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.

Comparison of sexual functions in women with and without type 1 diabetes

SUMMARY OBJECTIVE: This study aimed to investigate female sexual function in patients with type 1 diabetes by comparing female sexual function index scores between women with and without type 1 diabetes. METHODS: A total of 62 women with type 1 diabetes and 69 age-matched women without diabetes but with similar backgrounds were enrolled in the patient and control groups, respectively. All participants were sexually active and had no systemic diseases other than diabetes in the patient group. RESULTS: The frequency of female sexual dysfunction was significantly higher, and the mean female sexual function index score was significantly lower in women with diabetes compared to the control group (p=0.01). There was a significant relationship between sexual dysfunction and duration of diabetes, glycosylated hemoglobin test, and body mass index (p<0.05). CONCLUSION: This study demonstrates that female sexual dysfunction is more common among women with type 1 diabetes than among women without type 1 diabetes. Patients with type 1 diabetes should be evaluated in terms of sexual health. Health professionals should give more attention to and provide guidance regarding sexual function in women with type 1 diabetes.

Perfil social e clínico de crianças e adolescentes com diabetes mellitus tipo 1 / Perfil social y clínico de niños y adolescentes con diabetes mellitus tipo 1 / Social and clinical profile of children and adolescents with type 1 diabetes mellitus

Objetivo: identificar o perfil social e clínico de crianças e adolescentes com diabetes mellitus tipo 1. Método: pesquisa quantitativa, transversal e descritiva, desenvolvida com 81 responsáveis de crianças e adolescentes com diabetes mellitus tipo 1 entre março e setembro/2021, em dois centros de referência da Paraíba. A análise descritiva foi realizada com auxílio do software Statistical Package for the Social Science, versão 18. Resultados: predominantemente, os acompanhantes das crianças e adolescentes eram as próprias mães, 90,1%, e cerca de 40% viviam com renda familiar menor que um salário mínimo. Entre as crianças e adolescentes, 54% apresentaram valores elevados de hemoglobina glicada, mesmo estando em tratamento; 65,4% indicaram desconhecimento na forma correta de armazenamento da insulina, e 77,6% possuía lipohipertrofia. Conclusão: foram preponderantes a vulnerabilidade socioeconômica e o manejo clínico ineficaz do diabetes mellitus tipo 1 em crianças e adolescentes.

Objective: to identify the social and clinical profile of children and adolescents with type 1 diabetes mellitus. Method: quantitative, cross-sectional and descriptive research, developed with 81 guardians of children and adolescents with type 1 diabetes mellitus between March and September/2021, in two reference centers in Paraiba. The descriptive analysis was performed using the Statistical Package for the Social Science software, version 18. Results: predominantly, the companions of the children and adolescents were the mothers themselves, 90.1%, and about 40% lived with family income lower than a minimum wage. Among the children and adolescents, 54% had high glycated hemoglobin values, even though they were undergoing treatment; 65.4% indicated ignorance of the correct form of insulin storage, and 77.6% had lipohypertrophy. Conclusion: socioeconomic vulnerability and ineffective clinical management of type 1 diabetes mellitus in children and adolescents were predominant.

Objetivo: identificar el perfil social y clínico de niños y adolescentes con diabetes mellitus tipo 1. Método: investigación cuantitativa, transversal y descriptiva, realizada con 81 cuidadores de niños y adolescentes con diabetes mellitus tipo 1 entre marzo y septiembre/2021, en dos centros de referencia en Paraíba. El análisis descriptivo fue realizado mediante el software Statistical Package for Social Science, versión 18. Resultados: predominantemente, los acompañantes de los niños y adolescentes eran sus madres, el 90,1%, y cerca del 40% vivían con renta familiar inferior a un salario mínimo. Entre los niños y adolescentes, el 54% presentaba niveles elevados de hemoglobina glucosilada, a pesar de estar en tratamiento; El 65,4% indicó desconocer la forma correcta de almacenar la insulina y el 77,6% presentaba lipohipertrofia. Conclusión: predominó la vulnerabilidad socioeconómica y el manejo clínico ineficaz de la diabetes mellitus tipo 1 en niños y adolescentes.

O autocuidado no contexto do diabetes infantil: desafios do processo de transferência da autonomia / Self-care in the context of childhood diabetes: challenges of the process of transfer of autonomy / El autocuidado en el contexto de la diabetes infantil: desafíos en el proceso de transferencia de autonomía

Objetivo: analisar o processo de transferência de autonomia para o autocuidado das crianças e adolescentes com diabetes tipo 1, sob a ótica do binômio mãe e filho. Método: pesquisa convergente assistencial, realizada com 16 binômios, atendidos em ambulatório especializado na região sul brasileira. A coleta ocorreu em 2017 através de entrevistas e observação que foram transcritas e analisadas conforme as etapas do método proposto. Seguiu-se os preceitos éticos. Resultados: algumas mães apresentaram dificuldade em delegar autonomia para o autocuidado dos filhos, e alguns filhos não se sentiam seguros para desenvolver o autocuidado. As dificuldades no cuidado estiveram relacionadas a alimentação, automonitoramento glicêmico, medicação e exercícios físicos. Conclusão: o processo de transferência do autocuidado é complexo, com dificuldades para contornar a postura de (super)proteção materna e promover a autonomia dos filhos, em função da recorrência nos descuidos e da falta de comprometimento, com impactos ao controle adequado na doença.

