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Mesa A, Giménez M, Perea V, Serés-Noriega T, Boswell L, Blanco J, Milad C, Pané A, Esmatjes E, Vinagre I, Conget I, Viñals C, Amor AJ. Severe hypoglycemia and hypoglycemia awareness are associated with preclinical atherosclerosis in patients with type 1 diabetes without an estimated high cardiovascular risk. Diabetes Metab Res Rev 2024; 40:e3785. [PMID: 38436542 DOI: 10.1002/dmrr.3785] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2023] [Revised: 12/20/2023] [Accepted: 02/02/2024] [Indexed: 03/05/2024]
Abstract
AIMS To explore the relationship between severe hypoglycemia (SH) and hypoglycemia awareness with preclinical atherosclerosis in type 1 diabetes (T1D). MATERIALS AND METHODS Cross-sectional study in patients with T1D without cardiovascular disease (CVD), and with ≥1 of the following: ≥40 years, diabetic kidney disease, or ≥10 years of T1D duration with another risk factor. CVD risk was estimated with the Steno T1 Risk Engine (Steno-Risk). Carotid plaque was evaluated using standardised ultrasonography protocol. Logistic regression models adjusted for CVD risk factors were constructed to test the independent associations with SH or hypoglycemia awareness assessed by the Clarke questionnaire (Clarke). The inclusion of SH and Clarke in Steno-Risk was further evaluated. RESULTS We included 634 patients (52.4% men, age 48.3 ± 10.8 years, T1D duration 27.4 ± 11.1 years, 39.9% harbouring plaque). A stepped increase in the presence of plaque according to Steno-Risk was observed (13.5%, 37.7%, and 68.7%, for low, moderate, and high risk, respectively; p < 0.001). SH history (OR 4.4 [1.3-14.6]) and Clarke score (OR 1.7 [1.2-2.2]) were associated with plaque in low-risk patients (n = 192). Clarke score was also associated with plaque burden in low-moderate-risk participants (n = 436; ≥2 plaques: OR 1.2 [1.0-1.5], p = 0.031; ≥3 plaques: OR 1.4 [1.1-2.0], p = 0.025). The inclusion of SH and Clarke scores in Steno-Risk significantly improved the identification of low-risk individuals with atherosclerosis (area under the curve: 0.658 vs. 0.576; p = 0.036). CONCLUSIONS In patients with T1D without an estimated high CVD risk, SH and hypoglycemia awareness assessment score were independently associated with preclinical atherosclerosis and improved identification of patients who would benefit from an intensive approach.
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Affiliation(s)
- Alex Mesa
- Diabetes Unit, Endocrinology and Nutrition Department, ICMDM, Hospital Clínic de Barcelona, Barcelona, Spain
- IDIBAPS (Institut d'investigacions biomèdiques August Pi i Sunyer), Barcelona, Spain
| | - Marga Giménez
- Diabetes Unit, Endocrinology and Nutrition Department, ICMDM, Hospital Clínic de Barcelona, Barcelona, Spain
- IDIBAPS (Institut d'investigacions biomèdiques August Pi i Sunyer), Barcelona, Spain
- Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Instituto de Salud Carlos III, Madrid, Spain
| | - Verónica Perea
- Endocrinology and Nutrition Department, Hospital Universitari Mútua Terrassa, Terrassa, Spain
| | - Tonet Serés-Noriega
- Diabetes Unit, Endocrinology and Nutrition Department, ICMDM, Hospital Clínic de Barcelona, Barcelona, Spain
| | - Laura Boswell
- Diabetes Unit, Endocrinology and Nutrition Department, ICMDM, Hospital Clínic de Barcelona, Barcelona, Spain
- IDIBAPS (Institut d'investigacions biomèdiques August Pi i Sunyer), Barcelona, Spain
- Endocrinology and Nutrition Department, Althaia University Health Network, Manresa, Spain
| | - Jesús Blanco
- Diabetes Unit, Endocrinology and Nutrition Department, ICMDM, Hospital Clínic de Barcelona, Barcelona, Spain
- IDIBAPS (Institut d'investigacions biomèdiques August Pi i Sunyer), Barcelona, Spain
| | - Camila Milad
- Diabetes Unit, Endocrinology and Nutrition Department, ICMDM, Hospital Clínic de Barcelona, Barcelona, Spain
| | - Adriana Pané
- Diabetes Unit, Endocrinology and Nutrition Department, ICMDM, Hospital Clínic de Barcelona, Barcelona, Spain
- IDIBAPS (Institut d'investigacions biomèdiques August Pi i Sunyer), Barcelona, Spain
| | - Enric Esmatjes
- Diabetes Unit, Endocrinology and Nutrition Department, ICMDM, Hospital Clínic de Barcelona, Barcelona, Spain
- IDIBAPS (Institut d'investigacions biomèdiques August Pi i Sunyer), Barcelona, Spain
- Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Instituto de Salud Carlos III, Madrid, Spain
| | - Irene Vinagre
- Diabetes Unit, Endocrinology and Nutrition Department, ICMDM, Hospital Clínic de Barcelona, Barcelona, Spain
| | - Ignacio Conget
- Diabetes Unit, Endocrinology and Nutrition Department, ICMDM, Hospital Clínic de Barcelona, Barcelona, Spain
- IDIBAPS (Institut d'investigacions biomèdiques August Pi i Sunyer), Barcelona, Spain
- Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Instituto de Salud Carlos III, Madrid, Spain
| | - Clara Viñals
- Diabetes Unit, Endocrinology and Nutrition Department, ICMDM, Hospital Clínic de Barcelona, Barcelona, Spain
| | - Antonio J Amor
- Diabetes Unit, Endocrinology and Nutrition Department, ICMDM, Hospital Clínic de Barcelona, Barcelona, Spain
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Serés-Noriega T, Viñals C, Perea V, Mesa A, Boswell L, Mariaca K, Blanco J, Vinagre I, Pané A, Milad C, Solà C, Esmatjes E, Conget I, Giménez M, Amor AJ. Adherence to an energy-restricted Mediterranean diet is associated with the presence and burden of carotid atherosclerosis in people with type 1 diabetes. Diabetes Metab Res Rev 2024; 40:e3783. [PMID: 38402458 DOI: 10.1002/dmrr.3783] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Revised: 01/18/2024] [Accepted: 01/24/2024] [Indexed: 02/26/2024]
Abstract
AIMS People with type 1 diabetes (T1D) have an increased risk of cardiovascular disease (CVD). The Mediterranean diet is associated with reduced CVD; however, the evidence in T1D is scarce. We aimed to analyse the relationships between adherence to the energy-restricted Mediterranean diet (erMEDd) and carotid atherosclerosis. MATERIALS AND METHODS We included children with T1D without CVD, with ≥1 of the following: age ≥40 years, diabetic kidney disease, or ≥10 years of disease duration with another risk factor. Plaque presence (intima-media thickness ≥1.5 mm) was determined by ultrasonography. The PREDIMED-Plus 17-item questionnaire (PP-17) was used to assess adherence to the erMEDd. RESULTS Four hundred one individuals were included (48% males, age 48.3 ± 11 years, diabetes duration 26.8 ± 11.4 years). Those harbouring plaques (42%) showed lower adherence to the erMEDd (PP-17: 8.9 ± 2.3 of a maximum of 17 vs. 9.8 ± 2.5, p < 0.001). Greater adherence to the erMEDd was correlated with an overall better metabolic profile. After adjusting for multiple confounders, adherence to the erMEDd was independently associated with carotid atherosclerosis (OR 0.86 [0.77-0.95] for plaque presence and OR 0.85 [0.75-0.97] for ≥2 plaques). The consumption of fruit and nuts and preference of white over red meat was higher in individuals without atherosclerosis (p < 0.05). Fruit and nut consumption was associated with lower plaque prevalence in the fully adjusted models (OR 0.38 [0.19-0.73] and 0.51 [0.29-0.93]). CONCLUSIONS Greater adherence to the erMEDd is associated with less carotid atherosclerosis in children with T1D at high risk of CVD. Strategies to improve and implement healthy dietary patterns in this population should be encouraged.
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Affiliation(s)
- Tonet Serés-Noriega
- Diabetes Unit, Endocrinology and Nutrition Department, Hospital Clínic, Barcelona, Spain
| | - Clara Viñals
- Diabetes Unit, Endocrinology and Nutrition Department, Hospital Clínic, Barcelona, Spain
| | - Verónica Perea
- Endocrinology and Nutrition Department, Hospital Universitari Mútua de Terrassa, Terrassa, Spain
| | - Alex Mesa
- Diabetes Unit, Endocrinology and Nutrition Department, Hospital Clínic, Barcelona, Spain
| | - Laura Boswell
- Diabetes Unit, Endocrinology and Nutrition Department, Hospital Clínic, Barcelona, Spain
- Endocrinology and Nutrition Department, Althaia University Health Network, Manresa, Spain
- Institut de Recerca i Innovació en Ciències de la Vida i de la Salut a la Catalunya Central (IRIS-CC), Vic, Spain
| | - Karla Mariaca
- Diabetes Unit, Endocrinology and Nutrition Department, Hospital Clínic, Barcelona, Spain
| | - Jesús Blanco
- Diabetes Unit, Endocrinology and Nutrition Department, Hospital Clínic, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Hospital Clínic, Barcelona, Spain
| | - Irene Vinagre
- Diabetes Unit, Endocrinology and Nutrition Department, Hospital Clínic, Barcelona, Spain
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Hospital Clínic, Barcelona, Spain
| | - Adriana Pané
- Diabetes Unit, Endocrinology and Nutrition Department, Hospital Clínic, Barcelona, Spain
- Centro de Investigación Biomédica en Red de la Fisiopatología de la Obesidad y Nutrición. (CIBEROBN), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
| | - Camila Milad
- Diabetes Unit, Endocrinology and Nutrition Department, Hospital Clínic, Barcelona, Spain
| | - Clara Solà
- Diabetes Unit, Endocrinology and Nutrition Department, Hospital Clínic, Barcelona, Spain
| | - Enric Esmatjes
- Diabetes Unit, Endocrinology and Nutrition Department, Hospital Clínic, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Hospital Clínic, Barcelona, Spain
| | - Ignacio Conget
- Diabetes Unit, Endocrinology and Nutrition Department, Hospital Clínic, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Hospital Clínic, Barcelona, Spain
| | - Marga Giménez
- Diabetes Unit, Endocrinology and Nutrition Department, Hospital Clínic, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Hospital Clínic, Barcelona, Spain
| | - Antonio J Amor
- Diabetes Unit, Endocrinology and Nutrition Department, Hospital Clínic, Barcelona, Spain
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Seaquist E, Giménez M, Yan Y, Matsuhisa M, Kao CY, Wadwa RP, Nagai Y, Khunti K. Nasal Glucagon Reverses Insulin-induced Hypoglycemia With Less Rebound Hyperglycemia: Pooled Analysis of Clinical Trials. J Endocr Soc 2024; 8:bvae034. [PMID: 38444629 PMCID: PMC10913376 DOI: 10.1210/jendso/bvae034] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Indexed: 03/07/2024] Open
Abstract
Background Rebound hyperglycemia may occur following glucagon treatment for severe hypoglycemia. We assessed rebound hyperglycemia occurrence after nasal glucagon (NG) or injectable glucagon (IG) administration in patients with type 1 diabetes (T1D) and type 2 diabetes (T2D). Methods This was a pooled analysis of 3 multicenter, randomized, open-label studies (NCT03339453, NCT03421379, NCT01994746) in patients ≥18 years with T1D or T2D with induced hypoglycemia. Proportions of patients achieving treatment success [blood glucose (BG) increase to ≥70 mg/dL or increase of ≥20 mg/dL from nadir within 15 and 30 minutes]; BG ≥70 mg/dL within 15 minutes; in-range BG (70-180 mg/dL) 1 to 2 and 1 to 4 hours postdose; and BG >180 mg/dL 1 to 2 and 1 to 4 hours postdose were compared. Incremental area under curve (iAUC) of BG >180 mg/dL and area under curve (AUC) of observed BG values postdose were analyzed. Safety was assessed in all studies. Results Higher proportions of patients had in-range BG with NG vs IG (1-2 hours: P = .0047; 1-4 hours: P = .0034). Lower proportions of patients had at least 1 BG value >180 mg/dL with NG vs IG (1-2 hours: P = .0034; 1-4 hours: P = .0068). iAUC and AUC were lower with NG vs IG (P = .025 and P < .0001). As expected, similar proportions of patients receiving NG or IG achieved treatment success at 15 and 30 minutes (97-100%). Most patients had BG ≥70 mg/dL within 15 minutes (93-96%). The safety profile was consistent with previous studies. Conclusion This study demonstrated lower rebound hyperglycemia risk after NG treatment compared with IG. Clinical Trial Registration NCT03421379, NCT03339453, NCT01994746.
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Affiliation(s)
- Elizabeth Seaquist
- Department of Medicine, Division of Endocrinology and Diabetes, University of Minnesota, Minneapolis, MN 55455, USA
| | - Marga Giménez
- Diabetes Unit, Endocrinology and Nutrition Department, Hospital Clínic de Barcelona, Barcelona 08036, Spain
| | - Yu Yan
- Eli Lilly and Company, Indianapolis, IN 46225, USA
| | - Munehide Matsuhisa
- Diabetes Therapeutics and Research Center, Institute of Advanced Medical Sciences, Tokushima University, Tokushima 770-8503, Japan
| | | | - R Paul Wadwa
- Barbara Davis Center for Diabetes, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, USA
| | - Yukiko Nagai
- Eli Lilly and Company, Indianapolis, IN 46225, USA
| | - Kamlesh Khunti
- Diabetes Research Centre, University of Leicester, Leicester LE1 7RH, UK
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Mariaca K, Serés-Noriega T, Viñals C, Perea V, Conget I, Mesa A, Boswell L, Font C, Pané A, Vinagre I, Blanco J, Esmatjes E, Giménez M, Amor AJ. Neutrophil-to-lymphocyte ratio is independently associated with carotid atherosclerosis burden in individuals with type 1 diabetes. Nutr Metab Cardiovasc Dis 2024; 34:395-403. [PMID: 37951756 DOI: 10.1016/j.numecd.2023.09.017] [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: 06/23/2023] [Revised: 08/26/2023] [Accepted: 09/19/2023] [Indexed: 11/14/2023]
Abstract
BACKGROUND AND AIMS Recent studies have identified a relationship between innate versus. Adaptative immunity and cardiovascular disease (CVD) in the general population, but information on type 1 diabetes (T1D) is lacking. We aimed to study the relationship between inflammatory biomarkers and preclinical atherosclerosis in this population. METHODS AND RESULTS Cross-sectional study in T1D individuals without CVD and with ≥1 of the following: ≥40 years, diabetic kidney disease, or ≥10 years of diabetes duration with classical CVD risk factors. Carotid plaques were evaluated by ultrasonography. C-reactive protein, total leukocyte count, neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio and systemic immune-inflammation index were assessed as inflammatory markers. Multivariate-adjusted models including age, sex, and other CVD risk factors were constructed to test their independent associations with atherosclerosis burden. We included 602 subjects (52.8% men, 48.7 ± 10.2 years old and 27.0 ± 10.5 years of diabetes duration). Carotid plaques were found in 41.2% of the individuals (12.8%, ≥3 plaques). The number of carotid plaques (none, 1-2, ≥3 plaques), was directly associated with the leukocyte count (6570 [5445-8050], 6640 [5450-8470] and 7310 [5715-8935] per mm3, respectively; p for trend = 0.021) and the NLR (1.63 [1.28-2.13], 1.78 [1.38-2.25] and 2.14 [1.58-2.92], respectively; p for trend <0.001), but only the NLR remained directly associated in fully-adjusted models (presence of plaques; OR 1.285 [1.040-1.587]; ≥3 plaques, OR 1.377 [1.036-1.829]). CONCLUSIONS The NLR was independently and directly associated with carotid plaque burden in T1D individuals. Our data support the role of innate versus. Adaptative immunity in atherosclerosis also among the T1D population.
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Affiliation(s)
- Karla Mariaca
- Diabetes Unit, Endocrinology and Nutrition Department, Hospital Clínic, Barcelona, Spain
| | - Tonet Serés-Noriega
- Diabetes Unit, Endocrinology and Nutrition Department, Hospital Clínic, Barcelona, Spain.
| | - Clara Viñals
- Diabetes Unit, Endocrinology and Nutrition Department, Hospital Clínic, Barcelona, Spain
| | - Verónica Perea
- Endocrinology and Nutrition Department, Hospital Universitari Mútua de Terrassa, Terrassa, Spain
| | - Ignacio Conget
- Diabetes Unit, Endocrinology and Nutrition Department, Hospital Clínic, Barcelona, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Hospital Clínic, Barcelona, Spain; Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
| | - Alex Mesa
- Diabetes Unit, Endocrinology and Nutrition Department, Hospital Clínic, Barcelona, Spain
| | - Laura Boswell
- Diabetes Unit, Endocrinology and Nutrition Department, Hospital Clínic, Barcelona, Spain; Endocrinology and Nutrition Department, Althaia University Health Network, Manresa, Spain
| | - Carla Font
- Diabetes Unit, Endocrinology and Nutrition Department, Hospital Clínic, Barcelona, Spain
| | - Adriana Pané
- Diabetes Unit, Endocrinology and Nutrition Department, Hospital Clínic, Barcelona, Spain; Centro de Investigación Biomédica en Red de la Fisiopatología de la Obesidad y Nutrición. (CIBEROBN), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
| | - Irene Vinagre
- Diabetes Unit, Endocrinology and Nutrition Department, Hospital Clínic, Barcelona, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Hospital Clínic, Barcelona, Spain
| | - Jesús Blanco
- Diabetes Unit, Endocrinology and Nutrition Department, Hospital Clínic, Barcelona, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Hospital Clínic, Barcelona, Spain; Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
| | - Enric Esmatjes
- Diabetes Unit, Endocrinology and Nutrition Department, Hospital Clínic, Barcelona, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Hospital Clínic, Barcelona, Spain; Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
| | - Marga Giménez
- Diabetes Unit, Endocrinology and Nutrition Department, Hospital Clínic, Barcelona, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Hospital Clínic, Barcelona, Spain; Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
| | - Antonio J Amor
- Diabetes Unit, Endocrinology and Nutrition Department, Hospital Clínic, Barcelona, Spain.
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Perea V, Vinagre I, Serés-Noriega T, Viñals C, Mesa A, Pané A, Milad C, Esmatjes E, Conget I, Giménez M, Amor AJ. Impact of preeclampsia and parity on sex-based discrepancies in subclinical carotid atherosclerosis in type 1 diabetes. J Clin Endocrinol Metab 2023:dgad755. [PMID: 38149646 DOI: 10.1210/clinem/dgad755] [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: 09/22/2023] [Revised: 12/20/2023] [Accepted: 12/22/2023] [Indexed: 12/28/2023]
Abstract
CONTEXT The excess risk of fatal and non-fatal cardiovascular events is roughly twice as high in women than in men with type 1 diabetes (T1D). OBJECTIVE To evaluate the impact of preeclampsia and parity on sex-based discrepancies in preclinical atherosclerosis and on the diagnostic performance of a cardiovascular risk scale. DESIGN Cross-sectional study. SETTING Single tertiary hospital. PATIENTS 728 T1D (48.5% women) without cardiovascular disease and age ≥40 years, nephropathy, and/or ≥10 years of diabetes duration with another risk factor. INTERVENTION Standardized carotid ultrasonography. MAIN OUTCOME MEASURES Carotid plaque determined by ultrasonography and cardiovascular risk estimated according to the Steno T1 Risk Engine (Steno-Risk). RESULTS Nulliparous women and parous women without previous preeclampsia had a lower risk for carotid plaque than men (adjusted odds ratio [OR]: 0.48, 95% confidence interval [0.28-0.82]; adjusted OR: 0.51 [0.33-0.79], respectively), without differences in the preeclampsia group. The prevalence of carotid plaque increased as the estimated cardiovascular risk increased in all subgroups except for preeclampsia group. The area under the curve (AUC) of the Steno-Risk for identifying ≥2 carotid plaques was lower in the preeclampsia group (men: 0.7886, nulliparous women: 0.9026, women without preeclampsia: 0.8230, preeclampsia group: 0.7841; p between groups=0.042). Neither the addition of parity nor preeclampsia in the Steno-Risk led to a statistically significant increase in the AUC. CONCLUSIONS The risk for carotid plaque in women compared to men decreased as exposure to obstetric factors diminished. However, the addition of these factors did not improve the prediction of the Steno-Risk.
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Affiliation(s)
- Verónica Perea
- Endocrinology and Nutrition Department, Hospital Universitari Mútua de Terrassa, Spain
| | - Irene Vinagre
- Endocrinology and Nutrition Department, Hospital Clínic de Barcelona, Spain
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Hospital Clínic, Barcelona, Spain
| | | | - Clara Viñals
- Endocrinology and Nutrition Department, Hospital Clínic de Barcelona, Spain
| | - Alex Mesa
- Endocrinology and Nutrition Department, Hospital Clínic de Barcelona, Spain
| | - Adriana Pané
- Endocrinology and Nutrition Department, Hospital Clínic de Barcelona, Spain
- Centro de Investigación Biomédica en Red de la Fisiopatología de la Obesidad y Nutrición. (CIBEROBN), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
| | - Camila Milad
- Endocrinology and Nutrition Department, Hospital Clínic de Barcelona, Spain
| | - Enric Esmatjes
- Endocrinology and Nutrition Department, Hospital Clínic de Barcelona, Spain
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Hospital Clínic, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
| | - Ignacio Conget
- Endocrinology and Nutrition Department, Hospital Clínic de Barcelona, Spain
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Hospital Clínic, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
| | - Marga Giménez
- Endocrinology and Nutrition Department, Hospital Clínic de Barcelona, Spain
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Hospital Clínic, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
| | - Antonio J Amor
- Endocrinology and Nutrition Department, Hospital Clínic de Barcelona, Spain
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Mesa A, Beneyto A, Martín-SanJosé JF, Viaplana J, Bondia J, Vehí J, Conget I, Giménez M. Safety and performance of a hybrid closed-loop insulin delivery system with carbohydrate suggestion in adults with type 1 diabetes prone to hypoglycemia. Diabetes Res Clin Pract 2023; 205:110956. [PMID: 37844798 DOI: 10.1016/j.diabres.2023.110956] [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: 05/30/2023] [Revised: 10/09/2023] [Accepted: 10/13/2023] [Indexed: 10/18/2023]
Abstract
AIMS To evaluate the safety and performance of a hybrid closed-loop (HCL) system with automatic carbohydrate suggestion in adults with type 1 diabetes (T1D) prone to hypoglycemia. METHODS A 32-hour in-hospital pilot study, including a night period, 4 meals and 2 vigorous unannounced 45-minute aerobic sessions, was conducted in 11 adults with T1D prone to hypoglycemia. The primary outcome was the percentage of time in range 70-180 mg/dL (TIR). Main secondary outcomes were time below range < 70 mg/dL (TBR < 70) and < 54 (TBR < 54). Data are presented as median (10th-90th percentile ranges). RESULTS The participants, 6 (54.5%) men, were 24 (22-48) years old, and had 22 (9-32) years of T1D duration. All of them regularly used an insulin pump and a continuous glucose monitoring system. The median TIR was 78.7% (75.6-91.2): 92.7% (68.2-100.0) during exercise and recovery period, 79.3% (34.9-100.0) during postprandial period, and 95.4% (66.4-100.0) during overnight period. The TBR < 70 and TBR < 54 were 0.0% (0.0-6.6) and 0.0% (0.0-1.2), respectively. A total of 4 (3-9) 15-g carbohydrate suggestions were administered per person. No severe acute complications occurred during the study. CONCLUSIONS The HCL system with automatic carbohydrate suggestion performed well and was safe in this population during challenging conditions in a hospital setting.
