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1.
Artigo em Inglês | MEDLINE | ID: mdl-34200592

RESUMO

Alongside glucose lowering therapy, clinical guidelines recommend lifestyle interventions as cornerstone in the care of people living with type 2 diabetes (T2DM). There is a specific need for an up-to-date review assessing the effectiveness of lifestyle interventions for people with T2DM living in low-and-middle income countries (MICs). Four electronic databases were searched for RCTs published between 1990 and 2020. T2DM, lifestyle interventions, LMICs and their synonyms were used as search terms. Data codebooks were developed and data were extracted. Narrative synthesis and meta-analysis were conducted using random effects models to calculate mean differences (MD) and standardized mean differences (SMD) and 95% confidence intervals (CI). Of 1284 articles identified, 30 RCTs (n = 16,670 participants) met the inclusion criteria. Pooled analysis revealed significant improvement in HBA1c (MD -0.63; CI: -0.86, -0.40), FBG (SMD -0.35; CI: -0.54, -0.16) and BMI (MD -0.5; CI: -0.8, -0.2). In terms of intervention characteristics, those that included promoted self-management using multiple education components (e.g., diet, physical activity, medication adherence, smoking cessation) and were delivered by healthcare professionals in a hospital/clinic setting were deemed most effective. However, when interpreting these results, it is important to consider that most included studies were evaluated as being of low quality and there was a significant amount of intervention characteristics heterogeneity. There is a need for further well-designed studies to inform the evidence base on which lifestyle interventions are most effective for glycemic control in adults with T2DM living in LMICs.


Assuntos
Países em Desenvolvimento , Diabetes Mellitus Tipo 2 , Adulto , Diabetes Mellitus Tipo 2/terapia , Controle Glicêmico , Humanos , Estilo de Vida , Ensaios Clínicos Controlados Aleatórios como Assunto
2.
Stem Cell Res Ther ; 12(1): 385, 2021 07 07.
Artigo em Inglês | MEDLINE | ID: mdl-34233739

RESUMO

BACKGROUND: The therapeutic efficacy of mesenchymal stem cells (MSCs) of different tissue origins on metabolic disorders can be varied in many ways but remains poorly defined. Here we report a comprehensive comparison of human MSCs derived from umbilical cord Wharton's jelly (UC-MSCs), dental pulp (PU-MSCs), and adipose tissue (AD-MSCs) on the treatment of glucose and lipid metabolic disorders in type II diabetic mice. METHODS: Fourteen-to-fifteen-week-old male C57BL/6 db/db mice were intravenously administered with human UC-MSCs, PU-MSCs, and AD-MSCs at various doses or vehicle control once every 2 weeks for 6 weeks. Metformin (MET) was given orally to animals in a separate group once a day at weeks 4 to 6 as a positive control. Body weight, blood glucose, and insulin levels were measured every week. Glucose tolerance tests (GTT) and insulin tolerance tests (ITT) were performed every 2 weeks. All the animals were sacrificed at week 6 and the blood and liver tissues were collected for biochemical and histological examinations. RESULTS: UC-MSCs showed the strongest efficacy in reducing fasting glucose levels, increasing fasting insulin levels, and improving GTT and ITT in a dose-dependent manner, whereas PU-MSCs showed an intermediate efficacy and AD-MSCs showed the least efficacy on these parameters. Moreover, UC-MSCs also reduced the serum low-density lipoprotein cholesterol (LDL-C) levels with the most prominent potency and AD-MSCs had only very weak effect on LDL-C. In contrast, AD-MSCs substantially reduced the lipid content and histological lesion of liver and accompanying biomarkers of liver injury such as serum aspartate transaminase (AST) and alanine aminotransferase (ALT) levels, whereas UC-MSCs and PU-MSCs displayed no or modest effects on these parameters, respectively. CONCLUSIONS: Taken together, our results demonstrated that MSCs of different tissue origins can confer substantially different therapeutic efficacy in ameliorating glucose and lipid metabolic disorders in type II diabetes. MSCs with different therapeutic characteristics could be selected according to the purpose of the treatment in the future clinical practice.


