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1.
Arq Bras Cardiol ; 113(4): 787-891, 2019 Nov 04.
Artigo em Inglês, Português | MEDLINE | ID: mdl-31691761
2.
Int J Endocrinol ; 2019: 7065713, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31210762

RESUMO

Purpose: Graves' ophthalmopathy (GO) is the most common extra-thyroid manifestation of Graves' disease (GD). The Clinical Activity Score (CAS) has been widely used to evaluate GO inflammation severity and response to treatment; however, it is quite subjective. Infrared thermography (IRT) is a portable and low-cost device to evaluate local temperature and assess inflammation. The aim was to evaluate ocular temperature by IRT as an instrument for measuring inflammatory activity in GO and its correlation with CAS. Methods: This is a cross-sectional study involving 136 consecutive GD patients (12 with CAS ≥ 3/7, 62 with CAS < 3 and 62 without apparent GO) with 62 healthy controls. Patients with active ophthalmopathy were prospectively evaluated. Exophthalmometry, CAS, and thermal images from caruncles and upper eyelids were acquired from all subjects. Results: All eye areas of thermal evaluation had higher temperatures in GD patients with active ophthalmopathy (caruncles, p<0.0001; upper eyelids, p<0.0001), and it was positively correlated with CAS (r=0.60 and p<0.0001 at caruncles; r=0.58 and p<0.0001 at upper eyelids). No difference in temperature was found between other groups. Patients with active ophthalmopathy were prospectively evaluated after 6 or 12 months of the treatment and a significant difference was found in ophthalmometry (p=0.0188), CAS (p=0.0205), temperature of caruncles (p=0.0120), and upper eyelids (p=0.0066). Conclusions: IRT was an objective and simple tool for evaluation and follow-up of inflammation in GO, allowed evidencing patients with significant inflammatory activity, and had a good correlation with the CAS score.

3.
Endocrine ; 63(1): 87-93, 2019 01.
Artigo em Inglês | MEDLINE | ID: mdl-30173328

RESUMO

PURPOSE: To assess quality of life (QoL) and cognitive function among Graves' disease (GD) patients with different thyroid status, with and without ophthalmopathy. METHODS: This is a cross-sectional clinic-based study involving 154 patients with GD (81.27% were female, mean age 45.6 ± SD 11.2 years) and 54 (35.06%) had ophthalmopathy. Data were collected after an informed consent from all patients was obtained. All patients completed the 36-Item Short Form Health Survey and Mini-Mental State Examination. Patients with ophthalmopathy also completed the Graves' Orbitopathy Quality of Life Questionnaire. RESULTS: Patients with hyperthyroidism presented a greater impairment in QoL when compared to euthyroidism group. A lower score in physical role functioning was found in both subgroups with active disease (hyperthyroidism and euthyroidism using thionamides). A lower score was also seen in visual function, only in patients with hyperthyroidism, without difference in appearance. No difference was found in cognition between patients. Younger ages at diagnosis, male sex, euthyroidism and absence of ophthalmopathy were factors associated with better QoL, as well as a shorter disease duration was associated with better recall, attention and calculation. CONCLUSIONS: An impairment in QoL among patients with active GD was evidenced, even in those receiving thionamides and in euthyroidism. Ophthalmopathy was a factor associated with a poor QoL and no clear evidence of cognitive impairment was demonstrated.


Assuntos
Cognição , Doença de Graves/fisiopatologia , Doença de Graves/psicologia , Qualidade de Vida , Glândula Tireoide/fisiopatologia , Adulto , Fatores Etários , Idoso , Estudos Transversais , Feminino , Oftalmopatia de Graves/fisiopatologia , Oftalmopatia de Graves/psicologia , Humanos , Hipertireoidismo/etiologia , Hipertireoidismo/fisiopatologia , Hipertireoidismo/psicologia , Masculino , Testes de Estado Mental e Demência , Pessoa de Meia-Idade , Fatores Sexuais , Hormônios Tireóideos/sangue , Visão Ocular
4.
Int J Endocrinol ; 2018: 3171280, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30018638

RESUMO

To better understand the genesis of autoimmunity in Graves' disease (GD), it is essential to study the mechanism of apoptosis and cell proliferation in thyroid cells and intrathyroidal lymphocytic infiltrate of GD patients. Methods. A cross sectional, observational study performed by evaluating histopathological samples of thyroidectomy products from GD patients using immunohistochemistry. New histological sections were prepared for immunohistochemical analysis with markers of cell proliferation, antiproliferation, apoptosis, and antiapoptosis. Results. Patients with GD who underwent radioiodine therapy (RIT) had a lower lymphocytic expression level of p27Kip1, and those who took beta-blockers had higher expression levels of BID (BH3-interacting domain) and a lower Ki-67 expression level in thyrocytes than those who did not. The association of a shorter diagnostic time with a lower expression level of MCL-1 in thyroid cells suggests that the hyperthyroid state was related to a lower antiapoptotic effect on thyrocytes. In comparison to patients with GD not using antithyroid drugs (ATD), we found a lower expression level of BID in lymphocytes for those who used ATD. Conclusion. In GD, the hyperthyroid state was associated with a lower antiapoptotic effect on thyroid cells. RIT, beta-blockers, and thionamide act by stimulating apoptosis of thyrocytes by intrathyroidal lymphocytes.

