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1.
Arq. bras. cardiol ; 109(6,supl.1): 1-31, dez. 2017. tab
Artigo em Português | LILACS-Express | ID: biblio-887990

RESUMO

Resumo Fundamentação: desde o primeiro posicionamento da Sociedade Brasileira de Diabetes (SBD) sobre diabetes e prevenção cardiovascular, em 2014,1 importantes estudos têm sido publicados na área de prevenção cardiovascular e tratamento do diabetes,2 os quais contribuíram para a evolução na prevenção primária e secundária nos pacientes com diabetes. Ferramentas de estratificação de risco mais precisas, novos fármacos hipolipemiantes e novos antidiabéticos com efeitos cardiovasculares e redução da mortalidade, são parte desta nova abordagem para os pacientes com diabetes. O reconhecimento de que o diabetes é uma doença heterogênea foi fundamental, sendo claramente demonstrado que nem todos os pacientes diabéticos pertencem a categorias de risco alto ou muito alto. Um porcentual elevado é composto por pacientes jovens, sem os fatores de risco clássicos, os quais podem ser classificados adequadamente em categorias de risco intermediário ou mesmo em baixo risco cardiovascular. O presente posicionamento revisa as melhores evidências atualmente disponíveis e propõe uma abordagem prática, baseada em risco, para o tratamento de pacientes com diabetes. Estruturação: perante este desafio e reconhecendo a natureza multifacetada da doença, a SBD uniu-se à Sociedade Brasileira de Cardiologia (SBC) e à Sociedade Brasileira de Endocrinologia e Metabolismo (SBEM), e formou um painel de especialistas, constituído por 28 cardiologistas e endocrinologistas, para revisar as melhores evidências disponíveis e elaborar uma diretriz contendo recomendações práticas para a estratificação de risco e prevenção da Doença Cardiovascular (DVC) no Diabetes Melito (DM). As principais inovações incluem: (1) considerações do impacto de novos hipolipemiantes e das novas medicações antidiabéticas no risco cardiovascular; (2) uma abordagem prática, baseada em fator de risco, para orientar o uso das estatinas, incluindo novas definições das metas da Lipoproteína de Baixa Densidade-colesterol (LDL-colesterol) e colesterol não Lipoproteína de Alta Densidade HDL; (3) uma abordagem baseada em evidências, para avaliar a isquemia miocárdica silenciosa (IMS) e a aterosclerose subclínica em pacientes com diabetes; (4) as abordagens mais atuais para o tratamento da hipertensão; e (5) recomendação de atualizações para o uso de terapia antiplaquetária. Esperamos que esta diretriz auxilie os médicos no cuidado dedicado aos pacientes com diabetes. Métodos: inicialmente, os membros do painel foram divididos em sete subcomitês para definirem os tópicos principais que necessitavam de uma posição atualizada das sociedades. Os membros do painel pesquisaram e buscaram no PubMed estudos clínicos randomizados e metanálises de estudos clínicos e estudos observacionais de boa qualidade, publicados entre 1997 e 2017, usando termos MeSH: [diabetes], [diabetes tipo 2], [doença cardiovascular], [estratificação de risco cardiovascular] [doença arterial coronária], [rastreamento], [isquemia silenciosa], [estatinas], [hipertensão], [ácido acetilsalicílico]. Estudos observacionais de baixa qualidade, metanálises com alta heterogeneidade e estudos transversais não foram incluídos, embora talvez tenham impactado no Nível de Evidência indicado. A opinião de especialistas foi usada quando os resultados das buscas não eram satisfatórios para um item específico. É importante salientar que este posicionamento não teve a intenção de incluir uma revisão sistemática rigorosa. Um manuscrito preliminar, destacando recomendações de graus e níveis de evidência (Quadro 1), foi esboçado. Este passo levou a várias discussões entre os membros dos subcomitês, que revisaram os achados e fizeram novas sugestões. O manuscrito foi, então, revisto pelo autor líder, encarregado da padronização do texto e da inclusão de pequenas alterações, sendo submetido à apreciação mais detalhada pelos membros dos comitês, buscando uma posição de consenso. Depois desta fase, o manuscrito foi enviado para a banca editorial e edição final, sendo encaminhado para publicação. Quadro 1 Graus de recomendações e níveis de evidências adotados nesta revisão Grau de recomendação Classe I A evidência é conclusiva ou, se não, existe consenso de que o procedimento ou tratamento é seguro e eficaz Classe II Há evidências contraditórias ou opiniões divergentes sobre segurança, eficácia, ou utilidade do tratamento ou procedimento Classe IIa As opiniões são favoráveis ao tratamento ou procedimento. A maioria dos especialistas aprova Classe IIb A eficácia é bem menos estabelecida, e as opiniões são divergentes Classe III Há evidências ou consenso de que o tratamento ou procedimento não é útil, eficaz, ou pode ser prejudicial Níveis de Evidência A Múltiplos estudos clínicos randomizados concordantes e bem elaborados ou metanálises robustas de estudos clínicos randomizados B Dados de metanálises menos robustas, um único estudo clínico randomizado ou estudos observacionais C Opinião dos especialistas

2.
Diabetol Metab Syndr ; 9: 70, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-28932289

RESUMO

[This corrects the article DOI: 10.1186/s13098-017-0225-1.].

