Seasonal variation of haemoglobin A1c in a Portuguese adult population

Haemoglobin A1c (Hb A1c) is routinely used for monitoring glycemic control in patients with diabetes. Hb A1c seasonal fluctuations can be directly related to different biological, geographical and cultural influences. Our purpose was to evaluate seasonal variation of Hb A1c in a hospital-based adult population over a period of 5 years.

Dietary program impact on biochemical markers in diabetics: systematic review

Diabetes mellitus is a chronic disorder with major expansion worldwide. It’s estimated that the number of diabetes sufferers increase rapidly in the coming decades due to the population ageing (Ena,2016;IDF,2015). The nutrition intervention emphasizing the promotion of healthy eating has been shown to be an importante point in Diabetes Mellitus treatment since it fosters a better glycemic control and lipid profile (ADA2016).

Prevalencia de no adherencia a la terapia con insulina y factores sociales asociados en pacientes con diabetes mellitus tipo 2 de la consulta externa de endocrinología del Hospital Vicente Corral Moscoso”, de la ciudad de Cuenca.2015

ANTECEDENTES: De acuerdo al estudio CODE-2 (Costo de la Diabetes en Europa: tipo 2) halló que en Europa solo el 28% de los pacientes diabéticos logra un buen control glucémico. En Ecuador durante el año 2011, se registraron 4.455 muertes a causa de Diabetes Mellitus, convirtiéndose en la principal causa de mortalidad general con un porcentaje de 7,15% (INEC). OBJETIVO GENERAL: Determinar la prevalencia de no adherencia al tratamiento con insulina y factores sociales asociados al mismo, en pacientes con Diabetes Mellitus tipo 2, en la consulta externa de endocrinología del “Hospital Vicente Corral Moscoso” en la ciudad de Cuenca 2015. METODOLOGÍA: Se realizó un estudio cuantitativo analítico transversal con una muestra de 225 pacientes insulino-requirentes de la consulta externa de endocrinología del Hospital Vicente Corral Moscoso. Se trabajó con el porcentaje de incidencia de la ALAD para insulino requerimiento (55%) se calculó 225 pacientes a quienes se sometieron a una encuesta para determinar la no adherencia. Los datos obtenidos fueron tabulados y analizados en el programa SPSS. USO DE RESULTADOS: Como fuente de información, para estudiantes y médicos, además van a constituir un respaldo para futuros trabajos de investigación. CONCLUSIÓN: Concluimos que la mayoría de pacientes pertenecen al sexo femenino, con una media de edad de 61 ±13.58 años, nivel de instrucción primario y estado civil casado, el porcentaje de no adherencia es de 65.8% y el principal factor social asociado a la no adherencia es el olvido

Development and evaluation of floating microspheres of curcumin in alloxan-induced diabetic rats

Purpose: To prepare and evaluate floating microspheres of curcumin for prolonged gastric residence and to study their effect on alloxan-induced diabetic rats. Methods: Floating microsphere were prepared by emulsion-solvent diffusion method, using hydroxylpropyl methylcellulose, chitosan and Eudragit S 100 polymer in varying proportions. Ethanol/dichloromethane blend was used as solvent in a ratio of 1:1. The floating microspheres were evaluated for flow properties, particle size, incorporation efficiency, as well as in-vitro floatability and drug release. The anti-diabetic activity of the floating microspheres of batch FM4 was performed on alloxaninduced diabetic rats. Result: The floating microspheres had particle size, buoyancy, drug entrapment efficiency and yield in the ranges of 255.32 - 365.65 μm, 75.58 - 89.59, 72.6 - 83.5, and 60.46 - 80.02 %, respectively. Maximum drug release after 24 h was 82.62 % for formulation FM4 and 73.879, 58.613 and 46.106 % for formulations FM1, FM2, and FM3 respectively. In-vivo data obtained over a 120-h period indicate that curcumin floating microspheres from batch FM4 showed the better glycemic control than control and a commercial brand of the drug. Conclusion: The developed floating curcumin delivery system seems economical and effective in diabetes management in rats, and enhances the bioavailability of the drug.

