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ABSTRACT Objective: The aim of this study was to investigate the factors associated with hypoglycemia and severe hypoglycemia (SH) in individuals with type 1 diabetes mellitus (T1D) in Brazil. Materials and methods: This multicenter, cross-sectional study was conducted between August 2011 and August 2014 across 10 Brazilian cities. The data were obtained from 1,760 individuals with T1D. Sociodemographic and clinical characteristics related to hypoglycemic events in the previous 4 weeks were evaluated. Results: Of 1,760 individuals evaluated, 1,319 (74.9%) reported at least one episode of hypoglycemia in the previous 4 weeks. The main factors associated with hypoglycemia were lower hemoglobin A1c (HbA1c) level, better adherence to self-monitoring of blood glucose (SMBG), and higher education level. Episodes of SH were reported by 251 (19%) individuals who, compared with subjects with nonsevere hypoglycemia, received lower doses of prandial insulin and higher doses of basal insulin, in addition to reporting less frequent use of long-acting basal insulin analogs. The percentage of SH episodes was evenly distributed across all ranges of HbA1c levels, and there were no correlations between the mean number of nonsevere or severe hypoglycemic events and HbA1c values. Higher alcohol consumption and more frequent hospitalizations were independently associated with SH. Conclusion: Although individuals presenting with hypoglycemia had lower HbA1c values than those not presenting hypoglycemia, there were no correlations between the number of nonsevere hypoglycemia or SH and HbA1c values. Also, the frequency of SH was evenly distributed across all ranges of HbA1c values. Better adherence to SMBG and higher education level were associated with hypoglycemia, while alcohol consumption, higher doses of basal insulin, and more frequent hospitalizations in the previous year were associated with SH.
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ABSTRACT Objective To analyze interstitial glucose behavior during glucocorticoid use in non-diabetic patients receiving chemotherapy for hematologic malignancies. Methods Prospective pilot study carried out to assess interstitial glucose levels in 15 non-diabetic individuals with hematologic malignancies who received glucocorticoids in combination with chemotherapy. The FreeStyle Libre flash monitoring system (Abbott Diabetes Care) was used for up to 14 days to measure interstitial glucose. Results Median age and body mass index were 53 (42-61) years and 25 (23-28) kg/m2 respectively. Interstitial glucose levels >180mg/dL lasting at least one hour were detected in 60% of participants. Interstitial glucose profile parameters (median and peak interstitial glucose levels and percentage of time during which interstitial glucose levels were >180mg/dL) were significantly (p<0.01) higher during glucocorticoid use (115mg/dL, 218mg/dL and 10% respectively) than after glucocorticoid discontinuation (97mg/dL, 137mg/dL and 0% respectively). Mean interstitial glucose levels increased in the afternoon and at night during glucocorticoid use. Conclusion This pilot study was the first to evaluate interstitial glucose levels in non-diabetic individuals using glucocorticoids in treatment of hematologic cancer. Glucocorticoid use during chemotherapy significantly increases interstitial glucose levels in these patients.
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OBJETIVO: Avaliar a resposta da embolização arterial tireoidiana como terapêutica para o hipertireoidismo primário.MATERIAIS E MÉTODOS: Cinco mulheres com falha ao tratamento farmacológico com tionamida foram submetidas a vaso-oclusão em três artérias dominantes tireoidianas (avaliadas por ultrassonografia Doppler e arteriografia) e acompanhadas até 8 semanas após o procedimento (três acompanhadas até 16 semanas) com ultrassonografia Doppler, calcemia, função tireoidiana e controle clínico.RESULTADOS: Nenhuma alcançou remissão permanente de doença após 8 semanas. Houve recidiva de hipertireoidismo em 24 semanas, mesmo com redução do volume tireoidiano de 49,5 ± 15,2% em 16 semanas. Não encontramos complicações, mas radioiodo foi necessário após 24 semanas em três das pacientes acompanhadas.CONCLUSÃO: Nas pacientes que concluíram o protocolo, a vaso-oclusão arterial com polivinil álcool nas três artérias dominantes permitiu redução volumétrica do bócio, entretanto, foi ineficiente em controlar o hipertireoidismo.
OBJECTIVE: To evaluate the therapeutic response to thyroid arterial embolization for primary hyperthyroidism.MATERIALS AND METHODS: Five women whose pharmacological treatment with thionamides failed to control Graves' disease were submitted to embolization of three dominant thyroid arteries (following assessment with ultrasound Doppler and arteriography) and followed-up at the 1st, 8th and 16th weeks after the procedure, with ultrasound Doppler, calcium blood test, thyroid function test and clinical examination. Three of the patients completed 16-week follow-up.RESULTS: None of the patients achieved permanent remission after 8 weeks. Disease recurrence was observed at the 24th week, despite the decrease in thyroid volume (49.5 ± 15.2%) observed at the 16th week. Complications were not observed, but radioiodine therapy was required for three of the patients followed-up.CONCLUSION: Embolization of three dominant thyroid arteries with polyvinyl alcohol allowed reduction in goiter volume in the three patients who completed the protocol, but was not effective to control hyperthyroidism.
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Humans , Female , Adult , Middle Aged , Embolization, Therapeutic/methods , Hyperthyroidism/therapy , Iodine Radioisotopes/therapeutic use , Thyroid Gland , Angiography , Clinical Protocols , Creatinine , Hemodynamics , Ultrasonography, DopplerABSTRACT
OBJETIVO: Determinar a variação da CPK sérica em função do TSH e T4 livre (FT4) e avaliar a CPK sérica nos estados patológicos da tireoide (hipertireoidismo e hipotireoidismo), em relação ao eutireoidismo. MATERIAIS E MÉTODOS: Analisaram-se, retrospectivamente, 6.230 exames laboratoriais de 2007 a 2011, com as dosagens de TSH e CPK. Destas, 3.369 com dosagens de FT4. Avaliou-se a correlação entre CPK com TSH e com os estados patológicos da tireoide. RESULTADOS: A correlação entre TSH e CPK foi positiva (r = 0,065), enquanto entre CPK e FT4 foi inversamente proporcional (r = -0,091, p < 0,05). Do total, 586 (9,4%) medidas foram de hipertireoidismo com mediana (intervalo) do CPK de 98 U/L (27 a 1.113) e 556 (8,9%), hipotireóideos com CPK de 114 U/L (25-4.182). CONCLUSÃO: Houve correlação positiva entre CPK sérica e TSH e negativa com FT4, sendo a CPK menor no grupo com hipertireoidismo e maior no grupo de hipotireoidismo.
OBJECTIVE: To determine serum CPK variation based on TSH e free T4 (FT4), and to assess serum CPK in pathological states of the thyroid (hyperthyroidism and hypothyroidism), in relation to the euthyroidism. MATERIAL AND METHODS: We evaluated retrospectively 6,230 laboratory results of TSH and CPK from 2007 to 2011. From these, 3,369 had free T4 results. We evaluated the correlation between CPK and TSH and the pathological states of the thyroid. RESULTS: The correlation between TSH and CPK was positive (r = 0.065), while that between CPK and FT4 was negative (r = -0.091, p < 0.05). From the total of results analyzed, 586 (9.4%) were measures of hyperthyroidism, with a median (range) of CPK of 98 U/L (27 to 1,113), and 556 (8.9%) were of hypothyroidism, with CPK of 114 U/L (25-4,182). CONCLUSION: A positive correlation was found between serum CPK and TSH, and a negative correlation between CPK and FT4. CPK was lower in the group with hyperthyroidism, and greater in that with hypothyroidism.