTS: Complete data were available from 1151 patients (98%). Frequency of DKA was 39.5%, which is not significantly different from previous Spanish studies. 33.8%, children of 0-4.9 years of age, 40.8% aged 5-10.9 and 25.2% aged 11-14.9 years. Mean age of patients with DKA was significantly lower than the one of patients without DKA (7.44 +/- 4.10 versus 8.47 +/- 3.63 years). Mild DKA was occurring more frequently than moderate and severe forms (47.8%, versus 34.4% versus 17.8%, p<0.0001). Incidence of severe DKA was significantly higher in children under 4.9 years of age, especially in those younger than 2 years (p<0.001). Severe DKA led to complications in three children (cerebral oedema [n=1]), cerebral infarction (n=1) and femoral vein thrombosis (n=1). CONCLUSION: Frequency of DKA at diagnosis of T1DM in Spain is still high although most cases were mild. Children under 2 years of age seem to be at increased risk for severe DKA.

Prevalence of insulin resistance and impaired glucose tolerance in a sample of obese Spanish children and adolescents.

The prevalence of obesity in children has increased in developed countries in the last decades. It is associated with alterations in glucose metabolism that may be present in childhood. To assess the frequency of glucose metabolism alterations and insulin resistance and their possible determinants in a sample of obese children from Valladolid (Spain), we retrospectively studied 100 obese children and adolescents (11.59 ± 2.73 years). Anthropometric measures, biochemical parameters, and oral glucose tolerance test (OGTT) were performed. Insulin resistance was evaluated with fasting insulin, HOMA index, and insulin values in OGTT. Impaired glucose tolerance was found in 15% of the sample, and was the most frequent of glucose metabolism alterations. Impaired fasting glucose was found in 2%. No case of type 2 diabetes was found. Acanthosis nigricans was present in 22%, with predominance in females, but not all presented insulin resistance. The prevalence of insulin resistance was 29% when HOMA index was used, and 50% when the insulin response in OGTT was used. Not all patients with impaired glucose tolerance had a pathological HOMA index, and not all with pathological HOMA index presented insulin resistance when insulin values in OGTT were used. Higher 2-h post-OGTT insulin levels were found in children with impaired glucose tolerance. It is paramount to identify young people with glucose regulation alterations for early, intensive intervention to prevent or at least postpone the onset of type 2 diabetes. OGTT is a screening tool necessary to fulfill this objective.

Hiperglucemia en ayunas y polimorfismo en el promotor de la glucoquinasa (rs1799884) / Fasting hyperglycaemia and polymorphism in glucokinase promoter (rs1799884)

La glucoquinasa es uno de los principales reguladores de la glucemia plasmática en ayunas. Numerosas mutaciones en el gen de la glucoquinasa (GCK) se han identificado como base molecular de la diabetes monogénica. Recientemente se han descrito polimorfismos en su promotor que se asocian a incrementos en la glucemia plasmática en ayunas. Se presenta a un niño de 7 años y 7 meses con sobrepeso y antecedentes de diabetes en dos generaciones previas. En la sobrecarga oral de glucosa presentó alteración de la glucemia en ayunas y a las 2h, con respuesta de insulina elevada. Las alteraciones analíticas mejoraron tras pérdida ponderal manteniendo una discreta hiperglucemia en ayunas. El estudio de las diabetes monogénicas más frecuentes, MODY subtipos 1, 2 y 3, fue negativo, encontrándose la variante alélica (G/A) en el polimorfismo rs1799884, localizado en el promotor de GCK (AU)

Glucokinase is one of the most important regulators of fasting glucose levels. There are several mutations in the glucokinase gene (GCK) which are linked with monogenic diabetes. Recently, a polymorphism in its promoter has been described, which is associated with impaired fasting glucose levels. We present a 7 years and 7 months old boy with overweight and a familial background of diabetes in two previous generations. In the oral glucose tolerance test, he had impaired fasting glucose levels and after two hours, with a high insulin response. Laboratory abnormalities improved after weight loss, but he maintains a slight fasting hyperglycaemia. The molecular study of the most common monogenic diabetes forms, MODY subtypes 1, 2, and 3, was negative. The allelic variant G/A was however detected at the GCK promoter polymorphism rs1799884 (AU)

