Evidencias del efecto del grano integral en las enfermedades crónicas no transmisibles

Los cereales integrales son una categoría de alimentos fundamental para la dieta humana y representan una fuente invaluable de carbohidratos, proteínas, fibras, fitoquímicos, minerales y vitaminas. Muchos estudios han demostrado que el consumo de cereales integrales está relacionado con un menor riesgo de enfermedades crónicas no transmisibles. Sin embargo, varios de sus efectos positivos para la salud parecen desaparecer cuando se refinan los cereales. La pregunta de investigación es cuál sería el efecto de los cereales integrales en la prevención de enfermedades crónicas no transmisibles. Este artículo describe los efectos positivos del consumo de cereales integrales en la prevención de estas enfermedades. Para ello, se realiza una descripción narrativa que revisa los antecedentes disponibles sobre: a) situación epidemiológica en Chile y su relación con la alimentación; b) consumo de cereales integrales en el mundo y en Chile; y c) el efecto del consumo de cereales integrales en la reducción del riesgo de enfermedad cardiovascular. obesidad, diabetes tipo 2 y cáncer. Los antecedentes generales son muy alentadores sobre el efecto positivo del consumo de cereales integrales sobre determinadas enfermedades, especialmente las de origen metabólico. Sin embargo, la incertidumbre de algunas asociaciones negativas merece mayor atención.

Whole grains are a fundamental food category for the human diet and represent an invaluable source of carbohydrates, proteins, fibers, phytochemicals, minerals and vitamins. Many studies have shown that consumption of whole grains is linked to a lower risk of chronic non-communicable diseases. However, several of its positive health effects seem to disappear when grains are refined. The research question is what would be the effect of whole grains in the prevention of Chronic Non-Communicable Diseases. This article describes the positive effects of whole grain consumption in these diseases.To this end, a narrative description is made that reviews the available background on: a) epidemiological situation in Chile and its relationship with diet; b) consumption of whole grains in the world and in Chile; and c) the effect of whole grain consumption on reducing the risk of cardiovascular disease. obesity, type 2 diabetes, and cancer. The general background is very encouraging for a positive effect of whole grain consumption on certain diseases, especially those of metabolic origin. However, the uncertainty of some negative associations deserves further attention.

Natural products and drug discovery.

This review covers the recent history of a series of very important natural products and their derivatives that are currently in use or under evaluation in the areas of anti-infectives, important cancer treatments that include antibody drug conjugates, followed by a discussion of type 2 diabetes (T2DM) drugs and angiotensin converting enzyme inhibitors. The current structures of the agents are shown, though in the case of some peptides used in T2DM drugs the standard single letter abbreviation for an amino acid is used.

A diabetic milieu increases ACE2 expression and cellular susceptibility to SARS-CoV-2 infections in human kidney organoids and patient cells.

It is not well understood why diabetic individuals are more prone to develop severe COVID-19. To this, we here established a human kidney organoid model promoting early hallmarks of diabetic kidney disease development. Upon SARS-CoV-2 infection, diabetic-like kidney organoids exhibited higher viral loads compared with their control counterparts. Genetic deletion of the angiotensin-converting enzyme 2 (ACE2) in kidney organoids under control or diabetic-like conditions prevented viral detection. Moreover, cells isolated from kidney biopsies from diabetic patients exhibited altered mitochondrial respiration and enhanced glycolysis, resulting in higher SARS-CoV-2 infections compared with non-diabetic cells. Conversely, the exposure of patient cells to dichloroacetate (DCA), an inhibitor of aerobic glycolysis, resulted in reduced SARS-CoV-2 infections. Our results provide insights into the identification of diabetic-induced metabolic programming in the kidney as a critical event increasing SARS-CoV-2 infection susceptibility, opening the door to the identification of new interventions in COVID-19 pathogenesis targeting energy metabolism.

Clinical Role of Serum miR107 in Type 2 Diabetes and Related Risk Factors.

