Improvement of Na+-K+ ATPase Activity and Gene Expression Associated with Glomerular Ultrastructural Protection in Diabetic Nephropathy by Acacia senegal: Role of Oxidative Stress Disturbances / Mejora de la actividad Na+-K+ ATPasa y la Expresión Génica Asociada con la Protección Ultraestructural Glomerular en la Nefropatía Diabética por Acacia senegal: Papel de las Alteraciones del Estrés Oxidativo

SUMMARY: This study assessed the effects of Acacia Senegal (AS) combined with insulin on Na+/K+-ATPase (NKA) activity and mRNA expression, serum glucose, renal function, and oxidative stress in a rat model of diabetic nephropathy (DN). Sixty rats were equally divided into six groups: normal control, normal+AS, diabetic (DM), DM+insulin, DM+AS, and DM+insulin+AS groups. Diabetes mellitus (type 1) was induced by a single injection of streptozotocin (65 mg/kg), and insulin and AS treatments were carried until rats were culled at the end of week 12. Serum glucose and creatinine levels, hemoglobin A1c (HbA1c) were measured. Renal homogenate levels of NKA activity and gene expression, malondialdehyde, superoxide dismutase (SOD), catalase and reduced glutathione (GSH) were evaluated as well as kidney tissue histology and ultrastructure. Diabetes caused glomerular damage and modulation of blood and tissue levels of creatinine, glucose, HbA1c, malondialdehyde, NKA activity and gene expression, SOD, catalase and GSH, which were significantly (p<0.05) treated with AS, insulin, and insulin plus AS. However, AS+insulin treatments were more effective. In conclusion, combined administration of AS with insulin to rats with DN decreased NKA activity and gene expression as well as oxidative stress, and improved glycemic state and renal structure and function.

Este estudio evaluó los efectos de Acacia senegal (AS) combinada con insulina sobre la actividad Na+/K+- ATPasa (NKA) y la expresión de ARNm, la glucosa sérica, la función renal y el estrés oxidativo en un modelo de nefropatía diabética (ND) en ratas. Sesenta ratas se dividieron equitativamente en seis grupos: control normal, normal+AS, diabética (DM), DM+insulina, DM+AS y DM+insulina+AS. La diabetes mellitus (tipo 1) se indujo mediante una única inyección de estreptozotocina (65 mg/kg), y los tratamientos con insulina y AS se llevaron a cabo hasta que las ratas fueron sacrificadas al final de la semana 12. Se midieron niveles séricos de glucosa y creatinina, hemoglobina A1c (HbA1c). Se evaluaron los niveles de homogeneizado renal de actividad NKA y expresión génica, malondialdehído, superóxido dismutasa (SOD), catalasa y glutatión reducido (GSH), así como la histología y ultraestructura del tejido renal. La diabetes causó daño glomerular y modulación de los niveles sanguíneos y tisulares de creatinina, glucosa, HbA1c, malondialdehído, actividad y expresión génica de NKA, SOD, catalasa y GSH, los cuales fueron tratados significativamente (p<0,05) con AS, insulina e insulina más AS. Sin embargo, los tratamientos con AS+insulina fueron más efectivos. En conclusión, la administración combinada de AS con insulina a ratas con DN disminuyó la actividad de NKA y la expresión genética, así como el estrés oxidativo, y mejoró el estado glucémico y la estructura y función renal.

Diabetes tipo II. A terapia periodontal não cirúrgica pode favorecer o controle glicêmico do paciente? / Type II Diabetes. Does nonsurgical periodontal therapy improve glycemic control in patientes? / Diabetes tipo II. ¿Puede la terapia periodontal no quirúrgica mejorar el control glicémico del paciente?

Introdução:A doença periodontal corresponde àcondição que acomete os tecidos de proteção e/ou suporte do dente através de uma inflamação crônica causadapor patógenos.Estacondição pode ser modificada ou associada às doenças sistêmicas, como por exemplo, o diabetes mellitus tipo II (DM2).Objetivo:Avaliar quais os efeitos da terapia periodontal não cirúrgica sobre o controle glicêmico de pacientes diagnosticados com DM2.Metodologia:Revisão integrativa elaborada a partir de pesquisas clínicas randomizadas indexadas nas bases de dados Pubmed, Embase, Cochrane, Web of Science e BVS, na qual foram utilizados os descritores "periodontal diseases treatment", "glycemic control" e "metabolic control".Resultados:Dos trabalhos avaliados, seis foram selecionados para compor a revisão, tendo em vista os critérios de inclusão e exclusão estabelecidos. Logo, é notório que a terapia periodontal básica indica melhora no controle glicêmico dos pacientes com DM2, de acordo comanálise da HbA1c e PCR,portanto, com base nos resultados dessa pesquisa, o tratamento periodontal não cirúrgico parece contribuir para o controle metabólico. Apesar disso, alguns estudos se opõem aoresultadodo controle glicêmicodesses pacientes, reforçando a existência de variáveis que interferem nos resultados da pesquisa, como os níveis de hemoglobina, estágio da doença periodontal, amostra, dietae atividade física dos pacientes.Conclusões:O resultado deverá ser avaliado com maior cautela, tendo em vista as possibilidades de variáveis presentes nesse tipo de pesquisa. Por fim, ensaios controlados devem ser realizados para alcançar um maior esclarecimento a respeito dos efeitos da terapia periodontal não cirúrgica no controle glicêmico de pacientes com DM2 (AU).

Introduction:Periodontal disease is a condition in which protective or supportive tissues of the tooth are affected by chronic inflammation caused by pathogens. This condition may be modified or associated with systemic diseases such as type 2 diabetes mellitus (T2DM).Objective:To evaluate the effects of nonsurgical periodontal therapy on glycemic control in patients diagnosed with T2DM. Methodology:An integrative review was performed using randomized clinical trials indexed in PubMed, Embase, Cochrane, Web of Science, and BVS databases. The descriptors "periodontal disease treatment," "glycemic control," and "metabolic control" were used. Results:From the reviewed studies, six were selected for the review considering the established inclusion and exclusion criteria.Basic periodontal therapy improves glycemic control in patients with T2DM, as evidenced by analysis of glycated hemoglobin (HbA1c) and polymerase chain reaction (PCR). Therefore, based on the results of this research, nonsurgical periodontal treatment contributes to metabolic control. However, some studies contradict the effect of glycemic control in these patients, reinforcing the presence of variables that interfere with research results, such as hemoglobin levels, stage of periodontal disease, sample, dietand physical activity of patients. Conclusions:The results should be evaluated with more caution considering the potential variables present in this type of research. Finally, controlled trials should be conducted to understand better the effects of nonsurgical periodontal therapy on glycemic control in patients with T2DM (AU).

Introducción: La enfermedad periodontal es una condición en la cual los tejidos protectores o de soportedel diente se ven afectados por una inflamación crónica causada por patógenos. Esta condición puede modificarse o asociarse a enfermedades sistémicas como la diabetes mellitus tipo 2 (DM2). Objetivo: Evaluar los efectos de la terapia periodontal no quirúrgica en el control glucémico en pacientes diagnosticados con DM2. Metodología: Se realizó una revisión integradora utilizando ensayos clínicos aleatorizados indexados en las bases de datos de PubMed, Embase, Cochrane, Web of Science y BVS. Se utilizaron los descriptores "tratamiento de enfermedades periodontales", "control glucémico" y "control metabólico". Resultados: De los estudios revisados, se seleccionaron seis para la revisión, considerando los criterios de inclusión y exclusión establecidos. La terapia periodontal básica mejora el control glucémico en pacientes con DM2, como se evidencia en el análisis de la hemoglobina glicosilada (HbA1c) y la reacción en cadena de la polimerasa (PCR). Por lo tanto, basándose en los resultados de esta investigación, el tratamiento periodontal no quirúrgico contribuye al control metabólico. Sin embargo, algunos estudios contradicen el efecto del control glucémico en estos pacientes, lo que refuerza la presencia de variables que interfieren en los resultados de la investigación, como los niveles de hemoglobina, el estadio de la enfermedad periodontal, la muestra, la dieta y la actividad física de los pacientes. Conclusiones: Los resultados deben evaluarse con mayor precaución, considerando las posibles variables presentes en este tipo de investigación. Por último, se deben realizar ensayos controlados para comprender mejor los efectos de la terapia periodontal no quirúrgica en el control glucémico en pacientes con DM2 (AU).

