El efecto agudo sobre niveles de glucemia en adultos mayores con el Entrenamiento Interválico de Alta Intensidad / Acute effect of High-Intensity Interval Training on glycemia levels in elderly people

Introducción: El Entrenamiento Interválico de Alta Intensidad durante los últimos años ha sido postulado como tratamiento no farmacológico para enfermedades como la diabetes tipo II en diferentes poblaciones, sin embargo, son pocos los estudios que se han realizado en adultos mayores. Objetivo: Determinar el efecto agudo de una sesión de Entrenamiento Interválico de Alta Intensidad sobre los niveles de glucosa en adultos mayores físicamente activos. Métodos: Se realizó un estudio experimental. La muestra estuvo conformada por 19 adultos mayores (60-85 años). El grupo fue sometido a una sesión de Entrenamiento Interválico de Alta Intensidad, en la que se combinaron ejercicios de fuerza con resistencia cardiovascular, y se realizaron 12 ejercicios con duración de 30 segundos de trabajo por 10 de descanso. La intensidad de la sesión fue controlada a través de la Escala de Percepción del Esfuerzo OMNI-GSE. Se midió la talla (cm), el peso (kg) e índice de masa corporal. Los niveles de glucosa en sangre fueron determinados antes y después de la sesión. Resultados: Se obtuvo una disminución significativa en los niveles de glucosa en sangre posterior a la realización de la sesión de Entrenamiento Interválico de Alta Intensidad (pre: 140,5 mg/dL y post: 116,1 mg/dL; p < 0,01) Conclusiones: El Entrenamiento Interválico de Alta Intensidad reduce en una sola sesión los niveles de glucosa en sangre en adultos mayores(AU)

Introduction: in recent years, High-Intensity Interval Training has been recognized as a non-pharmacological treatment for diseases like type II diabetes in a variety of populations. However, few studies about this topic have been conducted with elderly people. Objective: determine the acute effect of a High-Intensity Interval Training session on glucose levels in physically active elderly people. Methods: an experimental study was conducted. The sample was 19 elderly people aged 60-85 years. The group participated in a High-Intensity Interval Training session in which strength and cardiovascular resistance exercises were combined. The 12 exercises performed had a duration of 30 seconds' work and 10 seconds' rest. The intensity of the session was controlled with the OMNI-GSE Effort Perception Scale. Measurements were taken of the height (cm), weight (kg) and body mass index of participants. Blood glucose levels were gauged before and after the session. Results: a significant reduction in blood glucose levels was obtained after the conduct of the High-Intensity Interval Training session (pre: 140.5 mg/dl and post: 116.1 mg/dl; p < 0.01). Conclusions: in only one session, High-Intensity Interval Training reduces blood glucose levels in elderly people(AU)

Índice glucosa-triglicéridos como marcador de resistencia a la insulina en pacientes con diagnóstico de hipertensión arterial esencial / Glycemia-triglyceride index as marker of insulin resistance in essential hypertensive patients

Introducción: El índice glucemia-triglicéridos se utiliza para el diagnóstico presuntivo de la resistencia insulínica, que en los pacientes hipertensos se relaciona con la severidad de la hipertensión arterial. Objetivo: Determinar la utilidad del índice glucemia-triglicéridos como marcador de resistencia a la insulina en pacientes adultos con diagnóstico de hipertensión arterial esencial. Métodos: Se realizó un estudio descriptivo transversal en 232 pacientes con diagnóstico de hipertensión arterial esencial. Se calculó el índice glucemia-triglicéridos y se comparó con el índice HOMA. Para este análisis se utilizó la curva ROC, la correlación de Pearson y el Índice de Kappa, se consideró significativo un valor de p menor a 0,05. Resultados: Se obtuvo un punto de corte de 8,1 que mostró una sensibilidad de 98,6 con una especificidad de 41,4. La curva ROC mostró un área bajo la curva con valor de 0,694 ≈ 0,7. Se observó correlación positiva (p=0,008) Índice de Kappa=88,4 por ciento. Conclusiones: El índice glucemia-triglicéridos resulto ser útil en pacientes con hipertensión arterial como marcador de resistencia a la insulina con un punto de corte de 8,1(AU)

Introduction: The glycemia-triglyceride index is used for the presumptive diagnosis of insulin resistance, which in hypertensive patients is related to the severity of high blood pressure. Objective: To determine the utility of the glycemia-triglyceride index as a marker of insulin resistance in adult patients diagnosed with essential arterial hypertension. Methods: A descriptive cross-sectional study was carried out in 232 patients diagnosed with essential arterial hypertension. The glycemia-triglyceride index was calculated and compared with HOMA index. For this analysis, ROC curve, Pearson correlation and Kappa index were used, p value less than 0.05 was considered significant. Results: We obtained an 8.1 cut-off point, showing 98.6 sensitivity and 41.4 specificity. The area below the ROC curve showed 0.694 ≈ 0.7 value. Positive correlation was observed (p = 0.008). Kappa index = 88.4 percent. Conclusions: The glycemia-triglyceride index turned out to be useful in patients with essential hypertension as a marker of insulin resistance with a cut-off point of 8.1(AU)

Esteatosis hepática en pacientes con diabetes tipo 2 y su relación con el control glucémico / Hepatic steatosis in type 2 diabetes patients and its relationship with glycemic control

