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1.
Evid. actual. práct. ambul. (En línea) ; 27(3): e007113, 2024. graf, tab
Article in Spanish | LILACS, UNISALUD, BINACIS | ID: biblio-1586661

ABSTRACT

Introducción. Los cuestionarios TBQ evalúan la carga de trabajo que implican los tratamientos recomendados a las personas con condiciones crónicas. En Argentina se encontraba disponible la versión para ser administrada a través de un entrevistador a pacientes con diabetes tipo 2, sin que contáramos con una versión contestable en forma autónoma por el propio paciente. Objetivo. Validar una variante autoadministrada del cuestionario TBQ para medir la carga del tratamiento de personas con diabetes tipo 2, evaluando su comprensibilidad y su desempeño psicométrico. Métodos. Investigación cuali-cuantitativa, con análisis factorial exploratorio (AFE). La validez de criterio concurrente fue evaluada con tres escalas (OMS-5, PHQ-9, Índice de Adherencia de Morisky-Green-Levine). La consistencia interna fue evaluada a través del coeficiente alfa de Cronbach. Resultados. Participaron 100 personas, 38 % con escolaridad primaria completa, 47 % con enfermedad de menos de cinco años de antigüedad y 70 % recibiendo tratamiento por vía oral en forma exclusiva. De manera concordante con la versión validada previamente, el AFE agrupó los ítems en cuatro dominios con fuerte correlación entre sí: 1) tratamiento farmacológico; 2) asistencia sanitaria/sistema de salud; 3) mantenimiento de un estilo de vida y su repercusión económica;4) repercusión psicosocial de la enfermedad. Documentamos una correlación inversa entre el puntaje TBQ y el de bienestar OMS-5 (-0,4308; p=0,0014) y directa con el de depresión PHQ-9 (+0,3452; p=0,0122). Las personas categorizadas como no adherentes al tratamiento (escala Morisky-Green-Levine) arrojaron en promedio un resultado de 18,24 (intervalo de confianza del 95 % 1,82 a 34,68; p=0,03) puntos más en la escala TBQ-diabetes que las adherentes. El coeficiente Alfa de Cronbach fue 0,890 para el factor 1, 0,764 para el 2, 0,673 para el 3 y 0,709 para el 4. Conclusiones. La versión autoadministrada del cuestionario TBQ-diabetes para evaluar la carga de trabajo en personas con diabetes tipo 2 fue adecuadamente comprendida y mostró satisfactorias propiedades psicométricas. (AU)


Introduction. The TBQ questionnaires assess the burden involved in the treatments recommended for people with chronic conditions. In Argentina, an interviewer-administered version was available for patients with type 2 diabetes, but there wasno self-administered version available. Objective. To validate a self-administered variant of the TBQ questionnaire to measure the treatment burden of people with type 2 diabetes, evaluating its understandability and psychometric performance. Methods. Quali-quantitative research, with exploratory factor analysis (EFA). Concurrent criterion validity was evaluated with three scales (OMS-5, PHQ-9, Morisky-Green-Levine Adherence Index). Internal consistency was evaluated through Cronbach's alpha coefficient. Results. 100 people participated, 38 % of whom had completed primary school, 47 % had been ill for less than five years and 70 % were receiving oral treatment exclusively. Consistent with the previously validated version, the EFA grouped thei tems into four strongly correlated domains: 1) pharmacological treatment; 2) healthcare/health system; 3) maintenance ofa lifestyle and its economic impact; 4) psychosocial impact of the disease. We documented an inverse correlation between the TBQ score and the OMS-5 well-being score (-0.4308; p=0.0014) and a direct correlation with the PHQ-9 depressionscore (+0.3452; p=0.0122). Those categorized as non-adherent to the treatment (Morisky-Green-Levine scale) scored onaverage 18.24 (95 % CI: 1.82 to 34.68; p=0.03) points higher on the TBQ-diabetes scale than adherents. Cronbach's Alpha coefficient was 0.890 for factor 1, 0.764 for factor 2, 0.673 for factor 3 and 0.709 for factor 4. Conclusions. The self-administered version of the TBQ-diabetes questionnaire for assessing burden in people with type2 diabetes was well understood and showed satisfactory psychometric properties. (AU)


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Young Adult , Quality of Life , Attitude to Health , Cost of Illness , Psychosocial Impact , Diabetes Mellitus, Type 2/therapy , Psychometrics , Surveys and Questionnaires , Reproducibility of Results , Factor Analysis, Statistical
2.
Int. j. med. surg. sci. (Print) ; 10(3): 1-18, sept. 2023. graf, ilus, tab
Article in English | LILACS | ID: biblio-1580917

ABSTRACT

This study's objective was to evaluate the effectiveness of three different families of drugs (Empagliflozin [an SGLT-2 inhibitor], Tirzepatide [a GLP-1 receptor co-agonist], and Teneligliptin [DPP-4 inhibitor] used in the treatment of type 2 diabetes in lowering HbA1c levels in people with type 2 diabetes mellitus (T2DM). The effectiveness of different families of diabetic drugs was assessed using a meta-analytic approach. Data were gathered from a variety of research publications using ICTRP, CT.gov, and PubMed databases. The data were analyzed, and conclusions were drawn using forest plots. Teneligliptin (a DPP-4 Inhibitor) substantially lowered HbA1c levels in T2DM patients compared to other classes of T2DM drugs with a P-value of 0.0002 and 95% CI -0.63 [-0.97 to -0.30] after reviewing many pertinent articles. The pooled data analysis showed that Tirzepatide and Empagliflozin did not significantly lower HbA1c levels, with the P-value for Tirzepatide being P = 0.55 and for Empagliflozin, it was P = 0.64. According to our research, Teneligliptin may be more effective than Empagliflozin and Tirzepatide as a monotherapy for lowering HbA1c levels in T2DM patients. To corroborate these findings, further research studies are required.


