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2.
Oral Health Prev Dent ; 19(1): 121-128, 2021 Jan 07.
Artículo en Inglés | MEDLINE | ID: mdl-33600089

RESUMEN

PURPOSE: To evaluate the effect of a full-mouth disinfection protocol (FMD) on periodontal parameters, glycaemic control and subgingival microbiota of periodontal patients with type 1 and type 2 diabetes, as well as those without diabetes. MATERIALS AND METHODS: This study included 33 patients with periodontitis. Eleven of them were type 1 diabetes patients, 11 were type 2 diabetes patients, and 11 were non-diabetics. At baseline and 3 months after the FMD, the periodontal parameters of each patient were recorded, samples of capillary blood for the chairside assessment of HbA1c were taken, and plaque samples from the two deepest periodontal pockets were collected to test for the presence of Aggregatibacter actinomycetemcomitans (Aa), Porphyromonas gingivalis (Pg), Prevotella intermedia (Pi), Tannerella forsythia (Tf) and Treponema denticola (Td). RESULTS: Bleeding on probing (BOP), probing pocket depth (PPD), clinical attachment level (CAL) and glycated haemoglobin (HbA1c) decreased statistically significantly (p < 0.05) in all three groups 3 months after FMD. Only the proportion of Pg in the control group decreased statistically significantly (p < 0.05), while the proportion of other bacteria decreased or remained the same, whereby the differences were not statistically significant. Moreover, the proportion of Aa in type 1 diabetics increased statistically significantly (p < 0.05). CONCLUSION: The FMD protocol improves periodontal parameters and glycaemic control of type 1 and type 2 diabetes patients with periodontitis.


Asunto(s)
Diabetes Mellitus Tipo 2 , Microbiota , Diabetes Mellitus Tipo 2/terapia , Desinfección , Humanos , Porphyromonas gingivalis , Prevotella intermedia , Treponema denticola
3.
Medicine (Baltimore) ; 100(3): e23963, 2021 Jan 22.
Artículo en Inglés | MEDLINE | ID: mdl-33545979

RESUMEN

INTRODUCTION: Exercise has been believed to have positive effects on blood glucose control in patients with type 2 diabetes mellitus. However, few medical evidences have been found to ascertain which type of exercise has the best effect on blood glucose control in diabetes and which type of exercise is more acceptable. The purpose of this study is to compare the effects and acceptability of different exercise modes on glycemic control in type 2 diabetes patients by using systematic review and network meta-analysis. METHODS AND ANALYSIS: Relevant randomized controlled trial studies will be searched from PubMed, EMbase, CochraneCENTRAL, CNKI, VIP, and Chinese medical paper libraries. Primary outcome indicators: glycosylated hemoglobin and dropout rate of the research (number of dropouts/numbers of initially enrolled subjects). Secondary outcome measures: fasting blood glucose, body weight, total cholesterol (TC), low-density lipoprotein cholesterol (LDL), high-density lipoprotein cholesterol, triglycerides (TG), diastolic pressure, systolic pressure (SBP). Two reviewers are arranged to screen Title, Abstract, and then review full text to further extract data. Standard meta-analysis and network meta-analysis of the data are performed afterward. Methodological quality assessment is planned to be conducted using Cochrane risk of bias tool. The outcome will be analyzed statistically according to Bayesian analysis methods. After that, subgroup analysis is conducted on the duration of intervention, whether there is supervision of intervention, frequency of intervention per week, age, gender, and medication use. TRIAL REGISTRATION NUMBER: PROSPERO CRD42020175181. DISCUSSION: The systematic review and network meta-analysis include evidence of the impact of different exercise modes on blood glucose control in type 2 diabetes mellitus. There are 2 innovative points in this study. One is to conduct a classified study on exercise in as much detail as possible, and the other is to study the acceptability of different exercise modes. The network meta-analysis will reduce the uncertainty of intervention and enable clinicians, sports practitioners, and patients to choose more effective and suitable exercise methods. ETHICS AND DISSEMINATION: The findings of the study will be disseminated through publications in peer-reviewed journals and scientific conferences and symposia. Further, no ethical approval is required in this study.


Asunto(s)
Protocolos Clínicos , Diabetes Mellitus Tipo 2/terapia , Terapia por Ejercicio/métodos , /métodos , Diabetes Mellitus Tipo 2/fisiopatología , Terapia por Ejercicio/normas , Humanos , Metaanálisis como Asunto , Revisiones Sistemáticas como Asunto
4.
Medicine (Baltimore) ; 100(4): e24444, 2021 Jan 29.
Artículo en Inglés | MEDLINE | ID: mdl-33530250

