Factores predictivos de la microalbuminuria en pacientes pediátricos con diabetes mellitus tipo 1 (DMt1) / Microalbuminuria predictive factors in pediatric patients with type 1 diabetes mellitus (type 1 DM)

La nefropatía constituye la complicación más grave de la diabetes mellitus tipo 1 (DMt1) siendo una de las manifestaciones iniciales la microalbuminuria. Objetivos: Determinar el comportamiento de los factores epidemiológicos, clínicos y bioquímicos en el desarrollo de microalbuminuria en pacientes con DMt1. Diseño: Estudio de casos y controles. Lugar: Servicio de Endocrinología del Instituto Nacional de Salud del Niño, Lima, Perú. Participantes: Pacientes diabéticos tipo 1 menores de 18 años. Intervenciones: Se estudió 64 pacientes portadores de DMt1, 22 con microalbuminuria y 42 sin esta manifestación, que constituyeron los casos y controles respectivamente. Se consignó como factores epidemiológicos la edad al diagnóstico, tiempo de evolución, género, antecedentes familiares de diabetes, nefropatía, dislipidemia, hipertensión arterial; como factores clínicos, el estado nutricional, desarrollo puberal (Tanner), presión arterial; y como factores bioquímicos, la hemoglobina glicosilada (HbA1c), microalbuminuria y perfil lipídico. Tanto los casos como los controles fueron seguidos durante un año. El análisis estadístico se hizo mediante pruebas de chi cuadrado, odds ratio y regresión logística, para establecer predominancia de factores. Principales medidas de resultados: Estadio puberal, perfil lipídico y HbA1c. Resultados: Los factores de riesgo hallados fueron la presión arterial diastólica elevada (p=0,037), la pubertad (p=0,008), HbA1c alta (p< 0,0001), hipertrigliceridemia (p= 0,007) y la hipercolesterolemia (p< 0,0001). Conclusiones: La HbA1c elevada, la hipercolesterolemia y la pubertad fueron los factores de riesgo de mayor preponderancia para el desarrollo de microalbuminuria. A fin de prevenir el desarrollo de microalbuminuria, se sugiere buen control metabólico y cuidadoso manejo de la dislipidemia, en especial en pacientes púberes.

Nephropathy constitutes the most serious type 1 diabetes mellitus (type 1 DM) complication and microalbuminuria is the initial manifestation. Objectives: To determine the role of epidemiological, clinical and biochemical factors in the development of microalbuminuria in type 1 DM patients. Design: Case and control study. Setting: Endocrinology Unit, National Institute of Child Health, Lima, Peru. Patients: Subjects less than 18 year-old with type 1 DM. Interventions: Sixty-four type 1 DM patients were studied, 22 patients with microalbuminuria (cases) and 42 patients without it (controls). Epidemiological factors studied were age at diagnosis, time from onset, gender, family history of diabetes, nephropathy, dyslipidemia, and/or hypertension; clinical factors studied were nutritional status, pubertal stage (Tanner method) and blood pressure; biochemical factors were glycated hemoglobin (HbA1c), microalbuminuria and lipid profile. Both cases and controls were followed for one year. Statistical analysis used chi square, odds ratio and multiple logistic regression calculations to determine main risk factors. Main outcome measures: Pubertal stage, lipid profile and HbA1c. Results: Risk factors determined were high diastolic blood pressure (p=0.037), puberty (p=0.008), high HbA1C (p<0.0001), hypertriglyceridemia (p=0.007), and hypercholesterolemia (p<0.0001). Conclusions: Elevated HbA1c, hypercholesterolemia and puberty were the more important risk factors for development of microalbuminuria. Main measures to prevent development of microalbuminuria were good metabolic control and good management of dyslipidemia, especially in pubertal patients.

