Quantitatively Evaluating the Relationships between Insulin Resistance and Retinal Neurodegeneration with Optical Coherence Tomography in Early Type 2 Diabetes Mellitus.

INTRODUCTION: The aim of this study was to quantitatively assess retinal neurodegenerative changes with optical coherence tomography (Cirrus HD-OCT) in type 2 diabetes mellitus (T2DM) patients without diabetic retinopathy (DR) and evaluate their relationships with insulin resistance (IR) and associated systemic indicators. METHODS: 102 T2DM patients without DR and 48 healthy controls were included in this observational cross-sectional study. The OCT parameters of macular retinal thickness (MRT) and ganglion cell-inner plexiform layer (GCIPL) thicknesses were evaluated between diabetic and normal eyes. The receiver operating characteristics (ROC) curve was generated to evaluate the discrimination power of early diabetes. Correlation and multiple regression analysis were performed between ophthalmological parameters and T2DM-related demographic and anthropometric variables, and serum biomarkers and homeostasis model assessment of insulin resistance (HOMA-IR) scores. RESULTS: MRT and GCIPL thicknesses showed significant thinning in patients, especially in inferotemporal area. High body mass index (BMI) correlated with decreased GCIPL thicknesses and elevated intraocular pressure (IOP). A negative correlation between waist-to-hip circumference ratio (WHR) and GCIPL thicknesses was also found. High-density lipoprotein (HDL) and fasting C-peptide (CP0) were associated with GCIPL thickness but only in inferotemporal region (r = 0.20, p = 0.04; r = -0.20, p = 0.05, respectively). Multiple regression analysis showed that increased HOMA-IR scores independently predicted both average (ß = -0.30, p = 0.05) and inferotemporal (ß = -0.34, p = 0.03) GCIPL thinning. CONCLUSION: Retinal thinning in early T2DM was associated with obesity-related metabolic disorders. IR as an independent risk factor for retinal neurodegeneration may increase the risk of developing glaucoma.

Barreras identificadas por pacientes con diabetes mellitus de tipo 2 en su atención integral / Barriers identified for patients with type 2 diabetes mellitus in their integral care

Introducción: La diabetes mellitus de tipo 2 es un problema de salud a escala mundial. Existe interés creciente por la calidad de la atención integral a nivel primario y centrada en el paciente. Objetivo: Identificar las principales barreras desde la perspectiva de las personas con diabetes mellitus de tipo 2 sobre su atención integral, en áreas de salud seleccionadas. Métodos: Se realizó una investigación cualitativa, descriptiva y transversal, durante el 2017, para la cual se crearon 6 grupos focales. La muestra estuvo constituida por 56 personas con diabetes mellitus de tipo 2, pertenecientes a los policlínicos José Antonio Echeverría, Héroes del Moncada y el Centro de Atención al Diabético de Cárdenas, provincia de Matanzas, así como los policlínicos Carlos J. Finlay, Julián Grimau y el Centro de Atención al Diabético del municipio de Santiago de Cuba, provincia de igual nombre. Resultados: Predominaron las personas de la tercera edad, del sexo femenino. Las barreras estuvieron relacionadas con el tratamiento farmacológico y no farmacológico, el seguimiento en los servicios de salud, así como el apoyo y la comunicación por parte del personal de salud de los consultorios del médico de la familia; esta última afectó la relación personal de salud - paciente. Conclusión: A pesar de los diferentes contextos geográficos existieron puntos en común. A medida que se intervenga con estrategias acertadas para eliminar las barreras percibidas por los pacientes con diabetes mellitus de tipo 2, existirá mejoraría en su estado de salud.

