Preventing diabetes complications.

The key aim of diabetes management is to prevent complications, which are a major cause of morbidity and mortality. At an individual level, people with diabetes are less likely than they were several decades ago to experience classical macrovascular and microvascular complications as a result of improvements in modifiable cardiovascular risk factors and preventive healthcare. However, a significant burden of diabetes complications persists at a population level because of the increasing incidence of diabetes, as well as longer lifetime exposure to diabetes because of younger diagnosis and increased life expectancy. Trials have shown that the most effective strategy for preventing complications of diabetes is a multifactorial approach focussing simultaneously on the management of diet, exercise, glucose levels, blood pressure and lipids. In addition to the cornerstone strategies of addressing diet, exercise and lifestyle measures, the introduction of newer glucose-lowering agents, including sodium-glucose transport protein 2 inhibitors and glucagon-like peptide-1 agonists, have brought about a paradigm shift in preventing the onset and progression of complications of type 2 diabetes, particularly cardiovascular and renal disease. The improvement in rates of classical complications of diabetes over time has been accompanied by a growing awareness of non-traditional complications, including non-alcoholic fatty liver disease. These emerging complications may not respond to a glycaemic-centred approach alone and highlight the importance of foundational strategies centred on lifestyle measures and supported by pharmaceutical therapy to achieve weight loss and reduce metabolic risk in patients living with diabetes.

Recommendations for management of diabetes and its complications during Hajj (Muslim Pilgrimage) - 2024 update.

Hajj is an obligatory duty for all healthy adult Muslims once in the lifetime subjected to the ability. Considering the 10.5 % global prevalence of diabetes coupled with the numbers of Muslims performing the Hajj, ∼ 1.8 million in 2023, it is estimated that Muslims with diabetes performing Hajj may exceed 340,000 this year. During Hajj the pattern and amount of their meal, fluid intake and physical activity are markedly altered. Many people with diabetes insist on doing the Hajj duty, thereby creating a medical challenge for themselves and their health care providers. It is therefore important that medical professionals be aware of the potential risks that may be associated with Hajj. People with diabetes may face many health hazards during Hajj including but not limited to the killer triad which might occur during Hajj: Hypoglycemia, Foot injury and Infections. Many precautions should be taken to prevent and treat these potentially serious complications. Risk stratification, medication adjustments, proper clinical assessment, and education before doing Hajj are crucial.

Role of Synbiotics (Prebiotics and Probiotics) as Dietary Supplements in Type 2 Diabetes Mellitus Induced Health Complications.

Diabetes is a metabolic disorder whose prevalence has become a worrying condition in recent decades. Chronic diabetes can result in serious health conditions such as impaired kidney function, stroke, blindness, and myocardial infarction. Despite a variety of currently available treatments, cases of diabetes and its complications are on the rise. This review article provides a comprehensive account of the ameliorative effect of prebiotics and probiotics individually or in combination i.e. synbiotics on health complications induced by Type 2 Diabetes Mellitus (T2DM). Recent advances in the field underscore encouraging outcomes suggesting the consumption of synbiotics leads to favorable changes in the gut microbiota. These changes result in the production of bioactive metabolites such as short-chain fatty acids (crucial for lowering blood sugar levels), reducing inflammation, preventing insulin resistance, and encouraging the release of glucagon-like peptide-1 in the host. Notably, novel strategies supplementing synbiotics to support gut microbiota are gaining attraction as pivotal interventions in mitigating T2DM-induced health complications. Thus, by nurturing a symbiotic relationship between prebiotics and probiotics i.e. synbiotics, these interventions hold promise in reshaping the microbial landscape of the gut thereby offering a multifaceted approach to managing T2DM and its associated morbidities. Supporting the potential of synbiotics underscores a paradigm shift toward holistic and targeted interventions in diabetes management, offering prospects for improved outcomes and enhanced quality of life for affected individuals. Nevertheless, more research needs to be done to better understand the single and multispecies pre/pro and synbiotics in the prevention and management of T2DM-induced health complications.

Avaliação do autocuidado com os pés entre pacientes portadores de diabetes melito / Evaluation of self-care with feet among patients with diabetes mellitus

Resumo Contexto O pé diabético é uma complicação do diabetes melito (DM), sendo a maior causa de amputação dos membros inferiores. Objetivos Avaliar a prática de medidas de autocuidado com os pés, segundo sexo e escolaridade, em pacientes portadores de DM na região nordeste no estado da Bahia. Métodos Estudo quantitativo, observacional, analítico, transversal, realizado com 88 pacientes portadores de DM, em consulta de rotina, de fevereiro a março de 2020. A coleta de dados foi executada através da aplicação de questionários socioeconômico e do autocuidado com os pés (conhecimento sobre pé diabético, hábitos de cuidado/inspeção dos pés e procura pela Unidade de Saúde na presença de alterações com a saúde dos pés). Resultados Do total, 58% dos indivíduos desconhecia o termo "pé diabético", porém possuíam cuidados mínimos adequados com os pés, como inspecioná-los (60,2%), hidratá-los (65,9%), não andar descalço (81,8%) e cortar as unhas (92%), apesar de 90,9% não utilizar sapatos considerados adequados. Houve relação entre menor nível de escolaridade e pior desempenho nas questões referentes a andar descalço, hidratar os pés, cortar as unhas, usar calçados adequados e identificar micoses (p < 0,05), porém não houve associação da realização das medidas de autocuidado e sexo. Conclusão Os portadores de DM entrevistados não realizaram todas as medidas de autocuidado com os pés e desconheciam o termo "pé diabético". Houve associação entre menor escolaridade e menor capacidade de realização dessas medidas, o que sugere que o letramento em saúde seria importante para melhoria desse autocuidado, contribuindo para diminuição de complicações e amputações dos pés.

