A1C e o controle glicêmico: um desafio para todos

Universidade Federal de São Paulo (UNIFESP) Grupos de Educação e Controle do Diabetes do Hospital do Rim e HipertensãoHospital Alemão Oswaldo Cruz Centro de DiabetesUNIFESP, Grupos de Educação e Controle do Diabetes do Hospital do Rim e HipertensãoSciEL

Importance of nutritional counseling and dietary fiber content on glycemic control in type 2 diabetic patients under intensive educational intervention

OBJECTIVE: To evaluate the importance of nutritional counseling within a set of multidisciplinary interventions. SUBJECTS AND METHODS: Forty-seven patients with type 2 diabetes and hyperglycemia (A1C > 8%), treated conventionally (n = 19, GC) or intensively in six weekly visits (n = 28, GI) were analyzed. We evaluated mean weekly blood glucose (MWG) at baseline and after 6 weeks in both groups. RESULTS: GI reduced caloric (p = 0.001), carbohydrate (p = 0.004), and fat (p = 0.001) intake, and increased fiber consumption, while GC reduced fiber intake (p = 0.018). Glycemic control (MWG < 150 mg/dL) occurred in 75% of GI patients and in 31.6% of CG patients (p = 0.003), with negative correlation between changes in fiber intake and MWG values (r =-0.309; P = 0.035). Results were maintained after 12 weeks. CONCLUSION: Educational short-term intensive intervention was more effective than conventional treatment to achieve glycemic control. Our results also indicate that a more appropriate fiber content in the diet contributes for better blood glucose control in these patients.OBJETIVO: Avaliar a orientação nutricional dentro de um conjunto de intervenções multidisciplinares. SUJEITOS E MÉTODOS: Quarenta e sete pacientes diabéticos tipo 2, hiperglicêmicos, tratados de forma convencional (n = 19) ou intensiva (n = 28) e avaliados pela glicemia média semanal (GMS) no início e após 6 semanas. RESULTADOS: GI reduziu o consumo de calorias (p = 0,001), carboidratos (p = 0,004), lipídios (p = 0,001) e aumentou o de fibras, enquanto o GC reduziu o consumo de fibras (p = 0,018). Controle glicêmico (GMS < 150 mg/dL) ocorreu em 75% do GI e, em 31,6% do GC (p = 0,003), houve correlação negativa entre as variações do consumo de fibras e a GMS (r =-0,309; p = 0,035). Os resultados mantiveram-se por 12 semanas. CONCLUSÃO: A intervenção educacional intensiva de curto prazo mostrou-se mais eficaz que o tratamento convencional para a obtenção do controle glicêmico. Nossos resultados ainda indicam que um consumo mais adequado de fibras na alimentação contribui para a obtenção de um melhor controle da glicemia.Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)Universidade Federal de São Paulo (UNIFESP) Escola Paulista de Medicina Departamento de MedicinaUNIFESP-EPM Departamento de Medicina PreventivaUNIFESP, EPM, Depto. de MedicinaUNIFESP, EPM Depto. de Medicina PreventivaSciEL

Algorithm for the treatment of type 2 diabetes: a position statement of Brazilian Diabetes Society

The Brazilian Diabetes Society is starting an innovative project of quantitative assessment of medical arguments of and implementing a new way of elaborating SBD Position Statements. The final aim of this particular project is to propose a new Brazilian algorithm for the treatment of type 2 diabetes, based on the opinions of endocrinologists surveyed from a poll conducted on the Brazilian Diabetes Society website regarding the latest algorithm proposed by American Diabetes Association /European Association for the Study of Diabetes, published in January 2009

The interdisciplinary team in type 2 diabetes management:challenges and best practice solutions from real-world scenarios

The Global Partnership for Effective Diabetes Management has previously recommended the implementation of an interdisciplinary team (IDT) approach to type 2 diabetes (T2DM) management as one of 10 practical steps for health care professionals to help more people achieve their glycaemic goal. This article discusses some of the key contributors to success and also the challenges faced when applying IDT care, by examining case studies and examples from around the world. The real-world practices discussed show that implementing successful interdisciplinary care in diabetes is possible despite significant barriers such as established hierarchal structures and financial resource constraints. Instituting collaborative, integrated working relationships among multiple disciplines under strong leadership, together with enhanced and active communication and improved patient access to appropriate specialties is essential. Patients have a crucial role in the management of their own disease and including them as part of the treatment team is also critical. IDTs in diabetes care improve patient outcomes in terms of control of glycaemia and cardiometabolic risk factors, and decreased risk of diabetes complications. Ensuring access to an appropriate IDT, in whatever form, is paramount to enable the best care to be delivered

Eficácia de intervenções multifatoriais no controle em curto prazo do diabetes tipo 2: a randomized, controlled proof-of-concept study

O objetivo deste estudo foi o de testar a hipótese segundo a qual uma abordagem de ajustes mais frequentes da terapêutica farmacológica, associados a uma estratégia multifatorial e interdisciplinar poderia resultar numa melhora mais rápida do controle glicêmico, contribuindo, assim, para reforçar a adesão do paciente às recomendações e condutas terapêuticas definidas individualmente pela equipe de educação e controle do diabetes

Diabetes Guidelines May Delay Timely Adjustments During Treatment and Might Contribute to Clinical Inertia

Clinical inertia and poor knowledge by many physicians play an important role in delaying diabetes control. Among other guidelines, the Position Statement of the American Diabetes Association/European Association for the Study of Diabetes on Management of Hyperglycemia in Type 2 Diabetes is a respected guideline with high impact on this subject in terms of influencing physicians in the definition of strategic approach to overcome poor glycemic control. But, on the other hand, it carries a recommendation that might contribute to clinical inertia because it can delay the needed implementation of more vigorous, intensive, and effective strategies to overcome poor glycemic control within a reasonable time frame during the evolution of the disease. the same is true with other respected algorithms from different diabetes associations. Together with pharmacological interventions, diabetes education and more intensive blood glucose monitoring in the initial phases after the diagnosis are key strategies for the effective control of diabetes. the main reason why a faster glycemic control should be implemented in an effective and safe way is to boost the confidence and the compliance of the patient to the recommendations of the diabetes care team. Better and faster results in glycemic control can only be safely achieved with educational strategies, structured self-monitoring of blood glucose, and adequate pharmacological therapy in the majority of cases.Universidade Federal de São Paulo, Kidney & Hypertens Hosp, Diabet Educ & Control Grp, São Paulo, BrazilUniversidade Federal de São Paulo, Kidney & Hypertens Hosp, Dept Endocrinol, São Paulo, BrazilUniversidade Federal de São Paulo, Kidney & Hypertens Hosp, Diabet Educ & Control Grp, São Paulo, BrazilUniversidade Federal de São Paulo, Kidney & Hypertens Hosp, Dept Endocrinol, São Paulo, BrazilWeb of Scienc