Incidence of type 1 diabetes in Navarra, 2009-2020. Evidence of a stabilization.

INTRODUCTION: The evolution of the incidence of type 1 diabetes (T1D) in all groups is controversial. Our objective is to study the incidence from 2009 to 2020, based on the Type 1 Diabetes Registry of Navarra, and to analyze the clinical presentation as diabetic ketoacidosis (DKA), and HbA1c at onset. MATERIALS AND METHODS: Descriptive study of all cases diagnosed as T1D and included in the Population Registry of T1D of Navarra in the period 1/1/2009 to 12/31/2020. Data are obtained from primary and secondary sources with an ascertainment rate of 96%. Incidence rates are expressed per 100,000 person-years of risk, by age group and sex. Likewise, a descriptive analysis of the HbA1c and DKA at diagnosis of each patient is performed. RESULTS: 627 new cases are registered, which represents an incidence of 8.1 (10 in men, 6.3 in women), without differences throughout the analyzed period. The group with the highest incidence is the 10-14 years old children (27.8), followed by that of 5-9 years old (20.6). The incidence in people older than 15 years is 5.8. Twenty six percent of patients present DKA at onset. The global mean of HbA1c is 11.6%, without changes throughout the studied period. CONCLUSIONS: The population registry of T1D of Navarra shows a stabilization in the incidence of T1D at all ages in the 2009-2020 period. The percentage of presentation as severe forms is high, even in adulthood.

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