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Medicine (Baltimore) ; 98(50): e18346, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31852132


BACKGROUND: Type 2 diabetes (T2D) is a significant health concern worldwide, and good glycemic control is the basis of avoiding disease progression. Herbal tea, as a convenient and effective medication method, has gained popularity among many diabetic patients. However, there are no systematic reviews or meta-analyses to evaluate the clinical efficacy of herbal tea on T2D. METHODS: Four English electronic databases and 4 Chinese electronic databases were searched for randomized controlled trials (RCTs) meeting inclusion criteria; Clinical trials were searched to explore the relevant unpublished data. Fasting blood glucose and glycated hemoglobin will be measured as primary outcomes. Secondary outcomes include 2-hour postprandial blood glucose, fasting insulin, and homeostasis model assessment-insulin resistance. The heterogeneity of data will be investigated by Chi-square and I test; subgroup analysis and sensitivity analysis will be conducted to explore the sources of heterogeneity; funnel plot will be used to evaluate publication bias; finally, we will use grading of recommendations assessment, development, and evaluate system method to evaluate the quality of evidence. Merging analysis of data will be performed using Rev Man 5.3 software. RESULTS: The results will be published in a peer-reviewed journal. CONCLUSIONS: The systematic review will confirm whether herbal tea consumption is benefit to the glycemic control in patients with T2D. PROSPERO REGISTRATION NUMBER: CRD42019129863.

Glicemia/análise , Diabetes Mellitus Tipo 2/sangue , Índice Glicêmico , Chás de Ervas , Diabetes Mellitus Tipo 2/dietoterapia , Jejum , Hemoglobina A Glicada/análise , Humanos , Insulina/sangue , Resistência à Insulina , Metanálise como Assunto , Projetos de Pesquisa , Revisão Sistemática como Assunto
Endocrinol. diabetes nutr. (Ed. impr.) ; 66(10): 647-653, dic. 2019. tab, graf
Artigo em Inglês | IBECS | ID: ibc-184792


Introduction: Several sweeteners are introduced to replace sucrose in the human diet. However, they had their own limitations and concerns, particularly in terms of their taste and their long-term health consequences. This study examined the effect of a new mixture of sugars and sugar alcohol on the postprandial blood glucose levels and its possible gastrointestinal (GI) adverse reactions in human adults. Methods: In this double-blind three-way randomized clinical trial, adults (21 with type 2 diabetes and 20 healthy) received 300 ml of three beverages containing 50 g glucose, sucrose, and lacritose (a mixture of lactose, fructose, sucrose, and erythritol) when they were in the fasted state in a random order. Postprandial serum glucose was checked every 30min up to 2 h and the gastrointestinal reactions were collected. Results: The mean serum glucose was significantly lower in all time points after ingestion of the lacritose for participants with type 2 diabetes compared to glucose and sucrose (P < 0.05). The blood glucose levels were significantly lower in the 30th and 60th min for healthy subjects (P < 0.05). Adverse GI reactions were not significant between the test beverages. Conclusions: The ingestion of a 50 g dose of lacritose containing lactose, fructose, sucrose, and erythritol, led to an improved blood glucose levels without any significant adverse effect compared to the same amount of glucose and sucrose. Studying the long-term effects of lacritose on appetite, metabolic markers and adverse reactions is recommended. The trial was registered in Iranian registry of clinical trials: IRCT2015050912571N2

Introducción: Se han utilizado varios edulcorantes para sustituir a la sacarosa en la dieta humana. Sin embargo, tenían sus propias limitaciones y problemas, sobre todo por su sabor y sus consecuencias a largo plazo para la salud. En este estudio se explora el efecto de una nueva muestra de azúcares y alcohol de azúcar en los niveles de glucemia posprandial y las posibles reacciones adversas digestivas a ella en adultos humanos. Métodos: En este ensayo clínico doble ciego aleatorizado de tres vías, adultos (21 con diabetes tipo 2 y 20 sanos) recibieron 300ml de tres bebidas que contenían 50 g de glucosa, sacarosa y lacritosa (una mezcla de lactosa, fructosa, sacarosa y eritritol) en orden aleatorio en ayunas. Se comprobó la glucose sérica posprandial cada 30 minutos hasta las dos horas y se recogieron las reacciones digestivas. Resultados: Los valores medios de glucosa en suero eran significativamente menores en todos los puntos temporales tras la ingesta de lacritosa que tras la de glucosa y sacarosa en los participantes con diabetes tipo 2 (P < 0,05). Los niveles de glucemia eran significativamente menores a los 30 y 60 minutos en los sujetos sanos (P < 0,05). No había diferencias significativas en las reacciones digestivas adversas entre las bebidas estudiadas. Conclusiones: La ingesta de una dosis de 50 g de lacritosa que contiene lactosa, fructosa, sacarosa y eritritol, mejoró los niveles de glucemia sin efectos adversos importantes comparada con la misma cantidad de glucosa y sacarosa. Se recomienda estudiar los efectos a largo plazo de la lacritosa en el apetito, los marcadores metabólicos y las reacciones adversas. El ensayo se inscribió en el registro de ensayos clínicos de Irán: IRCT2015050912571N2

Humanos , Feminino , Adulto , Pessoa de Meia-Idade , Glicemia/análise , Sacarose/sangue , Hiperglicemia/sangue , Hiperglicemia/induzido quimicamente , Álcoois Açúcares/análise , Sacarose/efeitos adversos , Índice Glicêmico , Hiperglicemia/complicações , Método Duplo-Cego , Álcoois Açúcares/efeitos adversos , Álcoois Açúcares/sangue , Antropometria
Adv Clin Exp Med ; 28(11): 1577-1585, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31756065