5.
Endocr J ; 65(10): 1029-1037, 2018 Oct 29.
Artigo em Inglês | MEDLINE | ID: mdl-30058600

RESUMO

Several studies have shown the correlation between vitamin D [25(OH)D] deficiency and thyroid autoimmunity and reducing of thyroid autoantibodies in patients with normal levels of vitamin D combining with thyroid hormone replacement. However, other authors not agree with this association. It is still unclear whether the low 25(OH)D levels are the result of HT disease or a part of its cause. We studied 88 patients with HT regarding vitamin D status and thyroid autoimmunity markers as well as the relationship with cytokines produced by Th1, Th2, and Th17 cells compared with a control group of 71 euthyroid healthy subjects. The present study demonstrated that vitamin D concentrations were similar in patients HT and the control group. The reduction of free T4 levels was a predictor of vitamin D insufficiency for Hashimoto's thyroiditis, but not for the control group. Lower concentrations of TNF-α was a predictor of lower levels of vitamin D. Differences in the association between HT and vitamin D insufficiency remain unresolved in the literature. The thyroid hormone status would play a role in the maintenance of vitamin D sufficiency, and its immunomodulatory role would influence the presence of autoimmune thyroid disease. The positive correlation between free T4 and vitamin D concentrations suggests that adequate levothyroxine replacement in HT would be an essential factor in maintaining vitamin D at sufficient levels.


Assuntos
Doença de Hashimoto/sangue , Inflamação/sangue , Glândula Tireoide/fisiopatologia , Tiroxina/sangue , Vitamina D/análogos & derivados , Adulto , Idoso , Feminino , Doença de Hashimoto/fisiopatologia , Humanos , Inflamação/fisiopatologia , Masculino , Pessoa de Meia-Idade , Testes de Função Tireóidea , Fator de Necrose Tumoral alfa/sangue , Vitamina D/sangue , Adulto Jovem
6.
Diabetes Metab Syndr ; 12(1): 39-44, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-28864058

RESUMO

AIMS: We aimed to explore insulin initiation barriers in the Brazilian Type 2 Diabetes Mellitus (T2DM) elderly population, according to the physician's perspective, and suggest strategies to overcome them. METHODS: A 45-questions survey addressing issues as clinical characteristics, barriers to insulinization, and treatment strategies in elderly patients with T2DM, was sent to six endocrinologists from different Brazilian locations. Thereafter, all the respondents participated in a panel discussion to validate their responses and collect additional relevant data. RESULTS: Endocrinologists had at least 15 years of experience, with a mean of 63 elderly patients per month. Nearly 25% of the elderly patients were treated in the Brazilian public healthcare system (SUS, Unified Health System); only a quarter presented proper glycemic control. In contrast, 55% of the patients from private healthcare system presented adequate glycemic control. The main barriers for insulin initiation for patients, according to physicians' perspective, are side effects and negative perception over treatment (100%). For endocrinologists, main barriers were lack of time to guide patients and concern over side effects (83%). Therefore, specialists considered education for both healthcare professionals and patients as one of the most important strategies to circumvent the current scenario related insulin therapy among elderly patients in the country. CONCLUSION: Insulin therapy remains underused due to several barriers, such as concern over side effects and negative perception. Educational measures for patients and HCPs could improve the current scenario.


Assuntos
Atitude do Pessoal de Saúde , Diabetes Mellitus Tipo 2/tratamento farmacológico , Conhecimentos, Atitudes e Prática em Saúde , Hipoglicemiantes/uso terapêutico , Insulina/uso terapêutico , Biomarcadores/análise , Glicemia/análise , Diabetes Mellitus Tipo 2/psicologia , Seguimentos , Hemoglobina A Glicada/análise , Pessoal de Saúde/psicologia , Humanos , Pessoa de Meia-Idade , Aceitação pelo Paciente de Cuidados de Saúde , Padrões de Prática Médica/normas , Prognóstico
7.
Diabetol Metab Syndr ; 9: 34, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-28507609

