Educational intervention on perceived stress among adults with type 2 diabetes and metabolic syndrome: a non-randomized clinical trial.

Objective: To assess the effectiveness of an educational intervention on perceived stress and metabolic syndrome parameters among adults with type 2 diabetes mellitus. Method: Fifty-one adults (aged 48.73±7.84; 86.3% of women) were included in a non-randomized clinical trial performed in a healthcare unit for six months (Brazilian Clinical Trial Registry: RBR-43K52N). All participants were diagnosed with type 2 diabetes mellitus and metabolic syndrome (intervention group, n=26; control group, n=25). The intervention consisted of a nurse-led educational health-promoting program with a multidisciplinary approach organized in seven workshops. The primary outcome was decreased perceived stress, and the secondary outcome was improvement in metabolic syndrome parameters according to perceived stress levels. These outcomes were assessed at two points in time, at the baseline and follow-up. Results: Participation in the intervention program resulted in a significant decrease in perceived stress (p=0.028). The stressed participants in the intervention group experienced a significant decrease in blood glucose levels (p=0.001) and a significant increase in high-density lipoprotein-cholesterol (p=0.003) concentrations after the six-month intervention. Conclusion: The nurse-led educational health-promoting program decreased perceived stress among adults with type 2 diabetes mellitus and metabolic syndrome, improving fasting blood glucose and high-density lipoprotein cholesterol among the stressed participants in the intervention group.

Roux-en-Y Gastric Bypass vs Vertical Sleeve Gastrectomy in the Remission of Type 2 Diabetes Mellitus: A Systematic Review and Meta-Analysis.

<b><br>Introduction:</b> Obesity's associated comorbidities and treatment costs have risen significantly, highlighting the importance of early weight loss strategies. Bariatric surgeries like Roux-en-Y gastric bypass (RYGB) and vertical sleeve gastrectomy (VSG) have been effective in promoting weight loss and improving type 2 diabetes mellitus (T2DM) management.</br> <b><br>Aim:</b> The aim was to determine whether Roux-en-Y gastric bypass is more effective than vertical sleeve gastrectomy in the remission of type 2 diabetes mellitus (T2DM).</br> <b><br>Methods:</b> A systematic review and meta-analysis was performed. A literature search was performed in the databases Web of Science, Medline/PubMed, Embase, Scopus, and Medline/Ovid. A total of 1323 results were identified; after screening, 14 articles were selected and included in the systematic review. Primary and secondary outcomes were measured by RR with a 95% CI.</br> <b><br>Results:</b> The primary outcome of T2DM remission was 15% in favor of VSG (RR: 1.15, [95% CI: 1.04-1.28]). For secondary outcomes, hypertension remission was 7% in favor of VSG (RR: 1.07, [95% CI: 1.00-1.16]). Remission of dyslipidemia was 16% in favor of VSG (RR: 1.16, [95% CI: 1.06-1.26]). BMI after surgery was in favor of RYGB (MD: -1.31, [95% CI: -1.98 to -0.64]). For weight loss, the results favored VSG (MD: 6.50, [95% CI: 4.99-8.01]). In relation to total cholesterol, they were 65% favorable for RYGB (MD: -0.35, [95% CI: -0.46 to -0.24]), with a value of p <0.05. For LDL values, our results were 69% favorable for RYGB (MD: -0.31, [95% CI: -0.45 to -0.16]), p <0.01 value.</br> <b><br>Conclusions:</b> Laparoscopic sleeve gastrectomy is more effective in T2DM remission, hypertension remission, dyslipidemia remission, and weight loss compared to Roux-en-Y gastric bypass. Roux-en-Y gastric bypass is more effective at lowering BMI, total cholesterol, LDL, and TG compared to laparoscopic sleeve gastrectomy.</br>.

Unveiling contrasts in microbiota response: A1c control improves dysbiosis in low-A1c T2DM, but fails in high-A1c cases-a key to metabolic memory?

INTRODUCTION: Type 2 diabetes mellitus (T2DM) is associated with dysbiosis in the gut microbiota (MB). Individually, each medication appears to partially correct this. However, there are no studies on the response of the MB to changes in A1c. Therefore, we investigated the MB's response to intensive glycemic control. RESEARCH DESIGN AND METHODS: We studied two groups of patients with uncontrolled T2DM, one group with an A1c <9% (18 patients-G1) and another group with an A1c >9% (13 patients-G2), aiming for at least a 1% reduction in A1c. We collected A1c and fecal samples at baseline, 6, and 12 months. G1 achieved an average A1c reduction of 1.1%, while G2 a reduction of 3.13%. RESULTS: G1's microbiota saw a decrease in Erysipelotrichaceae_UCG_003 and in Mollicutes order (both linked to metabolic syndrome and associated comorbidities). G2, despite having a more significant reduction in A1c, experienced an increase in the proinflammatory bacteria Megasphaera and Acidaminococcus, and only one beneficial genus, Phascolarctobacterium, increased, producer of butyrate. CONCLUSION: Despite a notable A1c outcome, G2 could not restore its MB. This seeming resistance to change, leading to a persistent inflammation component found in G2, might be part of the "metabolic memory" in T2DM.

Cardiovascular Outcomes of Sodium-Glucose Cotransporter-2 Inhibitors Therapy in Patients With Type 2 Diabetes Mellitus and Chronic Kidney Disease: A Systematic Review and Updated Meta-Analysis.

BACKGROUND AND OBJECTIVES: The efficacy of sodium-glucose cotransporter-2 inhibitors (SGLT2i) may depend on renal function, and this raises theoretical concern over its effects on cardiovascular outcomes in patients with type 2 diabetes mellitus (T2DM) and chronic kidney disease (CKD). METHODS: This systematic review and updated meta-analysis of randomized controlled trials (RCTs) compared cardiovascular outcomes of patients with T2DM and CKD treated with SGLT2i to placebo. PubMed, Embase, and Cochrane were systematically searched. Prespecified subgroup analyses were performed in strata of estimated glomerular filtration rate (eGFR) of <45 mL/min/1.73 m² and 45 to 59 mL/min/1.73 m². RESULTS: Nine RCTs comprising 29,146 patients were selected. Average follow-up ranged from 0.75 to 4.2 years. SGLT2i were shown to reduce the risk of all-cause mortality (hazard ratio [HR], 0.88; 95% confidence interval [CI], 0.79-0.97; p=0.01), the composite of cardiovascular mortality or hospitalizations for heart failure (HHF: HR, 0.71; 95% CI, 0.65-0.78; p<0.001), cardiovascular mortality (HR, 0.86; 95% CI, 0.76-0.98; p=0.02), HHF (HR, 0.62; 95% CI, 0.55-0.71; p<0.001), major adverse cardiovascular events (HR, 0.85; 95% CI, 0.77-0.94; p=0.002), stroke (HR, 0.76; 95% CI, 0.59-0.97; p=0.03), and myocardial infarction (HR, 0.78; 95% CI, 0.67-0.91; p=0.001). These findings were consistent over strata of eGFR, albeit with a lower incidence of stroke in patients treated with SGLT2i with eGFR <45 mL/min/1.73 m² (p-value for interaction=0.04). CONCLUSIONS: Compared with a placebo, patients with T2DM and CKD treated with SGLT2i experience a reduction in all-cause mortality, cardiovascular mortality, and HHF. TRIAL REGISTRATION: PROSPERO Identifier: CRD42023401081.