Estado actual y recomendaciones sobre la utilización de los sistemas de monitorización continua de glucosa en niños y adolescentes con diabetes mellitus tipo 1 / Current status and recommendations on the use of continuous blood glucose monitoring systems in children and adolescents with type 1 diabetes mellitus

Los métodos de medición de la glucemia han presentado un gran avance en la última década con la aparición de los sistemas de monitorización continua de la glucosa (SMCG) que miden los niveles de glucosa en el líquido intersticial y ofrecen información sobre patrones y tendencias de los niveles de la glucemia pero no sustituyen el autocontrol de la glucemia capilar. La mejoría del control de la diabetes utilizando los SMCG depende de la motivación y formación recibida por el paciente y familia, así como de la continuidad en su uso. Debido al gran desarrollo y la amplia utilización en la práctica clínica de estos sistemas, el grupo de diabetes de la Sociedad Española de Endocrinología Pediátrica ha elaborado un documento de consenso para su indicación y uso en la edad pediátrica. Existe un número limitado de ensayos clínicos en población pediátrica sobre el uso de esta tecnología. Se necesitan más datos para poder valorar su impacto sobre el control metabólico (AU)

Glucose monitoring methods have made great advances in the last decade with the appearance of the continuous glucose monitoring systems (CGMS) that measure the glucose levels in the interstitial liquid, providing information about glucose patterns and trends, but do not replace the self-monitoring of capillary glucose. Improvement in diabetes control using the CGMS depends on the motivation and training received by the patient and family and on the continuity in its use. Due to the development and widespread use of these systems in clinical practice, the diabetes group of the Sociedad Española de Endocrinología Pediátrica has drafted a document of consensus for their indication and use in children and adolescents. Only a limited number of trials have been performed in children and adolescent populations. More data are needed on the use of this technology in order to define the impact on metabolic control (AU)

[Fasting hyperglycaemia and polymorphism in glucokinase promoter (rs1799884)]. / Hiperglucemia en ayunas y polimorfismo en el promotor de la glucoquinasa (rs1799884).

Glucokinase is one of the most important regulators of fasting glucose levels. There are several mutations in the glucokinase gene (GCK) which are linked with monogenic diabetes. Recently, a polymorphism in its promoter has been described, which is associated with impaired fasting glucose levels. We present a 7 years and 7 months old boy with overweight and a familial background of diabetes in two previous generations. In the oral glucose tolerance test, he had impaired fasting glucose levels and after two hours, with a high insulin response. Laboratory abnormalities improved after weight loss, but he maintains a slight fasting hyperglycaemia. The molecular study of the most common monogenic diabetes forms, MODY subtypes 1, 2, and 3, was negative. The allelic variant G/A was however detected at the GCK promoter polymorphism rs1799884.

[Current status and recommendations on the use of continuous blood glucose monitoring systems in children and adolescents with type 1 diabetes mellitus]. / Estado actual y recomendaciones sobre la utilización de los sistemas de monitorización continua de glucosa en niños y adolescentes con diabetes mellitus tipo 1.

Glucose monitoring methods have made great advances in the last decade with the appearance of the continuous glucose monitoring systems (CGMS) that measure the glucose levels in the interstitial liquid, providing information about glucose patterns and trends, but do not replace the self-monitoring of capillary glucose. Improvement in diabetes control using the CGMS depends on the motivation and training received by the patient and family and on the continuity in its use. Due to the development and widespread use of these systems in clinical practice, the diabetes group of the Sociedad Española de Endocrinología Pediátrica has drafted a document of consensus for their indication and use in children and adolescents. Only a limited number of trials have been performed in children and adolescent populations. More data are needed on the use of this technology in order to define the impact on metabolic control.