Over the past 30 years, a significant increase in the prevalence of insulin resistance (IR) has been observed. It is associated with more frequent occurrence of impaired glucose tolerance, diabetes, excessive weight, cardiovascular diseases, and endocrine disorders. The results of current studies do not indicate a necessity to exclude dairy products from the diet of insulin-resistant individuals. In addition, it has been found that moderate amounts of alcohol as part of a balanced, low-energy diet do not have a negative effect on insulin sensitivity. The authors of recent studies emphasize the importance of reducing the intake of simple sugars, especially from sweet drinks, sweets and excessive fruit juice consuption. Many studies have demonstrated the beneficial effects of consuming complex, low-glycemic-index carbohydrates that are rich in dietary fiber. An insulin-resistant patient's diet should be rich in whole grains and high amounts of non-starchy vegetables and raw fruit. The beneficial effect of the Dietary Approaches to Stop Hypertension (DASH diet) and the Mediterranean diet has been confirmed. The positive correlation between low-carbohydrate and very-low-carbohydrate diets requires confirmation in long-term studies with the participation of insulin-resistant patients. Research shows the benefits of increased calorific intake during the first half of the day, especially from a high-energy and low-glycemic-index breakfast. Furthermore, many researchers indicate that slow and mindful eating is a significant component of an appropriate diet for insulin-resistant individuals.

Glicemia/metabolismo , Dieta , Índice Glicêmico/fisiologia , Resistência à Insulina/fisiologia , Carboidratos da Dieta , Fibras na Dieta , Humanos , Insulina , Verduras
Endocrinol. diabetes nutr. (Ed. impr.) ; 66(9): 540-549, nov. 2019. tab, graf
Artigo em Inglês | IBECS | ID: ibc-184376


Introduction: Few studies assessing the relationship between oxidative stress and glycemic variability in children with type 1 diabetes mellitus (T1DM) are available, and most of them reported no significant results. Objective: To assess the relationship between glucose control, glycemic variability, and oxidative stress as measured by urinary excretion of 8-iso-prostanglandin F2-alpha (8-iso-PGF2alfa) in children with T1DM. Materials and methods: A cross-sectional study including 25 children with T1DM. Participants were evaluated during five days in two different situations: 1st phase during a summer camp, and 2nd phase in their everyday life at home. The following data were collected in each study phase:. Six capillary blood glucose measurements per day. Mean blood glucose (MBG) levels and glucose variability parameters, including standard deviation, coefficient of variation, and mean amplitude of glycemic excursions (MAGE), were calculated. - Capillary HbA1c level. - 24-h urine sample to measure 8-iso-PGF2alfa. Results: There were no statistically significant differences in urinary 8-iso-PGF2alfa levels (142 ± 37 vs. 172 ± 61 pg/mg creatinine) and glucose control and glycemic variability parameters between both phases. In the 2nd phase, statistically significant correlations were found between urinary 8-iso-PGF2alfa and HbA1c levels (r = 0.53), MBG (r = 0.72), standard deviation (r = 0.49), and MAGE (r = 0.42). No significant correlations between glucose control, glycemic variability and urinary 8-iso-PGF2alfa excretion were found in the 1st phase. Conclusions: A significant correlation was found between glycemic variability and HbA1c level and urinary 8-iso-PGF2α excretion in a group of children with T1DM during their daily lives. Additional studies are needed to confirm this finding and to explore its long-term impact on health

Introducción: En niños con diabetes tipo 1 (DM1) hay pocos estudios que evalúen la relación entre estrés oxidativo y variabilidad glucémica, y la mayoría de ellos no encuentran resultados significativos. Objetivo: Evaluar la relación entre control metabólico, variabilidad glucémica y estrés oxidativo medido por la excreción urinaria de 8-iso-prostaglandina F2 alfa (8-iso-PGF2alfa) en niños con DM1. Material y método: Estudio transversal que incluyó 25 niños con DM1. Los participantes fueron evaluados durante 5 días en 2 situaciones diferentes: 1.a fase durante un campamento de verano y 2.a fase durante su actividad habitual en domicilio. En cada fase se recogieron:- Seis determinaciones de glucemia capilar diarias. Se calcularon glucemia media y parámetros de variabilidad glucémica: desviación estándar, coeficiente de variación y «mean amplitude of glycemic excursions» (MAGE). - HbA1c capilar. - Muestra de orina de 24h para la determinación de 8-iso-PGF2alfa. Resultados: No se encontraron diferencias estadísticamente significativas en excreción urinaria de 8-iso-PGF2alfa (142 ± 37 vs. 172 ± 61 pg/mg creatinina) y parámetros de control y variabilidad glucémicos entre las fases. En la 2.a fase se observaron correlaciones estadísticamente significativas entre 8-iso-PGF2alfa urinario con HbA1c (r = 0,53), glucemia media (r = 0,72), desviación estándar (r = 0,49) y MAGE (r = 0,42). En la 1.a fase del estudio no se han detectado correlaciones significativas. Conclusiones: Se ha encontrado una correlación significativa entre parámetros de variabilidad glucémica y HbA1c con la excreción urinaria de 8-iso-PGF2alfa en un grupo de niños con DM1 evaluados durante su vida diaria. Son necesarios más estudios para confirmar estos resultados y evaluar el impacto a largo plazo sobre la salud

Humanos , Criança , Diabetes Mellitus Tipo 1/complicações , Estresse Oxidativo , Índice Glicêmico , Metabolismo Basal , Dinoprosta/análogos & derivados , Diabetes Mellitus Tipo 1/sangue , Diabetes Mellitus Tipo 1/diagnóstico , Estudos Transversais , Diabetes Mellitus Tipo 1/urina , Dinoprosta/sangue
Transplant Proc ; 51(9): 2952-2957, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31607623


