Decreasing complexity of glucose time series derived from continuous glucose monitoring is correlated with deteriorating glucose regulation / 医学前沿

Most information used to evaluate diabetic statuses is collected at a special time-point, such as taking fasting plasma glucose test and providing a limited view of individual's health and disease risk. As a new parameter for continuously evaluating personal clinical statuses, the newly developed technique "continuous glucose monitoring" (CGM) can characterize glucose dynamics. By calculating the complexity of glucose time series index (CGI) with refined composite multi-scale entropy analysis of the CGM data, the study showed for the first time that the complexity of glucose time series in subjects decreased gradually from normal glucose tolerance to impaired glucose regulation and then to type 2 diabetes (P for trend < 0.01). Furthermore, CGI was significantly associated with various parameters such as insulin sensitivity/secretion (all P < 0.01), and multiple linear stepwise regression showed that the disposition index, which reflects β-cell function after adjusting for insulin sensitivity, was the only independent factor correlated with CGI (P < 0.01). Our findings indicate that the CGI derived from the CGM data may serve as a novel marker to evaluate glucose homeostasis.

Prevalence of maturity-onset diabetes of the young in phenotypic type 2 diabetes in young adults: a nationwide, multi-center, cross-sectional survey in China / 中华医学杂志(英文版)

BACKGROUND@#Maturity-onset diabetes of the young (MODY) is the most common monogenic diabetes. The aim of this study was to assess the prevalence of MODY in phenotypic type 2 diabetes (T2DM) among Chinese young adults.@*METHODS@#From April 2015 to October 2017, this cross-sectional study involved 2429 consecutive patients from 46 hospitals in China, newly diagnosed between 15 years and 45 years, with T2DM phenotype and negative for standardized glutamic acid decarboxylase antibody at the core laboratory. Sequencing using a custom monogenic diabetes gene panel was performed, and variants of 14 MODY genes were interpreted as per current guidelines.@*RESULTS@#The survey determined 18 patients having genetic variants causing MODY (6 HNF1A , 5 GCK , 3 HNF4A , 2 INS , 1 PDX1 , and 1 PAX4 ). The prevalence of MODY was 0.74% (95% confidence interval [CI]: 0.40-1.08%). The clinical characteristics of MODY patients were not specific, 72.2% (13/18) of them were diagnosed after 35 years, 47.1% (8/17) had metabolic syndrome, and only 38.9% (7/18) had a family history of diabetes. No significant difference in manifestations except for hemoglobin A1c levels was found between MODY and non-MODY patients.@*CONCLUSION@#The prevalence of MODY in young adults with phenotypic T2DM was 0.74%, among which HNF1A -, GCK -, and HNF4A -MODY were the most common subtypes. Clinical features played a limited role in the recognition of MODY.

Associations between glycated hemoglobin and glucose indicators in adults in areas at different altitude in China / 中华流行病学杂志

Objective: To explore the associations of glycated hemoglobin (HbA1c) with FPG and oral glucose tolerance test 2-hour (OGTT-2 h) in areas at different altitude in China. Methods: Subjects who participated in 2018-2019 China Chronic Disease and Risk Factor Surveillance and had no prior type 2 diabetes diagnosis were included. Subsequently, they were categorized into three groups based on altitude of living area (<2 000, 2 000- and ≥3 000 m). With adjustment for intracluster correlation, multivariable linear regression analysis was performed to evaluate the associations of HbA1c with FPG and OGTT-2 h in the context of HbA1c was normal (<5.7%) or abnormal (≥5.7%). Furthermore, the shape of relationships between HbA1c and glucose indicators was examined using restricted cubic spline. Finally, receiver operating characteristic curve was used to evaluate the diagnostic performance of HbA1c for diabetes. Results: A total of 157 277 subjects were included in the analysis. While FPG and OGTT-2 h levels gradually decreased with increase of altitude, HbA1c level was similar among the three groups. When HbA1c was <5.7%, its association with FPG and OGTT-2 h was weak and no obvious difference was observed among the three groups. When HbA1c was ≥5.7%, the FPG and OGTT-2 h increased by 15.45% (95%CI:14.71%- 16.18%) and 24.54% (95%CI:23.18%-25.91%) respectively per one standard deviation increase in HbA1c in group in area at altitude <2 000 m. However, the FPG and OGTT-2 h increased by 13.08% (95%CI:10.46%-15.76%) and 21.72% (95%CI:16.39%-27.31%), respectively, in group in area at altitude 2 000- m, and increased by 11.41% (95%CI:9.32%-13.53%) and 20.03% (95%CI:15.38%- 24.86%), respectively, in group of altitude ≥3 000 m. The restricted cubic spline indicated that the curve showing the association of HbA1c with FPG and OGTT-2 h was flat when HbA1c was <5.7%, but showed a positive linear relationship when HbA1c was ≥5.7%. The area under curve for detecting diabetes was 0.808 (95%CI:0.803-0.812) in group of altitude <2 000 m and 0.728 (95%CI:0.660-0.796, P=0.022) in group of altitude ≥3 000 m. The relevant optimal cutoff value of HbA1c was 5.7%, with a sensitivity of 65.4% and a specificity of 83.0%, and 6.0%, with a sensitivity of 48.3% and a specificity of 93.7%, respectively. Conclusions: When HbA1c was ≥5.7%, the association between HbA1c and glucose indicators became weaker as the increase of altitude. In the area at altitude ≥3 000 m, it may not be appropriate to use HbA1c in the diagnosis of diabetes.

