Control of type 1 diabetes, pending subject – IM Hospital Doctor

This data is extracted from the SED 1 study, carried out by the Spanish Society of Endocrinology in 2021. This cross-sectional observational study included 647 adults and children with DM1 treated in the consultations of 75 Spanish hospitals, distributed geographically to be representative of the Spanish population.1 This study aims to … This data is extracted from the SED 1 study, carried out by the Spanish Society of Endocrinology in 2021. This cross-sectional observational study included 647 adults and children with DM1 treated in the outpatient clinics of 75 Spanish hospitals, distributed geographically. to be representative of the Spanish population.1 In this study, it was observed that metabolic control was better (lower glycaemia) with a greater number of daily capillary glycaemia self-tests, with a higher level of education, with a greater number of hypoglycaemias and carbohydrate counts. carbon. On the contrary, it was worse with longer duration of the disease, higher total dose of insulin, worse adherence to diet and with a family history of DM. In other words, glycemic control is associated with self-care performed by the patient, as well as the duration of the disease and its treatment. 1 However, this is not an isolated event that only occurs in our country. Both the management of these patients and the treatment they receive is similar to that observed in other Western countries. But what consequences can poor glycemic control have for the patient? Well, the answer is many complications and of a very diverse nature. Intensive treatment of DM1 delays the onset and slows the progression of between 35% and more than 70% of clinically important retinopathy, nephropathies, and neuropathies.2 Likewise, intensive treatment also reduces the risk of a cardiovascular event by 42 % and reduces the risk of serious clinical events, including nonfatal myocardial infarction, stroke, or death from cardiovascular disease, by 57%. In addition, it delays the progression of arteriosclerosis and the prevalence of coronary artery calcification. 3 The risk of these consequences is higher when the patient’s mean HbA1c values ​​increase. 2,3 What prevents improving glycemic control in patients with DM1? Both health professionals and patients are aware of the importance of keeping blood sugar levels within the target range defined for each patient.4 The difficulties come from the excessive burden that DM1 entails for patients. On the one hand, they must understand all aspects of the disease, such as the consequences of eating different types of food, the sugar expenditure involved in physical exercise, psychological stress and long periods of concentration or common diseases. Following a strict diet, where carbohydrates must be balanced with energy expenditure, while maintaining adequate nutrition, involves considerable wear. On the other hand, they must follow the treatment guidelines as strictly as possible, since any forgetfulness supposes a time out of range that damages health. However, only 10% of patients have maximum adherence to their treatment, while 48% have poor or minimal adherence. Between patients with high and low adherence, a significant difference was observed in their mean HbA1c.5 And with all this, patients must maintain motivation and face the social stigmas of the disease. Much is required of patients with DM1 and health professionals have a privileged position from which to continue encouraging them, training them and seeking new ways to facilitate their adherence to the correct lifestyle and treatment. _______________________________________________________ References Gómez-Peralta F, et al. Clinical characteristics and management of type 1 diabetes in Spain. SED1 Study Endocrinology, Diabetes and Nutrition 2021; 68(9):642-653. Nathan DM, Genuth S, Lachin J, et al. The effect of intensive treatment of diabetes on the development and progression of long-term complications in insulin-dependent diabetes mellitus. N Engl J Med 1993;329:977–986. Nathan DM, Cleary PA, Backlund JY, et al. Intensive diabetes treatment and cardiovascular disease in patients with type 1 diabetes. N Engl J Med 2005;353:2643–2653. Dalewitz J, et al. Barriers to control of blood glucose in diabetes mellitus. Am J Med Qual 2000;15(1):16-25. Gomes MB et al. Adherence to insulin therapeutic regimens in patients with type 1 diabetes. A nationwide survey in Brazil. Diabetes Res Clin Pract. 2016;120:47-55.