Educational intervention on perceived stress among adults with type 2 diabetes and metabolic syndrome: a non-randomized clinical trial / Intervención educativa sobre el estrés percibido en adultos con diabetes tipo 2 y síndrome metabólico: ensayo clínico no aleatorizado / Intervenção educativa sobre o estresse percebido de adultos com diabetes tipo 2 e síndrome metabólica: ensaio clínico não-randomizado

Objective.To assess the effectiveness of an educational intervention on perceived stress and metabolic syndrome parameters among adults with type 2 diabetes mellitus. Method. Fifty-one adults (aged 48.73±7.84; 86.3% of women) were included in a non-randomized clinical trial performed in a healthcare unit for six months (Brazilian Clinical Trial Registry: RBR-43K52N). All participants were diagnosed with type 2 diabetes mellitus and metabolic syndrome (intervention group, n=26; control group, n=25). The intervention consisted of a nurse-led educational health-promoting program with a multidisciplinary approach organized in seven workshops. The primary outcome was decreased perceived stress, and the secondary outcome was improvement in metabolic syndrome parameters according to perceived stress levels. These outcomes were assessed at two points in time, at the baseline and follow-up. Results. Participation in the intervention program resulted in a significant decrease in perceived stress (p=0.028). The stressed participants in the intervention group experienced a significant decrease in blood glucose levels (p=0.001) and a significant increase in high-density lipoprotein-cholesterol (p=0.003) concentrations after the six-month intervention. Conclusion.The nurse-led educational health-promoting program decreased perceived stress among adults with type 2 diabetes mellitus and metabolic syndrome, improving fasting blood glucose and high-density lipoprotein cholesterol among the stressed participants in the intervention group.

Objetivo. Evaluar la efectividad de una intervención educativa sobre el estrés percibido y los componentes del síndrome metabólico en adultos con diabetes mellitus tipo 2. Métodos. Se incluyeron 51 adultos (48.73±7.84 años; 86.3% mujeres) de un estudio no-ensayo aleatorizado realizado en una unidad de salud durante seis meses, con Registro Brasileño de Ensayos Clínicos: RBR-43K52N, todos los participantes fueron diagnosticados con diabetes mellitus tipo 2 y síndrome metabólico (grupo intervención, n=26; grupo control, n=25). La intervención consistió en un programa educativo de promoción de la salud con enfoque multidisciplinario, liderado por una enfermera, estructurado en siete talleres grupales. El resultado primario fue la reducción del estrés percibido y el secundario, la mejora de los componentes del síndrome metabólico influenciados por el nivel de estrés percibido, evaluado en dos momentos, al inicio y después del seguimiento. Resultados. La participación en el programa de intervención resultó en una reducción significativa del estrés percibido en comparación con el grupo control (p=0.028). Los participantes estresados en el grupo de intervención tuvieron, respectivamente, una disminución y un aumento significativos en las concentraciones séricas de glucosa (p=0.001) y lipoproteínas de alta densidad-colesterol (p=0.003) después de seis meses de intervención. Conclusión. Un programa educativo de promoción de la salud liderado por enfermeras fue eficiente para reducir el estrés percibido entre adultos con diabetes mellitus tipo 2 y síndrome metabólico, además de mejorar la glucemia en ayunas y el colesterol unido a lipoproteínas de alta densidad en los participantes del grupo estresado de intervención.

Objetivo. Avaliar a efetividade de uma intervenção educativa sobre o estresse percebido e os componentes da síndrome metabólica em adultos com diabetes mellitus tipo 2. Métodos. Foram incluídos 51 adultos (48.73±7.84 anos de idade; 86.3% mulheres) em um ensaio clínico não-randomizado realizado em uma unidade de saúde durante seis meses, com Registro de Ensaio Clínico Brasileiro: RBR-43K52N.Todos os participantes apresentavam diagnóstico de diabetes mellitus tipo 2 e síndrome metabólica (grupo intervenção, n=26; grupo controle, n=25). A intervenção consistiu em um programa educativo de promoção da saúde com abordagem multidisciplinar, liderado por enfermeiro, estruturado em sete oficinas em grupo. O desfecho primário foi a redução do estresse percebido, e o secundário, a melhora dos componentes da síndrome metabólica conforme influência do nível de estresse percebido, avaliados em dois momentos, na condição basal e após o acompanhamento. Resultados. A participação no programa de intervenção resultou na redução significativa do estresse percebido em comparação com o grupo controle (p=0.028). Os participantes estressados do grupo intervenção tiveram, respectivamente, diminuição e aumento significativos das concentrações séricas de glicose (p=0.001) e da lipoproteína-colesterol de alta densidade (p=0.003) após seis meses de intervenção. Conclusão. Um programa educativo de promoção da saúde liderado por enfermeiros foi eficiente para reduzir estresse percebido entre adultos com diabetes mellitus tipo 2 e síndrome metabólica, além de causar melhora da glicemia de jejum e e da lipoproteína-colesterol de alta densidade dos participantes estressados do grupo intervenção.

Elementos precondicionantes de complicaciones cardiacas en el paciente diabético con infarto agudo de miocardio / Preconditioning elements of cardiac complications among patients with diabetes and acute myocardial infarction

RESUMEN Objetivo: Identificar factores de riesgo, basados en los parámetros clínicos, ecocardiográficos y terapéuticos, para predecir complicaciones cardiacas en pacientes diabéticos con infarto agudo de miocardio (IAM). Materiales y métodos: Se realizó un estudio observacional, analítico, de casos y controles en el Centro de Cirugía Cardiovascular y Cardiología Santiago de Cuba, adjunto al Hospital Provincial Saturnino Lora, durante el periodo comprendido entre los años 2019 y 2021. La muestra quedó constituida por 266 pacientes, elegidos por muestreo aleatorio simple 1:2. Las variables de estudio se agruparon en demográficas, clínico-ecocardiográficas y terapéuticas. Se realizó el análisis multivariado con todas las variables que constituyeron factores de riesgo; se empleó el análisis de la varianza unidireccional y la regresión logística binaria. Resultados: Las complicaciones más frecuentes fueron la fibrilación auricular y la insuficiencia cardiaca en un 12 %, aproximadamente. Las cifras de control metabólico mostraron alteración al ingreso (OR = 6,92; LI: 2,61; LS: 18,32; p = 0,001). El análisis univariado demostró que diez factores incrementaron el riesgo de presentar complicaciones, entre ellos, el diagnóstico de diabetes mellitus ≥10 años (OR = 2,50; LI: 1,14; LS: 5,45; p = 0,020); además, el análisis multivariado reveló que la edad ≥60 años (OR = 5,624; IC = 1,607-19,686; p = 0,007), el control metabólico al ingreso alterado (OR = 5,245; IC = 1,491-18,447; p = 0,010), la no aplicación de terapia trombolítica (OR = 5,74; IC = 1,46-22,586; p = 0,012), la FEVI ≤ 40 % (OR = 5,245; IC = 1,17-23,433; p = 0,030), la presión de la aurícula izquierda ≥15 mmHg (OR = 12,335; IC = 3,45-44,08; p = 0,001) y la motilidad ≥1,5 puntos (OR = 4,702; IC = 1,258-17,575; p = 0,021) incrementaron el riesgo de forma independiente. Conclusiones: El estudio demostró el valor de seis factores de riesgo de complicaciones cardiacas en el paciente diabético con IAM, donde sobresale el control glucémico al ingreso, la fracción de eyección disminuida del ventrículo izquierdo, la presión de la aurícula izquierda aumentada y la no terapia de reperfusión coronaria.

