Quality of Life of Type 2 Diabetic Patients attending a Tertiary Hospital in South-South Nigeria

Background: Type 2 Diabetes mellitus affects the quality of life of individuals and their ability to function. It affects the physical, social and mental well-being of patients with immediate and delayed complications.This study determined the quality of life of type 2 diabetic patients attending a tertiary hospital in south-south Nigeria.Methods:This was a descriptive cross-sectional study conducted among type 2 diabetic patients attending the medical outpatient clinic of the University of Port Harcourt Teaching Hospital between September and November 2019. Purposive sampling technique was used to select a total of 347 participants for the study following ethical approval. WHOQOL-BREF questionnaire was used to measure the QoL of the participants. Data were analyzed using SPSS version 23.0. Descriptive data were presented in frequency distribution tables while summary statistics were done using mean and standard deviation for continuous variables and in proportions for categorical variables. Results:Results revealed that majority of the type 2 diabetic patients were females (53.3%) and between the ages of 51-60 years. 27.2% of them had poor overall QoL with the score of <45% while 65.7% had fair overall QoL with a score of 45-65 %. 7.1% had good overall QoL with a score of ≥65%. Conclusion:Majority of the type 2 diabetic patients had fair QoL while the least had good QoL. There is urgent need for increased health awareness and education of diabetic patients regarding diabetic care.

Evaluation de la fréquence de la consommation journalière des aliments des diabétiques de type 1 et leurs fratries du district d'Abidjan, Côte d'Ivoire / Evaluation of the frequency of daily food consumption of Type 1 diabetes and their siblings in the district of Abidjan, Cote D'ivoire

Contexte. L'alimentation joue un rôle important dans la prise en charge du diabète en Côte D'Ivoire. L'objectif de ce travail est d'évaluer la fréquence de consommation journalière des aliments chez les diabétiques de type 1 (DT1) et leurs fratries du district d'Abidjan. Méthodes. Une fi che d'enquête comportant les mets Ivoiriens a été utilisée pour la réalisation de l'étude. Etaient eligibles les patients déclarés diabétiques et ayant au moins un frère ou une sœur non diabétique âgé de 5 à 21 ans. Les patients séropositifs au VIH et sous traitement antirétroviral n'ont pas été retenu dans l'étude. le logiciel Graphpad Prism version 5. Résultats. Le riz, l'attiéké et le pain de boulangerie ont été les aliments les plus consommés par les DT1 et leurs fratries (100 %). Au niveau des protéines animales, ce sont la viande dans la sauce, la viande fumée, le poisson dans la sauce et le poisson fumé qui ont été le plus consommés chez les DT1 et leurs fratries (63,15 % et 86,66 %; 68,42 % et 73,33 %; 68,42 % et 66,66 %; 68,42 % et 76,66 %). Les DT1 et leurs fratries ont consommé comme lipides, les huiles alimentaires et la sauce graine. Conclusion. Le régime alimentaire des DT1 et leurs fratries est équilibré, avec un régime plus ouvert chez la fratrie

Context. Diet plays an important role in the management of diabetes in Côte d'Ivoire. The objective of this work is to evaluate the frequency of daily food consumption in type 1 diabetics (T1D) and their siblings in the district of Abidjan. Methods. A survey sheet including Ivorian dishes was used to carry out the study. Results. Rice, attiéké and bakery bread were the foods most consumed by T1Ds and their siblings (100%). At level of animal protein, meat in sauce, smoked meat, fi sh in sauce and smoked fi sh were the most consumed among T1D and their siblings (63.15% and 86.66% ; 68.42% and 73.33% ; 68.42% and 66.66% ; 68.42% and 76.66%). T1Ds and their siblings consumed lipids, edible oils and seed sauce. Conclusion. the diet of T1D and their siblings is balanced, with a more open diet in the siblings.

Elaboração, validação e reprodutibilidade de um questionário de frequência alimentar para hipertensos e/ou diabéticos / Development, validation and reproducibility of a food frequency questionnaire focused on adult hypertensive and/or diabetic individuals

Objetivo: O presente estudo teve por objetivo elaborar e avaliar a validade e a reprodutibilidade de um questionário de frequência alimentar (QFA) para hipertensos e/ou diabéticos do município de Maceió-AL, Brasil. Métodos: O QFA foi elaborado a partir de 1.603 inquéritos dietéticos recordatórios de 24 h (IDR24H). Para avaliar a validade e a reprodutibilidade do QFA aplicaram-se, em uma amostra de 40 indivíduos, três QFAS e três IDR24H concomitantemente e com intervalo máximo de 45 dias entre as aplicações. A validade foi avaliada por meio dos coeficientes de correlação de Pearson (CCP) ou de Spearman (CCS) entre o QFA 1, 2 e 3, e a média dos 3IDR24H, adotando-se o IDR24H como padrão de referência; e a reprodutibilidade, por meio do coeficiente de correlação intraclasse (CCI) entre os QFAs. Resultados: Quanto à validade, os CCP ou CCS atingiram os valores recomendados entre 0,4 e 0,7 para energia, macronutrientes, cálcio e sódio para as aplicações 1 e 2 do QFA (validade satisfatória); e para os demais nutrientes, CCP < 0,4. Quanto à reprodutibilidade, todos os nutrientes estudados apresentaram CCI dentro dos valores recomendados, exceto potássio entre QFA1 e QFA3 (CCI = 0,28). Conclusão: O QFA elaborado e avaliado neste estudo constitui um bom instrumento de avaliação de consumo alimentar para avaliação de energia, macronutrientes, cálcio e sódio para hipertensos e/ou diabéticos, podendo fornecer informações importantes para estudos de epidemiologia nutricional neste público-alvo. (AU)