RESUMO

BACKGROUND: Obesity's increasing follows decreased perception of weight status in obese persons, mainly female, undergoing age-related changes. OBJECTIVE: To study weight perception and psychological alterations associated to MS and T2DM. METHODS: 200 patients selected from Metabolic Syndrome Outpatient Clinic of University of Campinas. Instruments: Beck Depression and Beck Anxiety Inventories', Toronto Alexithymia Scale-26s, questionnaire and data from reports. Approved by Unicamp Research Ethic Committee. RESULTS: Patients aged 18-40 years perceived their weight higher than actual (A < D) (p = 0.0272), amongst untreated hypertensive (p = 0.037). ≥41 years old patient's subdivided into A = D and A > D. A = D had 4.3 more chances to be alexithymic than A < D. 35% of A < D accepted their physical appearance, contrarily A = D (66%) and A > D (69%) (p = 0.0018). 50% of A < D felt offended by social aggression due to their weight; A = D (20%) and A > D (34%) (p = 0.007). 3.6 more chances of A > D than A < D using anti-hypertensive drugs (p = 0.021) (≥41 years old) and 3.5 more chances to perceive A = D (41-60 years old) (p = 0.023). A = D presented 3.8 more chances of depression than A < D and 4.3 more chances of alexithymia than A < D (62% of 41-60 year-old patients with higher cholesterol, mainly LDL and hyper-triglycerides). A = D with alexithymia, partially linked with higher cholesterol, suggests neuroinflammation due to hypertriglycerides. Females, who declared had been anteriorly made diet as treatment to lose weight were exactly those who perceived their weight A > D (45%, p = 0.0091). CONCLUSIONS: Age as a period of development, in which cultural influences occurs, was a factor in weight misperception. A < D and A > D were distinct in age, history of obesity and BMI.

8.
PLoS One ; 11(8): e0158751, 2016.
Artigo em Inglês | MEDLINE | ID: mdl-27490249

RESUMO

BACKGROUND: The major adverse consequences of obesity are associated with the development of insulin resistance (IR) and adiposopathy. The Homeostasis Model Assessment-Adiponectin (HOMA-AD) was proposed as a modified version of the HOMA1-IR, which incorporates adiponectin in the denominator of the index. OBJECTIVES: To evaluate the performance of the HOMA-AD index compared with the HOMA1-IR index as a surrogate marker of IR in women, and to establish the cutoff value of the HOMA-AD. SUBJECTS/METHODS: The Brazilian Metabolic Syndrome Study (BRAMS) is a cross-sectional multicenter survey. The data from 1,061 subjects met the desired criteria: 18-65 years old, BMI: 18.5-49.9 Kg/m² and without diabetes. The IR was assessed by the indexes HOMA1-IR and HOMA-AD (total sample) and by the hyperglycemic clamp (n = 49). Metabolic syndrome was defined using the IDF criteria. RESULTS: For the IR assessed by the clamp, the HOMA-AD demonstrated a stronger coefficient of correlation (r = -0.64) compared with the HOMA1-IR (r = -0.56); p < 0.0001. In the ROC analysis, compared with the HOMA1-IR, the HOMA-AD showed higher values of the AUC for the identification of IR based on the clamp test (AUC: 0.844 vs. AUC: 0.804) and on the metabolic syndrome (AUC: 0.703 vs. AUC: 0.689), respectively; p < 0.001 for all. However, the pairwise comparison did not show evidence of superiority for the HOMA-AD in comparison with the HOMA1-IR in the diagnosis of IR and metabolic syndrome (p > 0.05). The optimal cutoff identified for the HOMA-AD for the diagnosis of IR was 0.95. CONCLUSIONS: The HOMA-AD index was demonstrated to be a useful surrogate marker for detecting IR among adult women and presented a similar performance compared with the HOMA1-IR index. These results may assist physicians and researchers in determining which method to use to evaluate IR in light of the available facilities.


Assuntos
Adiponectina/metabolismo , Resistência à Insulina , Síndrome Metabólica/patologia , Adulto , Antropometria , Área Sob a Curva , Composição Corporal , Índice de Massa Corporal , Brasil , Colesterol/sangue , HDL-Colesterol/sangue , Estudos Transversais , Ensaio de Imunoadsorção Enzimática , Feminino , Humanos , Síndrome Metabólica/complicações , Pessoa de Meia-Idade , Obesidade/complicações , Curva ROC , gama-Glutamiltransferase/sangue
9.
Endocrine ; 51(1): 63-71, 2016 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-26049370

RESUMO

Thyroid hormone (TH) abnormalities are common in patients with diabetes mellitus (DM). These thyroid hormone abnormalities have been associated with inflammatory activity in several conditions but this link remains unclear in DM. We assessed the influence of subclinical inflammation in TH metabolism in euthyroid diabetic patients. Cross-sectional study involving 258 subjects divided in 4 groups: 70 patients with T2DM and 55 patients with T1DM and two control groups of 70 and 63 non-diabetic individuals, respectively. Groups were paired by age, sex, and body mass index (BMI). We evaluated the association between clinical and hormonal variables [thyrotropin, reverse T3 (rT3), total and free thyroxine (T4), and triiodothyronine (T3)] with the inflammation markers C-reactive protein (hs-CRP), serum amyloid A (SAA), and interleukin-6 (IL-6). Serum T3 and free T3 were lower in patients with diabetes (all P < 0.001) compared to the control groups. Interleukin-6 showed positive correlations with rT3 in both groups (P < 0.05). IL-6 was independently associated to FT3/rT3 (B = -0.193; 95% CI -0.31; -0.076; P = 0.002) and FT4/rT3 (B = -0.107; 95% CI -0.207; -0.006; P = 0.039) in the T1DM group. In the T2DM group, SAA (B = 0.18; 95% CI 0.089; 0.271; P < 0.001) and hs-CRP (B = -0.069; 95% CI -0.132; -0.007; P = 0.03) predicted FT3 levels. SAA (B = -0.16; 95% CI -0.26; -0.061; P = 0.002) and IL6 (B = 0.123; 95% CI 0.005; 0.241; P = 0.041) were related to FT4/FT3. In DM, differences in TH levels compared to non-diabetic individuals were related to increased subclinical inflammatory activity and BMI. Altered deiodinase activity was probably involved. These findings were independent of sex, age, BMI, and HbA1c levels.


