Asociación entre Glucemia inestable, tiempo de estancia y mortalidad de pacientes en estado críticos: Estudio de cohorte / Associação Entre Glicemia Instável, Tempo de Permanência e Mortalidade de Pacientes Críticos: Estudo de Coorte / Relationships between unstable Glycemia, Hospital Length Of Stay, and mortality In Critically Ill patients: A cohort study

Resumen Introducción: El control y la evaluación de los niveles glucémicos de pacientes en estado críticos es un desafío y una competencia del equipo de enfermería. Por lo que, determinar las consecuencias de esta durante la hospitalización es clave para evidenciar la importancia del oportuno manejo. Objetivo: Determinar la asociación entre la glucemia inestable (hiperglucemia e hipoglucemia), el resultado de la hospitalización y la duración de la estancia de los pacientes en una unidad de cuidados intensivos. Metodología: Estudio de cohorte prospectivo realizado con 62 pacientes a conveniencia en estado crítico entre marzo y julio de 2017. Se recogieron muestras diarias de sangre para medir la glucemia. Se evaluó la asociación de la glucemia inestable con la duración de la estancia y el resultado de la hospitalización mediante ji al cuadrado de Pearson. El valor de p<0.05 fue considerado significativo. Resultados: De las 62 personas participantes, 50 % eran hombres y 50 % mujeres. La edad media fue de 63.3 años (±21.4 años). La incidencia de glucemia inestable fue del 45.2 % y se asoció con una mayor duración de la estancia en la UCI (p<0.001) y una progresión a la muerte como resultado de la hospitalización (p=0.03). Conclusión: Entre quienes participaron, la glucemia inestable se asoció con una mayor duración de la estancia más prolongada y con progresión hacia la muerte, lo que refuerza la importancia de la actuación de enfermería para prevenir su aparición.

Resumo Introdução: O controle e avaliação dos níveis glicêmicos em pacientes críticos é um desafio e uma competência da equipe de enfermagem. Portanto, determinar as consequências da glicemia instável durante a hospitalização é chave para evidenciar a importância da gestão oportuna. Objetivo: Determinar a associação entre glicemia instável (hiperglicemia e hipoglicemia), os desfechos hospitalares e o tempo de permanência dos pacientes em uma unidade de terapia intensiva. Métodos: Um estudo de coorte prospectivo realizado com 62 pacientes a conveniência em estado crítico entre março e julho de 2017. Foram coletadas amostras diariamente de sangue para medir a glicemia. A associação entre a glicemia instável com o tempo de permanência e o desfecho da hospitalização foi avaliada pelo teste qui-quadrado de Pearson. O valor de p <0,05 foi considerado significativo. Resultados: Das 62 pessoas participantes, 50% eram homens e 50% mulheres. A idade média foi de 63,3 anos (±21,4 anos). A incidência de glicemia instável foi de 45,2% e se associou a um tempo de permanência mais prolongado na UTI (p <0,001) e uma progressão para óbito como desfecho da hospitalização (p = 0,03). Conclusão: Entre os participantes, a glicemia instável se associou a um tempo mais longo de permanência e com progressão para óbito, enfatizando a importância da actuação da equipe de enfermagem para prevenir sua ocorrência.

Abstract Introduction: The control and evaluation of glycemic levels in critically ill patients is a challenge and a responsibility of the nursing team; therefore, determining the consequences of this during hospitalization is key to demonstrate the importance of timely management. Objective: To determine the relationship between unstable glycemia (hyperglycemia and hypoglycemia), hospital length of stay, and the hospitalization outcome of patients in an Intensive Care Unit (ICU). Methods: A prospective cohort study conducted with 62 critically ill patients by convenience sampling between March and July 2017. Daily blood samples were collected to measure glycemia. The correlation of unstable glycemia with the hospital length of stay and the hospitalization outcome was assessed using Pearson's chi-square. A p-value <0.05 was considered significant. Results: Among the 62 patients, 50% were male and 50% were female. The mean age was 63.3 years (±21.4 years). The incidence of unstable glycemia was 45.2% and was associated with a longer ICU stay (p<0.001) and a progression to death as a hospitalization outcome (p=0.03). Conclusion: Among critically ill patients, unstable glycemia was associated with an extended hospital length of stay and a progression to death, emphasizing the importance of nursing intervention to prevent its occurrence.

