Diabetes, hemoglobin A1c, and cognitive performance in older adults: is there any impact of frailty? Evidence from the ELSI-Brazil study

Abstract The aim of this study was to evaluate the association between diabetes and cognitive performance in a nationally representative study in Brazil. We also aimed to investigate the interaction between frailty and diabetes on cognitive performance. A cross-sectional analysis of the Brazilian Longitudinal Study of Aging (ELSI-Brazil) baseline data that included adults aged 50 years and older was conducted. Linear regression models were used to study the association between diabetes and cognitive performance. A total of 8,149 participants were included, and a subgroup analysis was performed in 1,768 with hemoglobin A1c data. Diabetes and hemoglobin A1c levels were not associated with cognitive performance. Interaction of hemoglobin A1c levels with frailty status was found on global cognitive z-score (P-value for interaction=0.038). These results suggested an association between higher hemoglobin A1c levels and lower cognitive performance only in non-frail participants. Additionally, undiagnosed diabetes with higher hemoglobin A1c levels was associated with both poor global cognitive (β=-0.36; 95%CI: -0.62; -0.10, P=0.008) and semantic verbal fluency performance (β=-0.47; 95%CI: -0.73; -0.21, P=0.001). In conclusion, higher hemoglobin A1c levels were associated with lower cognitive performance among non-frail participants. Higher hemoglobin A1c levels without a previous diagnosis of diabetes were also related to poor cognitive performance. Future longitudinal analyses of the ELSI-Brazil study will provide further information on the role of frailty in the association of diabetes and glycemic control with cognitive decline.

Translation, cross-cultural adaptation, and validation of health and self-management in diabetes questionnaire (HASMID-10) into Brazilian Portuguese

ABSTRACT BACKGROUND: Considering the ability of the health and self-management in diabetes questionnaire (HASMID-10) to verify the impact of self-management on diabetes, we highlight its relevance to scientific research and clinical applicability. However, to date, no study has been conducted to scientifically support its use in other languages. OBJECTIVE: To translate, cross-culturally adapt, and validate the HASMID-10 into the Brazilian Portuguese. DESIGN AND SETTING: A translation, cross-cultural adaptation, and validation study conducted at Ceuma University. METHODS: Study was conducted in accordance with the Guidelines for the Process of Cross-Cultural Adaptation of Self-Report Measures and Consensus-based Standards for the Selection of Health Measurement Instruments. We included participants of both sexes diagnosed with diabetes, aged between 18 and 64 years, and without cognitive deficits or any other limitations that would prevent them from answering the questionnaire. We assessed participants using the problem areas in diabetes (PAID) scale and HASMID-10. We assessed reliability using a test-retest model with a 7-day interval between assessments. We used intraclass correlation coefficient (ICC), 95% confidence interval (CI), standard error of measurement (SEM), minimum detectable difference (MDD), Spearman correlation coefficient, and floor and ceiling effects. RESULTS: Sample comprised 116 participants, most of whom were women, overweight, non-practitioners of physical activity, and nonsmokers. We observed significant correlations (P = 0.006; rho = −0.256) between the HASMID-10 and PAID, adequate reliability (ICC = 0.780) and internal consistency (Cronbach's alpha = 0.796). No ceiling or floor effects were observed. CONCLUSION: HASMID-10 has adequate measurement properties and may be used for Brazilians.

Combined administration of gallic acid and glibenclamide mitigate systemic complication and histological changes in the cornea of diabetic rats induced with streptozotocin

Purpose: To determine the effect of gallic acid or its combination with glibenclamide on some biochemical markers and histology of the cornea of streptozotocin (STZ) induced diabetic rats. Methods: Following induction of diabetes, 24 male albino rats were divided into four groups of six rats each. Groups 1 and 2 (control and diabetic) received rat pellets and distilled water; group 3 (gallic acid) received rat pellets and gallic acid (10 mg/kg, orally) dissolved in the distilled water; and group 4 (gallic acid + glibenclamide) received rat pellets, gallic acid (10 mg/kg, orally), and glibenclamide (5 mg/kg, orally) dissolved in the distilled water. The treatments were administered for three months after which the rats were sacrificed after an overnight fast. Blood and sera were collected for the determination of biochemical parameters, while their eyes were excised for histology. Results: STZ administration to the rats induced insulin resistance, hyperglycemia, microprotenuria, loss of weight, oxidative stress, inflammation, and alteration of their cornea histology, which was abolished following supplementation with gallic acid or its combination with glibenclamide. Conclusions: The study showed the potentials of gallic acid and glibenclamide in mitigating systemic complication and histological changes in the cornea of diabetic rats induced with STZ.

Atención de enfermería en salud mental a personas con diabetes mellitus: revisión integrativa / Mental health nursing care for people with diabetes mellitus: An integrative review / Cuidados de enfermagem em saúde mental para pessoas com diabetes mellitus: revisão integrativa

Objetivo: evaluar las evidencias disponibles en la literatura sobre la atención de enfermería en salud mental a personas con diabetes mellitus en los diferentes niveles de atención de salud. Método: revisión integrativa de la literatura. Búsqueda en cinco bases de datos. Muestra de 14 estudios, exportados al gerenciador EndNote®. Los datos se organizaron en planilla de Microsoft Excel®. La calidad metodológica de los estudios fue evaluada mediante herramientas propuestas por el Joanna Briggs Institute. Las etapas de muestreo, categorización, evaluación, interpretación de resultados y síntesis de los estudios incluidos fueron realizadas por dos revisores de manera independiente y ciega. El análisis descriptivo de resultados está presentado en tres categorías. Resultados: recomendaciones para autocuidado reforzado por la red de apoyo social, incluyendo herramientas y estrategias de los ámbitos físico y psíquico; estrategias de comunicación terapéutica y psicoterapia, haciendo foco en la psicoterapia y la comunicación terapéutica; e intervenciones de autogestión/autogerenciamiento, abordando el autocuidado en base a teorías conductuales. Conclusión: la síntesis de conocimientos reveló que las pautas de autocuidado reforzadas por la red de apoyo social, las estrategias de comunicación terapéutica y psicoterapia y las intervenciones de autogestión/autogerenciamiento son intervenciones positivas que ayudan a las personas con diabetes mellitus y trastornos mentales a prevenir complicaciones.

