Effect of Christmas Holidays on Type 1 Diabetes Mellitus in Users of Glucose Flash Systems.

OBJECTIVE: Christmas holidays can impact weight and glycemic control in type 2 diabetes, but their effect on type 1 diabetes (T1D) remains understudied. This study assessed how Christmas holidays affect individuals with T1D who use flash continuous glucose monitoring systems. METHODS: This retrospective study involved 812 adults diagnosed with T1D recruited from 3 hospitals. Clinical, anthropometric, and socioeconomic data were collected. Glucose metrics from 14 days before January 1st, and before December 1st and February 1st as control periods, were recorded. Analyses adjusted for multiple variables were conducted to assess the holiday season's impact on glycemic control. RESULTS: The average time in range during the holidays (60.0 ± 17.2%) was lower compared to December (61.9 ± 17.2%, P < .001) and February (61.7 ± 17.7%, P < .001). Time above range (TAR > 180 mg/dL) was higher during Christmas (35.8 ± 18.2%) compared to December (34.1 ± 18.3%, P < .001) and February (34.2 ± 18.4%, P < .001). Differences were also observed in TAR >250 mg/dL, coefficient of variation, and average glucose (P < .05). No differences were found in time below range or other metrics. Linear regression models showed that the holidays reduced time in range by 1.9% (ß = -1.92, P = .005) and increased TAR >180 mg/dL by 1.8% (ß = 1.75, P = .016). CONCLUSION: Christmas holidays are associated with a mild and reversible deterioration in glucose metrics among individuals with T1D using flash continuous glucose monitoring, irrespective of additional influencing factors. These discoveries can be useful to advise individuals with diabetes during the festive season and to recognize potential biases within studies conducted during this timeframe.

Impact of socioeconomic status on chronic control and complications of type 1 diabetes mellitus in users of glucose flash systems: a follow-up study.

BACKGROUND: This study investigates the association between socioeconomic status (SES) and glycemic control in individuals with type 1 diabetes (T1D) using flash glucose monitoring (FGM) devices within a public health system where these technologies are freely available and utilized according to recommended guidelines. METHODS: A follow-up study of 1060 adults (mean age 47.4 ± 15.0 years, 49.0% women) with T1D, receiving care at three Spanish university hospitals that regularly employ the FGM system. SES was assessed using the Spanish Deprivation Index and the average annual net income per person. Glycemic data were collected over a 14-day follow-up period, including baseline glycated hemoglobin (HbA1c) levels prior to sensor placement, the last available HbA1c levels, and FGM-derived glucose metrics. Individuals with sensor usage time < 70% were excluded. Chronic micro and macrovascular complications related to diabetes were documented. Regression models, adjusted for clinical variables, were employed to determine the impact of SES on optimal sensor control (defined as time in range (TIR) ≥ 70% with time below range < 4%) and disease complications. RESULTS: The average follow-up was of 2 years. The mean TIR and the percentage of individuals with optimal control were higher in individuals in the highest SES quartile (64.9% ± 17.8% and 27.9%, respectively) compared to those in the lowest SES quartile (57.8 ± 17.4% and 12.1%) (p < 0.001). Regression models showed a higher risk of suboptimal control (OR 2.27, p < 0.001) and ischemic heart disease and/or stroke (OR 3.59, p = 0.005) in the lowest SES quartile. No association was observed between SES and the risk of diabetic nephropathy and retinopathy. FGM system improved HbA1c levels across all SES quartiles. Although individuals in the highest SES quartile still achieved a significantly lower value at the end of the follow-up 55 mmol/mol (7.2%) compared to those in the lowest SES quartile 60 mmol/mol (7.6%) (p < 0.001), the significant disparities in this parameter between the various SES groups were significantly reduced after FGM technology use. CONCLUSIONS: Socioeconomic status plays a significant role in glycemic control and complications in individuals with T1D, extending beyond access to technology and its proper utilization. The free utilization of FGM technology helps alleviate the impact of social inequalities on glycemic control.

