Diabetes mellitus tipo 2 de inicio en paciente joven: implicancias en la población chilena / Young-onset type 2 diabetes mellitus: implications in the chilean population

La diabetes mellitus tipo 2 (DM2), habitualmente asociada a adultos en edad media y adulto mayor, ha presentado un aumento en su incidencia en pacientes menores de 40 años, lo que se conoce como DM2 de inicio en paciente joven. Varios estudios sugieren que este tipo de diabetes presenta no sólo un deterioro más rápido de las células beta-pancreáticas en comparación con la DM2 de inicio más tardío, sino que también un mayor riesgo de complicaciones que pacientes con DM Tipo1, lo que sugiere una variable independiente de los años de exposición a la enfermedad y por tanto, un fenotipo más agresivo. Por otra parte, hay evidencia que afirma que existen grupos poblacionales en mayor riesgo de desarrollar esta patología, particularmente ciertas etnias. En el presente trabajo se exponen los principales hallazgos de una reciente revisión del tema y se los compara con los datos nacionales disponibles. Dada la alta prevalencia de DM2 en la población chilena y la escasa cantidad de estudios epidemiológicos de calidad que permitan conocer nuestro panorama con mayor precisión, es que se destaca la importancia de estos últimos para poder tomar medidas de salud pública adecuadas.

Type 2 diabetes mellitus type 2 (T2DM), commonly associated with the middle to old aged adults group, has shown an increase in incidence in patients younger than 40 years old, which is known as young-onset type 2 diabetes mellitus. Several studies suggest that this type of diabetes not only exhibits a faster deterioration of the beta-pancreatic cells in comparison with type 1 diabetes mellitus patients, but also a greater risk of complications not regarding the time of exposure to the disease, therefore a more aggressive phenotype. Otherwise, there is evidence which asserts that some population groups are in mayor risk of developing this disease, especially certain ethnics. In this work it is exposed the main findings of a recent review of the subject and it is contrasted with available national data. Given the high prevalence of T2DM in the chilean population and the little amount of epidemiological high-quality studies that allows us to know our outlook with greater precision, it is highlighted the need for them in order to make adequate public health decisions.

Infección por coronavirus en pacientes con diabetes / Coronavirus infection in patients with diabetes

Resumen La diabetes mellitus es una enfermedad crónica, compleja, multifactorial, que se caracteriza por alteración en el metabolismo de la glucosa, las grasas y las proteínas. Los pacientes que la padecen con frecuencia cursan con hiperglucemia y la enfermedad arterial coronaria es la principal causa de muerte. Las comorbilidades que se asocian a la diabetes son: sobrepeso y obesidad, hipertensión arterial sistémica, dislipidemia aterogénica y en algunos pacientes enfermedad vascular periférica, daño renal, neuropatía y retinopatía. El descontrol crónico de la enfermedad se asocia a mayor susceptibilidad a infecciones, las cuales generalmente cursan con pocos síntomas, pero generalmente se magnifica la hiperglucemia, lo cual empeora el curso de las infecciones. Desde diciembre de 2019, cuando se identificó la enfermedad producida por uno de los coronavirus (coronavirus 2 del síndrome respiratorio agudo grave, SARS-CoV-2) y que ha sido llamada enfermedad por coronavirus 2019 (COVID-19), ha habido algunos reportes que asocian la presencia de diabetes con un mayor riesgo de mortalidad. En este artículo de revisión nos hemos enfocado en cuatro puntos específicos: 1) epidemiología de la prevalencia y de la mortalidad de COVID 19 en la población general y en la población con diabetes mellitus tipo 2; 2) fisiopatología relacionada con la unión del SARS-CoV-2 a los receptores en sujetos con diabetes; 3) la respuesta inmunológica inducida por el SARS-CoV-2, y 4) el tratamiento ambulatorio y hospitalario que se recomienda en los pacientes con diabetes que se infectan con SARS-CoV-2.

