The association of diabetic peripheral neuropathy with cardiac autonomic neuropathy in individuals with diabetes mellitus: A systematic review.

This systematic review aimed to explore the relationship between diabetic peripheral neuropathy (DPN) and cardiac autonomic neuropathy (CAN) in individuals with type 1 and 2 diabetes mellitus (DM). METHODS: The systematic review follow the protocol registered in Prospero (CRD42020182899). Two authors independently searched the PubMed, Scopus, Embase, Cochrane, and Web of Science databases. Discrepancies were resolved by a third author. The review included observational studies investigating the relationship between CAN and DPN in individuals with DM. RESULTS: Initially, out of 1165 studies, only 16 were selected, with 42.8 % involving volunteers with one type of diabetes, 14.3 % with both types of diabetes and 14.3 % not specify the type. The total number of volunteers was 2582, mostly with type 2 DM. It was analyzed that there is a relationship between CAN and DPN. It was observed that more severe levels of DPN are associated with worse outcomes in autonomic tests. Some studies suggested that the techniques for evaluating DPN might serve as risk factors for CAN. CONCLUSION: The review presents a possible relationship between DPN and CAN, such as in their severity.

Adherence to Self-care and Quality of Life of Patients with Diabetic Foot Ulcers Treated with Low-Level Laser Therapy: An Exploratory Study.

OBJECTIVE: To evaluate the quality of life (QoL) of patients with a diabetic foot ulcer undergoing treatment with low-level laser therapy (LLLT) at 904 nm and its association with self-care. METHODS: In this randomized, exploratory study, participants were divided into the following four groups: control group (CG) with LLLT placebo, LLLT group 1 (LG1) at 10 J/cm2, LLLT group 2 (LG2) at 8 J/cm2, and LLLT group 3 (LG3) at 4 J/cm2. Participants received light therapy (or placebo) twice a week, for a total of 20 sessions. Researchers assessed participants' QoL using the Short-Form 36 questionnaire. RESULTS: Sixty-two participants were included in the analysis (CG = 18, LG1 = 14, LG2 = 17, LG3 = 13). The LG1 group showed a higher proportion of healing, whereas the CG group showed a lower proportion than the other groups. The LG1 group showed a relationship between physical limitations and blood glucose monitoring, pain and foot care, and general health status (GHS) and foot care. The GL2 group showed a relationship between physical limitations and blood glucose monitoring, vitality and foot care, and GHS and diet. CONCLUSIONS: Low-level laser therapy had a positive impact on QoL as assessed by the Short-Form 36 questionnaire (functional capacity, vitality, and pain domains), and there was a positive association between QoL and self-care in the LLLT groups (physical limitations, pain, GHS, and vitality domains).

The role of light emitting diode in wound healing: A systematic review of experimental studies.

Wounds represent a growing global issue demanding increased attention. To expedite wound healing, technologies are under development, and light emitting diode (LED) devices of varying wavelengths are being explored for their stimulating influence on the healing process. This article presents a systematic literature review aiming to compile, organize, and analyze the impacts of LED devices on wound healing. This review is registered on the PROSPERO platform [CRD42023403870]. Two blinded authors conducted searches in the Pubmed, Web of Science, Scopus, Embase, and ScienceDirect databases. In vitro and in vivo experimental studies assessing LED utilization in the wound healing process were included. The search yielded 1010 studies, of which 27 were included in the review. It was identified that LED stimulates different healing pathways, promoting enhanced cell proliferation and migration, angiogenesis stimulation, increased collagen deposition, and modulation of the inflammatory response. Thus, it can be concluded that the LED stimulates cellular and molecular processes contingent on the utilized parameters. The effects depend on the standards used. Cell migration and proliferation were better influenced by green and red LED. The extracellular matrix components and angiogenesis were regulated by all wavelengths and the modulation of inflammation was mediated by green, red, and infrared LEDs.

Dose-response and efficacy of 904 nm photobiomodulation on diabetic foot ulcers healing: a randomized controlled trial.

