Prescription of DPP4 inhibitors: Indication and effect on glycosylated hemoglobin in a primary care institution of Colombia / Prescripción de inhibidores de la DPP-4: indicación y efecto sobre la hemoglobina glicosilada en un primer nivel de Colombia

Abstract Introduction and objective: In Colombia, Dipeptidyl-Peptidase IV (DPP4) inhibitors are recommended as second-best choice for type 2 diabetes mellitus treatment. However, no evaluation of the accomplishment or impact of this recommendation was performed. The objective was to determine the prescription of the DPP4 inhibitor according to the Colombian Clinicial Practice Guide regarding type 2 diabetes mellitus treatment, and its effects on glycosylated hemoglobin (HbAlc). Materials and methods: A descriptive study that included patients with type 2 diabetes mellitus who attended a first level between 2016 and 2018, had a prescription for DPP4 inhibitor and at least two control appointments. Variables included were sociodemographic, clinics, treatment and comorbidities. The unadjusted prescription was defined as the lack of accomplishment of Colombian guidelines. Descriptive statistics and X2 test were used for the comparison of categorical variables. A binary logistic regression model was applied. Results: 112 out of 207 patients accomplished inclusion criteria, of which 77 were women (68.8%). Also, 68.8% of the patients had an unadjusted prescription of the iDPP4. There was a 0.21% total reduction in HbA1c levels, with a mean of 198.2 ± 124 days between the first and second control measurement (reduction of 0.55% when the prescription was adjusted to the guidelines and 0.05% if it was unadjusted). Conclusion: There is a limited impact of DPP4 inhibitors regarding the reduction of HbA1c and metabolic control, and there is a slight follow-up to the Colombian guidelines in patients who attend a first level.

Resumen Introducción y Objetivo: En Colombia se recomiendan los inhibidores de la Dipeptidil Peptidasa-IV (iDPP4) como segunda opción para el manejo de la diabetes mellitus tipo 2. No se ha evaluado el cumplimiento e impacto de esta recomendación. Como objetivo se buscó determinar la prescripción de los iDPP4 según las recomendaciones de la Guía de Práctica Clínica colombiana, y su efecto sobre la hemoglobina glicosilada (HbA1c). Materiales y métodos: Estudio descriptivo que incluyó pacientes con diabetes mellitus tipo 2 que consultaron a un primer nivel entre 2016 y 2018, y tenían formulado un iDPP4, con al menos dos consultas de seguimiento. Se incluyeron variables sociodemográficas, clínicas, tratamiento y comorbilidades. La prescripción no ajustada se definió como la falta de cumplimento de la recomendación de la guía colombiana. Se empleó estadística descriptiva y pruebas X2 para la comparación de variables categóricas. Se aplicó un modelo de regresión logística binaria. Resultados: Hubo 207 pacientes de los cuales 112 cumplieron criterios de inclusión, 77 eran mujeres (68,8%). El 68,8% de los pacientes presentaron una prescripción no ajustada del iDPP4. Hubo una reducción total de 0,21%, con una media de 198,2±124 días entre la primera y segunda medición de HbA1c de control (reducción de 0,55% cuando la prescripción se ajustaba a la guía colombiana y 0,05% cuando no). Conclusión: Hay un limitado impacto de los iDPP4 frente a la reducción de HbA1c y poco seguimiento de la guía colombiana en pacientes de primer nivel de atención.

Association between glycemic control and albuminuria among Peruvian adults with diabetes mellitus 2: a cross-sectional analytical study

ABSTRACT BACKGROUND: Albuminuria is a risk factor for microvascular and macrovascular complications in the diabetic population. However, few studies have correlated poor glycemic control and albuminuria prevalence in Hispanic populations. OBJECTIVE: To evaluate the association between glycemic control and albuminuria among Peruvian adults with type 2 diabetes mellitus (T2DM). DESIGN AND SETTING: Cross-sectional analytical study among adults with T2DM in Lima, Peru. METHODS: We included adults over 18 years old who were in a clinical follow-up program at a private clinic in Lima in 2018. Poor glycemic control was defined as a serum value of glycosylated hemoglobin A1C (HbA1C) ≥ 7%. Albuminuria was defined as albumin values > 30 mg/dl in the first morning urine. We generated generalized linear regression models from the Poisson family with robust variance. We calculated the crude and adjusted prevalence ratios (PRs) with their 95% confidence interval (CI). RESULTS: We analyzed 907 participants of median age 58 years (interquartile range, IQR 49 to 66), and 62.8% were males. The prevalence of poor glycemic control was 39.8%, and the prevalence of albuminuria was 22.7%. The prevalences of albuminuria in groups with poor glycemic control and adequate glycemic control were 32.7% and 16.1%, respectively. In the adjusted regression analysis, we found a statistically significant association between poor glycemic control and albuminuria (annual percentage rate, aPR = 1.70; 95% CI: 1.28-2.27). CONCLUSIONS: The prevalence of poor glycemic control and albuminuria was high in our study population. Moreover, Peruvian T2DM adults with poor glycemic control were more likely to have albuminuria.

Glycated Haemoglobin Levels and Its Effect on Outcomes in Cardiac Surgery

Abstract There remains a significant paucity of information evaluating the effect of glycated HbA1c levels and its theorized effect on mortality and morbidity rates following cardiac surgery. Diabetes is a very common comorbidity in patients undergoing open heart surgery, as there is a shift in patient characteristics and greater risk. Currently, there is no clear consensus that an increase in HbA1c level is associated with increased perioperative mortality rate. However, the reported literature is more commonly able to demonstrate that elevated HbA1c levels is associated with increased rates of wound infection, cardiovascular events and renal failure, and thus, higher post-operative morbidities. This review aims to examine and synthesis the evidence behind each of the morbidities and mortalities associated with open heart surgery and the impact of high HbA1c on the reported outcomes.

The effect of elevated glycated hemoglobin on in-hospital and short-term outcome of patients with acute anterior myocardial infarction / Efecto de la hemoglobina glicosilada elevada sobre el desenlace hospitalario y a corto plazo en pacientes con infarto agudo de miocardio anterior

Abstract Introduction: Hyperglycemia has a negative impact on morbidity and mortality among patients with acute myocardial infarction (AMI). Objective: The objective of the study was to evaluate the impact of chronic hyperglycemia on in-hospital and short-term outcome in patients with acute anterior MI treated with streptokinase as thrombolytic therapy. Materials and methods: A total of 100 patients with acute anterior myocardial infarction received streptokinase as thrombolytic therapy were enrolled. They were classified according to the admission glycated hemoglobin (HbA1c) level into two groups: Chronic hyperglycemic group (HbA1c ≥ 6.5%) (36 patients) and non-chronic hyperglycemic group (HbA1c <6.5%) (64 patients). Laboratory investigation, conventional echocardiography, and speckle tracking were performed. Results: Global longitudinal strain (GLS) was significantly lower in patients with chronic hyperglycemia group compared to non-chronic hyperglycemia group (−13.52 ± 4.83 vs. −15.27 ± 1.87%, p = 0.009). In-hospital outcome: Heart failure and reinfarction were significantly increased in patients with chronic hyperglycemia (45.5 vs. 16.7% and 18.2 vs. 3.3%, respectively, p < 0.05). Six months outcome: Heart failure, left ventricular (LV) remodeling, arrhythmias, and bleeding rates were significantly increased in patients with chronic hyperglycemia (41.9 vs. 12.1%, 51.6 vs. 13.8%, 6.5 vs. 1.7%, and 6.5 vs. 1.7%, respectively, p < 0.05). GLS cutoff value ≥ −13.5 has the best diagnostic accuracy in predicting LV remodeling (sensitivity: 100%, specificity: 93%, positive predictive value: 94%, negative predictive value: 100%, accuracy: 97%, and area under curve: 0.99). Conclusion: Chronic hyperglycemia had higher incidence of heart failure and LV remodeling following acute MI. GLS can be used as a predictor of LV remodeling.