Assuntos
Diabetes Mellitus Tipo 1/complicações , Diabetes Mellitus Tipo 2/complicações , Inflamação/complicações , Doenças da Glândula Tireoide/complicações , Hormônios Tireóideos/sangue , Adulto , Doenças Assintomáticas , Proteína C-Reativa/metabolismo , Estudos de Casos e Controles , Estudos Transversais , Diabetes Mellitus Tipo 1/sangue , Diabetes Mellitus Tipo 1/epidemiologia , Diabetes Mellitus Tipo 2/sangue , Diabetes Mellitus Tipo 2/epidemiologia , Feminino , Humanos , Inflamação/sangue , Inflamação/epidemiologia , Interleucina-6/sangue , Masculino , Pessoa de Meia-Idade , Proteína Amiloide A Sérica/metabolismo , Doenças da Glândula Tireoide/sangue , Doenças da Glândula Tireoide/epidemiologia , Testes de Função Tireóidea , Tri-Iodotironina Reversa/sangue , Adulto Jovem
10.
Diabetol Metab Syndr ; 7: 57, 2015.
Artigo em Inglês | MEDLINE | ID: mdl-26136850

RESUMO

The development of extended-action insulin analogues was motivated by the unfavorable pharmacokinetic (PK) profile of the conventional long-acting insulin formulations, generally associated with marked inter and intra patient variability and site- and dose-dependent effect variation. The new ultra-long insulin analogue degludec (IDeg) has the same amino acid sequence as human insulin except for the removal of threonine in the position 30 of the B chain (Des-B30, "De") and the attachment, via a glutamic acid linker ("glu"), of a 16-carbon fatty diacid (hexadecanoic diacid, "dec") to lysine in the position 29 of the B chain. These modifications allow that, after changing from the pharmaceutical formulation to the subcutaneous environment, IDeg precipitates in the subcutaneous tissue, forming a depot that undergoes a highly predictable gradual dissociation. Thus, once-daily dosing of IDeg results in a low peak: trough ratio, with consequent low intra-individual variability and plasmatic concentrations less critically dependent upon the time of injections. The clinical development program of IDeg (BEGIN) was comprised of 9 therapeutic confirmatory trials of longer duration (26-52 weeks) and showed that the efficacy of IDeg is comparable to insulin glargine in type 1 (T1D) and type 2 (T2D) diabetes patients across different age, body mass index and ethnic groups. This new ultra-long insulin analogue presents as advantages flexibility in dose timing and lower risk of hypoglycemia.

11.
PLoS One ; 10(5): e0125365, 2015.
Artigo em Inglês | MEDLINE | ID: mdl-25951458

RESUMO

BACKGROUND: Sagittal abdominal diameter (SAD) has been proposed as a surrogate marker of insulin resistance (IR). However, the utilization of SAD requires specific validation for each ethnicity. We aimed to investigate the potential use of SAD, compared with classical anthropometrical parameters, as a surrogate marker of IR and to establish the cutoff values of SAD for screening for IR. METHODS: A multicenter population survey on metabolic disorders was conducted. A race-admixtured sample of 824 adult women was assessed. The anthropometric parameters included: BMI, waist circumference (WC), waist-to-hip ratio and SAD. IR was determined by a hyperglycemic clamp and the HOMA-IR index. RESULTS: After adjustments for age and total body fat mass, SAD (r = 0.23 and r = -0.70) and BMI (r = 0.20 and r = -0.71) were strongly correlated with the IR measured by the HOMA-IR index and the clamp, respectively (p < 0.001). In the ROC analysis, the optimal cutoff for SAD in women was 21.0 cm. The women with an increased SAD presented 3.2 (CI 95%: 2.1-5.0) more likelihood of having IR, assessed by the HOMA-IR index compared with those with normal SAD (p < 0.001); whereas women with elevated BMI and WC were 2.1 (95% CI: 1.4-3.3) and 2.8 (95% CI: 1.7-4.5) more likely to have IR (p < 0.001), respectively. No statistically significant results were found for waist-to-hip ratio. CONCLUSIONS: SAD can be a suitable surrogate marker of IR. Understanding and applying routine and simplified methods is essential because IR is associated with an increased risk of obesity-related diseases even in the presence of normal weight, slight overweight, as well as in obesity. Further prospective analysis will need to verify SAD as a determinant of clinical outcomes, such as type 2 diabetes and cardiovascular events, in the Brazilian population.