The association of hyperglycemia with the development of infectious complications in adult Filipino patients with acute lymphoblastic leukemia

Abstract Introduction Hyperglycemia occurs in Acute Lymphoblastic Leukemia (ALL) due to chemotherapeutic agents and may be stress-induced. Given the potential impact of hyperglycemia on the clinical outcomes of ALL patients, we sought to determine the association of hyperglycemia with the development of infectious complications. Methods This is a retrospective cohort involving adult Filipino ALL patients admitted at a tertiary referral center. Patients were stratified according to blood glucose levels and infections were classified into microbiologically and clinically defined infections. Logistic regression was performed to determine whether hyperglycemia was associated with the development of infectious complications. Results Of the 174 patients admitted for ALL, only 76 patients (44%) underwent blood glucose monitoring and were thus included in this study. Hyperglycemia was observed in 64 patients (84.21%). Infectious complications were seen in 56 patients (73.68%), of whom 37 patients (48.68%) had microbiologically defined infections and 19 (25%) had clinically defined infections. The respiratory tract was the most common site of infection and gram-negative bacteria were the predominant isolates. Hyperglycemia significantly increased the likelihood of infectious complications, particularly at blood glucose levels ≥ 200 mg/dL. Conclusion Hyperglycemia is associated with an increased likelihood of infectious complications in Filipino ALL patients. With sepsis being one of the main causes of mortality in this population, our study provides compelling evidence for us to consider routine blood glucose monitoring in order to manage and potentially decrease the occurrence of infections in these patients.

Cetoacidosis diabética posterior a vacuna contra SARS-CoV-2: reporte de un caso / Diabetic ketoacidosis following SRS-CoV-2 vaccination: a one case report

Las emergencias hiperglicémicas como la cetoacidosis diabética (CAD) y el síndrome hiperglicémico hiperosmolar (SHH) se han descrito en el contexto de infección por SARS-CoV-2, como también secundarias a las múltiples vacunas desarrolladas contra el virus. La fisiopatología que explicaría esta asociación aún no está clara, pero existen diversas teorías que incluyen la destrucción directa de los islotes pancreáticos por el virus o secundario a mecanismos inmuno-inflamatorios. Presentamos el caso de un paciente que debutó con CAD al tercer día de la primera dosis de CoronaVac, y que posteriormente presentó hiperglicemia sin cumplir criterios de CAD luego de la segunda y tercera dosis de CoronaVac y Pfizer respectivamente. La temporalidad, como la falta de gatillante y la evolución del cuadro, apuntan a la vacuna como el principal precipitante. Por lo anterior, es importante mantener una vigilancia estricta de los efectos adversos de las vacunas y educar sobre los síntomas sugerentes de una crisis hiperglicémica para pesquisarla a tiempo y actuar oportunamente.

Hyperglycemic emergencies such as diabetic ketoacidosis (DKA) and hyperosmolar hyperglycemic syndrome (HHS) have been reported in SARS-CoV-2 infections and after vaccination. The pathophysiology behind this association is still unclear, several theories have been described that include the direct destruction of the pancreatic islets by the virus, and some immuno-inflammatory mechanisms. We present the case of a patient who develope DKA the third day after the first dose of CoronaVac vaccine, and then hypergycemia after the second and third dose of CoronaVac and Pfizer repectively. The temporal relation, lack of a trigger and evolution of the disease, point the vaccine as the main precipitant. The strict surveillance of vaccines adverse effects and education of symptoms suggestive of hyperglicemic emergency are critical to prevent and treat promptly this kind of situations.

Psicologia e diabetes no Brasil: um mapeamento de profissionais e de suas ações / Psychology and diabetes in Brazil: the mapping of professionals and their practices / Psicología y diabetes en Brasil: un mapeo de los profesionales y sus acciones

Pouco se sabe sobre a atuação do psicólogo no Brasil junto a pessoas com Diabetes Mellitus. O objetivo desta pesquisa foi identificar os psicólogos brasileiros que trabalham com essa população e suas ações. Foram convidados a responder a um questionário online psicólogos que atuam ou atuaram junto a pessoas com diabetes. Participaram 79 psicólogos, principalmente da região Sudeste (59,5%). Todos declararam que haviam cursado pósgraduação. Na amostra, predominou o gênero feminino (89,9%), com idade entre 26 e 40 anos (46,8%). A maioria dos que atuam com diabetes declarou-se autônoma ou voluntária, e quase metade trabalhava menos do que 10 horas semanais. Entre aqueles que deixaram de trabalhar com diabetes, apenas uma minoria tinha vínculo empregatício. Além do trabalho com pessoas com diabetes, a maior parte declarou exercer outras atividades profissionais, como atendimentos clínicos em consultórios particulares, sugerindo que esta não é a atividade principal. Majoritariamente, os respondentes declararam não ter conhecimentos suficientes para o atendimento específico às pessoas com diabetes. Discute-se a qualidade da formação profissional dos psicólogos no Brasil, a necessidade de aprimoramento em relação à atuação com pessoas com diabetes e as condições de trabalho.(AU)

