Person: Hormazábal Aguayo, Ignacio
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Hormazábal Aguayo
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Ignacio
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Ciencias de la Salud
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0009-0002-7221-1731
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812495
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Publication Open Access Incidence of type 1 diabetes mellitus in children and adolescents under 20 years of age across 55 countries from 2000 to 2022: a systematic review with meta-analysis(Wiley, 2023) Hormazábal Aguayo, Ignacio; Ezzatvar, Yasmin; Huerta Uribe, Nidia; Ramírez Vélez, Robinson; Izquierdo Redín, Mikel; García Hermoso, Antonio; Ciencias de la Salud; Osasun ZientziakAims: the aim of this study was to determine the global incidence of type 1 diabetes mellitus (T1DM) in children and adolescents under 20 years of age from 2000 to 2022. Materials and methods: two reviewers searched three electronic databases (PubMed, Web of Science, and CINAHL) for studies published between January 2000 and November 2022. Pooled estimates of T1DM incidence with a 95% confidence interval (CI) per 100,000 person-years were calculated by country/region, sex, age, and COVID-19 pandemic period (pre-COVID-19 and pandemic). Results: the study included 126 studies from 55 countries and 18 regions. The incidence rate (IR) of T1DM from 2000 to 2022 was 14.07 (95%CI, 12.15-16.29) per 100,000 person-years. Finland and high-income North America had the highest IR, with 56.81 (95%CI, 55.91-57.73) and 28.77 (95%CI, 26.59-31.13) per 100,000 person-years, respectively. The IR was 13.37 (95%CI, 10.60-16.88) per 100,000 person-years in boys and 13.87 (95%CI, 11.51-16.70) per 100,000 person-years in girls. There were statistically significant differences among different age ranges: 0-4 versus 5-9 and 10-14 years old (p < 0.001); 5-9 versus 15-19 (p < 0.001) and 10- 14 versus 15-19 years old (p = 0.003). Finally, during the pandemic period (2020-2022), the IR was 24.84 (95%CI, 17.16-35.96) per 100,000 person-years, which was higher but not significant compared with the prepandemic period (2017-2019) of 13.56 (95%CI, 7.49-24.56) per 100,000 person-years (p = 0.090). Conclusions: the IR of T1DM in children and adolescents under 20 years of age is substantial, especially during the pandemic period, although it varies across regions. More reliable data from additional countries are needed to determine the worldwide incidence of T1DM.Publication Open Access Association of physical activity patterns with nocturnal hypoglycemia events in youth with type 1 diabetes(Oxford University Press, 2024-07-02) Hormazábal Aguayo, Ignacio; Huerta Uribe, Nidia; Muñoz Pardeza, Jacinto; Ezzatvar, Yasmin; Izquierdo Redín, Mikel; García Hermoso, Antonio; Ciencias de la Salud; Osasun ZientziakAims This study sought to elucidate the interactions among physical activity (PA) patterns, mean glucose concentrations, and the incidence of nocturnal hypoglycemia events in children and adolescents with type 1 diabetes, examining the moderating influence of daily dosage on these associations.Methods Eighty-two participants aged 6 to 18 years (43.9% girls) from the Diactive-1 Cohort Study, diagnosed with type 1 diabetes, were included. Data collection involved continuous glucose monitoring, accelerometry to assess real-world PA, as well as documentation of daily insulin doses and carbohydrate counting over the same 7 days.Results A total of 19 participants experienced at least 1 nocturnal hypoglycemia event over a span of 574 measurement days (106 days with and 451 days without nocturnal hypoglycemia). Higher levels of vigorous PA (VPA) were associated with lower same-day mean glucose levels (P = .014). Additionally, higher levels of moderate PA (P = .023), VPA (P = .011), and moderate-to-vigorous PA (P = .010) were associated with a greater number of nocturnal hypoglycemia events. Specifically, a significant association was identified between VPA and nocturnal hypoglycemia events when the daily insulin dose was at or above 1.04 units per kilogram of body weight per day (P = .016).Conclusion Daily VPA is associated with glucose reductions, potentially leading to more hypoglycemic episodes, particularly when there is an excess of daily insulin. This highlights the need for careful insulin management in children and adolescents with type 1 diabetes engaging in VPA.Publication Open Access Youth with type 1 diabetes mellitus are more inactive and sedentary than apparently healthy peers: a systematic review and meta-analysis(Elsevier, 2023) Huerta Uribe, Nidia; Hormazábal Aguayo, Ignacio; Izquierdo Redín, Mikel; García Hermoso, Antonio; Ciencias de la Salud; Osasun Zientziak; Universidad Pública de Navarra / Nafarroako Unibertsitate PublikoaAims: To conduct a meta-analysis of differences in physical activity, sedentary behaviour, and physical fitness between children and adolescents with type 1 diabetes and their healthy peers. Methods: The databases EMBASE, PubMed and SportsDiscus were searched for studies. Pooled effects were calculated using random effects inverse-variance models with the Hartung–Knapp–Sidik–Jonkman adjustment. Results: Thirty-five studies were included, comprising a total of 4,751 youths (53% girls, 2,452 with type 1 diabetes). Youth with type 1 diabetes were less physically active (Cohen’s