ABSTRACT Objective: To identify the risk factors based on clinical, echocardiographic and therapeutic parameters which predict the development of cardiac complications among patients with diabetes and acute myocardial infarction (AMI). Materials and methods: An observational, analytical, case-control study was conducted at Centro de Cardiología y Cirugía Cardiovascular de Santiago de Cuba, attached to Hospital Provincial Saturnino Lora, from 2019 to 2021. The sample consisted of 266 patients, chosen by simple random sampling 1:2. The study included demographic, clinical- echocardiographic and therapeutic variables. A multivariate analysis was performed with all the variables considered as risk factors; one-way analysis of variance and binary logistic regression were used. Results: The most frequent cardiac complications were atrial fibrillation and heart failure (approximately 12 %). A metabolic control analysis on admission yielded altered results (OR = 6.92; LI: 2.61; LS: 18.32; p = 0.001). The univariate analysis showed that ten factors increased the risk of complications, including the diagnosis of diabetes mellitus ≥ 10 years (OR = 2.50; LI: 1.14; LS: 5.45; p = 0.020). On the other hand, the multivariate analysis revealed six factors that predict the development of cardiac complications: age ≥ 60 years (OR = 5.624; CI = 1.607-19.686; p = 0.007), altered metabolic control on admission (OR = 5.245; CI = 1.491-18.447; p = 0.010), lack of use of thrombolytic therapy (OR = 5.74; CI = 1.46-22.586; p = 0.012), left ventricular ejection fraction (LVEF) ≤ 40 % (OR = 5.245; CI = 1.17-23.433; p = 0.030), left atrial pressure ≥ 15 mmHg (OR = 12.335; CI = 3.45-44.08; p = 0.001) and motility ≥ 1.5 points (OR = 4.702; CI = 1.258-17.575; p = 0.021). Conclusions: The study demonstrated the value of six risk factors of cardiac complications among patients with diabetes and AMI, where glycemic control on admission, decreased LVEF, increased left atrial pressure and no reperfusion therapy stand out.

Role of endoscopic duodenojejunal bypass liner in obesity management and glycemic control.

The treatment of obesity and its comorbidities ranges from clinical management involving lifestyle changes and medications to bariat-ric and metabolic surgery. Various endoscopic bariatric and metabolic therapies recently emerged to address an important therapeutic gap by offering a less invasive alternative to surgery that is more effective than conservative therapies. This article compre-hensively reviews the technical aspects, mechanism of action, outcomes, and future perspectives of one of the most promising endoscopic bariatric and metabolic therapies, named duodenojejunal bypass liner. The duodenojejunal bypass liner mimics the mechanism of Roux-en-Y gastric bypass by preventing food contact with the duodenum and proximal jejunum, thereby initiating a series of hormonal changes that lead to delayed gastric emptying and malabsorptive effects. These physiological changes result in significant weight loss and improved metabolic control, leading to better glycemic levels, preventing dyslipidemia and non-alcoholic fatty liver disease, and mitigating cardiovascular risk. However, concern ex-ists regarding the safety profile of this device due to the reported high rates of severe adverse events, particularly liver abscesses. Ongo-ing technical changes aiming to reduce adverse events are being evaluated in clinical trials and may provide more reliable data to sup-port its routine use in clinical practice.

Patient activation levels and socioeconomic factors among the Amazonas population with diabetes: a cross-sectional study.

BACKGROUND: The presence of chronic conditions such as type 2 diabetes mellitus (T2DM) requires behavioral lifestyle changes mediated by individuals' motivation for change and adherence to treatment. This study aims to explore activation levels in individuals with T2DM treated in primary care facilities and to identify the association between demographic, clinical, psychosocial factors, and patient activation amongst populations in the Brazilian state of Amazonas. METHODS: SAPPA is a cross-sectional study conducted in Amazonas, approved by the Universidade Federal do Amazona's IRB in Brazil. Individuals with T2DM were evaluated in their homes (n = 4,318,325). The variables were sex, age, skin color, education level; health-related variables such as body mass index, nutritional behavior, and frequency of physical activity. Measures related to patient self-management behaviors over the past 6 months (Patient Activation Measure - PAM-13) were included in the survey. Descriptive and frequency data are presented as mean (standard deviation (SD)) or numeric percentage). Statistical testing was performed using IBM SPSS V.26, and a p-value of < 0.050 showed significance. Activation levels were dichotomized into low activation (Levels 1 and 2) and high activation (Levels 3 and 4). A multivariate linear model assessed the association between the PAM-13 score and the following variables: age, sex, BMI, skin color, number of comorbidities, burden of symptoms, and number of medications. RESULTS: Logistic regression analyses indicated a statistically significant association between sex, age, education, self-rated health, and general satisfaction with life. men were 43% more likely to score lower levels (p < 0.001). The results also indicated that advanced age had lower PAM levels (p < 0.001). Participants with fewer years of education were 44% more likely to have lower levels of PAM (p = 0.03). Worse self-rated health (p < 0.001) and lower general life satisfaction (p = 0.014) were associated with lower PAM levels. CONCLUSIONS: Low patient activation was associated with worse sociodemographic, health, and psychological conditions in the Amazon population. The low level of patient activation observed in this sample highlights an important impediment to diabetes disease management/self-management in disadvantaged populations.

Early choroidal and retinal changes detected by swept-source oct in type 2 diabetes and their association with diabetic kidney disease: a longitudinal prospective study.

BACKGROUND: To evaluate structural changes in retina and choroid in patients with type 2 diabetes (T2D) and their association with diabetic kidney disease (DKD). METHODS: T2D patients with mild or no diabetic retinopathy (DR) were followed for 3 years using structural SS-OCT and OCT angiography (OCT-A) taken every 6 months. Parameters were compared longitudinally and according to the DKD status on baseline. RESULTS: One hundred and sixty eyes from 80 patients were followed for 3 years, 72 with no DKD (nDKD) at baseline and 88 with DKD. Trend analysis of T2D showed significant thinning in GCL + and circumpapillary retinal fiber neural layer (cRFNL), choroid, and decreased vascular density (VD) in superficial plexus and central choriocapillaris with foveal avascular zone (FAZ) enlargement. Patients with no DKD on baseline presented more significant declines in retinal center and choroidal thickness, increased FAZ and loss of nasal and temporal choriocapillaris volume. In addition, the nDKD group had worse glycemic control and renal parameters at the end of the study. CONCLUSION: Our data suggests the potential existence of early and progressive neurovascular damage in the retina and choroid of patients with Type 2 Diabetes (T2D) who have either no or mild Diabetic Retinopathy (DR). The progression of neurovascular damage appears to be correlated with parameters related to glycemic control and renal damage.

