Relação entre apoio social, adesão aos tratamentos e controle metabólico de pessoas com diabetes mellitus

This cross-sectional and quantitative study aimed to analyze the relationship among social support, adherence to non-pharmacological (diet and physical exercise) and pharmacological treatments (insulin and/or oral anti-diabetic medication) and clinical and metabolic control of 162 type 2 diabetes mellitus patients. Data were collected through instruments validated for Brazil. Social support was directly correlated with treatment adherence. Adherence to non-pharmacological treatment was inversely correlated with body mass index, and medication adherence was inversely correlated with diastolic blood pressure. There were no associations between social support and clinical and metabolic control variables. Findings indicate that social support can be useful to achieve treatment adherence. Studies with other designs should be developed to broaden the analysis of relations between social support and other variables.O presente estudo objetivou analisar a relação entre apoio social, adesão aos tratamentos não medicamentoso (dieta e exercício físico) e medicamentoso (insulina e/ou antidiabéticos orais) e controle clínico-metabólico de 162 pessoas com diabetes mellitus tipo 2. Constituiu-se em um estudo seccional, de abordagem quantitativa. Os dados foram coletados por meio de instrumentos validados. O apoio social teve correlação direta com a adesão aos tratamentos. Observou-se correlação inversa entre adesão ao tratamento não medicamentoso e índice de massa corporal, bem como entre adesão medicamentosa e pressão arterial diastólica. Não houve associações entre apoio social e variáveis de controle clínico-metabólico. Conclui-se que o apoio social poderá ser útil para se obter a adesão aos tratamentos. Estudos com outros delineamentos devem ser desenvolvidos, a fim de se ampliar a análise das relações entre apoio social e outras variáveis.El presente estudio objetivó analizar la relación entre apoyo social, adhesión a los tratamientos no medicamentoso (dieta y ejercicio físico) y medicamentoso(insulina y/o antidiabéticos orales) y control clínico-metabólico de 162 personas con diabetes mellitus tipo 2. Se trata de un estudio seccional, de abordaje cuantitativo. Los datos fueron recolectados por medio de instrumentos validados. El apoyo social tuvo correlación directa con la adhesión al tratamiento. Se observó correlación inversa entre adhesión al tratamiento no medicamentoso y índice de masa corporal, así como entre adhesión medicamentosa y presión arterial diastólica. No hubo asociaciones entre apoyo social y variables de control clínico-metabólico. Se concluye que el apoyo social podrá ser útil para obtener la adhesión a los tratamientos. Estudios con otros delineamientos deben ser desarrollados, a fin de ampliar el análisis de las relaciones entre apoyo social y otras variables

Adaptação cultural e validação do Neuropathy - and Foot Ulcer - Specific Quality of Life (NeuroQol) para a língua portuguesa do Brasil - Fase 1