Diabetes Mellitus tipo 1 em Odontopediatria

A Diabetes Mellitus é conhecida por uma doença metabólica caracterizada por um défice na ação ou secreção da insulina, na qual a consequência direta é o aparecimento de hiperglicemia, isto é, o nível de glicose apresentar valores elevados (Kidambi, 2008; Silva-Sousa, 2003). A DM1, especificamente, é apresentada como uma doença que é resultado da destruição das células beta do pâncreas, desenvolvendo assim, um défice na produção de insulina (Raymond et al., 2001). As complicações orais da DM1 incluem xerostomia, doença periodontal (gengivite e periodontite), abcessos dentários, perda de dentes, lesões de tecidos moles e síndrome de ardência oral. A complicação oral mais frequente da DM1 nas crianças é o aumento da sensibilidade à doença periodontal. A doença periodontal é caracterizada como uma reação inflamatória infecciosa dos tecidos gengivais (gengivite) ou do suporte dos dentes, ou seja, ligamento periodontal, cemento e osso alveolar (periodontite), podendo induzir um certo grau de resistência à insulina. Ambas as doenças resultam da interação entre microorganismos periodontais patogénicos. A avaliação e influência do controlo da doença é expressa pelos valores médios de hemoglobina glicosada (Hba1c) na saúde oral nas crianças e adolescentes com DM1. Vários estudos demonstraram que o controlo glicémico teve uma influencia sobre a saúde oral de crianças e adolescentes com DM1. Assim uma avaliação oral, deve fazer parte de procedimentos de rotina no atendimento de crianças e adolescentes com DM1. O dentista deve ser parte da equipa multidisciplinar que auxilia os indivíduos com DM1. O tratamento precoce numa população infantil com DM1, pode diminuir a severidade da doença periodontal. O presente trabalho tem por objectivo realizar uma revisão bibliográfica sobre a importância do estudo em crianças e adolescentes portadores de DM1 e doenças da cavidade oral, nomeadamente, a periodontite, e respetivas implicações.

Update in the management of critically ill burned patients

The management of critically ill burn patients is challenging. These patients have to be managed in specialized centers, where the expertise of physicians and nursing personnel guarantees the best treatment. Mortality of burn patients has improved over the past decades due to a better understanding of burn shock pathophysiology, optimal surgical management, infection control and nutritional support. Indeed, a more aggressive resuscitation, early excision and grafting, the judicious use of topical antibiotics, and the provision of an adequate calorie and protein intake are key to attain best survival results. General advances in critical care have also to be implemented, including protective ventilation, glycemic control, selective decontamination of the digestive tract, and implementation of sedation protocols.

Impacto de la implementación de un modelo de gestión integral de atención de la enfermedad y cuidado coordinado en la población en diálisis en Colombia

La atención hospitalaria en el costo global de la atención de los pacientes en diálisis es muy importante. Este estudio se realizó con el fin de evaluar resultados posteriores a la implementación de un modelo de gestión de la enfermedad y cuidado coordinado en una red de diálisis en Colombia, evaluando los cambios específicos en las tasas de hospitalización de una cohorte de pacientes renales con dos años de seguimiento. El modelo se enfoca básicamente en mejorar la atención de los pacientes en diálisis protocolizando en el manejo de comorbilidades (diabetes, riesgo cardiovascular, patologías infecciosas) y en el cuidado coordinado entre el tratamiento ambulatorio y hospitalario de los pacientes en diálisis asegurando la continuidad en el proceso de atención de los pacientes. El Estudio observacional analítico de cohortes compuesto por 2 fases una primera cohorte histórica retrospectiva y una segunda con dos cohortes prospectivas, incluyó pacientes mayores de 18 años, con más de 90 días en diálisis, con al menos tres meses de intervención con el modelo de gestión de enfermedad en la red Renal Therapy Services (RTS®). En conclusión, la realización de este estudio, se pudo asociar a la reducción en la atención hospitalaria de pacientes en diálisis y a una menor mortalidad, modelos como este y otras soluciones para mejorar los desenlaces en salud en los pacientes en diálisis deben seguir siendo implementados para aliviar la carga de la enfermedad y reducir los costos de la atención en salud de esta población.

