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1. A novel kidney disease index reflecting both the albumin-to-creatinine ratio and estimated glomerular filtration rate, predicted cardiovascular and kidney outcomes in type 2 diabetes

Author

Hertzel C. Gerstein, Chinthanie Ramasundarahettige, Alvero Avezum, Jan Basile, Ignacio Conget, William C. Cushman, Gilles R. Dagenais, Edward Franek, Mark Lakshmanan, Fernando Lanas, Lawrence A. Leiter, Nana Pogosova, Jeffrey Probstfield, Peter J. Raubenheimer, Matthew Riddle, Jonathan Shaw, Wayne H.-H. Sheu, Theodora Temelkova-Kurktschiev, Ibrahim Turfanda, and Denis Xavier

Subjects
Risk Factor, Kidney, Albuminuria, Cardiovascular Outcomes, Kidney Outcomes, Diseases of the circulatory (Cardiovascular) system, RC666-701
Abstract

Abstract Background The estimated glomerular filtration rate (eGFR) and the albumin-to-creatinine ratio (ACR) are risk factors for diabetes-related outcomes. A composite that captures information from both may provide a simpler way of assessing risk. Methods 9115 of 9901 Researching Cardiovascular Events with a Weekly Incretin in Diabetes (REWIND) participants with both an ACR and eGFR at baseline were included in this post hoc epidemiologic analysis. The hazard of higher baseline levels of 1/eGFR and natural log transformed ACR (calculated as ln [ACR × 100] to eliminate negative values) and their interaction for incident major adverse cardiovascular events (MACE), kidney outcomes, and deaths was estimated. The hazard of the geometric mean of these two baseline measures (the kidney disease index or KDI) was also assessed. Results A non-linear relationship was observed between 1/eGFR and all three outcomes, and between ln [ACR × 100] and the kidney outcome. There was also a negative interaction between these two risk factors with respect to MACE and death. Conversely, a linear relationship was noted between the KDI and all three outcomes. People in the highest KDI fifth experienced the highest incidence of MACE, death, and the kidney outcome (4.43, 4.56, and 5.55/100 person-years respectively). C statistics for the KDI were similar to those for eGFR and albuminuria. Conclusions The KDI combines the baseline eGFR and ACR into a novel composite risk factor that has a simple linear relationship with incident serious outcomes in people with diabetes and additional CV risk factors. Trial Registration clinicaltrials.gov NCT01394952.

Published
2022
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2. Validation of a Probabilistic Prediction Model for Patients with Type 1 Diabetes Using Compositional Data Analysis

Author

Alvis Cabrera, Lyvia Biagi, Aleix Beneyto, Ernesto Estremera, Iván Contreras, Marga Giménez, Ignacio Conget, Jorge Bondia, Josep Antoni Martín-Fernández, and Josep Vehí

Subjects
compositional data, continuous glucose monitoring, prediction model, time in range, type 1 diabetes, Mathematics, QA1-939
Abstract

Glycemia assessment in people with type 1 diabetes (T1D) has focused on the time spent in different glucose ranges. As this time reflects the relative contributions to the finite duration of a day, it should be treated as compositional data (CoDa) that can be applied to T1D data. Previous works presented a tool for the individual categorization of days and proposed a probabilistic transition model between categories, although validation has hitherto not been presented. In this study, we consider data from eight real adult patients with T1D obtained from continuous glucose monitoring (CGM) sensors and introduce a methodology based on compositional methods to validate the previously presented probability transition model. We conducted 5-fold cross-validation, with both the training and validation data being CoDa vectors, which requires developing new performance metrics. We design new accuracy and precision measures based on statistical error calculations. The results show that the precision for the entire model is higher than 95% in all patients. The use of a probabilistic transition model can help doctors and patients in diabetes treatment management and decision-making. Although the proposed method was tested with CoDa applied to T1D data obtained from CGM, the newly developed accuracy and precision measures apply to any other data or validation based on CoDa.

Published
2023
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3. Blood Hemoglobin Substantially Modulates the Impact of Gender, Morbid Obesity, and Hyperglycemia on COVID-19 Death Risk: A Multicenter Study in Italy and Spain

Author

Jordi Mayneris-Perxachs, Maria Francesca Russo, Rafel Ramos, Ana de Hollanda, Arola Armengou Arxé, Matteo Rottoli, María Arnoriaga-Rodríguez, Marc Comas-Cufí, Michele Bartoletti, Ornella Verrastro, Carlota Gudiol, Ester Fages, Marga Giménez, Ariadna de Genover Gil, Paolo Bernante, Francisco Tinahones, Jordi Carratalà, Uberto Pagotto, Ildefonso Hernández-Aguado, Fernando Fernández-Aranda, Fernanda Meira, Antoni Castro Guardiola, Geltrude Mingrone, José Manuel Fernández-Real, Obesity-T2DM Covid19 Study Group, Mariona Reixach Fumaña, Susana Jimenez-Murcia, Mikel Eatxandi, Alexander Rombauts, Gabriela Abelenda-Alonso, Caterina Guidone, Danila Anello, Giulia Giannetti, Emilio Ortega, Ignacio Conget, Clara Viñals, Carmen Hernández-Aguado, Josep-Maria Sirvent, Ramon Orriols, Mercé Fernández-Balsells, and Wifredo Ricart

Subjects
COVID-19, hemoglobin, hyperglycemia, obesity, epidemiology, mortality, Diseases of the endocrine glands. Clinical endocrinology, RC648-665
Abstract

BackgroundHyperglycemia 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.MethodsConsecutive 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.ResultsAs 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.ConclusionsBlood 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.

