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Chico A, Moreno-Fernández J, Fernández-García D, Solá E. The Hybrid Closed-Loop System Tandem t:slim X2™ with Control-IQ Technology: Expert Recommendations for Better Management and Optimization. Diabetes Ther 2024; 15:281-295. [PMID: 37857988 PMCID: PMC10786785 DOI: 10.1007/s13300-023-01486-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Accepted: 10/04/2023] [Indexed: 10/21/2023] Open
Abstract
Technological advances in the management of diabetes, especially type 1 diabetes (T1D), have played a main role in significantly improving glycemic control of these patients in recent years. Undoubtedly, the most important advance has been the commercialization of hybrid closed-loop systems (HCL). Their effectiveness places them in the different guidelines from scientific societies as the gold standard for the treatment of people with T1D. However, obtaining the maximum performance from these systems requires a degree of expertise from the professionals who care for these patients. Specifically, the Tandem X2:slim with Control-IQ technology system, due to its features and configuration options and adjustments, allows T1D patients to better adapt the management of diabetes to multiple circumstances in their day-to-day life. It is necessary, however, to follow a systematic process to start the system and also for the subsequent follow-up, which allows its optimization in the shortest possible time. This expert recommendation reviews the main features of this HCL system, suggesting how to implement it and optimize its use after gaining experience treating many patients.
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Affiliation(s)
- Ana Chico
- Department of Endocrinology and Nutrition, Hospital Santa Creu i Sant Pau, Av. Pare Claret 167, 08025, Barcelona, Spain.
- Universitat Autònoma de Barcelona, Barcelona, Spain.
- CIBER-BBN, Instituto de Salud Carlos III, Madrid, Spain.
| | - Jesús Moreno-Fernández
- Department of Endocrinology and Nutrition, Hospital General Universitario de Ciudad Real, Ciudad Real, Spain
| | - Diego Fernández-García
- Department of Endocrinology and Nutrition, Hospital Universitario Virgen de la Victoria, Málaga, Spain
- Hospital Vithas Xanit Benalmádena, Málaga, Spain
- Instituto de Investigación Biomédica de Málaga, Málaga, Spain
- CIBER-OBN, Instituto Salud Carlos III, Madrid, Spain
| | - Eva Solá
- Department of Endocrinology and Nutrition, Hospital Universitario Dr Peset, Foundation for the Promotion of Health and Biomedical Research in the Valencian Region (FISABIO), Valencia, Spain
- Departament of Medicine, University of Valencia, Valencia, Spain
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Mateu-Salat M, Moreno-Fernández J, Mangas N, Genua I, Martínez MJ, López A, González C, Chico A. Evaluation of the usefulness of and satisfaction with the flash glucose monitoring system (FreeStyle Libre®) guide for use in patients with type 1 diabetes⋆. ENDOCRINOL DIAB NUTR 2022; 69:316-321. [PMID: 35577748 DOI: 10.1016/j.endien.2022.03.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Revised: 03/29/2021] [Accepted: 04/15/2021] [Indexed: 06/15/2023]
Abstract
The Flash Guide (FG) for insulin dosing (A. Chico, C. González) was the first document intended for FreeStyle Libre® (FSL) user patients to help with decision-making depending on glucose level and trend. The objective of the study was to evaluate the usefulness of and the level of satisfaction with the recommendations given by the FG in a group of patients with type 1 diabetes (DM1) who were FSL users. It included 31 subjects (54% women; age 41 ± 15 years; DM duration 21 ± 14 years; 22 with FSL > 12 months) who were provided with the FG. They completed a questionnaire on decision-making depending on glucose trend in different situations (before and three months after using the FG), and a satisfaction questionnaire (ad hoc). Demographic, clinical and glycaemic control data were collected. The percentage of subjects who used glucose trend in decision-making after receiving the FG increased: for adjusting insulin (51 vs. 83; p = 0.016), action without insulin (51 vs. 90%; p = 0.001), and in special circumstances. The FG was evaluated as very useful (4.19/5). There were no significant changes in glycaemic control, although the percentage of data gathered increased significantly (89.07 vs. 94.46%; p = 0.042). In conclusion, the FG was evaluated well for managing glucose trends with FSL by the patients with DM1 analysed, increasing their use of trend in decision-making, with no changes in glycaemic control, but with more data gathered.
