Methodological guidelines for preparing a structured therapeutic education program: From design to evaluation. / Guía metodológica para la elaboración de un programa estructurado de educación terapéutica: del diseño a la evaluación.

BACKGROUND AND OBJECTIVE: Therapeutic patient education (TPE) is effective and essential in the context of the growing prevalence of chronic diseases, in which tools are needed for planning structured programs. The objective of this project was to develop guidelines for designing and assessing a TPE program. METHODS: 1) We assembled a multidisciplinary group of 8 leaders in TPE, chronicity, quality and safety from the hospital and the university. 2) We conducted an exhaustive review of the scientific literature on the planning of TPE programs directed at chronically ill patients, their relatives and caregivers. 3) The final text underwent comments and suggestions by participants from the hospital and primary care centre during a course on information and TPE methodology. The recommendations were unanimously agreed upon by the writing group. RESULTS: We obtained a standardised work procedure targeted at professionals involved in planning TPE programs, based on international recommendations. The document is structured into sections: a) Definition of the health problem and analysis of the situation; b) Program structure (human resources and materials); objectives (health-related, behaviour-related and educational) and methodology; c) Path the patient and family/caregiver follows in the program; and d) Assessment and indicators. The assessment of the procedure, in the framework of the methodology courses, was favourable. CONCLUSIONS: The methodology provided by this document serves as an instrument for the standardised and systematic planning of educational programs and unifies the criteria in their drafting. However, the document needs to be adapted to the condition and population to which each program is directed.

Analysis of the quality of patient therapeutic education and information in a high complexity reference hospital.

BACKGROUND AND OBJECTIVES: The application and monitoring of quality criteria in information and therapeutic patient education can identify areas to improve care. The objectives of this study were: (1) To analyze the characteristics of patient information materials, educational activities, and self-management programs, and (2) to determine health care provider (HCP) proposals on therapeutic patient education. MATERIALS AND METHODS: Using a cross-sectional study, an online questionnaire was sent to hospital departments in a high complexity reference hospital from September to December 2013 to record: (a) information materials, (b) patient educational activities, and self-management program characteristics, (c) HCP proposals. The materials were analyzed using Health Promoting Hospitals (HPH) recommendations. RESULTS: (1) An analysis was performed on 258 materials (leaflets [54%]) for chronic patients (86%), acute patients (7%), and the general population (7%). More than half (55%) lacked the authors, and 43% the year issued, and 69% followed HPH recommendations. (2) An evaluation was made of 70 educational activities and 37 self-management programs addressed to patients/relatives with diabetes/obesity, musculoskeletal disorders, COPD/asthma, pelvic-floor disorders, transplantation, bowel-inflammation/liver disease, hypertension, cancer, heart failure, acquired immune deficiency syndrome, chronic renal insufficiency, splenectomy, anticoagulation and older-patient dependence. The structure, process and outcome evaluation varied. (3) HCP proposals included: standardization of materials criteria, web accessibility, list of accredited websites, cross-sectional use, and HCP training in self-management education. CONCLUSIONS: The online questionnaire showed the weaknesses and strengths of patient information and education, and can be used to monitor their quantity and quality. These results help in the definition of a useful model to improve patient information and education policies.

Estándares de calidad de actividades educativas dirigidas a pacientes y familiares en un hospital universitario / Quality standards of educational activities for patients and families in a university hospital

Objetivo. Identificar grupos de pacientes que reciben atención educativa en el hospital, diferenciando actividades puntuales de programas estructurados; así como analizar información sobre estructura, proceso y resultados de los programas. Material y métodos. Estudio transversal mediante lista de verificación, generada por traducción y adaptación de los National Standards for Diabetes Self-Management Education. Se recogió información sobre estructura (recursos, disponibilidad del programa escrito y formación de profesionales), proceso que sigue el paciente (evaluación inicial, metodología, cursos, material de soporte y registro de actividad) y resultados en el paciente (evaluación post-intervención, instrumentos, registro de evaluación y resultados) y del programa (número de pacientes/familiares incluidos, evaluación periódica). Resultados. Los grupos de pacientes tributarios de educación identificados fueron: enfermos crónicos, susceptibles de tratamiento psiquiátrico y enfermos onco-hematológicos. Mayoritariamente consistían en actividades informativas y entrenamiento de habilidades técnicas, a demanda e integradas en la actividad asistencial. Los programas de educación terapéutica estructurados iban dirigidos a pacientes/familiares con: diabetes, obesidad, enfermedades del aparato locomotor, sida, esplenectomizados, enfermedad pulmonar obstructiva crónica, hipertensión e incontinencia urinaria. No todos disponían de programa escrito ni tenían definidos parámetros sobre estructura, proceso y resultados. Conclusiones. La aplicación de estándares de calidad a los programas educativos es útil en la identificación de: pacientes tributarios de educación, calidad y tipo de intervenciones realizadas, así como puntos débiles. El desarrollo de software basado en estos estándares permitiría conocer tendencias de la educación al paciente e identificar oportunidades de mejora, así como la evaluación del impacto de la actividad educativa sobre los indicadores de calidad relacionados con cada programa(AU)