d = − 0.23, 95%CI − 0.42 to − 0.04), more sedentary (Cohen’s d = 0.33, 95%CI 0.06 to 0.61), and had lower cardiorespiratory fitness (Cohen’s d = − 0.52, 95%CI − 0.73 to − 0.31) than their healthy peers. This corresponds to –12.72 min/day of moderate-tovigorous physical activity, 63.3 min/day of sedentary time (accelerometry) and –4.07 ml/kg/min of maximum/peak oxygen consumption. In addition, young people with type 1 diabetes were less likely to meet the international physical activity recommendations than their healthy peers (odds ratio = 0.44, 95%CI 0.31 to 0.62). Conclusions: Keeping in mind the heterogeneity between studies in the design, population and assessment, our findings show that children and adolescents with type 1 diabetes seem to be less active, more sedentary, and have lower cardiorespiratory fitness levels than their healthy peers.Publication Open Access Nonpharmacological interventions on glycated haemoglobin in youth with type 1 diabetes: a Bayesian network meta-analysis(BMC, 2024-07-01) Muñoz Pardeza, Jacinto; López Gil, José Francisco; Huerta Uribe, Nidia; Hormazábal Aguayo, Ignacio; Izquierdo Redín, Mikel; García Hermoso, Antonio; Ciencias de la Salud; Osasun ZientziakThe available evidence on the impact of specific non-pharmacological interventions on glycaemic control is currently limited. Consequently, there is a need to determine which interventions could provide the most significant benefits for the metabolic health of young individuals with type 1 diabetes mellitus. The aim of this study was to identify optimal nonpharmacological interventions on glycaemic control, measured by glycated haemoglobin (HbA1c), in children and adolescents with type 1 diabetes. Systematic searches were conducted in PubMed, Web of Science, Scopus, and SPORTDiscus from inception to July 1, 2023. Randomised clinical trials (RCT) investigating nonpharmacological interventions (e.g., physical activity, nutrition, and behavioural therapies) were included. Primary outcome was change in HbA1c levels. Secondary outcome was change in daily insulin dose requirement. Seventy-four RCT with 6,815 participants (49.43% girls) involving 20 interventions were analysed using a network meta-analysis. Most interventions showed greater efficacy than standard care. However, multicomponent exercise, which includes aerobic and strength training (n = 214, standardised mean difference [SMD] =– 0.63, 95% credible interval [95% CrI] – 1.09 to – 0.16) and nutritional supplements (n = 146, SMD =– 0.49, – 0 .92 to – 0.07) demonstrated the greatest HbA1c reductions. These interventions also led to the larger decreases in daily insulin needs (n = 119, SMD =– 0.79, 95% CrI – 1.19 to – 0.34) and (n = 57, SMD =– 0.62, 95% CrI – 1.18 to – 0.12, respectively). The current study underscores non-pharmacological options such as multicomponent exercise and nutritional supplements, showcasing their potential to significantly improve HbA1c in youth with type 1 diabetes. Although additional research to confirm their efficacy is required, these approaches could be considered as potential adjuvant therapeutic options in the management of type 1 diabetes among children and adolescents.Publication Open Access Comprehensive management of children and adolescents with type 1 diabetes mellitus through personalized physical exercise and education using an mHealth system: the Diactive-1 study protocol(Frontiers Media, 2024) Hormazábal Aguayo, Ignacio; Muñoz Pardeza, Jacinto; López Gil, José Francisco; Huerta Uribe, Nidia; Chueca-Guindulain, María J.; Berrade-Zubiri, Sara; Burillo Sánchez, Elisabeth; Izquierdo Redín, Mikel; Ezzatvar, Yasmin; García Hermoso, Antonio; Ciencias de la Salud; Osasun ZientziakIntroduction: The use of new technologies presents an opportunity to promote physical activity, especially among young people with type 1 diabetes (T1DM), who tend to be less active compared to their healthy counterparts. The aim of this study is to investigate the impact of a personalized resistance exercise program, facilitated by the Diactive-1 App, on insulin requirements among children and adolescents diagnosed with T1DM. Methods and analysis: A minimum of 52 children and adolescents aged 8-18 years, who were diagnosed with T1DM at least 6 months ago, will be randomly assigned to either a group engaging in an individualized resistance exercise program at least 3 times per week over a 24-week period or a waiting-list control group. The primary outcome will be the daily insulin dose requirement. The secondary outcomes will include glycemic control, cardiometabolic profile, body composition, vascular function, physical fitness, 24-hour movement behaviors, diet, and psychological parameters. The usability of the app will also be assessed. Ethics and dissemination: Ethical approval to conduct this study has been granted by the University Hospital of Navarra Research Board (PI_2020/140). Parents or legal guardians of minors participating in the study will provide written consent, while children and adolescents will sign an assent form to indicate their voluntary agreement. The trial's main findings will be shared through conference presentations, peer-reviewed publications, and communication directly with participating families. This study aims to offer valuable insights into the holistic management of children and adolescents with T1DM by utilizing personalized exercise interventions through an mHealth system.