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1.
Pan Afr Med J ; 32: 209, 2019.
Artigo em Francês | MEDLINE | ID: mdl-31312321

RESUMO

Introduction: This study aims to determine the clinical and evolutionary profile of skin and soft tissue lesions in diabetics followed up at the dressing room. Methods: We conducted an observational descriptive and analytical study in the dressing room of the Marc Sankalé Diabetes Center, Dakar from 1 January to 31 December 2017. Our study focused on diabetics who were examined in the dressing room. Results: A total of 37.173 procedures were recorded at the Marc Sankalé Diabetes Center; 16.418 patients were treated in the dressing room, representing a prevalence of 14.16%. The average age of patients was 56,6 ±12 years, the sex ratio (M/F) was 0,88. Type 2 diabetes predominated (78,97%) and the average disease duration was 8.06 ± 7.9 years. The mean capillary blood glucose concentration was 2.4±1 g/l. Diabetic neuropathy was found in 72.33% of patients. Limb lesions were found in 93,98% of patients(1185 cases). The most common lesions included: ulcer (46,76%), abscess (13.46%), phlegmon (13.20%), gangrene (8.41%), erysipelas (3.78%), perforating ulcer (3.53%), intertrigo (3.95%). The lesions were be divided into infectious lesions (61,41), non-infectious lesions(33,50%), pure vascular lesions (1.57%) and mixed lesions (3.70%). Out of 1189 patients 7.57% had had osteitis. The germs found were Gram-positive bacteria (12.70%), Gram-negative bacteria (23.80%). Amputation was performed according to the topographical features of the lesion (p=0.00), the type of lesion (p=0.000), the seniority of diabetes (p=0.02), the type of diabetes (p=0.008), the presence of osteitis (p=0.006). Minor amputation was performed in 43,33% of cases, major amputation in 37.43% of cases; 70 deaths were recorded (5.89%). Conclusion: Skin and soft tissue lesions were dominated by diabetic foot. Mortality is not negligible and the risk of amputation was statistically related to the topographical features of the lesion, the type of lesion, the seniority and the type of diabetes and the presence of osteitis.


Assuntos
Diabetes Mellitus Tipo 1/complicações , Diabetes Mellitus Tipo 2/complicações , Dermatopatias/epidemiologia , Infecções dos Tecidos Moles/epidemiologia , Adolescente , Adulto , Fatores Etários , Idoso , Amputação/estatística & dados numéricos , Glicemia/análise , Diabetes Mellitus Tipo 1/epidemiologia , Diabetes Mellitus Tipo 2/epidemiologia , Pé Diabético/epidemiologia , Neuropatias Diabéticas/epidemiologia , Feminino , Infecções por Bactérias Gram-Negativas/epidemiologia , Infecções por Bactérias Gram-Positivas/epidemiologia , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência , Fatores de Risco , Senegal/epidemiologia , Dermatopatias/patologia , Infecções dos Tecidos Moles/patologia , Adulto Jovem
2.
Rev. chil. endocrinol. diabetes ; 12(3): 170-174, jul. 2019. tab
Artigo em Espanhol | LILACS | ID: biblio-1006512

RESUMO

Objetivo: El objetivo del estudio fue describir las características y evolución de los pacientes que acudieron a las urgencias de nuestro hospital y fueron diagnosticados de cetoacidosis diabética (CAD) utilizando la novedosa herramienta de Big Data Savana. Método: Estudio retrospectivo descriptivo de los pacientes atendidos en urgencias del Hospital Universitario Infanta Leonor durante los años 2011 al 2016 con diagnóstico de CAD. La búsqueda se realizó con Savana Manager. Resultados: Se diagnosticaron 95 episodios de CAD en 68 pacientes. Del total de episodios de CAD, 57 fueron en diabéticos tipo 1 (de ellos 4 LADA), 25 en diabéticos tipo 2, 2 en diabéticos postpancreatectomía y 12 fueron debuts diabéticos. Del total, 61 (64,2%) requirieron ingreso hospitalario, de ellos 23 (24,2%) ingresaron en UCI. La media de HbA1c fue de 10,6 ± 2,1%. Tres pacientes requirieron reingreso tras el alta. La mortalidad fue muy baja con el fallecimiento en 1 paciente diagnosticado simultáneamente de cáncer pulmonar. Los desencadenantes de la CAD fueron: 35 casos (36,8%) falta de adherencia al tratamiento, 31 (32,6%) infecciones, 12 (12,6%) debuts, 8 (8,4%) varias causas y 9 (9,5%) no se pudo determinar la causa. Se clasificaron como CAD de gravedad leve un 28%, un 38% como de gravedad moderada y 34% como graves. La duración del ingreso no se relacionó con la severidad de la cetoacidosis. Conclusiones: La CAD es una complicación grave que afecta tanto a diabéticos tipo 1 como a tipo 2 con elevado porcentaje de ingresos hospitalarios y en UCI, aunque con baja mortalidad en nuestro medio. La duración de los ingresos no se relaciona con la severidad del cuadro.