Objective. To identify groups of patients receiving hospital-based educational programs, to determine whether the education was structured or ad hoc, and to analyse information on the structure, process and results of the programs. Material and methods. We performed a cross-sectional study using a translated and adapted version of the National Standards for Diabetes Self-Management Education. Information was collected on structure (resources, availability of a written program and professional training), the process followed by the patient (baseline assessment, methodology, training courses, support materials and record of activities), patient outcomes (post-intervention assessment, tools, record of evaluation and results) and program results (number of patients/relatives included, regular assessment). Results. Patient groups receiving education were: patients with chronic diseases, patients with treatable psychiatric disorders and patients with oncological and haematological processes. Most educational activities involved informative activities and technical skills training, both on-demand and integrated in care activity. Structured therapeutic education programs were aimed at patients/relatives with: diabetes, obesity, musculoskeletal diseases, AIDS, splenectomy, chronic obstructive pulmonary disease, hypertension and urinary incontinence. Not all programs had written guidelines or defined parameters with respect to structure, process and results. Conclusions. The application of quality standards to hospital educational programs is useful in detecting: patients receiving education and the quality, type and weaknesses of the programs studied. Software based on these standards may provide information on trends in patient education, identify opportunities for improvement and aid the evaluation of the impact of each educational activity on the quality indicators associated with each program(AU)

[Quality standards of educational activities for patients and families in a university hospital]. / Estándares de calidad de actividades educativas dirigidas a pacientes y familiares en un hospital universitario.

OBJECTIVE: To identify groups of patients receiving hospital-based educational programs, to determine whether the education was structured or ad hoc, and to analyse information on the structure, process and results of the programs. MATERIAL AND METHODS: We performed a cross-sectional study using a translated and adapted version of the National Standards for Diabetes Self-Management Education. Information was collected on structure (resources, availability of a written program and professional training), the process followed by the patient (baseline assessment, methodology, training courses, support materials and record of activities), patient outcomes (post-intervention assessment, tools, record of evaluation and results) and program results (number of patients/relatives included, regular assessment). RESULTS: Patient groups receiving education were: patients with chronic diseases, patients with treatable psychiatric disorders and patients with oncological and haematological processes. Most educational activities involved informative activities and technical skills training, both on-demand and integrated in care activity. Structured therapeutic education programs were aimed at patients/relatives with: diabetes, obesity, musculoskeletal diseases, AIDS, splenectomy, chronic obstructive pulmonary disease, hypertension and urinary incontinence. Not all programs had written guidelines or defined parameters with respect to structure, process and results. CONCLUSIONS: The application of quality standards to hospital educational programs is useful in detecting: patients receiving education and the quality, type and weaknesses of the programs studied. Software based on these standards may provide information on trends in patient education, identify opportunities for improvement and aid the evaluation of the impact of each educational activity on the quality indicators associated with each program.

Monitorización glucémica y educación terapéutica en la diabetes / Self-monitoring of blood glucose and therapeutic education in diabetes

En la actualidad existen dos métodos para que el profesional de la salud y elpaciente puedan evaluar el control glucémico y conocer la efi cacia del plan detratamiento en la diabetes: 1) la automonitorización de la glucemia capilar y/ola monitorización continua de la glucosa tisular intersticial realizadas por el propiopaciente, y 2) la medición de la hemoglobina glicosilada. La posibilidad detener información del control glucémico mediante la automonitorización de laglucemia capilar permite al propio paciente tomar decisiones en tiempo realsobre la pauta de tratamiento y/o en la planifi cación de sus actividades, lo quehace necesario un proceso educativo estructurado y adaptado a sus necesidades.Este artículo se centrará en la automonitorización de la glucemia capilar yla educación terapéutica, analizando por un lado la utilidad de la automonitorizaciónglucémica según el tipo de diabetes y el tipo de tratamiento, y según lasevidencias actuales y las recomendaciones de diferentes sociedades científi cas,y por otro lado describiendo las características de los diferentes glucómetros ydispositivos de punción de glucemia capilar disponibles actualmente en España(AU)

