Enfoque actual de la enfermedad arterial periférica asintomática en personas con diabetes melllitus / Current Approach to Asymptomatic Peripheral Arterial Disease in People with Diabetes Mellitus

La creciente epidemia de diabetes impone la necesidad de implementar estrategias para la detección de complicaciones diabéticas en etapas tempranas cuando aún están en estadio preclínico. La enfermedad arterial periférica es una de ellas, con consecuencias devastadoras para el paciente, la familia y la sociedad. Su frecuencia aumenta con la edad y el tiempo de evolución de la diabetes. La mayoría de los pacientes son asintomáticos lo que dificulta el diagnóstico, además, las limitaciones del examen físico exigen complementarlo con estudios no invasivos. El índice de presiones tobillo-brazo es el principal método para su detección pero es necesario conocer sus limitaciones en las personas con diabetes para interpretar correctamente los resultados. Los pacientes con enfermedad arterial periférica asintomática tienen más rápida declinación funcional con probabilidad de progresar a formas mas graves de la enfermedad como la isquemia crítica y la amputación, así como, mayor riesgo de eventos cardiovasculares isquémicos en otros territorios arteriales y de mortalidad. La detección sistemática de enfermedad arterial periférica asintomática en las personas con diabetes identificaría los pacientes que se beneficiarían con intervenciones más intensivas por lo que constituye una fuerte recomendación en la actualidad. Con este trabajo nos proponemos debatir sobre la importancia de la búsqueda de esta complicación en las personas con diabetes, así como, los retos actuales para su detección y diagnóstico(AU)

The growing diabetes epidemic demands the need to implement strategies for the identification of diabetic complications in early stages, when they are still in the preclinical stage. Peripheral arterial disease is one of them, with devastating consequences for the patient, the family, and society. Its frequency of occurrence increases with age and with the time of evolution of diabetes. Most of the patients are asymptomatic, which makes diagnosis difficult. In addition, due to the limitations of physical examination, complementary tests are required, always with noninvasive studies. The ankle-brachial pressure index is the main method for detecting it, but it is necessary to know its limitations in people with diabetes, in order to interpret the results correctly. Patients with asymptomatic peripheral arterial disease have a faster functional decline with the probability of progressing to more serious forms of the disease, such as critical ischemia and amputation, as well as a higher risk of ischemic cardiovascular events in other arterial territories and of mortality. Screening for asymptomatic peripheral arterial disease in people with diabetes would permit identifying patients who would benefit from more intensive interventions; therefore, it is strongly recommended nowadays. With this work, we intend to discuss the importance of screening for this complication in people with diabetes, as well as the current challenges for its detection and diagnosis(AU)

Observational Cohort Study of Hepatic Encephalopathy After Transjugular Intrahepatic Portosystemic Shunt (TIPS)

Abstract: Introduction and aim. Hepatic encephalopathy (HE) is a common complication of transjugular intrahepatic portosystemic shunting (TIPS). It is associated with a reduced quality of life and poor prognosis. The aim of this study was to compare two groups of patients who did and did not develop overt HE after TIPS. We looked for differences between these groups before TIPS. Material and methods. A study of 895 patients was conducted based on a retrospective analysis of clinical data. Data was analyzed using Fisher’s exact test, χ2, Mann Whitney test, unpaired t-test and logistic regression. After the initial analyses, we have looked at a regression models for the factors associated with development of HE after TIPS. Results. 257 (37.9%) patients developed HE after TIPS. Patients’ age, pre-TIPS portal venous pressure, serum creatinine, aspartate transaminase, albumin, presence of diabetes mellitus and etiology of portal hypertension were statistically significantly associated with the occurrence of HE after TIPS (p < 0.01). However, only the age, pre-TIPS portal venous pressure, serum creatinine, presence of diabetes mellitus and etiology of portal hypertension contributed to the regression model. Patients age, serum creatinine, presence of diabetes mellitus and portal vein pressure formed the model describing development of HE after TIPS for a subgroup of patients with refractory ascites. Conclusion. We have identified, using a substantial sample, several factors associated with the development of HE after TIPS. This could be helpful in further research.

