Impact of My Dose Coach App Frequency of Use on Clinical Outcomes in Type 2 Diabetes.

INTRODUCTION: My Dose Coach (MDC) is a US Food and Drug Administration-approved digital smartphone application designed to help users with type 2 diabetes (T2D) titrate their basal insulin (BI) according to a clinician-prescribed individualized titration plan. The aim of this analysis was to assess the impact of the frequency of MDC use on clinical outcomes. METHODS: This retrospective observational analysis included people with T2D who were registered for MDC (August 1st, 2018-April 30th, 2020) and received BI. Users with an activated care plan and ≥2 fasting blood glucose (FBG) observations spanning ≥2 weeks were defined as active. Outcomes included percentage achieving their individual FBG target, time to FBG target, change in FBG, change in insulin dose and hypoglycemia. Users were stratified into high (>3 days per week), moderate (>1- ≤3 days per week), and low (≤1 day per week) MDC usage groups. RESULTS: The analysis included 2517 active MDC users. Approximately 49% of users had high MDC usage. Overall, 44% of users across all usage frequencies achieved their individual FBG target. High MDC use was associated with significantly better FBG target achievement and less time to FBG target versus moderate- and low-usage groups (p≤0.01 for all). Insulin dose change was significantly greater in the high- versus moderate-usage group (p=0.01). There was no significant difference in hypoglycemia incidence among MDC usage groups (12%-16% of users in any usage group). CONCLUSIONS: More frequent MDC usage was associated with better FBG outcomes without increased hypoglycemia risk.

The effectiveness of a comprehensive diabetes program for glycemic control and adherence, and the selection of candidates for sensor-augmented insulin pump therapy.

OBJECTIVE: This study aimed to estimate the effectiveness of a comprehensive diabetes program (CDP) in terms of glycemic control, adherence, and the selection of candidates for sensor-augmented insulin pump therapy (SAP). METHODS: We compared diabetes control before and 6 months after CDP. The program was based on disease management using a logical model dealing with the following: case management, education and coaching, nutritional assessment, and mental health. RESULTS: The CDP improved glycemic control, HbA1c decreased by 0.56% (p-value=0.004; 95% CI: 0.14-0.98) and 19.1% of the patients reached the HbA1c goal without hypoglycemia. The CDP reduced by 52.4% the indication for SAP due to better glycemic control (36.4%) or non-adherence issues (63.6%); the remaining 47.6% persisted with poor glycemic control despite good adherence and were scaled to SAP. Among the 30 suitable candidates for SAP therapy, 60% did not reach the HbA1c goal and 40% had either hypoglycemic episodes (severe or persistent) or dawn phenomenon. The overall non-adherence rate was 33.3%. CONCLUSIONS: CDP optimized the selection of suitable candidates for SAP by improving glycemic control and identifying adherence issues early. These results provide evidence of the impact of the implementation of patient selection and educational protocols in the real-life setting of a highly experienced clinic.

Real-world effectiveness and safety of sensor-augmented insulin pump therapy in adults with type 1 diabetes: Long-term follow-up.

OBJECTIVE: To evaluate the effectiveness and safety of sensor-augmented insulin pump therapy (SAP) in addition to a comprehensive diabetes program on glycated hemoglobin (HbA1c), severe hypoglycemia, ketoacidosis, and the hospital admission rate in patients with type 1 diabetes under real-world settings during a 2-year follow-up. METHODS: This was a retrospective real-life study comparing diabetes control before and after SAP therapy initiation. Patients ≥18 years old with type 1 diabetes were included. They were followed for 2 years with clinical assessments at months 3, 6, 12, 18, and 24. Effectiveness was estimated by difference in medians of HbA1c from baseline and at each follow-up visit. Safety was assessed by comparing the annual rates of severe hypoglycemia, hyperglycemic crisis, and hospital admission related to diabetes. RESULTS: 162 patients were included, median age 32 years, women 73%). The main indication for SAP was poor metabolic control (51.2%). At 2 years HbA1c decreased from 8.4% to 7.5% (-0.9%, 95% CI: 0.5-1.2; p<0.0001), HbA1c ≤7% improved from 14.2% to 25.3% (11.1%, 95% CI: 19.7-2.5; p=0.006), and severe hypoglycemia decreased from 22.2% to 14.1% (-8.1%, 95% CI: -16.5 to 0.3; p=0.03). CONCLUSIONS: SAP therapy improved glycemic control after the third month of use and for up to 2 years of follow-up, with lower rates of hospital admission and severe hypoglycemia. More studies are needed to assess the add-on impact of education programs and technologies for diabetes care.