Correlación entre tiempo en rango y hemoglobina glicosilada en personas con diabetes mellitus: revisión sistemática / Correlation between time on target and glycated hemoglobin in people with diabetes mellitus: systematic review / Correlação entre tempo no alvo e hemoglobina glicada de pessoas com diabetes mellitus: revisão sistemática

Objetivo: analizar la correlación entre el tiempo en rango y la hemoglobina glicosilada de personas que viven con diabetes mellitus y realizan la monitorización continua de la glucemia o el automonitoreo de la glucemia capilar Método: revisión sistemática de etiología y riesgo basada en las directrices del JBI e informada según los Preferred Reporting Items for Systematic Reviews and Meta-Analyses, abarcando seis bases de datos y la literatura gris. La muestra incluyó 16 estudios y la calidad metodológica fue evaluada utilizando las herramientas del JBI. Protocolo registrado en Open Science Framework, disponible en https://doi.org/10.17605/OSF.IO/NKMZB. Resultados: tiempo en rango (70-180 mg/dl) mostró una correlación negativa con la hemoglobina glicosilada, mientras que el tiempo por encima del rango (>180 mg/dl) mostró una correlación positiva. Los coeficientes de correlación variaron entre -0,310 y -0,869 para el tiempo en rango, y entre 0,66 y 0,934 para el tiempo por encima del rango. Un estudio se realizó en una población que hacía el automonitoreo. Conclusión: hay una correlación estadísticamente significativa entre el tiempo en rango y el tiempo por encima del rango con la hemoglobina glicosilada. Cuanto mayor sea la proporción en el rango glucémico adecuado, más cerca o por debajo del 7% estará la hemoglobina glicosilada. Se necesitan más estudios que evalúen esta métrica con datos del automonitoreo de la glucemia.

Objective: to analyze the correlation between time on target and glycated hemoglobin in people living with diabetes mellitus and carrying out continuous blood glucose monitoring or self-monitoring of capillary blood glucose. Method: systematic review of etiology and risk based on JBI guidelines and reported according to Preferred Reporting Items for Systematic Reviews and Meta- Analyses, covering six databases and grey literature. The sample included 16 studies and methodological quality was assessed using JBI tools. Protocol registered in the Open Science Framework, available at https://doi.org/10.17605/OSF.IO/NKMZB. Results: time on target (70-180 mg/dl) showed a negative correlation with glycated hemoglobin, while time above target (>180 mg/dl) showed a positive correlation. Correlation coefficients ranged between -0.310 and -0.869 for time on target, and between 0.66 and 0.934 for time above target. A study was carried out on a population that performed self-monitoring. Conclusion: there is a statistically significant correlation between time on target and time above target with glycated hemoglobin. The higher the proportion in the adequate glycemic range, the closer to or less than 7% the glycated hemoglobin will be. More studies are needed to evaluate this metric with data from self-monitoring of blood glucose.

Objetivo: analisar a correlação entre o tempo no alvo e a hemoglobina glicada de pessoas que vivem com diabetes mellitus e realizam a monitorização contínua da glicemia ou a automonitorização da glicemia capilar. Método: revisão sistemática de etiologia e de risco pautada nas diretrizes do JBI e reportada conforme Preferred Reporting Items for Systematic Reviews and Meta-Analyses, abrangendo seis bases de dados e a literatura cinzenta. A amostra incluiu 16 estudos e a qualidade metodológica foi avaliada utilizando as ferramentas do JBI. Registrado protocolo no Open Science Framework, disponível em https://doi.org/10.17605/OSF.IO/NKMZB. Resultados: tempo no alvo (70-180 mg/dl) apresentou correlação negativa com a hemoglobina glicada, enquanto o tempo acima do alvo (>180 mg/dl) mostrou correlação positiva. Os coeficientes de correlação variaram entre -0,310 e -0,869 para o tempo no alvo, e entre 0,66 e 0,934 para o tempo acima do alvo. Um estudo foi efetuado com população que realizava a automonitorização. Conclusão: há correlação estatisticamente significativa entre o tempo no alvo e o tempo acima do alvo com a hemoglobina glicada. Quanto maior a proporção na faixa glicêmica adequada, mais próxima ou inferior a 7% estará a hemoglobina glicada. São necessários mais estudos que avaliem essa métrica com dados da automonitorização da glicemia.

Retinopatía diabética y su relación con los niveles de hemoglobina glucosilada / Diabetic Retinopathy and its Relationship with Glycosylated Hemoglobin Levels

Introducción: La retinopatía diabética es la principal causa de ceguera en personas diabéticas de 20 a 64 años de edad, e incrementa su aparición frente a un mal control de la enfermedad, que se expresa con valores altos de hemoglobina glucosilada (HbA1C). Objetivo: Establecer la relación entre los niveles de hemoglobina glucosilada y la presencia de retinopatía en los pacientes con diabetes mellitus tipo 2. Métodos: Se llevó a cabo un estudio descriptivo, prospectivo y transversal, en el que se obtuvieron, mediante ficha de observación, datos sociodemográficos, de evaluación oftalmológica y niveles de HbA1C, de los pacientes atendidos en consulta externa del Hospital General Isidro Ayora de la ciudad de Loja, Ecuador, en el período febrero-junio de 2018. Se aplicaron medidas de frecuencia y asociación para el análisis estadístico. Resultados: Se incluyeron 160 pacientes: 108 mujeres y 52 hombres, todos de raza mestiza. Se identificó retinopatía en 26,8 por ciento (N = 43) de los pacientes, de quienes 41 por ciento (N = 18) tenía más de 65 años de edad. La media de HbA1C en pacientes sin retinopatía fue de 7,4 por ciento, y en aquellos con retinopatía de 9,8 por ciento en mayor porcentaje de pacientes con valores de HbA1C de 7 por ciento o más presentaron retinopatía diabética, en comparación con aquellos de HbA1C menores a 7 por ciento (p < 0,0001), la retinopatía no proliferativa moderada fue el principal diagnóstico realizado. Conclusiones: El mal control glucémico en las personas con diabetes mellitus tipo 2 se asocia con mayor probabilidad de aparición de lesiones retinianas(AU)

Introduction: Diabetic retinopathy is the main cause of blindness in diabetic people aged 20 to 64 years; it increases its occurrence due to poor control of the disease, expressed by high values of glycosylated hemoglobin (HbA1c). Objective: To establish the relationship between glycosylated hemoglobin levels and the presence of retinopathy in patients with type 2 diabetes mellitus. Methods: A descriptive, prospective and cross-sectional study was carried out, in which sociodemographic data, others from an ophthalmologic evaluation and HbA1c levels were obtained, by means of an observation card, from patients seen in the outpatient clinic of Hospital General Isidro Ayoraof the city of Loja, Ecuador, in the period February-June 2018. Frequency and association measures were applied for statistical analysis. Results: The study included 160 patients: 108 women and 52 men, all of mixed race. Retinopathy was identified in 26.8percent (N=43) of patients, of whom 41percent (N=18) were over 65 years of age. The mean HbA1c in patients without retinopathy was 7.4percent, and 9.8percent in those with retinopathy. A higher percentage of patients with HbA1c values of 7percent more had diabetic retinopathy, compared to those with HbA1C under 7percent (p<0.0001). Moderate nonproliferative retinopathy was the main diagnosis. Conclusions: Poor glycemic control in persons with type 2 diabetes mellitus is associated with increased likelihood of retinal lesions(AU)

