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Objective: To evaluate whether use of a culturally adapted mobile application (app) for adolescents with type 1 diabetes is associated with improved metabolic control. Methods: The Dominican Republic's National Institute of Diabetes, Endocrinology, and Nutrition and the Learning to Live clinic recruited 23 pediatric participants for the study. Blood tests were performed before and after use of the app for a period of 3 months. Based on the user profile, participants were encouraged to use the app's bolus insulin calculator after each meal. The app included a list of regionally and culturally specific foods, color-coded to indicate a high glycemic index (GI) as red; medium GI as yellow; and low GI as green. The color-coding was designed to assist participants in making healthier eating choices. Results: There were statistically significant improvements in lipid profile. Mean high-density lipoprotein values rose to acceptable levels, while low-density lipoproteins and triglyceride levels fell to the recommended values. The overall quality of life increased, although glycated hemoglobin levels showed no statistically significant changes. Conclusion: The findings of this study suggest that using this culturally tailored app can help young patients with type 1 diabetes to improve metabolic health.

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BACKGROUND: Low adherence to the number of insulin injections and glycemic variability are among the challenges of insulin therapy in type 1 diabetes (T1D). The TOP1 study investigated the effect of switching from twice-daily (BID) basal insulin to once daily (OD) insulin glargine 300 U/mL (Gla-300) on glycemic control and quality of life. METHODS: In this 28-week, phase 4 trial, people with T1D aged ≥ 18 years, who were treated with BID basal insulin in combination with prandial rapid-acting insulin for at least 1 year, and had HbA1c between 7.5% and 10.0%, were switched to Gla-300 OD as basal insulin. The present study aimed to evaluate the impact of this change on HbA1c, glycemic profile, treatment satisfaction and safety. The change in HbA1c from baseline to Week 24 was the primary endpoint. RESULTS: One hundred and twenty-three people with T1D (mean age 37 ± 11 years; 54.5% female) were studied. The disease duration was 20.0 ± 9.8 years, baseline HbA1c and fasting plasma glucose (FPG) were 8.6 ± 0.7% and 201 ± 80.3 mg/dL, respectively. After switching from BID to OD insulin regimen, no significant change in HbA1c was observed from baseline to Week 24 (p = 0.873). There were significant reductions in fasting self-monitoring blood glucose (SMBG) from baseline to Week 24 (175 ± 42 vs. 156 ± 38 mg/dL; p < 0.0001), and in glycemic profile (8-point SMBG) at several time points. There was a significant decrease in the proportion of patients with at least one hypoglycemic event (p = 0.025), in numbers of hypoglycemic events per patient-years of any type (p = 0.036), symptomatic (p = 0.007), and confirmed ≤ 70 mg/dL events (p = 0.049) from run-in to the last 4 weeks on treatment. There were significant improvements in treatment satisfaction (p < 0.0001), perceived hyperglycemia (p < 0.0001) scores and satisfaction with the number of injections between post-run-in and Week 24, and a significant decrease in fear of hypoglycemia. CONCLUSIONS: Switch from BID basal insulin to OD Gla-300 as part of basal bolus therapy in T1D resulted in similar glycemic control as measured by HbA1c, but provided significant improvements in SMBG, daily glucose profile, a lower incidence of hypoglycemia and increased patient satisfaction. TRIAL REGISTRATION: NCT03406000.

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La diabetes mellitus tipo 1 (DM1) es una enfermedad crónica autoinmune, con una incidencia creciente a nivel mundial. Los avances en el diagnóstico y en el tratamiento de los últimos años prolongaron la esperanza de vida, aumentando así el número de adultos con DM1. Se realizó un corte transversal que incluyó 201 personas adultas con diagnóstico de DM1, afiliados activos a la prepaga institucional de un hospital de alta complejidad de Argentina a Marzo de 2020. Se consignaron las siguientes variables: edad, sexo, comorbilidades, presencia de complicaciones, control glucémico y tratamiento farmacológico. Hubo un porcentaje similar de hombres y mujeres (51,2%), con una mediana de edad de 45 años (IIC 31-59). Un tercio de la población era mayor de 65 años. La mediana de evolución desde el diagnóstico fue de 14,5 años, y la mediana de último valor de hemoglobina glicosilada fue de 7,9%. Entre las complicaciones microvasculares más frecuentes se mencionan pie diabético (18%), retinopatía (6%) y nefropatía (2%). Un 4% presentó enfermedad cardiovascular (infarto agudo de miocardio, enfermedad coronaria, accidente cerebrovascular y/o enfermedad vascular periférica). El 88% recibía tratamiento con esquema intensificado de insulina y 6% usaban infusores de insulina. En relación al tratamiento con antidiabéticos orales, solo 11% recibían metformina, mientras que el uso de otros antidiabéticos orales fue inferior al 4%. En conclusión, este estudio proporciona valiosa información sobre las características de los adultos con DM1, dado que no hay demasiados estudios que aborden esta población (AU)

