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Rev. méd. Chile ; 151(2): 222-228, feb. 2023. ilus
Article in Spanish | LILACS | ID: biblio-1522070


Atrial Fibrillation (AF) is the most common sustained arrhythmia and is highly prevalent in elderly patients. It confers a higher risk for ischemic stroke, heart failure and death. The diagnosis and treatment of AF has been extensively studied and remain under constant revision. This article reviews the recent European guidelines and the advances observed with the introduction of direct oral anticoagulants in the last ten years. This new family of drugs has clear benefits in terms of efficacy and safety compared with traditional vitamin K antagonists. Treatment of most common comorbidities in patients with AF such as advanced age, heart failure, diabetes, renal failure, and others are also analyzed. New therapies for AF will be shortly available.

Humans , Aged, 80 and over , Atrial Fibrillation/complications , Atrial Fibrillation/diagnosis , Atrial Fibrillation/drug therapy , Stroke/etiology , Stroke/drug therapy , Diabetes Mellitus/drug therapy , Heart Failure/drug therapy , Comorbidity , Administration, Oral , Anticoagulants/adverse effects
China Journal of Chinese Materia Medica ; (24): 3949-3964, 2023.
Article in Chinese | WPRIM | ID: wpr-981527


This study aimed to evaluate the efficacy of Qi-supplementing and Yin-nourishing Chinese patent medicine in the treatment of early diabetic nephropathy(DN) by network Meta-analysis to explore the Chinese patent medicine with optimal efficacy and provide references for preventing renal deterioration and delaying the progression of early DN. Eight databases, including CNKI, Wanfang, VIP, SinoMed, PubMed, EMbase, Cochrane Library, and Web of Science, were searched for clinical randomized controlled trial(RCT) of Qi-supplementing and Yin-nourishing Chinese patent medicines in the treatment of early DN. After the literature mee-ting the inclusion criteria was screened, the quality of the literature was evaluated using the Cochrane risk-of-bias tool, and network Meta-analysis was performed using the BUGSnet package in R 4.2.1. Seventy-two research articles with a sample size of 6 344 cases were included, involving eight Chinese patent medicines and seven outcome indicators. The results of the network Meta-analysis showed that(1)in terms of improving urinary albumin excretion rate(UAER), Chinese patent medicines combined with conventional treatment were superior to conventional treatment, and Qiyao Xiaoke Capsules + conventional treatment was optimal.(2)In terms of reducing serum crea-tinine(Scr), Bailing Capsules + conventional treatment had superior efficacy.(3)In terms of reducing 24-hour urine total protein(24hUTP), Shenyan Kangfu Tablets + conventional treatment and Jinshuibao Capsules + conventional treatment had equivalent efficacy, and Shenyan Kangfu Tablets + conventional treatment was superior.(4)In terms of improving fasting blood glucose(FBG), Shenyan Kangfu Tablets + conventional treatment had superior efficacy.(5)In terms of improving total cholesterol(TC), Qiyao Xiaoke Capsules +conventional treatment had superior efficacy.(6)In terms of reducing triglyceride(TG), Bailing Capsules + conventional treatment had superior efficacy.(7)In terms of safety, the occurrence of adverse reactions was reported in seven interventions, but due to the large clinical heterogeneity, the quantitative analysis could not be performed. Overall, Qi-supplementing and Yin-nourishing Chinese patent medicines combined with conventional treatment were superior to conventional treatment alone in the treatment of early DN. The results showed that Qi-supplementing and Yin-nourishing Chinese patent medicines combined with conventional treatment had good clinical efficacy, and they could significantly reduce renal function indicators such as UAER, Scr, and 24hUTP, and reduce blood sugar and blood lipid, which can provide evidence-based support for the treatment of early DN. However, due to the differences in the quantity and quality of the included research articles, large-sample, multi-center, high-quality studies are still needed for further verification.

Humans , Diabetic Nephropathies/drug therapy , Nonprescription Drugs/therapeutic use , Qi , Network Meta-Analysis , Capsules , Drugs, Chinese Herbal/therapeutic use , Tablets , Diabetes Mellitus/drug therapy
China Journal of Chinese Materia Medica ; (24): 3633-3649, 2023.
Article in Chinese | WPRIM | ID: wpr-981494


This study aimed to evaluate the efficacy and safety of various Chinese patent medicines in the treatment of inflammatory response in diabetic nephropathy(DN) based on network Meta-analysis. Randomized controlled trial(RCT) of oral Chinese patent medicines for improving inflammatory response in patients with DN was retrieved from CNKI, Wanfang, VIP, SinoMed, PubMed, Cochrane Library, EMbase, Web of Science, and other databases from database inception to October 2022. All investigators independently screened the literature, extracted data, and evaluated the quality. Stata 16.0 software and RevMan 5.4.1 were used to analyze the data of the literature that met the quality standards. Finally, 53 RCTs were included, involving 6 Chinese patent medicines. The total sample size was 4 891 cases, including 2 449 cases in the test group and 2 442 cases in the control group. The network Meta-analysis showed that(1) in terms of reducing TNF-α, the top 3 optimal interventions according to the surface under the cumulative ranking curve(SUCRA) were Shenshuaining Capsules/Granules/Tablets + conventional western medicine, Jinshuibao Capsules + conventional western medicine, and Niaoduqing Granules + conventional western medicine.(2) In terms of reducing hs-CRP, the top 3 optimal interventions according to SUCRA were Bailing Capsules + conventional western medicine, Tripterygium Glycosides Tablets + conventional western medicine, and Shenshuaining Capsules/Granules/Tablets + conventional western medicine.(3) In terms of reducing IL-6, the top 3 optimal interventions according to SUCRA were Bailing Capsules + conventional western medicine, Tripterygium Glycosides Tablets + conventional western medicine, and Jinshuibao Capsules + conventional western medicine.(4) In terms of reducing UAER, the top 3 optimal interventions according to SUCRA were Shenshuaining Capsules/Granules/Tablets + conventional western medicine, Huangkui Capsules + conventional western medicine, and Jinshuibao Capsules + conventional western medicine.(5) In terms of reducing Scr, the top 3 optimal interventions according to SUCRA were Jinshuibao Capsules + conventional western medicine, Niaoduqing Granules + conventional wes-tern medicine, and Tripterygium Glycosides Tablets + conventional western medicine.(6) In terms of reducing BUN, the first 3 optimal interventions according to SUCRA were Niaoduqing Granules + conventional western medicine, Tripterygium Glycosides Tablets + conventional western medicine, and Huangkui Capsules + conventional western medicine.(7) In terms of improving the clinical total effective rate, the first 3 optimal interventions according to SUCRA were Jinshuibao Capsules + conventional western medicine, Niaoduqing Granu-les + conventional western medicine, and Huangkui Capsules + conventional western medicine. The results showed that the combination of western medicine and Chinese patent medicine could reduce the expression of serum inflammatory factors TNF-α, hs-CRP, and IL-6 and inhibit the inflammatory response. The combination of western medicine and Chinese patent medicine was superior to western medicine alone in reducing Scr, BUN, and UAER, and improving the total effective rate of treatment. Due to the limitation of the quantity and quality of literature included, the above conclusions need to be validated by more high-quality studies.

