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1.
Rev. latinoam. enferm. (Online) ; 27: e3161, 2019. tab
Article in Portuguese | LILACS, BDENF | ID: biblio-1014207

ABSTRACT

Objetivo: identificar o risco de desenvolvimento de diabetes tipo 2 em enfermeiras e sua relação com as alterações metabólicas. Método: estudo transversal, com 155 enfermeiras. As variáveis investigadas foram: sociodemográficas, índice de massa corporal, a circunferência da cintura, índice cintura-quadril, perfil lipídico, a glicemia basal e a curva oral de tolerância à glicose. Para a coleta de dados utilizou-se o Finnish Diabetes Risk Score. Resultados: Das 155 (100%) enfermeiras, a média de idade foi de 44 anos e 85% apresentavam sobrepeso ou obesidade; 52% tinham história familiar de diabetes e 21%, hiperglicemia ocasional. Em relação ao risco, 59% foram identificados com risco moderado e muito alto de diabetes tipo 2. A glicose, a insulina, a hemoglobina glicosilada A1c e a resistência à insulina aumentaram paralelamente ao aumento do risco de diabetes tipo 2, embora os lipídios não tenham aumentado. 27% das participantes apresentaram glicemia em jejum alterada, 15%, intolerância à glicose e 5%, diabetes tipo 2. Conclusão: houve uma elevada taxa de detecção de risco de diabetes tipo 2 (59%) e a pontuação de risco alto e muito alto foi associado com níveis elevados de hemoglobina glicosilada A1c, glicose, insulina e resistência à insulina, mas não com lipídios.


Objective: to detect the risk of development of type 2 diabetes in nurses and its relationship with metabolic alterations. Method: cross-sectional study, with 155 nurses. The variables investigated were: sociodemographic, body mass index, waist circumference, waist-hip index, lipid profile, basal glycemia and oral glucose tolerance curve. The Finnish Diabetes Risk Score was used to collect data. Results: 155 nurses were included, with an average age of 44 years and 85% were overweight or obese. 52% had a family history of diabetes and 21% had occasional hyperglycemia. With respect to the risk, 59% were identified with moderate and very high risk for type 2 diabetes. Glucose, insulin, glycosylated hemoglobin A1c and insulin resistance increased in parallel to the increased risk for type 2 diabetes, although lipids did not increase. 27% of the sample had impaired fasting glycemia. 15% had glucose intolerance and 5% had type 2 diabetes. Conclusion: there was a high detection rate of people at risk for type 2 diabetes (59%) and the high and very high risk score was associated with high levels of glycosylated hemoglobin A1c, glucose, insulin and insulin resistance, but not with lipids.


Objetivo: identificar el riesgo de desarrollo de diabetes tipo 2 en enfermeras y su relación con alteraciones metabólicas. Método: estudio transversal, con 155 enfermeras. Las variables investigadas fueron: sociodemográficas, el índice de masa corporal, circunferencia de cintura, índice cintura-cadera, perfil de lípidos, glucemia basal y curva de tolerancia oral a la glucosa. Para la recolección de datos se utilizó el Finnish Diabetes Risk Score. Resultados: De las 155 enfermeras, la edad promedio fue 44 años y 85% tenía sobrepeso u obesidad. El 52% tenía antecedentes familiares de diabetes de primera línea, el 21% hiperglucemia ocasional. Con relación al riesgo, se identificaron 59% con riesgo de diabetes tipo 2 moderado y muy alto. Glucosa, insulina, hemoglobina glucosa A1c y la resistencia a la insulina incrementaron paralelos al aumento del riesgo de diabetes tipo 2, aunque los lípidos no. El 27% de las enfermeras presentó glucemia basal alterada. El 15% tuvo intolerancia a la glucosa y 5% diabetes tipo 2. Conclusión: la detección de riesgo de diabetes tipo 2 fue elevada (59%) y el puntaje de riesgo alto y muy alto se relacionó con valores mayores de hemoglobina glucosa A1c, glucosa, insulina y resistencia a la insulina pero no con lípidos.


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Prediabetic State/complications , Prediabetic State/prevention & control , Body Mass Index , Diabetes Mellitus, Type 2/ethnology , Diabetes Mellitus, Type 2/prevention & control , Overweight/complications , Hyperglycemia/diagnosis , Obesity/complications , Socioeconomic Factors , Insulin Resistance , Cross-Sectional Studies , Surveys and Questionnaires , Mexico
2.
Rev. medica electron ; 39(5): 1084-1093, set.-oct. 2017.
Article in Spanish | LILACS, CUMED | ID: biblio-902227

ABSTRACT

Introducción: la diabetes mellitus tiene prevalencia nacional cercana al 60% y sus complicaciones se producen fundamentalmente por mal control metabólico por lo que el manejo y reducción de este, es objetivo principal de los programas de control para la enfermedad. Objetivo: caracterizar algunas variables clínicas y epidemiológicas de los pacientes con diabetes mellitus tipo 2 en 3 Consultorios Médicos de la Familia del Policlínico "Milanés" del municipio de Matanzas durante el periodo comprendido de mayo del 2013 a mayo del 2014. Materiales y Métodos: se realizó un estudio descriptivo-transversal, con un universo conformado por 129 pacientes dispensarizados con diabetes mellitus tipo 2 en 3 consultorios médicos de la familia del policlínico "Milanes", la muestra quedó integrada por 85 pacientes seleccionados por muestreo aleatorio simple. Las variables objeto de estudio fueron: edad, sexo, hábitos tóxicos y antecedentes patológicos personales. Resultados: el mayor % de diabéticos correspondió al sexo femenino y a los pacientes mayores de 70 años, según antecedentes patológicos personales prevaleció la hipertensión arterial con 57 pacientes para el 67,1% de la muestra. Al distribuir los pacientes según hábitos tóxicos se aprecian una baja prevalencia del hábito de fumar con un 14,1% y 3,5% para el consumo de alcohol. Conclusiones: hubo un predominio del sexo femenino con aumentos de la incidencia de la enfermedad a partir de los 60 años de edad. Entre los antecedentes patológicos personales se asocia la hipertensión arterial, seguido de las enfermedades cerebrovascular. Al distribuirse los pacientes según hábitos tóxicos, predominó el hábito de fumar (AU).


Introduction: diabetes mellitus shows a national prevalence of around 60 % and its complications are produced mainly due to a bad metabolic control; therefore the metabolic control management and reduction is the main objective of this disease's control programs. Aim: to characterize several clinical and epidemiologic variables of the patients with type 2 diabetes mellitus in three Family Physician Offices of the Policlinic "Milanés", municipality of Matanzas, during the period from May 2013 to May 2014. Material and Methods: a cross sectional, descriptive study was carried out in a universe of 129 patients with type 2 diabetes mellitus in three Family Physician Offices of the Polyclinic "Milanes"; the sample was formed by 85 patients chosen by simple randomized sampling. The studied variables were: age, sex, toxic habits and personal pathological antecedents. Results: the highest percent of diabetic patients were female ones and patients aged more than 70 years. According to the personal pathologic antecedents, arterial hypertension prevailed with 57 patients, for 67.1 % of the sample. When grouping the patients according to their toxic habits, it was found a low prevalence of smoking (14.1 %) and alcohol consumption (3.5 %). Conclusions: the female sex prevailed with an increase of the disease's incidence beginning after the age of 60 years. Among other personal pathologic antecedents, arterial hypertension is associated, followed by vascular brain diseases. When grouping the patients according to their toxic habits, smoking predominated (AU).