Abstract Background The diabetic foot is a complication of diabetes mellitus (DM) and is the most common cause of lower limb amputation. Objectives To assess foot self-care practices by sex and educational level in DM patients from the Northeast of Brazil, state of Bahia. Methods This was a quantitative, cross-sectional, observational, analytical study with 88 DM patients seen at routine consultations from February to March of 2020. Data were collected using questionnaires on socioeconomic data and self-care of feet (knowledge about the diabetic foot, habits related to care/inspection of feet, and visits to the Healthcare Center when changes to foot health are detected). Results 58% of the sample did not know the term "diabetic foot", but a majority did perform minimum adequate foot care practices, such as inspecting feet (60.2%), moisturizing feet (65.9%), avoiding walking barefoot (81.8%), and trimming toenails (92%), although 90.9% did not wear footwear considered appropriate. There was a relationship between lower educational level and worse performance in questions relating to walking barefoot, moisturizing feet, trimming toenails, wearing appropriate footwear, and identifying mycoses (p < 0.05), but there was no association between performing self-care activities and sex. Conclusions Interviewed patientswith DM did not perform all foot self-care activities and did not know what the term "diabetic foot" means. There was an association between lower educational level and reduced capacity to perform these activities, which suggests that health literacy is important to improve self-care of feet, contributing to reduce complications and foot amputations.

Riesgo cardiovascular en la mujer diabética / Cardiovascular risk in the diabetic woman

Resumen Introducción: La enfermedad cardiovascular en mujeres ha sido un apartado con diversas investigaciones que han intentado llegar a los factores de riesgo más determinantes o las vías moleculares más específicas para explicar el riesgo aumentado que poseen las mujeres respecto a los hombres. Objetivo: Dar una visión global de esta situación al lector, involucrando especialmente aquella población de mujeres que padece diabetes mellitus tipo 2, cuya condición es un factor de riesgo independiente para el desarrollo de enfermedad cardiovascular, de gran costo y morbimortalidad mundiales. Métodos: Se realizó una búsqueda en PubMed y Google Scholar con términos MeSH y términos comunes y se obtuvieron algunas referencias cruzadas a criterio de los autores. Conclusiones: Es necesario implementar en la práctica médica diaria un contexto específico de prevención de riesgo cardiovascular mediante programas de educación continuada o por medio de las entidades prestadoras de servicios de salud para evitar la progresión de enfermedad cardiovascular en las mujeres diabéticas antes de llegar a desenlaces mayores y potencialmente fatales.

Abstract Introduction: Cardiovascular disease in woman has been an issue with plenty of investigations towards the finding of the most determinant risk factors o the specific molecular paths to explain the increased risk in women compared to men. Objective: To give to the reader a global vision of this situation, involving specially the type 2 diabetes mellitus woman population, whose condition is an independent risk factor to the development of the cardiovascular disease with great cost and morbidity and mortality worldwide. Methods: A PUBMED and Google Scholar search was performed with MeSH and common terms and were obtained some cross-references at the discretion of the authors. Conclusions: It is necessary to implement a specific context of cardiovascular risk prevention in daily medical practice through continuing education programs or through health service providers to prevent the progression of cardiovascular disease in diabetic women before reaching major outcomes and potentially fatal.

Asociación entre conocimientos y actitudes preventivas sobre complicaciones crónicas en diabéticos de un policlínico peruano / Association between knowledge and preventive attitudes about chronic complications in diabetics in a Peruvian polyclinic

Introducción: Hay escasos estudios realizados para valorar la asociación entre el nivel de conocimientos sobre la diabetes mellitus tipo 2 y las actitudes que tienen los pacientes para mejorar el control de su enfermedad. Objetivo: Determinar la asociación entre el nivel de conocimientos y las actitudes preventivas sobre las complicaciones crónicas en pacientes con diabetes mellitus tipo 2. Métodos: Estudio transversal analítico en pacientes con diabetes tipo 2 de Chiclayo, Perú. Se indagó la asociación entre actitudes preventivas y nivel de conocimientos, además se exploró asociación con edad, sexo, nivel de instrucción, instrucción diabetológica previa, antecedentes familiares, hospitalizaciones previas, tiempo de enfermedad. Resultados: De 150 pacientes, el 60 por ciento fueron mujeres. El 40,0 por ciento presentó un nivel de conocimientos intermedio y un 84,7 por ciento reportaron actitudes preventivas favorables. Se encontró que los pacientes con nivel de conocimiento adecuado tenían 43 por ciento mayor frecuencia de presentar actitudes preventivas favorables (razón de prevalencia = 1,43). Los pacientes que tenían entre 7 a 15 años de enfermedad resultaron asociados positivamente a tener actitudes preventivas favorables (razón de prevalencia = 1,32). Conclusiones: Los pacientes diabéticos con conocimientos adecuados sobre su enfermedad tienen actitudes preventivas favorables frente a su padecimiento y sus complicaciones crónicas. Adicionalmente, los pacientes diagnosticados entre 7 - 15 años atrás tienen mejores actitudes preventivas(AU)

Introduction: There are few studies carried out to assess the association between the level of knowledge about type 2 diabetes mellitus and the attitudes that patients have to improve the control of their disease. Objective: To determine the association between the level of knowledge and preventive attitudes about chronic complications in patients with type 2 diabetes mellitus. Methods: Analytical cross-sectional study in patients with type 2 diabetes in Chiclayo, Peru. The association between preventive attitudes and level of knowledge was investigated, as well as the association with age, sex, level of education, previous diabetic education, family history, previous hospitalizations, time of illness. Results: Of 150 patients, 60 percent were women. 40.0 percent presented an intermediate level of knowledge and 84.7 percent reported favorable preventive attitudes. It was found that patients with an adequate level of knowledge had a 43 percent higher frequency of presenting favorable preventive attitudes (Prevalence ratio = 1,43). Patients who had between 7 and 15 years of disease were positively associated with having favorable preventive attitudes (Prevalence ratio = 1,32). Conclusions: Diabetic patients with adequate knowledge about their disease have favorable preventive attitudes towards their condition and its chronic complications. In addition, patients diagnosed between 7 - 15 years ago have better preventive attitudes(AU)

Control glicémico perioperatorio / Perioperatory glycemic control

Diabetes is the most common endocrinopathy, in 2014, 8.6% of the population suffered from diabetes, and it was responsible for at least 3.7 million deaths per year. It is estimated that by that by 2050 more than 30% of the population will have this disease. In cardiovascular surgery, it is described that 5.2% of patients are undiagnosed diabetics and this rises to 10% -28% in non-cardiac surgeries. The adverse results are markedly high in those patients with poor glycemic control including an increase of more than 50% in mortality, as well as an increase in respiratory infections, surgical site infection, urinary infection, heart attack and acute kidney injury among others. During the preoperative period of patients with diabetes, it is important to review glycemic control and its current treatment, in addition to providing the patient instructions on how to adjust medications. Intraoperatively, any condition that leads to an uncontrolled increase in surgical stress must be controlled, since this in turn generates hyperglycemia. Knowledge of insulins, their pharmacology and schedules is essential to maintain blood glucose intraoperatively in normal ranges. Different practical algorithms are proposed for the correct and safe management of hyperglycemia in the perioperative period. All care should be continued in the postoperative period defining the continuity of the insulin therapies established and the postoperative care of the patient.