Humans , Tumor Necrosis Factor-alpha , Network Meta-Analysis , Nonprescription Drugs , Diabetic Nephropathies/drug therapy , C-Reactive Protein , Capsules , Interleukin-6 , Drugs, Chinese Herbal/therapeutic use , Glycosides , Tablets , Diabetes Mellitus/drug therapy
China Journal of Chinese Materia Medica ; (24): 5091-5101, 2023.
Article in Chinese | WPRIM | ID: wpr-1008679


This study explored the prescription and medication rules of traditional Chinese medicine(TCM) in the prevention and treatment of diabetic microangiopathy based on literature mining. Relevant literature on TCM against diabetic microangiopathy was searched and prescriptions were collected. Microsoft Excel 2021 software was used to establish a prescription database, and an analysis was conducted on the frequency, properties, flavors, meridian tropism, and efficacy classifications of drugs. Association rule analysis, cluster analysis, and factor analysis were performed using SPSS Modeler 18.0 and SPSS Statistics 26.0 software. The characteristic active components and mechanisms of action of medium-high frequency drugs in the analysis of medication rules were explored through li-terature mining. A total of 1 327 prescriptions were included in this study, involving 411 drugs, with a total frequency reaching 19 154 times. The top five high-frequency drugs were Astragali Radix, Angelicae Sinensis Radix, Poria, Salviae Miltiorrhizae Radix et Rhizoma, and Rehmanniae Radix. The cold and warm drugs were used in combination. Drugs were mainly sweet, followed by bitter and pungent, and acted on the liver meridian. The majority of drugs were effective in tonifying deficiency, clearing heat, activating blood, and resolving stasis. Association rule analysis identified the highly supported drug pair of Astragali Radix-Angelicae Sinensis Radix and the highly confident drug combination of Poria-Alismatis Rhizoma-Corni Fructus. The strongest correlation was found among Astragali Radix, Angelicae Sinensis Radix, Poria, and Salviae Miltiorrhizae Radix et Rhizoma through the complex network analysis. Cluster analysis identified nine categories of drug combinations, while factor analysis identified 16 common factors. The analysis of active components in high-frequency drugs for the treatment of diabetic microangiopathy revealed that these effective components mainly exerted their effects by inhibiting oxidative stress and suppressing inflammatory reactions. The study found that the pathogenesis of diabetic microangiopathy was primarily characterized by deficiency in origin, with a combination of deficiency and excess. Deficiency was manifested as Qi deficiency and blood deficiency, while excess as phlegm-heat and blood stasis. The key organ involved in the pathological changes was the liver. The treatment mainly focused on supplementing Qi and nourishing blood, supplemented by clearing heat, coo-ling blood, activating blood, and dredging collaterals. Commonly used formulas included Danggui Buxue Decoction, Liuwei Dihuang Pills, Erzhi Pills, and Buyang Huanwu Decoction. The mechanisms of action of high-frequency drugs in the treatment of diabetic microangiopathy were often related to the inhibition of oxidative stress and suppression of inflammatory reactions. These findings can provide references for the clinical treatment of diabetic microangiopathy and the development of targeted drugs.

Humans , Medicine, Chinese Traditional , Drugs, Chinese Herbal/therapeutic use , Prescriptions , Drug Combinations , Diabetic Angiopathies/drug therapy , Data Mining , Diabetes Mellitus/drug therapy
China Journal of Chinese Materia Medica ; (24): 4137-4146, 2023.
Article in Chinese | WPRIM | ID: wpr-1008610


