Impacto en la calidad de vida de los adolescentes con diabetes mellitus tipo 1 / Impact on the quality of life of adolescents with diabetes mellitus type 1

INTRODUCCIÓN: La diabetes mellitus tipo 1 (DM1) es una enfermedad que se perfila para toda la vida. OBJETIVO: Identificar evidencia científica sobre el impacto de la DM1 en la calidad de vida de los adolescentes portadores de esta enfermedad. MÉTODO: Revisión sistemática en las bases bibliografías MEDLINE, LILACS, CINAHL y ScIELO, utilizando los descriptores "Adolescent*", "Teen*", "Diabe tes Mellitus, Type1", "Diabetes, type 1", "Type 1 diabetes", "Quality of life", "Health related quality of life", "Life quality", "Health impact assessment", "Health impact", "Impact assessment, health", "Diabetes Impact Measurement Scales", "PedsQL", "Glycated Hemoglobin A1c", "Glycosylated He moglobin A1c", y "HbA1c". De los 679 artículos localizados, 25 fueron incluidos en el análisis. Al gunos estudios fueron multicéntricos nacionales e internacionales. Los instrumentos más utilizados, relativos a las mediciones de la calidad de vida, fueron el Cuestionario de Calidad de Vida Pediátrica (PedsQL) en su versión genérica y módulo diabetes. RESULTADOS: La calidad de vida evaluada por el adolescente que padece DM1 mediante Escalas de calidad de vida, está significativamente e inversa mente asociada a los valores de HbA1c. Esta vinculación se extiende a una correlación significativa entre los puntajes genéricos totales de calidad de vida y HbA1c, pero no tiene la misma repercusión en los puntajes específicos. CONCLUSIONES: El control metabólico se establece como la piedra angular que incide en el impacto en la relación DM1 y calidad de vida; vinculación que se vislumbra como bidireccional, aunque no se evidencia un consenso absoluto sobre los tipos de factores y los grados que influirían en el control metabólico.

INTRODUCTION: Type 1 diabetes mellitus (DM1) is a chronic disease. OBJECTIVE: To identify scientific evidence on the impact of DM1 on the quality of life of adolescents with this disease. METHOD: Sys tematic review in the bibliographic databases MEDLINE, LILACS, CINAHL, and ScIELO, using the following descriptors: "Adolescent *", "Teen *", "Diabetes Mellitus, Type1", "Diabetes, type 1", "Type 1 diabetes", "Quality of life", "Health related quality of life", "Life quality", "Health impact assessment", "Health impact", "Impact assessment, health", "Diabetes Impact Measurement Scales", "PedsQL", "Glycated Hemoglobin A1c", "Glycosylated Hemoglobin A1c", and "HbA1c". Out of 679 articles identified, 25 were included in the analysis. Some studies were national and international multicenter. The most widely used instruments related to quality of life measurements were the Pediatric Quality of Life Questionnaire (PedsQL) in its generic version and the diabetes module. RESULTS: The quality of life assessed by the adolescent with DM1 using Quality of Life Scales is significantly and inversely associated with HbA1c values. This association includes a significant correlation between the total generic quality of life scores and HbA1c but does not have the same impact on specific sco res. CONCLUSIONS: Metabolic control appears to be the cornerstone that influences the impact on the bidirectional relationship between DM1 and quality of life, however, there is no absolute consensus on the types of factors and degrees that would influence metabolic control.

Different amounts of moderate to vigorous physical activity and change in glycemic variability in adolescents with type 1 diabetes: is there dose-response relationship?

ABSTRACT Objective To identify the level of physical activity and glycemic variability of adolescents with type 1 diabetes mellitus and to compare glycemic variability on days with different amounts of moderate to vigorous physical activity (MVPA). Subjects and methods A sample of 34 subjects aged 10 to 15 years, 18 (52.94%) female; age: 13.04 ± 1.94; HbA1c: 9.76 ± 1.51. Physical activity was measured by wGT3X accelerometer. The glucose data were obtained using continuous glucose monitoring, and the following glycemic variability measures were calculated: standard deviation (SD), low blood glucose index (LBGI), high blood glucose index (HBGI), mean amplitude of glycemic excursions (MAGE), glycemic risk assessment in diabetes equation (GRADE) and coefficient of variation (CV). The most and least active days (the days with greater and lesser time dedicated to physical activities of moderate to vigorous intensity, respectively) were identified. In addition, based on the whole period of accelerometer use, daily means of time spent in MVPA were identified among participants, who were then divided into three groups: up to 100 minutes; from 101 to 200 minutes and above 201 minutes. Then, the measures of glycemic variability were compared among the most and least active days and among the groups too. Results The amount of MVPA was significantly different between the days evaluated (237.49 ± 93.29 vs. 125.21 ± 58.10 minutes), but glycemic variability measures did not present a significant difference. Conclusion Despite the significant differences in the amount of MVPA between the two days evaluated, the glycemic variability did not change significantly. Arch Endocrinol Metab. 2020;64(3):312-8

Stiffness degree of ankle range of motion in diabetic patients with atypical amputation

SUMMARY In diabetics, foot deformities are risk factors that increase the risk of amputation as a result of developing ulcers. However, knowledge of the influence of plantar stiffness is still limited. The main objective was to describe connections between the degree of stiffness of the ankle, atypical amputation, and the Foot Posture Index (FPI). METHODS 62 diabetic patients, 58 with type 2 and 4 with type 1 (average age 63.35 years) were included. Records of foot deformities were included; A range of motion test of the ankle joint was used to determine the degree of stiffness. An exploratory analysis of the association of foot position and the degree of rigidity was performed. RESULTS The dorsal flexion range of the ankle was 9.6 ± 5.1 0, 13.8 ± 5.9 0 and 17.2 ± 6.5 0 and 20.5 ± 6.8 0 to 45, 67, 89 and 111 N respectively in the amputated feet., And 14 patients (22.58%) had a high level of pronation of IPF with an average value of 3.7 ± 2.629, CI (3.032.-4.367) in amputated feet compared to non-amputees. We use the device "Iowa ankle range of motion" (IAROM) to determine the differences in ankle stiffness. Proper IPF was associated with the presence of amputation and an increase in stiffness CONCLUSIONS There was an increase in the degree of limitation of movement of the ankle, as a greater force was applied. Comparing FPI between the groups, there was a higher frequency of prone feet in the group of amputees

RESUMO Nos diabéticos, as enfermidades nos pés são fatores de risco, que aumentam o risco de sofrerem uma amputação, como resultado do desenvolvimento de úlceras. Contudo, o conhecimento sobre a influência da rigidez plantar ainda é limitado. O objetivo principal foi descrever conexões entre o grau de rigidez do tornozelo, a amputação atípica e o Foot Posture Index (FPI). MÉTODOS 62 diabéticos, 58 com tipo 2; e 4 com tipo 1 (idade média de 63.35 anos). Incluindo o registro de deformidades do pé; teste de classificação do movimento da articulação do tornozelo, para determinar o grau de rigidez. Realizou-se uma análise exploratória da associação da posição do pé com o grau de rigidez. RESULTADO A classificação de flexão dorsal do tornozelo foi de 9.6 ± 5.1 0, 13.8 ± 5.9 0 e de 17.2 ± 6.5 0 e 20.5 ± 6.8 0 a 45, 67, 89 e 111 N respectivamente nos pés amputados, e 14 pacientes (22.58%) teve alto nível de pronação de FPI com um valor médio de 3.7 ±2.629, IC(3.032.-4.367) em pés amputados com relação aos não amputados. Utilizamos o dispositivo "Iowa ankle range of motion" (IAROM) para determinar as diferenças de rigidez do tornozelo. O FPI pronado foi associado à presença de amputação e um aumento da rigidez. CONCLUSÕES Aumento do grau de limitação do movimento do tornozelo; à medida que se aplicava uma força maior. Comparando FPI entre os grupos existentes maior frequência de pés pronados no grupo de amputados.