Subject(s)
Humans , Male , Female , Medical Records , Diabetes Mellitus, Type 2/epidemiology , Alcohol Drinking/adverse effects , Diabetes Mellitus, Type 2/complications , Diabetes Mellitus, Type 2/diagnosis , Diabetes Mellitus, Type 2/pathology , Observational Studies as Topic , Hyperglycemia/diagnosis
3.
Rev. méd. Chile ; 145(3): 393-396, Mar. 2017.
Article in Spanish | LILACS | ID: biblio-845553

ABSTRACT

Diabetic ketoacidosis with mild hyperglycemia is a major complication of sodium-glucose cotransporter 2 inhibitors. Although its use is not approved for patients with type 1 diabetes mellitus, the drug is often prescribed with the hope of optimizing metabolic control. We report a 20 years old female with hypothyroidism and type 1 diabetes consulting for vomiting and abdominal pain. The patient had used canagliflozin during the two previous months. Laboratory showed a blood glucose of 200 mg/dl, a severe metabolic acidosis (pH 7.1) and ketonemia. The patient was successfully treated in the intensive care unit.


Subject(s)
Humans , Female , Adult , Diabetic Ketoacidosis/chemically induced , Canagliflozin/adverse effects , Hyperglycemia/chemically induced , Hypoglycemic Agents/adverse effects , Diabetic Ketoacidosis/diagnosis , Diabetes Mellitus, Type 1/drug therapy , Canagliflozin/therapeutic use , Sodium-Glucose Transporter 2 Inhibitors , Hyperglycemia/diagnosis , Hypoglycemic Agents/therapeutic use
4.
Rev. latinoam. enferm. (Online) ; 25: e2893, 2017. graf
Article in English | LILACS, BDENF | ID: biblio-845319

ABSTRACT

ABSTRACT Objective: to identify evidence in the literature on the possible risk factors for the risk of unstable blood glucose diagnosis in individuals with type 2 diabetes mellitus, and to compare them with the risk factors described by NANDA International. Method: an integrative literature review guided by the question: what are the risk factors for unstable blood glucose level in people with type 2 diabetes mellitus? Primary studies were included whose outcomes were variations in glycemic levels, published in English, Portuguese or Spanish, in PubMed or CINAHL between 2010 and 2015. Results: altered levels of glycated hemoglobin, body mass index>31 kg/m2, previous history of hypoglycemia, cognitive deficit/dementia, autonomic cardiovascular neuropathy, comorbidities and weight loss corresponded to risk factors described in NANDA International. Other risk factors identified were: advanced age, black skin color, longer length of diabetes diagnosis, daytime sleepiness, macroalbuminuria, genetic polymorphisms, insulin therapy, use of oral antidiabetics, and use of metoclopramide, inadequate physical activity and low fasting glycemia. Conclusions: risk factors for the diagnosis, risk for unstable blood glucose level, for persons with type 2 diabetes mellitus were identified, and 42% of them corresponded to those of NANDA International. These findings may contribute to the practice of clinical nurses in preventing the deleterious effects of glycemic variation.


RESUMO Objetivo: identificar evidências na literatura acerca de possíveis fatores de risco do diagnóstico risco de glicemia instável para pessoas com diabetes mellitus tipo 2 e compará-los com os fatores de risco descritos pela NANDA International . Método: revisão integrativa norteada pela pergunta: quais são os fatores de risco de glicemia instável em pessoas com diabetes mellitus tipo 2? Incluíram-se estudos primários cujos desfechos eram variações nos níveis glicêmicos, publicados em inglês, português ou espanhol no PubMed ou CINAHL entre 2010 e 2015. Resultados: observou-se que alteração nos níveis de hemoglobina glicada, índice de massa corpórea>31 Kg/m2, história prévia de hipoglicemia, déficit cognitivo/demência, neuropatia autonômica cardiovascular, comorbidades e perda de peso correspondiam a fatores de risco descritos pela NANDA International . Outros fatores de risco identificados foram: idade avançada, raça negra, maior tempo de diagnóstico de diabetes, sonolência diurna, macroalbuminúria, polimorfismos genéticos, insulinoterapia, uso de antidiabéticos orais, uso de metoclopramida, atividade física inadequada e glicemia de jejum baixa. Conclusões: identificaram-se fatores de risco do diagnóstico risco de glicemia instável para pessoas com diabetes mellitus tipo 2, dos quais 42% correspondiam àqueles da NANDA International . Esses achados podem contribuir para a prática de enfermeiros clínicos na prevenção dos efeitos deletérios da variação glicêmica.


RESUMEN Objetivo: identificar evidencias en la literatura acerca de posibles factores de riesgo del diagnóstico "riesgo de nivel de glucemia inestable" para personas con diabetes mellitus tipo 2 y compararlos con los factores de riesgo descritos por la NANDA International . Método: revisión integradora orientada por la pregunta: ¿Cuáles son los factores de riesgo de nivel de glucemia inestable en personas con diabetes mellitus tipo 2? Se incluyeron estudios primarios cuyos resultados eran variaciones en los niveles glucémicos, publicados en inglés, portugués o español en el PubMed o CINAHL entre 2010 y 2015. Resultados: se observó que una alteración en los niveles de: hemoglobina glucosilada, índice de masa corporal >31 Kg/m2, historia previa de hipoglucemia, déficit cognitivo/demencia, neuropatía autonómica cardiovascular, comorbilidades y pérdida de peso, correspondían a factores de riesgo descritos por la NANDA International . Otros factores de riesgo identificados fueron: edad avanzada, raza negra, mayor tiempo de diagnóstico de diabetes, somnolencia diurna, macroalbuminuria, polimorfismos genéticos, insulinoterapia, uso de antidiabéticos orales, uso de metoclopramida, actividad física inadecuada y glucemia de ayuno baja. Conclusiones: se identificaron factores de riesgo del diagnóstico riesgo de nivel de glucemia inestable para personas con diabetes mellitus tipo 2, de los cuales 42% correspondían a los de la NANDA International . Esos hallazgos pueden contribuir para la práctica de enfermeros clínicos en la prevención de los efectos deletéreos de la variación glucémica.


Subject(s)
Humans , Blood Glucose/analysis , Nursing Diagnosis , Diabetes Mellitus, Type 2/blood , Hyperglycemia/diagnosis , Hypoglycemia/diagnosis , Risk Factors , Diabetes Mellitus, Type 2/complications , Hyperglycemia/etiology , Hyperglycemia/blood , Hypoglycemia/etiology , Hypoglycemia/blood
5.
Arch. endocrinol. metab. (Online) ; 60(6): 526-531, Nov.-Dec. 2016. tab
Article in English | LILACS | ID: biblio-827795

ABSTRACT

ABSTRACT Objectives To evaluate the ability of BMI, WC and WHtR to discriminate hyperglycemia in young people, and to determine whether there is an increase in the accuracy with the addition of WC and/or WHtR to BMI. Subjects and methods A cross-sectional study was conducted on 1,139 schoolchildren aged 6 to 17 years from Northeastern Brazil. Body weight, height, WC and fasting glucose levels were measured, and the BMI and WHtR were calculated. The presence of hyperglycemia was defined as a fasting glucose level ≥ 100 mg/dL. Results The prevalence of hyperglycemia was 6.6%. Strong correlations were observed between the anthropometric indicators studied (BMI vs. WC = 0.87; BMI vs. WHtR = 0.87; WC vs. WHtR = 0.90). Hyperglycemia was more likely to be present in young people with excess weight (PR = 1.70), high WC (PR = 1.85), and high WHtR (PR = 1.91). The accuracies to discriminate hyperglycemia were significant, but low, for the individual (BMI = 0.56; WC = 0.53; WHtR = 0.55) and combined indicators (BMI + WC = 0.55; BMI + WHtR = 0.55). Conclusion Our findings do not support the use of BMI, WC or WHtR as screening tools for hyperglycemia in children and adolescents.