Salivary biomarkers: novel noninvasive tools to diagnose chronic inflammation / 国际口腔科学杂志·英文版

Several chronic disorders including type 2 diabetes (T2D), obesity, heart disease and cancer are preceded by a state of chronic low-grade inflammation. Biomarkers for the early assessment of chronic disorders encompass acute phase proteins (APP), cytokines and chemokines, pro-inflammatory enzymes, lipids and oxidative stress mediators. These substances enter saliva through the blood flow and, in some cases, there is a close relation between their salivary and serum concentration. Saliva can be easily collected and stored with non-invasive and cost-saving procedures, and it is emerging the concept to use it for the detection of inflammatory biomarkers. To this purpose, the present review aims to discuss the advantages and challenges of using standard and cutting-edge techniques to discover salivary biomarkers which may be used in diagnosis/therapy of several chronic diseases with inflammatory consequences with the pursuit to possibly replace conventional paths with detectable soluble mediators in saliva. Specifically, the review describes the procedures used for saliva collection, the standard approaches for the measurement of salivary biomarkers and the novel methodological strategies such as biosensors to improve the quality of care for chronically affected patients.

Modelo predictivo de riesgo para el diagnóstico temprano de la diabetes mellitus de tipo 2 / Predictive model of risk for the early diagnosis of type II diabetes mellitus i: en

Introducción: El diagnóstico temprano de la diabetes mellitus de tipo 2 permite al personal de salud implementar estrategias para evitar las complicaciones crónicas que pudieran derivarse. A tales efectos, en las últimas dos décadas se han desarrollado modelos predictivos que incluyen cada día más variables. Objetivo: Elaborar un modelo predictivo para el diagnóstico temprano de la diabetes mellitus de tipo 2 en una población holguinera. Métodos: Se realizó un estudio de cohorte que incluyó a todos los pacientes atendidos en las consultas de endocrinología del área de salud Pedro Díaz Coello y del Hospital Militar Fermín Valdés Domínguez de la provincia de Holguín, para lo cual se tomaron 2 cohortes: una de análisis y otra de validación. Para el procesamiento estadístico se efectuó el análisis univariado y el multivariado; en tanto se determinó la asociación entre variables dependientes e independientes. Resultados: En la serie predominaron el sexo femenino, los pacientes sin antecedentes de diabetes mellitus e hipertensión arterial, así como los que presentaban hipotiroidismo, enfermedad periodontal y normopeso, entre otros; asimismo, el modelo resultó significativo estadísticamente (X2=31,1 y p=0,000) y explicó 80,9 % de la variable de salida, validada por las variables de análisis. La sensibilidad fue de 96,9 % y la especificidad de 86,6 %; mientras que el área bajo la curva tuvo un rango de 0,725 a 0,833. Conclusiones: El modelo predictivo elaborado es una herramienta muy útil para el diagnóstico de pacientes con riesgo de presentar diabetes mellitus de tipo 2.

Introduction: The early diagnosis of the type II diabetes mellitus allows the health staff to implement strategies in order to avoid the chronic complications that could be derived. To such effects, in the last two decades predictive models have been developed that include more variables every day. Objective: To elaborate a predictive model for the early diagnosis of type II diabetes mellitus in a population from Holguín. Methods: A cohort study was carried out that included all the patients assisted in the endocrinology services of Pedro Díaz Coello health area and Fermín Valdés Domínguez Military Hospital in Holguín province, for which 2 cohorts were taken: one of analysis and another of validation. For the statistical processing the univaried and multivaried analysis were carried out; as long as the association between dependent and independent variables was determined. Results: In the series there was a prevalence of the female sex, patients without history of diabetes mellitus and hypertension, as well as those that presented hypothyroidism, periodontal disease and normal weight, among others; also, the pattern was statistically significant (X2=31.1 and p=0.000) and explained 80.9 % of the logout variable validated by the analysis variables. The sensibility was of 96.9 % and the specificity of 86.6 %; while the area under the curve had a range from 0.725 to 0.833. Conclusions: The predictive model elaborated is a very useful tool for the diagnosis of patients with risk of type II diabetes mellitus.

Monitor sanitario: experiencia de gestión y monitoreo de líneas de cuidado priorizadas en Córdoba / Health monitor: management and monitoring experience of prioritized lines of care in Córdoba

Para la gestión en salud, fortalecer la Atención Primaria como estrategia es un desafío. Esto implica coordinar los esfuerzos entre los distintos niveles de atención. En el caso de Argentina, la organización del sistema de salud divide las responsabilidades sobre cada nivel de atención en distintas jurisdicciones, quedando el primer nivel en la órbita de los municipios. En el caso de Córdoba, este escenario es particularmente complejo, ya que la descentralización del primer nivel de atención trajo consecuencias adversas, dificultando la integración de información sanitaria producida en los municipios. El Ministerio de Salud de la Provincia ha desarrollado una herramienta de monitoreo (el Monitor Sanitario) que construye indicadores de evaluación aprovechando los datos reportados por 754 efectores de salud públicos al programa Sumar. Estos indicadores se organizan por líneas de cuidado, y ya se encuentran en marcha los tableros que muestran los resultados para la línea de cuidado de personas gestantes y la de cuidado de personas con diabetes. La medición periódica de los desempeños por municipio de estas líneas se asocia a un pago por desempeño. Consideramos que esta experiencia permite mostrar la integración de esfuerzos para impactar en los tres componentes del sistema: en el modelo de atención (por definir priorización de cuidados y estimular la proactividad), en el modelo de financiamiento (al indicar las posibilidades de reporte al programa Sumar y al establecer un pago por resultados) y en el modelo de gestión (al orientar las gestiones locales a los resultados) (AU)

For health management, strengthening Primary Care as a strategy is a challenge. This implies coordinating efforts between the different levels of health care. In the case of Argentina, the health system assigns the responsibilities for each level of care to different jurisdictions, leaving the primary level of care in the orbit of the local governments. In the case of Córdoba, this scenario is particularly complex, considering the decentralization of the primary level of care brought adverse consequences, making it difficult to integrate health information produced in local governments.The Ministry of Health of the Province has developed a monitoring tool (the Health Monitor) that builds evaluation indicators taking advantage of the data reported by 754 public health effectors to Sumar program. These indicators are organized by lines of care, and there are two boards that already shows the results for pregnancy care and for people with diabetes. The periodic measurement of the performance of each local government in these lines is associated with a payment for performance.This experience shows how the integration of efforts impacts on the three components of the system: in the care model (by defining care prioritization and stimulating proactivity), in the financing model (by indicating the possibilities of reporting to Sumar program and establishing a payment for results) and in the management model (by directing local managements to results) (AU)

When do we need to suspect maturity onset diabetes of the young in patients with type 2 diabetes mellitus?

