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2.
Med. clín (Ed. impr.) ; 154(5): 157-162, mar. 2020. tab
Artigo em Espanhol | IBECS | ID: ibc-186627

RESUMO

Objetivo: Identificar los factores predictivos de hiperglucemia en pacientes que reciben nutrición parenteral (NP). Material y métodos: Estudio observacional retrospectivo (enero 2016-diciembre 2016) realizado en un hospital universitario de 450 camas. Se incluyeron los pacientes adultos hospitalizados que recibieron NP total por vía central durante al menos 48h de duración. Se recogieron las variables necesarias para caracterizar a los pacientes, y aquellas referentes a la NP recibida y se definió hiperglucemia como 3 glucemias consecutivas superiores a 150mg/dl o 2 superiores a 180mg/dl. Se realizó un análisis estadístico descriptivo, comparativo bivariante, y un análisis multivariante mediante regresión logística binaria (SPSS.v.24.). Resultados: Se incluyeron 234 pacientes. La prevalencia de hiperglucemia en la población bajo estudio fue del 44%. Las principales diferencias observadas en el análisis bivariante entre los pacientes hiperglucémicos y normoglucémicos se relacionaron con edad, comorbilidades previas, servicio médico, presencia de sepsis, duración y aporte de glucosa en la NP, así como los valores analíticos de glucemia y el tratamiento con corticoides. Los factores predictivos de hiperglucemia obtenidos tras el análisis multivariante fueron: aclaramiento renal (OR=0,982; IC95% 0,968-0,996; p=0,010), glucemia previa a la NP (OR=1,039; IC95% 1,026-1,051; p<0,001), diabetes mellitus (OR=11,016; IC95% 3,028-31,697; p<0,001), medicina intensiva (OR=3,303; IC95% 1,183-9,219; p=0,023), corticoides (OR=3,115; IC95% 1,179-8,226; p=0,022). Conclusiones: El aclaramiento renal disminuido, la glucemia previa elevada, la diabetes, la utilización de corticoides y el paciente crítico son factores predictores de hiperglucemia, por lo que sería conveniente considerarlos en el diseño de la fórmula de inicio de NP


Objective: To identify the predictive factors of hyperglycaemia in patients receiving parenteral nutrition (PN). Material and methods: Retrospective observational study (January 2016-December 2016) conducted in a 450-bed university hospital. Adult hospitalized patients who received total PN through a central line for at least 48hours were included. The required variables to characterize patients, and those related to the PN received were collected and hyperglycaemia was defined as 3 consecutive glycaemias greater than 150mg/dl or 2 greater than 180mg/dl. A descriptive, comparative bivariate statistical analysis was carried out, as well as a multivariate analysis using binary logistic regression (SPSS.v.24.) Results: 234 patients were included. The prevalence of hyperglycaemia in the population under study was 44.0%. The main differences observed in the bivariate analysis between hyperglycaemic and normoglycemic patients were related to age, previous comorbidities, medical department, presence of sepsis, duration and glucose contribution in PN, as well as blood glucose levels and corticosteroids. The predictors of hyperglycaemia obtained after the multivariate analysis were: renal clearance (OR=.982, 95% CI .968-.996, P=.010), pre-PN glycaemia (OR=1.039, 95% CI 1.026-1.051, P<.001), diabetes mellitus (OR=11.016, 95% CI 3.028-31.697, P<.001), intensive medicine (OR=3.303, 95% CI 1.183-9.219, P=.023), corticosteroids (OR=3.155, 95% CI 1.179-8.226, P=.022). Conclusions: Decreased renal clearance, high blood glucose levels, diabetes, corticosteroid use, and critical patients are predictors of hyperglycaemia, therefore it would be advisable to consider them in the design of PN start formula


Assuntos
Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Hiperglicemia/dietoterapia , Hiperglicemia/diagnóstico , Nutrição Parenteral/métodos , Valor Preditivo dos Testes , Estudos Retrospectivos , Análise Multivariada , Modelos Logísticos , Hiperglicemia/epidemiologia , Corticosteroides
6.
Endocrinol. diabetes nutr. (Ed. impr.) ; 66(10): 647-653, dic. 2019. tab, graf
Artigo em Inglês | IBECS | ID: ibc-184792

RESUMO

Introduction: Several sweeteners are introduced to replace sucrose in the human diet. However, they had their own limitations and concerns, particularly in terms of their taste and their long-term health consequences. This study examined the effect of a new mixture of sugars and sugar alcohol on the postprandial blood glucose levels and its possible gastrointestinal (GI) adverse reactions in human adults. Methods: In this double-blind three-way randomized clinical trial, adults (21 with type 2 diabetes and 20 healthy) received 300 ml of three beverages containing 50 g glucose, sucrose, and lacritose (a mixture of lactose, fructose, sucrose, and erythritol) when they were in the fasted state in a random order. Postprandial serum glucose was checked every 30min up to 2 h and the gastrointestinal reactions were collected. Results: The mean serum glucose was significantly lower in all time points after ingestion of the lacritose for participants with type 2 diabetes compared to glucose and sucrose (P < 0.05). The blood glucose levels were significantly lower in the 30th and 60th min for healthy subjects (P < 0.05). Adverse GI reactions were not significant between the test beverages. Conclusions: The ingestion of a 50 g dose of lacritose containing lactose, fructose, sucrose, and erythritol, led to an improved blood glucose levels without any significant adverse effect compared to the same amount of glucose and sucrose. Studying the long-term effects of lacritose on appetite, metabolic markers and adverse reactions is recommended. The trial was registered in Iranian registry of clinical trials: IRCT2015050912571N2