Abstract Diabetes mellitus is a complex, multifactorial, chronic disease characterized by impaired metabolism of glucose, fats and proteins. Patients who suffer from it frequently have hyperglycemia and coronary artery disease is the leading cause of death. The comorbidities associated with diabetes are overweight and obesity, systemic arterial hypertension, atherogenic dyslipidemia and in some patients peripheral vascular disease, kidney damage, neuropathy and retinopathy. Chronic lack of control of the disease is associated with increased susceptibility to infections, which generally have few symptoms, but hyperglycemia is generally magnified, which worsens the course of infections. Since December 2019, when the disease caused by one of the coronaviruses (coronavirus 2 of severe acute respiratory syndrome, SARS-CoV-2) was identified and has been called coronavirus disease 2019 (COVID-19), there have been some reports that associate the presence of diabetes with an increased risk of mortality. In this review article we have focused on four specific points: 1) epidemiology of the prevalence and mortality of COVID 19 in the general population and in the population with type 2 diabetes mellitus; 2) pathophysiology related to the binding of SARS-CoV-2 to receptors in subjects with diabetes; 3) the immune response induced by SARS-CoV-2, and 4) the outpatient and hospital treatment recommended in patients with diabetes who become infected with SARS-CoV-2.

Prevalence, treatment, and control of dyslipidemia in diabetic participants of two brazilian cohorts: a place far from heaven

SUMMARY OBJECTIVE Diabetes is one of the leading causes of cardiovascular mortality. Over the last years, mortality has decreased significantly, more in individuals with diabetes than in healthy ones. That is mostly due to the control of other cardiovascular risk factors. The objective of our study was to analyze the dyslipidemia control in two diabetes cohorts. METHODS Patients from two distinct cohorts were studied, 173 patients from the BHS (Brasília Heart Study) and 222 patients from the BDS (Brazilian Diabetes Study). The data on dyslipidemia control were studied in both different populations. All patients had diabetes. RESULTS There are significant differences concerning comorbidities between the LDL-C and BDS groups. The average glycated hemoglobin is of 8.2 in the LDL-C > 100 group in comparison with 7.7 and 7.5 in the 70-100 and < 70 groups, respectively (p = 0.024). There is a higher percentage of hypertensive patients with LDL between 70-100 (63.9%), when comparing the < 70 and > 100 groups (54.3% and 54.9%, respectively; p = 0.005). Diastolic pressure is higher in the group with LDL > 100, with an average of 87 mmHg, in comparison with 82.6 mmHg and 81.9 mmHg in the 70-100 and < 70 groups, respectively (p = 0.019). The group with LDL > 100 has the greatest percentage of smokers (8.7%) in comparison with the groups with LDL between 70-100 and < 70 (5.6% and 4.3%, respectively; p = 0.015). There is also a difference in the previous incidence of coronaropathy. In the group with LDL < 70, 28.3% of patients had already experienced a previous infarction, compared with 11.1% and 10.6% in the 70-100 and > 100 groups, respectively (p < 0.001). CONCLUSIONS The data in our study have shown that the dyslipidemia control in diabetic patients is inadequate and there is a tendency of direct association between lack of blood glucose control and lack of dyslipidemia control, in addition to the association with other cardiovascular risk factors, such as diastolic hypertension and smoking. This worsened control might be related to the plateau in the descending curve of mortality, and investments in this regard can improve the cardiovascular health in diabetic patients.

