Factores relacionados con la adherencia al tratamiento de rehabilitación de los pacientes con Diabetes Mellitus tipo 2 con amputación de miembro inferior

Objetivo: Determinar los factores clínicos y sociodemográficos relacionados con la adherencia al tratamiento de rehabilitación de los pacientes con Diabetes Mellitus tipo 2 con amputación de miembro inferior. Material y métodos: Estudio observacional, retrospectivo, comparativo y relacional; se incluyeron 113 pacientes con DM tipo 2 del Departamento de Investigación, Docencia y Rehabilitación Integral en Amputados, quemados y Trastornos Posturales del Instituto Nacional de Rehabilitación "Dra. Adriana Rebaza Flores" AMISTAD PERÚ - JAPÓN, que ingresaron en el periodo 2016 al 2019. Se recolectaron variables sociodemográficas y clínicas; y para la adherencia al tratamiento de rehabilitación se consideró la asistencia de los pacientes a 5 áreas de atención en salud, y el alta de prótesis de los pacientes. Resultados: El 75,52 % de pacientes fueron del sexo masculino, con edad media de 66,6 ± 12,1; y la media del tiempo de alta de prótesis fue 11,4 ± 6,75 meses. Se encontró diferencia significativa entre adherencia y no adherencia en la edad, nivel socioeconómico, estado civil y cobertura de atención (p < 0,05) Conclusiones: La mayoría de los pacientes amputados con DM tipo 2 fueron del sexo masculino cuyo cumplimiento o adherencia a la rehabilitación se relacionó con factores sociodemográficos como la edad, estado civil, nivel socioeconómico y cobertura de salud.

SUMMARY Objective: To determine clinical and sociodemographic factors related to the adherence to rehabilitation treatment among type 2 diabetic patients who underwent lower limb amputation. Methods: An observational retrospective study that included 113 type 2 diabetic patients attended at the Departamento de Investigación, Docencia y Rehabilitación Integral en Amputados, quemados y Trastornos Posturales del Instituto Nacional de Rehabilitación "Dra. Adriana Rebaza Flores" AMISTAD PERÚ - JAPÓN from 2016 to 2019. Clinical and sociodemographic variables were collected; to measure adherence patients had to attend five evaluations and the discharge visit after a prosthetic device had been inserted. Results: 75.52% were males; mean age was 66.6 ± 12.1 years, and mean time after insertion of the prosthetic device was 11.4 ± 6.75 months. Factors associated with no adherence were age, socioeconomic level, marital status and health care coverage (p<0.05). Conclusions: Most of the type 2 diabetic patients who underwent lower limb amputation were males, adherence to the rehabilitation treatment was related to sociodemographic factors.

Construção e validação de painel móvel para educação em saúde de usuários com diabetes mellitus tipo II na atenção primária à saúde / Construction and validation of a mobile panel for health education of users with type II diabetes mellitus in primary health care

Resumo: Este estudo de produção tecnológica que teve como objetivo, construir, validar o conteúdo e aparência de uma tecnologia educacional, no formato de painel móvel, para educação em saúde de usuários com Diabetes Mellitus tipo II, atendidos na Atenção Primária à Saúde do município de Ji-Paraná - Rondônia. Método: trata-se de estudo metodológico, realizado em três fases: 1. Exploratória ­ quando foi realizado o diagnóstico situacional e busca na literatura sobre Diabetes Mellitus tipo II. 2. Desenvolvimento - definição, validação do conteúdo que compôs o painel móvel e elaboração gráfica e designer. 3. Validação: validação da aparência do painel móvel utilizando o Instrumento para Validação de Aparência de Tecnologias Educacionais em Saúde. Resultados: Participaram do diagnóstico situacional 17 profissionais da saúde, sendo 41,18% representada pela equipe de enfermagem. Os participantes afirmaram realizar educação em saúde para o autocuidado durante a realização das reuniões, atendimentos e/ou consultas dos usuários com DM tipo II. Dois (15,68%) participantes afirmaram que utilizavam alguma tecnologia educacional durante os atendimentos e/ou consultas e quatro (40%) participantes utilizavam alguma tecnologia educacional nas reuniões com usuários com diabetes Mellitus tipo II. O conteúdo do painel móvel foi organizado nos seguintes tópicos: Diabetes Mellitus tipo II: o que é? Quais as complicações da doença? O que é autocuidado? Cuidados com a alimentação, os pés, os olhos, a saúde bucal e mental; uso correto das medicações; práticas de exercícios físicos e cessação do tabagismo. O Índice de Validade de Conteúdo atingiu 94,44%, sendo considerado satisfatório. A aparência foi validada, obtendo Índice de Validade de Aparência total de 92%. O painel móvel foi confeccionado em acrílico, contendo frente e verso, com rodas para facilitar o manuseio e uso em diferentes locais. Conclusão: a tecnologia desenvolvida possui capacidade de cumprir o propósito de subsidiar a equipe de saúde na educação dos usuários com Diabetes Mellitus tipo II. O painel móvel apresenta qualidades de inovação, praticidade no uso e validade de conteúdo e aparência. Seu potencial para a interlocução entre a equipe de saúde e usuários visa a construção do conhecimento sobre a doença, autocuidado e prevenção de complicações. A replicabilidade da tecnologia em saúde cumpre o papel social deste estudo.