3.
Diabetol Metab Syndr ; 9: 53, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-28725272

RESUMO

BACKGROUND: Since the first position statement on diabetes and cardiovascular prevention published in 2014 by the Brazilian Diabetes Society, the current view on primary and secondary prevention in diabetes has evolved as a result of new approaches on cardiovascular risk stratification, new cholesterol lowering drugs, and new anti-hyperglycemic drugs. Importantly, a pattern of risk heterogeneity has emerged, showing that not all diabetic patients are at high or very high risk. In fact, most younger patients who have no overt cardiovascular risk factors may be more adequately classified as being at intermediate or even low cardiovascular risk. Thus, there is a need for cardiovascular risk stratification in patients with diabetes. The present panel reviews the best current evidence and proposes a practical risk-based approach on treatment for patients with diabetes. MAIN BODY: The Brazilian Diabetes Society, the Brazilian Society of Cardiology, and the Brazilian Endocrinology and Metabolism Society gathered to form an expert panel including 28 cardiologists and endocrinologists to review the best available evidence and to draft up-to-date an evidence-based guideline with practical recommendations for risk stratification and prevention of cardiovascular disease in diabetes. The guideline includes 59 recommendations covering: (1) the impact of new anti-hyperglycemic drugs and new lipid lowering drugs on cardiovascular risk; (2) a guide to statin use, including new definitions of LDL-cholesterol and in non-HDL-cholesterol targets; (3) evaluation of silent myocardial ischemia and subclinical atherosclerosis in patients with diabetes; (4) hypertension treatment; and (5) the use of antiplatelet therapy. CONCLUSIONS: Diabetes is a heterogeneous disease. Although cardiovascular risk is increased in most patients, those without risk factors or evidence of sub-clinical atherosclerosis are at a lower risk. Optimal management must rely on an approach that will cover both cardiovascular disease prevention in individuals in the highest risk as well as protection from overtreatment in those at lower risk. Thus, cardiovascular prevention strategies should be individualized according to cardiovascular risk while intensification of treatment should focus on those at higher risk.

4.
Diabetol Metab Syndr ; 9: 25, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-28435446

RESUMO

Although patients with diabetes have 2 to 4 times increased risk of cardiovascular morbidity and mortality than individuals without diabetes, recent studies indicate that a significant part of patients are in a lower cardiovascular risk category. Men younger than 35 years, women younger than 45 years, patients with diabetes duration of less than 10 years without other risk factors have a much lower risk than patients who have traditional cardiovascular risk factors, and subclinical or established coronary artery disease (CAD). These patients are not risk equivalent as stated in previous studies. On the contrary, when in the presence of traditional risk factors or evidence of subclinical coronary disease (e.g. high coronary calcium score), the coronary risk is much increased and patients may be classified at a higher-risk category. Recent guidelines do not anymore consider diabetes as a CAD risk equivalent and recommend cardiovascular risk stratification for primary prevention. Stratification of diabetic patients improves accuracy in prediction of subclinical CAD, silent ischemia and future cardiovascular events. Stratification also discriminates higher from lower risk patients who may need intensive statin or aspirin prevention, while avoiding overtreatment in lower risk cases. It may also allow the clinician to decide whether to intensify risk reduction actions through specific newer drugs for glucose control such as SGLT-2 inhibitors or GLP-1 agonists, which recently have shown additional cardiovascular protector effect. This review addresses the assessment of cardiovascular disease risk using traditional and non-traditional cardiovascular risk factors. It also reviews the use of risk calculators and new reclassification tools, focusing on the detection of subclinical atherosclerosis as well as silent ischemia in the asymptomatic patients with diabetes.

5.
Nutr Metab (Lond) ; 14: 18, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-28239405

RESUMO

BACKGROUND: Non-nutritive sweeteners (NNS) have been associated with increased prevalence of obesity. In previous studies, we demonstrated that saccharin could induce an increase in weight gain either when compared to sucrose or to a non-sweetened control at a similar total caloric intake. These data raised the hypothesis that reduced energy expenditure (EE) could be a potential mechanism explaining greater weight gain with saccharin use in rats. The aim of the present study was to compare long-term energy expenditure at rest between rats using saccharin or sucrose and correlate it with weight gain. . METHODS: In the present study, we examine the potential impact of saccharin compared to sucrose in the EE of Wistar rats. In a controlled experiment of 17 weeks, 24 Wistar rats were divided into 2 groups: saccharin-sweetened yogurt (SAC) or sucrose-sweetened yogurt (SUC), plus a free chow diet. Only rats that consumed at least 70% of the offered yogurt were included. EE (kcal/day) was determined at rest through open circuit indirect calorimetry system in the early post-absorptive period with determinations of both VO2 consumption and CO2 production. Measurements were evaluated at baseline, 5 and 12 weeks of dietary intervention. Weight gain, caloric intake (from yogurt, from chow and total) were determined weekly. RESULTS: Body weight and EE were similar between groups at baseline: (p = .35) and (p = .67) respectively. At the end of the study, SAC increased total weight gain significantly more in relation to SUC (p = .03). Cumulative total caloric intake (yogurt plus chow) was similar between groups during the whole period (p = .54). At 12 weeks, the EE was smaller in SAC compared to SUC (p = .009). Considering both groups, there was a strong negative correlation between total weight gain and change in EE observed [r(20) = -.61, p = .003]. However, when analyzing the groups separately we found that SUC maintained this inverse correlation [r(8) = -.68, p = .03], while SAC did not [r(10) = -.33, p = .29]. CONCLUSION: These data support the hypothesis that long-term use of saccharin may blunt post-absorptive EE at rest in Wistar rats, which is related to weight gain. On the other hand, long-term sucrose intake can increase energy expenditure in rats. This effect combined can explain, at least partially, the weight gain increases associated to saccharin in relation to sucrose in these animals.

