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Objective: The aim of the study was to describe how physical exercise affects metabolic control, insulin requirements and carbohydrate intake in children who use hybrid closed-loop systems. Methods: Cross-sectional study design. The sample included 21 children and adolescents diagnosed with type 1 diabetes. During the study, participants were monitored for a period of 7 days to gather comprehensive data on these factors. Results: Nine participants (42.9%) had switched to exercise mode to raise the target glucose temporarily to 150 mg/dL. The HbA1c values ranged from 5.5% to 7.9% (median, 6.5%; IQR, 0.75). The percentage of time within the target range of 70−180 mg/dL was similar; however, there was an increased duration of hyperglycaemia and more autocorrections on exercise days. The time spent in severe hyperglycaemia (>250 mg/dL) increased by 2.7% in exercise compared to non-exercise days (P = .02). It is worth noting that hypoglycaemic episodes did not increase during the exercise days compared with non-exercise days. Conclusion: The hybrid closed-loop system was effective and safe in children and adolescents with type 1 diabetes during the performance of competitive sports in real life. Resumen: Objetivo: El objetivo de este estudio es describir cómo el ejercicio físico afecta el control metabólico, las necesidades de insulina y el consumo de carbohidratos en niños usuarios de un sistema híbrido de circuito cerrado. Métodos: Diseño de estudio transversal. Se reclutaron veintiún niños y adolescentes diagnosticados con diabetes tipo 1. Durante el estudio, los participantes fueron monitoreados durante un período de 7 días para recopilar datos completos sobre estos factores. Resultados: Nueve participantes (42,9%) habían activado el modo de ejercicio, para elevar temporalmente la glucosa objetivo a 150 mg/dL. La HbA1c osciló entre 5,5% y 7,9% (mediana 6,5%, IQR 0,75). El porcentaje de tiempo dentro del rango de 70−180 mg/dL fue similar; sin embargo, hubo una mayor duración de la hiperglucemia y más autocorrecciones en los días en que se realizó ejercicio. El porcentaje de tiempo en hiperglucemia grave (>250 mg/dL) fue 2,7 mayor durante el ejercicio versus los días sin ejercicio (p = 0,02). En particular, los episodios de hipoglucemia no aumentaron durante los días de práctica de ejercicio, en comparación con los días sin ejercicio. Conclusiones: El sistema híbrido de circuito cerrado fue efectivo y seguro en niños y adolescentes diagnosticados con diabetes tipo 1 durante ejercicios físicos competitivos en la vida real.

Introduction: The recommended social distancing measures to prevent the spread of Covid-19 caused high mental suffering, mainly for those affected by diabetes mellitus due to multiple metabolic, inflammatory and vascular changes. Objective: This work aims to test the association between the perception of feelings, the measurement of blood glucose and the conditions of social distancing due to the Covid19 pandemic in adults with type 1 diabetes in Brazil. Materials and methods: The research was approved by the Ethics Committee and Research with Human Beings, carried out through an online form, it is a cross-sectional, descriptive and analytical study, carried out during the month of July 2020. Results: 472 adults with DM1 participated, 50.4% said that social distancing was causing stress in their home environment. For statistical analysis, the Statistical Package for Social Sciences software, version 21, was used, a relationship was found between stress, hyperglycemia and less willingness to remain in social isolation; normoglycemia feeling of joy and greater willingness to remain in social isolation. Conclusion: Given this, it is observed that social distancing caused glycemic and mood changes in these individuals. Therefore, the inclusion of care in the health of this population should be considered, through different interventions with the multidisciplinary team. [ABSTRACT FROM AUTHOR]

This study investigates the diabetes management strategies of three high-level athletes with Type 1 Diabetes (T1D) during the 43rd London Marathon. The athletes' strategies, which included insulin dose adjustments, carbohydrate intake, and monitoring techniques, were analyzed using a collaborative autoethnographic approach and data from medical and running devices. The athletes, two males and one female, used various technologies such as Supersapiens, Freestyle Libre, and the Medtronic Minimed 780G insulin pump to manage their diabetes during the marathon. Despite individual challenges, all three athletes successfully completed the marathon. The study presents the strategies, glycemic data, and major highlights using visual narratives, providing valuable insights into the experiences of athletes with T1D during endurance events. These narratives effectively communicate the challenges faced by athletes with T1D and can help optimize diabetes management during endurance events. [ABSTRACT FROM AUTHOR]

Contexto: el cuestionario de Clarke (CC), determina la percepción de síntomas de hipoglucemia y un puntaje ?4 detecta pacientes con hipoglucemia inadvertida (HI). La evidencia sobre la asociación entre las métricas del Monitoreo Continuo de Glucosa (MCG) y el puntaje del CC es limitada. Objetivo: describir la asociación entre el puntaje del CC y métricas del MCG en pacientes con diagnóstico de diabetes tratados con insulina y alto riesgo de hipoglucemia. Metodología: estudio de corte transversal, en pacientes adultos con diagnóstico de diabetes tratados con insulina e historia de hipoglucemia severa o factores de riesgo para (HI). Se registraron datos demográficos, clínicos y puntaje de Clarke basales. Se realizó MCG profesional durante 6 días. Se compararon las métricas del MCG para los grupos con o sin HI, utilizando diferentes puntos de corte (Clarke ?4 y ?3). Resultados: se incluyeron 83 pacientes (mediana de edad 63 años [RIC 53.5-70.5], 71.1% DM2, HbA1c 7.6±1.6%). La mediana de tiempo en rango (TIR70-180 mg/dL) fue 75% [RIC 63-92], tiempo debajo rango (TBR180 mg/dL 15% [3-27]. En pacientes con Clarke ?4 el %TIR fue menor (Mediana 55[RIC 41-89] vs 77[RIC 68-92], p=0.05) a expensas de mayor %TAR (Mediana 23[RIC 7-54] vs 15[RIC 3-16], p=0.15). No se encontraron diferencias significativas en %TBR