Type 1 diabetes mellitus (T1DM) is a chronic autoimmune disease, with an increasing incidence worldwide. Advances in diagnosis and treatment in recent years have extended life expectancy, thus increasing the number of adults with T1DM. A cross-sectional study was conducted, including 201 adult individuals diagnosed with T1DM, active members of the institutional health plan of a high-complexity hospital in Argentina as of March 2020. The following variables were recorded: age, gender, comorbidities, presence of complications, glycemic control, and pharmacological treatment. There was a similar percentage of men and women (51.2%), with a median age of 45 years (IQR 31-59). One-third of the population was over 65 years old. The median duration since diagnosis was 14.5 years, and the median of the last glycated hemoglobin value was 7.9%. Among the most frequent microvascular complications, diabetic foot (18%), retinopathy (6%), and nephropathy (2%) were mentioned. 4% had cardiovascular disease (acute myocardial infarction, coronary artery disease, stroke, and/or peripheral vascular disease). 88% received treatment with intensified insulin regimens, and 6% used insulin pumps. Regarding treatment with oral antidiabetic drugs, only 11% received metformin, while the use of other oral antidiabetic drugs was less than 4%. In conclusion, this study provides valuable information about the characteristics of adults with T1DM, as there are not many studies that address this population (AU)

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BACKGROUND: Mesenchymal stem cell infusion and vitamin D supplementation may have immunomodulatory actions that could prolong the preservation of residual insulin secretion in patients with type 1 diabetes (T1D). Intervention with these agents after onset of T1D could favor the development of a remission phase, with potential clinical impact. We aimed to compare the presence of clinical remission (CR), glycemic control and daily insulin requirement at 6, 12, 18, 24 and 36 months after the diagnosis of T1D using IDAA1c in patients who received therapy with adipose tissue-derived mesenchymal stem cell (ASC) infusion and vitamin D supplementation and a control group. METHODS: This retrospective cohort study analyzed data from the medical records of patients with T1D diagnosed between 15 and 40 years. Partial CR was defined as an IDAA1c index < 9. Patients in the intervention group received an infusion of adipose tissued-derived mesenchymal stem cells (ASCs) within 3 months after diagnosis and supplementation with 2000 IU of cholecalciferol for 1 year, started on the day following the infusion. Partial CR was also determined using the ISPAD criteria, to assess its agreement with IDAA1c. RESULTS: A total of 28 patients were evaluated: 7 in the intervention group (group 1) and 21 in the control group (group 2). All patients in group 1 evolved with partial CR while only 46.7% of patients in group 2 had this outcome. Group 1 had a higher frequency of CR when evaluated with IDAA1c and ISPAD criteria. The mean duration of CR varied between the two criteria. Although HbA1c was similar between groups during follow-up, group 1 had a lower total daily insulin requirement (p < 0.005) at all time points. At 36 months, group 1 used 49% of the total daily insulin dose used by group 2 with similar glycemic control. CONCLUSION: The intervention with infusion of ASC + vitamin D supplementation was associated with partial CR at 6 months. Although there were no differences in CR established by the IDAA1c and ISPAD criteria after three years of follow-up, patients who underwent intervention had nearly the half insulin requirement of controls with conventional treatment, with similar glycemic control. TRIAL REGISTRATION: 37001514.0.0000.5257.

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INTRODUCCIÓN: La bioimpedancia eléctrica, fundamentada en la resistencia de los tejidos biológicos a las corrientes eléctricas, ha emergido como una herramienta clave en la evaluación de la salud metabólica y nutricional en niños y adolescentes. En este contexto, el ángulo de fase, derivado de la bioimpedancia, se destaca como un indicador que proporciona información detallada sobre la integridad celular y la distribución del agua. OBJETIVO: Investigar la asociación del ángulo de fase con la salud celular en niños y adolescentes con Diabetes Mellitus Tipo 1 (DM1). MATERIALES Y MÉTODOS: Estudio transversal que incluyó treinta niños y adolescentes con DM1 obesos DM1 y eutrófico. RESULTADOS: Los hallazgos revelaron asociaciones no significativas entre el ángulo de fase y cambios en la salud celular y la distribución del agua en pacientes con DM1. DISCUSIÓN: A pesar de la falta de asociaciones significativas, la identificación de diferencias en la composición corporal sugiere que la bioimpedancia eléctrica y el ángulo de fase podrían ser útiles para evaluar la DM1 en niños y adolescentes CONCLUSIÓN: A pesar de no encontrarse asociaciones significativas entre el ángulo de fase y cambios en la salud celular y la distribución del agua en niños y adolescentes con DM1 en este estudio, se observaron diferencias significativas en la masa magra y el porcentaje de grasa corporal entre los grupos de pacientes. Estos hallazgos sugieren que la bioimpedancia eléctrica y el ángulo de fase podrían ser herramientas útiles para evaluar la composición corporal en esta población. Se requieren investigaciones adicionales para confirmar estos resultados y explorar más a fondo el papel del ángulo de fase en la evaluación de la DM1 en niños y adolescentes.

ABSTRACT: INTRODUCTION: Bioelectrical impedance, based on the resistance of biological tissues to electrical currents, has emerged as a key tool in assessing metabolic and nutritional health in children and adolescents. In this context, phase angle, derived from bioimpedance, stands out as an indicator that provides detailed information on cellular integrity and water distribution. OBJECTIVE: To investigate the association of phase angle with cellular health in children and adolescents with Type 1 Diabetes Mellitus (T1DM), MATERIALS AND METHODS: A cross-sectional study that included thirty children and adolescents with obese and eutrophic T1DM. RESULTS: The findings revealed non-significant associations between phase angle and changes in cellular health and water distribution in T1DM patients. DISCUSSION: Despite the lack of significant associations, the identification of differences in body composition suggests that bioelectrical impedance and phase angle could be useful for evaluating T1DM in children and adolescents. CONCLUSION: Despite not finding significant associations between phase angle and changes in cellular health and water distribution in children and adolescents with Type 1 Diabetes Mellitus (T1DM) in this study, significant differences were observed in lean mass and body fat percentage between patient groups. These findings suggest that bioelectrical impedance and phase angle could be useful tools for evaluating body composition in this population. Further research is needed to confirm these results and explore more deeply the role of phase angle in the evaluation of T1DM in children and adolescents.

