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1.
Cambios rev. méd ; 23(2): 981, 30/11/2024. tabs
Article in Spanish | LILACS | ID: biblio-1579263

ABSTRACT

La hiperglucemia inducida por corticoides es un aumento anormal de la glucosa en sangre debido al uso de glucocorticoides (GC). Su incidencia varía según la dosis, la forma de administración y factores individuales como la edad, el IMC y los antece-dentes familiares de diabetes. Según la ADA, entre el 10% de los pacientes hospita-lizados reciben corticoides, y el 56-86% de estos pueden desarrollar hiperglucemia inducida por corticoides, incluso sin diabetes previa. Los glucocorticoides afectan el metabolismo de carbohidratos al disminuir la absor-ción de glucosa debido a la resistencia a la insulina en el hígado, músculos y otros tejidos periféricos. Los efectos varían según el tipo y la dosis de los glucocorticoides; los de acción intermedia (prednisona) causan principalmente hiperglucemia pos-tprandial, mientras que los de acción prolongada (dexametasona) generan hiperglu-cemia persistente más allá de las 24 horas.En cuanto al tratamiento, los objetivos deben individualizarse según las comorbili-dades, esperanza de vida, adherencia al tratamiento y riesgo de hipoglucemia. Se recomienda un rango objetivo de glucosa de 140 a 180 mg/dL para la mayoría de los pacientes hospitalizados, con ajustes según la condición clínica del paciente, el tipo de glucocorticoide y la dosis recibida. En casos leves, se pueden usar hipogluce-miantes orales como metformina, sulfonilureas, inhibidores de DPP-4 o agonistas del receptor GLP-1. En hiperglucemias más significativas, la insulina es el tratamiento de elección.Esta revisión busca ofrecer una guía completa para el diagnóstico, manejo y trata-miento de estos pacientes, con el objetivo de reducir el riesgo de complicaciones a corto y largo plazo, tanto en el entorno hospitalario como ambulatorio.En conclusión, la identificación de pacientes en riesgo, el monitoreo adecuado de los niveles de glucosa y el ajuste oportuno del tratamiento son fundamentales para minimizar complicaciones y mejorar los resultados clínicos,


Corticosteroid-induced hyperglycemia is an abnormal increase in blood glucose due to the use of glucocorticoids (GCs). Its incidence varies depending on the dose, the method of adminis-tration, and individual factors such as age, BMI, and family history of diabetes. According to the ADA, 10 to 15% of hospitalized patients receive corticosteroids, and 56 to 86% of them may develop corticosteroid-induced hyperglycemia, even without prior diabetes. Glucocorticoids affect carbohydrate metabolism by decreasing glucose absorption due to insulin resistance in the liver, muscle, and other peripheral tissues. The effects vary depending on the type and dose of glucocorticoids; intermediate-acting ones (prednisone) mainly cause postpran-dial hyperglycemia, while long-acting ones (dexamethasone) generate persistent hyperglycemia beyond 24 hours.Regarding treatment, the objectives must be individualized according to comorbidities, life ex-pectancy, adherence to treatment and risk of hypoglycemia. A target glucose range of 140 to 180 mg/dL is recommended for most hospitalized patients, with adjustments based on the patient's clinical condition, type of glucocorticoid, and dose received. In mild cases, oral hypoglycemic agents such as metformin, sulfonylureas, DPP-4 inhibitors, or GLP-1 receptor agonists may be used. In more significant hyperglycemia, insulin is the treatment of choice.This review aims to provide a comprehensive guide for the diagnosis, management and treat-ment of these patients, with the aim of reducing the risk of short- and long-term complications, both in the inpatient and outpatient setting.In conclusion, the identification of patients at risk, adequate control of glucose levels and timely adjustment of treatment are essential to minimize complications and improve clinical outcomes.


Subject(s)
Humans , Male , Female , Diabetes Mellitus , Glucocorticoids/therapeutic use , Glucose , Hyperglycemia/diagnosis , Hypoglycemic Agents , Insulin , Tertiary Healthcare , Dexamethasone , Prednisone , Ecuador , Glucagon-Like Peptide-1 Receptor Agonists , Insulin/therapeutic use , Metformin
2.
Int. j. morphol ; 42(1): 205-215, feb. 2024. ilus, tab
Article in English | LILACS | ID: biblio-1528814

ABSTRACT

SUMMARY: This study assessed the effects of Acacia Senegal (AS) combined with insulin on Na+/K+-ATPase (NKA) activity and mRNA expression, serum glucose, renal function, and oxidative stress in a rat model of diabetic nephropathy (DN). Sixty rats were equally divided into six groups: normal control, normal+AS, diabetic (DM), DM+insulin, DM+AS, and DM+insulin+AS groups. Diabetes mellitus (type 1) was induced by a single injection of streptozotocin (65 mg/kg), and insulin and AS treatments were carried until rats were culled at the end of week 12. Serum glucose and creatinine levels, hemoglobin A1c (HbA1c) were measured. Renal homogenate levels of NKA activity and gene expression, malondialdehyde, superoxide dismutase (SOD), catalase and reduced glutathione (GSH) were evaluated as well as kidney tissue histology and ultrastructure. Diabetes caused glomerular damage and modulation of blood and tissue levels of creatinine, glucose, HbA1c, malondialdehyde, NKA activity and gene expression, SOD, catalase and GSH, which were significantly (p<0.05) treated with AS, insulin, and insulin plus AS. However, AS+insulin treatments were more effective. In conclusion, combined administration of AS with insulin to rats with DN decreased NKA activity and gene expression as well as oxidative stress, and improved glycemic state and renal structure and function.


Este estudio evaluó los efectos de Acacia senegal (AS) combinada con insulina sobre la actividad Na+/K+- ATPasa (NKA) y la expresión de ARNm, la glucosa sérica, la función renal y el estrés oxidativo en un modelo de nefropatía diabética (ND) en ratas. Sesenta ratas se dividieron equitativamente en seis grupos: control normal, normal+AS, diabética (DM), DM+insulina, DM+AS y DM+insulina+AS. La diabetes mellitus (tipo 1) se indujo mediante una única inyección de estreptozotocina (65 mg/kg), y los tratamientos con insulina y AS se llevaron a cabo hasta que las ratas fueron sacrificadas al final de la semana 12. Se midieron niveles séricos de glucosa y creatinina, hemoglobina A1c (HbA1c). Se evaluaron los niveles de homogeneizado renal de actividad NKA y expresión génica, malondialdehído, superóxido dismutasa (SOD), catalasa y glutatión reducido (GSH), así como la histología y ultraestructura del tejido renal. La diabetes causó daño glomerular y modulación de los niveles sanguíneos y tisulares de creatinina, glucosa, HbA1c, malondialdehído, actividad y expresión génica de NKA, SOD, catalasa y GSH, los cuales fueron tratados significativamente (p<0,05) con AS, insulina e insulina más AS. Sin embargo, los tratamientos con AS+insulina fueron más efectivos. En conclusión, la administración combinada de AS con insulina a ratas con DN disminuyó la actividad de NKA y la expresión genética, así como el estrés oxidativo, y mejoró el estado glucémico y la estructura y función renal.


Subject(s)
Animals , Male , Rats , Plant Extracts/administration & dosage , Sodium-Potassium-Exchanging ATPase/drug effects , Diabetic Nephropathies/drug therapy , Acacia/chemistry , Superoxide Dismutase , Glycated Hemoglobin/analysis , Plant Extracts/pharmacology , Gene Expression , Rats, Sprague-Dawley , Sodium-Potassium-Exchanging ATPase/genetics , Oxidative Stress , Microscopy, Electron, Transmission , Disease Models, Animal , Drug Therapy, Combination , Glycemic Control , Insulin/administration & dosage , Kidney/drug effects , Malondialdehyde
3.
Article in English | WPRIM | ID: wpr-1013467

