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2.
Medicine (Baltimore) ; 98(39): e17326, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31574867

RESUMO

BACKGROUND: Diabetes mellitus type 2 (DM2) is a chronic disease of significant prevalence causing hyperglycemia and several comorbidities. Evidences highlight the performance of non - protein bioactive compounds found in vegetables in the control of hyperglycemia. This study describes a protocol of a systematic review, which analyzes the action of proteins and bioactive peptides of plants in DM2. METHODS: The Preferred Reporting Items guide this protocol for Systematic Reviews and Meta-Analyzes Protocols (PRISMA-P) was used. The databases that will be used for searching will be PubMed, ScienceDirect, Scopus, Web of Science, EMBASE, and Virtual Health Library, Brazil (VHL). Studies that use bioactive proteins and peptides of vegetal origin in DM2 will be included in the systematic review. The studies will be identified using clinical parameters and the effect on insulin resistance. The characteristics of the studies as control groups, test substance, dosage, intervention time, and the main results will be described. Selection of studies, data extraction, and methodological quality assessment will be performed independently by two experienced reviewers. RESULTS: This protocol will be the basis for a systematic review identifying the mechanism of action of plant proteins and peptides in type 2 diabetes mellitus. CONCLUSION: Systematic reviews from this protocol will provide support for the construction of researches that analyze the effect of plant bioactive proteins and peptides on the control of hyperglycemia and how these molecules act in the control of DM2. PROSPERO REGISTRATION NUMBER: CRD42019110956.


Assuntos
Diabetes Mellitus Tipo 2/terapia , Proteínas de Vegetais Comestíveis/farmacologia , Produtos Biológicos/farmacologia , Humanos , Resultado do Tratamento
3.
Endocrinol. diabetes nutr. (Ed. impr.) ; 66(7): 443-458, ago.-sept. 2019. graf, tab
Artigo em Espanhol | IBECS | ID: ibc-182864

RESUMO

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


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


Assuntos
Humanos , Diabetes Mellitus Tipo 2/terapia , Diabetes Mellitus Tipo 2/complicações , Fatores de Risco , Sociedades Médicas/normas , Documentos , Índice Glicêmico , Estilo de Vida , Sociedades Médicas/organização & administração , Estratégias de eSaúde , Exercício/fisiologia
4.
Medicine (Baltimore) ; 98(36): e16860, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31490370

RESUMO

BACKGROUND: The blood glucose response to moderate-intensity exercise remains unclear for patients with type 2 diabetes (T2DM). In addition, little is known about determinants of blood glucose response to a 12-week moderate-intensity exercise training. Therefore, this study aimed to explore trends in blood glucose in response to a 12-week moderate-intensity exercise training in patients with T2DM and to explore the predictors of post-exercise blood glucose (PEBG) and exercise-induced glucose response (EIGR). METHODS: A prospective longitudinal study was conducted. Of the 66 participants with T2DM recruited from outpatient clinics of a medical center, 20 were eligible to enroll in a 12-week moderate-intensity exercise training. Participants were randomly assigned to 1 of 3 exercise times (morning, afternoon, or evening). Blood glucose were measured pre- and post-exercise. The EIGR was calculated by subtracting the PEBG from the before-exercise blood glucose (BEBG). Generalized estimating equations were used to examine the trends and predictors of PEBG and EIGR. RESULTS: The BEBG declined progressively (ß = -1.69, P < .001); while the PEBG (ß = -0.18, P = .08) remained stable over time during the 12-week exercise training. Higher BEBG predicted higher (ß = 0.53, P < .001) PEBG. Higher baseline maximum oxygen uptake (VO2max) contributed to a larger magnitude of EIGR; higher HgbA1c and BEBG predicted higher EIGR (ß = 0.27, P = .02; ß = 0.45, P < .001); afternoon or evening exercise predicted lower (ß = -13.2, P = .04; ß = -5.96, P = .005) EIGR than did morning exercise. CONCLUSIONS: A 12-week moderate-intensity exercise training appears safe for patients with T2DM. Time of day for exercise, baseline VO2max, and baseline metabolic control may influence the impact of exercise for individuals with T2DM. These findings provide considerations for design of optimal exercise training for T2DM patients.


