Impacto da teleconsulta farmacêutica no controle glicêmico de pessoas com diabetes mellitus tipo 2 em uma farmácia pública no Brasil: Protocolo de ensaio clínico randomizado (TelePharmaceutical Care Diabetes Trial) – TPCDT

Telepharmacy is a fundamental tool to ensure glycemic control in patients who don’t access health services. The objective of this protocol is to report the procedures of a randomized clinical trial that will evaluate the impact and economic evaluation of a pharmaceutical teleconsultation service for patients using dapagliflozin, recently incorporated by the Brazilian public health system for the treatment of type 2 diabetes (T2D). Patients aged 65 years or older, with T2D, and who withdraw dapagliflozin in a public pharmacy located in southern Brazil will be recruited. They will be electronically randomized with allocation for intervention or control group. The intervention will be conducted out through three teleconsultations, one per month, with a pharmacist. The main outcomes will be glycemic control (hemoglobin A1c) and treatment adherence. Secondary outcomes will include lipid profile, blood pressure, and body mass index, number of hospital admissions, number of emergency room visits, number of medical consultations performed, number of problems related to pharmacotherapy identified and resolved, cost related to service and quality of life. The economic evaluation will be carried out using time-driven activity-based costing. Through this research, we will be able to identify whether pharmaceutical teleconsultation services can complement face-to-face consultations to improve health outcomes in T2D patients on dapagliflozin. The study was registered in Clinical Trials (NCT05380596).La telefarmacia es una herramienta fundamental para asegurar el control glucémico en pacientes que no acceden a los servicios de salud. El objetivo de este protocolo es relatar los procedimientos de un ensayo clínico aleatorizado que evaluará el impacto y la evaluación económica de un servicio de teleconsulta farmacéutica para pacientes que utilizan dapagliflozina, recientemente incorporado por el sistema de salud pública brasileño para el tratamiento de la diabetes tipo 2 (DM2). ). Se reclutarán pacientes de 65 años o más, con DM2 y que retiren dapagliflozina en una farmacia pública ubicada en el sur de Brasil. Serán aleatorizados electrónicamente con asignación al grupo de intervención o de control. La intervención se realizará a través de tres teleconsultas, una por mes, con un farmacéutico. Los principales resultados serán el control glucémico (hemoglobina A1c) y la adherencia al tratamiento. Los resultados secundarios incluirán el perfil de lípidos, la presión arterial y el índice de masa corporal, la cantidad de ingresos hospitalarios, la cantidad de visitas a la sala de emergencias, la cantidad de consultas médicas realizadas, la cantidad de problemas relacionados con la farmacoterapia identificados y resueltos, el costo relacionado con el servicio y la calidad de vida. . La evaluación económica se realizará mediante costeo por actividades en función del tiempo. A través de esta investigación, podremos identificar si los servicios de teleconsulta farmacéutica pueden complementar las consultas presenciales para mejorar los resultados de salud en pacientes con DM2 que usan dapagliflozina. El estudio fue registrado en Ensayos Clínicos (NCT05380596).A telefarmácia é uma ferramenta fundamental para garantir o controle glicêmico em pacientes que não acessam os serviços de saúde. O objetivo deste protocolo é relatar os procedimentos de um ensaio clínico randomizado que avaliará o impacto e a avaliação econômica de um serviço de teleconsulta farmacêutica para pacientes em uso de dapagliflozina, recentemente incorporado pelo sistema público de saúde brasileiro para o tratamento do diabetes tipo 2 (DM2). Serão recrutados pacientes com idade igual ou superior a 65 anos, portadores de DM2 e que retirem dapagliflozina em uma farmácia pública localizada no sul do Brasil. Eles serão randomizados eletronicamente com alocação para grupo intervenção ou controle. A intervenção será realizada através de três teleconsultas, uma por mês, com um farmacêutico. Os principais desfechos serão o controle glicêmico (hemoglobina A1c) e a adesão ao tratamento. Os desfechos secundários incluirão perfil lipídico, pressão arterial e índice de massa corporal, número de internações hospitalares, número de atendimentos de emergência, número de consultas médicas realizadas, número de problemas relacionados à farmacoterapia identificados e resolvidos, custo relacionado ao serviço e qualidade de vida. A avaliação econômica será realizada usando o custeio baseado em atividades baseado no tempo. Por meio desta pesquisa, poderemos identificar se os serviços de teleconsulta farmacêutica podem complementar as consultas presenciais para melhorar os resultados de saúde em pacientes com DM2 em uso de dapagliflozina. O estudo foi registrado em Clinical Trials (NCT05380596)