ABSTRACT

Objective@#To determine the efficacy of metformin and insulin in the management of gestational diabetes mellitus (GDM). @*Methodology@#Randomized controlled trials (RCT) were retrieved from the databases. All references cited in the articles were also searched by hand to identify additional publications. Studies included were limited to trials on metformin and insulin in the management of GDM in singleton pregnancies. Four RCTs were analyzed in the study. The risk of bias was assessed using Preferred Reporting Items for Systematic reviews and Meta-Analyses Cochrane Collaboration’s tool (Rob 2). Random effects meta-analysis was carried out to pool the data. All analyses were conducted in Review Manager 5.3.5 (2014). @*Results@#Meta-analysis of four RCT involving 807 participants (405 were treated with metformin and 402 were treated with insulin) shows that there was no significant difference between metformin and insulin in achieving glycemic control as to fasting blood sugar (FBS), postprandial blood glucose (PPBG), and glycosylated hemoglobin, mean difference (MD) −0.43 (95% confidence interval [CI] −2.77–1.91; P = 0.72), MD −2.13 (95% CI −5.16–0.90, P = 0.17), MD −0.09 (95% CI −0.20–0.02, P = 0.10), respectively. For maternal outcomes, there was a statistically significant 69% decreased risk of hypoglycemia in the metformin group (risk ratio [RR] 0.31, 95% CI 0.20–0.49; P < 0.001). There was no difference in terms of risk of preterm birth (RR 1.11, 95% CI 0.75–1.64, P = 0.60); hypertensive disorders (RR 1.06, 95% CI 0.71–1.60, P = 0.77); polyhydramnios (RR 1.04, 95% CI 0.51–2.14, P = 0.91); and risk of cesarean delivery (RR 0.90, 95% CI 0.75–1.08, P = 0.27). For neonatal outcomes, there was statistically significant 34% reduction on the risk of neonatal hypoglycemia (RR 0.66, 95% CI 0.46–0.94; P = 0.02) in the metformin group. There was no statistical difference in terms of mean birthweight (MD − 81.34, 95% CI −181.69–19.02, P = 0.11). Metformin has decreased the risk of newborns weighing more than 4000 g, babies with birthweight >90th percentile by 27% (RR 0.73, 95% CI 0.28–1.90, P = 0.52), and 20% (RR 0.80, 95% CI 0.54–1.18,P = 0.26), respectively, but these were not statistically significant. There was no significant difference in terms of risk of birthweight <10th percentile (RR 1.17, 95% CI 0.60–2.31, P = 0.65); APGAR <7 (RR 1.17, 95% CI 0.65–2.08, P = 0.60), birth trauma (RR 0.77, 95% CI 0.23–2.58, P = 0.67), and jaundice requiring phototherapy RR 1.04, 95% CI 0.66–1.65, P = 0.85). Neonatal intensive care unit admission (RR 0.89, 95% CI 0.64–1.23, P = 0.48), respiratory distress syndrome (RR 0.73, 95% CI 0.36–1.50, P = 0.39), transient tachypnea (RR 0.78, 95% CI 0.27–2.19, P = 0.63), and any congenital anomaly (RR 0.58, 95% CI 0.20–1.67, P = 0.31) were decreased in the metformin group but was not statistically significant. @*Conclusion@#There was no significant difference between metformin and insulin in achieving glycemic control as to FBS and PPBG among patients with GDM. There was a statistically significant reduction in the risk of maternal and neonatal hypoglycemia in the use of metformin.


Subject(s)
Diabetes, Gestational , Glycemic Control , Insulin , Metformin
4.
Rev. latinoam. enferm. (Online) ; 32: e4167, 2024. tab
Article in English | LILACS, BDENF | ID: biblio-1560141

ABSTRACT

Objective: to understand the experiences with diabetes mellitus management of people who use insulin, in order to identify possible factors that may influence adherence to self-care and thus define their learning demands for diabetes self-management. Method: this is a qualitative study carried out using individual semi-structured interviews online. The interviews were recorded, transcribed and evaluated using Atlas.ti® software by means of Thematic Content Analysis, using the Health Beliefs Model as a theoretical framework. Results: 11 people living with diabetes and using insulin took part in the study. Four categories were identified: understanding diabetes, how to deal with diabetes, difficulties related to insulin use and emotional adaptation. Conclusion: the perception of the severity of the disease, its complications and the benefits of adhering to treatment positively influences adherence to self-care behaviors. Although the study participants have lived with diabetes for many years, they are not exempt from difficulties related to insulin use and disease management, reinforcing the importance of continuing health education. In this sense, the findings of this study guide important educational themes to be worked on by health professionals to promote autonomy in diabetes self-management.


Objetivo: comprender las experiencias en el manejo de la diabetes mellitus de personas que utilizan insulina, para identificar posibles factores que pueden influir en la adhesión al autocuidado y, así, definir sus demandas de aprendizaje para la autogestión de la diabetes. Método: se trata de una investigación cualitativa realizada mediante entrevistas semi-estructuradas individuales en la modalidad online . Las entrevistas fueron grabadas, transcritas y evaluadas en el software Atlas.ti ® mediante el Análisis de Contenido Temático, utilizando como marco teórico el Modelo de Creencias en Salud. Resultados: participaron 11 personas que conviven con diabetes, usuarias de insulina. Se identificaron cuatro categorías: entendimiento sobre la diabetes, cómo lidiar con la diabetes, dificultades relacionadas con el uso de la insulina y adaptación emocional. Conclusión: la percepción sobre la severidad de la enfermedad, sus complicaciones, y de los beneficios de adherirse al tratamiento influye positivamente en la adhesión a los comportamientos de autocuidado. A pesar de que los participantes del estudio han convivido muchos años con la diabetes, no están exentos de dificultades relacionadas con el uso de la insulina y el manejo de la enfermedad, reforzando la importancia de la educación en salud continuada. En este sentido, los hallazgos de este estudio orientan temas educativos importantes a ser trabajados por los profesionales de la salud para la promoción de la autonomía en la autogestión de la diabetes.


Objetivo: compreender as experiências com o manejo do diabetes mellitus de pessoas que utilizam a insulina, para identificar possíveis fatores que podem influenciar na adesão ao autocuidado e, assim, definir suas demandas de aprendizado para a autogestão do diabetes. Método: trata-se de pesquisa qualitativa realizada por meio de entrevistas semiestruturadas individuais na modalidade online . As entrevistas foram gravadas, transcritas e avaliadas no software Atlas.ti ® por meio da Análise de Conteúdo Temática, utilizando-se como referencial teórico o Modelo de Crenças em Saúde. Resultados: participaram 11 pessoas que convivem com diabetes, usuárias de insulina. Foram identificadas quatro categorias: entendimento sobre o diabetes, como lidar com o diabetes, dificuldades relacionadas ao uso da insulina e adaptação emocional. Conclusão: a percepção sobre a severidade da doença, suas complicações, e os benefícios de aderir ao tratamento influencia positivamente na adesão aos comportamentos de autocuidado. Apesar dos participantes do estudo conviverem há muitos anos com o diabetes, eles não são isentos de dificuldades relacionadas ao uso da insulina e ao manejo da doença, reforçando a importância da educação em saúde continuada. Nesse sentido, os achados deste estudo norteiam temas educacionais importantes a serem trabalhados pelos profissionais da saúde para promoção da autonomia na autogestão do diabetes.


Subject(s)
Self Care , Health Education , Qualitative Research , Diabetes Mellitus , Self-Management , Insulin
5.
Rev. cienc. cuidad ; 21(1): 85-94, 2024.
Article in Spanish | LILACS, BDENF, COLNAL | ID: biblio-1553645

ABSTRACT

Introducción: El uso de mHealth puede mejorar la adherencia a el automonitoreo con glucometría capilar (GC) en la transición del ámbito hospitalario al ambulatorio. Objetivo: evaluar la adherencia al automonitoreo con GC de los pacientes con Diabetes Tipo 2 (DM2) vinculados a un programa de educación usuarios de mHealth (ClouDi) comparado con el programa de educación y seguimiento presencial usual. Materiales y métodos: Estudio longitudinal prospectivo. Se analizaron pacientes con DM2 valorados por consulta de educación de diabetes con indicación de tratamiento con insulina al egreso hospitalario. Se analizaron dos grupos: uno con seguimiento presencial y otro vinculado a un programa educativo y uso de ClouDi. Resultados: De los 86 pacientes (44% de sexo femenino, 41 usuarios ClouDi, edad promedio 58.8 ± 11.2 años, con una media de duración de la diabetes de 7.8 ± 7.4 años), 53.6% se encontraban en estrato 2, el 92.9% pertenecían al régimen contributivo, el 42.9% con educación básica primaria y 51.2% empleados. Fue considerada la adherencia a la GC al realizar y registrar 3 o más mediciones por día en los pacientes de ClouDi fue mayor comparado con los pacientes en cuidado usual (64.4% vs 28.2%, p <0.001), independiente de las variables sociodemográficas. Conclusión: El uso de ClouDi se asoció a mayor adherencia a automonitoreo con GC comparado con seguimiento presencial independiente de variables sociodemográficas. El uso de esta tecnología podría ser útil en el seguimiento de pacientes usuarios de insulina al egreso hospitalario