There are currently two methods for the health care professional and the patientto evaluate glycaemic control and determine the efficacy of the treatmentplan in diabetes: 1) self-monitoring of blood glucose and/or continuous glucosemonitoring of interstitial tissular glucose by the patient, and 2) measurementof glycosylated haemoglobin. The possibility of obtaining information relatedto glycaemic control by self-monitoring of capillary glycaemia allows thepatient himself to make real-time therapeutic decisions and/or for planningdaily activities, making a structured educational process adapted to the patient’sneeds increasingly more necessary. This article is focused on self-monitoringof blood glucose and therapeutic education, analysing, on the one hand,their utility according to the type of diabetes and treatment following the recommendationsof the different scientific societies and, on the other hand, describingthe characteristics of the different glucose meters and the digitalpuncture devices currently available in Spain(AU)

Quality of life outcomes in subjects with type 1 diabetes with and without repeated hypoglycaemia. Short-term results of CSII treatment

Objectives: To evaluate quality of life (QoL) characteristics and outcomesin subjects with T1D with and without non-severe (NSH)/severehypoglycaemia (SH) as a main indication for CSII. Patientsand methods: Two groups of T1D subjects were selected fromcandidates to CSII following the criteria of the Catalan National HealthService. Twenty-one subjects (aged 34.6±7.5 years; 13 women) inwhom CSII was started because of recurrent NSH and SH) were included(H Group). They were compared to 18 T1D subjects (aged32.3±10.1 years; 14 women) in whom CSII was initiated becauseof non-optimal control without repeated NSH/SH (NH group). Generalcharacteristics, metabolic control and QoL/health state (DQoL/SF-12 questionnaires) were evaluated (baseline/after 12-months).Results: In the H group, the number of NSH/week diminished from5.01±1.56 (baseline) to 2.76±1.09 after 12 months (p <0.001).SH diminished from 1.24±0.62 per subject year (baseline) to0.12±0.21 (12 months, p <0.001). There were no differences inA1c (6.9±1.3 vs 6.5±0.8%; NH and H) after 12-months of CSII.The H group scored better in DQoL-impact of treatment subscale atbaseline (45.7±7.0 vs 33.7±7.3; p <0.001, NH and H). QoL improvedsimilarly after 12 months in both groups, but the differencein DQoL-impact of treatment (41.5±8.5 vs 31.0±5.8; p <0.001)was maintained. Conclusions: CSII improves QoL independently ofits main indication. Subjects who initiate CSII because of repeatedhypoglycaemic episodes display a different QoL perception thanthose without this indication when starting this therapy. Although thisfinding does not preclude favorable results, probably it has to beconsidered in order to encourage patients to start this modality oftreatment(AU)

Importancia del cumplimiento terapéuticoen la diabetes mellitus / The importance of adherence to the treatment in diabetes mellitus

El mejor tratamiento pierde su eficacia si el paciente no lo sigue deforma adecuada. De ahí la importancia que tiene la adherencia terapéuticaen las enfermedades crónicas de las diferentes disciplinas.En este artículo, se revisa la adherencia al tratamiento de la diabetescon una enfermedad crónica. Se describen las barreras más frecuentesencontradas en los pacientes con diabetes, los diferentesmétodos para analizar la adherencia terapéutica, así como, las estrategiasde control que se han demostrado más eficaces. Entre ellas,destaca la educación terapéutica de los pacientes y de sus familiares.Por último, este artículo incide en el posicionamiento de la OrganizaciónMundial de la Salud sobre adherencia terapéutica (AU)

Even the best treatment loses its efficacy if the patient does not followit properly. That explains the importance of therapeutic adherencein chronic diseases from different disciplines. This article reviewsadherence to the treatment in diabetes as a chronic disease.A description of the most common barriers found in patients withdiabetes, different methods for the analysis of therapeutic adherence,as well as control strategies that have proven to be most efficient isfound in this review. Between them, a therapeutic education of patientsand their family members is underline. Finally, this article emphasizesthe position of the World Health Organization on therapeuticadherence(AU)

The burden of chronic disorders on hospital admissions prompts the need for new modalities of care: a cross-sectional analysis in a tertiary hospital.

