RESUMO
AIMS: To assess the prevalence of elevated liver enzymes in adults with type 1 diabetes mellitus (T1DM) in routine clinical care and the association with cardiovascular risk profile in the Diabetes-Prospective-Documentation (DPV) network in Germany and Austria. SUBJECTS AND METHODS: This cross sectional observational study from the DPV registry includes data from 45 519 adults with T1DM at 478 centres up to September 2016. Liver enzyme measurements were available in 9226 (29%) patients at 270 centres and were analysed for increased alanine aminotransferase (ALT; men >50 U/L, women >35U/L) and/or aspartate aminotransferase (AST; men >50 U/L, women >35U/L) and/or gamma-glutamyltransferase (GGT; men >60U/L, women >40 U/L). A subgroup analysis in patients for whom 2 or more ALT measurements were available (n = 2335, 25%) and whose ALT was increased at least twice (men >30 U/L, women >19U/L) was performed. Associations with glycaemic control, cardiovascular risk factors and late complications were investigated with multiple regression analyses. RESULTS: Twenty percent (19.8%, n = 1824) had increased liver enzyme(s) on one or more occasions. Increased liver enzymes were associated with worse glycaemic control and higher BMI (both P < .0001), dyslipidemia (OR, 1.75; 95% CI, 1.54-2.0), hypertension (OR, 1.48; 95% CI: 1.31-1.68), myocardial infarction (OR, 1.49; 95% CI, 1.17-1.91) and end stage renal disease (OR, 1.59; 95% CI, 1.17-2.17). ALT was increased twice in 29% and was associated with worse glycaemic control (P < .0001), higher BMI (P < .0001), hypertension (OR, 1.58; 95% CI, 1.26-1.97) and dyslipidemia (OR, 1.89; 95% CI, 1.51-2.37). CONCLUSIONS: In this clinical audit in adults with T1DM, elevated liver enzymes on routine assessment were associated with a less favourable cardiovascular risk profile and with poorer glycaemic control.
Assuntos
Diabetes Mellitus Tipo 1/complicações , Insuficiência Hepática/complicações , Hiperglicemia/prevenção & controle , Hipoglicemia/prevenção & controle , Fígado/fisiopatologia , Adulto , Áustria/epidemiologia , Biomarcadores/sangue , Estudos de Coortes , Comorbidade , Estudos Transversais , Diabetes Mellitus Tipo 1/sangue , Diabetes Mellitus Tipo 1/epidemiologia , Diabetes Mellitus Tipo 1/terapia , Feminino , Seguimentos , Alemanha/epidemiologia , Insuficiência Hepática/sangue , Insuficiência Hepática/epidemiologia , Insuficiência Hepática/fisiopatologia , Humanos , Masculino , Hepatopatia Gordurosa não Alcoólica/sangue , Hepatopatia Gordurosa não Alcoólica/complicações , Hepatopatia Gordurosa não Alcoólica/epidemiologia , Hepatopatia Gordurosa não Alcoólica/fisiopatologia , Prevalência , Estudos Prospectivos , Sistema de Registros , Fatores de RiscoRESUMO
BACKGROUND: To analyze whether medical care is in accordance with guidelines for secondary prevention of myocardial infarction (MI), or stroke in patients with type 2 diabetes from Germany and Austria. METHODS: 29,325 patients (≥ 20 years of age) with type 2 diabetes and MI, or stroke, documented between 2006 and 2015 were selected from the Diabetes-Patienten-Verlaufsdokumentation database. We analyzed medication, clinical characteristics, and lifestyle factors according to national secondary prevention guidelines in patients with MI, or stroke, separately. RESULTS: HbA1C <7.5 % was achieved in 64.9 % (MI), and in 61.1 % (stroke) of patients. LDL <100 mg/dl was documented in 56.2 % (MI), and in 42.2 % (stroke). Non-smoking was reported in 92.0 % (MI), and in 93.1 % (stroke), physical activity in 9.6 % (MI), and 5.5 % (stroke). Target values of blood pressure (<130/80 mmHg in MI, 120/70-140/90 in stroke) were reached in 67.0 % (MI), and in 89.9 % (stroke). Prescription prevalence of inhibitors of platelet aggregation (IPA) was 50.7 % (MI), and 31.7 % (stroke). 57.0 % (MI), and 40.1 % (stroke) used statins, 65.1 % (MI), and 65.8 % (stroke) used any type of antihypertensives, and ACE inhibitors were prescribed in 49.7 % (MI), and 41.3 % (stroke). A body mass index (BMI) <27 kg/m(2) and the use of beta blockers were only recommended in subjects with MI. Of the patients with MI, 32.0 % had a BMI <27 kg/m(2), and 59.5 % used beta blockers. CONCLUSIONS: Achievement of treatment goals in secondary prevention of MI, or stroke in subjects with type 2 diabetes needs improvement. Target goals were met more frequently in patients with MI compared to subjects with stroke. Especially the use of IPA was very low in patients with stroke. There remains great potential to reduce the risk of repeated macrovascular events and premature death, as well as to increase patients' quality of life.
