Pesquisa translacional em diabetes melito gestacional e hiperglicemia gestacional leve: conhecimento atual e nossa experiência

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

Streptozotocin-Induced Diabetes Models: Pathophysiological Mechanisms and Fetal Outcomes

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

Estudo das alterações estruturais e da função diastólica cardíaca em mulheres portadoras de diabetes melito gestacional

Pós-graduação em Ginecologia, Obstetrícia e Mastologia - FMB

Alterações da matriz extracelular causadas pelo diabetes: o impacto sobre a continência urinária

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

Effects of maternal diabetes on male offspring: high cell proliferation and increased activity of MMP-2 in the ventral prostate

This study presents a comprehensive view of the histological and functional status of the prostate of adult rat offspring of mothers subjected to gestational diabetes induced by alloxan. The ventral prostate of male adult offspring of diabetic (DP) or normal (CP) mothers was evaluated for collagen fibres, cell death, fibroblasts, smooth muscle cells, cell proliferation, matrix metalloproteinases (MMPs), androgen receptors (AR), transforming growth factor beta 1 (TGF beta-1), catalase and total antioxidant activity. The prostates of DP animals were lower in weight than those of the CP group. The DP group also exhibited hyperglycaemia and hypotestosteronemia, higher cell proliferation and AR expression, a reduction in alpha-actin (possibly interfering with the reproductive function of the prostate), and enhanced activity of MMP-2, although the absolute content of MMP-2 was lower in this group. These findings were associated with increased TGF beta-1 and decreased collagen distribution. The prostates of DP rats additionally exhibited reductions in catalase and total antioxidant activity. Thus, rats developing in a diabetic intrauterine environment have glycaemic and hormonal changes that impact on the structure and physiology of the prostate in adulthood. The increased AR expression possibly leads to elevated cell proliferation. Stromal remodelling was characterized by enhanced activity of MMP-2 and collagen degradation, even with increased TGF beta-1 activation. These changes associated with increased oxidative stress might interfere with tissue architecture and glandular homeostasis.

Oxidative DNA damage in diabetic and mild gestational hyperglycemic pregnant women

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

Efeito Diabetes mellitus gestacional na modulação de genes relacionados ao metabolismo mitocondrial e a implicação na predisposiçao do recém-nascido à obesidade

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

Diabetes mellitus: avaliação do conhecimento de cirurgiões-dentistas em municípios de três estados brasileiros

Introduction: Pathological changes in the bucal cavity associated with Diabetes mellitus (DM) may include gingivitis, periodontal disease, salivary gland dysfunction and xerostomia (dry mouth), susceptibility to bucal infections, burning mouth syndrome, and altered taste. Objective: This study assessed the technical and scientific knowledge of dentists working in primary care in the National Health System (SUS) on the DM. Material and method: The study was conducted in the municipalities of Birigui-SP, Maringá-PR and TrêsLagoas-MS, with the participation of 76 dentists working in the SUS primary care system.These professionals agreed to answer to a questionnaire developed for this study and the results of the questions were submitted to a quantitative analysis. Result: Showed that 94.7% were in contact with diabetic patients; 97.4% know what is DM; about other types of DM, 77.6% said they know, the most mentioned (by 55.9%) was the gestational DM. The DM2 was indicated as the most prevalent by 59.2%; the normal range of fasting blood glucose level was quoted correctly by 2.6% of the participants; obesity was reported by 98.7% of participants as a risk factor for DM; 96.0% stated correctly what are the main signs and symptoms related to Diabetes; periodontal disease was reported by 92.1% as an bucal manifestation in diabetic patients. Conclusion: The dentist needs to develop specific knowledge about DM, being able to identify normal levels of blood glucose and ready to identify and meet the bearer of DM.

Diabetes mellitus gestacional: enfoque nos novos critérios diagnósticos

Alterations in maternal metabolism are important in order to supply the demands of the fetus. However, pregnant women with some degree of insulin resistance, such as in cases of overweight/obesity, central obesity and polycystic ovaries syndrome, associated to the action of anti-insulin placental hormones, contribute to a case of hyperglycemia of varied intensity, characterizing gestational diabetes mellitus (GDM) and leading to adverse effects both maternal and fetal. At the absence of a universal consensus to the tracking and diagnosis of GDM, this review had the purpose of listing the various protocols that have been proposed, as well as highlighting the risk factors associated with GDM and its complications. The most recent protocol is the one from the American Diabetes Association, with changes that would be justified by the alarming raise in worldwide obesity and, consequently, the potential increase to the occurrence of type 2 diabetes mellitus, not always diagnosed before the gestational period. The intention of this protocol is to identify the gestating women that could benefit from hyperglycemia control, improving the prognostic of these pregnancies and preventing future complications for mothers and their children.

Diabetes e o polimorfismo Arg972: atualização bibliográfica

The objective of this update was to perform an evaluation of articles published in recent years about the Arg972 polymorphism of IRS-1 gene and its role in diabetes. It was used the database site of National Center of Biotechnology Information (NCBI - PUB- -MED). For search of articles the terms “polymorphisms on IRS-1 and diabetes” were used. Approximately 54% of the articles found were related to the polymorphism of interest and of these, approximately 68% the polymorphism was linked to various forms of diabetes. The Arg972 polymorphism is associated with decreased insulin synthesis and secretion with reduced stimulation of the activity of insulin pathway PI3K, MAPK and thymidine incorporation. It more frequently in patients with type 2 diabetes and gestational diabetes, showing a direct connection with the status of obesity and insulin resistance.