Objective: evaluate the evidence available on mental health nursing care for people with diabetes mellitus at different levels of health care. Method: integrative literature review. The search was conducted in five databases. The sample consisted of 14 studies. The studies were exported to the EndNote manager and their data to a Microsoft Excel spreadsheet. The methodological quality of the studies was evaluated using tools proposed by the Joanna Briggs Institute. Sampling, categorization, evaluation, interpretation of the results, and synthesis of the included studies were carried out by two reviewers independently. The descriptive analysis of the results is presented in three categories. Results: self-care guidelines enhanced by the social support network, encompassing physical and psychological tools and strategies; therapeutic communication and psychotherapy strategies, focusing on psychotherapy and therapeutic communication; and self-management interventions, addressing self-care based on behavioral theories. Conclusion: the synthesis of knowledge revealed that guidelines for self-care enhanced by the social support network, psychotherapy and therapeutic communication strategies, and self-management interventions are positive interventions that contribute to people with mental disorders and diabetes mellitus in the prevention of diseases.

Objetivo: avaliar as evidências disponíveis sobre os cuidados de enfermagem em saúde mental para pessoas com diabetes mellitus nos diferentes níveis de atenção à saúde. Método: revisão integrativa da literatura. Busca realizada em cinco bases de dados. Amostra composta por 14 estudos. Os estudos foram exportados para o gerenciador EndNote, e seus dados, para uma planilha desenvolvida pelo Microsoft Excel. A qualidade metodológica dos estudos foi avaliada por meio de ferramentas propostas pelo Joanna Briggs Institute. Etapas de amostragem, categorização, avaliação, interpretação dos resultados e síntese dos estudos incluídos foram realizadas por dois revisores de forma independente e mascarada. A análise descritiva dos resultados é apresentada em três categorias. Resultados: orientações para o autocuidado potencializadas pela rede de suporte social, englobando ferramentas e estratégias no âmbito físico e psíquico; estratégias de comunicação terapêutica e psicoterapia, focalizando a psicoterapia e a comunicação terapêutica; e intervenções de autogestão/ autogerenciamento, abordando o autocuidado com base em teorias comportamentais. Conclusão: a síntese do conhecimento revelou que as orientações para o autocuidado potencializadas pela rede de suporte social, estratégias de comunicação terapêutica e psicoterapia e intervenções de autogestão/autogerenciamento são intervenções positivas que auxiliam as pessoas com transtornos mentais e diabetes mellitus na prevenção de agravos.

Efectos de las tecnologías educativas en la prevención y tratamiento de la úlcera diabética: revisión sistemática y metaanálisis / Effects of educational technologies on the prevention and treatment of diabetic ulcers: A systematic review and meta-analysis / Efeitos das tecnologias educativas na prevenção e tratamento da úlcera diabética: revisão sistemática e metanálise

Objetivo: analizar los efectos de las tecnologías educativas en la prevención y tratamiento de la úlcera diabética. Método: revisión sistemática realizada en siete bases de datos, un índice bibliográfico, una biblioteca electrónica y literatura gris. La muestra estuvo compuesta por 11 ensayos clínicos controlados aleatorizados. La síntesis de los resultados fue descriptiva y mediante metaanálisis. Resultados: las tecnologías educativas predominantes fueron la capacitación y la orientación verbal, se destacaron las tecnologías blandas-duras. En comparación con la atención habitual, las tecnologías educativas demostraron ser un factor protector para prevenir la incidencia de úlcera diabética (RR=0,40; IC 95%=0,18-0,90; p=0,03) y la evaluación de certeza de evidencia fue baja. Las tecnologías educativas también demostraron ser un factor protector para prevenir la incidencia de amputación en miembros inferiores (RR=0,53; IC 95%=0,31-0,90; p=0,02) y la certeza de evidencia fue muy baja. Conclusión: tecnologías educativas blandas-duras, como orientación verbal estructurada, juegos educativos, clase expositiva, capacitación teórico-práctica, video educativo, folder, rotafolio educativo y dibujos lúdicos, y tecnologías duras, como calzado terapéutico, plantillas, termómetro infrarrojo digital, kits para el cuidado de los pies, aplicación de telemedicina y teléfono móvil, resultaron efectivas para la prevención y el tratamiento de la úlcera diabética, sin embargo, es necesario que se realicen estudios más robustos.

Objective: to analyze the effects of educational technologies in the prevention and treatment of diabetic ulcers. Method: a systematic review conducted in seven databases, a bibliographic index, an electronic library and the Gray Literature. The sample consisted of 11 randomized controlled clinical trials. The synthesis of the results was descriptive and through meta-analysis. Results: the predominant educational technologies were training sessions and verbal guidelines, with soft-hard technologies standing out. When compared to usual care, the educational technologies presented a protective factor to prevent the incidence of diabetic ulcers (RR=0.40; 95% CI=0.18-0.90; p=0.03) and the certainty of the evidence assessment was low. The educational technologies also had a protective factor to prevent the incidence of lower limb amputations (RR=0.53; 95% CI=0.31-0.90; p=0.02) and certainty of the evidence was very low. Conclusion: soft-hard educational technologies such as structured verbal guidelines, educational games, lectures, theoretical-practical training sessions, educational videos, folders, serial albums and playful drawings, and hard technologies such as therapeutic footwear, insoles, infrared digital thermometer, foot care kits, Telemedicine app and mobile phone use, were effective for the prevention and treatment of diabetic ulcers, although more robust studies are required.

