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1.
Braz. j. biol ; 84: e250739, 2024. tab
Article in English | LILACS, VETINDEX | ID: biblio-1355896

ABSTRACT

Abstract Several reasons may underlie the dramatic increase in type2 diabetes mellitus. One of these reasons is the genetic basis and variations. Vitamin D receptor polymorphisms are associated with different diseases such as rheumatoid arthritis and diabetes. The aim of this study is to investigate the possible association of two identified mutations ApaI (rs7975232) and TaqI (rs731236). Eighty-nine healthy individuals and Fifty-six Type 2 Diabetic (T2D) patients were investigated using RFLP technique for genotyping and haplotyping as well. The distribution of Apal genotypes was not statistically significant among the control (P=0.65) as well as for diabetic patients (P=0.58). For Taql allele frequencies of T allele was 0.61 where of G allele was 0.39. The frequency distribution of Taql genotypes was not statistically significant among the control (P=0.26) as well as diabetic patients (P=0.17). Relative risk of the allele T of Apa1 gene is 1.28 and the odds ratio of the same allele is 1.53, while both estimates were < 1.0 of the allele G. Similarly, with the Taq1 gene the relative risk and the odds ratio values for the allele T are 1.09 and 1.27 respectively and both estimates of the allele C were 0.86 for the relative risk and 0.79 for the odds ratio. The pairwise linkage disequilibrium between the two SNPs Taq1/apa1 was statistically significant in control group (D = 0.218, D' = 0.925 and P value < 0.001) and similar data in diabetic groups (D = 0.2, D' = 0.875 and P value < 0.001). These data suggest that the T allele of both genes Apa1 and Taq1 is associated with the increased risk of type 2 diabetes. We think that we need a larger number of volunteers to reach a more accurate conclusion.


Resumo Várias razões podem estar subjacentes ao aumento dramático da diabetes mellitus tipo 2. Um desses motivos é a base genética e variações. Os polimorfismos do receptor da vitamina D estão associados a diferentes doenças, como artrite reumatoide e diabetes. O objetivo deste estudo é investigar a possível associação de duas mutações identificadas ApaI (rs7975232) e TaqI (rs731236). Oitenta e nove indivíduos saudáveis ​​e 56 pacientes com diabetes tipo 2 (T2D) foram investigados usando a técnica RFLP para genotipagem e haplotipagem também. A distribuição dos genótipos Apal não foi estatisticamente significativa entre o controle (P = 0,65), bem como para os pacientes diabéticos (P = 0,58). Para as frequências do alelo Taql, o alelo T foi de 0,61, onde o alelo G foi de 0,39. A distribuição de frequência dos genótipos Taql não foi estatisticamente significativa entre o controle (P = 0,26), bem como os pacientes diabéticos (P = 0,17). O risco relativo do alelo T do gene Apa1 é 1,28 e a razão de chances do mesmo alelo é 1,53, enquanto ambas as estimativas foram < 1,0 do alelo G. Da mesma forma, com o gene Taq1, os valores de risco relativo e razão de chances para o alelo T são 1,09 e 1,27, respectivamente, e ambas as estimativas do alelo C foram de 0,86 para o risco relativo e 0,79 para o odds ratio. O desequilíbrio de ligação par a par entre os dois SNPs Taq1 / apa1 foi estatisticamente significativo no grupo de controle (D = 0,218, D' = 0,925 e valor P < 0,001) e dados semelhantes em grupos diabéticos (D = 0,2, D' = 0,875 e valor P < 0,001). Esses dados sugerem que o alelo T de ambos os genes Apa1 e Taq1 está associado ao aumento do risco de diabetes tipo 2. Achamos que precisamos de um número maior de voluntários para chegar a uma conclusão mais precisa.


Subject(s)
Humans , Receptors, Calcitriol/genetics , Diabetes Mellitus, Type 2/genetics , Diabetes Mellitus, Type 2/epidemiology , Saudi Arabia , Case-Control Studies , Polymorphism, Single Nucleotide , Gene Frequency , Genotype
2.
Braz. j. biol ; 83: e242818, 2023. tab, graf
Article in English | LILACS, VETINDEX | ID: biblio-1285628

ABSTRACT

Abstract The study was aimed to assess impact of high fat diet (HFD) and synthetic human gut microbiota (GM) combined with HFD and chow diet (CD) in inducing type-2 diabetes (T2D) using mice model. To our knowledge, this is the first study using selected human GM transplantation via culture based method coupled dietary modulation in mice for in vivo establishment of inflammation leading to T2D and gut dysbiosis. Twenty bacteria (T2D1-T2D20) from stool samples of confirmed T2D subjects were found to be morphologically different and subjected to purification on different media both aerobically and anerobically, which revealed seven bacteria more common among 20 isolates on the basis of biochemical characterization. On the basis of 16S rRNA gene sequencing, these seven isolates were identified as Bacteroides stercoris (MT152636), Lactobacillus acidophilus (MT152637), Lactobacillus salivarius (MT152638), Ruminococcus bromii (MT152639), Klebsiella aerogenes (MT152640), Bacteroides fragilis (MT152909), Clostridium botulinum (MT152910). The seven isolates were subsequently used as synthetic gut microbiome (GM) for their role in inducing T2D in mice. Inbred strains of albino mice were divided into four groups and were fed with CD, HFD, GM+HFD and GM+CD. Mice receiving HFD and GM+modified diet (CD/HFD) showed highly significant (P<0.05) increase in weight and blood glucose concentration as well as elevated level of inflammatory cytokines (TNF-α, IL-6, and MCP-1) compared to mice receiving CD only. The 16S rRNA gene sequencing of 11 fecal bacteria obtained from three randomly selected animals from each group revealed gut dysbiosis in animals receiving GM. Bacterial strains including Bacteroides gallinarum (MT152630), Ruminococcus bromii (MT152631), Lactobacillus acidophilus (MT152632), Parabacteroides gordonii (MT152633), Prevotella copri (MT152634) and Lactobacillus gasseri (MT152635) were isolated from mice treated with GM+modified diet (HFD/CD) compared to strains Akkermansia muciniphila (MT152625), Bacteriodes sp. (MT152626), Bacteroides faecis (MT152627), Bacteroides vulgatus (MT152628), Lactobacillus plantarum (MT152629) which were isolated from mice receiving CD/HFD. In conclusion, these findings suggest that constitution of GM and diet plays significant role in inflammation leading to onset or/and possibly progression of T2D. .


Resumo O estudo teve como objetivo avaliar o impacto da dieta rica em gordura (HFD) e da microbiota intestinal humana sintética (GM) combinada com HFD e dieta alimentar (CD) na indução de diabetes tipo 2 (T2D) usando modelo de camundongos. Para nosso conhecimento, este é o primeiro estudo usando transplante de GM humano selecionado através do método baseado em cultura acoplada à modulação dietética em camundongos para o estabelecimento in vivo de inflamação que leva a T2D e disbiose intestinal. Vinte bactérias (T2D1-T2D20) de amostras de fezes de indivíduos T2D confirmados verificaram ser morfologicamente diferentes e foram submetidas à purificação em meios diferentes aerobicamente e anaerobicamente, o que revelou sete bactérias mais comuns entre 20 isolados com base na caracterização bioquímica. Com base no sequenciamento do gene 16S rRNA, esses sete isolados foram identificados como Bacteroides stercoris (MT152636), Lactobacillus acidophilus (MT152637), Lactobacillus salivarius (MT152638), Ruminococcus bromii (MT152639), Klebsiella aerogenides (MT152640), Bacteroides fragilis (MT152909), Clostridium botulinum (MT152910). Esses sete isolados foram, posteriormente, usados ​​como microbioma intestinal sintético (GM) por seu papel na indução de T2D em camundongos. Linhagens consanguíneas de camundongos albinos foram divididas em quatro grupos e foram alimentadas com CD, HFD, GM + HFD e GM + CD. Camundongos que receberam a dieta modificada com HFD e GM + (CD / HFD) mostraram um aumento altamente significativo (P < 0,05) no peso e na concentração de glicose no sangue, bem como um nível elevado de citocinas inflamatórias (TNF-α, IL-6 e MCP-1) em comparação com os ratos que receberam apenas CD. O sequenciamento do gene 16S rRNA de 11 bactérias fecais obtidas de três animais selecionados aleatoriamente de cada grupo revelou disbiose intestinal em animais que receberam GM. Cepas bacterianas, incluindo Bacteroides gallinarum (MT152630), Ruminococcus bromii (MT152631), Lactobacillus acidophilus (MT152632), Parabacteroides gordonii (MT152633), Prevotella copri (MT152634) e Lactobacillus Gasseri (MT152635D), foram tratadas com dieta modificada / CD) em comparação com as linhagens Akkermansia muciniphila (MT152625), Bacteriodes sp. (MT152626), Bacteroides faecis (MT152627), Bacteroides vulgatus (MT152628), Lactobacillus plantarum (MT152629), que foram isoladas de camundongos recebendo CD / HFD. Em conclusão, esses resultados sugerem que a constituição de GM e dieta desempenham papel significativo na inflamação levando ao início ou/e possivelmente à progressão de T2D.


