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Beato-Víbora PI, Chico A, Moreno-Fernandez J, Bellido-Castañeda V, Nattero-Chávez L, Picón-César MJ, Martínez-Brocca MA, Giménez-Álvarez M, Aguilera-Hurtado E, Climent-Biescas E, Azriel-Mira S, Rebollo-Román Á, Yoldi-Vergara C, Pazos-Couselo M, Alonso-Carril N, Quirós C. Response to Comment on Beato-Víbora et al. A Multicenter Prospective Evaluation of the Benefits of Two Advanced Hybrid Closed-Loop Systems in Glucose Control and Patient-Reported Outcomes in a Real-world Setting. Diabetes Care 2024;47:216-224. Diabetes Care 2024; 47:e46-e47. [PMID: 38640410 DOI: 10.2337/dci24-0017] [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: 02/20/2024] [Accepted: 02/23/2024] [Indexed: 04/21/2024]
Affiliation(s)
| | - Ana Chico
- Hospital Santa Creu i Sant Pau, Barcelona, Spain
| | | | | | - Lia Nattero-Chávez
- Hospital Universitario Ramón y Cajal, Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Madrid, Spain
| | | | | | | | | | | | | | | | | | | | | | - Carmen Quirós
- Hospital Universitari Mutua de Terrassa, Barcelona, Spain
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Quirós C, Herrera MT, Amigó J, Wagner A, Beato-Vibora PI, Azriel S, Climent E, Soldevila B, Barquiel B, Colomo N, Durán-Martínez M, Corcoy R, Codina M, Díaz-Soto G, Márquez-Pardo R, Martínez-Brocca MA, Rebollo Román Á, López Gallardo G, Cuesta M, García Fernández J, Goya MM, Vega Guedes B, Mendoza-Mathison LC, Perea V. Real-world evidence of off-label use of commercially automated insulin delivery systems compared to multiple daily insulin injections in pregnancies complicated by type 1 diabetes. Diabetes Technol Ther 2024. [PMID: 38417014 DOI: 10.1089/dia.2023.0594] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/01/2024]
Abstract
AIMS To compare glycemic control and maternal-fetal outcomes of women with type 1 diabetes (T1D) using hybrid closed loop (HCL) vs. multiple daily insulin injections (MDI) plus continuous glucose monitoring (CGM). METHODS Multicenter prospective cohort study of pregnant women with T1D in Spain. We evaluated HbA1c and time spent within (TIR), below (TBR) and above (TAR) the pregnancy-specific glucose range 3.5-7.8 mmol/L. Adjusted models were performed for adverse pregnancy outcomes including baseline maternal characteristics and center. RESULTS 112 women were included (HCL n=59). Women in the HCL group had a longer duration of diabetes and higher rates of prepregnancy care. There were no between-group differences in HbA1c in any trimester. However, in the second trimester, MDI users had a greater decrease in HbA1c (-6.12±9.06 vs. -2.16 ±7.42 mmol/mol, p=0.031). No differences in TIR (3.5-7.8 mmol/L) and TAR were observed between HCL and MDI users, but with a higher total insulin dose in the second trimester (+0.13 IU/Kg/d). HCL therapy was associated with increased maternal weight gain during pregnancy (βadjusted 3.20 kg, 95%CI 0.90-5.50). Regarding neonatal outcomes, newborns of HCL users were more likely to have higher birthweight (βadjusted 279.0 g, 95% CI 39.5-518.5) and macrosomia (ORadjusted 3.18, 95% CI 1.05-9.67) compared to MDI users. These associations disappeared when maternal weight gain or third trimester HbA1c were included in the models. CONCLUSIONS In a real-world setting, HCL users gained more weight during pregnancy and had larger newborns than MDI users, while achieving similar glycemic control in terms of HbA1c and TIR.