Introducción: La esteatosis hepática no alcohólica es la enfermedad con mayor frecuencia en el mundo, esta se asocia a diabetes mellitus tipo 2; padecimiento con gran impacto económico-social. Objetivo: Describir el comportamiento de esteatosis hepática en una población de pacientes con diagnóstico de diabetes mellitus tipo 2. Métodos: Se realizó un estudio observacional, descriptivo, transversal en 94 pacientes diabéticos atendidos en el Hospital Clínico Quirúrgico Hermanos Ameijeiras, en el periodo comprendido entre febrero 2016- febrero 2018. Resultados: La esteatosis fue leve en 42,6 por ciento, moderada (44,7 por ciento) y severa en 12,8 por ciento, en ambos casos, con un NAFLD score principalmente indeterminado (72,3 por ciento). Se detectó fibrosis F0-1 en 58,5 por ciento de los pacientes, F2 (29,8 por ciento) y significativa (F3 y F4) en 11,7 por ciento). Se detectó asociación entre ecogenicidad hepática aumentada, patrón hepático difuso y grado severo de esteatosis por ecografía con mayor grado de fibrosis según elastografía. Se detectó relación significativa de niveles elevados de HBA1C con fibrosis significativa medida tanto por NAFLD score como por elastografía. Conclusiones: La esteatosis hepática presente en los pacientes con diabetes mellitus fue principalmente leve a moderada con prevalencia de fibrosis leve, el grado de fibrosis significativa se asoció con ecogenicidad hepática aumentada, patrón hepático difuso, grado severo de esteatosis por ecografía y niveles elevados de hemoglobina glucosilada(AU)

Introduction: Non-alcoholic liver steatosis is the most frequent disease in the world. It is associated with type 2 diabetes mellitus, representing great economic-social impact. Objective: To describe the behavior of hepatic steatosis in a population of patients diagnosed with type 2 diabetes mellitus. Methods: An observational, descriptive, cross-sectional study was conducted in 94 diabetic patients treated at Hermanos Ameijeiras Clinical Surgical Hospital, from February 2016 to February 2018. Results: Steatosis was mild in 42.6 percent, moderate (44.7 percent) and severe in 12.8 percent, with a mainly indeterminate NAFLD score (72.3 percent). F0-1 fibrosis was detected in 58.5 percent of the patients, F2 (29.8 percent) and significant (F3 and F4) in 11.7 percent). Association between increased liver echogenicity, diffuse liver pattern and severe degree of steatosis were ostensible by ultrasound with higher degree of fibrosis according to elastography. Significant relationship of elevated levels of HBA1C with significant fibrosis was detected, measured both by NAFLD score and by elastography. Conclusions: Hepatic steatosis present in patients with diabetes mellitus was mainly mild to moderate with prevalence of mild fibrosis, the degree of significant fibrosis was associated with increased liver echogenicity, diffuse liver pattern, severe degree of steatosis by ultrasound and high levels of hemoglobin. glycosylated(AU)

Hipovitaminose D e índices glicêmicos em trabalhadores de turno alternante de empresa de mineração / Hypovitaminosis D and glycemic index in individuals working in rotate shifts of a mining company

Objetivo: Demonstrar a prevalência da hipovitaminose D em trabalhadores de turno de uma empresa de mineração e verificar se, nesta população, há correlação entre as variáveis glicêmicas (hemoglobina glicada e glicemia de jejum) e os níveis séricos de vitamina D. Métodos: Estudo transversal observacional realizado por 2 anos consecutivos com trabalhadores de turno. No primeiro ano, foram analisados os níveis séricos de vitamina D (25(OH)D) e glicemia de jejum, excluindo indivíduos que realizavam tratamento para controle glicêmico, suplementação de vitamina D e/ou participantes do sexo feminino, totalizando 548 trabalhadores. No ano seguinte, foram selecionados da amostra anterior apenas os indivíduos que apresentaram hipovitaminose D (25(OH) D<30ng/mL). Nestes, foram analisados os níveis de 25(OH)D, glicemia de jejum e hemoglobina glicada. Foram aplicados o teste de normalidade Kolmogorov-Smirnov e a correlação de Spearman. Resultados: A idade média dos participantes foi de 38,2 anos. No primeiro ano, 80,8% dos trabalhadores apresentaram hipovitaminose D e 10,8% apresentavam glicemia de jejum fora dos níveis de normalidade. Dentre a amostra do ano seguinte, 81,1% permaneceram com hipovitaminose D, 18,2% apresentaram glicemia de jejum fora dos níveis de normalidade e 15,8% apresentaramhemoglobina glicada alterada. Não foram encontradas correlações significativas entre a 25(OH)D e a glicemia de jejum e hemoglobina glicada. Conclusão: Foi observada alta prevalência de hipovitaminose nos trabalhadores de turno. Diferentemente de outros estudos, não foram encontradas correlações significativas entre as variáveis glicêmicas e a concentração sérica da vitamina D. (AU)

Objective: To demonstrate the prevalence of hypovitaminosis D in shift workers of a mining company, and to check whether, in this population, there is a correlation between glycemic variables (glycosylated hemoglobin and fasting plasma glucose)- and serum levels of vitamin D. Methods: These are cross-sectional observational studies performed in two consecutive years with shift workers. In the first year, the serum levels of vitamin D (25(OH)D) and fasting plasma glucose were analyzed, with people who underwent treatment for glycemic control, vitamin D supplementation, and/or female participants being excluded, totalizing 548 workers. In the following year, only those individuals who presented hypovitaminosis D (25 (OH) D <30 ng/dL) were selected from the previous sample. The levels of 25 (OH) D, fasting plasma glucose, and HbA1C of these individuals were analyzed. The Kolmorogov-Smirnov normality test and the Spearman correlation were applied. Results: Th e m ean a ge o f participants was 38.2 years. In the first year, 80.8% (n=442) of the workers presented hypovitaminosis D, and 10.8% had fasting plasma glucose out of normal levels. Among the sample of the following year, 81.1% remained with hypovitaminosis D, 18.2% (n=51) had fasting glycemia out of normal levels, and 15.8% (n=44) had altered glycosylated hemoglobin. Conclusion: A high prevalence of hypovitaminosis in shift workers was observed. Differently from other studies, no significant correlations were found between glycemic variables and serum vitamin D concentration. (AU)

