Book Review: Diabetes and wellbeing: Managing psychological and emotional challenges of diabetes types 1 and 2

Book Review in peer revewed Journal of Diabetes Nursing about the psychological and emotional challenges associated with living with Diabetes. The book is recommended to both health professionals and people with Diabetes.

Efeitos da suplementação de L-arginina e do exercício em cicloergômetro sobre a função endotelial e estresse oxidativo em indivíduos com diabetes tipo 1

Introdução e Objetivo: O fluxo sangüíneo gera estresse de cisalhamento sobre a parede dos vasos induzindo a conversão do aminoácido L-arginina em L-citrulina pela ação da eNOs, liberando o vasodilatador óxido nítrico. O exercício aumenta o fluxo sangüíneo e ativa a eNOs, promovendo vasodilatação. Um aumento no diâmetro do vaso diminuiria os níveis de estresse oxidativo pela diminuição do estresse de cisalhamento. O objetivo deste estudo foi verificar os efeitos da suplementação de L-arginina sobre a função endotelial e estresse oxidativo em indivíduos com diabetes tipo 1. Métodos: Foram avaliados 10 indivíduos do sexo masculino com diabetes do tipo 1 e 20 indivíduos saudáveis para controle, que realizaram teste de cargas progressivas em cicloergômetro para a determinação da carga de exercício, que correspondia a 10% abaixo do 2 º limiar ventilatório. Em uma nova data, os voluntários se exercitaram durante 45 minutos em cicloergômetro, onde foram avaliados parâmetros de função endotelial e estresse oxidativo antes e depois do exercício. Os voluntários foram separados aleatoriamente em dois grupos: L-arginina e placebo. A suplementação de L-arginina foi realizada a partir da ingesta de 7g ao dia na forma de cápsulas; o grupo placebo recebeu amido. Após a suplementação, foi repetido o protocolo de exercício. A função endotelial foi avaliada através da avaliação do fluxo sangüíneo e concentração de nitritos plasmáticos; o estresse oxidativo foi avaliado pelas técnicas do TBARS, carbonil, TRAP e ácido úrico plasmáticos Utilizou-se ANOVA Fatorial de duas vias e teste post hoc de Tukey para análise dos resultados, aceitou-se p<0,05 como significativo. Resultados: Os dados estão expressos em média + erro padrão. Os indivíduos com diabetes do tipo 1 não apresentaram disfunção endotelial quando comparados aos controle, entretanto tiveram parâmetros de estresse oxidativo elevados (TBARS de 1,09 + 0,41 e 2,44 + 0,46 nmolMDA.mg PTN-1, p=0,039; carbonil de 0,148 + 0,02 e 1,48 + 0,20 fM.mg PTN-1, p=0,000 e ácido úrico de 44,55 + 2,06 e 28,10 + 1,57 mg/dl, p=0,000, em controles e diabéticos, respectivamente). O exercício aumentou significativamente o fluxo sangüíneo nos controle e diabéticos ( de 3,53 + 0,35 para 5,46 + 0,35 ml.100ml-1.min-1 no controle, p=0,001 e de 2,66 + 0,33 para 3,77 + 0,36 ml.100ml-1.min-1 nos indivíduos com diabetes, p= 0,000), mas não alterou as concentrações plasmáticas de nitritos nem os parâmetros de estresse oxidativo. Os diabéticos que receberam suplementação com L-arginina tiveram seus valores de fluxo sangüíneo em repouso elevados significativamente (de 3,05 + 0,63 para 4,74 + 0,86 ml.100ml-1.min-1 , p=0,036), efeito não encontrado no grupo controle que recebeu a suplementação. Entretanto, este grupo não apresentou aumento do fluxo sangüíneo após o exercício, conforme observado no momento antes da suplementação. Conclusão: O exercício físico em cicloergômetro aumenta o fluxo sangüíneo sem alterar os parâmetros de estresse oxidativo em indivíduos controle e diabéticos tipo 1. A suplementação com L-arginina aumenta a vasodilatação dependente do endotélio em indivíduos com diabetes do tipo 1, e atenua o aumento do fluxo sangüíneo em resposta ao exercício nestes pacientes. Esta resposta demonstrou uma possível melhora na função endotelial na situação de repouso com a suplementação. Entretanto, restam questões obscuras sobre a resposta de fluxo ao exercício sob o efeito da L-arginina nesta população, sendo necessários estudos adicionais para o esclarecimento.