Influence of tobacco, alcohol and diabetes on the collagen of cremaster muscle in patients with inguinal hernias / Influência do tabaco, álcool e diabete sobre a interação célula-colágeno em músculo cremaster de humanos com hérnias inguinais

ABSTRACT Background: New findings point out that the mechanism of formation of the hernias can be related to the collagenous tissues, under activity of aggressive agents such as the tobacco, alcohol and diabetes. Aim: To analyze the collagen present in the cremaster muscle in patients with inguinal hernias, focusing the effect of tobacco, alcohol, and diabetes. Methods: Fifteen patients with inguinal hernia divided in three groups were studied: group I (n=5) was control; group II (n=5) were smokers and/or drinkers; and group III (n=5) had diabetes mellitus. All subjects were underwent to surgical repair of the inguinal hernias obeying the same pre, intra and postoperative conditions. During surgery, samples of the cremaster muscle were collected for analysis in polarized light microscopy, collagen morphometry and protein. Results: The area occupied by the connective tissue was higher in groups II and III (p<0.05). The collagen tissue occupied the majority of the samples analyzed in comparison to the area occupied by muscle cells. The content of total protein was higher in groups II and III compared to the control group (p<0.05). Conclusion: The tobacco, alcohol and diabetes cause a remodel the cremaster muscle, leading to a loss of support or structural change in this region, which may enhance the occurrences and damage related to inguinal hernias.

RESUMO Racional: Estudos recentes sinalizam que o mecanismo de formação das hérnias pode estar relacionado aos tecidos colagenosos, sob a ação de agentes agressores como o tabaco, o álcool e o diabete. Objetivo: Avaliar o colágeno presente no músculo cremaster em pacientes com hérnias inguinais enfocando o efeito do tabaco, álcool e diabete. Métodos: Foram estudados 15 pacientes com hérnias inguinais divididos em: grupo I (n=5) controles; grupo II (n=5) indivíduos fumantes e/ou etilistas; e grupo III (n=5) indivíduos que apresentavam diabete melito. Todos foram submetidos à correção cirúrgica das hérnias inguinais obedecendo às mesmas condições pré, intra e pós-operatórias. Durante o procedimento cirúrgico, amostras do músculo cremaster foram coletadas para análises em microscopia de luz polarizada, morfometria do colágeno e de proteínas. Resultados: A área ocupada por tecido conjuntivo foi maior nos grupos II e III (p<0,05). O tecido colágeno ocupou a maior parte das amostras analisadas, em comparação à área ocupada pelas células musculares. O conteúdo de proteínas totais foi maior nos grupos II e III, quando comparado com o grupo controle (p<0,05). Conclusão: O tabaco, o álcool e o diabete ocasionam remodelação no músculo cremaster, levando à perda de suporte ou alteração estrutural nesta região, podendo intensificar as ocorrências e os danos relacionados às hérnias inguinais.

La diabetes y la alimentación determinantes en la progresión de aterosclerosis / Diabetes and type of diet as determinant factor in the progression of atherosclerosis

Resumen El propósito de esta revisión es analizar la progresión bioquímica de la placa aterosclerótica y la relación que presenta con la diabetes y la alimentación. Se exponen las evidencias científicas de pacientes con diabetes, que a diferencia de pacientes no diabéticos presentan niveles más elevados de algunos ácidos grasos en la placa de ateroma (como el palmítico, linoleico y oleico), elevada incidencia de trombosis coronaria relacionada con el incremento en el tamaño de la base necrótica y la disminución del tamaño de la capa fibrosa de los ateromas. Entre ambos grupos de pacientes se expone la diferencia en el perfil de lípidos de la placa aterosclerótica, así como los cambios celulares involucrados en la formación de la misma y la influencia de la alimentación sobre su desarrollo.

Abstract The purpose of this review is to analyze the biochemical progression of atherosclerotic plaque and its association with diet and diabetes. This study shows the scientific evidence of demonstrating that diabetic patients present high levels of fatty acids like palmitic acid and linoleic acid in their atheroma plaques in comparison with non-diabetic patients. This study also establishes how patients with diabetes mellitus have a higher prevalence of atherosclerotic heart diseases in the form of Coronary Thrombosis and have different anatomopathological appearance like higher necrotic core and thin fibrotic layer than the general population. Furthermore this review describes the different anatomopathological appearance and cellular changes involved in the formation of these plaques and how diet can affect the development of these plaques.