Previous studies have shown that high blood glucose-induced chronic microinflammation can cause inflammatory podocyte injury in patients with diabetic kidney disease(DKD). Therein, necroptosis is a new form of podocyte death that is closely associated with renal fibrosis(RF). To explore the effects and mechanisms in vivo of total flavones of Abelmoschus manihot(TFA), an extract from traditional Chinese herbal medicine Abelmoschus manihot for treating kidney diseases, on podocyte necroptosis and RF in DKD, and to further reveal its scientific connotation with multi-pathway and multi-target, the authors randomly divided all rats into four groups: a namely normal group, a model group, a TFA group and a rapamycin(RAP) group. After the modified DKD rat models were successfully established, four group rats were given double-distilled water, TFA suspension and RAP suspension, respectively by gavage every day. At the end of the 4th week of drug treatment, all rats were sacrificed, and the samples of their urine, blood and kidneys were collected. And then, the various indicators related to podocyte necroptosis and RF in the DKD model rats were observed, detected and analyzed, respectively. The results indicated that, general condition, body weight(BW), serum creatinine(Scr), urinary albumin(UAlb), and kidney hypertrophy index(KHI) in these modified DKD model rats were both improved by TFA and RAP. Indicators of RF, including glomerular histomorphological characteristics, fibronectin(FN) and collagen type Ⅰ(collagen Ⅰ) staining extent in glomeruli, as well as the protein expression levels of FN, collagen Ⅰ, transforming growth factor-β1(TGF-β1) and Smad2/3 in the kidneys were improved respectively by TFA and RAP. Podocyte damage, including foot process form and the protein expression levels of podocin and CD2AP in the kidneys was improved by TFA and RAP. In addition, tumor necrosis factor-α(TNF-α)-mediated podocyte necroptosis in the kidneys, including the morphological characteristics of podocyte necroptosis, the extent and levels of the protein expression of TNF-α and phosphorylated mixed lineage kinase domain like pseudokinase(p-MLKL) was improved respectively by TFA and RAP. Among them, RAP had the better effect on p-MLKL. More importantly, the activation of the receptor interacting serine/threonine protein kinase 1(RIPK1)/RIPK3/MLKL signaling axis in the kidneys, including the expression levels of its key signaling molecules, such as phosphorylated receptor interacting serine/threonine protein kinase 1(p-RIPK1), p-RIPK3, p-MLKL and cysteinyl aspartate specific proteinase-8(caspase-8) was improved respectively by TFA and RAP. Among them, the effect of TFA on p-RIPK1 was superior. On the whole, in this study, the authors demonstrated that TFA alleviates podocyte necroptosis and RF in DKD through inhibiting the activation of the TNF-α-mediated RIPK1/RIPK3/MLKL signaling axis in diabetic kidneys. The authors' findings provide new pharmacological evidence to reveal the scientific connotation of TFA in treating RF in DKD in more depth.

Humans , Rats , Animals , Diabetic Nephropathies/drug therapy , Abelmoschus , Flavones/pharmacology , Podocytes , Tumor Necrosis Factor-alpha/metabolism , Necroptosis , Receptor-Interacting Protein Serine-Threonine Kinases/metabolism , Fibrosis , Threonine/pharmacology , Collagen/metabolism , Serine/pharmacology , Diabetes Mellitus/drug therapy
Journal of Integrative Medicine ; (12): 226-235, 2023.
Article in English | WPRIM | ID: wpr-982675


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.

Humans , PPAR gamma/metabolism , Curcumin/therapeutic use , Phosphatidylinositol 3-Kinases , Diabetes Mellitus/drug therapy , Hypoglycemic Agents/pharmacology , Hyperglycemia/drug therapy , Glucose
Braz. j. biol ; 83: 1-9, 2023. tab
Article in English | LILACS, VETINDEX | ID: biblio-1468869


The present study was conducted to evaluate the chemical composition, antioxidant activity and hypoglycemic effects of whole kumquat (Ku) powder in diabetic rats fed a high-fat-high-cholesterol (HFHC) diet. The antioxidant activities were evaluated using stable 1,1-diphenyl 2-picrylhydrazyl (DPPH) free radical scavenging method, 2,2'-azinobis (3-ethyl benzo thiazoline-6-sulphonic acid) radical cation (ABTS) and Ferric reducing antioxidant power (FRAP). Total phenolic content was (51.85 mg GAE/g) and total flavonoid content was (0.24 mg Cateachin Equivalent, CE/g). DPPH and ABTS values were 3.32 and 3.98 mg Trolox equivalent (TE)/g where FRAP value was 3.00 mM Fe²+/kg dry material. A total of 90 albino rats were used in the present study. Rats group were as follows: normal diet; normal treated (2, 4, and 6% Ku.), diabetic rats (non-treated), diabetic + HFHC diet (non-treated), HFHC (non-treated), Diabetic (treated), HFHC (treated) and Diabetic + HFHC (treated). The diets were followed for 8 weeks. Blood samples were collected at the end of the experiment. Serum glucose was recorded and thyroid hormones (T4, Thyroxine and T3, Triiodothyronine) were conducted. Diet supplemented with Kumquat at different concentrations have a hypoglycemic effect and improve the thyroid hormones of both diabetic rats and HFHC diabetic rats.

O presente estudo foi conduzido para avaliar a composição química, a atividade antioxidante e os efeitos hipoglicêmicos do pó de kumquat (Ku) em ratos diabéticos alimentados com uma dieta rica em gordura e colesterol (HFHC). As atividades antioxidantes foram avaliadas usando o método de eliminação de radicais livres de 1,1-difenil 2-picrilhidrazil (DPPH), 2,2'-azinobis (ácido 3-etilbenzotiazolina-6-sulfônico) radical cátion (ABTS) e antioxidante redutor férrico potência (FRAP). O conteúdo fenólico total foi (51,85 mg GAE / g) e o conteúdo total de flavonoides foi (0,24 mg Cateachin Equivalent, CE / g). Os valores de DPPH e ABTS foram 3,32 e 3,98 mg equivalente de Trolox (TE) / g, em que o valor de FRAP foi de 3,00 mM Fe²+ / kg de material seco. Um total de 90 ratos albinos foi usado no presente estudo. O grupo dos ratos foi o seguinte: dieta normal: tratados normais (2, 4 e 6% Ku.), ratos diabéticos (não tratados), diabéticos + dieta HFHC (não tratados), HFHC (não tratados), diabéticos (tratados), HFHC (tratados) e diabéticos + HFHC (tratados). As dietas foram seguidas por 8 semanas. Amostras de sangue foram coletadas ao final do experimento. A glicose sérica foi registrada e os hormônios tireoidianos (T4, Tiroxina e T3, Triiodotironina) foram conduzidos. A dieta suplementada com kumquat em diferentes concentrações tem um efeito hipoglicêmico e melhora os hormônios tireoidianos tanto de ratos diabéticos quanto de ratos diabéticos com HFHC.

