Understanding the Impact of Different Doses of Reducose® Mulberry Leaf Extract on Blood Glucose and Insulin Responses after Eating a Complex Meal: Results from a Double-Blind, Randomised, Crossover Trial.

Non-communicable diseases (NCDs) are becoming an increasingly important health concern due to a rapidly ageing global population. The fastest growing NCD, type 2 diabetes mellitus (T2DM), is responsible for over 2 million deaths annually. Lifestyle changes, including dietary changes to low glycemic response (GR) foods, have been shown to reduce the risk of developing T2DM. The aim of this study was to investigate whether three different doses of Reducose®, a mulberry leaf extract, could lower the GR and insulinemic responses (IR) to a full meal challenge in healthy individuals. A double-blind, randomised, placebo-controlled, repeat-measure, crossover design trial was conducted by the Oxford Brookes Centre for Nutrition and Health; 37 healthy individuals completed the study. Participants consumed capsules containing either 200 mg, 225 mg, 250 mg Reducose® or placebo before a test meal consisting of 150 g white bread and egg mayo filler. Capillary blood samples were collected at 15-min intervals in the first hour and at 30-min intervals over the second and third hours to determine glucose and plasma insulin levels. The consumption of all three doses of Reducose® resulted in significantly lower blood glucose and plasma insulin levels compared to placebo. All three doses of Reducose® (200 mg, 225 mg, 250 mg) significantly lowered glucose iAUC 120 by 30% (p = 0.003), 33% (p = 0.001) and 32% (p = 0.002), respectively, compared with placebo. All three doses of Reducose® (200 mg, 225 mg, 250 mg) significantly lowered the plasma insulin iAUC 120 by 31% (p = 0.024), 34% (p = 0.004) and 38% (p < 0.001), respectively. The study demonstrates that the recommended dose (250 mg) and two lower doses (200 mg, 225 mg) of Reducose® can be used to help lower the GR and IR of a full meal containing carbohydrates, fats and proteins.

Effects of Satureja Khuzestanica supplementation on glycemic indices and lipid profile in type 2 diabetes patients: a randomized controlled clinical-trial.

BACKGROUND: Several studies showed the hypoglycemic and hypolipidemic effects of Satureja Khuzestanica (SK) in animal models. This study aimed to determine the effect of SK supplementation on glycemic and lipid outcomes of patients with type 2 diabetes mellitus (T2DM). METHODS: The study was designed as a double-blind, placebo-controlled, randomized clinical trial using block randomization. Seventy-eight T2DM patients were randomly assigned to intervention (n = 39) or placebo (n = 39) groups. They received SK or placebo in 500 mg capsules daily for 12 weeks. Anthropometric, blood pressure, liver enzymes, glycemic, and lipid outcomes were measured before and after the intervention. RESULTS: At baseline, there were no significant differences in age, sex, or glycated hemoglobin (HbA1c) levels between the groups. SK supplementation led to a significant decrease in FBS (-12.6 ± 20.7 mg/dl in the intervention group versus 3.5 ± 31.9 mg/dl; p = 0.007), HbA1c (-0.28 ± 0.45 in the intervention group versus 0.11 ± 0.54% in the placebo group; p = < 0.001), insulin (-1.65 ± 6.18 in the intervention group versus 2.09 ± 5.90 mIU/L in the placebo group; p = 0.03), total cholesterol (-14.6 ± 21.1 mg/dl in the intervention group versus 8.2 ± 30.9 mg/dl in the placebo group; p < 0.001), LDL-cholesterol (-4.6 ± 15.2 mg/dl in the intervention group versus 5.8 ± 14.6 mg/dl in placebo group; p < 0.001) levels, and significant increase in HDL-cholesterol (3.9 ± 4.9 mg/dl in the intervention group versus 0.9 ± 5.2 mg/dl in placebo group; p = 0.005). CONCLUSION: Based on the study results, SK supplementation may improve glycemic indices and lipid profile of patients with T2DM. Our findings may provide novel complementary treatments without adverse effects for diabetes complications. These results need to be further confirmed in clinical trials. REGISTRATION: This trial has been registered in the Iranian Registry of Clinical Trials (IRCT ID: IRCT20190715044214N1, registration date: 21/02/2021).

Effectiveness of date seed on glycemia and advanced glycation end-products in type 2 diabetes: a randomized placebo-controlled trial.

