Disfunción tiroidea y diabetes mellitus tipo 1 / Thyroid dysfunction and type 1 diabetes mellitus

Introducción: La diabetes mellitus tipo 1 es una enfermedad autoinmunitaria que se relaciona con alteraciones tiroideas. Objetivo: Describir la relación que existe entre diabetes mellitus tipo 1 y enfermedad tiroidea autoinmune. Métodos: Se realizó una revisión de la literatura nacional e internacional de los últimos 15 años en bases de datos, en español y en inglés. Se utilizaron las siguientes palabras clave: diabetes mellitus tipo 1, autoinmunidad, enfermad tiroidea autoinmune, disfunción tiroidea y anticuerpos antitiroideos. Análisis e integración de la información: La alteración más frecuente es el hipotiroidismo subclínico y se presenta con mayor frecuencia en el sexo femenino, por lo que se sugiere realizar periódicamente el perfil tiroideo a estos pacientes. Conclusiones: Se debe tener en cuenta en la práctica clínica estas implicaciones para brindar un tratamiento oportuno, mejorar complicaciones derivadas como las enfermedades cardiovasculares y disminuir las cifras de morbilidad y mortalidad(AU)

Introduction: Type 1 diabetes mellitus is an autoimmune disease that is related to thyroid abnormalities. Objective: Describe the relationship between type 1 diabetes mellitus and autoimmune thyroid disease. Methods: A review of the national and international literature of the last 15 years was carried out in databases, in Spanish and in English. The following keywords were used: type 1 diabetes mellitus, autoimmune, autoimmune thyroid disease, thyroid dysfunction and antithyroid antibodies. Analysis and integration of information: The most common alteration is subclinical hypothyroidism and it occurs most often in the female sex, so it is suggested to periodically perform the thyroid profile to these patients. Conclusions: These implications should be taken into account in clinical practice to provide timely treatment, improve complications such as cardiovascular disease and reduce morbidity and mortality figures(AU)

Microscopia confocal de la córnea en pacientes diabéticos / Confocal microscopy of the cornea in diabetic patients

RESUMEN Objetivo: Identificar las características morfológicas del epitelio, el estroma y el endotelio corneal, así como la densidad celular de este último mediante el empleo de la microscopia confocal de la córnea en pacientes diabéticos. Métodos: Se realizó un estudio descriptivo, comparativo, en 90 ojos; 60 de ellos pertenecientes a pacientes diabéticos (30 tipo 1 y 30 tipo 2) y 30 ojos a pacientes supuestamente sanos. El estudio se realizó en el Instituto Cubano de Oftalmología "Ramón Pando Ferrer" entre enero del año 2012 y enero de 2017. Resultados: Predominó el sexo masculino con 66,7 por ciento en los pacientes con diabetes mellitus tipo 1; el sexo femenino en los pacientes con diabetes mellitus tipo 2 (60 por ciento) y aparentemente sanos (56,7 por ciento). En los pacientes con diabetes mellitus tipo 1 fueron más frecuentes las edades entre 45 y 54 años (33,3 por ciento) y entre 55 y 66 años en los pacientes con diabetes mellitus tipo 2 y aparentemente sanos con 60 y 40 por ciento respectivamente. La morfología del epitelio y el estroma corneal fue normal en el 86,7 y 87,3 por ciento respectivamente. Predominaron las alteraciones de la morfología endotelial en pacientes diabéticos tipo 1 (73,3 por ciento), así como el polimegatismo y el pleomorfismo (73,3 y 56,7 por ciento respectivamente) y la densidad celular más baja (2 222,76 células /mm2). Conclusiones: La ausencia de alteraciones morfológicas del epitelio y el estroma corneal y la presencia de polimegatismo y de pleomorfismo fueron los hallazgos más frecuentes(AU)

