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1.
Diabetes Res Clin Pract ; 142: 110-119, 2018 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-29857092

RESUMO

AIM: We investigated the association of impaired glucose metabolism with tooth loss in adults in the Northern Finland Birth Cohort Study 1966 (NFBC1966). METHODS: We examined 4394 participants from the 46-year follow-up of the NFBC1966. Self-reported number of teeth as well as insulin and glucose values, taken during a standard oral glucose tolerance test (OGTT), served as the primary study variables. A multinomial logistic regression model served to analyse (unadjusted, smoking-adjusted and fully adjusted) the association between number of teeth (0-24, 25-27, 28-32) and glucose metabolism in women and men. RESULTS: Among women, type 2 diabetes - whether previously known or detected during screening - pointed to a higher likelihood of 0-24 teeth (fully adjusted OR = 2.99, 95%CI = 1.54-5.80) and 25-27 teeth (OR = 1.91, 95%CI = 1.18-3.08) than did normal glucose tolerance. Similarly, impaired fasting glucose and impaired glucose tolerance together indicated a higher likelihood of 0-24 teeth (OR = 1.71, 95%CI = 1.09-2.69) than did normal glucose tolerance. A similar, statistically non-significant, pattern emerged among men. Number of teeth associated with OGTT insulin and glucose curves as well as with the Matsuda index in both women and men. CONCLUSIONS: Tooth loss strongly associated with impaired glucose metabolism in middle-aged Finnish women.


Assuntos
Diabetes Mellitus Tipo 2/complicações , Intolerância à Glucose/complicações , Teste de Tolerância a Glucose/efeitos adversos , Estado Pré-Diabético/complicações , Perda de Dente/etiologia , Estudos de Coortes , Estudos Transversais , Feminino , Finlândia , História do Século XX , Humanos , Masculino , Pessoa de Meia-Idade
2.
Diabetes Obes Metab ; 20(2): 352-361, 2018 02.
Artigo em Inglês | MEDLINE | ID: mdl-28776922

RESUMO

AIM: To evaluate the efficacy, pharmacokinetic (PK) profile and tolerability of subcutaneous (s.c.). exendin 9-39 (Ex-9) injection in patients with post-bariatric hypoglycaemia (PBH). METHODS: Nine women who had recurrent symptomatic hypoglycaemia after undergoing Roux-en-Y gastric bypass were enrolled in this 2-part, single-blind, single-ascending-dose study. In Part 1, a single participant underwent equimolar low-dose intravenous (i.v.) vs s.c. Ex-9 administration; in Part 2, 8 participants were administered single ascending doses of s.c. Ex-9 during an oral glucose tolerance test (OGTT). Glycaemic, hormonal, PK and symptomatic responses were compared with those obtained during the baseline OGTT. RESULTS: Although an exposure-response relationship was observed, all doses effectively prevented hyperinsulinaemic hypoglycaemia and improved associated symptoms. On average, the postprandial glucose nadir was increased by 66%, peak insulin was reduced by 57%, and neuroglycopenic symptoms were reduced by 80%. All doses were well tolerated with no treatment-emergent adverse events observed. CONCLUSIONS: Injection s.c. of Ex-9 appears to represent a safe, effective and targeted therapeutic approach for treatment of PBH. Further investigation involving multiple doses with chronic dosing is warranted.


Assuntos
Derivação Gástrica/efeitos adversos , Receptor do Peptídeo Semelhante ao Glucagon 1/antagonistas & inibidores , Hiperinsulinismo/prevenção & controle , Hipoglicemia/prevenção & controle , Hipoglicemiantes/administração & dosagem , Fragmentos de Peptídeos/administração & dosagem , Complicações Pós-Operatórias/prevenção & controle , Adulto , Área Sob a Curva , Estudos de Coortes , Relação Dose-Resposta a Droga , Feminino , Receptor do Peptídeo Semelhante ao Glucagon 1/metabolismo , Teste de Tolerância a Glucose/efeitos adversos , Meia-Vida , Humanos , Hiperinsulinismo/sangue , Hiperinsulinismo/etiologia , Hiperinsulinismo/metabolismo , Hipoglicemia/sangue , Hipoglicemia/etiologia , Hipoglicemia/metabolismo , Hipoglicemiantes/efeitos adversos , Hipoglicemiantes/farmacocinética , Hipoglicemiantes/uso terapêutico , Infusões Intravenosas , Injeções Subcutâneas , Insulina/sangue , Pessoa de Meia-Idade , Fragmentos de Peptídeos/efeitos adversos , Fragmentos de Peptídeos/farmacocinética , Fragmentos de Peptídeos/uso terapêutico , Projetos Piloto , Complicações Pós-Operatórias/sangue , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/metabolismo , Período Pós-Prandial , Método Simples-Cego
3.
Physiol Res ; 66(6): 993-999, 2017 12 20.
Artigo em Inglês | MEDLINE | ID: mdl-28937255