Resumen Introducción: La hiperglucemia tiene un impacto negativo sobre la morbimortalidad en pacientes con infarto agudo de miocardio. Objetivo: Evaluar el impacto de la hiperglucemia crónica sobre el desenlace hospitalario y a corto plazo en pacientes con infarto agudo de miocardio (IAM) anterior, tratados con estreptoquinasa como terapia trombolítica. Materiales y métodos: Se incluyeron un total de 100 pacientes con IAM anterior, quienes recibieron estreptoquinasa como terapia trombolítica. Se clasificaron en dos grupos de acuerdo con el nivel de hemoglobina glicosilada (HbA1c) al ingreso: el grupo con hiperglucemia crónica (HbA1c ≥ 6.5%) (36 pacientes) y el grupo sin hiperglucemia crónica (HbA1c <6.5%) (64 pacientes). Se practicaron estudios de laboratorio, y ecocardiografía convencional y con rastreo de marcas. Resultados: El strain longitudinal global (SLG) fue significativamente menor en pacientes del grupo con hiperglucemia crónica comparados con los del grupo sin hiperglucemia crónica (−13.52 ± 4.83 vs. −15.27 ± 1.87%, p = 0.009). Desenlace hospitalario: La falla cardíaca y el reinfarto aumentaron significativamente en los pacientes con hiperglucemia crónica (45.5 vs. 16.7% y 18.2 vs. 3.3%, respectivamente, p < 0.05). Desenlace a los seis meses: Las tasas de falla cardíaca, remodelación del ventrículo izquierdo (VI), arritmia, y sangrado aumentaron significativamente en pacientes con hiperglucemia crónica (41.9 vs. 12.1%, 51.6 vs. 13.8%, 6.5 vs. 1.7% y 6.5 vs. 1.7%, respectivamente, p < 0.05). El punto de corte de SLG ≥ −13.5 tiene la mejor precisión diagnóstica para predecir la remodelación del VI (sensibilidad: 100%, especificidad: 93%, VPP: 94%, VPN: 100%, precisión: 97% y área bajo la curva -AUC-: 0.99). Conclusión: La hiperglucemia crónica tuvo una mayor frecuencia de falla cardíaca y remodelación del VI luego de un infarto agudo de miocardio. El SLG se puede utilizar como predictor de la remodelación del VI.

The importance of optimal 25-hydroxyvitamin D levels in the glycemic control of older adults with type 2 Diabetes Mellitus: Data from the study on aging and longevity EELO

INTRODUCTION: Optimal serum levels of vitamin D are of great importance, especially in populations with comorbidities such as Diabetes Mellitus (DM). OBJECTIVE: The study evaluated the relationship between hypovitaminosis D and glycemic control in older adults with type 2 DM. METHODS: Cross-sectional and prospective study, part of the EELO project (Study on Aging and Longevity), conducted in Southern Brazil. Glycated hemoglobin (diabetes ≥6.5%) and serum levels of vitamin D (25(OH)D) were evaluated. Hypovitaminosis D was determined using cutoff points <20 and <30 ng/mL). Multivariate logistic regression was used to assess the risk of having uncontrolled DM. RESULTS: Of the 120 older adults included in the study, aged between 60 and 87 years, 74.2% were women, 66.7% used hypoglycemic medications and 75.8% exhibited uncontrolled diabetes. An inverse correlation was observed between the levels of 25(OH) D and glycated hemoglobin (rS=-0.19, p=0.037), suggesting that low levels of vitamin D are associated with poor glycemic control in diabetic individuals. The prevalence of hypovitaminosis D when using the cutoff points of <20 and <30 ng/mL were 34.2% and 75.0%, respectively. The odds ratio (OR) analysis showed that individuals with 25(OH)D<20ng/mL have almost 4 times more risk of having uncontrolled DM (OR:3.94; CI95%:1.25-12.46, p=0.02) when compared to the older adults with sufficient levels of vitamin D. CONCLUSION: The results indicate that the optimal serum levels currently recommended for 25(OH)D should preferably be 30 ng/mL or higher to contribute to better glycemic control in older adults with type 2 DM.

INTRODUÇÃO: Os níveis séricos ideais de vitamina D são de grande importância, especialmente na população com comorbidades como o Diabetes Mellitus (DM). OBJETIVO: O estudo avaliou a relação entre hipovitaminose D e controle glicêmico em idosos com DM tipo 2. MÉTODOS: Estudo transversal e prospectivo, parte do projeto EELO (Estudo sobre Envelhecimento e Longevidade), no Sul do Brasil. A hemoglobina glicada (diabetes ≥6,5%) e os níveis séricos de vitamina D (25(OH)D) foram avaliados. Hipovitaminose D foi determinada usando ponto de corte <20 e <30 ng/mL. Regressão logística multivariada foi utilizada para avaliar o risco de ter DM descompensado. RESULTADOS: Dos 120 idosos incluídos no estudo, idade entre 60 a 87 anos, 74,2% eram mulheres, 66,7% faziam uso de medicamentos hipoglicemiantes e 75,8% apresentavam diabetes descompensada. Uma correlação inversa foi observada entre os níveis de 25(OH)D e hemoglobina glicada (rS=-0,19; p=0.037), sugerindo que baixos níveis de vitamina D está associado a um pior controle glicêmico em diabéticos. A prevalência de hipovitaminose D quando se utiliza ponto de corte <20 e <30 ng/mL foi de 34,2% e 75,0%, respectivamente. A análise Odds ratio (OR) mostrou que indivíduos com 25(OH)D<20 ng/mL tem quase 4 vezes mais risco de ter DM descompensado (OR:3,94; IC95%:1,25­12,46; p=0,02) quando comparado aos idosos com níveis suficientes de vitamina D. CONCLUSÃO: Os resultados indicam que os níveis sérios ideais atualmente recomendados para 25(OH)D maior ou igual a 30 ng/ml contribuem para o melhor controle glicêmico na população idosa com DM tipo 2.

