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Background: Clinical Practice Guidelines (CPGs) provide healthcare professionals with performance and decision-making support during the treatment of patients. Sometimes, however, they are poorly implemented. The IDE4ICDS platform was developed and validated with CPGs for type 2 diabetes mellitus (T2DM). Objective: The main objective of this paper is to present the results of the clinical validation of the IDE4ICDS platform in a real clinical environment at two health clinics in the Andalusian Public Health System (SSPA) in the southern Spanish region of Andalusia. Methods: National and international knowledge sources on T2DM were selected and reviewed and used to define a diabetes CPG model on the IDE4ICDS platform. Once the diabetes CPG was configured and deployed, it was validated. A total of 506 patients were identified as meeting the inclusion criteria, of whom 130 could be recruited and 89 attended the appointment. Results: A concordance analysis was performed with the kappa value. Overall agreement between the recommendations provided by the system and those recorded in each patient's EHR was good (0.61 - 0.80) with a total kappa index of 0.701, leading to the conclusion that the system provided appropriate recommendations for each patient and was therefore well-functioning. Conclusions: A series of possible improvements were identified based on the limitations for the recovery of variables related to the quality of these recolected variables, the detection of duplicate recommendations based on different input variables for the same patient, and clinical usability, such as the capacity to generate reports based on the recommendations generated. Nevertheless, the project resulted in the IDE4ICDS platform: a Clinical Decision Support System (CDSS) capable of providing appropriate recommendations for improving the management and quality of patient care and optimizing health outcomes. The result of this validation is a safe and effective pathway for developing an

Objetivos: Estudiar si existen evidencias de deterioro cognitivo en pacientes adultos con Diabetes Mellitus tipo 1 (DM1) mediante el estudio neurofisiológico y neuropsicológico. Analizar las posibles asociaciones entre las variables clínicas, neuropsicológicas y neurofisiológicas. Material y métodos: Estudio descriptivo transversal en pacientes adultos con DM1 y sujetos control. La evaluación neuropsicológica se realizó con pruebas neuropsicológicas validadas como la BNS, ToLx, TMT, Figura compleja de Rey, FAS, WCST y la Lista de palabras de la escala Weschler. Para la evaluación neurofisiológica se utilizaron la Estimulación Magnética Transcraneal (EMT) y Estimulación eléctrica. Se recogieron variables clínicas relacionadas con la diabetes y se procedió a la Monitorización continua de glucosa (iPro®2) en los 6 días previos a la evaluación neurocognitiva tanto para pacientes con DM1 como para sujetos control. Resultados: 54 participantes (27 pacientes con DM1 y 28 controles) con edad y años de escolarización homogéneos. Peor rendimiento neuropsicológico en pacientes con DM1, especialmente en procesos ejecutivos, mnésicos, de memoria de trabajo y sistema inhibitorio (p<0,05). No se observó esta menor eficiencia cognitiva en pacientes adultos con DM1 en tareas visoconstructivas y de lenguaje. Estos déficits se asocian significativamente a la presencia de hiperglucemias, un mayor nivel de variabilidad en HbA1c y mayor años de evolución de la enfermedad. Neurofisiológicamente, los pacientes con DM1 presentan menor inhibición tanto en el protocolo SICI como en LICI. Conclusiones: Se observa un peor rendimiento neuropsicológico en pacientes adultos con DM1, especialmente en áreas mnésicas, inhibitorias, ejecutivas y de memoria de trabajo. El tiempo de evolución de la enfermedad, la exposición a hiperglucemias así como la variabilidad en el control metabólico crónico son variables asociadas y predictoras de una menor eficiencia cognitiva. Los pacientes con DM1 presentan un

Background: Fear of hypoglycemia is an important problem in individuals with diabetes and could produce a negative impact on blood glucose control and quality of life in individuals with type 1 diabetes. Aim: To analyze (1) the associations among resilience, diabetes-related quality of life, and anxiety and depression in patients with type 1 diabetes with fear of hypoglycemia and (2) whether anxiety and depression mediate the relationship between resilience and quality of life. Design: A non-experimental, descriptive correlational design was used. Methods: Participants were 30 patients with type 1 diabetes with fear of hypoglycemia. Data were collected using several questionnaires administered between September 2019 and March 2020. Results: Resilience played a significant role in the anxiety and depression that accompanies diabetes. Mediation analysis was performed to assess whether the association between resilience and quality of life was mediated by anxiety and depression in series. The results show that the effect of resilience was mainly mediated by anxiety but not by depression. Conclusions: This study provides further evidence that high resilience could be a protective factor against the development of psychological symptomatology, which has a high prevalence in chronic conditions such as diabetes and can improve quality of life. Impact: Our study addresses the relationship between the positive psychological characteristic of resilience and anxiety, depression, and quality of life and the association between these variables. The results indicate that resilience has a positive impact on quality of life in people with type 1 diabetes who experience fear of hypoglycemia. Moreover, health professionals who provide care to these individuals should consider implementing programs to build resilience.