RESUMO OBJETIVO O diabetes é importante causa de mortalidade cardiovascular. Nos últimos anos, a mortalidade diminuiu substancialmente, mais em diabéticos do que em não diabéticos, em grande parte devido ao controle de outros fatores de risco cardiovasculares. Nosso estudo tem como objetivo analisar o controle de dislipidemia em duas coortes de diabéticos. MÉTODOS Foram estudados pacientes de duas coortes distintas, sendo 173 pacientes do BHS (Brasília Heart Study) e 222 pacientes do BDS (Brazilian Diabetes Study). Os dados sobre controle de dislipidemia foram estudados nas duas populações diferentes. Todos os pacientes eram diabéticos. RESULTADOS Há diferenças significativas em relação às comorbidades entre os grupos de LDL-C no BDS. A média de hemoglobina glicada é de 8,2 no grupo com LDL-C > 100, comparado com 7,7 e 7,5 nos grupos 70-100 e < 70, respectivamente (p = 0,024). Há maior porcentagem de pacientes hipertensos com LDL entre 70-100 (63,9%), quando comparado aos grupos < 70 e > 100 (54,3% e 54,9%, respectivamente; p = 0,005). A pressão diastólica é mais elevada no grupo com LDL > 100, com média de 87 mmHg, comparado com 82,6 mmHg e 81,9 mmHg nos grupos 70-100 e < 70, respectivamente (p = 0,019). O grupo com LDL > 100 tem maior porcentagem de tabagistas (8,7%) quando comparado aos grupos com LDL entre 70-100 e < 70 (5,6% e 4,3%, respectivamente; p = 0,015). Há, também, diferença na incidência prévia de coronariopatia. No grupo com LDL < 70, 28,3% dos pacientes já apresentaram infarto prévio, comparados com 11,1% e 10,6% nos grupos 70-100 e > 100, respectivamente (p < 0,001). CONCLUSÃO Os dados do nosso estudo mostram que o controle de dislipidemia em diabéticos é inadequado, e há uma tendência de associação direta entre descontrole glicêmico e descontrole de dislipidemia, além de associação com outros fatores de risco cardiovascular, como hipertensão diastólica e tabagismo. Esse pior controle pode estar relacionado ao platô no descenso da curva de mortalidade, e o investimento nesse quesito pode melhorar a saúde cardiovascular dos diabéticos.

Cardiovascular autonomic neuropathy in type 2 diabetic patients

SUMMARY Diabetes is one of the most common chronic pathologies around the world, involving treatment with general clinicians, endocrinologists, cardiologists, ophthalmologists, nephrologists and a multidisciplinary team. Patients with type 2 Diabetes Mellitus (T2DM) can be affected by cardiac autonomic neuropathy, leading to increased mortality and morbidity. In this review, we will present current concepts, clinical features, diagnosis, prognosis, and possible treatment. New drugs recently developed to reduce glycemic level presented a pleiotropic effect of reducing sudden death, suggesting a potential use in patients at risk.

RESUMO Diabetes é uma das mais frequentes patologias crônicas em todo o mundo, cujo tratamento envolve uma equipe multidisciplinar, médicos generalistas, endocrinologistas, cardiologistas, nefrologistas e oftalmologistas. Pacientes com diabetes mellitus tipo 2 (DMT2) podem apresentar neuropatia autonômica cardíaca (NAC), levando a aumento de mortalidade e morbidade. Nesta revisão, apresentaremos atuais conceitos, características clínicas, diagnóstico, prognóstico e possíveis tratamentos. Novas drogas recentemente desenvolvidas para redução de níveis glicêmicos apresentaram efeito pleiotrópico de redução de morte súbita, sugerindo um potencial uso neste perfil de pacientes.

Is the recent increment in attributable deaths to type-2 diabetes (T2D) associated with the latest chikungunya outbreak in a major epidemic area in Brazil?

Abstract INTRODUCTION: Chikungunya virus (CHIKV) can negatively influence outcomes in patients with pre-existing conditions. We investigated the association between the recent CHIKV outbreak and increased type 2 diabetes (T2D)-attributable deaths. METHODS: Monthly averages of T2D-attributable deaths between 2001 and 2016 were determined and compared to the equivalent data for 2017 and the recent CHIKV outbreak. RESULTS: CHKV outbreak peaked in April 2017 with 4,394.4 cases/100,000 inhabitants, while T2D-attributable deaths in the same period increased by 35.2%. CONCLUSIONS: T2D-attributable deaths significantly increased compared to the previous data, which overlapped with CHIKV incidence. The pathophysiology of this association warrants further investigations.