Objective: the study was designed to describe the clinical features and evolution of the diabetic patients attended in our hospital emergency department with diabetic ketoacidosis (DKA) using the novel Big Data tool Savana. Method: Retrospective descriptive study of the patients attended in the emergency room of the Infanta Leonor University Hospital during the years 2011 to 2016 with diagnosis of CAD. The search was made with Savana. Results: 95 episodes of DKA were diagnosed in 68 patients. Of the total episodes of CAD 57 were in type 1 diabetics (of which 4 were LADA), 25 in type 2 diabetics, 2 in diabetics postpancreatectomy and 12 were new onset of diabetes. Of the total, 61 (64.2%) required hospital admission, of which 23 (24.2%) were admitted to the intensive care unit (ICU). The mean HbA1c was 10.6 ± 2.1%. Three patients required readmission after discharge. Mortality was very low with death in 1 patient simultaneously diagnosed of lung cancer. The triggers of CAD were: 35 cases (36,8%) lack of adherence to treatment, 31 (32.6%) infections, 12 (12.6%) new onset, 8 (8,4%) various causes and 9 (9.5%) the cause could not be determined. They were classified as mild DKA 28%, 38% as moderate and 34% as severe. The duration of admission was not related to the severity of ketoacidosis. Conclusions: DKA is a serious complication that affects both, type 1 and type 2 diabetics patients, with a high percentage of hospital and ICU admissions, although with low mortality in our environment. The lenght of the stay in hospital is not related to the severity of the DKA.


Assuntos
Humanos , Masculino , Feminino , Criança , Adolescente , Adulto , Pessoa de Meia-Idade , Cetoacidose Diabética/epidemiologia , Complicações do Diabetes/epidemiologia , Espanha/epidemiologia , Informática Médica , Epidemiologia Descritiva , Estudos Retrospectivos , Cetoacidose Diabética/etiologia , Diabetes Mellitus Tipo 1/complicações , Diabetes Mellitus Tipo 1/epidemiologia , Diabetes Mellitus Tipo 2/complicações , Diabetes Mellitus Tipo 2/epidemiologia , Serviço Hospitalar de Emergência , Hiperglicemia/complicações , Hiperglicemia/epidemiologia
3.
Diabetes Res Clin Pract ; 152: 53-57, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31063857

RESUMO

BACKGROUND: T1DM is divided into 1A (immune-mediated), 1B (virus-triggered, genetic and idiopathic). Presence of auto-antibodies may be correlated to glycemic control. AIM: Assessment relation between the autoantibodies and the poor glycemic control in T1DM. METHODS: 60 patients T1DM 30 males, 30 females, subjected to full history, clinical, anthropometric assessment and laboratory assessment of fasting C-peptide, FBS, 2 h PP glucose, HbA1c, GADA, ICA and IAA level. Classified into two groups; Group I: negative auto-antibodies, Group II: positive auto-antibodies, Group II was further classified into 3 sub-groups, Group II a:1 positive autoantibody, Group II b: 2 positive autoantibodies and Group II c: 3 positive autoantibodies. RESULTS: HbA1c was significantly higher in group II than group I (11.85 ±â€¯1.61% vs. 8.52 ±â€¯0.41%, p = 0.000). HbA1c was highest in group IIc followed by IIb then IIa (12.25 ±â€¯1.48% vs. 11.57 ±â€¯1.59% vs. 10.78 ±â€¯1.73%, p = 0.038). Total insulin units per day was significantly higher in group II than group I (109.83 ±â€¯7.77 U/day vs. 100.83 ±â€¯1.83 U/day, p = 0.007). Duration of diabetes was significantly higher in group I than group II (10.17 ±â€¯1.94 years vs. 8.11 ±â€¯2.20 years, p = 0.033). HbA1c, total insulin units per day and duration of diabetes were independent predictive factors for presence of autoantibodies (p = 0.007, p = 0.033 and p = 0.043 respectively). CONCLUSION: Autoantibodies affect the glycemic control presented by high HbA1c; also it causes increase in total insulin units needed by patients; the more autoantibodies, the higher HbA1c, the more insulin units required to control glycemic state.


Assuntos
Autoanticorpos/sangue , Glicemia/metabolismo , Diabetes Mellitus Tipo 1/sangue , Adolescente , Adulto , Autoanticorpos/imunologia , Peptídeo C/sangue , Estudos de Coortes , Estudos Transversais , Diabetes Mellitus Tipo 1/epidemiologia , Diabetes Mellitus Tipo 1/imunologia , Egito/epidemiologia , Feminino , Glutamato Descarboxilase/imunologia , Humanos , Insulina/imunologia , Anticorpos Anti-Insulina/sangue , Masculino , Proteínas Tirosina Fosfatases Classe 8 Semelhantes a Receptores/imunologia , Adulto Jovem
4.
Diabetes Res Clin Pract ; 152: 58-64, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31102682

RESUMO

AIM: To report glycemic control and pregnancy outcome in pregnant women with type 1 diabetes on insulin degludec. METHODS: Twenty-two women with type 1 diabetes on degludec from conception to delivery between 2014 and 2018 were compared with 51 pregnant women with type 1 diabetes on glargine. RESULTS: Baseline characteristics were comparable, however HbA1c was higher at median 9 (range 5-19) weeks in women on degludec compared to women on glargine (6.9% (5.7-8.7); (52 (39-72) mmol/mol) versus 6.4% (5.1-10.1); (46 (32-87) mmol/mol), p = 0.04). HbA1c was similar in late pregnancy (6.3% (5.6-7.1); (45 (38-54) mmol/mol) versus 6.1% (5.2-9.0); (43 (33-75) mmol/mol), p = 0.28). The prevalence of severe hypoglycemia was 3 (14%) versus 6 (12%), p = 1.00 during pregnancy and 0 versus 1, p = 1.00 during hospital admittance after delivery. Most women on degludec used one daily injection in early (20 (91%) versus 25 (49%), p = 0.001) and late pregnancy (21 (96%) versus 19 (37%), p < 0.001). No significant differences in obstetrical and neonatal outcomes were found between the groups. Maternal hospital admittance after delivery was 2 (1-5) versus 3 (2-11) days (p = 0.004). CONCLUSIONS: Glycemic control in late pregnancy, severe hypoglycemia during and immediately after pregnancy as well as pregnancy outcome were comparable in women on degludec or glargine. Degludec initiated preconceptionally may be continued in pregnancy.