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Affiliation(s)
- Alex Mesa
- Diabetes Unit, Endocrinology and Nutrition Department, Hospital Clínic de Barcelona, Barcelona, Spain
| | - Aleix Beneyto
- Institute of Informatics and Applications, University of Girona, Girona, Spain
| | - Juan-Fernando Martín-SanJosé
- Instituto Universitario de Automática e Informática Industrial, Universitat Politècnica de València, València, Spain
| | - Judith Viaplana
- Fundació Clínic per a la Recerca Biomèdica (FCRB), Barcelona, Spain
| | - Jorge Bondia
- Instituto Universitario de Automática e Informática Industrial, Universitat Politècnica de València, València, Spain; Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas, Instituto de Salud Carlos III. Madrid, Spain
| | - Josep Vehí
- Institute of Informatics and Applications, University of Girona, Girona, Spain; Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas, Instituto de Salud Carlos III. Madrid, Spain.
| | - Ignacio Conget
- Diabetes Unit, Endocrinology and Nutrition Department, Hospital Clínic de Barcelona, Barcelona, Spain; Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas, Instituto de Salud Carlos III. Madrid, Spain; IDIBAPS (Institut d'investigacions biomèdiques August Pi i Sunyer). Barcelona, Spain
| | - Marga Giménez
- Diabetes Unit, Endocrinology and Nutrition Department, Hospital Clínic de Barcelona, Barcelona, Spain; Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas, Instituto de Salud Carlos III. Madrid, Spain; IDIBAPS (Institut d'investigacions biomèdiques August Pi i Sunyer). Barcelona, Spain.
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Giménez M, Khunti K, Matsuhisa M, Chenji S, Syring K, Yan Y. Systematic Literature Review and Indirect Treatment Comparison of Three Ready-to-Use Glucagon Treatments for Severe Hypoglycemia. Diabetes Ther 2023; 14:1757-1769. [PMID: 37707700 PMCID: PMC10570215 DOI: 10.1007/s13300-023-01466-6] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Accepted: 08/21/2023] [Indexed: 09/15/2023] Open
Abstract
INTRODUCTION Ready-to-use glucagon represents a significant advancement in the management of severe hypoglycemia for people with diabetes and their caregivers. This indirect treatment comparison (ITC) evaluated the efficacy and safety differences among the three ready-to-use glucagon treatments, Baqsimi® (nasal glucagon), Gvoke® (glucagon injection) and Zegalogue® (dasiglucagon injection), in adults and children with type 1 diabetes (T1D) or type 2 diabetes (T2D). METHODS A systematic literature review was conducted to identify randomized clinical trials assessing the efficacy and safety of Baqsimi, Gvoke or Zegalogue versus reconstituted, injectable glucagon (IG) in reversing insulin-induced hypoglycemia. Bayesian fixed-effect network meta-analysis was used to perform the ITC. Study endpoints included proportion of participants achieving treatment success, maximum blood glucose achieved, time to achieve treatment success and maximum blood glucose and treatment-emergent adverse events (TEAE). RESULTS Ten clinical trials were included in the ITC (four for Baqsimi, three for Gvoke, and three for Zegalogue). All three treatments achieved high proportions of treatment success (> 98%). In adults, the efficacy results from combined T1D and T2D analysis were consistent with the T1D analysis, except statistically significantly faster in achieving treatment success for Baqsimi vs Gvoke in the combined analysis (13.96 vs 14.66 min). The mean maximum blood glucose values were also statistically significantly lower for Baqsimi (168 mg/dl) vs Gvoke (220 mg/dl) and Zegalogue (190 mg/dl). There was a trend towards a lower number of adults experiencing ≥ 1 TEAE with Baqsimi compared to Gvoke or Zegalogue, but no statistical significance was reached. CONCLUSION Baqsimi, Gvoke and Zegalogue had comparable high proportions of treatment success in reversing insulin-induced hypoglycemia. Baqsimi achieved a lower mean maximum blood glucose value, which may have implications for the re-establishment of euglycemia. These findings may help support patients, caregivers and health care providers in their decision-making process when discussing various ready-to-use glucagon treatment options.
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Affiliation(s)
| | | | - Munehide Matsuhisa
- Diabetes Therapeutics and Research Center, Institute of Advanced Medical Sciences, Tokushima University, Tokushima, Japan
| | - Suresh Chenji
- Eli Lilly and Company, Lilly Corporate Center, Indianapolis, IN, 46285, USA
| | - Kristen Syring
- Eli Lilly and Company, Lilly Corporate Center, Indianapolis, IN, 46285, USA
| | - Yu Yan
- Eli Lilly and Company, Lilly Corporate Center, Indianapolis, IN, 46285, USA.
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Pueyo I, Viñals C, Mesa A, Giménez M, Conget I. Strategy and results of the massive implementation of reimbursed continuous glucose monitoring in people with type 1 diabetes. ENDOCRINOL DIAB NUTR 2023; 70 Suppl 3:73-75. [PMID: 36517387 DOI: 10.1016/j.endien.2022.03.011] [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: 01/26/2022] [Accepted: 03/16/2022] [Indexed: 06/17/2023]
Affiliation(s)
- Irene Pueyo
- Servicio de Endocrinología y Nutrición, Hospital Clínic de Barcelona, Barcelona, Spain
| | - Clara Viñals
- Servicio de Endocrinología y Nutrición, Hospital Clínic de Barcelona, Barcelona, Spain
| | - Alex Mesa
- Servicio de Endocrinología y Nutrición, Hospital Clínic de Barcelona, Barcelona, Spain.
| | - Marga Giménez
- Servicio de Endocrinología y Nutrición, Hospital Clínic de Barcelona, Barcelona, Spain; Institut d'investigacions biomèdiques August Pi I Sunyer (IDIBAPS), Barcelona, Spain; Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Spain
| | - Ignacio Conget
- Servicio de Endocrinología y Nutrición, Hospital Clínic de Barcelona, Barcelona, Spain; Institut d'investigacions biomèdiques August Pi I Sunyer (IDIBAPS), Barcelona, Spain; Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Spain
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Contreras M, Mesa A, Pueyo I, Claro M, Milad C, Viñals C, Roca D, Granados M, Giménez M, Conget I. Effectiveness of flash glucose monitoring in patients with type 1 diabetes and recurrent hypoglycemia between early and late stages after flash glucose monitoring initiation. J Diabetes Complications 2023; 37:108560. [PMID: 37480703 DOI: 10.1016/j.jdiacomp.2023.108560] [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: 03/27/2023] [Revised: 07/07/2023] [Accepted: 07/16/2023] [Indexed: 07/24/2023]
Abstract
AIMS Evaluate the effectiveness of reimbursed flash glucose monitoring with optional alarms (FGM) in preventing severe hypoglycemia (SH) and reducing hypoglycemia exposure in T1D patients prone to hypoglycemia. METHODS Ambispective study in T1D patients treated with multiple daily injections (MDI) and prone to hypoglycemia, initiating reimbursed FGM (FreeStyle Libre 2). The primary outcome was the number of SH events (requiring third party assistance) and main secondary outcomes were time below range < 70 (TBR < 70) and < 54 mg/dL (TBR < 54), impaired awareness of hypoglycemia (IAH) and quality of life (QoL). Logistic regression models were constructed to explore variables associated with success of the intervention. RESULTS We included 110 patients (52.7 % women, mean age 47.8 ± 17.0 years). SH events at 1-year follow-up decreased from 0.3 ± 0.6 to 0.03 ± 0.2 (p < 0.001). Significant reductions in patients presenting an SH (26.4 % vs. 2.9 %, p < 0.001) and IAH (47.1 % vs. 25.9 %, p = 0.002) were observed, as well as improvements in QoL. TBR < 70 and TBR < 54 were not significantly reduced. Baseline GMI was inversely associated with a decrease in TBR < 70 [OR 0.37 (0.15-0.93)] and directly with an increase in time in range 70-180 mg/dL [OR 2.10 (1.03-4.28)]. CONCLUSIONS FGM decreased SH and improved hypoglycemia awareness and QoL. Initial tight glycemic control was associated with a decrease in hypoglycemia, while patients with suboptimal control reduced hyperglycemia.
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Affiliation(s)
- Macarena Contreras
- Endocrinology and Nutrition Department, Hospital Central de la Defensa Gómez Ulla, Madrid, Spain; Diabetes Unit, Endocrinology and Nutrition Department, ICMDM, Hospital Clínic de Barcelona, Spain
| | - Alex Mesa
- Diabetes Unit, Endocrinology and Nutrition Department, ICMDM, Hospital Clínic de Barcelona, Spain
| | - Irene Pueyo
- Diabetes Unit, Endocrinology and Nutrition Department, ICMDM, Hospital Clínic de Barcelona, Spain
| | - Maria Claro
- Diabetes Unit, Endocrinology and Nutrition Department, ICMDM, Hospital Clínic de Barcelona, Spain
| | - Camila Milad
- Diabetes Unit, Endocrinology and Nutrition Department, ICMDM, Hospital Clínic de Barcelona, Spain
| | - Clara Viñals
- Diabetes Unit, Endocrinology and Nutrition Department, ICMDM, Hospital Clínic de Barcelona, Spain
| | - Daria Roca
- Diabetes Unit, Endocrinology and Nutrition Department, ICMDM, Hospital Clínic de Barcelona, Spain
| | - Montse Granados
- Diabetes Unit, Endocrinology and Nutrition Department, ICMDM, Hospital Clínic de Barcelona, Spain
| | - Marga Giménez
- Diabetes Unit, Endocrinology and Nutrition Department, ICMDM, Hospital Clínic de Barcelona, Spain; IDIBAPS (Institut d'investigacions biomèdiques August Pi i Sunyer), Barcelona, Spain; CIBERDEM (Centro de Investigación en Red de Diabetes y Enfermedades Metabólicas), Madrid, Spain.
| | - Ignacio Conget
- Diabetes Unit, Endocrinology and Nutrition Department, ICMDM, Hospital Clínic de Barcelona, Spain; IDIBAPS (Institut d'investigacions biomèdiques August Pi i Sunyer), Barcelona, Spain; CIBERDEM (Centro de Investigación en Red de Diabetes y Enfermedades Metabólicas), Madrid, Spain
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Serés-Noriega T, Ortega E, Giménez M, Perea V, Boswell L, Mariaca K, Font C, Mesa A, Viñals C, Blanco J, Vinagre I, Pané A, Esmatjes E, Conget I, Amor AJ. Advanced lipoprotein profile identifies atherosclerosis better than conventional lipids in type 1 diabetes at high cardiovascular risk. Nutr Metab Cardiovasc Dis 2023; 33:1235-1244. [PMID: 37088651 DOI: 10.1016/j.numecd.2023.03.025] [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: 01/09/2023] [Revised: 03/14/2023] [Accepted: 03/30/2023] [Indexed: 04/25/2023]
Abstract
BACKGROUND AND AIMS People with type 1 diabetes (T1D) present lipoprotein disturbances that could contribute to their increased cardiovascular disease (CVD) risk. We evaluated the relationship between lipoprotein alterations and atherosclerosis in patients with T1D. METHODS AND RESULTS Cross-sectional study in subjects with T1D, without previous CVD, but high-risk (≥40 years, nephropathy, or ≥10 years of evolution of diabetes with another risk factor). The presence of plaque (intima-media thickness ≥1.5 mm) in the different carotid segments was determined by ultrasound. The advanced lipoprotein profile was analysed by magnetic resonance imaging (1H NMR). We included 189 patients (42% women, 47.8 ± 10.7 years, duration of diabetes 27.3 ± 10.1 years, HbA1c 7.5% [7-8]). Those with carotid plaques (35%) were older, with longer diabetes duration, had a higher prevalence of hypertension, and showed lower and smaller LDL particles (LDL-P) and HDL particles (HDL-P), but higher VLDL particles (VLDL-P). Some LDL, HDL and VLDL-related parameters were associated with atherosclerosis in sex, age and statin use adjusted models (p < 0.05), but after adjusting for multiple confounders, including conventional lipid parameters, only HDL-P (OR 0.440 [0.204-0.951]; p = 0.037), medium HDL-P (OR 0.754 [0.590-0.963]; p = 0.024), HDL-P cholesterol content (OR 0.692 [0.495-0.968]; p = 0.032), 1H NMR LDL-P number/conventional LDL-cholesterol (OR 1.144 [1.026-1.275]; p = 0.015), and 1H NMR non-HDL particle number/conventional non-HDL-cholesterol ratios (OR 1.178 [1.019-1.361], p = 0.026) remained associated with atherosclerosis. CONCLUSIONS In adults with T1D at high-risk, variables related to HDL, LDL and total atherogenic particle number are independently associated with preclinical atherosclerosis. Advanced lipoprotein profiling could be used to identify those at the highest risk of CVD.
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Affiliation(s)
- Tonet Serés-Noriega
- Diabetes Unit, Endocrinology and Nutrition Department, Hospital Clínic, Barcelona, Spain.
| | - Emilio Ortega
- Diabetes Unit, Endocrinology and Nutrition Department, Hospital Clínic, Barcelona, Spain; Centro de Investigación Biomédica en Red de la Fisiopatología de la Obesidad y Nutrición. (CIBEROBN), Instituto de Salud Carlos III (ISCIII), Madrid, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Hospital Clínic, Barcelona, Spain
| | - Marga Giménez
- Diabetes Unit, Endocrinology and Nutrition Department, Hospital Clínic, Barcelona, Spain; Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Instituto de Salud Carlos III (ISCIII), Madrid, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Hospital Clínic, Barcelona, Spain
| | - Verónica Perea
- Endocrinology and Nutrition Department, Hospital Universitari Mútua de Terrassa, Terrassa, Spain
| | - Laura Boswell
- Diabetes Unit, Endocrinology and Nutrition Department, Hospital Clínic, Barcelona, Spain; Endocrinology and Nutrition Department, Althaia University Health Network, Manresa, Spain
| | - Karla Mariaca
- Diabetes Unit, Endocrinology and Nutrition Department, Hospital Clínic, Barcelona, Spain
| | - Carla Font
- Diabetes Unit, Endocrinology and Nutrition Department, Hospital Clínic, Barcelona, Spain
| | - Alex Mesa
- Diabetes Unit, Endocrinology and Nutrition Department, Hospital Clínic, Barcelona, Spain
| | - Clara Viñals
- Diabetes Unit, Endocrinology and Nutrition Department, Hospital Clínic, Barcelona, Spain
| | - Jesús Blanco
- Diabetes Unit, Endocrinology and Nutrition Department, Hospital Clínic, Barcelona, Spain; Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Instituto de Salud Carlos III (ISCIII), Madrid, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Hospital Clínic, Barcelona, Spain
| | - Irene Vinagre
- Diabetes Unit, Endocrinology and Nutrition Department, Hospital Clínic, Barcelona, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Hospital Clínic, Barcelona, Spain
| | - Adriana Pané
- Diabetes Unit, Endocrinology and Nutrition Department, Hospital Clínic, Barcelona, Spain; Centro de Investigación Biomédica en Red de la Fisiopatología de la Obesidad y Nutrición. (CIBEROBN), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
| | - Enric Esmatjes
- Diabetes Unit, Endocrinology and Nutrition Department, Hospital Clínic, Barcelona, Spain; Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Instituto de Salud Carlos III (ISCIII), Madrid, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Hospital Clínic, Barcelona, Spain
| | - Ignacio Conget
- Diabetes Unit, Endocrinology and Nutrition Department, Hospital Clínic, Barcelona, Spain; Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Instituto de Salud Carlos III (ISCIII), Madrid, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Hospital Clínic, Barcelona, Spain
| | - Antonio J Amor
- Diabetes Unit, Endocrinology and Nutrition Department, Hospital Clínic, Barcelona, Spain.
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Boswell L, Perea V, Amor AJ, Seguí N, Bellart J, Roca D, Giménez M, Conget I, Vinagre I. Impaired hypoglycaemia awareness in early pregnancy increases risk of severe hypoglycaemia in the mid-long term postpartum irrespective of breastfeeding status in women with type 1 diabetes. ENDOCRINOL DIAB NUTR 2023; 70 Suppl 2:18-26. [PMID: 37268354 DOI: 10.1016/j.endien.2022.02.023] [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: 12/16/2021] [Accepted: 02/14/2022] [Indexed: 06/04/2023]
Abstract
INTRODUCTION Information regarding the postpartum period in women with type 1 diabetes (T1D) is scarce. We aim to evaluate the relation of impaired hypoglycaemia awareness (IAH) in early pregnancy and breastfeeding status (its presence and duration) with severe postpartum hypoglycaemia (SH). MATERIALS AND METHODS Retrospective cohort study of women with T1D followed during pregnancy between 2012 and 2019. Data on SH were recorded before and during pregnancy. IAH was evaluated at the first antenatal visit. Data on breastfeeding and the long-term postpartum period were collected by questionnaire and from medical records. RESULTS A total of 89 women with T1D were included with a median follow-up after pregnancy of 19.2 [8.7-30.5] months. Twenty-eight (32%) women had IAH at the first antenatal visit. At discharge, 74 (83%) started breastfeeding during a median of 8 [4.4-15] months. A total of 18 (22%) women experienced ≥1 SH during postpartum. The incidence of SH significantly increased from pregestational to the gestational and post-partum period (0.09, 0.15 and 0.25 episodes/patient-year, respectively). Postpartum SH rates were comparable in breastfeeding and non-breastfeeding women (21.4% vs. 25%, respectively, p>0.05). Clarke test score at the first antenatal visit was associated with postpartum SH (for each 1-point increase: OR 1.53; 95% CI, 1.06-2.21) adjusted for confounders. No other diabetes and pregnancy-related variables were identified as predictors of SH in this period. CONCLUSIONS SH are common in the long-term postpartum period independently of breastfeeding. Assessing IAH in early pregnancy could identify those at an increased risk of SH in the postpartum period.
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Affiliation(s)
- Laura Boswell
- Endocrinology and Nutrition Department, Hospital Clínic de Barcelona, Barcelona, Spain; Institut d'Investigacions Biomèdiques August Pi Sunyer (IDIBAPS), Barcelona, Spain; Endocrinology and Nutrition Department, Althaia University Health Network, Manresa, Spain
| | - Verónica Perea
- Endocrinology Department, Hospital Universitari Mútua de Terrassa, Terrassa, Spain.
| | - Antonio J Amor
- Endocrinology and Nutrition Department, Hospital Clínic de Barcelona, Barcelona, Spain
| | - Núria Seguí
- Endocrinology and Nutrition Department, Hospital Clínic de Barcelona, Barcelona, Spain
| | - Jordi Bellart
- Obstetrics and Gynecology Department, Hospital Clínic de Barcelona, Barcelona, Spain
| | - Daria Roca
- Endocrinology and Nutrition Department, Hospital Clínic de Barcelona, Barcelona, Spain
| | - Marga Giménez
- Endocrinology and Nutrition Department, Hospital Clínic de Barcelona, Barcelona, Spain; Institut d'Investigacions Biomèdiques August Pi Sunyer (IDIBAPS), Barcelona, Spain; Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
| | - Ignacio Conget
- Endocrinology and Nutrition Department, Hospital Clínic de Barcelona, Barcelona, Spain; Institut d'Investigacions Biomèdiques August Pi Sunyer (IDIBAPS), Barcelona, Spain; Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
| | - Irene Vinagre
- Endocrinology and Nutrition Department, Hospital Clínic de Barcelona, Barcelona, Spain.
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Serés-Noriega T, Ortega E, Perea V, Giménez M, Boswell L, Mariaca K, Font C, Mesa A, Viñals C, Blanco J, Vinagre I, Pané A, Esmatjes E, Conget I, Amor AJ. Nuclear Magnetic Resonance-Based Lipidomics in the Assessment of Cardiometabolic Risk in Type 1 Diabetes: An Exploratory Analysis. Diabetes Ther 2023; 14:553-567. [PMID: 36732434 PMCID: PMC9981843 DOI: 10.1007/s13300-023-01372-x] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Accepted: 01/17/2023] [Indexed: 02/04/2023] Open
Abstract
INTRODUCTION Cardiovascular disease (CVD) is the leading cause of mortality in type 1 diabetes (T1D). However, there is a need for daily practice tools for identifying those more prone to suffer from these events. We aimed to assess the relationships between nuclear magnetic resonance (1H NMR)-based lipidomic analysis and several CVD risk variables (including preclinical carotid atherosclerosis) in individuals with T1D at high risk. METHODS We included patients with T1D without CVD, with at least one of the following: age ≥ 40 years, diabetic kidney disease, or ≥ 10 years of evolution with another risk factor. The presence of plaque (intima-media thickness > 1.5 mm) was determined by standardized ultrasonography protocol. Lipidomic analysis was performed by 1H NMR. Bivariate and multivariate-adjusted differences in 1H NMR lipidomics were evaluated. RESULTS We included n = 131 participants (49.6% female, age 46.4 ± 10.3 years, diabetes duration 27.0 ± 9.5 years, 47.3% on statins). Carotid plaques were present in 28.2% of the individuals (n = 12, with ≥ 3 plaques). Glucose (HbA1c), anthropometric (body mass index and waist circumference), and insulin resistance-related (fatty liver index and estimated glucose disposal rate) variables were those most associated with 1H NMR-derived lipidomic analysis (p < 0.01 for all). Regarding preclinical atherosclerosis, sphingomyelin was independently associated with carotid plaque presence (for 0.1 mmol/L increase, OR 0.50 [0.28-0.86]; p = 0.013), even after adjusting for age, sex, hypertension, statin use, mean 5-year HbA1c and diabetes duration. Furthermore, linoleic acid and ω-6 fatty acids remained independently associated with higher plaque burden (≥ 3 plaques) in multivariate models (0.17 [0.03-0.93] and 0.27 [0.07-0.97], respectively; p < 0.05 for both). CONCLUSION In our preliminary study of individuals with T1D at high risk, several 1H NMR-derived lipidomic parameters were independently associated with preclinical atherosclerosis. Specifically, ω-6 fatty acids and linoleic acid seem promising for identifying those with higher plaque burden.