La diabetes es la endocrinopatía más común, en 2014, el 8,6% de la población padecía diabetes siendo responsable de 3,7 millones de muertes por año. Se estima que para el 2050 más del 30% de la población tendrá diabetes. En cirugía cardiovascular el 5,2% de los pacientes son diabéticos no diagnosticados, cifra que aumenta hasta 10%-28% en cirugías no cardíacas. Los resultados adversos son marcadamente elevados en aquellos pacientes con mal control incluyendo un aumento del 50% en la mortalidad, así mismo, incremento de infecciones respiratorias, infección del sitio quirúrgico, infección urinaria, infarto agudo de miocardio y lesión renal aguda, entre otros. Durante el preoperatorio de pacientes con diabetes, es importante revisar el control glucémico y su tratamiento, además de proporcionar al paciente instrucciones por escrito sobre cómo ajustarlo. En el intraoperatorio se debe controlar cualquier condición que lleve a un aumento del estrés quirúrgico pues este a su vez genera hiperglucemia. Es fundamental el conocimiento de las insulinas, su farmacología y esquemas para mantener glucemias en el intraoperatorio en rangos normales. Se proponen diferentes algoritmos prácticos para el correcto y seguro manejo de la hiperglucemia en el perioperatorio. La atención debe continuarse en el posoperatorio definiendo continuidad de terapias insulínicas instauradas y el adecuado cuidado del paciente.

El entrenamiento de Vibración de Cuerpo Completo no mejora el Umbral de Sensibilidad a la Vibración Periferica: estudio controlado aleatorizado doble ciego / Whole Body Vibration training not improves perception thresohld in patients with Diabetes Mellitus type 2: double-blind randomized controlled study

OBJETIVOS: El propósito de este estudio es comprobar los efectos de un entrenamiento de Vibración de Cuerpo Completo (VCC) de 8 semanas sobre el Umbral de Sensibilidad a la Vibración Periférica (USVP) en personas con Diabetes Mellitus (DM) tipo 2. CONFIGURACIÓN Y DISEÑO: Estudio controlado aleatorizado a doble ciego (ISRCTN16866781). MATERIALES Y MÉTODOS: Un total de 76 personas con DM tipo 2 son incluidas en el análisis estadístico, siendo repartidos 39 pacientes en el grupo de VCC y 37 pacientes en el grupo placebo. A ambos grupos se les aplicó un entrenamiento de 8 semanas de VCC, siendo 3 sesiones por semana, para ser en total 24 sesiones de VCC y de placebo. Se les evaluó el USVP a través del Biotensiómetro Vibratron II antes de la intervención y después de las 8 semanas de entrenamiento. ANÁLISIS ESTADÍSTICO UTILIZADO: Para comprobar que los grupos eran comparables en la línea base en cuanto a las características de los participantes se realizó una prueba T para muestras independientes. Para determinar si la intervención de VCC había tenido efecto sobre el USVP, se realizó un ANCOVA, utilizando como covariable el nivel inicial del USVP. La significación estadística fue establecida en P <,05. RESULTADOS: El grupo de VCC y el grupo placebo fueron comparables en la línea base en todas las variables incluídas para la caracterización de la muestra. El entrenamiento de VCC no tuve ningún efecto estadísticamente significativo sobre el USVP. CONCLUSIONES: Tras un entrenamiento de Vibración de Cuerpo Completo de 8 semanas de duración no hubo efectos sobre el umbral de sensibilidad a la vibración periférica

AIMS: The purpose of this study is to assess the effects of an 8-week Whole Body Vibration (WBV) training on the Peripheral Vibration Sensitivity Threshold (PVST) in people with Diabetes Mellitus (DM) type 2. SETTING AND DESIGN: A double-blind randomized controlled study (ISRCTN16866781). Methods and Material: A total of 76 people with DM type 2 are included in the statistical analysis, 39 patients in the WBV group and 37 patients in the placebo group. Both groups were given 8 weeks of WBV training, 3 sessions per week, for a total of 24 sessions of WBV and placebo. The PVST was assessed through the Biotensiometer Vibratron II before the intervention and after the 8 weeks of training. STATISTICAL ANALYSIS USED: To check that the groups were comparable at the baseline in terms of participant characteristics, a T-test for independent samples was performed. To determine whether the WBV intervention had had an effect on the PVST, an ANCOVA was performed, using the initial level of the PVST as a covariate. Statistical significance was established at P <.05. RESULTS: The WBV group and the placebo group were comparable at baseline on all variables included for sample characterization. The WBV training had no statistically significant effect on the PVST. CONCLUSIONS: After 8 weeks of Whole Body Vibration training there was no effect on the Peripheral Vibration Sensitivity Threshold

No se ha encontrado relación entre el Umbral de la Sensibilidad y el cuestionario FHSQ en personas con Diabetes Mellitus tipo 2 / No association can be determined between Peripheral Vibration Sensitivity Threshold and the Foot Health Status Questionnaire (FHSQ) in a population of people with Diabetes Mellitus Type 2