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Resumen Introducción. La diabetes mellitus de tipo 1 se considera una de las enfermedades crónicas más frecuentes de la infancia. Es un factor de gran riesgo de desarrollar enfermedad cardiovascular temprana y afecta también la salud ósea. Objetivo. Describir las características demográficas y los parámetros bioquímicos de una población de niños con diabetes de tipo 1, supervisados en la unidad pediátrica de diabetes de un hospital español de tercer nivel. Materiales y métodos. En este estudio retrospectivo, se determinaron los parámetros de control metabólico, lipídico y óseo en 124 niños con diabetes de tipo 1, a los que se hizo seguimiento en la Unidad Pediátrica de Diabetes del Hospital Universitario Miguel Servet de Zaragoza, desde mayo del 2020 hasta julio del 2021. Resultados. Los niños con diabetes de tipo 1 presentan peor control metabólico de la enfermedad en la pubertad, pero su control lipídico se puede considerar aceptable. Existe una correlación inversa de los marcadores de formación ósea con el tiempo de evolución de la enfermedad, así como con el control metabólico. Conclusión. Los marcadores de formación ósea se encuentran correlacionados de forma inversa con el porcentaje de hemoglobina glicosilada y con el tiempo de evolución de la diabetes. En estos pacientes, el perfil lipídico y el óseo son más favorables cuando existe un buen control metabólico de la enfermedad.

Abstract Introduction. Type 1 diabetes mellitus is considered one of the most common chronic diseases of childhood. It is a high-risk factor for developing early cardiovascular disease and it also affects bone health. Objective. To describe demographic characteristics and biochemical parameters of a population of children with type 1 diabetes, evaluated in the pediatric diabetes unit of a tertiary Spanish hospital. Materials and methods. In this retrospective study, we determined metabolic, lipid, and bone parameters in 124 children with type 1 diabetes who were monitored in the pediatric diabetes unit of the Hospital Universitario Miguel Servet in Zaragoza (Spain) from May 2020 to July 2021. Results. Children with type 1 diabetes have worse metabolic control of the disease at puberty, but their lipid control is considered acceptable. We found an inverse correlation between bone formation markers and disease duration, as well as with metabolic control. Conclusion. Bone formation markers are inversely correlated with the percentage of glycated hemoglobin and diabetes evolution time. Patients' lipid and bone profiles are more favorable when metabolic control of the disease is achieved.

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BACKGROUND: Type 1 diabetes increases the prevalence of urinary incontinence and may be responsible for additional changes to those existing in a regular gestational period. This study aimed to describe the presence and symptoms of urinary incontinence in pregnant women with type 1 diabetes. METHODS: In this Cross-sectional case control study, forty pregnant women in third gestational trimester were allocated in two equal groups - control group (CG) and type 1 diabetic group (1DMG). The patients answered the International Consultation on Incontinence Questionnaire Short Form and, to characterize the sample, they answered the Pregnancy Physical Activity Questionnaire, gynecological history and, after delivery, the newborn weight was registered. The groups were compared using the Student's T Test for parametric variables and the U-Mann Whitney Test for non-parametric variables, both at 5% probability. RESULTS: The International Consultation on Incontinence Questionnaire Short Form score (p = 0.026) is higher in 1DMG (3.95 ± 4.70) compared to CG (1.05 ± 2.23). No correlations were found between time of diagnosis, HbA1c and newborn weight in relation to ICIQ-SF and other variables in CG and 1DMG with ICIQ-SF (p < 0.05). CONCLUSION: Type 1 diabetes mellitus, in the third trimester of gestation, seem to be associated with increase in the ICIQ-SF score.

HIGHLIGHTS: No correlation between gestational characteristics and urinary incontinence symptoms.The diabetic women group had more episiotomies and abortions.The diabetic women had higher scores in the total score of the International Consultation on Incontinence Questionnaire - Short Form (ICIQ-SF).

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Given the psychosocial and economic costs of behaviors of patients who seem not to benefit from the medications, technologies, and medical therapies available for chronic diseases such as Type 1 Diabetes Mellitus, therapeutic adherence has been identified as one of the main focuses in the intervention. This paper presents contributions from semiotic cultural clinical psychology for understanding problems associated with the implementation of medical treatment in patients with Type 1 Diabetes Mellitus to explore psychological dimensions not yet reported in depth. A narrative review of 24 scientific articles published between 2012 and 2023 is carried out. The information is produced through thematic analysis, and the results are presented in three themes: 1. illness characteristics, 2. adherence and associated concepts, and 3. modes of intervention. It concludes with the development of a two-axis proposal for understanding the experience of patients that privileges psychological aspects involved in the disease and its treatment, considering the approach to the goals of treatment as dynamic and fluctuating rather than as final states.