Objective: The aims of the current study are to develop and assess the validity and reproducibility of a food frequency questionnaire (FFQ) focused on hypertensive and/or diabetic individuals living in Maceió City - AL, Brazil. Methods: The questionnaire was developed based on 1,603 twenty-four-hour recall dietary surveys (24-HDR). Three FFQs and three 24-HDRs were concomitantly applied to a sample of 40 individuals, at maximum interval of 45 days between applications, in order to assess FFQ validity and reproducibility. Validity assessment was based on Pearson's (PCC) or Spearman's (SCC) correlation coefficient between FFQs 1, 2, 3 and the mean of three 24-HDRs (the 24- HDR was used as reference standard). Reproducibility assessment was based on the intraclass correlation coefficient (ICC) among FFQs. Results: PCCs or SCCs recorded the recommended validity values (from 0.4 and 0.7) for energy, macronutrients, calcium and sodium in FFQs 1 and 2 (satisfactory validity), whereas other nutrients recorded PCC < 0.4. All investigated nutrients presented ICC within the recommended reproducibility values, except for potassium, which recorded ICC equal to 0.28 between FFQs 1 and 3. Conclusion: The FFQ developed and evaluated in the current study is a good food intake-evaluation instrument to assess energy, macronutrients, calcium and sodium in hypertensive and/or diabetic individuals, since it can provide important information for studies about nutritional epidemiology in this target population. (AU)

Aceitabilidade e fatores associados ao consumo dietético em pacientes diabéticos de um hospital público universitário / Acceptability and factors associated with dietary consumption in diabetic patients of a public university

A dietoterapia é essencial para pacientes hospitalizados. O objetivo deste estudo foi avaliar a aceitabilidade das refeições do almoço de pacientes que receberam a dietética para Diabetes Mellitus (DM) e verificar aspectos que podem interferir nesse consumo, como as estações do ano. Estudo quantitativo descritivo que avaliou o consumo da refeição almoço dos pacientes que receberam dietética DM em um período de verão e outro de inverno no ano de 2019. Os dados foram verificados em frequências absolutas, porcentagens, médias, e o teste estatístico foi o de regressão logística com a correlação de dados a um nível de significância de 95% (p <0,05) usando o software SPSS® 18.0. Foram selecionadas duas unidades de internação, com amostra de 49 indivíduos (63,3% do sexo masculino). Das 115 refeições servidas, 55,7% foram parcialmente consumidas ou não consumidas. O desperdício de pratos nas refeições do almoço apresentou média per capita de 64,15 g (consumo de 310,89g) no verão e de 135,99g (consumo de 248,12g) no inverno. O padrão do cardápio foi semelhante nas duas estações. Encontrou-se p <0,05 em relação à temporada na associação do odds ratio univariável. Pesquisas dessa natureza são importantes para auxiliar no prognóstico do paciente. (AU)

Diet therapy is essential for hospitalized patients. This study aimed to evaluate the acceptability of lunch meals in patients who received diet for diabetes mellitus (DM) and to verify aspects that may interfere with this consumption, such as seasons. This is a quantitative, descriptive study. The consumption of lunch meal in patients who received dietary DM in summer and a winter period in 2019 was evaluated. The data were verified in absolute frequencies, percentages, means, and the statistical test was the logistic regression with the association data at a 95% significance level (p <0.05) using the SPSS® 18.0 software. Two inpatient units were selected, with a sample of 49 individuals (63.3% males). Out of the 115 lunch meals served, 55.7% were partially consumed or not consumed. The plate waste for the lunch meals showed a mean per capita of 64.15 g (intake of 310.89g) in the summer and of 135.99g (intake of 248.12g) in winter. The menu pattern was similar for both seasons. It was found p <0.05 in relation to the season in the association of univariable odds ratio. This typo of research is important to assist in the patient's prognosis. (AU)

Extra Virgin Olive Oil and Postprandial Blood Glucose in Type 2 Diabetes Mellitus Patients: A Randomized Controlled Cross-over Trial

@#INTRODUCTION: Dietary intervention remains an important factor in the management of diabetes mellitus, and many patients have employed herbs and oils to help manage their chronic diseases. Extra virgin olive oil (EVOO) is widely known for its cardio-vascular benefits. However, its effect on the blood glucose of type 2 diabetes mellitus patients has not been extensively studied. In this study, we aimed to determine if the addition of EVOO to meals results in a lower postprandial blood glucose among type 2 diabetes mellitus patients. METHODS: Thirteen patients were included in this randomized controlled cross-over trial. They were randomized to receive a meal with or without EVOO followed by a one week washout period, where they were given the other intervention. The primary outcome is the trans-meal blood glucose, which was calculated as the percent change in two-hour postprandial blood glucose. RESULTS: In group A, there was a noted 88.55% increase in two-hour postprandial blood glucose in taking meals with EVOO, versus 72.11% change in meals without EVOO. The same was observed in Group B, with a 71.08% and 49.22% increase in two-hour postprandial blood glucose in meals with EVOO and without EVOO, respectively. The difference was significant with a p-value of 0.044. Free fatty acids inhibit glucose transport and insulin secretion, this effect may be more predominant in asian type 2 diabetes mellitus patients. CONCLUSION: This study found that adding extra virgin olive oil on top of meals provided no additional benefit in terms of post-prandial glucose excursion.

