Proteína C reactiva ultrasensible y riesgo cardiovascular en pacientes con diabetes mellitus tipo 2 / Ultrasensitive reactive C protein and cardiovascular risk in patients with type 2 diabetes mellitus

Objetivo: describir el riesgo cardiovascular de pacientes con diabetes mellitus tipo 2 (DM2), según los valores de proteína C reactiva ultrasensible (PCR-us). Material y métodos: estudio descriptivo transversal, realizado en el Patronato del Diabético de zona 1, Ciudad de Guatemala, en el cual participaron 196 pacientes mayores de 50 años de edad, obteniéndose características sociodemográficas, medidas antropométricas. Además, se tomaron muestras de sangre que fueron procesadas en iCroma ll para determinar los valores de Proteína C reactiva ultrasensible (PCR-us). Resultados: los pacientes que aceptaron formar parte del estudio, tuvieron una media de edad de 62±8.62 DE; 74.4% (146) fueron del sexo femenino; 54% (106) eran católicos y el 82.1% (161), residían en la Ciudad de Guatemala. El estado nutricional fue normal en el 26% (50), el 11% (21) tenía sobrepeso y 63% (125), obesidad. Para índice cintura cadera (ICC) con respecto al sexo femenino, se obtuvo una media de 0.89±0.05 DE y una media 0.97±0.05 DE del sexo masculino. Respecto al riesgo cardiovascular, se obtuvo una media en valores de PCR-us de 2.9±2.8 DE, con 76% (148) de los pacientes en riesgo cardiovascular moderado/alto. Conclusiones: los valores de PCR-us tuvieron una media de 2.9±2.8 DE y 8 de cada 10 pacientes están en riesgo moderado/alto. De los pacientes estudiados, 7 de cada 10 fueron mujeres, con una media para a edad de 62 años. Se encontraron 7 de cada 10 con sobrepeso u obesidad, con una media para índice cintura cadera con respecto al sexo elevado.

Objective: to describe the cardiovascular risk of patients with type 2 diabetes mellitus, according to the values of ultrasensitive C-reactive protein (PCR-us). Material and methods: descriptive cross-sectional study, carried out on 196 patients over 50 years of age, from the Diabetic Board of Trustees in Zone 1, Guatemala. Data on sociodemographic characteristics, anthropometric measurements and blood were obtained. The blood samples were processed in iCroma ll to determine the values of ultrasensitive reactive Protein C (PCR-us). Results: the patients who accepted to be part of the study had a mean age of 62 ± 8.62 SD years; 74.4% (146) were female; 54% (106) were catholic, and 82.1% (161) resided in Guatemala City. Nutritional status was normal in 50 patients (26%), 21, overweight (11%) and 125, obese (63%). For the waisthip index, with respect to the female, an average of 0.89 ± 0.05 SD and for males, an average 0.97 ± 0.05 SD were obtained. Regarding cardiovascular risk, an average in PCR-us values of 2.9 ± 2.8 SD was obtained; 76% (148) of patient were at moderate / high cardiovascular risk.

Ambulatory arterial stiffness index in diabetic patients / Índice de rigidez arterial ambulatorio en pacientes diabéticos

ABSTRACT Background The ambulatory arterial stiffness index (AASI), derived from 24 h ambulatory blood pressure monitoring (ABPM) can be a good indicator of arterial stiffness. Aim To assess the correlation between AASI and brachial-ankle pulse wave velocity (baPWV), ankle-brachial index (ABI) and cardio-ankle vascular index (CAVI) in patients with type 2 diabetes mellitus without hypertension. Material and Methods Cross sectional study in 28 diabetic patients aged 49 ± 7 years (40% women). AASI was calculated as 1 minus the regression slope of diastolic on systolic blood pressure, using ABPM data. ABPM was measured in the arm using an oscillometric device. ABI was calculated as the ratio between ankle and brachial systolic blood pressure. CAVI was derived from pulse wave velocity using the Vasera VS-1000 device. Correlations were calculated using a bivariate Spearman correlation. Results The mean values for AASI, ABI, baPWV and CAVI were 0.39 ± 0.14, 1.14 ± 0.09, 15.15 ± 2.71 m/s and 7.60 ± 1.90, respectively. There was a significant negative correlation between AASI and ABI (r = -0.491, p < 0.01). Conclusions In these diabetic patients, there was an association between AASI, an arterial stiffness marker and ABI, an indicator for the presence of atherosclerosis.

Antecedentes El índice de rigidez arterial ambulatorio (AASI), derivado del monitoreo ambulatorio de presión arterial de 24 h (MAPA), puede ser un buen indicador de rigidez arterial. Objetivo Evaluar la correlación entre el AASI y la velocidad de onda de pulso braquial (VOP), el índice tobillo-brazo (ITB) y el índice vascular cardio-tobillo (CAVI) en pacientes con diabetes mellitus tipo 2 sin hipertensión arterial. Material y Métodos Estudio transversal en 28 pacientes con diabetes de 49 ± 7 años (40% mujeres). El AASI se calculó como 1 menos la pendiente de regresión de la presión arterial diastólica sobre la sistólica, usando datos del MAPA de 24 h, el cual se midió en el brazo, usando un dispositivo oscilométrico. El ITB se calculó como la razón entre la presión arterial sistólica del tobillo sobre la del brazo. El CAVI se derivó de la velocidad de onda de pulso medida con el dispositivo Vasera VS-1000. Para el análisis estadístico se utilizó el coeficiente de correlación bivariada de Spearman. Resultados Los valores de AASI, VOP, ITB y CAVI fueron 0.39 ± 0.14, 1.14 ± 0.09, 15.15 ± 2.71 m/s y 7.60 ± 1.90, respectivamente. Hubo una correlación negativa significativa entre AASI e ITB (r = -0.491, p < 0.01). Conclusiones Hay una asociación entre AASI, un marcador de rigidez arterial e ITB, un indicador de aterosclerosis, en estos pacientes con diabetes mellitus tipo 2.

