Statistical Analysis of Diabetes Mellitus

Diabetes mellitus is a disease where the glucosis-content of the blood does not automatically decrease to a ”normal” value between 70 mg/dl and 120 mg/dl (3,89 mmol/l and 6,67 mmol/l) between perhaps one hour (or two hours) after eating. Several instruments can be used to arrive at a relative low increase of the glucosis-content. Besides drugs (oral antidiabetica, insulin) the blood-sugar content can mainly be influenced by (i) eating, i.e., consumption of the right amount of food at the right time (ii) physical training (walking, cycling, swimming). In a recent paper the author has performed a regression analysis on the influence of eating during the night. The result was that one ”bread-unit” (12g carbon-hydrats) increases the blood-sugar by about 50 mg/dl, while one hour after eating the blood-sugar decreases by about 10 mg/dl per hour. By applying this result-assuming its correctness - it is easy to eat the right amount during the night and to arrive at a fastening blood-sugar (glucosis-content) in the morning of about 100 mg/dl (5,56 mmol/l). In this paper we try to incorporate some physical exercise into the model.

Control de glicèmia en pacients crítics mitjançant CGMS

L’estudi que es realitza en aquest projecte/treball final de carrera queda englobat dins del grup de recerca MICE (Modal Intervals Control and Engeneering), el qual realitza investigacions entorn al control de glucèmia. Aquest grup de recerca vinculat a la Universitat de Girona col•labora amb l’Hospital Universitari Dr. Josep Trueta de Girona. La temàtica principal tractarà de realitzar el control de glucèmia en pacients crítics, que es troben ingressats en la unitat de cures intensives de qualsevol hospital. Com a conseqüència d’aquesta problemàtica, s’ha implementat en un entorn virtual, un pacient el qual simula la situació d’un pacient real en la unitat de cures intensives. El model emprat per a la obtenció del model de pacient virtual és el desenvolupat per Chase et al. (2005), el qual mitjançant variables com l’alimentació enteral i la sensibilitat insulínica, es podien realitzar assajos reals per a validar protocols de control ‘in silico’ per posteriorment realitzar assajos amb població real

Prediction of glucose excursions under uncertain parameters and food intake in intensive insulin therapy for type 1 diabetes mellitus

Considering the difficulty in the insulin dosage selection and the problem of hyper- and hypoglycaemia episodes in type 1 diabetes, dosage-aid systems appear as tremendously helpful for these patients. A model-based approach to this problem must unavoidably consider uncertainty sources such as the large intra-patient variability and food intake. This work addresses the prediction of glycaemia for a given insulin therapy face to parametric and input uncertainty, by means of modal interval analysis. As result, a band containing all possible glucose excursions suffered by the patient for the given uncertainty is obtained. From it, a safer prediction of possible hyper- and hypoglycaemia episodes can be calculated

Efecto de la glicemia materna en la monitoría electrónica fetal

Introducción: Después del ingreso de la monitoría fetal electrónica como estudio de bienestar fetal, se ha considerado por décadas que un aporte de carbohidratos a la gestante antes de la realización de la monitoría fetal influye en el reporte pero existen estudios que consideran que los niveles de glicemia materna no afecta la variabilidad de la monitoría fetal. Metodología: Se realizó un estudio de corte transversal, para evaluar el efecto de la glicemia materna en la monitoría fetal electrónica comparando los valores de glicemia materna con su resultado, según la categorización del ACOG. Las principales variables fueron las horas de ayuno, valores de glicemia, variabilidad de la monitoría fetal y presencia de aceleraciones. Resultados: Se incluyeron un total de 60 pacientes, que ingresaron al servicio de obstetricia y ginecología del Hospital Universitario Mayor Méderi en el periodo de estudio. No se encontraron diferencias estadísticamente significativas entre los resultados de monitoría fetal y los valores de glicemia materna. Ninguna paciente presentó monitoría categoría III (según categorización de la ACOG). Discusión Se requieren estudios analíticos más amplios para evaluar el papel de la glicemia en el resultado de la monitoría, pero el presente estudio sugiere que no existe relación entre la glicemia materna y el resultado de la monitoría fetal electrónica en la categorización del Colegio Americano De Ginecología Y Obstetricia (ACOG).

Factores perinatales para riesgo de sobrepeso y obesidad en niños de 4 a 5 años en Colombia 2010.

