Flash Glucose Monitoring and Reduction of Acute Diabetes Complications

Capillary blood glucose monitoring has been fundamental throughout the history of diabetes to improve metabolic control and reduce complications. Among the various continuous glucose monitoring (CGM) systems, the most widely used is the "flash" system, which measures glucose continuously.

Continuous glucose monitoring throughout the day with this system can prevent periods of hypoglycemia and hyperglycemia, unlike the traditional system. This method not only alerts the patient to fluctuations in glucose levels, but also facilitates quick and efficient action through more precise administration of the required insulin. This system shows the trend of blood glucose levels and allows the patient to predict what their levels will be in the short term.

The Flash System consists of two main components: a handheld reader and a disposable sensor that is worn on the back of the arm. The reader is used to wirelessly scan the sensor and obtain glucose readings. When the patient scans the sensor with a special device or cell phone, the current and previous 8-hour blood glucose levels are provided. This allows the patient to take preventative measures against hyper- and hypoglycemia.

The only "flash" system on the market is the FreeStyle Libre (FSL), which is why it is widely used in developed countries and financed by most public health systems.

A study conducted at the University of Paris analyzed hospital admissions for hyperglycemia, severe hypoglycemia, ketoacidosis, and diabetes-related coma over a one-year period. Patients with type 1 (DM1) and type 2 (DM2) diabetes, treated with a "flash" system, participated and their evolution was compared with the previous year without continuous glucose monitoring. The sample included 74,011 individuals, 45% with DM1 and 55% with DM2. Of these, 88% were treated with multiple doses of insulin or an insulin pump. The use of the Flash system showed a dramatic reduction in hospital admissions for diabetic decompensation, namely 49.0% in people with DM1 and 39.4% in people with DM2. The most significant reductions were in admissions for ketoacidosis, which were more than halved (56.2% in DM1 and 52.1% in DM2), and for diabetes-related coma (39.6% in DM1 and 31.9% in DM2). Hospitalizations for hypoglycemia and hyperglycemia decreased by 10.8% and 26.5%, respectively, in people with DM2.

An interesting finding of the study related to capillary blood glucose monitoring was that hospitalizations for hypoglycemia were marginal, most likely due to the ability of patients to resolve them without the need for hospitalization.

The General Alliance of Patients (AGP) believes that:

• The new Flash Glucose Monitoring System breaks new ground in the management of patients with diabetes who are treated with multiple doses of insulin (MDIs).
• Obtaining glucose levels in a simple and painless way, without the daily finger prick, allows for more frequent monitoring. The patient has more information that is easy to interpret and use, which contributes to improved adherence and metabolic control.
• By having more data about their glycemic profile, patients will be able to better adjust the insulin doses needed to optimize their own metabolic control, thus avoiding acute complications in the short term and chronic complications in the long term.
• This device will provide patients with greater self-management of their disease and autonomy in decision making, which is a critical element in treatment adherence and a reduction in the burden of care by reducing the number of doctor's visits and hospitalizations. This situation will lead to savings for the health system, both economically and in terms of human resources.
• The new Flash Glucose Monitoring System facilitates communication between professionals and patients with the common goal of optimizing metabolic control by sharing information and knowledge to improve decision making. This defines a new model focused on patient care, autonomy, and shared responsibility. It is important to emphasize the importance of involving all stakeholders in the system in order to achieve collaborative efficiency.
• Non-adherence reflects the difficulty of living with diabetes and is one of the main reasons for not achieving the desired goals. It also has a major negative impact on the natural history of DM and on costs.
• In patients treated with multiple insulin injections, the high number of daily injections is one of the main causes of non-compliance and optimization of metabolic control. Elimination of these habitual injections will undoubtedly have a positive influence on the psychological state of the patients.
• Personal empowerment is key for patients to be able to manage their DM on a daily basis with greater confidence in the control and optimization of their treatment. It is important to emphasize the importance of providing patients with resources that facilitate their daily decision making, as they are the active daily decision makers in the management of their disease. In this way, the patient will be able to better control his pathology by understanding and participating in his treatment in a much more positive and active way.
• This new Flash Glucose Monitoring System is a key technological innovation that will enable both professionals and patients to make the right decisions. Daily information is essential to know the pattern of glucose levels, their variability and to make the necessary therapeutic adjustments.