Subject(s)
Humans , Animals , Rabbits , Diabetes Mellitus, Type 2 , Gastrointestinal Microbiome , Bacteroides , RNA, Ribosomal, 16S/genetics , Prevotella , Bacteroidetes , Ruminococcus , Diet, High-Fat/adverse effects , Dysbiosis , Inflammation , Mice, Inbred C57BL
3.
Ciênc. Saúde Colet. (Impr.) ; 27(9): 3583-3602, set. 2022. tab
Article in Portuguese | LILACS-Express | LILACS | ID: biblio-1394224

ABSTRACT

Resumo Este artigo tem o objetivo de apresentar uma proposta de compatibilização dos instrumentos utilizados nos três ciclos do PMAQ-AB e analisar as informações de acesso, cobertura, estrutura, organização e oferta de serviços na APS relacionadas ao cuidado para DM no Brasil, segundo regiões, a partir da perspectiva das equipes de saúde da família e dos usuários. Foi realizada uma análise do grau de compatibilidade das questões do PMAQ-AB (2012, 2014 e 2017). Para análise da evolução temporal dos componentes realizou-se teste de diferença de proporção. Calculou-se a diferença percentual entre a perspectiva das Equipes e dos Usuários, por ano analisado, para Brasil. Em geral, houve melhora da qualidade do cuidado e realização de exames, com exceção do pé diabético. Foram encontrados resultados piores para o Norte em relação às demais regiões. Apesar da melhora estrutural e na qualidade da atenção reportada pelas equipes, foram evidenciadas lacunas significativas na qualidade do cuidado ao paciente com DM no SUS. No cenário de investimento escasso e crescente prevalência de DM, os obstáculos tornam-se cada vez mais desafiadores e, por isso, o monitoramento e avaliação da qualidade dos serviços prestados são tarefas precípuas do SUS.


Abstract This article aims to present a proposal for making the instruments used in the three cycles of the PMAQ-AB compatible and to analyze the information on access, coverage, structure, organization and provision of services in PHC related to care for DM in Brazil, according to regions, from the perspective of family health professionals and users. We performed an analysis of the degree of compatibility of the PMAQ-AB questions (2012, 2014 and 2017). To analyze the temporal evolution of the components, we performed a proportion difference test. We calculated the percentage difference between the perspective of professionals and users, per year analyzed, for Brazil. In general, there was an improvement in the quality of care and examinations, except for the diabetic foot. Worse results were found for the North region in relation to the other regions. Despite the structural improvement and the quality of care reported by professionals, there are significant gaps in the quality of care for patients with DM in the SUS. In the scenario of scarce investment added to the growing prevalence of DM, obstacles become progressively more challenging. Therefore, monitoring and evaluating the quality of services provided are essential tasks of the Brazilian Health System.

4.
Rev. Soc. Argent. Diabetes ; 56(2): 43-50, mayo - ago. 2022. ilus
Article in Spanish | LILACS, BINACIS | ID: biblio-1395828

ABSTRACT

Introducción: el uso prolongado de metformina y la carencia de consumo de vitamina B12 (B12) pueden provocar su déficit en pacientes con diabetes mellitus tipo 2 (DM2). Objetivos: analizar la frecuencia de consumo insuficiente de B12 según: características personales, datos antropométricos, de laboratorio y uso de metformina; asociar niveles séricos de cobalamina con dosis y tiempo de metformina; establecer la relación entre la ingesta de B12 y los niveles séricos. Materiales y métodos: diseño transversal. Mediante encuesta de frecuencia de consumo de alimentos fuente de B12 en 200 pacientes tratados con metformina por más de 18 meses. Se analizaron datos clínicos, antropométricos, de laboratorio, tiempo y dosis de metformina, en dos centros de salud de la Provincia de Buenos Aires. Resultados: el porcentual de consumo deficiente fue del 29%. Se registró un 47,5% de desocupación que alcanzó un déficit de ingesta del 32,6%. Se midió B12 sérica en el 65% de la muestra y un 53,8% de los valores fue anormal (0,8% en niveles deficientes o bajos y 23% en niveles normal-bajo), observándose asociación significativa a dosis de metformina ≥1.500 mg. Las deficiencias de consumos de B12 (<2,4 µg/día) fueron casi cuatro veces mayores en el grupo con menor recuento eritrocítico (76,9 % vs 18,5%; p<0,00 ). El volumen corpuscular medio (VCM) y el recuento de plaquetas arrojaron datos estadísticamente significativos. Conclusiones: si bien el 29% de la muestra exhibió consumo vitamínico deficiente, el 90% de los pacientes con déficit sérico registró ingestas adecuadas de B12. Dado que se trató de un diseño transversal, donde no pudo evaluarse causalidad, en pacientes intervenidos farmacológicamente con metformina se sugiere considerar su impacto en situaciones deficitarias.


Introduction: the prolonged use of metformin and the lack of consumption of vitamin B12 can cause its deficit, in T2D. Objectives: to analyze the frequency of insufficient consumption of vitamin B12 according to: personal characteristics, anthropometric and laboratory data, and use of metformin; associate serum cobalamin levels with metformin dose and time; establish a relationship between B12 intake and serum levels. Materials and methods: cross-sectional design. Through a survey of the frequency of consumption of food sources of B12 in 200 patients treated with metformin for more than 18 months. Clinical, anthropometric, laboratory data, time and dose of metformin were analyzed in 2 health centers in the Province of Buenos Aires. Results: the percentage of deficient consumption was 29%. 47.5% of unemployment was registered, which reached an intake deficit of 32.6%. Serum B12 was measured in 65% of the sample where 53.8% of values were abnormal (0.8% in deficient levels) and 23% at levels normal lower cut-off point, with a significant association being observed at doses of metformin ≥1,500 mg. Deficiencies in B12 intake (<2.4 µg/day) were almost 4 times higher in the group with the lowest erythrocyte count (76.9% vs 18.5%; p<0.00 ). The MCV and platelet count yielded statistically significant data. Conclusions: although 29% of the sample exhibited poor vitamin intake, 90% of patients with serum deficiency had adequate intakes of vitamin B12. Given that it is a cross-sectional design, where causality cannot be evaluated, it is suggested: in patients undergoing pharmacological intervention with metformin, consider the impact of this in deficient situations.


Subject(s)
Diabetes Mellitus, Type 2 , Vitamin B 12 , Dosage , Metformin
5.
Rev. Soc. Argent. Diabetes ; 56(suple. 2): 2-8, may. - ago. 2022. ilus
Article in Spanish | LILACS, BINACIS | ID: biblio-1396069

ABSTRACT

La metformina es el agente antidiabético oral más utilizado para el tratamiento de la diabetes mellitus tipo 2 (DM2) y se ha descrito la asociación de su uso con el déficit de vitamina B12. Se realizó una revisión narrativa de estudios para conocer la evidencia de dicha asociación, y las recomendaciones para su pesquisa, prevención y tratamiento. La prevalencia informada del déficit de vitamina B12 en los pacientes tratados con metformina osciló entre el 5,8% y el 52% en las diferentes series. Los pacientes de mayor edad, aquellos que reciben metformina a altas dosis y por más tiempo, y los que no consumen alimentos de origen animal, son quienes presentan mayor riesgo de padecer este déficit. Se recomienda la determinación de vitamina B12 cada año en pacientes con DM2 tratados con metformina y la eventual reposición en caso de déficit. Si bien existe consenso sobre el tratamiento del déficit, aún falta evidencia que permita realizar la recomendación sobre el tratamiento preventivo.