Diarrea crónica en el diabético: Una revisión de la literatura / Chronic diarrhea in the diabetic: A review of the literature

Desde hace más de 70 años se conoce la asociación de diarrea con diabetes mellitus. En pacientes diabéticos su prevalencia es de alrededor del 20%. Sus manifestaciones clínicas son diversas, y representa un reto diagnóstico y terapéutico. Existen ciertos diagnósticos de mayor prevalencia en pacientes diabéticos que en la población general. Las distintas etiologías relacionadas pueden ser diagnosticadas adecuadamente a través de la historia clínica y pruebas diagnósticas complementarias. Los medicamentos utilizados por el paciente diabético para el manejo de su enfermedad, frecuentemente causan diarrea crónica, por lo que se debe profundizar en los antecedentes farmacológicos al momento de estudiar la diarrea. Los pacientes diabéticos pueden presentar otras condiciones patológicas asociadas, como enfermedad celíaca o colitis microscópica, cuya molestia única es la diarrea. La función del páncreas exocrino puede estar disminuida en el paciente diabético, frecuentemente llevando a insuficiencia pancreática exocrina. Factores dietarios, como los edulcorantes libres de azúcar y otros agentes, pueden causar diarrea en el paciente diabético. La presencia de condiciones como la neuropatía autonómica y neuropatía periférica secundarias a la diabetes mellitus, pueden explicar desordenes como la disfunción anorrectal y la incontinencia fecal. Finalmente, la enteropatía diabética per se o con sobrecrecimiento bacteriano asociado, puede causar diarrea. Lograr un control glicémico adecuado constituye el pilar del tratamiento de la diarrea en el diabético, después de esto existen medidas adicionales que se aplican según el contexto especifico del paciente. En el presente artículo se revisan las causas de mayor incidencia diarrea en el paciente diabético y los mecanismos fisiopatológicos implicados

The association of diarrhea with diabetes mellitus has been known for more than 70 years. In diabetic patients its prevalence is around 20%.Its clinical manifestations are diverse, and represents a diagnostic and therapeutic challenge.There are certain diagnoses of higher prevalence in diabetic patients than in the general population.The different related etiologies can be adequately diagnosed through the clinical history and complementary diagnostic tests.The medications used by the diabetic patient to manage their disease often cause chronic diarrhea, so the pharmacological background should be studied at the time of the study of diarrhea.Diabetic patients can present other associated pathological conditions, such as celiac disease or microscopic colitis, which only discomfort is diarrhea.Exocrine pancreatic function may be decreased in the diabetic patient, frequently leading to exocrine pancreatic insufficiency. Dietary factors, such as sugar-free sweeteners and other agents, can cause diarrhea in the diabetic patient.The presence of conditions such as autonomic neuropathy and peripheral neuropathy secondary to diabetes mellitus may explain disorders such as anorectal dysfunction and faecal incontinence. Finally, diabetic enteropathy alone or with associated bacterial overgrowth can cause diarrhea.Achieving adequate glycemic control is the pillar of the treatment of diarrhea in the diabetic, after which there are additional measures that are applied according to the specific context of the patient.This article reviews the causes of higher diarrhea incidence in the diabetic patient and the pathophysiological mechanisms involved

Anti-hyperglycemic activity of Rutin in streptozotocin-induced diabetic rats: An effect mediated through cytokines, antioxidants and lipid biomarkers.

Administration of rutin (50 and 100 mg/kg) and pioglitazone (10 mg/kg) orally for 3 weeks treatment significantly improved body weight, reduced plasma glucose and glycosylated hemoglobin, pro-inflammatory cytokines (IL-6 and TNF-α), restored the depleted liver antioxidant status and serum lipid profile in high fat diet + streptozotocin induced type 2 diabetic rats. Rutin treatment also improved histo-architecture of ß islets and reversed hypertrophy of hepatocytes. Rutin exhibited significant antidiabetic activity, presumably by inhibiting inflammatory cytokines, improving antioxidant and plasma lipid profiles in High fat diet + streptozotocin induced type 2 diabetic model and may be useful as a diabetic modulator along with standard antidiabetic drugs. However, such effects need to be confirmed on human subjects in clinical condition.

Effects of ursolic acid on glucose metabolism, the polyol pathway and dyslipidemia in non-obese type 2 diabetic mice.