Awareness of the diagnosis, treatment, and control of diabetes mellitus in Brazil / Conhecimento do diagnóstico, tratamento e controle do diabetes mellitus no Brasil

ABSTRACT OBJECTIVE To estimate the proportions of awareness, treatment, and control of diabetes mellitus (DM) in the Brazilian adult population. METHOD This is a cross-sectional study, with data from a representative sample of the Brazilian population, taken from the National Health Survey(PNS 2014/2015). Outcomes were defined based on glycated hemoglobin (HbA1c) measurements, self-reported DM diagnosis, and use of hypoglycemic agents or insulin. The proportion of DM awareness, treatment, and control was estimated according to sociodemographic characteristics, health conditions, and access to health services, and their respective 95% confidence intervals. RESULTS DM prevalence in the Brazilian population was of 8.6% (95%CI: 7.8-9.3): 68.2% (95%CI: 63.9-72.3) were aware of their diagnosis, 92.2% (95%CI: 88.6-94.7) of those who were aware were undergoing drug treatments, and, of these, 35.8% (95%CI: 30.5-41.6) had controlled HbA1c levels. The proportions of DM awareness, control, and treatment were lower in men aged 18 to 39 years, individuals with low education, without health insurance, and beneficiaries of the Bolsa Família program. CONCLUSION Approximately one in ten Brazilians has DM. A little more than half of this population is aware of their diagnosis, a condition measured by HbA1c dosage and clinical diagnosis. Among those who know, the vast majority are undergoing drug treatments. However, less than half of these have their HbA1c levels controlled. Worse scenarios were found in subgroups with high social vulnerability.

RESUMO OBJETIVO Estimar as proporções dos indivíduos que têm conhecimento do diagnóstico, tratamento e controle do diabetes mellitus (DM) na população adulta brasileira. MÉTODO Este é um estudo transversal, com dados de amostra representativa da população brasileira, provenientes da Pesquisa Nacional de Saúde (PNS 2014/2015). Os desfechos foram definidos com base na medida de hemoglobina glicada (HbA1c), no diagnóstico autorreferido de DM e no uso de hipoglicemiantes ou de insulina. Estimou-se a proporção do conhecimento, tratamento e controle do DM de acordo com as características sociodemográficas, condição de saúde e de acesso aos serviços de saúde, e seus respectivos intervalos de 95% de confiança (IC95%). RESULTADOS A prevalência de DM na população brasileira foi 8,6% (IC95% 7,8-9,3), 68,2% (IC95% 63,9-72,3) tinham conhecimento do seu diagnóstico, 92,2% (IC95% 88,6-94,7) dos que tinham conhecimento realizam tratamento medicamentoso, e desses, 35,8% (IC95% 30,5-41,6) tinham os níveis de HbA1c controlados. As proporções de conhecimento, controle e tratamento foram menores nos homens, com idade de 18 a 39 anos, indivíduos que possuem baixa escolaridade, sem plano de saúde e beneficiários do Programa Bolsa Família. CONCLUSÃO Aproximadamente um em cada dez brasileiros apresenta DM. Um pouco mais da metade desta população tem conhecimento do seu diagnóstico, condição aferida por dosagem de HbA1c e diagnóstico clínico. Entre os que sabem, a grande maioria está sob tratamento medicamentoso. Porém, menos da metade destes tem seus níveis de HbA1c controlados. Cenários piores foram encontrados em subgrupos com alta vulnerabilidade social.

Relación de IMC con marcadores de inflamación y hemoglobina glicosilada en niños y jóvenes con diabetes mellitus 1 / Relationship of BMI with markers of inflammation and glycosylated hemoglobin in children and young adults with diabetes mellitus 1

La diabetes mellitus tipo 1 (DM1) es una enfermedad autoinmune que genera dependencia exógena de insulina de forma permanente, presenta inflamación subclínica crónica lo que conlleva a una elevación de marcadores de inflamación como factor de necrosis tumoral alfa (TNF-α), proteína C reactiva (PCR) e interleuquina 6 (IL-6). OBJETIVO: determinar la relación entre el IMC sobre los marcadores de inflamación y el control metabólico en niños y jóvenes con DM1 entre 5 a 15 años de edad. METODOLOGÍA: Se realizó un estudio clínico, observacional, exploratorio. A partir de La recolección de datos de fichas clínicas y muestras de sangre en el Instituto de Investigaciones Materno Infantil (IDIMI) del Hospital San Borja Arriarán de la Universidad de Chile. Clasificación del estado nutricional utilizando datos registrados en ficha clínica. Marcadores de inflamación por medio de ELISA, hemoglobina glicosilada mediante métodos estándares. El análisis estadístico incluyó correlaciones mediante test de Spearman y diferencia de medias mediante test de Kruskal-Wallis seguido de post hoc Dunns. RESULTADOS: Un 30% de los pacientes con DM1 presentaron malnutrición por exceso. Al analizar la relación entre los niveles de marcadores inflamatorios y Hb glicosilada se observó la existencia de asociacion positiva entre usPCR y HbA1c (r= 0,30; p=0,0352) y entre IL-6 y HbA1c (r= - 0,038; p=0,0352). CONCLUSIONES: este estudio describe una posible asociación entre parámetros clásicos de inflamación con la hemoglobina glicosilada en las categorias de sobrepeso y obesidad en pacientes con DM1.

Type 1 diabetes mellitus (T1D) is an autoimmune disease that generates permanent exogenous insulin dependence, accompanied by chronic subclinical inflammation that leads to an elevation of inflammation markers such as tumor necrosis factor-alpha (TNF-α), C-reactive protein (CRP) and interleukin-6 (IL-6). OBJECTIVE: To determine the relationship between BMI on markers of inflammation and metabolic control in children and young people with T1D between 5 and 15 years of age. METHODOLOGY: A clinical, observational and exploratory study was carried out, based on the collection of data from clinical records and blood samples of children and adolescents with DM1 at the Instituto de Investigaciones Materno Infantil (IDIMI) of the Hospital San Borja Arriarán of the Universidad de Chile. Nutritional status, levels of inflammation markers and glycosylated hemoglobin were determined by standardized methods. Statistical analysis included correlations by Spearman test and mean difference by Kruskal-Wallis test followed by post hoc Dunns test. RESULTS: A total of 56 patients with T1D were analyzed, 30% of whom presented excess malnutrition. Those children or adolescents with obesity presented significantly higher usPCR levels compared to underweight patients or patients at risk of malnutrition (p=0.039). In addition, HbA1c levels were determined which were negatively associated with usPCR (r= 0.30; p=0.0352) and IL-6 (r= - 0.038; p=0.0352) levels. CONCLUSIONS: This study points out that nutritional status is associated with usPCR levels, in agreement with what is described in the literature and shows a possible association between classical parameters of inflammation with glycosylated hemoglobin in children and adolescents with nutritional diagnosis of overweight or obesity.

