Browsing by Author "Velandia, Oscar Mauricio Munoz"

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    Determination of time in range associated with HbA1c <= 6.5% in Latin American pregnant women diagnosed with type 1 diabetes mellitus using an automated insulin delivery system
    (ELSEVIER IRELAND LTD, 2023) Medina, Ana Maria Gomez; Chavez, Maria Juliana Soto; Carrillo, Diana Cristina Henao; Sanchez, Juan Camilo Salgado; Gonzalez, Javier Alberto Gomez; Grassi Corrales, Bruno; Velandia, Oscar Mauricio Munoz
    Aims: To determine the correlation between %TIR and HbA1c in pregnant women with type 1 diabetes mellitus (DM1)., Methods: Diagnostic test study in a prospective cohort of pregnant patients with DM1 using automated insulin delivery system (AID) in Colombia and Chile., Results: Fifty-two patients were included [mean age 31.8 +/- 6.2 years, pregestational HbA1c 7.2% [interquartile range (IQR), 6.5-8.2]. During follow-up, we found a better metabolic control during the second (HbA1c 6.40%, IQR 5.9,7.1) and third trimesters (HbA1c 6.25%;IQR 5.9,6.8). A weak and negative correlation between %TIR and HbA1c was found for all the gestation (Spearman's rank correlation coefficient:-0.22, p:0.0329), and in the second (r:-0.13, p: 0.38) and third trimesters (r:-0.26, p = 0.08). %TIR had poor discriminating capacity for predicting HbA1c < 6% (area under the curve [AUC], 0.59; 95% confidence interval [CI],0.46-0.72) and for predicting HbA1c < 6.5% (AUC, 0.57;95% CI,0.44-0.70). The optimal cutoff points for %TIR were > 66.1% for predicting HbA1c < 6% (65% sensitivity, 62% specificity) and %TIR > 61.1% for HbA1c < 6.5% (59% sensitivity, 54% specificity)., Conclusion: The correlation between HbA1c and %TIR during pregnancy was weak. The optimal cutoff points for identifying patients with HbA1c < 6.0% and < 6.5% were %TIR > 66.1% and > 61.1%, respectively, with moderate sensitivity and specificity.
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    Time in range and mean glucose cut-off points for reduction of fetal outcomes in pregnant women with type 1 diabetes using automated insulin delivery systems
    (2024) Medina, Ana Maria Gomez; Carrillo, Diana Cristina Henao; Macias, Maria Natalia Serrano; Chavez, Maria Juliana Soto; Gomez, Maria Alejandra Robledo; Parra, Dario; Gonzalez, Javier Alberto Gomez; Grassi, Bruno; Imitola, Angelica; Cob, Alejandro; Rondon, Martin; Garcia, Maira; Velandia, Oscar Mauricio Munoz
    Aim: In pregnant women with Type 1 Diabetes (T1D), achieving a lower recommended time in range (TIRp,63-140 mg/dl) could have an impact on fetal outcomes. To determine the TIRp and mean glucose cut-off point associated with better fetal outcomes in pregnant women using automated insulin delivery (AID) systems. Methods: A prospective cohort of pregnant women with T1D, using AID systems and followed-up in Latin America was analyzed. Optimal TIRp and mean glucose cut-off points for predicting large for gestational age (LGA) were determined using the Liu method. Fetal outcomes were evaluated for the identified cut-off point and the one recommended by guidelines (TIRp > 70 %). Results: Sixty-two patients were included (mean age 31.9 +/- 5.9 years, HbA1c 7.57 %+/- 1.29 %, TIRp 59.8 %+/- 14.6 %). 27.5 % on advanced hybrid closed loop systems (AHCL). LGA (50 vs 17.9 %,p = 0.010) and hyperbilirubinemia (45 % vs 11.8 %,p = 0.016) were more common in patients with TIRp < 59.1 %. Optimal cut-off of TIRp in the second trimester for predicting LGA was < 59.1 % (sensitivity 75 %, specificity 61 %) with an AUC of 0.68(CI 0.48-0.88). Optimal cut-off for mean glucose was 133 mg/dL (sensitivity 69 %, specificity 70 %) with an AUC of 0.70(CI 0.51-0.88) in the same trimester. Better metabolic control during the third trimester was seen in the AHCL users compared to other devices. Conclusions: TIRp > 59.1 % and mean glucose < 133 mg/dl in the second trimester, is associated with lower fetal outcomes of large for gestational age. One of the strategies that would improve TIRp is the early use of AHCL systems. Further studies are needed before a strong recommendation can be made.