Multifactorial intervention for diabetes control among older users of insulin

ABSTRACT OBJECTIVE: To evaluate if the closer follow-up with the supply of insulin pens and the measurement of capillary blood glucose improve the management of older patients with type 2 diabetes without adequate glycemic control despite extensive therapy. METHODS: This is a prospective, non-randomized, quasi-experimental study. We have included 45 patients over 60 years old, from both sexes, with glycated hemoglobin (HbA1c) > 8.5% using oral hypoglycemic agents and insulin. The intervention consisted of monthly medical visits, with the provision of insulin pens and strips for blood glucose measurement. All patients received insulin pen, refills of Neutral Protamine Hagedorn and regular insulin, needles for the pen, blood glucose meter, and capillary blood glucose tests (three tests/day). Treatment was adjusted with the same endocrinologist monthly for six months. Glycated hemoglobin was measured at baseline and 12 and 24 weeks after intervention. RESULTS: Glycated hemoglobin at baseline was 10.34% (SE = 0.22%) and 8.54% (SE = 0.24%, p < 0.001) and 8.09% (SE = 0.21%, p < 0.001) at 12 and 24 weeks after intervention, respectively, with a significant reduction from baseline. CONCLUSIONS: More frequent medical visits, with treatment inputs including the use of insulin pens and self-monitoring, have improved glycemic control (reduction of 2.25% in HbA1C, on average, at 24 weeks of follow-up). Our data support a change in the management and medical behavior of older patients with chronically decompensated diabetes.

Phytotherapy in reducing glycemic index and testicular oxidative stress resulting from induced diabetes: a review / Fitoterapia na redução da glicemia e do estresse oxidativo testicular resultantes do diabetes experimental: uma revisão

Abstract Oxidative stress plays a main role in the development of diabetes complications. The impairment of gonadal antioxidant potential and endocrine disturbance in diabetic males causes testicular damage and failure in sperm production. Plants have been widely used to control diabetes due their hypoglycemic and antioxidant potential, contributing towards the recovery of testicular function. Current study comprises a review of the literature on the main medicinal plants used in the recovery of testicular oxidative damage in animals with experimental diabetes. Eighteen plant species in the nineteen studies selected from the search strategy were evaluated. Plant extracts were evaluated according to their effects on blood glucose and insulin levels, antioxidant enzymes and oxidant levels, lipid peroxidation, total protein, testosterone levels, gonadosomatic index, diameter of seminiferous tubules, seminiferous epithelium height and integrity, number of germ cells at stage VII and apoptosis in the seminiferous epithelium, sperm production, motility, viability and morphology. After the analysis of the studies, it was observed that plant species, used alone or in combination, may control testicular oxidative damage triggered by diabetes. The antioxidant potential varies among species, with some plants proving to have a better performance in the recovery of reproduction parameters than others.

Resumo O estresse oxidativo desempenha um dos principais papéis no desenvolvimento das complicações do diabetes. Em machos diabéticos, as alterações ao potencial antioxidante gonadal e os distúrbios endócrinos resultam em danos testiculares e falhas na produção de espermatozoides. Plantas têm sido amplamente utilizadas como um método de controle do diabetes devido aos seus potenciais hipoglicemiante e antioxidante, contribuindo para a recuperação da função testicular. Assim, o objetivo deste estudo é fazer uma revisão da literatura sobre as principais plantas medicinais utilizadas na recuperação de danos oxidativos testiculares em animais induzidos ao diabetes experimental. Nos dezenove estudos selecionados a partir da estratégia de busca, dezoito espécies de plantas foram utilizadas. Os extratos das espécies vegetais foram avaliados de acordo com os seus efeitos nas concentrações de glicose e insulina, níveis das enzimas antioxidantes e dos oxidantes, peroxidação lipídica, quantidade de proteínas totais, níveis de testosterona, índice gonadossomático, diâmetro dos túbulos seminíferos, altura e integridade do epitélio seminífero, número de células germinativas no estágio VII, número de células em apoptose no epitélio seminífero, produção, motilidade, viabilidade e morfologia espermática. Depois das análises aos estudos, foi observado que as espécies vegetais, sozinhas ou em combinação, podem ajudar a controlar os danos oxidativos testiculares desencadeados pelo diabetes. Contudo, o potencial antioxidante varia entre as espécies, algumas tenho uma melhor performance na recuperação dos parâmetros reprodutivos do que outras.