BACKGROUND: Type 2 diabetes mellitus (T2DM) is a chronic medical condition affecting more than 95% of people with diabetes. Traditionally, some medicinal plants have been considered as an effective approach in management of T2DM. This trial evaluated the effects of date seed powder (DSP) on glycemia indices and oxidative stress in T2DM patients. METHODS: In this trail, 43 patients with T2DM were randomized to two groups: either 5 g/d of the DSP or placebo for 8 weeks. Levels of glycemic indices, lipolpolysaccharide (LPS), and soluble receptor for advanced glycation end products (s-RAGE), as well as other parameters associated with oxidative stress were assessed at baseline and after 8 weeks. Independent t-test and analysis of covariance (ANCOVA) were used for between-groups comparisons at baseline and the post-intervention phase, respectively. RESULTS: The results showed that supplementation with DSP significantly decreased HbA1c (-0.30 ± 0.48%), insulin (-1.70 ± 2.21 µU/ml), HOMA-IR (-1.05 ± 0.21), HOMA-B (-0.76 ± 21.21), lipopolysaccharide (LPS) (-3.68 ± 6.05 EU/mL), and pentosidine (118.99 ± 21.67 pg/mL) (P < 0.05, ANCOVA adjusted for baseline and confounding factors). On the other hand, DSP supplementation significantly increased total antioxidant capacity (TAC) (0.50 ± 0.26 mmol/L), superoxide dismutase (SOD) (0.69 ± 0.32 U/ml), and s-RAGE (240.13 ± 54.25 pg/mL) compared to the placebo group. FPG, hs-CRP, GPx, CML, and uric acid had no significant within- or between-group changes. CONCLUSION: Supplementation of DSP could be considered an effective strategy to improve glycemic control and oxidative stress in T2DM patients (Registration ID at www.irct.ir : IRCT20150205020965N10).

Utilización de TICs en medicina de urgencias: valoración de un software de ayuda a la prescripción del paciente con hiperglucemia (DIAGETHER(R)), por parte de médicos residentes / Use of ICTs in emergency medicine: assessment of a prescription aid software for patients with hyperglycemia (DIAGETHER(R)), by resident doctors

INTRODUCCIÓN: La permisividad ante la hiperglucemia es nociva para los pacientes ingresados. DIAGETHER es una aplicación que ayuda al médico en el tratamiento del paciente diabético. OBJETIVOS: Determinar grado de usabilidad, nivel de confianza y valoración global de DIAGETHER empleada por médicos residentes en distintos escenarios clínicos. MÉTODO: Estudio descriptivo multicéntrico, basado en una encuesta de valoración sobre DIAGETHER, a 42 residentes de dos hospitales, valorando la toma de decisiones con respecto a la terapéutica de pacientes con alteraciones glucémicas en distintos escenarios clínicos. RESULTADOS: DIAGETHER fue valorado positivamente respecto a usabilidad, confianza en resolución de casos, y tiempo empleado. La valoración global de la herramienta fue del 87,5. En el lado negativo, es necesario realizar estudios en terreno real para saber la adaptación real de la herramienta al trabajo médico. CONCLUSIONES: La aplicación DIAGETHER(R) es una herramienta fácil de usar, rápida en la toma de decisiones y le da al médico seguridad en el tratamiento de pacientes con hiperglucemia, lo que hace que su valoración global sea alta. En el lado negativo, el estudio fue realizado en condiciones "no reales", sería interesante desarrollar futuros estudio en varios servicios de urgencias

INTRODUCTION: Permissiveness to hyperglycemia is harmful to admitted patients. DIAGETHER is an application that helps the doctor in the treatment of the diabetic patient. OBJECTIVES: Determine degree of usability, level of confidence and overall assessment of DIAGETHER used by physicians resident in different clinical settings. Method. Multicenter descriptive study, based on a DIAGETHER assessment survey, of 42 residents of two hospitals, assessing decision-making regarding the therapeutics of patients with glycemic disorders in different clinical settings. RESULTS: DIAGETHER was positively assessed regarding usability, confidence in case resolution, and time spent. The overall assessment of the tool was 87.5. On the negative side, it is necessary to conduct real-field studies to know the real adaptation of the tool to medical work. CONCLUSIONS: The DIAGETHER(R) application is an easy-to-use, quick decision-making tool and gives the doctor safety in the treatment of patients with hyperglycemia, which makes their overall assessment high. On the negative side, the study was conducted under "non-real" conditions, it would be interesting to develop future studies in several emergency departments

La atención en casa: el apoyo familiar en el control glicémico en pacientes con diabetes mellitus tipo 2 / Home care: family support in glycemic control in patients with type 2 diabetes mellitus