This methodological study aimed to adapt the Neuropathy - and Foot Ulcer - Specific Quality of Life instrument - NeuroQol to Brazilian Portuguese and to analyze its psychometric properties. Participants were 50 people with peripheral diabetic neuropathy and foot ulcers. The floor and ceiling effects, the convergent and discriminant validity and the reliability were analyzed. The Cronbachs alpha coefficient was used to test the reliability and the Pearsons correlation coefficient to estimate the convergent validity, the Students t test was used to evaluate the discriminant validity in the comparison of the NeuroQol scores between participants with and without ulcers. Floor and ceiling effects were found in some domains of the NeuroQol. The reliability was satisfactory. The correlations between the domains of the NeuroQol and the SF-36 were negative, significant and of moderate to strong magnitude. The findings show that the Brazilian version of the NeuroQol is reliable and valid and may be employed as a useful tool for improving nursing care for people with DM.Estudio metodológico que tuvo como objetivos adaptar el Neuropathy - and Foot Ulcer - Specific Quality of Life - NeuroQol para el idioma portugués de Brasil y analizar sus propiedades psicométricas. Participaron 50 personas con neuropatía diabética periférica y úlceras en los pies. Fueron analizados los efectos floor y ceiling, la validez convergente, la discriminante y la confiabilidad. Fue utilizado el coeficiente alfa de Cronbach para comprobar la confiabilidad y la correlación de Pearson para estimar la validez convergente; el test t-Student fue empleado para evaluar la validez discriminante en la comparación de los puntajes del NeuroQol entre los participantes con y sin úlceras. Se constataron efectos floor y ceiling en algunos dominios del NeuroQol. La confiabilidad fue satisfactoria. Las correlaciones entre los dominios del NeuroQol y SF-36 fueron negativas, significativas, de moderada a fuerte magnitud. Los hallazgos evidencian que la versión brasileña del NeuroQol es confiable y válida y podrá ser utilizado como una herramienta útil para la mejoría de la asistencia de enfermería para las personas con DM.Trata-se de estudo metodológico que teve como objetivos adaptar o Neuropathy - and Foot Ulcer - Specific Quality of Life - NeuroQol para a língua portuguesa do Brasil, e analisar suas propriedades psicométricas. Participaram 50 pessoas com neuropatia diabética periférica e úlceras nos pés. Foram analisados os efeitos floor e ceiling, a validade convergente, a discriminante e a confiabilidade. Foi utilizado o coeficiente alfa de Cronbach para testar a confiabilidade e o de correlação de Pearson para estimar a validade convergente; o teste t-Student foi empregado para avaliar a validade discriminante, na comparação dos escores do NeuroQol entre os participantes com e sem úlceras. Constataram-se efeitos floor e ceiling em alguns domínios do NeuroQol. A confiabilidade foi satisfatória. As correlações entre os domínios do NeuroQol e SF-36 foram negativas, significativas, de moderada a forte magnitude. Os achados evidenciam que a versão brasileira do NeuroQol é confiável e válida, e que ele poderá ser utilizado como ferramenta útil para melhoria da assistência de enfermagem para as pessoas com DM

Fatores imunogenéticos associados ao diabetes mellitus do tipo 1

Type 1 diabetes mellitus has been considered an organ-specific autoimmune disease derived from the selective destruction of pancreatic beta cells. It presents a complex pathogenesis, involving the participation of several factors, including the immunogenetic susceptibility with strong association to histocompatibility genes (HLA), environmental events and autoimmune response with the presence of autoantibodies and/or autoreactive lymphocytes, culminating in metabolic abnormalities. In this study, the literature review describes mechanisms through which some factors cause susceptibility to its appearance and, additionally, prediction innovations regarding this disorder, which will certainly contribute to nursing care for patients with type 1 diabetes.La Diabetes Mellitus tipo 1 ha sido considerada una enfermedad autoinmune órgano-específica debido a la destrucción selectiva de las células beta pancreáticas. Presenta una patogenia compleja, involucrando la participación de varios factores, entre esos la susceptibilidad inmunogenética con fuerte asociación a los genes de histocompatibilidad (HLA), eventos ambientales y respuesta autoinmune con presencia de auto-anticuerpos y/o linfocitos auto-reactivos, culminando en anormalidades metabólicas. En este estudio, la revisión de la literatura describe los mecanismos por los cuales determinados factores resultan en susceptibilidad para su desarrollo y, adicionalmente, las innovaciones en la predicción de ese desorden que, por cierto, van a contribuir para la atención de enfermería a los pacientes portadores de la diabetes tipo 1.O diabetes mellitus do tipo 1 tem sido considerado uma doença auto-imune órgão-específica, decorrente da destruição seletiva das células betapancreáticas. Apresenta patogenia complexa, envolvendo a participação de vários fatores, dentre esses a susceptibilidade imunogenética com forte associação aos genes de histocompatibilidade (HLA), eventos ambientais e resposta auto-imune com presença de auto-anticorpos e/ou linfócitos auto-reativos, culminando em anormalidades metabólicas. Neste estudo, a revisão da literatura descreve os mecanismos pelos quais determinados fatores conferem susceptibilidade para o seu desencadeamento e, adicionalmente, as inovações na predição dessa desordem que, certamente, contribuirão para a assistência de enfermagem aos pacientes portadores do diabetes tipo 1

