Impact of diabetes mellitus on arterial stiffness in a representative sample of an urban Brazilian population

Background\ud Independent of other cardiovascular (CV) risk factors, increased arterial stiffness has been established as a predictor of morbidity and mortality. The main aim of this study was to investigate the impact of diabetes on arterial stiffness in a representative sample of an urban Brazilian population plus Amerindians.\ud \ud Methods\ud A total of 1,415 individuals from the general population were randomly selected plus 588 Amerindians from a native community in Brazil. In addition, a sub-sample of 380 individuals from the general population had 5-year follow-up data. Pulse wave velocity (PWV) was measured with a non-invasive automatic device (Complior, Colson; Garges les Gonesses, France) and increased arterial stiffness was defined as PWV ≥ 12 m/s.\ud \ud Results\ud In the overall group, diabetic individuals had higher frequencies of increased arterial stiffness and hypertension. They also had higher values of PWV, body mass index, total cholesterol, triglycerides, systolic and diastolic blood pressures compared to non-diabetic individuals (p < 0.01). In an analysis stratified by hypertension, PWV values and increased arterial stiffness frequency were higher in diabetic individuals in both groups (hypertensive and non-hypertensive) (p < 0.05). Furthermore, higher risk for increased arterial stiffness was observed in the diabetic individuals from the overall group (OR = 2.27; CI = 1.47-3.52, p < 0.001) and from the hypertensive group (OR = 2.70; CI = 1.58-4.75, p < 0.001), adjusted for covariates. Regarding the ethnic stratification, diabetic individuals from Amerindian, White, and Mulatto (mixed-race) groups had higher PWV values and a greater frequency of increased arterial stiffness compared to non-diabetic individuals. Both diabetic and non-diabetic individuals had higher PWV values after 5 years. There was no significant difference in the 5-year PWV progression in diabetic compared to non-diabetic individuals.\ud \ud Conclusions\ud These results confirm, in a sample of Brazilian population, that the presence of diabetes is associated with increased arterial stiffness and it may contribute in part to increased cardiovascular risk in diabetic patients.PCJL Santos is the recipient of a fellowship from FAPESP, Proc. 2010-17465-8, Brazil. The technical assistance of the Laboratory of Genetics and Molecular Cardiology group, Heart Institute group is gratefully acknowledged

Non-HFE hemochromatosis

Hereditary hemochromatosis (HH) is an autosomal recessive disorder classically related to HFE mutations. However, since 1996, it is known that HFE mutations explain about 80% of HH cases, with the remaining around 20% denominated non-HFE hemochromatosis. Nowadays, four main genes are implicated in the pathophysiology of clinical syndromes classified as non-HFE hemochromatosis: hemojuvelin (HJV, type 2Ajuvenile HH), hepcidin (HAMP, type 2B juvenile HH), transferrin receptor 2 (TFR2, type 3 HH) and ferroportin (SLC40A1, type 4 HH). The aim of this review is to explore molecular, clinical and management aspects of non-HFE hemochromatosis

Association between UCP2 A55V polymorphism and risk of cardiovascular events in patients with multi-vessel coronary arterial disease