Programa de gerenciamento de doenças crônicas em um plano de saúde, são paulo, brasil / Programa de gestión de enfermedades crónicas en un seguro salud en el estado de são paulo, brasil / Chronic disease management program in a health plan, são paulo, brazil

RESUMO Atualmente as doenças crônicas não transmissíveis são as principais causas de morte no mundo. Consideradas doenças multifatoriais, têm em comum fatores de riscos modificáveis tais como inatividade física, colesterol elevado, excesso de peso, tabagismo, consumo excessivo de bebidas alcoólicas e alimentação não saudável. Com o objetivo de verificar o impacto por um programa de Gerenciamento de Doenças Crônicas, após dois anos de acompanhamento, surgiu esta pesquisa. Trata-se de programa desenvolvido com um grupo de clientes de uma autogestão localizada no estado de São Paulo. É um estudo transversal realizado durante os anos de 2014-2015 com dados de prontuário eletrônico que foram comparados parâmetros clínicos e hábitos de vida de 1.509 indivíduos participantes de um programa de gerenciamento de doenças em dois momentos: na entrada ao programa e após dois anos de participação. Observaram-se resultados satisfatórios na melhora de parâmetros clínicos relacionados aos níveis pressóricos e à dosagem de glicemia em jejum, assim como diminuição do sedentarismo em indivíduos abaixo dos 60 anos.

RESUMEN Actualmente las enfermedades crónicas no transmisibles son las principales causas de muerte en todo el mundo. Consideradas enfermedades multifactoriales, tienen en común factores de riesgo modificables, tales como inactividad física, colesterol alto, sobrepeso, tabaco, exceso de alcohol y alimentación poco sana. Con el objetivo de averiguar el impacto por un programa de Gestión de Enfermedades Crónicas, tras dos años de acompañamiento, se hizo esta investigación. Se trata de un programa desarrollado con un grupo de clientes de una autogestión ubicada en el estado de São Paulo, Brasil. Es un estudio transversal realizado durante los años de 2014-2015 con datos de registros médicos electrónicos, comparándose los parámetros clínicos y hábitos de vida de 1.509 personas que participan en un programa de gestión de enfermedades en dos ocasiones: cuando entran en el programa y después de dos años de participación. Se observaron resultados satisfactorios en la mejora de los parámetros clínicos relacionados con los niveles de presión arterial y a la dosificación de glucemia en ayunas, así como la disminución de la inactividad física en personas con edad abajo de 60 años.

ABSTRACT Currently, non-transmissible chronic diseases are leading causes of death worldwide. Considered as multifactorial diseases, they have common modifiable risk factors such as physical inactivity, high cholesterol, overweight, smoking, excessive alcohol consumption, and unhealthy diets. Aiming at verifying the impact of theChronic Disease Management program, this study arose after two years of follow-up. This is a program developed with a group of customers in a self-management platform in the state of São Paulo. This was a cross-sectional study carried out during 2014 and 2015 with electronic medical record data through the comparison ofthe clinical and lifestyle parameters of 1,509 individuals participating in a disease management program in two moments: at the program'sentry and two years after participation. Satisfactory results in the improvement of clinical parameters related to blood pressure and blood glucose levels in fasting were observed as well as decreased physical inactivity in individuals under 60 years of age.

Comportamiento de la hemoglobina glucosilada en diabéticos tipo 2 con macroangiopatía diabética de los miembros inferiores / Behavior of glycosylated hemoglobin type 2 in diabetics with diabetic macroangiopathy in the lower members

Introducción: la hemoglobina glucosilada es utilizada para evaluar el grado de control glucémico. Se ha publicado que la disminución de este indicador en el 2 % reduce la aparición o progresión de las complicaciones micro- o macrovasculares. Objetivo: determinar el comportamiento de la hemoglobina glucosilada en pacientes diabéticos tipo 2 con macroangiopatía diabética de los miembros inferiores. Métodos: se estudiaron 100 pacientes diabéticos tipo 2 con o sin macroangiopatía diabética de los miembros inferiores; 36 hombres y 64 mujeres, con una edad promedio de 61,8 años (44-79 años). Se cuantificó el grado de glucosilación de la hemoglobina y se calculó su valor de referencia. Se identificó y describió el tipo de asociación del indicador con diferentes factores de riesgo y con el tipo de macroangiopatía diabética. Resultados: se escogió el valor de 8,6 por ciento de hemoglobina glucosilada por ser el punto de corte con los mayores valores de sensibilidad (73,7 por ciento), especificidad (83,7 por ciento) y razón de probabilidad (4,52). Se constató un mal control glucémico en el 48,3 por ciento de los pacientes, donde la mayor proporción correspondió a la macroangiopatía de tipo ocluido (44,8 por ciento). En los pacientes descompensados fue la dislipidemia el factor de riesgo que más predominó (58,3 por ciento), así como la combinación del tabaquismo con la hipertensión arterial (35,3 por ciento). Conclusión: los pacientes diabéticos de tipo 2 con macroangiopatía diabética de los miembros inferiores de tipo ocluido mostraron valores muy elevados de hemoglobina glucosilada indicativo de un mal control metabólico(AU)