Evaluation of Electrocardiographic Ventricular Depolarization and Repolarization Variables in Type 1 Diabetes Mellitus / Avaliação de Variáveis Eletrocardiográficas de Despolarização e Repolarização Ventricular em Diabetes Mellitus Tipo 1

Abstract Background: The risk of cardiovascular events and sudden death increases with type 1 diabetes mellitus (T1DM). Objective: To evaluate electrocardiographic markers of arrhythmias in T1DM patients. Methods: Electrocardiographic parameters reflecting ventricular depolarization and repolarization, namely, QT, QTc, QTd, QTdc, Tp-e, JT, and JTc intervals and Tp-e/QT and Tp-e/QTc ratios, of 46 patients diagnosed with T1DM were retrospectively analyzed and compared with 46 healthy age-, sex-, and body mass-matched controls. Correlations between T1DM duration, hemoglobin A1c (HbA1c), and ventricular repolarization variables were analyzed. P values lower than 0.05 were considered statistically significant. Results: Diabetes duration was 16.6 ± 7.1 years, and HbA1c was 10.81% ± 3.27% in the T1DM group. In comparison with the control group, heart rate, QTc, QTd, QTdc, Tp-e and JTc intervals, Tp-e/QT ratio (p < 0.001), and Tp-e/QTc ratio (p = 0.007) were significantly higher in T1DM patients. T1DM duration and HbA1c levels were significantly correlated with QTc, QTd, QTdc, Tp-e, and JTc intervals and Tp-e/QT and Tp-e/QTc ratios. Conclusions: In T1DM patients, potential electrocardiographic repolarization predictors were significantly increased in correlation with disease duration and HbA1c levels. These findings may contribute to the understanding of sudden cardiac death in patients with T1DM.

Resumo Fundamento: O risco de eventos cardiovasculares e morte súbita aumenta com diabetes mellitus tipo 1 (DM1). Objetivo: Avaliar alguns marcadores eletrocardiográficos de arritmias em pacientes com DM1. Métodos: Parâmetros eletrocardiográficos que refletem despolarização e repolarização ventricular, a saber, os intervalos QT, QTc, QTd, QTdc, Tp-e, JT e JTc e as relações Tp-e/QT e Tp-e/QTc, de 46 pacientes diagnosticados com DM1 foram retrospectivamente analisados e comparados com 46 controles saudáveis, pareados por idade, sexo e massa corporal. As correlações entre duração de DM1, HbA1c e variáveis de repolarização ventricular foram analisadas. Foram considerados estatisticamente significativos os valores de p inferiores a 0,05. Resultados: A duração de diabetes foi de 16,6 ± 7,1 anos, e HbA1c foi 10,81% ± 3,27% no grupo DM1. Em comparação com o grupo controle, a frequência cardíaca, os intervalos QTc, QTd, QTdc, Tp-e e JTc, a relação Tp-e/QT (p < 0,001) e a relação Tp-e/QTc (p = 0,007) foram significativamente mais altos em pacientes com DM1. A duração de DM1 e os níveis de HbA1c foram significativamente correlacionados com os intervalos QTc, QTd, QTdc, Tp-e e JTc e com as relações Tp-e/QT e Tp-e/QTc. Conclusões: Em pacientes com DM1, potenciais preditores eletrocardiográficos de repolarização foram significativamente aumentados em correlação com a duração da doença e com os níveis de HbA1c. Estes achados podem contribuir à compreensão da morte súbita cardíaca em pacientes com DM1.

Análise das emissões otoacústicas transitórias por banda de frequência em adolescentes com diabetes mellitus tipo 1 / Transient otoacoustic emissions analysis by frequency bands in adolescents with type 1 diabetes mellitus

Introdução: A associação entre perda auditiva e Diabetes Mellitus tipo 1 (DM1) é ainda pouco estudada. A perda auditiva é uma das complicações crônicas relacionadas ao grau de controle glicêmico, que os pacientes podem apresentar com a progressão da doença. Objetivo: Investigar o comprometimento auditivo por meio das emissões otoacústicas transitórias (EOAT) por banda de frequência em adolescentes com DM1 e relação com o controle glicêmico. Métodos: Foram incluídos 80 adolescentes, 50% do gênero masculino, entre 10 e 19 anos de idade: 40 com DM1 e 40 controles saudáveis, pareados por gênero e idade. Os dados clínicos e laboratoriais foram pesquisados nos prontuários médicos. O controle glicêmico foi avaliado por meio dos exames de hemoglobina glicada e os pacientes com DM1 analisados de acordo com o controle glicêmico. A avaliação auditiva foi realizada por meio da imitanciometria, audiometria, e posteriormente EOAT, em sala tratada acusticamente, pelo protocolo "TE Test" de clique não-linear (1 KHz a 4 kHz) a 80 dB NPS de intensidade (AuDX - Biologic). Resultados: As respostas às EOAT foram ausentes em 5,12% em pacientes com DM1, com diferença significativa em relação aos controles (p=0,04). A análise das EOAT por bandas de frequência mostrou maior proporção de alteração nos adolescentes com DM1 mal controlados quando comparados aos bem controlados, nas frequências de 1000Hz, 2000Hz e 3000Hz (p<0,05). Conclusão: As EOAT por bandas de frequência permitiram a identificação precoce de comprometimento auditivo em adolescentes com DM1 e mostraram associação entre DM1 mal controlado e perda auditiva. (AU)

Introduction: The association between hearing loss and type 1 diabetes mellitus (DM1) is still poorly studied. Hearing loss is one of the chronic complications related to the degree of glycemic control that patients may present with the progression of the disease. Objective: To investigate auditory impairment through transient otoacoustic emissions (TEOAE) by frequency band in adolescents with DM1 and in relation to glycemic control. Methods: Were included 80 adolescents, 50% males, between 10 and 19 years of age: 40 with DM1 and 40 healthy controls, matched by gender and age. Clinical and laboratory data were taken from the medical records. Glycemic control was evalueted by glycated hemoglobin and the patients with DM1 were analyzed according to glycemic control. To the auditory evaluation were used the immittance and audiometry, and the TEOAE. The test was performed in the acoustically treated room, the non-linear TE test protocol (1 KHz to 4 kHz) at 80 dB SPL (AuDX - Biologic ). Results: TEOAE responses were absent in 5.12% of patients with DM1, with a significant difference in relation to controls (p = 0.04). The analysis of TEOAE by frequency bands showed a higher proportion of alteration in adolescents with DM1 poorly controlled when compared to well controlled ones, in the frequencies of 1000Hz, 2000Hz and 3000Hz (p <0.05). Conclusion: TEOAE by frequency bands allowed the early identification of auditory impairment in adolescents with DM1 and showed an association between poorly controlled DM1 and hearing loss. (AU)

