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1.
J Stroke Cerebrovasc Dis ; 29(10): 105157, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32912502

RESUMO

Cerebral arteriovenous malformations (AVMs) are generally attributed to congenital lesions that arise from aberrant vasculogenesis between the fourth and eighth weeks of embryonic life. However, this dogma has been challenged by several recent observations, one of which is de novo formation of AVMs. Forty cases of de novo AVMs were published between 2000 and 2019, all of which involved a history of intracranial insult, such as vascular abnormalities or nonvascular conditions, prior to AVM diagnosis. We hereby present two unique operative cases of ruptured de novo AVMs in older adult patients. Case 1 is novel in the sense that the patient did not experience any kind of environmental trigger ("second hit") such as a previous intracranial insult, while Case 2 serves as the second report of a de novo AVM patient with a medical history of Bell's palsy. Although the exact mechanisms of AVM formation remain to be elucidated, it is likely to be a multifactorial process related to environmental and hemodynamic factors.


Assuntos
Paralisia de Bell/complicações , Angiopatias Diabéticas/complicações , Hipertensão/complicações , Malformações Arteriovenosas Intracranianas/etiologia , Idoso , Paralisia de Bell/diagnóstico , Circulação Cerebrovascular , Angiopatias Diabéticas/diagnóstico , Hemodinâmica , Humanos , Hipertensão/diagnóstico , Malformações Arteriovenosas Intracranianas/diagnóstico por imagem , Malformações Arteriovenosas Intracranianas/fisiopatologia , Malformações Arteriovenosas Intracranianas/cirurgia , Masculino , Pessoa de Meia-Idade , Recidiva , Fatores de Risco , Resultado do Tratamento
2.
Diab Vasc Dis Res ; 17(4): 1479164120944134, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32713196

RESUMO

OBJECTIVE: The primary objective of the study was to estimate the prevalence of sub-clinical left ventricular dysfunction among asymptomatic diabetic patients, while the secondary objectives were to determine its association with microvascular complications and to find correlation with the baseline clinical and demographic parameters. MATERIAL AND METHODOLOGY: This was a cross-sectional study conducted on 226 type 2 diabetic patients who did not have any diagnosed cardiac disease, baseline ECG abnormality or cardiac symptoms. Two-dimensional strain echocardiography was performed to estimate the prevalence of left ventricular systolic dysfunction by measuring global longitudinal strain rate (cutoff < 18). Its association with microvascular complications was analysed with SPSS 23 software. Other baseline clinical parameters and demographic profile were also analysed. RESULT: Among 226 patients (151 males, 75 females), cardiac abnormality was found in 29.2% patients. Diabetic microvascular complications (e.g. neuropathy, retinopathy and nephropathy) were strongly associated with it (each with p < 0.0001) in addition to dyslipidaemia, history of hypertension, higher body mass index and poor glycaemic parameters. Among them, proteinuria showed a linear inverse relationship without any specific cutoff value. CONCLUSION: It was found that sub-clinical left ventricular dysfunction was found in significantly high proportion among patients with microvascular complications. Hence, routine screening of all diabetics for such complications and subsequently high-risk patients undergoing strain echocardiography can be a very cost-effective diagnostic, therapeutic and prognostic modality.


Assuntos
Diabetes Mellitus Tipo 2/epidemiologia , Angiopatias Diabéticas/epidemiologia , Disfunção Ventricular Esquerda/epidemiologia , Função Ventricular Esquerda , Doenças Assintomáticas , Estudos Transversais , Diabetes Mellitus Tipo 2/diagnóstico , Angiopatias Diabéticas/diagnóstico , Ecocardiografia , Feminino , Humanos , Índia/epidemiologia , Masculino , Pessoa de Meia-Idade , Prevalência , Medição de Risco , Fatores de Risco , Sístole , Disfunção Ventricular Esquerda/diagnóstico por imagem , Disfunção Ventricular Esquerda/fisiopatologia
3.
Cardiovasc Diabetol ; 19(1): 105, 2020 07 06.
Artigo em Inglês | MEDLINE | ID: mdl-32631323

RESUMO

BACKGROUND: To assess the associations of various HbA1c measures, including a single baseline HbA1c value, overall mean, yearly updated means, standard deviation (HbA1c-SD), coefficient of variation (HbA1c-CV), and HbA1c variability score (HVS), with microvascular disease (MVD) risk in patients with type 2 diabetes. METHODS: Linked data between National Cheng Kung University Hospital and Taiwan's National Health Insurance Research Database were utilized to identify the study cohort. The primary outcome was the composite MVD events (retinopathy, nephropathy, or neuropathy) occurring during the study follow-up. Cox model analyses were performed to assess the associations between HbA1c measures and MVD risk, with adjustment for patients' baseline HbA1c, demographics, comorbidities/complications, and treatments. RESULTS: In the models without adjustment for baseline HbA1c, all HbA1c variability and mean measures were significantly associated with MVD risk, except HVS. With adjustment for baseline HbA1c, HbA1c-CV had the strongest association with MVD risk. For every unit of increase in HbA1c-CV, the MVD risk significantly increased by 3.42- and 2.81-fold based on the models without and with adjustment for baseline HbA1c, respectively. The associations of HbA1c variability and mean measures with MVD risk in patients with baseline HbA1c < 7.5% (58 mmol/mol) were stronger compared with those in patients with baseline HbA1c ≥ 7.5% (58 mmol/mol). CONCLUSIONS: HbA1c variability, especially HbA1c-CV, can supplement conventional baseline HbA1c measure for explaining MVD risk. HbA1c variability may play a greater role in MVD outcomes among patients with relatively optimal baseline glycemic control compared to those with relatively poor baseline glycemic control.