Introduction: The type 2 diabetes mellitus is a health problem worldwide. There is a growing interest for the quality of integral care at primary level and focused on the patient. Objective: To identify the main barriers from the perspective of people with type 2 diabetes mellitus on their integral care, in selected health areas. Methods: A qualitative, descriptive and cross-sectional investigation was carried out during 2017, for which 6 focal groups were created. The sample was constituted by 56 people with type 2 diabetes mellitus, belonging to José Antonio Echeverría, Héroes del Moncada polyclinics and the Diabetic Care Center, in Cárdenas, the province of Matanzas, as well as Carlos J. Finlay, Julián Grimau polyclinics and the Diabetic Care Center in the municipality of Santiago de Cuba, in the province with the same name. Results: There was a prevalence of the elderly from the female sex. The barriers were related to the pharmacological and non pharmacological treatment, the follow up in the health services, as well as the support and the communication on the part of the health staff in the family doctor offices; this latter affected the relationship health staff - patient. Conclusion: In spite of the different geographical contexts there were points shared by them. As one takes the control with relevant strategies to eliminate the barriers perceived by the patients with type 2 diabetes mellitus, their health state will improve.

Narrativas de vida de pessoas com Diabetes Mellitus tipo 2: potencialidades para o cuidado de enfermagem / Narratives of life of people with type 2 Diabetes Mellitus: potential for nursing care

Em diferentes etapas da vida, os seres humanos estão expostos a vulnerabilidades, sendo que cada uma dessas vulnerabilidades se expressa de maneira diferente, dependendo da faixa etária em que se encontram e dos contextos em que vivem, podendo trazer implicações de todas as ordens para a vida das pessoas. Nesse sentido,questiona-se: quais os modos de viver da pessoa que vive com Diabetes Mellitus tipo 2 que podem torná-la vulnerável? Quais são as estratégias de enfrentamento das vulnerabilidades adotadas pelas pessoas que vivem com Diabetes Mellitus tipo 2? Para tanto, o objetivo geral deste estudo écompreender as vulnerabilidades em saúde a que estão expostos os indivíduos com diabetes tipo 2 reveladas pela narrativa de vida. E os objetivos específicos são: identificar os modos de viver das pessoas com diabetes mellitus tipo 2 relacionados à vulnerabilidade e analisar os modos de proteção dos indivíduos no enfrentamento das vulnerabilidades. A metodologia utilizada foi de abordagem qualitativa, descritiva, guiada pelo Método Narrativa de Vida. A pesquisa foi desenvolvida na Policlínica Piquet Carneiro, uma unidade da Universidade do Estado do Rio de Janeiro (PPC/UERJ), no período de março a julho de 2015.Os participantes do estudo foram 20 pessoas com diagnóstico de Diabetes Mellitus tipo 2 atendidas na Policlínica Piquet Carneiro da Universidade do Estado do Rio de Janeiro. A questão norteadora da entrevista foi: fale a respeito da sua vida que tenha relação com a assistência a saúde que você recebeu desde o momento em que recebeu o diagnóstico de Diabetes Mellitus tipo 2. As entrevistas foram realizadas individualmente, no consultório do Centro de Tratamento em Diabetes, gravadas em um aparelho de MP4 e armazenadas em CD-ROM. Em seguida foram transcritas na íntegra. Após a organização dos dados o processo analítico empregado foi a análise temática, emergindo três categorias: descoberta e convívio com o diabetes mellitus; vulnerabilidades em saúde das pessoas com Diabetes Mellitus tipo 2; e enfrentamento da doença e promoção da saúde. Evidenciou-se que o momento do diagnóstico foi muito difícil, assustador, gerando medo, tristeza e às vezes depressão.O conviver com a doença está relacionado com a determinação de limites que variam entre a rejeição e a aceitação. A alimentação adequada é considerada o principal desafio enfrentado pelas pessoas. Os modos de viver das pessoas e o entendimento que elas têm do processo saúde-adoecimento são cruciais para o sucesso, acompanhamento e tratamento da enfermidade. A promoção à saúde é extremamente necessária para população, focando na autonomia e na singularidade dos indivíduos. Para a enfermagem, este estudo permitiu apontar diferentes formas de cuidado de pessoas com Diabetes Mellitus tipo 2, para que as pessoas possam vencer os impactos causados pelas vulnerabilidades e viver melhor dentro de suas possibilidades e limites.

