Real-world outcomes of two different sensor-augmented insulin pumps with predictive low glucose suspend function in type 1 diabetes patients.

AIM: To analyse the real-life outcomes of two sensor-augmented pumps (SAP) with predictive low glucose suspend (PLGS) function, Medtronic Minimed 640G™ with SmartGuard (MM640G) and Tandem T Slim X2™ with Basal-IQ™ (TTSX2), in Type 1 Diabetes Mellitus (T1DM) patients. METHODS: Observational cross-sectional study using data obtained from computerized clinical records. All T1DM patients on TTSX2 therapy were compared (1:1) with MM640G treated patients selected through stratified sampling. Primary efficacy outcome was to describe time in rage (TIR, 70-180 mg/dL, 3.9-10 mmol/L) interstitial glucose differences according to a non-inferiority hypothesis with TTSX2 compared to MM640G. RESULTS: Forty-four patients were analyzed (female 66%). Mean age was 38.9 yrs. (range 23-59 yrs.) and mean diabetes duration was 23.4 ± 9.2 yrs. Patients treated with TTSX2 showed a numerically slightly lower, but non-statistically significantly different, TIR from the MM640G pump group (64.9 ± 16.4% vs. 72.4 ± 17.0%, P = 0.108). Similarly, we did no find differences in HbA1c between T1D patients treated with TTSX2 and MM640G (6.8 ± 1.0% vs. 7.0 ± 0.9%, 51 ± 11 mmol/mol vs. 53 ± 10 mmol/mol, P = 0.312). Moreover, rest of evaluated glycemic outcomes were similar between both treatment groups. CONCLUSIONS: Patients using two different SAP with PLGS automatic function showed similar glycaemic control in a real-world scenario. NCT04741685.

Iodine status and thyroid function among Spanish schoolchildren aged 6-7 years: the Tirokid study.

I deficiency is still a worldwide public health problem, with children being especially vulnerable. No nationwide study had been conducted to assess the I status of Spanish children, and thus an observational, multicentre and cross-sectional study was conducted in Spain to assess the I status and thyroid function in schoolchildren aged 6-7 years. The median urinary I (UI) and thyroid-stimulating hormone (TSH) levels in whole blood were used to assess the I status and thyroid function, respectively. A FFQ was used to determine the consumption of I-rich foods. A total of 1981 schoolchildren (52 % male) were included. The median UI was 173 µg/l, and 17·9 % of children showed UI<100 µg/l. The median UI was higher in males (180·8 v. 153·6 µg/l; P<0·001). Iodised salt (IS) intake at home was 69·8 %. IS consumption and intakes of ≥2 glasses of milk or 1 cup of yogurt/d were associated with significantly higher median UI. Median TSH was 0·90 mU/l and was higher in females (0·98 v. 0·83; P<0·001). In total, 0·5 % of children had known hypothyroidism (derived from the questionnaire) and 7·6 % had TSH levels above reference values. Median TSH was higher in schoolchildren with family history of hypothyroidism. I intake was adequate in Spanish schoolchildren. However, no correlation was found between TSH and median UI in any geographical area. The prevalence of TSH above reference values was high and its association with thyroid autoimmunity should be determined. Further assessment of thyroid autoimmunity in Spanish schoolchildren is desirable.

Sustained benefit of continuous subcutaneous insulin infusion on glycaemic control and hypoglycaemia in adults with Type 1 diabetes.