Prevalencia de diabetes y descontrol glucémico en México: resultados de la Ensanut 2016 / Prevalence of diabetes and poor glycemic control in Mexico: results from Ensanut 2016

Resumen: Objetivo: Estimar la prevalencia de diabetes (total, diagnosticada y no diagnosticada), de descontrol glucémico en México y sus factores asociados. Material y métodos: Se analizaron 3 700 adultos participantes en la Encuesta Nacional de Salud y Nutrición de 2016. Se estimaron las prevalencias con ponderadores poblacionales y los factores asociados con diabetes total y descontrol glucémico con modelos de regresión de Poisson. Resultados: La prevalencia total de diabetes fue de 13.7% (9.5% diagnosticada, 4.1% no diagnosticada); 68.2% de los diagnosticados presentó descontrol glucémico. Mayor tiempo de diagnóstico, vivir en el centro/sur del país y ser atendido en farmacias se asoció con descontrol glucémico, mientras que ser atendido en los servicios de seguridad social se asoció con mejor control glucémico. Conclusión: Se requieren esfuerzos multisectoriales para fortalecer el tamizaje, diagnóstico oportuno y control de la enfermedad, considerando las diferencias por región y tipo de servicio de salud.

Abstract: Objective: To estimate the prevalence of total, diagnosed and undiagnosed diabetes, and the prevalence of poor glycemic control in Mexico, and its associated factors. Materials and methods: Data from 3 700 adult participants were analysed in the 2016 National Health and Nutrition Survey. Diabetes prevalences were estimated with population weights, and the factors associated with total diabetes and poor glycemic control with Poisson regression models. Results: The total prevalence of diabetes was 13.7% (9.5% diagnosed, 4.1% undiagnosed); 68.2% of people with diagnosed diabetes presented poor glycemic control. Longer disease duration, living in the centre or south of the country and being treated in pharmacies were associated with poor glycemic control. Being treated in a social security system was associated with better glycemic control. Conclusion: Multisectoral efforts are needed to strengthen screening, timely diagnosis and disease control, considering differences by region and type of health service.

Use of flash glucose-sensing technology in patients with type 2 diabetes treated with liraglutide combined with CSII: a pilot study

Glycemic variability (GV) may be linked to the development of diabetic complications by inducing inflammation, oxidative stress, and endothelial dysfunction. Flash glucose monitoring (FGM) provides a novel method of continuously monitoring interstitial glucose levels for up to 14 days. This study randomly assigned poorly controlled type 2 diabetes mellitus patients treated with metformin and multiple daily injections of insulin (n=60) to either continuous subcutaneous insulin infusion (CSII) treatment or CSII in combination with liraglutide (CSII+Lira) treatment for 14 days during hospitalization. GV was assessed using a FGM system; weight and cardiometabolic biomarkers were also evaluated. The coefficient of variation was significantly reduced in the CSII+Lira group (P<0.001), while no significant change was observed in the CSII group. The changes differed significantly between the two groups in mean amplitude of glycemic excursions (P=0.004), standard deviation (P=0.006), and the percentage of time in the target range (4-10 mmol/L, P=0.005 and >10 mmol/L, P=0.028). The changes in mean of daily differences, interquartile range, and percentage of time in hypoglycemia (<3.3 mmol/L) and hyperglycemia (>13.9 mmol/L) identified by FGM showed no difference. Treatment with liraglutide increased serum adiponectin [33.5 (3.5, 47.7) pg/mL, P=0.003] and heme oxygenase-1 levels [0.4 (-0.0, 1.8) ng/mL, P=0.001] and reduced serum leptin levels [-2.8 (3.9) pg/mL, P<0.001]. Adding the glucagon-like peptide-1 analog liraglutide improved GV, weight, and some cardiometabolic risk markers. The FGM system is, therefore, shown to be a novel and useful method for glucose monitoring.

Pharmaceutical care-based interventions in type 2 diabetes mellitus: a systematic review and meta-analysis of randomized clinical trials / Intervenções farmacêuticas no diabetes mellitus tipo 2: uma revisão sistemática e metanálise de ensaios clínicos randomizados

ABSTRACT Objective To investigate the impact of pharmaceutical care-based interventions on type 2 diabetes mellitus . Methods PubMed®, Cochrane and Web of Science data bases were searched for randomized controlled clinical trials. Studies evaluating pharmaceutical care-based interventions in type 2 diabetes mellitus published between 2012 and 2017 were included. Glycated hemoglobin was defined as the primary endpoint; blood pressure, triglycerides and cholesterol as secondary endpoints. The random effects model was used in meta-analysis. Results Fifteen trials involving 2,325 participants were included. Meta-analysis revealed considerable heterogeneity (I2>97%; p<0.001), reduction in glycated hemoglobin (-1.07%; 95%CI: -1.32; -0.83; p<0.001), glucose (-29.91mg/dL; 95%CI: -43.2; -16.6; p<0.001), triglyceride (19.8mg/dL; 95%CI: -36.6; -3.04; p=0.021), systolic blood pressure (-4.65mmHg; 95%CI: -8.9; -0.4; p=0.032) levels, and increased HDL levels (4.43mg/dL; 95%CI: 0.16; 8.70; p=0.042). Conclusion Pharmaceutical care-based clincal and education interventions have significant impact on type 2 diabetes mellitus . The tools Summary of Diabetes Self-Care Activities and the Morisky Medication Adherence Scale may be useful to monitor patients.

