[Self monitoring of capillary blood glucose. Evaluation of long-term results (3 to 7 years)]. / Autocontrol de la glucemia capilar. Evaluación del resultado a largo plazo (3 a 7 años).

We analyzed data provided by 60 diabetic patients (DP) included in a Program (P) of Self Blood Glucose Monitoring (SBGM) which showed an initial adherence of at least 6 months. Total follow-up was 67,293 DP-days (110,504 capillary glycemias). Only 50% of DP's remained for > 3 years. Rates of drop-out (DO) peaked early (3th semester (S) and late (10th. S) mean +/- SE of daily SBGM reported in the preprogram period and during the 1st S on P-SBGM by the future DO was significantly higher (4.25 +/- 0.22) than those reported by their P-SBGM-mates who stayed in the program (3.11 +/- 0.29; p < 0.01). DO showed a higher % of capillary glycemias < 60 mg/dl (hypoglycemia) (5.34 +/- 1.49 vs 2.85 +/- 1.14; p < 0.01). During the 3rd S early DO showed significantly higher Glycosilated Hemoglobin (HbA1) levels (10.4 +/- 0.49%) than late DO (8.19 +/- 0.45%; p < 0.01). HbA1's recorded by the late DO's just before leaving P-SBGM were significantly higher (10.14 +/- 0.61%) than those seen at 2nd/5th S (8.2 +/- 0.2; p < 0.01). However, HbA1's of 1-DO at time of abandoning P-SBGM were comparable to those shown by those DP's who remained (10.14 +/- 0.61 vs 9.46 +/- 0.27%). DP's performed daily SBGM's in 70% of possible days during 4 years and in only 50% afterwards. Daily SBGM's was 3.3 +/- 1 during the first 3 years and 2.1 +/- 0.8 thereafter. Compared to preprogram period, all DP's improved HbA1's (12.5 +/- 0.31 vs 9.46 +/- 0.27; p < 0.001) and mean blood glucose (166 +/- 5.2 vs 146 +/- 3.6; p < 0.01). DP's who reached a faster and more satisfactory degree of glycemic control in earlier stages of P-SBGM showed the highest rates of drop-out. Early identification of such patients, as well as setting of feasable and individualy adjusted goals of glycemic control may improve current compliance of DP's on long term tight control.

Autocontrol de la glucemia capilar. Evaluación del resultado a largo plazo (3 a 7 años). / [Self monitoring of capillary blood glucose. Evaluation of long-term results (3 to 7 years)]

We analyzed data provided by 60 diabetic patients (DP) included in a Program (P) of Self Blood Glucose Monitoring (SBGM) which showed an initial adherence of at least 6 months. Total follow-up was 67,293 DP-days (110,504 capillary glycemias). Only 50

of DPs remained for > 3 years. Rates of drop-out (DO) peaked early (3th semester (S) and late (10th. S) mean +/- SE of daily SBGM reported in the preprogram period and during the 1st S on P-SBGM by the future DO was significantly higher (4.25 +/- 0.22) than those reported by their P-SBGM-mates who stayed in the program (3.11 +/- 0.29; p < 0.01). DO showed a higher

of capillary glycemias < 60 mg/dl (hypoglycemia) (5.34 +/- 1.49 vs 2.85 +/- 1.14; p < 0.01). During the 3rd S early DO showed significantly higher Glycosilated Hemoglobin (HbA1) levels (10.4 +/- 0.49

) than late DO (8.19 +/- 0.45

; p < 0.01). HbA1s recorded by the late DOs just before leaving P-SBGM were significantly higher (10.14 +/- 0.61

) than those seen at 2nd/5th S (8.2 +/- 0.2; p < 0.01). However, HbA1s of 1-DO at time of abandoning P-SBGM were comparable to those shown by those DPs who remained (10.14 +/- 0.61 vs 9.46 +/- 0.27

). DPs performed daily SBGMs in 70

of possible days during 4 years and in only 50

afterwards. Daily SBGMs was 3.3 +/- 1 during the first 3 years and 2.1 +/- 0.8 thereafter. Compared to preprogram period, all DPs improved HbA1s (12.5 +/- 0.31 vs 9.46 +/- 0.27; p < 0.001) and mean blood glucose (166 +/- 5.2 vs 146 +/- 3.6; p < 0.01). DPs who reached a faster and more satisfactory degree of glycemic control in earlier stages of P-SBGM showed the highest rates of drop-out. Early identification of such patients, as well as setting of feasable and individualy adjusted goals of glycemic control may improve current compliance of DPs on long term tight control.