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INTRODUCTION: Pregnancy and diabetes mellitus promote several musculoskeletal changes predisposing this population to complaints of Lower Back (LB) and Pelvic Pain (PP). OBJECTIVE: To assess the frequency of LB and PP and associated factors in type 1 Diabetic (DM1) pregnant women. METHOD: An observational analytical cross-sectional study. Thirty-six pregnant women with DM1 were evaluated through a postural assessment with a focus on pelvic positioning and what patients reported. The associated factors were assessed using the State-Trait Anxiety Inventory (STAI), the International Consultation on Incontinence Questionnaire Short Form (ICIQ-SF), and the Female Sexual Function Index (FSFI). RESULTS: The frequency of LB and PP was 55.6 % and 30.6 %, respectively. The presence of anxiety was not associated with a higher prevalence of pain. The incidence of sexual dysfunctions was higher in the GD. DM1 duration had a mean of 14.9 years (± 8.2 SD) in the GD and 9.0 years (± 6.9 SD) in the GSD, which was statistically significant (p ≤ 0.050). In the multiple binary regression analysis for the occurrence of pain, the independent factor was DM1 duration ≥ 17 years (OR = 11.2; 95 % CI = 1.02‒124.75). The association between DM1 duration ≥ 17 years and being overweight showed a probability of 95 % for the studied population in the analysis of the probabilities of occurrence of the pain event. CONCLUSION: There was a high frequency of LB and PP related to pregnancy in DM1 pregnant women in the second trimester of pregnancy. The incidence of sexual dysfunction and DM1 duration ≥ 17 years increases the chance that DM1 pregnant women will experience pain. There was no association between anxiety. urinary incontinence and pain in DM1 pregnant women.

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AIM: Physical exercise is part of the type 1 diabetes mellitus (T1DM) treatment. However, this practice is still neglected due to the wide variety of glycemic responses under the influence of anaerobic exercise. Therefore, this study aimed to investigate the influence of anaerobic exercise on biomarkers of T1DM. METHODS: The systematic review was conducted on PubMed, Lilacs, and Embase, according to PRISMA. For this purpose, three groups of descriptors were used: Adults with T1DM, anaerobic physical exercise, and glycemic control. The search filter was set to human beings older than 18 years of age, longitudinal and cross-sectional studies, with studies published from 2000 to 2023 in English, Spanish, or Portuguese. Titles and abstracts were read independently by two reviewers, and then the articles were selected for this review. The Kappa coefficient was measured to evaluate the selection. RESULTS: A total of 738 articles were identified, and five were selected to be part of the review after applying the steps of the procedure. Some benefits were observed in fatigue reduction, absence of diabetic ketoacidosis requiring hospitalization, and enhancement of glucose monitoring during exercise. In the anaerobic workouts of the groups with T1DM, glycemic mean values ranged from 124.5-185.0 mg/dl, and glycated hemoglobin records ranged from 6.7-8.1%. CONCLUSION: Anaerobic exercise improved the biomarkers of T1DM, especially glycemic control, and the reduction of symptomatic hypoglycemic episodes. Anaerobic exercise can be performed by individuals with T1DM, suggesting an individualized training prescription and encouraging its practice associated with aerobic exercise.

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The impact of diabetes on various organs failure including testis has been highlighted during the last decades. If on one hand diabetes-induced hyperglycemia has a key role in induced damages; on the other hand, glucose deprivation plays a key role in inducing male infertility. Indeed, glucose metabolism during spermatogenesis has been highlighted due to post-meiotic germ cells drastic dependence on glucose-derived metabolites, especially lactate. In fact, hyperglycemia-induced spermatogenesis arrest has been demonstrated in various studies. Moreover, various sperm maturation processes related to sperm function such as motility are directly depending on glucose metabolism in Sertoli cells. It has been demonstrated that diabetes-induced hyperglycemia adversely impacts sperm morphology, motility and DNA integrity, leading to infertility. However, fertility quality is another important factor to be considered. Diabetes-induced hyperglycemia is not only impacting sperm functions, but also affecting sperm epigenome. DNA packing process and epigenetics modifications occur during spermatogenesis process, determining next generation genetic quality transmitted through sperm. Critical damages may occur due to under- or downregulation of key proteins during spermatogenesis. Consequently, unpacked DNA is more exposed to oxidative stress, leading to intensive DNA damages. Moreover, epigenetic dysregulation occurred during spermatogenesis may impact embryo quality and be transmitted to next generations, increasing offspring genetic issues. Herein we discuss the mechanisms by which diabetes-induced hyperglycemia can affect epigenetic modifications and DNA packaging and methylation during spermatogenesis thus promoting long-lasting effects to the next generation.

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Abstract This cross-sectional study evaluated the association between salivary immunoglobulins, plaque index, and gingival index in Brazilian children with and without type 1 diabetes mellitus (DM1). The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) checklist for the reporting of observational studies was followed. The DM1 group had 38 children, and an equal number of volunteers matched by sex and age were recruited as controls. Clinical examination was performed for plaque index and gingival index determination. Non-stimulated whole saliva was collected. Concentrations of IgA, IgG, and IgM were determined by ELISA test. Data were tested by the Kolmogorov-Smirnov, Mann-Whitney, and Spearman tests and a multiple linear regression model (p<0.05) was performed. Gingival index was higher in the Control (DM1: 0.16±0.17; Control: 0.24±0.23, p=0.040). In DM1, there was a correlation between IgA and age (rho=0.371, p=0.024), IgM and IgG (rho=0.459, p=0.007), and IgM and gingival index (rho=0.394, p=0.014). In DM1, multiple linear regression showed that age (p=0.041; β=0.363), gingival index (p=0.041; β=0.398), and plaque index (p=0.008; β=-0.506) were good predictors of IgA levels in saliva. Thus, IgA was the only researched immunoglobulin that was directly associated with plaque and gingival indices in Brazilian children with DM1, but not in control subjects.