Little is known about the practice of psychologists in Brazil caring for people with Diabetes Mellitus. The aim of this research was to identify the Brazilian psychologists who work with this population and describe their actions. Psychologists who work or have worked with people diagnosed with diabetes were invited to answer an online questionnaire. The 79 participants lived mainly in the Southeast Region (59.5%). All of them declared to have a graduate degree, most were female (89.9%), aged 26 to 40 years (46.8%). Most of those working with diabetes declared to be autonomous or voluntary, and almost half had a workload of less than 10 hours a week. Among those who stopped working with diabetes, only a minority had a formal employment contract. In addition, most of them stated that they had other professional activities related to clinical care in private offices, suggesting that working with diabetes is not their main activity. Mostly, respondents stated that they did not have enough knowledge to care for people with diabetes. The quality of professional education of psychologists in Brazil, the need for specific improvement in labor relations and conditions were discussed.(AU)

Son escasas las informaciones del trabajo de los psicólogos en Brasil con las personas con Diabetes Mellitus. El objetivo de este estudio fue identificar los psicólogos brasileños que trabajan con esta población y describir sus acciones. Se invitó a psicólogos que trabajan o hayan trabajado con personas con diabetes a responder un cuestionario en línea. Participaron 79 psicólogos, principalmente de la región Sureste de Brasil (59,5%). Todos declararon tener posgrado. En la muestra hubo una mayor prevalencia del género femenino (89,9%), de edades de entre 26 y 40 años (46,8%). La mayoría de los que trabajan con personas con diabetes se declararon autónomos o voluntarios, y casi la mitad trabajaba menos de 10 horas a la semana. Entre los que dejaron de trabajar con las personas con diabetes, solo una minoría tenía una relación laboral. Además de trabajar con personas con diabetes, la mayoría afirmó tener otras actividades profesionales, como la atención clínica en consultorios privados, lo que sugiere que esta no es su actividad principal. La mayoría de los encuestados afirmaron que no tenían los conocimientos suficientes para atender específicamente a las personas con diabetes. Se discuten la calidad de la formación profesional de los psicólogos en Brasil, la necesidad de mejora en relación con el trabajo con personas con diabetes y las condiciones laborales.(AU)

Predictors of poor glycemic control and increased glucose variability among admitted moderate to critical COVID-19 patients with type 2 diabetes mellitus: A single center cross-sectional study / Journal of the ASEAN Federation of Endocrine Societies

Objectives@#COVID-19 exacerbates the long-standing, low-grade chronic inflammation observed in diabetes leading to heightened insulin resistance and hyperglycemia. Mortality increases with hyperglycemia and poor glycemic variability, hence, this study aims to identify the predictors associated with poor glycemic control and increased glucose variability among patients with COVID-19 and Type 2 Diabetes Mellitus (T2DM).@*Methodology@#A retrospective chart review of 109 patients with moderate to severe COVID-19 and T2DM admitted from March 2020 to June 2021 was done. Logistic regression was done to determine predictors for hyperglycemia and poor variability.@*Results@#Of the 109 patients, 78% had hyperglycemia and poor variability and 22% had no poor outcomes. Chronic kidney disease (eOR 2.83, CI [1.07-7.46], p=0.035) was associated with increased glycemic variability. In contrast, increasing eGFR level (eOR 0.97, CI [0.96-0.99], p=0.004) was associated with less likelihood of increased variability. Hs-CRP (eOR 1.01, CI [1.00-1.01], p=0.011), HbA1c (eOR 1.86, CI [1.23-2.82], p=0.003), severe COVID-19 (eOR 8.91, CI [1.77-44.94], p=0.008) and critical COVID-19 (eOR 4.42, CI [1.65-11.75], p=0.003) were associated with hyperglycemia. Steroid use (eOR 71.17, CI [8.53-593.54], p<0.001) showed the strongest association with hyperglycemia.@*Conclusion@#Potential clinical, laboratory and inflammatory profiles were identified as predictors for poor glycemic control and variability outcomes. HbA1c, hs-CRP, and COVID-19 severity are predictors of hyperglycemia. Likewise, chronic kidney disease is a predictor of increased glycemic variability.