Subject(s)
Humans , Male , Female , Child , Adolescent , Body Mass Index , Mass Screening/standards , Waist Circumference , Waist-Height Ratio , Hyperglycemia/diagnosis , Blood Glucose/analysis , Brazil/epidemiology , Prevalence , Cross-Sectional Studies , Sensitivity and Specificity , Fasting/blood , Data Accuracy , Hyperglycemia/epidemiology
6.
Rev. ADM ; 73(2): 72-80, mar.-abr. 2016. tab
Article in Spanish | LILACS, BNUY | ID: lil-789837

ABSTRACT

Antecedentes: la diabetes mellitus es considerada un problema de salud pública en todo el mundo Este padecimiento afecta órganos y sistemas, incluyendo la cavidad oral; sin embargo, hay pocos informes en la literatura de los efectos de la diabetes mellitus en la cavidad bucal en la población del estado de Durango. Objetivo: El objetivode este estudio fue determinar la asociación de diversas enfermedadesorales, el índice de masa corporal, así como el nivel de glucosa en sangre en pacientes con diabetes mellitus. Material y métodos: Se realizó un estudio de casos y controles para identifi car la prevalencia de las enfermedades orales en individuos con y sin diabetes mellitus.Los sujetos con diabetes mellitus tipo 1 o 2 se definieron como casos y aquellos con otras enfermedades fueron defi nidos como controles. El índice de masa corporal y la concentración de glucosa en sangre fueron evaluados en todos los sujetos. El análisis estadístico incluyólas pruebas chi cuadrada y promedio y desviación estándar de los datos. esultados: Se evaluaron 312 personas, 38 pacientes con diabetes mellitus tipo 1, 79 con diabetes mellitus tipo 2 y 195 sin diabetes mellitus. Diferencias signifi cativas fueron encontradas en individuos con DM2, que mostraron una mayor frecuencia de periodontitis, así como diferencias significativas entre este tipo de diabetes y niveles elevadosde glucosa en sangre...


Background: Diabetes mellitus is considered a public health problem worldwide and one that affects organs and systems alike, including the oral cavity. However, there are few reports in the literature on the effects of diabetes mellitus on the oral cavity of the population in the north of Mexico. Objective: The aim of this study was to determine the link between various oral diseases, body mass index, and blood glucose level in patients with diabetes mellitus. Material and methods:A case-control study was conducted to identify the prevalence of oral diseases in patients with and without diabetes mellitus. Patients with type 1 or type 2 diabetes mellitus were defi ned as cases and patients with other diseases were defi ned as controls. The body mass index and blood glucose concentration of all subjects were measured. Statistical analysis included chi-squared tests, and the average and standard deviation of the data. Results: 312 subjects were assessed: 38 patients with type 1 diabetes mellitus, 79 with type 2 diabetes mellitus, and 195 without diabetes mellitus. Signifi cant differences were found in DM2 patients, who were more likely to exhibit periodontitis and high blood glucose levels. Furthermore, the presence of obesity and hypertension in patients with type 2 diabetes was found to be a risk factor for de-veloping periodontitis...


Subject(s)
Humans , Male , Female , Adolescent , Adult , Middle Aged , Young Adult , /epidemiology , Periodontal Diseases/epidemiology , Periodontal Diseases/etiology , Hyperglycemia/diagnosis , Data Interpretation, Statistical , Age and Sex Distribution , Case-Control Studies , Hypertension/diagnosis , Mexico , Obesity/diagnosis
7.
Article in Portuguese | LILACS | ID: biblio-882997

ABSTRACT

Emergências glicêmicas são complicações frequentes na prática do emergencista, constituindo importante causa de morbimortalidade. Este capítulo objetiva abordar de forma prática o diagnóstico e o manejo das emergências glicêmicas mais comuns em sala de emergência.


Glycemic emergencies are frequent complications in the practice of the emergencist physician, and it is an important cause of morbidity and mortality. This chapter aims to approach in a practical way the diagnosis and management of the most common glycemic emergencies in the emergency room.


Subject(s)
Glucose Metabolism Disorders/diagnosis , Diabetes Mellitus , Emergencies , Hyperglycemia/diagnosis , Hypoglycemia/diagnosis
8.
Braz. j. otorhinolaryngol. (Impr.) ; 81(4): 347-351, July-Aug. 2015. ilus
Article in English | LILACS | ID: lil-758016

ABSTRACT

INTRODUCTION: Changes in carbohydrate metabolism may lead to recurrence of benign paroxysmal positional vertigo.OBJECTIVE: To evaluate the influence of the disturbance of carbohydrate metabolism in the recurrence of idiopathic BPPV.METHODS: A longitudinal prospective study of a cohort, with 41 months follow-up. We analyzed the results of 72 glucose-insulin curves in patients with recurrence of BPPV. The curves were classified into intolerance, hyperinsulinemia, hyperglycemia and normal.RESULTS: The RR for hyperinsulinism was 4.66 and p = 0.0015. Existing hyperglycemia showed an RR = 2.47, with p = 0.0123. Glucose intolerance had a RR of 0.63, with p = 0.096. When the examination was within normal limits, the result was RR = 0.2225 and p = 0.030.DISCUSSION: Metabolic changes can cause dizziness and vertigo and are very common in people who have cochleovestibular disorders. However, few studies discuss the relationship between idiopathic BPPV and alterations in carbohydrate metabolism. In the present study, we found that both hyperglycemia and hyperinsulinemia are risk factors for the recurrence of BPPV, whereas a normal test was considered a protective factor; all these were statistically significant. Glucose intolerance that was already present was not statistically significant in the group evaluated.CONCLUSION: Hyperinsulinemia and hyperglycemia are risk factors for the recurrence of idiopathic BPPV and a normal exam is considered a protective factor.


INTRODUÇÃO: As alterações do metabolismo do carboidrato podem levar a recorrência de vertigem posicional paroxística benigna.OBJETIVO: Avaliar a influência dos distúrbios do carboidrato na recorrência da VPPB idiopática.MÉTODO: Estudo longitudinal, do tipo coorte, prospectivo, com 41 meses de acompanhamento. Analisaram-se 72 resultados de curvas glicoinsulinêmicas em pacientes portadores de recorrência de VPPB. As curvas foram classificadas em intolerância, hiperinsulinemia, hiperglicemia e normal.RESULTADOS: O hiperinsulinismo teve RR = 4,66 e p = 0,0015. A hiperglicemia apresentou um RR = 2,47 e p = 0,0123. Na intolerância a glicose o RR = 0,63 e p = 0,096. No exame normal, o RR = 0,2225 e p = 0,030.DISCUSSÃO: As alterações metabólicas podem causar tontura e vertigem e são muito frequentes na população que apresenta distúrbios cocleovestibulares. Contudo, poucos trabalhos falam sobre a relação entre a VPPB idiopática e as alterações nos carboidratos. No presente estudo, verificou-se que tanto a hiperglicemia, quanto o hiperinsulinismo são fatores de risco para recorrência de VPPB, ao passo que o exame normal foi considerado fator protetor, todos estes estatisticamente significantes. Já a intolerância à glicose não teve significância estatística no grupo avaliado.CONCLUSÃO: O hiperinsulinismo e a hiperglicemia se comportam como fatores de risco para a recorrência de VPPB idiopática, assim como o exame normal como um fator protetor.