Assuntos
Síndrome Metabólica/diagnóstico , Diâmetro Abdominal Sagital , Adulto , Biomarcadores , Brasil , Feminino , Humanos , Resistência à Insulina , Síndrome Metabólica/etnologia , Pessoa de Meia-Idade , Curva ROC , Adulto Jovem
12.
Arq Bras Endocrinol Metabol ; 58(7): 709-14, 2014 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-25372579

RESUMO

OBJECTIVE: Retinol-binding protein 4 (RBP4) is an adipokine responsible for vitamin A (retinol) transportation. Studies associated RBP4 increased levels with severity of type 2 diabetes mellitus (T2DM) and insulin resistance (IR). The study aimed to quantify RBP4 serum standards in women with a wide range of body mass index (BMI) and glucose tolerance level. SUBJECTS AND METHODS: Cross-sectional study was performed with 139 women divided into three groups: Group 1 (lean-control, n = 45) and Group 2 (obese, n = 53) with normal glucose tolerance and group 3 (obese with T2DM, n = 41), called G1, G2 and G3. Were assessed clinical, biochemical, anthropometric and body composition parameters. RESULTS: According to data analysis, we obtained in G1 higher RBP4 levels (104.8 ± 76.8 ng/mL) when compared to G2 (87.9 ± 38 ng/mL) and G3 (72.2 ± 15.6 ng/mL) levels. Also, were found: in G1 positive correlations of RBP4 with BMI (r = 0.253), glycated hemoglobin (r = 0.378) and fasting insulin (r = 0.336); in G2 with glycated hemoglobin (r = 0.489); in G3 with glycated hemoglobin (r = 0.330), fasting glucose (r = 0.463), HOMA-IR (r = 0.481). CONCLUSIONS: Although RBP4 have shown lower levels in diabetic and obese, a strong correlation with HOMA-IR index highlights that, in our study, there is growing IR when there is an increasing in RBP4 levels.


Assuntos
Tecido Adiposo/metabolismo , Glicemia/metabolismo , Índice de Massa Corporal , Obesidade/metabolismo , Proteínas de Ligação ao Retinol/metabolismo , Adulto , Estudos Transversais , Diabetes Mellitus Tipo 2/sangue , Feminino , Teste de Tolerância a Glucose , Hemoglobina A Glicada/metabolismo , Humanos , Insulina/sangue , Resistência à Insulina/fisiologia , Pessoa de Meia-Idade
13.
Arq. bras. endocrinol. metab ; 58(7): 709-714, 10/2014. tab, graf
Artigo em Inglês | LILACS | ID: lil-726259

RESUMO

Objective Retinol-binding protein 4 (RBP4) is an adipokine responsible for vitamin A (retinol) transportation. Studies associated RBP4 increased levels with severity of type 2 diabetes mellitus (T2DM) and insulin resistance (IR). The study aimed to quantify RBP4 serum standards in women with a wide range of body mass index (BMI) and glucose tolerance level. Subjects and methods: Cross-sectional study was performed with 139 women divided into three groups: Group 1 (lean-control, n = 45) and Group 2 (obese, n = 53) with normal glucose tolerance and group 3 (obese with T2DM, n = 41), called G1, G2 and G3. Were assessed clinical, biochemical, anthropometric and body composition parameters. Results According to data analysis, we obtained in G1 higher RBP4 levels (104.8 ± 76.8 ng/mL) when compared to G2 (87.9 ± 38 ng/mL) and G3 (72.2 ± 15.6 ng/mL) levels. Also, were found: in G1 positive correlations of RBP4 with BMI (r = 0.253), glycated hemoglobin (r = 0.378) and fasting insulin (r = 0.336); in G2 with glycated hemoglobin (r = 0.489); in G3 with glycated hemoglobin (r = 0.330), fasting glucose (r = 0.463), HOMA-IR (r = 0.481). Conclusions Although RBP4 have shown lower levels in diabetic and obese, a strong correlation with HOMA-IR index highlights that, in our study, there is growing IR when there is an increasing in RBP4 levels. .


Objetivo A proteína carreadora do retinol 4 (RBP4) é uma adipocina responsável pelo transporte de vitamina A (retinol). Estudos associam os níveis aumentados de RBP4 com a gravidade do diabetes melito tipo 2 (DM2) e resistência à insulina (RI). O objetivo deste estudo foi investigar como esses níveis se comportam em mulheres com ampla variação do índice de massa corporal (IMC) e tolerância à glicose. Sujeitos e métodos: Estudo transversal realizado com 139 mulheres, divididas em três grupos: Grupo 1 (controles-magras; n = 45) e Grupo 2 (obesas; n = 53), com tolerância normal à glicose; Grupo 3 (obesas DM2; n = 41), denominados G1, G2 e G3. Foram avaliados parâmetros clínicos, bioquímicos, antropométricos e composição corporal. Resultados De acordo com a análise dos dados, obtivemos em G1 maiores níveis de RBP4 (104,8 ± 76,8 ng/mL) em comparação ao G2 (87,9 ± 38 ng/mL) e G3 (72,2 ± 15,6 ng/mL). Também foram encontradas correlações positivas entre RBP4 e IMC (r = 0,253), hemoglobina glicada (r = 0,378) e insulinemia de jejum (r = 0,336); em G2 com hemoglobina glicada (r = 0,489); G3 com hemoglobina glicada (r = 0,330), insulinemia de jejum (r = 0,463) e HOMA-IR (r = 0,481). Conclusões Embora a RBP4 tenha apresentado níveis menores em pacientes diabéticas e obesas, a forte correlação com o índice HOMA-IR deixa claro que, em nosso estudo, há crescente RI quando os níveis dessa proteína também são crescentes. .