Erratum to: The study of cardiovascular risk in adolescents – ERICA: rationale, design and sample characteristics of a national survey examining cardiovascular risk factor profile in Brazilian adolescents

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FUNCTIONAL CAPACITY IN CHILDREN AND ADOLESCENTS WITH CONGENITAL HEART DISEASE

ABSTRACT Objective: To evaluate the physical activity level and functional capacity of children and adolescents with congenital heart disease and to describe correlations between functionality, surgical and echocardiographic findings, metabolic and inflammatory profile and differences between acyanotic and cyanotic heart defects. Methods: A cross-sectional study including children and adolescents with congenital heart disease between six and 18 years old that were evaluated with the 6-minute walk test (6MWT) to assess functional capacity. The short version form of the International Physical Activity Questionnaire (IPAQ) was performed to evaluate physical activity levels. Also, echocardiography and blood collection, to evaluate the metabolic (blood glucose, lipids, insulin) and inflammatory markers (C-reactive protein), were assessed. Results: Twenty-five individuals were evaluated. Of them, 14 had acyanotic heart defects and 11 cyanotic heart defects. Mean age was 12.0±3.7 years, and 20 (80%) were male. IPAQ showed that six (24%) individuals were very active, eight (32%) were active, nine (36%) had irregular physical activity, and two (8%) were sedentary. The mean distance walked in the 6MWT, considering all studied individuals, was 464.7±100.4 m, which was 181.4±42.0 m less than the predicted (p=0.005). There was a positive correlation between Z score 6MWT and the number of surgical procedures (r=-0.455; p=0.022). Conclusions: Children and adolescents with congenital heart disease have low functional capacity, but they are not completely sedentary

Cardiovascular Changes in Animal Models of Metabolic Syndrome

Metabolic syndrome has been defined as a group of risk factors that directly contribute to the development of cardiovascular disease and/or type 2 diabetes. Insulin resistance seems to have a fundamental role in the genesis of this syndrome. Over the past years to the present day, basic and translational research has used small animal models to explore the pathophysiology of metabolic syndrome and to develop novel therapies that might slow the progression of this prevalent condition. In this paper we discuss the animal models used for the study of metabolic syndrome, with particular focus on cardiovascular changes, since they are the main cause of death associated with the condition in humans

Associação entre diabetes mellitus e gravidade da doença arterial coronariana em pacientes submetidos a intervenção coronária percutânea

Introdução: O diabetes mellitus está associado a um risco aumentado de doenças cardiovasculares. Pacientes com diabetes submetidos à revascularização miocárdica por intervenção coronariana percutânea (ICP) apresentam piores respostas ao tratamento, desenvolvendo mais complicações e reestenoses em curto e longo prazo. Objetivos: Avaliar a prevalência de diabetes mellitus buscando associação com a gravidade da doença arterial coronária (DAC) em pacientes submetidos à ICP em centro de referência no sul do Brasil. Métodos: Estudo transversal. Avaliados todos os pacientes submetidos à ICP entre novembro/2006 e dezembro/2007 em hospital de referência. Aplicado questionário previamente ao procedimento e realizada glicemia capilar em jejum. Realizada regressão logística para avaliar a associação entre diabetes e DAC. Resultados: Foram realizadas 617 ICPs, implantados 718 stents em 569 indivíduos (1,32 stents por intervenção). Destes, 177 pacientes (32,2%) foram considerados diabéticos. Características demográficas, fatores de risco para DAC, vaso-alvo, diâmetro do vaso e extensão da lesão foram semelhantes entre os grupos. Doença arterial coronária grave, categoria III e IV, foi encontrada em 51,2% dos pacientes com diabetes comparado com 37,6% dos sem diabetes (p< 0.001). Houve correlação significativa entre os níveis de glicemia e a gravidade da DAC (p<0,05). Conclusões: Existe associação entre a presença de diabetes e a gravidade angiográfica da DAC em pacientes submetidos à ICP, o que sugere que esta maior gravidade possa contribuir para os desfechos adversos nestes pacientes