Animals , Rats , Antioxidants/analysis , Diabetes Mellitus/drug therapy , Hypoglycemic Agents/analysis , Thyroid Hormones/pharmacology , Rats/metabolism , Rats/blood , Rutaceae/chemistry
Clin. biomed. res ; 43(1): 14-20, 2023.
Article in Portuguese | LILACS | ID: biblio-1435593


Introdução: Diabetes Mellitus é doença metabólica, caracterizada pela deficiência absoluta ou relativa de insulina, que acomete cerca de 382 milhões de pessoas em todo mundo, tendo uma das complicações mais comuns a polineuropatia. A Metformina, medicamento amplamente utilizado como tratamento do Diabetes, foi descrita como responsável, em algumas literaturas, por causar ou agravar deficiência de vitamina B12, que está similarmente relacionada ao desenvolvimento de polineuropatia.Métodos: Nesse sentido, foi conduzido um estudo no município de Soledade ­ RS, com objetivo de verificar se essa relação é condizente com a realidade da localidade. Foram escolhidos 58 pacientes, dos quais 30 responderam questionários adaptados baseados na literatura e na Classificação de Neuropatia de Michigan (MNSS-Brasil), então colhidos 5 ml de sangue venoso da fossa antecubital, preparado soro do qual uma alíquota foi separada para determinação bioquímica da vitamina B12.Resultados: Analisando os resultados, a maioria dos pacientes analisados apresentou sintomas de polineuropatia, e 10% deste, deficiência vitamínica.Conclusão: nenhuma variável explicou a correlação do uso crônico da Metformina, dose e gênero com a deficiência da vitamina B12, o que indica que não há evidências fortes o suficiente que sustentem esse fato, de acordo com as particularidades da localidade analisada.

Introduction: Diabetes Mellitus is a metabolic disease, characterized by absolute or relative insulin deficiency, which affects about 382 million people, with polyneuropathy being one of the most common complications. Metformin, a drug widely used as a treatment for diabetes, has been described as responsible, in some literature, for causing or aggravating vitamin B12 deficiency, which is similarly related to the development of polyneuropathy.Methods: In this sense, a study was conducted in Soledade ­ RS, in order to verify whether this relationship is consistent with the reality of the locality. Fifty-eight patients were selected, of which 30 answered adapted questionnaires based on the literature and on the Michigan Neuropathy Classification (MNSS-Brazil), then 5 ml of venous blood was collected from the antecubital fossa, serum prepared from which an aliquot was separated for biochemical determination of the vitamin B12.Results: Analyzing the results, most of these patients presented symptoms of polyneuropathy and, 10% of them, vitamin deficiency.Conclusion: no variable explained the correlation of chronic use of Metformin, dose and gender with vitamin B12 deficiency, which indicates that there is not enough evidence to support this fact, according to the particularities of the analyzed locality.

Humans , Male , Female , Adult , Middle Aged , Aged , Aged, 80 and over , Vitamin B 12 Deficiency/diagnosis , Diabetes Mellitus/drug therapy , Diabetic Neuropathies/complications , Metformin/adverse effects , Vitamin B 12/therapeutic use , Surveys and Questionnaires/statistics & numerical data
Article in English | LILACS | ID: biblio-1433851


Objective: to identify sociodemographic and regional differences in the lack of access of aged Brazilians to medicines for hypertension and/or diabetes mellitus in the last 30 days, in the years 2017, 2018 and 2019, based on data from the Telephone-based Surveillance of Risk and Protective Factors for Chronic Diseases (VIGITEL). Methods: a population-based transversal study using data from VIGITEL. Were eligible the elderly (≥60 years) who answered affirmatively to the questions "In the past 30 days, did you have been without any hypertension medications for some time?", "In the past 30 days did you have been without any high to control diabetes for some time?", and "In the past 30 days, did you ran out of insulin?" Chisquared test was used to describe the prevalence of the outcome in accordance with the independent variables, and ajusted Poisson Regression was used to estimate the prevalence ratio and respective 95% confidence intervals (95% CI). Results: the prevalence of the outcome was 11.8% in 2017, 11.4% in 2018, and 11.2% in 2019. A higher prevalence of lack of access to medications for hypertension and diabetes mellitus was observed among elderly people of black/brown/yellow/indigenous skin color, less educated, beneficiaries of Bolsa Família, without private health plan and living in the Northeast and North regions.Conclusion: there was a small reduction in the lack of access to medication for hypertension and diabetes between 2017 and 2019. Furthermore, the results reveal inequality in access to these medicines

Objetivos: identificar diferenças sociodemográficas e regionais na falta de acesso de idosos brasileiros a medicamentos para hipertensão e/ou diabetes mellitus nos últimos 30 dias, nos anos de 2017, 2018 e 2019, com base nos dados da Vigilância de Fatores de Risco e Proteção para Doenças Crônicas por Inquérito Telefônico (VIGITEL). Métodos: estudo transversal de base populacional com dados do VIGITEL. Foram elegíveis os idosos (≥60 anos) que responderam afirmativamente às questões "'Nos últimos 30 dias, o(a) Sr.(a). ficou sem algum dos medicamentos para controlar a pressão alta por algum tempo?', 'Nos últimos 30 dias, o(a) Sr.(a). ficou sem algum dos medicamentos para controlar a diabetes por algum tempo?' e 'Nos últimos 30 dias, o(a) Sr.(a). ficou sem insulina?'". O teste qui-quadrado foi utilizado para descrever a prevalência do desfecho de acordo com as variáveis independentes e a Regressão de Poisson ajustada foi utilizada para estimar a razão de prevalência e respectivos intervalos de confiança de 95% (IC 95%). Resultados: a prevalência do desfecho foi de 11,8% em 2017, 11,4% em 2018 e 11,2% em 2019. A prevalência de falta de acesso a medicamentos para hipertensão e diabetes mellitus foi maior entre os idosos de cor da pele preta/parda/amarela/indígena, com menor escolaridade, beneficiários do Bolsa Família, sem plano privado de saúde e residentes nas regiões Nordeste e Norte. Conclusão: houve uma pequena redução na falta de acesso a medicamentos para hipertensão e diabetes entre 2017 e 2019. Além disso, os resultados revelam desigualdade no acesso a esses medicamentos

