M A Alvarez

Hospital Universitario Ramón y Cajal, Madrid, Madrid, Spain

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Publications (5)6.85 Total impact

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    ABSTRACT: The transition between paediatric and adult care for young people with type 1 diabetes (T1D) is often poorly managed, with adverse consequences for health, as well as a decrease in the follow-up.
    Anales de Pediatría (English Edition). 11/2014;
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    ABSTRACT: The transition between pediatric and adult care for young people with type 1 diabetes (T1D) is often poorly managed, with adverse consequences for health, as well as a decrease in the follow-up. To analyze the metabolic control and the degree of satisfaction in a group of patients with T1D after being transferred from the Pediatric Diabetes Unit (PDU) to Adult Diabetes Unit (ADU). Retrospective study in a cohort of 49 patients (43% female) with T1D. The age at diagnosis and transfer to ADU, time of onset of the disease, metabolic control (HbA1c), presence of diabetic complications and characteristics of medical follow-up were analysed using the statistics program: SPSS, version 17.0. Mean age at diagnosis 8.3±4.6 years and transfer to ADU 19.2±1.8 years. Mean time since onset of T1D in pediatrics, adults and overall: 10.8±5.0, 4.1±2.6 and 15.0±5.7 years, respectively. The 6% of adult patients were not being medically tracked. Among adults, 25% did not provide data about chronic complications, and 6% did not know their last HbA1c. The metabolic control after their transfer to the ADU worsened in 52% of the patients (HbA1c +0.79±0.70%). No correlation was found between the time since onset and the HbA1c value. Degree of satisfaction was either good or very good in 96% of patients in the PDU and 74% in ADU. Better planning for the transfer of pediatric patients with T1D to ADU is highly recommended, in order to avoid deterioration of control and/or loss of follow-up.
    Anales de Pediatría 12/2013; · 0.87 Impact Factor
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    ABSTRACT: Introduction The transition between pediatric and adult care for young people with type 1 diabetes (T1D) is often poorly managed, with adverse consequences for health, as well as a decrease in the follow-up. Objective To analyze the metabolic control and the degree of satisfaction in a group of patients with T1D after being transferred from the Pediatric Diabetes Unit (PDU) to Adult Diabetes Unit (ADU). Patients and methods Retrospective study in a cohort of 49 patients (43% female) with T1D. The age at diagnosis and transfer to ADU, time of onset of the disease, metabolic control (HbA1c), presence of diabetic complications and characteristics of medical follow-up were analysed using the statistics program: SPSS, version 17.0. Results Mean age at diagnosis 8.3±4.6 years and transfer to ADU 19.2±1.8 years. Mean time since onset of T1D in pediatrics, adults and overall: 10.8±5.0, 4.1±2.6 and 15.0±5.7 years, respectively. The 6% of adult patients were not being medically tracked. Among adults, 25% did not provide data about chronic complications, and 6% did not know their last HbA1c. The metabolic control after their transfer to the ADU worsened in 52% of the patients (HbA1c +0.79±0.70%). No correlation was found between the time since onset and the HbA1c value. Degree of satisfaction was either good or very good in 96% of patients in the PDU and 74% in ADU. Conclusion Better planning for the transfer of pediatric patients with T1D to ADU is highly recommended, in order to avoid deterioration of control and/or loss of follow-up.
    Anales de Pediatría. 01/2013;
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    ABSTRACT: The aims of this observational study were to identify the special needs of children with Type 1 diabetes in schools from the parents' point of view and the difficulties experienced with full integration, and to define a series of interventions which may improve the situation. Parents of children aged 3-18 years with Type 1 diabetes were eligible. Those who agreed to participate completed a self-reporting questionnaire which determined the effects of the disease on children, parents and school personnel, and addressed aspects including children's integration, glycaemic control, insulin administration, meals, sports, trips and attitudes of teachers and school colleagues to their disease. A total of 499 questionnaires were completed and validated. Median age of children was 11.5 years (95% CI 7.8-15.2). Only 34% of parents believed that teachers could recognize the symptoms of a mild hypoglycaemic episode. Seventeen per cent of parents experienced problems at their schools when they informed staff about their children's disease, 5% were finally not accepted and 8% were forced to change school. In some cases, they had to modify glucose monitoring (9%) and treatment administration (16%) because of a lack of cooperation from the school. Training sessions on Type 1 diabetes, an increase in the number of nurses, better availability of resources from diabetic associations to schools and improved communication between school personnel and parents were identified as key factors that may improve the full integration of the diabetic child in this setting.
    Diabetic Medicine 11/2007; 24(10):1073-9. · 3.24 Impact Factor
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    ABSTRACT: To determine the efficacy and safety of insulin glargine (IG) in children and adolescents with type 1 diabetes. In a prospective, 6-month study, 80 patients, aged 2-19 years, received IG once daily plus insulin regular or rapid analogue before meals. The data of body mass index, frequency of severe hypoglycaemia, daily mean blood glucose, fasting blood glucose, haemoglobin A1c and total daily insulin dosage before and after institution of glargine therapy were collected. After 6 months, the average HbA1c level in the entire cohort dropped from 7.63+/-0.81 to 7.14+/-0.70% (p<0.001). Fasting blood glucose decreased from 161+/-37 to 150+/-35 mg/dl (p<0.05) in the total group. Severe hypoglycaemic episodes were reduced from 0.18 events per patient in the 6 months before IG therapy to 0.11 events per patient in the 6 months after IG therapy. The total daily insulin dose was reduced in the entire group from 0.90+/-0.32 to 0.83+/-0.29 u/kg/day (p<0.05). Body mass index (BMI) remained unchanged. In the 14 preschooler children, the HbA1c dropped from 7.54+/-0.60 to 6.96+/-0.57% (p<0.05). Insulin glargine is an efficacious treatment to improve metabolic control in children and adolescents with type 1 diabetes. It also improved the metabolic control in preschool-age children, without increasing the number of hypoglycaemic events.
    Diabetes Research and Clinical Practice 10/2005; 70(1):1-7. · 2.74 Impact Factor