Objective: to analyze the process of transferring autonomy to self-care for children and adolescents with type 1 diabetes, from the perspective of the mother-child binomial. Method: convergent care research, carried out with 16 pairs, assisted in a specialized clinic in the southern region of Brazil. The collection took place in 2017 through interviews and observation that were transcribed and analyzed according to the steps of the proposed method. The ethical precepts were followed. Results: some mothers had difficulty delegating autonomy for their children's self-care, and some children did not feel safe to develop self-care. Difficulties in care were related to food, glycemic self-monitoring, medication and physical exercises. Conclusion: the self-care transfer process is complex, with difficulties in overcoming the posture of (super) maternal protection and promoting the children's autonomy, due to the recurrence of carelessness and lack of commitment, with impacts on adequate control of the disease.

Objetivo: analizar el proceso de transferencia de autonomía al autocuidado de niños y adolescentes con diabetes tipo 1, desde la perspectiva del binomio madre-hijo. Método: investigación de atención convergente, realizada con 16 pares, atendidos en una clínica especializada en la región sur de Brasil. La recolección se llevó a cabo en 2017 a través de entrevistas y observación que fueron transcritas y analizadas según los pasos del método propuesto. Se siguieron los preceptos éticos. Resultados: algunas madres tuvieron dificultad para delegar autonomía para el autocuidado de sus hijos, y algunos niños no se sintieron seguros para desarrollar el autocuidado. Las dificultades en la atención se relacionaron con la alimentación, el autocontrol glucémico, la medicación y el ejercicio físico. Conclusión: el proceso de transferencia del autocuidado es complejo, con dificultades para superar la postura de (super) protección materna y promover la autonomía de los niños, debido a la recurrencia del descuido y la falta de compromiso, con impactos en el adecuado control de la enfermedad.

Recurrent hypoglycemic coma and diabetic ketoacidosis caused by insulin antibody: a rare case of type 1 diabetes mellitus / Hipoglicemia hiperinsulinémica causada por anticuerpos antiinsulina: informe de un caso

ABSTRACT Insulin antibodies (IAs) induced by exogenous insulin rarely cause hypoglycemia. However, insulin autoantibodies (IAAs) in insulin autoimmune syndrome (IAS) can cause hypoglycemia. The typical manifestations of IAS are fasting or postprandial hypoglycemia, elevated insulin level, decreased C-peptide levels, and positive IAA. We report a 45-year-old male with type 1 diabetes mellitus (T1DM) treated with insulin analogues suffering from recurrent hypoglycemic coma and diabetic ketoacidosis (DKA). His symptoms were caused by exogenous insulin and were similar to IAS. A possible reason was that exogenous insulin induced IA. IA titers were 61.95% (normal: 300 mU/L and < 0.02 nmol/L when hypoglycemia occurred. Based on his clinical symptoms and other examinations, he was diagnosed with hyperinsulinemic hypoglycemia caused by IA. His symptoms improved after changing insulin regimens from insulin lispro plus insulin detemir to recombinant human insulin (Gensulin R) and starting prednisone.

Los anticuerpos contra la insulina (AI) inducidos por la insulina exógena raramente causan hipoglucemia. No obstante, los autoanticuerpos contra la insulina (AIA) en el síndrome autoinmune de insulina (SAI) pueden causar hipoglucemia. Las manifestaciones típicas del SAI son la hipoglucemia en ayunas o posprandial, niveles elevados de insulina, la disminución del nivel de péptido C y AIA positivos. Presentamos un paciente hombre de 45 años con diabetes mellitus de tipo 1 (DMT1) tratado con análogos de insulina, que sufría comas hipoglucémicos recurrentes y cetoacidosis diabética (CAD). Sus síntomas fueron causados por la insulina exógena y fueron similares al SAI. La posible razón fue que la insulina exógena indujo AI. El título de AI era del 61,95% (Normal: 300 mU/L y < 0,02 nmol/L cuando se producía la hipoglucemia. Basados en sus síntomas clínicos y otros exámenes, se le diagnosticó hipoglucemia hiperinsulinémica causada por la AI. Sus síntomas mejoraron después de cambiar el régimen de insulina de lispro más insulina detemir a insulina humana recombinante (Gensulin R) y de empezar a tomar prednisona.