Introduction: The use of mHealth can improve adherence to self-monitoring blood Glucose (SMBG) in the transition from hospital to outpatient setting. Objective: To evaluate adherence to self-monitoring with GC in patients with type 2 diabetes (T2DM) linked to an mHealth user education program (ClouDi) compared with the usual face-to-face education and follow-up program. Materials and Methods: Prospective longitudinal study. Patients with T2D assessed by diabetes education counseling with an indication for insulin treatment at hospital discharge were analyzed. Two groups were analyzed: one with face-to-face follow-up and another linked to an educational program and use of ClouDi. Results: Of the 86 patients (44% female, 41 ClouDi users, mean age 58.8 ± 11.2 years, with a mean duration of diabetes of 7.8 ± 7.4 years), 53.6% were in stratum 2, 92.9% belonged to the contributory system, 42.9% with basic pri-mary education and 51.2% were employed. Compliance with the SMBG was considered if 3 or more measurements per day were taken and recorded, was higher in ClouDi patients com-pared to usual care patients (64.4% vs. 28.2%, p <0.001), independent of sociodemographic variables.Conclusions: The use of ClouDi was associated with greater adherence to SMBG compared to in-person follow-up, independent of sociodemographic variables. The use of this technology may be useful in monitoring insulin-using patients after hospital discharge


Introdução: A utilização do mHealth pode melhorar a adesão à automonitorização com glico-metria capilar (GC) na transição do hospital para o ambulatório. Objetivo: avaliar a adesão ao automonitoramento com GC de pacientes com Diabetes Tipo 2 (DM2) vinculados a um progra-ma de educação de usuários de mHealth (ClouDi) em comparação com o programa habitual de educação e acompanhamento presencial. Materiais e métodos: Estudo prospectivo longitudi-nal. Foram analisados pacientes com DM2 avaliados por consulta de educação em diabetes com indicação de tratamento insulínico na alta hospitalar. Foram analisados dois grupos: um com acompanhamento presencial e outro vinculado a um programa educativo e uso do ClouDi. Re-sultados: Dos 86 doentes (44% do sexo feminino, 41 utilizadores do ClouDi, idade média 58,8 ± 11,2 anos, com duração média da diabetes de 7,8 ± 7,4 anos), 53,6% encontravam-se no estra-to 2, 92,9% pertenciam ao regime contributivo, 42,9% com ensino fundamental básico e 51,2% empregados. A adesão ao GC foi considerada quando realizada e registrada 3 ou mais medidas por dia em pacientes ClouDi foi maior em comparação aos pacientes em cuidados habituais (64,4% vs 28,2%, p <0,001), independente das variáveis sociodemográficas. Conclusão: O uso do ClouDi esteve associado à maior adesão ao automonitoramento com GC em comparação ao acompanhamento presencial independente das variáveis sociodemográficas. O uso dessa tecnologia pode ser útil no monitoramento de pacientes usuários de insulina na alta hospitalar


Subject(s)
Diabetes Mellitus, Type 2 , Technology , Education , Insulin
6.
Rev. chil. endocrinol. diabetes ; 17(1): 16-22, 2024.
Article in Spanish | LILACS | ID: biblio-1525785

ABSTRACT

INTRODUCCIÓN: El aumento global de la prevalencia de la diabetes ha generado un interés creciente en terapias alternativas, incluyendo el uso de edulcorantes no nutritivos (ENN) en reemplazo de la sacarosa. En el mercado chileno la sucralosa y la estevia son los más utilizados. OBJETIVO: Describir los efectos de la ingesta de estevia y sucralosa sobre los resultados metabólicos y apetito-saciedad en sujetos con diabetes DM1 y DM2, considerando la evidencia disponible. MÉTODOS: Revisión descriptiva. Se realizó búsqueda en PubMed, WoS y Scopus utilizando los siguientes términos y palabras clave: "stevia rebaudiana", "blood glucose", "insulin", "metabolic processes", "sucralose", "diabetes type 1 and 2", "appetite" o "satiety". El análisis de los estudios seleccionados fue discrecional. RESULTADOS: La evidencia sobre la respuesta glicémica e insulínica es variable, con algunos estudios sugiriendo beneficios en la sensibilidad a la insulina y otros reportando efectos nulos. Además, se identificó que los efectos de los ENN en los receptores de sabor dulce y la respuesta hormonal de incretinas, juegan un papel clave en la homeostasis de la glucosa. En cuanto a apetito-saciedad, los ENN podrían no tener el mismo poder saciante que la sacarosa, potencialmente estimulando el apetito y el consumo excesivo. Es fundamental destacar que la heterogeneidad en la metodología de los estudios revisados, en aspectos como el tamaño muestral, la duración, la dosis y la vía de administración de los edulcorantes, dificulta la obtención de conclusiones firmes. CONCLUSIÓN: Aunque la ingestión de estevia y sucralosa ha revelado efectos beneficiosos en el metabolismo glucídico, se subraya la necesidad de llevar a cabo más investigaciones para comprender más a fondo los efectos metabólicos y sobre el apetito-saciedad, especialmente en la población con diabetes adulta y pediátrica.


INTRODUCTION: The global increase in the prevalence of diabetes has sparked a growing interest in alternative therapies, including the use of non-nutritive sweeteners (NNS) as a substitute for sucrose. In the Chilean market, sucralose and stevia are the most widely used. OBJECTIVE: To describe the effects of stevia and sucralose intake on metabolic outcomes and appetite-satiety in individuals with type 1 (DM1) and type 2 (DM2) diabetes, considering the available evidence. METHODS: Descriptive review. A search was conducted on PubMed, WoS, and Scopus using the following terms and keywords: "stevia rebaudiana," "blood glucose," "insulin," "metabolic processes," "sucralose," "diabetes type 1 and 2," "appetite," or "satiety." The analysis of selected studies was discretionary. RESULTS: Evidence regarding glycemic and insulin response is variable, with some studies suggesting benefits in insulin sensitivity and others reporting null effects. Additionally, it was identified that the effects of NNS on sweet taste receptors and the hormonal response of incretins play a key role in glucose homeostasis. Regarding appetite-satiety, NNS may not have the same satiating power as sucrose, potentially stimulating appetite and excessive consumption. It is crucial to highlight that the heterogeneity in the methodology of reviewed studies, including sample size, duration, dose, and route of administration of sweeteners, complicates drawing firm conclusions. CONCLUSION: Although the ingestion of stevia and sucralose has demonstrated beneficial effects on carbohydrate metabolism, there is a pressing need for further research to better understand the metabolic effects and their impact on appetite-satiety, especially in the adult and pediatric diabetic population.


Subject(s)
Humans , Diabetes Mellitus, Type 1 , Diabetes Mellitus, Type 2 , Non-Nutritive Sweeteners/administration & dosage , Appetite/drug effects , Satiation/drug effects , Sucrose/administration & dosage , Blood Glucose/drug effects , Stevia , Non-Nutritive Sweeteners/pharmacology , Insulin , Metabolism/drug effects
7.
Rev. Soc. Argent. Diabetes ; 57(3): 111-112, sept.-dic.2023.
Article in Spanish | LILACS, BINACIS | ID: biblio-1577888

ABSTRACT

la diabetes mellitus 1 (DM1) es una enfermedad autoinmune órgano-específica que resulta de la destrucción crónica inmunomediada de las células ß productoras de insulina, afecta a más de 14 millones de personas en el mundo. Es un proceso progresivo caracterizado por una fase preclínica de evolución asintomática variable, con la aparición de múltiples autoanticuerpos que preceden al desarrollo de la disglucemia y, posteriormente, por una fase clínica con los síntomas cardinales típicos que contribuyen al diagnóstico


Subject(s)
Diabetes Mellitus, Type 1 , Autoantibodies , Autoimmune Diseases , Insulin
8.
Rev. Soc. Argent. Diabetes ; 57(3): 121-139, sept.-dic.2023. ilus
Article in Spanish | LILACS, BINACIS | ID: biblio-1577964