RESUMO Objetivo Identificar o impacto das intervenções providenciadas pelo cuidado farmacêutico no diabetes mellitus tipo 2. Métodos Buscas por ensaios clínicos randomizados controlados foram realizadas nas bases PubMed®, Cochrane e Web of Science . Foram incluídos estudos publicados entre 2012 e 2017, que avaliaram o impacto do cuidado farmacêutico no diabetes mellitus tipo 2. A hemoglobina glicada foi o desfecho primário, e os secundários foram pressão arterial, triglicérides e colesterol. O modelo de efeitos aleatórios foi utilizado na metanálise. Resultados Foram incluídos 15 estudos envolvendo 2.325 participantes. A metanálise demonstrou heterogeneidade elevada (I2>97%; p<0,001), redução nos níveis de hemoglobina glicada (-1,07%; IC95%: -1,32; -0,83; p<0,001), glicose (-29,91mg/dL; IC95%: -43,2; -16,6; p<0,001), triglicérides (19,8mg/dL; IC95%: -36,6; -3,04; p=0,021), pressão arterial sistólica (-4,65mmHg; IC95%: -8,9; -0,4; p=0,032) e aumento do colesterol HDL (4,43mg/dL; IC95%: 0,16; 8,70; p=0,042). Conclusão As intervenções clínicas e educacionais providenciadas pelo cuidado farmacêutico têm impacto significativo no diabetes mellitus tipo 2. Ferramentas como o Summary of Diabetes Self-Care Activities e a Morisky Medication Adherence Scale podem ser úteis no acompanhamento dos pacientes.

Niveles de colesterol no HDL en la población chilena y su asociación con enfermedad cardiovascular y diabetes mellitus: estudio de corte transversal en Encuesta Nacional de Salud 2009-2010 / Non-HDL cholesterol levels in Chilean population and their association with diabetes mellitus and cardiovascular disease

Background Despite aggressive treatment aimed at lowering LDL cholesterol (LDL-C) levels with statins, there is a high residual prevalence of cardiovascular diseases, which may depend on plasma cholesterol transported in other atherogenic lipoproteins. Aims To describe non-HDL cholesterol (non-HDL-C) levels in the Chilean population and their association with diabetes mellitus and cardiovascular disease. To evaluate compliance with non-HDL-C therapeutic goals -according to individual cardiovascular risk- at different levels of triglycerides, in comparison with LDL-C goal achievement. Material and Methods: We analyzed data from 2,792 Chilean subjects aged ≥ 15 years who were included in the 2009-2010 National Health Survey and had valid data for blood lipids, diabetes, and cardiovascular disease. Results Forty five percent of subjects had high non-HDL-C levels. The proportion of diabetic and non-diabetic subjects with high non-HDL-C levels was 81 and 42%, respectively (p < 0.01). A significant discordance was observed in the achievement of therapeutic objectives when LDL-C or non-HDL-C levels were considered, particularly in presence of triglycerides ≥ 150 mg/dl. Namely, 8% of the population showed elevated levels of high non-HDL-C despite adequate LDL-C levels. Conclusions Evaluation and management of elevated non-HDL-C in patients with adequate levels of LDL-C seems worthwhile considering the discordance observed between these blood cholesterol fractions. This strategy may be effective to reduce the residual cardiovascular risk in the Chilean population.

Structural equation modeling of associations between night work and glycemic levels

ABSTRACT Objective Different pathways may lead from night work to metabolic diseases, including type 2 diabetes. This study aimed to explore the direct and indirect pathways from night work to glycemic levels, considering the role of physical activity, waist circumference and snacking using data from ELSA-Brasil. Materials and methods A structural equation model was used to confirm the pathways from night work to glycemic levels. The latent variable, "glycemic levels", included fasting glucose, glycated hemoglobin and 2-hour plasma glucose. Results A total of 10.396 participants were included in the analyses. The final model showed that among women, night work was associated with increased glycemic levels. A statistical significant association between night work and glycemic levels mediated by waist circumference was observed among women and men. Conclusions The association between night shift and glycemic levels can be interpreted as an important step toward understanding the pathways that could explain night work as a risk factor for diabetes using epidemiological data.

Is Uric Acid elevation a random finding or a causative agent of diabetic nephropathy?

SUMMARY OBJECTIVE In this study, we aimed to analyze the relationship between serum uric acid (UA) and microalbuminuria as a marker of renal injury in type 2 diabetes mellitus. METHODS A total of 100 patients with type 2 diabetes mellitus were enrolled in the study. Participants were divided into two groups according to the urinary microalbumin/creatinine ratio: diabetic nephropathy and non-nephropathy group. UA and microalbuminuria were compared between the study groups. RESULTS Serum UA levels of diabetic nephropathy patients were significantly higher than those in the non-nephropathy group (UA in patients with diabetic nephropathy groups: 6.3 (1.82) mg/dl, UA in patients of the non-nephropathic group: 4.85 (1.92) mg/dl) (p<0.001). There was a correlation between microalbuminuria and UA (r=0.238). This correlation was statistically significant (p=0.017). CONCLUSION UA levels may be an important predictor of nephropathy in diabetic patients.

RESUMO OBJETIVO O objetivo deste estudo foi analisar a relação entre o ácido úrico sérico e a microalbuminúria como marcador de lesão renal no diabetes mellitus tipo 2. MÉTODOS Um total de 100 pacientes com diabetes mellitus tipo 2 foram inscritos no estudo. Os grupos de estudo foram divididos em dois, de acordo com a relação microalbumina/creatinina na urina: nefropatia diabética e grupo não nefropático. UA e microalbuminúria foram comparados entre os grupos de estudo. RESULTADOS Os níveis séricos de AU de pacientes com nefropatia diabética foram significativamente maiores do que o grupo sem nefropatia (AU em pacientes com grupos de nefropatia diabética: 6,3 (1,82) mg/dl, AU em pacientes com grupos não nefropáticos: 4,85 (1,92) mg/dl ) (p<0,001). Houve correlação entre microalbuminúria e AU (r=0,238). Essa correlação foi estatisticamente significativa (p=0,017). CONCLUSÃO Os níveis de AU podem ser um importante preditor de nefropatia em pacientes diabéticos.