Background and aims: To face the rapid spread of SARS-CoV2 coronavirus pandemic, home lockdown in Spain was decreed on 15th March 2020. The main objective of this study is to evaluate the impact of this constraint on glycemic control in children and adolescents with type 1 diabetes mellitus (T1D). Patients and methods: Observational, retrospective study in children and adolescents with T1D users of interstitial glucose monitoring systems. The following information corresponding to the last 2 weeks of lockdown was collected for subsequent comparison with data of 2 weeks prior to quarantine: daily insulin needs, mean interstitial glucose, estimated HbA1c, coefficient of variation (CV), time in range (70–180 mg/dl), hypoglycemia (180 and> 250 mg/dl), sensor use and number of blood glucose measurements. Data about meal routines, physical exercise, need for adjustments in therapy, acute complications and lockdown of caregivers were assessed via a survey. Results: 80 patients were studied (mean age 12.61 ± 3.32 years, mean time of evolution of the disease 5.85 ± 3.92 years), 66.2% treated with an insulin pump, users of following glucose monitoring systems: Guardian 3 (65%), FreeStyle Libre (18.8%) and Dexcom G6 (16.2%). Time in range in the cohort increased significantly during confinement (72.1 ± 10.5 vs 74.8 ± 10.5%; P = 0.011) with lower time in hypoglycemia both 250 mg/dl (4.6 ± 3.9 vs 3.7 ± 3.7%; P = 0.038). CV also decreased (35.8 ± 6.3 vs 33.1 ± 6.1%; P 180 y >250 mg/dl), uso del sensor y número de glucemias capilares. Mediante encuesta se obtuvo información acerca de rutinas de ingesta, ejercicio físico, necesidad de ajustes en la terapia, complicaciones agudas surgidas y acompañamiento de los pacientes por sus cuidadores durante el confinamiento. Resultados: Se incluyeron 80 pacientes (edad media 12,61 ± 3,32 años, tiempo medio de evolución de la enfermedad 5,85 ± 3,92 años), 66,2% tratados con bomba de insulina, usuarios de los siguientes sistemas de monitorización: Guardian 3 (65%), FreeStyle Libre (18,8%) y Dexcom G6 (16,2%). El tiempo en rango en la cohorte se incrementó de forma significativa durante el confinamiento (72,1 ± 10,5 vs 74,8 ± 10,5%; p = 0,011) a expensas de una disminución del tiempo en hipoglucemia tanto 250 mg/dl (4,6 ± 3,9 vs 3,7 ± 3,7%; p = 0,038), reduciéndose también el CV (35,8 ± 6,3 vs 33,1 ± 6,1%; p

Objective: The aim of the study was to describe how physical exercise affects metabolic control, insulin requirements and carbohydrate intake in children who use hybrid closed-loop systems., Methods: Cross-sectional study design. The sample included 21 children and adolescents diagnosed with type 1 diabetes. During the study, participants were monitored for a period of 7 days to gather comprehensive data on these factors., Results: Nine participants (42.9%) had switched to exercise mode to raise the target glucose temporarily to 150 mg/dL. The HbA1c values ranged from 5.5% to 7.9% (median, 6.5%; IQR, 0.75). The percentage of time within the target range of 70-180 mg/dL was similar; however, there was an increased duration of hyperglycaemia and more autocorrections on exercise days. The time spent in severe hyperglycaemia (>250 mg/dL) increased by 2.7% in exercise compared to non-exercise days (P = .02). It is worth noting that hypoglycaemic episodes did not increase during the exercise days compared with non-exercise days., Conclusion: The hybrid closed-loop system was effective and safe in children and adolescents with type 1 diabetes during the performance of competitive sports in real life., (Copyright © 2024 Asociación Española de Pediatría. Published by Elsevier España, S.L.U. All rights reserved.)

