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2.
Diabetologia ; 63(4): 711-721, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-31901950

RESUMO

AIMS/HYPOTHESIS: We evaluated the secular trend of glycaemic control in individuals with type 2 diabetes in developing countries, where data are limited. METHODS: The International Diabetes Management Practices Study provides real-world evidence of patient profiles and diabetes care practices in developing countries in seven cross-sectional waves (2005-2017). At each wave, each physician collected data from ten consecutive participants with type 2 diabetes during a 2 week period. The primary objective of this analysis was to evaluate trends of glycaemic control over time. RESULTS: A total of 66,088 individuals with type 2 diabetes were recruited by 6099 physicians from 49 countries. The proportion of participants with HbA1c <53 mmol/mol (<7%) decreased from 36% in wave 1 (2005) to 30.1% in wave 7 (2017) (p < 0.0001). Compared with wave 1, the adjusted ORs of attaining HbA1c ≤64 mmol/mol (≤8%) decreased significantly in waves 2, 5, 6 and 7 (p < 0.05). Over 80% of participants received oral glucose-lowering drugs, with declining use of sulfonylureas. Insulin use increased from 32.8% (wave 1) to 41.2% (wave 7) (p < 0.0001). The corresponding time to insulin initiation (mean ± SD) changed from 8.4 ± 6.9 in wave 1 to 8.3 ± 6.6 years in wave 7, while daily insulin dosage ranged from 0.39 ± 0.21 U/kg (wave 1) to 0.33 ± 0.19 U/kg (wave 7) for basal regimen and 0.70 ± 0.34 U/kg (wave 1) to 0.77 ± 0.33 (wave 7) U/kg for basal-bolus regimen. An increasing proportion of participants had ≥2 HbA1c measurements within 12 months of enrolment (from 61.8% to 92.9%), and the proportion of participants receiving diabetes education (mainly delivered by physicians) also increased from 59.0% to 78.3%. CONCLUSIONS: In developing countries, glycaemic control in individuals with type 2 diabetes remained suboptimal over a 12 year period, indicating a need for system changes and better organisation of care to improve self-management and attainment of treatment goals.

3.
Am Heart J ; 219: 47-57, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31707324

RESUMO

BACKGROUND: Obesity is a risk factor for type 2 diabetes (T2D) and cardiovascular disease (CVD). Whether obesity affects outcomes among those with T2D and atherosclerotic CVD (ASCVD) remains uncertain. Our objective was to investigate the relationship between body mass index (BMI) and ASCVD outcomes among TECOS participants with T2D and ASCVD. METHODS: BMI categories were defined as underweight/normal weight (BMI <25 kg/m2), overweight (25-29.9 kg/m2), obese class I (30-34.9 kg/m2), obese class II (35-39.9 kg/m2), and obese class III (≥ 40 kg/m2). Asian-specific BMI categories were applied to Asian participants. Kaplan-Meier survival analysis and Cox proportional hazards models were used to examine associations between baseline BMI and a composite CV outcome (CV death, nonfatal myocardial infarction, nonfatal stroke, or hospitalization for unstable angina). RESULTS: For 14,534 TECOS patients with available BMI, mean age was 65.5 years; 29.3% were female, 32.0% non-White, and 23.1% insulin-treated, with median 3 years' follow-up. At baseline, 11.6% (n = 1686) were underweight/normal weight, 38.1% (n = 5532) overweight, 32.2% (n = 4683) obese class I, 12.4% (n = 1806) obese class II, and 5.7% (n = 827) obese class III. The composite CV outcome occurred in 11.4% (n = 1663) of participants; the outcome risk was lower, compared with under/normal weight, in overweight (HR 0.83, 95% CI 0.71-0.98) and obese class I (HR 0.79, 95% CI 0.67-0.93) individuals. Obesity was not associated with worse glycemic control. CONCLUSIONS: The majority of TECOS participants with ASCVD and T2D were overweight or obese, yet overweight or obese class I individuals had lower CV risk than those who were under/normal weight. These results suggest the presence of an obesity paradox, but this paradox may reflect an epidemiological artifact rather than a true negative association between normal weight and clinical outcomes.

