Impact of Flash Glucose Monitoring on the Fear of Hypoglycemia Phenomenon in Adults with Type 1 Diabetes.

Objective: To assess the clinical impact of flash glucose monitoring (FGM) systems on fear of hypoglycemia (FoH) and quality of life in adults with type 1 diabetes mellitus (T1DM). Methods: Prospective quasi-experimental study with a 12-month follow-up. People with T1DM (18-80 years old) and self-monitoring by blood capillary glycemia controls were included. The FH15 questionnaire, a survey validated in Spanish in a comparable study population, was used to diagnose FoH with a cutoff point of 28 points. Results: A total of 181 participants were included, with a FoH prevalence of 69% (n = 123). A mean reduction in FH15 score of -4 points (95% confidence interval [-5.5 to -3]; P < 0.001) was observed, along with an improvement in quality of life (EsDQOL-test (Diabetes Quality of Life, Spanish version), -7 points [-10; -4], P < 0.001) and satisfaction with treatment (Diabetes Treatment Satisfaction questionnaire, self-reported version [DTSQ-s] test, +4.5 points [4; 5.5], P < 0.001). At the end of the follow-up, 64.2% of the participants saw an improved FoH intensity, compared to 35.8% who scored the same or higher. This improvement in FoH status was associated with a higher time-in-range at the end of the follow-up (P = 0.003), as well as a lower time spent in hyperglycemia (P = 0.005). In addition, it was linked to participants with a high baseline FoH levels (P < 0.001) and those who were university degree holders (P = 0.07). Conclusions: FGM is associated with an overall reduction of FoH in adults with T1DM and with an increase in their quality of life. Nevertheless, a significant percentage of patients may experience an increase of this phenomenon leading to clinical repercussions and a profound impact on quality of life.

Effectiveness of a flash glucose monitoring systems implementation program through a group and telematic educational intervention in adults with type 1 diabetes.

OBJECTIVES: Verifying the clinical effectiveness and the impact on quality-of-life parameters, fear of hypoglycaemia and satisfaction with the treatment obtained with a flash glucose monitoring (MFG) devices implantation program that includes a telematic and group educational intervention in adults with type 1 diabetes. PATIENTS AND METHODS: Prospective quasi-experimental study, carried out during the COVID-19 pandemic period with a 9-month follow-up at the Virgen Macarena University Hospital, Sevilla. RESULTS: Eighty-eight participants were included (men: 46.6%; mean age (years) 38.08, SD: 9.38); years of DM1 evolution: 18.4 (SD: 10.49); treatment with multiple doses insulin (MDI) 70.5% vs 29.5% subcutaneous insulin infusion therapy (CSII)). Baseline HbA1c was 7.74% (1.08). After the intervention, the global decrease in HbA1c was -0.45% (95% CI [-0.6, -0.25], P < 0.01), increasing to -1.08% in the group that started with HbA1c ≥ 8% (P < 0.01). A mean decrease in the Fear of Hypoglycemia 15 (FH15) test score of -6.5 points was observed (P < 0.01). In the global score of the Spanish version of Diabetes Quality Of Life (DQOL-s) test, the decrease was -8.44 points (P < 0.01). In Diabetes Treatment Satisfaction Questionnaire test (DTQ-s), global score increased in + 4 points (P < 0.01). CONCLUSIONS: The incorporation of an educational program in group and telematic format within the development of MFG devices implantation strategies is an effective option, with associated benefits in quality of life and fear of hypoglycemia in adult patients with DM1. This option can be implemented in usual clinical practice.

Increased salivary oxidative stress parameters in patients with type 2 diabetes: Relation with periodontal disease. / Incremento de los parámetros de estrés oxidativo salival en pacientes con diabetes tipo 2: relación con la enfermedad periodontal.

