RESUMO

BACKGROUND AND AIMS: Evidence supports the efficacy and safety of the Hybrid Close loop (HCL) system in patients with type 1 diabetes (T1D). However, limited data are available on the long-term outcomes of patients on HCL with telemedicine follow-up. METHODS: A prospective observational cohort study including T1D patients, who were upgrading to HCL system. Virtual training and follow-up were done through telemedicine. CGM data were analyzed to compare the baseline time in range (TIR), time below range (TBR), glycemic variability and auto mode (AM), with measurements performed at 3, 6 and 12 months. RESULTS: 134 patients were included with baseline A1c 7.6% ± 1.1. 40.5% had a severe hypoglycemia event in the last year. Baseline TIR, measured two weeks after starting AM was 78.6 ± 9.94%. No changes were evident at three (Mean difference - 0.15;CI-2.47,2.17;p = 0.96), six (MD-1.09;CI-3.42,1.24;p = 0.12) and 12 months (MD-1.30;CI-3.64,1.04;p = 0.08). No significant changes were found in TBR or glycemic variability throughout the follow-up. Use of AM was 85.6 ± 17.5% and percentage of use of sensor was 88.75 ± 9.5% at 12 months. No severe hypoglycemic (SH) events were reported. CONCLUSIONS: HCL systems allow to improve TIR, TBR and glycemic variability safely, early and sustained up to 1 year of follow-up in patients with T1D and high risk of hypoglycemia followed through telemedicine.

Assuntos

Diabetes Mellitus Tipo 1 , Hipoglicemia , Telemedicina , Humanos , Diabetes Mellitus Tipo 1/etiologia , Insulina/uso terapêutico , Glicemia , Estudos Prospectivos , Sistemas de Infusão de Insulina/efeitos adversos , Hipoglicemiantes/uso terapêutico , Hipoglicemia/etiologia , Hipoglicemia/induzido quimicamente , Automonitorização da Glicemia

RESUMO

Modern Density Functional Theory models are now suitable for many molecular and condensed phase studies. The study of noncovalent interactions, a well-known drawback, is no longer an insurmountable obstacle through design and empirical corrections. However, using empirical corrections as in the DFT-D methods might not be an all-in-one solution. This work uses a simple system, X2 -H2 O with X = Cl or Br, with two different interactions, halogen-bonded (XB) and hydrogen-halogen (HX), to investigate the capability of current density functional approximations (DFA) in predicting interaction energies with eight different exchange-correlation functionals. SAPT(DFT) provides, for all the studied cases, better predictions than the widely used supermolecular approach. In addition, the components of the interaction energy suggest where some of the shortcomings originate in each DFA. The analysis of the functionals used confirms that PBE0 and ω-B97X-D have a physically correct behavior. Using SAPT(DFT) and PBE0, and ω-B97X-D, we obtained the interaction energy of Cl2 and Br2 inside different clathrate cages and satisfactorily compared with wavefunction results; hence, the lower and upper limits of this value are defined: Cl2 @512 , -5.3 ± 0.3 kcal/mol; Cl2 @512 62 , -5.5 ± 0.1 kcal/mol; Br2 @512 62 , -7.6 ± 1.0 kcal/mol; Br2 @512 63 , -10.6 ± 1.0 kcal/mol; Br2 @512 64 , -10.9 ± 0.8 kcal/mol.