Glycemic index of pre-exercise meal in diabetes mellitus: a systematic review / índice glicêmico da refeição pré-exercício no diabetes mellitus: uma revisão sistemática / índice glicémico de comida pre-ejercicio en la diabetes mellitus: una revisión sistemática

Physical exercise and diet quality are essential for glycemic control of diabetic patients, but consideration must be given to the risk of hypoglycemia in response to exercise. Therefore this study aims at 1) conducting a systematic review of the glycemic index (GI) of the pre-exercise meal and of glycemic behavior during and after aerobic exercise in diabetic subjects, and 2) discussing the safest and most appropriate pre-exercise nutritional guidance for this population. In accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA), two researchers independently undertook a systematic search. A third researcher participated in the selection of articles due to the presence of discrepancies. We selected two studies which both suggest that a low glycemic index (GI) meal is the best pre-exercise option, one of which suggests that the optimal time for food intake is 30 minutes before exercise. However, these results are not sufficient to define a clinical conduct, and other studies are needed to elucidate whether GI is a relevant parameter for pre- and post-exercise clinical monitoring of patients with diabetes mellitus (DM), particularly as regards to the different guidelines for type 1 and type 2 DM. Level of Evidence II; Prognostic Study.

Exercício físico e qualidade da alimentação são fundamentais para o controle glicêmico dos pacientes diabéticos, porém é necessário considerar o risco de hipoglicemia em resposta ao exercício. Dessa forma, os objetivos deste estudo são: 1) conduzir uma revisão sistemática sobre o índice glicêmico (IG) da refeição pré-exercício e do comportamento glicêmico durante e após exercício aeróbico em diabéticos e 2) discutir qual orientação nutricional pré-exercício seria mais adequada e segura nessa população. Em concordância com os Itens de Relatório Preferidos para Revisões Sistemáticas e Metanálises (PRISMA), dois pesquisadores independentes realizaram uma busca sistemática. Um terceiro pesquisador participou da seleção dos artigos por causa da presença de discrepâncias. Foram selecionados dois estudos e ambos sugerem que a refeição de baixo índice glicêmico (IG) é a melhor opção pré-exercício, e um deles sugere que o tempo ideal para ingestão alimentar é 30 minutos antes do exercício. Porém, esses resultados não são suficientes para definir uma conduta clínica, sendo necessários outros estudos para elucidar se o IG é um parâmetro relevante para o monitoramento clínico do paciente com diabetes mellitus (DM) antes e depois do exercício, principalmente com relação às orientações distintas às do DM tipo 1 e tipo 2. Nível de evidência II; Estudo Prognóstico.

Ejercicio físico y la calidad de los alimentos son esenciales para el control glucémico de la diabetes, sin embargo, es necesario prestar atención al riesgo de hipoglucemia en respuesta al ejercicio. Por lo tanto, los objetivos de este estudio son: 1) Realizar una revisión sistemática del índice glucémico (IG) de la comida previa al ejercicio y el comportamiento de la glucemia durante y después del ejercicio aeróbico en los diabéticos y 2) discutir cuál orientación nutricional previa al ejercicio sería más apropiada y segura en esta población. En conformidad con los ítems de Informe Preferido para Revisiones Sistemáticas y Meta-análisis (PRISMA), dos investigadores llevaron a cabo, de forma independiente, una búsqueda sistemática y observaron divergencia; y un tercer investigador participó en la selección de artículos. Se seleccionaron dos estudios, y ambos sugieren que la comida de bajo índice glucémico es la mejor opción antes del ejercicio; uno de ellos sugiere que el tiempo antes de la ingesta de alimentación adecuada es de 30 minutos. Sin embargo, estos resultados no son suficientes para definir una conducta clínica y se necesitan otros estudios para dilucidar si IG es un parámetro relevante para el monitoreo clínico del paciente con diabetes mellitus (DM), durante y después del ejercicio, principalmente en relación con las diferentes orientaciones de DM tipo 1 y tipo 2. Nivel de evidencia II; Estudio Pronóstico.

Relationship between Cardiometabolic Parameters and Elevated Resting and Effort Heart Rate in Schoolchildren / Associação entre Indicadores Cardiometabólicos e Elevação da Frequência Cardíaca de Repouso e Esforço em Escolares

Abstract Background: Little has been studied on heart rate and its relationship with metabolic disorders. Objective: To identify possible association between heart rate (HR) and metabolic disorders in children and adolescents. Methods: This cross-sectional study evaluated 2.098 subjects, aged between 7 and 17 years. The variables evaluated were: HR, systolic (SBP) and diastolic blood pressure (DBP), pulse pressure (PP), double-product (DP), myocardial oxygen consumption (mVO2), lipids, glucose and uric acid levels, body mass index (BMI) and waist circumference (WC). The values of HR at rest and effort were divided into quartiles. The association between continuous values of HR and cardiometabolic indicators was tested by linear regression. Results: LDL cholesterol presented a significantly higher mean (p = 0.003) in schoolchildren with resting HR greater or equal to 91 bpm, compared to students with less than 75 bpm. Compared with the quartiles of effort HR, SBP, DBP, glucose and uric acid presented high values when HR was greater or equal than 185 bpm. SBP, glucose and HDL cholesterol demonstrated a significant association with resting HR. Uric acid was observed as a predictor of increased effort HR. Conclusion: Schoolchildren with a higher resting HR have higher mean of LDL cholesterol. For effort HR, there was an increase in blood pressure, glucose and uric acid levels. Uric acid has been shown to be a predictor of elevated effort HR.

