Obesity and kidney disease in type 1 and 2 diabetes: an analysis of the National Diabetes Audit

Background: Obesity is increasingly prevalent in many countries. Obesity is a major risk factor for the development of type 2 diabetes but its relationship with diabetic kidney disease (DKD) remains unclear. Some studies have suggested that the metabolic syndrome (including obesity) may be associated with DKD in type 1 diabetes. Aim: To investigate the association between obesity and DKD. Design: Retrospective cross-sectional study. Methods: National Diabetes Audit data were available for the 2007–08 cycle. Type 1 and 2 diabetes patients with both a valid serum creatinine and urinary albumin:creatinine ratio were included. DKD was defined as an estimated glomerular filtration rate (eGFR) <60 ml/min/1.73 m2, albuminuria or both. Logistic regression was used to analyse associations of obesity (body mass index ≥30 kg/m2) and other variables including year of birth, year of diagnosis, ethnicity and stage of kidney disease. Results: A total of 58 791 type 1 and 733 769 type 2 diabetes patients were included in the analysis. After adjustment, when compared with type 1 diabetes patients with normal renal function those with DKD were up to twice as likely to be obese. Type 2 DKD patients were also more likely to be obese. For example, type 2 diabetes patients with an eGFR <15 ml/min/1.73 m2 and normoalbuminuria, microalbuminuria or macroalbuminuria were all more likely to be obese; odds ratios (95% CI) 1.65 (1.3–2.1), 1.56 (1.28–1.92) and 1.27 (1.05–1.54), respectively. Conclusions: This study has highlighted a strong association between obesity and kidney disease in type 1 diabetes and confirmed their association in type 2 diabetes.

Diabetes in the young - a global view and worldwide estimates of numbers of children with type 1 diabetes

This paper describes the methodology, results and limitations of the 2013 International Diabetes Federation (IDF) Atlas (6th edition) estimates of the worldwide numbers of prevalent cases of type 1 diabetes in children (<15 years). The majority of relevant information in the published literature is in the form of incidence rates derived from registers of newly diagnosed cases. Studies were graded on quality criteria and, if no information was available in the published literature, extrapolation was used to assign a country the rate from an adjacent country with similar characteristics. Prevalence rates were then derived from these incidence rates and applied to United Nations 2012 Revision population estimates for 2013 for each country to obtain estimates of the number of prevalent cases. Data availability was highest for the countries in Europe (76%) and lowest for the countries in sub-Saharan Africa (8%). The prevalence estimates indicate that there are almost 500,000 children aged under 15 years with type 1 diabetes worldwide, the largest numbers being in Europe (129,000) and North America (108,700). Countries with the highest estimated numbers of new cases annually were the United States (13,000), India (10,900) and Brazil (5000). Compared with the prevalence estimates made in previous editions of the IDF Diabetes Atlas, the numbers have increased in most of the IDF Regions, often reflecting the incidence rate increases that have been well-documented in many countries. Monogenic diabetes is increasingly being recognised among those with clinical features of type 1 or type 2 diabetes as genetic studies become available, but population-based data on incidence and prevalence show wide variation due to lack of standardisation in the studies. Similarly, studies on type 2 diabetes in childhood suggest increased incidence and prevalence in many countries, especially in Indigenous peoples and ethnic minorities, but detailed population-based studies remain limited.

Análise do polimorfismo HLA/DR-DQ em Angolanos portadores de Diabetes Mellitus tipo I