Introducción: La OMS revela que en 2010 alrededor de 43 millones de niños menores de 5 años presentan sobrepeso. En Colombia según la Encuesta Nacional de Situación Nutricional en Colombia en su versión 2005, mostraba una prevalencia general de sobrepeso de 3.1% niños de 0 a 4 años. Es una condición de salud de origen multifactorial en la que interviene factores genéticos, ambientales, maternos y perinatales. Objetivo: Establecer la asociación de riesgo entre el bajo peso al nacer y el desarrollo de sobrepeso y obesidad en niños de 4 a 5 años. Metodología: Se realizó un estudio observacional descriptivo retrospectivo de corte transversal con los datos nutricionales, maternos y perinatales de la Encuesta Nacional de Demografía en Salud del año 2010 en Colombia. Se analizó la asociación entre la variable independiente bajo peso al nacer con el desenlace sobrepeso y obesidad en menores de 4 a 5 años, usando como medida el IMC según la edad. Se realizaron análisis univariados, bivariados y de regresión logística con un modelo de riesgo según las variables que inciden en el desenlace y la variable independiente. Resultados: La muestra obtenida para el estudio fue de 2166 niños de 4 a 5 años de edad quienes cumplían los criterios de inclusión. La prevalencia de sobrepeso u obesidad en la primera infancia fue de 21.8% (472) y el bajo peso al nacer. Los resultados sugieren la asociación de bajo peso y sobrepeso u obesidad es de ORajustado= 0.560 (0.356 – 0.881). Conclusiones: Los resultados sugieren que existe una asociación como factor protector entre el bajo peso y el sobrepeso u obesidad en la primera infancia. Sin embargo, debido al comportamiento de las variables consideradas en la muestra no hay suficiente información para rechazar completamente la hipótesis nula.

Malonato complexes of oxidovanadium(IV): synthesis, structural characterization and exploration of their insulin mimetic properties

Several bis-malonatooxidovanadium(IV) complexes of the general type [M(2)(H2(O))(n)][VO(mal)(2)(H(2)O)] (where M = Li(1), Na(2), K(3), Cs(4) and NH4(5); n = 3.5, 1, 3, 1 and 1, respectively) were isolated in good yield and high purity. These complexes were fully characterized by various physicochemical techniques (elemental analysis, UV- Vis, IR, EPR, CV, etc.) complexes 1, 2 and 3 were structurally characterized by single crystal X- ray diffraction technique. In vivo antidiabetic properties of bis- malonato complexes 1, 2, 3 and 5 have been studied using Streptozotocin induced diabetic rats. Significant lowering of blood sugar level has been noticed. At the same time these complexes were found to regulate secondary pathophysiological complications like liver damage and lowering of the total antioxidant status (TAS) in diabetic rats. Results of these study are expected to a expand the possibility of designing new oxidovanadium(IV) complexes of O, O chelating ligands with significant antidiabetic properties

Melatonin and the circadian entrainment of metabolic and hormonal activities in primary isolated adipocytes

The aim of this work was to investigate the effect of the in vitro circadian-like exposure to melatonin [in the presence or absence of insulin (Ins)] on the metabolism and clock gene expression in adipocytes. To simulate the cyclic characteristics of the daily melatonin profile, isolated rat adipocytes were exposed in a circadian-like pattern to melatonin added to the incubating medium for 12 hr (mimicking the night), followed by an equal period without melatonin (mimicking the day) combined or not with Ins. This intermittent incubation was interrupted when four and a half 24-hr cycles were fulfilled. At the end, either during the induced night (melatonin present) or the induced day (melatonin absent), the rates of lipolysis and D-[U-(14)C]-glucose incorporation into lipids were estimated, in addition to the determination of lipogenic [glucose-6-phosphate dehydrogenase and fatty acid synthase (FAS)] and lipolytic (hormone sensitive lipase) enzymes and clock gene (Bmal-1b, Clock, Per-1 and Cry-1) mRNA expression. The leptin release was also measured. During the induced night, the following effects were observed: an increase in the mRNA expression of Clock, Per-1 and FAS; a rise in lipogenic response and leptin secretion; and a decrease in the lipolytic activity. The intermittent exposure of adipocytes to melatonin temporally and rhythmically synchronized their metabolic and hormonal function in a circadian fashion, mimicking what is observed in vivo in animals during the daily light-dark cycle. Therefore, this work helps to clarify the physiological relevance of the circadian pattern of melatonin secretion and its interactions with Ins, contributing to a better understanding of the adipocyte biology.