BACKGROUND AND AIMS: Despite the excellent long-term outcomes in liver transplant (LT) recipients, several medical complications related to lifestyle still represent an issue. This study examined the effects of a 12-month supervised aerobic and strength training program on the aerobic capacity, muscle strength, metabolic profile, liver function, and quality of life of a cohort of LT recipients. METHODS: LT recipients with stable liver function were assigned to interventional exercise (group A) or usual care (group B). Aerobic capacity, muscle strength, metabolic profile, liver and kidney function, and health-related quality of life were assessed at baseline and after 6 and 12 months. Group A attended supervised training sessions 3 times per week for 12 months. Group B received general recommendations about home-based exercise. RESULTS: Forty patients from 6 Italian LT centers were randomized. Twenty-nine (72.5%, men-to-women ratio 23:6, mean age, 52 ± 8 years) LT recipients completed the study. Baseline characteristics were similar between groups except for body mass index and time from LT. No episode of acute rejection nor increase of transaminases occurred. Maximum workload and body mass index increased in both groups over time, but fasting glucose significantly decreased in group A (94.0 ± 15.0 mg/dL vs 90.0 ± 17.0 mg/dL; P = .037) and increased in controls (95.0 ± 24.0 mg/dL vs 102.0 ± 34.0 mg/dL, P = .04). Upper limb muscle strength increased only in supervised LT recipients. Vitality and general and mental health domains significantly improved after physical exercise. CONCLUSIONS: Supervised combined training was safe and effective in increasing aerobic capacity, muscle strength, and quality of life and in improving glucose metabolism in stable LT recipients.

Terapia por Exercício/métodos , Transplante de Fígado/reabilitação , Aptidão Física , Qualidade de Vida , Adulto , Índice de Massa Corporal , Feminino , Índice Glicêmico , Humanos , Itália , Masculino , Pessoa de Meia-Idade , Força Muscular
Rev. Soc. Cardiol. Estado de Säo Paulo ; 29(4 (Supl)): 432-440, out.-dez. 2019. tab, graf
Artigo em Português | LILACS | ID: biblio-1047350


O diabetes mellitus tipo 2 (DM2) é considerado um dos principais distúrbios metabólicos relacionados ao desenvolvimento de doenças cardiovasculares e outras comorbidades, com elevada incidência e prevalência no Brasil e no mundo. Apesar dos avanços em seu tratamento, a projeção mundial é de aumento no número de diagnósticos. No Brasil, o total de pessoas com a doença cresceu mais de 60% em 10 anos. Como o manejo dietético é um dos pilares no tratamento do DM2, este trabalho objetivou analisar os estudos que compararam as dietas restritas em carboidratos com outras abordagens dietéticas a fim de elucidar se esta seria a opção mais adequada para os pacientes com DM2. Assim, fez-se uma revisão de ensaios clínicos randomizados por meio das plataformas de pesquisa PubMed e Cochrane Library em outubro de 2018, selecionando os estudos segundo a estratégia PICO de pesquisa. Dos 398 artigos encontrados, 19 atenderam os critérios de elegibilidade. Após a análise, demonstrou-se que as dietas restritas em carboidratos favorecem o controle glicêmico, melhora do perfil lipídico e redução dos medicamentos para DM2 em relação às outras opções dietéticas, no entanto, os trabalhos apresentam vieses metodológicos e são, em geral, de curto prazo. Sendo assim, é precipitado afirmar que essas dietas são mais efetivas para o tratamento do DM

Type 2 diabetes mellitus (T2DM) is considered one of the primary metabolic disorders related to the development of cardiovascular diseases and other comorbidities, with high incidence and prevalence in Brazil and in the world. Despite advances in its treatment, an increase in the number of diagnoses is estimated worldwide. In Brazil, the total number of people with the disease has grown more than 60% in 10 years. As dietary management is one of the mainstays in the treatment of T2DM, this study aimed to analyze the studies that compared carbohydrate-restricted diets with other dietary approaches to elucidate if this would be the most appropriate option for patients with T2DM. Thus, randomized clinical trials were reviewed through the PubMed and Cochrane Library research platforms in October 2018, selecting the studies according to the PICO research strategy. Of the 398 articles found, 19 met the eligibility criteria and had their data collected. After the analysis, it was demonstrated that carbohydrate-restricted diets support glycemic control, loss of body mass, improvement of lipid profile and reduction of medications for T2DM compared to other dietary options. However, a significant part of the studies has methodological biases and is generally short-term. Therefore, the level of evidence supporting dietary restriction of carbohydrates in the management of T2DM is considered moderate. Thus, according to the principle of the null hypothesis, it is unwise to affirm that these diets are superior in the treatment of DM2

Carboidratos , Diabetes Mellitus/terapia , Dieta com Restrição de Carboidratos , Doenças Cardiovasculares , Índice de Massa Corporal , Fatores de Risco , Índice Glicêmico , Dieta , Obesidade
Nutr. hosp ; 36(5): 1081-1086, sept.-oct. 2019. tab, graf
Artigo em Inglês | IBECS | ID: ibc-184630