RESUMEN

BACKGROUND: This study aimed to access the efficacy and safety of integrated Traditional Chinese and Western medicine treatment for patients with ulcerative colitis (UC) combined diabetes. METHODS: This protocol adheres to the preferred reporting items for systematic reviews and meta-analysis protocol statement. We plan to search 8 electronic databases to identify qualifying studies published from database inception until December 1, 2020. The software of EndNote reference manager (X9) will be used to study selection. A pre-developed standardized data collection form will be used to extract from all eligible studies. For included studies, the quality will be assessed by Cochrane Risk of bias tool. The RevMan 5.3 software (Copenhagen: The Nordic Cochrane Centre, The Cochrane Collaboration, 2014) developed by the Cochrane Collaboration will be used for all statistical analysis. If possible, meta-analysis will be undertaken for each of the outcomes. For continuous variable data, we will used mean differences with 95% confidence intervals (CIs) as summary statistics. For dichotomous variable data, we will calculate Mantel-Haenszel odds ratio with 95% CIs as summary statistics from the numbers of events in control and intervention groups. We will consider a result to be statistically significant if P < .05. If outcomes cannot be meta-analyzed, we will performer a descriptive analysis. RESULTS: This study will be performed to test the efficacy and safety of integrated Traditional Chinese and Western medicine treatment for patients with UC combined diabetes. CONCLUSION: The results of our study will be published in a peer-reviewed journals, and we will promotion results in domestic and foreign conferences. REGISTRATION NUMBER: INPLASY2020120087. ETHICS AND DISSEMINATION: As a systematic review and meta-analysis which based on previously published literature, ethical approval, and informed consent from patients are not required.


Asunto(s)
Colitis Ulcerosa/terapia , Prestación Integrada de Atención de Salud/métodos , Diabetes Mellitus Tipo 1/terapia , Diabetes Mellitus Tipo 2/terapia , Medicina China Tradicional/métodos , Adolescente , Adulto , Anciano , Colitis Ulcerosa/complicaciones , Terapia Combinada , Diabetes Mellitus Tipo 1/complicaciones , Diabetes Mellitus Tipo 2/complicaciones , Femenino , Humanos , Masculino , Metaanálisis como Asunto , Persona de Mediana Edad , Ensayos Clínicos Controlados Aleatorios como Asunto , Proyectos de Investigación , Revisiones Sistemáticas como Asunto , Resultado del Tratamiento , Adulto Joven
5.
Endocr Pract ; 27(2): 158-164, 2021 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-33554873

RESUMEN

OBJECTIVE: To familiarize health care providers with diagnosis and treatment of binge-eating disorder (BED), a common comorbidity of type 2 diabetes (T2DM). METHODS: Literature review of binge eating and T2DM. Key words used in search include BED, T2DM, obesity, and treatment. RESULTS: The prevalence of BED in patients with T2DM appears to be much higher than the 2% to 3.5% prevalence seen in the general population. Studies suggest that up to 20% of patients with T2DM have an underlying eating disorder, the most common of which is binge eating. BED is probably underdiagnosed, even though there are multiple simple tools that providers can use to improve screening for the disorder. Though the relationship between BED and hemoglobin A1c control can vary, it appears that binge-eating behaviors can worsen metabolic markers, including glycemic control. Various medications used by patients with diabetes have been associated with new-onset BED, and treatment may be as simple as removing or replacing such agents. Several medications have been found to significantly reduce binge-eating frequency, and potentially, weight. Patients with BED generally benefit from psychotherapy, including cognitive behavioral therapy. CONCLUSION: BED, only recently added to the International Classification of Disease-10 diagnostic list, is very common in patients with obesity and T2DM. The diagnosis is important to establish, as treatment or referral for treatment, could potentially improve many of the comorbidities and metrics of T2DM.


Asunto(s)
Trastorno por Atracón , Terapia Cognitivo-Conductual , Diabetes Mellitus Tipo 2 , Trastorno por Atracón/diagnóstico , Trastorno por Atracón/epidemiología , Trastorno por Atracón/terapia , Comorbilidad , Diabetes Mellitus Tipo 2/complicaciones , Diabetes Mellitus Tipo 2/epidemiología , Diabetes Mellitus Tipo 2/terapia , Humanos , Obesidad/complicaciones , Obesidad/epidemiología
6.
N Z Med J ; 134(1529): 80-85, 2021 02 05.
Artículo en Inglés | MEDLINE | ID: mdl-33582710

RESUMEN

Diabetes is one of the most common chronic disorders in emerging adults (15-25 years of age), and the prevalence of both type 1 diabetes (T1D) and type 2 diabetes (T2D) in New Zealand continues to increase in this age group. Tight glycaemic control in both T1D and T2D is well known to reduce diabetic microvascular and macrovascular complications and improve survival. However, in New Zealand and worldwide, emerging adulthood is typically the period of worst glycaemic control in the lifespan due to the high prevalence of psychosocial stressors and increased insulin resistance of puberty and risk-taking behaviours. In addition, the glycaemic control of emerging adults with diabetes in New Zealand often deteriorates due to the loss of support from family and friends from moving regions, the failure of support from paediatric services to extend to emerging adulthood and the loss of public funding for insulin pump therapy as glycaemic targets are no longer met. Given the high prevalence of psychosocial stressors and the loss of support, the International Society for Paediatric and Adolescent Diabetes's (ISPAD's) guidelines recommend that emerging adults with diabetes receive ambulatory care from a dedicated multidisciplinary team consisting of 0.75 full time equivalent (FTE)/100 patients of an endocrinologist, 1-1.25 FTE/100 patients of a diabetes nurse specialist, 0.5 FTE/100 patients of a dietitian, 0.3 FTE/100 patients of a psychologist and 0.3 FTE/100 patients of a social worker or youth worker.