RESUMO

A personalized antidiabetic therapy is not yet part of the official guidelines of professional societies for clinical practice. The aim of this study was to evaluate the serum C-peptide and plasma glucose levels in patients with type 2 diabetes mellitus (T2DM) after oral administration of whey proteins. Sixteen overweight T2DM Caucasians with good glycemic control and with preserved fasting serum C-peptide levels (>200 nmol/l) were enrolled in this study. Two oral stimulation tests - one with 75 g of glucose (OGTT) and the other with 75 g of whey proteins (OWIST) - were administered for assessing serum C-peptide and plasma glucose levels in each participant. Both oral tests induced similar pattern of C-peptide secretion, with a peak at 90 min. The serum C-peptide peak concentration was 2.91+/-0.27 nmol/l in OWIST, which was 22 % lower than in OGTT. Similarly, the C-peptide iAUC(0-180) were 32 % lower in the OWIST than in the OGTT (p<0.01). Contrary to OGTT the OWIST did not cause a significant increase of glycemia (p<0.01). Our study showed that the OWIST represents a useful tool in estimation of stimulated serum C-peptide levels in patients with T2DM.


Assuntos
Glicemia/metabolismo , Peptídeo C/sangue , Diabetes Mellitus Tipo 2/diagnóstico , Teste de Tolerância a Glucose , Proteínas do Soro do Leite/administração & dosagem , Administração Oral , Idoso , Idoso de 80 Anos ou mais , Biomarcadores/sangue , Estudos Cross-Over , República Tcheca , Diabetes Mellitus Tipo 2/sangue , Diabetes Mellitus Tipo 2/terapia , Feminino , Teste de Tolerância a Glucose/efeitos adversos , Humanos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Fatores de Tempo , Proteínas do Soro do Leite/efeitos adversos
4.
Cochrane Database Syst Rev ; 8: CD007222, 2017 08 03.
Artigo em Inglês | MEDLINE | ID: mdl-28771289

RESUMO

BACKGROUND: Gestational diabetes mellitus (GDM) is a form of diabetes that occurs in pregnancy. Although GDM usually resolves following birth, it is associated with significant morbidities for mothers and their infants in the short and long term. There is strong evidence to support treatment for GDM. However, there is uncertainty as to whether or not screening all pregnant women for GDM will improve maternal and infant health and if so, the most appropriate setting for screening. This review updates a Cochrane Review, first published in 2010, and subsequently updated in 2014. OBJECTIVES: To assess the effects of screening for gestational diabetes mellitus based on different risk profiles and settings on maternal and infant outcomes. SEARCH METHODS: We searched Cochrane Pregnancy and Childbirth's Trials Register (31 January 2017), ClinicalTrials.gov, the WHO International Clinical Trials Registry Platform (ICTRP) (14 June 2017), and reference lists of retrieved studies. SELECTION CRITERIA: We included randomised and quasi-randomised trials evaluating the effects of different protocols, guidelines or programmes for screening for GDM based on different risk profiles and settings, compared with the absence of screening, or compared with other protocols, guidelines or programmes for screening. We planned to include trials published as abstracts only and cluster-randomised trials, but we did not identify any. Cross-over trials are not eligible for inclusion in this review. DATA COLLECTION AND ANALYSIS: Two review authors independently assessed study eligibility, extracted data and assessed the risk of bias of the included trials. We resolved disagreements through discussion or through consulting a third reviewer. MAIN RESULTS: We included two trials that randomised 4523 women and their infants. Both trials were conducted in Ireland. One trial (which quasi-randomised 3742 women, and analysed 3152 women) compared universal screening versus risk factor-based screening, and one trial (which randomised 781 women, and analysed 690 women) compared primary care screening versus secondary care screening. We were not able to perform meta-analyses due to the different interventions and comparisons assessed.Overall, there was moderate to high risk of bias due to one trial being quasi-randomised, inadequate blinding, and incomplete outcome data in both trials. We used GRADEpro GDT software to assess the quality of the evidence for selected outcomes for the mother and her child. Evidence was downgraded for study design limitations and imprecision of effect estimates. Universal screening versus risk-factor screening (one trial) MotherMore women were diagnosed with GDM in the universal screening group than in the risk-factor screening group (risk ratio (RR) 1.85, 95% confidence interval (CI) 1.12 to 3.04; participants = 3152; low-quality evidence). There were no data reported under this comparison for other maternal outcomes including hypertensive disorders of pregnancy, caesarean birth, perineal trauma, gestational weight gain, postnatal depression, and type 2 diabetes. ChildNeonatal outcomes: large-for-gestational age, perinatal mortality, mortality or morbidity composite, hypoglycaemia; and childhood/adulthood outcomes: adiposity, type 2 diabetes, and neurosensory disability, were not reported under this comparison. Primary care screening versus secondary care screening (one trial) MotherThere was no clear difference between the primary care and secondary care screening groups for GDM (RR 0.91, 95% CI 0.50 to 1.66; participants = 690; low-quality evidence), hypertension (RR 1.41, 95% CI 0.77 to 2.59; participants = 690; low-quality evidence), pre-eclampsia (RR 0.80, 95% CI 0.36 to 1.78; participants = 690;low-quality evidence), or caesarean section birth (RR 1.00, 95% CI 0.80 to 1.27; participants = 690; low-quality evidence). There were no data reported for perineal trauma, gestational weight gain, postnatal depression, or type 2 diabetes. ChildThere was no clear difference between the primary care and secondary care screening groups for large-for-gestational age (RR 1.37, 95% CI 0.96 to 1.96; participants = 690; low-quality evidence), neonatal complications: composite outcome, including: hypoglycaemia, respiratory distress, need for phototherapy, birth trauma, shoulder dystocia, five minute Apgar less than seven at one or five minutes, prematurity (RR 0.99, 95% CI 0.57 to 1.71; participants = 690; low-quality evidence), or neonatal hypoglycaemia (RR 1.10, 95% CI 0.28 to 4.38; participants = 690; very low-quality evidence). There was one perinatal death in the primary care screening group and two in the secondary care screening group (RR 1.10, 95% CI 0.10 to 12.12; participants = 690; very low-quality evidence). There were no data for neurosensory disability, or childhood/adulthood adiposity or type 2 diabetes. AUTHORS' CONCLUSIONS: There are insufficient randomised controlled trial data evaluating the effects of screening for GDM based on different risk profiles and settings on maternal and infant outcomes. Low-quality evidence suggests universal screening compared with risk factor-based screening leads to more women being diagnosed with GDM. Low to very low-quality evidence suggests no clear differences between primary care and secondary care screening, for outcomes: GDM, hypertension, pre-eclampsia, caesarean birth, large-for-gestational age, neonatal complications composite, and hypoglycaemia.Further, high-quality randomised controlled trials are needed to assess the value of screening for GDM, which may compare different protocols, guidelines or programmes for screening (based on different risk profiles and settings), with the absence of screening, or with other protocols, guidelines or programmes. There is a need for future trials to be sufficiently powered to detect important differences in short- and long-term maternal and infant outcomes, such as those important outcomes pre-specified in this review. As only a proportion of women will be diagnosed with GDM in these trials, large sample sizes may be required.