Relación de la calidad de sueño, adherencia al tratamiento, hemoglobina glucosilada en mujeres con diabetes / Relationship of sleep quality, adherence to treatment, glycated hemoglobin in women with diabetes

Introducción: La Diabetes Tipo 2 es considerado un problema de salud pública que afecta principalmente a las mujeres, que sumado a una mala adherencia al tratamiento terapéutico y, a una falta de calidad de sueño, aumentan la problemática de salud. Objetivo: Determinar las interrelaciones existentes entre la Calidad de Sueño, la Adherencia al Tratamiento Terapéutico y los valores de HbA1c en Mujeres con DT2, perteneciente a una comunidad de la ciudad de Puebla. Materiales y Métodos: El diseño del estudio fue de tipo descriptivo, correlacional y de corte transversal. La muestra se calculó con un nivel de significancia de .05, un coeficiente de correlación .30 y un poder estadístico del 90%, obteniendo una n=110. Los instrumentos utilizados fueron: una cédula de datos personales, el Índice de calidad de sueño de Pittsburgh (PSQI), el Cuestionario de Adherencia Terapéutica MBG (Martín-Bayarre-Grau) y el dispositivo Eclipse A1c. Resultados: Se encontró una relación negativa y significativa para la calidad de sueño con los niveles de HbA1c (rs=-.355; p=.001); no así para con la variable de adherencia al tratamiento terapéutico. Discusión: La información obtenida concuerda con otros estudios, al reafirmar de manera indirecta, las reacciones bioquimicas que ocurren durante la privación del sueño. Conclusiones: Los resultados descubiertos contribuyen al fortalecimiento científico de enfermería, orientando en la mejora de cuidados, que servirá para el diseño de intervenciones que favorezcan a la salud de las mujeres con Diabetes Tipo 2.

Introduction: Type 2 Diabetes is considered a public health problem that mainly affects women, which, added to poor adherence to therapeutic treatment and a lack of quality sleep, increase health problems. Objective: To determine the existing interrelations between Sleep Quality, Adherence to Therapeutic Treatment and HbA1c values in Women with T2D, belonging to a community in the city of Puebla. Materials and Method: the study design was descriptive, correlational and cross-sectional. The sample was calculated with a significance level of .05, a correlation coefficient of .30 and a statistical power of 90%, obtaining n = 110. The instruments used were: a personal data card, the Pittsburgh Sleep Quality Index (PSQI), the MBG Therapeutic Adherence Questionnaire (Martín-Bayarre-Grau) and the Eclipse A1c device. Results: a negative and significant relationship was found for sleep quality with HbA1c levels (rs = -. 355; p = .001); not so for the variable of adherence to therapeutic treatment. Discussion: The information obtained agrees with other studies, indirectly reaffirming the biochemical reactions that occur during sleep deprivation. Conclusions: the results discovered contribute to the scientific strengthening of nursing, guiding the improvement of care, which will serve to design interventions that favor the health of women with Type 2 Diabetes.

Introdução: A diabetes tipo 2 é considerada um problema de saúde pública que afeta principalmente as mulheres, o que somado a uma má aderência ao tratamento terapêutico e, a falta de qualidade do sono, aumenta o problema de saúde. Objetivo: Determinar as inter-relações entre a qualidade do sono, a adesão ao tratamento terapêutico e os valores de HbA1c nas mulheres com DT2, pertencentes a uma comunidade da cidade de Puebla. Materiais e Métodos: O desenho do estudo foi descritivo, correlacional e transversal. A amostra foi calculada com um nível de significância de 0,05, um coeficiente de correlação de 0,30 e um poder estatístico de 90%, obtendo-se uma n=110. Os instrumentos utilizados foram: um formulário de dados pessoais, o Índice de Qualidade de Sono de Pittsburgh (PSQI), o Questionário MBG para Avaliar Adesão Terapêutica (Martín-Bayarre-Grau) e o dispositivo Eclipse A1c. Resultados: Foi encontrada uma relação negativa e significativa da qualidade do sono com os níveis de HbA1c (rs=-.355; p=.001); este não foi o caso para a variável de aderência ao tratamento terapêutico. Discussão: As informações obtidas concordam com outros estudos, reafirmando indiretamente as reações bioquímicas que ocorrem durante a privação do sono. Conclusões: Os resultados descobertos contribuem para o fortalecimento científico da enfermagem, orientando a melhoria dos cuidados, que servirão para o desenho de intervenções que favoreçam a saúde das mulheres com diabetes tipo 2.

Perfiles de hipoglicemiantes e insulinas en pacientes con diabetes mellitus tipo 2 y su efecto en control metabólico, hipoglicemia y otros efectos adversos / Profile of glucose lowering drug use in outpatients with type 2 diabetes mellitus

BACKGROUND: The use of glucose lowering agents with favorable weight profile is a growing practice in Diabetology. AIM: To characterize medication combinations in patients with type 2 Diabetes (T2D) and their effect on metabolic control. MATERIAL AND METHODS: Review of medical records of 249 outpatients with T2D with a median age of 66 years, cared for at a medical network. Clinical characteristics, glycated hemoglobin (HbA1c), details of Diabetes treatment (types of drugs or insulin), renal function, lipids and B12 vitamin levels were registered. RESULTS: The median disease duration was 16 years. The most recent HbA1c was 7.4%. No patient was using sulfonylureas, 45 were using Dipeptidyl peptidase 4 inhibitors, 113 were using Sodium-glucose Cotransporter-2 (SGLT2i) Inhibitors, 21 used Glucagon-like Peptide-1 Receptor Agonists (GLP1ra), 158 used basal insulin and 61 on basal plus bolus insulin. The use of SGLT2i or GLP1ra was associated with a metabolic control similar to those patients not using them, while patients on rapid insulin had a significantly worse metabolic control and a tendency to greater body mass index. The use of basal insulin and rapid insulin was significantly associated with more hypoglycemia events. CONCLUSIONS: The use of SGLT2i and GLP1ra in patients with T2D is associated with better metabolic control than rapid insulin with less risk of hypoglycemia. The use of these therapies should be prioritized in the future.

Glucemia en ayunas entre 100 y 109 mg/dL versus prediabetes según hemoglobina glicosilada / Fasting blood glucose between 100 and 109 mg/dL versus prediabetes according to glycosylated hemoglobin

Introducción: algunos estudios han señalado que valores de glucemia en ayunas entre 100 y 109 mg/dL se asocian con frecuencias elevadas de prediabetes cuando el criterio de clasificación son los valores de HbA1c. La Sociedad Argentina de Diabetes (SAD) sostiene a 110 mg/dL como valor a partir del cual se clasifica a un paciente como portador de glucemia en ayunas alterada; la frecuencia de individuos posiblemente clasificados en forma incorrecta, según este criterio, aún no se conoce en la población argentina. Objetivos: establecer la frecuencia con que se presenta prediabetes según HbA1c en una población sin diagnóstico de diabetes mellitus (DM) con glucemias en ayunas entre 100 y 109 mg/dL; correlacionar las dos variables y cuantificar la probabilidad de que esto ocurra respecto de otros con glucemias en ayunas <100 mg/dL. Materiales y métodos: se incluyeron 1.002 muestras de igual número de sujetos desde 45 laboratorios de análisis clínicos de la Asociación de Laboratorios de Alta Complejidad (ALAC), con procesamiento local de glucemia y centralizado de HbA1c por high performance liquid chromatography (HPLC). Análisis estadístico: chi cuadrado, odds ratio, coeficiente de correlación y determinación de Pearson, y correlación serial de Durbin-Watson. Resultados: frecuencia de HbA1c ≥5,7% en la población estudiada con glucemias de ayunas entre 100 y 109 mg/dL=29,7%; test de chi cuadrado: p<0,001; odds ratio de tener HbA1c ≥5,7% entre la población con glucemias en ayunas de 100 a 109 mg/dL vs aquella con valores <100 mg/dL=4,328 (IC 95% 2,922-6,411); r=0,852, r2 = 0,727, Durbin-Watson=1,152. Conclusiones: la prediabetes diagnosticada por HbA1c resultó cuatro veces más frecuente en la población estudiada con glucemias en ayunas entre 100 y 109 mg/dL, que en aquella con valores por debajo de 100 mg/dL.

