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)

Telemonitoring type 1 diabetes patients during the COVID-19 pandemic in Brazil: was it useful?

ABSTRACT Objectives: To evaluate the performance of telemonitoring in detecting clinical and psychological needs and adherence to the protective measures imposed by the COVID-19 pandemic in addition to providing remote assistance for patients with type 1 diabetes (T1D) in a public university center in Brazil. Subjects and methods: Telemonitoring protocol included phone calls and e-mails. Patients were asked to rate COVID-19-like symptoms, psychological symptoms, epidemiological issues, and adherence to diabetes management (insulin, exercise, and diet) using a 0-to-10 scale. An e-mail address and phone number were offered for further contact if needed. Clinical, demographic, and laboratorial data from the consultations before the pandemic were collected from medical records. Results: Among 321 patients with a previously scheduled consultation over the first 15 weeks of social distancing, 237 (73.8%) could be successfully contacted. Of these, 207 (87.3%) were exclusively evaluated by telemonitoring (190 only by phone or text message and 17 who were also reached by email), and 30 (12.7%) patients attended the consultation for medical reasons detected during the telephone screening. Overall, 44 (18.5%) patients reported COVID-19-like symptoms. One (2.3%) patient was hospitalized and subsequently died. Psychological symptoms were reported by 137 (60.4%) patients and 30 (12.7%) required remote psychological assistance. Appropriate social distancing was performed by 203 (87.9%) patients, and 221 (97.8%) referred use of masks. Conclusions: Telemonitoring T1D patients during the pandemic helped reduce the need for in-person consultations, detect clinical and psychological needs, and offer support to patients in addition to monitoring suspected COVID-19 cases and the adherence to protective measures.

Associação entre diabetes mellitus e doenças oculares em pessoas com deficiência visual / Association between diabetes mellitus and eye diseases in people with visual impairment / Asociación entre diabetes mellitus y enfermedades oculares en personas con discapacidad visual

Objetivo: verificar associação entre diabetes mellitus e doenças oculares em pessoas com deficiência visual. Método: estudo transversal com 51 pessoas com diabetes e deficiência visual, em um centro de reabilitação visual do interior paulista, que participaram de entrevista estruturada, em 2018. Utilizou-se os testes: Kolmogorov Smirnov, Regressão de Poisson, Regressão de Logística Binária, e Correlação de Spearman. Resultados: a maioria das pessoas era cega e relatou que a retinopatia diabética, o glaucoma e a catarata foram causa da deficiência visual; com tempo de diagnóstico do diabetes acima de 109 meses. A catarata apresentou um nível de correlação baixa (r=0,280 e p=0,047), e a retinopatia diabética um nível de correlação moderada (r=0,565 e p=0,000), considerando o tempo de diagnóstico do diabetes. Conclusão: associação estatisticamente significante entre o tipo de diabetes e a retinopatia, e correlação estatisticamente significante entre o tempo de diagnóstico do diabetes, a catarata e a retinopatia diabética.

Objective: to verify the association between diabetes mellitus and eye diseases in people with visual impairment. Method: this cross-sectional study involved 51 people with diabetes and visual impairment at a Visual Rehabilitation Center in São Paulo, who participated in a structured interview in 2018. The tests used were: Kolmogorov Smirnov, Poisson Regression, Binary Logistic Regression, and Spearman Correlation. Results: most participants were blind, reported that diabetic retinopathy, glaucoma and cataracts were the causes of their visual impairment, and had been diagnosed with diabetes over 109 months earlier. Cataract returned a low level of correlation with time with diagnosis of diabetes (r = 0.280 and p = 0.047), and diabetic retinopathy, moderate correlation (r = 0.565 and p = 0.000). Conclusion: a statistically significant association was found between type of diabetes and retinopathy, and statistically significant correlations between the time diagnosed with diabetes, cataracts and diabetic retinopathy.

Objetivo: verificar la asociación entre diabetes mellitus y enfermedades oculares en personas con discapacidad visual. Método: este estudio transversal involucró a 51 personas con diabetes y discapacidad visual en un Centro de Rehabilitación Visual en São Paulo, quienes participaron en una entrevista estructurada en 2018.Las pruebas utilizadas fueron: Kolmogorov Smirnov, Regresión de Poisson, Regresión Logística Binaria y Spearman Correlación. Resultados: la mayoría de los participantes eran ciegos, informaron que la retinopatía diabética, el glaucoma y las cataratas eran las causas de su discapacidad visual y habían sido diagnosticados con diabetes más de 109 meses antes. La catarata devolvió un bajo nivel de correlación con el tiempo con el diagnóstico de diabetes (r = 0,280 yp = 0,047) y la retinopatía diabética, correlación moderada (r = 0,565 yp = 0,000). Conclusión: se encontró asociación estadísticamente significativa entre tipo de diabetes y retinopatía, y correlaciones estadísticamente significativas entre el tiempo de diagnóstico de diabetes, cataratas y retinopatía diabética.

Endocrinopatías por inmunoterapia oncológica / Endocrinopathies by oncological immunotherapy

La relación entre inmunidad y cáncer es compleja. Las células tumorales desarrollan mecanismos de evasión a las respuestas del sistema inmunitario. Esta capacidad permite su supervivencia y crecimiento. La inmunoterapia ha transformado el tratamiento oncológico mejorando la respuesta inmunitaria contra la célula tumoral. Esta se basa en el bloqueo de los puntos de control inmunitario mediante anticuerpos monoclonales contra la molécula inhibidora CTLA-4 (antígeno 4 del linfocito T citotóxico [CTLA-4]) y la proteína 1 de muerte celular programada y su ligando (PD-1/PD-L1). Aunque los inhibidores de los puntos de control inmunitario (ICIs) son fármacos bien tolerados, tienen un perfil de efectos adversos conocido como eventos adversos inmunorrelacionados (EAI). Estos afectan varios sistemas, incluyendo las glándulas endocrinas. Los eventos adversos endocrinos más frecuentes son la disfunción tiroidea, la insuficiencia hipofisaria, la diabetes mellitus autoinmune y la insuficiencia suprarrenal primaria. El creciente conocimiento de estos efectos adversos endocrinos ha llevado a estrategias de tratamiento efectivo con el reemplazo hormonal correspondiente. El objetivo de esta revisión es reconocer la incidencia de estas nuevas endocrinopatías, la fisiopatología, su valoración clínica y el manejo terapéutico. (AU)