7.
Diabetol Metab Syndr ; Jul(9): 53-53, 2017.
Artigo em Inglês | Sec. Est. Saúde SP, SESSP-IDPCPROD, Sec. Est. Saúde SP | ID: ses-36559

RESUMO

BACKGROUND: Since the first position statement on diabetes and cardiovascular prevention published in 2014 by the Brazilian Diabetes Society, the current view on primary and secondary prevention in diabetes has evolved as a result of new approaches on cardiovascular risk stratification, new cholesterol lowering drugs, and new anti-hyperglycemic drugs. Importantly, a pattern of risk heterogeneity has emerged, showing that not all diabetic patients are at high or very high risk. In fact, most younger patients who have no overt cardiovascular risk factors may be more adequately classified as being at intermediate or even low cardiovascular risk. Thus, there is a need for cardiovascular risk stratification in patients with diabetes. The present panel reviews the best current evidence and proposes a practical risk-based approach on treatment for patients with diabetes. MAIN BODY: The Brazilian Diabetes Society, the Brazilian Society of Cardiology, and the Brazilian Endocrinology and Metabolism Society gathered to form an expert panel including 28 cardiologists and endocrinologists to review the best available evidence and to draft up-to-date an evidence-based guideline with practical recommendations for risk stratification and prevention of cardiovascular disease in diabetes. The guideline includes 59 recommendations covering: (1) the impact of new anti-hyperglycemic drugs and new lipid lowering drugs on cardiovascular risk; (2) a guide to statin use, including new definitions of LDL-cholesterol and in non-HDL-cholesterol targets; (3) evaluation of silent myocardial ischemia and subclinical atherosclerosis in patients with diabetes; (4) hypertension treatment; and (5) the use of antiplatelet therapy...(AU)


Assuntos
Glucose , Sangue , Doença da Artéria Coronariana , Diabetes Mellitus , Dislipidemias , Hipertensão , Fatores de Risco
8.
Appetite ; 96: 604-610, 2016 Jan 01.
Artigo em Inglês | MEDLINE | ID: mdl-26555482

RESUMO

In a previous study, we showed that saccharin can induce weight gain when compared with sucrose in Wistar rats despite similar total caloric intake. We now question whether it could be due to the sweet taste of saccharin per se. We also aimed to address if this weight gain is associated with insulin-resistance and to increases in gut peptides such as leptin and PYY in the fasting state. In a 14 week experiment, 16 male Wistar rats received either saccharin-sweetened yogurt or non-sweetened yogurt daily in addition to chow and water ad lib. We measured daily food intake and weight gain weekly. At the end of the experiment, we evaluated fasting leptin, glucose, insulin, PYY and determined insulin resistance through HOMA-IR. Cumulative weight gain and food intake were evaluated through linear mixed models. Results showed that saccharin induced greater weight gain when compared with non-sweetened control (p = 0.027) despite a similar total caloric intake. There were no differences in HOMA-IR, fasting leptin or PYY levels between groups. We conclude that saccharin sweet taste can induce mild weight gain in Wistar rats without increasing total caloric intake. This weight gain was not related with insulin-resistance nor changes in fasting leptin or PYY in Wistar rats.


Assuntos
Ingestão de Energia , Resistência à Insulina , Sacarina/efeitos adversos , Paladar , Ganho de Peso , Animais , Glicemia/metabolismo , Água Potável , Jejum , Transportador de Glucose Tipo 2/genética , Transportador de Glucose Tipo 2/metabolismo , Insulina/sangue , Leptina/sangue , Masculino , Peptídeo YY/sangue , Ratos , Sacarina/administração & dosagem , Iogurte
9.
Arq Bras Endocrinol Metabol ; 58(4): 377-81, 2014 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-24936732

RESUMO

OBJECTIVE: The objective of this study was to evaluate the association between insulin-resistance and fasting levels of ghrelin and PYY in Wistar rats. MATERIALS AND METHODS: A total of 25 male Wistar rats, weighing 200-300 g, was included in this study. The animals were maintained in cages with a 12/12h light-dark cycle and fed standard chow and water ad libitum. After 12-h overnight fasting, ghrelin, PYY, insulin and glucose values were determined. Insulin resistance was assessed by means of the HOMA-IR, which was ranked and the median was used as a cut-off value to categorize insulin-resistance. HOMA-IR values equal and above 2.62 were considered insulin-resistant (IR) while values below 2.62 were considered insulin sensitive (IS). Differences between means were determined using the Student t-test. Multiple regression and Pearson's correlation test were used to evaluate the association between variables. RESULTS: HOMA-IR median IQ range values for IS and IR groups were, respectively, 1.56 (0.89 - 2.16) vs. [4.06 (3.50 - 4.61); p < 0.001]. The IR group presented increased levels of fasting ghrelin, PYY and insulin respectively: [50.35 (25.99 - 74.71) pg/mL vs. 12.33 (8.77 - 15.89) pg/mL; p = 0.001]; [54.38 (37.50 - 71.26) pg/mL vs. 33.17 (22.34 - 43.99) pg/mL; p = 0.016]; [18.04 (14.48 - 21.60) uU/mL vs. 7.09 (4.83 - 9.35) uU/mL; p = 0.001]. Ghrelin, but not PYY, correlated linearly and positively with HOMA-IR: ghrelin vs. HOMA-IR (r = 0.52; p = 0.008), and PYY vs. HOMA-IR (r = 0.22; p = 0.200). This correlation was independent of body weight. CONCLUSION: Fasting ghrelin and PYY serum levels are increased in lean, relatively insulin resistant Wistar rats, and this increase is independent of weight.


