Endocrine Abstracts

Objective: We retrospectively analyzed patients with type 1 diabetes onset, attended during the years 2005 and 2006 on the specific query of type 1 DM debut of a tertiary hospital, with initial treatment assessment, at 1 and 5 years evolution.

Results: Patients were treated for newly diagnosed DM 1, 25 patients (72% male, 28% female) mean age 23.2 years (14–36), mean BMI: 23.18 (18–33.8%).The clinical presentation included: 88.24% presented with weight loss average (mean: 8.91 kg (4–18 kg), 28% of patients had ketoacidosis requiring hospitalization 41% (mean stay: 5.7 days).

In 65% of patients starting insulin therapy was prescribed in endocrinology. Of the patients who weren’t initially treated in our Endocrinology Department 40% were treated with NPH, 20% with mixed insulin (rapid analogs and NPH) and 40% with OHA (oral hypoglicemic agents).

The initial insulin therapy regimens used in our clinic were: 5% 2 doses of NPH, 38.88% mixed insulin (NPH and rapid analog in three doses). 55.54% of patients initiated functional basal-bolus insulin therapy (Lantus/Levemir + rapid analogues).

At baseline, mean HbA1c: 10.58%, mean C-peptide: 1.1. Autoimmunity to GAD positive in 80%, 52% for IA2 and 23.8% for antiinsulin antibody.

After a year of evolution, 81.25% of patients have a functional basal-bolus insulin therapy, with a mean insulin requirements 0.49 U/kg per day, mean HbA1c 6.4%, average Peptide C: 1.0, Autoimmunity positive for GAD 79% for IA2 50% and 45.8% for anti-insulin Ab.

After 5 years of evolution, 100% of patients have a functional basal-bolus insulin therapy, with mean insulin requirements 0.75 U/kg per day, mean HbA1c 7.2%, with a mean weight gain of 1.9 kg and counting carbohydrate portions of up to 67% of cases.

Conclusions: In endocrinology tends to precocious intensive insulin therapy since DM1 debut, with an exponential increase in the usage of insulin analogues to mimic as much as possible the physiology of the pancreas. But there is a percentage that optimal treatment is delayed for late referral to the Endocrinology Department, mainly from primary care.