Plasma Carotenoids and Onset of Dysglycemia in an Elderly Population: Results of the Epidemiology of Vascular Ageing Study

OBJECTIVE—The hypothesis of carotenoid having a preventive role in diabetes is suggested by their antioxidant properties. In this report, we investigated the relationship between baseline total plasma carotenoid levels and 9-year onset of dysglycemia (impaired fasting glucose or type 2 diabetes) in a healthy elderly population

Análise de custos da assistência à saúde aos portadores de diabetes melito e hipertensão arterial em uma unidade de saúde pública de referência em Recife - Brasil = Analysis of health care costs of patients with diabetes mellitus and hypertension in a public health reference unit in Recife - Brazil

Objective: To analyze health care costs of patients with diabetes mellitus and hypertension, and to estimate the cost of medium complexity outpatient procedures, compared with the standard reimbursement values used in Brazil. Materials and methods: We analyzed direct health costs in a public health reference unit in Recife/PE, in 2007. Costs were determined and allocated using the techniques of absorption costing and apportionment. Results: Direct costs and the amount reimbursed by the SUS totaled R$4,855,291.82 and R$ 2.118.893,56, respectively. The greatest groups of expenditure were medications, with R$1,762,424.42 (36.3$ 996,637.82 (20.5%); and personnel, with R$ 978,096.10 (20.1%). All procedures had higher estimated costs than what is reimbursed by the SUS. Conclusions: Drugs were associated with the highest health care costs, a considerable difference was observed between estimated costs and the amount reimbursed by the SUS. Arq Bras Endocrinol Metab. 2011;55(6):406-1

Analysis of access to hypertensive and diabetic drugs in the Family Health Strategy, State of Pernambuco, Brazil

OBJECTIVE: To evaluate the access to drugs for hypertension and diabetes and the direct cost of buying them among users of the Family Health Strategy (FHS) in the state of Pernambuco, Brazil. METHODS: Population-based, cross-sectional study of a systematic random sample of 785 patients with hypertension and 823 patients with diabetes mellitus who were registered in 208 randomly selected FHS teams in 35 municipalities of the state of Pernambuco. The selected municipalities were classified into three levels with probability proportional to municipality size (LS, large-sized; MS, medium-sized; SS, small-sized). To verify differences between the cities, we used the χ2 test. RESULTS: Pharmacological treatment was used by 91.2% patients with hypertension whereas 85.6% patients with diabetes mellitus used oral antidiabetic drugs (OADs), and 15.4% used insulin. The FHS team itself provided antihypertensive medications to 69.0% patients with hypertension, OADs to 75.0% patients with diabetes mellitus, and insulin treatment to 65.4%. The 36.9% patients with hypertension and 29.8% with diabetes mellitus that had to buy all or part of their medications reported median monthly cost of R$18.30, R$ 14.00, and R$ 27.61 for antihypertensive drugs, OADs, and insulin, respectively

Fatores associados ao controle glicêmico em pessoas com diabetes na Estratégia Saúde da Família em Pernambuco