Nutritional knowledge, dietary habits and nutritional status of diabetic patients attending teaching hospitals in Lagos, Nigeria

Background: This study assessed the nutritional knowledge, dietary habits and nutritional status of adult diabetic patients attending teaching hospitals in Lagos State, Nigeria. Methods: A cross-sectional study was conducted among adult diabetic patients attending the out-patient clinics of the two Teaching Hospitals in Lagos. Respondents were recruited from the clinics consecutively until the desired sample size (342) was obtained. A pre-tested interviewer-administered questionnaire was used to collect data. Dietary habits were assessed using food frequency questionnaire and BMI was assessed following standard procedure and compared with the World Health Organization (WHO) standards. Data was analyzed using IBM SPSS (Version 20). Chi-square and fisher's exact probability test were used to determine the association between variables. The level of significance was set at p-value less than 5%. Results: The mean age of the respondents was 59.6 + 13.0 years. Only 125 (37%) of the respondents had good nutritional knowledge. Majority ate three meals every day, 237 (69.3%) and have had dietary counseling, 255 (74.6%). More than half of the respondents, 202 (59.1%) skipped meals, 80 (23.4%) consumed alcohol while only 42 (12.3%) ate fruits and vegetables daily. The commonest food consumed was processed cereals. Majority of the respondents were overweight or obese (74%). Obesity was associated with being female and not having dietary counseling. Conclusion: Nutritional knowledge and dietary habits were poor while overweight and obesity were high. Dietary counseling will be necessary to improve the dietary pattern and nutritional status of the diabetic patients

La alimentación para pacientes con diabetes mellitus de tipo 2 en tres hospitales públicos de Cundinamarca, Colombia / Feeding in adults with type II diabetes mellitus in three public hospitals in Cundinamarca, Colombia

Resumen Introducción. En el mundo y en Colombia, la diabetes mellitus de tipo 2 es una de las principales causas de morbimortalidad, y afecta principalmente a los hombres y mujeres mayores de 45 años. Un control inapropiado de la enfermedad puede desembocar en mayores complicaciones de salud y convertirla en una de las de más alto costo. El tratamiento incluye otros componentes, además del control de la glucemia, así como un seguimiento constante del personal médico, y actividades educativas dirigidas al paciente y a su familia. Objetivo. Caracterizar la alimentación de pacientes con diabetes mellitus de tipo 2 en tres hospitales públicos de Cundinamarca. Materiales y métodos. Se hizo un estudio descriptivo y transversal con 212 pacientes, el cual incluyó el análisis sociodemográfico, el de la frecuencia del consumo de alimentos y las prácticas alimentarias. Resultados. La mayoría de la población era mayor de 45 años y tenía un bajo nivel educativo; el 52 % contaba con un plan de alimentación, y solo el 8,9 % recibía orientación nutricional a cargo de un nutricionista. Predominó el consumo de carbohidratos y un bajo consumo de proteínas, vitaminas, minerales y fibra. El consumo de azúcares era menor en los pacientes que tenían un plan dietético (p<0,05). Conclusiones. La mayoría de los pacientes no recibía una alimentación adecuada. Se evidenció un deficiente cumplimiento del tratamiento dietético, así como limitaciones en la asesoría nutricional y barreras de acceso a los alimentos. Estos resultados contribuirán a mejorar las políticas de prevención y control de la diabetes mellitus de tipo 2 y las estrategias que tengan en cuenta el contexto sociocultural de los pacientes.

Abstract Introduction: Type II diabetes mellitus (DMII) is one of the main causes of morbidity and mortality both worldwide and in Colombia. It mainly affects men and women over 45 years of age. Inadequate control of this disease can generate greater health complications making it one of the most costly diseases in the country. Treatment includes activities other than glycemic control and requires constant monitoring by medical personnel and educational processes directed at the patient and his or her family. Objective: To characterize the feeding of patients with DMII in three public hospitals of Cundinamarca. Materials and methods: We conducted a cross-sectional descriptive study of 212 patients that analyzed sociodemographic characteristics, frequency of consumption and feeding practices. Results: Most of the population was over 45 years old and had a low educational level. In total, 52% had a dietary plan, but only 8.9% received nutritional guidance from a nutritionist. The consumption of carbohydrates predominated, with low consumption of proteins, vitamins, minerals, and fiber. The consumption of sugars was lower in patients with a dietary plan (p <0.05). Conclusions: Most of the patients did not have an adequate nutrition; moreover, there was low adherence to dietary treatment, weakness in nutritional counseling and barriers to food access. These results can contribute to improving policies for the prevention and control of DMII and strategies based on the sociocultural context of the patients.

Effects of adherence to Korean diets on serum GGT and cardiovascular disease risk factors in patients with hypertension and diabetes / 한국영양학회지

PURPOSE: This study examined whether the supply of healthy Korean diets for 12 weeks is effective in improving the risk factors related to serum GGT and cardiovascular diseases in patients with hypertension and diabetes. METHODS: This study selected 41 patients, who were treated with hypertension and diabetes. The Korean diet was composed of cooked-rice, soup, kimchi, and various banchan with one serving called bapsang, which emphasize proportionally high consumption of vegetables and fermented foods, moderate to high consumption of legumes and fish, and low consumption of animal foods. The control group was instead instructed to “eat and exercise as usual” while following the Korean Diabetes Association's dietary guidelines with an intake that can assist in glycemic control, maintain adequate weight, and meet the nutritional requirements. The Korean diet group (21 patients) were served three healthy Korean meals a day for 12 weeks, and the control group (20 patients, who trained in the diet guideline of diabetes) maintained their usual diabetic diet. The serum GGT, blood pressure, heart rate, glycemic control data, cardiovascular risk indicators, and changes in diet measured at the four visits (week 0, 4, 8, and 12) during the course of 12 weeks were compared and evaluated. RESULTS: The serum GGT (p < 0.001), HbA1c (p = 0.004), heart rate (p = 0.007), weight (p = 0.002), Body Mass Index (p = 0.002), body fat mass (p < 0.001), body fat (%) (p < 0.001), and free fatty acid (p = 0.007) in the Korean diet group decreased significantly after the dietary intervention compared to the control group. The amount of intake of rice, whole grains, green vegetables, Kimchi, and soybean fermented food were increased significantly compared to the control group (p < 0.001). The Korean diet group showed significant decreases (p < 0.001) in the intake of animal protein, lipid, and cholesterol derived from animal foods compared to the control group but significant increases (p < 0.001) in the intake of total calories, folic acid, dietary fiber, sodium, potassium, and vitamins A, E, and C. CONCLUSION: In patients with hypertension and diabetes, it was confirmed that regular eating of a healthy Korean diet helps improve the risk factors for GGT and cardiovascular diseases.

