A1C e o controle glicêmico: um desafio para todos

Universidade Federal de São Paulo (UNIFESP) Grupos de Educação e Controle do Diabetes do Hospital do Rim e HipertensãoHospital Alemão Oswaldo Cruz Centro de DiabetesUNIFESP, Grupos de Educação e Controle do Diabetes do Hospital do Rim e HipertensãoSciEL

Importance of nutritional counseling and dietary fiber content on glycemic control in type 2 diabetic patients under intensive educational intervention

OBJECTIVE: To evaluate the importance of nutritional counseling within a set of multidisciplinary interventions. SUBJECTS AND METHODS: Forty-seven patients with type 2 diabetes and hyperglycemia (A1C > 8%), treated conventionally (n = 19, GC) or intensively in six weekly visits (n = 28, GI) were analyzed. We evaluated mean weekly blood glucose (MWG) at baseline and after 6 weeks in both groups. RESULTS: GI reduced caloric (p = 0.001), carbohydrate (p = 0.004), and fat (p = 0.001) intake, and increased fiber consumption, while GC reduced fiber intake (p = 0.018). Glycemic control (MWG < 150 mg/dL) occurred in 75% of GI patients and in 31.6% of CG patients (p = 0.003), with negative correlation between changes in fiber intake and MWG values (r =-0.309; P = 0.035). Results were maintained after 12 weeks. CONCLUSION: Educational short-term intensive intervention was more effective than conventional treatment to achieve glycemic control. Our results also indicate that a more appropriate fiber content in the diet contributes for better blood glucose control in these patients.OBJETIVO: Avaliar a orientação nutricional dentro de um conjunto de intervenções multidisciplinares. SUJEITOS E MÉTODOS: Quarenta e sete pacientes diabéticos tipo 2, hiperglicêmicos, tratados de forma convencional (n = 19) ou intensiva (n = 28) e avaliados pela glicemia média semanal (GMS) no início e após 6 semanas. RESULTADOS: GI reduziu o consumo de calorias (p = 0,001), carboidratos (p = 0,004), lipídios (p = 0,001) e aumentou o de fibras, enquanto o GC reduziu o consumo de fibras (p = 0,018). Controle glicêmico (GMS < 150 mg/dL) ocorreu em 75% do GI e, em 31,6% do GC (p = 0,003), houve correlação negativa entre as variações do consumo de fibras e a GMS (r =-0,309; p = 0,035). Os resultados mantiveram-se por 12 semanas. CONCLUSÃO: A intervenção educacional intensiva de curto prazo mostrou-se mais eficaz que o tratamento convencional para a obtenção do controle glicêmico. Nossos resultados ainda indicam que um consumo mais adequado de fibras na alimentação contribui para a obtenção de um melhor controle da glicemia.Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)Universidade Federal de São Paulo (UNIFESP) Escola Paulista de Medicina Departamento de MedicinaUNIFESP-EPM Departamento de Medicina PreventivaUNIFESP, EPM, Depto. de MedicinaUNIFESP, EPM Depto. de Medicina PreventivaSciEL

Algorithm for the treatment of type 2 diabetes: a position statement of Brazilian Diabetes Society

The Brazilian Diabetes Society is starting an innovative project of quantitative assessment of medical arguments of and implementing a new way of elaborating SBD Position Statements. The final aim of this particular project is to propose a new Brazilian algorithm for the treatment of type 2 diabetes, based on the opinions of endocrinologists surveyed from a poll conducted on the Brazilian Diabetes Society website regarding the latest algorithm proposed by American Diabetes Association /European Association for the Study of Diabetes, published in January 2009

Eficácia de intervenções multifatoriais no controle em curto prazo do diabetes tipo 2: a randomized, controlled proof-of-concept study

O objetivo deste estudo foi o de testar a hipótese segundo a qual uma abordagem de ajustes mais frequentes da terapêutica farmacológica, associados a uma estratégia multifatorial e interdisciplinar poderia resultar numa melhora mais rápida do controle glicêmico, contribuindo, assim, para reforçar a adesão do paciente às recomendações e condutas terapêuticas definidas individualmente pela equipe de educação e controle do diabetes