Metformin is the most widely used oral antidiabetic agent for the treatment of type 2 diabetes (T2D) and the association of the use of this drug with vitamin B12 deficiency has been described. A review of studies was carried out to find out the evidence of this association and the recommendations for its detection, prevention and treatment. The reported prevalence of vitamin B12 deficiency in patients treated with metformin ranged from 5.8% to 52% in the different series. Older patients, those who received metformin at high doses and for a longer time, and those who do not consume food of animal origin, are those who are at greater risk of suffering from this deficit. The determination of vitamin B12 every 1 year is recommended in patients with T2D treated with metformin, and the eventual replacement in case of deficiency. Although there is consensus on the treatment of the deficit, there is still a lack of evidence to make recommendations on a preventive treatment


Subject(s)
Diabetes Mellitus, Type 2 , Vitamin B 12 , Vitamin B 12 Deficiency , Metformin
6.
Rev. méd. Paraná ; 80(1): 1-5, jan. 2022.
Article in Portuguese | LILACS | ID: biblio-1380881

ABSTRACT

O diabete melito está entre as principais causas de mortalidade no mundo e pode ser agravada pela inatividade física. O objetivo deste estudo descritivo transversal foi identificar as barreiras percebidas para a prática de atividade física sob a perspectiva dae pacientes diabéticos tipo 2. Participaram 220 pacientes (111 mulheres e 109 homens), com média de idade de 62,9 anos. Foram coletados índice de massa corporal, dados sociodemográficos e informações relacionadas ao histórico de doenças preexistentes. Para a análise das barreiras percebidas para a prática de atividades físicas, utilizou-se um questionário estruturado e validado para a população adulta brasileira proposto por Martins&Petroski. As barreiras foram analisadas individualmente e agrupadas em domínios ambiental, comportamental, físico e social. Em conclusão, as barreiras percebidas foram a falta de interesse (38,6%), cansaço físico (32,3%) e jornada de trabalho extensa (26,3%) e, assim, medidas devem ser adotadas visando minimizar os efeitos dessas barreiras e promover a atenção primária à saúde à essa população


Diabetes is among the leading causes of mortality in the world and can be aggravated by physical inactivity. This descriptive cross-sectional study aimed to identify the perceived barriers to the practice of physical activity from the perspective of type 2 diabetic patients. 220 diabetic patients participated in the research (111 women and 109 men), with a mean age of 62.9 years. Body mass index, sociodemographic data and information related to the history of preexisting diseases were collected. For the analysis of perceived barriers to the practice of physical activities, a structured and validated questionnaire for the Brazilian adult population proposed by Martins&Petroski was used. Barriers were analyzed individually and grouped into environmental, behavioral, physical and social domains. In conclusion, the main barriers perceived were lack of interest (38.6%), physical fatigue (32.3%) and long working hours (26.3%) and, them, measures should be taken to minimize the effects of these barriers, in order to promote primary health care in this population


Subject(s)
Humans , Male , Female , Middle Aged , Primary Health Care , Exercise , Body Mass Index , Cross-Sectional Studies , Diabetes Mellitus , Sedentary Behavior
7.
Más Vita ; 4(2): 368-385, jun. 2022. tab, graf
Article in Spanish | LILACS, LIVECS | ID: biblio-1392663

ABSTRACT

La diabetes tipo 2 es un trastorno metabólico progresivo complejo, que representa una amenaza significativa para la salud humana y representa más del 91% de todos los casos de diabetes. Objetivo: evaluar el efecto de la adición de tintura de Notholaena nivea al tratamiento con metformina en pacientes con tolerancia alterada a la glucosa (IGT) y diabetes de tipo 2 (DMT2). Materiales y Método: Ensayo clínico unicentral, aleatorizado, simple ciego, controlado con placebo. Todos los participantes con diagnóstico de IGT y DMT2 que tomaban metformina fueron asignados aleatoriamente a recibir kits con tintura de Notholaena nivea autentica (40 pacientes) o placebo (58 pacientes), fijando 6 gotas diarias, 30 minutos antes del desayuno y almuerzo durante 26 semanas, se hicieron 3 controles (0, 13 y 26 semanas) midiendo glucosa plasmática en ayunas (FPG), nivel de hemoglobina glucosilada (HbA1C) y perfil lipídico. Resultados: del grupo de tratamiento (tintura de Notholaena nivea más metformina) fueron significativamente eficientes a las 13 semanas de iniciado el ensayo, manteniendo la directriz de reducción de glucosa plasmática (FPG), al iniciar el estudio el grupo control y tratamiento obtuvieron niveles de FPG similares con valores de .57±1.7 y 7.84±1.9 mmol/l respectivamente (p>0.05), a las 13 semanas se redujo a 7.21±1.mmol/l para el grupo control y 6.49±2.33 mmol/l para el grupo tratamiento (p<0.01), mientras que a la semana 26 el grupo control reporto 7.09±1.41 mmol/l en tanto el grupo tratamiento obtuvo 5.98±0.71 mmol/l (p<0.01). Hubo reducción de los niveles de HbA1C dentro de los grupos, pero no se evidenciaron diferencias por efecto del tratamiento. En el perfil lipídico el tratamiento de Metformina sola evidencio una mejor respuesta con la reducción de colesterol total y aumento de lipoproteínas de alta densidad (HDL) pero aumento la concentración de triglicéridos, mientras que el tratamiento con tintura de Notholaena nivea mantuvo los perfiles lipídicos al igual que en un inicio (p>0.05). Conclusiones: el tratamiento combinado de metformina más tintura de Notholaena nivea reduce acelerada y eficazmente las concentraciones de FPG en sangre de pacientes con IGT o DMT2, pero es ineficaz en el tratamiento del perfil lipídico(AU)


Type 2 diabetes is a complex progressive metabolic disorder, which represents a significant threat to human health and accounts for more than 91% of all diabetes cases. Objective: to evaluate the effect of adding Notholaena nivea tincture to metformin treatment in patients with impaired glucose tolerance (IGT) and type 2 diabetes (DMT2). Materials and Method: Unicentral, randomized, single-blind, placebo-controlled clinical trial. All participants diagnosed with IGT and T2DM who were taking metformin were randomly assigned to receive authentic Notholaena nivea tincture kits (40 patients) or placebo (58 patients), setting 6 drops daily, 30 minutes before breakfast and lunch for 26 weeks. , 3 controls were made (0, 13 and 26 weeks) measuring fasting plasma glucose (FPG), glycosylated hemoglobin level (HbA1C) and lipid profile. Results: the treatment group (Notholaena nivea tincture plus metformin) were significantly efficient at 13 weeks from the start of the trial, maintaining the plasma glucose reduction guideline (FPG), at the start of the study the control and treatment groups obtained levels of Similar FPG with values of .57±1.7 and 7.84±1.9 mmol/l respectively (p>0.05), at 13 weeks it was reduced to 7.21±1.mmol/l for the control group and 6.49±2.33 mmol/l for the treatment group (p<0.01), while at week 26 the control group reported 7.09±1.41 mmol/l while the treatment group obtained 5.98±0.71 mmol/l (p<0.01). There was a reduction in HbA1C levels within the groups, but no differences due to treatment effect were observed. In the lipid profile, the treatment with Metformin alone showed a better response with the reduction of total cholesterol and an increase in high-density lipoproteins (HDL) but increased the concentration of triglycerides, while the treatment with Notholaena nivea tincture maintained the lipid profiles at the same as at the beginning (p>0.05). Conclusions: the combined treatment of metformin plus Notholaena nivea tincture rapidly and effectively reduces FPG concentrations in the blood of patients with IGT or DMT2, but it is ineffective in the treatment of the lipid profile.Keywords: Type 2 diabetes, Notholaena nivea, FPG, Metformin, lipid(AU)


Subject(s)
Humans , Male , Female , Middle Aged , Aged , Glucose Intolerance , Diabetes Mellitus, Type 2 , Metformin/administration & dosage , Patients , Exercise , Nutrition Therapy , Healthy Lifestyle , Glucose
8.
Arq. gastroenterol ; 59(2): 231-237, Apr.-June 2022. tab, graf
Article in English | LILACS-Express | LILACS | ID: biblio-1383840

ABSTRACT

ABSTRACT Background: Gastrointestinal (GI) motility disorders in type 2 diabetes mellitus (T2DM) are common. However, the endpoints in well-controlled T2DM in elderly patients are barely understood. Objective: To evaluate GI transit and gastric myoelectric activity in elderly patients with T2DM who were undergoing treatment with metformin and to compare them with non-diabetic healthy controls. Methods: A total of thirty participants were enrolled in this study: young non-diabetic (n=10), elderly non-diabetic controls (n=10), and patients with T2DM managed with metformin (n=10). After fasting overnight, the participants ingested a standard meal and magnetic markers for non-invasive monitoring of GI transit and gastric contractility using the alternating current biosusceptometry and electrogastrography techniques. Results: Mean gastric emptying time, mean colon arrival time, and mean intestinal transit time were determined. There were no significant differences between the groups and in the parameters evaluated (P>0.05). The frequency and amplitude of gastric myoelectric activity were not different between groups; however, abnormal rhythmic index and the half-bandwidth were slightly higher for both elderly diabetic and non-diabetic groups compared with the young adults (P<0.01 and P<0.05, respectively). Conclusion: Our study showed unaltered gastric emptying and intestinal transit in T2DM patients with good glycemic control, and suggest changes in the gastric electrical activity can be a part of aging.


