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BACKGROUND: Gestational diabetes is one of the most prevalent diseases in pregnancy, with an incidence of 5 to 18% in Brazil, and is associated with high morbidity rates. The first-line treatment is insulin, although some recent studies have indicated that metformin might also be effective. Metformin is safe in pregnancy and appears to produce better results than insulin, including reduced gestational weight gain (GWG) and smaller gestational-age newborns. Few studies have been conducted on this topic in low- and middle-income countries. METHODS: We designed an open randomized controlled trial comparing two treatments for pregnant women with type II diabetes mellitus (DM) and gestational diabetes (DMG): the metformin group (intervention) and the insulin group (as a routine service). The primary outcome is glycemic control. The secondary outcomes are GWG, the occurrence of hypertensive syndromes, macrosomia, and neonatal hypoglycemia. The sample will comprise 92 pregnant women, 46 per group. The inclusion criteria will be GDM or type II DM requiring medication for glycemic control, singleton pregnancy, and gestational age under 34 weeks. The exclusion criteria will be current treatment with any medication for glycemic control, type I DM, and intolerance to the study medications (metformin or insulin). Women will be routinely followed during antenatal care, childbirth, and the postpartum period. Statistical analyses will include the intention-to-treat approach and a comparison between the two groups. DISCUSSION: Considering the Brazilian socioeconomic reality and the safety of metformin demonstrated in previous trials, we expect that the MevIP study will demonstrate that metformin is an adequate and appropriate medication for GDM treatment in the Brazilian population, representing an alternative to insulin for GDM. TRIAL REGISTRATION: This protocol has been registered prospectively in ReBEC under the ID RBR-3j3cktx in August 11, 2023.

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People Living with HIV (PLWHIV) present an increased risk of developing non-communicable diseases, such as type 2 diabetes (T2D), making it crucial to optimize glycemic control and assess metabolic markers. HbA1c is considered the gold standard for evaluating glycemic control, while fructosamine (FA) offers advantages in assessing non-glycemic determinants. Discrepancies between HbA1c and FA are common and may be influenced by temporal factors. The Glycation Gap (G-gap) emerges as a tool to clarify these discrepancies. A cross-sectional analytical study was conducted involving PLWHIV with various glycemic statuses, as well as patients with T2D and controls. Sociodemographic data were collected along with blood samples to measure biochemical profiles and FA. HbA1c predicted from FA (pHbA1c) was calculated using a linear regression equation, facilitating G-gap determination. A positive correlation was found between G-gap and levels of VLDL-C and triglycerides (TG). Additionally, a negative correlation was observed between HDL-C levels < 40 mg/dL and a positive G-gap. These associations suggest that the G-gap may be a useful tool for metabolic evaluation in PLWHIV and a preventive method for identifying individuals at risk of developing chronic complications related to T2D.

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BACKGROUND: There is no strong evidence demonstrating whether or not aerobic exercise in conjunction with resistance exercise improves metabolic diabetes markers in postmenopausal women. OBJECTIVE: To evaluate the effect of aerobic exercise and resistance training on metabolic markers in postmenopausal women with type 2 diabetes mellitus (T2DM) by means of a systematic review and meta-analysis. METHODS: The searches were completed using EMBASE, MEDLINE/PubMed, Scopus and Web of Science databases. This study included non-blinded, single or double-blinded randomized control trials and postmenopausal women diagnosed with T2DM. The imposed intervention was aerobic exercise plus any training protocol to strengthen muscle groups for resistance intervention. The outcomes of interest were the blood glucose levels, insulin secretion, homeostasis model assessment-insulin resistance index (HOMA-IR) and glycated hemoglobin (HbA1c). Risk of Bias tools and GRADE were obligatory. RESULTS: Three studies were included (83 participants). Exercise intervention ranged between two to four days per week. Compared to the control group, in the group submitted to aerobic exercise + resistance training, no significant change was noted for HbA1c (subtotal = mean difference - 0.35 [95% CI: -0.85, 0.15], p = .17, and heterogeneity = 0%) (GRADE: very low), nevertheless, HOMA-IR index was significantly improved (subtotal = mean difference -0.52 [95% CI: -0.99, -0.05], p = .03, and heterogeneity = 0%) (GRADE: very low). CONCLUSION: Despite the very low certainty found in the quality of evidences, our analysis showed that aerobic exercise along with strength exercise seems to improve some metabolic diabetes markers in postmenopausal women with T2DM. There is a need for further studies to support our preliminary findings.