Abstract: This technological production study aimed to build, validate the content and appearance of an educational technology, in the form of a mobile panel, for health education of users with Type II Diabetes Mellitus, assisted in Primary Health Care in the municipality of Ji -Paraná - Rondônia. Method: this is a methodological study, carried out in three phases: 1. Exploratory ­ when the situational diagnosis and literature search on Type II Diabetes Mellitus were carried out. 2. Development - definition, validation of the content that made up the mobile panel and graphic design and design. 3. Validation: validation of the appearance of the mobile panel using the Instrument for Appearance Validation of Educational Technologies in Health. Results: 17 health professionals participated in the situational diagnosis, 41.18% of which were represented by the nursing team. The participants stated that they carried out health education for self-care during meetings, consultations and/or consultations with users with type II DM. Two (15.68%) participants stated that they used some educational technology during consultations and/or consultations and four (40%) participants used some educational technology in meetings with users with type II diabetes Mellitus. The content of the mobile panel was organized into the following topics: Type II Diabetes Mellitus: what is it? What are the complications of the disease? What is self-care? Care for food, feet, eyes, oral and mental health; correct use of medications; physical exercise practices and smoking cessation. The Content Validity Index reached 94.44%, being considered satisfactory. Appearance was validated, obtaining a total Appearance Validity Index of 92%. The mobile panel was made of acrylic, containing front and back, with wheels to facilitate handling and use in different places. Conclusion: the developed technology has the capacity to fulfill the purpose of supporting the health team in the education of users with Type II Diabetes Mellitus. The mobile panel presents qualities of innovation, practicality in use and validity of content and appearance. Its potential for dialogue between the health team and users is aimed at building knowledge about the disease, self-care and prevention of complications. The replicability of health technology fulfills the social role of this study.

Hypolipidemic, hipoglycemiant and antioxidant effects of Myrcia splendens (Sw) DC in an animal type 2 diabetes model induced by streptozotocin / Efectos hipolipemiante, hipoglucemiante y antioxidante de Myrcia splendens (Sw) DC en un modelo animal de diabetes tipo 2 inducido por estreptozotocina

We investigated the effects of dichloromethane extract (DME) from Myrcia splendenson alterations caused by type 2 diabetes in the blood and kidney of rats, in order to reduce side effects caused by synthetic drugs. Rats received streptozotocin (60 mg/kg),15 minutes after nicotinamide (120 mg/kg) or water. After 72 hours, the glycemic levels were evaluated to confirm diabetes and the animals received (15 days) DME (25, 50, 100 or 150 mg/Kg) or water. DME partially reversed hyperglycemia and (100 and 150 mg/kg) reversed hypertriglyceridemia. Histopathological findings elucidated that DME reduced damage to pancreatic islets. DME 150 mg/kgreversed the increases in TBA-RS, the reduction in the sulfhydryl content, 100 and 150 mg/kg increased CAT, reversed the decrease in GSH-Px and increased it activity in the blood. DME 150 mg/kg reversed CAT and GSH-Px reductions in the kidney. We believe that DME effects might be dependent on the presence of phenolic compounds.

Investigamos los efectos del extracto de diclorometano (DME)de Myrcia splendens sobre las alteraciones causadas por la diabetes tipo 2 en la sangre y los riñones de las ratas, para reducir los efectos secundarios causados por las drogas sintéticas. Las ratas recibieron estreptozotocina (60 mg/kg), 15 minutos después de la nicotinamida (120 mg/kg) o agua. Después de 72 horas, se confirmo la diabetes y los animales recibieron (15 días) DME (25, 50, 100 o 150 mg/Kg) o agua. DME revierte parcialmente la hiperglucemia y revierte la hipertrigliceridemia. DME redujo el daño a los islotes pancreáticos. DME revirtió los aumentos en TBA-RS, la reducción en el contenido de sulfhidrilo, aumentó la CAT, revirtió la disminución en GSH-Px y aumentó su actividad en la sangre. Además, DME revirtió las reducciones de CAT y GSH-Px en el riñón. Creemos que los efectos provocados por DME pueden depender de la presencia de compuestos fenólicos.