Assuntos
Antagonistas Adrenérgicos beta/uso terapêutico , Diabetes Mellitus Tipo 2/tratamento farmacológico , Infarto do Miocárdio/prevenção & controle , Inibidores da Agregação Plaquetária/uso terapêutico , Prevenção Secundária/estatística & dados numéricos , Acidente Vascular Cerebral/prevenção & controle , Adulto , Idoso , Idoso de 80 Anos ou mais , Áustria , Diabetes Mellitus Tipo 2/complicações , Feminino , Alemanha , Humanos , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio/epidemiologia , Infarto do Miocárdio/etiologia , Qualidade de Vida , Fatores de Risco , Acidente Vascular Cerebral/epidemiologia , Acidente Vascular Cerebral/etiologia , Adulto JovemRESUMO
OBJECTIVE: Craniopharyngiomas (CPs) are benign brain tumors presenting frequently in childhood and are treated by surgery with or without radiotherapy. About 50% of cured patients suffer from eating disorders and obesity due to hypothalamic damage, as well as hypopituitarism, necessitating subsequent hormone substitution therapy. Gastric bypass surgery has been reported to be an efficient treatment strategy for morbid hypothalamic obesity. However, so far it is unknown whether oral hormone substitution is affected by impaired intestinal drug absorption, potentially leading to severe hypopituitarism or pituitary crisis. METHODS: Four morbidly obese CP patients with panhypopituitarism treated by gastric bypass surgery were included in this retrospective analysis. Dosages of hormone substitution therapy, blood concentrations of hormones, potential complications of impaired drug absorption, and anthropometric characteristics were investigated pre- and postoperatively after 6 to 14 months and 13 to 65 months. RESULTS: In all CP patients (3 female/1 male; baseline body mass index, 49 ± 7 kg/m(2)), gastric bypass resulted in distinct weight loss (-35 ± 27 kg). In follow-up examinations, mean daily dosage of thyroid hormone (levothyroxinebaseline 156 ± 44 µg/day versus levothyroxinefollow-up 150 ± 30 µg/day), hydrocortisone (hydrocortisonebaseline 29 ± 12 mg/day versus hydrocortisonefollow-up 26 ± 2 mg/day), growth-hormone (somatotropinbaseline 0.9 ± 0.5 mg/day versus somatotropinfollow-up 1.0 ± 0.4 mg/day), and desmopressin (desmopressinbaseline 222 ± 96 µg/day versus desmopressinfollow-up 222 ± 96 µg/day) substitution was unchanged. No patient developed adrenal insufficiency. Oral thyroid/hydrocortisone absorption testing performed in 1 patient indicated sufficient gastrointestinal drug absorption after bariatric surgery. CONCLUSION: Our preliminary results suggest that oral hormone substitution therapy is not impaired following gastric bypass operation in CP patients with morbid obesity, indicating that it might be a safe and effective treatment strategy.
Assuntos
Craniofaringioma/complicações , Terapia de Reposição Hormonal , Hipopituitarismo/tratamento farmacológico , Hipopituitarismo/etiologia , Obesidade Mórbida/etiologia , Obesidade Mórbida/cirurgia , Neoplasias Hipofisárias/complicações , Adolescente , Adulto , Craniofaringioma/tratamento farmacológico , Craniofaringioma/cirurgia , Feminino , Derivação Gástrica/reabilitação , Humanos , Hipopituitarismo/cirurgia , Masculino , Procedimentos Neurocirúrgicos/efeitos adversos , Obesidade Mórbida/tratamento farmacológico , Hormônios Hipofisários/uso terapêutico , Neoplasias Hipofisárias/tratamento farmacológico , Neoplasias Hipofisárias/cirurgia , Estudos Retrospectivos , Adulto JovemRESUMO
OBJECTIVES: Ertapenem pharmacokinetics were determined in the interstitium of healthy tissue and of infected tissue of patients suffering from diabetic foot infections, to evaluate if antibiotic concentrations at the target site are sufficient to achieve bacterial killing. PATIENTS AND METHODS: Nine patients with diabetic foot infections received 1 g of ertapenem per day intravenously. At steady-state, ertapenem concentrations were measured over 8 h in plasma and in the interstitium of healthy subcutaneous adipose tissue and of soft tissue adjacent to the foot infection using microdialysis. RESULTS: The maximum total concentration (Cmax) of ertapenem in plasma was 59.4 ± 12.9 mg/L. Free interstitial Cmax in the infected leg (4.5 ± 2.7 mg/L) was significantly higher (P=0.01) than in healthy subcutaneous tissue (2.4 ± 1.6 mg/L). For bacterial pathogens with an MIC of 1 mg/L, the free mean 'time above MIC' (T>MIC) in the interstitium of infected tissue was calculated to be 38%± 25% of the 24 h dosing interval. Accordingly, bacteriostatic (T>MIC >20%) and maximal bactericidal (T>MIC >40%) effects would be reached in 8/9 and 4/9 diabetic feet, respectively. CONCLUSIONS: Although total plasma concentrations of ertapenem were lower in diabetics than reported for healthy subjects, free interstitial tissue concentrations in diabetics were similar to those known from healthy volunteers. Penetration of ertapenem into the interstitium of inflamed tissue of diabetic feet was not impaired in spite of angiopathy. Daily doses of >1 g of ertapenem might be considered to optimize bactericidal effects in diabetic foot infections caused by moderately susceptible strains.