Estimación del riesgo cardiovascular en pacientes con diabetes mellitus tipo 2

Introducción: Las personas diabéticas tienen entre dos y tres veces más riesgo de morbilidad y mortalidad cardiovascular que aquellas que no padecen la enfermedad. Objetivo: Estimar el riesgo cardiovascular en pacientes con diabetes mellitus tipo 2 atendidos en un Área de Salud. Métodos: Se realizó un estudio descriptivo y trasversal de 103 pacientes con diabetes mellitus tipo 2, pertenecientes al Consultorio Médico de la Familia No. 23 del policlínico Carlos J Finlay, municipio Songo-La Maya en la provincia Santiago de Cuba, desde enero hasta diciembre de 2023. Se estudiaron variables cualitativas y cuantitativas (edad, año de diagnóstico y duración de la enfermedad); se estimó el riesgo cardiovascular según el modelo para la predicción del riesgo en personas con diabetes tipo 2. Resultados: Se observó predominio del sexo femenino (58,3 %). La mayoría de los pacientes tenían hipertensión arterial (76 %) y microalbuminuria (31,2 %). La edad media de los pacientes fue de 65,5 años y como promedio tenían un tiempo de evolución de la diabetes de 8,6 años. La evaluación del riesgo cardiovascular ubicó a 43,3 % de la población en un nivel moderado y 25,7 % con alto riesgo. Conclusiones: Los pacientes diabéticos estudiados mostraron un riesgo de moderado a alto de presentar eventos cardiovasculares. Se hace necesario realizar intervenciones educativas en estos pacientes y sus familiares para lograr cambios favorables en los estilos de vida y mejorar el control de la enfermedad, previniendo así complicaciones y la ocurrencia de eventos fatales en los próximos años.

Introduction: Diabetic people have between two and three times more risk of cardiovascular morbidity and mortality than those who do not suffer from the disease. Objective: To estimate cardiovascular risk in patients with type 2 diabetes mellitus treated in a Health Area. Methods: A descriptive and cross-sectional study was carried out on 103 patients with type 2 diabetes mellitus, belonging to the Family Medical Office No. 23 of the Carlos J. Finlay polyclinic, Songo-La Maya municipality, Santiago de Cuba province, from January to December 2023. Qualitative variables and quantitative (age, year of diagnosis and duration of the disease) were studied; Cardiovascular risk was estimated according to the model for predicting cardiovascular risk in people with type 2 diabetes. Results: A predominance of the female sex was observed (58.3%). Most patients had arterial hypertension (76.0%) and microalbuminuria (31.2%). The average age of the patients was 65.5 years and on average they had a duration of diabetes of 8.6 years. The cardiovascular risk evaluation placed 43.3% of the population at a moderate level and 25.7% at high risk. Conclusions: The diabetic patients studied showed a moderate to high risk of presenting cardiovascular events. It is necessary to carry out educational interventions in these patients and their families to achieve favorable changes in lifestyles and improve disease control, thus preventing complications and the occurrence of fatal events in the coming years.

Terminology subset for the International Classification of Nursing Practice in Diabetes Mellitus / Subconjunto terminológico para la Clasificación Internacional para la Práctica de Enfermería en Diabetes Mellitus / Subconjunto terminológico para la Clasificación Internacional para la Práctica de Enfermería en Diabetes Mellitus

Objective: to describe the process of developing a terminological subset for the International Classification of Nursing Practice in Diabetes Mellitus, based on Horta's Basic Human Needs Theory and Bandura's Social Cognitive Theory. Method: a methodological study based on the identification in the literature of 313 statements of nursing diagnoses pertinent to diabetes care, selected and validated by a consensus of nurses from different states of Brazil, specialists in diabetes, using the nominal group technique. Results: 156 nursing diagnosis/result statements were selected, of which 111 (71.15%) related to psychobiological needs, 42 (26.92%) to psychosocial needs and three (1.92%) to psychospiritual needs. A total of 433 nursing interventions were developed. The diagnostic statements were validated on the basis of a consensus among the experts, with an average content validity index of 0.89: 0.87 for psychobiological needs, 0.93 for psychosocial needs, and 0.77 for psychospiritual needs. Conclusion: the study validated the terminological subset for the International Classification of Nursing Practice in Diabetes, favoring clinical reasoning, the qualification of the Nursing Process, and the improvement of self-care practices in diabetes. It has made it possible to use nursing's own language based on a globally recognized classification.

Objetivo: describir el proceso de elaboración de un subconjunto terminológico para la Clasificación Internacional para la Práctica de Enfermería en Diabetes Mellitus , basado en la Teoría de las Necesidades Humanas Básicas de Horta y en la Teoría Social Cognitiva de Bandura. Método: estudio metodológico realizado a partir de la identificación en la literatura de 313 enunciados de diagnósticos de Enfermería pertinentes al cuidado en diabetes, seleccionados y validados por consenso de enfermeras especializadas en diabetes, provenientes de diferentes estados de Brasil, utilizando la técnica de grupo nominal. Resultados: fueron seleccionados 156 enunciados diagnósticos/resultados de Enfermería, así relacionados: 111 (71,15%) con las necesidades psicobiológicas; 42 (26,92%) con las psicosociales y tres (1,92%) con las psicoespirituales. Fueron construidas 433 intervenciones de Enfermería. Los enunciados diagnósticos fueron validados a partir del consenso entre las especialistas con índice de validez de contenido medio de 0,89; siendo: 0,87 para las necesidades psicobiológicas; 0,93 para las psicosociales y 0,77 para las psicoespirituales. Conclusión: el estudio validó los enunciados del subconjunto terminológico para la Clasificación Internacional para la Práctica de Enfermería en diabetes, favoreciendo el raciocinio clínico, la calificación del Proceso de Enfermería y la mejora de las prácticas de autocuidado en diabetes. También, posibilitó la utilización de lenguaje propio de la Enfermería basado en una clasificación reconocida mundialmente.

Objetivo: descrever o processo de elaboração de um subconjunto terminológico para a Classificação Internacional para a Prática de Enfermagem em Diabetes Mellitus , baseado na Teoria das Necessidades Humanas Básicas de Horta e na Teoria Social Cognitiva de Bandura. Método: estudo metodológico realizado a partir da identificação na literatura de 313 enunciados de diagnósticos de Enfermagem pertinentes ao cuidado em diabetes, selecionados e validados por consenso de enfermeiras especialistas em diabetes, provenientes de diferentes estados do Brasil, utilizando a técnica de grupo nominal. Resultados: foram selecionados 156 enunciados diagnósticos/resultados de Enfermagem, sendo relacionados: 111 (71,15%) às necessidades psicobiológicas; 42 (26,92%) às psicossociais e três (1,92%) às psicoespirituais. Foram construídas 433 intervenções de Enfermagem. Os enunciados diagnósticos foram validados a partir do consenso entre os especialistas com índice de validade de conteúdo médio de 0,89, sendo: 0,87 para as necessidades psicobiológicas; 0,93 para as psicossociais e 0,77 para as psicoespirituais. Conclusão: o estudo validou os enunciados do subconjunto terminológico para a Classificação Internacional para a Prática de Enfermagem em diabetes, favorecendo o raciocínio clínico, a qualificação do Processo de Enfermagem e a melhoria das práticas de autocuidado em diabetes. Possibilitou a utilização de linguagem própria da Enfermagem com base em uma classificação reconhecida mundialmente.