Published
2021
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4. Conditional Synthesis of Blood Glucose Profiles for T1D Patients Using Deep Generative Models

Author

Omer Mujahid, Ivan Contreras, Aleix Beneyto, Ignacio Conget, Marga Giménez, and Josep Vehi

Subjects
deep generative models, conditional data synthesis, type 1 diabetes simulators, blood glucose data generation, Mathematics, QA1-939
Abstract

Mathematical modeling of the glucose–insulin system forms the core of simulators in the field of glucose metabolism. The complexity of human biological systems makes it a challenging task for the physiological models to encompass the entirety of such systems. Even though modern diabetes simulators perform a respectable task of simulating the glucose–insulin action, they are unable to estimate various phenomena affecting the glycemic profile of an individual such as glycemic disturbances and patient behavior. This research work presents a potential solution to this problem by proposing a method for the generation of blood glucose values conditioned on plasma insulin approximation of type 1 diabetes patients using a pixel-to-pixel generative adversarial network. Two type-1 diabetes cohorts comprising 29 and 6 patients, respectively, are used to train the generative model. This study shows that the generated blood glucose values are statistically similar to the real blood glucose values, mimicking the time-in-range results for each of the standard blood glucose ranges in type 1 diabetes management and obtaining similar means and variability outcomes. Furthermore, the causal relationship between the plasma insulin values and the generated blood glucose conforms to the same relationship observed in real patients. These results herald the aptness of deep generative models for the generation of virtual patients with diabetes.

Published
2022
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5. A Machine Learning Approach to Minimize Nocturnal Hypoglycemic Events in Type 1 Diabetic Patients under Multiple Doses of Insulin

Author

Adrià Parcerisas, Ivan Contreras, Alexia Delecourt, Arthur Bertachi, Aleix Beneyto, Ignacio Conget, Clara Viñals, Marga Giménez, and Josep Vehi

Subjects
hypoglycemia, machine learning, multiple daily injections, prediction model, support vector machine, type 1 diabetes, Chemical technology, TP1-1185
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.

Published
2022
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7. Advanced lipoprotein profile identifies atherosclerosis better than conventional lipids in type 1 diabetes at high cardiovascular risk

Author

Tonet Serés-Noriega, Emilio Ortega, Marga Giménez, Verónica Perea, Laura Boswell, Karla Mariaca, Carla Font, Alex Mesa, Clara Viñals, Jesús Blanco, Irene Vinagre, Adriana Pané, Enric Esmatjes, Ignacio Conget, and Antonio J. Amor

Subjects
Nutrition and Dietetics, Endocrinology, Diabetes and Metabolism, Medicine (miscellaneous), Cardiology and Cardiovascular Medicine
Published
2023

11. Responsabilidades de autocuidado acordes a la edad en población pediátrica con diabetes tratada con ISCI

Author

Carmen Yoldi Vergara, Ignacio Conget Donlo, Roque Cardona Hernández, Irune Goicoechea Manterola, Marina Llobet Garcés, María Teresa Rouco Gómez, and Marta Ramon Krauel

Subjects
General Medicine
Abstract

RESUMEN Objetivo: Determinar en población infantil con Diabetes tipo 1 (DT1) en tratamiento con infusión subcutánea continua de insulina (ISCI), si asumir responsabilidades de autocuidado tras recibir un programa estructurado de educación terapéutica (PEET) se relaciona con el control metabólico y la calidad de vida (CV). Métodos: Estudio observacional, transversal. Se realizó un sub-análisis retrospectivo. Se incluyeron sujetos con DT1 (edad 9-17 años) en terapia ISCI (>1año) que habían recibido el mismo PEET al inicio de ISCI. Se registraron: grado en que asumían responsabilidades de autocuidado acordes a su edad, control metabólico, CV, nivel de conocimientos sobre diabetes y uso de funciones específicas del dispositivo. Resultados: Se incluyeron 44 pacientes. Los niños que asumieron responsabilidades de autocuidado acordes a su edad presentaron valores de hemoglobina glicada (HbA1c) significativamente menores que los niños que no las asumieron (8,0±0,7% vs. 9,2±1,1%, respectivamente, p1year) were included. All patients received the same structured PEET when initiating ISCI treatment. The degree of self-care age-appropriate responsibilities assumed by children was registered. Data related to metabolic control, diabetes knowledge, use of different pump features, and quality of life were also collected. Results: Forty-four patients were included. Children assuming age-appropriate self-care responsibilities had a significantly lower glycated hemoglobin (HbA1c) value compared to those children who did not take on these responsibilities (8,0±0,7% vs. 9,2±1,1%, p

