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Letter to the Editor
Comment about the article “Type 1 diabetes mellitus prevalence and care in children under 15 years old in Asturias''
Comentarios sobre el artículo «Prevalencia y datos asistenciales de la diabetes mellitus tipo 1 en menores de 15 años en Asturias»
Belén Huidobro Fernándeza,
Corresponding author
bhuidobro@hotmail.com

Corresponding author.
, Maria Riestra Fernándezb, Cristina Rodríguez Dehlic, Isolina Riaño Galánd
a Servicio de Pediatría, Hospital Universitario de Cabueñes, Gijón, Asturias, Spain
b Servicio de Endocrinología y Nutrición, Hospital Universitario de Cabueñes, Gijón, Asturias, Spain
c Servicio de Pediatría, Hospital Universitario San Agustín, Avilés, Asturias, Spain
d AGP de Pediatría, Hospital Universitario Central de Asturias, Oviedo, Asturias, Spain
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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">We have read the original paper entitled &#34;Type 1 diabetes mellitus prevalence and care in children under 15 years old in Asturias&#34;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> with special interest&#46; Critical analysis of the situation of the pediatric population in our region is essential in order to advance in the optimum management of these patients&#46; On the other hand&#44; the progressive incorporation of new technologies&#44; mainly continuous subcutaneous insulin infusion &#40;CSII&#41; and continuous glucose monitoring &#40;CGM&#41;&#44; represents a fundamental change in the routine care of patients with type 1 diabetes mellitus &#40;T1DM&#41;&#46; The data presented by Osorio-&#193;lvarez et al&#46; reflect the situation of T1DM care in pediatric patients in 2015&#46; Fortunately&#44; over the past few years&#44; that situation has gradually changed&#46; In this respect&#44; we wish to present some data referred to the follow-up of pediatric patients diagnosed with T1DM in healthcare areas <span class="elsevierStyleSmallCaps">iii</span> &#40;Avil&#233;s&#41;&#44; <span class="elsevierStyleSmallCaps">iv</span> &#40;Oviedo&#41; and <span class="elsevierStyleSmallCaps">v</span> &#40;Gij&#243;n&#41;&#44; corresponding to the situation on 16 April 2019&#44; and which pool the information of most of the patients and reflect the important changes that have taken place since 2015&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">In the mentioned areas a total of 145 pediatric patients with T1DM aged 12 months to 16 years are being followed-up on&#46; Thirty-six children are under treatment with CSII&#44; representing 24&#46;8 &#37; of the total patients - though this figure is still far from the 44&#46;4 &#37; reported in the SWEET study&#46;<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> The rest of the patients are treated with multiple insulin doses &#40;MDI&#41;&#46; With regard to CGM&#44; since October 2018 all children in the Autonomous Community of Asturias aged 4&#8211;13 years &#40;adolescents up to 18 years of age have subsequently been included&#41; have access to the flash CGM system&#46; In the particular case of children under 10 years of age&#44; their access to real-time CGM systems has been regulated through the Diabetes Technologies Commission of Asturias&#46; Accordingly&#44; all children currently have access to some CGM system&#46; Specifically&#44; 40 patients &#40;27&#46;5 &#37;&#41; have real-time CGM systems &#40;35 patients integrated with CSII and 5 patients with MDI&#41;&#44; and the rest have flash CGM systems &#40;with the exception of some point cases due to patient personal decision&#41;&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">Therapeutic education &#40;TE&#41; is another fundamental aspect in the care of all patients with T1DM&#46; The fact that only 37&#46;7 &#37; of the patients have received some intervention in this regard should cause us to think&#46; As the authors of the article point out&#44; it is clear that to a greater or lesser extent&#44; all families receive some type of TE at the start and during the course of the disease&#46; Consequently&#44; the mentioned figure appears to reflect deficiencies in data registry in the case histories - a situation which we as the professionals that care for these patients must correct&#46; It may also reflect problems in digitalization of the case histories&#44; since the transition from paper to electronic history format took place during that period&#46; However&#44; we are aware that a significant proportion of families did not have continued access to a quality and up to date TE&#46; Therapeutic education in diabetes is the main tool for implicating the family environment in the care of pediatric patients with T1DM&#44; as well as for training caregivers to control the disease as far as possible&#44; prevent acute decompensation episodes &#40;hypoglycemia&#44; hyperglycemia&#41;&#44; and reduce the risk of chronic complications&#46;<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> It has been widely shown that TE in childhood and adolescence results in benefits in terms of both blood glucose control and psychosocial aspects&#46; All children and their families should have access to structured&#44; quality TE adapted to the age of the patient and to the needs of the family&#44; in order to ensure increased treatment effectiveness&#44; including the incorporation of new diabetes technologies &#40;particularly CSII and CGM systems&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">At present&#44; structured educational programs with different levels of knowledge &#40;survival&#44; basic and advanced&#41; are available&#44; based on the needs of each patient and family&#44; as well as recycling and specific sessions for using CGM systems and support for using digital tools&#46; Practically all the patients followed-up on by the public health system have received TE interventions&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">Lastly&#44; although there has been a significant change in recent years in relation to the incorporation of new technologies and TE in the management of T1DM in pediatric patients&#44; we are of the opinion that there is still a long way to go&#46; Teamwork and coordination among the different areas are essential to develop diagnostic&#44; monitoring&#44; treatment and TE protocols&#44; as well as to promote the incorporation of new technologies and the protocolized implementation of telemedicine&#46; All this should be done from a perspective focused on the patient and family&#44; instructing them through training and promoting their autonomy and responsibility in self-care&#46;</p></span>"
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Article information
ISSN: 25300180
Original language: English
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2024 July 8 3 11
2024 June 9 3 12
2024 May 6 1 7
2024 April 9 2 11
2024 March 19 5 24
2024 February 5 3 8
2024 January 9 1 10
2023 December 6 2 8
2023 November 5 1 6
2023 October 9 2 11
2023 September 6 0 6
2023 August 9 3 12
2023 July 9 2 11
2023 June 4 1 5
2023 May 3 4 7
2023 April 4 3 7
2023 March 6 0 6
2023 February 7 3 10
2023 January 8 6 14
2022 December 9 3 12
2022 November 11 8 19
2022 October 5 6 11
2022 September 15 7 22
2022 August 5 8 13
2022 July 10 8 18
2022 June 8 6 14
2022 May 12 5 17
2022 April 7 3 10
2022 March 11 5 16
2022 February 9 3 12
2022 January 15 5 20
2021 December 8 8 16
2021 November 12 4 16
2021 October 6 8 14
2021 September 6 7 13
2021 August 11 6 17
2021 July 13 7 20
2021 June 11 5 16
2021 May 13 9 22
2021 April 29 8 37
2021 March 13 4 17
2021 February 5 12 17
2021 January 8 8 16
2020 December 8 8 16
2020 November 15 10 25
2020 October 4 7 11
2020 September 12 7 19
2020 August 8 8 16
2020 July 9 2 11
2020 June 4 2 6
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es en pt

¿Es usted profesional sanitario apto para prescribir o dispensar medicamentos?

Are you a health professional able to prescribe or dispense drugs?

Você é um profissional de saúde habilitado a prescrever ou dispensar medicamentos