Peripheral arterial disease progression and ankle brachial index: a cohort study with newly diagnosed patients with type 2 diabetes.

BACKGROUND: Little is known about the evolution of peripheral arterial disease (PAD) since diagnosis and its association with glycemic and lipid control in patients with Type 2 Diabetes Mellitus (T2DM). OBJECTIVE: Evaluate the actual criteria to start screening PAD with ankle-brachial index (ABI) in T2DM patients and assess its progression and relationship with glycemic and lipid control since diagnosis. METHODS: We performed a 3-year prospective cohort study with two groups: group 1 (978 individuals with T2DM undergoing drug treatment) and group 2 [221 newly diagnosed drug-naive (< 3 months) patients with T2DM]. PAD diagnosis was by ABI ≤ 0.90, regardless any symptoms. RESULTS: As expected, abnormal ABI prevalence was higher in group 1 vs. Group 2 (87% vs. 60%, p < 0.001). However, abnormal ABI prevalence did not differ between patients over and under 50 years in both groups. Our drug-naive group stabilizes ABI (0.9 ± 0.1 vs 0.9 ± 0.1, p = NS) and improved glycemic and lipid control during follow-up [glycated hemoglobin (HbA1c) = 8.9 ± 2.1 vs 8.4 ± 2.3%, p < 0.05; LDL = 132 ± 45 vs 113 ± 38 mg/dL, p < 0.01, respectively]. When compared, patients who evolved with normalization or maintained normal ABI levels at the end [Group A, N = 60 (42%)] with those who decreased ABI to abnormal levels (ABI basal 1.0 ± 0.1 vs final 0.85 ± 0.1, p < 0.001) [Group B, N = 26 (18%)], an improvement in HbA1c (9 ± 2 vs 8 ± 2%, p < 0.05) and a correlation between the final HbA1c with ABI (r = - 0.3, p = 0.01) was found only in the first. In addition, a correlation was found between albuminuria variation and ABI solely in group A (r = - 0.3; p < 0.05). CONCLUSION: Our study suggests that ABI should be measured at diagnosis in T2DM patients, indicating that current criteria to select patients to screen PAD with ABI must be simplified. An improvement in albuminuria and glycemic and lipid control could be related with ABI normalization in newly diagnosed T2DM drug-naive patients.

Health-related quality of life in T1DM patients after high-dose cholecalciferol supplementation: data from a pilot clinical trial.

BACKGROUND: Type 1 Diabetes Mellitus (T1DM) impacts health-related quality of life (HRQoL). Cross-sectional studies suggest that low levels of vitamin D (VD) may impair HRQoL, however, the effect of VD supplementation on quality of life in T1DM patients has not yet been clarified. Our study evaluated the effects of high-dose VD supplementation on HRQoL in T1DM. METHODS: We performed a prospective study with 64 patients receiving cholecalciferol (4000 IU/day for patients with 25-OH-vitamin D [25(OH)D] between 30 and 60 ng/mL, and 10,000 IU/day for those with 25(OH)D below 30 ng/mL) for 12 weeks, as part of a research protocol. HRQoL was assessed with EuroQol instruments (EQ-5D and EQ-VAS). RESULTS: There was an improvement in global EQ-5D index, and analysing specifically the EQ-5D domains, we observed an improvement in mobility (1.3 ± 0.6 versus 1.1 ± 0.3, p < 0.01). Evaluating possible outcome influencing variables, we detected a reduction in albuminuria at the end of the trial, without changes in BMI, lipids, blood pressure, glycemic control and insulin doses. We found correlations between final albuminuria and the dimensions: mobility (r = 0.6; p < 0.01), personal care (r = 0.7; p < 0.01), pain and discomfort (r = 0.6; p < 0.01) and habitual activities (r = 0.6; p < 0.01), suggesting an association between albuminuria reduction and the impact of VD supplementation on HRQoL. CONCLUSION: Our data showed that high doses of cholecalciferol supplementation can improve HRQoL in patients with T1DM, and the reduction of albuminuria seems to be an important factor in this context. TRIAL REGISTRATION: (ISRCTN32601947), 03/06/2017 retrospectively registered.

Cochlear dysfunction and microvascular complications in patients with type 1 diabetes mellitus.

Sensorineural hearing impairment has been associated with DM, and it is probably linked to the same pathophysiological mechanisms as well-established in microvascular diabetes complications. The study of otoacoustic emissions (OAEs) is useful to identify subclinical cochlear dysfunction. Therefore, the aim of this study was to evaluate the association between abnormal OAEs responses, diabetic kidney disease (DKD) and diabetic cardiac autonomic neuropathy (CAN). We performed a cross-sectional study with 37 type 1 DM patients without auditory symptoms, submitted to the study of Distortion Product Otoacoustic Emissions (DPOAEs) and screened for DKD and CAN. The otoacoustic emissions responses were considered abnormal in 27/37 (73%) patients. A correlation was found between abnormal OAEs responses and presence of DKD (r = 0.36, p < 0.05), and 14/16 (88%) patients with a lower amplitude of OAEs in 8 kHz frequency band presented DKD. Abnormal OAEs responses in the 6 kHz frequency band were correlated with the presence (r = 0.41, p = 0.01) and severity of CAN (r = 0.44, p < 0.001). Additionally, 7/9 (78%) patients with abnormal OAE responses in this frequency also presented abnormal CAN scores. Our results suggest that abnormal otoacoustic emissions responses in high frequency bands are associated with diabetes microvascular complications and could be a risk marker for DKD and CAN, presenting low sensitivity and high specificity. Therefore, assuming that hearing impairment is a pre-clinical stage of hearing loss, performing distortion product otoacoustic emissions in T1DM patients with microvascular complications could be useful to identify those who would be benefit with regular audiologic follow up and tighter diabetes control.

