ABSTRACT
Background: Information regarding diagnosis, treatment, and follow-up of patients with type 1 diabetes (PWT1D) in Mexico is limited. We developed an on-line platform Registro Nacional de Pacientes con Diabetes Tipo 1 (RENACED-DT1). Objective: The objective of the study was to describe the characteristics and healthcare of PWT1D registered in RENACED-DT1. Methods: Analyses of 965 PWT1D from July 2014 to January 2018 in different endocrinology clinics around Mexico. Results: Sixty-one percent were female with median age of 21 years, age at diagnosis 11 years, and disease duration at inclusion 8.2 years. Treatment regimen was basal-bolus in 61% and insulin-pumps in 21% (mainly in the private sector); 33.3% with self-monitoring of blood-glucose (SMBG) ≥4 times/day. Mean HbA1c at last follow-up was 8.7 ± 2.1% (72±23 mmol/mol), 18% had HbA1c < 7% (53 mmol/mol), and 35% > 9% (75 mmol/mol). SMBG ≥ 4 times/day was associated with HbA1c < 7%. Time since diagnosis > 10 years, female sex, BMI ≥ 30 kg/m2, SMBG < 4 times/day, and any hypoglycemia were associated with microvascular complications (p < 0.05). Conclusions: Percentage of patients achieving HbA1c < 7% is low; increased blood glucose monitoring is associated with better glycemic control. The achievement of optimal glycemic control must be increased to reduce the incidence of chronic complications and improve quality of life in PWT1D.
Subject(s)
Humans , Male , Female , Child , Adolescent , Young Adult , Diabetes Mellitus, Type 1/therapy , Diabetes Mellitus, Type 1/epidemiology , Quality of Life , Blood Glucose , Glycated Hemoglobin/analysis , Blood Glucose Self-Monitoring , Registries , Hypoglycemic Agents , Insulin , Mexico/epidemiologyABSTRACT
La difícil interpretación de los hallazgos sugestivos de meningitis bacteriana y viral en el líquido cefalorraquídeo con frecuencia imposibilita su diferenciación. Por décadas, los investigadores han intentado crear escalas predictivas que permitan resolver tal disyuntiva. El objetivo del presente trabajo es determinar la validez y seguridad de una escala clínica predictiva para el diagnóstico de meningitis bacteriana en Pediatría. Realizamos un estudio retrospectivo, transversal, de evaluación de una prueba diagnóstica en una muestra de pacientes con edades entre 29 días y 12 años, egresados con diagnóstico de meningitis entre enero de 1992 y diciembre de 2006, del Deparatmento de Pediatría del Hospital "Dr. Jesús Yerena", ubicado en Caracas, Venezuela. aplicamos una escala clínica predictiva y calculamos su sensibilidad, especificidad, valores predictivos y razones de verosimilitud para el diagnóstico de meningitis bacteriana. La muestra estuvo conformada por 41 pacientes. Predomino el sexo masculino (n=29; 70,73 por ciento). El grupo etareo más afectado fue el de los lactantes menores (26=; 63,41 por ciento). Se identificaron 14 meningitis bacterianas y 27 asépticas. Mediante la escala clínica predictiva se clasificaron 31 meningitis como de alto riesgo de meningitis v¡bacteriana y 10 como de bajo riesgo. La sensibilidad y valor predictivo negativo fueron de 100 por ciento. La escala clínica predictiva resultó ser válida y segura para descartar meningitis bacteriana.
The overlapping of finding suggestive of bacterial or viral meningitis in cerebrospinal fluid makes it difficult to differentiate one of another. For decades, investigators have attempted to create clinical prediction scores to resolve such disjunctive. The objetive of this investigation was to determine the validity and safety of a clinical prediction score for the diagnosis of bacterial meningitis in childhood. We perfomed a retrospective, transversal, diagnosis test evaluation study of a sample of patients between 29 days to 12 years of age, dischanged from January 1992 to December 2006, with diagnosis of meningitis, from the Pediatrics Department of Dr. Jesús Yerena Hospital, in Caracas, Venezuela. The clinical prediction score was applied. We evaluated its validity and safety with the calculation of sensibility, specificity, predictive values and likelihood ratios for the diagnosis of bacterial meningitis. A total of 41 patients were included. Male gender was more common (n=29; 70,73%). The infant age group was predominant (n=26; 63,41%). We identified 14 bacterial meningitis and 27 aseptic meningitis. With the clinical predictin score, 31 meningitis were classified as high risk of bacterial meningitis and 10 as low risk. The sensibility and the negative value were 100%. The clinical prediction score applied resulted to be valid and safe for identifying patients without bacterial meningitis.