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1.
Arch. argent. pediatr ; 120(5): e223-e225, oct. 2022.
Article in Spanish | LILACS, BINACIS | ID: biblio-1395831

ABSTRACT

La ataxia de Friedreich, de herencia autosómica recesiva causada por una expansión repetida de trinucleótidos se asocia, entre otras complicaciones sistémicas, con diabetes mellitus. La aparición de torpeza motriz, con dificultad en la carrera y el salto en un varón de 6 años motivaron el estudio genético para ataxia de Friedrich y permitieron confirmar el diagnóstico. Tres años más tarde, se diagnosticó diabetes mellitus y se inició el tratamiento con insulina. Durante el seguimiento, presentó un importante deterioro neurológico, con necesidad de usar silla de ruedas, lo que dificultó un adecuado control metabólico. Se presenta el manejo y la evolución de un paciente con ataxia de Friedreich y diabetes mellitus


Friedreich's ataxia is an autosomal recessive disease caused by trinucleotide repeat expansion, presenting among other systemic complications, diabetes mellitus. The appearance of motor clumsiness, with running and jumping difficulties in a 6-year-old boy prompted the genetic study of Friedreich's ataxia, confirming his diagnosis. After diagnosis,it was evaluated by Pediatric Cardiology, detecting the presence of non-obstructive hypertrophic cardiomyopathy, and by Pediatric Endocrinology, due to overweight. At 9 years of age, he was diagnosed with diabetes mellitus, a regimen of insulin treatment was initiated. During follow-up, he presented significant neurological deterioration, reaching the use of a wheelchair,which hinders adequate metabolic control. This is a report of a pediatric patient with Friedrich ataxia and diabetes mellitus.


Subject(s)
Humans , Male , Child , Friedreich Ataxia/complications , Friedreich Ataxia/diagnosis , Friedreich Ataxia/genetics , Diabetes Mellitus , Insulins , Family
2.
Arq. bras. med. vet. zootec. (Online) ; 73(6): 1301-1308, Nov.-Dec. 2021. tab
Article in English | LILACS, VETINDEX | ID: biblio-1355670

ABSTRACT

The objective was to evaluate the antioxidant capacity, glucose and insulin concentration and reproductive performance of ewes supplemented with orange residue prior to insemination. Fifty-five multiparous ewes were divided into two corrals, and 15 unbred ewes were kept individually to measure feed consumption. Two integral diets were administered; T0: control treatment and T1: with 20% of dry matter of orange residue. Ten days after the start of supplementation, the ewes were synchronized. Supplementation was finalized prior to artificial insemination, then, a blood sample was taken to measure the antioxidant capacity and glucose and insulin concentration. An analysis of variance was made to evaluate the effect of treatment on the antioxidant capacity, glucose and insulin; and to analyze the response to estrus, percentage of gestation and prolificity a ji squared test was performed. Of 9 antioxidant compounds found in the orange residue, hesperidin (7.44%), chlorogenic acid (0.50%) and protocatechuic acid had the highest concentration. Feed intake, estrus response, percentage of gestation, antioxidant capacity, and glucose and insulin concentration were not affected by the treatment. It is concluded that inclusion of 20% of orange residue in the diet prior to insemination in ewes is possible.(AU)


O objetivo deste estudo foi avaliar a capacidade antioxidante, a concentração de glicose e insulina e o comportamento reprodutivo de ovelhas suplementadas com resíduo de laranja antes da inseminação. Cinquenta e cinco ovelhas multíparas foram divididas em dois currais e 15 ovelhas sem raça foram mantidas individualmente para se medir o consumo de ração. Duas dietas integrais foram administradas; T0: tratamento controle e T1: dieta com 20% de resíduo de laranja seco. Dias após o início da suplementação, as ovelhas foram sincronizadas. A suplementação foi finalizada antes da inseminação artificial e, em seguida, foi coletada uma amostra de sangue para medir a capacidade antioxidante e a concentração de glicose e insulina. Uma análise de variância foi feita para avaliar o efeito do tratamento sobre a capacidade antioxidante, a glicose e a insulina, e um teste do ji quadrado foi realizado para analisar a resposta ao estro, a porcentagem de gestação e de prolificidade. Dos nove compostos antioxidantes encontrados no resíduo laranja, a hesperidina (7,44%), o ácido clorogênico (0,50%) e o ácido protocatecuico foram os de maior concentração. O consumo alimentar, a resposta ao estro, a porcentagem de gestação, a capacidade antioxidante, a concentração de glicose e a insulina não foram afetados pelo tratamento. Conclui-se que é possível a inclusão de 20% de resíduos de laranja na dieta antes da inseminação em ovelhas.(AU)


Subject(s)
Animals , Female , Blood Glucose/analysis , Sheep/physiology , Citrus sinensis/metabolism , Estrus Synchronization/methods , Insulins/analysis , Antioxidants/analysis , Insemination, Artificial/veterinary , Garbage
3.
Arch. endocrinol. metab. (Online) ; 65(2): 164-171, Mar.-Apr. 2021. tab, graf
Article in English | LILACS | ID: biblio-1248819