A study to assess the clinicopathological spectrum of acute complications of diabetes mellitus type II

Background: The acute metabolic complications of diabetes consist of diabetic ketoacidosis (DKA), hyperosmolar non-ketotic coma (HNC), lactic acidosis (LA), and hypoglycemia. All of these are associated with significant morbidity and mortality. These can easily be prevented by early recognition and prompt management. Therefore, this study was conducted to assess the clinicopathological spectrum of acute complications of diabetes mellitus type II.Methods: This observational, analytical study was conducted on 100 patients aged more than 18 years admitted in the ICU with acute complication of Diabetes mellitus Type II. Medical history was recorded. Physical examination and investigations were done and recorded.Results: The mean age of the study population was 55.26±13.13 years. Hypoglycemia was more common (63%) than DKA (37%). Fever and sweating had the overall highest incidence (and were more in patients with hypoglycemia) while stupor, nausea and abdominal pain had the lowest incidence (and were more in patients with DKA). On examination, only one patient of DKA was drowsy. Mean temperature, pulse and respiratory rate were higher in the patients having DKA while blood pressure was higher in patients having hypoglycemia.Conclusions: It can be effectively concluded from the present study that DKA and hypoglycaemia have a broad spectrum of clinicopathological features. But the incidences vary widely. This may help in early recognition of the impending complication and thereby enabling prompt management of the same, reducing the associated morbidity and mortality.

Angelica keiskei (ashitaba) as adjuvant therapy in the maintenance of blood glucose levels among patients with type II diabetes mellitus / The Health Sciences Journal

INTRODUCTION@#This study aimed to determine if using Angelica keiskei (ashitaba) tablets as adjuvant therapy to the usual medications for patients with type II diabetes mellitus would result in significant lowering of blood sugar.@*METHODS@#The antidiabetic effect of Angelica keiskei was evaluated in diabetic Filipino patients as an adjuvant treatment to antidiabetic medications through a randomized single-blind placebo-controlled clinical trial. Patients recruited from select barangays in Quezon City and San Juan City were randomly assigned to either ashitaba or placebo group. The effect was measured by obtaining and comparing fasting blood sugar pre- and post-treatment.@*RESULTS@#There was no significant change in FBS from the baseline in the ashitaba (p = 0.174) and placebo (p = 0.128) groups after two weeks. There was a significant increase in the systolic BP of the ashitaba group (p= 0.014) but not in the placebo group. There were no significant changes in the diastolic BP of either group. @*CONCLUSION@#Dietary supplementation of 500 mg ashitaba capsules thrice daily for two weeks did not exhibit any glucose-lowering effects among type II diabetic patients maintained on oral anti-diabetic medications.

Factores de riesgo asociados a la diabetes mellitus tipo ii en indígenas de latinoamerica, revisión de literatura 2000-2016

La Diabetes Mellitus (DM) es una enfermedad que se presenta cuando el páncreas no puede fabricar insulina suficiente y genera un factor de riesgo en la salud cardiovascular de quien la padece. Objetivo: Identificar los factores de riesgo asociados a la diabetes Mellitus tipo II (DMII), en indígenas de Latinoamérica a la luz de la literatura, con el fin de aportar información que contribuya a mejorar las estrategias de vigilancia en esta población. Materiales y métodos: Revisión de literatura publicada entre los años 2000 y 2016 en países latinoamericanos, en bases de datos como Scielo, Science Direct, Pubmed y Lilacs; 32 artículos cumplieron con los criterios de selección, en tres idiomas: inglés, español y portugués. La búsqueda se realizó con los términos de lenguaje libre, Decs y Mesh. Resultados: Se puede asociar los riesgos metabólicos de las razas no indígenas frente a las indígenas, como factores predisponentes para el padecimiento de la DM II. Conclusiones: Los diferentes autores coinciden en afirmar, los cambios y culturización de las comunidades indígenas de Latinoamérica hacen que se aumente el riesgo en el padecimiento de la DM II.

Diabetes Mellitus (DM) is a disease that occurs when the pancreas is not able to produce enough insulin and generates a risk factor in the cardiovascular health of those who suffer it. Objective: To identify the risk factors associated with type II diabetes mellitus (DMII) in Latin America Indigenous people according to the literature, in order to provide information that contributes to improving the surveillance strategies in this population. Materials and Methods: Literature review in Latin American countries and published between 2000 and 2016, in databases such as Scielo, Science Direct, Pubmed and Lilacs; 32 articles complied with the selection criteria, in three languages English, Spanish and Portuguese. The search was made with the terms of free language, Decs and Mesh. Results: It is possible to associate the metabolic risks of the non-indigenous races with the indigenous ones, as predisposing factors to developing DM II. Conclusions: different authors agree in affirming that, the changes and acculturation of the indigenous communities of Latin America make the risk to suffering DM II arises.