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Affiliation(s)
- Manuel Mateu-Salat
- Servicio de Endocrinología y Nutrición, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Jesús Moreno-Fernández
- Sección de Endocrinología y Nutrición, Hospital Universitario de Ciudad Real, Ciudad Real, Spain
| | - Natalia Mangas
- Servicio de Endocrinología y Nutrición, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Idoia Genua
- Servicio de Endocrinología y Nutrición, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - María José Martínez
- Servicio de Endocrinología y Nutrición, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Alicia López
- Servicio de Endocrinología y Nutrición, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Cintia González
- Servicio de Endocrinología y Nutrición, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain; Centro de Investigación Biomédica en Red de Bioingeniería, Biomateriales y Nanomedicina (CIBER-BBN), Madrid, Spain; Universitat Autònoma de Barcelona, Bellaterra, Barcelona, Spain
| | - Ana Chico
- Servicio de Endocrinología y Nutrición, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain.
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Moreno-Fernández J, Herrera Montoro V, Virlaboa Cebrian R, Martín Davila FJ. Parasitic thyroid nodules: The differential diagnosis. ENDOCRINOL DIAB NUTR 2022; 69:381-382. [PMID: 35697470 DOI: 10.1016/j.endien.2022.05.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Accepted: 02/05/2021] [Indexed: 06/15/2023]
Affiliation(s)
- Jesús Moreno-Fernández
- Endocrinology and Nutrition Department, Ciudad Real General University Hospital, Ciudad Real, Spain.
| | - Violeta Herrera Montoro
- Anatomical Pathology Department, Ciudad Real General University Hospital, Ciudad Real, Spain
| | - Rita Virlaboa Cebrian
- Endocrinology and Nutrition Department, Ciudad Real General University Hospital, Ciudad Real, Spain
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Herranz-Antolín S, Sastre J, Gonzalvo-Díaz C, Del Val-Zaballos F, Moreno-Fernández J, González-López J, Quiroga-López I, López-Gallardo G. Prevalence of autoimmune diseases in patients with type 1 diabetes mellitus. DIACAM 1 study 2010-2020. Med Clin (Barc) 2022; 159:522-528. [PMID: 35339291 DOI: 10.1016/j.medcli.2022.01.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Revised: 01/25/2022] [Accepted: 01/27/2022] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To evaluate the prevalence of autoimmune diseases (AD) associated with type 1 diabetes mellitus (T1DM). PATIENTS AND METHODS Analytical cross-sectional study, nested in a multicenter prospective cohort of 1121 adults with DM1 with active follow-up in endocrinology clinics. Sociodemographic and clinical variables and the presence of AD were analysed in 2010 and 2020. RESULTS In this second analysis, 49,5% were male, mean age was 49.4 ± 12.8 years, median T1DM duration was 27,1 years (20,7-35,1) and mean glycated hemoglobin was 7.66 ± 1.06%. There is an absolute increase of 13% (95% CI 11-15) (p < 0.001) of patients with at least one AE and an absolute increase of 11.6% (95% CI 9.7-13.5) (p < 0.0001) of any type of autoimmune thyroid disease (ATD) after 10 years of follow-up. Likewise, the prevalence of celiac disease, autoimmune gastritis and other AD increased statistically significantly. In the multivariate logistic regression analysis, the factors that were independently associated with the presence of ATD were female gender [OR 2.9 (95% CI 2.3-3.7); p < 0.0001] and the presence of type 1 b diabetes (OR 0.5 [95% CI 0.3-0.9]; p = 0.041). CONCLUSIONS After 10 years of follow-up, there is a substantial increase in other types of AE in patients with DM1. It seems necessary to carry out a systematic screening of these AD to optimize the follow-up of patients with 1 TDM, mainly of the ATD.
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Affiliation(s)
- Sandra Herranz-Antolín
- Sección de Endocrinología y Nutrición, Hospital Universitario de Guadalajara, Guadalajara, España.