Estresse no trabalho e níveis de hemoglobina glicada: o papel da escolaridade. Dados da linha de base do Estudo Longitudinal de Saúde do Adulto (ELSA-Brasil) / Job stress and glycated hemoglobin levels: the role of educational attainment. Baseline data from the Longitudinal Study of Adult Health (ELSA-Brasil)

Resumo Introdução: as condições estressantes do trabalho estão associadas ao aumento dos níveis glicêmicos, mas pouco se conhece sobre o papel da escolaridade neste contexto. Objetivos: analisar a associação entre o estresse psicossocial no trabalho e os níveis de hemoglobina glicada (HbA1c) e a influência da escolaridade como modificador de efeito. Métodos: estudo transversal com dados de 11.922 trabalhadores ativos da linha de base do Estudo Longitudinal de Saúde do Adulto (ELSA-Brasil). O estresse psicossocial no trabalho foi avaliado pelo modelo demanda-controle. Foram empregadas a regressão logística multinomial e interações multiplicativas. Resultados: em trabalhadoras do sexo feminino com baixa escolaridade, observou-se associação entre baixo uso de habilidades no trabalho (OR 1,56; IC95% 1,09-2,24) e HbA1c elevada. A baixa autonomia no trabalho foi relacionada à HbA1c limítrofe (OR 1,21; IC95% 1,01-1,45) e elevada (OR 1,73; IC95% 1,19-2,51). Entre trabalhadores do sexo masculino com baixa escolaridade, o trabalho de alto desgaste (OR 1,94; IC95% 1,18-3,21), o baixo uso de habilidades (OR 2,00; IC95% 1,41-2,83) e a baixa autonomia no trabalho (OR 1,58; IC95% 1,13-2,21) foram associados à HbA1c elevada. Conclusão: o estresse psicossocial no trabalho foi associado a níveis limítrofes e elevados de HbAlc para trabalhadores com baixa escolaridade de ambos os sexos. Assim, ações para modificar as relações de trabalho e prevenir doenças crônicas devem ser priorizadas.

Abstract Introduction: stressful work conditions are associated to increased glycemic levels, but little is known about the role of educational attainment in this association. Objectives: to analyze the association between psychosocial stress at work, levels of glycated hemoglobin (HbA1c), and the role of educational attainment as an effect modifier. Methods: a cross-sectional study with baseline data from 11,922 active workers who participated in the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil). Psychosocial stress at work was measured via the Demand-Control model. Multinomial logistic regression and multiplicative interactions were performed. Results: among female workers with low educational attainment, there was an association of low skill discretion and elevated HbA1c (OR 1.56; 95% CI 1.09-2.24). Low decision authority was associated to borderline (OR 1.21; 95% CI 1.01-1.45) and high (OR 1.73; 95% CI 1.19-2.51) HbA1c. Among male workers with low educational attainment, high strain (OR 1.94; 95% CI 1.18-3.21), low skill discretion (OR 2.0; 95% CI 1.41-2.83), and low decision authority (OR 1.58; 95% CI 1.13-2.21) were associated to high HbA1c. Conclusion: Stress at work was associated to high and borderline levels of HbAlc in workers from both genders with low educational attainment. Actions to modify work relations and to prevent chronic diseases should be prioritized for this group.

Evaluation of sleep characteristics of children and adolescents with type 1 diabetes mellitus / Avaliação das características do sono em crianças e adolescentes portadores de diabetes melito tipo 1

ABSTRACT Objective: To evaluate sleep characteristics of children and adolescents with type 1 diabetes mellitus (T1DM) and their relationship with glycemic control. Methods: A cross-sectional study was conducted at a public hospital in São Paulo, Brazil. It included 86 patients with T1DM, aged between 10 and 18 years old, who were on insulin therapy, had performed at least three measurements of capillary blood glucose throughout the day, and had normal thyroid function. The clinical, anthropometric, and laboratory data of each patient were evaluated. The Pediatric Daytime Sleepiness Scale (PDSS) and the Munich Chronotype Questionnaire (MCTQ) were used to assess the sleep characteristics. Results: The mean level of glycated hemoglobin (HbA1c) was 9.2±2.1%, and it was higher in adolescents than in children. The mean score of PDSS was 13.9±4.7. Patients with HbA1c<7.5% had lower PDSS scores and longer sleep duration on weekdays than patients with HbA1c≥7.5%. HbA1c levels were negatively correlated with chronotype values and sleep duration on weekdays and positively correlated with social jet lag. Patients who had had T1DM for less than three years had a higher prevalence of daytime sleepiness. The regression analysis showed that higher HbA1c (≥7.5%) and shorter time since the diagnosis of T1DM increased the chance of daytime sleepiness, regardless of age and sex. Conclusions: Patients with higher HbA1c had more daytime sleepiness, a morning chronotype, shorter sleep duration on weekdays and a more significant social jet lag. The shorter diagnosis time for T1DM and greater levels of HbA1c increased the chance of daytime sleepiness.

RESUMO Objetivo: Avaliar as características do sono em crianças e adolescentes portadores de diabetes melito tipo 1 (DM1) e sua relação com o controle glicêmico. Métodos: Estudo transversal realizado em um hospital público de São Paulo. A amostra foi composta de 86 portadores de DM1 entre 10 e 18 anos, aderentes à insulinoterapia, com monitoração mínima de três glicemias capilares ao dia e função tireoidiana normal. Foram avaliados os dados clínicos, antropométricos e laboratoriais de cada paciente. Utilizaram-se a Escala de Sonolência Diurna Pediátrica (ESDP) e o Questionário de Cronotipo de Munique (QCTM). Resultados: A média de hemoglobina glicada (HbA1c) foi 9,2±2,1%, sendo maior em adolescentes. A média do escore da ESDP foi 13,9±4,7. Pacientes com HbA1c<7,5% tiveram menor escore na ESDP e maior duração do sono em dias de semana do que pacientes com HbA1c≥7,5%. Verificaram-se correlações negativas da HbA1c com valores do cronotipo e com duração do sono em dias de semana e correlação positiva da HbA1c com jet lag social. Pacientes com tempo de DM1 menor que três anos tiveram maior prevalência de sonolência diurna. A análise de regressão apontou que, quanto maior a HbA1c e menor o tempo de diagnóstico de DM1, maior a chance de sonolência diurna, independentemente de idade e sexo. Conclusões: Pacientes com HbA1c mais elevada apresentaram mais sonolência diurna, cronotipo matutino, menor duração do sono em dias de semana e maior jet lag social. O menor tempo de diagnóstico de DM1 e HbA1c≥7,5% aumentaram a chance de maior sonolência diurna.

