Validación de una escala enfermera para evaluar las actitudes del profesorado en la atención diabética / Validation of a nursing scale for assessing teachers' attitudes to diabetes care

Objetivo: Validar el Inventario de Actitudes Negativas del Profesorado hacia la Atención del Alumnado con Diabetes Mellitus tipo 1 (INAPAD) y estudiar su fiabilidad mediante los coeficientes Alfa de Cronbach y Omega de McDonald. Material y método: Este estudio describe el proceso de diseño y validación de la escala enfermera INAPAD en una muestra de 382 docentes en las etapas de Educación Infantil, Educación Primaria, Educación Secundaria Obligatoria, Bachillerato y Formación Profesional en una provincia española. El INAPAD pretende valorar diversas dimensiones actitudinales sobre la atención educativa al alumnado con Diabetes Mellitus tipo 1, incidiendo tanto en el perfil docente y profesional del profesorado, como en las características y necesidades específicas de este alumnado. Por su parte, la validez de constructo se ha evaluado mediante análisis factoriales exploratorios por componentes principales y rotación varimax. Resultados y Conclusión: Los resultados obtenidos informan de la viabilidad del INAPAD para ser utilizado como un instrumento útil para el diagnóstico del prejuicio o predisposición del profesorado hacia la atención del alumnado con DM tipo 1 y, por ende, para predecir el éxito de las medidas psicopedagógicas y los cuidados del niño y adolescente con diabetes. (AU)

Objective: To validate the Inventory of Teachers' Negative Attitudes towards the Care of Students with Diabetes Mellitus type 1 (INAPAD) and to study its reliability using Cronbach's Alpha and McDonald's Omega coefficients. Enfermería GlobalNº 74 Abril 2024Página 195Methods: This study describes the design and validation process of the INAPAD nursing scale in a sample of 382 teachers in the stages of Early Childhood Education, Primary Education, Compulsory Secondary Education, Baccalaureate and Vocational Training in a Spanish province. In order to validate the INAPAD, its reliability has been studied using Cronbach's Alpha and McDonald's Omega Coefficients. Hence, the construct validity has been evaluated through exploratory factor analysis by principal components and varimax rotation. Results and conclusion: The findings obtained inform the viability of the INAPAD to be used as an effective instrument for the diagnosis of prejudice or predisposition of educators towards the care of learners with type 1 DM and for the prediction of the success of psycho-pedagogical measures and of the care for children and adolescents with diabetes. (AU)

Use of probiotics and similar in pediatric patients with Type 1 Diabetes Mellitus: a systematic review / Uso de probióticos e similares em pacientes pediátricos com Diabetes Mellitus tipo 1: uma revisão sistemática

ABSTRACT Objective: To perform a systematic review of randomized controlled trials, evaluating the effect of probiotics, prebiotics or symbiotics supplementation on glycemic and inflammatory control in children with Type 1 Diabetes Mellitus (T1DM). Data source: The Medical Literature Analysis and Retrieval System Online (MEDLINE/PubMed), Clinical Trials, Literatura Latino-Americana e do Caribe em Ciências da Saúde (LILACS) and Scientific Electronic Library Online (SciELO) databases were searched. Randomized clinical trials of pediatric patients with DM1 using probiotics, prebiotics or symbiotics were included, regardless of year or language of publication. Studies that did not evaluate glycated hemoglobin (HbA1c) were excluded. Metabolic results (HbA1c, total insulin dose and C-peptide) and inflammatory control [interleukin-10 (IL-10), tumor necrosis factor-alpha (TNF-α) and interferon-gamma (IFN-γ)] during probiotic supplementation or similar, related to modification of the intestinal microbiota, were analyzed. PROSPERO ID: CRD42022384485. Data synthesis: Five studies were selected for a systematic review. Regarding metabolic markers, only one of the articles that analyzed HbA1c showed a significant decrease (p=0.03) in the intervention group. One study identified a reduction in the total dose of insulin and increased C-peptide levels. Regarding the evaluation of inflammatory parameters (IL-10, TNF-α, INF-γ), there were no statistical relevant modifications. Conclusions: Current data from the literature were not conclusive in identifying an improvement in glycemic control and did not observe changes in inflammatory parameters with the use of probiotics, prebiotics or symbiotics in pediatric patients with T1DM.

RESUMO Objetivo: Realizar uma revisão sistemática de ensaios clínicos randomizados controlados avaliando o efeito da suplementação de probióticos, prebióticos ou simbióticos no controle glicêmico e inflamatório em crianças com diabetes mellitus tipo 1 (DM1). Fontes de dados: As bases Medical Literature Analysis and Retrieval System Online (MEDLINE/PubMed), Clinical Trials, Literatura Latino-Americana e do Caribe em Ciências da Saúde (LILACS) e Scientific Electronic Library Online (SciELO) foram pesquisadas. Foram incluídos ensaios clínicos randomizados de pacientes pediátricos com DM1 em uso de probióticos, prebióticos ou simbióticos, independentemente de ano ou idioma de publicação. Foram excluídos os trabalhos que não avaliaram hemoglobina glicada (HbA1c). Os resultados metabólicos (HbA1c, dose de insulina total e peptídeo C) e o controle inflamatório [interleucina-10 — IL-10), fator de necrose tumoral-alfa (TNF-α) e interferon-gama (IFN-γ)] durante a suplementação de probióticos ou similares, relacionados à modificação da microbiota intestinal, foram analisados. ID PROSPERO: CRD42022384485. Síntese dos dados: Cinco estudos foram selecionados para revisão sistemática. Com relação aos marcadores metabólicos, apenas um dos artigos que analisaram a HbA1c apresentou diminuição significativa (p=0,03) no grupo intervenção. Um estudo identificou redução da dose total de insulina e aumento dos níveis de peptídeo C. Quanto à avaliação dos parâmetros inflamatórios (IL-10, TNF-α, INF-γ), não houve modificações de relevância estatística. Conclusões: Os dados atuais da literatura não foram conclusivos em identificar melhora no controle glicêmico e não observaram mudanças nos parâmetros inflamatórios com o uso de probióticos, prebióticos ou simbióticos em pacientes pediátricos com DM1.

Autogestão do diabetes na adolescência: experiência de jovens adultos e pais portugueses / Autogestión de la diabetes en la adolescencia: experiencias de jóvenes adultos y padres portugueses / Self-management of diabetes in adolescence: experience of Portuguese young adults and their parents

Resumo Objetivo Identificar os fatores que facilitam ou dificultam a construção da autonomia na adolescência através da experiência de jovens adultos com diabetes tipo 1 e seus pais. Métodos Estudo de natureza qualitativa, descritiva e exploratória. Foram realizadas duas entrevistas de grupo focal, uma com nove jovens adultos peritos na gestão de sua doença e outra com sete pais. Para análise dos dados, foram usados análise de conteúdo temática e categorial, com particularidades de entrevista de grupo focal, e recurso ao software NVIVO 12. Resultados Emergiram duas grandes categorias e dez subcategorias relativas aos fatores que facilitaram (sistemas de suporte, conhecimentos, alimentação, bomba de insulina, responsabilização precoce pela gestão da terapêutica, características dos jovens), e dificultaram (regime terapêutico, estigma, atitude dos profissionais de saúde, características dos jovens, conhecimento) o desenvolvimento da autonomia na gestão da doença. Conclusão A autonomia na gestão do diabetes envolve vários desafios aos adolescentes, o que requer adequação de atitudes e intervenções de profissionais. Além da gestão tradicional da condição de saúde, é essencial abordar temas relacionados com a socialização dos adolescentes, procurando estratégias inovadoras que promovam o coping e a qualidade de vida. Os resultados deste estudo possibilitam refletir sobre a relação terapêutica com os adolescentes, salientando a importância de individualizar cuidados e respostas inovadoras às suas necessidades específicas.