Riscos associados à mortalidade em pacientes atendidos em um programa de prevenção do pé diabético / Efecto del cuidado de enfermería en pacientes atendidos en un programa de prevención del pie diabético / Effects of nursing care on patients in an educational program for prevention of diabetic foot

Resumo OBJETIVO SIdentificar em pacientes com diabetes tipo 2 quais alterações nos pés estariam associadas às características demográficas, clínicas, bioquímicas e de tratamento e quais delas aumentariam o risco de mortalidade. MÉTODOS Estudo longitudinal retrospectivo que avaliou as alterações nos pés de pacientes externos atendidos em consulta de enfermagem. Os dados da história clínica e do exame dos pés foram coletados de 918 prontuários de uma amostra por conveniência. RESULTADOS Em 10 anos, a mortalidade cumulativa atribuída a polineuropatia sensitiva periférica foi 44,7%, pela doença vascular periférica 71,7%, pela associação das duas condições 62,4% e pela amputação 67,6%. Após análise multivariável, o tempo de acompanhamento com enfermeiros permaneceu como único fator de proteção para a mortalidade (p < 0,001). CONCLUSÃO O risco de morrer nesses pacientes diminuiu quando consultaram com enfermeiros educadores. Permaneceu como fator de risco independente pacientes com pé isquêmico, amputação e doença arterial coronariana.

Resumen OBJETIVOS Identificar en pacientes con diabetes tipo 2 que alteraciones en los pies estarían asociadas a las características demográficas, clínicas, bioquímicas y de tratamiento y cuáles de ellas aumentarían el riesgo de mortalidad. MÉTODOS Estudio longitudinal retrospectivo que evaluó los cambios en los pies de pacientes externos atendidos en consulta de enfermería. Los datos de la historia clínica y del examen de los pies fueron recolectados de 918 prontuarios, una muestra por conveniencia. RESULTADOS En 10 años, la mortalidad acumulativa atribuida a la polineuropatía sensitiva periférica fue 44.7%, por la enfermedad vascular periférica 71.7%, por la asociación de las dos condiciones 62.4% y por la amputación 67.6%. Después del análisis multivariable, el tiempo de acompañamiento con enfermeros permaneció como único factor de protección para la mortalidad (p < 0,001). CONCLUSIÓN El riesgo de morir en estos pacientes disminuyó cuando consultaron con enfermeros educadores. Se mantuvo como factor de riesgo independiente pacientes con pie isquémico, amputación y enfermedad arterial coronaria.

Abstract OBJECTIVES Identify in patients with type 2 diabetes what changes in the feet would be associated with demographic, clinical, biochemical and treatment characteristics and which would increase the risk of mortality. METHODS Retrospective longitudinal study evaluating the alterations in feet of outpatients attended at a nursing visit. Data from the clinical history and foot exam were collected from 918 medical records of a convenience sample. RESULTS At 10 years, the cumulative mortality attributable to peripheral polyneuropathy was 44.7%, to peripheral artery disease was 71.7%, to both conditions were 62.4%, and to amputation was 67.6%. After multivariate analysis, duration of nursing follow-up remained as the only protective factor against death (p < 0.001). CONCLUSIONS The risk of death in these patients decreased when they had consultations with a nurse educator. Ischemic feet, amputation, and coronary artery disease remained independent risk factors.