BACKGROUND: As the diagnostic and treatment options for diabetes improve, more attention nowadays is being paid to the exact identification of the etiopathological mechanism of type 2 diabetes (T2DM). Insulin resistance (IR) is a pathogenetic background for T2DM. Several studies demonstrate that miRNAs play an important role in systemic inflammation and thus in T2DM pathogenesis. Overexpression of miR-107 may cause an imbalance of glucose homeostasis, obesity, and dyslipidemia, by regulating insulin sensitivity through the insulin signaling pathway. METHODS: 53 patients with T2DM and 54 nondiabetic patients were involved in the study. This study aimed to examine whether miR-107 expression in the serum of patients with diabetes was different from the control group (non-diabetic) and whether miR-107 expression correlated with lipid levels, BMI, and other factors, and finally, with insulin resistance in general. RESULTS: miR-107 expression was higher in the T2DM group than in the control group (1.33 versus 0.63 (p = 0.016). In general, miR-107 expression was directly and positively associated with BMI (r = 0.3, p = 0.01), age (r = 0.3, p = 0.004), and male gender (p = 0.006). Moreover, miR-107 was related to dyslipidemia: Patients with higher miR-107 levels had lower HDL levels (in the control group: r = -0.262, p = 0.022 vs. diabetic group: r = -0.315, p = 0.007). Finally, the overexpression of miR-107 was associated with higher HOMA-IR in the diabetic group (r = 0.373, p = 0.035). CONCLUSION: MiR-107 expression is higher among diabetic patients than that of nondiabetic control subjects. Higher miR-107 levels are also related to dyslipidemia (lower HDL levels)-in the general cohort and non-diabetic subjects. Moreover, higher miR-107 expression is related to insulin resistance in the diabetic group. In general, higher miR-107 expression levels are related to a higher BMI, older age, and the male gender.

Leptin receptor defect with diabetes causes skeletal muscle atrophy in female obese Zucker rats where peculiar depots networked with mitochondrial damages.

Tibialis anterior muscles of 45-week-old female obese Zucker rats with defective leptin receptor and non-insulin dependent diabetes mellitus (NIDDM) showed a significative atrophy compared to lean muscles, based on histochemical-stained section's measurements in the sequence: oxidative slow twitch (SO, type I) < oxidative fast twitch (FOG, type IIa) < fast glycolytic (FG, type IIb). Both oxidative fiber's outskirts resembled 'ragged' fibers and, in these zones, ultrastructure revealed small clusters of endoplasm-like reticulum filled with unidentified electron contrasted compounds, contiguous and continuous with adjacent mitochondria envelope. The linings appeared crenated stabbed by circular patterns resembling those found of ceramides. The same fibers contained scattered degraded mitochondria that tethered electron contrasted droplets favoring larger depots while mitoptosis were widespread in FG fibers. Based on other interdisciplinary investigations on the lipid depots of diabetes 2 muscles made us to propose these accumulated contrasted contents to be made of peculiar lipids, including acyl-ceramides, as those were only found while diabetes 2 progresses in aging obese rats. These could interfere in NIDDM with mitochondrial oxidative energetic demands and muscle functions.

Composite probiotics alleviate type 2 diabetes by regulating intestinal microbiota and inducing GLP-1 secretion in db/db mice.