Assuntos
Diabetes Mellitus Experimental , Diabetes Mellitus Tipo 2 , Transplante de Células-Tronco Mesenquimais , Células-Tronco Mesenquimais , Animais , Diabetes Mellitus Experimental/terapia , Diabetes Mellitus Tipo 2/terapia , Glucose , Humanos , Masculino , Camundongos , Camundongos Endogâmicos C57BL , Cordão Umbilical
3.
Artigo em Inglês | MEDLINE | ID: mdl-34200198

RESUMO

BACKGROUND: The aim of this study was to assess the efficacy of Beat It-a community-based exercise and lifestyle intervention-in improving anthropometric and physical fitness outcomes in older adults with type 2 diabetes mellitus (T2DM). METHODS: Australians with T2DM who were aged 60 years or older were included. These individuals were enrolled in Beat It, a twice-weekly supervised group exercise and education program conducted over 8 weeks. Anthropometric measurements and physical fitness parameters were assessed at baseline and completion. Physical fitness measures were then compared to validated criterion standards of fitness levels required by older adults to remain physically independent into later life. RESULTS: A total of 588 individuals were included in the study. At baseline, a substantial proportion of the cohort had physical fitness measures that were below the standard for healthy independent living for their gender and age. Significant improvements in waist circumference and physical fitness were observed post program and resulted in an increase in the number of participants who met the standard for healthy independent living. CONCLUSIONS: Participation in Beat It improved important health outcomes in older adults with T2DM. A longer-term follow-up is needed to determine whether these positive changes were maintained beyond the delivery of the program.


Assuntos
Diabetes Mellitus Tipo 2 , Idoso , Austrália , Diabetes Mellitus Tipo 2/terapia , Exercício Físico , Humanos , Estilo de Vida , Avaliação de Resultados em Cuidados de Saúde , Aptidão Física
4.
Curr Cardiol Rep ; 23(8): 104, 2021 07 01.
Artigo em Inglês | MEDLINE | ID: mdl-34196800

RESUMO

PURPOSE OF REVIEW: Obesity is associated with an increased risk for type 2 diabetes, and weight loss in adults with obesity and type 2 diabetes may be indicated to reduce health risk and improve diabetes control. It is important to understand the effectiveness of weight loss interventions for the prevention and treatment of type 2 diabetes. RECENT FINDINGS: Lifestyle interventions for weight loss show effectiveness for prevention of type 2 diabetes. Weight loss in patients with type 2 diabetes can decrease cardiometabolic risk and improve diabetes control. However, diabetes remission with lifestyle approaches is limited and to achieve this medical approaches such as bariatric surgery that result in greater magnitudes of weight loss may be necessary. Dissemination of lifestyle interventions for weight loss, along with other medical approaches such as bariatric surgery when indicated, are needed to reduce the health burden of type 2 diabetes in patients with obesity.


Assuntos
Cirurgia Bariátrica , Diabetes Mellitus Tipo 2 , Adulto , Diabetes Mellitus Tipo 2/complicações , Diabetes Mellitus Tipo 2/terapia , Humanos , Estilo de Vida , Obesidade/complicações , Obesidade/terapia , Perda de Peso
5.
Niger J Clin Pract ; 24(7): 978-985, 2021 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-34290172

RESUMO

Background: Self-care practices in individuals with diabetes are important skills required to effectively prevent, manage, and limit complications associated with diabetes since patients spend considerably less time with health care providers than spend alone to manage their diabetes condition. Aims: The aim of the study was to assess self-cate practices and their determinants among patients with type 2 diabetes. Hence, this study aimed at assessing self-care practices and their determinants among patients with type 2 diabetes. Materials and Methods: This cross-sectional, descriptive, multi-center study was conducted among 348 type 2 diabetes patients selected from six tertiary hospitals in Southwest Nigeria. Descriptive statistical analysis was employed for categorical and continuous variables and multivariable logistic regression assessed association between determinant factors and adherence to self-monitoring of blood glucose (SMBG). Results: Of the study participants, 83.1%, 66.9%, 28.4%, and 27.9% adhered to prescribed medications, physical exercise, had meal plans incorporated into their diabetes management and SMBG, respectively. There was a statistically significant association between male gender, duration of diabetes, and previous episode of hypoglycemia with adherence to SMBG practices while lower educational level and use of insulin were associated with less likelihood of adherence to prescribed medications. Conclusion: The degree to which individuals with diabetes adhered to recommended self-care practice components were less than satisfactory especially SMBG, physical activity, and having meal plans.