Avaliação dos protocolos de diagnóstico e de controle da hiperglicemia materna: impacto na prevalência de Diabetes Melito Gestacional (DMG) e de Hiperglicemia Gestacional Leve (HGL) e nos resultados perinatais

Pós-graduação em Ginecologia, Obstetrícia e Mastologia - FMB

Effect of Type 2 Diabetes Mellitus on the Pharmacokinetics of Metformin in Obese Pregnant Women

Background and Objective The use of metformin throughout gestation by women with polycystic ovary syndrome (PCOS) and type 2 diabetes mellitus (T2DM) significantly reduces the number of first-trimester spontaneous abortions and the rate of occurrence of gestational diabetes and hypertensive syndromes. Metformin is taken up into renal tubular cells by organic cation transport 2 (OCT2) and eliminated unchanged into the urine. The objective of this study was to analyse the influence of T2DM on the pharmacokinetics of metformin in obese pregnant women and in a control group of non-diabetic obese pregnant women with PCOS. Methods Eight non-diabetic obese pregnant women with PCOS and nine obese pregnant women with T2DM taking oral metformin 850 mg every 12 h were evaluated throughout gestation. Serial blood samples were collected over a 12-h period during the third trimester of pregnancy. Steady-state plasma concentrations of metformin were determined by high-performance liquid chromatography with a UV detector. The pharmacokinetic results of the two groups, reported as median and 25th and 75th percentile, were compared statistically using the Mann Whitney test, with the level of significance set at p < 0.05. Results The pharmacokinetic parameters detected for PCOS versus T2DM patients, reported as median, were, respectively: elimination half-life 3.75 versus 4.00 h; time to maximum concentration 2.00 versus 3.00 h; maximum concentration 1.42 versus 1.21 mu g/mL; mean concentration 0.53 versus 0.56 mu g/mL; area under the plasma concentration time curve from time zero to 12 h 6.42 versus 6.73 mu g.h/mL; apparent total oral clearance 105.39 versus 98.38 L/h; apparent volume of distribution after oral administration 550.51 versus 490.98 L; and fluctuation (maximum minimum concentration variation) of 179.56 versus 181.73%. No significant differences in pharmacokinetic parameters were observed between the groups. Conclusion T2DM in the presence of insulin use does not influence the pharmacokinetics of metformin in pregnant patients, demonstrating the absence of a need to increase the dose, and consequently does not influence the OCT2-mediated transport in pregnant women with PCOS.

Periodontal disease and diabetes mellitus

Periodontal disease (PD) is one of the most commonly known human chronic disorders. The relationship between PD and several systemic diseases such as diabetes mellitus (DM) has been increasingly recognized over the past decades. Objective The purpose of this review is to provide the reader with knowledge concerning the relationship between PD and DM. Many articles have been published in the English and Portuguese literature over the last 50 years examining the relationship between these two chronic diseases. Data interpretation is often confounded by varying definitions of DM, PD and different clinical criteria were applied to determine the prevalence, extent and severity of PD, levels of glycemic control and diabetes-related complications. Methods This paper provides a broad overview of the predominant findings from research conducted using the BBO (Bibliografia Brasileira de Odontologia), MEDLINE, LILACS and PubMed for Controlled Trials databases, in English and Portuguese languages published from 1960 to October 2012. Primary research reports on investigations of relationships between DM/DM control, PD/periodontal treatment and PD/DM/diabetes-related complications identified relevant papers and meta-analyses published in this period. Results 7This paper describes the relationship between PD and DM and answers the following questions: 1- The effect of DM on PD, 2- The effects of glycemic control on PD and 3- The effects of PD on glycemic control and on diabetes-related complications. Conclusions The scientific evidence reviewed supports diabetes having an adverse effect on periodontal health and PD having an adverse effect on glycemic control and on diabetes-related complications. Further research is needed to clarify these relationships and larger, prospective, controlled trials with ethnically diverse populations are warranted to establish that treating PD can positively influence glycemic control and possibly reduce the burden of diabetes-related complications.

Long-term type 1 diabetes impairs decidualization and extracellular matrix remodeling during early embryonic development in mice

Introduction: Endometrial decidualization and associated extracellular matrix (ECM) remodeling are critical events to the establishment of the maternal-fetal interface and successful pregnancy. Here, we investigated the impact of type 1 diabetes on these processes during early embryonic development, in order to contribute to the understanding of the maternal factors associated to diabetic embryopathies. Methods: Alloxan-induced diabetic Swiss female mice were bred after different periods of time to determine the effects of diabetes progression on the development of gestational complications. Furthermore, the analyses focused on decidual development as well as mRNA expression, protein deposition and ultrastructural organization of decidual ECM. Results: Decreased number of implantation sites and decidual dimensions were observed in the group mated 90-110 days after diabetes induction (D), but not in the 50-70D group. Picrosirius staining showed augmentation in the fibrillar collagen network in the 90e110D group and, following immunohistochemical examination, that this was associated with increase in types I and V collagens and decrease in type III collagen and collagen-associated proteoglycans biglycan and lumican. qPCR, however, demonstrated that only type I collagen mRNA levels were increased in the diabetic group. Alterations in the molecular ratio among distinct collagen types and proteoglycans were associated with abnormal collagen fibrillogenesis, analyzed by transmission electron microscopy. Conclusions: Our results support the concept that the development of pregnancy complications is directly related with duration of diabetes (progression of the disease), and that this is a consequence of both systemic factors (i.e. disturbed maternal endocrine-metabolic profile) and uterine factors, including impaired decidualization and ECM remodeling