For all these reasons, a system that is integrated into the daily life of the diabetic patient, that provides easy-to-interpret data and, at the same time, eliminates the routine of finger pricking, allowing a better social adaptation of the diabetic patient, will undoubtedly become a fundamental element in improving the control of the disease and will help the patient to make appropriate decisions regarding his or her treatment.

by Global

World Diabetes Day

World Diabetes Day has been celebrated since 1991 and is promoted by the International Diabetes Federation (IDF) and the World Health Organization (WHO), who launched this global campaign in response to the alarming increase in the incidence of diabetes around the world.

The date of November 14 was chosen because it coincides with the centenary of the birth of Frederick Banting, who, along with Charles Best, conceived the idea that led to the discovery of insulin in October 1921.

The purpose of the day is to raise awareness of the causes, symptoms, treatment, and complications associated with the disease. World Diabetes Day reminds us that the incidence of this serious disease is increasing and will continue to do so unless we take action now to prevent this enormous growth. The number of people with diabetes has quadrupled over the past 40 years. It is the only non-communicable disease for which the risk of premature death is increasing rather than decreasing.

WHO facts and figures

• The number of people with diabetes increased from 108 million in 1980 to 422 million in 2014. The prevalence of the disease has increased faster in low- and middle-income countries than in high-income countries.
• Diabetes is a leading cause of blindness, kidney failure, heart attack, stroke, and lower limb amputation.
• Between 2000 and 2016, premature mortality from diabetes increased by 5%.
• In 2019, diabetes was the direct cause of an estimated 1.5 million deaths, and in 2012, 2.2 million people died as a result of hyperglycemia.

World Diabetes Day brings together millions of people in more than 160 countries to raise awareness about diabetes, including children and adults affected by diabetes, healthcare professionals, health policy makers and the media. Numerous local and national events are organized by Member Associations of the International Diabetes Federation and other diabetes-related organizations, healthcare professionals, health authorities and individuals committed to diabetes. World Diabetes Day unites the global diabetes community by creating a powerful voice for diabetes awareness. In Spain, the Spanish Diabetes Society and the Spanish Diabetes Federation are member associations of the International Diabetes Federation.

The World Diabetes Day logo is a blue circle - the global symbol of diabetes, created as part of the Unite for Diabetes awareness campaign. The logo was adopted in 2007 to commemorate the adoption of the United Nations Resolution on World Diabetes Day. The meaning of the blue circle symbol is incredibly positive. In many cultures, the circle symbolizes life and health. The color blue represents the sky that unites all nations and is the color of the United Nations flag. The blue circle symbolizes the unity of the international diabetes community in response to the diabetes pandemic.

Diabetes mellitus is a chronic disease that occurs when the pancreas does not produce enough insulin or when the body does not use the insulin it does produce effectively. Insulin is a hormone that regulates the concentration of glucose in the blood, or blood sugar. The result of uncontrolled diabetes is hyperglycemia (high blood glucose), which over time can cause serious damage to many organs and systems, especially nerves and blood vessels.

• Type 1 diabetes (formerly known as insulin-dependent or juvenile diabetes) is characterized by the absence of insulin synthesis.
• Type 2 diabetes (formerly called non-insulin-dependent or adult-onset diabetes) results from the body's inability to use insulin effectively, often as a result of obesity or physical inactivity.
• Gestational diabetes is hyperglycemia first detected during pregnancy.

Types of Diabetes

A century after their discovery, insulin and other essential components of diabetes care remains out of reach for those who need them. This must change. Support our call to action to make sure it reaches the people who need to hear it. That's why the central theme of World Diabetes Day 2021-23 is Access to Diabetes Care.

• Millions of people with diabetes around the world lack access to diabetes care.
• People with diabetes need ongoing care and support to manage their condition and prevent complications.

Simple lifestyle changes have been shown to effectively prevent or delay the onset of type 2 diabetes. To prevent type 2 diabetes and its complications, these behaviors should be followed: eating a healthy diet, getting regular physical activity, maintaining a normal body weight, and avoiding tobacco use.

by Global

Importance of first five years of brain development

The brain is the only organ in the body that takes a long time to grow and develop, undergoing amazing anatomical and functional changes from the prenatal stage to early adulthood.

After birth, a baby's daily experiences play an important role in the development of his or her brain. The number of new synapses increases exponentially in the postnatal period, especially in the first two weeks of life. At this stage of development, the production of new neurons (neurogenesis) and the connection between them (synaptogenesis) increases the possibility of modification of brain function (brain plasticity), which depends mainly on early experiences. This means that if the baby is exposed to affective deprivation at this stage, phenomena of neuronal death (apoptosis) will occur at the cerebral level, resulting in a greater vulnerability to stress and a decrease in the infant's immune response.

