Manejo de la diabetes mellitus tipo 2 en adolescentes y adultos jóvenes en atención primaria

  1. S. Miravet-Jiménez 1
  2. M.P. Pérez-Unanua 2
  3. M. Alonso-Fernández 3
  4. F.J. Escobar-Lavado 4
  5. B. González-Mohino Loro 5
  6. A. Piera-Carbonell 6
  1. 1 EAP Martorell urbà-Institut Català de la Salut, Barcelona, España
  2. 2 CS Dr. Castroviejo, Servicio de Salud de la Comunidad de Madrid, Madrid, España
  3. 3 EAP La Ería, Servicio de Salud del Principado de Asturias, Oviedo, Asturias, España
  4. 4 CS Valsequillo, Servicio Canario de Salud, Las Palmas, Canarias, España
  5. 5 CS La Puebla de Montalbán, Servicio de Salud de Castilla-La Mancha, Toledo, España
  6. 6 CS Luanco, Servicio de Salud del Principado de Asturias, Gozón, Asturias, España
Revista:
Semergen: revista española de medicina de familia

ISSN: 1138-3593

Ano de publicación: 2020

Número: 6

Páxinas: 415-424

Tipo: Artigo

DOI: 10.1016/J.SEMERG.2019.11.008 DIALNET GOOGLE SCHOLAR

Outras publicacións en: Semergen: revista española de medicina de familia

Objetivos de desarrollo sostenible

Resumo

La prevalencia de la diabetes tipo 2 diagnosticada en la infancia/juventud está aumentando y se caracteriza por una disminución acelerada de la función de las células beta pancreáticas y resistencia a la insulina. Los principales factores de riesgo para su desarrollo son obesidad e inactividad física. Los criterios diagnósticos son similares a los utilizados en adultos, aunque la HbA1c como método diagnóstico está cuestionada. Las complicaciones son más agresivas que en la diabetes tipo 2 del adulto, siendo la nefropatía la más frecuente. Las complicaciones macrovasculares aparecen precozmente y su mortalidad es elevada. La alimentación saludable y el ejercicio físico continuado son los pilares básicos del tratamiento, y la metformina, insulina y liraglutide (aprobado por la FDA en Estados Unidos) las opciones farmacológicas con indicación en esta población. Es importante establecer modelos de transición de la atención pediátrica a la atención adulta para garantizar la continuidad asistencial y evitar pérdidas en el seguimiento de estos pacientes.

Información de financiamento

A los miembros del GT de diabetes de la SEMERGEN que han colaborado en este art?culo: Abdurrahman Adlbi Sibai, Laia Homedes Celma, Diego Murillo Garc?a, Ana Olivares Loro, Andr?s Sim?n Fuentes y a nuestra coordinadora nacional Flora L?pez Simarro.