ABSTRACT

ABSTRACT Objective: The aim of this study was to evaluate the frequency of hypoglycemia and the treatment satisfaction in patients with type 1 diabetes (T1D) using insulin analogues. Subjects and methods: This observational retrospective study included 516 adult patients with T1D from 38 cities in Southern Brazil. Demographics and clinical data were collected using a self-report questionnaire. Hypoglycemia was defined as an event based on either symptoms or self-monitored blood glucose < 70 mg/dL. Treatment satisfaction was evaluated using the Diabetes Treatment Satisfaction Questionnaire status version (DTSQs) and with a specific question with scores ranging from 0-10. Common mental disorders were assessed using the General Health Questionnaire (GHQ-12). Results: Overall, the mean age was 38 ± 14 years and 52% of the participants were women. The median diabetes duration was 18 years. The scores for insulin analogue treatment satisfaction were higher than those for previous treatments. DTSQ scores had a median value of 32 (interquartile range 29-35) and remained unchanged over time. The percentage of patients with hypoglycemia (including severe and nocturnal) was comparable across groups divided according to duration of use of insulin analogues. Most patients (n=395, 77%) screened positive for common mental disorders. Conclusions: Patient satisfaction with insulin analogue treatment was high and remained unchanged with time. Episodes of hypoglycemia also remained unchanged over time among patients using insulin analogues.


Subject(s)
Humans , Male , Female , Adult , Young Adult , Diabetes Mellitus, Type 1/drug therapy , Insulins/therapeutic use , Hypoglycemia/chemically induced , Hypoglycemic Agents/therapeutic use , Blood Glucose , Glycated Hemoglobin/analysis , Retrospective Studies , Patient Satisfaction , Middle Aged
4.
Arch. endocrinol. metab. (Online) ; 65(5): 570-578, 2021. tab, graf
Article in English | LILACS | ID: biblio-1345201

ABSTRACT

ABSTRACT Objectives: The purpose of this study was to investigate the heterogeneity of the association between glycemic variability and oxidative stress markers in T1DM patients under daily life insulin treatment. Subjects and methods: We studied, in a cross-sectional analysis, 76 T1DM patients without clinical chronic diabetes complications and 22 healthy individuals. Were evaluated the short-term glycemic variability (STGV), long-term glycemic variability (LTGV), oxidative stress markers [8-isoprostaglandin-F2α (Ur-8-iso-PGF2α), nitric oxide (NO), thiobarbituric acid reactive substances (TBARS) and erythrocytes reduced/oxidized glutathione (GSH/GSSG)] and biochemical dosages (glycaemia, HbA1c, lipidogram, albuminuria). Results: Plasmatic NO was positively associated with LTGV (last year average of HbA1c) (8.7 ± 1.6% or 71 ± 18 mmol) (rS: 0.278; p: 0.042). Plasmatic TBARS, erythrocytes GSH/GSSH and Ur-8-iso-PGF-2α didn't show correlation with glycemic variability. GSH/GSSG was inversely correlated with LDL-cholesterol (rS: - 0.417; p: 0.047) and triglycerides (rS: −0.521; p: 0.013). Albuminuria was positive correlated with age (rS: 0.340; p: 0.002), plasmatic NO (rS: 0.267; p 0.049) and TBARS (rS: 0.327; p: 0.015). Conclusion: In daily life insulin treatment, young T1DM patients have higher plasmatic NO than healthy subjects. However, the correlation between glycemic variability and oxidative stress markers is heterogeneous. Lipid profile and albuminuria are associated with different oxidative stress markers. These data collaborate to explain the controversial results in this issue.


Subject(s)
Humans , Diabetes Mellitus, Type 1/drug therapy , Insulins/therapeutic use , Blood Glucose , Glycated Hemoglobin/analysis , Cross-Sectional Studies , Oxidative Stress
5.
J. Health Biol. Sci. (Online) ; 9(1): 1-5, 2021. tab
Article in Portuguese | LILACS | ID: biblio-1352370

ABSTRACT

Objetivo: desenvolver e validar cartilhas para aprimorar o preparo e a utilização de insulinas, bem como o monitoramento da glicemia capilar. Métodos: as cartilhas foram elaboradas considerando a acessibilidade das informações e a compreensibilidade das imagens, a fim de torná-las didáticas ao público-alvo. Posteriormente, foram submetidas à validação. Resultados: por meio da Técnica Delphi, criou-se um questionário contendo 10 perguntas para cada uma das quatro cartilhas validadas, o qual foi enviado para 32 painelistas, especialistas na área. A fim de avaliar o consenso entre as respostas dos painelistas, em cada item, empregou-se o cálculo do Coeficiente de Validade de Conteúdo (CVC), que varia de 0 a 1. Considerou-se validado, o valor de CVC superior a 0,8. Ao final de duas rodadas, foi possível validar as quatro cartilhas. Conclusão: o material possui vasto potencial de contribuição para o uso racional, efetivo e seguro das insulinas, além de poder contribuir com a qualidade de vida dos pacientes e com a redução de custos para o sistema de saúde.


Objective: the present study aimed to develop and validate educational booklets to improve the preparation and use of insulins, as well as the monitoring of capillary blood glucose. Methods: the educational booklets were developed considering the accessibility of information and the comprehensibility of images in order to make them didactic to the target audience. Subsequently, they were submitted to validation. Results: through the Delphi Technique, a questionnaire was created containing 10 questions for each of the four educational booklets, which was sent to 32 expert panelists in the area. In order to assess the consensus among the panelists' answers, in each item the calculation of the Content Validity Coefficient (CVC) was used, which varies from 0 to 1. The CVC above 0.8 was considered valid. At the end of two rounds, it was possible to validate the four educational booklets. Conclusion: the material has a vast potential to contribute to the rational, effective and safe use of insulins, in addition to being able to contribute to the quality of life of patients and the reduction of costs for the health system.


