Characteristics of people with type 1 diabetes who use technology in their treatment and who use frequently the technical assistance teleconsultation service.

INTRODUCTION: Technical issues related to continuous subcutaneous insulin infusion (CSII), associated or not with continuous glucose monitoring (SAP), are handled by tele-technical assistance from the manufacturer. We analyze the characteristics of the most demanding patients of technical teleassistance. MATERIAL AND METHODS: Patients with type 1 diabetes (T1D) in treatment with CSII or SAP, who made use of technical teleassistance from 01/01/2017 to 02/28/2021 (2298 consultations) were included. We selected the group of patients who made ≥10 calls (90th percentile, P90) and the one who made a single call (10th percentile, P10). The number and most frequent reasons for consultation, clinical characteristics and HbA1c were collected and both groups were compared. RESULTS: 51 patients (P90) made a total of 876 calls (38.1% of calls), 32 used SAP. The most frequent reason for consultation was related to continuous glucose monitoring (36.8%). 51 (P10) made 51 calls (2.2%), 3 used SAP. The most frequent reason for consultation was related to device damage (25.5%). The most demanding patients used SAP more frequently (62.7 vs. 5.9%, P < .001), had been in advanced treatment for less time (7.1 ±â€¯5.5 vs. 12.1 ±â€¯6.2 years, P < .001) and their HbA1c was lower (7.2 ±â€¯0.9 vs 7.6 ±â€¯0.8%). CONCLUSIONS: Most of the calls to the technical teleassistance service for ISCI/SAP devices come from a more demanding group of people with T1D. The greatest demand is concentrated in patients who use SAP, with a shorter time of use of advanced therapy and a better degree of glucose control.

Continuous Subcutaneous Insulin Infusion in Type 1 Diabetes Mellitus Patients: Results from the Spanish National Registry.

Aim: To analyze the clinical effect of continuous subcutaneous insulin infusion (CSII) in type 1 diabetes mellitus (T1D) patients in the Spanish real-world scenario. Methods: All T1D patients on CSII registered in the SPAnish Insulin Pump (SPAIP) registry were included. The primary efficacy outcome was change in HbA1c during follow-up. Secondary efficacy outcomes included: insulin pump indications, diabetes complication rates, insulin and pump use, and continuous glucose monitoring (CGM) glycometrics. Patient data were typed through the web-based SPAIP registry. Results: Data from 2979 T1D patients treated with CSII were analyzed. The median age was 44 years (interquartile range [IQR] 34-52 years), and T1D duration was 27 years (IQR 18-35 years). The median duration of CSII therapy was 6 years (IQR 3-10 years). The main indications for treatment were suboptimal glycemic control (33.8%), hypoglycemia (22.1%), and increased glycemic variability (18.8%). Glycated hemoglobin decreased by 6 mmol/mol (95% CI, -5 to -6 mmol/mol, P < 0.001) [-0.5%, 95% CI, -0.4 to -0.5, P < 0.001] during the follow-up. The percentage of patients with severe hypoglycemia decreased from 14.9% to 0.9% (P < 0.001). We observed an inverse correlation between final HbA1c levels and CGM adherence (R = -0.24, P < 0.001) or percentage of time with active hybrid closed-loop functions (R = -0.25, P < 0.001). Conclusions: CSII treatment was associated with a sustained improvement in glycemic control in the Spanish population. This benefit was greater among patients with higher CGM or active hybrid closed-loop functions adherence. The protocol was publicly registered at ClinicalTrials.gov (NCT04761094).

Management of glucose profile throughout strict COVID-19 lockdown by patients with type 1 diabetes prone to hypoglycaemia using sensor-augmented pump.