The Effect of Garlic and Voluntary Exercise on Cardiac Angiogenesis in Diabetes: The Role of MiR-126 and MiR-210 / O Efeito do Alho e de Exercícios Físicos Voluntários na Angiogênese Cardíaca no Diabetes: O Papel do miRNA-126 e do miRNA-210

Abstract Background: Diabetes mellitus (DM) is one of the major risk factors for cardiovascular disease, leading to endothelial dysfunction and angiogenesis impairment . MiR-126 and miR-210 support angiogenic response in endothelial cells. Objective: The present study sought to explore the effect of garlic and voluntary exercise, alone or together, on miR-126 and miR-210 expressions and cardiac angiogenesis in rats with type 1 diabetes. Methods: Male Wistar rats were divided into five groups (n = 7): Control, Diabetes, Diabetes+Garlic, Diabetes+Exercise, and Diabetes+Garlic+Exercise. Diabetes was induced in the animals by streptozotocin (ip, 50 mg/kg). The rats were then fed raw fresh garlic homogenate (250 mg/kg) or were subjected to voluntary exercise, or to combined garlic and voluntary exercise for 6 weeks. MiR-126 and miR-210 expressions in the myocardium were determined by real time PCR, and the serum lipid profile was measured by enzymatic kits. Angiogenesis was evaluated by immunostaining for PECAM-1/ CD31 in the myocardium. Results: Diabetes reduced both cardiac miR-126 expression and angiogenesis (p < 0.05). On the other hand, there was a miR-210 expression increase in the myocardium of diabetic animals (p < 0.001). However, those effects reversed either with garlic or voluntary exercise (p < 0.01). Moreover, treating diabetic rats with garlic and voluntary exercise combined had an additional effect on the expressions of miR-126 and miR-210 (p < 0.001). Furthermore, both voluntary exercise and garlic significantly improved serum lipid profiles (p < 0.001). Conclusion: The induction of diabetes decreased angiogenesis in the myocardium, whereas our treatment using long-term voluntary exercise and garlic improved myocardial angiogenesis. These changes were possibly owing to the enhancement of myocardial miR-126 and miR-210 expressions.

Resumo Fundamento: O diabetes mellitus (DM) é um dos principais fatores de risco para doenças cardiovasculares, levando à disfunção endotelial e inibição da angiogênese. O miRNA-126 e o miRNA-210 promovem a resposta angiogênica em células endoteliais. Objetivo: O presente estudo buscou explorar o efeito do alho e de exercícios físicos voluntários, isoladamente ou em conjunto, nas expressões do miRNA-126 e do miR-210 e na angiogênese cardíaca em ratos com diabetes tipo 1. Métodos: Ratos Wistar machos foram divididos em cinco grupos (n = 7): Controle, Diabetes, Diabetes+Alho, Diabetes+Exercícios e Diabetes+Alho+Exercícios. Introduziu-se diabetes nos animais por estreptozotocina (ip, 50 mg/kg). Os ratos foram então alimentados com homogenato de alho fresco cru (250 mg/kg), ou foram submetidos a exercícios voluntários, ou a uma combinação de alho e exercícios voluntários, durante 6 semanas. As expressões do miRNA-126 e do miRNA-210 no miocárdio foram determinadas por PCR em tempo real, e o perfil lipídico sérico foi medido por kits enzimáticos. A angiogênese foi avaliada por imunocoloração por PECAM-1/CD31 no miocárdio Resultados: O diabetes reduziu a expressão do miRNA-126 cardíaco e da angiogênese (p < 0,05). Por outro lado, houve um aumento da expressão do miRNA-210 no miocárdio dos animais diabéticos (p < 0,001). No entanto, tais efeitos foram revertidos com alho ou exercícios voluntários (p < 0,01). Além disso, o tratamento de ratos diabéticos conjuntamente com alho e exercícios voluntários teve um efeito adicional sobre as expressões do miRNA-126 e do miRNA-210 (p < 0,001). Além disso, tanto os exercícios voluntários quanto o alho melhoraram significativamente os perfis lipídicos séricos (p < 0,001). Conclusões: A indução de diabetes diminuiu a angiogênese no miocárdio, enquanto nosso tratamento com exercícios voluntários de longa duração e alho melhorou a angiogênese miocárdica. Estas alterações devem-se, possivelmente, ao aumento das expressões do miRNA-126 e do miRNA no miocárdio.

Translation and validation of Pediatric Quality of Life InventoryTM 3 0 Diabetes Module (PedsQLTM 3 0 Diabetes Module) in Brazil-Portuguese language / Tradução e validação do Pediatric Quality of Life InventoryTM 3 0 Diabetes Module (PedsQLTM 3 0 Diabetes Module) para a língua portuguesa do Brasil

Abstract Objective: The aim of the present study was to create a translated version of the Pediatric Quality of Life InventoryTM 3.0 Diabetes Module (PedsQLTM 3.0 Diabetes Module) in Brazilian Portuguese that was conceptually equivalent to the original American English version and to linguistically validate it in a Brazilian pediatric population with type 1 diabetes mellitus and their parents or caregivers. Methods: The instrument was translated, back-translated, and then administered to 83 children/adolescents (5-18 years) with type 1 diabetes mellitus and their family members and to 25 parents/caregivers of patients aged between 2 and 4 years. The final translated version was tested for reliability by analyzing internal consistency, intraobserver (test-retest) reliability, and concurrent validity. Results: Cronbach's alpha coefficient for the total score of the questionnaires of children/adolescents (α = 0.85) and their parents (α = 0.82) was above the recommended minimum of 0.70 for group comparisons. Intraobserver reliability and concurrent validity exhibited a significant positive correlation (p < 0.001), indicating the reliability of the translated instrument. A moderate but significant positive correlation (r = 0.40; p < 0.001) was demonstrated between the total scores of patient self-report and parent proxy-report scales. There was no significant correlation between glycated hemoglobin (HbA1c) levels and the respective scores in the questionnaires answered by patients and their parents/caregivers. Conclusion: The analysis of the translated version of the PedsQLTM 3.0 Diabetes Module revealed adequate psychometric characteristics with respect to reliability and validity following administration to a sample of Brazilian children/adolescents with type 1 diabetes mellitus and their caregivers.

Resumo Objetivo: Produzir uma versão do questionário Pediatric Quality of Life InventoryTM 3.0 Diabetes Module (PedsQLTM 3.0 Diabetes Module) para a língua portuguesa do Brasil, que fosse conceitualmente equivalente à versão original em inglês, e proceder à sua validação linguística numa população pediátrica brasileira portadora de diabetes mellitus tipo 1 (DM1) e seus pais ou cuidadores. Métodos: A tradução do instrumento foi feita pela metodologia de tradução-tradução reversa, foi aplicado a 83 crianças/adolescentes (5-18 anos) portadores de diabetes mellitus tipo 1 com seus parentes e a 25 pais/cuidadores de pacientes entre 2 e 4 anos de idade. A confiabilidade da versão traduzida foi avaliada pelas seguintes análises: consistência interna, confiabilidade teste-reteste e validade concorrente. Resultados: O coeficiente alfa de Cronbach para a pontuação total do questionário das crianças/adolescentes (α = 0,85) e seus pais (α = 0,82) excedeu o mínimo recomendado 0,70 para comparação entre grupos. Na confiabilidade intraobservador e validade concorrente observou-se correlação positiva e estatisticamente significativa (p < 0,001), indicou a fidedignidade do instrumento traduzido. Na comparação entre os escores totais obtidos por pais/cuidadores e crianças/adolescentes, houve uma correlação positiva, pequena, mas significativa (r = 0,40; p < 0,001). Não houve correlações estatisticamente significativas entre os níveis de hemoglobina glicada e os escores obtidos nos questionários respondidos pelos pacientes e seus pais/cuidadores. Conclusão: As análises do instrumento PedsQLTM 3.0 Módulo Diabetes demonstraram propriedades psicométricas adequadas em termos de confiabilidade e validade quando aplicado nessa amostra de crianças/adolescentes brasileiros portadores de DM tipo 1 e seus cuidadores.

