Clinical Use of Insulin Glargine 300 U/mL in Adults with Type 2 Diabetes : Hypothetical Case Studies

Type 2 diabetes (T2D) is a progressive disease, with many individuals eventually requiring basal insulin therapy to maintain glycaemic control. However, there exists considerable therapeutic inertia to the prompt initiation and optimal titration of basal insulin therapy due to barriers that include fear of injections, hypoglycaemia, weight gain, and burdensome regimens. Hypoglycaemia is thought to be a major barrier to optimal glycaemic control and is associated with significant morbidity and mortality. Newer second-generation basal insulin analogues provide comparable glycaemic control with lower risk of hypoglycaemia compared with first-generation basal insulin analogues. The present review article discusses clinical evidence for one such second-generation basal insulin analogue, insulin glargine 300 U/mL (Gla-300), in the context of hypothetical case studies that are representative of individuals who may attend routine clinical practice. These case studies discuss individualised treatment needs for people with T2D who are insulin-naive or pre-treated. Clinical characteristics such as older age, frequent nocturnal hypoglycaemia, and renal impairment, which are known risk factors for hypoglycaemia, are also considered.Peer reviewe

Waist-Height Ratio and the Risk of Severe Diabetic Eye Disease in Type 1 Diabetes : A 15-Year Cohort Study

Context: Obesity prevalence has increased in type 1 diabetes (T1D). However, the relationship between body composition and severe diabetic eye disease (SDED) is unknown. Objective: To investigate the associations between body composition and SDED in adults with T1D. Methods: From 5401 adults with T1D in the Finnish Diabetic Nephropathy Study, we assessed 3468, and 437 underwent dual-energy X-ray absorptiometry for body composition analysis. The composite outcome was SDED, defined as proliferative retinopathy, laser treatment, antivascular endothelial growth factor treatment, diabetic maculopathy, vitreous hemorrhage, and vitrectomy. Logistic regression analysis evaluated the associations between body composition and SDED. Multivariable Cox regression analysis assessed the associations between the anthropometric measures and SDED. Subgroup analysis was performed by stages of albuminuria. The relevance ranking of each variable was based on the z statistic. Results: During a median follow-up of 14.5 (interquartile range 7.8-17.5) years, 886 SDED events occurred. Visceral/android fat ratio was associated with SDED [odds ratio (OR) 1.40, z = 3.13], as well as the percentages of visceral (OR 1.80, z = 2.45) and android fat (OR 1.28, z = 2.08) but not the total body fat percentage. Waist-height ratio (WHtR) showed the strongest association with the SDED risk [hazard ratio (HR) = 1.28, z= 3.73], followed by the waist (HR 1.01, z = 3.03), body mass index (HR 1.03, z = 2.33), and waist-hip ratio (HR 1.15, z= 2.22).The results were similar in normo- and microalbuminuria but not significant in macroalbuminuria. A WHtR >= 0.5 increased the SDED risk by 28% at the normo- and microalbuminuria stages. Conclusions: WHtR, a hallmark of central obesity, is associated with SDED in individuals with T1D.Peer reviewe

A importância dos equipamentos de proteção individual (EPI) como forma preventiva do acidente de trabalho: estudo de caso: The importance of personal protective equipment (PPE) as a preventive form of work accident: case study

A construção civil ganha a cada dia mais um relevante espaço na economia brasileira, no entanto apesar deste avanço e reconhecimento, esta área carrega também uma grande responsabilidade a partir de suas obras, seja em âmbito ambiental ou como será visto no presente estudo, quanto a prevenção de acidentes da equipe que na obra labora tendo em vista que a construção civil durante os últimos anos estava em destaque como setor responsável pelos altos números de acidente de trabalho. O presente estudo tem por objetivo analisar a importância do uso dos equipamentos de proteção individual – EPI’s como forma preventiva de acidente de trabalho, tendo como base diversas fundamentações teóricas sobre o tema e o estudo de caso realizado em uma obra de reforma e ampliação de uma escola na cidade de Manaus/AM. A partir da realização do estudo de caso observou-se que cerca de 90% dos colaboradores demonstram resistência quanto ao uso de EPI’s sob a justificativa de que os equipamentos causam incômodo e desconforto.&nbsp