INTRODUCCIÓN: La diabetes mellitus tipo 2 (DM2) es una enfermedad en la que el sujeto presenta alteraciones metabólicas de los carbohidratos, proteínas y grasas, de origen genético, por una deficiencia de la secreción de insulina o por la incapacidad para utilizarla, con grados variables de resistencia a ésta. Un individuo con diabetes debe de cambiar su estilo de vida, para lo cual es importante que reciba ayuda, generalmente de su familia. OBJETIVO: Describir la trascendencia entre la atención en casa y/o apoyo familiar de la persona que vive con diabetes mellitus tipo 2 en lo que respecta al control glucémico. MÉTODO: Estudio observacional, transversal en pacientes DM Tipo 2. Se aplicó 100 encuestas para la recolección de información que midió el apoyo familiar percibido por el paciente diabético. RESULTADOS: El promedio de edad de los participantes fue de 45 años, el 55 % de la muestra correspondió al sexo masculino. El 57% de la población presenta niveles glucémicos superiores a 200 mg/dl. 27% presentan apoyo familiar y este es menor en las mujeres. CONCLUSIÓN: De acuerdo con los resultados obtenidos se concluye que el apoyo familiar es uno de los factores que influyen directamente con el cumplimiento del tratamiento farmacológico y no farmacológico

INTRODUCTION: Diabetes mellitus type 2 (DM2) is a disease in which the subject presents metabolic alterations of carbohydrates, proteins and fats, of genetic origin, due to a deficiency in insulin secretion or due to the inability to use it, with variable degrees of insulin resistance to it. An individual with diabetes should change their lifestyle, for which it is important that they receive help, usually from their family. OBJECTIVE: Describe the importance of home care and / or family support for the person living with type 2 diabetes mellitus in regard to glycemic control. METHOD: Observational, cross-sectional study in DM Type 2 patients. 100 surveys were applied to collect information that measured the family support perceived by the diabetic patient. RESULTS: The average age of the participants was 45 years, 55% of the sample corresponded to the male sex. 57% of the population have glycemic levels higher than 200 mg / dl. 27% have family support and this is lower in women. CONCLUSION: According to the results obtained, it is concluded that family support is one of the factors that directly influence the compliance of pharmacological and non-pharmacological treatment

Evaluación del impacto glucémico de una formulación líquida de carbón activado en pacientes con intoxicación medicamentosa aguda / Blood glucose level after infusing an activated charcoal suspensionfor acute drug poisoning

OBJETIVO: La suspensión líquida de carbón activado (CA) contiene como excipiente 600 mg/mL de sacarosa. Se eva¬lúa el impacto glucémico de la administración de CA en pacientes con intoxicación medicamentosa aguda (IMA). MÉTODO: Se identificaron pacientes con IMA y determinación de la glucemia antes y después de haber recibido CA. Se compararon estos cambios de glucemia con los generados por el desayuno en un grupo control de no intoxicados. RESULTADOS: Se incluyeron 55 IMA. En el 82% de los casos la glucemia aumentó tras administrar CA. La media de las glucemias previas al carbón fue de 98,2 mg/dL y a la hora posterior de 124,2 mg/dL (p < 0,001). El cambio glucémico no condicionó eventos clínicos adversos. En el grupo control (n = 23) la glucemia aumentó en el 82,6% de los casos. La media de las glucemias antes del desayuno fue de 117,1 mg/dL y la posterior de 152,0 mg/dL (p < 0,001). CONCLUSIÓN: La administración de CA induce un aumento estadísticamente significativo de la glucemia, pero sin rele¬vancia clínica y equiparable al producido por un desayuno

OBJECTIVE: Activated charcoal in suspension contains 600 mg/mL of sucrose. We aimed to assess the impact of an activated charcoal suspension on blood glucose levels in patients with acute medication poisoning. METHODS: We identified drug patients whose blood glucose levels were measured before and after administration of activated charcoal to treat poisoning. The impact on blood glucose level was compared to changes after breakfast in a control group not receiving treatment for poisoning. RESULTS: Fifty-five poisoned patients were included. Eighty-two percent had higher blood glucose levels after activated charcoal administration. The mean glucose levels before and 1 hour after treatment were 98.2 mg/dL and 124.2 mg/dL, respectively (P<.001). The increase did not translate to adverse clinical events. Glucose levels increased in 82.6% of the 23 patients in the control group. Mean glucose levels before breakfast and 1 hour later were 117.1 mg/dL and 152.0 mg/dL (P<.001). CONCLUSION: Activated charcoal induces an increase in blood glucose level that is statistically but not clinically significant. The increase is comparable to the increase after breakfast

Seguimiento farmacoterapeútico de pacientes diabeticos tipo II con prescripción de antidepresivos en una farmacia comunitaria Argentina / Pharmacotherapeutic monitoring of type 2 diabetic patients with prescription of antidepressants in a community pharmacy in Argentina

