Estudio de calidad de vida y adherencia al tratamiento en pacientes de 2 a 16 años con diabetes mellitus tipo 1 en Andalucía / Study of the quality of life and adherence to treatment in patients from 2 to 16 years-old with type 1 diabetes mellitus in Andalusia, Spain

INTRODUCCIÓN: La diabetes mellitus 1 es la segunda enfermedad crónica y el trastorno endocrino-metabólico más frecuente en la infancia. Se estima una prevalencia entre 1,1 y 1,4/1000 menores de 15 años. En Andalucía la prevalencia es mayor (1,7 por mil). El objetivo del estudio es analizar la calidad de vida y adherencia al tratamiento, centrándonos en la población pediátrica de Andalucía. MÉTODOS: Estudio analítico observacional transversal multicéntrico. La muestra fue de 178 pacientes de seis hospitales con Endocrinología Pediátrica. A cada paciente se le entregaron dos cuestionarios; la encuesta de calidad de vida (PedsQL versión 3.0) y adherencia al tratamiento SCI-R. Además, se recogieron datos demográficos, clínicos, del control metabólico, y complicaciones. RESULTADOS: Se obtuvieron niveles altos tanto en la adherencia como en la calidad de vida. La primera se relacionó de forma inversa con la edad y la HbA1c, aunque el coeficiente fue tan bajo que no permite sacar conclusiones significativas. La calidad de vida se asoció con el uso de sistema de monitorización continua de glucosa en tiempo real (MCG-TR) integrado con ISCI, así como con menos hipoglucemias graves y complicaciones renales. La HbA1c media fue 7,1%. El 12,9% de los pacientes usaban ISCI. El 83,2% empleaban exclusivamente la glucemia capilar, mientras que el 16,8% usaba algún dispositivo de monitorización de glucosa intersticial. CONCLUSIONES: Se trata del primer estudio realizado en Andalucía que analiza la calidad de vida en pacientes pediátricos. Los resultados muestran niveles altos de adherencia y de calidad de vida, además de un buen control metabólico

INTRODUCTION: Diabetes mellitus 1 is the second most frequent chronic disease, and the most frequent endocrine-metabolic disorder in childhood. The estimated prevalence is between 1.1 and 1.4 / 1000 children under 15 years years-old. In Andalusia the prevalence is higher (1.7 per thousand). The objective of the study is to evaluate health-related quality of life (HRQoL) and adherence to treatment, specifically in the paediatric population of Andalusia. METHODS: A multicentre cross-sectional observational analytical study was conducted on a sample of 178 patients from six hospitals with a Paediatric Endocrinology Unit. Each patient received two questionnaires; quality of life (PedsQL version 3.0) and adherence to the self-care recommendations (SCI-R) treatment. The demographic, clinical, metabolic control data, and possible complications were also collected. RESULTS: High levels were obtained in both adherence and health-related quality of life (HRQoL). Adherence was inversely related to age and HbA1c. The health-related quality of life (HRQoL) was associated with the use of a continuous real-time glucose monitoring system (MCG-TR) combined with continuous subcutaneous insulin infusion (CSII), as well as with a lower number of severe hypoglycaemia and renal complications. The mean HbA1c was 7.1%. 12,9% of patients used ISCI. 83.2% used capillary glycemia exclusively, while 16.8% used some interstitial glucose monitoring device. CONCLUSIONS: This is the first study in Andalusia that analyzes the health-related quality of life (HRQoL) of pediatric patients. The results show high levels of adherence and health-related quality of life (HRQoL), as well as good metabolic control

[Study of the quality of life and adherence to treatment in patients from 2 to 16 years-old with type 1 diabetes mellitus in Andalusia, Spain]. / Estudio de calidad de vida y adherencia al tratamiento en pacientes de 2 a 16 años con diabetes mellitus tipo 1 en Andalucía.