A diabetes mellitus do tipo 1 (DM1) é o distúrbio endócrino-metabólico mais frequente em crianças. É uma doença autoimune resultado da destruição selectiva das células beta pancreáticas. A velocidade de destruição das células beta pode ser rápida em algumas pessoas e lenta em outras; esta última é típica de adulto é conhecido como diabetes autoimune latente em adulto (LADA). A sua etiologia envolve factores ambientais e genéticos, dos genes envolvidos a maior contribuição vem da região do genoma onde estão localizados os genes do Complexo Principal de Histocompatibilidade (MHC). A combinação de diferentes alelos do sistema de antigénio leucocitário humano tipo II (HLAII) esta associada a susceptibilidade da doença e as principais molécula envolvidas são a DQ e DR. O estágio pré-clínico da doença se caracteriza pela presença de auto-anticorpos, sendo o anti-GAD o mais sensível nesta patologia. OBJECTIVO: Analizar a frequência dos polimorfismos HLA-DR/DQ em angolanos portadores de diabetes tipo 1, residentes em Luanda. O tipo de estudo adotado foi casocontrolo num universo de voluntários provenientes da consulta externa de hospitais e clínicas locais no período de outubro de 2012 a outubro 2013. A amostra biológica utilizada foi sangue total, tendo sido processada no laboratório LABGENE, da Faculdade de Medicina (FM) da Universidade Agostinho Neto (UNA). Os auto-anticorpos, anti-GAD, foram doseados pelo método de ELISA. O ADN genómico foi extraído à partir de sangue total periférico e tipagem genética foi realizada mediante PCR-SSP.O alelo DQB1*02 (DQ2/DQ2) (p=0,033, OR= 4, IC (1,2-13,3) foi associado a susceptibilidade da DM1; os alelos DQB1*06 (DQ6/DQ6) (p=0,000, OR=0,30, IC (0,17-0,54); *11 (p=0,011, OR=0,14, IC=0,032-0,62); *13 (p=0,006, OR=0,13, IC=0,049-0,588) e *15 (p=0,001, OR=0,044, IC=0,005-0,39) foram associados a proteção. Foi encontrado 29,2% de positividade para o anti-GAD, não houve associação significativa (p=0,69) entre a resposta positiva do anti-GAD e a idade. Não foi encontrada associação significativa (p=0,39) entre o tempo de diagnóstico e resposta humoral. Observou-se associação significativa entre os alelos de risco DQB1*02 (p=0.000) e resposta positiva para anti-GAD; da mesma maneira houve uma associação significativa para os alelos DQB1*06 (p=0,002), DRB1*11 (p=0,048); *13 (p=0,004) e *15 (p=0,021) e a resposta negativa do anti-GAD.Os dados demostram o forte envolvimentos do gene HLA-II (DQ) com a suceptibilidade a DM1 e sugere que a autoimunidade se desenvolve na presença de susceptibilidade genética, quer dizer, em associação com alelos HLA-II específicos.

Desigualdades na diabetes mellitus e hipertensão arterial: um estudo ao nível de freguesia

RESUMO - Introdução: A diabetes mellitus e a hipertensão arterial são problemas de saúde de elevada prevalência em Portugal. A sua distribuição geográfica e social é pouco conhecida, comprometendo o desenho e implementação de políticas de saúde. Assim, este estudo teve como objetivo avaliar a existência das desigualdades socioeconómicas na prevalência de diabetes mellitus tipo 2 e de hipertensão arterial, na população residente na região Norte de Portugal, no ano de 2013. Métodos: Foi realizado um estudo ecológico que analisou as 2028 freguesias da região Norte. Os dados foram obtidos através do Sistema de Informação das Administrações Regionais de Saúde e do Censos 2011. A associação entre os indicadores socioeconómicos e a prevalência destas doenças foi medida através da diferença de prevalências, do risco atribuível populacional, do índice relativo de desigualdades e pelo coeficiente de regressão. Resultados: A prevalência de diabetes mellitus tipo 2 e hipertensão arterial foi de 6,16% e 19,35%, respetivamente, e apresentou uma distribuição heterogénea entre freguesias (variando entre 0%-23,7% para a diabetes e 2,8%-66,7% para a hipertensão). A prevalência de ambas as doenças estava significativamente associada com o baixo nível educacional, baixa atividade em sector terciário, desemprego e baixo rendimento (com diferença de prevalências entre decis opostos de até 1,3% na diabetes e até 5,3% na hipertensão). Os determinantes socioeconómicos foram responsáveis até 20% da prevalência destas doenças na população. Conclusão: Estes resultados demonstram a existência de uma distribuição socioeconómica e geográfica heterogéneas e a necessidade de criação de políticas de saúde que atuem nas freguesias menos favorecidas.