Serum Annexin V and Anti-Annexin V levels and their relationship with metabolic parameters in patients with type 2 diabetes

SUMMARY BACKGROUND We investigated the serum annexin V and anti-annexin V levels and their relationship with metabolic parameters in patients recently diagnosed type 2 diabetic. METHODS A total of 143 patients recently diagnosed type 2 diabetes and 133 control subjects were included in the study. Body mass index (BMI), hs-CRP, HOMA-IR, carotid intima-media thickness, and serum levels of annexin V and anti-annexin V were investigated. RESULTS HOMA-IR, serum hs-CRP, and carotid intima-media thickness were found to be statistically significant. The Pearson correlation analysis revealed a statistically significant positive relationship between the carotid intima-media thickness and the annexin V level (r=0.29, p=0.006*). A statistically significant positive relationship was also detected between the Annexin V level and level of serum hs-CRP (r=0.29 p=0.006*). CONCLUSION A positive relationship was observed between the carotid intima-media thickness and annexin V at the end of our investigation. In this regard, we also believe that serum levels of annexin V may be increased for cardiovascular protection in the elevation of carotid intima-media thickness.

RESUMO OBJETIVO Investigar os níveis séricos de anexina V e antianexina V e sua relação com os parâmetros metabólicos em pacientes diabéticos tipo 2 recém-diagnosticados. MÉTODOS Foram incluídos no estudo 143 pacientes e 133 controles com diabetes tipo 2 recém-diagnosticado. O índice de massa corporal (IMC), PCR-as, Homa-IR, espessura íntima média carotídea e níveis séricos de anexina V e antianexina V foram investigados. RESULTADOS O Homa-IR, a PCR-s do soro e a espessura média da carótida foram estatisticamente significantes. A análise de correlação de Pearson revelou uma relação positiva estatisticamente significante entre a espessura média da carótida e anexina V (r=0,29; p=0,006 *). Foi também detectada uma relação positiva estatisticamente significativa entre o nível de anexina V e o nível sérico de PCR-as (r=0,29, p=0,006*). CONCLUSÃO Também foi observada uma relação positiva entre a espessura média da carótida e anexina V no final da nossa investigação. A esse respeito, também pensamos que os níveis séricos de anexina V podem ser aumentados para proteção cardiovascular na elevação da espessura média da carótida.

Evaluative Research on Pharmacist-managed Diabetes Care: Focus on Self-Monitoring of Blood Glucose / Investigación Evaluativa sobre Atención a la Diabetes Gestionada por los Farmacéuticos: Enfoque del Automonitoreo de la Glucosa en Sangre

ABSTRACT Objective: Pharmacists have not demonstrated the ability to manage chronic diseases such as Type 2 Diabetes Mellitus, which is an ongoing problem in Trinidad and Tobago. The primary objective was to demonstrate that pharmacists can assist patients to achieve at least a 1% decrease in glycosylated haemoglobin (HbA1c). Methods: A randomized, controlled Pharmacist Evaluative Research Study compared the efficacy of pharmacist-managed care (the intervention), and routine standard management (control) of poorly controlled (abnormal HbA1c, blood pressure, blood glucose and lipid panel) adult diabetic patients. Participants in the intervention group met with the pharmacist at their respective primary care sites on a regular basis for an assessment of adherence to medications, barriers to adherence and education. Control group participants consisted of patients receiving routine care by their primary physician but with no direct intervention by the pharmacist except for the filling of prescriptions. Results: Seventy-five patients were initially recruited. Of these, 48 (20 intervention and 28 control) met the inclusion criteria. It was only possible to analyse the result from 20 patients: 14 (70%) intervention and 6 (21.4%) control because of incomplete collected data. A minimum decrease of at least 1% HbA1c was obtained by 8 (57%) intervention participants compared to 2 (33%) in the control group; while HbA1c remained unchanged for two participants, each in the intervention and control groups (14% and 33%, respectively). Conclusion: We could not conclude any statistical or clinical significance in the paper as the data could only be analysed using descriptive methods. Building a culture of research among pharmacists may promote the use of pharmacists as adjunctive healthcare practitioners to achieve better patient outcomes.

RESUMEN Objetivo: Los farmacéuticos no han demostrado ser capaces de manejar el tratamiento de enfermedades crónicas como el tipo 2 Diabetes mellitus, que es un problema actual en Trinidad y Tobago. El objetivo principal fue demostrar que los farmacéuticos pueden ayudar a los pacientes a lograr al menos una disminución del 1% en hemoglobina (Hba1C). Métodos: Un Estudio de Investigación Evaluativa Farmacéutico controlado aleatorio, comparó la eficacia de la atención gestionada por los farmacéuticos (intervención) y el manejo estándar de rutina (control) de pacientes diabéticos adultos con pobre control (niveles anormales de hemoglobina glicosilada, presión arterial, glucosa en sangre, y perfil lipídico). Los participantes en el grupo de intervención se reunieron de manera regular con el farmacéutico en sus respectivos centros de atención primaria para evaluar el cumplimiento con los medicamentos, así como los obstáculos a la observancia y la educación. Los participantes del grupo de control eran pacientes que recibían atención de rutina de parte de su médico primario, pero sin intervención directa del farmacéutico, excepto para el llenado de prescripciones. Resultados: Setenta-cinco pacientes fueron reclutados inicialmente. De estos, 48 (20 de intervención y 28 de control) cumplían los criterios de inclusión. Debido a que los datos recopilados estaban incompletos, sólo fue posible analizar el resultado de 20 pacientes: 14 (70%) de intervención y 6 (21.4%) de control. Una disminución mínima de al menos 1% de HbA1C fue obtenida por 8 (57%) participantes de intervención en comparación con 2 (33%) en el grupo de control, mientras que el HbA1C permaneció inalterado para 2 participantes, cada uno en los grupos de intervención y control (14% y 33%, respectivamente). Conclusión: Los datos apoyan la hipótesis de que la gestión de los farmacéuticos como profesionales complementarios de la salud, posibilita lograr mejores resultados en los pacientes, a diferencia de lo que ocurre en ausencia de tal gestión.