Resumo Fundamento: Pouco se tem estudado sobre frequência cardíaca e suas relações com alterações metabólicas. Objetivo: Verificar se existe associação entre frequência cardíaca e disfunções metabólicas em crianças e adolescentes. Método: Estudo transversal com 2.098 escolares, com idade entre 7 e 17 anos. As variáveis avaliadas foram: frequência cardíaca (FC), pressão arterial sistólica (PAS), diastólica (PAD) e de pulso (PP), duplo-produto (DP), consumo de oxigênio pelo miocárdio (mVO2), perfil lipídico e glicêmico, níveis de ácido úrico, índice de massa corporal (IMC) e circunferência da cintura (CC). Os valores de FC de repouso e esforço foram divididos em quartis. A associação entre os valores contínuos de FC com indicadores cardiometabólicos foi testada por meio da regressão linear. Resultados: O colesterol LDL apresentou média significativamente superior (p = 0,003) nos escolares com FC de repouso maior ou igual a 91 bpm, em comparação aos escolares que apresentaram menos de 75 bpm. Comparados com os quartis da FC de esforço, a PAS, PAD, glicose e ácido úrico apresentaram valores elevados quando a FC foi igual ou superior a 185 bpm. A PAS, a glicose e o colesterol HDL demonstraram associação significativa com a FC de repouso. Observou-se o ácido úrico como um preditor do aumento da FC de esforço. Conclusão: Escolares com FC de repouso mais elevada apresentam médias superiores de colesterol LDL. Para FC de esforço, observou-se elevação na pressão arterial, nos níveis de glicose e de ácido úrico. O ácido úrico demonstrou ser preditor da elevação da FC de esforço.

Low glycemic index diet reduces body fat and attenuates inflammatory and metabolic responses in patients with type 2 diabetes

ABSTRACT Objective The aim of this study was to verify the effects of glycemic index (GI) on body composition, and on inflammatory and metabolic markers concentrations in patients with type 2 diabetes. Subjects and methods In this randomized controlled parallel trial, twenty subjects (aged 42.4 ± 5.1 years, BMI 29.2 ± 4.8 kg.m-2) were allocated to low GI (LGI) (n = 10) or high GI (HGI) (n = 10) groups. Body composition, inflammatory and metabolic markers were assessed at baseline and after 30 days of intervention. Food intake was monitored during the study using three-day food records completed on two non-consecutive weekdays and on a weekend day. Results Body fat reduced after the LGI intervention compared with baseline (P = 0.043) and with the HGI group (P = 0.036). Serum fructosamine concentration (P = 0.031) and TNF-α mRNA expression (P = 0.05) increased in the HGI group. Serum non-esterified fatty acids were greater in the HGI than in the LGI group (P = 0.032). IL-6 mRNA expression tended to decrease after the consumption of the LGI diet compared to baseline (P = 0.06). Conclusion The LGI diet reduced body fat and prevented the negative metabolic and inflammatory responses induced by the HGI diet.

Ingesta de hidratos de carbono y ácidos grasos de la dieta en sujetos con esquizofrenia y trastorno bipolar, y su asociación con parámetros antropométricos / Association of carbohydrate and fatty acid intake with anthropometric parameters in subjects with schizophrenia and bipolar disorders

Background: People with psychiatric disorders have higher rates of obesity, diabetes mellitus and dyslipidemia. These comorbidities are associated with the underlying psychopathology and drug therapy. Aim: To determine the quality and quantity of carbohydrates and fatty acids in the diet and their association with anthropometric parameters in subjects with schizophrenia and bipolar disorders. Patients and Methods: We studied 30 patients with schizophrenia and bipolar disorders in treatment with atypical antipsychotics or mood stabilizers. Three 24-hour recall dietary surveys were carried out. Glycemic index, intake of carbohydrates and fatty acids (g/day) were calculated, and the ratio of saturated, monounsaturated and polyunsaturated fatty acids was determined. Body mass index, waist circumference (WC) and body fat percentage were evaluated. Results: The average intakes of carbohydrates and fatty acids were 295 ± 111 and 73 ± 38 g/day respectively. The mean glycemic index was 59% ± 5.4, while the ratio of saturated, monounsaturated and polyunsaturated fatty acids was 2: 1.4: 0.6. No association between dietary and anthropometric variables was found. Patients using second-generation antipsychotics had a significantly higher waist circumference than those using mood stabilizing drugs. Conclusions: We found no association between the amount and quality of carbohydrate or fatty acid dietary intake and anthropometric parameters.

Associação entre o índice glicêmico e a carga glicêmica da dieta de frequentadores de clínicas estéticas privadas de Porto Alegre - RS e indicadoresde adiposidade corporal / Association between glycemic index and glycemic load in the diet of clients of private esthetics clinics in Porto Alegre and body fat indicators

Objective: To evaluate the possible association between dietary glycemic index (GI) and glycemic load (GL) and anthropometric indicators of adiposity in clients of private esthetics clinics of Porto Alegre, Rio Grande do Sul state, Brazil. Methods:Observational, cross-section study in which all participants underwent anthropometric (measurement of weight, height, BMI, and waist circumference) and dietary (24-hour recall) assessments. The dietary GI and GL were calculated as proposed by the Food and Agriculture Organization ? FAO, considering the values of the International Table of GlycemicIndex (2008). Dietary analysis was performed using DietWin® software and statistical analysis using SPPS 16.0 Package®. Results: One hundred nineteen clients of three private cosmetic clinics of Porto Alegre were Included in the current study. The following data were collected from the study subjects: 39.12 ± 13.55 years old, BMI equals to 26.21 ± 5.10kg/m², and waist circumference equal to 80.5 ± 11.3 cm for women and 99.7 ± 13.7 cm for men. The daily GL was equal to 89.9 ± 38.7 grams and the GI was equal to 54.4 ± 7.5%. The daily GL differed between participants categorized byBMI, considering the cutoff of the World Health Organization (WHO): higher GL was observed among overweight and obese participants in comparison to participants with underweight and normal weight (89.9 ± 38.7 g vs 89.9 ± 38.7 grams, p = 0.02). The GL explained approximately 26% of the variability in waist circumference values (p <0.001). Conclusion: Clients of private cosmetic clinics of Porto Alegre included in the current study presented overweight in a high proportion; it could be related to a high dietary GL. This aspect should be considered in the nutrition counseling ofthis group of patients regarding carbohydrate intake