ABSTRACT Objetivo: Maturity onset diabetes of the young (MODY) patients have clinical heterogeneity as shown by many studies. Thus, often it is misdiagnosed to type 1 or type 2 diabetes(T2DM). The aim of this study is to evaluate MODY mutations in adult T2DM patients suspicious in terms of MODY, and to show clinical and laboratory differences between these two situations. Subjects and methods: In this study, we analyzed 72 type 2 diabetic patients and their relatives (35F/37M) who had been suspected for MODY and referred to genetic department for mutation analysis. The gene mutations for MODY have been assessed in the laboratory of Marmara University genetics. Totally 67 (32F/35M; median age 36.1) diabetic patients were analyzed for 7 MODY mutations. Twelve patients who have uncertain mutation (VUS) were excluded from study for further evaluation. MODY(+) (n:30) patients and T2DM patients (n:25) were compared for clinical and laboratory parameters. Results: In MODY(+) subjects, mutations in GCK (MODY 2) (n:12; 40%) were the most common followed by HNF4A (MODY 1) (n:4; 13.3%). Diabetes diagnosis age was younger in MODY(+) group but not statistically significant. Sixty-six percent of MODY(+) subjects had diabetes history at 3-consecutive generations in their family compared with 28% of T2DM patients statistically significant (p:0.006). Gender, BMI, C-peptide, HbA1c, lipid parameters, creatinine, GFR, microalbuminuria, vitamin D and calcium were not statistically different between the groups. Conclusion: According to present study results, MODY mutation positivity is most probable in young autoantibody (-) diabetic patients diagnosed before 30 years of age, who have first degree family history of diabetes.

Evaluation of Accuracy and Influencing Factors for Diagnosis of Two Chronic Diseases by Primary Healthcare Providers in Sichuan Rural Areas Based on Standardized Patients / 中国医学科学院学报

Objective We used standardized patients to evaluate the accuracy and explore the influencing factors of the diagnosis of unstable angina pectoris and type 2 diabetes by primary healthcare providers in Sichuan rural areas,aiming to provide a scientific basis for improving the diagnosis accuracy of primary healthcare providers for the two chronic diseases. Methods A multi-stage stratified random cluster sampling method was adopted to select 100 villages from 50 townships in 5 districts/counties in Zigong city,Sichuan province. General and internal medicine practioners who were on duty on the survey day were enrolled in the survey.Two rounds of data collection were conducted.In the first round,the basic information of providers from township health centers and village clinics was collected.One month after the the first survey,standardized patients were used to collect the information related to the diagnosis of unstable angina pectoris and type 2 diabetes by rural primary providers.Logistic regression was carried out to analyze the factors influencing the diagnosis accuracy. Results A total of 172 rural primary healthcare providers were enrolled in the survey,who completed 186 standardized patient visits and showed the correct diagnosis rate of 48.39%.Specifically,the correct diagnosis rates of unstable angina pectoris and type 2 diabetes were 18.68%(17/91) and 76.84%(73/95),respectively.The providers with medical practitioner qualifications were more likely to make correct diagnosis(OR=4.857,95%CI=1.076-21.933, P=0.040).The providers who involved more necessary consultation and examination items in the diagnosis process had higher probability of correct diagnosis(OR=1.627,95%CI=1.065-2.485, P=0.024).Additionally,the providers were more likely to make a correct diagnosis for type 2 diabetes than for unstable angina pectoris(OR=6.306,95%CI=3.611-11.013, P<0.001). Conclusions The overall diagnosis accuracy of unstable angina pectoris and type 2 diabetes was relatively low among primary healthcare providers in Sichuan rural areas.The training of diagnosis process can be taken as a key for improving providers' practice ability so as to increase the diagnosis accuracy of chronic diseases.

Prevalence of hypertension and obesity in patients with type 2 Diabetes Mellitus

Abstract Faced with the increase of type 2 Diabetes mellitus (DM2) and the failure in treatment, questions have been raised about the clinical situation of these patients. The present study analyzes the prevalence of hypertension and obesity in DM2 patients. Data were collected through interviews and anamnesis of 16 participants. After the meetings, in which capillary glycemia and blood pressure were measured, the participants received guidance about glycemic monitoring, blood pressure control and changes in lifestyle. Approximately 75% of the participants were women with average age of 65 years, 87.5% were sedentary, 18.75% smoked and/or used alcoholic beverages and none performed regular blood glucose monitoring. The initial blood glucose average was 148 mg/ dL and finally decreased to 133 mg/dL. There was no significant difference in blood pressure levels. Regarding the body mass index, 89.4% of the patients were above normal standards and 100% had altered waist circumference values. There is a need for studies like this in order to promote educational practices for health and disease control, highlighting the importance of multidisciplinary teams and the pharmaceutical professional, since non-adherence to blood glucose monitoring, also associated with hypertension and obesity, can interfere with the individual's clinical condition.