Associação do receptor toll-like 2 com o estado pró-inflamatório do diabetes tipo 1

Inflammation has been pointed out as an important factor in development of chronic diseases, as diabetes. Hyperglycemia condition would be responsible by toll-like receptors, TLR2 and TLR4, and, consequently by local and systemic inflammation induction. Thus, the objective of present study was to evaluate type 1 Diabetes mellitus (T1DM) pro-inflammatory state through mRNA expression of TLRs 2 and 4 and proinflammatory cytokines IL-1β, IL-6 and TNF-α correlating to diabetic nephropathy. In order to achieve this objective, 76 T1DM patients and 100 normoglycemic (NG) subjects aged between 6 and 20 years were evaluated. T1DM subjects were evaluated as a total group DM1, and considering glycemic control (good glycemic control DM1G, and poor glycemic control DM1P) and considering time of diagnosis (before achieving 5 years of diagnosis DM1< 5yrs, and after achieving 5 years of diagnosis DM1 <5yrs). Metabolic control was evaluated by glucose and glycated hemoglobin concentrations; to assess renal function serum urea, creatinine, albumin, total protein and urinary albumin-to-creatinine ratio were determined and to evaluate hepatic function, AST and ALT serum activities were measured. Pro-inflammatory status was assessed by mRNA expression of TLRs 2 and 4 and the inflammatory cytokines IL-1β, IL-6 and TNF-α. Except for DM1G group (18.4%), DM1NC patients (81.6%) showed a poor glycemic control, with glycated hemoglobin (11,2%) and serum glucose (225,5 md/dL) concentrations significantly increased in relation to NG group (glucose: 76,5mg/dL and glycated hemoglobin: 6,9%). Significantly enhanced values of urea (20%) and ACR (20,8%) and diminished concentrations of albumin (5,7%) and total protein (13,6%) were found in T1DM patients, mainly associated to a poor glycemic control (DM1P increased values of urea: 20% and ACR:49%, and diminished of albumin: 13,6% and total protein:13,6%) and longer disease duration (DM1 <5yrs - increased values of urea: 20% and ACR:20,8%, and diminished of albumin: 14,3% and total protein:13,6%). As regarding pro-inflammatory status evaluation, significantly increased mRNA expressions were presented for TLR2 (37,5%), IL-1β (43%), IL-6 (44,4%) and TNF-α (15,6%) in T1DM patients in comparison to NG, mainly associated to DM1P (poor glycemic control TLR2: 82%, IL-1β: 36,8% increase) and DM1 <5yrs (longer time of diagnosis TLR2: 85,4%, IL-1β: 46,5% increased) groups. Results support the existence of an inflammatory state mediated by an increased expression of TLR2 and pro-inflammatory cytokines IL-1β, IL-6 and TNF-α in T1DM

Avaliação da presença de osteopatia decorremte do diabetes tipo 1 em criança e adolecentes do Rio Grande do Norte

Diabetes Mellitus (DM) and osteoposes are chronic diseases with great socioeconomic consequences, mainly due to the late complications and consequent disabilities. The potential effects of DM on bone metabolism remain a very conroversial issue, and disagreement exists with regard to the clinical implications of diabetic osteopenia and the mechanism of its ocurrence. The issue is further complicated by the contribuicion of the especific factors, such as duration of disease an dthe degree of metabolic control. The objective of this study is to identify the osteopathy in children and adolescents with DM 1 assisted in the hospital of pediatrics, UFRN, through biochemical markers of bone and mineral metabolism and the extent of bone mineral density. The study was composed by 74 diabetics type 1 patients (DM1) of both gender and aged 6 to 20 yars. Normoglicêmic group was composed by 97 healthy subjects of both genders, which showed the same age range of DM1, in addition to same socioeconomic class. These individuals qere students from the networks of public education in the city of Natal-RN, randomly invited to paticipate in our study. Both groups DM1 and NG were divided intofour subgroups, according to the classification of tanner , T1, T2, T3, T4 for achieving a benchmark. Diabetic individuals showed up with a poor glycemic control. the group DN1 T4 showed an incresead value for total protein, albumin, urea and microalbumiuria are predictors of grumelura injury in DM1 patients . The total alkaline phosphatase activitywas kept on high levels for both groups because they are in a stature development age. For osteocalcin there were decreased levels for groups Dm1 T1, T2, and T3 when compared to their NG (s), suggesting that this decrease could be associated with reduction in the number and/or differentiation os osteoblasts thereby contributing to reducing bone formation. There were no changes in the activity of TRAP. The serum concentrations of total and ionized calcium, phosphorus and magnesium were included within the RV. It was observed that the BMD (Z- SCORE ) has always been within the RV for both groups, despite to DM1 T4. Taking all together, our results support the hypothesis that children and adolescents with type 1 DM present the risk in the long run to suffer a reduction in the bone mass, associated to poor glicemic control and disease duration. It could limit the bone growth and increase the probality of development of osteopenia, as well as other complications surch as retinopathy and renal failure