Objetivo: Avaliar a possível associação entre o índice glicêmico (IG) e a carga glicêmica (CG) da dieta de frequentadores de clínicas estéticas privadas de Porto Alegre/RS e indicadores antropométricos de adiposidade corporal. Métodos: Estudo observacional transversal em que os participantes foram submetidos à avaliação antropométrica [peso, estatura, índice de massa corporal (IMC) e circunferência da cintura (CC)] e do consumo alimentar (recordatório de 24 horas). O IG e a CG das dietas foram calculados conforme padrão proposto pela FAO, a partir dos valores de IG da Tabela internacional (2008). A análise dietética dos dados foi realizada no software DietWin® e as análises estatísticas no Pacote SPPS 16.0®. Resultados: Foram avaliados 119 frequentadores de três clínicas estéticas privadas de Porto Alegre com idade média de 39,12 ± 13,55 anos, IMC de 26,21 ± 5,10Kg/m² e CC de 80,5 ± 11,3cm (para mulheres) e de 99,7 ± 13,7cm (para homens). A CG diária foi igual a 89,9 ± 38,7g e o IG igual a 54,4 ± 7,5%. A CG diária diferiu entre os grupos quando categorizados pelo IMC, considerando-se os pontos de corte da Organização Mundial de Saúde (OMS): maior CG diária entre os participantes com sobrepeso e obesidade em comparação àqueles com baixo peso e eutrofia (89,9 ± 38,7g vs. 89,9 ± 38,7g, P=0,02). A CG da dieta explicou cerca de 26% da variabilidade nos valores de CC dos participantes (P<0.001). Conclusão: Elevada prevalência de excesso de peso corporal foi observada na amostra de frequentadoresde clínicas estéticas privadas avaliada, o que foi relacionado ao consumo de dieta com elevada CG. A orientação nutricional desse grupo específico de indivíduos deve ponderar para esse aspecto quando da escolha de alimentos-fonte de carboidrato.

Sleep and glycemic control in type 1 diabetes

Objective Our aim in the present study was to elucidate how type 1 diabetes mellitus (T1DM) and sleep parameters interact, which was rarely evaluated up to the moment. Materials and methods Eighteen T1DM subjects without chronic complications, and 9 control subjects, matched for age and BMI, were studied. The following instruments used to evaluate sleep: the Epworth Sleepiness Scale, sleep diaries, actimeters, and polysomnography in a Sleep Lab. Glycemic control in T1DM individuals was evaluated through: A1C, home fingertip glucometer for 10 days (concomitant with the sleep diary and actimeter), and CGM or concomitant with continuous glucose monitoring (during the polysomnography night). Results Comparing with the control group, individuals with diabetes presented more pronounced sleep extension from weekdays to weekends than control subjects (p = 0.0303). Among T1DM, glycemic variability (SD) was positively correlated with sleep latency (r = 0.6525, p = 0.0033); full awakening index and arousal index were positively correlated with A1C (r = 0.6544, p = 0.0081; and r = 0.5680, p = 0.0272, respectively); and mean glycemia values were negatively correlated with sleep quality in T1DM individuals with better glycemic control (mean glycemia < 154 mg/dL). Conclusion Our results support the hypothesis of an interaction between sleep parameters and T1DM, where the glycemic control plays an important role. More studies are needed to unveil the mechanisms behind this interaction, which may allow, in the future, clinicians and educators to consider sleep in the effort of regulating glycemic control. Arch Endocrinol Metab. 2015;59(1):71-8 .

Parâmetros a serem considerados no tratamento e controle do Diabetes Gestacional / Parameters to be considered in the treatment and control of Gestational Diabetes

O diabetes gestacional é uma doença metabólica crônica, cuja principal característica é a resistência insulínica, que repercute na morbidade materna e nos desfechos perinatais. Sua prevalência no Brasil está em torno de 7 a 10%. Quando utilizados valores glicêmicos mais baixos do que aqueles anteriormente propostos, um grupo maior de gestantes é enquadrado no diagnóstico desta doença, contribuindo para aumento de sua incidência. Diante deste fato e dos diversos efeitos adversos do diabetes, como hiperinsulinemia fetal e macrossomia, é necessário instituir uma terapêutica rápida e eficaz. A decisão em iniciar esta terapêutica baseia-se em conceitos sabidamente conhecidos, tais como valores glicêmicos de controle, estudo ecográfico fetal (medida da circunferência abdominal), idade gestacional e obesidade materna. Neste trabalho, esses conceitos foram discutidos após uma revisão dos artigos atuais e de maior relevância cientifica.(AU)

The gestational diabetes is a metabolic chronic disorder which main feature is the insulin resistance and its consequences as maternal morbidity and perinatal outcomes. The prevalence in Brazil is from 7 to 10%. When we use lower targets of glycemic control than those previously used, a greater group of pregnants fits into the diagnosis of diabetes, and thereby increasing the incidence of the disease. Towards this and the several adverse outcomes, as fetal hyperinsulinemia and macrossomia, an early and effective treatment has to be established. The decision in begin the therapy is based on elements already known, as the glycemic targets, fetal ultrasound (abdominal circumference measure), gestational age and maternal obesity. These elements are discussed in this paper after a literature review of the latest and more scientific important articles.(AU)

Comportamiento del infarto agudo del miocardio en personas con diabetes mellitus de la provincia Granma / Situation of the acute myocardial infarction in persons with diabetes mellitus in Granma province