Assuntos
Glicemia/metabolismo , Diabetes Mellitus Tipo 2/fisiopatologia , Diabetes Mellitus Tipo 2/terapia , Exercício/fisiologia , Adulto , Índice de Massa Corporal , Feminino , Humanos , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Consumo de Oxigênio/fisiologia , Estudos Prospectivos
5.
J Assoc Physicians India ; 67(7): 18-21, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31559762

RESUMO

Objectives: Hemoglobin A1C (HbA1C) estimation is the standard and commonly used method for diagnosis and monitoring of diabetes therapy. We conducted a questionnaire based survey to understand the Indian physician's adherence to HbA1C for effectively managing Type 2 diabetes mellitus (T2DM) patients and its influence on the decision making process. Methods: A validated questionnaire comprising of 10 questions was administered to physicians/endocrinologists at the 44th Annual Conference of RSSDI-2016, Hyderabad. The questions of the survey were designed to understand average cutoff HbA1C level for physicians to start the mono-therapy or combination therapy with or without insulin along with preferred class of Oral anti-diabetic drugs (OAD) in Indian T2DM patients. Results: 41% physicians selected HbA1C level in between 7.0-7.4% to start mono-therapy while 94.5% chose metformin as the first line OAD. In metformin uncontrolled patients, 56.8% responders chose to start a DPP4 inhibitor. To initiate dual therapy 42.9% responders chose HbA1c level of 8.0-8.4% while for triple therapy 37.1% responders selected HbA1c level of 9.0-9.4%. Conclusion: This survey shows the management patterns of T2DM patients by Indian physicians are in line with western guidelines especially AACE. Though guidelines do not offer stringent recommendation on first/second add-on class of OADs, DPP4i emerged as preferred choice for mono-therapy in metforminintolerant patients and as first add-on in patients uncontrolled on metformin alone.


Assuntos
Diabetes Mellitus Tipo 2/terapia , Hemoglobina A Glicada/metabolismo , Glicemia , Estudos Transversais , Diabetes Mellitus Tipo 2/metabolismo , Quimioterapia Combinada , Humanos , Hipoglicemiantes , Índia , Médicos , Inquéritos e Questionários
6.
J Assoc Physicians India ; 67(9): 78-82, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31561694

RESUMO

Personalized medicine is an individualized and stratified approach to the management of a disease. Personalized medicine can reform the prevention, prediction, and management of diabetes. Use of genetic information in polygenic and monogenic forms of diabetes can help to identify genetic variants and reclassify patients into pathophysiological subgroups. Targeted diagnostic, preventive, and therapeutic interventions can be defined for these groups for effective management of diabetes. Pharmacogenetics combines genotypic and phenotypic factors to develop personalized care in various pathophysiological subgroups of persons with diabetes. Personalized medicine finds wider utility in monogenic (especially Maturity Onset Diabetes of the Young (MODY) and Neonatal Diabetes Mellitus [NDM]) than in polygenic, diabetes. The most frequently mutated genes in MODY include HNF1A and HNF3A. the common genes responsible for NDM include KCNJ11 and ABCC8 (SUR) genes. These genes influence various aspects of glucose metabolism such as ß-cell K-ATP channel modulation, production of insulin and development of pancreas. The Madras Diabetes Research Foundation has fostered research in personalized medicine for diabetes based upon genetic information and has developed a national registry for neonatal diabetes and other monogenic form of diabetes.


Assuntos
Diabetes Mellitus Tipo 2/terapia , Medicina de Precisão , Humanos , Índia , Insulina , Mutação
7.
BMC Public Health ; 19(1): 1146, 2019 Aug 20.
Artigo em Inglês | MEDLINE | ID: mdl-31429735

