ABSTRACT
Background: The effect of glycemic control on diabetic kidney disease (DKD) is well known. Recent evidence has suggested that Vitamin D (VD) may have a nephroprotective effect in diabetes, but the relationship between VD, glycemic control, and albuminuria has yet to be clarified. Objective: Evaluate the relationship between 25-hydroxy-vitamin D [25(OH)D], HbA1c, and albuminuria in Diabetes Mellitus (DM). Patients and Methods: Cross-sectional study with 1576 individuals with DM who had 25(OH)D, HbA1c, and albuminuria levels measured. Patients with abnormal creatinine levels were excluded, in order to avoid interference on VD levels by impaired kidney function. Results: Patients with HbA1c ≥7% had lower 25(OH)D when compared to patients with HbA1c <7% (29.7 ± 10.2 vs 28.1 ± 9.9 ng/ml, p = 0.003) and 25(OH)D levels seems to predict 1.5% of HbA1c behavior. The 25(OH)D concentrations in patients with normoalbuminuria were higher than the levels observed in those with micro or macroalbuminuria (29.8 ± 9.0 vs 26.8 ± 8.6 and 25.1 ± 7.6, respectively, p = 0.001), patients who had 25(OH)D <20 ng/ml and 25(OH)D <30 ng/ml were at a higher risk of presenting albuminuria [OR = 2.8 (95% CI = 1.6 - 4.9), p<0.001, and OR = 2.1 (95% CI = 1.3 - 4.6), p<0.001, respectively]. In our regression model, albuminuria was influenced by HbA1c (r² = 0.076, p<0.00001) and 25(OH)D (r² = 0.018, p = 0.002) independently. Conclusion: Our study found an association between vitamin D levels, HbA1c and DKD. Additionally, our data suggest that the association between urinary albumin excretion and vitamin D levels is independent of glycemic control in patients with diabetes. Even though our patients presented normal creatinine levels, it is necessary further prospective studies to confirm if this association precedes or not the loss of renal function.
Subject(s)
Albuminuria/blood , Diabetes Mellitus/blood , Glycated Hemoglobin/metabolism , Vitamin D/analogs & derivatives , Aged , Albuminuria/epidemiology , Albuminuria/etiology , Brazil/epidemiology , Cross-Sectional Studies , Diabetes Mellitus/epidemiology , Diabetic Nephropathies/blood , Diabetic Nephropathies/diagnosis , Diabetic Nephropathies/epidemiology , Diabetic Nephropathies/etiology , Female , Glycemic Control/statistics & numerical data , Humans , Male , Middle Aged , Risk Factors , Vitamin D/blood , Vitamin D Deficiency/blood , Vitamin D Deficiency/complications , Vitamin D Deficiency/epidemiologyABSTRACT
OBJETIVO: Avaliar o grau de independência funcional, por meio das Atividades Básicas de Vida Diária, entre idosos usuários de um centro de saúde. MÉTODOS: Estudo do tipo transversal e descritivo, realizado no Centro de Saúde Escola do Marco, em Belém (PA). A coleta de dados foi feita por meio de dois protocolos de pesquisa: um de dados pessoais e um contendo perguntas sobre as Atividades Básicas de Vida Diária, de acordo com o índice de Katz. A coleta de dados foi realizada de forma aleatória às terças, quartas e sextas-feiras. Foram pesquisados 165 idosos. As Atividades Básicas de Vida Diária foram avaliadas pelo índice de Katz. Para análise estatística, foram utilizados os testes não paramétricos qui quadrado e G de independência. RESULTADOS: Houve correlação significativa entre nível de dependência e diabetes mellitus, prática de atividades físicas e Atividades Básicas de Vida Diária. Dentre os idosos, 69,7% foram considerados independentes, sendo 69,09% alocados na classificação A da escala, 24,85% como B, 0,61% como C e 5,45% em outras classificações. A Atividade Básica de Vida Diária que mais apresentou idosos dependentes foi a relacionada a continência. CONCLUSÃO: A maioria dos idosos pesquisados é independente para as Atividades Básicas de Vida Diária.
OBJECTIVE: To evaluate functional independence degree among elderly users of a healthcare center through their Activities of daily living (ADL). METHODS: This is a crosssectional, descriptive study performed at Centro de Saúde Escola do Marco, in the city of Belem (PA, Brazil). Data collection was performed through two research protocols: one containing personal information, and the other containing questions about participants' ADL, according to Katz Index. Data collection was randomly performed on Tuesdays, Wednesdays and Fridays. A total of 165 elderly participated in this study. Activities of daily living were analyzed according to Katz Index. For statistical analysis, Chi-square test, and G-test of independency were used. RESULTS: There was a significant correlation betweenthe dependence degree and diabetes mellitus, physical activities practices and Activities of daily living. Among the elderly, 69,7% were classified as independent, with 69,09% being allocated in classification A of the Index, 24,85% in B, 0,61% in C, and 5,45% in others classifications. The Activity of daily living that was mostly related to dependent elderly was continence. CONCLUSIONS: Most of the surveyed elderly were independent for Activities of daily living.