Dose-Dependent association of cumulative tobacco consumption with the presence of carotid atherosclerosis in individuals with type 1 diabetes.

AIMS: Evaluate the association between cumulative tobacco consumption (CTC; packs-year) and atherosclerosis in type 1 diabetes (T1D), and study whether the inclusion of CTC in the Steno T1 Risk Engine (ST1RE) equation improves the identification of plaques. METHODS: Cross-sectional study in T1D patients without cardiovascular disease (CVD), with ≥ 1 of the following: ≥40 years-old, diabetic kidney disease, and/or T1D duration ≥ 10 years + cardiovascular risk factors.Preclinical atherosclerosis was evaluated by carotid ultrasonography. RESULTS: N = 584 patients were included (46.1 % women, age 48.7 ± 10.5 years, T1D duration 27.3 ± 10.8 years, 26.2 % active smokers). The overall plaque prevalence was 40.9 %. In models adjusted for age, sex, lipids, blood pressure, kidney function, statin use, microvascular complications and HbA1c, CTC was dose-dependently associated with the number of plaques (none, 1-2, ≥3) overall and in both active and former smokers (p < 0.001). This association remained after adjusting for ST1RE (OR 1.11 [1.02-1.19]). Although the inclusion of CTC in the ST1RE did not improve plaque identification overall (p = 0.180), it did so when analyzing active smokers separately (AUC 0.738 vs. 0.768; p < 0.01). CONCLUSIONS: In T1D patients, CTC is dose-dependently associated with atherosclerosis. Further prospective studies are needed to determine if CTC could identify T1D individuals more prone to accelerated atherosclerosis.

Severe hypoglycemia and hypoglycemia awareness are associated with preclinical atherosclerosis in patients with type 1 diabetes without an estimated high cardiovascular risk.

AIMS: To explore the relationship between severe hypoglycemia (SH) and hypoglycemia awareness with preclinical atherosclerosis in type 1 diabetes (T1D). MATERIALS AND METHODS: Cross-sectional study in patients with T1D without cardiovascular disease (CVD), and with ≥1 of the following: ≥40 years, diabetic kidney disease, or ≥10 years of T1D duration with another risk factor. CVD risk was estimated with the Steno T1 Risk Engine (Steno-Risk). Carotid plaque was evaluated using standardised ultrasonography protocol. Logistic regression models adjusted for CVD risk factors were constructed to test the independent associations with SH or hypoglycemia awareness assessed by the Clarke questionnaire (Clarke). The inclusion of SH and Clarke in Steno-Risk was further evaluated. RESULTS: We included 634 patients (52.4% men, age 48.3 ± 10.8 years, T1D duration 27.4 ± 11.1 years, 39.9% harbouring plaque). A stepped increase in the presence of plaque according to Steno-Risk was observed (13.5%, 37.7%, and 68.7%, for low, moderate, and high risk, respectively; p < 0.001). SH history (OR 4.4 [1.3-14.6]) and Clarke score (OR 1.7 [1.2-2.2]) were associated with plaque in low-risk patients (n = 192). Clarke score was also associated with plaque burden in low-moderate-risk participants (n = 436; ≥2 plaques: OR 1.2 [1.0-1.5], p = 0.031; ≥3 plaques: OR 1.4 [1.1-2.0], p = 0.025). The inclusion of SH and Clarke scores in Steno-Risk significantly improved the identification of low-risk individuals with atherosclerosis (area under the curve: 0.658 vs. 0.576; p = 0.036). CONCLUSIONS: In patients with T1D without an estimated high CVD risk, SH and hypoglycemia awareness assessment score were independently associated with preclinical atherosclerosis and improved identification of patients who would benefit from an intensive approach.

Impact of an advanced hybrid closed-loop system on glycemic control throughout the menstrual cycle in women with type 1 diabetes prone to hypoglycemia.