AIMS: Spain has been one of the worst affected countries by the COVID-19 pandemic. A very strict lockdown at home was imposed with a tough restriction of mobility. We aimed to evaluate the impact of this exceptional scenario on glucose profile of patients with type 1 diabetes (T1D) prone to hypoglycaemia using sensor-augmented pump (SAP). METHODS: Patients with T1D prone to hypoglycaemia using SAP (640G Medtronic-Minimed®) for at least 6 months under the funding of a National Health Service were included in an observational, retrospective study. Data were collected in two periods: pre-lockdown (PL), February 23rd-March 7th and within lockdown (WL), April 1st to 14th 2020. The primary outcome was the difference in the proportion of time in target glucose range of 70-180 mg/dL (TIR). Additional glucometric data and total daily insulin were also analysed. RESULTS: Fifty-nine patients were included: 33 women, age 46.17 ± 13.0 years and disease duration of 30.2 ± 12.0 years. TIR 70-180 mg/dL (67.6 ± 11.8 vs. 69.8 ± 12.0%), time > 180 (28.1 ± 13.6 vs. 25.5 ± 13.1%), time > 250 (6.9 ± 6.1 vs. 5.1 ± 4.8) and estimated HbA1c (6.94 ± 0.8 vs. 6.75 ± 0.7%) significantly improved (PL vs. WL, respectively, p < 0.05). Time in hypoglycaemia, coefficient of variation, sensor usage and total daily insulin dose remained unchanged. CONCLUSIONS: Lockdown conditions imposed by the COVID-19 pandemic may be managed successfully in terms of glycaemia control by population with DT1 prone to hypoglycaemia using SAP. The strict daily routine at home could probably explain the improvement in the time in glycemic target without increasing the time hypoglycaemia.

The impact of strict COVID-19 lockdown in Spain on glycemic profiles in patients with type 1 Diabetes prone to hypoglycemia using standalone continuous glucose monitoring.

AIMS: Spain has been one of the worst affected countries by the COVID-19 pandemic. A very strict lockdown at home was imposed with a tough restriction of mobility. We aimed to evaluate the impact of this exceptional scenario on glucose profile of patients with T1D prone to hypoglycemia using standalone continuous glucose monitoring. METHODS: Patients with T1D prone to hypoglycemia using multiple daily injections and either a Dexcom G5® or a Free Style Libre® CGM systems for at least 6 months under the funding of National Health Service were included in an observational, retrospective study. Data were collected in two periods: pre-lockdown (PL), February 23rd-March 7th and within lockdown (WL), April 1st-14th 2020. The primary outcome was the difference in the proportion of time in target glucose range of 70-180 mg/dL (TIR). Additional glucometric data were also analysed. RESULTS: 92 patients were included: 40 women, age 42.8 ± 3.9 years, disease duration of 23.1 ± 12.6 years. Seventeen patients used Dexcom G5® and 75 Free Style Libre®. TIR 70-180 mg/dL (59.3 ± 16.2 vs 62.6 ± 15.2%), time > 180 (34.4 ± 18.0 vs 30.7 ± 16.9%), >250 (11.1 ± 10.6 vs 9.2 ± 9.7%) and Glucose Management Indicator (7.2 ± 0.8 vs 7.0 ± 0.8%) significantly improved (PL vs WL, respectively, p < 0.05). Time in hypoglycemia remained unchanged. CONCLUSIONS: Lockdown conditions imposed by the COVID-19 pandemic may be managed successfully in terms of glycemic control by population with T1D prone to hypoglycemia using CGM. The strict daily routine at home could probably explain the improvement in the time in glycemic target without increasing the time in hypoglycemia.

Hipoglucemia desapercibida en jóvenes con diabetes tipo 1 trasladados a un centro de adultos / Hypoglycaemia unawareness in young people with type 1 diabetes transferred to an adult center