Published
2023

18. Dulaglutide and cardiovascular and heart failure outcomes in patients with and without heart failure: a post‐hoc analysis from the REWIND randomized trial

Author

Kelley R.H. Branch, Gilles R. Dagenais, Alvaro Avezum, Jan Basile, Ignacio Conget, William C. Cushman, Petr Jansky, Mark Lakshmanan, Fernando Lanas, Lawrence A. Leiter, Prem Pais, Nana Pogosova, Peter J. Raubenheimer, Lars Ryden, Jonathan E. Shaw, Wayne H.H. Sheu, Theodora Temelkova‐Kurktschiev, M. Angelyn Bethel, Hertzel C. Gerstein, Ramasundarahettige Chinthanie, and Jeffrey L. Probstfield

Subjects
Cardiology and Cardiovascular Medicine
Published
2022

20. Carotid ultrasonography as a strategy to optimize cardiovascular risk management in type 1 diabetes: a cohort study

Author

Laura Boswell, Tonet Serés-Noriega, Alex Mesa, Verónica Perea, Adriana Pané, Clara Viñals, Jesús Blanco, Marga Giménez, Irene Vinagre, Enric Esmatjes, Ignacio Conget, and Antonio J. Amor

Subjects
Adult, Male, Endocrinology, Diabetes and Metabolism, Cholesterol, LDL, General Medicine, Middle Aged, Cohort Studies, Diabetes Mellitus, Type 1, Endocrinology, Cardiovascular Diseases, Risk Factors, Heart Disease Risk Factors, Internal Medicine, Humans, Female, Hydroxymethylglutaryl-CoA Reductase Inhibitors, Ultrasonography
Abstract

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.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]).Carotid-US is independently associated with an intensification of lipid-lowering therapy in a high-risk T1D population.

Published
2022

21. 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

Author

Tonet Serés-Noriega, Marga Giménez, Verónica Perea, Laura Boswell, Clara Viñals, Jesús Blanco, Irene Vinagre, Adriana Pané, Enric Esmatjes, Ignacio Conget, and Antonio J. Amor

Subjects
Adult, Male, Advanced and Specialized Nursing, Endocrinology, Diabetes and Metabolism, Middle Aged, Atherosclerosis, Lipids, Risk Assessment, Diabetes Mellitus, Type 1, Cardiovascular Diseases, Risk Factors, Internal Medicine, Humans, Female, Hydroxymethylglutaryl-CoA Reductase Inhibitors
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 ( 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 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.

Published
2022

23. Blood glucose monitoring during hospitalisation: Advanced practice nurse and semi-automated insulin prescription tools

Author

Gema, Yago-Esteban, Montse, Venturas, Jesús, Blanco, Inma, Pérez, Carlos, Falces, Mercè, Roqué, Xavier, Yugueros, Laura, Cardete, Arturo, Renu, David, Caellas, Ignacio, Conget, and Emilio, Ortega

Subjects
Blood Glucose, Glycated Hemoglobin, Hospitalization, Prescriptions, Blood Glucose Self-Monitoring, Hyperglycemia, Humans, Insulin, Atrial Natriuretic Factor
Abstract

Hyperglycemia is very common in hospitalized patients and is associated with worse clinical outcomes.We implemented a clinical and educational program to improve the overall glycemic control during hospital admission, and, in patients with HbANon-critical patients admitted to cardiovascular areas between October-2017 and February-2019. The program was led by an advanced nurse practitioner (ANP) and included a semiautomated insulin prescription tool. Program in 3 phases: 1) observation of routine practice, 2) implementation, and 3) follow-up after discharge.During the implementation phase the availability of HbA1c increased from 42 to 81%, and the ANP directly intervened in 73/685 patients (11%), facilitating treatment progression at discharge in 48% (de novo insulin in 36%). One-year after discharge, HbA1c in patients who were admitted during the observation phase with HbA1c8% (n = 101) was higher than similar patients admitted during implementation phase (8,6 ± 1,5 vs. 7,3 ± 1,2%, respectively, p 0,001). We evaluated 47710 point of care capillary blood glucose (POC-glucose) in two 9 months periods (one before, one during the program) in cardiology and cardiovascular surgery wards. POC-glucose ≥250 mg/dl (pre vs. during: cardiology 10,7 vs. 8,4%, and surgery 7,4 vs. 4,5%, both p 0,05) and70 mg/dl (2,3 vs. 0,8% y 1,5 vs 1%, p 0,05), respectively, improved during the program.The program allowed improving inpatient glycemic control, detect patients with poor glycemic control, and optimize metabolic control 1-year after discharge.