Background\ud UCP2 (uncoupling protein 2) plays an important role in cardiovascular diseases and recent studies have suggested that the A55V polymorphism can cause UCP2 dysfunction. The main aim was to investigate the association of A55V polymorphism with cardiovascular events in a group of 611 patients enrolled in the Medical, Angioplasty or Surgery Study II (MASS II), a randomized trial comparing treatments for patients with coronary artery disease and preserved left ventricular function.\ud \ud Methods\ud The participants of the MASS II were genotyped for the A55V polymorphism using allele-specific PCR assay. Survival curves were calculated with the Kaplan–Meier method and evaluated with the log-rank statistic. The relationship between baseline variables and the composite end-point of cardiac death, acute myocardial infarction (AMI), refractory angina requiring revascularization and cerebrovascular accident were assessed using a Cox proportional hazards survival model.\ud \ud Results\ud There were no significant differences for baseline variables according genotypes. After 2 years of follow-up, dysglycemic patients harboring the VV genotype had higher occurrence of AMI (p=0.026), Death+AMI (p=0.033), new revascularization intervention (p=0.009) and combined events (p=0.037) as compared with patients carrying other genotypes. This association was not evident in normoglycemic patients.\ud \ud Conclusions\ud These findings support the hypothesis that A55V polymorphism is associated with UCP2 functional alterations that increase the risk of cardiovascular events in patients with previous coronary artery disease and dysglycemia.Financial support provided in part by a research grant from the Zerbini Foundation, Sao Paulo, Brazil. PCJLS is recipient from fellowship from FAPESP, Proc. 2010-17465-8, Sao Paulo, Brazil

Evaluation of the nicotine metabolite ratio in smoking patients treated with varenicline and bupropion

Background: Smoking is the leading cause of preventable death worldwide. It is responsible for several types of cancer, cardiovascular diseases, and diseases of the reproductive system, among others. Therefore, advances in research are increasingly necessary in order to make smoking cessation treatment more effective. Some studies have investigated the association of the nicotine metabolite ratio (NMR) with general characteristics and treatment outcomes. In the present study, the main aim was to evaluate the NMR in smoking patients from an Assistance Program of a tertiary cardiology hospital.Methodology: Serum samples were collected from 185 patients at T0 (while patients were still smoking and before starting pharmacological treatment). Cotinine and hydroxycotinine analytes were measured using liquid-chromatography tandem mass-spectrometry (LC-MS/MS). By looking at the relationship between hydroxycotinine and cotinine, we can obtain the NMR, with which it is possible to classify patients into slow metabolizers (NMR &lt; 0.31), as well as normal or fast metabolizers (NMR ≥ 0.31).Results: From 185 patients, 55 were considered slow metabolizers and 130 as normal/fast. The metabolite averages were associated with the number of cigarettes smoked per day (p &lt; 0.001 for cotinine and 0.023 hydroxycotinine). However, we were unable to analyze the association of the NMR with general and clinical characteristics of patients under smoking cessation treatment.Conclusion: We were able to evaluate the NMR, and to observe categories of metabolizers in Brazilian patients under pharmacological treatments. Thus, this study can contribute to the indication of a form of analysis, which might form part of the customization of smoking cessation treatments and, consequently, improve the success rates

Worldwide trends in hypertension prevalence and progress in treatment and control from 1990 to 2019: a pooled analysis of 1201 population-representative studies with 104 million participants