Reversal of postprandial endothelial dysfunction by cyclooxygenase Inhibition in healthy volunteers

The aim of this study was to evaluate the role of cyclooxygenase (COX) in venous vascular reactivity changes after an oral lipid overload (OLO). Venous endothelial function (dorsal hand vein technique) was evaluated in fasting, 30 minutes after COX inhibition (aspirin-fasting), 2 to 4 hours after an OLO (1000 kcal,58% fat), and again after COX inhibition (aspirin-OLO, 600 mg/200 mL water) in 10 healthy adults (age, 28.1 6 1.3 years; body mass index, 22.3 6 0.6 kg/m2). Fasting, 2- to 4-hour post-OLO, and 60-minute postaspirin plasma glucose, insulin, and lipids were also evaluated. The OLO increased triglycerides and insulin, reduced lowdensity lipoprotein and high-density lipoprotein, but glycemia and total cholesterol remained unchanged. There were no metabolic differences between OLO and aspirin-OLO. In fasting, aspirin reduced acetylcholine-induced venodilation (107.0% 6 14% versus 57.3% 6 11%; P , 0.001). Vascular reactivity was blunted after the OLO (phenylephrine dose: 0.3 6 0.2 fasting versus 1.9 6 0.8 nmol/min after OLO; P , 0.001) and was partially corrected by aspirin (0.4 6 0.2; P , 0.001). Similar changes were observed in maximum venodilation after acetylcholine (107.0% 6 14% fasting versus 60.4% 6 9% after OLO, P , 0.001; aspirin-OLO: 95.9% 6 6%; P , 0.001). The responses to sodium nitroprusside remained unchanged during the study. We conclude that the OLO reduction in the endothelium-dependent venoconstriction and venodilation is partially the result of the action of COX

Forearm blood flow (FBF), forearm vascular resistance (FVR), and mean arterial pressure (MAP) immediately after the end of inspiratory loading (onset of forearm exercise), at minute 1, minute 2 and at the end of forearm exercise.

<p>Groups: Controls (C, closed squares), patients with type 2 diabetes without autonomic neuropathy (DM, open circles), and patients with type 2 diabetes and cardiovascular autonomic neuropathy (DM-CAN, closed circles). Data expressed as mean ± SD. Analysis: Generalized estimating equations (GEE) for repeated measures, followed by Bonferroni’s post hoc test. Panel A: group (p<0.05), time (p<0.05), interaction (p<0.05); Panel B: group (p = 0.29), time (p = 0.49), interaction (p = 0.34); Panel C: group (p = 0.34), time (p = 0.74), interaction (p = 0.16); Panel D: group (p<0.001), time (p<0.001), interaction (p<0.001); Panel E: group (p<0.001), time (p<0.001), interaction (p<0.001); Panel F: group (p<0.001), time (p<0.001), interaction (p<0.001); ^†p<0.05 <i>vs</i>. C.</p

Glucose levels as measured by the continuous subcutaneous glucose monitoring system (CGMS) at rest, breath control (grey bar), load (dark bar), handgrip exercise (black bar) and recovery period during placebo experiment (2% PImax) and during induction of the inspiratory muscle metaboreflex (60% PImax) in a random subgroup of 6 diabetic patients, both without cardiovascular autonomic neuropathy and with cardiovascular autonomic neuropathy.

<p>Data expressed as mean ± SD. Analysis: Generalized estimating equations (GEE) for repeated measures, followed by Bonferroni’s post hoc test. Group (Pimax load 2% <i>vs</i>. Pimax load 60%, p<0.05), time (p<0.001) and interaction (p<0.05). §p<0.05 <i>vs</i>. baseline; ^†p<0.05 <i>vs</i>. PImax load 2%.</p