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Affiliation(s)
- Tonet Serés-Noriega
- Diabetes Unit, Endocrinology and Nutrition Department, Hospital Clínic, Villarroel 170, 08036, Barcelona, Spain.
| | - Emilio Ortega
- Diabetes Unit, Endocrinology and Nutrition Department, Hospital Clínic, Villarroel 170, 08036, Barcelona, Spain
- Centro de Investigación Biomédica en Red de la Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Hospital Clínic, Barcelona, Spain
| | - Verónica Perea
- Endocrinology and Nutrition Department, Hospital Universitari Mútua de Terrassa, Terrassa, Spain
| | - Marga Giménez
- Diabetes Unit, Endocrinology and Nutrition Department, Hospital Clínic, Villarroel 170, 08036, Barcelona, Spain
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Hospital Clínic, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
| | - Laura Boswell
- Diabetes Unit, Endocrinology and Nutrition Department, Hospital Clínic, Villarroel 170, 08036, Barcelona, Spain
- Endocrinology and Nutrition Department, Althaia University Health Network, Manresa, Spain
| | - Karla Mariaca
- Diabetes Unit, Endocrinology and Nutrition Department, Hospital Clínic, Villarroel 170, 08036, Barcelona, Spain
| | - Carla Font
- Diabetes Unit, Endocrinology and Nutrition Department, Hospital Clínic, Villarroel 170, 08036, Barcelona, Spain
| | - Alex Mesa
- Diabetes Unit, Endocrinology and Nutrition Department, Hospital Clínic, Villarroel 170, 08036, Barcelona, Spain
| | - Clara Viñals
- Diabetes Unit, Endocrinology and Nutrition Department, Hospital Clínic, Villarroel 170, 08036, Barcelona, Spain
| | - Jesús Blanco
- Diabetes Unit, Endocrinology and Nutrition Department, Hospital Clínic, Villarroel 170, 08036, Barcelona, Spain
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Hospital Clínic, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
| | - Irene Vinagre
- Diabetes Unit, Endocrinology and Nutrition Department, Hospital Clínic, Villarroel 170, 08036, Barcelona, Spain
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Hospital Clínic, Barcelona, Spain
| | - Adriana Pané
- Diabetes Unit, Endocrinology and Nutrition Department, Hospital Clínic, Villarroel 170, 08036, Barcelona, Spain
- Centro de Investigación Biomédica en Red de la Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
| | - Enric Esmatjes
- Diabetes Unit, Endocrinology and Nutrition Department, Hospital Clínic, Villarroel 170, 08036, Barcelona, Spain
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Hospital Clínic, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
| | - Ignacio Conget
- Diabetes Unit, Endocrinology and Nutrition Department, Hospital Clínic, Villarroel 170, 08036, Barcelona, Spain
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Hospital Clínic, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
| | - Antonio J Amor
- Diabetes Unit, Endocrinology and Nutrition Department, Hospital Clínic, Villarroel 170, 08036, Barcelona, Spain.
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Boswell L, Serés-Noriega T, Mesa A, Perea V, Pané A, Viñals C, Blanco J, Giménez M, Vinagre I, Esmatjes E, Conget I, Amor AJ. Carotid ultrasonography as a strategy to optimize cardiovascular risk management in type 1 diabetes: a cohort study. Acta Diabetol 2022; 59:1563-1574. [PMID: 36006487 DOI: 10.1007/s00592-022-01959-z] [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: 06/13/2022] [Accepted: 08/09/2022] [Indexed: 11/01/2022]
Abstract
BACKGROUND AND AIMS Although cardiovascular disease (CVD) remains the leading cause of mortality in type 1 diabetes (T1D), the use of cardioprotective drugs is scarce. We aimed to evaluate the impact of carotid ultrasonography (US) on the improvement in cardiovascular risk factors (CVRFs) in T1D. METHODS AND RESULTS T1D patients without CVD meeting criteria for lipid treatment according to guidelines (age ≥ 40 years, nephropathy and/or ≥ 10 years of diabetes duration with ≥ 1 additional CVRFs) were included. The carotid-US group (US-G) underwent a standardized US protocol and CVRF assessment; recommendations were made according to subclinical atherosclerosis status. The control group (CG) followed usual clinical practice. Changes in CVRFs, specially statin use and LDL cholesterol levels, at 1 year were analysed. A total of 318 patients were included (51.3% female, mean age of 49.1 years and 25.5 years of diabetes duration): 211 in the US-G and 107 in the CG. Participants in the US-G had a higher baseline LDL cholesterol than controls (114 vs. 102 mg/dL; p < 0.001). Lipid-lowering treatment was modified in 38.9% in the US-G and 6.5% in the CG (p < 0.001). At 1 year, the US-G was more frequently on statins, had lower LDL cholesterol and 27% had stopped smoking (p < 0.001 for all). Changes were more pronounced in those with plaques (p < 0.001). In multivariate analyses adjusted for age, sex and other CVRFs, belonging to the US-G was independently associated with the intensification of lipid-lowering treatment (OR 10.47 [4.06-27.01]). Propensity score-matching analysis yielded similar results (OR 20.09 [7.86-51.37]). CONCLUSION Carotid-US is independently associated with an intensification of lipid-lowering therapy in a high-risk T1D population.
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Affiliation(s)
- Laura Boswell
- Endocrinology and Nutrition Department, Hospital Clínic de Barcelona, Villarroel 170, 08036, Barcelona, Spain.
- Institut d'Investigacions Biomèdiques August Pi Sunyer (IDIBAPS), Barcelona, Spain.
- Endocrinology and Nutrition Department, Althaia University Health Network, Manresa, Spain.
| | - Tonet Serés-Noriega
- Endocrinology and Nutrition Department, Hospital Clínic de Barcelona, Villarroel 170, 08036, Barcelona, Spain
| | - Alex Mesa
- Endocrinology and Nutrition Department, Hospital Clínic de Barcelona, Villarroel 170, 08036, Barcelona, Spain
- Institut d'Investigacions Biomèdiques August Pi Sunyer (IDIBAPS), Barcelona, Spain
| | - Verónica Perea
- Endocrinology and Nutrition Department, Hospital Universitari Mútua de Terrassa, Terrassa, Spain
| | - Adriana Pané
- Endocrinology and Nutrition Department, Hospital Clínic de Barcelona, Villarroel 170, 08036, Barcelona, Spain
- Centro de Investigación Biomédica en Red Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
| | - Clara Viñals
- Endocrinology and Nutrition Department, Hospital Clínic de Barcelona, Villarroel 170, 08036, Barcelona, Spain
| | - Jesús Blanco
- Institut d'Investigacions Biomèdiques August Pi Sunyer (IDIBAPS), Barcelona, Spain
- Diabetes Unit, Endocrinology and Nutrition Department, Hospital Clínic de Barcelona, Villarroel 170, 08036, Barcelona, Spain
| | - Marga Giménez
- Institut d'Investigacions Biomèdiques August Pi Sunyer (IDIBAPS), Barcelona, Spain
- Diabetes Unit, Endocrinology and Nutrition Department, Hospital Clínic de Barcelona, Villarroel 170, 08036, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Carlos III Health Institute, Madrid, Spain
| | - Irene Vinagre
- Diabetes Unit, Endocrinology and Nutrition Department, Hospital Clínic de Barcelona, Villarroel 170, 08036, Barcelona, Spain
| | - Enric Esmatjes
- Institut d'Investigacions Biomèdiques August Pi Sunyer (IDIBAPS), Barcelona, Spain
- Diabetes Unit, Endocrinology and Nutrition Department, Hospital Clínic de Barcelona, Villarroel 170, 08036, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Carlos III Health Institute, Madrid, Spain
| | - Ignacio Conget
- Institut d'Investigacions Biomèdiques August Pi Sunyer (IDIBAPS), Barcelona, Spain
- Diabetes Unit, Endocrinology and Nutrition Department, Hospital Clínic de Barcelona, Villarroel 170, 08036, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Carlos III Health Institute, Madrid, Spain
| | - Antonio J Amor
- Diabetes Unit, Endocrinology and Nutrition Department, Hospital Clínic de Barcelona, Villarroel 170, 08036, Barcelona, Spain.
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Serés-Noriega T, Giménez M, Perea V, Boswell L, Viñals C, Blanco J, Vinagre I, Pané A, Esmatjes E, Conget I, Amor AJ. Use of the Steno T1 Risk Engine Identifies Preclinical Atherosclerosis Better Than Use of ESC/EASD-2019 in Adult Subjects With Type 1 Diabetes at High Risk. Diabetes Care 2022; 45:2412-2421. [PMID: 35944257 DOI: 10.2337/dc22-0118] [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: 01/19/2022] [Accepted: 06/27/2022] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To evaluate the concordance between the 2019 ESC Guidelines on diabetes, pre-diabetes, and cardiovascular diseases developed in collaboration with the EASD (ESC/EASD-2019) and the Steno T1 Risk Engine (Steno-Risk) cardiovascular risk scales for individuals with type 1 diabetes (T1D) without cardiovascular disease (CVD) and to analyze the relationships of their use with identification of preclinical atherosclerosis. RESEARCH DESIGN AND METHODS We consecutively selected patients with T1D, without CVD, age ≥40 years, with nephropathy, and/or with ≥10 years of T1D evolution with another risk factor. The presence of plaque at different carotid segments was determined by ultrasonography. Cardiovascular risk was estimated in accord with ESC/EASD-2019 risk groups (moderate/high/very high) and the Steno-Risk (<10%, low; 10-20%, moderate; ≥20%, high), as T1D-specific scores. In an exploratory analysis, we also evaluated the non-T1D-specific 2013 ACC/AHA Guideline on the Assessment of Cardiovascular Risk (ACC/AHA-2013) pooled cohort equation for individuals between 40 and 79 years of age. RESULTS We included 501 patients (53% men, mean age 48.8 years, median T1D duration 26.5 years, 41.3% harboring plaques). Concordance between T1D-specific scales was poor (κ = 0.19). A stepped increase in the presence of plaques according to Steno-Risk category was seen (18.4%, 38.2%, and 64.1%, for low, moderate, and high risk, respectively; P for trend <0.001), with no differences according to ESC/EASD-2019 (P = 0.130). Steno-Risk identified individuals with plaques, unlike ESC/EASD-2019 (area under the curve [AUC] 0.691, P < 0.001, vs. AUC 0.538, P = 0.149). Finally, in polynomial regression models (with adjustment for lipid parameters and cardioprotective treatment), irrespective of the ESC/EASD-2019 category, high risk by Steno-Risk was directly associated with atherosclerosis (in moderate/high-risk by ESC/EASD-2019 odds ratio 2.91 [95% CI 1.27-6.72] and 4.94 [2.35-10.40] for the presence of plaque and two or more plaques). Similar results were obtained with discordant higher Steno-Risk versus ACC/AHA-2013 (P < 0.001). CONCLUSIONS Among T1D patients undergoing primary prevention, use of Steno-Risk seems to result in better recognition of individuals with atherosclerosis in comparison with ESC/EASD-2019. Notwithstanding, carotid ultrasound could improve the categorization of cardiovascular risk.
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Affiliation(s)
- Tonet Serés-Noriega
- Diabetes Unit, Endocrinology and Nutrition Department, Hospital Clínic, Barcelona, Spain
| | - Marga Giménez
- Diabetes Unit, Endocrinology and Nutrition Department, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Hospital Clínic, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
| | - Verónica Perea
- Endocrinology and Nutrition Department, Hospital Universitari Mútua de Terrassa, Terrassa, Spain
| | - Laura Boswell
- Diabetes Unit, Endocrinology and Nutrition Department, Hospital Clínic, Barcelona, Spain
- Endocrinology and Nutrition Department, Althaia University Health Network, Manresa, Spain
| | - Clara Viñals
- Diabetes Unit, Endocrinology and Nutrition Department, Hospital Clínic, Barcelona, Spain
| | - Jesús Blanco
- Diabetes Unit, Endocrinology and Nutrition Department, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Hospital Clínic, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
| | - Irene Vinagre
- Diabetes Unit, Endocrinology and Nutrition Department, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Hospital Clínic, Barcelona, Spain
| | - Adriana Pané
- Diabetes Unit, Endocrinology and Nutrition Department, Hospital Clínic, Barcelona, Spain
| | - Enric Esmatjes
- Diabetes Unit, Endocrinology and Nutrition Department, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Hospital Clínic, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
| | - Ignacio Conget
- Diabetes Unit, Endocrinology and Nutrition Department, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Hospital Clínic, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
| | - Antonio J Amor
- Diabetes Unit, Endocrinology and Nutrition Department, Hospital Clínic, Barcelona, Spain
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15
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Masnou H, Aguilar A, Iborra I, Sala M, Torner M, Clos-Parals A, Ardèvol A, Giménez M, Fortuny M, Sarrias MR, Morillas RM, Domènech E. Incidence, risk factors and clinical outcomes of multidrug-resistant microorganism infections among patients admitted for decompensated cirrhosis: a prospective study. Gastroenterología y Hepatología 2022; 46:288-296. [PMID: 36115630 DOI: 10.1016/j.gastrohep.2022.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Revised: 08/24/2022] [Accepted: 09/10/2022] [Indexed: 10/14/2022]
Abstract
BACKGROUND Bacterial infections remain one of the main complications in cirrhosis and worsen patients' prognosis and quality of life. An increase in multidrug resistant microorganism (MDRM) infections among patients with cirrhosis, together with infection-related mortality rates, have been reported in recent years. Therefore, adaptation of the initial empiric antibiotic approach to different factors, particularly the local epidemiology of MDRM infections, has been recommended. We aim to describe the main features, outcomes and risk factors of MDRM infections in patients with cirrhosis. METHODS Prospective registry of all episodes of in-hospital infections occurring among cirrhotic patients admitted within a 2-year period at a single center. Clinical and microbiological data were collected at the time of infection diagnosis, and the in-hospital mortality rate of the infectious episode was registered. RESULTS A total of 139 infectious episodes were included. The disease-causing microorganism was identified in 90 episodes (65%), of which 31 (22%) were caused by MDRM. The only two factors independently associated with MDRM infections were rectal colonization by MDRM and a nosocomial or healthcare-associated source. The infection-related mortality rate was 18.7%. MDRM infection and a past history of hepatic encephalopathy were independently associated with in-hospital mortality. CONCLUSIONS Almost one fourth of bacterial infections occurring in admitted cirrhotic patients were due to MDRM. Rectal colonization was the most important risk factor for MDRM infections in decompensated cirrhosis. Screening for MDRM rectal colonization in patients admitted for decompensated cirrhosis should be assessed as a tool to improve local empiric antibiotic strategies.
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16
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Mesa A, Giménez M, Pueyo I, Perea V, Viñals C, Blanco J, Vinagre I, Serés-Noriega T, Boswell L, Esmatjes E, Conget I, Amor AJ. Hyperglycemia and hypoglycemia exposure are differentially associated with micro- and macrovascular complications in adults with Type 1 Diabetes. Diabetes Res Clin Pract 2022; 189:109938. [PMID: 35662616 DOI: 10.1016/j.diabres.2022.109938] [Citation(s) in RCA: 4] [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: 04/05/2022] [Revised: 05/10/2022] [Accepted: 05/30/2022] [Indexed: 11/03/2022]
Abstract
AIMS Evaluate the relationship between high and low exposure continuous glucose monitoring (CGM)-derived glucometrics and micro- and macrovascular complications in type 1 diabetes (T1D). METHODS Cross-sectional study in T1D without cardiovascular disease (CVD) and with ≥ 1 of the following: ≥40 years, diabetic nephropathy, or ≥ 10 years of diabetes duration with CVD risk factors. Glucometrics were obtained over 14 consecutive days: glucose management indicator (GMI) and proportion of time < 54 (TBR < 54), <70, 70-180 (TIR), >180 (TAR). Carotid plaque was evaluated by ultrasonography. Logistic regression models adjusted for age, sex, and other risk factors were constructed to test the independent associations with chronic complications. RESULTS We included 152 patients (54.6% men, 48.7 ± 10.0 years-old). Sixty-seven patients had plaque and n = 71 microvascular complications. TAR (OR 1.28 [1.09-1.51]) and GMI (OR 3.05 [1.46-6.36]) were directly associated with the presence of microvascular complications, while TIR had an inverse relationship (OR 0.79 [0.66-0.93]). TBR < 54 was directly associated with the presence of plaque, even after adjusting for 5-year mean HbA1c (OR 1.51 [1.07-2.13]). CONCLUSIONS High-glucose glucometrics were independently associated with microvascular complications. Only low-glucose exposure glucometrics was significantly associated with preclinical atherosclerosis. Our data support the role of hypoglycemia in the development of CVD in this population.
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Affiliation(s)
- Alex Mesa
- Diabetes Unit, Endocrinology and Nutrition Department, ICMDM, Hospital Clínic de Barcelona, Spain
| | - Marga Giménez
- Diabetes Unit, Endocrinology and Nutrition Department, ICMDM, Hospital Clínic de Barcelona, Spain; IDIBAPS (Institut d'investigacions biomèdiques August Pi i Sunyer), Barcelona, Spain; CIBERDEM (Centro de Investigación en Red de Diabetes y Enfermedades Metabólicas), Madrid, Spain.
| | - Irene Pueyo
- Diabetes Unit, Endocrinology and Nutrition Department, ICMDM, Hospital Clínic de Barcelona, Spain
| | - Verónica Perea
- Endocrinology and Nutrition Department, Hospital Universitari Mútua Terrassa, Terrassa, Spain
| | - Clara Viñals
- Diabetes Unit, Endocrinology and Nutrition Department, ICMDM, Hospital Clínic de Barcelona, Spain
| | - Jesús Blanco
- Diabetes Unit, Endocrinology and Nutrition Department, ICMDM, Hospital Clínic de Barcelona, Spain; IDIBAPS (Institut d'investigacions biomèdiques August Pi i Sunyer), Barcelona, Spain
| | - Irene Vinagre
- Diabetes Unit, Endocrinology and Nutrition Department, ICMDM, Hospital Clínic de Barcelona, Spain; IDIBAPS (Institut d'investigacions biomèdiques August Pi i Sunyer), Barcelona, Spain
| | - Tonet Serés-Noriega
- Diabetes Unit, Endocrinology and Nutrition Department, ICMDM, Hospital Clínic de Barcelona, Spain
| | - Laura Boswell
- Diabetes Unit, Endocrinology and Nutrition Department, ICMDM, Hospital Clínic de Barcelona, Spain; Endocrinology and Nutrition Department, Althaia - Xarxa Assistencial Universitària de Manresa, Manresa, Spain
| | - Enric Esmatjes
- Diabetes Unit, Endocrinology and Nutrition Department, ICMDM, Hospital Clínic de Barcelona, Spain; IDIBAPS (Institut d'investigacions biomèdiques August Pi i Sunyer), Barcelona, Spain; CIBERDEM (Centro de Investigación en Red de Diabetes y Enfermedades Metabólicas), Madrid, Spain
| | - Ignacio Conget
- Diabetes Unit, Endocrinology and Nutrition Department, ICMDM, Hospital Clínic de Barcelona, Spain; IDIBAPS (Institut d'investigacions biomèdiques August Pi i Sunyer), Barcelona, Spain; CIBERDEM (Centro de Investigación en Red de Diabetes y Enfermedades Metabólicas), Madrid, Spain
| | - Antonio J Amor
- Diabetes Unit, Endocrinology and Nutrition Department, ICMDM, Hospital Clínic de Barcelona, Spain.
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17
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Pueyo I, Viñals C, Mesa A, Giménez M, Conget I. Implantación masiva de la monitorización continua de glucosa en personas con diabetes tipo 1 en una Unidad de Diabetes de referencia bajo financiación pública: estrategia y resultados. ENDOCRINOL DIAB NUTR 2022. [DOI: 10.1016/j.endinu.2022.03.002] [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: 11/25/2022]
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18
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Alemany A, Perez-Zsolt D, Raïch-Regué D, Muñoz-Basagoiti J, Ouchi D, Laporte-Villar C, Baro B, Henríquez N, Prat N, Gianinetto MO, Gutiérrez MV, Sánchez-Paniagua MG, Henríquez NL, Vicente JM, Ara J, Rodriguez-Arias MA, Puig J, Blanco I, Lopez CC, Hernández Á, Bordoy AE, Redondo CE, Soler VG, Giménez M, Blanc V, León R, Gispert J, Clotet B, Izquierdo-Useros N, Mitjà O. Cetylpyridinium Chloride Mouthwash to Reduce Shedding of Infectious SARS-CoV-2: A Double-Blind Randomized Clinical Trial. J Dent Res 2022; 101:1450-1456. [PMID: 35727681 DOI: 10.1177/00220345221102310] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
The airborne transmission of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) via respiratory fluids and droplets suggests that mouthwashes containing substances with virucidal activity can help reduce viral spread. We conducted a multicenter, double-blind, placebo-controlled, randomized trial to assess the virucidal activity of cetylpyridinium chloride (CPC) mouthwashes. Outpatients who tested positive for SARS-CoV-2 infection with or without symptoms were randomized to perform washes and gargles for 1 min with 15 mL of either colored distilled water or 0.07% CPC (Vitis CPC Protect) mouthwash. The study outcomes were the SARS-CoV-2 log10 viral RNA load and the nucleocapsid protein levels, both in saliva at 1 and 3 h after the intervention. In total, 118 patients were enrolled and randomized (mean [SD], age 46 [14] y). Thirteen of 118 participants (11%) did not complete follow-up or had insufficient sample volume for testing and were excluded from the analysis. The assessment of the viral load showed no significant differences between groups at any of the investigated points. However, the levels of SARS-CoV-2 nucleocapsid protein of lysed viruses were significantly higher in the CPC group compared with the control group at 1 h (adjusted difference 269.3 pg/mL; 95% confidence interval [CI], 97.1-441.5) and at 3 h postintervention (561.1 pg/mL; 95% CI, 380.0-742.2). In nonhospitalized patients with asymptomatic or mild symptomatic SARS-CoV-2 infection, a 0.07% CPC mouthwash, compared to placebo, was associated with a significant increase of nucleocapsid protein levels in saliva, indicating enhanced disruption of viral particles.