Objetivo: analisar os efeitos das tecnologias educativas na prevenção e tratamento da úlcera diabética. Método: revisão sistemática conduzida em sete bases de dados, um índice bibliográfico, uma biblioteca eletrônica e na literatura cinzenta. A amostra foi constituída de 11 ensaios clínicos controlados randomizados. A síntese dos resultados foi descritiva e por meio de metanálise. Resultados: as tecnologias educativas predominantes foram os treinamentos e as orientações verbais, destacando-se as tecnologias leve-duras. Na comparação com o cuidado usual, as tecnologias educativas apresentaram fator de proteção para prevenção da incidência de úlcera diabética (RR=0,40; IC 95%=0,18-0,90; p=0,03) e a avaliação de certeza da evidência foi baixa. As tecnologias educativas também tiveram fator de proteção para prevenção da incidência de amputação em membros inferiores (RR=0,53; IC 95%=0,31-0,90; p=0,02) e a certeza da evidência foi muito baixa. Conclusão: as tecnologias educativas leve-duras, como orientações verbais estruturadas, jogos educativos, aula expositiva, treinamentos teórico-práticos, vídeo educativo, folder, álbum seriado e desenhos lúdicos, e as tecnologias duras, a exemplo do calçado terapêutico, palmilhas, termômetro digital de infravermelho, kits de cuidados com os pés, aplicativo de telemedicina e telefone móvel, foram efetivas para prevenção e tratamento da úlcera diabética, porém, estudos mais robustos são necessários.

Analysis of the impact of a diabetes education program on glycemic control and prevalence of chronic complications

ABSTRACT Objective: Diabetes mellitus (DM) is a chronic disease of increasing importance in public health, associated with chronic complications including retinopathy, neuropathy, and kidney, cardiovascular and cerebrovascular disease. This study assessed the impact of strategic DM education actions on glycemic control and prevalence of chronic complications in patients with DM. Subjects and methods: Retrospective, quantitative, cohort study at a diabetes patients association comprised of a multidisciplinary team. In all, 533 individuals with DM were included. Sociodemographic and clinical data were collected using questionnaire and medical records. Of these, 333 patients evaluated for 12 to 24 months, with type 2 DM (T2DM, n = 317) and other types of DM (n = 16), were selected to collect data on retinopathy and diabetes kidney disease (DKD). Results: There was a predominance of elderly individuals, low education level, women, high rate of overweight and obesity, physical inactivity, dietary errors, dyslipidemia, and T2DM. More patients with T2DM versus type 1 DM had optimal glycemic control (46.3% vs. 12.2%, respectively; p < 0.001). The impact of the educational processes was demonstrated by the analysis of the initial and final glycated hemoglobin (HBA1c) levels. There was an increased prevalence of individuals with well-controlled DM during follow-up (prevalence ratio [PR] 2.76, 95%, p = 0.001), along with a significant reduction in retinopathy (PR: 0.679, p = 0.001) and albuminuria (PR: 0.637, 95%, p = 0.002) when these variables were evaluated in well-controlled versus uncontrolled HbA1c groups. Conclusions: A multidisciplinary approach with integration and quality was associated with improvements in DM control and reduced occurrence of chronic DM complications.

Alteraciones del metabolismo glucídico y factores de riesgo aterogénico en familiares de primera línea de pacientes diabéticos

Fundamento la diabetes mellitus es una de las enfermedades con mayor morbilidad y mortalidad entre las afecciones crónicas no trasmisibles y su prevalencia en individuos con antecedentes familiares de primer grado es elevada. Objetivo: describir las alteraciones del metabolismo glucídico y los factores de riesgo aterogénicos presentes en familiares de primera línea de pacientes diabéticos de un consultorio médico Método: se realizó un estudio descriptivo de corte transversal entre los meses de enero de 2020 a enero de 2022, que incluyó a los familiares de primera línea de los pacientes diabéticos tipo 2, dispensarizados en el consultorio No. 10 perteneciente al Policlínico Universitario Héroes del Moncada del municipio Plaza de la Revolución. Se estudiaron 122 pacientes mayores de 19 años. Se analizaron como variables: edad, sexo y color de la piel, factores de riesgo aterogénico y las alteraciones del metabolismo de los hidratos de carbono. Resultados: predominaron los pacientes del sexo femenino y el grupo de edad 19 y 39 años. El factor de riesgo más frecuente fue la dislipemia, presente en el 43,4 % seguido de la hipertensión arterial y del sobrepeso/obesidad. Las alteraciones del metabolismo glucídico se presentaron en 74,6 % de los pacientes, con predominio de la glucemia en ayunas alterada en el 30,3 % y en 11,5 % se diagnósticó diabetes mellitus. Conclusiones: las alteraciones del metabolismo glucídico y los factores de riesgo aterogénicos detectadas ponen de manifiesto la asociación entre factores genéticos y ambientales en el desarrollo de la enfermedad y la importancia de trazar estrategias de prevención desde edades tempranas de la vida.