Assuntos
Diabetes Gestacional/diagnóstico , Teste de Tolerância a Glucose/métodos , Programas de Rastreamento/métodos , Diabetes Gestacional/terapia , Feminino , Teste de Tolerância a Glucose/efeitos adversos , Humanos , Bem-Estar do Lactente , Recém-Nascido , Bem-Estar Materno , Gravidez , Resultado da Gravidez , Ensaios Clínicos Controlados Aleatórios como Assunto
5.
J Pediatr Endocrinol Metab ; 30(5): 525-530, 2017 May 01.
Artigo em Inglês | MEDLINE | ID: mdl-28328533

RESUMO

BACKGROUND: Little is known regarding the relationships among circulating brain-derived neurotrophic factor (BDNF) levels and glucose or insulin in children and adolescents. The objective of this study was to investigate whether circulating BDNF levels would change during the oral glucose tolerance test (OGTT). METHODS: We performed the OGTT and measured the serial changes in BDNF levels in both plasma and serum. RESULTS: There were 22 subjects in the normal type (N) group and 20 in the borderline/diabetic type (B/D) group, defined by the results of the OGTT. Serum levels of BDNF were almost five times higher and plasma levels gradually decreased during the OGTT, whereas serum levels showed no significant change. The reduction of plasma BDNF level changes from baseline to 120 min were significantly different between the N and B/D groups (36.3% vs. 20.8%, p=0.023). CONCLUSIONS: Our results showed that plasma levels of BDNF are more sensitive to acute changes in glucose or insulin levels than serum.


Assuntos
Biomarcadores/sangue , Fator Neurotrófico Derivado do Encéfalo/sangue , Diabetes Mellitus Tipo 2/fisiopatologia , Teste de Tolerância a Glucose/efeitos adversos , Hiperglicemia/etiologia , Adolescente , Glicemia/análise , Criança , Pré-Escolar , Diabetes Mellitus Tipo 2/complicações , Feminino , Humanos , Insulina/sangue , Masculino
8.
Med Sci Monit ; 22: 2602-7, 2016 Jul 22.
Artigo em Inglês | MEDLINE | ID: mdl-27447783