Obesidad, hipertensión, síndrome metabólico y diabetes mellitus tipo 2 en dadores de sangre, individuos presuntamente sanos, del banco de sangre, tejidos y biológicos, de la ciudad de Posadas / Obesity, hypertension, metabolic syndrome and type 2 diabetes mellitus in blood donors, presumably healthy individuals, from the blood, tissue and biological bank of the city of Posadas

Resumen La enfermedad cardiovascular ocupa uno de los primeros puestos como causa de muerte en el mundo. Durante el primer año del proyecto, nos propusimos hallar la prevalencia y su distribución por sexo de hipertensión, obesidad general y abdominal en donantes de sangre. Establecer la frecuencia y su distribución por sexo de Síndrome Metabólico y hallar la incidencia de diabetes mellitus tipo 2; en el segundo año nos centramos en re-evaluar y valorar el impacto de la intervención en cada individuo. En una población de dadores de sangre presuntamente sanos del Banco de Sangre, Tejidos y Biológicos de la Provincia de Misiones. Se obtuvieron datos antropométricos y presión arterial. Se realizó una extracción sanguínea con ayuno de 12 horas para las determinaciones bioquímicas, consulta médica y tratamiento para quienes lo necesitaron. Se realizó una encuesta abierta cualitativa. Se obtuvieron datos de 141 donantes voluntarios de sangre, 47 mujeres y 94 varones. El 38,1% tenía presión arterial elevada. El 29,5% presento obesidad. El 59 % obesidad abdominal. 41,7 % de los donantes presentaba SM. Se halló una incidencia de diabetes mellitus tipo 2 de 8,6 % (n=12). El 39,6 % (n=55) de los individuos presentó Glucemia Alterada en Ayunas. Todos los individuos que presentaron algún factor de riesgo, concurrieron a la consulta médica. Al año se los recito para su control. De los 30 individuos que estaban en tratamiento solo 9 continuaron haciendolo, impidiendo esto una correcta evaluación clínica global y medición del impacto de las intervenciones que se realizaron. De toda la poblacion de estudio, solo en 4 individuos se ha notado un cambio significativo transcurrido un año. Casi la totalidad de la población de donantes presentó al menos un factor de riesgo para enfermedad cardiovascular, todos ellos modificables, destacando de ello la corta edad de la población. Ninguno de los individuos del estudio tenía conocimiento de su estado.

ABSTRACT Cardiovascular disease occupies one of the first places as a cause of death in the world. During the first year of the project, we set out to find the prevalence and its distribution by sex of hypertension, general and abdominal obesity in blood donors. Establish the frequency and distribution by sex of Metabolic Syndrome (MS) and find the incidence of type 2 diabetes mellitus; while in the second year we focused on re-evaluating and assessing the impact of the intervention on each individual. In a population of presumably healthy blood donors of the Blood, Tissue and Biological Bank of the Province of Misiones. Volunteer donors between 20 and 50 years were evaluated, 2014-2015 period. Anthropometric data and blood pressure were obtained. A blood extraction with fasting of 12 hours was performed for biochemical determinations, medical consultation and treatment for those who needed it. Period 2015-2016, a qualitative open survey and biochemical-clinical evaluation of individuals was conducted. Data were obtained from 141 voluntary blood donors, 47 women and 94 men. 38.1% of the total population had high blood pressure, 29.5% obesity, 59% of the study population had abdominal obesity and 41.7% of donors had MS. An incidence of type 2 diabetes mellitus of 8.6% (n = 12) and 39.6% (n = 55) of the individuals had altered fasting blood glucose. All the individuals who presented some risk factor attended the medical consultation. At the end of one year they are re-scheduled for re-evaluation. Although, the majority agreed on the importance of carrying out health checks, of the 30 individuals who were in treatment only 9 continued to do so, preventing this a correct global clinical evaluation and measuring the impact of the interventions that were performed. Of all the study population, only 4 individuals have noticed a significant change after one year, improving all their risk factors. The parameter that showed the greatest change, in a year, was the fasting blood glucose. Everyone was aware of the significance of cardiovascular risk factors and what their consequences were. Almost all of the donor population had at least one risk factor for cardiovascular disease, all of them modifiable, highlighting the short age of the population. None of the individuals in the study was aware of their condition. Only 9 individuals completed the treatment scheme indicated according to their pathology.