ABSTRACT Objective: Identify the morphological characteristics of the corneal epithelium, stroma and endothelium, as well as the cell density of the endothelium by means of confocal microscopy of the cornea in diabetic patients. Methods: A descriptive comparative study was conducted of 90 eyes: 60 from diabetic patients (30 type 1 and 30 type 2) and 30 from supposedly healthy patients, at Ramón Pando Ferrer Cuban Institute of Ophthalmology from January 2012 to January 2017. Results: A predominance was found of the male sex (66.7 percent) among patients with diabetes mellitus type 1 and of the female sex among patients with diabetes mellitus type 2 (60 percent) and seemingly healthy patients (56.7 percent). The most common age ranges were 45-54 years for patients with diabetes mellitus type 1 (33.3 percent) and 55-66 years for patients with diabetes mellitus type 2 (60 percent) and seemingly healthy patients (40 percent). Morphology of the corneal epithelium and stroma was normal in 86.7 percent and 87.3 percent, respectively. In type 1 diabetic patients there was a predominance of endothelial morphological alterations (73.3 percent), polymegethism and pleomorphism (73.3 percent and 56.7 percent, respectively) and the lowest cell density (2 222.76 cells /mm2). Conclusions: Absence of morphological alterations of the corneal epithelium and stroma, as well as the presence of polymegethism and pleomorphism were the most common findings(AU)

Algunos apuntes sobre la Epidemiología de la diabetes mellitus tipo 1 / Some notes on the Epidemiology of type 1 diabetes mellitus

La diabetes mellitus es un padecimiento conocido desde hace siglos; sin embargo, a fin del milenio el conocimiento de su etiología, historia natural y epidemiología es aún incompleto. Los estudios epidemiológicos sobre esta enfermedad y específicamente, de su tipo1 han tenido un gran impacto en la comunidad científica internacional(AU)

Diabetes mellitus is a condition known for centuries; however, at the end of the millennium the knowledge of its etiology, natural history and epidemiology is still incomplete. Epidemiological studies on this disease and specifically on type 1 have had a major impact in the international scientific community(AU)

Vitamin D and diabetes mellitus: an update 2013 / Vitamin D e diabetes melito: uma atualização 2013

Vitamin D deficiency and diabetes mellitus are two common conditions and they are widely prevalent across all ages, races, geographical regions, and socioeconomic conditions. Epidemiologic studies have shown association of vitamin D deficiency and increased risk of chronic diseases, such as cancer, cardiovascular disease, type 2 diabetes, and autoimmune diseases, such as multiple sclerosis and type 1 diabetes mellitus. The identification of 1,25(OH)2D receptors and 1-α-hydroxilase expression in pancreatic beta cells, in cells of the immune system, and in various others tissues, besides the bone system support the role of vitamin D in the pathogenesis of type 2 diabetes. Observational studies have revealed an association between 25(OH) D deficiency and the prevalence of type 1 diabetes in children and adolescents. This review will focus on the concept of vitamin D deficiency, its prevalence, and its role in the pathogenesis and risk of diabetes mellitus and cardiovascular diseases.

A deficiência de vitamina D e o diabetes melito são enfermidades comuns na população e são altamente prevalentes em todas as raças, idades, regiões geográficas e situação socioeconômica. Estudos epidemiológicos mostram uma associação entre hipovitaminose D com o aumento do risco de doenças crônicas, tais como câncer, doença cardiovascular, diabetes melito do tipo 2 e doenças autoimunes como a esclerose múltipla e o diabetes mellitus do tipo 1. A identificação de receptores da 1,25(OH)2 D e da expressão da 1 α-hidroxilase nas células betapancreáticas, em células do sistema imunológico e em uma variedade de células do organismo além do tecido ósseo, suporta o papel da vitamina D na patogênese do diabetes tipo 2 e do tipo 1. Esta revisão apresenta e discute o conceito de deficiência de vitamina D, sua prevalência e seu papel na patogênese e no risco de desenvolvimento do diabetes melito e doenças cardiovasculares.

Does breastfeeding influence the risk of developing diabetes mellitus in children? A review of current evidence / O aleitamento materno influencia o risco de desenvolvimento de diabetes mellitus na criança? Uma análise das evidências atuais