RESUMO

BACKGROUND It is well known that enteral nutrients result in acute suppression of bone turnover markers (BTMs), and incretin hormones are believed to play a significant role in this physiological skeletal response. However, there is limited research exploring the impact of parenteral nutrients on BTMs. Our aim was to assess the influence of intravenous glucose on BTMs in adults with normal glucose tolerance (NGT). MATERIAL AND METHODS We conducted 1-h intravenous glucose tolerance test (IVGTT) in 24 subjects with NGT. Blood samples were collected before and 5, 10, 15, 20, 30, 60 min after administration of glucose, then serum levels of bone formation marker procollagen type I N-terminal propeptide (P1NP) and resorption marker C-terminal cross-linking telopeptides of collagen type I (CTX) were measured. RESULTS During IVGTT, the fasting CTX level fell gradually and reached a nadir of 80.4% of the basal value at 60 min. Conversely, the fasting P1NP level decreased mildly and reached a nadir of 90.6% of the basal value at 15 min, then gradually increased and reached 96.6% at 60 min. The CTX-to-P1NP ratio increased slightly and reached a peak of 104.3% of the basal value at 10 min, then fell gradually and reached a nadir of 83% at 60 min. CONCLUSIONS Our study indicates that intravenous glucose results in an acute suppression of BTMs in the absence of incretin hormones. The mechanism responsible for this needs further investigation.


Assuntos
Remodelação Óssea/fisiologia , Teste de Tolerância a Glucose/métodos , Adulto , Biomarcadores/sangue , Glicemia/metabolismo , Colágeno Tipo I/sangue , Feminino , Glucose/metabolismo , Teste de Tolerância a Glucose/efeitos adversos , Voluntários Saudáveis , Humanos , Incretinas/metabolismo , Masculino , Osteocalcina/sangue , Fragmentos de Peptídeos/sangue , Pró-Colágeno/sangue
9.
Arch Endocrinol Metab ; 60(4): 307-13, 2016 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-26910630

RESUMO

OBJECTIVE: The oral glucose tolerance test (OGTT) is used in the screening of gestational diabetes, in diagnosis of type 2 diabetes in conjunction with fasting blood glucose and glycated hemoglobin. The aim of this study was to examine the incidence and risk factors of adverse effects of OGTT in patients who underwent bariatric surgery, in addition to proposing standardization for ordering the OGTT in these patients. SUBJECTS AND METHODS: This study assessed the incidence of adverse effects in 128 post-bariatric surgery patients who underwent the OGTT. Descriptive and logistic regression analysis were performed, the dependent variables were defined as the presence of signs (tremor, profuse sweating, tachycardia), symptoms (nausea, diarrhea, dizziness, weakness), and hypoglycemia (blood glucose ≤ 50 mg/dL). RESULTS: One hundred and seventeen participants (91.4%) were female; 38 (29.7%) participants were pregnant. High incidence (64.8%) of adverse effects was observed: nausea (38.4%), dizziness (30.5%), weakness (25.8%), diarrhea (23.4%), hypoglycemia (14.8%), tachycardia (14.1%), tremor (13.3%), profuse sweating (12.5%) and one case of severe hypoglycemia (24 mg/dL). The presence of signs was associated with hypoglycemia (OR = 8.1, CI 95% 2.6-25.1). The arterial hypertension persisted as a risk factor for the incidence of signs (OR = 3.6, CI 95% 1.2-11.3). Fasting glucose below 75 mg/dL increased the risk of hypoglycemia during the test (OR = 9.5, CI 95% 2.6-35.1). CONCLUSION: In this study, high incidence of adverse effects during the OGTT was observed in post-bariatric surgery patients. If these results are confirmed by further studies, the indication and regulation of the OGTT procedure must be reviewed for these patients.


Assuntos
Cirurgia Bariátrica/efeitos adversos , Teste de Tolerância a Glucose/efeitos adversos , Hipoglicemia/epidemiologia , Hipoglicemia/etiologia , Adulto , Glicemia/análise , Brasil/epidemiologia , Depressão/epidemiologia , Depressão/etiologia , Diabetes Mellitus Tipo 2/diagnóstico , Diabetes Gestacional/diagnóstico , Dislipidemias/epidemiologia , Dislipidemias/etiologia , Jejum/sangue , Feminino , Humanos , Hipertensão/epidemiologia , Hipertensão/etiologia , Hipotireoidismo/epidemiologia , Hipotireoidismo/etiologia , Incidência , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Período Pós-Operatório , Gravidez , Fatores de Risco , Fatores de Tempo
10.
J Clin Endocrinol Metab ; 100(8): 2987-95, 2015 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-26079776