RESUMO

BACKGROUND: UK African and Caribbean (AfC) communities are disproportionately burdened by type 2 diabetes (T2D). Promoting healthy eating and physical activity through structured education is the cornerstone of T2D care, however cultural barriers may limit engagement in these communities. In addition, changes in lifestyle behaviour are shaped by normative influences within social groups and contextual factors need to be understood to facilitate healthful behaviour change. The Behaviour Change Wheel (BCW) and associated COM-B framework offer intervention designers a systematic approach to developing interventions. The aim of this study was to apply the BCW in the design of a culturally sensitive self-management support programme for T2D in UK AfC communities. METHODS: An intervention development study was conducted. Focus groups were held with 41 AfC patients with T2D to understand healthful weight-management, diet and physical activity behaviours. The COM-B framework and BCW were used to evaluate the qualitative data, identify appropriate behaviour change techniques and specify the intervention components. RESULTS: Participants were motivated to avoid diabetes-related consequences although did not always understand the negative impact of their current health behaviours on long-term diabetes outcomes. Barriers to healthful behaviour included gaps in knowledge related to diet, physical activity and weight management guidance. In addition, motivation and social opportunity barriers included an acceptance of larger body sizes, rejection of body mass index for weight guidance and cultural identity being strongly linked to consumption of traditional starches. There was a lack of social opportunity to perform moderate to vigorous physical activity, although walking and dance were culturally acceptable. The resulting Healthy Eating & Active Lifestyles for Diabetes (HEAL-D) intervention uses social support, social comparison, credible sources and demonstration as key behaviour change techniques. CONCLUSION: Use of COM-B and the BCW highlighted the need for an intervention to address motivational and social opportunity barriers to engaging in healthful behaviours, as well as addressing key gaps in knowledge. This framework facilitated the linkage of theoretical behaviour constructs with evidence-based behaviour change techniques, which will enable us to evaluate operationalisation of our chosen BCTs and their impact on behaviour change in a future feasibility study.


Assuntos
Terapia Comportamental/educação , Assistência à Saúde Culturalmente Competente/métodos , Diabetes Mellitus Tipo 2/etnologia , Dieta para Diabéticos/métodos , Educação de Pacientes como Assunto/métodos , Autogestão/educação , Adulto , Grupo com Ancestrais do Continente Africano/educação , Terapia Comportamental/métodos , Região do Caribe/etnologia , Diabetes Mellitus Tipo 2/terapia , Dieta para Diabéticos/etnologia , Exercício , Feminino , Grupos Focais , Comportamentos Relacionados com a Saúde/etnologia , Dieta Saudável/etnologia , Dieta Saudável/métodos , Estilo de Vida Saudável , Humanos , Masculino , Pessoa de Meia-Idade , Motivação , Avaliação de Programas e Projetos de Saúde , Autogestão/métodos , Apoio Social , Reino Unido
8.
Rev Med Suisse ; 15(659): 1423-1424, 2019 08 21.
Artigo em Francês | MEDLINE | ID: mdl-31436056
9.
Complement Ther Clin Pract ; 36: 100-112, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31383426

RESUMO

BACKGROUND: Acupuncture has been used to treat type 2 diabetes (T2DM) for 2000 years and there are emerging clinical evidence and animal studies for its efficacy. However, we are unable to conclude the effectiveness and safety on this issue yet. OBJECTIVES: To assess the effects and safety of acupuncture for T2DM. METHODS: We systematically searched 5 databases and 2 clinical registry platforms from inception to 2018-6-4. RCTs for acupuncture or its variants compared with sham acupuncture or no acupuncture controls for T2DM were included. The primary outcomes were glycemic control and adverse events. RESULTS: A total of 21 studies, which comprised a total of 1943 participants, were included in the final meta-analysis. Compared with sham acupuncture or no acupuncture plus baseline treatments, acupuncture plus baseline treatments yield reduction in FBG(MD 1.21 mmol/l, 95%CI 1.56 to 0.87), 2 h BG(MD 2.13 mmol/l, 95%CI 2.79 to 1.46), HA1c (MD 1.12%, 95%CI 1.62 to 0.62). Our results also show acupuncture can improve blood lipids and blood pressure control, and reduce weight. CONCLUSIONS: As one type of multifactorial intervention, acupuncture could be recommended as a supplementary treatment in the management of T2DM, especially in those with obesity or metabolic disorders. However, due to the small sample size, poor methodological quality of trials reviewed, the amount of evidence is not fully convincing. There is a need for well-planned, long-term studies. REGISTRATION: International Prospective Register of Systematic Reviews (Number CRD42018094573).


Assuntos
Terapia por Acupuntura , Diabetes Mellitus Tipo 2/terapia , Humanos , Ensaios Clínicos Controlados Aleatórios como Assunto
10.
BMC Health Serv Res ; 19(1): 575, 2019 Aug 16.
Artigo em Inglês | MEDLINE | ID: mdl-31419980

