Promoção da saúde à pessoa com diabetes: percepções dos profissionais da atenção primária à saúde / Health promotion for people with diabetes: perceptions of primary health care professionals / Promoción de la salud para personas con diabetes: percepciones de los profesionales de atención primaria de salud

Objetivo: identificar a percepção dos profissionais de saúde que atuam na atenção primária sobre a promoção da saúde às pessoas com Diabetes. Método: estudo qualitativo, do tipo pesquisa ação, por meio do Itinerário de Pesquisa de Paulo Freire, que compreende três etapas: investigação temática, codificação e descodificação e desvelamento crítico. Realizou-se um círculo de cultura em setembro de 2021 com seis profissionais de saúde de uma Unidade Básica de uma cidade do sul do Brasil. Resultados: os profissionais identificaram que a saúde não é somente ausência da doença, mas envolve os determinantes sociais na vida da pessoa. Relacionam a promoção da saúde com as condições socioeconômicas, estilo de vida e equilíbrio entre ambos. Considerações finais: os profissionais ao identificarem o cuidado com base nos determinantes sociais e a promoção da saúde vislumbraram a construção de um protocolo individual de atendimento com melhoria da qualidade de vida das pessoas com diabetes(AU)

Objective: to identify the perception of health professionals working in primary care about health promotion for people with diabetes. Method: qualitative study, of the action research type, through Paulo Freire's Research Itinerary, which comprises three stages: thematic investigation, codification and decoding and critical unveiling. A culture circle was held in September 2021 with six health professionals from a Basic Unit in a city in southern Brazil. Results: professionals identified that health is not just the absence of disease, but involves social determinants in a person's life. They relate health promotion with socioeconomic conditions, lifestyle and balance between both. Final considerations: when professionals identified care based on social determinants and health promotion, they envisioned building an individual care protocol with improved quality of life for people with diabetes(AU)

Objetivo: identificar la percepción de los profesionales de la salud que trabajan en la atención primaria sobre la promoción de la salud de los pacientes con diabetes. Método: estudio cualitativo, del tipo investigación acción, a través del Itinerario de Investigación de Paulo Freire, que comprende tres etapas: investigación temática, codificación y decodificación y develamiento crítico. En septiembre de 2021, se realizó un círculo de cultura con seis profesionales de la salud de una Unidad Básica de una ciudad del sur de Brasil. Resultados: los profesionales han identificado que la salud no es sólo la ausencia de enfermedad, sino que involucra determinantes sociales en la vida de una persona. Relacionan la promoción de la salud con las condiciones socioeconómicas, el estilo de vida y el equilibrio entre ambos. Consideraciones finales: cuando los profesionales identificaron la atención basada en los determinantes sociales y la promoción de la salud, vislumbraron la construcción de un protocolo de atención individual con mejora de la calidad de vida de las personas con diabetes(AU)

Efectos de las tecnologías educativas en la prevención y tratamiento de la úlcera diabética: revisión sistemática y metaanálisis / Effects of educational technologies on the prevention and treatment of diabetic ulcers: A systematic review and meta-analysis / Efeitos das tecnologias educativas na prevenção e tratamento da úlcera diabética: revisão sistemática e metanálise

Objetivo: analizar los efectos de las tecnologías educativas en la prevención y tratamiento de la úlcera diabética. Método: revisión sistemática realizada en siete bases de datos, un índice bibliográfico, una biblioteca electrónica y literatura gris. La muestra estuvo compuesta por 11 ensayos clínicos controlados aleatorizados. La síntesis de los resultados fue descriptiva y mediante metaanálisis. Resultados: las tecnologías educativas predominantes fueron la capacitación y la orientación verbal, se destacaron las tecnologías blandas-duras. En comparación con la atención habitual, las tecnologías educativas demostraron ser un factor protector para prevenir la incidencia de úlcera diabética (RR=0,40; IC 95%=0,18-0,90; p=0,03) y la evaluación de certeza de evidencia fue baja. Las tecnologías educativas también demostraron ser un factor protector para prevenir la incidencia de amputación en miembros inferiores (RR=0,53; IC 95%=0,31-0,90; p=0,02) y la certeza de evidencia fue muy baja. Conclusión: tecnologías educativas blandas-duras, como orientación verbal estructurada, juegos educativos, clase expositiva, capacitación teórico-práctica, video educativo, folder, rotafolio educativo y dibujos lúdicos, y tecnologías duras, como calzado terapéutico, plantillas, termómetro infrarrojo digital, kits para el cuidado de los pies, aplicación de telemedicina y teléfono móvil, resultaron efectivas para la prevención y el tratamiento de la úlcera diabética, sin embargo, es necesario que se realicen estudios más robustos.

Objective: to analyze the effects of educational technologies in the prevention and treatment of diabetic ulcers. Method: a systematic review conducted in seven databases, a bibliographic index, an electronic library and the Gray Literature. The sample consisted of 11 randomized controlled clinical trials. The synthesis of the results was descriptive and through meta-analysis. Results: the predominant educational technologies were training sessions and verbal guidelines, with soft-hard technologies standing out. When compared to usual care, the educational technologies presented a protective factor to prevent the incidence of diabetic ulcers (RR=0.40; 95% CI=0.18-0.90; p=0.03) and the certainty of the evidence assessment was low. The educational technologies also had a protective factor to prevent the incidence of lower limb amputations (RR=0.53; 95% CI=0.31-0.90; p=0.02) and certainty of the evidence was very low. Conclusion: soft-hard educational technologies such as structured verbal guidelines, educational games, lectures, theoretical-practical training sessions, educational videos, folders, serial albums and playful drawings, and hard technologies such as therapeutic footwear, insoles, infrared digital thermometer, foot care kits, Telemedicine app and mobile phone use, were effective for the prevention and treatment of diabetic ulcers, although more robust studies are required.

Objetivo: analisar os efeitos das tecnologias educativas na prevenção e tratamento da úlcera diabética. Método: revisão sistemática conduzida em sete bases de dados, um índice bibliográfico, uma biblioteca eletrônica e na literatura cinzenta. A amostra foi constituída de 11 ensaios clínicos controlados randomizados. A síntese dos resultados foi descritiva e por meio de metanálise. Resultados: as tecnologias educativas predominantes foram os treinamentos e as orientações verbais, destacando-se as tecnologias leve-duras. Na comparação com o cuidado usual, as tecnologias educativas apresentaram fator de proteção para prevenção da incidência de úlcera diabética (RR=0,40; IC 95%=0,18-0,90; p=0,03) e a avaliação de certeza da evidência foi baixa. As tecnologias educativas também tiveram fator de proteção para prevenção da incidência de amputação em membros inferiores (RR=0,53; IC 95%=0,31-0,90; p=0,02) e a certeza da evidência foi muito baixa. Conclusão: as tecnologias educativas leve-duras, como orientações verbais estruturadas, jogos educativos, aula expositiva, treinamentos teórico-práticos, vídeo educativo, folder, álbum seriado e desenhos lúdicos, e as tecnologias duras, a exemplo do calçado terapêutico, palmilhas, termômetro digital de infravermelho, kits de cuidados com os pés, aplicativo de telemedicina e telefone móvel, foram efetivas para prevenção e tratamento da úlcera diabética, porém, estudos mais robustos são necessários.