Introduction: some studies have shown that fasting blood glucose values between 100 and 109 mg/dL are associated with high rates of prediabetes when the classification criteria are HbA1c values. The Argentine Diabetes Society still maintains 110 mg/dL as the value from which a patient is classified as having impaired fasting blood glucose; the frequency of individuals possibly incorrectly classified, according to this criterion, is not yet known in any Argentine population. Objectives: to establish the frequency in a population without a diagnosis of diabetes mellitus with fasting blood glucose levels between 100 and 109 mg/dL in which prediabetes occurs according to HbA1c, to correlate both variables and to quantify the probability that this predicts with respect to others with fasting blood glucose levels <100 mg/dL. Materials and methods: 1.002 samples from the same number of subjects from 45 clinical laboratories belonging to ALAC, with local processing of blood glucose and centralized processing of HbA1c by high performance liquid chromatography (HPLC). Statistical analysis: chi square, odds ratio, Pearson correlation coefficient, coefficient of determination and Durbin-Watson serial correlation. Results: frequency of HbA1c ≥5.7% in the studied population with fasting blood glucose levels between 100 and 109 mg/ dL = 29.7%, chi square test: p<0.001; odds ratio of having HbA1c ≥5.7% between the population with fasting blood glucose levels of 100 to 109 mg/dL vs that one with values <100 mg/dL=4.328 (95% CI 2.922-6.411); r=0.852, r2 =0.727, DurbinWatson=1.152. Conclusions: prediabetes diagnosed by HbA1c was four times more frequent in the studied population with fasting glucose values between 100 and 109 mg/dL than in that one with values below 100 mg/dL.

Efectos de los agonistas del receptor de péptido similar al glucagón tipo 1 como tratamiento en pacientes con obesidad y diabetes mellitus tipo 2 / Effects of glucagon-like peptide-1 receptor antagonist in the treatment of patients with obesity and Type 2 diabetes mellitus

Introducción: Recientemente se han descubierto nuevos medicamentos para el tratamiento de la diabetes tipo 2, con novedosos mecanismos de acción y menos efectos adversos. Dentro de ellos tenemos los análogos del péptido similar al glucagón tipo 1. Objetivo: Explicar la evidencia existente sobre los efectos del tratamiento con agonistas del receptor del péptido similar al glucagón tipo 1 en las personas con obesidad y diabetes mellitus tipo 2. Material y Métodos: Se realizó una revisión sistemática que incluyó estudios de los efectos de los agonistas del receptor del péptido similar al glucagón tipo1 como tratamiento en personas mayores de 12 años con obesidad y diabetes tipo 2. Se realizó una síntesis narrativa formal de los datos recogidos, no se realizó una síntesis estadístico formal. La calidad de evidencia para cada desenlace se determinó, según la metodología Grading of Recommendations Assessmet, Developmet and Evaluation. Resultados: La evidencia disponible demuestra que los agonistas del receptor del péptido similar al glucagón tipo 1, lograron una mayor disminución del peso corporal (-7,0 por ciento vs -2 por ciento) y de las cifras de hemoglobina glucosilada (HbA1c) (-0,40 por ciento vs -0,10 %) respecto al grupo placebo. Además, de una mayor reducción de la cintura abdominal. Conclusiones: La evidencia analizada muestra que los fármacos del tipo agonistas del receptor del péptido similar al glucagón tipo 1 tienen efectos beneficiosos en el tratamiento de las personas con obesidad y diabetes, disminuyendo el peso corporal y los valores de glucemia(AU)

Introduction: New drugs with novel mechanisms of action and fewer adverse effects have recently been discovered for the treatment of type 2 diabetes. Among them are glucagon-like peptide-1 analogues. Objective: To explain the existing evidence of the effects of treatment with glucagon-like peptide-1 receptor agonists in people with obesity and type 2 diabetes mellitus. Material and Methods: We conducted a systematic review that included studies on the effects of glucagon-like peptide -1 receptor agonists for the treatment of people older than 12 years with obesity and type 2 diabetes. A formal narrative synthesis of the collected data was performed, whereas a formal statistical synthesis was not performed. The quality of evidence for each outcome was determined according to the Grading of Recommendations Assessment, Development and Evaluation method. Results: The available evidence shows that glucagon-like peptide -1 receptor agonists achieved a greater reduction in body weight (-7,0 percent vs -2 percent) and glycosylated hemoglobin (HbA1c) (-0,40 percent vs -0,10 percent) compared to the placebo group. In addition, there was a greater reduction in abdominal waist circumference. Conclusions: The evidence analyzed shows that glucagon-like peptide -1 receptor agonists have beneficial effects in the treatment of people with obesity and diabetes, reducing body weight and glycemia values(AU)

The importance of optimal 25-hydroxyvitamin D levels in the glycemic control of older adults with type 2 Diabetes Mellitus: Data from the study on aging and longevity EELO

INTRODUCTION: Optimal serum levels of vitamin D are of great importance, especially in populations with comorbidities such as Diabetes Mellitus (DM). OBJECTIVE: The study evaluated the relationship between hypovitaminosis D and glycemic control in older adults with type 2 DM. METHODS: Cross-sectional and prospective study, part of the EELO project (Study on Aging and Longevity), conducted in Southern Brazil. Glycated hemoglobin (diabetes ≥6.5%) and serum levels of vitamin D (25(OH)D) were evaluated. Hypovitaminosis D was determined using cutoff points <20 and <30 ng/mL). Multivariate logistic regression was used to assess the risk of having uncontrolled DM. RESULTS: Of the 120 older adults included in the study, aged between 60 and 87 years, 74.2% were women, 66.7% used hypoglycemic medications and 75.8% exhibited uncontrolled diabetes. An inverse correlation was observed between the levels of 25(OH) D and glycated hemoglobin (rS=-0.19, p=0.037), suggesting that low levels of vitamin D are associated with poor glycemic control in diabetic individuals. The prevalence of hypovitaminosis D when using the cutoff points of <20 and <30 ng/mL were 34.2% and 75.0%, respectively. The odds ratio (OR) analysis showed that individuals with 25(OH)D<20ng/mL have almost 4 times more risk of having uncontrolled DM (OR:3.94; CI95%:1.25-12.46, p=0.02) when compared to the older adults with sufficient levels of vitamin D. CONCLUSION: The results indicate that the optimal serum levels currently recommended for 25(OH)D should preferably be 30 ng/mL or higher to contribute to better glycemic control in older adults with type 2 DM.