Modulación de marcadores de inflamación y estrés oxidativo en pacientes con diabetes tipo 1 y sobrepeso que participan en un programa de cambio de estilo de vida / Modulation of Inflammatory and oxidative stress markers in overweight type 1 Diabetes patients participating in a lifestyle change program

Introduction: Reduction in the expression of inflammatory markers and oxidative stress associated with exercise will protect against cardiovascular complications in Diabetes Mellitus (DM). Aim: The aim of this study was evaluated cardiovascular fitness (VO2 Max), interleukin-6 (IL-6), monocyte chemo-attractant protein 1 (MCP-1) and serum lipid peroxidation (TBARS) in overweight patients with Type-1 diabetes (T1DM) participating in a lifestyle-change program. Results: 20 T1DM overweight patients (43.3 ± 13.8 years), with BMI= 29.6 ± 3.5 kg/m2 , initial HbA1c 7.9 ± 0.91% and treated with multiple insulin injections, were included in this work. The lifestyle-change program consisted of: a) walking 10,000 steps/day, b) sequence of exercises of 24 minutes, 3-5 times/week, c) ¨healthy-plate¨ (and counting carbohydrates, and d) prandial insulin as blood-glucose levels. VO2 max, HbA1c, TBARS, IL6, MCP-1 were determined before starting the lifestyle-change program. Six months of adherence later, participants showed an average number of steps of 8242 ± 1834, a significant increase in VO2 max, (33.4 ±1.3 vs 36.2 ±1.5 ml.Kg-1.min-1 p= 0.008), a significant decrease in serum MCP-1 (314 ±42 vs 235 ±43 MFI p= 0.02), and less TBARS (3.01 ±0.44 vs 2.12 ±0.22 µmol/mL p= 0.015). IL-6 and HbA1c showed no significant decrease. Conclusion: Our results showed that a 6-month systemized and simple exercise plan improves cardiorespiratory fitness (VO2 max), and reduces both circulating oxidative stress and inflammation markers in overweight patients with T1DM.

Introducción: La reducción en la expresión de marcadores inflamatorios y de estrés oxidativo asociado con el ejercicio podría proteger contra las complicaciones cardiovasculares de la diabetes mellitus (DM). Objetivo: El objetivo de este estudio fue evaluar en pacientes con DM tipo1 (DMT1) y sobrepeso, la capacidad cardiorespiratoria (VO2 Max), la expresión sérica de marcadores inflamatorios (IL-6 y MCP-1) y la peroxidación lipídica sérica (TBARS), luego de participar por 6 meses de un programa de cambios de estilo de vida. Resultados: Veinte pacientes adultos (43.3 ± 13.8 años), de ambos sexos, con un Índice de Masa Corporal de 29.6 ± 3.5 kg/m2 , HbA1c inicial de 7,9% ± 0,91, en tratamiento con inyecciones múltiples de insulina participaron del estudio. Se indicó: 1) caminar 10.000 pasos/día, 2) realizar en domicilio una secuencia de ejercicios de 20 minutos, 3-5 veces/semana, 3) plato saludable (consumo de 1 fruta antes de las 3 comidas principales), 4) Insulina prandial según glucemia y conteo de carbohidratos. Se registraron parámetros antropométricos, presión arterial, se determinó VO2 max, y se midieron los niveles séricos de HbA1c, IL6, MCP-1 y TBARs. Luego de seis meses, los participantes alcanzaron un número promedio de pasos de 8242 ± 1834 y mostraron un aumento significativo en VO2 max, (33.4 ±1.3 vs 36.2 ±1.5 ml.Kg-1.min-1 p= 0.008). Además, se encontró una disminución significativa de MCP-1 (314 ±42 vs 235 ±43 MFI p=0.02) y TBARs (3.01 ±0.44 vs 2.12 ±0.22 µmol/mL p= 0.015) en comparación con el día 0. No se observaron modificaciones en los niveles de IL-6 y HbA1c. Conclusión: Nuestros resultados demuestran que el ejercicio, implementado como un plan accesible y acompañado, es adecuado para reducir los riesgos de inflamación y estado pro-oxidativo en pacientes con DM tipo1.

Influence of Type 1 Diabetes on the Symbolic Analysis and Complexity of Heart Rate Variability in Young Adults / Influência do Diabetes Tipo 1 na Análise Simbólica e Complexidade da Variabilidade da Frequência Cardíaca em Jovens Adultos

Abstract Background: Type 1 diabetes mellitus can cause autonomic changes, which can be assessed by heart rate variability. Among the heart rate variability assessment methods, the symbolic analysis and Shannon entropy, based on the Chaotic dynamics, have gained prominence. Objective: To compare heart rate variability indexes, obtained through symbolic analysis and Shannon entropy, in young adults with type 1 diabetes mellitus and healthy young individuals, associated with the analysis of linear indexes; and to verify if there are associations between the indexes obtained by the symbolic analysis and by Shannon entropy and linear indexes in diabetic individuals. Methods: Heart rate variability data from 39 young adults with type 1 diabetes mellitus and 43 healthy young individuals were analyzed, using a cardio-frequency meter. Linear indexes (standard deviation of all normal RR intervals recorded in a time interval expressed in milliseconds; square root of the mean of the squared differences between adjacent normal RR intervals in a time interval expressed in milliseconds; low and high frequency components in millisecond squared; and normalized units and ratio between low and high frequency components) and nonlinear ones (Shannon entropy and symbolic analysis - standard without variation; with one or two variations; and with two different variations) of the heart rate variability were calculated. The statistical significance was set at 5%, and the confidence interval was 95%. Results: Significantly lower values were observed in the DM1 group compared to healthy young adults for the standard deviation indexes of all normal RR intervals recorded in a time interval [37.30 (29.90) vs. 64.50 (36.20); p = 0.0001], square root of the mean of the squared differences between adjacent normal RR intervals in a time interval [32.73 (17.43) vs. 55.59 (21.60); p = 0.0001], low frequency component [402.00 (531.00) vs. 1,203.00 (1,148.00); p = 0.0001], high frequency component [386.00 (583.00) vs. 963.00 (866.00); p = 0.0001] and the pattern with two different variations [15,33 (9,22) vs. 20.24 (12.73); p = 0.0114], with the effect of this difference being considered large (standard deviation of all normal RR intervals recorded in a time interval, square root of the mean of the squared differences between adjacent normal RR intervals in a time interval and low frequency component), medium (high frequency component) and small (standard with two different variations). The agreement of the associations between the linear and non-linear indexes was considered elevated for the high frequency component index - normalized units (r = -0.776), with the standard index without variation, and moderate for the indexes square root of the mean of the squared differences between adjacent normal RR intervals in a time interval (r = 0.550), standard deviation of all normal RR intervals recorded in a time interval (r = 0.522), high frequency component - normalized units (r = 0.638) with the index standard with two similar variations, as well as for the indexes square root of the mean of the squared differences between adjacent normal RR intervals in a time interval (r = 0.627) and high frequency component - normalized units (r = 0.601) with the index standard with two different variations. Conclusion: Type 1 diabetes mellitus influenced linear indexes and symbolic analysis, but not yet in the complexity of heart rate variability. Additionally, heart rate variability indexes correlated with the symbolic dynamics.