Resumen Objetivo Identificar los factores que facilitan o dificultan la construcción de la autonomía en la adolescencia a través de la experiencia de jóvenes adultos con diabetes tipo 1 y sus padres. Métodos: Estudio de naturaleza cualitativa, descriptiva y exploratoria. Se realizaron dos entrevistas de grupo focal, una con nueve jóvenes adultos expertos en la gestión de su enfermedad y otra con siete padres. Para el análisis de datos se utilizó el análisis de contenido temático y categorial, con particularidades de entrevista de grupo focal y recurso del software NVIVO 12. Resultados Surgieron dos grandes categorías y diez subcategorías relativas a los factores que facilitaron el desarrollo de la autonomía en la gestión de la enfermedad (sistemas de apoyo, conocimientos, alimentación, bomba de insulina, responsabilización temprana de la gestión de la terapéutica, características de los jóvenes) y los que la dificultaron (régimen terapéutico, estigma, actitudes de los profesionales de la salud, características de los jóvenes, conocimientos). Conclusión La autonomía en la gestión de la diabetes incluye muchos desafíos para los adolescentes, lo que requiere adaptación de actitudes e intervenciones de profesionales. Además de la gestión tradicional del estado de salud, es esencial abordar temas relacionados con la socialización de los adolescentes y buscar estrategias innovadoras que promuevan el coping y la calidad de vida. Los resultados de este estudio permiten reflexionar sobre la relación terapéutica con los adolescentes y destacar la importancia de individualizar los cuidados y las respuestas innovadoras para sus necesidades específicas.

Abstract Objective To identify the factors that facilitate or hinder the construction of autonomy in adolescence through the experience of young adults with type-1 diabetes and their parents. Methods This was a qualitative, descriptive, and exploratory study. Two focus group interviews were conducted: one with nine young adults who were experts in managing their illness and the other with seven parents. Thematic and categorical content analysis was used for data analysis, with particularities of a focus group interview and the use of the NVIVO 12 software. Results Two major categories and ten subcategories related to factors that facilitated (support systems, knowledge, diet, insulin pump, early responsibility for managing therapy, and characteristics of young people) and hindered (therapeutic regimen, stigma, attitude of health professionals, characteristics of young people, and knowledge) the development of autonomy in disease management emerged. Conclusion Autonomy in the management of diabetes involves several challenges for adolescents, which requires adaptation of attitudes and interventions by professionals. In addition to the traditional management of the health condition, addressing issues related to the socialization of adolescents is essential, looking for innovative strategies that promote coping and quality of life. The results of this study make it possible to reflect on the therapeutic relationship with adolescents, emphasizing the importance of individualizing care and innovative responses to their specific needs.

Percepción de apoyo social en padres de niños con diabetes mellitus tipo 1

Fundamento: el apoyo de familiares y del equipo de salud a los padres cuidadores de sus hijos diabéticos es fundamental para el afrontamiento a los cambios que provoca esta enfermedad en la dinámica familiar. Objetivo: describir la percepción de los padres cuidadores sobre el apoyo familiar y de los Sistemas de Salud en el comienzo de sus hijos con diabetes mellitus tipo 1. Métodos: estudio cualitativo descriptivo realizado mediante entrevista semiestructurada a cuatro padres cuidadores de niños con diagnóstico de diabetes tipo 1. El consentimiento informado fue realizado vía Google Forms y la entrevista fue vía plataforma ZOOM. Las entrevistas tuvieron una duración de 30 minutos. El análisis de las entrevistas se realizó utilizando el programa ATLAS.ti versión 22. Resultados: el comienzo de la enfermedad de los niños fue recibido por los padres con mucha confusión y falta de conocimiento. En cuanto a las redes de apoyo, los padres declararon la soledad como vivencia en el cuidado de los niños y, en relación a los equipos de salud, relataron que está enfocada en los cuidados básicos que tenían que cumplir, como la alimentación y el control glucémico, con ausencia de preocupación por el apoyo emocional. Conclusiones: las necesidades de apoyo desde los equipos de salud, a los padres cuidadores, más allá del control de la enfermedad, es una necesidad explícita desde la evidencia, que aún no ha sido considerada por los Sistemas de Salud. El apoyo debe trascender la familia, con una actuación importante de los profesionales de la salud y todo el contexto en que están insertos los niños, para contribuir a un manejo adecuado de la enfermedad.

Foundation: the support of family members and the health team for parents caring for their diabetic children is essential for facing with the changes that this disease causes in family dynamics. Objective: to describe the perception of parent caregivers about family support and Health Systems at the beginning of their children with type 1 diabetes mellitus. Methods: qualitative descriptive study carried out through semi-structured interviews with four parent caregivers of children with a diagnosis of type 1 diabetes. Informed consent was carried out via Google forms and the interview was via the ZOOM platform. The interviews lasted 30 minutes. The analysis of the interviews was carried out using the ATLAS.ti version 22 program. Results: the beginning of the children's illness was received by parents with much confusion and lack of knowledge. Regarding the support networks, the parents declared loneliness in the experience of caring for the children and, in relation to the health teams, they reported that it is focused on the basic care that they had to fulfill, such as food and hygiene, glycemic control, with absence of concern for emotional support. Conclusions: the support needs from health teams to parent caregivers, beyond disease control, is an explicit need from the evidence, which has not yet been considered by Health Systems. Support must go beyond the family, with important action by health professionals and the entire context in which children are inserted, to contribute to adequate management of the disease.

Perfil das pessoas com diabetes que utilizaram a telefarmácia na pandemia de covid-19: resultados da DIABETES / Profile of people with diabetes who used telepharmacy during the covid-19 pandemic: results from DIABETES / Perfil de personas con diabetes que usaron telefarmacia durante la pandemia de covid-19: resultados de DIABETES

O objetivo foi analisar o perfil das pessoas com diabetes que utilizaram a telefarmácia na pandemia de covid-19. Trata-se de um estudo transversal com dados oriundos da websurvey DIABETESvid que ocorreu nos meses de setembro e outubro de 2020. Verificou-se que 45 participantes recorreram à telefarmácia, sendo que 55,6% eram do sexo masculino, 42,2% tinham idade compreendida entre 18 e 34 anos e 46,7% estudaram 12 ou mais anos. Além disso, 48,9% autorreferiram diabetes mellitus tipo 1. A maioria usava insulina (55,6%) e obteve os medicamentos para o diabetes em farmácias do sistema público de saúde (60%). Ademais, as pessoas que tiveram o diagnóstico de covid-19 buscaram mais pela telefarmácia (RP=2,20; IC95% 1,23­3,94). Sabe-se que os medicamentos são essenciais para o tratamento do diabetes. Logo, no período estudado em que se preconizava o distanciamento físico, os participantes apropriaram-se da telefarmácia a fim de obter a integralidade do cuidado