Background and aims: Post-prandial glucose control is essential to achieve metabolic goals in patients with type 1 diabetes mellitus (T1DM). The new “faster aspart” insulin has a pharmacological profile noted for its faster absorption and onset of action, and increased early availability, resulting in improved blood glucose control after meals. The main objective of the study was to analyse the efficacy of “faster aspart” vs. “insulin aspart” in children and adolescents with DM1 on sensor-augmented pump treatment. Patients and methods: Multicentre, longitudinal and prospective analytical trial evaluating the use of faster aspart insulin for three months in children with T1DM with MiniMed640G® sensor-augmented pumps previously treated with aspart insulin. At the beginning and end of the study the following variables were analysed for subsequent comparison: mean sensor glucose, percentage of time in range, hypoglycaemia and hyperglycaemia, area under the curve (AUC) 180 mg/dL, mean sensor glucose pre- and postprandial in main meals, daily insulin requirements, basal/bolus percentage, and HbA1c. Acute complications, adverse events and satisfaction survey were assessed. Results: The study included 32 patients with a mean of 13.49 ± 2.42 years of age and with T1DM of 7.0 ± 3.67 years of onset. The use of faster aspart was associated with lower time in hyperglycaemia >180 mg/dL (25.8 ± 11.3 vs. 22.4 ± 9.5; p = .011) and >250 mg/dL (5.2±4.9 vs. 4.0 ± 3.6; p = .04), lower AUC >180 mg/dL (10.8 ± 6.5 vs. 9.3 ± 6.1; p = .03), and increased time in range (71.4 ± 10.0 vs. 74.3 ± 9.2; p = .03). No significant changes in hypoglycaemia, HbA1c, insulin requirements, and basal/bolus percentages were detected. Faster aspart was safe and well-evaluated by patients and caregivers. Conclusions: Faster aspart achieves better glycaemic control by increasing glucose time in range in children and adolescents with T1DM on treatment with sensor-augmented pumps. Resumen: Introducción y objetivos: El control glucémico postprandial es fundamental para conseguir los objetivos metabólicos en pacientes con diabetes mellitus tipo 1 (DM1). La nueva insulina faster aspart presenta un perfil farmacológico caracterizado por una absorción e inicio de acción más rápidos, mayor disponibilidad precoz y menor incremento de la glucosa postprandial. El objetivo principal del estudio fue analizar su eficacia en pacientes con DM1 tratados con un sistema integrado. Pacientes y métodos: Estudio analítico, longitudinal, prospectivo y multicéntrico, evaluando el empleo de faster aspart durante tres meses en pacientes en edad pediátrica con DM1 con sistema integrado MiniMed640G® tratados previamente con insulina aspart. Al inicio y final del estudio se analizaron para posterior comparación: glucosa media, porcentajes de tiempo en objetivo, tiempo en hipoglucemia e hiperglucemia, área bajo la curva (AUC) 180 mg/dL, glucosa media pre y postprandial en comidas principales, necesidades diarias de insulina, porcentaje basal/bolo y HbA1c. Se registraron complicaciones agudas y eventos adversos, y se evaluó grado de satisfacción mediante encuesta. Resultados: Se incluyeron 32 pacientes de 13,49 ± 2,42 años de edad con DM1 de 7,0 ± 3,67 años de evolución. Faster aspart se asoció a menor porcentaje de tiempo en hiperglucemia >180 mg/dL (25,8 ± 11,3 vs. 22,4 ± 9,5; p = 0,011) y >250 mg/dL (5,2 ± 4,9 vs. 4,0 ± 3,6; p = 0,04) y AUC >180 mg/dL (10,8 ± 6,5 vs. 9,3 ± 6,1; p = 0,03), incrementándose el tiempo en objetivo (71,4 ± 10,0 vs. 74,3 ± 9,2; p = 0,03) sin aumentar hipoglucemias. Las necesidades de insulina, porcentajes basal/bolo y HbA1c no se modifican significativamente. Faster aspart fue bien tolerada y valorada por los participantes. Conclusiones: Faster aspart consigue un mejor control glucémico, aumentando el tiempo de glucosa en objetivo en niños y adolescentes con DM1 en tratamiento con un sistema integrado.

Introducción: la terapia intensiva con insulina mediante infusión subcutánea continua y con monitoreo continuo de glucosa en tiempo real es una buena opción de tratamiento para pacientes seleccionados con diabetes mellitus tipo 1. Además, la introducción de la tecnología llamada sistema híbrido avanzado de asa cerrada representa una nueva era en el tratamiento de la diabetes tipo 1. Objetivo: reportar uno de los primeros entrenamientos exitosos con el nuevo sistema Mini MedÔ 780G en un paciente, usuario de tecnología, con mal control metabólico previo. Presentación del caso: se trata de un paciente de 59 años con diabetes tipo 1, en tratamiento con Mini MedÔ 640G con historia de mal control metabólico e hipoglucemias frecuentes, quien decidió cambiarse al sistema Mini MedÔ 780G. Los registros del historial del paciente se recolectaron de los entrenamientos realizados en el servicio de Endocrinología del Hospital Universitario San Ignacio de Bogotá, a través del software Medtronic CareLinkÔ y de los seguimientos habituales en la consulta externa. Al final del entrenamiento con la nueva tecnología, el tiempo en rango del paciente mejoró notablemente, sin presentar hipoglucemias ni hiperglucemias severas. Discusión y conclusión: el sistema Mini MedÔ 780G en personas con diabetes tipo 1 que no han logrado un adecuado control metabólico con tecnologías anteriores, puede ser una herramienta eficaz y segura para mejorar el control glucémico.

Copyright of Actualización en Nutrición is the property of Sociedad Argentina de Nutricion and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

The effectiveness of psychoeducational interventions in children and adolescents with type 1 diabetes is unclear. A systematic review was developed in accordance with PRISMA. Relevant databases (Pubmed, Cochrane, PsycINFO, and PsyARTICLES) were analyzed. Articles of the last decade with type 1 diabetes population between 6 and 18 years participating in psychoeducational interventions were the inclusion criteria. Twenty studies were reviewed, and improvements were found in glycosylated hemoglobin, diabetes knowledge, and psychosocial variables. The results support the positive effect of these interventions. The characteristics that seem to be behind the success of these interventions are the design appropriate to the characteristics of the population, the participation of psychologist and educators, the continuity of the program over time, and the use of digital tools and interaction strategies. Further studies need to be carried out and replicated in different groups of children and adolescents. [ABSTRACT FROM AUTHOR]

Diabetes mellitus type 1 is a condition in which the pancreas loses its ability to produce enough insulin, increasing the levels of blood glucose. This work presents the design of a mathematical model of the glucose - insulin dynamics of a type 1 diabetes patient, contemplating the contribution to the concentration of blood glucose by the intake of carbohydrates, fats and proteins. The model also includes the absorption dynamics of 5 insulin types, different administration methods of exogenous insulin, and the variation of insulin sensitivity during the day. The model was integrated into a closed-loop insulin regulation algorithm, in order to evaluate the performance of the model and the eficiency of closed-loop treatments, compared to open-loop therapies. The results show the response of the model to different situations of a real patient, and tests of the controller’s performance

En las últimas décadas los avances en el tratamiento de los pacientes con diabetes tipo 1 han permitido optimizar el control metabólico y disminuir cada vez más la frecuencia de eventos de seguridad entre ellos la hipoglucemia. La tecnología juega un papel fundamental en el control glucémico de estos pacientes y cada vez es más utilizada en la población diabética mundial. Sin embargo, los cambios en el estilo de vida continúan teniendo un papel protagónico y entre ellos el ejercicio se considera fundamental para el manejo no solo de la diabetes sino de las comorbilidades asociadas. La presente revisión busca reforzar el conocimiento desde las bases fisiológicas de esta relación dicotómica y fuerte entre ejercicio físico y diabetes tipo 1 y sentar las bases terapéuticas enfocadas en la disminución de eventos de seguridad principalmente la hipoglucemia.