RESUMO

BACKGROUND: Recently, there has been growing interest in providing more tailored, patient-centered care for the treatment of type 2 diabetes mellitus (T2DM). Yet it remains unclear which patient characteristics should be determined to guide such an approach. Therefore, the opinions of healthcare providers (HCP) and people with T2DM about relevant patient characteristics for estimating healthcare needs of people with T2DM were assessed and compared. METHODS: Two separate online Delphi studies were conducted according to the RAND-UCLA Appropriateness Method: one with HCPs (n = 22) from Dutch primary and secondary care and one with people with T2DM treated in Dutch primary care (n = 46). The relevance of patient characteristics for estimating healthcare needs, defined as the number of yearly consultations, was assessed on a 5-point Likert scale. Characteristics with a median of 4 or 5 and an interquartile range ≤ 1.5 were considered relevant with consensus. Participants were also asked to select the top 5 of most relevant patient characteristics. To determine the overall top 5, the mean relative importance score of each characteristic was calculated. RESULTS: In two Delphi rounds, 28 and 15 patient characteristics were rated by HCPs and people with T2DM, respectively. Both HCPs and people with T2DM found health-related characteristics relevant for estimating healthcare needs of people with T2DM. However, HCPs preferred to estimate healthcare needs using person- and context-related characteristics. They ranked self-efficacy as the most relevant estimator. In contrast, people with T2DM were more in favor of health-related characteristics and ranked HbA1c as the most relevant estimator. CONCLUSIONS: The findings show that there is discrepancy in opinions on relevant patient characteristics for estimating healthcare needs between HCPs and people with T2DM. To achieve more tailored, patient-centered care, it is important that both groups agree on the topics to be discussed during patient consultations.


Assuntos
Diabetes Mellitus Tipo 2/terapia , Pessoal de Saúde/organização & administração , Determinação de Necessidades de Cuidados de Saúde/organização & administração , Assistência Centrada no Paciente/organização & administração , Idoso , Técnica Delfos , Feminino , Pesquisa sobre Serviços de Saúde , Humanos , Masculino
12.
Int J Equity Health ; 18(1): 133, 2019 08 23.
Artigo em Inglês | MEDLINE | ID: mdl-31443659

RESUMO

BACKGROUND: The prevalence of type 2 diabetes (T2D) in Mexico is one of the highest in the world, with high morbidity and mortality, and difficulty meeting glycemic targets. The purpose of this study was to identify the challenges for T2D self-management as perceived by both adults with T2D and health care providers in primary health clinics from Seguro Popular in Mexico City. METHODS: This was a qualitative descriptive study conducted in three Seguro Popular primary care clinics in Mexico City using convenience sampling. Semi-structured interviews were conducted with participants and data were analyzed using a content analysis approach. RESULTS: The sample included 20 adults with T2D [52.5 years old (SD = 9.9), diagnosed with T2D for 12.3 years (SD = 6.3), mean A1C of 9.8% (SD = 2.4), 80% female, 90% with financial insecurity] and 19 providers [primarily female (78.9%), mean age of 41.6 years old (SD = 11.4), 12.3 mean years in practice (SD = 8.50)]. Personal challenges included cultural beliefs, lack of resources, challenges to lifestyle modification, lack of family support/competing demands, and mental health issues. System level challenges included lack of resources, perceived quality of care, and patient engagement barriers. CONCLUSIONS: Evidence-based diabetes self-management programs need to become more accessible, taking into consideration the social determinants of health and building upon current initiatives to improve early diagnosis and treatment of T2D. Cultural beliefs, personal control, and low health literacy influence diabetes self-management in adults with T2D with limited resources. Mental health and financial challenges of adults with T2D will require multidisciplinary team-based care. Future research on best practices to implement and scale-up evidence-based patient-centered T2D prevention and DSME programs for the poor and underserved is warranted in Mexico and world-wide.


Assuntos
Assistência à Saúde , Diabetes Mellitus Tipo 2/terapia , Pobreza , Autogestão , Adulto , Instituições de Assistência Ambulatorial , Atitude do Pessoal de Saúde , Glicemia/metabolismo , Cidades , Cultura , Diabetes Mellitus Tipo 2/sangue , Feminino , Alfabetização em Saúde , Recursos em Saúde , Acesso aos Serviços de Saúde , Humanos , Estilo de Vida , Masculino , Saúde Mental , México , Pessoa de Meia-Idade , Aceitação pelo Paciente de Cuidados de Saúde , Pesquisa Qualitativa
13.
Internist (Berl) ; 60(9): 903-911, 2019 Sep.
Artigo em Alemão | MEDLINE | ID: mdl-31375850