RESUMO Contexto: As desordens da motilidade gastrintestinal (GI) no diabetes mellitus tipo 2 (DM2) são comuns. No entanto, os desfechos em pacientes idosos com DM2 bem controlado são pouco compreendidos. Objetivo: Avaliar o trânsito GI e a atividade mioelétrica gástrica em idosos com DM2 em tratamento com metformina e compará-los com controles saudáveis não diabéticos. Métodos: Trinta participantes foram incluídos neste estudo: adultos jovens não diabéticos (n=10), idosos não diabéticos (n=10) e pacientes com DM2 tratados com metformina (n=10). Após jejum noturno, os participantes ingeriram uma refeição padrão e marcadores magnéticos para monitoramento não invasivo do trânsito GI e da contratilidade gástrica usando as técnicas de biosusceptometria de corrente alternada e eletrogastrografia. Resultados: Foram determinados o tempo médio de esvaziamento gástrico, o tempo médio de chegada ao cólon e o tempo médio de trânsito intestinal. Não houve diferenças significativas entre os grupos e nos parâmetros avaliados (P>0,05). A frequência e amplitude da atividade mioelétrica gástrica não foram diferentes entre os grupos; entretanto, o índice rítmico anormal e a meia largura de banda foram ligeiramente maiores para os grupos idosos diabéticos e não diabéticos em comparação com os adultos jovens (P<0,01 e P<0,05, respectivamente). Conclusão: Nosso estudo mostrou esvaziamento gástrico e trânsito intestinal inalterados em pacientes com DM2 com bom controle glicêmico, sugerindo que as alterações na atividade elétrica gástrica podem fazer parte do envelhecimento.

9.
Arch. endocrinol. metab. (Online) ; 66(3): 295-302, June 2022. tab, graf
Article in English | LILACS-Express | LILACS | ID: biblio-1393846

ABSTRACT

ABSTRACT Objectives: Diabetic nephropathy is a microvascular complication of diabetes and the most common cause of end-stage renal failure throughout the world. Videocapillaroscopy is a simple and noninvasive method that can display capillaries in the nail bed at the micron level. A few studies have been conducted on detecting retinopathy, another important diabetic microvascular complication, with videocapillaroscopy; however, no comprehensive study has been performed on diabetic nephropathy. We aimed to determine the relationship between nephropathy and capillaroscopic changes. Subjects and methods: Capillaroscopic findings of 144 patients with type 2 diabetes and 88 healthy controls were assessed prospectively by nailfold videocapillaroscopy. Twelve capillaroscopic findings were evaluated in all subjects. Results: Patients with albuminuria had more capillary aneurysms (15.5%), more microhemorrhages (15.5%), greater tortuosity (76.3%), more neoformations (29.9%), more bizarre capillaries (49.5%) and more bushy capillaries (20.6%) than the control group. In logistic regression analysis, tortuosity was significantly correlated with albuminuria (OR: 2.451, p = 0.048). Conclusions: Our findings show that the application of nailfold videocapillaroscopy can detect microvascular abnormalities in the nail bed that occur in diabetes mellitus patients compared to healthy people. Although there was no difference in the microvascular changes among the stages of diabetic nephropathy, a relationship between tortuosity and albuminuria was identified by logistic regression analysis. Nailfold videocapillaroscopy may be a new application that can be used to screen the microvascular changes that occur in diabetes mellitus.

10.
Rev. bras. med. esporte ; 28(2): 85-88, Mar-Apr. 2022. tab, graf
Article in English | LILACS-Express | LILACS | ID: biblio-1365681

ABSTRACT

ABSTRACT Introduction: There is an annual increase in type 2 diabetes (T2DM) incidence in middle-aged people. Aerobic exercise is known to influence glucose metabolic pathways positively. Few studies concerning calisthenic aerobic exercise and its influence on elderly patients with T2DM. Objective: To measure the therapeutic effect of calisthenic exercise in obese Middle-aged people with T2DM. Methods: A total of 86 patients with T2DM were selected from the physical examination of employees of the same unit. They were randomly divided into the exercise group and the control group. The exercise intervention lasted for 16 weeks, with sessions held 3-5 times per week, varying from 60 to 90 minutes per session. The markers evaluated were defined according to the literature and statistically verified. Results: After 16 weeks of calisthenic exercise intervention, compared to the control group or before the experiment, we observed significant reductions in variables VFA (visceral fat area), FPG (fasting glucose), Fins (fasting insulin), HOMA-IR (homeostasis model evaluation of insulin resistance), 2hPBG (postprandial two hours glucose) and HbAlc (hemoglobin Alc) of the exercise group were significantly reduced (P<0.01). Conclusion: Calisthenic exercise intervention can reduce the levels of VFA, FPG. FIns, HOMA-HR, 2hPBG and HbAlc in patients with T2DM. It was also found to reduce the visceral fat content of obese elderly patients with T2DM, reducing obesity risks. Level of evidence II; Therapeutic studies - investigation of treatment results.


RESUMO Introdução: Há um aumento anual na incidência de diabetes tipo 2 (T2DM) nas pessoas de meia idade. O exercício aeróbico é conhecido por influenciar positivamente as vias metabólicas da glicose. Porém há poucos estudos sobre o exercício aeróbico calistênico e sua influência em pacientes entre 40 a 60 anos com T2DM. Objetivo: Medir o efeito terapêutico do exercício calistênico em pacientes de meia idade com obesidade e T2DM. Métodos: Um total de 86 pacientes com T2DM foram selecionados a partir do exame físico dos funcionários da mesma unidade. Eles foram divididos aleatoriamente entre o grupo de exercícios e o grupo de controle. A intervenção do exercício durou 16 semanas, com sessões realizadas de 3 a 5 vezes por semana, variando de 60 a 90 minutos por sessão. Os marcadores avaliados foram definidos de acordo com a literatura e verificados estatisticamente. Resultados: Após 16 semanas de intervenção de exercício aeróbico calistênico, em comparação ao grupo controle ou antes do experimento, observamos reduções significativas nas variáveis VFA (área de gordura visceral), FPG (glicose de jejum), Fins (insulina em jejum), HOMA-IR (avaliação do modelo de homeostase de resistência à insulina), 2hPBG (glicose pós-prandial de duas horas) e HbAlc (hemoglobina Alc) do grupo exercício foram significativamente reduzidas (P<0,01). Conclusão: A intervenção de exercício aeróbico calistênico pode reduzir os níveis de VFA, FPG. FIns, HOMA-HR, 2hPBG e HbAlc em pacientes com T2DM. Também foi constatado que reduz o conteúdo de gordura visceral de pacientes idosos obesos com T2DM, reduzindo os riscos de obesidade. Nível de evidência II; Estudos terapêuticos - investigação dos resultados do tratamento.


RESUMEN Introducción: Cada año aumenta la incidencia de la diabetes tipo 2 (T2DM) en personas de mediana edad. Se sabe que el ejercicio aeróbico influye positivamente en las vías metabólicas de la glucosa. Pero hay pocos estudios sobre el ejercicio aeróbico calisténico y su influencia en pacientes de 40-60 años con T2DM. Objetivo: Medir el efecto terapéutico del ejercicio calisténico en pacientes de mediana edad con obesidad y T2DM. Métodos: Se seleccionó un total de 86 pacientes con T2DM a partir de la exploración física de los empleados de la misma unidad. Se dividieron aleatoriamente entre el grupo de ejercicio y el grupo de control. La intervención de ejercicios duró 16 semanas, con sesiones realizadas de 3 a 5 veces por semana, de 60 a 90 minutos por sesión. Los marcadores evaluados se definieron según la literatura y se verificaron estadísticamente. Resultados: Después de 16 semanas de intervención de ejercicio aeróbico calisténico, en comparación con el grupo de control o antes del experimento, observamos reducciones significativas en las variables VFA (área de grasa visceral), FPG (glucosa en ayunas), Fins (insulina en ayunas), HOMA-IR (evaluación del modelo de homeostasis de resistencia a la insulina), 2hPBG (glucosa postprandial de dos horas) y HbAlc (hemoglobina Alc) del grupo de ejercicio se redujeron significativamente (P<0,01). Conclusión: La intervención de ejercicio aeróbico calisténico puede reducir los niveles de AGV, FPG. FIns, HOMA-HR, 2hPBG y HbAlc en pacientes con T2DM. También se ha comprobado que reduce el contenido de grasa visceral en pacientes ancianos obesos con T2DM, reduciendo el riesgo de obesidad. Nivel de evidencia II; Estudios terapéuticos - investigación de los resultados del tratamiento.