Double diabetes (DD) refers to patients with type 1 diabetes who have developed insulin resistance. The objective of this review is to update relevant information on the prescription of physical activity, pharmacological adjustments and consumption of carbohydrates in DD. A systematic search for scientific articles was carried out in the following databases: PubMed, Cochrane, EBSCO, WoS, ScienceDirect and Medline. The evidence analyzed shows that both physical activity (PA) and physical exercise (PE) are essential to achieve metabolic control in people with DD. Physiological considerations such as: insulin adjustments, insulin injection sites, time to perform PA and PE, absolute and relative contraindications are essential to avoid complications, especially hypoglycemia., (Copyright © 2024 Sociedad Española de Rehabilitación y Medicina Física. Publicado por Elsevier España, S.L.U. All rights reserved.)

Introduction: The Medtronic MiniMed™ 780G (MM780G) system uses an algorithm that includes autocorrection bolus (AB) delivery. This study evaluates the impact of omitted meal boluses and the system settings, glucose target and active insulin time (AIT), on the AB., Method: Retrospective observational study on data uploaded by all MiniMed 780G users in our healthcare area, obtained through the remote monitoring platform Care Connect, from April to August 2023. Downloads with a sensor usage time <95% were excluded., Results: 235 downloads belonging to 235 users were analysed. AB delivery was significantly higher at 2 h AIT (36.08 ± 13.17%) compared to the rest of settings (2.25-4 h) (26.43 ± 13.2%) (p < 0.001). AB differences based on the glucose target were not found. Patients with <3 meal boluses per day had higher AB delivery (46.91 ± 19.00% vs 27.53 ± 11.54%) (p < 0.001) and had more unfavourable glucometric parameters (GMI 7.12 ± 0.45%, TIR 67.46 ± 12.89% vs GMI 6.78 ± 0.3%, TIR 76.51 ± 8.37%) (p < 0.001). However, the 2-h AIT group presented similar TAR, TIR and GMI regardless of the number of meal boluses., Conclusion: The fewer user-initiated boluses, the greater the autocorrection received. The active insulin time of 2 h entails a more active autocorrection pattern that makes it possible to more effectively compensate for the omission of meal boluses without increasing hypoglycaemias., (Copyright © 2024 SEEN and SED. Published by Elsevier España, S.L.U. All rights reserved.)

Objective: To stablish the relationship between socioeconomic status of a cohort of children and adolescents with type 1 diabetes (T1D) with glycemic control, therapeutic adherence and diabetes quality of life (DQoL)., Patients Y Methods: A cross-sectional, observational study with consecutive inclusion was carried out. Participants aged 8-18 years with T1D duration >1 year. Data on family structure, family income, parents' educational level and parental role on primary diabetes care supervision were registered. Adherence (DMQ-Sp) and DQoL (PedsQl) were analyzed. Linear and logistic regression models adjusted for demographics, family structure and parental role on primary diabetes care responsibility were applied., Results: A total of 323 patients (T1D duration 5,3 ± 3,3 years; HbA1c 7,7 ± 1,0%; age 13,3 ± 2,8 years; 49,8% females) were included. Patients living in a nuclear family and those whose main diabetes care supervision was shared by both parents showed lower HbA1c [adjusted for demographics and family structure (7,06; CI 95% 6,52-7,59); adjusted for demographics and role on primary diabetes care supervision (7,43; CI 95% 6,57-8,28)]. DMQ-Sp score (adjusted for demographics and role on main supervision) was higher in patients whose parents shared the diabetes care supervision (84,56; CI 95% 73,93-95,19). Parents sharing diabetes care supervision showed a significantly higher PedsQl score (both 74,63 ± 12,70 vs mother 68,53 ± 14,59; p = 0,001)., Conclusions: Children and adolescents with T1D had lower HbA1c, better therapeutic adherence and better DQoL when lived in a nuclear family, with higher socioeconomic status and the responsibility for supervising diabetes care was shared by both parents., (Copyright © 2024 SEEN and SED. Published by Elsevier España, S.L.U. All rights reserved.)

Introduction: School-aged children with type 1 diabetes (DM1) require access to appropriate and safe care for their disease during their stay in the educational centre. Objective: To identify the needs perceived by families of schoolchildren with DM1 that affect their educational integration, safety, and well-being during the school day. Methodology: A descriptive and cross-sectional study was conducted using a questionnaire based on information and opinions provided by families of 362 schoolchildren between 3 and 16 years old with DM1 registered in their health history in the Public Health System of Extremadura. Results: The response rate was 56.9% (206). It was shown that 35% of schoolchildren with DM1 were treated with continuous subcutaneous insulin infusion therapy. Almost all of them (95.1%) required glucose monitoring, and 57.8% required insulin administration during the school day. Most (88%) children had adjusted well to school and did not describe any type of discriminatory treatment (87.4%). Glucagon is available in 82% of educational centres, in which 43.7% had a trained adult person to administer it. That teachers could recognise a hypoglycaemia was expressed by 21.4% of the families, and 29.1% were unaware of the existence of coordination protocols in the school. More than half (58.7%) claimed that the information available in schools about diabetes was low, and 77.2% stated that the control of the disease would improve if more training was provided to teachers. Conclusions: There are aspects optimally covered in the care of schoolchildren with DM1 in the schools of Extremadura. Among situations identified with potential room for improvement were adherence to the coordination protocol, information about diabetes, and training of adults to deal with emergency situations. Resumen: Introducción: El alumnado con diabetes tipo 1 (DM1) requiere durante su estancia en el centro educativo unos cuidados adecuados y seguros para su enfermedad. Objetivo: Identificar las necesidades percibidas por las familias del alumnado con DM1 que afecten a la integración educativa, seguridad y bienestar durante la jornada educativa. Métodos: Estudio descriptivo y transversal, mediante encuesta, basado en la información y opiniones proporcionada por las familias de los 362 pacientes entre 3 y 16 años con DM1, registrados en la historia de salud del Sistema Sanitario Público de Extremadura. Resultados: Tasa de respuesta del 56,9% (206). El 35% del alumnado con DM1 estaba en tratamiento con infusión subcutánea continua de insulina. El 95,1% precisó medir la glucemia y el 57,8% administrarse insulina durante la jornada escolar. Un 88% presentó buena adaptación al colegio y el 87,4% no describió ningún tipo de trato discriminatorio. El 82% de centros dispuso de glucagón y en un 43,7% hubo alguna persona adulta entrenada para administrarlo. Un 21,4% de familias pensaban que los profesores podían reconocer una hipoglucemia. El 29,1% desconocían la existencia de protocolos de coordinación en centros educativos, el 58,7% alegaron que la información en el centro sobre diabetes fue poca y un 77,2% que su control mejoraría con más formación del profesorado. Conclusiones: Existen aspectos óptimamente cubiertos en la atención al alumnado con DM1 en los centros educativos de Extremadura. Las situaciones con margen de mejora son la adherencia al protocolo de coordinación, la información sobre la diabetes y el adiestramiento de adultos ante emergencias.

