Hipoglucemia desapercibida en jóvenes con diabetes tipo 1 trasladados a un centro de adultos / Hypoglycaemia unawareness in young people with type 1 diabetes transferred to an adult center

OBJETIVO: Evaluar la frecuencia de las hipoglucemias desapercibidas (HD) en pacientes con diabetes tipo 1, trasladados de pediatría, que siguen programa específico de atención y educación terapéutica (PAET) en el hospital de adultos. PACIENTES Y MÉTODOS: Jóvenes trasladados entre 2009-2011. El PAET incluyó proceso de traslado coordinado, visitas individuales y en grupo. Al inicio y a los 12 meses se valoran: HbA1c, frecuencia de hipoglucemias graves paciente/año (HG) y no graves. Los pacientes fueron clasificados y comparados en 2 grupos: hipoglucemia percibida e HD, según los resultados del Test de Clarke < 3R o > 3R respectivamente. RESULTADOS: Realizaron PAET 56 pacientes (edad 18,1±0,3 años, 46% chicas, HbA1c 8,0 ± 1,2%). En la valoración inicial el 16% presentaba HD. El número de episodios de HG fue superior en el grupo HD (0,33 ± 0,50 vs. 0,09 ± 0,28 p < 0,05). El porcentaje de pacientes con > 2 hipoglucemias no graves/semana fue superior en el grupo HD, aunque sin significación estadística (66% vs. 34%, p = 0,06). A los 12 meses todavía un 11% de pacientes presentaba HD. El número de HG siguió siendo superior en el grupo con HD (0,38 ± 1,06 vs. 0,02 ± 0,15, p = 0,04). CONCLUSIONES: El porcentaje de jóvenes con diabetes tipo 1 e HD es considerable en el momento del traslado. El PAET mejora su pronóstico, pero no lo soluciona a medio plazo. Los pacientes con HD presentan mayor frecuencia de HG. La detección de HD es necesaria para reducir las HG que todavía son una asignatura pendiente

OBJECTIVE: To evaluate frequency of hypoglycaemia unawareness (HU) in patients with type 1 diabetes (T1D) transferred from Paediatrics following a specific therapeutic education programme (TEP) in an adult hospital. PATIENTS AND METHODS: Young patients transferred from 2009-2011 were evaluated. The TEP included a coordinated transfer process, individual appointments and a group course. At baseline and at 12 months we evaluated glycated haemoglobin (HbA1c) frequency of severe (SH) hypoglycaemia/patient/year and non severe hypoglycaemia (NSH). The patients were classified into two groups and compared: hypoglycaemia awareness (HA) and HU according to the Clarke Test < 3R or > 3R respectively. RESULTS: Fifty-six patients (age 18.1 ± 0.3 years, 46% females, HbA1c 8.0 ± 1.2%) underwent the TEP. In the baseline evaluation 16% presented HU. The number of SH was higher in the HU Group (0.33 ± 0.50 vs. 0.09 ± 0.28 P < .05). The percentage of patients with > 2 NSH/week was higher, albeit not significantly, in the HU group (66% vs. 34%, p = 0.06). At 12 months 11% of the patients continued to present HU. The number of SH remained higher in the HU group (0.38 ± 1.06 vs. 0.02 ± 0.15 P = .04). CONCLUSIONS: The percentage of young people with T1D with HU is quite high at transfer. Although the TEP improves hypoglycaemia awareness it does not solve this important problem. Patients with HU more frequently present SH. It is necessary to identify HU in order to reduce SH which continues to be a problem in people with T1D

Hypoglycaemia unawareness in young people with type 1 diabetes transferred to an adult center. / Hipoglucemia desapercibida en jóvenes con diabetes tipo 1 trasladados a un centro de adultos.