Foundation: diabetes mellitus is one of the diseases with the highest morbidity and mortality among non-communicable chronic conditions and its prevalence in individuals with a first-degree family history is high. Objective: to describe the alterations in glucose metabolism and the atherogenic risk factors present in diabetic patients' first-degree relatives of a medical office. Method: a descriptive cross-sectional study was carried out between January 2020 and January 2022, which included first-degree relatives of type 2 diabetic patients, dispensed at medical office No. 10 belonging to the Héroes del Moncada University Policlinic from the Plaza de la Revolución municipality, 122 patients older than 19 years old were studied. The following variables were analyzed: age, sex, and skin color, atherogenic risk factors, and changes in carbohydrate metabolism. Results: female patients and the age group 19 and 39 years old predominated. The most frequent risk factor was dyslipidemia, present in 43,4 % followed by arterial hypertension and overweight/obesity. Alterations in glucose metabolism occurred in 74,6 % of the patients, with a predominance of altered fasting glycemia in 30,3 % and 11,5 % diagnosed with diabetes mellitus. Conclusions: the alterations in glucose metabolism and the atherogenic risk factors detected reveal the association between genetic and environmental factors in the development of the disease and the importance of developing prevention strategies from an early age of life.

Foot wound risk and quality of life of people with type 2 diabetes are related to self-care / O risco de feridas nos pés e a qualidade de vida de pessoas com diabetes tipo 2 estão relacionados a prática do autocuidado

INTRODUCTION: Adherence to self-care has been identified as a means of preventing diabetic foot wounds, positively influencing the clinical outcomes and quality of life of patients. The adherence to this strategy is divergent in different populations. It is essential to determine the self-care practices that are associated with diabetic foot ulcers and the quality of life in adults with diabetes. OBJECTIVE: To understand self-care practices and explore their relationship with the foot wound risk and quality of life of persons with type 2 diabetes in a city in northeastern Brazil. METHODS: A descriptive exploratory study was conducted with a sample of 300 individuals with type 2 diabetes. Data were collected using a sociodemographic questionnaire, classification of foot wound risk, the Summary of Diabetes Self-Care Activities, and SF-36. RESULTS: Adherence to self-care was low for physical exercise, self-monitoring of blood glucose, and foot care. The diet and the use of medication had better adherence by the participants. Foot wound risk was related to no adherence to diet (OR 2.2 95% CI 1.32-3.38), physical activity (OR 0.49 95% CI 0.25-0.95), and blood glucose checking (OR 5.31 95% CI 1.58-17.78). Quality of life was associated with physical activity (OR 0.35 95% CI 0.16-0.74). CONCLUSION: It can be concluded that is a relationship between self-care practices adherence, risk of foot wounds, and quality of life.

INTRODUÇÃO: A adesão ao autocuidado tem sido apontado como meio de prevenção de feridas no pé diabético, influenciando positivamente nos desfechos clínicos e na qualidade de vida dos pacientes. A adesão a esta estratégia é divergente em diferentes populações. É essencial determinar as práticas de autocuidado que estão associadas às feridas do pé diabético e à qualidade de vida em adultos com diabetes. OBJETIVO: Conhecer as prática de autocuidado e explorar sua relação com o risco de feridas nos pés e a qualidade de vida de pessoas com diabetes tipo 2 em uma cidade do nordeste do Brasil. MÉTODOS: Foi realizado um estudo exploratório descritivo com uma amostra de 300 pessoas com diabetes tipo 2. Os dados foram coletados por meio de questionário sociodemográfico, classificação de risco de feridas nos pés, resumo das atividades de autocuidado com a diabetes e sf-36. RESULTADOS: A adesão ao autocuidado foi baixa para exercícios físicos, automonitorização da glicemia e cuidados com os pés. A dieta e o uso de medicamentos apresentaram melhor adesão pelos participantes. O risco de ferimento no pé foi relacionado à não adesão a dieta (OR 2,2 IC 95% 1,32-3,38), atividade física (OR 0,49 IC 95% 0,25-0,95) e verificação da glicemia (OR 5,31 IC 95% 1,58-17,78). A qualidade de vida foi associada à atividade física (OR 0,35 IC 95% 0,16-0,74). CONCLUSÃO: Pode-se concluir que existe relação entre a adesão ao autocuidado, risco de feridas nos pés e qualidade de vida.

A cross-sectional study to describe the spectrum of ocular manifestations and risk factors of mucormycosis presenting to a tertiary hospital of East India

Purpose: To report the clinico?demographic profile of rhino?orbito?cerebral mucormycosis (ROCM) in patients during the “second wave” of the COVID?19 pandemic in eastern India, and their ophthalmic manifestations at presentation to our tertiary institute. Methods: Cross?sectional study amongst patients presenting to our center based on their hospital records. Demographic information, history related to COVID?19, records of detailed ocular examination, and microbiological, radiological, and histopathological investigation were entered into an online worksheet and analyzed using SPSS 26.0. Results: A total of 219 patients with ROCM were treated from May to September 2021, and 110 of these had ocular manifestations at presentation (50.2%). The age of patients ranged from 22 to 83 years and the mean ± standard deviation (SD) age was 49.9 ± 12.9 years. Ninety (81.8%) patients had been diagnosed with diabetes mellitus, 31 (34%) had hypertension, and 10 had other comorbidities. The duration between the onset of COVID?19 and mucormycosis symptoms was 0 to 60 days with a mean ± SD interval of 20.9 ± 12.6 days. Fifty?six (50.9%) patients had a history of steroid use. Unrelenting ocular or facial pain was the most common presenting symptom, ptosis was the most common anterior segment manifestation, and ophthalmic artery occlusion was the most common posterior segment manifestation. Conclusion: Our data from eastern India reinforces the relationship between COVID?19, diabetes, corticosteroid use, and ROCM. Knowledge of various presenting anterior and posterior segment manifestations of the disease as described in the present study will guide clinicians to recognize the disease early and make every effort to prevent complications.