Regular physical exercise, in type 1 diabetes should provide cardiovascular protection and immunomodulatory properties, but the complex interaction between the effects of exercise on carbohydrate metabolism and exogenous insulin therapy is a real challenge. Aerobic exercise due to muscle contraction decreases blood glucose, leads to a state of relative hyperinsulinemia and generates hypoglycemia at the beginning or after, while anaerobic exercise is associated with hyperglycemia by increased catecholamines and increased lactate that promotes hepatic neoglycogenesis. The deterioration of the counterregulatory hormone response existing in type 1 diabetes amplifies glycemic variability and hinders metabolic control. There are guidelines and recommendations that seek to provide a safe framework for prescription of physical activity considering the multiplicity of sports disciplines, age and chronic complications before starting the activity. The therapeutic strategies are adjustment of carbohydrates intake, pre and post exercise of insulin therapy and intensive control of blood glucose and ketones. New insulin pump infusers and glycemic monitoring offer the possibility of split and/or suspend the insulin dose, becoming the gold standard among high performance athletes. Normal glycemic control, effortless will be possible in near future, thanks to the development of integrated models with intelligent exercise calculators, predictive capacity and “individualized learning” (artificial pancreas) that will optimize and multiply the benefits of exercise.

Copyright of Revista Mexicana de Endocrinología, Metabolismo y Nutrición is the property of Publicidad Permanyer SLU and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Revista de la ALAD is the property of Publicidad Permanyer SLU and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Introduction: The global increase in the prevalence rates of overweight or obesity has also affected patients with type 1 diabetes (T1D), where this disease had traditionally been associated with a lean phenotype. On the other hand, the effect of obesity on new glycemic control metrics obtained from continuous glucose monitoring (CGM) in T1D is poorly understood. We wanted to assess whether there is any relationship between BMI (body mass index) and the different CGM metrics or HbA1c., Methods: Two hundred and twenty-five patients with T1D (47.1% ♀, mean age 42.9±14.7 years) with a CGM for a minimum of 6 months were analysed by downloading their CGM and collecting clinical and anthropometric variables., Results: 35.1% (79/225) of the T1D patients had overweight and 17.3% (39/225) lived with obesity, while the remaining 47.6% had a normal weight. A negative correlation was found between GMI (glucose management indicator) and BMI (-0.2; p=0.008) and HbA1c (-0.2; p=0.01). In contrast, a positive correlation was observed between the total dose of insulin and the BMI (0.3; p<0.0001). No significant correlations were found between BMI and other CGM metrics., Conclusions: Overweight or obesity do not imply worse glycemic control in patients with T1D or less use of CGM. Possibly, and in order to achieve a good glycemic control, more units of insulin are necessary in these patients which, in turn, makes weight control more difficult., (Copyright © 2024 SEEN and SED. Published by Elsevier España, S.L.U. All rights reserved.)

RESUMEN Introducción: La prueba de tolerancia de comida mixta es considerada la prueba de oro para la medición de la producción de insulina endógena en pacientes con diabetes tipo 1. Objetivo: Determinar la utilidad de la prueba de tolerancia de comida mixta con Nutrial I para evaluar la función de las células β en diabéticos tipo 1 de diagnóstico reciente y la relación de esa función con algunas características clínicas y bioquímicas. Métodos: Se estudiaron variables bioquímicas como la glucemia, hemoglobina glucosilada (HbA1c), péptido C y fracciones lipídicas. La prueba de tolerancia de comida mixta con Nutrial I se aplicó a 18 sujetos con diabetes tipo 1 de diagnóstico reciente y a 8 voluntarios con edades comprendidas entre 19 y 35 años. El consumo del suplemento Nutrial I se calculó según el peso del paciente. Se obtuvieron muestras para glucemia y péptido C a los -10, 0, 30, 60, 90 y 120 minutos. Resultados: Se observaron concentraciones elevadas de glucemia y disminuidas de péptido C durante la prueba de tolerancia de comida mixta en los diabéticos tipo 1 de diagnóstico reciente, en comparación con los voluntarios, así como, diferencias en las áreas bajo la curva de péptido C (AUC-pc) (p= 0,001). En los diabéticos tipo 1 de diagnóstico reciente se evidenció una correlación negativa entre el AUC-pc con los niveles de glucemia en ayunas (r= -0,747; p ( 0,0001) y la HbA1c (r= -0,535; p= 0,022). Por el contrario, se encontró una correlación positiva entre el AUC-pc y el péptido C en ayunas (r= 0,722; p= 0,001). El AUC-pc después de la prueba de tolerancia de comida mixta es mayor en los sujetos con glucemia en ayunas si GA < 7 mmol/L con respecto a los sujetos con glucemia en ayunas ( 7 mmol/L (p= 0,012). Conclusiones: El empleo del Nutrial I en la prueba de tolerancia de comida mixta fue útil en la evaluación de la función de las células β en diabéticos tipo 1 de diagnóstico reciente. Los valores bajos de glucemia en ayunas durante esta prueba son marcadores indirectos de una función residual de células ( más conservada en los diabéticos tipo 1 de diagnóstico reciente.