RESUMO

BACKGROUND: Inhibitors of sodium-glucose cotransporters type 2 (SGLT-2) are a class of oral antidiabetic drugs with a novel specific mode of action in the kidneys. OBJECTIVE: The effects of SGLT-2 inhibitors on cardiovascular (CV) and renal endpoints in outcome trials with type 2 diabetes patients. MATERIAL AND METHODS: Differential analysis and interpretation of the results of outcome trials with the SGLT-2 inhibitors empagliflozin, canagliflozin and dapagliflozin in type 2 diabetes mellitus. RESULTS: In the EMPA-REG OUTCOME trial, empagliflozin demonstrated a significant reduction in major cardiac adverse events (MACE), hospitalization for heart failure (HHI), renal endpoints, CV and total mortality vs. placebo in >7000 patients with type 2 diabetes and established CV disease over 3.1 years. In the CANVAS program, canagliflozin demonstrated a significant reduction of MACE, HHI and renal endpoints vs. placebo in >10,000 patients with type 2 diabetes and high CV risk over 2.4 years. In the CREDENCE trial, canagliflozin demonstrated a significant reduction of a combined renal endpoint and CV endpoints vs. placebo in >4000 patients with type 2 diabetes and established kidney disease with albuminuria over 2.6 years. In the DECLARE-TIMI 58 trial, dapagliflozin demonstrated a significant reduction in a combined endpoint of CV death and HHI vs. placebo in >17,000 patients with type 2 diabetes and established CV disease or with multiple CV risk factors over 3.1 years. CONCLUSION: Outcome trials with SGLT-2 inhibitors have collectively demonstrated cardioprotective and nephroprotective effects in patients with type 2 diabetes and high CV risk. The use of SGLT-2 inhibitors is recommended in current guidelines and consensus statements as primary combination partners for metformin in patients with type 2 diabetes and established CV disease, high CV risk, heart failure or kidney disease.


Assuntos
Canagliflozina/uso terapêutico , Doenças Cardiovasculares/fisiopatologia , Diabetes Mellitus Tipo 2/tratamento farmacológico , Diabetes Mellitus Tipo 2/terapia , Nefropatias/fisiopatologia , Inibidores do Transportador 2 de Sódio-Glicose/uso terapêutico , Glicemia/efeitos dos fármacos , Glicemia/metabolismo , Canagliflozina/efeitos adversos , Diabetes Mellitus Tipo 2/metabolismo , Humanos , Hipoglicemiantes/uso terapêutico , Avaliação de Resultados (Cuidados de Saúde) , Guias de Prática Clínica como Assunto , Transportador 2 de Glucose-Sódio/efeitos dos fármacos , Transportador 2 de Glucose-Sódio/metabolismo , Inibidores do Transportador 2 de Sódio-Glicose/efeitos adversos , Resultado do Tratamento
14.
Rev Lat Am Enfermagem ; 27: e3164, 2019 Aug 19.
Artigo em Português, Inglês, Espanhol | MEDLINE | ID: mdl-31432918

RESUMO

OBJECTIVE: to translate and cross-culturally adapt the Behavior Change Protocol for educational practices in Diabetes Mellitus. METHOD: methodological study aimed at cross-cultural adaptation, comprising the steps of translation, back-translation, assessment by an expert committee and pre-testing of the instrument on a sample of 30 healthcare service users with type 2 Diabetes Mellitus. RESULTS: the instrument was assessed based on criteria pertaining semantic, idiomatic, conceptual and cultural equivalence between the original instrument and the translated version, its mean Content Validity Index being 0.85. CONCLUSION: results showed content validity indicating the instrument's successful cross-cultural adaptation to the Brazilian culture for use in educational practices targeting self-care in type 2 DM.


Assuntos
Diabetes Mellitus Tipo 2/terapia , Educação de Pacientes como Assunto/normas , Autocuidado/normas , Inquéritos e Questionários/normas , Tradução , Brasil , Comparação Transcultural , Características Culturais , Feminino , Serviços de Saúde , Humanos , Masculino , Pessoa de Meia-Idade , Variações Dependentes do Observador , Educação de Pacientes como Assunto/métodos , Valores de Referência , Reprodutibilidade dos Testes , Autocuidado/métodos
15.
Diabetes Res Clin Pract ; 154: 124-129, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31299196

