Obesity related adipokines release in rat adipose derived stem cell cultures influenced by pulsed electromagnetic field.

OBJECTIVE: The main goal of our studies was to investigate the effect exerted by pulsed electromagnetic led (PEMF) on adipocytokines secretion in cell culture supernatants from rat adipose derived stem cells (ADSCs) grown on varied energy-rich diet. O spring and adult animals were randomly selected for two types of experimental diets: low (LF) or high fat (HF) diet for 7 weeks. A er the diet period, serum glucose level was measured, ADSCs were isolated from adipose tissues from different locations. ADSCs from all experimental groups were exposed to PEMF, supernatants collected and adipokines level was determined. RESULTS: HF diet feed in pups/adult animals elevated blood glucose level and increased the level of adiponectin (Apn) and leptin of both genders and age measured in serum. ADSCs cell cultures originated from female pups on LF diet and exposed to PEMF released large amounts of Apn. PEMF effect exerted on Apn release was also observed in ADSCs isolated from male pups HF diet. ADSCs from female pups on LF diet exposed to PEMF released smaller amounts of leptin in comparison to cell cultures without PEMF treatment. PEMF exposure of ADSCs cell cultures originated from female adults on LF diet decreased release of Apn, contrary adult male on LF diet ADSCs under PEMF treatment produced more leptin. PEMF treated male HF diet-originated ADSCs cultures released significantly more leptin than controls. CONCLUSION: Our results suggest that PEMF exposure is responsible for metabolic physiological balance effects obtained in ADSCs cultures originating from adult animals on HF diet.

Low stress hyperglycemia ratio predicts worse prognosis in diabetic acute heart failure patients.

INTRODUCTION: Acute blood glucose but not glycated hemoglobin (HbA1c) predicts poor outcome in acute heart failure (HF). The stress hyperglycemia ratio (SHR) has been proposed as a prognostic predictor in various clinical settings. OBJECTIVES: We assessed the prognostic implications of the SHR in acute HF patients with and without diabetes. METHODS: We performed a retrospective analysis of an acute HF registry conducted between 2009 and 2010. Estimated average glucose (eAG) was calculated as (28.7×HbA1c)-46.7 and SHR as acute blood glucose divided by eAG. The primary endpoint was all-cause mortality. Follow-up was three months. Patients were grouped by SHR tertiles (≤0.88, 0.89-1.16, and >1.16). Cox regression analysis was used to test the association of SHR (cut-off 0.88) with all-cause mortality. Analysis was stratified according to the presence of diabetes. Multivariate models were built accounting for acute blood glucose and for eAG (models 1 and 2, respectively). RESULTS: We studied 599 patients, mean age 76±12 years, of whom 62.1% had reduced ejection fraction and 50.9% had diabetes. Median acute blood glucose, eAG and SHR were 136 (107-182) mg/dl, 131 (117-151) mg/dl, and 1.02 (0.20-3.34), respectively. During follow-up 102 (17.0%) died. In patients with diabetes, those in the lowest SHR tertile had a hazard ratio (HR) of 2.24 (95% CI: 1.05-5.22) (model 1) and 2.34 (1.25-4.38) (model 2). In patients without diabetes, the HR of three-month death in the lowest SHR tertile was 0.71 (95% CI: 0.36-1.39) and 1.02 (0.58-1.81). Significant interaction was observed between diabetes and SHR. CONCLUSIONS: In HF patients with diabetes, a SHR ≤0.88 was associated with a more than twofold higher three-month mortality risk. No such association was found in non-diabetic patients. The presence of diabetes influences the association of the SHR with mortality.

Oleuropein-enriched chocolate by extra virgin olive oil blunts hyperglycaemia in diabetic patients: Results from a one-time 2-hour post-prandial cross over study.

BACKGROUND & AIMS: Oleuropein, a component of extra virgin olive oil (EVOO), reduces post-prandial glycemia with a mechanism counteracting oxidative stress-mediated incretin down-regulation. In this study we evaluated if the intake of an oleuropein-enriched chocolate could have positive effects on glycaemia and insulin levels in patients with type 2 diabetes mellitus (T2DM) and healthy subjects (HS). METHODS: Twenty-five consecutive T2DM patients and 20 HS were recruited. Participants were randomized to receive 40 g oleuropein-enriched chocolate by EVOO or 40 g control chocolate spread in a cross-over design. Serum glucose, insulin, glucagon-like peptide-1 (GLP1), and dipeptidyl-peptidase-4 (DPP4) were measured before and 2 h after chocolate intake. RESULTS: In T2DM, the pairwise comparisons showed that intake of oleuropein-enriched chocolate was associated with a significantly less increase of blood glucose compared to control; GLM analysis showed a significant difference for treatments with respect to glucose (p = 0.04), GLP1 (p < 0.001) and DPP-4 activity (p = 0.01). In HS, the pairwise comparisons showed that, after oleuropein-enriched chocolate intake, blood glucose concentration and DPP4 activity did not change; conversely a significant increase was observed for insulin and GLP1. After control chocolate intake, a significant increase for blood glucose, insulin levels and DPP4 activity were observed while GLP1 did not change. CONCLUSION: The study shows that using EVOO as source of oleuropein administration of 40 g oleuropein-enriched chocolate is associated with a modest increase or no change of glycemia in T2DM and HS respectively, via an incretin-mediated mechanism.

[Effects of interval exercise in the improvement of glycemic control of obese adults with insulin resistance]. / Efectos del ejercicio físico intervalado en la mejora del control glicémico de adultos obesos con insulinorresistencia.

INTRODUCTION: Background: physical exercise presents evidence for the treatment of insulin resistance. However, it is necessary to deepen this knowledge. Objective: to compare the effectiveness of a high intensity interval training program (HIIT) with one of resistance training (RT) to improve biochemical parameters of insulin/basal glycemia and post-load. Material and methods: twenty-eight (36 ± 13 years old) non-medicated insulin-resistant individuals (age 36 ± 13 years) were studied. Two groups were randomly formed: RT group (n = 14) and HIIT group (n = 14). Each group participated in 12 weeks of intervention (three sessions/week). Both groups were homogeneous (p > 0.05) in terms of age, weight, height and BMI. Basal glycemia/insulinemia and post-load were evaluated, pre and post intervention. Results: after the intervention there were significant decreases in both groups in: fat (%) HIIT (Pre = 40.20 ± 7.31 vs Post = 36.49 ± 7.28%, p = 0.006), RT (Pre: 39.04 ± 8.52 vs Post: 34.91 ± 8.80%, p = 0.002); fasting insulin, HIIT (Pre: 20.64 ± 9.44 vs. Post: 15.20 ± 6.47uIU/ml, p = 0.0006), RT (Pre: 18.50 ± 8.24, vs Post: 13.59 ± 6.11 uIU/ml, p = 0.015); insulin post load, HIIT (Pre: 127.57 ± 71.73 vs Post: 69.25 ± 39.42 uIU/ml, p < 0.0001), RT (Pre: 125.78 ± 59.85 vs Post: 63.45 ± 36.44uIU/ml, p < 0.0001); and fasting glycemia, HIIT (Pre: 92.86 ± 11.39 vs Post: 87.36 ± 8.00, p = 0.031), RT (Pre: 90.79 ± 11.26 vs Post: 85.26 ± 7.88 mg/dl, p = 0.045). In relation to post-load glycemia only the HIIT group decreased significantly (Pre: 128.57 ± 26.90 vs Post: 103.47 ± 12.70 mg/dl, p < 0.001), reporting differences with the RT group (p < 0.042). Conclusion: both programs showed similar results for the treatment of insulin resistance.