Asunto(s)
Servicios de Salud del Niño/estadística & datos numéricos , Diabetes Mellitus Tipo 1/terapia , Diabetes Mellitus Tipo 2/terapia , Endocrinólogos/provisión & distribución , Fuerza Laboral en Salud/estadística & datos numéricos , Adolescente , Adulto , Niño , Servicios de Salud del Niño/organización & administración , Diabetes Mellitus Tipo 1/epidemiología , Diabetes Mellitus Tipo 2/epidemiología , Manejo de la Enfermedad , Femenino , Encuestas de Atención de la Salud , Humanos , Masculino , Nueva Zelanda/epidemiología , Grupo de Atención al Paciente/estadística & datos numéricos , Adulto Joven
7.
Medicine (Baltimore) ; 100(1): e24208, 2021 Jan 08.
Artículo en Inglés | MEDLINE | ID: mdl-33429812

RESUMEN

OBJECTIVE: To explore the influence of the education of lifestyle in the type 2 diabetes mellitus (T2DM) patients with microalbuminuria as a part of the enhanced multifactorial intervention. METHODS: This study will be conducted from May 2021 to August 2022 at Ningbo No.6 hospital. The experiment was granted through the Research Ethics Committee of Ningbo No.6 hospital (539D035). The patients will be included if they are between 18 and 65 years old and are diagnosed with T2DM with microalbuminuria and the patients who have signed the written informed consent. While the patients will be excluded if they have serious physical comorbidities and patients who are unwilling to offer the informed consent to take part in this experiment. We measure the clinical examination (fasting blood-glucose, glycosylated hemoglobin and routine urine test) timely. Detail of daily dietary intake and lifestyle factors are also recorded. RESULTS: Table 1 reflects the comparison of the biochemical and clinical variables and the lifestyle factors. CONCLUSION: Lifestyle education is effective in facilitating the control of T2DM and reducing microalbuminuria. TRIAL REGISTRATION NUMBER: researchregistry6348.


Asunto(s)
Diabetes Mellitus Tipo 2/terapia , Educación del Paciente como Asunto , Asunción de Riesgos , Albuminuria/complicaciones , Diabetes Mellitus Tipo 2/complicaciones , Humanos
8.
Lancet Diabetes Endocrinol ; 9(3): 174-188, 2021 03.
Artículo en Inglés | MEDLINE | ID: mdl-33515493

RESUMEN

Hyperglycaemia in people with and without diabetes admitted to the hospital is associated with a substantial increase in morbidity, mortality, and health-care costs. Professional societies have recommended insulin therapy as the cornerstone of inpatient pharmacological management. Intravenous insulin therapy is the treatment of choice in the critical care setting. In non-intensive care settings, several insulin protocols have been proposed to manage patients with hyperglycaemia; however, meta-analyses comparing different treatment regimens have not clearly endorsed the benefits of any particular strategy. Clinical guidelines recommend stopping oral antidiabetes drugs during hospitalisation; however, in some countries continuation of oral antidiabetes drugs is commonplace in some patients with type 2 diabetes admitted to hospital, and findings from clinical trials have suggested that non-insulin drugs, alone or in combination with basal insulin, can be used to achieve appropriate glycaemic control in selected populations. Advances in diabetes technology are revolutionising day-to-day diabetes care and work is ongoing to implement these technologies (ie, continuous glucose monitoring, automated insulin delivery) for inpatient care. Additionally, transformations in care have occurred during the COVID-19 pandemic, including the use of remote inpatient diabetes management-research is needed to assess the effects of such adaptations.


Asunto(s)
/terapia , Diabetes Mellitus Tipo 1/terapia , Diabetes Mellitus Tipo 2/terapia , Manejo de la Enfermedad , Hospitalización/tendencias , Hiperglucemia/terapia , Glucemia/efectos de los fármacos , Glucemia/metabolismo , /epidemiología , Diabetes Mellitus Tipo 1/sangre , Diabetes Mellitus Tipo 1/epidemiología , Diabetes Mellitus Tipo 2/sangre , Diabetes Mellitus Tipo 2/epidemiología , Humanos , Hiperglucemia/sangre , Hiperglucemia/epidemiología , Hipoglucemiantes/administración & dosificación , Insulina/administración & dosificación
9.
Rech Soins Infirm ; (143): 19-34, 2021 Jan 13.
Artículo en Francés | MEDLINE | ID: mdl-33485281

