Implantação da tecnica de detecção de anticorpos antiilhota pancreatica e sua aplicação em pacientes e irmãos de pacientes com diabetes mellitus tipo I

Orientador: Ricardo PasquiniCo-orientador: Luis Fernando Bleggi TorresDissertação (mestrado) - Universidade Federal do Parana, Setor de Ciencias da SaudeResumo: Desde a primeira descrição dos anticorpos citoplasmáticos contra células da ilhota (ICAs) em pacientes com diabetes tipo I, estes marcadores humorais vem sendo progressivamente mais utilizados em investigação clínica. No presente estudo, um método para detecção dos ICAs foi implantado no Hospital de Clínicas da Universidade Federal do Paraná. Os anticorpos foram determinados de acordo com um protocolo padrão, baseado na técnica convencional de imunofluorescência indireta, em cortes de pâncreas humano realizados em criostato. ICAs foram primeiramente pesquisados pesquisando-se 5 pâncreas diferentes e 10 amostras de soro. Através da comparação dos resultados com aqueles obtidos na Universidade de Minnesota, um dos pâncreas foi selecionado para ser usado na segunda parte do estudo. Uma curva padrão foi construída, baseada no título final de diluição obtido neste mesmo pâncreas para diferentes diluições do soro internacional de referência, possibilitando a expressão dos resultados em unidades JDF (Juvenile Diabetes Foundation). A prevalência dos ICAs foi então determinada em cinqüenta crianças e jovens com diabetes tipo I recémdiagnosticado e em 40 irmãos não-afetados de pacientes com diabetes tipo I. A porcentagem encontrada de pacientes com ICAs na instalação do diabetes (66%) se encontra dentro da variação descrita por outros (50-84%). A freqüência relativamente alta de ICAs no grupo de irmãos (5%) exige testes futuros em um número maior de pessoas, com acompanhamento rigoroso.Abstract: Since the first description of cytoplasmic islet cell antibodies (ICA) in type I diabetic patients, these humoral markers have been increasingly applied in clinical investigations. In this study, a method for ICA detection was established at the Hospital de Clínicas of the Universidade Federal do Paraná. These antibodies were determined according to a standard protocol based on the conventional indirect immunofluorescence technique, on cryostat sections of human pancreas. ICA were first determined using 5 different pancreata and 10 serum samples. By comparison of results with those obtained at the University of Minnesota, one of the pancreas was selected to be used in the second part of the study. A standard curve was constructed based on end-point titers obtained on this very pancreas for different dilutions of the international reference serum, making it possible to express the results in JDF (Juvenile Diabetes Foundation) units. The prevalence of ICA was then studied in 50 newly diagnosed children and juveniles with type I diabetes, and in 40 unaffected siblings of type I diabetic patients. The percentage of patients with ICA at the onset of the disease (66%) was within the range reported by others (50-84%). The relatively high frequency of ICA in the group of siblings (5%) demands further testing in a greater number of persons, and close follow-u

Health-related quality of life in patients with type 1 diabetes mellitus in the different geographical regions of Brazil : data from the Brazilian Type 1 Diabetes Study Group

Background: In type 1 diabetes mellitus (T1DM) management, enhancing health-related quality of life (HRQoL) is as important as good metabolic control and prevention of secondary complications. This study aims to evaluate possible regional differences in HRQoL, demographic features and clinical characteristics of patients with T1DM in Brazil, a country of continental proportions, as well as investigate which variables could influence the HRQoL of these individuals and contribute to these regional disparities. Methods: This was a retrospective, cross-sectional, multicenter study performed by the Brazilian Type 1 Diabetes Study Group (BrazDiab1SG), by analyzing EuroQol scores from 3005 participants with T1DM, in 28 public clinics, among all geographical regions of Brazil. Data on demography, economic status, chronic complications, glycemic control and lipid profile were also collected. Results: We have found that the North-Northeast region presents a higher index in the assessment of the overall health status (EQ-VAS) compared to the Southeast (74.6 ± 30 and 70.4 ± 19, respectively; p < 0.05). In addition, North- Northeast presented a lower frequency of self-reported anxiety-depression compared to all regions of the country (North-Northeast: 1.53 ± 0.6; Southeast: 1.65 ± 0.7; South: 1.72 ± 0.7; Midwest: 1.67 ± 0.7; p < 0.05). These findings could not be entirely explained by the HbA1c levels or the other variables examined. Conclusions: Our study points to the existence of additional factors not yet evaluated that could be determinant in the HRQoL of people with T1DM and contribute to these regional disparities