BACKGROUD/AIM: Previous studies have found that probiotic fermented camel milk has anti-diabetic effect by inducing (glucagon-like peptide-1) GLP-1 secretion. Probiotics are valuable in prevention and treatment of diabetes. As a result, our team islolated 14 probiotics from fermented camel milk. These probiotics have beneficial characteristics, but the possible anti-diabetic mechanisms remains unclear. The present study aimed to explore the possoble anti-diabetic mechanisms of 14 probiotics. METHODS: C57BL/Ks mice were normal group. The db/db mice were randomized into five groups: model group, metformin group, liraglutide group, low-dose and high-dose probiotic group. Biochemical parameters were determined by the respective assay kits. The levels of the short-chain fatty acids (SCFAs) and microbiota were respectively determined by gas chromatography and qRT-PCR. HE staining and immunofluorescence were used for histomorphological observation. Quantitative PCR and western-blot were determined the gene and protein expression of Bax, Bcl-2, Caspase-3 and PI3K/AKT. RESULTS: Probiotics significantly improved blood glucose and blood lipid parameters, as well as the morphological changes of pancreas, liver and kidney. Probiotics improved the gut barrier function through increasing the levels of SCFA-producing bacteria and SCFAs as well as the expression of claudin-1 and mucin-2, and decreasing Escherichia coli and LPS level. In additon, probiotics enhanced insulin secretion through glucose-triggered GLP-1 secretion by upregulating G protein-coupled receptor 43/41 (GPR43/41), proglucagon and proconvertase 1/3 activity. Forthermore, probiotics protected pancreas against apoptosis, which may be dependent on the upregulation of PI3K/AKT pathway. CONCLUSIONS: The anti-diabetic effect of 14 probiotics in db/db mice seem to be related to an increase of SCFA-producing bacteria, the improvement of intestinal barrier function and the upregulation of GLP-1 production, and indicate these probiotics might be a good candidate to prevent and treat diabetes.

Avaliação do limiar anaeróbio pela variabilidade da frequência cardíaca em diabéticos tipo 2 / Evaluation of anaerobic threshold by heart rate variability in type 2 diabetics

A diabetes é um problema de saúde pública devido a sua alta prevalência, morbidade e mortalidade. O tipo 2 é mais prevalente e representa de 90 a 95% dos casos, sendo as complicações mais comuns o acúmulo de gordura no músculo esquelético e a resistência à insulina. O exercício físico regular contribui para regulação da glicemia, destacando-se o limiar anaeróbio como importante marcador para prescrição de exercícios físicos. OBJETIVO: Avaliar o limiar anaeróbio de indivíduos com diabetes tipo 2 através da variabilidade da frequência cardíaca. MATERIAIS E MÉTODOS: Estudo de caráter transversal, recrutou 18 participantes de ambos os sexos em uma unidade básica de saúde do município de Lagarto-SE, esse foram divididos em 2 grupos de 9 indivíduos. Na análise estatística utilizou-se o teste de Shapiro-Wilk para avaliação da normalidade e posteriormente Anova com pós teste de Tukey para comparação dos grupos. O grupo 1 composto de indivíduos diabéticos tipo 2 e o grupo 2 de indivíduos saudáveis. Também foi avaliada a média da frequência cardíaca em repouso e após o teste de esforço progressivo. RESULTADOS: As características de idade foram homogêneas sendo o grupo 1 com média de 62,1 (±13,9) anos e grupo 2 de 62,0 (±7,0) anos. A média da frequência de repouso foi de 79,8 bpm do grupo diabéticos e 78 bpm do grupo comparação, no limiar anaeróbio foi de 111,5 no grupo 1 e 119 no grupo 2. O tempo para atingir o L.A foi similar entre os grupos, 9,5 min no grupo experimental e 8 min no grupo comparação. CONCLUSÃO: Os valores do limiar anaeróbio de ambos os grupos foram considerados de baixo condicionamento físico, estes não apresentaram diferença estatística.

Diabetes is a public health problem due to its high prevalence, morbidity and mortality. Type 2 is more prevalent and accounts for 90 to 95% of cases, with the most common complications being the accumulation of fat in skeletal muscle and insulin resistance. Regular physical exercise contributes to glycemic regulation, highlighting the anaerobic threshold as an important marker for prescribing physical exercises. OBJECTIVE: To assess the anaerobic threshold of individuals with type 2 diabetes through heart rate variability. MATERIALS AND METHODS: A cross-sectional study, recruited 18 participants of both sexes in a basic health unit in the municipality of Lagarto-SE, which were divided into 2 groups of 9 individuals. In the statistical analysis, the Shapiro-Wilk test was used to assess normality and subsequently Anova with Tukey's post-test to compare the groups. Group 1 consisted of type 2 diabetic individuals and group 2 of healthy individuals. The mean heart rate at rest and after the progressive exercise test was also evaluated. RESULTS: Age characteristics were homogeneous, with group 1 averaging 62.1 years (± 13.9) and group 2 62.0 years (± 7.0). The mean resting frequency was 79.8 bpm in the diabetic group and 78 bpm in the comparison group, at the anaerobic threshold it was 111.5 in group 1 and 119 in group 2. The time to reach the LA was similar between groups , 9.5 min in the experimental group and 8 min in the comparison group. CONCLUSION: The values of the anaerobic threshold of both groups were considered of low physical conditioning, these did not present statistical difference.