| | - Julia Sastre
- Servicio de Endocrinología y Nutrición, Complejo Hospitalario de Toledo, Toledo, España
| | - César Gonzalvo-Díaz
- Servicio de Endocrinología y Nutrición, Complejo Hospitalario de Albacete, Albacete, España
| | | | - Jesús Moreno-Fernández
- Sección de Endocrinología y Nutrición, Hospital General Universitario de Ciudad Real, Ciudad Real, España
| | | | - Iván Quiroga-López
- Sección de Endocrinología y Nutrición, Hospital General Nuestra Señora del Prado, Talavera de la Reina, Toledo, España
| | - Gema López-Gallardo
- Sección de Endocrinología y Nutrición, Hospital Santa Bárbara,Puertollano, Ciudad Real, España
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Mateu-Salat M, Moreno-Fernández J, Mangas N, Genua I, Martínez MJ, López A, González C, Chico A. Evaluation of the usefulness of and satisfaction with the flash glucose monitoring system (FreeStyle Libre®) guide for use in patients with type 1 diabetes. ENDOCRINOL DIAB NUTR 2021; 69:S2530-0164(21)00185-3. [PMID: 34452877 DOI: 10.1016/j.endinu.2021.04.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Revised: 03/29/2021] [Accepted: 04/15/2021] [Indexed: 10/20/2022]
Abstract
The Flash Guide (FG) for insulin dosing (A. Chico, C. González) was the first document intended for FreeStyle Libre® (FSL) user patients to help with decision-making depending on glucose level and trend. The objective of the study was to evaluate the usefulness of and the level of satisfaction with the recommendations given by the FG in a group of patients with type 1 diabetes (DM1) who were FSL users. It included 31 subjects (54% women; age 41±15 years; DM duration 21±14 years; 22 with FSL>12 months) who were provided with the FG. They completed a questionnaire on decision-making depending on glucose trend in different situations (before and three months after using the FG), and a satisfaction questionnaire (ad hoc). Demographic, clinical and glycaemic control data were collected. The percentage of subjects who used glucose trend in decision-making after receiving the FG increased: for adjusting insulin (51 vs. 83; P=.016), action without insulin (51 vs. 90%; P=.001), and in special circumstances. The FG was evaluated as very useful (4.19/5). There were no significant changes in glycaemic control, although the percentage of data gathered increased significantly (89.07 vs. 94.46%; P=.042). In conclusion, the FG was evaluated well for managing glucose trends with FSL by the patients with DM1 analysed, increasing their use of trend in decision-making, with no changes in glycaemic control, but with more data gathered.
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Affiliation(s)
- Manuel Mateu-Salat
- Servicio de Endocrinología y Nutrición, Hospital de la Santa Creu i Sant Pau, Barcelona, España
| | - Jesús Moreno-Fernández
- Sección de Endocrinología y Nutrición, Hospital Universitario de Ciudad Real, Ciudad Real, España
| | - Natalia Mangas
- Servicio de Endocrinología y Nutrición, Hospital de la Santa Creu i Sant Pau, Barcelona, España
| | - Idoia Genua
- Servicio de Endocrinología y Nutrición, Hospital de la Santa Creu i Sant Pau, Barcelona, España
| | - María José Martínez
- Servicio de Endocrinología y Nutrición, Hospital de la Santa Creu i Sant Pau, Barcelona, España
| | - Alicia López
- Servicio de Endocrinología y Nutrición, Hospital de la Santa Creu i Sant Pau, Barcelona, España
| | - Cintia González
- Servicio de Endocrinología y Nutrición, Hospital de la Santa Creu i Sant Pau, Barcelona, España; Centro de Investigación Biomédica en Red de Bioingeniería, Biomateriales y Nanomedicina (CIBER-BBN), Madrid, España; Universitat Autònoma de Barcelona, Bellaterra, Barcelona, España
| | - Ana Chico
- Servicio de Endocrinología y Nutrición, Hospital de la Santa Creu i Sant Pau, Barcelona, España; Centro de Investigación Biomédica en Red de Bioingeniería, Biomateriales y Nanomedicina (CIBER-BBN), Madrid, España; Universitat Autònoma de Barcelona, Bellaterra, Barcelona, España.
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Moreno-Fernández J, García-Seco JA. Commercialized Hybrid Closed-Loop System (Minimed Medtronic 670G) Results During Pregnancy. AACE Clin Case Rep 2021; 7:177-179. [PMID: 34095482 PMCID: PMC8165106 DOI: 10.1016/j.aace.2020.11.039] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Revised: 11/17/2020] [Accepted: 11/26/2020] [Indexed: 11/27/2022] Open
Abstract
Objective Hybrid closed-loop (HCL) devices can achieve tight glycemic control but are rarely used in pregnancy, which remains an off-label indication. We present a case of a pregnant patient with type 1 diabetes mellitus (T1DM) who used the Medtronic MiniMed 670G HCL system. Methods MiniMed 670G includes an advanced automode option (HCL therapy), which our patient used from the first trimester to the end of the pregnancy. Results An unplanned pregnancy was detected in the T1DM patient, with a glycated hemoglobin level of 8.7 mmol/L (7.1%). The patient started sensor-augmented pump therapy at week 13. Subsequently, she entered automode (HCL) at week 16. The time in range (3.7-7.8 mmol/mol, 63-140 mg/dL) increased from 46.8% to 51.3% after HCL initiation. The glycated hemoglobin level remained close to 48 mmol/mol (6.5%) until the end of the pregnancy. Furthermore, the time under range (<3.7 mmol/mol, <63 mg/dL) remained below the optimal 4% level during the gestation. Finally, a healthy male baby was born at week 37. No safety events were recorded. Conclusion This case represents the successful off-label use of HCL during pregnancy in a patient with T1DM.