Financiadores

Referencias bibliográficas

  • S. Arslanian, F. Bacha, M. Grey, M.D. Marcus, N.H. White, P. Zeitler Evaluation and management of youth-onset type 2 diabetes: A position statement by the American Diabetes Association Diabetes Care, 41 (2018), pp. 2648-2668 10.2337/dci18-0052 CrossRefView Record in ScopusGoogle Scholar
  • D. Dabelea, E.J. Mayer-Davis, S. Saydah, G. Imperatore, B. Linder, J. Divers, et al., SEARCH for Diabetes in Youth Study Prevalence of type1 and type 2 diabetes among children and adolescents from 2001 to 2009 JAMA, 311 (2014), pp. 1778-1786 10.1001/jama.2014.3201 CrossRefView Record in ScopusGoogle Scholar
  • J.B. Buse, F.R. Kaufman, B. Linder, K. Hirst, L. El Ghormli, S. Willi, HEALTHY Study Group Diabetes screening with hemoglobin A1c versus fasting plasma glucose in a multiethnic middleschool cohort Diabetes Care, 36 (2013), pp. 429-435 10.2337/dc12-0295 CrossRefView Record in ScopusGoogle Scholar
  • K.C. Copeland, P. Zeitler, M. Geffner, C. Guandalini, J. Higgins, K. Hirst, et al., TODAY Study Group Characteristics of adolescents and youth with recent-onset type 2 diabetes: The TODAY cohort at baseline J Clin Endocrinol Metab, 96 (2011), pp. 159-167 10.1210/jc.2010-1642 CrossRefView Record in ScopusGoogle Scholar
  • Organización Mundial de la Salud. La salud de los jóvenes: un desafío para la sociedad. 2000. Informe Salud para todos en el año 2000 [consultado 30 agosto de 2019]. Disponible en: https://apps.who.int/iris/bitstream/handle/10665/36922/WHO_TRS_731_spa.pdf;jsessionid=4D0969C70086D3C06FA2E4065541B87B?sequence=1 Google Scholar
  • R. Gandica, P. Zeitler Update on youth-onset type 2 diabetes: Lessons learned from the TODAY clinical trial Adv Pediatr, 63 (2016), pp. 195-209, 10.1016/j. yapd.2016.04.01 ArticleDownload PDFView Record in ScopusGoogle Scholar
  • E.T. Jensen, D. Dabelea Type 2 diabetes in youth: New lessons from the SEARCH Study Current Diabetes Reports, 18 (2018), p. 36, 10.1007/s11892-018-0997-1 View Record in ScopusGoogle Scholar
  • G. Imperatore, J.P. Boyle, T.J. Thompson, D. Case, D. Dabelea, R.F. Hamman, et al., SEARCH for diabetes in Youth Study Group Projections of type 1 and type 2 diabetes burden in the U.S. population aged, 20 years through 2050: Dynamic modeling of incidence, mortality, and population growth Diabetes Care, 35 (2012), pp. 2515-2520 10.2337/dc12-0669 CrossRefView Record in ScopusGoogle Scholar
  • E. Felszeghy, E. Juhasz, R. Kaposzta, I. Ilyes Alterations of glucoregulation in childhood obesity-association with insulin resistance and hyperinsulinemia J Pediatr Endocrinol Metab, 2 (2008), pp. 847-853 Doi.org/10.1515/JPEM .2008.21.9.847 View Record in ScopusGoogle Scholar
  • R. Barrio, P. Ros Diabetes tipo 2 en población pediátrica española: cifras, pronóstico y posibilidades terapéuticas Av Diabetol, 29 (2013), pp. 27-35, 10.1016/j.avdiab.2013.01.003 ArticleDownload PDFView Record in ScopusGoogle Scholar
  • M.G. Guijarro, S. Monereo, S. Civantos, J.M. Montano, P. Iglesias, M. Duran Prevalencia de alteraciones del metabolismo hidrocarbonado en una población infanto-juvenil con obesidad grave Endocrinol Nutr, 57 (2010), pp. 467-471 10.1016 /j. endonu.2010.09.002 Google Scholar
  • Estudio ALADINO. Estrategia NAOS. Ministerio de Sanidad, Consumo y Bienestar Social [consultado 2 Agos 2019]. Disponible en: http://www.aecosan.msssi.gob.es/AECOSAN/docs/documentos/nutricion/observatorio/estudio_ALADINO_2011.pdf Google Scholar
  • N. Lascar, J. Brown, H. Pattison, A.H. Barnett, C.J. Bailey, S. Bellary Type 2 diabetes in adolescents and young adults Lancet Diabetes Endocrinol, 6 (2018), pp. 69-80 10.1016/S2213-8587(17)30186-9 ArticleDownload PDFView Record in ScopusGoogle Scholar