Antecedentes: la diabetes mellitus, además de ser un factor de riesgo para el infarto agudo del miocardio, parece conferir per se un peor pronóstico en los pacientes con esta entidad. Objetivo: evaluar el comportamiento del infarto agudo del miocardio en personas con diabetes mellitus de la provincia de Granma. Métodos: se realizó un estudio transversal y descriptivo con 159 pacientes que ingresaron en la Unidad de Cuidados Intensivos Coronarios del Hospital Carlos Manuel de Céspedes, de Bayamo, Granma, con diagnóstico de infarto agudo del miocardio, en el período comprendido entre enero de 2010 y junio de 2011. De ellos, 39 con diabetes mellitus y 120 sin ella. De las historias clínicas se extrajeron los datos de las variables demográficas, clínicas y metabólicas estudiadas. Resultados: en los casos con diabetes mellitus el porcentaje de infartos extensos y sin dolor precordial fue superior a los no diabéticos, sin llegar a ser estadísticamente significativo (p= 0,3283 y p= 0,1066). Los pacientes diabéticos presentaron 2,8 veces más posibilidad de sufrir una complicación eléctrica que aquellos sin diabetes mellitus (p= 0,0121). No hubo relación significativa entre las complicaciones mecánicas del infarto agudo del miocardio y la presencia de diabetes mellitus (p= 0,4104). El número de defunciones fue significativamente mayor en los casos con diabetes mellitus, que en los no diabéticos (p= 0,0124). Los niveles de glucemia al ingreso estuvieron significativamente más elevados en los casos complicados y fallecidos, tanto en los diabéticos como en los no diabéticos. Conclusiones: el infarto agudo del miocardio, en los pacientes diabéticos de nuestro medio, con frecuencia se presenta sin dolor precordial, extenso, con complicaciones eléctricas y asociado con una elevada mortalidad. La hiperglucemia al ingreso está relacionada con un incremento de la morbilidad y la mortalidad del infarto agudo del miocardio(AU)

Background: diabetes mellitus is a risk factor for acute myocardial infarction and additionally, it seems to grant per se a prognosis of severity for the patients suffering this disease. Objective: to evaluate the situation of the acute myocardial infarct in people with diabetes mellitus living in Granma province. Methods: a cross-sectional descriptive study of 159 patients, who were admitted to the coronary intensive care unit of Carlos Manuel de Céspedes hospital in Bayamo, Granma and diagnosed with acute myocardial infarction in the period of January 2010 to June 2011. Out of these patients, 39 had diabetes mellitus and 120 were not affected by the disease. Demographic, clinical and metabolic data were taken from the medical histories. Results: the percentage of extensive infarction without precordial pain in diabetes mellitus cases was higher than in non-diabetics, but it was not statistically significant (p= 0.3283 and p= 0,1066 respectively). The diabetic patients were 2,8 times more likely to suffer electrical complications that those non-diabetics (p= 0.0121). No significant association between mechanical complications of the acute myocardial infarction and diabetes mellitus was found. The number of deaths was significantly higher in cases with diabetes mellitus than in non-diabetic cases (p= 0.0214). The glycemic levels on admission were significantly higher in complicated and in dead cases, both diabetics and non-diabetics. Conclusions: the acute myocardial infarctions in the diabetic patients of our province are often extensive and occur without precordial pain, with electrical complications and associated with high mortality rates. Hyperglycemia on admission is related to increased mortality and morbidity from acute myocardial infarction(AU)

Control glucémico en el proceso perioperatorio de los pacientes con diabetes mellitus / Glycemia control in the perioperative process of patients presenting with diabetes mellitus

El paciente diabético requiere con frecuencia algún tipo de cirugía o la realización de un proceder diagnóstico invasivo, que puede, incluso, ser realizado de urgencia. En la actualidad el riesgo quirúrgico del diabético ha disminuido gracias a los avances en las técnicas anestésicas y al control metabólico perioperatorio, aunque las complicaciones aún son más frecuentes, y generan una hospitalización prolongada y una tasa mayor de invalidez. En la evaluación preoperatoria se deben precisar las características de la diabetes, el tipo de proceder quirúrgico, el riesgo anestésico quirúrgico, y realizar los ajustes necesarios al tratamiento habitual. La infusión continua de insulina endovenosa con aporte de glucosa es el método más racional y fisiológico en la mayoría de las intervenciones quirúrgicas, lo que implica monitoreo glucémico frecuente con ajustes inmediatos. Algunas situaciones especiales, como las cirugías complejas o las de urgencia, requieren esquemas terapéuticos específicos, por lo que cada equipo debe tener su protocolo de trabajo, según las particularidades de las intervenciones quirúrgicas que realicen. El control metabólico perioperatorio es esencial para evitar las alteraciones metabólicas e hidroelectrolíticas agudas y favorecer la evolución satisfactoria en el posoperatorio. Por su importancia, se realiza una revisión con un enfoque actual, que ayude a mejorar la calidad de la atención al paciente diabético que requiere de una intervención quirúrgica(AU)

The diabetic patients require frequently some type of surgery or the implementation of an invasive diagnostic procedure which may even be carried out as an emergence. Nowadays the surgical risk of the diabetic patient has decrease thanks to the advances in the anesthetic techniques and to the perioperative metabolic control, although the complications are more frequent and to generate a lengthy hospitalization and a great disability rate. In the preoperative assessment it is necessary to specify exactly the diabetes's features, the type of surgical procedure, surgical anesthetic risk and to perform the fitting necessary in the habitual treatment. The continuous infusion of intravenous insulin with glucose is the more rational and physiologic method in most of surgical interventions, involving the frequent glycemia monitoring with immediate fittings. Some special situations including complicated surgeries or those of emergence, require specific therapeutical schemes, thus each staff must to have its work protocol, according the peculiarities of the surgical interventions performed. The perioperative metabolic control is essential to avoid the metabolic and acute hydroelectrolytic alterations and to favor the satisfactory course during the postoperative period. Due its significance, authors carried out a review with the current approach helping to improve the quality of care of diabetic patient requiring a surgical intervention(AU)

