http://opendata.unex.es/recurso/ciencia-tecnologia/investigacion/tesis/Tesis/2013-41

Introducción: Este estudio analiza las características que presentan los pacientes con diabetes mellitus tipo 1 de inicio en no pediátrica, en el momento del diagnostico, en el Área de Salud de Badajoz. Desarrollo teórico: Se analizaron retrospectivamente los datos del ingreso hospitalario de 301 pacientes adolescentes y adultos diagnosticados de diabetes mellitus tipo 1 entre 1993 y 2011. En los pacientes que continuaron el seguimiento en Consultas Externas, se analizó el comportamiento de la diabetes a lo largo de los años de evolución posteriores al diagnóstico. En un subgrupo de los pacientes incluidos en el estudio se indicó la realización de una monitorización continua de glucosa en un momento dado de la evolución. Se analizaron los datos derivados de dicha monitorización y se calcularon diferentes parámetros de variabilidad glucémica.Conclusiones: Encontramos un predominio del sexo masculino, un patrón estacional con mayor incidencia de casos en los meses más fríos y una alta frecuencia de eventos estresantes e infecciosos antes del diagnóstico. En los últimos años objetivamos un aumento en la edad y la HbA1c en el diagnóstico y en el número de casos diagnosticados y una reducción en la frecuencia de pacientes diagnosticados con cetoacidosis diabética. El sexo femenino y el diagnóstico en edades más jóvenes se relacionaron con mayores necesidades de insulina durante el transcurso de la diabetes. La presencia de autoinmunidad pancreática y de tipaje HLA de riesgo fueron predictores de un mal control glucémico. La reserva pancreática menor y la mayor descompensación metabólica en el diagnóstico se relacionaron con mayores necesidades de insulina y peor control glucémico. El valor MAGE se correlacionó con el péptido C estimulado en el momento del diagnóstico. Los pacientes con valores más altos de AUC superior a 180 mg/dl y de porcentaje de tiempo en hiperglucemia habían presentado valores de HbA1c más altos en el diagnóstico. Bibliografía:1 Eisenbarth GS. Type I diabetes mellitus. A chronic autoinmune disease. N Engl J Med. 1986; 314(21): 1360-1368.2 De Block CEM, De Leeuw IH, Vertommen JJF, Rooman RPA, Du Caju MVL, Van Campenhout CM, et al. Beta-cell, thyroid, gastric, adrenal and coeliac autoimmunity and HLA-DQ types in type 1 diabetes. Clin Exp Immunol. 2001; 126(2): 236-241.3 García MA, Giralt P, Fernández B, Benito P. Diferencias evolutivas en pacientes pediátricos con diabetes mellitus de tipo 1 en función de su grupo genético HLA DQ. Med Clin (Barc). 2010; 134(9): 381-385.4 Eisenbarth GS. Update in type 1 diabetes. J Clin Endocrinol Metab. 2007; 92(7): 2403-2407.5 Oikarinen M, Tauriainen S, Oikarinen S, Honkanen T, Collin P, Rantala I, et al. Type 1 diabetes is associated with enterovirus infection in gut mucosa. Diabetes. 2012. 61(3): 687-691.6 Kim CS, Song MK, Park JS, Cho MH, Kim HJ, Nam JS, et al. The clinical and immunogenetic characteristics of adult-onset type 1 diabetes mellitus in Korea. Acta Diabetol. 2007; 44(2): 45-54.7 Noble JA, Valdes AM, Varney MD, Carlson, JA, Moonsamy P, Fear AL, et al. HLA class I and genetic susceptibility to type 1 diabetes: results from the type 1 diabetes genetics consortium. Diabetes. 