Avaliação dos níveis da citocina pró-inflamatória fator de necrose tumoral-α em pacientes com diabetes tipo 2 e sua relação com variações genéticas de enzimas antioxidantes e obesidade / Evaluation of proinflammatory cytokine tumor necrosis factor-α levels in obese vs nonobese patients with type 2 diabetes and their relationship to CAT C-262T polymorphism

Introdução: Diabetes tipo 2 (DM2) é um distúrbio multifatorial caracterizado pelo aumento dos níveis de radicais livres. Tanto o estresse oxidativo quanto a obesidade contribuem para um estado inflamatório da doença, principalmente pelo aumento da citocina TNF-α. Sabendo-se que a genética individual pode contribuir para o estresse oxidativo, o estudo avaliou o impacto das variações genéticas de enzimas antioxidantes C262T no gene CAT e polimorfismos nulos dos genes GSTM1 e GSTT1 nos níveis de TNF-α, assim como, avaliou se as variantes genéticas atuariam sinergicamente com a obesidade aumentando os níveis da citocina em diabéticos da Grande Vitória/ES, Brasil.Métodos: O polimorfismo no gene CAT foi avaliado pela técnica PCR/RFLP e nos genes GSTM1 e GSTT1 por PCR multiplex, em 56 pacientes, sendo 28 obesos e 28 não obesos. Níveis de TNF-α foram medidos pela técnica de ELISA sanduíche.Resultados: Frequências das variantes nulas de GSTM1 e GSTT1 foram 44,6% e 17,9%, respectivamente. As frequências genotípicas C262T-CAT foram 73,2%, 25% e 1,8% para homozigoto normal, heterozigoto e homozigoto polimórfico, respectivamente. Não houve associação entre genótipos polimórficos e aumento dos níveis de TNF-α, assim como, não foi demonstrado aumento significante da citocina quando avaliado o sinergismo entre obesidade e genética individual do paciente.Conclusão: Níveis de TNF-α não se elevam em diabéticos tipo 2 na presença dos polimorfismos nos genes CAT, GSTM1 e GSTT1, e a obesidade não atua no aumento dessa citocina na população estudada, separadamente ou em conjunto com a genética individual de variantes nos genes CAT, GSTM1 e GSTT1.

Introduction: Type 2 diabetes is a multifactorial disorder characterized by increased levels of free radicals. Both oxidative stress and obesity contribute to an inflammatory state of the disease, mainly by increasing the levels of the proinflammatory cytokine tumor necrosis factor-α (TNF-α). Considering that personal genetics may contribute to oxidative stress, this study assessed the impact of CAT C-262T polymorphism and GSTM1 and GSTT1 null polymorphisms on TNF-α levels in patients with type 2. diabetes. The study also evaluated whether the genetic variants act synergistically with obesity to increase TNF-α levels in patients with diabetes from Grande Vitória, Brazil.Methods: Fifty-six patients were included, of whom 28 were obese and 28 were nonobese. The CAT gene polymorphism was assessed using the polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) method, whereas GSTM1 and GSTT1 polymorphisms were assessed using multiplex PCR. TNF-α levels were measured using the sandwich ELISA technique.Results: Frequencies of GSTM1 and GSTT1 null polymorphisms were 44.6% and 17.9%, respectively. The genotype frequencies of CATC-262T polymorphism were 73.2%, 25.0%, and 1.8% for normal homozygote, heterozygote, and polymorphic homozygote, respectively. Polymorphic genotypes were not associated with increased TNF-α levels, and there was no significant increase in TNF-α levels when evaluating the synergism between obesity and personal genetics.Conclusion: The presence of CAT, GSTM1, and GSTT1 gene polymorphisms was not associated with increased TNF-α levels in patients with type 2 diabetes. Obesity alone or combined with personal genetics of CAT, GSTM1, and GSTT1gene polymorphisms did not promote increased TNF-α levels in the study population.

Factores de riesgo asociados a diabetes mellitus tipo 2. Policlínico Docente José Jacinto Milanés. Matanzas, 2019 / Risk factors associated with type 2 diabetes mellitus. Teaching Polyclinic José Jacinto Milanés. Matanzas, 2019

RESUMEN Introducción: la diabetes es un trastorno endocrino-metabólico crónico que afecta a diversos órganos y tejidos. Más del 90 % de los que la padecen sufren diabetes tipo 2. Esta se acompaña de complicaciones crónicas, que pueden prevenirse mediante un control adecuado de la hiperglucemia y de los factores de riesgo cardiovascular. Objetivo: caracterizar los factores de riesgo asociados a la diabetes mellitus tipo 2, en pacientes del Consultorio del Médico de la Familia no. 27 del Policlínico Docente José Jacinto Milanés, del municipio Matanzas. Materiales y métodos: se realizó un estudio descriptivo de corte transversal, durante el período de enero a diciembre de 2019. El universo estuvo constituido por 50 pacientes pertenecientes al consultorio no. 27 del Policlínico Docente José Jacinto Milanés, del municipio Matanzas, dispensarizados con diabetes mellitus tipo 2. Resultados: el sexo femenino fue el predominante, y el 24 % de los pacientes se encontraban entre 55 y 59 años. En cuanto al estado nutricional, resultó la obesidad el de mayor frecuencia. En el 52 % existían antecedentes familiares de diabetes tipo 2. Conclusiones: la obesidad, los malos hábitos dietéticos, el sedentarismo y la hipertensión arterial constituyeron los factores de riesgo más frecuentes en estos pacientes (AU).

ABSTRACT Introduction: diabetes is a chronic endocrine-metabolic disorder that affects numerous organs and tissues. More than 90 % of those with it suffer from type 2 diabetes. This is accompanied by chronic complications, which can be prevented by adequate control of hyperglycemia and cardiovascular risk factors. Objective: to characterize the risk factors associated with type 2 diabetes mellitus in patients from the Family Physician's Office no. 27 of the Teaching Polyclinic José Jacinto Milanés, of the municipality of Matanzas. Materials and methods: a cross-sectional, descriptive study was carried out during the period from January to December 2019. The universe were 50 patients belonging to Family Physician's Office no. 27 of the Teaching Polyclinic José Jacinto Milanés, of the municipality of Matanzas, diagnosed with type 2 diabetes mellitus. Results: female sex predominated, and 24 % of patients were aged 55-59 years. According to the nutritional status, obesity was the more frequent. There was a family history of type 2 diabetes mellitus in 52 %. Conclusion: obesity, poor dietary habits, sedentary way of life, and arterial hypertension were the most frequent risk factors found in these patients (AU).