Atención de enfermería en salud mental a personas con diabetes mellitus: revisión integrativa / Mental health nursing care for people with diabetes mellitus: An integrative review / Cuidados de enfermagem em saúde mental para pessoas com diabetes mellitus: revisão integrativa

Objetivo: evaluar las evidencias disponibles en la literatura sobre la atención de enfermería en salud mental a personas con diabetes mellitus en los diferentes niveles de atención de salud. Método: revisión integrativa de la literatura. Búsqueda en cinco bases de datos. Muestra de 14 estudios, exportados al gerenciador EndNote®. Los datos se organizaron en planilla de Microsoft Excel®. La calidad metodológica de los estudios fue evaluada mediante herramientas propuestas por el Joanna Briggs Institute. Las etapas de muestreo, categorización, evaluación, interpretación de resultados y síntesis de los estudios incluidos fueron realizadas por dos revisores de manera independiente y ciega. El análisis descriptivo de resultados está presentado en tres categorías. Resultados: recomendaciones para autocuidado reforzado por la red de apoyo social, incluyendo herramientas y estrategias de los ámbitos físico y psíquico; estrategias de comunicación terapéutica y psicoterapia, haciendo foco en la psicoterapia y la comunicación terapéutica; e intervenciones de autogestión/autogerenciamiento, abordando el autocuidado en base a teorías conductuales. Conclusión: la síntesis de conocimientos reveló que las pautas de autocuidado reforzadas por la red de apoyo social, las estrategias de comunicación terapéutica y psicoterapia y las intervenciones de autogestión/autogerenciamiento son intervenciones positivas que ayudan a las personas con diabetes mellitus y trastornos mentales a prevenir complicaciones.

Objective: evaluate the evidence available on mental health nursing care for people with diabetes mellitus at different levels of health care. Method: integrative literature review. The search was conducted in five databases. The sample consisted of 14 studies. The studies were exported to the EndNote manager and their data to a Microsoft Excel spreadsheet. The methodological quality of the studies was evaluated using tools proposed by the Joanna Briggs Institute. Sampling, categorization, evaluation, interpretation of the results, and synthesis of the included studies were carried out by two reviewers independently. The descriptive analysis of the results is presented in three categories. Results: self-care guidelines enhanced by the social support network, encompassing physical and psychological tools and strategies; therapeutic communication and psychotherapy strategies, focusing on psychotherapy and therapeutic communication; and self-management interventions, addressing self-care based on behavioral theories. Conclusion: the synthesis of knowledge revealed that guidelines for self-care enhanced by the social support network, psychotherapy and therapeutic communication strategies, and self-management interventions are positive interventions that contribute to people with mental disorders and diabetes mellitus in the prevention of diseases.

Objetivo: avaliar as evidências disponíveis sobre os cuidados de enfermagem em saúde mental para pessoas com diabetes mellitus nos diferentes níveis de atenção à saúde. Método: revisão integrativa da literatura. Busca realizada em cinco bases de dados. Amostra composta por 14 estudos. Os estudos foram exportados para o gerenciador EndNote, e seus dados, para uma planilha desenvolvida pelo Microsoft Excel. A qualidade metodológica dos estudos foi avaliada por meio de ferramentas propostas pelo Joanna Briggs Institute. Etapas de amostragem, categorização, avaliação, interpretação dos resultados e síntese dos estudos incluídos foram realizadas por dois revisores de forma independente e mascarada. A análise descritiva dos resultados é apresentada em três categorias. Resultados: orientações para o autocuidado potencializadas pela rede de suporte social, englobando ferramentas e estratégias no âmbito físico e psíquico; estratégias de comunicação terapêutica e psicoterapia, focalizando a psicoterapia e a comunicação terapêutica; e intervenções de autogestão/ autogerenciamento, abordando o autocuidado com base em teorias comportamentais. Conclusão: a síntese do conhecimento revelou que as orientações para o autocuidado potencializadas pela rede de suporte social, estratégias de comunicação terapêutica e psicoterapia e intervenções de autogestão/autogerenciamento são intervenções positivas que auxiliam as pessoas com transtornos mentais e diabetes mellitus na prevenção de agravos.

Status Quo and Research Progress in Diagnosis and Treatment of Patients With Diabetes Mellitus and Chronic Kidney Disease / 中国医学科学院学报

As the incidence of diabetes mellitus is rapidly increasing worldwide,that of related complications,such as diabetic kidney disease(DKD),also increases,conferring a heavy economic burden on the patients,families,society,and government.Diabetes mellitus complicated with chronic kidney disease(CKD)includes DKD and the CKD caused by other reasons.Because of the insufficient knowledge about CKD,the assessment of diabetes mellitus complicated with CKD remains to be improved.The therapies for diabetes mellitus complicated with CKD focus on reducing the risk factors.In clinical practice,DKD may not be the CKD caused by diabetes.According to clinical criteria,some non-diabetic kidney disease may be misdiagnosed as DKD and not be treated accurately.This review summarizes the status quo and research progress in the assessment,diagnosis,and treatment of diabetes mellitus complicated with CKD and predicts the directions of future research in this field.

A Health Education Program for Home Emergency Management of Acute Complications of Diabetes in the Elderly / 中国医学科学院学报

Objective To establish a health education program for home emergency management of acute complications of diabetes in the elderly.Methods The program was drafted by literature review and panel discussion.The final draft was formed after two rounds of correspondence from 13 experts.Results The recovery rate of the two rounds of expert correspondence was 100%,and the expert authority coefficient was 0.98.The Kendall's harmony coefficients of the two rounds of correspondence were 0.263 and 0.212 respectively(both P<0.001).The established health education program included indicators of three categories:early stage of acute complications of diabetes at home(understanding the inducing factors),emergency warning(quick and early identification in case of emergency),and emergency treatment at home.Conclusion The contents of the health education program are systematic and reliable and meet the needs of health education for home emergency management of the elderly with diabetes.