Introduction: Stevia rebaudiana extracts can be used as a sweetener due to their glycoside content: specifically stevioside and rebaudioside. Both compounds have adequate pharmacological characteristics for human consumption. Objective: the aim of this study was to standardize the formulation of marmalades using nopal-pineapple-stevia aqueous extract ratios. Methods: the products were evaluated to determine their physicochemical properties, in vitro inhibition of α-amylase and glycemia in healthy volunteers. Storage study was conducted for 20 days at room temperature 23-30 °C and relative humidity 80-85%. Results: incorporation of stevia significantly modified physicochemical properties like °Brix, color and flow index. After storage, the presence of molds and bacteria were not detected. Sensory evaluation indicated that marmalade with 50% stevia replacement was equally accepted as marmalade with sucrose. Marmalade with 50 and 100% of stevia inhibited 35.89 and 38.50% of the α-amylase activity. After an intake of 30 g, it seems that marmalades with stevia had a significant effect on the glycemia of the volunteers. Conclusions: however, further studies with larger doses of nopal-pineapple-stevia marmalade and consumed for longer in both healthy volunteers and patients with diabetes are needed to achieve results that are more precise

Introducción: los extractos de Stevia rebaudiana pueden ser utilizados como edulcorante debido a su contenido de glucósidos: específicamente esteviósido y rebaudiósido. Ambos compuestos presentan características farmacológicas adecuadas para el consumo humano. Objetivos: el objetivo del presente trabajo fue estandarizar formulaciones de mermeladas con diferentes proporciones de nopal-piña-extracto acuoso de stevia. Métodos: se estudiaron las propiedades fisicoquímicas de las mermeladas, su capacidad de inhibir in vitro a la enzima α-amilasa y la glicemia en voluntarios sanos. Los estudios de vida de anaquel se efectuaron durante 20 días a temperatura ambiente 23-30 °C y humedad relativa 80-85%. Resultados: la incorporación de estevia modificó significativamente los grados Brix, el color y el índice de flujo de las mermeladas. Concluido el estudio de anaquel, no se observó la presencia de hongos o bacterias. La evaluación sensorial indicó que la mermelada con 50% de estevia fue aceptada con el mismo nivel de agrado que la mermelada con sacarosa. Las mermeladas con 50 y 100% de estevia inhibieron la actividad de la α-amilasa con valores de 35.89% y 38.50%, respectivamente. Posterior a una ingesta de 30 g de mermelada se observó un efecto significativo en la glicemia de voluntarios sanos. Conclusiones: deberán efectuarse estudios de consumo prolongado y de mayores cantidades de mermelada tanto en voluntarios sanos como con diabetes para obtener resultados más precisos

Humanos , Geleia de Frutas , Ananas/enzimologia , Química Física/métodos , alfa-Amilases/biossíntese , Stevia/química , Ananas/química , Voluntários Saudáveis , Extratos Vegetais/farmacologia , Glicemia/análise , Índice Glicêmico
Endocrinol. diabetes nutr. (Ed. impr.) ; 66(7): 443-458, ago.-sept. 2019. graf, tab
Artigo em Espanhol | IBECS | ID: ibc-182864


Objetivo: El tratamiento de la diabetes tipo 2 (DM2) es complejo y su propósito es reducir la morbimortalidad, por lo que su manejo tiene que incluir: un control glucémico individualizado precoz (mediante una adecuada educación diabetológica, modificaciones del estilo de vida y tratamiento farmacológico), el control de los factores de riesgo cardiovascular (CV), la detección y tratamiento precoz de las complicaciones y la evaluación de las comorbilidades asociadas. El objetivo fue elaborar un documento para unificar los aspectos necesarios para el abordaje integral de las personas con DM2. Participantes: Miembros del Grupo de trabajo de Diabetes Mellitus de la Sociedad Española de Endocrinología y Nutrición. Métodos: Se realizó una revisión de la evidencia disponible relativa a cada aspecto del manejo de la diabetes: objetivos de control glucémico, dieta y ejercicio, tratamiento farmacológico, tratamiento y control de factores de riesgo, detección de complicaciones y manejo del paciente frágil con DM2. Las recomendaciones se formularon según los grados de evidencia recogidos en los Standards of Medical Care in Diabetes 2018. Tras la formulación de las recomendaciones el documento fue consensuado por los miembros del Grupo de trabajo de Diabetes Mellitus de la Sociedad Española de Endocrinología y Nutrición. Conclusiones: El objetivo de este documento es proporcionar, desde el punto de vista del endocrinólogo clínico, unas recomendaciones prácticas basadas en la evidencia acerca de todos los aspectos necesarios para el abordaje integral de la DM2

Objective: Treatment of type 2 diabetes mellitus (T2DM) is complex and is intended to decrease morbidity and mortality. Management should therefore include adequate diabetes education, lifestyle changes, drug treatment to achieve early blood glucose control and reduction of cardiovascular (CV) risk factors, early detection and treatment of complications, and assessment of associated comorbidities. The objective was to prepare a document including all aspects required for a comprehensive approach to T2DM. Participants: Members of the Diabetes Mellitus Working Group of the Spanish Society of Endocrinology. Methods: The available evidence regarding each aspect of diabetes management (blood glucose control goals, diet and exercise, drug treatment, risk factor management and control, detection of complications, and management of frail patients) was reviewed. Recommendations were formulated based on the grades of evidence stated in the 2018 Standards of Medical Care in Diabetes. Recommendations were discussed and agreed by the working group members. Conclusions: This document is intended to provide evidence-based practical recommendations for comprehensive management of T2DM by clinical endocrinologists

Humanos , Diabetes Mellitus Tipo 2/terapia , Diabetes Mellitus Tipo 2/complicações , Fatores de Risco , Sociedades Médicas/normas , Documentos , Índice Glicêmico , Estilo de Vida , Sociedades Médicas/organização & administração , Estratégias de eSaúde , Exercício/fisiologia
Aten. prim. (Barc., Ed. impr.) ; 51(7): 442-451, ago.-sept. 2019. graf, tab
Artigo em Espanhol | IBECS | ID: ibc-185732