Percepção dos usuários com diabetes sobre o autocuidado com os pés: uma análise qualitativa / Perception of diabetic users about self-care for their feet: a qualitative analysis / Percepción de los usuarios con diabetes sobre el autocuidado de sus pies: un análisis cualitativo

RESUMO Objetivo: valiou-se a percepção de usuários com Diabetes Mellitus tipo 2 (DM2) para autocuidado com os pés mediante a utilização de vídeos educativos. Método: trata-se de uma pesquisa qualitativa, realizada com usuários com DM2 atendidos na Atenção Primária à Saúde no estado do Amazonas, Brasil. Os participantes assistiram a dois vídeos sobre o autocuidado com os pés e responderam a seis perguntas sobre suas percepções. A análise dos dados foi produzida com o apoio do software ATLAS.ti 9®. Resultados: foram originadas três categorias: 1) 'conhecimento prévio' com as subcategorias 'fragilidade nas orientações profissionais' e 'os vídeos como ferramentas para lembrar'; categoria 2) 'assimilação da linguagem e formato audiovisual'; e categoria 3) 'possibilidades de impacto no autocuidado'. Conclusão: Observou-se a falta de informações necessárias sobre os cuidados com o pé diabético em comunidades remotas. Dispor de tecnologias audiovisuais para educação em saúde é essencial para informar e promover o autocuidado.

ABSTRACT Objective: To assess the perception of users with type 2 diabetes mellitus (DM2) regarding self-care of their feet using educational videos. Method: This qualitative study was carried out with users with DM2 treated in primary health care in Amazonas, Brazil. The participants watched two videos on foot care and answered six questions about their perceptions. The data was analyzed using ATLAS.ti 9® software. Results: Three categories were created: 1) 'previous knowledge' with the subcategories 'fragility in professional guidance' and 'videos as tools for remembering'; category 2) 'assimilation of language and audiovisual format'; and category 3) 'possibilities of impact on self-care'. Conclusion: A lack of necessary information on diabetic foot care was observed in remote communities. Audiovisual technologies for health education are essential to inform and promote self-care.

RESUMEN Objetivo: Evaluar la percepción de los usuarios con diabetes mellitus tipo 2 (DM2) sobre el autocuidado de sus pies mediante el uso de videos educativos. Método: Se trata de un estudio cualitativo realizado con usuarios con DM2 atendidos en Atención Primaria de Salud en el estado de Amazonas, Brasil. Los participantes vieron dos videos sobre el cuidado de los pies y respondieron a seis preguntas sobre sus percepciones. Los datos se analizaron con el software ATLAS.ti 9®. Resultados: TSurgieron tres categorías: 1) "conocimientos previos" con las subcategorías "fragilidad en la orientación profesional" y "videos como herramientas para recordar"; categoría 2) "asimilación del lenguaje y del formato audiovisual"; y categoría 3) "posibilidades de repercusión en el autocuidado". Conclusión: Se señaló la falta de información necesaria sobre el cuidado del pie diabético en las comunidades remotas. Las tecnologías audiovisuales para la educación sanitaria son esenciales para informar y promover el autocuidado.

Pronóstico de defunciones según enfermedad crónica de pacientes ingresados en un hospital público / Prognosis of Deaths According to Chronic Disease of Patients Admitted to a Public Hospital

Introducción: Las enfermedades crónicas repercuten en gran medida en la calidad de vida de los pacientes, ya sea por sus características inherentes o por las complicaciones derivadas que ocasionan emergencias recurrentes. Objetivo: Pronosticar los días de hospitalización hasta el desenlace de pacientes con enfermedad crónica ingresados en un hospital público peruano. Métodos: Se realizó una investigación descriptiva, retrospectiva y transversal, entre julio y agosto del 2022, con 488 pacientes con enfermedad crónica ingresados en el Hospital Regional Docente de Cajamarca. Los datos demográficos de ingreso y el tipo de diagnóstico de los pacientes fueron proporcionados por la oficina de estadística del hospital. El análisis univariado se realizó con distribuciones absolutas y relativas, junto a sus intervalos de confianza al 95 por ciento y la relación pronóstica con Log Rank (Mantel-Cox) - ji al cuadrado, análisis de supervivencia de Kaplan-Meier (p < 0,05) y tablas de mortalidad. Resultados: El 53,1 por ciento de pacientes fueron mujeres, con 67,1 años de edad promedio, ingresaron al hospital por el servicio de emergencia (66,0 por ciento) y la enfermedad crónica fue la causa principal (79,1 por ciento). El promedio de hospitalización fue de 67,5 días, con mayor número en la hipertensión arterial (63 días), las diferencias numéricas en el tiempo de hospitalización según enfermedad crónica no se reflejan a nivel estadístico (p = 0,130). Las defunciones ocurrieron dentro del primer mes de hospitalización. Conclusión: Los días de hospitalización hasta el desenlace no son independientes de la enfermedad crónica de los pacientes, pues en ambos casos pueden ocurrir defunciones si sus características clínicas son irrecuperables(AU)

Introduction: Chronic diseases greatly impact the quality of life of patients, either due to their inherent characteristics or due to the derived complications that cause recurrent emergencies. Objective: To predict the days of hospitalization until the outcome of patients with chronic disease admitted to a Peruvian public hospital. Methods: A descriptive, retrospective and cross-sectional investigation was carried out from July to August 2022, with 488 patients with chronic disease admitted to Cajamarca Regional Teaching Hospital. Admission demographic data and type of patient diagnosis were provided by the hospital statistics office. The univariate analysis was performed with absolute and relative distributions, along with their 95percent confidence intervals and the prognostic relationship with Log Rank (Mantel-Cox) - chi square, Kaplan-Meier survival analysis (p < 0.05) and mortality tables. Results: 53.1percent of patients were women, with average age of 67.1 years, who were admitted to the hospital through the Emergency Service (66.0percent) and chronic disease was the main cause (79.1percent). The average hospitalization time was 67.5 days, with greater number in high blood pressure (63 days). The numerical differences in hospitalization time, according to chronic disease, are not reflected at a statistical level (p = 0.130). Deaths occurred within the first month of hospitalization. Conclusion: The days of hospitalization until the outcome are not independent of the patients' chronic illness, since in both cases deaths can occur if their clinical characteristics are irrecoverable(AU)

Consideraciones epidemiológicas y clínicas de la COVID-19 en pacientes con diabetes mellitus / Epidemiological and Clinical Considerations of COVID-19 in Patients with Diabetes Mellitus

Introducción: Los pacientes con diabetes mellitus tienen una predisposición a las infecciones de tipo viral, bacterianas y micóticas. Ante la pandemia por COVID-19, se ha demostrado cómo la diabetes es una comorbilidad frecuente entre los afectados por esta enfermedad. Objetivo: Describir la relación existente entre la COVID-19 y la diabetes mellitus. Métodos: Se realizó una revisión bibliográfica de febrero a mayo de 2021. Se consultaron artículos científicos de acceso abierto disponibles en las bases de datos SCOPUS y PubMed. Se incluyeron investigaciones originales, metaanálisis, revisiones, guías de consenso y documentos de resumen de organizaciones oficiales y sociedades científicas. En total se trabajó con 60 publicaciones. Conclusiones: Los estudios observacionales han aportado evidencia a favor de la relación entre la diabetes y el riesgo de desarrollar formas graves de COVID-19. En esta susceptibilidad se involucran factores fisiopatológicos que incluyen el estado proinflamatorio que se genera en la diabetes, la sobreexpresión de la enzima convertidora de angiotensina 2 y la tormenta de citoquinas. El riesgo es mayor en pacientes de avanzada edad, del sexo masculino, con otras comorbilidades, vulnerabilidad socioeconómica y mal control glucémico (HbA1c > 7 por ciento). Los profesionales de la salud relacionados con la atención y el cuidado de pacientes con diabetes deben mantenerse actualizados y orientar a sus pacientes en las medidas de cuidado, para disminuir el riesgo de contagio y en ese caso, la incidencia de formas graves de la enfermedad(AU)