Assuntos
Diabetes Mellitus Tipo 1/tratamento farmacológico , Insulina de Ação Prolongada/administração & dosagem , Gravidez em Diabéticas/tratamento farmacológico , Adulto , Glicemia/metabolismo , Diabetes Mellitus Tipo 1/sangue , Diabetes Mellitus Tipo 1/epidemiologia , Feminino , Hemoglobina A Glicada/análise , Hemoglobina A Glicada/metabolismo , Hospitalização/estatística & dados numéricos , Humanos , Hipoglicemia/induzido quimicamente , Hipoglicemia/epidemiologia , Hipoglicemiantes/administração & dosagem , Hipoglicemiantes/efeitos adversos , Insulina Glargina/administração & dosagem , Insulina Glargina/efeitos adversos , Insulina de Ação Prolongada/efeitos adversos , Pessoa de Meia-Idade , Gravidez , Resultado da Gravidez/epidemiologia , Gravidez em Diabéticas/sangue , Gravidez em Diabéticas/epidemiologia , Prevalência , Resultado do Tratamento , Adulto Jovem
5.
Diabetes Res Clin Pract ; 152: 88-95, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31121274

RESUMO

AIMS: To secure adequate carbohydrate supply in pregnancy, the Institute of Medicine (IOM) recommends a minimum amount of carbohydrates of 175 g daily. Currently a low carbohydrate diet is a popular health trend in the general population and this might also be common among overweight and obese pregnant women with type 2 diabetes (T2D). Thus, we explored carbohydrate consumption among pregnant women with T2D including women with type 1 diabetes (T1D) for comparison. METHODS: A retrospective cohort study of consecutive women with T2D (N = 96) and T1D (N = 108), where dietary records were collected at the first antenatal visit. RESULTS: Among women with T2D and T1D, bodyweight at the first visit was 90.8 ±â€¯22 (mean ±â€¯SD) and 75.5 ±â€¯15 kg (P < 0.001) while HbA1c was 6.6 ±â€¯1.2% (49 ±â€¯13 mmol/mol) and 6.6 ±â€¯0.8% (48 ±â€¯8 mmol/mol), P = 0.8, respectively. The average daily carbohydrate consumption from the major carbohydrate sources was similar in the two groups (159 ±â€¯56 and 167 ±â€¯48 g, P = 0.3), as was the level of total daily physical activity (median (interquartile range)): 215 (174-289) and 210 (178-267) metabolic equivalent of task-hour/week (P = 0.9). A high proportion of women with T2D and T1D (52% and 40%, P = 0.08) consumed fewer carbohydrates than recommended by the IOM. The prevalence of ketonuria (≥4 mmol/L) was 1% in both groups. CONCLUSIONS: In early pregnancy, a lower daily carbohydrate consumption than recommended by the IOM was common among women with T2D. The results were quite similar to women with T1D, despite a markedly higher bodyweight in women with T2D. Reassuringly, ketonuria was rare in both groups.


Assuntos
Diabetes Mellitus Tipo 2/dietoterapia , Carboidratos da Dieta/administração & dosagem , Ingestão de Alimentos/fisiologia , Gravidez em Diabéticas/dietoterapia , Gravidez em Diabéticas/epidemiologia , Cuidado Pré-Natal/normas , Recomendações Nutricionais , Adulto , Glicemia/metabolismo , Dinamarca/epidemiologia , Diabetes Mellitus Tipo 1/dietoterapia , Diabetes Mellitus Tipo 1/epidemiologia , Diabetes Mellitus Tipo 2/epidemiologia , Dieta com Restrição de Carboidratos/normas , Carboidratos da Dieta/normas , Feminino , Idade Gestacional , Humanos , National Academies of Science, Engineering, and Medicine (U.S.) Health and Medicine Division , Obesidade/dietoterapia , Obesidade/prevenção & controle , Gravidez , Cuidado Pré-Natal/métodos , Prevalência , Estudos Retrospectivos , Estados Unidos
6.
Medicine (Baltimore) ; 98(19): e15625, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-31083260

RESUMO

Assessment of sedentary behaviors in children and adolescents with type 1 diabetes (T1D), relative to the method of insulin therapy used, and in comparison to healthy controls.The study group consisted of 215 children with T1D, including 109 (50.7%) insulin pen and 106 (49.3%) insulqsain pump users. The control group comprised 115 healthy children. The subjects' sedentary time was measured with a tri-axial accelerometer ActiGraph GT3X+, used continuously for 7 days.The diabetes group was characterized by a significantly higher "% in sedentary time" score (P = .024) and a lower "mean daily breaks in sedentary time" result (P = .007), which means that they spent much more time on sedentary activities compared to the control group. There were no significant differences between the children using insulin pump and insulin pen in the "% in sedentary time" score (P = .294) and "mean daily breaks in sedentary time" (P = .251).The T1D is a serious encumbrance, leading to longer duration of sedentary time, in comparison to healthy controls. The type of insulin therapy did not significantly affect the percentage of the wear-day spent in sedentary time and mean daily breaks in sedentary time.