The impact of diabetes and metabolic syndromes to the effectiveness of cyclosporine a pharmacotherapy in psoriatic patients.

Metabolic diseases concurrent with psoriasis may considerably affect the intensity of its symptoms and therapy efficacy. Cyclosporine A (CsA) is one of the medicines used in conventional therapy of psoriasis. The aim of the study was to determine whether Diabetes 2 and metabolic syndromes influence the efficacy of the CsA therapy in psoriatic patients. The sample group was composed of 32 patients with diagnosed moderate to severe forms of psoriasis vulgaris. The group was divided into subgroups, with regard to concurrently occurring Diabetes 2 and metabolic syndromes. The subgroups were composed of as follows: with diabetes-7 patients, without diabetes-25, with metabolic syndrome-15, without concurrent metabolic syndrome-17, with a metabolic syndrome without diabetes-8 and with both a metabolic syndrome and diabetes-7 patients. The efficacy of therapy was evaluated in each subgroup on the basis of the following scales: PASI, BSA, DLQI on the day of therapy commencing, after 42 and 84 days of the CsA therapy. The statistical analysis was performed with the use of STATISICA 12 (Cracow, Poland; p < .05). The following tests were used: The ANOVA Friedeman test, the posthoc test for ANOVA Friedeman test, the Mann-Whitney U test. We observed clinical improvement measured with PASI BSA scales in each subgroup. The patients themselves also reported improved comfort in their lives, which is confirmed by the lower score in the DLQI scale after 42 and 84 days of the pharmacotherapy. Differences in the values of each scale in a given subgroup turned to be statistically significant. The biggest differences occur after the first 42 days of therapy and they last in the later period of observations. We did not determine any statistically significant differences as a response to treatment in the subgroups subject to comparison. Diabetes and a metabolic syndrome concurrent with psoriasis vulgaris do not affect the efficacy of CsA therapy, which indicates no necessity to modify the standard dosage of the medicine and therapy regime.

Determinación de Hemoglobina Glicosilada en Pacientes Diabéticos tipo 2 en Tratamiento / Determination of Glycosylated Hemoglobin in type 2 Diabetic Patients in Treatment

La diabetes mellitus es un grupo de desórdenes metabólicos comunes que comparten el fenotipo de hiperglicemia. Muchos casos de diabetes mellitus tipo 2 (DM2) son causados por la interacción de la genética con factores ambientales. La falta de regulación metabólica en DM 2 causa cambios fisiopatológicos secundarios en múltiples sistemas que representan una tremenda carga para el individuo con diabetes y para el sistema de salud. (1). La hemoglobina glicosilada (HbA1C) nos permite tanto evaluar el control del paciente en los últimos tres meses, así como complicaciones que podrían presentarse. Objetivos: Determinar el porcentaje de pacientes que se encuentra dentro de la meta terapéutica establecida por la Asociación Americana de Diabetes (ADA), así como, determinar la relación entre el índice de masa corporal (IMC) y el valor de HbA1C y determinar si existe diferencia entre pacientes diabéticos tratados en una clínica privada y en un hospital público. Se indagó la escolaridad del paciente y el control glicémico, como también la relación entre el conocimiento general del paciente acerca de la enfermedad y el nivel de HbA1C y por último la relación entre el uso de insulina y un mayor IMC. Metodología: Diseño descriptivo, transversal. Se realizó medición de HbA1C a 392 pacientes, 306 públicos y 86 privados. Se realizó una encuesta para evaluar el conocimiento general acerca de su enfermedad, su escolaridad y el tratamiento que utilizaba. Se midió y pesó para calcular el IMC. Se tomó como referencia las guías de la ADA, las cuales establecen la meta terapéutica de HbA1C en 7% y a partir de este valor se clasificó a los pacientes. Resultados: De los 392 pacientes únicamente 88 (22%) se encontraban dentro de la meta terapéutica de hemoglobina glicosilada, menor de 7%. De los cuales 22 pacientes eran privados (25%) y 66 (21%) pacientes eran públicos. Conclusiones: El 22% de los pacientes diabéticos tipo 2 con más de 6 meses de tratamiento se encuentra dentro de las metas terapéuticas. Los pacientes privados están mejor controlados que los pacientes públicos. Se concluyó que no existe relación estadísticamente significativa entre el control glicémico de los pacientes y las siguientes variables: conocimiento general acerca de la enfermedad, la escolaridad del paciente y el IMC del paciente. De la misma manera se concluyó que no existe diferencia entre tratamientos para la DM2 y el control glicémico. Palabras clave: Diabetes 2, hemoglobina glicosilada, índice de masa corporal