Evaluation of sleep characteristics of children and adolescents with type 1 diabetes mellitus / Avaliação das características do sono em crianças e adolescentes portadores de diabetes melito tipo 1

ABSTRACT Objective: To evaluate sleep characteristics of children and adolescents with type 1 diabetes mellitus (T1DM) and their relationship with glycemic control. Methods: A cross-sectional study was conducted at a public hospital in São Paulo, Brazil. It included 86 patients with T1DM, aged between 10 and 18 years old, who were on insulin therapy, had performed at least three measurements of capillary blood glucose throughout the day, and had normal thyroid function. The clinical, anthropometric, and laboratory data of each patient were evaluated. The Pediatric Daytime Sleepiness Scale (PDSS) and the Munich Chronotype Questionnaire (MCTQ) were used to assess the sleep characteristics. Results: The mean level of glycated hemoglobin (HbA1c) was 9.2±2.1%, and it was higher in adolescents than in children. The mean score of PDSS was 13.9±4.7. Patients with HbA1c<7.5% had lower PDSS scores and longer sleep duration on weekdays than patients with HbA1c≥7.5%. HbA1c levels were negatively correlated with chronotype values and sleep duration on weekdays and positively correlated with social jet lag. Patients who had had T1DM for less than three years had a higher prevalence of daytime sleepiness. The regression analysis showed that higher HbA1c (≥7.5%) and shorter time since the diagnosis of T1DM increased the chance of daytime sleepiness, regardless of age and sex. Conclusions: Patients with higher HbA1c had more daytime sleepiness, a morning chronotype, shorter sleep duration on weekdays and a more significant social jet lag. The shorter diagnosis time for T1DM and greater levels of HbA1c increased the chance of daytime sleepiness.

RESUMO Objetivo: Avaliar as características do sono em crianças e adolescentes portadores de diabetes melito tipo 1 (DM1) e sua relação com o controle glicêmico. Métodos: Estudo transversal realizado em um hospital público de São Paulo. A amostra foi composta de 86 portadores de DM1 entre 10 e 18 anos, aderentes à insulinoterapia, com monitoração mínima de três glicemias capilares ao dia e função tireoidiana normal. Foram avaliados os dados clínicos, antropométricos e laboratoriais de cada paciente. Utilizaram-se a Escala de Sonolência Diurna Pediátrica (ESDP) e o Questionário de Cronotipo de Munique (QCTM). Resultados: A média de hemoglobina glicada (HbA1c) foi 9,2±2,1%, sendo maior em adolescentes. A média do escore da ESDP foi 13,9±4,7. Pacientes com HbA1c<7,5% tiveram menor escore na ESDP e maior duração do sono em dias de semana do que pacientes com HbA1c≥7,5%. Verificaram-se correlações negativas da HbA1c com valores do cronotipo e com duração do sono em dias de semana e correlação positiva da HbA1c com jet lag social. Pacientes com tempo de DM1 menor que três anos tiveram maior prevalência de sonolência diurna. A análise de regressão apontou que, quanto maior a HbA1c e menor o tempo de diagnóstico de DM1, maior a chance de sonolência diurna, independentemente de idade e sexo. Conclusões: Pacientes com HbA1c mais elevada apresentaram mais sonolência diurna, cronotipo matutino, menor duração do sono em dias de semana e maior jet lag social. O menor tempo de diagnóstico de DM1 e HbA1c≥7,5% aumentaram a chance de maior sonolência diurna.

Quality evaluation of registration data of Shenzhen Type 1 Diabetes Alliance: based on the collaborative research platform network of China Type 1 Diabetes Alliance / 中国医师杂志