OBJECTIVE: To evaluate frequency of hypoglycaemia unawareness (HU) in patients with type 1 diabetes (T1D) transferred from Paediatrics following a specific therapeutic education programme (TEP) in an adult hospital. PATIENTS AND METHODS: Young patients transferred from 2009-2011 were evaluated. The TEP included a coordinated transfer process, individual appointments and a group course. At baseline and at 12 months we evaluated glycated haemoglobin (HbA1c) frequency of severe (SH) hypoglycaemia/patient/year and non severe hypoglycaemia (NSH). The patients were classified into two groups and compared: hypoglycaemia awareness (HA) and HU according to the Clarke Test <3R or>3R respectively. RESULTS: Fifty-six patients (age 18.1±0.3 years, 46% females, HbA1c 8.0±1.2%) underwent the TEP. In the baseline evaluation 16% presented HU. The number of SH was higher in the HU Group (0.33±0.50 vs. 0.09±0.28 P<.05). The percentage of patients with>2 NSH/week was higher, albeit not significantly, in the HU group (66% vs. 34%, p=0.06). At 12 months 11% of the patients continued to present HU. The number of SH remained higher in the HU group (0.38±1.06 vs. 0.02±0.15 P=.04). CONCLUSIONS: The percentage of young people with T1D with HU is quite high at transfer. Although the TEP improves hypoglycaemia awareness it does not solve this important problem. Patients with HU more frequently present SH. It is necessary to identify HU in order to reduce SH which continues to be a problem in people with T1D.

Formación en educación terapéutica en diabetes. ¿Qué tenemos y qué nos falta? / Training in diabetes therapeutic education: what do we have and what do we lack?

La Organización Mundial de la Salud manifiesta que los profesionales de la salud dedicados a la educación terapéutica en diabetes (ETD) deben tener una formación adecuada. En Estados Unidos, esta formación académica está avalada por las sociedades científicas competentes y está regulada de tal modo que disponer o no de ella determina la cobertura sanitaria de esa intervención terapéutica. En Europa, existe una oferta de formación específica ligada a la universidad que en algunos países es requerida para acceder a un puesto de trabajo dedicado a la ETD. En España, la posibilidad de acceder a una formación universitaria específica es mucho menor y no se requiere para trabajar como educador en diabetes. Esto produce que la atención a las personas con diabetes no sea homogénea. Disponer de un marco curricular básico y acreditado, así como sensibilizar a las autoridades sanitarias de la necesidad de este, contribuiría a mejorar la calidad de la atención de las personas con diabetes(AU)

The World Health Organization has stated that health professionals involved in diabetes therapeutic education (DTE) must be adequately trained. In the U.S, specific training is supported by competent scientific societies and is regulated, as such that if not performed by an accredited nurse educator it could affect health insurance cover. There are also specific training programs in universities in many European countries, and such training is mandatory for a DTE position. This is not the case in Spain. The lack of regulation of DTE training leads to very unequal care for patients with diabetes. Having a certified basic curriculum framework and with health authorities being aware of the need for this, could improve the quality of care of the diabetic population(AU)

[Childhood diabetes]. / La diabetes en la edad pediátrica.

The authors review diabetes in children up to the age of 16, emphasizing how to treat this disease, the importance diet and physical exercise have in treating diabetes; plus the authors mention the influence of other factors such as psychological ones or the importance of educating patients about their diabetes. Lastly the authors analyze the role schools play and the importance there is at the time of transferring a diabetes patient from a pediatrics unit to an adult hospital.

La diabetes en la edad pediátrica / Childhood Diabetes

Se repasa la presentación de esta patología en la edad pediátrica, haciendo hincapié en su tratamiento, la importancia de la alimentación y el ejercicio físico, y también se tiene en cuenta la influencia de otros aspectos como los psicológicos o la importancia del material y la educación diabetológica. Se analiza, por último, la actuación de la escuela y la importancia de la transferencia desde las unidades pediátricas a un hospital de adultos(AU)

The authors review diabetes in children up to the age of 16, emphasizing how to treat this disease, the importance diet and physical exercise have in treating diabetes; plus the authors mention the influence of other factors such as psychological ones or the importance of educating patients about their diabetes. Lastly, the authors analyze the role schools play and the importance there is at the time of transferring a diabetes patient from a pediatrics unit to an adult hospital(AU)

Educación terapéutica ante la Diabetes Tipo 1(DM1). Iniciación con infusión subcutánea continua de insulina (ISCI) / Therapeutic education regarding type 1 diabetes (DM1)