Dapagliflozin combined with liraglutide for the treatment of type 2 diabetes mellitus complicated by chronic heart failure in 90 patients / 中国基层医药

Objective:To investigate the efficacy and safety of dapagliflozin combined with liraglutide in the treatment of type 2 diabetes mellitus complicated by chronic heart failure.Methods:Ninety patients with type 2 diabetes mellitus complicated by chronic heart failure, who received treatment in the Siming Branch of the First Affiliated Hospital of Xiamen University from August 2018 to August 2020, were included in this study. They were randomly assigned to receive either routine treatment + liraglutide (control group, n = 45) or routine treatment + liraglutide + dapagliflozin (observation group, n = 45) for 16 weeks. Blood glucose control, glycosylated hemoglobin level, cardiac function grade, serum N-terminal B-type natriuretic peptide precursor level, left ventricular ejection fraction, total effective rate, and adverse reactions were compared between the control and observation groups before and after treatment. Results:There were no significant differences in blood glucose level, glycosylated hemoglobin, and cardiac function grade between the two groups (all P > 0.05) before treatment. After treatment, fasting blood glucose level, 2-hour postprandial glucose level, glycosylated hemoglobin level, cardiac function grade, N-terminal B-type natriuretic peptide precursor , and left ventricular ejection fraction were (7.21 ± 1.23) mmol/L, (9.14 ± 2.24) mmol/L, (7.03 ± 2.59)%, (1.25 ± 0.21), (548.9 ± 116.3) ng/L, and (46.7 ± 7.5)%, respectively, in the observation group and they were (9.45 ± 2.21) mmol/L, (11.24 ± 5.29) mmol/L, (8.23 ± 1.91)%, (2.23 ± 0.46), (510.3 ± 110.7) ng/L, and (48.1 ± 6.8)%, respectively in the control group. There were significant differences in these indexes between the two groups ( t = 24.03, 20.47, 51.09, 32.42, 10.19, 13.23, all P < 0.05). Total effective rate was significantly higher in the observation group than in the control group [97.78% (44/45) vs. 80.00% (36/45), χ2 = 7.20, P < 0.05). There was no significant difference in the incidence of adverse reactions between the two groups ( P > 0.05). Conclusion:Dapagliflozin combined with liraglutide is highly effective in the treatment of type 2 diabetes mellitus complicated by chronic heart failure. The combined therapy has good effects on blood glucose level and cardiac function and is certainly safe.

Relationship between pancreatic fibrotic markers and glycated hemoglobin levels in patients with type 3c diabetes mellitus secondary to chronic pancreatitis / 中华胰腺病杂志

Objective:To investigate the relationship between pancreatic fibrotic marker transforming growth factor-β(TGF-β) and platelet derived growth factor-BB(PDGF-BB) and serum glycated hemoglobin (HbA1c) levels in patients with type 3c diabetes mellitus secondary to chronic pancreatitis(CP-T3cDM).Methods:The clinical data of 39 patients with CP-T3cDM admitted to the Department of Gastroenterology of the First Affiliated Hospital of Naval Medical University between February 2018 and August 2020 were collected, and the patients' age, gender, body mass index, duration of chronic pancreatitis and diabetes mellitus, smoking history, alcohol consumption history, serum HbA1c level at admission, degree of pancreatic atrophy, morphology of the main pancreatic duct, and treatment of diabetes mellitus were recorded. Serum TGF-β and PDGF-BB were detected by ELISA. Patients were divided into high and low level group according to the median TGF-β and PDGF-BB levels, respectively. Clinical characteristics of patients were compared between the TGF-β and PDGF-BB high and low level group. The correlation between TGF-β, PDGF-BB and HbA1c was analyzed by Spearman's correlation analysis.Results:A total of 39 CP-T3cDM patients were included; 35 were male and 4 were female. The age of first onset of chronic pancreatitis was (42±14) years old, and the duration of diabetes mellitus was 24(4, 36) months. The serum HbA1c level was (7.8±1.6)%, and the serum TGF-β and PDGF-BB levels were 20.5(10.5, 43.1) and 647.5(276.9, 1349.2)pg/ml, respectively. The serum HbA1c levels of patients in the high-level group of serum TGF-β and PDGF-BB were significantly higher than those in the corresponding low-level group [8.6%(7.4%, 9.9%) vs 6.7%(6.2%, 7.8%) and 8.6%(7.4%, 9.6%) vs 6.7%(6.1%, 7.8%), respectively] , and the difference was statistically different (both P value <0.01), while none of other indicators showed statistically significant differences between both groups. The correlation analysis showed that the levels of TGF-β and PDGF-BB were significantly positively correlated with HbA1c level ( r=0.45, 0.53, both P value <0.01). Conclusions:Increased pancreatic fibrosis in patients with CP-T3cDM was an important factor contributing to elevated blood glucose level. Patients with higher serum pancreatic fibrotic factors exhibited a significant increase in HbA1c level.

Intravenous thrombolysis with recombinant tissue plasminogen activator in acute ischemic stroke with high stress hyperglycemia / 中华神经科杂志

Objective:To investigate the efficacy and safety of intravenous thrombolysis with recombinant tissue plasminogen activator (rt-PA) for acute ischemic stroke with stress hyperglycemia under the guidance of glycosylated hemoglobin A1c (GHbA1c).Methods:The clinical data of 195 patients of acute cerebral infarction with admission blood glucose over 22.2 mmol/L and GHbA1c less than 15.59% were collected in Nankai University Affiliated Tianjin Fourth Central Hospital from January 2018 to June 2021 and analyzed retrospectively. Patients were divided into control group (60 cases), rt-PA low-dose group (0.6 mg/kg, 70 cases) and rt-PA standard-dose group (0.9 mg/kg, 65 cases) to evaluate the guiding effect of GHbA1c and the efficacy and safety of rt-PA.Results:The effective rate at 24 hours and good rate at 7 days were 61.4% (43/70) and 72.9% (51/70) in the rt-PA low-dose group, 64.6% (42/65) and 69.2% (45/65) in the rt-PA standard-dose group, respectively, both better than the control group [30.0% (18/60); χ2=18.25, P<0.001 and 46.7% (28/60); χ2=13.65, P=0.001]. The good outcome rate at 90 days was 82.8% (58/70) in the rt-PA low-dose group, which was better than 63.3% (38/60) in the control group (χ2=6.38, P=0.016), but without statistically significant difference compared with the rt-PA standard-dose group [72.3% (47/65); χ2=2.17, P=0.153]. The case fatality rate at 90 days of the rt-PA low-dose group was 7.1% (5/70), which was lower than 20.0% (13/65) in the rt-PA standard-dose group (χ2=4.82, P=0.041) and 18.3% (11/60) in the control group (χ2=5.04, P=0.030). The incidence of intracranial hemorrhage and symptomatic intracranial hemorrhage was 8.5% (6/70) and 2.9% (2/70) in the rt-PA low-dose group, lower than 20.0% (13/65; P=0.048) and 13.8% (9/65; P=0.020) in the rt-PA standard-dose group. The incidence of extracranial hemorrhage was 7.1% (5/70) in the rt-PA low-dose group, lower than 18.9% (12/65) in the rt-PA standard-dose group ( P=0.042). Conclusion:Acute cerebral infarction patients with admission blood glucose over 22.2 mmol/L can receive rt-PA treatment when GHbA1c is less than 15.59%, and 0.6 mg/kg dosage is recommended.