AIM: To evaluate the sustainability of the benefits of continuous subcutaneous insulin infusion therapy in routine practice in a cohort of adults with diabetes. METHODS: The clinical records of all adults starting continuous subcutaneous insulin infusion over 12 years at our centre were included in this study. Baseline and mean annual HbA(1c) levels were recorded. The frequency of mild-to-moderate and severe hypoglycaemia and hypoglycaemia awareness were analysed in a subgroup. RESULTS: Adequate data were available from 327 patients, of whom 71% were female. The patients' mean ± sd age was 41 ± 14 years, the mean ± sd (range) follow-up for continuous subcutaneous insulin infusion was 4.3 ± 2.7 (1-12) years. The mean ± sd HbA(1c) concentration fell by 8 ± 5 mmol/mol (0.7 ± 0.5%) at year 1 [to 63 ± 12 mmol/mol from 70 ± 18 mmol/mol (7.9 ± 1.1% from 8.6 ± 1.6%); P < 0.0005], sustained to year 5. In patients with initial poor control, HbA(1c) dropped by 12 ± 11 mmol/mol (1.1 ± 1.0%; P < 0.0005) at year 1, sustained to year 6. The percentage of patients with ≥ 5 mild to moderate hypoglycaemic episodes per week fell from 29 to 12% (n = 163; P = 0.006). In the subgroup (n = 87; follow-up 2.5 ± mean ± sd 1.1 years), the frequency of severe hypoglycaemia fell from 0.6 ± 1.7 episodes per patient per year to 0.3 ± 0.9 (P = 0.047). Of 24 patients with impaired awareness of hypoglycaemia (Gold score ≥ 4), the mean ± sd Gold score improved from 4.9 ± 0.9 to 3.8 ± 1.7 (P = 0.011). Nine people regained awareness. No deterioration in HbA(1c) was seen in the hypoglycaemia-prone groups. CONCLUSIONS: The benefits of continuous subcutaneous insulin infusion with regard to improving glycaemic control and reducing hypoglycaemia frequency, along with improvement in hypoglycaemia awareness without deterioration in glycaemic control, can be sustained over several years in clinical practice.

Obesidad y sus complicaciones: resistencia insulínica y diabete mellitus tipo 2 / Obesity and its complications: insulin resistance and type 2 diabetes mellitus

La obesidad es una enfermedad crónica ocasionada por un desequilibrio entre la ingesta y el gasto energético consecuencia, en la mayoría de los casos, de una interacción entre el ambiente (ingesta, actividad, tóxicos, virus) y los genes de un individuo, de los que se han identificado casi 400 que pueden estar asociados con la obesidad. Existen numerosas complicaciones de la obesidad, sobre todo la visceral, que pueden mejorar con la pérdida de peso. Entre ellas, destacan las metabólicas, como diabetes mellitus y dislipemia aterogénica, enfermedad cardiovascular y distintos tipos de cáncer. En la génesis de la mayoría de complicaciones se ha implicado a la resistencia insulínica, originada a su vez por mecanismos inflamatorios consecuencia de la producción de citokinas y hormonas por el tejido adiposo. La obesidad también aumenta el riesgo de mortalidad por cualquier causa y asociada a enfermedad cardiovascular, diabetes y cáncer. Hay distintos tratamientos dietéticos que podemos emplear para reducir el peso corporal con similares resultados a largo plazo, si bien las dietas pobres en hidratos de carbono presentan unos efectos adversos que desaconsejan su uso. El tratamiento quirúrgico de la obesidad ha evolucionado hacia técnicas mixtas, la más frecuentemente empleada es el bypass gástrico, que consigue mejorar las comorbilidades y el riesgo de mortalidad, aunque puede ocasionar efectos adversos metabólicos que deben controlarse tras la cirugía. Presentamos una revisión de la epidemiología, etiopatogenia, complicaciones, estimación de requerimientos y opciones de tratamiento en la obesidad, destacando la asociación con la resistencia insulínica y diabetes mellitus de tipo 2 (AU)

Obesity is a chronic disease caused by a dysbalanced intake and energy expenditure relation that is mostly a consequence of an interaction between environment (intake, activity, toxics, viruses) and genes in a person; almost 400 of this genes may be linked with obesity. There are many complications of obesity, mainly visceral adiposity, among them, metabolic as diabetes mellitus or atherogenic dyslipidemia or cardiovascular ones and several types of cancer. Insulin resistance is involved in the pathogenesis of most of these complications and it is caused by inflammatory mechanisms derived from adipose tissue-produced cytokines and hormones. Obesity also increases the risk of any cause mortality as well as associated to cardiovascular disease, diabetes or cancer. Several diet therapies may be used to diminish body weight, all of them with similar long-term results; nevertheless, low-carbohydrate diets are discouraged because of the adverse effects they have shown. Surgical treatment of obesity has evolved to mixed restrictive-malabsorptive procedures, with gastric bypass as the most common employed; this procedure improves comorbidities and lower the risk of mortality, but it can cause metabolic adverse effects that must be controlled after surgery has be done. We are presenting a revision of obesity epidemiology, pathogenesis, complications, requirements estimations and different treatments, highlighting its association with insulin resistance and type 2 diabetes mellitus (AU)