Scientific letter
Adherence to the RECORD Guidelines in patients with type 1 diabetes aged under 18
Adherencia a las recomendaciones de la Guía RECORD en los pacientes con diabetes mellitus tipo 1 menores de 18 años
Beatriz Salamanca-Zarzuela
, Inés Mulero-Collantes, Félix Morales-Luengo, Fernando Centeno Malfaz
Corresponding author
Servicio de Pediatría, Hospital Universitario Río Hortega, Valladolid, Spain
Read
789
Timeswas read the article
187
Total PDF
602
Total HTML
Share statistics
array:24 [ "pii" => "S2530018020301189" "issn" => "25300180" "doi" => "10.1016/j.endien.2019.09.004" "estado" => "S300" "fechaPublicacion" => "2020-10-01" "aid" => "981" "copyright" => "SEEN and SED" "copyrightAnyo" => "2019" "documento" => "article" "crossmark" => 1 "subdocumento" => "crp" "cita" => "Endocrinol Diabetes Nutr. 2020;67:553-6" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "Traduccion" => array:1 [ "es" => array:19 [ "pii" => "S2530016419302332" "issn" => "25300164" "doi" => "10.1016/j.endinu.2019.09.006" "estado" => "S300" "fechaPublicacion" => "2020-10-01" "aid" => "981" "copyright" => "SEEN y SED" "documento" => "simple-article" "crossmark" => 1 "subdocumento" => "crp" "cita" => "Endocrinol Diabetes Nutr. 2020;67:553-6" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "es" => array:10 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Carta científica</span>" "titulo" => "Adherencia a las recomendaciones de la Guía RECORD en los pacientes con diabetes mellitus tipo 1 menores de 18 años" "tienePdf" => "es" "tieneTextoCompleto" => "es" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "553" "paginaFinal" => "556" ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "Adherence to the RECORD Guidelines in patients with type 1 diabetes aged under 18" ] ] "contieneTextoCompleto" => array:1 [ "es" => true ] "contienePdf" => array:1 [ "es" => true ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Beatriz Salamanca-Zarzuela, Inés Mulero-Collantes, Félix Morales-Luengo, Fernando Centeno Malfaz" "autores" => array:4 [ 0 => array:2 [ "nombre" => "Beatriz" "apellidos" => "Salamanca-Zarzuela" ] 1 => array:2 [ "nombre" => "Inés" "apellidos" => "Mulero-Collantes" ] 2 => array:2 [ "nombre" => "Félix" "apellidos" => "Morales-Luengo" ] 3 => array:2 [ "nombre" => "Fernando" "apellidos" => "Centeno Malfaz" ] ] ] ] ] "idiomaDefecto" => "es" "Traduccion" => array:1 [ "en" => array:9 [ "pii" => "S2530018020301189" "doi" => "10.1016/j.endien.2019.09.004" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2530018020301189?idApp=UINPBA00004N" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2530016419302332?idApp=UINPBA00004N" "url" => "/25300164/0000006700000008/v2_202012090815/S2530016419302332/v2_202012090815/es/main.assets" ] ] "itemSiguiente" => array:19 [ "pii" => "S2530018020301207" "issn" => "25300180" "doi" => "10.1016/j.endien.2020.01.006" "estado" => "S300" "fechaPublicacion" => "2020-10-01" "aid" => "1030" "copyright" => "SEEN and SED" "documento" => "simple-article" "crossmark" => 1 "subdocumento" => "crp" "cita" => "Endocrinol Diabetes Nutr. 2020;67:556-8" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "en" => array:10 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Scientific letter</span>" "titulo" => "Obstetric and perinatal complications in type 1 diabetes: A retrospective single-center study" "tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "556" "paginaFinal" => "558" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Complicaciones obstétricas y perinatales en la diabetes tipo 1: estudio retrospectivo unicéntrico" ] ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Carmen González-Lamuño, Gonzalo Díaz, Susana García, Vanesa Matías, Cristina Álvarez, Mª. Pilar Bahíllo" "autores" => array:6 [ 0 => array:2 [ "nombre" => "Carmen" "apellidos" => "González-Lamuño" ] 1 => array:2 [ "nombre" => "Gonzalo" "apellidos" => "Díaz" ] 2 => array:2 [ "nombre" => "Susana" "apellidos" => "García" ] 3 => array:2 [ "nombre" => "Vanesa" "apellidos" => "Matías" ] 4 => array:2 [ "nombre" => "Cristina" "apellidos" => "Álvarez" ] 5 => array:2 [ "nombre" => "Mª. Pilar" "apellidos" => "Bahíllo" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S2530016420300902" "doi" => "10.1016/j.endinu.2020.01.003" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2530016420300902?idApp=UINPBA00004N" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2530018020301207?idApp=UINPBA00004N" "url" => "/25300180/0000006700000008/v1_202011131001/S2530018020301207/v1_202011131001/en/main.assets" ] "itemAnterior" => array:19 [ "pii" => "S2530018020301232" "issn" => "25300180" "doi" => "10.1016/j.endien.2020.05.004" "estado" => "S300" "fechaPublicacion" => "2020-10-01" "aid" => "1044" "copyright" => "SEEN and SED" "documento" => "article" "crossmark" => 1 "subdocumento" => "pgl" "cita" => "Endocrinol Diabetes Nutr. 2020;67:545-52" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "en" => array:11 