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Affiliation(s)
- Jesús Moreno-Fernández
- Endocrinology and Nutrition Department, Ciudad Real University Hospital, Ciudad Real, Spain
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Moreno-Fernández J, Herrera Montoro V, Virlaboa Cebrian R, Martín Davila FJ. Parasitic thyroid nodules: The differential diagnosis. ENDOCRINOL DIAB NUTR 2021; 69:S2530-0164(21)00120-8. [PMID: 34031013 DOI: 10.1016/j.endinu.2021.02.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Revised: 02/01/2021] [Accepted: 02/05/2021] [Indexed: 11/20/2022]
Affiliation(s)
- Jesús Moreno-Fernández
- Endocrinology and Nutrition Department, Ciudad Real General University Hospital, Ciudad Real, Spain.
| | - Violeta Herrera Montoro
- Anatomical Pathology Department, Ciudad Real General University Hospital, Ciudad Real, Spain
| | - Rita Virlaboa Cebrian
- Endocrinology and Nutrition Department, Ciudad Real General University Hospital, Ciudad Real, Spain
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Alfaro Martínez JJ, Peña-Cortés VM, Gómez-García IR, Platero-Rodrigo E, Moreno-Fernández J, Calderón-Vicente DM, Martínez-García A, Barrera-Martín A, Sanz-Velasco A, Miralles-Moragrega R, Palma-Moya M, Gonzalvo-Díaz C. Actividad asistencial en las consultas de Endocrinología y Nutrición de Castilla-La Mancha (estudio AACENCAM). ENDOCRINOL DIAB NUTR 2021; 68:251-259. [DOI: 10.1016/j.endinu.2019.11.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2019] [Revised: 11/22/2019] [Accepted: 11/24/2019] [Indexed: 10/24/2022]
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Moreno-Fernández J, García-Seco JA, Rodrigo EMO, Segura AMS, García-Seco F, Muñoz-Rodríguez JR. Vaccination adherence to influenza, pneumococcal and hepatitis B virus in adult type 1 diabetes mellitus patients. Prim Care Diabetes 2020; 14:343-348. [PMID: 31582202 DOI: 10.1016/j.pcd.2019.09.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Revised: 09/06/2019] [Accepted: 09/09/2019] [Indexed: 12/19/2022]
Abstract
AIM To document adherence to influenza, pneumococcal and hepatitis B virus (HBV) vaccination programme in adult type 1 diabetes mellitus (T1DM) patients. MATERIALS AND METHODS Observational retrospective study using data obtained from computerized clinical records. We contacted all adult T1DM registered in our database from a tertiary diabetes care hospital. Primary efficacy outcome was to describe influenza, pneumococcal and HBV vaccination status. RESULTS Three hundred patients were analyzed (male 53%). Mean age was 40.0±14.4years and T1DM duration was 19.7±11.8years. Thirty-five percent of the patients had complementary indications for studied vaccines. Adherence to vaccination program for influenza, pneumococcal and HBV was achieved by 55%, 18% and 17% of the patients, respectively. Only 3% of the subjects were vaccinated against the three microorganisms. Predictor of correct vaccination were: age, shorter diabetes duration, insulin pump treatment, better diabetes control and being a health professional. We detected 17 sick leaves, 127 lost working days and 3 hospitalizations due to flue during the follow-up. CONCLUSIONS The uptake of recommended vaccinations against influenza, pneumococcal and HBV in adult T1DM patients was below desirable levels. A special effort is required to all health professionals to implement immunization among adult people with T1DM. Clinical Trials NCT03478254.
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Affiliation(s)
- Jesús Moreno-Fernández
- Endocrinology and Nutrition Department, Ciudad Real University Hospital, Ciudad Real, Spain.