Male , Female , Middle Aged , Aged , Aged, 80 and over , Diabetes Mellitus/drug therapy , Hypertension/drug therapy , Primary Health Care , Pharmaceutical Preparations
Arq. ciências saúde UNIPAR ; 26(3): 643-656, set-dez. 2022.
Article in Portuguese | LILACS | ID: biblio-1399314


O Diabetes Mellitus (DM) é uma doença crônica, que tem elevada prevalência na sociedade e representa um problema de saúde pública devido à natureza de suas complicações, acredita-se que a dificuldade na manutenção do tratamento, pode estar relacionada a deficiência ou falta de adesão. O estudo teve como objetivo relatar à adesão ao tratamento do Diabetes Mellitus na Atenção Primária a Saúde. Trata-se de um estudo descritivo, com abordagem qualitativa, realizado com 30 pacientes diabéticos de uma Unidade de Atenção Primária à Saúde de Guaiúba-CE, no período de agosto a outubro de 2021. A coleta de dados deu-se por entrevista semiestruturada utilizando questões norteadoras sobre adesão ao tratamento, adoção de práticas promotoras de saúde e posteriormente sujeita a análise de conteúdo. Observou-se que a adesão ao tratamento do diabetes envolve inúmeros desafios, relacionados principalmente ao usuário e sistemas de saúde/profissionais. Os maiores desafios encontrados foram em relação a supervalorização do tratamento medicamentoso frente a adoção de hábitos saudáveis e de ações promotoras de autocuidado. Nesse cenário, nota-se a importância de conhecer os fatores que influenciam na adesão ao tratamento com o intuito de se lançar estratégias para aperfeiçoar o planejamento de ações e intervenções a esses pacientes.

Diabetes Mellitus (DM) is a chronic disease that is highly prevalent in society and represents a public health problem due to the nature of its complications. The study aimed to report on the adherence to treatment of Diabetes Mellitus in Primary Health Care. This is a descriptive study, with a qualitative approach, conducted with 30 diabetic patients from a Primary Health Care Unit in Guaiúba-CE, in the period from August to October 2021. Data were collected through semi-structured interviews using guiding questions about adherence to treatment, adoption of health-promoting practices and later subjected to content analysis. It was observed that diabetes treatment adherence involves numerous challenges, mainly related to the user and health systems/professionals. The biggest challenges found were related to the overvaluation of drug treatment against the adoption of healthy habits and self-care promoting actions. In this scenario, it is important to know the factors that influence treatment adherence in order to develop strategies to improve the planning of actions and interventions for these patients.

La diabetes mellitus (DM) es una enfermedad crónica, que tiene una alta prevalencia en la sociedad y representa un problema de salud pública debido a la naturaleza de sus complicaciones, se cree que la dificultad para mantener el tratamiento puede estar relacionada con la deficiencia o falta de adherencia. El estudio tenía como objetivo informar sobre la adherencia al tratamiento de la Diabetes Mellitus en Atención Primaria. Se trata de un estudio descriptivo con enfoque cualitativo, realizado con 30 pacientes diabéticos de una Unidad de Atención Primaria de Salud de Guaiúba-CE, en el período de agosto a octubre de 2021. La recogida de datos se llevó a cabo mediante entrevistas semiestructuradas en las que se utilizaron preguntas orientativas sobre la adherencia al tratamiento y la adopción de prácticas de promoción de la salud, y posteriormente se sometieron a un análisis de contenido. Se ha observado que el acceso al tratamiento de la diabetes conlleva numerosos desafíos, relacionados principalmente con el usuario y los sistemas de salud/profesionales. Los mayores retos encontrados estaban relacionados con la sobrevaloración del tratamiento farmacológico frente a la adopción de hábitos saludables y acciones de promoción del autocuidado. En este escenario, se constata la importancia de conocer los factores que influyen en la adherencia al tratamiento para poner en marcha estrategias que mejoren la planificación de las acciones e intervenciones para estos pacientes.

Male , Female , Adult , Middle Aged , Aged , Aged, 80 and over , Patients , Primary Health Care/organization & administration , Diabetes Mellitus/drug therapy , Treatment Adherence and Compliance , Self Care/instrumentation , Unified Health System , Pharmaceutical Preparations/analysis , Exercise/physiology , Public Health , Chronic Disease/drug therapy , Diabetes Mellitus/diagnosis , Drug Therapy , Diet, Healthy , Health Promotion , Health Services Accessibility , Nursing Care/methods
Bol. latinoam. Caribe plantas med. aromát ; 21(5): 593-606, sept. 2022. mapas, tab
Article in English | LILACS | ID: biblio-1553740


Despite access to conventional medical therapies, the use of complementary medicine is increasing in many communities. The present study aimed to evaluate the popular knowledge of medicinal plants used to treat diabetes and its co-morbidities, in four rural communities in the municipality of Vitória de Santo Antão, in the Brazilian State of Pernambuco. The relative importance of a particular medicinal plant was calculated based on the percentage of mentions (IR%). The similarity between the communities was quantified using the Sørensen index (Ss). Interviews were conducted with 141 patients, of these, 83 reported use of medicinal plants as an alternative treatment. Overall there were 186 mentions, covering 61 ethnospecies. In relation to IR%, Mentha × villosa presented the highest value.Knowing the factors that influence selection of medicinal plants sheds light on the mechanisms through which patterns of use develop and this may help to preserve this knowledge.