The relationship between immunity and cancer is complex. Tumor cells develop evasion mechanisms to the immune system responses. This ability allows their survival and progression. Immunotherapy has transformed cancer treatment by improving the immune response against tumor cells. This is achieved by blocking immune checkpoints with monoclonal antibodies against cytotoxic T lymphocyte-associated antigen 4 (CTLA-4) and programmed cell death protein 1 and its ligand (PD-1 / PD-L1). Although the immune checkpoint inhibitors (ICIs) are well tolerated drugs, they have a profile of adverse effects known as immune-related adverse events (irAES). These involve diverse systems, including the endocrine glands. The most frequent endocrine immune-related adverse events are thyroid and pituitary dysfunction, autoimmune diabetes mellitus and primary adrenal insufficiency. The increasing knowledge of these irAES has led to effective treatment strategies with the corresponding hormonal replacement. The objective of this review is to recognize the incidence of these new endocrinopathies, the physiopathology, their clinical evaluation, and therapeutic management. (AU)

Nueva mutación identificada en el gen FOXP3 en lactante menor con diarrea crónica como manifestación de enteropatía autoinmune - síndrome IPEX / New mutation in FOXP3 gene identified in an infant with chronic diarrhea as manifestation of autoinmune enteropathy - IPEX syndrome

INTRODUCCIÓN: El síndrome IPEX (inmunodesregulación, poliendocrinopatía y enteropatía autoinmune ligada a X) causado por mutaciones en el gen FOXP3, se caracteriza por diarrea prolongada, alteraciones endocrinológicas y dermatitis. El tratamiento consiste en la administración de medicamentos inmunosupresores, siendo el trasplante de médula ósea la única cura potencial. OBJETIVO: Describir una nueva mutación del gen FOXP3, así como los hallazgos y evolución de un paciente con síndrome IPEX. CASO CLÍNICO: Lactante menor masculino que debutó al mes de vida con diarrea cró nica, falla intestinal e infecciones recurrentes. Exámenes de laboratorio y biopsia intestinal sugerentes de enteropatía autoinmune. Durante el seguimiento, el paciente presentó refractariedad al manejo inmunosupresor con esteroides, ciclosporina y tacrolimus, falleciendo a los 7 meses de edad por complicaciones vasculares. Antecedente familiar por línea materna de múltiples muertes en hombres menores de 1 año. Ante la sospecha de síndrome IPEX se realizó exoma en trío que reportó una mutación probablemente patogénica en el gen FOXP3. CONCLUSIÓN: Se documentó una nueva mutación del gen FOXP3 en paciente con síndrome IPEX. A pesar de la baja prevalencia de esta enfermedad, es importante el reconocimiento de síntomas no específicos pero sugerentes del diagnóstico.

INTRODUCTION: The IPEX (immune dysregulation, polyendocrinopathy, enteropathy, X-linked) syn drome is caused by the mutations of the FOXP3 gene, characterized by persistent diarrhea, endo crine disorders, and dermatitis. The treatment is the administration of immunosuppressive drugs, where hematopoietic stem cell transplantation is the only potential cure. OBJECTIVE: To describe a new FOXP3 gene mutation, as well as the findings and evolution of a patient with IPEX syndrome. CLINICAL CASE: Male infant presenting at one month of age with chronic diarrhea, intestinal failure, and recurrent infections. Lab tests and intestinal biopsy suggested autoimmune enteropathy. During follow-up, the patient presented resistance to immunosuppressive treatment with corticosteroids, cyclosporine, and tacrolimus, dying at 7 months of age due to vascular complications. He had a ma ternal family history of multiple deaths of men under 1 year of age. IPEX syndrome was suspected therefore a trio whole-exome sequencing was performed that showed a probably pathogenic FOXP3 gene mutation. CONCLUSION: A new FOXP3 gene mutation is reported in a patient with IPEX syndro me. Despite the low prevalence of this disease, it is important to recognize non-specific but suggestive symptoms for its diagnosis.

Utilidad de la prueba de tolerancia de comida mixta con Nutrial I para la evaluación de la función de las células beta en diabetes tipo 1 / Usefulness of the tolerance test of mixed food with Nutrial I for the assessment of beta cells function in diabetes type 1

RESUMEN Introducción: La prueba de tolerancia de comida mixta es considerada la prueba de oro para la medición de la producción de insulina endógena en pacientes con diabetes tipo 1. Objetivo: Determinar la utilidad de la prueba de tolerancia de comida mixta con Nutrial I para evaluar la función de las células ß en diabéticos tipo 1 de diagnóstico reciente y la relación de esa función con algunas características clínicas y bioquímicas. Métodos: Se estudiaron variables bioquímicas como la glucemia, hemoglobina glucosilada (HbA1c), péptido C y fracciones lipídicas. La prueba de tolerancia de comida mixta con Nutrial I se aplicó a 18 sujetos con diabetes tipo 1 de diagnóstico reciente y a 8 voluntarios con edades comprendidas entre 19 y 35 años. El consumo del suplemento Nutrial I se calculó según el peso del paciente. Se obtuvieron muestras para glucemia y péptido C a los -10, 0, 30, 60, 90 y 120 minutos. Resultados: Se observaron concentraciones elevadas de glucemia y disminuidas de péptido C durante la prueba de tolerancia de comida mixta en los diabéticos tipo 1 de diagnóstico reciente, en comparación con los voluntarios, así como, diferencias en las áreas bajo la curva de péptido C (AUC-pc) (p= 0,001). En los diabéticos tipo 1 de diagnóstico reciente se evidenció una correlación negativa entre el AUC-pc con los niveles de glucemia en ayunas (r= -0,747; p ( 0,0001) y la HbA1c (r= -0,535; p= 0,022). Por el contrario, se encontró una correlación positiva entre el AUC-pc y el péptido C en ayunas (r= 0,722; p= 0,001). El AUC-pc después de la prueba de tolerancia de comida mixta es mayor en los sujetos con glucemia en ayunas si GA < 7 mmol/L con respecto a los sujetos con glucemia en ayunas ( 7 mmol/L (p= 0,012). Conclusiones: El empleo del Nutrial I en la prueba de tolerancia de comida mixta fue útil en la evaluación de la función de las células β en diabéticos tipo 1 de diagnóstico reciente. Los valores bajos de glucemia en ayunas durante esta prueba son marcadores indirectos de una función residual de células ( más conservada en los diabéticos tipo 1 de diagnóstico reciente(AU)