Assuntos
Diabetes Mellitus Tipo 1/tratamento farmacológico , Insulina/uso terapêutico , Comportamento Sedentário , Acelerometria , Adolescente , Criança , Diabetes Mellitus Tipo 1/epidemiologia , Diabetes Mellitus Tipo 1/fisiopatologia , Feminino , Humanos , Masculino , Fatores de Tempo
7.
Diabetes Res Clin Pract ; 151: 224-230, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-31004670

RESUMO

AIMS: Type1 diabetes is generally regarded as an abruptly presenting disease in children without family history. The incidence and prevalence of insulin requiring diabetes in adults is unclear. The aim of this study was to clarify this issue by examining the epidemiology of type 1 diabetes diagnosed in adulthood in a countrýs whole population. METHODS: Complete clinical and prescription data were used to identify cases of insulin requiring diabetes in the Icelandic population 18 years and older during the decade preceding February 2013. Health care databases and the insulin reimbursement system allowed for near 100% ascertainment of cases. RESULTS: Mean age at diagnosis was 32.1 years. The WHO age-adjusted incidence rate was 4.29/100.000 individuals and the point prevalence 0.10%. One fourth of cases were diagnosed after the age of forty. The male-to-female incidence rate ratio was 1.59. Almost 30% of cases presented with diabetic ketoacidosis and 40% had a positive family history. CONCLUSION: Type 1 like diabetes commonly presents in adults and family history is not rare. One can expect one case of type 1 diabetes in adults for every two children diagnosed. These results emphasize the need to acknowledge the possibility of absolute insulin deficiency in any newly presenting adult with diabetes.


Assuntos
Diabetes Mellitus Tipo 1/epidemiologia , Adolescente , Adulto , Idoso , Feminino , Humanos , Islândia , Incidência , Masculino , Pessoa de Meia-Idade , Prevalência , Adulto Jovem
9.
Indian Pediatr ; 56(3): 191-195, 2019 Mar 15.
Artigo em Inglês | MEDLINE | ID: mdl-30954988

RESUMO

OBJECTIVE: To study glycemic control, mortality and long-term complications in children with type 1 diabetes (T1D). DESIGN: Cross-sectional study. SETTING: Referral centre at a government teaching hospital. PARTICIPANTS: Patients with T1D with age £18 years at onset. METHODS: We retrospectively collected demographic data from computer records from 1991 to 2015. Prospective study for outcomes was conducted between 2012 and 2016. MAIN OUTCOME MEASURES: Mortality rate, glycosylated hemoglobin (HbA1c), and microvascular complication rate. RESULTS: The proportion of T1D patients (n=512) <5 years of age at onset was 18.6% between 1995 and 2004, and 24.2% in 2005-2014 (P<0.001). Twenty eight patients had died out of 334 whose living status was known (mortality 1.1 per 100 patient-years over 2549 patient-years follow up). Median (range) HbA1c (n=257) was 8.3% (5.1-15.0%). At least one episode of severe hypoglycemia (coma/seizure/inability to assist self) had occurred in 22.8% patients over two years. Hypertension was present in 11.7% patients. Microvascular complications screen in 164 eligible patients [median (range) age 20 (8-45) y and duration of diabetes 9.1 (5-30) y] showed diabetic nephropathy in 3.0%, proliferative retinopathy in 3.6% and LDL cholesterol >100 mg/dL in 34% patients. CONCLUSIONS: The mortality rate and prevalence of hypertension were high, given the short duration of diabetes of the patients. The proportion of patients with age ≤5 years at onset of diabetes has increased at our center.


Assuntos
Diabetes Mellitus Tipo 1 , Adolescente , Adulto , Criança , Estudos Transversais , Complicações do Diabetes/epidemiologia , Diabetes Mellitus Tipo 1/sangue , Diabetes Mellitus Tipo 1/complicações , Diabetes Mellitus Tipo 1/epidemiologia , Diabetes Mellitus Tipo 1/mortalidade , Feminino , Hemoglobina A Glicada/análise , Humanos , Hipoglicemia/epidemiologia , Hipoglicemia/etiologia , Índia/epidemiologia , Masculino , Estudos Retrospectivos , Resultado do Tratamento , Adulto Jovem
10.
Diabetes Res Clin Pract ; 151: 82-87, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30935926

RESUMO

AIMS: To evaluate the temporal trend of newly diagnosed Type 1 Diabetes cases over a 35-year period in a reference Pediatric Endocrinology service in the city of Belo Horizonte, Brazil. METHODS: Subjects were all children and adolescents diagnosed with Type 1 Diabetes in the Federal University of Minas Gerais Hospital. Information collected included: gender, age and date of Type 1 diabetes diagnosis. Temporal trends were analyzed between 1980 and 2014 and divided in 5-year intervals. RESULTS: During this period 642 children and adolescents were diagnosed with Type 1 diabetes. From 1980 to 1994 there was an increase in the proportion of children diagnosed between 0 and 4 years old, followed by progressive decrease in the subsequent decades (47% in 1990-1994 to 20% in 2010-2014; p = 0.01). There was an increase in the proportion of children diagnosed between 10 and 18 years old (13% in 1990-1994 to 54% in 2010-2014; p = 0.01). There was no statistical difference in the proportion of children diagnosed between 5 and 9 years old through the studied time. CONCLUSIONS: In the studied population Type 1 Diabetes in infants and toddlers seems to be decreasing throughout the years while in the age group older than 10 years, it seems to be increasing.