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Affiliation(s)
- A Alemany
- Fight AIDS and Infectious Diseases Foundation, Badalona, Spain.,Hospital Universitari Germans Trias i Pujol, Badalona, Spain.,Facultat de Medicina-Universitat de Barcelona, Barcelona, Spain
| | | | | | | | - D Ouchi
- Fight AIDS and Infectious Diseases Foundation, Badalona, Spain.,Universitat Autònoma de Barcelona, Barcelona, Spain
| | | | - B Baro
- ISGlobal, Hospital Clinic Universitat de Barcelona, Barcelona, Spain
| | - N Henríquez
- Gerència Territorial Metropolitana Nord, Institut Català de la Salut, Barcelona, Spain
| | - N Prat
- Gerència Territorial Metropolitana Nord, Institut Català de la Salut, Barcelona, Spain
| | - M Ochoa Gianinetto
- Gerència Territorial Metropolitana Nord, Institut Català de la Salut, Barcelona, Spain
| | - M Viaplana Gutiérrez
- Gerència Territorial Metropolitana Nord, Institut Català de la Salut, Barcelona, Spain
| | | | - N Larrosa Henríquez
- Gerència Territorial Metropolitana Nord, Institut Català de la Salut, Barcelona, Spain
| | - J Moreno Vicente
- Gerència Territorial Metropolitana Nord, Institut Català de la Salut, Barcelona, Spain
| | - J Ara
- Hospital Universitari Germans Trias i Pujol, Badalona, Spain.,Gerència Territorial Metropolitana Nord, Institut Català de la Salut, Barcelona, Spain
| | - M A Rodriguez-Arias
- Fight AIDS and Infectious Diseases Foundation, Badalona, Spain.,Hospital Universitari Germans Trias i Pujol, Badalona, Spain
| | - J Puig
- Fight AIDS and Infectious Diseases Foundation, Badalona, Spain
| | - I Blanco
- Metropolitana Nord Laboratory, Institut Català de la Salut, Badalona, Spain
| | - C Casañ Lopez
- Microbiology Department, Clinical Laboratory Metropolitana Nord, Badalona, Barcelona, Spain
| | - Á Hernández
- Universitat Autònoma de Barcelona, Barcelona, Spain.,Microbiology Department, Clinical Laboratory Metropolitana Nord, Badalona, Barcelona, Spain
| | - A E Bordoy
- Microbiology Department, Clinical Laboratory Metropolitana Nord, Badalona, Barcelona, Spain
| | - C Esteban Redondo
- Microbiology Department, Clinical Laboratory Metropolitana Nord, Badalona, Barcelona, Spain
| | - V González Soler
- Microbiology Department, Clinical Laboratory Metropolitana Nord, Badalona, Barcelona, Spain.,Centre of Epidemiological Studies of HIV/AIDS and STI of Catalonia (CEEISCAT), Health Department, Generalitat de Catalunya, Badalona, Spain.,CIBER Epidemiologia y Salud Pública (CIBERESP), Madrid, Spain
| | - M Giménez
- Microbiology Department, Clinical Laboratory Metropolitana Nord, Badalona, Barcelona, Spain.,CIBER Enfermedades Respiratorias (CIBERES), Madrid, Spain
| | - V Blanc
- DENTAID Research Center, Cerdanyola del Vallès, Spain
| | - R León
- DENTAID Research Center, Cerdanyola del Vallès, Spain
| | - J Gispert
- DENTAID Research Center, Cerdanyola del Vallès, Spain
| | | | - B Clotet
- Fight AIDS and Infectious Diseases Foundation, Badalona, Spain.,Hospital Universitari Germans Trias i Pujol, Badalona, Spain.,IrsiCaixa AIDS Research Institute, Badalona, Spain.,Universitat de Vic-Universitat Central de Catalunya (UVIC-UCC), Vic, Spain
| | - N Izquierdo-Useros
- IrsiCaixa AIDS Research Institute, Badalona, Spain.,Germans Trias i Pujol Research Institute, Badalona, Spain
| | - O Mitjà
- Fight AIDS and Infectious Diseases Foundation, Badalona, Spain.,Hospital Universitari Germans Trias i Pujol, Badalona, Spain.,Universitat de Vic-Universitat Central de Catalunya (UVIC-UCC), Vic, Spain.,Lihir Medical Centre, International SOS, Lihir Island, Papua New Guinea
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Amor AJ, Vinagre I, Valverde M, Alonso-Carril N, Urquizu X, Meler E, López E, Giménez M, Codina L, Conget I, Barahona MJ, Perea V. Erratum to 'Novel glycoproteins identify preclinical atherosclerosis among women with previous preeclampsia regardless of type 1 diabetes status' [Nutrition, Metabolism & Cardiovascular Diseases 31 (2021) 3407-3414]. Nutr Metab Cardiovasc Dis 2022; 32:1070. [PMID: 35067444 DOI: 10.1016/j.numecd.2021.11.016] [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] [Indexed: 10/19/2022]
Affiliation(s)
- Antonio J Amor
- Endocrinology and Nutrition Department, Hospital Clínic de Barcelona, Spain.
| | - Irene Vinagre
- Endocrinology and Nutrition Department, Hospital Clínic de Barcelona, Spain
| | - Maite Valverde
- Endocrinology and Nutrition Department, Hospital Universitari Mútua de Terrassa, Spain
| | - Núria Alonso-Carril
- Endocrinology and Nutrition Department, Hospital Universitari Mútua de Terrassa, Spain
| | - Xavier Urquizu
- Obstetrics and Gynecology Department, Hospital Universitari Mútua de Terrassa, Spain
| | - Eva Meler
- Fetal iþD Fetal Medicine Research Center, BCNatal-Barcelona Center for Maternal-Fetal and Neonatal Medicine (Hospital Clínic and Hospital Sant Joan de Déu), IDIBAPS, University of Barcelona, Spain
| | - Eva López
- Obstetrics and Gynecology Department, Hospital Universitari Mútua de Terrassa, Spain
| | - Marga Giménez
- Endocrinology and Nutrition Department, Hospital Clínic de Barcelona, Spain; CIBER de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
| | - Laura Codina
- Obstetrics and Gynecology Department, Hospital Universitari Mútua de Terrassa, Spain
| | - Ignacio Conget
- Endocrinology and Nutrition Department, Hospital Clínic de Barcelona, Spain; CIBER de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
| | - Maria J Barahona
- Endocrinology and Nutrition Department, Hospital Universitari Mútua de Terrassa, Spain
| | - Verónica Perea
- Endocrinology and Nutrition Department, Hospital Universitari Mútua de Terrassa, Spain.
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20
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Osumili B, Artime E, Mitchell B, Rubio-de Santos M, Díaz-Cerezo S, Giménez M, Spaepen E, Sharland H, Valentine WJ. Cost of Severe Hypoglycemia and Budget Impact with Nasal Glucagon in Patients with Diabetes in Spain. Diabetes Ther 2022; 13:775-794. [PMID: 35297026 PMCID: PMC8991229 DOI: 10.1007/s13300-022-01238-8] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Accepted: 02/23/2022] [Indexed: 11/28/2022] Open
Abstract
INTRODUCTION Severe hypoglycemic events (SHE) represent a clinical and economic burden in patients with diabetes. Nasal glucagon (NG) is a novel treatment for SHEs with similar efficacy, but with a usability advantage over injectable glucagon (IG) that may translate to improved economic outcomes. The economic implications of this usability advantage on SHE-related spending in Spain were explored in this analysis. METHODS A cost-offset and budget impact analysis (BIA) was conducted using a decision tree model, adapted for the Spanish setting. The model calculated average costs per SHE over the SHE treatment pathway following a treatment attempt with IG or NG. Analyses were performed separately in three populations with insulin-treated diabetes: children and adolescents (4-17 years) with type 1 diabetes (T1D), adults with T1D and adults with type 2 diabetes (T2D), with respective population estimates applied in BIA. Treatment probabilities were assumed to be equal for IG and NG, except for treatment success following glucagon administration. Epidemiologic and cost data were obtained from Spanish-specific sources. BIA results were presented at a 3-year time horizon. RESULTS On a per SHE level, NG was associated with lower costs compared to IG (children and adolescents with T1D, EUR 820; adults with T1D, EUR 804; adults with T2D, EUR 725). Lower costs were attributed to reduced costs of professional medical assistance in patients treated with NG. After 3 years, BIA showed that relative to IG, the introduction of NG was projected to reduce SHE-related spending by EUR 1,158,969, EUR 142,162,371, and EUR 6,542,585 in children and adolescents with T1D, adults with T1D, and adults with insulin-treated T2D, respectively. CONCLUSIONS In Spain, the usability advantage of NG over IG translates to potential cost savings per SHE in three populations with insulin-treated diabetes, and the introduction of NG was associated with a lower budget impact versus IG in each group.
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Affiliation(s)
| | | | | | | | | | - Marga Giménez
- Diabetes Unit, Endocrinology and Nutrition Department, IMDM, Hospital Clínic i Universitari de Barcelona, Barcelona, Spain
| | | | - Helen Sharland
- Ossian Health Economics and Communications GmbH, Bäumleingasse 20, 4051, Basel, Switzerland
| | - William J Valentine
- Ossian Health Economics and Communications GmbH, Bäumleingasse 20, 4051, Basel, Switzerland.
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21
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Parcerisas A, Contreras I, Delecourt A, Bertachi A, Beneyto A, Conget I, Viñals C, Giménez M, Vehi J. A Machine Learning Approach to Minimize Nocturnal Hypoglycemic Events in Type 1 Diabetic Patients under Multiple Doses of Insulin. Sensors (Basel) 2022; 22:s22041665. [PMID: 35214566 PMCID: PMC8876195 DOI: 10.3390/s22041665] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Revised: 02/10/2022] [Accepted: 02/19/2022] [Indexed: 11/16/2022]
Abstract
Nocturnal hypoglycemia (NH) is one of the most challenging events for multiple dose insulin therapy (MDI) in people with type 1 diabetes (T1D). The goal of this study is to design a method to reduce the incidence of NH in people with T1D under MDI therapy, providing a decision-support system and improving confidence toward self-management of the disease considering the dataset used by Bertachi et al. Different machine learning (ML) algorithms, data sources, optimization metrics and mitigation measures to predict and avoid NH events have been studied. In addition, we have designed population and personalized models and studied the generalizability of the models and the influence of physical activity (PA) on them. Obtaining 30 g of rescue carbohydrates (CHO) is the optimal value for preventing NH, so it can be asserted that this is the value with which the time under 70 mg/dL decreases the most, with almost a 35% reduction, while increasing the time in the target range by 1.3%. This study supports the feasibility of using ML techniques to address the prediction of NH in patients with T1D under MDI therapy, using continuous glucose monitoring (CGM) and a PA tracker. The results obtained prove that BG predictions can not only be critical in achieving safer diabetes management, but also assist physicians and patients to make better and safer decisions regarding insulin therapy and their day-to-day lives.
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Affiliation(s)
- Adrià Parcerisas
- Institut d’Informàtica i Aplicacions, Universitat de Girona, 17003 Girona, Spain; (A.P.); (I.C.); (A.D.); (A.B.)
| | - Ivan Contreras
- Institut d’Informàtica i Aplicacions, Universitat de Girona, 17003 Girona, Spain; (A.P.); (I.C.); (A.D.); (A.B.)
| | - Alexia Delecourt
- Institut d’Informàtica i Aplicacions, Universitat de Girona, 17003 Girona, Spain; (A.P.); (I.C.); (A.D.); (A.B.)
| | - Arthur Bertachi
- Campus Guarapuava, Federal University of Technology—Paraná (UTFPR), Guarapuava 85053-525, Brazil;
| | - Aleix Beneyto
- Institut d’Informàtica i Aplicacions, Universitat de Girona, 17003 Girona, Spain; (A.P.); (I.C.); (A.D.); (A.B.)
| | - Ignacio Conget
- Endocrinology and Diabetes Unit, Hospital Clínic, 08036 Barcelona, Spain; (I.C.); (C.V.); (M.G.)
- Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), 28029 Madrid, Spain
- Institut d’Investigacions Biomèdiques August Pi i Sunyer, 08036 Barcelona, Spain
| | - Clara Viñals
- Endocrinology and Diabetes Unit, Hospital Clínic, 08036 Barcelona, Spain; (I.C.); (C.V.); (M.G.)
| | - Marga Giménez
- Endocrinology and Diabetes Unit, Hospital Clínic, 08036 Barcelona, Spain; (I.C.); (C.V.); (M.G.)
- Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), 28029 Madrid, Spain
- Institut d’Investigacions Biomèdiques August Pi i Sunyer, 08036 Barcelona, Spain
| | - Josep Vehi
- Institut d’Informàtica i Aplicacions, Universitat de Girona, 17003 Girona, Spain; (A.P.); (I.C.); (A.D.); (A.B.)
- Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), 28029 Madrid, Spain
- Correspondence:
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22
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Amor AJ, Vinagre I, Valverde M, Alonso N, Urquizu X, Meler E, López E, Giménez M, Codina L, Conget I, Barahona MJ, Perea V. Novel glycoproteins identify preclinical atherosclerosis among women with previous preeclampsia regardless of type 1 diabetes status. Nutr Metab Cardiovasc Dis 2021; 31:3407-3414. [PMID: 34663538 DOI: 10.1016/j.numecd.2021.08.041] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [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: 05/04/2021] [Revised: 07/23/2021] [Accepted: 08/19/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND AND AIMS Information regarding inflammation and cardiovascular disease (CVD) risk in type 1 diabetes (T1D) or preeclampsia (PE) is scarce. We assessed differences in inflammation markers according to the presence of both conditions and their association with atherosclerosis. METHODS AND RESULTS We recruited 112 women without CVD and last pregnancy ≥5 years previously (n = 28 per group): a)T1D and PE; b)T1D without PE; c)PE without T1D; and d)Controls (without T1D or PE). Groups were matched by several CVD risk factors, and diabetes duration and retinopathy in T1D. Carotid intima-media thickness (IMT) and plaque presence (IMT ≥1.5 mm) were assessed by ultrasonography. Inflammatory markers included classical variables (leucocytes and high-sensitivity C-reactive protein [hsCRP]) and glycoproteins by nuclear magnetic resonance (1H-NMR) spectroscopy (GlycA, GlycB, GlycF and the height/width [H/W] ratios of GlycA and GlycB). The age of the participants was 44.9 ± 7.8 years, and 20.5% harbored plaque. There were no differences in inflammatory markers among the four study groups. Overall, in multivariate-adjusted models, all 1H-NMR-glycoproteins (except GlycB) were positively associated with IMT measures (IMT of bulb and maximum-IMT of any carotid segment; p < 0.05). After dividing the sample according to PE status, previous findings remained largely unchanged. Furthermore, GlycF was independently associated with carotid plaque only in PE group (OR 5.08 [1.03-25.01] per 0.1 log-increments, p = 0.046). Neither leucocytes nor hsCRP were related to atherosclerosis. Regarding T1D status, non-uniform results were observed. CONCLUSIONS High 1H-NMR-glycoprotein concentrations have a negative impact on carotid atherosclerosis among women with preeclampsia, regardless of T1D status.
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Affiliation(s)
- Antonio J Amor
- Endocrinology and Nutrition Department, Hospital Clínic de Barcelona, Spain.
| | - Irene Vinagre
- Endocrinology and Nutrition Department, Hospital Clínic de Barcelona, Spain
| | - Maite Valverde
- Endocrinology and Nutrition Department, Hospital Universitari Mútua de Terrassa, Spain
| | - Nuria Alonso
- Endocrinology and Nutrition Department, Hospital Universitari Mútua de Terrassa, Spain
| | - Xavier Urquizu
- Obstetrics and Gynecology Department, Hospital Universitari Mútua de Terrassa, Spain
| | - Eva Meler
- Fetal i+D Fetal Medicine Research Center, BCNatal-Barcelona Center for Maternal-Fetal and Neonatal Medicine (Hospital Clínic and Hospital Sant Joan de Déu), IDIBAPS, University of Barcelona, Spain
| | - Eva López
- Obstetrics and Gynecology Department, Hospital Universitari Mútua de Terrassa, Spain
| | - Marga Giménez
- Endocrinology and Nutrition Department, Hospital Clínic de Barcelona, Spain; CIBER de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
| | - Laura Codina
- Obstetrics and Gynecology Department, Hospital Universitari Mútua de Terrassa, Spain
| | - Ignacio Conget
- Endocrinology and Nutrition Department, Hospital Clínic de Barcelona, Spain; CIBER de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
| | - Maria J Barahona
- Endocrinology and Nutrition Department, Hospital Universitari Mútua de Terrassa, Spain
| | - Verónica Perea
- Endocrinology and Nutrition Department, Hospital Universitari Mútua de Terrassa, Spain.
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Abstract
Automated insulin delivery (AID) is the most recent advance in type 1 diabetes (T1D) management. It has the potential to achieve glycemic targets without disabling hypoglycemia, to improve quality of life and reduce diabetes distress and burden associated with self-management. Several AID systems are currently licensed for use by people with T1D in Europe, United States, and the rest of the world. Despite AID becoming a reality in routine clinical practice over the last few years, the commercially hybrid AID and other systems, are still far from a fully optimized automated diabetes management tool. Implementation of AID systems requires education and support of healthcare professionals taking care of people with T1D, as well as users and their families. There is much to do to increase usability, portability, convenience and to reduce the burden associated with the use of the systems. Co-design, involvement of people with lived experience of T1D and robust qualitative assessment is critical to improving the real-world use of AID systems, especially for those who may have greater need. In addition to this, information regarding the psychosocial impact of the use of AID systems in real life is needed. The first commercially available AID systems are not the end of the development journey but are the first step in learning how to optimally automate insulin delivery in a way that is equitably accessible and effective for people living with T1D.
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Affiliation(s)
- Marga Giménez
- Diabetes Unit, Endocrinology and
Nutrition Department, Hospital Clínic i Universitari, Barcelona, Spain
- CIBERDEM, Centro de Investigación
Biomédica en Red de Diabetes y Enfermedades Metabólicas, Madrid, Spain
- IDIBAPS, Institut
d’Investigacions Biomèdiques August Pi i Sunyer, Barcelona, Spain
| | - Ignacio Conget
- Diabetes Unit, Endocrinology and
Nutrition Department, Hospital Clínic i Universitari, Barcelona, Spain
- CIBERDEM, Centro de Investigación
Biomédica en Red de Diabetes y Enfermedades Metabólicas, Madrid, Spain
- IDIBAPS, Institut
d’Investigacions Biomèdiques August Pi i Sunyer, Barcelona, Spain
| | - Nick Oliver
- Department of Metabolism,
Digestion and Reproduction, Faculty of Medicine, Imperial College London,
London, UK
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24
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Serés-Noriega T, Giménez M, Perea V, Blanco J, Vinagre I, Pané A, Ruiz S, Cofán M, Mesa A, Esmatjes E, Conget I, Ortega E, Amor AJ. Quantification of glycoproteins by nuclear magnetic resonance associated with preclinical carotid atherosclerosis in patients with type 1 diabetes. Nutr Metab Cardiovasc Dis 2021; 31:2099-2108. [PMID: 34039504 DOI: 10.1016/j.numecd.2021.03.021] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [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: 11/12/2020] [Revised: 03/23/2021] [Accepted: 03/23/2021] [Indexed: 12/25/2022]
Abstract
BACKGROUND AND AIMS Glycoproteins play a key role in inflammatory and cardiometabolic processes. Their implication in atherosclerosis in type 1 diabetes (T1D) is unknown. We assessed the relationships between classic inflammatory markers, glycoproteins measured by nuclear magnetic resonance (1H-NMR), and preclinical atherosclerosis in these patients. METHODS AND RESULTS We selected patients with T1D, without cardiovascular disease (CVD), with: age ≥40 years, nephropathy (micro/macroalbuminuria), or ≥10 years of evolution with another risk factor. The presence of plaque (intima-media thickness >1.5 mm) was determined by ultrasonography. Concentrations of high-sensitive C-reactive protein (hsCRP), circulating leukocytes (classical inflammation markers) and 1H-NMR-glycoproteins (GlycA, GlycB, GlycF, and the height/width [H/W] ratios of GlycA and GlycB) were determined. We included 189 patients (58% male, age 47.0 [40.7-55.2] years). Thirty-five percent presented plaques (22%, ≥2 plaques). There was no association between hsCRP or leukocytes and atherosclerosis. However, in age- and sex-adjusted models, GlycA, GlycF, and the H/W ratios of GlycA and GlycB gradually increased with the number of plaques (0, 1, ≥2 plaques) only in patients without statins (p < 0.05), with no association in patients receiving this drug (p for interaction <0.05; in ≥2 plaques). Finally, in models adjusted for other classical and T1D-specific risk factors, GlycA and GlycB H/W ratios remained associated with carotid plaque (OR 1.39 [1.12-1.90] and OR 6.89 [1.85-25.62], respectively). CONCLUSION In T1D individuals without lipid-lowering treatment, 1H-NMR-glycoproteins were independently associated with the presence and amount of carotid atherosclerosis, unlike other classical inflammatory markers. Further studies are needed to ascertain their utility as CVD biomarkers.
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Affiliation(s)
- Tonet Serés-Noriega
- Diabetes Unit, Endocrinology and Nutrition Department, Hospital Clínic, Barcelona, Spain
| | - Marga Giménez
- Diabetes Unit, Endocrinology and Nutrition Department, Institut d'Investigacions BiomèdiquesAugust Pi i Sunyer (IDIBAPS), Hospital Clínic, Barcelona, Spain; Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
| | - Verónica Perea
- Endocrinology and Nutrition Department, Hospital Universitari Mútua de Terrassa, Terrassa, Spain
| | - Jesús Blanco
- Diabetes Unit, Endocrinology and Nutrition Department, Institut d'Investigacions BiomèdiquesAugust Pi i Sunyer (IDIBAPS), Hospital Clínic, Barcelona, Spain; Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
| | - Irene Vinagre
- Diabetes Unit, Endocrinology and Nutrition Department, Institut d'Investigacions BiomèdiquesAugust Pi i Sunyer (IDIBAPS), Hospital Clínic, Barcelona, Spain
| | - Adriana Pané
- Diabetes Unit, Endocrinology and Nutrition Department, Hospital Clínic, Barcelona, Spain
| | - Sabina Ruiz
- Diabetes Unit, Endocrinology and Nutrition Department, Hospital Clínic, Barcelona, Spain
| | - Monserrat Cofán
- Endocrinology and Nutrition Department, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Hospital Clínic, Barcelona, Spain; Centro de Investigación Biomédica en Red Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
| | - Alex Mesa
- Diabetes Unit, Endocrinology and Nutrition Department, Hospital Clínic, Barcelona, Spain
| | - Enric Esmatjes
- Diabetes Unit, Endocrinology and Nutrition Department, Institut d'Investigacions BiomèdiquesAugust Pi i Sunyer (IDIBAPS), Hospital Clínic, Barcelona, Spain; Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
| | - Ignacio Conget
- Diabetes Unit, Endocrinology and Nutrition Department, Institut d'Investigacions BiomèdiquesAugust Pi i Sunyer (IDIBAPS), Hospital Clínic, Barcelona, Spain; Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
| | - Emilio Ortega
- Endocrinology and Nutrition Department, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Hospital Clínic, Barcelona, Spain; Centro de Investigación Biomédica en Red Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III (ISCIII), Madrid, Spain.
| | - Antonio J Amor
- Diabetes Unit, Endocrinology and Nutrition Department, Hospital Clínic, Barcelona, Spain.
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25
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Mesa A, Cofán M, Esmatjes E, Perea V, Boswell L, Giménez M, Sala-Vila A, Vinagre I, Viñals C, Chiva-Blanch G, Serés-Noriega T, Blanco J, Conget I, Ortega E, Amor AJ. Biomarkers of fatty acid intake are independently associated with preclinical atherosclerosis in individuals with type 1 diabetes. Eur J Nutr 2021; 60:4595-4605. [PMID: 34152460 DOI: 10.1007/s00394-021-02611-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 11/12/2020] [Accepted: 06/08/2021] [Indexed: 01/02/2023]
Abstract
PURPOSE Information on the association between diet and cardiovascular disease (CVD) in type 1 diabetes (T1D) is scarce. We assessed the association between biomarkers of fatty acid (FA) intake and the presence of carotid plaques (a surrogate marker of future CVD events) in this high-risk population. METHODS Cross-sectional study in 167 consecutive T1D patients without CVD and with at least one of the following: ≥ 40 years, diabetic nephropathy, or ≥ 10 years of T1D duration with another CVD risk factor. The FA profile of erythrocyte membranes was determined by gas chromatography, and the number of carotid plaques (intima-media thickness ≥ 1.5 mm) was assessed by ultrasonography. Regression models were constructed adjusting for classical (age, gender, blood pressure, smoking habit, LDL-cholesterol, body mass index and statins) and T1D-specific risk factors (diabetes duration, HbA1c and chronic complications). RESULTS A total of 58.7% were men (mean age 48.3 ± 10.3 years, T1D duration 27.2 ± 10.1 years). Sixty-one patients (36.5%) showed carotid plaque. Linoleic acid decreased and all-C18:1trans increased with the number of carotid plaques (none, 1-2, ≥ 3 plaques; p for trend < 0.05). In multivariate regression models, linoleic acid remained inversely associated with the presence of plaque [1% increase of total FAs; OR 0.71 (0.53-0.95), p = 0.021] and ≥ 2 plaques [OR 0.70 (0.51-0.98), p = 0.039]; whereas, all-C18:1trans was positively associated with ≥ 3 plaques (0.1% increase of total FAs; OR 1.51 [1.05-2.16], p = 0.026). CONCLUSIONS Erythrocyte FA composition, as a biomarker of FA intake, was independently associated with preclinical atherosclerosis in T1DM. Our data support the potential role of an unfavorable pattern of fat intake and CVD risk in this population.