Association of acute hyperglycemia and diabetes mellitus with Platelet-derived Microparticle (PDMP) levels during acute myocardial infarction / Journal of the ASEAN Federation of Endocrine Societies

Objectives@#This research aims to investigate whether there is an association between acute hyperglycemia and diabetes mellitus and the amount of circulating platelet-derived microparticles (PDMPs) during acute myocardial infarction (AMI) initial episode.@*Methodology@#This was a cross-sectional study. Subjects were AMI patients underwent hospitalization. Demography and clinical data were obtained from hospital records. Diabetes mellitus was defined from history of disease, antidiabetic use and/or level of HbA1C ≥6.5%. Levels of HbA1c, admission random and fasting blood glucose levels were measured in hospital laboratory. The PDMPs was measured by flow-cytometry method, by tagging with CD-41 FITC and CD-62 PE markers and threshold size of <1 µm, from venous blood. The circulating PDMPs amount was compared according to glucometabolic state, namely acute hyperglycemia (admission random glucose ≥200 mg/dL and fasting glucose ≥140 mg/dL) and diabetes mellitus. The comparative analysis between group was conducted with Student T tests or Mann-Whitney tests, where applicable.@*Results@#A total of 108 subjects were included and their data analyzed. Circulating PDMPs amount was significantly lower in subjects with admission random glucose ≥200 mg/dL as compared to those with below level (median (interquartile range (IQR)): 2,710.0 (718.0-8,167.0) count/mL vs. 4,452.0 (2,128.5-14,499.8) count/mL, p=0.05) and in subjects with fasting glucose ≥140 mg/dL as compared to those with below level (median (IQR): 2,382.0 (779.0-6,619.0) count/mL vs. 5,972.0 (2,345.7-14,781.3) count/mL, p=0.006). Circulating PDMPs amount was also significantly lower in diabetes mellitus as compared to non diabetic (median (IQR): 2,655.0 (840.0-5,821.0) count/mL vs. 4,562.0 (2,128.5-15,055.8) count/mL; p=0.007).@*Conclusion@#Acute hyperglycemia and diabetes mellitus significantly associated with lower amount of circulating PDMPs during the initial episode of AMI.

Predictive value of stress-induced hyperglycemia on 28 d risk of all-cause death in intensive care patients / 北京大学学报(医学版)

OBJECTIVE@#To investigate the relationship between stress glucose elevation and the risk of 28 d all-cause mortality in intensive care unit (ICU) patients, and to compare the predictive efficacy of different stress glucose elevation indicators.@*METHODS@#ICU patients who met the inclusion and exclusion criteria in the Medical Information Mart for Intensive Care Ⅳ (MIMIC-Ⅳ) database were used as the study subjects, and the stress glucose elevation indicators were divided into Q1 (0-25%), Q2 (>25%- 75%), and Q3 (>75%-100%) groups, with whether death occurred in the ICU and the duration of treatment in the ICU as outcome variables, and demographic characteristics, laboratory indicators, and comorbidities as covariates, Cox regression and restricted cubic splines were used to explore the association between stress glucose elevation and the risk of 28 d all-cause death in ICU patients; and subject work characteristics [receiver operating characteristic (ROC) and the area under curve (AUC)] were used to evaluate the predictive efficacy of different stress glucose elevation indicators, The stress hyperglycemia indexes included: stress hyperglycemia ratio (SHR1, SHR2), glucose gap (GG); and the stress hyperglycemia index was further incorporated into the Oxford acute severity of illness score (OASIS) to investigate the predictive efficacy of the improved scores: the AUC was used to assess the score discrimination, and the larger the AUC indicated, the better score discrimination. The Brier score was used to evaluate the calibration of the score, and a smaller Brier score indicated a better calibration of the score.@*RESULTS@#A total of 5 249 ICU patients were included, of whom 7.56% occurred in ICU death. Cox regression analysis after adjusting for confounders showed that the HR (95%CI) for 28 d all-cause mortality in the ICU patients was 1.545 (1.077-2.217), 1.602 (1.142-2.249) and 1.442 (1.001-2.061) for the highest group Q3 compared with the lowest group Q1 for SHR1, SHR2 and GG, respectively, and The risk of death in the ICU patients increased progressively with increasing indicators of stressful blood glucose elevation (Ptrend < 0.05). Restricted cubic spline analysis showed a linear relationship between SHR and the 28 d all-cause mortality risk (P>0.05). the AUC of SHR2 and GG was significantly higher than that of SHR1: AUCSHR2=0.691 (95%CI: 0.661-0.720), AUCGG=0.685 (95%CI: 0.655-0.714), and AUCSHR1=0.680 (95%CI: 0.650-0.709), P < 0.05. The inclusion of SHR2 in the OASIS scores significantly improved the discrimination and calibration of the scores: AUCOASIS=0.820 (95%CI: 0.791-0.848), AUCOASIS+SHR2=0.832 (95%CI: 0.804-0.859), P < 0.05; Brier scoreOASIS=0.071, Brier scoreOASIS+SHR2=0.069.@*CONCLUSION@#Stressful glucose elevation is strongly associated with 28 d all-cause mortality risk in ICU patients and may inform clinical management and decision making in intensive care patients.