Assuntos
Diabetes Mellitus Tipo 1/diagnóstico , Diabetes Mellitus Tipo 1/epidemiologia , Brasil/epidemiologia , Criança , Estudos Transversais , Diabetes Mellitus Tipo 1/patologia , Feminino , Humanos , Masculino , Estudos Retrospectivos , Fatores de Tempo
11.
Nutrients ; 11(4)2019 Mar 29.
Artigo em Inglês | MEDLINE | ID: mdl-30934897

RESUMO

BACKGROUND: Iron overload has been associated with diabetes. Studies on iron exposure during pregnancy and in early life and risk of childhood type 1 diabetes (T1D) are sparse. We investigated whether iron supplementation during pregnancy and early in life were associated with risk of childhood T1D. METHODS: In a case-cohort design, we identified up to 257 children with T1D (prevalence 0.37%) from the Danish National Birth Cohort through linkage with the Danish Childhood Diabetes Register. The primary exposure was maternal pure iron supplementation (yes/no) during pregnancy as reported in interview two at 30 weeks of gestation (n = 68,497 with iron supplement data). We estimated hazard ratios (HRs) using weighted Cox regression adjusting for multiple confounders. We also examined if offspring supplementation during the first 18 months of life was associated with later risk of T1D. RESULTS: Maternal iron supplementation was not associated with later risk of T1D in the offspring HR 1.05 (95% CI: 0.76⁻1.45). Offspring intake of iron droplets during the first 18 months of life was inversely associated with risk of T1D HR 0.74 (95% CI: 0.55⁻1.00) (ptrend = 0.03). CONCLUSIONS: Our large-scale prospective study demonstrated no harmful effects of iron supplementation during pregnancy and in early life in regard to later risk of childhood T1D in the offspring.


Assuntos
Diabetes Mellitus Tipo 1/etiologia , Ferro/administração & dosagem , Ferro/efeitos adversos , Adolescente , Adulto , Estudos de Casos e Controles , Criança , Pré-Escolar , Estudos de Coortes , Dinamarca/epidemiologia , Diabetes Mellitus Tipo 1/epidemiologia , Suplementos Nutricionais , Relação Dose-Resposta a Droga , Feminino , Humanos , Lactente , Transtornos da Nutrição do Lactente , Recém-Nascido , Gravidez , Fenômenos Fisiológicos da Nutrição Pré-Natal , Fatores de Risco
12.
Acta Diabetol ; 56(9): 973-980, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-30945047

RESUMO

Meta-analyses of clinical trials comparing CSII with traditional insulin injections usually show a small, but significant advantage of CSII with respect to HbA1c and risk of severe hypoglycemia. On the other hand, CSII is associated with a small, but relevant risk of ketoacidosis, mainly due to malfunction of insulin pump and/or catheter occlusion. During last time, the technology of insulin pumps and infusion sets has improved as the profound evolution in type and schemes with traditional insulin injections. Aim of the present study is to update previous meta-analyses comparing CSII with traditional insulin injections in subjects with type 1 diabetes. Specific subgroup analyses were designed for assessing the effects of CSII in comparison with basal-bolus MDI, with short-acting analogues as bolus and long-acting analogues as basal insulin. In addition, an exploratory analysis was performed to verify the effect of CSII in insulin-naïve patients with type 1 diabetes. The present analysis includes all randomized clinical trials comparing CSII with traditional injections in type 1 diabetes, with a duration of at least 12 weeks. Animal studies were excluded, whereas no language or date restriction was imposed. If duplicate publications of a single trial were present, the paper containing more adequate information was considered as principal publication. In trials comparing CSII with basal-bolus MDI, performed before the introduction of rapid-acting analogues, regular human insulin was used for CSII, and as prandial insulin in control groups. CSII was associated with a significant reduction of A1c, in comparison with MDI, irrespective of the use of either human insulin or rapid-acting analogues. However, in trials with rapid-acting analogue the advantage of CSII was significantly smaller than in trials with regular human insulin (HbA1c difference: - 0.29[- 0.46; - 0.13] vs - 1.93[- 1.84; - 0.42]%; p = 0.02). Different rapid-acting analogues provided similar results (HbA1c reduction vs MDI: - 0.25 [- 0.48; - 0.02]%, p = 0.03, and - 0.29 [- 0.49; - 0.09]%, p = 0.005, for lispro and aspart, respectively). In addition, in trials comparing CSII with basal-bolus MDI, CSII reduced HbA1c to a similar extent irrespective of the use of either NPH or long-acting analogues as basal insulin in the control groups (HbA1c reduction vs MDI: - 0.31 [- 0.55; - 0.06]%, p = 0.01, and - 0.20 [- 0.38; - 0.03]%, p = 0.02, for NPH and long-acting analogues, respectively. With respect to severe hypoglycemia, CSII did not produce a significant reduction of risk in comparison with traditional insulin injections. Conversely, CSII was associated with a significant increase in the incidence of reported diabetic ketoacidosis (DKA). Notably, the increased risk of DKA was significant in trials comparing CSII with conventional insulin therapy, whereas only a nonsignificant trend toward an increased risk was observed in comparisons with basal-bolus MDI. Only two trials comparing CSII with basal-bolus MDI, both using rapid-acting analogues, were performed on insulin-naïve type 1 diabetic patients. When those two trials were analyzed separately, CSII did not produce any relevant effect on HbA1c (difference from control: - 0.10[- 0.38; + 0.17]%; p = 0.46). No meta-analysis could be performed on either severe hypoglycemia or DKA, which were not reported by one of the two trials. CSII seems to produce a small improvement in HbA1c in patients with type 1 diabetes inadequately controlled with MDI. This apparent effect, which could be partly due to publication bias, is smaller when MDI is properly performed using basal-bolus schemes with short-acting insulin analogues. Other outcomes different from HbA1c (such as quality of life) could be relevant for the choice of CSII instead of MDI. In addition, further studies are needed to better define the profile of patients who could benefit most from CSII.