[Objetivos] Estudiar si existen evidencias de deterioro cognitivo en pacientes adultos con Diabetes Mellitus tipo 1 (DM1) mediante el estudio neurofisiológico y neuropsicológico. Analizar las posibles asociaciones entre las variables clínicas, neuropsicológicas y neurofisiológicas., [Material y métodos] Estudio descriptivo transversal en pacientes adultos con DM1 y sujetos control. La evaluación neuropsicológica se realizó con pruebas neuropsicológicas validadas como la BNS, ToLx, TMT, Figura compleja de Rey, FAS, WCST y la Lista de palabras de la escala Weschler. Para la evaluación neurofisiológica se utilizaron la Estimulación Magnética Transcraneal (EMT) y Estimulación eléctrica. Se recogieron variables clínicas relacionadas con la diabetes y se procedió a la Monitorización continua de glucosa (iPro®2) en los 6 días previos a la evaluación neurocognitiva tanto para pacientes con DM1 como para sujetos control., [Resultados] 54 participantes (27 pacientes con DM1 y 28 controles) con edad y años de escolarización homogéneos. Peor rendimiento neuropsicológico en pacientes con DM1, especialmente en procesos ejecutivos, mnésicos, de memoria de trabajo y sistema inhibitorio (p<0,05). No se observó esta menor eficiencia cognitiva en pacientes adultos con DM1 en tareas visoconstructivas y de lenguaje. Estos déficits se asocian significativamente a la presencia de hiperglucemias, un mayor nivel de variabilidad en HbA1c y mayor años de evolución de la enfermedad. Neurofisiológicamente, los pacientes con DM1 presentan menor inhibición tanto en el protocolo SICI como en LICI., [Conclusiones] Se observa un peor rendimiento neuropsicológico en pacientes adultos con DM1, especialmente en áreas mnésicas, inhibitorias, ejecutivas y de memoria de trabajo. El tiempo de evolución de la enfermedad, la exposición a hiperglucemias así como la variabilidad en el control metabólico crónico son variables asociadas y predictoras de una menor eficiencia cognitiva. Los pacientes con DM1 presentan una menor inhibición neurofisiológica mediada por GabaA aunque ésta no se asocia con un peor rendimiento cognitivo en ninguna de las áreas estudiadas.

[Introduction] Diabetic retinopathy (DR) is a preventable cause of vision loss and blindness worldwide. We aim at analyzing the impact of a population-based screening program of DR using retinal photography with remote reading in terms of population coverage, diagnosis of asymptomatic DR and impact on visual disability, in the region of Andalusia, Spain, in the period 2005–2019., [Research design and methods] Descriptive study. Sociodemographic and clinical features included in the Andalusian program for early detection of diabetic retinopathy (APDR) were analyzed. Population coverage, annual incidence of DR, and DR severity gradation were analyzed. Estimated data on prevalence and incidence of legal blindness due to DR were included., [Results] 407 762 patients with at least one successful DR examination during the study period were included. Most of the performed retinographies (784 584, 84.3%) were ‘non-pathological.’ Asymptomatic DR was detected in 52 748 (5.9%) retinographies, most of them (94.2%) being classified as ‘mild to moderate non-proliferative DR.’ DR was detected in 44 815 patients, while sight-threatening DR (STDR) in 6256 patients; cumulative incidence of DR was 11.0% and STDR was 1.5%, as DR and STDR was detected in 44 815 and 6256 patients, respectively. Annual incidence risk per patient recruitment year progressively decreased from 22.0% by January 2005 to 3.2% by June 2019., [Conclusions] Implementation of a long-term population-based screening program for early detection of DR is technically feasible and clinically viable. Thus, after 15 years of existence, the program has enabled the screening of the vast majority of the target population allowing the optimization of healthcare resources and the identification of asymptomatic DR.

