Análise da força de preensão manual e risco cardiovascular de adolescentes com Diabetes Melitos tipo 1 / Analysis of handgrip muscle strength and cardiovascular risk in adolescents with diabetes mellitus type 1

Comparar a força de preensão manual de adolescentes com e sem diabetes mellitus tipo 1 (DM1) e correlacionar as variáveis hemodinâmicas com o controle da glicemia pela hemoglobina glicada (HbA1c) nos adolescentes diabéticos. Método: Foram avaliados 49 adolescentes com DM1 (12,73 ± 1,23 anos; índice de massa corporal 19,52 ± 2,62 kg/m2 ) e 75 adolescentes sem DM1 (13,31 ± 1,16 anos; índice de massa corporal 20,79 ± 3,64 kg/m2 ). A HbA1c foi determinada por cromatografia líquida de alta ficiência (HPLC) e a força de preensão foi obtida com o dinamômetro Jamar®. As variáveis hemodinâmicas registradas foram à frequência cardíaca e a pressão arterial (PA) na posição sentada. Resultados: Os adolescentes do gênero masculino com DM1 apresentaram menores valores de força de preensão manual absoluta da mão direita (26,48 ± 6,24 vs 32,59 ± 9,59 kg; p = 0,004), da mão esquerda (25,45 ± 6,52 vs 30,76 ± 8,19 kg; p = 0,006) e maior PA diastólica (66,43 ± 8,62 vs 72,40 ± 10,01 mmHg; p = 0,019) do que os adolescentes sem DM1. As adolescentes do gênero feminino com DM1 apresentaram menores valores de força de preensão manual absoluta da mão direita (26,20 ± 4,09 vs 29,53 ± 5,27 kg; p = 0,017) e da mão esquerda (24,50 ± 4,29 vs 27,79 ± 5,11 kg; p = 0,017). Houve correlação positiva da frequência cardíaca (0,44; p = 0,01) e da PA diastólica (0,37; p = 0,01) com a HbA1c. Conclusão: Adolescentes com DM1 devem receber atenção quanto a menor força muscular e risco cardiovascular com o aumento da HbA1c...(AU)

To compare the handgrip muscle strength of adolescents with and without diabetes mellitus type 1 (DM1) and to correlate the hemodynamic variables with the glycemic control by glycated hemoglobin (A1c) in the diabetic adolescents. Method: 49 adolescents with DM1 (12.73 ± 1.23 years; body mass index 19.52 ± 2.62 kg/m2 ) and 75 adolescents without DM1 (13.31 ± 1.16 years; body mass index 20.79 ± 3.64 kg/m2 ) were evaluated. The A1c was determined by high performance liquide chromatography (HPLC) and handgrip muscle strength was obtained by the Jamar® dynamometer. The hemodynamic variable measured were heart rate and blood pressure (BP) in the seated position. Results: The male adolescents with DM1 presented lower values of handgrip muscle strength in the right hand (26.48 ± 6.24 vs 32.59 ± 9.59 kg; p = 0.004), and left hand (25.45 ± 6.52 vs 30.76 ± 8.19 kg; p = 0.006) and higher diastolic BP (66.43 ± 8.62 vs 72.40 ± 10.01 mmHg; p = 0.019) as compared with the male adolescents without DM1. The female adolescents with DM1 presented lower values of handgrip strength in the right hand (26.20 ± 4.09 vs 29.53 ± 5.27 kg; p = 0.017), and left hand (24.50 ± 4.29 vs 27.79 ± 5.11 kg; p = 0.017). There was a positive correlation of heart rate (0.44; p = 0.01) and diastolic BP (0.37; p = 0.01) with A1c. Conclusion: Adolescents with DM1 should receive attention regarding their reduced muscle strength and cardiovascular risk with the increase in A1c...(AU)

Evaluation of diabetic patients after three month use of continuous subcutaneous insulin infusion, dispensed by a protocolled form at outpatient reference clinic of Taguatinga Regional Hospital

Objective To evaluate the data of continuous subcutaneous insulin infusion protocol (CSII) for diabetics waived by the Health State Secretariat of Distrito Federal (HSSDF) and therapeutic responses three months after the transfer of multiple daily injections regimen for CSII. Subjects and methods Eighty patients (49 female) took part in this experimental study, mean age and disease duration were 27.9 years and 13 years, respectively; 96% patients had type 1 diabetes mellitus. Results The entire sample (ECO) and 3 subgroups (group 1 – A1c decrease, group 2 – A1c stable, and group 3 – A1c increase), stratified according to a ≥ 0.5% change in A1c, were analyzed. Group 1 involved 64% of the patients. The ECO showed a significant A1c decrease: MDI 8.1 ± 1.4% vs. CSII 7.3 ± 0.9%, p < 0.0001 (0.8% difference pro CSII therapy). Group 1 demonstrated an A1c decrease from 8.7% to 7.3% (1.4% difference). Group 2 mean A1c was 7.1%. Rate of hypoglycemia (< 50 mg/dL) decreased 61% in the ECO and 79% in Group 2. Conclusion This study reinforces the safety and efficacy of CSII with a robust A1c reduction and hypoglycemia. The pioneer care HSSDF ambulatory attests to be achievable the free dispensing by Unified Health System (UHS) following a protocol, and this approach results in less wastage to the patient and represents a rational policy of therapy with CSII for UHS. Arch Endocrinol Metab. 2015;59(1):23-8 .