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Affiliation(s)
- Carmen Quirós
- Hospital Universitari MutuaTerrassa, 58955, Pl. Dr Robert 5,, Terrassa, Spain, 08221;
| | - Maria Teresa Herrera
- Nuestra Senora de la Candelaria University Hospital, 16825, Endocrinology, Santa Cruz de Tenerife, Canarias, Spain;
| | - Judit Amigó
- Vall d'Hebron Research Institute, 203275, Diabetes and Metabolism Research Unit, Passeig de la Vall Hebron 119, Barcelona, Spain, 08035;
| | - Ana Wagner
- Complejo Hospitalario Universitario Insular Materno-Infantil de Canarias. Universidad de Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, Spain;
| | | | - Sharona Azriel
- Infanta Sofia University Hospital, 161633, San Sebastian de los Reyes, Madrid, Spain;
| | | | - Berta Soldevila
- Hospital Universitari Germans Trias i Pujol, 16514, Badalona, Spain;
| | | | - Natalia Colomo
- Hospital Regional Universitario de Málaga, 16330, Endocrinology and Nutrition, Plaza del Hospital Civil, Malaga, Spain, 29010
- Instituto de Investigación Biomédica de Málaga, 582139, Malaga, Spain, 29010;
| | | | - Rosa Corcoy
- Hospital de la Santa Creu i Sant Pau, Carrer Sant Antoni M Claret 147, Barcelona, Spain, 08025;
| | | | - Gonzalo Díaz-Soto
- Hospital Clinico Universitario de Valladolid, 16238, Av Ramon y Cajal, Valladolid, Castilla y León, Spain, 47005;
| | - Rosa Márquez-Pardo
- Specialty Hospital Juan Ramon Jimenez, 16839, Endocrinology and Nutrition, Ronda Norte s/n, Huelva, Spain, 21005;
| | | | | | | | - Martín Cuesta
- Hospital Clinico San Carlos, 16267, Endocrinology and Nutrition, Madrid, Comunidad de Madrid, Spain;
| | - Javier García Fernández
- Hospital Universitario Nuestra Señora de la Candelaria, 16825, Santa Cruz de Tenerife, Spain;
| | - María Mar Goya
- Vall D'Hebron, Obstetrics and Gynecology, Barcelona, Spain;
| | - Begoña Vega Guedes
- Complejo Hospitalario Materno-Insular, 16853, Las Palmas de Gran Canaria, Spain;
| | | | - Verónica Perea
- Hospital Universitari MutuaTerrassa, 58955, Dr Robert 5 sq, Terrassa, Spain, 08221;
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Rodríguez de Vera Gómez P, Mateo Rodríguez C, Rodríguez Jiménez B, Hidalgo Sotelo L, Peinado Ruiz M, Torrecillas Del Castillo E, Ruiz-Aranda D, Serrano Olmedo I, Candau Martín Á, Martínez-Brocca MA. Impact of Flash Glucose Monitoring on the Fear of Hypoglycemia Phenomenon in Adults with Type 1 Diabetes. Diabetes Technol Ther 2024. [PMID: 38315507 DOI: 10.1089/dia.2023.0370] [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] [Indexed: 02/07/2024]
Abstract
Objective: To assess the clinical impact of flash glucose monitoring (FGM) systems on fear of hypoglycemia (FoH) and quality of life in adults with type 1 diabetes mellitus (T1DM). Methods: Prospective quasi-experimental study with a 12-month follow-up. People with T1DM (18-80 years old) and self-monitoring by blood capillary glycemia controls were included. The FH15 questionnaire, a survey validated in Spanish in a comparable study population, was used to diagnose FoH with a cutoff point of 28 points. Results: A total of 181 participants were included, with a FoH prevalence of 69% (n = 123). A mean reduction in FH15 score of -4 points (95% confidence interval [-5.5 to -3]; P < 0.001) was observed, along with an improvement in quality of life (EsDQOL-test (Diabetes Quality of Life, Spanish version), -7 points [-10; -4], P < 0.001) and satisfaction with treatment (Diabetes Treatment Satisfaction questionnaire, self-reported version [DTSQ-s] test, +4.5 points [4; 5.5], P < 0.001). At the end of the follow-up, 64.2% of the participants saw an improved FoH intensity, compared to 35.8% who scored the same or higher. This improvement in FoH status was associated with a higher time-in-range at the end of the follow-up (P = 0.003), as well as a lower time spent in hyperglycemia (P = 0.005). In addition, it was linked to participants with a high baseline FoH levels (P < 0.001) and those who were university degree holders (P = 0.07). Conclusions: FGM is associated with an overall reduction of FoH in adults with T1DM and with an increase in their quality of life. Nevertheless, a significant percentage of patients may experience an increase of this phenomenon leading to clinical repercussions and a profound impact on quality of life.
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Affiliation(s)
| | - Carmen Mateo Rodríguez
- Endocrinology and Nutrition Department, Hospital Universitario Virgen Macarena, Seville, Spain
| | | | - Lucía Hidalgo Sotelo
- Endocrinology and Nutrition Department, Hospital Universitario Virgen Macarena, Seville, Spain
| | - Mercedes Peinado Ruiz
- Endocrinology and Nutrition Department, Hospital Universitario Virgen Macarena, Seville, Spain
| | | | | | - Isabel Serrano Olmedo
- Endocrinology and Nutrition Department, Hospital Universitario Virgen Macarena, Seville, Spain
| | - Ángela Candau Martín
- Endocrinology and Nutrition Department, Hospital Universitario Virgen Macarena, Seville, Spain