Chlorpropamide treatment restores the reduced carrageenan-induced paw edema and pleural exudate volume in diabetic rats

Objective and design: Knowing that hyperglycemia is a hallmark of vascular dysfunction in diabetes and that neonatal streptozotocin-induced diabetic rats (n-STZ) present reduced inflammatory response, we decided to evaluate the effect of chlorpropamide-lowered blood glucose levels on carrageenan-induced rat paw edema and pleural exudate in n-STZ. Materials: Diabetes was induced by STZ injection (160 mg/kg, ip) in neonates (2-day-old) Wistar rats. Treatment: n-STZ diabetic rats were treated with chlorpropamide (200 mg/kg, 15 d, by gavage) 8 weeks after STZ injection. Methods: Carrageenan-induced paw edema and pleural exudate volumes were assessed concomitantly with peripheral and exudate leukocyte count. We also evaluated the expression of inducible nitric oxide synthase (iNOS) in lungs of all experimental groups. Results: Chlorpropamide treatment improved glucose tolerance, beta-cell function (assessed by HOMA-beta), corrected paw edema, and pleural exudate volume in n-STZ. Neither leukocyte count nor iNOS expression were affected by diabetes or by chlorpropamide treatment. Conclusion: Chlorpropamide treatment by restoring beta-cell function, reducing blood sugar levels, and improving glucose tolerance might be contributing to the correction of the reduced inflammatory response tested as paw edema and pleural exudate in n-STZ diabetic rats.

Manoeuvring between anxiety and control : Patients experience of learning to live with diabetes: a lifeworld phenomenological study

Research shows that people with diabetes want their lives to proceed as normally as possible, but some patients experience difficulty in reaching their desired goals with treatment. The learning process is a complex phenomenon interwoven into every facet of life. Patients and healthcare providers often have different perspectives in care which gives different expectations on what the patients need to learn and cope with. The aim of this study, therefore, is to describe the experience of learning to live with diabetes. Interviews were conducted with 12 patients afflicted with type 1 or type 2 diabetes. The interviews were then analysed with reference to the reflective lifeworld research approach. The analysis shows that when the afflicted realize that their bodies undergo changes and that blood sugar levels are not always balanced as earlier in life, they can adjust to their new conditions early. The afflicted must take responsibility for balancing their blood sugar levels and incorporating the illness into their lives. Achieving such goals necessitates knowledge. The search for knowledge and sensitivity to changes are constant requirements for people with diabetes. Learning is driven by the tension caused by the need for and dependence on safe blood sugar control, the fear of losing such control, and the fear of future complications. The most important responsibilities for these patients are aspiring to understand their bodies as lived bodies, ensuring safety and security, and acquiring the knowledge essential to making conscious choices.

Viktiga faktorer i egenvårdsprogram som främjar livskvaliteten för personer med diabetes typ 2. : En litteraturöversikt

Bakgrund: Diabetes typ 2 är en endokrin sjukdom och är en av de största folksjukdomarna i världen. Förhöjda blodsockervärden gör att både små och stora blodkärl tar skada och detta leder till olika komplikationer såsom hjärtinfarkt, stroke och njurskador. Med hjälp av viktnedgång, kostreglering, regelbundet fysisk aktivitet och övervakning av blodglukosnivåerna kan risken för komplikationer förebyggas. Genom att förebygga komplikationer kan livskvaliteten främja patientens dagliga liv. En del av diabetesvården består av egenvårdsprogram där patienten får stöd och rådgivning att hantera sin diabetes. Syfte: Denna litteraturstudie syftar till att studera vilka faktorer i egenvårdsprogram som främjar livskvaliteten hos patienter med diabetes typ 2. Metod: Litteraturstudie, artiklarna söktes i databaserna CINAHL, PubMed och Web of Science. 14 kvantitativa artiklar inkluderades. Resultat: Resultatet visade att information, individuell målsättning och uppföljning var viktiga faktorer i egenvårdsprogrammen för att främja livskvaliteten hos patienter med diabetes typ 2. Slutsats: Att leva med diabetes typ 2 kräver noggrannhet och planering i det dagliga livet. Egenvårdsprogram kan minska risken för komplikationer där följsamhet till egenvården främjas och livskvaliteten gynnas.