INTRODUCCIÓN: Introducción: el ejercicio físico presenta evidencia para el tratamiento de la resistencia a la insulina. Sin embargo, es necesario profundizar en base a estos conocimientos. Objetivo: comparar la efectividad de un programa de entrenamiento intervalado de alta intensidad (HIIT) con uno de resistencia muscular (RT) para mejorar parámetros bioquímicos de insulina/glicemia basal y poscarga. Material y métodos: se estudiaron 28 personas (edad 36 ± 13 años) insulinorresistentes no medicadas. Se formaron aleatoriamente dos grupos: grupo RT (n = 14) y grupo HIIT (n = 14). Cada grupo participó de 12 semanas de intervención (tres sesiones/semana). Ambos grupos fueron homogéneos (p > 0,05) en cuanto a edad, peso, talla e índice de masa corporal (IMC). La glicemia/insulinemia basal y poscarga igual fueron evaluadas pre- y posintervención. Resultados: tras la intervención existieron disminuciones significativas en ambos grupos en grasa (%), HIIT (Pre = 40,20 ± 7,31 vs. Post = 36,49 ± 7,28%, p = 0,006), RT (Pre: 39,04 ± 8,52 vs. Post: 34,91 ± 8,80%, p = 0,002); en insulina en ayunas HIIT (Pre: 20,64 ± 9,44 vs. Post: 15,20 ± 6,47 uIU/ml, p = 0,0006), RT (Pre: 18,50 ± 8,24, vs. Post: 13,59 ± 6,11 uIU/ml, p = 0,015); en insulina post carga, HIIT (Pre: 127,57 ± 71,73 vs. Post: 69,25 ± 39,42 uIU/ml, p < 0,0001), RT (Pre: 125,78 ± 59,85 vs. Post: 63,45 ± 36,44 uIU/ml, p < 0,0001); y en glicemia en ayunas, HIIT (Pre: 92,86 ± 11,39 vs. Post: 87,36 ± 8,00 mg/dl, p = 0,031), RT (Pre: 90,79 ± 11,26 vs. Post: 85,26 ± 7,88 mg/dl, p = 0,045). En relación a la glicemia poscarga, solo el grupo HIIT disminuyó significativamente (Pre: 128,57 ± 26,90 vs. Post: 103,47 ± 12,70 mg/dl, p < 0,001), reportando diferencias con el grupo RT (p < 0,042). Conclusión: ambas metodologías de trabajos muestran similares resultados para el tratamiento de la insulinorresistencia.

Development of nopal-pineapple marmalade formulated with stevia aqueous extract: effect on physicochemical properties, inhibition of α-amylase, and glycemia response.

INTRODUCTION: Introduction: Stevia rebaudiana extracts can be used as a sweetener due to their glycoside content: specifically stevioside and rebaudioside. Both compounds have adequate pharmacological characteristics for human consumption. Objective: the aim of this study was to standardize the formulation of marmalades using nopal-pineapple-stevia aqueous extract ratios. Methods: the products were evaluated to determine their physicochemical properties, in vitro inhibition of α-amylase and glycemia in healthy volunteers. Storage study was conducted for 20 days at room temperature 23-30 °C and relative humidity 80-85%. Results: incorporation of stevia significantly modified physicochemical properties like °Brix, color and flow index. After storage, the presence of molds and bacteria were not detected. Sensory evaluation indicated that marmalade with 50% stevia replacement was equally accepted as marmalade with sucrose. Marmalade with 50 and 100% of stevia inhibited 35.89 and 38.50% of the α-amylase activity. After an intake of 30 g, it seems that marmalades with stevia had a significant effect on the glycemia of the volunteers. Conclusions: however, further studies with larger doses of nopal-pineapple-stevia marmalade and consumed for longer in both healthy volunteers and patients with diabetes are needed to achieve results that are more precise.

INTRODUCCIÓN: Introducción: los extractos de Stevia rebaudiana pueden ser utilizados como edulcorante debido a su contenido de glucósidos: específicamente esteviósido y rebaudiósido. Ambos compuestos presentan características farmacológicas adecuadas para el consumo humano. Objetivos: el objetivo del presente trabajo fue estandarizar formulaciones de mermeladas con diferentes proporciones de nopal-piña-extracto acuoso de stevia. Métodos: se estudiaron las propiedades fisicoquímicas de las mermeladas, su capacidad de inhibir in vitro a la enzima α-amilasa y la glicemia en voluntarios sanos. Los estudios de vida de anaquel se efectuaron durante 20 días a temperatura ambiente 23-30 °C y humedad relativa 80-85%. Resultados: la incorporación de estevia modificó significativamente los grados Brix, el color y el índice de flujo de las mermeladas. Concluido el estudio de anaquel, no se observó la presencia de hongos o bacterias. La evaluación sensorial indicó que la mermelada con 50% de estevia fue aceptada con el mismo nivel de agrado que la mermelada con sacarosa. Las mermeladas con 50 y 100% de estevia inhibieron la actividad de la α-amilasa con valores de 35.89% y 38.50%, respectivamente. Posterior a una ingesta de 30 g de mermelada se observó un efecto significativo en la glicemia de voluntarios sanos. Conclusiones: deberán efectuarse estudios de consumo prolongado y de mayores cantidades de mermelada tanto en voluntarios sanos como con diabetes para obtener resultados más precisos.

Influence of socioeconomic and psychological factors in glycemic control in young children with type 1 diabetes mellitus.

