Browsing by Author "Grassi, Bruno"

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    Factors associated with clinically significant hypoglycemia in patients with type 1 diabetes using sensor-augmented pump therapy with predictive low-glucose management: A multicentric study on iberoamerica
    (2021) Gomez, Ana M.; Imitola, Angelica; Henao, Diana; Garcia-Jaramillo, Maira; Gimenez, Marga; Vinals, Clara; Grassi, Bruno; Torres, Mariana; Zuluaga, Isabella; Munoz, Oscar Mauricio; Rondon, Martin; Leon-Vargas, Fabian; Conget, Ignacio
    Background and aims: Despite using sensor-augmented pump therapy (SAPT) with predictive lowglucose management (PLGM), hypoglycemia is still an issue in patients with type 1 Diabetes (T1D). Our aim was to determine factors associated with clinically significant hypoglycemia (<54 mg/dl) in persons with T1D treated with PLGM-SAPT.
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    Real-world performance of the MiniMed 780G advanced hybrid closed loop system in Latin America: Substantial improvement in glycaemic control with each technology iteration of the MiniMed automated insulin delivery system
    (2023) Grassi, Bruno; Gomez, Ana Maria; Calliari, Luis Eduardo; Franco, Denise; Raggio, Marcela; Riera, Francisca; Castro, Matias; McVean, Jennifer; van den Heuvel, Tim; Arrieta, Arcelia; Castaneda, Javier; Cohen, Ohad
    Aim: We studied real-world performance of MiniMed (MM) 780G system users from Argentina, Brazil, Colombia and Chile (geographical analysis), and the effect of each technology iteration of the MM system on glycaemic control (technology iteration analysis).Materials and Methods: CareLink data from August 2020 to September 2022 were extracted. Endpoints included continuous glucose monitoring metrics. For the geographical analysis, aggregated endpoints for MM780G system users were calculated. For the technology iteration analysis, MM780G system user outcomes were compared with outcomes when the same individuals were still using the MM640G or MM670G system.Results: On average, 1025 MM780G system users from the geographical analysis were followed for 136 (SD 135) days, spent 91.5 (14.3)% in advanced hybrid closed loop, showed a glucose management indicator (GMI) of 6.7 (0.3)%, a time in range between 70 and 180 mg/dl (TIR) of 76.5 (9.0)%, and a time below range 70 mg/dl (TBR) of 2.7 (2.1)%. The percentage of users reaching targets of GMI < 7%, TIR > 70% and TBR < 4% was 80.8%, 78.1% and 80.1%, respectively. The technology iteration analysis on users transitioning from MM640G to MM780G system (N = 381) showed 0.4% decrease in GMI (7.1% to 6.7%, p < .0001), 10.7% increase in TIR (65.9% to 76.6%, p < .0001), while TBR remained. The percentage of insulin delivered automatically increased as well (47.5%-57.7%, p < .0001). Users transitioning from MM670G system (N = 78) showed a similar but less pronounced pattern.Conclusions: Real-world Latin American MM780G users on average showed good glucose control, achieving international targets. Glycaemic control increased with every technology iteration of the MM system, providing more automation each time.
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    Reduced burnout and higher mindfulness in medical students after a self-care program during the COVID-19 pandemic
    (2021) Zuniga, Denisse; Torres-Sahli, Manuel; Nitsche, Pia; Echeverria, Guadalupe; Pedrals, Nuria; Grassi, Bruno; Cisternas, Marcela; Rigotti, Attilio; Bitran, Marcela
    Background: Medical students experience high levels of psychological stress during clinical training. However, most medical curricula do not teach self-care skills. The COVID-19 pandemic has disrupted medical education causing increased distress among students. Aim: To report the implementation and impact of an eight-week multifaceted mindfulness-based self-care program on medical students' distress and well-being during the COVID-19 pandemic. Material and Methods: One hundred twenty-three fourth-year medical students attended the program as part of a mandatory course from April to May 2020, during the rising phase of COVID-19 in Chile. They were evaluated using validated tests before and immediately after the program. The measures included burnout, dispositional mindfulness, perceived stress, traumatic stress reactions, general well-being, resilience, and stress coping strategies. Results: Burnout prevalence decreased from 48% to 24%, whereas students with high dispositional mindfulness increased from 25% to 44%. Burnout reduction was mostly due to decreased emotional exhaustion. Additionally, students reported lower levels of stress, self-blaming, and traumatic stress reactions alongside an increased use of active coping strategies and resilience levels after the program. Conclusions: A formal educational intervention, teaching self-awareness and self-regulation skills can help reduce medical students' distress and promote their well-being even amidst a pandemic.
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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.