INTRODUÇÃO: Os níveis séricos ideais de vitamina D são de grande importância, especialmente na população com comorbidades como o Diabetes Mellitus (DM). OBJETIVO: O estudo avaliou a relação entre hipovitaminose D e controle glicêmico em idosos com DM tipo 2. MÉTODOS: Estudo transversal e prospectivo, parte do projeto EELO (Estudo sobre Envelhecimento e Longevidade), no Sul do Brasil. A hemoglobina glicada (diabetes ≥6,5%) e os níveis séricos de vitamina D (25(OH)D) foram avaliados. Hipovitaminose D foi determinada usando ponto de corte <20 e <30 ng/mL. Regressão logística multivariada foi utilizada para avaliar o risco de ter DM descompensado. RESULTADOS: Dos 120 idosos incluídos no estudo, idade entre 60 a 87 anos, 74,2% eram mulheres, 66,7% faziam uso de medicamentos hipoglicemiantes e 75,8% apresentavam diabetes descompensada. Uma correlação inversa foi observada entre os níveis de 25(OH)D e hemoglobina glicada (rS=-0,19; p=0.037), sugerindo que baixos níveis de vitamina D está associado a um pior controle glicêmico em diabéticos. A prevalência de hipovitaminose D quando se utiliza ponto de corte <20 e <30 ng/mL foi de 34,2% e 75,0%, respectivamente. A análise Odds ratio (OR) mostrou que indivíduos com 25(OH)D<20 ng/mL tem quase 4 vezes mais risco de ter DM descompensado (OR:3,94; IC95%:1,25­12,46; p=0,02) quando comparado aos idosos com níveis suficientes de vitamina D. CONCLUSÃO: Os resultados indicam que os níveis sérios ideais atualmente recomendados para 25(OH)D maior ou igual a 30 ng/ml contribuem para o melhor controle glicêmico na população idosa com DM tipo 2.

Dose-ranging effects of SGLT2 inhibitors in patients with type 2 diabetes: a systematic review and meta-analysis

ABSTRACT The lowest dosage of empagliflozin (10 mg) showed similar benefits on glycated hemoglobin (HbA1c) level, body weight, blood pressure, and total and cardiovascular mortality in comparison with the highest available dose (25 mg) in the EMPAREG trial. These findings have not been clearly demonstrated for canagliflozin and dapagliflozin. The objective was to compare the effect of different doses of SGLT2 inhibitors commercially available in Brazil on HbA1c and body weight of patients with type 2 diabetes. MEDLINE, Cochrane and Embase databases were searched from inception until 11th October 2021 for randomized controlled trials of SGLT2 inhibitors in type 2 diabetes patients, lasting at least 12 weeks. HbA1c and body weight variations were described using standard mean difference. We performed direct and indirect meta-analysis, as well as a meta-regression with medication doses as covariates. Eighteen studies were included, comprising 16,095 patients. In the direct meta-analysis, SGLT2 inhibitors reduced HbA1c by 0.62% (95% CI −0.66 to −0.59) and body weight by 0.60 kg (95% CI −0.64 to −0.55). In the indirect meta-analysis, canagliflozin 300 mg ranked the highest regarding reductions in HbA1c and body weight. The remaining medications and dosages were clinically similar, despite some statistically significant differences among them. Canagliflozin 300 mg seems to be more potent in reducing HbA1c and body weight in patients with type 2 diabetes. The remaining SGLT2 inhibitors at different doses lead to similar effects for both outcomes. Whether these glycemic and weight effects are reflected in lower mortality and cardiovascular events is still uncertain and may be a topic for further studies.

Prescription of DPP4 inhibitors: Indication and effect on glycosylated hemoglobin in a primary care institution of Colombia / Prescripción de inhibidores de la DPP-4: indicación y efecto sobre la hemoglobina glicosilada en un primer nivel de Colombia

Abstract Introduction and objective: In Colombia, Dipeptidyl-Peptidase IV (DPP4) inhibitors are recommended as second-best choice for type 2 diabetes mellitus treatment. However, no evaluation of the accomplishment or impact of this recommendation was performed. The objective was to determine the prescription of the DPP4 inhibitor according to the Colombian Clinicial Practice Guide regarding type 2 diabetes mellitus treatment, and its effects on glycosylated hemoglobin (HbAlc). Materials and methods: A descriptive study that included patients with type 2 diabetes mellitus who attended a first level between 2016 and 2018, had a prescription for DPP4 inhibitor and at least two control appointments. Variables included were sociodemographic, clinics, treatment and comorbidities. The unadjusted prescription was defined as the lack of accomplishment of Colombian guidelines. Descriptive statistics and X2 test were used for the comparison of categorical variables. A binary logistic regression model was applied. Results: 112 out of 207 patients accomplished inclusion criteria, of which 77 were women (68.8%). Also, 68.8% of the patients had an unadjusted prescription of the iDPP4. There was a 0.21% total reduction in HbA1c levels, with a mean of 198.2 ± 124 days between the first and second control measurement (reduction of 0.55% when the prescription was adjusted to the guidelines and 0.05% if it was unadjusted). Conclusion: There is a limited impact of DPP4 inhibitors regarding the reduction of HbA1c and metabolic control, and there is a slight follow-up to the Colombian guidelines in patients who attend a first level.

Resumen Introducción y Objetivo: En Colombia se recomiendan los inhibidores de la Dipeptidil Peptidasa-IV (iDPP4) como segunda opción para el manejo de la diabetes mellitus tipo 2. No se ha evaluado el cumplimiento e impacto de esta recomendación. Como objetivo se buscó determinar la prescripción de los iDPP4 según las recomendaciones de la Guía de Práctica Clínica colombiana, y su efecto sobre la hemoglobina glicosilada (HbA1c). Materiales y métodos: Estudio descriptivo que incluyó pacientes con diabetes mellitus tipo 2 que consultaron a un primer nivel entre 2016 y 2018, y tenían formulado un iDPP4, con al menos dos consultas de seguimiento. Se incluyeron variables sociodemográficas, clínicas, tratamiento y comorbilidades. La prescripción no ajustada se definió como la falta de cumplimento de la recomendación de la guía colombiana. Se empleó estadística descriptiva y pruebas X2 para la comparación de variables categóricas. Se aplicó un modelo de regresión logística binaria. Resultados: Hubo 207 pacientes de los cuales 112 cumplieron criterios de inclusión, 77 eran mujeres (68,8%). El 68,8% de los pacientes presentaron una prescripción no ajustada del iDPP4. Hubo una reducción total de 0,21%, con una media de 198,2±124 días entre la primera y segunda medición de HbA1c de control (reducción de 0,55% cuando la prescripción se ajustaba a la guía colombiana y 0,05% cuando no). Conclusión: Hay un limitado impacto de los iDPP4 frente a la reducción de HbA1c y poco seguimiento de la guía colombiana en pacientes de primer nivel de atención.

Hemoglobina glucosilada en el diagnóstico de diabetes gestacional en mujeres mexicanas durante el tercer trimestre / Glycosylated hemoglobin in the diagnosis of gestational diabetes in Mexican women during the third trimester

Resumen El objetivo del trabajo fue analizar los valores de hemoglobina glucosilada en el tercer trimestre de embarazo como predictores alternativos de la diabetes gestacional en pacientes del Noreste de México. Se trata de un estudio retrospectivo de casos y controles a partir de 121 expedientes de pacientes embarazadas, divididos en dos grupos, pacientes con diabetes gestacional (casos) y gestantes con valores glucémicos normales (controles). Se analizaron los factores de riesgo asociados a la diabetes gestacional y se obtuvo un punto de corte para la hemoglobina glucosilada. Se encontró que la obesidad materna, la edad y el antecedente del padecimiento fueron asociados significativamente con la diabetes gestacional. Valores de hemoglobina glucosilada ≥5% incrementaron el riesgo de padecer diabetes mellitus gestacional 4 veces y, aunado a un factor de riesgo, la probabilidad se incrementó 7 veces. Se concluye que los valores de hemoglobina glucosilada en el tercer trimestre de embarazo podrían emplearse como prueba diagnóstica de la diabetes gestacional en pacientes del Noreste de México. Sin embargo, aunque las diferencias encontradas fueron estadísticamente significativas, los resultados se deben interpretar con cautela y requieren su confirmación con estudios que incluyan una muestra mayor.