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Beato-Víbora PI, Chico A, Moreno-Fernandez J, Bellido-Castañeda V, Nattero-Chávez L, Picón-César MJ, Martínez-Brocca MA, Giménez-Álvarez M, Aguilera-Hurtado E, Climent-Biescas E, Azriel-Mir S, Rebollo-Román Á, Yoldi-Vergara C, Pazos-Couselo M, Alonso-Carril N, Quirós C. A Multicenter Prospective Evaluation of the Benefits of Two Advanced Hybrid Closed-Loop Systems in Glucose Control and Patient-Reported Outcomes in a Real-world Setting. Diabetes Care 2024; 47:216-224. [PMID: 37948469 DOI: 10.2337/dc23-1355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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] [Received: 07/25/2023] [Accepted: 10/22/2023] [Indexed: 11/12/2023]
Abstract
OBJECTIVE Advanced hybrid closed-loop systems (AHCL) have been shown to improve glycemic control and patient-reported outcomes in type 1 diabetes. The aim was to analyze the outcomes of two commercially available AHCL in real life. RESEARCH DESIGN AND METHODS A prospective study was performed, including adolescents and adults with type 1 diabetes, AHCL naïve, from 14 centers, who initiated the use of MM780G with SmartGuard or Tandem t:slimX2 with Control-IQ. Baseline and 3-month evaluations were performed, assessing HbA1c, time in different glycemic ranges, and patient-reported outcomes. The primary outcome was the between-group time in range 70-180 mg/dL difference from beginning to end of follow-up. RESULTS One hundred fifty participants were included, with 75 initiating each system (age: 39.9 ± 11.4 years [16-72]; 64% female; diabetes duration: 21.6 ± 11.9 years). Time in range increased from 61.53 ± 14.01% to 76.17 ± 9.48% (P < 0.001), with no between-group differences (P = 0.591). HbA1c decreased by 0.56% (95% CI 0.44%, 0.68%) (6 mmol/mol, 95% CI 5, 7) (P < 0.001), from 7.43 ± 1.07% to 6.88 ± 0.60% (58 ± 12 to 52 ± 7 mmol/mol) in the MM780G group, and from 7.14 ± 0.70% to 6.56 ± 0.53% (55 ± 8 to 48 ± 6 mmol/mol) in the Control-IQ group (both P < 0.001 to baseline, P = 0.819 between groups). No superiority of one AHCL over the other regarding fear of hypoglycemia or quality of life was found. Improvement in diabetes-related distress was higher in Control-IQ users (P = 0.012). Sleep quality was improved (PSQI: from 6.94 ± 4.06 to 6.06 ± 4.05, P = 0.004), without differences between systems. Experience with AHCL, evaluated by the INSPIRE measures, exceeded the expectations. CONCLUSIONS The two AHCL provide significant improvement in glucose control and satisfaction, with no superiority of one AHCL over the other.
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Affiliation(s)
| | - Ana Chico
- Hospital Santa Creu i Sant Pau, Barcelona, Spain
| | | | | | | | | | | | | | | | | | | | | | | | | | | | - Carmen Quirós
- Hospital Universitari Mutua de Terrassa, Barcelona, Spain
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Rodríguez de Vera-Gómez P, Jiménez-Varo I, Martínez-Brocca MA. Hyperglycemic crisis associated with immune-checkpoint inhibitors therapy: Report of three cases. Med Clin (Barc) 2023; 160:279-280. [PMID: 36473775 DOI: 10.1016/j.medcli.2022.10.010] [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] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Revised: 10/20/2022] [Accepted: 10/23/2022] [Indexed: 12/12/2022]
Affiliation(s)
| | - Ignacio Jiménez-Varo
- Endocrinology and Nutrition Department, University Hospital Virgen Macarena, Seville, Spain
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Moreno-Fernandez J, Chico A, Martínez-Brocca MA, Beato-Víbora PI, Vidal M, Piedra M, Quirós C, Muñoz-Rodríguez JR. Continuous Subcutaneous Insulin Infusion in Type 1 Diabetes Mellitus Patients: Results from the Spanish National Registry. Diabetes Technol Ther 2022; 24:898-906. [PMID: 35947087 DOI: 10.1089/dia.2022.0207] [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] [Indexed: 11/12/2022]
Abstract
Aim: To analyze the clinical effect of continuous subcutaneous insulin infusion (CSII) in type 1 diabetes mellitus (T1D) patients in the Spanish real-world scenario. Methods: All T1D patients on CSII registered in the SPAnish Insulin Pump (SPAIP) registry were included. The primary efficacy outcome was change in HbA1c during follow-up. Secondary efficacy outcomes included: insulin pump indications, diabetes complication rates, insulin and pump use, and continuous glucose monitoring (CGM) glycometrics. Patient data were typed through the web-based SPAIP registry. Results: Data from 2979 T1D patients treated with CSII were analyzed. The median age was 44 years (interquartile range [IQR] 34-52 years), and T1D duration was 27 years (IQR 18-35 years). The median duration of CSII therapy was 6 years (IQR 3-10 years). The main indications for treatment were suboptimal glycemic control (33.8%), hypoglycemia (22.1%), and increased glycemic variability (18.8%). Glycated hemoglobin decreased by 6 mmol/mol (95% CI, -5 to -6 mmol/mol, P < 0.001) [-0.5%, 95% CI, -0.4 to -0.5, P < 0.001] during the follow-up. The percentage of patients with severe hypoglycemia decreased from 14.9% to 0.9% (P < 0.001). We observed an inverse correlation between final HbA1c levels and CGM adherence (R = -0.24, P < 0.001) or percentage of time with active hybrid closed-loop functions (R = -0.25, P < 0.001). Conclusions: CSII treatment was associated with a sustained improvement in glycemic control in the Spanish population. This benefit was greater among patients with higher CGM or active hybrid closed-loop functions adherence. The protocol was publicly registered at ClinicalTrials.gov (NCT04761094).