Avaliação do status antioxidante, expressão gênica e polimorfismos dos genes SOD1, SOD2 e GPx1 em crianças, adolescentes e adultos jovens com diabetes tipo 1

Studies report that the pathophysiological mechanism of diabetes complications is associated with increased production of Reactive Oxygen Species (ROS)-induced by hyperglycemia and changes in the capacity the antioxidant defense system. In this sense, the aim of this study was to evaluate changes in the capacity of antioxidant defense system, by evaluating antioxidant status, gene expression and polymorphisms in the genes of GPx1, SOD1 and SOD2 in children, adolescents and young adults with type 1 diabetes. We studied 101 individuals with type 1 diabetes (T1D) and 106 normoglycemic individuals (NG) aged between 6 and 20 years. Individuals with type 1 diabetes were evaluated as a whole group and subdivided according to glycemic control in DM1G good glycemic control and DM1P poor glycemic control. Glycemic and metabolic control was evaluate by serum glucose, glycated hemoglobin, triglycerides, total cholesterol and fractions (HDL and LDL). Renal function was assessed by measurement of serum urea and creatinine and albumin-to-creatinine ratio (ACR) in spot urine. Antioxidant status was evaluate by content of reduced glutathione (GSH) in whole blood and the activity of erythrocyte enzymes glutathione peroxidase (GPx) and superoxide dismutase (SOD). We also analyzed gene expression and gene polymorphisms of GPx1 (rs1050450), SOD1 (rs17881135) and SOD2 (rs4880) by the technique of real-time PCR (Taqman®). Most individuals with DM1 (70.3%) had poor glycemic control (glycated hemoglobin> 8%). Regarding the lipid profile, individuals with type 1 diabetes had significantly elevated total cholesterol (p <0.001) and LDL (p <0.000) compared to NG; for triglycerides only DM1NC group showed significant increase compared to NG. There was an increase in serum urea and RAC of individuals with DM1 compared to NG. Nine individuals with type 1 diabetes showed microalbuminuria (ACR> 30 mg / mg). There was a decrease in GSH content (p = 0.006) and increased erythrocyte GPx activity (p <0.001) and SOD (p <0.001) in DM1 group compared to NG. There was no significant difference in the expression of GPx1 (p = 0.305), SOD1 (.365) and SOD2 (0.385) between NG and DM1. The allele and genotype frequencies of the polymorphisms studied showed no statistically significant difference between the groups DM1 and NG. However, the GPx1 polymorphism showed the influence of erythrocyte enzyme activity. There was a decrease in GPx activity in individuals with type 1 diabetes who had a polymorphic variant T (p = 0.012). DM1 patients with the polymorphic variant G (AG + GG) for polymorphism of SOD2 (rs4880) showed an increase in the RAC (p <0.05). The combined data suggest that glucose control seems to be the predominant factor for the emergence of changes in lipid profile, renal function and antioxidant system, but the presence of the polymorphisms studied may partly contribute to the onset of complications

Adesão ao tratamento por pacientes portadores de diabetes tipo 1 e tipo 2: efeitos do treino de discriminação de dicas internas e externas