Introducción: Se han utilizado varios edulcorantes para sustituir a la sacarosa en la dieta humana. Sin embargo, tenían sus propias limitaciones y problemas, sobre todo por su sabor y sus consecuencias a largo plazo para la salud. En este estudio se explora el efecto de una nueva muestra de azúcares y alcohol de azúcar en los niveles de glucemia posprandial y las posibles reacciones adversas digestivas a ella en adultos humanos. Métodos: En este ensayo clínico doble ciego aleatorizado de tres vías, adultos (21 con diabetes tipo 2 y 20 sanos) recibieron 300ml de tres bebidas que contenían 50 g de glucosa, sacarosa y lacritosa (una mezcla de lactosa, fructosa, sacarosa y eritritol) en orden aleatorio en ayunas. Se comprobó la glucose sérica posprandial cada 30 minutos hasta las dos horas y se recogieron las reacciones digestivas. Resultados: Los valores medios de glucosa en suero eran significativamente menores en todos los puntos temporales tras la ingesta de lacritosa que tras la de glucosa y sacarosa en los participantes con diabetes tipo 2 (P < 0,05). Los niveles de glucemia eran significativamente menores a los 30 y 60 minutos en los sujetos sanos (P < 0,05). No había diferencias significativas en las reacciones digestivas adversas entre las bebidas estudiadas. Conclusiones: La ingesta de una dosis de 50 g de lacritosa que contiene lactosa, fructosa, sacarosa y eritritol, mejoró los niveles de glucemia sin efectos adversos importantes comparada con la misma cantidad de glucosa y sacarosa. Se recomienda estudiar los efectos a largo plazo de la lacritosa en el apetito, los marcadores metabólicos y las reacciones adversas. El ensayo se inscribió en el registro de ensayos clínicos de Irán: IRCT2015050912571N2


Assuntos
Humanos , Feminino , Adulto , Pessoa de Meia-Idade , Glicemia/análise , Sacarose/sangue , Hiperglicemia/sangue , Hiperglicemia/induzido quimicamente , Álcoois Açúcares/análise , Sacarose/efeitos adversos , Índice Glicêmico , Hiperglicemia/complicações , Método Duplo-Cego , Álcoois Açúcares/efeitos adversos , Álcoois Açúcares/sangue , Antropometria
8.
Aten. prim. (Barc., Ed. impr.) ; 51(7): 442-451, ago.-sept. 2019. graf, tab
Artigo em Espanhol | IBECS | ID: ibc-185732

RESUMO

El adecuado tratamiento de la diabetes mellitus tipo 2 (DM2) incluye la alimentación saludable y el ejercicio (150 min/semana) como pilares básicos. Para el tratamiento farmacológico, la metformina es el fármaco de elección inicial, salvo contraindicación o intolerancia; en caso de mal control, se dispone de 8 familias terapéuticas (6 orales y 2 inyectables) como posibles combinaciones. Se presenta un algoritmo y unas recomendaciones para el tratamiento de la DM2. En prevención secundaria cardiovascular se recomienda asociar un inhibidor del cotransportador sodio-glucosa tipo2 (iSGLT2) o un agonista del receptor de glucagon-like peptide-1 (arGLP1) en pacientes con obesidad. En prevención primaria, si el paciente presenta obesidad o sobrepeso la metformina deberá combinarse con iSGLT2, arGLP1 o inhibidores de la dipeptidilpeptidasa tipo 4 (iDPP4). Si el paciente no presenta obesidad, podrán emplearse los iDPP4, los iSGLT2 o la gliclazida, sulfonilurea recomendada por su menor tendencia a la hipoglucemia


Treatment of diabetes mellitus type 2 (DM2) includes healthy eating and exercise (150 minutes/week) as basic pillars. For pharmacological treatment, metformin is the initial drug except contraindication or intolerance; in case of poor control, 8 therapeutic families are available (6 oral and 2 injectable) as possible combinations. An algorithm and some recommendations for the treatment of DM2 are presented. In secondary cardiovascular prevention, it is recommended to associate an inhibitor of the sodium-glucose cotransporter type 2 (iSGLT2) or a glucagon-like peptide-1 receptor agonist (arGLP1) in patients with obesity. In primary prevention if the patient is obese or overweight metformin should be combined with iSGLT2, arGLP1, or inhibitors of type 4 dipeptidylpeptidase (iDPP4). If the patient does not present obesity, iDPP4, iSGLT2 or gliclazide, sulfonylurea, recommended due to its lower tendency to hypoglycaemia, may be used


Assuntos
Humanos , Hiperglicemia/tratamento farmacológico , Diabetes Mellitus Tipo 2/terapia , Fatores de Risco , Estilo de Vida Saudável , Exercício Físico , Algoritmos , Dieta Saudável , Índice Glicêmico , Doenças Cardiovasculares/prevenção & controle , Terapia Combinada
10.
Rev. clín. med. fam ; 12(2): 67-74, jun. 2019. tab, graf
Artigo em Espanhol | IBECS | ID: ibc-186258