A review of patent literature on the regulation of glucose metabolism by six phytocompounds in the management of diabetes mellitus and its complications / 中西医结合学报

Diabetes mellitus is a chronic disease, typified by hyperglycemia resulting from failures in complex multifactorial metabolic functions, that requires life-long medication. Prolonged uncontrolled hyperglycemia leads to micro- and macro-vascular complications. Although antidiabetic drugs are prescribed as the first-line treatment, many of them lose efficacy over time or have severe side effects. There is a lack of in-depth study on the patents filed concerning the use of natural compounds to manage diabetes. Thus, this patent analysis provides a comprehensive report on the antidiabetic therapeutic activity of 6 phytocompounds when taken alone or in combinations. Four patent databases were searched, and 17,649 patents filed between 2001 and 2021 were retrieved. Of these, 139 patents for antidiabetic therapeutic aids that included berberine, curcumin, gingerol, gymnemic acid, gymnemagenin and mangiferin were analyzed. The results showed that these compounds alone or in combinations, targeting acetyl-coenzyme A carboxylase 2, serine/threonine protein kinase, α-amylase, α-glucosidase, lipooxygenase, phosphorylase, peroxisome proliferator-activated receptor-γ (PPARγ), protein tyrosine phosphatase 1B, PPARγ co-activator-1α, phosphoinositide 3-kinase and protein phosphatase 1 regulatory subunit 3C, could regulate glucose metabolism which are validated by pharmacological rationale. Synergism, or combination therapy, including different phytocompounds and plant extracts, has been studied extensively and found effective, whereas the efficacy of commercial drugs in combination with phytocompounds has not been studied in detail. Curcumin, gymnemic acid and mangiferin were found to be effective against diabetes-related complications. Please cite this article as: DasNandy A, Virge R, Hegde HV, Chattopadhyay D. A review of patent literature on the regulation of glucose metabolism by six phytocompounds in the management of diabetes mellitus and its complications. J Integr Med. 2023; 21(3): 226-235.

Diacylated anthocyanins from purple sweet potato (Ipomoeabatatas L.) attenuate hyperglycemia and hyperuricemia in mice induced by a high-fructose/high-fat diet / 浙江大学学报（英文版）（B辑：生物医学和生物技术）

Studies have shown that targeting xanthine oxidase (XO) can be a feasible treatment for fructose-induced hyperuricemia and hyperglycemia. This study aimed to evaluate the dual regulatory effects and molecular mechanisms of diacylated anthocyanins from purple sweet potato (diacylated AF-PSPs) on hyperglycemia and hyperuricemia induced by a high-fructose/high-fat diet. The body weight, organ index, serum biochemical indexes, and liver antioxidant indexes of mice were measured, and the kidneys were observed in pathological sections. The relative expression levels of messenger RNAs (mRNAs) of fructose metabolism pathway enzymes in kidney were detected by fluorescent real-time quantitative polymerase chain (qPCR) reaction technique, and the expression of renal transporter protein and inflammatory factor pathway protein was determined by immunohistochemistry (IHC) technique. Results showed that diacylated AF-PSPs alleviated hyperuricemia in mice, and that this effect might be related to the regulation of liver XO activity, lipid accumulation, and relevant renal transporters. Diacylated AF-PSPs reduced body weight and relieved lipid metabolism disorder, liver lipid accumulation, and liver oxidative stress, thereby enhancing insulin utilization and sensitivity, lowering blood sugar, and reducing hyperglycemia in mice. Also, diacylated AF-PSPs restored mRNA levels related to renal fructose metabolism, and reduced kidney injury and inflammation. This study provided experimental evidence for the mechanisms of dual regulation of blood glucose and uric acid (UA) by diacylated AF-PSPs and their utilization as functional foods in the management of metabolic syndrome.

Efeito da dieta hipocalórica na pressão arterial e demais cofatores da síndrome metabólica / Effect of hypocaloric diet on blood pressure and other cofactors of metabolic syndrome