Depressive symptoms among older adults with diabetes mellitus: a cross-sectional study

ABSTRACT BACKGROUND: Diabetes mellitus is a chronic disease with long-term consequences that is often associated with depressive symptoms. This relationship predicts increased morbidity and mortality rates, leading to serious health consequences. OBJECTIVE: To identify the prevalence and health factors associated with depressive symptoms among older adults with diabetes mellitus. DESIGN AND SETTING: An observational cross-sectional study was conducted among 236 older adults in the Basic Healthcare Units of Jequié, Brazil. METHODS: A survey containing sociodemographic, behavioral, and health conditions was used as a data collection instrument, in addition to the Geriatric Depression Scale. The main inclusion criterion was older adults diagnosed with diabetes mellitus. To identify the risk factors associated with depressive symptoms among older adults with diabetes mellitus, logistic regression analysis was conducted for calculating the odds ratio (OR), and a 95% confidence interval (CI) was considered statistically significant. RESULTS: The prevalence of depressive symptoms was 24.2% among older adults with diabetes, corroborating the Brazilian average of 30%. The final multivariate analysis model for the risk of depressive symptoms showed a significant association with diabetes complications [OR = 2.50, 95% CI 1.318-4.74)] and osteoporosis [OR = 2.75, 95% CI 1.285-5.891)]. CONCLUSION: A high prevalence of depressive symptoms was observed among older adults with diabetes. Critically examining older adults with diabetes mellitus is necessary, and screening for depressive symptoms is highly recommended, especially for those with complications resulting from diabetes mellitus and musculoskeletal comorbidities, such as osteoporosis, as it seems to be associated with depressive symptoms.

Fatores associados ao autocuidado das pessoas com diabetes mellitus na pandemia de COVID-19 / Associated factors with the self-care of people with diabetes mellitus in the COVID-19 pandemic

RESUMO Objetivo analisar os fatores associados ao autocuidado em pessoas com diabetes durante a pandemia de COVID-19. Métodos estudo transversal analítico e exploratório online com 70 participantes, utilizando o Questionário de Atividades de Autocuidado com o Diabetes. O perfil clínico e sociodemográfico foi retratado com uma análise descritiva. Já para a associação entre as variáveis, aplicaram-se o teste exato de Fisher, o teste Qui-quadrado e regressão de Poisson com variância robusta. Resultados após a regressão, os itens Atividade física, Uso de medicação e Alimentação geral do Questionário de Atividades de Autocuidado com o Diabetes apresentaram, respectivamente, associação significativa com as variáveis exercício físico (p<0,001), ocupação (p=0,005) e idade (p=0,01). Conclusão os itens de exercício físico, uso de medicação e alimentação geral do questionário de autocuidado se relacionaram com as variáveis de idade, ocupação e prática de exercício físico, respectivamente. Contribuições para a prática os serviços de saúde devem intensificar a investigação dos fatores associados às dificuldades das pessoas com diabetes, para oferecer uma melhor qualidade de vida e uma promoção de saúde adequada para essa população.

ABSTRACT Objective to analyze the factors associated with self-care in people with diabetes during the COVID-19 pandemic. Methods cross-sectional analytical and exploratory online study with 70 participants, using the Summary Diabetes Self-Care Activities Questionnaire. The clinical and sociodemographic profile was portrayed with a descriptive analysis. Fisher's exact test, the Chi-square test and Poisson regression with robust variance were used to determine the association between the variables. Results after regression, the items Physical Activity, Use of Medication and General Diet from the Summary Diabetes Self-Care Activities Questionnaire showed, respectively, a significant association with the variables Physical Exercise (p<0.001), Occupation (p=0.005) and Age (p=0.01). Conclusion the physical exercise, medication use and general diet items on the self-care questionnaire were related to the variables of age, occupation, and physical exercise, respectively. Contributions to practice health services should intensify the investigation of factors associated with the difficulties of people with diabetes, to offer a better quality of life and adequate health promotion for this population.

Analysis of Helicobacter pylori infection in patients with diabetes mellitus and cardiovascular diseases / 中国基层医药

Objective:To investigate the incidence of Helicobacter pylori ( Hp) infection in diabetes and cardiovascular diseases. Methods:A total of 500 people who received physical examination in Wuzhou Red Cross Hospital from June 2021 to May 2022 were randomly selected for this study. Hp detection was performed in all people included in this study. The Hp infection rate in patients with diabetes and cardiovascular disease were analyzed. Results:The Hp infection rate in healthy people, patients with diabetes mellitus, cardiovascular disease, or diabetes mellitus complicated by cardiovascular disease was 29.3%, 70.3%, 58.5%, and 90.2%, respectively, with a statistically significant difference ( χ2 = 106.45, P < 0.001). The Hp infection rate of patients with diabetes complicated by one, two, three or more cardiovascular diseases was 83.9%, 94.6%, and 100.0%, respectively, with a statistically significant difference ( χ2 = 8.82, P < 0.001). Conclusion:The Hp infections rate in patients with diabetes complicated by cardiovascular disease was higher than that in patients with diabetes mellitus or cardiovascular disease, in particular in patients with diabetes mellitus complicated by several cardiovascular diseases.