Ejercicio intermitente y consejería nutricional mejoran control glicémico y calidad de vida en pacientes con diabetes mellitus tipo 2 / Effects of high-intensity interval training and nutritional education in patients with type 2 diabetes

Background: High-intensity interval training (HIIT) improves cardiometabolic markers, but its effects on the quality of life of patients with type 2 diabetes (T2D) is not well known. Aim: To determine the effects of a 12-week HIIT exercise program on cardiometabolic and quality of life variables of T2D patients. Material and Methods: Nine T2D women were assigned to a HIIT + nutritional education (GE) and 10, to a nutritional education alone group (GC). At baseline and after each intervention, anthropometric and body composition parameters using bio-impedance were assessed, and a blood sample was obtained to measure serum lipid levels, blood glucose and glycated hemoglobin. Quality of life was assessed using the SF-12 questionnaire adapted for the Chilean population. Results: There were no significant changes on the lipid profile variables in the GE group, although HDL cholesterol was increased significantly (p < 0.05) in the GC group. Total fat mass was decreased in the GE group from 43.5 ± 1.5 to 41.9 ± 1.5%, p < 0.01. Fasting glucose and glycated hemoglobin decreased in the GE group. There was a significant correlation between the decrease in total fat mass and that of glycated hemoglobin. There were significant increases in quality of life parameters; physical function, physical role, pain, general health, vitality, emotional role, mental health, and social function in the GE but not in the GC group. Conclusions: A 12-week program of HIIT plus nutritional education improves cardiometabolic and quality of life parameters on type 2 diabetics.

Nutrition management in obese patients with type 2 diabetes mellitus after laparoscopic sleeve gastrectomy / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To explore the value of nutrition management in obese patients with type 2 diabetes mellitus(T2DM) after laparoscopic sleeve gastrectomy(LSG).</p><p><b>METHODS</b>Clinical data of 22 obese T2DM patients undergoing LSG from March 2013 to July 2015 in Fudan University Pudong Medical Center were collected. All the patients strictly followed the specialized instruction by nutritionists: diabetic and low calorie diet 3347.2 to 5020.8 kJ (800 to 1200 kcal) per day before the operation; low calorie liquid diet 2510.4 kJ(600 kcal) per day before operation for promoting gastric emptying; fasting diet before postoperative ventilation; clear liquid diet 1673.6 to 2510.4 kJ (400 to 600 kcal) per day after postoperative ventilation (liquid intake >2000 ml); low fat liquid diet 2928.8 to 3765.6 kJ (700 to 900 kcal) per day (protein 60 g per day at least, 2000 ml liquid) 2 weeks after the operation; semi-liquid diet 1 month after operation and gradually normal diet. All the 22 patients were followed up at 1 week, 1, 3, 6 months after operation on time. Changes of body weight, waist circumference, hip circumference, body mass index(BMI), blood glucose indexes induding fasting blood glucose(FBG), 2-hour postparandial blood glucose(PBG), fasting C-peptide, 2-hour postprandial C-peptide, fasting serum inculin(FINS), 2-hour postprandial inculin(INS), HbAlc, blood pressure and blood lipid indexes were observed and analyzed before and 1 week, 1, 3, 6 months after operation.</p><p><b>RESULTS</b>The average age of 22 patients (10 men and 12 women) was 38.6 years (18 to 66 years). The duration of diabetes varied from 1 month to 15 years. Comorbidity included 12 patients of high blood pressure, 14 of fatty liver, 1 of coronary heart disease, 1 of gout, 1 of chronic thyroiditis and 1 of menstrual disorder. LSG was performed successfully in all the patients and no severe complications and transference to laparotomy occurred. As compared to pre-operation, at 6 months after operation, the average body weight decreased from (103.9±20.2) kg to (80.9±12.6) kg (t=6.294, P=0.000), waist circumference from (118.6±13.8) cm to (96.4±8.0) cm (t=6.331, P=0.000), hip circumference from (116.9±12.6) cm to (104.0±7.7) cm (t=3.854, P=0.000), BMI from (36.2±5.9) kg/mto (27.9±3.5) kg/m(t=5.630, P=0.000), showing a decreasing trend over time. There was no underweight patient after 6 months follow-up. As compared to pre-operation, at 6 months after operation, the average FBG reduced from (7.4±1.4) mmol/L to (6.0±0.9) mmol/L (t=3.172, P=0.003), 2 h PBG from (14.1±4.9) mmol/L to (7.5±2.2) mmol/L (t=7.026, P=0.000), FINS from (160.0±71.9) mIU/L to (43.8±20.8) mIU/L (t=7.259, P=0.000), 2-hour postprandial INS from (437.6±261.4) mIU/L to (140.5±104.6) mIU/L (t=5.858, P=0.000), fasting C-peptide from (1.1±0.6) μg/L to (0.7±0.3) μg/L (t=3.560, P=0.000), 2-hour postprandial C-peptide from (2.5±0.9) μg/L to (1.5±0.7) μg/L (t=3.865, P=0.000), HbAlc from (8.0±1.6)% to (5.9±0.6)% (t=5.953, P=0.000), showing a decreasing trend over time except FBG, 2h postprandial C-peptide and HbAlc(all P<0.05). FBG and 2-hour PBG of 16 patients returned to normal 3 months after the operation. Blood pressure and trigly ceride decreased obviously 6 months after operation compared to pre-operation with significant difference(P<0.05). At 6 months after operation, blood pressure of 8 comorbidity patients with high blood pressure became normal (8/12, 66.7%) and of 4 patients improved(4/12, 33.3%); B ultrasound examination revealed normal in 11 comorbidity patients with fatty liver(11/14,78.6%) and improvement in 3 patients (3/14,15.4%). Blood uric acid of the gout patient and the menstruation of the menstrual disorder patient returned to normal 3 months and 1 month after the operation respectively.</p><p><b>CONCLUSION</b>As for obese patients with T2DM undergoing LSG, reasonable nutrition management is helpful to decrease body weight, and to obtain an ideal improvement of blood glucose and blood lipid levels.</p>