OBJECTIVE: To evaluate the influence of socioeconomic and psychological factors on glycemic control in young children with type 1 diabetes mellitus. METHODS: This was a cross-sectional study assessing prepubertal children with type 1 diabetes mellitus. The authors analyzed the socioeconomic status using the Brazil Economic Classification Criterion (Critério de Classificação Econômica Brasil [CCEB]) and psychological conditions through the Brazilian version of the Problem Areas in Diabetes, associated with glycemic control, measured by glycated hemoglobin (HbA1c). Descriptive analysis was used. The variables were assessed by bivariate and multivariate robust Poisson regression model, as well as Fisher's exact and Pearson's chi-squared tests to obtain the ratios of gross and adjusted prevalence ratio, with confidence interval being estimated at 95%. RESULTS: A total of 68 children with type 1 diabetes mellitus were included in the study. A negative association between glycemic control (glycated hemoglobin levels), socioeconomic status (Brazil Economic Classification Criterion), and psychological condition (Brazilian version of the Problem Areas in Diabetes) was observed. Among the study participants, 73.5% (n=50) of the children had an unfavorable socioeconomic status; these participants were 1.4 times more likely to present altered glycated hemoglobin values. In relation to individuals with compromised psychological status, 26 (38.2%) had a score above 70, thus being classified with psychological stress; these children were 1.68 times more likely (95% confidence interval: 1.101, 1.301) to have higher glycated hemoglobin levels. CONCLUSIONS: The socioeconomic conditions and psychological characteristics of the study participants were negatively associated with glycated hemoglobin results. These data reinforce the importance of the studied variables as predictors of glycemic control.

Glucose alteration and insulin resistance in asymptomatic obese children and adolescents.

OBJECTIVE: Obesity is associated with the abnormal glucose metabolism preceding type 2 diabetes mellitus. Thus, further investigation on the prediction of this lethal outcome must be sought. The objective was the profile glycemic assessment of asymptomatic obese children and adolescents from Salvador, Brazil. METHOD: A fasting venous blood sample was obtained from 90 consecutive obese individuals aged 8-18 years, of both sexes, for laboratory determinations of glycated hemoglobin, basal insulin, and the Homeostasis Model Assessment Insulin Resistance index. The clinical evaluation included weight, height, waist circumference, assessment of pubertal development, and acanthosis nigricans research. The body mass index/age indicator was used for the severity of overweight assessment. RESULTS: Glycemic alterations were evidenced clinically and biochemically, although these individuals had no complaints or symptoms related to blood sugar levels. Quantitative and qualitative variables were respectively expressed measures of central tendency/dispersion and simple/relative frequency, using the SPSS, version 20.0. A p-value <0.05 was considered significant. CONCLUSION: Notably, this study found a high prevalence of glucose and insulin disorders in asymptomatic obese children and adolescents.

Auto-reporte de Periodontitis en diabéticos. Estudio transversal en Montevideo, Uruguay / Self-report of Periodontitis in Diabetes. A cross-sectional study

Objetivo: Conocer la ocurrencia de periodontitis a partir de un cuestionario de auto-reporte en una población de diabéticos en Montevideo, Uruguay. Materiales y métodos: Fueron invitados los participantes del 1er Encuentro de Diabetes en Uruguay, con diagnóstico de diabetes según auto-reporte, con al menos 18 años de edad y que firmaron el consentimiento informado. En todos los casos, fue aplicado un cuestionario con ocho preguntas previamente validadas al español de forma de estimar la ocurrencia de la Periodontits además de identificar indicadores asociados. Resultados: Un total de 37 personas respondieron el cuestionario suministrado, en su mayoría correspondientes al sexo femenino y de 45 años de edad promedio. La ocurrencia de periodontits fue del 68% de los encuestados, no existiendo diferencias significativas para el tipo de diabetes y las franjas etarias consideradas. Sin embargo las personas que presentaban periodontits tuvieron menos dientes naturales (según auto-reporte) al ser comparados con quienes no tenían periodontitis (27.5 vs. 20.4, p=0.01). Conclusiones: Los resultados del estudio permiten apreciar una condición oral deficitaria en aquellos diabéticos con periodontitis auto-reportada debido a la ocurrencia elevada de la misma así como la menor cantidad de dientes naturales.

Objective: To determine the occurrence of periodontitis from a self-report questionnaire in a population of diabetics in Montevideo, Uruguay. Materials and methods: Participants of the 1st Diabetes Meeting in Uruguay, with a diagnosis of diabetes according to self-report, with at least 18 years of age and signed the informed consent, were invited. In all cases, a questionnaire with eight questions previously validated in Spanish was applied in order to estimate the occurrence of Periodontits in addition to identifying associated indicators. Results: A total of 37 people answered the supplied questionnaire, mostly corresponding to the female sex and an average age of 45 years. The occurrence of periodontitis was 68%, with no significant differences for the type of diabetes and the age groups considered. However, people with periodontitis had fewer natural teeth (according to self-report) when compared to those who did not have periodontitis (27.5 vs. 20.4, p = 0.01). Conclusions: The results of the study allow us to appreciate a poor oral condition in those diabetics with self-reported periodontitis due to its high occurrence as well as the lower number of natural teeth.

Effects of liquid extract from Plinia cauliflora fruits residues on Chinese hamsters biochemical parameters / Efeitos do extrato líquido de resíduos de frutos de Plinia cauliflora sobre os parâmetros bioquímicos de hamsters chineses

Plinia cauliflora (Mart.) Kausel, popularly known as jabuticaba, is rich in polyphenols. Phenolic compounds exhibit several biological properties, which reflect on biomarkers such as biochemical parameters. In the present study, we evaluated the plasmatic levels of glucose, total cholesterol, HDL-cholesterol, triglycerides, and uric acid of Chinese hamsters fed for 45 days with a regular diet or cholesterol-enriched diet supplemented with a liquid extract obtained from P. cauliflora fruits residues standardized in ellagic acid and total phenolic compounds. The results showed that the concentrated extract obtained from jabuticaba residues increased the glycemia of animals fed with a regular diet and reduced the plasmatic uric acid levels of animals fed with a cholesterol-enriched diet. Since hyperuricemia is considered to be a significant risk factor of metabolic disorders and the principal pathological basis of gout, the liquid extract from P. cauliflora fruits residues would be a promising candidate as a novel hypouricaemic agent for further investigation.

Plinia cauliflora (Mart.) Kausel, popularmente conhecida como jabuticaba, é rica em polifenois. Os compostos fenólicos apresentam diversas propriedades biológicas, que refletem em biomarcadores, como os parâmetros bioquímicos. No presente estudo, avaliamos os níveis plasmáticos de glicose, colesterol total, HDL-colesterol, triglicerídeos e ácido úrico em hamsters chineses alimentados por 45 dias com dieta regular ou dieta enriquecida com colesterol suplementada com extrato líquido obtido de resíduos de frutos de P. cauliflora padronizado em ácido elágico e compostos fenólicos totais. Os resultados mostraram que o extrato concentrado obtido dos resíduos de jabuticaba aumentou a glicemia dos animais alimentados com dieta regular e reduziu os níveis plasmáticos de ácido úrico dos animais alimentados com dieta rica em colesterol. Uma vez que a hiperuricemia é considerada um fator de risco significativo de distúrbios metabólicos e a principal base patológica da gota, o extrato líquido dos resíduos de frutas de P. cauliflora seria um candidato promissor como um novo agente hipouricêmico para investigação posterior.