ABSTRACT

El músculo esquelético (ME), debido a su significativo tamaño y función, representa el tejido que más energía demanda durante la actividad física. En respuesta a esta demanda, ha desarrollado un sistema altamente especializado para almacenar energía y satisfacer sus necesidades metabólicas. Para alcanzar esta eficacia en el almacenamiento y abastecimiento de nutrientes, en particular de glucosa, el ME depende de una incorporación nutricional eficaz. La relación entre la insulina y el ejercicio ilustra un ejemplo de equilibrio complejo y de adaptación, en el que dos fuerzas reguladoras metabólicas se contraponen en contextos cambiantes. El aumento de la insulina en la sangre comunica al ME la presencia de niveles elevados de glucosa plasmática. Aunque la insulina se secreta tras la ingesta y es la principal hormona que aumenta el almacenamiento de glucosa y ácidos grasos en forma de glucógeno y triglicéridos, respectivamente, el ejercicio es una situación fisiológica que exige la movilización y oxidación de las reservas energéticas. Por lo tanto, durante la actividad física, los efectos del almacenamiento inducidos por la insulina deben mitigarse median-te la inhibición de la liberación de insulina durante el ejercicio, y la activación de los mecanismos sistémicos y locales de movilización de energía. La interacción de la insulina con su receptor da lugar a una compleja cascada de señales que promueve la captación de glucosa y la síntesis de glucógeno. Uno de los efectos más estudiados de la señalización insulínica en él ME es el incremento en la captación de la glucosa muscular. Tanto la insulina como la actividad contráctil aumentan la entrada de glucosa en el ME, proceso que involucra la translocación y fusión de vesículas que contienen el transportador de glucosa GLUT-4 en la membrana (GSV: vesículas de almacenamiento de GLUT-4). Así, los estímulos mencionados provocan el traslado de las GSV hacia la superficie celular, donde se fusionan, lo que aumenta la presencia de GLUT-4 y favorece la captación de glucosa del entorno intersticial. Este proceso de fusión se conoce como "exocitosis de GLUT-4". Tras la actividad física, es necesario reponer las reservas de energía consumidas, en especial, el glucógeno en el músculo. El proceso se ve favorecido por un aumento de la sensibilidad a la insulina en los músculos previamente ejercitados, lo que facilita la utilización de la glucosa en la resíntesis del glucógeno. Este trabajo de revisión abarca los nuevos actores de la cascada de señalización de la insulina, el transporte de GLUT-4 y las interacciones insulina-ejercicio durante y después de la actividad física. Además, explora los efectos del entrenamiento físico regular sobre la acción de la insulina (AU)


Skeletal muscle (SM) due to its significant size and function, represents the most energetically demanding tissue during physical activity. Based on this demand, SM has developed a highly specialized system for energy storage to meet its metabolic requirements. To achieve efficiency in nutrient storage and supply, particularly glucose, SM relies on effective nutritio-nal incorporation. The relationship between insulin and exercise illustrates a complex example of balance and adaptation, wherein two regulatory metabolic forces counteract within changing contexts.The increase in blood insulin communicates the presence of elevated glucose levels in the plasma to SM. Although insulin is secreted post-intake and is the primary hormone respon-sible for increasing the storage of glucose and fatty acids in the form of glycogen and triglycerides, respectively, exercise constitutes a physiological situation that demands the mobili-zation and oxidation of energy reserves. Consequently, during physical activity, it is necessary to mitigate the storage effects promoted by insulin. This is achieved by inhibiting insulin release during exercise and activating systemic and local mecha-nisms for energy mobilization.The interaction of insulin with its receptor results in a complex cascade of signals that promote glucose uptake and glycogen synthesis. One of the most studied effects of insulin signalingin SM is the increase in muscular glucose uptake. Both insulin and contractile activity augment glucose entry into SM, a process involving the translocation and fusion of vesicles containing the glucose transporter GLUT-4 in the membrane (GSVs: GLUT-4 storage vesicles). Thus, these stimuli trigger the movement of GSVs to the cell surface, where they fuse, increasing the presence of GLUT-4 and promoting the up-take of glucose from the interstitial environment. This fusion process is known as "GLUT-4 exocytosis".Post-physical activity, replenishing the consumed energy reserves, especially muscle glycogen, becomes necessary. This process is enhanced by an increase in insulin sensitivity in pre-viously exercised muscles, facilitating the utilization of glucose in glycogen resynthesis. This review encompasses new contributors in the insulin signaling cascade, GLUT-4 transport, and insulinexercise interactions during and after physical activity. Additionally, it explores the effects of regular physical training on insulin action(AU)


Subject(s)
Muscle, Skeletal , Insulin Resistance , Exercise , Insulin , Muscles
9.
Rev. méd. Minas Gerais ; 33: e-33203, Jan.-Dez. 2023.
Article in English, Portuguese | LILACS | ID: biblio-1552666

ABSTRACT

INTRODUÇÃO: A diabetes é uma doença com alta incidência na população mundial. Uma das alternativas de tratamento para essa doença é a utilização da insulinoterapia por via subcutânea, diariamente, na maioria das vezes, aplicada pelo próprio paciente. Com isso, pacientes não treinados adequadamente na autoadministração da insulina podem evoluir com complicações do seu uso. OBJETIVOS: Descrever as evidências de forma a explicitar as dificuldades dos pacientes com diabetes no processo de autoadministração de insulina. MÉTODOS: Realizou-se uma revisão da literatura com o método scoping review, nas bases LILACS, CINAHL, PubMed, biblioteca Cochrane, SCOPUS, SciELO, Biblioteca Digital de Teses e Dissertações USP, Busca Integrada USP e banco de Teses CAPES. Foram incluídos artigos que tinham como participantes usuários de insulina; que explorassem a dificuldade apresentada pelos pacientes; e que estudaram o processo da autoaplicação de insulina. Resultados: Foram selecionados 26 estudos publicados entre 1998 e 2020. A análise apontou 12 categorias acerca das dificuldades encontradas no processo de autoaplicação, das quais as mais relevantes foram: dor, medo, dificuldade em conhecer a dose correta e/ou ajustá-la baseado na glicemia capilar, desconhecimento sobre a técnica de aplicação e alteração funcional. CONCLUSÃO: A dor foi a objeção mais encontrada nos estudos, o que reflete a relação dela com as outras dificuldades. A dificuldade em conhecer a dose e/ou ajustá-la de acordo com a glicemia capilar foi apresentada em quantidade considerável, de modo a inferir a deficiência de condutas de educação em saúde na atenção primária à saúde.


INTRODUCTION: Diabetes is a disease with a high incidence in the world population. One of the treatment alternatives for this disease is the use of subcutaneous insulin therapy, daily, most often applied by the patients themselves. As a result, patients that are not properly trained in insulin self-administration may develop complications from its use. OBJECTIVES: Describe the evidence in order to explain the difficulties of patients with diabetes in the process of self-administration of insulin. METHODS: A literature review was carried out using the scoping review method, in LILACS, CINAHL, PubMed, Cochrane Library, SCOPUS, SciELO, Biblioteca Digital de Teses e Dissertações USP, Busca Integrada USP, and CAPES Thesis Bank. We included articles that had insulin users as participants; that explored the difficulty presented by patients; and that studied the process of insulin self-application. RESULTS: Twenty-six studies published between 1998 and 2020 were selected. The analysis pointed to 12 categories about the difficulties encountered in the self-application process, of which the most relevant were: pain, fear, difficulty in knowing the correct dose and/or adjusting it based on capillary glycemia, lack of knowledge about the application technique, and functional alteration. Conclusion: Pain was the most common objection found in the studies, which reflects its relationship with other difficulties. The difficulty in knowing the dose and/or adjusting it according to capillary blood glucose was presented in a considerable amount, in order to infer the deficiency of health education conducts in Primary Health Care.


Subject(s)
Humans , Self Administration/adverse effects , Insulin/administration & dosage , Self Care , Health Knowledge, Attitudes, Practice , Patient Medication Knowledge , Treatment Adherence and Compliance , Injections, Subcutaneous , Insulin/therapeutic use
10.
Rio de Janeiro; s.n; s.n; 20230000. 151 p. ilus, tab, graf.
Thesis in Portuguese | LILACS, BDENF | ID: biblio-1580955