Assuntos
Antibacterianos/administração & dosagem , Antibacterianos/farmacocinética , Infecções Bacterianas/tratamento farmacológico , Pé Diabético/complicações , Pele/química , beta-Lactamas/administração & dosagem , beta-Lactamas/farmacocinética , Administração Intravenosa , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Ertapenem , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Plasma/química , Pele/patologia , Adulto JovemRESUMO
Diabetes education and self-management play a critical role in diabetes care. Patient empowerment aims to actively influence the course of the disease by self-monitoring and subsequent treatment modification as well as the ability of patients to integrate diabetes into their daily life and to appropriately adapt diabetes to their life style situation. Diabetes education has to be made accessible for all persons with the disease. In order to be able to provide a structured and validated education program, adequate personnel as well as space, organizational and financial prerequisites are required. Besides an increase in knowledge about the disease it has been shown that a structured diabetes education is able to improve diabetes outcome as measured by parameters, such as blood glucose, HbA1c, lipids, blood pressure and body weight in follow-up evaluations. Modern education programs emphasize the ability of patients to integrate diabetes into everyday life, stress physical activity besides healthy eating as important components of life style therapy and use interactive methods in order to increase the acceptance of personal responsibility. Specific situations (e.g. impaired hypoglycemia awareness, illness, travel), the occurrence of diabetic complications and the use of technical devices such as glucose sensor systems and insulin pumps require additional educational measures supported by adequate electronic tools (diabetes apps and diabetes web portals). New data demonstrate the effect of telemedicine and internet-based services for diabetes prevention and management.
Assuntos
Diabetes Mellitus Tipo 2 , Diabetes Mellitus , Hipoglicemia , Humanos , Adulto , Diabetes Mellitus/epidemiologia , Diabetes Mellitus/terapia , Hipoglicemia/prevenção & controle , Aconselhamento , Estilo de Vida , Glicemia , Autocuidado , Diabetes Mellitus Tipo 2/prevenção & controleRESUMO
The heterogenous category "specific types of diabetes due to other causes" encompasses disturbances in glucose metabolism due to other endocrine disorders such as acromegaly or hypercortisolism, drug-induced diabetes (e.g. antipsychotic medications, glucocorticoids, immunosuppressive agents, highly active antiretroviral therapy (HAART), checkpoint inhibitors), genetic forms of diabetes (e.g. Maturity Onset Diabetes of the Young (MODY), neonatal diabetes, Down, Klinefelter- and Turner Syndrome), pancreatogenic diabetes (e.g. postoperatively, pancreatitis, pancreatic cancer, haemochromatosis, cystic fibrosis), and some rare autoimmune or infectious forms of diabetes. Diagnosis of specific diabetes types might influence therapeutic considerations. Exocrine pancreatic insufficiency is not only found in patients with pancreatogenic diabetes but is also frequently seen in type 1 and long-standing type 2 diabetes.
Assuntos
Diabetes Mellitus Tipo 2 , Diabetes Mellitus , Doenças do Sistema Endócrino , Insuficiência Pancreática Exócrina , Neoplasias Pancreáticas , Recém-Nascido , Humanos , Diabetes Mellitus Tipo 2/diagnóstico , Diabetes Mellitus/diagnóstico , Diabetes Mellitus/terapia , Insuficiência Pancreática Exócrina/diagnóstico , Insuficiência Pancreática Exócrina/terapiaRESUMO
Hyperglycemia significantly contributes to complications in patients with diabetes mellitus. While lifestyle interventions remain cornerstones of disease prevention and treatment, most patients with type 2 diabetes will eventually require pharmacotherapy for glycemic control. The definition of individual targets regarding optimal therapeutic efficacy and safety as well as cardiovascular effects is of great importance. In this guideline we present the most current evidence-based best clinical practice data for healthcare professionals.