ALDH1A3 + INS + cells in non-diabetic subjects and risk for type 2 diabetes: Analysis of cross-sectional data / 中华内分泌代谢杂志

Objective:To investigate the correlations of β cell dedifferentiation in non-diabetic subjects with risk factors for type 2 diabetes mellitus(T2DM).Methods:Immunofluorescence staining with insulin and β cell dedifferentiated marker ALDH1A3 was used to evaluate the β cell dedifferentiation levels in 38 non-diabetic and 23 T2DM. Correlation analyses were performed between β cell dedifferentiation levels and available clinical parameters including age, body mass index, HbA 1C level, triglycerides, and cholesterol levels in non-diabetic subjects. Results:β cell dedifferentiation level defined by the positive expression of ALDH1A3 in β cells(ALDH1A3 + INS + cell proportion) was significantly elevated in T2DM subjects( P<0.001). In PreD subjects, ALDH1A3 + INS + cells proportion were decreased( P=0.050) and negatively correlated with HbA 1C( r=-0.44, P=0.006), but not with age and body mass index. The analysis of correlation with lipidemic parameters showed that ALDH1A3 + INS + cells proportion was positively correlated with plasma total cholesterol level( r=0.39, P=0.045), but not plasma total triglyceride. Conclusion:ALDH1A3 + INS + cells were found to be decreased in prediabetes, suggesting that there may be enhanced β-cell identity in prediabetes to compensate for insulin secretion requirements; ALDH1A3 + INS + cells were elevated in people with high plasma total cholesterol levels, suggesting that total cholesterol may be one of the factors that induce β-cell dedifferentiation.

Research progress on blood glucose monitoring strategy of hyperglycemia during pregnancy / 中国医师杂志

Gestational hyperglycemia is increasing all over the world and leads to serious maternal and infant complications. Effective blood glucose monitoring helps to improve adverse pregnancy outcomes. Therefore, blood glucose monitoring plays a vital role in blood glucose control of patients with gestational hyperglycemia. The current blood glucose monitoring methods include self-monitoring blood glucose (SMBG), glycosylated hemoglobin (HbA 1c), glycosylated albumin (GA), continuous blood glucose monitoring (CGM) and time within glucose target range (TIR). Different blood glucose monitoring methods have their advantages and limitations. This paper reviews the latest research progress on the application value of different blood glucose monitoring methods in patients with hyperglycemia during pregnancy at home and abroad.

Dislipidemias en pacientes diabéticos internados en el Hospital Vicente Corral Moscoso / Dyslipidemias in diabetic patients hospitalized at the Vicente Corral Moscoso Hospital / Dislipidemias em doentes diabéticos hospitalizados no Hospital Vicente Corral Moscoco

La Diabetes Mellitus tipo 2 como una enfermedad endocrino metabólica puede generar alteraciones importantes en el perfil lipídico del paciente, por tanto, un importante riesgo cardiovascular. OBJETIVO: caracterizar las dislipidemias en pacientes diabéticos internados en el área de clínica del Hospital Vicente Corral Moscoso de Cuenca durante el año 2019. MATERIALES Y MÉTODOS: investigación cuantitativa, no experimental, transversal, observacional de tipo descriptivo y documental, de 137 pacientes diabéticos. Se analizaron variables sociodemográficas, cuantificación del lipidograma, HbA1c, IMC, adherencia al tratamiento, años de diagnóstico, tipo de tratamiento, presencia de hipotiroidismo e hipertensión. Se realizó análisis de frecuencias, medidas de tendencia central, chi cuadrado, Odds ratio y Riesgo Relativo. Para los análisis se consideró p<0,05. Resultados. La media de edad fue de 65,73±15,11 años, correspondiendo al grupo etario adulto mayor; con predominio de mujeres. Alrededor del 46% presentaban IMC normal y 52,2% obesidad y sobrepeso. El 51% tenía tiempo de diagnóstico menor o igual a 10 años. El 76,7% de pacientes presentaron dislipidemia, 43,6% hipercolesterolemia, 57,9% hipertrigliceridemia; 60,9% disminución de HDL; 50,4% valores elevados de LDL; y 74,4% VLDL elevado. El 83,3% de pacientes presentaron hemoglobina glicosilada elevada, con falta de adherencia al tratamiento del 66,2%. CONCLUSIÓN: los pacientes diabéticos presentan dentro del transtorno metabólico dislipidemias, con hipertrigliceridemia mantenida, hipercolesterolemia, disminución de HDL y aumento de LDL. La asociación de dislipidemias con la hemoglobina glicosilada la convierte en un valor predictor de presentar enfermedades cardiovasculares.

Diabetes Mellitus type 2 as an endocrine metabolic disease can generate important alterations in the lipid profile of the patient, therefore, an important cardiovascular risk. OBJECTIVE: to characterize dyslipidemias in diabetic patients hospitalized in the clinical area of the Vicente Corral Moscoso Hospital of Cuenca during 2019. MATERIALS AND METHODS: quantitative, non-experimental, cross-sectional, observational, descriptive and documentary research of 137 diabetic patients. Sociodemographic variables, lipidogram quantification, HbA1c, BMI, adherence to treatment, years of diagnosis, type of treatment, presence of hypothyroidism and hypertension were analyzed. Frequency analysis, measures of central tendency, chi-square, Odds ratio and Relative Risk were performed. For the analyses, p<0.05 was considered. RESULTS: the mean age was 65.73±15.11 years, corresponding to the older adult age group; with a predominance of women. About 46% had normal BMI and 52.2% had obesity and overweight. Fifty-one percent of the patients had been diagnosed less than or equal to 10 years. 76.7% of patients presented dyslipidemia, 43.6% hypercholesterolemia, 57.9% hypertriglyceridemia; 60.9% decreased HDL; 50.4% elevated LDL values; and 74.4% elevated VLDL. A total of 83.3% of patients had elevated glycosylated hemoglobin, with a lack of adherence to treatment of 66.2%. CONCLUSIONS: diabetic patients present dyslipidemias within the metabolic disorder, with maintained hypertriglyceridemia, hypercholesterolemia, decreased HDL and increased LDL. The association of dyslipidemia with glycosylated hemoglobin makes it a predictor of cardiovascular disease.

Diabetes Mellitus tipo 2 como doença endócrino-metabólica pode gerar alterações importantes no perfil lipídico do paciente, portanto, um risco cardiovascular importante. OBJETIVO: caracterizar dislipidemias em pacientes diabéticos internados na área clínica do Hospital Vicente Corral Moscoso em Cuenca durante 2019. MATERIAIS E MÉTODOS: pesquisa quantitativa, não-experimental, transversal, observacional, descritiva e documental de 137 pacientes diabéticos. Foram analisadas variáveis sociodemográficas, quantificação lipidográfica, HbA1c, IMC, aderência ao tratamento, anos de diagnóstico, tipo de tratamento, presença de hipotireoidismo e hipertensão. Foram realizadas análises de freqüência, medidas de tendência central, qui-quadrado, razão de chances e risco relativo. P<0,05 foi considerado para as análises. RESULTADOS: a idade média foi de 65,73±15,11 anos, correspondendo à faixa etária dos adultos mais velhos; com predomínio das mulheres. Cerca de 46% tinham um IMC normal e 52,2% eram obesos ou acima do peso. Cinqüenta e um por cento haviam sido diagnosticados menos ou igual a 10 anos antes do diagnóstico. 76,7% dos pacientes apresentavam dislipidemia, 43,6% hipercolesterolemia, 57,9% hipertrigliceridemia; 60,9% diminuíram o HDL; 50,4% elevaram os valores de LDL; e 74,4% elevaram o VLDL. 83,3% dos pacientes tinham hemoglobina glicosilada elevada, com 66,2% de não aderência ao tratamento. CONCLUSÃO: os pacientes diabéticos apresentam dislipidemias dentro do distúrbio metabólico, com hipertrigliceridemia sustentada, hipercolesterolemia, diminuição do HDL e aumento do LDL. A associação de dislipidemia com a hemoglobina glicosilada faz dela um preditor de doenças cardiovasculares.