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Affiliation(s)
- Jesus Moreno-Fernandez
- Department of Endocrinology and Nutrition, Ciudad Real General University Hospital, Ciudad Real, Spain
| | - Ana Chico
- Department of Endocrinology and Nutrition, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | | | | | - Mercé Vidal
- Department of Endocrinology and Nutrition, Barcelona Clinic Hospital, Barcelona, Spain
| | - María Piedra
- Department of Endocrinology and Nutrition, Marqués de Valdecilla University Hospital, Santander, Spain
| | - Carmen Quirós
- Department of Endocrinology and Nutrition, Terrassa Hospital, Terrassa, Barcelona, Spain
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7
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Rodríguez de Vera-Gómez P, Mateo-Rodríguez C, Vivas-López C, Serrano-Olmedo I, Méndez-Muros M, Morales-Portillo C, Sevillano Jiménez M, Hernández-Herrero C, Martínez-Brocca MA. Effectiveness of a flash glucose monitoring systems implementation program through a group and telematic educational intervention in adults with type 1 diabetes. ENDOCRINOL DIAB NUTR 2022; 69:657-668. [PMID: 36424340 DOI: 10.1016/j.endien.2022.11.002] [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: 06/27/2021] [Accepted: 09/15/2021] [Indexed: 06/16/2023]
Abstract
OBJECTIVES Verifying the clinical effectiveness and the impact on quality-of-life parameters, fear of hypoglycaemia and satisfaction with the treatment obtained with a flash glucose monitoring (MFG) devices implantation program that includes a telematic and group educational intervention in adults with type 1 diabetes. PATIENTS AND METHODS Prospective quasi-experimental study, carried out during the COVID-19 pandemic period with a 9-month follow-up at the Virgen Macarena University Hospital, Sevilla. RESULTS Eighty-eight participants were included (men: 46.6%; mean age (years) 38.08, SD: 9.38); years of DM1 evolution: 18.4 (SD: 10.49); treatment with multiple doses insulin (MDI) 70.5% vs 29.5% subcutaneous insulin infusion therapy (CSII)). Baseline HbA1c was 7.74% (1.08). After the intervention, the global decrease in HbA1c was -0.45% (95% CI [-0.6, -0.25], P < 0.01), increasing to -1.08% in the group that started with HbA1c ≥ 8% (P < 0.01). A mean decrease in the Fear of Hypoglycemia 15 (FH15) test score of -6.5 points was observed (P < 0.01). In the global score of the Spanish version of Diabetes Quality Of Life (DQOL-s) test, the decrease was -8.44 points (P < 0.01). In Diabetes Treatment Satisfaction Questionnaire test (DTQ-s), global score increased in + 4 points (P < 0.01). CONCLUSIONS The incorporation of an educational program in group and telematic format within the development of MFG devices implantation strategies is an effective option, with associated benefits in quality of life and fear of hypoglycemia in adult patients with DM1. This option can be implemented in usual clinical practice.
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Affiliation(s)
| | - Carmen Mateo-Rodríguez
- Servicio de Endocrinología y Nutrición, Hospital Universitario Virgen Macarena, Sevilla, Spain
| | - Carmen Vivas-López
- Servicio de Endocrinología y Nutrición, Hospital Universitario Virgen Macarena, Sevilla, Spain
| | - Isabel Serrano-Olmedo
- Servicio de Endocrinología y Nutrición, Hospital Universitario Virgen Macarena, Sevilla, Spain
| | - Mariola Méndez-Muros
- Servicio de Endocrinología y Nutrición, Hospital Universitario Virgen Macarena, Sevilla, Spain
| | | | - María Sevillano Jiménez
- Servicio de Endocrinología y Nutrición, Hospital Universitario Virgen Macarena, Sevilla, Spain
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Rodríguez de Vera-Gómez P, del Pino-Bellido P, García-González JJ, Sánchez-Jiménez F, Oliva-Rodríguez R, Arrobas-Velilla T, Martínez-Brocca MA. Novel APOB nonsense variant related to familial hypobetalipoproteinemia and hepatic steatosis: A case report and review. J Clin Lipidol 2022; 16:601-607. [DOI: 10.1016/j.jacl.2022.07.008] [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] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Revised: 06/29/2022] [Accepted: 07/11/2022] [Indexed: 11/30/2022]
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9
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Rodríguez de Vera-Gómez P, Piñar-Gutiérrez A, Guerrero-Vázquez R, Bellido V, Morales-Portillo C, Sancho-Márquez MP, Espejo-García P, Gros-Herguido N, López-Gallardo G, Martínez-Brocca MA, Soto-Moreno A. Flash Glucose Monitoring and Diabetes Mellitus Induced by Immune Checkpoint Inhibitors: An Approach to Clinical Practice. J Diabetes Res 2022; 2022:4508633. [PMID: 36387939 PMCID: PMC9652069 DOI: 10.1155/2022/4508633] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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] [Received: 05/18/2022] [Revised: 09/01/2022] [Accepted: 10/19/2022] [Indexed: 11/06/2022] Open
Abstract