Ursolic acid (UA) is a pentacyclic triterpenoid compound that naturally occurs in fruits, leaves and flowers of medicinal herbs. This study investigated the dose-response efficacy of UA (0.01 and 0.05%) on glucose metabolism, the polyol pathway and dyslipidemia in streptozotocin/nicotinamide-induced diabetic mice. Supplement with both UA doses reduced fasting blood glucose and plasma triglyceride levels in non-obese type 2 diabetic mice. High-dose UA significantly lowered plasma free fatty acid, total cholesterol and VLDL-cholesterol levels compared with the diabetic control mice, while LDL-cholesterol levels were reduced with both doses. UA supplement effectively decreased hepatic glucose-6-phosphatase activity and increased glucokinase activity, the glucokinase/glucose-6-phosphatase ratio, GLUT2 mRNA levels and glycogen content compared with the diabetic control mice. UA supplement attenuated hyperglycemia-induced renal hypertrophy and histological changes. Renal aldose reductase activity was higher, whereas sorbitol dehydrogenase activity was lower in the diabetic control group than in the non-diabetic group. However, UA supplement reversed the biochemical changes in polyol pathway to normal values. These results demonstrated that low-dose UA had preventive potency for diabetic renal complications, which could be mediated by changes in hepatic glucose metabolism and the renal polyol pathway. High-dose UA was more effective anti-dyslipidemia therapy in non-obese type 2 diabetic mice.

Alterações da matriz extracelular causadas pelo diabetes: o impacto sobre a continência urinária / Changes in the extracellular matrix due to diabetes and their impact on urinary continence

A prevalência de incontinência urinária em gestantes diabéticas é significantemente elevada e persiste por até dois anos após o parto cesárea, podendo ser a sequela mais frequente da hiperglicemia gestacional comparada a outras complicações. Dessa forma, identificar os fatores de risco para o desenvolvimento da incontinência urinária em diabéticas é o principal objetivo na prevenção dessa condição tão comum. Pesquisas recentes apontam que não apenas o músculo uretral mas também a matriz extracelular uretral desempenham papel importante no mecanismo da continência urinária. Os trabalhos do nosso grupo de pesquisa evidenciaram que, em ratas, o diabetes durante a prenhez lesa a matriz extracelular e o músculo estriado uretral, o que pode explicar a alta prevalência de incontinência e disfunção do assoalho pélvico em mulheres com diabetes mellitus gestacional. O diabetes exerce efeito sobre a expressão, organização e alteração dos componentes da matriz extracelular em diversos órgãos, e a remodelação do tecido e a fibrose parecem ser uma consequência direta dele. Assim, a compreensão do impacto de fatores de risco modificáveis, como o diabetes, permitirá que, utilizando estratégias preventivas, reduzamos as taxas de incontinência urinária, bem como os custos de assistência à saúde, e melhoremos a qualidade de vida das mulheres, especialmente na gestação e no pós-parto.

The prevalence of urinary incontinence in diabetic pregnant women is significantly high two years after cesarean section. Incontinence can be the most common consequence of hyperglycemia compared to other complications. Thus, identifying the risk factors for the development of urinary incontinence in diabetes is the major aim in the prevention of this very common condition. Recent surveys have shown that not only muscle but also the urethral extracellular matrix play an important role in the mechanism of urinary continence. Translational work on rats by our research group showed that diabetes during pregnancy damages the extracellular matrix and urethral striated muscle, a fact that may explain the high prevalence of urinary incontinence and pelvic floor dysfunction in women with gestational diabetes mellitus. Diabetes affects the expression, organization and change in extracellular matrix components in different organs, and tissue remodeling and fibrosis appear to be a direct consequence of it. Therefore, understanding the impact of modifiable risk factors, such as diabetes, which involves using preventive strategies, can reduce the rates of urinary incontinence and the health care costs, and improve the quality of life of women, especially during pregnancy and postpartum.

Cetoacidosis diabética en niños menores de 15 años / Diabetic ketoacidosis in children under 15 years

Introducción: la Cetoacidosis diabética constituye un problema clínico y es la causa más común de hospitalización en los niños que presentan Diabetes Mellitus Tipo 1. Objetivo: identificar las características clínicas de la Cetoacidosis diabética en niños menores de 15 años. Métodos: se realizó un estudio descriptivo y transversal en 18 pacientes menores de 15 años ingresados en el Hospital Pediátrico "Luis Ángel Milanés Tamayo" de Bayamo, Granma, con el diagnóstico de Cetoacidosis diabética, en el período comprendido de Junio de 2006 a Junio de 2012. Se estudiaron variables como: edad, sexo, factores desencadenantes, edad de debut, dosis diaria de insulina, complicaciones agudas y crónicas. Para establecer la relación entre número de episodios por cetoacidosis y esquema de tratamiento habitual se determinó el coeficiente de contingencia c. Resultados: se observó el predominio del grupo de 9-12 años con un total de 9 casos 50,0 porciento. Los factores desencadenantes estudiados más frecuentes resultaron las transgresiones dietéticas presentes en 10 de los casos estudiados 55,55 por ciento y las omisiones del tratamiento en 8 pacientes 44,44 por ciento. La edad media de debut de la cetoacidosis fue 6,5 años DS 2,40, y la dosis media diaria de insulina por kilogramo de peso corporal fue de 0,8 unidades DS 0,23. Se presentaron complicaciones crónicas en 4 pacientes 22,22 por ciento, que incluyeron 2 casos de retinopatía y nefropatía respectivamente. Las complicaciones agudas relacionadas con el tratamiento fueron, 4 casos con hipopotasemia y 2 con edema cerebral. Conclusiones: los pacientes más afectados pertenecían al grupo de edades de 9-12 años y entre los factores desencadenantes se destacaron las transgresiones dietéticas y la omisión del tratamiento. Los episodios de cetoacidosis se asociaron con mayor frecuencia al esquema de tratamiento de tipo convencional...

