Observaciones en el mundo real sobre la efectividad del sistema flash de monitorización de glucosa en la práctica clínica en Chile / Real-world observations of the effectiveness of the flash glucose monitoring in clinical practice in Chile

OBJETIVO: Evaluar el tiempo en rango de glucosa y su asociación con otras medidas del control glicémico establecidas por el consenso internacional del tiempo en rango en usuarios de vida real del sistema flash de monitorización de glucosa FreeStyle LibreTM en Chile. MÉTODOS: Se analizaron los datos provenientes de la base de datos Freestyle Libre™ entre diciembre de 2014 y enero de 2022. Las lecturas se dividieron en 10 grupos (deciles) del mismo tamaño (cada decil contenía aproximadamente 498 usuarios) en función del tiempo en rango. Para cada decil se calculó la media de determinaciones diarias, el promedio de glucosa, la HbA1c, la desviación estándar de glucosa, el coeficiente de variación de la glucosa, el tiempo en rango, el tiempo de glucosa (porcentaje) por encima de 250 mg/dL (TA250), el tiempo de glucosa (porcentaje) por encima de 180 mg/dL (TA180), el tiempo por debajo (porcentaje) de 70 mg/dL (TB70) y el tiempo por debajo (porcentaje) de 54 mg/dL (TB54). RESULTADOS: Desde diciembre de 2014 hasta enero de 2022 hubo 4984 lectores. El grupo con el mayor tiempo en rango mostró significativamente una menor glucosa promedio que el grupo con el tiempo en rango más bajo (decil 1: media 248,3 mg/dL, decil 10: media 113,2 mg/L, diferencia ­135,1 mg/dL, p<0.05). Asimismo, el mayor tiempo en rango se asoció con una menor desviación estándar (decil 1: media 93,7mg/dL, decil 10: media 26,7mg/L, diferencia: -67,0 mg/ dL, p<0,05), menor coeficiente de variación (decil 1: media 37,8%, decil 10: media 23,3%, diferencia: -14,5%, p<0,05), menor TA250 (decil 1: media 46,5%, decil 10: media 0,2%, diferencia: -46,3%, p<0.05), menor TA180 (decil 1: media 73,9%, decil 10: media 3,8%, diferencia: -70,1%, p<0.05), menor TB70 (decil 5: mediana 6,13%, decil 10: mediana 1,70%, diferencia: -4,43%, p<0.05) y menor TB54 (decil 5: mediana 1,79%, decil 10: mediana 0,12%, diferencia: -1,67%, p<0.05). El mayor tiempo en rango se asoció también significativamente con más determinaciones diarias (decil 1: media 11,4, decil 10: media 16,6, diferencia: 5,2, p<0,05). La frecuencia media de las determinaciones entre todos los lectores fue de 14,7 determinaciones diarias. CONCLUSIONES: En los pacientes con diabetes en Chile, el empleo del sistema flash de monitorización demuestra la asociación entre el mayor tiempo en rango, la reducción de la variabilidad de la glucosa y un menor riesgo de hiperglucemias e hipoglicemias y también con un mayor compromiso.

OBJECTIVE: To evaluate glucose time in range and its association with other metrics of glucose control established by the International Consensus on TIR amongst real-life patients using the Flash Glucose Monitoring system FreeStyle LibreTM in Chile. METHODS: Data from the Freestyle Libre™ database between December 2014 and January 2022 were analyzed. Readers were divided into 10 groups (deciles) of the same size (each decile had approximately 498 users) according to time in range. For each decile of time in range, the mean of daily scans, average glucose, estimated HbA1c, glucose standard deviation, glucose coefficient of variation, time in range, glucose time (percentage) above 250 mg/dL (TA250), and glucose time (percentage) above 180 mg/dL (TA180), and the median of glucose time (percentage) below 70 mg/dL (TB70) and glucose time (percentage) below 54 mg/dL (TB54), were calculated. RESULTS: From December 2014 to January 2022, there were 4984 readers. The group with the highest TIR showed significantly lower average glucose than the group with the lowest TIR (decile 1: mean 248.3 mg/dL, decile 10: mean 113.2 mg/L, difference: ­135.1 mg/dL, p<0.05). In addition, more time in range was associated with a lower glucose standard deviation (decile 1: mean 93.7 mg/dL, decile 10: mean 26.7 mg/L, difference: -67.0 mg/dL, p<0.05), lower glucose coefficient of variation (decile 1: mean 37.8%, decile 10: mean 23.3%, difference: -14.5%, p<0.05), lower TA250 (decile 1: mean 46.5%, decile 10: mean 0.2%, difference: -46.3%, p<0.05),lower TA180 (decile 1: mean 73.9%, decile 10: mean 3.8%, difference: -70.1%, p<0.05), lower TB70 (decile 5: median 6.13%, decile 10: median 1.70%, difference: -4.43%, p<0.05) and lower TB54 (decile 5: median 1.79%, decile 10: median 0.12%, difference: -1.67%, p<0.05). Greater TIR was also associated with significantly more daily scans (decile 1: mean 11.4, decile 10: mean 16.6, difference: 5.2, p<0.05). Mean scan frequency amongst all readers was 14.7 daily scans. CONCLUSIONS: In patients with diabetes from Chile, the use of the flash glucose monitoring system demonstrates the association between greater TIR, reduced glucose variability, and reduced risk of hyperglycemia and hypoglycemia, and also its association with greater engagement.