Diabetes Mellitus (DM) é uma doença que ocorre quando o pâncreas não consegue fabricar insulina suficiente e gera um fator de risco na saúde cardiovascular dos pacientes. Objetivo: Identificar os fatores de risco associados ao diabetes mellitus tipo II (DMII) em povos indígenas da América Latina à luz da literatura, a fim de fornecer informações que contribuam para melhorar as estratégias de vigilância nessa população. Materiais e Métodos: Revisão de literatura em países da América Latina publicada entre 2000 e 2016, em bases de dados como Scielo, Science Direct, Pubmed e Lilacs; 32 artigos preencheram os critérios de seleção, em três idiomas: inglês, espanhol e português. A busca foi feita com os termos de linguagem livre, Decs e Mesh. Resultados: É possível associar os riscos metabólicos das raças não indígenas com aqueles dos indígenas, como fatores predisponentes ao padecimento do DM II. Conclusões: Os diferentes autores concordam em afirmar que as mudanças e aculturação das comunidades indígenas da América Latina fazem com que o risco no padecimento do DM II seja aumentado.

Effects of glargine insulin on glycemic control in patients with diabetes mellitus type II undergoing off-pump coronary artery bypass graft

Background: The prevalence of diabetes mellitus in patients requiring coronary artery bypass grafting (CABG) is noticeably high (20%–30%). These patients have inferior perioperative outcome, reduced long-term survival, and high risk of recurrent episodes of angina. To improve perioperative outcome surgical unit defined satisfactory glycemic control is desired during this period. Hence, the aim of our study is to compare the efficacy of glargine insulin combination with continuous human insulin infusion for perioperative glycemic control in patients with diabetes undergoing CABG. Materials and Methods: Fifty Patients, who were posted for off-pump CABG with diabetes mellitus type II, were randomized in two group, Group I normal saline + human insulin infusion during the perioperative period, Group II (glargine group): Glargine + human insulin infusion during perioperative period. Results: During surgery and in the postoperative period, random blood sugar and human insulin requirement are significantly higher in control group than glargine group. Other infection, step-up antibiotics, intensive care unit (ICU) stay, and hospital stay were significantly higher in control groups in postoperative period. Conclusion: Our study results suggest that glargine effectively manages blood glucose level with significantly greater control over postoperative morbidity.

Diabetes mellitus and sensorineural hearing loss: is there an association? Baseline of the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil)

OBJECTIVES: Although several studies have investigated the effects of diabetes on hearing loss, the relationship between these two conditions remains unclear. Some studies have suggested that diabetes may cause sensorineural hearing loss, whereas others have failed to find an association. The biggest challenge in investigating the association between diabetes and hearing loss is the presence of confounding variables and the complexity of the auditory system. Our study investigated the association between diabetes and sensorineural hearing loss. We evaluated the influence of time from diabetes diagnosis on this association after controlling for age, gender, and hypertension diagnosis and excluding those subjects with exposure to noise. METHODS: This cross-sectional study evaluated 901 adult and elderly Brazilian Longitudinal Study of Adult Health (ELSA-Brasil) participants from São Paulo, Brazil who underwent audiometry testing as part of ELSA-Brasil’s baseline assessment. RESULTS: Hearing thresholds and speech test results were significantly worse in the group with diabetes than in the group without diabetes. However, no significant differences were found between participants with and without diabetes after adjusting for age, gender, and the presence of hypertension. Hearing thresholds were not affected by occupational noise exposure in the groups with and without diabetes. In addition, no association between the duration of diabetes and hearing thresholds was observed after adjusting for age, gender, and hypertension. CONCLUSION: We found no association between the duration of diabetes and worse hearing thresholds after models were adjusted for age, gender, and the presence of hypertension.

Association between Total Bilirubin and Hemoglobin A1c in Korean Type 2 Diabetic Patients

Recent studies have shown that bilirubin is negatively associated with hemoglobin A1c (HbA1c) in the general population. The association between bilirubin and HbA1c in serum of diabetes patients has not yet been studied. The aim of the present study was to evaluate the association between total bilirubin and HbA1c in Korean patients with type 2 diabetes. A total of 690 of the 1,275 type 2 diabetes patients registered with the public health centers in Seo-gu, Gwangju and Gokseong-gun, Jeollanam-do participated in this study. Following an overnight fast, venous blood and urine samples were collected and analyzed. The mean HbA1c values differed significantly according to total bilirubin ( or = 0.8 mg/dL, 7.1%; P for trend = 0.016) after we adjusted for other confounding factors. When the odds ratio (OR) was adjusted for other confounding factors, there was a significant association between total bilirubin and HbA1c (OR, 0.4 [95% confidence interval, 0.2-0.8] for total bilirubin > or = 0.8 mg/dL versus < or = 0.4 mg/dL. In conclusion, total bilirubin concentrations in serum are negatively associated with HbA1c levels after adjustment for sex, age, and other confounding factors in type 2 diabetes patients.