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OBJECTIVE: Calorie restriction and exercise are commonly used first interventions to prevent the progression of prediabetes and alleviate the symptoms of type 2 diabetes. Our study was designed to determine the effect of the energy deficit caused by long-term (12-week) calorie restriction and exercise programs on appetite responses in obese individuals with prediabetes and type 2 diabetes. METHODS: Calorie restriction and exercise programs appropriate for age, gender, and work environment were applied to 22 individuals with prediabetes and 22 with type 2 diabetes participating in the study for a period of 12 weeks. Ghrelin, glucagon-like peptide-1, and peptide tyrosine tyrosine values of samples taken before and after treatment were determined by the enzyme-linked ιmmunosorbent assay method. RESULTS: Appetite hormone levels did not change after calorie restriction and exercise in the prediabetes group (p>0.05). In the diabetes group, calorie restriction and exercise significantly increased ghrelin and peptide tyrosine tyrosine concentrations (p<0.005). Additionally, when all patients were evaluated together, ghrelin, glucagon-like peptide-1 and peptide tyrosine tyrosine levels differed significantly after the intervention (p<0.005). CONCLUSION: The energy deficit created by long-term calorie restriction and exercise did not modulate the appetite hormones in prediabetic and obese individuals. However, increased ghrelin and peptide tyrosine tyrosine levels in individuals with diabetes support that the same treatment program is an effective method to regulate appetite hormones.

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PURPOSE OF REVIEW: This article explores the cardiovascular effects of sodium-glucose cotransporter 2 inhibitors (SGLT2i) in patients with type 2 diabetes mellitus (T2DM), with a particular focus on their impact on lipid profiles. As evidence grows of the cardiovascular benefits of SGLT2i beyond glucose control, it is essential to better understand their effects on lipoproteins and their impact on cardiovascular disease. RECENT FINDINGS: SGLT2i have shown significant cardiovascular benefits in patients with type 2 diabetes mellitus, beyond their role in lowering blood glucose. Studies indicate that SGLT2i reduce major adverse cardiovascular events by impacting factors such as blood pressure, body weight, and arterial stiffness. However, their effects on lipid profile remain complex and somewhat inconsistent. Some research points to modest increases in LDL cholesterol, while others report shifts toward less atherogenic lipid profile, including reductions in triglycerides and small, dense LDL particles, and increases in HDL-C. SGLT2i represent a significant advancement in managing diabetes and associated cardiovascular risks, with benefits such as triglyceride reduction and HDL-C increase. While their impact on LDL-C remains controversial and varies across studies, the reduction of small, dense LDL particles may mitigate negative effects. This article highlights the need for future research to better understand the specific mechanisms behind lipid modulation.

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The incretins (glucose-dependent insulinotropic polypeptide [GIP] and glucagon-like peptide-1 [GLP-1]), along with amylin/islet amyloid polypeptide (IAPP) and insulin-degrading enzyme (IDE), are hormones/enzymes that have been pharmacological targets, such as dipeptidyl peptidase-4 (DPP-4) inhibitors, due to their insulinotropic actions. Physical training is recommended as a treatment for type 2 diabetes mellitus (T2DM); however, its effects on the concentrations of these hormones/enzymes are not well known. Thus, the present study aimed to evaluate the effects of combined training (CT) on the concentrations of hormones/enzymes with insulinotropic actions in individuals with T2DM and overweight. Individuals of both sexes with T2DM (age 51.73 ± 4.19 years; body mass index [BMI] 29.46 ± 3.39 kg/m2) were randomly distributed in the control group (CG, n = 17) and the combined training group (CTG, n = 17). The CT consisted of strength followed by erobic training, 3 times/week, for 16 weeks. Functional variables, body composition, and serum biochemical analyses (clinical markers, GLP-1, GIP, DPP-4, amylin/IAPP, and IDE) were evaluated. The CTG showed a decrease in GLP-1 (pre: 32.8 ± 12.1, post: 28.4 ± 13.5, and p = 0.04) in the group/time analysis. In the evaluation of the Δ% of variation, CTG presented a decrease for GLP-1 (-9.3%; p = 0.03) and amylin/IAPP (-13.4%; p < 0.01), in addition to an increase for DPP-4 (6.2%; p = 0.04) enzyme. CT decreases the baseline levels of important hormones with insulinotropic actions in individuals with T2DM and overweight. The improvement in overall metabolism provided by CT must be the main reason for these effects. These results broaden the understanding of the effects and relationships between CT and glucose metabolism.