Nutritional factors related to glucose and lipid modulation in diabetic dogs: literature review / Fatores nutricionais relacionados ao controle glicêmico e lipídico de cães diabéticos: revisão de literatura

Diabetes mellitus is a chronic disorder that results in hyperglycemia by absolute or relative insulin deficiency, sometimes leading to fatal complications. The successful treatment of diabetic dogs depends on nutritional management and insulin applications. Studies evaluating the nutrition of diabetic dogs focused on fiber as the main factor in glycemic control; however, new research describes the role of starch as key in postprandial glycemic fluctuation, also attributing a central role for body condition scores and feed management in the adequate glycemic control of diabetic dogs. The aim of this paper is to review nutritional aspects to better control diabetes in dogs.(AU)

Diabetes Mellitus é uma desordem crônica que resulta em hiperglicemia pela deficiência absoluta ou relativa de insulina, que gera complicações que podem levar à morte. O sucesso do tratamento do cão diabético depende da aplicação de insulina e do adequado manejo nutricional. Estudos que avaliaram aspectos nutricionais de cães diabéticos focavam na fibra dietética como o principal fator controlador da glicemia, porém novas pesquisas apontam o amido como principal responsável pelas respostas glicêmicas pós-prandiais e atribuem importante papel ao escore de condição corporal e ao manejo alimentar no adequado controle glicêmico de cães diabéticos. O objetivo deste trabalho é revisar os principais aspectos da nutrição de cães diabéticos para o melhor controle da doença.(AU)

Clinical practice guideline for the prevention, early detection, diagnosis, management and follow up of type 2 diabetes mellitus in adults / Guía de práctica clínica para la prevención, diagnóstico, tratamiento y seguimiento de la diabetes mellitus tipo 2 en la población mayor de 18 años

In Colombia, diabetes mellitus is a public health program for those responsible for creating and implementing strategies for prevention, diagnosis, treatment, and follow-up that are applicable at all care levels, with the objective of establishing early and sustained control of diabetes. A clinical practice guide has been developed following the broad outline of the methodological guide from the Ministry of Health and Social Welfare, with the aim of systematically gathering scientific evidence and formulating recommendations using the GRADE (Grading of Recommendations Assessment, Development and Evaluation) methodology. The current document presents in summary form the results of this process, including the recommendations and the considerations taken into account in formulating them. In general terms, what is proposed here is a screening process using the Finnish Diabetes Risk Score questionnaire adapted to the Colombian population, which enables early diagnosis of the illness, and an algorithm for determining initial treatment that can be generalized to most patients with diabetes mellitus type 2 and that is simple to apply in a primary care context. In addition, several recommendations have been made to scale up pharmacological treatment in those patients that do not achieve the objectives or fail to maintain them during initial treatment. These recommendations also take into account the evolution of weight and the individualization of glycemic control goals for special populations. Finally, recommendations have been made for opportune detection of micro- and macrovascular complications of diabetes.

En Colombia la Diabetes Mellitus es un problema de salud pública por lo que deben generarse e implementarse estrategias de prevención, diagnóstico, tratamiento y seguimiento, aplicables en todos los niveles de atención con miras a establecer el control de la diabetes en forma temprana y sostenida. Se elaboró una guía de práctica clínica siguiendo los lineamientos de la guía metodológica del Ministerio de Salud y Protección Social para recolectar de forma sistemática la evidencia científica y formular las recomendaciones utilizando la metodología GRADE. El presente documento muestra, de forma resumida, el resultado de ese proceso, incluyendo las recomendaciones y las consideraciones tenidas en cuenta para llegar a ellas. En términos generales, se propone un proceso de tamización mediante el cuestionario FINDRISC adaptado a población Colombiana que permite llegar a un diagnóstico temprano de la enfermedad y un algoritmo para el manejo inicial que es generalizable a la gran mayoría de los pacientes con diabetes mellitus tipo 2 y que es sencillo de aplicar en atención primaria. También se hacen unas recomendaciones para escalar el tratamiento farmacológico de los pacientes que no alcanzan la meta o la pierden con el manejo inicial, teniendo en cuenta principalmente la evolución del peso y la individualización de la meta de control glucémico en poblaciones especiales. Finalmente se proponen algunas recomendaciones para la detección oportuna de las complicaciones micro y macrovasculares de la diabetes.