Resíduos gerados por usuários de insulina em domicílio: proposta de protocolo para unidades de saúde / Waste generated by using insulin at home: protocol proposal for health care unit / Residuos generados por usuarios de insulina en domicilio: propuesta de protocolo para unidad de salud

Este estudo teve por objetivo propor um protocolo para o manejo de resíduos de serviços de saúde gerados em domicílios de indivíduos com diabetes Mellitus usuários de insulina, com foco nos resíduos biológicos, químicos e perfurocortantes. Constitui-se de uma pesquisa descritivo-exploratória realizada em um núcleo de Saúde da Família de Ribeirão Preto - SP. Participaram do estudo 26 usuários de insulina. Os dados foram coletados por meio do SIAB e entrevistas com os sujeitos selecionados, durante o mês de julho de 2010. Os dados foram analisados por meio da estatística descritiva. Os resultados revelaram um descarte inadequado dos resíduos de serviços de saúde gerados em domicílios de usuários de insulina. Essa situação requer a adoção de protocolos com critérios para o controle da distribuição e descarte de seringas, favorecendo a minimização da geração de resíduos de serviços de saúde em domicílios. O uso racional de seringas também pode contribuir para a aquisição de materiais em quantidade adequada pelos usuários de insulina. Os conhecimentos gerados nesta pesquisa, relacionados ao manejo de resíduos de serviços de saúde gerados em domicílios de usuários deinsulina, pode despertar a implementação de ações de educação em saúde e embasar o desenvolvimento de protocolos nas unidades de Saúde.

This study aimed to propose a protocol to the management of medical waste generated in households of individuals with diabetes mellitus who are insulin users, focusing on biological, chemical and sharp waste. This is a descriptive and exploratory study carried out in a Family Health Center in the city of Ribeirão Preto, State of São Paulo, Brazil. The sample was composed of 26 users of insulin. Data were collected through the Information System of Primary Care and interviews with selected participants during the month of July 2010. Data were analyzed using descriptive statistics. Results showed the improper disposal of medical waste generated in households of insulin users. This situation requires the adoption to protocols for the control of distribution and disposal of syringes, which could help to minimize the generation of medical waste in households. The rational use of syringes may avoid the wasting and it is a way to ensure the acquisition of adequate amounts of material by the insulin users. The knowledge generated in this research related to the problem of the management of medical waste generated in households of insulin users may to contribute to the development of actions in health education and protocols in health units.

Este estudio tuvo el objetivo de proponer un protocolo para el manejo de residuos de servicios de saludgenerados en domicilios de individuos con diabetes mellitus, usuarios de insulina, centrándose en los residuos biológicos, químicos y corto-punzantes. Se trata de una investigación descriptiva-exploratoria, realizada en un Núcleo de Salud de la Familia en la ciudad de Ribeirão Preto, estado de São Paulo, Brasil. Participaron delestudio 26 usuarios de insulina. Los datos fueron recogidos por medio del Sistema de Información de Atención Primaria y entrevistas con los sujetos seleccionados, durante el mes de julio de 2010 y analizados utilizando la estadística descriptiva. Los resultados revelaron la eliminación inadecuada de los residuos de servicios de salud generados en domicilios de usuarios de insulina. Esta situación requiere la adopción de protocolos con criterios para el control de la distribución y eliminación de jeringas, favoreciendo la disminución de la generación de residuos de servicios de salud en domicilios. El uso racional de jeringas también puede contribuir para la adquisición de materiales en cantidad adecuada por los usuarios de insulina. Los conocimientos generados en esta investigación, relacionados al manejo de residuos de servicios de salud generados en domicilios de usuarios de insulina, puede contribuir para la implementación de acciones de educación en salud y basar el desarrollo de protocolos en las Unidades de Salud.