2010; 59(11): 2972-2979.8 Pozzilli P, Strollo R, Barchetta I. Natural history and immunopathogenesis of type 1 diabetes. Endocrinol Nutr. 2009; 56(Suppl 4): 50-52.9 Pociot F, Akolkar B, Concannon P, Erlich HA, Julier C, Morahan G, et al. Genetics of type 1 diabetes: what's next? Diabetes. 2010; 59(7): 1561-1571.10 Erlich H, Valdes AM, Noble J, Carlson JA, Varney M, Concannon P, et al. HLA DR-DQ haplotypes and genotypes and type 1 diabetes risk: analysis of the type 1 diabetes genetics consortium families. Diabetes. 2008; 57(4): 1084-1092.11 Giralt P, Urra JM, Sanabria C, Giralt J, Pérez MJ, Benito P. Diferencias biológicas en la presentación de la diabetes tipo 1A en relación con los marcadores genéticos HLA-DQ. Med Clin (Barc). 2002; 120(1): 6-9.12 Couper JJ, Donaghue KC. Phases of diabetes in children and adolescents. Pediatr Diabetes. 2009; 10(Suppl 12): 13-16.13 Haller MJ, Atkinson MA, Schatz D. Type 1 diabetes mellitus: etiology, presentation, and management. Pediatr Clin North Am. 2005; 52(6): 1553-1578.14 Mäkinen A, Härkönen T, Ilonen J, Knip M; the Finnish Pediatric Diabetes Register. Characterization of the humoral immune response to islet antigen 2 in children with newly diagnosed type 1 diabetes. Eur J Endocrinol. 2008; 159(1): 19-26. 15 Roep BO. The role of T-cells in the pathogenesis of type 1 diabetes: from cause to cure. Diabetologia. 2003; 46(3): 305-321.16 Bingley PJ. Clinical applications of diabetes antibody testing. J Clin Endocrinol Metab. 2010; 95(1): 25-33.17 Wenzlau JM, Juhl K, Yu L, Moua O, Sarkar SA, Gottlieb P, et al. The cation efflux transporter ZnT8 (Slc30A8) is a major autoantigen in human type 1 diabetes. Proc Natl Acad Sci USA. 2007; 104: 17040-17045.18 Atkinson MA, Eisenbarth GS. Type 1 A diabetes: new perspectives on disease pathogenesis and treatment. Lancet. 2001; 358(9277): 221-229.19 Kawasaki E, Matsuura N, Eguchi K. Type 1 diabetes in Japan. Diabetologia. 2006; 49(5): 828-836.20 Aguilera E, Recasens M, Morínigo RA, Casamitjana R, Oriola J, Ercilla G, et al. Características clínicas, metabólicas, inmunológicas y genotípicas de un grupo de adolescentes y adultos con diabetes mellitus tipo 1A. Inicio y pronóstico a corto plazo. Med Clin (Barc.). 2003; 120(4): 121-124.21 Soriano P, De Pablos PL. Epidemiología de la diabetes mellitus. Endocrinol Nutr. 2007; 54(Suppl 3): 2-7.22 López-Siguero JP, Del Pino-De la Fuente A, Martínez-Aedo MJ, Moreno-Molina JA. Increased incidence of type 1 diabetes in the south of Spain. Diabetes Care. 2002; 25(6): 1099.23 Rewers A, Klingensmith G, Davis C, Petitti DB, Pihoker C, Rodríguez B, et al. Presence of diabetic ketoacidosis at diagnosis of diabetes mellitus in youth: the Search for Diabetes in Youth Study. Pediatrics. 2008; 121(5): e1258-1266.24 Patterson CC, Dahlquist GG, Gyürüs E, Green A, Soltész G; EURODIAB Study Group. Incidence trends for childhood type 1 diabetes in Europe during 1989-2003 and predicted new cases 2005-20: a multicentre prospective registration study. Lancet. 2009; 373(9680): 2027-2033.25 Imkampe AK, Gulliford MC. Trends in type 1 diabetes incidence in the UK in 0- to 14-year-olds and in 15- to 34-year-olds, 1991-2008. Diabet Med. 2011; 28(7): 811-814.26 Harjutsalo V, Sjöberg L, Tuomilehto J. Time trends in the incidence of type 1 diabetes in Finnish children: a cohort study. Lancet. 2008; 371(9626): 1777-1782.27 Berhan Y, Waernbaum I, Lind T, Möllsten A, Dahlquist G, for the Swedish Childhood Diabetes Study Group. Thirty years of prospective nationwide incidence of childhood type 1 diabetes. The accelerating increase by time tends to level off in Sweden. Diabetes. 