OBJECTIVE: The aim of this study was to perform a review to investigate the influence of breastfeeding as a protective agent against the onset of diabetes in children. SOURCES: Non-systematic review of SciELO, LILACS, MEDLINE, Scopus, and VHL databases, and selection of the 52 most relevant studies. A total of 21 articles, specifically on the topic, were analyzed (nine related to type 1 diabetes and 12 to type 2 diabetes). DATA SYNTHESIS: The duration and exclusivity of breastfeeding, as well as the early use of cow's milk, have been shown to be important risk factors for developing diabetes. It is believed that human milk contains substances that promote the maturation of the immune system, which protect against the onset of type 1 diabetes. Moreover, human milk has bioactive substances that promote satiety and energy balance, preventing excess weight gain during childhood, thus protecting against the development of type 2 diabetes. Although the above mentioned benefits have not been observed by some researchers, inaccuracies on dietary habit reports during childhood and the presence of interfering factors have been considered responsible for the lack of identification of beneficial effects. CONCLUSION: Given the scientific evidence indicated in most published studies, it is believed that the lack of breastfeeding can be a modifiable risk factor for both type 1 and type 2 diabetes. Strategies aiming at the promotion and support of breastfeeding should be used by trained healthcare professionals in order to prevent the onset of diabetes. .

OBJETIVO: Realizar uma análise crítica da literatura para avaliar a influência da amamentação no risco de desenvolvimento de diabetes mellitus. FONTE DOS DADOS: Revisão não sistemática nas bases de dados SciELO, LILACS, MEDLINE, Scopuse BVS, selecionando-se 52 referências mais relevantes. Especificamente sobre o tema, foram analisadas 21 (sendo 9 para diabetes tipo 1 e 12 para diabetes tipo 2). SÍNTESE DOS DADOS: A duração, a exclusividade do aleitamento materno e uso precoce do leite de vaca têm sido apresentados como fatores de risco para o desenvolvimento de diabetes. Acredita-se que o leite humano contenha substâncias que promovem a maturação do sistema imunológico protegendo contra o diabetes tipo 1. Além disso, ele possui substâncias bioativas, que promovem o equilíbrio energético e a saciedade, prevenindo o ganho de peso excessivo da criança e protegendo, consequentemente, contra o aparecimento do diabetes tipo 2. Apesar dos benefícios anteriormente citados não terem sido constatados por alguns pesquisadores, a imprecisão no relato dos hábitos dietéticos da infância e a presença de fatores interferentes têm sido responsabilizadas pela falta de identificação dos efeitos benéficos. CONCLUSÃO: Diante das evidências científicas pautadas em grande parte dos estudos, acredita-se que a ausência da amamentação seja um possível fator de risco modificável para diabetes tipo 1 e tipo 2. Estratégias que visem à promoção e ao suporte ao aleitamento materno devem ser adotadas por profissionais de saúde devidamente treinados como forma de prevenir a manifestação da doença. .

Mastopatia Diabética: una entidad infrecuente a diferenciar / Diabetic mastitis: an uncommon entity differentiate

Introducción: La Diabetes mellitus produce microvasculitis y alteración histoarquitectural de la mama. Se encuentra en el 1% de la mastopatía benigna. Sin embargo, la distorsión delparénquima produce sintomatología inflamatoria clínicamente similar a las mastopatías inflamatorias infecciosas. Su diagnóstico imagenológico, es a su vez, de gran dificultad interpretativa. Estos parámetros inespecíficos, desembocan a tratamientos que no logran eficacia en la enfermedad, más aún si se ignora el contexto de la enfermedad de origen, la cual essistémica. Objetivos: destacar la importancia del diagnóstico diferencial de esta infrecuente entidad patológica. Material y Métodos: se revisaron historias clínicas de un servicio de mastología por el término de seis meses, a efectos de recabar información estadística. Resultados: histológicamente, estas pacientes presentaron rasgos microscópicos que consisten en una lobulitis linfocitaria que afecta al epitelio y gran vasculitis edematosa. El diagnóstico histológico es crucial para llegar al tratamiento. Conclusiones: la mastopatía de las pacientes diabéticas insulinodependientes es la manifestación crónica de eventos sistémicos, producido en un porcentaje muy bajo de pacientes con la enfermedad. La correcta interpretación clínica y mamográfica, además de la sospecha semiológica desembocanen el adecuado tratamiento de esta enfermedad, inserta en un contexto sistémico.