RESUMO

Objetivo: Conocer los cambios en el grado de control después de 2 años, de pacientes con diabetes mellitus tipo 2 (DM2) en un centro de Salud español (público, SESCAM) y otro portugués (Unidad de Salud Funcional). Diseño: Estudio de cohorte. Emplazamiento: Atención Primaria. Participantes: Pacientes con DM2 que revisados 2 años después de un primer control (julio y noviembre del 2014, respectivamente en Portugal y España). Mediciones Principales: A partir de las historias clínicas informatizas se obtuvieron los siguientes datos: sexo, edad, años de evolución, índice de masa corporal (IMC), microalbuminuria, hemoglobina glicosilada (HbA1c), perfil lipídico, presencia de complicaciones y tratamiento. La información fue introducida en una base de datos informatizada por medio del programa estadístico SPSS 17.0. Se realizó estadística descriptiva y comparación de proporciones y medias/medianas. Resultados: En 2014 se estudiaron 200 pacientes portugueses y 278 españoles. Dos años después, se disponía de información en sus historias clínicas para 135 portugueses y 248 españoles. La media de edad de estos pacientes en 2016 era de 71,2 años (DE: 11,0), con 46,0 % de mujeres. No había diferencias en la distribución por edad y sexo entre ambos centros. La mediana de variación en la HbA1c a los 2 años era 0,0 (rango intercuartil:-0,4 a 0,5), sin diferencias estadísticamente significativas en los portugueses y un moderado aumento (p=0,05) para los españoles. Los portugueses presentaban una disminución media del IMC de 0,05 (IC95 %:-0,27 a 0,37) y los españoles tenían un aumento medio de 0,07 (IC95 %:-0,27 a 0,41), sin existir diferencias estadísticamente significativas. Conclusiones: A los 2 años de seguimiento, los pacientes portugueses mostraron una leve reducción de peso, con estabilidad en sus cifras de HbA1c, mientras que los españoles empeoraron ligeramente en ambos parámetros


Objective: The aim of the study is to know the changes in the degree of control of patients with type 2 diabetes mellitus in a Spanish health center (public, SESCAM) and a Portuguese health center (Functional Health Unit) after a two-year follow-up period. Design: Cohort study. Location: Primary Care. Participants: Patients with type 2 diabetes who were reviewed two years after a first control (July and November 2014, respectively in Portugal and Spain). Main measurements: The data obtained from the computerized clinical records were sex, age, years of disease course, body mass index (BMI), microalbuminuria, glycosylated hemoglobin (HbA1c), lipid profile, complications, and treatment. The information was entered into a computerized database with the statistical program SPSS 17.0. Descriptive statistics and comparison of proportions and means/medians were performed. Results: 200 Portuguese patients and 278 Spanish patients were studied in 2014. Information on their clinical follow-up was available two years after for 135 Portuguese and 248 Spanish. The mean age of these patients in 2016 was 71.2 years (SD: 11.0), with 46.0% of women. There were no differences in the distribution by age and sex in both centers. The median of variation in HbA1c after 2 years was 0.0 (interquartile range:-0.4 to 0.5), without statistically significant (NS) differences for Portuguese patients and moderate increase (p=0.05) for Spanish patients. The Portuguese presented a mean BMI decrease of 0.05 (95%CI:-0.27 to 0.37) and Spanish patients had a mean increase of 0.07 (95%CI:-0.27 to 0.41), NS differences. Conclusion: After 2 years of follow-up, Portuguese patients showed a slight weight reduction, with stability in their HbA1c levels, while Spanish patients worsened slightly in both parameters


Assuntos
Humanos , Diabetes Mellitus Tipo 2/epidemiologia , Hemoglobina A Glicada/análise , Hiperglicemia/prevenção & controle , Sobrepeso/prevenção & controle , Seguimentos , Atenção Primária à Saúde/estatística & dados numéricos , Espanha/epidemiologia , Portugal/epidemiologia , Estudos Transversais , Pesos e Medidas Corporais/estatística & dados numéricos
11.
Rev. clín. esp. (Ed. impr.) ; 219(4): 177-183, mayo 2019. tab, graf
Artigo em Espanhol | IBECS | ID: ibc-186528

RESUMO

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


Assuntos
Humanos , Masculino , Feminino , Adolescente , Adulto Jovem , Adulto , Pessoa de Meia-Idade , Idoso , Diabetes Mellitus/epidemiologia , Hipoglicemiantes/uso terapêutico , Hiperglicemia/prevenção & controle , Diabetes Mellitus/tratamento farmacológico , Índice Glicêmico/efeitos dos fármacos , Prevalência , Estudos Retrospectivos , Glicemia/análise , Hemoglobina A Glicada/análise
12.
Enferm. intensiva (Ed. impr.) ; 30(1): 4-12, ene.-mar. 2019. tab
Artigo em Espanhol | IBECS | ID: ibc-181636

RESUMO

Objetivo: Evaluar la efectividad de la implantación de un protocolo de control glucémico del paciente crítico liderado por enfermeras, en términos de mantenimiento de un rango preestablecido de glucemias, reducción de hiperglucemia y prevención de hipoglucemia severa. Método: Estudio cuasiexperimental prospectivo «pre-pos» realizado en una unidad de cuidados intensivos polivalente. Se incluyeron pacientes adultos en tratamiento con insulina endovenosa. Se registraron todas las determinaciones de glucemia desde noviembre de 2014 a agosto de 2015 (preintervención) y desde noviembre de 2015 a agosto de 2016 (pos). La intervención consistió en la implementación de un protocolo basado en la evidencia, para conseguir rangos de glucemia entre 140-180 mg/dl. Las variables principales incluyeron proporciones de glucemias dentro de rango, tasas de hipoglucemia severa (menos de 40 mg/dl) y tasas de hiperglucemia superior a 200 mg/dl. Resultados: Se evaluaron 7864 determinaciones de glucemia pertenecientes a 125 pacientes, 66 preintervención y 59 postintervención. La edad media fue de 66,24±13,99 años, el 64% eran hombres. La proporción de determinaciones dentro del rango fue superior en el grupo postintervención (38,82 vs. 44,34 p<0,001). Se identificó un caso de hipoglucemia severa, que sucedió en el grupo preintervención. La tasa de hiperglucemia severa resultó menor en el grupo postintervención (19,19 vs. 16,28 p=0,001). Conclusiones: Nuestra experiencia muestra que una implantación basada en la evidencia puede mejorar el control glucémico en pacientes críticos. Se observaron mayores tasas de glucemia dentro de rango. El protocolo resultó útil en la prevención de la hipoglucemia severa. El liderazgo del equipo de enfermería y la toma de decisiones autónomas basadas en datos clínicos permitió mejorar los resultados en salud de los pacientes


