[Evaluation of a follow-up program for diabetes after hospital discharge]. / Evaluación de un protocolo de seguimiento para diabetes tras el alta hospitalaria.

BACKGROUND: Given the higher rate of hospital admissions among diabetic patients, discharge should be used to optimize outpatient treatment. We evaluate a follow-up program for diabetic patients after hospital discharge to determine the evolution of glycemic control. METHOD: Retrospective collection of data on 375 diabetic patients enrolled in the follow-up program for optimization treatment: telephonic follow-up where treatment was adjusted if needed; and three months after discharge an in-person consultation was scheduled. Factors potentially associated with a 1% improvement in HbA1c were studied by multivariate logistic regression. RESULTS: Seventy-three percent of enrolled patients completed the follow-up program; each patient received an average of 4.6 phone calls. Globally, basal mean HbA1c was significantly lower three months later regarding the initial value (8.6 vs. 7.2%); the most relevant lowering was found in the group of hyper-glycemia by poor metabolic control (from 9.9 to 7.7%), combined hyperglycemia (from 9.3 to 7.3%) and debut (from 8.3 to 6.4%). Twenty percent of patients reported capillary hypoglycemia, with two severe events. A shorter duration of diabetes, absence of corticotherapy and absence of hypoglycemia during the follow-up period were independent predictors for a 1% reduction in three-months HbA1c. CONCLUSION: In patients whose treatment is changed on hospital discharge, a program allowing frequent treatment adjustment would improve HbA1c levels. These results could help to organize health resources more rationally.

Evaluación de un protocolo de seguimiento para diabetes tras el alta hospitalaria / Evaluation of a follow-up program for diabetes after hospital discharge

FUNDAMENTO: Ante la mayor tasa de hospitalizaciones de los pacientes con diabetes (DM), se recomienda aprovechar el momento del alta hospitalaria para optimizar su tratamiento ambulatorio. Evaluamos un protocolo de seguimiento tras el alta hospitalaria de pacientes con DM para conocer la evolución del control glucémico. MATERIAL Y MÉTODOS: Se recogieron de forma retrospectiva datos de los 375 pacientes diabéticos incluidos en el protocolo, basado en optimización del tratamiento previo, seguimiento telefónico con ajuste terapéutico intermedio durante tres meses y consulta presencial al final del periodo. Se estudiaron factores potencialmente relacionados con una disminución del 1% en la HbA1c final mediante regresión logística. RESULTADOS: El 73% de los pacientes incluidos completaron el seguimiento, recibiendo una media de 4,6 llamadas. Globalmente, la HbA1c se redujo significativamente a los tres meses respecto a la inicial (de 8,62 a 7,19%); los mayores descensos se observaron en pacientes con hiperglucemia por mal control metabólico previo (de 9,85 a 7,65%), hiperglucemia combinada (de 9,32 a 7,31%) y debut (de 8,29 a 6,36%). El 20,5 % de los pacientes presentaron hipoglucemia capilar, en dos casos grave. Un menor tiempo de evolución de la DM, la no necesidad de corticoterapia y la ausencia de hipoglucemias en el seguimiento fueron predictores independientes de una reducción de 1% en la HbA1c a los tres meses. CONCLUSIÓN: Un protocolo de seguimiento mediante contacto telefónico de pacientes con DM con cambios de tratamiento al alta hospitalaria, permite el ajuste frecuente de la dosis y mejora los niveles de HbA1c, lo que podría ayudar a distribuir los recursos asistenciales de forma más racional

BACKGROUND: Given the higher rate of hospital admissions among diabetic patients, discharge should be used to optimize outpatient treatment. We evaluate a follow-up program for diabetic patients after hospital discharge to determine the evolution of glycemic control. METHOD: Retrospective collection of data on 375 diabetic patients enrolled in the follow-up program for optimization treatment: telephonic follow-up where treatment was adjusted if needed; and three months after discharge an in-person consultation was scheduled. Factors potentially associated with a 1% improvement in HbA1c were studied by multivariate logistic regression. RESULTS: Seventy-three percent of enrolled patients completed the follow-up program; each patient received an average of 4.6 phone calls. Globally, basal mean HbA1c was significantly lower three months later regarding the initial value (8.6 vs. 7.2%); the most relevant lowering was found in the group of hyper-glycemia by poor metabolic control (from 9.9 to 7.7%), combined hyperglycemia (from 9.3 to 7.3%) and debut (from 8.3 to 6.4%). Twenty percent of patients reported capillary hypoglycemia, with two severe events. A shorter duration of diabetes, absence of corticotherapy and absence of hypoglycemia during the follow-up period were independent predictors for a 1% reduction in three-months HbA1c. CONCLUSION: In patients whose treatment is changed on hospital discharge, a program allowing frequent treatment adjustment would improve HbA1c levels. These results could help to organize health resources more rationally

Comparación del tratamiento con infusión subcutánea continua de insulina frente a la terapia con múltiples dosis de insulina con calculador de bolus en pacientes con diabetes tipo 1 / Comparison of treatment with continuous subcutaneous insulin infusion versus multiple daily insulin injections with bolus calculator in patients with type 1 diabetes