Assuntos
Adulto , Feminino , Humanos , Pessoa de Meia-Idade , Tecido Adiposo/metabolismo , Índice de Massa Corporal , Glicemia/metabolismo , Obesidade/metabolismo , Proteínas de Ligação ao Retinol/metabolismo , Estudos Transversais , /sangue , Teste de Tolerância a Glucose , Hemoglobina A Glicada/metabolismo , Resistência à Insulina/fisiologia , Insulina/sangue
14.
Einstein (Sao Paulo) ; 12(2): 251-3, 2014 Apr.
Artigo em Inglês, Português | MEDLINE | ID: mdl-25003936

RESUMO

The maintenance of glucose homeostasis is complex and involves, besides the secretion and action of insulin and glucagon, a hormonal and neural mechanism, regulating the rate of gastric emptying. This mechanism depends on extrinsic and intrinsic factors. Glucagon-like peptide-1 secretion regulates the speed of gastric emptying, contributing to the control of postprandial glycemia. The pharmacodynamic characteristics of various agents of this class can explain the effects more relevant in fasting or postprandial glucose, and can thus guide the individualized treatment, according to the clinical and pathophysiological features of each patient.


Assuntos
Glicemia/metabolismo , Diabetes Mellitus/fisiopatologia , Esvaziamento Gástrico/fisiologia , Peptídeo 1 Semelhante ao Glucagon/metabolismo , Período Pós-Prandial/fisiologia , Diabetes Mellitus/sangue , Diabetes Mellitus/tratamento farmacológico , Humanos
15.
Metabolism ; 63(7): 922-9, 2014 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-24854384

RESUMO

OBJECTIVE: To estimate the impact of aging and diabetes on insulin sensitivity, beta-cell function, adipocytokines, and incretin production. METHODS: Hyperglycemic clamps, arginine tests and meal tolerance tests were performed in 50 non-obese subjects to measure insulin sensitivity (IS) and insulin secretion as well as plasma levels of glucagon, GLP-1 and GIP. Patients with diabetes and healthy control subjects were divided into the following groups: middle-aged type 2 diabetes (MA-DM), aged Type 2 diabetes (A-DM) and middle-aged or aged subjects with normal glucose tolerance (MA-NGT or A-NGT). RESULTS: IS, as determined by the homeostasis model assessment, glucose infusion rate, and oral glucose insulin sensitivity, was reduced in the aged and DM groups compared with MA-NGT, but it was similar in the MA-DM and A-DM groups. Insulinogenic index, first and second phase insulin secretion and the disposition indices, but not insulin response to arginine, were reduced in the aged and DM groups. Postprandial glucagon production was higher in MA-DM compared to MA-NGT. Whereas the GLP-1 production was reduced in A-DM, no differences between groups were observed in GIP production. CONCLUSIONS: In non-obese subjects, diabetes and aging impair insulin sensitivity. Insulin production is reduced by aging, and diabetes exacerbates this condition. Aging associated defects superimposed diabetic physiopathology, particularly regarding GLP-1 production. On the other hand, the glucose-independent secretion of insulin was preserved. Knowledge of the complex relationship between aging and diabetes could support the development of physiopathological and pharmacological based therapies.


Assuntos
Adiponectina/metabolismo , Envelhecimento , Diabetes Mellitus Tipo 2/fisiopatologia , Regulação para Baixo , Peptídeo 1 Semelhante ao Glucagon/metabolismo , Insulina/metabolismo , Pâncreas/fisiopatologia , Adiponectina/sangue , Tecido Adiposo/metabolismo , Adulto , Idoso , Estudos Transversais , Diabetes Mellitus Tipo 2/sangue , Diabetes Mellitus Tipo 2/metabolismo , Polipeptídeo Inibidor Gástrico/sangue , Polipeptídeo Inibidor Gástrico/metabolismo , Glucagon/sangue , Glucagon/metabolismo , Peptídeo 1 Semelhante ao Glucagon/sangue , Humanos , Incretinas/sangue , Incretinas/metabolismo , Insulina/sangue , Resistência à Insulina , Secreção de Insulina , Masculino , Pessoa de Meia-Idade , Pâncreas/metabolismo , Período Pós-Prandial , Regulação para Cima
16.
Einstein (Säo Paulo) ; 12(2): 251-253, Apr-Jun/2014.
Artigo em Inglês | LILACS | ID: lil-713010

RESUMO

The maintenance of glucose homeostasis is complex and involves, besides the secretion and action of insulin and glucagon, a hormonal and neural mechanism, regulating the rate of gastric emptying. This mechanism depends on extrinsic and intrinsic factors. Glucagon-like peptide-1 secretion regulates the speed of gastric emptying, contributing to the control of postprandial glycemia. The pharmacodynamic characteristics of various agents of this class can explain the effects more relevant in fasting or postprandial glucose, and can thus guide the individualized treatment, according to the clinical and pathophysiological features of each patient.


