RESUMO
OBJECTIVE: To assess the presence of insulin resistance (IR) in patients with type 1 diabetes (T1DM) according to the estimated glucose disposal rate formula (eGDR) and the insulin sensitivity score (ISS) and to estimate the correlation between these two measures and identify the clinical and laboratory markers related to IR. RESEARCH DESIGN AND METHODS: Cross-sectional study of adults with T1DM (n = 135). The results of the formulas that estimate IR were separated into quartiles and correlated with demographic data, clinical characteristics and laboratory parameters. We analyzed the total and regional adiposity by dual-energy X-ray absorptiometry and skin fold thickness measurements. RESULTS: Two thirds of the patients were overweight or obese. A moderate correlation was found between eGDR and ISS (r = 0.612). The results of both formulas were positively correlated with BMI (r = -0.373 eGDR and r = -0.721 ISS), thoracic-abdominal fat (r = -0.484 eGDR and r = -0.758 ISS), waist/height ratio (r = -0.537 eGDR and r = -0.779 ISS), subscapular skinfold (mm) (r = -0.356 eGDR and r = -0.569 ISS), total dose insulin IU/lean mass (kg) (r = -0.279 eGDR and r = -0.398 ISS), age (years) (r = -0.495 eGDR and r = -0.190 ISS) and diabetes duration (years) (r = -0.428 eGDR and r = -0.187 ISS). A moderate agreement (Kappa 0.226) was observed between the 1st quartile of results determined by the formulas in 10.4% of the patients, but the 4th quartile presented a strong correlation (Kappa 0.679). The individuals with IR that were classified in the 1st quartile by the ISS formula had a higher chance of presenting with acanthosis nigricans (OR = 5.58, 95% CI =1.46-21.3). CONCLUSIONS: The correlations found in this study indicate the possibility of using clinical and laboratory data to estimate IR in patients with TDM1. The detection of IR in T1DM patients may allow early intervention and possibly impact on future diabetes complications.
RESUMO
Na década de 1990, foi demonstrada alta prevalência no uso abusivo de opioides pelos anestesiologistas. Desde então, houve aumento nas pesquisas desse tipo de comportamento entre os profissionais da área de saúde. No entanto, observa-se aumento da prevalência da dependência de drogas entre esses profissionais, devido a várias situações como: estresse, extensas jornadas de trabalho e o fácil acesso aos medicamentos. Outros fatores envolvidos estão relacionados a aspectos bioquímicos, genéticos e psiquiátricos. Objetivo: discutir a real prevalência, a etiologia e as estratégias de controle no abuso de propofol, opioides e cetamina entre os profissionais da saúde, especialmente entre as especialidades médicas. Métodos: revisão de artigos científicos disponíveis nos bancos de dados do Pubmed e Scielo. Resultados: entre os profissionais de saúde, a prevalência da dependência química de propofol, opioides (principalmente fentanil e sufentanil) e cetamina é mais alta entre os anestesiologistas, médicos socorristas e psiquiatras. Foi encontrada considerável associação entre a dependência química desses profissionais e outras psicopatogenias, como transtornos de personalidade e depressão. Esses transtornos podem até mesmo influenciar a escolha da droga utilizada. Conclusão: apesar do aumento do número de dependentes químicos em propofol, opioides e cetamina entre os profissionais da saúde, existem poucas estratégias de controle para impedir o acesso a esses medicamentos para uso próprio. Além disso, há poucas informações sobre a segurança do profissional em relação ao retorno ao ambiente de trabalho após o período de reabilitação.
A high prevalence of opioid abuse was found among anesthesiologists in the 1990s. Ever since, an increased number of studies have focused on health professionals? behaviors. However, the prevalence of drug abuse has increased among these professionals as a result of: stress, long work hours, and easy access to the drugs. Other factors involved are of biochemical, genetic and psychiatric nature. Objective: To discuss the actual prevalence, etiology and control strategies related to propofol, opioid and ketamine abuse among health professionals, particularly specialist physicians. Methods: Review of academic articles available on Pubmed and Scielo databases. Results: The prevalence of chemical dependence on propofol, opioids (specially fentanyl and sufentanil) and ketamine is higher among the anesthesiologists, paramedics, and psychiatrists. A meaningful correlation was found between these professionals? chemical dependence and other psychopathologies, including personality disorder, and depression. Such disorders may.