RESUMO

CONTEXT: Hyperglucagonemia is a characteristic feature of type 2 diabetes (T2DM) that has been postulated to be due to ß-cell dysfunction and the resultant loss of insulin-mediated α-cell suppression. When administered in early T2DM, short-term intensive insulin therapy (IIT) can improve ß-cell function, resulting in reduced glycemic variability. OBJECTIVE: To evaluate the impact of IIT on hyperglucagonemia and its associations with ß-cell function and glycemic variability. Design/Setting/Participants/Intervention: Sixty-two patients with T2DM of mean 3.0 ± 2.1 years duration and glycated hemoglobin of 6.8 ± 0.7% underwent 4 weeks of IIT, consisting of basal detemir and premeal insulin aspart. MAIN OUTCOME MEASURES: Glucagon response was measured by area under the glucagon curve (AUCglucagon) on oral glucose tolerance test at baseline and 1 day post-IIT. ß-Cell function before and after IIT was assessed by Insulin Secretion-Sensitivity Index-2 and ΔISR0-120/Δglucose0-120*Matsuda index (where ISR is the prehepatic insulin secretion rate determined by C-peptide deconvolution). Glucose variability was assessed in both the first and last weeks by the coefficient of variation of capillary glucose on daily six-point self-monitoring profiles. RESULTS: Both Insulin Secretion-Sensitivity Index-2 and ΔISR0-120/Δglucose0-120*Matsuda index demonstrated improvement in ß-cell function after IIT (both P ≤ .02), accompanied by reduced glycemic variability (P = .05). There was a marked reduction in AUCglucagon after IIT, as compared to baseline (P < .001). However, the decrease in AUCglucagon was not associated with the change in either ß-cell measure (both P ≥ .34) or glucose variability (P = .37). CONCLUSIONS: Short-term IIT can reduce post-challenge hyperglucagonemia in early T2DM, but this effect does not appear to be due to improved ß-cell function.


Assuntos
Diabetes Mellitus Tipo 2/tratamento farmacológico , Glucagon/sangue , Hipoglicemiantes/farmacologia , Insulina de Ação Prolongada/farmacologia , Insulina Regular Humana/farmacologia , Pancreatopatias/prevenção & controle , Adulto , Idoso , Glicemia/efeitos dos fármacos , Glicemia/metabolismo , Diabetes Mellitus Tipo 2/sangue , Feminino , Teste de Tolerância a Glucose/efeitos adversos , Hemoglobina A Glicada/metabolismo , Humanos , Hipoglicemiantes/administração & dosagem , Insulina Detemir , Insulina de Ação Prolongada/administração & dosagem , Insulina Regular Humana/administração & dosagem , Masculino , Pessoa de Meia-Idade , Pancreatopatias/sangue , Pancreatopatias/induzido quimicamente , Regulação para Cima
11.
Endocrine ; 48(1): 329-33, 2015 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-24833548

RESUMO

The purpose of this study was to evaluate the safety of the oral glucose tolerance test (OGTT) and its capacity to suppress growth hormone (GH) in diabetic patients without acromegaly. A total of 135 diabetic patients submitted to the OGTT for GH suppression were studied. The following selection criteria were applied: age between 20 and 70 years; body mass index≥18.5 and ≤27 kg/m2; absence of kidney, liver, or thyroid disease; no use of estrogens, androgens, corticosteroids, or levothyroxine. Adequate suppression of GH was defined as a nadir below the cut-off established for a sample of 200 normoglycemic subjects (<0.25 µg/L for men, <0.74 µg/L for premenopausal women, and <0.5 µg/L for postmenopausal women). Acromegaly was diagnosed in five patients. Among the 130 diabetic patients without known pituitary disease or a clinical suspicion of acromegaly, 95.5% of men, 94% of premenopausal women, and 96.6% of postmenopausal women presented adequate GH suppression (vs 97.5% of normoglycemic controls). In all patients without acromegaly, the lowest GH levels (nadir) were achieved after the administration of glucose and not during baseline measurement. None of the patients had acute complications [ketoacidosis, hyperosmolar state, and symptomatic marked hyperglycemia (>300 mg/dL)] on the day of the test and up to 3 days thereafter. We demonstrated the safety of the OGTT and its capacity to suppress GH in diabetic patients without acromegaly. In addition, we suggest the adoption of a protocol to prevent possible risks of the OGTT in patients with diabetes.


Assuntos
Diabetes Mellitus/diagnóstico , Teste de Tolerância a Glucose/efeitos adversos , Teste de Tolerância a Glucose/métodos , Hormônio do Crescimento Humano/antagonistas & inibidores , Acromegalia/induzido quimicamente , Acromegalia/complicações , Adulto , Idoso , Glicemia/metabolismo , Feminino , Hemoglobina A Glicada/análise , Hormônio do Crescimento Humano/sangue , Humanos , Fator de Crescimento Insulin-Like I/metabolismo , Masculino , Pessoa de Meia-Idade , Padrões de Referência , Adulto Jovem
12.
Cochrane Database Syst Rev ; (2): CD007222, 2014 Feb 11.
Artigo em Inglês | MEDLINE | ID: mdl-24515533