Assuntos
Diabetes Mellitus Tipo 2 , Hiperglicemia , Humanos , Hipoglicemiantes/uso terapêutico , Diabetes Mellitus Tipo 2/diagnóstico , Diabetes Mellitus Tipo 2/tratamento farmacológico , Diabetes Mellitus Tipo 2/complicações , Hiperglicemia/tratamento farmacológico , GlicemiaRESUMO
Insulin replacement in type 1 diabetes mellitus (T1DM) needs intensified treatment, which can either be performed by multiple daily injections (MDI) or continuous subcutaneous insulin infusion (CSII). This retrospective analysis of a real-world scenario aimed to evaluate whether glycaemic and cardiovascular risk factors could be controlled with CSII outclass MDI as suggested by recent evidence. Data from patients with either insulin pump (n=68) or injection (n=224) therapy at an Austrian tertiary care centre were analysed between January 2016 and December 2017. There were no significant differences with regard to the latest glycosylated hemoglobin, cardiovascular risk factor control or diabetes-associated late complications. Hypoglycaemia was less frequent (P<0.001), sensor-augmented therapy was more common (P=0.003) and mean body mass index (BMI) was higher (P=0.002) with CSII treatment. This retrospective analysis of real-world data in T1DM did not demonstrate the superiority of insulin pump treatment with regard to glycaemic control or cardiovascular risk factor control.
Assuntos
Diabetes Mellitus Tipo 1 , Diabetes Mellitus Tipo 1/tratamento farmacológico , Humanos , Hipoglicemiantes/efeitos adversos , Estudos Retrospectivos , Centros de Atenção Terciária , Resultado do TratamentoRESUMO
BACKGROUND: Growth differentiation factor-15 (GDF-15) is a stress-responsive cytokine linked to obesity comorbidities such as cardiovascular disease, inflammation, and cancer. GDF-15 also has adipokine properties and recently emerged as a prognostic biomarker for cardiovascular events. METHODS: We evaluated the relationship of plasma GDF-15 concentrations with parameters of obesity, inflammation, and glucose and lipid metabolism in a cohort of 118 morbidly obese patients [mean (SD) age 37.2 (12) years, 89 females, 29 males] and 30 age- and sex-matched healthy lean individuals. All study participants underwent a 75-g oral glucose tolerance test; 28 patients were studied before and 1 year after Roux-en-Y gastric bypass surgery. RESULTS: Obese individuals displayed increased plasma GDF-15 concentrations (P < 0.001), with highest concentrations observed in patients with type 2 diabetes. GDF-15 was positively correlated with age, waist-to-height ratio, mean arterial blood pressure, triglycerides, creatinine, glucose, insulin, C-peptide, hemoglobin A(1c), and homeostatic model assessment insulin resistance index and negatively correlated with oral glucose insulin sensitivity. Age, homeostatic model assessment index, oral glucose insulin sensitivity, and creatinine were independent predictors of GDF-15 concentrations. Roux-en-Y gastric bypass led to a significant reduction in weight, leptin, insulin, and insulin resistance, but further increased GDF-15 concentrations (P < 0.001). CONCLUSIONS: The associations between circulating GDF-15 concentrations and age, insulin resistance, and creatinine might account for the additional cardiovascular predictive information of GDF-15 compared to traditional risk factors. Nevertheless, GDF-15 changes following bariatric surgery suggest an indirect relationship between GDF-15 and insulin resistance. The clinical utility of GDF-15 as a biomarker might be limited until the pathways directly controlling GDF-15 concentrations are better understood.