Published
2022

25. Resultados del programa de educación terapéutica de optimización dirigido a pacientes insulinizados con diabetes tipo 2 desarrollado por enfermería de práctica avanzada en diabetes en el ámbito de atención primaria

Author

Carla Cabré Font, Cristina Colungo Francia, Ignacio Conget Donlo, Irene Vinagre Torres, and Marga Jansà i Morató

Subjects
03 medical and health sciences, 0302 clinical medicine, Nutrition and Dietetics, Endocrinology, Endocrinology, Diabetes and Metabolism, 030209 endocrinology & metabolism, 030212 general & internal medicine
Abstract

Resumen Introduccion La educacion terapeutica es clave en el tratamiento de la diabetes mellitus tipo 2 (DT2). La participacion de una enfermera de practica avanzada (EPA) en diabetes en un Programa de Atencion y Educacion Terapeutica (PAET) en Atencion Primaria (AP) podria mejorar la atencion y los resultados de salud en pacientes en tratamiento con 2 o mas dosis de insulina con mal control metabolico. Nuestro objetivo fue evaluar resultados clinicos, educativos y de satisfaccion de este programa. Material y metodos Estudio prospectivo, longitudinal, de intervencion y valoracion antes y despues del programa, con una duracion de 6 meses con visitas presenciales, telefonicas e intervencion grupal. Resultados Se incluyo a 184 pacientes, de los cuales 161 fueron analizados. El 89,4% de los sujetos fueron incluidos por mal control metabolico (GMCM) y el 10,6% por hipoglucemias de repeticion (GMCH). En el GMCM el descenso promedio de la hemoglobina glucosilada (HbA1c) fue de –1,34 ± 1,45%, sin aumento de hipoglucemias. En el GMCH, disminuyeron las hipoglucemias/semana (2,52 ± 1,66 vs. 0,53 ± 1,06; p Conclusiones La implementacion de un PAET con la incorporacion de una EPA en diabetes en AP permite en su conjunto la mejora de resultados clinicos, educativos y de satisfaccion en pacientes con DT2 tratados con ≥ 2 dosis de insulina y control suboptimo.

Published
2021

26. Clinical characteristics and management of type 1 diabetes in Spain. The SED1 study

Author

Fernando Gómez-Peralta, Edelmiro Menéndez, Santiago Conde, Ignacio Conget, and Anna Novials

Subjects
Adult, Blood Glucose, Glycated Hemoglobin, Male, Blood Glucose Self-Monitoring, Infusions, Subcutaneous, Cross-Sectional Studies, Diabetes Mellitus, Type 1, Insulin Infusion Systems, Spain, Humans, Hypoglycemic Agents, Female, Child
Abstract

To determine the sociodemographic and clinical profile of a representative sample of people with type 1 diabetes mellitus (DM1) in Spain and identify factors associated with glycemic control.A cross-sectional observational study was carried out in adults and children with DM1 treated in 75 Spanish public hospitals, geographically distributed in order to be representative of the Spanish population. Within each center, the patients were included on a consecutive basis as they visited the clinic. They were interviewed, and their clinical histories were reviewed. A descriptive statistical analysis was made, and factors associated with HbAA total of 647 patients were included: 55.3% females, aged 36.6 ± 14.4 years, 97.2% Caucasians, BMI 24.7 ± 4.4 kg/mThe management of patients with DM1 in Spain, as well as the treatment they receive, is similar to that seen in other Western countries. Blood glucose control is associated with educational level, disease duration, and the characteristics of treatment and self-care.

Published
2021

27. Características clínicas y manejo de la diabetes tipo 1 en España. Estudio SED1

Author

Ignacio Conget, Fernando Gomez-Peralta, Edelmiro Menéndez, Santiago Conde, and Anna Novials

Subjects
03 medical and health sciences, 0302 clinical medicine, Nutrition and Dietetics, Endocrinology, Endocrinology, Diabetes and Metabolism, 030209 endocrinology & metabolism, 030212 general & internal medicine
Abstract