Abstract The objective of this study was to analise glycosylated hemoglobin values in the third trimester of pregnancy as an alternative predictor of gestational diabetes in North East Mexican cohort patients. This is a retrospective case-control study based on 121 records of pregnant patients, divided into two groups, patients with gestational diabetes (cases) and pregnant women with normal glycemic values (control). The risk factors associated with gestational diabetes were analised and a cut-off point for glycosylated hemogestaglobin was obtained. It was found that maternal obesity, age and a history of the condition were significantly associated with gestational diabetes. Values of glycosylated hemoglobin ≥5% increased the risk of suffering from gestational diabetes 4 times, and coupled with a risk factor, the risk increased 7 times. It is concluded that glycosylated hemoglobin values in the third trimester of pregnancy could be used as a diagnostic test for gestational diabetes in patients from the North East of Mexico. Although the differences found were statistically significant, our results must be interpreted with caution and require confirmation by studies with a larger sample.

Resumo O objetivo deste estudo foi analisar os valores da hemoglobina glicada no terceiro trimestre de gestação como preditores alternativos do diabetes gestacional em pacientes na região nordeste do México. Trata-se de um estudo retrospectivo de casos e controles utilizando 121 prontuários de gestantes divididas em dois grupos; pacientes com diabetes gestacional (casos) e gestantes com valores de glicemia normais (controles). Foram analisados os fatores de risco associados a diabetes gestacional obtendo-se um ponto de corte para a hemoglobina glicada. Descobriu-se que a obesidade materna, idade e antecedentes da doença foram associados significativamente ao diabetes gestacional. Valores da hemoglobina glicada ≥ 5% aumentaram o risco de padecer diabetes mellitus gestacional 4 vezes, e juntamente a um fator de risco, a probabilidade aumentou 7 vezes. Conclui-se que os valores da hemoglobina glicada no terceiro trimestre de gestação poderiam ser usados como teste diagnóstico do diabetes gestacional em pacientes da região nordeste do México. Embora as diferenças encontradas tenham sido estatisticamente significativas, os resultados devem ser interpretados com cautela e requerem confirmação através de estudos que incluam uma amostra maior.

Educating diabetic patients through an SMS intervention: a randomized controlled trial at a Brazilian public hospital

ABSTRACT Objective: Diabetes mellitus (DM) has a high healthcare system cost worldwide. Educational strategies are important to improve self-care and control this disease. This study aimed to evaluate satisfaction and clinical efficacy of a Short Message Service (SMS) educational intervention in self-care and nutrition at a Brazilian university hospital. Materials and methods: We conducted a trial of educational intervention and assigned eligible patients with DM to either receive weekly educational SMS for 6 months (intervention group [IG]) or no SMS at all (control group). A satisfaction questionnaire was applied before and after the intervention in both groups. Laboratory (fasting glucose, hemoglobin [Hb] A1c, total cholesterol, triglycerides, high-density lipoprotein, and low-density lipoprotein) and clinical (blood pressure) data were also collected. Data were analyzed using nonparametric tests with the Statistical Package for the Social Sciences. Results: We included 128 patients (64 in each group). Responses to the satisfaction questionnaire with self-care and healthcare professionals from 112 patients revealed an improvement in the perception of receiving information regarding helpful eating habits and in healthy eating behavior and an improvement in satisfaction with their diabetes care in the IG. In the post-intervention period, improved systolic blood pressure and HbA1c levels were observed in the IG as illustrated by delta % (post-intervention minus pre-intervention data divided by pre-intervention data multiplied by 100) reductions of 2.3% and 3.9%, respectively Conclusion: SMS intervention was useful as an educational tool for improving satisfaction and glycemic and blood pressure control of patients with DM observed at a Brazilian university hospital.

Prevalencia de diabéticos controlados con hemoglobina glicosilada en dos áreas de salud. Cárdenas, 2019 / Prevalence of diabetics controlled by glycosylated hemoglobin in two health areas. Cardenas, 2019

RESUMEN Introducción: la diabetes mellitus es un trastorno metabólico caracterizado por hiperglucemia crónica con alteraciones en carbohidratos, grasas y proteínas. Debido al aumento de la morbimortalidad por diabetes, esta constituye un problema de salud en el mundo, en Cuba y en el contexto matancero. Objetivo: determinar la prevalencia de diabéticos controlados con la hemoglobina glicosilada (HbA1c), los factores asociados, y las barreras para una intervención posterior. Materiales y métodos: estudio epidemiológico, transversal, analítico a una cohorte de 601 diabéticos tipo 2 mayores de 18 años, en dos policlínicos, estudiados anteriormente. Se encuestaron y procesaron en el programa Epi-Info 7. Se obtuvieron frecuencias y proporciones de variables, prevalencia de diabéticos controlados con la hemoglobina HbA1c, los factores asociados, las comorbilidades con el OR, y las diferencias de variables entre los dos policlínicos, con el Chi2 y p < 0,05 %. Resultados: la prevalencia de diabéticos controlados fue de un 69,3 %. Las variables demográficas, comorbilidades y factores del estilo de vida no tuvieron diferencias estadísticamente significativas. Todas las variables (presencia y ausencia del factor) presentaron un control por encima del 64 %. El peso saludable, sobrepeso, enfermedades del corazón y respiratorias crónicas, ingestión de bebidas azucaradas y alimentación inadecuada, presentaron diferencias estadísticamente significativas entre los dos policlínicos. Conclusiones: No existieron diferencias entre las variables de diabéticos controlados y no controlados. Se identificaron las barreras para mejorar el control de los pacientes para una postintervención y mejorar su calidad de vida, pues un 30 % de los diabéticos no controlados presentaron algunos de los factores de riesgo estudiados (AU).

ABSTRACT Introduction: diabetes Mellitus is a metabolic disorder characterized by chronic hyperglycemia with alterations in carbohydrates, fats and proteins. Due to the increase of the morbidity and mortality rates, this is a health problem in the world, in Cuba and the province of Matanzas. Objective: to determine the prevalence of diabetics controlled with glycosylated hemoglobin (HbA1c), associated factors, and barriers to further intervention. Materials and method: an epidemiological, cross-sectional, analytical study was carried out in a cohort of 601 previously studied, type 2 diabetics over 18 years of age, in two polyclinics. The patients were surveyed and data processed in the Epi-Info 7 program. Frequencies and proportions of variables, prevalence of diabetics controlled by hemoglobin HbA1c, associated factors, comorbidities with odds ratio, as well as differences of variables between the two polyclinics were calculated by using Chi2 and p value <0.05 %. Results: the prevalence of controlled diabetics was 69.3 %. There were no statistically significant differences between demographic variables, co-morbidities and associated life style risk factors. All variables (presence and absence of the factor) showed control above 64 %. Healthy weight, overweight, heart and chronic respiratory diseases, sweet beverages intake and inadequate diet revealed statistically significant differences between the two polyclinics. Conclusions: there were no differences between the variables controlled and non-controlled diabetics. Barriers to improve patients control were identified for the sake of performing a subsequent intervention and improving their life quality, because 30 % of uncontrolled diabetic patients had some of the studied risk factors (AU).