Mortalidad por diabetes tipo 2 y la implementación del programa PREVENIMSS: un estudio de series de tiempo en México, 1998-2015 / Mortalidade por diabetes tipo 2 e implementação do programa PREVENIMSS: um estudo de série temporal no México, 1998-2015 / Mortality from type 2 diabetes and implementation of the PREVENIMSS program: a time series study in Mexico, 1998-2015

Resumen: La diabetes tipo 2 es la principal causa de mortalidad y morbilidad en el mundo. En México es la primera causa de mortalidad, discapacidad, años perdidos por muerte prematura. El Instituto Mexicano del Seguro Social (IMSS) implementó la estrategia PREVENIMSS. El objetivo del presente estudio es determinar el efecto de dicho programa en la tendencia de la mortalidad por diabetes tipo 2, realizando un análisis de series de tiempo interrumpidas. Al inicio del periodo de tiempo analizado, la tasa de mortalidad de diabetes en los derechohabientes era mayor, en comparación con la población control. Posterior a la implementación del programa, se presentó una discreta reducción en la tendencia de la mortalidad, mientras que en el grupo control la tendencia fue ascendente. Las diferencias encontradas en las tendencias entre las poblaciones comparadas sugieren que no son resultado exclusivo de las intervenciones institucionales. Las condiciones de vida y de trabajo podrían explicar dichas diferencias.

Resumo: O diabetes tipo 2 é a primeira causa de morbi-mortalidade no mundo. No México, é a primeira causa de mortalidade, incapacidade e anos de vida perdidos. O Instituto Mexicano de Seguridade Social (IMSS) implementou a estratégia conhecida como PREVENIMSS. O estudo atual teve como objetivo estimar o efeito do programa sobre a tendência na mortalidade por diabetes tipo 2, com base em uma análise de série temporal ininterrupta. No início do período de estudo, a taxa de mortalidade por diabetes era mais alta entre segurados do IMSS do que na população controle. Depois da implementação do programa, houve uma pequena redução na mortalidade, enquanto o grupo controle mostrava uma tendência crescente. Diferenças nas tendências entre os dois grupos sugerem que não resultam exclusivamente de intervenções institucionais. As condições de vida e de trabalho podem ajudar a explicar essas diferenças.

Abstract: Type 2 diabetes is the leading cause of morbidity and mortality in the world. In Mexico it is the first cause of mortality, disability, and potential years of life lost due to premature death. The Mexican Institute of Social Security (IMSS) implemented the PREVENIMSS strategy. The aim of the current study was to estimate the program's effect on the mortality trend from type 2 diabetes, based on an interrupted time series analysis. At the beginning of the target period, the diabetes mortality rate was higher in IMSS beneficiaries than in the control population. After the program's implementation, there was a slight reduction in the mortality trend, while the control group showed an upward trend. Differences in the trends between the two groups suggest that they are not the exclusive result of institutional interventions. Living and work conditions could explain these differences.

Carga do diabetes mellitus tipo 2 no Brasil / Carga de la diabetes mellitus tipo 2 en Brasil / Burden of type 2 diabetes mellitus in Brazil

O diabetes mellitus tipo 2 se destaca, atualmente, na composição dos indicadores dos Estudos de Carga Global de Doença. Este estudo estimou a carga de doença atribuível ao diabetes mellitus tipo 2 e suas complicações crônicas no Brasil, 2008. Foram calculados os anos de vida perdidos ajustados por incapacidade (DALY), anos de vida perdidos por morte prematura (YLL) e os anos de vida perdidos por conta da incapacidade (YLD) estratificados por sexo, faixa etária e região. O diabetes mellitus tipo 2 representou 5% da carga de doença no Brasil, posicionando-se como a 3ª causa mais importante nas mulheres e a 6ª nos homens na construção do DALY. A maioria do DALY se concentrou na faixa etária entre 30 e 59 anos e foi representado majoritariamente pelo YLD. As maiores taxas de YLL e YLD se concentraram nas regiões Nordeste e Sul, respectivamente. As complicações crônicas do diabetes mellitus tipo 2 representaram 80% do YLD. O diabetes mellitus tipo 2 representou um dos principais agravos de saúde no Brasil em 2008, contribuindo com relevantes parcelas de mortalidade e morbidade.