Introduction: Patients with diabetes mellitus have a predisposition to viral, bacterial and fungal infections. In the face of the COVID-19 pandemic, it has been shown how diabetes is a common comorbidity among those affected by this disease. Objective: To describe the relationship between COVID-19 and diabetes mellitus. Methods: A bibliographic review was carried out from February to May 2021. Open access scientific articles available in SCOPUS and PubMed databases were consulted. Original research, meta-analyses, reviews, consensus guidelines and summary documents from official organizations and scientific societies were included. Sixty publications were worked on, in total. Conclusions: Observational studies have provided evidence in favor of the relationship between diabetes and the risk of developing severe forms of COVID-19. This susceptibility involves pathophysiological factors that include the pro-inflammatory state that is generated in diabetes, the overexpression of ACE2, and the cytokine storm. The risk is greater in elderly, male patients, with other comorbidities, socioeconomic vulnerability and poor glycemic control (HbA1c > 7percent). Health professionals related to the assistance and care of patients with diabetes must stay updated and guide their patients in care measures, to reduce the risk of contagion and, in that case, the incidence of severe forms of the disease(AU)

[Real-world evidence on pharmacological appropriateness in type 2 diabetes mellitus and cardiovascular disease]. / Evidencia de mundo real sobre adecuación farmacológica en diabetes tipo 2 y enfermedad cardiovascular.

Objective: To estimate the proportion of individuals with established Type 2 Diabetes Mellitus (T2DM) and Cardiovascular Disease (CVD) who are receiving pharmacological anti-diabetic treatment with evidence of cardiovascular benefit at a hospital in Argentina. Materials and Methods: Cross-sectional study conducted at the Italian Hospital of Buenos Aires. A consecutive sample of adult patients affiliated with the institutional prepaid health plan active in March 2020, diagnosed with T2DM and established CVD, was included. Data were collected from the Electronic Health Record. The proportion of pharmacological adequacy (combined use of metformin plus sodium-glucose co-transporter 2 inhibitors and/or glucagon-like peptide 1 receptor agonists) was reported along with its respective 95% confidence interval (CI). Results: A total of 1539 patients were included, with a mean age of 76.2 years; 65.3% were male, and 81.6% were overweight or obese. Hemoglobin A1c levels were recorded in the past year for 74.9% of patients, with an average value of 6.9% (SD 1.2). The most prescribed drugs were metformin (61.3%), insulin (26.7%), and gliptins (11%). Out of the total included patients, 82 exhibited pharmacotherapeutic adequacy for diabetes treatment, with a prevalence of 5.3% (95% CI 4.2-6.5). Conclusions: The prevalence of prescribing anti-diabetic drugs with evidence of cardiovascular benefit was 5.3% (95% CI 4.2-6.5). This real-world evidence highlights the low frequency of prescribing this type of medication at the time of the study in a high cardiovascular risk population.

Objetivo: Estimar la proporción de personas con Diabetes Mellitus tipo 2 (DM2) y Enfermedad Cardiovascular (ECV) establecida que reciben tratamiento farmacológico anti-diabético con evidencia de beneficio cardiovascular en un hospital en Argentina. Materiales y Métodos: Estudio de corte transversal realizado en el Hospital Italiano de Buenos Aires. Se incluyó una muestra consecutiva de pacientes adultos afiliados a prepaga institucional activos a Marzo 2020, con diagnóstico de DM2 y ECV establecida. Los datos se tomaron de la Historia Clínica Electrónica. Se informó la proporción de adecuación farmacológica (uso combinado de metformina más inhibidores del cotransportador de sodio glucosa tipo 2 y/o agonistas del Péptido Similar al Glucagón tipo 1) con su respectivo IC95%. Resultados: Se incluyeron 1539 pacientes, con una media de edad 76,2 años, 65,3% eran de sexo masculino, 81,6% con sobrepeso u obesidad. Un 74,9% de los pacientes tenían registro de hemoglobina glicosilada en el último año, con un valor promedio de 6,9% (DE 1,2). Las drogas más prescritas fueron: metformina (61,3%), insulina (26,7%), y gliptinas (11%). Del total de pacientes incluidos, 82 presentaron adecuación fármaco-terapéutica antidiabética, con una prevalencia de 5,3% (IC95% 4,2-6,5). Conclusiones: La prevalencia de prescripción de drogas antidiabéticas con evidencia de beneficio cardiovascular fue de 5,3% (IC95% 4,2-6,5). Esta información extraída de evidencia del mundo real identifica la baja frecuencia de prescripción de este tipo de fármacos al momento del estudio en una población de alto riesgo cardiovascular.

[Basic health indicators in the NutrIMSS program: a retrospective study]. / Indicadores básicos de salud en el programa NutrIMSS: estudio retrospectivo.

Background: The NutrIMSS program is granted to populations with chronic conditions to improve basic health indicators and its effectiveness in this population is unknown. Objective: To analyze the change in the basic health indicators of patients who attended the NutrIMSS Program, at the UMF No. 2 of the IMSS in Mexico City, during the period 2018 to 2019. Material and methods: From 105 files of IMSS beneficiaries, a retrospective cohort study was carried out considering two measurements, before and after the NutrIMSS program. To evaluate the average change over time of health indicators, GEE models (Generalized Estimation Equations) and multiple linear regression models were used. Statistical analysis was used using the statistical program StataCorp 2015. Results: Patients who attended the Program showed changes between the beginning and end of the period with an average of three months of follow-up. They presented a decrease in the following health indicators: body weight of 1 kg, body mass index: 0.8 kg/m2, glucose of 13 mg/dL, triglycerides of 57 mg/dL and cholesterol of 17 mg/dL (p < 0.005 in all cases). There was no difference in the level of blood pressure. Conclusions: The NutrIMSS program influenced the improvement of the health indicators of the population of the program and is an ally to improve the health of the IMSS beneficiary population.