O aluno com diabetes: avaliação dos pais sobre o ambiente escolar / The student with diabetes: parental assessment of the school environment

Introdução: O diabetes mellitus tipo 1 (DM1) é uma das doenças crônicas mais comuns da infância. O adequado controle do DM1 engloba uma ação multidisciplinar e envolve ambientes nos quais as crianças passam grande parte do tempo do seu dia, as escolas. Objetivos: Identificar a realidade vivenciada pelo aluno com diabetes no ambiente escolar sob a visão dos pais ou responsáveis. Métodos: Aplicado um questionário a 200 pais ou responsáveis por alunos com diabetes matriculados na educação infantil, nos ensinos fundamental e médio de escolas públicas e privadas de Belo Horizonte, compreendidos entre a faixa etária dos quatro aos dezoito anos. Resultados: A escolha da escola pelos pais foi influenciada pelo fato da criança ter diabetes em 16,5% dos casos. Houve negação inicial de matrícula. Foram necessárias explicações sobre o DM1 para os professores em 67,5% dos casos. Para 74,5% dos pais, os professores das escolas envolvidas não possuem o conhecimento necessário sobre diabetes. A maioria das crianças tem a permissão para realizar a glicemia capilar em sala de aula. Cerca de 54,5% dos alunos com diabetes fazem o uso de insulina na escola, entretanto, grande parte delas não oferecem um local específico para tal procedimento. A merenda escolar foi considerada inadequada. Houve relato de bullying. Alguns foram impedidos de participarem de excursões e até mesmo da educação física. Conclusão: Os alunos com DM1 vivenciam uma realidade inadequada no ambiente escolar. A maioria das escolas não está preparada do ponto de vista técnico e estrutural para receber estas crianças.

Introduction: Type 1 diabetes mellitus (DM1) is one of the most common chronic diseases in childhood. Proper control of DM1 encompasses a multidisciplinary action and involves environments in which children spend much of their day, such as schools. Objectives: To identify the reality experienced by students with diabetes in the school environment from the perspective of parents or guardians. Methods: A questionnaire was applied for 200 parents or guardians of students with diabetes enrolled in early childhood education, in the elementary and high schools of public and private schools in Belo Horizonte, in the age group of four to eighteen years. Results: The parents' choice of school was influenced by the fact that the child had diabetes in 16.5% of cases. There was an initial denial of registration on school. Explanations about DM1 were needed for teachers in 67.5% of cases. For 74.5% of parents, school teachers do not have the necessary knowledge about diabetes. Most children are allowed to take capillary blood glucose in the classroom. About 54.5% of students with diabetes use insulin at school, however, in most of them there are not a specific place for such procedure. The school meal was considered inadequate. There was a bullying relationship. Some students were prevented from getting involved in extracurricular activities such as excursions and in physical education. Conclusion: Students with DM1 experience an inadequate reality in the school environment. Most schools are not technically and structurally prepared to receive these children.