Subject(s)
Pharmaceutical Services , Diabetes Mellitus , Quality of Life , Self Care , Blood Glucose , Validation Study , Insulins
6.
Rev. chil. endocrinol. diabetes ; 14(4): 171-177, 2021. tab
Article in Spanish | LILACS | ID: biblio-1348218

ABSTRACT

Los avances en el campo de la fibrosis quística han aumentado la esperanza de vida de estos pacientes, por lo que cada vez es más prevalente la Diabetes Relacionada con la Fibrosis Quística (DRFQ) y sus complicaciones. La DRFQ se asocia a mayor morbimortalidad, deterioro de la función pulmonar y del estado nutricional. Por lo mismo, el manejo óptimo de esta patología depende de un diagnóstico precoz, tratamiento individualizado y vigilancia de las complicaciones diabéticas. El screening de DRFQ debe realizarse anualmente a partir de los 10 años, mediante una Prueba de Tolerancia a la Glucosa Oral (PTGO), lo cual permite el diagnóstico. El manejo de esta patología tiene por objetivo estabilizar y mejorar la función pulmonar y el estado nutricional y metabólico de los pacientes. Actualmente, la insulina es el tratamiento farmacológico de elección para controlar la hiperglicemia y el esquema de uso debe ser individualizado para cada persona. En caso de enfermedades agudas pueden existir mayores requerimientos de insulina. Además, se deben tener consideraciones especiales en cuanto a la dieta y la insuficiencia pancreática exocrina que presentan estos pacientes. Para la vigilancia de complicaciones microvasculares se debe realizar una monitorización anual a partir de los 5 años desde el diagnóstico de DRFQ. Debido a la complejidad de estos pacientes, para alcanzar el mejor cuidado posible se necesita un enfoque multidisciplinario con distintos profesionales de la salud coordinados, incluyendo en la toma de decisiones al paciente y su familia.


Advances made in the field of cystic fibrosis have increased the life expectancy of these patients, which is why Cystic Fibrosis-Related Diabetes (CFRD) and its complications are becoming more and more prevalent. CFRD is associated with increased morbidity and mortality, lower lung function and inadequate weight maintenance. Therefore, the optimal management of this pathology depends on an early diagnosis, individualized treatment and monitoring of diabetic complications. For CFRD, routine screening with an Oral Glucose Tolerance Test (OGTT) should be carried out yearly from the age of 10, which allows to diagnose it. The treatment goals in CFRD are to stabilize and improve lung function and obtain adequate weight gain. Currently, insulin is the pharmacological treatment of choice to control hyperglycemia and the insulin regimen must be personalized for each person. In acute illnesses, there may be higher insulin requirements. In addition, special considerations must be taken regarding diet and exocrine pancreatic insufficiency that these patients present. For the surveillance of microvascular complications, annual monitoring should be carried out 5 years after the diagnosis of CFRD. Due to the complexity of these patients, in order to achieve the best possible care, a multidisciplinary approach is needed with different coordinated health professionals, including the patients and their family in the decision-making process.


Subject(s)
Humans , Cystic Fibrosis/complications , Cystic Fibrosis/diagnosis , Cystic Fibrosis/therapy , Diabetes Mellitus/etiology , Diabetes Mellitus/therapy , Patient Care Team , Mass Screening , Cystic Fibrosis/physiopathology , Nutrition Therapy , Diabetes Mellitus/diagnosis , Diabetes Mellitus/physiopathology , Insulins/therapeutic use , Glucose Tolerance Test , Hypoglycemic Agents/therapeutic use
7.
In. Spósito García, Paola; García, Silvia. Manejo de la hiperglucemia en el paciente con diabetes mellitus. Montevideo, Oficina del Libro-FEFMUR, 2021. p.59-70, tab.
Monography in Spanish | LILACS, BNUY, UY-BNMED | ID: biblio-1373143
8.
In. Spósito García, Paola; García, Silvia. Manejo de la hiperglucemia en el paciente con diabetes mellitus. Montevideo, Oficina del Libro-FEFMUR, 2021. p.71-75.
Monography in Spanish | LILACS, BNUY, UY-BNMED | ID: biblio-1373145
9.
In. Spósito García, Paola; García, Silvia. Manejo de la hiperglucemia en el paciente con diabetes mellitus. Montevideo, Oficina del Libro-FEFMUR, 2021. p.77-79.
Monography in Spanish | LILACS, BNUY, UY-BNMED | ID: biblio-1373154
10.
Article in Chinese | WPRIM | ID: wpr-879819

ABSTRACT

OBJECTIVE@#To study the clinical effect of continuous subcutaneous insulin infusion (CSⅡ) versus multiple daily injection (MDI) on blood glucose control in children with type 1 diabetes mellitus (T1DM).@*METHODS@#A retrospective analysis was performed on the medical data of 91 children with T1DM who were treated with CSⅡ for more than 1 year and 75 children with T1DM who were treated with MDI. The two groups were compared in terms of glycosylated hemoglobin (HbA1C) and the recurrence of diabetic ketoacidosis (DKA) to evaluate the difference in the efficacy during the 3-year follow-up. A survey was conducted for the children in the CSⅡ group and their family members to investigate the degree of satisfaction with insulin pump.@*RESULTS@#There was no significant difference in age, sex, and course of diabetes between the CSⅡ and MDI groups at disease onset and in the first year, the second year, and the third year of follow-up (@*CONCLUSIONS@#Children with T1DM treated with CSⅡ have a better control of blood glucose than those treated with MDI, and children and their family members are satisfied with CSⅡ treatment. Therefore, it holds promise for clinical application.