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Affiliation(s)
- Alex Mesa
- Endocrinology and Nutrition Department, Hospital Clinic de Barcelona, Carrer de Villarroel, 170, 08036, Barcelona, Spain
| | - Montserrat Cofán
- Endocrinology and Nutrition Department, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Hospital Clínic de Barcelona, Barcelona, Spain.,Centro de Investigación Biomédica en Red Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
| | - Enric Esmatjes
- Endocrinology and Nutrition Department, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Hospital Clínic de Barcelona, Barcelona, Spain.,Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
| | - Verónica Perea
- Endocrinology and Nutrition Department, Hospital Universitari Mútua de Terrassa, Terrassa, Spain
| | - Laura Boswell
- Endocrinology and Nutrition Department, Hospital Clinic de Barcelona, Carrer de Villarroel, 170, 08036, Barcelona, Spain.,Endocrinology and Nutrition Department, Althaia-Xarxa Assistencial Universitària de Manresa, Manresa, Spain
| | - Marga Giménez
- Endocrinology and Nutrition Department, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Hospital Clínic de Barcelona, Barcelona, Spain.,Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
| | - Aleix Sala-Vila
- Endocrinology and Nutrition Department, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Hospital Clínic de Barcelona, Barcelona, Spain.,Centro de Investigación Biomédica en Red Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
| | - Irene Vinagre
- Endocrinology and Nutrition Department, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Hospital Clínic de Barcelona, Barcelona, Spain
| | - Clara Viñals
- Endocrinology and Nutrition Department, Hospital Clinic de Barcelona, Carrer de Villarroel, 170, 08036, Barcelona, Spain
| | - Gemma Chiva-Blanch
- Endocrinology and Nutrition Department, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Hospital Clínic de Barcelona, Barcelona, Spain.,Centro de Investigación Biomédica en Red Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
| | - Tonet Serés-Noriega
- Endocrinology and Nutrition Department, Hospital Clinic de Barcelona, Carrer de Villarroel, 170, 08036, Barcelona, Spain
| | - Jesús Blanco
- Endocrinology and Nutrition Department, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Hospital Clínic de Barcelona, Barcelona, Spain
| | - Ignacio Conget
- Endocrinology and Nutrition Department, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Hospital Clínic de Barcelona, Barcelona, Spain.,Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
| | - Emilio Ortega
- Endocrinology and Nutrition Department, Hospital Clinic de Barcelona, Carrer de Villarroel, 170, 08036, Barcelona, Spain. .,Endocrinology and Nutrition Department, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Hospital Clínic de Barcelona, Barcelona, Spain. .,Centro de Investigación Biomédica en Red Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III (ISCIII), Madrid, Spain.
| | - Antonio J Amor
- Endocrinology and Nutrition Department, Hospital Clinic de Barcelona, Carrer de Villarroel, 170, 08036, Barcelona, Spain.
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Viñals C, Mesa A, Roca D, Vidal M, Pueyo I, Conget I, Giménez M. Management of glucose profile throughout strict COVID-19 lockdown by patients with type 1 diabetes prone to hypoglycaemia using sensor-augmented pump. Acta Diabetol 2021; 58:383-388. [PMID: 33125525 PMCID: PMC7596617 DOI: 10.1007/s00592-020-01625-2] [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] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Accepted: 10/15/2020] [Indexed: 12/21/2022]
Abstract
AIMS Spain has been one of the worst affected countries by the COVID-19 pandemic. A very strict lockdown at home was imposed with a tough restriction of mobility. We aimed to evaluate the impact of this exceptional scenario on glucose profile of patients with type 1 diabetes (T1D) prone to hypoglycaemia using sensor-augmented pump (SAP). METHODS Patients with T1D prone to hypoglycaemia using SAP (640G Medtronic-Minimed®) for at least 6 months under the funding of a National Health Service were included in an observational, retrospective study. Data were collected in two periods: pre-lockdown (PL), February 23rd-March 7th and within lockdown (WL), April 1st to 14th 2020. The primary outcome was the difference in the proportion of time in target glucose range of 70-180 mg/dL (TIR). Additional glucometric data and total daily insulin were also analysed. RESULTS Fifty-nine patients were included: 33 women, age 46.17 ± 13.0 years and disease duration of 30.2 ± 12.0 years. TIR 70-180 mg/dL (67.6 ± 11.8 vs. 69.8 ± 12.0%), time > 180 (28.1 ± 13.6 vs. 25.5 ± 13.1%), time > 250 (6.9 ± 6.1 vs. 5.1 ± 4.8) and estimated HbA1c (6.94 ± 0.8 vs. 6.75 ± 0.7%) significantly improved (PL vs. WL, respectively, p < 0.05). Time in hypoglycaemia, coefficient of variation, sensor usage and total daily insulin dose remained unchanged. CONCLUSIONS Lockdown conditions imposed by the COVID-19 pandemic may be managed successfully in terms of glycaemia control by population with DT1 prone to hypoglycaemia using SAP. The strict daily routine at home could probably explain the improvement in the time in glycemic target without increasing the time hypoglycaemia.
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Affiliation(s)
- Clara Viñals
- Diabetes Unit. Endocrinology and Nutrition Department, Hospital Clínic i Universitari, Villarroel 170, 08036, Barcelona, Spain.
| | - Alex Mesa
- Diabetes Unit. Endocrinology and Nutrition Department, Hospital Clínic i Universitari, Villarroel 170, 08036, Barcelona, Spain
| | - Daria Roca
- Diabetes Unit. Endocrinology and Nutrition Department, Hospital Clínic i Universitari, Villarroel 170, 08036, Barcelona, Spain
| | - Merce Vidal
- Diabetes Unit. Endocrinology and Nutrition Department, Hospital Clínic i Universitari, Villarroel 170, 08036, Barcelona, Spain
| | - Irene Pueyo
- Diabetes Unit. Endocrinology and Nutrition Department, Hospital Clínic i Universitari, Villarroel 170, 08036, Barcelona, Spain
| | - Ignacio Conget
- Diabetes Unit. Endocrinology and Nutrition Department, Hospital Clínic i Universitari, Villarroel 170, 08036, Barcelona, Spain
- CIBERDEM, Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas, Madrid, Spain
- IDIBAPS, Institut d'Investigacions Biomèdiques August Pi i Sunyer, Barcelona, Spain
| | - Marga Giménez
- Diabetes Unit. Endocrinology and Nutrition Department, Hospital Clínic i Universitari, Villarroel 170, 08036, Barcelona, Spain
- CIBERDEM, Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas, Madrid, Spain
- IDIBAPS, Institut d'Investigacions Biomèdiques August Pi i Sunyer, Barcelona, Spain
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27
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Gómez AM, Imitola A, Henao D, García-Jaramillo M, Giménez M, Viñals C, Grassi B, Torres M, Zuluaga I, Muñoz OM, Rondón M, León-Vargas F, Conget I. Factors associated with clinically significant hypoglycemia in patients with type 1 diabetes using sensor-augmented pump therapy with predictive low-glucose management: A multicentric study on iberoamerica. Diabetes Metab Syndr 2021; 15:267-272. [PMID: 33477103 DOI: 10.1016/j.dsx.2021.01.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 06/01/2020] [Revised: 01/01/2021] [Accepted: 01/02/2021] [Indexed: 12/17/2022]
Abstract
BACKGROUND AND AIMS Despite using sensor-augmented pump therapy (SAPT) with predictive low-glucose management (PLGM), hypoglycemia is still an issue in patients with type 1 Diabetes (T1D). Our aim was to determine factors associated with clinically significant hypoglycemia (<54 mg/dl) in persons with T1D treated with PLGM-SAPT. METHOD ology: This is a multicentric prospective real-life study performed in Colombia, Chile and Spain. Patients with T1D treated with PLGM-SAPT, using sensor ≥70% of time, were included. Data regarding pump and sensor use patterns and carbohydrate intake from 28 consecutive days were collected. A bivariate and multivariate Poisson regression analysis was carried out, to evaluate the association between the number of events of <54 mg/dl with the clinical variables and patterns of sensor and pump use. RESULTS 188 subjects were included (41 ± 13.8 years-old, 23 ± 12 years disease duration, A1c 7.2% ± 0.9). The median of events <54 mg/dl was four events/patient/month (IQR 1-10), 77% of these events occurred during day time. Multivariate analysis showed that the number of events of hypoglycemia were higher in patients with previous severe hypoglycemia (IRR1.38; 95% CI 1.19-1.61; p < 0.001), high glycemic variability defined as Coefficient of Variation (CV%) > 36% (IRR 2.09; 95%CI 1.79-2.45; p < 0.001) and hypoglycemia unawareness. A protector effect was identified for adequate sensor calibration (IRR 0.77; 95%CI 0.66-0.90; p:0.001), and the use of bolus wizard >60% (IRR 0.74; 95%CI 0.58-0.95; p:0.017). CONCLUSION In spite of using advanced SAPT, clinically significant hypoglycemia is still a non-negligible risk. Only the identification and intervention of modifiable factors could help to prevent and reduce hypoglycemia in clinical practice.
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Affiliation(s)
- Ana M Gómez
- Pontificia Universidad Javeriana, Carrera 7 No. 40-62, Bogotá, Colombia; Hospital Universitario San Ignacio, Endocrinology Unit, Carrera 7 No. 40-62, Bogotá, Colombia.
| | - Angelica Imitola
- Pontificia Universidad Javeriana, Carrera 7 No. 40-62, Bogotá, Colombia; Hospital Universitario San Ignacio, Endocrinology Unit, Carrera 7 No. 40-62, Bogotá, Colombia.
| | - Diana Henao
- Pontificia Universidad Javeriana, Carrera 7 No. 40-62, Bogotá, Colombia; Hospital Universitario San Ignacio, Endocrinology Unit, Carrera 7 No. 40-62, Bogotá, Colombia.
| | | | - Marga Giménez
- Diabetes Unit, Endocrinology and Nutrition Department, IDIBAPS (Institut D'investigacions Biomèdiques August Pi i Sunyer), CIBERDEM (Centro de Investigaciones Biomédicas en Red Sobre Diabetes y Enfermedades Metabólicas), Barcelona, Spain.
| | - Clara Viñals
- Diabetes Unit, Endocrinology and Nutrition Department, IDIBAPS (Institut D'investigacions Biomèdiques August Pi i Sunyer), CIBERDEM (Centro de Investigaciones Biomédicas en Red Sobre Diabetes y Enfermedades Metabólicas), Barcelona, Spain.
| | - Bruno Grassi
- Pontificia Universidad Católica de Chile, Chile.
| | - Mariana Torres
- Pontificia Universidad Javeriana, Carrera 7 No. 40-62, Bogotá, Colombia.
| | - Isabella Zuluaga
- Pontificia Universidad Javeriana, Carrera 7 No. 40-62, Bogotá, Colombia.
| | - Oscar Mauricio Muñoz
- Pontificia Universidad Javeriana, Carrera 7 No. 40-62, Bogotá, Colombia; Hospital Universitario San Ignacio, Department of Internal Medicine, Bogotá, Colombia; Department of Clinical Epidemiology and Biostatistics, Pontificia Universidad Javeriana, Carrera 7 No. 40-62, Bogotá, Colombia.
| | - Martin Rondón
- Department of Clinical Epidemiology and Biostatistics, Pontificia Universidad Javeriana, Carrera 7 No. 40-62, Bogotá, Colombia.
| | | | - Ignacio Conget
- Diabetes Unit, Endocrinology and Nutrition Department, IDIBAPS (Institut D'investigacions Biomèdiques August Pi i Sunyer), CIBERDEM (Centro de Investigaciones Biomédicas en Red Sobre Diabetes y Enfermedades Metabólicas), Barcelona, Spain.
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Amor AJ, Vinagre I, Valverde M, Urquizu X, Meler E, López E, Quirós C, Giménez M, Codina L, Conget I, Barahona MJ, Perea V. Nuclear magnetic resonance lipoproteins are associated with carotid atherosclerosis in type 1 diabetes and pre-eclampsia. Diabetes Metab Res Rev 2021; 37:e3362. [PMID: 32515046 DOI: 10.1002/dmrr.3362] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [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: 03/15/2020] [Revised: 05/22/2020] [Accepted: 05/26/2020] [Indexed: 12/29/2022]
Abstract
AIMS Persistence of lipoprotein abnormalities in type 1 diabetes (T1D) and/or pre-eclampsia could be associated with cardiovascular disease (CVD). We assessed differences in the advanced lipoprotein profiles according to the presence of both conditions and their differential association with atherosclerosis. MATERIAL AND METHODS We recruited 112 women without CVD and last pregnancy ≥5 years previously, divided into four groups (n = 28 per group): (a) T1D and previous pre-eclampsia; (b) T1D without pre-eclampsia; (c) pre-eclampsia without T1D; and (d) controls (without T1D/pre-eclampsia). Groups were matched by several risk factors, and diabetes duration and retinopathy in T1D. Carotid intima-media thickness (IMT) and the presence of plaque (IMT ≥1.5 mm) were assessed by ultrasonography. The lipoprotein profile was evaluated by nuclear magnetic resonance (NMR) spectroscopy. RESULTS The participants were 44.9 ± 7.8 years old. Carotid plaque presence was 20.5%, with a higher prevalence in T1D and/or pre-eclampsia vs controls (P < .05). High-density lipoprotein (HDL)-related variables differed among groups, mainly driven by an increase in T1D (P < .05), whereas triglyceride-related variables were increased in pre-eclampsia [medium very low-density lipoprotein (VLDL) particles and triglyceride enrichment in HDL and low-density lipoprotein (LDL)]. Overall, in multivariate-adjusted models, LDL-related variables were the most strongly associated with atherosclerosis (P < .05). In age- and statin-adjusted models, previous pre-eclampsia showed an independent association with triglyceride-related variables (plaque: medium-VLDL-particles, OR 1.550 [1.013-2.374]; HDL-cholesterol/HDL-triglycerides ratio, OR 0.411 [0.175-0.967]). Regarding T1D, HDL-parameters were also differentially associated (maximum-IMT: HDL-cholesterol/HDL-particles ratio, β = -.258, P = .036). CONCLUSIONS NMR lipoproteins were differentially and independently associated with atherosclerosis in T1D/pre-eclampsia. Further studies are needed to ascertain the role of NMR parameters as CVD biomarkers in this high-risk population.
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Affiliation(s)
- Antonio J Amor
- Endocrinology and Nutrition Department, Hospital Clínic de Barcelona, Barcelona, Spain
| | - Irene Vinagre
- Endocrinology and Nutrition Department, Hospital Clínic de Barcelona, Barcelona, Spain
| | - Maite Valverde
- Endocrinology and Nutrition Department, Hospital Universitari Mútua de Terrassa, Terrassa, Spain
| | - Xavier Urquizu
- Obstetrics and Gynecology Department, Hospital Universitari Mútua de Terrassa, Terrassa, Spain
| | - Eva Meler
- Fetal i+D Fetal Medicine Research Center, BCNatal-Barcelona Center for Maternal-Fetal and Neonatal Medicine (Hospital Clínic and Hospital Sant Joan de Déu), IDIBAPS, University of Barcelona, Barcelona, Spain
| | - Eva López
- Obstetrics and Gynecology Department, Hospital Universitari Mútua de Terrassa, Terrassa, Spain
| | - Carmen Quirós
- Endocrinology and Nutrition Department, Hospital Universitari Mútua de Terrassa, Terrassa, Spain
| | - Marga Giménez
- Endocrinology and Nutrition Department, Hospital Clínic de Barcelona, Barcelona, Spain
- CIBER de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
| | - Laura Codina
- Obstetrics and Gynecology Department, Hospital Universitari Mútua de Terrassa, Terrassa, Spain
| | - Ignacio Conget
- Endocrinology and Nutrition Department, Hospital Clínic de Barcelona, Barcelona, Spain
- CIBER de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
| | - Maria J Barahona
- Endocrinology and Nutrition Department, Hospital Universitari Mútua de Terrassa, Terrassa, Spain
| | - Verónica Perea
- Endocrinology and Nutrition Department, Hospital Universitari Mútua de Terrassa, Terrassa, Spain
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Amor AJ, Vinagre I, Valverde M, Urquizu X, Meler E, López E, Alonso N, Pané A, Giménez M, Codina L, Conget I, Barahona MJ, Perea V. Nuclear magnetic resonance-based metabolomic analysis in the assessment of preclinical atherosclerosis in type 1 diabetes and preeclampsia. Diabetes Res Clin Pract 2021; 171:108548. [PMID: 33238177 DOI: 10.1016/j.diabres.2020.108548] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 09/21/2020] [Revised: 11/01/2020] [Accepted: 11/07/2020] [Indexed: 12/18/2022]
Abstract
AIMS Evaluate the role of plasma metabolomics in atherosclerosis according to the presence of type 1 diabetes (T1D) or previous preeclampsia. METHODS We recruited 105 women without cardiovascular disease and last pregnancy ≥5 years previously, divided according to the presence of T1D or previous preeclampsia. Preclinical atherosclerosis was defined as the presence of carotid plaque (intima-media thickness ≥1.5 mm) assessed by ultrasonography. Metabolomics were evaluated by nuclear magnetic resonance (NMR). Bivariate and multivariate-adjusted differences in NMR-metabolomics were evaluated. RESULTS The participants were 44.9 ± 8.1 years-old; 20% harbored plaques. There were significant differences in lipidic-, energetic- and nitrogen-related metabolites according to the presence of T1D/preeclampsia (p < 0.05). In multivariate-adjusted models (by age, statins, blood pressure and T1D/preeclampsia), only lipidomic-related metabolites were associated with atherosclerosis in the whole sample. However, stronger associations were observed in women with previous preeclampsia (vs. without; per 0.5 mmol/L increments); phosphatidylcholine, OR 4.08 (1.32-27.22); free cholesterol, 5.18 (1.22-21.97); saturated fatty acids, OR 2.99 (1.37-6.48); w-7, OR 2.29 (1.15-4.56); and w-9 fatty acids, OR 1.49 (1.00-2.23). CONCLUSIONS NMR-metabolomics showed a differential pattern according to the presence of T1D/preeclampsia in relation to preclinical atherosclerosis. Since most of these metabolites mirror lifestyle factors, they could help tailor dietetic advice in high-risk women.
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Affiliation(s)
- Antonio J Amor
- Endocrinology and Nutrition Department, Hospital Clínic de Barcelona, Spain.
| | - Irene Vinagre
- Endocrinology and Nutrition Department, Hospital Clínic de Barcelona, Spain
| | - Maite Valverde
- Endocrinology and Nutrition Department, Hospital Universitari Mútua de Terrassa, Spain
| | - Xavier Urquizu
- Obstetrics and Gynecology Department, Hospital Universitari Mútua de Terrassa, Spain
| | - Eva Meler
- Fetal i+D Fetal Medicine Research Center, BCNatal-Barcelona Center for Maternal-Fetal and Neonatal Medicine (Hospital Clínic and Hospital Sant Joan de Déu), IDIBAPS, University of Barcelona, Spain
| | - Eva López
- Obstetrics and Gynecology Department, Hospital Universitari Mútua de Terrassa, Spain
| | - Nuria Alonso
- Endocrinology and Nutrition Department, Hospital Universitari Mútua de Terrassa, Spain
| | - Adriana Pané
- Endocrinology and Nutrition Department, Hospital Clínic de Barcelona, Spain
| | - Marga Giménez
- Endocrinology and Nutrition Department, Hospital Clínic de Barcelona, Spain; CIBER de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
| | - Laura Codina
- Obstetrics and Gynecology Department, Hospital Universitari Mútua de Terrassa, Spain
| | - Ignacio Conget
- Endocrinology and Nutrition Department, Hospital Clínic de Barcelona, Spain; CIBER de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
| | - Maria J Barahona
- Endocrinology and Nutrition Department, Hospital Universitari Mútua de Terrassa, Spain
| | - Verónica Perea
- Endocrinology and Nutrition Department, Hospital Universitari Mútua de Terrassa, Spain.
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Mayneris-Perxachs J, Russo MF, Ramos R, de Hollanda A, Arxé AA, Rottoli M, Arnoriaga-Rodríguez M, Comas-Cufí M, Bartoletti M, Verrastro O, Gudiol C, Fages E, Giménez M, Gil ADG, Bernante P, Tinahones F, Carratalà J, Pagotto U, Hernández-Aguado I, Fernández-Aranda F, Meira F, Castro Guardiola A, Mingrone G, Fernández-Real JM. Blood Hemoglobin Substantially Modulates the Impact of Gender, Morbid Obesity, and Hyperglycemia on COVID-19 Death Risk: A Multicenter Study in Italy and Spain. Front Endocrinol (Lausanne) 2021; 12:741248. [PMID: 34795637 PMCID: PMC8593102 DOI: 10.3389/fendo.2021.741248] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Accepted: 10/04/2021] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Hyperglycemia and obesity are associated with a worse prognosis in subjects with COVID-19 independently. Their interaction as well as the potential modulating effects of additional confounding factors is poorly known. Therefore, we aimed to identify and evaluate confounding factors affecting the prognostic value of obesity and hyperglycemia in relation to mortality and admission to the intensive care unit (ICU) due to COVID-19. METHODS Consecutive patients admitted in two Hospitals from Italy (Bologna and Rome) and three from Spain (Barcelona and Girona) as well as subjects from Primary Health Care centers. Mortality from COVID-19 and risk for ICU admission were evaluated using logistic regression analyses and machine learning (ML) algorithms. RESULTS As expected, among 3,065 consecutive patients, both obesity and hyperglycemia were independent predictors of ICU admission. A ML variable selection strategy confirmed these results and identified hyperglycemia, blood hemoglobin and serum bilirubin associated with increased mortality risk. In subjects with blood hemoglobin levels above the median, hyperglycemic and morbidly obese subjects had increased mortality risk than normoglycemic individuals or non-obese subjects. However, no differences were observed among individuals with hemoglobin levels below the median. This was particularly evident in men: those with severe hyperglycemia and hemoglobin concentrations above the median had 30 times increased mortality risk compared with men without hyperglycemia. Importantly, the protective effect of female sex was lost in subjects with increased hemoglobin levels. CONCLUSIONS Blood hemoglobin substantially modulates the influence of hyperglycemia on increased mortality risk in patients with COVID-19. Monitoring hemoglobin concentrations seem of utmost importance in the clinical settings to help clinicians in the identification of patients at increased death risk.