Waist‑height ratio and waist are the best estimators of visceral fat in type 1 diabetes

Visceral fat is associated with cardiovascular and kidney disease. However, the relationship between body composition and anthropometric measures in type 1 diabetes is unknown. Using z-statistics, we ranked the ability of body mass index (BMI), waist circumference (WC), waist-hip ratio (WHR), waist-height ratio (WHtR) and a body shape index (ABSI) to capture measures of body composition from 603 Dual-energy-X-Ray-Absorptiometry scans of adults with type 1 diabetes. Albuminuria was defined as urinary albumin excretion rate of at least 30 mg/24 h. Women with albuminuria had higher visceral fat mass % (VFM%) (0.9 vs. 0.5%, p = 0.0017) and lower appendicular lean mass % (AppLM%) (25.4 vs 26.4%, p = 0.03) than those without. Men with albuminuria had higher VFM% (1.5 vs. 1.0%, p = 0.0013) and lower AppLM% (30.0 vs 32.3, p < 0.0001) than those without. In men, WHtR estimated VFM% best (z-statistics = 21.1), followed by WC (z = 19.6), BMI (z = 15.1), WHR (z = 14.6) and ABSI (z = 10.1). In women, the ranking was WC (z = 28.9), WHtR (z = 27.3), BMI (z = 20.5), WHR (z = 12.7) and ABSI (z = 10.5). Overall, the ranking was independent of albuminuria. Adults with type 1 diabetes and albuminuria have greater VFM% and lower AppLM% than those without. WHtR and WC best estimate the VFM% in this population, independently of albuminuria and sex.Peer reviewe

The relationship between FGF23 and body composition according to albuminuria stage in type 1 diabetes

Aims: Fibroblast growth factor 23 (FGF23) and obesity are linked to kidney disease. However, the relationship between FGF23 and body composition is unclear. Associations between FGF23 and body composition were investigated in type 1 diabetes from the Finnish Diabetic Nephropathy Study according to albuminuria stages. Methods: Data were available from 306 adults with type 1 diabetes (229 normal albumin excretion rate, T1Dnormo; 38 microalbuminuria, T1Dmicro; 39 macroalbuminuria, T1Dmacro), and 36 controls. Serum FGF23 was measured by ELISA. Body composition was assessed with dual-energy X-ray absorptiometry. Associations between body composition and serum FGF23 were investigated using linear regression models. Results: Compared with T1Dnormo, individuals with more advanced kidney disease were older, had longer diabetes duration, higher serum hsCRP, and higher FGF23 concentration. However, FGF23 concentration was comparable between T1Dnormo and controls. Adjusted for potential confounders, in T1Dmicro, FGF23 was positively associated with the percentages of total fat, visceral fat, and android fat tissues, while negative associations between FGF23 and lean tissue were observed. FGF23 was not associated with body composition in T1Dnormo, T1Dmacro, and controls. Conclusions: In type 1 diabetes, the relationship between FGF23 and body composition is dependent on albuminuria stages.Peer reviewe

Relationship between ABO blood groups and cardiovascular disease in type 1 diabetes according to diabetic nephropathy status

Background ABO blood groups have previously been associated with cardiovascular disease (CVD) in the general population. This study aimed to investigate the potential relationship between ABO blood groups and CVD in individuals with type 1 diabetes according to diabetic nephropathy (DN) status. Methods Adults with type 1 diabetes (4531 individuals) from the FinnDiane Study were evaluated. DN was determined by two out of three measurements of urinary albumin excretion rate. Albuminuria was defined as an excretion rate above 20 mu g/min. CVD events were identified by linking the data with the Finnish Care Register for Health Care and the Finnish Cause of Death Register. Follow-up ranged from the baseline visit until a CVD event, death or the end of 2017. The impact of ABO blood groups on CVD risk was estimated by multivariable Cox-regression analyses adjusted for traditional risk factors. Results At baseline, the median age was 38.5 (IQR 29.2-47.9) years, 47.5% were female and median duration of diabetes was 20.9 (11.4-30.7) years. There were 893 incident ischemic heart disease (IHD) events, 301 ischemic strokes (IS), and 415 peripheral artery disease (PAD) events during a median follow up of 16.5 (IQR 12.8-18.6) years. The A blood group showed the highest risk of IHD versus the O blood group, when microalbuminuria was present. Comparing the population with microalbuminuria with those with normoalbuminuria, only the A blood group elevated the risk of IHD. This increased risk was neither explained by the FUT2 secretor phenotype nor by the A-genotype distribution. The risk of IS or PAD was no different among the ABO blood groups regardless of diabetic nephropathy stage. Conclusion The A blood group is a risk factor for IHD in individuals with type 1 diabetes and microalbuminuria.Peer reviewe