Evaluation of information retention and adherence to treatment in patients with gestational diabetes mellitus after multidisciplinary group / Avaliação da retenção de informações e da adesão ao tratamento em pacientes com diabetes mellitus gestacional após grupo multiprofissional

SUMMARY Objective: To evaluate the retention of information after participation in multidisciplinary group in patients with gestational diabetes mellitus (GDM) through a phone contact. Method: 122 pregnant women diagnosed with gestational diabetes were included. After diagnosis of gestational diabetes, the patients were referred to the multidisciplinary group where they received medical, nutrition and nursing guidelines related to the disease. After three days these patients received one telephone call from a nurse, who made the same questions regarding the information received. In the statistical analysis, results were presented as absolute and relative frequencies. Results: Most patients 119/122 patients (97.5%) were managing to do self glucose monitoring. Twenty-one patients (17.2%) reported having difficulty performing the blood glucose, especially finger pricking. When questioning whether the woman was following the proposed diet, 24/122 (19.7%) patients said they did not; the meal frequency was not reached by 23/122 (18.9%) of the women, and forty-seven (38.5%) of the women reported having ingested sugar in the days following the guidance in multidisciplinary group. Conclusion: Regarding the proposed treatment, there was good adherence of patients, especially in relation to blood glucose monitoring. As for nutritional control, we observed greater difficulty in following the guidelines demonstrating the need for long-term monitoring, as well as further clarification to the patients about the importance of nutrition in diabetes management.

RESUMO Objetivo: avaliar a retenção de informações, após participação em grupo multiprofissional, em pacientes com diabetes mellitus gestacional (DMG), por meio de contato telefônico. Método: foram incluídas 122 gestantes com diagnóstico de DMG. Após o diagnóstico, as pacientes eram encaminhadas ao grupo multiprofissional para receber orientações médicas, nutricionais e de enfermagem relacionadas à doença. Após três dias, as pacientes receberam um contato telefônico de um enfermeiro, que realizou perguntas relacionadas às informações recebidas. Na análise estatística, os resultados foram apresentados em frequências absolutas e relativas. Resultados: a maioria das pacientes, 119/122 (97,5%), estava conseguindo fazer a automonitorização glicêmica. Vinte e uma pacientes (17,2%) referiram ter dificuldades para realizar a glicemia capilar, sendo a principal relacionada às lancetas. Quanto à dieta proposta, 24/122 (19,7%) referiram que não estavam conseguindo cumprir; o fracionamento da dieta não foi alcançado por 23/122 (18,9%) das gestantes e 47 (38,5%) relataram ter ingerido açúcar nos dias seguintes à orientação do grupo multiprofissional. Conclusão: em relação ao tratamento proposto, houve boa adesão das pacientes, especialmente quanto à automonitorização glicêmica. Em relação aos controles nutricionais, observamos maior dificuldade no seguimento das orientações, mostrando haver necessidade de seguimento em longo prazo e de fornecer melhor esclarecimento às pacientes sobre a importância da nutrição no controle do diabetes.

Practical Diet Education for Patients with Type 2 Diabetes: Tips for Physicians / 임상당뇨병

Comprehensive education is the cornerstone of diabetes management. However, in Korea, diabetes education is constrained by short office visits. This article intends to introduce various educational strategies, particularly regarding diet style modification, that can be employed in the time-limited outpatient setting to improve diabetes management. Instructing patients to reduce their intake of carbohydrates, the predominant nutrient consumed in a traditional Korean diet, may be beneficial. The use of novel educational technologies or the introduction of new healthy diet plans may also help.

Knowledge of diabetes among patients in the United Arab Emirates and trends since 2001: a study using the Michigan Diabetes Knowledge Test

Knowledge of diabetes among patients with the disease in the United Arab Emirates is essential for effective self-management. We assessed the level of diabetes-related knowledge among patients and compared it with that found in previous studies in the same city. A cross-sectional study, using an interviewer-administered questionnaire, was conducted at two clinics in Al Ain, United Arab Emirates. The Michigan Diabetes Knowledge Test, translated into Arabic, was used to assess knowledge of diabetes. Of 165 participants with diabetes, 130 [78.8%] were women. The mean knowledge score was low at 55% [6.6 out of a maximum possible score of 12, standard deviation 1.8]. This is comparable to levels found in previous studies: 55.5% in 2001 and 68.2% in 2006. Misconceptions about the diabetic diet and blood testing were common. The level of diabetes-related knowledge has remained low since 2001. These results are of concern in view of the substantial investments made in diabetes care and health education in the region

Conocimiento que tiene los pacientes diabéticos y sus familiares sobre la enfermedad y sus cuidados en el hogar. Consultorio de Endocrinología del Hospital Guillermo C. Paterson. 2014

El presente estudio titulado "Conocimientos que tienen los pacientes diabéticos y sus familiares sobre la enfermedad y sus Cuidados en el Hogar. En el consultorio externo de Endocrinología del Hospital Guillermo C. Paterson durante los meses de junio - agosto del 2014", tuvo como objetivo general determinar el nivel de conocimientos que tienen los pacientes diabéticos y sus familiares sobre la enfermedad y sus cuidados en el hogar y como objetivos específicos identificar el nivel de conocimiento que tienen los pacientes diabéticos sobre la enfermedad, identificar el nivel de conocimientos que tienen los pacientes diabéticos sobre los cuidado en el hogar, identificar el nivel de conocimiento que tienen los familiares de los pacientes diabéticos sobre la enfermedad e identificar el nivel de conocimientos que tienen los familiares de los pacientes diabéticos sobre los cuidados en el hogar

SUMMARY: The presente this estudy entitled "Knowledge having diabetic patients and their familiars about the diseases and its care home, at the consulting room external of endocrinology at the hospital clinica C. Paterson during the months of june to august 2014" he had as its overall objective determine the level of knowledge among the diabetic patients and their families about the disease and its home care specific objectives and identify the level of knowledge that aiabetic patients have about the disease, identifiy the level of knowledge that diabetic patients have on home care, identify the level of knowledge they have relatives of diabetic patients about the disease and identify the level of knowledge with relatives of diabetic patients on home care