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Consensus document</span>" "titulo" => "An update on gestational hyperglycemia diagnosis during the COVID-19 pandemic" "tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "545" "paginaFinal" => "552" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Actualización del diagnóstico de hiperglucemia gestacional durante la pandemia -19" ] ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:8 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 4181 "Ancho" => 2917 "Tamanyo" => 864723 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0005" "detalle" => "Fig. " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Schematic representation of diagnostic strategies for gestational hyperglycemia – modified by the COVID-19 pandemic.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Mercè Codina, Rosa Corcoy, María M. Goya" "autores" => array:4 [ 0 => array:2 [ "nombre" => "Mercè" "apellidos" => "Codina" ] 1 => array:2 [ "nombre" => "Rosa" "apellidos" => "Corcoy" ] 2 => array:2 [ "nombre" => "María M." "apellidos" => "Goya" ] 3 => array:1 [ "colaborador" => "en representación del GEDE Consenso del Grupo Españnol de Diabetes y Embarazo (GEDE)" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S2530016420301063" "doi" => "10.1016/j.endinu.2020.05.002" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2530016420301063?idApp=UINPBA00004N" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2530018020301232?idApp=UINPBA00004N" "url" => "/25300180/0000006700000008/v1_202011131001/S2530018020301232/v1_202011131001/en/main.assets" ] "en" => array:15 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Scientific letter</span>" "titulo" => "Adherence to the RECORD Guidelines in patients with type 1 diabetes aged under 18" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "553" "paginaFinal" => "556" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Beatriz Salamanca-Zarzuela, Inés Mulero-Collantes, Félix Morales-Luengo, Fernando Centeno Malfaz" "autores" => array:4 [ 0 => array:4 [ "nombre" => "Beatriz" "apellidos" => "Salamanca-Zarzuela" "email" => array:1 [ 0 => "bsalamanca@saludcastillayleon.com" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:2 [ "nombre" => "Inés" "apellidos" => "Mulero-Collantes" ] 2 => array:2 [ "nombre" => "Félix" "apellidos" => "Morales-Luengo" ] 3 => array:2 [ "nombre" => "Fernando" "apellidos" => "Centeno Malfaz" ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Servicio de Pediatría, Hospital Universitario Río Hortega, Valladolid, Spain" "identificador" => "aff0005" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Adherencia a las recomendaciones de la Guía RECORD en los pacientes con diabetes mellitus tipo 1 menores de 18 años" ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Physical activity is one of the mainstays of treatment for type 1 diabetes mellitus (DM1). When done safely, it is beneficial for improving metabolic control and patient quality of life, and for reducing the chronic complications of diabetes.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> With the aim of establishing a consensus regarding safe sports activities in these patients, the Spanish Society of Endocrinology and Nutrition developed the RECORD guidelines, addressing assessment before, during and after exercise, as well as intervention in risk situations.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">A cross-sectional observational study was carried out, based on a specifically designed survey using vocabulary adapted to the age of the subjects, to assess the adherence of patients with DM1 to the sports activity recommendations of the RECORD guidelines<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> (<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>). The survey was targeted independently to both the patients (if over 8 years of age) and to their main caregivers. A joint interview was conducted when the results did not prove consistent. All patients with DM1 under 18 years of age and controlled in the Pediatric Endocrinology outpatient clinic of Hospital Universitario Río Hortega in Valladolid (Spain) were included in the study. At the start, the participants received diabetes education, including the sports activity measures recommended by the RECORD guidelines. All patients were duly informed about the study, and the corresponding consent form was signed by at least one of the parents or guardians, and by the patients in person if over 12 years of age. The study was approved by the Research Ethics Committee of Área Oeste (Valladolid, Spain). The Pearson chi-square test was used to analyze associations between the study variables. If the number of cells with expected values of <5 was greater than 20%, the corresponding likelihood ratio (LR) was calculated. The Student t-test for two independent samples was used for the comparison of mean values, while analysis of variance (ANOVA) was used when more groups were involved. The alternative nonparametric tests were the Mann-Whitney U-test (for two groups) or the Kruskal–Wallis H test (for more than two groups). Statistical significance was considered for p<span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>0.05.