Objective:To evaluate the data quality of Shenzhen Type 1 Diabetes Alliance (SZT1D), and to provide a basis for evaluation and improvement for the continuous improvement of data quality.Methods:From December 2018 to July 2021, 697 first-visit type 1 diabetes (T1DM) patients (including 501 in Shenzhen and 196 out-of-Shenzhen) and 120 re-visited T1DM patients (including 113 in Shenzhen and 7 out-of-Shenzhen) who were registered by SZT1D in collaborative research platform network of China Type 1 Diabetes Alliance (hereinafter referred to as China T1D). The data quality was evaluated from three dimensions: data completion, accuracy and revisit. The data completion degree was evaluated by the overall data completion degree and the key indicator completion degree; the data accuracy was evaluated by the probability of abnormal blood glucose value; the patient′s return visit was evaluated by the return visit rate.Results:The main characteristics of T1DM in SZT1D were young and middle-aged adults [age: (34.4±17.1)years] with thin body [BMI: (19.80±3.52)kg/m 2)], half of male and female patients [proportion of male: 52.4%(365/697)]; the main types of diagnosis were classical T1DM [65.22%(150/230)] and latent autoimmune diabetes in adults(LADA) [26.08%(60/230)], and the fasting blood glucose (FPG) [(10.93±6.98)mmol/L] and glycosylated hemoglobin (HbA 1c) [(10.63±3.01)%] were high. The average completion rate of the overall data of the first diagnosed patients in SZT1D was only 60% [(62.9±31.5)%]: the number of patients with overall data completion ≥80% in SZT1D was only 50.2%(350/697); the number of patients with overall data completion ≥80% in Shenzhen was less than that outside Shenzhen [44.3%(222/501) vs 65.3%(128/196), P<0.001]. The key indicators with better completion rate of first-visit were disease course [76.2%(531/697)], age of onset [75.8%(528/697)], family history of diabetes [74.9%(522/697)], etc., but none of them had a completion rate of more than 80%, and the diabetes self-management behavior assessment questionnaire and scale score were completely missing; the frequency of daily blood glucose monitoring [46.1%(231/501) vs 64.3%(126/196), P<0.001], current insulin regimen [44.3%(222/501) vs 63.3%(124/196), P<0.001], number of diabetic ketoacidosis (DKA) since the onset of the disease [45.7%(229/501) vs 64.8%(127/196), P<0.001] and the number of symptomatic hypoglycemia in the past 1 month [39.3%(197/501) vs 63.8%(125/196), P<0.001] were higher in Shenzhen than those reported outside Shenzhen. In addition, the probability of abnormal FPG and postprandial glucose (PPG) [5.2%(24/466); 3.8%(19/236)] were low. The revisit rate was not high [17.2%(120/697)], and the revisit rate in Shenzhen was higher than that outside Shenzhen [22.6%(113/501) vs 3.6%(7/196), P<0.001]. The first revisit rate was 16.2%(113/697) and the second revisit rate was seriously insufficient [1.0%(7/697)]. Conclusions:The data quality of T1DM patients recorded by SZT1D needs to be further improved. Improving the information interconnection between China-T1D and SZT1D, employing quality control personnel and building a systematic data quality evaluation analysis and feedback mechanism are methods to promote the comprehensive, accurate and efficient input of T1DM data and continuously improve the evaluation methods to improve the overall data quality.

Construction of a nomogram predictive model for readmission risk within 1 year of children with type 1 diabetes and its verification / 中国实用护理杂志

Objective:To construct and validate a nomogram predictive model for readmission risk within 1 year of children with type 1 diabetes.Methods:A total of 395 children with type 1 diabetes who were hospitalized in four hospitals in Xi′an City from February 2019 to February 2021 were selected as the research subjects. The children were divided into training set ( n = 219) and verification set ( n = 175) in 5∶4 ratios. A nomogram prediction model for readmission risk within 1 year of children with type 1 diabetes was constructed based on the training set data, and internal validation was carried out. The external validation was carried out based on validation set data. Results:A total of 85 (21.5%) children were readmitted within 1 year. Mean glycohemoglobin A1c ≥ 7.5%, co-infection, complications of diabetes, and family history of diabetes were risk factors for readmission within 1 year of children with type 1 diabetes ( OR values were 4.010 - 5.510, P<0.05), and age of onset >7 years old was a protective factor ( OR = 0.070, P<0.05). The internal verification of nomogram model showed that the area under ROC curve was 0.778 (95% CI 0.703- 0.853), and the observed curve in calibration curve was basically consistent with the predicted curve. The external verification showed that the area under ROC curve was 0.748 (95% CI 0.642- 0.854), and the observed curve in calibration curve was basically consistent with the predicted curve. Conclusions:The nomogram predictive model for readmission risk within 1 year of children with type 1 diabetes is scientific and practical, and has certain clinical value in guiding targeted prevention and intervention of readmission of children with type 1 diabetes within one year.

Clinical progress of monogenic autoimmune syndrome associated with type 1 diabetes mellitus / 中国医师杂志

The impairment of islets β cell by autoimmune response is an important cause of type 1 diabetes mellitus (T1DM). Some monogenic autoimmune syndromes could induce T1DM in difference chance, which are important disease models to deeply understand autoimmunity and T1DM. This article reviews the diagnosis, treatment and genetic detection of eight known single gene autoimmune syndromes associated with T1DM, arming to expand the diagnosis and treatment of T1DM.

Application of immunological markers in the diagnosis and prediction of type 1 diabetes / 中国医师杂志

Type 1 diabetes mellitus (T1DM) is an organ-specific autoimmune disease mediated by T cells. Untreated T1DM deteriorate rapidly. Early prediction and diagnosis lead to early treatment and prognosis of patients. Immune system plays an important role in the destruction of β cells in T1DM patients, and the emergence of immunological markers has facilitated the diagnosis and prediction of T1DM. Based on the results of various cohort studies and clinical studies in recent years, this review comprehensively discusses the application of immunological markers in the prediction and diagnosis of T1DM from two aspects: humoral immune markers and cellular immune markers.