At different stages of life, humans are exposed to vulnerabilities, each of which is expressed differently depending on the age group they are in, the contexts in which they live, and may have implications for all orders for life of people. In this sense the main question is: what are the ways of life of the person living with type 2 mellitus diabetes that can make it vulnerable? What are the coping strategies adopted by the vulnerabilities of people living with type 2 mellitus diabetes? Thus, the aim of this study is: understanding the health vulnerabilities they are exposed to individuals with type 2 diabetes revealed by the life narrative. The specific objectives are: identify the ways of life of people with type 2 mellitus diabetes related to vulnerability; analyze the ways of protection of individuals in addressing the vulnerabilities. The research methodology was qualitative, descriptive approach, guided by Narrative Method of Life. The research was conducted at the Piquet CarneiroPolyclinic, a unit of Rio de Janeiro State University (PPC / UERJ), from March to July 2015. Study participants were 20 people diagnosed with type 2 mellitus diabetes, met at the Rio de Janeiro State University'sPiquet CarneiroPolyclinic. The main question of the interview was: talk about your life that is related to the health care you received from the moment that she was diagnosed with diabetes mellitus type 2. The interviews were conducted individually, in the Treatment Center Diabetesoffice, recorded on a MP4 player and stored on CD-ROM, then fully transcribed. After the organization of the employee, data analytic process was to thematic analysis three categories emerged: discover and live with mellitus diabetes; vulnerabilities in health of people with type 2 mellitus diabetes; confronting the disease and promoting health. It became clear that the time of diagnosis was very difficult and scary, generating fear, sadness and sometimes depression. Living with the disease is related to the determination of limits ranging between rejection and acceptance. Proper nutrition is considered the main challenge faced by the people. The ways of life of the people and the comprehension they have about thehealth-illness processare crucial factors for success, monitoring and treatment of the disease. Promoting health is sorely needed for population, focusing on autonomy, uniqueness of individuals. For nursing, this study indicates different forms of care of people with type 2 Diabetes, in which people can overcome the impacts caused by vulnerabilities and live better within their possibilities and limits.

Inflammatory unbalance of TLR3 and TLR4 in PCI patients with or without type 2 diabetes mellitus.

BACKGROUND: Toll-like receptors, the most characterized innate immune receptors, have recently been demonstrated to play an important role in coronary atherosclerotic disease and diabetes mellitus (DM). TLR3 and TLR4 are known to act as anti-inflammatory and pro-inflammatory factors respectively in multi-factorial inflammatory disease states. However, there is less research about TLR3 and TLR4 expression in percutaneous transluminal coronary intervention (PCI) patients, particularly those with type 2 diabetes mellitus (DM2). METHODS: We examined TLR3 and TLR4 expression and their downstream signaling pathway in PCI patients with (n=31) or without (n=32) DM2 compared with controls (n=35). RESULTS: TLR3 and downstream anti-inflammatory factors (IRF-3, INF-ß and IL-10) were significantly down-regulated in PCI patients with or without DM2 compared with controls, as determined by the quantification of both mRNA and protein. In contrast, TLR4 and downstream proinflammatory factors (MyD88 and TNF-α) were up-regulated in PCI patients with or without DM2 compared with controls. CONCLUSIONS: Patients undergoing PCI were shown to have a TLR-dependent pro-inflammatory state, mediated by a downregulation of TLR3 pathway, and upregulation of TLR4. This occurred in both with or without type 2 diabetes mellitus compared with controls in this research. The inflammatory imbalance observed in PCI patients was exacerbated in patients with DM2, consistent with a likely contribution of DM2 to the inflammatory state of coronary atherosclerotic disease, via impact on the innate immune response. This data supports the potential of TLRs as a novel therapeutic target in diabetics with coronary atherosclerotic disease.