4.
Am J Ther ; 27(1): e79-e90, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31567175

RESUMO

BACKGROUND: Since the discovery of insulin, it was the only drug available for the treatment of diabetes until the development of sulfonylureas and biguanides 50 years later. But even with the availability of oral glucose-lowering drugs, insulin supplementation was often needed to achieve good glucose control in type 2 diabetes. Insulin NPH became the basal insulin therapy of choice and adding NPH to metformin and/or sulfonylureas became the standard of care until basal insulin analogs were developed and new glucose-lowering drugs became available. AREAS OF UNCERTAINTY: The advantages in cost-benefit of insulin analogs and their combination with new glucose-lowering drugs are still a matter of debate. There is no general agreement on how to avoid inertia by prescribing insulin therapy in type 2 diabetes when really needed, as reflected by the diversity of recommendations in the current clinical practice guidelines. DATA SOURCES: When necessary for this review, a systematic search of the evidence was done in PubMed and Cochrane databases. THERAPEUTIC ADVANCES: Adding new oral glucose-lowering drugs to insulin such as DPP-4 inhibitors lead to a modest HbA1c reduction without weight gain and no increase in hypoglycemia. When SGLT-2 inhibitors are added instead, there is a slightly higher HbA1c reduction, but with body weight and blood pressure reduction. The downside is the increase in genital tract infections. GLP-1 receptor agonists have become the best alternative when basal insulin fails, particularly using fixed ratio combinations. Rapid-acting insulins via the inhaled route may also become an alternative for insulin supplementation and/or intensification. "Smart insulins" are under investigation and may become available for clinical use in the near future. CONCLUSIONS: Aggressive weight loss strategies together with the new glucose-lowering drugs which do not cause hypoglycemia nor weight gain should limit the number of patients with type 2 diabetes needing insulin. Nevertheless, because of therapeutic inertia and the progressive nature of the disease, many need at least a basal insulin supplementation and insulin analogs are the best choice as they become more affordable. Fixed ratio combinations with GLP1 receptor agonists are a good choice for intensification of insulin therapy.

5.
Diabetes Ther ; 2019 Dec 17.
Artigo em Inglês | MEDLINE | ID: mdl-31848983

RESUMO

INTRODUCTION: Basal-bolus (BB) regimens are generally used to intensify basal insulin therapy in patients with type 2 diabetes (T2D) not meeting glycemic targets. However, drawbacks include multiple injection burden and risk of weight gain and hypoglycemia. A once-daily titratable fixed-ratio combination of insulin glargine 100 U/mL and lixisenatide (iGlarLixi) may provide a simple, well-tolerated, and efficacious alternative. We compared these treatments in a post hoc propensity score matched analysis using randomized trial data. METHODS: From the LixiLan-L study, 195 patients who had been randomized to iGlarLixi were matched for age, sex, race, T2D duration, baseline body mass index, glycated hemoglobin (HbA1c), fasting plasma glucose, insulin dose, and metformin use to 195 patients who had been randomized to a BB regimen in the GetGoal Duo-2 trial. RESULTS: At study end, estimated treatment differences for reduction in HbA1c and weight change, and ratio of hypoglycemia events per patient-year (BB vs iGlarLixi) were - 0.28% (standard error 0.08, P = 0.0002), - 1.32 kg (standard error 0.30, P < 0.0001), and 2.85 (P < 0.0001), respectively, all favoring iGlarLixi over BB. Also, proportions of patients reaching individual and composite goals (HbA1c < 7% [< 53 mmol/mol], no weight gain, and no hypoglycemia) were higher in the iGlarLixi compared with the BB treatment group. Gastrointestinal side effects were more common with iGlarLixi. CONCLUSIONS: In patients with T2D inadequately controlled on basal insulin, iGlarLixi offers an effective alternative to BB regimen for reducing HbA1c, without increased risk of hypoglycemia and weight gain. TRIAL REGISTRATION: ClinicalTrials.gov: NCT02058160 (LixiLan-L trial); NCT01768559 (GetGoal Duo-2 trial). Plain language summary available for this article.