ABSTRACT Introduction: The tolerance test of mixed food is considered the gold standard for the measurement of endogenous insulin production in patients with diabetes type 1. Objective: To determine the usefulness of the tolerance test of mixed food with Nutrial I to assess the ß-cells function in patients with diabetes type 1 of recent diagnosis and the relation of this function with some clinical and biochemical characteristics. Methods: There were studied biochemical variables as the blood glucose, glycosylated haemoglobin (HbA1c), C-peptide and lipid fractions. The tolerance test of mixed food with Nutrial I was applied to 18 individuals with diabetes type 1 of recent diagnosis and in 8 volunteers aged between 19 and 35 years old. The consumption of Nutrial I supplement was calculated according to the weight of the patient. Samples were obtained for blood glucose and C-peptide at -10, 0, 30, 60, 90 and 120 minutes. Results: There were observed high concentrations of glycemia and decreased amounts of C-peptide during the tolerance test of mixed food in recently diagnosed type 1 diabetics in comparison with the volunteers, as well as differences in areas under the curve of C-peptide (AUC-pc) (p= 0.001). In the recently diagnosed type 1 diabetics was evident a negative correlation between the AUC-pc with fasting plasma glucose levels (r= -0,747; p(0.0001) and HbA1c (r= -0,535; p= 0.022). On the contrary, it was found a positive correlation between the AUC-pc and fasting C-peptide (r = 0.722; p = 0.001). The AUC-pc after the tolerance test of mixed food was greater in subjects with fasting blood glucose < 7 mmol/L with respect to the subjects with fasting blood glucose ( 7 mmol/L (p= 0.012). Conclusions: The use of Nutrial I in the tolerance test of mixed food was useful in the assessment of the role of the β-cells in patients with recently diagnosed diabetes type 1. Low values of fasting blood glucose during this test are indirect markers of a residual function of (cells more preserved in type 1 diabetics of recent diagnosis(AU)

Asociación entre síntomas depresivos de las madres y control metabólico en adolescentes con Diabetes Mellitus tipo 1 / Association between depressive symptoms in mothers and metabolic control in adolescents with type 1 diabetes

Resumen: Introducción: Un mal control metabólico en pacientes con Diabetes Mellitus tipo 1 (DM1) se asocia a complica ciones a corto y largo plazo. Los adolescentes con Diabetes tipo 1 presentan peor control metabólico comparado con pacientes de otros grupos etarios. Escasos estudios han demostrado una asociación entre síntomas depresivos de las madres con el control metabólico de sus hijos adolescente. Objetivo: Evaluar la asociación entre síntomas depresivos maternos y control metabólico de adolescentes con DM1. Sujetos y Método: Estudio observacional transversal realizado en adolescentes, edades 10 a 18 años, con diagnóstico de DM1 de más de un año de evolución y sus madres. Se aplicó test de Beck II, cuestionario de depresión infantil, cuestionario SALUFAM y cuestionario de datos sociodemográficos. Se realizó hemoglobina glicosilada capilar, como marcador de control metabólico. Resultados: Se estudiaron 86 parejas (madre-hijo adolescente), adolescentes de edad media 14.04 años y 5.95 años de evolución de DM1. El 25.6% (n 22) de las madres presentó síntomas depresivos, asociándose a peor control metabólico en sus hijos (HbA1c: 7.66% y 8.91%, p < 0.001). El 17.9% de adolescentes presentó síntomas depresivos, no asociándose a síntomas depresivos maternos ni a peor control metabólico. Los síntomas depresivos maternos se asociaron a menor nivel educacional materno y pater no, mayor número de hijos en la familia, presencia de otros hermanos con enfermedades crónicas y a mayor vulnerabilidad en salud (SALUFAM). Conclusiones: La presencia de síntomas depresivos maternos se asocia a peor control metabólico en el adolescente con DM1, siendo fundamental un enfoque multidisciplinario familiar para obtener mejores resultados metabólicos en los adolescentes.

Abstract: Introduction: Poor metabolic control in patients with Type 1 Diabetes Mellitus (T1DM) is associated with short- and long-term complications. Adolescents with T1DM present poorer metabolic control than patients of other age groups. Few studies have shown an association between mothers with depressive symptoms and the metabolic control of their adolescent children. Objective: To evaluate the associa tion between maternal depressive symptoms and metabolic control of their adolescents with T1DM. Subjects and Method: Cross-sectional observational study carried out with adolescents aged between 10 and 18 years, with T1DM diagnosis of at least 1 year ago and their mothers. The Beck Depression Inventory-II and the SALUFAM questionnaire were applied, and sociodemographic data were co llected. Glycosylated hemoglobin from capillary blood was used as a marker of metabolic control. Results: 86 couples (mother-adolescent children) were studied. The average age of the adolescents was 14.04 years and the average evolution time of T1DM was 5.95 years. 27.325.6% of mothers had depressive symptoms, which was associated with worse metabolic control of their children (HbA1c of 7.66% and 8.91%, p-value <0.001). 17.9% of adolescents had depressive symptoms, which was not associated with maternal depressive symptoms or worse metabolic control. Maternal depressive symptoms were also associated with lower maternal and paternal educational levels, high number of children in the family, presence of other siblings with chronic illnesses, and high health vulnera bility (SALUFAM). Conclusions: The mother's depressive symptoms can be associated with worst metabolic control in T1MD adolescents. It is fundamental a multidisciplinary family approach to get better metabolic controls in T1DM adolescents.

Apego y estrés en niños con Diabetes tipo 1 y sus madres / Attachment and stress in children with type 1 Diabetes and their mothers

Resumen: Objetivo: Comprender la relación entre apego y diabetes y el rol mediador del estrés en niños con diabetes mellitus tipo 1 (DM1) y sus madres. Material y Método: Se aplicaron Instrumentos de evaluación correspondientes a Escalas de Apego (ECR-R), Estrés percibido (PSS), Seguridad (SS) y Estrés en niños (SiC), como medidas de autoreporte completadas por niños(as) y sus madres. Se analizaron variables demográficas, tiempo de inicio de diabetes, y el promedio de las ultimas 3 medi ciones de Hemoglobina glicosilada HbA1c como parámetro del control metabólico del último año. Resultados: Las estrategias de apego maternas e infantiles y el estrés materno mostraron una asocia ción significativa con los resultados de la diabetes del niño(a), aunque con importantes diferencias de género. Conclusiones: Las estrategias de apego, infantiles y maternas, son relevantes en el curso de la diabetes.

Abstract: Objective: To understand the relationship between attachment and diabetes and the role of stress mediators in children with type 1 diabetes (T1D) and their mothers. Material and Method: The following assessment instruments were applied as self-report measures: Attachment Scale (ECR- R), Perceived Stress Scale (PSS), Security Scale (SS), and the Stress in Children (SiC) questionnaire, which were completed by children and their mothers. We analyzed demographic variables, diabetes onset time, and the average of the last three glycosylated hemoglobin (HbA1c) measurements as a parameter of metabolic control in the last year. Results: Attachment strategies of both mother and child, as well as maternal stress, showed a significant association with the child's diabetes outcomes, although with important gender differences. Conclusions: Both mother and child attachment strate gies are relevant aspects of the T1D course.