Diagnosis and treatment strategy of periodontitis with diabetes / 中华口腔医学杂志

The number of diabetic patients visiting stomatology for periodontal disease is increasing, and the symptoms are relatively severe, and often complications increase the complexity of periodontal treatment. This article briefly describes the research progress and clinical manifestations of the epidemiology and related pathological mechanisms of periodontitis with diabetes, focusing on the treatment and providing reference for stomatologists in the clinical diagnosis and treatment of patients with diabetic periodontitis.

Research advances in neuromodulation techniques for blood glucose regulation and diabetes intervention / 生物医学工程学杂志

Diabetes and its complications that seriously threaten the health and life of human, has become a public health problem of global concern. Glycemic control remains a major focus in the treatment and management of patients with diabetes. The traditional lifestyle interventions, drug therapies, and surgeries have benefited many patients with diabetes. However, due to problems such as poor patient compliance, drug side effects, and limited surgical indications, there are still patients who fail to effectively control their blood glucose levels. With the development of bioelectronic medicine, neuromodulation techniques have shown great potential in the field of glycemic control and diabetes intervention with its unique advantages. This paper mainly reviewed the research advances and latest achievements of neuromodulation technologies such as peripheral nerve electrical stimulation, ultrasound neuromodulation, and optogenetics in blood glucose regulation and diabetes intervention, analyzed the existing problems and presented prospects for the future development trend to promote clinical research and application of neuromodulation technologies in the treatment of diabetes.

A importância do controle pressórico e alcance de metas pressóricas intensivas em pacientes diabéticos e em pacientes com acidente vascular cerebral: os estudos optimal-diabetes e optimal-stroke / The importance of blood pressure control and intensive blood pressure targets in patients with diabetes and stroke: the optimaldiabetes and optimal-stroke trials

A hipertensão arterial sistêmica representa um dos principais problemas de saúde pública no Brasil e no mundo. O controle pressórico estrito é essencial para a redução de eventos cardiovasculares maiores, pois a pressão arterial sistólica elevada é o principal fator de risco modificável para doenças cardiovasculares e mortalidade total. Ensaios clínicos randomizados prévios, como o SPRINT trial e o STEP trial, geraram evidências robustas sobre os benefícios do alcance de metas pressóricas intensivas na redução de eventos cardiovasculares maiores em pacientes hipertensos de alto risco cardiovascular não-diabéticos e sem acidente vascular cerebral (AVC) prévio. Porém, ainda há dúvidas sobre o benefício de tal estratégia nestas duas populações de pacientes. Para dar uma resposta definitiva a esta questão, os estudos OPTIMAL-DIABETES e OPTIMAL-STROKE estão sendo conduzidos com alto rigor científico no Brasil e estes já são os maiores estudos sobre o tema em nível global. Os resultados destes dois estudos, previstos para 2024/2025, são muito esperados para nos dar as evidências necessárias sobre o benefício do controle pressórico intensivo em pacientes diabéticos e pós-AVC (AU).

Hypertension represents one of the main public health problems in Brazil and in the world. Blood pressure (BP) control is essential to reduce major cardiovascular events, as high systolic BP is the main modifiable risk factor for cardiovascular diseases and any-cause deaths. Previous randomized clinical trials, such as the SPRINT trial and the STEP trial, have provided robust evidence on the benefits of intensive BP targets on the reduction of major cardiovascular events in hypertensive patients with high cardiovascular risk without diabetes and previous stroke. However, there is still uncertainty about the benefits of such strategy on this two populations of patients. To provide a definitive answer to this question, the OPTIMAL-DIABETES and OPTIMAL-STROKE trials are being conducted with high scientific rigor in Brazil and these are already the biggest studies in this area globally. The results of these two trials, expected in 2024/2025, are long awaited to provide us the necessary evidence on the benefits of intensive BP control in patients with diabetes and patients with stroke (AU).

Práticas preventivas realizadas pelo enfermeiro da equipe de saúde da família relacionadas as úlceras em membros inferiores no cuidado às pessoas com diabetes mellitus / Preventive practices carried out by the nurse of the family health team related to lower limb ulcers in the care of people with diabetes mellitus

Dentre as Doenças Crônicas não Transmissíveis (DCNT), o Diabetes Mellitus (DM) se destaca por sua constante ascensão e taxas de morbimortalidade e aos altos custos sociais, econômicos e psicológicos. Ainda, quando não controlado o DM, propicia o desenvolvimento de complicações altamente incapacitantes, destacando-se as úlceras ou infecções em membros inferiores o que conhecemos como "pé diabético". O objetivo do estudo foi identificar as ações preventivas para úlceras ou infecções em membros inferiores em pessoas com diabetes mellitus realizadas pelos enfermeiros nas equipes de Saúde da Família. Além disso, realizar um produto tecnológico como elaborar um roteiro de rastreamento para úlceras ou infecções em membros inferiores para as pessoas com diabetes mellitus. Pesquisa de abordagem qualitativa realizada com 24 enfermeiros de equipes de saúde da família (eSF) do município de Passos - Minas Gerais. Foram incluídos no estudo os enfermeiros que atuam diretamente na assistência por mais de seis meses e excluídos aqueles que estivessem em cargo de gestão, de férias ou afastados por algum motivo. As entrevistas foram realizadas nas unidades de saúde por meio de um roteiro de perguntas para identificação de conhecimentos acerca da temática. As entrevistas foram audiogravadas e transcritas e analisadas pela técnica de análise temática e discutidas pela literatura científica. Dos 24 enfermeiros que atuam nas eSF, 12,5% eram do sexo masculino e 87,5% do sexo feminino. Apenas 16,6% dos entrevistados possuíam curso sobre o cuidado para pessoa com DM e apresentaram conhecimento limitado sobre a temática das úlceras ou infecções de membros inferiores. As ações de cuidado voltam-se para o controle glicêmico e avaliação da medicação para atendimento do hiperdia. Em relação as práticas preventivas as orientações realizadas versam sobre os cuidados gerais de higiene, uso de calçados, corte das unhas e tratamento local de feridas. Pouco se realiza na consulta de enfermagem a avaliação clínica para o risco de úlceras ou infecções em membros inferiores. Acerca dos recursos que o município dispõe para o atendimento à pessoa com úlceras ou infecções em membros inferiores evidencia-se que o município não dispõe de uma local de referência para o tratamento da diabetes e que o serviço especializado é bastante demorado e falta recursos humanos e materiais. Portanto, destaca-se a necessidade da promoção da educação continuada e permanente como ferramenta para que possa ter conhecimentos e habilidades, bem como, discutir sobre o processo de trabalho para proporcionar cuidados efetivos com conhecimento baseado em evidências. Além disso, é preciso investimentos para qualificar a consulta de enfermagem à pessoa com DM e as práticas preventivas, especialmente, as voltadas para o risco de desenvolvimento de úlceras ou infecções em membros inferiores. No intuito de colaborar para a melhoria das práticas preventivas e identificação de risco no processo de trabalho dos enfermeiros, foi elaborado um roteiro de rastreamento para úlceras ou infecções em membros inferiores para que os enfermeiros possam utilizar nas consultas às pessoas com DM

