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La hipoglucemia inadvertida (HI) es una complicación del tratamiento de la diabetes mellitus tipo 1 (DM1) y DM2 tratada con insulina o sulfonilureas, que se caracteriza por una capacidad reducida para percibir el inicio de los episodios de hipoglucemia. En general, coexiste con una insuficiente respuesta hormonal contrarreguladora a la hipoglucemia denominada falla autonómica asociada a la hipoglucemia (FAAH). El desarrollo de HI y de falla contrarreguladora a la hipoglucemia aumentan significativamente el riesgo de hipoglucemias severas. Se han desarrollado escalas de puntuación para identificar, en la consulta clínica, a este grupo de personas con elevado riesgo de hipoglucemias severas. La piedra angular del tratamiento consiste en evitar las hipoglucemias mediante una intervención multifactorial de cuidados clínicos y educación estructurada.

Hypoglycemia unawereness is a complication of type 1 diabetes treatment and of type 2 diabetes treatment treated with insulin or sulfonylureas, characterized by a reduced ability to perceive the onset of episodes of hypoglycemia. In general, it coexists with an insufficient counterregulatory hormonal response to hypoglycemia called: hypoglycemia associated autonomic failure (HAAF). The development of hypoglycemia unawereness and counterregulatory failure to hypoglycemia significantly increase the risk of severe hypoglycemia. Scoring scales have been developed to identify this group of people at high risk of severe hypoglycemia in the clinic. The cornerstone of treatment is to avoid hypoglycemia through a multifactorial intervention of clinical care and structured education.

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ABSTRACT This is a retrospective report of the frequency of severe hypoglycemia and the association between common mental disorders and type 1 diabetes mellitus treated with insulin analogues. Patients with severe hypoglycemia compared with those without this complication had a higher prevalence of positive screening for common mental disorders (88% vs.77%, respectively, p = 0.03).

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This is a retrospective report of the frequency of severe hypoglycemia and the association between common mental disorders and type 1 diabetes mellitus treated with insulin analogues. Patients with severe hypoglycemia compared with those without this complication had a higher prevalence of positive screening for common mental disorders (88% vs. 77%, respectively, p = 0.03).

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A hipoglicemia é uma das principais complicações frente ao manejo inadequado do diabetes, com destaque para a hipoglicemia grave que configura-se como um problema relevante para a manutenção da qualidade de vida dos indivíduos. Os objetivos do presente estudo foram caracterizar os episódios de hipoglicemia grave em pacientes com diabetes em unidades de internação clínica; analisar a associação entre os fatores de risco e os episódios de hipoglicemia grave de pacientes com diabetes em unidade de internação; estimar o tempo de sobrevida até o episódio hipoglicêmico grave. A metodologia empregada para esse estudo considerou casos episódios hipoglicêmicos graves, definidos por valores glicêmicos abaixo de 50 mg/dL. Foram considerados controles os episódios hipoglicêmicos não graves definidos por valores glicêmicos entre 51 a 70mg/dl. Considerou-se como fatores associados à hipoglicemia grave variáveis propostas pela revisão integrativa de literatura realizada para a construção dessa pesquisa. Ainda, também foi analisado o diagnóstico de enfermagem risco de glicemia instável da nomenclatura NANDA-I e sua pertinência quanto aos fatores de risco associados à ocorrência de episódios de hipoglicemia grave. A coleta de dados desenvolveu-se através de análise documental retrospectiva. Foram observados 47 episódios de hipoglicemia grave e 60 episódios de hipoglicemia não grave, respectivamente caso e controle. Os fatores de risco para hipoglicemia grave com evidências na literatura e que foram validados neste estudo caso- controle foram: escolaridade; terapia insulínica; uso de insulinas associadas; modificação recente da dose; insuficiência renal; outras comorbidades; episódio hipoglicêmico anterior e habilidade deficiente para o autocuidado. Identificou-se que o tempo de sobrevida até o episódio hipoglicêmico configura-se em uma curva descendente.A média de tempo que uma pessoa sobrevive até o desfecho de hipoglicemia grave mostrou que o paciente que tem diabetes e está internado tem chances progressivamente maiores de desenvolver episódio de hipoglicemia grave logo nos primeiros dias de internação. Frente aos resultados obtidos, sugere-se que novos estudos sejam realizados com o objetivo descrever aprofundadamente os mecanismos de associação destas variáveis com o episódio hipoglicêmico grave. A identificação da magnituddos fatores de risco para hipoglicemia grave, apresentada através do estudo caso-controle, fornece bases para a construção de instrumentos padronizados de avaliação adequada de pacientes com diabetes em unidades de internação.