ABSTRACT

INTRODUÇÃO: O uso de tecnologias no âmbito da educação em Diabetes tem se mostrado como uma importante ferramenta no fortalecimento do aprendizado e no desenvolvimento de competências. Sabendo que o processo educativo pode ser realizado a partir de diferentes modalidades, esta pesquisa estuda a aplicação de uma inovadora estratégia de simulação, denominada Prática Deliberada em Ciclos Rápidos, para treinar pacientes com Diabetes no procedimento de autoadministração de insulina. Além disso, a pesquisa avança para verificar evidências de validade de um instrumento que mensura satisfação e autoconfiança adaptando-o para a população estudada. Por fim, desenvolve-se um chatbot como forma de auxílio educacional na autoadministração de insulina. OBJETIVOS GERAIS: 1) Verificar evidências de validade da "escala de satisfação dos estudantes e autoconfiança com a aprendizagem" para o contexto de treinamento por simulação do tipo Prática Deliberada em Ciclos Rápidos de pacientes com diabetes mellitus em autoadministração de insulina; 2) Avaliar a Prática Deliberada em Ciclos Rápidos como uma tecnologia educacional e sua influência na performance de pacientes com diabetes mellitus na técnica de autoadministração de insulina; 3) Descrever o desenvolvimento de um protótipo de chatbot destinado a auxiliar pacientes com Diabetes Mellitus na técnica de autoadministração de insulina. MÉTODO: Estudo multi-métodos concomitante de abordagem quantitativa, cuja execução ocorreu em três fases: 1) Evidência de validade psicométrica da escala de "Satisfação do Aprendiz e Autoconfiança na Aprendizagem" no contexto de treinamento por simulação do tipo Prática Deliberada em Ciclos Rápidos de pacientes com diabetes mellitus em autoadministração de insulina. Realizou-se análise fatorial confirmatória e calculou-se a consistência interna da escala a partir dos valores de Ômega de McDonald e Alfa de Cronbach; 2) estudo quase experimental do tipo antes e depois de uma intervenção em grupo único. Aplicou-se pré-teste, pós teste e a escala de satisfação e autoconfiança em amostra de pacientes de dois ambulatórios localizados no Rio de Janeiro, RJ, Brasil. A intervenção da pesquisa foi o treinamento por simulação do tipo Prática Deliberada em Ciclos Rápidos no contexto de autoadministração de insulina. Foram realizadas comparações das porcentagens de acertos entre os testes e verificada diferença estatística a partir do teste de McNemar, considerando o nível de significância de 5%. Também foi calculado o tamanho de efeito da intervenção por meio do Odds Ratio e medida D de Cohen. Os dados de Satisfação e Autoconfiança foram verificados a partir de medidas de tendência central; 3) Estudo metodológico para desenvolvimento de um protótipo de chatbot que auxilie o processo educativo para a autoadministração de insulina em pacientes com Diabetes. O estudo seguiu as etapas de construção de Chatbot na modalidade de ciclo de vida de software. RESULTADOS: 103 pacientes foram treinados. A Escala de Satisfação do Aprendiz e Autoconfiança na Aprendizagem obteve bons resultados psicométricos com índices de ajuste (CFI e TLI) acima de 0,95 e medida de erro (RMSEA) abaixo de 0,05. As cargas fatoriais estavam acima de 0,4 e as medidas de R2 acima de 0,2. Em relação à consistência interna, o valor de Ômega de McDonald foi de 0,806 para a subescala de satisfação e de 0,881 para a subescala de autoconfiança. Os participantes mostraram-se satisfeitos e autoconfiantes com moda e mediana de valores 5. Quanto à performance, a taxa de acertos no pré-teste foi de 52,8% e no pós teste foi de 94,3% (p<0,001). O tamanho de efeito verificado pela medida D de Cohen foi de 1,55. O Chatbot recebeu o nome de Lina e foi construído em dois eixos principais: jornada de administração de insulina com seringa e a jornada de administração com caneta de insulina. CONCLUSÃO: Observa-se uma melhora na performance na técnica de autoadministração de insulina, com tamanho de efeito muito grande da intervenção. Na perspectiva do paciente, observou-se alto grau de satisfação e autoconfiança. Infere-se, portanto, que a intervenção com simulação pode ser aplicada como uma ferramenta para a educação em diabetes e pode contribuir para o autocuidado, gerando prevenção de complicações e aumento do manejo do diabetes. Ademais, a Lina chatbot pode ser utilizada como uma ferramenta online que auxilia a manutenção dos conhecimentos adquiridos nos treinamentos, fornecendo todo o passo-a-passo para uma correta administração de insulina.


INTRODUCTION: The use of technologies in Diabetes education has proven to be an important tool in strengthening learning and developing skills. Knowing that the educational process can be done using different modalities, this research studies the application of an innovative simulation strategy, called Rapid Cycle Deliberate Practice, to train patients with Diabetes in the insulin self-administration procedure. Furthermore, the research advances to verify evidence of validity of an instrument that measures satisfaction and self-confidence, adapting it to the population studied. Finally, a chatbot is developed as a form of educational assistance in insulin self-administration. GENERAL OBJECTIVES: 1) Verify evidence of validity of the "student satisfaction and self-confidence with learning scale" for the context of Rapid Cycle Deliberate Practice simulation training for patients with diabetes mellitus in self-administration of insulin; 2) Evaluate Rapid Cycle Deliberate Practice as an educational technology and its influence on the performance of patients with diabetes mellitus in the insulin self-administration technique; 3) Describe the development of a chatbot prototypes designed to assist patients with Diabetes Mellitus in the technique of self-administration of insulin. METHOD: Concomitant multi-method study with a quantitative approach, carried out in three phases: 1) Evidence of psychometric validity of the "Learner Satisfaction and Self-Confidence in Learning" scale in the context of Rapid Cycle Deliberate Practice simulation training for patients with diabetes mellitus in self-administration of insulin. Confirmatory factor analysis was run and the internal consistency of the scale was calculated based on the McDonald Omega and Cronbach's Alpha values; 2) quasi-experimental study before and after a single group intervention. The pre-test, post-test and the satisfaction and self-confidence scale were applied to a sample of patients from two outpatient clinics located in Rio de Janeiro, RJ, Brazil. The research intervention was the Rapid Cycle Deliberate Practice simulation training in the context of insulin self-administration. Comparisons were made of the percentages of correct answers between the tests and a statistical difference was verified using the McNemar test, considering a significance level of 5%. The effect size of the intervention was also calculated using the Odds Ratio and Cohen's D measure. Satisfaction and Self-Confidence data were verified using central tendency measures; 3) Methodological study to develop a chatbot prototype that assists the educational process for insulin self-administration in patients with Diabetes. The study followed the stages of building a Chatbot in the software life cycle modality. RESULTS: 103 patients were trained. The Learner Satisfaction and Self-Confidence in Learning Scale obtained good psychometric results with fit indices (CFI and TLI) above 0.95 and error measurement (RMSEA) below 0.05. The factor loadings were above 0.4 and the R2 measures above 0.2. Regarding internal consistency, the McDonald Omega value was 0.806 for the satisfaction subscale and 0.881 for the self-confidence subscale. Participants were satisfied and selfconfident with mode and median values of 5. Regarding performance, the success rate in the pre-test was 52.8% and in the post-test it was 94.3% (p<0.001). The effect size verified by Cohen's D measure was 1.55. The Chatbot was named after Lina and was built on two main axes: the insulin administration journey with a syringe and the insulin administration journey with an insulin pen. CONCLUSION: An improvement in performance in the insulin selfadministration technique was observed, with a very large effect size of the intervention. From the patient's perspective, a high degree of satisfaction and self-confidence was observed. It is therefore inferred that the intervention with simulation training can be applied as a tool for diabetes education and can contribute to self-care, preventing complications and increasing diabetes management. Furthermore, Lina chatbot can be used as an online tool that helps maintain the knowledge acquired in training, providing all the step-by-step instructions for correct insulin administration.


Subject(s)
Self Administration , Simulation Training , Injections, Subcutaneous , Insulin , Psychometrics , Self Care , Biomedical Technology , Diabetes Mellitus
11.
Rev. enferm. Cent.-Oeste Min ; 13: 4993, jun. 2023.
Article in Portuguese | LILACS, BDENF | ID: biblio-1537216

ABSTRACT

Objetivo: Analisar a relação entre os níveis de adesão às recomendações de boas práticas em insulinoterapia e as métricas de controle glicêmico em pacientes com diabetes mellitus. Métodos: Estudo descritivo, transversal e quantitativo, realizado com 102 pacientes com diabetes mellitus. A coleta de dados ocorreu por meio de entrevista semiestruturada e, em caráter complementar, com dados obtidos dos prontuários. Aplicaram-se quatro instrumentos de coleta: I) formulário de caracterização sociodemográfica e clínica, II) recordatório de orientações sobre insulinoterapia, III) folha de registro da automonitorização da glicemia capilar e IV) formulário de registro das métricas de avaliação do controle glicêmico. Resultados: Houve associação estatística significativa entre nível de não adesão (100%) às recomendações em insulinoterapia e tempo no alvo estimado ≤ 70%, assim como entre 80% de não adesão e desvio padrão ≥ 50 mg/dl. Conclusão: Esses achados validam que a não adesão às recomendações de boas práticas de insulinoterapia contribui para o descontrole glicêmico.