Entrevista motivacional no autogerenciamento de cuidados a adolescentes com diabetes tipo 1: revisão integrativa / Entrevista motivacional en la autogestión de los cuidados a adolescentes con diabetes tipo 1: revisión integradora / Motivational interviewing and self-management among adolescents with type 1 diabetes: an integrative review

RESUMO Objetivo analisar evidências científicas sobre entrevista motivacional e sua influência no autogerenciamento do cuidado do adolescente com diabetes mellitus tipo 1. Método revisão integrativa cuja busca aconteceu em junho de 2020 nas bases de dados LILACS, PubMed, CINAHL, Scopus e Web of Science para atender a pergunta: Quais evidências científicas sobre entrevista motivacional e sua influência no autogerenciamento do cuidado ao adolescente com diabetes mellitus tipo 1? Todos os artigos identificados estavam no idioma inglês e publicados entre 2003 e 2020. Resultados entre os dez estudos incluídos, nove foram realizados nos Estados Unidos e um no Reino Unido. As pesquisas tiveram métodos diversificados na aplicação da entrevista motivacional em circunstâncias diferentes e os resultados mostraram impactos positivos no autogerenciamento dos cuidados de adolescentes com DM1, principalmente em relação ao controle glicêmico e/ou nos níveis de hemoglobina glicada. Conclusão a entrevista motivacional favorece o autogerenciamento do cuidado e autonomia do adolescente com diabetes.

RESUMEN Objetivo analizar evidencias científicas sobre entrevista motivacional y su influencia en la autogestión del cuidado de adolescentes con diabetes mellitus tipo 1 (DM1). Métodos revisión integradora llevada a cabo en junio de 2020 en las bases de datos LILACS, PubMed, CINAHL, Scopus y WoS para responder a la pregunta: ¿Cuáles son las evidencias científicas sobre entrevista motivacional y su influencia en la autogestión del cuidado de adolescentes con diabetes mellitus tipo 1? Los artículos encontrados estaban en inglés y fueron publicados entre 2003 y 2020. Resultados de los diez estudios incluidos, nueve se realizaron en Estados Unidos y uno en Reino Unido. Las investigaciones utilizaron diferentes métodos de aplicación de la entrevista motivacional en diferentes circunstancias y los resultados señalaron impactos positivos en la autogestión de los cuidados de adolescentes con DM1, especialmente cuanto al control glucémico y/o niveles de hemoglobina glucosilada. Conclusión la entrevista motivacional favorece la autogestión del cuidado y la autonomía de adolescentes con diabetes.

ABSTRACT Objective this study examined scientific evidence on motivational interviewing and its influence on self-management among adolescents with type-1 diabetes mellitus (DM1). Methods the survey for this integrative review took place in June 2020 in the LILACS, PubMed, CINAHL, Scopus, and Web of Science databases to answer the question: What scientific evidence is available on motivational interviewing and its influence on self-management among adolescents with DM1? All the articles found were in English and published between 2003 and 2020. Results of the ten studies included, nine were conducted in the United States and one in the United Kingdom. The studies used different methods for applying motivational interviewing in differing circumstances, and their findings revealed positive impacts on self-management among adolescents with type-1 diabetes, especially on blood glucose monitoring and/or on glycated hemoglobin levels. Conclusion motivational interviewing is an intervention that favors self-management and autonomy among adolescents with diabetes.

Entrevista motivacional no autogerenciamento de cuidados a adolescentes com diabetes tipo 1: revisão integrativa / Motivational interviewing and self-management among adolescents with type 1 diabetes: an integrative review / Entrevista motivacional en la autogestión de los cuidados a adolescentes con diabetes tipo 1: revisión integradora

Objetivo: analisar evidências científicas sobre entrevista motivacional e sua influência no autogerenciamento do cuidado do adolescente com diabetes mellitus tipo 1. Método: revisão integrativa cuja busca aconteceu em junho de 2020 nas bases de dados LILACS, PubMed, CINAHL, Scopus e Web of Science para atender a pergunta: Quais evidências científicas sobre entrevista motivacional e sua influência no autogerenciamento do cuidado ao adolescente com diabetes mellitus tipo 1? Todos os artigos identificados estavam no idioma inglês e publicados entre 2003 e 2020. Resultados: entre os dez estudos incluídos, nove foram realizados nos Estados Unidos e um no Reino Unido. As pesquisas tiveram métodos diversificados na aplicação da entrevista motivacional em circunstâncias diferentes e os resultados mostraram impactos positivos no autogerenciamento dos cuidados de adolescentes com DM1, principalmente em relação ao controle glicêmico e/ou nos níveis de hemoglobina glicada. Conclusão: a entrevista motivacional favorece o autogerenciamento do cuidado e autonomia do adolescente com diabetes.

Objective: this study examined scientific evidence on motivational interviewing and its influence on self-management among adolescents with type-1 diabetes mellitus (DM1). Methods: the survey for this integrative review took place in June 2020 in the LILACS, PubMed, CINAHL, Scopus, and Web of Science databases to answer the question: What scientific evidence is available on motivational interviewing and its influence on self-management among adolescents with DM1? All the articles found were in English and published between 2003 and 2020. Results: of the ten studies included, nine were conducted in the United States and one in the United Kingdom. The studies used different methods for applying motivational interviewing in differing circumstances, and their findings revealed positive impacts on self-management among adolescents with type-1 diabetes, especially on blood glucose monitoring and/or on glycated hemoglobin levels. Conclusion: motivational interviewing is an intervention that favors self-management and autonomy among adolescents with diabetes.

