PERFIL E EVOLUÇÃO CLÍNICA DOS PACIENTES COM DIABETES MELLITUS TIPO 1: ESTUDO LONGITUDINAL EM UM CENTRO DE REFERÊNCIA SECUNDÁRIA DE MINAS GERAIS

RESUMO Objetivou-se avaliar o perfil e a evolução clínica dos pacientes com diabetes mellitus tipo 1 (DM1) de um centro de referência secundária de Minas Gerais. Trata-se de estudo longitudinal com 174 pessoas com DM1 atendidos em um centro de referência secundária de Minas Gerais no período de 2010 a 2015. Avaliaram-se variáveis sociodemográficas, tempo de diabetes, tratamento, comorbidades, hemoglobina glicada (A1c) e LDL colesterol. Utilizou-se o teste T pareado e de McNemar para as comparações anuais da A1c e do LDL-c, com nível de significância inferior a 5%. Os resultados mostraram que 5,7% dos pacientes estavam em uso de sistema contínuo de infusão de insulinas, 61,5% de NPH e 32,8% de glargina; 47,1% dos pacientes usavam estatina; 63,21% chegaram ao serviço com valores de A1c acima de 8%, sendo 27,0% acima de 10%. Ao final do primeiro ano de acompanhamento, esse percentual reduziu-se para 49,9%, com maior redução dos que tinham A1c acima de 9%. Observouse diminuição significativa nas médias de A1c (9,01±2.46 em 2010 e 8,2±1.74 em 2011;

VALIDAÇÃO DO INSTRUMENTO DE AVALIAÇÃO DO CONHECIMENTO DOS AGENTES COMUNITÁRIOS DE SAÚDE SOBRE DIABETES

RESUMO Objetivo: elaborar, adequar culturalmente e validar o “conhecimento dos agentes comunitários de saúde (ACS) sobre diabetes” – diabetes-ACS – para avaliação do conhecimento dos ACS sobre diabetes mellitus. Métodos: estudo metodológico desenvolvido em três etapas: a) construção do instrumento; b) validação de conteúdo e adequação cultural com médicos de família e ACS, seguidas de avaliação das sugestões por comitê de especialistas; c) validação psicométrica do instrumento a partir de sua aplicação em uma amostra de 102 ACS, por meio da ferramenta e-Surv. As análises de consistência interna e reprodutibilidade foram realizadas no ambiente de programação estatística R. Resultados: o instrumento, constituído de 29 questões de múltipla escolha, apresentou consistência interna satisfatória, com alfa de Cronbach 0,732 (IC 95% 0,652; 0,802) e coeficiente de correlação intraclasse de 0,70 (IC 95% 0,59–0,79), entre os escores do teste e do reteste. Conclusão: considera-se adequado e validado o instrumento diabetes-ACS para avaliação de agentes comunitários de saúde

Effects of different exercise programs and minimal detectable changes in hemoglobin A1c in patients with type 2 diabetes

The incidence of diabetes mellitus is increasing worldwide, resulting in a global epidemic. The most common type, the type 2 diabetes mellitus, constitutes of 90–95 % of the cases and is characterized by the action of and/or impaired insulin secretion. Regular exercise is a recommended strategy in several studies and guidelines for type 2 diabetes control and complications associated with it. Therefore, we evaluated and compared the effects of aerobic and strength exercise programs on the glycemic control in patients with type 2 diabetes. The selected patients were divided into groups which performed moderate strength training (ST) and aerobic training (AT). The study lasted 20 weeks and was divided into two 10 week phases with anthropometric (body mass index, waist, abdomen and hips circumferences, waist/hip ratio) and biochemical (glycemic and lipid profile) assessments at baseline, 10 weeks and 20 weeks. For intra and inter analyses a mixed ANOVA model was used. Individual changes were calculated using the minimum detectable change, based on a 90 % confidence interval. Eleven patients (five men and six women) completed the 20 weeks of training; five from the ST group and six from the AT. No significant changes were observed in any anthropometric variable in either group. Statistically significant differences were found in mean hemoglobin A1c in both groups between baseline (AT: 8.6 ± 2.5; ST: 9.2 ± 1.9) and 10 weeks (AT: 7.2 ± 1.7; ST: 7.9 ± 1.2) (p = 0.03), and baseline (AT: 8.6 ± 2.5; ST: 9.2 ± 1.9) and 20 weeks (AT: 7.5 ± 1.7; ST: 7.4 ± 0.9) (p = 0.01). For the minimal detectable changes, 40 % of the ST and 33 % of AT achieved these changes for hemoglobin A1c. Both aerobic and strength exercises can help the metabolic control in patients with type 2 diabetes, even without significant changes in anthropometry over the 20 weeks of training. However, this period was sufficient to cause changes in hemoglobin A1c values and the estimated average glucose, which are important parameters in controlling diabetes, thus signaling an important consequence of adhering to an exercise routine for type 2 diabetic patients

Type 1 diabetes mellitus: can coaching improve health outcomes?