Assuntos
Sistema Cardiovascular/metabolismo , Fator 15 de Diferenciação de Crescimento/sangue , Resistência à Insulina , Obesidade Mórbida/sangue , Adulto , Biomarcadores/sangue , Pressão Sanguínea , Pesos e Medidas Corporais , Creatinina/sangue , Diabetes Mellitus Tipo 2/sangue , Diabetes Mellitus Tipo 2/complicações , Feminino , Derivação Gástrica , Glucose/metabolismo , Humanos , Inflamação/sangue , Testes de Função Renal , Metabolismo dos Lipídeos , Masculino , Obesidade Mórbida/complicações , Obesidade Mórbida/cirurgiaRESUMO
NT-proBNP is an excellent predictor of adverse events in patients with diabetes mellitus. Due to an aging population it is of interest to determine whether NT-proBNP can predict cardiac events with equal precision in subgroups with different ages. 1395 outpatients with diabetes mellitus were recruited for this prospective observational study. NT-proBNP, renal function, lipid status and other demographic variables were measured at baseline. The cohort was divided into three groups: Group I (609 patients under 60 years of age), group II (634 patients ranging from 60-75) and group III (152 patients older than 75). Patients were followed during a mean observation period of 11 months, 75 patients reached the defined endpoint, which was unplanned hospitalization due to a cardiac event. Mean age was 60 ± 30 years, mean HbA(1c) was 7.6% and mean NT-proBNP was 242 ± 437 pg/ml. In a multiple Cox regression model, age (hazard ratio (HR) 11.18, p < 0.01) and the absence of a cardiac disease (HR 0.49, p < 0.01) were important variables for short-term prognosis. The addition of the logarithm of NT-proBNP provided independent prognostic information (HR 1.81 p < 0.01) and significantly increased the explained variance of the model (χ(2 )= 22.93; d.f. = 1; p < 0.01). More importantly, the predictive power of this model was similar in different age-groups. The prognostic information of NT-proBNP was not influenced by age and this biomarker remained a reliable predictor of short-term cardiac events in patients with diabetes mellitus aged 75 years or older.
Assuntos
Doenças Cardiovasculares/etiologia , Diabetes Mellitus/sangue , Peptídeo Natriurético Encefálico/sangue , Fragmentos de Peptídeos/sangue , Medição de Risco , Idoso , Áustria/epidemiologia , Biomarcadores/sangue , Doenças Cardiovasculares/sangue , Doenças Cardiovasculares/epidemiologia , Diabetes Mellitus/epidemiologia , Progressão da Doença , Feminino , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Prognóstico , Precursores de Proteínas , Fatores de RiscoRESUMO
BACKGROUND: With the rapid advancement of the educational reform, the requirements for primary and secondary school teachers are increasing, which makes the work pressure of teachers become greater, which can lead to a variety of mental health problems. It is the primary task to promote the psychological health of primary and secondary school teachers by analyzing the stress of teachers and putting forward reasonable countermeasures. OBJECTIVE: The study aimed to analyze the direct and indirect effects of occupational stress on the mental health level of primary and secondary school teachers. METHODS: 317 teachers from 6 rural primary and secondary schools in Zhejiang province were selected as research subjects. A questionnaire was designed to collect information of occupational stress, mental health, and social support scores. The teachers were compared for differences in gender, marriage status, class teacher, occupational stress, and mental health. The correlation among occupational stress, mental health, and social support was analyzed by structural equation model. RESULTS: The occupational stress of male teachers was higher than that of female teachers in self-development, work load, and career expectation, and the mental health was lower than that of female teachers in work (Pâ<â0.05). The occupational stress of married teachers was significantly higher than that of unmarried teachers, and their mental health was significantly higher than that of unmarried teachers (Pâ<â0.05). The occupational stress of teachers with senior professional titles was lower than that of teachers with primary and intermediate titles in the dimensions of self-development, work load, and career expectation (Pâ<â0.05). The occupational stress of class teachers was higher than that of non-class teachers in terms of student factors, work load, and career expectation (Pâ<â0.05). The direct path coefficient between occupational stress and mental health was -0.421, and the indirect path coefficient between occupational stress and mental health was -0.172. CONCLUSIONS: The occupational stress of male, married, class teacher, and teacher with the primary and intermediate titles was significantly greater than that of female, unmarried, non-class teacher, and senior title teacher. In conclusion, the occupational stress of primary and secondary school teachers can not only directly predict the mental health level, but also indirectly affect the mental health level through social support.
Assuntos
Saúde Mental , Estresse Ocupacional , Feminino , Humanos , Masculino , Professores Escolares , Instituições Acadêmicas , Estresse Psicológico , Inquéritos e QuestionáriosRESUMO
Chemosensory dysfunction has been reported in patients with diabetes mellitus (DM). However, the clinical significance in relation to the disease stage remains unclear. The aim of this investigation was to assess olfactory and gustatory function with valid clinical tests in patients with DM types 1 and 2 with and without accompanying diseases. Seventy-six patients with DM were divided into three groups according to disease stage. Taste function was tested by means of impregnated paper strips and smell function was screened using a five-item smell identification test. The results of the patients with uncomplicated DM were compared with the results from 29 healthy subjects. The results showed no significant differences in smell and taste function between patients with uncomplicated DM and healthy subjects. However, patients with additional diseases exhibited decreased smell acuity. Moreover, patients with DM type 2 showed impaired smell function compared with patients with DM type 1.