PURPOSE: This study aimed to examine the impact of a 904 nm photobiomodulation (PBM) on diabetic ulcers using varying dosages. METHODS: The study was a randomized, double-blind, placebo-controlled clinical trial that compared treatments using PBM (GaAs 904 nm 30w) with three different energy densities (4 J/cm2; 8 J/cm2; 10 J/cm2) in the healing process of non-infected diabetic foot ulcers. Eighty volunteers (48.75% female; 58.5 ± 11.1 years) were randomized into three intervention groups treated with PBM and one control group (PBM placebo). Volunteers performed up 20 interventions with PBM, either placebo or actual, in conjunction with conventional therapy, which involved dressing the wound with Helianthus annuus vegetable oil. The primary variable was the ulcer size reduction rate. RESULTS: GaAs 904 nm PBM yielded a clinically and significant ulcer size rate reduction of diabetic foot ulcers, independently of energy density range (p < 0.05). However, 10 J/cm² had 60% of completely healed ulcers and the highest proportion of patients reaching 50% of ulcer reduction rate after 5 weeks of treatment. In addition, only 10 J/cm² showed a significant difference between control group after a 10-week follow-up (p < 0.05). CONCLUSION: GaAs 904 nm PBM was effective in treating diabetic foot ulcers in this study and a dosage of 10 J/cm², after a 10-week follow-up, proved to be the most effective compared to the other groups. CLINICAL TRIAL REGISTRATION NUMBER: NCT04246814.

Therapeutic Interventions to Improve Static Balance in Type 2 DiabetesMellitus: A Systematic Review and Meta-Analysis.

INTRODUCTION: Diabetes mellitus (DM) is a metabolic disorder characterized by an abnormal increase in blood glucose levels resulting from insulin secretion and/or dysfunctional activity that can lead to several serious complications in addition to decreased postural balance. OBJECTIVE: This study aimed to identify and analyze the main interventions used to improve static balance in patients with DM. METHODS: For the selection of articles, a bibliographic search was performed using PubMed, Scopus, Web of Science, Embase, and Cochrane databases. Only clinical trials that investigated the effect of training on static balance in adults with type 2 DM were selected, and 34 studies were included. RESULTS: The search resulted in the identification of 2681 articles, and of these, 31 were eligible for the study. The identified interventions were proprioceptive, aerobic, resistance training on platforms, in virtual reality, and Tai Chi. The main results obtained were an increase in time in the one-leg stance, Romberg test, and tandem position, a significant increase in the Berg Balance Scale score and balance index, and a reduction in the variables of postural sway. CONCLUSION: There are a variety of effective training methods for improving static balance, and the choice of intervention to be applied goes beyond proven effectiveness, depending on reproducibility and/or financial cost.

Morphological and functional changes in skeletal muscle in type 2 diabetes mellitus: A systematic review and meta-analysis.

INTRODUCTION: Changes in the skeletal muscle are common in patients with type 2 diabetes mellitus (T2DM). These changes impair your motor skills. OBJECTIVE: This systematic review aimed to investigate changes in skeletal muscle in patients with T2DM. METHODS: The search was carried out in the PubMed, Scopus, and Web of Science databases until December 1, 2021. Observational studies that evaluated musculoskeletal changes in people with T2DM were included. The review was based on PRISMA recommendations. The primary parameters analyzed were muscle strength, muscle mass, muscle power, and muscle endurance. RESULTS: Forty-eight studies were included, with a total of 26,042 participants. The results revealed that T2DM is associated with a reduction in handgrip [-2.64 (CI 95% = -3.33 to -1.95, Z = -7.50, p < .0001], and knee extension muscle strength [-0.56 (CI 95% = -0.76 to -0.36, Z = -5.64, p < .0001)], a higher percentage of type II fibers [11.74 (CI 95% = 6.24 to 17.25, Z = 4.18, p < .0001)], and a lower percentage of type I fibers [-15.69 (CI 95% = -18.22 to -13.16, Z = -12.16, p < .0001], in addition to a greater thickness of the calcaneus tendon (p < .0001). CONCLUSION: Individuals with T2DM present skeletal muscle impairments, mainly reduced muscle strength, mass, and endurance; increase in the thickness of the calcaneus tendon, and alteration in the proportion of type I and II fibers, even in the initial stage of the disease.