11.
Ciênc. Saúde Colet. (Impr.) ; 27(4): 1653-1667, abr. 2022. tab, graf
Article in Portuguese | LILACS-Express | LILACS | ID: biblio-1374926

ABSTRACT

Resumo Este artigo tem como objetivo apresentar uma metodologia de monitoramento dos procedimentos preconizados no protocolo de atenção ao paciente diabético a partir do indicador de razão entre a oferta e a demanda de exames, segundo nível nacional, macrorregiões, UF e municípios. A prevalência de diabetes mellitus (DM) e suas complicações foi estimada a partir de modelo multinomial. A oferta de procedimentos para DM foi obtida a partir do Sistema de Informações Ambulatoriais (SIA/SUS) e a demanda a partir do número de exames definidos no protocolo como necessários por ano, segundo categorias de risco da doença. A partir disso foi criado o indicador de razão entre oferta e demanda. A inovação que ora apresentamos consiste em analisar conjuntamente a demanda por cuidado ao diabético segundo parâmetros estabelecidos e a oferta de serviços de saúde. A conexão entre o protocolo de tratamento preconizado e a existência do serviço ofertado em relação da demanda de cuidado baseada na prevalência da doença disponibiliza uma ferramenta chave de monitoramento. E, quando analisado conjuntamente ao indicador de razão entre oferta e demanda de procedimentos, essas medidas tornam-se proxy da qualidade da prevenção e atenção ao portador da doença.


Abstract This article aims to present a methodology for monitoring the procedures recommended in the care protocol for diabetic patients, based on the indicator of the ratio between supply and demand for exams, according to Brazil, macro-regions, federative units (FUs), and municipalities. The prevalence of diabetes mellitus (DM) and its complications were estimated using a multinomial model. The offer of DM procedures was obtained from the Ambulatory Information System (SIA/SUS) and the demand from the number of tests defined in the protocol as necessary per year, according to disease risk categories. Based on this, the supply-demand ratio indicator was created. The innovation here consists of analyzing the demand for diabetic care according to established parameters and the supply of health services together. The connection between the recommended treatment protocol and the existence of the service offered concerning the demand for care based on the prevalence of the disease provides a key monitoring tool. And, when analyzed together with the indicator of the ratio between supply and demand for procedures, these measures become a proxy for the quality of prevention and care for patients with the disease.

12.
Article in Spanish | LILACS-Express | LILACS | ID: biblio-1385252

ABSTRACT

RESUMEN: Objetivo: Describir el rol de la Salud Oral en las estrategias nacionales y políticas sanitarias para el manejo integral y control de Diabetes Mellitus Tipo 2 (DM2) en los 38 Estados miembros de la Organización para la Cooperación y Desarrollo Económico (OCDE). Materiales y Método: Se realizó una revisión sistemática exploratoria, siguiendo la pauta PRISMA-ScR. Se incluyeron reportes gubernamentales, guías de práctica clínica, documentos oficiales OMS y OCDE, y artículos identificados en PubMED y LiLACS hasta diciembre de 2020. Se sintetizó: 1) Inclusión de la Salud Oral en planes nacionales o guías clínicas de DM2, 2) Prestaciones y cobertura odontológica para DM2 y 3) Indicadores de salud asociados al control de DM2. Resultados: 84 documentos fueron incluidos. 1) La Salud Oral está incorporada en los planes nacionales de 22 países OCDE para el control de DM2. 2) De estos, 8 garantizan la atención odontológica con alta cobertura para DM2. 3) Países OCDE con alta cobertura odontológica presentan los mejores indicadores de control metabólico de DM2. Conclusiones: En el marco de la Salud Global, países que no tienen integrada la salud oral podrían beneficiarse si incorporan la atención odontológica con cobertura universal en el manejo integral y control de la DM2.


ABSTRACT: Aim: To describe the role of Oral Health in national strategies and health policies for the comprehensive management and control of Type 2 Diabetes Mellitus (T2DM) in the 38 member states of the Organization for Economic Cooperation and Development (OECD). Method: A scoping review was carried out, according to the PRISMA-ScR guideline. Government reports, clinical practice guidelines, official WHO and OECD documents, and review articles identified in PubMED and LiLACS were included up to December 2020. The following were synthesized: 1) Inclusion of Oral Health in national plans or clinical guidelines for DM2, 2) Dental benefits and coverage for DM2 and 3) Health indicators associated with the control of DM2. Results: 84 documents were included. 1) Oral Health is incorporated in the national plans of 22 OECD countries for the control of DM2. 2) Of these, 8 provide dental care with high coverage for DM2. 3) OECD countries with high dental coverage have the best indicators of metabolic control of DM2. Conclusions: In the framework of Global Health, countries that do not have Oral Health integrated could benefit if they add dental care in the comprehensive management and control of DM2.

13.
Rev. Soc. Argent. Diabetes ; 56(1): 19-30, ene. - abr. 2022. ilus
Article in Spanish | LILACS, BINACIS | ID: biblio-1395756

ABSTRACT

Introducción: la enfermedad periodontal (EP) es un factor de riesgo en la génesis y evolución de numerosas enfermedades crónicas sistémicas como la diabetes mellitus (DM). Ambas comparten una evolución compleja y constituyen una relación bidireccional. Objetivos: describir la frecuencia de EP en pacientes adultos con diagnóstico de DM2, así como su gravedad y extensión al momento del diagnóstico inicial, su correlación con variables metabólicas y signos de complicación. Materiales y métodos: estudio transversal. Se recolectaron 626 historias clínicas de pacientes adultos con DM2 en la Ciudad Autónoma de Buenos Aires (CABA) y la Provincia de Buenos Aires. Resultados: la frecuencia de EP para la muestra (n=614) fue del 98% (gingivitis y periodontitis), la relación hombres y mujeres fue de 53/47% respectivamente, y la edad media 57,7±10,4 años. El análisis entre la derivación tardía, los años de antigüedad de la DM y la gravedad no resultaron significativos (p=0,49; p=0,7). Se observó correlación positiva con el mal control metabólico tanto para HbA1c (p=0,02) como para las glucemias en ayunas, y la relación microalbuminuria/creatininuria (p=0,0001). Se encontró relación entre las categorías de cobertura de salud, y la gravedad y extensión de la EP (p=0,0001). Los pacientes sin cobertura de salud presentaron cuadros más severos. Conclusiones: la frecuencia de EP fue altamente significativa en pacientes con DM2. Se evidenció correlación directa y significativa para la HbA1c y la microalbuminuria con respecto a la gravedad y la extensión de la EP, asociada con alteraciones microangiopáticas. Se requieren nuevos estudios sobre el análisis de marcadores metabólicos, de complicación micro y macrovascular en asociación con la EP


Introduction: periodontal disease (PD) is a risk factor in the genesis and evolution of numerous chronic systemic diseases, such as diabetes. Both share a complex evolution constituting a bidirectional relationship. Objectives: to describe the frequency of PD in adult patients diagnosed with type 2 diabetes (T2D), as well as its severity and extension at the time of initial diagnosis, its correlation with metabolic variables and signs of complications. Materials and methods: cross-sectional study; 626 medical records of adult patients with T2D in Autonomous city of Buenos Aires and the province of Buenos Aires. Results: the frequency of PD for the sample (n=614) was 98% (gingivitis and periodontitis), the relationship between men and women was 53/47%, respectively, mean age 57.7±10.4 years. The analysis between late referral, years of diabetes and severity were not significant (p=0.49; p=0.7). A positive correlation was observed with poor metabolic control for both HbA1c (p=0.02) and fasting glycemia, and the microalbuminuria/creatininuria ratio (p=0.0001). A relationship was found between health coverage categories, severity, and extension of PD (p=0.0001). Patients without health coverage presented more severe conditions. Conclusions: the frequency of PD is highly significant in patients with T2D. A direct and significant correlation was found for HbA1c and microalbuminuria with respect to the severity and extension of PD, associated with microangiopathic alterations. New studies are needed on the analysis of metabolic markers of micro and macro vascular complications in association with periodontal disease


Subject(s)
Diabetes Mellitus, Type 2 , Periodontal Diseases , Chronic Disease
14.
Rev. peru. med. exp. salud publica ; 39(1): 55-64, ene.-mar. 2022. tab
Article in Spanish | LILACS-Express | LILACS | ID: biblio-1389928

