Effect of the COVID-19 pandemic on glycemic control in Brazilian patients with type 2 diabetes.

PURPOSE: To investigate the effect of restrictive measures the COVID-19 pandemic imposed on glycemic control of patients with type 2 diabetes (T2D) and its associated factors. METHODS: Outpatients with T2D who had an appointment scheduled during the social distancing period were eligible for telemonitoring. Clinical and laboratorial data were collected from medical records in the last consultation before and from the first visit after the COVID-19 pandemic lockdown period. RESULTS: From the 1241 eligible patients, 816 (65.7%) could be contacted by phone, 137 (11%) attended the unit for consultation during the social distancing period, and 1040 (83.8%) returned up to 12 months after the end of the lockdown period. We observed a meaningful reduction of glycated hemoglobin (HbA1c) (7.9 [7-9] vs. 7.7 [6.9-8.8] p = 0.004) and no difference in body mass index (29.5 [26-33.7] vs. 29.6 [26.2-34.1], p = 0.17) before and after the social distancing period. According to insulin use at baseline, the HbA1c variation was +0.6 (-0.7 to +2) and -0.6 (-2.1 to +0.7) in patients without and with insulin, respectively (p < 0.001). In the multivariate model, insulin therapy was the only independent significant predictor of HbA1c reduction. CONCLUSION: This study observed an improvement in glycemic control after the lockdown. The only independent predictor found was previous insulin use. Probably, the longer time available to perform frequent blood glucose self-monitoring at home and adjustments in insulin therapy could explain our findings.

Early blood pressure level as a mark of familial aggregation of metabolic cardiovascular risk factors--the Rio de Janeiro Study.

OBJECTIVE: To investigate the familial aggregation of metabolic risk factors (RF) according to blood pressure (BP) percentile of children and adolescents. DESIGN AND METHODS: Normal BP was established in 3906 children and adolescents in 1987. From this population two groups of target individuals were separated: group A (n = 327) with systolic and/or diastolic BP percentile > 95 and group B (n = 327) with systolic and diastolic BP percentile < or = 50. Ten years later, familial aggregation of metabolic RF was evaluated using clinical and laboratorial data from 785 individuals, divided into two groups: group 1 with 135 target individuals (BP percentile > 95), 181 parents, 100 siblings and 16 grandparents; and group 2: 106 target individuals (BP percentile < or = 50), 145 parents, 84 siblings and 18 grandparents. RESULTS: (1) The longitudinal study 10 years later (tracking effect) showed that 34.8% of target individuals of group 1 and 90.5% of group 2 remained at the same BP percentile. (2) Comparing the two groups of target individuals, group 1 had higher weight and body mass index (BMI), systolic BP (SBP), diastolic BP (DBP), and heart rate (HR) (P < 0.001) and lower HDL (P < 0.003). (3) Comparing target individuals' and their relatives' measurements together, group 1 had higher BMI, HR, SBP, DBP (P < 0.03) and lower HDL (P < 0.001). (4) SBP and DBP showed significant correlation with all metabolic variables even when BMI was controlled in a multiple regression analysis (P < 0.04). CONCLUSION: BP level in children and adolescents was a good marker for familial aggregation of metabolic RF, suggesting an interaction of genetic and environmental factors. Primary intervention should be carried out in early stages of life.

Hyperglycemia, hyperinsulinemia, overweight, and high blood pressure in young adults: the Rio de Janeiro Study.

Children and adolescents (n=3906, 10-15 years old) have been participating in a screening program for high blood pressure. Sixty-four individuals (17-23 years old) from this population were followed up for 8 years and four consecutive screenings and were stratified into three groups according to blood pressure: group 1 (n=23), > or = 95th percentile for at least three of four evaluations; group 2 (n=28), < 50th percentile for at least three of four screenings; and group 3 (n=13), with unstable blood pressure percentiles. All 64 individuals underwent an oral glucose tolerance test after a 12-hour fast. Blood samples were collected at 0, 30, 60, 90, and 120 minutes for insulin and glucose measurements. Group 1 had a greater body mass index and higher systolic and diastolic blood pressures, basal glucose and insulin levels, and peak values of insulin and glucose levels than the other groups (P<.05). Group 1 also had a higher prevalence of overweight and abnormal values of basal insulin than the other groups (P<.05) and a higher proportion of glucose-intolerant individuals when compared with group 2 (P<.05). Systolic and diastolic blood pressures were positively related to body mass index (P<.05) and insulin variables (P<.05); however, when body mass index was controlled for, only systolic blood pressure demonstrated a significant correlation with insulin variables (P<.05). The association of overweight, hyperinsulinemia, glucose intolerance, and high blood pressure can be detected early, but the significance of these findings would be better explained by longitudinal studies.