Diabetic ketoacidosis as the initial presentation of type 1 diabetes in children and adolescents: epidemiological study in southern brazil / Cetoacidose diabética como apresentação inicial de diabetes tipo 1 em crianças e adolescentes: estudo epidemiológico no sul do brasil

ABSTRACT Objective: To analyze the variables associated with the presence of diabetic ketoacidosis in type 1 diabetes mellitus (T1DM) diagnosis and its impact on the progression of the disease. Methods: We reviewed the records of 274 children and adolescents under 15 years, followed in a Pediatric Endocrinology clinic of a university hospital in Curitiba-PR. They had their first appointment between January 2005 and April 2015. Results: Most patients received their T1DM diagnosis during a diabetic ketoacidosis episode. The associated factors were: lower age and greater number of visits to a physician's office prior to diagnosis; diabetic ketoacidosis was less frequent in patients who had siblings with T1DM and those diagnosed at the first appointment. Nausea and vomiting, abdominal pain, tachydyspnea, and altered level of consciousness were more common in the diabetic ketoacidosis group. There was no association with socioeconomic status, duration of symptoms before diagnosis, and length of the honeymoon period. Conclusions: Prospective studies are necessary to better define the impact of these factors on diagnosis and disease control. Campaigns to raise awareness among health professionals and the general population are essential to promote early diagnosis and proper treatment of diabetes mellitus in children and adolescents.

RESUMO Objetivo: Avaliar as variáveis associadas ao diagnóstico de diabetes melito tipo 1 (DM1) na vigência de cetoacidose diabética e seu impacto na evolução da doença. Métodos: Foram avaliadas 274 crianças e adolescentes com idade até 15 anos acompanhados em um ambulatório de endocrinologia pediátrica de um hospital universitário de Curitiba, Paraná, cuja primeira consulta ocorreu entre janeiro de 2005 e abril de 2015. Resultados: A maioria dos pacientes teve diagnóstico de DM1 na vigência de cetoacidose diabética. Os fatores associados foram: menor idade e maior número de consultas prévias ao diagnóstico; a cetoacidose diabética foi menos frequente quando havia um irmão com DM1 e quando o diagnóstico foi feito na primeira consulta médica. Náuseas ou vômitos, dor abdominal, taquidispneia e alteração do nível de consciência foram mais frequentes no grupo com cetoacidose diabética ao diagnóstico. Não se observou associação com nível socioeconômico, tempo de sintomas antes do diagnóstico e duração do período de lua de mel. Conclusões: São necessários estudos prospectivos para definir melhor o impacto desses fatores no diagnóstico e no controle da doença. Campanhas de conscientização dos profissionais de saúde e da população são necessárias para que haja diagnóstico precoce e tratamento adequado do diabetes melito em crianças e adolescentes.

Avaliação imunológica promovida pelo consumo de kombucha em camundongos diabéticos / Immunologic evaluation promoted by the consumption of kombucha in diabetic mice

O kombucha é uma bebida fermentada tradicional, originária da China, preparada pela fermentação de chá preto adoçado com cultura mista de bactérias e leveduras chamada Simbiotic Culture of Bacteria and Yeast (SCOBY). Tem sido alegado que o mesmo possui propriedades funcionais, tais como recuperação ou manutenção de peso corporal, atividade antihiperglicêmica, entre outras. Por não existirem estudos suficientes que as comprovem, este trabalho teve por objetivo avaliar a influência do consumo de kombucha como tratamento alternativo para amenizar e/ou retardar sintomas e complicações do Diabetes Mellitus e identificar as possíveis modificações metabólicas, morfológicas e imunológicas ocorridas em camundongos com diabetes tipo 1. De acordo com os resultados obtidos, observou-se que, apesar de ter havido recuperação de massa corpórea próxima daquela que se tinha antes da indução da diabetes, esse efeito não foi exclusivo do kombucha e, embora a influência no controle glicêmico tenha sido maior nos camundongos normoglicêmicos que diabéticos, acredita-se que a administração por um período prolongado pudesse indicar melhores resultados, uma vez que as avaliações histológicas e morfométricas do intestino demonstraram resultados satisfatórios quanto ao aumento da superfície de mucosa e diminuição do infiltrado inflamatório, favorecendo a modulação imunológica. Logo, considera-se necessária a realização de mais trabalhos para comprovação da capacidade funcional do kombucha e elucidação de sua eficácia enquanto tratamento exclusivo e/ou complementar do diabetes

Kombucha is a traditional Chinese fermented beverage prepared by fermenting sweetened black tea with mixed bacterial and yeast culture called Simbiotic Culture of Bacteria and Yeast (SCOBY). It has been claimed that it has functional properties such as body weight recovery or maintenance, antihyperglycemic activity, among others. Because there are not enough studies to prove them, this study aimed to evaluate the influence of kombucha consumption as an alternative treatment to alleviate and/or delay symptoms and complications of Diabetes Mellitus and to identify possible metabolic, morphological and immunological changes in mice with type 1 diabetes. According to the results obtained, it was observed that, although there was a recovery of body mass close to the one obtained before diabetes induction, this effect was not unique to kombucha, and although the influence on glycemic control was greater in normoglycemic rather than diabetic mice, it is believed that administration over a prolonged period could indicate better results, since histological and morphometric evaluations of the intestine showed satisfactory results in terms of mucosal surface enlargement and decreased inflammatory infiltrate, favoring immune modulation. . Therefore, further work is considered necessary to prove the functional capacity of kombucha and to elucidate its effectiveness as an exclusive and / or complementary treatment of diabetes

Autoimmune Polyglandular Syndrome type 2

SUMMARY Autoimmune polyglandular syndrome type 2 (APS 2) is defined by the presence of Addison's disease (AD) associated with autoimmune thyroid disease and/or Type 1 diabetes mellitus (T1DM). It is a rare disease, affecting about 1.4-2 cases/100,000 inhabitants. Its less frequent clinical presentation is the combination of AD, Graves' disease, and T1DM. We present the case of a 42-year-old woman with a history of total thyroidectomy due to Graves' disease, type 2 diabetes mellitus, and hypertension, who sought the ED due to asthenia, dizziness, nausea, and vomiting. She reported having stopped antihypertensive therapy due to hypotension and presented a glycemic record with frequent hypoglycemia. On physical examination, she had cutaneous hyperpigmentation. She had no leukocytosis, anemia, hypoglycemia, hyponatremia or hyperkalemia, and a negative PCR. Serum cortisol <0.5 ug/dl (4,3-22,4), urine free cortisol 9 ug/24h (28-214), ACTH 1384 pg/mL (4,7-48,8), aldosterone and renin in erect position of 0 pg/ml (41-323) and 430.7 uUI/ml (4.4-46.1) respectively. Quantiferon TB was negative; computerized axial tomography of the adrenals showed no infiltrations, hemorrhage, or masses. The 21-hydroxylase antibody assay was positive. B12 vitamin was normal, anti-GAD antibodies were positive, anti-insulin, anti-IA2, and anti-transglutaminase antibodies were all negative. The patient started insulin therapy and treatment for AD with prednisolone and fludrocortisone with good clinical response. This case aims to alert to the need for high clinical suspicion in the diagnosis of AD. Since this is a rare autoimmune disease, it is important to screen for other autoimmune diseases in order to exclude APS.