Diabetes mellitus is a group of common metabolic disorders that share the hypoglycemia phenotype. Many cases of DM2 are caused by the interaction of genetic factors with environmental ones. The lack of metabolic regulation in DM2 causes secondary pathophysiologic changes in multiple systems that represent an overload for the individual and for the health system in general. (1) Glycosylated hemoglobin allows us to evaluate the patient's metabolic control in the last 3 months and it also allows us to predict the probable complications. Objectives: To determine with serum glycosylated hemoglobin's values, the percentage of patients that reach a metabolic control after at least 6 months of treatment, so as, to explore the relation between the BMI and HbA1C values. The relation between the patients' knowledge about the disease and the glycemic control was determined. Other objectives were to determine differences in HbA1C values depending on the drug treatment the patient was on and also the relationship between the patient's level of education and the HbA1C values. Finally, we measured the relationship between insulin use and a higher BMI. Methods: Descriptive, transversal study. Glycosylated hemoglobin was measured in 392 patients, 306 public patients and 86 private. Patients were interviewed to evaluate their general knowledge about their disease, their level of education and their treatment. Patients were also measured and weighted to calculate their body mass index. The American Diabetes Association (ADA) guidelines suggest an HbA1C value of ≤ 7% for an adequate metabolic control. The patients were classified according to that value. Results: Only 88 (22%) of the 392 patients achieved the therapeutic goal established by the ADA, 22 were private (25%) and 66 (21%) were public patients. Conclusions: Only 22% of the type 2 diabetic patients with more than 6 months of treatment did achieve the therapeutic goal. Private patients have a better control of diabetes than public patients do. There is no relationship between the patient's HbA1C values and the following variables: patient's knowledge about the disease, patient's level of education and body mass index. There are no differences between the treatments used for diabetes control. Keywords: type 2 diabetes, glycosylated hemoglobin

Manga gástrica laparoscópica. Experiencia en 730 casos. Seguimiento a 5 años / Laparoscopic gastric sleeve. Experience in 730 cases. 5 years follow up

La obesidad se ha convertido en la epidemia del siglo XXI, incrementado las patologías asociadas a la misma como: diabetes mellitus tipo 2, síndrome metabólico, hipertensión arterial, enfermedades cardiovasculares, entre otras, afectando negativamente la calidad y expectativa de vida. La manga gástrica ha ganado popularidad en el tratamiento quirúrgico primario de la obesidad. Pacientes y métodos: Se realizó un estudio prospectivo con 730 casos sometidos a manga gástrica en el Instituto Clínico La Florida años 2006 - 2012. Se analizó: sexo, edad, índice de masa corporal, porcentaje de exceso de peso perdido, tiempo quirúrgico, complicaciones, y respuesta postoperatoria de pacientes diabéticos 2 e hipertensos. Resultados: Femenino 533 (73%), masculino 197 (27%), edad promedio 40,1 años, tiempo quirúrgico 79 min, índice masa corporal promedio pre-operatorio 40,7; promedio postoperatorio 28,6 en 60 meses. Promedio pérdida del exceso de peso 72,1 % en 60 meses; complicaciones: disrupción de la línea de engrapado 1,09 %, Sangrado 1,2 %, neumonía 0,5 %, deshidratación 1,3 %, infección herida 5 casos (0,6%), estenosis 0 %, obstrucción 0 %, conversiones: 0 %, mortalidad: 0 %. De 42 pacientes diabéticos remisión en 34 (81 %) y mejoría en 8 (19 %) y 112 pacientes hipertensos remisión en 70 (62,5 %), mejoría 28 (25 %) y sin respuesta 14 (12,5 %). Conclusión: Se concluye que la manga gástrica es una técnica segura y efectiva para el tratamiento primario de la obesidad y la resolución de comorbilidades como la diabetes 2 e hipertensión arterial(AU)