This study aimed to evaluate the impact of advanced hybrid closed-loop (AHCL) on glycemic control throughout the menstrual cycle (MC) in women with type 1 diabetes (T1D). We included 39 pairs of spontaneous MC from 13 participants, before and after switching from sensor-augmented pump to AHCL. Baseline time below range <70 mg/dL (TBR<70) was significantly higher during the mid-follicular phase than during late luteal phase (5.7±5.0% vs. 4.1±3.0%), but similar time in range 70-180 mg/dL (TIR) was observed throughout the MC. After switching to AHCL, a reduction in TBR<70 and an increase in TIR were observed in all phases. Phase-dependent changes in insulin infusion were detected and pre-existing differences in TBR<70 were eradicated (3.5±3.2% vs. 3.0±3.0%). However, TIR became significantly higher during the early follicular than during the late luteal phase (79.1±9.3% vs. 74.5±10.0%). In conclusion, AHCL improved glycemic control throughout the MC, but performance differed according to phase.

Adherence to an energy-restricted Mediterranean diet is associated with the presence and burden of carotid atherosclerosis in people with type 1 diabetes.

AIMS: People with type 1 diabetes (T1D) have an increased risk of cardiovascular disease (CVD). The Mediterranean diet is associated with reduced CVD; however, the evidence in T1D is scarce. We aimed to analyse the relationships between adherence to the energy-restricted Mediterranean diet (erMEDd) and carotid atherosclerosis. MATERIALS AND METHODS: We included children with T1D without CVD, with ≥1 of the following: age ≥40 years, diabetic kidney disease, or ≥10 years of disease duration with another risk factor. Plaque presence (intima-media thickness ≥1.5 mm) was determined by ultrasonography. The PREDIMED-Plus 17-item questionnaire (PP-17) was used to assess adherence to the erMEDd. RESULTS: Four hundred one individuals were included (48% males, age 48.3 ± 11 years, diabetes duration 26.8 ± 11.4 years). Those harbouring plaques (42%) showed lower adherence to the erMEDd (PP-17: 8.9 ± 2.3 of a maximum of 17 vs. 9.8 ± 2.5, p < 0.001). Greater adherence to the erMEDd was correlated with an overall better metabolic profile. After adjusting for multiple confounders, adherence to the erMEDd was independently associated with carotid atherosclerosis (OR 0.86 [0.77-0.95] for plaque presence and OR 0.85 [0.75-0.97] for ≥2 plaques). The consumption of fruit and nuts and preference of white over red meat was higher in individuals without atherosclerosis (p < 0.05). Fruit and nut consumption was associated with lower plaque prevalence in the fully adjusted models (OR 0.38 [0.19-0.73] and 0.51 [0.29-0.93]). CONCLUSIONS: Greater adherence to the erMEDd is associated with less carotid atherosclerosis in children with T1D at high risk of CVD. Strategies to improve and implement healthy dietary patterns in this population should be encouraged.

Impact of Preeclampsia and Parity on Sex-based Discrepancies in Subclinical Carotid Atherosclerosis in Type 1 Diabetes.

CONTEXT: The excess risk of fatal and nonfatal cardiovascular events is roughly twice as high in women than in men with type 1 diabetes. OBJECTIVE: To evaluate the impact of preeclampsia and parity on sex-based discrepancies in preclinical atherosclerosis and on the diagnostic performance of a cardiovascular risk scale. DESIGN: Cross-sectional study. SETTING: Single tertiary hospital. PATIENTS: A total of 728 people with type 1 diabetes (48.5% women) without cardiovascular disease and age ≥40 years, nephropathy, and/or ≥10 years of diabetes duration with another risk factor. INTERVENTION: Standardized carotid ultrasonography. MAIN OUTCOME MEASURES: Carotid plaque determined by ultrasonography and cardiovascular risk estimated according to the Steno T1 Risk Engine (Steno-Risk). RESULTS: Nulliparous women and parous women without previous preeclampsia had a lower risk for carotid plaque than men (adjusted odds ratio: .48, 95% confidence interval [.28-.82]; adjusted odds ratio: .51 [.33-.79], respectively), without differences in the preeclampsia group. The prevalence of carotid plaque increased as the estimated cardiovascular risk increased in all subgroups except for preeclampsia group. The area under the curve of the Steno-Risk for identifying ≥2 carotid plaques was lower in the preeclampsia group (men: .7886; nulliparous women: .9026; women without preeclampsia: .8230; preeclampsia group: .7841; P between groups = .042). Neither the addition of parity nor preeclampsia in the Steno-Risk led to a statistically significant increase in the area under the curve. CONCLUSION: The risk for carotid plaque in women compared with men decreased as exposure to obstetric factors diminished. However, the addition of these factors did not improve the prediction of the Steno-Risk.