Resumen Objetivos Conocer el perfil sociodemografico y clinico en una muestra representativa de personas con diabetes mellitus tipo 1 (DM1) en Espana, e identificar los factores asociados con el control glucemico. Material y metodos Estudio observacional, transversal en adultos y ninos con DM1 tratados en las consultas de 75 hospitales publicos espanoles, distribuidos geograficamente para ser representativos de la poblacion espanola. Dentro de cada centro, los pacientes fueron incluidos de forma consecutiva segun acudian a consulta. Se les entrevisto y se revisaron sus historias clinicas. Se realizo un analisis estadistico descriptivo y se analizaron los factores asociados con la hemoglobina glicada (HbA1c) utilizando un analisis de regresion lineal multivariante. Resultados Se incluyeron 647 pacientes: 55,3% mujeres, edad 36,6 ± 14,4 anos, 97,2% caucasicos, indice de masa corporal (IMC) 24,7 ± 4,4 kg/m2 (12,1% ≥ 30 kg/m2) y el 74,0% tenia estudios secundarios/universitarios. El 20,2% eran fumadores activos. El tiempo medio desde el diagnostico de DM1 fue de 17,9 ± 12,0 anos. Un 48,7% presentaban comorbilidades, un 19,3% retinopatia y un 16,4% hipotiroidismo. Respecto al tratamiento para la DM1, el 76,5% usaban insulinoterapia basal-bolo y el 20,7% infusion subcutanea continua de insulina (ISCI); el 51,0% de los pacientes utilizaban una ratio insulina/hidratos de carbono (ICR), realizaban 4,6 ± 1,6 autoanalisis de glucemia capilar (AAGC) diaria y el 24,8% utilizaba monitorizacion continua de glucosa (MCG). El valor medio de la HbA1c fue del 7,6 ± 1,1% (30% inferior al 7%). El control metabolico fue mejor (menor HbA1c) a mayor numero de AAGC diarios (B = −0,053; p = 0,009), mayor nivel de estudios (B = 0,461; p Conclusiones El manejo de los pacientes con DM1 en Espana, asi como el tratamiento que reciben, es similar al observado en otros paises occidentales. El control glucemico esta asociado al nivel de estudios, la duracion de la enfermedad y las caracteristicas del tratamiento y autocuidado.

Published
2021

28. Novel glycoproteins identify preclinical atherosclerosis among women with previous preeclampsia regardless of type 1 diabetes status

Author

Marga Giménez, Eva López, Irene Vinagre, Eva Meler, Antonio J. Amor, Ignacio Conget, Verónica Perea, Maite Valverde, Laura Codina, Maria J. Barahona, Núria Alonso, and Xavier Urquizu

Subjects
Adult, Carotid atherosclerosis, medicine.medical_specialty, Endocrinology, Diabetes and Metabolism, Medicine (miscellaneous), Inflammation, Disease, Gastroenterology, Preeclampsia, Pre-Eclampsia, Pregnancy, Internal medicine, Humans, Medicine, cardiovascular diseases, Glycoproteins, chemistry.chemical_classification, Type 1 diabetes, Nutrition and Dietetics, business.industry, Middle Aged, Atherosclerosis, medicine.disease, Diabetes Mellitus, Type 1, chemistry, Female, medicine.symptom, Cardiology and Cardiovascular Medicine, business, Glycoprotein, Biomarkers, Retinopathy
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 Conclusions High 1H-NMR-glycoprotein concentrations have a negative impact on carotid atherosclerosis among women with preeclampsia, regardless of T1D status.

Published
2021

29. Connected Insulin Pens and Caps: An Expert's Recommendation from the Area of Diabetes of the Spanish Endocrinology and Nutrition Society (SEEN).

Author

Tejera-Pérez, Cristina, Chico, Ana, Azriel-Mira, Sharona, Lardiés-Sánchez, Beatriz, Gomez-Peralta, Fernando, Jesús, Amor Fernández Antonio, Amparo, Bartual Rodrigo, Virginia, Bellido, Diego, Bellido Guerrero, Antonio, Botana López Manuel, Miguel, Brito Sanfiel, Gloria, Canovas Molina, Daniel, Cepero Garcia, Ana, Chico Ballesteros, Ignacio, Conget Donlo, Antonio, de Luis Román Daniel, María, Durán Martínez, Alejandra, Duran Rodriguez-Hervada, Javier, Escalada San Martin Francisco, and Carlos, Fernández García José

Subjects
INSULIN therapy, INSULIN pumps, PEOPLE with diabetes, TYPE 1 diabetes, GLYCEMIC control, TYPE 2 diabetes, ENDOCRINOLOGISTS
Abstract

Undoubtedly, technological advances have revolutionised diabetes management in recent years. The development of advanced closed hybrid loop insulin pumps or continuous glucose monitoring (CGM) systems, among others, have increased the quality of life and improved glycaemic control of people with diabetes. However, only some patients have access to such technology, and only some want to use it. CGM has become much more widespread, but in terms of insulin delivery, most people with type 1 diabetes (T1D) and almost all people with type 2 diabetes (T2D) on insulin therapy are treated with multiple-dose insulin injections (MDI) rather than an insulin pump. For these patients, using connected insulin pens or caps has shown benefits in reducing missed insulin injections and promoting correct administration over time. In addition, using these devices improves the quality of life and user satisfaction. The integration of insulin injection and CGM data facilitates both users and the healthcare team to analyse glucose control and implement appropriate therapeutic changes, reducing therapeutic inertia. This expert's recommendation reviews the characteristics of the devices marketed or in the process of being marketed and their available scientific evidence. Finally, it suggests the profile of users and professionals who would benefit most, the barriers to its generalisation and the changes in the care model that implementing these devices can bring with it. [ABSTRACT FROM AUTHOR]

