Glycemic control in patients with diabetes mellitus and cardiovascular disease monitored at a reference outpatient clinic

Introduction: Controlling hyperglycemia in diabetes mellitus is an important part of the treatment and is associated with long-term reduction of chronic complications. However, it is difficult to achieve, and different approaches to glycemic control are being investigated. We aimed to analyze glycemic control in a sample of patients treated at a tertiary hospital, as well as to analyze possible predictors of good glycemic control during follow-up.Methods: In this observational study, we collected data from the electronic medical records of patients with type 2 diabetes treated at a reference outpatient clinic. We analyzed demographic, clinical and laboratory variables (blood glucose, glycosylated hemoglobin (HbA1c), lipids, creatinine and microalbuminuria).Results: Out of 57 patients, 61.4% (n = 35) had HbA1c levels ≤ 8% (controlled diabetes mellitus group, CDM), and 38.6% (n = 22) did not reach this value (uncontrolled diabetes mellitus group, UDM) in 1 year. Most patients in the UDM group were women (p = 0.030). Age, association with other comorbidities, educational attainment, and duration of diabetes were not different between groups. The number of scheduled appointments was similar between groups, but the number of attended appointments was higher in the UDM group. Initial glycemic control was worse in the UDM group (HbA1c 9.2 ± 1.4 vs. 11.0 ± 1.5%, p < 0.001). Outpatient discharge was more frequent in the CDM group (p = 0.01).Conclusion: Intensifying diabetes care by a specialized team at tertiary centers can improve metabolic control for the majority of these patients, especially for those with a lower HbA1c at the time of referral.

Perception of uncontrolled blood pressure and non-adhrenece to anti-hypertensive agents in diabetic hypertensive patients

We assessed the association between adherence to antihypertensive drug treatment and patient's perception of uncontrolled blood pressure (BP) in diabetic hypertensive subjects. This was a cross-sectional study that evaluated adherence to antihypertensives (Morisky questionnaire), patients' perception of abnormal BP, office BP, and ambulatory BP monitoring in diabetic hypertensive subjects. We evaluated 323 patients, 65.2% women, aged 56.5 ± 7 years, glycosylated hemoglobin (HbA1c) 8.0% (range, 6.9%–9.6%), diabetes duration of 10 years (range, 5–17 years). Adherence to drug treatment was 51.4%. Patients who reported hypertension-related symptoms (60.4%) had a lower level of adherence (P < .001). Non-adherence occurred four times more frequently in patients who reported hypertension-related symptoms (P < .001, adjusted for use of three or more anti-hypertensives, age, and duration of diabetes). Non-adherents had higher office diastolic BP (83.6 ± 11.9 vs. 79.8 ± 9.9; P = .003), but no difference between groups was observed considering systolic, diastolic, and mean BP evaluated by ambulatory BP monitoring. Low rates of adherence to antihypertensive drug treatment were observed in outpatient hypertensive diabetic subjects. Perception of uncontrolled BP levels was strongly and independently associated with non-adherence. Non-adherence determined repercussion on office BP that may have clinical implications in cardiovascular risk

Adesão ao tratamento medicamentoso anti-hipertensivo em pacientes hipertensos com diabetes : um estudo de coorte com avaliação de desfechos cardiovasculares

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Adesão ao tratamento medicamentoso anti-hipertensivo em pacientes hipertensos com diabetes

Realizou-se estudo transversal com o objetivo de avaliar a adesão ao tratamento medicamentoso anti-hipertensivo, buscando associação entre adesão ao tratamento, autopercepção dos níveis pressóricos e pressão arterial (PA). Foram obtidas variáveis clínicas, demográficas e laboratoriais. Para aferir adesão aplicou-se Questionário de Morisky (QMorisky) e escala visual (EV). Foi realizada a monitorização ambulatorial da pressão arterial de 24 horas (MAPA 24h) em todos os pacientes. Foram avaliados 225 pacientes, com idade de 56,5 ± 6,6 anos, 62,7% mulheres. Foram aderentes 46,2% e 56,9% considerando-se os métodos QMorisky e EV, respectivamente. Houve concordância moderada entre os dois métodos (Kappa = 0,53). Os pacientes que referiram sentir a PA alterada (59,8%) apresentaram um menor nível de adesão quando aplicado o QMorisky, P<0,001. Entretanto, tal diferença não resultou em diferenças significativas nos níveis pressóricos aferidos por MAPA 24h. Demonstrou-se com o presente estudo que pacientes que têm autopercepção da PA alterada aderem menos ao tratamento anti-hipertensivo, mas não se apresentam mais hipertensos quando comparados com aqueles que negam a autopercepção dos níveis pressóricos

Clinical features and outcomes in patients with diabetes mellitus undergoing coronary artery bypass graft in a reference center in southern Brazil