For this reason, parental attention during early childhood is crucial for brain maturation, especially for the structures responsible for affectivity and memory.

Humans need a significant postnatal experience to adapt to the new environment and to learn a form of communication that allows them to survive in it. In this sense, lullabies, the mother's conversations with her baby, her tone and timbre of voice from the first moments of life will help the baby to produce and decode the speech sounds that will form the basis of language, since daily experiences modify the neural circuits during the so-called critical periods for learning spoken language.

Early childhood is the launching pad for our sensory and perceptual universe, which will not only allow us to stay alive (when approaching or moving away from a stimulus) but will also be the vehicle for the conduction of cognitive, motor, and emotional information. The first years of life are critical for human development, as early experiences shape the architecture of the brain and shape future behavior. During this period, the brain undergoes phenomenal changes: it grows, develops, and goes through sensitive periods for some learning, so it needs an environment with meaningful experiences, multisensory stimuli, adequate physical resources; but above all, it needs an environment enriched by the care, responsibility, and affection of a committed adult.

That is why experts advise, and never forget: Read, sing, and talk to your young son or daughter because they need it.

A groundbreaking TED Talk by 7-year-old Molly Wright, a second-grader from Queensland, Australia, who is now one of the youngest TED speakers in history, is set to change the way parents and caregivers around the world view early childhood brain development and the way adults interact with children, and aims to show that there are simple but transformative things we can all do to help children thrive.

MOLLY’S TED TALK Project aims to raise awareness around the world about the critical importance of brain development in the first five years of a child's life and the impact it has on their future.

Backed by the latest research on child development and presented as a TED Talk, the short film aims to empower and motivate parents, caregivers, and community members to engage more meaningfully and frequently with children.

The talk highlights the tangible benefits of positive, reciprocal "serve and give back" interactions and the impact this has on a child's lifelong learning, health, and well-being. It also includes key messages about the importance of play, the prenatal period, and children's mental health.

Building on the five key tips of connect, talk, play, healthy home and community, the talk explains the simple and fun things we can do to make a big difference to a child's brain development and well-being, and the role we can all play.

So, can a game of hide-and-seek change the world?

by Global

The effects of blue screen light on our skin

More and more people are becoming aware of the damage that UVA and UVB rays can cause to the skin and are taking effective steps to protect themselves from them.

Now, experts are warning us about the risk posed by unprotected exposure to another type of radiation, known as visible light. This has also been shown to be detrimental to skin health. Visible light is nothing more than the small portion of the electromagnetic spectrum that the human eye can detect. It is usually associated with sunlight, whose harmful effects on the skin are well known. However, it is not as well known that household light bulbs or the screens of electronic devices such as smartphones, televisions, computers, or tablets also produce visible light. Forty percent of the visible light emitted by these devices is blue light.

Blue light can penetrate the skin and cause damage to the deepest layers of the skin. Given the number of hours that most people spend in front of computer screens, it is important to be aware of the effects of blue light and its impact on skin health.

The screens are emitting blue light in a more intense way and the exposures are getting longer and longer. A warning to consider in the current pandemic situation we're living in, where exposure to cell phones, computers and tablets has skyrocketed due to telecommuting, online meetings, and classes... Everything is much more virtual.

Although the light we receive from mobile devices is much less energetic and does not affect us in the same way, it all adds up. Its rays are able to penetrate the skin deeper than UV rays and can damage epithelial cells, causing the following effects:

Dehydration: Blue light can cause a decrease in aquaporins, molecules responsible for maintaining skin hydration. This reduces the skin's ability to retain water, accelerating premature aging.

Wrinkles in the skin: The effects of blue light promote the uncontrolled and disorganization of enzymes known as metalloproteinases, thus destroying the extracellular matrix. This results in the degradation of collagen and elastin, causing a loss of firmness and elasticity and favoring the appearance of wrinkles in the skin.

Skin spots: Exposure to blue light for many hours stimulates the activation of melanocytes. This increases the amount of melanin in the skin, promoting hyperpigmentation. 

Premature skin aging: Blue light stimulates the formation of free radicals. These radicals damage the extracellular matrix. The result is a loss of skin firmness and the appearance of wrinkles. In addition, blue light can alter the structure of fibroblasts. Fibroblasts are responsible for stimulating the collagen that keeps skin firm and radiant. The stress caused by blue light on cells can last up to 48 hours after exposure.

Fatigue: Prolonged use of devices causes insomnia due to the overstimulation of the brain from light throughout the day. Lack of rest leads to dehydration and decreased collagen synthesis, resulting in loss of luminosity and firmness.