OBJETIVO: Evaluar la frecuencia de las hipoglucemias desapercibidas (HD) en pacientes con diabetes tipo 1, trasladados de pediatría, que siguen programa específico de atención y educación terapéutica (PAET) en el hospital de adultos. PACIENTES Y MÉTODOS: Jóvenes trasladados entre 2009-2011. El PAET incluyó proceso de traslado coordinado, visitas individuales y en grupo. Al inicio y a los 12 meses se valoran: HbA1c, frecuencia de hipoglucemias graves paciente/año (HG) y no graves. Los pacientes fueron clasificados y comparados en 2 grupos: hipoglucemia percibida e HD, según los resultados del Test de Clarke < 3R o > 3R respectivamente. RESULTADOS: Realizaron PAET 56 pacientes (edad 18,1±0,3 años, 46% chicas, HbA1c 8,0 ± 1,2%). En la valoración inicial el 16% presentaba HD. El número de episodios de HG fue superior en el grupo HD (0,33 ± 0,50 vs. 0,09 ± 0,28 p < 0,05). El porcentaje de pacientes con > 2 hipoglucemias no graves/semana fue superior en el grupo HD, aunque sin significación estadística (66% vs. 34%, p = 0,06). A los 12 meses todavía un 11% de pacientes presentaba HD. El número de HG siguió siendo superior en el grupo con HD (0,38 ± 1,06 vs. 0,02 ± 0,15, p = 0,04). CONCLUSIONES: El porcentaje de jóvenes con diabetes tipo 1 e HD es considerable en el momento del traslado. El PAET mejora su pronóstico, pero no lo soluciona a medio plazo. Los pacientes con HD presentan mayor frecuencia de HG. La detección de HD es necesaria para reducir las HG que todavía son una asignatura pendiente

OBJECTIVE: To evaluate frequency of hypoglycaemia unawareness (HU) in patients with type 1 diabetes (T1D) transferred from Paediatrics following a specific therapeutic education programme (TEP) in an adult hospital. PATIENTS AND METHODS: Young patients transferred from 2009-2011 were evaluated. The TEP included a coordinated transfer process, individual appointments and a group course. At baseline and at 12 months we evaluated glycated haemoglobin (HbA1c) frequency of severe (SH) hypoglycaemia/patient/year and non severe hypoglycaemia (NSH). The patients were classified into two groups and compared: hypoglycaemia awareness (HA) and HU according to the Clarke Test < 3R or > 3R respectively. RESULTS: Fifty-six patients (age 18.1 ± 0.3 years, 46% females, HbA1c 8.0 ± 1.2%) underwent the TEP. In the baseline evaluation 16% presented HU. The number of SH was higher in the HU Group (0.33 ± 0.50 vs. 0.09 ± 0.28 P < .05). The percentage of patients with > 2 NSH/week was higher, albeit not significantly, in the HU group (66% vs. 34%, p = 0.06). At 12 months 11% of the patients continued to present HU. The number of SH remained higher in the HU group (0.38 ± 1.06 vs. 0.02 ± 0.15 P = .04). CONCLUSIONS: The percentage of young people with T1D with HU is quite high at transfer. Although the TEP improves hypoglycaemia awareness it does not solve this important problem. Patients with HU more frequently present SH. It is necessary to identify HU in order to reduce SH which continues to be a problem in people with T1D

Hypoglycaemia unawareness in young people with type 1 diabetes transferred to an adult center. / Hipoglucemia desapercibida en jóvenes con diabetes tipo 1 trasladados a un centro de adultos.

OBJECTIVE: To evaluate frequency of hypoglycaemia unawareness (HU) in patients with type 1 diabetes (T1D) transferred from Paediatrics following a specific therapeutic education programme (TEP) in an adult hospital. PATIENTS AND METHODS: Young patients transferred from 2009-2011 were evaluated. The TEP included a coordinated transfer process, individual appointments and a group course. At baseline and at 12 months we evaluated glycated haemoglobin (HbA1c) frequency of severe (SH) hypoglycaemia/patient/year and non severe hypoglycaemia (NSH). The patients were classified into two groups and compared: hypoglycaemia awareness (HA) and HU according to the Clarke Test <3R or>3R respectively. RESULTS: Fifty-six patients (age 18.1±0.3 years, 46% females, HbA1c 8.0±1.2%) underwent the TEP. In the baseline evaluation 16% presented HU. The number of SH was higher in the HU Group (0.33±0.50 vs. 0.09±0.28 P<.05). The percentage of patients with>2 NSH/week was higher, albeit not significantly, in the HU group (66% vs. 34%, p=0.06). At 12 months 11% of the patients continued to present HU. The number of SH remained higher in the HU group (0.38±1.06 vs. 0.02±0.15 P=.04). CONCLUSIONS: The percentage of young people with T1D with HU is quite high at transfer. Although the TEP improves hypoglycaemia awareness it does not solve this important problem. Patients with HU more frequently present SH. It is necessary to identify HU in order to reduce SH which continues to be a problem in people with T1D.

