Unidad de Endocrinología y Diabetes Pediátrica / Pediatric endocrinology and diabetes unit

La Unidad de Endocrinología y Diabetes Pediátrica del Hospital Universitario Ramón y Cajal ha tenido siempre como objetivo conseguir los más altos estándares internacionales de calidad en la atención al niño y al adolescente. En particular y para el paciente con diabetes, las nuevas tecnologías, así como la educación diabetológica, son el centro de nuestro trabajo, implicando no solo a padres y pacientes sino a los profesores y a todos aquellos que conviven a su alrededor, buscando así el mejor control metabólico y la mejor calidad de vida (AU)

The objective of the Pediatric and Endocrinology Unit of the University Hospital Ramón y Cajal has always been that of achieving the highest international standards of quality in the care of children and adolescents. Specifically, and for the patient with diabetes, the new technologies and education in diabetes are the center of our work, this not only involving parents and patients but also the professors and all those within their surroundings, seeking in this way the best metabolic control and best quality of life (AU)

Enfermedad de Graves con predominio de T3 en la edad pediátrica / T3-predominant Graves' disease in paediatric patients

No disponible

Factores de riesgo cardiovascular en niños y adolescentes españoles con diabetes mellitus tipo 1: evolución a lo largo de 9 años / Nine-year longitudinal study of cardiovascular risk factors in spanish children and adolescents with type 1 diabetes

OBJETIVOS: Analizar la prevalencia, evolución de factores de riesgo cardiovascular (FRCV) y su relación con el control metabólico en pacientes pediátricos con diabetes mellitus tipo 1 (DM1). PACIENTES Y MÉTODOS: Estudio longitudinal ambispectivo en 75 niños y adolescentes españoles con DM1 diagnosticados en los años 1996-2003 y seguidos durante 9 años. Analizamos los FRCV y su evolución al segundo, sexto y noveno años tras el diagnóstico, y los antecedentes familiares (AF) de FRCV. RESULTADOS: El 46,6% tenía AF de FRCV. En el segundo, sexto y noveno años encontramos una prevalencia de HbA1c > 7,5% del 45,3, el 53,3 y el 56%, respectivamente; de obesidad (índice de masa corporal > 2 desviaciones estándar) del 5,3, el 5,3 y el 6,7%, y de HTA (presión arterial > p90) del 14,6, el 8 y el 13,3%. Colesterol total > 200 mg/dl en el 25,3, el 13,3 y el 16%; lipoproteína de alta densidad del colesterol (HDL-c) < 40 mg/dl en el 1,3, el 1,3 y el 4%; lipoproteína de baja densidad del colesterol (LDL-c) > 100 mg/dl en el 38,6, el 34,6 y el 38,6%; triglicéridos (TG) > 150 mg/dl en el 0, el 1,3 y el 2,6%, respectivamente. Encontramos un aumento significativo en la prevalencia de TG/HDL-c≥ 2 entre el sexto y el noveno años de evolución de la enfermedad (1,3% y 9,3%, p < 0,05). Una HbA1c≥ 7,5% en el segundo y el sexto años se asoció de forma significativa a una disminución en el HDL-c z-score de 0,94, y una HbA1c < 7,5% durante ese mismo periodo se asoció significativamente a un aumento del HDL-c z-score del 0,55(p = 0,015). CONCLUSIONES: El peor control metabólico de la DM1 en los primeros años de evolución se asocia a una disminución del HDL-c z-score. El cociente TG/HDL-c podría ser un marcador precoz de riesgo cardiovascular