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Continuous glucose monitoring (CGM) provides comprehensive and dynamic information to guide the management of diabetes mellitus (DM). This paper summarizes the evidence and implications of the use of the new CGM system, FreeStyle Libre 2 (FSL2). A global review of the literature on the use of FSL2 in people with DM was performed. All types of studies were included. The evidence is presented qualitatively together with expert clinical opinion. FSL2 is an integrated CGM system with real-time glucose readings (no scanning required) and customizable alarms. In studies of subjects aged 2 years and older with DM1 or DM2, the overall mean absolute relative difference for FSL2 was 8.2%, with a high degree of clinical accuracy. Compared to blood monitoring in DM1, studies show higher time within range, lower time below range and lower time above range at 4, 8 and 12 weeks of FSL2 use. These results were confirmed in observational studies in DM, where the majority of FSL2 users reported greater satisfaction with treatment and a significant improvement in quality of life. In concluded, Including the FSL2 system in the management of people with DM would also reduce the risks associated with DM complications, improving the prognosis of this population and allowing for the appropriate use of healthcare resources.

El monitoreo continuo de glucosa (MCG) proporciona información completa y dinámica para guiar el tratamiento de la diabetes mellitus (DM). Este documento sintetiza la evidencia e implicancias del uso del FreeStyle Libre 2 (FSL2), un sistema integrado de MCG con lecturas de glucosa en tiempo real (sin necesidad de escaneo) y alarmas personalizables. Se realizó una revisión global de la literatura que incluyó todo tipo de estudios y se presentó la evidencia de manera cualitativa junto con la opinión de expertos clínicos. Se identificaron estudios en sujetos a partir de los 2 años de edad con DM1/DM2, que han registrado una diferencia media relativa absoluta global del 8.2% para FSL2, con un alto grado de exactitud clínica. En comparación con la monitorización sanguínea en DM1, los ensayos muestran mayor tiempo dentro del rango, menor tiempo por debajo del rango y menor tiempo por encima del rango, a 4, 8 y 12 semanas de uso del FSL2. Estos resultados se han confirmado en estudios observacionales en DM, en los que la mayoría de los usuarios de FSL2 reportaron mayor satisfacción con el tratamiento y mejor calidad de vida. En conclusión, la inclusión del sistema FSL2 en el manejo de la DM reduciría los riesgos asociados a las complicaciones de la DM, mejorando el pronóstico de esta población y permitiendo un uso adecuado de los recursos sanitarios.

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BACKGROUND/OBJECTIVES: Goto-Kakizaki (GK) rats exhibit insulin resistance and type 2 diabetes mellitus (T2DM) without obesity. This study explored the effects of ω-3 fatty acid supplementation on T lymphocyte polarization in Wistar (WT) and GK rats. METHODS: They were administered ω-3 fatty acid-rich fish oil (FO) containing eicosapentaenoic (540 mg/g) and docosahexaenoic acids (100 mg/g) by oral gavage at 2 g/kg, thrice a week for 8 weeks. The control groups (WT CT and GK CT) received the same volume of water. The following groups were investigated: GK CT, n = 14; GK ω-3, n = 15; Wistar CT, n = 15; and Wistar ω-3, n = 11. Glucose and insulin tolerance tests (GTT and ITT) were performed. Fasting plasma insulinemia and glycemia were measured. After euthanasia, the lymphocytes were extracted from the mesenteric lymph nodes. RESULTS: The results showed that GK rats supplemented with FO had significantly improved glucose tolerance and insulin sensitivity (kITT). It also promoted greater polarization of lymphocytes toward T regulatory (Treg) features and a reduction in Th1 and Th17 profiles. Additionally, the GK ω-3 group exhibited lower cell proliferation, decreased pro-inflammatory cytokines, and increased IL-10 levels compared to the GK control. CONCLUSIONS: In conclusion, FO supplementation benefited GK rats by improving glucose intolerance, suppressing insulin resistance, and modulating lymphocytes toward Treg polarization.