OBJETIVOS: Comparar el control glucémico, la calidad de vida, así como el miedo y percepción de las hipoglucemias en el grupo de infusión subcutánea continua de insulina (ISCI) frente a la terapia con múltiples dosis de insulina (MDI) con calculador de bolus. MATERIAL Y MÉTODOS: Estudio de cohortes retrospectivo con seguimiento durante los 12 primeros meses desde que el grupo ISCI (n = 30) comienza a utilizar el «bolus ayuda» y el grupo MDI-calculador (n = 30), comienza a utilizar el calculador de bolus (Accu-Chek® Aviva Expert). Variable de desenlace primaria: HbA1c (3, 6 y 12 meses). Cuestionarios empleados: EsDQOL (calidad de vida), FH-15 (miedo a las hipoglucemias), Clarke (percepción de las hipoglucemias). Análisis estadístico: T de Student y pruebas no paramétricas. RESULTADOS: El descenso medio de HbA1c a lo largo del estudio fue significativamente mayor en el grupo ISCI (−0,56 ± 0,84%) que en el grupo MDI (0,097 ± 0,94%), p = 0,028. La dosis media de insulina basal fue significativamente mayor en el grupo MDI (al inicio, 6 y 12 meses). No se encontraron diferencias significativas entre ambos grupos de tratamiento en los cuestionarios EsDQOL, FH-15 y Clarke. La calidad de vida percibida por los pacientes, valorada mediante el cuestionario EsDQOL, en el grupo ISCI fue significativamente mejor al final del estudio que al inicio de la utilización de la bomba de insulina. CONCLUSIONES: El descenso medio de HbA1c fue significativamente mayor en el grupo ISCI. Se objetivó una mejor calidad de vida en el grupo ISCI al final del estudio que al inicio

OBJECTIVES: A study of the glycemic control, quality of life, and fear and perception of hypoglycemia by comparing continuous subcutaneous insulin infusion (CSII) group with multiple daily inyections (MDI) with bolus calculator group. MATERIAL AND METHODS: This is a retrospective cohort study with following up during the first 12 months that CSII group (n = 30) begins the use of "bolus wizard" and the MDI-calculator (n = 30) group begins the use of the bolus calculator (Accu-Chek® Aviva Expert). Primary outcome: HbA1c (3, 6 and 12 months). Questionnaires used: EsDQOL (quality of life), FH-15 (fear of hypoglycemia), and Clarke (perception of hypoglycemia). Statistical analysis: T Student and nonparametric tests. RESULTS: The average reduction in HbA1c during the study was significantly higher in CSII group (−0.56 ± 0.84%) compared with the MDI group (0.097 ± 0.94%), P = .028. The average basal insulin dose was significantly higher in the MDI group (at baseline, 6 and 12 months). No significant differences were found between the 2 treatment groups after analyzing the EsDQOL, FH-15 and Clarke questionnaires. In the CSII group, perceived quality of life assessed by the EsDQOL questionnaire was found to be better at the end of the study than at the beginning of using the insulin pump. CONCLUSIONS: The average reduction in HbA1c was significantly higher in the CSII group. In the CSII group, perceived quality of life was better at the end of the study than at the beginning

Comparison of treatment with continuous subcutaneous insulin infusion versus multiple daily insulin injections with bolus calculator in patients with type 1 diabetes.

OBJECTIVES: A study of the glycemic control, quality of life, and fear and perception of hypoglycemia by comparing continuous subcutaneous insulin infusion (CSII) group with multiple daily inyections (MDI) with bolus calculator group. MATERIAL AND METHODS: This is a retrospective cohort study with following up during the first 12 months that CSII group (n=30) begins the use of "bolus wizard" and the MDI-calculator (n=30) group begins the use of the bolus calculator (Accu-Chek(®) Aviva Expert). PRIMARY OUTCOME: HbA1c (3, 6 and 12 months). Questionnaires used: EsDQOL (quality of life), FH-15 (fear of hypoglycemia), and Clarke (perception of hypoglycemia). STATISTICAL ANALYSIS: T Student and nonparametric tests. RESULTS: The average reduction in HbA1c during the study was significantly higher in CSII group (-0.56±0.84%) compared with the MDI group (0.097±0.94%), P=.028. The average basal insulin dose was significantly higher in the MDI group (at baseline, 6 and 12 months). No significant differences were found between the 2 treatment groups after analyzing the EsDQOL, FH-15 and Clarke questionnaires. In the CSII group, perceived quality of life assessed by the EsDQOL questionnaire was found to be better at the end of the study than at the beginning of using the insulin pump. CONCLUSIONS: The average reduction in HbA1c was significantly higher in the CSII group. In the CSII group, perceived quality of life was better at the end of the study than at the beginning.