Resumo Fundamento: O diabetes melito tipo 1 pode promover alterações autonômicas, que podem ser avaliadas pela variabilidade da frequência cardíaca. Dentre os métodos da variabilidade da frequência cardíaca, têm ganhado destaque a análise simbólica e a entropia de Shannon, baseadas na dinâmica do caos. Objetivo: Comparar índices da variabilidade da frequência cardíaca obtidos por meio da análise simbólica e da entropia de Shannon, entre jovens com diabetes melito tipo 1 e jovens saudáveis, associados à análise de índices lineares; e verificar se há associações entre os índices obtidos pela análise simbólica e pela entropia de Shannon e índices lineares em indivíduos diabéticos. Métodos: Foram analisados dados da variabilidade da frequência cardíaca de 39 jovens com diabetes melito tipo 1 e 43 jovens saudáveis, obtidos por meio de um cardiofrequencímetro. Foram calculados os índices lineares (desvio padrão de todos os intervalos RR normais gravados em um intervalo de tempo expresso em milissegundo; raiz quadrada da média do quadrado das diferenças entre intervalos RR normais adjacentes em um intervalo de tempo expresso em milissegundo; componentes de baixa e alta frequência, em milissegundo ao quadrado; e unidades normalizadas e razão entre componente de baixa e alta frequência) e não lineares (entropia de Shannon e análise simbólica - padrão sem variação; com uma ou duas variações; e com duas variações diferentes) da variabilidade da frequência cardíaca. A significância estatística adotada foi fixada em 5%, e o intervalo de confiança em 95%. Resultados: Foram observados valores significativamente menores no Grupo DM1 em comparação aos jovens saudáveis para os índices desvio padrão de todos os intervalos RR normais gravados em um intervalo de tempo [37,30 (29,90) vs. 64,50 (36,20); p = 0,0001], raiz quadrada da média do quadrado das diferenças entre intervalos RR normais adjacentes em um intervalo de tempo [32,73 (17,43) vs. 55,59 (21,60); p = 0,0001], componente de baixa frequência [402,00 (531,00) vs. 1.203,00 (1.148,00); p = 0,0001], componente de alta frequência [386,00 (583,00) vs. 963,00 (866,00); p = 0,0001] e padrão com duas variações diferentes [15,33 (9,22) vs. 20,24 (12,73); p = 0,0114], sendo o efeito desta diferença considerado grande (desvio padrão de todos os intervalos RR normais gravados em um intervalo de tempo, raiz quadrada da média do quadrado das diferenças entre intervalos RR normais adjacentes em um intervalo de tempo e componente de baixa frequência), médio (componente de alta frequência) e pequeno (padrão com duas variações diferentes). A concordância das associações entre os índices lineares e não lineares foi considerada elevada para o índice componente de alta frequência - unidades normalizadas (r = -0,776), com o índice padrão sem variação, e moderada para os índices raiz quadrada da média do quadrado das diferenças entre intervalos RR normais adjacentes em um intervalo de tempo (r = 0,550), desvio padrão de todos os intervalos RR normais gravados em um intervalo de tempo (r = 0,522), componente de alta frequência - unidades normalizadas (r = 0,638) com o índice padrão com duas variações similares, assim como para os índices raiz quadrada da média do quadrado das diferenças entre intervalos RR normais adjacentes em um intervalo de tempo (r = 0,627) e componente de alta frequência - unidades normalizadas (r = 0,601) com o índice padrão com duas variações diferentes. Conclusão: O diabetes melito tipo 1 influenciou nos índices lineares e na análise simbólica, mas ainda não na complexidade da variabilidade da frequência cardíaca. Além disso, índices de variabilidade da frequência cardíaca apresentaram correlação com a dinâmica simbólica.

Higher fiber intake is associated with lower blood pressure levels in patients with type 1 diabetes

ABSTRACT Objective The present investigation sought to evaluate the potential association between dietary fiber intake and blood pressure (BP) in adult patients with type 1 diabetes (T1D). Subjects and methods A cross-sectional study was carried out in 111 outpatients with T1D from Porto Alegre, Brazil. Patients were predominantly male (56%) and white (88%), with a mean age of 40 ± 10 years, diabetes duration of 18 ± 9 years, BMI 24.8 ± 3.85 kg/m2, and HbA1c 9.0 ± 2.0%. After clinical and laboratory evaluation, dietary intake was evaluated by 3-day weighed-diet records, whose reliability was confirmed by 24-h urinary nitrogen output. Patients were stratified into two groups according to adequacy of fiber intake in relation to American Diabetes Association (ADA) recommendations: below recommended daily intake (< 14g fiber/1000 kcal) or at/above recommended intake (≥ 14g/1000 kcal). Results Patients in the higher fiber intake group exhibited significantly lower systolic (SBP) (115.9 ± 12.2 vs 125.1 ± 25.0 mmHg, p = 0.016) and diastolic blood pressure (DBP) (72.9 ± 9.2 vs 78.5 ± 9.3 mmHg, p = 0.009), higher energy intake (2164.0 ± 626.0 vs 1632.8 ± 502.0 kcal, p < 0.001), and lower BMI (24.4 ± 3.5 vs 26.2 ± 4.8, p = 0.044). Linear regression modelling, adjusted for age, energy intake, sodium intake, and BMI, indicated that higher fiber intake was associated with lower SBP and DBP levels. No significant between-group differences were observed with regard to duration of diabetes, glycemic control, insulin dosage, or presence of hypertension, nephropathy, or retinopathy. Conclusion We conclude that fiber consumption meeting or exceeding current ADA recommendations is associated with lower SBP and DBP in patients with T1D.

Association of different biomarkers of renal function with D-dimer levels in patients with type 1 diabetes mellitus (renal biomarkers and D-dimer in diabetes)

ABSTRACT Objective This study aimed to evaluate the association between different renal biomarkers with D-Dimer levels in diabetes mellitus (DM1) patients group classified as: low D-Dimer levels (< 318 ng/mL), which included first and second D-Dimer tertiles, and high D-Dimer levels (≥ 318 ng/mL), which included third D-Dimer tertile. Materials and methods D-Dimer and cystatin C were measured by ELISA. Creatinine and urea were determined by enzymatic method. Estimated glomerular filtration rate (eGFR) was calculated using CKD-EPI equation. Albuminuria was assessed by immunoturbidimetry. Presence of renal disease was evaluated using each renal biomarker: creatinine, urea, cystatin C, eGFR and albuminuria. Bivariate logistic regression analysis was performed to assess which renal biomarkers are associated with high D-Dimer levels and odds ratio was calculated. After, multivariate logistic regression analysis was performed to assess which renal biomarkers are associated with high D-Dimer levels (after adjusting for sex and age) and odds ratio was calculated. Results Cystatin C presented a better association [OR of 9.8 (3.8-25.5)] with high D-Dimer levels than albuminuria, creatinine, eGFR and urea [OR of 5.3 (2.2-12.9), 8.4 (2.5-25.4), 9.1 (2.6-31.4) and 3.5 (1.4-8.4), respectively] after adjusting for sex and age. All biomarkers showed a good association with D-Dimer levels, and consequently, with hypercoagulability status, and cystatin C showed the best association among them. Conclusion Therefore, cystatin C might be useful to detect patients with incipient diabetic kidney disease that present an increased risk of cardiovascular disease, contributing to an early adoption of reno and cardioprotective therapies.