Tiempo promedio del efecto máximo de la insulina análoga en la glucemia postprandial y factores relacionados

Introducción: El tiempo promedio del efecto máximo de la insulina regular rápida en la glucemia postprandial ha sido considerado durante años de 120 minutos. En pacientes con Diabetes Mellitus (DM) que usan insulinas análogas este tiempo y los factores asociados no se encuentran reportados para ser aplicados en el automonitoreo. El objetivo de este estudio fue calcular el tiempo y factores relacionados al efecto máximo de la insulina en la glucemia postprandial. Metodología: Se desarrolló un estudio longitudinal retrospectivo a partir de una fuente secundaria donde se realizó un análisis descriptivo y bivariado con las variables demográficas y clínicas presentes en la población. Resultados: El tiempo promedio del pico máximo de insulina en pacientes con DM1 fue de 78.4 (DE± 16.512) y DM2 75.01(DE± 12.02) minutos. El 75% de la población con DM1 y el 54.2% en DM2 era de sexo femenino, la edad promedio en DM1 era 42.38 años y en DM2 68 años, en cuanto a la categorización del IMC el 50% de la población en DM1 y el 37.5% en DM2 estaban dentro del rango de obesidad y se encontró una relación con respecto al tipo de comida “desayuno-cena” vs el tiempo promedio del efecto máximo de la insulina calculado para ambos grupos (p:0.010). Conclusiones: El tiempo promedio del efecto máximo de la insulina calculado fue menor al tiempo reportado en la literatura clínica de 120 minutos. El tipo de comida principal mostró una relación con el tiempo promedio del efecto máximo en ambos grupos.

Correlacion entre hemoglobina glicosilada con hallazgos sintax score ii en pacientes con sospecha clínica de enfermedad coronaria, hospitalizados en la unidad coronaria del hospital San José centro en enero a septiembre del año 2015

Se realiza un estudio de corte transversal en el periodo de enero a septiembre del año 2016 en la unidad coronaria del Hospital San José Centro de la Ciudad de Bogotá; en pacientes con sospecha de enfermedad coronaria (Síndrome coronario agudo y angina estable) y antecedente de Diabetes Mellitus Tipo 2, se recolectaron 42 pacientes con los criterios de inclusión a quienes se realizó angiografía coronaria como parte del protocolo de estudio y manejo de la unidad, el objetivo primario fue demostrar la posible correlación entre niveles de hemoglobina glicosilada y la escala de severidad SYNTAX Score I y II de enfermedad coronaria, como objetivos secundarios; caracterizar las variables sociodemográficas, comorbilidades y posible relación con el tipo de presentación de enfermedad coronaria. Como hallazgos relevantes no se encontró correlación importante ni significativa entre niveles de hemoglobina glicosilada y la escala Syntax score II ni Syntax score I, a pesar de que la mayoría de pacientes mostraban mal control crónico de su diabetes mellitus tipo 2, con niveles mayores > 7%, como hallazgo positivo se encontro asociación estadísticamente significativa con niveles de LDL y las diferentes formas de presentación de enfermedad coronaria, a mayor niveles de LDL mayor probabilidad de IAM e IAM con elevación del segmento ST. Se considera que con estudios multicentricos en diferentes ciudades y unidades de cuidado cardiovascular con diferentes niveles de riesgo, se podría demostrar la posible correlación entre niveles de hemoglobina glicosilada y los grados de severidad de enfermedad coronaria representados por las escalas Syntax score I y II.