RESUMEN

Introduction : People living with type 2 diabetes are brought to make demanding behavioral changes that can lead to self-management difficulties.Background : The guidelines recommend that healthcare professionals follow a person-centered approach (PCA) when caring. However, this approach seems difficult to adopt in practice.Objective : Coconstruct an intervention inspired by the concept map (CM) to promote the adoption of PCA by nurses during self-management support encounters.Method : This study is based on a model for developing evidence-based nursing interventions. Five experts (2 patients, 2 nurses, 1 educational specialist) collaborated in the coconstruction of the intervention.Results : The Person-Centered Approach Diabetes Self-Management Support (PCA-DSMS) intervention has been developed in accordance with the foundations of a PCA and the CM. It includes four steps : 1) Introduce the intervention ; 2) Develop the Needs Map ; 3) Intervene according to priority needs ; 4) Conclude and plan a follow-up.Discussion : More studies are needed to explore whether the intervention is acceptable and feasible as well as its ability to lead nurses to adopt PCA.Conclusion : The PCA-DSMS could bring nurses to adopt a PCA.


Asunto(s)
Diabetes Mellitus Tipo 2 , Atención Dirigida al Paciente , Automanejo , Diabetes Mellitus Tipo 2/terapia , Humanos , Atención Dirigida al Paciente/organización & administración
10.
Nat Commun ; 12(1): 650, 2021 01 28.
Artículo en Inglés | MEDLINE | ID: mdl-33510172

RESUMEN

Hepatic inflammation is the driving force for the development and progression of NASH. Treatment targeting inflammation is believed to be beneficial. In this study, adoptive transfer of CD4+ T cells converted double negative T cells (cDNT) protects mice from diet-induced liver fat accumulation, lobular inflammation and focal necrosis. cDNT selectively suppress liver-infiltrating Th17 cells and proinflammatory M1 macrophages. IL-10 secreted by M2 macrophages decreases the survival and function of cDNT to protect M2 macrophages from cDNT-mediated lysis. NKG2A, a cell inhibitory molecule, contributes to IL-10 induced apoptosis and dampened suppressive function of cDNT. In conclusion, ex vivo-generated cDNT exert potent protection in diet induced obesity, type 2 diabetes and NASH. The improvement of outcome is due to the inhibition on liver inflammatory cells. This study supports the concept and the feasibility of potentially utilizing this autologous immune cell-based therapy for the treatment of NASH.


Asunto(s)
Linfocitos T CD4-Positivos/metabolismo , Inflamación/metabolismo , Hígado/metabolismo , Macrófagos/metabolismo , Enfermedad del Hígado Graso no Alcohólico/metabolismo , Traslado Adoptivo/métodos , Animales , Linfocitos T CD4-Positivos/inmunología , Diabetes Mellitus Tipo 2/etiología , Diabetes Mellitus Tipo 2/metabolismo , Diabetes Mellitus Tipo 2/terapia , Dieta Alta en Grasa/efectos adversos , Progresión de la Enfermedad , Perfilación de la Expresión Génica/métodos , Inflamación/genética , Interleucina-10/metabolismo , Hígado/patología , Macrófagos/clasificación , Macrófagos/inmunología , Masculino , Ratones Endogámicos C57BL , Subfamília C de Receptores Similares a Lectina de Células NK/metabolismo , Enfermedad del Hígado Graso no Alcohólico/patología , Enfermedad del Hígado Graso no Alcohólico/terapia , Obesidad/etiología , Obesidad/metabolismo , Obesidad/terapia
12.
Medicine (Baltimore) ; 99(50): e23625, 2020 Dec 11.
Artículo en Inglés | MEDLINE | ID: mdl-33327339

RESUMEN

OBJECTIVE: To assess the effect of the program of individualized diabetes education on type 2 diabetes mellitus (DM) patients. METHODS: This is a single-center randomized controlled trial that will be implemented from December 2020 to April 2021. The experiment was granted through the Research Ethics Committee of People's Hospital of Chengyang District (03982765). Patients are randomly assigned to the study group and control group with 50 cases in each group. Patients who meet the following criteria will be included in our study: patients diagnosed with type 2 DM based on the World Health Organization diagnostic criteria in 1999; patients who can take part in the follow-up researches after discharge; patients who can provide the written informed consent. And the exclusion criteria include: the known mental or psychological disorders, for instance, severe anxiety disorders or depression; severe comorbidities, e.g. liver dysfunction, kidney failure, stroke, and cancer; Uncontrolled diabetes complications, for instance, infection, acidosis, as well as peripheral vascular disease. The clinical examination shall be conducted during each follow-up period, and the laboratory examination is implemented as necessary in the process of each hospital visit. At the end of the 6-month study, each patient's blood pressure, waist circumference, body mass index, blood lipids, as well as fasting blood glucose are evaluated. RESULTS: Table 1 reveals the comparison of biochemical results and clinical results between the control group and the study group. CONCLUSION: Individualized diabetes education may improve the clinical outcomes in patients with type 2 DM. TRIAL REGISTRATION: The protocol was registered in Research Registry (researchregistry6232).