Assuntos
Peso Corporal/fisiologia , Jejum/metabolismo , Grelina/metabolismo , Resistência à Insulina/fisiologia , Fragmentos de Peptídeos/metabolismo , Peptídeo YY/metabolismo , Animais , Glicemia/análise , Estudos Transversais , Grelina/sangue , Insulina/sangue , Masculino , Fragmentos de Peptídeos/sangue , Peptídeo YY/sangue , Ratos Wistar , Análise de Regressão
10.
Arq. bras. endocrinol. metab ; 58(4): 377-381, 06/2014. tab, graf
Artigo em Inglês | LILACS | ID: lil-711633

RESUMO

Objective: The objective of this study was to evaluate the association between insulin-resistance and fasting levels of ghrelin and PYY in Wistar rats. Materials and methods: A total of 25 male Wistar rats, weighing 200-300 g, was included in this study. The animals were maintained in cages with a 12/12h light-dark cycle and fed standard chow and water ad libitum. After 12-h overnight fasting, ghrelin, PYY, insulin and glucose values were determined. Insulin resistance was assessed by means of the HOMA-IR, which was ranked and the median was used as a cut-off value to categorize insulin-resistance. HOMA-IR values equal and above 2.62 were considered insulin-resistant (IR) while values below 2.62 were considered insulin sensitive (IS). Differences between means were determined using the Student t-test. Multiple regression and Pearson’s correlation test were used to evaluate the association between variables. Results: HOMA-IR median IQ range values for IS and IR groups were, respectively, 1.56 (0.89 – 2.16) vs. [4.06 (3.50 – 4.61); p < 0.001]. The IR group presented increased levels of fasting ghrelin, PYY and insulin respectively: [50.35 (25.99 – 74.71) pg/mL vs. 12.33 (8.77 – 15.89) pg/mL; p = 0.001]; [54.38 (37.50 – 71.26) pg/mL vs. 33.17 (22.34 – 43.99) pg/mL; p = 0.016]; [18.04 (14.48 – 21.60) uU/mL vs. 7.09 (4.83 – 9.35) uU/mL; p = 0.001]. Ghrelin, but not PYY, correlated linearly and positively with HOMA-IR: ghrelin vs. HOMA-IR (r = 0.52; p = 0.008), and PYY vs. HOMA-IR (r = 0.22; p = 0.200). This correlation was independent of body weight. Conclusion: Fasting ghrelin and PYY serum levels are increased in lean, relatively insulin resistant Wistar rats, and this increase is independent of weight. .


Objetivo: O objetivo deste estudo foi avaliar a associação entre a resistência à insulina e os níveis de grelina e PYY em jejum em ratos Wistar. Materiais e métodos: Um total de 25 ratos Wistar machos, pesando 200-300 g, foi usado neste estudo. Os animais foram mantidos em gaiolas com um ciclo de luz escuro de 12/12h e alimentados com ração padrão e água ad libitum. Depois de um jejum de 12h, os valores de grelina, PYY, insulina e glicose foram determinados. A resistência à insulina foi avaliada pelo HOMA-IR que foi ordenado e a mediana utilizada como valor de corte para categorizar a resistência à insulina. Os valores de HOMA-IR iguais ou acima de 2,62 foram considerados resistentes à insulina (RI), enquanto valores abaixo de 2,62 foram considerados sensíveis (SI). As diferenças entre as médias foram determinadas usando-se o teste t de Student. A análise de regressões múltiplas e o teste de correlação de Pearson foram usados para se avaliar a associação entre as variáveis. Resultados: A mediana e a variação IQ do HOMA-IR para os grupos RI e SI foram, respectivamente, 1,56 (0,89 – 2,16) contra [4,06 (3,50 – 4,61); p < 0,001]. O grupo RI apresentou níveis aumentados de grelina, PYY e insulina em jejum, respectivamente, [50,35 (25,99 – 74,71) pg/mL contra 12,33 (8,77 – 15,89) pg/mL; p = 0,001]; [54,38 (37,50 – 71,26) pg/mL contra 33,17 (22,34 – 43,99) pg/mL; p = 0,016]; [18,04 (14,48 – 21,60) uU/mL contra 7,09 (4,83 – 9,35) uU/mL; p = 0.001]. A grelina, mas não PYY, se correlacionou de forma linear e positiva com o HOMA-IR: a grelina contra HOMA-IR (r = 0,52; p = 0,008), e PYY contra HOMA-IR (r = 0,22; p = 0,200). Essa correlação foi independente do peso corporal. Conclusão: Os níveis séricos de jejum de grelina ...