[Background] To assess gender differences in Quality of life (QoL) and in sociodemographic, clinical and psychological factors associated with impaired QoL in adults with long-standing type 1 diabetes mellitus (DM1)., [Methods] Cross-sectional evaluation in a random cohort of DM1 adult patients from a tertiary care hospital. QoL was evaluated using translated and validated self-administered Diabetes QoL questionnaire (Es-DQoL), and results transformed into a 0–100 scale. Psychological assessment included a planned psychological interview and self-reported questionnaires (Beck Depression Inventory II, State-Trait Anxiety Inventory Form Y, Fear of hypoglycaemia Scale, Medical Outcomes Study Social Support Survey)., [Results] A total of 312 patients (51.6% male; 38.2 ± 12.7 years; HbA1c 7.5 ± 1.1% (58.5 ± 14.2 mmol/mol); 20.4 ± 12.0 years of DM1) were included in the analysis. Male and female subgroups showed similar sociodemographic and diabetes-related features and comparable social support. Among female patients, higher frequency of depression [31.7% (IC95% 26.2–40.8) vs. 14.9% (IC95% 10.1–20.8), p < 0.05] and anxiety [23.2% (IC95% 19.3–33.14) vs. 13.0% (IC95% 8.1–18.4), p < 0.05] and severity of depressive and anxious symptoms were also found. Compared to male patients, female patients showed lower QoL [75 (IC95% 73.6–77.5) vs. 80 (IC95% 75.7–83.1), p < 0.05] and scored significantly worse in subscale Diabetes-related worries [69 (IC95% 50.0–81.0) vs. 75 (IC95% 72.9–79.0), p < 0.05]. Fear of hypoglycemia and severity of depressive and anxious symptoms were factors independently associated to lower QoL in men and women while high frequency of glycemic excursions was a female-specific predictive one., [Conclusions] Adult women with long-standing DM1 showed lower QoL probably related to higher frequency and severity of psychopathological syndromes. Depressive and anxious symptoms and, among women, exposure to glycemic excursions were identified as modifiable, QoL-related variables. Educational, technological and psychological interventions are needed in order to improve QoL in DM1 patients.

[Objective] To assess the impact of a telemedicine visit using the platform Diabetic compared with a face-to-face visit on clinical outcomes, patients’ health-related quality of life (HRQoL), and physicians’ satisfaction in patients with type 1 diabetes., [Research design and methods] PLATEDIAN (Telemedicine on Metabolic Control in Type 1 Diabetes Mellitus Andalusian Patients) (NCT03332472) was a multicenter, randomized, 6-month follow-up, open-label, parallel-group controlled study performed in patients with type 1 diabetes with suboptimal metabolic control (HbA1c <8% [<64 mmol/mol]), treated with multiple daily injections. A total of 388 patients were assessed for eligibility; 379 of them were randomized 1:1 to three face-to-face visits (control cohort [CC]) (n = 167) or the replacement of an intermediate face-to-face visit by a telemedicine visit using Diabetic (intervention cohort [IC]) (n = 163). The primary efficacy end point was the mean change of HbA1c levels from baseline to month 6. Other efficacy and safety end points were mean blood glucose, glucose variability, episodes of hypoglycemia and hyperglycemia, patient-reported outcomes, and physicians’ satisfaction., [Results] At month 6, the mean change in HbA1c levels was −0.04 ± 0.5% (−0.5 ± 5.8 mmol/mol) in the CC and 0.01 ± 0.6% (0.1 ± 6.0 mmol/mol) in the IC (P = 0.4941). The number of patients who achieved HbA1c <7% (<53 mmol/mol) was 73 and 78 in the CC and IC, respectively. Significant differences were not found regarding safety end points at 6 months. Changes in HRQoL between the first visit and final visit did not differ between cohorts, and, regarding fear of hypoglycemia (FH-15 score ≥28), statistically significant differences observed at baseline remained unchanged at 6 months (P < 0.05)., [Conclusions] The use of telemedicine in patients with type 1 diabetes with HbA1c <8% (<64 mmol/mol) provides similar efficacy and safety outcomes as face-to-face visits.

[Introduction] Type 1 diabetes mellitus (T1DM) is one of the most frequent chronic endocrine diseases in the paediatric population. As a result, this disease has a strong impact on psychological well-being. In line with this, emotional factors play an important role in adaptation. The aim of the present study protocol is to design an emotional abilities programme to improve metabolic control assessed by haemoglobin A1c (HbA1c) samples. Specifically, this intervention will be focused on adaptive coping strategies to deal with unpleasant emotions associated with T1DM. The primary aim of this project is to assess whether the employment of this new psychological intervention improves the emotional abilities of adolescents with T1DM., [Methods] and analysis Two focus groups will be carried out for the design and evaluation of the programme following the APEASE criteria (affordability, practicability, effectiveness, acceptability, side effects/safety and equity). Behavioural change will be based on the Behaviour Change Wheel. Sixty-two participants from 12 to 18 years of age will be recruited at a public hospital and randomised to either an intervention or a control group. The intervention group will receive an emotional abilities training programme. The control group will receive usual educational intervention. The primary outcomes are metabolic control and emotional abilities. The secondary outcomes include emotional distress control, positive and negative affect, healthy habits, and quality of life. Data will be collected at baseline, immediately postintervention, and at follow-up visits at 6 and 12 months. A feasibility analysis will be conducted., [Ethics and dissemination] The study has been approved by the Ethics Committee of Universidad Loyola Andalucía. Results will be submitted for publication in peer-reviewed journals and disseminated across the scientific community., [Trial registration number] NCT03734367.