7.
Prim Care Diabetes ; 13(6): 574-582, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31202539

RESUMO

AIMS: To evaluate the performance of the Latin American Finnish Diabetes Risk Score (LA-FINDRISC) compared with the original O-FINDRISC in general population. To establish the best cut-off to detect unknown type 2 diabetes (uT2D) and prediabetes. METHODS: The EVESCAM was a national population-based, cross-sectional, randomized cluster sampling study, which assessed 3454 adults from July 2014 to January 2017. Those with self-report of diabetes were excluded; a total of 3061 subjects were analyzed. Waist circumference adapted for Latin America was the difference between the LA-FINDRISC and the O-FINDRISC. The area under the curve (AUC), sensitivity, and specificity were calculated. RESULTS: The prevalence of uT2D and prediabetes were 3.3% and 38.5%. The AUC with the LA-FINDRISC vs. the O-FINDRISC were: for uT2D, 0.722 vs. 0.729 in men (p=0.854) and 0.724 vs. 0.732 in women (p=0.896); for prediabetes (impaired fasting glucose [IFG] + impaired glucose tolerance [IGT], 0.590 vs. 0.587 in men (p=0.887) and 0.621 vs. 0.627 in women (p=0.777); for IFG, 0.582 vs. 0.580 in men (p=0.924) and 0.607 vs. 0.617 in women (p=0.690); for IGT, 0.691 vs. 0.692 in men (p=0.971) and 0.672 vs. 0.671 in women (p=0.974). Using the LA-FINDRISC, the best cut-offs to detect uT2D were 9 in men and 10 in women and to detect IGT was 9 in both genders. CONCLUSION: LA-FINDRISC has similar performance than O-FINDRISC in Venezuelan adults and showed a good performance to detect uT2D and IGT, but not IFG. The best cut-offs to detect glucose alterations were established.

8.
Diabetes Res Clin Pract ; 147: 47-54, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30118748

RESUMO

AIMS: This study aimed to evaluate the impact of diabetes education and access to healthcare coverage on disease management and outcomes in Latin America. METHODS: Data were obtained from a sub-analysis of 2693 patients with type 1 diabetes mellitus recruited from 9 Latin American countries as part of the International Diabetes Mellitus Practices Study (IDMPS), a multinational, observational survey of diabetes treatment in developing regions. RESULTS: Results from the Latin American cohort show that only 25% of participants met HbA1c target value (< 7% [53 mmol/mol]). Attainment of this target was significantly higher among participants who had received diabetes education than those who hadn't (28% vs. 19%, p < 0.001), and among those who practiced self-management (27% vs. 21% no self-management, p = 0.001). Multivariate analysis showed that participants who had received diabetes education were more likely to manage their diabetes (OR:1.65 [95% CI: 1.24, 2.19]; p = 0.001), and to attain HbA1c target values (OR:1.48 [95% CI: 1.14, 1.93]; p = 0.003). CONCLUSIONS: Given the association between uncontrolled diabetes and long-term complications, health authorities and care providers should increase efforts to ensure widespread healthcare coverage and access to self-management education to reduce the socioeconomic and humanistic burden of type 1 diabetes.