Programa de atención y educación terapéutica en el debut de la diabetes tipo 2: un nuevo modelo de abordaje en atención primaria / Health care and therapeutic education program for newly diagnosed type 2 diabetes: A new approach in primary care

Introducción: A pesar de la evidencia favorable, existen pocas iniciativas en nuestro sistema público sobre programas específicos de educación terapéutica estructurada dirigidos a pacientes con diagnóstico reciente de diabetes tipo 2 (DM2), un momento de especial importancia en la evolución posterior de la enfermedad. Objetivos: Evaluar la efectividad del Programa de Atención y educación Terapéutica en el debut de la DM2 (PAET-Debut DM2) de ámbito territorial y consensuado entre centros de Atención Primaria y Hospital de referencia. Métodos: Estudio piloto prospectivo en pacientes con edad >18 años diagnosticados de DM2 entre febrero 2012-2013. El PAET-DebutDM2 se planifica e implementa en 4 Centros de Atención Primaria del área de referencia del Hospital Clínic de Barcelona. Se identifican referentes (médico de familia y enfermera) en cada centro y se realiza formación específica para estandarización de procesos clínicos y metodología de educación terapéutica. Se evalúan resultados a los 6 y 12 meses. Resultados: Se propone el programa a 345 pacientes, 191(55,3%) son incluidos, finalizando 134(70,2%). Al finalizar el programa el 84% de pacientes está en objetivos de control (HbA1c<7%) y 88% completa el cribado de complicaciones crónicas. Observamos una mejora del peso corporal, de la actividad física (p<0,001), del nivel de conocimientos (p<0,05), y constatamos menos urgencias hospitalarias por DM comparados con los no incluidos (p=0,023). Conclusión: El PAET-DebutDM2 estandariza la intervención, la educación y es efectivo en los resultados clínicos, educativos y de satisfacción del paciente. Enfatiza la importancia de la educación y de la intervención desde el debut, y reordena recursos, sin incrementar la presión asistencial en el centro de atención primaria, reduciendo la atención hospitalaria

Introduction: Despite the favorable evidence available, our public health care system has no specific programs including therapeutic education for patients newly diagnosed with type 2 diabetes (T2DM), which would be crucial for the subsequent course of the disease. Objectives: To assess the effectiveness of a "Health care and Therapeutic Education Program for newly diagnosed type 2 diabetes (PAET-Debut DM2)" agreed by the primary care centers and the reference hospital in a given geographical area. Methods: A prospective pilot study in patients over 18 years of age diagnosed with T2DM between February 2012 and 2013. The PAET-DebutDM2 is planned and set up in four primary care centers in the area covered by Hospital Clínic in Barcelona. Reference persons (family doctor and nurse) are designated at each center and specific training is provided to standardize the clinical processes and therapeutic education methods. First results are assessed and compared at 6 and 12 months. Results: The program was proposed to 345 patients, of which 191 (55.3%) were enrolled in it and 134 (70.2%) completed the program. At the end of the program, 84% achieved the control goal (HbA1c <7%) and 88% passed the screening of chronic complications. Improvements were seen in body weight, physical activity (p<0,001), and disease awareness (p<0.05), and there were less hospital emergencies due to DM as compared to patients not included in the program (p=0.023). Conclusion: The PAET-DebutDM2 standardizes intervention and education and is effective in terms of clinical and educational results and patient satisfaction. The program emphasizes the importance of early education and intervention, reorganizing resources without increasing care pressure in the primary care centers, thus reducing hospital care

Health care and therapeutic education program for newly diagnosed type 2 diabetes: A new approach in primary care. / Programa de atención y educación terapéutica en el debut de la diabetes tipo 2: un nuevo modelo de abordaje en atención primaria.