[Aim] To assess the relationship between choroidal thickness and renal function in diabetic patients., [Methods] Cross-sectional retrospective clinical study of 42 eyes of 21 ocular treatment-na?ve diabetic patients. Demographic data included: age, sex, type and course of diabetes. Ocular data included: severity of diabetic retinopathy; retinal thickness at the central macular region, as well as choroidal thickness at the central and paracentral quadrants, using automatically generated maps by swept-source optical coherence tomography; presence of cystic macular edema; and ocular axial length (AXL). Lab-test parameters included: glycated hemoglobin (HbA1c), albuminuria, albumin/creatinine ratio in urine, and glomerular filtration rate., [Results] A significant negative correlation was mainly observed between several choroidal thicknesses, age (P<0.020) and ocular AXL (P<0.030). On the contrary, a significant positive correlation was found between all choroidal thicknesses, HbA1c (P<0.035) and albuminuria (P<0.040)., [Conclusion] Choroidal thickness can represent an additional tool to help clinicians predicting the renal status in ocular treatment-naïve diabetic patients.

CONCLUSIONES1. Los diabéticos tipo 1 presentan una situación de mayor estrés oxidativo e inflamatorio respecto a la población sana.2. La terapia con sistemas de infusión continua de insulina mejora significativamente el control glucémico (HbA1c) y la variabilidad glucémica en diabéticos tipo 1 seleccionados sobre la base de las indicaciones aceptadas en nuestro entorno a los tres meses de iniciada la terapia.3. La reducción de la HbA1c obtenida con la terapia con sistemas de infusión continua de insulina no se asocia a un incremento de la tasa de hipoglucemias ni lleva asociada una ganancia de peso.4. La mejoría del control glucémico obtenida con la terapia con bombas de insulina no se asocia directamente con modificaciones en parámetros inflamatorios o factores de riesgo cardiovascular clásicos.5. Las modificaciones del control glucémico conseguida con los sistemas de infusión continua de insulina conlleva cambios en algunos parámetros de estrés oxidativo (ácido úrico y superóxido dismutasa).6. Las estimaciones de la variabilidad glucémica proporcionadas por el sensor CGMS® no muestran asociación con un mayor grado de estrés oxidativo o inflamatorio en diabéticos tipo 1 de forma independiente del control glucémico global.7. Conocer si la reducción de la variabilidad glucémica obtenida con esta terapia puede suponer un beneficio adicional a la mejoría conseguida en el control glucémico en términos de reducción de complicaciones micro o macrovasculares y los mecanismos por los cuales es potencialmente patógena requieren estudios de intervención con seguimiento a largo plazo.

Skeletal muscle plays a major role in glucose and lipid metabolism. Active hepatocyte growth factor (HGF) is present in the extracellular matrix in skeletal muscle. However, the effects of HGF on glucose and lipid metabolism in skeletal muscle are completely unknown. We therefore examined the effects of HGF on deoxyglucose uptake (DOGU), glucose utilization, and fatty acid oxidation (FAO) in skeletal muscle cells. HGF significantly enhanced DOGU in mouse soleus muscles in vitro. Furthermore, HGF significantly increased: (i) DOGU in a time- and dose-dependent manner; (ii) glucose utilization; and (iii) plasma membrane expression of Glut-1 and Glut-4 in the rat skeletal muscle model of L6 myotubes. HGF-mediated effect on DOGU was dependent on the activation of phosphatidylinositol 3-kinase signaling pathway. On the other hand, HGF markedly and significantly decreased FAO in L6 myotubes without affecting the activities of carnitine palmitoyltransferase I and II. Collectively, these results indicate that HGF is a potent activator of glucose transport and metabolism and also a strong inhibitor of FAO in rodent myotubes. HGF, through its ability to stimulate glucose transport and metabolism and to impair FAO, may participate in the regulation of glucose disposal in skeletal muscle.