Obesity has become the epidemic of the 21st century, increasing pathologies associated with it such as diabetes mellitus type 2, metabolic syndrome, hypertension, and cardiovascular diseases, among others, negatively affecting the quality of life and life expectancy. Sleeve gastrectomy has gained popularity in the primarily surgical treatment of obesity. Patients and methods: A prospective study of 730 cases that underwent sleeve gastrectomy was performed at the Instituto Clínico la Florida from 2006 to 2012. Gender, age, corporal mass index, percentage of excess of weight loss, duration of surgery, complications, postoperative reaction of diabetes-2 and hypertensive patients were analyzed. Results: 533 females (73%), 197 males (27%), Age Average: 40.1 years, surgery duration: 79 minutes; corporal mass index: preoperative average: 40.7; post-operative average: 28.6 in 60 months. Average weight excess loss: 72.1 % in 60 months. Complications: disruption of staple line 1.09 %, bleeding: 1.2%, pneumonia: 0.5 %, dehydration: 1.3 %, wound infection 5 cases (0.6 %), stenosis 0 %, obstruction 0 %, conversions: 0 %, mortality: 0 %. In 42 diabetic patients, 34 were in remission (81 %), 8 showed improvement (19 %). In 112 hypertensive patients, 70 were in remission (62.5 %), 28 showed improvement (25 %) and 14 showed no results (12.5 %). Conclusion: It is concluded that sleeve gastrectomy is a safe and effective technique for the primary treatment of obesity and the resolution of comorbidities like diabetes-2 and hypertension(AU)

Caracterización de pacientes con prediabetes en instituciones de servicio de salud de primer nivel en Cali, Colombia / Characterization of patients with pre-diabetes in first-level health care service institutions Cali, Colombia

Introduction: Type 2 diabetes (DM 2) is one of the first ten causes of mortality in Colombia. Pre-diabetes is a state of hyperglycemia that associated with other risk factors appears 5-10 years before this disease. It has been reported that controlling the diet and exercise decreases the probability of suffering DM 2 by 60%. This intervention requires establishing the risk in pre-diabetic patients.Objectives: To detect patients with pre-diabetes who are members of a private health care provider (EPS for its name in Spanish) in Cali and to describe the clinical and epidemiological characteristics related to the risk of developing DM 2.Materials and methods: This is a cross-sectional descriptive study in patients with altered glucemias (Impaired fasting glucose: 100-125 mg/dl and impaired glucose tolerance: 140-199 mg/dl). Clinical histories were reviewed and surveys on risk factors, habits and perception of knowledge were conducted. We determined: fasting glucose, vital signs, and anthropometric measures.Results: 111 patients were included (64% women) whose most common occupation was home duties (39.6%). The descriptive analysis reported high risk; the results were: noticeable presence of associate pathological antecedents as follows: Diabetes in the family (64%), obesity (54.1%), dyslipidemia (72.1%), and hypertension (66.7%) in a population with a mean age at 51 years and 10.8% were under 40 years of age. This great proportion of overweight or obesity (86.5%), according to BMI, influenced the determination of the high cardio-metabolic risk (81%, agreeing with the WHO). When evaluating diet with consumption frequency, we still found the intake of simple carbohydrates and animal fats; when reviewing physical activity, 53.2% of the patients reported activity in the last 7 days according to the International Physical Activity Questionnaire (IPAQ). Conclusions: 66% of pre-diabetics did not have diagnosis of some disorder of the metabolism of carbohydrates.