OBJECTIVES The aim of this study is to investigate in depth diabetes mellitus associated with immune checkpoint inhibitors (DM-ICIs) by analysing a case series. We also evaluated the clinical impact of flash glucose monitoring (FGM) systems in the management of this entity. METHODS We conducted an observational cohort study of DM-ICIs diagnosed in two hospitals in Seville (Spain). Patients with a new diagnosis of diabetes mellitus (DM) or with sudden worsening of preexisting DM after starting treatment with ICIs, with a random 5 hour-postprandial C-peptide value of <0.6 nmol/L and without possibility of subsequent withdrawal of insulin treatment, were included. RESULTS A total of 7 cases were identified, mostly males (n = 6; 85.7%), with a mean age of 64.9 years. The mean glycated hemoglobin (HbA1c) upon diagnosis was 8.1%, with diabetic ketoacidosis (DKA) observed in 6 cases (85.7%). Subcutaneous flash glucose monitoring (FGM) systems were used in six cases, with a mean follow-up period of 42.7 weeks. During the first 90 days of use, mean average glucose was 167.5 mg/dL, with a coefficient of variation (CV) of 34.6%. The mean time in the range 70-180 mg/dL (TIR) was 59.7%, with a mean time above range (TAR) 181-250 mg/dL of 27.8% and a mean TAR > 250 mg/dL of 10.2%. The mean time below range (TBR) 54-69 mg/dL was 2%, while the mean TBR < 54 mg/dL was 0.3%. The mean glucose management indicator (GMI) was 7.3%. No significant differences were observed in FGM values for the following 90 days of follow-up. A progressive improvement in all parameters of glycaemic control was observed between the first month of FGM use and the sixth month of FGM use. Of note, there was a decrease in mean CV (40.6% to 34.1%, p = 0.25), mean TAR 181-250 (30.3% to 26%, p = 0.49), mean TAR > 250 mg/dL (16.3% to 7.7%, p = 0.09), mean TBR 54-69 mg/dL (5.2% to 2%, p = 0.16), and mean TBR < 54 mg/dL (1.8% to 0.2%, p = 0.31), along with an increase in mean values of TIR 70-180 mg/dL (46.5% to 60.5%, p = 0.09). The lack of statistical significance in the differences observed in the mean FGM values over the follow-up period may be related to the small sample size. CONCLUSION DM-ICI is recognised by a state of sudden-onset insulinopenia, often associated with DKA. The use of FGM systems may be a valid option for the effective management of DM-ICIs and for the prevention of severe hyperglycaemic and hypoglycaemic episodes in this condition.
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Affiliation(s)
| | - Ana Piñar-Gutiérrez
- Endocrinology and Nutrition Department, Hospital Universitario Virgen del Rocío, Seville, Spain
| | - Raquel Guerrero-Vázquez
- Endocrinology and Nutrition Department, Hospital Universitario Virgen Macarena, Seville, Spain
| | - Virginia Bellido
- Endocrinology and Nutrition Department, Hospital Universitario Virgen del Rocío, Seville, Spain
| | | | | | | | - Noelia Gros-Herguido
- Endocrinology and Nutrition Department, Hospital Universitario Virgen del Rocío, Seville, Spain
| | - Gema López-Gallardo
- Endocrinology and Nutrition Department, Hospital Universitario Virgen del Rocío, Seville, Spain
| | | | - Alfonso Soto-Moreno
- Endocrinology and Nutrition Department, Hospital Universitario Virgen del Rocío, Seville, Spain
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Rodríguez de Vera-Gómez P, Mateo-Rodríguez C, Vivas-López C, Serrano-Olmedo I, Méndez-Muros M, Morales-Portillo C, Sevillano Jiménez M, Hernández-Herrero C, Martínez-Brocca MA. Efectividad de un programa de implantación de sistemas de monitorización flash de glucosa a través de una intervención educativa grupal y telemática en adultos con diabetes tipo 1. ENDOCRINOL DIAB NUTR 2021. [DOI: 10.1016/j.endinu.2021.09.008] [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] [Indexed: 10/19/2022]
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11
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Garrido-Hermosilla AM, Méndez-Muros M, Gutiérrez-Sánchez E, Morales-Portillo C, Díaz-Granda MJ, Esteban-González E, Relimpio-López I, Martínez-Brocca MA, Rodríguez-de-la-Rúa-Franch E. Renal function and choroidal thickness using swept-source optical coherence tomography in diabetic patients. Int J Ophthalmol 2019; 12:985-989. [PMID: 31236357 DOI: 10.18240/ijo.2019.06.17] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [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: 10/09/2018] [Accepted: 11/26/2018] [Indexed: 11/23/2022] Open
Abstract
AIM To assess the relationship between choroidal thickness and renal function in diabetic patients. METHODS Cross-sectional retrospective clinical study of 42 eyes of 21 ocular treatment-naïve diabetic patients. Demographic data included: age, sex, type and course of diabetes. Ocular data included: severity of diabetic retinopathy; retinal thickness at the central macular region, as well as choroidal thickness at the central and paracentral quadrants, using automatically generated maps by swept-source optical coherence tomography; presence of cystic macular edema; and ocular axial length (AXL). Lab-test parameters included: glycated hemoglobin (HbA1c), albuminuria, albumin/creatinine ratio in urine, and glomerular filtration rate. RESULTS A significant negative correlation was mainly observed between several choroidal thicknesses, age (P<0.020) and ocular AXL (P<0.030). On the contrary, a significant positive correlation was found between all choroidal thicknesses, HbA1c (P<0.035) and albuminuria (P<0.040). CONCLUSION Choroidal thickness can represent an additional tool to help clinicians predicting the renal status in ocular treatment-naïve diabetic patients.