BACKGROUND: Chronic disorders constitute a primary concern because of their burden on healthcare systems worldwide. Integrated care strategies enhancing the interface between tertiary care and primary care are pivotal to improve chronic care. AIM: To asses the prevalence of chronic disorders on hospital discharges and their impact on unplanned admissions and mortality. DESIGN: Cross-sectional analysis of discharge information over 1 year (2004) in one University hospital. METHODS: Adoption of an operational definition of chronic disorder based on the WHO. MAIN OUTCOME: co-morbid conditions, emergency room and hospital admissions, outpatient consultations and mortality. RESULTS: Fifty-eight percent of patients presented at least one chronic condition (19 192 patients, 53% males, 63 +/- 18 years) as primary (12 526 patients, 38%) or secondary diagnosis. The Charlson index was 2 +/- 3. Each chronic condition was associated with a 30% increase of having had an admission in the previous year. Up to 9% (1 656) of chronic patients showed multiple admissions in the previous year: two (917 patients, 55%), three (360, 22%) and four or beyond (379, 23%), being mostly unscheduled hospitalizations. The three most prevalent chronic disorders were cancer, cardiovascular diseases and chronic obstructive pulmonary disease (COPD). The rate of admissions was associated with co-morbidity (P < 0.001) and mortality (P < 0.001). CONCLUSION: The study shows a high impact of cancer on planned hospitalizations whereas cardiovascular diseases and COPD generates a high percentage of unscheduled admissions. We conclude that integrated care services including patient-oriented guidelines are strongly needed to enhance both health and managerial outcomes.

Actualización sobre técnicas y sistemas de administración de la insulina (y II) / Update on insulin administration techniques and devices (II)

No disponible

Actualización sobre técnicas y sistemas de administración de la insulina (I) / Update on insulin administration techniques and devices (I)

No disponible

Valoración del sistema telemático Medical Guard Diabetes® en pacientes con diabetes tipo 1 / Evaluation of the telematic system Medical Guard Diabetes™ in patients with type 1 diabetes

El control de la diabetes tipo 1 requiere la interacción entre lospacientes y el equipo de salud. En esta línea, los sistemas telemáticospodrían ser de utilidad. El objetivo de este trabajo fue evaluarla eficacia y seguridad del sistema telemático Medical Guard Diabetes® (MGD), que fue modificado para poder enviar glucemias yotros datos. Se incluyeron 20 pacientes con diabetes tipo 1 y malcontrol metabólico, que fueron aleatorizados a control presencialmensual (CP) o envío de información (glucemias, dosis de insulina,raciones de carbohidratos) con MGD (MG) y respuesta mensualmediante SMS (short message system). La intervención duró 6meses. Se evaluaron la hemoglobina glucosilada (HbA1c), el númerode hipoglucemias, los conocimientos sobre la diabetes, la calidadde vida y el coste de la intervención. Las características basalesde ambos grupos fueron similares. Un paciente del grupo MGabandonó el estudio. Sólo los pacientes del grupo MG presentaronuna disminución significativa en el número de hipoglucemias alfinal del estudio respecto del inicio (p= 0,027). En el grupo CP, lavariación de la HbA1c durante el seguimiento fue del –0,66% (p=0,102), y en el grupo MG fue del 0,16% (p= 0,666). En ambosgrupos se observó una mejoría en los test de conocimientos (CP:p= 0,025; MG: p= 0,023) al final de la intervención. No hubodiferencias en los tests de calidad de vida. La duración de las visitasfue menor en el grupo MG (p= 0,025), al igual que los costes totalesde la intervención (CP= 119,20 euros frente a MG= 82,70euros). En conclusión, el sistema MGD es eficaz y seguro para elenvío de datos, y la visita telemática resulta menos costosa que lasconvencionales