Diabetes Guidelines May Delay Timely Adjustments During Treatment and Might Contribute to Clinical Inertia

Clinical inertia and poor knowledge by many physicians play an important role in delaying diabetes control. Among other guidelines, the Position Statement of the American Diabetes Association/European Association for the Study of Diabetes on Management of Hyperglycemia in Type 2 Diabetes is a respected guideline with high impact on this subject in terms of influencing physicians in the definition of strategic approach to overcome poor glycemic control. But, on the other hand, it carries a recommendation that might contribute to clinical inertia because it can delay the needed implementation of more vigorous, intensive, and effective strategies to overcome poor glycemic control within a reasonable time frame during the evolution of the disease. the same is true with other respected algorithms from different diabetes associations. Together with pharmacological interventions, diabetes education and more intensive blood glucose monitoring in the initial phases after the diagnosis are key strategies for the effective control of diabetes. the main reason why a faster glycemic control should be implemented in an effective and safe way is to boost the confidence and the compliance of the patient to the recommendations of the diabetes care team. Better and faster results in glycemic control can only be safely achieved with educational strategies, structured self-monitoring of blood glucose, and adequate pharmacological therapy in the majority of cases.Universidade Federal de São Paulo, Kidney & Hypertens Hosp, Diabet Educ & Control Grp, São Paulo, BrazilUniversidade Federal de São Paulo, Kidney & Hypertens Hosp, Dept Endocrinol, São Paulo, BrazilUniversidade Federal de São Paulo, Kidney & Hypertens Hosp, Diabet Educ & Control Grp, São Paulo, BrazilUniversidade Federal de São Paulo, Kidney & Hypertens Hosp, Dept Endocrinol, São Paulo, BrazilWeb of Scienc

Rapid Improvement of Glycemic Control in Type 2 Diabetes Using Weekly Intensive Multifactorial Interventions: Structured Glucose Monitoring, Patient Education, and Adjustment of Therapy—A Randomized Controlled Trial

Background: We evaluated intensive intervention in poorly controlled patients with type 2 diabetes mellitus involving weekly clinic visits and adjustment of therapy with analysis of three seven-point glucose profiles and intervention from an interdisciplinary staff.Methods: Sixty-three patients were randomized to an intensive treatment group that obtained self-monitoring of blood glucose (SMBG) profiles (six or seven values per day, 3 days/week) and were seen in the clinic at Weeks 1-6 and 12. SMBG results were downloaded, analyzed using Accu-Chek (R) 360 degrees software (Roche Diagnostics, Indianapolis, IN), and used to adjust therapy. Control group subjects obtained glucose profiles and had clinic visits only at Weeks 0, 6, and 12.Results: There were highly statistically significant improvements in the intensive treatment group compared with the control group between Weeks 0 and 6 with greater reductions in weekly mean glycemia (WMG) (-76.7 +/- 8.9 mg/dL vs. -20.5 +/- 8.1mg/dL), glycemic variability (SD) (-16.3 +/- 3.1 mg/dL vs. -5.0 +/- 3.1mg/dL), and glycated hemoglobin (-1.82 +/- 0.16% vs. -0.66 +/- 0.22%) without significant changes in frequency of hypoglycemia or weight. Improvements were sustained in the intensive treatment group through Week 12. A minimal but statistically significant degree of improvement was seen in the control group at Week 12.Conclusions: This short-term pilot study of an intensive monitoring, educational, and pharmacological interventions program resulted in dramatic improvement of glycemic control within 6 weeks, and these effects are sustained through Week 12. SMBG glucose profiles, calculation of WMG and SD, and graphical displays of glucose data can improve the effectiveness of adjustment of therapy at weekly clinic visits when combined with intensive support from a multidisciplinary team.Diabetes Education and Control Group of the Kidney and Hypertension Hospital, Federal University of São Paulo, São Paulo, BrazilUniversidade Federal de São Paulo, Kidney & Hypertens Hosp, Diabet Educ & Control Grp, BR-04038002 São Paulo, BrazilUniversidade Federal de São Paulo, Kidney & Hypertens Hosp, Ctr Hypertens & Cardiovasc Metabol, BR-04038002 São Paulo, BrazilBiomed Informat Consultants, Potomac, MD USAUniversidade Federal de São Paulo, Kidney & Hypertens Hosp, Diabet Educ & Control Grp, BR-04038002 São Paulo, BrazilUniversidade Federal de São Paulo, Kidney & Hypertens Hosp, Ctr Hypertens & Cardiovasc Metabol, BR-04038002 São Paulo, BrazilWeb of Scienc