Prevalence and factors associated with statin use in high-risk patients with type 1 diabetes from a specialized diabetes unit / Prevalencia y factores asociados con el uso de estatinas en pacientes de alto riesgo con diabetes tipo 1 en una unidad especializada de diabetes

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

Generalizability of results from the recent FDA-guided cardiovascular outcomes trials to a representative population with Type 2 Diabetes attending primary care clinics / Generalización de los resultados de un reciente ensayo clínico de objetivos cardiovasculares promovido por la FDA a una población representativa de pacientes con diabetes tipo 2 en atención primaria

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Situación clínica de una cohorte de pacientes con diabetes tipo 1 más de 2 décadas después del inicio. Resultados de un programa específico de seguimiento en una unidad de referencia / Clinical status of a cohort of patients with type 1 diabetes diagnosed more than 2 decades before. Results of a specific clinical follow-up program

Antecedentes y objetivo: El curso clínico de la diabetes tipo 1 (DT1) ha cambiado en las últimas décadas. Nos propusimos describir las características de una población con DT1 de más de 20 años de evolución bajo el mismo programa de seguimiento desde el inicio. Pacientes y método: Estudio observacional de corte transversal en el que incluimos los pacientes del registro de inicios de DT1 entre 1986 y 1994 de nuestra Unidad de Diabetes. Desde 1986 todos siguen el mismo protocolo de seguimiento y tratamiento. Recogimos la presencia de complicaciones micro- y macrovasculares, factores de riesgo cardiovascular, control metabólico y tratamiento. Los datos se obtuvieron de la historia clínica informatizada. La comparación entre variables cuantitativas y cualitativas se realizó con el test apropiado en cada caso. Se consideró estadísticamente significativa una p<0,05. Resultados: De 279 pacientes del registro, 153 continuaban en nuestro centro (edad media±desviación estándar: 46,6±8,6 años) con una duración media de la DT1 de 23,3±2,6 años. De estos, un 53,6% eran mujeres. El 24,8% estaba en tratamiento con infusión subcutánea continua de insulina (ISCI). La media de HbA1c en el último año fue de 7,7±1,1% (7,3±1,5% en el grupo de ISCI) y de 7,8±0,9% en los últimos 5 años. Un 19,6% fumaban, 15,7% tenían hipertensión arterial y 37,9% dislipidemia. Un 20,4% presentaban retinopatía diabética y el 11,3% nefropatía. Únicamente un 1,3% presentaba antecedentes de enfermedad cardiovascular. Conclusiones: Tras más de 2 décadas de evolución de la DT1, consideramos que la prevalencia de complicaciones micro- y macrovasculares en nuestros pacientes con DT1 en un programa específico de seguimiento desde el inicio de la enfermedad es baja o, en algún caso, sustancialmente inferior a la esperada (AU)

Background and objective: The clinical course of type 1 diabetes mellitus (T1DM) has changed in recent decades. The aim of our study was to assess the long-term (> 20 years) clinical status of a patient cohort with T1DM under a specific treatment and follow-up program. Patients and methods: A single center, observational, cross-sectional study was conducted of a patient cohort diagnosed with T1DM in the 1986-1994 period at our tertiary university hospital. Clinical characteristics, metabolic parameters, and occurrence of chronic complications and comorbidities after > 20 years of follow-up were collected. All subjects entered our specific program for patients with newly-diagnosed T1D and were followed up using the same clinical protocol. Data are shown as mean (standard deviation) or as number of patients and percentage. The appropriate test was used to compare quantitative and qualitative data. A Pvalue <0.05 was considered statistically significant. Results: A total of 279 patients were recorded, of whom 153 (53.6% women; mean age 46.6±8.6 years; age at onset 23.3±8.8 years; disease duration, 23.3±2.6 years) continued to attend our diabetes unit at the time of the analysis. Of these patients, 24.8% were administered continuous subcutaneous insulin infusion (CSII). Mean HbA1c in the past 5 years and in the last year were7.8±0.9% and 7.7±1.1% respectively (7.3±1.5% in those given CSII). Smoking was reported by 19.6% of patients, while 15.7% had high blood pressure and 37.9% dyslipidemia. Diabetic retinopathy was diagnosed in 20.4%, and 11.3% of the total cohort had nephropathy. Only 1.3% of our patients had a history of CVD. Conclusions: Data collected from a cohort of patients with T1DM for more than 2 decades regularly followed up with a specific program in a tertiary university hospital suggest a remarkably low prevalence of diabetic complications (AU)