El adecuado tratamiento de la diabetes mellitus tipo 2 (DM2) incluye la alimentación saludable y el ejercicio (150 min/semana) como pilares básicos. Para el tratamiento farmacológico, la metformina es el fármaco de elección inicial, salvo contraindicación o intolerancia; en caso de mal control, se dispone de 8 familias terapéuticas (6 orales y 2 inyectables) como posibles combinaciones. Se presenta un algoritmo y unas recomendaciones para el tratamiento de la DM2. En prevención secundaria cardiovascular se recomienda asociar un inhibidor del cotransportador sodio-glucosa tipo2 (iSGLT2) o un agonista del receptor de glucagon-like peptide-1 (arGLP1) en pacientes con obesidad. En prevención primaria, si el paciente presenta obesidad o sobrepeso la metformina deberá combinarse con iSGLT2, arGLP1 o inhibidores de la dipeptidilpeptidasa tipo 4 (iDPP4). Si el paciente no presenta obesidad, podrán emplearse los iDPP4, los iSGLT2 o la gliclazida, sulfonilurea recomendada por su menor tendencia a la hipoglucemia

Treatment of diabetes mellitus type 2 (DM2) includes healthy eating and exercise (150 minutes/week) as basic pillars. For pharmacological treatment, metformin is the initial drug except contraindication or intolerance; in case of poor control, 8 therapeutic families are available (6 oral and 2 injectable) as possible combinations. An algorithm and some recommendations for the treatment of DM2 are presented. In secondary cardiovascular prevention, it is recommended to associate an inhibitor of the sodium-glucose cotransporter type 2 (iSGLT2) or a glucagon-like peptide-1 receptor agonist (arGLP1) in patients with obesity. In primary prevention if the patient is obese or overweight metformin should be combined with iSGLT2, arGLP1, or inhibitors of type 4 dipeptidylpeptidase (iDPP4). If the patient does not present obesity, iDPP4, iSGLT2 or gliclazide, sulfonylurea, recommended due to its lower tendency to hypoglycaemia, may be used

Humanos , Hiperglicemia/tratamento farmacológico , Diabetes Mellitus Tipo 2/terapia , Fatores de Risco , Estilo de Vida Saudável , Exercício , Algoritmos , Dieta Saudável , Índice Glicêmico , Doenças Cardiovasculares/prevenção & controle , Terapia Combinada
Diabetes Metab Syndr ; 13(4): 2513-2517, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31405670


OBJECTIVE: It is usually difficult to clinically identify thyroid abnormalities in diabetics as features of thyroid dysfunction may simulate diabetes symptoms or complications. So, assessing thyroid dysfunction prevalence in patients with type 2 diabetes mellitus (DM) would help better control of DM and its complications. Several studies reported this prevalence, however, some included small sample size or lacked a control group. We aimed to determine thyroid dysfunction prevalence in diabetic patients as well as its relation to glycemic control. METHODS: A cross-sectional study included 200 patients having type 2 DM and 200 apparently healthy controls. Each participant was tested for fasting and 2-h post-prandial blood glucose, glycated haemoglobin (HbA1C), thyroid function tests: thyroid-stimulating hormone (TSH), free tri-iodothyronine (FT3), free thyroxine (FT4), serum total cholesterol and triglycerides and thyroid antibodies; anti-thyroid peroxidase (anti-TPO) and anti-thyroglobulin (anti-Tg) for hypothyroidism only. RESULTS: There was a significant increase in serum TSH and T3 levels in diabetics when compared with the controls, (P < 0.001, P = 0.001), respectively. Thyroid dysfunction was significantly more prevalent in patients with HbA1c ≥ 8%, (P = 0.0001), and in those having longer diabetes duration, (P < 0.001). CONCLUSION: There was a higher prevalence of thyroid dysfunction among patients with type 2 DM. This dysfunction increased with the rise of HbA1c. This could suggest that poor glycemic control may have a role in the development of thyroid dysfunction in type 2 DM patients. Subclinical hypothyroidism was the most prevalent type of thyroid dysfunction in diabetic patients.

Biomarcadores/sangue , Diabetes Mellitus Tipo 2/complicações , Hemoglobina A Glicada/análise , Doenças da Glândula Tireoide/epidemiologia , Hormônios Tireóideos/sangue , Glicemia/análise , Estudos de Casos e Controles , Estudos Transversais , Feminino , Seguimentos , Índice Glicêmico , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência , Prognóstico , Doenças da Glândula Tireoide/sangue , Doenças da Glândula Tireoide/etiologia , Testes de Função Tireóidea
Indian J Med Microbiol ; 37(1): 54-59, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31424011


Background: Porphyromonas gingivalis is a major periodontal pathogen. Saliva is the most easy, non-invasive microbiological sample for detection of periodontal pathogens. Aim and Objectives: A prospective study on 37 diabetic patients was grouped into well-controlled diabetes with/without periodontitis and uncontrolled diabetic with periodontitis. PCR and sequencing of P. gingivalis was performed in saliva samples. Materials and Methods: DNA was extracted from saliva using Triton X-100 and 16s rRNA gene (404 bp) was amplified by polymerase chain reaction. DNA sequencing was performed for two samples. Results: P. gingivalis was detected in 27.03% (n = 10), of which 30% (n = 9) were diabetic with periodontal disease and 14.3% (n = 1) were diabetic without periodontal disease. The percentage of poor oral hygiene was 50% and 20% in uncontrolled and controlled glycaemic patients, respectively. DNA sequencing of two samples showed 100% identity with the sequences in the GenBank database (Gen Bank accession no: KX640913-KX640914). Conclusion: Type 2 diabetes mellitus and periodontitis are interlinked. Early detection of P. gingivalis and appropriate treatment with doxycycline will also assist in controlling the glycaemic status.