OBJETIVO Identificar los factores asociados con el control glucémico en personas con Diabetes Mellitus (DM) tipo 2 registradas en la Estrategia Salud de la Familia (ESF) en Pernambuco, Brasil. MÉTODO Fueron investigadas, por regresión múltiple, las asociaciones entre el control glucémico (hemoglobina A glicosilada menor o mayor o igual al 7%) presentado por las personas con DM y variables relacionadas con condiciones sociodemográficas, hábitos de vida, características de la diabetes, de su tratamiento y seguimiento de los pacientes por los servicios sanitarios. RESULTADOS Más del 65% de los participantes presentaron control glucémico inadecuado, especialmente aquellos de menos edad, duración de la enfermedad más larga, más contactos anuales con la ESF y régimen terapéutico complejo. Personas con DM sin derivaciones a especialistas presentaron un mayor descontrol glucémico. Asociaciones con escolaridad y obesidad no permanecieron significativas en el modelo multivariado. CONCLUSIÓN La evolución de la diabetes dificulta el control adecuado. Sin embargo, la atención a las personas con DM más jóvenes y las derivaciones a especialistas son factores susceptibles de mejora del control glucémico.OBJETIVO Identificar fatores associados ao controle glicêmico em pessoas com Diabetes Mellitus (DM) tipo 2 cadastradas na Estratégia Saúde da Família (ESF) em Pernambuco, Brasil. MÉTODO Foram investigadas, por regressão múltipla, as associações entre o controle glicêmico (hemoglobina A glicosilada menor ou maior ou igual a 7%) apresentado pelas pessoas com DM e variáveis relacionadas com condições sociodemográficas, hábitos de vida, características do diabetes, de seu tratamento e acompanhamento dos pacientes pelos serviços de saúde. RESULTADOS Mais de 65% dos participantes apresentaram controle glicêmico inadequado, principalmente aqueles com idade menor, duração da doença mais longa, mais contatos anuais com a ESF e regime terapêutico complexo. Pessoas com DM sem encaminhamentos para especialistas apresentaram um maior descontrole glicêmico. Associações com escolaridade e obesidade não permaneceram significativas no modelo multivariado. CONCLUSÃO A evolução do diabetes dificulta o controle adequado, todavia, a atenção às pessoas com DM mais jovens e os encaminhamentos para especialistas são fatores suscetíveis de melhora do controle glicêmico.OBJECTIVE Identifying factors associated with glycemic control in people with type 2 Diabetes Mellitus (DM) registered in the Family Health Strategy (FHS) in Pernambuco, Brazil. METHOD Associations between glycemic control (glycosylated hemoglobin A lower or equal to 7%) presented by people with DM and variables related to sociodemographic conditions, lifestyle, characteristics of diabetes, treatment and follow-up of patients by health services were investigated by multiple regression. RESULTS More than 65% of the participants presented inadequate glycemic control, especially those with lower age, longer illness duration, more annual contacts with FHS and complex therapeutic regimen. People with DM without referrals to specialists presented greater glycemic control. Associations with education level and obesity did not remain significant in the multivariate model. CONCLUSION The evolution of diabetes hinders adequate control, however, attention to younger people with DM and referrals to specialists are factors that can improve glycemic control

Risk factor control in hypertensive and diabetic subjects attended by the Family Health Strategy in the State of Pernambuco, Brazil : the SERVIDIAH study = Controle dos fatores de risco em hipertensos e diabéticos acompanhados pela Estratégia Saúde da Família no Estado de Pernambuco, Brasil : estudo SERVIDIAH

The SERVIDIAH study (Evaluation of Health Services for Diabetic and Hypertensive Subjects) was conducted in 2010 in the State of Pernambuco, Brazil. A multi-stage random sample of 785 hypertensive and 823 diabetic patients was drawn from 208 Family Health Strategy (FHS) units selected throughout 35 municipalities. Patients underwent a structured interview and weight, height, blood pressure and HbA1c levels (for diabetic patients) were measured. Mean age was approximately 60 years, and women were overrepresented in the sample (70%). 43.7% of hypertensive subjects and 25.8% of diabetic subjects achieved adequate blood pressure control and 30.5% of diabetic subjects had HbA1c levels below 7%. Despite 70% of the patients being overweight or obese, few had adhered to a weight-loss diet. The study of this representative sample of hypertensive and diabetic patients attended by the FHS in the State of Pernambuco shows that improvements in the management of hypertension and diabetes are needed in order to prevent the occurrence of serious and costly complications, especially given the context of increasing incidence of these two conditions

Relationships between glycaemic abnormalities, obesity and insulin resistance in nondiabetic Polynesians of New Caledonia