Assuntos
Glicemia/metabolismo , Diabetes Mellitus Tipo 2/sangue , Angiopatias Diabéticas/sangue , Hemoglobina A Glicada/metabolismo , Adulto , Idoso , Biomarcadores/sangue , Bases de Dados Factuais , Diabetes Mellitus Tipo 2/diagnóstico , Diabetes Mellitus Tipo 2/epidemiologia , Angiopatias Diabéticas/diagnóstico , Angiopatias Diabéticas/epidemiologia , Nefropatias Diabéticas/sangue , Nefropatias Diabéticas/diagnóstico , Nefropatias Diabéticas/epidemiologia , Neuropatias Diabéticas/sangue , Neuropatias Diabéticas/diagnóstico , Neuropatias Diabéticas/epidemiologia , Retinopatia Diabética/sangue , Retinopatia Diabética/diagnóstico , Retinopatia Diabética/epidemiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Prognóstico , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Taiwan/epidemiologia , Fatores de Tempo
4.
Nutr Metab Cardiovasc Dis ; 30(10): 1723-1731, 2020 09 24.
Artigo em Inglês | MEDLINE | ID: mdl-32636121

RESUMO

AIMS: To investigate the associations between Lp(a), Apo A1, Apo B, and Apo B/Apo A1 ratio with micro- and macrovascular complications of diabetes. METHODS AND RESULTS: In this case-cohort study, 1057 patients with type 2 diabetes (T2DM) were followed in the diabetes clinic of Vali-Asr Hospital from 2014 to 2019. The association between serum Lp (a) and apolipoproteins with cardiovascular disease (CVD), neuropathy, and nephropathy were assessed by using binary regression analysis. The ROC curve analysis was used to evaluate the predictive properties of proteins. Youden index was used to calculate cutoff values. Among patients with T2DM, 242, 231, and 91 patients developed CVD, neuropathy, and nephropathy, respectively. The serum Lp (a) level was positively correlated with the development of all three. (P-values = 0.022, 0.042, and 0.038, respectively). The Apo A1 level was negatively correlated with nephropathy. Among the biomarkers, Lp(a) had the highest AUC for prediction of CVD, neuropathy, and nephropathy. Calculated cutoff values of Lp(a), and Apo A1 levels were higher than the standard cutoff values. CONCLUSION: Serum level of Lp(a) is a predictor for CVD, neuropathy, and nephropathy. Based on the calculated cutoff values in patients with T2DM, we should consider diabetic complications at higher levels of Lp(a).


Assuntos
Apolipoproteína A-I/sangue , Doenças Cardiovasculares/epidemiologia , Diabetes Mellitus Tipo 2/sangue , Angiopatias Diabéticas/epidemiologia , Nefropatias Diabéticas/epidemiologia , Neuropatias Diabéticas/epidemiologia , Dislipidemias/sangue , Lipoproteína(a)/sangue , Idoso , Apolipoproteína B-100/sangue , Biomarcadores/sangue , Doenças Cardiovasculares/diagnóstico , Estudos de Casos e Controles , Diabetes Mellitus Tipo 2/diagnóstico , Diabetes Mellitus Tipo 2/epidemiologia , Angiopatias Diabéticas/diagnóstico , Nefropatias Diabéticas/diagnóstico , Neuropatias Diabéticas/diagnóstico , Dislipidemias/diagnóstico , Dislipidemias/epidemiologia , Feminino , Humanos , Incidência , Irã (Geográfico)/epidemiologia , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Estudos Prospectivos , Medição de Risco , Fatores de Risco
5.
Angiology ; 71(10): 876-885, 2020 11.
Artigo em Inglês | MEDLINE | ID: mdl-32638622

RESUMO

Vascular complications in patients with diabetes mellitus (DM) are common. Since impaired oxygen balance in plasma plays an important role in the pathogenesis of chronic DM-associated complications, the administration of hyperbaric oxygen therapy (HBOT) has been recommended to influence development of vascular complications. Hyperbaric oxygen therapy involves inhalation of 100% oxygen under elevated pressure from 1.6 to 2.8 absolute atmospheres in hyperbaric chambers. Hyperbaric oxygen therapy increases plasma oxygen solubility, contributing to better oxygen diffusion to distant tissues and preservation of the viability of tissues reversibly damaged by atherosclerosis-induced ischemia, along with microcirculation restoration. Hyperbaric oxygen therapy exerts antiatherogenic, antioxidant, and cardioprotective effects by altering the level and composition of plasma fatty acids and also by promoting signal transduction through membranes, which are impaired by hyperglycemia and hypoxia. In addition, HBOT affects molecules involved in the regulation of nitric oxide synthesis and in that way exerts anti-inflammatory and angiogenic effects in patients with DM. In this review, we explore the recent literature related to the effects of HBOT on DM-related vascular complications.


Assuntos
Angiopatias Diabéticas/diagnóstico , Angiopatias Diabéticas/terapia , Oxigenação Hiperbárica , Animais , Angiopatias Diabéticas/etiologia , Modelos Animais de Doenças , Humanos
7.
Cardiovasc Diabetol ; 19(1): 85, 2020 06 13.
Artigo em Inglês | MEDLINE | ID: mdl-32534578

RESUMO

BACKGROUND: Type 2 diabetes (T2D) is associated with renal impairment and vascular endothelial dysfunction. Therefore, this pathological connection is an important therapeutic target. Recent cardiovascular and renal outcome trials demonstrated that sodium glucose cotransporter 2 inhibitors (SGLT2is) consistently reduced the risks of cardiovascular and renal events and mortality in patients with T2D and various other background risks including chronic kidney disease (CKD). However, the precise mechanisms by which SGLT2is accords these therapeutic benefits remain uncertain. It is also unknown whether these SGLT2is-associated benefits are associated with the amelioration of endothelial dysfunction in patients with T2D and CKD. METHODS: The PROCEED trial is an investigator-initiated, prospective, multicenter, open-label, randomized-controlled trial. The target sample size is 110 subjects. After they furnish informed consent and their endothelial dysfunction is confirmed from their decreased reactive hyperemia indices (RHI), eligible participants with T2D (HbA1c, 6.0-9.0%) and established CKD (30 mL/min/1.73 m2 ≤ estimated glomerular filtration ratio [eGFR] < 60 and/or ≥ urine albumin-to-creatinine ratio 30 mg/g Cr) will be randomized (1:1) to receive either 50 mg ipragliflozin daily or continuation of background treatment (non-SGLT2i). The primary endpoint is the change in RHI from baseline after 24 weeks. To compare the treatment effects between groups, the baseline-adjusted means and their 95% confidence intervals will be estimated by analysis of covariance adjusted for HbA1c (< 7.0% or ≥ 7.0%), age (< 70 y or ≥ 70 y), RHI (< 1.67 or ≥ 1.67), eGFR (< 45 mL/min/1.73 m2 or ≥ 45 mL/min/1.73 m2), and smoking status. Prespecified responder analyses will be also conducted to determine the proportions of patients with clinically meaningful changes in RHI at 24 weeks. DISCUSSION: PROCEED is the first trial to examine the effects of ipragliflozin on endothelial dysfunction in patients with T2D and CKD. This ongoing trial will establish whether endothelial dysfunction is a therapeutic target of SGLT2is in this population. It will also provide deep insights into the potential mechanisms by which SGLT2is reduced the risks of cardiovascular and renal events in recent outcome trials. Trial registration Unique Trial Number, jRCTs071190054 (https://jrct.niph.go.jp/en-latest-detail/jRCTs071190054).