Programa de transición: una intervención para adolescentes con diabetes tipo 1: estudio de casos y controles / Transition program: an intervention for adolescents with type 1 diabetes: cases and controls study

Introduction: The transition programs (TP) are planned interventions with specific aims which support type 1 diabetes adolescents in their process to emigrate from a pediatric care system to an adult care system. Objective: To evaluate the effectiveness of a TP in type 1 diabetes adolescents. Subjects and Method: This study was performed in 20 adolescents: 10 in TP and 10 controls (no TP) attended in an adult care system in a traditional way. The applied program included: coordination of attention dates, administrative supervision of the cases, and integral health team attention: physician every three months, psychologist with psychosocial follow-up every three months, nutricionist and university nurse according to the case necessities. After a year of the TP implementation the indicators of adherence were evaluated: continuity of care, regular medical appointments, physician/adolescent relationship, psychosocial follow-up, and to maintain or improve the HbA1c. The statistical analysis of variables comparison was performed with Kwallis Test o Mann-Whitney Test, in STATA 12.0 program. Results: At comparing groups, it was found that the intervened adolescents presented a major frequency of: continuity of diabetes care, regular medical appointments, physician/adolescent relationship and psychosocial follow-up (p < 0,01); the indicator of maintaining or improving the HbA1c was better in the patients with TP (60 percent vs 30 percent) yet not significant. Conclusion: In type 1 diabetes adolescents, with the applied TP we get better indicators of adherence to the diabetes treatment

Impaired flow-mediated dilation response and carotid intima-media thickness in patients with type 1 diabetes mellitus with a mean disease duration of 4 1 years

ABSTRACT Objective This study aimed at assessing the endothelial function in patients with Type 1 diabetes (T1DM) using flow-mediated dilation (FMD) response and carotid artery intima-media thickness (CIMT). Materials and methods This study enrolled 32 T1DM patients (mean disease duration 4.1 years) and 28 age-matched controls (CTL Group). Endothelial function and CIMT were assessed with high-resolution ultrasound using standardized offline measurements. Results FMD was significantly lower in patients in the T1DM Group (8.9 ± 3.2%) compared with those in the CTL Group (13.3 ± 4.3%; P-value < 0.0001). Similarly, CIMT differed significantly between T1DM patients (0.525 ± 0.03 mm) and controls (0.508 ± 0.03 mm; P-value = 0.041). Even though, the values are within the normal range for age. Conclusions Patients with T1DM have impaired endothelial function characterized by reduced FMD when compared to controls. However, vascular remodeling as seen by increases in CIMT was not found in this study.

Speech perception performance of subjects with type I diabetes mellitus in noise / Desempenho da percepção de fala no ruído em indivíduos com diabetes mellitus tipo I

Abstract Introduction: Diabetes mellitus (DM) is a chronic metabolic disorder of various origins that occurs when the pancreas fails to produce insulin in sufficient quantities or when the organism fails to respond to this hormone in an efficient manner. Objective: To evaluate the speech recognition in subjects with type I diabetes mellitus (DMI) in quiet and in competitive noise. Methods: It was a descriptive, observational and cross-section study. We included 40 participants of both genders aged 18-30 years, divided into a control group (CG) of 20 healthy subjects with no complaints or auditory changes, paired for age and gender with the study group, consisting of 20 subjects with a diagnosis of DMI. First, we applied basic audiological evaluations (pure tone audiometry, speech audiometry and immittance audiometry) for all subjects; after these evaluations, we applied Sentence Recognition Threshold in Quiet (SRTQ) and Sentence Recognition Threshold in Noise (SRTN) in free field, using the List of Sentences in Portuguese test. Results: All subjects showed normal bilateral pure tone threshold, compatible speech audiometry and "A" tympanometry curve. Group comparison revealed a statistically significant difference for SRTQ (p = 0.0001), SRTN (p < 0.0001) and the signal-to-noise ratio (p < 0.0001). Conclusion: The performance of DMI subjects in SRTQ and SRTN was worse compared to the subjects without diabetes.

Resumo Introdução: O diabetes mellitus (DM) é um distúrbio metabólico crônico de várias origens, que ocorre quando o pâncreas deixa de produzir insulina em quantidade suficiente ou quando o organismo não consegue responder a esse hormônio de maneira eficiente. Objetivo: Avaliar o reconhecimento de fala em indivíduos com diabetes mellitus tipo I (DMI) no silêncio e no ruído competitivo. Método: Estudo descritivo, observacional e transversal. Foram incluídos 40 participantes de ambos os sexos entre 18 e 30 anos, divididos em um grupo controle (GC) de 20 indivíduos saudáveis sem queixas ou alterações auditivas, pareados por idade e sexo com o grupo de estudo, composto por 20 indivíduos com diagnóstico de DMI. Inicialmente aplicou-se uma avaliação audiológica (audiometria tonal, logoaudiometria e imitanciometria) para todos os indivíduos; a seguir, os mesmos foram avaliados para o Limiar de Reconhecimento de Sentenças no Silêncio (LRSS) e Limiar de Reconhecimento de Sentenças no Ruído (LRSR), em campo livre, por meio do teste Lista de Sentenças em Português. Resultados: Todos os participantes apresentaram audiometria tonal dentro dos padrões de normalidade bilateralmente, logoaudiometria compatível e curva timpanométrica do tipo A. A comparação dos grupos revelou uma diferença estatisticamente significante para LRSS (p = 0,0001), LRSR (p < 0,0001) e a relação sinal-ruído (p < 0,0001). Conclusões O desempenho dos indivíduos com DMI para LRSS e LRSR foi pior em comparação com os indivíduos sem diabetes.

Endothelial dysfunction in children with type 1 diabetes mellitus

ABSTRACT Objective The purpose of this study was to verify the presence of endothelial dysfunction and initial structural atherosclerotic changes in children with Type 1 diabetes mellitus (T1DM). Subjects and methods The study population comprised 31 diabetic children aged 6 to 12 years, divided into two subgroups according to the duration of the T1DM diagnosis: subgroup 1, with less than 5 years elapsed since diagnosis, and subgroup 2, with more than 5 years elapsed since diagnosis. The control group comprised 58 age-matched healthy children. Ultrasonographic techniques were used to measure the flow-mediated dilatation (FMD) of the brachial artery and the intima-media thickness (IMT) of the carotid arteries. Results Children with T1DM with longer disease duration showed significantly decreased mean values of FMD compared with those in the control group. No significant differences between the groups were found in relation to IMT. The FMD percentage presented a moderate negative correlation with glycated hemoglobin (HbA1c) and fasting glucose levels. Conclusion Our findings suggest that endothelial dysfunction may be already present in children with 5 years or more elapsed since diagnosis, even in the absence of atherosclerotic structural changes. The decreased vasodilation response correlated with hyperglycemia.