The objective was to analyze the profile of people with diabetes who used telepharmacy during the covid-19 pandemic. This is a cross-sectional study with data from the DIABETESvid websurvey that took place in September and October 2020. It was found that 45 participants used telepharmacy, 55.6% of whom were male, 42.2% were between 18 and 34 years-old and 46.7% studied 12 or more years. In addition, 48.9% self-reported type 1 diabetes mellitus. Most used insulin (55.6%) and obtained their diabetes medication from pharmacies in the public health system (60%). Also, people diagnosed with covid-19 used telephar-macy more often (PR=2.20; 95%CI 1.23­3.94). It is known that drugs are essential for the treatment of diabetes. Therefore, in the period studied in which physical distancing was advocated, the participants used telepharmacy to obtain comprehensive care

El objetivo fue analizar el perfil de las personas con diabetes que utilizaron la telefarmacia durante la pandemia del covid-19. Estudio transversal con datos de la encuesta por internet DIABETESvid realizada en septiembre y octubre de 2020. Se encontró que 45 participantes recurrieron a la telefarmacia, de los cuales el 55,6% eran hombres, el 42,2% tenían entre 18 y 34 años y el 46,7% estudiaban 12 o más años. Además, el 48,9% se autorrefirió diabetes mellitus tipo 1. La mayoría utilizaba insulina (55,6%) y recibía su medicación antidiabética en farmacias del sistema público (60%). Además, las personas diagnosticadas con covid-19 buscaron telefarmacia con más frecuencia (RP = 2,20; IC 95% 1,23­3,94). Los medicamentos son esenciales para el tratamiento de la diabetes. Por lo tanto, en el período estudiado en el que se propugnaba el distanciamiento físico, los participantes se apropiaron de la telefarmacia para la atención integral

Monitorización flash en pacientes con diabetes mellitus tipo 1: adherencia, complicaciones y parámetros clínicos / Flash monitoring in patients with type 1 diabetes mellitus: treatment adherence, complications and clinical parameters

Objetivos: describir el perfil sociodemográfico y clínico de las personas con diabetes mellitus tipo 1 (DM1), así como el uso del dispositivo de monitorización flash Freestyle Libre (FL) en quienes se lo habían costeado por cuenta propia, y analizar las diferencias (parámetros analíticos, complicaciones de la enfermedad y adherencia al tratamiento) frente a pacientes con DM1 que utilizaban los controles glucémicos tradicionales mediante punción capilar.Método: estudio descriptivo transversal en 206 pacientes con DM1 de un área de salud en la región de Castilla-La Mancha. Variables de estudio: tener dispositivo FL por cuenta propia, variables sociodemográficas y clínicas (incluyendo parámetros analíticos) y el cuestionario validado Self Care Inventory Revised (SCI-R). Se realizaron análisis univariante y bivariante, así como un análisis multivariante de regresión logística (variable dependiente: tener el dispositivo FL por cuenta propia).Resultados: el análisis multivariante mostró que no tener el dispositivo FL era más probable en quienes tenían estudios primarios/sin estudios (OR 4,86 (IC95%: 1,03-22,88); Referencia (Ref): estudios secundarios/universitarios), dislipemia (OR 3,18 (IC95% 1,39-7,26); Ref: no dislipemia), 6 o más hipoglucemias/semana (OR 3,21 (IC95%: 1,44-7,16); Ref: menos de 6) y 4 o más punciones/día (OR: 17,56 (IC95%: 6,09-50,64); Ref: menos de 4). Tanto le media de glucosa basal como la HBA1c eran más bajas (p< 0,001) en quienes tenían el dispositivo, así como mejores puntuaciones en el SCI-R (p< 0,001).Conclusión: el uso de los dispositivos de control glucémico permite un mejor manejo de las complicaciones de la DM1: menor número de hiper e hipoglucemias, punciones y mejor adherencia al tratamiento.(AU)

Objectives: to describe the sociodemographic and clinical profile of persons with Type 1 Diabetes Mellitus (T1D), as well as the use of the FreeStyle Libre (FL) flash monitoring device in those who had paid for it out of their own pocket, and to analyse the differences (lab test parameters, disease complications and treatment adherence) vs. T1D patients using traditional glycemic monitoring through finger prick.Method: a descriptive cross-sectional study in 206 patients with T1D from a health area in the Castilla-La Mancha region. Study variables: to have a FL device purchased out of pocket, sociodemographic and clinical variables (including lab test parameters) and the validated Self Care Inventory Revised (SCI-R) questionnaire. Univariate and bivariate analyses were conducted, as well as multivariate logistical regression analysis (dependent variable: to have purchased the FL out of pocket).Results: the multivariate analysis showed that not having the FL device was more likely among those with primary education / no education (OR 4.86 (CI95%: 1.03-22.88); Reference (Ref): secondary / university education, dyslipidemias (OR 3.18 (CI95% 1.39-7.26); Ref: no dyslipidemia, 6 or more hypoglycaemias/ week (OR 3.21 (CI95%: 1.44-7.16); Ref: less than 4, or more finger pricks/day (OR: 17.56 (CI95%: 6.09-50.64); Ref: less than 4. Both the mean baseline glucose and the HBA1c were lower (p< 0.001) among those who had the device, who also had better scores in the SCI-R questionnaire (p< 0.001).Conclusion: the use of the glycemic control devices allows better management of TDI complications: a lower number of hyper and hypoglycaemias and finger pricks, and better treatment adherence.(AU)

The Tandem Control-IQ advanced hybrid system improves glycemic control in children under 18 years of age with type 1 diabetes and night rest in caregivers.

OBJECTIVE: To determine the impact of switching from the predictive low glucose suspend (PLGS) system to the advanced hybrid Tandem Control-IQ system on glucometrics and glycosylated haemoglobin (HbA1c) at one year. To assess the impact on the quality of life perceived by parents. METHOD: Prospective study in 71 patients aged 6-18 years with type 1 diabetes (DM1), in treatment with PLGS, who switched to an advanced hybrid system. Glucometric data were collected before the change, at 4 and 8 weeks, and at one year of use; HbA1c before the change and after one year. The Diabetes Impact and Devices Satisfaction (DIDS) questionnaire was used at weeks 4 and 8. RESULTS: An increase in time in range (TIR) was observed with a median of 76% (P<.001) at 4 weeks, which was maintained after one year (+8% in the total group). Overall, 73.24% of patients achieved a TIR above 70%. The subgroup with an initial TIR of less than 56% increased it by 14.4%. After one year there was a 0.3% reduction in HbA1c. Level 1 hypoglycaemia, level 1 and level 2 hyperglycaemia, mean glucose (GM) and coefficient of variation (CV) decreased. Auto mode stayed on 97% of the time and no dropouts occurred. Caregivers had a perception of better glycaemic control and less need to monitor blood glucose variations during the night. None of them would switch back to the previous system and they feel safe with the new system. CONCLUSIONS: The Tandem Control-IQ advanced hybrid system was shown to be effective one year after its implementation with improvement in all glucometric parameters and HbA1c, as well as night-time rest in caregivers.

