Avances en Diabetología最新文献

Objective

The aim of this study was to evaluate the effectiveness of a joint intervention, with educational, self-evaluation and feedback components, in order to optimize diabetes control by measuring HbA1c in capillary blood.

Material and methods

A prospective, pilot study, of one year duration was carried out in the Primary Care Health Centre «El Carmen» (VII Area Murcia East). A total of 266 patients over 16 years old were included in the study. Instant capillary HbA1c (DCA VANTAGE de SIEMENS) was measured on patients who attended the clinics. The patients were divided into 4 different groups, depending on HbA1c values and the requirement of intensifying treatment (Group A: patients with good control of their diabetes (HbA1c < 7%, or 8% in patients over 70 years old) and no changes in the treatment; B: patients with good control of their diabetes and required changes in the treatment; C: patients with poor control and no changes in treatment (non-optimization criteria); and D: patients with poor control and treatment intensification).

Results

The mean age was 66.36 ± 12.56 years, and the body mass index (BMI) was 29.72 ± 4.92 kg/m². The initial HbA1c mean value was 7.79 ± 1.57%, which decreased to a final HbA1c mean value of 6.91 ± 1.07% (P < .001). A change in the therapeutic inertia was searched by the healthcare personnel, who found that the 74.81% of the diabetic patients reached the control objectives. BMI decreased by –0.34 ± 1.04 kg/m² (P < .001).

Conclusions

Instant capillary HbA1c is a simple, rapid and efficient method to improve diabetes control. It is necessary to sensitize the healthcare personnel in Primary Care to assume this kind of intervention, both educational and pharmacological, to improve values in type 2 diabetes patients.

A description is presented on the different areas of therapeutic intervention and the role of the dietitian in each of these. The increasing prevalence of obesity has led to a parallel increase in the number of patients seeking and receiving treatment, which represents a new and challenging opportunity for dietitians to develop innovative programs. Interpersonal skills of dietitians play an important role in the treatment outcomes, and deserve periodic review and training. A full understanding of the pathology and how this can affect people's lives, increase dietitian skills to empathize, and thereby, facilitate patient management in the short and long term to ensure a comprehensive multidisciplinary approach.

Management of brittle diabetes is undoubtedly a challenge for both patients and professionals. The unpredictable glycemic variations that characterize it, and also greatly hinder the patient's metabolic control, cause a significant deterioration in their quality of life and makes the therapeutic approach complex and often frustrating. However, we now have multiple tools in our hands that, in conjunction with the appropriate cooperation between doctors, nurses and patients themselves, will enable us to deal with this condition with high chances of success. This article reviews the general characteristics of brittle diabetes and the various treatment options available to manage it.

Introduction

Type 1 diabetes (T1DM) treatment involves lifestyle changes that can lead to classic eating disorders (ED) like anorexia or bulimia. However, there is a lack of evidence on the presence of ED and/or its relation with psychosocial characteristics of these subjects.

Objective

To estimate the number of subjects at risk of ED in a T1DM youth population sample using two different tools and to analyze its concordance, establishing the relations between anxiety, depression, quality of life and emotional-management, and the risk of developing ED.

Material and methods

The population studied consisted of 40 young subjects with T1DM and 40 control peers. To detect ED, EAT-26/ChEAT test for the general population and DEPS/R specific for T1DM was performed. Several characteristics such as depression, anxiety and peer-relationships were analyzed by self-administered validated tests.

Results

There is a great disparity in identifying ED in the T1DM patients on using the screening tool used. Thus, DEPS-R showed 40% more subjects at risk than the EAT-26 test. Obsessive behavior, social phobia, and peer-relationships and family-relationships were significantly associated with the risk of developing ED (P < .05 in all cases).

Conclusions

To properly identify ED in T1DM patients, it would be necessary to develop specific screening tools that take into account the lifestyle modifications undergone by these patients. In addition, to prevent the development of ED, these patients should be taught to efficiently manage social situations that could lead to anxiety and undesirable behaviors.

The ambulatory glucose profile is an instrument used to detect blood glucose patterns from patient results by recording blood glucose results or, more usually, by continuous glucose monitoring. This instrument analyzes the changes in glucose levels obtained over a number of days, and expresses the data, depending on the time of the day, using the median and the 10^th, 25^th, 75^th and 90^th percentiles. It is very useful for identifying glycemic patterns over the day, to quantify blood glucose variability, and to classify hypoglycemia risk according to time. This should be complemented with the analysis of individual blood glucose data, diet, and exercise, to detect potential causes of variability and correct them.

[email protected] study results are impressive, showing that diabetes affects 13.8% of the Spanish population. Not only the statistical facts are alarming, but the increasing incidence of this disease is a major problem, as pandemic proportions of type 2 diabetes are expected. Thus, the study of diabetes represents a challenge not only for health services, but also for the Ministries of Health and Finance. Technology has become an essential tool in the quality care of patients with diabetes, as it helps in the healthcare processes to obtain an optimum metabolic balance and prevent possible complications. Insulin pumps, continuous glucose monitoring and self-monitoring blood glucose have all proved their efficiency, and telemedicine it is making good progress. The indirect costs of diabetes in Spain are much higher than the direct ones, showing the importance of inverting the paradox. The optimization of resources depends not only on the ability of the physicians, but also the administration, to implant and sustain technological innovations in our system, and with that make it effective in terms of benefits. Cost-effectiveness and cost-utility analysis are needed to prioritize and allow health management services to make the correct choices for approaching this prevalent chronic disease.