Introduction: diabetic ketoacidosis is a clinical problem and it is the most common cause of hospitalization in children with Type 1 Diabetes Mellitus. Objective: to identify the clinical characteristics of diabetic ketoacidosis in children under 15 years. Methods: a descriptive cross-sectional study was conducted in 18 patients younger than 15 years admitted to the Paediatric Hospital in Bayamo, Granma, with the diagnosis of diabetic ketoacidosis, from June 2006 to June 2012. Variables such age, sex, precipitating factors, age of onset, daily insulin dose, acute and chronic complications were studied. The contingency coefficient c was determined in order to establish the relationship between the number of ketoacidosis episodes and the usual treatment. Results: the group aged 9-12 years prevailed with a total of 9 cases 50.0 percent. The most common triggers studied were dietary transgressions present in 10 of the cases studied 55.55 percent and omission of treatment in 8 patients 44.44 percent. The average age of ketoacidosis onset was 6.5 years SD 2.40, and mean daily insulin dose per kilogram of body weight was 0.8 units SD 0.23. Chronic complications in 4 patients 22.22 percent, which included 2 cases of retinopathy and nephropathy were respectively presented. Acute complications were related to treatment, 4 patients with hypokalemia and 2 with cerebral edema.Conclusions: the most affected patients were in the group aged 9-12 years and dietary transgressions and failure of treatment are highlighted among triggers. Ketoacidosis episodes were most frequently associated with conventional treatment...

relationship between the level of glutathione, impairment of glucose metabolism and complications of diabetes mellitus

To investigate whether there is a difference between the subjects with new-onset type 2 diabetes mellitus [DM], impaired glucose tolerance [IGT] and normal fasting blood glucose levels with respect to the level of glutathione [GSH] and the relationship between the presence of complication of diabetes and the level of GSH. Oral Glucose Tolerance Test [OGTT] was performed in IFG patients, with no episode of drug use, who were admitted to hospital. According to the results of the application 30 subjects with type 2 DM, 30 subjects with IGT and 28 subjects with normal blood glucose level were included in the study. Anthropometric measurements and blood pressure values of all subjects were recorded. The biochemical parameters of subjects were studied in the biochemistry laboratory by utilizing Olympus AV-2700. The subjects with diabetic retinopathy and nephropathy were established subsequent to the examination of the retina and 24-hour urine collection test performed to subjects with diagnosis of DM. Levels of GSH in all subjects were measured by enzymatic recycling method. The mean levels of GSH in subjects with DM were significantly reduced compared with IGT or normal subjects [respectively p=0.02 and p < 0.001]. Besides, lower levels of GSH were acquired in subjects with IGT compared to normal subjects [p < 0.001]. The mean levels of GSH in subjects with diabetic retinopathy were lower than the subjects with no established diagnosis of diabetic retinopathy [p < 0.001]. Similarly, lower levels of GSH [p < 0.001] were obtained in microalbuminuric subjects than normoalbuminuric subjects. At the end of the study, we came to the conclusion that GSH deficiency was of great significance in the pathogenesis of Diabetes Mellitus

Avaliação de sintomas depressivos em pessoas com diabetes mellitus e pé ulcerado / Assessment of depressive symptoms in people with diabetes mellitus and foot ulcers

OBJETIVO: Avaliar a intensidade de sintomas de depressão nos pacientes diabéticos com úlceras no pé. MÉTODOS: Estudo exploratório, descritivo, analítico e transversal, realizado no ambulatório de feridas de um hospital público, de Sorocaba/SP. Participaram 50 pacientes com diabetes mellitus e pé ulcerado. Para mensurar a intensidade dos sintomas de depressão foi utilizado o inventário de Avaliação de Depressão de Beck. RESULTADOS: Dos 50 pacientes avaliados, 41 apresentavam algum grau de sintoma depressivo, sendo que 32 (64 por cento) com depressão moderada, apresentando sintomas de autodepreciação, tristeza, distorção da imagem corporal e diminuição da libido. CONCLUSÃO: Pacientes diabéticos com pé ulcerado apresentaram graus variados de sintomas depressivos.