Este artículo presenta una introducción sobre la diabetes, sus problemas asociados y la evidencia científica de prevenir y/o atrasar las complicaciones crónicas a través de la optimización del control metabólico. Se referencia uno de los estudios «The Diabetes Control and Complications Trial-DCCT» más importantes que ha marcado un antes y un después en el tratamiento de la diabetes mellitus tipo 1 (DM1). Centrado en el tratamiento con ISCI se describe: 1) Pacientes candidatos según las sociedades científicas. 2) Características y funcionamiento de los infusores de insulina, así como los diferentes modelos de infusores, catéteres, agujas e insertadores comercializados actualmente en España. Se aporta la experiencia del equipo de diabetes del Hospital Clínic de Barcelona en la terapia ISCI (en inglés, CSII). Se describe la estructura, el proceso que sigue el paciente y los resultados (evaluados a los dos años de seguimiento) del programa de Educación Terapéutica dirigido a las personas con DM1 candidatas a terapia ISCI(AU)

This article presents an introduction to diabetes and the problems associated with diabetes as well as scientific evidence on how to prevent or retard chronic complications diabetes causes by means of optimizing a diabetes sufferer’s metabolic control. The authors make reference to one of the most important studies by The Diabetes Control and Complications Trial-DCCT which has signified a before and an after in the treatment of type 1 diabetes mellitus (DM1). Focusing on the treatment of diabetes with continuous subcutaneous insulin injection (CSII), the authors describe 1) Patients who are candidates for this treatment according to scientific associations; 2) Characteristics and functioning methods for insulin delivery systems as well as the different models of insulin delivery systems, catheters, needles and commercial inserting mechanisms presently available in Spain. The authors report on the experiences that the diabetes team at the Barcelona «Hospital Clinic» have with CSII therapy. The authors describe the structure of a Therapeutic Educational Program directed at patients suffering from DM1 who are candidates for CSII therapy, the process which these patients follow and the results of this program, evaluated after two years of follow-up study(AU)

[Therapeutic education regarding type 1 diabetes (DM1)]. / Educación terapéutica ante la diabetes tipo 1 (DM1).

This article presents an introduction to diabetes and the problems associated with diabetes as well as scientific evidence on how to prevent or retard chronic complications diabetes causes by means of optimizing a diabetes sufferer's metabolic control. The authors make reference to one of the most important studies by The Diabetes Control and Complications Trial-DCCT which has signified a before and an after in the treatment of type 1 diabetes mellitus (DM1). Focusing on the treatment of diabetes with continuous subcutaneous insulin injection (CSII), the authors describe 1) Patients who are candidates for this treatment according to scientific associations; 2) Characteristics and functioning methods for insulin delivery systems as well as the different models of insulin delivery systems, catheters, needles and commercial inserting mechanisms presently available in Spain. The authors report on the experiences that the diabetes team at the Barcelona "Hospital Clinic" have with CSII therapy The authors describe the structure of a Therapeutic Educational Program directed at patients suffering from DM1 who are candidates for CSII therapy the process which these patients follow and the results of this program, evaluated after two years of follow-up study.

Health-related quality of life in rheumatoid arthritis: therapeutic education plus pharmacological treatment versus pharmacological treatment only.

OBJECTIVE: To determine whether therapeutic education added to conventional drug therapy reduced disability and pain in patients with early rheumatoid arthritis (RA). METHODS: Fourty-three patients with RA, 29F/14 M, were included in a randomized, controlled trial and assigned to a control group receiving conventional pharmacological treatment only (n=21), or an intervention group receiving therapeutic education added to conventional pharmacological treatment (n=22). The main outcome variable was self-reported disability on the Stanford health assessment questionnaire (HAQ). RESULTS: At 18 months, patients in the intervention group had less disability (HAQ), pain intensity, number of tender and swollen joints, and patient's and physician's global assessments (p=0.003, 0.031, 0.003, 0.001, 0.014, and 0.004, respectively) compared with baseline, and improvements in disability and number of tender and swollen joints (p=0.024, 0.040, and 0.003, respectively), compared with controls. CONCLUSIONS: Patients receiving pharmacological treatment and therapeutic education had a better evolution than those receiving only pharmacological treatment.