A manutenção da homeostase glicêmica é complexa e envolve, além da secreção e da ação da insulina e do glucagon, mecanismos hormonais e neurais, que regulam a taxa de esvaziamento gástrico. Esse mecanismo depende de fatores extrínsecos e intrínsecos. A secreção do peptídeo 1 semelhante ao glucagon regula a velocidade de esvaziamento gástrico, de modo a contribuir para o controle da glicemia pós-prandial. As características farmacodinâmicas dos diversos agentes dessa classe podem explicar os efeitos mais relevantes na glicemia de jejum ou pós-prandial e, portanto, podem orientar o tratamento individualizado, de acordo com as características clínicas e fisiopatológicas de cada paciente.


Assuntos
Humanos , Glicemia/metabolismo , Diabetes Mellitus/fisiopatologia , Esvaziamento Gástrico/fisiologia , Peptídeo 1 Semelhante ao Glucagon/metabolismo , Período Pós-Prandial/fisiologia , Diabetes Mellitus/sangue , Diabetes Mellitus/tratamento farmacológico
17.
Diabetol Metab Syndr ; 5(1): 50, 2013 Sep 06.
Artigo em Inglês | MEDLINE | ID: mdl-24011173

RESUMO

Brazil is expected to have 19.6 million patients with diabetes by the year 2030. A key concept in the treatment of type 2 diabetes mellitus (T2DM) is establishing individualized glycemic goals based on each patient's clinical characteristics, which impact the choice of antihyperglycemic therapy. Targets for glycemic control, including fasting blood glucose, postprandial blood glucose, and glycated hemoglobin (A1C), are often not reached solely with antihyperglycemic therapy, and insulin therapy is often required. Basal insulin is considered an initial strategy; however, premixed insulins are convenient and are equally or more effective, especially for patients who require both basal and prandial control but desire a more simplified strategy involving fewer daily injections than a basal-bolus regimen. Most physicians are reluctant to transition patients to insulin treatment due to inappropriate assumptions and insufficient information. We conducted a nonsystematic review in PubMed and identified the most relevant and recently published articles that compared the use of premixed insulin versus basal insulin analogues used alone or in combination with rapid-acting insulin analogues before meals in patients with T2DM. These studies suggest that premixed insulin analogues are equally or more effective in reducing A1C compared to basal insulin analogues alone in spite of the small increase in the risk of nonsevere hypoglycemic events and nonclinically significant weight gain. Premixed insulin analogues can be used in insulin-naïve patients, in patients already on basal insulin therapy, and those using basal-bolus therapy who are noncompliant with blood glucose self-monitoring and titration of multiple insulin doses. We additionally provide practical aspects related to titration for the specific premixed insulin analogue formulations commercially available in Brazil.

18.
ISRN Endocrinol ; 2013: 673146, 2013.
Artigo em Inglês | MEDLINE | ID: mdl-23762596

RESUMO

Objectives. Assess the prevalence of thyroid nodules and predictors of malignant origin in patients with autoimmune thyroid diseases. Patients and Methods. Retrospective study including 275 patients, 198 with Graves' disease and 77 with Hashimoto's thyroiditis. Clinical and demographical data, ultrasonographical nodule characteristics, total thyroid volume and histological characteristics were recorded. Results. Graves' disease: the prevalence of thyroid nodules and thyroid carcinoma were 27.78% and 5.05%, respectively. Older age (OR = 1.054; 95% CI = 1.029-1.080) and larger thyroid volumes (OR = 1.013; 95% CI = 1.003-1.022) increased the chance of nodules. Younger age (OR = 1.073; 95% CI = 1.020-1.128) and larger thyroid volume (OR = 1.018; 95% CI = 1.005-1.030) predicted thyroid carcinoma. Hashimoto's thyroiditis: the prevalence of thyroid nodules and carcinomas were 50.7% and 7.8%, respectively. Nodules were predicted by thyroid volume (OR = 1.030; 95% CI = 1.001-1.062). We found higher number of nodules in patients with thyroid carcinoma than in those with benign nodules (3 versus 2; P = 0.03). Patients with Hashimoto's thyroiditis presented nodules more frequently than patients with Graves' disease (50.65% versus 27.28%; P < 0.001), while the prevalence of carcinoma was similar (P = 0.751). Conclusions. Larger goiter was associated with carcinoma in Graves' disease and Hashimoto's thyroiditis. Younger patients presented higher risk of papillary thyroid carcinoma in Graves' disease. The prevalence of carcinoma was similar in both conditions.