Among Chronic Noncommunicable Diseases (NCDs), Diabetes Mellitus (DM) stands out for its constant rise and morbidity and mortality rates and the high social, economic and psychological costs. Still, when DM is not controlled, it favors the development of highly disabling complications, especially ulcers or infections in the lower limbs, what we know as "diabetic foot". The objective of the study was to identify preventive actions for ulcers or infections in the lower limbs in people with diabetes mellitus carried out by nurses in the Family Health teams. In addition, making a technological product such as developing a screening script for ulcers or infections in the lower limbs for people with diabetes mellitus. Qualitative research carried out with 24 nurses from family health teams (eSF) in the city of Passos - Minas Gerais. Nurses who work directly in care for more than six months were included in the study, and those who were in management positions, on vacation or on leave for some reason were excluded. The interviews were carried out in the health units through a script of questions to identify knowledge about the theme. The interviews were audio-recorded and transcribed and analyzed using the thematic analysis technique and discussed in the scientific literature. Of the 24 nurses working in the eSF, 12.5% were male and 87.5% were female. Only 16.6% of respondents had taken a course on care for people with DM and had limited knowledge on the subject of ulcers or lower limb infections. Care actions focus on glycemic control and assessment of medication for hyperdia treatment. Regarding preventive practices, the guidelines provided deal with general hygiene care, use of shoes, nail trimming and local treatment of wounds. Little is done in the nursing consultation regarding the clinical assessment of the risk of ulcers or infections in the lower limbs. Regarding the resources that the municipality has for the care of people with ulcers or infections in the lower limbs, it is evident that the municipality does not have a reference place for the treatment of diabetes and that the specialized service is quite time consuming and lacks human resources and materials. Therefore, there is a need to promote continuing and permanent education as a tool to acquire knowledge and skills, as well as to discuss the work process to provide effective care with evidence-based knowledge. In addition, investments are needed to qualify the nursing consultation for people with DM and preventive practices, especially those aimed at the risk of developing ulcers or infections in the lower limbs In order to contribute to the improvement of preventive practices and risk identification in the work process of nurses, a screening script for ulcers or infections in the lower limbs was elaborated so that nurses can use it in consultations with people with DM

Alternativas de controle do diabetes / Alternatives for diabetes control / Alternativas para el control de la diabetes

O Diabetes desde a antiguidade tem sido uma das maiores causas de morte entre as populações do globo, e segundo a Organização Mundial da Saúde continua assolando nos nossos dias. Apesar das descobertas de tratamentos mais eficazes, a doença vem avançando em progressões assustadoras atualmente, com projeções preocupantes para a saúde pública. Como estratégia de acompanhamento terapêutico, estatístico direcionado a portadores de diabetes, o Governo Federal lançou o programa HIPERDIA (Hipertensos e Diabéticos), que faz o acompanhamento da evolução da doença e das complicações dos pacientes. E neste sentido, também são utilizadas terapêuticas mais acessíveis como as plantas medicinais. O objetivo desta pesquisa consiste em realizar uma revisão bibliográfica abordando as opções de terapias de controle do diabetes oferecidas no Sistema Único de Saúde e pesquisar fitoterápicos com potencial hipoglicêmico aprovados pela Anvisa. Através de levantamento bibliográfico, foram identificadas oito espécies vegetais utilizadas pela medicina popular no controle do diabetes, sendo estas: Bauhinia Forficata, Syzygium Cumini, Annona Muricata, Cynara Scolymus, Momordica Charantia, Eugenia Uniflora e Baccharis Trimera. Essas plantas do programa, embora tenham comprovação de seu efeito hipoglicêmico e redutores dos sintomas diabéticos, pelas suas propriedades antioxidantes e antiinflamatórias, colabora para uma melhor qualidade de vida aos pacientes.

Since antiquity, Diabetes has been one of the biggest causes of death amon-g populations around the globe, and according to the World Health Organization, it continues to plague our days. Despite discoveries of more effective treatments, the disease is currently advancing in frightening progressions, with worrying projections for public health. As a therapeutic, statistical follow-up strategy aimed at people with diabetes, the Federal Government launched the HIPERDIA (Hypertensive and Diabetic) program, which monitors the evolution of the disease and the complications of patients. And in this sense, more accessible therapies such as medicinal plants are also used. The objective of this research is to carry out a literature review addressing the options for diabetes control therapies offered in the Unified Health System and to search for herbal medicines with hypoglycemic potential approved by Anvisa. Through a bibliographical survey, eight plant species used by folk medicine to control diabetes were identified, namely: Bauhinia Forficata, Syzygium Cumini, Annona Muricata, Cynara Scolymus, Momordica Charantia, Eugenia Uniflora and Bacharis Trimera. These plants in the program, although they have evidence of their hypoglycemic effect and reduce diabetic symptoms, due to their antioxidant and anti-inflammatory properties, contribute to a better quality of life for patients.

La diabetes ha sido desde la antigüedad una de las principales causas de muerte entre las poblaciones del planeta, y según la Organización Mundial de la Salud sigue haciendo estragos en nuestros días. A pesar de los descubrimientos de tratamientos más eficaces, la enfermedad avanza actualmente con una progresión aterradora, con proyecciones preocupantes para la salud pública. Como estrategia de seguimiento terapéutico, estadísticamente dirigida a las personas con diabetes, el Gobierno Federal puso en marcha el programa HIPERDIA (Hipertensión y Diabetes), que controla la evolución de la enfermedad y las complicaciones de los pacientes. En este sentido, también se utilizan terapias más accesibles, como las plantas medicinales. El objetivo de esta investigación es realizar una revisión bibliográfica que aborde las opciones de terapias para el control de la diabetes ofrecidas en el Sistema Único de Salud y buscar fitoterapias con potencial hipoglucemiante aprobadas por Anvisa. Mediante un estudio bibliográfico, se identificaron ocho especies vegetales utilizadas por la medicina popular en el control de la diabetes, a saber: Bauhinia Forficata, Syzygium Cumini, Annona Muricata, Cynara Scolymus, Momordica Charantia, Eugenia Uniflora y Baccharis Trimera. Estas plantas del programa, aunque han demostrado su efecto hipoglucemiante y reductor de los síntomas diabéticos, por sus propiedades antioxidantes y antiinflamatorias, colaboran a una mejor calidad de vida para los pacientes.