Effects of liquid extract from Plinia cauliflora fruits residues on Chinese hamsters biochemical parameters

Abstract Plinia cauliflora (Mart.) Kausel, popularly known as jabuticaba, is rich in polyphenols. Phenolic compounds exhibit several biological properties, which reflect on biomarkers such as biochemical parameters. In the present study, we evaluated the plasmatic levels of glucose, total cholesterol, HDL-cholesterol, triglycerides, and uric acid of Chinese hamsters fed for 45 days with a regular diet or cholesterol-enriched diet supplemented with a liquid extract obtained from P. cauliflora fruits residues standardized in ellagic acid and total phenolic compounds. The results showed that the concentrated extract obtained from jabuticaba residues increased the glycemia of animals fed with a regular diet and reduced the plasmatic uric acid levels of animals fed with a cholesterol-enriched diet. Since hyperuricemia is considered to be a significant risk factor of metabolic disorders and the principal pathological basis of gout, the liquid extract from P. cauliflora fruits residues would be a promising candidate as a novel hypouricaemic agent for further investigation.

Resumo Plinia cauliflora (Mart.) Kausel, popularmente conhecida como jabuticaba, é rica em polifenois. Os compostos fenólicos apresentam diversas propriedades biológicas, que refletem em biomarcadores, como os parâmetros bioquímicos. No presente estudo, avaliamos os níveis plasmáticos de glicose, colesterol total, HDL-colesterol, triglicerídeos e ácido úrico em hamsters chineses alimentados por 45 dias com dieta regular ou dieta enriquecida com colesterol suplementada com extrato líquido obtido de resíduos de frutos de P. cauliflora padronizado em ácido elágico e compostos fenólicos totais. Os resultados mostraram que o extrato concentrado obtido dos resíduos de jabuticaba aumentou a glicemia dos animais alimentados com dieta regular e reduziu os níveis plasmáticos de ácido úrico dos animais alimentados com dieta rica em colesterol. Uma vez que a hiperuricemia é considerada um fator de risco significativo de distúrbios metabólicos e a principal base patológica da gota, o extrato líquido dos resíduos de frutas de P. cauliflora seria um candidato promissor como um novo agente hipouricêmico para investigação posterior.

Associações entre Obesidade Eutrófica e Alterações no Perfil Lipídico de Adultos Jovens / Associations between Normal-Weight Obesity and Disturbances in the Lipid Profile of Young Adults

Resumo Fundamento A obesidade eutrófica (OE) é caracterizada por índice de massa corporal (IMC) normal, mas com alto percentual de gordura corporal (%GC), o que aumenta os riscos de comorbidades cardiometabólicas. A avaliação e interpretação precisas dos dados de composição corporal são necessárias para reduzir esses riscos. Objetivos Comparar o perfil cardiometabólico de indivíduos com OE e %GC normal e avaliar os fatores de risco associados. Métodos Foi realizado estudo transversal com 222 adultos brasileiros de uma comunidade universitária, dos quais 157 tinham OE e 65 tinham IMC e %GC normais (grupo sem OE). Todos os participantes relataram ser assintomáticos e sem problemas de saúde subjacentes. Foram avaliadas características socioeconômicas, estilo de vida, consumo alimentar, antropometria, medidas de composição corporal (por meio de absorciometria radiológica de dupla energia) e perfis lipídico e glicêmico. Valor de p < 0,05 foi estabelecido como significativo. Resultados A mediana de idade dos participantes foi de 23 anos (intervalo interquartil: 21 a 25), sendo a maioria do sexo feminino (67,1%). Não foram encontradas diferenças significativas na pressão arterial, idade ou nível de atividade física entre os grupos com e sem OE. No entanto, a frequência de distúrbios do perfil lipídico foi maior no grupo com OE (54%) em comparação com o grupo sem OE (34%) (p < 0,006). Circunferência do pescoço, %GC e distúrbios do perfil lipídico foram positivamente associados com a OE. Conclusão Indivíduos com OE apresentam pior perfil cardiometabólico do que aqueles sem OE, e essa condição está associada a importantes biomarcadores. Torna-se importante abordar esses resultados para prevenir complicações cardiometabólicas de longo prazo. A avaliação e a interpretação precisas dos dados da composição corporal, independentemente do IMC, são cruciais nesse cenário.

Abstract Background Normal-weight obesity (NWO) is characterized by normal body mass index (BMI) but high body fat percentage (%BF) that increases the risks of cardiometabolic comorbidities. Accurate assessment and interpretation of body composition data are necessary to reduce these risks. Objectives To compare the cardiometabolic profile of individuals with NWO and normal %BF and evaluate the associated risk factors. Methods A cross-sectional study was conducted with 222 Brazilian adults from a university community, of whom 157 had NWO and 65 had normal BMI and %BF (non-NWO). All participants reported being asymptomatic and without underlying health conditions. Socioeconomic, lifestyle, food intake, anthropometry, body composition measures (using dual-energy radiological absorptiometry), and lipid and glycemic profiles were evaluated. A p < 0.05 was established as significant. Results The median age of the participants was 23 years (interquartile range: 21 to 25), and most were female (67.1%). No significant differences were found in blood pressure, age, or physical activity levels between the NWO and non-NWO groups. However, the frequency of lipid profile disturbances was higher in the NWO group (54%) compared to the non-NWO group (34%) (p < 0.006). Neck circumference, %BF, and lipid profile disturbances were positively associated with NWO. Conclusion Individuals with NWO have a worse cardiometabolic profile than those without NWO, and this condition is associated with important biomarkers. Addressing these outcomes is important for preventing long-term cardiometabolic complications. Accurate assessment and interpretation of body composition data, regardless of BMI, are crucial in this scenario.

Association of altered serum glucose and lipid profiles with headaches in young women: clinical, cross-sectional study / Associação de perfis séricos glicêmicos e lipídicos alterados com cefaleias em mulheres jovens: estudo clínico transversal

Introduction: Headaches, including migraines and tension headaches, affect millions of people globally. Migraines are the most common neurological disorder, with around 14.4% of the world's population affected. It is suggested that dysregulation of biochemical markers and individual metabolic differences may contribute to headaches. Objective: We evaluated the frequency of headaches or migraines with changes in lipid, glucose and vitamin D serum levels in young women. Methods: Clinical, cross-sectional study with 139 young women, aged at least 18 years, based on the third edition of the International Classification of Headache Disorders (ICHD-3). The individuals were divided into two groups: one without headache and another with headache. Anthropometric analyzes (BMI, WC, BP and DBP) and blood samples were collected for analysis of vitamin D, glycemia and lipid profile. Results: Mean age was 22 (±4.6) years. We observed associations between headache and the following factors: high glucose levels (97 mg/dL, p=0.028), total cholesterol (180.4 mg/dL, p=0.002), HDL (44.2 mg/dL, p=0.017), and LDL (121.6 mg/dL, p=0.005). Longer duration of headache attacks was associated with increased levels of glucose (97.9 mg/dL, p=0.028), total cholesterol (186.8 mg/dL, p=0.05), diastolic blood pressure (74 mmHg, p=0.038), and BMI (24.6 kg/m2, p=0.024). High glucose levels were found to be directly related to the presence of migraine, particularly those with aura (105 mg/dL, p=0.034). However, there was no significant difference in vitamin D levels (p=0.640). Conclusion: Elevated levels of blood glucose and total plasma cholesterol and its fractions seems to be associated can increase with bouts of headache attacks, especially migraine, prolonging the duration of pain.