La diabetes mellitus tipo 2 es una enfermedad crónica donde co-existen trastornos del estado emocional, que resultan la principal barrera de adherencia al tratamiento, siendo la más común la depresión, recomendándose el tratamiento con antidepresivos. El uso conjunto de hipoglucemiantes orales (HGO) y antidepresivos (ATD), pueden alterar las glucemias por interacción de estos medicamentos. El objetivo fue analizar correlación sobre el control de la glucemia preprandial, en pacientes con prescripción de hipoglucemiantes orales y antidepresivos a fin de evaluar la incorporación de esta información en la ficha de seguimiento. MATERIAL Y MÉTODOS: Estudio observacional, descriptivo y transversal durante abril y mayo 2017.Pacientes diabéticos tipo 2 que asistieron a retirar sus medicamentos en una farmacia de la ciudad de Córdoba, con mediciones de glucemias preprandiales por autocontroles realizados en el mes. Se registró tipo de tratamientos HGO y ATD utilizaban. RESULTADOS: Se incorporaron 81 pacientes, 42 tuvieron con prescripción de HGO y ATD, 39 solo HGO. El promedio de edad fue de 61 años, 57% de mujeres. El 71% de paciente presentaron valores promedio anormales de glucemias preprandiales. El HGO más prescripto fue metformina solo o en asociaciones y el antidepresivo más prescripto paroxetina. No se encontró correlación entre el uso de antidepresivos y alteración de valores de glucemia preprandial. CONCLUSIÓN: La correlación entre la concentración de glucemia preprandial en pacientes diabéticos tipo 2, con o sin prescripción de tratamiento antidepresivo no resulto ser estadísticamente significativa para la muestra estudiada. Sin embargo se consideró oportuno el incorporar como alerta el uso de antidepresivos debido a los antecedentes bibliográficos encontrados

Diabetes Diabetes mellitus type 2 is a chronic disease on which emotional state disorders coexist. They represent the main barrier to treatment adherence and the most common one is depression. Treatment with antidepressants is recommended. Used together, oral hypoglycaemic agents (HGO) and antidepressants (ATD) achieve a better glycaemic regulation. The aim of this study was to analyse the correlation between preprandial glycemia, in patients with concomitant prescription of oral hypoglycaemic agents and antidepressant drugs. MATERIAL AND METHODS: An observational, descriptive and cross-sectional study was carried out during the months of April and May 2017. Type 2 diabetic patients who attended to withdraw their medications in a pharmacy in the city of Córdoba, with preprandial blood glucose measurements by self-test performed during the month were included in the study. It was also recorded what type of HGO and ATD treatments they used. RESULTS: 81 patients were incorporated to the study. 42 were prescribed with HGO and ATD, 39 only with HGO. The average age was 61 years and 57% were women. 71% of the patients had abnormal average preprandial blood glucose levels. The most prescribed HGO was metformin alone or in associations and the most prescribed antidepressant paroxetine. There was found no correlation between the use or not of antidepressants and preprandial blood glucose values. CONCLUSION: The correlation between the concentration of pre-prandial glycaemia in type 2 diabetic patients, with or without an antidepressant treatment prescription, was not statistically significant for the studied sample. However, it was considered appropriate to incorporate the use of antidepressants as an alert due to the bibliographic background found

Multifactorial intervention for diabetes control among older users of insulin

ABSTRACT OBJECTIVE: To evaluate if the closer follow-up with the supply of insulin pens and the measurement of capillary blood glucose improve the management of older patients with type 2 diabetes without adequate glycemic control despite extensive therapy. METHODS: This is a prospective, non-randomized, quasi-experimental study. We have included 45 patients over 60 years old, from both sexes, with glycated hemoglobin (HbA1c) > 8.5% using oral hypoglycemic agents and insulin. The intervention consisted of monthly medical visits, with the provision of insulin pens and strips for blood glucose measurement. All patients received insulin pen, refills of Neutral Protamine Hagedorn and regular insulin, needles for the pen, blood glucose meter, and capillary blood glucose tests (three tests/day). Treatment was adjusted with the same endocrinologist monthly for six months. Glycated hemoglobin was measured at baseline and 12 and 24 weeks after intervention. RESULTS: Glycated hemoglobin at baseline was 10.34% (SE = 0.22%) and 8.54% (SE = 0.24%, p < 0.001) and 8.09% (SE = 0.21%, p < 0.001) at 12 and 24 weeks after intervention, respectively, with a significant reduction from baseline. CONCLUSIONS: More frequent medical visits, with treatment inputs including the use of insulin pens and self-monitoring, have improved glycemic control (reduction of 2.25% in HbA1C, on average, at 24 weeks of follow-up). Our data support a change in the management and medical behavior of older patients with chronically decompensated diabetes.