Assuntos
Diabetes Mellitus Tipo 2/tratamento farmacológico , Angiopatias Diabéticas/tratamento farmacológico , Nefropatias Diabéticas/tratamento farmacológico , Endotélio Vascular/efeitos dos fármacos , Glucosídeos/uso terapêutico , Insuficiência Renal Crônica/tratamento farmacológico , Inibidores do Transportador 2 de Sódio-Glicose/uso terapêutico , Tiofenos/uso terapêutico , Diabetes Mellitus Tipo 2/diagnóstico , Diabetes Mellitus Tipo 2/epidemiologia , Diabetes Mellitus Tipo 2/fisiopatologia , Angiopatias Diabéticas/diagnóstico , Angiopatias Diabéticas/epidemiologia , Angiopatias Diabéticas/fisiopatologia , Nefropatias Diabéticas/diagnóstico , Nefropatias Diabéticas/epidemiologia , Nefropatias Diabéticas/fisiopatologia , Endotélio Vascular/fisiopatologia , Glucosídeos/efeitos adversos , Humanos , Japão/epidemiologia , Estudos Multicêntricos como Assunto , Estudos Prospectivos , Ensaios Clínicos Controlados Aleatórios como Assunto , Insuficiência Renal Crônica/diagnóstico , Insuficiência Renal Crônica/epidemiologia , Insuficiência Renal Crônica/fisiopatologia , Inibidores do Transportador 2 de Sódio-Glicose/efeitos adversos , Tiofenos/efeitos adversos , Fatores de Tempo , Resultado do Tratamento
8.
Diab Vasc Dis Res ; 17(3): 1479164120928303, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32538145

RESUMO

AIM: The aim of this study was to investigate the correlation between skin microvascular reactivity and clinical microangiopathy in patients with type 1 diabetes. METHODS: We included 61 patients with type 1 diabetes, that is, 31 patients with and 30 without clinical microangiopathy, and 31 healthy controls. A microangiopathy scoring system was introduced for comparison of data between patients with microangiopathy. Responses to iontophoresis of acetylcholine and sodium nitroprusside were assessed by laser Doppler imaging. RESULTS: Patients with microangiopathy had reduced acetylcholine- and sodium nitroprusside-mediated flux in forearm skin microcirculation compared to healthy controls (p = 0.03 and p < 0.001, respectively, repeated measures analysis of variance), whereas no significant differences were found between patients without microangiopathy and controls. Skin reactivity was reduced in patients with microangiopathy compared to patients without microangiopathy: 1.43 ± 0.38 versus 1.59 ± 0.39 arbitrary units for acetylcholine-mediated peak flux and 1.44 ± 0.46 versus 1.74 ± 0.34 arbitrary units for sodium nitroprusside-mediated peak flux (p < 0.05 for both). A tendency of gradual decrease in acetylcholine and sodium nitroprusside responses was found in patients with increasing microangiopathy scores. CONCLUSION: We conclude that skin microvascular reactivity is associated with clinical microangiopathy in patients with type 1 diabetes. Impaired skin microvascular function in type 1 diabetes seems to be multifactorial and involves both endothelial-dependent and endothelial-independent pathways. We introduce a novel microangiopathy score that could easily be used in a clinical setting for comparison of patients with various degrees of microangiopathy.


Assuntos
Diabetes Mellitus Tipo 1/complicações , Angiopatias Diabéticas/etiologia , Microcirculação , Pele/irrigação sanguínea , Vasodilatação , Administração Cutânea , Adulto , Idoso , Velocidade do Fluxo Sanguíneo , Estudos de Casos e Controles , Estudos Transversais , Diabetes Mellitus Tipo 1/diagnóstico , Diabetes Mellitus Tipo 1/fisiopatologia , Angiopatias Diabéticas/diagnóstico , Angiopatias Diabéticas/fisiopatologia , Feminino , Antebraço , Humanos , Iontoforese , Fluxometria por Laser-Doppler , Masculino , Microcirculação/efeitos dos fármacos , Angioscopia Microscópica , Pessoa de Meia-Idade , Projetos Piloto , Valor Preditivo dos Testes , Fatores de Risco , Vasodilatação/efeitos dos fármacos , Vasodilatadores/administração & dosagem
9.
Cardiovasc Diabetol ; 19(1): 50, 2020 05 02.
Artigo em Inglês | MEDLINE | ID: mdl-32359350

RESUMO

BACKGROUND: The prognostic importance of an increased visit-to-visit blood pressure variability (BP-VVV) for the future development of micro- and macrovascular complications in type 2 diabetes has been scarcely investigated and is largely unsettled. We aimed to evaluate it in a prospective long-term follow-up study with 632 individuals with type 2 diabetes. METHODS: BP-VVV parameters (systolic and diastolic standard deviations [SD] and variation coefficients) were measured during the first 24-months. Multivariate Cox analysis, adjusted for risk factors and mean BP levels, examined the associations between BP-VVV and the occurrence of microvascular (retinopathy, microalbuminuria, renal function deterioration, peripheral neuropathy) and macrovascular complications (total cardiovascular events [CVEs], major adverse CVEs [MACE] and cardiovascular and all-cause mortality). Improvement in risk discrimination was assessed by the C-statistic and integrated discrimination improvement (IDI) index. RESULTS: Over a median follow-up of 11.3 years, 162 patients had a CVE (132 MACE), and 212 patients died (95 from cardiovascular diseases); 153 newly-developed or worsened diabetic retinopathy, 193 achieved the renal composite outcome (121 newly-developed microalbuminuria and 95 deteriorated renal function), and 171 newly-developed or worsened peripheral neuropathy. Systolic BP-VVV was an independent predictor of MACE (hazard ratio: 1.25, 95% CI 1.03-1.51 for a 1-SD increase in 24-month SD), but not of total CVEs, cardiovascular and all-cause mortality, and of any microvascular outcome. However, no BP-VVV parameter significantly improved cardiovascular risk discrimination (increase in C-statistic 0.001, relative IDI 0.9%). CONCLUSIONS: Systolic BP-VVV was an independent predictor of MACE, but it did not improve cardiovascular risk stratification. The goal of anti-hypertensive treatment in patients with type 2 diabetes shall remain in controlling mean BP levels, not on decreasing their visit-to-visit variability.