Poor glycemic control and associated factors in diabetic people attending a reference outpatient clinic in Mato Grosso, Brazil / Descontrol glucémico y factores asociados en personas diabéticas que acuden a una clínica de referencia en Mato Grosso, Brasil / Descontrole glicêmico e fatores associados em pessoas diabéticas que consultam em ambulatório de referência de Mato Grosso, Brasil

Objective. To identify the proportion of poor of glycemic control and associated factors among people with type 2 diabetes attending a regional reference outpatient clinic in Mato Grosso (Brazil). Methods. This is a cross-sectional quantitative study based on data from medical records of 338 people with type 2 diabetes who attend a state reference outpatient clinic in Mato Grosso (Brazil). Information on glycemic control, sociodemographic factors, lifestyle and clinical conditions was collected. Results. The prevalence of elevated glycated hemoglobin was 47.34%. In the Poisson multiple regression model analysis with robust variance, poor glycemic control was significantly associated (p<0.05) with the following factors: insulin use (Prevalence Ratio -PR = 2.03), fasting glucose ≤70 and ≥100 mg/dL (PR = 2.0), postprandial glucose ≥180 mg/dL (PR = 1.76), no physical activity (PR = 1.62), the interaction between age group ≤59 years and the time of disease diagnosis >10 years (PR = 1.58), and presence of arterial hypertension (PR = 0.79). Conclusion. Most users of the reference outpatient clinic with type 2 diabetes had poor glycemic control associated with risk factors that alter glycated hemoglobin and negatively affect the achievement of established glycemic levels.

Objetivo. Identificar la proporción de falta de control glucémico y los factores asociados entre las personas con diabetes tipo 2 que acuden a un ambulatorio regional de referencia en Mato Grosso (Brasil). Métodos. Se trata de un estudio transversal basado en los datos de las historias clínicas de 338 personas con diabetes tipo 2 atendidas en un ambulatorio estatal de referencia. Se tomó información del control glucémico, los factores sociodemográficos, el estilo de vida y las condiciones clínicas. Resultados. La prevalencia de hemoglobina glicosilada elevada fue del 47.34%. En el análisis del modelo de regresión múltiple de Poisson con varianza robusta mostró que el descontrol glucémico estaba significativamente asociado (p<0.05) con los siguientes factores: el uso de insulina (Ratio de Prevalencia -RP = 2.03), la glucemia en ayunas ≤70 y ≥100 mg/dL (PR = 2), la glucemia postprandial ≥180 mg/dL (PR = 1.76), la ausencia de actividad física (PR = 1.62), la interacción entre el grupo de edad ≤59 años y el tiempo de diagnóstico de la enfermedad >10 años (PR = 1.58) y la presencia de hipertensión (PR = 0.79). Conclusión. Una buena parte de los usuarios del ambulatorio de referencia con diabetes tipo 2 presentaba descontrol glucémico asociado a factores de riesgo que alteran la hemoglobina glicosilada y afectan negativamente la consecución de los niveles glucémicos establecidos.

Objetivo. Identificar a proporção de falta de controle glicêmico e fatores associados entre pessoas com diabetes tipo 2 que visitam um ambulatório de referência regional em Mato Grosso (Brasil). Métodos. Trata-se de um estudo transversal e quantitativo, com base em dados de prontuários de 338 pessoas com diabetes tipo 2 atendidas em ambulatório de referência estadual de Mato Grosso (Brasil). Foi recolhida informação sobre controlo glicémico, factores socio-demográficos, estilo de vida e condições clínicas. Resultados. A prevalência de hemoglobina glicada elevada foi de 47,34%. Na análise do modelo de regressão múltipla de Poisson com variância robusta, foi demonstrado que o descontrole glicêmico foi significativamente associado (p<0,05) aos seguintes fatores: uso de insulina (Razão de Prevalência -RP = 2.03), glicemia de jejum ≤70 e ≥100 mg / dL (RP = 2.0), glicemia pós-prandial ≥180 mg / dL (RP = 1.76), nenhuma atividade física (RP = 1.62), a interação entre a faixa etária ≤59 anos e o tempo de diagnóstico da doença > 10 anos (RP = 1.58) e apresentar hipertensão arterial (RP = 0.79). Conclusão. Boa parte dos usuários do ambulatório de referência com diabetes do tipo 2 apresentou descontrole glicêmico associados a fatores de risco que alteram a hemoglobina glicada e afeta negativamente o alcance dos níveis glicêmicos estabelecidos.

The effect of physical exercise on blood sugar control in diabetic patients / O efeito do exercício físico no controle do açúcar no sangue em pacientes diabéticos / El efecto del ejercicio físico sobre el control del azúcar en sangre en pacientes diabéticos

ABSTRACT Introduction Diabetes is a metabolic disease characterized by hyperglycemia. It is a metabolic syndrome in which blood sugar levels increase due to defects in insulin secretion or impaired function, or even both defects. Object To understand the effect of diabetic patients in controlling blood sugar through physical exercise, the paper analyzes the correlation between the exercise status and physiological indicators of diabetic patients in our hospital. Methods We randomly selected 41 diabetic patients and monitored their exercise. At the same time, we check the physiological indicators of the patients after the exercise is completed and analyze the control of blood sugar by sports. Results After healthy physical exercise, the blood sugar level of diabetic patients tended to stabilize, and the glycosylated hemoglobin level decreased. The blood sugar levels of patients who did not participate in healthy physical exercises were not stable, and their glycosylated hemoglobin levels did not improve. Conclusion Healthy sports is a simple, easy, safe and effective adjuvant therapy for the prevention and treatment of diabetes, and it is worthy of clinical promotion. Level of evidence II; Therapeutic studies - investigation of treatment results.

RESUMO Introdução O diabetes é uma doença metabólica caracterizada por hiperglicemia. É uma síndrome metabólica em que os níveis de açúcar no sangue aumentam devido a defeitos na secreção de insulina ou função prejudicada, ou mesmo ambos os defeitos. Objetivo Para compreender os pacientes diabéticos no controle da glicemia por meio do exercício físico, o artigo analisa a correlação entre o estado de exercício e os indicadores fisiológicos de pacientes diabéticos em nosso hospital. Métodos Selecionamos aleatoriamente 41 pacientes diabéticos e monitoramos seus exercícios. Ao mesmo tempo, verificamos os indicadores fisiológicos dos pacientes após a realização do exercício e analisamos o controle da glicemia pelo esporte. Resultados Após exercícios físicos saudáveis, o nível de açúcar no sangue de pacientes diabéticos tendeu a se estabilizar e o nível de hemoglobina glicosilada diminuiu. Os níveis de açúcar no sangue dos pacientes que não praticavam exercícios físicos saudáveis não foram estáveis e os níveis de hemoglobina glicosilada não melhoraram. Conclusão O esporte saudável é uma terapia adjuvante simples, fácil, segura e eficaz para a prevenção e tratamento do diabetes e merece divulgação clínica. Nível de evidência II; Estudos terapêuticos - investigação dos resultados do tratamento.

RESUMEN Introducción la diabetes es una enfermedad metabólica caracterizada por hiperglucemia. Es un síndrome metabólico en el que los niveles de azúcar en sangre aumentan debido a defectos en la secreción de insulina o función alterada, o incluso a ambos defectos. Objeto Para comprender a los pacientes diabéticos en el control de la glucemia a través del ejercicio físico, el trabajo analiza la correlación entre el estado de ejercicio y los indicadores fisiológicos de los pacientes diabéticos en nuestro hospital. Métodos Seleccionamos aleatoriamente a 41 pacientes diabéticos y monitoreamos su ejercicio. Al mismo tiempo, verificamos los indicadores fisiológicos de los pacientes una vez finalizado el ejercicio y analizamos el control del azúcar en sangre mediante los deportes. Resultados Después de un ejercicio físico saludable, el nivel de azúcar en sangre de los pacientes diabéticos tendió a estabilizarse y el nivel de hemoglobina glicosilada disminuyó. Los niveles de azúcar en sangre de los pacientes que no participaron en ejercicios físicos saludables no fueron estables y sus niveles de hemoglobina glicosilada no mejoraron. Conclusión El deporte saludable es una terapia adyuvante simple, fácil, segura y eficaz para la prevención y el tratamiento de la diabetes y es digno de promoción clínica. Nivel de evidencia II; Estudios terapéuticos: investigación de los resultados del tratamiento.