Maior frequência de neuropatia periférica diabética associada ao hiperparatireoidismo secundário / Higher prevalence of diabetic peripheral neuropathy associated with secondary hyperparathyroidism

INTRODUÇÃO: A neuropatia periférica diabética (ND) é comum na nefropatia diabética (NFD) e não há informações se o hiperparatireoidismo secundário (HPS) aumenta seus sintomas. O objetivo foi determinar ND por sinais em pacientes com HPS. MATERIAL E MÉTODOS: É um estudo caso-controle. O Grupo Controle (GC) é composto por doentes com NFD e valores de paratormônio (PTH)<60pg / ml. O Grupo de Hiperparatireoidismo (GH) engloba pacientes com NFD e PTH≥60pg/ml e critérios bioquímicos de HPS. As variáveis foram, entre outras, a presença de sinais de ND e foram comparados com o teste t de Student e o qui-quadrado. RESULTADOS: Foram 60 participantes em cada grupo, sendo 35 (58,3%) homens no GC vs 33 (55,0%) em GH (p = 0,713). A idade do GC foi de 67±11,0 anos, vs 72±11 anos GH (p=0,009). A taxa de filtração glomerular (TFG) no GC foi 53,82±25,13 vs GH 35,34±18,43ml/min/1,73m2 (p <0,001). O PTH no GC foi de 38,02±15,32 pg/ml, em GH 119,07±84,33 pg/ml (p <0,001). A ND, devido aos sintomas no GC, foi de 28,3% e 36,6% no GH (p=0,330). A neuropatia por sinais no GC foi de 38,3% e no GH 83,3% (p<0,001). O odds ratio de GH para neuropatia presente devido a sinais foi de 8,044 (IC 95% 3,42­8,92). CONCLUSÃO: Constatou-se uma maior presença de sinais de NPD em pacientes com HPS em nosso centro.

BACKGROUND: Diabetic peripheral neuropathy (DN) is common in diabetic nephropathy (DNP), and there is no information if secondary hyperparathyroidism (SHP) increases its symptoms. The purpose was to determine DN by signs in patients with SHP. METHODS: It is a case-control study. Control patients (CG) with DN and parathyroid hormone (PTH) values<60pg/ml. The Hyperparathyroidism group (HG), patients with DNP and PTH≥60pg/ml and HPS biochemical criteria. The variables were, among others, the presence of DN signs, and were compared with Student's t and chi-square. RESULTS: There were 60 participants in each group, 35(58.3%) men in CG vs.33(55.0%) in GH (p=0.713). The age of the CG was 67±11.0 years, vs 72±11years HG (p=0.009). The glomerular filtration rate (GFR) in the CG was 53.82±25.13 vs in HG 35.34±18.43ml/min/1.73m2(p<0.001). The PTH in the CG were 38.02±15.32pg/ml and in GH 119.07±84.33pg/ml(p<0.001). The DN due to symptoms in CG was 28.3% and in GH 36.6%(p=0.330). Neuropathy due to signs in the CG was 38.3% and in GH 83.3% (p<0.001). The HG odds ratio to present neuropathy due to signs was 8.044 (95% CI 3.42­18.92). CONCLUSION: There was a statistical association between HPS and signs of DN in patients with DNP in our canter.

Relación entre el consumo de alcohol y el riesgo de diabetes tipo 2 en los trabajadores / Relationship Between Alcohol Consumption and Risk Of Diabetes Type 2 in Workers

Introducción. El consumo de alcohol daña la mayoría de los órganos y sistemas de nuestro organismo, con un efecto nocivo sobre la diabetes tipo 2. En nuestro país, el consumo de alcohol es tolerado y socialmente bien considerado, lo que provoca que una parte importante de la población tenga una ingesta excesiva de alcohol. Por tanto, quisimos evaluar el efecto de la ingesta excesiva de alcohol en la población trabajadora y su efecto sobre el riesgo de desarrollar diabetes tipo 2. Métodos. Estudio descriptivo y transversal en 55.147 trabajadores españoles en el que se evaluó el efecto del consumo excesivo de alcohol sobre el riesgo de desarrollar diabetes tipo 2. El riesgo de diabetes se evaluó con las escalas Findrisk y QDScore. El consumo de alcohol se evalúa con la unidad de bebida estándar, equivalente a 10 g de alcohol. Se considera consumo excesivo cuando se superan semanalmente 35 unidades de bebida estándar en hombres y 20 en mujeres. Resultados. El consumo excesivo de alcohol en comparación con no beber, beber poco o moderadamente aumenta el riesgo de diabetes tipo 2 en ambas escalas de riesgo. La razón de probabilidades es 12,22 (IC 95 11,51-12,99) para la escala Findrisk y 13,36 (IC 95% 12,04-14,69) para el riesgo relativo con QDScore. Conclusión. El consumo excesivo de alcohol aumenta el riesgo de diabetes tipo 2 con las escalas Findrisk y QDScore en la población laboral española