Influência do índice glicêmico da dieta sobre parâmetros antropométricos e bioquímicos em pacientes com diabetes tipo 1 / Influence of dietary glycemic index on anthropometric and biochemical parameters in patients with type 1 diabetes

OBJETIVO: Avaliar a influência de uma intervenção não farmacológica, constituída de uma dieta de baixo índice glicêmico (IG) por um período de seis meses, no controle metabólico e nos indicadores antropométricos de pacientes com diabetes melito tipo 1 (DM1). SUJEITOS E MÉTODOS: Noventa e seis pacientes com DM1 foram submetidos à avaliação antropométrica, bioquímica e dietética antes e 6 meses após a prescrição de uma dieta baseada no índice glicêmico. RESULTADOS: Observamos diminuição significativa da A1c (9,8 ± 2,26 por cento vs. 9,1 ± 2,16 por cento; p = 0,023) e aumento de peso (61,3 ± 11,68 kg vs. 62,8 ± 12,07 kg; p = 0,04) após o período de intervenção. CONCLUSÃO: A dieta de baixo índice glicêmico foi capaz de melhorar o controle glicêmico em pacientes com DM1. Estudos com maior tempo de seguimento serão necessários para estabelecermos se a aderência dos pacientes a esse tipo de dieta influencia na manutenção do controle glicêmico.

OBJECTIVE: To assess the influence of a non-pharmacological intervention, consisting of a diet low glycemic index (GI) for a period of six months on metabolic control and anthropometric parameters in patients with type 1 diabetes mellitus. SUBJECTS AND METHODS: Ninety-six type 1 diabetic patients underwent an anthropometric, biochemical and dietary assessment before and six months after the prescription of diet based on the glycemic index. RESULTS: After six months we observed a decrease in A1C levels (9,8 ± 2,26 percent vs. 9,1 ± 2.16 percent; p = 0,023) and increase in body weight (61,3 ± 11,68 kg vs. 62,8 ± 12,07 kg; p = 0,04). CONCLUSION: A low GI diet improved glycemic control in patients with DM1. Further studies with longer time of follow-up are needed to assess if patients' adherence to this kind of diet influences the maintenance of glycemic control.

Associação entre fatores nutricionais e o controle glicêmico de crianças e adolescentes com diabetes melito tipo 1 / Relationship between nutrition factors and glycemic control in children and adolescents with type 1 diabetes mellitus

OBJETIVO: Identificar fatores nutricionais que influenciaram o controle glicêmico da população estudada. SUJEITOS E MÉTODOS: Participaram do estudo 146 crianças e adolescentes, entre 7 e 19 anos de idade, atendidos na Divisão de Endocrinologia Pediátrica do Hospital das Clínicas da Universidade Federal de Minas Gerais. A dieta foi avaliada por meio de Questionário Quantitativo de Frequência Alimentar validado e adaptado à população estudada. O controle glicêmico foi avaliado como bom, regular ou ruim a partir da média de dois resultados de HbA1c dos seis meses anteriores à data da avaliação dietética. RESULTADOS: Dietas com maior teor de proteína, menor teor de gordura saturada e com índice glicêmico (IG) e carga glicêmica (CG) mais baixos afetaram positivamente o controle glicêmico dos indivíduos estudados. O hábito de consumir sacarose e merenda gratuita influenciou negativamente o controle glicêmico. CONCLUSÃO: O consumo de dietas nutricionalmente adequadas e de baixo IG/CG favoreceu o controle glicêmico da população estudada.

OBJECTIVE: To identify nutritional factors that affected the glycemic control of the studied population. SUBJECTS AND METHODS: One hundred forty-six children and adolescents, aged 7 to 19 years, followed-up at the Division of Pediatric Endocrinology of the Hospital das Clínicas da Universidade Federal de Minas Gerais participated in the study.The diet of each participant was evaluated by means of a Quantitative Food Frequency Questionnaire, previously validated in a pilot-project. Glycemic control was assessed through the average of HbA1c results obtained six months prior to date of diet evaluation. RESULTS: Diets with high protein content, less saturated fats, and lower glycemic index (GI)/glycemic load (GL) had a positive effect on glycemic control. The consumption of sucrose and of free snacks provided by the school had a negative influence on glycemic control. CONCLUSION: The consumption of nutritionally adequate and low GI/GL diets favored glycemic control of the studied population.

Dietary glycemic load, glycemic index, and refined grains intake are associated with reduced beta-cell function in prediabetic Japanese migrants / Associação entre carga glicêmica da dieta, índice glicêmico e consumo de cereais refinados e função reduzida das células-beta em migrantes japoneses com pré-diabetes

Objective: To investigate the association between carbohydrate intakes and β-cell function (HOMA-β) in Japanese-Brazilians with impaired glucose tolerance (IGT). Methods: Dietary intakes were assessed by a validated food frequency questionnaire in a cross-sectional survey carried out in 2000. The associations between diet and HOMA-β were verified in 270 newly diagnosed IGT in multiple linear regression models. Results: The mean (SD) age was 58 (11) years and the mean HOMA-β was 65 (47). The glycemic load was inversely associated with HOMA-β, β1 -0.140 (95%CI = -1.044; -0.078), p = 0.023. The inverse association was also observed for refined grains intakes: -0.186 (95%CI = -0.4862; -0.058), p = 0.012. After adjustments for body mass index, the glycemic index was inversely associated with HOMA-β: -0.1246 (95%CI = -2.2482, -0.0257), p < 0.001. Conclusions: These data suggested that dietary glycemic load, glycemic index, and refined grains intakes are associated with reduced β-cell function, and the quality of dietary carbohydrates may be relevant for maintaining β-cell function among individuals with IGT.