Aim: To assess the effectiveness of the implementation of a protocol for glycaemic control in critical care, in terms of maintenance of a pre-established target of blood glucose level, reduction of hyperglycaemia and prevention of severe hypoglycaemia. Method: Prospective "pre-post" quasi-experimental study carried out in a general critical care unit. Adult patients treated with intravenous insulin were included. We recorded all glycaemic tests performed from November 2014 to August 2015 (pre-intervention) and from November 2015 to August 2016 (post-intervention). The intervention consisted of the implementation of an evidence-based glycaemic control protocol to achieve glycaemic levels in a range of 140-180 mg/dl. Main variables analysed were: proportion of glycaemic tests in the target range, proportions of severe hypoglycaemia (under 40 mg/dl) and hyperglycaemia over 200 mg/dl. Results: We analysed 7864 glycaemic tests from 125 patients, 66 pre-intervention and 59 post-intervention. Average age was 66.24±13.99 years, 64% of patients were male. The proportion of tests within the target range was higher in the intervention group (38.82 vs. 44.34 p<.001). Only one case of severe hypoglycaemia was identified, which happened in the pre-intervention period. The rate of severe hyperglycaemia was lower in the post-intervention group (19.19 vs. 16.28 p=.001). Conclusions: Our experience shows that implementation of evidence-based interventions can improve glycaemic control during critical illness. We found higher glycaemia levels in the target range. The protocol proved useful in the prevention of severe hypoglycaemia. Nurse-led interventions based on clinical data improved health results in our patients


Assuntos
Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Idoso , Avaliação de Eficácia-Efetividade de Intervenções , Enfermagem Baseada em Evidências , Hiperglicemia/prevenção & controle , Estresse Psicológico/complicações , Enfermagem de Cuidados Críticos , Avaliação em Enfermagem , Estudos Prospectivos , Unidades de Terapia Intensiva , Liderança , Tomada de Decisões
13.
Rev. clín. esp. (Ed. impr.) ; 219(1): 18-25, ene.-feb. 2019. tab, graf
Artigo em Espanhol | IBECS | ID: ibc-185585

RESUMO

Antecedentes y objetivos: la información sobre el manejo de los pacientes diabéticos en el momento del alta hospitalaria es reducida. El objetivo del estudio fue evaluar el impacto de la implementación de las recomendaciones del Consenso español para el manejo del alta hospitalaria en pacientes con diabetes tipo 2 (DM2) o hiperglucemia durante la hospitalización. Métodos: estudio observacional con un grupo de recogida prospectiva y otra retrospectiva de pacientes con DM2/hiperglucemia (> 140mg/dl) durante la hospitalización de 19 hospitales españoles. Se recopilaron indicadores de calidad en el informe de alta, terapia hipoglucémica, HbA1c y eventos adversos al ingreso, en el momento del alta y a los 3 meses del alta. Resultados: se incluyó a 199 pacientes en el grupo prospectivo y 75 en el retrospectivo. Los indicadores de calidad del informe de alta hospitalaria fueron mayores en el grupo prospectivo (p<0,001). La proporción de pacientes con tratamiento de insulina, fármacos antidiabéticos orales (ADO) e insulina+ADO sufrió modificaciones en el momento del alta hospitalaria de los pacientes del grupo prospectivo con HbA1c<7,5% (p<0,005) y ≥ 7,5% (p<0,001), y en los pacientes del grupo retrospectivo con HbA1c ≥ 7,5% (p<0,001). En el mes 3 tras el alta, los niveles de HbA1c descendieron de 8,2± 1,9% a 7,3±1,2% (p<0,001) en el grupo prospectivo y desde 8,2±1,9% a 7,3±1,2% (p<0,001) en el retrospectivo. Los episodios de hipoglucemia e hiperglucemia así como los de reingreso fueron semejantes en ambos grupos. Conclusiones: la aplicación del documento español de consenso de las recomendaciones para el manejo del alta hospitalaria en pacientes con DM2 o hiperglucemia mejora de forma considerable el registro de indicadores de calidad en el informe de alta. La conciliación de la medicación antidiabética en el momento del alta hospitalaria mejora el control glucémico después del alta