Assuntos
Diabetes Mellitus Tipo 2 , Glicemia , Automonitorização da Glicemia , Estudos Transversais , Diabetes Mellitus Tipo 2/terapia , Humanos , Masculino , Nigéria , Autocuidado
6.
Int J Mol Sci ; 22(13)2021 Jun 30.
Artigo em Inglês | MEDLINE | ID: mdl-34209306

RESUMO

Diabetic foot ulcer (DFU) is a diabetes complication which greatly impacts the patient's quality of life, often leading to amputation of the affected limb unless there is a timely and adequate management of the patient. DFUs have a high economic impact for the national health system. Data have indeed shown that DFUs are a major cause of hospitalization for patients with diabetes. Based on that, DFUs represent a very important challenge for the national health system. Especially in developed countries diabetic patients are increasing at a very high rate and as expected, also the incidence of DFUs is increasing due to longevity of diabetic patients in the western population. Herein, the surgical approach focused on the targeted use of the acellular dermal matrix has been integrated with biochemical and morphological/histological analyses to obtain evidence-based information on the mechanisms underlying tissue regeneration. In this research report, the clinical results indicated decreased postoperative wound infection levels and a short healing time, with a sound regeneration of tissues. Here we demonstrate that the key biomarkers of wound healing process are activated at gene expression level and also synthesis of collagen I, collagen III and elastin is prompted and modulated within the 28-day period of observation. These analyses were run on five patients treated with Integra® sheet and five treated with the injectable matrix Integra® Flowable, for cavitary lesions. In fact, clinical evaluation of improved healing was, for the first time, supported by biochemical and histological analyses. For these reasons, the present work opens a new scenario in DFUs treatment and follow-up, laying the foundation for a tailored protocol towards complete healing in severe pathological conditions.


Assuntos
Derme Acelular , Diabetes Mellitus Tipo 1 , Diabetes Mellitus Tipo 2 , Pé Diabético , Cicatrização , Idoso , Diabetes Mellitus Tipo 1/metabolismo , Diabetes Mellitus Tipo 1/patologia , Diabetes Mellitus Tipo 1/terapia , Diabetes Mellitus Tipo 2/metabolismo , Diabetes Mellitus Tipo 2/patologia , Diabetes Mellitus Tipo 2/terapia , Pé Diabético/metabolismo , Pé Diabético/patologia , Pé Diabético/terapia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade
7.
BMC Health Serv Res ; 21(1): 688, 2021 Jul 12.
Artigo em Inglês | MEDLINE | ID: mdl-34253211

RESUMO

BACKGROUND: For people with Type 2 diabetes (T2D), lifestyle changes may be the most effective intervention. Online groups for people with diabetes holds a great potential to support such changes. However, little is known about the association between participation in online groups and lifestyle changes based on internet information in people with T2D. The aim of this study was to investigate the association between self-reported lifestyle changes and participation in online groups in people with T2D. METHODS: We used e-mail survey data from 1,250 members of The Norwegian Diabetes Association, collected in 2018. Eligible for analyses were the 540 respondents who reported to have T2D. By logistic regressions we studied the association between self-reported lifestyle changes and participation in online groups. Analyses were adjusted for gender, age, education, and time since diagnosis. RESULTS: We found that 41.9 % of the participants reported lifestyle changes based on information from the internet. Only 6 % had participated in online groups during the previous year. Among those with a disease duration of less than 10 years, 56.0 % reported lifestyle changes, whereas 33.4 % with a disease duration of 10 years or more did so. The odds for lifestyle changes were more than doubled for those who participated in online groups. People who had been diagnosed with diabetes for less than 10 years were significantly more likely to change their lifestyle compared to those with a longer disease duration. CONCLUSIONS: Lifestyle changes based on information from the internet among people with T2D are associated with participation in online groups. Lifestyle changes are also associated with time since diagnosis, making the first years after a T2D diagnosis particularly important for lifestyle interventions. People with T2D, web site developers, online group moderators, health care services, and patient organisations should be aware of this important window for lifestyle change, and encourage participation in online groups.