</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0015" class="elsevierStylePara elsevierViewall">The data are expressed as percentages to facilitate understanding of the results, except in the case of small groups where the data are expressed as whole numbers. Quantitative variables are reported as the arithmetic mean and standard deviation (SD).</p><p id="par0020" class="elsevierStylePara elsevierViewall">A total of 46 surveys were conducted (21 males and 25 females), with a mean age of 11.75 years (SD: 3.08, minimum 4 and maximum: 17.3); 67.4% were adolescents.</p><p id="par0025" class="elsevierStylePara elsevierViewall">A total of 84.8% of those surveyed were involved in sports activities outside school. From the start of the disease, 13% maintained their previous physical activity, 8.6% performed less exercise, and 78.4% performed more exercise. Sports activities were performed an average of 2.57 days a week (SD: 1.63), with a mean duration per session of 1.14<span class="elsevierStyleHsp" style=""></span>h (SD: 0.6).</p><p id="par0030" class="elsevierStylePara elsevierViewall">In 73.9% of the cases sports activities were for fun (with no gender difference; 23 of them being adolescents), while 13% performed exercise because they considered it part of their treatment (4 females and 2 males; 50% adolescents), 10.8% did so due to parental obligation (3 females and 2 males), and the rest performed exercise for more than one of these reasons. The subjects involved in sports obliged by their parents showed significant differences (LR: p<span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>0.05) between adolescents and prepubertal individuals, but not between genders.</p><p id="par0035" class="elsevierStylePara elsevierViewall">As regards metabolic control, blood glucose control was common before exercise in 69.9% of the cases and afterwards in 47.8% of the cases, though 19.6% avoided blood glucose controls because they were embarrassed to be seen by their colleagues. There were no differences between pubertal stage and gender in this group. A total of 19.6% of the patients did not inform anyone of the glycemic control values obtained - most of them (n: 7) being adolescents (LR: p<span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>0.05) - while 21.7% reported the values to their parents - most of them preadolescents (n: 8) - and 58.7% to their teachers or coaches (22 of them being adolescents).</p><p id="par0040" class="elsevierStylePara elsevierViewall">Of those subjects who performed prior blood glucose testing, 6.5% participated in sports activities regardless of the values obtained, while the rest considered consuming carbohydrates before starting physical activity in the presence of low blood glucose levels, defined as 92<span class="elsevierStyleHsp" style=""></span>mg/dl (SD: 31.3). Fifty percent did not perform sports with high glucose levels, taken to represent >258.7<span class="elsevierStyleHsp" style=""></span>mg/dl (SD: 31.3).</p><p id="par0045" class="elsevierStylePara elsevierViewall">With regard to the insulin dose administered in the previous hours, 63% did not modify the dose, 34.8% administered a lesser dose if sport was to be performed, and a single patient required a higher dosage. In turn, 67.4% did not change the site of insulin administration, while 17.4% modified it according to the activity to be performed. The remaining 15.2% had a continuous infusion pump.</p><p id="par0050" class="elsevierStylePara elsevierViewall">Prior to physical exercise, 50% systematically consumed food, while 46% did so afterwards. Hydration was ensured with some type of drink prior to physical activity in 37% of the cases, and in 60.9% afterwards.</p><p id="par0055" class="elsevierStylePara elsevierViewall">Of the patients surveyed, 33 had experienced hypoglycemia episodes during physical activity. The symptoms during these episodes were mainly tiredness (30%) or dizziness (22%). Less frequent symptoms were tremor (n: 6), abdominal pain (n: 2) or headache (n: 1). In the event of hypoglycemia symptoms, all subjects performed blood glucose controls and consumed carbohydrates. The rescue foods in this regard were cookies in 41.7% of the cases, sachets of glucose formulations in 19.4%, fruit juice in 19.4%, energy bars in 11.1%, yogurt drinks in 5.6%, and sachets of sugar in one patient. Cookies and juice were the preferred foods in younger patients, versus glucose tablets in adolescents (LR: p<span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>0.05), with no gender differences.