[From insulin pump and continuous glucose monitoring to the artificial pancreas]. / De la bomba de insulina y el monitoreo continuo de glucosa al páncreas artificial.

Technology for diabetes care has undergone major development during recent decades. These technological advances include continuous subcutaneous insulin infusion (CSII), also known as insulin pumps, and real-time continuous glucose monitoring system (RT-CGMS). The integration of CSII and RT-CGMS into a single device has led to sensor-augmented pump therapy and more recently, a technology that has automated delivery of basal insulin therapy, known as hybrid system. These new technologies have led to benefits in attaining better metabolic control and decreasing the incidence of severe hypoglycemia, especially in patients with type 1 diabetes. This review describes the types of technologies currently available or under investigation for these purposes, their benefits and disadvantages, recommendations and the appropriate patient selection for their use. The clinical use of the hybrid system and artificial pancreas seem to be possible in the near future.

De la bomba de insulina y el monitoreo continuo de glucosa al páncreas artificial / From insulin pump and continuous glucose monitoring to the artificial pancreas

Technology for diabetes care has undergone major development during recent decades. These technological advances include continuous subcutaneous insulin infusion (CSII), also known as insulin pumps, and real-time continuous glucose monitoring system (RT-CGMS). The integration of CSII and RT-CGMS into a single device has led to sensor-augmented pump therapy and more recently, a technology that has automated delivery of basal insulin therapy, known as hybrid system. These new technologies have led to benefits in attaining better metabolic control and decreasing the incidence of severe hypoglycemia, especially in patients with type 1 diabetes. This review describes the types of technologies currently available or under investigation for these purposes, their benefits and disadvantages, recommendations and the appropriate patient selection for their use. The clinical use of the hybrid system and artificial pancreas seem to be possible in the near future.

Terapia antiretroviral en pacientes con VIH: una respuesta inesperada / Antiretroviral therapy in HIV infected patients: an unexpected response

En relación al uso de terapia antiretroviral (TAR) en pacientes con VIH, se ha descrito un síndrome clínico tras el inicio o cambio de la terapia, denominado Síndrome de Reconstitución Inmune (SRI). Se trata de un cuadro caracterizado por el deterioro inesperado en el estado clínico de los pacientes, producto de una respuesta inflamatoria exagerada en contra de patógenos oportunistas, tumores o antígenos propios del paciente. El manejo del SRI, incluye uso de antimicrobianos específicos y/o terapia antiinflamatoria, sin ser necesaria la descontinuación de la TAR. Es prioritario en la investigación del SRI, el desarrollo de estrategias de prevención, métodos de pesquisa de factores de riesgo y criterios diagnósticos.

Related to the antiretroviral therapy in HIV infected persons, it has been described a clinical syndrome called the Immune Restoration Disease (IRD). It appears after the initiation or switching of the therapy and is characterized by an exaggerated inflammatory response after the improvement of the immune system, which leads to an unexpected worsening of the clinical condition of the patient. This inflammatory response is presented against opportunist pathogens, tumors or the patient’s own antigens. The management of IRD often requires the use of anti-microbial and/or anti-inflammatory therapy, without interruption of the antiretroviral therapy. It is a priority for future research, to develop strategies to prevent IRD, risk assessment methods and diagnostic criteria.