A review of flash glucose monitoring in type 2 diabetes.

BACKGROUND: Continuous glucose monitoring systems are increasingly being adopted as an alternative to self-monitoring of blood glucose (SMBG) by persons with diabetes mellitus receiving insulin therapy. MAIN BODY: The FreeStyle Libre flash glucose monitoring system (Abbott Diabetes Care, Witney, United Kingdom) consists of a factory-calibrated sensor worn on the back of the arm which measures glucose levels in the interstitial fluid every minute and stores the reading automatically every 15 min. Swiping the reader device over the sensor retrieves stored data and displays current interstitial glucose levels, a glucose trend arrow, and a graph of glucose readings over the preceding 8 h. In patients with type 2 diabetes (T2D) receiving insulin therapy, pivotal efficacy data were provided by the 6-month REPLACE randomized controlled trial (RCT) and 6-month extension study. Compared to SMBG, the flash system significantly reduced the time spent in hypoglycemia and frequency of hypoglycemic events, although no significant change was observed in glycosylated hemoglobin (HbA1c) levels. Subsequent RCTs and real-world chart review studies have since shown that flash glucose monitoring significantly reduces HbA1c from baseline. Real-world studies in both type 1 diabetes or T2D populations also showed that flash glucose monitoring improved glycemic control. Higher (versus lower) scanning frequency was associated with significantly greater reductions in HbA1c and significant improvements in other measures such as time spent in hypoglycemia, time spent in hyperglycemia, and time in range. Additional benefits associated with flash glucose monitoring versus SMBG include reductions in acute diabetes events, all-cause hospitalizations and hospitalized ketoacidosis episodes; improved well-being and decreased disease burden; and greater treatment satisfaction. CONCLUSION: T2D patients who use flash glucose monitoring might expect to achieve significant improvement in HbA1c and glycemic parameters and several associated benefits.

The effectiveness of a comprehensive diabetes program for glycemic control and adherence, and the selection of candidates for sensor-augmented insulin pump therapy.

OBJECTIVE: This study aimed to estimate the effectiveness of a comprehensive diabetes program (CDP) in terms of glycemic control, adherence, and the selection of candidates for sensor-augmented insulin pump therapy (SAP). METHODS: We compared diabetes control before and 6 months after CDP. The program was based on disease management using a logical model dealing with the following: case management, education and coaching, nutritional assessment, and mental health. RESULTS: The CDP improved glycemic control, HbA1c decreased by 0.56% (p-value=0.004; 95% CI: 0.14-0.98) and 19.1% of the patients reached the HbA1c goal without hypoglycemia. The CDP reduced by 52.4% the indication for SAP due to better glycemic control (36.4%) or non-adherence issues (63.6%); the remaining 47.6% persisted with poor glycemic control despite good adherence and were scaled to SAP. Among the 30 suitable candidates for SAP therapy, 60% did not reach the HbA1c goal and 40% had either hypoglycemic episodes (severe or persistent) or dawn phenomenon. The overall non-adherence rate was 33.3%. CONCLUSIONS: CDP optimized the selection of suitable candidates for SAP by improving glycemic control and identifying adherence issues early. These results provide evidence of the impact of the implementation of patient selection and educational protocols in the real-life setting of a highly experienced clinic.