Diabetes mellitus tipo 1 y ganglioneuroma retroperitoneal / Onset of diabetes type 1 and retroperitoneal ganglioneuroma

El ganglioneuroma es un tumor poco frecuente, benigno, perteneciente al grupo de los tumores neuroblásticos periféricos, que aparece sobre todo en la infancia. Los tumores procedentes de la cresta neural abarcan un amplio espectro de neoplasias que incluyen formas benignas (ganglioneuroma) y formas malignas (neuroblastoma). El ganglioneuroma puede proceder de un neuroblastoma diferenciado o puede ser diagnosticado deforma primaria. Aunque la mayoría de los ganglioneuromas se descubren de forma casual, pueden originar manifestaciones clínicas por la compresión de estructuras vecinas o por su actividad metabólica intrínseca. Presentamos un caso de ganglioneuroma retroperitoneal diagnosticado incidentalmente en una niña de 6 años de edadc on sintomatología clásica de diabetes mellitus (poliuria, polidipsia y pérdida ponderal) (AU)

Introduction: A ganglioneuroma is an uncommon tumor, which belongs to the peripheral neuroblastic tumors, which appear mainly during childhood. Tumors of neural crest originin clude a broad spectrum of neoplasias ranging from benign (ganglioneuroma) to malignant tumors (neuroblastoma).The ganglioneuroma might evolve from differentiating neuroblastoma or may be diagnosed as a primary manner. Although most of ganglioneuromas are discovered incidentally, they may originate clinical manifestations due to the compression of neighboring structures or by an intrinsic metabolic activity. Case report: We present a case of retroperitoneal ganglioneuroma incidentally discovered in a 6 years girl with classic sintomatology of type 1 diabetes (polyuria, polydipsia and weight loss) (AU)

Documento de consenso sobre tratamiento con infusión subcutánea continua de insulina de la diabetes tipo 1 en la edad pediátrica / Consensus document on continuous subcutaneous insulin infusion (CSII) treatment in paediatrics with type I diabetes

Este artículo expone el documento consenso al que ha llegado el Grupo de Trabajo de Diabetes Pediátrica de la Sociedad Española de Endocrinología Pediátrica de la Asociación Española de Pediatría sobre el tratamiento con infusión subcutánea continua de insulina en diabetes tipo 1 en la edad pediátrica. Se recogen los aspectos prácticos sobre requisitos, indicaciones, contraindicaciones, candidatos, ventajas e inconvenientes de dicho tipo de tratamiento. Las conclusiones se basan en la revisión de los consensos internacionales basados en la evidencia y en el acuerdo de los participantes (AU)

This article reports on the Spanish Position Statement for the Diabetes Pediátric Group for the Spanish Pediatric Endocrinology Society (SEEP) on continuous subcutaneous insulin infusion in children and adolescents with type 1 diabetes. The practical issues about their indications, appropriate candidates, feasibility, and limits are outlined. The conclusions are based on the comprehensive review and balanced assessment of the evidence base on the international consensus and consensual answers to these questions for the participants (AU)

[Consensus document on continuous subcutaneous insulin infusion (CSII) treatment in paediatrics with type I diabetes]. / Documento de consenso sobre tratamiento con infusión subcutánea continua de insulina de la diabetes tipo 1 en la edad pediátrica.

This article reports on the Spanish Position Statement for the Diabetes Pediátric Group for the Spanish Pediatric Endocrinology Society (SEEP) on continuous subcutaneous insulin infusion in children and adolescents with type 1 diabetes. The practical issues about their indications, appropriate candidates, feasibility, and limits are outlined. The conclusions are based on the comprehensive review and balanced assessment of the evidence base on the international consensus and consensual answers to these questions for the participants.

Hemorragia vaginal aislada en tres niñas prepuberales / Isolated vaginal bleeding in three pre-puberty children

No disponible

[Epidemiology of type 1 diabetes in children and adolescents aged less than 15 years in the provinces of Castilla y León]. / Epidemiología de la diabetes tipo 1 en menores de 15 años en las provincias de Castilla y León.