Caractérisation du rôle de l’amyline (IAPP) dans le diabète de type 2 : études de dérivés peptidiques et de composés inhibiteurs de la formation d’amyloïde

L’amyloïdose, une maladie progressive et incurable, implique une vaste panoplie de pathologies et de pathogénèses, qui est expliquée par la grande variabilité biologique et structurale des protéines responsables de la formation des dépôts d’amyloïde. L’amyline (polypeptide amyloïde des îlots pancréatiques, IAPP) est une protéine très susceptible de subir des changements de conformation impliquant les feuillets bêta et conférant aussi des propriétés physicochimiques distinctes. Cette protéine prend alors une forme fibrillaire et se dépose dans les îlots de Langerhans chez les humains atteints de diabète de type 2 ou d’insulinome. Ces dépôts d’amyloïde pancréatique (AIAPP) ont été décrits chez certaines espèces animales telles que les félins domestiques, les grands félins, le raton laveur et les primates non humains. La formation de dépôts d’amyloïde contribue à la pathogénèse du diabète de type 2, mais les mécanismes qui induisent la conversion de l’amyline (IAPP) en amyloïde (AIAPP) ne sont pas complètement compris. Les hypothèses du projet sont que certaines variations présentes dans les séquences peptidiques de l’IAPP provenant de différentes espèces animales jouent un rôle critique pour la formation de fibrilles et que plusieurs composés chimiques aromatiques/phénoliques sont capables d’abroger la formation de dépôts d’amyloïde. Le projet de recherche consiste donc à caractériser la propension des différentes isoformes animales d’IAPP à former de l’amyloïde in vitro afin d’identifier les acides aminés jouant un rôle clé dans cette transformation structurale et ultimement d’inhiber la formation d’amyloïde pancréatique. Le projet se divise en deux volets principaux. Le premier consiste à identifier les différentes séquences peptidiques de l’IAPP retrouvées chez les espèces animales. L’objectif est d’identifier les acides aminés jouant un rôle clé dans la formation d’amyloïde. Le gène de l’IAPP a été séquencé chez plus d’une quarantaine d’espèces. Le potentiel d’agrégation des séquences obtenues a été simulé à l’aide d’outils bioinformatique. Une librairie de 23 peptides a été commandée afin de procéder à des analyses physicochimiques in vitro permettant d’évaluer le potentiel amyloïdogénique (test fluorimétrique à la thioflavine T, essai de liaison au rouge Congo, dichroïsme circulaire, microscopie électronique à transmission) et cytotoxique (sur une lignée cellulaire provenant d’insulinome : INS-1). Les analyses effectuées à partir de la librairie constituée de 23 peptides ont permis d’identifier trois séquences ne formant pas d’amyloïde et qui proviennent des espèces animales suivantes : le tamarin lion doré (Leontopithecus rosalia), le grand dauphin (Tursiops truncatus) et l’alpaga (Vicugna pacos). Un site potentiellement critique est le segment 8-20 présentant le motif NFLVH qui ne forme plus d’amyloïde lorsqu’il est remplacé par le motif DFLGR ou KFLIR. Les acides aminés 29P, 14K et 18R sont également impliqués dans l’inhibition de la transformation structurale en fibrille. La dernière partie du projet consiste à inhiber la formation de l’amyloïde en utilisant des composés chimiques commercialisés (hypoglycémiants, anti-inflammatoires non stéroïdiens) ou nouvellement synthétisés dans notre laboratoire (les aryles éthyles urées). Un criblage d’une soixantaine de composés chimiques a été conduit dans cette étude. Leur efficacité a été testée sur l’IAPP humaine, qui possède un fort potentiel amyloïdogénique. Les techniques utilisées sont les mêmes que celles exploitées précédemment. L’essai de liaison croisée photo-induite ("photo-induced cross-linking of unmodified proteins", PICUP) a été réalisé afin d’étudier les formes intermédiaires (monomères, oligomères). Un total de 11 composés chimiques a démontré un potentiel à inhiber l’agrégation des fibrilles. Pour la classe des hypoglycémiants, le glyburide, le répaglinide et la troglitazone ont montré l’activité thérapeutique la plus élevée pour retarder et réduire la formation de fibrilles. Les anti-inflammatoires antiamyloïdogènes actifs incluaient le diclofenac, le méloxicam, le phénylbutazone, le sulindac et le ténoxicam. Les aryles étyles urées les plus intéressantes étaient la EU-362 et la EU-418. Tous ces composés ont conféré une protection cellulaire contre l’activité cytotoxique des fibrilles. Les molécules actives possèdent des éléments structuraux communs tels des substituants donneurs d’électrons (alcool, amine, halogène) sur un noyau benzène. En conclusion, ce projet de recherche a permis de caractériser l’IAPP chez diverses espèces animales, dont plusieurs chez lesquelles elle n’avait pas encore été décrite, de déterminer les sites jouant un rôle clé dans sa transformation en amyloïde et, ultimement, de tester le potentiel thérapeutique de nouveaux agents antiamyloïdogènes dans le diabète de type 2. Nous espérons que ce projet ouvrira ainsi la porte à de nouvelles stratégies de traitement.