</p><p id="par0060" class="elsevierStylePara elsevierViewall">Although there are a number of publications on the effects of sports activities upon metabolic control in pediatric patients with T1DM1 and on the recommendations for doing sports safely,<a class="elsevierStyleCrossRefs" href="#bib0015"><span class="elsevierStyleSup">3–5</span></a> we only found one study similar to our own that evaluated compliance with these standards.<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> After analyzing our study population, we concluded that patients with DM1 globally perform sports activities adequately adjusted to their age. Behavior should be routinely examined to ensure safe exercise, for as demonstrated by the present study, some recommendations tend to be forgotten over the years. Our patients focused their attention on glycemic control, but often ignored the recommendations referring to intake and hydration before and after exercise. Roberts et al.<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> presented similar results regarding changes in insulin administration, though they only included patients with insulin infusion pumps. The percentage of patients who ate immediately before exercise was higher in their series (70% versus 50% in our study). A particularly important aspect is the fact that while most of our patients experienced hypoglycemia during exercise, many of them did not inform anyone around them, with the risk that this implies. Our data coincide with those of other previously published series,<a class="elsevierStyleCrossRefs" href="#bib0035"><span class="elsevierStyleSup">7–10</span></a> in which adolescence represents a turning point in metabolic control, not only because of hormonal changes inherent to the body, but also because of the rejection of disease control, which leads to less physical activity and less safe exercise. However, the previously published study<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> recorded no differences in relation to age, though the mean age of the patients was higher than in our sample, since it comprised patients between 10–18 years of age, their sample being more homogeneous in this regard.</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Financial support</span><p id="par0065" class="elsevierStylePara elsevierViewall">The present study has not received specific financial support from public agencies, the commercial sector or from non-profit entities.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:3 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Financial support" ] 1 => array:2 [ "identificador" => "xack492123" "titulo" => "Acknowledgments" ] 2 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Salamanca-Zarzuela B, Mulero-Collantes I, Morales-Luengo F, Centeno Malfaz F. Adherencia a las recomendaciones de la Guía RECORD en los pacientes con diabetes mellitus tipo 1 menores de 18 años. Endocrinol Diabetes Nutr. 2020;67:553–556.</p>" ] ] "multimedia" => array:1 [ 0 => array:8 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0005" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:2 [ "leyenda" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Italics show the section of the RECORD guidelines which the questions refer to. This text did not appear in the patient survey.</p>" "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleBold">Age</span> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleBold">Gender</span> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleBold">Age at baseline</span> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleBold">Years of diabetes</span> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleBold">Type of exercise (in addition to school exercise)</span> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">• What exercise do you do? \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">• How many days a week? \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">• At what time? \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">• For how long? \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">• Has the way you do sports changed since the diagnosis? \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">• In what way? \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">• Do you change the intensity of exercise if it is very cold or very hot? \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleItalic">Changes to be made in eating habits</span> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">• <span class="elsevierStyleItalic">Capillary blood glucose should be measured before starting sports activities. If <100<span class="elsevierStyleHsp" style=""></span>mg/dl, it is advisable to take a 10–20<span class="elsevierStyleHsp" style=""></span>g supplement of slow-absorbing CH in patients treated with insulin. If <70<span class="elsevierStyleHsp" style=""></span>mg/dl, sports should be postponed until levels >100<span class="elsevierStyleHsp" style=""></span>mg/dl are reached.