OBJECTIVE: To evaluate the intensity of symptoms of depression in patients with diabetic foot ulcers. METHODS: a exploratory, descriptive, analytical and cross-sectional study was held at the wound clinic of a public hospital in Sorocaba, São Paulo State, Brazil. Fifty patients with diabetes mellitus and foot ulcers were enrolled. To assess the intensity of the symptoms of depression, a Beck Depression inventory was used. RESULTS: Of the 50 patients evaluated, 41 had some degree of depressive symptoms and 32 (64 percent) had moderate depression, with symptoms of self-loathing, grief, body image distortion and decreased libido. CONCLUSION: Patients with diabetic foot ulcers showed varying degrees of depressive symptoms.

Asociación de la neuropatía autonómica cardiovascular y el intervalo QT prolongado con la morbimortalidad cardiovascular en pacientes con diabetes mellitus tipo 2 / Association of cardiovascular autonomic neuropathy and prolonged QT interval with cardiovascular morbidity and mortality in patients with type 2 diabetes mellitus

Con el objetivo de evaluar la relación entre la neuropatía autonómica cardiovascular (NACV) y el intervalo QT corregido (QTc) con la morbimortalidad cardiovascular en pacientes con diabetes mellitus tipo 2, se realizó el seguimiento a 5 años de 67 pacientes que acudieron a consulta externa del Servicio de Endocrinología. Se presentaron eventos cardiovasculares en 16 pacientes; el 82 por ciento completó el seguimiento y se encontró que el intervalo QTc prolongado fue la única variable que se asoció de forma significativa a morbimortalidad cardiovascular en el análisis de regresión logística múltiple (RR: 13,56; IC 95 por ciento: 2,01-91,36) (p=0,0074).

In order to evaluate the relationship between cardiovascular autonomic neuropathy and corrected QT interval (QTc) with cardiovascular morbidity and mortality in patients with type 2 diabetes mellitus, we followed up for 5 years 67 patients attending the outpatient Endocrinology Service. 82 percent completed follow-up and cardiovascular events occurred in 16 patients. We found that long QTc interval was the only variable significantly associated with cardiovascular morbidity and mortality in the multiple logistic regression analysis (RR: 13.56, 95 percent CI: 2.01-91.36) (p = 0.0074).

Central Corneal Thickness and Corneal Endothelial Cell Changes Caused by Contact Lens Use in Diabetic Patients

PURPOSE: To analyze the effects of soft contact lenses on central corneal thickness and morphologic characteristics of the corneal endothelium in diabetic patients. MATERIALS AND METHODS: Ultrasound pachymetry and noncontact specular microscopy were performed on 26 diabetic patients who regularly use soft contact lenses (group 1), 27 diabetic patients who do not use soft contact lenses (group 2) and 30 normal subjects (group 3). We compared the values in each group using the Mann-Whitney test. RESULTS: The central cornea was found to be thicker in diabetic patients, both those who use and do not use contact lenses, than in the normal control group. The central corneal thickness was significantly higher in group 1 (564.73 +/- 35.41 microm) and group 2 (555.76 +/- 45.96 microm) than in the control group (534.05 +/- 27.02 microm), but there was no statistically significant difference between groups 1 and 2. Endothelial cell density was significantly different between the groups, and was smallest in the group of diabetic patients using contact lenses. The coefficient of variation of cell size was significantly higher and the percentage of hexagonal cells was significantly lower in contact lens using diabetic patients than in non-contact lens using diabetic patients and in the control group. CONCLUSION: Central corneal thickness and endothelial cell density is more affected by diabetes mellitus, and corneal endothelial cell morphology is more affected by contact lens use, when compared with normal subjects.