Objective: To analyze the relation between adherence levels to good practice recommendations for insulin therapy and glycemic control metrics in patients with diabetes mellitus. Methods: A descriptive, cross-sectional, quantitative study was conducted with 102 patients with diabetes mellitus. Data were collected by means of semi-structured interviews and complemented by information obtained from medical records. Participants answered four collection instruments: I) a sociodemographic and clinical characterization form, II) a reminder of insulin therapy guidelines, III) a capillary blood glucose self-monitoring record sheet and IV) a record form of glycemic control assessment metrics. Results: Results showed a statistically significant association between non-adherence level (100%) to insulin therapy recommendations with estimated time on target ≤ 70% and between non-adherence (80%) and standard deviation ≥ 50 mg/dl. Conclusion: These findings corroborate that non-adherence to good insulin therapy recommendations contribute to a lack of glycemic control


Objetivo: Analizar la relación entre los niveles de adherencia a las recomendaciones de buenas prácticas en insulinoterapia y las métricas de control glucémico en pacientes con diabetes mellitus. Métodos: estudio descriptivo, transversal y cuantitativo, realizado con 102 pacientes con diabetes mellitus. Para larecolección de datos se utilizaron entrevistas semiestructuradas y, de forma complementaria, se obtuvieron datos de las historias clínicas. Se aplicaron cuatro instrumentos de recolección: I) formulario de caracterización sociodemográfica y clínica, II) recordatorio de pautas de insulinoterapia, III) formulario de autocontrol de glucemia capilar y IV) formulario de registro de métricas de evaluación del control glucémico. Resultados: hubo una asociación estadísticamente significativa entre el nivel de no adherencia (100%) a las recomendaciones de insulinoterapia y el tiempo estimado ≤ 70%; así como entre el 80% de no adherencia y la desviación estándar ≥ 50 mg/dl. Conclusión: estos hallazgos evidencian que la no adherencia a las recomendaciones de buenas prácticas de insulinoterapia contribuye a la falta de control glucémico


Subject(s)
Humans , Male , Female , Good Manipulation Practices , Treatment Adherence and Compliance , Glycemic Control , Insulin
12.
Acta méd. costarric ; 65(2): 65-76, abr.-jun. 2023. tab
Article in Spanish | LILACS, SaludCR | ID: biblio-1556681

ABSTRACT

Resumen Objetivo: Caracterizar un grupo de mujeres universitarias costarricenses con síndrome de ovario poliquístico mediante una evaluación clínica y bioquímica. Métodos: Estudio observacional-descriptivo en que participaron 160 mujeres costarricenses con edades comprendidas entre los 17 y 28 años con el fin de identificar posibles asociaciones al síndrome de ovario poliquístico. Se estudiaron algunas de sus características físicas y parámetros clínicos, como sobrepeso, acné, hirsutismo, abortos espontáneos y trastornos menstruales, junto con parámetros bioquímicos, tales como glucosa, perfil lipídico, insulina, testosterona total y TSH, entre otros. Los datos fueron analizados aplicando estadística descriptiva. La prueba t-Student se utilizó para comparar los promedios de las variables con distribución normal, mientras que la prueba de Mann-Whitney se realizó para variables no paramétricas. Un valor de p < 0,05 se consideró como significativo. Los coeficientes de Spearman se utilizaron para determinar los niveles de correlación entre las diferentes variables del estudio. Resultados: Las mujeres con síndrome de ovario poliquístico presentaron valores significativamente más altos en relación con las mujeres sin el síndrome en las variables de peso (p = 0,003), el índice de masa corporal (p < 0,001), así como de la concentración sanguínea de testosterona total (p < 0,001), LDL- colesterol (p = 0,020), triglicéridos (p < 0,001) y el índice de Castelli (p < 0,001). La concentración de HDL-colesterol (p < 0,001) fue más alta en las mujeres sin el síndrome. Además, se observó una proporción más alta de mujeres con el síndrome que presentaban resistencia a la insulina (p = 0,007), la relación LH/ FSH > 2,8 (p = 0,009), hirsutismo (p = 0,001), trastornos menstruales (p=0,029) y obesidad (p=0,014) en comparación con las mujeres sin el síndrome. Conclusiones: El hiperandrogenismo, la resistencia a la insulina, la concentración de lípidos alterada e índices de Castelli elevados son los parámetros bioquímicos más prevalentes en la muestra de mujeres costarricenses con síndrome de ovario poliquístico. La ejecución de proyectos con perfiles bioquímicos más amplios junto con pruebas de ultrasonido son los nuevos retos para futuras investigaciones del síndrome de ovario poliquístico en Costa Rica.


Abstract Aim: Describe some clinical findings and biochemical characterization of a sample of Costa Rican university women with polycystic ovarian syndrome. Methods: Observational-descriptive study where 160 Costa Rican women between 17 and 28 years old participated. Some physical characteristics and clinical parameters (overweight, acne, hirsutism, spontaneous abortions, menstrual disorders, among others) and biochemical parameters (glucose, lipid profile, insulin, total testosterone, TSH, among others) associated with the syndrome were studied. Data was analyzed applying descriptive statistics. The t-Student test was used to compare the means of the variables with normal distribution, while the Mann-Whitney test was performed for non-parametric variables. A p value < 0.05 was considered significant. Spearman's coefficients were used to determine the levels of correlation between the different study variables. Results: Women with Polycystic Ovarian Syndrome presented significantly higher values in relation to women without the syndrome in the variables of weight (p = 0.003), body mass index (p < 0.001), as well as blood total testosterone concentration (p < 0.001), LDL-cholesterol (p = 0.020), triglycerides (p < 0.001) and the Castelli index (p < 0.001). HDL-cholesterol concentration (p < 0.001) was significantly higher in women without the Syndrome. In addition, there was a significantly higher proportion of women with the syndrome who had insulin resistance (p = 0.007), LH/FSH ratio > 2.8 (p = 0.009), hirsutism (p = 0.001), menstrual disorders (p=0.029) and obesity (p=0.014) compared to women without the syndrome. Conclusions: Hyperandrogenism, insulin resistance, altered lipid concentrations and high Castelli Indexes are the most prevalent biochemical parameters in the sample of Costa Rican women with Polycystic Ovarian Syndrome. The execution of projects with broader biochemical profiles together with ultrasound tests are the new challenges for future research on Polycystic Ovarian Syndrome in Costa Rica.


Subject(s)
Humans , Female , Adult , Polycystic Ovary Syndrome/diagnosis , Students , Costa Rica , Insulin/therapeutic use , Obesity
13.
Enferm. foco (Brasília) ; 14: 1-7, mar. 20, 2023. fig
Article in Portuguese | LILACS, BDENF | ID: biblio-1428842

ABSTRACT

Objetivo: Analisar as formas de descarte correto do resíduo doméstico advindo da insulinoterapia e elaborar uma tecnologia para educação aos pacientes (cartilha). Métodos: Estudo descritivo e exploratório, do tipo revisão integrativa. O levantamento das publicações foi realizado entre os meses de julho a dezembro de 2021, a partir das bases de dados Literatura Latino-Americana em ciências da saúde (Lilacs), Scientific Electronic Library Online (Scielo) e Biblioteca Virtual em Saúde (BVS), utilizando como descritores: Diabetes Mellitus; Insulina; Gerenciamento de Resíduos. Resultados: Identificou-se que a orientação a pessoa com Diabetes Mellitus quanto ao descarte correto de agulhas, seringas, lancetas, fitas reagentes, entre outros é deficiente e que a falta de legislação brasileira específica para resíduos de saúde produzidos em residências é o principal problema para o gerenciamento inadequado dos resíduos de serviços de saúde. A partir dos achados foi possível desenvolver uma tecnologia para educação a pessoas em uso de insulina. Conclusão: Há necessidade de investir em ações de orientação e prevenção, para reforçar aos usuários os cuidados no descarte dos resíduos de serviços de saúde. A capacitação dos profissionais da saúde possibilita o repasse de orientações adequadas e consistentes aos usuários, visando a proteção de quem produz os resíduos, dos coletores e do meio ambiente. (AU)


Objective: To analyze the forms of correct disposal of domestic waste from insulin therapy and develop a technology for patient education (booklet). Methods: Descriptive and exploratory study, integrative review type. The survey of publications was conducted between July and December 2021, from the Latin American Literature in Health Sciences (Lilacs), Scientific Electronic Library Online (Scielo) and Virtual Health Library (VHL) databases, using the following descriptors: Diabetes Mellitus; Insulin; Waste Management. Results: It was identified that the guidance to people with Diabetes Mellitus regarding the correct disposal of needles, syringes, lancets, reagent strips, among others is deficient and that the lack of specific Brazilian legislation for health care waste produced in households is the main problem for the inadequate management of health care waste. From the findings it was possible to develop a technology for education of people using insulin. Conclusion: There is a need to invest in guidance and prevention actions, to reinforce to users the care in the disposal of health services waste. The training of health professionals enables the transfer of appropriate and consistent guidance to users, aiming to protect those who produce waste, the collectors and the environment. (AU)