Asistencia a la gestante con diabetes. Guía de práctica clínica actualizada en 2014 / Care of pregnancies complicated by diabetes. Clinical practice guidelines: 2014 update

La diabetes es una de las complicaciones metabólicas más frecuentes de la gestación y se asocia a un incremento del riesgo de morbimortalidad maternal y fetal, que pueden evitarse y/o reducirse con un adecuado control. En la diabetes pregestacional, la preparación específica previa a la gestación es indispensable para intentar conseguir un control glucémico lo más próximo a la normalidad, evaluar complicaciones y revisar las pautas de tratamientos farmacológicos. En el caso de la diabetes gestacional, el tratamiento de esta entidad ha demostrado disminuir la tasa de complicaciones maternas y perinatales, por lo que su diagnóstico está justificado. En relación con la estrategia diagnóstica, ante la falta de consenso y la controversia desatada tras la aparición de los nuevos criterios IADPSG, el grupo ha decidido mantener la misma estrategia diagnóstica en 2 pasos y con los mismos puntos de corte hasta disponer de datos sólidos que avalen la introducción de nuevos criterios

Diabetes is one of the most common metabolic complications of pregnancy, and is associated with an increased risk of maternal and foetal morbidity and mortality that can be prevented and/or reduced with adequate glycaemic control. In pre-gestational diabetes, specific preparation prior to the pregnancy is essential in order to achieve glycaemic control near to normal as possible and to evaluate complications and review pharmacologic treatment prescription. The treatment of gestational diabetes has been shown to decrease the rate of maternal and perinatal complications, thus its diagnosis is justified. As regards the diagnostic strategy and due to the lack of consensus and the controversy arising after the publication of the new International Association of the Diabetes and Pregnancy Study Groups (IADPSG), the group has decided to keep the same diagnostic strategy in two stages, and with the same cut-off points, until there are solid data available that support the introduction of new criteria

Postpartum metabolic control in a cohort of women with type 1 diabetes / Control metabólico posparto en una cohorte de mujeres con diabetes tipo 1

BACKGROUND AND OBJECTIVE: Pregnancy in women with type 1 diabetes (T1D) involves greater risks as compared to non-diabetic women, but less information is available about blood glucose and weight control after delivery. Our aim was to evaluate the postpartum metabolic profile (blood glucose and weight control) of women with T1D and the factors related to those metabolic outcomes. METHODS: A retrospective, observational study of 36 women with T1D during pregnancy and for up to one year after delivery. RESULTS: Fifty percent of patients attended a preconceptional planning program (PPP), and 44.4% of women were treated with continuous subcutaneous insulin infusion. Mean preconceptional HbA1c and body mass index (BMI) were 7.2 ± 1.2% and 23.8 ± 5.0 respectively. In the total cohort, blood glucose control significantly worsened one year after delivery (HbA1c: 7.2 ± 1.2 vs 7.6 ± 1.2%, P < 0.001). Lower preconceptional HbA1c values were found in patients who attended PPP (6.6 ± 0.5 vs. 7.8 ± 1.4%; P = 0.02), and were maintained for one year after delivery. No differences were found in body mass index (BMI) from the pregestational period to one year after delivery in any of two groups (No PPP 22.5 ± 4.6 vs 23.2 ± 4.8, P = 0.078; PPP 25.4 ± 3.4 vs 25.5 ± 3.4 kg/m2, P = 0.947). Preconceptional HbA1c was shown to be the most important determinant of metabolic control (beta = 0.962, p < 0.001) and weight one year after delivery (beta = 0.524, p = 0.025) and weight gain during pregnancy (beta = 0.633,p = 0.004). CONCLUSIONS: Pregnant women with T1D return to prepregnancy body weight one year after delivery, especially those with lower HbA1c levels and BMI before pregnancy. However, blood glucose control deteriorates after delivery, suggesting the need for changes in clinical practice after deliver