The C-peptide response to a standard mixed meal in a group of Brazilian type 1 diabetic patients

In order to analyze the different parameters used in the interpretation of C-peptide response in a functional test, we compared a group of 26 type 1 diabetics aged 21.1 + 8.2 years, with a diabetes duration of 7.9 + 6.7 months, with a group of 24 non-diabetic subjects aged 25.0 + 4.4 years. A standard mixed meal of 317 kcal was used as a stimulus. Blood sampling for C-peptide determinations was performed at regular intervals. Although all the studied C-peptide variables were significantly lower in the diabetic group (P<0.0001), some overlapping of parameters was observed between the two groups. The highest degree of overlapping was found for basal value (BV) (30.8 percent) and percent increase (42.31 percent), and the lowest for incremental area, absolute increase, peak value (PV) (3.8 percent), and total area (7.7 percent) (X2 = 31.6, P<0.0001). We did not observe a definite pattern in the time of maximum response among the 21 diabetics who showed an increase in C-peptide levels after the stimulus. In this group, however, there was a highly significant number of late responses (120 min) (X2 = 5.7, P<0.002). Although BV showed a significant correlation with PV (rs = 0.95, P<0.0001), the basal levels of C-peptide did not differentiate the groups with and without response to the stimulus. We conclude that the diabetic group studied showed delayed and reduced C-peptide responses, and that the functional test can be an important tool for the evaluation of residual beta cell function.

Discriminative capacity of fasting C-peptide levels in a functional test according to different criteria of response to a stimulus. A study of Brazilian insulin-dependent diabetic patients.

In order to study the discriminative capacity of the C-peptide basal values (BV) in a functional test, we analysed the C-peptide response curve after a mixed meal in 26 insulin-dependent patients. The five criteria of response used were: (1) any increment after the stimulus; (2) percentual increment above 21%; (3) absolute increment above 0.35 ng/ml; (4) incremental area above 42.76 ng.min.ml-1, and (5) peak value above 2.16 ng/ml. Considering the first two criteria, many patients showed positive responses, in the diabetic group as a whole and when we analysed patients with BV > or = 0.74 ng/ml and < 0.74 ng/ml separately. When we applied only the last three criteria the number of positive responses was considerably smaller. Moreover, the majority of patients with BV < 0.74 ng/ml could not increase their levels over the ones established above. In patients with BV > or = 0.74 ng/ml, the number of positive and negative responses were similar. The comparison between the subgroups achieves statistical significance only for incremental area (chi 2 = 3.55, p = 0.03). We conclude that the functional test was important mainly for patients with BV > or = 0.74 ng/ml, and could have been omitted for patients with BV < 0.74 ng/ml. The best criteria of response were those based on the mean minus two standard deviations of each parameter in a non-diabetic group (the last three criteria), especially the incremental area.

The C-peptide response to a standard mixed meal in a group of Brazilian type 1 diabetic patients.

In order to analyze the different parameters used in the interpretation of C-peptide response in a functional test, we compared a group of 26 type 1 diabetics aged 21.1 +/- 8.2 years, with a diabetes duration of 7.9 +/- 6.7 months, with a group of 24 non-diabetic subjects aged 25.0 +/- 4.4 years. A standard mixed meal of 317 kcal was used as a stimulus. Blood sampling for C-peptide determinations was performed at regular intervals. Although all the studied C-peptide variables were significantly lower in the diabetic group (P < 0.0001), some overlapping of parameters was observed between the two groups. The highest degree of overlapping was found for basal value (BV) (30.8%) and percent increase (42.31%), and the lowest for incremental area, absolute increase, peak value (PV) (3.8%), and total area (7.7%) (chi 2 = 31.6, P < 0.0001). We did not observe a definite pattern in the time of maximum response among the 21 diabetics who showed an increase in C-peptide levels after the stimulus. In this group, however, there was a highly significant number of late responses (120 min) (chi 2 = 5.7, P < 0.002). Although BV showed a significant correlation with PV (rS = 0.95, P < 0.0001), the basal levels of C-peptide did not differentiate the groups with and without response to the stimulus. We conclude that the diabetic group studied showed delayed and reduced C-peptide responses, and that the functional test can be an important tool for the evaluation of residual beta cell function.