RESUMO A síndrome poliglandular autoimune tipo 2 (SPGA2) é definida pela presença de doença de Addison (DA) associada à doença tiroideia autoimune e/ou diabetes mellitus tipo 1 (DMT1). Trata-se de uma doença rara, afetando cerca de 1,4-2 casos/100.000 habitantes. A apresentação clínica menos frequente é a combinação de DA, doença de Graves e DMT1. Apresenta-se mulher de 42 anos, com antecedentes de tiroidectomia total por doença de Graves, diabetes mellitus tipo 2 e hipertensão, que recorre ao SU por quadro arrastado de astenia, emagrecimento, tonturas, náuseas e vômitos. Referia ter suspendido terapêutica anti-hipertensora por hipotensão e apresentava registro glicêmico com hipoglicemias frequentes. Ao exame físico, salientava hiperpigmentação cutânea. Analiticamente sem leucocitose, anemia, hipoglicemia, hiponatremia ou hipercaliemia, PCR negativa. Cortisol sérico matinal <0,5 ug/dl (4,3-22,4), cortisol livre na urina 9 ug/24h (28-214), ACTH 1.384 pg/mL (4,7-48,8), aldosterona e renina em posição ereta de 0 pg/mL (41-323) e 430,7 uUI/mL (4,4-46,1), respectivamente. Realizado estudo complementar para averiguar causa de insuficiência suprarrenal primária. Quantiferon TB negativo, tomografia axial computadorizada das suprarrenais sem infiltrações, hemorragia ou massas. Anticorpos anti-21-hidroxilase positivos. Foi aprofundada a investigação com vitamina B12 normal, anti-GAD positivo, anti-insulina, anti-IA2, antitransglutaminase, negativos. Nesse contexto, a doente iniciou insulinoterapia e tratamento dirigido para a DA com prednisolona e fludrocortisona, com boa resposta clínica. Este caso tem como objetivo alertar para a necessidade de elevada suspeição clínica no diagnóstico de DA. Sendo esta uma doença autoimune rara, é importante rastrear outras doenças autoimunes no sentido de excluir SPGA.

Lipohipertrofias en niños con diabetes mellitus tipo 1 / Lipohypertrophy in child with type 1 diabetes mellitus

ntroducción: La diabetes mellitus tipo 1 (DM1) es la enfermedad crónica más frecuente en la edad pediátrica. La educación del niño con DM1 es fundamental para un adecuado control de la enfermedad. Las lipohipertrofias son una de las complicaciones más frecuentes que se producen por el tratamiento con insulina. Estas son consideradas problemas de colaboración y, por lo tanto, es labor de la enfermera controlar su aparición e intervenir para minimizar sus consecuencias. Objetivo: Determinar las características de las lipohipertrofias en niños diagnosticados con diabetes mellitus tipo 1. Métodos: Estudio descriptivo transversal mediante muestreo por conveniencia. Se evaluó la presencia, localización y tamaño de las lipohipertrofias y la relación de la persona que administra la insulina con el régimen de tratamiento. Se estudiaron pacientes de edades comprendidas entre 2 y 18 años que tuviesen, al menos, 3 meses de tratamiento insulínico. Se calculó el tamaño de la muestra mediante estimación de la proporción. Resultados: La prevalencia de lipohipertrofias fue del 44,5 por ciento. Sin embargo, entre los niños estudiados que se encontraban en tratamiento con múltiples dosis de insulina, el porcentaje se elevó a 53,8 por ciento. Los análogos de acción rápida eran inyectados principalmente en abdomen y brazo, los de acción lenta en glúteo y muslo. Los lugares con más lipohipertrofias eran muslos (superando el 50 por ciento), seguido de brazos y abdomen. Conclusiones: Se detectaron diferencias significativas en la aparición de lipohipertrofias entre los niños que portan bomba de insulina y los que utilizan un régimen de múltiples dosis de insulina. Por lo tanto, se podría recomendar la utilización de bomba de insulina o de catéteres de infusión subcutánea (i-Port ®) para la disminución de estas(AU)

Introduction: Type 1 diabetes mellitus (T1DM) is the most common chronic disease in the pediatric age. In order to obtain a positive control of this illness, the T1DM child education is basic. Lipohypertrophies are one of the most frequent difficulties that appear as a consequence of the insulin treatment. When this happen, is nurse's responsibility to monitor the appearance of lipohypertrophies and to try to reduce their consequences. Objectives: Establish the prevalence of lipohypertrophy in children with T1DM performed at the Pediatric Endocrinology Unit of the Hospital Universitario La Paz. Methods: To analyze lipohypertrophy it has been performed a descriptive study. The method used for the sampling was for convenience. Appearance, location and size of lipohypertrophies were evaluated. This has been related with person who administers the insulin and the treatment regimen. Results: Lipohypertrophy prevalence in the sample represented a 44.5 percent, however, between patients which were in a treatment with multiple daily injections this was 53.8 percent. Quick action analogues were mainly injected in abdomen and arms, slow action analogues were aministered in buttocks and leg. Legs were the part of the body with the most lipohypertrophies concentration (exceeded 50 percent), follow by arms and abdomen. Conclusions: Meaningful differences are shown in the appearance of lipohypertrophies between children in treatment with continuous subcutaneous insulin infusion and those that use a multiple daily injections treatment. Therefore, we concluded considering the possibility to recommend the use of continuous subcutaneous insulin infusion or indwelling catheters (i-Port ®) in order to decrease lipohypertrophies(AU)

Impacto psicosocial de la diabetes mellitus tipo 1 en niños, adolescentes y sus familias: revisión de la literatura / Psychosocial impact of type 1 diabetes mellitus in children, adolescents and their families: literature review

La diabetes mellitus tipo 1 es la patología endocrina crónica más común en niños. El tratamiento incluye dieta, actividad física, medicación con insulina y un autocontrol adecuado. Este autocontrol puede ser dificultoso, provocando que niños, adolescentes y sus familias sufran diversas complica ciones psicosociales. Existe una relación inversa entre autocontrol y presencia de complicaciones psicosociales, siendo los principales problemas ansiedad y depresión, donde los adolescentes llegan a ser 2,3 veces más propensos a presentar problemas de salud mental. Las familias se ven afectadas inicialmente en el período de debut por un estado de shock, con sentimientos de angustia e ira. Los necesarios cambios de hábitos y estilos de vida pueden generar problemas psicosociales entre los que destacan trastornos ansiosos, depresivos y alimenticios. Posteriormente, el niño o adolescente y su grupo familiar pueden transitar a un nuevo equilibrio caracterizado por un buen autocontrol y adherencia al tratamiento o profundizar los trastornos individuales y grupales, trastornos que pue den reaparecer, especialmente en la adolescencia. El tratamiento integral de la diabetes mellitus tipo 1 requiere atender estos aspectos mediante equipos multidisciplinarios que incluyen profesionales médicos y del ámbito psicosocial. En esta revisión se analizan los principales aspectos relacionados al impacto psicosocial en niños y adolescentes con diabetes mellitus tipo 1 y sus familias.