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ABSTRACT Objective: to interpret the meanings attributed to the health-related quality of life by caregivers of adolescents with type 1 diabetes mellitus. Methods: qualitative, descriptive-exploratory study of 14 caregivers of adolescents with diabetes developed at the reference outpatient clinic for endocrine diseases in a city in the state of Paraíba. Interviews were performed between May and September 2021. Inductive thematic analysis of the empirical material, and its interpretation in light of the concepts of health-related quality of life and family functioning were performed. Results: the meanings attributed by caregivers to the health-related quality of life of adolescents converged on the feeling of being healthy, healthy eating, satisfactory family income, family involvement in care and effective access to the care network. Final Considerations: knowledge of these meanings enables health professionals to develop strategies that meet the unique demands of caregivers experiencing this diagnosis.

RESUMEN Objetivo: interpretar los significados atribuídos a la calidad de vida relacionada con la salud por cuidadores de adolescentes con diabetes mellitus tipo 1. Métodos: estudio cualitativo, descriptivo-exploratorio con 14 cuidadores de adolescentes con diabetes desarrollado en el ambulatorio de referencia para enfermedades endocrinas de una ciudad del estado de Paraíba. Las entrevistas se realizaron entre mayo y septiembre de 2021. Se realizó un análisis temático inductivo del material empírico y su interpretación a la luz de los conceptos de calidad de vida relacionada con la salud y funcionamiento familiar. Resultados: los significados atribuídos por los cuidadores a la calidad de vida relacionada con la salud de los adolescentes convergieron en el sentimiento de estar sano, alimentación saludable, ingreso familiar satisfactorio, involucramiento familiar en el cuidado y acceso efectivo a la red de cuidados. Consideraciones Finales: el conocimiento de estos significados permite a los profesionales de la salud desarrollar estrategias que atiendan las demandas únicas de los cuidadores que experimentan este diagnóstico.

RESUMO Objetivo: interpretar os sentidos atribuídos à qualidade de vida relacionada à saúde por cuidadoras de adolescentes com diabetes mellitus tipo 1. Métodos: estudo qualitativo, descritivo-exploratório desenvolvido no ambulatório de referência para doenças endócrinas em uma cidade da Paraíba com 14 cuidadoras de adolescentes com diabetes. As entrevistas ocorreram entre maio e setembro de 2021. O material empírico foi submetido à análise temática indutiva e interpretado à luz dos conceitos de qualidade de vida relacionada à saúde e do funcionamento familiar. Resultados: os sentidos atribuídos pelas cuidadoras à qualidade de vida relacionada à saúde dos adolescentes convergiram para sensação de estar com saúde, alimentação saudável, renda familiar satisfatória, envolvimento da família no cuidado e acesso efetivo à rede assistencial. Considerações Finais: o conhecimento destes sentidos possibilita que os profissionais de saúde elaborem estratégias que atendam às demandas singulares de cuidadores que vivenciam esse diagnóstico.

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ABSTRACT Objective: To perform a systematic review of randomized controlled trials, evaluating the effect of probiotics, prebiotics or symbiotics supplementation on glycemic and inflammatory control in children with Type 1 Diabetes Mellitus (T1DM). Data source: The Medical Literature Analysis and Retrieval System Online (MEDLINE/PubMed), Clinical Trials, Literatura Latino-Americana e do Caribe em Ciências da Saúde (LILACS) and Scientific Electronic Library Online (SciELO) databases were searched. Randomized clinical trials of pediatric patients with DM1 using probiotics, prebiotics or symbiotics were included, regardless of year or language of publication. Studies that did not evaluate glycated hemoglobin (HbA1c) were excluded. Metabolic results (HbA1c, total insulin dose and C-peptide) and inflammatory control [interleukin-10 (IL-10), tumor necrosis factor-alpha (TNF-α) and interferon-gamma (IFN-γ)] during probiotic supplementation or similar, related to modification of the intestinal microbiota, were analyzed. PROSPERO ID: CRD42022384485. Data synthesis: Five studies were selected for a systematic review. Regarding metabolic markers, only one of the articles that analyzed HbA1c showed a significant decrease (p=0.03) in the intervention group. One study identified a reduction in the total dose of insulin and increased C-peptide levels. Regarding the evaluation of inflammatory parameters (IL-10, TNF-α, INF-γ), there were no statistical relevant modifications. Conclusions: Current data from the literature were not conclusive in identifying an improvement in glycemic control and did not observe changes in inflammatory parameters with the use of probiotics, prebiotics or symbiotics in pediatric patients with T1DM.