Tipo de tratamiento farmacológico y deterioro de la función pulmonar en pacientes con diabetes tipo 2

Antecedentes: En la actualidad no es clara la relación de la DM 2 con respecto al deterioro de la función pulmonar y menos aún si el tipo de tratamiento modifica parámetros espirométricos e inflamatorios. Objetivo: Comparar la función pulmonar de pacientes con DM 2 tratados con metformina vs secretagogos y la combinación con insulinas. Establecer el nivel de biomarcadores inflamatorios entre los grupos de tratamiento. Metodología: Estudio observacional analítico de corte transversal 495 pacientes diabéticos, entre julio 2005 y septiembre de 2007. Se obtuvieron variables espirométricas, niveles de biomarcadores inflamatorios como ferritina, fibrinógeno, PCR, Iinterleukina 6, TNF-α. Se realizó análisis de residuales de función pulmonar (valores esperados-observados) entre tipo de tratamiento con respecto al deterioro en la función pulmonar (variables espirométricas) y los niveles plasmáticos de biomarcadores. Resultados: Sin embargo un resultado valioso que se muestra en nuestro estudio, es que Después de ajustar por determinantes conocidos de la función pulmonar; los pacientes tratados con metformina tenían una tendencia no significativa de menor residual del VEF1 siendo de -133.2 vs -174.8 ml en el grupo de secretagogos. Al igual que un residual de CVF menor en los pacientes tratados con metformina en comparación con secretagogos, siendo de -212.1 ml vs -270.2 ml respectivamente con una p de 0.039. En el grupo de pacientes tratados con Metformina, los niveles de biomarcadores inflamatorios fueron menores. Conclusiones: Este estudio sustenta que la metformina parece evitar el deterioro de la función pulmonar de los pacientes diabéticos, al igual que parece tener un efecto antiinflamatorio.

Sociodemographic correlates of the increasing trend in prevalence of gestational diabetes mellitus in a large population of women between 1995 and 2005