A pesar del acceso a las terapias médicas convencionales, el uso de la medicina complementaria está aumentando en muchas comunidades. El presente estudio tuvo como objetivo evaluar el conocimiento popular de las plantas medicinales utilizadas para el tratamiento de la diabetes y sus comorbilidades, en cuatro comunidades rurales del municipio de Vitória de Santo Antão, en el estado brasileño de Pernambuco. La importancia relativa de una planta medicinal en particular se calculó en base al porcentaje de menciones (% de IR). La similitud entre las comunidades se cuantificó mediante el índice de Sørensen (Ss). Se realizaron entrevistas con 141 pacientes, de estos, 83 informaron el uso de plantas medicinales como tratamiento alternativo. En total hubo 186 menciones, cubriendo 61 etnoespecies. En relación al% de RI, Mentha × villosa presentó el valor más alto. Conocer los factores que influyen en la selección de plantas medicinales arroja luz sobre los mecanismos a través de los cuales se desarrollan los patrones de uso y esto puede ayudar a preservar este conocimiento.

Plants, Medicinal , Diabetes Mellitus/drug therapy , Medicine, Traditional/statistics & numerical data , Brazil , Medicine, Traditional/methods
Int. j. cardiovasc. sci. (Impr.) ; 35(3): 342-353, May-June 2022. tab
Article in English | LILACS | ID: biblio-1375653


Abstract Background: Public programs that provide access to essential medications have played an important role in the care of hypertensive and diabetic patients. However, access in small municipalities has been poorly studied. Objectives: To describe the sociodemographic profile and the medication and health service usage of patients with systemic arterial hypertension and/or diabetes mellitus in a small municipality who use the public medication access programs Health has no Price (Saúde Não Tem Preço - SNTP) and the Minas Pharmacy Network. Methods: This cross-sectional study with 341 participants was conducted in 2019. Home interviews were conducted using a standardized, semi-structured questionnaire. The data are expressed as absolute and relative frequencies, and Pearson's chi-square test was used for comparisons between proportions (α = 5%). Results: Most of the participants (70.68%) had hypertension only, 11.14% had diabetes only, and 18.18% had both. Regarding the origin of the hypertension medications, 82.67% were provided by the Minas Pharmacy Network and/or SNTP programs. Regarding oral hypoglycemic agents and insulins, 88.61% were provided by the Minas Pharmacy Network and/or SNTP. Most participants were female (63.1%), at least 65 years of age (50.30%), non-White (66.96%), resided in an urban area (67.16%), were illiterate or had a low education level (89.94%), and had a maximum income ≤ 2 times the federal minimum salary (89.19%). Overall user perception was significantly better for SNTP (p=0.010). Conclusion: The results of this study indicate that programs which provide access to essential medications are important sources of hypertension and diabetes medications in the study area, especially for people with low incomes.

Diabetes Mellitus/epidemiology , National Drug Policy , Access to Essential Medicines and Health Technologies , Hypertension/epidemiology , Pharmaceutical Services/supply & distribution , Cross-Sectional Studies , Diabetes Mellitus/drug therapy , Hypertension/drug therapy
REME rev. min. enferm ; 26: e-1433, abr.2022.
Article in English, Portuguese | LILACS, BDENF | ID: biblio-1377624


Objetivo: sintetizar a produção científica sobre a técnica da autoaplicação de insulina em adultos com diabetes Mellitus no contexto domiciliar Método: revisão integrativa realizada entre dezembro de 2019 e janeiro de 2020, a partir da busca de publicações em periódicos indexados no PubMed, CINAHL, EMBASE, SCOPUS, Web of Science, LILACS e BDENF utilizando-se os termos controlados diabetes Mellitus, self care, insulin, health education, disposable equipment, medical wastedisposal e self administration e seus correspondentes em português, combinados com o operador booleano AND. Foram incluídos artigos originais publicados entre 2009 e 2019, nos idiomas inglês, português e espanhol e que responderam à questão norteadora: qual a produção científica sobre a técnica da autoaplicação de insulina em adultos com diabetes Mellitus no contexto domiciliar nos últimos 10 anos? Resultados: compuseram a amostra final oito artigos. Predominaram estudos realizados no Brasil, por enfermeiros no contexto da atenção primária à saúde. Em relação à técnica de autoaplicação de insulina, os resultados foram agrupados em quatro eixos: pré-aplicação, técnica de preparo da insulina, aplicação e pós-aplicação. Observaram-se ações inadequadas em todos os eixos tais como: transporte, armazenamento, autoaplicação, reutilização de agulhas e descarte incorreto. Tais inadequações podem resultar em procedimentos dolorosos, prejuízos no controle glicêmico e complicações para a saúde da pessoa com diabetes Mellitus. Conclusão: os resultados evidenciaram que a realidade da autoaplicação de insulina em adultos com diabetes Mellitus no domicílio pode ser modificada a partir da educação em saúde pelo enfermeiro, bem como colaborar para o planejamento das ações estratégicas para diminuir tais problemas.(AU)