Assuntos
Diabetes Mellitus Tipo 2 , Estudos Transversais , Diabetes Mellitus Tipo 2/diagnóstico , Diabetes Mellitus Tipo 2/epidemiologia , Diabetes Mellitus Tipo 2/terapia , Escolaridade , Humanos , Internet , Estilo de Vida , Inquéritos e Questionários
8.
BMC Health Serv Res ; 21(1): 721, 2021 Jul 22.
Artigo em Inglês | MEDLINE | ID: mdl-34294112

RESUMO

BACKGROUND: Self-care is one of the cornerstones in the treatment of type 2 diabetes. Patients with type 2 diabetes struggle to maintain acceptable levels of blood sugar, blood pressure and lipids, the fundamental for the prevention of macro- and microvascular as well as neuropathic complications. The primary aim of the study was to evaluate the feasibility and describe patients' and caregivers' experiences of using the web- and smartphone-based system Triabetes. The secondary aim was to investigate if the use of the system could improve patients' clinical outcomes. METHODS: Feasibility was assessed with describing recruitment rate and the participant´s views of using the system. Laboratory and anthropometry data were also collected. RESULTS: The study showed that recruitment of patients to participate in the intervention was limited and compliance to the study protocol was low. A majority of the patients stated that the system was easy to get an overview of and that the system motivated them and made it easier and fun to handle lifestyle habits. A secondary finding of the study was that there was a significant lowering of LDL values. CONCLUSIONS: Feasibility in terms of recruitment rate was low. The participants agreed that the application overall was useful but suggested several improvements. Summarized lessons learned from this study are following: (1) we need more knowledge about what motivates a person to use a digital tool for a longer period of time; (2) the tool must be easy and less time consuming to use; (3) the technical structure needs to be improved and automatic recording of data must be improved.


Assuntos
Diabetes Mellitus Tipo 2 , Pressão Sanguínea , Diabetes Mellitus Tipo 2/terapia , Estudos de Viabilidade , Humanos , Internet , Cooperação do Paciente
9.
Rev Med Suisse ; 17(741): 1087-1090, 2021 Jun 02.
Artigo em Francês | MEDLINE | ID: mdl-34077041

RESUMO

The transition from hospital to ambulatory care is a high-risk period for patients with diabetes mellitus and is a challenge for health care professionals. Various interprofessional collaborative interventions have shown a positive impact on continuity of care at discharge. Communication and transmission of information between the hospital and ambulatory settings as well as coordination between healthcare professionals are key points to explore and to improve to ensure optimal continuity of care.


Assuntos
Diabetes Mellitus Tipo 2 , Transferência de Pacientes , Continuidade da Assistência ao Paciente , Diabetes Mellitus Tipo 2/epidemiologia , Diabetes Mellitus Tipo 2/terapia , Hospitais , Humanos , Alta do Paciente
10.
Rev Bras Epidemiol ; 24: e210032, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34105595

RESUMO

OBJECTIVE: To evaluate the association between dental visits and variation in the glycated hemoglobin index (A1C) of patients with type 2 diabetes (T2DM) with well or not well glycemic control over time. METHODS: Patients with T2DM, A1C ≥ 7% (not well-controlled) and < 7% (well-controlled), who attended a primary care service and were followed up from January 2010 to May 2018. The outcome was the variation of A1C obtained from reference laboratories. At the beginning of the study, a questionnaire with behavioral, clinical, and socioeconomic information was carried out. Multiple linear regression analyses tested interaction terms of all variables with the initial glycemic level (not well-controlled or well-controlled). RESULTS: The sample consisted of 507 people, 65% women, and 66% individuals 55 to 74 years old, followed on average for 5.4 years. There was an interaction (p = 0.01) between dental visits and initial A1C. Patients not well-controlled with at least one dental visit had an average reduction in A1C of -0.56 percentage point (95%CI -1.06 - -0.56), whereas the well-controlled group who also had at least one dental visit had an increase of 0.34 percentage point (95%CI -0.18 - 0.87). CONCLUSION: Dental visits were associated with an improvement in A1C of approximately a half-percentage point in patients who had the initial A1C considered as not well-controlled.