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BACKGROUND: Type 2 diabetes (T2D) has become a worldwide pandemic. While ceramides may serve as intermediary between obesity-related lipotoxicity and T2D, the relationship with simple glycosphingolipids remains uncertain. The aim of this study was to characterize the associations between blood glycosphingolipid and ceramide species with T2D and to identify a circulating sphingolipid profile that could serve as novel biomarker for T2D risk. METHODS: Cross-sectional relationship between sphingolipid levels, insulin resistance, and T2D prevalence were evaluated in 2,072 American adults from MIDUS cohort. Prospectively, the association between sphingolipid species and the incidence of T2D was analyzed using a case-cohort design nested within the PREDIMED trial (250 cases and a random sample of 692 participants, with 3.8 years of median follow-up). Circulating levels of sphingolipid species in both populations were measured using LC/MS. Hazard ratios were estimated with weighted Cox regression models using Barlow weights. RESULTS: In American adults, only CER18:0 and CER22:0 were linked to insulin resistance and a higher prevalence of T2D. Conversely, three lactosylceramides (LCER 14:0, 16:0, and 24:1) showed a strong inverse relationship with both insulin resistance and T2D. These findings led to development of two sphingolipid scores. In the prospective analysis, these scores consistently predicted a reduced risk of T2D incidence in PREDIMED (HR: 0.64, 95% CI 0.44 to 0.94 and 0.58, 0.40 to 0.85 respectively) between extreme quartiles, with 5-year absolute risk differences of 9.6% (95% CI: 0.3-20.5%) and 11.4% (1.0-21.6%). They were validated in the same trial with samples obtained after 1 year of follow-up. CONCLUSIONS: Our findings support the potential usefulness of circulating sphingolipid profiles as novel biomarkers for T2D risk. Moreover, this study opens the door for future research on the predictive value and possible protective roles of lactosylceramides in T2D.

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OBJECTIVE: High serum uric acid levels are associated with metabolic syndrome and diabetes mellitus. Several observational studies have shown the association between metabolic dysfunction-associated fatty liver disease and high serum uric acid. However, this association is controversial due to reverse causality. We aimed to investigate the relationship between the serum uric acid level and "aspartate aminotransferase-platelet ratio index score," which noninvasively shows the possible changes of metabolic dysfunction-associated fatty liver disease in the liver in patients diagnosed with type II diabetes mellitus. METHODS: This retrospective study was conducted with a total of 94 patients, 36 females and 58 males, who were hospitalized in the gastroenterohepatology outpatient clinic and diagnosed with hepatosteatosis and type II diabetes mellitus between January 2023 and January 2024. Laboratory tests, height, weight, body mass index, presence of fatty liver disease on ultrasound, and aspartate aminotransferase-platelet ratio index scores of the patients were examined. RESULTS: The mean serum uric acid level of the patients was 5.26±1.52 mg/dL, and the mean aspartate aminotransferase-platelet ratio index score was 0.26±0.13. The serum uric acid level was found to be associated with the hemoglobin A1c value (p=0.001; p<0.01). However, the aspartate aminotransferase-platelet ratio index scores of the patients did not show a statistically significant difference according to serum uric acid levels (p>0.05). CONCLUSION: No significant association was observed between serum uric acid and the noninvasive liver test aspartate aminotransferase-platelet ratio index score. Although a causal relationship between metabolic dysfunction-associated fatty liver disease and serum uric acid has been demonstrated in several studies, further research is needed to evaluate possible mechanisms in the liver.