Associação estresse-diabetes mellitus tipo II / Stress-diabetes mellitus type II association

JUSTIFICATIVA E OBJETIVOS: Diversos estudos evidenciam a importância do estresse na gênese e na progressão de doenças. Dentre estas, o diabetes mellitus tipo II (DMII) se reveste de especial importância, pois se estima que aproximadamente 11% da população acima de 40 anos seja portadora dessa doença. O objetivo deste estudo foi resumir os aspectos epidemiológicos e fisiopatológicos desta associação, presentes na literatura nacional e internacional sobre o assunto, no período entre 1996 e 2006. CONTEÚDO: Pesquisou-se nas bases de dados bibliográficos (MedLine e LILACS), utilizando-se as palavras-chave: estresse e diabetes mellitus tipo II, foram consultados 53 artigos sobre o assunto. CONCLUSÃO: O estudo tornou evidente a importância do estresse como fator associado à possibilidade de descompensação dos pacientes portadores de DMII e a necessidade de incorporação de medidas que incluam o controle de estresse ao tratamento preconizado para esta doença, com a finalidade de melhorar os níveis glicêmicos e prevenir o aparecimento de complicações.

BACKGROUND AND OBJECTIVES: Many studies have focused the role of stress as a causal relationship for chronic diseases decompensation. Among that, diabetes mellitus type II is one of the most important, affecting 11% of Brazilian population over 40 years. The aim of this study is to review the literature for epidemiological and psychopathologic aspects of stress and DMII relationship, published from 1996 to 2006. CONTENTS: Using a database systematic medical literature review in MEDLINE and LILACS, with the search terms diabetes mellitus type II, stress, 53 articles were obtained and consulted. CONCLUSION: This review emphasize stress as a well-established risk factor to diabetes mellitus type II metabolic decompensation and the need to target DMII resources to reduce stress in this patients.

Factores involucrados en la adhesión al tratamiento de la diabetes mellitus tipo II en una muestra de pacientes diabéticos de la zona norte de Costa Rica: un estudio psicométrico / Factors involved in the adhesion to the treatment of the diabetes mellitus type II in a sample of diabetic patients of the north zone of Costa Rica: a psychometric study

Se probó la Escala de Adhesión al Tratamiento de la Diabetes Mellitus tipo II-versión III (EATDM-III©), la cual estaba compuesta por los factores apoyo familiar, organización y apoyo comunal, ejercicio físico, control médico, higiene y autocuidado, dieta y valoración de la condición física. La investigación se realizó en centros de salud públicos de la zona norte de Costa Rica, y se aplicó a una muestra de 59 personas de ambos géneros entre febrero y marzo de 2006. El instrumento demostró una confiabilidad alta (á=0,92). Se obtuvieron correlaciones significativas (p<0,05) entre cada factor y en la relación factores-escala total. La EATDM-III© es un instrumento valioso para medir la adhesión al tratamiento en personas con diabetes mellitus tipo II.

The Adhesion to the Treatment of the Diabetes Mellitus type II (EATDM-III©) scale was proved, which was composed by the factors Familiar Support, Organization and Communal Support, Physical Exercise, Medical checkup, Hygiene and Self-Care, Diet and Valuation of the Physical Training Conditions. The investigation was made in public health centers of the North Zone of Costa Rica, n=59, both genders, it takes place during February-March of 2006. The instrument demonstrated a high reliability (á=0,92). Significant correlations were obtained (p<0,05) between each factor and in the total relation factor-Scale. The EATDM-III© is an valuable instrument to measure the adhesion to the treatment in people with Diabetes Mellitus type II.