Assuntos
Diabetes Mellitus Tipo 2 , Idoso , Brasil , Estudos de Coortes , Diabetes Mellitus Tipo 2/terapia , Feminino , Hemoglobina A Glicada/análise , Humanos , Masculino , Pessoa de Meia-Idade , Atenção Primária à Saúde , Estudos Retrospectivos
11.
BMC Public Health ; 21(1): 1269, 2021 06 29.
Artigo em Inglês | MEDLINE | ID: mdl-34187461

RESUMO

BACKGROUND: Self-management of diabetes is associated with glycaemic control and adherence to medication and healthy lifestyle practices. There is lack of information on the barriers to and facilitators of diabetes self-management practices in low income country, Nepal. This study aimed to explore the barriers to and facilitators of Type 2 diabetes self-management practices taking multiple stakeholders' perspectives in Nepal. METHODS: Four focus group discussions and 16 semi-structured interviews with people with Type 2 diabetes, caregivers, health care providers and health managers were conducted from April to May 2018 in Rupandehi district of Western Nepal. They were audio-recorded, transcribed, and analysed using a thematic approach. RESULTS: Five main themes emerged that influenced diabetes self-management practices: individual factors, socio-cultural and economic factors, health system and policy factors, availability and accessibility of resources, and environmental factors. The important barriers were: lack of knowledge about diabetes self-management practices, cultural practices, insufficient counselling, lack of guidelines and protocols for counselling, and financial problems. The major facilitators were: motivation; support from family, peers, and doctors; and availability of resources in the community. CONCLUSION: Based on our findings, a multilevel approach is needed to address these barriers and facilitators. These findings will help guide strategies to develop programs that impart knowledge and skills to improve the diabetes self-management practices of people with Type 2 diabetes.


Assuntos
Diabetes Mellitus Tipo 2 , Autogestão , Diabetes Mellitus Tipo 2/terapia , Pessoal de Saúde , Humanos , Nepal , Pesquisa Qualitativa
12.
BMC Public Health ; 21(1): 1191, 2021 06 22.
Artigo em Inglês | MEDLINE | ID: mdl-34157994

RESUMO

BACKGROUND: Describing implementation features of an intervention is required to compare interventions and to inform policy and best practice. The aim of this study was to conduct a process evaluation of the first 12 months of the Sophia Step Study: a primary care based RCT evaluating a multicomponent (self-monitoring of daily steps plus counseling) and a single component (self-monitoring of steps only) physical activity intervention to standard care on cardiometabolic health. METHODS: The evaluation was guided by the Medical Research Council Guidance for complex interventions. To describe the implementation communication with the health professionals implementing the interventions, attendance records and tracking of days with self-monitored pedometer-determined steps were used. Change in physical activity behaviour was measured at baseline, 6 and 12 months as daily steps by accelerometry. RESULTS: During April 2013 to January 2018 188 participants were randomized and intervened directly after inclusion. Response rate was 49% and drop out was 10%. A majority, 78%, had type 2 diabetes and 22% were diagnosed with prediabetes. Mean [Standard deviation (SD)] body mass index was 30.4 (4.4) kg/m2 and steps per day was 6566 (3086). The interventions were delivered as intended with minor deviation from the protocol and dose received was satisfying for both the multicomponent and single component group. The mean [95% Confidence Interval (CI)] change in daily steps from baseline to 6 months was 941(227, 1655) steps/day for the multicomponent intervention group, 990 (145, 1836) step/day for the single component group and - 506 (- 1118, 107) for the control group. The mean (95% CI) change in daily steps from baseline to 12 months was 31(- 507, 570) steps/day for the multicomponent intervention group, 144 (- 566, 853) step/day for the single component group and - 890 (- 1485, - 294) for the control group. There was a large individual variation in daily steps at baseline as well as in step change in all three groups. CONCLUSIONS: Applying self-monitoring of steps is a feasible method to implement as support for physical activity in the primary care setting both with and without counseling support. TRIAL REGISTRATION: ClinicalTrials.gov , NCT02374788 . Registered 2 March 2015.


Assuntos
Diabetes Mellitus Tipo 2 , Estado Pré-Diabético , Aconselhamento , Diabetes Mellitus Tipo 2/terapia , Exercício Físico , Humanos , Estado Pré-Diabético/diagnóstico , Estado Pré-Diabético/terapia , Atenção Primária à Saúde
13.
J Fam Pract ; 70(4 Suppl)2021 05.
Artigo em Inglês | MEDLINE | ID: mdl-34184984