ABSTRACT

RESUMEN Objetivo. Determinar si existe asociación entre la presencia de diabetes mellitus tipo 2 (DM2) y la duración, dificultad para dormir, y calidad de sueño, en sujetos de 30 a 69 años en Tumbes. Materiales y métodos. Estudio transversal analítico. Las variables dependientes fueron dificultad para dormir (a veces/casi nunca y frecuentemente), duración del sueño (normal, corto y prolongado) y calidad del sueño (buena y mala). La variable independiente fue la presencia de DM2 evaluada usando la prueba de tolerancia oral a la glucosa (no DM2, con DM2 y sin diagnóstico previo, y con DM2 y diagnóstico previo). Se usó modelos de regresión de Poisson para reportar razones de prevalencia (RP) e intervalos de confianza al 95% (IC 95%). Resultados. Se analizaron 1604 individuos, con una edad media de 48,2 años; 50,3% fueron mujeres; 71 (4,4%) tenían DM2 sin diagnóstico previo y 105 (6,5%) tenían DM2 con diagnóstico previo. Según las características del sueño, 12,0% presentó sueño corto y 8,2% presentó sueño prolongado; 3,7% reportó dificultad para dormir, y 19,5% tuvo mala calidad de sueño. En el modelo multivariable, tener DM2 con diagnóstico previo estuvo asociado con dificultad para dormir (RP = 2,20; IC 95%: 1,13-4,27) y mala calidad de sueño (RP = 1,40; IC 95%: 1,05-1,92) comparado con aquellos sin DM2. Conclusiones. Los individuos con DM2 que tenían diagnóstico previo tuvieron mayor probabilidad de presentar dificultad para dormir y mala calidad de sueño. Nuestros resultados sugieren la necesidad de evaluar en forma periódica las características del sueño en pacientes con DM2.


ABSTRACT Objective. To determine if there is an association between type 2 diabetes mellitus (T2DM) and some sleep characteristics: duration, sleep difficulties and quality, in a population aged between 30 and 69 years in Tumbes. Materials and methods. Cross-sectional study. The outcomes were sleep difficulty (sometimes/ almost never vs. frequently), sleep duration (normal, short, and long), and sleep quality (good and bad). The exposure of interest was the presence of T2DM assessed using the glucose tolerance test (without T2DM, with T2DM but without previous diagnosis, and with T2DM and with previous diagnosis). Poisson regression models were used to report prevalence ratio (PR) and 95% confidence intervals (95%CI). Results. A total of 1604 subjects were analyzed and the mean age was 48.2 years; 50.3% were women, 71 (4.4%) had T2DM without a previous diagnosis, and 105 (6.5%) had T2DM with a previous diagnosis. Regarding sleep characteristics, 12.0% had short sleep, 8.2% had long sleep, 3.7% had sleep difficulties, and 19.5% presented poor sleep quality. In a multivariable model, T2DM with previous diagnosis was associated with sleep difficulty (PR= 2.20; 95%CI: 1.13 - 4.27) and bad sleep quality (PR= 1.40; 95%CI: 1.05 - 1.92) compared to those without T2DM. Conclusions. Individuals with previous diagnosis of T2DM had greater probability of presenting sleep difficulties and poor sleep quality. These results suggest the need to evaluate periodically the sleep characteristics of patients with T2DM.

15.
Rev. cir. traumatol. buco-maxilo-fac ; 22(1): 17-21, jan.-mar. 2022. ilus
Article in Portuguese | LILACS, BBO | ID: biblio-1391396

ABSTRACT

A mucormicose é uma infecção fúngica angioinvasiva que afeta uma ampla faixa etária, geralmente imunodeprimidos, sem predileção por gênero ou raça e com alta taxa de mortalidade. Essa infecção inicia se no nariz, devido à inalação dos esporos, podendo-se espalhar pelos seios paranasais, órbita e estruturas intracranianas. As características clínicas incluem parestesia perinasal, celulite periorbitária, rinorréia, obstrução nasal, epistaxe e diminuição de peso. O tratamento efetivo dessa comorbidade compoe uma combinação de manejo clínico e medicamentoso, conjuntamente com desbridamento cirúrgico radical do tecido infectado e/ou necrótico. O caso clínico descrito nesse trabalho refere-se a uma paciente diagnosticada com Mucormicose rino maxilar e diabetes do tipo II, a qual foi submetida a procedimento cirúrgico de hemimaxilectomia do lado esquerdo com posterior reabilitação protética para selamento de comunicação buco-naso-sino-etmoidal... (AU)


Mucormycosis is an angioinvasive fungal infection that affects a wide age group, usually immunocompromised, with no gender or race predilection, and with a high mortality rate. This infection starts in the nose, due to the inhalation of spores, and can spread through the paranasal sinuses, orbit and intracranial structures. Clinical features include perinasal paresthesia, periorbital cellulitis, rhinorrhea, nasal obstruction, epistaxis and weight loss. Effective treatment of this comorbidity comprises a combination of clinical and drug management, together with radical surgical debridement of infected and/or necrotic tissue. The clinical case described in this work refers to a patient diagnosed with Mucormycosis Rhinomaxilla and Type II diabetes, who underwent a surgical procedure of left hemimaxillectomy with subsequent prosthetic rehabilitation for sealing of the bucco nasal-sino-ethmoidal communication... (AU)


La mucormicosis es una micosis angioinvasiva que afecta a un amplio grupo de edad, habitualmente inmunodeprimidos, sin predilección de género ni raza, y con una alta tasa de mortalidad. Esta infección comienza en la nariz, debido a la inhalación de esporas, y puede extenderse a través de los senos paranasales, la órbita y las estructuras intracraneales. Las características clínicas incluyen parestesia perinasal, celulitis periorbitaria, rinorrea, obstrucción nasal, epistaxis y pérdida de peso. El tratamiento eficaz de esta comorbilidad comprende una combinación de manejo clínico y farmacológico, junto con un desbridamiento quirúrgico radical del tejido infectado y / o necrótico. El caso clínico descrito en este trabajo se refiere a una paciente diagnosticada de Mucormicosis Rinomaxilar y diabetes Tipo II, que fue sometida a un procedimiento quirúrgico de hemimaxilectomía izquierda con posterior rehabilitación protésica para sellar la comunicación buco-nasal-sino-etmoidal... (AU)


Subject(s)
Humans , Female , Middle Aged , Paranasal Sinuses/surgery , Surgical Procedures, Operative , Diabetes Mellitus, Type 2 , Mouth/surgery , Mouth Rehabilitation , Mucormycosis , Nasal Obstruction , Infections , Mucorales
16.
Rev. Assoc. Méd. Rio Gd. do Sul ; 66(1): 01022105, 20220101.
Article in Portuguese | LILACS-Express | LILACS | ID: biblio-1400268

ABSTRACT

Introdução: Avaliar o quanto a Retinopatia Diabética (RD) pode interferir na qualidade de vida (QV) e alterar a capacidade de resiliência de pacientes diabéticos tipo 2 que realizam acompanhamento em clínica de referência em cidade no sul do Brasil. Métodos: Participaram 220 pacientes que realizaram o exame padrão ouro para RD (angiorretinografia fluoresceínica-AGF), avaliados entre junho/2015-outubro/2017. Instrumentos utilizados: Whoqol-Breff, Resilience Scale de Wagnild&Young, questionário autoaplicado (dados sociodemográficos, de saúde física e mental) e exames laboratoriais. Resultados: Prevalência de RD 73,3%( 18,76% leve e 81,24% moderada/grave). Pacientes com RD leve apresentaram níveis de glicemia de jejum em média 49,97 (p<0,01,IC 83,27;-16,67) mais elevados que aqueles sem RD e, em média, 20,50 (p=0,01,IC 50,60;-9,58) acima dos com RD moderada/grave. A capacidade de resiliência dos pacientes com RD moderada/grave foi em média 9,32 (p=0,01,IC2,05;16,59) acima daqueles com RD leve. Quanto à QV: domínio psicológico - pacientes com RD moderada/grave obtiveram médias 6,79 (p=0,02,IC-0,72;12,85) acima daqueles com RD leve; domínio social e Whoqol total esse mesmo grupo apresentou médias 9,27 (p=0,04,IC0,21;18,33) e 6,33 (p=0,02,IC1,05;11,60) vezes maiores quando comparados aos - com RD leve. A análise multivariada apresentou RP de 1,030 (IC 1.010 - 1.06) de piora da QV, quando ajustada para idade e glicemia de jejum, em relação aos pacientes com RD leve, quando comparados aos pacientes sem ou com RD moderada/grave. Conclusão: Pacientes com RD leve apresentaram piores níveis glicêmicos, pior capacidade de resiliência e QV quando comparados a pacientes com RD moderada/grave. A hiperglicemia crônica e a dificuldade de lidar com as limitações e mudanças que a RD impõe podem influenciar negativamente na evolução das complicações destes pacientes.