Subject(s)
Humans , Benign Paroxysmal Positional Vertigo/etiology , Hyperglycemia/complications , Hyperinsulinism/complications , Glycemic Index , Hyperglycemia/diagnosis , Hyperinsulinism/diagnosis , Longitudinal Studies , Prospective Studies , Recurrence , Risk Factors
9.
Article in Portuguese | LILACS | ID: lil-749183

ABSTRACT

INTRODUÇÃO: O Diabetes Mellitus (DM) consiste em uma doença crônica ocasionada pela hiperglicemia. Sabe-se que essa patologia esta presente em aproximadamente 10% das internações hospitalares, e que uma porcentagem significativa dos pacientes com Diabetes Mellitus apresenta-se sem diagnóstico prévio no momento da internação. A hiperglicemia pode provocar efeitos deletérios no organismo como processo inflamatório. OBJETIVO: Avaliar a HbA1c como ferramenta diagnóstica e preditiva da evolução clínica de pacientes com e sem diagnóstico de Diabetes Mellitus, avaliada durante período de internação hospitalar e sua relação com as complicações hospitalares. MÉTODOS: Foram avaliados 100 pacientes no período de um ano e verificado através do protocolo Institucional NUMAD (Núcleo de assistência ao Paciente Diabético) os valores de hemoglobina glicada HbA1c em pacientes com hiperglicemia. RESULTADOS: Os pacientes sem diagnóstico prévio de Diabetes Mellitus apresentaram HbA1c entre 5,8% e 7,5%, com a mediana do tempo de internação de 9 dias, sem complicações. Os pacientes com Diabetes Mellitus que evoluíram com complicações, apresentaram HbA1c entre 7,3% e 12,4% e correspondiam a 20% do estudo, com tempo de internação de 34,5 dias. DISCUSSÃO: Estudos descrevem a prevalência de hiperglicemia relacionada a mortalidade e período de internação hospitalar, e principalmente em relação a hemoglobina glicada como marcador de gravidade independente da patologia. Nosso estudo demonstrou a importância dessa ferramenta como um aliado ao tratamento hospitalar. CONCLUSÃO: A HbA1c demonstrou em nosso estudo ser um marcador prognóstico e preditivo importante em pacientes com hiperglicemia hospitalar.


INTRODUCTION: Diabetes Mellitus (DM) is a chronic disease caused by hyperglycemia. It is known that this disease is present in approximately 10% of hospital admissions, and there is a significant percentage of patients with Diabetes Mellitus presents with no previous diagnosis at admission. Hyperglycemia can cause deleterious effects in the body as an inflammatory process. OBJECTIVE: To evaluate the HbA1c as a diagnostic and predictive tool outcome of patients with and without diagnosis of Diabetes Mellitus, performed during hospital stay and its relation with the hospital complications. METHODS: A total of 100 patients in the period of a year and verified by the Institutional NUMAD protocol (service core to Diabetic Patients) the glycated hemoglobin HbA1c in patients with hyperglycemia. RESULTS: Patients with no previous diagnosis of Diabetes Mellitus had HbA1c between 5.8% and 7.5%, with the median length of stay of nine days without complications. Patients with Diabetes Mellitus who developed complications, had HbA1c between 7.3% and 12.4% and accounted for 20% of the study, with hospital stay of 34.5 days. DISCUSSION: Studies describe the prevalence of hyperglycemia related mortality and hospital stay, and especially in relation to glycated hemoglobin as a marker of severity regardless of pathology. Our study demonstrated the importance of this tool as an ally to the hospital treatment. CONCLUSION: HbA1c demonstrated in our study to be a prognostic and predictive marker important in patients with hospital hyperglycemia.


Subject(s)
Humans , Male , Female , Middle Aged , Diabetes Complications , Glycated Hemoglobin A/analogs & derivatives , Hyperglycemia/diagnosis , Hyperglycemia/epidemiology , Inpatients , Diabetes Mellitus
10.
Arq. bras. endocrinol. metab ; 58(2): 197-204, 03/2014. tab
Article in English | LILACS | ID: lil-709334

ABSTRACT

Objectives: The aims of this study were to estimate the local rate of postpartum diabetes screening after gestational diabetes mellitus (GDM) pregnancies, and to identify clinical variables associated with retesting rates and with the persistence of decreased glucose tolerance. Subjects and methods: Prospective cohort of GDM women with prenatal delivery at a specialized center, from November 2009 to May 2012. All women were advised to schedule a 6 weeks postpartum 75-g oral glucose tolerance test (OGTT). Results: Of the 209 women included, 108 (51.7%) returned to be tested with fasting plasma glucose (n = 14), OGTT (n = 93) or random glucose (n = 1). Return was associated with lower parity rate (2 vs. 3, p < 0.001) and higher pregnancy 2-h OGTT (165 vs. 155 mg/dL, p = 0.034), but not with socio-demographic characteristics. Four women (3.7%) had diabetes, 22 (20.4%) had impaired fasting glucose or impaired glucose tolerance. Persistent hyperglycemia was associated with a positive family history of diabetes (relative risk - RR 2.41, p = 0.050), diagnostic 2-h OGTT in pregnancy (RR 1.01, p = 0.045), insulin use during pregnancy (RR 2.37, p = 0.014), and cesarean section (RR 2.61, p = 0.015). Conclusions: Even though postpartum abnormalities were frequent in GDM, rates of postpartum diabetes screening were undesirably low. As no specific clinical profile defines who will adhere to postpartum testing, it is essential to encourage all women to reevaluate their glucose status, particularly those with a family history of diabetes and more severe hyperglycemia. Arq Bras Endocrinol Metab. 2014;58(2):197-204 .


Objetivos: Os objetivos foram estimar a taxa de reavaliação de diabetes pós-parto em mulheres com diabetes melito gestacional (DMG) e identificar fatores associados ao retorno e à persistência das alterações glicêmicas. Sujeitos e métodos: Coorte prospectiva de mulheres com DMG atendidas em ambulatório de pré-natal especializado, de novembro de 2009 a maio de 2012. Todas foram orientadas a agendar o teste oral de tolerância à glicose (TOTG) a partir da sexta semana pós-parto. Resultados: Das 209 mulheres arroladas na gestação, 108 (51,7%) foram avaliadas após o parto: 14 com glicemia de jejum, 93 com o TOTG e uma com glicemia ao acaso. O retorno para reavaliação foi associado com menor paridade (2 vs. 3, p < 0,001) e com glicemia de 2-h mais elevada no TOTG diagnóstico (165 vs. 155 mg/dL, p = 0,034). Diabetes foi diagnosticado em quatro mulheres (3,7%) e pré-diabetes em 22 (20,4%). Análise multivariada evidenciou que a história familiar de diabetes (risco relativo – RR 2,41, p = 0,050), a glicemia de 2 horas no TOTG da gestação (RR 1,01, p = 0,045), o uso de insulina na gestação (RR 2,37, p = 0,014) e a taxa de cesariana (RR 2,61, p = 0,015) foram os fatores associados à persistência da hiperglicemia. Conclusões: O retorno para reavaliação foi baixo, embora as alterações glicêmicas tenham sido frequentes. Como não houve fatores que indiquem quais mulheres retornarão, estratégias para aumentar a adesão são necessárias, especialmente quando há história familiar ou o DMG foi mais grave. Arq Bras Endocrinol Metab. 2014;58(2):197-204 .