Objective: to synthesize the scientific production on the technique of self-administration of insulin in adults with diabetes Mellitus in the home context. Method: integrative review carried out between December 2019 and January 2020, based on the search for publications in journals indexed in PubMed, CINAHL, EMBASE, SCOPUS, Web of Science, LILACS and BDENF using the controlled terms diabetes Mellitus, self-care, insulin, health education, disposable equipment, medical waste disposal and self-administration and their corresponding words in Portuguese, combined with the Boolean operator AND. Original articles published between 2009 and 2019, in English, Portuguese and Spanish, were included, which answered the guiding question: what is the scientific production on the technique of self-administration of insulin in adults with diabetes Mellitus in the home context in the last 10 years? Results: the final sample comprised eight articles. Studies carried out in Brazil by nurses in the context of primary health care predominated. Regarding the insulin self-administration technique, the results were grouped into four axes: pre-administration, insulin preparation technique, administration, and post-administration. Inadequate actions were observed in all axes such as: transport, storage, self-application, reuse of needles and incorrect disposal. Such inadequacies can result in painful procedures, impaired glycemic control, and health complications for the person with diabetes Mellitus. Conclusion: the results showed that the reality of self-administration of insulin in adults with diabetes Mellitus at home can be modified based on health education by nurses, as well as collaborating in the planning of strategic actions to reduce such problems.(AU)

Objetivo: sintetizar la producción científica sobre la técnica de autoadministración de insulina en adultos con diabetes Mellitus en el contexto domiciliario. Método: revisión integradora realizada entre diciembre de 2019 y enero de 2020, a partir de la búsqueda de publicaciones en revistas indexadas en PubMed, CINAHL, EMBASE, SCOPUS, Web of Science, LILACS y BDENF utilizando los términos controlados diabetes Mellitus, self care, insulin, health education, disposable equipment, medical wastedisposal y self administration y sus equivalentes en portugués, combinados con el operador booleano AND. Se incluyeron artículos originales publicados entre 2009 y 2019, en inglés, portugués y español, que respondieron a la pregunta orientadora: ¿cuál es la producción científica sobre la técnica de autoadministración de insulina en adultos con diabetes Mellitus en el contexto domiciliario en los últimos 10 años? Resultados: la muestra final estuvo formada por ocho artículos. Predominaron los estudios realizados en Brasil por enfermeros en el contexto de la atención primaria de salud. En cuanto a la técnica de auto aplicación de insulina, los resultados se agruparon en cuatro ejes: antes de la aplicación, técnica de preparación de insulina, aplicación y post aplicación. Se observaron acciones inadecuadas en todos los ejes, tales como: transporte, almacenamiento, auto aplicación, reutilización de agujas y disposición incorrecta. Tales deficiencias pueden resultar en procedimientos dolorosos, deterioro del control glucémico y complicaciones de salud para las personas con diabetes Mellitus. Conclusión: los resultados mostraron que la realidad de la insulina autoadministrada en adultos con diabetes Mellitus en el hogar puede modificarse a partir de la educación en salud brindada por enfermeros, además de ayudar a planificar acciones estratégicas para reducir dichos problemas.(AU)

Humans , Adult , Self Care , Diabetes Mellitus/drug therapy , Medication Therapy Management , Insulin/administration & dosage , Primary Health Care , Health Knowledge, Attitudes, Practice , Health Education , Glycemic Control
Arq. ciências saúde UNIPAR ; 26(1): 23-32, Jan-Abr. 2022.
Article in Portuguese | LILACS | ID: biblio-1362667


O descarte inadequado de medicamentos pode levar a impactos ambientais negativos e deve ser considerado um problema de saúde pública. O presente estudo teve como objetivo levantar dados quantitativos e qualitativos relacionados ao perfil dos medicamentos descartados no município de Governador Valadares - MG. O trabalho foi desenvolvido nas UAPS/ESF que possuíam farmácias, e também na Farmácia Central/Policlínica Municipal. Nesses locais, foi realizada uma análise dos medicamentos descartados no período de julho de 2017 a maio de 2018. Por meio dos dados obtidos nesse período foi possível perceber que as principais classes de medicamentos descartadas foram os inibidores da enzima conversora de angiotensina, antagonistas da angiotensina II, agentes betabloqueadores, diuréticos, hipoglicemiantes, contraceptivos hormonais e agentes modificadores de lipídeos. Além disso, foi realizada uma ação de educação em saúde e aplicado um questionário semiestruturado aos usuários participantes dos grupos operativos. Dos 34 usuários respondentes do questionário, 23 (69,70%) não tinham acesso a informação sobre o local correto de descarte e armazenamento de medicamentos. Após a ação de educação em saúde verificou-se um aumento no quantitativo de medicamentos descartados pelos usuários nas UAPS/ESF Mãe de Deus I e II, Altinópolis III e IV, Santa Rita II, São Pedro I e II e Esperança e Nossa Senhora das Graças. O trabalho desenvolvido permitiu apresentar dados relevantes para a gestão municipal demonstrando a importância do farmacêutico no cuidado em saúde e o caráter epidemiológico local da prevalência das doenças crônico não transmissíveis.

The inadequate disposal of drugs can lead to negative environmental impacts and should be treated as a public health problem. This study aimed at surveying quantitative and qualitative data related to the profile of drugs discarded in the city of Governador Valadares - MG. The work was developed in the UAPS / ESF that had pharmacies, and also in the Central Pharmacy/Municipal Polyclinic. In these locations, an analysis of the drugs discarded between July 2017 and May 2018 was carried out. Through the data obtained in this period, it was possible to notice that the main classes of drugs discarded were angiotensin-converting enzyme inhibitors, angiotensin II antagonists, beta-blocking agents, diuretics, hypoglycemic agents, hormonal contraceptives, and lipid-modifying agents. In addition, a health education action was carried out and a semi-structured questionnaire was applied to users participating in the operating groups. From the 34 users who responded the questionnaire, 23 (69.70%) did not have access to information on the correct place to dispose and store medicines. After the health education action, there was an increase in the amount of drugs discarded by users in the UAPS/ESF Mãe de Deus I and II, Altinópolis III and IV, Santa Rita II, São Pedro I and II, and Esperança and Nossa Senhora das Graças. The work carried out made it possible to present relevant data for municipal management, demonstrating the importance of the pharmacist in health care and the local epidemiological character of the prevalence of chronic non-communicable diseases.