Introducción: La diabetes tipo 2 (DM 2) es una de las diez primeras causas de mortalidad en Colombia. La prediabetes es un estado de hiperglucemia que, asociado con otros factores de riesgo, se presenta 5-10 años antes de dicha enfermedad. Se ha informado que controlar la dieta y el ejercicio disminuye la probabilidad de padecer DM 2 hasta en 60%. Identificar y caracterizar el riesgo en los pacientes prediabéticos contribuye en la prevención de la DM 2.Objetivos: Detectar los pacientes con prediabetes afiliados a una EPS privada de Cali, evaluar y describir su estado de riesgo.Materiales y métodos: Se realizó estudio descriptivo transversal en pacientes con glucemias alteradas (glucemia en ayunas, 100-125 mg/dl y glucemia post-carga, 140-199 mg/dl). Se revisaron historias clínicas y se realizó encuesta de factores de riesgo, hábitos y percepción de conocimientos. Se determinaron glucemia en ayunas, signos vitales y medidas antropométricas.Resultados: Se incluyeron 111 pacientes (64% mujeres), con edad promedio de 51 años y 10.8% menor de 40 años, cuya mayor ocupación fue el hogar (39.6%). Se encontró alto riesgo para desarrollar DM 2 de acuerdo con los siguientes resultados: alta proporción de antecedentes patológicos asociados como diabetes familiar (64%), obesidad (54.1%), dislipidemias (72.1%) e hipertensión (66.7%). La gran proporción de sobrepeso u obesidad según IMC hallado (86.5%), influyó en la determinación del alto riesgo cardiometabólico (81% según criterios de la OMS). Al evaluar dieta con frecuencia de consumo, se encontró todavía ingesta de carbohidratos simples y grasas animales; luego de revisar actividad física, 53.2% informó actividad en la semana antes del Cuestionario Internacional de Actividad Física (IPAQ).Conclusiones: Del total de los prediabéticos, 66% no tenía diagnóstico de algún desorden del metabolismo de los carbohidratos.

Incretinas, incretinomiméticos, inhibidores de DPP IV: (2ª parte) / Incretins, Incretinmimetics, Inhibitors (2nd part)

En los últimos años se reconoce un nuevo mecanismo involucrado en la fisiopatología de la Diabetes Mellitus tipo 2: el déficit de producción y/o acción de las incretinas. Las incretinas son enterohormonas que estimulan la secreción de insulina en respuesta a la ingesta de nutrientes. Glucagon like peptide-1 (GLP1) y Polipéptido insulinotrópico glucosa dependiente (GIP) son las principales incretinas descubiertas hasta hoy. Ambas presentan también efecto trófico sobre las células beta de los islotes pancreáticos. GLP-1 presenta otras acciones como son la inhibición de la secreción de glucagón, enlentecimiento del vaciamiento gástrico e inhibición del apetito. Ambas incretinas son rápidamente clivadas por la enzima dipeptidil peptidasa 4 (DPP-4). Nuevas drogas como los incretinomiméticos, análogos y los inhibidores de DPP-4 se presentan como una terapéutica prometedora para los pacientes con diabetes tipo 2. Conflicto de intereses: Dr. León Litwak - Miembro del Board Latinoamericano de Eli Lilly y Sanofi Aventis - Miembro del Board Nacional de los laboratorios Novo Nordisk, Novartis, GlaxoSmithKline, Sanofi Aventis, Boheringer Ingelheim, Bristol Myers, Astra Zeneca - Investigador principal de protocolos pertenecientes a Eli Lilly, Novo Nordisk, Novartis, GlaxoSmithKline, Takeda, PPDF, Pfizer, Merck Sharp and Dôhme, Amger, Roche, Minimed, Quintiles - Conferencista de los laboratorios mencionados.