ANTECEDENTES Y OBJETIVO: La gestación en mujeres con diabetes tipo 1 (T1D) conlleva mayor riesgo que en las mujeres sanas; sin embargo, existe menos información acerca del control glucémico y del peso tras la gestación. Nuestro objetivo ha sido evaluar el perfil metabólico posparto (control glucémico y peso) en mujeres con T1D y qué factores están relacionados con dichos resultados metabólicos. MÉTODOS: Estudio observacional retrospectivo de 36 mujeres con T1D durante el embarazo y hasta un año posparto. RESULTADOS: El 50% de las pacientes realizaron un programa de planificación pregestacional (PPP) y el 44,4% realizaban tratamiento con infusor subcutáneo de insulina. La HbA1c y el índice de masa corporal (IMC) fueron de 7,2 ± 1,2% y 23,8 ± 5,0 respectivamente. En la cohorte total se observó un empeoramiento significativo del control glucémico al año posparto (7,2 ± 1,2 vs 7,6 ± 1,2%, p < 0,001). Las pacientes que acudieron al PPP (6,6 ± 0,5 vs. 7,8 ± 1,4%; p = 0,02) presentaban una menor HbA1c pregestacional, y esto se mantuvo un año tras el parto. No se objetivaron diferencias en el índice de masa corporal (IMC) entre el periodo pregestacional y al año posparto en ninguno de los 2 grupos (no PPP 22,5 ± 4,6 vs 23,2 ± 4,8, p = 0,078; PPP 25,4 ± 3,4 vs 25,5 ± 3,4 kg/m2, p = 0,947). La HbA1c fue el mayor determinante del grado de control metabólico (beta = 0,962, p < 0,001) y del peso un año posparto (beta = 0,524 p = 0,025) y de la ganancia ponderal durante la gestación (beta = 0,633, p = 0,004). CONCLUSIONES: Las mujeres embarazadas con T1D recuperan el peso preconcepcional al año posparto, especialmente aquellas con menor HbA1c e IMC pregestación. Sin embargo, el control glucémico se deteriora tras el parto, sugiriendo que es necesario modificar nuestra práctica clínica en este periodo

Transition of continuous subcutaneous insulin infusion systems in a very short time frame as a consequence of a public tender process

AIM: The procurement of pumps/supplies through a tender process is common practice among public services. A report is presented on the feasibility and safety of the transition from one continuous subcutaneous insulin infusion (CSII) system to another within a very short time frame (4-weeks) as the consequence of a public tender. METHODS: The program consisted of: Session-1 was a system start-up training session. Patient satisfaction was evaluated. Session-2 consisted of a call from technical staff 72 h after Session- 1 to provide support regarding the programming or the change of infusion set. Session-3 was a training session regarding the use of therapy management software. During and 2 months after Session-2, clinical events, technical issues, and training reinforcement incidents were registered. HbA1c data were collected retrospectively. RESULTS: A total of 219 patients were enrolled. During the second week, 81% of patients weretransferred to the new system. Patient overall satisfaction scored 9.4/10 (none <7). There were 30 training reinforcement events and 7 technical issues, with all 37 of them being were sorted out over the telephone. There were 31 additional clinical events (infusion set issues). Twentyfour were considered mild, and were solved by phone technical support. Medical assistance was needed in six (five unexpected hyperglycemia, one ketosis). There was only one severe event (ketoacidosis requiring hospitalization). HbA1c did not deteriorate during the transition process. One hundred twenty-eight patients attended the therapy management software training. CONCLUSIONS: With the assistance of a specific program, a complete switch to a new insulin pump in a large population of patients with T1D in the context of a public tender in a very short time was carried out safely and without deterioration of metabolic control