Diabetes mellitus tipo 1 de presentación súbita inducida por inhibidores del punto de control inmunitario en el tratamiento de cáncer avanzado. Serie de casos / Sudden onset type 1 diabetes mellitus induced by immune checkpoint inhibitors in the treatment of advanced cancer. Cases report

Tres pacientes con cáncer avanzado en tratamiento con inhibidores del punto de control inmunitario (inmune checkpoint inhibitors, ICIs), sin antecedentes de diabetes mellitus (DM), ingresaron al Servicio de Urgencias con poliuria, polidipsia y pérdida de peso, y diagnóstico de cetoacidosis diabética, sin evidencia clínica de infección. Fueron tratados con líquidos e infusión de insulina pasando luego a un régimen de insulina bolo basal que continuó después del alta. Las pruebas de detección de autoanticuerpos para DM resultaron negativas, y se les diagnosticó DM inducida por ICIs, pembrolizumab en dos de ellos y nivolumab en el otro. El propósito de esta serie de casos es demostrar el desarrollo de la DM1 en forma aguda en pacientes tratados con inhibidores de PD-1. Sobre la base de estos casos y la literatura revisada, se buscaron determinar las características clínicas, y sugerir estrategias para la identificación, control, tratamiento precoz y seguimiento de los pacientes tratados con ICIs a fin de minimizar el impacto de la disfunción autoinmune.

Three patients with advanced cancer, treated with inmune checkpoint inhibitors (ICIs), with no history of diabetes mellitus (DM), were admitted to the Emergency Department with polyuria, polydipsia, and weight loss and a diagnosis of diabetic ketoacidosis without clinical evidence of infection. They were treated with fluids and insulin infusion transitioning to a basal-bolus insulin regimen, which continued after discharge. Autoantibody detection tests for DM were negative and they were diagnosed with DM induced by ICIs, pembrolizumab in two of them, and nivolumab in another. The purpose of this case report is to show the development of DM1 in an acute form in patients treated with PD-1 inhibitors. Based on these cases and the reviewed literature, we seek to identify clinical characteristics and suggest strategies for the proper identification, control, treatment, and follow-up of patients treated with ICIs to minimize the impact of autoimmune dysfunction.

Sentimentos e desafios vivenciados pelo cuidador familiar da criança com diabetes mellitus tipo 1 / Feelings and challenges experienced by family caregivers of children with type 1 diabetes mellitus / Sentimientos y desafíos vividos por cuidadores familiares de niños con diabetes mellitus tipo 1

Objetivo: descrever as vivências e desafios do cuidador/familiar da criança com diabetes mellitus tipo 1. Método: estudo descritivo de abordagem qualitativa, junto a cuidadores de crianças com faixa etária de três a 12 anos incompletos, residentes em um município de Santa Catarina, Brasil. Os dados foram coletados entre julho e agosto de 2021, por meio de entrevistas em plataformas virtuais, e analisados conforme análise temática. Resultados: há vivências que transitam desde o medo e insegurança na descoberta do diagnóstico, dificuldades para aprender os cuidados com a criança, as mudanças de comportamentos de toda família, até preocupações com a criança no ambiente escolar, o que sobressai a importância das redes de apoio neste contexto, embora pouco mencionadas ou conhecidas pelos participantes. Considerações finais: as vivências e desafios do cuidador da criança com diabetes extrapola a esfera familiar, e indica que esse perfil de família necessita de acompanhamento mais próximo pelas equipes de saúde, na medida que isso garanta maior compreensão sobre a doença, cuidados necessários e referência de acolhimento.

Objective: to describe the experiences and challenges of the caregivers/family members of children with type 1 diabetes mellitus. Method: descriptive study with a qualitative approach, with caregivers of children aged between three and 12 years old, living in a municipality in Santa Catarina, Brazil. Data were collected between July and August 2021, through interviews on virtual platforms, and analyzed according to thematic analysis. Results: there are experiences that range from fear and insecurity when discovering the diagnosis, difficulties in learning how to care for the child, changes in the behavior of the entire family, to concerns about the child in the school environment, which highlights the importance of support networks in this context, although little mentioned or known by participants. Final considerations: the experiences and challenges of the caregiver of a child with diabetes go beyond the family sphere, and indicate that this family profile requires closer monitoring by health teams, as this guarantees greater understanding of the disease, necessary care and referral support.

Capacitação dos enfermeiros de saúde escolar para o suporte a crianças e jovens com Diabetes Mellitus Tipo 1 / Training School Health Nurses to support children and young people with Type 1 Diabetes Mellitus

O relatório apresenta-se como um processo de construção de saberes profissionais baseados na autorreflexão e análise, constituindo-se como um caminho para o desenvolvimento das competências do enfermeiro especialista e do enfermeiro especialista em saúde comunitária e de saúde pública. Numa abordagem inicial, no primeiro campo de estágio, procedeu-se à elaboração do diagnóstico de saúde da comunidade, emergindo como área problemática a Diabetes Mellitus. Partindo de uma necessidade já identificada pelo Agrupamento de Centros de Saúde do Pinhal Litoral, a inexistência de formação dos enfermeiros de saúde escolar, integrou-se o Projeto DARE+ para colmatar essas necessidades. A Diabetes Mellitus tipo 1 é uma doença metabólica e crónica que pode afetar pessoas de qualquer idade, a mesma desenvolve-se mais em crianças e jovens, tornando-se uma das doenças mais prevalentes em contexto escolar. A permanência da criança e jovem na escola abrange um período alargado do dia, neste sentido as recomendações internacionais orientam para que seja garantida a gestão adequada da doença neste contexto. O Projeto de Intervenção Comunitária, Projeto DARE+, segundo a metodologia do Planeamento em Saúde, teve como objetivo melhorar os conhecimentos dos Enfermeiros de saúde escolar através da formação avançada. Recorreu-se ao referencial teórico de enfermagem Modelo Sistémico de Betty Neuman para a tomada de decisão em enfermagem, que nos conduziu à intervenção comunitária. Desenvolveu-se uma Revisão Integrativa da Literatura com a seguinte questão de investigação: Quais são as intervenções de enfermagem dirigidas a enfermeiros de saúde escolar na área da diabete Mellitus tipo 1? Nas evidências obtidas identificou-se a importância da formação avançada aos respetivos enfermeiros. A avaliação da intervenção realizada teve lugar no segundo campo de estágio, que nos permitiu concluir que a formação reforçou as linhas de defesa dos enfermeiros de saúde escolar criando barreira aos stressores, isto é, à falta de conhecimento. Os resultados apontam para um aumento de conhecimentos médio de 86,6%, demonstrando o impacte positivo na formação deste grupo profissional. É essencial continuar a intervir com os Enfermeiros de saúde escolar com vista à uniformização dos conhecimentos e intervenções adequadas às crianças e jovens com as necessidades identificadas.

The report presents itself as a process of building professional knowledge based on self-reflection and analysis, constituting a path for developing the skills of specialist nurses and specialist nurses in community health and public health. In an initial approach, in the first internship field, a community health diagnosis was drawn up, with Diabetes Mellitus emerging as a problem area. Based on a need already identified by the Pinhal Litoral Health Center Group, the lack of training for school health nurses, the DARE+ Project was integrated to meet these needs. Type 1 Diabetes Mellitus is a metabolic and chronic disease that can affect people of any age, it develops more in children and young people, becoming one of the most prevalent diseases in school contexts. The stay of children and young people at school covers an extended period of the day, in this sense, international recommendations provide guidance to ensure adequate management of the disease in this context. The Community Intervention Project, Project DARE+, according to the Health Planning methodology, aimed to improve the knowledge of school health nurses through advanced training. Betty Neuman's theoretical nursing framework was used for decision-making in nursing, which led us to community intervention. An Integrative Literature Review was developed with the following research question: What are the nursing interventions aimed at school health nurses in the area of type 1 diabetes mellitus? The evidence obtained identified the importance of advanced training for respective nurses. The evaluation of the intervention carried out took place in the second internship field, which allowed us to conclude that the training reinforced the lines of defense of school health nurses by creating a barrier to stressors, that is, the lack of knowledge. The results point to an average increase in knowledge of 86.6%, demonstrating the positive impact on the training of this professional group. It is essential to continue to intervene with school health nurses with a view to standardizing knowledge and appropriate interventions for children and young people with identified needs.