Crianças e adolescentes que convivem com diabetes e doença celíaca / Niños y adolescentes viviendo con la diabetes y la enfermedad celíaca / Children and adolescents living with diabetes and celiac disease

RESUMO Objetivo Compreender a experiência de crianças e adolescentes que convivem com diabetes mellitus tipo 1 e doença celíaca. Método Estudo qualitativo, exploratório e descritivo. A coleta de dados ocorreu entre janeiro e setembro de 2012, com 3 crianças e 2 adolescentes, em um ambulatório de diabetes do Hospital das Clinicas da FMUSP ou na residência dos participantes na cidade de São Paulo, por meio de entrevistas semiestruturadas. Utilizou-se a Análise de Conteúdo como método de tratamento dos dados. Resultados A dieta aparece como foco da experiência dos participantes, porém com diferentes significados. As crianças têm dificuldade em seguir a dieta, enquanto os adolescentes referem que os aspectos sociais e afetivos são os mais afetados. Conclusão Reforça-se a importância do enfermeiro buscar estratégias em parceria com as crianças, os adolescentes e suas famílias a fim de minimizar as dificuldades encontradas principalmente no manejo da dieta imposta por ambas as doenças.

RESUMEN Objective Comprender la experiencia de los niños y adolescentes que viven con diabetes tipo 1 y la enfermedad celíaca. Método Estudio cualitativo exploratorio y descriptivo, se incluyeron 3 niños y 2 adolescentes; los datos fueron colectados de enero a septiembre de 2012, en la clínica de diabetes del Hospital de Clínicas de la Facultad de Medicina de la Universidad de São Paulo o en la residencia de los participantes en São Paulo, a través de entrevistas semi-estructuradas. Para el tratamiento de los datos se utilizó la técnica de Análisis de Contenido. Resultados La dieta es el foco de la experiencia de los participantes, pero con diferentes significados. Los niños tienen dificultad para seguir la dieta, mientras que los adolescentes reportan que los aspectos sociales y afectivos son los más afectados. Conclusión Los resultados refuerzan la importancia de la enfermera buscar estrategias en colaboración con los niños, adolescentes y sus familias para minimizar dificultades encontradas principalmente en la gestión de la dieta impuesta por ambas enfermedades.

ABSTRACT Objective To understand the experience of children and adolescents living with type 1 diabetes and celiac disease. Method This is a qualitative exploratory-descriptive study. The participants were 3 children and 2 adolescents. The data were collected by means of semi-structured interviews between January and September 2012 at the participant's residence or at the diabetic outpatient clinic of the Hospital das Clinicas, Faculty of Medicine, University of Sao Paulo in São Paulo, Brazil. The content analysis technique was used to process the data. Results The key aspect of the illness experience of the patients was their diet, but with different meanings. The children had difficulty following the diet, while the adolescents reported that they had greater difficulty coping with the social and affective aspects of their diet. Conclusion The results reinforce the importance of nurses who seek strategies, together with the patients and their families, that help minimize the difficulties of these patients, especially with regard to managing the diet imposed by both diseases.

Evaluation of the telephone intervention in the promotion of diabetes self-care: a randomized clinical trial / Avaliação da intervenção telefônica na promoção do autocuidado em diabetes: ensaio clínico randomizado / Evaluación de la intervención telefónica en la promoción del autocuidado en diabetes: ensayo clínico aleatorio

ABSTRACT Objective: to evaluate the effectiveness of the telephone intervention for promoting self-care related to physical activity and following a diet plan in users with diabetes, compared to conventional monitoring of users over a six-month period. Method: this was a randomized clinical trial, which included 210 users with diabetes, linked to eight Primary Health Units of Belo Horizonte, Minas Gerais. The experimental group (104 members) received six telephone interventions over the six-month monitoring; the control group (106 members) received conventional monitoring. To evaluate the self-care practices related to physical activity and following a healthy eating plan, in both groups, the self-care questionnaire was applied before the intervention and at three and six months after its start. Results: the mean effect of self-care scores in the experimental group was 1.03 to 1.78 higher than the control group, with progressive and significant improvement (p<0.001). Conclusion: the results indicate that the telephone intervention had a beneficial effect on diabetes self-care. The primary identifier of the clinical trials registry was: RBR-8wx7qb.

RESUMO Objetivo: avaliar a efetividade da intervenção telefônica na promoção do autocuidado relacionado à atividade física e ao seguimento de um plano alimentar, em usuários com diabetes, quando comparada ao acompanhamento convencional dos usuários, durante o período de seis meses. Métodos: trata-se de um ensaio clínico randomizado, no qual participaram 210 usuários com diabetes, vinculados a oito Unidades Básicas de Saúde de Belo Horizonte, Minas Gerais. O grupo-experimental (104 usuários) recebeu seis intervenções telefônicas em seis meses de acompanhamento; o grupo-controle (106 usuários) recebeu acompanhamento convencional. Para avaliar as práticas de autocuidado, relacionada à atividade física e ao seguimento do plano alimentar saudável, em ambos os grupos, aplicou-se o questionário de autocuidado antes das intervenções, três e seis meses após o seu início. Resultados: o efeito médio dos escores de autocuidado no grupo-experimental a pontuação foi de 1,03 a 1,78 maior do que o grupo-controle, apresentando melhora progressiva e significativa (valor-p<0,001). Conclusão: os resultados apontam que a intervenção telefônica tem efeito benéfico sobre o autocuidado em diabetes. O registro clínico obteve identificador primário: RBR-8wx7qb.