Assuntos
Pressão Sanguínea , Doenças Cardiovasculares/epidemiologia , Diabetes Mellitus Tipo 2/epidemiologia , Angiopatias Diabéticas/epidemiologia , Nefropatias Diabéticas/epidemiologia , Neuropatias Diabéticas/epidemiologia , Idoso , Brasil/epidemiologia , Doenças Cardiovasculares/diagnóstico , Doenças Cardiovasculares/mortalidade , Doenças Cardiovasculares/fisiopatologia , Causas de Morte , Diabetes Mellitus Tipo 2/diagnóstico , Diabetes Mellitus Tipo 2/mortalidade , Diabetes Mellitus Tipo 2/fisiopatologia , Angiopatias Diabéticas/diagnóstico , Angiopatias Diabéticas/mortalidade , Angiopatias Diabéticas/fisiopatologia , Nefropatias Diabéticas/diagnóstico , Nefropatias Diabéticas/mortalidade , Nefropatias Diabéticas/fisiopatologia , Neuropatias Diabéticas/diagnóstico , Neuropatias Diabéticas/mortalidade , Neuropatias Diabéticas/fisiopatologia , Progressão da Doença , Feminino , Humanos , Incidência , Rim/fisiopatologia , Masculino , Pessoa de Meia-Idade , Prognóstico , Estudos Prospectivos , Medição de Risco , Fatores de Risco , Sístole , Fatores de Tempo
10.
Microvasc Res ; 131: 104013, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32428521

RESUMO

Diabetes is frequently associated with structural and functional impairment of the microcirculation. Blood perfusion is an important indicator of both physiological and pathological conditions of the microcirculation. Given that temperature is closely related to blood perfusion and is more easily measured, blood perfusion can be estimated from variations in skin temperature using an inverse method. The aim of this paper was to develop a thermal analysis method for estimation of blood perfusion and apply it in the assessment of skin blood perfusion in diabetic rats. First, diabetes was induced in the rat models of the experimental group. Skin temperature from the rats left hind paws was measured during a 10-min local heating period followed by a 15-min cooling period. A simple one-dimensional heat transfer model, including an arteriolar vessel node, was used to describe the skin heat transfer process. The blood perfusion of the arteriole was estimated by correlating the calculated skin temperature with known experimental temperatures using a genetic algorithm. The results indicated that the average blood perfusion in the control group was higher during local heating and decreased faster during the cooling period, showing dynamic responses to the thermal stimuli. In contrast, the blood perfusion of diabetic rats was reduced compared with that of the control rats during the heating phase and the rate of decrease in perfusion during the cooling stage was similarly reduced, implying a slower response to thermal stimulation in these rats. It is interesting to note that diabetic rats fed a normal diet showed a similar blood perfusion pattern to that in the control rats, implying that diet may be important in the treatment of diabetes-associated microvascular dysfunction.


Assuntos
Algoritmos , Diabetes Mellitus Experimental/diagnóstico , Diabetes Mellitus Tipo 2/diagnóstico , Angiopatias Diabéticas/diagnóstico , Microcirculação , Modelos Cardiovasculares , Temperatura Cutânea , Pele/irrigação sanguínea , Termometria , Animais , Diabetes Mellitus Experimental/complicações , Diabetes Mellitus Experimental/fisiopatologia , Diabetes Mellitus Tipo 2/complicações , Diabetes Mellitus Tipo 2/fisiopatologia , Angiopatias Diabéticas/etiologia , Angiopatias Diabéticas/fisiopatologia , Transferência de Energia , Valor Preditivo dos Testes , Ratos Sprague-Dawley , Fluxo Sanguíneo Regional , Fatores de Tempo
11.
SEMERGEN, Soc. Esp. Med. Rural Gen. (Ed. Impr.) ; 46(3): 175-185, abr. 2020. tab
Artigo em Espanhol | IBECS | ID: ibc-196701

RESUMO

OBJETIVOS: Evaluar el grado de cumplimiento de las recomendaciones de las guías de práctica clínica (GPC) en el diagnóstico y seguimiento de las principales complicaciones crónicas vasculares de los pacientes con diabetes tipo2 (DM2) en atención primaria (AP). MATERIAL Y MÉTODOS: Estudio descriptivo transversal retrospectivo en pacientes de 18 o más años de edad seleccionados consecutivamente a medida que acudieron a la consulta en AP. Los datos de los pacientes se obtuvieron mediante acceso a la historia informatizada, registrándose variables clínicas y analíticas de interés. Se consideró adecuada la determinación y el registro de microalbuminuria (MALB), filtrado glomerular (FG), exploración pies (palpación pulsos, monofilamento o diapasón) y electrocardiograma (ECG) si habían sido realizados de manera anual, y del fondo de ojo (FO) cada dos años. RESULTADOS: Se incluyó a 1.420 pacientes (55,8% varones), con una edad media (DE) de 70,6 (10,8) años y una media de 9,3 (6,2) años de evolución de su diabetes. El índice de masa corporal (IMC) medio (kg/m2) fue de 30,1 (5,4) en mujeres y de 29,5 (4,7) en varones (p = 0,023) y la HbA1c (%), de 6,9 (1,2). El buen control metabólico de la DM se alcanzó en el 63,0% (IC95%: 60,4-65,5). Tenían realizado FO en los dos últimos años 976 pacientes (68,7%; IC95%: 66,2-71,1). La MALB se había realizado a 1.228 pacientes (86,5%; IC95%: 84,6-88,2), el FG estimado a 1.391 (98,0%; IC95%: 97,1-98,6), la exploración de los pulsos del pie a 626 (44,1%; IC95%: 41,5-46,7) y la exploración neurológica a 473 (33,3%; IC95%: 30,8-35,8). CONCLUSIONES: Los resultados de nuestro estudio indican que en una proporción importante de los pacientes con DM2 no se explora la presencia de retinopatía ni de neuropatía. A siete de cada diez pacientes se les ha cribado de retinopatía, uno de cada tres tiene realizada exploración neurológica y uno de cada cuatro tiene realizadas todas las exploraciones recomendadas por las GPC