Capacitação dos educadores escolares responsáveis por crianças com diabetes tipo I / Training school educators responsible for children with type I diabetes

Introdução: O presente relatório tem como objetivo apresentar o trabalho desenvolvido, as competências adquiridas e os resultados obtidos, durante o Estágio do Mestrado em Enfermagem Comunitária e de Saúde Pública com relatório final. A Diabetes Mellitus é uma doença metabólica crónica que surge como um problema à nível mundial. A doença não afeta apenas as faixas etárias mais velhas, mas também afeta as crianças/ jovens e a sua sobrevivência depende da adequada gestão da sua diabetes. A Escola é um local de inclusão, devendo ser mobilizado os recursos para a gestão de situações intercorrentes da doença. É imprescindível a implementação de programas e estratégias que garantam um ambiente seguro da criança. Objetivo: Capacitar os educadores escolares para a apropriada gestão da diabetes tipo 1, em contexto escolar. Método: O projeto de intervenção teve por base a metodologia do planeamento em saúde, garantindo uma gestão adequada em todo o processo de planeamento, e ainda articulado com o referencial teórico de Enfermagem da Promoção da Saúde de Nola Pender. Procedeu-se a aplicação de um instrumento de recolha de dados aos educadores de criança com diabetes tipo1 antes e após as sessões de educação para a saúde. Foi também realizada uma revisão integrativa da literatura, o que permitiu incorporar e aplicar os novos conhecimentos obtidos, reforçando e suportando, assim, a intervenção numa prática baseada na evidência e utilizando bases de dados como uma ferramenta de procura de conhecimento rápida e fidedigna. Resultados: Verificou-se défice de conhecimento na gestão da diabetes: controle de sintomas, alimentação e regime terapêutico. A intervenção comunitária obteve resultados positivos, aumentando o nível de conhecimentos sobre diabetes, dos educadores escolares. Conclusão: Educar para a saúde é implementar atividades de aprendizagem, promover e desenvolver habilidades, consciencializando as pessoas para fazer escolhas informadas sobre os seus comportamentos de saúde e mudança de atitudes, de forma voluntaria. A educação para saúde é uma estratégia de intervenção eficaz no empoderamento e capacitação das pessoas, grupos ou comunidades. O caminho é longo, muito há ainda por fazer. A mudança tem de acontecer a nível do poder político, com reforço económico e de recursos humanos, ao nível das escolas, e com a devida regulamentação da formação da diabetes.

Introduction: This report aims to present the work developed, the skills acquired and the results obtained, during the Master's Internship in Community and Public Health Nursing with a final report. Diabetes Mellitus is a chronic metabolic disease that has emerged as a worldwide problem. The disease not only affects older age groups, but also affects children/young people and their survival depends on the adequate management of their diabetes. The School is a place of inclusion, and resources must be mobilized to manage intercurrent situations caused by the disease. It is essential to implement programs and strategies that guarantee a safe environment for children. Objective: To train school educators in the appropriate management of type 1 diabetes, in a school context. Method: The intervention project was based on the health planning methodology, ensuring adequate management throughout the planning process, and also articulated with the theoretical framework of Health Promotion Nursing by Nola Pender. A data collection instrument was applied to educators of children with type 1 diabetes before and after the health education sessions. An integrative literature review was also carried out, which made it possible to incorporate and apply the new knowledge obtained, thus reinforcing and supporting the intervention in an evidence-based practice and using databases as a quick and reliable knowledge search tool. Results: There was a lack of knowledge in diabetes management: symptom control, nutrition and therapeutic regimen. The community intervention achieved positive results, increasing the level of knowledge about diabetes among school educators. Conclusion: Educating for health is implementing learning activities, promoting and developing skills, raising people's awareness to make informed choices about their health behaviors and changing attitudes, voluntarily. Health education is an effective intervention strategy in empowering and qualifying people, groups or communities. The road is long, there is still a lot to be done. Change must happen at the level of political power, with economic and human resources reinforcement, at the level of schools, and with the proper regulation of diabetes training.

Faster-acting insulin aspart reduces glycaemic variability in sensor-augmented pump treated type 1 diabetes patients.

AIM: To evaluate the effect of faster aspart over glycaemic variability in type 1 diabetes (T1D) patients treated with sensor-augmented pump (SAP) in a real-world scenario. METHODS: Observational study with SAP-treated adult T1D patients treated with faster aspart for three months. The primary endpoint was the mean amplitude of glucose excursions (MAGE). RESULTS: Fifty patients were treated with faster aspart. Eleven patients (23%) withdrew during the follow-up mainly due to worsening of diabetes control (9 patients). Mean age was 41.2 yrs. (range 21-59) and T1D duration 22.4±10.0 yrs. Mean SAP treatment duration was 3.6±3.1 yrs. We detected a reduction of -7.0 (95% CI -1.1, -12.9; p=0.021) in MAGE at the end of the study. Other glycemic variability indices were also improved: standard deviation of mean interstitial glucose (-3mg/dl; 95% CI, -1, -5; p=0.01), CONGA4 (-2.2; 95% CI -0.3, -4.2; p=0.029), CONGA6 (-2.6; 95% CI -0.6, -4.6; p=0.011), GRADE (-0.5; 95% CI -0.1, -0.9; p=0.022), HBGI (-0.7; 95% CI -0.2, -1.3; p=0.013), J-index (-2.9; 95% CI -0.7, -5.0; p=0.011) and MODD (-5.7; 95% CI -1.7, -9.7; p=0.006). A slight reduction in mean glucose management indicator was also detected (-0.14%; 95% CI, -0.02, -0.27; -1.4mmol/mol; 95% CI -0.1, -3.3; p=0.03). CONCLUSIONS: In SAP-treated T1D patients, faster aspart insulin was associated with reduced glycaemic variability, but also a high percentage of dropouts due to worsened glycaemic control. NCT04233203.