OBJECTIVES: To analyse the prevalence, evolution of cardiovascular risk factors (CVRF) and their relationship with follow-up of metabolic control in pediatric patients with Type 1 Diabetes (T1DM). PATIENTS AND METHODS: Longitudinal ambispective study including 75 children and adolescents with T1DM diagnosed from 1996 to 2003 and followed-up for nine years. Family history of CVRF was registered. Data from the second, sixth and ninth year after diagnosis were analysed. RESULTS: Family history of CVRF was found in 46.6% of the patients. The prevalence of HbA1c > 7.5% in the second, sixth and ninth year after diagnosis was 45.3%, 53.3% y 56%, respectively. The prevalence of obesity (BMI > 2SDS) in the three visits was 5.3%, 5.3% y 6.7%, respectively. Hypertension (BP > p90) was found in 14.6%, 8% and 13.3% of the patients in the three visits, respectively. Total cholesterol > 200 mg/dl: 25.3%, 13.3% and 16%; high density cholesterol lipoprotein < 40mg/dl: 1.3%, 1.3% and 4%; low density cholesterol lipoprotein > 100mg/dl: 38.6%, 34.6% and 38.6%; triglyceride > 150 mg/dl: 0%, 1.3% and 2.6%, respectively. There was a significant increase in the prevalence of TG/HDL-C≥2 between the sixth and the ninth year after diagnosis (1.3% and 9.3%, P < .05). A persistent HbA1c≥7.5% showed a statistically significant relationship to a 0.94 decrease in HDL-C z-score between the second and the sixth year, and a persistent HbA1c < 7.5% was significantly associated with a 0.55 increase in HDL-C z-score (P = .015) in the same period. CONCLUSIONS: A non-optimal metabolic control in first years of DM1 is associated with a decrease in HDL-C z-score. TG/HDL-C ratio could be an early marker of cardiovascular risk

Diabetes mellitus tipo 2 en adolescentes en una unidad de diabetes pediátrica / Type 2 diabetes mellitus in adolescents in a pediatric diabetes unit

No disponible

[Nine-year longitudinal study of cardiovascular risk factors in Spanish children and adolescents with type 1 diabetes]. / Factores de riesgo cardiovascular en niños y adolescentes españoles con diabetes mellitus tipo 1: evolución a lo largo de 9 años.

OBJECTIVES: To analyse the prevalence, evolution of cardiovascular risk factors (CVRF) and their relationship with follow-up of metabolic control in pediatric patients with Type 1 Diabetes (T1DM). PATIENTS AND METHODS: Longitudinal ambispective study including 75 children and adolescents with T1DM diagnosed from 1996 to 2003 and followed-up for nine years. Family history of CVRF was registered. Data from the second, sixth and ninth year after diagnosis were analysed. RESULTS: Family history of CVRF was found in 46.6% of the patients. The prevalence of HbA1c>7.5% in the second, sixth and ninth year after diagnosis was 45.3%, 53.3% y 56%, respectively. The prevalence of obesity (BMI>2SDS) in the three visits was 5.3%, 5.3% y 6.7%, respectively. Hypertension (BP>p90) was found in 14.6%, 8% and 13.3% of the patients in the three visits, respectively. Total cholesterol>200mg/dl: 25.3%, 13.3% and 16%; high density cholesterol lipoprotein< 40 mg/dl: 1.3%, 1.3% and 4%; low density cholesterol lipoprotein>100mg/dl: 38.6%, 34.6% and 38.6%; triglyceride>150 mg/dl: 0%, 1.3% and 2.6%, respectively. There was a significant increase in the prevalence of TG/HDL-C ≥ 2 between the sixth and the ninth year after diagnosis (1.3% and 9.3%, P<.05). A persistent HbA1c ≥ 7.5% showed a statistically significant relationship to a 0.94 decrease in HDL-C z-score between the second and the sixth year, and a persistent HbA1c<7.5% was significantly associated with a 0.55 increase in HDL-C z-score (P=.015) in the same period. CONCLUSIONS: A non-optimal metabolic control in first years of DM1 is associated with a decrease in HDL-C z-score. TG/HDL-C ratio could be an early marker of cardiovascular risk.

Diabetes latente autoinmune en el joven / Latent autoimmune diabetes in the young

No disponible

Eficacia del tratamiento con 131I en la enfermedad de Graves pediátrica / Efficacy of treatment with I 131 in paediatric Graves disease