Type 1 diabetes mellitus is the most common chronic endocrine pathology among children. Treatment includes diet, physical activity, insulin medication, and proper self-control. This self-control may be difficult, resulting in children, adolescents and their families suffering diverse psychosocial complications. There is an inverse relationship between self-control and psychosocial complications, the main problems being anxiety and depression, where adolescents are 2.3 times more likely to have mental health problems. Families are initially affected, in the debut period by a state of shock, with feelings of distress and anger. The necesary changes in habits and lifestyles can lead to psychosocial problems, including anxiety, depression and eating disorders. Subsequently, the child or adolescent and his or her family group may move into new balance characterized by good self-control and adherence to tratment, or deepen individual and group disorders which may reappear, especially in adolescence. The comprehensive treatment of type 1 diabetes mellitus requires addressing these aspects through multidisciplinary teams which include medical and phychosocial professionals. This review analyses the main aspects related to the psychosocial impact of diabetes mellitus type 1 among children, adolescents and their families.

Mecanismos moleculares mediadores da citoproteção de células beta pancreáticas induzidos por prolactina / Role of HSPB1 in PRL-induced cytoprotective effects on beta cells

A manutenção da célula de ilhotas in vitro aparece como uma estratégia atraente para aumentar o resultado do transplante de ilhotas pancreáticas. Entretanto, o destino das ilhotas em cultura é determinado pelo equilíbrio entre mediadores pró e antiapoptóticos. Nós mostramos anteriormente que os níveis de HSPB1 são aumentados pela prolactina (PRL) tanto nas células beta pancreáticas humanas quanto nas células de insulinoma murino MIN6. Além disso, mostramos que os efeitos pró- sobrevivência induzidos pela prolactina nas células beta pancreáticas são mediados pela HSPB1. Uma vez que o papel da HSPB1 nas células beta não foi estudado diretamente, procuramos explorar os mecanismos moleculares pelos quais a HSPB1 medeia a citoproteção da célula beta induzida pela PRL. Para isso, células MIN6 derivadas de um insulinoma de camundongo e cultura primária de ilhotas pancreáticas murinas (I), silenciadas ou superexpressando HSPB1 foram submetidas à privação de soro e então pré- tratadas na presença ou na ausência de PRL (300 ng / mL) e expostos a ou citocinas (IL-1ß (0,8 ng / mL), IFN-γ (4 ng / mL) e TNF-α (8 ng / mL) por 16 ou 24 h. Após esses períodos de tempo foi avaliada a viabilidade celular. De fato, as células silenciadas para HSPB1 tiveram maiores porcentagens de morte celular em comparação aos controles. No entanto, a superexpressão de HSPB1 sozinha imita os efeitos citoprotectores da Prolactina em ambas as células MIN6 e nas culturas primárias das ilhotas. Estes resultados mostram o papel fundamental da HSPB1 no efeito citoprotetor inibindo a apoptose inducida pelo tratamento com citocinas pró-inflamatórias. Além disso, os lisados de células Min6 tratadas com citocinas na presença ou na ausência de PRL durante 6 h foram sujeitos a imunoprecipitação de HSPB1. Proteínas coimmunoprecipitadas separadaspor SDS-PAGE e posteriormente identificadas por nano-HPLC acoplado à espectrometria de massas. Células pré-tratadas com PRL apresentaram um enriquecimento de proteínas que coprescipitaram com HSPB1 relacionadas em processos de resistência ao estresse oxidativo, degradação proteica e metabolismo de carboidratos. Células MIN6, silenciadas ou superexpressando HSPB1 foram expostas á menadiona e peróxido de hidrogênio e parâmetros oxidativos foram analisados. O silenciamento de HSPB1 promoveu células mais sensíveis ao estresse oxidativo e levou a uma redução da capacidade antioxidante, enquanto que prolactina induziu citoproteção mediada por HSPB1 contra o estresse oxidativo. A superexpressão de HSPB1, no entanto, levou a efeitos opostos. O tratamento com PRL, o silenciamento ou superexpressão de HSPB1 não mudou a expressão de enzimas antioxidantes, mas os níveis proteicos de HSPB1 estão relacionados com a modulação da razão GSH/GSSG e a atividade de G6PD. Dado de estudos recentes reportam que o perfil respiratório das ilhotas prévias ao transplante pode predizer seu desempenho e que não se sabe nada sobre se a PRL poderia modular a função mitocondrial nas células beta; no presente projeto foi investigado se o tratamento hormonal poderia aumentar a eficiência mitocondrial das células beta. Observamos que o tratamento com citocinas pró-inflamatórias produziu uma diminuição na eficiência do consumo de oxigênio mitocondrial estar relacionado à síntese de ATP. Esses resultados foram significativamente revertidos a valores similares ao obtidos nas células submetidas Às condições de máxima viabilidade após o tratamento com PRL. Além disso, os resultados mostraram que os níveis elevados de HSPB1 medeiam este efeito, uma vez que a falta desta proteína anulou significativamente a recuperação da função mitocondrial induzida pelo tratamento hormonal. Visto que as taxas de síntese de ATP mitocondrial são as responsáveis pela elevação na sua concentração intracelular e que esse evento está diretamente relacionado com a secreção de insulina nas células beta, analisamos se diferentes níveis proteicos de HSPB1 poderia modificar a função secretora de células beta. Para isso foram calculados os índices de estímulo da secreção de insulina em resposta ao aumento da concentraçãode glicose no meio de cultura tanto em células parentais MIN6 como em culturas primárias de ilhotas pancreáticas murinas que foram submetidas ou não ao silenciamento ou superexpressão de HSPB1. Nossos resultados mostraram que nem a presença de citocinas, Prolactina, ou a ausência ou superexpressão de HSPB1 nas culturas celulares analisadas apresentaram diferença significativa em relação aos índices de estímulo da secreção e conteúdo de insulina. Esses resultados sugerem que nem a falta, nem a superexpressão de HSPB1 poderia alterar a função de célula beta. Nós mostramos a relevância da HSPB1 em ambos os efeitos pró- sobrevivência da PRL contra a morte da célula beta induzida tanto por citocinas quanto por indução de estresse oxidativo. Este último efeito poderia também estar relacionado com a participação da HSPB1 na recuperação da função mitocondrial observada após o tratamento hormonal corroborando assim parte dos resultados obtidos nos experimentos de immunoprecipitação. Finalmente, nossos resultados destacam a importância de mais estudos visando um entendimento mais profundo das funções da HSPB1 nas células beta, uma vez que elas poderiam levar à mitigação da morte da célula beta através da regulação positiva de uma via de proteção endógena, que não é dependente da modulação do sistema imunológico