OBJETIVOS: El propósito de este estudio es determinar la correlación entre el Umbral de Sensibilidad a la Vibración Periférica (USVP) y el cuestionario de salud del pie FHSQ. CONFIGURACIÓN Y DISEÑO: Estudio de corte transversal descriptivo (ISRCTN16866781). MATERIALES Y MÉTODOS: Un total de 88 personas con DM tipo 2 han sido incluidas en el análisis estadístico, siendo 55 hombres y 33 mujeres. A ambos grupos se les evaluó el USVP a través del Biotensiómetro Vibratron II y se les aplicó el cuestionario de salud del pie (FHSQ). ANÁLISIS ESTADÍSTICO UTILIZADO: Para comprobar que los grupos eran comparables en la línea base en cuanto a las características y el género de los participantes se realizó una prueba T para muestras independientes y un análisis de U-Mann Whitney. Para establecer el grado de correlación entre las 8 dimensiones del cuestionario FHSQ y el USVP se utilizó el coeficiente de correlación de Spearman, dado que las puntuaciones de las 8 dimensiones del FHSQ seguían una distribución no paramétrica. Para disminuir la probabilidad de cometer un error de tipo I, al tratarse de una correlación múltiple, se ha aplicado la corrección de Bonferroni, estableciendo el nivel de significación en p<.006. RESULTADOS: No existe asociación estadísticamente significativa entre el USVP y las dimensiones del cuestionario de salud del pie FHSQ, tras aplicarle la corrección de Bonferroni. CONCLUSIONES: En este estudio no se ha encontrado ninguna asociación estadísticamente significativa, tras la aplicación de la corrección de Bonferroni, entre el Umbral de la Sensibilidad a la Vibración Periférica y el cuestionario de la salud de pie Foot Health Status Questionnaire (FHSQ)

AIMS: The purpose of this study is to determine the correlation between the Peripheral Vibration Sensitivity Threshold (PVST) and the Foot Health Status Questionnaire (FHSQ). SETTINGS AND DESIGN: A descriptive cross-sectional study (ISRCTN16866781). METHODS AND MATERIALS: A total of 88 people with DM type 2 were included in the statistical analysis, 55 men and 33 women. Both groups were evaluated the PVST through the Vibratron II Biotensiometer and the Foot Health Status Questionnaire (FHSQ). STATISTICAL ANALYSIS USED: To check that the groups were comparable at the baseline in terms of participant characteristics and gender, were carried out a T-test for independent samples and a U-Mann Whitney analysis. To establish the degree of correlation between the 8 dimensions of the FHSQ questionnaire and the PVST, the Spearman correlation coefficient was used, given that the scores of the 8 dimensions of the FHSQ followed a non-parametric distribution. To reduce the probability of committing a type I error, since it is a multiple correlation, the Bonferroni correction has been applied, establishing the significance level at p<.006. RESULTS: There is no statistically significant association between the PVST and the dimensions of the FHSQ, after applying Bonferroni's correction. CONCLUSIONS: In this study no statistically significant association was found, after the application of Bonferroni's correction, between the recording of the Peripheral Vibration Sensitivity Threshold test and the Foot Health Status Questionnaire (FHSQ)

Trastornos de la conducta alimentaria y diabetes mellitus: tratamiento nutricional / Eating disorders and diabetes mellitus: nutritional treatment

El presente trabajo describe las particularidades en el manejo nutricional y la presentación clínica de los pacientes diabéticos con trastornos de la conducta alimentaria. Es importante el diagnóstico precoz de estas comorbilidades, para tomar las medidas necesarias y evitar complicaciones. Los profesionales sanitarios deben estar alerta a los signos de alarma (incremento de HbA1c, cambios de peso, omisión del tratamiento, excesiva preocupación en la calidad y cantidad de comida, etc.). Según algunos estudios, hasta el 60% de los pacientes con Diabetes Mellitus tipo 1 y hasta el 40% de los pacientes con Diabetes Mellitus tipo 2 pueden cumplir criterios de trastornos de la conducta alimentaria (Diabulimia, Trastorno por atracón, Síndrome del comedor nocturno y formas no específicas). El tratamiento debe llevarse a cabo por un equipo interdisciplinar, teniendo como objetivo principal el restablecimiento del peso adecuado y el control de los comportamiento propios de los trastornos de la conducta alimentaria (purgas, omisiones de tratamiento, atracones, restricciones), se debe establecer un plan dietético nutricional progresivo, evitando centrar la atención en el recuento de raciones de hidratos de carbono, sino en la educación nutricional adecuada y en aquellos con insulina asegurar su adecuada administración. Es importante establecer con el paciente objetivos reales (peso, controles glucémicos, HbA1c) y hablar sobre las complicaciones agudas y crónicas de la diabetes con el paciente y la familia. Todavía quedan muchas áreas de estudio para mejorar el tratamiento integral de estos pacientes

This paper describes the special characteristics in nutritional management and clinical presentation of patients with diabetes and eating disorders at the same time. The screening of these two comorbidities is important in order to take the necessary measures and to avoid complications. Professionals should be aware for warning signs (High HbA1c, weight changes, treatment omission , excessive concern about the quality and quantity of meal, etc.). Some studies show that more than 60% of type 1 Diabetes Mellitus and more than 40% of type 2 Diabetes Mellitus meet criteria for eating disorders (Diabulimia, Binge Eating Disorder, Night eating syndrome and non-specific forms). The treatment must be carried out by an interdisciplinary team, with the main objective of restoring adequate weight and avoiding of eating disorders' behavior (purges, treatment omission, binge eating, restrictions), a progressive dietary plan must be established, not to be focus on counting carbohydrate rations, but on adequate nutritional education and on those patients with insulin to ensure its adequate administration. It is important establish real objectives (weight, blood measure test, HbA1c) and to discuss acute and chronic complications of diabetes not only with the patient but with his/her family. There are still many study'areas to improve the comprehensive treatment of these patients

Parámetros clínicos, bioquímicos y metabólicos predictores de complicaciones micro y macrovasculares en diabéticos tipo 2 / Clinical, biochemical and metabolic parameters predictive of micro and macrovascular complications in type 2 diabetics

Introducción: la diabetes mellitus (DM) es una enfermedad endocrino-metabólica, vascular, crónica, producida por una interacción variable de factores genéticos y ambientales. Actualmente la DM2 es considerada por algunos autores como pandémica, sin la existencia de signos de reducción de las tasas de incidencia. Objetivo: identificar los parámetros clínicos, bioquímicos y metabólicos predictores de complicaciones micro y macrovasculares en personas con diabetes mellitus tipo 2. Método: se realizó un estudio analítico de tipo casos y controles con pacientes ingresados en el Centro de Atención al Diabético de Bayamo (CAD), Granma, desde el año 2010 al 2017, 81 con alguna complicación microvascular, 40 con alguna complicación macrovascular y 162 sin ninguna complicación. Resultados: en el análisis univariado se observó que el tiempo de evolución de la enfermedad y la HTA descontrolada fueron los factores de riesgo para el desarrollo de una complicación microvascular, mientras que a estas se le unieron el tabaquismo y la hipercolesterolemia como factores de riesgo para el desarrollo de complicaciones macrovasculares. Las variables que mostraron una relación independiente con el riesgo dedesarrollar alguna complicación microvascular fueron el tiempo de evolución de la enfermedad y la HTA descontrolada, mientras que para el desarrollo de complicaciones macrovasculares fueron el tiempo de evolución de la enfermedad y el tabaquismo. Conclusiones: el tiempo de evolución de la diabetes y la HTA descontrolada y el tiempo de evolución de la enfermedad y el tabaquismo se asocian de forma independiente con la aparición de complicaciones microvasculares y macrovasculates respectivamente(AU)