</span> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleItalic">Nutrition during sports activities</span> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleItalic">As a general rule, it may be stated that:</span> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">• <span class="elsevierStyleItalic">In exercise lasting <60<span class="elsevierStyleHsp" style=""></span>min, it is essential to maintain good hydration, preferably through water intake. Drinks containing CH should be avoided unless exercise is of high intensity. In these cases, CH supplements providing 30–60<span class="elsevierStyleHsp" style=""></span>g of glucose are adequate.</span> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">• <span class="elsevierStyleItalic">In exercise lasting 1–2.5<span class="elsevierStyleHsp" style=""></span>h, in addition to maintaining good hydration, supplements providing 30–60<span class="elsevierStyleHsp" style=""></span>g of glucose per hour of exercise are recommended.</span> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">• <span class="elsevierStyleItalic">In exercise lasting >2.5<span class="elsevierStyleHsp" style=""></span>h, the recommendations are similar to the previous case. It is advisable to mix the CH sources, adding slow-absorbing CH.</span> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">• <span class="elsevierStyleItalic">After sports, it is advisable to monitor blood glucose and, if <120<span class="elsevierStyleHsp" style=""></span>mg/dl, 15–20<span class="elsevierStyleHsp" style=""></span>g of CH should be consumed. In competitive sports, the recovery period is very important, because muscle glycogen must be replaced, and this is an insulin-dependent process. In such cases, 1–1.5<span class="elsevierStyleHsp" style=""></span>g/kg of CH should be consumed as soon as possible after the end of exercise. In explosive sports activities, post-exercise hyperglycemia is a problem in the first 60<span class="elsevierStyleHsp" style=""></span>min after the end of exercise.</span> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleItalic">The most common situations associated with physical activity</span> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">• <span class="elsevierStyleItalic">Intense heat/cold (both local and environmental) may increase or decrease insulin absorption, respectively, even hours later.</span> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">• <span class="elsevierStyleItalic">Changes in insulin absorption. Insulin absorption may be increased by the stimulation of subcutaneous blood flow and by pumping action due to muscle contraction. It is advisable to avoid injecting insulin into areas that are going to be exercised immediately.</span> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleBold">Insulin therapy and food intake (also exercise at school)</span> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">• Do you change the insulin injection site according to the exercise you are going to perform? \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">• Do you lower the insulin dose if you are going to do exercise on that day? \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">• Do you regularly eat anything before exercise? \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">• What? \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">• Do you drink anything before exercise? \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">• And after exercise? \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleItalic">Effects of different types of exercise upon glycemic control</span> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleItalic">Sports activity, especially in children and adolescents, is associated with an increased risk of hypoglycemia during or after exercise. Sports performed late in the day are associated with a biphasic increase in insulin sensitivity (up to 7–11<span class="elsevierStyleHsp" style=""></span>h later) that could increase the risk of nocturnal hypoglycemia. A greater duration and intensity of physical activity is associated with an increased risk of hypoglycemia.</span> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleBold">Blood glucose control</span> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">• Do you control your blood glucose before exercising? \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">• And after exercise? \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">• From what blood sugar levels do you decide not to exercise? \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">• What do you do when the levels are low? \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">• And when they are high? \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">• What ketone bodies do you consider dangerous for doing exercise? \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">• Do you worry that people will see you checking your blood glucose levels? \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">• If your blood sugar is altered, do you tell anyone? \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleItalic">The most common clinical situations associated with sports/physical activity</span> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">• <span class="elsevierStyleItalic">Physical exercise in situations of hyperglycemia: people with very deficient insulin levels and ketosis may worsen their decompensation due to physical exercise by stimulating the secretion of counter-regulatory hormones.