Real-world effectiveness and safety of sensor-augmented insulin pump therapy in adults with type 1 diabetes: Long-term follow-up.

OBJECTIVE: To evaluate the effectiveness and safety of sensor-augmented insulin pump therapy (SAP) in addition to a comprehensive diabetes program on glycated hemoglobin (HbA1c), severe hypoglycemia, ketoacidosis, and the hospital admission rate in patients with type 1 diabetes under real-world settings during a 2-year follow-up. METHODS: This was a retrospective real-life study comparing diabetes control before and after SAP therapy initiation. Patients ≥18 years old with type 1 diabetes were included. They were followed for 2 years with clinical assessments at months 3, 6, 12, 18, and 24. Effectiveness was estimated by difference in medians of HbA1c from baseline and at each follow-up visit. Safety was assessed by comparing the annual rates of severe hypoglycemia, hyperglycemic crisis, and hospital admission related to diabetes. RESULTS: 162 patients were included, median age 32 years, women 73%). The main indication for SAP was poor metabolic control (51.2%). At 2 years HbA1c decreased from 8.4% to 7.5% (-0.9%, 95% CI: 0.5-1.2; p<0.0001), HbA1c ≤7% improved from 14.2% to 25.3% (11.1%, 95% CI: 19.7-2.5; p=0.006), and severe hypoglycemia decreased from 22.2% to 14.1% (-8.1%, 95% CI: -16.5 to 0.3; p=0.03). CONCLUSIONS: SAP therapy improved glycemic control after the third month of use and for up to 2 years of follow-up, with lower rates of hospital admission and severe hypoglycemia. More studies are needed to assess the add-on impact of education programs and technologies for diabetes care.

Síndrome de Cushing exógeno e insuficiencia adrenal relacionada con consumo de producto natural / Exogenous Cushing's syndrome and adrenal insufficiency related to consumption of alternative medicinal product

Resumen La insuficiencia adrenal es una endocrinopatía cuya principal causa se debe a la deficiencia en la producción de hormona adrenocorticotrópica, generalmente explicada por factores iatrogénicos y en menor número de casos al defecto primario de la glándula adrenal (enfermedad de Adisson). Su diagnóstico y la búsqueda de una etiología específica es muy importante, dado las implicaciones a largo plazo que conlleva por necesidad de suplencia hormonal, manejo en condiciones críticas, riesgo de muerte y compromiso de la actividad laboral. Presentamos el caso de una mujer quien consultó por ganancia excesiva de peso, signos de hipercortisolismo e hipertensión, se documentó una probable fuente exógena de esteroides, encontrando un cortisol sérico suprimido. Dos años antes estaba recibiendo artrivid PLUS, un producto natural para el manejo del dolor articular. Después de suspender ésta medicación presentó síntomas compatibles con insuficiencia adrenal, requiriendo el reinicio de prednisolona, con mejoría clínica y logrando su desmonte gradual posterior. (Acta Med Colomb 2017; 42: 243-246).

Abstract Adrenal insufficiency is an endocrinopathy whose main cause is due to the deficiency in the production of adrenocorticotropic hormone, usually explained by iatrogenic factors and in a smaller number of cases to the primary defect of the adrenal gland (Adisson's disease). Diagnosis and the search for a specific etiology is very important, given the long-term implications involved by the need of hormone replacement, management in critical conditions, risk of death and the compromise of work activity. The case of a woman who consulted for excessive weight gain, signs of hypercortisolism and hypertension, is presented. A probable exogenous source of steroids was documented, finding a suppressed serum cortisol. Two years before she was receiving artrivid PLUS, a natural product for joint pain management. After stopping this medication, she presented symptoms compatible with adrenal insufficiency, requiring the resumption of prednisolone, with clinical improvement and achieving its subsequent gradual removal. (Acta Med Colomb 2017; 42: 243-246).