Fatores de risco cardiovasculares em adultos jovens com hipertensão arterial e/ou diabetes mellitus / Factores de riesgo cardiovascular en adultos jóvenes con hipertensión y/o diabetes mellitus / Cardiovascular risk factors in young adults with arterial hypertension and/or diabetes mellitus

Objetivou-se investigar os fatores de risco associados em adultos jovens com hipertensão arterial e diabetes mellitus acompanhados em seis Unidades Básicas de Saúde da Família (UBASF), de Fortaleza, Ceará. Estudo descritivo e documental, desenvolvido a partir das fichas de cadastro do Programa de Atenção à Hipertensão Arterial e ao Diabetes Mellitus (HIPERDIA). A amostra é composta de 60 fichas, incluindo hipertensos, diabéticos e os que possuíam os dois diagnósticos. Os resultados mostraram maior frequência de adultos jovens do sexo feminino (78 por cento). Com relação aos fatores de risco, sobressaíram-se a hipertensão arterial (n=45), antecedentes familiares (n=33), sobrepeso (n=33) e sedentarismo (n=27). Na estratificação do risco cardiovascular, a maioria apresentou médio risco adicional para doença cardiovascular. Conclui-se que a avaliação individualizada dos fatores de risco subsidia uma ação direcionada para eventos possíveis, sendo necessários investimentos na prevenção e também na capacitação e manutenção do sistema HIPERDIA.

Se pretendió investigar los factores de riesgo en adultos jóvenes con hipertensión y diabetes mellitus en pacientes de seis Unidades Básicas de Salud Familiar (UBASF), Fortaleza, Ceará, Brasil. Estudio descriptivo y documental, desarrollado a partir de los registros de inscripción en el Programa de Atención a la Hipertensión Arterial y Diabetes Mellitus (HIPERDIA). La muestra consistió en 60 fichas, incluyendo hipertensos, diabéticos y los que poseían ambos diagnósticos. Los resultados señalaron mayor frecuencia de adultos jóvenes femeninos (78 por ciento). Mientras a los factores de riesgo, sobresalieron hipertensión (n=45), antecedentes familiares (n=33), sobrepeso (n=33) y sedentarios (n=27). En la estratificación del riesgo, la mayoría tuvo riesgo promedio para enfermedad cardiovascular. Se concluye que la evaluación individualizada de factores de riesgo subvenciona una acción dirigida a los eventos posibles, que requieren inversión en la prevención, así como en la formación y mantenimiento del sistema HIPERDIA.

In this study we aimed to investigate the risk factors associated with arterial hypertension and diabetes mellitus in young adults assisted in six Family Health Units (UBASF), of Fortaleza, Ceará, Brazil. This is a descriptive and documental study, developed based on the records of the Care Program to Arterial Hypertension and Diabetes Mellitus (HIPERDIA). The sample was composed of 60 records, including hypertensive, diabetics and patients with the two diagnoses. The results showed prevalence of young female adults (78 percent). Regarding the risk factors, arterial hypertension (n=45), family history (n=33), overweight (n=33) and sedentary lifestyle (n=27) stood out. Regarding the cardiovascular risk stratification, most presented Medium additional risk for cardiovascular disease. We concluded that the individualized evaluation of risk factors supports an action addressed for possible events, being necessary investments in prevention and also in training and maintenance of the HIPERDIA system.

Glucosilación no enzimática y complicaciones crónicas de la diabetes mellitus / Non-enzymatic glycosylation and chronic complications of diabetes mellitus

La hiperglucemia es considerada hoy como un factor patogénico fundamental del desarrollo de las complicaciones neurovasculares diabéticas y, específicamente, desempeña un papel preponderante en el fenómeno de la glucosilación no enzimática y la formación de productos finales de la glucosilación avanzada. Objetivos: describir los mecanismos de la formación de los productos finales de la glucosilación avanzada y su relación con las complicaciones de la diabetes mellitus. Desarrollo: los productos finales de la glucosilación avanzada se producen por la reacción no enzimática de la glucosa y otros derivados glucados (glioxal, metilglioxal y 3-desoxiglucosona) con grupos amino de proteínas de larga vida. La glucosilación altera la estructura, las propiedades físico-químicas y la función de las proteínas intracelulares y extracelulares. En la membrana basal de los pequeños vasos se produce un engrosamiento y una distorsión de su estructura, que ocasiona pérdida de la elasticidad de la pared vascular y una permeabilidad anormal de esta a las proteínas (disfunción endotelial), así como aumento de la génesis de especies reactivas del oxígeno. La unión de productos finales de la glucosilación avanzada a sus receptores de membrana favorece la producción citoquinas y factores de crecimiento por los macrófagos y células mesangiales. Todo lo anterior favorece al desarrollo de aterosclerosis. Los productos finales de la glucosilación avanzada desempeñan un importante papel en el desarrollo de las complicaciones microvasculares y macrovasculares en el diabético. El control metabólico estricto de la glucemia y, en la actualidad, la terapéutica farmacológica con agentes que inhiben la formación de productos finales de la glucosilación avanzada o tienen acción antioxidante, constituyen alternativas terapéuticas para la prevención y solución del problema de las complicaciones crónicas de la diabetes mellitus(AU)