INTRODUCTION: Diabetes mellitus 1 is the second most frequent chronic disease, and the most frequent endocrine-metabolic disorder in childhood. The estimated prevalence is between 1.1 and 1.4 / 1000 children under 15 years years-old. In Andalusia the prevalence is higher (1.7 per thousand). The objective of the study is to evaluate health-related quality of life (HRQoL) and adherence to treatment, specifically in the paediatric population of Andalusia. METHODS: A multicentre cross-sectional observational analytical study was conducted on a sample of 178 patients from six hospitals with a Paediatric Endocrinology Unit. Each patient received two questionnaires; quality of life (PedsQL version 3.0) and adherence to the self-care recommendations (SCI-R) treatment. The demographic, clinical, metabolic control data, and possible complications were also collected. RESULTS: High levels were obtained in both adherence and health-related quality of life (HRQoL). Adherence was inversely related to age and HbA1c. The health-related quality of life (HRQoL) was associated with the use of a continuous real-time glucose monitoring system (MCG-TR) combined with continuous subcutaneous insulin infusion (CSII), as well as with a lower number of severe hypoglycaemia and renal complications. The mean HbA1c was 7.1%. 12,9% of patients used ISCI. 83.2% used capillary glycemia exclusively, while 16.8% used some interstitial glucose monitoring device. CONCLUSIONS: This is the first study in Andalusia that analyzes the health-related quality of life (HRQoL) of pediatric patients. The results show high levels of adherence and health-related quality of life (HRQoL), as well as good metabolic control.

Prospective Analysis of the Impact of Commercialized Hybrid Closed-Loop System on Glycemic Control, Glycemic Variability, and Patient-Related Outcomes in Children and Adults: A Focus on Superiority Over Predictive Low-Glucose Suspend Technology.

Background: Automatization of insulin delivery by closed-loop systems represents a major step in type 1 diabetes management. The aim of this study was to analyze the effect of the commercialized hybrid closed-loop system, the MiniMed 670G system, on glycemic control, glycemic variability, and patient satisfaction. Methods: A prospective study, including type 1 diabetes patients consecutively starting on the 670G system in one adult and two pediatric hospitals, was performed. Baseline and 3-month visits were documented. Two weeks of data from the system were downloaded. Glycemic variability measures were calculated. Adults and adolescents completed a set of questionnaires (Gold and Clarke scores, Hypoglycemia Fear Survey, Diabetes Quality of Life [DQoL], Diabetes Treatment Satisfaction [DTS], Diabetes Distress Scale, Pittsburgh Sleep Quality Index). Results: Fifty-eight patients were included (age: 28 ± 15 years [7-63], <18 years old: 38% [n = 22], 59% [n = 34] females, previous use of SAP-PLGS [predictive low-glucose suspend]: 60% [n = 35]). HbA1c was reduced from 57 ± 10 to 53 ± 7 mmol/L (7.4% ± 0.9% to 7.0% ± 0.6%) (P < 0.001) and time in range 70-180 mg/dL was increased from 63.0% ± 11.4% to 72.7% ± 8.7% (P < 0.001). In patients with high baseline hypoglycemia risk, time <54 and <70 mg/dL were reduced from 0.9% ± 1.1% to 0.45% ± 0.7% (P = 0.021) and from 3.3% ± 2.8% to 2.1% ± 2.1% (P = 0.019), respectively. Glycemic variability measures improved. Time in auto mode was 85% ± 17%, the number of auto mode exits was 0.6 ± 0.3 per day, and the number of alarms was 8.5 ± 3.7 per day. Fear of hypoglycemia, DQoL, DTS, and diabetes distress improved, while the percentage of patients with poor sleep quality was reduced. The discontinuation rate was 3%. Conclusion: The commercialized hybrid closed-loop system improves glycemic control and glycemic variability in children and adults, reducing the burden of living with type 1 diabetes.