RESUMO

AIMS: To investigate the effect of exercise training on musculoskeletal pain in patients with type 2 diabetes. METHODS: The intervention was exercise twice weekly for 12 weeks. The primary outcome was musculoskeletal pain assessed using a 0-10 Numeric Rating Scale (NRS) in 11 body sites. Secondary outcomes were use of analgesics, glycaemic control and body weight. RESULTS: The participants (n = 69) were 66 ±â€¯10 years old, 38 were men and 50 completed the intervention. Pain in the limbs was more frequently reported by the participants compared to a matched general population (80.9% vs 65.3%, p = 0.007). The participants who had any pain at baseline (NRS > 0) and severe pain (NRS > 3) reported significantly decreased pain in the feet, calf muscles, knees, thighs, hips, lower back and arms after the training period. Use of analgesics was unchanged, HbA1c (mmol/mol) decreased from 60 ±â€¯15 to 54 ±â€¯11, p < 0.001 and body weight (kg) decreased from 100.5 ±â€¯19.1 to 98.6 ±â€¯17.7, p = 0.005. CONCLUSIONS: The participants with type 2 diabetes reported more frequent pain than a matched general population. The training intervention was associated with reduced musculoskeletal pain. Reduced pain may together with a positive impact on glycaemic control be an important motivational factor in patients with type 2 diabetes to perform exercise training.


Assuntos
Diabetes Mellitus Tipo 2/terapia , Exercício , Dor Musculoesquelética/prevenção & controle , Idoso , Glicemia/análise , Peso Corporal , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Prognóstico
16.
BMC Public Health ; 19(1): 907, 2019 Jul 08.
Artigo em Inglês | MEDLINE | ID: mdl-31286927

RESUMO

BACKGROUND: Novel interactive and pictorial health education tool named Diabetes Conversation Map (DCM) might be effective for the improvement of diabetes management self-efficacy (DMSE) and diabetes distress (DD) among diabetic patients in lower middle-income setting. This study protocol will assess the effectiveness of DCM as compared to routine care (RC) to improve DMSE, decrease DD and glycated hemoglobin (HbA1c) among patients with type 2 diabetes (T2DM). METHODS: This will be two arms randomized controlled trial, conducted at national institute of diabetes and endocrinology (NIDE) in Karachi, Pakistan. A sample of 120 T2DM patients of age 30-60 years with suboptimal diabetes control will be screened through eligibility criteria and DD screening tool. Patients who fulfill the eligibility criteria and have diabetes distress will be randomized into interventional and control arm. The intervention arm will receive four education sessions (40 min each) using DCM for 4 weeks duration of enrollment. Controlled arm will receive RC. DMSE and DD will be measured using the validated Likert tools at baseline and after 3 months of enrollment. Latest results of HbA1c will be retrieved from the respective medical record files at baseline and 3 months. Change in DMSE, DD scores and HbA1c levels within groups (pre-post) and between the groups after 3 months of enrollment will be compared. Multivariable linear regression will be conducted to adjust for any potential confounders. DISCUSSION: In a study in UK, 70% of the patients with diabetes reported DCM had helped them in controlling their diabetes and recommended this method to teach other patients with diabetes also. In China, a study found that patients with diabetes who received DCM based education had significantly lower DD and significantly higher diabetes empowerment score after six months of the intervention as compared to the traditional counselling. A cross sectional study conducted in Pakistan also demonstrated that teaching based on DCM was useful in improving the knowledge, attitude and practices of patients with T2DM. Besides, no other study has evaluated the effectiveness of these novel tools for DMSE and diabetes distress DD in well-designed, sufficiently powered clinical trials. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT03747471 . Date of registration: Nov 20. 2018. Version and Date of Protocol: Version 1, IRB Approval date 28 June 2018.


Assuntos
Diabetes Mellitus Tipo 2/psicologia , Educação de Pacientes como Assunto/métodos , Autoeficácia , Autogestão/psicologia , Estresse Psicológico/psicologia , Adulto , China , Comunicação , Diabetes Mellitus Tipo 2/sangue , Diabetes Mellitus Tipo 2/terapia , Feminino , Hemoglobina A Glicada/análise , Humanos , Masculino , Pessoa de Meia-Idade , Paquistão , Ensaios Clínicos Controlados Aleatórios como Assunto , Estresse Psicológico/sangue
17.
Georgian Med News ; (290): 144-149, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-31322533