Desfecho clínico de pessoas com diabetes infectadas pelo SARS-CoV-2 que desenvolveram Síndrome Respiratória Aguda Grave, Brasil / Clinical outcomes of SARS-CoV-2 infected people with diabetes who developed Severe Acute Respiratory Syndrome in Brazil

Objetivo: Comparar os desfechos clínicos de pessoas com e sem Diabetes Mellitus tipo 2 (DM 2), infectadas pelo SARS-CoV-2, que desenvolveram Síndrome Respiratória Aguda Grave (SRAG) no Brasil. Métodos: Trata-se de um estudo transversal realizado a partir de análise da ficha de notificação compulsória de Síndrome Respiratória Aguda Grave Hospitalizado, obtidas no DATASUS. Foram analisados homens e mulheres com e sem DM2, infectados pelo SARS-CoV-2 e notificados como SRAG no período de fevereiro de 2020 a maio de 2021. Foram identificados os desfechos: hospitalização, admissão em Unidade de Terapia Intensiva (UTI) e óbito. Em seguida, a porcentagem de cada desfecho entre pessoas com DM2 foi comparada com a de pessoas não-diabéticas infectadas no mesmo período, utilizando o teste de Qui-Quadrado, com intervalo de confiança de 95%. Resultados: De um total de 384.805 pacientes, 111.046 eram diabéticos e 273.759 não diabéticos. Entre os diabéticos, 98.2% foram hospitalizados, 43.7% admitidos em UTI e 44.6% evoluíram a óbito. Enquanto entre os não-diabéticos, 97.3% necessitaram de hospitalização, 37.2% foram admitidos em UTI e 35.7% evoluíram a óbito. Após a análise com o teste de Qui-Quadrado, nos desfechos analisados foi encontrada uma diferença estatística significante (p<0.001) entre os grupos. Conclusão: A presença de DM 2 esteve associada a um pior prognóstico da COVID-19, quando comparada a pessoas sem DM2 na população brasileira. Entretanto, são necessários mais estudos para estabelecer a causalidade e elucidar a fisiopatologia dessa associação (AU)

Objective: Compare the clinical outcomes of people with and without Type 2 Diabetes Mellitus (DM2), infected by SARS-CoV-2, who developed Severe Acute Respiratory Syndrome (SARS) in Brazil. Methodology: This is a cross-sectional study. The research was carried out by analyzing the compulsory notification form Severe Acute Respiratory Syndrome of hospitalized patients, obtained from DATASUS. Type 2 diabetic and non-diabetic men and women infected with SARS-CoV-2 and notified as SARS in the period February 2020 to May 2021 were analyzed. The outcomes were identified as: hospitalization, Intensive Care Unit (ICU) admission, and death. The percentage of each outcome among diabetic patients was compared with that of the infected non-diabetic patients in the same period using the Chi-square test, with a 95% confidence interval. Results: From a total of 384,805 patients, 111,046 were diabetic and 273,759 non-diabetic. Among the diabetic patients, 98.2% were hospitalized, 43.7% were admitted to the ICU, and 44.6% died. While among non-diabetics, 97.3% required hospitalization, 37.2% were admitted to the ICU, and 35.7% died. After the analysis with the Chi-square test, a statistically significant difference was found between the groups (p<0.001). Conclusion: The presence of DM2 was associated with a worse prognosis for COVID-19 compared to people without DM2, in the Brazilian population. However, further studies are needed to establish causality and elucidate the pathophysiology of this association (AU)

Importancia del ejercicio físico en las personas con diabetes mellitus / Importance of physical exercise in people with diabetes mellitus

Introducción: el ejercicio físico constituye uno de los pilares fundamentales en el tratamiento de las personas con diabetes. Ajustar el régimen terapéutico permite una participación segura y un alto desempeño de la actividad física. Objetivo: describir los efectos y la importancia del ejercicio físico en las personas con diabetes mellitus. Método: se realizó una investigación documental, se utilizó como buscador de información científica Google Académico. Se evaluaron libros, artículos de investigación y de revisión de diferentes bases de datos: LILACS, PubMed, SciElo, Cochrane y páginas web, en idioma español, inglés o portugués. Resultados: en las personas con diabetes se recomiendan los ejercicios físicos aeróbicos, los mismos incrementan la sensibilidad a la insulina influyendo favorablemente sobre el control metabólico; los ejercicios de resistencia también son beneficiosos con el objetivo de mejorar la fuerza muscular. Antes de desarrollar un programa de ejercicios, la persona con diabetes mellitus debe someterse a una evaluación médica detallada. La indicación del tipo de ejercicio, su intensidad y duración debe ser personalizada. El control glucémico antes, durante y después del ejercicio es fundamental. En los niños pequeños fomentar el juego es la mejor manera de garantizar una actividad física placentera. Conclusiones: el ejercicio físico debe indicarse en las personas con diabetes mellitus por sus múltiples beneficios relacionados con la salud. Su indicación debe ser individualizada

Introduction: Physical exercise is one of de fundamental pillars in the treatment of people with diabetes. Adjusting the therapeutic regimen allows safe participation and high performance of physical activity. Aim: To describe the effects and importance of physical exercise in people with diabetes mellitus. Method: A documentary investigation was carried out. It was used as a search engine for scientific information Google Academic. Books, research and review articles from different databases were evaluated: LILACS, PubMed, SciElo, Cochrane and web pages in Spanish, English and Portuguese. Results: In people with diabetes, aerobic physical exercises are recommended, they increase insulin sensitivity and have a favorable influence on metabolic control. Resistance exercises are also beneficial in order to improve muscle strength. Before developing an exercise program, the person with diabetes mellitus must undergo a detailed medical evaluation. The indication of the type of exercise, its intensity and duration must be personalized. Glycemic control before, during and after exercise is essential. Encouraging play in young children is the best way to ensure enjoyable physical activity. Conclusions: The physical exercise should be indicated in people with diabetes mellitus due to its multiple health- related benefits; its indication must be individualized.