INTRODUCCIÓN: El sistema público de salud financia la utilización de infusores subcutáneos de insulina (ISCI) como tratamiento no convencional en pacientes con diabetes mellitus tipo 1 (DT1). En este contexto, y con el fin de mejorar la eficiencia, es frecuente que los centros encargados de este tipo de terapia utilicen procedimientos de licitación. Nuestro objetivo fue evaluar la eficacia y la seguridad de un proceso de recambio de dispositivos ISCI a llevar a cabo en un breve periodo (4 semanas) en un procedimiento de concurso público. PACIENTES Y MÉTODOS: El proceso de recambio incluyó 3 sesiones precedidas por la presentación y la justificación del mismo: sesión 1: adiestramiento en la utilización del nuevo dispositivo ISCI y administración de una encuesta de satisfacción; sesión 2: contacto telefónico de soporte a las 72 h de iniciado el programa a la búsqueda de incidencias, y sesión 3: a los 3 meses, sesión de refuerzo/consolidación de los conocimientos y adiestramiento en el uso de programa informático de gestión del tratamiento. Durante 2 meses se recogieron todas las incidencias clínicas y técnicas. Retrospectivamente, se obtuvo la HbA1c más cercana al inicio y la primera una vez finalizado el programa. RESULTADOS: Se efectuó el recambio en 219 pacientes, el 81% de los recambios se efectuó en las 2 primeras semanas. En la encuesta de satisfacción realizada se obtuvo una puntuación media de 9,4 sobre 10. Se efectuaron un total de 30 llamadas telefónicas extra con el fin de reforzar aspectos educativos y en 7 ocasiones se atendieron incidencias técnicas que fueron resueltas de manera inmediata. Veinticuatro de 31 eventos clínicos registrados fueron considerados de carácter leve. Seis de ellos fueron moderados (5 hiperglucemias simples/1 cetosis). Un evento fue catalogado como grave (cetoacidosis diabética). Todos los eventos se relacionaron con el equipo de infusión (recambio) y en todos se resolvieron de manera satisfactoria. La HbA1c tras el recambio no cambió significativamente. Ciento veintiocho pacientes acudieron al adiestramiento en el uso del programa informático de gestión del tratamiento. CONCLUSIONES: En el contexto de un proceso de licitación y bajo un programa diseñado específicamente, el recambio de dispositivos ISCI puede realizarse de manera segura y sin deterioro alguno en el control metabólico en un considerable número de pacientes y en un corto periodo

Evaluación de la utilización de las prestaciones específicas de los sistemas de infusión subcutánea de insulina y su relación con el control metabólico en pacientes con diabetes tipo 1 / Assessment of use of specific features of subcutaneous insulin infusion systems and their relationship to metabolic control in patients with type 1 diabetes

ANTECEDENTES Y OBJETIVO: Los pacientes con diabetes tipo 1 (DT1) en tratamiento con infusión subcutánea de insulina (ISCI) tienen a su alcance diversas prestaciones específicas para estos dispositivos. El objetivo del estudio fue valorar la relación entre la utilización real de las mismas y el grado de control glucémico en pacientes habituados a este tipo de terapia. PACIENTES Y MÉTODOS: Incluimos 44 pacientes con DT1 en tratamiento con ISCI con o sin monitorización continua de glucosa (MCG). Recogimos retrospectivamente los datos de 14 días consecutivos mediante la plataforma Care Link Personal/Pro® y la determinación de HbA1c realizada en ese periodo. Posteriormente, analizamos las diferencias en el uso de las prestaciones del dispositivo en función del grado de control glucémico y las diferencias entre los grupos con o sin MCG. RESULTADOS: La HbA1c media del grupo fue de 7,5 ± 0,8%. El número de bolus/día administrados fue de 5,1 ± 1,8, siendo el 75,4% de ellos en forma de bolus ayuda (BA). Los pacientes con mejor control (HbA1c < 7,5%) se administraban más bolus/día (5,3 ± 1,6 vs. 4,3 ± 1,6; p = 0,056) que aquellos con peor control. Existía una tendencia a una mayor utilización de BA en los pacientes con mejor control (82,8 ± 21,4% vs. 69,9 ± 29,1%; p = 0,106). Sin alcanzar la significación estadística, los pacientes portadores de MCG (n = 8) tenían una HbA1c inferior a aquellos sin esta prestación (7,6 ± 0,8 vs. 7,1 ± 0,7; p = 0,067). CONCLUSIONES: El mayor uso del BA en los pacientes con DT1 en tratamiento con terapia ISCI tiende a asociarse con un mejor grado de control metabólico. En la práctica clínica habitual la utilización de MCG combinada con ISCI podría asociarse a un mejor control glucémico