Clinical Outcomes After 1 Year of Augmented Insulin Pump Therapy in Patients with Diabetes in a Specialized Diabetes Center in Medellín, Colombia.

BACKGROUND: Type 1 diabetes can be difficult to control. Augmented pump therapy (CSII-rtCGM) has become an important tool for controlling blood glucose and decreasing hypoglycemia. METHODS: Describe the results 1 year after starting CSII-rtCGM in patients with diabetes in Medellín, Colombia. This is an observational, retrospective study. Patients with type 1 and type 2 diabetes started on CSII-rtCGM between January 2008 and June 2015 were included. Qualitative variables were analyzed as absolute or relative frequencies. Quantitative variables were obtained through central tendency and dispersion according to the normal distribution of the analyzed variable using Kolmogorov-Smirnov. SPSS 19 from IBM was used. RESULTS: Two hundred forty-seven patients were identified, of those 183 were included. The starting HbA1C was 8.7% ± 1.7% and 7.4% ± 0.8% (P < 0.05) 1 year later. 16.5% of patients had been admitted to the hospital before starting CSII-rtCGM, after 1 year the admission rate was 6.0% (P < 0.05). The incidence of severe hypoglycemia at the beginning was 32%, 1 year later it was 7.1%. CONCLUSION: CSII-rtCGM therapy improves glucose control and decreases severe hypoglycemic events and hospital admission rate.

Sitagliptina versus insulina en pacientes hospitalizados con diabetes tipo 2. Estudio comparativo de costos / Sitagliptin vs insulin in hospitalized patients with type 2 diabetes: a comparative cost analysis

Introducción: tradicionalmente, el paciente hospitalizado con diabetes tipo 2 (DT2) se trata con insulina en un esquema basal/bolo, pero han surgido investigaciones en las que se muestra similar control metabólico con agentes orales, como sitagliptina. Basado en un ensayo clínico aleatorizado en el que se pudo comprobar esta hipótesis se plantea en este estudio las consecuencias en el costo para instituciones en Colombia de esta alternativa. Objetivo:determinar, a partir de un ensayo clínico aleatorizado publicado, los costos derivados de la utilización de sitagliptina o sitagliptina más insulina basal o insulina basal/bolo, en pacientes hospitalizados con diagnóstico de diabetes tipo 2. Métodos: partiendo de un ensayo clínico aleatorizado de referencia se evaluaron tres brazos: 1) sitagliptina + correcciones, 2) sitagliptina + basal + correcciones y, 3) insulina basal/bolo. Se diseñó una matriz de costos con casos tipo para cada brazo. Se tuvo en cuenta la posibilidad de fallo terapéutico y la necesidad de correcciones con insulina de acción rápida. Se realizó un análisis de sensibilidad de una vía, evaluando la influencia de los cambios en el costo de sitagliptina. Resultados: en el caso base, se observó una diferencia de COL $2 cuando se comparó sitagliptina + correcciones contra insulina basal/bolo. El modelo fue sensible al cambio de precio de la sitagliptina. La estrategia sitagliptina + basal siempre se comportó como la más costosa. Conclusión: en los escenarios evaluados no existen diferencias entre el uso de sitagliptina + correcciones o el esquema basal/bolo en pacientes con diabetes hospitalizados y que ingresan sin medicación, usando un agente oral o usando dosis de insulina inferiores a 0,4 UI/kg. El modelo es sensible al cambio en el costo de sitagliptina.