RESUMO

Diabetes is a progressive disease associated with micro- and macrovascular complications. Type 2 diabetes (T2D) is the leading contributor to chronic kidney disease (CKD) worldwide, which itself is associated with an increased burden of cardiovascular disease, increased risk of hypoglycemia, and increased risk of death beyond that caused by diabetes alone. In this video series available on The Journal of Family Practice website, the authors discuss how CKD in people with T2D is defined, potential consequences of CKD in this patient population, and how those with CKD and T2D should be identified, monitored, and treated. The authors discuss the best management approaches for CKD in those with T2D, including blood pressure control, renin-angiotensin-aldosterone system blockade, use of sodium-glucose cotransporter-2 inhibitors, and glycemic control. The importance of glycemic control in the prevention and reduction of CKD progression in people with T2D is reviewed, with an emphasis on the use of antihyperglycemic agents as renal function declines. Finally, the authors discuss the use of basal insulin in this patient population, emphasizing the importance of reaching glycemic control goals while minimizing hypoglycemia. They note that, in people with T2D and reduced renal function, second-generation basal insulin analogs have demonstrated comparable efficacy to first-generation basal insulin analogs in reducing HbA1c levels­but with less hypoglycemia.


Assuntos
Diabetes Mellitus Tipo 2/complicações , Insuficiência Renal Crônica/etiologia , Insuficiência Renal Crônica/terapia , Complicações do Diabetes/prevenção & controle , Complicações do Diabetes/terapia , Diabetes Mellitus Tipo 2/terapia , Progressão da Doença , Humanos , Hipoglicemiantes/uso terapêutico , Inibidores do Transportador 2 de Sódio-Glicose/uso terapêutico
14.
Artigo em Inglês | MEDLINE | ID: mdl-34065775

RESUMO

Controlling type 2 diabetes (T2DM) requires a comprehensive approach including patient education, self-monitoring of blood glucose, individualized behavioral strategies, and frequent contact with healthcare professionals (HCPs). We aimed to compare the efficacy of a personalized lifestyle intervention based on a mobile phone application with regular care in participants with T2DM. This is an ongoing randomized controlled open-label parallel-group trial with a target accrual of 282 participants, of which 181 have been enrolled to date. Participants are randomly assigned to one of three groups: (1) regular care; (2) mobile diabetes management; or (3) mobile diabetes management with HCP feedback. The mobile application is enabled to integrate with both electronic medical records (EMR) and a web-based diabetes management system for HCPs. It can send customized messages based on participants' responses to lifestyle questionnaires administered at the baseline. The intervention period is 26 weeks followed by observation for 26 weeks. We evaluate the intervention's features in order to assess its clinical utility and efficacy and compare outcomes with regular care considering relevant clinical factors, such as age, baseline HbA1c, etc. We expect our study to provide new evidence in support of customized mobile application tools for the management of T2DM.


Assuntos
Telefone Celular , Diabetes Mellitus Tipo 2 , Aplicativos Móveis , Glicemia , Diabetes Mellitus Tipo 2/terapia , Registros Eletrônicos de Saúde , Humanos
15.
Rev Bras Enferm ; 74(2): e20200351, 2021.
Artigo em Inglês, Português | MEDLINE | ID: mdl-34161540

RESUMO

OBJECTIVES: to verify the adherence to self-care activities among people with diabetes mellitus and its association with quality of care received in Primary Care. METHODS: a cross-sectional study with 329 people with diabetes assisted in Primary Care. Sociodemographic and self-care data were collected. To assess quality of care in Primary Care, secondary data from the Access and Quality Improvement Program were used. For comparisons between adherence to self-care activities and quality of care received in Primary Care, the Kruskal-Wallis Test was used. RESULTS: better adherence to the diet, blood glucose monitoring and medication use were observed among people with diabetes treated in Primary Care with better coordination of care, agenda organization, and equipment. Foot examination, despite the inverse relationship with quality of care, proved to be desirable. CONCLUSIONS: adherence to self-care among people with diabetes was associated with quality of care received in Primary Care.