  • J. Grulich-Henn, D. Klose Understanding childhood diabetes mellitus: New pathophysiological aspects J Inherit Metab., 41 (2018), pp. 19-27, 10.1007/s10545-017-0120-9 CrossRefView Record in ScopusGoogle Scholar
  • S. Arslanian, L. Pyle, G. Washington, M. Payan, F. Bacha, S. Caprio, et al., TODAY Study Group Effects of metformin, metformin plus rosiglitazone, and metformin plus lifestyle on insulin sensitivity and (-cell function in TODAY Diabetes Care., 36 (2013), pp. 1749-1757, 10.2337/dc12-2393 View Record in ScopusGoogle Scholar
  • L. Hecht, R. Weiss Nonalcoholic fatty liver disease and type 2 diabetes in obese children Curr Diab Rep, 14 (2014), p. 448 Doi.org/10.1007/s11892-013-y0448 Google Scholar
  • E. Wilmot, I. Idris Early onset type 2 diabetes: Risk factors, clinical impact and management Ther Adv Chronic Dis, 5 (2014), pp. 234-244 Doi.org/10.1177/2040622314548679 CrossRefView Record in ScopusGoogle Scholar
  • A. Khokhar, V. Umpaichitra, V.L. Chin, S. Perez-Colon Metformin use in children and adolescents with prediabetes Pediatr Clin North Am, 64 (2017), pp. 1341-1353, 10.1016/j.pcl.2017.08.010 ArticleDownload PDFView Record in ScopusGoogle Scholar
  • American Diabetes Association. Standards of medical care in diabetes-2019: Summary of revisions. Diabetes Care. 2019;42(Suppl 1) [consultado 1 Agos 2019]. Disponible en: https://care.diabetesjournals.org/content/diacare/suppl/2018/12/17/42.Supplement_1.DC1/DC_42_S1_2019_UPDATED.pdf Google Scholar
  • G.J. Klingensmith, L. Pyle, S. Arslanian, K.C. Copeland, L. Cuttler, F. Kaufman, et al., TODAY Study Group The presence of GAD and IA-2 antibodies in youth with a type 2 diabetes phenotype: Results from the TODAY study Diabetes Care, 33 (2010), pp. 1970-1975 10.2337/dc10-0373 CrossRefView Record in ScopusGoogle Scholar
  • P. Nowicka, N. Santoro, H. Liu, D. Lartaud, M. Shaw, R. Goldberg, et al. Utility of hemoglobin A1c for diagnosing prediabetes and diabetes in obese children and adolescents Diabetes Care, 34 (2011), pp. 1306-1311 10.2337/dc10-1984 CrossRefView Record in ScopusGoogle Scholar
  • C.L. Chan, L. Pyle, L. Newnes, K.J. Nadeau, P.S. Zeitler, M.M. Kelsey Continuous glucose monitoring and its relationship to hemoglobin A1c and oral glucose tolerance testing in obese and prediabetic youth J Clin Endocrinol Metab, 100 (2015), pp. 902-910 10.1210/jc.2014-3612 CrossRefView Record in ScopusGoogle Scholar
  • A.H. Al-Saeed, M.I. Constantino, L. Molyneaux, M. D'Souza, F. Limacher-Gisler, C. Luo, et al. An inverse relationship between age of type 2 diabetes onset and complication risk and mortality: The impact of youth-onset type 2 diabetes Diabetes Care, 39 (2016), pp. 823-882 10.2337/dc15-0991 CrossRefView Record in ScopusGoogle Scholar
  • T.S. Hannon, S.A. Arslanian The year in diabetes and obesity the changing face of diabetes in youth: Lessons learned from studies of type 2 diabetes Ann NY Acad Sci, 1353 (2015), pp. 113-137 10.1111/nyas.12939 CrossRefView Record in ScopusGoogle Scholar
  • A.B. Dart, P.J. Martens, C. Rigatto, M.D. Brownell, H.J. Dean, E.A. Sellers Earlier onset of complications in youth with type 2 diabetes Diabetes Care, 37 (2014), pp. 436-443 CrossRefView Record in ScopusGoogle Scholar
  • TODAY Study Group. Rapid rise in hypertension and nephropathy in youth with type 2 diabetes: The TODAY clinical trial. Diabetes Care. 2013;36:1735-41. Google Scholar
  • M.E. Pavkov, P.H. Bennett, W.C. Knowler, J. Krakoff, M.L. Sievers, R.G. Nelson Effect of youth-onset type 2 diabetes mellitus on incidence of end-stage renal disease and mortality in young and middle-aged Pima Indians JAMA, 296 (2006), pp. 421-426 CrossRefView Record in ScopusGoogle Scholar
  • P. Zeitler Progress in understanding youth onset type 2 diabetes in the United States: Recent lessons from clinical trials World J Pediatr. (2019) Disponible en: https://doi.org/10.1007/s12519-019-00247-1 Google Scholar