INTRODUCCIÓN: El tratamiento con radioyodo en la enfermedad de Graves (EG) es una opción terapéutica curativa cada vez más utilizada en niños por encima de 5 años. En Estados Unidos su uso está muy extendido, pero en Europa sigue existiendo controversia respecto a su indicación en la edad pediátrica. OBJETIVO: Presentar nuestra experiencia con la administración de I131 en la EG en edad pediátrica y analizar su eficacia y seguridad. PACIENTES Y MÉTODOS: Estudio retrospectivo descriptivo de los pacientes pediátricos (< 18 años) diagnosticados de EG en nuestro hospital desde 1982 hasta 2012. Al alcanzar la pubertad, se ofreció una opción curativa a aquellos pacientes que no habían respondido al tratamiento con fármacos antitiroideos (AT). Analizamos las características de los pacientes, niveles de hormona tirotropa, T3 y T4, y autoanticuerpos, respuesta a AT, frecuencia de la remisión de la enfermedad post-I131, aparición de hipotiroidismo y efectos secundarios del I131.ResultadosDesde 1982 hasta 2012 fueron diagnosticados de EG 50 pacientes. Todos recibieron como tratamiento inicial AT, con una duración media 35,3 ± 25,9 meses. Se consiguió remisión permanente en el 46%. Se realizó tiroidectomía a 5 pacientes y se administró I131 a 14 pacientes. La dosis de yodo administrada osciló entre 8,5 y 13 mCi (10,9 ± 1,09). Se obtuvo remisión en el 100%. La tasa de hipotiroidismo permanente fue del 90%. No se observaron progresión de la oftalmopatía ni efectos secundarios en ningún paciente tratado con I131. CONCLUSIONES: El tratamiento con 131I en la EG pediátrica es seguro, lleva a la remisión completa a costa de hipotiroidismo y no exacerba la oftalmopatía. Puede considerarse su utilización en mayores de 5 años cuando no existe respuesta a AT o ante efectos secundarios importantes con esta medicación

INTRODUCTION: Radioiodine is an important therapeutic option in young patients with Grave's disease (GD). In the United States it is a widespread therapy, but in Europe its use in paediatrics is still controversial. AIM: To report our experience in radioiodine therapy of paediatric GD patients and analyse its effectiveness and safety. PATIENTS AND METHODS: We retrospectively studied our paediatric population (<18 years of age) with GD, diagnosed from 1982 to 2012. A curative option was offered to patients who did not respond to anti-thyroid drug (AT) at puberty. We analysed, the patient characteristics, TSH, T4, T3 and thyroid antibodies levels, AT response, remission post I131, side effects, and hypothyroidism rates. RESULTS: A total of 50 patients were diagnosed with GD from 1982 to 2012. All patients received AT as initial treatment (mean duration: 35.3±25.9 months). Permanent remission was achieved in 46%. Thyroidectomy was performed in 5 patients, and 14 patients received I131 (mean dose: 10.9±1.09 mCi). Remission with I131 was obtained in 100%. The rate of permanent hypothyroidism was 90%. There was no progression of ophthalmopathy or side effects in any patientst reated with I131.CONCLUSION: Radioiodine treatment of paediatric GD patients is safe, leads to complete remission at the expense of hypothyroidism, and does not exacerbate ophthalmopathy. It can be considered in patients older than 5 years, who do no not respond to AT or with significant side effects with this medication

[Efficacy of treatment with I(131) in paediatric Graves disease]. / Eficacia del tratamiento con (131)I en la enfermedad de Graves pediátrica.

INTRODUCTION: Radioiodine is an important therapeutic option in young patients with Grave's disease (GD). In the United States it is a widespread therapy, but in Europe its use in paediatrics is still controversial. AIM: To report our experience in radioiodine therapy of paediatric GD patients and analyse its effectiveness and safety. PATIENTS AND METHODS: We retrospectively studied our paediatric population (<18 years of age) with GD, diagnosed from 1982 to 2012. A curative option was offered to patients who did not respond to anti-thyroid drug (AT) at puberty. We analysed, the patient characteristics, TSH, T4, T3 and thyroid antibodies levels, AT response, remission post I(131), side effects, and hypothyroidism rates. RESULTS: A total of 50 patients were diagnosed with GD from 1982 to 2012. All patients received AT as initial treatment (mean duration: 35.3±25.9 months). Permanent remission was achieved in 46%. Thyroidectomy was performed in 5 patients, and 14 patients received I(131) (mean dose: 10.9±1.09 mCi). Remission with I(131) was obtained in 100%. The rate of permanent hypothyroidism was 90%. There was no progression of ophthalmopathy or side effects in any patients treated with I(131.) CONCLUSION: Radioiodine treatment of paediatric GD patients is safe, leads to complete remission at the expense of hypothyroidism, and does not exacerbate ophthalmopathy. It can be considered in patients older than 5 years, who do no not respond to AT or with significant side effects with this medication.