The control of type 1 diabetes requires interaction between patientsand the healthcare team. To achieve this, telematic systemsmay be useful. The aim of this study was to assess the efficacy andsafety of the telematic system Medical Guard Diabetes® (MGD),which was modified for sending glycaemia and other data. In thisstudy, 20 type 1 diabetic patients with poor metabolic control wererandomized to either carry out hospital appointments (CP) or tosend information (glycaemia, insulin, carbohydrate intake) with theMGD (MG) and monthly contact by SMS. The study period was 6months evaluating HbA1c, number of hypoglycaemias, patientknowledge on diabetes, quality of life and costs. Both groups werecomparable at baseline. One patient in the MG group left the study.On comparing basal and final values only the MG group showed asignificant decrease in the number of hypoglycaemias (p= 0.027).During the follow-up, the change in HbA1c was –0.66% (p= 0.102)in the CP group and 0.16% (p= 0.666) in the MG group. Bothgroups showed an improvement in the knowledge test at the endof study (CP: p= 0.025; MG: p= 0.023). There was no significantdifference in the quality of life tests. The length of the visits wasshorter in the MG group (p= 0.025) as was the intervention totalcost (CP=119.20 € vs. MG= 82.70 €). In conclusion, the MGDsystem is effective and safe for sending information and thetelematic appointment is less expensive than hospital appointments

Efficacy of continuous subcutaneous insulin infusion in Type 1 diabetes: a 2-year perspective using the established criteria for funding from a National Health Service.

AIM: To determine the 2-year efficacy of continuous subcutaneous insulin infusion (CSII) following the current established criteria for funding of a National Health Service. METHODS: Longitudinal, prospective, observational unicentre study. Included in the study were 153 Type 1 diabetes (T1D) subjects, previously treated with multiple daily injections (MDI) of insulin, in whom CSII was started in accordance with the criteria for reimbursement of the Catalan National Health Service. At baseline, we recorded data on age, gender, duration of the disease, body mass index (BMI), insulin dose and indications for CSII. Glycated haemoglobin (HbA(1c)) and the frequency of hypoglycaemic events were used to assess glycaemic control. Quality of life was assessed using three different self-report questionnaires. After 24 months, these same items were remeasured in all subjects. Serious adverse events and injection-site complications were also recorded. RESULTS: In 96% of subjects, CSII indication included less than optimal glycaemic control using MDI. HbA(1c) fell from 7.9 +/- 1.3 to 7.3 +/- 1.1% (P < or = 0.001) after 24 months of CSII. Insulin requirements were significantly lower at the end of follow-up (0.55 +/- 0.21 U/kg body weight) in comparison with before use of CSII (0.70 +/- 0.20, P < or = 0.001). BMI increased from 24.0 +/- 3.1 to 24.4 +/- 3.2 kg/m(2) after 24 months (P < or = 0.025). The rate of episodes of diabetic ketoacidosis per year remained unchanged. Mild and severe hypoglycaemic episodes were significantly reduced. The scores in all subsets of the Diabetes Quality-of-Life (DQoL) questionnaire significantly improved after 24 months of CSII. CONCLUSIONS: CSII, commenced according to the criteria for a nationally funded clinical programme, improves glycaemic control and quality-of-life outcomes with fewer hypoglycaemic episodes in T1D subjects previously conventionally treated with MDI.

Entrenamiento del paciente y de la familia en el cálculo de raciones de hidratos de carbono / Training of the patient and his or her family in carbohydrate counting

La educación dietético-nutricional es el conjunto de intervenciones dirigidas a modificar los conocimientos, las habilidades, las actitudes y los comportamientos, tanto individuales como de grupos, en vista de mejorar y racionalizar sus hábitos alimentarios. En este trabajo, se introduce la base de los planes de alimentación por raciones como estrategia de individualización según necesidades nutritivas, metabólicas y de hábitos dietéticos en personas con diabetes. Asimismo, se exponen las aportaciones del estudio Diabetes Control and Complications Trial -DCCT- sobre las estrategias utilizadas para individualizar los planes de alimentación y facilitar un adecuado aprendizaje dietético en los pacientes con diabetes tipo 1 en terapia intensiva con múltiples dosis de insulina o infusión subcutánea continua de insulina. Además, se analizan los fundamentos del sistema de cálculo de hidratos de carbono adaptados a las últimas recomendaciones de la Asociación Americana de Diabetes -ADA 2006-, así como diferentes niveles de aprendizaje: inicial, intermedio y avanzado. Para cada nivel, se exponen el tipo de pacientes al que va dirigido, tópicos de aprendizaje y nivel asistencial donde se debería realizar esta educación. En relación con este tema, se aporta la experiencia del equipo de diabetes del Hospital Clínic de Barcelona. Se expone el proceso que siguen el paciente y la familia para individualizar y pactar plan de alimentación por raciones adaptado a medidas de referencia por volumen, sistema adaptado y validado en el propio hospital (método Clínic) y actualmente utilizado, tanto en la asistencia primaria como en la hospitalaria. Se diferencian el nivel de aprendizaje básico y el avanzado