Mi experiencia con liraglutida en pacientes con diabetes mellitus de tipo 2 de corta evolución / My experience with liraglutide in patients with type 2 diabetes mellitus at early Stages

El tratamiento integral de la diabetes mellitus de tipo 2 (DM2) debería estar dirigido al control de todas las comorbilidades asociadas e incluir como eje fundamental la pérdida de peso, especialmente la de grasa visceral. En aquellos pacientes en que no se han conseguido los objetivos de control glucémico con metformina, fármaco de elección en primera línea en el tratamiento de la DM2, es necesario asociar un segundo fármaco. Entre los fármacos de segunda línea están las terapias basadas en incretinas (agonistas del receptor del péptido1 similar al glucagón GLP-1 [ARGLP-1] e inhibidores de la dipeptidilpeptidasa 4 [DPP-4]). En este artículo se revisan brevemente los efectos del ARGLP-1 liraglutida sobre la diabetes y los factores de riesgo cardiovascular y los datos comparativos con los inhibidores de la DPP-4. Se propone que el tratamiento con liraglutida debería iniciarse preferentemente en las fases tempranas de la DM2

The comprehensive treatment of diabetes mellitus type 2 (DM2) should be targeted to control all associated comorbidities and include weight loss, especially visceral fat. In patients not achieving the goals of glycaemic control with metformin–the drug of choice in first-line treatment of type 2 diabetes-a second associated drug will be needed. Among second-line drugs are incretin-based therapies (GLP-1 receptor agonists [GLP-1-RA] and DPP-4 inhibitors). This article briefly reviews the effects of the GLP-1-RA, liraglutide, on diabetes and cardiovascular risk factors and the comparative data with DPP-4inhibitors. It is proposed that treatment with liraglutide should preferably be initiated in the early stages of type 2 diabetes

Phytotherapy in reducing glycemic index and testicular oxidative stress resulting from induced diabetes: a review / Fitoterapia na redução da glicemia e do estresse oxidativo testicular resultantes do diabetes experimental: uma revisão

Abstract Oxidative stress plays a main role in the development of diabetes complications. The impairment of gonadal antioxidant potential and endocrine disturbance in diabetic males causes testicular damage and failure in sperm production. Plants have been widely used to control diabetes due their hypoglycemic and antioxidant potential, contributing towards the recovery of testicular function. Current study comprises a review of the literature on the main medicinal plants used in the recovery of testicular oxidative damage in animals with experimental diabetes. Eighteen plant species in the nineteen studies selected from the search strategy were evaluated. Plant extracts were evaluated according to their effects on blood glucose and insulin levels, antioxidant enzymes and oxidant levels, lipid peroxidation, total protein, testosterone levels, gonadosomatic index, diameter of seminiferous tubules, seminiferous epithelium height and integrity, number of germ cells at stage VII and apoptosis in the seminiferous epithelium, sperm production, motility, viability and morphology. After the analysis of the studies, it was observed that plant species, used alone or in combination, may control testicular oxidative damage triggered by diabetes. The antioxidant potential varies among species, with some plants proving to have a better performance in the recovery of reproduction parameters than others.

Resumo O estresse oxidativo desempenha um dos principais papéis no desenvolvimento das complicações do diabetes. Em machos diabéticos, as alterações ao potencial antioxidante gonadal e os distúrbios endócrinos resultam em danos testiculares e falhas na produção de espermatozoides. Plantas têm sido amplamente utilizadas como um método de controle do diabetes devido aos seus potenciais hipoglicemiante e antioxidante, contribuindo para a recuperação da função testicular. Assim, o objetivo deste estudo é fazer uma revisão da literatura sobre as principais plantas medicinais utilizadas na recuperação de danos oxidativos testiculares em animais induzidos ao diabetes experimental. Nos dezenove estudos selecionados a partir da estratégia de busca, dezoito espécies de plantas foram utilizadas. Os extratos das espécies vegetais foram avaliados de acordo com os seus efeitos nas concentrações de glicose e insulina, níveis das enzimas antioxidantes e dos oxidantes, peroxidação lipídica, quantidade de proteínas totais, níveis de testosterona, índice gonadossomático, diâmetro dos túbulos seminíferos, altura e integridade do epitélio seminífero, número de células germinativas no estágio VII, número de células em apoptose no epitélio seminífero, produção, motilidade, viabilidade e morfologia espermática. Depois das análises aos estudos, foi observado que as espécies vegetais, sozinhas ou em combinação, podem ajudar a controlar os danos oxidativos testiculares desencadeados pelo diabetes. Contudo, o potencial antioxidante varia entre as espécies, algumas tenho uma melhor performance na recuperação dos parâmetros reprodutivos do que outras.