The success of islet transplantation has improved lately. Unfortunately, it is still compromised by cell loss. Maintaining islet cell in vitro appears as an attractive strategy to increase the outcome of pancreatic islet transplantation. However, islet fate in culture is determined by the balance between pro- and anti- apoptotic mediators. We have previously shown that Heat Shock Protein B1 (HSPB1) levels are increased by prolactin (PRL) on both human pancreatic beta cells and MIN6 murine insulinoma cells. Furthermore, we have demonstrated the prolactin-induced pro-survival effects on pancreatic beta-cells are mediated by HSPB1. Since HSPB1 role in beta cells has not been directly studied, we set out to explore the molecular mechanisms by which HSPB1 mediates PRL-induced beta cell cytoprotection. For this purpose, MIN6 insulinoma mouse cells and primary culture of murine pancreatic islets (I) wild type, HSPB1 silenced or overexpressing the chaperone were subjected to serum starvation and then pre-treated in the presence or in the absence of PRL (300 ng/mL) and exposed to or cytokines (IL-1ß (0,8 ng/mL), IFN-γ (4 ng/mL) and TNF-α (8 ng/mL)) for 16 or 24h. Then, we analyse cell viability. HSPB1silenced cells presented higher percentages of cell death compared to controls. However, the overexpression of HSPB1, independently of hormonal treatment, was able mimic the cytoprotective effects of Prolactin. These results point at the key role of HSPB1 in the cytoprotective effect against proinflammatory cytokines-induced beta cell death. In addition, lysates from Min6 cells incubated for 6 hours in the presence of a cocktail of cytokines and/or PRL were subjected to HSPB1 immunoprecipitation. Co-precipitated proteins were identified by SDS-PAGE coupled to mass spectrometry. We found an enrichment of proteins relatedto signaling pathways involved in a response against oxidative and endoplasmic reticulum stress induction. Moreover, we also identified antiapoptotic effects and carbohydrate metabolism related proteins. Indeed, HSPB1 knockdown rendered cells more sensitive to oxidative stress and led to a reduced antioxidant capacity, while prolactin induced an HSPB1- mediated cytoprotection against ROS induced beta-cell apoptosis. One again, HSPB1 overexpression mimic PRL- induced cytoprotection. While hormonal treatment, HSPB1 silencing or overexpression did not change the expression of antioxidant enzymes; this conditions influenced reduced glutathione cell content and G6DP activity. Since recent studies have pointed that islets respiratory profile prior to transplantation may predict their performance; we also investigated whether PRL treatment could increase beta-cell mitochondrial efficiency. We observed a cytokine-induced increase of mitochondrial oxygen consumption rate not related to ATP synthesis, which was significantly decreased upon PRL treatment. HSPB1 was a key mediator of this effect since the lack of this protein significantly abrogated PRL-induced mitochondrial function recovery. The secretory function was then analysed in wild type MIN6 cells as well as in primary cultures of pancreatic islets either HSPB1 silenced or overexpressing the chaperone. Cells were subjected to serum starvation and then pre-treated in the presence or in the absence of PRL and exposed to cytokines for 16 or 24h. We didn´t found significant differences in both glucose induced-insulin secretion and insulin content between the hormonal treatment, HSPB1 silencing or overexpression. These results suggest that neither lack, nor overexpression of HSPB1 could alter beta cell function. Altogether our results have shown the importance of HSPB1 on PRL prosurvival effects as well as on maintenance of mitochondrial efficiency against both cytokine treatment and oxidative-stress-induced beta cell damage. These results are in accordance with the PRL-induced enrichment of HSPB1 interacting proteins displaying functions related to protein degradation, oxidative stress protection or mitochondrial carbohydrate metabolism.Finally, our results outline the importance of further studies aiming at a deeper understanding of HSPB1 functions on beta cells, since they could lead to the mitigation of beta cell death through the up-regulation of an endogenous protective pathway, which is not dependent on the modulation of the immune system

Ankle-brachial index and diabetic neuropathy: study of 225 patients / Index tornozelo-braquial e neuropatia diabética: estudo de 225 pacientes

ABSTRACT Objective To evaluate neuropathic pain and peripheral vascular disease in diabetics and compare this with the length of time since diagnosis in type 1, and type 2 diabetes. Methods A cross-sectional study with 225 diabetics chosen from their responses on the DN4 questionnaire, who were then evaluated with the ankle-brachial index (ABI), separating type 1 diabetes from type 2 diabetes. Results A higher incidence of neuropathic pain in those over 60 years of age showed an ABI > 1.3. Neuropathic pain was related to an abnormal ABI in 144 patients (64.2%). A statistically significant value was obtained in type 2 diabetes patients with more than 10 years from disease onset, 69 with altered ABI and 25 with normal ABI. There was an altered ABI (< 0.9) observed in 33% of type 1 diabetes patients and in 67% of type 2 diabetes patients. Conclusion The ABI test in type 1 diabetes and type 2 diabetes patients is important even in those who are asymptomatic. A diagnosis of more than 10 years prior, regardless of the presence of neuropathic pain or ischemic signs, altered the ABI.

RESUMO Objetivo Avaliar dor neuropática e doença vascular periférica em diabéticos e comparar com, tempo de diagnóstico de diabetes tipo 1(DM 1) e diabetes tipo 2(DM2). Métodos Estudo de corte transversal onde, 225 diabéticos responderam ao questionário (DN4) sendo submetidos ao índice tornozelo-braquial (ITB). Resultados predomínio de dor neuropática foi em pacientes acima de 60 anos com (DM2), com um ITB > 1,3 nesta população; assim a dor neuropática foi relacionada com o ITB anormal em 144 pacientes, total de 64,2%. Um valor estatisticamente significativo foi com (DM2).Um ITB alterado (< 0,9) em 33% no (DM 1) e em 67% (DM 2). Totalizando 132 indivíduos com alterações no ITB. Conclusão O teste ITB é útil em pacientes com DM 1 e DM 2 quando a dor neuropática é suspeita, mesmo em assintomáticos. E o tempo prolongado de diabetes (> 10 anos), independentemente da presença de dor ou sinais isquêmicos, alterou o ITB.

Diabetic ketoacidosis in a pediatric intensive care unit / Cetoacidose diabética em uma unidade de terapia intensiva pediátrica

Abstract Objective: To describe the characteristics of children aged 0-14 years diagnosed with diabetic ketoacidosis and compare the following outcomes between children with prior diagnosis of type 1 diabetes mellitus and children without prior diagnosis of type 1 diabetes mellitus length of hospital stay, severity on admission, insulin dosage, time of continuous insulin use, volume of fluids infused during treatment, and complications. Methods: A retrospective descriptive study with review of medical records of patients admitted to the pediatric intensive care unit of a referral hospital from June 2013 to July 2015. The following data regarding 52 admissions were analyzed: age, sex, weight, body surface area, signs, symptoms and severity on admission, blood gas, blood glucose, glycated hemoglobin, serum osmolarity, and index of mortality. The insulin dosage, time of continuous insulin use, volume administered in the expansion phase and in the first 24 h, length of stay, and complications such as electrolyte disturbances, hypoglycemia, cerebral edema, and death were compared between the two groups. Results: Patients without a previous diagnosis of DM1 were younger at admission, with mean age of 8.4 years (p < 0.01), reported more nausea or vomiting, polydipsia and polyuria, and showed more weight loss (p < 0.01). This study also observed a higher prevalence of hypokalemia (p < 0.01) and longer hospital stay in this group. Conclusions: No differences in severity between groups were observed. The study showed that children without prior diagnosis of type 1 diabetes mellitus were younger at admission, had more hypokalemia during the course of treatment, and had greater length of hospital stay.