INTRODUCTION: The incidence of type 1 diabetes shows wide geographical variability and heterogeneity. The aim of this study was to determine the incidence and prevalence of type 1 diabetes in children and adolescents ages less than 15 years in the different provinces of Castilla-León. MATERIAL AND METHODS: To determine incidence, all new cases of type 1 diabetes with onset under 15 years of age in 2003-2004 were obtained. Incidence was expressed as the crude value with the corresponding confidence interval and as standardized incidence. The capture-recapture method was used to calculate the completeness of ascertainment. To determine prevalence, all cases of type 1 diabetes in persons ages less than 15 years at 31 December 2004 were obtained. RESULTS: Incidence showed wide variability among the different provinces of Castilla-León. The highest values were found in Segovia (38.77/100,000/year), Valladolid (32.07/100,000/ year) and Avila (23.21/100,000/year) and the lowest in Zamora (8.14/100,000/year). Incidences were highest in the 5-9 years age group in all provinces except Burgos. Prevalence was highest in Segovia (1.54/1,000), Valladolid (1.41/1,000), Avila (1.38/1,000) and Zamora (1.32/1,000) and lowest in Burgos (0.91/1,000). CONCLUSIONS: Castilla-León seems to have one of the highest incidences of type 1 diabetes in Spain; several of its provinces have values similar to those in Northern Europe.

Epidemiología de la diabetes tipo 1 en menores de 15 años en las provincias de Castilla y León / Epidemiology of type 1 diabetes in children and adolescents aged less than 15 years in the provinces of Castilla y León (Spain)

Introducción La incidencia de diabetes tipo 1 presenta gran heterogeneidad y variabilidad geográfica. El objetivo de este estudio es determinar la incidencia y prevalencia de la diabetes tipo 1 en niños menores de 15 años en las distintas provincias de Castilla y León. Material y métodos Para el estudio de la incidencia se recogieron los nuevos diagnósticos de diabetes tipo 1 en menores de 15 años en 2003-2004. La incidencia se expresó como valor crudo con su intervalo de confianza y como incidencia estandarizada. Se utilizó el método captura-recaptura para calcular la exhaustividad. Para el cálculo de la prevalencia se recogieron todos los diabéticos tipo 1 menores de 15 años existentes en Castilla y León a fecha 31 de diciembre de 2004. Resultados Las cifras de incidencia son muy heterogéneas en las diferentes provincias de Castilla y León: las más altas se observaron en Segovia (38,77/100.000/año), Valladolid (32,07/100.000/año) y Ávila (23,21/100.000/año) y las menores en Zamora (8,14/100.000/año). El grupo de edad con mayor incidencia fue el de 5-9 años en todas las provincias excepto en Burgos. La mayor prevalencia se observa en Segovia (1,54/1.000), Valladolid (1,41/1.000), Ávila (1,38/1.000) y Zamora (1,32/1.000) y la menor en Burgos (0,91/1.000). Conclusiones Castilla y León parece tener una de las mayores incidencias de diabetes tipo 1 en España, con cifras en varias de sus provincias similares a las de algunos países nórdicos

Introduction The incidence of type 1 diabetes shows wide geographical variability and heterogeneity. The aim of this study was to determine the incidence and prevalence of type 1 diabetes in children and adolescents ages less than 15 years in the different provinces of Castilla-León. Material and methods To determine incidence, all new cases of type 1 diabetes with onset under 15 years of age in 2003-2004 were obtained. Incidence was expressed as the crude value with the corresponding confidence interval and as standardized incidence. The capture-recapture method was used to calculate the completeness of ascertainment. To determine prevalence, all cases of type 1 diabetes in persons ages less than 15 years at 31 December 2004 were obtained. Results Incidence showed wide variability among the different provinces of Castilla-León. The highest values were found in Segovia (38.77/100,000/year), Valladolid (32.07/100,000/ year) and Ávila (23.21/100,000/year) and the lowest in Zamora (8.14/100,000/year). Incidences were highest in the 5-9 years age group in all provinces except Burgos. Prevalence was highest in Segovia (1.54/1,000), Valladolid (1.41/1,000), Ávila (1.38/1,000) and Zamora (1.32/1,000) and lowest in Burgos (0.91/1,000). Conclusions Castilla-León seems to have one of the highest incidences of type 1 diabetes in Spain; several of its provinces have values similar to those in Northern Europe