Assuntos
Animais , Masculino , Peso Corporal/fisiologia , Jejum/metabolismo , Grelina/metabolismo , Resistência à Insulina/fisiologia , Fragmentos de Peptídeos/metabolismo , Peptídeo YY/metabolismo , Glicemia/análise , Estudos Transversais , Grelina/sangue , Insulina/sangue , Fragmentos de Peptídeos/sangue , Peptídeo YY/sangue , Ratos Wistar , Análise de Regressão
11.
Diabetol Metab Syndr ; 6: 58, 2014.
Artigo em Inglês | MEDLINE | ID: mdl-24855495

RESUMO

There is a very well known correlation between diabetes and cardiovascular disease but many health care professionals are just concerned with glycemic control, ignoring the paramount importance of controlling other risk factors involved in the pathogenesis of serious cardiovascular diseases. This Position Statement from the Brazilian Diabetes Society was developed to promote increased awareness in relation to six crucial topics dealing with diabetes and cardiovascular disease: Glicemic Control, Cardiovascular Risk Stratification and Screening Coronary Artery Disease, Treatment of Dyslipidemia, Hypertension, Antiplatelet Therapy and Myocardial Revascularization. The issue of what would be the best algorithm for the use of statins in diabetic patients received a special attention and a new Brazilian algorithm was developed by our editorial committee. This document contains 38 recommendations which were classified by their levels of evidence (A, B, C and D). The Editorial Committee included 22 specialists with recognized expertise in diabetes and cardiology.

12.
Appetite ; 60(1): 203-207, 2013 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-23088901

RESUMO

It has been suggested that the use of nonnutritive sweeteners (NNSs) can lead to weight gain, but evidence regarding their real effect in body weight and satiety is still inconclusive. Using a rat model, the present study compares the effect of saccharin and aspartame to sucrose in body weight gain and in caloric intake. Twenty-nine male Wistar rats received plain yogurt sweetened with 20% sucrose, 0.3% sodium saccharin or 0.4% aspartame, in addition to chow and water ad libitum, while physical activity was restrained. Measurements of cumulative body weight gain, total caloric intake, caloric intake of chow and caloric intake of sweetened yogurt were performed weekly for 12 weeks. Results showed that addition of either saccharin or aspartame to yogurt resulted in increased weight gain compared to addition of sucrose, however total caloric intake was similar among groups. In conclusion, greater weight gain was promoted by the use of saccharin or aspartame, compared with sucrose, and this weight gain was unrelated to caloric intake. We speculate that a decrease in energy expenditure or increase in fluid retention might be involved.


Assuntos
Aspartame/administração & dosagem , Sacarina/administração & dosagem , Sacarose/administração & dosagem , Ganho de Peso/efeitos dos fármacos , Animais , Ingestão de Energia , Metabolismo Energético , Masculino , Ratos , Ratos Wistar , Saciação/efeitos dos fármacos , Edulcorantes/administração & dosagem , Iogurte
13.
Rev Assoc Med Bras (1992) ; 57(1): 74-7, 2011 Jan-Feb.
Artigo em Português | MEDLINE | ID: mdl-21390463

RESUMO

This paper reviews involvement of the serotonergic system in the control of food intake and satiety. It is of great interest to understand the relevance of this system for physiological control of energy balance and obesity. Over 35 years of research suggest that serotonin (5-HT) plays an important role in satiety. Thus, the serotonergic system has been a viable target for weight control. The 5-HT has control over hunger and satiety through different receptors with distinct functions. The 5-HT2C receptor may be more important in the relationship between food intake and energy balance. This review will discuss the mechanisms of the serotonergic system involved in the control of food intake and satiety.


Assuntos
Ingestão de Alimentos/fisiologia , Fome/fisiologia , Hipotálamo/metabolismo , Saciação/fisiologia , Agonistas do Receptor de Serotonina/fisiologia , Animais , Humanos , Neurotransmissores/fisiologia , Obesidade/tratamento farmacológico , Saciação/efeitos dos fármacos , Serotonina/fisiologia , Agonistas do Receptor 5-HT1 de Serotonina/fisiologia , Agonistas do Receptor 5-HT2 de Serotonina/fisiologia
14.
J Clin Endocrinol Metab ; 96(5): 1493-9, 2011 May.
Artigo em Inglês | MEDLINE | ID: mdl-21346068