Assuntos
Diabetes Mellitus Tipo 2 , Diabetes Mellitus , Glicemia , Automonitorização da Glicemia , Estudos Transversais , Diabetes Mellitus/terapia , Diabetes Mellitus Tipo 2/terapia , Humanos , Atenção Primária à Saúde , Autocuidado
16.
Int J Mol Sci ; 22(9)2021 May 01.
Artigo em Inglês | MEDLINE | ID: mdl-34062938

RESUMO

Diabetes mellitus represents a growing concern, both for public economy and global health. In fact, it can lead to insidious macrovascular and microvascular complications, impacting negatively on patients' quality of life. Diabetic patients often present diabetic kidney disease (DKD), a burdensome complication that can be silent for years. The average time of onset of kidney impairment in diabetic patients is about 7-10 years. The clinical impact of DKD is dangerous not only for the risk of progression to end-stage renal disease and therefore to renal replacement therapies, but also because of the associated increase in cardiovascular events. An early recognition of risk factors for DKD progression can be decisive in decreasing morbidity and mortality. DKD presents patient-related, clinician-related, and system-related issues. All these problems are translated into therapeutic inertia, which is defined as the failure to initiate or intensify therapy on time according to evidence-based clinical guidelines. Therapeutic inertia can be resolved by a multidisciplinary pool of healthcare experts. The timing of intensification of treatment, the transition to the best therapy, and dietetic strategies must be provided by a multidisciplinary team, driving the patients to the glycemic target and delaying or overcoming DKD-related complications. A timely nephrological evaluation can also guarantee adequate information to choose the right renal replacement therapy at the right time in case of renal impairment progression.


Assuntos
Diabetes Mellitus Tipo 2/fisiopatologia , Diabetes Mellitus Tipo 2/terapia , Nefropatias Diabéticas/fisiopatologia , Nefropatias Diabéticas/terapia , Glicemia , Diabetes Mellitus Tipo 2/epidemiologia , Nefropatias Diabéticas/epidemiologia , Progressão da Doença , Humanos , Rim/fisiopatologia , Falência Renal Crônica/epidemiologia , Falência Renal Crônica/fisiopatologia , Qualidade de Vida , Fatores de Risco
17.
Artigo em Inglês | MEDLINE | ID: mdl-34167953

RESUMO

INTRODUCTION: To assess the cost-effectiveness of a multidisciplinary and comprehensive innovative diabetes care program (CAIPaDi) versus usual treatment in public health institutions. RESEARCH DESIGN AND METHODS: Using a cost-effectiveness analysis, we compared the CAIPaDi program versus usual treatment given in Mexican public health institutions. The analysis was based on the IQVIA Core Diabetes Model, a validated simulation model used to estimate long-term clinical outcomes. Data were prospectively obtained from the CAIPaDi program and from public databases and published papers. Health outcomes were expressed in terms of life-years gained and quality-adjusted life years (QALYs). Health and economic outcomes were estimated from a public perspective and discounted at 5% per year over a 20-year horizon. Costs are reported in US dollars (US$) of 2019. A probabilistic sensitivity analysis was performed using life-years gained and QALYs. RESULTS: The CAIPaDi costs on average US$559 (95% CI: -$879 to -$239) less than the usual treatment (95% CI: -$879 to -$239) and produced a difference in mean life-years gained (0.48, 95% CI: 0.45 to 0.52) and mean QALYs (1.43, 95% CI: 1.40 to 1.46). The cost-effectiveness ratio resulted in a saving per life-year gained of -US$1155 (95% CI: -$1962 to -$460). Mean differences in QALYs resulted in a saving per QALY of -US$735 (95% CI: -$1193 to -$305). Probabilistic sensitivity analysis proved the results are robust on both life-years gained and QALYs. CONCLUSIONS: CAIPaDi has a better cost-effectiveness ratio than the usual therapy in Mexican public health institutions.


Assuntos
Diabetes Mellitus Tipo 2 , Autogestão , Análise Custo-Benefício , Diabetes Mellitus Tipo 2/diagnóstico , Diabetes Mellitus Tipo 2/epidemiologia , Diabetes Mellitus Tipo 2/terapia , Hospitais , Humanos , México/epidemiologia
18.
Artigo em Inglês | MEDLINE | ID: mdl-34064492