Combination therapy with lansoprazole and cholecalciferol is associated with a slower decline in residual beta-cell function and lower insulin requirements in children with recent onset type 1 diabetes: results of a pilot study

Abstract Objective To investigate the effects of combination therapy with cholecalciferol and lansoprazole on residual β-cell function and glycemic control in children with new-onset type 1 diabetes. Methods Children aged 6-12 years with type 1 diabetes were allocated to receive cholecalciferol and lansoprazole (Group 1) or no treatment (Group 2). Children were maintained on their respective insulin regimens and kept records of blood sugar and insulin doses taken. Children were followed at three-month intervals for six months. Changes in mean fasting C-peptide and HbA1c levels, daily insulin doses, fasting blood glucose and mean blood glucose levels from baseline to end of the study were analyzed. Results Twenty-eight children (14 per group) met the eligibility criteria. Fasting C-peptide levels decreased significantly from baseline to study end in both groups (mean decrease -0.19±0.09ng/mL and -0.28±0.08ng/mL, p=0.04 and p=0.001; Group 1 and Group 2 respectively). However, fasting C-peptide level drop was significantly smaller in Group 1 compared to Group 2 (30.6% and 47.5% respectively; p=0.001). Likewise, daily insulin doses decreased significantly in both groups (-0.59±0.14units/kg and -0.37±0.24units/kg respectively; p=0.001). All patients recruited completed the study. No adverse events were reported. Conclusion Combined therapy with cholecalciferol and lansoprazole for six months was associated with smaller decline in residual β-cell function and lower insulin requirements in children with new-onset type 1 diabetes. Preliminary findings of this small-scale study need to be confirmed by larger studies. Registry of Clinical Trials (www.ctri.nic.in) under number REF/2021/03/041415 N.

Efectos de una intervención con llamadas telefónicas educativas para mejorar la adherencia y el control metabólico en personas con diabetes mellitus tipo 2 mal controlada: un ensayo clínico aleatorizado / Effects of an Intervention with educational phone calls to improve adherence and metabolic control in people with type 2 diabetes mellitus: a randomized clinical trial

RESUMEN Introducción: Las tecnologías de información y comunicación pueden ayudarnos a mejorar el control metabólico y la adherencia de las personas con diabetes mellitus tipo 2 (DM2). Objetivo: Evaluar los efectos de una intervención con llamadas telefónicas en pacientes ambulatorios con DM2 mal controlada de un hospital en Perú. Métodos: Ensayo clínico aleatorizado. Incluimos adultos con DM2 con mal control glicémico (HbA1c > 7%), quienes fueron aleatorizados al grupo control (cuidado usual) o al grupo intervención (cuidado usual más una intervención con llamadas telefónicas cada dos semanas por tres meses). El desenlace principal fue la reducción ≥ 1% de hemoglobina glicosilada a los tres meses. Resultados: Se reclutó 94 participantes (47 en cada grupo). La edad promedio fue 59,8 años (DE: 10,2), 69,2 % fueron mujeres. A los tres meses, solo 14/47 participantes del grupo control y 13/47 participantes del grupo intervención tuvieron medición de HbA1c. Entre estos, el porcentaje de los que lograron una disminución ≥ 1% de HbA1c fue de 35,7% (5/14) en el grupo control y 53,8% (7/13) en el grupo intervención (RR: 0,72, IC 95%: 0,35-1,47). No se encontró diferencias en la adherencia al tratamiento entre ambos grupos. Conclusiones: No se encontró diferencias estadísticamente significativas para los desenlaces de interés. Posiblemente esto se deba al bajo porcentaje de participantes a los que se logró completar el seguimiento.

ABSTRACT Introduction: Information and communication technologies can help us improve metabolic control and adherence in people with type 2 diabetes mellitus (DM2). Objective: To evaluate the effects of an intervention with telephone calls in outpatients with poorly controlled DM2 in a hospital in Peru. Methods: Randomized clinical trial. We included adults with DM2 with poor glycemic control, who were randomized to the control group (usual care) or to the intervention group (usual care plus a telephone intervention every two weeks for three months). The primary outcome was a ≥ 1% reduction in glycosylated hemoglobin at three months. Results: 94 participants were recruited (47 in each group). Mean age was 59.8 years (SD: 10.2), 69.2 % were women. At three months, only 14/47 participants in the control group and 13/47 participants in the intervention group had HbA1c measurement. Among these, the percentage of those who achieved a ≥ 1% decrease in HbA1c was 35,7% (5/14) in the control group and 53,8% (7/13) in the intervention group (RR: 0,72, 95% CI: 0,35-1,47). No differences were found in adherence to treatment between groups. Conclusions: No statistically significant differences were found for the outcomes of interest. This is possibly due to the low percentage of participants who were able to complete follow-up. Innovative solutions are needed to improve the control of people with DM2.

Efectos de una intervención con llamadas telefónicas educativas para mejorar la adherencia y el control metabólico en personas con diabetes mellitus tipo 2 mal controlada: Un ensayo clínico aleatorizado / Effects of an Intervention with educational phone calls to improve adherence and metabolic control in people with type 2 diabetes mellitus: A randomized clinical trial

Introducción: Las tecnologías de información y comunicación pueden ayudarnos a mejorar el control metabólico y la adherencia de las personas con diabetes mellitus tipo 2 (DM2). Objetivo: Evaluar los efectos de una intervención con llamadas telefónicas en pacientes ambulatorios con DM2 mal controlada de un hospital en Perú. Material y Métodos: Ensayo clínico aleatorizado. Incluimos adultos con DM2 con mal control glicémico (HbA1c > 7%), quienes fueron aleatorizados al grupo control (cuidado usual) o al grupo intervención (cuidado usual más una intervención con llamadas telefónicas cada dos semanas por tres meses). El desenlace principal fue la reducción ≥ 1% de hemoglobina glicosilada a los tres meses. Resultados: Se reclutó 94 participantes (47 en cada grupo). La edad promedio fue 59,8 años (DE: 10,2), 69,2 % fueron mujeres. A los tres meses, solo 14/47 participantes del grupo control y 13/47 participantes del grupo intervención tuvieron medición de HbA1c. Entre estos, el porcentaje de los que lograron una disminución ≥ 1% de HbA1c fue de 35,7% (5/14) en el grupo control y 53,8% (7/13) en el grupo intervención (RR: 0,72, IC 95%: 0,35-1,47). No se encontró diferencias en la adherencia al tratamiento entre ambos grupos. Conclusiones: No se encontró diferencias estadísticamente significativas para los desenlaces de interés. Posiblemente esto se deba al bajo porcentaje de participantes a los que se logró completar el seguimiento.