BACKGROUND AND OBJECTIVE: Patients with type 1 diabetes (T1DM) treated with continuous subcutaneous insulin infusion (CSII) have available several specific features of these devices. The aim of this study was to evaluate the relationship between real use of them and the degree of glycemic control in patients using this therapy. PATIENTS AND METHODS: Forty-four T1DM patients on CSII therapy with or without real-time continuous glucose monitoring (CGM) were included. Data from 14 consecutive days were retrospectively collected using the therapy management software CareLink Personal/Pro® and HbA1c measurement performed at that period. The relationship between the frequency of usie of specific features of insulin pumps (non-sensor augmented or sensor-augmented) and glycemic control was analyzed. RESULTS: Mean HbA1c in the group was 7.5 ± .8%. Mean daily number of boluses administered was 5.1 ± 1.8, with 75.4% of them being bolus wizards (BW). Daily number of boluses was significantly greater in patients with HbA1c < 7.5% than in those with HbA1c > 7.5% (5.3 ± 1.6 vs. 4.3 ± 1.6, P = .056). There was a trend to greater use of BW in patients with better control (82.8 ± 21.4% vs. 69.9 ± 29.1%,P = .106). HbA1c was lower in patients using CGM (n = 8) as compared to those not using sensor-augmented pumps (7.6 ± .8 vs 7.1 ± .7, P = .067), but the difference was not statistically significant. CONCLUSIONS: More frequent use of BW appears to be associated to better metabolic control in patients with T1DM using pump therapy. In standard clinical practice, augmentation of insulin pump with CGM may be associated to improved glycemic control

Sensor augmented pump therapy in the management of type 1 diabetes complicated with Addison's disease prior to and during pregnancy / Tratamiento combinado con sistema bomba-sensor para el control de la diabetes de tipo 1 complicada con enfermedad de Addison antes del embarazo y durante este

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Diabetes mellitus gestacional y etnia materna: alta prevalencia de macrosomía fetal en mujeres no caucásicas / Gestational diabetes mellitus and maternal ethnicity: high prevalence of fetal macrosomia in non-Caucasian women

Fundamento y objetivo: En gestantes con diabetes mellitus gestacional (DMG) se han descrito diferencias en los resultados perinatales según la etnia materna. El objetivo de este estudio fue analizar la relación entre etnia, características maternas y resultados perinatales en mujeres con DMG en nuestro medio.Pacientes y método: Análisis retrospectivo de mujeres con DMG atendidas en el período 1986-2007. Se estudiaron 2.543 parejas madre-hijo (8,9% gestaciones múltiples, 2.480 mujeres caucásicas [C] y 63 no caucásicas [NC]). Se compararon las características maternas y los resultados perinatales según la etnia materna y se realizaron regresiones logísticas multivariantes (backward) para predecir los resultados perinatales. Resultados: Los 2 grupos (C frente a NC) difirieron en gestaciones previas, antecedentes obstétricos, índice de masa corporal pregestación, retraso de entrada en clínica, glucemia basal al diagnóstico y hemoglobina glucosilada inicial y en el tercer trimestre, todos más desfavorables en el grupo NC. En resultados perinatales se observaron diferencias en la prevalencia de recién nacidos macrosomas (4,3 frente a 19,4%) y grandes para la edad gestacional (GEG) (9,5 frente a 32,3%), más elevada en el grupo NC. En los análisis de regresión logística, NC fue un predictor independiente de macrosomía, GEG e ictericia, con odds ratio que oscilaron entre 2,767 (intervalo de confianza del 95% [IC 95%] 1,257-6,091) para GEG y 3,629 (IC 95% 0,972-13,548) para ictericia neonatal. Conclusiones: Las pacientes NC con DMG presentaron resultados perinatales más desfavorables que se explicaron solo parcialmente por los antecedentes, datos antropométricos y control glucémico materno. La etnia NC fue un predictor independiente de resultados perinatales desfavorables (AU)