Acute effect of different orders of concurrent training on glycemia

The present study verified the effect of a concurrent training (CT) session in different orders, Strength + Endurance (SE) and Endurance + Strength (ES), on the glycemic control. The crossover study included 20 young men, 21.80 ± 2.90 years, IMC ≥ 23 kg/m2, 24.83 ± 3.68% of fat, who performed both CT sessions separated by 72 h. Capillary glycemia was measured at pre, immediately post the end of each exercise session, and during the recovery period at 30, 60, and 90 minutes. The comparisons were performed using Two-way ANOVA (order and time), paired test-t for the area under the curve, as well as Cohen's d effect size. There was effect of exercise order (F = 5.973; p = 0.03), effect of time (F = 18.345; p = 0.001) and interaction between order and time (F = 2.835; p = 0.03). The area under the curve presented a significant reduction (p = 0.03, effect size = 0.51, moderate). The area under the curve was smaller in SE, as well as glucose concentrations at end and post 30 min of exercise, suggesting better efficiency in glycemic control compared to ES.

Depresión en pacientes con diabetes mellitus y su relación con el control glucémico / Depression in patients with diabetes mellitus and its relationship with the glycemic control

Introducción: Algunos estudios resaltan la presencia de manifestaciones psiquiátricas en pacientes con diabetes mellitus. La depresión es el trastorno mental más frecuente en diabéticos; se considera que 1 de cada 3 pacientes con diabetes tienen depresión y, a su vez, el riesgo de tener un trastorno depresivo es 2 veces mayor que en la población general. Objetivo: Identificar algunos factores asociados con la depresión en pacientes diabéticos y su efecto en el control glucémico. Métodos: Se realizó un estudio descriptivo y transversal de 457 pacientes diabéticos, atendidos en el Hospital Central de Nampula, Mozambique, desde marzo de 2014 hasta diciembre de 2016. Como principales variables figuraron: frecuencia de los síntomas de depresión, trastornos depresivos, características sociodemográficas, eventos vitales actuales y control glucémico. Se utilizó el porcentaje como medida de resumen y como estadística inferencial la prueba de X2 de independencia y odds ratio, con un intervalo de confianza de 95 %. Resultados: La frecuencia de síntomas de depresión y de trastornos depresivos en la consulta externa fue de 32,3 y 24,3 %, respectivamente. Los factores mayormente asociados con la depresión fueron: el sexo femenino, estar viudo o divorciado y ser ama de casa. Por otra parte, experimentar 2 o más eventos vitales actuales incrementó la probabilidad de depresión y esta última se asoció con un mal control glucémico (p<0,05). Conclusiones: La frecuencia de depresión en pacientes diabéticos es elevada y está asociada con algunas variables sociodemográficas, con eventos vitales actuales y con un mal control glucémico.

Introduction: Some studies emphasize the presence of psychiatric signs in patients with diabetes mellitus. The depression is the most frequent mental disorder in diabetic patients; it is considered that 1 out of 3 patients with diabetes have depression and, in turn, the risk of having a depressive disorder is 2 times higher than in the general population. Objective: To identify some factors associated with the depression in diabetic patients and their effect in the glycemic control. Methods: A descriptive and cross-sectional study of 457 diabetic patients, assisted in the Central Hospital of Nampula, Mozambique, was carried out from March, 2014 to December, 2016. As main variables we can mention: frequency of the depression symptoms, depressive disorders, sociodemographic characteristics, current vital events and glycemic control. The percentage was used as summary measure and as inference statistics the chi-squared test of independence and odds ratio, with a 95 % confidence interval. Results: The frequency of depression symptoms and depressive disorders in the outpatient service was 32.3 and 24.3 %, respectively. The factors mostly associated with the depression were: the female sex, being widower or divorced and being a housewife. On the other hand, to experience 2 or more current vital events increased the depression probability and the latter was associated with a poor glycemic control (p <0.05). Conclusions: The frequency of depression in diabetic patients is high and it is associated with some sociodemographic variables, with current vital events and with a poor glycemic control.