OBJECTIVE—Gestational diabetes mellitus (GDM) is an increasingly prevalent risk factor for the development of type 2 diabetes in the mother and is  responsible for morbidity in the child. To better identify women at risk of developing GDM we examined sociodemographic correlates and changes in the prevalence of GDM among all births between 1995 and 2005 in Australia's largest state.
RESEARCH DESIGN AND METHODS—A computerized database of all births (n = 956,738) between 1995 and 2005 in New South Wales, Australia, was used in a multivariate logistic regression that examined the association between sociodemographic characteristics and the occurrence of GDM.
RESULTS—Between 1995 and 2005, the prevalence of GDM increased by 45%, from 3.0 to 4.4%. Women born in South Asia had the highest adjusted odds ratio (OR) of any region (4.33 [95% CI 4.12–4.55]) relative to women born in Australia. Women living in the three lowest socioeconomic quartiles had higher adjusted ORs for GDM relative to women in the highest quartile (1.54 [1.50–1.59], 1.74 [1.69–1.8], and 1.65 [1.60–1.70] for decreasing socioeconomic status quartiles). Increasing age was strongly associated with GDM, with women aged >40 years having an adjusted OR of 6.13 (95% CI 5.79–6.49) relative to women in their early 20s. Parity was associated with a small reduced risk. There was no association between smoking and GDM.
CONCLUSIONS—Maternal age, socioeconomic position, and ethnicity are important correlates of GDM. Future culturally specific interventions should target prevention of GDM in these high-risk groups.

Vitamin C and the risk of gestational diabetes mellitus: a case-control study

OBJECTIVE: To examine whether low maternal dietary intake of vitamin C and low maternal plasma ascorbic acid (AA) concentrations are associated with an increased risk of gestational diabetes mellitus (GDM).
METHODS: Cases were 67 women with GDM meeting National Diabetes Data Group criteria. Controls were 260 women without such a diagnosis. Maternal dietary vitamin C consumption during the periconceptional period and during pregnancy was assessed using a 121-item, semiquantitative food frequency questionnaire. Maternal plasma AA concentrations were determined using automated enzymatic procedures on specimens collected during the intrapartum period.
RESULTS: Mean maternal daily consumption of vitamin C and plasma AA concentrations were 10% and 31% lower, respectively, among GDM cases as compared with controls (130.7 +/- 10.2 vs. 145 +/- 4.9 mg/d, P = .190; 36 +/- 2.0 vs. 53 +/- 1.0 micromol/L, P <.001). After controlling for maternal age, race, prepregnancy adiposity, family history of type 2 diabetes, energy intake and income, women reporting low daily vitamin C intake (< 70 mg/d), as compared with the other women, experienced a 3.7-fold increased risk of GDM (odds ratio [OR] = 3.7, 95% confidence interval [CI] 1.7-8.2). There was a linear relation in risk of GDM with decreasing concentrations of plasma AA (P for linear trend <.001). After adjusting for confounders, women in the lowest quartile (< 42.6 micromol/L), as compared with women in the highest quartile (> 63.3 micromol/L), experienced > 12-fold increased risk of GDM (OR = 12.8, 95% CI 3.5-46.2). CONCLUSION: Low maternal dietary vitamin C intake and low plasma AA concentrations are associated with an increased risk of GDM. Large, prospective, cohort studies are needed to further evaluate the potential beneficial role of vitamin C and other antioxidants in the prevention of impaired glucose tolerance in pregnancy.

Maternal plasma ascorbic acid (vitamin C) and risk of gestational diabetes mellitus

Background : Antioxidants, particularly vitamin C (ascorbic acid), have the capacity to influence glucose tolerance. Modification of diet could reduce the likelihood of developing gestational diabetes mellitus.

Methods : In a prospective cohort study of pregnant women, we studied the association of maternal plasma ascorbic acid concentrations, measured at an average of 13 weeks' gestation, with subsequent risk of gestational diabetes. Maternal plasma ascorbic acid concentrations were determined using automated enzymatic procedures. Dietary vitamin C intake during the periconceptional period and early pregnancy was ascertained using a semiquantitative food frequency questionnaire. We fitted generalized linear models to derive estimates of relative risks and 95% confidence intervals (CIs).