Subject(s)
Child , Diabetes Mellitus, Type 1/drug therapy , Diabetic Ketoacidosis , Follow-Up Studies , Humans , Insulins , Retrospective Studies
11.
Article in English | WPRIM | ID: wpr-765770

ABSTRACT

The purpose of the present overview of meta-analysis is to summarize and critically assess the effect of isoflavones and genistein on glucose metabolism among the peri- and post-menopausal women. Two independent authors searched the databases of MEDLINE, Scopus and Cochrane Library for meta-analysis. Three databases were searched from inception to January 2018. Methodological quality of each meta-analysis of randomized controlled trials was evaluated using the AMSTAR (a measurement tool used to assess systematic reviews). Four meta-analyses were included to the current overview. Fasting insulin levels and homeostatic model assessment of insulin resistance (HOMA-IR) values were significantly lower in peri-menopausal and postmenopausal. Two meta-analyses showed that treatment with isoflavones could not alter fasting blood glucose. However, one meta-analysis depicted that isoflavones significantly improved blood glucose levels in non-Asian postmenopausal women. Treatment with genistein could have significant beneficial effects on fasting insulin, blood glucose and HOMA-IR in comparison to the control group. Regardless of the population, the treatment with genistein is effective in improving fasting insulin, HOMA-IR and glucose levels. Nevertheless, the high heterogeneity among studies and poor methodology of reviews made it difficult to draw a definite conclusion on the positive impacts of soy on glucose metabolism.


Subject(s)
Blood Glucose , Fasting , Female , Genistein , Glucose Metabolism Disorders , Glucose , Humans , Insulin , Insulin Resistance , Insulins , Isoflavones , Menopause , Metabolism , Population Characteristics
12.
São Paulo; s.n; s.n; 2019. 120 p. graf.
Thesis in English | LILACS | ID: biblio-1048970

ABSTRACT

The thiazolidinediones (TZDs) class comprises drugs with hypoglycemic effects, reducing insulin resistance in peripheral tissues. Our group has demonstrated in preliminary in vivo studies that a new TZD, GQ-11, improves insulin resistance as well as modulates cytokines involved in inflammatory process, suggesting an interesting approach for therapeutic alternatives in tissue repair, especially in metabolic decompensation cases, as insulin resistance and ischemia-reperfusion. In this context, the aim of this study was to investigate GQ-11 effects in tissue repair in three different models: insulin resistance in db/db mice, reconstructed human epidermis (RHE) in glycated collagen matrix and ischemia/reperfusion induced by aorta clamping in Wistar rats. In insulin resistance context, GQ-11 treatment upregulated the expression of anti-inflammatory mediators, such as IL-10, TGF-ß and Arg-1, downregulated the expression of pro-inflammatory cytokines both in db/db mice wounds and in macrophage, besides increasing re-epithelization and collagen deposition. In addition, the treatment also induced keratinocytes proliferation and fibroblasts differentiation in RHE. In ischemia-reperfusion model, the same anti-inflammatory effect was observed along with anti-oxidant properties through regulation of enzymes, such as catalase and GPx, as well as by decreasing TBARS formation. Animals imaging by positron emission tomography (PET) indicated significant less 18F-FDG uptake in animal treated with GQ-11 compared to controls, suggesting decrease of the inflammation process related to reperfusion after aorta clamping. Concluding, the dual PPARα/γ agonist GQ-11 has an important antiinflammatory effect, suggesting a new approach to tissue repair management in diabetes and in prevention of ischemia-reperfusion syndrome post-surgery


As tiazolidinadionas (TZDs) compreendem uma classe de fármacos hipoglicemiantes que reduzem a resistência à insulina pelos tecidos periféricos. Dados preliminares in vivo obtidos em nosso grupo de pesquisa mostraram que um dos novos derivados tiazolidínicos, GQ-11, além de aumentar a resposta à insulina, pode inibir citocinas pró-inflamatórias, o que a torna uma alternativa terapêutica promissora no reparo tecidual, em especial, nos casos de descompensação metabólica como ocorre na resistência à insulina e na isquemia/reperfusão. Nesse contexto, o objetivo deste trabalho foi investigar os efeitos da GQ-11 nas etapas do processo de reparo tecidual em três modelos: resistência à insulina utilizando camundongos db/db, epiderme humana reconstruída em matriz de colágeno glicado e isquemia/reperfusão induzida por clampeamento da aorta em ratos Wistar. No contexto de resistência à insulina, o tratamento com GQ-11 induziu a expressão de mediadores anti-inflamatórios como IL-10, TGF-ß e Arg-1 e diminuiu a expressão de citocinas pró-inflamatórias em lesões de camundongos db/db e em macrófagos, além de aumentar a capacidade de re-epitelização e a deposição de colágeno. Além disso, o tratamento também induziu a proliferação de queratinócitos e a diferenciação de fibroblastos em epiderme humana reconstruída em matriz de colágeno glicado. No modelo de isquemia-reperfusão, o mesmo efeito anti-inflamatório da GQ-11 foi observado ao lado de efeitos anti-oxidantes através da regulação de enzimas como catalase, GPx e diminuição de TBARS. O imageamento dos animais através de tomografia por emissão de pósitrons (PET) demonstrou menor captação de 18F-FDG (18F-fluordesoxiglicose), indicando diminuição do processo inflamatório decorrente da reperfusão pós clampeamento aórtico. Dessa forma, conclui-se que GQ-11, um agonista dual de PPARα/γ, tem efeito anti-inflamatório importante, podendo ser um candidato à fármaco com possível aplicação no reparo tecidual no diabetes e na prevenção da síndrome de isquemia-reperfusão desenvolvida após procedimentos cirúrgicos