La diabetes mellitus tipo 2 se destaca, actualmente, en la composición de los indicadores de los Estudios de Carga Global de Enfermedad. Este estudio estimó la carga de la enfermedad, atribuible a la diabetes mellitus tipo 2 y sus complicaciones crónicas en Brasil, 2008. Se calcularon los años de vida perdidos, ajustados por incapacidad (DALY), años de vida perdidos por muerte prematura (YLL) y los años de vida perdidos, debido a la incapacidad (YLD), estratificados por sexo, franja de edad y región. La diabetes mellitus tipo 2 representó un 5% de la carga de enfermedad en Brasil, posicionándose como la 3ª causa más importante en las mujeres y la 6ª en los hombres en la construcción del DALY. La mayoría del DALY se concentró en la franja de edad entre 30 y 59 años y fue representado mayoritariamente por el YLD. Las mayores tasas de YLL y YLD se concentraron en las regiones del nordeste y sur, respectivamente. Las complicaciones crónicas de la diabetes mellitus tipo 2 representaron un 80% del YLD. El diabetes mellitus tipo 2 representó uno de los principales agravios de salud en Brasil en 2008, contribuyendo con relevantes cuotas de mortalidad y morbilidad.

Type 2 diabetes mellitus currently ranks high among indicators used in Global Burden of Disease Studies. The current study estimated the burden of disease attributable to type 2 diabetes mellitus and its chronic complications in Brazil, 2008. We calculated disability-adjusted life years (DALYs), years of life lost (YLLs), and years lived with disability (YLDs) stratified by gender, age bracket, and major geographic region. Type 2 diabetes mellitus accounted for 5% of the burden of disease in Brazil, ranking 3rd in women and 6th in men in the composition of DALYs. The largest share of DALYs was concentrated in the 30-59-year age bracket and consisted mainly of YLDs. The highest YLL and YLD rates were in the Northeast and South of Brazil, respectively. Chronic complications represented 80% of YLDs from type 2 diabetes mellitus. Type 2 diabetes mellitus ranked as a leading health problem in Brazil in 2008, accounting for relevant shares of mortality and morbidity.

Adult obesity, disease and longevity in Mexico / Obesidad, enfermedad y longevidad en adultos mexicanos

Objective. To obtain estimates of the effects of overweight and obesity on the incidence of type 2 diabetes (T2D) and adult mortality. Materials and methods. We use three waves (2000, 2002, 2012) of the Mexican Health and Aging Survey (MHAS).We employ parametric hazard models to estimate mortality and conventional logistic models to estimate incidence of T2D. Results. Obesity and overweight have a strong effect on the incidence of T2D;this, combined with the large impact of diabetes on adult mortality, generates increases in mortality that translate into losses of 2 to 3 years of life expectancy at age 50. Conclusions. If increasing trends in obesity in Mexico continue as in the past, progress in adult survival may be slowed down considerably and the incidence of T2D will continue to increase.

Objetivo. Estimar los efectos de sobrepeso y obesidad en edad adulta en la incidencia de diabetes tipo 2 y en la mortalidad. Material y métodos. Se emplearon tres paneles (2000, 2002, 2012) de la Encuesta Nacional de Salud y Envejecimiento en México (Enasem), junto a modelos de sobrevivencia y logísticos convencionales para estimar la mortalidad y la incidencia de diabetes, respectivamente. Resultados. El sobrepeso y la obesidad tienen un impacto poderoso en la incidencia de diabetes tipo 2, lo que en combinación con el incremento del riesgo de mortalidad asociado con la diabetes de tipo 2, se traduce en pérdidas de 2 a 3 años de vida a la edad de 50 años. Conclusiones. Si la tasa de crecimiento de la prevalencia de sobrepeso y obesidad en edad adulta mantiene el ritmo que ha tenido recientemente, las mejoras en sobrevivencia adulta se verán comprometidas y la incidencia de diabetes tipo 2 continuará en aumento.

