RT info:eu-repo/semantics/doctoralThesis
T1 Evaluación del Índice de Riesgo Glucémico como nuevo parámetro glucométrico en población adulta y pediátrica con diabetes Mellitus tipo 1
A1 Pérez López, Paloma
A2 Universidad de Valladolid. Escuela de Doctorado
K1 Diabetes
K1 Type 1 Diabetes Mellitus
K1 Diabetes mellitus tipo 1
K1 Glycemia Risk Index
K1 Indice de Riesgo Glucémico
K1 32 Ciencias Médicas
AB The Glycemia Risk Index (GRI) is a new glycemic parameter that attempts to synthesize the enormous amount of information provided by continuous glucose monitoring (CGM) systems, summarizing in a single number the overall quality of a given patient's glycemic control. The aims of the present study were: to evaluate the usefulness of the GRI as a new parameter of glycemic control in pediatric and adult population with type 1 diabetes mellitus (T1D) in clinical practice; to study the relationship between the GRI and other glucometric parameters of the CGM; and finally, to evaluate the relationship between the GRI and different psychosocial aspects in adult patients with T1D.A retrospective study of adult and pediatric patients with T1D on intensive insulin therapy (multiple insulin doses or continuous subcutaneous insulin infusion (CSII) and intermittent scanning CGM was carried out, analyzing clinical, metabolic and glucometric parameters.Results:- Article 1: The GRI was significantly lower in pediatric patients (48.0 ± 22.2 vs. 56.8 ± 23.4; p < 0.05), associated with a higher component of hypoglycemia (7.1 ± 5.1 vs. 5.0 ± 4.5; p < 0.01) and lower component of hyperglycemia (16.8 ± 9.8 vs. 26.5 ± 15.1; p < 0.01) than in adults. When analyzing treatment with continuous subcutaneous infusion of insulin compared to multiple doses of insulin, there was a non-significant trend toward a shorter time in range in the former (51.0 ± 15.3 vs. 55.0 ± 25.4; p = 0.162), with higher levels of hypoglycemia component (6.5 ± 4.1 vs 5.4 ± 5.0; p < 0.01) and lower hyperglycemia component (19.6 ± 10.6 vs 24.6 ± 15.2; p < 0.05) compared to multiple insulin doses.- Article 2: A strong negative correlation was observed between GRI and time in range (R = -0.917; R2 = 0.840; p < 0.01), showing differences when dividing patients with low glycemic variability (Coefficient of Variation (CV) < 36%) (R = -0.974; R2 = 0.948; p < 0.001) versus those with higher instability (CV ≥36%) (R = -0.885; R2 = 0.784; p < 0.01). A strong positive correlation was observed with glycosylated hemoglobin A1c (R = 0.617; R2 = 0.380; p < 0.01), mean glucose (R = 0. 677; R2 = 0.458; p < 0.01), standard deviation (R = 0.778; R2 = 0.605; p < 0.01), time above 250 mg/dL (R = 0.801; R2 = 0.641; p < 0.01) and time below 54 mg/dL (R = 0.481; R2 = 0.231; p < 0.01). - Article 3: Worse metabolic control as defined by GRI correlated with worse scores on VAS (R=-0.209, p < 0.05), diabetes-related quality of life (DQoL) questionnaire (R= 0.205, p < 0.05), and DDS (R= 0.205, p < 0.05). When analyzing DQoL as a dependent variable in a multiple linear regression, only age (β= 0.747, p < 0.001) and the hyperglycemia component (β=0.717, p<0.001) maintained statistical significance.Conclusions: Glycemic GRI is a useful parameter to assess the overall risk of hypoglycemia and hyperglycemia in clinical practice in adult and pediatric patients with type 1 diabetes mellitus, regardless of the type of treatment used. There is a good correlation between the GRI and classical glucometric parameters related to hyper- and hypoglycemia. The GRI and its components were associated with parameters of the psychosocial sphere.
YR 2023
FD 2023
LK https://uvadoc.uva.es/handle/10324/68548
UL https://uvadoc.uva.es/handle/10324/68548
LA spa
NO Escuela de Doctorado
DS UVaDOC
RD 08-jul-2024