Introdução: Dores de cabeça, incluindo enxaquecas e dores de cabeça tensionais, afetam milhões de pessoas em todo o mundo. As enxaquecas são o distúrbio neurológico mais comum, afetando cerca de 14,4% da população mundial. Sugere-se que a desregulação dos marcadores bioquímicos e as diferenças metabólicas individuais possam contribuir para as dores de cabeça. Objetivo: Avaliamos a frequência de dores de cabeça ou enxaquecas com alterações nos níveis séricos de lipídios, glicose e vitamina D em mulheres jovens. Métodos: Estudo clínico, transversal, com 139 mulheres jovens, com idade mínima de 18 anos, baseado na terceira edição da Classificação Internacional de Cefaleias (ICHD-3). Os indivíduos foram divididos em dois grupos: um sem cefaleia e outro com cefaleia. Foram coletadas análises antropométricas (IMC, CC, PA e PAD) e amostras de sangue para análise de vitamina D, glicemia e perfil lipídico. Resultados: A média de idade foi de 22 (±4,6) anos. Observamos associações entre cefaleia e os seguintes fatores: níveis elevados de glicose (97 mg/dL, p=0,028), colesterol total (180,4 mg/dL, p=0,002), HDL (44,2 mg/dL, p=0,017) e LDL (121,6 mg/dL, p=0,005). A maior duração das crises de cefaleia foi associada ao aumento dos níveis de glicose (97,9 mg/dL, p=0,028), colesterol total (186,8 mg/dL, p=0,05), pressão arterial diastólica (74 mmHg, p=0,038) e IMC (24,6kg/m2, p=0,024). Verificou-se que níveis elevados de glicose estão diretamente relacionados à presença de enxaqueca, principalmente naqueles com aura (105 mg/dL, p=0,034). Entretanto, não houve diferença significativa nos níveis de vitamina D (p=0,640). Conclusão: Níveis elevados de glicose no sangue e colesterol plasmático total e suas frações parecem estar associados e podem aumentar com crises de dor de cabeça, especialmente enxaqueca, prolongando a duração da dor.

Variação glicêmica em idosos diabéticos com COVID-19 / Glycemic variation in elderly diabetic patients with COVID-19

Este estudo teve como objetivo identificar a variação glicêmica de idosos com diabetes mellitus e COVID-19 em instituições de longa permanência. Foram coletados e analisados prontuários e resultados de exames laboratoriais de 203 idosos residentes em 4 ILPIs no município de Maringá, pertinentes ao período entre 2017 e 2022. Destes, 10 idosos apresentavam diagnóstico de diabetes mellitus, sendo selecionados os 5 que apresentaram diagnóstico de COVID-19 e exames de glicemia detalhada durante o período estudado. Três deles apresentaram aumento na glicemia, enquanto os outros dois praticamente mantiveram os mesmos índices glicêmicos pré e pós-COVID-19. Todos os casos apresentaram manifestações leves da COVID-19 sem necessidade de internação. Os resultados indicam que idosos com índices glicêmicos elevados para a sua respectiva idade podem apresentar índices de elevação da glicêmica quando infectados pelo SARS-CoV-2.

This study aimed to identify the glycemic variation in the elderly with diabetes mellitus and COVID-19 in long stay institutions. Medical records and laboratory test results from 203 elderly residents of 4 LSIE in the municipality of Maringá, pertaining to the period between 2017 and 2022. Of these, 10 were diagnosed with diabetes mellitus, being selected the 5 who were diagnosed with Covid-19 and that had detailed glycemic lab test results from the period in question. Three of them showed glycemic increase, while the other two practically maintained the same glycemic indices before and after Covid-19. All cases had light manifestations of Covid-19, without the need for hospitalization. The results indicate that elderly people with glycemic indices above the normal established for their age may have increased blood glucose when infected with SARS-CoV-2.

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.

Caracterización clínica y sociodemográfica de Diabetes Mellitus en pacientes pediátricos del Hospital Regional de la Orinoquía, Yopal, Colombia

Introducción: La Diabetes Mellitus (DM) es una alteración metabólica crónica, creciente en la población pediátrica que conduce a múltiples complicaciones micro y macrovasculares. Es un problema de salud pública por los altos costos que conlleva el diagnóstico y tratamiento. Según la Federación Internacional de Diabetes (IFD), la incidencia anual en el mundo está aumentando, debido a que la prevalencia de edad entre 0-14 años es de 98.2% y de 0-19 años es de 128.9% entre el 2019 y 2021 con una incidencia de 108.3% y 149.5%, respectivamente, por 100.000 habitantes en 215 países. Objetivo: Describir las características clínicas de un grupo de niños y adolescentes que ingresaron al servicio de urgencias del Hospital Regional de la Orinoquía (HORO) de Yopal-Casanare, en el período 2019 -2020 con diagnóstico de novo o previo de diabetes mellitus. Metodología: Se realizó un estudio observacional, descriptivo y retrospectivo, tipo serie de casos, donde se incluyeron pacientes menores de 18 años con diagnóstico de novo o previo de diabetes mellitus en el período de 2019 -2020 en el Hospital Regional de la Orinoquía. Se analizaron un total de 15 pacientes. Resultados: Se muestra la clasificación de los pacientes según grupo de edades y sexo, se encuentra predominio del género masculino con un 53,3% de los 15 pacientes que cumplían con los criterios diagnósticos, mientras que la población femenina fue de 46,6%. La edad promedio de los pacientes pediátricos fue de 13 ± 13.2 Conclusiones: En el estudio realizado en el Hospital regional de la Orinoquía, la edad entre 11 - 13 años es la más frecuente para DM, con un predominio significativo del sexo masculino, provenientes de áreas urbanas. Se halló que el bajo peso es un dato alarmante, además de valores de glicemia alterados que se relacionan con las complicaciones presentadas al momento del ingreso del paciente, lo cual representa un problema de salud pública entre niños y adultos jóvenes debido a la heterogeneidad, del factor genético y ambiental.