Background and aims: information for the adequate management of diabetic patients at hospital discharge is limited. We aimed to evaluate the impact of implementation of recommendations of the Spanish consensus for the management hospital discharge in patients with type 2 diabetes or hyperglycaemia during hospitalization. Methods: observational multicentric study with a prospective and a retrospective colection of patients with type 2 diabetes /hyperglycaemia (>140mg/dl) during hospitalization from 19 Spanish hospitals. Quality indicators in discharge report, antidiabetic therapy, HbA1c and adverse events were gathered at hospital admission, hospital discharge and 3 month post-discharge. Results: 199 and 75 subjects in the prospective and retrospective group respectively were included. The indicators of quality in the hospital discharge reports was higher in the prospective group (P<.001). The proportion of patients with insulin, oral antidiabetic drugs (OADs), and insulin+OADs was modified at discharge in patients with HbA1c<7.5% (P<.005) and ≥7.5% (P<.001) in the prospective group and in patients with HbA 1c ≥7.5% (P<.001) in the retrospective group. At 3 month post-discharge HbA1c levels decreased from 8.2±1.9% to 7.3±1.2% (P<.001) in the prospective group, and from 8.3±1.5% to 7.2±1.2% (P<.001) in the retrospective group. Hypoglycaemic and hyperglycaemic episodes and hospital readmissions were similar in both groups. Conclusions: implementation of Spanish consensus recommendations for the management of hospital discharge in patients with diabetes type 2 or hyperglycaemia considerably improved the registration of quality indicators in the discharge report. Reconciliation of antidiabetic medication at the time of hospital discharge, improves glycaemic control after hospital discharge


Assuntos
Humanos , Hiperglicemia/prevenção & controle , Hospitalização/estatística & dados numéricos , Diabetes Mellitus Tipo 2/epidemiologia , Hipoglicemiantes/uso terapêutico , Hiperglicemia/epidemiologia , Sumários de Alta do Paciente Hospitalar/estatística & dados numéricos , Consenso , Reconciliação de Medicamentos/métodos , Índice Glicêmico , Indicadores de Qualidade em Assistência à Saúde/estatística & dados numéricos , Cooperação do Paciente/estatística & dados numéricos
15.
Pharm. pract. (Granada, Internet) ; 16(4): 0-0, oct.-dic. 2018. tab
Artigo em Inglês | IBECS | ID: ibc-180981

RESUMO

Background: High level of self-efficacy and adherence to self-care activities have a positive impact on the achievement of glycemic goal among diabetic patients. In Sudan, there is a gap in knowledge related to self-efficacy management and its influence on adherence to self-care activities and overall disease control. Objective: To identify the influence of management self-efficacy on adherence to self-care activities and treatment outcome among Sudanese patients with type 2 diabetes mellitus. Methods: A cross-sectional study was conducted at two health care facilities in Sudan from April to May 2016. Patients with type 2 diabetes mellitus were included. Convenience sampling method was adopted. Diabetes Management Self-Efficacy Scale and the Revised Summary of Diabetes Self-care Activities were used to collect data through a face-to-face interview. Logistic regression analysis was performed. A p value <0.05 was considered to be significant. Data were processed using the software SPPS v 21.0. Results: A total of 392 patients were included. Respondents classified with high level of self- efficacy across all domains were 191 (48.7%). Moreover, high level of education [adjusted OR 0.5 (0.3-0.7), (p=0.001)] and formal health education on diabetes [adjusted OR 2.4 (1.6-3.7), (p<0.001)], were found to be significantly associated with high level of diabetes management self-efficacy. Patients who had high level of self-efficacy to manage nutrition, physical exercise activity and medication were found more adherent to general diet, exercise activity, and medication taking, respectively. Patients with controlled disease were 87(22.2%). The only predictor of diabetes control was diabetes management self-efficacy [OR 2.1(1.3- 3.5), (p=0.002)]. Conclusions: Diabetes management self-efficacy was associated with high level of education and receiving health education. Self-efficacy was significantly associated with adherence to self-care activities and glycemic control. Substantial efforts are still needed to empower the patients with self-efficacy and improving adherence to self-care activities through appropriate interventions


No disponible


Assuntos
Humanos , Masculino , Feminino , Diabetes Mellitus Tipo 2/tratamento farmacológico , Autoeficácia , Cooperação do Paciente/estatística & dados numéricos , Adesão à Medicação/estatística & dados numéricos , Hipoglicemiantes/uso terapêutico , Hiperglicemia/prevenção & controle , Diabetes Mellitus Tipo 2/psicologia , Inquéritos e Questionários/estatística & dados numéricos , Comportamentos Relacionados com a Saúde/classificação , Sudão/epidemiologia , Avaliação de Eficácia-Efetividade de Intervenções , Assistência Farmacêutica/estatística & dados numéricos
16.
Pharm. pract. (Granada, Internet) ; 16(4): 0-0, oct.-dic. 2018. tab
Artigo em Espanhol | IBECS | ID: ibc-180985