RESUMO

BACKGROUND: Gestational diabetes mellitus (GDM) is a form of diabetes that occurs in pregnancy. Although GDM usually resolves following birth, it is associated with significant morbidities for mother and baby both perinatally and in the long term. There is strong evidence to support treatment for GDM. However, there is little consensus on whether or not screening for GDM will improve maternal and infant health and if so, the most appropriate protocol to follow. OBJECTIVES: To assess the effects of different methods of screening for GDM and maternal and infant outcomes. SEARCH METHODS: We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (1 December 2013). SELECTION CRITERIA: Randomised and quasi-randomised trials evaluating the effects of different methods of screening for GDM. DATA COLLECTION AND ANALYSIS: Two review authors independently conducted data extraction and quality assessment. We resolved disagreements through discussion or through a third author. MAIN RESULTS: We included four trials involving 3972 women in the review. One quasi-randomised trial compared risk factor screening with universal or routine screening by 50 g oral glucose challenge testing. Women in the universal screening group were more likely to be diagnosed with GDM (one trial, 3152 women, risk ratio (RR) 0.44, 95% confidence interval (CI) 0.26 to 0.75). This trial did not report on the other primary outcomes of the review (positive screen for GDM, mode of birth, large-for-gestational age, or macrosomia). Considering secondary outcomes, infants of mothers in the risk factor screening group were born marginally earlier than infants of mothers in the routine screening group (one trial, 3152 women, mean difference (MD) -0.15 weeks, 95% CI -0.27 to -0.03).The remaining three trials evaluated different methods of administering a 50 g glucose load. Two small trials compared glucose monomer with glucose polymer testing, with one of these trials including a candy bar group. One trial compared a glucose solution with food. No differences in diagnosis of GDM were found between each comparison. However, in one trial significantly more women in the glucose monomer group screened positive for GDM than women in the candy bar group (80 women, RR 3.49, 95% CI 1.05 to 11.57). The three trials did not report on the primary review outcomes of mode of birth, large-for-gestational age or macrosomia. Overall, women drinking the glucose monomer experienced fewer side effects from testing than women drinking the glucose polymer (two trials, 151 women, RR 2.80, 95% CI 1.10 to 7.13). However, we observed substantial heterogeneity between the trials for this result (I² = 61%). AUTHORS' CONCLUSIONS: There was insufficient evidence to determine if screening for gestational diabetes, or what types of screening, can improve maternal and infant health outcomes.


Assuntos
Diabetes Gestacional/diagnóstico , Teste de Tolerância a Glucose/métodos , Programas de Rastreamento/métodos , Diabetes Gestacional/terapia , Feminino , Teste de Tolerância a Glucose/efeitos adversos , Humanos , Bem-Estar do Lactente , Recém-Nascido , Bem-Estar Materno , Gravidez , Resultado da Gravidez , Ensaios Clínicos Controlados Aleatórios como Assunto
14.
Rev. cuba. med. mil ; 41(4)oct.-dic. 2012.
Artigo em Espanhol | CUMED | ID: cum-67468

RESUMO

Introducción: el comienzo de la diabetes mellitus tipo 2 precede en varios años el diagnóstico clínico, y está relacionado con algunos factores de riesgo aterogénicos y con la historia familiar de la enfermedad. Objetivo: identificar la presencia y evolución de dichos factores y las alteraciones del metabolismo glucídico en familiares de pacientes diabéticos. Métodos: estudio de cohorte en 113 sujetos, familiares de primer y de segundo grado de pacientes que padecen diabetes tipo 2 y que no presentaban alteraciones conocidas del metabolismo glucídico. Se midió semestralmente la tensión arterial, índice de masa corporal, lipidograma, glucemias (ayunas y posprandial), insulinemia e insulinorresistencia.Resultados: se encontraron valores medios elevados de índice de masa corporal, tensión arterial y lípidos, los cuales se incrementaron de forma evolutiva. Se diagnosticaron 90 nuevos pacientes con alteraciones de este metabolismo y se observó un deterioro progresivo del metabolismo glucídico, la insulinorresistencia y la insulinosecreción. Conclusiones: los familiares de primer y de segundo grado de pacientes diabéticos tipo 2 tienen una alta prevalencia de factores de riesgo aterogénicos, y evolucionan hacia el deterioro progresivo de estos y de la homeostasis glucídica(AU)


Introduction: the onset of type-2 diabetes mellitus proceeds several years from the clinical diagnosis and it is associated with atherogenic risk factors and family history of this disease. Objective: to identify the presence and evolution of such factors, and carbohydrate metabolism disorders in relatives of diabetic patients. Methods: a cohort study in 113 subjects, first-and second-degree relatives of patients who have type-2 diabetes and who had no known disorders of glucose metabolism. Twice a year, blood pressure, body mass index, lipid profile, blood glucose (fasting and postprandial), insulin and insulin resistance were measured. Results: high mean values were found for body mass index, blood pressure and lipids, which increased in an evolutionary form. 90 new patients were diagnosed with disorders of this metabolism and a progressive deterioration of glucose metabolism; insulin resistance and insulin secretion were showed. Conclusions: the first-and second-degree relatives of patients with type-2 diabetes have a high prevalence of atherogenic risk factors, and they evolve into progressive deterioration of these factors and glucose homeostasis(AU)


Assuntos
Humanos , Diabetes Mellitus Tipo 2/diagnóstico , Diabetes Mellitus Tipo 2/epidemiologia , Fatores de Risco , Resistência à Insulina , Teste de Tolerância a Glucose/efeitos adversos , Estudos de Coortes
15.
Clin Pharmacol Ther ; 92(1): 29-39, 2012 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-22669289