INTRODUCTION: Despite the favorable evidence available, our public health care system has no specific programs including therapeutic education for patients newly diagnosed with type 2 diabetes (T2DM), which would be crucial for the subsequent course of the disease. OBJECTIVES: To assess the effectiveness of a "Health care and Therapeutic Education Program for newly diagnosed type 2 diabetes (PAET-Debut DM2)" agreed by the primary care centers and the reference hospital in a given geographical area. METHODS: A prospective pilot study in patients over 18 years of age diagnosed with T2DM between February 2012 and 2013. The PAET-DebutDM2 is planned and set up in four primary care centers in the area covered by Hospital Clínic in Barcelona. Reference persons (family doctor and nurse) are designated at each center and specific training is provided to standardize the clinical processes and therapeutic education methods. First results are assessed and compared at 6 and 12 months. RESULTS: The program was proposed to 345 patients, of which 191 (55.3%) were enrolled in it and 134 (70.2%) completed the program. At the end of the program, 84% achieved the control goal (HbA1c <7%) and 88% passed the screening of chronic complications. Improvements were seen in body weight, physical activity (p<0,001), and disease awareness (p<0.05), and there were less hospital emergencies due to DM as compared to patients not included in the program (p=0.023). CONCLUSION: The PAET-DebutDM2 standardizes intervention and education and is effective in terms of clinical and educational results and patient satisfaction. The program emphasizes the importance of early education and intervention, reorganizing resources without increasing care pressure in the primary care centers, thus reducing hospital care.

Detailed description of a prepregnancy care program and its impact on maternal glucose control, weight gain, and dropouts.

BACKGROUND: The aim of this study was to analyze the clinical and metabolic changes observed during a prepregnancy care (PPC) program. METHODS: We performed a retrospective, observational, cohort study of 104 women with type 1 diabetes initiating a PPC program from 2011 to 2014. The outcomes measured were changes in HbA1c levels, weight and hypoglycemic events during PPC. Risk factors associated with severe hypoglycemia events, achieving the HbA1c target and dropouts were evaluated. RESULTS: HbA1c decreased from 7.2 ± 0.8% (55.3 ± 8.8 mmol/mol) to 6.7 ± 0.9% (49.8 ± 10.3 mmol/mol) (P < .001) within a median of 14.2 months (interquartile interval 5.4-23.2); 71.2% obtained HbA1c  < 7% (53 mmol/mol). HbA1c at the end of PPC was associated with baseline HbA1c (ß = .318, P = .001) and the number of previous pregnancies (ß = .224, P = .038), PPC was accompanied by 1.4 ± 4.0 kg weight gain (P = .003) without changes in severe hypoglycemic events. The risk factors for severe hypoglycemia were severe hypoglycemic events during the 2 years before (odds ratio [OR] 11.99, confidence interval 95% 1.89-75.95) and PPC duration (OR 1.09, 1.03-1.16). A total of 33 patients (31.7%) dropped out from PPC during follow-up, with dropout being associated with age (OR 1.17, 1.04-1.36) and PPC duration (OR 1.06, 1.02-1.11). CONCLUSIONS: Our PPC program was associated with an improvement in glycemic control without a significant increase in severe hypoglycemic events, although with some weight gain. A considerable number of patients dropped out during follow-up, this being related to older age and a longer duration of the program. This information could be of help to design new and more effective PPC approaches. Copyright © 2016 John Wiley & Sons, Ltd.