RESUMO

There have been presented the results of the histomorphological research of the effect of the beans' thick extract (BTE) on the state of the pancreas on the model of diabetes mellitus type 2 on the background of obesity in the rats in our research. The simulation of type 2 diabetes on the background of obesity in the animals has led to the development of signs of insulin's inhibition of insulin producing apparatus - some different expressions of dystrophy and degeneration of the ß-cells. The consequence of the hyperfunction has been exhaustion and even death of ß-cells, the development of the diabetic condition. The redistribution of pancreatic islet ß-content of cells has contributed to the increase of the small islands and had a compensatory nature. The treatment of the animals by the BTE has fully prevented an excessive negative impact on revenues of carbohydrates insulin producing apparatus, because it improves the morphological status of ß-cells, reduces the part of small pancreatic islets, almost restores medium and large islets to the level of the «Intact control¼ group. The comparison drug - metformin - has a positive effect on the morphological status of the pancreatic ß-cells, but this effect is obviously not enough for improving or restoring the normal % of distribution of islets.


Assuntos
Diabetes Mellitus Experimental/tratamento farmacológico , Diabetes Mellitus Experimental/patologia , Diabetes Mellitus Tipo 2/terapia , Hipoglicemiantes/uso terapêutico , Ilhotas Pancreáticas/metabolismo , Ilhotas Pancreáticas/patologia , Obesidade/complicações , Extratos Vegetais/uso terapêutico , Sementes/química , Animais , Tamanho Celular/efeitos dos fármacos , Diabetes Mellitus Experimental/metabolismo , Hipoglicemiantes/administração & dosagem , Hipoglicemiantes/química , Insulina , Células Secretoras de Insulina/efeitos dos fármacos , Metformina/administração & dosagem , Extratos Vegetais/química , Ratos , Açúcares
18.
Med Care ; 57(8): 592-600, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-31268954

RESUMO

BACKGROUND: Social determinants of health (SDH) at the area level are understood to influence the likelihood of having poor glycemic control for patients with type 2 diabetes mellitus (T2DM). OBJECTIVES: To develop a model for predicting whether a person with T2DM has uncontrolled diabetes (hemoglobin A1c ≥9%), incorporating individual and area-level (census tract) covariates. RESEARCH DESIGN: Development and validation of machine learning models. SUBJECTS: Total of N=1,015,808 privately insured persons in claims data with T2DM. MEASURES: C-statistic, sensitivity, specificity, positive predictive value, negative predictive value, and accuracy. RESULTS: A standard logistic regression model selecting among the available individual-level covariates and area-level SDH covariates (at the census tract level) performed poorly, with a C-statistic of 0.685, sensitivity of 25.6%, specificity of 90.1%, positive predictive value of 56.9%, negative predictive value of 70.4%, and accuracy of 68.4% on a 25% held-out validation subset of the data. By contrast, machine learning models improved upon risk prediction, with the highest performance from a random forest algorithm with a C-statistic of 0.928, sensitivity of 68.5%, specificity of 94.6%, positive predictive value of 69.8%, negative predictive value of 94.3%, and accuracy of 90.6%. SDH variables alone explained 16.9% of variation in uncontrolled diabetes. CONCLUSIONS: A predictive model developed through a machine learning approach may assist health care organizations to identify which area-level SDH data to monitor for prediction of diabetes control, for potential use in risk-adjustment and targeting.


Assuntos
Diabetes Mellitus Tipo 2/epidemiologia , Determinantes Sociais da Saúde/estatística & dados numéricos , Idoso , Diabetes Mellitus Tipo 2/terapia , Feminino , Hemoglobina A Glicada/análise , Humanos , Modelos Logísticos , Aprendizado de Máquina , Masculino , Pessoa de Meia-Idade , Modelos Estatísticos , Medição de Risco , Fatores de Risco
20.
Rev Med Chil ; 147(3): 361-366, 2019 Mar.
Artigo em Espanhol | MEDLINE | ID: mdl-31344174

RESUMO

The increase in chronic noncommunicable diseases is one of the main concerns worldwide. Therefore, it is pertinent to ask how care system organizations responded to the requirements currently being posed by chronic diseases, specifically type 2 diabetes mellitus (T2DM). In the world, different models have been developed considering elements that transcend the biological stability of the disease. Chile has the great challenge of exploring new models that emphasize the promotion and prevention of health rather than the management of the disease. The impact of variables such as health literacy, self-efficacy and subjective well-being on T2DM should be explored. In addition, it is necessary to validate and implement guidelines and protocols of care that incorporate the aforementioned variables.


Assuntos
Diabetes Mellitus Tipo 2/terapia , Chile , Doença Crônica , Alfabetização em Saúde , Humanos
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