Assuntos
Diabetes Mellitus/epidemiologia , Transtornos do Olfato/epidemiologia , Transtornos do Olfato/fisiopatologia , Distúrbios do Paladar/epidemiologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Índice de Massa Corporal , Angiopatias Diabéticas/epidemiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Transtornos do Olfato/diagnóstico , Índice de Gravidade de Doença , Distúrbios do Paladar/diagnóstico , Adulto JovemRESUMO
AIMS: This study evaluated the predictive value of NT-proBNP for patients with diabetes mellitus and compared the prognostic aptitude of this neurohumoral marker to traditional markers of cardiovascular events. METHODS AND RESULTS: A prospective observational study was conducted in 631 diabetic patients. The composite endpoint consisted of unplanned hospitalization for cardiovascular events or death within the observation period of 12 months. Of all variables analysed (age, gender, history of hypertension, ischaemic heart disease/any cardiac disease, smoking, duration of diabetes, body mass index, blood pressure, New York Heart Association-class, Dyspnoea score, Minnesota Living with Heart Failure Questionnaire, LDL-cholesterol, HbA(1c), creatinine, glomerular filtration rate), the logarithm of NT-proBNP gave the most potent information in a stepwise Cox regression analysis (P < 0.0001). Bootstrapping with 500 samples supports this result in 95% samples. The negative predictive value of a normal value (<125 pg/mL) of NT-proBNP for short-term cardiovascular events in diabetic patients is 98%. CONCLUSION: We have demonstrated a strong and independent correlation between NT-proBNP and short-term prognosis of cardiovascular events for patients with diabetes mellitus. With a high negative predictive value it can identify individuals who are not at intermediate risk for cardiovascular events. NT-proBNP proved to be of higher predictive value than traditional cardiovascular markers, in this unselected cohort.
Assuntos
Biomarcadores/metabolismo , Angiopatias Diabéticas/prevenção & controle , Peptídeo Natriurético Encefálico/metabolismo , Fragmentos de Peptídeos/metabolismo , Angiopatias Diabéticas/mortalidade , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Minnesota , Valor Preditivo dos Testes , Prognóstico , Estudos Prospectivos , Medição de Risco , Sensibilidade e EspecificidadeRESUMO
Diabetes education and self-management play a critical role in diabetes care. Patient empowerment aims to actively influence the course of the disease by self-monitoring and subsequent treatment modification as well as the ability of patients to integrate diabetes into their daily life and to appropriately adapt it to their life style situation. Diabetes education has to be made accessible for all persons with the disease. In order to be able to provide a structured and validated education program, adequate personnel as well as space, organizational and financial prerequisites are required. Besides an increase in knowledge about the disease it has been shown that a structured diabetes education is able to improve diabetes outcome as measured by parameters, such as blood glucose, HbA1c, blood pressure and body weight in follow-up evaluations. Modern education programs emphasize the ability of patients to integrate diabetes into everyday life, stress physical activity besides healthy eating as important components of life style therapy and use interactive methods in order to increase the acceptance of personal responsibility. Specific situations (e.â¯g. impaired hypoglycemia awareness, illness, travel) and technical innovations, such as glucose sensor systems and insulin pumps require additional educational measures by information exchange in small groups supported by adequate electronic tools (diabetes apps and diabetes web portals).
Assuntos
Aconselhamento , Diabetes Mellitus Tipo 2 , Educação de Pacientes como Assunto , Adulto , Automonitorização da Glicemia , Diabetes Mellitus Tipo 2/prevenção & controle , Promoção da Saúde , Humanos , Hipoglicemia/prevenção & controle , Sistemas de Infusão de Insulina , Guias de Prática Clínica como Assunto , AutocuidadoRESUMO
The heterogenous catagory "specific types of diabetes due to other causes" encompasses disturbances in glucose metabolism due to other endocrine disorders such as acromegaly or hypercortisolism, drug-induced diabetes (e.â¯g. antipsychotic medications, glucocorticoids, immunosuppressive agents, highly active antiretroviral therapy (HAART)), genetic forms of diabetes (e.â¯g. Maturity Onset Diabetes of the Young (MODY), neonatal diabetes, Down Syndrome, Klinefelter Syndrome, Turner Syndrome), pancreatogenic diabetes (e.â¯g. postoperatively, pancreatitis, pancreatic cancer, haemochromatosis, cystic fibrosis), and some rare autoimmune or infectious forms of diabetes. Diagnosis of specific diabetes types might influence therapeutic considerations. Exocrine pancreatic insufficiency is not only found in patients with pancreatogenic diabetes but is also frequently seen in type 1 and long-standing type 2 diabetes.