Basal metabolic rate in Brazilian patients with type 2 diabetes: comparison between measured and estimated values

ABSTRACT Objectives: The aims of this study are to investigate which of the seven selected predictive equation for estimating basal metabolic rate (BMR) is the best alternative to indirect calorimetry (IC) and to evaluate the dietary energy intake in patients with type 2 diabetes. Subjects and methods: Twenty-one patients with type 2 diabetes participated in this diagnostic test study. Clinical and laboratorial variables were evaluated as well as body composition by absorptiometry dual X-ray emission (DXA) and BMR measured by IC and estimated by prediction equations. Dietary intake was evaluated by a quantitative food frequency questionnaire. Data were analyzed using Bland-Altman plots, paired t-tests, and Pearson's correlation coefficients. Results: Patients were 62 (48-70) years old, have had diabetes for 8 (2-36) yeas, and 52.4% were females. The mean body composition comprised a fat-free mass of 49.8 ± 9.4 kg and a fat mass of 28.3 ± 7.2 kg. The energy intake was 2134.3 ± 730.2 kcal/day and the BMR by IC was 1745 ± 315 kcal/day. There was a wide variation in the accuracy of BMR values predicted by equations when compared to IC BMR measurement. Harris-Benedict, Oxford, FAO/WHO/UNO equations produced the smallest differences to IC, with a general bias of < 8%. The FAO/WHO/UNO equation provided the best BMR prediction in comparison to measured BMR. Conclusion: In patients with type 2 diabetes, the equation of the FAO/WHO/UNO was the one closest to the BMR values as measured by IC.

Diabetic regulation of subjects with type 2 diabetes mellitus is associated with serum vitamin D levels

SUMMARY OBJECTIVE Vitamin D deficiency is not only associated with bone metabolism but also with diabetes mellitus. We aimed to study the possible association between serum vitamin D concentration and HbA1c level in patients with type 2 diabetes mellitus (T2DM) in this retrospective report. METHODS Patients with T2DM were enrolled to the study either in regulated or non-regulated T2DM groups, according to HbA1c levels. An HbA1c level of <8% was considered as relatively controlled and others were considered as poorly controlled T2DM. RESULTS Serum vitamin D levels in poorly controlled T2DM subjects (9.4 (4.9-34) ng/ml) were significantly lower than that of the relatively well regulated T2DM patients (13.5 (3.4-36) ng/ml) (p=0.03). Vitamin D was strongly and inversely correlated with HbA1c levels (r= -0.295, p=0.005). CONCLUSION Whatever the cause or result of the diabetes mellitus, it is clear that lower vitamin D is strongly associated with worse diabetic regulation in T2DM subjects. Randomized controlled larger studies, which research the relation between diabetic regulation and vitamin D status, are needed to claim whether it could be a therapeutic target in future in diabetic subjects.

RESUMO CONTEXTO E OBJETIVO A deficiência de vitamina D não é apenas associada ao metabolismo ósseo, mas também ao diabetes mellitus. Procurou-se estudar a possível associação entre os níveis de concentração do soro de vitamina D e de HbA1c em pacientes com diabetes mellitus tipo 2 neste relatório retrospectivo. MÉTODOS Os pacientes com diabetes mellitus tipo 2 foram inscritos no estudo em regulada ou não regulada de acordo com os grupos de níveis de HbA1c DM2. HbA1c nível de <8% caracterizava DM2 controlada e HbA1c > 8% DM2 descontrolada. RESULTADOS Os níveis de vitamina D no soro em indivíduos com DM2 mal regulados (9,4 (4,9 a 34) ng/ml) foram significativamente menores do que o do bem regulado em doentes DM2 (13,5 (3,4-36) ng/ml) (p = 0,03). A vitamina D foi forte e inversamente correlacionada com os níveis de HbA1c (p = 0,005). CONCLUSÃO Seja qual for a causa ou o resultado do diabetes mellitus, é claro que níveis baixos de vitamina D são fortemente associados com pior regulação em indivíduos diabéticos com DM2. Maiores estudos randomizados e controlados que pesquisam a relação entre o status de vitamina D e a regulação em diabéticos são necessários para molusco se é, no futuro, poderia ser um alvo terapêutico em indivíduos diabéticos.

Serum uric acid to HDL-cholesterol ratio is a strong predictor of metabolic syndrome in type 2 diabetes mellitus

SUMMARY OBJECTIVE Metabolic syndrome (MS) is a clinical entity that associated with increased risk of type 2 Diabetes Mellitus (DM) and cardiovascular diseases. Serum uric acid levels are correlated MS criteria. We hypothesized whether a uric acid to HDL-cholesterol ratio (UHR) could predict diabetic regulation and presence of MS in type 2 diabetic subjects. METHODS Admissions of the subjects with type 2 DM to outpatient clinics of our institution were retrospectively analyzed. Study population grouped into well-controlled and poorly controlled diabetics according to the HbA1c level (cut off 7%) and further grouped into type 2 DM with and without MS according to the presence of MS. UHR of study groups compared. RESULTS A hundred diabetic subjects enrolled. Mean UHR was significantly lower in well-controlled diabetics (9.7 ± 3.7%) compared to poorly controlled subjects (14 ± 5.4%) (p<0.001). Median UHR of diabetics with MS (13 (6-29) %) was greater than that of the diabetics without MS (9 (3-16) %) (p<0.001). UHR greater than 11% has 77% sensitivity and 60% specifity in predicting worse diabetic control (AUC: 0.752, p<0.001) and a UHR greater than 10.6% has 83% sensitivity and 71% specifity in predicting MS (AUC: 0.839, p<0.001). Sensitivity and specifity of UHR in predicting MS were better than most of the sensitivities and specifities of the five criteria of MS. CONCLUSION We suggest utilization of UHR in diagnosis of MS as a novel criteria. Nevertheless, prospective studies with larger population may make a better scientific evidence in that issue.