[Intensified insulin therapy in the management of gestational diabetes]. / Insulinoterapia intensificada en el manejo de la diabetes pregestacional.

A total of 35 pregnancies in 28 Pregestational Diabetic Patients (PDP) were followed with the goal of achieving and maintaining near normoglycemia (as many pre-postprandial glycemias as possible between 60-140 mg/dl); 13 patients (16 pregnancies) were assigned to Subcutaneous Continuous Preprogrammed Insulin Infusion (SCII) because of high risk pregnancies (HRP) (at least one of the following: former history of spontaneous abortions, stillbirths, premature deliveries and/or sterility). The remaining 12 PDP's (15 pregnancies with no past history of the above nature) were treated with Multiple Conventional Insulin Injections (MCII). Both groups were comparable regarding the following clinical parameters: age, time of onset and class of diabetes. All patients were instructed in performing 3 to 7 daily Self Capillary Blood Glucose controls (SCBG). Mean follow-up observation period was (mean +/- SEM) 28.5 +/- 2.5 weeks for SCII and 3.2 MCII and 28.8 +/- 3.2 weeks for MCII. All the 3 PDP drop out's (4 pregnancies) belonged to the CMII group. No drop out's were recorded in the SCII group. Both insulin therapy approaches were similarly effective in improving metabolic control in that comparable levels of mean blood glucose (MBG) and HbA1 were attained by SCII and MCII (Fig. 1). Compliance, as evidenced by average of daily SCBG was also similar in both groups (Fig. 2). Such satisfactory metabolic control was achieved mostly because of an increase in the percentage (65%) of "fair" glycemias (60-139 mg/dl) and not because of an increase in hypoglycemias (< 60 mg/dl) which could have canceled out an undesirable degree of hyperglycemias thus rendering "false satisfactory" MBG's and HbA1 (Fig. 1). With the above degree of metabolic control obtained there occurred no severe hypoglycemic episodes requiring medical intervention. All newborns to the PDP's who remained under treatment showed an adequate APGAR (X +/- SEM, 9.5 +/- 0.2) regardless of the modality (SCII or MCII) of insulin delivery used (Tables 1, 2). The single malformed baby found in this series was born to a patient on SCII who happened to start on the intensified insulin treatment rather late in her pregnancy (21st week) and, in addition, the patient self medicated with high doses of chlorpromazine because of recurrent vomiting episodes. Incidence of neonatal hypoglycemia (HY) or macrosomy (MS) was comparable in both groups (Tables 1, 2). It is to be pointed out, however, that PDP's who bore the babies with no HY or MS had presented a larger number of low glycemic values than mothers who bore the babies with HY and/or MS.(ABSTRACT TRUNCATED AT 400 WORDS)

Insulinoterapia intensificada en el manejo de la diabetes pregestacional. / [Intensified insulin therapy in the management of gestational diabetes]