Introdução: a hipertensão arterial sistêmica (HAS) está associada a fatores de risco metabólicos e pode ser definida como uma doença crônica multifatorial, com valores persistentes de pressão arterial sistólica (PAS) e (ou) pressão arterial diastólica (PAD) maiores ou iguais a 140 mmHg x 90 mmHg, respectivamente. A HAS é um dos fatores que compõem a síndrome metabólica (SM) juntamente com a hiperglicemia, dislipidemia e (ou) obesidade central. Modificações no estilo de vida, como a alimentação e perda de peso, demonstraram melhorar os parâmetros cardiometabólicos nos pacientes com HAS e SM. Objetivo: verificar o efeito de uma dieta hipocalórica na antropometria, na pressão arterial e em outros cofatores da síndrome metabólica. Metodologia: trata-se de um ensaio clínico não randomizado, retrospectivo, com dados secundários, em que o mesmo grupo foi de "intervenção" e "comparador", e cujos dados foram coletados antes (baseline) e após a intervenção. A pesquisa foi realizada com 84 pacientes, adultos, com síndrome metabólica, de ambos os sexos. Os pacientes seguiram dieta com restrição calórica de 200 a 500kcal/dia, com cálculo energético em torno de 20kcal/kg de peso, valor energético total não inferior a 1200kcal, durante um período de dois meses. Foi utilizada estatística descritiva e o teste t pareado ou Wilcoxon-Sign-Rank intragrupo para analisar as variações ao longo do tempo (p < 0,05). Resultado:houve uma redução na antropometria (índice de massa corporal, circunferência da cintura, circunferência do braço e circunferência do quadril), PAS e PAD, glicemia de jejum e triglicerídeos com p< 0,05 dos pacientes após a intervenção, mas não houve melhora no HDL (p > 0,05). Conclusão: a dieta hipocalórica reduziu as medidas antropométricas, a pressão arterial e os demais cofatores da SM nos pacientes avaliados após o acompanhamento de dois meses.

Introduction: systemic arterial hypertension (SAH) is associated with metabolic risk factors and can be defined as a multifactorial chronic disease, with persistent values of systolic blood pressure (SBP) and (or) diastolic blood pressure (DBP) greater than or equal to 140 mmHg x 90 mmHg, respectively. SAH is one of the factors that make up the metabolic syndrome (MS) along with hyperglycemia, dyslipidemia and (or) central obesity. Lifestyle modifications, such as diet and weight loss, have been shown to improve cardiometabolic parameters in patients with SAH and MS. Objective: to verify the effect of a hypocaloric diet on anthropometry, blood pressure and other cofactors of the metabolic syndrome. Methodology: this is a non-randomized, retrospective clinical trial, with secondary data, in which the same group was "intervention" and "comparator", and whose data were collected before (baseline) and after the intervention. Research was carried out with 84 patients, adults, with metabolic syndrome, of both sexes. Patients followed a calorie-restricted diet of 200 to 500kcal/day, with energy calculation around 20kcal/kg of weight, total energy value not less than 1200kcal, during a period of two months. Descriptive statistics and the paired t test or intragroup Wilcoxon-Sign-Rank were used to analyze variations over time (p < 0.05). Result: there was a reduction in anthropometry (body mass index, waist circumference, arm circumference and hip circumference), SBP and DBP, fasting glucose and triglycerides with p<0.05 of patients after the intervention, but there was no improvement in HDL (p > 0.05). Conclusion: the hypocaloric diet reduced anthropometric measurements, blood pressure and other MS cofactors in the patients evaluated after a two-month follow-up.

Pregestational Diabetes and Congenital Heart Defects / Diabetes pré-gestacional e defeitos cardíacos congênitos

Abstract Studies have consistently shown a significant increase in the risk of congenital heart defects in the offspring of diabetic mothers compared with those of nondiabetic pregnancies. Evidence points that all types of pregestational diabetes have the capacity of generating cardiac malformations in a more accentuated manner than in gestational diabetes, and there seems to be an increased risk for all congenital heart defects phenotypes in the presence of maternal diabetes. Currently, the application of some therapies is under study in an attempt to reduce the risks inherent to diabetic pregnancies; however, it has not yet been possible to fully prove their effectiveness. The present review aims to better understand the mechanisms that govern the association between pregestational diabetes and congenital heart defects and how maternal diabetes interferes with fetal cardiac development, as there is still a long way to go in the investigation of this complex process.

Resumo Estudos têm demonstrado consistentemente um aumento significativo no risco de defeitos cardíacos congênitos em filhos de mães diabéticas em comparação com os de gestações não diabéticas. Evidências apontam que todos os tipos de diabetes pré-gestacional têm capacidade de gerar malformações cardíacas mais acentuadas do que no diabetes gestacional e parece haver um risco aumentado para todos os fenótipos de cardiopatias congênitas na presença de diabetes materno. Atualmente, está em estudo a aplicação de algumas terapias na tentativa de diminuir os riscos inerentes à gravidez diabética; no entanto, ainda não foi possível comprovar totalmente a sua eficácia. A presente revisão visa compreender melhor os mecanismos que regem a associação entre diabetes pré-gestacional e cardiopatias congênitas e como o diabetes materno interfere no desenvolvimento cardíaco fetal, pois ainda há um longo caminho a percorrer na investigação deste processo complexo.