Introduction: Information and communication technologies can help us improve metabolic control and adherence in people with type 2 diabetes mellitus (DM2). Objective: To evaluate the effects of an intervention with telephone calls in outpatients with poorly controlled DM2 in a hospital in Peru. Material and Methods: Randomized clinical trial. We included adults with DM2 with poor glycemic control, who were randomized to the control group (usual care) or to the intervention group (usual care plus a telephone intervention every two weeks for three months). The primary outcome was a ≥ 1% reduction in glycosylated hemoglobin at three months. Results: 94 participants were recruited (47 in each group). Mean age was 59.8 years (SD: 10.2), 69.2 % were women. At three months, only 14/47 participants in the control group and 13/47 participants in the intervention group had HbA1c measurement. Among these, the percentage of those who achieved a ≥ 1% decrease in HbA1c was 35,7% (5/14) in the control group and 53,8% (7/13) in the intervention group (RR: 0,72, 95% CI: 0,35-1,47). No differences were found in adherence to treatment between groups. Conclusions: No statistically significant differences were found for the outcomes of interest. This is possibly due to the low percentage of participants who were able to complete follow-up. Innovative solutions are needed to improve the control of people with DM2.

Poor glycemic control and associated factors in diabetic people attending a reference outpatient clinic in Mato Grosso, Brazil / Descontrol glucémico y factores asociados en personas diabéticas que acuden a una clínica de referencia en Mato Grosso, Brasil / Descontrole glicêmico e fatores associados em pessoas diabéticas que consultam em ambulatório de referência de Mato Grosso, Brasil

Objective. To identify the proportion of poor of glycemic control and associated factors among people with type 2 diabetes attending a regional reference outpatient clinic in Mato Grosso (Brazil). Methods. This is a cross-sectional quantitative study based on data from medical records of 338 people with type 2 diabetes who attend a state reference outpatient clinic in Mato Grosso (Brazil). Information on glycemic control, sociodemographic factors, lifestyle and clinical conditions was collected. Results. The prevalence of elevated glycated hemoglobin was 47.34%. In the Poisson multiple regression model analysis with robust variance, poor glycemic control was significantly associated (p<0.05) with the following factors: insulin use (Prevalence Ratio -PR = 2.03), fasting glucose ≤70 and ≥100 mg/dL (PR = 2.0), postprandial glucose ≥180 mg/dL (PR = 1.76), no physical activity (PR = 1.62), the interaction between age group ≤59 years and the time of disease diagnosis >10 years (PR = 1.58), and presence of arterial hypertension (PR = 0.79). Conclusion. Most users of the reference outpatient clinic with type 2 diabetes had poor glycemic control associated with risk factors that alter glycated hemoglobin and negatively affect the achievement of established glycemic levels.

Objetivo. Identificar la proporción de falta de control glucémico y los factores asociados entre las personas con diabetes tipo 2 que acuden a un ambulatorio regional de referencia en Mato Grosso (Brasil). Métodos. Se trata de un estudio transversal basado en los datos de las historias clínicas de 338 personas con diabetes tipo 2 atendidas en un ambulatorio estatal de referencia. Se tomó información del control glucémico, los factores sociodemográficos, el estilo de vida y las condiciones clínicas. Resultados. La prevalencia de hemoglobina glicosilada elevada fue del 47.34%. En el análisis del modelo de regresión múltiple de Poisson con varianza robusta mostró que el descontrol glucémico estaba significativamente asociado (p<0.05) con los siguientes factores: el uso de insulina (Ratio de Prevalencia -RP = 2.03), la glucemia en ayunas ≤70 y ≥100 mg/dL (PR = 2), la glucemia postprandial ≥180 mg/dL (PR = 1.76), la ausencia de actividad física (PR = 1.62), la interacción entre el grupo de edad ≤59 años y el tiempo de diagnóstico de la enfermedad >10 años (PR = 1.58) y la presencia de hipertensión (PR = 0.79). Conclusión. Una buena parte de los usuarios del ambulatorio de referencia con diabetes tipo 2 presentaba descontrol glucémico asociado a factores de riesgo que alteran la hemoglobina glicosilada y afectan negativamente la consecución de los niveles glucémicos establecidos.

Objetivo. Identificar a proporção de falta de controle glicêmico e fatores associados entre pessoas com diabetes tipo 2 que visitam um ambulatório de referência regional em Mato Grosso (Brasil). Métodos. Trata-se de um estudo transversal e quantitativo, com base em dados de prontuários de 338 pessoas com diabetes tipo 2 atendidas em ambulatório de referência estadual de Mato Grosso (Brasil). Foi recolhida informação sobre controlo glicémico, factores socio-demográficos, estilo de vida e condições clínicas. Resultados. A prevalência de hemoglobina glicada elevada foi de 47,34%. Na análise do modelo de regressão múltipla de Poisson com variância robusta, foi demonstrado que o descontrole glicêmico foi significativamente associado (p<0,05) aos seguintes fatores: uso de insulina (Razão de Prevalência -RP = 2.03), glicemia de jejum ≤70 e ≥100 mg / dL (RP = 2.0), glicemia pós-prandial ≥180 mg / dL (RP = 1.76), nenhuma atividade física (RP = 1.62), a interação entre a faixa etária ≤59 anos e o tempo de diagnóstico da doença > 10 anos (RP = 1.58) e apresentar hipertensão arterial (RP = 0.79). Conclusão. Boa parte dos usuários do ambulatório de referência com diabetes do tipo 2 apresentou descontrole glicêmico associados a fatores de risco que alteram a hemoglobina glicada e afeta negativamente o alcance dos níveis glicêmicos estabelecidos.

Asociación entre soporte familiar y control glicémico en pacientes con diabetes mellitus de tipo 2 en un Consultorio de Endocrinología de un hospital nacional / Association between family support and glycemic control among patients with type 2 diabetes mellitus who attend an endocrinology office of a public hospital

RESUMEN Objetivo: Determinar la asociación entre soporte familiar y control glicémico en pacientes con diabetes mellitus tipo 2 que acuden al Consultorio Externo de Endocrinología del Hospital Nacional Dos de Mayo. Materiales y métodos: Se realizó un estudio cuantitativo, observacional y transversal. La muestra fue de 158 sujetos diabéticos mayores de 18 años con hemoglobina glicosilada al momento de la consulta, obtenida mediante Epi info v7.9.2, con un nivel de confianza 95 %, precisión del 5 % y con una frecuencia esperada de 12,11 %. El muestreo fue no probabilístico por conveniencia. Se aplicó una ficha de recolección, registrándose datos sociodemográficos, clínicos y del entorno social del paciente, así como una encuesta de la Escala de Cohesión y Adaptabilidad Familiar-FACES III para determinar el soporte familiar. Se realizó la prueba chi cuadrado para determinar la asociación entre soporte familiar y control glicémico. Resultados: El 50,60 % (n = 80) de los participantes fueron mujeres. La edad media fue de 63,5± 12,10 años. La figura familiar más representativa de cuidador primario fue el hijo en un 50,6 % (n = 80) seguido del cónyuge 20,3 % (n = 32). De los 158 sujetos, 98 (62 %) tuvieron control glicémico controlado y de estos 44 (44,9 %) un soporte familiar adecuado. De los 60 no controlados, 16 (26,6 %) tuvieron un soporte familiar adecuado. Se determinó la asociación entre soporte familiar y control glicémico siendo estadísticamente significativa X2 = 5,252, con un ρ < 0,05. Conclusiones: Existe una asociación significativa entre el soporte familiar y el control glicémico en los pacientes diabéticos que se atienden en los consultorios de endocrinología del Hospital Nacional Dos de Mayo.