RESUMO Objetivo: Realizar uma revisão sistemática de ensaios clínicos randomizados controlados avaliando o efeito da suplementação de probióticos, prebióticos ou simbióticos no controle glicêmico e inflamatório em crianças com diabetes mellitus tipo 1 (DM1). Fontes de dados: As bases Medical Literature Analysis and Retrieval System Online (MEDLINE/PubMed), Clinical Trials, Literatura Latino-Americana e do Caribe em Ciências da Saúde (LILACS) e Scientific Electronic Library Online (SciELO) foram pesquisadas. Foram incluídos ensaios clínicos randomizados de pacientes pediátricos com DM1 em uso de probióticos, prebióticos ou simbióticos, independentemente de ano ou idioma de publicação. Foram excluídos os trabalhos que não avaliaram hemoglobina glicada (HbA1c). Os resultados metabólicos (HbA1c, dose de insulina total e peptídeo C) e o controle inflamatório [interleucina-10 — IL-10), fator de necrose tumoral-alfa (TNF-α) e interferon-gama (IFN-γ)] durante a suplementação de probióticos ou similares, relacionados à modificação da microbiota intestinal, foram analisados. ID PROSPERO: CRD42022384485. Síntese dos dados: Cinco estudos foram selecionados para revisão sistemática. Com relação aos marcadores metabólicos, apenas um dos artigos que analisaram a HbA1c apresentou diminuição significativa (p=0,03) no grupo intervenção. Um estudo identificou redução da dose total de insulina e aumento dos níveis de peptídeo C. Quanto à avaliação dos parâmetros inflamatórios (IL-10, TNF-α, INF-γ), não houve modificações de relevância estatística. Conclusões: Os dados atuais da literatura não foram conclusivos em identificar melhora no controle glicêmico e não observaram mudanças nos parâmetros inflamatórios com o uso de probióticos, prebióticos ou simbióticos em pacientes pediátricos com DM1.

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Resumo Objetivo Identificar os fatores que facilitam ou dificultam a construção da autonomia na adolescência através da experiência de jovens adultos com diabetes tipo 1 e seus pais. Métodos Estudo de natureza qualitativa, descritiva e exploratória. Foram realizadas duas entrevistas de grupo focal, uma com nove jovens adultos peritos na gestão de sua doença e outra com sete pais. Para análise dos dados, foram usados análise de conteúdo temática e categorial, com particularidades de entrevista de grupo focal, e recurso ao software NVIVO 12. Resultados Emergiram duas grandes categorias e dez subcategorias relativas aos fatores que facilitaram (sistemas de suporte, conhecimentos, alimentação, bomba de insulina, responsabilização precoce pela gestão da terapêutica, características dos jovens), e dificultaram (regime terapêutico, estigma, atitude dos profissionais de saúde, características dos jovens, conhecimento) o desenvolvimento da autonomia na gestão da doença. Conclusão A autonomia na gestão do diabetes envolve vários desafios aos adolescentes, o que requer adequação de atitudes e intervenções de profissionais. Além da gestão tradicional da condição de saúde, é essencial abordar temas relacionados com a socialização dos adolescentes, procurando estratégias inovadoras que promovam o coping e a qualidade de vida. Os resultados deste estudo possibilitam refletir sobre a relação terapêutica com os adolescentes, salientando a importância de individualizar cuidados e respostas inovadoras às suas necessidades específicas.

Resumen Objetivo Identificar los factores que facilitan o dificultan la construcción de la autonomía en la adolescencia a través de la experiencia de jóvenes adultos con diabetes tipo 1 y sus padres. Métodos: Estudio de naturaleza cualitativa, descriptiva y exploratoria. Se realizaron dos entrevistas de grupo focal, una con nueve jóvenes adultos expertos en la gestión de su enfermedad y otra con siete padres. Para el análisis de datos se utilizó el análisis de contenido temático y categorial, con particularidades de entrevista de grupo focal y recurso del software NVIVO 12. Resultados Surgieron dos grandes categorías y diez subcategorías relativas a los factores que facilitaron el desarrollo de la autonomía en la gestión de la enfermedad (sistemas de apoyo, conocimientos, alimentación, bomba de insulina, responsabilización temprana de la gestión de la terapéutica, características de los jóvenes) y los que la dificultaron (régimen terapéutico, estigma, actitudes de los profesionales de la salud, características de los jóvenes, conocimientos). Conclusión La autonomía en la gestión de la diabetes incluye muchos desafíos para los adolescentes, lo que requiere adaptación de actitudes e intervenciones de profesionales. Además de la gestión tradicional del estado de salud, es esencial abordar temas relacionados con la socialización de los adolescentes y buscar estrategias innovadoras que promuevan el coping y la calidad de vida. Los resultados de este estudio permiten reflexionar sobre la relación terapéutica con los adolescentes y destacar la importancia de individualizar los cuidados y las respuestas innovadoras para sus necesidades específicas.

Abstract Objective To identify the factors that facilitate or hinder the construction of autonomy in adolescence through the experience of young adults with type-1 diabetes and their parents. Methods This was a qualitative, descriptive, and exploratory study. Two focus group interviews were conducted: one with nine young adults who were experts in managing their illness and the other with seven parents. Thematic and categorical content analysis was used for data analysis, with particularities of a focus group interview and the use of the NVIVO 12 software. Results Two major categories and ten subcategories related to factors that facilitated (support systems, knowledge, diet, insulin pump, early responsibility for managing therapy, and characteristics of young people) and hindered (therapeutic regimen, stigma, attitude of health professionals, characteristics of young people, and knowledge) the development of autonomy in disease management emerged. Conclusion Autonomy in the management of diabetes involves several challenges for adolescents, which requires adaptation of attitudes and interventions by professionals. In addition to the traditional management of the health condition, addressing issues related to the socialization of adolescents is essential, looking for innovative strategies that promote coping and quality of life. The results of this study make it possible to reflect on the therapeutic relationship with adolescents, emphasizing the importance of individualizing care and innovative responses to their specific needs.