ABSTRACT Objective: To evaluate the introduction of coaching in the interdisciplinary care of individuals with type 1 diabetes mellitus in the public health care system. Subjects and methods: Ten patients routinely attending a public health care service and with a glycated hemoglobin (HbA1c) level above 75% participated in eight coaching sessions. This study evaluated the patients' self-management of the disease and personal behavior. The participants were assessed at the beginning of the program and on two occasions after the intervention, with evaluation of biochemical and anthropometric data, and frequency of self-monitoring of blood glucose (SMBG). Questionnaires were applied during these evaluations to analyze emotional burden (B-PAID), medication adherence (Morisky Adherence Scale), and self-efficacy (IMDSES). Results HbA1c had a median level of 8.0% (range 76-10.3%) at the beginning of the study and reduced significantly 3 months after initiation of the intervention (7.78% [6.5-10%], p = 0.028), with no significant increase at 6 months (8.3% [713-9.27%], p = 0.386). SMBG improved significantly from the beginning to the end of the study, with the median number of glucose tests per week varying from 16.5 (range 0-42) at baseline to 29.0 (7-42) at 3 months and 27.5 (10-48) at 6 months (p = 0.047). No significant differences were observed in anthropometric parameters or in the scores of the instruments between the three measurements. Conclusion: A coaching intervention focused on patients' values and sense of purpose may provide added benefit to traditional diabetes education programs and could be an auxiliary method to help individuals with type 1 diabetes achieve their treatment goals

Centro Hiperdia Minas: avaliação da intervenção interdisciplinar no cuidado de usuários com diabetes tipo 2

Introduction: Diabetes mellitus is a growing pandemic, affecting costs related to health and quality of life of the population. The Chronic Conditions Care Model has been adopted to minimize such impacts. In Minas Gerais, among the actions developed in this perspective, the implementation of Hiperdia Minas Centers stands out. Such model advocates, among other actions, the interdisciplinary approach and user-centered attention. Objective: To analyze the effectiveness of interdisciplinary intervention in the care of users with type 2 diabetes mellitus assisted by the Hiperdia Minas Center of Viçosa Health Region Materials and Methods: We used data recorded in the medical records of 95 users with type 2 diabetes treated from 2011 to 2015 and evaluated the initial and final data. Results: The evaluation of the interdisciplinary intervention indicated significant improvement in glycated hemoglobin and cholesterol levels, in relation to the data obtained in the first consultation, in addition to the appropriate drug prescription. On the other hand, there was no improvement in BMI and triglyceride rates, and it is also important to highlight the service's difficulties in assessing complications of type 2 diabetes. Conclusion: The creating initiative of Hiperdia Minas Centers is important advance. The team presented satisfactory performance, although weaknesses are perceived.Introdução: O diabetes mellitus configura-se como uma pandemia em crescimento, impactando nos custos relativos à saúde e à qualidade de vida da população. O Modelo de Atenção às Condições Crônicas tem sido adotado com intuito de minimizar tais impactos. Em Minas Gerais, dentre as ações desenvolvidas nesta perspectiva, destaca-se a implementação dos Centros Hiperdia Minas. Tal modelo preconiza, entre outras ações, o enfoque interdisciplinar e a atenção centrada no usuário. Objetivo: Analisar a eficácia da intervenção interdisciplinar no cuidado aos usuários com diabetes mellitus tipo 2 assistidos pelo Centro Hiperdia Minas da Região de Saúde de Viçosa. Materiais e Métodos: Foram utilizados dados registrados nos prontuários de 95 usuários com diabetes tipo 2 atendidos no período de 2011 a 2015, sendo avaliados os dados iniciais e finais. Resultados: A avaliação da intervenção interdisciplinar indicou melhora significativa na hemoglobina glicada e nos níveis de colesterol, em relação aos dados obtidos na primeira consulta, além da adequada prescrição medicamentosa. Por outro lado, não houve melhora nos índices de IMC e triglicérides, sendo importante ressaltar também as dificuldades do serviço na avaliação das complicações do diabetes tipo 2. Conclusão: A iniciativa de criação dos Centros Hiperdia Minas representa um importante avanço na atenção aos diabéticos. A equipe apresentou desempenho satisfatório, embora sejam percebidas fragilidades. &nbsp