A total of 35 pregnancies in 28 Pregestational Diabetic Patients (PDP) were followed with the goal of achieving and maintaining near normoglycemia (as many pre-postprandial glycemias as possible between 60-140 mg/dl); 13 patients (16 pregnancies) were assigned to Subcutaneous Continuous Preprogrammed Insulin Infusion (SCII) because of high risk pregnancies (HRP) (at least one of the following: former history of spontaneous abortions, stillbirths, premature deliveries and/or sterility). The remaining 12 PDPs (15 pregnancies with no past history of the above nature) were treated with Multiple Conventional Insulin Injections (MCII). Both groups were comparable regarding the following clinical parameters: age, time of onset and class of diabetes. All patients were instructed in performing 3 to 7 daily Self Capillary Blood Glucose controls (SCBG). Mean follow-up observation period was (mean +/- SEM) 28.5 +/- 2.5 weeks for SCII and 3.2 MCII and 28.8 +/- 3.2 weeks for MCII. All the 3 PDP drop outs (4 pregnancies) belonged to the CMII group. No drop outs were recorded in the SCII group. Both insulin therapy approaches were similarly effective in improving metabolic control in that comparable levels of mean blood glucose (MBG) and HbA1 were attained by SCII and MCII (Fig. 1). Compliance, as evidenced by average of daily SCBG was also similar in both groups (Fig. 2). Such satisfactory metabolic control was achieved mostly because of an increase in the percentage (65

) of [quot ]fair[quot ] glycemias (60-139 mg/dl) and not because of an increase in hypoglycemias (< 60 mg/dl) which could have canceled out an undesirable degree of hyperglycemias thus rendering [quot ]false satisfactory[quot ] MBGs and HbA1 (Fig. 1). With the above degree of metabolic control obtained there occurred no severe hypoglycemic episodes requiring medical intervention. All newborns to the PDPs who remained under treatment showed an adequate APGAR (X +/- SEM, 9.5 +/- 0.2) regardless of the modality (SCII or MCII) of insulin delivery used (Tables 1, 2). The single malformed baby found in this series was born to a patient on SCII who happened to start on the intensified insulin treatment rather late in her pregnancy (21st week) and, in addition, the patient self medicated with high doses of chlorpromazine because of recurrent vomiting episodes. Incidence of neonatal hypoglycemia (HY) or macrosomy (MS) was comparable in both groups (Tables 1, 2). It is to be pointed out, however, that PDPs who bore the babies with no HY or MS had presented a larger number of low glycemic values than mothers who bore the babies with HY and/or MS.(ABSTRACT TRUNCATED AT 400 WORDS)

Insulinoterapia intensificada en el manejo de la diabetes pregestacional. / [Intensified insulin therapy in the management of gestational diabetes]

A total of 35 pregnancies in 28 Pregestational Diabetic Patients (PDP) were followed with the goal of achieving and maintaining near normoglycemia (as many pre-postprandial glycemias as possible between 60-140 mg/dl); 13 patients (16 pregnancies) were assigned to Subcutaneous Continuous Preprogrammed Insulin Infusion (SCII) because of high risk pregnancies (HRP) (at least one of the following: former history of spontaneous abortions, stillbirths, premature deliveries and/or sterility). The remaining 12 PDPs (15 pregnancies with no past history of the above nature) were treated with Multiple Conventional Insulin Injections (MCII). Both groups were comparable regarding the following clinical parameters: age, time of onset and class of diabetes. All patients were instructed in performing 3 to 7 daily Self Capillary Blood Glucose controls (SCBG). Mean follow-up observation period was (mean +/- SEM) 28.5 +/- 2.5 weeks for SCII and 3.2 MCII and 28.8 +/- 3.2 weeks for MCII. All the 3 PDP drop outs (4 pregnancies) belonged to the CMII group. No drop outs were recorded in the SCII group. Both insulin therapy approaches were similarly effective in improving metabolic control in that comparable levels of mean blood glucose (MBG) and HbA1 were attained by SCII and MCII (Fig. 1). Compliance, as evidenced by average of daily SCBG was also similar in both groups (Fig. 2). Such satisfactory metabolic control was achieved mostly because of an increase in the percentage (65