Estudio de costes directos de la diabetes mellitus tipo 1 en pacientes entre 2 y 16 años en Andalucía / Study of direct costs of type 1 diabetes mellitus in Andalusian patients aged 2-16 years

Introducción: La diabetes mellitus tipo 1 es la segunda enfermedad crónica y el trastorno endocrino-metabólico más frecuente en la infancia. El objetivo de este estudio es realizar una estimación del coste directo de la diabetes mellitus tipo 1 en Andalucía, en pacientes pediátricos. Metodología: Se trata de un estudio descriptivo, observacional multicéntrico realizado durante 6 meses consecutivos de 2017-2018, partiendo de una muestra de 220 pacientes, procedentes de 6 centros hospitalarios de Andalucía. Se recogieron variables demográficas, variables relacionadas con el control metabólico, uso de sistemas de monitorización continua de glucosa, hemoglobina glucosilada media, episodios de hipoglucemias graves o cetoacidosis, comorbilidades y complicaciones existentes, así como los costes directos sanitarios; englobando los costes de medicación, materiales, determinaciones analíticas, pruebas complementarias y los relacionados con la asistencia sanitaria tanto hospitalaria como extrahospitalaria. Resultados: Se obtuvo una muestra de 178 pacientes. La edad media al diagnóstico fue de 6 años y los años de evolución de la enfermedad de 4,69 (0,29 DE) años. La hemoglobina glucosilada media fue de 7,06%, encontrándose el 25% por encima de 7,5%. El coste medio anual estimado por paciente fue de 4.720,4 €. El derivado de las insulinas (2.212,9 €) y el material para la administración de la misma y monitorización de la glucemia (1.518 €) supusieron el mayor porcentaje del gasto (79,1%). No se detecta asociación entre el control metabólico, comorbilidades y el coste de la enfermedad. Conclusión: Este estudio demuestra un coste directo asociado a la DM en edad pediátrica en Andalucía de aproximadamente 4.700 € por paciente

Introduction: Type 1 Diabetes Mellitus (T1DM) is the second leading chronic disease and the most common endocrine-metabolic disorder in childhood. The study objective was to estimate the direct cost of T1DM in pediatric patients in Andalusia. Methodology: A descriptive, observational, multicenter study was conducted during six consecutive months of 2017-2018 on a sample of 220 patients from 6 hospitals in Andalusia. Variables collected included demographic characteristics, metabolic control parameters, glucose levels, use of continuous monitoring systems, mean HbA1c levels, episodes of severe hypoglycemia and ketoacidosis, comorbidities and complications, as well as direct healthcare costs, including costs of drugs, materials, laboratory tests, and supplemental tests, as well as those derived from both inpatient and outpatient care. Results: The study sample consisted of 178 patients. Mean age at diagnosis was 6 years, and mean disease duration was 4.69 (0.29 SD) years. Mean HbA1c level was 7.06%, and 25% of patients had values higher than 7.5%. The estimated annual cost per patient was € 4,720.4. Cost derived from use of insulins (€ 2,212.9) and materials for insulin administration and blood glucose monitoring (€ 1,518) accounted for greatest proportion of cost (79.1%). No association was found between metabolic control, comorbidities, or complications and cost of disease. Conclusion: This study has shown a direct cost associated to T1DM in Andalusian children of approximately € 4,700 per patient

Study of direct costs of type 1 diabetes mellitus in Andalusian patients aged 2-16 years. / Estudio de costes directos de la diabetes mellitus tipo 1 en pacientes entre 2 y 16 años en Andalucía.

INTRODUCTION: Type 1 Diabetes Mellitus (T1DM) is the second leading chronic disease and the most common endocrine-metabolic disorder in childhood. The study objective was to estimate the direct cost of T1DM in pediatric patients in Andalusia. METHODOLOGY: A descriptive, observational, multicenter study was conducted during six consecutive months of 2017-2018 on a sample of 220 patients from 6 hospitals in Andalusia. Variables collected included demographic characteristics, metabolic control parameters, glucose levels, use of continuous monitoring systems, mean HbA1c levels, episodes of severe hypoglycemia and ketoacidosis, comorbidities and complications, as well as direct healthcare costs, including costs of drugs, materials, laboratory tests, and supplemental tests, as well as those derived from both inpatient and outpatient care. RESULTS: The study sample consisted of 178 patients. Mean age at diagnosis was 6 years, and mean disease duration was 4.69 (0.29 SD) years. Mean HbA1c level was 7.06%, and 25% of patients had values higher than 7.5%. The estimated annual cost per patient was € 4,720.4. Cost derived from use of insulins (€ 2,212.9) and materials for insulin administration and blood glucose monitoring (€ 1,518) accounted for greatest proportion of cost (79.1%). No association was found between metabolic control, comorbidities, or complications and cost of disease. CONCLUSION: This study has shown a direct cost associated to T1DM in Andalusian children of approximately € 4,700 per patient.