Efectos de la terapia periodontal no quirúrgica sobre el control glucémico de la Diabetes Mellitus Tipo 2: Revisión de literatura / Effects of non-surgical periodontal therapy on glycemic control of Type 2 Diabetes Mellitus: A literature review

Resumen Objetivo: Conocer la relación entre la enfermedad periodontal y la diabetes mellitus tipo 2, en el control de la glucemia. Diseño y métodos de investigación: Se realizó una búsqueda bibliográfica utilizando una base de datos (PubMed) con restricción del idioma inglés, buscando las investigaciones más recientes y con el mayor número de sujetos de investigación. Resultados: Los artículos revisados coinciden en que el tratamiento de la enfermedad periodontal mejora el control glucémico en pacientes con diabetes mellitus tipo 2, con una disminución promedio de 0,69% en el nivel de hemoglobina glucosilada (HbA1c). Conclusiones: El tratamiento periodontal mejora el control de la glucemia en pacientes con Diabetes Mellitus Tipo 2, debido a que disminuye el estado de inflamación sistémica y por lo tanto, también la cantidad de células inflamatorias (como IL6 y TNF- α) que provocan alteraciones en la actividad de la insulina.

Abstract Objective: To know the relationship between periodontal disease and type 2 diabetes mellitus in the control of blood glucose. Design and research methods: A bibliographic search was conducted using a database (PubMed) with english language restriction, looking for the most recent research and with the largest number of research subjects. Results: The articles reviewed coincide in the treatment of periodontal disease improves glycemic control in patients with diabetes mellitus type 2, with an average of 0.69% in the level of glycosylated hemoglobin (HbA1c). Conclusions: Periodontal treatment improves glycemic control in patients with Type 2 Diabetes Mellitus, as well as the number of inflammatory cells (such as IL6 and TNF-α) that cause alterations in insulin activity.

Blood glucose threshold determination is stage length dependent

Aim: This study aimed to verify whether different stage length affects the intensity of the Blood Glucose Threshold (BGT), and the agreement between evaluators for BGT determination. Methods: Fourteen subjects attended the laboratory during the first session to perform anthropometric measures and become familiar with procedures. In the following three sessions, subjects performed an incremental test on the ergometer bicycle and in each test a different protocol was performed in randomized order (1, 3- and 5-min stage) to identify BGT. Three different evaluators determined the BGT. Results: Our data show that the BGT is stage length-dependent (1, 3- and 5-min; P<0.0001). The intraclass correlation coefficient showed that there was a strong correlation among evaluators for all protocols (ICC = 0.8 to 1 min; ICC = 0.8 to 3 min; and ICC 0.9 to 5 min). However, one evaluator determined the BGT at a higher intensity than others. The peak load was lower at long stage length. Conclusion: We concluded that stage length influences the BGT intensity determination. The BGT presents a good agreement among evaluators. However, a minimum of two evaluators is needed for BGT determination. The peak load is affected by stage length.(AU)

Características de la población diabética en el policlínico Victoria Cuba-Angola / Characteristics of the diabetic population in polyclinical Victoria Cuba Angola

Introducción: La diabetes mellitus es considerada actualmente como una epidemia por el acelerado incremento de su prevalencia. Objetivo: Caracterizar la población diabética perteneciente a un área de salud. Métodos: Se realizó un estudio descriptivo transversal donde se analizaron las historias clínicas de 92 pacientes diabéticos atendidos en la consulta de Atención Integral al Diabético del Policlínico Victoria Cuba-Angola en el año 2015. Se estudiaron variables socio-demográficas como la edad, sexo, color de la piel, y otras clínicas vinculadas con la enfermedad, como antecedentes patológicos familiares, tiempo de evolución de la diabetes y enfermedades asociadas. Se calculó el índice de masa corporal de cada paciente. Se describieron los tipos de tratamientos hipoglucemiantes utilizados, así como los fármacos de mayor consumo. Resultados: De los 92 pacientes estudiados, 66 correspondían al sexo femenino y 26 al masculino, con una media de edad de 63,5 años para ambos sexos. La prevalencia de hipertensión arterial en la población diabética estudiada fue de 71,7 por ciento y la obesidad se encontró hasta en 48,9 por ciento de los pacientes. La terapia farmacológica era utilizada en 92,4 por ciento de los pacientes, siendo la metformina el de mayor consumo (65 por ciento). Conclusiones: La diabetes mellitus frecuentemente se presenta en personas mayores de 45 años y asociada a la obesidad y la hipertensión arterial. La mayoría de los pacientes requirió de al menos un medicamento hipoglucemiante para alcanzar un adecuado control glucémico(AU)