Assuntos
Diabetes Mellitus Tipo 1/terapia , Educação em Saúde/métodos , Seguro Saúde/normas , Qualidade da Assistência à Saúde/normas , Adulto , Estudos Transversais , Diabetes Mellitus Tipo 1/patologia , Feminino , Humanos , América Latina , Masculino
10.
Diabetes Metab Res Rev ; 34(6): e3021, 2018 09.
Artigo em Inglês | MEDLINE | ID: mdl-29757486

RESUMO

Primary prevention of type 2 diabetes (T2D) should be achievable through the implementation of early and sustainable measures. Several randomized control studies that found success in preventing the progression to T2D in high-risk populations have identified early and intensive intervention based on an individualized prevention model as the key factor for participant benefit. The global prevalence of both overweight and obesity has now been widely recognized as the major epidemic of the 21st century. Obesity is a major risk factor for the progression from normal glucose tolerance to prediabetes and then to T2D. However, not all obese individuals will develop prediabetes or progress to diabetes. Intensive, multicomponent behavioural interventions for overweight and obese adults can lead to weight loss. Diabetes medications, including metformin, GLP-1 agonists, glitazones, and acarbose, can be considered for selected high-risk patients with prediabetes when lifestyle-based programmes are proven unsuccessful. Nutrition education is the cornerstone of a healthy lifestyle. Also, physical activity is an integral part of the prediabetes management plan and one of the main pillars in the prevention of diabetes. Mobile phones, used extensively worldwide, can facilitate communication between health professionals and the general population, and have been shown to be helpful in the prevention of T2D. Universal screening is needed. Noninvasive risk scores should be used in all countries, but they should be locally validated in all ethnic populations focusing on cultural differences around the world. Lifestyle interventions reduce the progression to prediabetes and diabetes. Nevertheless, many questions still need to be answered.


Assuntos
Consenso , Diabetes Mellitus Tipo 2/prevenção & controle , Saúde Global , Estado Pré-Diabético/terapia , Prevenção Primária , Diabetes Mellitus Tipo 2/epidemiologia , Saúde Global/normas , Saúde Global/tendências , Humanos , Guias de Prática Clínica como Assunto/normas , Estado Pré-Diabético/diagnóstico , Estado Pré-Diabético/epidemiologia , Estado Pré-Diabético/patologia , Prevenção Primária/métodos , Prevenção Primária/normas , Prevenção Primária/tendências
11.
Diabetes Obes Metab ; 20(6): 1427-1434, 2018 06.
Artigo em Inglês | MEDLINE | ID: mdl-29405540

RESUMO

AIM: Pooled efficacy studies suggest that glycaemic responses to dipeptidyl-peptidase 4 inhibitors in type 2 diabetes are greatest in Asians, who may also respond better to alpha-glucosidase inhibitors. We assessed the glycaemic impact of sitagliptin by race in the Trial Evaluating Cardiovascular Outcomes with Sitagliptin (TECOS), and whether this was enhanced in Asians with concomitant acarbose therapy. MATERIALS AND METHODS: TECOS enrolled 14 671 patients with type 2 diabetes, cardiovascular disease and HbA1c of 48-64 mmol/mol (6.5%-8.0%), and randomized them, double-blind, to sitagliptin or placebo. There were 3265 patients (22.3%) from Asian countries. Background glucose-lowering therapies were unaltered for the first 4 months post randomization unless clinically essential, facilitating comparison of sitagliptin-associated effects in self-identified East Asian, Other (South) Asian, White Caucasian, Hispanic, Black and Indigenous groups. RESULTS: Median baseline HbA1c by race was 54 to 57 mmol/mol (7.1%-7.4%). Mean 4-month reduction in placebo-adjusted HbA1c was greatest in East Asians (-6.6 mmol/mol [-0.60%] vs ≤6.0 mmol/mol [≤0.55%] in other groups), with significantly greater reduction vs the 2 largest groups (White Caucasians, Other Asians; P < .0001) after adjustment for covariates. After the first 4 months, East and Other Asians were more likely to initiate additional oral therapy (metformin and/or sulfonylureas) than insulin vs White Caucasians (P < .0001). Acarbose use increased in the Asian patients, but no glycaemic interaction with allocated study medication was observed (adjusted P = .12). CONCLUSIONS: The greatest initial reduction in HbA1c with sitagliptin in the TECOS population was in East Asians. No enhanced glycaemic effect was seen when sitagliptin was given with acarbose.