Análisis psicométrico de las versiones en lengua castellana y catalana de un cuestionario de percepción de la hipoglucemia / Psychometric analysis of the Spanish and Catalan versions of a questionnaire for hypoglycemia awareness

Fundamento y objetivo: El tratamiento intensivo con múltiples dosis de insulina de los pacientes con diabetes mellitus tipo 1 (DT1) se asocia con la aparición de hipoglucemias. Su recurrencia condiciona la pérdida progresiva de los síntomas asociados a las mismas y predispone a la aparición de episodios graves. Es importante disponer de cuestionarios específicos y validados para identificar a los pacientes con este problema. Con este objetivo se realizó el análisis psicométrico de las versiones castellana y catalana del cuestionario de Clarke et al. destinado a valorar la percepción de hipoglucemias. Pacientes y método: Análisis psicométrico en pacientes con DT1 de las versiones en castellano y catalán del cuestionario de Clarke et al. en 3 fases: 1) traducción, retrotraducción y adaptación cultural de la versión en inglés; 2) análisis de la consistencia interna, validez de constructo y test-retest del mismo, y 3) análisis de su sensibilidad al cambio en la percepción de hipoglucemias. Resultados: Ciento cuarenta y cuatro pacientes con DT1 contestaron los cuestionarios en lengua castellana o catalana, según preferencias (edad media [DE] de 36 [18] años, 46% varones). Se obtuvo un coeficiente a de Cronbach para la consistencia interna de 0,75, un coeficiente de correlación para la fiabilidad test-retest de r = 0,81 y una correlación de la puntuación del cuestionario con la frecuencia de hipoglucemias no graves y graves de r = 0,47 y r = 0,77, respectivamente. El análisis de 20 pacientes con DT1 durante 24 meses tras el inicio de infusión subcutánea continua de insulina mostro´ una disminución de la frecuencia de hipoglucemias no graves/semana (de una media de 5,40 [2,09] a 2,75 [1,74]), así como del número de episodios de hipoglucemia grave/año (de una media de 1,25 [0,44] a 0,05 [0,22]). Esta reducción se asoció con una mejora en la percepción de la hipoglucemia, con una disminución de la puntuación del cuestionario de Clarke et al. (de 5,45 [1,19] a 1,60 [2,03]). Conclusiones: Las versiones en lengua castellana y catalana del cuestionario de Clarke et al. Tienen buenas características psicométricas y pueden ser un instrumento útil para evaluar la presencia de hipoglucemia desapercibida en pacientes con DT1 de nuestro entorno (AU)

Background and objective: Intensive insulin therapy with multiple insulin doses in subjects with type 1 diabetes mellitus (T1D) is associated with a higher risk of hypoglycaemic episodes. Repeated hypoglycemia results in a reduced ability/failure to recognize hypoglycemia symptoms and predisposes to severe episodes. In this context is crucial to work with specific questionnaires to diagnose and address this burden. Our study aimed to perform the psychometric analysis of Spanish and Catalan versions of Clarke et al. questionnaire for hypoglycemia awareness. Patients and method: Psychometric analysis in patients with T1D of Spanish and Catalan versions of Clarke et al. questionnaire in 3 phases: 1) translation, back-translation and cultural adaptation of the English version; 2) analysis of internal, external and test-retest validity, and 3) assessing sensitivity to change in hypoglycemia perception. Results: One-hundred and forty-four subjects with T1D answered the Clarke et al. questionnaire (mean age [SD] 36 [18] years, 46% men). We observed a Cronbach a coefficient for internal validity of 0.75, a correlation coefficient for test-retest reliability of r = 0.81 and a correlation of the questionnaire score with the frequency of severe and no severe hypoglycemia events of r = 0.47 and r = 0.77, respectively. The analysis of 20 patients with T1D 24 months after the initiation of continuous subcutaneous insulin infusion showed a decrease in the frequency of non-severe hypoglycemia/week (from 5.40 [2.09] to 2.75 [1.74]) and in the number of severe hypoglycemic episodes/year (1.25 [0.44] to 0.05 [0.22]). This was associated with a decrease in scores of the translated versions of Clarke et al. questionnaire (from 5.45 [1.19] to 1.60 [2.03]). Conclusions: Spanish and Catalan versions of Clarke et al. questionnaire display good psychometric properties and both could be considered a useful tool for evaluating hypoglycemia awareness in patients with T1D from our area (AU)

Educación terapéutica en la cronicidad: el modelo de la diabetes / Therapeutic education in chronic patients: the diabetes model

No disponible

[Psychometric analysis of the Spanish and Catalan versions of a questionnaire for hypoglycemia awareness]. / Análisis psicométrico de las versiones en lengua castellana y catalana de un cuestionario de percepción de la hipoglucemia.