Introduction: Diabetes mellitus is considered nowadays as a pandemic due to its increasingly prevalence. Objectives: Characterize the diabetic population belonging to a health area. Methods: It was carried out a descriptive study analyzing 92 patients´ charts of diabetic patients who were assisted in the Diabetic consultation in policlinic Victoria Cuba Angola in 2015. It was studied the age, sex, color of the skin, and other clinical aspects related to the illness like family history, development of the illness and other associated diseases. The body mass index from each patient was calculated. It was described the kinds of hypoglycemic treatment as well as the drugs of higher intake. Results: Out of the patients studied, 66 were female and 26 were male, with a 63.5 age average. The prevalence of hypertension of this diabetic population was 71.7 percent and obesity up to 48.9 percent of all patients. 92.4 percent of patients used pharmacotherapy, being metformin the one of higher intake (65 percent). Conclusions: Diabetes mellitus is frequently found in people older than 45 years related to obesity and hypertension. Most patients required at least one hypoglycemic treatment to reach a right glycemic control(AU)

Hipoglicemia em diabéticos tipo 2 praticantes de exercício físico / Hypoglycemia in diabetic type 2 practitioners physical exercise

Introdução: A hipoglicemia é, de fato, o mais frequente efeito secundário do tratamento da diabetes, e o principal obstáculo para a otimização do controle glicêmico. Objetivo: O Objetivo deste estudo foi identificar episódios de hipoglicemia em diabéticos tipo 2 praticantes de exercício físico. Métodos: Pesquisa descritiva, quase-experimental. Amostra foi composta por 18 mulheres com diabetes tipo 2, participantes do Projeto Doce Vida-Programa de Exercício Físico Supervisionado para Diabéticos da ESEF/UPE. O programa de treinamento aeróbio, resistido e combinado, teve duração de 38 semanas. A monitorização da glicemia foi realizada antes e imediatamente após as sessões de treino. Análise estatística foi à descritiva, com avaliação da frequência absoluta. Resultados: Após análise de todos os treinamentos, identificou-se 233 hipoglicemias, sendo 19 hipoglicemias moderadas, 214 hipoglicemias leves. Não ocorreram casos de hipoglicemias grave. Conclusão: Por fim, conclui-se que o treinamento físico aeróbio, resistido e combinado podem causar hipoglicemias de leves a moderadas em diabéticos tipo 2 desta amostra, principalmente o treinamento físico aeróbio, que obteve um maior número de hipoglicemias.

Introduction: Hypoglycaemia is, in fact, the most frequent side effect of diabetes treatment, and the main obstacle to optimizing glycemic control. Objective: The objective of this study was to identify episodes of hypoglycemia in type 2 diabetics practicing physical exercise. Methods: Descriptive, quasi-experimental research. Sample was composed of 18 women with type 2 diabetes, participants of the Sweet Life Project - Supervised Exercise Exercise for Diabetics of the ESEF / UPE. The combined aerobic training program lasted 38 weeks. Blood glucose monitoring was performed before and immediately after the training sessions. Statistical analysis was descriptive, with absolute frequency evaluation. Results: After analyzing all the training, 233 hypoglycemia was identified, 19 moderate hypoglycemia, 214 mild hypoglycaemia. There were no cases of severe hypoglycemia. Conclusion: Finally, aerobic, resisted and combined physical training may cause mild to moderate hypoglycemia in type 2 diabetics of this sample, mainly aerobic physical training, which obtained a greater number of hypoglycemias.

Bombas de insulina (BI) / Insulin pumps (IP)

En la década pasada, el conocimiento sobre la historia natural y fisiopatogenia de la diabetes tipo 1 tuvo un importante crecimiento, particularmente en relación con predicción, heterogeneidad, patología pancreática y su epidemiología. Las mejoras tecnológicas específicamente en el desarrollo de bombas de insulina y sensores continuos de glucosa ayudan a los pacientes con diabetes tipo 1 en el desafío de la administración de insulina a largo plazo. A pesar de grandes inversiones sobre distintos aspectos de la enfermedad (financiación de proyectos, organizativos, educacionales, etc.) no existe hasta el momento la prevención ni la cura para la diabetes tipo 1, y sumado a esto la calidad sobre el manejo de la enfermedad es muy heterogéneo. Como el control glucémico mejora con un tratamiento intensificado (múltiples inyecciones de insulina), el número y frecuencia de eventos hipoglucémicos tienden a incrementarse. La hipoglucemia es generadora de cuadros de estrés, ansiedad y deterioro de la calidad de vida en los pacientes con diabetes. Una de las razones por las cuales existe gran dificultad de alcanzar los objetivos glucémicos en pacientes con diabetes tipo 1 es la variabilidad en la absorción de la insulina inyectada en forma subcutánea, la que conlleva mayor e impredecible variabilidad en la concentración glucémica y todo esto en general se relaciona con valores elevados de hemoglobina glicosilada e hipoglucemia. La terapia con bomba de insulina se inició hace más de 30 años con el objetivo de mejorar el control en pacientes con diabetes tipo 1. El objetivo de esta revisión es actualizar las herramientas tecnológicas en el tratamiento de la diabetes. (AU)

