Assessment of Alimentación Normal con Ajuste de Insulina (ANAIS), a Spanish version of the DAFNE programme, in people with Type 1 diabetes: a randomized controlled parallel trial.

AIM: To evaluate the effects of Alimentación Normal con Ajuste de Insulina (ANAIS), a group-based, therapeutic education programme for Type 1 diabetes based on a flexible insulin regimen adjusted to the individual's food intake. METHODS: Participants with Type 1 diabetes and HbA1c levels of 53-86 mmol/mol (7-10%) were recruited from outpatient clinics at a tertiary care centre. They were randomized (using opaque, sealed envelopes, with a 2:1 treatment allocation ratio) to attend the training course immediately (immediate ANAIS; intervention group) or a year later (delayed ANAIS; control group). The main outcome was HbA1c level at 1 year. Secondary outcomes included lipid levels, weight, hypoglycaemic events, insulin dose, treatment satisfaction, self-perceived dietary freedom, quality of life and participant-defined goals. RESULTS: A total of 48 participants were assigned to the intervention group and 32 to the control group. Twelve months after completing the training, adjusted HbA1c was not significantly different in the intervention group [64 ± 1.3 vs 68 ± 1.6 mmol/mol (8.0 ±0.1% vs 8.4 ±0.1%); P=0.081]. Treatment satisfaction was significantly higher in the intervention group, but no differences were found in hypoglycaemic events, weight, insulin dose or changes in dietary freedom. At 1 year after the intervention, 72% of the participants (vs 33% in the control group; P=0.046) reported exceeding their expectations regarding achievement of their main personal goal. CONCLUSION: Promoting dietary freedom and empowering people with Type 1 diabetes through structured education programmes, such as ANAIS, improves treatment satisfaction and self-defined goals. No significant improvement in HbA1c level was achieved.

[Incidence of type 1 diabetes mellitus in the Canary Islands (1995-1996). Epidemiologic Group of the Canary Society of Endocrinology and Nutrition]. / Incidencia de diabetes mellitus tipo 1 en las Islas Canarias (1995-1996). Grupo de Epidemiología de la Sociedad Canaria de Endocrinología y Nutrición.

OBJECTIVE: To prospectively evaluate the incidence of type 1 diabetes mellitus in patients up to 30 years of age in the Canary Islands during 1995 and 1996. PATIENTS AND METHODS: The population under study consisted of 744,444 inhabitants in the 0-29 year old group and 302,293 in the 0-14 year old group. The capture-recapture method was used for estimating the probability of ascertainment. Hospital records and endocrinologists' reports were the primary source, whereas reports from the Canary Diabetes Association reports and sales of blood glucose monitors were the secondary source. RESULTS: A total of 223 new cases of type 1 diabetes mellitus were detected during the study period. The degree of ascertainment was 90.1%. The observed incidence rates were 23.2 per 100,000 per year for the 0-14 year old group and 9.2 per 100,000 per year for the 15-29 year old group. The overall incidence rate was 15 per 100,000 per year for the entire group. The highest incidence was found in the 10-14 year old group. The incidence in males was higher than in females, and particularly significant in the 15-29 year old group. No seasonal onset pattern was detected. CONCLUSIONS: A high rate of incidence of type 1 diabetes mellitus was observed in this study in children aged less than 15 years living in the Canary Islands.

[Effectiveness of treatment with metformin in patients with type 2 diabetes mellitus poorly controlled with insulin treatment]. / Eficacia del tratamiento con metformina en pacientes con diabetes mellitus tipo 2 pobremente controlada con insulinoterapia.

Combined treatment with insulin plus metformin could be a good alternative to improve the glycemic control in patients with type 2 diabetes mellitus poorly controlled with insulin therapy. We retrospectively studied 21 obese insulin-treated type 2 diabetic patients with deficient metabolic control (HbA1c 9.2 +/- 1.2%) who were treated with metformin for a minimum of 8 months. After 4 months of treatment, a significant decrease in the percentage of HbA1c was observed (delta HbA1c -1.07 +/- 1.12%; p < 0.01), with maintained values since then. Non changes in body weight or insulin requirement were noted. Our results suggest that the addition of metformin to insulin treatment is a safe and effective strategy for the improvement of glycemic control among obese type 2 diabetic patients.

[Type II autoimmune polyglandular syndrome associated with empty sella turcica]. / Síndrome pluriglandular autoinmune tipo II asociado a silla turca vacía.

A case of autoimmune polyglandular deficiency type II (Addison's disease, primary hypothyroidism, primary hypogonadism of a lengthy evolution and vitiligo), associated with a progressive sellar enlargement, is presented.