RESUMO

CONTEXT: The relation between endothelial dysfunction (ED), glycemic control, and early type I diabetes mellitus (T1DM) is unclear. OBJECTIVE: The objective of the study was to evaluate the association of ED, glycemic control, and the duration of diabetes in T1DM. DESIGN: This was a cross-sectional study. SETTING: The study was conducted at a public outpatient clinic. PATIENTS: Fifty-seven T1DM adolescents and 10 healthy age-matched controls participated in the study. INTERVENTION: There were no interventions. METHODS AND OUTCOME MEASURES: Endothelial function (ED) was evaluated by flow-mediated dilation (FMD) in the brachial artery after reactive hyperemia. Biochemical data, including HbA1c (glycohemoglobin), high-sensitivity C-reactive protein, lipids, and urinary albumin excretion were collected. Means of four HbA1c values collected at 3-month intervals in the first and second year before FMD analyses were obtained. RESULTS: Mean FMD was decreased in T1DM compared with controls (P = 0.023), independent of age, smoking, hypertension, or dyslipidemia. Twenty-eight of 57 T1DM patients enrolled (49%) had ED. FMD was decreased in microalbuminuric (4.1%) compared with normoalbuminuric patients (10.1%, P = 0.01) and controls (14.6%, P < 0.001). FMD correlated inversely with mean second-year HbA1c (r = -0.426, P = 0.02), particularly in patients with less than 5 yr of T1DM (r = -0.61, P = 0.004). In these patients, high-sensitivity C-reactive protein was strongly correlated with mean first-year HbA1c (r = -0.66, P = 0.0003). In patients with more than 5 yr of T1DM, we found no significant correlations between ED and glycemic control. CONCLUSIONS: Endothelial dysfunction is common in T1DM adolescents with less than 5 yr of disease. It is associated with duration of disease, microalbuminuria, and mean second-year HbA1c but not with mean first-year HbA1c. These data support the metabolic memory hypothesis.


Assuntos
Glicemia/metabolismo , Diabetes Mellitus Tipo 1/sangue , Diabetes Mellitus Tipo 1/fisiopatologia , Endotélio Vascular/fisiopatologia , Adolescente , Adulto , Idade de Início , Albuminúria/complicações , Biomarcadores , Artéria Braquial/fisiopatologia , Proteína C-Reativa/metabolismo , Estudos Transversais , Diabetes Mellitus Tipo 1/metabolismo , Feminino , Hemoglobina A Glicada/metabolismo , Humanos , Hiperemia/fisiopatologia , Inflamação/complicações , Inflamação/patologia , Lipídeos/sangue , Masculino , Fumar/efeitos adversos , Vasodilatação/fisiologia , Adulto Jovem
15.
Rev. Assoc. Med. Bras. (1992) ; 57(1): 74-77, jan.-fev. 2011.
Artigo em Português | LILACS | ID: lil-576155

RESUMO

Este trabalho revisa a participação do sistema serotonérgico no controle da ingestão de alimentos e saciedade. É de grande interesse compreender a relevância desse sistema para o controle fisiológico do balanço energético e da obesidade. Mais de 35 anos de pesquisas sugerem que a serotonina (5-HT) desempenha um importante papel na saciedade. Assim, o sistema serotonérgico tem sido um alvo viável para o controle de peso. A 5-HT apresenta controle sobre a fome e a saciedade através de diversos receptores, com diferentes funções. O receptor 5-HT2C parece ser o mais importante na relação entre ingestão alimentar e balanço energético. Nesta revisão serão discutidos os mecanismos do sistema serotonérgico envolvidos no controle da ingestão de alimentos e saciedade.


This paper reviews involvement of the serotonergic system in the control of food intake and satiety. It is of great interest to understand the relevance of this system for physiological control of energy balance and obesity. Over 35 years of research suggest that serotonin (5-HT) plays an important role in satiety. Thus, the serotonergic system has been a viable target for weight control. The 5-HT has control over hunger and satiety through different receptors with distinct functions. The 5-HT2C receptor may be more important in the relationship between food intake and energy balance. This review will discuss the mechanisms of the serotonergic system involved in the control of food intake and satiety.


Assuntos
Animais , Humanos , Ingestão de Alimentos/fisiologia , Fome/fisiologia , Hipotálamo/metabolismo , Saciação/fisiologia , Agonistas do Receptor de Serotonina/fisiologia , Neurotransmissores/fisiologia , Obesidade/tratamento farmacológico , Saciação/efeitos dos fármacos , /fisiologia , /fisiologia , Serotonina/fisiologia
16.
Clinics (Sao Paulo) ; 65(11): 1139-42, 2010.
Artigo em Inglês | MEDLINE | ID: mdl-21243287

RESUMO

INTRODUCTION: Endothelium-dependent dilation is improved in insulin-treated diabetic patients, but this effect is probably due to improved glycemic control. The objective of the present study was to compare endothelium-dependent dilation in patients with well-controlled type 2 diabetes who are or are not using insulin as part of their therapy. METHODS: We studied 27 patients with type 2 diabetes (11 women, 60.3 years ± 6 years, with HbA1c < 7% and no nephropathy), including 16 patients treated with anti-diabetic agents (No-Ins, 8 women) and 11 patients treated with insulin alone or in combination with anti-diabetic agents (Ins, 3 women). Endothelial function was evaluated by the dorsal hand vein technique, which measures changes in vein diameter in response to phenylephrine, acetylcholine (endothelium-dependent vasodilation) and sodium nitroprusside (endothelium-independent vasodilation). RESULTS: Age, systolic blood pressure (No-Ins: 129.4 mmHg ± 11.8 mmHg, Ins: 134.8 mmHg ± 12.0 mmHg; P= 0.257), HbA1c, lipids and urinary albumin excretion rate [No-Ins: 9 mg/24 h (0-14.1 mg/24 h) vs. Ins: 10.6 mg/24 h (7.5-14.4 mg/24 h), P=0.398] were similar between groups. There was no difference between endothelium-dependent vasodilation of the No-Ins group (59.3% ± 26.5%) vs. the Ins group (54.0% ± 16.3%; P=0.526). Endothelium-independent vasodilation was also similar between the No-Ins (113.7% ± 35.3%) and Ins groups (111.9% ± 28.5%; P=0.888). CONCLUSIONS: Subcutaneous insulin therapy does not interfere with venous endothelial function in type 2 diabetes when glycemic and blood pressure control are stable.