Complicações do Diabetes/microbiologia , Diabetes Mellitus Tipo 2/epidemiologia , Periodontite/epidemiologia , Porphyromonas gingivalis/genética , Saliva/microbiologia , Adulto , Idoso , Infecções por Bacteroidaceae/tratamento farmacológico , Infecções por Bacteroidaceae/transmissão , Diabetes Mellitus Tipo 2/patologia , Doxiciclina/uso terapêutico , Feminino , Hemoglobina A Glicada/análise , Índice Glicêmico/efeitos dos fármacos , Humanos , Índia/epidemiologia , Masculino , Pessoa de Meia-Idade , Higiene Bucal/estatística & dados numéricos , Periodontite/tratamento farmacológico , Periodontite/microbiologia , Reação em Cadeia da Polimerase , Porphyromonas gingivalis/efeitos dos fármacos , Estudos Prospectivos , RNA Ribossômico 16S/genética
Nutr. hosp ; 36(4): 834-839, jul.-ago. 2019. tab, graf
Artigo em Espanhol | IBECS | ID: ibc-184708


Introducción: la obesidad y la diabetes mellitus tipo 2 (DM-2) disminuyen el entramado trabecular óseo aun cuando puede coexistir aumento del hueso cortical. Otro hallazgo en común es la presarcopenia/sarcopenia secundaria posiblemente a la insulinorresistencia y el estrés oxidativo. Queda por aclarar si estos cambios dependen fundamentalmente de las alteraciones glucídicas precoces (pre DM-2) o tardías (DM-2 establecida), o más bien estarían vinculadas de forma predominante por el exceso de masa grasa en individuos obesos. Objetivos: evaluar y comparar parámetros de composición corporal (compartimentos óseo, muscular y adiposo-visceral) en pacientes con sobrepeso/obesidad agrupados según presenten o no alteraciones glucídicas. Analizar si existen diferencias comparando FRAX vs. FRAX ajustado a trabecular bone score (TBS) en ambos grupos. Métodos: se incluyeron 16 pacientes con sobrepeso/obesidad. A todos se les realizó evaluación clínica-antropométrica, bioimpedanciometría, absorciometría de rayos X de energía dual o densitometría ósea (DXA) y análisis, y se les agrupó según glucemia en tres grupos: a) normal; b) glucemia basal alterada en ayunas (GBA); y c) DM-2. Para el análisis estadístico empleamos pruebas no paramétricas. Resultados: no se encontraron diferencias estadísticamente significativas en los grupos respecto a microarquitectura ósea, masa muscular o grasa visceral. El grupo GBA mostró el mayor promedio de masa muscular y grasa visceral. Tras reclasificar en solo dos grupos, glucemia normal en el grupo 1 y glucemia alterada en el grupo 2 (GBA y DM-2), encontramos diferencias estadísticamente significativas con detrimento de la microarquitectura ósea trabecular en el grupo 2 (p = 0,031) y cifras de fósforo con niveles inferiores en el grupo 1 (p = 0,42). Conclusiones: en nuestro estudio, la microarquitectura ósea está deteriorada en pacientes con glucemia alterada y obesos. Hacen falta estudios con mayor tamaño muestral para establecer en qué momento se instauran estos cambios en la evolución natural de la diabetes

Introduction: obesity and DM-2 decrease trabecular bone mass even though cortical bone increase may coexist. Another common finding is presarcopenia/sarcopenia, possibly due to insulin resistance and oxidative stress. It remains to be clarified whether these changes depend on either early (prediabetes) or late (established DM) glucidic alterations, or rather they would be linked predominantly by excess fat mass in obese patients Objectives: to evaluate and compare body composition parameters (bone, muscle and adipose-visceral tissues) in overweight/obese patients grouped by whether or not they present glucidic metabolism disorders. Analyze if there are differences between FRAX vs FRAX adjusted to trabecular bone score TBS in both groups. Methods: sixteen overweight/obese patients were included. In all of them clinical-anthropometric evaluation, bioimpedance, DXA and analysis were performed. They were grouped by glycemia as: a) normal; b) impaired fasting glycemia (IFG); and c) DM-2. Non-parametric tests were performed. Results: no statistically significant differences were found among groups regarding bone microarchitecture, muscle mass or visceral fat. The IFG group showed the highest average muscle mass and visceral fat. Then, patients were reclassified in only two groups, normal glycemia in group 1 and altered glycemia in group 2 (IFG and DM-2), and statistically significant differences were found at the expense of lower trabecular bone microarchitecture in group 2 (p = 0.031) and phosphorus lower levels in group 1 (p = 0.042). Conclusions: in our study, the bone microarchitecture is impaired in patients with altered glycemia and obesity. Studies with larger sample size are needed to establish when these changes take place in the natural evolution of diabetes

Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Idoso , Composição Corporal , Sobrepeso/diagnóstico , Obesidade/complicações , Síndrome Metabólica/diagnóstico , Antropometria , Estudos Prospectivos , Estudos Transversais , Análise de Variância , Índice Glicêmico
Nutr. hosp ; 36(4): 905-911, jul.-ago. 2019. tab, graf
Artigo em Inglês | IBECS | ID: ibc-184717