Objetivo: Descrever perfil/evolução de pacientes submetidos à cirurgia de revascularização miocárdica (CRM) em centro de referência cardiológico. Métodos: Estudo de coorte; avaliados todos os pacientes submetidos à CRM (janeiro/2004 e fevereiro/2006, n = 717) quanto às características clínicas/laboratoriais antes, durante e após a cirurgia (infecções, tempo de internação, óbitos). Resultados: Os pacientes tinham 61,9 ± 11 anos, 67,1% homens, 29,6% diabéticos. No transoperatório, aqueles com diabetes usaram cateter venoso central por mais tempo (p < 0,001), mas tempo de circulação extra-corpórea, de clampeamento da aorta e cirúrgico foi semelhante versus os sem diabetes. Infecção ocorreu em 19,1% dos pacientes (40,1% vs. 10,3% nos com e sem diabetes, p < 0,001). Tempo de permanência no hospital foi maior nos pacientes com diabetes versus pacientes sem diabetes, mas não houve diferença no número de óbitos ocorridos entre os grupos (p = 0,797). Conclusão: Pacientes com diabetes submetidos a CRM desenvolvem mais infecções e permanecem mais tempo internados do que aqueles sem diabetes.Objective: To describe clinical/laboratory features of patients undergoing coronary artery bypass graft (CABG) in a cardiology reference center. Methods: Cohort study; data from patients undergoing CABG (January 2004 to February 2006, n = 717) were evaluated for clinical/laboratory features before, during and after surgery (infections, duration of hospital stay, deaths). Results: Patients were 61.9 ± 11 years old, 67.1% males, 29.6% diabetics. Intraoperatively, diabetics had a central venous catheter placed for a longer period (p < 0.001), but extracorporeal circulation, aortic clamping and total surgery times were similar to those for non-diabetics. Infection occurred in 19.1% of patients (40.1% diabetics vs. 10.3% non-diabetics, p < 0.001). The duration of hospital stay was longer for patients with diabetes vs. non-diabetic patients, but there was no difference in deaths between the two groups (p = 0.797). Conclusion: Patients with diabetes undergoing CABG develop more infectious diseases and stay longer in hospital than non-diabetics

Predictors of infection in post-coronary artery bypass graft surgery

Introdução: Embora a cirurgia de revascularização miocárdica (CRM) seja uma boa alternativa terapêutica na doença arterial grave, pode evoluir com complicações, especialmente infecções. Objetivos: Determinar a incidência de infecção no pósoperatório de CRM e seus preditores clínicos em um centro de referência cardiológico brasileiro. Métodos: Estudo de coorte. Foram coletados dados de todos os pacientes submetidos à CRM entre janeiro/2004 e fevereiro/2006, excluindo-se cirurgias de urgência, sem glicemia pré-operatória e com infecção prévia à cirurgia. Análise estatística: teste t-Student, qui quadrado e regressão logística. Resultados: Foram avaliados 717 pacientes, 61,9 ± 11 anos, 67,1% homens, 29,6% com diabetes, dos quais 137 (19,1%) desenvolveram infecção (62% respiratória, 25% superficial de ferida operatória, 9,5% urinária, 3,6% profunda de ferida operatória). Diabetes foi mais prevalente naqueles que desenvolveram infecção, assim como maior tempo de permanência do cateter venoso central (79,3 ± 40,5 vs. 61,0 ± 19,3 h, P<0,001). Após análise multivariada (modelo ajustado para dislipidemia, hipertensão, tabagismo e leucócitos), tanto diabetes (OR 4,18 [2,60-6,74]), quanto tempo de permanência do cateter venoso central (OR 1,019 [1,00-1,02]) e cateterismo cardíaco durante a internação (OR 2,03 [1,14- 3,60] mantiveram-se preditores do desfecho infecção (P<0,001). Apesar do diabetes estar associado a maior percentual de infecções (P<0,001), glicemia do pré-operatório não se associou a maior risco de infecção. Conclusões: Diabetes e tempo de permanência do cateter venoso central se associaram ao desenvolvimento de infecção no pós-operatório de CRM. A glicemia pré-operatória não foi preditora de risco de infecção, provavelmente havendo necessidade de caracterização mais detalhada do controle glicêmico trans e pós-operatório imediato.Background: Although coronary artery bypass grafting (CABG) is a good alternative therapy in severe arterial disease, it may evolve with complications, especially infections. Objectives: To determine the incidence of infection in post-CABG and its clinical predictors in a cardiology reference center in Brazil. Methods: Cohort study. Data were collected from all patients undergoing CABG between January/2004 and February/2006, excluding emergency surgery, absent record of glucose blood levels preoperatively and infection prior to surgery. Statistical analysis: Student’s t test, chi square, logistic regression. Results: We evaluated 717 patients, 61.9 ± 11 years old, 67.1% were men, 29.6% with diabetes, of whom 137 (19.1%) developed infection (62% respiratory, 25% superficial wound, 9.5% urinary, 3.6% deep wound). Diabetes was more prevalent in those who developed infection, as well as prolonged time of indwelling central venous catheter (79.3 ± 40.5 vs. 61.0 ± 19.3 hours, P<0.001). After multivariate analysis (model adjusted for dyslipidemia, hypertension, smoking and leukocytes), both diabetes (OR 4.18 [2.60-6.74]), prolonged central venous line (OR 1.019 [1.00-1.02] and cardiac catheterism (OR 2.03 [1.14-3.60] remained predictors of infection. While diabetes is associated with a higher percentage of infections (P <0.001), preoperative serum glucose was not associated with increased risk of infection. Conclusions: Diabetes and permanence of central venous catheters were associated with development of infection in post-CABG. The preoperative blood glucose was not a predictor of risk of infection. It is probably necessary to study with greater detail glycemic control trans- and postoperatively