Assuntos
Diabetes Mellitus Tipo 2/tratamento farmacológico , Angiopatias Diabéticas/tratamento farmacológico , Inibidores da Dipeptidil Peptidase IV/administração & dosagem , Hipoglicemiantes/administração & dosagem , Fosfato de Sitagliptina/administração & dosagem , Acarbose/administração & dosagem , Grupo com Ancestrais do Continente Africano/etnologia , Idoso , Ásia/etnologia , Diabetes Mellitus Tipo 2/sangue , Diabetes Mellitus Tipo 2/etnologia , Angiopatias Diabéticas/sangue , Angiopatias Diabéticas/etnologia , Método Duplo-Cego , Esquema de Medicação , Quimioterapia Combinada , Grupo com Ancestrais do Continente Europeu/etnologia , Feminino , Hemoglobina A Glicada/metabolismo , Inibidores de Glicosídeo Hidrolases/administração & dosagem , Hispano-Americanos/estatística & dados numéricos , Humanos , Masculino , Pessoa de Meia-Idade , Resultado do Tratamento
12.
Ann Glob Health ; 83(3-4): 432-443, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-29221516

RESUMO

BACKGROUND: Type 2 diabetes (T2D) imposes a heavy burden in developing countries, requiring effective primary prevention policies. Randomized clinical trials have identified successful strategies in T2D prevention. However, translating these results to real-life scenarios and adapting to ethnocultural differences is a major challenge. Transculturalization allows incorporating cultural factors to diabetes prevention strategies to optimize implementation of clinical trials results. The purpose of this paper is to review the transcultural adaptations developed for T2D prevention in Latin America (LA). METHODS: A comprehensive literature review spanning 1960-2016 was performed, using "Diabetes," "Latin America," "Prevention," "Screening," and "Tools" as key words. RESULTS: Two major tasks are underway in LA: adaptation of screening tools for high-risk individuals, and implementation of diabetes prevention programs. The Finnish Diabetes Risk Score (FINDRISC) is the most widely used screening tool to detect new cases of T2D and people with prediabetes, and it has been adapted (LA-FINDRISC) to include the waist circumference cutoff values appropriate for LA population (≥94 cm for men and ≥90 cm for women). The validation of the LA-FINDRISC performance depends on the local characteristics. A LA-FINDRISC score >10 may be the best cutoff to identify individuals with impaired glucose regulation in population-based studies, but a higher score (>12-14) might be more appropriate in a clinical setting. A shorter version of the FINDRISC using only the 4 variables with highest impact has been developed and validated in Colombia (ColDRISC). The translation of the Diabetes Prevention Program study in a Latino population in Venezuela found a significant improvement in cardiometabolic risk factors. An adaptation of the Diabetes Prevention Study in the DEMOJUAN study in Barranquilla, Colombia, reduced 2-hour postload glucose. CONCLUSION: Successful transculturalization strategies have been implemented in screening tools and prevention programs in LA.


Assuntos
Assistência à Saúde Culturalmente Competente , Diabetes Mellitus Tipo 2/prevenção & controle , Diabetes Mellitus Tipo 2/diagnóstico , Humanos , América Latina , Programas de Rastreamento
13.
F1000Res ; 62017.
Artigo em Inglês | MEDLINE | ID: mdl-29152218

RESUMO

The treatment of type 2 diabetes mellitus has evolved in the present century toward safer and maybe more effective drugs, which in some cases can also reduce the risk of cardiovascular and renal outcomes. Nevertheless, we still need better strategies to reduce excess body weight in order to achieve diabetes remission, which is now a feasible target, as has been demonstrated with bariatric surgery. This review focuses on the significant advances in the management of blood glucose in type 2 diabetes mellitus, including the current understanding of the mechanisms of drug action but keeping in mind that the treatment of the disease is multifactorial.