Introduction: therapeutic lifestyles changes including frequent consumption of legumes have resulted in improved metabolic control and decreased blood pressure in type 2 diabetes-mellitus (T2DM) patients. Objective: this was a quasi-experimental-28-week crossover-study that assessed the effect of daily consumption of the legume Lupinus mutabilis (LM) on metabolic control of T2DM patients under hypoglycemic oral treatment. Material and methods: we recruited 79 adult male and female patients that were followed for 14-weeks without LM consumption and then received increasing doses of a LM-based-snack for other 14-weeks. Results: there was a significant decrease in blood pressure and a significant increase in HDL-cholesterol by the end of the study period. While patients with A1C concentrations > 8 and ≤ 10 did not significantly improve their metabolic control, patients with serum A1C concentrations ≤ 8.0% reduced significantly their A1C after the intervention and 71% achieved a target concentration of 6.5%. Conclusion: patients with T2DM could benefit with the addition of LM-snack to their conventional treatment

Introducción: los cambios recomendados sobre los estilos de vida, incluido el consumo frecuente de leguminosas, han resultado en un mejor control metabólico y disminución de la presión arterial en pacientes con diabetes mellitus tipo 2 (DMT2). Objetivo: este fue un estudio casi experimental cruzado de 28 semanas que evaluó el efecto del consumo diario de la leguminosa Lupinus mutabilis Sweet (LM) en el control metabólico de pacientes con DMT2 con tratamiento oral hipoglucemiante. Material y métodos: inicialmente se reclutaron 79 pacientes adultos, hombres y mujeres, que fueron seguidos durante 14 semanas sin consumo de LM y luego recibieron dosis crecientes de un tentempié de LM durante otras 14 semanas. Resultados: se observó una disminución significativa en la presión arterial y un aumento significativo en el colesterol-HDL después del consumo de LM. Mientras que los pacientes con concentraciones de A1C sérica > 8 y ≤ 10 no mejoraron significativamente su control metabólico, los pacientes con concentraciones séricas de A1C ≤ 8,0% redujeron significativamente su A1C después de la intervención y el 71% de estos pacientes llegó a la meta de tratamiento ≤ 6,5%. Conclusión: los pacientes con DMT2 podrían beneficiarse con la adición de un tentempié de LM a su tratamiento convencional

Humanos , Masculino , Feminino , Adulto , Diabetes Mellitus Tipo 2/dietoterapia , Lupinus , Resultado do Tratamento , Fabaceae , Lanches , Fitoterapia , Valor Nutritivo , Hipoglicemiantes/administração & dosagem , HDL-Colesterol/metabolismo , Pressão Arterial/efeitos dos fármacos , Gluconeogênese , Índice Glicêmico , Equador , Antropometria , Proteínas na Dieta , Sementes
Nutrients ; 11(7)2019 Jul 12.
Artigo em Inglês | MEDLINE | ID: mdl-31336986


The prevalence of diabetes is increasing globally, and its effect on patients and the healthcare system can be significant. Gestational diabetes mellitus (GDM) and type 2 diabetes are well established risk factors for cardiovascular disease, and strategies for managing these conditions include dietary interventions, such as the use of a low glycemic index (GI) diet. AIMS: This review aimed to evaluate the effects of a low GI diet on the cardio-metabolic and inflammatory parameters in patients with type 2 diabetes and women with GDM and assess whether the effects are different in these conditions. METHODS: This review was based on the preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines. Three databases (EMBASE, Pubmed, and PsycINFO) were searched from inception to 20 February 2019 using search terms that included synonyms and Medical Subject Headings (MeSH) in line with the population, intervention, comparator, outcomes, and studies (PICOS) framework. Studies were evaluated for the quality and risk of bias. RESULTS: 10 randomised controlled studies were included in the systematic review, while 9 were selected for the meta-analysis. Two distinct areas were identified: the effect of a low GI diet on lipid profile and the effect of a low GI diet on inflammatory parameters. The results of the meta-analysis showed that there were no significant differences (p > 0.05) between the low GI and higher GI diets with respect to total cholesterol, HDL, and LDL cholesterol in patients with type 2 diabetes. However, there was a significant difference (p = 0.027) with respect to triglyceride which increased by a mean of 0.06 mmol/L (0.01, 0.11) in patients with type 2 diabetes on higher GI diet. With respect to the women with GDM, the findings from the systematic review were not consistent in terms of the effect of a low GI diet on the lipid profile. The results of the meta-analysis did not show significant differences (p > 0.05) between low GI and higher GI diets with respect to adiponectin and C-reactive proteins in patients with type 2 diabetes, but a significant difference (p < 0.001) was observed between the two groups in relation to interleukin-6. CONCLUSION: This systematic review and meta-analysis have demonstrated that there were no significant differences (p > 0.05) between the low GI and higher GI diets in relation to total cholesterol-HDL and LDL cholesterol-in patients with type 2 diabetes. However, a significant difference (p < 0.05) was observed between the two groups with respect to triglyceride in patients with type 2 diabetes. The results of the effect of a low GI diet on the lipid profile in patients with GDM were not consistent. With respect to the inflammatory parameters, the low GI diet significantly decreased interleukin-6 in patients with type 2 diabetes compared to the higher GI diet. More studies are needed in this area of research.