Validation of a screening tool for identifying Brazilians with impaired glucose tolerance

This study was designed to validate a self-assessment tool for identifying Brazilians with Impaired Glucose Tolerance (IGT). The Finnish Diabetes Risk Score (FINDRISC) was applied in 829 people aged over 40 years without previous diagnosis of diabetes between November 2009 and April 2010 at the Viçosa city, Minas Gerais, Brazil. We randomly selected 300 subjects in the initial survey, which received by post a letter of invitation to attend the laboratory for the collection of the blood sample to identify levels of glycated hemoglobin (A1C). Of these 300 subjects invited, 162 attended subjects, this being the final sample for the validation study. The risk score was evaluated through the Area Under the Curve (AUC) in a Receiver Operating Characteristics (ROC) curve. We assume a maximum error of 5 % and confidence interval 95 %. The prevalence of IGT and diabetes according to the A1C test were 21.6 % and 8.6 % respectively. The Diabetes Risk Score value varied from 1 to 25. The AUC by considering all values of A1C ≥ 6.0 % was 0.69 (95 % CI 0.61–0.76). The score value ≥ 9 had sensitivity of 75.51 %, specificity of 49.56 %, Positive Predictive Value (PPV) of 39.4 % and Negative Predictive Value (NPV) of 82.4 %. The FINDRISC is a suitable tool to identify Brazilians with IGT

Aerobic exercise did not have compensatory effects on physical activity levels in type 2 diabetes patients

Although exercise promotes beneficial effects in diabetic patients, some studies have questioned the degree of their importance in terms of the increase in total energy expenditure. In these studies, the decrease of physical activity levels (PAL) was referred as “compensatory effect of exercise”. However, our aim was to investigate whether aerobic exercise has compensatory effects on PAL in type 2 diabetes patients. Eight volunteers (51.1 ± 8.2 years) were enrolled in a supervised exercise programme for 8 weeks (3 d · wk−1, 50–60% of VO2 peak for 30–60 min). PAL was measured using tri-axial accelerometers in the 1st, 8th and 12th weeks. Biochemical tests, cardiorespiratory fitness, anthropometric assessment and body composition were measured in the 2nd and 11th weeks. Statistical analysis was performed using non-parametric tests (Friedman and Wilcoxon, P < 0.05). We found no significant differences in PAL between intervention periods, and participants spent the majority of their awake time in sedentary activities. However, the exercise programme generated a significant 14.8% increase in VO2 peak and a 15% reduction in fructosamine. The exercise programme had no compensatory effects on PAL in type 2 diabetes patients, but improved their cardiorespiratory fitness and glycaemic control

Association of different biomarkers of renal function with D-dimer levels in patients with type 1 diabetes mellitus (renal biomarkers and D-dimer in diabetes)

ABSTRACT Objective This study aimed to evaluate the association between different renal biomarkers with D-Dimer levels in diabetes mellitus (DM1) patients group classified as: low D-Dimer levels (< 318 ng/mL), which included first and second D-Dimer tertiles, and high D-Dimer levels (≥ 318 ng/mL), which included third D-Dimer tertile. Materials and methods D-Dimer and cystatin C were measured by ELISA. Creatinine and urea were determined by enzymatic method. Estimated glomerular filtration rate (eGFR) was calculated using CKD-EPI equation. Albuminuria was assessed by immunoturbidimetry. Presence of renal disease was evaluated using each renal biomarker: creatinine, urea, cystatin C, eGFR and albuminuria. Bivariate logistic regression analysis was performed to assess which renal biomarkers are associated with high D-Dimer levels and odds ratio was calculated. After, multivariate logistic regression analysis was performed to assess which renal biomarkers are associated with high D-Dimer levels (after adjusting for sex and age) and odds ratio was calculated. Results Cystatin C presented a better association [OR of 9.8 (3.8–25.5)] with high D-Dimer levels than albuminuria, creatinine, eGFR and urea [OR of 5.3 (2.2–12.9), 8.4 (2.5–25.4), 9.1 (2.6–31.4) and 3.5 (1.4–8.4), respectively] after adjusting for sex and age. All biomarkers showed a good association with D-Dimer levels, and consequently, with hypercoagulability status, and cystatin C showed the best association among them. Conclusion Therefore, cystatin C might be useful to detect patients with incipient diabetic kidney disease that present an increased risk of cardiovascular disease, contributing to an early adoption of reno and cardioprotective therapies