Background Hypertension can be detected at the primary health-care level and low-cost treatments can effectively control hypertension. We aimed to measure the prevalence of hypertension and progress in its detection, treatment, and control from 1990 to 2019 for 200 countries and territories. Methods We used data from 1990 to 2019 on people aged 30–79 years from population-representative studies with measurement of blood pressure and data on blood pressure treatment. We defined hypertension as having systolic blood pressure 140 mm Hg or greater, diastolic blood pressure 90 mm Hg or greater, or taking medication for hypertension. We applied a Bayesian hierarchical model to estimate the prevalence of hypertension and the proportion of people with hypertension who had a previous diagnosis (detection), who were taking medication for hypertension (treatment), and whose hypertension was controlled to below 140/90 mm Hg (control). The model allowed for trends over time to be non-linear and to vary by age. Findings The number of people aged 30–79 years with hypertension doubled from 1990 to 2019, from 331 (95% credible interval 306–359) million women and 317 (292–344) million men in 1990 to 626 (584–668) million women and 652 (604–698) million men in 2019, despite stable global age-standardised prevalence. In 2019, age-standardised hypertension prevalence was lowest in Canada and Peru for both men and women; in Taiwan, South Korea, Japan, and some countries in western Europe including Switzerland, Spain, and the UK for women; and in several low-income and middle-income countries such as Eritrea, Bangladesh, Ethiopia, and Solomon Islands for men. Hypertension prevalence surpassed 50% for women in two countries and men in nine countries, in central and eastern Europe, central Asia, Oceania, and Latin America. Globally, 59% (55–62) of women and 49% (46–52) of men with hypertension reported a previous diagnosis of hypertension in 2019, and 47% (43–51) of women and 38% (35–41) of men were treated. Control rates among people with hypertension in 2019 were 23% (20–27) for women and 18% (16–21) for men. In 2019, treatment and control rates were highest in South Korea, Canada, and Iceland (treatment >70%; control >50%), followed by the USA, Costa Rica, Germany, Portugal, and Taiwan. Treatment rates were less than 25% for women and less than 20% for men in Nepal, Indonesia, and some countries in sub-Saharan Africa and Oceania. Control rates were below 10% for women and men in these countries and for men in some countries in north Africa, central and south Asia, and eastern Europe. Treatment and control rates have improved in most countries since 1990, but we found little change in most countries in sub-Saharan Africa and Oceania. Improvements were largest in high-income countries, central Europe, and some upper-middle-income and recently high-income countries including Costa Rica, Taiwan, Kazakhstan, South Africa, Brazil, Chile, Turkey, and Iran. Interpretation Improvements in the detection, treatment, and control of hypertension have varied substantially across countries, with some middle-income countries now outperforming most high-income nations. The dual approach of reducing hypertension prevalence through primary prevention and enhancing its treatment and control is achievable not only in high-income countries but also in low-income and middle-income settings

Heterogeneous contributions of change in population distribution of body mass index to change in obesity and underweight NCD Risk Factor Collaboration (NCD-RisC)

From 1985 to 2016, the prevalence of underweight decreased, and that of obesity and severe obesity increased, in most regions, with significant variation in the magnitude of these changes across regions. We investigated how much change in mean body mass index (BMI) explains changes in the prevalence of underweight, obesity, and severe obesity in different regions using data from 2896 population-based studies with 187 million participants. Changes in the prevalence of underweight and total obesity, and to a lesser extent severe obesity, are largely driven by shifts in the distribution of BMI, with smaller contributions from changes in the shape of the distribution. In East and Southeast Asia and sub-Saharan Africa, the underweight tail of the BMI distribution was left behind as the distribution shifted. There is a need for policies that address all forms of malnutrition by making healthy foods accessible and affordable, while restricting unhealthy foods through fiscal and regulatory restrictions

Hereditary hemochromatosis: relationship between HFE gene mutations and iron status in blood donors and HFE, HJV, HAMP, TFR2 and SLC40A1 gene sequencing in primary iron overload patients