Hypoglycemia is one of the main complications in the face of inadequate management of diabetes, where severe hypoglycemia is a relevant problem in terms of maintaining the quality of life of individuals. The objectives of the study were to characterize episodes of severe hypoglycemia in patients with diabetes in clinical inpatient units; to analyze the association between risk factors and episodes of severe hypoglycemia in patients with diabetes in the inpatient unit; estimate the survival time until the severe hypoglycemic episode. The methodology used for this study considered cases of severe hypoglycemic episodes, defined by glycemic values below 50 mg / dL. Non-severe hypoglycemic episodes were defined as controls defined by glycemic values between 51 to 70mg / dl. Factors associated with severe hypoglycemia were considered as variables proposed by the integrative literature review carried out for the construction of this research. Still, the Nursing Diagnosis Risk of Unstable Glycemia of the NANDA-I Nomenclature and its relevance regarding the risk factors associated with the occurrence of episodes of severe hypoglycemia were also analyzed. Data collection was developed through retrospective document analysis. 47 episodes of severe hypoglycemia and 60 episodes of non-severe hypoglycemia were analyzed, case and control, respectively. The risk factors for severe hypoglycemia with evidence in the literature that were validated in this case-control study were: education; insulin therapy; use of associated insulins; recent dose modification; renal insufficiency; other comorbidities; previous hypoglycemic episode and deficient ability for self-care. It was identified that the survival time until the hypoglycemic episode is configured in a descending curve. The average time that a person survives until the outcome of severe hypoglycemia showed that the patient who has diabetes and is hospitalized has a progressively greater chance of developing an episode of severe hypoglycemia in the first days of hospitalization. In view of the results obtained, it is suggested that further studies be carried out in order to describe in depth the mechanisms of association of these variables with the severe hypoglycemic episode. The identification of the magnitude of risk factors for severhypoglycemia, presented through the case-control study, provides the basis for the construction of standardized instruments for adequate assessment of patients with diabetes in inpatient units.

La hipoglucemia es una de las principales complicaciones ante el manejo inadecuado de la diabetes, donde la hipoglucemia severa es un problema relevante en cuanto al mantenimiento de la calidad de vida de los individuos. Los objetivos del estudio fueron caracterizar episodios de hipoglucemia severa en pacientes con diabetes en unidades de internación clínica; analizar la asociación entre factores de riesgo y episodios de hipoglucemia severa en pacientes con diabetes en la unidad de internación; Estime el tiempo de supervivencia hasta el episodio de hipoglucemia grave. La metodología utilizada para este estudio consideró casos de episodios hipoglucémicos graves, definidos por valores glucémicos inferiores a 50 mg / dL. Se consideraron controles los episodios hipoglucémicos no graves definidos como valores glucémicos entre 51 y 70 mg / dl. Los factores asociados a la hipoglucemia severa fueron considerados como variables propuestas por la revisión integradora de la literatura realizada para la construcción de esta investigación. Aún así, también se analizó el Diagnóstico de Enfermería Riesgo de Glucemia Inestable de la Nomenclatura NANDA-I y su relevancia con respecto a los factores de riesgo asociados a la ocurrencia de episodios de hipoglucemia severa. La recolección de datos se desarrolló a través del análisis retrospectivo de documentos. Se analizaron 47 episodios de hipoglucemia severa y 60 episodios de hipoglucemia no severa, caso y control, respectivamente. Los factores de riesgo de hipoglucemia severa con evidencia en la literatura que fueron validados en este estudio de casos y controles fueron: educación; terapia con insulina; uso de insulinas asociadas; modificación reciente de la dosis; insuficiencia renal; otras comorbilidades; episodio hipoglucémico previo y capacidad deficiente para el autocuidado. Se identificó que el tiempo de supervivencia hasta el episodio hipoglucémico se configura en una curva descendente. El tiempo promedio que una persona sobrevive hasta el resultado de una hipoglucemia severa mostró que el paciente que tiene diabetes y está hospitalizado tiene una probabilidad progresivamente mayor de desarrollar un episodio de hipoglucemia severa en los primeros días de hospitalización. A la vista de los resultados obtenidos, se sugiere realizar más estudios con el fin de describir en profundidad los mecanismos de asociación de estas variables con el episodio de hipoglucemia grave. La identificación de la magnitud de los factores de riesgo de hipoglucemia severa, presentada a través del estudio de casos y controles, proporciona la base para la construcción de instrumentos estandarizados para la evaluación adecuada de pacientes con diabetes en unidades de internación.

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OBJECTIVE: This study aimed to determine the frequency of sleep disorders in hypoglycemic diabetic patients and possible relationships with scores of sleep disorders and restless legs syndrome in mestizo population in Guayaquil, Ecuador. METHODS: A multicenter, cross-sectional study conducted at an outpatient endocrinology clinic in urban and rural Ecuador regions, included 290 participants with type 2 diabetes mellitus with severe hypoglycemic episodes, completed, validated, and culturally adapted sleep questionnaires to assess daytime sleepiness, risk of sleep apnea and restless legs syndrome. Logistic regression analysis was conducted to identify factors associated with severe hypoglycemia. RESULTS: The prevalence of EDS was 56.8%, RLS prevalence of 46.2%, and 38.6% prevalence of high risk Berlin score. Multivariate logistic regression indicated hypoglycemic T2DM in the range of 56-75 years old were more likely to have high ESS (p 0.0001). CONCLUSION: A high prevalence of sleep disorders in diabetic Latinos living in Ecuador was evidenced. The presence of somnolence in patients older than 56 years and high HbA1c levels should alert the clinician for the occurrence of hypoglycemic episodes.