Nutrition and dietetic education consists of a set of interventions aimed at modifying the knowledge, skills, attitudes and the behaviours of both individuals and groups in order to improve and rationalize their eating habits. In this manuscript, the basis of the dietetic meal plan involving the exchange system is introduced as a strategy for individualization according to nutritional and metabolic needs and dietary habits in individuals with diabetes. We also comment on the contributions of the Diabetes Control and Complications Trial (DCCT) regarding the strategies used to individualize dietetic meal planning and provide adequate dietetic training for type 1 diabetic patients under intensive insulin therapy with multiple insulin doses or continuous subcutaneous insulin infusion. In addition, we analyze the fundamentals of the carbohydrate counting system, adapted to the latest recommendations of the American Diabetes Association (ADA 2006), as well as the different levels of training: basic, intermediate and advanced. For each level, we describe the type of patients toward whom the interventions are aimed, the learning topics and the level of healthcare at which this education should be received. In this respect, we report the experience in this field of the diabetes team of the Hospital Clinic of Barcelona, Spain, and describe the process followed by the patient and his or her family to individualize and establish a dietetic meal plan adapted to the reference measures by volume. This system, which has been adapted and validated in our hospital (the Clinic method), is currently used in both the primary care and hospital care settings. The differences between the basic and advanced levels of training are also pointed out

Telecare in a structured therapeutic education programme addressed to patients with type 1 diabetes and poor metabolic control.

OBJECTIVE: To assess the effects of telecare on the results of intensive follow-up in T1D patients with poor metabolic control. METHODS: After initial evaluation, 40 T1D were randomised to either a Telecare (TG) or Conventional Group (CG). Patients had an intensive 6-month follow-up and helped to make decisions concerning treatment self-management. The TG had 12 appointments: 9 telematic with the GlucoBeep system+3 ambulatory. The CG had 12 outpatient appointments. At 0, 6 (end of study) and 12 months, metabolic control, self-management and quality of life were evaluated. Cost analysis was made at study end. RESULTS: Thirty patients completed the study (16 TG, 14 CG). Intention to treat analysis included 19 TG and 16 CG. Improvement in HbA(1c) was similar in both groups TG: 8.4+/-1.2%; 7.5+/-1.4%; 7.6+/-0.9%, p=0.008; CG: 8.9+/-1.3%; 7.7+/-0.9%; 7.6+/-0.7%, p=0.001; with a decrease in hypoglycaemic events and improvement in self-management and quality of life. Patient costs were lower in the TG versus CG in appointment length (0.25h versus 0.5h). However, 30% of the diabetes team and patient appointments were longer than expected due to technical difficulties: (0.25h versus 1h). CONCLUSIONS: Intensive telematic follow-up achieves similar results to those of intensive face-to-face follow-up with lower patient costs. However, communication technology must be improved.

Terapia con infusión subcutánea continua de insulina (ISCI): cálculo individualizado del “bolus” y de la línea basal / Therapy with continous subcutaneous insulin infusion (CSII): individualized calculation of bolus and basal rate

Para poder iniciarse como grupo en el tratamiento con sistemas de infusión continua subcutánea de insulina (ISCI) es necesario disponer de una serie de medios y de personal, y así poder conseguir los mejores resultados con este tipo de terapia. En este capítulo se describen los algoritmos básicos para que se puedan diseñar las pautas de insulina con ISCI al inicio de un tratamiento. Estos algoritmos tienen como objetivo calcular la dosis total de insulina que un paciente con ISCI va a necesitar, así como repartir esta dosis total de insulina calculada en forma de línea basal y de “bolus”. Se describen también los algoritmos de ayuda para poder calcular los “bolus” de insulina necesaria según la cantidad de carbohidratos que componen una comida determinada, así como la cantidad de insulina necesaria para tratar hiperglucemias puntuales. La información que se obtiene mediante la utilización de algoritmos se debe tomar con cierta cautela y sólo serán una forma de ayuda al inicio de un tratamiento con ISCI y posteriormente se irán adaptando en función de las características de cada paciente

