RESUMEN
BACKGROUND: Hypertension frequently coexists with type 2 diabetes (DM), and increases the risk of cardiovascular outcomes. The aim of the study was to obtain/maintain blood pressure (BP) goals (ADA/JNC 7) according to a stepwise algorithm using the medication supplied by the Brazilian government. METHODS: A one-year, single-arm interventional study conducted with type 2 diabetes patients. Intervention consisted of intensification of lifestyle changes and sequential prescription of drugs: diuretic; ACE inhibitors; ß-adrenergic blocking agent and calcium channel blocking agent if BP >130/80 mmHg. RESULTS: Seventy-eight patients completed the trial. During intervention, the number of antihypertensive tablets rose (3.6 ± 3.5 vs. 5.9 ± 3.5 pills/patient; p <0.001), as the number of antihypertensive classes increased (1.8 ± 1.0 vs. 2.70 ± 1.2; p < 0.01) and the overall drop of BP was 11 mmHg for SBP (145.0 ± 22.8 vs. 133.7 ± 20.9 mmHg; p < 0.01) and 5 mmHg for DBP (78.7 ± 11.5 vs. 73.7 ± 10.5 mmHg; p = 0.001). Although the number of patients with BP in target almost doubled [14 (18.7%) vs. 30 (38.5%) p = 0.008], less than 40% of the patients achieved the proposed goals. CONCLUSIONS: A BP algorithm applied to type 2 diabetic and hypertensive patients is able to lower BP, however more than half of the patients did not achieve the ADA/JNC 7 targets demonstrating the complexity of BP control in this population. TRIAL REGISTRATION: ClinicalTrials.gov: NCT06260.
RESUMEN
BACKGROUND: The American Diabetes Association (ADA) has published several diabetes treatment algorithms, but none have been tested in real-life settings. The aim of this study is to analyze the feasibility of achieving and/or maintaining HbA1c levels <7.0% using current diabetes treatment guidelines and the resources available in the public health care system of Brazil. METHODS: A one-year, single-arm interventional study was conducted with type 2 diabetes patients in a primary care unit. Intervention consisted of intensification of lifestyle changes and sequential prescription of drugs based on ADA guidelines using the medications available through the publicly funded Unified Health System (Sistema Único de Saúde, SUS). RESULTS: Ninety patients (age: 62.7±10.4 years; diabetes duration: 8.2±9.1 years) completed the trial. During the intervention period, increases were observed in number of oral antidiabetic agent (OAD) classes per patient (1.50±0.74 vs. 1.67±0.7; p=0.015), OAD pills per patient (2.64±1.89 vs. 3.33±2.23 pills/patient; p <0.001), insulin dosage (0.20±0.29 vs.0.50±0.36 UI/kg/day; p=0.008) and number of patients on insulin (19 [21%] vs. 31 [34%]; p<0.01), but no improvement in HbA1c (7.2±1.6% vs. 7.3±1.5%; p=0.453) or frequency of patients on target, defined as HbA1c <7% (53.3% vs. 48.9%; p=0.655). Patients with baseline HbA1c <7% had a small increase in HbA1c during the trial (6.3±0.4 vs. 6.7±0.9%; p=0.002). No such change was observed in those with baseline HbA1c ≥7%. CONCLUSIONS: In this group of patients with a mean baseline HbA1c of 7.2%, implementation of 2006/2009 ADA/EASD guidelines led to achievement of the therapeutic goal of HbA1c <7% in a small proportion of patients.
RESUMEN
Background: Chronic kidney disease (CKD) is a significant public health problem. It is still controversial if the metabolicsyndrome (MS) is associated with CKD.Methods: Cross-sectional study of individuals at high risk of developing diabetes at the endocrine outpatient clinic of Hospitalde Clínicas de Porto Alegre. Fasting and 2h-plasma glucose levels, A1c, insulin, cholesterol, triglycerides, creatinine, andurinary albumin excretion were measured. MS was defined as the presence of three out of five of the following factors: hypertension,low HDL-cholesterol, high triglyceride levels, elevated plasma glucose, and high waist circumference. Glomerularfiltration rate (GFR) was estimated by the Modified Diet in Renal Disease (MDRD) equation and insulin resistance wasmeasure using the Homeostasis Model of Assessment - Insulin Resistance (HOMA-IR). Correlation analyses were performedbetween each MS components and the GFR.Results: CKD was present in 20.9% of the subjects. GFR was lower in subjects with MS compared with those without MS(P =0.019). Estimated GFR decreased with the increasing number of MS criteria (mean ± SD; zero or one criterion103.09±9.5 vs. two criteria 99.14±21.2 vs. three criteria 90.9±21.1 vs. four criteria 91.0±19.4 vs. five criteria 80.9±23.5mL/min per 1.73m2; P =0.053). Only systolic arterial blood pressure was related to eGFR (r = 0.280; P =0.003).Discussion: According to our data, the previously described association between MS and decreased renal function wasconfirmed, mostly determined by the hypertension criterion.Conclusion: These data suggest that the relationship between MS and CKD is driven mostly by abnormalities in blood pressurehomeostasis.
Introdução: A Doença Renal Crônica (DRC) é um problema de saúde pública. Ainda é controversa a existência de associa-ção entre a presença de Síndrome Metabólica (SM) e DRC.Métodos: Indivíduos com risco aumentado para o desenvolvimento de diabete melito acompanhados no ambulatório deEndocrinologia do Hospital de Clínicas de Porto Alegre foram analisados em um estudo transversal. Pacientes foram submetidosao Teste de Tolerância Oral à Glicose, e hemoglobina glicada (A1c), insulina, colesterol, triglicerídeos, creatinina eexcreção urinária de albumina foram medidos. A presença de SM era baseada na presença de três entre os cinco critérios aseguir: hipertensão, níveis séricos de colesterol HDL diminuídos, níveis aumentados de triglicerídeos, hiperglicemia e circunferênciaabdominal aumentada. A taxa de filtração glomerular (TFG) foi calculada pela equação do Modified Diet in RenalDisease (MDRD) e a resistência insulínica, pelo Homeostasis Model of Assessment Insulin Resistance (HOMA-IR).Análises de correlação foram feitas entre cada componente da SM e a TFG.Resultados: DRC esteve presente em 20,9% dos indivíduos. Níveis diminuídos de TFG foram observados em pacientescom SM comparados com aqueles sem SM (P=0,019). TFG diminuiu com o aumento no número de critérios para SM (mé-dia±DP; 0 e 1 critério 103,09±9,5; vs. 2 critérios 99,14±21,2; vs. 3 critérios 90,9±21,1; vs. 4 critérios 91,0±19,4; vs. 5 crité-rios 80,9±23,3 ml/min; P=0,053). Apenas pressão arterial sistólica mostrou-se relacionada com a TFG (r=0,280; P=0,003).Discussão: Nosso trabalho confirmou a associação entre a presença de Síndrome Metabólica e TFG diminuída descritapreviamente por outros estudos, tendo, neste presente estudo, a hipertensão como o principal determinante desta relação.Conclusão: Nossos achados sugerem que a relação existente entre a presença de SM e o desenvolvimento de DRC é determinadaprincipalmente por anormalidades na homeostase pressórica.