</span> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">• <span class="elsevierStyleItalic">Hypoglycemia during physical exercise: the risk is greater in cases of prolonged physical exercise and at times of maximum insulin action.</span> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleBold">Complications during exercise</span> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">• Have you ever felt ill while doing sports? \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">• If so, what did you feel? \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">• What did you do then? \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleBold">Why do you do sports?</span> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">• Is it because it helps you to feel better? \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">• Is it because you know it’s good for your diabetes? \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">• Is it because you are obliged to do sports? \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">• Thank you for your cooperation \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab2424704.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Adherence questionnaire.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:10 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Insulinoterapia en la diabetes tipo 1 en la edad pediátrica" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "R. Barrio" 1 => "P. Ros" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:4 [ "tituloSerie" => "Protoc Diagn Ter Pediatr" "fecha" => "2011" "paginaInicial" => "65" "paginaFinal" => "75" ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0010" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Grupo de Trabajo de Diabetes Mellitus de la Sociedad Española de Endocrinología y Nutrición (SEEN). Recomendaciones clínicas para la práctica del deporte en pacientes con diabetes mellitus (Guía RECORD) Grupo de Trabajo de Diabetes Mellitus de la Sociedad Española de Endocrinología y Nutrición (SEEN)" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "M. Gargallo-Fernández" 1 => "J. Escalada San Martín" 2 => "F. Gómez-Peralta" 3 => "P. Rozas Moreno" 4 => "A. Marco Martínez" 5 => "M. Botella-Serrano" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.endonu.2015.02.004" "Revista" => array:6 [ "tituloSerie" => "Endocrinol Nutr" "fecha" => "2015" "volumen" => "62" "paginaInicial" => "e73" "paginaFinal" => "93" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25840764" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0015" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The decline in blood glucose levels is less with intermittent high-intensity compared with moderate exercise in individuals with type 1 diabetes" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "K.J. Guelfi" 1 => "T.W. Jones" 2 => "P.A. Fournier" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.2337/diacare.28.6.1289" "Revista" => array:6 [ "tituloSerie" => "Diabetes Care" "fecha" => "2005" "volumen" => "28" "paginaInicial" => "1289" "paginaFinal" => "1294" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15920041" "web" => "Medline" ] ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0020" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Dietary adherence and mealtime behaviors in young children with type 1 diabetes on intensive insulin therapy" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "S.R. Patton" 1 => "L.M. Dolan" 2 => "M. Chen" 3 => "S.W. Powers" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.jand.2012.09.013" "Revista" => array:6 [ "tituloSerie" => "J Acad Nutr Diet" "fecha" => "2013" "volumen" => "113" "paginaInicial" => "258" "paginaFinal" => "262" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23351629" "web" => "Medline" ] ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0025" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Blood glucose levels and performance in a sports camp for adolescents with type 1 diabetes mellitus?: A field study" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "D. Kelly" 1 => "J.K. Hamilton" 2 => "M.C. Riddell" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1155/2010/2161676" "Revista" => array:3 [ "tituloSerie" => "Int J Pediatr" "fecha" => "2010" "volumen" => "2010" ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib0030" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Do youth with type 1 diabetes exercise safely? A focus on patient practices and glycemic