2011; 60(2): 577-581.28 Pundziute-Lyckå A, Dahlquist G, Nyström L, Arnqvist H, Björk E, Blohmé G, et al. The incidence of type I diabetes has not increased but shifted to a younger age at diagnosis in the 0-34 years group in Sweden 1983-1998. Diabetologia. 2002; 45(7): 783-791.29 Dahlquist GG, Nyström L, Patterson CC. Incidence of type 1 diabetes in Sweden among individuals aged 0-34 years, 1983-2007: an analysis of time trends. Diabetes Care. 2011; 34(8): 1754-1759.30 Bruno G, Merletti F, Biggeri A, Cerutti F, Grosso N, De Salvia A, et al.; Piedmont Study Group for Diabetes Epidemiology. Increasing trend of type I diabetes in children and young adults in the province of Turin (Italy): analysis of age, period and birth cohort effects from 1984 to 1996. Diabetologia. 2001; 44(1): 22-25.31 Feltbower RG, McKinney PA, Parslow RC, Stephenson CR, Bodansky HJ. Type 1 diabetes in Yorkshire, UK: time trends in 0-14 and 15-29-year-olds, age at onset and age-period-cohort modelling. Diabet Med. 2003; 20(6): 437-441.32 Levy-Marchal C, Patterson CC, Green A; Eurodiab Ace Study Group. Geographical variation of presentation of type 1 diabetes in children: the EURODIAB study. Diabetologia. 2001; 44(Suppl 3): B75-B80.33 Seissler J, de Sonnaville JJ, Morgenthaler NG, Steinbrenner H, Glawe D, et al. Immunological heterogeneity in type I diabetes: presence of distinct autoantibody patterns in patients with acute onset and slowly progressive disease. Diabetologia. 1998; 41(8): 891-897.34 Vermeulen I, Weets I, Asanghanwa M, Ruige J, Van Gaal L, Mathieu C, et al. Contribution of antibodies against IA-2ß and zinc transporter 8 to classification of diabetes diagnosed under 40 years of age. Diabetes Care. 2011; 34(8): 1760-1765.35 Vandewalle CL, Coeckelberghs MI, De Leeuw IH, Du Caju MV, Schuit FC, Pipeleers DG, et al. Epidemiology, clinical aspects, and biology of IDDM patients under age 40 years. Diabetes Care. 1997; 20(10): 1501-1631.36 Sabbah E, Savola K, Ebeling T, Kulmala P, Vähäsalo P, Ilonen J, et al. Genetic, autoimmune, and clinical characteristics of childhood- and adult-onset type 1 diabetes. Diabetes Care. 2000; 23(9):1326-1332.37 Borg H. Gottsater A. Landin-Olsson M. Fernlund P. Sundkvist G. High levels of antigen-specific islet antibodies predict future [beta]-cell failure in patients with onset of diabetes in adult age. J Clin Endocrinol Metab. 2001; 86(7): 3032-3038.38 Thunander M, Petersson C, Jonzon K, Fornander J, Ossiansson B, Torn C, et al. Incidence of type 1 and type 2 diabetes in adults and children in Kronoberg, Sweden. Diabetes Res Clin Pract. 2008; 82(2): 247-255.39 Karjalainen J, Salmela P, Ilonen J, Surcel HM, Knip M. A comparison of childhood and adult type I diabetes mellitus. N Engl J Med. 1989; 320(14): 881-886.40 Xin Y, Yang M, Chen XJ, Tong YJ, Zhang LH. Clinical features at the onset of childhood type 1 diabetes mellitus in Shenyang, China. J Paediatr Child Health. 2010; 46(4): 171-175.41 Weets I, Truyen I, Verschraegen I, Van der Auwera B, De Schepper J, Dorchy H, et al. Belgian Diabetes Registry. Sex- and season-dependent differences in C-peptide levels at diagnosis of immune-mediated type 1 diabetes. Diabetologia. 2006; 49(6): 1158-1162.42 Roche EF, Menon A, Gill D, Hoey H. Clinical presentation of type 1 diabetes. Pediatr Diabetes. 