Results : Approximately 4% (n = 33) of 755 women who completed pregnancy developed gestational diabetes mellitus. Plasma ascorbic acid concentrations were inversely associated with the risk of gestational diabetes (P for trend = 0.023). After adjusting for maternal age, race, prepregnancy adiposity, parity, family history of type 2 diabetes, and household income, women with plasma ascorbic acid <55.9 micromol/L (lowest quartile) experienced a 3.1-fold increased risk of gestational diabetes (95% CI = 1.0 - 9.7) compared with women whose concentrations were > or = 74.6 micromol/L (upper quartile). Women who consumed <70 mg vitamin C daily experienced a 1.8-fold increased risk of gestational diabetes compared with women who consumed higher amounts (95% CI = 0.8 - 4.4).

Conclusions : If confirmed, our results raise the possibility that current efforts to encourage populations to consume diets rich in antioxidants, including vitamin C, could reduce the occurrence of gestational diabetes mellitus.

Diabetes mellitus in the australian indigenous community

This report aims to investigate the higher prevalence of type 2 diabetes (T2D) among Indigenous Australians, with recommendations to Australians Health Professionals in order to increase awareness of Indigenous health peculiarities related to diabetes mellitus (DM). Diabetes has become one of the most common public health problems of the 21st century. The proportion of Aborigines Australians developing T2D is 5 to 10 times greater than non-Aborigines. Although DM in Aboriginal community is multifactorial, this report shows three perceived causes: (i) obesity and the "Thrifty Gene Hypothesis", (ii) geographical position and (iii) smoking. It concluded that the combination of these causes have increased the incidence of DM among Indigenous Australians. Therefore, the following are recommended: improvement of genetic research, improvement of medical facilities, and increased employment of Indigenous Health Professionals and improvement of anti-smoking policies.

Associação entre hipoestesia corneana, olho seco e outros fatores em portadores de diabetes melito tipo 2

Portadores de diabetes parecem ter mais queixas de olho seco do que o resto da população. Acredita-se que isto possa estar associado a uma forma de neuropatia diabética expressa por uma redução na sensibilidade corneana desses pacientes. Nossos principais objetivos neste estudo foram avaliar a influência da diabetes melito tipo 2 na sensibilidade corneana central e verificar se há uma associação entre a sensibilidade corneana central e a síndrome do olho seco em indivíduos com a doença. Assim, 62 portadores de diabetes tipo 2 foram submetidos a um exame oftalmológico de rotina, a uma ceratoestesiometria e a testes específicos para avaliar olho seco e polineuropatia distal simétrica. Num outro grupo, 20 voluntários saudáveis tiveram seus olhos avaliados da mesma forma, exceto pela não realização dos testes específicos para disfunção lacrimal. Entre os indivíduos diabéticos avaliados, foram observados 53.2% com hipoestesia corneana, 54.2% com retinopatia diabética, 45.9% com polineuropatia distal simétrica e 51.6% com a síndrome do olho seco. Entre os principais achados, observamos associações significativas envolvendo: diabetes tipo 2 e hipoestesia corneana central, síndrome do olho seco e hipoestesia corneana central, produção lacrimal reflexa (avaliada pelo teste de Schirmer II) e sensibilidade corneana central e retinopatia diabética proliferativa e sensibilidade corneana central. Uma possível associação foi encontrada envolvendo síndrome do olho seco retinopatia diabética proliferativa. Os autores discutem os resultados obtidos e os mecanismos envolvidos.

Efeitos do treinamento aeróbio sobre sinais precoces do remodelamento do ventrículo esquerdo induzido pelo diabetes Mellitus experimental