Patients with type 2 diabetes admitted to the hospital have traditionally been treated with basal/bolus insulin. A study published by Umpierrez et al., has shown that the same glucose control can be achieved with Sitagliptin (DPP IV inhibitor) compared to insulin glargine and glulisine. Based on this data a cost analysis was made to assess if this strategy would change inpatient diabetic care in Colombia. Objectives: To determine, from a published randomized clinical trial, the cost of utilizing Sitagliptin or Sitagliptin and basal insulin or basal / bolus insulin in patients hospitalized with a diagnosis of T2DM. Methods: The study evaluated three arms: 1) Sitagliptin + supplemental insulin, 2) Sitagliptin + basal insulin + supplemental insulin and 3) Insulin basal / bolus + supplemental insulin. A Cost matrix was designed with type cases for each arm. It took into account the possibility of therapeutic failure and the need for corrections with a fast-acting insulin. A sensitivity analysis was performed in a platform, evaluating the influence of changes in the cost of Sitagliptin. Results: In the base case, a difference of $2 COP (Colombian pesos) was observed between the use of Sitagliptin + supplemental insulin compared with the basal/bolus + supplemental insulin strategy. The model is sensitive to the change in price of Sitagliptin. The Sitagliptin + Basal insulin strategy was the most expensive. Conclusion: In the 3 scenarios analyzed there was no difference between using Sitagliptin + supplemental insulin or basal / bolus + supplemental insulin in diabetic patients admitted to the hospital who were being treated with diet and exercise, oral agents or insulin at doses less than 0.4 IU / kg. The model is sensitive to changes in the cost of Sitagliptin.

Consenso médico de biopsia por aspiración con aguja fina de tiroides. reporte de citología tiroidea basado en el sistema de bethesda / Medical consensus of fine-needle aspiration biopsy of the thyroid. bethesda system for reporting thyroid cytopathology

En este artículo se presenta un consenso médico basado en el sistema de Bethesda del Instituto Nacionalde Cáncer (Estados Unidos) para el uso de la biopsia por aspiración con aguja fina en el manejo de nódulos tiroideos, realizado en conjunto con patólogos, radiólogos, endocrinólogos y otras especialidades médicas de Colombia, España, Chile, Venezuela, Estados Unidos y Panamá. En este trabajo se describen las indicaciones de la biopsia por aspiración con aguja fina de tiroides, requisitos previos, entrenamiento, acreditación, técnicas, terminología diagnóstica, pruebas complementarias y opciones de tratamiento. El objetivo del actual artículo es presentar ante la comunidad médica la clasificación de los reportes citológicos, el reporte de ecografía que propone usar el sistema de datos y el reporte de imágenes tiroideas (TIRADS, del inglés The Thyroid Imaging Reporting and Data System), el uso de la medición de tiroglobulina en biopsia por aspiración con aguja fina y técnicas de citología líquida;...

This article presents a medical consensus based on the Bethesda system of the National Cancer Institute (USA) for the use of fine needle aspiration biopsy in the management of thyroid nodules. This consensus was performed in conjunction with pathologists, radiologists, endocrinologists, and other medical specialties of Colombia, Spain, Chile, Venezuela, United States, and Panama. In this work was described the indications for fine needle aspiration biopsy of thyroid, prerequisites, training, accreditation, techniques, diagnostic terminology, additional tests and treatment options. The aim of this article is present to the medical community the classification of cytological report, ultrasound report using the data system, and the thyroid imaging reporting and data system (TIRADS); as well as, the use of thyroglobulin measurement in fine needle aspiration biopsy, and liquid-based cytology techniques...

Biopsia aspiracion con aguja fina en el diagnostico de quiste de paratiroides / Biopsy aspiration with fine needle in the diagnosis of cyst of paratiroides

Los quistes de paratiroides constituyen solamente del 1 al 5 por ciento de los quistes cervicales. Fueron descritos por primera vez por Sandstrom en 1880 y Goris en 1906 realizó la primera resección de la cual se tenga conocimiento. Desde esta descripción a la fecha, sólo se han reportado aproximadamente 250 casos en la literatura, se presenta el caso de una mujer de 25 años de edad con lesión paratraqueal derecha que consultó a Dinámica IPS para realizar biopsia aspiración con aguja fina guiada por ecografía saliendo líquido transparente que informó 300 pg/dL de paratohormona (valor 10-69 pg/dL). Se presenta el caso de un quiste de paratiroides diagnosticado por biopsia aspiración con aguja fina