Effects of melatonin on hemolymph glucose and lactate concentrations in the fiddler crab, uca pugilator

Melatonin (N-acetyl-5-methoxytryptamine) is an indolamine hormone produced by the pineal gland that works to regulate sleep/wake cycles and activity rhythms. The effects of melatonin in metabolism are far from understood. Melatonin was injected into the fiddler crab, Uca pugilator, to investigate the effects of melatonin on hemolymph glucose and lactate levels. Following injection at t=O, hemolymph samples were collected at t=O.5, 1.0, 1.5 and 5.0 hours. Melatonin caused a decrease in the stress response to injection and also caused delayed hyperglycemia. Melatonin-injected crabs also retained the glucose and lactate rhythymicity when compared to saline-injected crabs. Glucose and lactate rhythms followed the same pattern indicating that the cycles are coupled. Also, melatonin was synthesized using tbe Fischer Indole synthesis and characterized using H?NMR. The synthetic melatonin demonstrated biological activity when injected into the crabs as when compared to pure melatonin on the effects on glucose and lactate concentrations. Overall, melatonin influences both glucose metabolism and the production of lactate.

Enzymatic inhibitory activity of hydroxycinnamates (HCs): in silico studies

Diabetes is a worldwide health issue that has been expanding mainly in developed countries. It is characterized by abnormal levels of blood sugar due to several factors. The most common are resistance to insulin and the production of defective insulin which exerts little or no effect. Its most common symptoms include tissue damage to several systems due to elevated levels of blood sugar. One of the key enzymes in hydrocarbon metabolism is α-glucosidase (EC 3.2.1.20). It catalyzes the breakdown of complex carbohydrates into their respective monomers (glucose) which allows them to be absorbed. In this work, caffeoyl quinic acids and their metabolites were analyzed as potential inhibitors for α-glucosidase. The search for the best inhibitor was conducted using molecular docking. The affinity of each compound was compared to the inhibitor present in the crystal structure of the protein. As no inhibitor with a similar affinity was´found, a new approach was used, in situ drug design. It was not possible to achieve an inhibitor capable of competing with the one present in the crystal structure of the enzyme, which is also its current commercial inhibitor. It is possible to draw some conclusions as to which functional groups interact best with certain residues of the active site. This work was divided into three main sections. The first section, Diabetes, serves as an introduction to what is Diabetes, its symptoms and/or side effects and how caffeoyl quinic acids could be used as a treatment. The second section, Caffeoylquinic acids and their metabolites as inhibitors for Alfa-glucosidase, corresponds to the search through molecular docking of caffeoyl quinic acids as inhibitors for α-glucosidase and what was possible to draw from this search. The last section, In situ design of an inhibitor for α-glucosidase (EC 3.2.1.20), corresponds to the in situ drug design study and what it achieved. The representation of each of the molecules used as a ligand can be found in the Annexes.

Effect of the consumption of a new symbiotic shake on glycemia and cholesterol levels in elderly people with type 2 diabetes mellitus

Background: The consumption of foods containing probiotic and prebiotic ingredients is growing consistently every year, and in view of the limited number of studies investigating their effect in the elderly.Objective: The objective of this study was to evaluate the effect of the consumption of a symbiotic shake containing Lactobacillus acidophilus, Bifidobacterium bifidum and fructooligosaccharides on glycemia and cholesterol levels in elderly people.Methods: A randomized, double-blind, placebo-controlled study was conducted on twenty volunteers (ten for placebo group and ten for symbiotic group), aged 50 to 60 years. The criteria for inclusion in the study were: total cholesterol > 200 mg/dL; triglycerides > 200 mg/dL and glycemia > 110 mg/dL. Over a total test period of 30 days, 10 individuals (the symbiotic group) consumed a daily dose of 200 mL of a symbiotic shake containing 10(8) UFC/mL Lactobacillus acidophilus, 10(8) UFC/mL Bifidobacterium bifidum and 2 g oligofructose, while 10 other volunteers (the placebo group) drank daily the same amount of a shake that did not contain any symbiotic bacteria. Blood samples were collected 15 days prior to the start of the experiment and at 10-day intervals after the beginning of the shake intake. The standard lipid profile (total cholesterol, triglycerides and HDL cholesterol) and glycemia, or blood sugar levels, were evaluated by an enzyme colorimetric assay.Results: The results of the symbiotic group showed a non-significant reduction (P > 0.05) in total cholesterol and triglycerides, a significant increase (P < 0.05) in HDL cholesterol and a significant reduction (P < 0.05) in fasting glycemia. No significant changes were observed in the placebo group.Conclusion: The consumption of symbiotic shake resulted in a significant increase in HDL and a significant decrease of glycemia.