  • T.A. Hillier, K.L. Pedula Complications in young adults with early-onset type 2 diabetes: Losing the relative protection of youth Diabetes Care, 26 (2003), pp. 2999-3005 CrossRefView Record in ScopusGoogle Scholar
  • J. Krakoff, R.S. Lindsay, H.C. Looker, R.G. Nelson, R.L. Hanson, W.C. Knowler Incidence of retinopathy and nephropathy in youth-onset compared with adult-onset type 2 diabetes Diabetes Care, 26 (2003), p. 76 10.2337/diacare.26.1.76 CrossRefView Record in ScopusGoogle Scholar
  • D.M. Nathan, E. Chew, C.A. Christophi, M.D. Davis, S. Fowler, B.J. Goldstein, et al. The prevalence of retinopathy in impaired glucose tolerance and recent-onset diabetes in the Diabetes Prevention Program Diabet Med, 24 (2007), pp. 137-144 10.1111/j.1464-5491.2007.02043.x View Record in ScopusGoogle Scholar
  • E.J. Mayer-Davis, C. Davis, J. Saadine, R.M. D’Agostino, D. Dabalea, L. Dolan, et al. Diabetic retinopathy in the SEARCH for Diabetes in Youth Cohort: A pilot study Diabet Med, 29 (2012), pp. 1148-1152 10.1111/j.1464-5491.2012.03591.x CrossRefView Record in ScopusGoogle Scholar
  • A. Amutha, M. Datta, R. Unnikrishnan, R.M. Anjana, V. Mohan Clinical profile and complications of childhood- and adolescent-onset type 2 diabetes seen at a diabetes center in south India Diabetes Technol Ther, 14 (2012), pp. 497-504 10.1089/dia.2011.0283 CrossRefView Record in ScopusGoogle Scholar
  • M. Jaiswal, A. Lauer, C.L. Martin, R.A. Bell, J. Divers, D. Dabelea, et al. Peripheral neuropathy in adolescents and young adults with type 1 and type 2 diabetes from the SEARCH for diabetes in youth follow-up cohort Diabetes Care, 36 (2013), pp. 3903-3908 10.2337/dc13-1213 CrossRefView Record in ScopusGoogle Scholar
  • M.I. Constantino, L. Molyneaux, F. Limacher-Gisler, A. Al-Saeed, C. Luo, T. Wu, et al. Long-term complications and mortality in young-onset diabetes: Type 2 diabetes is more hazardous and lethal than type 1 diabetes Diabetes Care, 36 (2013), pp. 3863-3869 10.2337/dc12-2455 CrossRefView Record in ScopusGoogle Scholar
  • E.T. Rhodes, L.A. Prosser, T.J. Hoerger, T. Lieu, D.S. Ludwig, L.M. Laffel Estimated morbidity and mortality in adolescents and young adults diagnosed with Type 2 diabetes mellitus Diabet Med, 29 (2012), pp. 453-463 10.1111/j.1464-5491.2011.03542. x CrossRefView Record in ScopusGoogle Scholar
  • L. Katz, S. Gidding, F. Bacha, K. Hirst, S. McKay, L. Pyle, et al., TODAY Study Group Alterations in left ventricular, left atrial, and right ventricular structure and function to cardiovascular risk factors in adolescents with type 2 diabetes participating in the TODAY clinical trial Pediatr Diabetes., 16 (2015), pp. 39-47, 10.1111/pedi.12119 View Record in ScopusGoogle Scholar
  • F. Bacha, S.S. Gidding, L. Pyle, L. Levitt Katz, A. Kriska, K.J. Nadeau, et al. Relationship of cardiac structure and function to cardiorespiratory fitness and lean body mass in adolescents J Pediatr, 177 (2016), pp. 159-166, 10.1016/j.jpeds.2016.06.048 View Record in ScopusGoogle Scholar
  • J. McGavock, A. Dart, B. Wicklow Lifestyle therapy for the treatment of youth with type 2 diabetes Curr Diab Rep, 15 (2015), p. 568, 10.1007/s11892-014-0568-z Google Scholar
  • M. Savoye, P. Nowicka, M. Shaw, S. Yu, J. Dziura, G. Chavent, et al. Longterm results of an obesity program in an ethnically diverse pediatric population Pediatrics, 127 (2011), pp. 402-410 10.1542/peds.2010-0697 CrossRefView Record in ScopusGoogle Scholar
  • P. Zeitler, K. Hirst, L. Pyle, V. Linder, K. Copeland, S. Arslanian, et al., TODAY Study Group A clinical trial to maintain glycemic control in youth with type 2 diabetes N Engl J Med, 366 (2012), pp. 2247-2256 10.1056/NEJMoa1109333 Google Scholar