A hemocromatose hereditária é caracterizada pelo aumento da absorção intestinal de ferro, acarretando progressivo acúmulo no organismo. Os objetivos foram: 1- determinar as frequências das mutações p.C282Y, p.H63D e p.S65C no gene HFE e avaliar os efeitos nas concentrações dos parâmetros do ferro em doadores de sangue; 2- pesquisar mutações nos genes: 2.1- HFE, 2.2- HJV e HAMP, 2.3- TFR2 e SLC40A1, em pacientes portadores de sobrecarga de ferro primária. Participaram 542 doadores de sangue provenientes do Hemocentro da Santa Casa de São Paulo. Foram incluídos 51 pacientes que apresentavam saturação de transferrina &#8805; 50% (para mulheres) e &#8805; 60% (para homens) e ausência de causas secundárias. Os genótipos para as mutações nos genes HFE foram avaliados pela PCR-RFLP. Foi realizado sequenciamento direto bidirecional para cada éxon dos genes, utilizando o sequenciador Genetic Analizer 3500XL®. Nos doadores de sangue, as frequências dos alelos HFE 282Y, HFE 63D e HFE 65C foram 2,1, 13,6 e 0,6%, respectivamente. Os homens que doaram pela primeira vez, portadores do genótipo HFE 282CY, apresentaram maiores valores de saturação de transferrina; e também os portadores dos genótipos HFE 63DD e 63HD apresentaram maiores concentrações de ferritina sérica, em relação aos de genótipo selvagem. Para os pacientes, 72,5% (37/51) apresentaram ao menos 1 alteração no gene HFE e 11 foram identificados como homozigotos para a mutação p.C282Y. Uma mutação não descrita na literatura (p.V256I) foi identificada no gene HFE e a modelagem molecular (análises de ligação e estrutural) detectou que a mutação não reduziu a afinidade entre as proteínas HFE e &#946;2-microglobulina. No sequenciamento dos éxons dos genes HJV e HAMP foram identificadas as alterações já descritas: HJV p.E302K, HJV p.A310G, HJV p.G320V e HAMP p.R59G. Para o gene TFR2, foram identificados 3 polimorfismos já descritos (p.A75V, p.A617A e p.R752H). No gene SLC40A1 foram observados 6 polimorfismos (rs13008848, rs11568351, rs11568345, rs11568344, rs2304704 e rs11568346) e 1 alteração não descrita previamente na literatura (p.G204S). As conclusões foram: 1- em relação aos doadores de sangue, a presença dos alelos HFE 282Y e HFE 63D foi associada ao maior aporte de ferro nos homens que não doaram sangue anteriormente. 2.1- Para os pacientes com sobrecarga de ferro, a mutação p.C282Y em homozigose, ou em heterozigose composta com a p.H63D, foi a mais frequente alteração encontrada (33,3%). 2.2- O diagnóstico molecular de hemocromatose juvenil (HJ) no Brasil (HJV p.G320V em homozigose) foi relatado. As mutações funcionais HJV p.E302K e HAMP p.R59G foram identificadas, sendo possível que estas alterações possam estar contribuindo para consequências fenotípicas juntas as outras mutações em regiões intrônicas ou regulatórias dos genes. 2.3- Mutações funcionais nos genes TFR2 e SLC40A1 não foram identificadas.Hereditary hemochromatosis (HH) is characterized by increased intestinal iron absorption, which leads to a progressive accumulation of iron in the body. The aims were: 1- to assess the frequency of HFE gene mutations (p.C282Y, p.H63D and p.S65C) and to identify their relationship to iron status in blood donors; 2- to search in primary iron overload patients: 2.1- HFE, 2.2- HJV and HAMP, 2.3- TFR2 and SLC40A1 gene mutations. Blood donors (n=542) were recruited from Hemocentro of Santa Casa Hospital, Sao Paulo, Brazil. The study included 51 patients with transferrin saturation &#8805; 50% (women) and &#8805; 60% (men) and absence of secondary causes. The genotypes for HFE mutations were evaluated by PCR-RFLP. Subsequent bidirectional sequencing for each gene was performed using the Genetic Analizer sequencer 3500XL®. The frequencies of HFE 282Y, HFE 63D and HFE 65C alleles were 2.1, 13.6 and 0.6% in blood donors, respectively. The first time male donors carrying heterozygous genotype for the p.C282Y mutation had higher transferrin saturation values; and men carrying HFE 63DD and 63HD genotypes had higher serum ferritin concentrations when compared to the wild genotype. Thirtyseven (72.5%) out of the 51 patients presented at least one HFE mutation and 11 were identified as homozygous for the mutation p.C282Y. One novel mutation (p.V256I) in the HFE gene was indentified and molecular modeling (free energy and structural analysis in silico) showed that p.V256I mutation did not reduce the affinity binding between HFE and &#946;2-microglobulin. Sequencing in the HJV and HAMP genes revealed HJV p.E302K, HJV p.A310G, HJV p.G320V and HAMP p.R59G alterations. Sequencing in the TFR2 gene observed 3 polymorphisms (p.A75V, p.A617A e p.R752H); and sequencing in the SLC40A1 gene identified 6 polymorphisms (rs13008848, rs11568351, rs11568345, rs11568344, rs2304704 e rs11568346) and 1 p.G204S non-described mutation. The conclusions were: 1- for blood donors, the presence of HFE 282Y and HFE 63D alleles were associated with alterations on iron status only in first time male blood donors. 2.1- For patients with iron overload, the p.C282Y mutation in homozygous or in compound heterozygous with p.H63D, was the most frequent molecular change found (33.3%). 2.2- The molecular diagnosis of Juvenil Hemochromatosis (JH) in Brazil (homozygous genotype for the HJV p.G320V) was reported. The HJV p.E302K and HAMP p.R59G functional mutations were found and, it is conceivable that they may be contributing to phenotypic consequences together to other mutations in intronic or regulatory regions. 2.3- Functional mutation in the TFR2 and SLC40A1 genes were not identified