Introduction: Diabetes mellitus occurs histoarquitectural microvasculitis and alteration of the breast. It is found in 1% of benign breast disease . However, distortion occurs parenchymal inflammatory symptoms clinically similar to infectious inflammatory breast disease. Its diagnostic imaging , is in turn highly interpretive difficulty. These non specific parameters lead to effective treatments that fail in the disease , especially if the context of disease origin is unknown, which is systemic. Objectives: To highlight the importance of the differential diagnosis of this rare disease entity. Material and Methods : Clinical histories mastology service for a period of six months for the purpose of collecting statistical data were reviewed.Results: Histologically , these patients had microscopic features consisting lobulitis lymphocytic affecting large edematous epithelium and vasculitis. Histological diagnosis is crucial to get the treatment. Conclusions: Diabetic mastopathy in insulin dependent patients is chronic manifestation of systemic events , produced in a very low percentage of patients with the disease. The correct clinical and mammographic interpretation, in addition to lead to suspicion semiológica proper treatment of this disease, inserted in a systemic context.

Estudio temporal de diabetes mellitus tipo 1 en Chile: asociación con factores ambientales durante el período 2000-2007 / Association of the incidence of type 1 diabetes mellitus with environmental factors in Chile during the period 2000-2007

Background: Pollution and viral infections could be associated with the incidence of type 1 diabetes mellitus. Aim: To look for associations between the temporal patterns of Type 1 Diabetes Mellitus (T1D) in infants younger than the age of 15years, and environmental factors, such as air pollution and viruses. Material and Methods: Data registries from hospitals, emergency services, and the Infantile Diabetes Foundation were reviewed, corresponding to children aged less than 15years, who received their first insulin injection between 2000 and 2007. The incidence of type 1 diabetes was computed for each epidemiological week. Environmental ozone and particulate matter rates for each week were obtained from Environmental services. Rates of influenza and respiratory syncytial virus infections were obtained from the epidemiological department of the Ministry of Health. An ecological Bayesian Poisson regression model was fitted, introducing the covariates, lagged covariates and errors, to estimate the incidence by epidemiological week. Results: Three factors were significant by the proposed model: particulate matter PPM 2.5 (relative risk (RR): 1.003) lagged by two weeks, influenza (RR: 0.1808) and RSV (RR: 1.021). Trends and seasonality were clearly controlled by these covariates, considering the epidemiological week as a counting period. Conclusions: These results show that environmental factors could be related to peaks of type 1 diabetes incidence.

Anticuerpos antitiroperoxidasa y antitransglutaminasa en familiares de primer grado de personas con diabetes tipo 1 y su relación con algunas características clínicas, bioquímicas e inmunológicas / Antithyroperoxidase and antitransglutaminase antibodies in first degree relatives of type 1 diabetes persons and its relation to some clinical, biochemical and immunological features

Los anticuerpos antitiroperoxidasa (AcTPO) y antitransglutaminasa (ATGt) son útiles marcadores de enfermedad tiroidea autoinmune y enfermedad celíaca, respectivamente. Su presencia en familiares de primer grado de personas con diabetes tipo 1 no se ha descrito en Cuba. Objetivo: determinar las frecuencias de los AcTPO y ATGt en familiares de primer grado de personas con diabetes tipo 1 y su relación con algunas características clínicas, bioquímicas e inmunológicas. En un grupo de 285 sujetos se realizó la medición del AcTPO y en 262 individuos la de ATGt. Se incluyeron casos entre los 2 y 65 años de edad. Se registraron datos sobre edad, sexo, color de la piel, antecedentes personales, historia familiar de obesidad, diabetes tipo 2, enfermedad tiroidea y enfermedad celíaca. Se interrogaron síntomas y exploraron signos clínicos de enfermedad celíaca y enfermedad tiroidea autoinmune. Se determinó glucemia, insulinemia, AcTPO, ATGt y autoanticuerpos asociados a diabetes tipo 1 (AGAD y AIA-2), así como la resistencia a la insulina mediante el índice HOMA-IR. RESULTADOS: las frecuencias de AcTPO y ATGt positivos fueron 5,3 y 1,9 por ciento, respectivamente. La historia familiar de enfermedad tiroidea, el temblor muscular fino y el exoftalmos se relacionaron con la presencia de AcTPO. Malabsorción intestinal, diarrea persistente, dolor abdominal recurrente y antecedente personal de hepatopatía se asociaron con la presencia de ATGt. Se encontró asociación entre los ATGt y el AIA-2. La resistencia a la insulina no se asoció con la presencia de AcTPO ni de ATGt. En los familiares de primer grado de personas con diabetes tipo 1 las frecuencias de AcTPO y ATGt son bajas. Algunos antecedentes, síntomas y signos vinculados con enfermedad celíaca y enfermedad tiroidea autoinmune pueden ser indicadores prácticos previos a la indicación de estos autoanticuerpos(AU)