Implantação da tecnica de detecção de anticorpos antiilhota pancreatica e sua aplicação em pacientes e irmãos de pacientes com diabetes mellitus tipo I

Orientador: Ricardo PasquiniCo-orientador: Luis Fernando Bleggi TorresDissertação (mestrado) - Universidade Federal do Parana, Setor de Ciencias da SaudeResumo: Desde a primeira descrição dos anticorpos citoplasmáticos contra células da ilhota (ICAs) em pacientes com diabetes tipo I, estes marcadores humorais vem sendo progressivamente mais utilizados em investigação clínica. No presente estudo, um método para detecção dos ICAs foi implantado no Hospital de Clínicas da Universidade Federal do Paraná. Os anticorpos foram determinados de acordo com um protocolo padrão, baseado na técnica convencional de imunofluorescência indireta, em cortes de pâncreas humano realizados em criostato. ICAs foram primeiramente pesquisados pesquisando-se 5 pâncreas diferentes e 10 amostras de soro. Através da comparação dos resultados com aqueles obtidos na Universidade de Minnesota, um dos pâncreas foi selecionado para ser usado na segunda parte do estudo. Uma curva padrão foi construída, baseada no título final de diluição obtido neste mesmo pâncreas para diferentes diluições do soro internacional de referência, possibilitando a expressão dos resultados em unidades JDF (Juvenile Diabetes Foundation). A prevalência dos ICAs foi então determinada em cinqüenta crianças e jovens com diabetes tipo I recémdiagnosticado e em 40 irmãos não-afetados de pacientes com diabetes tipo I. A porcentagem encontrada de pacientes com ICAs na instalação do diabetes (66%) se encontra dentro da variação descrita por outros (50-84%). A freqüência relativamente alta de ICAs no grupo de irmãos (5%) exige testes futuros em um número maior de pessoas, com acompanhamento rigoroso.Abstract: Since the first description of cytoplasmic islet cell antibodies (ICA) in type I diabetic patients, these humoral markers have been increasingly applied in clinical investigations. In this study, a method for ICA detection was established at the Hospital de Clínicas of the Universidade Federal do Paraná. These antibodies were determined according to a standard protocol based on the conventional indirect immunofluorescence technique, on cryostat sections of human pancreas. ICA were first determined using 5 different pancreata and 10 serum samples. By comparison of results with those obtained at the University of Minnesota, one of the pancreas was selected to be used in the second part of the study. A standard curve was constructed based on end-point titers obtained on this very pancreas for different dilutions of the international reference serum, making it possible to express the results in JDF (Juvenile Diabetes Foundation) units. The prevalence of ICA was then studied in 50 newly diagnosed children and juveniles with type I diabetes, and in 40 unaffected siblings of type I diabetic patients. The percentage of patients with ICA at the onset of the disease (66%) was within the range reported by others (50-84%). The relatively high frequency of ICA in the group of siblings (5%) demands further testing in a greater number of persons, and close follow-u

Prevalence of adults with type 1 diabetes who meet the goals of care in daily clinical practice: A nationwide multicenter study in Brazil