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The aim of this study was to investigate the scientific evidence regarding the effectiveness of modified-ILIB (intravascular laser irradiation of blood) in the control of systemic conditions and/or oral changes during dental care. This systematic literature review study aimed to answer the question, "Is modified-ILIB an effective adjuvant therapy in the control of systemic conditions and/or oral changes in children and adults during dental treatment?". The protocol for this systematic review was registered in the PROSPERO database under number CRD42023493800. The search was carried out in the PubMed, Web of Science, LILACS, SCOPUS and EMBASE databases on June 10, 2024. Google Scholar was used as a search source for gray literature. Randomized clinical trials were included, without restrictions on language or year of publication. The RoB 2.0 tool was used to assess the risk of bias and GRADE was used to check the quality of the evidence. A total of 750 articles were retrieved and five studies were selected for this review. All studies were in English and were carried out in Brazil. The outcomes were periodontal parameters and glycemic control in patients with periodontitis and type II diabetes, anxiety control in pediatric dentistry, postoperative pain after third molar extraction and improving taste in post-COVID-19 patients. The majority of studies had a low risk of bias, while only one study was considered to have some concerns. The quality of evidence from the studies was considered very low. The current evidence does not overwhelmingly support the effectiveness of modified-ILIB in controlling oral and/or systemic conditions in dentistry.

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OBJECTIVE: This study was conducted to investigate the distribution of placental villous vessels in pregnant women with different degrees of hyperglycemia. METHODS: A cross-sectional study was performed using placental samples from 30 pregnant women without diabetes (n=10), with gestational diabetes mellitus (n=10), and with previous diabetes (type 1 and type 2 diabetes; n=10). Maternal glycemic control was evaluated using the glycemic mean and glycated hemoglobin levels. Placental samples were obtained during elective cesarean sections and processed for villous vessel analysis using immunohistochemistry for Von Willebrand factor. Vessels within 10µm of the villus margin were classified as peripheral, and vessels at a distance greater than 10µm were classified as central. The number, area, and perimeter of all vessels were evaluated, and the relationship between vessel area and total area of placental villus was calculated. RESULTS: Pregnant women with gestational diabetes mellitus and those with previous diabetes had higher glycated hemoglobin levels. The number of vessels was reduced in the villi of the previous Diabetes Group owing to peripheral reduction. Additionally, the area, perimeter, and percentage of peripheral blood were lower in the previous Diabetes Group than in the Non-Diabetic Group. CONCLUSION: Maternal glycemic levels can modify placental capillary distribution.

Moreli et al. demonstrated a reduction in vessels in the periphery of the placental villi in pregnant women with previous diabetes (type 1 and type 2). The placental vessels of this population are more distant from the maternal blood and may represent placental villous immaturity. These results were obtained when we classified the villous vessels as central or peripherial using 10µm of the villus margin as a reference.

■The number of vessels was reduced in the placental villi of pregnant women with diabetes. ■The placental villous vessels of women with previous diabetes were more distant from the maternal blood.

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BACKGROUND/OBJECTIVES: The optimal dietary approach for managing glycemic and metabolic control in type 2 diabetes (T2D) is still uncertain, though it should be tailored for clinical settings. Therefore, we sought to assess the impact of a multicomponent nutritional strategy on glycemic control in T2D patients within a public health system. METHODS: NUGLIC was an open-label, parallel-group, superiority, multicenter randomized controlled trial. Participants aged 30 and older with poorly controlled T2D were randomly assigned to either (1) a personalized dietary prescription (control group, n = 185) or (2) a strategy involving targeted nutritional advising, mindfulness techniques, and short message services (NUGLIC [intervention] group, n = 186). The primary outcomes were glycated hemoglobin (HbA1c, %) measured after 24 weeks and glycemic control, defined as having an HbA1c > 7% at baseline and achieving ≤7% after follow-up, or having HbA1c ≤ 7% at baseline and reducing the use of glucose-lowering medications post-follow-up. The secondary outcomes included cardiometabolic features, self-care practices, diet quality, and quality of life. RESULTS: A total of 371 participants were included in an intention-to-treat analysis for the primary outcomes. At six months, both groups exhibited a reduction in HbA1c levels compared to the baseline (NUGLIC group: -0.6% [95% confidence interval (CI) -0.9; -0.3], p < 0.001; control group: -0.5% [95% CI -0.7; -0.3], p < 0.001). However, no significant differences were observed between the groups in terms of HbA1c after follow-up (intervention group: 8.1%; control group: 8.3%; difference: -0.2% [95% CI -0.5; 0.1], p = 0.30) or glycemic control (NUGLIC group: 19.9%; control group: 18.9%; odds ratio 0.96 [95% CI 0.56; 1.67], p = 0.89). While the control group showed an improvement in overall diet quality, no significant differences emerged between the groups by the end of this study (p = 0.13). There were also no significant differences in other secondary outcomes nor in the use of glucose-lowering medications and adverse events after follow-up. CONCLUSIONS: The multicomponent nutritional strategy did not demonstrate superiority over personalized dietary prescriptions in achieving glycemic control for participants with poorly managed T2D. In this sense, both nutritional interventions could be used in clinical practice to improve HbA1c levels, considering the profile and preferences of individuals.