RESUMEN Objetivo: evaluar la efectividad de la intervención telefónica en la promoción del autocuidado relacionado a la actividad física y al seguimiento de un plan alimentario, en usuarios con diabetes, cuando comparada al acompañamiento convencional de los usuarios, durante el período de seis meses. Métodos: se trata de un ensayo clínico aleatorio, en el cual participaron 210 usuarios con diabetes, vinculados a ocho Unidades Básicas de la Salud de Belo Horizonte, Minas Gerais. El grupo experimental (104 usuarios) recibió seis intervenciones telefónicas en seis meses de acompañamiento; el grupo control (106 usuarios) recibió acompañamiento convencional. Para evaluar las prácticas de autocuidado, relacionadas a la actividad física y al seguimiento del plan alimentario saludable, en los dos grupos, se aplicó el cuestionario de autocuidado antes de las intervenciones, tres y seis meses después de su inicio. Resultados: el efecto promedio de los puntajes de autocuidado en el grupo experimental fue de 1,03 a 1,78 mayor que el grupo control, presentando mejoría progresiva y significativa (valor-p<0,001). Conclusión: los resultados apuntan que la intervención telefónica tiene efecto benéfico sobre el autocuidado en diabetes. El registro clínico obtuvo identificador primario: RBR-8wx7qb.

Efeito da restrição calórica e do treinamento resistido em marcadores de resistência à insulina de ratas ovariectomizadas / Effect of calorie restriction and strength training on markers of insulin resistance in ovariectomized rats

Neste estudo, avaliamos o efeito da restrição calórica e do treinamento resistido na massa corporal e na sensibilidade à insulina de ratas ovariectomizadas. 80 ratas fêmeas da linhagem Holtzman foram distribuídas em 8 grupos (n=10 cada): ovariectomizado (OVX), ovariectomizado com restrição calórica (OVX RC), ovariectomizado com treinamento resistido (OVX TR), ovariectomizado com restrição calórica e treinamento resistido (OVX TR+RC), Sham operado (SHAM), Sham com restrição calórica (SHAM RC), sham com treinamento resistido (SHAM TR), sham com restrição calórica e treinamento resistido (SHAM TR+RC). Após 13 semanas de intervenção, foram analisados: massa corporal, gordura corporal; concentrações sanguíneas de glicose, insulina e adiponectina; conteúdo de AKT total e fosforilada, pi3k e Glut 4 (nos tecidos adiposos subcutâneo e retroperitoneal). As ratas ovariectomizadas (OVX, OVX RC, OVX TR e OVX TR+RC) apresentaram maior massa corporal e gordura corporal quando comparadas ao grupo SHAM. As concentrações de glicose e insulina foram semelhantes em todos os grupos experimentais, porém a concentração de adiponectina foi menor nos grupos ovariectomizados (OVX, OVX RC, OVX TR e OVX TR+RC), quando comparados ao grupo SHAM. A RC e o TR aumentaram a concentração de adiponectina quando comparado ao grupo OVX. Não houve diferença entre os grupos em relação à via de sinalização da insulina nos tecidos adiposos subcutâneo e retroperitoneal. Concluímos que a ovariectomia causa aumento de massa e gordura corporal, levando à menor concentração de adiponectina, e que a RC e o TR alteram estas modificações

In this study, we evaluated the effect of calorie restriction and strength training on the body weight and insulin sensitivity of ovariectomized rats. Eighty female Holtzman rats were divided into eight groups (n=10 per group): ovariectomized (OVX), ovariectomized plus calorie restriction (OVX-CR), ovariectomized plus strength training (OVX-ST), ovariectomized plus strength training and calorie restriction (OVX-ST+CR), sham operated (SHAM), sham plus calorie restriction (SHAM-CR), sham plus strength training (SHAM-ST), and sham plus strength training and calorie restriction (SHAM-ST+CR). The following variables were analyzed after 13 weeks of intervention: body weight; body fat; blood concentrations of glucose, insulin and adiponectin; total and phosphorylated AKT content; pi3k and Glut 4 (in subcutaneous and retroperitoneal adipose tissues). Ovariectomized rats (OVX, OVX-CR, OVX-ST, and OVX-ST+CR) had a higher body weight and body fat than SHAM animals. Glucose and insulin concentrations were similar in all experimental groups, but adiponectin concentration was lower in the ovariectomized groups (OVX, OVX-CR, OVX-ST, and OVX-ST+CR) when compared to the SHAM group. Calorie restriction and ST increased the concentration of adiponectin when compared to the OVX group. There was no difference between groups in terms of insulin signaling in subcutaneous or retroperitoneal adipose tissue. We conclude that ovariectomy increases body weight and body fat, reducing adiponectin concentration, and that CR and ST alter these modifications

Síndrome de hipoglicemia autoinmune: Primeros casos en Chile / Insulin autoimmune syndrome: Report of two cases

Insulin autoimmune syndrome (IAS) is characterized by spontaneous hypoglycemia with extremely high insulin levels and the presence of circulating autoantibodies against insulin, in patients who have never been exposed to exogenous insulin. We report two patients with the syndrome. A 36 years old male presenting with hypoglycemia in the emergency room had an oral glucose tolerance test showed basal and 120 min glucose levels of 88 and 185 mg/dl. The basal and 120 min insulin levels were 2,759 and 5,942 μUI/ml. The presence of an insulin secreting tumor was discarded. Anti-insulin antibodies were positive. He was successfully treated with a diet restricted in carbohydrates and frequent meals in small quantities. A 65 years old female presenting with hypoglycemia in the emergency room had the fasting insulin levels of 1,910 µUI/ml. No insulin secreting tumor was detected by images and anti-insulin antibodies were positive. The polyethylene glycol precipitation test showed a basal and after exposition insulin level 1,483 and 114 µUI/ml, respectively. She responded partially to diet and acarbose and required the use of prednisone with a good clinical response.