O presente trabalho pretende comparar resultados de treinos de discriminação de sintomas e de ações relativas ao tratamento do diabetes Tipo 1 e Tipo 2, avaliando a eficácia desses treinos para a estimativa do índice glicêmico e para a promoção de adesão ao tratamento. Inúmeras pesquisas realizadas na área de psicologia da saúde têm o objetivo de proporcionar a melhora no tratamento ao paciente diabético. Parte dessas pesquisas utiliza um procedimento denominado de- automonitoração, a qual consiste em habilidades de observação, aferição e registro de aspectos relevantes no tratamento do diabetes. como: (a) índice glicêmico (IG) (b) sintomas (dicas internas -DI); e (c) ações envolvidas no tratamento nas áreas da medicação, alimentação e atividade física (dicas externas -DE). Estudos têm demonstrado que com a automonitoração o paciente diabético melhora o nível de discriminação das alterações glicêmicas. Essa.literatura não é clara em definir qual o melhor tipo de dica para melhorar a discriminação dos estados glicêmicos e afirm que o desenvolvimento desta habilidade não favorece a melhora na adesão ao tratamento. Esse estudo compreendeu três fases: (a) Entrevista inicial e de linha de Base; (b ) Entrevistas de Treino e (c) Entrevista Final e Devolutiva. A fase de treino está dividida em duas etapas Dicas Internas (DI) e Dicas Externas (DE). Nas etapas de treino os participantes estimaram e atribuíram causa para taxa de glicose sangüínea medida por um reflectômetro em cada entrevista. Na etapa DE. os participantes também recebiam feedback do pesquisador acerca do relato de seguimento das orientações, com base nas orientações recebidas em consulta e compiladas do prontuário do paciente. Foi calculado o índice de adesão (IA) nas duas primeiras fases. As entrevistas da fase de treino foram realizadas na residência do participante, em intervalos de três dias, nos quais o participante registrava a ocorrência de eventos correspondentes a etapa que estava realizando. Os resultados demonstram que independente do tipo de treino realizado os participantes estimaram os seus estados glicêmicos com base em dicas externas. Os sintomas' relatados na etapa DI nem sempre estavam associados ao Ia medido. Os participantes portadores de diabetes. Tipo 1 alcançaram maior precisão nas estimativas no treino de DE. A maioria dos participantes alcançaram melhor adesão quando iniciaram o treino por DE. Os resultados sugerem que: (a) relatos de sintomas não são os melhores indicadores para avaliar o estado glicêmico e a adesão ao tratamento (b) o melhor tipo de treino para promoção da adesão ao tratamento é o que envolve as dicas externas.

Análise da modulação autonômica em repouso e em resposta ao Tilt Test ativo em crianças com diabetes tipo 1

Pós-graduação em Fisioterapia - FCT

LrhA als Regulator der Flagellen, Motilität, Chemotaxis und Typ 1 Fimbrien in Escherichia coli

Das lrhA-Gen von E. coli kodiert für einen Transkriptionsregulator der LysR-Familie. Die Funktion von LrhA war ungeklärt und sollte durch Vergleich der Gesamt-mRNA aus einem E. coli-Wildtyp und einer isogenen lrhA-Mutante mit Hilfe von Genomanalysen untersucht werden. In der lrhA-Mutante war der mRNA-Gehalt vieler Gene um den Faktor 3 bis 80 erhöht. Es handelt sich um Flagellen-, Motilitäts- und Chemotaxisgene, bzw. um Gene der Typ 1 Fimbrien. Diese Ergebnisse wurden in Expressionsmessungen bestätigt. LrhA war in der Lage an den Promotor von flhDC zu binden, aber nicht an die Promotoren der übrigen Gene für Motilität und Chemotaxis. FlhDC kodiert für den übergeordneten Regulator FlhD2C2 der Fagellensynthese.LrhA war außerdem in der Lage an die Promotoren der Gene für Typ 1 Fimbrien fimA und fimE zu binden. Typ 1 Fimbrien stellen in E. coli Virulenzfaktoren dar. Eine Regulation weiterer Virulenzfaktoren durch LrhA konnte in DNA-Pathoarrays ausgeschlossen werden.LrhA ist damit ein wichtiger Transkriptionsregulator, der die Expression der Gene für Flagellen, Motilität, Chemotaxis und Typ 1 Fimbrien reguliert. FlhDC, fimA und fimE stellen dabei direkte Zielgene von LrhA dar. Außerdem konnte eine positive Autoregulation von LrhA nachgewiesen werden.