Asistencia al niño y adolescente con diabetes. Unidades de referencia en diabetes pediátrica / Treatment of the child and adolescent with type i diabetes: special paediatric diabetes units

El tratamiento intensivo de la diabetes mellitus tipo 1 (DM1) permite retrasar y enlentecer la progresión de las complicaciones crónicas (DCCT 1993). Este tipo de tratamiento en niños y adolescentes con DM1 tiene una complejidad diferente de la de otras etapas de la vida y por ello se necesitan Unidades de Asistencia Especializada en diabetes pediátrica. Se valoran los diferentes documentos y declaraciones sobre los derechos de los pacientes con DM1 y se enfatiza la necesidad de una adecuada asistencia sanitaria. En la última década, se han desarrollado en Europa varios proyectos para establecer una evaluación comparativa del tratamiento de la DM en edad pediátrica con el objetivo de establecer centros hospitalarios con una asistencia muy cualificada en su control. El Grupo de trabajo de Diabetes de la Sociedad Española de Endocrinología Pediátrica ha elaborado este documento con el objetivo de obtener un Consenso Nacional para la asistencia al niño y adolescente con DM1 en «Unidades de Referencia en diabetes pediátrica» y, a su vez, poder asesorar a las administraciones para establecer una Red Nacional dirigida a la asistencia del niño y adolescente con DM y organizar las Unidades de Atención Integral de la diabetes pediátrica en hospitales con nivel de referencia por su calidad asistencial (AU)

Intensive treatment of type 1 diabetes mellitus (DM1) delays and slows down the progression of chronic diabetes complications (DCCT 1993). This type of treatment in children and adolescents with DM1 has a different complexity to other stages of life and therefore, needs specialized care units. Various documents and declarations of diabetic patient's rights are evaluated, and the need for an adequate health care is emphasized. In the last decade, several projects have been developed in Europe to create a benchmark treatment of pediatric diabetes, with the aim of establishing hospitals with highly qualified healthcare to control it. The Diabetes Working Group of the Spanish Society for Pediatric Endocrinology (SEEP) has prepared this document in order to obtain a national consensus for the care of children and adolescents with type 1 diabetes in specialist Pediatric Diabetes Units, and at the same time advise Health Care Administrators to establish a national healthcare network for children and adolescents with diabetes mellitus, and organize comprehensive pediatric diabetes care units in hospitals with a reference level in quality of care (AU)

Influencia étnica en la prevalencia de síndrome metabólico en población pediátrica obesa / Ethnic influence on the prevalence of metabolic syndrome in an obese pediatric population

Introducción: La obesidad en la edad pediátrica es cada vez más prevalente. La población hispana inmigrante tiene un alto riesgo de obesidad y de diabetes tipo 2. Objetivo: Analizar la influencia étnica en la prevalencia del síndrome metabólico (SM) y sus componentes en una población pediátrica obesa. Pacientes y métodos: Estudio retrospectivo de 616 niños y adolescentes obesos ([IMC>2 DE (Hernández 1998-2004)]: 142 hispanos y 474 caucásicos. Se comparan la prevalencia de SM y sus componentes (criterios modificados Cook 2003): obesidad y ≥2 de los siguientes: colesterol HDL<40mg/dl, triglicéridos >110mg/dl, presión arterial sistólica y/o diastólica >p90 (Task Force 2004) y alteración del metabolismo hidrocarbonado (ADA 2011). Se evalúa también: historia familiar de SM, HbA1c, insulinorresistencia (HOMA), función hepática y evolución del IMC al año de tratamiento con cambios en el estilo de vida. Resultados: El 30,5% de los hispanos presentan SM frente al 15,5% de los caucásicos (OR=2,4 [IC del 95%, 1,5-3,8]), p<0,005]) y OR de 2,5 al ajustar por sexo, IMC-DE y pubertad. Los hispanos presentan mayor insulinorresistencia (58,6% vs 42,86%, p<0,005) y peor evolución del IMC al año de seguimiento. No hubo diferencias en el resto de datos analizados. Encontramos una peor adherencia a las medidas de cambio de alimentación y ejercicio físico en el grupo hispano. Conclusiones: La prevalencia de SM es superior en la población pediátrica hispana obesa que en la caucásica. La peor adherencia al tratamiento de los niños y adolescentes obesos hispanos hace que este grupo de pacientes tenga un riesgo potencialmente mayor de enfermedades cardiovasculares en la vida adulta (AU)