2005; 6(2): 75-78.43 Fava D, Gardner S, Pyke D, David R, Leslie RDG. Evidence that the age of diagnosis of IDDM is genetically determined. Diabetes Care. 1998; 21(6): 925-929.44 Howson JM, Rosinger S, Smyth DJ, Boehm BO; the ADBW-END Study Group, Todd JA. Genetic analysis of adult-onset autoimmune diabetes. Diabetes. 2011; 60(10): 2645-2653.45 Tridgell DM, Spiekerman C, Wang RS, Greenbaum CJ. Interaction of onset and duration of diabetes on the percent of GAD and IA-2 antibody-positive subjects in the Type 1 Diabetes Genetics Consortium Database. Diabetes Care. 2011; 34(4): 988-993.46 Wang J, Miao D, Babu S, Yu J, Barker J, Klingensmith J, et al. Prevalence of autoantibody-negative diabetes is not rare at all ages and increases with older age and obesity. J Clin Endocrinol Metab. 2007; 92(1): 88-92.47 Sabbah E, Savola K, Kulmala P, Veijola R, Vahasalo P, Karjalainen J, et al. Diabetes-associated autoantibodies in relation to clinical characteristics and natural course in children with newly diagnosed type 1 diabetes. J Clin Endocrinol Metab. 1999; 84(5): 1534-1539.48 Roth J, Whitford I, Dankner R, Szulc AL. How the immunoassay transformed C-peptide from a duckling into a swan. Diabetologia. 2012; 55(4): 865-869.49 Ludvigsson J, Carlsson A, Forsander G, Ivarsson S, Kockum I, Lernmark A, et al C-peptide in the classification of diabetes in children and adolescents. Pediatr Diabetes. 2012; 13(1): 45-50.50 Sherry NA, Tsai EB, Herold KC. Natural history of [beta]-cell function in type 1 diabetes. Diabetes. 2005; 54(Suppl 2): S32-S39.51 Palmer JP. C-peptide in the natural history of type 1 diabetes. Diabetes Metab Res Rev. 2009. 25(4): 325-328.52 Torn C, Landin-Olsson M, Lernmark A, Palmer JP, Arnqvist HJ, Blohme G, et al. Prognostic factors for the course of beta cell function in autoimmune diabetes. J Clin Endocrinol Metab. 2000; 85(12): 4619-4623.53 Palmer JP, Fleming GA, Greenbaum CJ, Herold KC, Jansa LD, Kolb H, et al. C-peptide is the appropriate outcome measure for type 1 diabetes clinical trials to preserve beta-cell function. Diabetes. 2004; 53(1): 250-264.54 Caillat-Zucman S, Garchon HJ, Timsit J, Assan R, Boitard C, Djilali-Saiah I, et al. Age-dependent HLA genetic heterogeneity of type 1 insulin-dependent diabetes mellitus. J Clin Invest. 1992; 90(6): 2242-2250.55 Leslie RD. Predicting adult-onset autoimmune diabetes: clarity from complexity. Diabetes 2010; 59(2): 330-331. 56 Fajans SS, Bell GI. MODY: history, genetics, pathophysiology, and clinical decision making. Diabetes Care. 2011; 34(8): 1878-1884.57 Expert committee on the diagnosis and classification of diabetes mellitus. Report of the expert committee on the diagnosis and classification of diabetes mellitus. Diabetes Care. 2003; 26(Suppl 1): S5-20.58 Fourlanos S, Varney MD, Tait BD, Morahan G, Honeyman MC, Colman PG, et al. The rising incidence of type 1 diabetes is accounted for by cases with lower-risk human leukocyte antigen genotypes. Diabetes Care. 2008; 31(8): 1546-1549.59 Ma RC, Chan JC. Diabetes: incidence of childhood type 1 diabetes: a worrying trend. Nat Rev Endocrinol. 2009; 5(10): 529-530.60 Forlenza GP, Rewers M. The epidemic of type 1 diabetes: what is it telling us? Curr Opin Endocrinol Diabetes Obes. 2011; 18(4): 248-251.61 Sandhu N, Witmans MB, Lemay JF, Crawford S, Jadavji N, Pacaud D. Prevalence of overweight and obesity in children and adolescents with type 1 diabetes mellitus. J Pediatr Endocrinol Metab. 