Introduction: diabetes mellitus (DM) is an endocrine-metabolic, vascular, chronic disease, produced by a variable interaction of genetic and environmental factors. Currently DM2 is considered by some authors as pandemic, without the existence of signs of reduction of incidence rates. Objective: to identify clinical, biochemical and metabolic parameters predictors of micro and macrovascular complications in people with type 2 diabetes mellitus. Method: an analytical case and control study was conducted with patients admitted to the Bayamo Diabetic Care Center (CAD), Granma, from 2010 to 2017, 81 with some microvascular complications, 40 with some macrovascular complications and 162 without any complications. Results: the univariate analysis found that disease progression time and uncontrolled HTA were the risk factors for the development of a microvascular complication, while these were joined by smoking and hypercholesterolemia as risk factors for the development of macrovascular complications. The variables that showed an independent relationship with the risk of developing some microvascular complications were the time of disease evolution and uncontrolled HTA, while for the development of macrovascular complications were the time of disease evolution and smoking. Conclusions: the time of evolution of diabetes and uncontrolled HTA and the time of disease and smoking evolution are independently associated with the emergence of microvascular and macrovasculate complications respectively(EU)

Avaliação do risco de ulceração nos pés em pessoas com diabetes mellitus na atenção primária / Evaluación del riesgo de ulceración en piesdepersonas con diabetes mellitus en la atención primaria de salud / Risk evaluation of feet ulceration in people with diabetes mellitus in primary care

RESUMO Objetivo: avaliar o risco de ulceração nos pés de pessoas com diabetes mellitus atendidas na atenção primária. Método: estudo transversal analítico realizado em Teresina, Piauí, com 308 pacientes, sendo incluídos maiores de 18 anos diagnosticados com diabetes mellitus e excluídos aqueles com ulceração ativa e/ou neuropatia atribuída a outros agravos. Os dados foram coletados mediante formulário sociodemográfico, clínico e de classificação do risco de ulceração nos pés, no período de fevereiro a agosto de 2019. A análise ocorreu a partir de estatísticas descritiva e inferencial. Resultados: dos participantes, 56,5% tinham mais de 60 anos, 59,7% não realizavam o controle da glicemia, 56,2% não praticavam atividade física, 51,3% estavam com sobrepeso e 54,2% apresentaram grau de risco 1 para ulceração nos pés. A situação conjugal, ocupação e diabetes mellitus há mais de 10 anos, controle glicêmico inadequado, hipertensão arterial, dislipidemia e obesidade tiveram associação estatisticamente significativa com o risco de ulceração. Aqueles com pele seca, deformidades, reflexo do tornozelo e percepção de vibração no hálux alterados apresentaram mais probabilidade de ulceração nos pés. Constatou-se que o exame clínico dos pés e a sensibilidade preservada ao monofilamento foram fatores de proteção. Conclusão: observouse que os aspectos sociodemográficos e clínicos interferem na probabilidade de ulceração, sendo que a maioria apresentou risco baixo. Além disso, no exame clínico dos pés, as alterações na sensibilidade vibratória e no reflexo do tornozelo aumentaram a probabilidade de ulceração, destacando-se que a classificação do risco de ulceração é imprescindível na assistência às pessoas com diabetes mellitus.

RESUMEN Objetivo: evaluar el riesgo de ulceración del pie en personas con diabetes mellitus tratadas en atención primaria. Método: estudio analítico transversal realizado en Teresina, Piauí, con 308 pacientes, incluidos los mayores de 18 años diagnosticados de diabetes mellitus y excluidos aquéllos con ulceración activa y / o neuropatía atribuida a otras condiciones. Los datos se recogieronde febrero a agosto de 2019 por medio de un formulario sociodemográfico, clínico y de clasificación de riesgo para la ulceración en el pie. El análisis se realizó a través de estadística descriptiva e inferencial. Resultados: el 56,5% de los participantes tenía más de 60 años, el 59,7% no realizaba control glucémico, el 56,2% no practicaba actividad física, el 51,3% tenía sobrepeso y el 54,2% tenía un grado de riesgo 1 de ulceración del pie. La situación conjugal, ocupación, diabetes mellitus durante más de 10 años, el inadecuado control glucémico, la hipertensión arterial, la dislipidemia y la obesidad tuvieron una asociación estadísticamente significativa con el riesgo de ulceración. Aquéllos con piel seca, deformidades, reflejo del tendón de Aquiles alterado y percepción alterada de la vibración del hallux tenían más probabilidades de ulceración de pies. Se encontró que el examen clínico de los pies y la sensibilidad conservada al monofilamento eran factores protectores. Conclusión: se observó que los aspectos sociodemográficos y clínicos interfieren con la probabilidad de ulceración, siendo la mayoría de bajo riesgo. Además, en el examen clínico de los pies, los cambios en la sensibilidad vibratoria y en el reflejo del tendón de Aquiles aumentaron la probabilidad de ulceración, destacando que la clasificación del riesgo de ulceración es esencial en la atención de las personas con diabetes mellitus.