Introducción: el programa NutrIMSS se otorga a población con padecimientos crónicos para mejorar los indicadores básicos de salud; sin embargo, se desconoce su efectividad en esta población. Objetivo: analizar el cambio en los indicadores básicos de salud de pacientes que acudieron al programa NutrIMSS, en la UMF No. 2 del Instituto Mexicano del Seguro Social (IMSS) en la Ciudad de México, durante el periodo 2018 a 2019. Material y métodos: a partir de 105 expedientes de derechohabientes del IMSS se realizó un estudio de cohorte retrospectiva, considerando dos mediciones, antes y después del programa NutrIMSS. Para evaluar el cambio promedio en el tiempo de los indicadores de salud se utilizaron modelos GEE (Ecuaciones de Estimación Generalizadas) y modelos de regresión lineal múltiple. Para el análisis estadístico se utilizó el programa estadístico StataCorp 2015. Resultados: los pacientes que acudieron a NutrIMSS mostraron cambios entre el inicio y el fin del periodo, con un promedio de seguimiento de tres meses. Presentaron una disminución en los siguientes indicadores de salud: peso corporal de 1 kg, índice de masa corporal: 0.8 kg/m2, glucosa de 13 mg/dL, triglicéridos de 57 mg/dL y colesterol de 17 mg/dL (p < 0.005, en todos los casos). No se presentó diferencia en el nivel de la tensión arterial. Conclusiones: el programa NutrIMSS influyó para mejorar los indicadores de salud de la población del programa y es un aliado en la mejora de la salud de la población derechohabiente del IMSS.

Association of the rs5186 polymorphism of the AGTR1 gene with decreased eGFR in patients with type 2 diabetes from Mexico City.

BACKGROUND: Early biomarkers search for Diabetic Kidney Disease (DKD) in patients with Type 2 Diabetes Mellitus (T2DM), as genetic markers to identify vulnerable carriers of the disease even before Glomerular Filtration Rate (GFR) decline or microalbuminuria development, has been relevant during the last few years. The rs5186 (A116C) polymorphism of the Angiotensin II Receptor Type I gene (AGTR1), has been associated to multiple effects of renal injury risk, commonly detected in patients with Diabetes Mellitus (DM). It has been described that rs5186 could have an effect in stability proteins that assemble Angiotensin II Receptor Type I (AT1), modifying its action, which is why it should be considered as a risk factor for Chronic Kidney Disease (CKD), characterized by a GFR progressive reduction. Even though, the association between rs5186 AGTR1 gene polymorphism and DKD in patients with T2DM has been controversial, inconclusive, and even absent. This disputable issue might be as a result of association studies in which many and varied clinical phenotypes included are contemplated as CKD inductors and enhancers. Although, the sample sizes studied in patients with T2DM are undersized and did not have a strict inclusion criteria, lacking of biochemical markers or KDOQI classification, which have hindered its examination. OBJECTIVE: The aim of our study was to establish an association between rs5186 AGTR1 gene polymorphism and GFR depletion, assessed as a risk factor to DKD development in patients with T2DM. METHODS: We analyzed 297 not related patients with T2DM, divided into 221 controls (KDOQI 1) and 76 cases (KDOQI 2). Arterial pressure, anthropometric and biochemical parameters were measured. rs5186 of AGTR1 genotyping was performed by TaqMan assay real-time PCR method. Allele and genotype frequencies, and Hardy-Weinberg equilibrium were measured. Normality test for data distribution was analyzed by Shapiro-Wilk test, variable comparison by Student's t-test for continuous variables, and Chi-squared test for categorical variables; ANOVA test was used for mean comparison of more than two groups. Effect of rs5186 to DKD was estimated by multiple heritability adjustment models for risk variables of DKD. Statistical significance was indicated by p<0.05. Data was analyzed using Statistical Package STATA v11 software. RESULTS: Dominant and Over-dominant models showed a likelihood ratio to GFR depletion of 1.89 (1.05-3.39, p=0.031) and 2.01 (1.08-3.73, p=0.023) in patients with T2DM. Risk factor increased to 2.54 (1.10-5.89) in women in Over-dominant model. CONCLUSION: In clinical practice, most of nephropathies progress at a slow pace into a total breakdown of renal function, even asymptomatic. This is the first study, reporting that rs5186 polymorphism of AGTR1 gene contribution to GFR depletion, and this could be evaluated as a predisposing factor for DKD in patients with T2DM.

Uso de terapias complementarias para la disminución del índice de masa corporal en personas mayores con Diabetes Mellitus tipo 2 / Use of complementary therapies to reduce body mass indexin older people with type 2 Diabetes Mellitus

Las enfermedades cardiovasculares están determinadas por ciertos factores de riesgos, la prevalencia y sinergia de éstos genera un de-terminado riesgo cardiovascular que deteriora la calidad de vida de quienes lo padecen. La realización de actividad física es considerada como una herramienta útil para disminuir uno de los factores de riesgo más importantes, la obesidad, medida mediante el índice de masa corporal. Sin embargo, no todos los seres humanos poseen las mismas características y capacidades físicas, por ende, la realización de ejercicio está restringida a éstas. Es en este sentido que se desarrolla el siguiente informe, el cual contempla una revisión sistemática que enfrenta a dos terapias complementarias: Yoga v/s Tai Chi, buscando la evidencia que permita la recomendación de una de ellas para la disminución de IMC en personas mayores con DM2. Los artículos fueron extraídos desde la plataforma académica PubMed, sometidos a 3 cribados de búsqueda, y criterios de inclusión y exclusión, resultando en la obtención de 4 artículos para el análisis, a partir de esta observación se obtiene que la realización de yoga es beneficiosa para la disminución de el IMC al caso índice. Por ende, se recomienda el uso de la terapia complementaria yoga, puesto que esta favorece la reducción del IMC en pacientes con enfermedades crónicas no transmisibles en comparación a la terapia complementaria Tai Chi[AU]

Cardiovascular diseases are determined by certain risk factors, the prevalence and synergy of which generates a certain cardiovascular risk that deteriorates the quality of life of those who suffer from it. Physical activity is considered a useful tool for reducing one of the most important risk factors, obesity, measured by the body mass index. However, not all human beings have the same physical capacities, therefore, exercise is restricted to them. It is in this sense that the following report is developed, which contemplates a systematic review that confronts two complementary therapies: yoga v/s Tai Chi, looking for the evidence that allows the recommendation of one of them for the decrease of BMI in elderly people with DM2.The articles were extracted from the academic platform PubMed, subjected to 3 search screens, and inclusion and exclusion criteria, resulting in obtaining 4 articles for analysis, from this observation it is obtained that the performance of yoga is beneficial for the decrease of the BMI to the index case. Therefore, the use of yoga complementary therapy is recommended, since it favors the reduction of BMI in patients with chronic noncommunicable diseases compared to Cardiovascular diseases are determined by certain risk factors, the prevalence and synergy of which generates a certain cardiovascular risk that deteriorates the quality of life of those who suffer from it. Physical activity is considered a useful tool for reducing one of the most important risk factors, obesity, measured by the body mass index. However, not all human beings have the same physical capacities, therefore, exercise is restricted to them. It is in this sense that the following report is developed, which contemplates a systematic review that confronts two complementary therapies: yoga v/s Tai Chi, looking for the evidence that allows the recommendation of one of them for the decrease of BMI in elderly people with DM2.The articles were extracted from the academic platform PubMed, subjected to 3 search screens, and inclusion and exclusion criteria, resulting in obtaining 4 articles for analysis, from this observation it is obtained that the performance of yoga is beneficial for the decrease of the BMI to the index case. Therefore, the use of yoga complementary therapy is recommended, since it favors the reduction of BMI in patients with chronic noncommunicable diseases compared to Tai Chi complementary[AU]