ABSTRACT Objective: To determine the association between family support and glycemic control among patients with type 2 diabetes mellitus who attend the outpatient endocrinology office of the Hospital Nacional Dos de Mayo. Materials and methods: A quantitative, observational and cross-sectional study was carried out. The sample consisted of 158 diabetic subjects over 18 years of age whose glycosylated hemoglobin was obtained at the time of the consultation using the Epi Info version 7.9.2 software, with a 95 % confidence level, 5 % accuracy and 12.11 % expected frequency. A non-probability convenience sampling was used. A data collection sheet was employed to register the patients' sociodemographic, clinical and social environment data, as well as the Family Adaptability and Cohesion Evaluation Scale III (FACES III) to determine the family support. A chi-square test was used to determine the association between family support and glycemic control. Results: Female patients accounted for 50.6 % (n = 80) of the sample. The mean age was 63.5 ± 12.10 years. The patients' children (50.6 %, n = 80) and spouses (20.3 %, n = 32) were the most likely primary caregivers. Out of the 158 study subjects, 98 (62 %) had a good glycemic control, 44 % of whom (44.9 %) presented an adequate family support. Out of the 60 patients with no glycemic control, 16 (26.6 %) had an adequate family support. A statistically significant association between family support and glycemic control was demonstrated, with X² = 5,252 and ρ value < 0.05. Conclusions: There is a significant association between family support and glycemic control among the diabetic patients treated at the outpatient endocrinology office of the Hospital Nacional Dos de Mayo.

The effect of physical exercise on blood sugar control in diabetic patients / O efeito do exercício físico no controle do açúcar no sangue em pacientes diabéticos / El efecto del ejercicio físico sobre el control del azúcar en sangre en pacientes diabéticos

ABSTRACT Introduction Diabetes is a metabolic disease characterized by hyperglycemia. It is a metabolic syndrome in which blood sugar levels increase due to defects in insulin secretion or impaired function, or even both defects. Object To understand the effect of diabetic patients in controlling blood sugar through physical exercise, the paper analyzes the correlation between the exercise status and physiological indicators of diabetic patients in our hospital. Methods We randomly selected 41 diabetic patients and monitored their exercise. At the same time, we check the physiological indicators of the patients after the exercise is completed and analyze the control of blood sugar by sports. Results After healthy physical exercise, the blood sugar level of diabetic patients tended to stabilize, and the glycosylated hemoglobin level decreased. The blood sugar levels of patients who did not participate in healthy physical exercises were not stable, and their glycosylated hemoglobin levels did not improve. Conclusion Healthy sports is a simple, easy, safe and effective adjuvant therapy for the prevention and treatment of diabetes, and it is worthy of clinical promotion. Level of evidence II; Therapeutic studies - investigation of treatment results.

RESUMO Introdução O diabetes é uma doença metabólica caracterizada por hiperglicemia. É uma síndrome metabólica em que os níveis de açúcar no sangue aumentam devido a defeitos na secreção de insulina ou função prejudicada, ou mesmo ambos os defeitos. Objetivo Para compreender os pacientes diabéticos no controle da glicemia por meio do exercício físico, o artigo analisa a correlação entre o estado de exercício e os indicadores fisiológicos de pacientes diabéticos em nosso hospital. Métodos Selecionamos aleatoriamente 41 pacientes diabéticos e monitoramos seus exercícios. Ao mesmo tempo, verificamos os indicadores fisiológicos dos pacientes após a realização do exercício e analisamos o controle da glicemia pelo esporte. Resultados Após exercícios físicos saudáveis, o nível de açúcar no sangue de pacientes diabéticos tendeu a se estabilizar e o nível de hemoglobina glicosilada diminuiu. Os níveis de açúcar no sangue dos pacientes que não praticavam exercícios físicos saudáveis não foram estáveis e os níveis de hemoglobina glicosilada não melhoraram. Conclusão O esporte saudável é uma terapia adjuvante simples, fácil, segura e eficaz para a prevenção e tratamento do diabetes e merece divulgação clínica. Nível de evidência II; Estudos terapêuticos - investigação dos resultados do tratamento.

RESUMEN Introducción la diabetes es una enfermedad metabólica caracterizada por hiperglucemia. Es un síndrome metabólico en el que los niveles de azúcar en sangre aumentan debido a defectos en la secreción de insulina o función alterada, o incluso a ambos defectos. Objeto Para comprender a los pacientes diabéticos en el control de la glucemia a través del ejercicio físico, el trabajo analiza la correlación entre el estado de ejercicio y los indicadores fisiológicos de los pacientes diabéticos en nuestro hospital. Métodos Seleccionamos aleatoriamente a 41 pacientes diabéticos y monitoreamos su ejercicio. Al mismo tiempo, verificamos los indicadores fisiológicos de los pacientes una vez finalizado el ejercicio y analizamos el control del azúcar en sangre mediante los deportes. Resultados Después de un ejercicio físico saludable, el nivel de azúcar en sangre de los pacientes diabéticos tendió a estabilizarse y el nivel de hemoglobina glicosilada disminuyó. Los niveles de azúcar en sangre de los pacientes que no participaron en ejercicios físicos saludables no fueron estables y sus niveles de hemoglobina glicosilada no mejoraron. Conclusión El deporte saludable es una terapia adyuvante simple, fácil, segura y eficaz para la prevención y el tratamiento de la diabetes y es digno de promoción clínica. Nivel de evidencia II; Estudios terapéuticos: investigación de los resultados del tratamiento.

Type 1 diabetes care in mexico: an analysis of the renaced-dt1 national registry

Background: Information regarding diagnosis, treatment, and follow-up of patients with type 1 diabetes (PWT1D) in Mexico is limited. We developed an on-line platform Registro Nacional de Pacientes con Diabetes Tipo 1 (RENACED-DT1). Objective: The objective of the study was to describe the characteristics and healthcare of PWT1D registered in RENACED-DT1. Methods: Analyses of 965 PWT1D from July 2014 to January 2018 in different endocrinology clinics around Mexico. Results: Sixty-one percent were female with median age of 21 years, age at diagnosis 11 years, and disease duration at inclusion 8.2 years. Treatment regimen was basal-bolus in 61% and insulin-pumps in 21% (mainly in the private sector); 33.3% with self-monitoring of blood-glucose (SMBG) ≥4 times/day. Mean HbA1c at last follow-up was 8.7 ± 2.1% (72±23 mmol/mol), 18% had HbA1c < 7% (53 mmol/mol), and 35% > 9% (75 mmol/mol). SMBG ≥ 4 times/day was associated with HbA1c < 7%. Time since diagnosis > 10 years, female sex, BMI ≥ 30 kg/m2, SMBG < 4 times/day, and any hypoglycemia were associated with microvascular complications (p < 0.05). Conclusions: Percentage of patients achieving HbA1c < 7% is low; increased blood glucose monitoring is associated with better glycemic control. The achievement of optimal glycemic control must be increased to reduce the incidence of chronic complications and improve quality of life in PWT1D.