Introduction: Obesity in children is becoming more prevalent. Obesity and type 2 diabetes is higher in the Latin American immigrant population. Objective: To analyze the influence of ethnicity on the prevalence of metabolic syndrome (MS) and its components in an obese pediatric population. Patients and methods: A retrospective study of 616 obese children and adolescents (BMI ≥2 SD [Hernández 88-04]), was conducted on 142 Latin American children and 474 Caucasians, which compared the prevalence of metabolic syndrome and its components according to modified Cook criteria (2003): obesity+2 or more of the following components: HDL-cholesterol <40mg/dl, triglycerides >110mg/dl, systolic and/or diastolic blood pressure >p90 (Task Force 2004), and impaired glucose metabolism (ADA 2011). Hepatic function, family history of MS, HbA1c, insulin resistance (HOMA) and BMI evolution at one year of treatment with changes in lifestyle (diet and exercise) were also assessed. Results: Almost one-third (30.5%) of Latin American children had MS compared to 15.5% of Caucasians (OR=2.4 [CI 95%: 1.5-3.8]), P<0.005] and OR=2.5 adjusting for sex, SD-BMI and puberty. Latin American children also had a higher insulin resistance (58.6% vs 42.8%, P<.005) and a worse outcome after one year of treatment. Conclusion: There is a higher prevalence of MS in our Latin American obese pediatric population with poor adherence to the measures of change in lifestyle, making these patients a group with potentially increased risks of cardiovascular disease in adulthood(AU)

Estudio de las funciones ejecutivas en diabetes tipo 1 mediante el test de evaluación neuropsicológica de las funciones ejecutivas en niños (ENFEN) / Executive functions in children with type 1 diabetes using the neuropsychology test

Introducción: La función ejecutiva en población infantil con diabetes es un campo apenas evaluado. Investigarlo puede ayudar a que esta población alcance un pleno rendimiento académico. Este hecho nos ha llevado a estudiar la repercusión que las variables, como la edad de diagnóstico de la diabetes y el nivel de control metabólico, puedan tener en la función ejecutiva de esta población. Pacientes y métodos: Estudiamos a 74 niños: 37 con diabetes tipo 1 (grupo A) y 37 controles (grupo B). El grupo A se dividió en 2 subgrupos, según la edad de diagnóstico: precoz, antes de los 5 años (grupo A1) y tardío, después de los 5 años (grupo A2). Se realizaron comparaciones entre los grupos A y B, y entre los grupos A1 y A2, utilizando el test evaluación neuropsicológica de las funciones ejecutivas en niños (ENFEN). El control metabólico de los 3 meses previos fue valorado mediante la HbA1c. En el momento de la realización del test, se determinó la glucemia capilar. Recogimos el número de hipoglucemias graves registradas en cada paciente. Resultados: Encontramos diferencias en la prueba de interferencias entre los grupos A y B a favor del grupo con diabetes. Entre los grupos A1 y A2 solo encontramos diferencias en las escalas de fluidez fonológica y en el trazado de sendero gris. Las puntuaciones obtenidas son superiores en ambos casos en el grupo A1. Los niveles de HbA1c y de glucemia capilar no guardaban relación con el rendimiento en las distintas pruebas del ENFEN. Ninguno de los pacientes había tenido hipoglucemias graves previas. Conclusiones: 1) Los niños con diabetes tipo 1 obtienen mejores resultados en actividades que requieren resistencia a la interferencia, atención sostenida y control atencional. 2) Los niños con diabetes de comienzo precoz obtienen puntuaciones más altas en tareas de fluidez fonológica y de flexibilidad cognitiva, que los niños con diabetes de comienzo tardío. 3) En nuestro estudio, los niveles de HbA1c y de glucemia capilar no guardan ningún tipo de relación con el rendimiento en las distintas pruebas del ENFEN (AU)