El objetivo de este estudio fue evaluar la efectividad de tres diferentes familias de medicamentos (Empagliflozina [un inhibidor de SGLT-2], Tirzepatida [un co-agonista del receptor de GLP-1], y Teneligliptina [un inhibidor de DPP-4]) utilizados en el tratamiento de la diabetes tipo 2 para reducir los niveles de HbA1c en personas con diabetes mellitus tipo 2 (DM2). La efectividad de las diferentes familias de medicamentos para la diabetes se evaluó utilizando un enfoque meta-analítico. Los datos se recopilaron a partir de una variedad de publicaciones de investigación utilizando las bases de datos ICTRP, CT.gov y PubMed. Los datos se analizaron y se extrajeron conclusiones utilizando gráficos de bosques. La Teneligliptina (un inhibidor de DPP-4) redujo significativamente los niveles de HbA1c en los pacientes con DM2 en comparación con otras clases de medicamentos para la DM2, con un valor P de 0.0002 y un IC del 95% -0.63 [-0.97 a -0.30] después de revisar muchos artículos pertinentes. El análisis de datos combinados mostró que la Tirzepatida y la Empagliflozina no redujeron significativamente los niveles de HbA1c, con el valor P para la Tirzepatida siendo P = 0.55 y para la Empagliflozina, fue P = 0.64. Según nuestra investigación, la Teneligliptina podría ser más efectiva que la Empagliflozina y la Tirzepatida como monoterapia para reducir los niveles de HbA1c en pacientes con DM2. Para corroborar estos hallazgos, se requieren más estudios de investigación.


Subject(s)
Humans , Diabetes Mellitus, Type 2/diagnosis , Diabetes Mellitus, Type 2/therapy , Pyrazoles/therapeutic use , Benzhydryl Compounds , Glycated Hemoglobin/analysis , Gastric Inhibitory Polypeptide/therapeutic use , Diabetes Mellitus, Type 2/drug therapy , Diabetes Mellitus, Type 2/blood , Hypoglycemic Agents/administration & dosage
3.
Beijing Da Xue Xue Bao ; (6): 450-455, 2023.
Article in Chinese | WPRIM | ID: wpr-986875

ABSTRACT

OBJECTIVE@#To investigate the mechanism of self-efficacy between self-management ability and self-management behavior and its differences among patients with different disease courses through mediation tests.@*METHODS@#In the study, 489 patients with type 2 diabetes who attended the endocrinology departments of four hospitals in Shanxi Province and Inner Mongolia Autonomous Region from July to September 2022 were enrolled as the study population. They were investigated by General Information Questionnaire, Diabetes Self-Management Scale, Chinese version of Diabetes Empowerment Simplified Scale, and Diabetes Self-Efficacy Scale. Mediation analyses were performed using the linear regression model, Sobel test, and Bootstrap test in the software Stata version 15.0 and divided the patients into different disease course groups for subgroup analysis according to whether the disease course was > 5 years.@*RESULTS@#In this study, the score of self-management behavior in the patients with type 2 diabetes was 6.16±1.41, the score of self-management ability was 3.99±0.74, and the score of self-efficacy was 7.05±1.90. The results of the study showed that self-efficacy was positively correlated with self-management ability (r=0.33) as well as self-management behavior (r=0.47) in the patients with type 2 diabetes (P < 0.01). The mediating effect of self-efficacy accounted for 38.28% of the total effect of self-management ability on self-management behaviors and was higher in the behaviors of blood glucose monitoring (43.45%) and diet control (52.63%). The mediating effect of self-efficacy accounted for approximately 40.99% of the total effect for the patients with disease course ≤ 5 years, while for the patients with disease course > 5 years, the mediating effect accounted for 39.20% of the total effect.@*CONCLUSION@#Self-efficacy enhanced the effect of self-management ability on the behavior of the patients with type 2 diabetes, and this positive effect was more significant for the patients with shorter disease course. Targeted health education should be carried out to enhance patients' self-efficacy and self-management ability according to their disease characteristics, to stimulate their inner action, to promote the development of their self-management behaviors, and to form a more stable and long-term mechanism for disease management.


Subject(s)
Humans , Diabetes Mellitus, Type 2/therapy , Self Efficacy , Self-Management , Blood Glucose Self-Monitoring , Blood Glucose , Self Care
4.
Zhongguo zhenjiu ; (12): 679-683, 2023.
Article in Chinese | WPRIM | ID: wpr-980778

ABSTRACT

OBJECTIVE@#To observe the effect of electroacupuncture (EA) on liver protein kinase B (Akt)/forkhead box transcription factor 1 (FoxO1) signaling pathway in Zucker diabetic fatty (ZDF) rats, and to explore the possible mechanism of EA on improving liver insulin resistance of type 2 diabetes mellitus.@*METHODS@#Twelve male 2-month-old ZDF rats were fed with high-fat diet for 4 weeks to establish diabetes model. After modeling, the rats were randomly divided into a model group and an EA group, with 6 rats in each group. In addition, six male Zucker lean (ZL) rats were used as the blank group. The rats in the EA group were treated with EA at bilateral "Zusanli" (ST 36), "Sanyinjiao" (SP 6), "Weiwanxiashu" (EX-B 3), and "Pishu" (BL 20). The ipsilateral "Zusanli" (ST 36) and "Weiwanxiashu" (EX-B 3) were connected to EA device, continuous wave, frequency of 15 Hz, 20 min each time, once a day, six times a week, for a total of 4 weeks. The fasting blood glucose (FBG) in each group was compared before modeling, before intervention and after intervention; the serum levels of insulin (INS) and C-peptide were measured by radioimmunoassay method, and the insulin resistance index (HOMA-IR) was calculated; HE staining method was used to observe the liver tissue morphology; Western blot method was used to detect the protein expression of Akt, FoxO1 and phosphoenolpyruvate carboxykinase (PEPCK) in the liver.@*RESULTS@#Before intervention, compared with the blank group, FBG was increased in the model group and the EA group (P<0.01); after intervention, compared with the model group, FBG in the EA group was decreased (P<0.01). Compared with the blank group, the serum levels of INS and C-peptide, HOMA-IR, and the protein expression of hepatic FoxO1 and PEPCK were increased (P<0.01), while the protein expression of hepatic Akt was decreased (P<0.01) in the model group. Compared with the model group, the serum levels of INS and C-peptide, HOMA-IR, and the protein expression of hepatic FoxO1 and PEPCK were decreased (P<0.01), while the protein expression of hepatic Akt was increased (P<0.01) in the EA group. In the model group, the hepatocytes were structurally disordered and randomly arranged, with a large number of lipid vacuoles in the cytoplasm. In the EA group, the morphology of hepatocytes tended to be normal and lipid vacuoles were decreased.@*CONCLUSION@#EA could reduce FBG and HOMA-IR in ZDF rats, improve liver insulin resistance, which may be related to regulating Akt/FoxO1 signaling pathway.