Over the past decade, knowledge of the pathogenesis and natural history of type 1 diabetes has grown substantially, particularly with regard to disease prediction and heterogeneity, pancreatic pathology, and epidemiology. Technological improvements in insulin pumps and continuous glucose monitors help patients with type 1 diabetes manage the challenge of lifelong insulin administration. Agents that show promise for averting debilitating disease-associated complications have also been identified. However, despite broad organisational, intellectual, and fiscal investments, no means for preventing or curing type 1 diabetes exists, and , globally, the quality of diabetes management remains uneven. As glycemic control improves with intensified insulin regimens, the frequency of hypoglycemia tends to increase. Hypoglycemia is the cause of considerable stress and anxiety, impaired well-being, and poor quality of life in patients with type diabetes. One reason for continued poor glycemic control in patients with type 1 diabetes is the erratic absorption and action of subcutaneously injected insulin, which lead to unpredictable swings in blood glucose concentrations, and those swings, in themselves, are associated with elevated glycated hemoglobin levels and hypoglycemia. Insulinpump therapy, or continuous subcutaneous insulin infusion, was introduced more than 30 years ago as a procedure for improving glycemic control in patients with type 1 diabetes. The primary goal is to perform an up date about the new technological tools in diabetes treatment. (AU)

Avaliação do perfil glicêmico de portadores de Diabetes Mellitus tipo II em UBSs que utilizam infusão de folhas de Bauhinia forficata Link / Evaluation of glycemic profile in patients with diabetes mellitus type II in health centers that use leaf infusion of Bauhinia forficata Link

Introdução: O Diabetes Mellitus (DM) é uma condição crônica de saúde caracterizada pelo excesso de glicose no sangue, em razão da produção deficiente de insulina ou pela resistência à sua ação nos tecidos. Objetivo: Comparar o perfil glicêmico de 20 portadores de DM2, usuários de Unidades Básicas de Saúde de municípios do interior do Rio Grande do Sul, mais especificamente de Dois Lajeados e Vespasiano Corrêa. Os indivíduos foram separados em dois grupos quanto ao uso ou não de infusão de folhas de Bauhinia forficata. Métodos: Foi realizada quinzenalmente, durante 75 dias, a avaliação da glicemia em jejum dos voluntários pelo Human Gene Therapy (HGT). Resultados: O grupo 1 obteve diminuição significativa no perfil glicêmico (t = 3.0449, p = 0.0139), enquanto o grupo 2 não obteve alteração significativa no perfil glicêmico (t = ?0.8511, p = 0.4167). Conclusão: A utilização da infusão de folhas de B. forficata é auxiliar no controle da glicemia.

Introduction: Diabetes mellitus (DM) is a chronic health condition characterized by excess blood glucose due to insufficient production of insulin or by resistance to its action on tissues. Objective: To compare the glycemic profile of 20 patients with DM2, users of the Basic Health Units of municipalities of Rio Grande do Sul, more specifically two Lajeados Cooke and Vespasian. The subjects were divided into two groups according to whether or not the infusion of Bauhinia forficata. Methods: We conducted fortnightly for 75 days, the evaluation of fasting blood glucose of volunteers for Human Gene Therapy (HGT). Results: Group 1 showed significant decrease in plasma glucose levels (t = 3.0449, p = 0.0139), while group 2 received no significant change in glycemic control (t = -0.8511, p = 0.4167). Conclusion: The use of an infusion of leaves of B. forficata is helping to control blood glucose.