Assuntos
Diabetes Mellitus Tipo 2/tratamento farmacológico , Endotélio Vascular/efeitos dos fármacos , Hipoglicemiantes/farmacologia , Insulina/farmacologia , Vasodilatação/efeitos dos fármacos , Idoso , Pressão Sanguínea/efeitos dos fármacos , Diabetes Mellitus Tipo 2/fisiopatologia , Endotélio Vascular/fisiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Fatores de Risco , Estatísticas não Paramétricas
17.
Clinics ; 65(11): 1139-1142, 2010. tab
Artigo em Inglês | LILACS | ID: lil-571431

RESUMO

INTRODUCTION: Endothelium-dependent dilation is improved in insulin-treated diabetic patients, but this effect is probably due to improved glycemic control. The objective of the present study was to compare endothelium-dependent dilation in patients with well-controlled type 2 diabetes who are or are not using insulin as part of their therapy. METHODS: We studied 27 patients with type 2 diabetes (11 women, 60.3 years ± 6 years, with HbA1c < 7 percent and no nephropathy), including 16 patients treated with anti-diabetic agents (No-Ins, 8 women) and 11 patients treated with insulin alone or in combination with anti-diabetic agents (Ins, 3 women). Endothelial function was evaluated by the dorsal hand vein technique, which measures changes in vein diameter in response to phenylephrine, acetylcholine (endothelium-dependent vasodilation) and sodium nitroprusside (endothelium-independent vasodilation). RESULTS: Age, systolic blood pressure (No-Ins: 129.4 mmHg ± 11.8 mmHg, Ins: 134.8 mmHg ± 12.0 mmHg; P= 0.257), HbA1c, lipids and urinary albumin excretion rate [No-Ins: 9 mg/24 h (0-14.1 mg/24 h) vs. Ins: 10.6 mg/24 h (7.5-14.4 mg/24 h), P=0.398] were similar between groups. There was no difference between endothelium-dependent vasodilation of the No-Ins group (59.3 percent ± 26.5 percent) vs. the Ins group (54.0 percent ± 16.3 percent; P=0.526). Endothelium-independent vasodilation was also similar between the No-Ins (113.7 percent ± 35.3 percent) and Ins groups (111.9 percent ± 28.5 percent; P=0.888). CONCLUSIONS: Subcutaneous insulin therapy does not interfere with venous endothelial function in type 2 diabetes when glycemic and blood pressure control are stable.


Assuntos
Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , /tratamento farmacológico , Endotélio Vascular/efeitos dos fármacos , Hipoglicemiantes/farmacologia , Insulina/farmacologia , Vasodilatação/efeitos dos fármacos , Pressão Sanguínea/efeitos dos fármacos , /fisiopatologia , Endotélio Vascular/fisiologia , Fatores de Risco , Estatísticas não Paramétricas
18.
Arq Bras Endocrinol Metabol ; 52(2): 416-26, 2008 Mar.
Artigo em Português | MEDLINE | ID: mdl-18438553

RESUMO

Vascular complications are the main cause of mortality and morbidity in diabetes. Mechanisms involved in the development of micro and macrovascular disease are complex and partially understood, but invariably begin as a dysfunctional endothelium. Nitric oxide is an important regulator of endothelial function and the impairment of its activity is determinant of the endothelial dysfunction. In type 1 diabetes, many factors like acute, chronic and post-prandial hyperglycemia, as well as the duration of diabetes or autonomic neuropathy and microalbuminuria are associated to endothelial dysfunction. Oxidative stress, polyol pathway activation, protein kinase C activation and the presence of advanced glycation end-products are potential mechanisms involved in the development of endothelial dysfunction. Early detection of endothelial dysfunction has prognostic value for the development of vascular complications and may be important in strategies for primary prevention of cardiovascular endpoints in type 1 diabetes.


Assuntos
Aterosclerose/fisiopatologia , Diabetes Mellitus Tipo 1/fisiopatologia , Angiopatias Diabéticas/fisiopatologia , Endotélio Vascular/fisiopatologia , Adolescente , Adulto , Idoso , Albuminúria/metabolismo , Albuminúria/fisiopatologia , Aterosclerose/etiologia , Biomarcadores , Glicemia/metabolismo , Criança , Diabetes Mellitus Tipo 1/complicações , Angiopatias Diabéticas/complicações , Endotélio Vascular/patologia , Produtos Finais de Glicação Avançada/metabolismo , Humanos , Hiperglicemia/complicações , Hiperglicemia/fisiopatologia , Pessoa de Meia-Idade , Óxido Nítrico/biossíntese , Estresse Oxidativo/fisiologia , Fatores de Tempo , Adulto Jovem
19.
Arq. bras. endocrinol. metab ; 52(2): 416-426, mar. 2008. tab
Artigo em Português | LILACS | ID: lil-481010