The Effects of a Cognitive Behavioral Stress Management Program on Diabetic Self-Care and Glycemic Control with Diabetes Mellitus Type II / 성인간호학회지

PURPOSE: The purpose of this study was to examine the effects of a cognitive behavioral stress management program on diabetic self-care and glycemic control with type 2 diabetic patients. METHODS: Thirty three diabetic patients who were older than 40 were recruited from a public health center and conveniently assigned into both experimental(n=16) and control groups(n=17). Participants in the experimental group had attended the weekly cognitive behavioral program for 8 weeks. Data were collected from June 2005 to August 2006 and analyzed by independent t-test using the SPSS WIN program. RESULTS: After an 8 week intervention, participants in the experimental group reported on increasement of diabetic self-care behaviors and an increasement of blood glucose levels, which were significantly different from those in the control group. CONCLUSION: On the basis of those findings, we concluded that the cognitive behavioral stress management program has positive effects on diabetic self-care and glycemic control for the patients with DM. Further research is needed to identify the long-term effects of the cognitive behavioral program.

Características psicométricas de la Escala de Adherencia al Tratamiento de la Diabetes Mellitus Tipo II-Versión III (EATDM-III©) en una muestra de pacientes diabéticos de Costa Rica / Psychometric characteristics of the scale for Treatment Adherence in Type 2 Diabetes Mellitus Version III (EATDMIII©) in a sample of diabetics patients of Costa Rica

Se probó la Escala de Adherencia al Tratamiento de la Diabetes Mellitus tipo IIversión III (EATDMIII©), la cual estaba compuesta por los factores Apoyo Familiar, la Organización y Apoyo Comunal, el Ejercicio Físico, el Control Médico, el Higiene y Autocuidado, la Dieta y la Valoración de la Condición Física. La investigación se realizó en el Hospital Dr. Rafael Ángel Calderón Guardia, Costa Rica, n=104 personas de ambos sexos, durante los meses de febreromarzo de 2006. El instrumento demostró una confiabilidad alta (á=0,88). Se obtuvieron correlaciones significativas entre cada factor y en la relación factoresEscala total. La EATDMIII© es un instrumento valioso para medir la adherencia al tratamiento en personas con Diabetes Mellitus tipo II.

The Scale for Treatment Adherence in Type 2 Diabetes Mellitus version III (EATDMIII©) was tested. It was compounded by the following factors: Family Support, Organization and Community Support, Physical Exercise, Medical Control, Hygiene and SelfCare, Diet and Assessment of Physical Condition. The research was developed at Dr. Rafael Ángel Calderón Guardia Hospital, Costa Rica, n=104 subjects, both genders, during the months of FebruaryMarch 2006. The instrument showed a high reliability (á=0,879) and several significant correlations inter factors and between factors and the total scale. The EATDMIII© is a valuable instrument to measure the treatment adherence in people with Type 2 Diabetes Mellitus.

Prevalência de infecção pelo vírus da hepatite C em pacientes com diabetes melito tipo 2 / Prevalence of hepatitis C infection in patients with type 2 diabetes mellitus

RACIONAL: Estudos recentes têm sugerido possível associação entre infecção pelo vírus da hepatite C (VHC) e diabetes melito tipo 2, relatando prevalência elevada de infecção pelo vírus C nessa população. OBJETIVO: Verificar a prevalência de infecção pelo VHC em adultos portadores de diabetes melito em nosso meio. MÉTODOS: Foram avaliados consecutivamente 145 adultos com diabetes melito tipo 2 e 104 com diabetes melito tipo 1, em acompanhamento no ambulatório de diabetes de um hospital universitário, quanto à presença de anticorpos contra VHC (anti-VHC) por método ELISA de quarta geração, utilizando como grupo controle 16 720 doadores de sangue da cidade de Curitiba, PR, no período em que foi realizada a pesquisa. Os pacientes diabéticos foram também avaliados quanto a dados demográficos, clínicos, bioquímicos (níveis séricos de aminotransferases) e exposição prévia a fatores de risco para infecção pelo VHC. RESULTADOS: Maior prevalência de positividade do anti-VHC foi observada em pacientes com diabetes melito tipo 2, em comparação aos doadores de sangue. A prevalência de anti-VHC naqueles com diabete melito tipo 2 foi superior à encontrada no tipo 1, embora não tenha alcançado significância estatística. Nos dois grupos de diabéticos houve predomínio do sexo feminino, sendo que os do tipo 2 apresentavam idade média superior aos do tipo 1. A distribuição de cor, tempo de diagnóstico do diabetes e a freqüência de exposição a fatores de risco foram semelhantes nos dois grupos. A mediana da taxa de alanina aminotransferase dos pacientes com diabetes tipo 2 foi superior à observada nos do tipo 1. CONCLUSÕES: Encontrou-se maior prevalência de infecção pelo VHC em diabéticos tipo 2 se comparado à população saudável de Curitiba, corroborando publicações prévias em outras populações.