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BACKGROUND: Pregnancy in women with type 1 diabetes (T1D) is associated with increased risk of maternal complications and neonatal morbidity and mortality. Optimizing glycemic control improves these outcomes. OBJECTIVE: To describe the experience of using sensor-augmented insulin pump therapy (SAPT) and SAPT + low-glucose suspension (LGS) on pregnant women with T1D, including neonatal and maternal outcomes. METHODS: A prospective observational study was conducted in women with T1D who started SAPT and SAPT + LGS before or during pregnancy at the San Ignacio University Hospital Diabetes Center in Bogotá, Colombia. The main indication was severe hypoglycemia (SH) and poor glycemic control. Glycated hemoglobin (A1c), hypoglycemia, and maternal and fetal outcomes were assessed. RESULTS: Thirty-four pregnant women with T1D on SAPT and SAPT + LGS were included. Sixteen patients started therapy during pregnancy at a mean gestational age of 17.6 ± 8.3 weeks. Mean preconceptional A1c was 8.24% ± 2.02%. Absolute reduction of A1c level from prepregnancy to third trimester was -1.63% (P < 0.0001), with a significant clinical and statistical reduction in both groups, women who initiated SAPT before or during pregnancy. 52.9% of patients in second trimester and 66.6% in third trimester achieved A1c <6.5%, respectively. 91.1% underwent cesarean section. The main reasons were iterative cesarean (30%), fetal distress (20%), and preeclampsia (16%). The median gestational age at delivery was 37 weeks and 15 pregnancies resulted in preterm delivery. There was neither maternal-fetal mortality nor severe hypoglycemic episodes. Two patients had diabetic ketoacidosis. CONCLUSIONS: In pregnant patients with T1D and high risk of hypoglycemia, SAPT and SAPT + LGS should be considered as a therapeutic alternative for A1c reduction with a low risk of SH. However, additional studies are required to evaluate the efficacy and safety of this therapy during pregnancy.

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BACKGROUND: Literature supports short-term efficacy and safety of Sensor Augmented Insulin Pump (SAP) therapy in patients with type 1 diabetes (T1D). However, no data are available showing long-term outcomes. Our study describes the long-term outcomes of SAP therapy with low-glucose suspend feature (SAP+LGS) in hypoglycemia in a Colombian population with T1D and hypoglycemia. METHODS: A cohort study was conducted with T1D patients receiving SAP+LGS therapy who initiated this therapy because of hypoglycemia at San Ignacio University Hospital diabetes center in Bogotá, Colombia. Glycated hemoglobin (A1c) was assessed at least every 6 months, severe hypoglycemia (SH) and hypoglycemia unawareness (HU) incidence yearly. Adherence to therapy was also evaluated. RESULTS: One hundred eleven patients were included in the analysis. Total daily insulin dose was reduced during follow-up (mean difference -0.22 U/kg; 95% confidence interval [CI] -0.18 to -0.26; P < 0.001). A1c levels were reduced from a baseline value of 8.8% ± 1.9% to 7.5% ± 1.0% at 5 months (mean difference -1.3%; 95% CI -1.09 to -1.50; P < 0.001) and 7.1% ± 0.8% (mean difference -1.7%; 95% CI -1.59 to -1.90; P < 0.001) at the end of follow-up (47 months on average). The incidence of SH and HU episodes decreased significantly since the first year, and this effect was maintained over time (P < 0.001). CONCLUSIONS: SAP+LGS therapy in T1D patients with hypoglycemia led to a significant and sustained decrease in A1c during long periods of follow-up, as well as a significant reduction in SH and HU. Future randomized clinical trials are desired.

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BACKGROUND: Type 1 diabetes can be difficult to control. Augmented pump therapy (CSII-rtCGM) has become an important tool for controlling blood glucose and decreasing hypoglycemia. METHODS: Describe the results 1 year after starting CSII-rtCGM in patients with diabetes in Medellín, Colombia. This is an observational, retrospective study. Patients with type 1 and type 2 diabetes started on CSII-rtCGM between January 2008 and June 2015 were included. Qualitative variables were analyzed as absolute or relative frequencies. Quantitative variables were obtained through central tendency and dispersion according to the normal distribution of the analyzed variable using Kolmogorov-Smirnov. SPSS 19 from IBM was used. RESULTS: Two hundred forty-seven patients were identified, of those 183 were included. The starting HbA1C was 8.7% ± 1.7% and 7.4% ± 0.8% (P < 0.05) 1 year later. 16.5% of patients had been admitted to the hospital before starting CSII-rtCGM, after 1 year the admission rate was 6.0% (P < 0.05). The incidence of severe hypoglycemia at the beginning was 32%, 1 year later it was 7.1%. CONCLUSION: CSII-rtCGM therapy improves glucose control and decreases severe hypoglycemic events and hospital admission rate.

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