RESUMO

Background: Diabetes type 2 is considered one of the main public health concerns. Lack of adherence to treatment leads to poor therapeutic outcome, poor glycemic control, and high risk for developing diabetes complications. Objectives: The aim of this study is to evaluate adherence to oral antidiabetic medication in Diabetes type 2 Lebanese patients, and to evaluate factors leading to low adherence. Methods: A cross-sectional study was conducted in outpatients endocrinology clinics of two hospitals and four private clinics located in Beirut-Lebanon. Data was collected using a well-structured questionnaire by trained pharmacists. Adherence level was measured by the Lebanese Medication Adherence Scale (LMAS-14). Bivariate and multivariate analyses were conducted using SPSS version 20. Results: Overall, 245 patients were included in the study with the majority being females (54.3%) and obese (47.8%). Only 29% of the participants had controlled glycemia (HbA1c <7%) with 31.8% of subjects had high adherence to their medication compared to 68.2% with low adherence. Increased working hours/day was associated with a decrease in adherence to oral antidiabetic medication (OR=0.31; 95% CI 0.11:0.88; p=0.029). Other factors significantly associated with decreased adherence to treatment were forgetfulness, high drug costs, complex treatment regimens, experiencing side effects, and perception of treatment inefficacy. Postponing physician office visits also decreased the probability of being adherent to oral antidiabetic medication (OR=0.36; 95% CI 0.15:0.86; p=0.022). Skipping or doubling the dose in case of hypo/hyperglycemia and the sensation of treatment burden also decreased medication adherence (OR=0.09; 95% CI 0.02:0.34; p=0.001, and OR=0.04; 95% CI 0.01:0.13; p<0.001 respectively). Conclusions: Adherence to oral antidiabetic medication is low for Lebanese patients, which leads to a poor glycemic control and increases the diabetes complications. Intervention programs including patient education strategies are essential to improve medication adherence


No disponible


Assuntos
Humanos , Diabetes Mellitus Tipo 2/tratamento farmacológico , Cooperação do Paciente/estatística & dados numéricos , Adesão à Medicação/estatística & dados numéricos , Hipoglicemiantes/uso terapêutico , Hiperglicemia/prevenção & controle , Diabetes Mellitus Tipo 2/psicologia , Inquéritos e Questionários/estatística & dados numéricos , Comportamentos Relacionados com a Saúde/classificação , Líbano/epidemiologia , Avaliação de Eficácia-Efetividade de Intervenções , Assistência Farmacêutica/estatística & dados numéricos , Estudos Transversais
17.
Endocrinol. diabetes nutr. (Ed. impr.) ; 65(10): 571-576, dic. 2018. tab, graf
Artigo em Espanhol | IBECS | ID: ibc-176482

RESUMO

Introducción: El objetivo fue estimar la incidencia de diabetes y explorar la mortalidad de pacientes hospitalizados durante el seguimiento posterior al alta, clasificados durante la misma según el comportamiento glucémico como hiperglucemia de estrés (HE) o normoglucemia (NG). Material y métodos: Cohorte retrospectiva de adultos no diabéticos con HE (>140mg/dl y HbA1c<6,5%) o NG (todos los valores de glucemia <=140mg/dl). Resultados: Se identificaron 3981 pacientes con NG y 884 con HE. Durante el período de observación (mediana de seguimiento de 1,83 años), hubo un total de 255 casos de diabetes y 831 muertes. La incidencia acumulada de diabetes al año fue de 1,59% (IC95%:1,23-2,06) en NG y 7,39% (IC95% 5,70-9,56) en HE. HE se asoció significativamente con la incidencia de diabetes (HR crudo 1,33; IC95% 1,13-1,73; p 0,025), incluso después del ajuste por edad y sexo (HR ajustado 1,38; IC95% 1,06-1,78; p 0,014). La incidencia de mortalidad al año fue 10,07% (IC95%:9,18-11,05) en NG y 13,24% (IC95%:11,17-15,65) en HE. El sub hazard ratio de desarrollar diabetes considerando la muerte como evento competitivo fue 1,41 (IC95% 1,29-1,53; p<0,001). Conclusiones: La HE es un factor de riesgo para desarrollar diabetes. No hubo diferencias de mortalidad en el seguimiento, pero la muerte parece comportarse como un evento competitivo al desarrollo de diabetes en esta población


Introduction: The study objective was to estimate during post-discharge follow-up the incidence of diabetes and to ascertain mortality in hospitalized patients, classified during follow-up as having stress hyperglycemia (SH) or normoglycemia (NG) based on blood glucose levels. Material and methods: A retrospective cohort of non-diabetic adults with SH (> 140mg/dl and HbA1c <6.5%) or NG (all blood glucose values ≤ 140mg/dl) was used. Results: There were 3981 patients with NG and 884 with SH. During the observation period (median follow-up of 1.83 years), there were 255 cases of diabetes and 831 deaths. The cumulative incidence of diabetes per year was 1.59% (95% CI: 1.23-2.06) in patients with NG and 7.39% (95% CI: 5.70-9.56) in those with SH. SH was significantly associated to diabetes (crude HR 1.33, 95% CI: 1.13-1.73, p .025), even after adjusting for age and sex (adjusted HR 1.38, 95% CI 1.06-1.78, p .014). The mortality rate at one year was 10.07% (95% CI: 9.18-11.05) in NG patients and 13.24% (95% CI: 11.17-15.65) in SH patients. The sub-hazard ratio of developing diabetes considering death as a competitive event was 1.41 (95% CI 1.29-1.53, p <.001). Conclusions: SH is a risk factor for diabetes. There were no differences in mortality during follow-up, but death appears to be a competitive event in development of diabetes in this population


Assuntos
Humanos , Feminino , Idoso , Idoso de 80 Anos ou mais , Masculino , Hiperglicemia/epidemiologia , Hospitalização , Diabetes Mellitus/etiologia , Estresse Psicológico/patologia , Argentina , Hiperglicemia/fisiopatologia , Hiperglicemia/mortalidade , Incidência , Mortalidade , Estudos de Coortes , Estudos Retrospectivos , Fatores de Risco
18.
Endocrinol. diabetes nutr. (Ed. impr.) ; 65(10): 611-624, dic. 2018. tab, graf
Artigo em Espanhol | IBECS | ID: ibc-176487