The antithyroperoxidase (TPOAb) and antitransglutaminase (tTGAb) antibodies are useful markers of autoimmune thyroid disease and celiac disease, respectively. Its presence in first-degree relatives of type 1 diabetes patients has not been described in Cuba. Objetive: to determine the TPOAb and tTGAb frequencies in first-degree relatives of type 1 diabetes patients and its relation to some clinical, biochemical and immunological features. In a group of 285 subjects we measured TPOAb and in 262 subjects we measured tTGAb. The cases included aged between 2 and 65. Data were registered on age, sex, skin color, personal backgrounds, and a family history of obesity, type 2 diabetes, thyroid disease and celiac disease. Symptoms were look for and clinical signs of celiac disease and autoimmune thyroid disease were explored. Fasting glucose, fasting insulin, TPOAb, tTGAb and type 1 diabetes associated autoantibodies (AGAD and AIA-2) were determined as well as the insulin resistance according the HOMA-IR index. RESULTS: the frequencies of positive TPOAb and tTGAb were of 5,3 and 1,9 percent, respectively. The family history of thyroid disease, slight muscular tremor and exophthalmos are related to presence of TPOAb. Intestinal malabsorption, persistent diarrhea, recurrent abdominal pain and personal background of liver disease were associated with presence of tTGAb. There was an association between tTGAb and AIA-2. Insulin resistance was not associated with the presence of both antibodies. In first-degree relatives of type 1 diabetes patients, frequencies of TPOAb and tTGAb are low. Some backgrounds, symptoms and signs linked to celiac disease and autoimmune thyroid disease may be practical indicators previous to perform these autoantibodies(AU)

O diabetes hiperlábil existe como entidade clínica? / Does brittle diabetes exist as a clinical entity?

A melhor compreensão das causas da instabilidade dos níveis da glicemia em pacientes com diabetes melito tipo 1 (DMT1) e a disponibilidade de novas alternativas para enfrentá-la com sucesso, como a bomba de infusão contínua de insulina e os análogos das insulinas, tornaram relevante o questionamento sobre a existência do diabetes hiperlábil como uma entidade bem como a necessidade de defini-lo. O presente artigo pretendeu descrever o conceito de diabetes hiperlábil à luz dos novos avanços na terapia do DMT1 e propor critérios objetivos para a quantificação da labilidade da glicemia.

The best comprehension about the instability of the glycemia levels in type 1 diabetes mellitus (T1DM) patients and the availability of new alternatives to successfully control it, like insulin pump therapy and the insulin analogues, underlined the questions about the brittle diabetes existence as a clinical entity as well as the necessity of define it. The aim of this article was to describe the concept of brittle diabetes in the light of the latest advances in the treatment of type 1 diabetes and propose objective criteria to evaluate the level of glucose liability.

El consumo de leche de vaca, respuesta inmune y diabetes mellitus tipo 1 / Cow milk consumption, immune response and type 1 diabetes mellitus

El mecanismo de acción de los diferentes factores nutricionales que quizás juegan un rol en el desarrollo de la autoinmunidad contra las células ß es básicamente desconocido. También queda por definir si estas exposiciones o la carencia de ellas inician la autoinmunidad contra las células ß, provocan o aceleran el proceso de destrucción de estas células. Los supuestos efectos del riesgo nutricional quizás sean diferentes en el período fetal, en la infancia temprana o en la adolescencia. Estos efectos posiblemente sean específicos, e induzcan una respuesta inmune contra algún componente nutricional, que provoque una reacción cruzada contra un antígeno específico de las células ß que presente cierta homología con el antígeno nutricional. También se plantea que la obesidad podría modificar el curso natural de la autoinmunidad contra las células ß pancreáticas, aunque en general es un efecto sobre el sistema inmune. Las características individuales, como el genotipo HLA, de igual forma modulan el efecto de los factores ambientales(AU)