Subject(s)
Male , Animals , Rats , Rats, Zucker , Proto-Oncogene Proteins c-akt/genetics , Diabetes Mellitus, Type 2/therapy , Insulin Resistance , C-Peptide , Electroacupuncture , Liver , Signal Transduction , Insulin , Lipids
5.
Zhongguo zhenjiu ; (12): 1343-1350, 2023.
Article in English | WPRIM | ID: wpr-1007492

ABSTRACT

OBJECTIVES@#To investigate the cerebral metabolism in the patients with type 2 diabetes mellitus-associated cognitive dysfunction (T2DACD) and explore the mechanism of electroacupuncture (EA) at the acupoints for Tiaozang Xingshen (adjusting zangfu function and rescuing the spirit) in treatment of T2DACD, using magnetic resonance spectroscopy.@*METHODS@#Fifteen patients with T2DACD (observation group) and 22 healthy subjects (control group) were enrolled. In the observation group, the patients were treated with EA for Tiaozang Xingshen at Baihui (GV 20) and Shenting (GV 24), and bilateral Feishu (BL 13), Pishu (BL 20), Shenshu (BL 23), Zusanli (ST 36), Sanyinjiao (SP 6), Hegu (LI 4) and Taichong (LR 3). EA was operated with disperse-dense wave, 2 Hz/100 Hz in frequency and 0.1 mA to 1.0 mA in current intensity; 30 min each time, once daily. One course of EA consisted of 5 treatments, at the interval of 2 days and the intervention lasted 8 courses. Before treatment in the control group, before and after treatment in the observation group, the score of Montreal cognitive assessment scale (MoCA), the score of clinical dementia rating (CDR), Flanker paradigm, Stroop paradigm, Nback paradigm, the score of self-rating anxiety scale (SAS), the score of self-rating depression scale (SDS), and the score of Hamilton depression rating scale (HAMD) were evaluated separately; the glycolipid metabolic indexes (fasting plasma glucose [FPG], glycosylated hemoglobin type A1c [HbA1c], total cholesterol [TC], triacylglycerol [TG], high-density lipoprotein cholesterol [HDL-C] and low-density lipoprotein cholesterol [LDL-C]) were determined;with the magnetic resonance spectroscopy technique adopted, the metabolites in the basal ganglia area were detected. The correlation analysis was performed for the metabolite values with MoCA score, CDR score , Flanker paradigm, Stroop paradigm, and Nback paradigm.@*RESULTS@#Before treatment, compared with the control group, in the observation group, MoCA score was lower (P<0.001), CDR score and the levels of FPG and HbA1c were higher (P<0.001); the reaction times of Flanker non-conflict, Flanker conflict, Stroop neutrality, Stroop congruence, Stroop conflict, and 1-back were prolonged (P<0.05, P<0.001), and the accuracy of Flanker conflict, Stroop conflict, and 1-back decreased (P<0.05, P<0.01); the ratio of N-acetyl aspartate (NAA) to creatine (Cr) in the left basal ganglia area was dropped (P<0.001), and that of myo-inositol (MI) to Cr in the right side increased (P<0.05). In the observation group after treatment, compared with the levels before treatment, MoCA score was higher (P<0.001), the scores of CDR, SAS and HAMD were reduced (P<0.01, P<0.05), the reaction times of Flanker conflict and Stroop conflict shortened (P<0.001, P<0.05), and the accuracy of Flanker conflict and 1-back increased (P<0.001, P<0.05); the ratio of NAA to Cr in the left basal ganglia area and that of the gamma-aminobutyric acid (GABA) to Cr in the right increased (P<0.05), that of MI to Cr in the right decreased (P<0.05). Before treatment, in the observation group, the ratio of MI to Cr in the right basal ganglia area was positively correlated with the reaction time of Stroop congruence (r=0.671, P=0.012) and this ratio was positively correlated with the reaction time of Stroop conflict (r=0.576, P=0.039).@*CONCLUSIONS@#Electroacupuncture for "adjusting zangfu function and rescuing the mind" improves the cognitive function of T2DACD patients, which may be related to the regulation of NAA, MI and GABA levels in the basal ganglia.