) of [quot ]fair[quot ] glycemias (60-139 mg/dl) and not because of an increase in hypoglycemias (< 60 mg/dl) which could have canceled out an undesirable degree of hyperglycemias thus rendering [quot ]false satisfactory[quot ] MBGs and HbA1 (Fig. 1). With the above degree of metabolic control obtained there occurred no severe hypoglycemic episodes requiring medical intervention. All newborns to the PDPs who remained under treatment showed an adequate APGAR (X +/- SEM, 9.5 +/- 0.2) regardless of the modality (SCII or MCII) of insulin delivery used (Tables 1, 2). The single malformed baby found in this series was born to a patient on SCII who happened to start on the intensified insulin treatment rather late in her pregnancy (21st week) and, in addition, the patient self medicated with high doses of chlorpromazine because of recurrent vomiting episodes. Incidence of neonatal hypoglycemia (HY) or macrosomy (MS) was comparable in both groups (Tables 1, 2). It is to be pointed out, however, that PDPs who bore the babies with no HY or MS had presented a larger number of low glycemic values than mothers who bore the babies with HY and/or MS.(ABSTRACT TRUNCATED AT 400 WORDS)

Bomba de infusión o inyecciones intensificadas de insulina: evaluación comparativa en un seguimiento prolongado / Subcutaneous insulin infusion with portable pump versus intensified conventional injections in diabetes: a long term follow up of comparative performance

Se comunica la evolución de 56 pacientes diabéticos insulinodependientes o requirentes enrolados en un Programa de Terapéutica insulínica Intensiva (TII)dirigido a lograr cuasi normoglucemia (60 a 180 mg/dl),durante un período de hasta 24 meses.De ellos,23 recibieron insulina mediante una bomba portable de infusión (BPI) durante XñES: 15.7ñ1.9 meses/pacientes y 33 por medio de inyecciones convencionales intensificadas (ICI) (2a4 por día),durante 19.6ñ1.4 meses/paciente.Fueron instruídos para realizar 3 a 7 autocontroles glucémicos capilares diarios (AGC) pre y/o 90 minutos posprandiales y en cualquier otro momento en que su sintomatología lo justificara.Ambos grupos mejoraron su control glucémico, evidenciado por un descenso significativo de sus glucemias medias capilares (GMC) hacia el 12º mes, para experimentar luego un progresivo deterioro del mismo, como lo muestra el incremento de las GMC, que retornaron a los valores pretratamiento,hacia el final del período de observación. Este deterioro en las GMC fue más precoz e importante en los pacientes en ICI y no sería atribuible a una disminución de la dosis de insulina diaria.Es de destacar que ambos grupos exhibieron controles glucémicos aceptables(GMC 12º mes:XñES: 129ñ3,8 en BPI y 136ñ3,9 en ICI) sólo cuando realizaban un promedio de 3 o más AGC/día. Sin embargo,este deterioro en las GMC (evidenciado por un incremento en el porcentaje de glucemias mayores de 180 mg/dl)no se acompañó de un deterioro de los niveles de HbA1 que,por el contrario,permanecieron dentro de un rango normal alto hasta el fina del período de observación

Bomba de infusión o inyecciones intensificadas de insulina: evaluación comparativa en un seguimiento prolongado / Subcutaneous insulin infusion with portable pump versus intensified conventional injections in diabetes: a long term follow up of comparative performance

Se comunica la evolución de 56 pacientes diabéticos insulinodependientes o requirentes enrolados en un Programa de Terapéutica insulínica Intensiva (TII)dirigido a lograr cuasi normoglucemia (60 a 180 mg/dl),durante un período de hasta 24 meses.De ellos,23 recibieron insulina mediante una bomba portable de infusión (BPI) durante XñES: 15.7ñ1.9 meses/pacientes y 33 por medio de inyecciones convencionales intensificadas (ICI) (2a4 por día),durante 19.6ñ1.4 meses/paciente.Fueron instruídos para realizar 3 a 7 autocontroles glucémicos capilares diarios (AGC) pre y/o 90 minutos posprandiales y en cualquier otro momento en que su sintomatología lo justificara.Ambos grupos mejoraron su control glucémico, evidenciado por un descenso significativo de sus glucemias medias capilares (GMC) hacia el 12º mes, para experimentar luego un progresivo deterioro del mismo, como lo muestra el incremento de las GMC, que retornaron a los valores pretratamiento,hacia el final del período de observación. Este deterioro en las GMC fue más precoz e importante en los