BACKGROUND: Recently, a possible epidemiological association between hepatitis C virus infection and diabetes mellitus has been suggested and a higher prevalence of HCV antibodies has been found among type 2 diabetic when compared with normal controls. AIM: To evaluate the prevalence of hepatitis C infection in diabetic patients in Curitiba, PR, Brazil. PATIENTS AND METHODS: A total of 145 type 2 and 104 type 1 diabetic patients attending the outpatient diabetic unit of an university hospital were consecutively tested for anti-HCV, using a fourth-generation enzyme-linked immunosorbent assay (ELISA). The control group was constituted by 16,720 volunteer blood donors attending the blood bank of the same hospital during the period of the study. Diabetic patients were also evaluated for clinical, biochemical (aminotransferase levels) and demographic variables and previous exposure to risk factors for hepatitis C infection. RESULTS: A higher prevalence of hepatitis C infection was observed in type 2 diabetic patients in comparison with blood donors. Although anti-HCV prevalence in type 2 diabetic patients was higher than found in type 1, it did not reach statistical significance. Both diabetic groups were predominantly female, and as expected, type 2 diabetic were older than type 1. Race distribution, duration of the disease, and previous exposure to hepatitis C risk factors were similar in both groups, but type 2 diabetic subjects had higher median levels of alanine aminotransferase than type 1. CONCLUSIONS: A higher prevalence of hepatitis C infection was detected in type 2 diabetic patients in comparison with blood donors in our region, in accordance with study data from different populations. If all type 2 diabetic patients should undergo regular screening for hepatitis C infection remains a question.

The Effects of Problem Solving Nursing Counseling and Intensified Walking Exercise on Diabetic Self-care, Coping Strategies, and Glycemic Control among Clients with DM Type II / 간호학회지

PURPOSE: The purpose of the study was to identify the effects of problem solving nursing counseling and intensified walking exercise on diabetic self-care, coping strategies, and glycemic control among older adults with DM type II. METHOD: Ninety nine DM patients who were older than 50 were recruited from DM clinics or public health centers and conveniently assigned into three groups: the Polar(n=41), counseling(n=30) and control groups (n=28). Participants in both Polar and counseling groups attended weekly problem solving nursing counseling for 12 weeks. Polar heart rate monitors were used in the Polar group to intensify walking exercise. Data was collected from November 2003 to August 2004 and analyzed by ANOVA or ANCOVA using the SPSS WIN program. RESULT: After a 12 week intervention, participants in both the Polar and counseling groups reported increased diabetic self care behaviors and decreased blood glucose levels, which is significantly different from those in the control group. There were no distinctively different program effects between the Polar and counseling groups. CONCLUSION: Based on the findings, we concluded that problem solving counseling alone could have positive effects on diabetic self care and glycemic controls for older adults with DM. Future research is needed to identify long-term effects of the program.

Self Care Activity, Metabolic Control, and Cardiovascular Risk Factors in accordance with the Levels of Depression of Clients with Type 2 Diabetes Mellitus / 간호학회지

PURPOSE: The purpose of this study was to explore the levels of depression experienced by clients (N=152) with Type 2 Diabetes Mellitus(DM), and to compare the levels of self care activity, metabolic control and cardiovascular risk factors between depressed and non-depressed clients. METHOD: Participants aged 50 and above were conveniently recruited in B city. The levels of depression, self-care activity, metabolic control of glucose and lipids, and cardiovascular risk factors of the participants were measured by using questionnaires and blood tests from November, 2003 to June, 2004. Data was analyzed with descriptive statistics, Pearson correlation, Spearman rho and t-test using the SPSS WIN 10.0 program. RESULT: The prevalence of depression(CES-D=16) among the participants was 44.1%. The levels of self-care activities(p=.012), glucose(p=.019), total cholesterol(p=.022), LDL(.007) and cardiovascular risk factors(p=.012) were significantly higher in the depressed group than those in the non-depressed group. CONCLUSION: Based on the findings, we concluded that many DM patients experience depression and the depression of type 2 DM clients is significantly related with self care activities, diabetic control, and cardiovascular complications. However, this study did not address causality among these variables. Therefore, further research, such as a longitudinal cohort study, is needed to identify causality among these variables.