OBJECTIVE: The aim of this study was to determine whether there are differences in salivary oxidative stress between patients with diabetes mellitus type 2 (DM2) and healthy non-diabetic patients, and whether this oxidative stress is associated with the presence of periodontal disease in diabetic patients. MATERIAL AND METHODS: This observational study included 70 patients divided into three groups according to metabolic control levels: 19 non-diabetic patients (control group); 24 patients with good metabolic control (HbA1c<7%), and 27 patients DM2 with poor metabolic control (HbA1c>7%). The following oxidative stress parameters were measured in all subjects: glutathione peroxidase (GPx), glutathione reductase (GRd), reduced glutathione (GSH) and oxidized glutathione (GSSG). Periodontal health was determined by means of the community periodontal index (CPI) recommended by the WHO. RESULTS: The diabetic group with good metabolic control showed a significant increase in GPx and GRd activity in comparison with the control group (P<.001). The activity of the enzymes measured was significantly less in patients with poor metabolic control in comparison with the control group and well-controlled diabetic groups (P<.001). Both diabetic groups showed higher GSSG/GSH quotients and CPI in comparison with the control group, and both parameters were significantly higher in diabetic patients with poor metabolic control in comparison with well-controlled diabetic patients. CONCLUSIONS: Poor metabolic control in DM2 patients is associated with higher levels of salivary oxidative stress and worse periodontal health.

Incremento de los parámetros de estrés oxidativo salival en pacientes con diabetes tipo 2: relación con la enfermedad periodontal / Increased salivary oxidative stress parameters in patients with type 2 diabetes: Relation with periodontal disease

Objetivo: Nuestro objetivo fue analizar si existen diferencias en los niveles de estrés oxidativo salival de pacientes con DM2 en comparación con sujetos sanos no diabéticos, y si dicho estrés oxidativo se puede asociar a la presencia de enfermedad periodontal en pacientes con diabetes. Material y métodos: Se realizó un estudio observacional que incluyó 70 pacientes, estableciéndose 3 grupos de estudio en función del control metabólico: 19 pacientes sin diabetes (grupo control); 24 pacientes DM2 con buen control metabólico (HbA1c<7%), y 27 pacientes DM2 con mal control metabólico (HbA1c>7%). En todos ellos se midieron los siguientes parámetros de estrés oxidativo salival: glutatión peroxidasa (GPx), glutatión reductasa (GRd), glutatión reducido (GSH) y glutatión oxidado (GSSG). El estado de salud periodontal se determinó mediante el índice periodontal comunitario (CPI), recomendado por la OMS. Resultados: El grupo de diabetes con buen control metabólico mostró un incremento significativo en la actividad de GPx y GRd con respecto al grupo control (p<0,001). La actividad de dichas enzimas fue significativamente menor en los pacientes con diabetes con mal control metabólico en comparación con el grupo control y de diabéticos bien controlados (p<0,001). Los 2 grupos de pacientes con diabetes mostraron mayor cociente GSSG/GSH e índice CPI con respecto al grupo control, resultando también ambos parámetros significativamente aumentados en el grupo de diabetes con mal control metabólico respecto a los bien controlados. Conclusiones: Un peor control metabólico se asocia a mayores niveles de estrés oxidativo en saliva de pacientes con DM2, así como a un peor estado de salud periodontal (AU)

Objective: The aim of this study was to determine whether there are differences in salivary oxidative stress between patients with diabetes mellitus type 2 (DM2) and healthy non-diabetic patients, and whether this oxidative stress is associated with the presence of periodontal disease in diabetic patients. Material and methods: This observational study included 70 patients divided into three groups according to metabolic control levels: 19 non-diabetic patients (control group); 24 patients with good metabolic control (HbA1c<7%), and 27 patients DM2 with poor metabolic control (HbA1c>7%). The following oxidative stress parameters were measured in all subjects: glutathione peroxidase (GPx), glutathione reductase (GRd), reduced glutathione (GSH) and oxidized glutathione (GSSG). Periodontal health was determined by means of the community periodontal index (CPI) recommended by the WHO. Results: The diabetic group with good metabolic control showed a significant increase in GPx and GRd activity in comparison with the control group (P<.001). The activity of the enzymes measured was significantly less in patients with poor metabolic control in comparison with the control group and well-controlled diabetic groups (P<.001). Both diabetic groups showed higher GSSG/GSH quotients and CPI in comparison with the control group, and both parameters were significantly higher in diabetic patients with poor metabolic control in comparison with well-controlled diabetic patients. Conclusions: Poor metabolic control in DM2 patients is associated with higher levels of salivary oxidative stress and worse periodontal health (AU)

Eficacia terapéutica de exenatida en una paciente con síndrome de Prader-Willi / Therapeutic effectiveness of exenatide in a patient with Prader-Willi syndrome

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Diabetes mellitus tipo 2 descompensada y disfunción renal en paciente con trasplante cardiaco en tratamiento inmunosupresor / Uncontrolled type 2 diabetes mellitus and renal impairment in a patient with heart transplant and immunosuppressive therapy

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