Risco cardiovascular em nipobrasileiros

Objective: To evaluate the prevalence of risk factors for cardiovascular disease in Japanese-Brazilian subjects. Subjects and methods: One hundred thirty-one residents of the Mombuca community were studied. Statistical analysis was based on the X-2 test, Fisher's Exact test, Student's t test, and ANOVA, at a 5% significance level. Results: The average age was 56.7 years-old; 76.3% had dyslipidemia, 24.4% pre-diabetes (PDM), 10.7% type 2 diabetes mellitus (T2DM), 46.6% hypertension, 52.7% abdominal obesity, and 35.8% metabolic syndrome (MS). There were significant correlations between HOMA-IR and MS diagnosis and obesity, while HOMA-beta levels were decreased in T2DM and PDM. The ankle-brachial index was positive for peripheral artery disease in 22.3% of the individuals. Electrocardiograms did not show increased evidence of myocardial ischemia. Conclusion: Subjects of this community are exposed to major cardiovascular risk factors, namely high prevalence of MS diagnoses and increased HOMA-IR. Arq Bras Endocrinol Metab. 2012; 56(9): 608-13Objetivo: Avaliar a presença de fatores de risco para doença cardiovascular em nipo-brasileiros. \ud Sujeitos e métodos: Foram estudados 131 moradores de Mombuca. Utilizaram-se os testes do \ud Qui-quadrado, Exato de Fisher, t de Student e ANOVA, com significância de 5%. Resultados: A \ud média de idade foi de 56,7 anos; 76,3% tinham dislipidemia, 24,4% pré-diabetes (PDM), 10,7% \ud diabetes melito tipo 2 (DM2), 46,6% hipertensão, 52,7% obesidade abdominal e 35,8% síndrome \ud metabólica (SM). Houve correlação significativa do HOMA-IR com SM e obesidade, enquanto \ud HOMA-b esteve reduzido na presença de DM2 e PDM. O índice tornozelo-braquial foi positivo \ud para doença arterial periférica em 22,3% dos indivíduos. O eletrocardiograma não mostrou \ud aumento de isquemia miocárdica. Conclusão: A comunidade está exposta aos fatores de risco \ud maiores para doença cardiovascular, o que pode ser resumido pela alta prevalência de diagnóstico de SM e valores elevados de HOMA-IR. Arq Bras Endocrinol Metab. 2012;56(9):608-1

Identifying common and specific microRNAs expressed in peripheral blood mononuclear cell of type 1, type 2, and gestational diabetes mellitus patients

Abstract\ud \ud \ud \ud Background\ud Regardless the regulatory function of microRNAs (miRNA), their differential expression pattern has been used to define miRNA signatures and to disclose disease biomarkers. To address the question of whether patients presenting the different types of diabetes mellitus could be distinguished on the basis of their miRNA and mRNA expression profiling, we obtained peripheral blood mononuclear cell (PBMC) RNAs from 7 type 1 (T1D), 7 type 2 (T2D), and 6 gestational diabetes (GDM) patients, which were hybridized to Agilent miRNA and mRNA microarrays. Data quantification and quality control were obtained using the Feature Extraction software, and data distribution was normalized using quantile function implemented in the Aroma light package. Differentially expressed miRNAs/mRNAs were identified using Rank products, comparing T1DxGDM, T2DxGDM and T1DxT2D. Hierarchical clustering was performed using the average linkage criterion with Pearson uncentered distance as metrics.\ud \ud \ud \ud Results\ud The use of the same microarrays platform permitted the identification of sets of shared or specific miRNAs/mRNA interaction for each type of diabetes. Nine miRNAs (hsa-miR-126, hsa-miR-1307, hsa-miR-142-3p, hsa-miR-142-5p, hsa-miR-144, hsa-miR-199a-5p, hsa-miR-27a, hsa-miR-29b, and hsa-miR-342-3p) were shared among T1D, T2D and GDM, and additional specific miRNAs were identified for T1D (20 miRNAs), T2D (14) and GDM (19) patients. ROC curves allowed the identification of specific and relevant (greater AUC values) miRNAs for each type of diabetes, including: i) hsa-miR-1274a, hsa-miR-1274b and hsa-let-7f for T1D; ii) hsa-miR-222, hsa-miR-30e and hsa-miR-140-3p for T2D, and iii) hsa-miR-181a and hsa-miR-1268 for GDM. Many of these miRNAs targeted mRNAs associated with diabetes pathogenesis.\ud \ud \ud \ud Conclusions\ud These results indicate that PBMC can be used as reporter cells to characterize the miRNA expression profiling disclosed by the different diabetes mellitus manifestations. Shared miRNAs may characterize diabetes as a metabolic and inflammatory disorder, whereas specific miRNAs may represent biological markers for each type of diabetes, deserving further attention.This study was funded by the Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP - (FAPESP #2008/56594-8, FAPESP #2010/05622-1, FAPESP #210/00932-2, FAPESP #2010/12069-7), Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq # 563731/2010-9), and NAP-DIN (Núcleo de Apoio à Pesquisa em Doenças Inflamatórias)