Perbandingan Hasil Belajar Menggunakan Model Everyone Is A Teacher Here dan Make A Match

This study aimed to compare the learning outcomes of students on the subjects of geography XI in high schools 10 Bandar Lampung. The purpose of this research is that is to knowing the difference learning outcomes of students, between students who use the model of learning everyone is a teacher here with students who use the learning model make a match that was given the assignment and project portfolio. Research method used is experiment with specious approach. Engineering data collection is done through poll and tests. To test instrument use the validity, test reliability, the trouble, and the different.Analysis techniques data using analysis variant two roads and the hypothesi. The research results show that the difference study results students, between students who use learning model everyone is a teacher here with students who use learning model make a match given the assignment portfolio and project.Penelitian ini dilatarbelakangi masalah rendahnya hasil belajar siswa pada mata pelajaran Geografi XI semester ganjil di SMA Negeri 10 Bandar Lampung. Tujuan penelitian ini adalah yaitu untuk mengetahui perbedaan hasil belajar siswa, antara siswa yang menggunakan model pembelajaran Everyone Is A Teacher Here dengan siswa yang menggunakan model pembelajaran Make A Match yang diberi Penugasan Portofolio dan Proyek. Metode penelitian yang digunakan adalah dengan pendekatan eksperimen semu. Teknik pengumpulan data dilakukan melalui angket dan tes. Untuk uji instrument menggunakan uji validitas, reliabilitas tes, tingkat kesukaran, dan daya beda. Teknik analisis data menggunakan analisis varian dua jalan dan uji t. Hasil Penelitian menunjukkan bahwa ada perbedaan hasil belajar siswa, antara siswa yang menggunakan model pembelajaran Everyone Is A Teacher Here dengan siswa yang menggunakan model pembelajaran Make A Match yang diberi Penugasan Portofolio dan Proyek