Objetivo: Investigar a associação entre o consumo de carboidratos e função das células-β (HOMA-β) em nipo-brasileiros portadores de tolerância à glicose diminuída (TGD). Métodos: O consumo alimentar habitual foi avaliado por meio do questionário quantitativo de frequência alimentar previamente validado em estudo transversal conduzido em 2000. A associação entredieta e HOMA-β foi verificada em 270 indivíduos portadores de TGD em modelos de regressão logística ajustados. Resultados: A média (DP) de idade foi 58 (11) anos e do HOMA-β foi 65 (47). A carga glicêmica foi inversamente associada ao HOMA-β, β1 -0.140 (95%CI = -1.044; -0.078), p = 0,023. Associação inversa com o consumo de cereais refinados também foi observada: -0.186 (95%CI = -0.4862; -0.058), p = 0,012. Após ajuste pelo índice de massa corpórea, foi verificada a associação inversa entre índice glicêmico e HOMA-β: -0.1246 (95%CI = -2.2482, -0.0257), p < 0,001. Conclusões: Os dados indicam que a carga glicêmica da dieta, o índice glicêmico e o consumo de cereais refinados estão associados a uma função reduzida das células-β e que aqualidade dos carboidratos da dieta habitual pode ser relevante na manutenção da função de células-β entre indivíduos portadores de TGD.

Anti-hyperglycaemic potential of Psidium guajava raw fruit peel.

Background & objectives: This study was undertaken to evaluate the glycaemic potential of aqueous extract of Psidium guajava unripe fruit peel on blood glucose level (BGL) of normal and streptozotocin induced mild and severely diabetic rats as an extension of our previous work carried out on Psidium guajava ripe fruit peel. Methods: The aqueous extract of P. guajava unripe fruits was prepared. Male 6-8 wk old albino Wistar rats were selected for the experiments. Diabetes was induced by streptozotocin infection. Blood glucose levels were measured by glucose oxidase method. Antihyperglycaemic activity of the extract was assessed in mild and severely diabetic rats. Results: The maximum fall of 21.2 per cent (P<0.01) and 26.9 per cent (P<0.01) after 3 h of glucose administration during glucose tolerance test (GTT) was observed in BGL from a dose of 400 mg/kg, identifi ed as the most effective dose, in normal and mild diabetic rats respectively. In severely diabetic rats the maximum fall of 20.8 and 17.5 per cent in fasting blood glucose (FBG) and post prandial glucose (PPG) levels, and 50 per cent (P<0.01) in urine sugar levels was observed with the same dose. Haemoglobin level increased by 5.2 per cent (P<0.05) and body weight by 2.5 per cent (P<0.05) after 21 days treatment. Interpretation & conclusions: Normal, mild and severely diabetic rat models had shown hypoglycaemic as well as antidiabetic effect of the unripe guava fruit peel aqueous extract. Further studies need to be done to characterize the active components of the peel.

Glycaemic evaluation of Psidium guajava in rats.

BACKGROUND & OBJECTIVE: Many plant polysaccharides exhibit hypoglycaemic effect. Though the fruit of Psidium guajava is known to contain free sugars, the fruit extract showed hypoglycaemic effect in alloxan treated mice and human subjects. The present study was aimed to determine the glycaemic potential of P. guajava fruit peel extract on blood glucose level (BGL) of normal and streptozotocininduced sub-diabetic rats during fasting blood glucose (FBG) and glucose tolerance test (GTT). METHODS: Female albino Wistar rats (n=42) were divided into seven equal groups, and were given different doses of fruit peel extract. Diabetes was induced by streptozotocin injection (ip) at a dose of 45 mg/kg body weight. Blood glucose levels were measured after collecting the blood from tail veins. RESULTS: The diabetic and sub-diabetic models showed hyperglycaemic effect from a single oral administration of variable doses of P. guajava fruit peel extract. The maximum rise of 26.51 per cent was observed in BGL from a dose of 400 mg/kg bw exactly after 8 h of administration in normal rats whereas the maximum rise of 90.7 per cent was observed with the same dose of 400 mg/kg bw after 2 h of glucose administration in sub-diabetic rats. INTERPRETATION & CONCLUSION: The hyperglycaemic effect of P. guajava fruit peel suggests that the diabetic patients should peel off the guava fruits before consuming. However, it can also be useful in controlling hypoglycaemia occasionally caused due to excess of insulin and other hypoglycaemic drugs.

Determinación de los índices glicémicos y de insulina en fórmulas para alimentación enteral en adultos sanos / Glycemic and insulin indices of tube feeding formulas in healthy adults

Background: In acute illnesses, plasma glucose levels are often increased and generally parallel the severity of stress. Hyperglycemia caused by reduced insulin sensitivity and reduced insulin secretion is associated with increased susceptibility to infections. Maintaining blood glucose levels at or below 110 mg/dl reduces morbidity and mortality in critically ill patients. Aim: To measure the glucose and insulin responses of four commercially available enteral formulas compared with a standard meal reference product. Material and Methods: The glycemic index (GI) and the insulin index (II) were determined in a randomized, cross over protocol in 38 healthy volunteers between 18 and 46 years of age. Each subject underwent five tests: three with the standard meal (bread) and two with the study products. The enteral formulas were Clinutren HPR (whole protein of high protein value), Crucial® (casein peptide based formula), Peptamen®, (whey peptide based formula), Glytrol® (formula for diabetics with whole protein with fiber). Each study product was evaluated 10 times. Results: The diabetic formula and the high protein energy dense formulas induced a significantly lower GI (p <0.02) compared with the standard meal. The GI response did not appear to be due to enhanced insulin secretion. The other tested formulas had lower GI than the standard meal, but in addition they exhibited increased II The whey based peptide formulation produced the highest insulin response (p <0.03). Conclusions: Both GI and II are related to the concentration, form and type of protein contained in the enteral formula. The whey peptide formulation produced a low GI with the highest insulin index. Based on the low GI of these enteral products, all can be useful to provide nutritional support during metabolic stress, without adding an additional challenge to blood glucose management.