RESUMO

As complicações vasculares são a maior causa de morbimortalidade em pacientes com diabetes. Os mecanismos envolvidos no desenvolvimento das doenças micro e macrovasculares são complexos e parcialmente compreendidos, mas se iniciam invariavelmente por um endotélio que se torna disfuncionado. O óxido nítrico é um importante regulador da função endotelial e o comprometimento da sua atividade é fator determinante para a disfunção endotelial (DE). No diabetes tipo 1, diversos fatores, como a hiperglicemia aguda, mau controle glicêmico crônico, tempo de diagnóstico e presença de neuropatia autonômica ou microalbuminúria estão associados à DE. Tanto o estresse oxidativo, como a ativação da via dos polóis, via da proteína quinase C e formação dos produtos avançados de glicação não-enzimática são potenciais mecanismos patogenéticos da DE. A detecção precoce da disfunção endotelial tem valor prognóstico para o desenvolvimento de complicações vasculares e pode ser importante em estratégias de prevenção primária de eventos cardiovasculares no diabetes tipo 1.


Vascular complications are the main cause of mortality and morbidity in diabetes. Mechanisms involved in the development of micro and macrovascular disease are complex and partially understood, but invariably begin as a dysfunctional endothelium. Nitric oxide is an important regulator of endothelial function and the impairment of its activity is determinant of the endothelial dysfunction. In type 1 diabetes, many factors like acute, chronic and post-prandial hyperglycemia, as well as the duration of diabetes or autonomic neuropathy and microalbuminuria are associated to endothelial dysfunction. Oxidative stress, polyol pathway activation, protein kinase C activation and the presence of advanced glycation end-products are potential mechanisms involved in the development of endothelial dysfunction. Early detection of endothelial dysfunction has prognostic value for the development of vascular complications and may be important in strategies for primary prevention of cardiovascular endpoints in type 1 diabetes.


Assuntos
Adolescente , Adulto , Idoso , Criança , Humanos , Pessoa de Meia-Idade , Adulto Jovem , Aterosclerose/fisiopatologia , Diabetes Mellitus Tipo 1/fisiopatologia , Angiopatias Diabéticas/fisiopatologia , Endotélio Vascular/fisiopatologia , Albuminúria/metabolismo , Albuminúria/fisiopatologia , Aterosclerose/etiologia , Biomarcadores , Glicemia/metabolismo , Diabetes Mellitus Tipo 1/complicações , Angiopatias Diabéticas/complicações , Endotélio Vascular/patologia , Produtos Finais de Glicação Avançada/metabolismo , Hiperglicemia/complicações , Hiperglicemia/fisiopatologia , Óxido Nítrico/biossíntese , Estresse Oxidativo/fisiologia , Fatores de Tempo , Adulto Jovem
20.
Diabetes Res Clin Pract ; 72(3): 258-64, 2006 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-16414143

RESUMO

With the aim to determine the influence of reducing systolic blood pressure in urinary TGF-beta1 of type 2 diabetes (DM2) with diabetic nephropathy (DN), 21 subjects with type 2 diabetes and proteinuria >500 mg/24 h were studied. Amlodipine and ramipril were added to their previous antihypertensive treatment for 12 weeks. Urinary TGF-beta1 (UTGF-beta1) was determined at 0, 4, 8 and 12 weeks. Plasma TGF-beta1 was determined at 0 and 12 weeks. Subjects whose mean systolic blood pressure (SBP) during treatment were under 140 mmHg were grouped as the better SBP controlled group (n = 11) and those with SBP equal to or greater than 140 mHg were grouped in a moderate SBP controlled group (n = 10). Compared to baseline, mean log UTGF-beta1 at 4, 8 and 12 weeks decreased (-0.22 +/- 0.15 pg/mg; p = 0.04) in better SBP controlled group but not in the moderate SBP controlled group (-0.12 +/- 0.08 pg/mg, p = 0.82). Mean SBP correlated with UTGF-beta1 (r = 0.458, p = 0.0357), and this effect was independent of HbA1c (p = 0.042). By controlling SBP in DM2 subjects with DN we might decrease UTGF-beta1. We propose that reduction of UTGF-beta1 is due to a decrease in renal TGF-beta1 production.


Assuntos
Pressão Sanguínea , Diabetes Mellitus Tipo 2/sangue , Diabetes Mellitus Tipo 2/urina , Nefropatias Diabéticas/sangue , Nefropatias Diabéticas/urina , Fator de Crescimento Transformador beta1/urina , Anlodipino/uso terapêutico , Inibidores da Enzima Conversora de Angiotensina/uso terapêutico , Anti-Hipertensivos/uso terapêutico , Atenolol/uso terapêutico , Glicemia/análise , Captopril/uso terapêutico , Creatinina/sangue , Creatinina/urina , Diabetes Mellitus Tipo 2/complicações , Nefropatias Diabéticas/tratamento farmacológico , Quimioterapia Combinada , Enalapril/uso terapêutico , Feminino , Seguimentos , Hemoglobina A Glicada/análise , Humanos , Hidroclorotiazida/uso terapêutico , Hipertensão/dietoterapia , Hipertensão/tratamento farmacológico , Hipertensão/urina , Masculino , Pessoa de Meia-Idade , Potássio/sangue , Propranolol/uso terapêutico , Ramipril/uso terapêutico
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