Subject(s)
Humans , Electroacupuncture , Acupuncture Therapy , Acupuncture Points , Diabetes Mellitus, Type 2/therapy , Glycated Hemoglobin , Cognitive Dysfunction/therapy , Cholesterol , gamma-Aminobutyric Acid
6.
Zhongguo zhenjiu ; (12): 1425-1430, 2023.
Article in English | WPRIM | ID: wpr-1007504

ABSTRACT

OBJECTIVES@#To observe the effects on the glucose-lipid metabolism and the expression of zinc-α2-glycoprotein (ZAG) and glucose transporter 4 (GLUT4) in the femoral quadriceps and adipose tissue after electroacupuncture (EA) at "Pishu" (BL 20), "Weiwanxiashu" (EX-B 3), "Zusanli" (ST 36) and "Sanyinjiao" (SP 6) in the rats with diabetes mellitus type 2 (T2DM), so as to explore the effect mechanism of EA in treatment of T2DM.@*METHODS@#Twelve ZDF male rats were fed with high-sugar and high-fat fodder, Purina #5008 for 4 weeks to induce T2DM model. After successfully modeled, the rats were randomly divided into a model group and an EA group, with 6 rats in each one. Additionally, 6 ZL male rats of the same months age were collected as the blank group. The rats in the EA group were treated with EA at bilateral "Pishu" (BL 20), "Weiwanxiashu" (EX-B 3), "Zusanli" (ST 36) and "Sanyinjiao" (SP 6), with continuous wave, 15 Hz in frequency, and 2 mA in intensity. The electric stimulation lasted 20 min each time. EA was delivered once daily, 6 times a week for 4 weeks. Separately, the levels of fasting blood glucose (FBG) was measured before modeling, before and after intervention, and the body mass of each rat was weighted before and after intervention. After intervention, the levels of the total cholesterol (TC), triacylglycerol (TG) and free fatty acid (FFA) in serum were detected using enzyme colorimetric method; and the levels of the serum insulin (INS) and ZAG were detected by ELISA. Besides, the insulin sensitivity index (HOMA-ISI) was calculated. With Western blot technique adopted, the protein expressions of ZAG and GLUT4 in the femoral quadriceps and adipose tissue were determined.@*RESULTS@#After intervention, compared with the blank group, the levels of FBG and body mass, and the levels of serum TC, TG, FFA and INS increased (P<0.01), while HOMA-ISI decreased (P<0.01); the level of ZAG in the serum and the protein expressions of ZAG and GLUT4 in the femoral quadriceps and adipose tissue dropped (P<0.01) in the model group. In the EA group, compared with the model group, the levels of FBG and body mass, and the levels of serum TC, TG, FFA and INS were reduced (P<0.01), and HOMA-ISI increased (P<0.01); the level of ZAG in the serum and the protein expressions of ZAG and GLUT4 in the femoral quadriceps and adipose tissue increased (P<0.01, P<0.05).@*CONCLUSIONS@#Electroacupuncture can effectively regulate glucose-lipid metabolism, improve insulin resistance and sensitivity in the rats with T2DM, which is associated with the modulation of ZAG and GLUT4 expression in the skeletal muscle and adipose tissue.


Subject(s)
Rats , Male , Animals , Glucose/metabolism , Electroacupuncture , Rats, Sprague-Dawley , Diabetes Mellitus, Type 2/therapy , Lipid Metabolism , Triglycerides , Adipose Tissue/metabolism , Acupuncture Points
7.
Chinese Journal of Biotechnology ; (12): 3747-3756, 2023.
Article in Chinese | WPRIM | ID: wpr-1007990

ABSTRACT

To develop a novel glucose-lowering biomedicine with potential benefits in the treatment of type 2 diabetes, we used the 10rolGLP-1 gene previously constructed in our laboratory and the CRISPR/Cas9 genome editing technique to create an engineered Saccharomyces cerevisiae strain. The gRNA expression vector pYES2-gRNA, the donor vector pNK1-L-PGK-10rolGLP-1-R and the Cas9 expression vector pGADT7-Cas9 were constructed and co-transformed into S. cerevisiae INVSc1 strain, with the PGK-10rolGLP-1 expressing unit specifically knocked in through homologous recombination. Finally, an S. cerevisiae strain highly expressing the 10rolGLP-1 with glucose-lowering activity was obtained. SDS-PAGE and Western blotting results confirmed that two recombinant strains of S. cerevisiae stably expressed the 10rolGLP-1 and exhibited the desired glucose-lowering property when orally administered to mice. Hypoglycemic experiment results showed that the recombinant hypoglycemic S. cerevisiae strain offered a highly hypoglycemic effect on the diabetic mouse model, and the blood glucose decline was adagio, which can avoid the dangerous consequences caused by rapid decline in blood glucose. Moreover, the body weight and other symptoms such as polyuria also improved significantly, indicating that the orally hypoglycemic S. cerevisiae strain that we constructed may develop into an effective, safe, economic, practical and ideal functional food for type 2 diabetes mellitus treatment.


Subject(s)
Mice , Animals , Saccharomyces cerevisiae/metabolism , CRISPR-Cas Systems , Glucose/metabolism , Blood Glucose/metabolism , Diabetes Mellitus, Type 2/therapy , Hypoglycemic Agents/metabolism
8.
Article in Portuguese | LILACS | ID: biblio-1511470

ABSTRACT

A Doença Renal do Diabetes (DRD) é assintomática nos estágios iniciais da doença, e por esse motivo, a maioria dos pacientes é diagnosticada somente quando já apresenta várias complicações. O objetivo deste estudo foi avaliar se o rastreio da DRD está sendo realizado de maneira adequada em pacientes com diabetes mellitus tipo 2 (DM2) atendidos na atenção primária à saúde (APS) do Sistema Único de Saúde. Foi realizado um estudo transversal, com duração de cinco meses, na APS dos municípios de Bernardino de Campos e Salto Grande, SP. Os critérios de inclusão foram: diagnóstico de DM2, idade > 18 anos, e ser acompanhado nas unidades participantes do estudo. Um total de 1093 atenderam aos critérios de inclusão e aceitaram participar do estudo. Foi verificado que 398 (36,4%) dos pacientes nunca realizaram os exames de albumina urinária e creatinina, e não tiveram calculados a relação albumina/creatinina em amostra de urina com o cálculo da taxa de filtração glomerular (TFG) estimada pela CKD-EPI a partir da creatinina sérica; 401 (36,7%) dos pacientes realizaram estes exames e tiveram estes índices calculados nos últimos 12 meses. Estes 401 pacientes realizaram estes exames e cálculos de rastreio da DRD uma vez a cada 12 meses nos últimos 5 anos. Os demais pacientes (294; 26,9%) realizaram somente exame de creatinina sérica nos últimos 12 meses. Os resultados demonstraram que o rastreamento da DRD não está sendo realizado de maneira adequada na maioria dos pacientes (AU).