Hereditary hemochromatosis: relationship between HFE gene mutations and iron status in blood donors and HFE, HJV, HAMP, TFR2 and SLC40A1 gene sequencing in primary iron overload patients

A hemocromatose hereditária é caracterizada pelo aumento da absorção intestinal de ferro, acarretando progressivo acúmulo no organismo. Os objetivos foram: 1- determinar as frequências das mutações p.C282Y, p.H63D e p.S65C no gene HFE e avaliar os efeitos nas concentrações dos parâmetros do ferro em doadores de sangue; 2- pesquisar mutações nos genes: 2.1- HFE, 2.2- HJV e HAMP, 2.3- TFR2 e SLC40A1, em pacientes portadores de sobrecarga de ferro primária. Participaram 542 doadores de sangue provenientes do Hemocentro da Santa Casa de São Paulo. Foram incluídos 51 pacientes que apresentavam saturação de transferrina &#8805; 50% (para mulheres) e &#8805; 60% (para homens) e ausência de causas secundárias. Os genótipos para as mutações nos genes HFE foram avaliados pela PCR-RFLP. Foi realizado sequenciamento direto bidirecional para cada éxon dos genes, utilizando o sequenciador Genetic Analizer 3500XL®. Nos doadores de sangue, as frequências dos alelos HFE 282Y, HFE 63D e HFE 65C foram 2,1, 13,6 e 0,6%, respectivamente. Os homens que doaram pela primeira vez, portadores do genótipo HFE 282CY, apresentaram maiores valores de saturação de transferrina; e também os portadores dos genótipos HFE 63DD e 63HD apresentaram maiores concentrações de ferritina sérica, em relação aos de genótipo selvagem. Para os pacientes, 72,5% (37/51) apresentaram ao menos 1 alteração no gene HFE e 11 foram identificados como homozigotos para a mutação p.C282Y. Uma mutação não descrita na literatura (p.V256I) foi identificada no gene HFE e a modelagem molecular (análises de ligação e estrutural) detectou que a mutação não reduziu a afinidade entre as proteínas HFE e &#946;2-microglobulina. No sequenciamento dos éxons dos genes HJV e HAMP foram identificadas as alterações já descritas: HJV p.E302K, HJV p.A310G, HJV p.G320V e HAMP p.R59G. Para o gene TFR2, foram identificados 3 polimorfismos já descritos (p.A75V, p.A617A e p.R752H). No gene SLC40A1 foram observados 6 polimorfismos (rs13008848, rs11568351, rs11568345, rs11568344, rs2304704 e rs11568346) e 1 alteração não descrita previamente na literatura (p.G204S). As conclusões foram: 1- em relação aos doadores de sangue, a presença dos alelos HFE 282Y e HFE 63D foi associada ao maior aporte de ferro nos homens que não doaram sangue anteriormente. 2.1- Para os pacientes com sobrecarga de ferro, a mutação p.C282Y em homozigose, ou em heterozigose composta com a p.H63D, foi a mais frequente alteração encontrada (33,3%). 2.2- O diagnóstico molecular de hemocromatose juvenil (HJ) no Brasil (HJV p.G320V em homozigose) foi relatado. As mutações funcionais HJV p.E302K e HAMP p.R59G foram identificadas, sendo possível que estas alterações possam estar contribuindo para consequências fenotípicas juntas as outras mutações em regiões intrônicas ou regulatórias dos genes. 