Subject(s)
Animals , Mice , Insulins , Hypoglycemic Agents/agonists , Inflammation/classification , Reperfusion Injury/classification , Ischemia
13.
Rev. cuba. endocrinol ; 29(3): 1-12, set.-dic. 2018. ilus, tab
Article in Spanish | LILACS | ID: biblio-978395

ABSTRACT

ntroducción: La diabetes mellitus tipo 1 (DM1) es la enfermedad crónica más frecuente en la edad pediátrica. La educación del niño con DM1 es fundamental para un adecuado control de la enfermedad. Las lipohipertrofias son una de las complicaciones más frecuentes que se producen por el tratamiento con insulina. Estas son consideradas problemas de colaboración y, por lo tanto, es labor de la enfermera controlar su aparición e intervenir para minimizar sus consecuencias. Objetivo: Determinar las características de las lipohipertrofias en niños diagnosticados con diabetes mellitus tipo 1. Métodos: Estudio descriptivo transversal mediante muestreo por conveniencia. Se evaluó la presencia, localización y tamaño de las lipohipertrofias y la relación de la persona que administra la insulina con el régimen de tratamiento. Se estudiaron pacientes de edades comprendidas entre 2 y 18 años que tuviesen, al menos, 3 meses de tratamiento insulínico. Se calculó el tamaño de la muestra mediante estimación de la proporción. Resultados: La prevalencia de lipohipertrofias fue del 44,5 por ciento. Sin embargo, entre los niños estudiados que se encontraban en tratamiento con múltiples dosis de insulina, el porcentaje se elevó a 53,8 por ciento. Los análogos de acción rápida eran inyectados principalmente en abdomen y brazo, los de acción lenta en glúteo y muslo. Los lugares con más lipohipertrofias eran muslos (superando el 50 por ciento), seguido de brazos y abdomen. Conclusiones: Se detectaron diferencias significativas en la aparición de lipohipertrofias entre los niños que portan bomba de insulina y los que utilizan un régimen de múltiples dosis de insulina. Por lo tanto, se podría recomendar la utilización de bomba de insulina o de catéteres de infusión subcutánea (i-Port ®) para la disminución de estas(AU)


Introduction: Type 1 diabetes mellitus (T1DM) is the most common chronic disease in the pediatric age. In order to obtain a positive control of this illness, the T1DM child education is basic. Lipohypertrophies are one of the most frequent difficulties that appear as a consequence of the insulin treatment. When this happen, is nurse's responsibility to monitor the appearance of lipohypertrophies and to try to reduce their consequences. Objectives: Establish the prevalence of lipohypertrophy in children with T1DM performed at the Pediatric Endocrinology Unit of the Hospital Universitario La Paz. Methods: To analyze lipohypertrophy it has been performed a descriptive study. The method used for the sampling was for convenience. Appearance, location and size of lipohypertrophies were evaluated. This has been related with person who administers the insulin and the treatment regimen. Results: Lipohypertrophy prevalence in the sample represented a 44.5 percent, however, between patients which were in a treatment with multiple daily injections this was 53.8 percent. Quick action analogues were mainly injected in abdomen and arms, slow action analogues were aministered in buttocks and leg. Legs were the part of the body with the most lipohypertrophies concentration (exceeded 50 percent), follow by arms and abdomen. Conclusions: Meaningful differences are shown in the appearance of lipohypertrophies between children in treatment with continuous subcutaneous insulin infusion and those that use a multiple daily injections treatment. Therefore, we concluded considering the possibility to recommend the use of continuous subcutaneous insulin infusion or indwelling catheters (i-Port ®) in order to decrease lipohypertrophies(AU)


Subject(s)
Humans , Child , Adolescent , Diabetes Mellitus, Type 1/diagnosis , Insulins/administration & dosage , Insulins/therapeutic use , Epidemiology, Descriptive , Cross-Sectional Studies , Nursing Care/statistics & numerical data
14.
Ciênc. Saúde Colet. (Impr.) ; 22(6): 1857-1864, jun. 2017. tab
Article in Portuguese | LILACS | ID: biblio-839992

ABSTRACT

Resumo As insulinas análogas são alvo de controvérsias quanto à sua superioridade terapêutica em relação às humanas. Talvez, em parte, devido a isso, são objetos frequentes de ações judicias. A judicialização da saúde tem sido muito estudada, mas pouco se sabe sobre os motivos que levam as pessoas a recorrerem ao Judiciário para obter acesso a medicamentos no SUS. Sendo assim, o presente estudo tem por objetivo analisar os motivos que levaram as pessoas a recorrerem ao Judiciário para obter o acesso às insulinas análogas no estado da Bahia, tratando-se de um estudo de caso apoiado em fonte documental. Foram analisadas, entre 2010 e 2013, 149 ações judiciais que solicitaram o fornecimento de análogas pela secretaria estadual da saúde. Os motivos do recurso à Justiça, citados nos autos, podem ser classificados em: hipossuficiência financeira do usuário, necessidade de insulina análoga, dever e obrigação do Estado em fornecê-las e dificuldades burocráticas. Majoritariamente, as pessoas recorreram ao Judiciário, porque os médicos que as acompanham, divergindo das políticas oficiais, acreditam que as insulinas análogas são melhores do que às humanas e o sistema público de saúde não as dispensa, não dispondo elas de condições financeiras que lhes permitam adquiri-las com recursos próprios.