Subject(s)
Adult , Female , Humans , Pregnancy , Blood Glucose/analysis , Diabetes, Gestational/blood , Diabetes, Gestational/diagnosis , Hyperglycemia/diagnosis , Postpartum Period/blood , Brazil/epidemiology , Chi-Square Distribution , Diabetes, Gestational/epidemiology , Fetal Macrosomia/epidemiology , Glucose Tolerance Test , Hyperglycemia/epidemiology , Multivariate Analysis , Prospective Studies , Pregnancy Complications/blood , Pregnancy Complications/diagnosis , Risk Factors , Severity of Illness Index , Time Factors
11.
Arq. bras. cardiol ; 100(5): 404-411, maio 2013. ilus, tab
Article in Portuguese | LILACS | ID: lil-675601

ABSTRACT

FUNDAMENTO: Hiperglicemia na fase aguda do infarto do miocárdio é importante fator prognóstico. Entretanto, sua fisiopatologia não está completamente elucidada. OBJETIVO: Analisar simultaneamente correlação entre hiperglicemia e marcadores bioquímicos relacionados ao estresse,metabolismo glicídico e lipídico, coagulação, inflamação e necrose miocárdica. MÉTODOS: Oitenta pacientes com infarto agudo do miocárdio foram incluídos prospectivamente. Os parâmetros analisados foram: glicose, hormônios do estresse (cortisol e norepinefrina), fatores do metabolismo glicídico [hemoglobina glicada (HbA1c), insulina], lipoproteínas (colesterol total, LDL, HDL, LDL eletronegativa minimamente modificada e adiponectina), glicerídeos (triglicérides, VLDL e ácido graxo), fatores da coagulação (fator VII, fibrinogênio,inibidor do ativador do plasminogênio-1), inflamação (proteína C reativa ultrassensível) e necrose miocárdica (CK-MB e troponina). Variáveis contínuas foram convertidas em graus de pertinência por intermédio de lógica fuzzy. RESULTADOS: Houve correlação significativa entre hiperglicemia e metabolismo glicídico (p < 0,001), lipoproteínas (p = 0,03) e fatores de necrose (p = 0,03). Na análise multivariada, somente metabolismo glicídico (OR = 4,3; IC = 2,1-68,9 e p < 0,001) e necrose miocárdica (OR = 22,5; IC = 2-253 e p = 0,012) mantiveram correlação independente e significativa.Para análise da influência da história de diabetes mellitus , modelo de regressão, incluindo somente pacientes sem diabetes mellitus foi desenvolvido, e os resultados não alteraram. Finalmente, no modelo ajustado para idade, sexo e variáveis clínicas(história de diabetes mellitus, hipertensão arterial e dislipidemia), três variáveis mantiveram associação significativa e independente com hiperglicemia: metabolismo glicídico (OR = 24,1; IC = 4,8-122,1 e p < 0,001) necrose miocárdica (OR = 21,9; IC = 1,3-360,9 e p = 0,03) e história de DM (OR = 27, IC = 3,7-195,7 e p = 0,001). CONCLUSÃO: Marcadores do metabolismo glicídico e necrose miocárdica foram os melhores preditores de hiperglicemia em pacientes com infarto agudo do miocárdio.


BACKGROUND: Hyperglycemia in the acute phase of myocardial infarction is an important prognostic factor. However, its pathophysiology is not fully understood. OBJECTIVE: To analyze simultaneously the correlation between hyperglycemia and biochemical markers related to stress, glucose and lipid metabolism, coagulation, inflammation, and myocardial necrosis. METHODS Eighty patients with acute myocardial infarction were prospectively included. The following parameters were analyzed: blood glucose; stress hormones (cortisol and norepinephrine); glucose metabolism factors [glycated hemoglobin (HbA1c); insulin]; lipoproteins (total cholesterol, LDL, HDL, minimally modified electronegative LDL, and adiponectin); glycerides (triglycerides, VLDL and fatty acids); coagulation factors (factor VII, fibrinogen, plasminogen activator inhibitor-1); inflammation (high-sensitivity C reactive protein); and myocardial necrosis (CK-MB and troponin). Continuous variables were converted into degrees of relevance using fuzzy logic. RESULTS: Significant correlation was observed between hyperglycemia and glucose metabolism (p < 0.001), lipoproteins (p = 0.03), and necrosis factors (p = 0.03). In the multivariate analysis, only glucose metabolism (OR = 4.3; CI = 2.1-68.9; and p < 0.001) and myocardial necrosis (OR = 22.5; CI = 2-253; and p = 0.012) showed independent and significant correlation. For the analysis of the influence of history of diabetes mellitus, a regression model including only patients without diabetes mellitus was developed, and the results did not change. Finally, in the model adjusted for age, gender, and clinical variables (history of diabetes mellitus, hypertension and dyslipidemia), three variables maintained a significant and independent association with hyperglycemia: glucose metabolism (OR = 24.1; CI = 4.8-122.1; and p < 0.001), myocardial necrosis (OR = 21.9; CI = 1.3-360.9; and p = 0.03), and history of DM (OR = 27; CI = 3.7-195.7; and p = 0.001). CONCLUSION: Glucose metabolism and myocardial necrosis markers were the best predictors of hyperglycemia in patients with acute myocardial infarction.


Subject(s)
Female , Humans , Male , Middle Aged , Diabetes Mellitus/diagnosis , Hyperglycemia/diagnosis , Myocardial Infarction/blood , Troponin/blood , Biomarkers/blood , Blood Coagulation/physiology , Creatine Kinase, MB Form/blood , Diabetes Mellitus/blood , Epidemiologic Methods , Glycated Hemoglobin A/analysis , Hyperglycemia/blood , Inflammation/blood , Insulin/blood , Lipoproteins/blood , Myocardial Infarction/pathology , Necrosis , Stress, Physiological/physiology
12.
Arq. bras. cardiol ; 100(2): 127-134, fev. 2013. graf, tab
Article in Portuguese | LILACS | ID: lil-667953

ABSTRACT

FUNDAMENTO: Na síndrome coronariana aguda (SCA), a hiperglicemia, à admissão hospitalar, está associada à presença de eventos adversos cardiovasculares em pacientes com ou sem diabetes. OBJETIVO: Avaliar o valor prognóstico da hiperglicemia de estresse na evolução intra-hospitalar de pacientes admitidos por SCA. MÉTODOS: Foram incluídos 152 pacientes admitidos, entre setembro de 2005 e fevereiro de 2010, em unidade de dor torácica de hospital terciário com diagnóstico de SCA, que apresentavam valor da glicemia laboratorial na admissão. O grupo I foi formado pelos pacientes com hiperglicemia de estresse, definida por glicemia na admissão > 126 mg/dL em não diabéticos e > 200 mg/dL nos diabéticos, e o grupo II pelos pacientes com níveis glicêmicos inferiores aos níveis estabelecidos. Analisou-se a associação da hiperglicemia e evolução intra-hospitalar. RESULTADOS: A hiperglicemia de estresse associou-se a complicações intra-hospitalares, aumento da idade e gênero feminino. Na análise multivariada, apenas gênero feminino (OR = 2,04; IC95% 1,03 - 4,06, p = 0,007) e complicações intra-hospitalares (OR = 3,65; IC95% 1,62 - 8,19, p = 0,002) se associaram de forma independente à hiperglicemia na admissão. CONCLUSÃO: A hiperglicemia de estresse é fator preditivo independente para complicações intra-hospitalares após SCA em pacientes diabéticos ou não. Os resultados alertam para a necessidade de avaliarmos a glicemia na admissão em todos os pacientes admitidos por SCA, incluindo os não diabéticos, com o intuito de identificarmos os indivíduos com maior risco de complicações.