Presencia de autoanticuerpos anti islotes pancreáticos en diabetes tipo 1 durante la edad pediátrica / Presence of anti-pancreatic islet autoantibodies in type 1 diabetes in children

En la Diabetes tipo 1 (DM1) la pérdida de células ß pancreáticas es consecuencia de un proceso de autoinmunidad que cursa con la presencia de autoanticuerpos anti-islotes pancreáticos (AAPs). Estos AAPs son marcadores útiles para la clasificación de la enfermedad. En un centro pediátrico de tercer nivel se analizó la frecuencia de presentación de GADA, IA-2A, ZnT8A e IAA en un grupo con reciente debut entre enero 2018 y agosto 2021 (n= 90). Además, se investigó la frecuencia de presentación y relación de los AAPs con la edad, sexo y tiempo de evolución en pacientes en seguimiento (n= 240). En el grupo de debut se obtuvo positividad de GADA, IA-2A, ZnT8A y IAA en 77,8; 60; 62 y 47,8% de los pacientes respectivamente, un 4% no presentó AAPs. El 95,6% de los pacientes presentaron al menos un AAPs positivo. La frecuencia de IAA en el grupo en debut fue mayor en menores de 5 años. En el grupo en seguimiento el 75,2% resultaron GADA positivo (85,7% en mujeres y 62,8% en varones) p<0,05. IA-2A y ZnT8A fueron positivos en 45 y 51.7% respectivamente. El 91% presentaron al menos un AAP positivo. En este grupo se evidenció una menor positividad en función del tiempo de evolución. Se pudo determinar la frecuencia de presentación de los AAPs en un grupo en debut y la relación con la edad, sexo y tiempo de evolución en pacientes en seguimiento. La determinación de APPs facilita la correcta clasificación y elección de la terapia adecuada (AU)

In type 1 diabetes (DM1) the loss of pancreatic ß-cells is a consequence of an autoimmune process that results in the presence of pancreatic anti-islet autoantibodies (PAAs). PAAs are useful markers for the classification of the disease. The frequency of presentation of GADA, IA-2A, ZnT8A, and IAA in a group with recent debut seen between January 2018 and August 2021 (n= 90) was analyzed in a tertiary pediatric center. In addition, we investigated the frequency of presentation and association of PAAs with age, sex, and time of evolution in patients in follow-up (n= 240). In the debut group, GADA, IA2A, ZnT8A, and IAA positivity was found in 77.8, 60, 62, and 47.8% of patients, respectively; no PAAs were observed in 4% of the patients. Overall, 95.6% presented at least one positive PAA. The frequency of IAA in the debut group was higher in children younger than 5 years. In the follow-up group, 75.2% were GADA positive (85.7% of females and 62.8% of males) p<0.05. IA-2A and ZnT8A were positive in 45 and 51.7% respectively. Ninety-one percent presented with at least one positive PAA. In this group, a lower positivity was evidenced as a function of the time of evolution. The frequency of presentation of PAAs in a debut group and the relationship with age, sex, and time of evolution in patients in follow-up was demonstrated. The assessment of PAAs facilitates the correct classification and choice of adequate therapy (AU)

Aplicativos para autogestão do diabetes tipo 1 em usuários de sistema de infusão contínua de insulina / Applications for self-management of type 1 diabetes in users of continuous insulin infusion system / Aplicaciones para el autocontrol de la diabetes tipo 1 en personas usuarias del sistema de infusión continua de insulina

Objetivo: Identificar e descrever as características dos aplicativos móveis para autogestão do diabetes mellitus tipo 1 em usuários de sistema de infusão contínua de insulina. Método: Revisão integrativa, com buscas efetuadas no mês de junho de 2020, a partir dos artigos publicados PUBMED, CINAHL, Cochrane Library, Web of Science e Scopus. Considerou-se como critério de elegibilidade estudos que abordavam sobre aplicativos móveis para autogestão do DM1 em usuários de Sistema de Infusão Contínua de Insulina, sem restrição temporal. Foram excluídos apenas estudos indisponíveis. Resultados: Após a análise de duas revisoras independentes foram incluídos na análise final 14 estudos e identificados 11 aplicativos móveis para smartphones que podem auxiliar no autogerenciamento do DM1, nomeados como iDECIDE, Sugar Sleuth, VoiceDiab, Blip, GoCARB, Nightscout, Gerenciamento Inteligente de Diabetes, Calculadora móvel de troca de Alimentos, Insulin Pump, DiaMob e Diário Interativo sobre Diabetes. Conclusão: Os aplicativos móveis foram desenvolvidos para promover mudanças de comportamento e ajustes no tratamento de maneira positiva, tanto em resultados clínicos quanto na qualidade de vida e autogestão do diabetes em pessoas com DM1. Aplicativos móveis para smartphones podem auxiliar no autogerenciamento do DM1, por possibilitar auxílio na decisão de aplicação de insulina, controle glicêmico, análise na necessidade de insulina nas refeições, gestão alimentar, cálculo dos componentes alimentares nas refeições, monitoramento contínuo da glicose e cálculo automático de bolus de carboidratos e insulina.

Objetivo: Identificar y comprender las características de las aplicaciones móviles para el autocontrol de la diabetes mellitus tipo 1 (DM1) en personas usuarias de sistemas de infusión continua de insulina. Método: Revisión integradora, con búsquedas realizadas en el mes de junio de 2020, de artículos publicados en las bases de datos PUBMED, CINAHL, Cochrane Library, Web of Science y Scopus. Los criterios de elegibilidad considerados para los estudios fueron que abordaran aplicaciones móviles para el autocuidado de DM1 en personas usuarias del sistema de infusión continua de insulina, sin restricción de tiempo. Solo se excluyeron los estudios no disponibles. Resultados: Después del análisis de dos revisores independientes, se incluyeron 14 estudios en el análisis final y se identificaron 11 aplicaciones móviles para teléfonos inteligentes que pueden ayudar en la autogestión de DM1, denominadas iDECIDE, Sugar Sleuth, VoiceDiab, Blip, GoCARB, Nightscout, Intelligent Manejo de la diabetes, Calculadora móvil de intercambio de alimentos, Bomba de insulina, DiaMob y Diario interactivo sobre diabetes. Conclusión: En los estudios analizados, se desarrollaron aplicaciones móviles para promover cambios de comportamiento y ajustes de tratamiento de forma positiva, tanto en los resultados clínicos como en la calidad de vida y el autocontrol de la diabetes en personas con DM1. Las aplicaciones móviles para teléfonos inteligentes pueden ayudar en el autocontrol de DM1, al permitir la asistencia en la decisión de aplicar insulina, control glucémico, análisis de la necesidad de insulina en las comidas, manejo de alimentos, cálculo de los componentes de los alimentos en las comidas, monitoreo continuo de glucosa y cálculo automático del bolo de carbohidratos e insulina.

Objetive: To identify and understand the characteristics of mobile applications for self-management of type 1 mellitus diabetes in users of continuous insulin infusion systems. Method: integrative review with searches carried out in the month of June 2020, based on the articles published in PUBMED, CINAHL, Cochrane Library, Web of Science and Scopus. The eligibility criteria were based to consider those studies that addressed mobile applications for self-management of DM1 in users of Continuous Infusion System of Insulin without time restriction. Only unavailable studies were excluded. Results: After the analysis of two independent reviewers, 14 studies were included in the final analysis, and 11 mobile applications for smartphones that can assist in self-management of DM1 were identified; these were named as iDECIDE, Sugar Sleuth, VoiceDiab, Blip, GoCARB, Nightscout, Intelligent Diabetes Management, Calculator Food exchange mobile, Insulin Pump, DiaMob and Interactive Diary on Diabetes. Conclusion: Mobile applications were developed to promote behavioral changes and treatment adjustments in a positive way, both in clinical results and in the quality of life and self-management of diabetes in people with DM1. Mobile apps for smartphones can assist in self-management of DM1 by enabling assistance in the decision to apply insulin, glycemic control, analysis of the need for insulin in meals, food management, calculation of food components in meals, continuous glucose monitoring and automatic calculation of bolus of carbohydrates and insulin.