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Affiliation(s)
- Antonio Manuel Garrido-Hermosilla
- Department of Ophthalmology, Virgen Macarena University Hospital, Seville 41009, Spain.,OftaRed, Institute of Health Carlos III, Madrid, Spain
| | - Mariola Méndez-Muros
- Department of Endocrinology and Nutrition, Virgen Macarena University Hospital, Seville 41009, Spain
| | - Estanislao Gutiérrez-Sánchez
- Department of Ophthalmology, Virgen Macarena University Hospital, Seville 41009, Spain.,OftaRed, Institute of Health Carlos III, Madrid, Spain
| | | | - María Jesús Díaz-Granda
- Department of Ophthalmology, Virgen Macarena University Hospital, Seville 41009, Spain.,OftaRed, Institute of Health Carlos III, Madrid, Spain
| | - Eduardo Esteban-González
- Department of Ophthalmology, Virgen Macarena University Hospital, Seville 41009, Spain.,OftaRed, Institute of Health Carlos III, Madrid, Spain
| | - Isabel Relimpio-López
- Department of Ophthalmology, Virgen Macarena University Hospital, Seville 41009, Spain.,OftaRed, Institute of Health Carlos III, Madrid, Spain
| | | | - Enrique Rodríguez-de-la-Rúa-Franch
- Department of Ophthalmology, Virgen Macarena University Hospital, Seville 41009, Spain.,OftaRed, Institute of Health Carlos III, Madrid, Spain
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Castellano-Guerrero AM, Guerrero R, Relimpio F, Losada F, Mangas MA, Pumar A, Martínez-Brocca MA. Prevalence and predictors of depression and anxiety in adult patients with type 1 diabetes in tertiary care setting. Acta Diabetol 2018; 55:943-953. [PMID: 29948408 DOI: 10.1007/s00592-018-1172-5] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [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: 02/17/2018] [Accepted: 05/30/2018] [Indexed: 12/12/2022]
Abstract
AIMS To determine gender and age differences in the prevalence of depression and anxiety and their predictive factors in adult patients with type 1 diabetes (DM1). METHODS Random sample of DM1 adult patients from a tertiary care hospital cohort. To evaluate the presence of depression and anxiety, psychological evaluation was performed using structured clinical interview (MINI). For the specific evaluation of fear of hypoglycemia (FH), FH-15 questionnaire was used. RESULTS 339 patients [51.6% male; 38.5 ± 12.9 years; HbA1c 7.5 ± 1.1% (58.5 ± 14.2 mmol/mol); 20.1 ± 12.0 years of DM1] met the inclusion criteria. Prevalence of depression, anxiety, and FH in men vs. women was as follows (%): depression: 15.4 vs. 33.5 (p < 0.05); anxiety: 13.7 vs. 26.2 (p < 0.05); and FH: 42.8 vs. 46.0 (p = NS). Among midlife female patients, prevalence of depression and anxiety was higher compared to male. Moreover, comorbid depressive and anxious symptoms were also higher in midlife female patients compared to age-matched male patients (3.5 vs. 14%, p < 0.05). Apart from age-related vulnerability, female gender, poor glycemic control, and microvascular and macrovascular complications were predictive factors for depressive and anxious symptomatology. Unawareness hypoglycemia and anxiety-prone personality were predictor factors for FH. CONCLUSIONS In adults with DM1, prevalence of depression and anxiety is higher in women. Midlife patients, in particular women, show a significantly higher prevalence of anxiety symptoms and comorbid depression and anxiety. The presence of secondary complications and sustained poor glycemic control should alert to the possibility of these mental disorders, especially in the most vulnerable age population; clinical, gender and age-related patterns could help to design more effective psychological assessment and support in adult patients with DM1.
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Affiliation(s)
- A M Castellano-Guerrero
- Unidad de Gestión Clínica de Endocrinología y Nutrición, Hospital Universitario Virgen del Rocío, Seville, Spain
| | - R Guerrero
- Unidad de Gestión Clínica de Endocrinología y Nutrición, Hospital Universitario Virgen del Rocío, Seville, Spain
- Instituto de Biomedicina de Sevilla (IBiS), Hospital Universitario Virgen del Rocío/Consejo Superior de Investigaciones Científicas/Universidad de Sevilla, Seville, Spain
| | - F Relimpio
- Unidad de Gestión Clínica de Endocrinología y Nutrición, Hospital Universitario Virgen del Rocío, Seville, Spain
- Instituto de Biomedicina de Sevilla (IBiS), Hospital Universitario Virgen del Rocío/Consejo Superior de Investigaciones Científicas/Universidad de Sevilla, Seville, Spain
| | - F Losada
- Unidad de Gestión Clínica de Endocrinología y Nutrición, Hospital Universitario Virgen del Rocío, Seville, Spain
- Instituto de Biomedicina de Sevilla (IBiS), Hospital Universitario Virgen del Rocío/Consejo Superior de Investigaciones Científicas/Universidad de Sevilla, Seville, Spain
| | - M A Mangas
- Unidad de Gestión Clínica de Endocrinología y Nutrición, Hospital Universitario Virgen del Rocío, Seville, Spain
- Instituto de Biomedicina de Sevilla (IBiS), Hospital Universitario Virgen del Rocío/Consejo Superior de Investigaciones Científicas/Universidad de Sevilla, Seville, Spain
| | - A Pumar
- Unidad de Gestión Clínica de Endocrinología y Nutrición, Hospital Universitario Virgen del Rocío, Seville, Spain
- Instituto de Biomedicina de Sevilla (IBiS), Hospital Universitario Virgen del Rocío/Consejo Superior de Investigaciones Científicas/Universidad de Sevilla, Seville, Spain
| | - M A Martínez-Brocca
- Unidad de Gestión Clínica de Endocrinología y Nutrición, Hospital Universitario Virgen Macarena, Seville, Spain.