EVALUACIÓN DE UN SISTEMA AGROALIMENTARIO EN LA REGIÓN SEMIÁRIDA BRASILEÑA: UNA VISIÓN ECONÓMICO-ECOLÓGICA

A implantação de um assentamento rural pelo Instituto Nacional de Colonização e Reforma Agrária – INCRA representa a construção de um novo território para o agricultor e sua família, onde é possível implantar práticas sustentáveis de agricultura. A pesquisa foi desenvolvida para avaliar um agroecossistema composto por quatro assentados de um mesmo núcleo familiar, sendo que dois praticam agricultura e pecuária conforme a tradição da região, enquanto os outros dois seguem os conceitos agroecológicos da permacultura. Para avaliar o agroecossistema foi escolhido o método de Análise Econômico-Ecológica de Agroecossistemas desenvolvido pelas Articulação Nacional de Agroecologia e AS-PTA – Agricultura Familiar e Agroecologia. A criação de uma rede de suporte que levou a uma série de cursos e benefícios como projetos de plantio de frutíferas e capineira, alavancaram a produção do núcleo familiar do agroecossistema e proporcionaram maior autonomia às mulheres do assentamento. A entrada da linha de crédito Fomento Mulher através do INCRA foi uma das causas apontadas para essa mudança. Investimentos na irrigação da horta e na capineira através de empréstimos do AgroAmigo e do CrediAmigo foram decisivos para garantir a soberania alimentar do Núcleo de Gestão Social do Agroecossistema – NSGA. A implantação da mandala proporcionou o plantio de novas culturas de frutas, legumes e verduras, além da piscicultura. A diversificação de produtos trouxe um incremento na qualidade e segurança da alimentação do NSGA, abriu um leque maior de produtos comercializáveis, onde  se destacam como fonte de renda cada vez mais crescente a venda de Tilápia e das hortaliças.The implementation of a rural settlement by the National Institute of Colonization and Agrarian Reform – INCRA represents the construction of a new territory for the farmer and their family, allowing for the adoption of sustainable farming practices. The purpose of the study was to assess an agroecosystem composed of four settlers belonging to the same family, wherein two practice agriculture and husbandry according to regional tradition, while the other two apply the agroecological concepts of permaculture. The method of Ecological-Economic Analysis of Agroecosystems developed by the National Articulation of Agroecology and AS-PTA – Family Agriculture and Agroecology was chosen to assess the agroecosystem. The creation of a support network led to a series of courses and benefits such as projects to plant fruit trees and forage grass that levered the production of the family’s agroecosystem and provided the women with increased autonomy.  One of the causes was a line of credit geared to the advancement of women (Fomento Mulher).  Investments in irrigation of the vegetable garden and the grass field, through loans from AgroAmigo and CrediAmigo were decisive in guaranteeing the food sovereignty of the Agroecosystem Social Management Nucleus – NSGA. The implementation of the mandala allowed the cultivation of new crops of fruits, legumes, and leafy vegetables, in addition to pisciculture. Product diversification brought the NSGA an increase in food quality and security, and expanded the range of saleable products, where tilapia and vegetables stand out as an ever-greater source of income for the nucleus.La implantación de un asentamiento rural por parte del Instituto Nacional de Colonización y Reforma Agraria - INCRA representa la construcción de un nuevo territorio para el agricultor y su familia, donde es posible implementar prácticas agrícolas sostenibles. La investigación se desarrolló para evaluar un agroecosistema compuesto por cuatro colonos del mismo núcleo familiar, dos de los cuales practican la agricultura y la ganadería de acuerdo con la tradición de la región, mientras que los otros dos siguen los conceptos agroecológicos de la permacultura. Para evaluar el agroecosistema, se eligió el método de Análisis Económico-Ecológico de Agroecosistemas desarrollado por la Articulación Nacional de Agroecología y AS-PTA - Agricultura familiar y agroecología. La creación de una red de apoyo que condujo a una serie de cursos y benefícios como proyectos de plantación de fruta y pasto impulsó la producción del núcleo familiar del agroecosistema y proporcionó una autonomía repentina para las mujeres en el asentamiento. La entrada de la línea de crédito Fomento Mulher a través de INCRA fue una de las causas señaladas para este cambio. Las inversiones en el riego de los huertos y pastizales a través de préstamos de AgroAmigo y CrediAmigo fueron decisivas para garantizar la soberanía alimentaria del Centro de Gestión Social del Agroecosistema - NSGA. La implementación del mandala proporcionó la plantación de nuevos cultivos de frutas y verduras, además de la piscicultura. La diversificación de productos trajo un aumento en la calidad y seguridad de los alimentos de la NSGA, abrió una gama más amplia de productos comercializables, ya que la venta de tilapia y verduras se destaca como una fuente de ingresos cada vez mayor

A viabilidade econômica do uso de paredes em Drywall em uma obra residencial da cidade de Manaus/AM / The economic feasibility of using Drywall walls in a residential project in the city of Manaus/AM

O custo-benefício do Drywall é o principal motivo para sua utilização e o principal motivo desta pesquisa, pois a utilização das paredes internas com placas de gesso acartonado (Drywall), é economicamente mais viável do que a alvenaria de tijolo cerâmico. Dessa maneira, o objetivo desse estudo é apresentar a viabilidade econômica do uso de paredes em Drywall em uma obra residencial na cidade de Manaus/AM. O estudo foi realizado por meio de levantamento de dados bibliográficos e estudo de caso através de pesquisa descritiva a partir do estudo de caso realizado em uma unidade residencial na cidade de Manaus. Conclui-se a partir do que foi apresentado ao longo do estudo que a viabilidade econômica na construção de paredes Drywall. Portanto, conclui-se que seu retorno financeiro é mais veloz dado que produz de maneira rápida e assim tem mais produtos para ofertar. As vedações com Drywall são seguras, podem receber vários tipos de acabamentos sofisticados, oferecem diversas formas geométricas e assim ganham maior área nas construções.