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Affiliation(s)
- Jordi Mayneris-Perxachs
- Department of Diabetes, Endocrinology and Nutrition, Dr. Josep Trueta University Hospital, Girona, Spain
- Nutrition, Eumetabolism and Health Group, Girona Biomedical Research Institute (IdibGi), Girona, Spain
- Department of Endocrinology and Nutrition, Centro de Investigación Biomédica en Red-Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Madrid, Spain
| | - Maria Francesca Russo
- Fondazione Policlinico Universitario A. Gemelli Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Università Cattolica del Sacro Cuore Rome, Rome, Italy
| | - Rafel Ramos
- Department of Medical Sciences, School of Medicine, University of Girona, Girona, Spain
- Vascular Health Research Group of Girona (ISV-Girona). Jordi Gol Institute for Primary Care Research (Institut Universitari per a la Recerca en AtencióPrimària Jordi Gol I Gurina -IDIAPJGol), Girona Biomedical Research Institute (IDIBGI), Dr. Josep Trueta University Hospital, Catalonia, Spain
- Girona Biomedical Research Institute (IDIBGI), Dr. Josep Trueta University Hospital, Catalonia, Spain
| | - Ana de Hollanda
- Department of Endocrinology & Nutrition, Hospital Clínic Barcelona, Diabetes Unit, Barcelona, Spain
- Department of Endocrinology and Nutrition, Institut d’investigacions biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Arola Armengou Arxé
- Department of Internal Medicine, Service of Internal Medicine Dr. Josep Trueta University Hospital, Catalonia, Spain
| | - Matteo Rottoli
- Department of Surgery, Diabetology and Otolaryngology, Surgery of the Alimentary Tract and Centre for the Study and Research of Treatment for Morbid Obesity, Bologna, Italy
- Infectious Diseases Unit, Department of Medical and Surgical Sciences, Alma Mater Studiorum University of Bologna, Sant’Orsola Policlinic, Bologna, Italy
| | - María Arnoriaga-Rodríguez
- Department of Diabetes, Endocrinology and Nutrition, Dr. Josep Trueta University Hospital, Girona, Spain
- Nutrition, Eumetabolism and Health Group, Girona Biomedical Research Institute (IdibGi), Girona, Spain
- Department of Endocrinology and Nutrition, Centro de Investigación Biomédica en Red-Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Madrid, Spain
- Department of Medical Sciences, School of Medicine, University of Girona, Girona, Spain
| | - Marc Comas-Cufí
- Vascular Health Research Group of Girona (ISV-Girona). Jordi Gol Institute for Primary Care Research (Institut Universitari per a la Recerca en AtencióPrimària Jordi Gol I Gurina -IDIAPJGol), Girona Biomedical Research Institute (IDIBGI), Dr. Josep Trueta University Hospital, Catalonia, Spain
| | - Michele Bartoletti
- Infectious Diseases Unit, Department of Medical and Surgical Sciences, Alma Mater Studiorum University of Bologna, Sant’Orsola Policlinic, Bologna, Italy
| | - Ornella Verrastro
- Fondazione Policlinico Universitario A. Gemelli Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Università Cattolica del Sacro Cuore Rome, Rome, Italy
| | - Carlota Gudiol
- Department of Infectious Diseases, Hospital Universitari de Bellvitge, Hospitalet de Llobregat, Barcelona, Spain
- Bellvitge Biomedical Research Institute (IDIBELL), Hospitalet de Llobregat, Barcelona, Spain
- Spanish Network for Research in Infectious Disease (REIPI), Instituto de Salud Carlos III, Madrid, Spain
- Department of Clinical Sciences, School of Medicine and Health Sciences, University of Barcelona, Barcelona, Spain
- Department of Oncology, Institut Català d’Oncologia (ICO) Hospitalet de Llobregat, Barcelona, Spain
| | - Ester Fages
- Vascular Health Research Group of Girona (ISV-Girona). Jordi Gol Institute for Primary Care Research (Institut Universitari per a la Recerca en AtencióPrimària Jordi Gol I Gurina -IDIAPJGol), Girona Biomedical Research Institute (IDIBGI), Dr. Josep Trueta University Hospital, Catalonia, Spain
- Girona Biomedical Research Institute (IDIBGI), Dr. Josep Trueta University Hospital, Catalonia, Spain
| | - Marga Giménez
- Department of Endocrinology & Nutrition, Hospital Clínic Barcelona, Diabetes Unit, Barcelona, Spain
- Department of Endocrinology and Nutrition, Institut d’investigacions biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
- Department of Endocrinology and Nutrition, Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Madrid, Spain
| | - Ariadna de Genover Gil
- Department of Internal Medicine, Service of Internal Medicine Dr. Josep Trueta University Hospital, Catalonia, Spain
| | - Paolo Bernante
- Department of Surgery, Diabetology and Otolaryngology, Surgery of the Alimentary Tract and Centre for the Study and Research of Treatment for Morbid Obesity, Bologna, Italy
- Infectious Diseases Unit, Department of Medical and Surgical Sciences, Alma Mater Studiorum University of Bologna, Sant’Orsola Policlinic, Bologna, Italy
| | - Francisco Tinahones
- Department of Endocrinology and Nutrition, Centro de Investigación Biomédica en Red-Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Madrid, Spain
- Department of Endocrinology and Nutrition, Hospital Clínico Universitario Virgen de Victoria de Malaga, Malaga, Spain
| | - Jordi Carratalà
- Department of Infectious Diseases, Hospital Universitari de Bellvitge, Hospitalet de Llobregat, Barcelona, Spain
- Bellvitge Biomedical Research Institute (IDIBELL), Hospitalet de Llobregat, Barcelona, Spain
- Spanish Network for Research in Infectious Disease (REIPI), Instituto de Salud Carlos III, Madrid, Spain
- Department of Clinical Sciences, School of Medicine and Health Sciences, University of Barcelona, Barcelona, Spain
| | - Uberto Pagotto
- Endocrinology and Prevention and Care of Diabetes Unit, Department of Medical and Surgical Sciences, Sant’ Orsola Policlinic, Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Ildefonso Hernández-Aguado
- Department of Public Health, Universidad Miguel Hernández de Elche, Alicante, Spain
- Department of Epidemiology, Centro de Investigación Biomédica en Red (CIBER) Epidemiology and Public Health (CIBERESP), Madrid, Spain
| | - Fernando Fernández-Aranda
- Department of Endocrinology and Nutrition, Centro de Investigación Biomédica en Red-Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Madrid, Spain
- Bellvitge Biomedical Research Institute (IDIBELL), Hospitalet de Llobregat, Barcelona, Spain
- Department of Clinical Sciences, School of Medicine and Health Sciences, University of Barcelona, Barcelona, Spain
- Department of Psychiatry, Hospital Universitari de Bellvitge, Hospitalet de Llobregat, Barcelona, Spain
| | - Fernanda Meira
- Department of Endocrinology and Nutrition, Institut d’investigacions biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
- Department of Endocrinology and Nutrition, Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Madrid, Spain
- Department of Infectious Diseases, Hospital Clínic Barcelona, Barcelona, Spain
| | - Antoni Castro Guardiola
- Department of Internal Medicine, Service of Internal Medicine Dr. Josep Trueta University Hospital, Catalonia, Spain
| | - Geltrude Mingrone
- Fondazione Policlinico Universitario A. Gemelli Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Università Cattolica del Sacro Cuore Rome, Rome, Italy
- Department of Internal Medicine, King’s College London, London, United Kingdom
| | - José Manuel Fernández-Real
- Department of Diabetes, Endocrinology and Nutrition, Dr. Josep Trueta University Hospital, Girona, Spain
- Nutrition, Eumetabolism and Health Group, Girona Biomedical Research Institute (IdibGi), Girona, Spain
- Department of Endocrinology and Nutrition, Centro de Investigación Biomédica en Red-Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Madrid, Spain
- Department of Medical Sciences, School of Medicine, University of Girona, Girona, Spain
- *Correspondence: José Manuel Fernández-Real,
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Viñals C, Beneyto A, Martín-SanJosé JF, Furió-Novejarque C, Bertachi A, Bondia J, Vehi J, Conget I, Giménez M. Artificial Pancreas With Carbohydrate Suggestion Performance for Unannounced and Announced Exercise in Type 1 Diabetes. J Clin Endocrinol Metab 2021; 106:55-63. [PMID: 32852548 DOI: 10.1210/clinem/dgaa562] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [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: 05/06/2020] [Accepted: 08/14/2020] [Indexed: 12/16/2022]
Abstract
OBJECTIVE To evaluate the safety and performance of a new multivariable closed-loop (MCL) glucose controller with automatic carbohydrate recommendation during and after unannounced and announced exercise in adults with type 1 diabetes (T1D). RESEARCH DESIGN AND METHODS A randomized, 3-arm, crossover clinical trial was conducted. Participants completed a heavy aerobic exercise session including three 15-minute sets on a cycle ergometer with 5 minutes rest in between. In a randomly determined order, we compared MCL control with unannounced (CLNA) and announced (CLA) exercise to open-loop therapy (OL). Adults with T1D, insulin pump users, and those with hemoglobin (Hb)A1c between 6.0% and 8.5% were eligible. We investigated glucose control during and 3 hours after exercise. RESULTS Ten participants (aged 40.8 ± 7.0 years; HbA1c of 7.3 ± 0.8%) participated. The use of the MCL in both closed-loop arms decreased the time spent <70 mg/dL of sensor glucose (0.0%, [0.0-16.8] and 0.0%, [0.0-19.2] vs 16.2%, [0.0-26.0], (%, [percentile 10-90]) CLNA and CLA vs OL respectively; P = 0.047, P = 0.063) and the number of hypoglycemic events when compared with OL (CLNA 4 and CLA 3 vs OL 8; P = 0.218, P = 0.250). The use of the MCL system increased the proportion of time within 70 to 180 mg/dL (87.8%, [51.1-100] and 91.9%, [58.7-100] vs 81.1%, [65.4-87.0], (%, [percentile 10-90]) CLNA and CLA vs OL respectively; P = 0.227, P = 0.039). This was achieved with the administration of similar doses of insulin and a reduced amount of carbohydrates. CONCLUSIONS The MCL with automatic carbohydrate recommendation performed well and was safe during and after both unannounced and announced exercise, maintaining glucose mostly within the target range and reducing the risk of hypoglycemia despite a reduced amount of carbohydrate intake.Register Clinicaltrials.gov: NCT03577158.
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Affiliation(s)
- Clara Viñals
- Diabetes Unit, Endocrinology and Nutrition Department Hospital Clínic de Barcelona, Spain
| | - Aleix Beneyto
- Institute of Informatics and Applications, University of Girona, Girona, Spain
| | - Juan-Fernando Martín-SanJosé
- Instituto Universitario de Automática e Informática Industrial, Universitat Politècnica de València, València, Spain
| | - Clara Furió-Novejarque
- Instituto Universitario de Automática e Informática Industrial, Universitat Politècnica de València, València, Spain
| | - Arthur Bertachi
- Federal University of Technology-Paraná (UTFPR), Guarapuava, Brazil
| | - Jorge Bondia
- Instituto Universitario de Automática e Informática Industrial, Universitat Politècnica de València, València, Spain
- Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Madrid, Spain
| | - Josep Vehi
- Institute of Informatics and Applications, University of Girona, Girona, Spain
- Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Madrid, Spain
| | - Ignacio Conget
- Diabetes Unit, Endocrinology and Nutrition Department Hospital Clínic de Barcelona, Spain
- Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Madrid, Spain
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Marga Giménez
- Diabetes Unit, Endocrinology and Nutrition Department Hospital Clínic de Barcelona, Spain
- Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Madrid, Spain
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
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Torres B, Alcubilla P, González-Cordón A, Inciarte A, Chumbita M, Cardozo C, Meira F, Giménez M, de Hollanda A, Soriano A. Impact of low serum calcium at hospital admission on SARS-CoV-2 infection outcome. Int J Infect Dis 2020; 104:164-168. [PMID: 33278624 PMCID: PMC7709580 DOI: 10.1016/j.ijid.2020.11.207] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [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: 08/29/2020] [Revised: 11/19/2020] [Accepted: 11/29/2020] [Indexed: 12/28/2022] Open
Abstract
Background Calcium is an essential ion for pathogen survival and virulence and is involved in the regulation of the inflammatory response. Hypocalcemia is a common laboratory finding in critically ill patients. Data regarding levels of calcium in SARS-CoV-2 infection is scarce. Patients with SARS-CoV-2 infection who present with hypocalcemia could have a worse outcome. Methods We performed a retrospective analysis of hospitalized patients with SARS-CoV-2 infection and included all patients who had any serum calcium measurement in the first 72 h since hospital admission. The main objective was to investigate the relation of low serum calcium with adverse outcome, measured by the requirement of high oxygen support – defined as high flow nasal cannula oxygen, non-invasive mechanical ventilation and/or invasive ventilation – intensive care unit admission or death. Results A total of 316 patients were included in the study. Median age was 65 years (IQR 55–74); 65% were men. Hypocalcemia within 72 h since hospital admission was present in 63% of patients. A higher number of patients in the hypocalcemia group required high oxygen support during hospitalization (49% vs 32%; p = 0,01) and were admitted to the ICU (42% vs 26%; p = 0,005). No differences in mortality were observed between groups. Conclusions Hypocalcemia is frequent in hospitalized patients with SARS-CoV-2 infection and can identify patients who will have a worse outcome. More studies are needed to understand the role of calcium metabolism in SARS-CoV-2 infection and to address the clinical implications and therapeutic interventions it might have.
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Affiliation(s)
- Berta Torres
- Infectious Diseases, Hospital Clínic, Barcelona, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain.
| | - Pau Alcubilla
- Clinical Pharmacology Department, Hospital Clínic, Barcelona, Spain
| | - Ana González-Cordón
- Infectious Diseases, Hospital Clínic, Barcelona, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Alexy Inciarte
- Infectious Diseases, Hospital Clínic, Barcelona, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | | | - Celia Cardozo
- Infectious Diseases, Hospital Clínic, Barcelona, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | | | - Marga Giménez
- Endocrinology and Diabetes Unit, IDIBAPS, Hospital Clínic, Barcelona, Spain; Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Spain
| | - Ana de Hollanda
- Endocrinology and Diabetes Unit, IDIBAPS, Hospital Clínic, Barcelona, Spain; Centro de Investigación Biomédica en Red de la Fisiopatología de la Obesidad y Nutrición (CIBER-OBN), Spain
| | - Alex Soriano
- Infectious Diseases, Hospital Clínic, Barcelona, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain.
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Giménez M, Cano M, Martínez-Zalacaín I, Real E, Alonso P, Segalàs C, Munuera J, Kegeles LS, Weinstein JJ, Xu X, Menchón JM, Cardoner N, Soriano-Mas C, Fullana MA. Is glutamate associated with fear extinction and cognitive behavior therapy outcome in OCD? A pilot study. Eur Arch Psychiatry Clin Neurosci 2020; 270:1003-1014. [PMID: 31432262 DOI: 10.1007/s00406-019-01056-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [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: 10/11/2018] [Accepted: 08/07/2019] [Indexed: 12/15/2022]
Abstract
Cognitive behavioral therapy (CBT) including exposure and response prevention is a well-established treatment for obsessive-compulsive disorder (OCD) and is based on the principles of fear extinction. Fear extinction is linked to structural and functional variability in the ventromedial prefrontal cortex (vmPFC) and has been consistently associated with glutamate neurotransmission. The relationship between vmPFC glutamate and fear extinction and its effects on CBT outcome have not yet been explored in adults with OCD. We assessed glutamate levels in the vmPFC using 3T magnetic resonance spectroscopy, and fear extinction (learning and recall) using skin conductance responses during a 2-day experimental paradigm in OCD patients (n = 17) and in healthy controls (HC; n = 13). Obsessive-compulsive patients (n = 12) then received manualized CBT. Glutamate in the vmPFC was negatively associated with fear extinction recall and positively associated with CBT outcome (with higher glutamate levels predicting a better outcome) in OCD patients. Glutamate levels in the vmPFC in OCD patients were not significantly different from those in HC, and were not associated with OCD severity. Our results suggest that glutamate in the vmPFC is associated with fear extinction recall and CBT outcome in adult OCD patients.
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Affiliation(s)
- M Giménez
- Department of Psychiatry, Bellvitge University Hospital, Bellvitge Biomedical Research Institute-IDIBELL, Feixa Llarga s/n, Hospitalet de Llobregat, 08907, Barcelona, Spain.,Carlos III Health Institute, Centro de Investigación Biomédica en Red de Salud Mental-CIBERSAM, Av. de Monforte de Lemos 5, 28029, Madrid, Spain
| | - M Cano
- Department of Psychiatry, Bellvitge University Hospital, Bellvitge Biomedical Research Institute-IDIBELL, Feixa Llarga s/n, Hospitalet de Llobregat, 08907, Barcelona, Spain.,Carlos III Health Institute, Centro de Investigación Biomédica en Red de Salud Mental-CIBERSAM, Av. de Monforte de Lemos 5, 28029, Madrid, Spain.,Department of Clinical Sciences, School of Medicine, University of Barcelona, Casanova 143, 08036, Barcelona, Spain
| | - I Martínez-Zalacaín
- Department of Psychiatry, Bellvitge University Hospital, Bellvitge Biomedical Research Institute-IDIBELL, Feixa Llarga s/n, Hospitalet de Llobregat, 08907, Barcelona, Spain.,Department of Clinical Sciences, School of Medicine, University of Barcelona, Casanova 143, 08036, Barcelona, Spain
| | - E Real
- Department of Psychiatry, Bellvitge University Hospital, Bellvitge Biomedical Research Institute-IDIBELL, Feixa Llarga s/n, Hospitalet de Llobregat, 08907, Barcelona, Spain.,Carlos III Health Institute, Centro de Investigación Biomédica en Red de Salud Mental-CIBERSAM, Av. de Monforte de Lemos 5, 28029, Madrid, Spain
| | - P Alonso
- Department of Psychiatry, Bellvitge University Hospital, Bellvitge Biomedical Research Institute-IDIBELL, Feixa Llarga s/n, Hospitalet de Llobregat, 08907, Barcelona, Spain.,Carlos III Health Institute, Centro de Investigación Biomédica en Red de Salud Mental-CIBERSAM, Av. de Monforte de Lemos 5, 28029, Madrid, Spain.,Department of Clinical Sciences, School of Medicine, University of Barcelona, Casanova 143, 08036, Barcelona, Spain
| | - C Segalàs
- Department of Psychiatry, Bellvitge University Hospital, Bellvitge Biomedical Research Institute-IDIBELL, Feixa Llarga s/n, Hospitalet de Llobregat, 08907, Barcelona, Spain.,Carlos III Health Institute, Centro de Investigación Biomédica en Red de Salud Mental-CIBERSAM, Av. de Monforte de Lemos 5, 28029, Madrid, Spain
| | - J Munuera
- Diagnostic Imaging Department, Fundació de Recerca Hospital Sant Joan de Déu, Passeig Sant Joan de Déu, 2, Esplugues de Llobregat, 08950, Barcelona, Spain
| | - L S Kegeles
- Department of Psychiatry and Radiology, Columbia University, 622 W 168th St, New York, 10032, USA.,New York State Psychiatric Institute, 1051 Riverside Dr, New York, 10032, USA
| | - J J Weinstein
- Department of Psychiatry and Radiology, Columbia University, 622 W 168th St, New York, 10032, USA.,New York State Psychiatric Institute, 1051 Riverside Dr, New York, 10032, USA.,Department of Psychiatry, Stony Brook University, Stony Brook, 101 Nicolls Rd, Stony Brook, New York, 11794, USA
| | - X Xu
- Department of Psychiatry and Radiology, Columbia University, 622 W 168th St, New York, 10032, USA.,New York State Psychiatric Institute, 1051 Riverside Dr, New York, 10032, USA
| | - J M Menchón
- Department of Psychiatry, Bellvitge University Hospital, Bellvitge Biomedical Research Institute-IDIBELL, Feixa Llarga s/n, Hospitalet de Llobregat, 08907, Barcelona, Spain.,Carlos III Health Institute, Centro de Investigación Biomédica en Red de Salud Mental-CIBERSAM, Av. de Monforte de Lemos 5, 28029, Madrid, Spain.,Department of Clinical Sciences, School of Medicine, University of Barcelona, Casanova 143, 08036, Barcelona, Spain
| | - N Cardoner
- Depression and Anxiety Program, Department of Mental Health, Parc Taulí Sabadell, Hospital Universitari, Parc Taulí 1, 08208, Sabadell, Spain.,Department of Psychiatry and Legal Medicine, Universitat Autònoma de Barcelona, Av. de Can Domènech, 737, 08193, Cerdanyola Del Vallès Barcelona, Barcelona, Spain
| | - C Soriano-Mas
- Department of Psychiatry, Bellvitge University Hospital, Bellvitge Biomedical Research Institute-IDIBELL, Feixa Llarga s/n, Hospitalet de Llobregat, 08907, Barcelona, Spain.,Carlos III Health Institute, Centro de Investigación Biomédica en Red de Salud Mental-CIBERSAM, Av. de Monforte de Lemos 5, 28029, Madrid, Spain.,Department of Psychobiology and Methodology of Health Sciences, Universitat Autònoma de Barcelona, Building B1, Ca n'Altayó, s/n, Bellaterra, 08193, Barcelona, Spain
| | - M A Fullana
- Carlos III Health Institute, Centro de Investigación Biomédica en Red de Salud Mental-CIBERSAM, Av. de Monforte de Lemos 5, 28029, Madrid, Spain. .,Department of Psychiatry and Legal Medicine, Universitat Autònoma de Barcelona, Av. de Can Domènech, 737, 08193, Cerdanyola Del Vallès Barcelona, Barcelona, Spain. .,Psychiatry Department, Hospital Clínic-Institute of Neurosciences, CIBERSAM, C/Rosselló 140, 08036, Barcelona, Spain.
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Pané A, Conget I, Boswell L, Ruiz S, Viñals C, Perea V, Giménez M, Cofán M, Blanco J, Vinagre I, Esmatjes E, Ortega E, Amor AJ. Insulin resistance is associated with preclinical carotid atherosclerosis in patients with type 1 diabetes. Diabetes Metab Res Rev 2020; 36:e3323. [PMID: 32266782 DOI: 10.1002/dmrr.3323] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [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: 08/13/2019] [Revised: 03/24/2020] [Accepted: 03/29/2020] [Indexed: 01/15/2023]
Abstract
AIM Although insulin resistance (IR) is a growing trait among type 1 diabetes (T1D) population, its relationship with atherosclerosis has been scarcely studied. We assessed the association between IR indexes and carotid atherosclerosis in T1D, a population at high cardiovascular disease (CVD) risk. MATERIALS AND METHODS We evaluated 191 participants with T1D and no prior CVD with at least one of the following criteria: ≥40 years old; diabetic nephropathy; or T1D duration ≥10 years harbouring ≥1 additional CVD risk factor. IR was assessed with the metabolic syndrome (MetS) harmonized definition proposed in 2009 and the estimated glucose disposal rate (eGDR), a T1D-specific IR surrogate marker (lower values indicating higher IR). Standardized carotid ultrasonography was performed, recording intima-media thickness (IMT), plaque presence and maximum height of plaque. Comparisons between patients according to their MetS status as well as concerning eGDR values were performed. RESULTS The participants' median age was 47.4 (41.1-53.3) years and diabetes duration 25.7 (21.6-32.5) years. Plaque prevalence was higher in patients with greater IR (49.1%, 29.1% and 20%, P = .001, for any plaque according to decreasing eGDR tertiles). Conversely, no statistically significant higher plaque prevalence was found in participants with MetS. In multivariate analyses (adjusted for general- and T1D-specific risk factors, and statin treatment), MetS was associated with neither IMT nor plaque. On the contrary, eGDR was independently related to ≥2 plaques (P = .018) and maximum plaque height (P < .01). CONCLUSIONS In T1D, IR assessed through eGDR but not by MetS definition was independently associated with plaque burden, a predictor of CVD.