- Instituto de Biomedicina de Sevilla (IBiS), Hospital Universitario Virgen del Rocío/Consejo Superior de Investigaciones Científicas/Universidad de Sevilla, Seville, Spain.
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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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Dueñas Disotuar S, Guerrero Vázquez R, del Castillo Palma MJ, Martínez-Brocca MA. Pancreatitis autoinmune en la enfermedad relacionada con IgG4 como causa infrecuente de diabetes mellitus. Med Clin (Barc) 2015; 145:274-6. [DOI: 10.1016/j.medcli.2014.11.020] [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] [Subscribe] [Scholar Register] [Received: 10/11/2014] [Revised: 11/09/2014] [Accepted: 11/20/2014] [Indexed: 10/24/2022]
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Martínez-Brocca MA, Morales C, Rodríguez-Ortega P, González-Aguilera B, Montes C, Colomo N, Piédrola G, Méndez-Muros M, Serrano I, Ruiz de Adana MS, Moreno A, Fernández I, Aguilar M, Acosta D, Palomares R. Implementation of subcutaneous insulin protocol for non-critically ill hospitalized patients in andalusian tertiary care hospitals. Endocrinol Nutr 2015; 62:64-71. [PMID: 25467634 DOI: 10.1016/j.endonu.2014.09.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/23/2014] [Revised: 09/27/2014] [Accepted: 09/29/2014] [Indexed: 06/04/2023]
Abstract
INTRODUCTION In 2009, the Andalusian Society of Endocrinology and Nutrition designed a protocol for subcutaneous insulin treatment in hospitalized non-critically ill patients (HIP). OBJECTIVE To analyze implementation of HIP at tertiary care hospitals from the Andalusian Public Health System. METHOD A descriptive, multicenter study conducted in 8 tertiary care hospitals on a random sample of non-critically ill patients with diabetes/hyperglycemia (n=306) hospitalized for ≥48 hours in 5 non-surgical (SM) and 2 surgical (SQ) departments. Type 1 and other specific types of diabetes, pregnancy and nutritional support were exclusion criteria. RESULTS 288 patients were included for analysis (62.5% males; 70.3±10.3 years; 71.5% SM, 28.5% SQ). A scheduled subcutaneous insulin regimen based on basal-bolus-correction protocol was started in 55.9% (95%CI: 50.5-61.2%) of patients, 63.1% SM vs. 37.8% SQ (P<.05). Alternatives to insulin regimen based on basal-bolus-correction included sliding scale insulin (43.7%), diet (31.3%), oral antidiabetic drugs (17.2%), premixed insulin (1.6%), and others (6.2%). For patients previously on oral antidiabetic drugs, in-hospital insulin dose was 0.32±0.1 IU/kg/day. In patients previously on insulin, in-hospital insulin dose was increased by 17% [-13-53], and in those on insulin plus oral antidiabetic drugs, in-hospital insulin dose was increased by 26.4% [-6-100]. Supplemental insulin doses used for<40 IU/day and 40-80 IU/day were 72.2% and 56.7% respectively. HbA1c was measured in 23.6% of patients (95CI%: 18.8-28.8); 27.7% SM vs. 13.3% SQ (P<.05). CONCLUSIONS Strategies are needed to improve implementation of the inpatient subcutaneous insulin protocol, particularly in surgical departments. Sliding scale insulin is still the most common alternative to insulin regimen based on basal-bolus-correction scheduled insulin. Metabolic control assessment during hospitalization should be encouraged.
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Affiliation(s)
- María Asunción Martínez-Brocca
- Unidad de Gestión Clínica Provincial de Endocrinología y Nutrición, Hospital Universitario Virgen del Rocío, Instituto de Investigación Biomédica de Sevilla (IBiS), Hospital Universitario Virgen del Rocío/CSIC/Universidad de Sevilla, Sevilla, España.