Introduction: Neurocognitive executive function in the paediatric diabetic population is a rarely studied field. To investigate and improve this aspect could help these patients to reach their full academic potential. This led us to study the impact that variables such as age at diagnosis and adequacy of metabolic control of diabetes may have on the executive cognitive functions of this population. Patients and methods: We studied 74 children: 37 with type 1 diabetes (group A) and 37 without diabetes (group B). Group A was divided into two subgroups, depending on age at diagnosis: early, before 5 years, (group A1) and late, after 5 years, (group A2). We compared group A and B and A1 and A2 groups using the test Neuropsychological assessment of executive functions in children (NAEFC). Diabetes metabolic control was performed by measuring HbA1c and capillary blood glucose before the test. Previous severe hypoglycaemic episodes were recorded. Results: Differences were found among groups A and B in the test of interference. Among the A1 and A2 groups only differences in the scales of phonological fluency and grey trail trace were found. The scores were higher in both cases in the early diabetic group. We did not found any correlation between HbA1c and blood glucose with the different tests of ENFEN results. None of the patients had previous severe hypoglycaemic episodes. Conclusions: 1) Children with diabetes performed better in activities that require resistance to interference, sustained attention and attentional control. 2) Diabetic children with early diagnoses achieved high scores in phonological fluency tasks, and cognitive flexibility. 3) Response to ENFEN was not influenced by HbA1c and blood glucose levels before the test(AU)

[Executive functions in children with type 1 diabetes using the neuropsychology test]. / Estudio de las funciones ejecutivas en diabetes tipo 1 mediante el test de evaluación neuropsicológica de las funciones ejecutivas en niños (ENFEN).

INTRODUCTION: Neurocognitive executive function in the paediatric diabetic population is a rarely studied field. To investigate and improve this aspect could help these patients to reach their full academic potential. This led us to study the impact that variables such as age at diagnosis and adequacy of metabolic control of diabetes may have on the executive cognitive functions of this population. PATIENTS AND METHODS: We studied 74 children: 37 with type 1 diabetes (group A) and 37 without diabetes (group B). Group A was divided into two subgroups, depending on age at diagnosis: early, before 5 years, (group A(1)) and late, after 5 years, (group A(2)). We compared group A and B and A(1) and A(2) groups using the test Neuropsychological assessment of executive functions in children (NAEFC). Diabetes metabolic control was performed by measuring HbA(1c) and capillary blood glucose before the test. Previous severe hypoglycaemic episodes were recorded. RESULTS: Differences were found among groups A and B in the test of interference. Among the A(1) and A(2) groups only differences in the scales of phonological fluency and grey trail trace were found. The scores were higher in both cases in the early diabetic group. We did not found any correlation between HbA(1c) and blood glucose with the different tests of ENFEN results. None of the patients had previous severe hypoglycaemic episodes. CONCLUSIONS: 1) Children with diabetes performed better in activities that require resistance to interference, sustained attention and attentional control. 2) Diabetic children with early diagnoses achieved high scores in phonological fluency tasks, and cognitive flexibility. 3) Response to ENFEN was not influenced by HbA(1c) and blood glucose levels before the test.

[Ethnic influence on the prevalence of metabolic syndrome in an obese pediatric population]. / Influencia étnica en la prevalencia de síndrome metabólico en población pediátrica obesa.

INTRODUCTION: Obesity in children is becoming more prevalent. Obesity and type 2 diabetes is higher in the Latin American immigrant population. OBJECTIVE: To analyze the influence of ethnicity on the prevalence of metabolic syndrome (MS) and its components in an obese pediatric population. PATIENTS AND METHODS: A retrospective study of 616 obese children and adolescents (BMI ≥2 SD [Hernández 88-04]), was conducted on 142 Latin American children and 474 Caucasians, which compared the prevalence of metabolic syndrome and its components according to modified Cook criteria (2003): obesity+2 or more of the following components: HDL-cholesterol <40mg/dl, triglycerides >110mg/dl, systolic and/or diastolic blood pressure >p90 (Task Force 2004), and impaired glucose metabolism (ADA 2011). Hepatic function, family history of MS, HbA1c, insulin resistance (HOMA) and BMI evolution at one year of treatment with changes in lifestyle (diet and exercise) were also assessed. RESULTS: Almost one-third (30.5%) of Latin American children had MS compared to 15.5% of Caucasians (OR=2.4 [CI 95%: 1.5-3.8]), P<.005] and OR=2.5 adjusting for sex, SD-BMI and puberty. Latin American children also had a higher insulin resistance (58.6% vs 42.8%, P<.005) and a worse outcome after one year of treatment. CONCLUSION: There is a higher prevalence of MS in our Latin American obese pediatric population with poor adherence to the measures of change in lifestyle, making these patients a group with potentially increased risks of cardiovascular disease in adulthood.