Prevalência de obesidade em crianças e adolescentes com diabetes melito tipo 1 / Prevalence of obesity in children and adolescents with type 1 diabetes mellitus

OBJETIVO: Conhecer a prevalência de obesidade e sua distribuição por sexo e idade em pacientes com diabetes melito tipo 1 (DM1), em acompanhamento em Serviço de Endocrinologia Pediátrica. MÉTODOS: Estudo transversal descritivo de pacientes em acompanhamento no Serviço de Endocrinologia Pediátrica do Hospital de Base de São José do Rio Preto, avaliando as seguintes variáveis: sexo, idade, dose e número de aplicações diárias de insulina, hemoglobina glicada (HbA1c), peso, estatura e índice de massa corpórea (IMC). A definição de sobrepeso e obesidade baseou-se nas curvas de IMC para a idade do Centers for Disease Control and Prevention (CDC, 2000). RESULTADOS: Foram incluídos 77 portadores de DM1 (44 meninas e 33 meninos) com idade entre três e 18 anos (média: 13,4). A determinação de HbA1c variou de 4,1 a 10,6 por cento (média: 7,7 por cento) e o IMC, de 15,1 a 28,6 kg/m² (média: 23,2). Conforme critérios do CDC, 8 por cento dos pacientes (três meninas e três meninos) apresentavam obesidade e 8 por cento (duas meninas e quatro meninos), sobrepeso. CONCLUSÕES: Nesta casuística de pacientes diabéticos, a prevalência de sobrepeso e obesidade não se mostrou diferente de populações não diabéticas.

OBJECTIVE: To describe the prevalence of obesity according to gender and age in patients with type 1 diabetes mellitus of a pediatric endocrinology follow-up clinic. METHODS: This cross-sectional descriptive study enrolled patients of the follow-up clinic of the Pediatric Endocrinology Unit of Hospital de Base of São José do Rio Preto, São Paulo, Brazil. The following data were collected: gender, age, insulin dosage, glycated hemoglobin (HbA1c), weight, height and body mass index (BMI). The cutoff criteria for overweight and obesity were based on BMI-for-age growth charts of the Centers for Disease Control and Prevention (CDC, 2000). RESULTS: 77 patients with type 1 diabetes mellitus were included (44 females and 33 males), with three to 18 years old (mean: 13.4). The value of HbA1c varied from 4.1 to 10.6 percent (mean: 7.7 percent) and the BMI ranged from 15.1 to 28.6 kg/m² (average: 23.2). Based on BMI charts, 8 percent (three girls and three boys) were obese and 8 percent (two girls and four boys) had overweight. CONCLUSION: Compared to the prevalence of obesity and overweight in non-diabetic pediatric population, the presence of these nutritional disturbances in the studied children was not significantly different.

Prevalencia y características de la hiperglicemia incidental en niños / Prevalence and characteristics of incidental hyperglycemia in children

Se describe la hiperglicemia incidental (HI) como una elevación transitoria de los niveles plasmáticos de la glucosa producida por una enfermedad intercurrente seria o sin causa aparente. Los niños con HI tienen un mayor riesgo de diabetes tipo 1, especialmente los sin enfermedad intercurrente. Nos interesó conocer la prevalencia de HI en niños sanos y sus características clínicas. En 585 niños de 2 a 18 años de edad que consultaban por control de salud o por cuadro infeccioso menor o antes de cirugía menor electiva, previo consentimiento del apoderado, se les efectuó una glicemia en sangre capilar con una máquina Optium (Abbott). Se consideró elevada una glicemia en ayunas sobre 110 mg/dL. El peso se midió con una balanza de precisión, la talla con un cartabón, los pliegues cutáneos con un Caliper de Lange, el % de grasa corporal se calculó por la fórmula de Durnin. Se encontró que un 6.9% de los niños presentó una glicemia sobre 110 mg/dL (8.8% de varones y 4.7% de mujeres). El promedio de peso y talla de nacimiento y edad gestacional fueron normales. El % de adecuación del IMC fue de 123.4%. Los 39 niños con HI comparados con los normales no tuvieron diferencias en el peso y talla de nacimiento, en las semanas de gestación, en el % de adecuación del IMC (114 vs 112%), en el % de grasa corporal. Sus madres no tuvieron mas antecedentes de diabetes previa o gestacional. Tuvieron mayor frecuencia de acantosis nigricans (9.5% vs 0.6% p< 0.001) y de estrías cutáneas (18% vs 3.0% p <0.001). Se concluye que existe un alto porcentaje de HI en una población de niños sanos, los que no presentaron mas antecedentes de riesgo de diabetes tipo 1 que los controles, pero presentaron mas acantosis y estrías de distensión que indicarían junto a los altos niveles de exceso de peso, una mayor posibilidad de hacer resistencia a la insulina y diabetes tipo 2, lo que sería de interés investigar.