OBJECTIVE: To evaluate the level of compliance to the clinical practice guidelines (CPG) recommendations for the diagnosis and monitoring of the main chronic vascular complications of patients with type2 diabetes (DM2) in Primary Care (PC). MATERIAL AND METHODS: A retrospective cross-sectional descriptive study was conducted on patients aged 18years and over and consecutively selected in PC. Patient data were obtained by direct interview and access to the computerised history, and recording the clinical and analytical variables of interest. The determination and recording of urine microalbumin (MALB), glomerular filtration rate (GFR), foot examination (pulse palpation, monofilament or tuning fork), and electrocardiogram (ECG), if performed annually, and the eye fundus (FO) every two years. RESULTS: A total of 1,420 patients were included, of which 55.8% were male. The mean age (SD) was 70.6 (10.8) years and the mean onset of the diabetes was 9.3 (6.2) years. The mean BMI (kg /m2) was 30.1 (5.4) in females and 29.5 (4.7) in males (P=.023), and a mean HbA1c (%) of 6.9 (1.2). Good metabolic control of DM was achieved in 63.0% (95%CI: 60.4-65.5). In the last two years, 976 (68.7%; 95%CI: 66.2-71.1) patients had an eye fundus examination. The urine microalbumin had been performed on 1,228 patients (86.5%; 95%CI: 84.6-88.2). The mean glomerular filtration rate was performed on 1,391 patients (98.0%; 95%CI: 97.1-98.6), the foot pulses examination on 626 (44.1%; 95%CI: 41.5-46.7), and the neurological examination on 473 patients (33.3%; 95%CI: 30.8-35.8). CONCLUSIONS: The results of the present study indicate that the presence of retinopathy or neuropathy is not explored in a significant percentage of patients with DM2. Only seven out of ten patients have been screened for retinopathy, one in three had a neurological examination, and only one in four have all the scans recommended by the CPG


Assuntos
Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Idoso , Diabetes Mellitus Tipo 2/complicações , Angiopatias Diabéticas/diagnóstico , Guias de Prática Clínica como Assunto/normas , Doença Crônica , Estudos Transversais , Estudos Retrospectivos , Atenção Primária à Saúde
12.
Acta Diabetol ; 57(6): 705-713, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32008161

RESUMO

AIMS: Type 2 diabetes mellitus (T2DM) is now very prevalent in China. Due to the lower rate of controlled diabetes in China compared to that in developed countries, there is a higher incidence of serious cardiovascular complications, especially acute coronary syndrome (ACS). The aim of this study was to establish a potent risk predictive model in the economically disadvantaged northwest region of China, which could predict the probability of new-onset ACS in patients with T2DM. METHODS: Of 456 patients with T2DM admitted to the First Affiliated Hospital of Xi'an Jiaotong University from January 2018 to January 2019 and included in this study, 270 had no ACS, while 186 had newly diagnosed ACS. Overall, 32 demographic characteristics and serum biomarkers of the study patients were analysed. The least absolute shrinkage and selection operator regression was used to select variables, while the multivariate logistic regression was used to establish the predictive model that was presented using a nomogram. The area under the receiver operating characteristics curve (AUC) was used to evaluate the discriminatory capacity of the model. A calibration plot and Hosmer-Lemeshow test were used for the calibration of the predictive model, while the decision curve analysis (DCA) was used to evaluate its clinical validity. RESULTS: After random sampling, 319 and 137 T2DM patients were included in the training and validation sets, respectively. The predictive model included age, body mass index, diabetes duration, systolic blood pressure (SBP), diastolic blood pressure (DBP), low-density lipoprotein cholesterol, serum uric acid, lipoprotein(a), hypertension history and alcohol drinking status as predictors. The AUC of the predictive model and that of the internal validation set was 0.830 [95% confidence interval (CI) 0.786-0.874] and 0.827 (95% CI 0.756-0.899), respectively. The predictive model showed very good fitting degree, and DCA demonstrated a clinically effective predictive model. CONCLUSIONS: A potent risk predictive model was established, which is of great value for the secondary prevention of diabetes. Weight loss, lowering of SBP and blood uric acid levels and appropriate control for DBP may significantly reduce the risk of new-onset ACS in T2DM patients in Northwest China.


Assuntos
Síndrome Coronariana Aguda/diagnóstico , Síndrome Coronariana Aguda/etiologia , Diabetes Mellitus Tipo 2/complicações , Angiopatias Diabéticas/diagnóstico , Modelos Estatísticos , Síndrome Coronariana Aguda/sangue , Síndrome Coronariana Aguda/epidemiologia , Idoso , Biomarcadores/sangue , Pressão Sanguínea/fisiologia , Índice de Massa Corporal , China/epidemiologia , LDL-Colesterol/sangue , Diabetes Mellitus Tipo 2/sangue , Diabetes Mellitus Tipo 2/diagnóstico , Diabetes Mellitus Tipo 2/epidemiologia , Angiopatias Diabéticas/sangue , Angiopatias Diabéticas/epidemiologia , Feminino , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Prevalência , Prognóstico , Fatores de Risco , Ácido Úrico/sangue
13.
Lancet Diabetes Endocrinol ; 8(3): 206-215, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-32032540