Assuntos
Diabetes Mellitus Tipo 1/tratamento farmacológico , Hipoglicemiantes/administração & dosagem , Sistemas de Infusão de Insulina , Insulina/administração & dosagem , Ensaios Clínicos Controlados Aleatórios como Assunto/estatística & dados numéricos , Diabetes Mellitus Tipo 1/sangue , Diabetes Mellitus Tipo 1/epidemiologia , Cetoacidose Diabética/tratamento farmacológico , Cetoacidose Diabética/epidemiologia , Esquema de Medicação , Combinação de Medicamentos , Feminino , Hemoglobina A Glicada/análise , Hemoglobina A Glicada/metabolismo , Humanos , Hipoglicemia/induzido quimicamente , Hipoglicemia/epidemiologia , Hipoglicemiantes/efeitos adversos , Injeções Subcutâneas , Insulina/efeitos adversos , Sistemas de Infusão de Insulina/efeitos adversos , Sistemas de Infusão de Insulina/estatística & dados numéricos , Insulina de Ação Prolongada/administração & dosagem , Insulina de Ação Prolongada/efeitos adversos , Masculino , Qualidade de Vida , Ensaios Clínicos Controlados Aleatórios como Assunto/métodos
13.
Health Psychol ; 38(7): 577-585, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-30973748

RESUMO

OBJECTIVE: Diabetic ketoacidosis (DKA) and elevated hemoglobin A1c (HbA1c) in youth with Type 1 diabetes (T1D) can result in significant morbidity and mortality. Elucidating the risk factors for poor glycemic control and DKA hospitalizations is crucial for the refinement and development of prevention and treatment efforts. METHOD: Based on a conceptual framework, this study used path analysis to evaluate individual and family characteristics, psychosocial responses, and individual and family responses that prospectively predict the number of DKA hospitalizations and HbA1c approximately 1 year after assessment, accounting for sociodemographics. A total of 174 youth 12-18 years old with T1D (M = 14.68, SD = 1.77) and their caregivers completed measures assessing demographics, internalizing symptoms, diabetes stress, diabetes-related family conflict, and adherence. Medical records were reviewed to obtain the number of episodes of DKA and the HbA1c at 1-year follow-up. RESULTS: Thirty-one participants had at least 1 episode of DKA based on chart review. Greater duration of diabetes, higher baseline HbA1c, lower income, identifying as non-Hispanic White, and higher youth report of internalizing symptoms were significant predictors of DKA at follow-up (p < .05). Identifying as Black-African American, a younger age, and higher baseline HbA1c significantly predicted higher HbA1c at follow-up (p < .05). CONCLUSIONS: Future studies should assess the utility and accuracy of using screeners for internalizing symptoms in pediatric endocrinology clinics to identify youth at risk for DKA hospitalizations. (PsycINFO Database Record (c) 2019 APA, all rights reserved).


Assuntos
Diabetes Mellitus Tipo 1/sangue , Diabetes Mellitus Tipo 1/diagnóstico , Cetoacidose Diabética/sangue , Cetoacidose Diabética/diagnóstico , Hemoglobina A Glicada/metabolismo , Hospitalização/tendências , Adolescente , Criança , Diabetes Mellitus Tipo 1/epidemiologia , Cetoacidose Diabética/epidemiologia , Feminino , Seguimentos , Humanos , Masculino , Valor Preditivo dos Testes , Fatores de Risco , Inquéritos e Questionários
14.
BMJ ; 365: l1328, 2019 Apr 09.
Artigo em Inglês | MEDLINE | ID: mdl-30967375