Assuntos
Diabetes Mellitus/classificação , Diabetes Mellitus/etiologia , Doenças do Sistema Endócrino , Insuficiência Pancreática Exócrina , Guias de Prática Clínica como Assunto , Diabetes Mellitus/terapia , Diabetes Mellitus Tipo 2 , Insuficiência Pancreática Exócrina/diagnóstico , Insuficiência Pancreática Exócrina/fisiopatologia , Humanos , Neoplasias PancreáticasRESUMO
The present article is a recommendation of the Austrian Diabetes Association for the practical use of insulin in type 2 diabetes, including the various insulin regimens.
Assuntos
Diabetes Mellitus Tipo 2 , Hipoglicemiantes/uso terapêutico , Insulina/uso terapêutico , Guias de Prática Clínica como Assunto , Áustria , Diabetes Mellitus Tipo 2/tratamento farmacológico , Relação Dose-Resposta a Droga , Esquema de Medicação , HumanosRESUMO
Hyperglycemia significantly contributes to complications in patients with diabetes mellitus. While lifestyle interventions remain cornerstones of disease prevention and treatment, most patients with type 2 diabetes will eventually require pharmacotherapy for glycemic control. The definition of individual targets regarding optimal therapeutic efficacy and safety as well as cardiovascular effects is of great importance. In this guideline we present the most current evidence-based best clinical practice data for healthcare professionals.
Assuntos
Glicemia/efeitos dos fármacos , Diabetes Mellitus Tipo 2 , Hipoglicemiantes/uso terapêutico , Guias de Prática Clínica como Assunto , Glicemia/metabolismo , Diabetes Mellitus Tipo 2/tratamento farmacológico , Humanos , Hiperglicemia/tratamento farmacológico , Estilo de VidaRESUMO
CONTEXT: Osteopontin (OPN) is a multifunctional protein involved in bone metabolism, cardiovascular disease, diabetes, and obesity. OPN levels are elevated in the plasma and adipose tissue of obese subjects, and are decreased with diet-induced weight loss. OBJECTIVE: We investigated the effect of bariatric surgery on plasma OPN concentrations in morbidly obese patients. SETTING: The study was performed at a university hospital. SUBJECTS: We investigated 40 obese patients aged 43.1 +/- 1.8 yr, scheduled to undergo bariatric surgery. Roux-en-Y gastric bypass (RYGB) was performed in 30 subjects (27 females, three males), and laparoscopic adjustable gastric banding (LAGB) in 10 subjects (eight females, two males). STUDY DESIGN: All patients were studied before and 1 yr (10.3-14.8 months) after the intervention. MAIN OUTCOME MEASURES: OPN, leptin, C-reactive protein, insulin, the homeostatic model assessment insulin resistance index, calcium, 25-hydroxyvitamin D, C telopeptide, and osteocalcin were determined. RESULTS: Both bariatric procedures significantly reduced body weight, body mass index, insulin, leptin, and C-reactive protein 1 yr after surgery. Plasma OPN increased from 31.4 +/- 3.8 to 52.8 +/- 3.7 ng/ml after RYGB (P < 0.001) and from 29.8 +/- 6.9 to 46.4 +/- 10.6 ng/ml after LAGB (P = 0.042). Preoperative OPN correlated with age, insulin, the homeostatic model assessment insulin resistance index, and postoperative OPN. Postoperative OPN correlated with C telopeptide and osteocalcin. CONCLUSIONS: One year after RYGB and LAGB, plasma OPN levels significantly increased and correlated with biomarkers of bone turnover. Unlike other proinflammatory cytokines, OPN does not normalize but increases further after bariatric surgery.
Assuntos
Cirurgia Bariátrica , Remodelação Óssea/fisiologia , Resistência à Insulina/fisiologia , Osteopontina/sangue , Adulto , Cirurgia Bariátrica/métodos , Biomarcadores/sangue , Colágeno Tipo I/sangue , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Obesidade Mórbida/sangue , Obesidade Mórbida/cirurgia , Osteocalcina/sangue , Peptídeos/sangue , Fatores de Tempo , Regulação para Cima , Redução de Peso/fisiologiaRESUMO
Circulating levels of B-type natriuretic peptide (BNP) and NH(2)-terminal-proBNP (NT-proBNP) increase in response to volume overload and help in the differential diagnosis of acute heart failure. Elevated plasma BNP levels are observed also in sepsis and do not always correspond to left ventricular dysfunction. Here, we investigated plasma NT-proBNP fluctuations in response to human bacterial endotoxinemia, an experimental model of systemic infection and inflammation. Escherichia coli endotoxin (LPS) (2 ng/kg) was administered to 10 healthy volunteers in a randomized, placebo-controlled, cross-over design. Plasma NT-proBNP, C-reactive protein (CRP), COOH terminal pro-endothelin-1 (CT-proET-1), and midregional-pro-adrenomedullin (MR-proADM) were measured at hourly intervals for 6 h. LPS administration induced a continuous increase in plasma NT-proBNP that reached peak values after 6 h (40.7 +/- 7.9 vs. 16.1 +/- 3.2 pg/ml in placebo days, mean +/- SE; P = 0.023). The profile of changes in NT-proBNP correlated to changes in body temperature (P < 0.001), heart rate (P = 0.005), CRP (P < 0.001), and CT-proET-1 (P = 0.008), but not to blood pressure values. Our results demonstrate that plasma NT-proBNP increases in a model of systemic infection/inflammation in healthy men with normal heart function. This finding emphasizes the necessity to consider concomitant infections when interpreting elevated circulating NT-proBNP concentrations.