Abstract Insulin analogues have been the object of controversy concerning their therapeutic superiority to human insulin. Perhaps, in part, because of this, insulin analogues are frequently the subject of lawsuits. The judicialization of health has been well studied, but little is known about the reasons that lead people to go to the courts to obtain access to medicines on SUS (the Brazilian National Health System). Therefore, this study aims to analyze the reasons that led people to appeal to the courts to obtain access to insulins analogues in the state of Bahia. This is a case study based on documentary sources. Between 2010 and 2013, 149 lawsuits requiring insulin analogues from the state health authority were filed in the courts. The main reasons for the appeal to the courts, cited in the cases, can be grouped into four categories: the users’ lack of finances, an essential need for insulin analogue, the duty and obligation of the state to provide them and bureaucratic difficulties. People turned to the courts, mostly, because doctors who accompany their patients have shifted from the official policy, believing that insulin analogues are better than human insulins. They also recognize that the public health system does not distribute them nor does it give doctors the wherewithal to purchase them with their own resources.


Subject(s)
Humans , Delivery of Health Care/legislation & jurisprudence , Insulins/supply & distribution , Health Services Accessibility/legislation & jurisprudence , National Health Programs/legislation & jurisprudence , Physicians/organization & administration , Brazil , Delivery of Health Care/economics , Insulins/economics , Health Services Accessibility/economics , Hypoglycemic Agents/economics , Hypoglycemic Agents/supply & distribution , National Health Programs/economics
15.
Braz. J. Pharm. Sci. (Online) ; 53(3): e00178, 2017. tab, graf
Article in English | LILACS | ID: biblio-889385

ABSTRACT

ABSTRACT Human insulin is provided by the Brazilian Public Health System (BPHS) for the treatment of diabetes, however, legal proceedings to acquire insulin analogs have burdened the BPHS health system. The aim of this study was to perform a cost-effectiveness analysis to compare insulin analogs and human insulins. This is a pharmacoeconomic study of cost-effectiveness. The direct medical cost related to insulin extracted from the Ministry of Health drug price list was considered. The clinical results, i.e. reduction in glycated hemoglobin (HbA1c), were extracted by meta-analysis. Different scenarios were structured to measure the uncertainties regarding the costs and reduction in HbA1c. Decision tree was developed for sensitivity of Incremental Cost Effectiveness Ratio (ICER). A total of fifteen scenarios were structured. Given the best-case scenario for the insulin analogs, the insulins aspart, lispro, glargine and detemir showed an ICER of R$ 1,768.59; R$ 3,308.54; R$ 11,718.75 and R$ 2,685.22, respectively. In all scenarios in which the minimum effectiveness was proposed, lispro, glargine and detemir were dominant strategies. Sensitivity analysis showed that the aspart had R$ 3,066.98 [95 % CI: 2339.22; 4418.53] and detemir had R$ 6,163.97 [95% CI: 3919.29; 11401.57] for incremental costs. We concluded there was evidence that the insulin aspart is the most cost-effective.


Subject(s)
Cost-Benefit Analysis/statistics & numerical data , Insulin, Long-Acting/analysis , Insulins/analysis , Insulin, Short-Acting/analysis , Unified Health System/statistics & numerical data , Glycated Hemoglobin , Costs and Cost Analysis , Diabetes Mellitus/drug therapy , Insulin Aspart/analysis , Insulin Detemir , Insulin/supply & distribution
16.
Article | WPRIM | ID: wpr-960114

ABSTRACT

INTRODUCTION: Pre-impaired  glucose  tolerance  (pre-IGT) or  compensated  hyperinsulinemia,  is  defined  as  normal glucose,  and  elevated  insulin  two  hours  after  a  75-gram oral glucose load.  It is characteristic of the early stages of diabetes  mellitus  (DM),  where  beta  cells  compensate  for  insulin resistance by increasing insulin secretion to maintain normoglycemia. With  continuing  beta  cell  failure,  insulin  secretion  eventually  fails,  leading  to  the  progression  to diabetes.    Nonalcoholic  fatty  liver  disease  (NAFLD),  a common feature of insulin resistance, is found in 50-75% and 42-55% of DM and pre-diabetes patients. We determined if NAFLD was present in patients with pre-IGT.METHOD: A study on the determination of NAFLD - diagnosed by liver ultrasound in pre-IGT patients at a university hospital.Descriptive statistics, Chi square test of independence, 2x2 Fischer  Exact  test,  Z  test  of  difference  in  proportion, were used  for  statistical  analysis  with  a  p-value  set  at  0.05?.IBMSPSS ver 21 was used as software.RESULTS:The mean age of 22 patients was 29.95 years, with average BMI of 25.73 kg/m2;77.3% were female.  Average lipid  panels  were  within  optimal  limits;  kidney  and  liver functions were normal.  The mean insulin level was 58.36 uIU/mL. NAFLD was identified in eight of the subjects. CONCLUSION: Although  pre-IGT  is  a  subclinical  phase  in  the  diabetes  spectrum,  36%  already  have  NAFLD.This prevalence  was  lower  compared  to  diabetics  and  pre-diabetics, but higher compared to the general population.There was a noticeable trend of increasing insulin levels with increasing severity of fatty liver.