Asunto(s)
Diabetes Mellitus Tipo 2/terapia , Educación del Paciente como Asunto , Autocuidado , Humanos
13.
Diving Hyperb Med ; 50(4): 386-390, 2020 Dec 20.
Artículo en Inglés | MEDLINE | ID: mdl-33325020

RESUMEN

INTRODUCTION: We have previously shown that hyperbaric oxygen treatment (HBOT) increased insulin sensitivity in men who were obese or overweight, both with and without type 2 diabetes. The aim of this study was to test whether this insulin-sensitising effect is seen in hyperbaric air (HA). METHODS: Men with type 2 diabetes who were obese or overweight were randomised to two groups: HBOT (n = 13) or HA (n = 11). A hyperinsulinaemic euglycaemic glucose clamp (80 mU·m-2·min-1) was performed at baseline and during hyperbaric intervention. Both groups were compressed to 203 kPa (two atmospheres absolute) for 90 minutes followed by a linear 30-minute decompression. The HBOT group breathed oxygen via a hood while the HA group breathed chamber air. Insulin sensitivity was assessed from the glucose infusion rate (GIR) during the last 30 minutes in the hyperbaric chamber (SS1) and the first 30 minutes after exit (SS2). Data were analysed for within-group effect by paired student t-test and between-group effect by one-way ANOVA. RESULTS: HBOT increased GIR by a mean 26% at SS1 (P = 0.04) and 23% at SS2 (P = 0.018). There was no significant change in GIR during or after HA. A between-group effect was evident for the change in GIR at SS1 in HBOT vs HA (P = 0.036). CONCLUSIONS: The pathway by which insulin sensitivity is increased in men with type 2 diabetes requires the high oxygen partial pressures of HBOT and should be further investigated. Insulin sensitivity was not changed in hyperbaric air.


Asunto(s)
Diabetes Mellitus Tipo 2 , Oxigenación Hiperbárica , Resistencia a la Insulina , Diabetes Mellitus Tipo 2/terapia , Humanos , Insulina , Masculino , Oxígeno
14.
PLoS One ; 15(12): e0243989, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-33332396

RESUMEN

Currently, qigong and tai chi exercises are the two most common preventive as well as therapeutic interventions for chronic metabolic diseases such as type 2 diabetes mellitus (T2DM). However, the quantitative evaluation of these interventions is limited. This study aimed to evaluate the therapeutic efficacy of qigong and tai chi intervention in middle-aged and older adults with T2DM. The study included 103 eligible participants, who were randomized to participate for 12 weeks, in one of the following intervention groups for the treatment of T2DM: fitness qigong, tai chi, and control group. Three biochemical measures, including fasting plasma glucose (FPG), glycated hemoglobin (HbA1C), and C-peptide (C-P) levels, assessed at baseline and 12 weeks, served as the primary outcome measures. During the training process, 16 of the 103 participants dropped out. After the 12-week intervention, there were significant influences on HbA1C (F2,83 = 4.88, p = 0.010) and C-P levels (F2,83 = 3.64, p = 0.031). Moreover, significant reduction in C-P levels was observed after 12-week tai chi practice (p = 0.004). Furthermore, there was a significant negative correlation between the duration of T2DM and the relative changes in FPG levels after qigong intervention, and the relative changes in HbA1C levels were positively correlated with waist-to-height ratio after tai chi practice. Our study suggests that targeted qigong exercise might have a better interventional effect on patients with a longer duration of T2DM, while tai chi might be risky for people with central obesity. Trial registration: This trial was registered in Chinese Clinical Trial Registry. The registration number is ChiCTR180020069. The public title is "Health-care qigong · study for the prescription of chronic diabetes intervention."


Asunto(s)
Diabetes Mellitus Tipo 2/terapia , Qigong/métodos , Tai Ji/métodos , Anciano , Glucemia/análisis , Proteína C-Reactiva/análisis , Diabetes Mellitus Tipo 2/sangre , Femenino , Hemoglobina A Glucada/análisis , Humanos , Masculino , Persona de Mediana Edad , Qigong/efectos adversos , Tai Ji/efectos adversos
15.
Rev. enferm. UERJ ; 28: e52728, jan.-dez. 2020.
Artículo en Inglés, Portugués | LILACS, BDENF - Enfermería | ID: biblio-1146306

RESUMEN

Objetivo: avaliar as atividades de autocuidado em pacientes com Diabetes Mellitus tipo 2. Método: estudo transversal que incluiu 40 pacientes. Aplicou-se 2 instrumentos para coleta de dados: questionário sociodemográfico e questionário de atividades de autocuidado com o diabetes, aplicados entre janeiro e março de 2020. Resultados: a menor pontuação foi para o item "Realizar exercício físico específico (nadar, caminhar, etc)", com média 0,6 (DP=1,54) dias por semana, e a maior para o item "Tomar medicamentos conforme recomendados (insulina ou comprimidos)" com média 5,1 (DP=2,74) dias por semana. Quanto ao tabagismo, 92,5% referiram não ter fumado cigarro nos últimos sete dias. Conclusão: as atividades de autocuidado prevalentes relacionaram-se as intervenções farmacológicas, enquanto os cuidados não farmacológicos, incluindo a alimentação e realização de exercícios físicos, foram menos frequentes.