Cyperus esculentus L. protects testis and sperm morphology of hyperglycaemic rats / Cyperus esculentus L. protege la morfología de los testículos y los espermatozoides de ratas hiperglicémicas

Cyperus esculentus L. (tiger nut) is a tuberous plant that promotes and protects reproductive functions, which are usually hampered in diabetics. The present study investigated the effect of Cyperus esculentus tuber extract (CETE) on testicular histology and sperm viability of alloxan-induced hyperglycaemic Wistar rats. Twenty-five adult male Wistar rats weighing 150-200g and grouped into five (n=5): Group 1, the control, administered tap water (20mL/kg), while groups 2-5 were administered a single intraperitoneal dose (120mg/kg b.w.) of alloxan, and each further received orally tap water (20mL/kg), CETE (100mg/kg), CETE (500 mg/kg) and metformin (500 mg/kg), respectively for 21 days. The animals were sacrificed, their sperm collected for analysis, while the testes were harvested, and processed for histology. Results showed significantly increased (p<0.05) blood glucose and testosterone, and significantly decreased (p<0.05) sperm pH, motility, count, morphology and density, as well as disruptions and hypertrophy of the spermatogenic and Sertoli cells of the hyperglycaemic group. There were significant (p<0.05) blood glucose decline, while the sperm parameters and testicular weight improved with normal testicular histology in the 100 mg/kg CETE, 500 mg/kg CETE, and metformin-treated groups compared to the control and hyperglycaemic group. Treatment with CETE showed blood glucose amelioration and improved sperm quality, as well as testicular damage attenuation.

Cyperus esculentus L. es una planta tuberosa que promueve y protege las funciones reproductivas, que generalmente se ven afectadas en los diabéticos. El presente estudio investigó el efecto del extracto de tubérculo de Cyperus esculentus (CETE) sobre la histología testicular y la viabilidad de los espermatozoides de ratas wistar con hiperglicemia inducida por alloxan. Veinticinco ratas Wistar macho adultas que pesaban 150-200 g y se agruparon en cinco (n = 5): el grupo 1, el control, administró agua del grifo (20ml / kg), mientras que los grupos 2-5 se les administró una dosis intraperitoneal única (120 mg / kg p.v.) de alloxan, y agua del grifo por vía oral (20ml/kg), CETE (100 mg/kg), CETE (500 mg/kg) y metformina (500 mg/kg), respectivamente durante 21 días. Los animales fueron sacrificados, su esperma recolectada para su análisis, mientras que los testículos fueron retirados y procesados para histología. Los resultados mostraron un aumento significativo (p<0,05) de la glucosa en sangre y la testosterona, y una disminución significativa (p<0,05) del pH, la motilidad, el recuento, la morfología y la densidad de los espermatozoides, así como interrupciones e hipertrofia de las células espermatogénicas y sertoli del grupo hiperglucémico. Hubo una disminución significativa (p<0,05) de la glucosa en sangre, mientras que los parámetros espermáticos y el peso testicular mejoraron con la histología testicular normal en los grupos de 100 mg / kg de CETE, 500 mg / kg de CETE y tratados con metformina en comparación con el grupo de control e hiperglucémico. El tratamiento con CETE mostró una mejora de la glucosa en sangre y una mejora de la calidad de los espermatozoides, así como atenuación del daño testicular.

Mecanismos bioquímicos en el pronóstico grave de pacientes con diabetes mellitus infectados por el virus SARS-CoV-2: revisión de la literatura / Biochemical mechanisms in the severe prognosis of patients with diabetes mellitus infected by SARS-CoV-2 virus: literature review

Resumen La diabetes mellitus (DM) es una enfermedad metabólica caracterizada principalmente por signos y síntomas derivados del aumento de glucosa sérica o hiperglucemia. La pandemia por la enfermedad del coronavirus 2019 (COVID- 19) afectó a todo el mundo con informes de pronóstico grave en pacientes diabéticos infectados por el virus del síndrome respiratorio agudo severo por coronavirus 2 (SARS-CoV-2) y elevada admisión hospitalaria en la unidad de cuidados intensivos (UCI) en comparación con pacientes no diabéticos. El objetivo del trabajo de revisión bibliográfica fue evaluar y describir algunos de los mecanismos bioquímicos que conducen al pronóstico grave en pacientes con DM infectados por el virus SARS-CoV-2 mediante la búsqueda sistemática de información en diferentes bases de datos. Los resultados mostraron que la elevada admisión a UCI con un pronóstico grave de pacientes diabéticos infectados por el virus fue por presentar inflamación excesiva que ocasiona síndrome de distrés respiratorio agudo, tormenta de citoquinas, neumonía severa, inmunidad deteriorada e hiperglucemia. El virus ingresa a la célula principalmente por la vía endocítica y no endosómica; los receptores celulares centrales implícitos en los mecanismos son receptores de insulina (RI), transportador de glucosa tipo 2 (GLUT-2), dipeptidil-peptidasa-4 (DPP4), transportador de glucosa tipo 4 (GLUT-4), enzima convertidora de angiotensina 2 (ECA2) y el correceptor proteasa transmembrana de serina 2 (TMPRSS2) esencial para la propagación viral. La mayor susceptibilidad a desarrollar COVID- 19 en pacientes diabéticos se debe a la sobreexpresión de ECA2 y las complicaciones graves se incrementan a niveles micro y macrovascular como nefropatías, neuropatías y enfermedades cardiovasculares.