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Abstract Introduction Pregnancy and diabetes mellitus promote several musculoskeletal changes predisposing this population to complaints of Lower Back (LB) and Pelvic Pain (PP). Objective To assess the frequency of LB and PP and associated factors in type 1 Diabetic (DM1) pregnant women. Method: An observational analytical cross-sectional study. Thirty-six pregnant women with DM1 were evaluated through a postural assessment with a focus on pelvic positioning and what patients reported. The associated factors were assessed using the State-Trait Anxiety Inventory (STAI), the International Consultation on Incontinence Questionnaire Short Form (ICIQ-SF), and the Female Sexual Function Index (FSFI). Results The frequency of LB and PP was 55.6 % and 30.6 %, respectively. The presence of anxiety was not associated with a higher prevalence of pain. The incidence of sexual dysfunctions was higher in the GD. DM1 duration had a mean of 14.9 years (± 8.2 SD) in the GD and 9.0 years (± 6.9 SD) in the GSD, which was statistically significant (p ≤ 0.050). In the multiple binary regression analysis for the occurrence of pain, the independent factor was DM1 duration ≥ 17 years (OR = 11.2; 95 % CI = 1.02‒124.75). The association between DM1 duration ≥ 17 years and being overweight showed a probability of 95 % for the studied population in the analysis of the probabilities of occurrence of the pain event. Conclusion There was a high frequency of LB and PP related to pregnancy in DM1 pregnant women in the second trimester of pregnancy. The incidence of sexual dysfunction and DM1 duration ≥ 17 years increases the chance that DM1 pregnant women will experience pain. There was no association between anxiety. urinary incontinence and pain in DM1 pregnant women.

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ABSTRACT Objective. To evaluate whether use of a culturally adapted mobile application (app) for adolescents with type 1 diabetes is associated with improved metabolic control. Methods. The Dominican Republic's National Institute of Diabetes, Endocrinology, and Nutrition and the Learning to Live clinic recruited 23 pediatric participants for the study. Blood tests were performed before and after use of the app for a period of 3 months. Based on the user profile, participants were encouraged to use the app's bolus insulin calculator after each meal. The app included a list of regionally and culturally specific foods, color-coded to indicate a high glycemic index (GI) as red; medium GI as yellow; and low GI as green. The color-coding was designed to assist participants in making healthier eating choices. Results. There were statistically significant improvements in lipid profile. Mean high-density lipoprotein values rose to acceptable levels, while low-density lipoproteins and triglyceride levels fell to the recommended values. The overall quality of life increased, although glycated hemoglobin levels showed no statistically significant changes. Conclusion. The findings of this study suggest that using this culturally tailored app can help young patients with type 1 diabetes to improve metabolic health.

RESUMEN Objetivo. Evaluar si el uso de una aplicación móvil (app) para adolescentes con diabetes tipo 1, adaptada desde el punto de vista cultural, se asocia a una mejora del control metabólico. Métodos. El Instituto Nacional de Diabetes, Endocrinología y Nutrición de República Dominicana y Learning to Live Clinic reclutaron a 23 participantes pediátricos para el estudio. Se realizaron análisis de sangre antes y después de utilizar la aplicación durante un período de 3 meses. En función del perfil de usuario, se alentó a los participantes a utilizar la calculadora del bolo de insulina de la aplicación después de cada comida. La aplicación incluía una lista de alimentos propios de la región y la cultura, codificados por colores para indicar un índice glucémico (IG) alto (rojo), medio (amarillo) o bajo (verde). El código de colores se diseñó para ayudar a los participantes a adoptar opciones de alimentación más saludables. Resultados. Se observaron mejoras estadísticamente significativas en el perfil lipídico. Los valores medios de las lipoproteínas de alta densidad aumentaron hasta niveles aceptables, mientras que los niveles de las lipoproteínas de baja densidad y los triglicéridos descendieron hasta los valores recomendados. Se observó una mejora en la calidad de vida general, si bien no se observaron cambios estadísticamente significativos en los niveles de hemoglobina glucosilada. Conclusiones. Los resultados de este estudio sugieren que el uso de esta aplicación adaptada desde el punto de vista cultural puede ayudar a los pacientes jóvenes con diabetes mellitus tipo 1 a mejorar su salud metabólica.

RESUMO Objetivo. Avaliar se o uso de um aplicativo móvel culturalmente adaptado para adolescentes com diabetes tipo 1 está associado a um melhor controle metabólico. Métodos. O Instituto Nacional de Diabetes, Endocrinologia e Nutrição da República Dominicana e a clínica Learning to Live recrutaram 23 participantes pediátricos para o estudo. Foram realizados exames de sangue antes e depois do uso do aplicativo por um período de 3 meses. Com base no perfil de usuário, os participantes foram incentivados a usar a calculadora de bolus de insulina do aplicativo após cada refeição. O aplicativo incluía uma lista de alimentos específicos da região e da cultura, codificados por cores para indicar índices glicêmicos (IG) altos em vermelho; IG médios em amarelo; e IG baixos em verde. O código de cores foi criado para ajudar os participantes a fazer escolhas alimentares mais saudáveis. Resultados. Houve melhoras estatisticamente significantes no perfil lipídico. Os valores médios de lipoproteínas de alta densidade subiram para níveis aceitáveis, e os níveis de lipoproteínas de baixa densidade e de triglicerídeos caíram para os valores recomendados. A qualidade de vida geral aumentou, embora os níveis de hemoglobina glicada não tenham apresentado alterações estatisticamente significantes. Conclusão. Os resultados deste estudo sugerem que o uso desse aplicativo culturalmente adaptado pode ajudar pacientes jovens com diabetes tipo 1 a melhorar sua saúde metabólica.