Diabete mellito nel cane: terapia, monitoraggio e aspetti prognostici

Il diabete mellito (DM) è una delle malattie endocrine più comuni nel cane. Una volta raggiunta la diagnosi di DM, è necessario iniziare un trattamento insulinico nonché una dieta specifica, al fine di controllare i livelli di glucosio nel sangue e di conseguenza i segni clinici. Inoltre, al fine di ottenere un buon controllo glicemico, è essenziale garantire uno stretto monitoraggio terapeutico. Nella presente tesi sono riportati numerosi studi relativi a trattamento, monitoraggio e prognosi dei cani con DM. Il capitolo 2 è una review che illustra i principali aspetti terapeutici e di monitoraggio del DM. Il capitolo 3 riporta uno studio che confronta l'efficacia e la sicurezza dell'insulina Lenta e dell'insulina Neutra Protamine Hagedorn (NPH). I metodi di monitoraggio per cani con DM possono essere classificati in diretti od indiretti. I metodi di monitoraggio diretto includono misurazioni serali della glicemia o monitoraggio continuo del glucosio interstiziale tramite appositi dispositivi (Continuous Glucose Monitoring System, CGMS). Le modalità indirette comprendono la valutazione dell'assunzione di acqua e del peso corporeo, la quantificazione del glucosio/chetoni nelle urine e la misurazione delle concentrazioni di proteine glicate. Il capitolo 4 mostra uno studio volto a valutare l'accuratezza e la precisione di un glucometro e un glucometro/chetometro nel cane. Il Flash Glucose Monitoring system è un CGMS recentemente validato per l'uso nel cane; la sua utilità clinica nel monitoraggio del DM canino è esaminata nel capitolo 5. Il capitolo 6 descrive uno studio in cui si validano 2 metodi analitici per la misurazione delle fruttosamine sieriche e dell'emoglobina glicata nel cane e confronta l’utilità delle due proteine glicate nel definire il controllo glicemico. Infine, il capitolo 7 riporta uno studio finalizzato a determinare il tempo di sopravvivenza e ad identificare il valore prognostico di diverse variabili cliniche e clinico-patologiche nei cani con DM.

Ionic and Histological Studies of Salivary Glands in Rats with Diabetes and Their Glycemic State After Laser Irradiation

Objectives: To evaluate the effect of laser irradiation (LI) on the glycemic state and the histological and ionic parameters of the parotid and submandibular glands in rats with diabetes. Methods: One hundred twenty female rats were divided into eight groups. Diabetes was induced by administration of streptozotocin and confirmed later according to results of glycemia testing. Twenty-nine days after the induction, the parotid and submandibular glands of the rats were irradiated with 5, 10, and 20 J/cm(2) using a laser diode (660nm/100mW) (without diabetes: C5, C10, and C20; with diabetes: D5, D10, and D20, respectively). On the following day, the rats were euthanized, and blood glucose determined. Histological and ionic analyses were performed. Results: Rats with diabetes without irradiation (D0) showed lipid droples accumulation in the parotid gland, but accumulation decreased after 5, 10, and 20 J/cm(2) of laser irradiation. A decrease in fasting glycemia level from 358.97 +/- 56.70 to 278.33 +/- 87.98mg/dL for D5 and from 409.50 +/- 124.41 to 231.80 +/- 120.18 mg/dL for D20 (p < 0.05) was also observed. Conclusion: LI should be explored as an auxiliary therapy for control of complications of diabetes because it can alter the carbohydrate and lipid metabolism of rats with diabetes.

Gut microbiota in children with type 1 diabetes differs from that in healthy children: a case-control study.

BACKGROUND A recent study using a rat model found significant differences at the time of diabetes onset in the bacterial communities responsible for type 1 diabetes modulation. We hypothesized that type 1 diabetes in humans could also be linked to a specific gut microbiota. Our aim was to quantify and evaluate the difference in the composition of gut microbiota between children with type 1 diabetes and healthy children and to determine the possible relationship of the gut microbiota of children with type 1 diabetes with the glycemic level. METHODS A case-control study was carried out with 16 children with type 1 diabetes and 16 healthy children. The fecal bacteria composition was investigated by polymerase chain reaction-denaturing gradient gel electrophoresis and real-time quantitative polymerase chain reaction. RESULTS The mean similarity index was 47.39% for the healthy children and 37.56% for the children with diabetes, whereas the intergroup similarity index was 26.69%. In the children with diabetes, the bacterial number of Actinobacteria and Firmicutes, and the Firmicutes to Bacteroidetes ratio were all significantly decreased, with the quantity of Bacteroidetes significantly increased with respect to healthy children. At the genus level, we found a significant increase in the number of Clostridium, Bacteroides and Veillonella and a significant decrease in the number of Lactobacillus, Bifidobacterium, Blautia coccoides/Eubacterium rectale group and Prevotella in the children with diabetes. We also found that the number of Bifidobacterium and Lactobacillus, and the Firmicutes to Bacteroidetes ratio correlated negatively and significantly with the plasma glucose level while the quantity of Clostridium correlated positively and significantly with the plasma glucose level in the diabetes group. CONCLUSIONS This is the first study showing that type 1 diabetes is associated with compositional changes in gut microbiota. The significant differences in the number of Bifidobacterium, Lactobacillus and Clostridium and in the Firmicutes to Bacteroidetes ratio observed between the two groups could be related to the glycemic level in the group with diabetes. Moreover, the quantity of bacteria essential to maintain gut integrity was significantly lower in the children with diabetes than the healthy children. These findings could be useful for developing strategies to control the development of type 1 diabetes by modifying the gut microbiota.

