Programa de transición: una intervención para adolescentes con diabetes tipo 1: estudio de casos y controles / Transition program: an intervention for adolescents with type 1 diabetes: cases and controls study

Introduction: The transition programs (TP) are planned interventions with specific aims which support type 1 diabetes adolescents in their process to emigrate from a pediatric care system to an adult care system. Objective: To evaluate the effectiveness of a TP in type 1 diabetes adolescents. Subjects and Method: This study was performed in 20 adolescents: 10 in TP and 10 controls (no TP) attended in an adult care system in a traditional way. The applied program included: coordination of attention dates, administrative supervision of the cases, and integral health team attention: physician every three months, psychologist with psychosocial follow-up every three months, nutricionist and university nurse according to the case necessities. After a year of the TP implementation the indicators of adherence were evaluated: continuity of care, regular medical appointments, physician/adolescent relationship, psychosocial follow-up, and to maintain or improve the HbA1c. The statistical analysis of variables comparison was performed with Kwallis Test o Mann-Whitney Test, in STATA 12.0 program. Results: At comparing groups, it was found that the intervened adolescents presented a major frequency of: continuity of diabetes care, regular medical appointments, physician/adolescent relationship and psychosocial follow-up (p < 0,01); the indicator of maintaining or improving the HbA1c was better in the patients with TP (60 percent vs 30 percent) yet not significant. Conclusion: In type 1 diabetes adolescents, with the applied TP we get better indicators of adherence to the diabetes treatment

Efecto de la metformina sobre la resistencia insulínica en mujeres obesas y obesas hiperandrogénicas / Effects of metformin on insulin resistance in obese and hyperandrogenic women

Background: Metformin is a biguanide often used in obese diabetics that improves tissue sensitivity to insulin. Aim:To assess the effects of metformin on tissue insulin sensitivity in obese and byperandrogenic women. Patients and methods: Eight obese and eight obese and eight and hyperandrogenic women received metformin 850 mg orally during 12 weeks. Before and at the end of the treatment period, an insulin tolerance test to measure insulin sensitivity was performed and blood was drawn to measure sex hormone binding globulin (SHBG), dehydroepiandrosterone sulphate (DHEAS), testosterone, triglycerides, total and HDL cholesterol. The free androgen index was calculated for each sample. Results: After metformin treatment, the insulin sensitivity index improved from 0.38 (0.05-0.5) to 0.43 (0.25-0.59) in obese and hyperandrogenic women. SHBG increased and total cholesterol and triglycerides decreased significantly in both groups. No other significant changes were observed. Conclusions: Metformin has a favorable effect on tissue sensitivity to insulin, SHBG and serum lipids in obese and hyperandrogenic women

Marcadores bioquímicos y métodos de cuantificación de insulinorresistencia en mujeres normales, obesas e hiperandrogénicas / Biochemical markers and methods to assess insulin resistance in normal, obese and hyperandrogenic women

Six normal, 6 obese and 12 hyperandrogenic women of similar ages, were studied. In two consecutive days, the ITT and the IVGTT were performed and a basal blood sample was obtained to measure SHBG, DHEAS and IGFBP-1. Insulin sensitivity was calculated as the blood glucose slope in the ITT and with the minimal model of Bergman in the IVGTT. Insulin sensitivity, measure with ITT was 0.58 (0.53-0.63) in normal, 0.38(0.05-0.59) in obese and 0.20(0.0-0.36) in hyperandrogenic women. The figures for the IVGTT were 7.97(4.1-15.4), 2.41 )0.81-4.89) and 1.1 (0.46-1.88), respectively. Both methods had a positive correlation coefficient of 0.792 (p 0.09). IGFBP-1 values were 3.0, 2.1 and 1.6 ng/ml respectively (p 0.05). DHEAS values were 132, 190 and 206 ug/dl, respectively (ND). ITT is a sample and reliable method to asses insulin sensitivity. SHBG discriminates subjects with different levels of insulin sensitivity

Experiencia clínica con un inhibidor de la alfa glucosidasa (acarbosa) en el tratamiento de la diabetes no insulinodependiente: estudio multicéntrico / Multicentric study on the effect of an alpha glucosidase inhibitor in the treatment of non insulin dependent diabetes

Diabetic patients received acarbose, 150 mg/day durign four weeks and this dose was increased to 300 mg/day durign 3 months. Afterwards, patients were followed for a period of 12 weeks without acarbose. Fasting and post-prandial blood glucose and glycosilated hemoglobin were measured sequentially durign the study. Results: Eighty five patients were recruited for the study but 64 complied with the treatment protocol. The age of these patients was 56 ñ 8.8 years old, their diabetes duration was 7.8 ñ 8.8 years and their body mass index was 27.6 ñ 3.6 kg/m². During acarbose treatment, glycosilated hemoglobin decreased from 8.36 ñ 1.33 to 7.71 + 1.7 percent (p < 0.001), fasting blood glucose decreased from 173 ñ 48 to 159 ñ 59 mg/dl (p < 0.03) and post-prandial blood glucose decreased from 254 ñ 80 to 241 ñ mg/dl (NS). After discontinuing acarbose glycosilated hemoglobin and blood glucose levels returned to basal levels. Body weight and blood pressure did not change during the treatment period. Fifty nine patients bad gastrointestinal symptoms (meteorism, flatulence and abdominal distention) that were mild in 59 percent and moderate in 39 percent. Episodes of hypoglycemia were not observed. Conclusions: Acarbose, associated to sylphonylureas is an effective drug to reduce blood glucose and glycosilated hemoglobin levels in patients with non insulin dependent diabetes

Prueba de tolerancia a la insulina: un método útil para determinar resistencia insulínica en mujeres hiperandrogénicas obesas / Insulin tolerance test: a useful method for insulinic resistance determination in obese hyperandrogenic women

Five healthy women aged 27ñ7 years old with a body mass index of 21ñ2 kg/m² and 6 hyperandrogenic women aged 25ñ4 years old with a body mass index of 40ñ5 kg/m² were studied after a 10 hours fast. For the insulin tolerance test, 0.1 U/Kg of crystalline insulin were injected intravenously and blood samples were drawn to measure glucose at -5,0,3,5,10 and 15 min. after the injection. Insulin resistance was calculated using the slope of descending blood glucose levels (SIû). For the intravenous glucose tolerance test, 29 blood glucose samples were obtained after an intravenous injection of 0,3 g glucose/kg followed by an injection of 0.02 U/kg of crystalline insulin. Insulin sensitivity (SI²) was calculated using Bergman's minimal model. Healthy women had a SIû of 0.58 (range 0.53-0.63) and a SI² of 7.9x10-4x min-û/uU/ml (range 4.15-9.11). For hyperandrogenic women were 0.18 (range 0.06-0.29) and 0.9x10-4xmin-û/uU/ml (range 0.46-1.79) respectively. Both methods had a positive correlation coefficient of 0.859 (p<0.001). In conclusion, insulin tolerance test is a good method to measure insulin resistance and has a good correlation with the frequently sampled intravenous glucose tolerance test