Caracterización clínica y sociodemográfica de Diabetes Mellitus en pacientes pediátricos del Hospital Regional de la Orinoquía, Yopal, Colombia

Introducción: La Diabetes Mellitus (DM) es una alteración metabólica crónica, creciente en la población pediátrica que conduce a múltiples complicaciones micro y macrovasculares. Es un problema de salud pública por los altos costos que conlleva el diagnóstico y tratamiento. Según la Federación Internacional de Diabetes (IFD), la incidencia anual en el mundo está aumentando, debido a que la prevalencia de edad entre 0-14 años es de 98.2% y de 0-19 años es de 128.9% entre el 2019 y 2021 con una incidencia de 108.3% y 149.5%, respectivamente, por 100.000 habitantes en 215 países. Objetivo: Describir las características clínicas de un grupo de niños y adolescentes que ingresaron al servicio de urgencias del Hospital Regional de la Orinoquía (HORO) de Yopal-Casanare, en el período 2019 -2020 con diagnóstico de novo o previo de diabetes mellitus. Metodología: Se realizó un estudio observacional, descriptivo y retrospectivo, tipo serie de casos, donde se incluyeron pacientes menores de 18 años con diagnóstico de novo o previo de diabetes mellitus en el período de 2019 -2020 en el Hospital Regional de la Orinoquía. Se analizaron un total de 15 pacientes. Resultados: Se muestra la clasificación de los pacientes según grupo de edades y sexo, se encuentra predominio del género masculino con un 53,3% de los 15 pacientes que cumplían con los criterios diagnósticos, mientras que la población femenina fue de 46,6%. La edad promedio de los pacientes pediátricos fue de 13 ± 13.2 Conclusiones: En el estudio realizado en el Hospital regional de la Orinoquía, la edad entre 11 - 13 años es la más frecuente para DM, con un predominio significativo del sexo masculino, provenientes de áreas urbanas. Se halló que el bajo peso es un dato alarmante, además de valores de glicemia alterados que se relacionan con las complicaciones presentadas al momento del ingreso del paciente, lo cual representa un problema de salud pública entre niños y adultos jóvenes debido a la heterogeneidad, del factor genético y ambiental.

Introduction: Diabetes mellitus (DM) is a chronic metabolic disorder that is increasing in the pediatric population and leads to multiple microvascular and macrovascular complications. It is a public health problem due to the high costs of diagnosis and treatment. According to the International Diabetes Federation (IFD) the annual incidence in the world is increasing, due to an age prevalence between 0-14 years of 98.2% and 0-19 years of 128.9% between 2019 and 2021 with an incidence of 108.3% and 149.5% respectively per 100,000 inhabitants in 215 countries. Objective: To describe the clinical characteristics of a group of children and adolescents admitted to the emergency department of the Hospital Regional de la Orinoquía (HORO) in Yopal-Casanare in the period 2019 to 2020 with de novo or previous diagnosis of diabetes mellitus. Methodology: An observational, descriptive, and retrospective study, case series type, where patients under 18 years of age with de novo or previous diagnosis of diabetes mellitus were included in the period from 2019 to 2020 in the Orinoquía Regional Hospital. Results: The classification of the patients according to age group and sex shows a predominance of the male gender with 53.3% of the 15 patients who met the diagnostic criteria, while the female population was 46.6%. The average age of the pediatric patients was 13 ± 13.2 Conclusions: The study carried out at the Hospital Regional de la Orinoquía showed that the most frequent age group was 11 to 13 years old, with a significant predominance of males, coming from urban areas. It was found that low weight is an alarming fact plus altered glycemia values are related to the complications presented at the time of the patient's admission, which represents a public health problem among children and young adults due to the heterogeneity of the genetic and environmental factors.

To evaluate the use and clinical effect of intermittently scanned continuous glucose monitoring in adults with type 1 diabetes: Results of a multicentre study.

AIM: To evaluate the use and clinical effect of intermittently scanned continuous glucose monitoring (isCGM) in adults with type 1 diabetes (T1D) in a public health service scenario. METHOD: Cross-sectional retrospective analysis of all patients with T1D and medical indication for isCGM use from a cohort followed since 2010 at Castilla-La Mancha Public Health Service (Spain). Primary outcome was HbA1c change during the first year of follow-up after isCGM initiation. Secondary outcomes included evaluation of self-monitoring of blood glucose (SMBG), isCGM and insulin use, along with glycometric indexes. RESULTS: A total of 945 T1D patients were analyzed. Median age was 49.5 years (IQ range 19.0 years) and T1D duration of 28.9 years (IQ range 14.0 years). The most frequent insulin therapy alternatives were multiple daily injections (85%) followed by insulin pump (11%). Eighty percent of the patients were active isCGM users with a 90% of adherence to the device. Patients showed a mean daily scan frequency of 10.1±6.4scans/day. Daily SMBG reduced by -3.5 test/day [95% CI -3.7, -3.2; P<0.001]. We detected an HbA1c reduction of -0.3% (-4mmol/mol) [95% CI -0.2, -0.4 (-3, -5); P<0.001] at the end of the follow-up. An inverse correlation between HbA1c levels at the end of the follow-up and daily frequency of isCGM scanning (R=-0.34, P<0.001) was observed. Dropout rate was 4%, and 4% of patients were not willing to use isCGM. CONCLUSIONS: Adult patients with T1D improved glycaemic control after isCGM initiation in a public health service scenario. Despite described clinical benefits, a higher than expected percentage of patients were not using isCGM technology. NCT05095610.

Incidence of type 1 diabetes mellitus in Asturias (Spain) between 2011 and 2020.

INTRODUCTION: Type 1 diabetes mellitus (DM1) is a chronic disease with important socio-health repercussions that requires epidemiological information for proper health management. The aim of this study was to determine the incidence of DM1 in Asturias between 2011-2020. METHODS: Descriptive study which included diagnoses of DM1 in Asturias between 2011-2020 captured as a primary source by reviewing the register of pancreatic autoimmunity analysis. Incidence rates were estimated, expressed per 100,000 population-years of risk by age group, sex, and health area. RESULTS: A total of 815 patients were diagnosed, 53.13% men. The mean age was 34.32±22.07 years; 9.85±4.46 in children under 19 years of age (10.48±4.45 in males and 9.00±4.36 in females). Of the diagnoses, 55.34% occurred at an age over 30 years. The incidence was 7.82 (7.29-8.37); 19.65 (17.17-22.39) in under 15s and 12.84 (11.73-14.03) in under 40s. The maximum incidence peak was between 10-14 years, both in males 31.16 (23.89-39.95) and in females 21.72 (15.59-29.47). There was no significant increase in incidence over the years studied. CONCLUSIONS: Asturias has a high incidence of DM1. In our study no earlier age at diagnosis was observed or an increase in incidence. Compared to previous studies, the increase in incidence is most likely due to an improvement in data capture, not to a real increase in incidence. A high percentage of diagnoses occur in adulthood.