Objetivo: analizar evidencias científicas sobre entrevista motivacional y su influencia en la autogestión del cuidado de adolescentes con diabetes mellitus tipo 1 (DM1). Métodos: revisión integradora llevada a cabo en junio de 2020 en las bases de datos LILACS, PubMed, CINAHL, Scopus y WoS para responder a la pregunta: ¿Cuáles son las evidencias científicas sobre entrevista motivacional y su influencia en la autogestión del cuidado de adolescentes con diabetes mellitus tipo 1? Los artículos encontrados estaban en inglés y fueron publicados entre 2003 y 2020. Resultados: de los diez estudios incluidos, nueve se realizaron en Estados Unidos y uno en Reino Unido. Las investigaciones utilizaron diferentes métodos de aplicación de la entrevista motivacional en diferentes circunstancias y los resultados señalaron impactos positivos en la autogestión de los cuidados de adolescentes con DM1, especialmente cuanto al control glucémico y/o niveles de hemoglobina glucosilada. Conclusión: la entrevista motivacional favorece la autogestión del cuidado y la autonomía de adolescentes con diabetes.

Type 1 diabetes and subcutaneous insulin resistance syndrome treated with pancreas transplantation / Diabetes tipo 1 y síndrome de resistencia subcutánea a la insulina tratada con trasplante de páncreas

Abstract We present a case of subcutaneous insulin resistance syndrome, a rare entity, consisting of subcutaneous and intramuscular insulin resistance, with normal or almost normal sensitivity to insulin when administered intravenously. Its cause is unknown and its treatment is challenging. Our patient required a pancreas transplant.

Resumen Presentamos un caso de síndrome de resistencia subcutánea a la insulina, entidad in frecuente, que consiste en resistencia a la insulina por vía subcutánea e intramuscular, con sensibilidad normal o casi normal a la insulina cuando se aplica por vía intravenosa. Se desconoce su causa y su tratamiento es un desafío. Nuestra paciente requirió trasplante de páncreas.

Type 1 diabetes care in mexico: an analysis of the renaced-dt1 national registry

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.

Adolescentes con diabetes mellitus tipo I y sus conocimientos sobre la enfermedad / Adolescents with Type I Diabetes Mellitus and their Knowledge about the Disease

RESUMEN Fundamento: la diabetes mellitus es una enfermedad endocrino-metabólica que se caracteriza por elevados niveles de glucosa en sangre que se produce como consecuencia de una deficiente secreción o acción de la insulina. Constituye un problema creciente de salud. Objetivo: identificar qué conocimientos tienen los adolescentes que padecen de diabetes mellitus tipo I en el Hospital Pediátrico Universitario Paquito González Cueto de Cienfuegos. Método: se realizó un estudio descriptivo de corte transversal con una muestra de 42 adolescentes con diagnóstico de diabetes mellitus tipo I que tienen seguimiento en consulta de endocrinología del Hospital Pediátrico Universitario de Cienfuegos. Las variables analizadas fueron: edad, nivel de escolaridad, tiempo de diagnóstico de la enfermedad y conocimientos relacionados con la diabetes mellitus. Para la obtención de la información fue diseñado un cuestionario el cual fue previamente validado. Resultados: el 71,4 % de los pacientes respondieron correctamente el concepto de la enfermedad. El grupo de 14 a 16 años de edad fue el más representado con 20 pacientes. En cuanto a los síntomas fueron señalados correctos más del 60 %. El nivel de escolaridad predominante fue secundaria básica y el 83,3 % fueron evaluados de bien. Los adolescentes de 1 a 2 años de diagnóstico obtuvieron una evaluación satisfactoria 7 (58,3 %). Conclusiones: el mayor número de pacientes estuvo entre los 14 y los 16 años. Existieron dificultades en la identificación de los síntomas de descompensación, así como en el tratamiento dietético. El mayor número de pacientes estudiados obtuvo una evaluación satisfactoria.

ABSTRACT Background: diabetes mellitus is an endocrine-metabolic disease characterized by high levels of glucose in blood that occurs due to a deficient secretion or action of insulin. It is a growing health problem. Objective: to identify what knowledge adolescents with type I diabetes mellitus have at the Paquito González Cueto Cienfuegos University Pediatric Hospital. Method: a descriptive cross-sectional study was carried out with 42 adolescents diagnosed with type I diabetes mellitus who are followed up in the endocrinology clinic of the Cienfuegos University Pediatric Hospital. The variables analyzed were: age, level of education, time of diagnosis of the disease and knowledge related to diabetes mellitus. A previously validated questionnaire was designed to obtain information. Results: the 30 (71.4 %) patient they answered the concept of the disease correctly. The group of 14 was 16 elderly years the most represented of 20 patients. They were marked as to the symptoms correct over the 60 %. The level of prevailing scholarship was secondary basic and they were the 83.3 % evaluated of good. The teens with 1 to 2 years of diagnosis obtained a satisfactory evaluation 7 (58.3 %). Conclusions: the largest number of patients was between 14 and 16 years old. There were difficulties in identifying decompensating symptoms, as well as in dietary treatment. The largest number of patients studied obtained a satisfactory evaluation.