Programa de gerenciamento de doenças crônicas em um plano de saúde, são paulo, brasil / Programa de gestión de enfermedades crónicas en un seguro salud en el estado de são paulo, brasil / Chronic disease management program in a health plan, são paulo, brazil

RESUMO Atualmente as doenças crônicas não transmissíveis são as principais causas de morte no mundo. Consideradas doenças multifatoriais, têm em comum fatores de riscos modificáveis tais como inatividade física, colesterol elevado, excesso de peso, tabagismo, consumo excessivo de bebidas alcoólicas e alimentação não saudável. Com o objetivo de verificar o impacto por um programa de Gerenciamento de Doenças Crônicas, após dois anos de acompanhamento, surgiu esta pesquisa. Trata-se de programa desenvolvido com um grupo de clientes de uma autogestão localizada no estado de São Paulo. É um estudo transversal realizado durante os anos de 2014-2015 com dados de prontuário eletrônico que foram comparados parâmetros clínicos e hábitos de vida de 1.509 indivíduos participantes de um programa de gerenciamento de doenças em dois momentos: na entrada ao programa e após dois anos de participação. Observaram-se resultados satisfatórios na melhora de parâmetros clínicos relacionados aos níveis pressóricos e à dosagem de glicemia em jejum, assim como diminuição do sedentarismo em indivíduos abaixo dos 60 anos.

RESUMEN Actualmente las enfermedades crónicas no transmisibles son las principales causas de muerte en todo el mundo. Consideradas enfermedades multifactoriales, tienen en común factores de riesgo modificables, tales como inactividad física, colesterol alto, sobrepeso, tabaco, exceso de alcohol y alimentación poco sana. Con el objetivo de averiguar el impacto por un programa de Gestión de Enfermedades Crónicas, tras dos años de acompañamiento, se hizo esta investigación. Se trata de un programa desarrollado con un grupo de clientes de una autogestión ubicada en el estado de São Paulo, Brasil. Es un estudio transversal realizado durante los años de 2014-2015 con datos de registros médicos electrónicos, comparándose los parámetros clínicos y hábitos de vida de 1.509 personas que participan en un programa de gestión de enfermedades en dos ocasiones: cuando entran en el programa y después de dos años de participación. Se observaron resultados satisfactorios en la mejora de los parámetros clínicos relacionados con los niveles de presión arterial y a la dosificación de glucemia en ayunas, así como la disminución de la inactividad física en personas con edad abajo de 60 años.

ABSTRACT Currently, non-transmissible chronic diseases are leading causes of death worldwide. Considered as multifactorial diseases, they have common modifiable risk factors such as physical inactivity, high cholesterol, overweight, smoking, excessive alcohol consumption, and unhealthy diets. Aiming at verifying the impact of theChronic Disease Management program, this study arose after two years of follow-up. This is a program developed with a group of customers in a self-management platform in the state of São Paulo. This was a cross-sectional study carried out during 2014 and 2015 with electronic medical record data through the comparison ofthe clinical and lifestyle parameters of 1,509 individuals participating in a disease management program in two moments: at the program'sentry and two years after participation. Satisfactory results in the improvement of clinical parameters related to blood pressure and blood glucose levels in fasting were observed as well as decreased physical inactivity in individuals under 60 years of age.

Amiotrofia diabética síndrome de Bruns-Garland asociado a rápida mejoría en el control metabólico / Bruns-Garland syndrome (diabetic amyotrophy) is associated with a rapid improvement in metabolic control

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Corazón y riñón en la diabetes: efectos de los glucosúricos / The heart and kidney in diabetes: Heart and kidney in diabetes

El riñón del diabético presenta un exceso de expresión y actividad del trasportador SGLT2 del túbulo proximal. Esta situación aumenta la reabsorción renal de Na y glucosa, y reduce la oferta distal de los mismos. Además de los efectos metabólicos sobre el medio interno de este exceso de glucosa reabsorbida, el túbulo renal se ve sometido a un estrés glicosilativo capaz de activar localmente tanto apoptosis como inflamasoma. El resultado es la pérdida progresiva de unidades nefronales, la activación de la transición epitelio mensangial y del depósito de colágeno. Se produce la activación de la señalización de insulina por la vía de la MAP kinasa y la resistencia a los efectos metabólicos de la insulina. Simultáneamente se superpone una vasodilatación aferente por la hiperglucemia, una inhibición del feed-back túbulo-glomerular por la reducción en la oferta distal de fluido, la desdiferenciación de los podocitos y la reducción en su número, estos últimos efectos debidos a la resistencia a la insulina. El resultado es un daño renal autoalimentado, con hiperpresión intraglomerular, desdiferenciación podocitaria, apoptosis tubular y activación local y a distancia del inflamasoma. Todos estos efectos son susceptibles de corregirse total o parcialmente al inhibir el trasporte de glucosa a través de los SGLT2