15.
Diab Vasc Dis Res ; 14(3): 172-183, 2017 05.
Artigo em Inglês | MEDLINE | ID: mdl-28467203

RESUMO

BACKGROUND: Glycaemic control is suboptimal in a large proportion of people with type 2 diabetes who are consequently at an increased and avoidable risk of potentially severe complications. We sought to explore attitudes and practices among healthcare professionals that may contribute to suboptimal glycaemic control through a review of recent relevant publications in the scientific literature. METHODS: An electronic search of the PubMed database was performed to identify relevant publications from January 2011 to July 2015. The electronic search was complemented by a manual search of abstracts from key diabetes conferences in 2014/2015 available online. RESULTS: Recently published data indicate that glycaemic control is suboptimal in a substantial proportion (typically 40%-60%) of people with diabetes. This is the case across geographic regions and in both low- and higher-income countries. Therapeutic inertia appears to be an important contributor to poor glycaemic control in up to half of people with type 2 diabetes. In particular, prescribers are often willing to tolerate extended periods of 'mild' hyperglycaemia as well as having low expectations for their patients. There are often delays of 3 years or longer in initiating or intensifying glucose-lowering therapy when needed. CONCLUSION: Many people with type 2 diabetes are failed by current management, with approximately half not achieving or maintaining appropriate target blood glucose levels, leaving these patients at increased and avoidable risk of serious complications. Review criteria: The methodology of this review article is detailed in the 'Methods' section.


Assuntos
Glicemia/efeitos dos fármacos , Diabetes Mellitus Tipo 2/tratamento farmacológico , Hipoglicemiantes/uso terapêutico , Biomarcadores/sangue , Glicemia/metabolismo , Diabetes Mellitus Tipo 2/sangue , Diabetes Mellitus Tipo 2/diagnóstico , Diabetes Mellitus Tipo 2/epidemiologia , Substituição de Medicamentos , Quimioterapia Combinada , Hemoglobina A Glicada/metabolismo , Fidelidade a Diretrizes , Humanos , Hipoglicemiantes/efeitos adversos , Guias de Prática Clínica como Assunto , Padrões de Prática Médica , Fatores de Risco , Fatores de Tempo , Tempo para o Tratamento , Resultado do Tratamento
17.
Invest. clín ; 58(1): 56-69, mar. 2017. ilus, graf
Artigo em Espanhol | LILACS-Express | ID: biblio-841137

RESUMO

The EVESCAM (EstudioVenezolano de Salud Cardio-Metabólica) is the first national, population survey in Venezuela, designed to examine the prevalence of diabetes and cardio-metabolic risk factors and its relationship with lifestyle. It is a cross-sectional, cluster sampling study, which recruited 4454 participants aged ≥ 20 years. The data were collected in community health-care centers by trained health professionals and medical students. The data collected from each subject included, after informed consent, structured questionnaires (clinical, demographic, physical activity, nutritional and psychological), anthropometric measurements (weight, height and waist circumference), body fat by bioelectrical impedance, hand grip, blood pressure, electrocardiogram, and biochemical measurements (standard 75 g oral glucose tolerance test, total cholesterol, HDL-cholesterol, LDL-cholesterol and triglycerides). The data will be used to estimate the prevalence of overweight, obesity, prediabetes, diabetes, hypertension, dyslipidemias, sarcopenia and metabolic syndrome; and to examine their relationships with lifestyle factors. The risk of coronary heart disease and impaired glucose regulation will be estimated using the Framingham Coronary Heart Disease Risk Score and the Latin America adaptation of the Finnish Diabetes Risk Score (LA-FINDRISC), respectively. These results will guide national cardiovascular and diabetes prevention strategies, and will be available for government agencies to help in the implementation of public health policies.