Introduction. Alcohol consumption damages most of the organs and systems of our organism, with a harmful effect on type 2 diabetes. In our country, alcohol consumption is tolerated and socially well regarded, which causes an important part of the population to have an excessive alcohol intake. Therefore, we want to evaluate the effect of excessive alcohol intake in the working population and its effect on the risk of developing type 2 diabetes. Methods. Descriptive and cross-sectional study in 55,147 Spanish workers in which the effect of excessive alcohol consumption on the risk of developing type 2 diabetes was assessed. Diabetes risk was assessed with the Findrisk and QDScore scales. Alcohol consumption is assessed with the standard drinking unit, equivalent to 10g of alcohol. Excessive consumption is considered when 35 standard drinking unit in men and 20 in women are exceeded weekly. Results. Heavy drinking compared to no, low or moderate drinking increases the risk of type 2 diabetes on both risk scales. The Odds ratio is 12.22 (CI 95 11.51-12.99) for the Findrisk scale and 13.36 (CI 95% 12.04-14.69) for the relative risk with QDScore. Conclusion. Excessive alcohol consumption increases the risk of type 2 diabetes with the Findrisk and QDScore scales in the Spanish working population

Diagnóstico diferencial de adenoma folicular y carcinoma papilar de tiroides mediante variables cariométricas. Matanzas 2013-2016 / Differential diagnosis of thyroidal follicular adenoma and papillary carcinoma by means of karyometric variables. Matanzas 2013-2016

RESUMEN Introducción: los carcinomas diferenciados de tiroides se originan en el epitelio folicular. De ellos el carcinoma papilar muestra una mayor incidencia. Una variante del mismo es la folicular, que en ocasiones muestra un patrón arquitectural que imita a un adenoma folicular. Objetivo: contribuir al diagnóstico diferencial entre el carcinoma papilar variante folicular y el adenoma folicular de tiroides, utilizando variables cariométricas de las células foliculares. Materiales y métodos: se aplicaron técnicas morfométricas a muestras de biopsias de tiroides con carcinoma papilar variante folicular y adenoma folicular, así como a muestras sin patología, en el período comprendido de enero de 2013 a diciembre de 2016, obtenidas en el Hospital Universitario Clínico Quirúrgico Comandante Faustino Pérez Hernández, de Matanzas. Las técnicas aplicadas se basaron en las variables cuantitativas: área, perímetro y factor de forma nuclear de las células foliculares. Los resultados se expresaron en porcentajes; la media aritmética como medida de tendencia central; desviación típica, incluyéndose el cálculo de los valores máximo, mínimo y recorrido para cada variable comprendida en el estudio, reflejados en tablas y gráficos realizados a través del software Microsoft Office Excel. Resultados: se obtuvieron valores elevados de área y perímetro nuclear de las células foliculares del carcinoma papilar variante folicular con relación al adenoma folicular, mientras que el factor de forma no arrojó resultados significativos para la diferenciación de dichas enfermedades tiroideas. Conclusiones: la aplicación de técnicas morfométricas a variables cariométricas en el tiroides, para el diagnóstico diferencial entre el carcinoma papilar variante folicular y el adenoma folicular, ofrece resultados aplicables en estudios histopatológicos (AU).

ABSTRACT Introduction: differentiated thyroid carcinomas are originated in the follicular epithelium. Of them, the papillary carcinoma shows higher incidence. Follicular carcinoma, one of its variants, occasionally shows an architectural pattern imitating a follicular adenoma. Objective: to contribute to the differential diagnosis between the papillary carcinoma, follicular variant, and thyroid follicular adenoma, using karyometric variables of follicular cells. Materials and methods: morphometric techniques were applied to samples of biopsies of thyroids with papillary carcinoma, follicular variant, and follicular adenoma, and also to samples without any pathology, in the period from January 2013 to December 2016, gathered in the University Hospital Comandante Faustino Perez, of Matanzas. The applied techniques were based on quantitative variables: area, perimeter and nuclear form factor. Results were expressed in percentages; the arithmetic median as measure of central tendency; typical deviation, including the calculation of maximal, minimal values and the course for each variable included in the study, were drawn in tables and graphics using Microsoft Office Excel software. Results: highs values of area and nuclear perimeter of the follicular cells of the papillary carcinoma, follicular variant, were obtained, while the shape factor did not show significant results for those thyroidal diseases differentiation. Conclusions: the application of morphometric techniques to karyometric variables in the thyroids, for the differential diagnosis between the papillary carcinoma, follicular variant, in follicular carcinoma, offers results that can be applied in histopathological studies (AU).

Social vulnerability associated with the self-reported diagnosis of type II diabetes: a multilevel analysis / Vulnerabilidade social se associa com o diagnóstico autorreferido de diabetes tipo II: uma análise multinível

ABSTRACT: Objective: To analyze the contextual factors associated with type II diabetes mellitus in Belo Horizonte City. Methods: Cross-sectional study with 5,779 adults living in Belo Horizonte City, participating in the Risk and Protection Factors Surveillance System for Chronic Diseases through Telephone Survey (Vigitel), in 2008, 2009, and 2010. Multilevel regression models were used to test the association between contextual indicators of physical and social environments, and self-reported diagnosis of diabetes, adjusted for individual sociodemographic and lifestyle factors. Descriptive analyzes and multilevel logistic regression models were used, considering a 5% significance level. Results: The prevalence of diabetes was 6.2% (95%CI 5.54 - 6.92), and 3.1% of the variability of chance of presenting diabetes were explained by contextual characteristics. Living in areas with high density of private places for physical activity and high income was associated with a lower chance of having diabetes. The areas with high level of social vulnerability were strongly associated with the chance of presenting diabetes, adjusted for individual characteristics. Conclusion: Characteristics of physical and social environments were associated with the chance of diabetes occurrence. Urban centers with opportunities to adopt healthy behaviors can help to reduce the occurrence of diabetes and its complications.