Diabetes Kidney Disease (DRD) is asymptomatic in the early stages of the disease, and for this reason, most patients are diagnosed only when they already have several complications. The aim of this study was to assess whether DRD screening is being carried out properly in patients with type 2 diabetes mellitus (DM2) treated in primary health care (PHC) of the Unified Health System. A cross-sectional study was carried out, lasting five months, in the PHC of the municipalities of Bernardino de Campos and Salto Grande, SP. Inclusion criteria were: diagnosis of DM2, age > 18 years, and being monitored in the units participating in the study. A total of 1093 met the inclusion criteria and agreed to participate in the study. It was found that 398 (36.4%) of the patients had never performed urine albumin and creatinine tests, and they did not calculate the albumin/creatinine ratio in a urine sample, together with the calculation of the glomerular filtration rate (GFR) estimated by CKD-EPI from serum creatinine; in contrast, 401 (36.7%) of the patients underwent these exams and had these indexes calculated in the last 12 months. These 401 patients had these DRD screening tests and calculations performed once every 12 months for the last 5 years. Os demais pacientes (294; 26,9%) realizaram somente exame de creatinina sérica nos últimos 12 meses. Os resultados demonstraram que o rastreamento da DRD não está sendo realizado de maneira adequada na maioria dos pacientes (AU).


Subject(s)
Humans , Primary Health Care , Diabetes Mellitus, Type 2/therapy , Diabetic Nephropathies , Renal Insufficiency, Chronic
9.
Journal of Integrative Medicine ; (12): 288-291, 2022.
Article in English | WPRIM | ID: wpr-939888

ABSTRACT

Theoretically, a new diagnosis of type 2 diabetes mellitus (T2DM) requires a dramatic change in an individual's way of life. Weight loss and physical activity can lead to remission of diabetes, which has been associated with a lower risk of developing complications. Today, the importance of a healthy lifestyle is further highlighted by data showing that obesity and diabetes increase the risk of severe complications from coronavirus disease 2019. However, remission rarely occurs in reality, probably due to the inability of people with T2DM to adhere to the intensive lifestyle interventions that are necessary. The complexity of contributing factors may explain why making these changes is so challenging and underscore the fact that there is no magical solution for T2DM. Instead, hard work from both patients and health care providers is needed for the conversion to be achieved. This article calls for more research on the underlying reasons why adhering to a healthy way of life is so difficult for people with diabetes and obesity. Clearly defining these barriers would facilitate the planning of effective policies to promote the adoption of appropriate lifestyle changes early in the course of the disease.


Subject(s)
Humans , COVID-19 , Diabetes Mellitus, Type 2/therapy , Exercise , Life Style , Obesity/therapy
10.
Zhongguo zhenjiu ; (12): 433-436, 2022.
Article in Chinese | WPRIM | ID: wpr-927402

ABSTRACT

To explore the possible new mechanism of acupuncture in the treatment of diabetes mellitus type 2 (T2DM) based on the islet inflammatory response. Islet macrophages, pancreatic adipose cells and islet β cells all participate in the pathogenesis of T2DM, and the three could form a network interaction. Acupuncture could regulate the functional phenotype of islet macrophages, improve the ectopic deposition of pancreatic adipose and repair the function of islet β cells, and play a unique advantage of overall regulation. It is suggested that acupuncture can be a potential treatment strategy for T2DM.


Subject(s)
Humans , Acupuncture Therapy , Diabetes Mellitus, Type 2/therapy , Insulin-Secreting Cells/pathology , Islets of Langerhans/pathology , Macrophages
12.
Gac. méd. Méx ; Gac. méd. Méx;157(3): 323-326, may.-jun. 2021. tab
Article in Spanish | LILACS | ID: biblio-1346114

ABSTRACT

Resumen Introducción: Los pacientes con diabetes experimentan dificultades para mantener el control glucémico durante el confinamiento por la pandemia de COVID-19, con el riesgo de presentar complicaciones crónicas de la diabetes y COVID-19 grave. Objetivo: El propósito de este estudio fue evaluar la conversión de un centro de atención primaria presencial de diabetes a un servicio de telemedicina por llamada telefónica. Métodos: Se realizaron consultas médicas por llamada telefónica durante la etapa inicial del confinamiento (abril a junio de 2020), para continuar el seguimiento de pacientes ingresados a un programa de atención multicomponente en diabetes. Resultados: Se realizaron 1118 consultas por llamada telefónica para continuar el seguimiento de 192 pacientes con diabetes tipo 2. Participaron diferentes profesionales de distintas áreas de la salud: atención médica, educación en diabetes, nutrición, psicología y podología. Conclusiones: La atención multicomponente en diabetes se transformó con éxito de un esquema de atención presencial a un servicio de telemedicina. Numerosos pacientes de atención primaria pueden ser candidatos a telemedicina. Se debe considerar un rediseño del modelo de atención que incorpore la telemedicina para mitigar la carga de morbimortalidad en enfermedades crónicas impuesta por la pandemia de COVID-19, pero también para la era pos-COVID-19.