Scans per day as predictors of optimal glycemic control in people with type 1 diabetes mellitus using flash glucose monitoring: what number of scans per day should raise a red flag?

AIMS: This study aimed to determine the minimum frequency of flash glucose monitoring (FGM) scans necessary for optimal glycemic control in patients with type 1 diabetes (T1D). METHODS: Data were collected from 692 patients (47.5% female, with a median age of 47.4 years) who used FGM systems daily and recorded their clinical variables and device data. RESULTS: Logistic regression models showed that performing more than 12 scans per day was associated with improved T1D control (OR = 4.22, p < 0.001) and a reduction in HbA1c (7.6 vs 7.0%, 60-53 mmol/mol p < 0.001). However, those performing less than 6 scans showed no improvement in HbA1c (7.9 vs 7.8%, 63-61 mmol/mol p = 0.514). Thirteen daily scans were determined as the optimal cutoff point for predicting optimal glycemic control using a maximally selected rank algorithm. Significant reductions were observed in mean glucose (< 0.001), coefficient of variation (< 0.001), HbA1c (< 0.001), and an increase in TIR (< 0.001) in patients who performed more than 12 daily scans. CONCLUSIONS: The results suggest that a higher frequency of daily scans by T1D patients using FGM systems leads to improved chronic glycemic control. The minimum recommended frequency for optimal control is 13 scans per day, and more than 6 daily scans are needed to improve HbA1c.

Inicio del curso escolar durante la segunda ola de la COVID 19: una oportunidad para la salud comunitaria en las zonas básicas de salud de La Elipa y Daroca (Madrid) / Start of the academic year during the second wave of COVID-19: an opportunity for community health in the basic health areas of La Elipa and Daroca (Madrid)

Introducción y objetivos: El comienzo del curso escolar durante la epidemia por COVID-19 hizo necesaria la comunicación entre el Centro de Salud Daroca (Madrid) y los centros educativos de su zona. Métodos: Se realizó un mapeo de los centros educativos estableciendo contacto telefónico y ofreciendo un correo electrónico para compartir incidencias. Se recogieron datos sobre las medidas adoptadas ante la epidemia y se celebraron sesiones informativas en los centros que lo solicitaron, evaluadas mediante cuestionarios. Resultados: Se contactó con 14 centros educativos de la zona (3.635 alumnos y 412 profesionales) y se intercambiaron 103 correos electrónicos. Todos los centros tomaron medidas especiales ante la epidemia. Se impartieron 13 sesiones informativas en 3 centros: 92,5% solicitaron más sesiones y la puntuación media fue de 8,1. Conclusiones: El contacto del centro de salud con los centros educativos tuvo muy buena acogida y supuso un punto de partida para establecer un vínculo comunicativo. (AU)

Introduction and objectives: The onset of the school year during the COVID-19 epidemic made communication between Daroca Health Centre (Madrid) and the schools in its area of influence of paramount importance. Methods. Schools were mapped after establishing contact by phone. Data were collected regarding the interventions made to tackle the epidemic. An e-mail for sharing incidences was provided. Informative sessions were held in the schools when requested; these were evaluated using ad hoc questionnaires. Results. Fourteen schools were contacted (3635 students and 412 school workers) and 103 e-mails were exchanged. All schools took special measures to tackle the epidemic and 13 briefing sessions were held in three centres. A total of 92.5% requested further sessions addressing health issues and their mean satisfaction score was 8.1 Conclusions. Contact between health centres and schools appears to be satisfactory and serves as a starting point for establishing a communication link. (AU)

Economic Migrants and Clinical Course of SARS-CoV-2 Infection: A Follow-Up Study.