Insulin Injection Technique Questionnaire: results of an international study comparing Brazil, Latin America and World data

Abstract Background In 2014–2015, the largest international survey of insulin injection technique in patients with diabetes taking insulin was conducted in 42 countries, totaling 13,289 participants. In Brazil, patients from five public health centers were included. This study aims to evaluate insulin injection technique in Brazilian patients and compare results with Latin America (LatAm) and World data. Methods The insulin Injection Technique Questionnaire (ITQ) survey consisted of an initial patient section (questions applied by an experienced nurse), followed by observation of injection technique and examination of the injection sites by the health care professional. Results In Brazil, 255 patients were evaluated: 25% had type 1 diabetes mellitus (T1DM) and 75% had T2DM. In this study, 79% of patients injected less than 4 times a day, and 17.3% used insulin pens, compared to 28% in LatAm and 86% worldwide. Syringes were used by 78% of patients in Brazil, compared to 65% in LatAm and 10% globally. Differences in needle length were substantial—nearly 64% in Brazil inject with 8 mm length needle compared to 48% in LatAm and 27% worldwide. Additionally, 48% of patients in Brazil skip doses, 80% reuse pen needles and 57% reuse syringes with 27% having lipohypertrophy by exam. Conclusion Brazilian patients use syringes more and pens less, inject with larger needles and have more lipohypertrophy when compared to Latin America and World data. Their re-use of needles and syringes is also high. This study showed that in Brazil, teaching of proper injection technique has to be more widespread, and more intensive during diabetes educational sessions, and the type of delivered supplies must be updated to smaller, shorter needles preferred by patients, in order to facilitate adherence to treatment. From the ITQ, we conclude that there are many aspects of insulin injection technique that may be improved in Brazil

Atualização sobre hemoglobina glicada (HbA1C) para avaliação do controle glicêmico e para o diagnóstico do diabetes: aspectos clínicos e laboratoriais Update on glycated hemoglobin (HbA1C) for assessment of glycemic control and the diagnosis of diabetes: clinical and laboratory aspects

Universidade Federal de São Paulo (UNIFESP) Hospital do Rim e Hipertensão Centro Integrado de Hipertensão e Metabologia CardiovascularSociedade Brasileira de Diabete/Medicina LaboratorialUniversidade Federal de São Paulo (UNIFESP), Escola Paulista de Medicina (EPM)Fundação do ABC Faculdade de MedicinaFederação Nacional das Associações e Entidades de DiabetesAssociação Nacional de Assitência ao DiabéticoUniversidade de Campinas Faculdade de Ciências Médicas Departamento de Clínica MédicaSociedade Brasileira de Endocrinologia e Metabologia Departamento de DiabetesUniversidade Estadual do Rio de JaneiroSanta Casa de São Paulo Faculdade de Ciências Médicas Departamento de Ciências FisiológicasSociedade Brasileira de Patologia Clínica e Medicina LaboratorialWorld Association of Societies of Pathology and Laboratory MedicineAssociação Paulista de MedicinaTotal LaboratóriosUniversidade de São Paulo Faculdade de MedicinaFMUSP Hospital das Clínicas Divisão de Laboratório CentralClínica do Fleury - Medicina e SaúdeUniversidade de Pernambuco Faculdade de Ciências MédicasSBEMFaculdade de Ciências Médicas de Minas GeraisSBDUNIFESP, Hospital do Rim e Hipertensão Centro Integrado de Hipertensão e Metabologia CardiovascularUNIFESP, EPMSciEL