RESUMO

BACKGROUND: Latent autoimmune diabetes of adulthood (LADA) differs in clinical features from type 2 diabetes. Whether this difference translates into different risks of complications remains controversial. We examined the long-term risk of microvascular complications in people enrolled in the UK Prospective Diabetes Study (UKPDS), according to their diabetes autoimmunity status. METHODS: We did a post-hoc analysis of 30-year follow-up data from UKPDS (UKPDS 86). UKPDS participants with diabetes autoantibody measurements available and without previous microvascular events were included. Participants with at least one detectable autoantibody were identified as having latent autoimmune diabetes, and those who tested negative for all autoantibodies were identified as having type 2 diabetes. The incidence of the primary composite microvascular outcome (first occurrence of renal failure, renal death, blindness, vitreous haemorrhage, or retinal photocoagulation) was compared between adults with latent autoimmune diabetes and those with type 2 diabetes. The follow-up ended on Sept 30, 2007. Baseline and updated 9-year mean values of potential confounders were tested in Cox models to adjust hazard ratios (HRs). UKPDS is registered at the ISRCTN registry, 75451837. FINDINGS: Among the 5028 participants included, 564 had latent autoimmune diabetes and 4464 had type 2 diabetes. After median 17·3 years (IQR 12·6-20·7) of follow-up, the composite microvascular outcome occurred in 1041 (21%) participants. The incidence for the composite microvascular outcome was 15·8 (95% CI 13·4-18·7) per 1000 person-years in latent autoimmune diabetes and 14·2 (13·3-15·2) per 1000 person-years in type 2 diabetes. Adults with latent autoimmune diabetes had a lower risk of the composite outcome during the first 9 years of follow-up than those with type 2 diabetes (adjusted HR 0·45 [95% CI 0·30-0·68], p<0·0001), whereas in subsequent years their risk was higher than for those with type 2 diabetes (1·25 [1·01-1·54], p=0·047). Correcting for the higher updated 9-year mean HbA1c seen in adults with latent autoimmune diabetes than in those with type 2 diabetes explained entirely their subsequent increased risk for the composite microvascular outcome (adjusted HR 0·99 [95% CI 0·80-1·23], p=0·93). INTERPRETATION: At diabetes onset, adults with latent autoimmune diabetes have a lower risk of microvascular complications followed by a later higher risk of complications than do adults with type 2 diabetes, secondary to worse glycaemic control. Implementing strict glycaemic control from the time of diagnosis could reduce the later risk of microvascular complications in adults with latent autoimmune diabetes. FUNDING: European Foundation for the Study of Diabetes Mentorship Programme (AstraZeneca).


Assuntos
Autoanticorpos/sangue , Biomarcadores/análise , Diabetes Mellitus Tipo 1/complicações , Diabetes Mellitus Tipo 2/complicações , Angiopatias Diabéticas/etiologia , Microvasos/patologia , Adolescente , Adulto , Idoso , Autoanticorpos/imunologia , Glicemia/análise , Estudos de Casos e Controles , Criança , Angiopatias Diabéticas/diagnóstico , Angiopatias Diabéticas/epidemiologia , Feminino , Seguimentos , Hemoglobina A Glicada/análise , Humanos , Incidência , Masculino , Microvasos/imunologia , Pessoa de Meia-Idade , Prognóstico , Estudos Prospectivos , Fatores de Tempo , Reino Unido/epidemiologia , Adulto Jovem
14.
Acta Diabetol ; 57(6): 673-679, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31938886

RESUMO

AIMS: To investigate the correlation of impairment in skeletal muscle and heart in spontaneous type 2 diabetes mellitus (T2DM) rhesus monkeys using magnetic resonance image (MRI). METHODS: Fifteen T2DM monkeys and fourteen healthy control (HC) monkeys were included. The microcirculation of skeletal muscle [skeletal muscle blood flow (SMBF), skeletal muscle oxygen extraction fraction (SMOEF)] and the function and strain of heart were evaluated by MRI. Three regions of interests were chosen on the soleus muscle (SOL), gastrocnemius muscle (GAS) and tibialis anterior muscle (TA) for image analysis. RESULTS: Eight T2DM monkeys and eight HC monkeys were obtained the full data. The SMBF reserves and SMOEF reserves were found significantly decreased in T2DM during inflation in SOL, GAS and TA muscles (all p < 0.05), and the SMBF reserves decreased during hyperemia in GAS and TA muscles (all p < 0.05). In these monkeys, the global peak longitudinal strain (longitudinal PS), peak systolic longitudinal strain rate (longitudinal PSSR) and peak diastolic longitudinal strain rate (longitudinal PDSR) were seen significantly different in T2DM compared to HC monkeys (all p < 0.05). The longitudinal PSSR was found negatively correlated with SMBF reserves in SOL, GAS and TA during inflation in all monkeys. CONCLUSIONS: The impaired microcirculation of skeletal muscle and the myocardial deformation were found in T2DM monkeys with normal ejection fraction. And a negative correlation was existed in the longitudinal PSSR and the SMBF reserves.


Assuntos
Diabetes Mellitus Tipo 2 , Modelos Animais de Doenças , Coração/diagnóstico por imagem , Macaca mulatta , Imagem por Ressonância Magnética , Músculo Esquelético/diagnóstico por imagem , Animais , Vasos Coronários/diagnóstico por imagem , Vasos Coronários/patologia , Diabetes Mellitus Tipo 2/complicações , Diabetes Mellitus Tipo 2/diagnóstico , Diabetes Mellitus Tipo 2/patologia , Diabetes Mellitus Tipo 2/fisiopatologia , Angiopatias Diabéticas/diagnóstico , Angiopatias Diabéticas/patologia , Angiopatias Diabéticas/fisiopatologia , Feminino , Coração/fisiopatologia , Humanos , Masculino , Microcirculação/fisiologia , Músculo Esquelético/irrigação sanguínea , Músculo Esquelético/patologia , Músculo Esquelético/fisiopatologia , Miocárdio/patologia , Fluxo Sanguíneo Regional
15.
Diabetes ; 69(4): 713-723, 2020 04.
Artigo em Inglês | MEDLINE | ID: mdl-31974140

RESUMO

Clinical studies have suggested that changes in peripheral nerve microcirculation may contribute to nerve damage in diabetic polyneuropathy (DN). High-sensitivity troponin T (hsTNT) assays have been recently shown to provide predictive values for both cardiac and peripheral microangiopathy in type 2 diabetes (T2D). This study investigated the association of sciatic nerve structural damage in 3 Tesla (3T) magnetic resonance neurography (MRN) with hsTNT and N-terminal pro-brain natriuretic peptide serum levels in patients with T2D. MRN at 3T was performed in 51 patients with T2D (23 without DN, 28 with DN) and 10 control subjects without diabetes. The sciatic nerve's fractional anisotropy (FA), a marker of structural nerve integrity, was correlated with clinical, electrophysiological, and serological data. In patients with T2D, hsTNT showed a negative correlation with the sciatic nerve's FA (r = -0.52, P < 0.001), with a closer correlation in DN patients (r = -0.66, P < 0.001). hsTNT further correlated positively with the neuropathy disability score (r = 0.39, P = 0.005). Negative correlations were found with sural nerve conduction velocities (NCVs) (r = -0.65, P < 0.001) and tibial NCVs (r = -0.44, P = 0.002) and amplitudes (r = -0.53, P < 0.001). This study is the first to show that hsTNT is a potential indicator for structural nerve damage in T2D. Our results indirectly support the hypothesis that microangiopathy contributes to structural nerve damage in T2D.