Análisis de los resultados de la terapia subcutánea continua de insulina como alternativa al tratamiento intensivo en pacientes con diabetes mellitus tipo 1 / Analysis of the results of continuous subcutaneous insulin therapy as an alternative to intensive treatment in type 1 diabetic patients

Objetivo: Verifi car la efectividad del tratamiento y determinar las característicasclínicas de los pacientes que han podido infl uir en elcontrol metabólico posterior. Materiales y métodos: Se estudió a37 pacientes (21 varones y 16 mujeres), con una media de edad de36,2 ± 9,4 años. El tiempo de evolución de la diabetes previa a lainfusión subcutánea continua de insulina (ISCI) fue de 16,2 ± 7,4 años.Las complicaciones angiopáticas fueron la retinopatía (50%), la nefropatía(19%) y la neuropatía (11,4%). Los motivos de indicaciónde ISCI fueron los siguientes: mal control (33,3%), petición propia(27,8%), hipoglucemias (22,2%), variabilidad glucémica (13,9%)y otros (2,7%). Resultados: Se observó un descenso de la hemoglobinaglucosilada (HbA1c) a los 12 meses de –0,71 ± 0,58%(p <0,001), que se mantuvo a los 36 meses en valores de –0,9 ±0,54% (p <0,001). Los requerimientos de insulina basal disminuyerony posteriormente se mantuvieron estables (inicio: 0,29 ± 0,08U/kg/día; 36 meses: 0,32 ± 0,14 U/kg/día). Se apreció una gananciade peso en los pacientes de 2,7 ± 4,8 kg a los 3 años con ISCI.Los participantes con una mayor HbA1c basal y un tiempo más largode evolución de la diabetes presentaron un descenso superior de laHbA1c con ISCI. Conclusiones: Se constató una mejora mantenidadel control glucémico y un descenso de las necesidades de insulinabasal. El mayor descenso de la HbA1c se obtuvo en los pacientes conuna mayor evolución de la diabetes y un peor control, que eran factorespronóstico de una mejor respuesta a esta terapia(AU)

Aim: To verify the efficacy of CSII treatment and determine patient’sclinical features that could have influenced the posterior metaboliccontrol. Methods: 37 patients; 21 males and 16 females, meanage of 36.2 ± 9.4 years. Mean duration of diabetes prior to CSII of16.2 ± 7.4 years and previous year mean A1c of 8.1 ± 0.9%. Diabeticcomplications: 50% retinopathy, 19% nephropathy, and 11.4%neuropathy. Indications for CSII: poor metabolic control (33.3%), patientrequest (27.8%), frequent hypoglycaemia (22.2%), glycaemicvariability (13.9%) and other (2.8%). Results: Starting A1c was loweredsignificantly in the first year of CSII –0.71 ± 0.58% (p <0.001)and stable –0.9 ± 0.54% (p <0.001) after 36 months. Basal insulinrequirements decreased and subsequently remained stable(start: 0.29 ± 0.08 U/kg/d; after 36 months: 0.32 ± 0.14 U/kg/d;p <0.001). The greatest reduction in A1c was found in patients withhigher baseline A1c and longer duration of diabetes. Conclusions:CSII resulted in a steady improvement in glycaemic control and reductionin insulin requirements. it could be considered a predictorfactor of treatment effect(AU)

[Morbidity and mortality among the hospitalized aged. Identification of prognostic factors]. / Morbimortalidad hospitalaria en la cuarta edad. Identificación de factores pronósticos.

BACKGROUND: Advancing age is an independent predictor of increased mortality. Our purpose was to study morbimortality in very elderly inpatients (Eighty years and older) and to recognize risk factors of hospital-associated mortality. METHODS: All consecutive eighty years and older patients admitted at the Hospital over a one year period were studied. On the first day we collected: symptoms, signs, presumed diagnostic, arterial blood pressure, pulse and respiratory frequency, level of alertness, hydration status, level of hemoglobin, plasma urea, creatinine, Na, K, albumin and arterial blood gases. We also collected end-stay diagnostic and outcome. RESULTS: A total of 131 patients were included with a mean age 83.92 +/- 3.53 (+/-SD). The most frequent diseases were heart failure, chronic obstructive pulmonary disease, stroke and pneumonia. While inpatient 21 (16%) died (Mean age 85.42 +/- 4.46, p < 0.05). Patients whose admission symptoms were arthralgia, myalgia, diarrhea, anemia, syncope and hemiparesis (p < 0.05) and whose presumed diagnostic were rheumatic disease (p < 0.01) and nephrourological disorder (p < 0.001) had lower mortality. A presumed diagnostic on admission of pneumonia had higher mortality (p < 0.05). Risk factors associated with higher mortality were dehydrations signs, decreased alertness status, hypoalbuminemia and elevated plasma urea (p < 0.001). When analysed altogether in order to predict Hospital-associated death had sensitivity 80%, specificity 87%, truepredictive rate 44% and false-predictive rate 97%. CONCLUSIONS: Morbidity of the very elderly patients is caused by chronic disorders. Pneumonia is a leading cause of death mainly in patients with decreased level of alertness, dehydration, hypoalbuminemia and elevated plasma urea.