Abstract Diabetes mellitus (DM) is a metabolic disease characterised mainly by signs and symptoms derived from increased serum glucose or hyperglycemia. The coronavirus disease 2019 (COVID-19) pandemic affected the entire world continenwith reports of severe prognosis in diabetic patients infected with the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and high hospital admissions in the intensive care unit (ICU) compared to non-diabetic patients. The objective of the bibliographic review was to evaluate and describe some of the biochemical mechanisms that lead to severe prognosis in patients with DM infected by the SARSCoV- 2 virus through a systematic search for information in different databases. The results showed that the high ICU admission with a severe prognosis of diabetic patients infected by the virus was due to excessive inflammation that causes acute respiratory distress syndrome, cytokine storm, severe pneumonia, impaired immunity, and hyperglycemia. The virus enters the cell mainly through the endocytic and non-endosomal pathway; the central cellular receptors involved in the mechanisms are insulin receptors (IR), glucose transporter type 2 (GLUT-2), dipeptidyl peptidase-4 (DPP4), glucose transporter type 4 (GLUT-4), glucose converting enzyme angiotensin 2 (ACE2), and the serine transmembrane protease co-receptor 2 (TMPRSS2) essential for viral propagation. The increased susceptibility to developing COVID-19 in diabetic patients is due to the overexpression of ACE2, and serious complications are increased at the microvascular and macrovascular levels, such as nephropathies, neuropathies, and cardiovascular diseases.

Resumo O diabetes mellitus (DM) é uma doença metabólica caracterizada principalmente por sinais e sintomas decorrentes do aumento de glicose sérica ou hiperglicemia. A pandemia pela doença do coronavírus 2019 (COVID-19) afetou o mundo inteiro com relatos de prognóstico grave em pacientes diabéticos infectados pelo vírus da síndrome respiratória aguda grave por coronavírus 2 (SARS-CoV-2) e altas internações hospitalares na unidade de terapia intensiva (UTI) em comparação com pacientes não diabéticos. O objetivo do trabalho de revisão bibliográfica foi avaliar e descrever alguns dos mecanismos bioquímicos que levam ao prognóstico grave em pacientes com DM infectados pelo vírus SARS-CoV-2 por meio da busca sistemática de informações em diferentes bancos de dados. Os resultados mostraram que a alta admissão na UTI com prognóstico grave de pacientes diabéticos infectados pelo vírus foi devido à inflamação excessiva que apresentavam e que causa síndrome de desconforto respiratório agudo, tempestade de citocinas, pneumonia grave, imunidade prejudicada e hiperglicemia. O vírus entra na célula principalmente pela via endocítica e não endossômica; os receptores celulares centrais envolvidos nos mecanismos são os receptores de insulina (IR), transportador de glicose tipo 2 (GLUT-2), dipeptidil peptidase-4 (DPP4), transportador de glicose tipo 4 (GLUT-4), enzima conversora de angiotensina 2 (ACE2), e o co-receptor protease transmembrana de serina 2 (TMPRSS2) essencial para a propagação viral. A maior suscetibilidade ao desenvolvimento de COVID-19 em pacientes diabéticos deve-se à superexpressão de ECA2, e complicações graves aumentam nos níveis micro e macrovascular, como nefropatias, neuropatias e doenças cardiovasculares.

Resistencia a Insulina: Revisión de literatura / Insulin Resistance: Literature Review

La resistencia a la insulina es una condición patológica de expresión variable asociada a riesgo cardiovascular, diabetes mellitus tipo 2, hígado graso de etiología no alcohólica, lipodistrofias, síndrome de ovario poliquístico y algunos cánceres. El propósito de esta revisión bibliográfica es brindar información actualizada al lector sobre algunos de los avances actuales de la resistencia a la insulina. Se realizó una búsqueda de literatura en PUBMED de enero 2014-octubre 2021, obteniéndose 1,354 referencias, seleccionando 39 publicaciones. Aunque continúe la discusión sobre la definición clínica y laboratorial, se ha determinado que el manejo terapéutico y preventivo para casos de resistencia a la insulina se debe basar en cambios de estilo de vida con apoyo farmacológico individualizado. El impacto actual y potencial en el futuro inmediato de la epidemiología de la resistencia a la insulina está en los estudios clínico-terapéuticos en curso y en las políticas públicas dirigidas a fomentar el estilo de vida saludable...(AU)