Los autoanticuerpos son proteínas producidas en el organismo por la inducción de un antígeno propio del individuo el cual no reconocen y rechazan. Su aparición en sangre puede iniciarse tiempo antes de la presentación de síntomas o signos. El deterioro funcional de dos o más glándulas es una afectación endocrinológica múltiple que puede asociarse con otras patologías autoinmunes no endocrinas, tales como vitiligo, alopecia areata, gastritis autoinmune y anemia perniciosa. Se clasifica en tres síndromes poliendocrinos autoinmunes (SPA). En Europa la incidencia del tipo I es menor a 1:100000 por año y los 2 y 3 varían entre 1–2:100000 por año. Colombia no cuenta con registros que permitan calcularla. Se reporta el caso de un hombre de 18 años diagnosticado con hipotiroidismo autoinmune, a los 15 años de edad debutó con cetoacidosis diabética y a los 17 con posterior aparición de vitiligo. El manejo inicial se realizó con levotiroxina sódica y análogos de insulina. Este caso corresponde a un SPA tipo IIIA, ya que cursa con hipotiroidismo autoinmune, diabetes mellitus y como último hallazgo cronológico la asociación con vitiligo. La detección de una endocrinopatía autoinmune en pacientes jóvenes debe alertar sobre la posible existencia de un SPA.

As atuais orientações em saúde preconizam a responsabilização dos individuos com condição crónica para o autocuidado, destacando o papel fundamental dos profissionais de saúde na sua capacitação e educação para as competências de autogestão. Nos ultimos anos a literatura tem destacado os programas de educação para a autogestão da condição crónica como uma abordagem holistica que envolve não só as necessidades especiais de saúde (tratamentos terapêutica e funcionalidade), como também as necessidades psicoafetivas e sociais. A evidência comprova a efetividade das intervenções psicoeducativas e destaca o programa de educação para a autogestão da condição crónica de Kate Lorig “Expert Patients Programme” que demonstrou ser eficaz em adultos e idosos pelos benefícios para a saúde, redução das hospitalizações e complicações, aumento significativo na adesão ao regime terapêutico e melhoria na qualidade de vida relacionada com a saúde e bem-estar, programa que foi adaptado e validado quanto à sua efetividade para adolescentes com Spina Bifida (SB)(Malheiro 2015). Deste modo, com base no programa de educação para adolescentes com SB, propomo-nos adaptar este programa, que utiliza pares peritos como educadores, para adolescentes com Diabetes Mellitus Tipo 1 (DM1), implementar e avaliar a sua efetividade nas competencias de autogestão, qualidade de vida, conhecimentos, autoeficácia e HbA1c. O programa distingue-se pela natureza inovadora das metodologias e estratégias utilizadas como o regime de tutoria entre pares (persuasão social), os Lay Led’s (educação por jovens adultos peritos na autogestão DMI) e pelas estratégias psicopedagógicas utilizadas nas sessões (questionamento, brainstorming, técnica de resolução de problemas, roleplaying, a automonitorização, a modelagem e o plano de ação).

Objetivo: se busca poner de manifiesto las tensiones que surgen en una institución pública de salud de San Miguel de Tucumán, Argentina en relación con la atención y el tratamiento de la diabetes tipo 1. Método: las reflexiones del presente trabajo muestran las conclusiones alcanzadas a partir de un enfoque cualitativo, de abordaje etnográfico en el Ciclo de Talleres de Nutrición llevados a cabo en el Hospital del Niño Jesús de San Miguel Tucumán, Argentina durante el 2016. Los talleres mencionados estaban destinados a pacientes diabéticos -niñas, niños y adolescentes- y a sus padres y madres. La información fue obtenida a través de la observación participante, de entrevistas en profundidad realizadas a pacientes, padres, madres y personal del equipo de salud y del análisis de las producciones escritas realizadas en los talleres. Resultados: se observa que existen representaciones e intereses diferentes entre los grupos de personas involucrados, lo que se traduce en dificultades en la comunicación. Se advierte una concepción adultocéntrica de la infancia que no atiende al presente de las y los pacientes y que les trata más como “objetos” de atención que como “sujetos”; esto ocurre en el marco de una cultura institucional que no apoya a su personal en el desarrollo de experiencias de atención alternativas como el dispositivo de talleres. Conclusiones: se plantea la necesidad de resignificar los modos de entender la salud, la enfermedad y la infancia en el contexto de una enfermedad crónica para ayudar en la adherencia al tratamiento.

Introduction: type 1 diabetes mellitus (dM1) is one of the most common chronic diseases in childhood and it is relevant in public health. european studies have reported an increase in the incidence and prevalence rate of dM1 in recent years, with a mean around 17.69/100,000 inhabitants/year. range of diabetic ketoacidosis debut corresponds to 25-40% of the cases. Objectives: to evaluate the casuistic of dM1 in the university hospital of gandia, spain, and to calculate the incidence of dM1 among the pediatric patients of the health department, to define the epidemiological and clinical-analytical characteristics of dM1, to analyse possible etiological factors and the diagnostic-therapeutic approach and to implement the necessary health service planning. Methods: descriptive and prospective-retrospective study which includes data of all patients <15 years with dM1 debut attended between January 2004 and december 2017. the data was obtained from the dM1 institutional register. Results: global incidence rate:15.8 cases/100,000 inhab/year, similar distribution by sex, 92.5% spaniards and 7.5% foreigner patients. Mean age: 8.1±4 years. Predominance during winter-autumn seasons. Family background of diabetes in 56%. comorbidity in 26,8%, mainly thyroiditis. Anti-gAd antibodies or other positive antibodies in 86.5%. ph values at admission:7.3±0.1 and hbA1c 10.7±2.7. 39.4% presented with ketoacidosis. Conclusions: global incidence rate is similar to others reports. the ketoacidosis rate at debut was high, although decreased during the last 5 years. A high percentage of patients with positive antibodies, family history and other associated autoimmune pathologies was found. [ABSTRACT FROM AUTHOR]