Introduction: Diabetes mellitus (DM) is a chronic metabolic disorder that is increasing in the pediatric population and leads to multiple microvascular and macrovascular complications. It is a public health problem due to the high costs of diagnosis and treatment. According to the International Diabetes Federation (IFD) the annual incidence in the world is increasing, due to an age prevalence between 0-14 years of 98.2% and 0-19 years of 128.9% between 2019 and 2021 with an incidence of 108.3% and 149.5% respectively per 100,000 inhabitants in 215 countries. Objective: To describe the clinical characteristics of a group of children and adolescents admitted to the emergency department of the Hospital Regional de la Orinoquía (HORO) in Yopal-Casanare in the period 2019 to 2020 with de novo or previous diagnosis of diabetes mellitus. Methodology: An observational, descriptive, and retrospective study, case series type, where patients under 18 years of age with de novo or previous diagnosis of diabetes mellitus were included in the period from 2019 to 2020 in the Orinoquía Regional Hospital. Results: The classification of the patients according to age group and sex shows a predominance of the male gender with 53.3% of the 15 patients who met the diagnostic criteria, while the female population was 46.6%. The average age of the pediatric patients was 13 ± 13.2 Conclusions: The study carried out at the Hospital Regional de la Orinoquía showed that the most frequent age group was 11 to 13 years old, with a significant predominance of males, coming from urban areas. It was found that low weight is an alarming fact plus altered glycemia values are related to the complications presented at the time of the patient's admission, which represents a public health problem among children and young adults due to the heterogeneity of the genetic and environmental factors.

Intensive glucose control in critically ill adults: a protocol for a systematic review and individual patient data meta-analysis / Controle intensivo da glicose em adultos em estado grave: um protocolo de revisão sistemática e metanálise de dados individuais de pacientes

ABSTRACT Objective: The optimal target for blood glucose concentration in critically ill patients is unclear. We will perform a systematic review and meta-analysis with aggregated and individual patient data from randomized controlled trials, comparing intensive glucose control with liberal glucose control in critically ill adults. Data sources: MEDLINE®, Embase, the Cochrane Central Register of Clinical Trials, and clinical trials registries (World Health Organization, clinical trials.gov). The authors of eligible trials will be invited to provide individual patient data. Published trial-level data from eligible trials that are not at high risk of bias will be included in an aggregated data meta-analysis if individual patient data are not available. Methods: Inclusion criteria: randomized controlled trials that recruited adult patients, targeting a blood glucose of ≤ 120mg/dL (≤ 6.6mmol/L) compared to a higher blood glucose concentration target using intravenous insulin in both groups. Excluded studies: those with an upper limit blood glucose target in the intervention group of > 120mg/dL (> 6.6mmol/L), or where intensive glucose control was only performed in the intraoperative period, and those where loss to follow-up exceeded 10% by hospital discharge. Primary endpoint: In-hospital mortality during index hospital admission. Secondary endpoints: mortality and survival at other timepoints, duration of invasive mechanical ventilation, vasoactive agents, and renal replacement therapy. A random effect Bayesian meta-analysis and hierarchical Bayesian models for individual patient data will be used. Discussion: This systematic review with aggregate and individual patient data will address the clinical question, 'what is the best blood glucose target for critically ill patients overall?' Protocol version 0.4 - 06/26/2023 PROSPERO registration: CRD42021278869

RESUMO Objetivo: Não está claro qual é a meta ideal de concentração de glicose no sangue em pacientes em estado grave. Realizaremos uma revisão sistemática e uma metanálise com dados agregados e de pacientes individuais de estudos controlados e randomizados, comparando o controle intensivo da glicose com o controle liberal da glicose em adultos em estado grave. Fontes de dados: MEDLINE®, Embase, Cochrane Central Register of Clinical Trials e registros de ensaios clínicos (Organização Mundial da Saúde, clinical trials.gov). Os autores dos estudos qualificados serão convidados a fornecer dados individuais de pacientes. Os dados publicados em nível de ensaio qualificado que não apresentem alto risco de viés serão incluídos em uma metanálise de dados agregados se os dados individuais de pacientes não estiverem disponíveis. Métodos: Critérios de inclusão: ensaios clínicos controlados e randomizados que recrutaram pacientes adultos, com meta de glicemia ≤ 120mg/dL (≤ 6,6mmol/L) comparada a uma meta de concentração de glicemia mais alta com insulina intravenosa em ambos os grupos. Estudos excluídos: aqueles com meta de glicemia no limite superior no grupo de intervenção > 120mg/dL (> 6,6mmol/L), ou em que o controle intensivo de glicose foi realizado apenas no período intraoperatório, e aqueles em que a perda de seguimento excedeu 10% até a alta hospitalar. Desfecho primário: Mortalidade intra-hospitalar durante a admissão hospitalar. Desfechos secundários: Mortalidade e sobrevida em outros momentos, duração da ventilação mecânica invasiva, agentes vasoativos e terapia de substituição renal. Utilizaremos metanálise bayesiana de efeito randômico e modelos bayesianos hierárquicos para dados individuais de pacientes. Discussão: Essa revisão sistemática com dados agregados e de pacientes individuais abordará a questão clínica: Qual é a melhor meta de glicose no sangue de pacientes graves em geral? Protocolo versão 0.4 - 26/06/2023 Registro PROSPERO: CRD42021278869

Infodemiologia sobre protocolos de automonitoramento da glicemia capilar na internet brasileira / Infodemiology on capillary blood glucose self-monitoring protocols on the Brazilian internet

A Automonitoramento da Glicemia Capilar (AMGC) é importante ferramenta no controle da glicemia e no manejo do Diabetes mellitus (DM) e os protocolos de dispensação de insumos são orientados por diretrizes de tratamento e regulamentações específicas. O objetivo desse estudo infodemiológico foi analisar as publicações na internet brasileira sobre protocolos AMGC por Secretarias Municipais e/ou Estaduais de saúde disponíveis em websites brasileiros. Para a busca foi utilizada a ferramenta Google e identificadas 286 URL. A pesquisa identificou 23 protocolos disponíveis em sites governamentais, revelando sendo que 10 (43,47%) são da região Sudeste, todos os protocolos definiram o diagnóstico de Diabetes mellitus (DM) tipo 1, DM tipo 2 em uso de insulina e DM gestacional (DMG), em 11 protocolos (47.8%) o fornecimento mensal de tiras de glicemia capilar é realizado pela farmácia e a quantidade variou de 30 até 120 tiras conforme o tipo de diabetes e uso de insulina. Os protocolos analisados enfatizam a importância da educação em DM, com 60,8% deles incorporando programas educacionais. Apesar da dinamicidade da informação na internet ressaltase a necessidade de transparência nos critérios de inclusão e manutenção do fornecimento das TGC, qualificando o cuidado ao paciente com DM. A elaboração e divulgação de protocolos fortalecem a transparência do SUS, auxiliam na organização dos fluxos de documentos entre os profissionais envolvidos e o acesso equitativo aos insumos.