Before a professional team intents to begin a subcutaneous continuous insulin infusion (CSII) therapy program is necessary to have enough resources and personal to achieve the best results with this therapy. In this chapter, basic algorithms to design initial appropriate doses with CSII therapy will be described. These algorithms show how to calculate total insulin doses that will be required for patients treated with CSII and how to distribute them as basal rate or bolus. Furthermore, additional help tools were introduced to estimate how much bolus will be used to cover the carbohydrate content of a meal or to correct for occasional high blood glucose values. The information delivered by the different algorithm exposed needs to be considered cautiously and will be considered only as a guidance before starting CSII therapy. Then, these algorithms require to be adapted to individual patient characteristics in the following visits

Bombas de insulina. Una alternativa en el tratamiento de la DM1 / No disponible

No disponible

[Content of carbohydrates and trace elements in a group of non-alcoholic drinks]. / Contenido en hidratos de carbono y en oligoelementos de un grupo de bebidas refrescantes no alcohólicas.

BACKGROUND: In order to elaborate recommendations for the dietetic care of diabetic patients and other clinical disorders we have measured the concentration of carbohydrates and trace elements in a group of non alcoholic refreshments of current use in Spain. MATERIAL AND METHODS: Thirty refreshments were classified into 10 groups. Glucose and phosphate were measured by hexokinase and reduction of phospho-molybdate methods respectively in an autoanalyzer Dax-72. Glucose and fructose were analyzed by cellulose thin-layer chromatography; glucose, fructose and sucrose by gas chromatographys. Sodium and potassium by emission spectrophotometry and calcium, magnesium, iron, copper and zinc by atomic absorption spectrophotometry. RESULTS: Light refreshments and soft drinks have no carbohydrates. Isotonic beverages, fruit juices, cool tea and non alcoholic beers had less than 10 g/dl. Tonic waters, Fanta, different coles, non alcoholic bitter and others had more than 10 g/dl. Sodium levels between 15-20 mEq/l were found in the isotonic beverages and 7-Up and levels of 7 mEq/l in the others. Potassium values between 15-40 mEq/l were found in the fruit juices, 3-4 mEq/l in Gatorade and less than 1 mEq/l in the others. CONCLUSIONS: Light refreshments and soft drinks contain low concentrations of carbohydrates and sodium. Fruit juices have high potassium concentration. Such information can be especially useful for dietetic care of diabetic patients.

Isolation of genomic DNA from milk samples by using Chelex resin.

A rapid procedure for isolating genomic DNA from milk samples has been devised, based on the use of Chelex resin. By using this protocol, genomic DNA was extracted from milk samples from 15 cows and 15 goats. The suitability of these DNA preparations as a template for performing the polymerase chain reaction (PCR) was tested by amplifying three different loci of the bovine genome: exon 4 of the kappa-casein gene and the INRA5 and INRA23 microsatellites, together with two others: exon 19 of the alpha s1-casein gene and exon 2 and part of intron 2 of the DRB gene of the caprine genome. No amplification products could be obtained from any sampless at 30 cycles. In contrast, at 45 cycles the number of amplified samples ranged from 86 to 100% and at 65 cycles all the DNA targets were amplified, indicating that the number of cycles was a critical factor to be optimized for obtaining the desired PCR target. These results suggest that this method may be a useful tool for analysing genetic polymorphism at the DNA level by PCR and relating it to milk composition and other traits of economic interest.

Human insulin-induced lipoatrophy. Successful treatment using a jet-injection device.

OBJECTIVE: To evaluate the efficacy of the administration of insulin by a jet-injector device in stopping and reversing severe human insulin-induced lipoatrophy. CASE: We report a case of a woman with severe human insulin-induced lipoatrophy who has been treated exclusively with recombinant DNA human insulin since the onset of IDDM. RESULTS: The loss of subcutaneous tissue in the injection areas was demonstrated and measured by high-frequency ultrasound. Dermatologic exam demonstrated a severe reduction of fat tissue. After 8 months of administration of human insulin by a jet injector, there were no more new lesions of lipoatrophy and those affected areas were substantially ameliorated. CONCLUSIONS: Jet-injection devices might constitute a helpful method to treat those patients affected by severe human insulin-induced lipoatrophy.