Objective: To analyze whether social deprivation and economic migrant (EM) status influence the risk of being hospitalized with COVID-19. Methods: This was a retrospective follow-up study including all patients older than 18 years attending the Daroca Health Center in Madrid, Spain, diagnosed with COVID-19 during September 2020. Data on EM status and other sociodemographic, lifestyle and comorbidities that could affect the clinical course of the infection were obtained from electronic medical records. Results: Of the 796 patients positive for COVID-19, 44 (5.53%) were hospitalized. No significant differences were observed between those who were hospitalized and those who were not in the mean of social deprivation index or socioeconomic status, but EM status was associated with the risk of being hospitalized (p = 0.028). Logistic regression models showed that years of age (OR = 1.07; 95% CI: 1.04-1.10), EM status (OR = 5.72; 95% CI: 2.56-12.63) and hypertension (OR = 2.22; 95% CI: 1.01-4.85) were the only predictors of hospitalization. Conclusion: Our data support that EM status, rather than economic deprivation, is the socioeconomic factor associated with the probability of hospital admission for COVID-19 in Madrid, Spain.

Safety and Efficacy of SGLT2 Inhibitors: A Multiple-Treatment Meta-Analysis of Clinical Decision Indicators.

To jointly assess the safety and effectiveness of sodium-glucose cotransporter 2 inhibitors (SGLT2i) on cardiorenal outcomes and all-cause mortality in type 2 diabetes mellitus (T2DM) with or at high risk of cardiovascular disease (CVD). We performed a systematic review and network meta-analysis, systematically searching the MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials and Web of Science databases up to September 2020. Primary outcomes were composite major adverse cardiovascular events (MACEs), hospitalization for heart failure, all-cause mortality and a composite renal outcome. We performed a random effects network meta-analysis estimating the pooled hazard ratio (HR), risk ratio and number needed to treat (NNT). Six trials evaluating empagliflozin, canagliflozin, dapagliflozin and ertugliflozin met the inclusion/exclusion criteria, which comprised 46,969 patients, mostly with established CVD. Pooled estimates (95% CI) of benefits of SGLT2i in terms of HR and NNT were as follows: for all-cause mortality, 0.85 (0.75, 0.97) and 58 (28, 368); for MACE, 0.91 (0.85, 0.97) and 81 (44, 271); for hospitalization for heart failure, 0.70 (0.62, 0.78) and 32 (20, 55); and for composite renal outcome, 0.61 (0.50, 0.74) and 20 (11, 44). Pooled estimates for serious adverse events were 0.92 (95% CI 0.89, 0.95). In patients with T2DM at cardiovascular risk, ertugliflozin is a less potent drug than empagliflozin, canagliflozin or dapagliflozin to prevent cardiorenal events and all-cause mortality. In addition, our data endorse that empagliflozin is the best treatment option among SGLT2i for this type of patient, but the evidence is not consistent enough.

Estudio de seguimiento de la prevalencia de delgadez y sobrepeso de una cohorte de escolares de 4 a 6 años de Castilla-La Mancha.

Introducción y objetivos: los objetivos del presente estudio fueron: a) estimar la prevalencia de sobrepeso/obesidad y delgadez en escolares nacidos en 2007 y 2008 de Castilla-La Mancha, España, en los años 2013 y 2015; y b) analizar la persistencia en las mismas categorías de estatus ponderal entre 2013 y 2015 en esta cohorte de escolares.Material y métodos: estudio de seguimiento en el que se analizaron los datos antropométricos de los escolares nacidos en 2007 y 2008 en los años 2013 (4-6 años) y 2015 (6-8 años). Se invitó a participar a todos los escolares de 21 colegios de las provincias de Cuenca y Ciudad Real que cursaban tercero de Educación Infantil o primero de Educación Primaria en 2013. En todos ellos se determinaron, además de variables sociodemográficas, peso, talla y porcentaje de grasa corporal por bioimpedancia eléctrica.Resultados: la prevalencia de delgadez, sobrepeso y obesidad en la medición basal fue de 20,7%, 12% y 8,2% respectivamente. Dos años después, la prevalencia de delgadez disminuyó hasta 14,7% y la de sobrepeso y obesidad aumentó hasta 15,4% y 8,4% respectivamente. Por otro lado, el 78,8% de los escolares permanecía en 2015 en la misma categoría ponderal que en 2013.Conclusiones: el aumento en la prevalencia de sobrepeso/obesidad de los escolares parece estar remitiendo, al mismo tiempo que el incremento en la prevalencia de bajo peso ha aumentado sustancialmente. Por último, los escolares tienden a mantener el estatus ponderal previo al rebote adiposo durante la edad escolar.