2.3- Mutações funcionais nos genes TFR2 e SLC40A1 não foram identificadas.Hereditary hemochromatosis (HH) is characterized by increased intestinal iron absorption, which leads to a progressive accumulation of iron in the body. The aims were: 1- to assess the frequency of HFE gene mutations (p.C282Y, p.H63D and p.S65C) and to identify their relationship to iron status in blood donors; 2- to search in primary iron overload patients: 2.1- HFE, 2.2- HJV and HAMP, 2.3- TFR2 and SLC40A1 gene mutations. Blood donors (n=542) were recruited from Hemocentro of Santa Casa Hospital, Sao Paulo, Brazil. The study included 51 patients with transferrin saturation &#8805; 50% (women) and &#8805; 60% (men) and absence of secondary causes. The genotypes for HFE mutations were evaluated by PCR-RFLP. Subsequent bidirectional sequencing for each gene was performed using the Genetic Analizer sequencer 3500XL®. The frequencies of HFE 282Y, HFE 63D and HFE 65C alleles were 2.1, 13.6 and 0.6% in blood donors, respectively. The first time male donors carrying heterozygous genotype for the p.C282Y mutation had higher transferrin saturation values; and men carrying HFE 63DD and 63HD genotypes had higher serum ferritin concentrations when compared to the wild genotype. Thirtyseven (72.5%) out of the 51 patients presented at least one HFE mutation and 11 were identified as homozygous for the mutation p.C282Y. One novel mutation (p.V256I) in the HFE gene was indentified and molecular modeling (free energy and structural analysis in silico) showed that p.V256I mutation did not reduce the affinity binding between HFE and &#946;2-microglobulin. Sequencing in the HJV and HAMP genes revealed HJV p.E302K, HJV p.A310G, HJV p.G320V and HAMP p.R59G alterations. Sequencing in the TFR2 gene observed 3 polymorphisms (p.A75V, p.A617A e p.R752H); and sequencing in the SLC40A1 gene identified 6 polymorphisms (rs13008848, rs11568351, rs11568345, rs11568344, rs2304704 e rs11568346) and 1 p.G204S non-described mutation. The conclusions were: 1- for blood donors, the presence of HFE 282Y and HFE 63D alleles were associated with alterations on iron status only in first time male blood donors. 2.1- For patients with iron overload, the p.C282Y mutation in homozygous or in compound heterozygous with p.H63D, was the most frequent molecular change found (33.3%). 2.2- The molecular diagnosis of Juvenil Hemochromatosis (JH) in Brazil (homozygous genotype for the HJV p.G320V) was reported. The HJV p.E302K and HAMP p.R59G functional mutations were found and, it is conceivable that they may be contributing to phenotypic consequences together to other mutations in intronic or regulatory regions. 2.3- Functional mutation in the TFR2 and SLC40A1 genes were not identified

Intervención nutricional estandarizado en pacientes con hipoglucemia y hospitalizados