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Albuminuria is an early marker of the kidney disease, its diagnosis is defined when the range of albumin/creatinine is greater than 30 mg/g and persists in at least two or three determinations like in the adult population. The conclusions of various pediatric studies are contradictory, some find associations between obesity, cardiovascular risk factors and albuminuria and others not. It is suggested that urinary albumin excretion may be increased in children with normal weight vs obese children, likely caused by increased physical activity in children with normal weight compared with obese children. A study in adolescents with type 2 diabetes, observed that those presenting albuminuria, developed kidney insufficiency in the early adulthood. In type 1 diabetes, screening is recommended for microalbuminuria annually after 10 years old or at 5 years from the onset of disease and in type 2 diabetes at the moment of diagnosis.

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The current health guidelines aim to increase the responsibility of people with chronic conditions to self-care, emphasizing the important role of health professionals on their empowerment and self-management skills education. The literature has highlighted educational programs for self-management of chronic condition as an holistic approach involving not only special health needs (treatment, therapy, physical well-being and functionality) but also the emotional, psychological and social needs. Some authors have proposed the use of self-management educational programs emphasizing the importance of the use peers, "lay-Led's", (self-management experts on the same chronic illness) as mentors on programs, like Lorig and Holman with adults and elderly population, and Malheiro with adolescent's with spina bifida (Malheiro 2015). These programs have shown to be effective, with positive health outcomes, such as an improvement on adherence to therapy, functionality, and decrease the use of emergency services and hospitalizations and reducing health costs. Thus, based on the education program designed by Malheiro we propose to adapt and implement this education program for self-management to adolescents with diabetes type 7 (DMi), using lay-led as educators, and evaluate their effectiveness on self-management competences, quality of life, self-efficacy, knowledge and HbAic. This is a project distinguished by the innovative methodologies and strategies used like: mentoring between peers (social persuasion); lay led's (modeling) and the psychoeducational strategies used in the sessions (e.g. questioning, brainstorming, problem solving, roleplaying, self-monitoring). [ABSTRACT FROM AUTHOR]

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Steel Magnolias (1989) shows viewers the human side of illness. It places us in contact with the ability of certain people to carry on a normal life in the face of chronic illness and its negative repercussions on one’s health. The main character, who suffers from diabetes, tries to live a life without limitations in a constant battle against the barriers that her disease creates and always puts her happiness before the fatal consequences that her acts may give rise to.

Introduction: Results from our laboratory (Bombicino et al., 2016, 2017) have shown that sustained hyperglycemia for 25 days leads to generalized cardiac mitochondrial dysfunction that includes reduction of tissue and mitochondrial O2 consumption, complexes I-III, II-III and IV activities, ATP production, ADP/O, and Mn-SOD activity; accompanied by enhancement of H2O2, NO and ONOO- generation rates, in addition to the triggering of mitochondrial biogenesis, although the "new" cardiac mitochondria of diabetic animals show structural alterations. This mitochondrial dysfunction occurs in the absence of hypertrophy and of changes in resting cardiac performance, but with cardiac compromise after a work overload, suggesting that mitochondrial dysfunction precedes myocardial failure in diabetic patients. Aim: To study the early events and to analyze the cardiac mitochondrial dysfunction time course in a type 1 Diabetes Mellitus model. Materials and methods: Diabetes was induced by Streptozotocin (STZ, single ip dose, 60 mg/kg) in male Wistar rats. Glycemia was measured at 72 h (C: 127 ± 5, DM: 415 ± 23 mg/dl). Animals were sacrificed 7, 10 or 14 days after STZ-injection (4, 7 or 11 days of hyperglycemia) and hearts were removed. Mitochondrial function and biogenesis, reactive oxygen and nitrogen species generation and redox state were determined

Introduction: Pancreas transplant alone (PTA) restores glycemic control with exogenous insulin independence in the after transplantation (posTx) in patients with type 1 diabetes mellitus (T1D). Between an 8% and 10% of the pancreas transplants cases are PTA. Advances in surgery techniques and immunosuppression improved the results of PTA. According to the International Registry on Organ Donation and Transplantation, survival increased to 5 years, to both the patient and the graft, 86% and 60%, respectively. Objectives: Evaluate the metabolic PTA results in patients with T1D from the institutional Pancreatic Transplant Program. Materials and Methods: Descriptive, observational study, in 5 T1D patients with PTA, made from 2015 to 2020; 3 were women, age 41±7 (range: 35 to 52 years old), diagnosed with T1D for 26±11 years. Pre-emptive transplant (preTx) insulin therapy, 4 with insulin infusion and 1 with MDI. PTA indication: 80% for diabetic retinopathy and metabolic lability, and 20% for psychological incapacity for insulin therapy. Donors’ age: 23.3±4.4 years, ischemic time: 10.8 hours. Pancreases were transplanted in the right iliac fossa, intraperitoneal, with anastomosis to iliac vessels. Quantitative variables with mean and standard deviation and qualitative variables with absolute frequencies are described. Correlation tendencies were calculated with Pearson’s correlation coefficient.