Diabetes Mellitus Tipo 2/dietoterapia , Diabetes Gestacional/dietoterapia , Dieta , Índice Glicêmico , Inflamação/dietoterapia , Feminino , Humanos , Gravidez
Nutrients ; 11(7)2019 Jul 09.
Artigo em Inglês | MEDLINE | ID: mdl-31323991


Gestational diabetes mellitus (GDM) is defined as "glucose intolerance that is first diagnosed during pregnancy". Mothers with GDM and their infants may experience both short and long term complications. Dietary intervention is the first therapeutic strategy. If good glycaemic control is not achieved, insulin therapy is recommended. There is no consensus on which nutritional approach should be used in GDM. In the last few years, there has been growing evidence of the benefits of a low glycaemic index (LGI) diet on diabetes and cardiovascular disease. The effect of a LGI diet on GDM incidence has been investigated as well. Several studies observed a lower incidence of GDM in LGI diet arms, without adverse maternal and fetal outcomes. The main positive effect of the LGI diet was the reduction of 2-h post-prandial glucose (PPG). Several studies have also evaluated the effect of the LGI diet in GDM treatment. Overall, the LGI diet might have beneficial effects on certain outcomes, such as 2-h PPG, fasting plasma glucose and lipid profile in patients with GDM. Indeed, most studies observed a significant reduction in insulin requirement. Overall, according to current evidence, the LGI nutritional approach is safe and it might therefore be considered in clinical care for GDM.

Diabetes Gestacional/prevenção & controle , Carboidratos da Dieta/administração & dosagem , Carboidratos da Dieta/normas , Diabetes Gestacional/dietoterapia , Feminino , Índice Glicêmico , Humanos , Gravidez , Resultado da Gravidez
Nutrients ; 11(8)2019 Jul 24.
Artigo em Inglês | MEDLINE | ID: mdl-31344892


This systematic review and meta-analysis aims to compare the effect of High-Glycemic Index (GI) versus Low-GI breakfasts on cognitive functions, including memory and attention, of children and adolescents. We systematically searched the MEDLINE (via PubMed), EMBASE, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, and Web of Science databases, from their inception until June 2019. Articles comparing the effect of Low-GI versus High-GI breakfasts on the cognitive function (i.e., immediate memory, delayed memory, and attention) of children and adolescents were included. The DerSimonian and Laird method was used to compute the pooled effect sizes (ESs) and their respective 95% confidence intervals (CIs). The pooled ESs were 0.13 (95% CI: -0.11, 0.37) for immediate memory and 0.07 (95% CI: -0.15, 0.28) for delayed memory. For attention, the pooled ES was -0.01 (95% CI: -0.27, 0.26). In summary, GI breakfasts do not affect cognitive domains in children and adolescents.

Comportamento do Adolescente , Desjejum , Comportamento Infantil , Cognição , Índice Glicêmico , Valor Nutritivo , Adolescente , Fatores Etários , Atenção , Criança , Humanos , Memória
Bull Exp Biol Med ; 167(3): 343-346, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31346865


We studied the effect of streptozotocin-induced diabetes mellitus on the level of glycemia and some other indices of lipid metabolism, including fatty acid metabolism and LPO intensity, during the development of diabetes mellitus in rats. Even at the early terms of diabetes development, hypertriglyceridemia and hypercholesterolemia were accompanied by changes in the blood content of fatty acid (at the expense of ω3 and ω6 fatty acids) that persisted throughout the observation period. Intensification of LPO against the background of suppressed activity of antioxidant enzymes and reduced level of ω3 fatty acids attested to the development of oxidative stress. These data attest to antioxidant property of ω3 fatty acids, which is seen from positive correlations between these fatty acids and activity of antioxidant enzymes.

Diabetes Mellitus Experimental/patologia , Dislipidemias/sangue , Ácidos Graxos Ômega-3/sangue , Ácidos Graxos Ômega-3/metabolismo , Metabolismo dos Lipídeos/fisiologia , Estresse Oxidativo/fisiologia , Animais , Diabetes Mellitus Experimental/sangue , Feminino , Índice Glicêmico , Hipercolesterolemia/patologia , Hipertrigliceridemia/patologia , Masculino , Ratos , Ratos Wistar , Estreptozocina
Bull Exp Biol Med ; 167(3): 351-355, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31346872


In type 1 diabetes mellitus, the levels of insulin and C-peptide decrease at the periphery and in CNS. C-peptide potentiates the regulatory effects of insulin. We studied the effects of single and repeated (over 7 days) individual and combined nasal administration of C-peptide (10 µg/day) and insulin (20 µg/day) on activity of Akt kinase and kinase-3ß-glycogen synthase (GSK3ß), the components of 3-phosphoinositide pathway, in the hypothalamus of intact rats and rats with mild streptozotocin-induced type 1 diabetes mellitus. Phosphorylation of Akt kinase at Thr308 and Ser473 (stimulation) and GSK3ß at Ser9 (inhibition) was evaluated. In diabetes, phosphorylation of Akt kinase and, to a lesser extent, GSK3ß, is reduced. A single injection of insulin or C-peptide and insulin increased this process. Long-term combined treatment with C-peptide and insulin normalized activity of Akt kinase and GSK3ß in diabetic rats, treatment with insulin alone produced less pronounced effect; monotherapy with C-peptide was ineffective. Intranasal co-administration of C-peptide and insulin effectively stimulates the insulin system in the hypothalamus that is weakened at diabetes mellitus type 1, which can be used in the treatment of this disease.

Peptídeo C/farmacologia , Diabetes Mellitus Experimental/tratamento farmacológico , Hipotálamo/metabolismo , Insulina/farmacologia , Fosfatidilinositóis/metabolismo , Administração Intranasal , Animais , Peptídeo C/administração & dosagem , Sinergismo Farmacológico , Índice Glicêmico/efeitos dos fármacos , Glicogênio Sintase Quinase 3 beta/metabolismo , Masculino , Fosforilação , Proteínas Proto-Oncogênicas c-akt/metabolismo , Ratos , Ratos Wistar , Estreptozocina , Perda de Peso/efeitos dos fármacos