Caracterização dos perfis glicêmicos domiciliares como estratégia para os ajustes insulinoterápicos em pacientes com diabetes mellitus do tipo 1 / Caracterización de los perfiles glicémicos domiciliares como estrategia para los ajustes insulino-terápicos en pacientes con diabetes mellitus tipo 1 / Glycemic profiles in insulin adjustments in patients with type 1 diabetes mellitus

O artigo tem como objetivo principal caracterizar os perfis glicêmicos domiciliares de pacientes com diabetes mellitus tipo1, a partir de um esquema de monitorização proposto, e adotá-los como estratégia de ajuste nas doses de insulina. Foram realizados 3259 testes, 781 antes do café, 752 antes do almoço, 765 antes do jantar, 740 antes de deitar e 221 pela madrugada. A média das glicemias nestes períodos ultrapassaram os limites superiores satisfatórios em 6,87%, 3,83%, 11,37%, 30,50% e 19,28% respectivamente. Estes dados forneceram subsídios para ajustes nos esquemas insulinoterápicos. Os níveis HbA1c não mudaram de forma significante com os ajustes realizados porém, foram mantidos em 10%.

The goal of this paper is to characterize the glycemic profiles of patients with type 1 diabetes mellitus like a strategy in insulin adjustments. A total of 3259 tests were realized being 781 before breakfast, 752 before lunch, 765 before dinner and 740 before bed and 221 in the dawn. The average of the blood glucose tests in these periods oversteped the superior limits in 6,87%, 3,83%, 11,37%, 30,50% e 19,28% respectively. These data gave the conditons to make the insulin adjustments. The HbA1c levels evidenced that there was no significant statistical difference in the metabolic control, but they remained in 10%.

El objetivo principal de este artículo consiste en caracterizar los perfiles glicémicos domiciliares de los pacientes con diabetes mellitus tipo 1, a partir de un esquema propuesto de monitorización, para aplicarlo como estrategia, en los ajustes de las dosis de insulina. Fueron realizados 3.259 tests, de los cuales 781se hicieron antes del desayuno, 752 se realizaron antes del almuerzo, 765 antes de la merienda, 740 se hicieron antes de dormir y los 221 se hicieron en la madarugada. La media de las glicemias en estos períodos ultrapasaron los límites superiores satisfactorios em 6,8%, 3,83%, 11,37%, 30,50% y 19,28% respectivamente. Estos datos ofrecieron subsidios para poder ajustar los esquemas insulinoterápicos. Los niveles de HbA1c no variaron de forma significativa com los ajustes realizados y se mantuvieron em 10%.

Simultaneous kidney-pancreatic transplantation with portal venous and enteric drainage:a report of 6 cases / 中国普通外科杂志

Objective To evaluate clinical effect of simultaneous kidney-pancreatic transplantation(SKPT) with portal venous and enteric drainage. Method Between June 2001 and June 2004, six insulin-dependent diabetes mellitus(IDDM) and renal failure patients underwent this procedure. The venous drainage of the graft was established between donor′s portal vein and recipient′s superior mesenteric vein. The exocrine secretion was drained into proximal jejunum via side-to-side anastomosis between donor′s duodenum and recipient′s proximal jejunum. Steroids, mycophenolate mofetil, tacrolimus and Zenapax were used as immunosuppressants. Results Procedures were successful in all 6 cases. Excellent renal function and euglycemia were achieved in 4 cases. Follow-up of 4-34 months on the 4 survivers found excellent kidney-pancreatic function without any rejection episode. Two patients died perioperatively due to sepsis secondary to pancreatic leakage and drug toxicosis of excessive FK506. Conclusion Our preliminary experience suggests that simultaneous pancreas-kidney transplantation with enteric and portal drainage is reliable procedure for the treatment of IDDM with renal failure.

Effect of 1,25-dihydroxyvitamin D_3 on immune intervention in NOD mice / 中华内分泌代谢杂志

Objective To investigate the preventive effect of 1,25-dihydroxyvitamin D_3 〔1,25-(OH)_2D_3〕 on type 1 diabetes in cyclophosphamide-treated NOD mice. Methods Twenty female NOD mice were administered 280 mg/kg cyclophosphamide by a single intraperitoneal injection at the beginning of the experiment and then divided into two equal groups. Group 1 received intraperitoneal injection of 5 ?g/kg 1,25-(OH)_2D_3 every other day; Group 2 received the intraperitoneal injection of peanut oil in the same volume as control. When the experiment was finished on the 30th day, the incidence of diabetes and the degree of insulitis were observed. The expressions of bcl-2 and bax in islets were detected with immunohistochemical technique. The apoptosis rate of spleen T lymphocyte was also measured by flow cytometry quantitative analysis. Results Intraperitoneal injections of 1,25-(OH)_2D_3 to NOD mice reduced the incidence of diabetes (10% vs 70%, P