Protocol for detection, diagnosis and treatment of diabetes mellitus during pregnancy

The authors present the approach to pregnant woman for screening and diagnosis of gestational diabetes mellitus (GDM) and treatment of the diabetes mellitus during pregnancy, established as routine by the Sector of High Risk Pregnancy of the Department and Gynecology and Obstetric and Division of Endocrinology and Metabolism of Medicine School of Ribeirão Preto - University of São Paulo and it was assumed as a routine pre-natal evaluation for screening and diagnosis of GDM at Ribeirão Preto Health Secretary’s Office. This protocol was based on the recommendations of the World Health Organization and the American Diabetes Organization.Os autores apresentam a abordagem da paciente gestante, para rastreamento e diagnóstico do Diabetes mellitus Gestacional (DMG) e tratamento do Diabetes mellitus durante a gravidez, estabelecida como procedimento rotineiro pelo Setor de Gestação de Alto Risco do Departamento de Ginecologia e Obstetrícia e Divisão de Endocrinologia e Metabologia do Departamento de Clínica Médica da Faculdade de Medicina de Ribeirão Preto - Universidade de São Paulo e adotado na avaliação pré-natal da Secretaria Municipal de Saúde de Ribeirão Preto para rastreamento e diagnóstico do DMG. Este protocolo foi baseado nas recomendações da Organização Mundial da Saúde e American Diabetes Association

Multiprofessional care of patients with diabetes mellitus at the endocrinology outpatient clinic of the university hospital of the Ribeirão Preto school of medicine (HCFMRP-USP)

The present study describes the flow of care delivery and activities with patients carriers of diabetes mellitus by a health multiprofessional team from the Endocrinology Outpatient Clinic of the University Hospital of the Ribeirão Preto School of Medicine. This program, according to the proposal of the America’s Declaration about Diabetes, aims at assuring to diabetes carriers conditions to acquire knowledge and skills regarding self-care.O presente estudo descreve o fluxo de atendimento e as atividades desenvolvidas pela equipe multiprofissional de saúde do Ambulatório de Endocrinologia e Metabologia do HCFMRPUSP, junto aos pacientes com diabetes mellitus. Este programa, em consonância aos propósitos da Declaração das Américas sobre Diabetes, visa assegurar que os pacientes com diabetes estejam em condições de adquirir conhecimentos e aptidões para o autocuidado

Health-related quality of life in patients with type 1 diabetes mellitus in the different geographical regions of Brazil : data from the Brazilian Type 1 Diabetes Study Group