Self-Monitoring of Blood Glucose (SMBG) is an important tool in controlling blood glucose and managing Diabetes mellitus (DM) and input dispensing protocols are guided by treatment guidelines and specific regulations. The objective of this infodemiological study was to analyze publications on the Brazilian internet about SMBG protocols by Municipal and/or State Health Departments available on Brazilian websites. For the search, the Google tool was used and 286 URLs were identified. The research identified 23 protocols available on government websites, revealing that 10 (43.47%) are from the Southeast region, all protocols defined the diagnosis of Diabetes mellitus (DM) type 1, type 2 DM using insulin and gestational DM (GDM), in 11 protocols (47.8%) the monthly supply of capillary blood glucose test strips is provided by the pharmacy and the quantity varies from 30 to 120 strips depending on the type of diabetes and insulin use. The protocols analyzed emphasize the importance of DM education, with 60.8% of them incorporating educational programs. Despite the dynamics of information on the internet, the need for transparency in the inclusion criteria and maintenance of the supply of BGTS is highlighted, qualifying care for patients with DM. The development and dissemination of protocols strengthens the transparency of the SUS, assists in the organization of document flows between the professionals involved and equitable access to inputs.

Glycemic variability and mortality in oncologic intensive care units / Variabilidade glicêmica e mortalidade em unidades de terapia intensiva oncológicas / Variabilidad glucémica y mortalidad en unidades de cuidados intensivos oncológicos

ABSTRACT Objective: This study aimed to investigate the association between glycemic variability and mortality in patients admitted to oncologic intensive care units. Methods: A retrospective cohort study was conducted using a convenience sample of 30 medical records of patients over 18 years of age of both sexes. Glycemic variability was measured using the standard deviation and general amplitude. Statistical analysis was performed using the receiver operating characteristic (ROC) curve and the area under the curve (AUC). The significance level (α) was set at 5% with a confidence interval (CI) of 95%. Results: The study included 14 male patients (46.67%) with a mean age of 60±15 years. A total of 1503 blood glucose samples were collected. The AUC analysis for the standard deviation did not show a statistically significant result (p=.966; 95% CI=[0.283, 0.726]). In contrast, the general amplitude had a statistically significant association with mortality (p=.049; 95% CI=[0.514, 0.916]). Conclusions: This study found that glycemic variability measured by the general amplitude was significantly associated with patient mortality in oncologic intensive care units. These findings suggest that monitoring glycemic variability may be an important factor in the management of critically ill patients in oncologic intensive care units.

RESUMO Objetivo: investigar a associação entre a variabilidade glicêmica e a mortalidade em pacientes internados em unidades de terapia intensiva oncológicas. Métodos: estudo de coorte retrospectivo foi conduzido utilizando uma amostra de conveniência de 30 prontuários médicos de pacientes com mais de 18 anos de ambos os sexos. A variabilidade glicêmica foi medida utilizando o desvio padrão e a amplitude geral. A análise estatística foi realizada utilizando a curva ROC (receiver operating characteristic) e a área sob a curva (AUC). O nível de significância (α) foi estabelecido em 5% com um intervalo de confiança (IC) de 95%. Resultados: o estudo incluiu 14 pacientes do sexo masculino (46,67%) com idade média de 60±15 anos. Um total de 1503 amostras de glicemia foram coletadas. A análise AUC para o desvio padrão não mostrou resultado estatisticamente significativo (p = 0,966; IC 95% = [0,283, 0,726]). Em contraste, a amplitude geral teve uma associação estatisticamente significativa com a mortalidade (p = 0,049; IC 95% = [0,514, 0,916]). Conclusões: Este estudo encontrou que a variabilidade glicêmica medida pela amplitude geral está significativamente associada à mortalidade do paciente em unidades de terapia intensiva oncológicas. Esses achados sugerem que o monitoramento da variabilidade glicêmica pode ser um fator importante no manejo de pacientes criticamente doentes em unidades de terapia intensiva oncológicas.

RESUMEN Objetivo: investigar la asociación entre la variabilidad glucémica y la mortalidad en pacientes ingresados en unidades de cuidados intensivos oncológicos. Métodos: Se llevó a cabo un estudio de cohorte retrospectivo utilizando una muestra de conveniencia de 30 historias clínicas de pacientes de ambos sexos mayores de 18 años. La variabilidad glucémica se midió utilizando la desviación estándar y la amplitud general. El análisis estadístico se realizó utilizando la curva ROC (receiver operating characteristic) y el área bajo la curva (AUC). El nivel de significancia (α) se estableció en un 5% con un intervalo de confianza (IC) del 95%. Resultados: El estudio incluyó a 14 pacientes masculinos (46,67%) con una edad media de 60±15 años. Se recopilaron un total de 1503 muestras de glucemia. El análisis AUC para la desviación estándar no mostró ningún resultado estadísticamente significativo (p = 0,966; IC del 95% = [0,283, 0,726]). Por el contrario, la amplitud general tuvo una asociación estadísticamente significativa con la mortalidad (p = 0,049; IC del 95% = [0,514, 0,916]). Conclusiones: Este estudio encontró que la variabilidad glucémica medida por la amplitud general está significativamente asociada con la mortalidad del paciente en unidades de cuidados intensivos oncológicos. Estos hallazgos sugieren que el monitoreo de la variabilidad glucémica puede ser un factor importante en el manejo de pacientes críticamente enfermos en unidades de cuidados intensivos oncológicos.

Observaciones en el mundo real sobre la efectividad del sistema flash de monitorización de glucosa en la práctica clínica en Chile / Real-world observations of the effectiveness of the flash glucose monitoring in clinical practice in Chile

OBJETIVO: Evaluar el tiempo en rango de glucosa y su asociación con otras medidas del control glicémico establecidas por el consenso internacional del tiempo en rango en usuarios de vida real del sistema flash de monitorización de glucosa FreeStyle LibreTM en Chile. MÉTODOS: Se analizaron los datos provenientes de la base de datos Freestyle Libre™ entre diciembre de 2014 y enero de 2022. Las lecturas se dividieron en 10 grupos (deciles) del mismo tamaño (cada decil contenía aproximadamente 498 usuarios) en función del tiempo en rango. Para cada decil se calculó la media de determinaciones diarias, el promedio de glucosa, la HbA1c, la desviación estándar de glucosa, el coeficiente de variación de la glucosa, el tiempo en rango, el tiempo de glucosa (porcentaje) por encima de 250 mg/dL (TA250), el tiempo de glucosa (porcentaje) por encima de 180 mg/dL (TA180), el tiempo por debajo (porcentaje) de 70 mg/dL (TB70) y el tiempo por debajo (porcentaje) de 54 mg/dL (TB54). RESULTADOS: Desde diciembre de 2014 hasta enero de 2022 hubo 4984 lectores. El grupo con el mayor tiempo en rango mostró significativamente una menor glucosa promedio que el grupo con el tiempo en rango más bajo (decil 1: media 248,3 mg/dL, decil 10: media 113,2 mg/L, diferencia ­135,1 mg/dL, p<0.05). Asimismo, el mayor tiempo en rango se asoció con una menor desviación estándar (decil 1: media 93,7mg/dL, decil 10: media 26,7mg/L, diferencia: -67,0 mg/ dL, p<0,05), menor coeficiente de variación (decil 1: media 37,8%, decil 10: media 23,3%, diferencia: -14,5%, p<0,05), menor TA250 (decil 1: media 46,5%, decil 10: media 0,2%, diferencia: -46,3%, p<0.05), menor TA180 (decil 1: media 73,9%, decil 10: media 3,8%, diferencia: -70,1%, p<0.05), menor TB70 (decil 5: mediana 6,13%, decil 10: mediana 1,70%, diferencia: -4,43%, p<0.05) y menor TB54 (decil 5: mediana 1,79%, decil 10: mediana 0,12%, diferencia: -1,67%, p<0.05). El mayor tiempo en rango se asoció también significativamente con más determinaciones diarias (decil 1: media 11,4, decil 10: media 16,6, diferencia: 5,2, p<0,05). La frecuencia media de las determinaciones entre todos los lectores fue de 14,7 determinaciones diarias. CONCLUSIONES: En los pacientes con diabetes en Chile, el empleo del sistema flash de monitorización demuestra la asociación entre el mayor tiempo en rango, la reducción de la variabilidad de la glucosa y un menor riesgo de hiperglucemias e hipoglicemias y también con un mayor compromiso.