Penile alterations at early stage of type 1 diabetes in rats

ABSTRACT Objective Diabetes affects the erectile function significantly. However, the penile alterations in the early stage of diabetes in experimental animal models have not been well studied. We examined the changes of the penis and its main erectile components in diabetic rats. Materials and methods Male Sprague-Dawley rats were divided into 2 groups: streptozotocin (STZ)-induced diabetics and age-matched controls. Three or nine weeks after diabetes induction, the penis was removed for immunohistochemical staining of smooth muscle and neuronal nitric oxide synthase (nNOS) in midshaft penile tissues. The cross-sectional areas of the whole midshaft penis and the corpora cavernosa were quantified. The smooth muscle in the corpora cavernosa and nNOS in the dorsal nerves were quantified. Results The weight, but not the length, of the penis was lower in diabetics. The cross-sectional areas of the total midshaft penis and the corpora cavernosa were lower in diabetic rats compared with controls 9 weeks, but not 3 weeks after diabetes induction. The cross-sectional area of smooth muscle in the corpora cavernosa as percentage of the overall area of the corpora cavernosa was lower in diabetic rats than in controls 9 weeks, but not 3 weeks after diabetes induction. Percentage change of nNOS in dorsal nerves was similar at 3 weeks, and has a decreased trend at 9 weeks in diabetic rats compared with controls. Conclusions Diabetes causes temporal alterations in the penis, and the significant changes in STZ rat model begin 3-9 weeks after induction. Further studies on the reversibility of the observed changes are warranted.

Corneal backscatter in insulin-dependent and non-insulin-dependent diabetes mellitus patients: a pilot study / Retroespalhamento luminoso das córneas de pacientes com diabete melito dependente e não dependente de insulina: estudo piloto

ABSTRACT Purpose: To compare central corneal backscatter obtained from Scheimpflug images between patients with insulin-dependent and non-insulin-dependent diabetes mellitus (IDDM and NIDDM, respectively) and healthy controls. Methods: Seven patients with IDDM (7 eyes), eleven patients with NIDDM (11 eyes), and sixteen healthy subjects (16 eyes) were included in this pilot study. Scheimpflug imaging system (Pentacam, Oculus Inc., Germany) was used to obtain optical sections of the cornea. Seven meridians were analyzed for each eye, oriented from 70° to 110°. Optical density values for the central 3-mm and 5-mm zones of the cornea were obtained by image analysis using external software. Results: Corneal backscatter was significantly higher in the diabetic patients than in the controls for the central 3-mm (p=0.016) and 5-mm (p=0.014) zones. No significant differences in corneal backscatter were found between the IDDM and NIDDM groups for either zone (both p>0.05). In the NIDDM group, significant correlations were observed for both central zones between corneal backscatter and age (3 mm: r=0.604, p=0.025; 5 mm: r=0.614, p=0.022) and central corneal thickness (3 mm: r=0.641, p=0.017; 5 mm: r=0.671, p=0.012); this was not found in the IDDM group (p>0.05). The presence of diabetes showed a significant effect on central corneal backscatter (Kruskal-Wallis test, p<0.001). Conclusions: Diabetic patients showed higher values of corneal light backscatter than healthy subjects. Corneal optical density analysis may be a useful tool for monitoring and assessing the ocular changes caused by diabetes.

RESUMO Objetivo: Determinar os valores de retroespalhamento luminoso central da córnea em pacientes diabéticos dependentes (IDDM) e não dependentes (NIDDM) de insulina, comparados com controles saudáveis, a partir de imagens de Scheimpflug. Métodos: Foram incluídos neste estudo piloto sete pacientes com IDDM (7 olhos), onze pacientes com NIDDM (11 olhos) e dezesseis indivíduos saudáveis (16 olhos). O sistema de Scheimpflug (Pentacam, Oculus Inc. Germany) foi utilizado para obter secções ópticas da córnea. Foram analisados sete meridianos para cada olho, orientados de 70º a 110º. A análise de imagem por meio de software externo permitiu a obtenção de valores da densidade óptica para os 3 e 5 mm centrais da córnea. Resultados: O retroespalhamento luminoso corneano foi significativamente maior em pacientes diabéticos para os 3 mm centrais (p=0,016) e para os 5 mm centrais (p=0,014) em relação ao grupo controle. Não foram encontradas diferenças significativas entre os grupos IDDM e NIDDM para cada zona analisada (p>0,05 em ambos os casos). No grupo NIDDM, observaram-se correlações significativas para as zonas centrais de 3 mm e 5 mm, entre retroespalhamento luminoso corneano e idade (r=0,604 p=0,025 e r=0,614 p=0,022, respectivamente) e espessura central corneana (r=0,641 p=0,017; r=0,671 p=0,012, respectivamente), o que não foi encontrado no grupo IDDM (p>0,05). O teste de Kruskall-Wallis indicou que a presença de diabete tem um efeito significativo sobre a retroespalhamento central da córnea (p<0,001). Conclusões: Pacientes diabéticos apresentaram valores mais elevados de retroespalhamento luminoso corneano do que indivíduos saudáveis. A análise da densidade óptica corneana pode ser uma ferramenta útil para monitorar e avaliar as alterações oculares causadas pela diabete.

Sensitivity, Specificity and Predictive Value of Heart Rate Variability Indices in Type 1 Diabetes Mellitus / Sensibilidade, Especificidade e Valor Preditivo dos Índices da Variabilidade da Frequência Cardíaca no Diabetes Mellitus Tipo 1

Abstract Background: Heart rate variability (HRV) indices may detect autonomic changes with good diagnostic accuracy. Type diabetes mellitus (DM) individuals may have changes in autonomic modulation; however, studies of this nature in this population are still scarce. Objective: To compare HRV indices between and assess their prognostic value by measurements of sensitivity, specificity and predictive values in young individuals with type 1 DM and healthy volunteers. Methods: In this cross-sectional study, physical and clinical assessment was performed in 39 young patients with type 1 DM and 43 young healthy controls. For HRV analysis, beat-to-beat heart rate variability was measured in dorsal decubitus, using a Polar S810i heart rate monitor, for 30 minutes. The following indices were calculated: SDNN, RMSSD, PNN50, TINN, RRTri, LF ms2, HF ms2, LF un, HF un, LF/HF, SD1, SD2, SD1/SD2, and ApEn. Results: Type 1 DM subjects showed a decrease in sympathetic and parasympathetic activities, and overall variability of autonomic nervous system. The RMSSD, SDNN, PNN50, LF ms2, HF ms2, RRTri, SD1 and SD2 indices showed greater diagnostic accuracy in discriminating diabetic from healthy individuals. Conclusion: Type 1 DM individuals have changes in autonomic modulation. The SDNN, RMSSD, PNN50, RRtri, LF ms2, HF ms2, SD1 and SD2 indices may be alternative tools to discriminate individuals with type 1 DM.