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Diabetes is a metabolic disease with a high worldwide prevalence and an important factor in mortality and disability in the population. Complications can be reduced or prevented with lifestyle changes in physical activity, dietary habits, and smoking cessation. High-protein diets (HPDs, >30% or >1.0 g/Kg/day) decrease hyperglycemia in part due to their content of branched-chain amino acids (BCAAs), mainly leucine. Leucine (and other BCAAs) improve glucose metabolism by directly signaling in the medio-basal hypothalamus (MBH), increasing liver insulin sensitivity. To determine the effectiveness of an HPD to lower hyperglycemia, we analyzed the results of published clinical studies focusing on the levels of fasting plasma glucose and/or glycosylated hemoglobin (HbA1c) in patients with type 2 diabetes mellitus (T2DM). We carried out a systematic search for clinical studies using HPDs. We searched five databases (Scopus, Web of Science, PubMed, Epistemonikos, and Cochrane), collecting 179 articles and finally selecting 8 articles to analyze their results. In conclusion, HPDs are an effective alternative to reduce hyperglycemia in patients with T2DM, especially so-called Paleolithic diets, due to their higher-quality protein from animal and vegetal sources and their exclusion of grains, dairy products, salt, refined fats, and added sugars.

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INTRODUCTION: Contradictory claims about the efficacy of several medicinal plants to promote glycemic control in patients with type 2 diabetes mellitus (T2DM) have been explained by divergences in the administration form and by extrapolation of data obtained from healthy individuals. It is not known whether the antidiabetic effects of traditional herbal medicines are influenced by gelatin capsules. This randomized crossover trial aimed to evaluate the acute effect of a single dose of raw cinnamon consumed orally either dissolved in water as a beverage or as ordinary hard gelatin capsules on postprandial hyperglycemia (>140 mg/dL; >7.8 mmol/L) in T2DM patients elicited by a nutritionally-balanced meal providing 50 g of complex carbohydrates. METHODS: Fasting T2DM patients (n = 19) randomly ingested a standardized meal in five experimental sessions, one alone (Control) and the other after prior intake of 3 or 6 g of crude cinnamon in the form of hard gelatin capsules or powder dissolved in water. Blood glucose was measured at fasting and at 0.25, 0.5, 0.75, 1, 1.5 and 2 hours postprandially. After each breakfast, its palatability scores for visual appeal, smell and pleasantness of taste were assessed, as well as the taste intensity sweetness, saltiness, bitterness, sourness and creaminess. RESULTS: The intake of raw cinnamon dissolved in water, independently of the dose, decreased the meal-induced large glucose spike (peak-rise of +87 mg/dL and Δ1-hour glycemia of +79 mg/dL) and the hyperglycemic blood glucose peak. When cinnamon was taken as capsules, these anti-hyperglycemic effects were lost or significantly diminished. Raw cinnamon intake did not change time-to-peak or the 2-h post-meal glycaemia, but flattened the glycemic curve (lower iAUC) without changing the shape that is typical of T2DM patients. CONCLUSIONS: This cinnamon's antihyperglycemic action confirms its acarbose-like property to inhibit the activities of the carbohydrate-digesting enzymes α-amylases/α-glucosidases, which is in accordance with its exceptionally high content of raw insoluble fiber. The efficacy of using raw cinnamon as a diabetes treatment strategy seems to require its intake at a specific time before/concomitantly the main hyperglycemic daily meals. Trial registration: Registro Brasileiro de Ensaios Clínicos (ReBEC), number RBR-98tx28b.

