Efeito da suplementação de altas doses de colecalciferol sobre o comportamento da pressão arterial em pacientes normotensos com diabetes mellitus tipo 1

Type 1 diabetes mellitus is an endocrine disease highly associated to cardiovascular (CV) risk. Vitamin D (VD) deficiency has been associated to a burden of chronic diseases due to the presence of vitamin D receptors (VDR) through diverse human tissues such as smooth vascular muscle, endothelium, cardiomiocytes and juxtaglomerular cells. Some studies have suggested an inverse relationship between vitamin D levels and blood pressure. High mean blood pressure levels have been found in vitamin D deficient patients. Additionally, previous studies have suggested that the VD-VDR complex might act as a negative regulator factor over renin angiotensin system, which could be responsible for positive effects on blood pressure. The main objective of this study was to evaluate high doses vitamin D supplementation effects on blood pressure of normotensive T1DM patients. Our study was a prospective interventionist study in 35 T1DM patients. The patients with vitamin D lower them 30ng/ml received 10.000UI/daily e if was 30-60 ng/ml was gave 4.000UI/daily. They made 24-hour ambulatory blood pressure monitoring, gycated hemoglobin, creatin, lipids profile, PCRus, before and after 12 weeks. We found an expressing reduce of systolic and diastolic morning blood pressures (117 ± 14 vs 112±14, p<0,05; 74±9 vs 70±10 mmHg, p<0,05, respectively) with no changes in order pressoric markers. Besides, we notice correlation between levels of VD after supplementation and diastolic morning blood pressure (r= -0,4; p<0.05). In conclusion, our study suggest that was an association with supplementation of high doses of vitamin D and reduce of morning blood pressure in normotensives type 1 diabetes mellitus patients.O diabetes mellitus tipo 1 (DM1) é uma endocrinopatia associada a alto risco cardiovascular (CV). A deficiência de vitamina D (VD) foi relacionada ao desenvolvimento de diversas doenças sistêmicas, em função da presença de receptores de vitamina D (VDR) em variados tecidos, incluindo músculo liso vascular, endotélio, cardiomiócitos e células justa-glomerulares. Alguns estudos sugerem uma relação inversa entre níveis VD e valores pressóricos. Médias de pressão arterial (PA) maiores em pessoas deficientes em VD foram observadas. Adicionalmente, sugere-se que o complexo VD - VDR possa atuar como um fator de regulação negativo sobre o sistema renina-angiotensina-aldosterona, no aparelho justa-glomerular em diabéticos, podendo exercer efeitos positivos sobre o comportamento da pressão arterial. Desse modo, nosso estudo visou a avaliar o efeito da suplementação de altas doses de vitamina D sobre o comportamento da pressão arterial em pacientes com diabetes mellitus tipo 1 normotensos. Realizamos um estudo prospectivo e intervencionista em 35 pacientes com DM1. Aqueles que tinham níveis de VD inferiores a 30 ng/mL receberam 10.000 UI/ dia, e quando de 30 a 60 ng/mL, utilizaram 4.000 UI/dia. Os pacientes foram submetidos ao sistema de monitorização ambulatorial de pressão arterial por 24 horas (24h-MAPA), HbA1c, creatinina, lipídios e PCRus (proteína C reativa ultrassensível) no basal e após 12 semanas. Houve uma redução marcante nas pressões arteriais sistólica e diastólica matutinas ao final do estudo (117 ± 14 vs 112±14, p<0,05; 74±9 vs 70±10 mmHg, p<0,05, respectivamente), sem alterações em outras variáveis pressóricas. Observou-se também correlação entre o nível de vitamina D pós-suplementação e a PA diastólica matutina (r= -0,4; p <0,05). Nosso estudo sugerr uma associação entre a suplementação de altas doses de VD e redução da PA matutina em pacientes com diabetes mellitus tipo 1 normotensos.HUJBB - Hospital Universitário João de Barros Barret

The Ankle-Arm Index As a Predictive Risk Factor For Peripheral Arterial Disease In Patients With In Patients With Type 2 Diabetes Mellitus

Background: Peripheral arterial disease in patients with type 2 diabetes mellitus is an important risk factor for vascular events. Recommendations about whether ankle-brachial index should be performed differ depending on the source; therefore, it is necessary to re-evaluate the most important risk factors associated with peripheral arterial disease and whether it is useful to perform ankle-brachial index in newly diagnosed and drug-naïve patients with diabetes, independent of age or peripheral arterial disease symptoms. Methods: A total of 711 subjects were divided into groups: group 1, 600 type 2 diabetes mellitus patients, symptomatic or not for peripheral arterial disease; group 2, 61 type 2 diabetes mellitus patients newly diagnosed and drug naïve; and group 3, 50 subjects without diabetes. Ankle-brachial index, medical records and physical examination were performed in all patients, accessing cardiovascular risk factors. Results: Analysing group 1 asymptomatic patient to peripheral arterial disease, we found abnormal ankle-brachial index in 49% (77/156) ⩾50years and 42% (16/38) <50years (p=not significant). Considering drug-naïve patients, a peripheral arterial disease prevalence of 39% (24/61) was found; among these, 48% (13/27) were <50years and 32% (11/34) were ⩾50years (p=not significant). A forward stepwise regression model was developed, with type 2 diabetes mellitus duration (r2=0.12) and sedentary lifestyle (r2=0.14) found as independent variable predictors of severity of peripheral arterial disease, related to ankle-brachial index. Conclusion: We suggest that, in type 2 diabetes mellitus, ankle-brachial index should be measured at diagnosis. In addition, sedentary lifestyle was strongly associated with presence and severity of peripheral arterial disease

Cochlear dysfunction and microvascular complications in patients with type 1 diabetes mellitus

Abstract Sensorineural hearing impairment has been associated with DM, and it is probably linked to the same pathophysiological mechanisms as well-established in microvascular diabetes complications. The study of otoacoustic emissions (OAEs) is useful to identify subclinical cochlear dysfunction. Therefore, the aim of this study was to evaluate the association between abnormal OAEs responses, diabetic kidney disease (DKD) and diabetic cardiac autonomic neuropathy (CAN). We performed a cross-sectional study with 37 type 1 DM patients without auditory symptoms, submitted to the study of Distortion Product Otoacoustic Emissions (DPOAEs) and screened for DKD and CAN. The otoacoustic emissions responses were considered abnormal in 27/37 (73%) patients. A correlation was found between abnormal OAEs responses and presence of DKD (r = 0.36, p < 0.05), and 14/16 (88%) patients with a lower amplitude of OAEs in 8 kHz frequency band presented DKD. Abnormal OAEs responses in the 6 kHz frequency band were correlated with the presence (r = 0.41, p = 0.01) and severity of CAN (r = 0.44, p < 0.001). Additionally, 7/9 (78%) patients with abnormal OAE responses in this frequency also presented abnormal CAN scores. Our results suggest that abnormal otoacoustic emissions responses in high frequency bands are associated with diabetes microvascular complications and could be a risk marker for DKD and CAN, presenting low sensitivity and high specificity. Therefore, assuming that hearing impairment is a pre-clinical stage of hearing loss, performing distortion product otoacoustic emissions in T1DM patients with microvascular complications could be useful to identify those who would be benefit with regular audiologic follow up and tighter diabetes control