Impact of Carbohydrate Counting Method during Pregnancy in Women with Pregestational Diabetes Mellitus: A Controlled Clinical Trial / Impacto do método de contagem de carboidratos em gestantes com diabetes mellitus prévio: Um ensaio clínico controlado

Abstract Objective To evaluate the effect of the carbohydrate counting method (CCM) on glycemic control,maternal, and perinatal outcomes of pregnant women with pregestational diabetes mellitus (DM). Methods Nonrandomized controlled clinical trial performed with 89 pregnant women who had pregestational DMand received prenatal care in a public hospital in Rio de Janeiro, state of Rio de Janeiro, Brazil, between 2009 and 2014, subdivided into historic control group and intervention group, not simultaneous. The intervention group (n=51) received nutritional guidance from the carbohydrate counting method (CCM), and the historical control group (n=38), was guided by the traditionalmethod (TM). The Mann-Whitney test or the Wilcoxon test were used to compare intra- and intergroup outcomes andanalysis of variance (ANOVA) for repeated measures, corrected by the Bonferroni post-hoc test,was used to assess postprandial blood glucose. Results Only the CCM group showed a reduction in fasting blood glucose. Postprandial blood glucose decreased in the 2nd (p=0.00) and 3rd (p=0.00) gestational trimester in the CCM group, while in the TM group the reduction occurred only in the 2nd trimester (p=0.015). For perinatal outcomes and hypertensive disorders of pregnancy, there were no differences between groups. Cesarean delivery was performed in 82% of the pregnant women and was associated with hypertensive disorders (gestational hypertension or pre-eclampsia; p=0.047). Conclusion Both methods of nutritional guidance contributed to the reduction of postprandial glycemia of women and no differences were observed for maternal and perinatal outcomes. However, CCM had a better effect on postprandial glycemia and only this method contributed to reducing fasting blood glucose throughout the intervention. ReBEC Clinical Trials Database The present study was registered in the ReBEC Clinical Trials Database (Registro Brasileiro de Ensaios Clínicos, number RBR-524z9n).

Resumo Objetivo Avaliar o efeito do método de contagem de carboidratos no controle glicêmico, desfechos maternos e perinatais de gestantes com diabetes mellitus (DM) pré-gestacional. Métodos Ensaio clínico controlado não randomizado realizado com 89 gestantes com DM pré-gestacional atendidas em hospital público do Rio de Janeiro, RJ, Brasil, entre 2009 e 2014, divididas emgrupo controle histórico e grupo intervenção. O grupo intervenção (n=51) recebeu orientação nutricional combase nométodo de contagem de carboidratos (CCM) e o grupo controle histórico (n=38) foi orientado pelo método tradicional (MT). Os testes de Mann-Whitney ou de Wilcoxon foram usados para comparar os desfechos intra- e intergrupos e, para avaliar a glicemia pós-prandial, análise de variância (ANOVA, na sigla em inglês) para medidas repetidas foi usada. Resultados Somente o grupo com método CCM apresentou redução da glicemia de jejum. A glicemia pós-prandial diminuiu no 2° (p=0,00) e 3° (p=0,00) trimestres gestacionais no grupo com método CCM, e no grupo com método tradicional, a redução ocorreu apenas no 2° trimestre (p=0,015). Para os resultados perinatais e distúrbios hipertensivos da gravidez, não houve diferenças entre os grupos. O parto cirúrgico foi realizado em 82% das gestantes e esteve associado a distúrbios hipertensivos gestacionais (p=0,047). Conclusão Ambos osmétodos de orientação nutricional contribuírampara a redução da glicemia pós-prandial e não foram observadas diferenças para os resultados maternos e perinatais. No entanto, o método CCM apresentou melhor efeito sobre a glicemia pós-prandial e foi o único que induziu redução da glicemia de jejum.

Influence of small-group experiential learning of integrated traditional Chinese and Western medicine on the oral health knowledge, beliefs, and behaviors of elderly patients with diabetes

SUMMARY OBJECTIVE: This study aimed at the oral health problems of elderly patients with diabetes. A training course of integrated traditional Chinese and Western medicine was constructed, helping patients improve their oral health quality of life. METHODS: A randomized controlled prospective experimental study was conducted. A total of 190 elderly patients were divided randomly into an observation group and a control group with 95 cases in each. The control group received regular health education, while the observation group was based on the control group to implement the integrated experiential learning of traditional Chinese and Western medicine in small groups. The oral health knowledge, attitude, behavior, and blood glucose control status along with the oral health quality of life of the two groups were compared before the intervention and at 3-month postintervention. RESULTS: Three months after the intervention, the fasting blood glucose control and the 2-h postprandial blood glucose/glycosylated hemoglobin levels in the observation group were significantly better than in the control group, and the difference was statistically significant (p<0.05). The oral health quality of life in the observation group was significantly better than in the control group, and the difference was statistically significant (p<0.05). CONCLUSION: The small-group experiential learning model of integrated Chinese and Western medicine can promote the transformation of knowledge-beliefs-behaviors in elderly patients with diabetes, which is conducive to controlling blood sugar levels and improving the quality of oral health.

Islet organoid as a promising model for diabetes

Studies on diabetes have long been hampered by a lack of authentic disease models that, ideally, should be unlimited and able to recapitulate the abnormalities involved in the development, structure, and function of human pancreatic islets under pathological conditions. Stem cell-based islet organoids faithfully recapitulate islet development in vitro and provide large amounts of three-dimensional functional islet biomimetic materials with a morphological structure and cellular composition similar to those of native islets. Thus, islet organoids hold great promise for modeling islet development and function, deciphering the mechanisms underlying the onset of diabetes, providing an in vitro human organ model for infection of viruses such as SARS-CoV-2, and contributing to drug screening and autologous islet transplantation. However, the currently established islet organoids are generally immature compared with native islets, and further efforts should be made to improve the heterogeneity and functionality of islet organoids, making it an authentic and informative disease model for diabetes. Here, we review the advances and challenges in the generation of islet organoids, focusing on human pluripotent stem cell-derived islet organoids, and the potential applications of islet organoids as disease models and regenerative therapies for diabetes.

Effect of electroacupuncture combined with mosapride on gastric motility in diabetic gastroparesis rats / 中国针灸