The Effects of Depressive Symptoms to Metabolic and Glycemic Control among Type 2 Diabetes Patients

BACKGROUND: Depression is common among type 2 diabetic patients. To determine the relationship between depressive symptoms and metabolic control, we evaluated the risk factors that are related to metabolic control in diabetic patients. METHODS: This study was performed among 356 type 2 diabetic outpatients, who visited the Department of Family Medicine and Endocrinology, Samsung Medical Center, from November 2003 to January 2004. The data were collected through questionnaire about sociodemographic features diabetes-related factors and health behaviors. Beck Depression Inventory (BDI) was administered to measure depressive symptoms. The medical records were reviewed to confirm metabolic controls including HbA1c, lipids, blood pressure, body mass index (BMI), past medical history, and prescriptions. RESULTS: The prevalence of depressive symptoms (BDI> or =11) was 35.4%, including severe symptoms (BDI> or =21) 6.8%. There were significant graded relationships between greater depressive symptoms and higher serum level of HbA1c (P=0.000) and LDL-cholesterol (P=0.046). In binary logistic regression analysis, low level of exercise (OR=1.97; 95% CI=1.18~3.28), lack of exercise (OR= 2.94; 95% CI=1.28~6.77), poor LDL-cholesterol control (OR=1.94; 95% CI=1.19~3.18), and depressed group (OR=2.20; 95% CI=1.35~3.60) were significantly associated with poor glycemic control. CONCLUSION: There is a significant association between depressive symptoms and glycemic control of type 2 diabetes. Therefore, family physicians who provide continuous and comprehensive primary care should be more concerned for depressive symptoms in type 2 diabetes patients.

Asociación entre hiperhomocisteinemia, cardiopatía isquémica y diabetes tipo 2

La hiperhomocisteinemia es considerada como un factor de riesgo para las enfermedades vasculares en la población general. Sin embargo, su rol en el desarrollo de la cardiopatía isquémica (CI) no ha sido totalmente dilucidado. El objetivo fue determinar, si existe, en primera instancia una asociación entre la cardiopatía isquémica y los niveles elevados de homocisteína en plasma y posteriormente investigar la posible asociación entre la hiperhomocisteinemia y la diabetes mellitus tipo 2. Se analizó la información de 204 pacientes atendidos en consultorios dependientes del CASMU con una edad promedio de 61,2±10,8 años. Se siguieron los criterios de las guías de Task Force y ADA para el diagnóstico de cardiopatía isquémica y diabetes, respectivamente. Se tomaron valores entre 5-15 µmoles/lt de homocisteína plasmática como normales. Los pacientes fueron clasificados en dos grupos: con cardiopatía isquémica (CCI) y sin cardiopatía isquémica (SCI). En las comparaciones realizadas entre los grupos se observaron diferencias significativas en la distribución de los niveles de homocisteína plasmática entre los individuos CCI y SCI (p<0,001). A su vez, se observó una asociación entre los valores de hiperhomocisteinemia y la CI (OR=2,66). Por otra parte, la ausencia de diferencias significativas entre diabéticos y no diabéticos con CI estaría indicando que la diabetes y la hiperhomocisteinemia serían dos características genéticas independientes o -dicho de otra forma- el hecho de ser diabético no altera la asociación entre la hiperhomocisteinemia y la cardiopatía isquémica.

A high plasmatic level of homocysteine is considered as a risk factor to vascular disease in the general population. However, the role of hyperhomocysteinaemia in the ischaemic heart disease development is not totally elucidated. The aim of our study was to determine in fist place, if in our sample there is an association between homocysteine levels and ischaemic heart disease and subsequently to investigate a possible association of hyperhomocysteinaemia to the presence of diabetes mellitus type 2. We analyzed the information of 204 patients attending to private health centers (depending from CASMU). All patients (61,2 ± 10,8 year olds average) were diagnosed as diabetic type 2 and ischaemic heart disease according to the ADA and Task Force guides criteria respectively. We took 5-15 µmol/l homocysteine plasmatic value as normal. The patients were classified in two groups: with (CCI) and without ischaemic heart disease (SCI). We observed statistical significant differences in the distribution of homocysteine plasmatic levels between: CCI and SCI (p<0,001). We also observed an association between hyperhomocysteinaemia and CI (OR=2,66). In the other hand, non-significant statistical differences between diabetic and non diabetics patient with CI would be indicate that that hyperhomocysteinaemia and diabetes are two independent genetics factors; the diabetes condition do not alter the association between hyperhomocisteinaemia and CI.

MECHANISM OF INSULIN RESISTANCE IN PATIENTS WITH IMPAIRED GLUCOSE TOLERANCE AND TYPE II DIABETES MELLITUS / 中华内分泌代谢杂志

Insulin sensitivity index (SI).glucose effectiveness (SG) and insulin secretion function were assessed by modified minimal model method (MMM) with frequently sampled intravenous glucose tolerance (FSIGT) test in the controls, in patients with impaired glucose tolerance (IGT), and type II diabetes mellitus (NIDDM). There was significant correlation between modified MMM and standard MMM in evaluating SI and SG. The results indicated that SI and SG were significantly elevated in the control than in the IGT and NTDDM groups. SI diminished much more in IGT group than in NIDDM group (P