| | - Cristóbal Morales
- Unidad de Gestión Clínica Provincial de Endocrinología y Nutrición, Hospital Universitario Virgen Macarena, Sevilla, España
| | - Pilar Rodríguez-Ortega
- Unidad de Gestión Clínica de Endocrinología y Nutrición, Hospital Juan Ramón Jiménez, Huelva, España
| | - Beatriz González-Aguilera
- Unidad de Gestión Clínica Provincial de Endocrinología y Nutrición, Hospital Universitario Virgen del Rocío, Instituto de Investigación Biomédica de Sevilla (IBiS), Hospital Universitario Virgen del Rocío/CSIC/Universidad de Sevilla, Sevilla, España
| | - Cristina Montes
- Unidad de Gestión Clínica de Endocrinología y Nutrición, Complejo Hospitalario de Jaén, Jaén, España
| | - Natalia Colomo
- Unidad de Gestión Clínica Intercentros, Hospital Regional Universitario de Málaga, Málaga, España
| | - Gonzalo Piédrola
- Unidad de Gestión Clínica de Endocrinología y Nutrición, Hospital Universitario Virgen de las Nieves, Granada, España
| | - Mariola Méndez-Muros
- Unidad de Gestión Clínica Provincial de Endocrinología y Nutrición, Hospital Universitario Virgen de Valme, Sevilla, España
| | - Isabel Serrano
- Unidad de Gestión Clínica Provincial de Endocrinología y Nutrición, Hospital Universitario Virgen Macarena, Sevilla, España
| | | | - Alberto Moreno
- Unidad de Gestión Clínica de Endocrinología y Nutrición, Complejo Hospitalario de Jaén, Jaén, España
| | - Ignacio Fernández
- Unidad de Gestión Clínica Provincial de Endocrinología y Nutrición, Hospital Universitario Virgen de Valme, Sevilla, España
| | - Manuel Aguilar
- Plan Integral de Diabetes, Unidad de Gestión Clínica Intercentros de Endocrinología y Nutrición, Hospital Universitario Puerta del Mar, Cádiz, España
| | - Domingo Acosta
- Unidad de Gestión Clínica Provincial de Endocrinología y Nutrición, Hospital Universitario Virgen del Rocío, Instituto de Investigación Biomédica de Sevilla (IBiS), Hospital Universitario Virgen del Rocío/CSIC/Universidad de Sevilla, Sevilla, España
| | - Rafael Palomares
- Unidad de Gestión Clínica de Endocrinología y Nutrición, Hospital Universitario Reina Sofía, Córdoba, España
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Martín-Vaquero P, Martínez-Brocca MA, García-López JM. Documento de posicionamiento sobre la eficiencia de las tecnologías aplicadas al manejo de la diabetes. ACTA ACUST UNITED AC 2014; 61:e45-63. [DOI: 10.1016/j.endonu.2014.08.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2014] [Accepted: 07/28/2014] [Indexed: 12/17/2022]
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Romero Lluch A, Jiménez I, García-García E, Guerrero R, Martínez-Brocca MA. [Endocrine and psychological changes in polysomy 48,XXXY]. Endocrinol Nutr 2012; 59:396-398. [PMID: 22285075 DOI: 10.1016/j.endonu.2011.11.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/03/2011] [Revised: 11/02/2011] [Accepted: 11/03/2011] [Indexed: 05/31/2023]
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Relimpio F, Guerrero R, Martínez-Brocca MA. HbA1c levels are better predicted by prebreakfast than postbreakfast blood glucose self-analyses in type 2 diabetes. Influence of duration of diabetes and mode of treatment. Acta Diabetol 2007; 44:55-9. [PMID: 17530467 DOI: 10.1007/s00592-007-0242-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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] [Received: 01/20/2005] [Accepted: 01/11/2007] [Indexed: 01/22/2023]
Abstract
The present study aimed at assessing the capability of both prebreakfast and postbreakfast home blood glucose self-analyses to predict HbA1c in type 2 diabetic individuals and the influence of duration of diabetes or mode of treatment in this regard. Two hundred and twenty-seven type 2 diabetic individuals consecutively attending our diabetes clinic between January 2000 and December 2002 (42.3% placed on oral drugs and 57.7% receiving insulin therapy, either alone or as a combination with oral drugs) were retrospectively selected and three more recent values regarding both home prebreakfast and one-hour postbreakfast blood glucose self-analyses were averaged. Patients were classified by their mode of treatment (submission or not to insulin therapy) and by quartile of duration of diabetes. The correlations of HbA1c levels with either prebreakfast or postbreakfast blood glucose self-analyses were performed in the whole group and in every subset considered. HbA1c values had a stronger correlation with prebreakfast blood glucose self-analyses (r=0.53, p<0.001) than with one-hour postbreakfast home glucose self-analyses (r=0.39, p<0.001). Prebreakfast (but not onehour postbreakfast) blood glucose self-analysis was selected as independently associated to HbA1c levels in a multiple regression analysis performed upon the whole study group as well as in most of the subsets considered. HbA1c values had a stronger correlation with prebreakfast glucose self-analyses in individuals with a shorter duration of diabetes (r=0.71, p<0.001) and not submitted to insulin therapy (r=0.59, p<0.001). Increasing age characterised individuals with the highest postbreakfast glucose excursions (one-way ANOVA, p<0.01). These data suggest that prebreakfast blood glucose self-analyses are more closely related to HbA1c levels than one-hour postbreakfast blood glucose self-analyses in most of the clinical spectrum of type 2 diabetes mellitus.
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Affiliation(s)
- F Relimpio
- Department of Endocrinology, University Hospital Virgen del Rocío, Seville, Spain.
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