Establishment of prediction nomogram model of type 2 diabetes mellitus complications based on laboratory indexes such as glycosylated hemoglobin / 中国医师进修杂志

Objective:To study the effect of related laboratory indexes such as glycosylated hemoglobin on the occurrence of complications in patients with type 2 diabetes mellitus, and to construct a nomogram model.Methods:The clinical data of 203 patients with 2 diabetes mellitus from May 2020 to April 2022 in Quzhou Hospital, Zhejiang Medical and Health Group were retrospectively analyzed. Among them, 64 patients had no diabetic complications (control group), and 139 patients had diabetic complications (complication group). The clinical data of the two groups were recorded, and the related influencing factors of complications in patients with type 2 diabetes were analyzed; receiver operating characteristic (ROC) curve was used to analyze the predicting value of significant indexes for the complications in patients with type 2 diabetes; multivariate Logistic regression analysis was used to analyze the independent risk factors of complications in patients with type 2 diabetes; R language software 4.0 "rms" package was used to construct the nomogram model for predicting the complications in patients with type 2 diabetes, the calibration curve was internally validated, and the decision curve was used to evaluate the predictive efficacy of the nomogram model.Results:The hypertension rate, hyperlipemia rate, course of disease, fasting blood glucose, postprandial 2 h blood glucose and glycosylated hemoglobin in complication group were significantly higher in those in control group: 44.60% (62/139) vs. 20.31% (13/64), 48.92% (68/139) vs. 25.00% (16/64), (5.42 ± 0.68) years vs. (4.84 ± 0.51) years, (12.60 ± 2.80) mmol/L vs. (10.20 ± 1.90) mmol/L, (16.50 ± 3.10) mmol/L vs. (12.50 ± 2.90) mmol/L and (9.62 ± 1.33)% vs. (7.96 ± 0.85)%, and there were statistical differences ( P<0.01); there were no statistical differences in gender composition, age, body mass index, smoking rate, drinking rate, albumin and creatinine between the two groups ( P>0.05). ROC curve analysis result showed that the area under the curve of the course of disease, fasting blood glucose, postprandial 2 h blood glucose and glycosylated hemoglobin for predicting the complications in patients with type 2 diabetes were 0.725, 0.752, 0.830 and 0.861, respectively; the optimal cut-off values were 5 year, 11.8 mmol/L, 15.1 mmol/L and 9.23%. Multivariate Logistic regression analysis result showed that hypertension, hyperlipemia, course of disease, fasting blood glucose, postprandial 2 h blood glucose and glycosylated hemoglobin were independent risk factors of complications in patients with type 2 diabetes ( OR = 1.563, 1.692, 1.451, 1.703, 1.506 and 1.805; 95% CI 1.268 to 1.689, 1.483 to 1.824, 1.215 to 1.620, 1.402 to 1.903, 1.303 to 1.801 and 1.697 to 1.926; P<0.05). The hypertension, hyperlipemia, course of disease, fasting blood glucose, postprandial 2 h blood glucose and glycosylated hemoglobin were used as predictors to construct a nomogram model for predicting the complications in patients with type 2 diabetes. Internal validation result showed that the nomogram model predicted the complications with good concordance in patients with type 2 diabetes (C-index = 0.815, 95% CI 0.796 to 0.843); the nomogram model predicted the complications in patients with type 2 diabetes at a threshold >0.18, provided a net clinical benefit, and all had higher clinical net benefits than hypertension, hyperlipemia, course of disease, fasting blood glucose, postprandial 2 h blood glucose and glycosylated hemoglobin. Conclusions:The nomogram model constructed based on hypertension, hyperlipemia, course of disease, fasting blood glucose, postprandial 2 h blood glucose and glycosylated hemoglobin has better clinical value in predicting the complications in patients with type 2 diabetes.

Diabetic peripheral neuropathy / 中华神经科杂志

Diabetes peripheral neuropathy (DPN) is one of the most common complications of diabetes. It not only causes physical disability and unbearable pain, but also may lead to emotional and psychological problems, reduce the quality of life of patients, and increase mortality. Although early diagnosis of diabetes may improve the clinical prognosis, the occurrence of DPN is sometimes unavoidable and the treatment is limited. This article summarizes the clinical features, diagnosis, investigations and treatment of DPN by reviewing the latest literature.

Effect of periodontitis on diabetes: a review of cohort studies / 口腔疾病防治

@#Periodontitis is an inflammation that occurs in the supporting tissues around teeth with plaque biofilm as the starting factor. Periodontitis is closely related to many systemic diseases, among which the relationship between periodontitis and diabetes is the most widely reported. A cohort study is an essential clinical research method to explore the etiology. Large, well-conducted prospective cohort studies have high power, which can provide important clinical evidence for the impact of periodontitis on blood sugar control, incidence rate and complications of diabetes mellitus. Periodontitis is associated with the deterioration of glycemic control. At present, there is moderate evidence that nonsurgical periodontal treatment can significantly improve the blood sugar level of diabetes patients with periodontitis compared with no periodontal treatment. Studies on the impact of periodontitis on the incidence rate of diabetes lack consistent conclusions because of different population backgrounds. The evidence regarding whether periodontitis affects the incidence rate of diabetes complications is relatively limited. Therefore, well-designed cohort studies are needed to provide high-quality clinical evidence.