Background and objective: Differences in perinatal outcomes according to ethnicity have been described in pregnant women with gestational diabetes mellitus (GDM). We analysed the relationship between ethnicity, maternal characteristics and perinatal outcomes in pregnant women with GDM.Patients and methods: Retrospective analysis of women with GDM attended at the centre between 1986 and 2007. We studied 2,543 mother-infant pairs (8.9% multiple pregnancies, 2,480 Caucasian [C] and 63 non-Caucasian [NC] mothers). Maternal characteristics and perinatal outcomes were compared according to maternal ethnicity and multivariable logistic regression analyses (backward method) were performed to predict perinatal outcomes. Results: The groups (C vs NC) differed in previous pregnancies, obstetric history, pregestational body mass index, delay between diagnosis and clinic entry, fasting plasma glucose at diagnosis and both initial and third trimester glycated hemoglobin, with all of them being worse in NC group. As to perinatal outcomes, we also observed differences in the prevalence of macrosomic (4.3 vs 19.4%) and large for gestational age newborns (LGA) (9.5 vs 32.3%), all of them being higher in the NC group. In the logistic regression analyses, NC was an independent predictor of macrosomia, LGA and jaundice with odds ratio ranging from 2.767 (95% confidence interval [95% CI] 1.257-6.091) for LGA and 3.629 (95% CI 0.972-13.548) for neonatal jaundice. Conclusions: NC-GDM patients had more adverse perinatal outcomes only partially explained by medical history, anthropometric data and maternal glycemic control. NC ethnicity was an independent predictor of poor perinatal outcomes (AU)

Switching to basal-bolus insulin therapy is effective and safe in long-term type 2 diabetes patients inadequately controlled with other insulin regimens

ObjetivoEvaluar en la práctica clínica habitual la factibilidad, la eficacia y la seguridad de un programa ambulatorio de paso a pauta bolus-basal en pacientes diabéticos de tipo 2 (DM2) con mal o inestable control glucémico.Material y métodosEstudio prospectivo de 37 sujetos con DM2 (edad 65±8 años, 62,2% varones, índice de masa corporal 28,8±6,2kg/m2, tiempo de evolución de la diabetes 18±8 años) en los que se transfirió a una pauta bolus-basal (una dosis de glargina y 3 de aspártica o lispro) según el criterio de su médico. El tratamiento se instauró en un programa ambulatorio y el seguimiento se realizó durante 6 meses. Los parámetros clínicos y analíticos se recogieron a los 0, 3 y 6 meses.ResultadosTras el cambio a la pauta bolus-basal, la hemoglobina glucosilada (HbA1c) se redujo de 9±1,2% al inicio a 8,1±1,2% (p<0,001) a los 3 meses y a 8,0±1,2% a los 6 meses (p<0,001) sin modificarse la dosis diaria total de insulina. El porcentaje de pacientes con HbA1c≥9% cayó del 51% inicial al 13,8% a los 3 meses y al 18,9% a los 6 meses, respectivamente. Se registró una hipoglucemia grave. El peso y la calidad de vida no mostraron cambios. El tamaño de las partículas de LDL (lipoproteínas de baja densidad) aumentó significativamente a los 3 y 6 meses, mientras que otros parámetros lipídicos no se modificaron.ConclusiónEste estudio confirma que las pautas bolus-basal son factibles, eficaces y seguras en pacientes con DM2 de larga evolución y no alteran su calidad de vida (AU)

AimTo assess in standard clinical practice the feasibility, efficacy, and safety of switching patients with long-standing type 2 diabetes (T2DM) and poor or unstable blood glucose control to basal-bolus insulin therapy.Material and methodsThis was a prospective, single center study including 37 patients with T2DM (age 65±8 years, 62.2% men, body mass index 28.8±6.2kg/m2, diabetes duration 18±8 years) with poor or unstable glycemic control, who were switched to a basal-bolus insulin regimen with glargine and rapid-acting insulin analogue at the discretion of their physicians. After a group-structured outpatient diabetes training program, patients were followed in a clinical practice setting for 6 months. Clinical and biochemical variables were collected before switching and at 3 and 6 months.ResultsAfter switching to basal-bolus therapy, glycosylated hemoglobin (HbA1c) decreased from 9±1.2% to 8.1±1.2% (p<0.001) at 3 months and to 8.0±1.2% at 6 months (p<0.001) without changing total daily insulin dose. The proportion of patients with HbA1c≥9% decreased from 51% to 13.8% at 3 months and to 18.9% at 6 months respectively. There was a single episode of severe hypoglycemia. No changes were seen in body weight and quality of life. The size of LDL (low density lipoprotein) particles significantly increased at 3 and 6 months, while all other lipid parameters remained unchanged.ConclusionsOur study confirmed that basal-bolus insulin therapy is feasible, effective, and safe in patients with long-standing T2DM, and does not impair their quality of life (AU)