Resumo Fundamento: Alguns índices da variabilidade da frequência cardíaca (VFC) podem ser capazes de detectar alterações autonômicas com boa acurácia diagnóstica. Indivíduos com Diabetes Mellitus (DM) tipo 1 podem apresentar alterações na modulação autonômica, contudo, estudos dessa natureza são incipientes nesses sujeitos. Objetivo: Comparar diferentes índices da VFC e avaliar seu valor prognóstico por medidas da sensibilidade, especificidade e valores preditivos em jovens com DM tipo 1 e jovens controles saudáveis. Métodos: Neste estudo transversal, foram realizadas avaliações físicas e clínicas em 39 jovens com DM tipo 1 e 43 jovens saudáveis. Para análise da VFC, a frequência cardíaca foi captada batimento a batimento usando um monitor de frequência acardíaca, PolarS810i, por 30 minutos com os voluntários em decúbito dorsal. Foram calculados os índices: SDNN, RMSSD, PNN50, TINN, RRTri, LF ms2, HF ms2, LF un, HF um, LF/HF, SD1, SD2, SD1/SD2, ApEn. Resultados: Indivíduos com DM tipo 1 apresentam redução na atividade simpática, parassimpática e na variabilidade global do sistema nervoso autônomo. Índices RMSSD, SDNN, PNN50, LF ms2, HF ms2, RRTri, SD1 e SD2 representam melhor acurácia diagnóstica para discriminar indivíduos diabéticos de saudáveis. Conclusão: Indivíduos com DM tipo 1 apresentam alterações na modulação autonômica e os índices SDNN, RMSSD, PNN50, RRtri, LF ms2, HF ms2, SD1 e SD2 podem ser uma opção utilizada para discriminar indivíduos com DM tipo 1.

Pubertal development and gonadotrophic hormones among girls with type 1 diabetes mellitus

Background: As a chronic disease occurring in childhood, type 1 diabetes is a factor potentially affecting the pubertal development, including age at menarche

Aim of study: To investigate the effect of type 1 diabetes on pubertal development among adolescents; and to investigate their gonadotrophic hormonal profile

Subjects and Methods: Nineteen Egyptian girls aged [13.8- 21.6] years were recruited into the study. Assessment of Pubertal development according to Marshall and Tanner [1969] was performed; and age at menarche was evaluated. Auxological assessment [weight, height, and body mass index] were performed. Laboratory investigations were done, including HbAlc levels and Hormone assays [basal and post stimulation levels]: Serum follicle- stimulating hormone [FSH], luteinizing hormone [LH], and LH/ FSH ratio was calculated

Intervention: Girls underwent GnRH- analogue test with triptorelin [0.1 mg] administered subcutaneously

Results: The mean age at menarche [13.24+ 1.25] yrs, among the 17 [89.5%] postmenarcheal T1DM girls, showed no significant difference [P>0.05] from the normal population; but still 2 [10.5%] girls did not achieve menarche until after the study period was terminated. Moreover, there was a highly significant delay [P< 0.01] in their attainment of adult sexual maturity Tanner stage V [B5, PH5]. Only 3 [15.8%] T1DM girls, had achieved optimal metabolic control, at [< 7.5%], while the remaining 16 [84.2%] had a statistically significant insufficient metabolic control [9.93+ 1.96] [P<0.00]. Also it was found that basal and stimulated LH and FSH levels were significantly decreased in T1DM girls [P<0.000]

Conclusion: Type 1 diabetes could affect pubertal development of girls, in the form of delay in their attainment of adult sexual maturity stages, Tanner Breast stage [B5] and Tanner Pubic Hair development [PH5]; however, their age at menarche, is within the range of normal Egyptian girls. The disease could alter their growth development, with a decrease in their height than the normal population. LH and FSH were significantly decreased than normal reference ranges

Testosterone and Voluntary Exercise, Alone or Together Increase Cardiac Activation of AKT and ERK1/2 in Diabetic Rats / Testosterona e Exercício Voluntário, Individualmente ou em Conjunto, Aumentam a Ativação Cardíaca de AKT e ERK1/2 em Ratos Diabéticos

Abstract Background: Impaired angiogenesis in cardiac tissue is a major complication of diabetes. Protein kinase B (AKT) and extracellular signal regulated kinase (ERK) signaling pathways play important role during capillary-like network formation in angiogenesis process. Objectives: To determine the effects of testosterone and voluntary exercise on levels of vascularity, phosphorylated Akt (P- AKT) and phosphorylated ERK (P-ERK) in heart tissue of diabetic and castrated diabetic rats. Methods: Type I diabetes was induced by i.p injection of 50 mg/kg of streptozotocin in animals. After 42 days of treatment with testosterone (2mg/kg/day) or voluntary exercise alone or in combination, heart tissue samples were collected and used for histological evaluation and determination of P-AKT and P-ERK levels by ELISA method. Results: Our results showed that either testosterone or exercise increased capillarity, P-AKT, and P-ERK levels in the heart of diabetic rats. Treatment of diabetic rats with testosterone and exercise had a synergistic effect on capillarity, P-AKT, and P-ERK levels in heart. Furthermore, in the castrated diabetes group, capillarity, P-AKT, and P-ERK levels significantly decreased in the heart, whereas either testosterone treatment or exercise training reversed these effects. Also, simultaneous treatment of castrated diabetic rats with testosterone and exercise had an additive effect on P-AKT and P-ERK levels. Conclusion: Our findings suggest that testosterone and exercise alone or together can increase angiogenesis in the heart of diabetic and castrated diabetic rats. The proangiogenesis effects of testosterone and exercise are associated with the enhanced activation of AKT and ERK1/2 in heart tissue.

Resumo Fundamento: Angiogênese prejudicada em tecido cardíaco é uma das principais complicações das diabetes. As vias de sinalização da proteína-quinase B (AKT) e a quinase regulada por sinal extracelular (ERK) exercem um importante papel durante a formação de uma rede similar à capilar no processo de angiogênese. Objetivos: Determinar os efeitos da testosterona e exercícios voluntários sobre os níveis de vascularidade, AKT fosforilada (P- AKT) e ERK fosforilada (P-ERK) sobre o tecido cardíaco de ratos diabéticos e castrados diabéticos. Métodos: A diabetes tipo 1 foi induzida através de injeção intraperitoneal de 50 mg/kg de estreptozotocina em animais. Após 42 dias de tratamento com testosterona (2mg/kg/dia) ou exercícios voluntários, individualmente ou em conjunto, as amostras de tecidos cardíacos foram coletadas e usadas para avaliação histológica e determinação de níveis de P-AKT e P-ERK através do método ELISA. Resultados: Os nossos resultados mostraram que a testosterona ou os exercícios aumentaram a capilaridade, os níveis de P-AKT, e P-ERK nos corações de ratos diabéticos. O tratamento de ratos diabéticos com testosterona e exercícios obteve um efeito sinérgico sobre a capilaridade, níveis de P-AKT, e P-ERK no coração. Além disto, na capilaridade do grupo diabético castrado, os níveis de P-AKT e P-ERK diminuíram significativamente no coração, ao passo que o tratamento com testosterona ou o treinamento com exercícios reverteu tais efeitos. O tratamento simultâneo de ratos diabéticos castrados com testosterona e exercícios obteve um efeito aditivo sobre os níveis de P-AKT e P-ERK. Conclusão: Nossas descobertas sugerem que a testosterona e exercícios, em conjunto ou individualmente, podem aumentar a angiogênese nos corações de ratos diabéticos e castrados diabéticos. Os efeitos favoráveis à angiogênese da testosterona e dos exercícios estão associados à ativação reforçada de AKT e ERK1/2 no tecido cardíaco.