2008; 21(7): 631-640.62 Beato P, Rodríguez P, Guzmán C, Rasero I, Cordero V, Cabanillas MO. Nutritional assessment in type 1 diabetic patients. Obes Rev. 2010; 11(Suppl 1): 360.63 Hyppönen E, Virtanen SM, Kenward MG, Knip M, Akerblom HK; Childhood Diabetes in Finland Study Group. Obesity, increased linear growth, and risk of type 1 diabetes in children. Diabetes Care. 2000; 23(12): 1755-1760.64 Gale EA. Spring harvest? Reflections on the rise of type 1 diabetes. Diabetologia. 2005; 48(12): 2445-2450.65 Wilkin TJ. The accelerator hypothesis: weight gain as the missing link between type I and type II diabetes. Diabetologia. 2001; 44(7): 914-922.66 Tuomi T. Type 1 and Type 2 diabetes: what do they have in common? Diabetes. 2005; 54(Suppl 2): S40-S45.67 Dabelea D, D'Agostino RB Jr, Mayer-Davis EJ, Pettitt DJ, Imperatore G, Dolan LM, et al.; SEARCH for Diabetes in Youth Study Group. Testing the accelerator hypothesis: body size, b-cell function, and age at onset of type 1 (autoimmune) diabetes. Diabetes Care. 2006; 29(2): 290-294.68 Verbeeten KC, Elks CE, Daneman D, Ong KK. Association between childhood obesity and subsequent type 1 diabetes: a systematic review and meta-analysis. Diabet Med. 2011; 28(1): 10-18.69 Betts P, Mulligan J, Ward P, Smith B, Wilkin T. Increasing body weight predicts the earlier onset of insulin-dependant diabetes in childhood: testing the `accelerator hypothesis¿ (2). Diabet Med. 2005; 22(2): 144-151.70 Pozzilli P, Buzzetti R. A new expression of diabetes: double diabetes. Trends in Endocrinol Metab. 2007; 18(2): 52-57.71 Pozzilli P, Guglielmi C, Pronina E, Petraikina E. Double or hybrid diabetes associated with an increase in type 1 and type 2 diabetes in children and youths. Pediatr Diabetes. 2007; 8(Suppl 9): 88-95.72 Bowden SA, Hoffman RP. Triple diabetes: coexistence of type 1 diabetes mellitus and a novel mutation in the gene responsible for MODY3 in an overweight adolescent. Pediatr Diabetes. 2008; 9(2): 162-164.73 Guglielmi C, Astorri E, Portuesi R, Bombardieri M, Valorani M, Pozzilli P. A diet rich in protein and poor in starch with reduced food intake prevents diabetes in the NOD mouse: the significance of Reg gene expression in the pancreas. Diabetologia. 2008; 51(Suppl 1): S229.74 Gale EA. Latent autoimmune diabetes in adults: a guide for the perplexed. Diabetologia. 2005; 48(11): 2195-2199.75 Pozzilli P, Guglielmi C, Caprio S, Buzzetti R. Obesity, autoimmunity, and double diabetes in youth. Diabetes Care. 2011; 34(Suppl 2): S166-170.76 Ize-Ludlow D, Sperling MA. The classification of diabetes mellitus: a conceptual framework. Pediatr Clin North Am. 2005; 52(6): 1533-1552.77 Gale EA. Declassifying diabetes. Diabetologia. 2006; 49(9): 1989-1995.78 Umpierrez GE, Latif KA, Murphy MB, Lambeth HC, Stentz F, Bush A, et al. Thyroid dysfunction in patients with type 1 diabetes: a longitudinal study. Diabetes Care. 2003; 26(4): 1181-1185.79 Mehmet M, Ozlem K, Levent T, Alper D, Elif G, Yilmaz K, et al. Screening frequency of celiac disease and autoimmune thyroiditis in children and adolescents with type 1 diabetes mellitus in Turkey and comparison with last surveys. Endocrinologist. 2010; 20(4):171-173.80 Fasy EA, Umpierrez G. Celiac disease: an important comorbibity associated with type 1 diabetes. Clin Diabetes. 2008; 26(2): 85-87. 