Projeto sala de espera: uma proposta para a educação em diabetes - doi:10.5020/18061230.2006.p197

Education is an essential aspect of diabetic care. For this, many strategies have been searched. The objectives of the present study were to describe “The Waiting Room Project”, a proposal based on using the time in which the patient waits for individual attendance, to promote Diabetes Education; and to evaluate the clinical and epidemiological profile of diabetic participants of this project. Twenty meetings were conducted from March to October 2006, with 350 patients followed-up at the Diabetes Clinics of Walter Cantídio University Hospital-UFC, and their companions. Of these, 76 randomly assigned patients were interviewed. The meetings occurred on each Friday, in 2 sessions of approximately half hour, which were coordinated by a multidisciplinary team, and took into account 25 patients each. At the end, a breakfast was served and used for nutritional education. Among the interviewed participants, women prevailed (85.5%), with mean age of 60.4±9.1 years, and average time of diagnosis of 10.6±5.9 years. In relation to treatment, 40.7% used insulin, 63.1% used oral anti-diabetics and 9.2% only adopted life style changes. Drugs compliance was present in only 47.8% of the participants and the majority (67.1%) did not practice physical activities. Regarding to the diet, only 31.5% fully adhered to it. More than 75% of the participants could read and write, and earned a minimum wage or less. From the observations derived from practice, one may perceive: a greater motivation of the patients after each meeting, a more active participation in doctor’s appointments and an increasing interest on their disease and care. To provide the participation of diabetic patients in their treatments, stimulating self-care, is a challenge to be reached by all health units, and that can be favored by strategies like this described.A educação é um aspecto fundamental do cuidado do diabético. Para tal, várias estratégias têm sido buscadas. Os objetivos do presente estudo foram descrever o “Projeto Sala de Espera”, uma proposta que se baseia na utilização do período em que o paciente aguarda o atendimento individual para promover educação em diabetes; e avaliar o perfil clínico-epidemiológico dos diabéticos participantes deste projeto. Foram realizadas 20 reuniões, de março a outubro de 2006, com 350 pacientes seguidos no Ambulatório de Diabetes, do Hospital Universitário Walter Cantídio - UFC e seus acompanhantes. Desses, 76 pacientes, selecionados aleatoriamente, foram entrevistados. As reuniões ocorriam a cada sexta-feira, em 2 sessões de aproximadamente meia-hora, que eram dirigidas por equipe uma multidisciplinar, e contavam com 25 participantes em cada. Ao término, era servido um café da manhã, o qual era utilizado para a educação nutricional. Entre os entrevistados, predominaram mulheres (85,5%), com média de idade 60,4±9,1 anos e tempo médio de diagnóstico de 10,6±5,9anos. Em relação ao tratamento, dos participantes, 40,7% usavam insulina; 63,1% antidiabéticos orais e 9,2% adotavam apenas mudanças no estilo de vida. A adesão às drogas era contínua em apenas 47,8% e a maioria (67,1%) não praticava atividades físicas. Quanto a dietoterapia, somente 31,5% aderiam plenamente. Mais de 75% dos avaliados eram alfabetizados e recebiam um salário mínimo ou menos. A partir das observações oriundas da prática, pode-se perceber: maior motivação dos pacientes após cada reunião, participação mais ativa nas consultas médicas e um crescente interesse sobre a sua enfermidade e o seu cuidado. Proporcionar a participação do diabético no seu tratamento, estimulando o autocuidado, é um desafio a ser alcançado por todos os serviços de saúde e que pode ser facilitada com a utilização de propostas como a descrita

Early commitment of cardiovascular autonomic modulation in Brazilian patients with congenital generalized lipodystrophy