Assuntos
Lipopolissacarídeos/farmacologia , Peptídeo Natriurético Encefálico/sangue , Fragmentos de Peptídeos/sangue , Adrenomedulina/metabolismo , Adulto , Pressão Sanguínea/efeitos dos fármacos , Proteína C-Reativa/metabolismo , Estudos Cross-Over , Ecocardiografia , Eletrocardiografia , Endotelina-1/metabolismo , Humanos , Masculino , Precursores de Proteínas/metabolismo , Adulto JovemRESUMO
BACKGROUND: European guidelines recommend intravenous methylprednisolone as first-line treatment for active and severe Graves' orbitopathy; however, it is common for patients to have no response or have relapse after discontinuation of treatment. We aimed to compare the efficacy and safety of add-on mycophenolate to methylprednisolone in comparison with methylprednisolone alone in patients with moderate-to-severe Graves' orbitopathy. METHODS: MINGO was an observer-masked, multicentre, block-randomised, centre-stratified trial done in two centres in Germany and two in Italy. Patients with active moderate-to-severe Graves' orbitopathy were randomly assigned to receive intravenous methylprednisolone (500 mg once per week for 6 weeks followed by 250 mg per week for 6 weeks) either alone or with mycophenolate (one 360 mg tablet twice per day for 24 weeks). The prespecified primary endpoints were rate of response (reduction of at least two parameters of a composite ophthalmic index [eyelid swelling, clinical activity score, proptosis, lid width, diplopia, and eye muscle motility] without deterioration in any other parameter) at 12 weeks and rate of relapse (a worsening of symptoms that occurred after a response) at 24 and 36 weeks. Rates of response at week 24 and sustained response at week 36 were added as post-hoc outcomes. Prespecified primary outcomes and post-hoc outcomes were assessed in the modified intention-to-treat population (defined as all patients assigned to treatment who received at least one infusion of methylprednisolone, when outcome data were available), and safety was assessed in all patients who received at least one dose of study drug. This trial is registered with the EU Clinical Trials Register, EUDRACT number 2008-002123-93. FINDINGS: 164 patients were enrolled and randomised between Nov 29, 2009, and July 31, 2015. 81 were randomly assigned to receive methylprednisolone alone and 83 to receive methylprednisolone with mycophenolate. In the intention-to-treat population at 12 weeks, responses were observed in 36 (49%) of 73 patients in the monotherapy group and 48 (63%) of 76 patients in the combination group, giving an odds ratio (OR) of 1·76 (95% CI 0·92-3·39, p=0·089). At week 24, 38 (53%) of 72 patients remaining in the monotherapy group and 53 (71%) of 75 patients remaining in the combination therapy group had responded to treatment (2·16, 1·09-4·25, p=0·026). At week 24, relapse occurred in four (11%) of 38 patients in the monotherapy group and four (8%) of 53 patients in the combination group (OR 0·71, 0·17-3·03, p=0·72). At week 36, relapse occurred in an additional three (8%) patients in the monotherapy group and two (4%) patients in the combination group (0·65, 0·12-3·44, p=0·61). At week 36, 31 (46%) of 68 patients in the monotherapy group and 49 (67%) of 73 patients in the combination group had a sustained response (OR 2·44, 1·23-4·82, p=0·011). 23 patients had 24 serious adverse events, with 11 events in ten patients in the combination group and 13 events in 13 patients in the monotherapy group. Mild and moderate (grade 1-2) drug-related adverse events occurred in 16 (20%) of 81 patients receiving monotherapy and 21 (25%) of 83 patients receiving combination therapy (p=0·48). INTERPRETATION: Although no significant difference was seen in the rate of response at 12 weeks or rate of relapse at 24 and 36 weeks, post-hoc analysis suggested that addition of mycophenolate to treatment with methylprednisolone improved rate of response to therapy by 24 weeks in patients with active and moderate-to-severe Graves' orbitopathy. FUNDING: Novartis, Germany.