[Treatment of the child and adolescent with type 1 diabetes: special paediatric diabetes units]. / Asistencia al niño y adolescente con diabetes. Unidades de referencia en diabetes pediátrica.

Intensive treatment of type 1 diabetes mellitus (DM1) delays and slows down the progression of chronic diabetes complications (DCCT 1993). This type of treatment in children and adolescents with DM1 has a different complexity to other stages of life and therefore, needs specialized care units. Various documents and declarations of diabetic patient's rights are evaluated, and the need for an adequate health care is emphasized. In the last decade, several projects have been developed in Europe to create a benchmark treatment of pediatric diabetes, with the aim of establishing hospitals with highly qualified healthcare to control it. The Diabetes Working Group of the Spanish Society for Pediatric Endocrinology (SEEP) has prepared this document in order to obtain a national consensus for the care of children and adolescents with type 1 diabetes in specialist Pediatric Diabetes Units, and at the same time advise Health Care Administrators to establish a national healthcare network for children and adolescents with diabetes mellitus, and organize comprehensive pediatric diabetes care units in hospitals with a reference level in quality of care.

Alteraciones hidrocarbonadas en pacientes impúberes con fibrosis quística / Abnormal glucose tolerance in prepubertal patients with cystic fibrosis

Introducción: El consenso internacional recomienda el cribado de las alteraciones hidrocarbonadas (AH) en fibrosis quística (FQ) mediante sobrecarga oral de glucosa (SOG) anual desde los 10 años de edad y/o iniciada la pubertad. Objetivos: Evaluar la presencia de AH y su posible repercusión clínica (cambios nutricionales y de función pulmonar) en pacientes impúberes con FQ. Pacientes y métodos: Estudio retrospectivo en 19 pacientes impúberes con FQ (68% varones). Según la SOG, clasificamos (Consenso 2010): tolerancia normal glucosa (TNG) o AH (alteración tolerancia glucosa [ATG], alteración indeterminada glucosa (AIG), diabetes [DRFQ]). Analizamos: SOG (glucemia e insulinemia), estado nutricional (IMC), función pulmonar (espirometría forzada) y función pancreática exocrina. Estudio estadístico con programa SPSS, versión-15.0 mediante pruebas no paramétricas. Resultados: Edad media primera SOG: 8,5 años (5,8-9,8); seguimiento medio: 2 años (2-3). Al inicio: el 53% TNG y el 47% AH; evolutivamente: 4/10 pacientes con TNG desarrollan AH (3ATG, 1DRFQ), 3/4 AIG desarrollan 2ATG y 1DRFQ. Edad media aparición AH: 8,6 años (6,4-11,1). El 69% tuvo deterioro nutricional y/o de la función pulmonar el año previo al diagnóstico de AH. Dos pacientes con AH eran suficientes pancreáticos exocrinos. La insulinemia basal y el área bajo la curva de la SOG fueron comparables entre TNG y AH. El índice insulinogénico fue inferior en AH (p=0,006). Todos los pacientes tuvieron un pico de secreción de insulina retrasado. Conclusiones: La frecuente detección de AH en pacientes impúberes con FQ y su repercusión clínica plantean la necesidad de adelantar su cribado. La suficiencia pancreática exocrina no excluye el desarrollo de AH(AU)