Background: In type 1 diabetes mellitus (T1DM) management, enhancing health-related quality of life (HRQoL) is as important as good metabolic control and prevention of secondary complications. This study aims to evaluate possible regional differences in HRQoL, demographic features and clinical characteristics of patients with T1DM in Brazil, a country of continental proportions, as well as investigate which variables could influence the HRQoL of these individuals and contribute to these regional disparities. Methods: This was a retrospective, cross-sectional, multicenter study performed by the Brazilian Type 1 Diabetes Study Group (BrazDiab1SG), by analyzing EuroQol scores from 3005 participants with T1DM, in 28 public clinics, among all geographical regions of Brazil. Data on demography, economic status, chronic complications, glycemic control and lipid profile were also collected. Results: We have found that the North-Northeast region presents a higher index in the assessment of the overall health status (EQ-VAS) compared to the Southeast (74.6 ± 30 and 70.4 ± 19, respectively; p < 0.05). In addition, North- Northeast presented a lower frequency of self-reported anxiety-depression compared to all regions of the country (North-Northeast: 1.53 ± 0.6; Southeast: 1.65 ± 0.7; South: 1.72 ± 0.7; Midwest: 1.67 ± 0.7; p < 0.05). These findings could not be entirely explained by the HbA1c levels or the other variables examined. Conclusions: Our study points to the existence of additional factors not yet evaluated that could be determinant in the HRQoL of people with T1DM and contribute to these regional disparities

Regional differences in clinical care among patients with type 1 diabetes in Brazil: Brazilian Type 1 Diabetes Study Group

Background\ud To determine the characteristics of clinical care offered to type 1 diabetic patients across the four distinct regions of Brazil, with geographic and contrasting socioeconomic differences. Glycemic control, prevalence of cardiovascular risk factors, screening for chronic complications and the frequency that the recommended treatment goals were met using the American Diabetes Association guidelines were evaluated.\ud \ud Methods\ud This was a cross-sectional, multicenter study conducted from December 2008 to December 2010 in 28 secondary and tertiary care public clinics in 20 Brazilian cities in north/northeast, mid-west, southeast and south regions. The data were obtained from 3,591 patients (56.0% females and 57.1% Caucasians) aged 21.2 ± 11.7 years with a disease duration of 9.6 ± 8.1 years (<1 to 50 years).\ud \ud Results\ud Overall, 18.4% patients had HbA1c levels <7.0%, and 47.5% patients had HbA1c levels ≥ 9%. HbA1c levels were associated with lower economic status, female gender, age and the daily frequency of self-blood glucose monitoring (SBGM) but not with insulin regimen and geographic region. Hypertension was more frequent in the mid-west (32%) and north/northeast (25%) than in the southeast (19%) and south (17%) regions (p<0.001). More patients from the southeast region achieved LDL cholesterol goals and were treated with statins (p<0.001). Fewer patients from the north/northeast and mid-west regions were screened for retinopathy and nephropathy, compared with patients from the south and southeast. Patients from the south/southeast regions had more intensive insulin regimens than patients from the north/northeast and mid-west regions (p<0.001). The most common insulin therapy combination was intermediate-acting with regular human insulin, mainly in the north/northeast region (p<0.001). The combination of insulin glargine with lispro and glulisine was more frequently used in the mid-west region (p<0.001). Patients from the north/northeast region were younger, non-Caucasian, from lower economic status, used less continuous subcutaneous insulin infusion, performed less SBGM and were less overweight/obese (p<0.001).\ud \ud Conclusions\ud A majority of patients, mainly in the north/northeast and mid-west regions, did not meet metabolic control goals and were not screened for diabetes-related chronic complications. These results should guide governmental health policy decisions, specific to each geographic region, to improve diabetes care and decrease the negative impact diabetes has on the public health system.We thank Mrs. Karianne Aroeira Davidson, Mrs. Anna Maria Ferreira, Mrs. Elisangela Santos and Sandro Sperandei for their technical assistance.This work was supported by grants from Farmanguinhos/Fundação Oswaldo Cruz/National Health Ministry, the Brazilian Diabetes Society, Fundação do Amparo à Pesquisa do Estado do Rio de Janeiro, and Conselho Nacional de Desenvolvimento Científico e Tecnológico do Brasil