Subject(s)
Humans , Male , Female , Aged , Middle Aged , Adult , Glucose Intolerance , Insulin Resistance , Non-alcoholic Fatty Liver Disease , Hyperinsulinism , Prediabetic State , Insulin-Secreting Cells , Insulins , Glucose , Lipids
17.
Article | WPRIM | ID: wpr-960104

ABSTRACT

INTRODUCTION: Pre-impaired  glucose  tolerance  (pre-IGT) or  compensated  hyperinsulinemia,  is  defined  as  normal glucose,  and  elevated  insulin  two  hours  after  a  75-gram oral glucose load.  It is characteristic of the early stages of diabetes  mellitus  (DM),  where  beta  cells  compensate  for  insulin resistance by increasing insulin secretion to maintain normoglycemia. With  continuing  beta  cell  failure,  insulin  secretion  eventually  fails,  leading  to  the  progression  to diabetes.    Nonalcoholic  fatty  liver  disease  (NAFLD),  a common feature of insulin resistance, is found in 50-75% and 42-55% of DM and pre-diabetes patients. We determined if NAFLD was present in patients with pre-IGT.METHOD: A study on the determination of NAFLD - diagnosed by liver ultrasound in pre-IGT patients at a university hospital.Descriptive statistics, Chi square test of independence, 2x2 Fischer  Exact  test,  Z  test  of  difference  in  proportion, were used  for  statistical  analysis  with  a  p-value  set  at  0.05?.IBMSPSS ver 21 was used as software.RESULTS:The mean age of 22 patients was 29.95 years, with average BMI of 25.73 kg/m2;77.3% were female.  Average lipid  panels  were  within  optimal  limits;  kidney  and  liver functions were normal.  The mean insulin level was 58.36 uIU/mL. NAFLD was identified in eight of the subjects. CONCLUSION: Although  pre-IGT  is  a  subclinical  phase  in  the  diabetes  spectrum,  36%  already  have  NAFLD.This prevalence  was  lower  compared  to  diabetics  and  pre-diabetics, but higher compared to the general population.There was a noticeable trend of increasing insulin levels with increasing severity of fatty liver.


Subject(s)
Humans , Male , Female , Aged , Middle Aged , Adult , Glucose Intolerance , Insulin Resistance , Non-alcoholic Fatty Liver Disease , Hyperinsulinism , Prediabetic State , Insulin-Secreting Cells , Insulins , Glucose , Lipids
18.
Article in English | WPRIM | ID: wpr-633444

ABSTRACT

INTRODUCTION: Pre-impaired  glucose  tolerance  (pre-IGT) or  compensated  hyperinsulinemia,  is  defined  as  normal glucose,  and  elevated  insulin  two  hours  after  a  75-gram oral glucose load.  It is characteristic of the early stages of diabetes  mellitus  (DM),  where  beta  cells  compensate  for  insulin resistance by increasing insulin secretion to maintain normoglycemia. With  continuing  beta  cell  failure,  insulin  secretion  eventually  fails,  leading  to  the  progression  to diabetes.    Nonalcoholic  fatty  liver  disease  (NAFLD),  a common feature of insulin resistance, is found in 50-75% and 42-55% of DM and pre-diabetes patients. We determined if NAFLD was present in patients with pre-IGT.METHOD: A study on the determination of NAFLD - diagnosed by liver ultrasound in pre-IGT patients at a university hospital.Descriptive statistics, Chi square test of independence, 2x2 Fischer  Exact  test,  Z  test  of  difference  in  proportion, were used  for  statistical  analysis  with  a  p-value  set  at  0.05?.IBMSPSS ver 21 was used as software.RESULTS:The mean age of 22 patients was 29.95 years, with average BMI of 25.73 kg/m2;77.3% were female.  Average lipid  panels  were  within  optimal  limits;  kidney  and  liver functions were normal.  The mean insulin level was 58.36 uIU/mL. NAFLD was identified in eight of the subjects. CONCLUSION: Although  pre-IGT  is  a  subclinical  phase  in  the  diabetes  spectrum,  36%  already  have  NAFLD.This prevalence  was  lower  compared  to  diabetics  and  pre-diabetics, but higher compared to the general population.There was a noticeable trend of increasing insulin levels with increasing severity of fatty liver.


Subject(s)
Humans , Male , Female , Aged , Middle Aged , Adult , Glucose Intolerance , Insulin Resistance , Non-alcoholic Fatty Liver Disease , Hyperinsulinism , Prediabetic State , Insulin-Secreting Cells , Insulins , Glucose , Lipids
19.
Lima; s.n; nov. 2016.
Non-conventional in Spanish | LILACS, BRISA | ID: biblio-848202