Introduction: Annual screening for abnormal glucose tolerance (AGT) with oral glucose test should begin by age 10 years in cystic fibrosis (CF) patients (Consensus-2010). Aims: To examine the frequency of AGT and its outcome in prepubertal CF patients and the changes in glycemic and nutritional status and lung function over the preceding year. Patients and methods: Retrospective study of 19 prepubertal CF patients (68% males). All subjects underwent an oral glucose tolerance test (OGTT). Results were classified as: normal glucose tolerance (NGT) or AGT (impaired glucose tolerance [IGT], CF related diabetes [CFRD] or indeterminate glucose tolerance [INDET]). We analyzed: OGTT (glucose and insulin levels), nutritional status (BMI-SD) and lung function (forced spirometry). Statistical analysis was performed with SPSS program-version-15.0, non parametric tests. Results: Mean age at first OGGT: 8.5 years (5.8-9.8). Mean follow-up: 2 years (2-3). Initially, 47% patients had AGT and 53% NGT. In follow-up: 4/10 NGT patients developed AGT (3 IGT, 1 CFRD). Among initial AGT patients, of 4 INDET: 2 developed IGT, 1 CFRD. Mean age of AGT onset: 8.6 years (6.4-11.1). In 69% AGT patients a declining BMI-DS and/or lung function was found in the preceding year. In OGTTs performed, fasting and 2h AUC insulin levels were comparable between NGT and AGT; however, insulinogenic index was lower in AGT patients (p=.006). Insulin secretion was delayed in all patients. Conclusions: The high frequency of AGT in prepubertal CF patients and their negative clinical impact supports the usefulness of an earlier glycemic screening(AU)

Documento consenso del Grupo de Diabetes de la SEEP: Programa de formación para la implantación del tratamiento con infusión subcutánea continua de insulina (ISCI) en pacientes pediátricos con diabetes tipo 1 / Consensus document of the Diabetes Group of the Spanish Society of Pediatric Endocrinology (SEEP): A training program to carry out treatment with continuous subcutaneous insulin infusion (CSII) in pediatric patients with type 1 diabetes

Los avances tecnológicos en los últimos años en el campo de la diabetes han permitido la aplicación de nuevas terapias para nuestros pacientes con el objetivo fundamental de mejorar su control metabólico, la calidad de vida y evitar las hipoglucemias. Esto obliga a establecer protocolos de consenso en el empleo de estas nuevas tecnologías para ser utilizadas por los distintos profesionales implicados en esta enfermedad. Este programa de formación incluye los conocimientos básicos y avanzados, para la utilización de la ISCI (AU)

Recently new technologies for the management of diabetes allow new therapeutic strategies for diabetes patients with the object of improve metabolic control, queality of life and avoid hypoglycaemias. Because physicians must be familiar with new diabetic are devices, new protocols must be establish. This article reports on the Spanish Position Statement for the Diabetes Pediatric Group for the Spanish Pediatric Endocrinology Society (SEEP) on educational program for the treatment of children and adolescent with type 1 diabetes with continuous subcutaneous insulin infusion (AU)

[Abnormal glucose tolerance in prepubertal patients with cystic fibrosis]. / Alteraciones hidrocarbonadas en pacientes impúberes con fibrosis quística.

INTRODUCTION: Annual screening for abnormal glucose tolerance (AGT) with oral glucose test should begin by age 10 years in cystic fibrosis (CF) patients (Consensus-2010). AIMS: To examine the frequency of AGT and its outcome in prepubertal CF patients and the changes in glycemic and nutritional status and lung function over the preceding year. PATIENTS AND METHODS: Retrospective study of 19 prepubertal CF patients (68% males). All subjects underwent an oral glucose tolerance test (OGTT). Results were classified as: normal glucose tolerance (NGT) or AGT (impaired glucose tolerance [IGT], CF related diabetes [CFRD] or indeterminate glucose tolerance [INDET]). We analyzed: OGTT (glucose and insulin levels), nutritional status (BMI-SD) and lung function (forced spirometry). Statistical analysis was performed with SPSS program-version-15.0, non parametric tests. RESULTS: Mean age at first OGGT: 8.5 years (5.8-9.8). Mean follow-up: 2 years (2-3). Initially, 47% patients had AGT and 53% NGT. In follow-up: 4/10 NGT patients developed AGT (3 IGT, 1 CFRD). Among initial AGT patients, of 4 INDET: 2 developed IGT, 1 CFRD. Mean age of AGT onset: 8.6 years (6.4-11.1). In 69% AGT patients a declining BMI-DS and/or lung function was found in the preceding year. In OGTTs performed, fasting and 2h AUC insulin levels were comparable between NGT and AGT; however, insulinogenic index was lower in AGT patients (p=.006). Insulin secretion was delayed in all patients. CONCLUSIONS: The high frequency of AGT in prepubertal CF patients and their negative clinical impact supports the usefulness of an earlier glycemic screening.