Implicações dos profissionais da Atenção Primária no atendimento à população em situação de rua / Implications of Primary Care professionals in the assistance to the population in street situation

Objetivo: Analisar as implicações dos profissionais da Atenção Primária com vistas ao atendimento em saúde à população em situação de rua utilizando, para isto, o referencial teórico-metodológico da Análise Institucional (AI), na perspectiva da análise no papel. Método: Trata-se de um estudo descritivo exploratório com abordagem qualitativa. Foram aplicadas entrevistas semiestruturadas a cinco profissionais que atuam em uma Unidade Básica de Saúde, em um município do Piauí. Resultados: Os dados apontam para um entrave ainda presente no imaginário dos profissionais da saúde, que é uma ótica de ações paternalistas e higienistas para a população em situação de rua, embora, indiquem a relevância de um cuidado efetivo, multiprofissional e intersetorial. Identificou-se, ainda, a necessidade de investir em formações permanentes das equipes da Estratégia Saúde da Família, discutindo a relevância do atendimento da Pessoa em Situação de Rua na Atenção Primária à Saúde.

Objective: To analyze the implications of Primary Care professionals focusing on the health care for the street population using the theoretical-methodological framework of Institutional Analysis (AI) from the perspective of the role analysis. Method: This is an exploratory, descriptive study with a qualitative approach. Semi-structured interviews were applied with 05 professionals working in a Basic Health Unit in a municipality of Piauí. Results: The data point to an obstacle still present in the health professionals' imaginary, which is a view of paternalistic and hygienist actions for the street population, although they indicate the relevance of effective, multiprofessional, and intersectoral care. The need to invest in permanent training of the Family Health Strategy teams was also identified, discussing the relevance of the assistance to the Person in Street Situation in Primary Health Care.

Dose-response and efficacy of low-level laser therapy on diabetic foot ulcers healing: Protocol of a randomized controlled trial.

BACKGROUND: Current evidence shows that low-level laser therapy (LLLT) is an effective non-invasive and non-pharmacological strategy to treat diabetic foot ulcers (DFU). However, knowledge of parameterization efficacy remains unclear. METHODS: This randomized, double-blind, controlled trial will be conducted at the Physical Therapy University Clinic. Eighty volunteers will be randomized into four groups. The control group will receive placebo LLLT + conventional treatment. The three active groups will receive 10 (G10), 8 (G8), or 4 J/cm2 (G4) of GaAs 904 nm LLLT plus conventional treatment twice a week for 20 sessions. Conventional treatment involves cleaning and dressing the ulcers. The main outcome will be the area of ulcers and Wagner classification score. Assessments will take place before treatment, after 5 and 10 weeks of treatment, and in the third month after treatment, by a blinded evaluator. IMPLICATIONS: This trial can potentially provide important information and assist in clinical decision-making regarding DFU treatment with LLLT. TRIAL REGISTRATION: NCT04246814, registered 29th January 2020.

Self-Care in Adults with Type 2 Diabetes Mellitus: A Systematic Review.

BACKGROUND: Self-care is essential for the prevention of complications in patients with diabetes, but several authors report that even with health education programs, the incidence of complications in patients with diabetes continues to increase. OBJECTIVE: We aimed to examine adherence to self-care strategies and the repercussions of adherence on the clinical profiles of individuals with type 2 diabetes. METHODS: We performed a systematic review according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. We searched for related studies in 4 databases: PubMed, Web of Science, Scopus, and Latin American and Caribbean Health Science Literature (LILACS). We included observational studies in English and Portuguese that evaluated the effects of selfcare in individuals with type 2 diabetes. RESULTS: The search resulted in the identification of 615 articles, of which 34 met all the inclusion criteria. General self-care was considered unsatisfactory. Physical exercise was classified as the self-care activity that was performed less frequently by individuals with type 2 diabetes mellitus; adherence to medication was the most frequent behavior among volunteers. CONCLUSION: The studies indicated poor adherence of the population to good self-care practices, reflected by the increase in complications related to DM.