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Affiliation(s)
- Adriana Pané
- Endocrinology and Nutrition Department, Hospital Clínic, Barcelona, Spain
| | - Ignacio Conget
- Endocrinology and Nutrition Department, Hospital Clínic, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
| | - Laura Boswell
- Endocrinology and Nutrition Department, Hospital Clínic, Barcelona, Spain
| | - Sabina Ruiz
- Endocrinology and Nutrition Department, Hospital Clínic, Barcelona, Spain
| | - Clara Viñals
- Endocrinology and Nutrition Department, Hospital Clínic, Barcelona, Spain
| | - Verónica Perea
- Endocrinology and Nutrition Department, Hospital Universitari Mútua de Terrassa, Terrassa, Spain
| | - Marga Giménez
- Endocrinology and Nutrition Department, Hospital Clínic, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
| | - Montserrat Cofán
- Endocrinology and Nutrition Department, Hospital Clínic, Barcelona, Spain
- Centro de Investigación Biomédica en Red Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
| | - Jesús Blanco
- Endocrinology and Nutrition Department, Hospital Clínic, Barcelona, Spain
| | - Irene Vinagre
- Endocrinology and Nutrition Department, Hospital Clínic, Barcelona, Spain
| | - Enric Esmatjes
- Endocrinology and Nutrition Department, Hospital Clínic, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
| | - Emilio Ortega
- Endocrinology and Nutrition Department, Hospital Clínic, Barcelona, Spain
- Centro de Investigación Biomédica en Red Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
| | - Antonio J Amor
- Endocrinology and Nutrition Department, Hospital Clínic, Barcelona, Spain
- Centro de Investigación Biomédica en Red Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
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Abstract
Background: Glycemic variability is an important factor to consider in diabetes management. It can be assessed with multiple glycemic variability metrics and quality of control indices based on continuous glucose monitoring (CGM) recordings. For this, a robust repeatable calculation is important. A widely used tool for automated assessment is the EasyGV software. The aim of this work is to implement new methods of glycemic variability assessment in EasyGV and to validate implementation of each glucose metric in EasyGV against a reference implementation of the calculations. Methods: Validation data used came from the JDRF CGM study. Validation of the implementation of metrics that are available in EasyGV software v9 was carried out and the following new methods were added and validated: personal glycemic state, index of glycemic control, times in ranges, and glycemic variability percentage. Reference values considered gold standard calculations were derived from MATLAB implementation of each metric. Results: The Pearson correlation coefficient was above 0.98 for all metrics, except for mean amplitude of glycemic excursion (r = 0.87) as EasyGV implements a fuzzy logic approach to assessment of variability. Bland-Altman plots demonstrated validation of the new software. Conclusions: The new freely available EasyGV software v10 (www.phc.ox.ac.uk/research/technology-outputs/easygv) is a validated robust tool for analyzing different glycemic variabilities and control metrics.
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Affiliation(s)
- Vanessa Moscardó
- Instituto Universitario de Automática e Informática Industrial, Universitat Politècnica de València, València, Spain
| | - Marga Giménez
- Diabetes Unit, Endocrinology and Nutrition Department, Hospital Clínic Universitari, IDIBAPS, Barcelona, Spain
| | - Nick Oliver
- Department of Metabolism, Digestion and Reproduction, Faculty of Medicine, Imperial College London, United Kingdom
- Address correspondence to: Nick Oliver, FRCP, Department of Metabolism, Digestion and Reproduction, Faculty of Medicine, Imperial College London, St. Mary's Campus, Norfolk Place, W2 1PG London, United Kingdom
| | - Nathan R. Hill
- Harris Manchester College, Mansfield Road, University of Oxford, Oxford, United Kingdom
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36
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Viñals C, Conget I, Pané A, Boswell L, Perea V, Blanco AJ, Ruiz S, Giménez M, Vinagre I, Esmatjes E, Ortega E, Amor AJ. Steno type 1 risk engine and preclinical atherosclerosis in Mediterranean individuals with type 1 diabetes. Diabetes Metab Res Rev 2020; 36:e3320. [PMID: 32239693 DOI: 10.1002/dmrr.3320] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Revised: 01/31/2020] [Accepted: 03/18/2020] [Indexed: 01/11/2023]
Abstract
BACKGROUND AND AIMS Tools to detect type 1 diabetes (T1D) individuals at overt cardiovascular disease (CVD) risk are scarce. We aimed to assess the usefulness of the score 'Steno Type 1 Risk Engine' (Steno-Risk) to identify T1D patients with advanced carotid atherosclerosis. MATERIAL AND METHODS T1D patients without CVD with at least one of the following were included: ≥40 years, diabetic nephropathy, or diabetes duration ≥10 years with ≥1 CVD risk factor. Intima-media thickness (IMT) and plaque presence (IMT ≥1.5 mm) were assessed by standardized B-mode ultrasonography. Steno-Risk was used to estimate 10-year risk (<10% low; 10%-20% moderate; ≥20% high risk). Associations between Steno-Risk and preclinical atherosclerosis were assessed after adjusting for other CVD risk factors. RESULTS We evaluated 302 patients (55% men, age 47.8 ± 9.8 years, T1D duration 26.3 ± 9.3 years). The prevalence of carotid plaque and ≥2 plaques were 36.4% and 19.2%, respectively; without sex differences. Age (57.4 ± 7.4 vs 37.1 ± 6.2 years), T1D duration (31.3 ± 10.4 vs 21.5 ± 7.1 years), hypertension (52.3% vs 6.3%), nephropathy (25.6% vs 5.1%) and retinopathy (53.5% vs 32.9%) were higher in high-risk (n = 86) vs low-risk participants (n = 79; P < .001 for all). Preclinical atherosclerosis (IMT and plaque) increased in parallel with Steno-Risk (P < .001). In logistic regression analysis, both age ≥40 years and Steno-Risk ≥20% were associated with the presence of plaque (OR 4.22 [1.57-11.36] and 3.79 [1.61-6.80]; respectively), but only high Steno-Risk remained independently associated with ≥2 plaques (OR 3.31 [1.61-6.80]). CONCLUSION Steno-Risk is independently associated with preclinical atherosclerosis. Further studies are needed to ascertain its usefulness in this high-risk population.
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Affiliation(s)
- C Viñals
- Endocrinology and Nutrition Department, Hospital Clínic de Barcelona, Barcelona, Spain
| | - I Conget
- Endocrinology and Nutrition Department, Hospital Clínic de Barcelona, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Madrid, Spain
- Institut d'investigacions biomèdiques August Pi i Sunyer, Barcelona, Spain
| | - A Pané
- Endocrinology and Nutrition Department, Hospital Clínic de Barcelona, Barcelona, Spain
| | - L Boswell
- Endocrinology and Nutrition Department, Hospital Clínic de Barcelona, Barcelona, Spain
| | - V Perea
- Endocrinology and Nutrition Department, Hospital Universitari Mútua de Terrassa, Terrassa, Spain
| | - A J Blanco
- Endocrinology and Nutrition Department, Hospital Clínic de Barcelona, Barcelona, Spain
- Institut d'investigacions biomèdiques August Pi i Sunyer, Barcelona, Spain
| | - S Ruiz
- Endocrinology and Nutrition Department, Hospital Clínic de Barcelona, Barcelona, Spain
| | - M Giménez
- Endocrinology and Nutrition Department, Hospital Clínic de Barcelona, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Madrid, Spain
- Institut d'investigacions biomèdiques August Pi i Sunyer, Barcelona, Spain
| | - I Vinagre
- Endocrinology and Nutrition Department, Hospital Clínic de Barcelona, Barcelona, Spain
- Institut d'investigacions biomèdiques August Pi i Sunyer, Barcelona, Spain
| | - E Esmatjes
- Endocrinology and Nutrition Department, Hospital Clínic de Barcelona, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Madrid, Spain
- Institut d'investigacions biomèdiques August Pi i Sunyer, Barcelona, Spain
| | - E Ortega
- Endocrinology and Nutrition Department, Hospital Clínic de Barcelona, Barcelona, Spain
- Institut d'investigacions biomèdiques August Pi i Sunyer, Barcelona, Spain
- Centro de Investigación Biomédica en Red Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
| | - A J Amor
- Endocrinology and Nutrition Department, Hospital Clínic de Barcelona, Barcelona, Spain
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Mesa A, Viñals C, Pueyo I, Roca D, Vidal M, Giménez M, Conget I. The impact of strict COVID-19 lockdown in Spain on glycemic profiles in patients with type 1 Diabetes prone to hypoglycemia using standalone continuous glucose monitoring. Diabetes Res Clin Pract 2020; 167:108354. [PMID: 32739380 PMCID: PMC7392049 DOI: 10.1016/j.diabres.2020.108354] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Revised: 07/10/2020] [Accepted: 07/26/2020] [Indexed: 11/02/2022]
Abstract
AIMS Spain has been one of the worst affected countries by the COVID-19 pandemic. A very strict lockdown at home was imposed with a tough restriction of mobility. We aimed to evaluate the impact of this exceptional scenario on glucose profile of patients with T1D prone to hypoglycemia using standalone continuous glucose monitoring. METHODS Patients with T1D prone to hypoglycemia using multiple daily injections and either a Dexcom G5® or a Free Style Libre® CGM systems for at least 6 months under the funding of National Health Service were included in an observational, retrospective study. Data were collected in two periods: pre-lockdown (PL), February 23rd-March 7th and within lockdown (WL), April 1st-14th 2020. The primary outcome was the difference in the proportion of time in target glucose range of 70-180 mg/dL (TIR). Additional glucometric data were also analysed. RESULTS 92 patients were included: 40 women, age 42.8 ± 3.9 years, disease duration of 23.1 ± 12.6 years. Seventeen patients used Dexcom G5® and 75 Free Style Libre®. TIR 70-180 mg/dL (59.3 ± 16.2 vs 62.6 ± 15.2%), time > 180 (34.4 ± 18.0 vs 30.7 ± 16.9%), >250 (11.1 ± 10.6 vs 9.2 ± 9.7%) and Glucose Management Indicator (7.2 ± 0.8 vs 7.0 ± 0.8%) significantly improved (PL vs WL, respectively, p < 0.05). Time in hypoglycemia remained unchanged. CONCLUSIONS Lockdown conditions imposed by the COVID-19 pandemic may be managed successfully in terms of glycemic control by population with T1D prone to hypoglycemia using CGM. The strict daily routine at home could probably explain the improvement in the time in glycemic target without increasing the time in hypoglycemia.
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Affiliation(s)
- Alex Mesa
- Diabetes Unit, Endocrinology and Nutrition Department, Hospital Clínic i Universitari, Barcelona, Spain
| | - Clara Viñals
- Diabetes Unit, Endocrinology and Nutrition Department, Hospital Clínic i Universitari, Barcelona, Spain
| | - Irene Pueyo
- Diabetes Unit, Endocrinology and Nutrition Department, Hospital Clínic i Universitari, Barcelona, Spain
| | - Daria Roca
- Diabetes Unit, Endocrinology and Nutrition Department, Hospital Clínic i Universitari, Barcelona, Spain
| | - Mercè Vidal
- Diabetes Unit, Endocrinology and Nutrition Department, Hospital Clínic i Universitari, Barcelona, Spain
| | - Marga Giménez
- Diabetes Unit, Endocrinology and Nutrition Department, Hospital Clínic i Universitari, Barcelona, Spain; CIBERDEM, Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas, Madrid, Spain; IDIBAPS, Institut d'Investigacions Biomèdiques August Pi i Sunyer, Barcelona, Spain
| | - Ignacio Conget
- Diabetes Unit, Endocrinology and Nutrition Department, Hospital Clínic i Universitari, Barcelona, Spain; CIBERDEM, Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas, Madrid, Spain; IDIBAPS, Institut d'Investigacions Biomèdiques August Pi i Sunyer, Barcelona, Spain.
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38
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Bertachi A, Viñals C, Biagi L, Contreras I, Vehí J, Conget I, Giménez M. Prediction of Nocturnal Hypoglycemia in Adults with Type 1 Diabetes under Multiple Daily Injections Using Continuous Glucose Monitoring and Physical Activity Monitor. Sensors (Basel) 2020; 20:E1705. [PMID: 32204318 PMCID: PMC7147466 DOI: 10.3390/s20061705] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Revised: 03/10/2020] [Accepted: 03/17/2020] [Indexed: 12/16/2022]
Abstract
(1) Background: nocturnal hypoglycemia (NH) is one of the most challenging side effects of multiple doses of insulin (MDI) therapy in type 1 diabetes (T1D). This work aimed to investigate the feasibility of a machine-learning-based prediction model to anticipate NH in T1D patients on MDI. (2) Methods: ten T1D adults were studied during 12 weeks. Information regarding T1D management, continuous glucose monitoring (CGM), and from a physical activity tracker were obtained under free-living conditions at home. Supervised machine-learning algorithms were applied to the data, and prediction models were created to forecast the occurrence of NH. Individualized prediction models were generated using multilayer perceptron (MLP) and a support vector machine (SVM). (3) Results: population outcomes indicated that more than 70% of the NH may be avoided with the proposed methodology. The predictions performed by the SVM achieved the best population outcomes, with a sensitivity and specificity of 78.75% and 82.15%, respectively. (4) Conclusions: our study supports the feasibility of using ML techniques to address the prediction of nocturnal hypoglycemia in the daily life of patients with T1D on MDI, using CGM and a physical activity tracker.
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Affiliation(s)
- Arthur Bertachi
- Institute of Informatics and Applications, University of Girona, 17003 Girona, Spain; (A.B.); (L.B.); (I.C.)
- Federal University of Technology—Paraná (UTFPR), Guarapuava 85053-525, Brazil
| | - Clara Viñals
- Diabetes Unit, Endocrinology and Nutrition Dpt. Hospital Clínic de Barcelona, 08036 Barcelona, Spain; (C.V.); (I.C.); (M.G.)
| | - Lyvia Biagi
- Institute of Informatics and Applications, University of Girona, 17003 Girona, Spain; (A.B.); (L.B.); (I.C.)
- Federal University of Technology—Paraná (UTFPR), Guarapuava 85053-525, Brazil
| | - Ivan Contreras
- Institute of Informatics and Applications, University of Girona, 17003 Girona, Spain; (A.B.); (L.B.); (I.C.)
| | - Josep Vehí
- Institute of Informatics and Applications, University of Girona, 17003 Girona, Spain; (A.B.); (L.B.); (I.C.)
- Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), 08036 Barcelona, Spain
| | - Ignacio Conget
- Diabetes Unit, Endocrinology and Nutrition Dpt. Hospital Clínic de Barcelona, 08036 Barcelona, Spain; (C.V.); (I.C.); (M.G.)
- Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), 08036 Barcelona, Spain
| | - Marga Giménez
- Diabetes Unit, Endocrinology and Nutrition Dpt. Hospital Clínic de Barcelona, 08036 Barcelona, Spain; (C.V.); (I.C.); (M.G.)
- Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), 08036 Barcelona, Spain
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Amor AJ, Vinagre I, Valverde M, Pané A, Urquizu X, Meler E, López E, Quirós C, Giménez M, Codina L, Conget I, Barahona MJ, Perea V. Preeclampsia Is Associated With Increased Preclinical Carotid Atherosclerosis in Women With Type 1 Diabetes. J Clin Endocrinol Metab 2020; 105:5570566. [PMID: 31529047 DOI: 10.1210/clinem/dgz031] [Citation(s) in RCA: 11] [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: 05/04/2019] [Revised: 07/30/2019] [Accepted: 09/09/2019] [Indexed: 12/26/2022]
Abstract
PURPOSE Although preeclampsia (PE) is a well-established cardiovascular risk factor (CVRF) in the general population, its role in type 1 diabetes (T1D) has been scarcely studied. We assessed the association between PE and preclinical atherosclerosis in T1D. METHODS We recruited 112 women without cardiovascular disease and last pregnancy ≥5 years before: (1) T1D and previous PE (T1D+/PE+; n = 28); (2) T1D without preeclampsia (T1D+/PE-; n = 28); (3) previous PE without T1D (T1D-/PE+; n = 28); and (4) controls (without T1D or PE; T1D-/PE-; n = 28). Groups were matched by age, several CVRFs, and diabetes duration and retinopathy (in T1D participants). Carotid intima-media thickness (IMT) and the presence of plaque (IMT ≥ 1.5 mm) were assessed by standardized ultrasonography protocol. RESULTS Mean age of the participants was 44.9 ± 7.8 years (14.3% hypertension and 21.4% active smokers). Groups including T1D (T1D+/PE+ and T1D+/PE-) more frequently presented hypertension and statin treatment (23.2% vs 5.4% and 37.5% vs 8.9%; respectively; P < 0.01), without differences in other CVRFs. Carotid plaques were observed in 20.5%. In multivariate models adjusted for age, CVRF, and statins, both T1D and PE showed a similar impact on the presence of plaque, with odds ratios (95% confidence interval), 5.45 (1.36-21.9) and 4.24 (1.04-17.3), respectively. Both entities showed an additive effect when combined, both in common carotid-IMT (T1D+/PE- or T1D-/PE+, β = 0.198; T1D+/PE+, β = 0.297) and in the presence of plaque (8.53 [1.07-68.2] and 28.1 [2.67-296.4], respectively). CONCLUSIONS Previous PE was independently associated with preclinical atherosclerosis in T1D. Further studies are needed to ascertain its usefulness for stratifying risk in T1D women.
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Affiliation(s)
- Antonio J Amor
- Endocrinology an d Nutrition Department, Hospital Clínic de Barcelona, Barcelona 08036, Spain
- CIBER de Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III (ISCIII), Madrid 28029, Spain
| | - Irene Vinagre
- Endocrinology an d Nutrition Department, Hospital Clínic de Barcelona, Barcelona 08036, Spain
| | - Maite Valverde
- Endocrinology and Nutrition Department, Hospital Universitari Mútua de Terrassa, Terrassa 08221, Spain
| | - Adriana Pané
- Endocrinology an d Nutrition Department, Hospital Clínic de Barcelona, Barcelona 08036, Spain
| | - Xavier Urquizu
- Obstetrics and Gynecology Department, Hospital Universitari Mútua de Terrassa, Terrassa 08221, Spain
| | - Eva Meler
- Fetal i+D Fetal Medicine Research Center, BCNatal-Barcelona Center for Maternal-Fetal and Neonatal Medicine (Hospital Clínic and Hospital Sant Joan de Déu), IDIBAPS, University of Barcelona, Barcelona 08036, Spain
| | - Eva López
- Obstetrics and Gynecology Department, Hospital Universitari Mútua de Terrassa, Terrassa 08221, Spain
| | - Carmen Quirós
- Endocrinology and Nutrition Department, Hospital Universitari Mútua de Terrassa, Terrassa 08221, Spain
| | - Marga Giménez
- Endocrinology an d Nutrition Department, Hospital Clínic de Barcelona, Barcelona 08036, Spain
- CIBER de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Instituto de Salud Carlos III (ISCIII), Madrid 28029, Spain
| | - Laura Codina
- Obstetrics and Gynecology Department, Hospital Universitari Mútua de Terrassa, Terrassa 08221, Spain
| | - Ignacio Conget
- Endocrinology an d Nutrition Department, Hospital Clínic de Barcelona, Barcelona 08036, Spain
- CIBER de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Instituto de Salud Carlos III (ISCIII), Madrid 28029, Spain
| | - Maria J Barahona
- Endocrinology and Nutrition Department, Hospital Universitari Mútua de Terrassa, Terrassa 08221, Spain
| | - Verónica Perea
- Endocrinology and Nutrition Department, Hospital Universitari Mútua de Terrassa, Terrassa 08221, Spain
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Vidal M, Jansà M, Roca D, Yoldi C, Cardona-Hernández R, Giménez M, Conget I. Hypoglycaemia unawareness in young people with type 1 diabetes transferred to an adult center. Endocrinol Diabetes Nutr (Engl Ed) 2019; 67:394-400. [PMID: 31668682 DOI: 10.1016/j.endinu.2019.07.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/12/2019] [Revised: 07/11/2019] [Accepted: 07/25/2019] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To evaluate frequency of hypoglycaemia unawareness (HU) in patients with type 1 diabetes (T1D) transferred from Paediatrics following a specific therapeutic education programme (TEP) in an adult hospital. PATIENTS AND METHODS Young patients transferred from 2009-2011 were evaluated. The TEP included a coordinated transfer process, individual appointments and a group course. At baseline and at 12 months we evaluated glycated haemoglobin (HbA1c) frequency of severe (SH) hypoglycaemia/patient/year and non severe hypoglycaemia (NSH). The patients were classified into two groups and compared: hypoglycaemia awareness (HA) and HU according to the Clarke Test <3R or>3R respectively. RESULTS Fifty-six patients (age 18.1±0.3 years, 46% females, HbA1c 8.0±1.2%) underwent the TEP. In the baseline evaluation 16% presented HU. The number of SH was higher in the HU Group (0.33±0.50 vs. 0.09±0.28 P<.05). The percentage of patients with>2 NSH/week was higher, albeit not significantly, in the HU group (66% vs. 34%, p=0.06). At 12 months 11% of the patients continued to present HU. The number of SH remained higher in the HU group (0.38±1.06 vs. 0.02±0.15 P=.04). CONCLUSIONS The percentage of young people with T1D with HU is quite high at transfer. Although the TEP improves hypoglycaemia awareness it does not solve this important problem. Patients with HU more frequently present SH. It is necessary to identify HU in order to reduce SH which continues to be a problem in people with T1D.
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Affiliation(s)
- Mercé Vidal
- Unidad de Diabetes, Endocrinología y Nutrición, Hospital Clínic i Universitari, Barcelona, España.
| | - Margarida Jansà
- Unidad de Diabetes, Endocrinología y Nutrición, Hospital Clínic i Universitari, Barcelona, España
| | - Daria Roca
- Unidad de Diabetes, Endocrinología y Nutrición, Hospital Clínic i Universitari, Barcelona, España
| | - Carmen Yoldi
- Unidad de Endocrinología Pediátrica, Hospital de Sant Joan de Déu, Esplugues de Llobregat, Barcelona, España
| | - Roque Cardona-Hernández
- Unidad de Endocrinología Pediátrica, Hospital de Sant Joan de Déu, Esplugues de Llobregat, Barcelona, España
| | - Marga Giménez
- Unidad de Diabetes, Endocrinología y Nutrición, Hospital Clínic i Universitari, Barcelona, España; IDIBAPS, Institut d'investigacions biomèdiques August Pi i Sunyer, Barcelona, España; CIBERDEM. Centro de Investigación Biomédica en Red de Diabetes y Enfermedades metabólicas, Madrid, España
| | - Ignacio Conget
- Unidad de Diabetes, Endocrinología y Nutrición, Hospital Clínic i Universitari, Barcelona, España; IDIBAPS, Institut d'investigacions biomèdiques August Pi i Sunyer, Barcelona, España; CIBERDEM. Centro de Investigación Biomédica en Red de Diabetes y Enfermedades metabólicas, Madrid, España
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Perea V, Bertran B, Bellart J, Orois A, Giménez M, Conget I, Vinagre I. Impaired awareness of hypoglycaemia: A new risk factor for adverse pregnancy outcomes in type 1 diabetes. Diabetes Metab Res Rev 2019; 35:e3176. [PMID: 31066196 DOI: 10.1002/dmrr.3176] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [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: 12/21/2018] [Revised: 03/30/2019] [Accepted: 04/30/2019] [Indexed: 02/02/2023]
Abstract
AIM The aim of this study is to evaluate the impact of impaired awareness of hypoglycaemia (IAH) on metabolic control and pregnancy outcomes in women with type 1 diabetes. MATERIAL AND METHODS This was a single-centre prospective cohort study of singleton pregnant women with type 1 diabetes. IAH was assessed at the first antenatal visit using Clarke's test (score ≥ 3). Data on metabolic control, hypoglycaemic events, and the lipid profile were collected from prior to pregnancy and in each trimester of gestation. Pregnancy outcomes were also recorded. RESULTS A total of 77 patients with type 1 diabetes were included; 24 (31.2%) were classified as having IAH. Compared with the normal awareness of hypoglycaemia (NAH) group, the IAH group did not show differences in HbA1c , weight gain, insulin doses, or severe and nonsevere hypoglycaemia events throughout pregnancy. IAH was associated with higher triglyceride concentrations in the second trimester (IAH: 154.8 ± 61.1 mg/dL, NAH: 128.6 ± 31.2 mg/dL, P = .034) and an increased risk of neonatal respiratory distress (odds ratio [OR] 11.24; 95% CI, 1.01-124.9, P = .041) in adjusted models. Increased risk of pre-eclampsia was related to higher second trimester triglyceride concentrations (OR 1.028; 95% CI, 1.004-1.053, P = .023) adjusted for confounders. CONCLUSIONS The IAH was associated with increased risk of neonatal respiratory distress and pre-eclampsia, despite showing no differences in metabolic control. Hypoglycaemia awareness in the first antenatal visit should be assessed to identify the subgroup of pregnant women with increased risk of complications.