RESUMO

OBJECTIVE: To assess the efficacy and safety of dual sodium glucose cotransporter (SGLT) 1/2 inhibitor sotagliflozin in type 1 diabetes mellitus. DESIGN: Meta-analysis of randomised controlled trials. DATA SOURCES: Medline; Cochrane Library; Embase; international meeting abstracts; international and national clinical trial registries; and websites of US, European, and Japanese regulatory authorities, up to 10 January 2019. ELIGIBILITY CRITERIA FOR SELECTING STUDIES: Randomised controlled trials evaluating the effect of sotagliflozin versus active comparators or placebo on glycaemic and non-glycaemic outcomes and on adverse events in type 1 diabetes in participants older than 18. Three reviewers extracted data for study characteristics, outcomes of interest, and risk of bias and summarised strength of evidence using the grading of recommendations assessment, development, and evaluation approach. Main outcomes were pooled using random effects models. RESULTS: Of 739 records identified, six randomised placebo controlled trials (n=3238, duration 4-52 weeks) were included. Sotagliflozin reduced levels of glycated haemoglobin (HbA1c; weighted mean difference -0.34% (95% confidence interval -0.41% to -0.27%), P<0.001); fasting plasma glucose (-16.98 mg/dL, -22.1 to -11.9; 1 mg/dL=0.0555 mmol/L) and two hour-postprandial plasma glucose (-39.2 mg/dL, -50.4 to -28.1); and daily total, basal, and bolus insulin dose (-8.99%, -10.93% to -7.05%; -8.03%, -10.14% to -5.93%; -9.14%, -12.17% to -6.12%; respectively). Sotagliflozin improved time in range (weighted mean difference 9.73%, 6.66% to 12.81%) and other continuous glucose monitoring parameters, and reduced body weight (-3.54%, -3.98% to -3.09%), systolic blood pressure (-3.85 mm Hg, -4.76 to -2.93), and albuminuria (albumin:creatinine ratio -14.57 mg/g, -26.87 to -2.28). Sotagliflozin reduced hypoglycaemia (weighted mean difference -9.09 events per patient year, -13.82 to -4.36) and severe hypoglycaemia (relative risk 0.69, 0.49 to 0.98). However, the drug increased the risk of ketoacidosis (relative risk 3.93, 1.94 to 7.96), genital tract infections (3.12, 2.14 to 4.54), diarrhoea (1.50, 1.08 to 2.10), and volume depletion events (2.19, 1.10 to 4.36). Initial HbA1c and basal insulin dose adjustment were associated with the risk of diabetic ketoacidosis. A sotagliflozin dose of 400 mg/day was associated with a greater improvement in most glycaemic and non-glycaemic outcomes than the 200 mg/day dose, without increasing the risk of adverse events. The quality of evidence was high to moderate for most outcomes, but low for major adverse cardiovascular events and all cause death. The relatively short duration of trials prevented assessment of long term outcomes. CONCLUSIONS: In type 1 diabetes, sotagliflozin improves glycaemic and non-glycaemic outcomes and reduces hypoglycaemia rate and severe hypoglycaemia. The risk of diabetic ketoacidosis could be minimised by appropriate patient selection and down-titration of the basal insulin dose.


Assuntos
Diabetes Mellitus Tipo 1/tratamento farmacológico , Glicosídeos/uso terapêutico , Hipoglicemia/prevenção & controle , Inibidores do Transportador 2 de Sódio-Glicose/uso terapêutico , Glicemia/análise , Automonitorização da Glicemia/métodos , Diabetes Mellitus Tipo 1/epidemiologia , Cetoacidose Diabética/induzido quimicamente , Cetoacidose Diabética/epidemiologia , Relação Dose-Resposta a Droga , Hemoglobina A Glicada/efeitos dos fármacos , Glicosídeos/administração & dosagem , Glicosídeos/efeitos adversos , Humanos , Avaliação de Resultados (Cuidados de Saúde) , Ensaios Clínicos Controlados Aleatórios como Assunto , Risco , Inibidores do Transportador 2 de Sódio-Glicose/administração & dosagem , Inibidores do Transportador 2 de Sódio-Glicose/efeitos adversos
16.
Can J Ophthalmol ; 54(1): 27-32, 2019 02.
Artigo em Inglês | MEDLINE | ID: mdl-30851771

RESUMO

OBJECTIVE: To evaluate the screening rates for diabetic pediatric patients in a regional center according to the Canadian Diabetes Association guidelines. DESIGN: Retrospective study. PARTICIPANTS: The study consisted of 82 patients seen in the pediatric diabetes clinic at Peterborough Regional Health Center. METHODS: Medical records for all pediatric patients with diabetes were reviewed between July 2016 and February 2017. Parents and children were surveyed on details of their ocular examination history. Logistic regression analysis was conducted to evaluate if any characteristics were associated with noncompliance to Canadian Diabetes Association guidelines. RESULTS: The average age of the patients in our study was 12 years old with a mean duration of diabetes of 4 years. The majority of patients had type 1 diabetes (n = 79/82, 96.3%) and the mean HbA1c level was 9.1. Only 16 patients (19.5%) adhered to the Canadian Diabetes Association guidelines for diabetic retinopathy screening. Of the 66 patients who did not comply with the guidelines, 65 (98.5%) had received more exams than recommended under their respective screening guidelines. All dilated eye examinations were normal, and no diabetic retinopathy was found. Statistical analysis revealed that the duration of diabetes may be a predicting factor of noncompliance to the guidelines (-0.2488, 95% CI -0.505, -0.042). CONCLUSIONS: This study shows a low compliance rate with screening guidelines in our diabetic pediatric population. Of interest, the low compliance in this cohort was related to excessive eye exams. This study also found a low incidence rate of diabetic retinopathy despite poor management of diabetes, similar to previous studies of pediatric diabetic eye disease.