BACKGROUND AND OBJECTIVE: Intensive insulin therapy with multiple insulin doses in subjects with type 1 diabetes mellitus (T1D) is associated with a higher risk of hypoglycaemic episodes. Repeated hypoglycemia results in a reduced ability/failure to recognize hypoglycemia symptoms and predisposes to severe episodes. In this context is crucial to work with specific questionnaires to diagnose and address this burden. Our study aimed to perform the psychometric analysis of Spanish and Catalan versions of Clarke et al. questionnaire for hypoglycemia awareness. PATIENTS AND METHOD: Psychometric analysis in patients with T1D of Spanish and Catalan versions of Clarke et al. questionnaire in 3 phases: 1) translation, back-translation and cultural adaptation of the English version; 2) analysis of internal, external and test-retest validity, and 3) assessing sensitivity to change in hypoglycemia perception. RESULTS: One-hundred and forty-four subjects with T1D answered the Clarke et al. questionnaire (mean age [SD] 36 [18] years, 46% men). We observed a Cronbach α coefficient for internal validity of 0.75, a correlation coefficient for test-retest reliability of r=0.81 and a correlation of the questionnaire score with the frequency of severe and no severe hypoglycemia events of r=0.47 and r=0.77, respectively. The analysis of 20 patients with T1D 24 months after the initiation of continuous subcutaneous insulin infusion showed a decrease in the frequency of non-severe hypoglycemia/week (from 5.40 [2.09] to 2.75 [1.74]) and in the number of severe hypoglycemic episodes/year (1.25 [0.44] to 0.05 [0.22]). This was associated with a decrease in scores of the translated versions of Clarke et al. questionnaire (from 5.45 [1.19] to 1.60 [2.03]). CONCLUSIONS: Spanish and Catalan versions of Clarke et al. questionnaire display good psychometric properties and both could be considered a useful tool for evaluating hypoglycemia awareness in patients with T1D from our area.

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

Assessment of use of specific features of subcutaneous insulin infusion systems and their relationship to metabolic control in patients with type 1 diabetes.

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.

Psychometric analysis of the Spanish and Catalan versions of the Diabetes Self-Care inventory-revised version questionnaire.

BACKGROUND: The purpose of this study was to validate the Spanish and Catalan versions of the Diabetes Self-Care Inventory-Revised Version (SCI-R) questionnaire to assess the degree of adherence to self-care among adults with diabetes. METHODS: We validated the Spanish and Catalan translation from, and back translation to, English and cultural adaptation of the SCI-R in type 1 diabetes patients on multiple insulin doses or continuous subcutaneous insulin infusion and in type 2 diabetes patients on oral agents and/or insulin. Internal reliability, structural validity, and external validity (correlation with glycated hemoglobin) were evaluated. Responsiveness to change was assessed in patients 1 year after onset of type 1 diabetes and following a structured education program. RESULTS: The SCI-R presented good internal reliability Cronbach's α: 0.75, test-retest reliability (r = 0.82) and structural validity (r > 0.40). The external validity was also good; the SCI-R correlated with HbA1c in patients with type 1 diabetes on multiple insulin doses (r = -0.50) or continuous subcutaneous insulin infusion (r = -0.66) and in patients with type 2 diabetes on multiple insulin doses (r = -0.62). However, it was not satisfactory in patients on oral agents (r = -0.20) and/or bedtime insulin (r = -0.35). Responsiveness to change was analyzed in 54 patients (age 27.3±7.4 years, 26% men, HbA1c 6.8% ±1.1%); the SCI-R score was 72.3% ±13.7% and correlated negatively with glycated hemoglobin (r = -0.42) and 3 scales of the Diabetes Quality of Life questionnaire (lower score indicating better perception): Impact (r = -0.37), Social Worry (r = -0.36) and Diabetes Worry (r = -0.38), all at P < 0.05. CONCLUSION: The Spanish and Catalan versions of the SCI-R questionnaire show good psychometric properties and both could be considered as useful tools for evaluating self-care behavior in patients with type 1 or type 2 diabetes. However, there are still some subgroups of patients with type 2 diabetes in which the validity of this questionnaire needs further evaluation.