Objective: Polynesians in New Caledonia have an increased risk for developing diabetes, compared to Melanesians or Europeans. They are also more prone to obesity. The aim of this study was to analyse differences in the pre-diabetic state that may explain the varying susceptibility to diabetes between these three ethnic groups, focusing on the balance between insulin resistance and capacity of pancreatic cells to secrete insulin. Design and subjects: The CALDIA Study is a population-based cross-sectional survey of diabetes prevalence conducted in New Caledonia. All participants who did not have diabetes, according to the results of a 0-2 h oral glucose tolerance test (n = 392), were selected for analysis. Results: Compared to Europeans, Polynesians and Melanesians had significantly higher body mass indices (BMI) and waist-to-hip ratios (WHRs). Polynesians had higher fasting plasma glucose values than Europeans or Melanesians (6.03 mmol/l, vs 5.78 and 5.46, respectively; P < 0.0001). Fasting plasma insulin level and the estimate of insulin resistance by homeostasis model assessment were not significantly different between the three ethnic groups. Homeostasis model assessment estimate of beta-cell secretory capacity was lower in Polynesians compared to the two other ethnic groups (83.1 mU/mmol, vs 119.3 and 125.2, respectively; P < 0.02). Conclusion: Despite a high prevalence of central obesity, as judged by high BMI and WHR, in Polynesians of New Caledonia, their high risk of diabetes may be more strongly related to a defect in insulin secretion capacity than to insulin resistance

Paradoxical relationships between anthropometric variables and phenotypic expression of the metabolic syndrome in non-diabetic Polynesians of New-Caledonia

ABSTRACT Objective : Obesity and diabetes are highly prevalent in Polynesians of New Caledonia. We explored whether this ethnic group would present the cluster of cardiometabolic disorders named &quot;metabolic syndrome&quot;, an established risk factor for type 2 diabetes and cardiovascular diseases in populations of European descent. Methods : A total of 419 non-diabetic participants were selected from the CALDIA Study, a population-based survey of diabetes prevalence in New Caledonia. Anthropometric variables, glucose, insulin, lipids and blood pressure were compared between the three main ethnic groups of the archipelago (Melanesians, Europeans, Polynesians). The associations between anthropometric and cardiometabolic variables were also studied. Results : Despite their much higher mean body mass index and waist circumference, Polynesians had lower plasma insulin levels and indices of moderate insulin resistance compared to Melanesians and Europeans. They also had a much higher rate of glycemic abnormalities. On the other hand, their mean triglycerides and blood pressure were lower compared to Melanesians, and total cholesterol was lower compared to Europeans. Moreover, in this ethnic group, triglycerides were not associated, and total cholesterol was inversely associated with abdominal obesity. Conclusions : Despite their high body mass, marked abdominal fat distribution and high blood glucose levels, non-diabetic Polynesians did not exhibit the cluster of abnormalities usually observed in the metabolic syndrome. This illustrates the diversity of phenotypic expressions of the metabolic syndrome across populations, and may have implications for the assessment of disease risk and for the design of preventive measures in Polynesians

Effects of 1-year treatment with metformin on metabolic and cardiovascular risk factors in non-diabetic upper-body obese subjects with mild glucose anomalies : a post-hoc analysis of the BIGPRO1 trial

Aim. - Metformin has recently been considered as a possible pharmacological complement to lifestyle measures for preventing type 2 diabetes in high-risk subjects. However, little is known of its effects on metabolic and cardiovascular risk factors in non-diabetic subjects. Methods. - The BIGPRO1 trial was a 1-year multicentre, randomized, double-blind, controlled clinical trial of metformin versus placebo, carried out in the early 1990s, in 457 upper-body obese non-diabetic subjects with no cardiovascular diseases or contraindications to metformin. We compared the changes (1-year minus baseline) in cardiometabolic risk factors between treatment groups in two subsets of trial subjects: those with impaired fasting glucose (IFG) or impaired glucose tolerance (IGT) (n = 101); and those who fulfilled the inclusion criteria of the Diabetes Prevention Program (DPP) (it = 5 1). Comparisons were adjusted for age and gender. Results. - In the IFG/IGT subset, significant differences in 1-year changes were observed for systolic blood pressure, which decreased markedly more in the metformin group than in the placebo group (P < 0.003), and for fasting plasma glucose, and total and LDL cholesterol, which decreased slightly in the metformin group, but increased in the placebo group (P < 0.04). Similar results were observed in the subset with DPP criteria. Also, there were no significant differences in 1-year changes for weight, waist-to-hip ratio, 2-h post-load blood glucose, fasting and 2-h post-load insulin, HDL cholesterol, triglycerides and fibrinolytic markers between the two treatment groups. Conclusion. - In subjects at high risk of developing diabetes, the use of metformin showed beneficial and no untoward effects on cardiometabolic risk factors