OBJECTIVE@#To observe the effect of electroacupuncture (EA) at "Zusanli" (ST 36) combined with mosapride on gastric emptying rate and gastric motility in the rats with diabetic gastroparesis.@*METHODS@#Using random number table method, 68 male SD rats were divided into a blank group (12 rats) and a model establishment group (56 rats). In the model establishment group, the models of diabetic gastroparesis were established with intraperitoneal injection of streptozotocin combined with high-fat and high-sugar diet. Six weeks later, the successful rat models in the model establishment group were randomized into a model group, an EA group, a mosapride group and a combined treatment group, 12 rats in each one. In the EA group, EA was exerted at "Zusanli" (ST 36) (disperse-dense wave, 2 Hz/15 Hz in frequency, 2 mA in intensity) for 20 min. In the mosapride group, mosapride was intervened with intragastric administration (2 mg/kg). In the combined treatment group, electroacupuncture at "Zusanli" (ST 36) was combined with intragastric administration of mosapride. The intervention was given once daily in each group. There was 1 day at interval after 6-day intervention, consecutively for 5 weeks. At the end of intervention, the random blood glucose, gastric emptying rate and the data of gastric motility (average intra-gastric pressure, amplitude and frequency of gastric motility) were detected.@*RESULTS@#Compared with the blank group, blood glucose was increased in the model group (P<0.001). Blood glucose was reduced in the EA group, the mosapride group and the combined treatment group as compared with the model group separately (P<0.001, P<0.01), whereas, compared with the mosapride group, blood glucose was decreased in the combined treatment group (P<0.05). In comparison with the blank group, the gastric emptying rate, the average intra-gastric pressure and the amplitude of gastric motility were all decreased in the model group (P<0.001) and the frequency of gastric motility was increased (P<0.001). Gastric emptying rate, the average intra-gastric pressure and the amplitude of gastric motility were increased in the EA group, the mosapride group and the combined treatment group (P<0.01, P<0.05, P<0.001) and the frequency of gastric motility was decreased (P<0.001) as compared with the model group respectively. Compared with the EA group, the average intra-gastric pressure and the amplitude of gastric motility were increased in the combined treatment group (P<0.001). In comparison with the mosapride group, the gastric emptying rate, the average intra-gastric pressure, the amplitude and frequency of gastric motility in the combined treatment group, as well as the frequency of gastric motility in the EA group were all increased (P<0.05, P<0.001, P<0.01).@*CONCLUSION@#Electroacupuncture at "Zusanli" (ST 36) combined with intragastric administration of mosapride could regulate blood glucose and improve the gastric motility in the rats with diabetic gastroparesis. The effect is better than either simple electroacupuncture or mosapride.

Indicadores da linha de cuidado de pessoas com diabetes no Brasil: Pesquisa Nacional de Saúde 2013 e 2019 / Indicadores de la línea de atención a personas con diabetes en Brasil: Encuesta Nacional de Salud 2013 y 2019 / Indicators of the line of care for people with diabetes in Brazil: National Health Survey 2013 and 2019

Objetivo: Comparar indicadores de cuidado assistencial em adultos com diagnóstico médico de diabetes mellitus (DM) no Brasil em 2013 e 2019, e analisar esses indicadores, em 2019, segundo características sociodemográficas. Métodos: Estudo transversal com dados da Pesquisa Nacional de Saúde de 2013 e 2019. Foram avaliados os indicadores de cuidado em pessoas com diagnóstico médico de DM. Resultados: A prevalência de DM aumentou de 6,2% (2013) para 7,7% (2019). Entre 2013 e 2019, ocorreu aumento no uso de medicamentos (de 80,2% para 88,8%) e de assistência médica (de 73,2% para 79,1%), houve redução no uso de medicamentos da Farmácia Popular (de 57,4% para 51,5%) e no acompanhamento com mesmo médico (de 65,2% para 59,4%). Em 2019, pessoas do sexo masculino, mais jovens, de raça/cor da pele preta e parda, menores escolaridade e renda apresentaram pior desempenho nos indicadores. Conclusão: A maioria dos indicadores permaneceu semelhante durante os últimos cinco anos, com diferenças segundo características sociodemográficas em 2019.

Objetivo: Comparar indicadores de atención de salud para adultos con diagnóstico médico de diabetes mellitus (DM) en Brasil, en 2013 y 2019, y analizar estos indicadores, en 2019, según características sociodemográficas. Métodos: Estudio transversal con datos de la Encuesta Nacional de Salud de 2013 y 2019. Se evaluaron indicadores de atención en personas con diagnóstico médico de DM. Resultados: La prevalencia de DM aumentó del 6,2% (2013) al 7,7% (2019). Entre 2013 y 2019 hubo aumento en uso de medicamentos (80,2% a 88,8%) y de atención médica (73,2% a 79,1%), reducción en uso de medicamentos de Farmacia Popular (57, 4% a 51,5%) y seguimiento con mismo médico (65,2% a 59,4%). En 2019, personas de sexo masculino, más jóvenes, de la raza/color de piel negra y mestiza, menor nivel educativo e ingresos mostraron un peor desempeño en los indicadores. Conclusión: La mayoría de los indicadores se mantuvieron similares durante los últimos cinco años, con diferencias según las características sociodemográficas en 2019.

Objective: To compare health care indicators for adults with medical diagnosis of diabetes mellitus (DM) in Brazil, in 2013 and 2019, and analyze the indicators for 2019 according to sociodemographic characteristics. Methods: Cross-sectional study using data from the 2013 and 2019 National Health Survey. Care indicators were evaluated in people with medical diagnosis of DM. Results: DM prevalence increased from 6.2% (2013) to 7.7% (2019). Between 2013 and 2019, there was an increase in the use of medications (from 80.2% to 88.8%) and of medical care (from 73.2% to 79.1%), a reduction in the use of Popular Pharmacy Program medications (from 57.4% to 51.5%) and in follow-up with the same physician (from 65.2% to 59.4%). In 2019, poorer indicators were observed for individuals who were male, younger, Black and Brown, and with lower education and income. Conclusion: Most indicators remained similar in the last five years, with differences according to sociodemographic characteristics in 2019.

Hiperglicemia y diabetes inducidas por esteroides / Hyperglycemia and steroid-induced diabetes

La hiperglicemia y/o diabetes inducida por esteroides, se define como la elevación de la glicemia, causada por la acción de los fármacos glucocorticoideos, sobre el metabolismo de los carbohidratos, y presenta una prevalencia entre un 20% al 50%, en pacientes sin diabetes previa, existiendo mayor riesgo para esta patología en pacientes con diabetes pre-existente, obesidad, uso crónico de esteroides o en dosis altas, entre otros. El diagnóstico se rige por los criterios para diabetes en la mayoría de los casos. No obstante, existen casos en donde la hiperglicemia por esteroides es sub-diagnosticada. Su manejo se basa en el tratamiento farmacológico (antidiabéticos orales, subcutáneos e insulina) y no farmacológico (dieta y ejercicio), tomando en cuenta, el patrón glicémico, peso, edad, co-morbilidades, dosis, tipo y tiempo de uso de los esteroides. La relevancia de conocer como diagnosticar y tratar dicha patología, se debe al riesgo de ingreso hospitalario, de infección, de mala cicatrización y de mortalidad en casos no tratados. En vista del aumento del uso de glucocorticoides en la actualidad, se hace una revisión del abordaje terapéutico de la hiperglicemia y diabetes inducida por esteroides.