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Abstract Objective Glycemic control is essential for reducing the risks of long-term complications in individuals living with type 1 diabetes mellitus. The study aimed to evaluate the relationship between glycemic control and demographic, economic, and clinical characteristics, and self-care behaviors for diabetes. Method A total of 107 people living with diabetes participated in the study. The participants completed an online self-report questionnaire containing clinical indicators and health care measures. Results The results showed that most participants did not have adequate glycemic control (based on glycated hemoglobin evaluation), especially due to difficulties in monitoring the disease and a lack of daily testing, as well as an increase in tobacco use. Low income, high body mass index, and low social class also predicted inadequate glycemic control. Conclusion It is recommended that health strategies sensitive to social inequalities and individual difficulties related to glycemic control be implemented to promote health.

Resumo Objetivo O controle glicêmico é essencial para diminuir os riscos de complicações em longo prazo de pessoas vivendo com diabetes mellitus tipo 1. O objetivo do estudo foi avaliar a relação entre controle glicêmico e características demográficas, econômicas, clínicas, e comportamentos de autocuidado para a diabetes. Método Participaram da pesquisa 107 pessoas vivendo com diabetes. Os participantes responderam um questionário de autorrelato online com indicadores clínicos e de cuidado com a saúde. Resultados Os resultados mostraram que a maioria dos participantes não possuía controle glicêmico adequado (baseado na avaliação de hemoglobina glicada), especialmente aqueles com dificuldade de monitorar a doença e pelas falhas em realizar a testagem diária e aumento do uso de tabaco. O controle glicêmico inadequado também foi predito pela baixa renda, índice de massa corporal elevado e baixa classe social. Conclusão Recomenda-se implementar estratégias em saúde sensíveis às desigualdades sociais e dificuldades individuais relacionadas ao controle glicêmico para promover a saúde.

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Abstract Antimicrobial photodynamic therapy (aPDT) is an adjuvant treatment to scaling and root planing (SRP) which improves periodontal health. It may be beneficial to patients with systemic diseases, such as type 1 diabetes mellitus. Objective This randomized clinical trial evaluated the adjunctive effect of aPDT on the periodontal treatment of patients with type 1 diabetes (T1D). Methodology 38 patients were included in the study and divided into four groups: DSRP - T1D patients treated with SRP; CSRP - normoglycemic patients treated with SRP; DPDT - T1D patients treated with SRP + aPDT (methylene blue and red laser); CPDT - normoglycemic patients treated with SRP + aPDT. , Periodontal clinical parameters and inflammatory cytokines in crevicular fluid were recorded at baseline and then after 1, 3 and 6 months. The clinical endpoint for treatment was evaluated after 6 months. Results Adjuvant aPDT treatment resulted in reduction of probing depth after 3 months (0.38 mm - p<0.05) on T1D patients and in control group after 6 months (0.66 mm - p<0.05). Reduction of clinical attachment levels was similar for both treatments in control patients (p>0.05). There was a significant reduction of TNF-α in crevicular fluid in both groups treated with aPDT (p<0.05). The T1D (65%) and normoglycemic (72%) groups achieved the clinical endpoint after both treatments (p>0.05). Conclusions Adjuvant aPDT provided additional benefits in improving periodontal clinical parameters and reducing inflammatory cytokines in both T1D and normoglycemic patients. However, normoglycemic patients showed greater clinical improvements compared to T1D patients following adjuvant aPDT treatment.

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Introduction: Insulin Infusion Sets (IIS) play a crucial role in ensuring the safe delivery of insulin through a Continuous Subcutaneous Insulin Infusion (CSII) for individuals with Type 1 Diabetes (T1D). Recent advancements in therapy have highlighted the need to address issues such as unexplained hyperglycemia and IIS occlusion. Objective: To investigate the adverse events (AEs) associated with IIS that impact the treatment of T1D, with a specific focus on promoting effective educational practices. Methods: One hundred and eighteen patients under treatment at the Diabetes Center Insulin Pump Ambulatory, Federal University of São Paulo responded to a semi-structured questionnaire. Over 6 months, a nurse researcher interviewed them via video calls. Results: Catheter-related adverse events (AEs) included catheter knots, folding, and accidental traction. AEs associated with cannula use were mainly related to cannula fixation adhesive, insulin leakage, bleeding episodes, and skin problems. The cannula patch tends to detach easily in hot conditions or when used for more than 3 days, leading to local itching. Adhesive glue can cause redness and pain. Insulin leakage typically occurs after the catheter disconnects from the cannula, accidental cannula traction, or beneath the cannula patch. Bleeding has been reported inside the cannula or at the insertion site, resulting in local pain and, in some cases, obstruction of insulin flow. When accidental cannula traction occurs, it is recommended to replace the entire IIS system. In situations involving bleeding, leakage, insulin odor, or unsuccessful attempts to correct hyperglycemic episodes with a "bolus" of insulin, it is advisable to change the IIS system and evaluate appropriate techniques for handling and infusing the device. Moreover, regular inspections of the device and reservoir/cartridge are essential. Conclusion: Serious AEs can occur even in cases where the occlusion alarm is not activated, leading to interruptions in insulin flow. Conversely, in less severe situations, alarm activation can occur even in the absence of insulin flow interruption. Accidental catheter traction and catheter bending are commonly encountered in everyday situations, while issues related to the cannula directly affect blood glucose levels. AEs related to the IIS cannula often involve insulin leakage into the skin, bleeding, and skin events attributed to adhesive issues with the cannula.