Ankle-brachial index and subclinical atherosclerosis in type 1 diabetes

SUMMARY OBJECTIVE: To assess the prevalence of altered ankle-brachial index (<0.9 or >1.3) in patients with type 1 diabetes and to compare it with the presence of subclinical atherosclerosis by carotid ultrasound. METHODS: Prospective, cross-sectional study in which 45 adults with type 1 diabetes were evaluated (age 34±10 years, 46.7% men). The data collected included anamnesis, clinical evaluation, calculation of the ankle-brachial index (relationship between systolic blood pressure in the ankle and brachial artery), and performance of carotid ultrasound. RESULTS: Thirty-two patients had ankle-brachial index >1.3 (66.7%) and no patient had ankle-brachial index <0.9. Carotid echocardiography was performed on 21 patients, 4 (19%) of whom had atherosclerosis. Age >35 years and ankle-brachial index >1.4 showed a good correlation with atherosclerosis (r=0.49, p=0.021; r=0.56, p=0.008, respectively). A model associating age >35 years and ankle-brachial index >1.4 showed an excellent relationship with atherosclerosis (r=0.59, p=0.004). CONCLUSIONS: Our study showed that vascular calcification (ankle-brachial index >1.4) was frequent in this population with type 1 diabetes and associated with subclinical atherosclerosis. A model combining ankle-brachial index >1.4 and age >35 years showed an excellent correlation with atherosclerosis and can assist in clinical suspicion and optimize the request for additional tests.

Efficacy of a glucose meter connected to a mobile app on glycemic control and adherence to self-care tasks in patients with T1DM and LADA: a parallel-group, open-label, clinical treatment trial

ABSTRACT Objective: The main aim of the study was to evaluate the patients' glycemic control and adherence to self-care tasks. Materials and methods: Patients with type 1 diabetes mellitus (T1DM) or latent autoimmune diabetes of the adult (LADA) using a multiple daily injection (MDI) regimen with carbohydrate counting (n = 25, Subgroup B) or fixed insulin dose (n = 25, Subgroup C) were allocated to use the application (app) for 12 weeks. Both subgroups were compared with each other and against a control group (n = 25, Group A) comprising patients with T1DM or LADA treated with continuous subcutaneous insulin infusion (CSII) in a parallel-group, open-label, clinical treatment trial. All patients had glycated hemoglobin (A1C) levels measured and were asked to fill out the Diabetes Self-Management Profile (DSMP) questionnaire at study start and end. The patients were instructed to measure capillary glucose six times daily in study weeks 4, 8, and 12. Results: Mean A1C levels decreased 0.725% in Subgroup C in intragroup analysis (p = 0.0063), and had a mean variation of 0.834% compared with Group A (p = 0.003). Mean DSMP scores increased 5.77 points in Subgroup B in intragroup analysis (p = 0.0004) and increased by a mean of 6.815 points in relation to Group A (p = 0.002). Conclusion: OneTouch Reveal improved both A1C levels and DSMP scores in patients with T1DM or LADA compared with standard treatment (CSII).

Marcadores inmunológicos de diabetes tipo 1: análisis de 4.164 perfiles en un centro de salud de Chile

Background: Previous studies have assessed the role of Type 1 diabetes (DM1) antibodies as predictors of the natural history of disease. Aim: To determine the frequency and combinations of positivity for DM1 antibodies in patients with DM1 and the relationship between antibody positivity and the age of the patient. To explore the relationship between history of insulin therapy or diabetic ketoacidosis (DKA) at the onset of the disease with antibody positivity in a subsample. Material and Methods: Data was gathered from every sample processed for DM1 antibodies in our laboratory between January 2015 and September 2019. Medical records from 84 patients who tested positive for at least one antibody were revised to study the relationship between insulin therapy or DKA at the onset of the disease with antibody positivity. Results: Forty percent of DM1 antibody tests were positive. Among positive tests, 1, 2, 3 or 4 DM1 antibodies were detected in 48%, 33%, 17% and 3% of cases, respectively. The likelihood of testing positive was inversely related with age for ICA, GAD, IA-2, ZnT8 and directlyproportionalforIAA (p= −0,012; −0,013; −0,014; −0,009; 0,005 respectively). An association between DKA at the onset of the disease and IA-2 positivity was observed (Odds ratio (OR) 5.38 95% confidence intervals (CI) 1.79 − 16.16, P < 0.01). No association was found between IAA positivity and history of insulin therapy (OR 2.25 95%CI 0.63 − 7.90, P = 0.2403). The results obtained from this study represent a novel local profile of DM1 antibody data, highlighting a relationship between antibody positivity and age.