Algebraische Zyklen auf abelschen Varietäten der Dimension 4 mit Polarisierung von Typ (1,2,2,2)

Diese Arbeit besch"aftigt sich mit algebraischen Zyklen auf komplexen abelschen Variet"aten der Dimension 4. Ziel der Arbeit ist ein nicht-triviales Element in $Griff^{3,2}(A^4)$ zu konstruieren. Hier bezeichnet $A^4$ die emph{generische} abelsche Variet"at der Dimension 4 mit Polarisierung von Typ $(1,2,2,2)$. Die ersten drei Kapitel sind eine Wiederholung von elementaren Definitionen und Begriffen und daher eine Festlegung der Notation. In diesen erinnern wir an elementare Eigenschaften der von Saito definierten Filtrierungen $F_S$ und $Z$ auf den Chowgruppen (vgl. cite{Sa0} und cite{Sa}). Wir wiederholen auch eine Beziehung zwischen der $F_S$-Filtrierung und der Zerlegung von Beauville der Chowgruppen (vgl. cite{Be2} und cite{DeMu}), welche aus cite{Mu} stammt. Die wichtigsten Begriffe in diesem Teil sind die emph{h"ohere Griffiths' Gruppen} und die emph{infinitesimalen Invarianten h"oherer Ordnung}. Dann besch"aftigen wir uns mit emph{verallgemeinerten Prym-Variet"aten} bez"uglich $(2:1)$ "Uberlagerungen von Kurven. Wir geben ihre Konstruktion und wichtige geometrische Eigenschaften und berechnen den Typ ihrer Polarisierung. Kapitel ref{p-moduli} enth"alt ein Resultat aus cite{BCV} "uber die Dominanz der Abbildung $p(3,2):mathcal R(3,2)longrightarrow mathcal A_4(1,2,2,2)$. Dieses Resultat ist von Relevanz f"ur uns, weil es besagt, dass die generische abelsche Variet"at der Dimension 4 mit Polarisierung von Typ $(1,2,2,2)$ eine verallgemeinerte Prym-Variet"at bez"uglich eine $(2:1)$ "Uberlagerung einer Kurve vom Geschlecht $7$ "uber eine Kurve vom Geschlecht $3$ ist. Der zweite Teil der Dissertation ist die eigentliche Arbeit und ist auf folgende Weise strukturiert: Kapitel ref{Deg} enth"alt die Konstruktion der Degeneration von $A^4$. Das bedeutet, dass wir in diesem Kapitel eine Familie $Xlongrightarrow S$ von verallgemeinerten Prym-Variet"aten konstruieren, sodass die klassifizierende Abbildung $Slongrightarrow mathcal A_4(1,2,2,2)$ dominant ist. Desweiteren wird ein relativer Zykel $Y/S$ auf $X/S$ konstruiert zusammen mit einer Untervariet"at $Tsubset S$, sodass wir eine explizite Beschreibung der Einbettung $Yvert _Thookrightarrow Xvert _T$ angeben k"onnen. Das letzte und wichtigste Kapitel enth"ahlt Folgendes: Wir beweisen dass, die emph{ infinitesimale Invariante zweiter Ordnung} $delta _2(alpha)$ von $alpha$ nicht trivial ist. Hier bezeichnet $alpha$ die Komponente von $Y$ in $Ch^3_{(2)}(X/S)$ unter der Beauville-Zerlegung. Damit und mit Hilfe der Ergebnissen aus Kapitel ref{Cohm} k"onnen wir zeigen, dass [ 0neq [alpha ] in Griff ^{3,2}(X/S) . ] Wir k"onnen diese Aussage verfeinern und zeigen (vgl. Theorem ref{a4}) begin{theorem}label{maintheorem} F"ur $sin S$ generisch gilt [ 0neq [alpha _s ]in Griff ^{3,2}(A^4) , ] wobei $A^4$ die generische abelsche Variet"at der Dimension $4$ mit Polarisierung vom Typ $(1,2,2,2)$ ist. end{theorem}