  • S. Garnett, M. Gow, M. Ho, L. Baur, M. Noakes, H. Woodhead, et al. Optimal macronutrient content of the diet for adolescents with prediabetes: RESIST a randomized control trial J Clin Endocrinol Metab, 98 (2013), pp. 2116-2125 10.1210/jc.2012-4251 CrossRefView Record in ScopusGoogle Scholar
  • E. Aslander-van Vliet, C. Smart, S. Waldron Nutritional management in childhood and adolescent diabetes Pediatric Diabetes, 8 (2007), pp. 323-339 10.1111/j.1399-5448.2007.00317. x CrossRefView Record in ScopusGoogle Scholar
  • M. Gow, L. Baur, N. Johnson, C. Cowell, S. Garnett Reversal of type 2 diabetes in youth who adhere to a VLED: A pilot study Diabetologia, 60 (2017), pp. 406-415, 10.1007/s00125-016-4163-5 CrossRefView Record in ScopusGoogle Scholar
  • K. Copeland, J. Silverstein, K. Moore, G. Prazar, T. Raymer, N. Shiffman, et al. Clinical practice guidelines. Management of newly diagnosed type 2 diabetes mellitus (T2DM) in children and adolescents Pediatrics, 131 (2013), pp. 364-384 10.1542/peds.2012-3494 CrossRefView Record in ScopusGoogle Scholar
  • A.D. Liese, A. Bortsov, A.L. Gunther, D. Dabelea, K. Reynolds, D.A. Standiford, et al. Association of DASH diet with cardiovascular risk factors in youth with diabetes mellitus: The SEARCH for diabetes in youth study Circulation, 123 (2011), pp. 1410-1417 10.1161/CIRCULATIONAHA.110.955922 View Record in ScopusGoogle Scholar
  • M.L. Marcovecchio, F. Chiarelli Pharmacotherapy options for pediatric diabetes Curr Opin Pediatr, 29 (2017), pp. 481-487 10.1097/MOP. 0000000000000504 View Record in ScopusGoogle Scholar
  • B. Namban, J. Silverstein, P. Cheng, K.J. Ruedy, R.W. Beck, R. Wadwa, et al. Pediatric diabetes consortium. A cross-sectional view of the current state of treatment of youth with type 2 diabetes in the USA: Enrollment data from the Pediatric Diabetes Consortium Type 2 Diabetes Registry Pediatr Diabetes, 18 (2017), pp. 222-229, 10.1111/pedi.12377 Google Scholar
  • M.P. Van der Aa, M.A. Elst, E.M. van de Garde, E.G. van Mil, C.A. Knibbe, M.M. van der Vorst Longterm treatment with metformin in obese, insulin-resistant adolescents: Results of a randomized double-blinded placebo-controlled trial Nutr Diabetes, 6 (2016), p. e228 10.1038/nutd.2016.37 CrossRefView Record in ScopusGoogle Scholar
  • Metformina. Ficha técnica [consultado 12 Agos 2019]. Disponible en: https://cima.aemps.es/cima/dochtml/ft/55211/FichaTecnica_55211.html Google Scholar
  • G. Derosa, A. D’Angelo, D. Romano, P. Maffioli Effects of metformin extended release compared to immediate release formula on glycemic control and glycemic variability in patients with type 2 diabetes Drug Des Devel Ther, 11 (2017), pp. 1481-1488 10.2147/DDDT.S 701316 CrossRefView Record in ScopusGoogle Scholar
  • W. Tamborlane, M. Barrientos-Pérez, U. Fainberg, H. Frimer-Larsen, M. Hafez, P. Hale, et al. Liraglutide in children and adolescents with type 2 diabetes N Engl J Med, 15 (2019), pp. 637-646, 10.1056/NEJMoa1903822 CrossRefView Record in ScopusGoogle Scholar
  • K. Nadeau, B. Anderson, E. Berg, J. Chiang, H. Chou, K. Copeland, et al. Youth-onset type 2 diabetes consensus report: Current status challenges, and priorities Diabetes Care, 39 (2016), pp. 1635-1642 10.2337/dc16-1066 CrossRefView Record in ScopusGoogle Scholar
  • T.H. Inge, A.P. Courcoulas, T.M. Jenkins, M.P. Michalsky, M.A. Helmrath, M.L. Brandt, et al. Weight loss and health status 3 years after bariatric surgery in adolescents N Engl J Med, 374 (2016), pp. 113-123, 10.1056/NEJMoa1506699 View Record in ScopusGoogle Scholar
  • M.A. Stefater, T.H. Inge Bariatric surgery for adolescents with type 2 diabetes: An emergin therapeutic strategy Curr Diab Rep, 17 (2017), p. 62 10.1007/s11892-017-0887-y Google Scholar