Assuntos
Diabetes Mellitus Tipo 2/diagnóstico por imagem , Angiopatias Diabéticas/diagnóstico , Neuropatias Diabéticas/diagnóstico , Imagem por Ressonância Magnética/métodos , Nervo Isquiático/diagnóstico por imagem , Troponina T/sangue , Adulto , Idoso , Biomarcadores/sangue , Estudos de Casos e Controles , Estudos Transversais , Diabetes Mellitus Tipo 2/sangue , Angiopatias Diabéticas/sangue , Angiopatias Diabéticas/diagnóstico por imagem , Neuropatias Diabéticas/sangue , Neuropatias Diabéticas/diagnóstico por imagem , Feminino , Humanos , Masculino , Pessoa de Meia-Idade
17.
Cardiovasc J Afr ; 31(1): 5-8, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31469387

RESUMO

OBJECTIVES: Previous reports have suggested an association between hypothyroidism and macrovascular complications in type 2 diabetes (T2DM) but the association with microvascular complications is not well documented. This study aimed to determine whether there were significant differences in these complications in patients with T2DM with and without hypothyroidism. METHODS: This was a retrospective, cross-sectional, case-control study from a single centre specialising in diabetes in South Africa. T2DM was defined by American Diabetes Association criteria. The cases were all patients treated for hypothyroidism and the controls were clinically and biochemically confirmed euthyroid, who were under follow up between 1 January and 1 July 2016. Chronic kidney disease (CKD) was defined as an estimated glomerular filtration rate (eGFR) of < 60 ml/min, determined by the CKD-epidemiology collaboration equation (CKD-EPI) and/or albumin/creatinine ratio > 3 mg/mmol. Diabetic retinopathy (DR) was defined as the presence of aneurysms, bleeds, exudates and new vessel formation on the retina examined by an ophthalmologist. Diabetic peripheral neuropathy (DPN) was defined as the presence of symptoms, loss of 128-Hz sensation and abnormal 10-gm monofilament. Cardiovascular disease (CVD) was defined as the presence of major adverse cardiovascular events (MACE). RESULTS: There were 148 cases and 162 controls. Compared to the controls, the cases were older (65.6 vs 59.4 years, p < 0.00001), more likely to be female (67.6 vs 39.5%, p < 0.0001) and white (89.2 vs 79.6%, p = 0.02), have a lower HbA1c level (7.5 vs 8.2%, p = 0.0001), eGFR (64.4 vs 72.7 ml/min, p = 0.0006) and triglyceride level (2.18 vs 2.55 mmol/l, p = 0.04), have a higher high-density lipoprotein cholesterol level (1.13 vs 1.02 mmol/l, p = 0.001), a longer duration of diabetes (14.8 vs 11.6 years, p = 0.001) and using fewer antidiabetic agents (1.82 vs 2.19, p = 0.001). There was a higher prevalence of CKD (44 vs 57.8%, p = 0.03) and CVD (59.3 vs 45.3, p = 0.06), and a trend towards higher DR (66.7 vs 47.6, p = 0.09). There was no difference in body mass index, hypertension, low-density lipoprotein cholesterol level (all patients received statin therapy), DPN and amputations. After adjusting for confounding factors, there was no association between CKD and DR, and hypothyroidism, but the trend to association with CVD persisted (OR 1.97. p = 0.07). CONCLUSIONS: Hypothyroidism in T2DM was not associated with microvascular disease after adjusting for confounding factors. There was a nearly two-fold risk of CVD. The study is limited by the retrospective and observational design.


Assuntos
Doenças Cardiovasculares/epidemiologia , Diabetes Mellitus Tipo 2/epidemiologia , Angiopatias Diabéticas/epidemiologia , Nefropatias Diabéticas/epidemiologia , Retinopatia Diabética/epidemiologia , Hipotireoidismo/epidemiologia , Idoso , Albuminúria/diagnóstico , Albuminúria/epidemiologia , Doenças Cardiovasculares/diagnóstico , Doenças Cardiovasculares/terapia , Estudos Transversais , Diabetes Mellitus Tipo 2/diagnóstico , Diabetes Mellitus Tipo 2/terapia , Angiopatias Diabéticas/diagnóstico , Angiopatias Diabéticas/terapia , Nefropatias Diabéticas/diagnóstico , Nefropatias Diabéticas/terapia , Neuropatias Diabéticas/diagnóstico , Neuropatias Diabéticas/epidemiologia , Retinopatia Diabética/diagnóstico , Retinopatia Diabética/terapia , Feminino , Humanos , Hipotireoidismo/diagnóstico , Hipotireoidismo/terapia , Masculino , Pessoa de Meia-Idade , Prevalência , Prognóstico , Estudos Retrospectivos , Fatores de Risco , África do Sul/epidemiologia
18.
Diabetes Care ; 43(1): 219-227, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31619394

RESUMO

OBJECTIVE: To evaluate the prognostic importance of resistant hypertension (RHT) for the development of complications in a cohort of individuals with type 2 diabetes. RESEARCH DESIGN AND METHODS: A total of 646 patients had the diagnosis of apparent treatment-resistant hypertension (aRHT) based on mean office blood pressure (BP) levels during the 1st year of follow-up. They were reclassified as white-coat/controlled or true/uncontrolled RHT according to 24-h ambulatory BP monitoring (ABPM), using the traditional BP cutoffs and the new 2017 American College of Cardiology (ACC)/American Heart Association (AHA) criteria. Multivariate Cox analyses examined the associations between RHT diagnoses and the occurrence of microvascular and cardiovascular complications and all-cause and cardiovascular mortality. RESULTS: During a median follow-up of 10 years, 177 patients had a cardiovascular event (145 major ones); 222 patients died (101 from cardiovascular diseases); 200 had a renal event; 156 had a retinopathy event; and 174 patients had a neuropathy event. In relation to non-RHT individuals, aRHT (present in 44.6% and 50% by the traditional and new criteria, respectively) predicted all cardiovascular and mortality outcomes, with hazard ratios (HRs) between 1.64 and 2.16, but none of the microvascular outcomes. True RHT increased the HRs (from 1.81 to 2.25) and additionally predicted renal outcomes. White-coat/controlled RHT implied an increased risk (HRs 1.33-1.86) that was intermediate between non-RHT and true RHT individuals. Classifications using the traditional and the new ACC/AHA criteria were equivalent. CONCLUSIONS: In patients with type 2 diabetes, the presence of aRHT implied an increased risk of cardiovascular and mortality outcomes, and classification based on ABPM predicted renal outcomes and improved cardiovascular/mortality risk stratification.