Extracción de conocimientos de la diabetes tipo 1 utilizando la metodología de "Data Mining"

La diabetes mellitus es un trastorno en la metabolización de los carbohidratos, caracterizado por la nula o insuficiente segregación de insulina (hormona producida por el páncreas), como resultado del mal funcionamiento de la parte endocrina del páncreas, o de una creciente resistencia del organismo a esta hormona. Esto implica, que tras el proceso digestivo, los alimentos que ingerimos se transforman en otros compuestos químicos más pequeños mediante los tejidos exocrinos. La ausencia o poca efectividad de esta hormona polipéptida, no permite metabolizar los carbohidratos ingeridos provocando dos consecuencias: Aumento de la concentración de glucosa en sangre, ya que las células no pueden metabolizarla; consumo de ácidos grasos mediante el hígado, liberando cuerpos cetónicos para aportar la energía a las células. Esta situación expone al enfermo crónico, a una concentración de glucosa en sangre muy elevada, denominado hiperglucemia, la cual puede producir a medio o largo múltiples problemas médicos: oftalmológicos, renales, cardiovasculares, cerebrovasculares, neurológicos… La diabetes representa un gran problema de salud pública y es la enfermedad más común en los países desarrollados por varios factores como la obesidad, la vida sedentaria, que facilitan la aparición de esta enfermedad. Mediante el presente proyecto trabajaremos con los datos de experimentación clínica de pacientes con diabetes de tipo 1, enfermedad autoinmune en la que son destruidas las células beta del páncreas (productoras de insulina) resultando necesaria la administración de insulina exógena. Dicho esto, el paciente con diabetes tipo 1 deberá seguir un tratamiento con insulina administrada por la vía subcutánea, adaptado a sus necesidades metabólicas y a sus hábitos de vida. Para abordar esta situación de regulación del control metabólico del enfermo, mediante una terapia de insulina, no serviremos del proyecto “Páncreas Endocrino Artificial” (PEA), el cual consta de una bomba de infusión de insulina, un sensor continuo de glucosa, y un algoritmo de control en lazo cerrado. El objetivo principal del PEA es aportar al paciente precisión, eficacia y seguridad en cuanto a la normalización del control glucémico y reducción del riesgo de hipoglucemias. El PEA se instala mediante vía subcutánea, por lo que, el retardo introducido por la acción de la insulina, el retardo de la medida de glucosa, así como los errores introducidos por los sensores continuos de glucosa cuando, se descalibran dificultando el empleo de un algoritmo de control. Llegados a este punto debemos modelar la glucosa del paciente mediante sistemas predictivos. Un modelo, es todo aquel elemento que nos permita predecir el comportamiento de un sistema mediante la introducción de variables de entrada. De este modo lo que conseguimos, es una predicción de los estados futuros en los que se puede encontrar la glucosa del paciente, sirviéndonos de variables de entrada de insulina, ingesta y glucosa ya conocidas, por ser las sucedidas con anterioridad en el tiempo. Cuando empleamos el predictor de glucosa, utilizando parámetros obtenidos en tiempo real, el controlador es capaz de indicar el nivel futuro de la glucosa para la toma de decisones del controlador CL. Los predictores que se están empleando actualmente en el PEA no están funcionando correctamente por la cantidad de información y variables que debe de manejar. Data Mining, también referenciado como Descubrimiento del Conocimiento en Bases de Datos (Knowledge Discovery in Databases o KDD), ha sido definida como el proceso de extracción no trivial de información implícita, previamente desconocida y potencialmente útil. Todo ello, sirviéndonos las siguientes fases del proceso de extracción del conocimiento: selección de datos, pre-procesado, transformación, minería de datos, interpretación de los resultados, evaluación y obtención del conocimiento. Con todo este proceso buscamos generar un único modelo insulina glucosa que se ajuste de forma individual a cada paciente y sea capaz, al mismo tiempo, de predecir los estados futuros glucosa con cálculos en tiempo real, a través de unos parámetros introducidos. Este trabajo busca extraer la información contenida en una base de datos de pacientes diabéticos tipo 1 obtenidos a partir de la experimentación clínica. Para ello emplearemos técnicas de Data Mining. Para la consecución del objetivo implícito a este proyecto hemos procedido a implementar una interfaz gráfica que nos guía a través del proceso del KDD (con información gráfica y estadística) de cada punto del proceso. En lo que respecta a la parte de la minería de datos, nos hemos servido de la denominada herramienta de WEKA, en la que a través de Java controlamos todas sus funciones, para implementarlas por medio del programa creado. Otorgando finalmente, una mayor potencialidad al proyecto con la posibilidad de implementar el servicio de los dispositivos Android por la potencial capacidad de portar el código. Mediante estos dispositivos y lo expuesto en el proyecto se podrían implementar o incluso crear