Our aim was to investigate the effects of an aerobic training program on adverse and early left ventricle (LV) remodeling, using an experimental model of short-term type 1 diabetes (T1D). Wistar rats were divided in 4 groups: sedentary control (SC), trained control (TC), sedentary diabetic (SD) and trained diabetic (TD). T1D was induced by streptozotocin (45 mg/kg). The training program consisted of 4 weeks running on a treadmill (13 m/min, 60 min/day, 5 days/week). At the end of the experiments, hearts were collected for analysis of morphology and transcriptional profile of LV, by focusing on its remodeling. Deaths were recorded during the 4-week period. We verified high mortality among animals of DS group, whereas it was significantly reduced in DT group. DS group also showed an increase in cross-sectional area of cardiomyocytes and fibrosis. TD group exhibited reduction in measures of cardiac trophism, but with respect to collagen content, it was similar to CS group. Analysis of gene expression related to cardiac remodeling revealed decreased expression of collagen I and III, as well as low expression of MMP-2 in DS group. TD group showed decreased levels of mRNA for MMP-9, and unchanged gene expression of MMP-2 when compared with the CS group. The expression of MMP-2 and TGF-1 were increased in CT group. The ratio between gene expression of collagen I and III was increased in the CT group and decreased in diabetic groups. These results establish early changes of the structure and transcriptional profile of LV myocardium. Moreover, they indicate that aerobic exercise training plays specific protection against mechanisms responsible for cardiac damage observed in T1D

Contribuição da glicemia pós-desjejum para o controle glicêmico do paciente com diabetes melito tipo 2

Estudos epidemiológicos observaram que glicemias pós-prandiais (GPPs) elevadas são fator principal na ocorrência de doenças cardiovasculares. Sabe-se que a hemoglobina glicada (HbA1C) reflete a glicemia média dos últimos 2-3 meses, entretanto é controversa a contribuição relativa da glicemia de jejum (GJ) e GPP para o valor da HbA1C. OBJETIVO: Avaliar a contribuição da GJ e GPPs para o valor da HbA1C em pacientes com diabetes melito tipo 2 (DM2). MÉTODOS: Participaram 53 indivíduos com DM2, estáveis e em tratamento com antidiabéticos orais (n= 27) e/ou insulina (n= 26). Cada paciente comparecia a 3 visitas a intervalos de 2 meses. em cada visita era medida a GJ, as GPPs (2h pós-desjejum: GPD e pós-almoço: GPA) e a HbA1C, sendo fornecido o desjejum e o almoço segundo seus hábitos alimentares. Mediu-se a glicose plasmática pela glicose-oxidase e a HbA1C, pela cromatografia de troca iônica. Realizou-se a análise das associações pelo coeficiente de correlação de Spearman, com P< 0,05. RESULTADOS: A HbA1C correlacionou-se melhor em cada visita ao longo do estudo com a GPD (r: 0,66­0,48), a glicemia média (r: 0,64­0,41), a área abaixo da curva glicêmica (r : 0,64­0,46) e a GPP média (r: 0,59­0,41). CONCLUSÕES: A GPD mostrou-se um parâmetro eficaz adicional no monitoramento glicêmico dos pacientes com DM2.

Diabetes mellitus and oral mucosa alterations: Prevalence and risk factors

Aims: To investigate the prevalence of oral mucosa alterations in patients with type 2 diabetes and to identify possible risk factors related to oral mucosa alterations.Methods: 146 patients with type 2 diabetes and 111 age-and gender-matched healthy controls subjects were consecutively recruited from Araraquara School of Dentistry to answer a structured questionnaire designed to collect demographic data as well as current and former history of diabetes. Clinical examination of the oral mucosa was carried out by a stomatologist.Results: A higher prevalence of oral mucosa alterations was found in patients with diabetes than in patients without diabetes (p < 0.001), with significant difference to development conditions (p < 0.0001), potentially malignant disorders (p < 0.0001) and fungal infections (p < 0.05). In the multiple logistic regression, diabetes (odds ratio 9.9 IC 5.11-19.16) and smoking habit (odds ratio 3.17 IC 1.42-7.12) increased the odds of oral mucosa alterations significantly.Conclusions: Patients with diabetes mellitus not only showed an increased prevalence of oral mucosa alterations but also a significant percentage of potentially malignant disorders. These findings elucidate the necessity of regular clinical examination to ensure early diagnosis and prompt management of oral mucosa lesions in patients with diabetes. (C) 2011 Elsevier B.V. All rights reserved.

Sequential IL-23 and IL-17 and increased Mmp8 and Mmp14 expression characterize the progression of an experimental model of periodontal disease in type 1 diabetes

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)