Objective: to evaluate self-care activities in patients with type-2 Diabetes Mellitus. Method: this cross-sectional study included 40 patients. Two instruments ­ a sociodemographic questionnaire and a questionnaire on diabetes self-care activities ­ were applied between January and March 2020. Results: the item "Perform specific physical exercise (swimming, walking, etc.)" scored lowest, averaging 0.6 (SD = 1.54) days a week, and "Taking medications as recommended (insulin or pills)" scored highest, with mean 5.1 (SD = 2.74) days a week. 92.5% reported not having smoked cigarettes in the prior seven days. Conclusion: selfcare activities relating to pharmacological interventions predominated, while non-pharmacological care, including food and physical exercise, was less frequent.


Objetivo: evaluar las actividades de autocuidado en pacientes con Diabetes Mellitus tipo 2. Método: este estudio transversal incluyó a 40 pacientes. Se aplicaron dos instrumentos, un cuestionario sociodemográfico y un cuestionario sobre actividades de autocuidado de la diabetes, entre enero y marzo de 2020. Resultados: el ítem "Realizar ejercicio físico específico (nadar, caminar, etc.)" obtuvo la puntuación más baja, con una media de 0,6 (DE = 1,54) días a la semana, y "Tomar los medicamentos según lo recomendado (insulina o píldoras)" obtuvo la puntuación más alta, con una media de 5,1 (DE = 2,74) días a la semana. El 92,5% informó no haber fumado cigarrillos en los siete días anteriores. Conclusión: predominaron las actividades de autocuidado relacionadas con las intervenciones farmacológicas, mientras que la atención no farmacológica, incluida la alimentación y el ejercicio físico, fue menos frecuente.


Asunto(s)
Humanos , Masculino , Femenino , Adulto , Persona de Mediana Edad , Anciano , Anciano de 80 o más Años , Adulto Joven , Autocuidado , Diabetes Mellitus Tipo 2/terapia , Brasil , Estudios Transversales , Recolección de Datos , Encuestas y Cuestionarios , Estrategia de Salud Familiar , Diabetes Mellitus Tipo 2/prevención & control
16.
Front Immunol ; 11: 576818, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-33335527

RESUMEN

COVID-19 is a disease caused by the coronavirus SARS-CoV-2 (Severe Acute Respiratory Syndrome Coronavirus-2), known as a highly contagious disease, currently affecting more than 200 countries worldwide. The main feature of SARS-CoV-2 that distinguishes it from other viruses is the speed of transmission combined with higher risk of mortality from acute respiratory distress syndrome (ARDS). People with diabetes mellitus (DM), severe obesity, cardiovascular disease, and hypertension are more likely to get infected and are at a higher risk of mortality from COVID-19. Among elderly patients who are at higher risk of death from COVID-19, 26.8% have DM. Although the reasons for this increased risk are yet to be determined, several factors may contribute to type-2 DM patients' increased susceptibility to infections. A possible factor that may play a role in increasing the risk in people affected by diabetes and/or obesity is the impaired innate and adaptive immune response, characterized by a state of chronic and low-grade inflammation that can lead to abrupt systemic metabolic alteration. SARS patients previously diagnosed with diabetes or hyperglycemia had higher mortality and morbidity rates when compared with patients who were under metabolic control. Similarly, obese individuals are at higher risk of developing complications from SARS-CoV-2. In this review, we will explore the current and evolving insights pertinent to the metabolic impact of coronavirus infections with special attention to the main pathways and mechanisms that are linked to the pathophysiology and treatment of diabetes.


Asunto(s)
Inmunidad Adaptativa , Complicaciones de la Diabetes , Inmunidad Innata , Obesidad , Factores de Edad , /inmunología , /terapia , Complicaciones de la Diabetes/inmunología , Complicaciones de la Diabetes/mortalidad , Complicaciones de la Diabetes/terapia , Diabetes Mellitus Tipo 2/inmunología , Diabetes Mellitus Tipo 2/mortalidad , Diabetes Mellitus Tipo 2/terapia , Humanos , Obesidad/inmunología , Obesidad/mortalidad , Obesidad/terapia , /inmunología , /terapia
17.
JAMA Netw Open ; 3(12): e2030207, 2020 12 01.
Artículo en Inglés | MEDLINE | ID: mdl-33355674