Assuntos
Instituições de Assistência Ambulatorial/estatística & dados numéricos , Diabetes Mellitus Tipo 1/complicações , Diabetes Mellitus Tipo 2/complicações , Retinopatia Diabética/diagnóstico , Programas de Rastreamento/métodos , Adolescente , Criança , Pré-Escolar , Diabetes Mellitus Tipo 1/epidemiologia , Diabetes Mellitus Tipo 2/epidemiologia , Retinopatia Diabética/epidemiologia , Retinopatia Diabética/etiologia , Feminino , Seguimentos , Humanos , Masculino , Ontário/epidemiologia , Prevalência , Estudos Retrospectivos
17.
Med Hypotheses ; 125: 41-50, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30902150

RESUMO

The globally increasing incidences of Type 1 diabetes (T1DM) and Type 2 diabetes (T2DM) can have a common background. If challenged by the contemporary high level of nutritional glucose stimulation, the ß-cells in genetically predisposed individuals are at risk for damage which can lead to the diseases. The fat to carbohydrate dietary shift can also contribute to the associated obesity epidemic.


Assuntos
Diabetes Mellitus Tipo 1/epidemiologia , Diabetes Mellitus Tipo 2/epidemiologia , Dieta Ocidental/efeitos adversos , Carboidratos da Dieta , Índice Glicêmico , Obesidade/epidemiologia , Animais , Diabetes Mellitus Tipo 1/complicações , Diabetes Mellitus Tipo 2/complicações , Dieta , Ingestão de Energia , Predisposição Genética para Doença , Saúde Global , Humanos , Hiperglicemia , Incidência , Alimentos Infantis , Modelos Biológicos , Obesidade/complicações , Estresse Oxidativo , Sacarose/química , Açúcares , Edulcorantes , Ganho de Peso
19.
N Z Med J ; 132(1491): 78-89, 2019 03 08.
Artigo em Inglês | MEDLINE | ID: mdl-30845131

RESUMO

AIMS: Insulin pump therapy (CSII) is becoming increasingly common for those living with type 1 diabetes (T1D), and has been publicly funded in New Zealand since 2012. The aim of the current study was to examine national uptake of publicly funded pumps from 2012 to 2016, with a focus on the proportion of patients using pumps analysed according to district health board (DHB) as well as demographic characteristics. METHODS: Data from nationally held data collections including the New Zealand Virtual Diabetes Register were used to calculate the overall and subgroup proportions using pumps. Logistic regression analysis was then used to estimate the independent contributions of DHB of residence and sociodemographic characteristics to variations in pump use. RESULTS: Between 2012 and 2016, CSII for those living with T1D (n=17,338) increased from 1.6 to 11.3% overall. However, speed of uptake differed by DHB of residence, ethnicity, degree of deprivation, age and gender. A four-fold difference in uptake between highest and lowest using DHBs was seen after adjusting for known confounders. CONCLUSIONS: From 2012 to 2016 there has been a steadily increasing uptake of CSII. Despite publicly funded access, disparities in use appear to exist, including by DHB of residence as well as traditionally described socio-demographic barriers to healthcare. Efforts to understand and reduce these disparities are required.


Assuntos
Diabetes Mellitus Tipo 1/tratamento farmacológico , Grupos Étnicos/estatística & dados numéricos , Sistemas de Infusão de Insulina/estatística & dados numéricos , Insulina/uso terapêutico , Sistema de Registros/estatística & dados numéricos , Adolescente , Adulto , Idoso , Criança , Pré-Escolar , Diabetes Mellitus Tipo 1/epidemiologia , Feminino , Disparidades nos Níveis de Saúde , Humanos , Lactente , Masculino , Pessoa de Meia-Idade , Nova Zelândia , Grupo com Ancestrais Oceânicos/estatística & dados numéricos , Fatores Sexuais , Fatores Socioeconômicos , Adulto Jovem
20.
Acta Diabetol ; 56(6): 697-705, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30868316

RESUMO

AIMS: To evaluate the relationship between social determinants, health care insurance status and occurrence of diabetes-related chronic complications (DRCC) in Brazilian patients with type 1 diabetes. METHODS: A multicenter cross-sectional study conducted between August 2011 and August 2014 in 14 public clinics in 10 Brazilian cities. Data were obtained from 1760 patients, aged 29.9 ± 11.9 years, with diabetes duration of 15.5 ± 9.3 years; 55.9% female, 54.5% Caucasians, 69.7% were attended exclusively by the public Brazilian National Health Care System (BNHCS) and 30.3% had also private health care insurance. Patients' information was obtained through a questionnaire and a chart review form. RESULTS: The social determinants associated with having both private and public health care insurance were being employed, belonging to medium or high socioeconomic status, having more years of school attendance and having younger age. Regarding DRCC, patients that had private and public health care had lower rates of diabetic retinopathy and of any other DRCC. Chronic kidney disease was not associated with health care coverage status after adjusting for classical clinical risk factors. CONCLUSIONS: Brazilian patients with type 1 diabetes had better clinical control and lower rates of DRCC, mainly retinopathy, when also having private health care insurance. These patients presented less frequently predictors of chronic complications such as high levels of HbA1c and blood pressure. BNHCS should change the approach for screening DRCC such as diabetic retinopathy, using methods such as telemedicine that would lead to earlier diagnosis, better outcomes and will be cost-effective sometime after its implementation.


Assuntos
Diabetes Mellitus Tipo 1/complicações , Retinopatia Diabética/epidemiologia , Cobertura do Seguro/estatística & dados numéricos , Determinantes Sociais da Saúde/estatística & dados numéricos , Adolescente , Adulto , Idoso , Brasil/epidemiologia , Diabetes Mellitus Tipo 1/epidemiologia , Feminino , Inquéritos Epidemiológicos , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência
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