Objective: To determine the prevalence of patients with type 1 diabetes mellitus who meet the glycemic and cardiovascular (CV) risk factors goals and the frequency of screening for diabetic complications in Brazil according to the American Diabetes Association guidelines. Research design and methods: This was a cross-sectional, multicenter study conducted between December 2008 and December 2010 in 28 public clinics in 20 Brazilian cities. Data were obtained from 1774 adult patients (56.8% females, 57.2% Caucasians) aged 30.3 +/- 9.8 years with diabetes duration of 14.3 +/- 8.8 years. Results: Systolic blood pressure was at goal in 40.3% and diastolic blood pressure was at goal in 26.6% of hypertensive patients. LDL cholesterol and HbA1c were at the goal in 45.2% and 13.2% of the patients, respectively. Overweight was presented in 25.6% and obesity in 6.9%. Among those with more than 5 years of disease, screening for retinopathy was performed in the preceding year in 70.1%. Nephropathy and feet complications were screened in 63.1% and 65.1%, respectively. Conclusions: The majority of patients did not meet metabolic control goals and a substantial proportion was not screened for diabetic complications. These issues may increase the risk of chronic complications and negatively impact public health. (C) 2012 Elsevier Ireland Ltd. All rights reserved.Farmanguinhos/Fundacao Oswaldo Cruz/National Health MinistryFarmanguinhos/Fundacao Oswaldo Cruz/National Health MinistryFundacao do Amparo a Pesquisa do Estado do Rio de JaneiroFundacao do Amparo a Pesquisa do Estado do Rio de JaneiroConselho Nacional de Desenvolvimento Cientifico e Tecnologico do BrasilConselho Nacional de Desenvolvimento Cientifico e Tecnologico do BrasilBrazilian Diabetes SocietyBrazilian Diabetes Societ

Health-related quality of life in patients with type 1 diabetes mellitus in the different geographical regions of Brazil : data from the Brazilian Type 1 Diabetes Study Group

Background: In type 1 diabetes mellitus (T1DM) management, enhancing health-related quality of life (HRQoL) is as important as good metabolic control and prevention of secondary complications. This study aims to evaluate possible regional differences in HRQoL, demographic features and clinical characteristics of patients with T1DM in Brazil, a country of continental proportions, as well as investigate which variables could influence the HRQoL of these individuals and contribute to these regional disparities. Methods: This was a retrospective, cross-sectional, multicenter study performed by the Brazilian Type 1 Diabetes Study Group (BrazDiab1SG), by analyzing EuroQol scores from 3005 participants with T1DM, in 28 public clinics, among all geographical regions of Brazil. Data on demography, economic status, chronic complications, glycemic control and lipid profile were also collected. Results: We have found that the North-Northeast region presents a higher index in the assessment of the overall health status (EQ-VAS) compared to the Southeast (74.6 ± 30 and 70.4 ± 19, respectively; p < 0.05). In addition, North- Northeast presented a lower frequency of self-reported anxiety-depression compared to all regions of the country (North-Northeast: 1.53 ± 0.6; Southeast: 1.65 ± 0.7; South: 1.72 ± 0.7; Midwest: 1.67 ± 0.7; p < 0.05). These findings could not be entirely explained by the HbA1c levels or the other variables examined. Conclusions: Our study points to the existence of additional factors not yet evaluated that could be determinant in the HRQoL of people with T1DM and contribute to these regional disparities

Health-related quality of life in patients with type 1 diabetes mellitus in the different geographical regions of Brazil : data from the Brazilian Type 1 Diabetes Study Group

Background: In type 1 diabetes mellitus (T1DM) management, enhancing health-related quality of life (HRQoL) is as important as good metabolic control and prevention of secondary complications. This study aims to evaluate possible regional differences in HRQoL, demographic features and clinical characteristics of patients with T1DM in Brazil, a country of continental proportions, as well as investigate which variables could influence the HRQoL of these individuals and contribute to these regional disparities. Methods: This was a retrospective, cross-sectional, multicenter study performed by the Brazilian Type 1 Diabetes Study Group (BrazDiab1SG), by analyzing EuroQol scores from 3005 participants with T1DM, in 28 public clinics, among all geographical regions of Brazil. Data on demography, economic status, chronic complications, glycemic control and lipid profile were also collected. Results: We have found that the North-Northeast region presents a higher index in the assessment of the overall health status (EQ-VAS) compared to the Southeast (74.6 ± 30 and 70.4 ± 19, respectively; p < 0.05). In addition, North- Northeast presented a lower frequency of self-reported anxiety-depression compared to all regions of the country (North-Northeast: 1.53 ± 0.6; Southeast: 1.65 ± 0.7; South: 1.72 ± 0.7; Midwest: 1.67 ± 0.7; p < 0.05). These findings could not be entirely explained by the HbA1c levels or the other variables examined. Conclusions: Our study points to the existence of additional factors not yet evaluated that could be determinant in the HRQoL of people with T1DM and contribute to these regional disparities