RESUMO CONTEXTO E OBJETIVO A síndrome metabólica (SM) é uma entidade clínica associada ao aumento do risco de diabetes mellitus tipo 2 (DM) e doenças cardiovasculares. Os níveis séricos de ácido úrico estão correlacionados com os critérios estabelecidos de EM. Uma vez que DM tipo 2 e MS são distúrbios metabólicos, nós hipotetizamos se uma relação ácido úrico para HDL-colesterol (UHR) poderia predizer a regulação diabética e a presença de MS em diabéticos tipo 2. MÉTODOS As admissões dos sujeitos com DM tipo 2 aos ambulatórios de nossa instituição foram analisadas retrospectivamente. A população do estudo agrupou-se em diabéticos bem controlados e mal controlados, de acordo com o nível de HbA1c (corte de 7%) e posteriormente agrupados em DM tipo 2 com e sem EM de acordo com a presença de EM. UHR dos grupos de estudo comparados. RESULTADOS Um total de 100 indivíduos diabéticos tipo 2 inscritos no estudo. A média UHR foi significativamente menor em diabéticos bem controlados (9,7 ± 3,7%) em comparação com indivíduos com DM tipo 2 mal controlada (14 ± 5,4%) (p < 0,001). A mediana da UAR de diabéticos com EM (13 (6-29)%) foi maior que a dos diabéticos sem SM (9 (3-16)%) (p < 0,001). Um UHR maior que 11% tem 77% de sensibilidade e 60% de especificidade em predizer um pior controle diabético (AUC: 0,762, p < 0,001) e um UHR maior que 10,6% tem 83% de sensibilidade e 71% de especificidade em prever MS (AUC : 0,839, p < 0,001). A sensibilidade e especificidade de UHR em predizer MS foram melhores do que a maioria das sensibilidades e especificidades dos cinco critérios de MS. CONCLUSÃO Sugerimos a utilização da UHR no diagnóstico da SM como um novo critério. No entanto, estudos prospectivos com maior população podem fazer uma melhor evidência científica nessa questão.

Diabetes control could through platelet-to-lymphocyte ratio in hemograms / O controle diabético poderia ser predicado por Platelet para a relação de linfócitos no hemograma

SUMMARY OBJECTIVE Association between type 2 diabetes mellitus and inflammation is well-established. We aimed to study platelet-to-lymphocyte ratio (PLR), a novel inflammatory index derived from hemogram, in diabetic patients in comparison to those in healthy volunteers. METHODS Medical data of type 2 diabetics that showed up in general outpatient medical clinics of our institution between February 2017 and August 2017 were recorded and analyzed. RESULTS Median PLR of type 2 diabetic patients was significantly higher than the PLR of healthy controls (p=0.001). Moreover, PLR was significantly and positively correlated with HbA1c (p<0.001, r=0.58), fasting plasma glucose (p<0.001, r=0.49), and c-reactive protein (p=0.003, r=0.30) levels. Type 2 diabetic subjects with proteinuria had significantly higher PLR levels than that of diabetic subjects without proteinuria. CONCLUSION As an inexpensive and easy to use index, PLR may be useful in predicting the development and control levels of type 2 diabetes mellitus. However, its correlation with HbA1c needs to be validated by larger prospective studies.

RESUMO OBJETIVO A associação entre diabetes mellitus tipo 2 e inflamação está bem estabelecida. Pretendemos estudar a relação plaquetária com linfócitos (PLR), um novo índice inflamatório derivado do hemograma, em pacientes diabéticos e comparar com aqueles em voluntários saudáveis. MÉTODOS Foram registrados e analisados dados médicos de diabéticos de tipo 2 que apareceram em clínicas ambulatoriais de medicina geral de nossa instituição entre fevereiro de 2017 e agosto de 2017. RESULTADOS A PLR mediana dos pacientes com diabetes tipo 2 foi significativamente maior que a PLR de controles saudáveis (p=0,001). Além disso, a PLR foi correlacionada de forma significativa e positiva com os níveis de glicemia de jejum (p<0,001, r=0,49) e níveis de proteína c-reativa (p=0,003, r=0,30) com HbA1c (p<0,001, r=0,58). Os indivíduos diabéticos de tipo 2 com proteinúria aumentaram significativamente os níveis de PLR do que os indivíduos diabéticos sem proteinúria. CONCLUSÃO Como um índice barato e fácil de usar, a PLR pode ser útil para prever o desenvolvimento e controle do nível de diabetes mellitus tipo 2. No entanto, sua correlação com HbA1c precisa ser validada por estudos prospectivos maiores.

Adipokine gene variability and plasma levels in patients with chronic periodontitis -a case-control study

Abstract: Specific variants in genes that encode adipokines and their mRNA and protein expression were previously studied in type 2 diabetes mellitus (T2DM) and obesity, and similar studies have been performed for chronic periodontitis (CP). The aim of this case-control study was to investigate the possible impacts of adiponectin (ADIPOQ), leptin (LEP) and its receptor (LEPR), and resistin (RETN) on the etiopathogenesis of CP. Examinations were performed on 118 non-periodontitis healthy subjects (healthy controls, HC), 205 healthy individuals with CP (H + CP) and 86 type 2 diabetes patients with CP (T2DM + CP). Variants within the ADIPOQ (rs2241766, rs1501299), LEP (rs13228377, rs2167270), LEP receptor (rs1805096), and RETN (rs1862513) genes were determined by qPCR. In addition, the plasma levels of ADIPOQ, LEP, and RETN were analysed by ELISA for 80 individuals. The genotype frequencies of the SNP ADIPOQ +45G/T (rs2241766) differed between the HC and H + CP groups (p=0.03, pcorr>0.05), and carriers of the TT genotype had a lower risk of developing CP compared to carriers of the GG or TG genotypes (p<0.01, pcorr>0.05). However, there were no significant differences in the plasma levels of ADIPOQ, LEP or RETN between the study groups (p > 0.05). Plasma levels of the adipokines were also independent of the gene profiles (p > 0.05). Adipokine plasma levels did not change in patients with H + CP/T2DM + CP compared to HC, but we did identify a specific polymorphism in the ADIPOQ gene that was associated with CP. Although the ADIPOQ +45G/T (rs2241766) gene variant may be a candidate biomarker for CP, further research is required in larger populations with different ethnic backgrounds before any final conclusions can be drawn about the role of this gene in CP.