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Alfaro-Martínez JJ, Peña-Cortés VM, Moreno-Fernández J, Platero-Rodrigo E, Calderón-Vicente DM, Gómez-García IR, Martínez-García A, Sanz-Velasco A, Gonzalvo-Díaz C, Miralles-Moragrega R. Healthcare on the Endocrinology and Nutrition ward in Castille-La Mancha (the AAPENCAM study). ACTA ACUST UNITED AC 2020; 67:665-671. [PMID: 32499203 DOI: 10.1016/j.endinu.2020.01.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2019] [Revised: 01/22/2020] [Accepted: 01/27/2020] [Indexed: 10/24/2022]
Abstract
INTRODUCTION The activity of an Endocrinology and Nutrition (E&N) department consists of inpatient care both by those attached to the department and through consultations with specialists from other departments. The inpatient care activity of all the E&N departments of a public health system has not been studied in Spain. MATERIAL AND METHODS This was a retrospective study of hospital ward activity during 2018 of the E&N departments of the Castilla-La Mancha Public Health Service. It was undertaken in order to ascertain the characteristics of the patients attended to, both by those in charge of the E&N departments and through interconsultation with other departments, as well as the case-mix of the pathology of these patients. All patients admitted to E&N and a 10% sample of those treated through interconsultation were analysed. RESULTS 261 admissions were recorded for Castilla-La Mancha Public Health Service E&N departments. 82.8% were urgent and 53.7% were due to type 1 diabetes mellitus. A total of 5955 patients were seen on an interconsultation basis, 591 of whom were analysed. The most frequent reason for interconsultation was diabetes mellitus/hyperglucemia (28.8%), requiring 6.1±6.7 days per patient. However, interconsultations for artificial nutrition required more days of attendance per patient and accounted for a higher percentage of the total number of days of interconsultation (60.4%). CONCLUSIONS The inpatient care activity of the E&N departments of Castilla-La Mancha Public Health Service mainly consists of attending to patients with chronic pathologies of high hospital prevalence such as diabetes mellitus/hyperglucemia and, especially, clinical nutrition.
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Affiliation(s)
| | | | - Jesús Moreno-Fernández
- Servicio de Endocrinología y Nutrición, Hospital General Universitario de Ciudad Real, Ciudad Real, España
| | - Eduardo Platero-Rodrigo
- Servicio de Endocrinología y Nutrición, Hospital Universitario de Guadalajara, Guadalajara, España
| | | | - Inés-Rosa Gómez-García
- Servicio de Endocrinología y Nutrición, Hospital La Mancha-Centro, Alcázar de San Juan, España
| | - Ana Martínez-García
- Servicio de Endocrinología y Nutrición, Hospital Nuestra Señora del Prado, Talavera de la Reina, España
| | - Alberto Sanz-Velasco
- Unidad de Endocrinología y Nutrición, Hospital General de Villarrobledo, Villarrobledo, España
| | - César Gonzalvo-Díaz
- Unidad de Endocrinología y Nutrición, Hospital General de Hellín, Hellín, España
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Díez-Fernández A, Cavero-Redondo I, Moreno-Fernández J, Pozuelo-Carrascosa DP, Garrido-Miguel M, Martínez-Vizcaíno V. Effectiveness of insulin glargine U-300 versus insulin glargine U-100 on nocturnal hypoglycemia and glycemic control in type 1 and type 2 diabetes: a systematic review and meta-analysis. Acta Diabetol 2019; 56:355-364. [PMID: 30506484 DOI: 10.1007/s00592-018-1258-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2018] [Accepted: 11/08/2018] [Indexed: 02/07/2023]
Abstract
AIMS To assess the effectiveness of insulin glargine 300 ui/ml (Gla-300) compared with insulin glargine 100 ui/ml (Gla-100) on reducing nocturnal hypoglycemia and improving glycemic control in type 1 and type 2 diabetes patients. METHODS We systematically searched in Medline, Embase, Web of Science, and Cochrane Central Register of Controlled Trials until July 4th, 2018. This study was registered with PROSPERO (CRD42017080134). We included randomized clinical trials comparing Gla-300 versus Gla-100 reporting the rate ratio or number of events of nocturnal hypoglycemia and HbA1c levels percentage or mmol/mol-1. The main outcome was the incidence rate ratio (RR) of nocturnal hypoglycemia events. The heterogeneity of results across studies was assessed using the I2 statistic. Fixed- and random-effect models were used to estimate pooled RRs. RESULTS Nine studies were included in the meta-analysis, including 3977 adult patients. Compared with Gla-100, the use of Gla-300 reduced confirmed nocturnal hypoglycemia [RR = 0.81 (0.69, 0.95)] and clinically significant nocturnal hypoglycemia [RR = 0.75 (0.63, 0.91)]. Reductions in clinically significant nocturnal hypoglycemia events [RR = 0.64 (0.42, 0.97)] in type 1 diabetes patients were found. A small decrease in HbA1c levels in favor of Gla-300 in the pooled sample was identified [ES = - 0.08 (95% CI - 0.14, - 0.01)]. CONCLUSIONS The best current evidence indicates that Gla-300 reduces the incidence of nocturnal hypoglycemia with slight improvements in glycemic control compared with Gla-100 in both type 1 and type 2 diabetes adult patients.