Incidental hyperglycemia (IH) is a transient elevation of plasma glucose produced by a severe illness or without a cause. Children with IH have an increased risk of type 1 diabetes (T1D), especially those without concurrent illnesses. We were interested in knowing the prevalence of IH in a population of healthy children and their clinical characteristics. A glycemia of capillary blood with an Optium machine (Abbott) was done in 585 children of both sexes, aged 2 to 18 years, going for a health control, a light infectious disease or for clinical test before minor surgery after obtaining a written consent from their parents. A fasting blood glycemia over 110 mg/dl was considered elevated. Body weight was measured with a precision scale, height with a podometer, skinfolds with a Lange Caliper and the percentage of body fat calculated by the Durnin formula. It was found that 6.9% of children presented IH (8.85% of boys and 4.7% of girls). Average birth weight and height and gestational age were normal. BMI adequacy was 123 %. Comparing the 39 children who presented IH with those who id not, they had no differences in birth weight and length, weeks of gestational age, in BMI adequacy (114% vs 112%) and in the percentage of body fat. Their mothers did not have a past history of previous diabetes or diabetes during pregnancy. IH children had increased frequency of acantosis nigricans (9.5% vs 0.6%) and dermic striae (18% vs 3.0%) when compared to control. We conclude that a high percentage of healthy children had IH without increase risk of T1D. However, increased prevalence of acantosis and striae and the increased BMI underline the possibility of developing insulin resistance and T2D which should be further investigated.

Trends in the incidence of type I diabetes mellitus worldwide / Tendencias en la incidencia de la diabetes mellitus de tipo i a nivel mundial

The incidence of Type I diabetes mellitus in children has increased worldwide over the past 50 years. This increase has occurred in rich and poor countries in Europe, Asia, the Americas and Oceania. Rapid increases in incidence in genetically stable populations eg Finland and Sardinia imply that environmental factors are of paramount importance as driving forces in this changing trend. The significance of these trends and putative aetiological factors are reviewed.

La incidencia de la diabetes mellitus de tipo I en los niños ha aumentado a nivel mundial en los últimos 50 años. Este aumento ha tenido lugar tanto en los países ricos como en los países pobres de Europa, Asia, las AmØricas y Ocean a. Los rápidos aumentos de incidencia en las poblaciones genéticamente estables, tales como Finlandia y Sardinia, implican que los factores ambientales desempeñan un papel primordial como fuerzas impulsoras de esta tendencia cambiante. Se examinan la significación de estas tendencias y los factores etiológicos putativos.

Características de la posmenopausia en mujeres con diabetes tipo 1 / Features of postmenospause in women presenting with Type 1 diabetes

En las diabéticas la menopausia ocurre a edades más tempranas. El objetivo del presente estudio es identificar las características de la menopausia espontánea y la posmenopausia en un grupo de mujeres con diabetes tipo 1 (DM 1). Se realizó un estudio transversal y descriptivo en 60 mujeres posmenopáusicas con DM 1 en edades de 40-59 años, y en 80 mujeres no diabéticas comparables (grupo control) sin enfermedades crónicas, aparentemente sanas. Las mujeres incluidas en el estudio son de procedencia urbana y tuvieron una menopausia espontánea. No se incluyeron mujeres con menopausia de causa quirúrgica u otras causas iatrogénicas. Se estudió: edad, índice de masa corporal, hábito de fumar, intensidad del hábito, número de embarazos, edad del primer embarazo, número de partos, edad del primer parto, lactancia materna, edad de la menarquia y las etapas de la posmenopausia, la presencia de síntomas y su severidad. En las diabéticas se consideró el tiempo de evolución de la DM 1. Se comprobó que la edad de la menopausia fue en las diabéticas de 40,06 ± 4,68 años y en las no diabéticas de 49,32 ± 3,22 años, p<0,003. El hábito de fumar, el número de embarazos y de partos, la lactancia y la edad de la menarquia no se asociaron con la edad de la menopausia en las diabéticas. Se confirmó que la edad cronológica y la de la menopausia fueron significativamente menores en las mujeres con DM 1. No existen diferencias relevantes en relación con los síntomas y su severidad, entre las mujeres con DM 1 y sin ella(AU)

