The Calculating Boluses on Multiple Daily Injections (CBMDI) study: A randomized controlled trial on the effect on metabolic control of adding a bolus calculator to multiple daily injections in people with type 1 diabetes.

BACKGROUND: Although the insulin bolus calculator is increasingly being used by people with type 1 diabetes (T1D) on multiple daily injection (MDI) therapy, few studies have investigated its effects on glycemic control. The aim of this study was to determine whether adding this device to therapeutic intensification could further improve metabolic control. METHODS: A 4-month randomized controlled clinical trial was performed comparing subjects undergoing therapeutic intensification and either using the bolus calculator (Cb group) or not (active control [Co] group). Metabolic control, fear of hypoglycemia, and treatment acceptance were evaluated. RESULTS: In all, 70 people completed the study (42 in the Cb group, 28 in the Co group). There was a significant decrease in HbA1c in both the Cb and Co groups (-7 mmol/mol [-0.7 %] vs -4 mmol/mol [-0.4 %], respectively). There were no significant differences in HbA1c at baseline or the end of the study, or in the decrease in HbA1c, glycemia, or changes in blood glucose levels at the end of the study between the two groups. There was a significant increase in the number of participants with good metabolic control (HbA1c <58 mmol/mol [7.5 %]) in the Cb group (from 16.7 % to 40.5 %), but not in the Co group. The incidence of hypoglycemic events was reduced slightly but significantly only in the Cb group. There was no change in the fear of hypoglycemia at the end of the study. The bolus calculator was well accepted. CONCLUSIONS: In T1D, adding a bolus calculator to intensive MDI resulted in a significant improvement in metabolic control and slightly decreased the number of hypoglycemic episodes. Metabolic control also improved in the Co group.

Precisión del diagnóstico de depresión en pacientes con diabetes mellitus tipo 1 / Accuracy of diagnosis of depression in patients with Type 1 diabetes mellitus

Este estudio valora la precisión que tiene el clínico (Médico Especialista en Endocrinología y Nutrición: MEEN) al realizar el diagnóstico de depresión en pacientes con diabetes mellitus tipo 1 (DM1). Participaron 11 MEEN y 153 pacientes con DM1. El diagnóstico de depresión se realizó mediante la entrevista estructurada SCID-1 y la valoración del clínico. De la muestra inicial se seleccionaron aleatoriamente 50 pacientes (imponiendo la condición de que estuviera compuesta por 25 pacientes con depresión y 25 sin depresión). Los resultados muestran que los clínicos realizaron un mayor porcentaje de diagnósticos negativos (paciente sin depresión) que positivos (paciente con depresión). Un porcentaje considerable de pacientes con depresión no fueron diagnosticados (25%). Parece, pues, necesario dotar a los clínicos de protocolos adecuados para evaluar la presencia de este trastorno en DM1, así como continuar la investigación sobre el proceso diagnóstico para la toma de decisiones clínicas (AU)

This study assesses the clinical accuracy of physicians (Specialists in Endocrinology and Nutrition: SEN) to make the diagnosis of depression in patients with Type 1 diabetes mellitus (DM1). This study involved 11 SEN physicians, and 153 patients with DM1. The diagnosis of depression was performed using the SCID-1 structured interview and clinical assessment. From the initial sample, 50 patients were randomly selected (imposing the condition that it was included 25 patients with depression and 25 without depression). The results show that clinicians performed a higher percentage of negative diagnoses (patients without depression) than positive ones (patients with depression). A significant percentage of patients with depression were not diagnosed (25%). It therefore seems necessary to provide adequate clinical protocols to evaluate the presence of this disorder in DM1, as well as continuing research into the diagnostic process for clinical decision making (AU)

Ansiedad, Depresión y otras variables en pacientes con diabetes mellitus Tipo I / Anxiety, depression and other variables in patients with type 1 diabetes mellitus

En el presente artículo se estudia si algunas variables psicológicas, biomédicas y sociodemográficas pueden predecir la calidad de vida de pacientes con diabetes mellitus tipo 1 (DM1) en tratamiento con Infusión Subcutánea Continua de Insulina (ISCI). Participaron 33 pacientes con DM1 que completaron una batería de test psicológicos (DQOL, BDI, STAI y MHLC). Hemos encontrado que la ansiedad, el sexo y las complicaciones de la enfermedad son variables importantes que permiten explicar su calidad de vida. Aunque no han alcanzado significación estadística en ninguno de los modelos, no deben desconsiderarse los datos obtenidos en otras variables como el control glucémico, locus de control interno o la depresión. Los resultados del estudio sugieren importantes implicaciones para el tratamiento integral de estos pacientes (AU)

The aim of this study is to analyse whether certain psychological, biomedical and socio demographic variables can predict the quality of life of patient with type 1 diabetes mellitus teasted with Continuous Subcutaneous Insulin Infusion (CSII). Thirty three patients with DM1 completed a battery of psychological tests (DQOL, BDI, STAI and MHLC). Results indicate that anxiety, sex and complications are important variables that can explain the quality of life. Although glycemic control, locus of internal control or depression have not reached statistical significance in any of the models, they should not be rejected. These results suggest important implications for the integral treatment of these patients (AU)

Predictores de Calidad de Vida en Pacientes con Diabetes Mellitus Tipo 1 / Predictors of Quality of Life in Patients with Type 1 Diabetes Mellitus

Resumen. En el presente artículo se pretende estudiar si variables psicológicas (depresión, ansiedad-estado, ansiedad-rasgo y locus de control) y metabólicas (control glucémico e hipoglucemias graves) pueden predecir la calidad de vida de pacientes con diabetes mellitus tipo 1 (DM1). Treinta y tres pacientes con DM1 completaron una batería de tests psicológicos (DQOL, BDI, STAI y MHLC). Los resultados muestran que la depresión y la ansiedad- rasgo son buenos predictores de la calidad de vida de los pacientes con DM1. El resto de las variables (locus de control, hemoglobina glicosilada e hipoglucemias graves) no se relacionan con la calidad de vida. Estos resultados evidencian que las variables psicológicas (depresión y ansiedad-rasgo) pueden ser buenos predictores de calidad de vida en pacientes con DM1. Por tanto, según nuestros resultados, para mejorar la calidad de vida de las personas con esta enfermedad habría que promover la aplicación de tratamientos psicológicos dirigidos a reducir su sintomatología depresiva y ansiosa (AU)

Abstract. The aim of this article is to study whether psychological (depression, state-anxiety, trait-anxiety and locus of control) and metabolic variables (glucemic control and serious hypoglycemic events) can predict the quality of life in patients with type 1 diabetes mellitus (DM1). Thirty-three patients with DM1 completed a battery of psychological tests (DQOL, BDI, STAI and MHLC). The results show that depression and trait-anxiety are good predictors of quality of life in DM1 patients. The rest of the variables (locus of control, glycosylated hemoglobin and serious hypoglycemic events) are not related to the quality of life. These results demonstrate that psychological variables (depression and trait-anxiety) can be good predictors of quality of life in DM1 patients. Therefore, according to our results, to improve the quality of life of people with this disease it would be necessary to promote the application of psychological treatments directed at reducing their depressive and anxious symptomatology (AU)