Objetivo: Analizar las formas de eliminación correcta de los desechos domésticos resultantes de la terapia con insulina y desarrollar una tecnología para la educación del paciente (cuaderno). Métodos: Estudio descriptivo y exploratorio, del tipo revisión integradora. El relevamiento de publicaciones se realizó entre julio y diciembre de 2021, a partir de las bases de datos Literatura Latinoamericana en Ciencias de la Salud (Lilacs), Biblioteca Científica Electrónica en Línea (Scielo) y Biblioteca Virtual en Salud (BVS), utilizando como descriptores: Diabetes Mellitus; Insulina; Gestión de residuos. Resultados: Se identificó que la orientación a las personas con Diabetes Mellitus sobre el correcto desecho de agujas, jeringas, lancetas, tiras reactivas, entre otros, es deficiente y que la falta de legislación brasileña específica para los desechos sanitarios producidos en los domicilios es el principal problema por la gestión inadecuada de los residuos sanitarios. Con base en los hallazgos, fue posible desarrollar una tecnología para educar a las personas que usan insulina. Conclusión: Existe la necesidad de invertir en acciones de orientación y prevención, para reforzar la atención de los usuarios en la eliminación de los residuos de los servicios de salud. La formación de los profesionales de la salud permite transmitir orientaciones adecuadas y coherentes a los usuarios, con el objetivo de proteger a los productores de residuos, a los recolectores y al medio ambiente. (AU)


Subject(s)
Diabetes Mellitus , Waste Management , Insulin
14.
Online braz. j. nurs. (Online) ; Online braz. j. nurs. (Online);22: e20236601, 01 jan 2023. tab
Article in English, Portuguese | LILACS, BDENF | ID: biblio-1413582

ABSTRACT

OBJETIVO: Analisar a correlação entre a consulta de enfermagem e o cumprimento de ações de autocuidado e práticas seguras em insulinoterapia por pessoas com diabetes. MÉTODO: Estudo observacional, retrospectivo e analítico. Analisaram-se características sociodemográficas e clínicas e acertos em questionário com 16 itens sobre práticas seguras em insulinoterapia, aplicado na primeira e segunda consulta de enfermagem. RESULTADOS: Constatou-se aumento significativo de acertos no questionário nos aspectos relacionados à insulinoterapia na segunda consulta (14,22±1,59), em comparação com a primeira (9,24±3,13) (p<0,001), sugerindo melhoria do autocuidado e da adesão às práticas seguras em insulinoterapia. CONCLUSÃO: Houve melhora do cumprimento de ações de autocuidado e práticas seguras em insulinoterapia, após as consultas de enfermagem, mostrando que essa intervenção é eficaz para promoção do tratamento insulínico adequado.


OBJECTIVE: To analyze the correlation between nursing consultation and the execution of self-care actions and safe practices in insulin therapy by people with diabetes. METHOD: Observational, retrospective, and analytical study. Sociodemographic and clinical characteristics and correct answers in a questionnaire with 16 items on safe practices in insulin therapy, applied in the first and second nursing consultations, were analyzed. RESULTS: There was a significant increase in the number of correct answers in the questionnaire regarding aspects related to insulin therapy in the second consultation (14.22±1.59) compared to the first (9.24±3.13) (p<0.001), suggesting improvement in self-care and adherence to safe practices in insulin therapy. CONCLUSION: There was an improvement in the execution of self-care actions and safe practices in insulin therapy after the nursing consultations, showing that this intervention effectively promotes adequate insulin treatment.


Subject(s)
Humans , Male , Female , Middle Aged , Office Nursing , Diabetes Mellitus , Patient Safety , Insulin/therapeutic use , Nursing Services , Self Care , Retrospective Studies
15.
Zhonghua fu chan ke za zhi ; Zhonghua fu chan ke za zhi;(12): 508-515, 2023.
Article in Chinese | WPRIM | ID: wpr-985671

ABSTRACT

Objective: To analyze the difference in blood uric acid levels between patients with polycystic ovary syndrome (PCOS) and healthy women of childbearing age, and to investigate the correlation between body composition and blood uric acid levels. Methods: A total of 153 eligible childbearing age patients with PCOS treated at Tianjin Medical University General Hospital from January 2018 to March 2022 were selected, and 153 healthy women with normal menstruation were selected as the control group. Fasting blood uric acid levels were measured by venous blood test, and body composition was measured by a body composition analyzer. Group comparisons were made to analyze the correlation between body composition and blood uric acid levels. Results: The incidence of hyperuricemia was higher in patients with PCOS than that in the control group [30.1% (46/153) vs 2.0% (3/153)], with a statistically significant difference (χ2=44.429, P<0.001). Blood uric acid level was also significantly higher in patients with PCOS than that in the control group [(371±98) vs (265±67) μmol/L; t=11.170, P<0.001]. Among PCOS patients, there were statistically significant differences in weight, body mass index (BMI), body fat mass, skeletal muscle mass, percent body fat, lean body weight, fat mass/lean body weight, percent skeletal muscle, and visceral fat level between the hyperuricemia group and the normal blood uric acid group (all P<0.001), but no significant difference was observed in waist-hip ratio (P=0.348). The following body composition indicators: weight, BMI, waist-hip ratio, body fat mass, skeletal muscle mass, percent body fat, visceral fat level, lean body weight, and fat mass/lean body weight in all subjects, the PCOS patients and the control group, were positively correlated with blood uric acid levels (all P<0.01). The blood uric acid level in PCOS obese patients was higher than that in non-obese PCOS patients, and the difference was statistically significant [(425±83) vs (336±91) μmol/L; t=6.133, P<0.001]. The blood uric acid level in central obesity PCOS patients was also higher than that in non-central obesity PCOS patients [(385±95) vs (299±79) μmol/L], the difference was statistically significant (t=4.261, P<0.001). The blood uric acid level in normal-weight obese PCOS patients was higher than that in normal-weight non-obese PCOS patients [(333±73) vs (277±54) μmol/L], and the difference was statistically significant (t=2.848, P=0.006). Blood uric acid levels in normal-weight [(315±74) vs (255±67) μmol/L], overweight [(362±102) vs (276±57) μmol/L], and obese PCOS patients [(425±83) vs (303±74) μmol/L] were all higher than those in the corresponding control groups, with statistically significant differences (all P<0.001). Conclusions: PCOS patients have a higher incidence of hyperuricemia than healthy women of childbearing age. Blood uric acid levels are closely correlated with body composition indicators, such as weight, BMI, waist-hip ratio, body fat mass, skeletal muscle mass, percent body fat, and visceral fat level. Body composition analysis of women with PCOS could help identify potentially obese people more accurately and carry out individualized treatment, thereby reducing the risk of metabolic abnormalities.


Subject(s)
Humans , Female , Polycystic Ovary Syndrome/complications , Uric Acid , Hyperuricemia/complications , Insulin , Body Composition/physiology , Obesity/complications , Body Mass Index
16.
Article in Chinese | WPRIM | ID: wpr-986995

ABSTRACT

OBJECTIVE@#To prepare vitamin E polyethylene glycol 1000 succinate (TPGS)-modified insulin-loaded liposomes (T-LPs/INS) and evaluate its safety, corneal permeability, ocular surface retention and pharmacokinetics in rabbit eyes.@*METHODS@#The safety of the preparation was investigated in human corneal endothelial cells (HCECs) using CCK8 assay and live/dead cell staining. In the ocular surface retention study, 6 rabbits were randomized into 2 equal groups for application of fluorescein sodium dilution or T-LPs/INS labeled with fluorescein in both eyes, which were photographed under cobalt blue light at different time points. In the cornea penetration test, another 6 rabbits divided into 2 groups for application of Nile red diluent or T-LPs/INS labeled with Nile red in both eyes, after which the corneas were harvested for microscopic observation. In the pharmacokinetic study, 2 groups of rabbits (n=24) were treated with eye drops of T-LPs/INS or insulin, and the aqueous humor and cornea were collected at different time points for measurement of insulin concentrations using enzyme linked immunosorbent assay. DAS2 software was used to analyze the pharmacokinetic parameters.@*RESULTS@#The prepared T-LPs/INS showed good safety in cultured HCECs. Corneal permeability assay and fluorescence tracer ocular surface retention assay demonstrated a significantly higher corneal permeability of T-LPs/INS with a prolonged drug residence in the cornea. In the pharmacokinetic study, insulin concentrations in the cornea at 6, 15, 45, 60, and 120 min (P < 0.01) and in the aqueous humor at 15, 45, 60, and 120 min after dosing were significantly higher in T-LPs/INS group. The changes in insulin concentrations in the cornea and aqueous humor were consistent with a two-compartment model in T-LPs/INS group and with the one-compartment model in the insulin group.@*CONCLUSION@#The prepared T-LPs/INS shows an improved corneal permeability, ocular surface retention capacity and eye tissue concentration of insulin in rabbits.