Estudio de seguimiento de la prevalencia de delgadez y sobrepeso de una cohorte de escolares de 4 a 6 años de Castilla-La Mancha / Trends in underweight and excess of weight prevalence in a cohort of 4-to 6-year-old schoolchildren from Castilla-La Mancha

Introducción y objetivos: los objetivos del presente estudio fueron: a) estimar la prevalencia de sobrepeso/obesidad y delgadez en escolares nacidos en 2007 y 2008 de Castilla-La Mancha, España, en los años 2013 y 2015; y b) analizar la persistencia en las mismas categorías de estatus ponderal entre 2013 y 2015 en esta cohorte de escolares. Material y métodos: estudio de seguimiento en el que se analizaron los datos antropométricos de los escolares nacidos en 2007 y 2008 en los años 2013 (4-6 años) y 2015 (6-8 años). Se invitó a participar a todos los escolares de 21 colegios de las provincias de Cuenca y Ciudad Real que cursaban tercero de Educación Infantil o primero de Educación Primaria en 2013. En todos ellos se determinaron, además de variables sociodemográficas, peso, talla y porcentaje de grasa corporal por bioimpedancia eléctrica. Resultados: la prevalencia de delgadez, sobrepeso y obesidad en la medición basal fue de 20,7%, 12% y 8,2% respectivamente. Dos años después, la prevalencia de delgadez disminuyó hasta 14,7% y la de sobrepeso y obesidad aumentó hasta 15,4% y 8,4% respectivamente. Por otro lado, el 78,8% de los escolares permanecía en 2015 en la misma categoría ponderal que en 2013. Conclusiones: el aumento en la prevalencia de sobrepeso/obesidad de los escolares parece estar remitiendo, al mismo tiempo que el incremento en la prevalencia de bajo peso ha aumentado sustancialmente. Por último, los escolares tienden a mantener el estatus ponderal previo al rebote adiposo durante la edad escolar (AU)

Introduction and objectives: The aims of this study were to: a) estimate the prevalence of overweight/obesity and thinness in a sample of schoolchildren which were born in 2007 and 2008 from Castilla-La Mancha, Spain, in the years 2013 and 2015; and b) examine the persistence, from 2013 to 2015, in the same weight status category in this cohort. Material and methods: Follow up study in which we analysed anthropometric variables in schoolchildren that were born in 2007 and 2008 during the years 2013 (4-6 years old) and 2015 (6-8 years old). We invited to participate all children belonging to third grade of pre-primary education and first grade of primary education of 21 schools from Cuenca and Ciudad Real provinces. Sociodemographic variables, weight, height and body fat percentage by electric bioimpedance were determined in all participants. Results: The prevalence of thinness, overweight and obesity at the baseline was 20.7%, 12% and 8.2%, respectively. After two years, the prevalence of thinness decreased to 14.7% and the prevalence of overweight and obesity increased to 15.4% and 8.4%, respectively. Besides, a 78.8% of schoolchildren remained at 2015 in the same weight status category that were in 2013. Conclusions: The increase in the prevalence of overweight/obesity in the Spanish schoolchildren might be levelling off; in parallel, thinness prevalence has substantially increased. Lastly, the weight status previous to adipose rebound tracks to school age (AU)