nuevas aplicaciones novedosas y muy útiles para este campo. Como conclusión del proyecto, y tras un exhaustivo análisis de los resultados obtenidos, podemos apreciar como logramos obtener el modelo insulina-glucosa de cada paciente. ABSTRACT. The diabetes mellitus is a metabolic disorder, characterized by the low or none insulin production (a hormone produced by the pancreas), as a result of the malfunctioning of the endocrine pancreas part or by an increasing resistance of the organism to this hormone. This implies that, after the digestive process, the food we consume is transformed into smaller chemical compounds, through the exocrine tissues. The absence or limited effectiveness of this polypeptide hormone, does not allow to metabolize the ingested carbohydrates provoking two consequences: Increase of the glucose concentration in blood, as the cells are unable to metabolize it; fatty acid intake through the liver, releasing ketone bodies to provide energy to the cells. This situation exposes the chronic patient to high blood glucose levels, named hyperglycemia, which may cause in the medium or long term multiple medical problems: ophthalmological, renal, cardiovascular, cerebrum-vascular, neurological … The diabetes represents a great public health problem and is the most common disease in the developed countries, by several factors such as the obesity or sedentary life, which facilitate the appearance of this disease. Through this project we will work with clinical experimentation data of patients with diabetes of type 1, autoimmune disease in which beta cells of the pancreas (producers of insulin) are destroyed resulting necessary the exogenous insulin administration. That said, the patient with diabetes type 1 will have to follow a treatment with insulin, administered by the subcutaneous route, adapted to his metabolic needs and to his life habits. To deal with this situation of metabolic control regulation of the patient, through an insulin therapy, we shall be using the “Endocrine Artificial Pancreas " (PEA), which consists of a bomb of insulin infusion, a constant glucose sensor, and a control algorithm in closed bow. The principal aim of the PEA is providing the patient precision, efficiency and safety regarding the normalization of the glycemic control and hypoglycemia risk reduction". The PEA establishes through subcutaneous route, consequently, the delay introduced by the insulin action, the delay of the glucose measure, as well as the mistakes introduced by the constant glucose sensors when, decalibrate, impede the employment of an algorithm of control. At this stage we must shape the patient glucose levels through predictive systems. A model is all that element or set of elements which will allow us to predict the behavior of a system by introducing input variables. Thus what we obtain, is a prediction of the future stages in which it is possible to find the patient glucose level, being served of input insulin, ingestion and glucose variables already known, for being the ones happened previously in the time. When we use the glucose predictor, using obtained real time parameters, the controller is capable of indicating the future level of the glucose for the decision capture CL controller. The predictors that are being used nowadays in the PEA are not working correctly for the amount of information and variables that it need to handle. Data Mining, also indexed as Knowledge Discovery in Databases or KDD, has been defined as the not trivial extraction process of implicit information, previously unknown and potentially useful. All this, using the following phases of the knowledge extraction process: selection of information, pre- processing, transformation, data mining, results interpretation, evaluation and knowledge acquisition. With all this process we seek to generate the unique insulin glucose model that adjusts individually and in a personalized way for each patient form and being capable, at the same time, of predicting the future conditions with real time calculations, across few input parameters. This project of end of grade seeks to extract the information contained in a database of type 1 diabetics patients, obtained from clinical experimentation. For it, we will use technologies of Data Mining. For the attainment of the aim implicit to this project we have proceeded to implement a graphical interface that will guide us across the process of the KDD (with graphical and statistical information) of every point of the process. Regarding the data mining part, we have been served by a tool called WEKA's tool called, in which across Java, we control all of its functions to implement them by means of the created program. Finally granting a higher potential to the project with the possibility of implementing the service for Android devices, porting the code. Through these devices and what has been exposed in the project they might help or even create new and very useful applications for this field. As a conclusion of the project, and after an exhaustive analysis of the obtained results, we can show how we achieve to obtain the insulin–glucose model for each patient.

