Pre- and postoperative respiratory muscle strength, body mass index and fasting glucose profile of patients with type 2 diabetes mellitus submitted to metabolic surgery / Perfil de pacientes com diabetes mellitus tipo 2 quanto a força muscular respiratória, o índice de massa corpórea e a glicemia em jejum avaliados no pré e no pós-operatório de cirurgia metabólica

Abstract Introduction: The lung is considered a target organ in diabetes mellitus as a consequence of alterations secondary to chronic hyperglycemia that compromise respiratory muscle strength. Metabolic surgery for improving diabetes mellitus has beneficial effects on weight loss and glucose metabolism. Objective: The objective of this study was to evaluate the respiratory muscle strength, assessed by MIP and MEP, body mass index (BMI) and fasting glucose profile of patients with type 2 diabetes mellitus before and after metabolic surgery without gastric resection. Method: Seventeen patients with type 2 diabetes mellitus participated in the study. The participants had a mean age of 44.8 ± 11.81 years. Results: The results showed a significant decrease of MEP values ​​in the immediate postoperative period when compared to the preoperative period (p=0.001), while no significant results were obtained for MIP. Regarding BMI and fasting glucose, significant weight loss and a significant reduction in fasting glucose levels were observed in the late postoperative period (p=0.006 and p=0.007, respectively). Conclusion: The MIP and MEP were reestablished and satisfactory results were obtained for BMI and fasting glucose in the late postoperative period. Further studies are needed to monitor patients in the pre- and postoperative period of metabolic surgery, identifying complications and acting on the care and recovery of these patients.

Resumo Introdução: O pulmão é considerado um dos órgãos-alvo do diabetes mellitus, como consequência das alterações secundárias à hiperglicemia crônica, comprometendo a força muscular respiratória. A cirurgia metabólica para a melhora do diabetes mellitus exerce efeitos benéficos na perda de peso e no metabolismo da glicose. Objetivo: O objetivo deste estudo foi avaliar o perfil da força muscular respiratória, avaliada por PImáx e PEmáx, o índice de massa corporal (IMC) e a glicemia em jejum de pacientes com diabetes mellitus tipo 2 antes e após a cirurgia metabólica sem ressecção gástrica. Método: Dezessete pacientes com diabetes mellitus tipo 2 participaram do estudo. Os participantes tinham idade média de 44,8±11,81 anos. Resultados: Os resultados mostraram uma diminuição significativa dos valores da PEmáx no pós-operatório imediato, quando comparado ao pré-operatório (p = 0,001), enquanto não foram obtidos resultados significativos para a PImáx. Em relação ao IMC e à glicemia em jejum, observou-se perda significativa de peso e redução significativa dos níveis de glicemia de jejum no pós-operatório tardio (p = 0,006; p= 0,007, respectivamente). Conclusão: A PImáx e a PEmáx foram restabelecidas e resultados satisfatórios foram obtidos para IMC e glicemia de jejum no pós-operatório tardio. Mais estudos são necessários para monitorar pacientes no pré e pós-operatório de cirurgia metabólica, identificando complicações e atuando no cuidado e recuperação desses pacientes.

Combination of preoperative pulmonary and nutritional preparation for esophagectomy

Abstract Purpose: To compare pulmonary and nutritional parameters before and after inspiratory muscle training (IMT) and enteral feeding support in patients with esophageal disease undergoing preoperative outpatient follow-up. Methods: Thirty patients with a mean age of 55.83 years, 16 men and 14 women, were included. Pulmonary assessment consisted of the measurement of MIP, MEP, and spirometry. Anthropometric measurements and laboratory tests were performed for nutritional assessment. After preoperative evaluation, inspiratory muscle training and enteral nutrition support were started. A p<0.05 was considered statistically significant. Results: After an outpatient follow-up period of 4 weeks, a significant increase in MIP (-62.20 ± 25.78 to -81.53 ± 23.09), MEP (73.4 ± 31.95 to 90.33 ± 28.39), and FVC (94.86 ± 16.77 to 98.56 ± 17.44) was observed. Regarding the anthropometric variables, a significant increase was also observed in BMI (20.18 ± 5.04 to 20.40 ± 4.69), arm circumference (23.38 ± 3.28 to 25.08 ± 4.55), arm muscle circumference (21.48 ± 3.00 to 22.07 ± 3.36), and triceps skinfold thickness (5.62 ± 2.68 to 8.33 ± 6.59). Conclusion: Pulmonary and nutritional preparation can improve respiratory muscle strength, FVC and anthropometric parameters. However, further studies are needed to confirm the effectiveness of this preoperative preparation.

Pulmonary function evaluation in type 2 diabetes mellitus patients submitted to metabolic surgery / Avaliação da função pulmonar em pacientes com diabetes mellitus tipo 2 submetidos à cirurgia metabólica

Abstract Introduction: Diabetes Mellitus (DM) is a multifactorial metabolic disorder. As considered a public health problem needing additional treatment options. Objective: This prospective study aimed at evaluating pulmonary function through spirometry, before and after metabolic surgery without gastric resection in type 2 DM patients. Methods: Sample was composed by 17 type 2 DM females. They were analyzed in pre (24 hours before surgical procedure), immediate post-operative period POST1 (24 hours after surgical procedure) and in the late postoperative period POST2 (two years after surgical procedure). Besides statistical analysis, it was evaluated the following spirometric parameters: forced vital capacity (FVC), forced expiratory volume in the first second (FEV1) and the FEV1 / FVC ratio (%). Results: Spirometric parameters showed a value increase when compared PRE and POS2 values, except for FVC and FEV1, which was not statistically significant. Conclusion: Type 2 DM women submitted to metabolic surgery without gastric resection showed spirometric value increased after two-year surgical procedure, when compared to preoperative period values. It is important additional studies about pulmonary function, diabetic patients and metabolic surgery without gastric resection.

Resumo Introdução: O Diabetes Mellitus (DM) é uma desordem metabólica multifatorial. Considerado um problema de saúde pública necessita de opções de tratamento adicionais. Objetivo: Este estudo prospectivo avaliou a função pulmonar, através da espirometria, antes e após a cirurgia metabólica sem ressecção gástrica em pacientes com diabetes mellitus tipo 2. Métodos: A amostra foi composta por 17 mulheres com diabetes mellitus tipo 2. Elas foram avaliadas no PRE (24 horas antes da cirurgia), pós-operatório imediato POST1 (24 horas após a cirurgia) e no pós-operatório tardio POST2 (dois anos após a cirurgia). Além da análise estatística, foram avaliados os seguintes parâmetros expirométricos: capacidade vital forçada (CVF), volume expiratório forçado no primeiro segundo (VEF1) e relação VEF1/CVF (%). Resultados: os parâmetros expirométricos aumentaram quando comparados aos valores PRE e POS2, exceto para CVF e VEF1, os quais não foram estatisticamente significativos. Conclusão: Mulheres diabéticas tipo 2 que realizaram cirurgia metabólica sem ressecção gástrica aumentaram o valor expirométrico após dois anos do procedimento cirúrgico, quando comparadas aos valores no pré-operatório. Estudos adicionais são importantes sobre a função pulmonar, diabetes e cirurgia metabólica sem ressecção gástrica.