BACKGROUND: In acute coronary syndrome (ACS), admission hyperglycemia is associated with adverse cardiovascular events in diabetic and nondiabetic patients. OBJECTIVE: To assess the prognostic value of stress hyperglycemia for the in-hospital outcome of patients admitted due to ACS. METHODS: This study included 152 patients admitted to the chest pain unit of a tertiary hospital diagnosed with ACS, who had admission blood glucose data, from September 2005 to February 2010. Group I comprised patients with stress hyperglycemia, defined as admission blood glucose concentration > 126 mg/dL for nondiabetic individuals and admission blood glucose concentration > 200 mg/dL for diabetic individuals. Group II was formed by patients with admission blood glucose concentration lower than those established. The association of hyperglycemia and in-hospital outcome was assessed. RESULTS: Stress hyperglycemia associated with in-hospital complications, age increase and female sex. On multivariate analysis, only female sex (OR = 2.04; 95% CI: 1.03 - 4.06; p = 0.007) and in-hospital complications (OR = 3.65; 95% CI: 1.62 - 8.19; p = 0.002) associated independently with admission hyperglycemia. CONCLUSIONS: Stress hyperglycemia is an independent predictive factor for in-hospital complications after ACS in diabetic and nondiabetic patients. The results highlight the need to assess admission blood glucose concentration in all patients admitted due to ACS, including nondiabetic ones, aiming at identifying those at higher risk for complications.


Subject(s)
Aged , Female , Humans , Male , Middle Aged , Acute Coronary Syndrome/blood , Blood Glucose/analysis , Diabetes Mellitus/blood , Hyperglycemia/diagnosis , Age Factors , Acute Coronary Syndrome/complications , Biomarkers/blood , Diabetes Complications/blood , Hospitalization , Prognosis , Reference Values , Risk Factors , Sex Factors
13.
Rev. cuba. med ; 50(4): 415-421, oct.-dic. 2011.
Article in Spanish | LILACS | ID: lil-615454

ABSTRACT

Introducción: Con la intención de evaluar la influencia de la hiperglucemia en la evolución de pacientes con accidentes macrovasculares agudos se estudiaron 73 personas hospitalizadas con síndrome coronario agudo o accidente cerebrovascular, independientemente de su condición de padecer diabetes mellitus (21,9 por ciento) o no. Métodos: Se registraron complicaciones tempranas (vasculares, sépticas y muerte) y se determinó la glucemia al ingreso, de ayuno y posprandial, así como la hemoglobina glucosilada (HbA1c). Se calcularon las medias de cada determinación y se compararon los grupos de pacientes complicados con aquellos que evolucionaron satisfactoriamente. Resultados: Se halló que solo la glucemia de ayuno se asoció con un peor pronóstico (p=0,004), lo que no se confirmó con el resto del perfil glucémico ni con la HbA1c (p=0,25), aún cuando todos los promedios fueron superiores en el grupo de pacientes complicados. El perfil lipídico tampoco se asoció con las complicaciones posteriores a un proceso macrovascular. Conclusiones: La hiperglucemia de ayuno, en rango diabético, se asoció con una evolución desfavorable en el grupo de pacientes estudiados


Introduction: To assess the influence of hyperglycemia on the course of patients with acute macrovascular accidents, 73 patients admitted due to acute coronary syndrome or cerebrovascular accident were studied, independently of its diabetes mellitus (21,9 percent) or not. Methods: There were early complications (vascular, septic and death); authors determined the presence of glycemia at admission, fasting and postprandial, as well as the glycosylated hemoglobin (HbA1c). The means of each determination were estimated and the groups of patients complicated were compared with a satisfactory evolution. Results: There was found that fasting glycemia was associated with the worse prognosis (p = 0,004) even though all averages were higher in the complicated patients group. The lipid profile was not associated with complications after a macrovascular process. Conclusions: Fasting hypoglycemia, in diabetes rank was associated with a unfavourable course in the group of study patients


Subject(s)
Stroke/complications , Hyperglycemia/diagnosis , Acute Coronary Syndrome/complications , Longitudinal Studies/methods , Retrospective Studies
14.
Rev. méd. Chile ; 139(6): 755-761, jun. 2011. ilus
Article in Spanish | LILACS | ID: lil-603121

ABSTRACT

Background: Postoperative nausea and vomiting (PONV) prophylaxis with dexamethasone may produce significant hyperglycemia in the postoperative period. Aim: To evaluate if this effect is of greater severity in type 2 diabetics compared with non-diabetic patients. Material and Methods: Forty non-diabetic and thirty type 2 diabetic patients undergoing laparoscopic cholecystectomy were studied in a prospective and double-blind fashion manner. Patients were randomly distributed into 4 groups: Group I, non-diabetics control (n = 20), Group II, non-diabetics dexamethasone (n = 20), Group III, type 2 diabetics control (n = 15), and Group I V, type 2 diabetics dexamethasone (n = 15). Immediately after induction, patients in groups I and III received isotonic saline and patients in the dexamethasone groups received 8 mg iv of the steroid. Capillary blood glucose concentrations were measured at baseline and every 2 hours during the first 12 hours since the start of surgery. A linear mixed effect model, adjusted for baseline capillary glucose concentration, age and duration of surgery was used to analyze the data. Results: No effect of the presence of diabetes mellitus was observed in the evolution of glucose concentrations. There was a difference in capillary glucose concentrations between patients who received dexamethasone and placebo that started 2 hours post-intervention, reaching a mean maximum difference of 34 mg/dl (adjusted model, p < 0.001) at 10 hours post-intervention. Conclusions: In this study, Type 2 diabetic patients did not show a higher susceptibility than non-diabetics to develop postoperative hyperglycemia after the use of prophylactic dexamethasone for PONV.


Subject(s)
Adult , Female , Humans , Male , Middle Aged , Antiemetics/adverse effects , Blood Glucose/drug effects , Dexamethasone/adverse effects , /metabolism , Hyperglycemia/chemically induced , Postoperative Nausea and Vomiting/prevention & control , Blood Glucose/metabolism , Cholecystectomy, Laparoscopic/adverse effects , /surgery , Epidemiologic Methods , Hyperglycemia/diagnosis
15.
Einstein (Säo Paulo) ; 9(1)jan.-mar. 2011. tab
Article in English, Portuguese | LILACS | ID: lil-583365

ABSTRACT

Objective: To evaluate the impact of screening hyper and hypoglycemia measured by capillary glycemia and standard monitorization of hyperglycemic patients hospitalized in regular care units of Hospital Israelita Albert Einstein. Methods: The capillary glycemia was measured by the Precision PCx (Abbott) glucosimeter, using the PrecisionWeb (Abbott) software. The detection of hyper and hypoglycemia during the months of May/June were compared to those of March/April in 2009 and to the frequency of the diagnosis of diabetes in 2007. Results: There was an increase in the glycemia screening from 27.7 to 77.5% of hospitalized patients (p < 0.001), of hyperglycemia detection (from 9.3 to 12.2%; p < 0.001) and of hypoglycemia (from 1.5 to 3.3%; p < 0.001) during the months of May/June 2009. According to this action 14 patients for each additional case of hyperglycemia and 26 cases for each case of hypoglycemia were identified. The detection of hyperglycemia was significantly higher (p < 0.001) than the frequency of registered diagnosis related do diabetes in the year of 2007. Conclusions: the adoption of an institutional program of glycemia monitorization improves the detection of hyper and hypoglycemia and glycemia control in hospitalized patients in regular care units.