In diabetic women menospause occur in earliest ages. Aim ot present paper is to identify feaures of spontaneous menopause and postmenopause in a group of women presenting with Type 1 diabetes (1 DM). A transversal and descriptive study was conducted in 60 postmenaopausal women presenting with 1 MD aged 40-59, and in 80 comparable non-diabetec women (control group) with chronic diseases, apparently healthy. Study women were resident in urban areas and have an spontaneous menopause. Women with menopause of surgical cause, or other iatrogenic causes were excluded. Age, body mass index, smoking, habit intensity, pregnancies, age in first pregnancy, birth rate, age in first birth, breast feeding, age in menarche, and stages of postmenospause, presence of symptoms and its severity. In diabetic women evoluliton time was conisered of 40,06 ? 4,68 years, and in those non-diabetec aged 49,32 ? 3,22, p <0,003. Smoking, labor and births rate, breast feeding, and age of menarche, weren't associated with age of menopause in diabetec women. It was confirmed that chronologic age and that of menaopause were smaller in women presenting with 1 MD. There aren't relevant differences related to symptoms and its severity, among women presenting with and without 1 MD(AU)

La educación a personas con diabetes mellitus en la atención primaria de salud / Education of persons presenting with diabetes mellitus in health primary care

La diabetología de finales de siglo asumió la idea clara de que no existe tratamiento eficaz de la diabetes sin educación y entrenamiento de su portador. Pero este proceso educativo no siempre se desarrolla de manera sistemática y, muy frecuentemente, adolece de falta de habilidad en ese otro saber hacer que exige cuidar y enseñar a cuidarse. El Programa Nacional de Diabetes del Sistema Nacional de Salud en Cuba, cuenta con un programa de educación que desarrolla de manera continuada la capacitación del personal de salud para realizar esta función educadora, y pone énfasis en el nivel primario de salud, donde se atiende más del 85 por ciento de las personas con diabetes mellitus. Aunque son pocos los trabajos que publiquen, con rigor científico los logros y dificultades que, en este quehacer, han enfrentado las áreas de salud, se conoce que hay un alto porcentaje de personas con diabetes mellitus no incorporadas al proceso educativo, mal controladas y complicadas. En este sentido, el propósito del presente trabajo es difundir los principios, la estructura y metodología de este programa educativo, así como las orientaciones más generales para su aplicación en la Atención Primaria de Salud, a fin de contribuir a su aplicación efectiva y uniforme en dichos servicios, conscientes de que en cada acto de cuidar está implícita la necesidad de enseñar a cuidarse y que solo aquel que aprenda a cuidarse podrá alcanzar una buena calidad de vida(AU)

Diabetes Science of end of this century had the clear idea on non-existence of efficaceous treatment for diabetes without education and training of its carrier. But this educational process is achieved in a systematic way, and frequently, lacks of ability of that another knowledge demanding care and teach on how to care. National Progam of Diabetes of National Health System of Cuba, has a teaching program developing in a continued way, training of health staff to perform this educating function, and emphasizes on primary level of health, where more than 85 per cent of persons presenting diabetes mellitus is seen. Although there is a lack of papers publishing with a scientific strictness, achievements and difficulties that related with that tasks, have challenged health areas, it is known that there is a high percentage of personas presenting with diabetes mellitus non-involved in educational process, with a poor control, and are complicated. En this context, goal of present paper is to spread principles, structure and methodology of this educational program as well as all directions more general for its application in Primary Care of Health, to contribute to its effective and uniform implementation in such servives, with a deep consciousness of that in each care action is implicit need of teaching to take care one self, and that only a person learning to care herself, will achieves a good cuality of life(AU)