81 Sud S, Marcon M, Assor E, Palmert MR, Daneman D, Mahmud FH. Celiac disease and pediatric type 1 diabetes: diagnostic and treatment dilemmas. Int J Pediatr Endocrinol. 2010; 2010:161285. Epub 2010 Jun 23. 82 The Diabetes Control and Complications Trial Research Group. The effect of intensive treatment of diabetes on the development and progression of longterm complications in insulin-dependent diabetes mellitus. N Engl J Med. 1993; 329(14): 977-986.83 Rosenbauer J, Dost A, Karges B, Hungele A, Stahl A, Bächle C, et al. Improved metabolic control in children and adolescents with type 1 diabetes: A trend analysis using prospective multicenter data from Germany and Austria. Diabetes Care. 2012; 35(1): 80-86.84 Viswanathan V, Sneeringer MR, Miller A, Eugster EA, DiMeglio LA.The utility of hemoglobin A1c at diagnosis for prediction of future glycemic control in children with type 1 diabetes. Diabetes Res Clin Pract. 2011; 92(1): 65-68.85 Thompson SJ, Auslander WF, White NH. Comparison of single-mother and two-parent families on metabolic control of children with diabetes. Diabetes Care. 2001, 24(2): 234-238.86 Mortensen HB, Swift PGF, Holl RW, Hougaard P, Hansen L, Bjoerndalen H, et al. Multinational study in children and adolescents with newly diagnosed type 1 diabetes: association of age, ketoacidosis, HLA status, and autoantibodies on residual beta-cell function and glycemic control 12 months after diagnosis. Pediatr Diabetes. 2010; 11(4): 218-226.87 Lombardo F, Valenzise M, Wasniewska M, Messina MF, Ruggeri C, Arrigo T, et al. Two-year prospective evaluation of the factors affecting honeymoon frequency and duration in children with insulin dependent diabetes mellitus: the key-role of age at diagnosis. Diabetes Nutr Metab. 2002; 15(4): 246-251.88 Johannesen J, Lyngsøe L, Rida H, Andersen ML, Lauridsen MH, Hertz B, et al. Diabetic ketoacidosis at onset of T1DM associates to futures HbA1c levels. Pediatr Diabetes. 2010; 11(Suppl 14): 33-34.89 Bowden SA, Duck MM, Hoffman RP. Young children (< 5 years) and adolescents (> 12 years) with type 1 diabetes mellitus have low rate of partial remission: diabetic ketoacidosis is an important risk factor. Pediatr Diabetes. 2008; 3(3 Pt 1): 197-201.90 Bober E, Dundar B, Buyukgebiz A. Partial remission phase and metabolic control in type 1 diabetes mellitus in children and adolescents. J Pediatr Endocrinol Metab. 2001; 14(4): 435-441.91 Ampudia-Blasco FJ. Hiperglucemia posprandial y variabilidad glucémica: nuevos objetivos de control en la diabetes. Av Diabetol. 2010; 26(Suppl 1): 29-34. 92 Ceriello A. Glycemic variability: a new therapeutic challenge in diabetes and the critical care setting. Av. Diabetol. 2010; 26(4): 222-225.93 Ceriello A, Esposito K, Piconi L, Ihnat MA, Thorpe JE, Testa R, et al. Oscillating glucose is more deleterious to endothelial function and oxidative stress than mean glucose in normal and type 2 diabetic patients. Diabetes. 2008; 57(5): 1349-1354.94 Marling CR, Shubrook JH, Vernier SJ, Wiley MT, Schwartz FL. Characterizing blood glucose variability using new metrics with continuous glucose monitoring data. J Diabetes Sci Technol. 2011; 5(4): 871-878.95 Kilpatrick ES, Rigby AS, Atkin SL. The effect of glucose variability on the risk of microvascular complications in type 1 diabetes. Diabetes Care. 2006; 29(7): 1486-1490.96 Kilpatrick ES, Rigby AS, Atkin SL. Glucose variability and diabetes complication risk: we need to know the answer. Diabet Med. 2010; 27(8): 868-871.97 Bragd J, Adamson U, Bäcklund LB, Lins PE, Moberg E, Oskarsson P. Can glycaemic variability, as calculated from blood glucose self-monitoring, predict the development of complications in type 1 diabetes over a decade? Diabetes Metab. 