RESUMO: Objetivo: Analisar os fatores contextuais associados ao diabetes mellitus tipo II em Belo Horizonte (MG). Métodos: Estudo transversal com 5.779 adultos residentes em Belo Horizonte, participantes do Sistema de Vigilância de Fatores de Risco e Proteção para Doenças Crônicas por Inquérito Telefônico, nos anos de 2008, 2009 e 2010. Foram utilizados modelos de regressão multinível para testar a associação entre indicadores contextuais do ambiente físico e social e diagnóstico autorreferido de diabetes, ajustados por fatores individuais sociodemográficos e de estilo de vida. Utilizaram-se análises descritivas e modelos de regressão logística multinível, considerando um nível de significância de 5%. Resultados: A prevalência de diabetes foi de 6,2% (IC95% 5,54-6,92), e 3,1% da variabilidade da chance de diabetes nas áreas de abrangência estudadas foi explicada por características contextuais. Residir em áreas com alta densidade de locais privados para prática de atividade física e com alta renda associou-se a menor chance de ter diabetes. As áreas com alto índice de vulnerabilidade social foram fortemente associadas ao diabetes, independentemente de características individuais. Conclusão: A ocorrência de diabetes está associada com as características do ambiente físico e social. Centros urbanos com oportunidades para adoção de comportamentos saudáveis podem ajudar a reduzir a ocorrência de diabetes e as suas complicações.

Repercussões metabólicas: quais, como e por que investigar? / Metabolic repercussions: which ones, how and why investigate?

A síndrome dos ovários policísticos (SOP) é frequentemente acompanhada de distúrbio metabólico, principalmente dos carboidratos e dos lipídeos, aumentando o risco de síndrome metabólica. Por essa razão, alguns investigadores ainda denominam a SOP de síndrome metabólica-reprodutiva. O objetivo deste capítulo é descrever as principais repercussões metabólicas, bem como como investigá-las e saber como suas consequências podem ser deletérias para a saúde da mulher. Esta é uma revisão narrativa mostrando a implicação do metabolismo dos carboidratos e dos lipídeos nas dislipidemias, bem como da síndrome metabólica sobre o sistema reprodutor, e o risco cardiovascular da mulher com SOP. Conclui-se que o manejo adequado dos distúrbios metabólicos na SOP é benéfico a curto e a longo prazo tanto para o sistema reprodutor quanto para o cardiovascular.(AU)

Associação entre diabetes mellitus e doenças oculares em pessoas com deficiência visual / Association between diabetes mellitus and eye diseases in people with visual impairment / Asociación entre diabetes mellitus y enfermedades oculares en personas con discapacidad visual

Objetivo: verificar associação entre diabetes mellitus e doenças oculares em pessoas com deficiência visual. Método: estudo transversal com 51 pessoas com diabetes e deficiência visual, em um centro de reabilitação visual do interior paulista, que participaram de entrevista estruturada, em 2018. Utilizou-se os testes: Kolmogorov Smirnov, Regressão de Poisson, Regressão de Logística Binária, e Correlação de Spearman. Resultados: a maioria das pessoas era cega e relatou que a retinopatia diabética, o glaucoma e a catarata foram causa da deficiência visual; com tempo de diagnóstico do diabetes acima de 109 meses. A catarata apresentou um nível de correlação baixa (r=0,280 e p=0,047), e a retinopatia diabética um nível de correlação moderada (r=0,565 e p=0,000), considerando o tempo de diagnóstico do diabetes. Conclusão: associação estatisticamente significante entre o tipo de diabetes e a retinopatia, e correlação estatisticamente significante entre o tempo de diagnóstico do diabetes, a catarata e a retinopatia diabética.

Objective: to verify the association between diabetes mellitus and eye diseases in people with visual impairment. Method: this cross-sectional study involved 51 people with diabetes and visual impairment at a Visual Rehabilitation Center in São Paulo, who participated in a structured interview in 2018. The tests used were: Kolmogorov Smirnov, Poisson Regression, Binary Logistic Regression, and Spearman Correlation. Results: most participants were blind, reported that diabetic retinopathy, glaucoma and cataracts were the causes of their visual impairment, and had been diagnosed with diabetes over 109 months earlier. Cataract returned a low level of correlation with time with diagnosis of diabetes (r = 0.280 and p = 0.047), and diabetic retinopathy, moderate correlation (r = 0.565 and p = 0.000). Conclusion: a statistically significant association was found between type of diabetes and retinopathy, and statistically significant correlations between the time diagnosed with diabetes, cataracts and diabetic retinopathy.

Objetivo: verificar la asociación entre diabetes mellitus y enfermedades oculares en personas con discapacidad visual. Método: este estudio transversal involucró a 51 personas con diabetes y discapacidad visual en un Centro de Rehabilitación Visual en São Paulo, quienes participaron en una entrevista estructurada en 2018.Las pruebas utilizadas fueron: Kolmogorov Smirnov, Regresión de Poisson, Regresión Logística Binaria y Spearman Correlación. Resultados: la mayoría de los participantes eran ciegos, informaron que la retinopatía diabética, el glaucoma y las cataratas eran las causas de su discapacidad visual y habían sido diagnosticados con diabetes más de 109 meses antes. La catarata devolvió un bajo nivel de correlación con el tiempo con el diagnóstico de diabetes (r = 0,280 yp = 0,047) y la retinopatía diabética, correlación moderada (r = 0,565 yp = 0,000). Conclusión: se encontró asociación estadísticamente significativa entre tipo de diabetes y retinopatía, y correlaciones estadísticamente significativas entre el tiempo de diagnóstico de diabetes, cataratas y retinopatía diabética.