Evaluation of the in vitro glycemic index of a fiber-rich extruded breakfast cereal produced with organic passion fruit fiber and corn flour

The aim of this study was to determine the influence of process parameters and Passion Fruit Fiber (PFF) addition on the Glycemic Index (GI) of an extruded breakfast cereal. A 2³ Central Composite Rotational Design (CCRD) was used, with the following independent variables: raw material moisture content (18-28%), 2nd and 3rd barrel zone temperatures (120-160 ºC), and PFF (0-30%). Raw materials (organic corn flour and organic PFF) were characterized as to their proximate composition, particle size, and in vitro GI. The extrudates were characterized as to their in vitro GI. The Response Surface Methodology (RSM) and Principal Component Analysis (PCA) were used to analyze the results. Corn flour and PFF presented 8.55 and 7.63% protein, 2.61 and 0.60% fat, 0.52 and 6.17% ash, 78.77 and 78.86% carbohydrates (3 and 64% total dietary fiber), respectively. The corn flour particle size distribution was homogeneous, while PFF presented a heterogeneous particle size distribution. Corn flour and PFF presented values of GI of 48 and 45, respectively. When using RSM, no effect of the variables was observed in the GI of the extrudates (average value of 48.41), but PCA showed that the GI tended to be lower when processing at lower temperatures (<128 ºC) and at higher temperatures (>158 ºC). When compared to white bread, the extrudates showed a reduction of the GI of up to 50%, and could be considered an interesting alternative in weight and glycemia control diets.

Evaluation of Glycemic and Lipid Profile of Offspring of Diabetic Wistar Rats Treated with Malpighia emarginata Juice

Knowing that maternal diabetes is related to hyperglycemia and fetal hyperinsulinemia, which affect the lipid metabolism, the aim of this study was to evaluate the effects of Malpighia emarginata (acerola) juice on the glycemic and lipid profile of offspring of diabetic and nondiabetic Wistar rats. The adult offspring of non-diabetic dams and of dams with severe streptozotocin-induced diabetes were divided into groups: G1, offspring (of control dams) treated with water, G2, offspring (of diabetic dams) treated with water, G3, male offspring (of control dams) treated with acerola juice, and G4, male offspring (of diabetic dams) treated with acerola juice. The offspring of diabetic dams treated with acerola juice showed significantly decreased levels of glucose, cholesterol, triglycerides, and increased HDL-c. The use of acerola juice is a potential strategy to aid in the prevention of DM and dyslipidemia and its complications or to act as an auxiliary in the treatment of these diseases.

Biochemical evaluation of glycemic levels of long-term tacrolimus therapy in rats

One of the more serious complications following transplantation is the development of post-transplantation diabetes mellitus (PTDM), which has a major impact on the quality of life, with effects ranging from the control of glycemia times to increased susceptibility to infections and cardiovascular complications. It has been suggested that immunosuppressive therapy, mainly tacrolimus therapy, may be an important factor in the development of PTDM. There is a lack of studies that explore the effects of long-term tacrolimus on PTDM in animal protocols. The objective of this study was therefore to evaluate the effects of long-term therapy with tacrolimus in rats. One group was treated with tacrolimus, injected subcutaneously, in a daily dose of 1 mg/kg of body weight. The chosen dose was sufficient to achieve therapeutic tacrolimus serum levels. The experimental periods were 60, 120, 180 and 240 days. One group was used as control and received daily subcutaneous injections of saline solution during all periods. A tendency towards increased glycemia levels during the initial periods (60 and 120 days) was observed. However, at 180 and 240 days, the glycemia levels were not statistically different from that of the control group of the same period. It may thus be concluded that the deleterious effects of tacrolimus therapy on glycemia may be a time-related side effect.