Humans , Male , Female , Pharmacies/supply & distribution , Pharmaceutical Preparations , Patients , Pharmacists/supply & distribution , Tablets/supply & distribution , Angiotensin-Converting Enzyme Inhibitors/supply & distribution , Health Centers , Public Health/education , Health Education , Municipal Management/legislation & jurisprudence , Delivery of Health Care , Diabetes Mellitus/drug therapy , Drug Storage , Environment , Hypertension/drug therapy , Hypoglycemic Agents/supply & distribution , Lipids/supply & distribution
Chinese Journal of Lung Cancer ; (12): 61-65, 2022.
Article in Chinese | WPRIM | ID: wpr-928780


Immune checkpoint inhibitors (ICIs) are widely used in clinic, and the incidence of rare adverse events are increasing. The aim of this paper is to better define the rare adverse effect of diabetes mellitus associated with ICIs. We report 2 cases of diabetes mellitus associated with ICIs. Literature review was conducted and we discussed the clinical presentation, potential mechanisms and suggestions for optimal management. Two patients were both elderly women, case 1 had increased blood glucose after 7 months of using Durvalumab, and cases 2 had diabetic ketoacidosis after 6 weeks of using Pembrolizumab. Both patients were administered exogenous insulin to control blood glucose. Case 1 has been treated with Durvalumab until now and case 2 discontinued using of Pembrolizumab. HLA genotypes and other factors may explain the risk factors of diabetes associated with ICIs in some individuals. Diabetes mellitus associated with ICIs is an uncommon but potentially life-threatening endocrine system adverse event, which requires doctors to be vigilant. The patients who use ICIs need to monitor blood glucose. If they have hyperglycemia, endocrinologists should be asked to assist in diagnosis and treatment.

Aged , Female , Humans , Blood Glucose , Diabetes Mellitus/drug therapy , Immune Checkpoint Inhibitors/adverse effects , Lung Neoplasms/drug therapy
Chinese Journal of Epidemiology ; (12): 598-602, 2022.
Article in Chinese | WPRIM | ID: wpr-935433


The expectancy and quality of life among people with HIV have improved remarkably with the widespread use of antiretroviral therapy (ART). In the meantime, the risks for HIV-related metabolic diseases have increased significantly, in particular diabetes mellitus. Multi-factors coeffect to increasing the risk of diabetes mellitus among HIV patients. Recently, growing of research has reported an association between HIV infections and ART and the development of diabetes mellitus. In this article, we summarize the recent studies investigating HIV infection and ART in diabetes mellitus to clarify their mechanism on the development of diabetes.

Humans , Diabetes Mellitus/drug therapy , HIV Infections/drug therapy , Metabolic Diseases , Quality of Life
Clin. biomed. res ; 42(3): 243-250, 2022.
Article in English | LILACS | ID: biblio-1415646


Introduction: Glycemic decompensation in diabetes is one of the major factors for the development of chronic disease complications. Factors involved in the adequate control of diabetes include adherence to pharmacological treatment and knowledge about the disease.Methods: Cross-sectional study on the factors associated with adherence to drug treatment and knowledge about diabetes in diabetic patients treated at Hospital Universitário de Santa Maria between 2018 and 2019, based on the validated Morisky-Green test and on the Diabetes Knowledge Questionnaire.Results: A total of 201 patients diagnosed with diabetes were included, the majority (85.6%) of which had type 2 diabetes and were white (75.6%), with a mean age of 59.4 years. An association between insufficient knowledge about diabetes and patients with type 2 diabetes was observed. An association was found between patients with type 2 diabetes using insulin and non-adherence to drug treatment compared with patients with type 2 diabetes who did use insulin. The research also showed that non-adherence to drug treatment was associated with higher occurrence of hypoglycemia compared with patients who adhered to drug treatment.Conclusion: The data obtained in our study allows us to conclude that non-adherence to pharmacological treatment makes diabetes therapy more complicated and worsens the prognosis.

Humans , Male , Female , Adult , Middle Aged , Aged , Aged, 80 and over , Young Adult , Diabetes Complications/complications , Medication Adherence/psychology , Treatment Adherence and Compliance/psychology , Glycemic Control/statistics & numerical data , Diabetes Mellitus/pathology , Diabetes Mellitus/drug therapy , Medication Adherence/statistics & numerical data
Braz. J. Pharm. Sci. (Online) ; 58: e20422, 2022. tab, graf
Article in English | LILACS | ID: biblio-1403684


Abstract The bidirectional relationship between tuberculosis (TB) and diabetes mellitus (DM) is a major concern for medical professionals and epidemiologists as DM affects the severity, progress and outcome of TB and vice versa. Patients affected with TB have a higher rate of morbidity, treatment failure and mortality. Likewise, DM triples the risk of contracting TB and therefore poses a threat to the progress made in the reduction of TB incidence. Hence, it is pivotal to address both the diseases keeping in mind the each other. It is known that adjunct therapy with immunomodulatory drugs can enhance TB immunity among diabetic patients. Metformin, a commonly used anti-diabetic drug with adenosine monophosphate-activated protein kinase (AMPK) activation property, has shown the capacity to reduce the growth of Mycobacterium tuberculosis within the cell. This drug inhibits the mitochondrial complex and possesses anti-inflammatory action. Therefore, Metformin can be considered as an ideal molecule for host-directed or host-targeted therapy for TB.

Protein Kinases/adverse effects , Tuberculosis/prevention & control , Tuberculosis/drug therapy , Patients/classification , Pharmaceutical Preparations/administration & dosage , Diabetes Mellitus/prevention & control , Diabetes Mellitus/drug therapy , Metformin/supply & distribution