Screens are necessary for work, communication, information, and entertainment. However, it is advisable to protect oneself from the blue light that they emit and to reduce the exposure to this type of radiation as much as possible. It is important to use products that protect your skin, just as it is advisable to use a filter on your screen to limit the blue light emitted by your computer or mobile phone.

You can control your exposure to blue light in the following ways:

• Move the LED light source away from your face:
  • Use a hands-free mobile phone.
  • Move your computer screen as far away from your face as possible.
• Use the night mode of the mobile screen, which emits less light than the normal mode.
• Use sunscreen with visible light filters, even indoors, if you cannot reduce exposure to blue light. We have a very strong sense that we need to protect our skin when we are going to be exposed to the sun. But we don't have the same attitude when we're in front of a computer.
• Moisturizing products with formulas rich in antioxidants, vitamin C, ferulic acid or vitamin E, which can fight free radicals, should be part of your daily skin care routine.

by Global

2021 World Breastfeeding Week

World Breastfeeding Week, which aims to promote breastfeeding and improve the health of babies around the world, is celebrated in more than 170 countries from 1 to 7 August.

World Breastfeeding Week was officially proclaimed by the World Health Organization (WHO) and UNICEF in 1992 to coincide with the anniversary of the Innocenti Declaration, formulated by senior officials of these two organizations in August 1990 to protect, promote and support breastfeeding.

However, in Europe, including Spain, because August is a holiday period, Breastfeeding Week is celebrated in October.

Breast milk is the first vaccine for the newborn, colostrum, the first milk, thick and yellowish, produced in the first hours and days after birth, is the best food for the newborn, there is no supplement that can replace it. This milk is very nutritious and gives the baby great protection against infections and other diseases.

Delayed breastfeeding increases the risk of neonatal mortality by up to 80%.

According to UNICEF, about 77 million newborns - or 1 in 2 - are not breastfed in the first hour after birth, depriving them of the nutrients, antibodies and contact with their mother's skin that are essential to protect them from illness and death.

Benefits of breastfeeding for infants and mothers

Exclusive breastfeeding is the best nutrition a newborn can receive until 6 months of age, when complementary feeding begins. The WHO recommends exclusive breastfeeding for the first 6 months of life. After that, it is recommended to continue breastfeeding until at least 2 years of age, with appropriate supplementation with other foods.

It protects the baby against infections such as gastroenteritis, respiratory tract infections, otitis, urinary tract infections and others, especially immune infections. It has also been shown to protect against Sudden Infant Death Syndrome.

But it also has beneficial effects on the mother's body. It speeds recovery after childbirth and has even been shown to reduce the risk of breast and ovarian cancer.

Every mother is capable of breastfeeding her baby, and although it may seem difficult at first, with good advice and a lot of patience and practice, this stage can be overcome. That is why it is important that the mother's environment supports her in achieving good breastfeeding. And that the hospitals and professionals who attend labor and delivery provide the right environment to succeed in establishing breastfeeding, which is key in the first hours and days.

Tips for successful breastfeeding

It is important to facilitate breastfeeding for mothers from the moment of birth, and this directly involves health professionals, midwives, doctors, and nurses. Hospitals are also involved.

Breastfeeding support groups often recommend the following practices:

• If the baby and mother are healthy, regardless of the mode of delivery, the newborn should be placed at the mother's breast until the first feeding. The first 2 hours are crucial because the newborn has a very strong sucking reflex.
• Offer the breast on demand. A newborn can have between 8 and 12 feedings a day, but it can be more.
• The composition of the milk varies during feeding, with more fat at the end, so it is recommended that the baby empties one breast completely before offering the other, otherwise he/she may not feed well and may become gassy.
• Check that latching and sucking are correct to avoid cracked nipples.
• Avoid using a pacifier until breastfeeding is well established. Pacifiers and nipples should not be offered for at least the first 4 to 6 weeks.
• Continuous use of nipple shields is not recommended.
• If help is needed, seek advice from a breastfeeding support group.
• There is no need to worry about whether the baby is feeding properly as long as he/she is gaining weight, has at least 5 wet diapers in 24 hours and is having a bowel movement (bowel movements are highly variable and 1 every 48 hours or 6 or 7 per day may be normal).

The theme for World Breastfeeding Week 2021 is "Protecting Breastfeeding: A Shared Responsibility" and will focus on the importance of preventing discrimination against breastfeeding mothers in all settings, providing family and community support, and implementing equitable policies and evidence-based health and social programmes.

by Global