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BACKGROUND: Digital educational technologies in health have been an important instrument for promoting learning, self-care, self-esteem, and security regarding prevention and health promotion actions that lead to changes in behavior, mainly for non-communicable disease patients, such as type 2 Diabetes Mellitus (DM 2). OBJECTIVE: This study aimed to describe a protocol for evaluating the effect of an app for cell phones and tablets on the blood glucose of older adults with DM 2. METHODS: The protocol will be used to compare the effectiveness of an application for mobile devices concerning the educational booklet in reducing Glycated Hemoglobin in older adults with DM 2 in Primary Health Care. This protocol is part of a Randomized Clinical Trial project entitled Effectiveness of a Mobile Device Application on Glycated Hemoglobin in Elderly People with Type 2 Diabetes Mellitus: a Randomized Clinical Trial. RESULTS: The protocol was structured in the following phases: (i) sample calculation, (ii) invitation to participate in the study according to the eligibility criteria; (iii) participant registration; (iv) randomization and allocation of participants into groups (double blinding); (v) application of the intervention; (vi) post-intervention procedures (post-test); (vii) data analysis. CONCLUSION: It is expected that encouraging studies on the impact of a mobile application will improve and enhance health education focused on self-care for older adults with DM 2, potentially influencing the local health system by reducing hospitalizations due to conditions that are sensitive to primary care, since health promotion and prevention of DM-related illnesses will be the main focus of the application and booklet developed.

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Objective: Sex differences in lipid metabolism associated with prevalent small dense (S-) low-density lipoprotein (LDL) cholesterol particles are not elucidated. An LDL to apolipoprotein B (ApoB) ratio < 1.2 can estimate how prevalent S-LDL particles are and, thus, reflect cardiovascular risk. The aim of this study was to evaluate the sex distribution of LDL/ApoB ratio among patients with type 2 diabetes (DM) and to assess, in both sexes, the correlations between key lipid parameters and LDL/ApoB < 1.2. Subjects and methods: The study included 190 Caucasian participants (mean age 51.8 ± 6.4 years) with DM (DM group) or without DM (control group) divided into subgroups according to sex. The participants were examined for levels of several lipid parameters, selected lipid-related oxidative stress markers, and estimated S-LDL prevalence. Results: An LDL/ApoB < 1.2 (p < 0.05) was observed in 67% of male and female patients with DM. Although triglyceride levels did not differ between men and women, women had higher levels of total cholesterol (p < 0.05) and LDL cholesterol (p < 0.01) than men. Among women with LDL/ApoB < 1.2, strong correlations were observed between values of lipid hydroperoxides (LOOH) and atherogenic index of plasma (p < 0.005) and between levels of triglycerides and LOOH (p < 0.005) and ApoB (p < 0.0001). Conclusions: The findings indicate that women with LDL/ApoB < 1.2 tend to have a higher cardiovascular risk than men. Additionally, LDL/ApoB < 1.2 can be a surrogate marker for estimating the S-LDL prevalence in individuals with potentially increased cardiovascular risk.

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OBJECTIVE: This study aimed to assess the association between emotional attitudes towards diabetes, eating behaviour styles and glycaemic control in outpatients with type 2 diabetes. DESIGN: Observational study. SETTING: Endocrinology Division of Hospital de Clínicas de Porto Alegre, Brazil. PARTICIPANTS: Ninety-one outpatients diagnosed with type 2 diabetes. Baseline assessments included data on clinical parameters, lifestyle factors, laboratory results, eating behaviour styles and emotional attitudes. All patients received nutritional counseling following diabetes recommendations. A follow-up visit was scheduled approximately 90 days later to evaluate changes in weight, medication dosages and glycated Hb (HbA1c) values. Patients were categorised based on their emotional attitude scores towards diabetes (positive or negative), and their characteristics were compared using appropriate statistical tests. RESULTS: At baseline, no differences were observed in the proportion of patients with good glycaemic control, eating behaviour styles and emotional attitudes. However, patients with a positive attitude towards the disease exhibited a significantly better response in glycaemic control compared with the reference group (OR = 3·47; 95 % CI = 1·12, 10·75), after adjusting for diabetes duration, sex and medication effect score. However, when BMI was included in the model, the association did not reach statistical significance. Therefore, these results should be interpreted with caution. CONCLUSIONS: Patients with a positive attitude towards diabetes showed a greater reduction in HbA1c levels following nutritional counseling. However, baseline BMI could be a potential confounding factor.