Concordância na velocidade da marcha de mulheres diabéticas tipo 2 em diferentes testes de caminhada / Agreement in the gait speed of type 2 diabetic women from different walking tests

O objetivo desse estudo foi verificar a concordância na velocidade da marcha (VM) a partir dos testes de caminhada de seis minutos (6MWT) e de quatro metros (4MWT) em mulheres diabéticas tipo 2 (DM2). Os testes foram realizados antes e após intervenção de 12 semanas com exercícios físicos. O 4MWT foi realizado em espaço de quatro metros, sendo o resultado do teste medido como o tempo gasto (segundos) no percurso. O 6MWT foi realizado em modelo de ir e vir em uma distância de 15 metros e o resultado foi a distância total (metros) percorrida. Os resultados foram padronizados para velocidade de deslocamento (m/s). Para avaliar a concordância (6MWTpré x 4MWTpré) e (6MWTpósx 4MWTpós), utilizou-se o teste de Bland-Altman (B-A) e o coeficiente de concordância de correlação de Lin. O nível de significância aceito para o estudo foi α 5%. Foram medidas 39 mulheres, com idade média de 58,79 ± 10,03 anos e diagnóstico de DM2 a 8,64 ± 8,53 anos. Verificou-se, pelo teste de B-A, diferenças na VM dos testes de -0,001 ± 0,19 m/s (IC95%: -0,37 a 0,37 m/s) no início e 0,02 ± 0,21 m/s (IC95%: -0,39 a 0,42 m/s) ao final e concordância de 0,60 (IC95%: 0,41 a 0,79; p < 0,001) e 0,52 (IC95%: 0,31 a 0,73; p < 0,001) pré e pós, respectivamente, pelo coeficiente de concordância de correlação Lin. Através dos dados obtidos, sugere-se que os dois testes podem ser utilizados para avaliar a VM das mulheres DM2, porém o 6MWT apresentou maior reprodutibilidade para detectar mudanças na VM ao longo do tempo

This study aimed to test the agreement in the gait speed (GS) between the 6-minute walk test and the 4-me-ter gait speed (6MWT - 4MWT) in type 2 diabetic women (T2DM). The tests were performed before and after a 12-week physical exercise intervention. The 4MWT was performed in a space of four meters, with results based on the time spent (seconds) to complete a 4-meter distance. The 6MWT was carried out similar to a yo-yo test in 15 meters and the result was operationalized by the total distance (meters) covered. The results of the tests were standardized as speed (m/s). To evaluate agreements (6MWTbefore x 4MWTbefore) and (6MWTafter x 4MWTafter), Bland-Altman (B-A), and Lin's agreements were used. The level of significance was set at 5%. A total of 39 women were evaluated, mean age 58.79 ± 10.03 years, diagnosis of diabetes at 8.64 ± 8.53 years.The B-A test showed a mean difference in GS of -0.001 ± 0.19 m/s (95%CI: -0.37 to 0.37 m/s) before and 0.02 ± 0.21 m/s (95%CI: -0.39 to 0.42 m/s) after, and Lin's agreements of 0.60 (95%CI: 0.41 to 0.79; p < 0.001) and 0.52 (95%CI: 0.31 to 0.73; p < 0.001) before and after, respectively. Based on our data it is suggested that the two tests can be used to evaluate the GS of T2DM women, but the 6MWT was more reproductible to detect changes in GS over time

Enfermedad arterial periférica y diabetes mellitus de tipo 2 en atención primaria / Peripheral arterial disease and diabetes mellitus type 2 in the primary care

Objetivo: Caracterizar la enfermedad arterial periférica en pacientes con diabetes mellitus tipo 2 e identificar su relación con variables sociodemográficas y clínicas. Métodos: Estudio descriptivo en 252 pacientes con diabetes melltus tipo 2. A todos se les midió el índice de presiones tobillo-brazo, para caracterizar la enfermedad y se les aplicó el cuestionario de Edimburgo. Las variables: índice de presiones tobillo-brazo, edad, sexo, años de evolución de la diabetes, factores de riesgo cardiovascular, claudicación intermitente. Resultados: La frecuencia del índice de presiones tobillo-brazo bajo fue de 37,2 por ciento (n= 99). Los factores asociados fueron el sexo, la edad, la hipertensión arterial y los años de evolución de la diabetes. El cuestionario de Edimburgo presentó una sensibilidad de 44,4 por ciento y una especificidad de 71,9 por ciento para detectar enfermedad arterial periférica sintomática. Conclusiones: La enfermedad arterial periférica se encuentra infradiagnosticada a pesar de la elevada frecuencia del índice de presiones tobillo-brazo bajo en pacientes con diabetes mellitus tipo 2; en Honduras hay escasa información, dado que no se implementan los métodos diagnósticos de manera rutinaria en pacientes con factores de riesgo para desarrollar la enfermedad, hasta que se encuentra muy avanzada. Hay relación directa de esta enfermedad con la edad, el sexo femenino, el tiempo de evolución de la diabetes mellitus y la hipertensión arterial. El cribado sistemático a través del índice tobillo-brazo identifica más individuos de alto riesgo candidatos a un control intensivo de sus factores de riesgo cardiovascular y facilita la búsqueda activa de enfermedad vascular en otros territorios(AU)

Objective: To characterize the peripheral arterial disease in patients with diabetes mellitus type 2 and to identify its relation with socio-demographic and clinical variables. Methods: A descriptive study in 252 patients with diabetes mellitus type 2. To all of them it was measured the ankle-brachial pressure index to characterize the disease and it was applied the Edinburgh questionnaire. The variables were: ankle-brachial pressure index, age, sex, years of evolution of diabetes, cardiovascular risk factors, and intermittent claudication. Results: The frequency of the ankle- upper arm pressures index was 37.2% (n=99). The associated factors were sex, age, hypertension and the years of evolution of diabetes. The Edinburgh questionnaire had a sensitivity of 44.4 percent and a specificity of 71.9 percent to detect symptomatic peripheral arterial disease. Conclusions: Peripheral arterial disease is underdiagnosed in spite of the high frequency of the of ankle- upper arm pressure index in patients with diabetes mellitus type 2; in Honduras, there is scarce information since there are not routinely implemented the diagnostic methods in patients with risk factors for developing the disease, until it is very advanced. There is a direct relation of this disease with the age, the female sex, time of evolution of diabetes mellitus and hypertension. The systematic screening through the ankle-brachial index identifies more high-risk individuals which are candidates for intensive control of cardiovascular risk factors and it facilitates the active search of vascular disease in other territories(AU)