Assuntos
Anti-Hipertensivos/uso terapêutico , Diabetes Mellitus Tipo 2/diagnóstico , Angiopatias Diabéticas/diagnóstico , Resistência a Medicamentos , Hipertensão/diagnóstico , Hipertensão/tratamento farmacológico , Adulto , Idoso , Idoso de 80 Anos ou mais , Pressão Sanguínea/efeitos dos fármacos , Pressão Sanguínea/fisiologia , Monitorização Ambulatorial da Pressão Arterial/efeitos adversos , Brasil , Doenças Cardiovasculares/complicações , Doenças Cardiovasculares/diagnóstico , Doenças Cardiovasculares/fisiopatologia , Estudos de Coortes , Diabetes Mellitus Tipo 2/complicações , Diabetes Mellitus Tipo 2/tratamento farmacológico , Diabetes Mellitus Tipo 2/fisiopatologia , Angiopatias Diabéticas/tratamento farmacológico , Angiopatias Diabéticas/fisiopatologia , Feminino , Seguimentos , Humanos , Hipertensão/complicações , Hipertensão/fisiopatologia , Masculino , Pessoa de Meia-Idade , Prognóstico
19.
Curr Vasc Pharmacol ; 18(2): 110-116, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-30961498

RESUMO

BACKGROUND: Type 2 diabetes mellitus (T2DM) has emerged as a pandemic. It has different complications, both microvascular and macrovascular. OBJECTIVE: The purpose of this review is to summarize the different types of macrovascular complications associated with T2DM. METHODS: A comprehensive review of the literature was performed to identify clinical studies, which determine the macrovascular complications associated with T2DM. RESULTS: Macrovascular complications of T2DM include coronary heart disease, cardiomyopathy, arrhythmias and sudden death, cerebrovascular disease and peripheral artery disease. Cardiovascular disease is the primary cause of death in diabetic patients. Many clinical studies have shown a connection between T2DM and vascular disease, but almost always other risk factors are present in diabetic patients, such as hypertension, obesity and dyslipidaemia. CONCLUSION: T2DM causes a variety of macrovascular complications through different pathogenetic pathways that include hyperglycaemia and insulin resistance. The association between T2DM and cardiovascular disease is clear, but we need more clinical studies in order to identify the pure effect of T2DM.


Assuntos
Sistema Cardiovascular/fisiopatologia , Diabetes Mellitus Tipo 2/complicações , Angiopatias Diabéticas/etiologia , Cardiopatias/etiologia , Doença Arterial Periférica/etiologia , Animais , Diabetes Mellitus Tipo 2/diagnóstico , Diabetes Mellitus Tipo 2/mortalidade , Diabetes Mellitus Tipo 2/fisiopatologia , Angiopatias Diabéticas/diagnóstico , Angiopatias Diabéticas/mortalidade , Angiopatias Diabéticas/fisiopatologia , Cardiopatias/diagnóstico , Cardiopatias/mortalidade , Cardiopatias/fisiopatologia , Humanos , Doença Arterial Periférica/diagnóstico , Doença Arterial Periférica/mortalidade , Doença Arterial Periférica/fisiopatologia , Prognóstico , Medição de Risco , Fatores de Risco
20.
Curr Vasc Pharmacol ; 18(2): 117-124, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31057114

RESUMO

BACKGROUND: Type 2 diabetes mellitus (T2DM) is a chronic, non communicable, multisystem disease that has reached epidemic proportions. Chronic exposure to hyperglycaemia affects the microvasculature, eventually leading to diabetic nephropathy, retinopathy and neuropathy with high impact on the quality of life and overall life expectancy. Sexual dysfunction is an often-overlooked microvascular complication of T2DM, with a complex pathogenesis originating from endothelial dysfunction. OBJECTIVE: The purpose of this review is to present current definitions, epidemiological data and risk factors for diabetic retinopathy, nephropathy, neuropathy and sexual dysfunction. We also describe the clinical and laboratory evaluation that is mandatory for the diagnosis of these conditions. METHODS: A comprehensive review of the literature was performed to identify data from clinical studies for the prevalence, risk factors and diagnostic methods of microvascular complications of T2DM. RESULTS: Diabetic nephropathy and retinopathy affect approximately 25% of patients with T2DM; diabetic neuropathy is encountered in almost 50% of the diabetic population, while the prevalence of erectile dysfunction ranges from 35-90% in diabetic men. The duration of T2DM along with glycemic, blood pressure and lipid control are common risk factors for the development of these complications. Criteria for the diagnosis of these conditions are well established, but exclusion of other causes is mandatory. CONCLUSION: Early detection of microvascular complications associated with T2DM is important, as early intervention leads to better outcomes. However, this requires awareness of their definition, prevalence and diagnostic modalities.


Assuntos
Diabetes Mellitus Tipo 2/epidemiologia , Angiopatias Diabéticas/epidemiologia , Nefropatias Diabéticas/epidemiologia , Neuropatias Diabéticas/epidemiologia , Disfunções Sexuais Fisiológicas/epidemiologia , Diabetes Mellitus Tipo 2/diagnóstico , Diabetes Mellitus Tipo 2/fisiopatologia , Angiopatias Diabéticas/diagnóstico , Angiopatias Diabéticas/fisiopatologia , Nefropatias Diabéticas/diagnóstico , Nefropatias Diabéticas/fisiopatologia , Neuropatias Diabéticas/diagnóstico , Neuropatias Diabéticas/fisiopatologia , Retinopatia Diabética/epidemiologia , Retinopatia Diabética/fisiopatologia , Diagnóstico Precoce , Feminino , Humanos , Masculino , Prevalência , Prognóstico , Medição de Risco , Fatores de Risco , Disfunções Sexuais Fisiológicas/diagnóstico , Disfunções Sexuais Fisiológicas/fisiopatologia
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