RESUMEN

Importance: Prepregnancy diabetes is associated with higher perinatal and maternal morbidity, especially if periconception glycemic control is suboptimal. It is not known whether improved glycemic control from preconception to early pregnancy and midpregnancy periods can reduce the risk of adverse perinatal and maternal outcomes. Objective: To determine whether a net decline in glycated hemoglobin A1c (HbA1c) from preconception to the first half of pregnancy is associated with a lower risk of adverse outcomes for mother and child. Design, Setting, and Participants: This population-based cohort study was completed in all of Ontario, Canada, from 2007 to 2018. Included were births among women with prepregnancy diabetes whose HbA1c was measured within 90 days preconception and again from conception through 21 weeks completed gestation (early pregnancy to midpregnancy). Statistical analysis was performed from July to September 2020. Exposures: Net decrease in HbA1c from preconception to early pregnancy and midpregnancy. Main Outcomes and Measures: The main outcome was a congenital anomaly from birth to age 1 year. Other outcomes included preterm birth or perinatal mortality among offspring as well as severe maternal morbidity (SMM) or death among mothers. Adjusted relative risks (aRRs) were calculated per 0.5% absolute net decline in HbA1c from preconception up to early pregnancy and midpregnancy, adjusting for maternal age at conception, preconception HbA1c and hemoglobin concentration, and gestational age at HbA1c measurement. Results: A total of 3459 births were included, with a mean (SD) maternal age of 32.6 (5.0) years at conception. Overall, the mean (SD) HbA1c decreased from 7.2% (1.6%) preconception to 6.4% (1.1%) in early pregnancy to midpregnancy. There were 497 pregnancies (14.4%) with a congenital anomaly, with an aRR of 0.94 (95% CI, 0.89-0.98) per 0.5% net decrease in HbA1c, including for cardiac anomalies (237 infants; aRR, 0.89; 95% CI, 0.84-0.95). The risk was also reduced for preterm birth (847 events; aRR, 0.89; 95% CI, 0.86-0.91). SMM or death occurred among 191 women (5.5%), with an aRR of 0.90 (95% CI, 0.84-0.96) per 0.5% net decrease in HbA1c. Conclusions and Relevance: These findings suggest that women with prepregnancy diabetes who achieve a reduction in HbA1c may have improved perinatal and maternal outcomes. Further study is recommended to determine the best combination of factors, such as lifestyle changes and/or glucose-lowering medications, that can influence periconception HbA1c reduction.


Asunto(s)
Diabetes Mellitus Tipo 2 , Hemoglobina A Glucada/análisis , Atención Preconceptiva/métodos , Complicaciones del Embarazo , Ajuste de Riesgo/métodos , Adulto , Anomalías Congénitas/epidemiología , Anomalías Congénitas/prevención & control , Diabetes Mellitus Tipo 2/sangre , Diabetes Mellitus Tipo 2/complicaciones , Diabetes Mellitus Tipo 2/diagnóstico , Diabetes Mellitus Tipo 2/terapia , Femenino , Edad Gestacional , Humanos , Recién Nacido , Ontario/epidemiología , Embarazo , Complicaciones del Embarazo/sangre , Complicaciones del Embarazo/diagnóstico , Complicaciones del Embarazo/prevención & control , Resultado del Embarazo/epidemiología , Nacimiento Prematuro/epidemiología , Nacimiento Prematuro/prevención & control
18.
Medicine (Baltimore) ; 99(46): e23039, 2020 Nov 13.
Artículo en Inglés | MEDLINE | ID: mdl-33181668

RESUMEN

BACKGROUND: With the rapid development of modern society, people's dietary structure has been changing accordingly. Diets high in salt, fat, and sugar have led to an increase in the incidence of diabetes year by year, posing a great threat to human health. More than 90% of diabetic patients have type 2 diabetes mellitus (T2DM). It is currently believed that the onset of T2DM is mainly related to factors such as genetics, insulin resistance, impaired insulin cell function, and obesity. The main mechanisms are as follows:The dominant flora of normal intestinal tract is mainly anaerobic bacteria which are beneficial to the human body. Under certain conditions, when intestinal flora is maladjusted, harmful bacteria and opportunistic bacteria become the dominant intestinal bacteria, resulting in metabolic disorders. Ingestion of probiotics can correct the imbalance of intestinal flora, and then, have a therapeutic effect on T2DM. Therefore, we designed this study to evaluate the effects of probiotics on blood glucose control and intestinal dominant flora in patients with T2DM. METHODS: The retrieval period of meta-analysis literature is set from January 1, 1990 to September 2020. We will mainly search five English electronic databases, including Cochrane Library, Pubmed, Excerpt Medical Database (EMBASE), Science Direct and Web of Science, and search the following four Chinese databases: China Biomedical Literature Database (CBM), China National Knowledge Infrastructure (CNKI), China Science Journal Database (VIP), Wanfang Database, and so on. At the same time, the two reviewers will independently conduct research selection, data extraction and deviation risk assessment, and use Review Manager 5.3 software provided by the Cochrane Collaboration for meta-analysis and heterogeneity assessment. RESULTS: This study will demonstrate an evidence-based review of probiotics on glycemic control and intestinal dominant flora in patients with type 2 diabetes mellitus. CONCLUSION: This study can be used to evaluate the efficacy and safety of probiotics on glycemic control and intestinal dominant flora in patients with T2DM. REGISTRATION NUMBER:: is INPLASY202090104.