Resumo Objetivo: Descrever as características de pacientes até 14 anos admitidos com diagnóstico de cetoacidose diabética e comparar desfechos entre os pacientes com diabete melito tipo 1 prévio e aqueles sem diabete melito tipo 1 prévio: tempo de internação, gravidade na admissão, dose de insulina usada, tempo de insulinização contínua, volume de líquido infundido durante o tratamento e complicações. Métodos: Estudo descritivo retrospectivo com revisão de prontuários de pacientes internados na UTI pediátrica de um hospital de referência de junho de 2013 a julho de 2015. Analisamos os seguintes dados referentes a 52 internações: idade, sexo, peso, superfície corporal, sinais, sintomas, gravidade na admissão, gasometrias, glicemia, hemoglobina glicada, osmolaridade sérica e índice de mortalidade. As crianças com diabete já diagnosticado foram comparadas com aquelas sem diagnóstico prévio quanto à dose de insulina, tempo de insulinização contínua, volume infundido na fase de expansão e nas primeiras 24 horas, tempo de internação e complicações como distúrbios hidroeletrolíticos, hipoglicemia, edema cerebral e morte. Resultados: Os pacientes sem diagnóstico prévio de DM I eram mais jovens no momento da admissão, com média de 8,4 anos (p < 0,01). Relataram mais sintomas como vômitos, polidipsia e poliúria e apresentaram mais perda de peso (p < 0,01). Observamos maior prevalência de hipocalemia (p < 0,01) e maior tempo de internação no grupo acima citado. Conclusões: Não observamos diferenças quanto à gravidade entre os grupos. Pacientes diabéticos prévios eram mais jovens na admissão, apresentaram mais hipocalemia durante o tratamento e permaneceram mais tempo internados.

Estándares para las Convivencias cubanas de niños y adolescentes con diabetes / Standards for residential weeks for diabetic children and adolescents in Cuba

Introducción: las Convivencias para niños y adolescentes con diabetes mellitus tipo 1 surgen en Cuba en el año 1993, como una alternativa para la educación diabetológica; desde entonces, se realizan en la mayoría de las provincias del país. Objetivo: estandarizar la organización y realización de las Convivencias para niños y adolescentes con diabetes mellitus tipo 1. Desarrollo: durante una semana se adiestran a los pacientes y sus familiares (por separado) en el manejo integral de la diabetes mellitus tipo 1. Las Convivencias combinan las actividades educativas con la evaluación clínica del paciente, por lo que incluye además el monitoreo glucémico diario, el ajuste del tratamiento, la realización de complementarios, así como la evaluación por diferentes especialidades. La estandarización ofrece los detalles del proceso, los horarios y lugares recomendados para cada actividad, las técnicas educativas según los grupos de edades, y las técnicas para la evaluación de la actividad. Conclusión: las Convivencias constituyen un proceder a la vez educativo, terapéutico y recreativo, que permite conocer no solo el estado de salud de los pacientes en general, sino también, la situación familiar existente alrededor del niño o adolescente que vive con diabetes. La acción holística de la convivencia resulta indispensable a fin de perfeccionar el tratamiento de la diabetes; así como, optimizar la calidad de vida de los pacientes que la padecen(AU)

Introduction: the residential weeks for children and adolescents with type 1 diabetes mellitus emerge in Cuba in 1993 as an alternative for education on diabetes; since then, they are held in most provinces. Objective: to standardize the organization and holding of the residential weeks for children and adolescents with type 1 diabetes mellitus. Development: during a week, the patients and their relatives (separately) are trained in the comprehensive management of type 1 diabetes mellitus. Residential weeks combine the educational activities with the clinical evaluation of the patient, so they include daily glycemic monitoring, adjustment of treatment, the performance of supplementary tests as well as their evaluation by different specialties. Standardization offers the details of the process, the recommended schedules and places for each activity, the educational techniques by age groups and the evaluation techniques of the activity. Conclusions: the residential week represents an educational, therapeutic and recreational procedure that allows knowing not only the health status of the patient but also the existing family situation of the child and the adolescent living with diabetes. The holistic action of the residential week is indispensable to improve the diabetes treatment as well as to optimize the quality of life of patients suffering it(AU)

Tratamiento basado en la administración de insulina, a través de infusores subcutáneos continuos de insulina (bombas de insulina) para personas con diagnóstico de diabetes tipo 1 inestable severa / Treatment based on insulin administration through continuous subcutaneous infusions of insulin (insulin pumps) for people diagnosed with severe unstable type 1 diabetes

Proporcionar un marco común para el manejo clínico de infusores subcutáneos continuos de \r\ninsulina en personas con diabetes tipo 1 inestable severa. Estandarizar el diagnóstico en personas con diabetes tipo 1 inestable severa, que requieran infusores subcutáneos continuos de insulina con sensor de glucosa. Estandarizar el tratamiento en personas con diabetes tipo 1 inestable severa, que requieran infusores subcutáneos continuos de insulina con sensor de glucosa. Los ámbitos de la aplicación son dirigidos a equipos multidisciplinarios de salud, que atienden personas con infusores subcutáneos continuos de insulina como tratamiento para la diabetes tipo 1 inestable severa. Población Objetivo para personas con diabetes tipo 1, que requieren el uso de infusores subcutáneos continuos de insulina de acuerdo a los siguientes subgrupos: Subgrupo 1: Personas con diagnóstico de diabetes tipo 1, con requerimientos de micro dosis de insulina, y que a pesar de llevar una correcta adherencia al tratamiento no pueden lograr un control glicémico apropiado, presentando niveles de hemoglobina glicosilada, mayor o igual a 8,0%; múltiples episodios de hiperglicemias sobre 300mg/dl o de cetoacidosis o cetosis recurrente, todas de causa no precisada. Subgrupo 2: Personas con diagnóstico de diabetes tipo 1, que a pesar de llevar una correcta adherencia al tratamiento, no pueden lograr un control glicémico apropiado, y que han presentado episodios de hipoglicemias severas o inadvertidas, de causa no precisada. El tratamiento consta de la administración de insulina a través de un infusor subcutáneo continuo. Este dispositivo de uso médico será entregado al beneficiario junto a todos los insumos necesarios para su funcionamiento y de acuerdo a las características de cada paciente.