Objetivo: Analisar o impacto do rastreamento de hiper e hipoglicemia mensurada por glicemia capilar e da monitorização padronizada em pacientes hiperglicêmicos internados em unidades não graves do Hospital Israelita Albert Einstein. Métodos: A glicemia capilar foi mensurada com glucosímetro Precision PCx (Abbott), rastreada com software PrecisionWeb (Abbott). A detecção de hiper e hipoglicemia no bimestre Maio/Junho foi comparada ao bimestre Março/Abril de 2009 e ainda quanto à frequência de diagnósticos relacionados ao diabetes no ano de 2007. Resultados: Houve um aumento do rastreamento de glicemia de 27,7 para 77,5% dos pacientes internados (p < 0,001), na detecção de hiperglicemia (de 9,3 para 12,2%; p < 0,001) e de hipoglicemia (de 1,5 para 3,3%; p < 0,001) no bimestre Maio-Junho de 2009. Com essa iniciativa, foram rastreados 14 pacientes para cada caso adicional de hiperglicemia e 26 pacientes para cada caso de hipoglicemia. A detecção de hiperglicemia foi significantemente maior (p < 0,001) que a frequência de registros de diagnósticos relacionados ao diabetes no ano de 2007. Conclusões: a adoção de um programa institucional de monitoramento de glicemia melhora a detecção de hiper e hipoglicemia e o controle de glicemia em pacientes internados em unidades não graves.


Subject(s)
Blood Glucose , Hyperglycemia/diagnosis , Hypoglycemia/diagnosis , Inpatients
16.
Biomedica. 2011; 27 (Jan.-Jun.): 52-56
in English | IMEMR | ID: emr-110357

ABSTRACT

To improve the practices of non-physician practitioners on early diagnosis and referral of patients with diabetes mellitus. Study will be conducted in a peri-urban village community in Lahore, Pakistan, during 2007 - 2008. Quasi - experimental study, one group before and after design was used to document the effect of training of non-physician practitioners on improving their diabetic patient identification practices and referral to the hospital for diagnostic and treatment facilities. Fasting blood glucose test was used to identify hyperglycaemics out of those referred by the NPPs. Patient referral was increased by 48.44% after training. Identification of hyperglycaemic patients on the basis of signs and symptoms was 47% before and 48% after training and the difference between two proportions was not significant. increased number of referral showed motivation of NPPs towards the task however more prolonged and structured training program is required to utilize their services in community as part of our health care delivery system


Subject(s)
Humans , Male , Female , Referral and Consultation , Hyperglycemia/diagnosis , Delivery of Health Care
17.
Rev. méd. Chile ; 138(9): 1109-1116, sept. 2010. ilus, tab
Article in Spanish | LILACS | ID: lil-572016

ABSTRACT

Background: Hyperglycemia at admission has been associated to an adverse prognosis in patients with ST-segment elevation acute myocardial infarction (STE-MI). However, its impact over the results of reperfusion therapies in patients with STEMI is still a matter of controversy. Aim: To determine the impact of admission hyperglycemia on hospital and long term mortality, according to the method of reper-fusion utilized in patients with STEMI. Material and Methods: Prospective registry of 1,634 consecutive patients aged 60 ± 12 years (77 percent male), from 3 participating hospitals in the Chilean Registry of Myocardial Infarction (GEMI). We evaluated demographic, clinical and laboratory variables, reperfusion method used, hospital and long term mortality. The impact of hyperglycemia on hospital and long term mortality was evaluated by a logistic regression analysis and Cox risk, respectively, adjusted by Thrombolysis in Myocardial Infarction (TIMI) risk score. Results: Twenty four percent of patients were diabetics and in 45 percent, the infarct was located on the anterior wall. The mean TIMI risk score was 3.2 ± 2.4. Hyperglycemia at entry was associated to a greater hospital and long term mortality, independently of the reperfusion strategy utilized. Primary angioplasty was associated to a greater benefit, compared to thrombolysis among hyperglycemic patients with an odds ratio: 2.9, 95 percent confi dence intervals: 1.0-8.0 and a hazard ratio of 2.9, 95 percent confi dence intervals: 1.44-5.88, independently of a previous history of diabetes mellitus and TIMI risk score. Conclusions: In patients with STEMI, admission hyperglycemia is associated with a worse prognosis which was significantly improved with primary angioplasty compared to thrombolysis, independently of the admission TIMI risk score.


Subject(s)
Female , Humans , Male , Middle Aged , Blood Glucose/analysis , Hospital Mortality , Hyperglycemia/mortality , Myocardial Reperfusion , Myocardial Infarction/mortality , Chile/epidemiology , Hyperglycemia/blood , Hyperglycemia/diagnosis , Logistic Models , Myocardial Infarction/diagnosis , Prognosis , Risk Factors , Sex Factors , Survival Rate
18.
Rev. cuba. med ; 49(2)abr.-jun. 2010.
Article in Spanish | LILACS | ID: lil-584779

ABSTRACT

Se realizó un estudio que evaluó la utilidad de las técnicas de tomografía axial multicorte en la detección, en fase subclínica, del daño coronario en pacientes con diabetes mellitus (DM), con el objetivo de describir la frecuencia de afectación aterosclerótica asintomática y su probable asociación con la hiperglucemia de ayuno y posprandial. Se incluyeron 59 pacientes con diabetes tipo 2, en el estudio se compararon los resultados de la determinación de calcio coronario con los hallazgos de la angiografía por tomografía axial computarizada multicortes (TAC-M). Se registró concordancia de un 44,1 por ciento entre ambos estudios. Predominaron las placas blandas en el 55,9 por ciento de los pacientes. El 42,4 por ciento de los pacientes mostró estrechamiento de la luz arterial, lo que fue significativo en el 16,5 por ciento del total. Un mayor número de pacientes con hiperglucemia presentaron daño coronario al compararlos con los enfermos con buen control glucémico (p=0,024). Esta relación fue más evidente con la hiperglucemia posprandial (p=0,016). La hiperglucemia mostró una mayor probabilidad (5,99 veces) de detectar lesiones coronarias por TAC-M al compararla con otros factores de riesgo ateroscleróticos mayores, como la hipertensión arterial, el tabaquismo, las dislipidemias y la obesidad, lo que se expresó de manera significativa (p=0,045). Concluimos que las técnicas de angio TAC-M y de calcio score son útiles en detectar lesiones de las arterias coronarias, en pacientes con diabetes mellitus tipo 2 asintomáticos de isquemia miocárdica, lo que se asoció a la presencia de hiperglucemia, fundamentalmente posprandial