[Continuous monitoring systems of glucose]. / Sistemas de monitorización continua de la glucosa.

The possibility of obtaining a continuous reading of glucose may represent a breakthrough and a useful tool for the management of diabetes. Technological advances can improve the quality of life and people with diabetes metabolic control, even if this means having to learn and incorporate new technical concepts, new algorithms for pattern modification and new challenges in Therapeutic Education.

Sistemas de monitorización continua de la glucosa / Continuous monitoring systems of glucose

La posibilidad de obtener una lectura continua de la glucosa puede representar un gran avance y una herramienta útil para el manejo de la diabetes. Los avances tecnológicos pueden mejorar la calidad de vida y el control metabólico de las personas con diabetes, aunque esto suponga tener que aprender e incorporar nuevos conceptos técnicos, nuevos algoritmos de modificación de pauta y nuevos retos en Educación Terapéutica(AU)

The possibility of obtaining a continuous reading of glucose may represent a breakthrough and a useful tool for the management of diabetes. Technological advances can improve the quality of life and people with diabetes metabolic control, even if this means having to learn and incorporate new technical concepts, new algorithms for pattern modification and new challenges in Therapeutic Education(AU)

[Therapeutic education didactic techniques]. / Técnicas didácticas en educacíon terapéutica.

This article includes an introduction to the role of Therapeutic Education for Diabetes treatment according to the recommendations of the American Diabetes Association (ADA), the Diabetes Education Study Group (DESG) of the "European Association for Study of Diabetes (EASD) and the clinical Practice Guidelines (CPG) of the Spanish Ministry of Health. We analyze theoretical models and the differences between teaching vs. learning as well as current trends (including Internet), that can facilitate meaningful learning of people with diabetes and their families and relatives. We analyze the differences, similarities, advantages and disadvantages of individual and group education. Finally, we describe different educational techniques (metaplan, case method, brainstorming, role playing, games, seminars, autobiography, forums, chats,..) applicable to individual, group or virtual education and its application depending on the learning objective.

Técnicas didácticas en educación terapéutica aplicadas a la diabetes / Therapeutic education didactic techniques

Este artículo incluye una introducción sobre el rol de la educación terapéutica en el tratamiento de la diabetes según las recomendaciones, entre otras, de la »American Diabetes Association (ADA)« y del »Diabetes Education Study Group (DESG)« de la »European Association for Study of Diabetes (EASD)« y las Guías de práctica clínica (GPC) del Ministerio de Sanidad. Se analizan diferentes modelos teóricos, las diferencias entre enseñar versus aprender, así como las tendencias actuales (incluyendo internet) que pueden facilitar un aprendizaje significativo de las personas con diabetes y sus familiares o cuidadores. Se analizan las diferencias, similitudes, ventajas y desventajas de la educación individualizada y de la educación grupal. Por último se describen las diferentes técnicas educativas (Metaplan, Método del caso, Lluvia de ideas, Rol Playing, Juego, Seminario, Autobiografía, Forum Chats) aplicables a la educación individual, grupal o virtual y su aplicación en función del objetivo de aprendizaje(AU)

This article includes an introduction to the role of Therapeutic Education for Diabetes treatment according to the recommendations of the American Diabetes Association (ADA), the Diabetes Education Study Group (DESG) of the European Association fot Study Diabetes (EASD) and the clinical Practice Guidelines (CPG) of the Spanish Ministry of Health. We analyze theoretical models and the differences between teaching vs. learning as well as current trends (including Internet), that can facilitate meaningful learning of people with diabetes and their families and relatives. We analyze the differences, similarities, advantages and disadvantages of individual and group education. Finally, we describe different educational techniques (Metaplan, Case Method, Brainstorming, Role Playing, Games, Seminars, autobiography, Forums, Chats,...) applicable to individual, group or virtual education and its application depending on the learning objective(AU)