ABSTRACT Objective: to evaluate the risk of foot ulceration in people with diabetes mellitus treated in primary care. Method: this is a cross-sectional analytical study carried out in Teresina, Piauí, with 308 patients, including those over 18 years old diagnosed with diabetes mellitus and excluding those with active ulceration and/ or neuropathy attributed to other conditions. The data were collected using a sociodemographic, clinical, and risk classification form for the foot ulceration, from February to August 2019. The analysis was based on descriptive and inferential statistics. Results: in the study, 56.5% of the participants were over 60 years old, 59.7% did not perform glycemic control, 56.2% did not practice physical activity, 51.3% were overweight and 54.2% had a degree of risk 1 for foot ulceration. Marital status, occupation, and diabetes mellitus for more than 10 years, inadequate glycemic control, arterial hypertension, dyslipidemia, and obesity had a statistically significant association with the risk of ulceration. Those with dry skin, deformities, ankle reflexes, and altered perception of hallux vibration were more likely to have foot ulcers. We found that the clinical examination of the feet and the preserved sensitivity to the monofilament were protective factors. Conclusion: we observed that the sociodemographic and clinical aspects interfere with the probability of ulceration and most of them present a low risk. Also, in the clinical examination of the feet, changes in vibratory sensitivity and ankle reflex increased the likelihood of ulceration, noting that the classification of the risk of ulceration is essential in assisting people with diabetes mellitus.

Disparities In The Use Of Drug-eluting Stents For Diabetic Patients With ST-elevation Acute Myocardial Infarction Assisted In the Public versus Private Network - VICTIM Register / Disparidades no Uso de Stents Farmacológicos para Pacientes Diabéticos com Infarto Agudo do Miocárdio com Supradesnivelamento do Segmento ST Assistidos na Rede Pública versus Privada - Registro VICTIM

Abstract Background: Primary angioplasty (PA) with placement of either bare metal or drug-eluting stents (DES) represents the main strategy in the treatment of ST-elevation myocardial infarction (STEMI). Diabetic patients, however, represent a special population in STEMI, with high rates of restenosis and unfavorable clinical outcomes, and with the use of DES, level of evidence A and indication class II, being indicated to reduce these damages. Objectives: To evaluate the DES rate of use in patients with STEMI and in the subgroup of diabetics assisted in the public versus private health network in Sergipe. Methods: This is a population-based, cross-sectional study with a quantitative approach using the data from the VICTIM Register. These were collected in the only four hospitals with capacity to perform PA in Sergipe, from December 2014 to March 2017. Results: A total of 707 patients diagnosed with STEMI were evaluated, of which 589 were attended at SUS and 118 at the private network. The use of DES in PA was lower in SUS compared to the private network in both the total sample (10.5% vs 82.4%, p<0.001) and in subgroup diabetic patients (8.7% vs 90.6%, p < 0.001), respectively. In all hypotheses tested, the level of significance was 5% (p < 0.05). Conclusions: The study reveals a disparity in the use of DES during the performance of PA between the public and private network, both in the total sample and the subgroup for diabetics, with lower rates for SUS users, demonstrating the challenges that need to be overcome in order to achieve quality improvements of the services provided.

Resumo Fundamento: A angioplastia primária (AP) com colocação de stent, seja ele convencional ou farmacológico, representa a principal estratégia no tratamento do infarto agudo do miocárdio com supradesnivelamento do segmento ST (IAMCSST). Os pacientes diabéticos, entretanto, representam população especial no IAMCSST, com altas taxas de reestenose e desfechos clínicos desfavoráveis, devendo-se indicar o uso de stents farmacológicos (SF), nível de evidência A e classe de indicação II, para redução destes danos. Objetivo: Avaliar a taxa de uso de SF em pacientes com IAMCSST e no subgrupo dos diabéticos assistidos na rede pública versus privada de saúde em Sergipe. Métodos: Trata-se de um estudo populacional, transversal, com abordagem quantitativa, que utilizou os dados do Registro VICTIM. Estes foram coletados nos quatro únicos hospitais com capacidade para realizar AP em Sergipe, no período de dezembro de 2014 a março de 2017. Em todas as hipóteses testadas, o nível de significância adotado foi de 5% (p < 0,05). Resultados: Foram avaliados 707 pacientes diagnosticados com IAMCSST, dos quais 589 foram atendidos pelo SUS e 118 pela rede privada. O uso de SF na AP foi menor no SUS em comparação com a rede privada, tanto no total da amostra (10,5% vs 82,4%; p < 0,001) quanto no subgrupo dos pacientes diabéticos (8,7% vs 90,6%; p < 0,001), respectivamente. Conclusões: O estudo revela disparidade no uso de SF durante a realização de AP entre a rede pública e privada, tanto na amostra total quanto no subgrupo dos diabéticos, com menores taxas para usuários do SUS, demonstrando os desafios que necessitam ser vencidos para se atingir melhorias na qualidade dos serviços prestados.

Efectividad del Decálogo de prevención cardiovascular en diabéticos / Effectiveness of a Decalogue for cardiovascular prevention in diabetics

INTRODUCCIÓN: Evaluar la efectividad en conocimiento, percepción de control y mejora del riesgo cardiovascular (RCV) mediante la entrega de un Decálogo visual. MATERIAL Y MÉTODOS: Ensayo clínico de intervención educativa, no farmacológico, con grupo control paralelo, aleatorizado, evaluado a ciegas, en pacientes diabéticos tipo 2, realizado en Atención Primaria de Salud. Ambos grupos recibieron una intervención educativa sobre RCV y su grado de control, y el de intervención además un Decálogo visual con los factores de RCV modificables que reflejaba visualmente su grado de control. Incluimos 50 pacientes en cada grupo para detectar una mejora del conocimiento multifactorial del RCV del 50%. Todos los pacientes recibieron un recuerdo telefónico a los 2 meses, evaluando enmascaradamente el conocimiento y la percepción de control del RCV, y al cabo de 6 meses se evaluó de nuevo presencialmente el conocimiento y el control real del RCV. RESULTADOS: Seleccionamos 51 hombres y 49 mujeres, de 62,9 años de edad media, 9,2 años de evolución y escaso nivel educativo (32% sin estudios y 52% estudios primarios). Basalmente, el conocimiento, la percepción y el control del RCV fueron del 55,0, 80,4 y 65,9%, respectivamente. A los 2 meses, el conocimiento aumentó en el grupo del Decálogo un 16,5% más que en el grupo de educación convencional (73,6% vs. 63,2%; p < 0,05); la percepción sobreestimada de control mejoró un 34,5% en el total de la muestra (p < 0,001) sin diferencias entre grupos, aunque mejoró más la concordancia en el grupo del Decálogo. A los 6 meses aumentó el conocimiento globalmente en un 25,6% (p < 0,001), desapareciendo las diferencias iniciales entre grupos. El control final del RCV aumentó globalmente y en el grupo del Decálogo en un 6,4% (p < 0,005) y un 9,4% (p < 0,001), respectivamente. El riesgo SCORE disminuyó significativamente de forma global y en ambos grupos, sin diferencias entre ambos. CONCLUSIONES: La intervención educativa mejora globalmente el conocimiento, la percepción y el control del RCV. El Decálogo de RCV incrementa rápidamente el conocimiento y disminuye la falsa percepción subjetiva de control del RCV, aunque el beneficio se equipara a los 6 meses si las intervenciones educativas persisten