A study was conducted to assess the usefulness of multi-scan axial tomography techniques to detect, in a subclinical stage, the coronary damage in patients presenting with diabetes mellitus (DM) to describe the frequency of asymptomatic atherosclerotic affection and its potential association with the fasting and postprandial hyperglycemia. In study were included 59 patients with type 2 diabetes to compare the results of coronary calcium determination with the findings of angiography by multi-scan axial computed tomography (CAT-M). There was a concordance of a 44.1 percent between both studies, as well as a predominance of soft plaques in the 55.9 percent of patients. The 42.4 percent showed a narrowing of arterial lumen, which was significant in the 16.5 percent of total. A high figure of patients with hyperglycemia had coronary damage compared to those ills with a good glycemia control (p = 0.024). This relation was more evident with the postprandial hyperglycemia (= 0.016). Hyperglycemia had a high opportunity (5.99 times) to detect coronary lesions by TAC-C compared to other major atherosclerosis risk factors like the high blood pressure, smoking, dyslipemias expressed in a significant way (p = 0.045). We conclude that Angio TAC-C and Calcio Score techniques are useful to detect lesions of coronary arteries in patients with type 2 diabetes mellitus without symptoms of myocardial ischemia, which was associated to presence of a hyperglycemia, fundamentally postprandial


Subject(s)
Humans , Adult , Middle Aged , Coronary Angiography/methods , Coronary Artery Disease/diagnosis , Hyperglycemia/diagnosis , Tomography, X-Ray Computed/methods , Epidemiology, Descriptive
19.
Rev. bras. cardiol. (Impr.) ; 23(3): 178-184, mai.-jun. 2010. ilus
Article in Portuguese | LILACS | ID: lil-568620

ABSTRACT

A insuficiência cardíaca é atualmente uma importante complicação das síndromes coronarianas agudas, e agrava de forma considerável o prognóstico intra e extrahospitalar. A presença da diabetes melito é classicamente un fator de risco para desenvolvimento de infarto agudo do miocárdio e insuficiência cardíaca, sendo um problema de alta prevalência com crescimento epidêmico na população mundial. A hiperglicemia de estresse está presente ente 25 a 50 por cento dos pacientes admitidos com sindrome coronariana aguda e associam-se ao risco de complicações, intra-hospitalares tanto em pacientes com e sem diabetes melito, sendo marcador de pior prognóstico para mortalidade, IC e choque cardiogênico. A abordagem terapêutica da hiperglicemia de estresse na síndrome coronária aguda é ainda controversa, não havendo consenso sobre o melhor método de mensuraçãoglicêmica assim como o melhor tipo de tratamento. O objetivo deste artigo é revisar o estado da arte entre aassociação da hiperglicemia de estresse e a incidência de insuficiência cardíaca após a síndrome coronariana aguda.


Heart failure is currently an important complication of acute coronary syndromes, with significantly poorerprognoses, both in and out of hospital. The presence of diabetes mellitus is classically a risk factor for thedevelopment of acute myocardial infarction and heart failure, constituting a highly prevalent problem that isexpanding like an epidemic through the world’s population. Stress hyperglycemia is present in 25% to 50% of patients admitted with acute coronary syndrome,associated with the risk of in-hospital complications for patients with and without diabetes mellitus, being amarker for poor prognosis in terms of death, heart failure and cardiogenic shock. The therapeutic approach to stress hyperglycemia in acute coronary syndrome is still controversial, with no consensus on the best glucosemeasurement method nor the best type of treatment. The purpose of this paper is to review the state of the art of the association between stress hyperglycemia and the incidence of heart failure after acute coronary syndrome.


Subject(s)
Humans , Hyperglycemia/complications , Hyperglycemia/diagnosis , Acute Coronary Syndrome/complications , Acute Coronary Syndrome/diagnosis , Myocardial Infarction/diagnosis , Heart Failure/diagnosis , Risk Factors
20.
Arq. gastroenterol ; 47(2): 170-173, abr.-jun. 2010. tab
Article in English | LILACS | ID: lil-554680

ABSTRACT

CONTEXT: Morbidly obese patients have an increased risk for nonalcoholic fat liver disease. Its severe form, nonalcoholic steatohepatitis may cause liver fibrosis. The diagnosis of advanced fibrosis has great value during the pre operative evaluation for bariatric surgery. Currently, liver biopsy is the gold standard for diagnosis of liver fibrosis. OBJECTIVE: To evaluate the nonalcoholic fat liver disease fibrosis score in morbidly obese patients undergoing Roux-en-Y gastric bypass in our population. METHODS: One hundred fifty-eight morbidly obese patients that had undergone bariatric surgery were included. Age, body mass index, hyperglycemia, platelet count, albumin and AST/ALT ratio were applied to the score formula. Scores above 0.676 were indicative of advanced liver fibrosis and scores under -1,455 absence of advanced liver fibrosis. These scores were compared to liver biopsy findings. RESULTS: The presence of advanced fibrosis could be diagnosed with good accuracy, with a positive predictive value of 83.7 percent. The score had a higher accuracy to exclude advanced fibrosis with a negative predictive value of 97 percent. Twenty-five patients (16 percent) had scores between the cutoffs points and were identified as indeterminate. The score sensibility and specificity was 83 percent and 97 percent respectively. CONCLUSIONS: The nonalcoholic fat liver disease fibrosis score has high accuracy to identify and exclude advanced liver fibrosis in morbidly obese patients subjected to bariatric surgery.


CONTEXTO: Pacientes com obesidade mórbida apresentam risco significativo para doença hepática gordurosa não-alcoólica e para suas formas mais graves, a esteatohepatite e a cirrose hepática. O diagnóstico de tais alterações é importante, principalmente na avaliação pré-operatória de cirurgia bariátrica. Até o momento, a biopsia hepática é o procedimento com maior precisão para tal diagnóstico. OBJETIVO: Avaliar o escore de fibrose hepática em doença hepática gordurosa não-alcoólica em pacientes com obesidade mórbida na população brasileira. MÉTODOS: Foram incluídos 158 pacientes com obesidade mórbida submetidos a cirurgia bariátrica. Idade, índice de massa corporal, hiperglicemia, albumina, contagem de plaquetas e razão AST/ALT foram aplicados à fórmula do escore de fibrose. Valores acima de 0,676 indicavam fibrose avançada e abaixo de - 1,455 indicavam ausência de fibrose. Estes valores foram comparados com os achados de biopsia hepática realizados no intra-operatório. RESULTADOS: A presença de fibrose avançada foi diagnosticada com boa precisão, valor preditivo positivo de 83,7 por cento. O escore teve melhor precisão para excluir fibrose avançada, com valor preditivo negativo de 97,2 por cento. Em 25 pacientes (16 por cento) o escore resultou indeterminado entre os pontos de corte. A sensibilidade e a especificidade do escore foram de 83 por cento e 97 por cento, respectivamente. CONCLUSÃO: O escore de fibrose para doença hepática gordurosa não-alcoólica apresenta elevada precisão para reconhecer e excluir fibrose avançada em pacientes com obesidade mórbida submetidos a cirurgia bariátrica.


Subject(s)
Adult , Female , Humans , Male , Bariatric Surgery , Fatty Liver/diagnosis , Liver Cirrhosis/diagnosis , Obesity, Morbid/surgery , Alanine Transaminase/blood , Aspartate Aminotransferases/blood , Biopsy , Fatty Liver/blood , Fatty Liver/etiology , Hyperglycemia/diagnosis , Liver Cirrhosis/blood , Liver Cirrhosis/etiology , Liver/pathology , Obesity, Morbid/blood , Obesity, Morbid/complications , Platelet Count , Predictive Value of Tests , Sensitivity and Specificity , Severity of Illness Index , Serum Albumin/analysis
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