OBJECTIVE: To evaluate glucose time in range and its association with other metrics of glucose control established by the International Consensus on TIR amongst real-life patients using the Flash Glucose Monitoring system FreeStyle LibreTM in Chile. METHODS: Data from the Freestyle Libre™ database between December 2014 and January 2022 were analyzed. Readers were divided into 10 groups (deciles) of the same size (each decile had approximately 498 users) according to time in range. For each decile of time in range, the mean of daily scans, average glucose, estimated HbA1c, glucose standard deviation, glucose coefficient of variation, time in range, glucose time (percentage) above 250 mg/dL (TA250), and glucose time (percentage) above 180 mg/dL (TA180), and the median of glucose time (percentage) below 70 mg/dL (TB70) and glucose time (percentage) below 54 mg/dL (TB54), were calculated. RESULTS: From December 2014 to January 2022, there were 4984 readers. The group with the highest TIR showed significantly lower average glucose than the group with the lowest TIR (decile 1: mean 248.3 mg/dL, decile 10: mean 113.2 mg/L, difference: ­135.1 mg/dL, p<0.05). In addition, more time in range was associated with a lower glucose standard deviation (decile 1: mean 93.7 mg/dL, decile 10: mean 26.7 mg/L, difference: -67.0 mg/dL, p<0.05), lower glucose coefficient of variation (decile 1: mean 37.8%, decile 10: mean 23.3%, difference: -14.5%, p<0.05), lower TA250 (decile 1: mean 46.5%, decile 10: mean 0.2%, difference: -46.3%, p<0.05),lower TA180 (decile 1: mean 73.9%, decile 10: mean 3.8%, difference: -70.1%, p<0.05), lower TB70 (decile 5: median 6.13%, decile 10: median 1.70%, difference: -4.43%, p<0.05) and lower TB54 (decile 5: median 1.79%, decile 10: median 0.12%, difference: -1.67%, p<0.05). Greater TIR was also associated with significantly more daily scans (decile 1: mean 11.4, decile 10: mean 16.6, difference: 5.2, p<0.05). Mean scan frequency amongst all readers was 14.7 daily scans. CONCLUSIONS: In patients with diabetes from Chile, the use of the flash glucose monitoring system demonstrates the association between greater TIR, reduced glucose variability, and reduced risk of hyperglycemia and hypoglycemia, and also its association with greater engagement.

Relación entre los niveles basales de fructosamina y glucosa en adultos mayores / Relationship between basal levels of fructosamine and glucose in older adults

INTRODUCCIÓN: los cambios fisiológicos a los que están expuestos los adultos mayores, son muchas veces factores negativos en su calidad de vida, sobre todo en aquellos que se encuentran en residencias geriátricas, existen parámetros como la glicemia y hemoglobina glucosilada que podrían ser útiles en el control metabólico. OBJETIVO: relacionar los niveles basales de Fructosamina y Glucosa en adultos mayores institucionalizados en residencias geriátricas del municipio de Tiquipaya, septiembre 2019. METODOLOGÍA: estudio no experimental, observacional, prospectivo, transversal, con enfoque de análisis positivista cuantitativo, con un universo de 97 adultos mayores de 65 años, con una muestra de 79 que cumplen con los criterios de inclusión y exclusión, con un 4,77% de error máximo aceptable. RESULTADOS: el 71% (n=56) de los pacientes fueron mujeres. Los ancianos predominaron como grupo etario. Se evidenció que no hay una buena concordancia entre los niveles basales de Glicemia y Fructosamina, mediante el cálculo estadístico del índice de Kappa que fue de 0,023; Test de Wilcoxon 0.081; Test correlación Pearson r=0.281. Los niveles basales de Fructosamina tienen una sensibilidad y especificidad altas del 82,14% (L.I. 62,42% -L.S. 93,23%) y 56.92% (L.I. 47,95% - L.S. 65,48%), respectivamente. CONCLUSIONES: no existe relación entre los niveles basales de Glucosa y la Fructosamina puesto que son parámetros de evaluación metabólica en diferente tiempo y una no remplaza la otra, por lo tanto, se debería implementar adicionalmente a la Glucosa la determinación de la Fructosamina para monitorizar a los pacientes adultos a mediano plazo.

INTRODUCTION: the physiological changes to which older adults are exposed; are many times negative factors in their quality of life, especially in those who are in geriatric residences. Glycemia and glycosylated hemoglobin are useful as metabolic control parameters. OBJECTIVE: to relate the basal levels of Fructosamine and Glucose in institutionalized older adults in geriatric residences in the municipality of Tiquipaya, September 2019. METHODOLOGY: non-experimental, observational, prospective, cross-sectional study, with a quantitative positivist analysis approach, with a universe of 97 adults over 65 years of age, with a sample of 79 that met the inclusion and exclusion criteria, with a maximum acceptable error of 4.77%. RESULTS: 71% (n=56) of the patients were female. The elderly dominated as an age group. It was evidenced that there is not a good agreement between basal levels of Glycemia and Fructosamine, through the statistical calculation of the Kappa index which was 0.023; Wilcoxon test 0.081; Pearson correlation test r= 0.281. The basal levels of Fructosamine have a high sensitivity and specificity of 82.14% (L.I. 62.42% - L.S. 93.23%) and 56.92% (L.I.47.95% - L.S. 65.48%), respectively. CONCLUSIONS: there is no relationship between basal levels of Glucose and Fructosamine since they are parameters of metabolic evaluation in different time and one does not replace the other, therefore, the determination of Fructosamine should be implemented in addition to Glucose to monitor adult patients in the medium term.