Published
2023
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30. Type 1 Diabetes Patient Experiences Before and After Transfer from a Paediatric to an Adult Hospital

Author

Mercè Vidal Flor, Margarida Jansà i Morató, Carmen Yoldi Vergara, Roque Cardona-Hernández, Marga Giménez Alvárez, Ignacio Conget Donlo, and Pilar Isla Pera

Subjects
Patient Preference and Adherence, Health Policy, Medicine (miscellaneous), Pharmacology, Toxicology and Pharmaceutics (miscellaneous), Social Sciences (miscellaneous)
Abstract

Mercè Vidal Flor,1 Margarida Jansà i Morató,1 Carmen Yoldi Vergara,2 Roque Cardona-Hernández,2 Marga Giménez Alvárez,1 Ignacio Conget Donlo,1 Pilar Isla Pera3 1Diabetes Unit, Department of Endocrinology and Nutrition, Hospital Clínic of Barcelona, Barcelona, Spain; 2Diabetes Unit, Endocrinology Service, Hospital Sant Joan de Déu, Esplugues de Llobregat, Barcelona, Spain; 3School of Nursing, University of Barcelona, Barcelona, SpainCorrespondence: Mercè Vidal Flor, Diabetes Unit, Department of Endocrinology and Nutrition, Hospital Clínic of Barcelona, Villarroel, 170, Barcelona, 08036, Spain, Tel +34 93 2279846, Email mvidal@clinic.catIntroduction: The management of type 1 diabetes (T1D) is especially complex during adolescence when youths are transferred to adult care centres. The objectives of this qualitative study were to: a) determine the expectations of young T1D patients prior to transfer, b) evaluate the transfer process between the 2 centres, and c) evaluate the therapeutic education and care programme (TECP) in the adult centre from their point of view.Material and Methods: Opinion sampling of adolescents from 2018– 2019 was performed: Phase 1: adolescents with T1D prior to transfer to the adult hospital; Phase 2: adolescents with T1D one or two years after transfer and having undergone TECP. A focus group (1.5h) and semi-structured interviews (45 min) were performed and taped, transcribed, and sent to the participants for confirmation. Date analysis was performed of the transcriptions of the focus group and interviews. Fragments were selected and meta-categories created.Results: Eleven youths accepted to participate: 7 in Phase 1, 4 repeated in Phase 2 and 4 more transferred 2 years previously were added. The meta-categories obtained were: 1) perception of the quality of care and therapeutic education in the paediatric hospital. 2) transfer to the adult hospital. 3) experience of the youths 1– 2 years after transfer and having undergone TECP. The data are presented in narrative form and are supported with text fragments of the participants’ discussions.Discussion and conclusions: Analysis of patients’ experience complemented by clinical-educational evaluation of TECP provides understanding of the perspectives of youths on the complexity of living with a chronic disease since childhood. It also provides information regarding the factors favouring quality care and therapeutic education, the complexity of transfer from paediatric to adult care, determination of the strong and weak points and the establishment of strategies to improve the programme.Keywords: Type 1 diabetes, adolescents, transition to adult care, qualitative research, patient experience, therapeutic patient education

Published
2022

31. The Steno Type 1 Risk Engine identifies preclinical atherosclerosis better than the ESC/EASD-2019 Guidelines in adult subjects with type 1 diabetes at high-risk

Author

Antonio J. Amor, Ignacio Conget, Enric Esmatjes, Adriana Pané, Irene Vinagre, Jesús Blanco, Clara Viñals, Laura Boswell, Verónica Perea, Marga Giménez, and Tonet Serés-Noriega

Abstract

Objective: To evaluate the concordance between the ESC/EASD-2019 and the Steno Type 1 Risk Engine (Steno-Risk) cardiovascular risk scales in persons with type 1 diabetes (T1D) without cardiovascular disease (CVD), and to analyze their relationships with preclinical atherosclerosis. Research design and methods: We consecutively selected patients with T1D, without CVD, with: ≥40 years, nephropathy, or ≥10 years of evolution with another risk factor. The presence of plaque at different carotid segments was determined by ultrasonography. Cardiovascular risk was estimated according to ESC/EASD-2019 risk groups (moderate/high/very-high) and the Steno-Risk ( Results: We included 501 patients (53% males, age 48.8 years, T1D duration 26.5 years, 41.3% harboring plaques). Concordance between T1D-specific scales was poor (kappa= 0.19). A stepped increase in the presence of plaques according to the Steno-Risk category was seen (18.4%, 38.2% and 64.1%, for low/moderate/high-risk; p for trend Conclusions: In T1D patient undergoing primary prevention, Steno-Risk seems to better recognize individuals with atherosclerosis in comparison to ESC/EASD-2019. Notwithstanding, carotid ultrasound could improve the categorization of cardiovascular risk.