Abstract Background Metabolic abnormalities in congenital generalized lipodystrophy (CGL) are associated with microvascular complications. However, the evaluation of different types of neuropathy in these patients, including the commitment of cardiovascular autonomic modulation, is scarce. The objective of the present study was to determine the prevalence of cardiovascular autonomic neuropathy (CAN) in patients with CGL compared with individuals with type 1 diabetes and healthy subjects. Methods Ten patients with CGL, 20 patients with type 1 diabetes and 20 healthy subjects were included in the study. Controls were paired 1:2 for age, gender, BMI and pubertal stage. Heart rate variability (HRV) was analyzed using cardiovascular autonomic reflex tests, including postural hypotension test, Valsalva (VAL), respiratory (E/I) and orthostatic (30/15) coefficients, and spectral analysis of the HRV, determining very low (VLF), low (LF) and high (HF) frequencies components. The diagnosis of CAN was defined as the presence of at least two altered tests. Results CAN was detected in 40% of the CGL patients, 5% in type 1 diabetes patients and was absent in healthy individuals (p < 0.05). We observed a significant reduction in the E/I, VLF, LF and HF in CGL cases vs. type 1 diabetes and healthy individuals and lower levels of 30/15 and VAL in CGL vs. healthy individuals. A significant positive correlation was observed between leptin and 30/15 coefficient (r = 0.396; p = 0.036) after adjusting for insulin resistance and triglycerides. Autonomic cardiovascular tests were associated with HbA1c, HOMA-IR, triglycerides and albumin/creatinine ratio in CGL cases. Conclusions We observed a high prevalence of CAN in young patients with CGL, suggesting that insulin resistance, hypertriglyceridemia and hypoleptinemia, may have been involved in early CAN development. Additional studies are needed to evaluate the role of leptinemia in the physiopathogenesis of the condition

Table_1_Heterogeneity and high prevalence of bone manifestations, and bone mineral density in congenital generalized lipodystrophy subtypes 1 and 2.docx

IntroductionCongenital Generalized Lipodystrophy (CGL) is a rare autosomal recessive disease caused by mutations in genes responsible for the formation and development of adipocytes. Bone abnormalities are described. However, there is a scarcity of data.ObjectiveTo describe bone characteristics in a large CGL1 and 2 case series.MethodsCross-sectional study that assessed bone radiological features of CGL patients of a reference hospital in Fortaleza (CE), Brazil. Patients underwent clinical and bone mineral metabolism evaluation, radiographs of the axial and appendicular skeleton and bone mineral density (BMD) assessment by DEXA (dual energy X-ray absorptiometry).ResultsNineteen patients were included, fourteen were CGL1 and 5, CGL2. Median age was 20 years (8–42) and 58% were women. Median BMI and percentage of body fat were, respectively, 21 Kg/m² (16–24), and 10.5% (7.6-15). The median leptin concentration was 1 ng/mL (0.1-3.3). Diabetes mellitus and dyslipidemia were present in 79% and 63% of patients, respectively. Median calcium and phosphate were normal in almost all patients (95%). Median parathyroid hormone and 25-OH-vitamin D were 23 pg/mL (7-75) and 28 ng/mL (18-43). Osteolytic lesions, osteosclerosis and pseudo-osteopoikylosis, were present in 74%, 42% and 32% of patients, respectively. Lytic lesions were found predominantly in the extremities of long bones, bilaterally and symmetrically, spine was spared. Osteosclerosis was present in axial and appendicular skeleton. Pseudo-osteopoikilosis was found symmetrically in epiphyses of femur and humerus, in addition to the pelvis. BMD Z-score greater than +2.5 SD was observed in 13 patients (68.4%). BMD was higher in CGL1 compared to CGL2 in lumbar spine and total body in adults. No associations were found between high BMD and HOMA-IR (p=0.686), DM (p=0.750), osteosclerosis (p=0.127) or pseudo-osteopoikilosis (p=0.342), and, between pain and bone lesions. Fractures were found in 3 patients.ConclusionBone manifestations are prevalent, heterogeneous, and silent in CGL1 and CGL2. Osteolytic lesions are the most common, followed by osteosclerosis and pseudo-osteopoikilosis. Bone mass is high in most cases. There was no pain complaint related to bone lesions. Thus, systematic assessment of bone manifestations in CGL is essential. Studies are needed to better understand its pathogenesis and clinical consequences.</p