The diabetic kidney presents excess expression and activity of the SGLT2 transporter of the proximal tubule. This situation increases the renal reabsorption of Na and glucose and reduces their distal supply. In addition to the metabolic effects on the internal environment of this excess reabsorbed glucose, the renal tubule is subjected to glycosylated stress capable of locally activating both apoptosis and inflammasome. The result is a progressive loss of nephron units, activation of transition of mesangial epithelium and collagen deposition. Activation of insulin signalling by the MAP kinase pathway and resistance to the metabolic effects of insulin take place. This is simultaneously combined with afferent vasodilation due to hyperglycaemia, tubuloglomerular feedback inhibition due to reduced distal fluid supply, podocyte dedifferentiation and reduction in their number, the latter effects being due to insulin resistance. The result is self-feeding renal damage, with intraglomerular hyper-pressure, podocyte dedifferentiation, tubular apoptosis, and local and distant activation of inflammasome. All these effects are susceptible to be totally or partially corrected by inhibiting glucose transport via the SGLT transporters

Comportamiento de la hemoglobina glucosilada en diabéticos tipo 2 con macroangiopatía diabética de los miembros inferiores / Behavior of glycosylated hemoglobin type 2 in diabetics with diabetic macroangiopathy in the lower members

Introducción: la hemoglobina glucosilada es utilizada para evaluar el grado de control glucémico. Se ha publicado que la disminución de este indicador en el 2 % reduce la aparición o progresión de las complicaciones micro- o macrovasculares. Objetivo: determinar el comportamiento de la hemoglobina glucosilada en pacientes diabéticos tipo 2 con macroangiopatía diabética de los miembros inferiores. Métodos: se estudiaron 100 pacientes diabéticos tipo 2 con o sin macroangiopatía diabética de los miembros inferiores; 36 hombres y 64 mujeres, con una edad promedio de 61,8 años (44-79 años). Se cuantificó el grado de glucosilación de la hemoglobina y se calculó su valor de referencia. Se identificó y describió el tipo de asociación del indicador con diferentes factores de riesgo y con el tipo de macroangiopatía diabética. Resultados: se escogió el valor de 8,6 por ciento de hemoglobina glucosilada por ser el punto de corte con los mayores valores de sensibilidad (73,7 por ciento), especificidad (83,7 por ciento) y razón de probabilidad (4,52). Se constató un mal control glucémico en el 48,3 por ciento de los pacientes, donde la mayor proporción correspondió a la macroangiopatía de tipo ocluido (44,8 por ciento). En los pacientes descompensados fue la dislipidemia el factor de riesgo que más predominó (58,3 por ciento), así como la combinación del tabaquismo con la hipertensión arterial (35,3 por ciento). Conclusión: los pacientes diabéticos de tipo 2 con macroangiopatía diabética de los miembros inferiores de tipo ocluido mostraron valores muy elevados de hemoglobina glucosilada indicativo de un mal control metabólico(AU)

Introduction: glycosylated hemoglobin is used to evaluate the level of glycemic control. It has been reported that its decrease by 2 % reduces the occurrence or progression of micro or macrovascular complications. Objective: to determine the behavior of glycosylated hemoglobin in type 2 diabetes patients with macroangiopathy in lower limbs. Method: study of one hundred type 2 diabetic patients with/without diabetic macroangiopathy in their lower limbs; 36 were males and 64 females averagely aged 61.8 years (44-74 years). The level of hemoglobin glycosylation was quantitated as well as the reference value was estimated. The kind of association of this indicator with several risk factors and with the type of diabetic macroangiopathy was also established and described. Results: the reference value of 8.6 percent of the glycosylated hemoglobin was chosen because it was the cutoff point with the highest sensitivity (73.7 percent), specificity (83.7 percent) and probability odds (4.52) values. Poor glycemic control was confirmed in 48.3 percent of patients, mainly affected by occluded macroangiopathy (44.8 percent). In decompensated patients, dyslipidemia was the predominant risk factor (58.3 percent) along with the combination of smoking and blood hypertension (35.3 percent). Conclusions: the type 2 diabetic patients with occluded diabetic macroangiopathy of the lower limbs showed very high glycosylated hemoglobin values indicative of poor metabolic control(AU)

Prevalencia de diabetes, utilización de antidiabéticos y grado de control glucémico en la provincia de Cádiz (2014-2016): un estudio de base poblacional / Prevalence of diabetes, use of antidiabetic drugs and degree of glycaemic control in the province of Cadiz (2014-2016): A population-based study