INTRODUCTION: To assess the effects of a visual Decalogue aid on the degree of knowledge, control perception and improvement in cardiovascular risk factors (CVRF). MATERIAL AND METHODS: A Primary care randomised non-pharmacological trial of an educational intervention with a parallel control group, and blind evaluation in type 2 diabetic patients. Both groups received an educational intervention on the management of CVRF. The intervention group also received a visual Decalogue aid that showed the level of control patients have over the modifiable CVRF. A total of 50 patients were included in each group in order to identify an improvement of 50% in the multifactorial knowledge of CVRF. All patients received a reminder telephone call at 2 months, with masked evaluation of knowledge and CVRF control perception. In a 6 months visit the level of knowledge and real control of CVRF were re-evaluated. RESULTS: The study included 51 males and 49 females, with mean age of 62.9 years, a mean disease duration of 9.2 years, and low educational level. The level of knowledge, control perception, and real control at baseline was 55%, 80.4%, and 65.9%, respectively. After 2 months the level of knowledge in the Decalogue group increased by 16.5% more than in the conventional education group (73.6% vs. 63.2%; P < .05) and the overestimated control perception improved by 34.5% (P < .001) with no differences between groups, although concordance was better in the Decalogue group. At 6 months there was an overall increase 25.6% (P < .001) in the level of knowledge, with the previous difference between groups levelling off. The final CVRF control improved overall and in the Decalogue group by 6.4% (P < .005) and 9.4% (P < .001), respectively. The SCORE risk significantly decreased overall with no differences between groups. CONCLUSIONS: The educational intervention improves the overall level of knowledge, perception and control of CVRF. The CVRF Decalogue quickly increases the level of knowledge, and decreases the false subjective risk control perception. The benefit, however, becomes equal at 6 months with ongoing education interventions

Prevención y tratamiento de la enfermedad infecciosa en personas con diabetes / Prevention and treatment of infectious diseases in diabetic patients

Es conocida la relación bidireccional entre enfermedades infecciosas y diabetes. Las personas con diabetes tienen mayor riesgo de presentar enfermedades infecciosas, pudiendo ser estas de mayor severidad; y por otro lado, las enfermedades infecciosas desestabilizan el control metabólico de las personas con diabetes. El envejecimiento importante de la población es debido en parte al aumento de la supervivencia de pacientes con enfermedades crónicas, entre ellas la diabetes. Mejorar la prevención de enfermedades infecciosas en este grupo de población podría disminuir las complicaciones de estas enfermedades, así como las consecuencias de la desestabilización de la enfermedad de base (morbilidad, discapacidad, ingresos hospitalarios, costes sanitarios, tasas de mortalidad), mejorando además la calidad de vida de las personas con diabetes. La presente revisión expone el tratamiento de las enfermedades infecciosas en personas con diabetes y el abordaje de las enfermedades inmunoprevenibles con las vacunas recomendadas en la actualidad

The bidirectional relationship between infectious diseases and diabetes is well-known. On the one hand, diabetes patients are at a higher risk of presenting with infectious diseases, possibly with more severity, and on the other hand, infectious diseases impair metabolic control in patients with diabetes. Population ageing arises partly due to an increased survival rate in chronic diseases, of which diabetes is amongst them. Improving infectious disease prevention could reduce complications arising from the former diseases, consequences of decompensated diabetes condition (morbidity, incapacity, hospital admissions, healthcare costs, and mortality rates) and result in improved quality of life in patients with diabetes. The current review presents the treatment of infectious diseases in patients with diabetes and the dealing with immuno-preventable diseases with the currently advised vaccinations

¿Serán las nuevas moléculas efectivas en protección renal y cardiovascular en la diabetes mellitus y la enfermedad renal diabética? / Will the new molecules be effective in renal and cardiovascular protection in diabetes mellitus and diabetic kidney disease?

No disponible

Conocimientos sobre salud oral en diabéticos atendidos en Atención Primaria / Knowledge about oral health in diabetic primary care patient

Objetivo: Determinar los conocimientos en salud oral en pacientes adultos con diabetes mellitus tipo 2, así como su relación con el nivel glucémico, factores sociodemográficos, hábitos en higiene oral y cuidados dentales profesionales. Diseño: Estudio observacional transversal. Emplazamiento: Consultas de medicina de familia de cuatro Centros de Salud. Participantes: Se seleccionaron mediante muestreo aleatorio accidental 247 pacientes diagnosticados de diabetes mellitus tipo 2. Mediciones Principales: Los pacientes contestaron un cuestionario sobre la relación entre salud oral y diabetes, clasificándolos en dos grupos de conocimientos en función de las respuestas correctas al cuestionario. También se registraron antecedentes sociales, autocuidados orales, uso de servicios dentales y los valores más recientes de hemoglobina glucosilada (HbA1c). Resultados: El grupo de pacientes sin estudios presentó un porcentaje de conocimientos bajos (CB) significativamente mayor (56,04 %) que el grupo de pacientes con estudios secundarios (32 %) y universitarios (16,67 %) (p<0,05). El porcentaje de pacientes con una mayor conciencia de la relación diabetes-salud oral fue mayor en la zona urbana (67,12 %) (p<0,05). La distribución de la frecuencia diaria de cepillado y el uso de pasta dental fluorada entre los dos grupos reflejó diferencias estadísticamente significativas (p<0,05). La variable HbA1c no reveló diferencias estadísticamente significativas en función del nivel de conocimientos. Conclusiones: Los conocimientos sobre salud oral de los pacientes con diabetes tipo 2 se relacionan con la frecuencia de cepillado, uso de complementos para higiene oral, lugar de residencia y nivel de estudios. El estudio mostró hábitos de higiene deficitarios y bajo uso de servicios sanitarios en relación con la salud oral