Overview of the application of Qing therapy in the treatment of diabetes and its complications / 国际中医中药杂志

The basic pathogenesis of diabetes is yin deficiency as the root and dry heat as the symptoms, both of which are reciprocal causation. The occurrence and development of this disease is closely related to pathogenic heat, and pathogenic heat has different degrees of deficiency and excess, and is often cemented with tangible pathogenic factors, such as dampness, phlegm and blood stasis. Clinical application of Traditional Chinese Medicine treatment of the eight methods of "clearing therapy" in the treatment of diabetes and its complications has often achieved significant efficacy, which is specifically divided into Qingxie method (clearing heat and purging fire method), for the syndrome of excessive heat in the viscera, and the representative prescriptions are Dahuang Huanglian Xiexin Decoction and Longdan Xiegan Decoction; Qingli method (clearing heat and draining dampness method), for the accumulation of damp heat in the spleen and stomach, gastrointestinal, block triple energizer, and the representative prescription is Gegen Qinlian Decoction; Qinghua method (clearing heat and resolving phlegm, removing blood stasis method) for the disease caused by phlegm, the course of the disease is lingering, complex and changeable, or caused by blood stasis. The disease is various, more serious, with more experience in clinical use of self-made prescriptions; Qingbu method (clearing heat and nourishing method) is for the patients with diabetes for a long time. The pathogenic heat hurts yin and consumes qi, and the representative prescriptions are Baihu Jia Renshen Decoction, Huanglian Ejiao Decoction, and Yu'nyu Decoction.

Clinical study of Qigui Tangtongning Granules combined with conventional western medicine in treating diabetic peripheral neuropathy syndrome of Qi deficiency and blood stasis / 国际中医中药杂志

Objective:To observe the clinical efficacy of Qigui Tangtongning Granules in the treatment of diabetic peripheral neuropathy (DPN) with qi deficiency and blood stasis.Methods:Prospective cohort study. A total of 80 DPN patients with Qi deficiency and blood stasis in Endocrinology Department of the First Affiliated Hospital of Anhui University of Chinese Medicine from May 2021 to May 2022 who met the inclusion criteria were divided into 2 groups by random number table method, with 40 cases in each group. The control group was treated with epalrestat on the basis of routine hypoglycemia, and the treatment group was treated with Qigui Tangtongning Granules on the basis of control group. Both groups were treated for 8 weeks. TCM syndromes were scored before and after treatment. Disease severity was assessed using the Toronto Clinical Scoring System (TCSS). The motor nerve conduction velocity (MNCV) and sensory nerve conduction velocity (SNCV) of median nerve and common peroneal nerve were detected by electromyography/induced potentiometer. Serum CRP, TNF-α and IL-6 were detected by ELISA, fasting blood glucose (FPG) and two hours post-meal blood glucose (2 hPG) were detected by automatic biochemical analyzer, and glycosylated hemoglobin (HbA1c) was detected by automatic HBA1C analyzer. Adverse reactions were recorded and clinical efficacy was evaluated.Results:The total effective rate was 95.0% (38/40) in the treatment group and 77.5% (31/40) in the control group, the difference between the two groups was statistically significant ( χ2=5.17, P=0.023). After treatment, the TCM syndrome score and TCSS score of the treatment group were significantly lower than those in the control group ( t=-3.19 and -7.63, P<0.01); Median nerve SNCV [(47.90±4.51) m/s vs. (44.76±3.72) m/s, t=3.40], MNCV [(53.79±3.65) m/s vs. (51.32±4.25) m/s, t=2.79] and common peroneal nerve SNCV [(44.21±2.08) m/s vs. (40.51±2.49) m/s, t=7.23], MNCV [(44.63±4.72) m/s vs. (41.36±4.87) m/s, t=3.05] were significantly higher than those in the control group ( P<0.01); FPG [(5.05±0.63) mmol/L vs. (7.05±1.23) mmol/L, t=-9.17], 2 hPG [(9.10±1.64) mmol/L vs. (12.19±2.61) mmol/L, t=-6.35], HbA1c [(6.79±0.90) % vs. (7.22±1.02) %, t=-2.02] were significantly lower than those in the control group ( P<0.01 or P<0.05); TNF-α [(15.75±5.44) ng/L vs. (32.01±5.33) ng/L, t=-13.51], hs-CRP [(2.58±0.80) mg/L vs. (3.79±1.04) mg/L, t=-5.83], IL-6 [(18.20±4.92) ng/L vs. (29.97±5.18) ng/L, t=-10.41] were significantly lower than those in the control group ( P<0.01). No obvious adverse reactions were observed in 2 groups during treatment. Conclusion:Qigui Tangtongning Granules combined with conventional Western medicine can improve nerve conduction velocity, reduce inflammation and improve clinical efficacy in DPN patients with Qi-deficiency and blood-stasis syndrome.

Measurement properties of the Brazilian version of the Kidney Symptom Questionnaire

SUMMARY OBJECTIVE: The aim of this study was to measure the reliability, internal consistency, and construct validity of the Kidney Symptom Questionnaire for the Brazilian population. METHODS: This is a cross-cultural adaptation and questionnaire validation study. We included native Brazilians of both sex aged>18 years, as well as hypertensive and/or diabetic patients. All participants were assessed using Screening for Occult Renal Disease, EuroQol 5 Dimensions, 36-Item Short Form Survey, and the Kidney Symptom Questionnaire. We used Spearman's coefficient (rho) to measure the correlations between the Kidney Symptom Questionnaire and other instruments; Cronbach's alpha to measure internal consistency; and intraclass correlation coefficient, standard error of measurement, and minimum detectable change to measure test-retest reliability. RESULTS: The sample was formed by 121 adult participants, mostly female, with systemic arterial hypertension and/or diabetes mellitus. We found excellent reliability (intraclass correlation coefficient≥0.978), adequate internal consistency (Cronbach's alpha≥0.860), and adequate construct validity on the Kidney Symptom Questionnaire domains; besides, we observed significant correlations between the Kidney Symptom Questionnaire and other instruments. CONCLUSION: The Brazilian version of the Kidney Symptom Questionnaire has adequate measurement properties to assess chronic/occult kidney disease in patients who do not require renal replacement therapy.