RESUMO

G-protein-coupled receptor 40 (GPR40), highly expressed in pancreatic ß-cells, mediates free fatty acid (FFA)-induced insulin secretion. This phase I, double-blind, randomized study investigated the safety, tolerability, pharmacokinetics (PK), and pharmacodynamics (PD) of a novel, glucose-lowering GPR40 agonist, TAK-875 (q.d., orally × 14 days), in type 2 diabetics (placebo, n = 14; at 25, 50, 100, 200, or 400 mg, n = 45). Approximately dose-proportional increases in AUC(0-24) and C(max) occurred. TAK-875 showed good tolerability with no dose-limiting side effects. Two subjects (on TAK-875) had mild hypoglycemia, probably related to prolonged fasting after oral glucose tolerance tests (OGTTs). TAK-875 showed reductions from baseline in fasting (2 to -93 mg/dl) and post-OGTT glucose (26 to -172 mg/dl), with an apparent dose-dependent increase in post-OGTT C-peptide over 14 days. Consistent with preclinical data, TAK-875 apparently acts as a glucose-dependent insulinotropic agent with low hypoglycemic risk. Its PK is suitable for once-daily oral administration.


Assuntos
Benzofuranos , Diabetes Mellitus Tipo 2/tratamento farmacológico , Receptores Acoplados a Proteínas-G/metabolismo , Sulfonas , Administração Oral , Benzofuranos/administração & dosagem , Benzofuranos/farmacologia , Disponibilidade Biológica , Glicemia/metabolismo , Peptídeo C/metabolismo , Diabetes Mellitus Tipo 2/metabolismo , Relação Dose-Resposta a Droga , Método Duplo-Cego , Ácidos Graxos não Esterificados/metabolismo , Teste de Tolerância a Glucose/efeitos adversos , Teste de Tolerância a Glucose/métodos , Humanos , Hipoglicemiantes/administração & dosagem , Hipoglicemiantes/farmacocinética , Insulina/metabolismo , Insulina/farmacocinética , Secreção de Insulina , Células Secretoras de Insulina/metabolismo , Sulfonas/administração & dosagem , Sulfonas/farmacologia , Resultado do Tratamento
16.
Rev. cuba. pediatr ; 84(1): 1-10, ene.-mar. 2012.
Artigo em Espanhol | CUMED | ID: cum-66062

RESUMO

Introducción: la obesidad se considera actualmente una epidemia en aumento a escala mundial. El fenómeno afecta a niños y adultos, y se asocia con la aparición precoz de enfermedades crónicas no trasmisibles que antes parecían exclusivas de los adultos, pero que se pueden presentar, incluso, en edades tempranas de la vida. Objetivo: identificar alteraciones clínicas y metabólicas en pacientes obesos y su asociación con la acantosis nigricans. Métodos: se realizó un estudio longitudinal prospectivo con 60 pacientes diagnosticados con obesidad exógena, con o sin acantosis nigricans, en el período comprendido de enero de 2009 a enero de 2010 en el servicio de endocrinología del Hospital Docente William Soler . Se les realizó, además de anamnesis y examen físico, prueba de tolerancia a la glucosa, con determinación de glucemia e insulinemia en ayunas y a las 2 horas, determinación de colesterol, triglicéridos y ultrasonido del hígado. Resultados: el 55 por ciento de los pacientes estudiados presentaban acantosis nigricans. La hipertensión arterial (18,2 por ciento), así como el hiperinsulinismo (21,2 por ciento), predominaron en este grupo de pacientes. La prueba de tolerancia a la glucosa alterada (6 por ciento), las alteraciones de los lípidos (27,2 por ciento) y la esteatosis hepática (39 por ciento) predominaron en los pacientes obesos con acantosis nigricans. Conclusiones: la obesidad en edad pediátrica puede constituir un riesgo elevado de sufrir complicaciones metabólicas, sobre todo, en el obeso con acantosis nigricans(AU)


Introduction: nowadays, obesity is considered a worldwide increasing epidemic. This phenomenon involves children and adults and it is associated with the early appearance of non-communicable chronic diseases that in the past were exclusive of adults, but that may be present in early ages of life. Objective: to identify the clinical and metabolic alterations in obese patients and its association with acanthosis nigricans. Methods: a prospective and longitudinal study was conducted in 60 patients diagnosed with exogenous obesity with or without acanthosis nigricans from January, 2009 to January, 2010 in the endocrinology services of the William Soler Teaching Children Hospital. Authors also carried out anamnesis and physical examination, glucose tolerance test, with fasting glycemia and insulinemia determination and at two hours, cholesterol determination, triglycerides and liver ultrasound. Results: the 55 percent of study patients had acanthosis nigricans. In this group of patients there was predominance of high blood pressure (18.2 percent), as well as the hyperinsulinism (21.2 percent). Altered glucose tolerance test (6 percent), lipid alterations (27.2 percent) and hepatic steatosis predominated in the obese patients presenting with acanthosis nigricans. Conclusions: obesity in pediatric age may be a high risk to suffer metabolic complications, mainly in the obese patient with acanthosis nigricans(AU)