Hyperglycemia is nowadays considered as a fundamental pathogenic factor for development of diabetic neurovascular complications and, specifically, plays a prevailing role in phenomenon of non-enzymatic glycosylation and the formation of end-products of advanced glycosylation. Objetives: to describe the mechanisms of end-products of advanced glycosylation and its relation to complications of diabetes mellitus. The above mentioned end-products are produced by the non-enzymatic reaction of glucose and other derivatives including glioxal, methylglioxal and 3-desoxiblucosone with amines groups of long-life proteins. The glycosylation changes the structure, the physical-chemical properties and the function of intracellular and extracellular proteins. In basal membrane of small vessels it is produced a thickening and a structure distortion provoking the elasticity of the vascular wall and its abnormal permeability to proteins (endothelial dysfunction), as well as an increase of genesis of oxygen-reactive species. The link of end-products of advanced glycosylation with its membrane receptors favor the production of cytokines and growth factors by macrophages and mesangial cells. All above mentioned favor the development of atherosclerosis. The end-products of advanced glycosylation play a significant role in the development of microvascular and macrovascular complications in the diabetic patient. The strict metabolic control of glycemia and at present time, the pharmacologic therapeutics including agents inhibiting the formation of end-products of the advanced glycosylation have antioxidant action or are therapeutical alternatives for prevention and solution of the problem related to chronic complications of diabetes mellitus(AU)

Uso de hipoglicemiantes e adesã à terapia por pacientes diabéticos atendidos no Sistema Único de Saúde / Use of oral hypoglycemic agents and adherence to therapy by diabetics in the Brazilian Unified Health System

Introdução: A incidência de Diabetes Melito atinge proporções epidêmicas fazendo com que sua prevenção seja uma prioridade de saúde pública. Programas de Atenção Farmacêutica vêm se destacando como instrumentos no cuidado dos pacientes diabéticos. Objetivo: Avaliar o uso de hipoglicemiantes e a adesão à terapia por pacientes diabéticos atendidos pelo Sistema Único de Saúde. Métodos: Foi realizado um estudo transversal. Utilizou-se um questionário farmacoterapêutico e avaliaram-se os valores de glicemia capilar, colesterol, triglicerídeos, hemoglobina glicada, pressão arterial e índice de massa corporal. Foi avaliada a existência dos Problemas Relacionados com Medicamentos. Resultados: Foram entrevistados 52 pacientes diabéticos, com idade média de 69,2±10,8 anos para as mulheres e 67,8 ±10,9 anos para os homens. Os valores de hemoglobina glicada mostraram diferença significativa (P<0,001) entre os sexos e o índice de massa corporal mostrou-se acima dos valores normais. Verificou-se que 51,9% dos pacientes utilizava mais de 5 medicamentos e 48,1% eram pouco aderentes à terapia. Encontrou-se 21 potenciais interações medicamentosas. Conclusão: Este estudo mostra a relevância do acompanhamento farmacoterapêutico à pacientes diabéticos e a importância do comprometimento de toda a equipe de saúde para desenvolver e acompanhar o plano terapêutico desses pacientes.

Background: The incidence of diabetes mellitus has reached epidemic proportions; therefore, its prevention is a public health priority in our days. Pharmaceutical care programs have gained prominence as a tool in the care of diabetic patients. Aim: To evaluate the use of hypoglycemic agents as well as the adherence to therapy by diabetic patients receiving treatment from the Brazilian Unified Health System. Methods: We conducted a cross-sectional study. A pharmacotherapeutic questionnaire was administered and values of capillary blood glucose, cholesterol, triglycerides, glycated hemoglobin, blood pressure, and body mass index were assessed. We evaluated the existence of drug related problems and drug interactions. Results: Fifty-two diabetic patients were interviewed with a mean age of 69.2±10.8 for women and 67.8±10.9 for men. Glycated hemoglobin levels showed significant difference (P<0.001) between men and women, body mass index was found to be above normal. The analysis of the drugs showed that 51.9% of the patients used more than five drugs and 48.1% of the patients were poorly adherent to therapy. We found 21 potential drug interactions. Conclusion: The present study demonstrates the relevance of the pharmaceutical follow-up of patients with diabetes; thus, the commitment of the entire health care team to develop and monitor the treatment of these patients is very important.