Role of anthropometric indexes and blood pressure as determinants of left ventricular mass and geometry in adolescents. The Rio de Janeiro Study.

To evaluate left ventricular structural changes and their relationship to blood pressure and anthropometric indexes, we examined by echocardiography 108 adolescents aged 13 to 19 years. Subjects were divided into three groups according to blood pressure tracking during three moments of observation: group 1 (n = 27), > or = 95th percentile; group 2 (n = 37), < or = 50th percentile; and group 3 (n = 44), blood pressure not stable in the original percentile. Left ventricular mass index and the prevalence of altered left ventricular geometry were greater in group 1 (P < .05 and P < .02, respectively). Of all the anthropometric indexes, body surface area showed the best correlation with left ventricular mass (P < .00001). Left ventricular mass also correlated with systolic and diastolic pressures (P < .00001 and P < .003, respectively). Ventricular septal and posterior wall thicknesses and left ventricular diastolic diameter showed good correlations with body surface area (P < .00001). These variables also correlated with systolic pressure (P < .001). In a multiple regression model when body surface area was controlled, systolic pressure did not correlate significantly with left ventricular mass. In a similar model systolic pressure maintained a significant correlation with ventricular septal and posterior wall (P < .00001) thicknesses but not with left ventricular diastolic diameter (P > .05). We conclude that left ventricular structural changes can occur early after initial abnormalities of blood pressure. Considering that body surface area and systolic pressure were the best predictors of left ventricular alterations in adolescents, the usual way of correcting left ventricular mass by body surface area should be reviewed.

[Assessment of third-degree congenital atrioventricular block by ergometric tests]. / Avaliação do bloqueio atrioventricular do 3 degrees. grau congênito pelo teste ergométrico.

PURPOSE: To analyse the use of the exercise testing as the method of initial evaluation, following a prognostic indicative of patients with congenital complete heart block. METHODS: Five patients were analysed (3 men and 2 woman) with ages between 7 and 34 years (mean = 22.8). The patients were submitted to a treadmill exercise testing using the Bruce protocol 1 and symptom limited. RESULTS: In all patients the atrial frequency increased from a median of 74.40 bpm in the basal to 155.20 bpm in the maximum effort; the atrial chronotropism was a little below that calculated based on the age of the patients. The median of the ventricular frequency in the maximum effort was 94.80 bpm, very different from that foreseen and showing a deficit of ventricular chronotropism. The median consumption of oxygen was 35.68ml0(2)/Kg/min. In one patients (20%) there was not any change in the ventricular frequency with the effort, in 3 (60%) complex ventricular arrhythmia arise during the effort and in one (20%) a definitive ventricular pacemaker was implanted. CONCLUSIONS: The exercise testing is a simple method of initial evaluation, providing information as chronotropism, functional capacity and the presence of arrhythmias, that can be very useful in the evaluation of prognostic. The presence of complex ventricular arrhythmias during the exercise is indicative of a more regular follow-up.

[Significance and prognosis of ventricular extrasystole induced by exertion in patients with arterial hypertension with a normal electrocardiogram]. / Significado e prognóstico das extra-sístoles ventriculares induzidas pelo esforço em portadores de hipertensão arterial com electrocardiograma normal.

We studied 13 patients with systemic arterial hypertension and normal electrocardiograms so as to evaluate the significance and prognosis of frequent and complex ventricular premature beats (VPB) induced by exercise testing. After a period of 9 to 33 months of follow-up (mean = 17.6 months), we repeated the exercise testing with the same protocol in all cases. In nine patients (69.2%), the arrhythmia disappeared during exercise, two increased the number of VPB and two others reduced the number of the arrhythmia. Complications, such as sustained ventricular tachycardia, were not seen in any case. The appearance of frequent and complex VPB with stress testing does not seem enhance the risk of sudden death or episodes of spontaneous ventricular tachycardia in patients with arterial hypertension but without electrocardiographic signs of cardiac hypertrophy.