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Type 2 diabetes mellitus is a metabolic disorder that causes chronic high blood sugar levels, and diabetic patients are more susceptible to infections. American cutaneous leishmaniasis is an infectious disease caused by a parasite that affects the skin and mucous membranes, leading to one or multiple ulcerative lesions. Chronic inflammation and functional changes in various organs and systems, including the immune system, are the primary causes of both diseases. Melatonin, an essential immunomodulatory, antioxidant, and neuroprotective agent, can benefit many immunological processes and infectious diseases, including leishmaniasis. Although, limited reports are available on diabetic patients with leishmaniasis. The literature suggests that melatonin may play a promising role in inflammatory disorders. This study was designed to assess melatonin levels and inflammatory mediators in diabetic patients affected by leishmaniasis. Blood samples from 25 individuals were analyzed and divided into four groups: a control group (without any diseases), a Leishmania-positive group, patients with type 2 diabetes mellitus, and patients with a combination of both diseases. This study measured the serum levels of melatonin through ELISA, while IL-4 and TNF-α were measured using flow cytometry, and C-reactive protein was measured through turbidimetry. This study found that patients with leishmaniasis significantly increased TNF-α and decreased melatonin levels. However, the group of diabetic patients with leishmaniasis showed higher melatonin levels than the control group. These observations suggest that TNF-α may influence melatonin production in patients with American cutaneous leishmaniasis, potentially contributing to the inflammatory characteristics of both diseases.

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(1) Background: Branched-chain and aromatic amino acids (BCAAs/AAAs) have been considered as markers of type 2 diabetes (T2D); however, studies on associations between these metabolites and T2D and cardiometabolic traits in Hispanic populations are limited. The aim of this study was to examine the associations between baseline BCAAs (isoleucine, leucine, valine)/AAAs (phenylalanine, tyrosine) and prevalent and incident T2D, as well as baseline and longitudinal (2 year) changes in cardiometabolic traits (measures of glycemia, dyslipidemia, inflammation, and obesity) in two large cohorts of adults of Puerto Rican descent. (2) Methods: We included participants of the Boston Puerto Rican Health Study (BPRHS, n = 670) and San Juan Overweight Adult Longitudinal study (SOALS, n = 999) with available baseline metabolite and covariate data. T2D diagnosis was defined based on American Diabetes Association criteria. Multivariable logistic (for baseline T2D), Poisson (for incident T2D), and linear (for cardiometabolic traits) regression models were used; cohort-specific results were combined in the meta-analysis and adjusted for multiple comparisons. (3) Results: Higher baseline BCAAs were associated with higher odds of prevalent T2D (OR1SD BCAA score = 1.46, 95% CI: 1.34-1.59, p < 0.0001) and higher risk of incident T2D (IRR1SD BCAA score = 1.24, 95% CI: 1.13-1.37, p < 0.0001). In multivariable longitudinal analysis, higher leucine and valine concentrations were associated with 2-year increase in insulin (beta 1SD leucine = 0.37 mcU/mL, 95% CI: 0.11-0.63, p < 0.05; beta 1SD valine = 0.43 mcU/mL, 95% CI: 0.17-0.68, p < 0.01). Tyrosine was a significant predictor of incident T2D (IRR = 1.31, 95% CI: 1.09-1.58, p < 0.05), as well as 2 year increases in HOMA-IR (beta 1SD tyrosine = 0.13, 95% CI: 0.04-0.22, p < 0.05) and insulin concentrations (beta 1SD tyrosine = 0.37 mcU/mL, 95% CI: 0.12-0.61, p < 0.05). (4) Conclusions: Our results confirmed the associations between BCAAs and prevalent and incident T2D, as well as concurrent measures of glycemia, dyslipidemia, and obesity, previously reported in predominantly White and Asian populations. Baseline leucine, valine, and tyrosine were predictors of 2 year increases in insulin, whereas tyrosine was a significant predictor of deteriorating insulin resistance over time. Our study suggests that BCAAs and tyrosine could serve as early markers of future glycemic changes in Puerto Ricans.