Antecedentes y objetivo: Los objetivos de este estudio fueron evaluar la prevalencia de diabetes mellitus tratada farmacológicamente, analizar los patrones de prescripción de los fármacos antidiabéticos y evaluar el grado de control de la enfermedad en la provincia de Cádiz. Pacientes y métodos: Estudio observacional retrospectivo utilizando las bases de datos del Sistema Público de Salud del Servicio Andaluz de Salud entre los años 2014 a 2016, ambos inclusive. Se consideró persona adulta con diabetes tratada (PADT) aquella persona mayor de 14 años que había consumido al menos un envase de medicación del grupo A10 a lo largo de cada uno de los años correspondientes de estudio. Resultados: La prevalencia de PADT varió entre el 8,65% y el 8,83% de 2014 a 2016, respectivamente. Un 71% de PADT estaban tratadas solo con fármacos no insulínicos, un 11% con insulinas y un 18% con una combinación de ambos. En aproximadamente un tercio de las PADT no se había realizado una determinación de HbA1c a lo largo de cada año. El 69% de las PADT evaluadas tenía en 2016 un adecuado grado de control de acuerdo a los criterios de la RedGDPS (según HbA1c y edad). Conclusión: La prevalencia de diabetes tratada farmacológicamente en la provincia de Cádiz es elevada y parece ir en aumento. Los pacientes presentan un limitado control glucémico, al que puede contribuir de forma predominante el seguimiento inadecuado en casi una tercera parte de los mismos

Background and objective: The aim of the study was to assess the prevalence of diabetes mellitus treated pharmacologically, analyse the prescription patterns of antidiabetic drugs and assess the degree of control over the disease in the province of Cadiz. Patients and methods: An observational retrospective study was conducted with the databases of the public health system of the Andalusian Health Service between 2014 and 2016, inclusive. Adults with treated diabetes (ATD) were considered those older than 14 years who had consumed at least 1 package of medication from the A10 group during the corresponding year covered by the study. Results: The prevalence of ATD varied between 8.65% and 8.83% from 2014 to 2016, respectively. Seventy-one percent of the ATD were treated with only noninsulin drugs, 11% were treated with insulin, and 18% were treated with a combination of both. For approximately one-third of the ATD, an HbA1c reading was not performed during each year. Sixty-nine percent of the assessed ATD in 2016 had an appropriate degree of control according to RedGDPS criteria (based on HbA1c and age). Conclusion: The prevalence of pharmacologically treated diabetes in the province of Cadiz is high and appears to be increasing. The patients presented limited glycaemic control, to which inadequate follow-up in almost a third of the patients could be the major contributor

Características da dieta nas diferentes fases da evolução do diabetes melito tipo 1 / Diet composition along the evolution of type 1 diabetes mellitus

A importância da terapia nutricional no tratamento do diabetes melito tem sido enfatizada desde os primórdios de seu conhecimento, quando era a única intervenção efetiva. No diabetes tipo 1, a dieta adequada é fundamental em conseqüência de sua conjugação com a utilização da insulina exógena. A ingestão energética adequada, para obtenção de peso normal mantém o anabolismo, assegurando crescimento e desenvolvimento, assim como diminui a resistência à insulina. O uso correto dos micro e macronutrientes é de fundamental importância. O conhecimento do metabolismo dos carboidratos e sua relação com a elevação glicêmica, em seus aspectos qualitativos e quantitativos é enfatizada por possibilitar um bom controle, principalmente no período pós-prandial. É comentada também a correta utilização de proteínas para prevenir ou tratar nefropatia e gorduras para evitar a dislipidemia, obesidade e doença cardiovascular. Sacarose e edulcorantes artificiais devem ser utilizados com critérios. A aderência ao tratamento, entretanto, é fundamental para obtenção das metas desejadas.

The importance of nutrition therapy in treating diabetes mellitus has been emphasized since it was first identified, being the only effective intervention then. In Type 1 diabetes, its importance is even more pronounced due to its association with the use of exogenous insulin. Appropriate caloric ingestion in order to attain normal body weight maintains anabolism, warranting growth and development and decreases insulin resistance. The correct use of micronutrients and macronutrients is vitally important. The knowledge of carbohydrate metabolism and its association with glycemic elevation, in qualitative and quantitative aspects, is emphasized since it enables good control, especially during the postprandial period. The correct use of proteins to prevent or treat nephropathies and lipids or to avoid dyslipidemia, obesity, and cardiovascular disease are also addressed. Sucrose and artificial sweeteners should be used with care. Compliance with treatment, however, is the key to reach the desired goals.