  • T.H. Inge, T.M. Jenkins, M. Zeller, L. Dolan, S.R. Daniels, V.F. Garcia, et al. Baseline BMI is a strong predictor of nadir BMI after adolescent gastric bypass J Pediatr, 156 (2010), pp. 103-108, 10.1016/j.jpeds.2009.07. 028 View Record in ScopusGoogle Scholar
  • T.H. Inge, G. Miyano, J. Bean, M. Helmrath, A. Courcoulas, C.M. Harmon, et al. Reversal of type 2 diabetes mellitus and improvements in cardiovascular risk factors after surgical weight loss in adolescents Pediatrics, 123 (2009), pp. 214-222 10.1542/peds.2008-0522 CrossRefView Record in ScopusGoogle Scholar
  • A. Feliu-Rovira Controversias en la cirugía de la obesidad en el niño y adolescentes Rev Esp Endocrinol Pediatr, 9 (2018), pp. 23-30 10.3266/RevEspEndocrinolPediatr.pre2018 View Record in ScopusGoogle Scholar
  • R. Blum, D. Garell, C. Hodgman, T. Jorissen, N. Okinow, D. Orr, et al. Transition from child-centered to adult health-care systems for adolescents with chronic conditions J Adolesc Health, 14 (1993), pp. 570-576, 10.1016/1054-139X (93)90143-D ArticleDownload PDFView Record in ScopusGoogle Scholar
  • Australian Paediatric Endocrine Group. Clinical practice guidelines: Type 1 diabetes in children and adolescents. Canberra: National Health and Medical Council; 2005 [consultado 24 Jun 2019]. Disponible en: http://www.nhmrc.gov.au/publications Google Scholar
  • A.L. Pai, H.M. Ostendorf Treatment adherence in adolescents and young adults affected by chronic illness during the health care transition from pediatric to adult health care: A literature review Childrens Health Care, 40 (2011), pp. 16-33, 10.1080/02739615.2011.537934 CrossRefView Record in ScopusGoogle Scholar
  • W. Gray, M. Schaefer, A. Resmini-Rawlinson, S. Wagoner Barriers to transition from pediatric to adult care: A systematic review J Pediatr Psychol, 43 (2017), pp. 488-502 10.1093/jepsy/jsx142 View Record in ScopusGoogle Scholar
  • R. Crowley, I. Wolfe, K. Lock, M. McKee Improving the transition between paediatric and adult healthcare; a systematic review Arch Dis Child, 96 (2011), pp. 548-553 10.1136/adc.2010.202473 CrossRefView Record in ScopusGoogle Scholar
  • L. Schwartz, L. Tuchman, W. Hobbie, J. Ginsberg A social-ecological model of readiness for transition to adult-oriented care for adolescents and young adults with chronic health conditions Child Care Health Dev, 37 (2011), pp. 883-895 10.1111/j.1365-2214.2011.01282. x CrossRefView Record in ScopusGoogle Scholar
  • I. Rica, J.C. Ferrer-García, R. Barrio, A. Gómez, J.A. Fornos, Grupo de trabajo de guías clínicas y consensos de la Sociedad Española de Diabetes. Grupo de Trabajo de Diabetes de la Sociedad Española de Endocrinología Pediátrica Transición del paciente con diabetes tipo 1 desde la unidad de diabetes pediátrica a la unidad de diabetes de adultos Av Diabetol, 30 (2014), pp. 80-86, 10.1016/j.avdiab.2014.03.002 ArticleDownload PDFView Record in ScopusGoogle Scholar
  • M. Martín-Frías, M.A. Álvarez, R. Yelmo, M. Alonso, R. Barrio Evaluación de la transición desde la unidad de diabetes pediátrica a la de adultos en adolescentes con diabetes mellitus tipo 1 An Pediatr, 81 (2014), pp. 389-392, 10.1016/j.anpedi.2013.10.048 ArticleDownload PDFView Record in ScopusGoogle Scholar
  • S. Agarwal, J.K. Raymond, S. Isom, J.M. Lawrence, G. Klingensmith, C. Pihoker, et al. Transfer from paediatric to adult care for young adults with type 2 diabetes: The SEARCH for diabetes in youth study Diabet Med, 35 (2018), pp. 504-512 10.1111/dme.13589 View Record in ScopusGoogle Scholar
  • R. Barrio La transición del adolescente con diabetes a la unidad de adultos Diabetes Práctica, 08 (2017), pp. 49-96 [consultado 24 Jun 2019]. Disponible en: http://www.diabetespractica.com/files/1500970536.04_habilidades-dp-8-2.pdf View Record in ScopusGoogle Scholar