El EVESCAM (Estudio Venezolano de Salud Cardio-Metabólica) es el primer estudio poblacional de muestreo nacional en Venezuela diseñado para examinar la prevalencia de diabetes y factores de riesgo cardio-metabólico, y su relación con el estilo de vida. Se trata de un estudio transversal de muestreo por conglomerados, reclutando 4454 participantes de 20 años o más. Los datos fueron recogidos en centros de salud de la comunidad por profesionales de salud y estudiantes de medicina entrenados. Después del consentimiento infor mado, los datos recolectados en cada sujeto incluyeron: cuestionarios estructurados (clínico, demográfico, actividad física, nutricional y psicológico), medidas antropométricas (peso, talla y circunferencia de cintura), grasa corporal por impedancia bioeléctrica, fuerza de aprehensión de la mano, presión arterial, electrocardiograma y medidas bioquímicas (prueba de tolerancia a la glucosa oral estándar con 75 g de glucosa, colesterol total, colesterol HDL, colesterol LDL y triglicéridos). Los datos se utilizarán para estimar la prevalencia de sobrepeso, obesidad, prediabetes, diabetes, hipertensión arterial, dislipidemias, sarcopenia y síndrome metabólico; y para examinar sus relaciones con factores de estilo de vida. El riesgo de cardiopatía coronaria y de alteración de la regulación de la glucosa se calculará utilizando la puntuación de riesgo de la enfermedad coronaria de Framingham y la adaptación para Latinoamérica de la puntuación finlandesa del riesgo de diabetes (LA-FINDRISC), respectivamente. Estos resultados guiarán las estrategias nacionales de prevención cardiovascular y diabetes, y estarán disponibles para que las agencias gubernamentales ayuden en la implementación de las políticas de salud pública.

18.
Diabetes Care ; 40(2): 164-170, 2017 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-27630212

RESUMO

OBJECTIVE: We evaluated the incidence of acute pancreatitis and pancreatic cancer in patients with type 2 diabetes and cardiovascular disease who were treated with sitagliptin, a dipeptidyl peptidase-4 inhibitor (DPP-4i). RESEARCH DESIGN AND METHODS: In the Trial Evaluating Cardiovascular Outcomes with Sitagliptin (TECOS) study, a cardiovascular safety study of sitagliptin, all suspected cases of acute pancreatitis and pancreatic cancer were collected prospectively for 14,671 participants during a median follow-up time of 3 years, and were adjudicated blindly. RESULTS: Baseline differences were minimal between participants confirmed to have no pancreatic events, acute pancreatitis, or pancreatic cancer. Among those participants randomized to receive sitagliptin, 23 (0.3%) (vs. 12 randomized to receive placebo [0.2%]) had pancreatitis (hazard ratio 1.93 [95% CI 0.96-3.88], P = 0.065; 0.107 vs. 0.056/100 patient-years), with 25 versus 17 events, respectively. Severe pancreatitis (two fatal) occurred in four individuals allocated to receive sitagliptin. Cases of pancreatic cancer were numerically fewer with sitagliptin (9 [0.1%]) versus placebo (14 [0.2%]) (hazard ratio 0.66 [95% CI 0.28-1.51], P = 0.32; 0.042 vs. 0.066 events/100 patient-years). Meta-analysis with two other DPP-4i cardiovascular outcome studies showed an increased risk for acute pancreatitis (risk ratio 1.78 [95% CI 1.13-2.81], P = 0.01) and no significant effect for pancreatic cancer (risk ratio 0.54 [95% CI 0.28-1.04], P = 0.07). CONCLUSIONS: Pancreatitis and pancreatic cancer were uncommon events with rates that were not statistically significantly different between the sitagliptin and placebo groups, although numerically more sitagliptin participants developed pancreatitis and fewer developed pancreatic cancer. Meta-analysis suggests a small absolute increased risk for pancreatitis with DPP-4i therapy.