Two main pathophysiological mechanisms are currently involved in Type 2 Diabetes (T2DM), insulin resistance and impairment of beta cell function. However, in recent years a new mechanism was reported: a significant decrease in incretins production and/or action. Incretins are gastrointestinal hormones whose main action is stimulating insulin secretion in response to nutrients. The best known incretins are glucagon like peptide-1 (GLP-1) and Gastric insulinotropic peptide (GIP). GLP-1 and GIP not only increase insulin secretion, but also decrease glucagon secretion, slow gastric emptying and reduce apetite, generating weight loss. Both incretins are rapidly clived by the enzyme dipeptidil peptidase 4 (DPP4). In order to emulate incretins action, several drugs were developed: GLP-1 receptor agonists, GLP-1 mimetics, and DPP4 inhibitors. All of them seem to became a very promising tool for the treatment of T2DM. Financial Interests: Dr. León Litwak - Member of the Latin American Board of Eli Lilly and Sanofi Aventis - Member of the National Board of the following laboratories: Novo Nordisk, Novartis, GlaxoSmithKlein Sanofi, Aventis, Boheringer Ingelheim, Bristol Myers, Astra Zeneca - Principal Investigator of Protocols from: Eli Lilly, Novo Nordisk, Novartis, GlaxoSmithKlein, Takeda, PPDF, Pfizer, Merck Sharp and Dôhme, Amgen, Roche, Minimed, Quintiles - Lecturer for the former laboratories.

Incretinas, Incretinomiméticos, Inhibidores de DPP IV: 1er parte / Incretins, Incretinmimetics, Inhibitors

En los últimos años se reconoce un nuevo mecanismo involucrado en la fisiopatología de la Diabetes Mellitus tipo 2: el déficit de producción y/o acción de las incretinas. Las incretinas son enterohormonas que estimulan la secreción de insulina en respuesta a la ingesta de nutrientes. Glucagon like péptido-1 (GLP1) y Polipéptido insulinotrópico glucosa dependiente (GIP) son las principales incretinas descubiertas hasta hoy. Ambas presentan también efecto trófico sobre las células beta de los islotes pancreáticos. GLP-1 presenta otras acciones como son la inhibición de la secreción de glucagón, enlentecimiento del vaciamiento gástrico e inhibición del apetito. Ambas incretinas son rápidamente clivadas por la enzima dipeptidil peptidasa 4 (DPP-4). Nuevas drogas como los incretinomiméticos, análogos y los inhibidores de DPP-4 se presentan como una terapéutica prometedora para los pacientes con diabetes tipo 2.

Two main patophysiological mechanisms are currently involved in Type 2 Diabetes (T2DM), insulin resistance and impairment of beta cell function. However in the last years a new mechanism was reported: a significant decrease in incretins production and or action. Incretins are gut hormones whose main action is stimulating insulin secretion in response to nutrients. The more known incretins are glucagon like peptide-1 (GLP-1) and Gastric insulinothropic peptide (GIP). GLP-1 and GIP not only increase insulin secretion, nor decrease glucagon secretion, slow gastric emptying and reduce apetite generating weight lose. Both incretins are rapidly clived by the enzyme dipeptidil peptidase 4 (DPP4). In order to emulate incretins action, several drugs where developed: agonists of GLP-1 receptors, GLP-1 mimetics, and inhibitors of the DPP4. All of them seems to became a very promise tool for the treatment of T2DM.

Diabetes mellitus do tipo 2 e do tipo 1 / Diabetes mellitus

A crescente prevalência de diabetes mellitus nos últimos anos no mundo desenvolvido e em desenvolvimento fez com que essa doença ganhasse uma importância sem precedentes. Levando-se em conta o grande impacto das complicações diabéticas na mortalidade e morbidade e a contribuição do diabetes como fator de risco cardiovascular, o diagnóstico precoce e a introdução rápida do tratamento são mandatórios para manutenção da qualidade de vida. Recentemente novas abordagens comportamentais e farmacológicas têm sido desenvolvidas, melhorando e facilitando a terapêutica do paciente diabético.