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Affiliation(s)
- Ana Díez-Fernández
- Health and Social Research Centre, Universidad de Castilla-La Mancha, C/ Santa Teresa Jornet, s/n, 16071, Cuenca, Spain
- Faculty of Nursing, Universidad de Castilla-La Mancha, Camino del Pozuelo, s/n, 16071, Cuenca, Spain
| | - Iván Cavero-Redondo
- Health and Social Research Centre, Universidad de Castilla-La Mancha, C/ Santa Teresa Jornet, s/n, 16071, Cuenca, Spain.
| | - Jesús Moreno-Fernández
- Department of Endocrinology and Nutrition, Ciudad Real General University Hospital, C/ Obispo Rafael Torija, s/n, 13005, Ciudad Real, Spain
| | - Diana P Pozuelo-Carrascosa
- Health and Social Research Centre, Universidad de Castilla-La Mancha, C/ Santa Teresa Jornet, s/n, 16071, Cuenca, Spain
| | - Miriam Garrido-Miguel
- Health and Social Research Centre, Universidad de Castilla-La Mancha, C/ Santa Teresa Jornet, s/n, 16071, Cuenca, Spain
| | - Vicente Martínez-Vizcaíno
- Health and Social Research Centre, Universidad de Castilla-La Mancha, C/ Santa Teresa Jornet, s/n, 16071, Cuenca, Spain
- Faculty of Health Sciences, Autonomous University of Chile, 5 y Medio Norte, 1670, Talca, Chile
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Beato-Víbora P, Chico-Ballesteros A, Giménez M, Guerrero-Vázquez R, Barrio-Castellanos R, Goñi-Iriarte MJ, Díaz-Soto G, Merino-Torres JF, Moreno-Fernández J, Martínez-Brocca MA. A national survey on the efficacy and safety of continuous subcutaneous insulin infusion in patients with type 1 diabetes in Spain. Diabetes Res Clin Pract 2018; 137:56-63. [PMID: 29278712 DOI: 10.1016/j.diabres.2017.12.009] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2017] [Revised: 11/29/2017] [Accepted: 12/12/2017] [Indexed: 11/15/2022]
Abstract
AIMS To assess safety and benefits of continuous subcutaneous insulin infusion (CSII) therapy in a cohort of type 1 diabetes patients in Spain. METHODS A web-based national registry was created by the Working Group of the Spanish Diabetes Association. All patients on CSII being followed at selected referral centers were included. A cross-sectional analysis was performed. RESULTS A total of 1275 patients were included. Data completion for patients on CSII was 67 ± 32%. Indications for treatment were suboptimal glycemic control (32%), high glucose variability (24%), preconception care (14%) and hypoglycemia (11%). In the patients on CSII for ≥1 year (n = 843, mean CSII duration of 5 years), HbA1c decreased by 5 mmol/mol (0.5%) in the whole population and by 8 mmol/mol (0.7%) in subjects with suboptimal glycemic control as CSII indication. Percentage of patients achieving HbA1c ≤ 53 mmol/mol (7%) increased from 20% before CSII to 34% at the end of follow-up. Severe hypoglycemia decreased from 29% to 5%. The rate of discontinuation was 9.5%. HbA1c was lower in patients using bolus advisor and temporary basal rates. CONCLUSIONS CSII was associated with a sustained improvement in glycemic control and a reduction in severe hypoglycemia. The use of advanced CSII settings was related to better glycemic control.