Assuntos
Humanos , Criança , Adolescente , Obesidade Pediátrica/diagnóstico , Acantose Nigricans/complicações , Teste de Tolerância a Glucose/efeitos adversos , Interpretação Estatística de Dados , Estudos Prospectivos , Estudos Longitudinais
19.
J Pediatr Endocrinol Metab ; 24(1-2): 55-9, 2011.
Artigo em Inglês | MEDLINE | ID: mdl-21528816

RESUMO

AIM: The aim of the study was to investigate the association between PPAR-gamma2 Pro12Ala polymorphism and laboratory characteristics of carbohydrate metabolism in children and adolescents with obesity. In addition, serum levels of tumor necrosis factor (TNF)-alpha, and soluble form of its receptors (sTNFR1 and sTNFR2) were assessed. METHODS: In a cross-sectional study, 79 obese children and adolescents of Caucasian origin were investigated. PPAR-gamma2 Pro12Ala polymorphism was determined using polymerase chain reaction--restriction fragment length polymorphism technique. Serum levels of TNF-alpha, sTNFR1 and sTNFR2 were measured by enzyme amplified sensitivity immunoassay. RESULTS: The minor Ala allele frequency was found to be 14.56% in our cohort. No significant differences in age, BMI, waist circumference, blood pressure, serum lipid, uric acid, TNF-alpha, sTNFR1 and sTNFR2 values were found between carriers of the Ala allele (Pro/Ala and Ala/Ala; n=21) vs. homozygous carriers of the Pro allele (Pro/Pro; n=58). However, post-challenge (120 min) plasma glucose and insulin values were significantly lower in Ala allele carriers vs. homozygous Pro allele carriers (6.56 +/- 0.26 vs. 7.36 +/- 0.25 mmol/L and 65.9 +/- 13.8 vs. 111.8 +/- 20.7 microU/mL, respectively; p < 0.05); while no significant differences were found at fasting state. CONCLUSIONS: The association between PPAR-gamma2 Prol2Ala polymorphism and glucose metabolism is already present in children and adolescents with obesity who might be at the very beginning of the natural course of type 2 diabetes. At this stage, higher insulin sensitivity can be detected in Ala allele carriers compared to homozygous Pro subjects at post-challenge but not in fasting state; however, the TNF-system seems not to be involved in the alteration of glucose homeostasis due to PPAR-gamma2 Pro12Ala polymorphism.


Assuntos
Transtornos do Metabolismo de Glucose/genética , Glucose/metabolismo , Obesidade/genética , Obesidade/metabolismo , PPAR gama/genética , Polimorfismo de Nucleotídeo Único , Adolescente , Alanina/genética , Substituição de Aminoácidos/genética , Substituição de Aminoácidos/fisiologia , Criança , Estudos de Coortes , Diabetes Mellitus Tipo 2/complicações , Diabetes Mellitus Tipo 2/genética , Diabetes Mellitus Tipo 2/metabolismo , Feminino , Predisposição Genética para Doença , Glucose/fisiologia , Transtornos do Metabolismo de Glucose/complicações , Teste de Tolerância a Glucose/efeitos adversos , Homeostase/genética , Homeostase/fisiologia , Humanos , Masculino , Obesidade/sangue , Obesidade/complicações , Polimorfismo de Nucleotídeo Único/fisiologia , Prolina/genética
20.
Rev. cuba. endocrinol ; 22(1)ene.-abr. 2011.
Artigo em Espanhol | LILACS | ID: lil-615030

RESUMO

Actualmente se define la PD como la situación de riesgo de padecer DM 2 y complicaciones vasculares en las personas con tolerancia a la glucosa alterada (TGA) o glicemia en ayunas alterada (GAA). Se conoce que en la progresión de la PD hacia la DM 2 ocurren paralelamente cambios de la TG, de la sensibilidad a la insulina, modificaciones de los patrones de secreción de esta hormona ante los cambios de los niveles de la glucosa en el plasma, trastornos tisulares y fenómenos aterogénicos y trombogénicos, que dependen de estos trastornos. Las intervenciones para la prevención de la DM no deben dirigirse solamente a las personas con hiperglucemia en ayunas o posprandial, pues la heterogeneidad del cuadro clínico y metabólico de esta etapa obliga a ampliar la exploración a toda la población con factores personales o antecedentes familiares que potencialmente lo colocan en una situación de riesgo


Assuntos
Humanos , Fatores de Risco , Teste de Tolerância a Glucose/efeitos adversos , /prevenção & controle , Estado Pré-Diabético/fisiopatologia , Doenças Cardiovasculares/epidemiologia , Síndrome Metabólica/etiologia , Diabetes Mellitus Tipo 2/complicações
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