Type B insulin resistance syndrome: a systematic review.

A literature review on the clinical, laboratory, and treatment features of type B insulin resistance syndrome (TBIRS). Data from PubMed, the Virtual Health Library and Cochrane database were selected and analyzed using the REDCap application and R statistical program. From 182 papers, 65 were selected, which assessed 119 clinical cases, 76.5% in females and 42.9% in African-Americans, with an average age of 44 years. A common feature of TBIRS is co-occurrence of autoimmune diseases, such as systemic lupus erythematosus (most frequently reported). Hyperglycemia of difficult control was the mostly reported condition. Tests for anti-insulin receptor antibodies were positive in 44.2% of the cases. Disease management comprised fractional diet, insulin therapy (maximum dose given was 57 600 IU/day), plasmapheresis and immunosuppression with several classes of drugs, mainly glucocorticoids. Remission occurred in 69.7% of cases, in 30.3% of these spontaneously. The mortality rate was 15.38%. There was an inverse relationship between anti-insulin antibodies and remission (p = 0.033); and a positive correlation between combined immunosuppressive therapy and remission (p = 0.002). Relapse occurred in 7.6% of the cases. This rare syndrome has difficult-to-control diabetes, even with high doses of insulin, and it is usually associated with autoimmune diseases. Therapeutic advances using immunomodulatory therapy have led to significant improvements in the rate of remission.

Prevalência das complicações micro e macrovasculares e de seus fatores de risco em pacientes com diabetes mellitus e síndrome metabólica / Prevalence of micro and macrovasculars complications and the risk factors in patients with diabetes mellitus and metabolic syndrome

JUSTIFICATIVA E OBJETIVOS: As complicações vasculares do diabetes mellitus tipo 2 (DM2) são as principais causas de morbimortalidade nos países desenvolvidos e constituem preocupação crescente para as autoridades de saúde. Alguns fatores estão envolvidosna gênese das complicações crônicas do DM2, destacando-se a hiperglicemia, hipertensão arterial sistêmica, dislipidemia e otabagismo, bem como disfunção endotelial, estado pré-trombóticoe inflamação. Dentro deste contexto, as complicações do DM2, tanto micro como macrovasculares, emergem como uma das maiores ameaças à saúde em todo o mundo, levando a custos econômicos e sociais de enorme repercussão. O objetivo deste estudo foi determinar a prevalência de complicações crônicas e os principais fatores de risco em pacientes com DM2 e com síndrome metabólica (SM), atendidos em hospital terciário da rede pública estadual.MÉTODO: Estudo transversal, retrospectivo, descritivo realizado no período de março a agosto de 2009, por análise de dados de prontuários de pacientes portadores de DM e SM, atendidos no ambulatório de diabetes do Serviço de Endocrinologia do Hospital Geral de Fortaleza (HGF). Os dados foram registrados em um banco de dados no Excel e análises por frequência foram realizadas. RESULTADOS: Foram avaliados 85 prontuários de pacientes diabéticos com SM, sendo 18,8% do sexo masculino e 81,2% do sexo feminino. Dentre as complicações microvasculares avaliadas,41,4% apresentou neuropatia periférica sensitiva, 28,2% nefropatia e 16,4% retinopatia. Por outro lado das complicações macrovasculares, a mais frequente foi a doença arterial coronariana (DAC) (20%),seguida da doença vascular periférica (DVP) (14,1%). A prevalência de doença vascular cerebral (DCV) foi de apenas 4,7%...

BACKGROUND AND OBJECTIVES: Cardiovascular complicationsof type 2 diabetes mellitus (T2DM) are the main morbidity and mortality causes in the developed countries and constitute growing concern for the authorities of health. Some factors are involvedin the genesis of these chronic complications of T2DM, standing out the hyperglycemia, high blood pressure, dyslipidemia and smoking,as well as endothelium dysfunction, thrombotic and inflammation state. Inside of this context, the micro and macrovasculares complications of T2DM emerge as one of the largest threats to the health all over the world, taking at economical and social costs of great repercussion. The aim of this study was to evaluate the prevalence of chronic complications and the main risk factors in patients with T2DM and metabolic syndrome (MS), assisted at a tertiary hospital of the state public net. METHOD: A cross-sectional study, retrospective, descriptive from March to August 2009, by analysis of data in medical handbooks of all the patients with T2DM and MS, assisted in a diabetes center of the Endocrinology Unit of the General Hospital of Fortaleza.The dates were registered in a database in Excel and analysis for frequency was made. RESULTS: 85 patients were analyzed of which 18.8% were in the male gender and 81.2% in the female gender. Among the microvasculares complications appraised, 41.4% presented sensitive neuropathy peripheral, 28.2% nephropathy and 16.4% retinopathy. On the other hand of the macrovasculares complications, the most frequent was coronary arterial disease (20%), following by the peripheral vascular disease (14.1%). The prevalence of cerebral vascular disease was of only 4.7%...