RESUMO

BACKGROUND: To test the feasibility of benchmarking the care of women with pregnancies complicated by hyperglycaemia. METHODS: A retrospective audit of volunteer diabetes services in Australia and New Zealand involving singleton pregnancies resulting in live births between 2014 and 2020. Ranges are shown and compared across services. RESULTS: The audit included 10,144 pregnancies (gestational diabetes mellitus (GDM) = 8696; type 1 diabetes (T1D) = 435; type 2 diabetes (T2D) = 1013) from 11 diabetes services. Among women with GDM, diet alone was used in 39.4% (ranging among centres from 28.8-57.3%), metformin alone in 18.8% (0.4-43.7%), and metformin and insulin in 10.1% (1.5-23.4%); when compared between sites, all p < 0.001. Birth was by elective caesarean in 12.1% (3.6-23.7%) or emergency caesarean in 9.5% (3.5-21.2%) (all p < 0.001). Preterm births (<37 weeks) ranged from 3.7% to 9.4% (p < 0.05), large for gestational age 10.3-26.7% (p < 0.001), admission to special care nursery 16.7-25.0% (p < 0.001), and neonatal hypoglycaemia (<2.6 mmol/L) 6.0-27.0% (p < 0.001). Many women with T1D and T2D had limited pregnancy planning including first trimester hyperglycaemia (HbA1c > 6.5% (48 mmol/mol)), 78.4% and 54.6%, respectively (p < 0.001). CONCLUSION: Management of maternal hyperglycaemia and pregnancy outcomes varied significantly. The maintenance and extension of this benchmarking service provides opportunities to identify policy and clinical approaches to improve pregnancy outcomes among women with hyperglycaemia in pregnancy.


Assuntos
Diabetes Mellitus Tipo 2 , Diabetes Gestacional , Adolescente , Adulto , Austrália/epidemiologia , Benchmarking , Criança , Diabetes Mellitus Tipo 2/epidemiologia , Diabetes Mellitus Tipo 2/terapia , Diabetes Gestacional/epidemiologia , Diabetes Gestacional/terapia , Feminino , Humanos , Recém-Nascido , Nova Zelândia/epidemiologia , Gravidez , Resultado da Gravidez/epidemiologia , Estudos Retrospectivos , Adulto Jovem
19.
Artigo em Inglês | MEDLINE | ID: mdl-34069859

RESUMO

The treatment of Type 2 Diabetes Mellitus (DM2) comprises physical activity (PA), diet, and medication. PA provides important benefits for people with diabetes. However, the majority of patients with DM2 do not attain the recommended levels of PA. Despite the evidence of the benefits to health of engaging in PA, the recommendations have not been fully translated into clinical improvements. Using a scoping review, this study aimed to identify the factors that influence levels of physical activity in adults with DM2. Eighteen studies published from 2009-2020 were identified by a search of relevant systematic databases between March 2019 and December 2020. The scoping review was carried out in accordance with the model defined by Arksey and O'Malley. The synthesis revelated sociodemographic characteristics, and six components-personal, motivation, social, mental, clinical, and self-efficacy-were identified as factors. Those that were most frequently identified were motivation and social support. In conclusion, these results should be considered to implement strategies to encourage people with DM2 to engage in physical exercise and thus improve the management of their condition.


Assuntos
Diabetes Mellitus Tipo 2 , Adulto , Diabetes Mellitus Tipo 2/terapia , Dieta , Exercício Físico , Humanos , Motivação , Apoio Social
20.
Rev Med Chil ; 149(1): 37-44, 2021 Jan.
Artigo em Espanhol | MEDLINE | ID: mdl-34106134

RESUMO

BACKGROUND: Among older people, physical exercise improves cognitive function, aerobic fitness, and thus functional independence. AIM: To determine the effects of a walking training program on aerobic fitness and cognitive function in older women with type 2 diabetes mellitus. MATERIAL AND METHODS: An experimental study was carried out in 76 women with type 2 diabetes mellitus aged between 64 and 78 years. Thirty-eight women in the exercise group (EG) participated in a controlled walking program 3 times a week for 48 sessions (60min /day) and 38 women in the control group (CG) were not trained. Weight, height, body mass index (BMI), estimated maximal oxygen uptake (VO2max), and cognitive function using the Minimental test were evaluated at baseline and the end of the intervention. RESULTS: The Minimental test improved significantly in the exercise group and did not change in the control group. Estimated VO-2max improved in women aged between 69 and 78 years. The distance walked in 6 minutes increased in all women of the experimental group. No changes in these parameters were observed in the control group. CONCLUSIONS: A structured walking program improved cognitive function, estimated aerobic capacity, and walking distance in these diabetic women.


Assuntos
Diabetes Mellitus Tipo 2 , Idoso , Cognição , Diabetes Mellitus Tipo 2/terapia , Exercício Físico , Feminino , Humanos , Pessoa de Meia-Idade , Consumo de Oxigênio , Aptidão Física
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