The ingestion of rapid absorption carbohydrates (RAC) can be useful to increase serum glucose. This sudy aimed to assess the effectiveness and applicability of nutritional intervention in hypoglycemic situations suffered by conscious inpatients in a general hospital who were receiving oral diet. Seventy-six patients were eligible. Hypoglycemia was defined as a capillary glucose level of &ge; 50 to &le; 70 mg/dL. Nutritional intervention consisted in providing 15-24 g of RAC. The level of capillary glucose was checked after 15 to 20 minutes of the intervention. During the studied period, the rate of effectiveness of the nutritional intervention was 97.6%. Results show that the administration of RAC, a non-invasive method, was applicable in a general hospital and was also potentially effective in restoring capillary glucose levels in conscious hypoglycemic inpatients receiving an oral diet.La ingesta de hidratos de carbono de absorción rápida (HAR) puede ser útil a la glucosa sérica. En este contexto, los principales objetivos fueron evaluar la eficacia y aplicabilidad de la atención nutricional en situaciones de hipoglucemia en el hospital general. Setenta y seis pacientes fueron elegibles. La hipoglucemia se definió como el nivel de glucosa en sangre &ge; 50 a &le; 70 mg/dL. Intervención nutricional que se ofrecía 15 a 24 gramos de HAR. Hubo una conferencia de glucosa en la sangre después de 15-20 minutos de acción. La tasa de eficacia de la intervención nutricional fue del 97,6% durante el período de estudio. Se concluye que la administración de HAR, un método no invasivo, es aplicable en las unidades de hospital general y fue potencialmente eficaz en la restauración de la glucosa en sangre en pacientes con hipoglucemia, consciente, y con dieta oral.A ingestão de carboidratos de rápida absorção (CRA) pode ser útil para o aumento sérico de glicose. Neste contexto, os principais objetivos foram avaliar a eficácia e a aplicabilidade da intervenção nutricional em situações hipoglicêmicas apresentadas por pacientes conscientes, com dieta via oral e internados em hospital geral. Setenta e seis pacientes foram elegíveis e a hipoglicemia foi definida como nível de glicemia capilar ³ 50 até £ 70mg/dL. A intervenção nutricional constituiu na oferta de 15 a 24 gramas de CRA. Houve a conferência da glicemia capilar após 15-20 minutos da intervenção. A taxa de efetividade da intervenção nutricional foi de 97,6%, durante o período de estudo. Conclui-se que a administração de CRA, um método não invasivo, foi aplicável em unidades de um hospital geral e foi potencialmente eficaz na restauração da glicemia capilar em pacientes hipoglicêmicos com dieta via oral e conscientes

INTERFERÊNCIAS EM EXAMES LABORATORIAIS: CRITÉRIO DIAGNÓSTICO PARA O DIABETES MELLITUS E PRINCIPAIS FÁRMACOS HIPOGLICEMIANTES

O diabetes mellitus (DM) está entre as principais condições crônicas de saúde. O critério diagnóstico atual para o DM propõe os seguintes testes laboratoriais: glicose plasmática em jejum, hemoglobina glicada ou glicosilada, teste oral de tolerância à glicose, frutosamina, insulina, peptídeo C e glucagon. Estes exames laboratoriais podem apresentar interferências de medicamentos, sejam fisiológicas ou analíticas. Na literatura consultada foi possível identificar 30 fármacos ou grupo de fármacos que possuem evidências de interferir nos principais exames de diagnóstico da DM. Ressalta-se que praticamente na sua totalidade estes interferem nos níveis de glicemia, sendo que, 81,5% destes contribuem de forma a aumentar estes valores. Dentre estes fármacos encontram-se MIPs (medicamentos isentos de prescrição), como o paracetamol e o ácido acetilsalicílico, e anti-inflamatórios esteroidais, como a dexametasona e prednisolona, amplamente utilizados na terapêutica medicamentosa. Da mesma forma, os medicamentos empregados no tratamento de pacientes diabéticos incluído na RENAME como insulina NPH (protamina neutra Hagedorn), insulina humana regular, glibenclamida, gliclazida e cloridrato de metformina podem interferir em exames laboratoriais. O diagnóstico precoce e o tratamento adequado se fazem necessários a fim de prevenirem maiores danos aos portadores desta doença complexa sub diagnosticada. Neste contexto, as interferências medicamentosas são importantes achados nos exames laboratoriais que avaliam o DM e devem ser reconhecidas pelos profissionais de saúde envolvidos