Published
2022

32. Psychometric analysis of the cross-cultural Spanish version of the diabetes management questionnaire

Author

Carmen Yoldi Vergara, Ignacio Conget Donlo, Roque Cardona-Hernandez, Irune Goicoechea Manterola, María Teresa Rouco Gómez, Marina Llobet Garcés, and Marta Ramon-Krauel

Subjects
Pediatrics
Abstract

Evaluation of the degree of adherence to self-care among Spanish type 1 diabetes (T1DM) pediatric population lacks of a validated tool.To cross-culturally adapt and determine the psychometric properties of the Spanish version of the Diabetes Management Questionnaire to assess the degree of adherence to self-care among children with T1DM.Translation, back-translation, and patient suggestions, were considered to obtain the Spanish version (DMQ-Sp). A cross-sectional study was conducted with 323 children (aged 8-18 years) with T1DM and their parents to determine internal reliability, structural validity, and external validity. Responsiveness to change was analyzed through a prospective longitudinal study involving 102 newly diagnosed T1DM patients. Psychometrics were evaluated for the entire sample and stratified by age (8-12 and 13-18 years).A total of 323 children with T1DM [49.8% female; age 13.3 ± 2.8 years; 155 aged 8-12; glycated hemoglobin (HbA1c) value 7.7 ± 1.0%] answered the Spanish final version. The internal consistency Cronbach's alpha was 0.76 and intraclass correlation coefficient 0.84. Test-retest reliability was r = 0.84 (p 0.001). Fit index of structural validity was0.7. External validity correlated inversely with HbA1c (r = -0.39; p 0.001). The DMQ-Sp score increased significantly after 6 months of receiving the full therapeutic education program (TEP) (baseline 57.07 ± 10.81 vs. 6 months 78.80 ± 10.31; p 0.001).The DMQ-Sp is reliable, valid, and sensitive to change in a large sample of children (aged 8-18 years) with T1DM and their parents.DMQ-Sp can be a useful tool for diabetes teams to identify adherence to different tasks and to evaluate TEPs.

Published
2022

34. Validation of a Probabilistic Prediction Model for Patients with Type 1 Diabetes Using Compositional Data Analysis

Author

Lyvia Regina Biagi Silva Bertachi, Ignacio Conget, Ernesto Estremera Toledo, Josep Antoni Martín-Fernández, Jorge Bondia, Aleix Beneyto Tantiña, Josep Vehi, Marga Giménez, Ivan Contreras, and Alvis Cabrera Tejera

Subjects
prediction model, type 1 diabetes, General Mathematics, time in range, Computer Science (miscellaneous), continuous glucose monitoring, Engineering (miscellaneous), compositional data
Abstract

Glycemia assessment in people with type 1 diabetes (T1D) has focused on the time spent in different glucose ranges. As this time reflects the relative contributions to the finite duration of a day, it should be treated as compositional data (CoDa) that can be applied to T1D data. Previous works presented a tool for the individual categorization of days and proposed a probabilistic transition model between categories, although validation has hitherto not been presented. In this study, we consider data from eight real adult patients with T1D obtained from continuous glucose monitoring (CGM) sensors and introduce a methodology based on compositional methods to validate the previously presented probability transition model. We conducted 5-fold cross-validation, with both the training and validation data being CoDa vectors, which requires developing new performance metrics. We design new accuracy and precision measures based on statistical error calculations. The results show that the precision for the entire model is higher than 95% in all patients. The use of a probabilistic transition model can help doctors and patients in diabetes treatment management and decision-making. Although the proposed method was tested with CoDa applied to T1D data obtained from CGM, the newly developed accuracy and precision measures apply to any other data or validation based on CoDa.

Published
2023

35. A Retrospective Observational Study Examining the Generalizability of Glucagon-Like Peptide 1 Receptor Agonist Cardiovascular Outcome Trials to the Real-World Population with Type 2 Diabetes in Spain: The REPRESENT Study

Author

Irene Romera, Esther Artime, Katharina Ihle, Silvia Díaz-Cerezo, Miriam Rubio de-Santos, Anna de Prado, Ana Cebrián-Cuenca, and Ignacio Conget

Subjects
Male, Glucagon-Like Peptides, General Medicine, Liraglutide, Middle Aged, Glucagon-Like Peptide-1 Receptor, Diabetes Mellitus, Type 2, Cardiovascular Diseases, Spain, Humans, Hypoglycemic Agents, Pharmacology (medical), Female, Aged
Abstract