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Lozano-Serrano M, García-Seco JA, García-Seco F, Lozano-Hernández MC, Seco-Segura ÁM, Moreno-Fernández J, Muñoz-Cazallas PA, Ferreiro-Vicario C, Sánchez-Covisa MA. [Satisfaction and quality of life evaluation in patients with type 1 diabetes mellitus treated using continuous subcutaneous insulin infusion compared with multiple daily injections]. Enferm Clin 2013; 23:96-102. [PMID: 23755944 DOI: 10.1016/j.enfcli.2013.02.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2012] [Revised: 02/11/2013] [Accepted: 02/16/2013] [Indexed: 10/26/2022]
Abstract
OBJECTIVE To assess the quality of life (QOL) and satisfaction (SF) in patients with type 1 diabetes mellitus (T1DM) treated with continuous subcutaneous insulin infusion (CSII) compared with multiple daily insulin injections (MDI). METHOD A descriptive study was conducted to assess the QOL and SF of 68 patients on CSII or MDI treatment (1:2). The instruments used were, the Spanish version of the Diabetes Quality of Life (EsDQOL) specific for diabetes related QOL, SF-36 for general QOL, and the Diabetes Treatment Satisfaction Questionnaire (DTSQ) for SF evaluation. RESULTS The EsDQOL scores for patients on CSII therapy were similar to those treated with MDI (87.20±21.11 vs 86.83±20.7, P=.86), with lower scores in the SF-36 questionnaire (66.91±15.76 vs 75.90±14.56, P=.03) except in Health Transition section, where patients treated with CSII showed higher scores (68.75±19.66 vs 57.93±17.18, p=.02). The values obtained in the DTSQ questionnaire were higher in CSII patients compared with the MDI group in last weeks (31.50±4.66 vs 27.83±6.06, p=.01) and last three months periods (13.2±6.73 vs 8.77±7.40, p=.01). CONCLUSIONS Patients with T1DM on CSII therapy showed a poorer global QOL, although they felt more satisfied with their treatment than those treated with MDI. No differences in diabetes related QOL were detected between groups.
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Affiliation(s)
- Monserrat Lozano-Serrano
- Sección de Endocrinología y Nutrición, Hospital General Universitario de Ciudad Real, Servicio de Salud de Castilla-La Mancha SESCAM, Ciudad Real, España.
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Moreno-Fernández J, Gutiérrez-Alcántara C, Palomares-Ortega R, García-Manzanares Á, Benito-López P. Valoración del programa de formación de médicos residentes en Endocrinología y Nutrición por facultativos: resultados de una encuesta. ACTA ACUST UNITED AC 2011; 58:510-5. [DOI: 10.1016/j.endonu.2011.07.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2011] [Revised: 07/01/2011] [Accepted: 07/12/2011] [Indexed: 11/17/2022]
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Martínez-Fuentes AJ, Molina M, Vázquez-Martínez R, Gahete MD, Jiménez-Reina L, Moreno-Fernández J, Benito-López P, Quintero A, de la Riva A, Diéguez C, Soto A, Leal-Cerro A, Resmini E, Webb SM, Zatelli MC, degli Uberti EC, Malagón MM, Luque RM, Castaño JP. Expression of functional KISS1 and KISS1R system is altered in human pituitary adenomas: evidence for apoptotic action of kisspeptin-10. Eur J Endocrinol 2011; 164:355-62. [PMID: 21169415 DOI: 10.1530/eje-10-0905] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
CONTEXT KISS1 was originally identified as a metastasis-suppressor gene able to inhibit tumor progression. KISS1 gene products, the kisspeptins, bind to a G-protein-coupled receptor (KISS1R, formerly GPR54), which is highly expressed in placenta, pituitary, and pancreas, whereas KISS1 mRNA is mainly expressed in placenta, hypothalamus, striatum, and pituitary. OBJECTIVE AND DESIGN KISS1/KISS1R pituitary expression profile, coupled to their anti-tumoral capacities, led us to hypothesize that this system may be involved in the biology of pituitary tumors. To explore this notion, expression levels of KISS1R and KISS1 were evaluated in normal and adenomatous pituitaries. Additionally, functionality of this system was assessed by treating dispersed pituitary adenoma cells in primary culture with kisspeptin-10 and evaluating intracellular calcium kinetics and apoptotic rate. RESULTS Both KISS1 and KISS1R were expressed in normal pituitary, whereas this simultaneous expression was frequently lost in pituitary tumors, where diverse patterns of KISS1/KISS1R expression were observed that differed among distinct types of pituitary adenomas. Measurement of calcium kinetics revealed that kisspeptin-10 elicits a remarkable increase in [Ca(2+)](i) in individual cells from four out of the five GH-producing adenomas studied, whereas cells derived from non-functioning pituitary adenomas (NFPA, n=45) did not respond. In contrast, kisspeptin-10 treatment increased the apoptotic rate in cells derived from both GH-producing and NFPA. CONCLUSIONS These results provide primary evidence that KISS1 and KISS1R expression can be differentially lost in pituitary tumor subtypes, where this system can exert functional, proapoptotic actions, and thereby offer novel insights to investigate the biology and therapeutic options to treat these tumors.