Objective: To determine the knowledge about oral health among adult patients with type 2 diabetes mellitus, as well as its relationship with glycemic level, sociodemographic factors, oral hygiene habits and professional dental care. Design: Observational cross-sectional study. Location: Primary Care consultations in four health centers. Participants: Accidental random sampling was used to include a total of 247 patients with type 2 diabetes mellitus. Main measures: Patients completed a questionnaire on the relationship between oral health and diabetes, classifying them into two knowledge groups according to the number of correct answers obtained. Data related to social background, oral self-care, use of dental services, and the most recent glycosylated hemoglobin (HbA1c) values were also collected. Results: Patients with little or no education showed a significantly higher percentage of limited knowledge (56.04%) than patients with secondary (32.14%) and university education (16.67%) (p<0.05). The percentage of patients with greater awareness of the link between diabetes and oral health was higher in urban areas (67.12%) (p<0.05). The distribution of daily toothbrushing frequency and the use of fluoride toothpaste showed statistically significant differences between the two groups (p<0.05). The variable HbA1c did not show statistically significant differences according to the level of knowledge. Conclusions: The knowledge about oral health of patients with type 2 diabetes is related to frequency of brushing, use of complements in oral hygiene, place of residence and educational level. The study also reflected deficiency in hygiene habits and in the use of healthcare services regarding oral health

Elaboração de protocolo de investigação de neuropatia periférica em pacientes diabéticos / Elaboration of a protocol for peripheral neuropathy investigation in diabetic patients / Elaboración de protocolo de investigación de neuropatía periférica en pacientes diabéticos

Introdução: A neuropatia distal diabética é uma das principais complicações do diabetes mellitus, acometendo metade dos pacientes com diabetes, e pode ser a causa de deformidades, úlceras e amputações. Mais de 70% dos pacientes com pé diabético apresentam neuropatias. A investigação e o reconhecimento precoce da presença da neuropatia distal diabética são importantes, pois permitem detectar pacientes que apresentam neuropatia distal diabética, que podem evoluir para úlcera e/ou amputação...(AU)

Introduction: Diabetic distal neuropathy is one of the main complications of diabetes mellitus, affecting half of diabetes patients, and may be the cause of deformities, ulcers and amputations. More than 70% of diabetic foot patients have neuropathies. Investigation and early recognition of the presence of diabetic distal neuropathy is important because it allows the detection of patients with diabetic distal neuropathy, which may progress to ulcer and / or amputation ... (AU)

Introducción: la neuropatía distal diabética es una de las principales complicaciones de la diabetes mellitus, afecta a la mitad de los pacientes con diabetes y puede ser la causa de deformidades, úlceras y amputaciones. Más del 70% de los pacientes con pie diabético tienen neuropatías. La investigación y el reconocimiento temprano de la presencia de neuropatía distal diabética es importante porque permite la detección de pacientes con neuropatía distal diabética, que puede progresar a úlcera y / o amputación ... (AU)

Atividades de autocuidado em pessoas com diabetes mellitus tipo 2 / Self-care activities in people with type 2 diabetes mellitus

Objetivo: analisar a frequência de atividades de autocuidado em pessoas com Diabetes Mellitus tipo 2 e sua associação com o controle clínico. Método: trata-se de um estudo quantitativo, analítico, em cinco Estratégias Saúde da Família, com 86 indivíduos. Coletaram-se os dados por meio de um formulário e um Questionário de Atividades de Autocuidado com o Diabetes. Analisaram-se os dados por meio do programa Statistical Package for the Social Sciences (SPSS) IBM®, versão 20.0. Resultados: observou-se, considerando o autocuidado, resultado satisfatório para a ingestão de doces e uso de medicamentos e insatisfatório para as demais atividades. Encontrou-se baixo percentual de tabagismo. Associouse a frequência de atividades de autocuidado significativamente com tempo de diagnóstico, tipo de medicação e glicemia capilar. Conclusão: conduziram-se os resultados a um perfil de autocuidado insatisfatório que influencia no mau controle clínico do DM2. Permitiu-se, além disso, avaliar a importância do autocuidado no controle metabólico do DM2, servindo como subsídio para o desenvolvimento de estratégias de enfrentamento.(AU)

Objective: to analyze the frequency of self-care activities in people with type 2 diabetes mellitus and their association with clinical control. Method: this is a quantitative, analytical study in five Family Health Strategies, with 86 individuals. Data was collected using a form and a Diabetes Self-Care Activity Questionnaire. Data was analyzed using IBM® Statistical Package for Social Sciences (SPSS), version 20.0. Results: it was observed, considering self-care, a satisfactory result for the ingestion of sweets and medication use and unsatisfactory for the other activities. A low percentage of smoking was found. The frequency of self-care activities was significantly associated with time since diagnosis, type of medication and capillary blood glucose. Conclusion: the results were led to an unsatisfactory selfcare profile that influences poor clinical control of T2DM. It was also allowed to evaluate the importance of self-care in the metabolic control of DM2, serving as a subsidy for the development of coping strategies.(AU)

Objetivo: analizar la frecuencia de las actividades de autocuidado en personas con Diabetes Mellitus tipo 2 y su asociación con el control clínico. Método: este es un estudio cuantitativo y analítico en cinco Estrategias de Salud Familiar, con 86 individuos. Los datos se recopilaron mediante un formulario y un Cuestionario de Actividades de autocuidado como Diabetes. Los datos se analizaron utilizando el programa Statistical Package for the Social Sciences (SPSS) IBM®, versión 20.0. Resultados: se observó, considerando el autocuidado, un resultado satisfactorio para la ingestión de dulces y el uso de medicamentos e insatisfactorio para las otras actividades. Se encontró un bajo porcentaje de tabaquismo. La frecuencia de las actividades de autocuidado se asoció significativamente con el tiempo desde el diagnóstico, el tipo de medicamento y la glucosa en sangre capilar. Conclusión: los resultados condujeron a un perfil de autocuidado insatisfactorio que influye en el control clínico deficiente de la DM2. También se permitió evaluar la importancia del autocuidado en el control metabólico de DM2, sirviendo como un subsidio para el desarrollo de estrategias de afrontamiento.(AU)