Increase of gastric area and weight gain in rats submitted to the ingestion of gasified water

OBJETIVO: em virtude do aumento progressivo da utilização de bebidas gaseificadas e do ganho de peso na população brasileira, e sabendo-se que os refrigerantes têm no gás carbônico um fator em comum, planejou-se um estudo experimental em ratos para investigar os efeitos da água gaseificada na ingestão hídrica e alimentar, ganho de peso, área gástrica, glicemia, hematócrito e hemoglobina. MÉTODOS: Foram constituídos 4 grupos de 12 ratos acompanhados por 36 dias. Ao Grupo-1 foi oferecido 35 g/dia de ração ad libitum e 20 ml de água não gaseificada em 4 períodos diários, ao Grupo-2 foi oferecido 35 g/dia de ração ad libitum e 20 ml de água gaseificada em 4 períodos diários, ao Grupo-3 foi oferecido 10 g/dia de ração ad libitum e 20 ml de água não gaseificada em 4 períodos diários e ao Grupo-4 foi oferecido 10 g/dia de ração ad libitum e 20 ml de água gaseificada em 4 períodos diários. RESULTADOS: Os resultados identificaram que os animais que foram submetidos ao tratamento com água gaseificada (Grupo-2 e Grupo-4), apresentaram um maior volume de ingestão hídrica e aumento significativo da área gástrica (p<0,001), no Grupo-2 a ingestão alimentar assim como o ganho de peso foi significativo (p<0,01), os dados de glicemia, hematócrito e hemoglobina não tiveram alterações significativas entre os grupos estudados. CONCLUSÃO: Nas condições em que foi realizado este experimento, concluímos que a água gaseificada favoreceu a ingestão hídrica e alimentar, o ganho de peso e o aumento da área gástrica.

Relevância de exames de rotina em pacientes de baixo risco submetidos a cirurgias de pequeno e médio porte

JUSTIFICATIVA E OBJETIVOS: A avaliação pré-operatória tem como objetivos diminuir a morbimortalidade do paciente cirúrgico, o custo do atendimento perioperatório e a ansiedade pré-operatória. A partir da avaliação clínica deve-se definir a necessidade de exames complementares e estratégias para reduzir o risco anestésico-cirúrgico. O objetivo deste trabalho foi avaliar o benefício de exames de rotina pré-operatório de pacientes de baixo risco em cirurgias de pequeno e médio porte. MÉTODOS: Trata-se de um estudo descritivo, transversal, com 800 pacientes atendidos no consultório de avaliação pré-anestésica do Hospital Santo Antonio, Salvador, BA. Foram incluídos pacientes de 1 a 45 anos, estado físico ASA I, que seriam submetidos a cirurgias eletivas de pequeno e médio porte. Avaliaram-se alterações no hemograma, coagulograma, eletrocardiograma, RX de tórax, glicemia, função renal e dosagem de sódio e potássio e as eventuais mudanças de conduta que ocorreram decorrentes dessas alterações. RESULTADOS: Dos 800 pacientes avaliados, 97,5% fizeram hemograma, 89% coagulograma, 74,1% eletrocardiograma, 62% RX de tórax, 68% glicemia de jejum, 55,7% dosagens séricas de ureia e creatinina e 10,1% dosagens de sódio e potássio séricos. Desses 700 pacientes, 68 (9,71%) apresentaram alteração nos exames pré-operatórios de rotina e apenas 10 (14,7%) dos considerados alterados tiveram conduta pré-operatória modificada, ou seja, solicitação de novos exames, interconsulta ou adiamento do procedimento. Nenhuma das cirurgias foi suspensa. CONCLUSÃO: Observou-se que excessivos exames complementares são solicitados no pré-operatório, mesmo em pacientes jovens, de baixo risco cirúrgico, com pouca ou nenhuma interferência na conduta perioperatória. Exames aboratoriais padronizados não são bons instrumentos de screening de doenças, além de gerar gastos elevados e desnecessários.