Hyperglycemia and Steroid-induced Diabetes is defined as the elevation of glycemia caused by the action of glucocorticoid drugs on carbohydrate metabolism, with a prevalence between 20% and 50% in patients without Diabetes. Though, there is a greater risk of this pathology in patients with pre-existing Diabetes, Obesity, chronic use of steroids or in high doses, among others. In most cases, the diagnosis is governed by the criteria of Diabetes; however, there are cases where hyperglycemia Steroid-induced is under-diagnosed. Its management is based on pharmacological treatment (oral and subcutaneous hypoglycemic agents and insulin) and non-pharmacological treatment (diet and exercise), in accordance with the glycemic pattern, weight, age, co-morbidities, dose, type and the duration of the use of steroid. The relevance of knowing how to diagnose and treat this pathology is the risk of hospital admission, infection, poor healing and mortality in untreated cases. In view of the increased use of glucocorticoids nowadays, a review is made about the therapeutic approach to hyperglycemia and steroid-induced Diabetes.

Efeitos não-clínicos da atividade física no tratamento de pessoas com diabetes, hipertensão ou obesidade / Non-clinical effects of physical activity in the treatment of people with diabetes, hypertension or obesity

Contexto: As práticas de atividade física são fortes aliadas na redução dos riscos à saúde, bem como no tratamento de doenças. Destaca-se sua relevância no cuidado a pessoas com doenças crônicas não transmissíveis, para as quais é importante investir na qualidade de vida. Esta revisão rápida aborda os efeitos não-clínicos das intervenções de atividade física em pessoas com diabetes mellitus tipo 2, hipertensão arterial sistêmica e sobrepeso/obesidade. Pergunta: Quais são os efeitos não-clínicos de diferentes modalidades de atividade física no tratamento de pessoas com diabetes, hipertensão ou obesidade? Métodos: Seguindo protocolo prévio, foram realizadas buscas por revisões sistemáticas (RS) em oito bases eletrônicas da literatura, em setembro de 2021. Nesta revisão rápida foram incluídas RS publicadas nos últimos 10 anos, com algumas especificações quanto a contexto e população. Apenas o processo de seleção foi realizado em duplicata e de forma independente. A avaliação da qualidade das RS foi feita por um revisor e checada por outro, por meio da ferramenta AMSTAR 2. Os resultados foram reunidos em síntese narrativa conforme similaridade do tipo de atividade física e população. Resultados: De 4.421 relatos encontrados nas bases de dados, 23 RS foram incluídas após processo de seleção e elegibilidade. Na avaliação da qualidade metodológica, uma RS foi considerada de confiança moderada, uma de confiança baixa e as demais de confiança criticamente baixa. As revisões apresentaram resultados de exercícios aeróbicos, anaeróbicos, combinados e de tipo não informado, envolvendo pessoas com diabetes mellitus tipo 2, hipertensão arterial sistêmica e sobrepeso/obesidade. O tipo de atividade mais presente foi de exercícios aeróbicos e a condição mais estudada foi diabetes mellitus tipo 2. Apenas uma RS apresentou informação a respeito da segurança da prática de atividade física, sem ocorrência de eventos adversos. Diversas modalidades de atividade física mostraram promover benefícios não-clínicos no tratamento de pessoas com diabetes, hipertensão e obesidade. Considerações finais: As evidências indicam que pessoas com diabetes ou hipertensão podem ter sua qualidade de vida melhorada com a prática de exercícios, em especial os aeróbicos. Para pessoas com obesidade ou comorbidades, as evidências são menos robustas. É importante levar em consideração algumas incertezas apontadas pelas RS, bem como as falhas metodológicas da maioria dessas RS.

Context: Physical activity practices are strong allies in reducing health risks, as well as in the treatment of diseases. Its relevance in the care of people with non-communicable chronic diseases is highlighted, for whom it is important to invest in quality of life. This rapid review addresses the non-clinical effects of physical activity interventions in people with type 2 diabetes mellitus, systemic arterial hypertension, and overweight/obesity. Question: What are the non-clinical effects of different physical activity modalities in the treatment of people with diabetes, hypertension or obesity? Methods: Following a previous protocol, searches for systematic reviews (SR) were carried out in eight electronic databases of the literature, in September 2021. This rapid review included SRs published in the last 10 years, with some specifications regarding context and population. Only the selection process was carried out in duplicate and independently. The evaluation of the quality of the SRs was carried out by one reviewer and checked by another, using the AMSTAR 2 tool. The results were gathered in a narrative synthesis according to the similarity of the type of physical activity and population. Results: Of the 4,421 reports found in the databases, 23 SRs were included after the selection and eligibility process. In the evaluation of methodological quality, one SR was considered moderately reliable, one of low confidence and the others of critically low confidence. The reviews presented results of aerobic, anaerobic, combined and unreported exercises involving people with type 2 diabetes mellitus, systemic arterial hypertension and overweight/obesity. The most common type of activity was aerobic exercises and the most studied condition was type 2 diabetes mellitus. Only one SR presented information about the safety of physical activity, without the occurrence of adverse events. Several modalities of physical activity have been shown to promote non-clinical benefits in the treatment of people with diabetes, hypertension and obesity. Final considerations: The evidence indicates that people with diabetes or hypertension can have their quality of life improved with the practice of exercises, especially aerobic ones. For people with obesity or comorbidities, the evidence is less robust. It is important to take into account some uncertainties pointed out by the SRs, as well as the methodological flaws of most of these SRs.

Educating diabetic patients through an SMS intervention: a randomized controlled trial at a Brazilian public hospital

ABSTRACT Objective: Diabetes mellitus (DM) has a high healthcare system cost worldwide. Educational strategies are important to improve self-care and control this disease. This study aimed to evaluate satisfaction and clinical efficacy of a Short Message Service (SMS) educational intervention in self-care and nutrition at a Brazilian university hospital. Materials and methods: We conducted a trial of educational intervention and assigned eligible patients with DM to either receive weekly educational SMS for 6 months (intervention group [IG]) or no SMS at all (control group). A satisfaction questionnaire was applied before and after the intervention in both groups. Laboratory (fasting glucose, hemoglobin [Hb] A1c, total cholesterol, triglycerides, high-density lipoprotein, and low-density lipoprotein) and clinical (blood pressure) data were also collected. Data were analyzed using nonparametric tests with the Statistical Package for the Social Sciences. Results: We included 128 patients (64 in each group). Responses to the satisfaction questionnaire with self-care and healthcare professionals from 112 patients revealed an improvement in the perception of receiving information regarding helpful eating habits and in healthy eating behavior and an improvement in satisfaction with their diabetes care in the IG. In the post-intervention period, improved systolic blood pressure and HbA1c levels were observed in the IG as illustrated by delta % (post-intervention minus pre-intervention data divided by pre-intervention data multiplied by 100) reductions of 2.3% and 3.9%, respectively Conclusion: SMS intervention was useful as an educational tool for improving satisfaction and glycemic and blood pressure control of patients with DM observed at a Brazilian university hospital.