2008; 34(6 Pt 1): 612-616.98 Siegelaar S, Kilpatrick E, Rigby A, Atkin S, Hoekstra J, DeVries J. Glucose variability does not contribute to the development of peripheral and autonomic neuropathy in type 1 diabetes: data from the DCCT. Diabetologia. 2009; 52(10): 2229-2232.99 Giménez M, Gilabert R, Lara M, Conget I. Preclinical arterial disease in patients with type 1 diabetes without other major cardiovascular risk factors or micro-/ macrovascular disease. Diab Vasc Dis Res. 2011; 8(1): 5-11.100 Kilpatrick ES, Rigby AS, Goode K, Atkin SL. Relating mean blood glucose and glucose variability to the risk of multiple episodes of hypoglycaemia in type 1 diabetes. Diabetologia 2007; 50(12): 2553-2561.

Literals

  • dcterms:director
    • Morales Pérez, Francisco Miguel (Codirector)
    • Tormo García, María Ángeles (Director)
  • dcterms:description
    • Introducción: Este estudio analiza las características que presentan los pacientes con diabetes mellitus tipo 1 de inicio en no pediátrica, en el momento del diagnostico, en el Área de Salud de Badajoz. Desarrollo teórico: Se analizaron retrospectivamente los datos del ingreso hospitalario de 301 pacientes adolescentes y adultos diagnosticados de diabetes mellitus tipo 1 entre 1993 y 2011. En los pacientes que continuaron el seguimiento en Consultas Externas, se analizó el comportamiento de la diabetes a lo largo de los años de evolución posteriores al diagnóstico. En un subgrupo de los pacientes incluidos en el estudio se indicó la realización de una monitorización continua de glucosa en un momento dado de la evolución. Se analizaron los datos derivados de dicha monitorización y se calcularon diferentes parámetros de variabilidad glucémica.Conclusiones: Encontramos un predominio del sexo masculino, un patrón estacional con mayor incidencia de casos en los meses más fríos y una alta frecuencia de eventos estresantes e infecciosos antes del diagnóstico. En los últimos años objetivamos un aumento en la edad y la HbA1c en el diagnóstico y en el número de casos diagnosticados y una reducción en la frecuencia de pacientes diagnosticados con cetoacidosis diabética. El sexo femenino y el diagnóstico en edades más jóvenes se relacionaron con mayores necesidades de insulina durante el transcurso de la diabetes. La presencia de autoinmunidad pancreática y de tipaje HLA de riesgo fueron predictores de un mal control glucémico. La reserva pancreática menor y la mayor descompensación metabólica en el diagnóstico se relacionaron con mayores necesidades de insulina y peor control glucémico. El valor MAGE se correlacionó con el péptido C estimulado en el momento del diagnóstico. Los pacientes con valores más altos de AUC superior a 180 mg/dl y de porcentaje de tiempo en hiperglucemia habían presentado valores de HbA1c más altos en el diagnóstico. Bibliografía:1 Eisenbarth GS. Type I diabetes mellitus. A chronic autoinmune disease. N Engl J Med. 1986; 314(21): 1360-1368.2 De Block CEM, De Leeuw IH, Vertommen JJF, Rooman RPA, Du Caju MVL, Van Campenhout CM, et al. Beta-cell, thyroid, gastric, adrenal and coeliac autoimmunity and HLA-DQ types in type 1 diabetes. Clin Exp Immunol. 