Diabetes burden in Brazil: fraction attributable to overweight, obesity, and excess weight / Carga de diabetes no Brasil: fração atribuível ao sobrepeso, obesidade e excesso de peso

OBJECTIVE To estimate the burden of type 2 diabetes mellitus and its percentage attributable to overweight and obesity in Brazil.METHODS The burden of diabetes mellitus was described in terms of disability-adjusted life years, which is the sum of two components: years of life lost and years lived with disability. To calculate the fraction of diabetes mellitus attributable to overweight, obesity, and excess weight, we used the prevalence of these risk factors according to sex and age groups (> 20 years) obtained from the 2008 Pesquisa Dimensões Sociais das Desigualdades (Social Dimensions of Inequality Survey) and the relative risks derived from the international literature.RESULTS Diabetes mellitus accounted for 5.4% of Brazilian disability-adjusted life years in 2008, with the largest fraction attributed to the morbidity component (years lived with disability). Women exhibited higher values for disability-adjusted life years. In Brazil, 49.2%, 58.3%, and 70.6% of diabetes mellitus in women was attributable to overweight, obesity, and excess weight, respectively. Among men, these percentages were 40.5%, 45.4%, and 60.3%, respectively. Differences were observed with respect to Brazilian regions and age groups.CONCLUSIONS A large fraction of diabetes mellitus was attributable to preventable individual risk factors and, in about six years, the contribution of these factors significant increased, particularly among men. Policies aimed at promoting healthy lifestyle habits, such as a balanced diet and physical activity, can have a significant impact on reducing the burden of diabetes mellitus in Brazil.

OBJETIVO Estimar a carga do diabetes mellitus tipo 2 e sua fração atribuível ao sobrepeso e obesidade no Brasil.MÉTODOS A carga de diabetes mellitus foi descrita por meio dos anos de vida perdidos ajustados por incapacidade, a partir da soma de dois componentes: anos de vida perdidos por morte prematura e anos de vida perdidos devido à incapacidade. Para o cálculo da fração do diabetes mellitus devida ao sobrepeso, à obesidade e ao excesso de peso, foram utilizadas as prevalências desses fatores de risco por sexo e faixa etária (> 20 anos), obtidas na Pesquisa Dimensões Sociais das Desigualdades, do ano de 2008, e os riscos relativos obtidos na literatura internacional.RESULTADOS Diabetes mellitus respondeu por 5,4% dos anos de vida perdidos ajustados por incapacidade em 2008, sendo a maior parcela atribuída ao componente de morbidade (anos de vida perdidos devido à incapacidade). As mulheres apresentaram maiores valores de anos de vida ajustados para incapacidade. No Brasil, 49,2%, 58,3% e 70,6% do diabetes mellitus no sexo feminino foram atribuíveis ao sobrepeso, à obesidade e ao excesso de peso, respectivamente. Entre os homens, esses percentuais foram 40,5%, 45,4% e 60,3%, respectivamente. Diferenças foram observadas no que tange às grandes regiões brasileiras e às faixas etárias.CONCLUSÕES Grande parte da carga do diabetes foi atribuível a fatores de risco modificáveis e, em aproximadamente seis anos, a contribuição desses fatores aumentou expressivamente, sobretudo entre os homens. Políticas voltadas à promoção de hábitos saudáveis de vida, como alimentação balanceada e prática de atividade física, podem ter um impacto significativo na redução da carga de diabetes mellitus no Brasil.

Measure of the Rate at which Mortality in Type 2 Diabetes Mellitus Occurs: Protocol for a Systematic Review.