The REPRESENT study aims to examine whether participants enrolled in glucagon-like peptide 1 receptor agonist cardiovascular outcome trials (CVOTs) LEADER (liraglutide), REWIND (dulaglutide), and SUSTAIN-6 (injectable semaglutide) are representative of the Spanish population with type 2 diabetes (T2D).This retrospective observational study used the IQVIA Electronic Medical Records database in Spain to identify adults aged 18 years and older with T2D diagnosed before/between January 2013 and December 2015. Demographic and clinical characteristics were analyzed descriptively. The proportions of individuals in the Spanish cohort who met the key selection criteria of each CVOT were calculated from individuals with available database entries for estimated glomerular filtration rate and body mass index using proxies.A total of 24,268 adults with T2D were identified from the IQVIA database. The Spanish cohort was predominantly male (55.5%) and had a mean (± SD) age of 66.8 ± 12.5 years and HbA1c of 7.2 ± 1.5%, with 14.0% having established cardiovascular disease and 2.9% having prior myocardial infarction. The characteristics of the Spanish cohort were more similar to that of REWIND than LEADER or SUSTAIN-6. The proportions of subjects in the Spanish cohort who met the CVOTs key selection criteria were 10.1% for LEADER, 53.6% for REWIND, and 10.4% for SUSTAIN-6.Although none of the CVOTs was fully representative of the Spanish cohort, the REWIND population was found to be more representative of the real-world Spanish population with T2D than those of LEADER and SUSTAIN-6. These findings reinforce the applicability of the results of REWIND in clinical practice.

Published
2022

36. Hyperglycemia and hypoglycemia exposure are differentially associated with micro- and macrovascular complications in adults with Type 1 Diabetes

Author

Alex Mesa, Marga Giménez, Irene Pueyo, Verónica Perea, Clara Viñals, Jesús Blanco, Irene Vinagre, Tonet Serés-Noriega, Laura Boswell, Enric Esmatjes, Ignacio Conget, and Antonio J. Amor

Subjects
Adult, Blood Glucose, Glycated Hemoglobin, Male, Blood Glucose Self-Monitoring, Endocrinology, Diabetes and Metabolism, General Medicine, Middle Aged, Hypoglycemia, Cross-Sectional Studies, Diabetes Mellitus, Type 1, Endocrinology, Cardiovascular Diseases, Hyperglycemia, Internal Medicine, Humans, Female
Abstract

Evaluate the relationship between high and low exposure continuous glucose monitoring (CGM)-derived glucometrics and micro- and macrovascular complications in type 1 diabetes (T1D).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.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]).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.

Published
2022

37. 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]

Author

Antonio J. Amor, Irene Vinagre, Maite Valverde, Núria Alonso-Carril, Xavier Urquizu, Eva Meler, Eva López, Marga Giménez, Laura Codina, Ignacio Conget, Maria J. Barahona, and Verónica Perea

Subjects
Nutrition and Dietetics, Endocrinology, Diabetes and Metabolism, Medicine (miscellaneous), Cardiology and Cardiovascular Medicine
Published
2022

38. Type 1 Diabetes Patient Experiences Before and After Transfer from a Paediatric to an Adult Hospital.

Author

Flor, Mercè Vidal, Morató, Margarida Jansà i, Vergara, Carmen Yoldi, Cardona-Hernández, Roque, Alvárez, Marga Giménez, Donlo, Ignacio Conget, and Pera, Pilar Isla

Subjects
TYPE 1 diabetes, PATIENTS' attitudes, PEOPLE with diabetes, ADULTS, PEDIATRICS, INSULIN pumps, PEDIATRIC nursing
Abstract

Introduction: The management of type 1 diabetes (T1D) is especially complex during adolescence when youths are transferred to adult care centres. The objectives of this qualitative study were to: a) determine the expectations of young T1D patients prior to transfer, b) evaluate the transfer process between the 2 centres, and c) evaluate the therapeutic education and care programme (TECP) in the adult centre from their point of view. Material and Methods: Opinion sampling of adolescents from 2018– 2019 was performed: Phase 1: adolescents with T1D prior to transfer to the adult hospital; Phase 2: adolescents with T1D one or two years after transfer and having undergone TECP. A focus group (1.5h) and semi-structured interviews (45 min) were performed and taped, transcribed, and sent to the participants for confirmation. Date analysis was performed of the transcriptions of the focus group and interviews. Fragments were selected and meta-categories created. Results: Eleven youths accepted to participate: 7 in Phase 1, 4 repeated in Phase 2 and 4 more transferred 2 years previously were added. The meta-categories obtained were: 1) perception of the quality of care and therapeutic education in the paediatric hospital. 2) transfer to the adult hospital. 3) experience of the youths 1– 2 years after transfer and having undergone TECP. The data are presented in narrative form and are supported with text fragments of the participants' discussions. Discussion and conclusions: Analysis of patients' experience complemented by clinical-educational evaluation of TECP provides understanding of the perspectives of youths on the complexity of living with a chronic disease since childhood. It also provides information regarding the factors favouring quality care and therapeutic education, the complexity of transfer from paediatric to adult care, determination of the strong and weak points and the establishment of strategies to improve the programme. [ABSTRACT FROM AUTHOR]

Published
2022
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