Introduction and Objective: The Clinical Practice Guidelines in diabetes establish precise clinical objectives on the good management of the disease, but little is known about adequate compliance in our environment. Being overweight and sedentary have generated stigmas of metabolic syndrome in the population with DM1. We evaluated compliance with 5 of these criteria: HbA1c

Introduction: Diabetes concerns family, given that the changes in the lifestyle of the diagnosed person demand family support, accompaniment in decision making, and abilities and skills for the adequate management of the disease. The Family APGAR questionnaire is useful in identifying families at-risk and it reflects the patient’s perception on the functional state of the family. Objectives: Evaluating family functionality through the FAMILY APGAR and its relationship with metabolic control and quality of life in people with type 1 diabetes. Materials and methods: People with type 1 diabetes and between 16 and 65 years old assisted by diabetologists in private practices and hospital services in Corrientes, Argentina. Validated and self-administered Family APGAR questionnaire, with 5 questions in a Likert-like scale from 0 to 4. The Diabetes-Specific Quality of Life Scale (DSQOLS). Glycated hemoglobin from the last year. Statistical analysis: Measures of positions and dispersion. Chi-Squared Test. The Pearson’s linear correlation coefficient and the Spearman’s correlation coefficient. The Cronbach's coefficient alpha and the intraclass correlation coefficient.

Introduction: Eating disorders (ED) are more prevalent among adolescents with type 1 diabetes compared to healthy adolescents. This association is worrying since it generates poor metabolic control and therefore increases the risk of developing the complications of diabetes, increasing the risk of mortality by three times (4). This is why early detection and proper management ofED in this population at risk represents a relevant aspect in their care. Objective: We examined the clinical utility of the DEPSR (diabetes eating problem surveyrevised) survey, a short selfreport questionnaire developed for patients with type 1 diabetes, in order to identify adolescents at risk. We also analysed whether other variables including clinical, psychosocial and conflict characteristics in relation to diabetes management are associated with a positive DEPS-R screening survey. Methods: Transversal, observational, analytical design study. Thirtythree adolescents with type 1 diabetes aged between 10 and 18 years old participated in an outpatient control of the Diabetes Service of the Hospital Pediátrico Dr Humberto Notti during the month of September 2019. All participants completed the DEPSR screening survey as well as a questionnaire regarding psychosocial characteristics and conflict around diabetes management (Diabetes Family Conflict Scale Revised DFCSR). The clinical variables were obtained from the participants' medical records. Differences were examined between the groups with positive (score greater than 20) and negative DEPR. Adolescents who submitted a positive screening survey were offered a referral to a specialized eating team for further evaluation.

Introduction: The family function is the capacity a family has to satisfy the need of its members and to adapt to the situations of change, such as the diagnosis of type 1 Diabetes in one of the members. The Family APGAR is a fast and simple technique to explore family function, developed by Smilkstein in 1978. It is a tool used to approach the perception on family support from the point of view of the people with the disease. Measuring the family function with the impact of T1D will enable to carry forward the strategies to approach the problematic that help with treatment adherence and in having a better life quality. Objectives: Validating the Family APGAR questionnaire in people from 16 to 65 years old with type 1 diabetes in Argentina. Materials and Methods: A transversal, descriptive study, applying the Family APGAR questionnaire in people with type 1 diabetes between 16 and 65 years old, done through email or WhatsApp with a GoogleDocs form, sent by diabetologists from different parts of Argentina and which is made up of 5 questions in a Likert-like scale from 0 to 4. An informed consent was signed in the same form. The interpretation of the instrument is that with higher score, better perception of family functioning. Information was collected about diabetes diagnosis history, age and latest HbA1c levels. The analysis was made with Spearman's correlation coefficient, Cronbach's coefficient alpha and the degree of coherence between the measurements with the intraclass correlation coefficient.

Background: Despite recent technological advances, optimal glycemic control remains a challenge in people with type 1 diabetes (T1D). Hybrid closed loop (HCL) system with algorithm-derived automated adjustment of insulin delivery aims to improve glycemic control. Aim: To evaluate the effectiveness of HCL on glycemic control in subjects with T1D Methods: Prospective observational registry, that included consecutive patients with T1D that initiated treatment with MiniMed™ 670G system in Argentina. Baseline and follow up visits at days 7, 28 and 90 days were carried out and data was downloaded in each visit.

Background: There are 303 new known cases of children and adolescents (0-19) with type 1 diabetes in Portugal, only in the year 2014, and more than 79000 new cases worldwide in 2013. The incidence of this chronic condition is rising, and the technological and medical advances in the last years allow for the well-being of individuals who, in other conditions, would not have survived. Health interventions directed to the adolescent with type 1 diabetes aim to motivate and facilitate self -management transition from caregiver to self, having the specificity of the adolescents in mind. The caregiver plays an essential role in this transition. His control and support should not end abruptly at the beginning of the adolescence, but slowly become an orientation that respects the young person’s autonomy. Type 1 diabetes has always been a widely studied subject, and the interventions directed specifically to the adolescence period are one of the focus on recent papers. Methodology: This scoping review was carried out according to of the Joanna Briggs Institute Reviewers’ Manual (2015). Initial search, including JBI Database of Systematic Reviews and Implementation Reports, CINAHL and MEDLINE, revealed there is not a scoping or a systematic review (published or in progress) about this subject. The objective of this review is to identify and map the knowledge about the self-management development process in adolescents with type 1 diabetes. It takes into account the perspectives of adolescents (aged 10-18) with type 1 diabetes and their parents/caregivers. It also includes the perspectives of health professionals and young adults (aged 18-25) with type 1 diabetes, where the participants are considered experts in their chronic condition. Results: Six main categories of factors considered as barriers or facilitators in the development process of self-management in adolescents with type 1 diabetes could be found: Adolescent Self; Family; School; Peers; Health Care and type 1 diabetes evolution/Health regimen. Interventions can be adopted by health professionals in order to surpass identified challenges to self -management. Further investigation is needed on the matter, and focus groups are recommended for adolescents, caregivers and young adults regarding this theme.