Bioética y Telesalud en Fonoaudiología: una investigación documental / Bioethics and Telehealth in Speech Therapy and Audiology: a documental study

El objetivo de este estudio es analizar de qué forma las cuestiones éticas y bioéticas fueron tratadas en la legislación de telesaluden Fonoaudiología, utilizando los principios constantes de la Declaración Universal sobre Bioética y Derechos Humanos(DUBDH). Se trata de un estudio documental. El método incluyó la selección, relevamiento y análisis de los documentosclavey comparación entre lo que preconiza la Resolución del Consejo Federal de Fonoaudiología (CFFa) nº 427/2013, quedispone sobre telesalud en Fonoaudiología, y los principios previstos en la DUBDH, con apoyo de la literatura científica sobreel tema. Los resultados mostraron que, con excepción del respeto por la diversidad cultural y por el pluralismo, los principiosde la DUBDH están respaldados en la legislación fonoaudiológica. De este modo esta legislación prevé la promoción deteleasistencia de calidad y de forma eficiente a cualquier brasileño y restringe la tele-educación de procedimientos diagnósticosy terapéuticos fonoaudiológicos apenas a profesionales y estudiantes de Fonoaudiología, anticipando la posibilidad de fallas enla realización de estos procedimientos, lo que no respetaría la dignidad humana. Como conclusión, se verificó la necesidad deuna revisión de la legislación, en lo que se refiere a explicitar el respeto por la diversidad cultural y por el pluralismo, para queeste principio también sea considerado y el fonoaudiólogo esté dispuesto a ver al otro libre de ideas pre-concebidas, lo quefacilitará la comprensión entre ambos. De esta forma, será más probable alcanzar el éxito de la intervención fonoaudiológicaa distancia

The aim of this study was to analyze how ethical and bioethical issues were addressed in telehealth Speech Therapy andAudiology legislation, using the principles contained in the Universal Declaration on Bioethics and Human Rights (UDBHR).This was a documental study. The methods included selection, collection and analysis of key documents, and the comparisonbetween the resolution of the Conselho Federal de Fonoaudiologia No. 427/2013, which provides for telehealth in SpeechTherapy and Audiologia, and principles seen in the UDBHR. This comparison was supported by scientific literature on thesubject. The results showed that the UDBHR principles are supported in Speech Pathology and Audiology legislation except theone that addresses respect for cultural diversity and pluralism. Thus, this legislation provides for the promotion of tele-assistancequality and efficiency to any Brazilian citizen, and restricts tele-education speech pathology and audiology diagnostic andtherapeutic procedures only to professionals and Speech Therapy and Audiology students. The possible failure to perform theseprocedures could disregard human dignity. In conclusion, it was verified that it is necessary to revise the legislation with regardto respect for cultural diversity and pluralism so that this principle will also be considered, and that the speech therapist andaudiologist would be ready to see other individuals free of preconceived ideas. This will facilitate the understanding betweenthem. Thus, the success of speech therapy and audiological therapy practiced at a distance will be more likely

O objetivo deste estudo foi analisar como as questões éticas e bioéticas foram tratadas na legislação de telessaúde emFonoaudiologia, utilizando os princípios constantes da Declaração Universal sobre Bioética e Direitos Humanos (DUBDH).Trata-se de estudo documental. O método incluiu a seleção, coleta e análise dos documentos-chave e comparação entreo que preconiza a Resolução do Conselho Federal de Fonoaudiologia (CFFa) nº 427/2013, que dispõe sobre telessaúdeem Fonoaudiologia, e os princípios previstos na DUBDH, com apoio da literatura científica sobre o tema. Os resultadosmostraram que, excetuando o respeito pela diversidade cultural e pelo pluralismo, os princípios da DUBDH estão respaldadosna legislação fonoaudiológica. Assim, essa legislação prevê a promoção de teleassistência de qualidade e de forma eficientepara qualquer brasileiro e restringe a tele-educação de procedimentos diagnósticos e terapêuticos fonoaudiológicos apenasa profissionais e estudantes de Fonoaudiologia, antecipando a possibilidade de falhas na realização desses procedimentos,o que desrespeitaria a dignidade humana. Como conclusão, verificou-se a necessidade de revisão da legislação no que serefere a explicitar o respeito pela diversidade cultural e pelo pluralismo para que este princípio seja também considerado e ofonoaudiólogo esteja disposto a ver o outro livre de ideias pré-concebidas, o que facilitará a compreensão entre ambos. Destaforma, será mais provável o êxito da intervenção fonoaudiológica à distância