Children with type 1 diabetes mellitus: the experience of disease / El niño con diabetes mellitus tipo 1: la experiencia de enfermar / A criança com diabetes Mellitus Tipo 1: a vivência do adoecimento

ABSTRACT Objective: To identify the main challenges faced by children with type 1 diabetes mellitus and describe their coping strategies. Method: Qualitative study conducted with a semi-structured interview with children aged 8 to 11 with type 1 diabetes mellitus diagnosis who received care in the outpatient clinic of a university hospital in the state of Rio de Janeiro, Brazil. The results have been analyzed and categorized as per thematic analysis. Results: Five children have participated. The reports have emerged from the systematization of the qualitative data, in a process of apprehending meaning from statements of children and adolescents, which led to the category "Living with diabetes", including two subcategories: "Challenges to disease coping" and "Family participation and support in the disease process". Conclusion: The process of disease coping is observed to occur differently for each child. However, family participation and support, as well as communication with health professionals, are fundamental in this process.

RESUMEN Objetivo: Identificar los principales desafíos para los niños con diabetes mellitus tipo 1 y describir las estrategias de afrontamiento que utilizan para adaptarse. Método: Estudio cualitativo, realizado a través de entrevistas semiestructuradas con niños de 8 a 11 años diagnosticados con diabetes mellitus tipo 1 y atendidos en el ambulatorio de un hospital universitario del estado de Rio de Janeiro, en Brasil. Los resultados se analizaron y clasificaron según el análisis temático. Resultados: Participaron cinco niños. Los relatos surgieron de la sistematización de los datos cualitativos, en un proceso de aprehensión del significado de los testimonios de niños y adolescentes, que derivó en la categoría "Vivir con diabetes", con dos subcategorías: "Desafíos en el afrontamiento de la enfermedad" y "Participación y apoyo de la familia en el proceso de la enfermedad". Conclusión: Se constata que el proceso de afrontamiento de la enfermedad ocurre singularmente con cada niño. Sin embargo, la participación y el apoyo de la familia, así como la comunicación de los profesionales sanitarios, son esenciales en este proceso.

RESUMO Objetivo: Identificar os principais desafios vivenciados pela criança com diabetes mellitus tipo 1 e descrever as estratégias de enfrentamento que utilizam para se adaptarem. Método: Estudo de abordagem qualitativa, realizado por meio de entrevista semiestruturada com crianças de 8 a 11 anos com diagnóstico de diabetes mellitus tipo 1 atendidas em ambulatório de um hospital universitário no Estado do Rio de Janeiro. Os resultados foram analisados e categorizados segundo análise temática. Resultados: Participaram cinco crianças. Os relatos emergiram da sistematização dos dados qualitativos, em um processo de apreensão de significado dos depoimentos das crianças e adolescentes, que derivou na categoria "Viver com diabetes", com duas subcategorias: "Desafios no enfrentamento do adoecimento" e "Participação e apoio da família no processo do adoecimento". Conclusão: Constata-se que o processo de enfrentamento do adoecimento ocorre de forma singular para cada criança. No entanto, a participação e o apoio da família, assim como a comunicação dos profissionais de saúde, são fundamentais nesse processo.

Characteristics of type 1 diabetes mellitus in children and adolescents with Down's syndrome in an admixed population

ABSTRACT Objective: People with Down's syndrome (DS) have a higher risk of developing type 1 diabetes mellitus (T1D) and may have specific clinical features compared to T1D patients without DS. This study evaluated the clinical and laboratory aspects of T1D in children and adolescents with DS in an admixed population. Subjects and methods: A case-control study comparing patients with T1D and DS (T1D+DS) to patients with T1D without DS (T1D controls) from two tertiary academic Hospitals in São Paulo, Brazil. Results: The sample consisted of 9 patients with T1D+DS and 18 T1D age and sex-matched controls. Anti-glutamic acid decarboxylase 65 antibodies were positive in 7/7 of the 9 T1D+DS patients, confirming the presence of diabetes autoimmunity in this group. Mean age at diagnosis of T1D was 4.9 ± 3.9 years in the T1D+DS group and 6.4 years ± 3 in the T1D control group; early diagnosis (<2 years old) occurred in three T1D+DS patients but only in one T1D control patients, both suggesting lower age of diagnosis in T1D+DS group, although without statistical significance (p = 0.282 and p = 0.093, respectively). The T1D+DS group presented lower total insulin dose (0.7 IU/kg/day ± 0.2) and HbA1c (7.2% ± 0.6) than the control group (1.0 IU/kg/day ± 0.3 and 9.1% ± 0.7, respectively) (p = 0.022 and p = 0.047, respectively). Conclusion: We confirmed the autoimmune etiology of diabetes in people with DS in this admixed population. T1D+DS patients developed diabetes earlier and achieved better metabolic control with a lower insulin dose than T1D controls. These findings are in agreement with previous studies in Caucasian populations.