Incremento de lipoproteína(a) en paciente pediátrico asociado a síndrome nefrótico / Increased lipoprotein(a) in a paediatric patient associated with nephrotic syndrome

Una complicación común en los pacientes pediátricos con síndrome nefrótico (SN) es la hiperlipidemia. Alrededor del 20% de los niños no responden al tratamiento con corticoides, presentando un SN corticorresistente (SNCR), que puede evolucionar a insuficiencia renal. Se ha observado que los pacientes pediátricos con SNCR cursan con incremento de c-LDL, c-VLDL y triglicéridos, y presentan niveles elevados de lipoproteína (a) [Lp(a)]. Presentamos el caso de un niño de 5 años con diagnóstico de SNCR y dislipemia, con niveles incrementados de c-LDL, apo B100 y Lp(a). Tras el mal pronóstico de la función renal, se inicia tratamiento inmunosupresor con tacrolimus y con atorvastatina para controlar la dislipemia. A pesar de que el tacrolimus produce una elevación del colesterol total y c-LDL, las notables alteraciones del perfil lipídico del niño sugieren la existencia de un riesgo cardiovascular elevado. En estos casos sería interesante disponer de valores de referencia en edades pediátricas para nuestra área sanitaria

A common complication in paediatric patients with nephrotic syndrome (NS) is hyperlipidaemia. About 20% of children do not respond to treatment with corticosteroids, presenting with a cortico-resistant NS (CRNS), which can progress to kidney failure. It has been observed that paediatric patients with CRNS have an elevated low density lipoprotein cholesterol (LDL-c), very low density lipoprotein cholesterol (VLDL-c), and triglycerides levels, as well as elevated Lipoprotein-a [Lp (a)] levels. The case is presented of a 5 year old boy, diagnosed with CRNS, presenting with dyslipidaemia with increased LDL-c, Apo-B100, and Lp(a) levels. After the poor prognosis of the renal function, immunosuppressant treatment was started with tacrolimus and atorvastatin to control dyslipidaemia. Although tacrolimus causes an elevation of total cholesterol and LDL-c, the significant alterations of the children lipid profile suggest the existence of a high cardiovascular risk. In these cases, it would be interesting to have reference values in children in our health area

[Increased lipoprotein(a) in a paediatric patient associated with nephrotic syndrome]. / Incremento de lipoproteína(a) en paciente pediátrico asociado a síndrome nefrótico.

A common complication in paediatric patients with nephrotic syndrome (NS) is hyperlipidaemia. About 20% of children do not respond to treatment with corticosteroids, presenting with a cortico-resistant NS (CRNS), which can progress to kidney failure. It has been observed that paediatric patients with CRNS have an elevated low density lipoprotein cholesterol (LDL-c), very low density lipoprotein cholesterol (VLDL-c), and triglycerides levels, as well as elevated Lipoprotein-a [Lp (a)] levels. The case is presented of a 5 year old boy, diagnosed with CRNS, presenting with dyslipidaemia with increased LDL-c, Apo-B100, and Lp(a) levels. After the poor prognosis of the renal function, immunosuppressant treatment was started with tacrolimus and atorvastatin to control dyslipidaemia. Although tacrolimus causes an elevation of total cholesterol and LDL-c, the significant alterations of the children lipid profile suggest the existence of a high cardiovascular risk. In these cases, it would be interesting to have reference values in children in our health area.

Anomalías de la diferenciación sexual. Síndrome del varón XX / Sexual differentiation anomalies. XX male síndrome

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