Abstract Introduction: Patients with diabetes experience difficulties to maintain glycemic control during the confinement due to the COVID-19 pandemic, with the risk of developing diabetes chronic complications and severe COVID-19. Objective: The purpose of this study was to evaluate the conversion of an outpatient diabetes primary care center from a face-to-face care modality to a telemedicine care service by telephone. Methods: Medical consultations were made by telephone during the initial phase of confinement (April to June 2020), to then continue the follow-up of patients admitted to a multicomponent diabetes care program. Results: A total of 1,118 consultations were made by telephone and follow-up was subsequently continued in 192 patients with type 2 diabetes. Different professionals from different health areas participated, including medical care, diabetes education, nutrition, psychology and podiatry. Conclusions: Multicomponent diabetes care was successfully transformed from a face-to-face care modality to a telemedicine service. Many primary care patients may be candidates for telemedicine. A redesign of the care model that incorporates telemedicine should be considered to mitigate chronic diseases burden of morbidity and mortality imposed by COVID-19 pandemic, but also for the post-COVID-19 era.


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Telemedicine/methods , Diabetes Mellitus, Type 2/therapy , Ambulatory Care/methods , COVID-19 , Primary Health Care/methods , Primary Health Care/statistics & numerical data , Cross-Sectional Studies , Prospective Studies , Telemedicine/statistics & numerical data , Ambulatory Care/statistics & numerical data
13.
Rev. cuba. endocrinol ; 32(1): e267, 2021.
Article in Spanish | LILACS, CUMED | ID: biblio-1289391

ABSTRACT

Introducción: La estrecha relación que existe entre diabetes mellitus tipo 2 y obesidad ha dado lugar a la creación del término "diabesidad", considerándose la nueva enfermedad del siglo XXI. La dupla entre estas produce grave lesión en el tejido hepático, músculo esquelético y sistema cardiovascular. Es importante un estilo de vida saludable y buena adherencia farmacológica para combatir esta pandemia. Objetivo: Describir aspectos generales acerca de la fisiopatología y el tratamiento de la diabesidad. Método: Se realizó una búsqueda bibliográfica no sistemática en las bases de datos Science Direct, EMBASE, LILACS, Redalyc, SciELO y PubMed. Los criterios de inclusión fueron publicaciones en inglés y español, en las que el título, palabras clave o resumen incluyen información pertinente al objetivo de estudio, periodicidad no mayor de cinco años. En la búsqueda se obtuvieron 50 artículos, de los cuales fueron seleccionados 35. Conclusión: La insulinorresistencia es el factor determinante para la progresión hacia diabetes mellitus tipo 2, en calidad de respuesta del tejido adiposo frente a altos niveles de ácidos grasos libres (lipotoxicidad), consecuencia de la obesidad, obligando al páncreas a secretar grandes cantidades de insulina, que con el tiempo compromete su funcionalidad. En la actualidad, existen diversas alternativas no farmacológicas, farmacológicas y quirúrgicas para el abordaje de la diabesidad, donde la prevención representa un aspecto de vital importancia(AU)


Introduction: The close relation among diabetes mellitus type 2 and obesity has led to the creation of the term "diabesity," considering it the new disease of XXI century. The fusion of these two diseases produces severe lesions in the hepatic tissue, the skeletal muscle and the cardiovascular system. It is important a healthy lifestyle and a good pharmacological adherence to fight this so called pandemic. Objective: Describe general aspects related to the physiopathology and treatment of diabesity. Method: It was carried out a non-systematic bibliographic search in databases like Science Direct, EMBASE, LILACS, Redalyc, SciELO and PubMed. The inclusion criteria were publications in English and Spanish language, with a periodicity of no more than 5 years, in which the title, keywords and abstract included information that will be relevant for the objective of the study. In the search 50 articles were found, of which 35 were selected. Conclusions: Insulin resistance is the key factor for the progression towards diabetes mellitus type 2, as a response of the adipose tissue to high levels of free fatty acids (lipotoxicity), which is a consequence of obesity, and obligates the pancreas to secrete big amounts of insulin that as time goes by compromises its functionality. Nowadays, there are different non-pharmacological, pharmacological and surgical alternatives to address the diabesity, in which prevention represents an aspect of vital importance(AU)


Subject(s)
Humans , Insulin Resistance , Diabetes Mellitus, Type 2/physiopathology , Healthy Lifestyle , Obesity/physiopathology , Review Literature as Topic , Databases, Bibliographic , Diabetes Mellitus, Type 2/therapy , Obesity/therapy
14.
Acta sci., Health sci ; 43: e53729, Feb.11, 2021.
Article in English | LILACS | ID: biblio-1368132

ABSTRACT

Type 2 Diabetes Mellitus (T2DM) is a costly, lifestyle-related disorder, its management is very critical and challenging hence lifestyle intervention may a cornerstone in the reversal and management of T2DM. This study designed to assess the impact of lifestyle intervention holistic (LIH) Model on blood glucose levels (BGL), Health-Related Quality of Life (HRQOL), and medical treatment cost in T2DM patients. This prospective, quasi-experimental study was conducted among 224 T2DM patients in Delhi Diabetes Research Center (DDRC), New Delhi. The study participants were allocated into two groups-Lifestyle Intervention Counseling (LIC) group received lifestyle-based counseling through the LIH model while the Usual-care group received only standard treatment. Study outcomes were assessed at baseline, 3rd, 6th, and 12th month and data were analyzed through SPSS. Study results revealed that LIC participants had decreased in fasting blood glucose 0.26 mg dL-1(-4.37 to 4.89), blood glucose postprandial -70.16 mg dL-1(-85.15 to -55.16), HbA1C -2.82% (-5.26 to -0.37), medicine cost (p < 0.004), hospitalization cost (p < 0.011), and cost of surgery (p < 0.0005). A significant improvement also observed in HRQOL and adherence towards a holistic model in LIC group. The study concludes that lifestyle-based counseling and its adherence was cost-effective and significantly improves BGL, HRQoL, and medical treatment in T2DM patients.