Asunto(s)
Glucemia/metabolismo , Diabetes Mellitus Tipo 2/terapia , Microbioma Gastrointestinal , Probióticos/uso terapéutico , Diabetes Mellitus Tipo 2/sangre , Diabetes Mellitus Tipo 2/microbiología , Humanos , Metaanálisis como Asunto , Proyectos de Investigación , Revisiones Sistemáticas como Asunto , Resultado del Tratamiento
19.
Curr Diab Rep ; 20(11): 67, 2020 11 05.
Artículo en Inglés | MEDLINE | ID: mdl-33150501

RESUMEN

PURPOSE OF REVIEW: Even with insurance coverage increasing over time among the population with diabetes, a large proportion continues to have poorly controlled disease. The purpose of this narrative literature review is to describe the social determinants of poor management of type 2 diabetes among the insured population and illustrate drivers of poor outcomes beyond insurance coverage. RECENT FINDINGS: Despite the provision of health insurance, social determinants play a significant role in shaping diabetes outcomes, especially for economic instability (employment, out-of-pocket expenses associated with diabetes management), food insecurity, education and literacy, access to quality health care (health systems designed to effectively manage chronic disease), neighborhood and the built environment (segregated neighborhoods, socioeconomic conditions of communities, housing), and social and community context (discrimination, social support). Multiple social determinants shape poor diabetes outcomes among the insured. These determinants are now being further exacerbated by the COVID-19 pandemic, which has created the worst economic crisis for US families since the Great Depression. The evidence of this review points to the imperative need for more multilevel intervention approaches to address these determinants in the management of diabetes.


Asunto(s)
Infecciones por Coronavirus , Diabetes Mellitus Tipo 2 , Pandemias , Neumonía Viral , Betacoronavirus , Diabetes Mellitus Tipo 2/epidemiología , Diabetes Mellitus Tipo 2/terapia , Humanos , Determinantes Sociales de la Salud
20.
JAMA ; 324(17): 1737-1746, 2020 11 03.
Artículo en Inglés | MEDLINE | ID: mdl-33141209

RESUMEN

Importance: Online programs may help with weight loss but have not been widely implemented in routine primary care. Objective: To compare the effectiveness of a combined intervention, including an online weight management program plus population health management, with the online program only and with usual care. Design, Setting, and Participants: Cluster randomized trial with enrollment from July 19, 2016, through August 10, 2017, at 15 primary care practices in the US. Eligible participants had a scheduled primary care visit and were aged 20 to 70 years, had a body mass index between 27 and less than 40, and had a diagnosis of hypertension or type 2 diabetes. Follow-up ended on May 8, 2019. Interventions: Participants in the usual care group (n = 326) were mailed general information about weight management. Participants in the online program only group (n = 216) and the combined intervention group (n = 298) were registered for the online program. The participants in the combined intervention group also received weight-related population health management, which included additional support from nonclinical staff who monitored their progress in the online program and conducted periodic outreach. Main Outcomes and Measures: The primary outcome was weight change at 12 months based on measured weights recorded in the electronic health record. Weight change at 18 months was a secondary outcome. Results: Among the 840 participants who enrolled (mean age, 59.3 years [SD, 8.6 years]; 60% female; 76.8% White), 732 (87.1%) had a recorded weight at 12 months and the missing weights for the remaining participants were imputed. There was a significant difference in weight change at 12 months by group with a mean weight change of -1.2 kg (95% CI, -2.1 to -0.3 kg) in the usual care group, -1.9 kg (95% CI, -2.6 to -1.1 kg) in the online program only group, and -3.1 kg (95% CI, -3.7 to -2.5 kg) in the combined intervention group (P < .001). The difference in weight change between the combined intervention group and the usual care group was -1.9 kg (97.5% CI, -2.9 to -0.9 kg; P < .001) and the difference between the combined intervention group and the online program only group was -1.2 kg (95% CI, -2.2 to -0.3 kg; P = .01). At 18 months, the mean weight change was -1.9 kg (95% CI, -2.8 to -1.0 kg) in the usual care group, -1.1 kg (95% CI, -2.0 to -0.3 kg) in the online program only group, and -2.8 kg (95% CI, -3.5 to -2.0 kg) in the combined intervention group (P < .001). Conclusions and Relevance: Among primary care patients with overweight or obesity and hypertension or type 2 diabetes, combining population health management with an online program resulted in a small but statistically significant greater weight loss at 12 months compared with usual care or the online program only. Further research is needed to understand the generalizability, scalability, and durability of these findings. Trial Registration: ClinicalTrials.gov Identifier: NCT02656693.


Asunto(s)
Intervención basada en la Internet , Obesidad/terapia , Pérdida de Peso , Programas de Reducción de Peso/métodos , Adulto , Anciano , Índice de Masa Corporal , Terapia Combinada/métodos , Diabetes Mellitus Tipo 2/terapia , Femenino , Humanos , Hipertensión/terapia , Masculino , Persona de Mediana Edad , Sobrepeso/terapia , Satisfacción del Paciente , Factores de Tiempo , Resultado del Tratamiento , Estados Unidos , Adulto Joven
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