As doenças cardiovasculares são determinadas por certos factores de risco, cuja prevalência e sinergia geram um certo risco cardio-vascular que deteriora a qualidade de vida das pessoas que delas sofrem. A atividade física é considerada uma ferramenta útil para reduzir um dos factores de risco mais importantes, a obesidade, medida pelo índice de massa corporal. No entanto, nem todos os seres humanos têm as mesmas características físicas e, por isso, o exercício é restrito a eles. É nesse sentido que se desenvolve o pre-sente relatório, que contempla uma revisão sistemática que con-fronta duas terapias complementares: yoga v/s Tai Chi, buscando as evidências que permitam a recomendação de uma delas para a diminuição do IMC em idosos com DM2. Os artigos foram ex-traídos da plataforma acadêmica Pubmed, submetidos a 3 telas de busca, e critérios de inclusão e exclusão, resultando na obtenção de 4 artigos para análise, a partir desta observação obtém-se que a realização do yoga é benéfica para a redução do IMC para o caso índice. Portanto, recomenda-se a utilização da terapia complemen-tar yoga, uma vez que favorece a redução do IMC em pacientes com doenças crónicas não transmissíveis em comparação com a terapia complementar Tai Chi[AU]

Factores de riesgo de fibrosis avanzada en enfermedad hepática esteatósica asociada a disfunción metabólica en pacientes con diabetes mellitus 2

Determinar factores de riesgo sociodemográficos, antropométricos, bioquímico-metabólicos, clínicos y comorbilidades asociadas a fibrosis avanzada por enfermedad hepática esteatósica asociada a disfunción metabólica en pacientes con diabetes mellitus tipo 2. Estudio de casos y controles. Se revisaron 174 historias clínicas de pacientes con enfermedad hepática esteatósica asociada a disfunción metabólica y diabetes mellitus tipo 2 atendidos en el Hospital Nacional Dos de Mayo de 2009 a 2018. Los casos fueron pacientes con fibrosis avanzada y los controles sin fibrosis. La presencia de fibrosis avanzada fue definida por paneles clínicos predictores y/o resultado de biopsia hepática. Para determinar asociación se calculó odds ratio, chi cuadrado de Pearson y análisis de regresión logística. Se encontró asociación con edad > 60 años, un índice de masa corporal ≥ 25 kg/m2 , perímetro abdominal en varones ≥ 94 cm y perímetro abdominal ≥ 88 cm en mujeres, tiempo de enfermedad de diabetes > 10 años; complicaciones crónicas microvasculares; HDL en mujeres 60 años, índice de masa corporal elevado, perímetro abdominal en mujeres, HDL bajo en mujeres, complicaciones crónicas microvasculares e hipertensión. Se encontraron como factores de riesgo de fibrosis avanzada, edad mayor a 60 años, índice de masa corporal elevado, perímetro abdominal ≥ 88 cm en mujeres, complicaciones crónicas microvasculares, nivel bajo de HDL en mujeres e hipertensión arterial como principal comorbilidad.

To determine sociodemographic, anthropometric, biochemical-metabolic, clinical risk factors and comorbidities associated with advanced fibrosis due metabolic dysfunction associated steatotic liver disease in patients with diabetes mellitus type 2. Case-control study. We reviewed 174 medical records of patients with metabolic dysfunction associated steatotic liver disease and type 2 diabetes mellitus treated at the Hospital Nacional Dos de Mayo from 2009 to 2018. The cases were patients with advanced fibrosis and controls without fibrosis. The presence of advanced fibrosis was defined by predictive clinical panels and/or liver biopsy result. To determine association, odds ratio, Pearson's chi-square and logistic regression analysis were calculated. An association was found with age > 60 years, a body mass index ≥ 25 kg/m2 , abdominal circumference in men ≥ 94 cm and abdominal circumference ≥ 88 cm in women, time of diabetes disease >10 years; chronic microvascular complications; HDL in women 60 years, high body mass index, abdominal circumference in women, low HDL in women, chronic microvascular complications and hypertension remained independent risk factors. The risk factors for advanced fibrosis were age over 60 years, high body mass index, abdominal circumference ≥ 88 cm in women, chronic microvascular complications, low HDL level in women and hypertension as the main comorbidity.

Factores asociados a la adherencia al tratamiento farmacológico en pacientes con diabetes sin hipertensión arterial

Objetivo: Identificar los factores asociados a la adherencia al tratamiento farmacológico en pacientes con diabetes mellitus tipo 2 sin hipertensión arterial. Materiales y métodos: Estudio transversal y analítico en pacientes con diabetes mellitus tipo 2 sin hipertensión arterial. Se integraron el grupo con adherencia al tratamiento (n = 145) y el grupo sin adherencia al tratamiento (n = 49), determinado por la escala de adherencia a la medicación de Morisky de 4 ítems (MMAS-4). Como factores asociados, se estudiaron sexo, vida en pareja, escolaridad, ocupación, edad agrupada en decenios y tiempo de evolución de la diabetes agrupada en menos de un año, de 1 a 5 años, de 6 a 10 años y más de 10 años. El plan de análisis estadístico incluyó la prueba de ji al cuadrado. Resultados: Se identificaron el sexo (p = 0,045), la vida en pareja (p = 0,045), la edad (p = 0,001) y el tiempo de evolución de la enfermedad (p = 0,001) como factores asociados a la adherencia al tratamiento farmacológico. La escolaridad no se identificó como un factor asociado a la adherencia terapéutica en el paciente con diabetes mellitus tipo 2 (p = 0,289). A mayor edad, menor adherencia al tratamiento farmacológico en el paciente con diabetes: el punto de corte se presenta a los 60 años; después de esta edad, el porcentaje en el grupo no adherente es mayor que en el grupo con adherencia (p = 0,001). A mayor tiempo de evolución de la diabetes, menor probabilidad de adherencia; en el grupo no adherente, el porcentaje de pacientes con más de 10 años de evolución es 67,3 % y en el grupo con adherencia el porcentaje corresponde a 33,8 % (p = 0,001). Conclusiones: Se identificaron los factores asociados a la adherencia al tratamiento farmacológico en pacientes con diabetes mellitus tipo 2 sin hipertensión arterial.

Objective: To identify the factors associated with adherence to drug therapy among patients with type 2 diabetes mellitus without hypertension. Materials and methods: A cross-sectional, analytical study conducted with patients with type 2 diabetes mellitus without hypertension, divided into an adherent group (n = 145) and a non-adherent group (n = 49), determined by the 4-item Morisky Medication Adherence Scale (MMAS-4). The associated factors were sex, cohabitation, schooling, occupation, age in 10-year groups and diabetes progression time grouped in less than 1 year, from 1 to 5 years, from 6 to 10 years and more than 10 years. The statistical analysis plan included the chi-square test. Results: The factors associated with adherence to drug therapy were identified as sex (p = 0.045), cohabitation (p = 0.045), age (p = 0.001) and disease progression time (p = 0.001). Schooling was not identified as a factor associated with adherence to drug therapy among patients with type 2 diabetes mellitus (p = 0.289). The older the patient with diabetes, the lower the adherence to drug therapy; the cut-off point was 60 years of age, after which the percentage in the non-adherent group was higher than in the adherent group (p = 0.001). The longer the diabetes progression time, the lower the probability of adherence; in the non-adherent group the percentage of patients with more than 10 years of disease progression was 67.3 % and in the adherent group the percentage was 33.8 % (p = 0.001). Conclusions: The factors associated with adherence to drug therapy among patients with type 2 diabetes mellitus without hypertension were identified