19.
Endocr J ; 60(7): 877-84, 2013.
Artigo em Inglês | MEDLINE | ID: mdl-23558976

RESUMO

Previous reports highlight the role of systemic inflammation in the genesis of non-thyroidal illness syndrome and type 2 diabetes mellitus (T2DM). Our objective was to assess whether body mass index and the low-grade systemic inflammation would be associated with changes in thyroid hormone metabolism in patients with type 2 diabetes. This was a cross-sectional study of 104 subjects; 52 patients with type 2 diabetes and 52 in a control group, paired by age, gender and body mass index. We measured total (T) and free (F) thyroxine (T4) and triiodothyronine (T3), reverse T3 (rT3), the ratios FT3/rT3, FT3/FT4 and FT4/rT3, clinical parameters (age, gender, diabetes duration and complications, body mass index, waist circumference, hypertension, HbA1c), and high sensitivity C-reactive protein. Patients with DM presented lower levels of TT4 (p=0.006), TT3 (p<0.001) and FT3 (p<0.001) and higher of FT4 (p<0.001), waist circumference (p=0.047) and C-reactive protein (p<0.001). Body mass index was inversely correlated with FT4 (p=0.036) and TT3 (p=0.008). C-reactive protein was positively correlated with rT3 (p=0.001) and inversely with FT4/rT3 (p<0.001) and FT3/rT3 (p=0.014). Body mass index was an independent predictor for FT4 (B=-0.011, p=0.029) and TT3 levels (B=-1.118, p=0.003). Inflammation predicted the FT4/rT3 ratio (B=-0.190, p<0.001). C-reactive protein (B=0.235, p<0.001) and body mass index (B=-0.008, p=0.047) were independent predictors for rT3. In conclusion, type 2 diabetes was associated with a low T3 state. Body mass index and the low-grade systemic inflammation are related to the non-thyroidal illness syndrome in these patients, possibly by altering the activity of peripheral deiodinases.


Assuntos
Índice de Massa Corporal , Diabetes Mellitus Tipo 2/sangue , Diabetes Mellitus Tipo 2/complicações , Inflamação/complicações , Hormônios Tireóideos/sangue , Proteína C-Reativa/análise , Estudos de Casos e Controles , Estudos Transversais , Diabetes Mellitus Tipo 2/epidemiologia , Diabetes Mellitus Tipo 2/metabolismo , Feminino , Humanos , Inflamação/epidemiologia , Inflamação/patologia , Masculino , Pessoa de Meia-Idade , Valores de Referência , Testes de Função Tireóidea/normas
20.
Clin Endocrinol (Oxf) ; 78(6): 874-81, 2013 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-22804918

RESUMO

OBJECTIVE: To investigate the relationship of the neck circumference (NC) with the metabolic syndrome (MetS) and insulin resistance (IR) in a large Brazilian population-based sample, within a wide range of adiposity and glucose tolerance, and to establish cut-off values of the NC for MetS and IR. CONTEXT: The NC correlates with cardiovascular risk factors, IR and components of MetS. Upper-body subcutaneous (sc) fat, as estimated by the NC, is associated with cardiovascular risk factors as much as abdominal fat, which is usually estimated by the waist circumference (WC). There are few epidemiological population-based studies on the clinical significance of the NC to MetS and IR. DESIGN: This is a cross-sectional study. PATIENTS: About 1053 Brazilian adults (18-60 years). MEASUREMENTS: Patients with BMI 18.5-40.0 kg/m(2), with normal glucose tolerance or type 2 diabetes (T2DM), were submitted to anthropometric measurements including waist circumference (WC), NC and BMI. Abdominal visceral fat (VF) was assessed by ultrasound. Insulin sensitivity (IS) was assessed by euglycaemic-hyperinsulinaemic clamp (10% of total sample) and HOMA-IR. Spearman correlations were used to evaluate the association between NC and IR and MetS risk factors. Receiver operating characteristic (ROC) curves were used for gender-specific cut-off values for the prediction of IR and MetS. Binary logistic regression analysis was used to assess the chance of developing IR or MetS according to the enlargement of NC and WC. RESULTS: The sample consisted of 28.6% men, with a mean age of 39.4 (12 years). T2DM diagnosis was present in 306 individuals, of whom 34% were men. NC correlated with WC and BMI in both men and women (P < 0.001). In both genders, NC showed a positive correlation with triglycerides, fasting glucose, fasting insulin and HOMA-IR, and NC had a negative association with high-density lipoprotein (HDL). NC and IS showed a moderate negative correlation. A significant correlation was demonstrated between VF and NC. In the ROC curves, NC presented the largest AUC for IR in women (P < 0.001), while NC presented a large AUC for MetS in both genders. CONCLUSIONS: Neck circumference measurements are an alternative and innovative approach for determining body fat distribution. The NC is positively associated with MetS risk factors, IR and VF, with established cut-off values for the prediction of MetS and IR.


Assuntos
Resistência à Insulina , Síndrome Metabólica/diagnóstico , Pescoço/anatomia & histologia , Adiposidade , Adulto , Índice de Massa Corporal , Brasil , Doenças Cardiovasculares/etiologia , Estudos Transversais , Diabetes Mellitus Tipo 2/diagnóstico , Feminino , Humanos , Gordura Intra-Abdominal/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Fatores de Risco , Ultrassonografia , Circunferência da Cintura
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