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Affiliation(s)
- Antonio J Martínez-Fuentes
- Department of Cell Biology, Physiology and Immunology, Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), and CIBER Fisiopatología de la Obesidad y Nutrición (CIBERobn), University of Córdoba, Córdoba, Spain
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Moreno-Fernández J, Benito-López P, García-Manzanares Á, Silva J, López M, Aguirre M, Gómez García IR. Resultados del sistema Paradigm Real Time 722® en una serie de pacientes con diabetes mellitus tipo I. ACTA ACUST UNITED AC 2011. [DOI: 10.1016/s1134-3230(11)70007-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Moreno-Fernández J, García-Manzanares A, Sánchez-Covisa MA, García EIRG. Manejo clínico del incidentaloma suprarrenal: resultados de una encuesta. Endocrinología y Nutrición 2009; 56:447-51. [PMID: 20114014 DOI: 10.1016/s1575-0922(09)73312-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/22/2009] [Accepted: 11/05/2009] [Indexed: 11/15/2022]
Affiliation(s)
- Jesús Moreno-Fernández
- Sección de Endocrinología y Nutrición, Complejo Hospitalario La Mancha Centro, Alcázar de San Juan, Ciudad Real, España.
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Moreno-Fernández J, Gutiérrez-Alcántara C, Gálvez Moreno MA, Jiménez-Reina L, Castaño JP, Benito-López P. Corticotrophin-dependent Cushing syndrome due to Sacrococcygeal Teratoma detected by [18F]fluorodeoxyglucose positron emission tomography. J Clin Endocrinol Metab 2008; 93:3282-3. [PMID: 18772458 DOI: 10.1210/jc.2008-0458] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- J Moreno-Fernández
- Service of Endocrinology and Nutrition., Reina Sofía Hospital., Avenida Menendez Pidal s/n., Córdoba. 14004. Spain.
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Moreno-Fernández J, Gutiérrez-Alcántara C, Palomares-Ortega R. Programa de formación MIR en endocrinología y nutrición: resultados de una encuesta nacional. ACTA ACUST UNITED AC 2006. [DOI: 10.1016/s1575-0922(06)71137-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Martínez-Fuentes AJ, Moreno-Fernández J, Vázquez-Martínez R, Durán-Prado M, de la Riva A, Tena-Sempere M, Diéguez C, Jiménez-Reina L, Webb SM, Pumar A, Leal-Cerro A, Benito-López P, Malagón MM, Castaño JP. Ghrelin is produced by and directly activates corticotrope cells from adrenocorticotropin-secreting adenomas. J Clin Endocrinol Metab 2006; 91:2225-31. [PMID: 16551736 DOI: 10.1210/jc.2006-0235] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
CONTEXT In Cushing's disease, ACTH hypersecretion by pituitary corticotrope adenoma cells and resulting hypercortisolism is accompanied by a severely blunted GH secretory response. Interestingly, in Cushing's disease, ghrelin markedly increases plasma ACTH, whereas its stimulatory action on GH secretion is reduced. Although the reported expression of ghrelin receptors (GHS-R) in corticotrope tumors offers a potential mechanism for ghrelin-induced ACTH hypersecretion, studies on the direct effects of synthetic GH secretagogues on corticotropinoma cells offered contradictory results. OBJECTIVE AND DESIGN To evaluate the direct action of ghrelin on corticotropinoma cells from two patients with Cushing's disease, we measured its effect on free cytosolic calcium concentration ([Ca(2+)](i)). Additionally, expression of GHS-R and its ligand ghrelin was examined in these cells and in five additional corticotropinomas. RESULTS Ghrelin (10(-6) m) induced a marked [Ca(2+)](i) increase in 89.5% (case 1; n = 19 cells) and 85% (case 2; n = 13 cells) of corticotropinoma cells. Moreover, RT-PCR showed that expression of GHS-R isoforms is accompanied by that of ghrelin in all seven corticotrope adenomas examined. Importantly, double immunogold electron microscopy revealed that ghrelin is costored within ACTH secretory vesicles in densely granulated adenomatous corticotropes. CONCLUSIONS These results constitute the first demonstration that ghrelin acts directly on corticotrope tumor cells derived from patients with Cushing's disease. The presence of ghrelin and GHS-R suggests that pituitary ghrelin may play an autocrine/paracrine role in regulating ACTH release in Cushing's disease. Our findings provide a plausible cellular basis for the exaggerated ACTH response to ghrelin in Cushing's disease and suggest novel research strategies to develop medical treatments for this disease.
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Affiliation(s)
- Antonio J Martínez-Fuentes
- Department of Cell Biology, Physiology, and Immunology, Edificio Severo Ochoa, Planta 3, Campus de Rabanales, University of Córdoba, E-14014 Córdoba, Spain.
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