Introduction: To assess to which extent diabetic retinopathy (DR) can interfere with quality of life (QoL) and alter the resilience of patients with type 2 diabetes mellitus followed up by a referral clinic in a city in the South region of Brazil. Methods: Participants of this study were 220 patients who underwent the gold standard test for DR (fluorescein angiography [FA]) and were seen between June 2015 and October 2017. We used the WHOQoLBref and Wagnild & Young's Resilience Scale instruments, as well as a self-administered questionnaire (sociodemographic data, physical and mental health data) and laboratory examinations. Results: There was a prevalence of DR of 73.3% (18.76% of mild cases and 81.24% of moderate/severe cases). Patients with mild DR presented fasting glycemia levels that were on average 49.97 (p<0.01, CI-83.27;-16.67) higher than those without DR, and on average 20.50 (p=0.01, CI-50.60;-9.58) higher than those with moderate/severe DR. The resilience of patients with moderate/severe DR was on average 9.32 (p=0.01, CI2.05;16.59) higher than that of those with mild DR. As to their QoL, in the psychological domain, patients with moderate/severe DR obtained mean scores that were 6.79 (p=0.02,CI-0.72;12.85) higher than those with mild DR; as to the social domain and total WHOQoL scores, the same group presented mean scores 9.27 (p=0.04,CI0.21;18.33) and 6.33 (p=0.02,CI1.05;11.60) times higher when compared to those with mild DR. A multivariate analysis presented a prevalence ratio of 1.030 (CI1.010-1.06) of worsening QoL when adjusted for age and fasting glycemia considering patients with mild DR in comparison to those without DR or with moderate/severe DR. Conclusion: Patients with mild DR presented worse glycemic levels, as well as inferior resilience and QoL when compared to patients with moderate/severe DR. Chronic hyperglycemia and difficulties in coping with limitations and lifestyle changes imposed by DR can negatively influence the progression of complications in these patients.

17.
Rev. bras. med. fam. comunidade ; 17(44): 2428, 20220304. ilus, tab
Article in Portuguese | LILACS, ColecionaSUS | ID: biblio-1380389

ABSTRACT

Introdução: Introdução: Diabetes mellitus tipo 2 é um importante e crescente problema de saúde para todos os países. Objetivo: Este trabalho visa avaliar a qualidade da evidência disponível sobre os fármacos inibidores de sódio-glicose 2 e agonistas de glucagon 1 em pessoas com diabetes mellitus e doença cardiovascular aterosclerótica Métodos: Realizou-se revisão integrativa utilizando as bases de dados MEDLINE via PubMed, Embase via Cochrane Library, Cochrane Library, LILACS via BVS. A pergunta de pesquisa foi estruturada da seguinte forma: população ­ pessoas com diabetes mellitus tipo 2 e doença cardiovascular estabelecida; intervenção ­ tratamento usual exceto insulina + inibidores de sódio-glicose 2 ou tratamento usual exceto insulina + agonistas de glucagon 1; controle - tratamento usual exceto insulina + placebo; desfecho ­ mortalidade geral, mortalidade por causas cardiovasculares, morbidade, efeitos adversos. Resultados: Selecionaram-se dois estudos sobre empagliflozina. Esse medicamento associado ao tratamento usual foi superior ao placebo associado ao tratamento usual no desfecho primário (HR 0,86; IC95% 0,74­0,99; p=0,04), na redução de hospitalização por insuficiência cardíaca (HR 0,65; IC95% 0,50­0,85; p=0,002), da mortalidade cardiovascular (HR 0,62; IC95% 0,49­0,77) e da mortalidade geral (HR 0,68; IC95% 0,57­0,82; p<0,001). No subgrupo de pessoas com diabetes que não usavam insulina, houve benefício com empagliflozina em relação ao desfecho primário (HR 0,79; IC95% 0,64­0,97; DR 2,5; NNT 40) e a mortes de causa cardiovascular (HR 0,61; IC95% 0,44­0,85; DR 2; NNT 49). Houve heterogeneidade entre os subgrupos com benefício de empagliflozina no desfecho primário apenas para aqueles com idade ³65 anos (p=0,01) e hemoglobina glicada <8,5 (p=0,01). Em relação às mortes por causas cardiovasculares, houve diferença (p=0,05) com o uso de empagliflozina reduzindo o risco somente no subgrupo com índice de massa corporal <30. Não houve diferença significativa em relação ao placebo para acidente vascular encefálico fatal e não fatal, tampouco no desfecho composto de acidente vascular encefálico debilitante não fatal e acidente vascular encefálico fatal (HR 0,81; IC95% 0,43­1,50; p=0,50). Houve mais pessoas acometidas por acidente vascular encefálico no grupo intervenção em que a hemoglobina glicada inicial era ≥8,5%, favorecendo o placebo (p=0,01). Conclusões: Os dados encontrados favorecem o benefício de utilizar esse medicamento no Sistema Único de Saúde em pessoas com doenças cardiovasculares. Entretanto, houve heterogeneidade entre grupos populacionais, o que pode ajudar a delinear estratégias de uso para esses medicamentos. São necessários mais estudos para avaliar qual seria o motivo de não haver benefício em desfechos cerebrovasculares isoladamente.


Introduction: Introduction: Type 2 diabetes mellitus is an important and growing health problem worldwide. Objective: This study aims to evaluate the quality of the evidence available on sodium-glucose cotransporter 2 inhibitors and glucagon-like peptide 1 agonists in people with diabetes mellitus and atherosclerotic cardiovascular disease. Methods: This integrative review was performed using the following databases: MEDLINE via PubMed, Embase via Cochrane Library, Cochrane Library, LILACS via VHL. The research question was structured as follows: population ­ people with type 2 diabetes mellitus and established cardiovascular disease; intervention ­ usual treatment, except insulin + sodium-glucose cotransporter 2 inhibitors or usual treatment, except insulin + and glucagon-like peptide 1 agonists; control ­ usual treatment, except insulin + placebo; outcome ­ overall mortality, mortality from cardiovascular causes, morbidity, adverse effects. Results: Two studies on empagliflozin were selected. This drug associated with the usual treatment was superior to placebo associated with the usual treatment in the primary outcome (hazard ratio ­ HR 0.86; 95% confidence interval ­ 95%CI 0.74­0.99; p=0.04), in reducing heart failure hospitalization (HR 0.65; 95%CI 0.50­0.85; p=0.002), in cardiovascular mortality (HR 0.62; 95%CI 0.49­0.77), and in overall mortality (HR 0.68; 95%CI 0.57­0.82; p<0.001). The subgroup of people with diabetes who were not on insulin benefited from using empagliflozin concerning the primary outcome (HR 0.79; 95%CI 0.64­0.97; risk difference ­ RD 2.5; number needed to treat ­ NNT 40) and cardiovascular mortality (HR 0.61; 95%CI 0.44­0.85; RD 2; NNT 49). The analysis of the subgroups showed heterogeneity. Participants aged 65 years or older (p=0.01) and those with glycated hemoglobin lower than 8.5 benefited from empagliflozin in the primary outcome. A difference (p=0.05) related to cardiovascular mortality was found, with the use of empagliflozin reducing the risk only in the subgroup with body mass index <30. No significant difference was identified with respect to placebo for fatal and nonfatal stroke nor for the composite outcome of nonfatal disabling stroke and fatal stroke (HR 0.81; 95%CI 0.43­1.50; p=0.50). More people had strokes in the intervention group in which the initial glycated hemoglobin was ≥8.5%, favoring placebo (p=0.01). Conclusions: The data found suggest the benefit of the Brazilian public health system using this drug in people with cardiovascular diseases. However, the population groups were heterogeneous, which may help outline strategies for using these medications. Further studies are necessary to assess why isolated cerebrovascular outcomes showed no benefit.