Diabetic foot ulcer self-care assessment: a scoping review / Avaliação do autocuidado da úlcera do pé diabético: revisão de escopo / Avaliação do autocuidado da úlcera do pé diabético: revisão de escopo

ABSTRACT Objectives: to map, in the world literature, instruments for assessing foot self-care of people with diabetes. Methods: a scoping review in Scopus by Elsevier, MEDLINE via PubMed, LILACS, SciELO databases and gray literature, using the controlled words diabetic foot, self care, questionnaire. Search was carried out in February and March 2021, according to JBI recommendations and PRISMA-ScR extension. Results: fifteen studies made up the review, 14 articles and one thesis, published between 2000 and 2020. 16 instruments were identified: five with an emphasis on general self-care and 11 on foot self-care. Inspection, hygiene, washing and drying between the toes, lotion application and use of proper shoes and socks were the main self-care measures presented. Final Considerations: foot self-care is assessed by knowledge, social support and frequency with which measures are being put into practice, encouraging professional practice.

RESUMEN Objetivos: mapear, en la literatura mundial, instrumentos para evaluar el autocuidado con los pies de personas con diabetes. Métodos: revisión de alcance en las bases de datos Scopus de Elsevier, MEDLINE vía PubMed, LILACS, SciELO y literatura gris, utilizando las palabras controladas diabetic foot, self care, questionnaire . La búsqueda se realizó en febrero y marzo de 2021, según recomendaciones del JBI y extensión de PRISMA-ScR. Resultados: 15 estudios integraron la revisión, 14 artículos y una tesis, publicados entre 2000 y 2020. Se identificaron 16 instrumentos: cinco con énfasis en el autocuidado general y 11 en el autocuidado con los pies. La inspección, higiene, lavado y secado entre los dedos, aplicación de loción y uso de zapatos y calcetines adecuados fueron las principales medidas de autocuidado presentadas. Consideraciones Finales: el autocuidado de los pies se evalúa por el conocimiento, el apoyo social y la frecuencia con la que se están poniendo en práctica las medidas, incentivando la práctica profesional.

RESUMO Objetivos: mapear, na literatura mundial, instrumentos de avaliação do autocuidado com os pés de pessoas com diabetes. Métodos: revisão de escopo nas bases de dados Scopus da Elsevier, MEDLINE via PubMed, LILACS, SciELO e literatura cinzenta, utilizando os vocábulos controlados diabetic foot, self care, questionnaire . Busca foi realizada em fevereiro e março de 2021, conforme as recomendações do JBI e extensão do PRISMA-ScR. Resultados: 15 estudos compuseram a revisão, sendo 14 artigos e uma tese, publicados entre 2000 e 2020. Foram identificados 16 instrumentos: cinco com ênfase no autocuidado geral e 11 no autocuidado com os pés. Inspeção, higiene, lavagem e secagem entre os dedos, aplicação de loção e uso de calçados e meias propriados foram as principais medidas de autocuidado apresentadas. Considerações Finais: o autocuidado dos pés é avaliado pelo conhecimento, apoio social e frequência com que as medidas estão sendo colocadas em prática, fomentando a prática profissional.

Relationship of advanced glycation end-products in hypertension in diabetic patients: a systematic review / Relação dos produtos finais de glicação avançada na hipertensão de pacientes com diabetes: uma revisão sistemática

Abstract Diabetes mellitus and arterial hypertension are among the five risk factors that increase mortality in the world. Both are chronic, non-communicable diseases (NCDs), that have a pathophysiological association. Advanced glycation end products (AGEs), produced by the lack of glycemic control in diabetic patients, interact with their AGE receptors (AGER) resulting in increased arterial stiffness, inflammation and endothelial changes - which increases the risk of developing hypertension and other complications. We ran a systematic review in Pubmed, SciELO, Cochrane Library and Web of Science databases using keywords and Boolean operators to optimize the search, with the objective of assessing the mechanism of non-enzymatic glycation of proteins present in patients with diabetes and its correlation with the onset of hypertension, exposing all the endothelial and cellular damage caused by AGEs. We found 719 papers, of which 99 were read in full, and 26 met the eligibility criteria and were included in the present review. AGEs should be considered one of the main cardiometabolic risk factors. Reducing the AGE-AGER interaction will result in cardiovascular protection and increased life expectancy.

Resumo Diabetes mellitus e hipertensão arterial estão entre os cinco fatores de risco que elevam a mortalidade no mundo. Ambas são doenças crônicas não transmissíveis (DCNT) que têm associação fisiopatológica. Os produtos finais de glicação avançada (AGEs), produzidos pela falta de controle glicêmico nos pacientes diabéticos, interagem com seus receptores para AGEs (RAGE) resultando no aumento da rigidez arterial e da inflamação e em alterações endoteliais, fatores que intensificam o risco do desenvolvimento da hipertensão e de demais complicações. Realizou-se uma revisão sistemática nas bases de dados Pubmed, SciELO, Cochrane Library e Web of Science utilizando descritores e operadores booleanos para otimizar a busca, com o objetivo de fornecer o mecanismo da glicação não enzimática de proteínas presente em pacientes com diabetes e sua correlação com o aparecimento da hipertensão, expondo todo o dano endotelial e celular ocasionado pelos AGEs. Foram encontrados 719 artigos, dos quais 99 foram lidos na íntegra, e 26 atenderam aos critérios de elegibilidade e foram incluídos na presente revisão. Os AGEs devem ser considerados um dos principais fatores de risco cardiometabólico. A redução da interação AGE-RAGE resultará na proteção cardiovascular e no aumento da expectativa de vida.