2001; 126(2): 236-241.3 García MA, Giralt P, Fernández B, Benito P. Diferencias evolutivas en pacientes pediátricos con diabetes mellitus de tipo 1 en función de su grupo genético HLA DQ. Med Clin (Barc). 2010; 134(9): 381-385.4 Eisenbarth GS. Update in type 1 diabetes. J Clin Endocrinol Metab. 2007; 92(7): 2403-2407.5 Oikarinen M, Tauriainen S, Oikarinen S, Honkanen T, Collin P, Rantala I, et al. Type 1 diabetes is associated with enterovirus infection in gut mucosa. Diabetes. 2012. 61(3): 687-691.6 Kim CS, Song MK, Park JS, Cho MH, Kim HJ, Nam JS, et al. The clinical and immunogenetic characteristics of adult-onset type 1 diabetes mellitus in Korea. Acta Diabetol. 2007; 44(2): 45-54.7 Noble JA, Valdes AM, Varney MD, Carlson, JA, Moonsamy P, Fear AL, et al. HLA class I and genetic susceptibility to type 1 diabetes: results from the type 1 diabetes genetics consortium. Diabetes. 2010; 59(11): 2972-2979.8 Pozzilli P, Strollo R, Barchetta I. Natural history and immunopathogenesis of type 1 diabetes. Endocrinol Nutr. 2009; 56(Suppl 4): 50-52.9 Pociot F, Akolkar B, Concannon P, Erlich HA, Julier C, Morahan G, et al. Genetics of type 1 diabetes: what's next? Diabetes. 2010; 59(7): 1561-1571.10 Erlich H, Valdes AM, Noble J, Carlson JA, Varney M, Concannon P, et al. HLA DR-DQ haplotypes and genotypes and type 1 diabetes risk: analysis of the type 1 diabetes genetics consortium families. Diabetes. 2008; 57(4): 1084-1092.11 Giralt P, Urra JM, Sanabria C, Giralt J, Pérez MJ, Benito P. Diferencias biológicas en la presentación de la diabetes tipo 1A en relación con los marcadores genéticos HLA-DQ. Med Clin (Barc). 2002; 120(1): 6-9.12 Couper JJ, Donaghue KC. Phases of diabetes in children and adolescents. Pediatr Diabetes. 2009; 10(Suppl 12): 13-16.13 Haller MJ, Atkinson MA, Schatz D. Type 1 diabetes mellitus: etiology, presentation, and management. Pediatr Clin North Am. 2005; 52(6): 1553-1578.14 Mäkinen A, Härkönen T, Ilonen J, Knip M; the Finnish Pediatric Diabetes Register. Characterization of the humoral immune response to islet antigen 2 in children with newly diagnosed type 1 diabetes. Eur J Endocrinol. 2008; 159(1): 19-26. 15 Roep BO. The role of T-cells in the pathogenesis of type 1 diabetes: from cause to cure. 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Preclinical arterial disease in patients with type 1 diabetes without other major cardiovascular risk factors or micro-/ macrovascular disease. Diab Vasc Dis Res. 2011; 8(1): 5-11.100 Kilpatrick ES, Rigby AS, Goode K, Atkin SL. Relating mean blood glucose and glucose variability to the risk of multiple episodes of hypoglycaemia in type 1 diabetes. Diabetologia 2007; 50(12): 2553-2561.
  • dcterms:creator
    • Beato Víbora, Pilar Isabel
  • dcterms:subject
    • Endocrinologia
  • dcterms:identifier
    • 2013-41
  • ou:programaDoctorado
    • Fisiologia
  • dcterms:title
    • Características Clínicas, Inmunológicas Y Genéticas En El Debut De Diabetes Mellitus Tipo 1 En Adolescentes Y Adultos Y Su Influencia En El Control Metabólico Y La Variabilidad Glucémica Posteriores.
  • ou:tribunal
    • García Ingelmo, María Teresa (Vocal)
    • Rodríguez López, Raquel C. (Secretario)
    • Campillo Álvarez, José Enrique (Presidente)
    • Rodriguez Jerez, Argimiro (Vocal)
    • Moreno Vazquez, Juan Manuel (Vocal)
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