ABSTRACT

INTRODUCCIÓN: Antecedentes: El presente dictamen expone la evaluación de tecnología de la eficacia y seguridad de Liraglutida en pacientes con diabetes melitus tipo 2 y sobrepeso, sin control metabólico adecuado (según HbA1c) a pesar de tratamiento bolo-basal con dosis altas de Insulina. Aspectos Generales: La diabetes melittus tipo 2 (conocida previamente como diabetes no insulino-dependiente o diabetes de inicio en el adulto) aparece por el uso inefectivo de la insulina por el organismo. Este tipo de diabetes incluyer a la mayoria de casos de diabetes en el mundo, y por contar con sintomas poco marcados o ausentes, puede no ser diagnosticada por varios años hasta la aparición de sus complicaciones. Tecnología Sanitaria de Interés: Los agonistas de receptores GLP-1 (Péptido similiar a1 glucagón tipo 1, por sus siglas en inglés) son un tipo de medicamentos antidiabéticos inyectables que pueden mejorar el control glicémico e inducir la disminución de peso. Estos medicamentos funcionan promoviendo la secreción de insulina dependiente de glucosa e inhibiendo la liberación promoviendo la secreción de insulina dependiente de glucosa e inhibiendo la liberación de glucagón. METODOLOGÍA: Estrategia de Búsqueda: Se realizó una estrategia de búsqueda sistemática de la evidencia científica con respecto a la eficacia y seguridad de liraglutida en pacientes con diabetes mellitus tipo 2 y sobrepeso, sin control metabólico adecuado (según HbA1c) a pesar de tratamiento bolo-basal con dosis altas de insulina. Se dio preferencia a estudios de tipo meta-análisis, revisiones sistemáticas y ensayos clínicos aleatorizados; así como a guías de práctica clínica de grupos o instituciones relevantes al tema analizado. RESULTADOS: Sinopsis de la Evidencia: Se realizó la búsqueda y revisión de la evidencia científica actual para la evaluación de la eficacia y seguridad de Liraglutida en pacientes con diabetes mellitus tipo 2 y sobrepeso, sin control metabólico adecuado a pesar de tratamiento bolo-basal con dosis altas de Insulina. Se presenta la información encontrada de acuerdo al tipo de evidencia revisada. CONCLUSIONES: La población de interés de la presente evaluación de tecnología sanitaria comprende los pacientes con diabetes mellitus tipo 2 y sobrepeso, sin control metabólico adecuado (según HbA1c) a pesar de tratamiento bolo-basal con dosis altas de Insulina. LOs ensayos clínicos revisados presentan un cambio significativo en los valores de HbA1c en pacientes que recibieron la intervención evaluada en comparación a los valores basales y al uso de insulina sola. Asimismo, se observa un resultado similar para el peso y dosis total de insulina diaria de los participantes. La frecuencia de efectos adversos severos asociados al uso de Liraglutida en combinación con Insulina bolo-basal es baja y el medicamento es bien tolerado. Las características de los GLP-1-RA los hacen útiles en casos en los que los pacientes reciben dosis altas de insulina y sus consecuentes efectos adversos. Se requiere la ejecución de estudios de costo-efectividad de uso de Liraglutida en combinación con insulina bolo-basal comparando dicho tratamiento con la Insulina bolo-basal sola para evaluar el impacto real de ambas terapias sobre los pacientes de interés. El Instituto de Evaluación de Tecnologías Sanitarias-IETSI, aprueba el uso de Liraglutida en apcientes con diabetes mellitus tipo 2 y sobrepeso, sin control metabólico adecuado a pesar de tratamiento bolo-basal con dosis altas de Insulina. El período de vigencia de este dictamen es de dos años y la continuación de dicha aprobación estará sujeta a los resultados obtenidos de los pacientes que se beneficien con dicho tratamiento y a nueva evidencia que pueda surgir en el tiempo.


Subject(s)
Humans , Diabetes Mellitus, Type 2/drug therapy , Diabetes Mellitus, Type 2/metabolism , Insulins/administration & dosage , Liraglutide/administration & dosage , Overweight , Technology Assessment, Biomedical , Treatment Outcome
20.
Medicina (B.Aires) ; 76(3): 173-179, June 2016. ilus, graf, tab
Article in Spanish | LILACS | ID: biblio-841566

ABSTRACT

La diabetes mellitus se asocia con complicaciones vasculares y elevadas tasas de morbimortalidad. La terapia oportuna con insulina y su intensificación cuando es necesaria, representan estrategias apropiadas para evitar o retardar la aparición de dichas complicaciones. Sin embargo, la incidencia de hipoglucemia y las dificultades en la adherencia al tratamiento representan barreras para alcanzar el éxito terapéutico. Las nuevas combinaciones de análogos de insulina constituyen tratamientos que presentarían ventajas farmacocinéticas y farmacodinámicas, logrando beneficios clínicos tales como un mejor control metabólico, la disminución de eventos hipoglucémicos y, por su simplicidad, potencialmente una mayor adherencia al tratamiento.


Diabetes mellitus is associated with vascular complications and high rates of morbidity and mortality. Timely insulin therapy, intensified when necessary, represent appropriate measures to prevent or delay the onset of complications. However, the incidence of hypoglycemia and difficulties in treatment adherence represent barriers to achieve therapeutic success. Premixes analogs and, specially, combinations of insulin analogues are associated with pharmacokinetic and pharmacodynamic advantages, that translate into clinical benefits such as improved metabolic control, decreased hypoglycemic events and, for their simplicity, potentially greater adherence.


Subject(s)
Humans , Diabetes Mellitus, Type 2/drug therapy , Insulins/therapeutic use , Hypoglycemic Agents/therapeutic use , Risk Factors , Treatment Outcome , Diabetes Mellitus, Type 2/prevention & control , Drug Therapy, Combination , Insulins/pharmacokinetics , Glucagon-Like Peptide-1 Receptor/antagonists & inhibitors , Hypoglycemia/chemically induced , Hypoglycemia/prevention & control , Hypoglycemic Agents/pharmacokinetics
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