Assuntos
Inibidores da Dipeptidil Peptidase IV/efeitos adversos , Neoplasias Pancreáticas/diagnóstico , Pancreatite/diagnóstico , Fosfato de Sitagliptina/efeitos adversos , Doença Aguda , Idoso , Doenças Cardiovasculares/tratamento farmacológico , Diabetes Mellitus Tipo 2/tratamento farmacológico , Inibidores da Dipeptidil Peptidase IV/administração & dosagem , Método Duplo-Cego , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Neoplasias Pancreáticas/induzido quimicamente , Pancreatite/induzido quimicamente , Modelos de Riscos Proporcionais , Fatores de Risco , Fosfato de Sitagliptina/administração & dosagem , Resultado do Tratamento
19.
Invest Clin ; 58(1): 56-69, 2017 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-29939500

RESUMO

The EVESCAM (EstudioVenezolano de Salud Cardio-Metabólica) is the first national, population survey in Venezuela, designed to examine the prevalence of diabetes and cardio-metabolic risk factors and its relationship with lifestyle. It is a cross-sectional, cluster sampling study, which recruited 4454 participants aged ≥ 20 years. The data were collected in community health-care centers by trained health professionals and medical students. The data collected from each subject included, after informed consent, structured questionnaires (clinical, demographic, physical activity, nutritional and psychological), anthropometric measurements (weight, height and waist circumference), body fat by bioelectrical impedance, hand grip, blood pressure, electrocardiogram, and biochemical measurements (standard 75 g oral glucose tolerance test, total cholesterol, HDL-cholesterol, LDL-cholesterol and triglycerides). The data will be used to estimate the prevalence of overweight, obesity, prediabetes, diabetes, hypertension, dyslipidemias, sarcopenia and metabolic syndrome; and to examine their relationships with lifestyle factors. The risk of coronary heart disease and impaired glucose regulation will be estimated using the Framingham Coronary Heart Disease Risk Score and the Latin America adaptation of the Finnish Diabetes Risk Score (LA-FINDRISC), respectively. These results will guide national cardiovascular and diabetes prevention strategies, and will be available for government agencies to help in the implementation of public health policies.


Assuntos
Síndrome Metabólica/epidemiologia , Adulto , Estudos Transversais , Feminino , Humanos , Masculino , Prevalência , Fatores de Risco , Venezuela/epidemiologia , Adulto Jovem
20.
Colomb Med (Cali) ; 47(2): 109-31, 2016 Jun 30.
Artigo em Inglês | MEDLINE | ID: mdl-27546934

RESUMO

In Colombia, diabetes mellitus is a public health program for those responsible for creating and implementing strategies for prevention, diagnosis, treatment, and follow-up that are applicable at all care levels, with the objective of establishing early and sustained control of diabetes. A clinical practice guide has been developed following the broad outline of the methodological guide from the Ministry of Health and Social Welfare, with the aim of systematically gathering scientific evidence and formulating recommendations using the GRADE (Grading of Recommendations Assessment, Development and Evaluation) methodology. The current document presents in summary form the results of this process, including the recommendations and the considerations taken into account in formulating them. In general terms, what is proposed here is a screening process using the Finnish Diabetes Risk Score questionnaire adapted to the Colombian population, which enables early diagnosis of the illness, and an algorithm for determining initial treatment that can be generalized to most patients with diabetes mellitus type 2 and that is simple to apply in a primary care context. In addition, several recommendations have been made to scale up pharmacological treatment in those patients that do not achieve the objectives or fail to maintain them during initial treatment. These recommendations also take into account the evolution of weight and the individualization of glycemic control goals for special populations. Finally, recommendations have been made for opportune detection of micro- and macrovascular complications of diabetes.


Assuntos
Diabetes Mellitus Tipo 2/diagnóstico , Diabetes Mellitus Tipo 2/terapia , Adulto , Fatores Etários , Idoso , Albuminúria/diagnóstico , Doenças Cardiovasculares/sangue , Doenças Cardiovasculares/diagnóstico , Colômbia , Diabetes Mellitus Tipo 2/prevenção & controle , Dieta para Diabéticos , Quimioterapia Combinada , Hemoglobina A Glicada/análise , Humanos , Hipoglicemiantes/uso terapêutico , Estilo de Vida , Pessoa de Meia-Idade , Inquéritos e Questionários
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