Introduction: glycosylated hemoglobin is used to evaluate the level of glycemic control. It has been reported that its decrease by 2 % reduces the occurrence or progression of micro or macrovascular complications. Objective: to determine the behavior of glycosylated hemoglobin in type 2 diabetes patients with macroangiopathy in lower limbs. Method: study of one hundred type 2 diabetic patients with/without diabetic macroangiopathy in their lower limbs; 36 were males and 64 females averagely aged 61.8 years (44-74 years). The level of hemoglobin glycosylation was quantitated as well as the reference value was estimated. The kind of association of this indicator with several risk factors and with the type of diabetic macroangiopathy was also established and described. Results: the reference value of 8.6 percent of the glycosylated hemoglobin was chosen because it was the cutoff point with the highest sensitivity (73.7 percent), specificity (83.7 percent) and probability odds (4.52) values. Poor glycemic control was confirmed in 48.3 percent of patients, mainly affected by occluded macroangiopathy (44.8 percent). In decompensated patients, dyslipidemia was the predominant risk factor (58.3 percent) along with the combination of smoking and blood hypertension (35.3 percent). Conclusions: the type 2 diabetic patients with occluded diabetic macroangiopathy of the lower limbs showed very high glycosylated hemoglobin values indicative of poor metabolic control(AU)

Rutin ameliorates glycemic index, lipid profile and enzymatic activities in serum, heart and liver tissues of rats fed with a combination of hypercaloric diet and chronic ethanol consumption.

Alcoholism and obesity are strongly associated with several disorders including heart and liver diseases. This study evaluated the effects of rutin treatment in serum, heart and liver tissues of rats subjected to a combination of hypercaloric diet (HD) and chronic ethanol consumption. Rats were divided into three groups: Control: rats fed a standard diet and drinking water ad libitum; G1: rats fed the HD and receiving a solution of 10% (v/v) ethanol; and G2: rats fed the HD and ethanol solution, followed by injections of 50 mg/kg-1 rutin as treatment. After 53 days of HD and ethanol exposure, the rutin was administered every three days for nine days. At the end of the experimental period (95 days), biochemical analyses were carried out on sera, cardiac and hepatic tissues. Body weight gain and food consumption were reduced in both the G1 and G2 groups compared to control animals. Rutin effectively reduced the total lipids (TL), triglycerides (TG), total cholesterol (TC), VLDL, LDL-cholesterol and glucose levels, while it increased the HDL-cholesterol in the serum of G2 rats, compared to G1. Although rutin had no effect on total protein, albumin, uric acid and cretinine levels, it was able to restore serum activities of alkaline phosphatase (ALP), lactate dehydrogenase (LDH), aspartate aminotransferase (AST), alanine aminotransferase (ALT) and creatine kinase (CK) in animals fed HD and receiving ethanol. Glycogen stores were replenished in both hepatic and cardiac tissues after rutin treatment. Moreover, rutin consistently reduced hepatic levels of TG and TC and cardiac AST, ALT and CK activities. Thus, rutin treatment was effective in reducing the risk factors for cardiac and hepatic disease caused by both HD and chronic ethanol consumption.

Características da dieta nas diferentes fases da evolução do diabetes melito tipo 1 / Diet composition along the evolution of type 1 diabetes mellitus

A importância da terapia nutricional no tratamento do diabetes melito tem sido enfatizada desde os primórdios de seu conhecimento, quando era a única intervenção efetiva. No diabetes tipo 1, a dieta adequada é fundamental em conseqüência de sua conjugação com a utilização da insulina exógena. A ingestão energética adequada, para obtenção de peso normal mantém o anabolismo, assegurando crescimento e desenvolvimento, assim como diminui a resistência à insulina. O uso correto dos micro e macronutrientes é de fundamental importância. O conhecimento do metabolismo dos carboidratos e sua relação com a elevação glicêmica, em seus aspectos qualitativos e quantitativos é enfatizada por possibilitar um bom controle, principalmente no período pós-prandial. É comentada também a correta utilização de proteínas para prevenir ou tratar nefropatia e gorduras para evitar a dislipidemia, obesidade e doença cardiovascular. Sacarose e edulcorantes artificiais devem ser utilizados com critérios. A aderência ao tratamento, entretanto, é fundamental para obtenção das metas desejadas.

The importance of nutrition therapy in treating diabetes mellitus has been emphasized since it was first identified, being the only effective intervention then. In Type 1 diabetes, its importance is even more pronounced due to its association with the use of exogenous insulin. Appropriate caloric ingestion in order to attain normal body weight maintains anabolism, warranting growth and development and decreases insulin resistance. The correct use of micronutrients and macronutrients is vitally important. The knowledge of carbohydrate metabolism and its association with glycemic elevation, in qualitative and quantitative aspects, is emphasized since it enables good control, especially during the postprandial period. The correct use of proteins to prevent or treat nephropathies and lipids or to avoid dyslipidemia, obesity, and cardiovascular disease are also addressed. Sucrose and artificial sweeteners should be used with care. Compliance with treatment, however, is the key to reach the desired goals.