Efecto del ejercicio sobre la inflamación y ferritina sérica en pacientes con obesidad y diabetes mellitus 2 / Effect of exercise on inflammation and serum ferritin in patients with obesity and type 2 diabetes mellitus

Type 2 Diabetes Mellitus (DM2) is considered a chronic inflammatory and systemic disease of low degree of intensity that promotes other pathologies such as cardiovascular disease, cancer and cognitive impairment. The relationship between inflammatory markers and insulin resistance in obese patients is known. Low-grade inflammation is an independent predictor of chronic diseases and mortality from all causes. Ferritin may be increased in DM2, but it is not clear if its cause is hyperglycemia or chronic inflammation. Objective: To evaluate the impact of a twenty-week program of exercise and diet on the markers of inflammation, metabolic control and the value of ferritin in a sample of obese patients with DM2, assisted in our National Health System. Materials and Methods: Open, controlled and randomized clinical trial in primary care patients. Of 161 patients with DM2 evaluated 35 fulfilled the inclusion criteria. They were divided into two homogeneous groups (control and intervention). Blood was taken from both groups to measure Ferritin along with other inflammatory and metabolic markers, before and after the exercise and diet program. These variables and the changes in serum Ferritin were analyzed. Results: At the beginning of the study Ferritin was elevated in 72.2% and 52.9% of the control and intervention group respectively. In the end, there was a significant difference between the groups, with benefit of the intervention group in the decrease of Interleukin-6, glycosylated hemoglobin, waist and body mass index. There was a non-significant decrease in C-reactive protein and Ferritin. This last one was not related to the other variables. The control group showed no significant decrease of any variable Conclusions: To apply a program of controlled exercise and diet, in the usual treatment of patients with DM2, improves inflammation and glucose homeostasis, discernible by the decrease in inflammatory parameters and by the improvement in the glycemic control. Serum ferritin was not useful to predict the metabolic control of these patients and assess the response to treatment.

Introducción: La diabetes mellitus 2 (DM2) es considerada una enfermedad inflamatoria crónica y sistémica de bajo grado de intensidad que promueve otras patologías. Es conocida la relación entre |inflamación e insulino resistencia en pacientes obesos, siendo un predictor independiente de morbimortalidad por todas las causas. Ferritina puede estar aumentada en la DM2, no es claro si su causa es la hiperglucemia o la inflamación crónica. Objetivo: Evaluar el impacto de un programa de veinte semanas de ejercicio y dieta sobre los marcadores de inflamación, control metabólico y el valor de ferritina en una muestra de pacientes con DM2 obesos. Materiales y Métodos: Ensayo clínico abierto, controlado y randomizado en pacientes del nivel primario de atención. Se evaluaron 35 pacientes con DM2 que se dividieron en dos grupos homogéneos (control e intervención). Se extrajo sangre para medir Ferritina, marcadores inflamatorios y metabólicos, antes y luego del programa de ejercicio y dieta. Analizamos los cambios de esas variables. Resultados: Ferritina estaba elevada en el 72.2% y 52.9% del grupo control e intervención respectivamente. Al final hubo una diferencia significativa entre los grupos, con beneficio del grupo intervención en el descenso de Interleucina-6, hemoglobina glicosilada, cintura e índice de masa corporal. Hubo un descenso no significativo de Ferritina y Proteína C reactiva. Ferritina no presentó relación con las demás variables. En el grupo control no hubo descenso significativo de ninguna variable. Conclusiones: Aplicar un programa de ejercicio controlado y dieta, en el tratamiento de pacientes con DM2, mejora la inflamación y la homeostasis de la glucosa, discernible por el descenso de parámetros inflamatorios y por la mejora en el control glucémico. Ferritina sérica no fue útil para predecir el control metabólico y valorar la respuesta al tratamiento.

Dapagliflozin versus saxagliptin as add-on therapy in patients with type 2 diabetes inadequately controlled with metformin

ABSTRACT Objective: This analysis compared the efficacy and safety of the sodium-glucose cotransporter-2 (SGLT2) inhibitor, dapagliflozin, and the dipeptidyl peptidase-4 (DPP4) inhibitor, saxagliptin, both added on to metformin. Materials and methods: This was a post-hoc analysis from a double-blind, randomized, 24-week clinical trial (NCT01606007) of patients with type 2 diabetes (T2D) inadequately controlled with metformin. We compared the dapagliflozin 10 mg (n = 179) and saxagliptin 5 mg (n = 176) treatment arms. Results: Dapagliflozin showed significantly greater mean reductions versus saxagliptin in HbA1c (difference versus saxagliptin [95% CI]: −0.32% [-0.54, −0.10]; p < 0.005), fasting plasma glucose (-0.98 [-1.42, −0.54] mmol/L; p < 0.0001), body weight (-2.39 [-3.08, −1.71] kg; p < 0.0001) and systolic blood pressure (SBP) (-3.89 [-6.15, −1.63] mmHg; p < 0.001). More dapagliflozintreated than saxagliptin-treated patients achieved the composite endpoint of HbA1c reduction ≥ 0.5%, weight loss ≥ 2 kg, SBP reduction ≥ 2 mmHg and no major/minor hypoglycemia (24% versus 7%). No major events of hypoglycemia were reported. More patients on dapagliflozin (6%) versus saxagliptin (0.6%) experienced genital infections. Conclusion: Dapagliflozin demonstrated greater glycemic efficacy than saxagliptin with additional benefits on weight and SBP, and the safety profile was consistent with previous studies.