Introducción: Diabetes mellitus tipo 2 es un importante y creciente problema de salud para todos los países. Objetivo: Este trabajo busca evaluar la calidad de la evidencia disponible sobre los fármacos Inhibidores del Cotransportador de Sodio-Glucosa 2 y agonistas de Péptido 1 similar al glucagón en personas con diabetes mellitus y enfermedad cardiovascular aterosclerótica. Métodos: Se realizó revisión integrativa utilizando las bases de datos MEDLINE vía PubMed, Embase vía Cochrane Library, Cochrane Library, LILACS vía BVS. La pregunta de investigación fue estructurada de la siguiente manera: población ­ personas con diabetes mellitus tipo 2 y enfermedad cardiovascular establecida; intervención ­ tratamiento usual excepto insulina + inhibidores de sodium-glucose cotransporter-2 o tratamiento usual excepto insulina + agonistas de Péptido 1 similar al glucagón; control ­ tratamiento habitual excepto insulina + placebo; desenlace ­ mortalidad general, mortalidad por causas cardiovasculares, morbilidad, efectos adversos. Resultados: Se seleccionaron dos estudios sobre empagliflozina. Este medicamento asociado al tratamiento habitual fue superior al placebo asociado al tratamiento usual en el resultado primario (HR 0.86; IC95% 0.74­0.99; p=0,04), en la reducción de hospitalización por insuficiencia cardíaca (HR 0.65; IC95% 0.50­0.85; p=0.002), de la mortalidad cardiovascular (HR 0,62; IC95% 0,49­0,77) y de la mortalidad general (HR 0,68; IC95% 0,57­0,82; p=0,001). En el subgrupo de personas con diabetes que no usaban insulina, hubo beneficio con empagliflozina con relación al desenlace primario (HR 0.79; IC95% 0.64­0.97; DR 2.5; NNT 40) y a muertes de causa cardiovascular (HR 0.61; IC95% 0.44­0.85; DR 2; NNT 49). No hubo diferencia significativa con relación al placebo para accidentes cerebrovasculares fatal y no fatal, tampoco en el resultado compuesto de accidente cerebrovascular debilitante no fatal y fatal (HR 0.81; IC95% 0.43­1.50; p=0.50). Hubo más personas acometidas por accidente cerebrovascular en el grupo intervención en que la hemoglobina glicada inicial era un 8,5%, favoreciendo el placebo (p=0.01). Conclusión: Los datos encontrados favorecen el beneficio de utilizar ese medicamento en el Sistema Único de Salud en personas con enfermedad cardiovascular. Entretanto ha habido heterogeneidad entre los grupos de población, lo que puede ayudar a delinear qué estrategias de uso para estos medicamentos. Son necesarios más estudios para evaluar cuál sería el motivo de no haber beneficio en resultados cerebrovasculares aisladamente.


Subject(s)
Cardiovascular Diseases , Diabetes Mellitus, Type 2 , Glucagon-Like Peptide 1 , Sodium-Glucose Transporter 2 Inhibitors
18.
Arch. endocrinol. metab. (Online) ; 66(1): 32-39, Jan.-Feb. 2022. tab
Article in English | LILACS | ID: biblio-1364313

ABSTRACT

ABSTRACT Objetivo: Maturity onset diabetes of the young (MODY) patients have clinical heterogeneity as shown by many studies. Thus, often it is misdiagnosed to type 1 or type 2 diabetes(T2DM). The aim of this study is to evaluate MODY mutations in adult T2DM patients suspicious in terms of MODY, and to show clinical and laboratory differences between these two situations. Subjects and methods: In this study, we analyzed 72 type 2 diabetic patients and their relatives (35F/37M) who had been suspected for MODY and referred to genetic department for mutation analysis. The gene mutations for MODY have been assessed in the laboratory of Marmara University genetics. Totally 67 (32F/35M; median age 36.1) diabetic patients were analyzed for 7 MODY mutations. Twelve patients who have uncertain mutation (VUS) were excluded from study for further evaluation. MODY(+) (n:30) patients and T2DM patients (n:25) were compared for clinical and laboratory parameters. Results: In MODY(+) subjects, mutations in GCK (MODY 2) (n:12; 40%) were the most common followed by HNF4A (MODY 1) (n:4; 13.3%). Diabetes diagnosis age was younger in MODY(+) group but not statistically significant. Sixty-six percent of MODY(+) subjects had diabetes history at 3-consecutive generations in their family compared with 28% of T2DM patients statistically significant (p:0.006). Gender, BMI, C-peptide, HbA1c, lipid parameters, creatinine, GFR, microalbuminuria, vitamin D and calcium were not statistically different between the groups. Conclusion: According to present study results, MODY mutation positivity is most probable in young autoantibody (-) diabetic patients diagnosed before 30 years of age, who have first degree family history of diabetes.


Subject(s)
Humans , Adult , Diabetes Mellitus, Type 2/diagnosis , Diabetes Mellitus, Type 2/genetics , C-Peptide , Hepatocyte Nuclear Factor 1-alpha/genetics , Mutation/genetics
19.
Arch. endocrinol. metab. (Online) ; 66(1): 68-76, Jan.-Feb. 2022. tab, graf
Article in English | LILACS | ID: biblio-1364297

ABSTRACT

ABSTRACT The lowest dosage of empagliflozin (10 mg) showed similar benefits on glycated hemoglobin (HbA1c) level, body weight, blood pressure, and total and cardiovascular mortality in comparison with the highest available dose (25 mg) in the EMPAREG trial. These findings have not been clearly demonstrated for canagliflozin and dapagliflozin. The objective was to compare the effect of different doses of SGLT2 inhibitors commercially available in Brazil on HbA1c and body weight of patients with type 2 diabetes. MEDLINE, Cochrane and Embase databases were searched from inception until 11th October 2021 for randomized controlled trials of SGLT2 inhibitors in type 2 diabetes patients, lasting at least 12 weeks. HbA1c and body weight variations were described using standard mean difference. We performed direct and indirect meta-analysis, as well as a meta-regression with medication doses as covariates. Eighteen studies were included, comprising 16,095 patients. In the direct meta-analysis, SGLT2 inhibitors reduced HbA1c by 0.62% (95% CI −0.66 to −0.59) and body weight by 0.60 kg (95% CI −0.64 to −0.55). In the indirect meta-analysis, canagliflozin 300 mg ranked the highest regarding reductions in HbA1c and body weight. The remaining medications and dosages were clinically similar, despite some statistically significant differences among them. Canagliflozin 300 mg seems to be more potent in reducing HbA1c and body weight in patients with type 2 diabetes. The remaining SGLT2 inhibitors at different doses lead to similar effects for both outcomes. Whether these glycemic and weight effects are reflected in lower mortality and cardiovascular events is still uncertain and may be a topic for further studies.


Subject(s)
Humans , Diabetes Mellitus, Type 2/drug therapy , Sodium-Glucose Transporter 2 Inhibitors/therapeutic use , Hypoglycemic Agents/therapeutic use , Blood , Body Weight , Brazil , Glycated Hemoglobin A/analysis , Randomized Controlled Trials as Topic , Canagliflozin/therapeutic use
20.
Rev. estomatol. Hered ; 32(1): 36-41, ene.-mar 2022. tab, graf
Article in Spanish | LILACS-Express | LILACS | ID: biblio-1389060

ABSTRACT

RESUMEN Objetivo : Obtener la prevalencia de Porphyromonas gingivalis en pacientes con Diabetes Mellitus tipo 2. Material y método : Este estudio fue de tipo descriptivo transversal. El tipo de muestreo fue por conveniencia y la muestra estuvo conformada por 50 pacientes diagnosticados con Diabetes Mellitus tipo 2. Los grados de Periodontitis se clasificaron de acuerdo a los criterios de Papapanou et al., año 2018. Se obtuvo la prevalencia de Porphyromonas gingivalis por PCR de punto final. La muestra se tomó en dos sitios con mayor profundidad de bolsa. El control de la glucosa se evaluó midiendo el porcentaje de hemoglobina glicosilada. El análisis estadístico fue realizado mediante el Software InfoStat 2019, y se empleó la Prueba de Independencia mediante el estadístico Chi-Cuadrado con un 5% de significancia. Resultados : Se obtuvo una prevalencia del 30 % de P. gingivalis. Un 56% de la muestra presentó un grado 0 de periodontitis un, 24 % grado I, 8% presentó un grado II y un 12%, un grado III. No se encontró diferencia estadísticamente significativa entre la presencia de P. gingivalis y los grados de periodontitis. Conclusión: La prevalencia de P. gingivalis en la muestra de pacientes con diabetes tipo 2 es de un 30% y su distribución es independiente del grado de enfermedad periodontal.


ABSTRACT Objective : To obtain the prevalence of Porphyromonas gingivalis in patients with type 2 Diabetes Mellitus. Material and method : This study was descriptive and cross-sectional. The type of sampling was for convenience and the sample consisted of 50 patients diagnosed with Type 2 Diabetes Mellitus. The degrees of Periodontitis were classified according to the criteria of Papapanou et al., (2018). The prevalence of Porphyromonas gingivalis was obtained by end-point PCR. The sample was taken in two places with greater depth of pocket. Glucose control was evaluated by measuring the percentage of glycosylated hemoglobin. The statistical analysis was performed using the InfoStat 2019 Software and the Independence Test was used using the Chi-Square statistic with 5% significance. Results : A 30% prevalence of P. gingivalis was obtained. 56% of the sample had a grade 0 of periodontitis, 24% grade I, 8% had grade II and 12% had grade III. No statistically significant difference was found between the presence of P. gingivalis and the degrees of periodontitis. Conclusions: The prevalence of P. gingivalis in the sample of patients with type 2 diabetes is 30% and its distribution is independent of the degree of periodontal disease.

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