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Diabetes Mellitus, Type 2/therapy , Glycemic Control , Life Style , Quality of Life , Tobacco Use Disorder/prevention & control , Blood Glucose , Exercise , Counseling , Diet/statistics & numerical data , Psychological Distress
15.
Rev. méd. Chile ; 149(1): 37-44, ene. 2021. graf, tab
Article in Spanish | LILACS | ID: biblio-1389348

ABSTRACT

BACKGROUND: Among older people, physical exercise improves cognitive function, aerobic fitness, and thus functional independence. Aim: To determine the effects of a walking training program on aerobic fitness and cognitive function in older women with type 2 diabetes mellitus. MATERRIAL AND METHODS: An experimental study was carried out in 76 women with type 2 diabetes mellitus aged between 64 and 78 years. Thirty-eight women in the exercise group (EG) participated in a controlled walking program 3 times a week for 48 sessions (60min /day) and 38 women in the control group (CG) were not trained. Weight, height, body mass index (BMI), estimated maximal oxygen uptake (VO2max), and cognitive function using the Minimental test were evaluated at baseline and the end of the intervention. RESULTS: The Minimental test improved significantly in the exercise group and did not change in the control group. Estimated VO-2max improved in women aged between 69 and 78 years. The distance walked in 6 minutes increased in all women of the experimental group. No changes in these parameters were observed in the control group. Conclusions: A structured walking program improved cognitive function, estimated aerobic capacity, and walking distance in these diabetic women.


Subject(s)
Humans , Female , Middle Aged , Aged , Diabetes Mellitus, Type 2/therapy , Oxygen Consumption , Exercise , Physical Fitness , Cognition
16.
Zhongguo zhenjiu ; (12): 866-870, 2021.
Article in Chinese | WPRIM | ID: wpr-887498

ABSTRACT

OBJECTIVE@#To observe the effect of acupuncture at @*METHODS@#Sixty patients with type-2 diabetic peripheral neuropathy were randomly divided into an observation group and a control group, 30 cases in each one. Both groups were treated with basic treatment, and the observation group was additionally treated with acupuncture at Neiting (ST 44), Xiangu (ST 43), Dadu (SP 2), Taibai (SP 3), Zusanli (ST 36), etc. once every other day, 3 times a week for 4 weeks. The changes of TCM symptom score, Toronto clinical assessment (TCSS) score, visual analogue scale (VAS) score of pain and serum tumor necrosis factor α(TNF-α) level were observed before and after treatment in the two groups, and the clinical effects of the two groups were evaluated.@*RESULTS@#Compared before treatment, the TCM syndrome score and the TCSS score in the two groups were reduced after treatment (@*CONCLUSION@#Acupuncture at


Subject(s)
Humans , Acupuncture Points , Acupuncture Therapy , Diabetes Mellitus, Type 2/therapy , Diabetic Neuropathies/therapy , Rivers , Treatment Outcome
17.
Journal of Integrative Medicine ; (12): 347-353, 2021.
Article in English | WPRIM | ID: wpr-888765

ABSTRACT

OBJECTIVE@#The prevalence of complementary and alternative medicine (CAM) usage among patients with type 2 diabetes mellitus (T2DM) in Indonesia is high. However, to date, little is known about why Indonesian T2DM patients choose CAM therapies, how their knowledge, attitude and practice (KAP) of CAM affects their choices, or how demographics correlate with patient choices. Therefore, this study aimed to investigate the KAP and predictors of CAM usage in T2DM patients in Indonesia.@*METHODS@#This was an observational, cross-sectional study. Patients were interviewed using a questionnaire. Chi-square tests or Fisher's exact tests were used to compare demographic and clinical data, as well as KAP assessments, between T2DM patients who use and do not use CAM. Multivariate logistic regression analyses were used to investigate predictors of CAM usage.@*RESULTS@#A total of 628 T2DM patients were enrolled in the study. CAM therapies were used by 341 patients (54.3%). The most common therapies were herbs and spiritual healing, used by 100.0% and 68.3% of CAM-using patients, respectively. CAM therapies were frequently recommended by family members (91.5%), and CAM users had significantly more knowledge and more positive attitudes toward CAM therapies than nonusers. Among users, 66% said they would not follow their healthcare providers' instructions to not use CAM therapies, and 69.5% said they would not disclose their plan to use CAM therapies with their healthcare provider. Neither demographic nor clinical characteristics were associated with CAM use. The factors that best predicted the use of CAM therapies were their availability and low cost (odds ratio [OR] = 4.59; 95% confidence interval [CI]: 3.01-7.01), the belief that CAM therapies were safe (OR = 2.04; 95% CI: 1.40-2.95), the belief that CAM therapies could help with diabetes control (OR = 1.75; 95% CI: 1.15-2.66), and the belief that CAM therapies could help maintain physical health (OR = 1.68; 95% CI: 1.13-2.49).@*CONCLUSION@#CAM therapy users were more knowledgeable and had more positive attitudes toward CAM, but most of them chose not to disclose their CAM use to their healthcare providers. CAM use in Indonesia was associated with its accessibility, affordability, safety and effectivity, but not with any demographic or clinical characteristics. This study provided new evidence and insights for nurses and physicians in Indonesia that will help to design educational programs about the safety and efficacy of CAM therapies.