RESUMO

BACKGROUND AND AIMS: In Colombia, the government established mandatory isolation after the first case of COVID-19 was reported. As a diabetes care center specialized in technology, we developed a virtual training program for patients with type 1 diabetes (T1D) who were upgrading to hybrid closed loop (HCL) system. The aim of this study is to describe the efficacy and safety outcomes of the virtual training program. METHOD: ology: A prospective observational cohort study was performed, including patients with diagnosis of T1D previously treated with multiple doses of insulin (MDI) or sensor augmented pump therapy (SAP) who were updating to HCL system, from March to July 2020. Virtual training and follow-up were done through the Zoom video conferencing application and Medtronic Carelink System version 3.1 software. CGM data were analyzed to compare the time in range (TIR), time below range (TBR) and glycemic variability, during the first two weeks corresponding to manual mode with the final two weeks of follow-up in automatic mode. RESULTS: 91 patients were included. Mean TIR achieved with manual mode was 77.3 ± 11.3, increasing to 81.6% ± 7.6 (p < 0.001) after two weeks of auto mode use. A significant reduction in TBR <70 mg/dL (2,7% ± 2,28 vs 1,83% ± 1,67, p < 0,001) and in glycemic variability (% coefficient of variation 32.4 vs 29.7, p < 0.001) was evident, independently of baseline therapy. CONCLUSION: HCL systems allows T1D patients to improve TIR, TBR and glycemic variability independently of previous treatment. Virtual training can be used during situations that limit the access of patients to follow-up centers.

Assuntos

COVID-19/epidemiologia , Diabetes Mellitus Tipo 1/epidemiologia , Diabetes Mellitus Tipo 1/terapia , Sistemas de Infusão de Insulina , Educação de Pacientes como Assunto/métodos , Telemedicina/métodos , Adolescente , Adulto , Idoso , Automonitorização da Glicemia/métodos , COVID-19/prevenção & controle , Estudos de Coortes , Colômbia/epidemiologia , Feminino , Seguimentos , Humanos , Hipoglicemiantes/administração & dosagem , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Adulto Jovem

RESUMO

Ruthenophanes have been recognized as potential candidates to the design of electrically conducting polymers, particularly due to their electrochemical, structural, and spectroscopic properties. The comprehension and rationalization of the metal-ligand interaction is fundamental to pave the way for future applications as the design of new conducting materials. For that reason, this investigation sheds light on the electronic details behind the cation-π interactions present in ruthenophanes by using [Ru(η6-C16H16)(NH3)3]2+ as a model. Zeroth-order symmetry-adapted perturbation theory (SAPT0) shows the interaction Ru(II)-[2.2]paracyclophane with a predominant covalent character. However, the hapticity analysis of [2.2]paracyclophane shows only two predominantly covalent Ru-C bonds, as highlighted by the total energy density, H(r), in the bond critical point (BCP) obtained from quantum theory of atoms in molecules (QTAIM) method, and by second-order stabilization energy, ΔE(2), related to the processes: π C-C → dσ or dπ Ru, achieved in the natural bond orbital (NBO) method. The other two Ru-C chemical bonds show a largely electrostatic character, as can be visualized from the delocalization index, DI, between the electron basins in the electron localization function (ELF) method. Remarkably, the interacting quantum atoms (IQA) method showed practically the same value of the total interaction energy, E[Formula: see text], between Ru and these C atoms and, then, corroborates the hapticity four of the ligand: [2.2]paracyclophane. Source function distribution presents a correlation with the electronic interactions between different groups in [Ru(η6-C16H16)(NH3)3]2+. Graphical Abstract The nature of the interactions between [Ru(NH3)3]2+ and [2.2]paracyclophane in [Ru(η6-C16H16)(NH3)3]2+ was investigated with different methods of energy decomposition and electron density analysis. This interaction has a predominantly covalent character. It was possible to observe that some Ru-C interactions have a larger covalent character, in contrast for other that are mainly ionic.

RESUMO

Continuous glucose monitoring (CGM) is a tool that allows constant evaluation of glycemic control, providing data such as the trend and fluctuation of interstitial glucose levels over time. In clinical practice, there are two modalities: the professional or retrospective and the personal or real-time CGM (RT-CGM). The latest-generation sensors are more accurate and sensitive for hypoglycemia, improving adherence to self-monitoring, which has allowed optimizing glycemic control. The development of algorithms that allow the suspension of the infusion of insulin during hypoglycemia gave rise to the integrated therapy or sensor-augmented insulin pump therapy with low glucose suspend, which has proven to be an effective and safe alternative in the treatment of diabetic patients with high risk of hypoglycemia. The objective of this review is to present the evidence of the advantages of RT-CGM, the clinical impact of integrated therapy, and cost-effectiveness of its implementation in the treatment of patients with diabetes mellitus.