outcomes" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "Aj Roberts" 1 => "J.P. Yi-Frazier" 2 => "K.E. Aitken" 3 => "C.A. Mitrovich" 4 => "M.F. Pascual" 5 => "C.E. Taplin" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/pedi.12402" "Revista" => array:6 [ "tituloSerie" => "Pediatr Diabetes" "fecha" => "2017" "volumen" => "18" "paginaInicial" => "367" "paginaFinal" => "375" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/27380934" "web" => "Medline" ] ] ] ] ] ] ] ] 6 => array:3 [ "identificador" => "bib0035" "etiqueta" => "7" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Exercise-promoting healthy lifestyles in children and adolescents" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "S.G. Trost" 1 => "LP" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "J Clin Lipid" "fecha" => "2008" "volumen" => "2" "paginaInicial" => "162" "paginaFinal" => "168" ] ] ] ] ] ] 7 => array:3 [ "identificador" => "bib0040" "etiqueta" => "8" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Insulin treatment in children and adolescents with diabetes" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "T. Danne" 1 => "H.-J. Bangstad" 2 => "L. Deeb" 3 => "P. Jarosz-Chobot" 4 => "L. Mungaie" 5 => "B. Saboo" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/pedi.12184" "Revista" => array:6 [ "tituloSerie" => "Pediatr Diabetes" "fecha" => "2014" "volumen" => "15 Suppl. 20" "paginaInicial" => "115" "paginaFinal" => "134" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/28334496" "web" => "Medline" ] ] ] ] ] ] ] ] 8 => array:3 [ "identificador" => "bib0045" "etiqueta" => "9" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Elevated glycated hemoglobin levels impair blood pressure in children and adolescents with type 1 diabetes mellitus" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "S. de Oliveira" 1 => "D. da Cunha Nascimento" 2 => "R.A. Tibana" 3 => "S.L. de Oliveira" 4 => "I.V. de Sousa Neto" 5 => "R.K. Falleiros" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1186/s13098-015-0118-0" "Revista" => array:6 [ "tituloSerie" => "Diabetol Metab Syndr" "fecha" => "2016" "volumen" => "8" "paginaInicial" => "4" "paginaFinal" => "9" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26759608" "web" => "Medline" ] ] ] ] ] ] ] ] 9 => array:3 [ "identificador" => "bib0050" "etiqueta" => "10" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Teenagers with diabetes-management challenges" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "F. Cameron" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.2337/dc14-S014" "Revista" => array:6 [ "tituloSerie" => "Aust Fam Physician" "fecha" => "2006" "volumen" => "35" "paginaInicial" => "386" "paginaFinal" => "390" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16751852" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] "agradecimientos" => array:1 [ 0 => array:4 [ "identificador" => "xack492123" "titulo" => "Acknowledgments" "texto" => "<p id="par0070" class="elsevierStylePara elsevierViewall">Thanks are due to all the patients who participated in the study.</p>" "vista" => "all" ] ] ] "idiomaDefecto" => "en" "url" => "/25300180/0000006700000008/v1_202011131001/S2530018020301189/v1_202011131001/en/main.assets" "Apartado" => array:4 [ "identificador" => "72435" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Scientific letter" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/25300180/0000006700000008/v1_202011131001/S2530018020301189/v1_202011131001/en/main.pdf?idApp=UINPBA00004N&text.app=https://www.elsevier.es/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2530018020301189?idApp=UINPBA00004N" ]
| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 3 | 1 | 4 |
| 2024 October | 8 | 1 | 9 |
| 2024 September | 9 | 4 | 13 |
| 2024 August | 13 | 4 | 17 |
| 2024 July | 14 | 2 | 16 |
| 2024 June | 8 | 2 | 10 |
| 2024 May | 10 | 3 | 13 |
| 2024 April | 12 | 5 | 17 |
| 2024 March | 25 | 5 | 30 |
| 2024 February | 21 | 2 | 23 |
| 2024 January | 5 | 1 | 6 |
| 2023 December | 8 | 2 | 10 |
| 2023 November | 4 | 2 | 6 |
| 2023 October | 12 | 1 | 13 |
| 2023 September | 7 | 0 | 7 |
| 2023 August | 9 | 4 | 13 |
| 2023 July | 6 | 4 | 10 |
| 2023 June | 19 | 2 | 21 |
| 2023 May | 35 | 0 | 35 |
| 2023 April | 23 | 0 | 23 |
| 2023 March | 16 | 1 | 17 |
| 2023 February | 14 | 5 | 19 |
| 2023 January | 8 | 2 | 10 |
| 2022 December | 9 | 2 | 11 |
| 2022 November | 9 | 6 | 15 |
| 2022 October | 13 | 5 | 18 |
| 2022 September | 10 | 19 | 29 |
| 2022 August | 12 | 8 | 20 |
| 2022 July | 7 | 7 | 14 |
| 2022 June | 6 | 7 | 13 |
| 2022 May | 11 | 7 | 18 |
| 2022 April | 7 | 6 | 13 |
| 2022 March | 9 | 9 | 18 |
| 2022 February | 10 | 5 | 15 |
| 2022 January | 10 | 3 | 13 |
| 2021 December | 29 | 8 | 37 |
| 2021 November | 5 | 6 | 11 |
| 2021 October | 46 | 8 | 54 |
| 2021 September | 45 | 3 | 48 |
| 2021 August | 30 | 3 | 33 |
| 2021 July | 12 | 8 | 20 |
| 2021 June | 8 | 4 | 12 |
| 2021 May | 8 | 4 | 12 |
| 2021 April | 17 | 6 | 23 |
Show all