Atividade Física e Diabetes tipo 1 em crianças: estudo de caso para análise de variações das concentrações glicémicas ao longo de 6 meses

Considerada como uma das mais importantes doenças crónicas na infância, a diabetes mellitus tipo 1 foi a base para a realização deste estudo de caso. A fim de conhecer e compreender as variações das concentrações glicémicas numa criança desportista com diabetes tipo 1, ao longo de 6 meses, foram efetuados registos diários das suas concentrações de glicémia em 5 diferentes momentos do dia (antes das refeições e durante o sono); registo dos momentos de prática de exercício físico; entrevista à enfermeira responsável pelo acompanhamento do referido indivíduo; conversas com os progenitores e uma recolha bibliográfica que esclarecesse toda a dinâmica e rotinas de crianças com diabetes mellitus tipo 1, bem como o seu efeito na prática desportiva, tentando perceber os benefícios que poderá induzir perante esta condição de saúde. Através da associação entre os resultados obtidos e a revisão literária, foi possível perceber a causa de ocorrência de híper e hipoglicémias. Ademais, foi possível inferir que a prática desportiva em crianças com diabetes mellitus tipo 1 é, na grande maioria dos casos, benéfica. Concluindo, o desporto proporciona, para além dos efeitos já conhecidos, uma diminuição na insulina necessária para um adequando equilíbrio glicémico e adaptações fisiológicas que melhoram a condição de saúde.

The impact of the metabolic syndrome and parental risk factors in patients with type 1 diabetes

Background: One-third of patients with type 1 diabetes develop diabetic complications, such as diabetic nephropathy. The diabetic complications are related to a high mortality from cardiovascular disease, impose a great burden on the health care system, and reduce the health-related quality of life of patients. Aims: This thesis assessed, whether parental risk factors identify subjects at a greater risk of developing diabetic complications. Another aim was to evaluate the impact of a parental history of type 2 diabetes on patients with type 1 diabetes. A third aim was to assess the role of the metabolic syndrome in patients with type 1 diabetes, both its presence and its predictive value with respect to complications. Subjects and methods: This study is part of the ongoing nationwide Finnish Diabetic Nephropathy (FinnDiane) Study. The study was initiated in 1997, and, thus far, 4,800 adult patients with type 1 diabetes have been recruited. Since 2004, follow-up data have also been collected in parallel to the recruitment of new patients. Studies I to III have a cross-sectional design, whereas Study IV has a prospective design. Information on parents was obtained from the patients with type 1 diabetes by a questionnaire. Results: Clustering of parental hypertension, cardiovascular disease, and diabetes (type 1 and type 2) was associated with diabetic nephropathy in patients with type 1 diabetes, as was paternal mortality. A parental history of type 2 diabetes was associated with a later onset of type 1 diabetes, a higher prevalence of the metabolic syndrome, and a metabolic profile related to insulin resistance, despite no difference in the distribution of human leukocyte antigen genotypes or the presence of diabetic complications. A maternal history of type 2 diabetes, seemed to contribute to a worse metabolic profile in the patients with type 1 diabetes than a paternal history. The metabolic syndrome was a frequent finding in patients with type 1 diabetes, observed in 38% of males and 40% of females. The prevalence increased with worsening of the glycemic control and more severe renal disease. The metabolic syndrome was associated with a 3.75-fold odds ratio for diabetic nephropathy, and all of the components of the syndrome were independently associated with diabetic nephropathy. The metabolic syndrome, independent of diabetic nephropathy, increased the risk of cardiovascular events and cardiovascular and diabetes-related mortality over a 5.5-year follow-up. With respect to progression of diabetic nephropathy, the role of the metabolic syndrome was less clear, playing a strong role only in the progression from macroalbuminuria to end-stage renal disease. Conclusions: Familial factors and the metabolic syndrome play an important role in patients with type 1 diabetes. Assessment of these factors is an easily applicable tool in clinical practice to identify patients at a greater risk of developing diabetic complications.