RESUMO

La diabetes mellitus tipo 2 (DM2) es un problema de dimensiones globales por su alta y creciente prevalencia en todo el mundo y por los costes personales y económicos asociados a ella. Un tratamiento adecuado ha demostrado reducir la mortalidad y las complicaciones asociadas. Recientemente se han incluido nuevos conceptos en la práctica clínica habitual y en el árbol de decisión de la terapia farmacológica de la DM2. Por ello, la Sociedad Española de Diabetes (SED) encargó al Grupo de Trabajo de Consensos y Guías Clínicas actualizar el documento de 2010 «Recomendaciones para el tratamiento farmacológico de la hiperglucemia en la diabetes tipo2». Entre los aspectos novedosos se incluyen nueve características para describir a cada grupo farmacológico: eficacia, riesgo de hipoglucemia, efectos en el peso corporal, efecto demostrado en el riesgo cardiovascular, nefroprotección, limitación de uso en la insuficiencia renal, frecuencia de los efectos secundarios, complejidad y coste. Así mismo, se detallan las opciones de combinación y se desarrollan el inicio y el ajuste de las terapias inyectables disponibles


Type 2 diabetes mellitus (DM2) has become a problem of global dimensions by their high and growing prevalence worldwide and the personal and economic costs associated with it. Correct treatment can reduce mortality and associated complications. New concepts have recently been included in routine clinical practice and have changed the algorithm of DM2 pharmacological therapy. Therefore, the Spanish Society of Diabetes (SED) entrusted to the Working Group of Consensus and Clinical Guidelines an update of the 2010 document Recommendations for Pharmacological Treatment of Hyperglycemia in Diabetes type2. Novel aspects include nine characteristics to describe each drug group: efficiency, the risk of hypoglycemia, effects on body weight, the demonstrated effect in cardiovascular risk, nephroprotection, limitation of use in renal insufficiency, the rate of secondary effects, complexity and costs. Additionally, the document details combination options, and develop the start and adjustment of available injectable therapies


Assuntos
Humanos , Hiperglicemia/tratamento farmacológico , Diabetes Mellitus Tipo 2/complicações , Sociedades Médicas/normas , Diabetes Mellitus Tipo 2/metabolismo , Diabetes Mellitus Tipo 2/fisiopatologia , Doenças Cardiovasculares/fisiopatologia , Fatores de Risco , Indicadores de Morbimortalidade , Ensaios Clínicos como Assunto , Hipoglicemiantes , Insulina/uso terapêutico
19.
Enferm. glob ; 17(52): 512-524, oct. 2018. tab
Artigo em Espanhol | IBECS | ID: ibc-173993

RESUMO

Objetivo: Determinar la prevalencia de los conocimientos y la actitud de las personas con diabetes mellitus tipo 2 en relación con la enfermedad y los factores asociados. Métodos: Investigación en los domicilios con 398 personas con diabetes mellitus tipo 2 inscritas en Atención Primaria. Se aplicaron tres cuestionarios: uno para el levantamiento de datos sociodemográficos y clínicos; el conocimiento de la diabetes Cuestionario (DKN-A) y la actitud de la diabetes Cuestionario (ATT-19). Para el análisis de datos, se utilizaron las pruebas bivariados y de regresión logística múltiple. Resultados: Más de la mitad de los sujetos (55,8%) tenía poco conocimiento sobre la enfermedad y la mayoría (92,2%), dificultad para resolverlos. Se verificó asociación entre el conocimiento acerca de la enfermedad con ocho o más años de estudio, cintura normal de la cadera, verificación de la glucosa en sangre regularmente, y relación inversa con el tiempo de diagnóstico <10 años. La actitud positiva hacia la enfermedad se asoció con edad entre 50 y 60 años y, a la inversa, con episodios de hiperglucemia. Conclusión: La baja prevalencia de conocimientos y actitudes positivas a la enfermedad. En cuanto a los factores asociados, cabe señalar que la mayoría de los destacados en este estudio no son modificables, lo que refuerza la importancia de que las actividades de promoción de la salud se centraron en gran medida en los grupos con estos factores


Objetivo: Verificar a prevalência do conhecimento e atitude de pessoas com diabetes mellitus tipo 2 em relação à doença e os fatores associados. Métodos: Inquérito domiciliar realizado com 398 pessoas com diabetes mellitus tipo 2 cadastradas na Atenção Primária. Foram aplicados três questionários: um para levantamento de dados sóciodemográficos e clínicos; o Diabetes Knowledge Questionnaire (DKN-A) e o Diabetes Attitude Questionnaire (ATT-19). Para análise dos dados, utilizou-se testes bivariados e regressão logística múltipla. Resultados: Mais da metade dos indivíduos (55,8%) apresentou conhecimento insatisfatório sobre a doença e a maioria (92,2%), dificuldade para o seu enfrentamento. Verificou-se associação entre conhecimento sobre a doença com oito ou mais anos de estudo, relação cintura quadril normal, verificação da glicemia capilar regular e, relação inversa com o tempo de diagnóstico <10 anos. A atitude positiva frente a doença apresentou associação com idade entre 50 a 60 anos e, de modo inverso, com episódios de hiperglicemia. Conclusão: A prevalência de conhecimento e atitudes positivas frente à doença foi considerada reduzida. Quanto aos fatores associados, salienta-se que a maioria daqueles evidenciados nesse estudo não são passíveis de modificação, reforçando a importância das atividades de promoção da saúde focadas sobremaneira nos grupos que apresentam estes fatores