HLA-DPB1, DQB1 genes and their correlation with autoantibodies in type 1 diabetes mellitus / 中华内分泌代谢杂志

Objective To investigate HLA-DPB1, DQB1 gene alleles and their correlation with autoantibodies in type 1 diabetes mellitus. Methods Sequence-based typing was used to determine the alleles of HLA-DPB1 and -DQB1 in 68 patients with type 1 diabetes and 50 healthy controls. Autoantibodies 〔glutamic acid decarboxylase antibody (GADA), islet cell antibody (ICA), insulin autoantibody (IAA)〕were detected by ELISA. Results Compared with the controls, the frequencies of DPB1*0402 and DQB1*0301 were significantly lower in type 1 diabetics (11.76%, 5.15% vs 30.00%, 22,00% respectively, P

Apoptosis and its modulation in type Ⅰ diabetes mellitus / 中国病理生理杂志

Apoptosis, also known as programmed cell death,is a normal process contributing to tissue tumor during development and in the adult.During development apoptosis is involved in tissue homeostasis and eliminating nonfunctional,superfluous or harmful cells.It is an active process controlled by some gene and factors such as caspases, bcl-2, Fas/FasL and NO.Type 1 diabetes mellitus is regarded as a chronic autoimmune disease resulting from progressive destruction of insulin-producing ?-cells in the pancreas.The relationship between apoptosis with its modulation and type 1 diabetes mellitus was reviwed.

Postoperative metabolic characteristics of islet transplantation in the treatment of type Ⅰ diabetes / 中国普通外科杂志

Objective To assess the effect of fetal islet transplantation for the treatment of Type Ⅰ diabetes. Methods The pancreatic islets from human aborted embryos were cultured and implanted into the greater omentum and omental bursa of 26 patients with type Ⅰ diabetes. The function of transplanted islets was evaluated. Results After transplantation, the exogenous insulin requirement significantly decreased (P

Expression of HLA class Ⅱ antigens, interleukin-2 receptors and transferrin receptors of monocytes from patients with insulindependent diabetes mellitus / 中国病理生理杂志

Expression of HLA class Ⅱ antigens(HLA-DR, DQ and DP), interleukin2 receptors(IL-2R) and transferrin receptors(TfR) of blood monocytes from 10 patients with insulin-dependent diabetes meIlitus (IDDM) were assayed with the indirect immune fluorescence technique using corresponding monoclonal antibodies and the FITC-labelled second antibody. The results showed that the number of HLA-DQ~+ monocytes was much more in diabetics than in normal controls. The percentages of HLA-DR~+ and HLA-DP~+ monocytes in diabetics were not different significantly from those in normal controls. Besides, IL-2R~+ and TfR~+ monocytes were also found to be very much increased in diabetics as compared with controls. It was possible that increased expression of HLA-DQ antigen, IL-2R and TfR of monocytes in patients with IDDM might play a role in the pathogenesis of the autoimmune reaction.

Islet autoantibodies and type 1 diabetes mellitus / 中华内分泌代谢杂志

The positive rate of autoantibodies was 29.7% in 1617 diabetic patients. The positive rate of monoautoantibody was lower than that of combined assay with 3 autoantibodies. Combined assay of multiple autoantibodies may enhance the positivity of early diagnosis of type 1 diabetes mellitus. Glutamic acid decarboxylase antibody (GADA) may be a better screening test for predicting insulin dependency, the prediction of GADA combined with protein tyrosine phosphatase antibody may approximate to 100%, whereas islet cell antibody assay may be needed in the adolescent patients.