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Affiliation(s)
- Verónica Perea
- Endocrinology Department, Hospital Universitari Mútua de Terrassa, Barcelona, Spain
| | - Berta Bertran
- University School of Nursing, Universitat de Barcelona, Barcelona, Spain
| | - Jordi Bellart
- Obstetrics and Gynecology Department, Hospital Clínic de Barcelona, Barcelona, Spain
| | - Aida Orois
- Endocrinology Department, Hospital Universitari Mútua de Terrassa, Barcelona, Spain
- Diabetes Unit, Endocrinology Department, Hospital Clínic de Barcelona, Barcelona, Spain
| | - Marga Giménez
- Diabetes Unit, Endocrinology Department, Hospital Clínic de Barcelona, Barcelona, Spain
| | - Ignacio Conget
- Diabetes Unit, Endocrinology Department, Hospital Clínic de Barcelona, Barcelona, Spain
| | - Irene Vinagre
- Diabetes Unit, Endocrinology Department, Hospital Clínic de Barcelona, Barcelona, Spain
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Moscardó V, Herrero P, Díez JL, Giménez M, Rossetti P, Georgiou P, Bondia J. Coordinated dual-hormone artificial pancreas with parallel control structure. Comput Chem Eng 2019. [DOI: 10.1016/j.compchemeng.2019.06.012] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Oviedo S, Contreras I, Bertachi A, Quirós C, Giménez M, Conget I, Vehi J. Minimizing postprandial hypoglycemia in Type 1 diabetes patients using multiple insulin injections and capillary blood glucose self-monitoring with machine learning techniques. Comput Methods Programs Biomed 2019; 178:175-180. [PMID: 31416546 DOI: 10.1016/j.cmpb.2019.06.025] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/07/2019] [Revised: 06/11/2019] [Accepted: 06/26/2019] [Indexed: 06/10/2023]
Abstract
BACKGROUND Diabetic patients treated with intensive insulin therapies require a tight glycemic control and may benefit from advanced tools to predict blood glucose (BG) concentration levels and hypo/hyperglycemia events. Prediction systems using machine learning techniques have mainly focused on applications for sensor augmented pump (SAP) therapy. In contrast, insulin bolus calculators that rely on BG prediction for multiple daily insulin (MDI) injections for patients under self-monitoring blood glucose (SMBG) are scarce because of insufficient data sources and limited prediction capability of forecasting models. METHODS We trained individualized models that can predict postprandial hypoglycemia via different machine learning algorithms using retrospective data from 10 real patients. In addition, we designed and tested a hypoglycemia reduction strategy for a similar in silico population. The system generates a bolus reduction suggestion as the scaled weighted sum of the predictions. We evaluated the general and postprandial glycemic outcomes of the in silico population to assess the systems capability of avoiding hypoglycemias. RESULTS The median [IQR] sensitivity and specificity for hypoglycemia cases where the BG level was below 70 mg/dL were 0.49 [0.2-0.5] and 0.74 [0.7-0.9], respectively. For hypoglycemia cases where the BG level was below 54 mg/dL, the median [IQR] sensitivity and specificity were 0.51 [0.4-0.6] and 0.74 [0.7-0.8], respectively. CONCLUSIONS The results indicated a decrease of 37% in the median number of postprandial hypoglycemias median decrease of 44% for hypoglycemias of 70 mg/dL and 54 mg/dL, respectively. This dramatic reduction makes this method a good candidate to be integrated into any Decision Support System for diabetes management.
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Affiliation(s)
- Silvia Oviedo
- Institut d'Informatica i Aplicacions. Universitat de Girona, Spain.
| | - Ivan Contreras
- Institut d'Informatica i Aplicacions. Universitat de Girona, Spain.
| | - Arthur Bertachi
- Institut d'Informatica i Aplicacions. Universitat de Girona, Spain; Federal University of Technology Paraná (UTFPR), Guarapuava 85053-525, Brazil.
| | - Carmen Quirós
- Servicio de Endocrinología y Nutrición. Hospital Universitari Mutua de Terrassa, Terrassa, Spain.
| | - Marga Giménez
- Diabetes Unit. Endocrinology and Nutrition Dpt. IDIBAPS (Institut d'investigacions biomédiques August Pi I Sunyer), Barcelona, Spain; Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Spain.
| | - Ignacio Conget
- Diabetes Unit. Endocrinology and Nutrition Dpt. IDIBAPS (Institut d'investigacions biomédiques August Pi I Sunyer), Barcelona, Spain; Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Spain.
| | - Josep Vehi
- Institut d'Informatica i Aplicacions. Universitat de Girona, Spain; Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Spain.
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Ciruela P, Broner S, Izquierdo C, Pallarés R, Muñoz-Almagro C, Hernández S, Grau I, Domínguez A, Jané M, Ciruela P, Izquierdo C, Broner S, Hernández S, Jané M, Muñoz-Almagro C, Esteva C, de Sevilla M, Henares D, Pallarés R, Ardanuy C, Grau I, Marco F, Margall N, González-Cuevas A, Díaz A, Martin M, Llaberia J, Curriu M, Gallés C, Capdevila E, Gassiot P, Martínez-Zurita M, Martí C, Morta M, Sauca G, Gassós A, Sanfeliu E, Ballester F, Pujol I, Olsina M, Raga X, Gómez-Bertomeu F, Pérez-Moreno M, Vilamala A, Navarro M, Ribelles M, Garcia M, Padilla E, Prim N, Fontanals D, Sanfeliu I, Benitez M, Jou E, Sanjosé C, Giménez M, Quesada M, de la Fuente J, Calderon A, Ayala P, Vega L, Pérez-Jové J, Blanco A, Balado C, Valle I, Bastida M, Gonzalez-Moreno O, Ubanell A, Fenoll A, Yuste J. Indirect effects of paediatric conjugate vaccines on invasive pneumococcal disease in older adults. Int J Infect Dis 2019; 86:122-130. [DOI: 10.1016/j.ijid.2019.06.030] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2019] [Revised: 06/28/2019] [Accepted: 06/30/2019] [Indexed: 12/29/2022] Open
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Laguna Sanz AJ, Díez JL, Giménez M, Bondia J. Enhanced Accuracy of Continuous Glucose Monitoring during Exercise through Physical Activity Tracking Integration. Sensors (Basel) 2019; 19:s19173757. [PMID: 31480343 PMCID: PMC6749476 DOI: 10.3390/s19173757] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Revised: 08/21/2019] [Accepted: 08/27/2019] [Indexed: 12/11/2022]
Abstract
Current Continuous Glucose Monitors (CGM) exhibit increased estimation error during periods of aerobic physical activity. The use of readily-available exercise monitoring devices opens new possibilities for accuracy enhancement during these periods. The viability of an array of physical activity signals provided by three different wearable devices was considered. Linear regression models were used in this work to evaluate the correction capabilities of each of the wearable signals and propose a model for CGM correction during exercise. A simple two-input model can reduce CGM error during physical activity (17.46% vs. 13.8%, p < 0.005) to the magnitude of the baseline error level (13.61%). The CGM error is not worsened in periods without physical activity. The signals identified as optimal inputs for the model are "Mets" (Metabolic Equivalent of Tasks) from the Fitbit Charge HR device, which is a normalized measurement of energy expenditure, and the skin temperature reading provided by the Microsoft Band 2 device. A simpler one-input model using only "Mets" is also viable for a more immediate implementation of this correction into market devices.
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Affiliation(s)
- Alejandro José Laguna Sanz
- Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Instituto de Salud Carlos III, 28029 Madrid, Spain
| | - José Luis Díez
- Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Instituto de Salud Carlos III, 28029 Madrid, Spain
- Institut Universitari d'Automàtica i Informàtica Industrial, Universitat Politècnica de València, Camino de Vera, s/n, 46022 València, Spain
| | - Marga Giménez
- Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Instituto de Salud Carlos III, 28029 Madrid, Spain
- Diabetes Unit, Endocrinology and Nutrition Department, Hospital Clínic Universitari, IDIBAPS (Institut d'investigacions Biomèdiques August Pi i Sunyer), 08036 Barcelona, Spain
| | - Jorge Bondia
- Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Instituto de Salud Carlos III, 28029 Madrid, Spain.
- Institut Universitari d'Automàtica i Informàtica Industrial, Universitat Politècnica de València, Camino de Vera, s/n, 46022 València, Spain.
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Perea V, Giménez M, Amor AJ, Bellart J, Conget I, Vinagre I. Prepregnancy care in women with type 1 diabetes improves HbA 1c and glucose variability without worsening hypoglycaemia time and awareness: Glycaemic variability during prepregnancy care. Diabetes Res Clin Pract 2019; 154:75-81. [PMID: 31271810 DOI: 10.1016/j.diabres.2019.06.015] [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: 04/21/2019] [Revised: 06/13/2019] [Accepted: 06/25/2019] [Indexed: 10/26/2022]
Abstract
AIMS To evaluate the impact of a prepregnancy care (PPC) programme, beyond HbA1c, on hypoglycaemia awareness and glycaemic variability (GV). METHODS Prospective pilot study. We selected women with Type 1 diabetes who initiated a PPC programme with normal hypoglycaemia awareness (n = 24). Hypoglycaemia awareness, hypoglycaemic events and GV derived from masked-continuous glucose monitoring were evaluated in the first visit and within 2 weeks after pregnancy confirmation. RESULTS The duration was 16.5 ± 13.0 months. HbA1c significantly decreased (-0.8 ± 0.7; p < 0.001). The Clarke score increased (0[0-1] vs. 1[0-2] points, p = 0.164), 2 out of 24 were reclassified as having impaired awareness of hypoglycaemia and 2 presented severe hypoglycaemia. GV decreased: standard deviation (p = 0.008), coefficient of variation (p = 0.021), mean amplitude of glycaemic excursions (p = 0.007), average daily risk range (p < 0.001), J-index (p = 0.010), high blood glucose index (HBGI) (p = 0.004), continuous overall net glycaemic action (CONGA) (p = 0.018), mean of daily differences (p = 0.045) and glycaemic risk assessment diabetes equation (p = 0.012). Final HbA1c was associated with baseline J-index, CONGA and HBGI (β = 0.535, β = 0.466, β = 0.534, respectively; p < 0.05). CONCLUSIONS A PPC programme improved HbA1c as well as GV with no significant impact on hypoglycaemia awareness. Moreover, GV could help to identify women less likely to achieve glycaemic targets. Larger studies are needed to confirm these results.
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Affiliation(s)
- Verónica Perea
- Endocrinology and Nutrition Department, Hospital Universitari Mútua de Terrassa, Barcelona, Spain.
| | - Marga Giménez
- Diabetes Unit, Endocrinology and Nutrition Department, Hospital Clínic de Barcelona, Spain
| | - Antonio J Amor
- Diabetes Unit, Endocrinology and Nutrition Department, Hospital Clínic de Barcelona, Spain
| | - Jordi Bellart
- Gynecology and Obstetrics Department, Hospital Clínic de Barcelona, Spain
| | - Ignacio Conget
- Diabetes Unit, Endocrinology and Nutrition Department, Hospital Clínic de Barcelona, Spain
| | - Irene Vinagre
- Diabetes Unit, Endocrinology and Nutrition Department, Hospital Clínic de Barcelona, Spain.
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Amor A, Vinagre I, Valverde M, Pané A, Urquizu X, Meler E, López E, Quirós C, Giménez M, Codina L, Alonso N, Conget I, Barahona M, Perea V. Preeclampsia: A Risk Factor On Preclinical Carotid Atherosclerosis With Similar Impact To Type 1 Diabetes. Atherosclerosis 2019. [DOI: 10.1016/j.atherosclerosis.2019.06.255] [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: 11/16/2022]
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Viñals C, Quirós C, Giménez M, Conget I. Real-Life Management and Effectiveness of Insulin Pump with or Without Continuous Glucose Monitoring in Adults with Type 1 Diabetes. Diabetes Ther 2019; 10:929-936. [PMID: 30900146 PMCID: PMC6531534 DOI: 10.1007/s13300-019-0599-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2018] [Indexed: 11/03/2022] Open
Abstract
INTRODUCTION To describe and compare the routine use of continuous subcutaneous insulin infusion (CSII) in type 1 diabetes (T1D) patients with and without continuous glucose monitoring (CGM) in routine clinical practice and its relationship with glycemic outcomes. METHODS Retrospective observational case-control study collecting routine use of CSII and CGM in T1D patients between January 2016 and December 2016. Patients with T1D using sensor augmented pump (SAP) were matched by sex and disease duration in a 1:3 ratio with those treated only with CSII. Patients used a Paradigm Veo or 640G Medtronic-Minimed® insulin pump with or without a glucose sensor (Enlite, Medtronic-Minimed®) for at least 12 months. RESULTS A total of 160 subjects with T1D were included, 40 using SAP and 120 on CSII (age 47 ± 12 years, 88 women, diabetes duration 29 ± 9.0 years, 10 ± 4.7 years on CSII, HbA1C 7.6 ± 0.8%). Those in SAP therapy used the sensor 63% of time, performed less self-monitored blood glucose (SMBG)/day (3.3 ± 1.9 vs. 4.5 ± 2.0; p < 0.01), more bolus/day (6.2 ± 3.6 vs. 4.8 ± 1.6; p < 0.05), more basal insulin segment/day (6.5 ± 2.1 vs. 5.9 ± 1.5; p < 0.05), and more suspension time of the pump (97 ± 93 vs. 9.6 ± 20 min/day; p < 0.0001). Regarding metabolic control, SAP therapy patients had lower HbA1c (7.4 ± 0.7 vs. 7.7 ± 0.9%; p = 0.068), lower average SMBG value (151 ± 32 vs. 163 ± 30 mg/dL; p < 0.05), a lower percentage of SMBG values greater than 180 mg/dL (30 ± 19 vs. 37 ± 16%; p < 0.05) with no differences in SMBG values less than 70 mg/dL (12 ± 8.0 vs. 9.8 ± 9.8%; p = 0.33) compared with patients on CSII. There were no differences in bolus wizard targets or in insulin/carbohydrate ratios per day. CONCLUSION In a real-world setting, SAP therapy is associated with more self-adjustments of insulin therapy when compared to CSII alone. This could result in an improvement in glucose control.
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Affiliation(s)
- Clara Viñals
- Diabetes Unit, Endocrinology and Nutrition Department, Hospital Clínic, Barcelona, Spain
| | - Carmen Quirós
- Diabetes Unit, Endocrinology and Nutrition Department, Hospital Clínic, Barcelona, Spain
- Endocrinology and Nutrition Department, Hospital Universitari Mútua de Tarrasa, Tarrasa, Spain
| | - Marga Giménez
- Diabetes Unit, Endocrinology and Nutrition Department, Hospital Clínic, Barcelona, Spain
- IDIBAPS (Institut d'Investigacions Biomèdiques August Pi i Sunyer), Barcelona, Spain
- CIBERDEM (CIBER in Diabetes and Associated Metabolic Disorders), Barcelona, Spain
| | - Ignacio Conget
- Diabetes Unit, Endocrinology and Nutrition Department, Hospital Clínic, Barcelona, Spain.
- IDIBAPS (Institut d'Investigacions Biomèdiques August Pi i Sunyer), Barcelona, Spain.
- CIBERDEM (CIBER in Diabetes and Associated Metabolic Disorders), Barcelona, Spain.
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Quirós C, Viñals C, Giménez M, Roca D, Conget I. Assessment of the effectiveness of long-term insulin pump therapy using a combined goal of HbA 1c decrease and absence of severe hypoglycemia. ACTA ACUST UNITED AC 2019; 66:534-539. [PMID: 31133475 DOI: 10.1016/j.endinu.2019.03.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [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: 09/22/2018] [Revised: 03/14/2019] [Accepted: 03/20/2019] [Indexed: 10/26/2022]
Abstract
OBJECTIVE Less than one third of patients with type 1 diabetes mellitus (T1DM) achieve the cut-off value proposed as good metabolic control by most guidelines, HbA1c<7%. However, HbA1c reductions and prevention of severe hypoglycemia (SH) have shown clinically relevant benefits. The study objective therefore was to assess the effectiveness of continuous subcutaneous insulin infusion (CSII) therapy at 5 years of follow-up in a cohort of patients attending a specialized unit using HbA1c reduction and abscence of SH as combined goals. METHODS A retrospective, observational study on 178 patients with T1DM who started CSII treatment at Hospital Clinic of Barcelona between 2003 and 2008. HbA1c levels at baseline and after 5 years of treatment with CSII and presence or absence of SH were recorded. The combined variables calculated included: a) HbA1c reduction by≥0.5 points and absence of SH in the last 2 years; b) HbA1c at 5 years<7.5% and no SH in the last 2 years; c) HbA1c<8.5% and no HG in the last 2 years, and d) HbA1c reduction by≥0.5 points and/or HbA1c<7.5% at 5 years with no SH in the last 2 years of follow-up. RESULTS Twenty-seven of the 178 patients were excluded due to loss to follow-up or CSII discontinuation. A total of 151 patients (aged 37.4±10.5 years, 64% women, diabetes duration of 19.2±10.7 years) were therefore analyzed. The 2 main reasons for starting CSII were suboptimal metabolic control (60.9%) and severe hypoglycemia/hypoglycemia unawareness (28.5%). HbA1c levels in the total cohort and in patients with suboptimal metabolic control were 8.0±1.2 and 8.4±1.1% at CSII start and 7.8±1.2 and 8.0±1.3% at 5 years of treatment (P=.104 and P=.016) respectively. In the overall cohort, 55.5% of patients achieved at 5 years the combined goal of HbA1c<7.5% and/or HbA1c reductions≥0.5% without SH. CONCLUSIONS After 5 years of CSII therapy, more than half of the patients achieved the combined goal of significant HbA1c reduction and absence of SH. The use of combined goals offers the opportunity to assess the effectiveness of T1DM treatment from a clinically more meaningful point of view.
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Affiliation(s)
- Carmen Quirós
- Servicio de Endocrinología y Nutrición, Hospital Universitari Mútua de Terrassa, Terrassa, Barcelona, España.
| | - Clara Viñals
- Unidad de Diabetes, Servicio de Endocrinología y Nutrición, Hospital Clínic de Barcelona, Barcelona, España
| | - Marga Giménez
- Unidad de Diabetes, Servicio de Endocrinología y Nutrición, Hospital Clínic de Barcelona, Barcelona, España; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, España; Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Barcelona, España
| | - Daria Roca
- Unidad de Diabetes, Servicio de Endocrinología y Nutrición, Hospital Clínic de Barcelona, Barcelona, España
| | - Ignacio Conget
- Unidad de Diabetes, Servicio de Endocrinología y Nutrición, Hospital Clínic de Barcelona, Barcelona, España; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, España; Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Barcelona, España
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Quirós C, Jansà M, Viñals C, Giménez M, Roca D, Escarrabill J, Garcia F, Pérez S, Conget I. Experiences and real life management of insulin pump therapy in adults with type 1 diabetes. ENDOCRINOL DIAB NUTR 2019; 66:117-123. [PMID: 30076125 DOI: 10.1016/j.endinu.2018.05.017] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [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: 03/28/2018] [Revised: 05/14/2018] [Accepted: 05/30/2018] [Indexed: 12/31/2022]
Abstract
OBJECTIVE There is scarce information regarding the performance of a specific, structured education program addressed to patients with type 1 diabetes (T1D) using continuous subcutaneous insulin infusion (CSII) including both routine use of the therapy and patient experience evaluation. We aimed to assess the routine use of CSII and patient's experience and satisfaction regarding a specific structured patient self-management education and care program. METHODS A retrospective, observational, cross-sectional study collecting CSII routine use downloaded data. Patient experience and satisfaction were evaluated using an anonymous online survey covering different aspects of CSII self-management education and care program. RESULTS 380 T1D subjects were included (aged 45.3±12.17 years, 62.1% women, diabetes duration 27.8±10.3 years, 9.7±4.7 years on CSII, HbA1c 7.7+1.0%; 61.0±7.9mmol/mol). Participants with HbA1c≤7.5% (58mmol/mol, n=178) did more SMBGs per day (4.4±2.1 vs. 3.9±1.9); used more boluses (5.0±1.8 vs. 4.5±2.0); the percentage of insulin given as bolus was higher (50.1±12.8 vs. 44.9±13.2%); the night bolus wizard (BW) high glucose target was lower (125.9±4.4 vs. 130.5±12.8mg/dl) and time on CSII therapy was shorter (8.9±4.6 vs. 10.3±4.6 years. p<0.05 all comparisons). More SMBG/day, shorter duration of CSII treatment, a lower BW low glucose target at night, a lower BW high glucose target at night, total insulin dose per day and total number of carbohydrates per day were related with better HbA1c levels. 60% of 373 patients answered the questionnaire. The response to the different aspects of the educational program was homogeneously highly satisfactory. Seventy-seven percent of patients scored the program as very useful. Ninety-three percent of CSII users would not return to their previous insulin treatment. CONCLUSIONS The analysis of routine clinical use of CSII by T1D patients demonstrates that glucose control may be associated with some pump usage and adherence parameters. The overall user experience and satisfaction with our CSII self-management education and care program was remarkably favorable.
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Affiliation(s)
- Carmen Quirós
- Diabetes Unit, Endocrinology and Nutrition Dpt, IMDM, Hospital Clínic i Universitari de Barcelona, Spain
| | - Marga Jansà
- Diabetes Unit, Endocrinology and Nutrition Dpt, IMDM, Hospital Clínic i Universitari de Barcelona, Spain
| | - Clara Viñals
- Diabetes Unit, Endocrinology and Nutrition Dpt, IMDM, Hospital Clínic i Universitari de Barcelona, Spain
| | - Marga Giménez
- Diabetes Unit, Endocrinology and Nutrition Dpt, IMDM, Hospital Clínic i Universitari de Barcelona, Spain; IDIBAPS (Institut d'Investigacions Biomèdiques August Pi i Sunyer), Spain; CIBERDEM (CIBER in Diabetes and Associated Metabolic Disorders), Spain
| | - Daria Roca
- Diabetes Unit, Endocrinology and Nutrition Dpt, IMDM, Hospital Clínic i Universitari de Barcelona, Spain
| | - Joan Escarrabill
- Chronicity Program, Hospital Clínic i Universitari de Barcelona, Spain
| | - Ferran Garcia
- Project Management and Web Domains, Hospital Clínic i Universitari de Barcelona, Spain
| | - Sofía Pérez
- Digestive and Metabolic Diseases Institute (IMDM), Hospital Clínic i Universitari de Barcelona, Spain
| | - Ignacio Conget
- Diabetes Unit, Endocrinology and Nutrition Dpt, IMDM, Hospital Clínic i Universitari de Barcelona, Spain; IDIBAPS (Institut d'Investigacions Biomèdiques August Pi i Sunyer), Spain; CIBERDEM (CIBER in Diabetes and Associated Metabolic Disorders), Spain.
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