Objective: To verify the prevalence of knowledge and attitude of people with diabetes mellitus type 2 in relation to the disease and associated factors. Methods: A household survey of 398 people with diabetes mellitus type 2 enrolled in Primary Care. Three questionnaires were applied: one for sociodemographic and clinical data collection; the Diabetes Knowledge Questionnaire (DKN-A) and the Diabetes Attitude Questionnaire (ATT-19). For data analysis, bivariate tests and multiple logistic regression were used. Results: More than half of the individuals (55.8%) presented unsatisfactory knowledge about the disease and the majority (92.2%) had difficulty in coping with it. There was an association between knowledge about the disease with eight or more years of study, normal waist hip ratio, regular capillary blood glucose check, and inverse relationship with time of diagnosis <10 years. The positive attitude towards the disease presented an association with age between 50 and 60 years and, conversely, with episodes of hyperglycemia. Conclusion: The prevalence of knowledge and positive attitudes towards the disease was considered low. As for the associated factors, most of those evidenced in this study are not subject to modification, reinforcing the importance of health promotion activities that are especially focused on the groups that present these factors


Assuntos
Humanos , Insulina/uso terapêutico , Hipoglicemiantes/uso terapêutico , Diabetes Mellitus Tipo 2/tratamento farmacológico , Hiperglicemia/enfermagem , Conhecimentos, Atitudes e Prática em Saúde , Atenção Primária à Saúde , Promoção da Saúde/métodos , Diabetes Mellitus/enfermagem , Diabetes Mellitus Tipo 2/enfermagem , Estudos Transversais
20.
Rev. andal. med. deporte ; 11(3): 0-0, sept. 2018. graf
Artigo em Português | IBECS | ID: ibc-181197

RESUMO

Objetivo: Apresentar o Doce Vida - programa de exercício físico supervisionado para diabéticos como estratégia para promoção e supervisão do exercício físico para pacientes diabéticos. Métodos: O Doce Vida caracteriza‐se como um programa de pesquisa e extensão universitária da Universidade de Pernambuco. Acontece três vezes por semana. Antes e após todas as sessões de exercício físico são avaliadas as variáveis glicêmicas e hemodinâmicas dos diabéticos. São realizadas avaliações físicas, palestras educativas e atividades de pesquisa. Resultados: O Doce Vida já atendeu diversos diabéticos nesses cinco anos, construiu um amplo banco de dados e, até ao início do mês de junho de 2015, mais de 72 350 dados já foram tabulados. Ao analisar a média da glicemia capilar dos participantes do Doce Vida durante esses cinco anos, podemos apresentar uma redução estatisticamente significativa de 49 mg/dL (181.0 ± 61.3 vs. 132.0 ± 61.0, p = 0.001). Conclusão: Programas deste cunho são eficazes no controle da diabetes, porém ainda são pouco divulgados. Assim sendo, é de suma importância a divulgação de propostas semelhante ao Doce Vida, que atua como estratégia efetiva de promoção e supervisão do exercício físico para diabéticos


Objetivo: Presentar Dulce Vida - Programa de ejercicio físico supervisado para diabéticos como una estrategia para la promoción y la supervisión del ejercicio físico para los pacientes diabéticos. Métodos: El programa Dulce Vida es un programa de investigación y extensión universitaria de la Universidad de Pernambuco. Las sesiones de ejercicio se celebran tres veces por semana. Antes y después de cada sesión de ejercicio se evalúa la glucemia y las variables hemodinámicas de los diabéticos. Se realizan evaluaciones físicas, charlas educativas y encuestas. Resultados: En el programa Dulce Vida han participado muchos diabéticos en estos cinco años, se elaboró una base de datos completa en la que se han incluido, hasta principios de junio de 2015, los datos de más de 72 350 participantes. Mediante el análisis de la glucemia media de los participantes en el programa Dulce Vida durante esos cinco años, podemos presentar una reducción estadísticamente significativa de 49 mg/dl (181.0 ± 61.3 vs. 132.0 ± 61.0, p = 0.001). Conclusiones: Los programas de esta naturaleza son eficaces en el control de la diabetes, pero aún son poco divulgados. Por lo tanto, es de suma importancia la divulgación de propuestas similares al programa Dulce Vida, que actúa como una estrategia eficaz para la promoción y supervisión de ejercicio para los diabéticos


Objectives: To present Sweet Life-Supervised Exercise Program for Diabetics as a strategy for promoting and supervising the exercise for diabetic patients. Methods: Sweet Life is characterized as a Research Program and University Extension of the University of Pernambuco. Exercise sessions are held three times a week. Before and after each exercise session, blood glucose and hemodynamic variables of diabetics are evaluated. Physical evaluations, educational talks and surveys are carried out. Results: In the Sweet Life program, many diabetics have participated in these five years, a complete database has been developed which, until the beginning of June 2015, has included data from more than 72 350 participants. By analyzing the mean blood glucose of the participants in the Sweet Life program during those five years, we can present a statistically significant reduction of 49 mg/dl (181.0 ± 61.3 vs. 132.0 ± 61.0, p = 0.001). Conclusions: Programs of this nature are effective in controlling diabetes, but are still poorly publicized. Therefore, the dissemination of proposals similar to the Sweet Life program, which acts as an effective strategy for the promotion and supervision of exercise for diabetics, is extremely important


Assuntos
Humanos , Terapia por Exercício/métodos , Diabetes Mellitus/reabilitação , Hiperglicemia/prevenção & controle , Brasil/epidemiologia , Complicações do Diabetes/prevenção & controle , Condicionamento Físico Humano/métodos
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