Diabetes tipo 1 y Miastenia Gravis / Type-1 Diabetes and Myasthenia Gravis

Introducción: El desarrollo de la tolerancia inmunológica frente a los autoantígenos se denomina autotolerancia. La Diabetes Mellitus tipo 1A (1ADM) es un trastorno metabólico secundario a la destrucción autoinmune de las células beta pancreáticas e insulitis. La miastenia grave (MG) es una enfermedad autoinmune causada por el bloqueo postsináptico de la placa mioneural por AAcs contra los receptores de acetilcolina (ACRA) o contra moléculas de la membrana postsináptica. La asociación entre DM1A y MG se puede observar en el síndrome poliglandular tipo III, caracterizado por enfermedad autoinmune de la glándula tiroides asociada con otras entidades autoinmunes. Método: Reporte de Casos, cuatro pacientes entre 7-19 años, con asociación de MG y DM1A atendidos en el Hospital Garrahan. Conclusión: La Tiroiditis de Hashimoto y la Enfermedad Celíaca son las enfermedades autoinmunes relacionadas más frecuentemente con DM1A en nuestra población. La bibliografía describe la asociación de MG y Tiroiditis de Hashimoto y su coexistencia con DM1A se describe en el Síndrome Poliglandular III. En este trabajo presentamos 4 casos de DM1A asociado con MG fuera de dicho síndrome (AU)

Introduction: The development of immune tolerance to autoantibodies (AAbs) is referred to as self-tolerance. Type 1A Diabetes Mellitus (1ADM) is a metabolic disorder secondary to autoimmune destruction of pancreatic beta cells and insulitis. Myasthenia gravis (MG) is an autoimmune disease caused by postsynaptic blockade of the myoneural plate by AAbs against acetylcholine receptors (Acra) or against postsynaptic membrane molecules. The association between 1ADM and MG may be observed in polyglandular syndrome type III, characterized by autoimmune disease of the thyroid associated with other autoimmune conditions. Methods: Case report; four patients between 7-19 years old, with an association of MG and 1ADM seen at the Garrahan Hospital. Conclusion: Hashimoto's thyroiditis and celiac disease are autoimmune diseases most frequently related to 1ADM in our population. In the literature, the association of MG and Hashimoto's thyroiditis has been described and its coexistence with 1ADM is reported in polyglandular syndrome III. In this study we present 4 cases of 1ADM associated with MG unrelated to this syndrome. (AU)

Effects of lockdown by COVID-19 on glycemic control of Cuban children and adolescents with type 1 diabetes mellitus / Efectos del confinamiento por COVID-19 sobre el control glucémico de niños y adolescentes con diabetes mellitus tipo 1 / Efeitos do confinamento COVID-19 no controle glicêmico de crianças e adolescentes com diabetes mellitus tipo 1

Introduction: The purpose of this study was to determine the impact of confinement due to COVID-19 on glycemic control in children and adolescents with type 1 diabetes mellitus. Material and methods: An observational, descriptive study with a prospective design was carried out in Cuba, between November 2020 and May 2021. The sample consisted of 41 children and adolescents from a Provincial Center for Care and Education for Diabetic Patients. Anthropometric measurements (weight, height, and BMI) were obtained from the patients' medical records at the time of debut and at the time of the follow-up visit during the study period. Glycemic control was determined from the value of glycosylated hemoglobin (HbA1c). The comparison of the means between independent groups of variables was carried out using the ANOVA analysis of variance of a Kruskal-Wallis factor when quantitative variables were brought, and Pearson's Chi square in the case of categorical variables. Results: It was shown that during confinement, 78.05% of the patients had poor glycemic control. In addition, the requirements for higher total doses of insulin (p=0.005), both fast-acting (p=0.011) and slow-acting (p=0.008), and the highest dosage by weight in kilograms (p=0.003), and the highest evolution time (p=0.011) were significantly related to poor glycemic control. Most of the variables that were associated with poor glycemic control during confinement were also associated before said period. Conclusions: The confinement had a negative impact on the glycemic control of children and adolescents with type 1 diabetes mellitus in Cuba, since during this period the patients required higher doses of insulin and showed higher HbA1c figures.

Introducción: El propósito de este estudio fue determinar el impacto del confinamiento por COVID-19 en el control glucémico de niños y adolescentes con diabetes mellitus tipo 1. Material y métodos: Se realizó un estudio observacional, descriptivo con diseño prospectivo en Cuba, entre noviembre de 2020 y mayo de 2021. La muestra estuvo constituida por 41 niños y adolescentes de un Centro Provincial de Atención y Educación al Paciente Diabético. Las mediciones antropométricas (peso, talla e IMC) fueron obtenidas de las historias clínicas de los pacientes al momento del debut y al momento de la consulta de seguimiento durante el periodo del estudio. El control glucémico fue determinado a partir del valor de la hemoglobina glucosilada (HbA1c). La comparación de las medias entre grupos de variables independientes fue llevada a cabo mediante el análisis de varianza ANOVA de un factor de Kruskal-Wallis cuando se trataba de variables cuantitativas, y Chi cuadrado de Pearson en el caso de las variables categóricas. Resultados: Se observó que durante el confinamiento el 78,05 % de los pacientes presentaban un mal control glucémico. Además, los requerimientos de mayores dosis totales de insulina (p=0,005), tanto de acción rápida (p=0,011) como lenta (p=0,008), y la mayor dosificación por peso en kilogramos (p=0,003), y el mayor tiempo de evolución (p=0,011) se relacionaron significativamente con el mal control glucémico. La mayoría las variables que se asociaron a un mal control glucémico durante el confinamiento, también lo hacían antes de dicho período. Conclusiones: El confinamiento tuvo un impacto negativo sobre el control glucémico de niños y adolescentes con diabetes mellitus tipo 1 en Cuba, ya que durante este período los pacientes requirieron mayores dosis de insulina y mostraron mayores cifras de HbA1c.

Introdução: O objetivo deste estudo foi determinar o impacto do confinamento devido ao COVID-19 no controle glicêmico em crianças e adolescentes com diabetes mellitus tipo 1. Material e métodos: Estudo observacional, descritivo, com desenho prospectivo, realizado em Cuba, entre novembro de 2020 e maio de 2021. A amostra foi composta por 41 crianças e adolescentes de um Centro Provincial de Atenção e Educação para Diabéticos. As medidas antropométricas (peso, altura e IMC) foram obtidas dos prontuários dos pacientes no momento da estreia e no momento da consulta de acompanhamento durante o período do estudo. O controle glicêmico foi determinado a partir do valor da hemoglobina glicosilada (HbA1c). A comparação das médias entre grupos de variáveis ​​independentes foi realizada por meio da análise de variância ANOVA de um fator de Kruskal-Wallis no caso de variáveis ​​quantitativas e do Qui-quadrado de Pearson no caso de variáveis ​​categóricas. Resultados: Observou-se que durante o confinamento, 78,05% dos pacientes apresentaram mau controle glicêmico. Além disso, as necessidades de maiores doses totais de insulina (p=0,005), tanto de ação rápida (p=0,011) quanto de ação lenta (p=0,008), e a maior dosagem por peso em quilogramas (p=0,003), e o maior tempo de evolução (p=0,011) relacionaram-se significativamente com o mau controle glicêmico. A maioria das variáveis ​​que se associaram ao mau controle glicêmico durante o confinamento também se associaram antes desse período. Conclusões: O confinamento teve um impacto negativo no controle glicêmico de crianças e adolescentes com diabetes mellitus tipo 1 em Cuba, pois durante esse período os pacientes necessitaram de doses mais altas de insulina e apresentaram valores de HbA1c mais elevados.