Introduction: Type 2 diabetes is the third largest cause of mortality in the United Kingdom, with about 50% of patients’ having developed complications at time of diagnosis. We consider that the evidence which explores the actual hazard ratios of mortality has not been consistent. n this paper we discuss methodology and review the most recent accurate data on mortality in type 2 diabetes. Methods: A systematic review will be undertaken aimed at synthesis of evidence of relative risk of mortality in type 2 diabetes, using the Centre for Reviews and Dissemination guidelines. We will explore conflicting and unanswered questions in relation to mortality. The primary outcome is all-cause, overall-cause or total mortality expressed as hazard ratios. Sub-groups will also be explored; age, gender, socio-economic factors and causes of death. We will review abstracts published after 1990 in the English language. Our data source will include electronic databases; the Cochrane library, the Centre for Reviews and Dissemination, Medline/PubMed, and other grey literature. The study populations are type 2 diabetes patients whose mortality outcome, expressed as hazard ratio, has been evaluated. Data extraction will be undertaken by one reviewer and triangulated by the second and third reviewer. The quality of the included studies will be evaluated in accordance with the inclusion/exclusion criteria; methodological quality that meets the critical appraisal framework and the relevance to the research questions. Evidence from data will be synthesised through a descriptive epidemiological review from included studies; meta-analysis will be used if appropriate. Result & Conclusion: We expect to pool homogenous studies of large population cohorts which explore the hazard ratio of mortality, and to summarise the evidence of the actual mortality risk in type 2 diabetes, with limited bias. This will help direct future research in areas of unanswered questions and may influence healthcare policy decisions.

Comparative analysis of associated complications of type-1 and type-2 diabetes mellitus

To analyse the associated complications of Type-1 and Type-2 diabetes mellitus in two tertiary care hospitals of Peshawar. A comparative cross sectional observational study was conducted at Khyber teaching hospital and Lady Reading hospital, Peshawar from January 2004 to February 2005. A total of 532 diagnosed patients of diabetes mellitus who had developed further complications were included. Patients were interviewed according to a pre-designed questionnaire. Out of 532 patients, 437 [82.1%] were Type-2 diabetics and 95 [17.9%] were Type-1 diabetics. Two hundred and seventy eight [52.25%] were females and 254 [47.74%] were males. Two hundred and seventy six [60.33%] patients had more than 10 years of duration of diabetes. The common complications in type-2 diabetics were coronary artery disease [CAD] in 268 [49.81%] cases, cerebrovascular accidents in 61 [11.46%] cases and diabetic ulcers in 59 [11.09%] cases. In type-1 diabetics, common complications were cardiovascular diseases in 38 [7.14%] cases, surgical ulcers in 16 [3%] cases, neuropathies in 15 [2.81%] cases and nephropathy in 9 [1.69%] cases. Type-2 diabetes coexists with hypertension in 112 [36.60%] cases of CAD and 31 [46.26%] cases of CVA cases. The frequency and morbidity of Type 2 diabetes is more common than Type 1 diabetes in our selected patients

Survival after myocardial infarction in patients with type 2 diabetes

To determine prospectively the survival of previously known diabetic patients admitted to coronary care unit with confirmed myocardial infarction [MI] over a one-year period and to assess the effects of gender, age, diabetes duration, hyperglycemia, hypertension, and anti-diabetic treatment on survival. In this prospective cohort study, we followed 59 patients hospitalized with a confirmed myocardial infarction at 3 coronary care units, Peshawar [Pakistan], between May 1, 2000 and April 30, 2001, We analyzed survival using univariate and multivariate Cox Proportional hazards regression models to control for potentially confounding factors. A total of 17 [28.8%] subjects [7 male and 10 female] died. Survival was significantly associated with previous history of hypertension and duration of diabetes [HR = 3-40, 95% CI = 1,33-9.22, P = 0,001, and HR = 1,24, 95% CI = 1,05-1.45, P = 0.009, by Univariate Cox model, respectively]. In multivariate analysis duration of diabetes was significantly associated with survival and Metformin treatment only, and Sulphonylurea and Metformin treatment together [P = 0.003, and 0-026, Multivariate Cox model, respectively]. Our results suggested that diabetes is associated with markedly increased mortality in the presence of hypertension after acute myocardial infarction and support for aggressive treatment of coronary risk factors among diabetic patients