Subject(s)
Humans , Complementary Therapies , Cross-Sectional Studies , Diabetes Mellitus, Type 2/therapy , Health Knowledge, Attitudes, Practice , Indonesia , Surveys and Questionnaires
19.
Esc. Anna Nery Rev. Enferm ; 25(5): e20210032, 2021. tab, graf
Article in Portuguese | BDENF, LILACS | ID: biblio-1286376

ABSTRACT

Resumo Objetivo elaborar um modelo interpretativo sobre a adesão ao autocuidado de pessoas com Diabetes Mellitus na Atenção Primária à Saúde. Método estudo de método misto realizado em quatro Unidades Básicas de Saúde. O estudo quantitativo transversal foi composto por 329 participantes, elegeram-se variáveis sociodemográficas e clínicas e o questionário de atividades de autocuidado. No estudo qualitativo, com 31 participantes, utilizou-se a vertente construtivista da Teoria Fundamentada nos Dados. Os dados foram analisados utilizando-se a estatística descritiva e a codificação inicial e focalizada. Resultados a maioria dos participantes é do sexo feminino, casada, com um a cinco anos de estudo, aposentada e com renda de um a três salários-mínimos. Obteve-se baixa adesão à alimentação saudável, à atividade física e ao monitoramento glicêmico. A adesão desejável foi relacionada ao uso de medicamentos e cuidados com os pés. Na etapa qualitativa, obteve-se como fenômeno: Enfrentando a complexidade do tratamento do Diabetes Mellitus e buscando o autocuidado. Este foi sustentado por duas categorias: Encontrando as dificuldades para seguir o tratamento e Valorizando os aspectos facilitadores do tratamento que deram subsídios para a elaboração do modelo. Conclusões e implicações para a prática foi elaborado um modelo interpretativo cujos elementos demonstram a complexidade do fenômeno e contribuem para a adesão ao autocuidado nessa população.


Resumen Objetivo elaborar un modelo interpretativo sobre adhesión al autocuidado de personas con Diabetes Mellitus en Atención Primaria de Salud. Método estudio de método mixto realizado en cuatro Unidades Básicas de Salud. El estudio cuantitativo transversal fue compuesto por 329 participantes, se eligieron variables sociodemográficas y clínicas y el cuestionario de actividades de autocuidado. En el estudio cualitativo, con 31 participantes, se utilizó el enfoque constructivista de Grounded Theory. Los datos se analizaron mediante estadística descriptiva y codificación inicial y focalizada. Resultados la mayoría de los participantes son mujeres, casadas, con uno a cinco años de estudio, jubiladas y con ingresos de uno a tres salarios mínimos. Se obtuvo una baja adhesión a la alimentación saludable, la actividad física y el control glucémico. La adhesión deseable se relacionó con el uso de medicamentos y el cuidado de los pies. En la etapa cualitativa se obtuvo el siguiente fenómeno: Enfrentando la complejidad del tratamiento de la Diabetes Mellitus y buscando el autocuidado. Esto fue apoyado por dos categorías: Encontrando las dificultades para seguir el tratamiento y Valorando los aspectos facilitadores del tratamiento que apoyaron el desarrollo del modelo. Conclusiones e implicaciones para la práctica se desarrolló un modelo interpretativo cuyos elementos demuestran la complejidad del fenómeno y contribuyen a la adhesión al autocuidado en esta población.


Abstract Objective to develop an interpretive model on the adherence to self-care of people with Diabetes Mellitus in Primary Health Care. Method a mixed-method study conducted in four Basic Health Units. The cross-sectional quantitative study was composed of 329 participants, sociodemographic and clinical variables and the questionnaire of self-care activities were chosen. In the qualitative study, with 31 participants, the constructivist strand of Grounded Theory was used. The data were analyzed using descriptive statistics and initial and focused coding. Results most participants are female, married, with one to five years of schooling, retired, and with an income of one to three minimum wages. Low adherence to healthy eating, physical activity, and glycemic monitoring was obtained. The desirable adherence was related to the use of medications and foot care. In the qualitative step, the phenomenon was: Facing the complexity of the treatment of Diabetes Mellitus and seeking self-care. This was supported by two categories: Encountering difficulties to follow the treatment and valuing the facilitating aspects of the treatment that provided subsidies for the development of the model. Conclusions and implications for practice an interpretative model was elaborated whose elements demonstrate the complexity of the phenomenon and contribute to the adherence to self-care in this population.


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Aged, 80 and over , Primary Health Care , Self Care , Diabetes Mellitus, Type 2/therapy , Treatment Adherence and Compliance , Social Support , Socioeconomic Factors , Exercise , Prevalence , Qualitative Research , Grounded Theory , Diet, Healthy , Glycemic Control
20.
Braz. arch. biol. technol ; Braz. arch. biol. technol;64: e21200037, 2021. tab, graf
Article in English | LILACS | ID: biblio-1249206

ABSTRACT

Abstract Increased apoptosis in the pancreas and beta cell death causes reduced insulin secretion in type 2 diabetes. This study was aimed to evaluate the effects of exercise training and testosterone administration on apoptosis marker (p53 protein) in the pancreas tissue in animal with diabetes. Type 2 diabetes was induced by high fat diet and injection of low dose STZ (35mg/kg; ip). After 2 months of treatment with testosterone (2mg/kg/day) or voluntary exercise alone or in combination, apoptosis (tunnel assay) and p53 protein (ELISA method) were measured. Testosterone and exercise decreased the blood glucose, HbA1c levels, HOMA-IR, p53 protein expression and increased insulin level in treated diabetic and diabetic castrated groups. Simultaneous treatment of these groups with testosterone together voluntary exercise had an additive effect on reducing p53 expression, blood glucose, HbA1c levels, HOMA-IR and subsequently decreasing apoptosis. Our results suggest that the apoptosis decreasing effect of testosterone and voluntary exercise is associated with the reduced levels of blood glucose, HbA1c and HOMA-IR that subsequently decreased the expression of p53 level.


Subject(s)
Animals , Rats , Testosterone/therapeutic use , Exercise , Diabetes Mellitus, Type 2/therapy , Apoptosis , Glycemic Control
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