Subject(s)
Humans , Animals , Rabbits , Insulin , Liposomes , Endothelial Cells , Lipopolysaccharides , Vitamin E , Cornea , Fluorescein
17.
Zhongguo zhenjiu ; (12): 60-66, 2023.
Article in Chinese | WPRIM | ID: wpr-969948

ABSTRACT

OBJECTIVE@#To observe the effect of electroacupuncture (EA) at different frequencies on learning and memory functions, as well as the relevant proteins of brain insulin signal transduction pathway in Alzheimer's disease (AD) mice and explore the effect mechanism of EA in treatment of AD.@*METHODS@#Seventy-two SPF Kunming male mice were randomized into a blank group, a sham-operation group, a model group, a 2 Hz EA group, a 15 Hz EA group and a 30 Hz EA group, 12 mice in each one. In the model group and each EA group, AD model were established by the injection with streptozotocin (ST2) solution (8 mg/kg) into the left lateral ventricles. In the sham-operation group, 0.9% sodium chloride solution of the same volume was injected into the left lateral ventricles. After successful modeling, in each EA group, EA was applied at "Baihui" (GV 20), "Dazhui" (GV 14) and "Shenshu" (BL 23) with corresponding frequencies, once daily. One course of EA intervention consisted of 7 treatments and 2 courses were given totally at interval of 1 day. After modeling and intervention, Morris water maze test was conducted for the mice of each group. Using immunohistochemistry and Western blot method, the protein expression of insulin receptor (IR), insulin receptor substrate-1 (IRS-1) and phosphatidylinositol 3-kinase (PI3K) was detected in the hippocampal of the mice after intervention.@*RESULTS@#Compared with the blank group, in the model group, the 2 Hz, 15 Hz and 30 Hz EA groups, the escape latency and the first time of crossing the platform were all extended (P<0.01), and the number of crossing the platform was reduced (P<0.01) after modeling. When compared with the blank group, the escape latency and the first time of crossing the platform were all extended (P<0.01), and the number of crossing the platform was reduced (P<0.01) in the model group after intervention. In the 2 Hz, 15 Hz and 30 Hz EA groups, the escape latency and the first time of crossing the platform were all shortened (P<0.01), and the number of crossing the platform was increased (P<0.05, P<0.01) after intervention when compared with the model group. The escape latency and the first time of crossing the platform were all shortened (P<0.01, P<0.05), and the number of crossing the platform was increased (P<0.05) in the 15 Hz and 30 Hz EA groups in comparison with the 2 Hz EA group. The protein expression levels of IR, IRS-1 and PI3K were reduced in the model group when compared with those of the blank group (P<0.01, P<0.05); and these protein expression levels were increased in the 15 Hz and 30 Hz EA groups compared with the model group (P<0.05, P<0.01). Compared with the 2 Hz EA group, the protein expression levels of IR, IRS-1 and PI3K were all elevated in the 15 Hz and 30 Hz EA groups (P<0.05).@*CONCLUSION@#The learning and memory function of AD mice may be improved through regulating brain insulin signaling transconduction pathway with electroacupuncture, and electroacupuncture at 15 Hz and 30 Hz obtains the overall better effect compared with the intervention at 2 Hz.


Subject(s)
Animals , Male , Mice , Alzheimer Disease/therapy , Electroacupuncture , Hippocampus/metabolism , Insulin/metabolism , Phosphatidylinositol 3-Kinases/metabolism , Signal Transduction
18.
Zhongguo Zhong Yao Za Zhi ; (24): 1032-1042, 2023.
Article in Chinese | WPRIM | ID: wpr-970575

ABSTRACT

Based on transcriptome sequencing technology, the mouse model of prediabetes treated with Huangjing Qianshi Decoction was sequenced to explore the possible mechanism of treating prediabetes. First of all, transcriptome sequencing was performed on the normal BKS-DB mouse group, the prediabetic model group, and the Huangjing Qianshi Decoction treatment group(treatment group) to obtain differentially expressed genes in the skeletal muscle samples of mice. The serum biochemical indexes were detected in each group to screen out the core genes of Huangjing Qianshi Decoction in prediabetes. Gene Ontology(GO) database and Kyoto Encyclopedia of Genes and Genomes(KEGG) database were used to conduct signaling pathway enrichment analysis of differentially expressed genes, and real-time quantitative polymerase chain reaction(RT-qPCR) was used to verify them. The results showed that the levels of fasting blood glucose(FBG), fasting insulin(FINS), insulin resistance index(HOMA-IR), total cholesterol(TC), triglycerides(TG), and low-density lipoprotein cholesterol(LDL-C) in the mouse model were significantly decreased after treatment with Huangjing Qianshi Decoction. In the results of differential gene screening, there were 1 666 differentially expressed genes in the model group as compared with the normal group, and there were 971 differentially expressed genes in the treatment group as compared with the model group. Among them, interleukin-6(IL-6) and NR3C2 genes, which were closely related to the regulation of insulin resis-tance function, were significantly up-regulated between the model group and the normal group, and vascular endothelial growth factor A(VEGFA) genes were significantly down-regulated between the model group and the normal group. However, the expression results of IL-6, NR3C2, and VEGFA genes were adverse between the treatment group and the model group. GO functional enrichment analysis found that the biological process annotation mainly focused on cell synthesis, cycle, and metabolism; cell component annotation mainly focused on organelles and internal components; and molecular function annotation mainly focused on binding molecular functions. KEGG pathway enrichment analysis found that it involved the protein tyrosine kinase 6(PTK6) pathway, CD28-dependent phosphoinositide 3-kinase/protein kinase B(PI3K/AKT) pathway, p53 pathway, etc. Therefore, Huangjing Qianshi Decoction can improve the state of prediabetes, and the mechanism may be related to cell cycle and apoptosis, PI3K/AKT pathway, p53 pathway, and other biological pathways regulated by IL-6, NR3C2, and VEGFA.


Subject(s)
Animals , Mice , Proto-Oncogene Proteins c-akt , Phosphatidylinositol 3-Kinases , Prediabetic State , Vascular Endothelial Growth Factor A , Interleukin-6 , Transcriptome , Tumor Suppressor Protein p53 , Insulin , Cholesterol
19.
Article in Chinese | WPRIM | ID: wpr-970880

ABSTRACT

OBJECTIVE@#To explore the genetic basis for an infant with permanent neonatal diabetes mellitus (PNDM).@*METHODS@#Clinical data of the child was collected. Targeted capture-next generation sequencing was carried out to identify the potential variants. Candidate variant was verified by Sanger sequencing of her family members.@*RESULTS@#The child was a 4-month-and-26-day female featuring onset of ketoacidosis accompanied with fasting blood glucose of 24.4 mmol/L, positive urine glucose, decreased serum C-peptide, HbA1c of 9.58%, and negative diabetes autoantibody. Genetic testing revealed that she has carried a heterozygous c.314T>G (p.L105R) variant of the INS gene. Sanger sequencing verified that neither of her parents has carried the same variant, which was also unreported in the literature. The variant was classified as likely pathogenic based on the ACMG guidelines.@*CONCLUSION@#The c.314T>G (P.L105R) variant of the INS gene probably underlay the genetic etiology in this child. Genetic testing should be conducted for children with suspected PNDM for early diagnosis and appropriate treatment.


Subject(s)
Humans , Infant , Child , Infant, Newborn , Female , Mutation , Insulin/genetics , Diabetes Mellitus/genetics , Genetic Testing
20.
Frontiers of Medicine ; (4): 68-74, 2023.
Article in English | WPRIM | ID: wpr-971628

ABSTRACT

Most information used to evaluate diabetic statuses is collected at a special time-point, such as taking fasting plasma glucose test and providing a limited view of individual's health and disease risk. As a new parameter for continuously evaluating personal clinical statuses, the newly developed technique "continuous glucose monitoring" (CGM) can characterize glucose dynamics. By calculating the complexity of glucose time series index (CGI) with refined composite multi-scale entropy analysis of the CGM data, the study showed for the first time that the complexity of glucose time series in subjects decreased gradually from normal glucose tolerance to impaired glucose regulation and then to type 2 diabetes (P for trend < 0.01). Furthermore, CGI was significantly associated with various parameters such as insulin sensitivity/secretion (all P < 0.01), and multiple linear stepwise regression showed that the disposition index, which reflects β-cell function after adjusting for insulin sensitivity, was the only independent factor correlated with CGI (P < 0.01). Our findings indicate that the CGI derived from the CGM data may serve as a novel marker to evaluate glucose homeostasis.


Subject(s)
Humans , Glucose , Blood Glucose , Insulin Resistance/physiology , Diabetes Mellitus, Type 2/diagnosis , Blood Glucose Self-Monitoring , Time Factors , Insulin
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