ABSTRACT
Diabetes is one of the most important epidemic diseases of this century and the number of people with diabetes has more than doubled over the past three decades. Our aim was to estimate the prevalence of diabetes in the adult Brazilian population and analyze the trends for the last three decades through a systematic review with meta-analysis. This review included observational studies published between 1980 and 2015, which were independently identified by two reviewers in five databases. Random effect models were used to estimate the prevalence and trends of diabetes. In total, 50 articles were included in this review. Three different patterns for diabetes diagnosis were identified: self-report (36 studies), fasting glucose (7 studies), and complex diagnosis (fasting glucose, oral glucose tolerance test, and self-report; 7 studies). The prevalence of diabetes was 5.6 % (95 % CI 5.0-6.3; I(2) = 100 %) by self-report, 6.6 % (95 % CI 4.8-8.9; I(2) = 94 %) by fasting glucose, and 11.9 % (95 % CI 7.7-17.8 I(2) = 100 %) by complex diagnosis. In trend analyses, we observed an increase in the prevalence of diabetes over time. The biggest increase was detected in studies using complex diagnosis: 7.4 % (95 % CI 7.1-7.7) in the 1980s to 15.7 % (95 % CI 9.8-24.3) in the 2010s. In conclusion, despite high heterogeneity, this study observed a high prevalence of diabetes in Brazilian adults over time and with a progressive increase in the last 35 years.
ABSTRACT
Fundamentos: A varfarina e a femprocumona são os anticoagulantes orais mais utilizados; no entanto, até então, não existem estudos randomizados comparando a estabilidade da anticoagulação entre estes dois fármacos. Objetivos: Comparar a varfarina e femprocumona quanto à estabilidade na manutenção de anticoagulação em nível terapêutico (razão normatizada internacional [RNI] entre 2,0 e 3,0) e avaliar a incidência de complicações hemorrágicas e tromboembólicas decorrentes de anticoagulação inadequada.Métodos: Ensaio clínico, randomizado, duplo-cego, incluindo pacientes em tratamento vigente com anticoagulante oral, porém com RNI abaixo do alvo terapêutico nas últimas três semanas, randomizados para uso de varfarina ou femprocumona. O ajuste da dose da medicação foi realizado conforme algoritmo pré-estabelecido. Resultados: Foram randomizados 62 pacientes, sendo 31 em cada grupo, durante as cinco primeiras semanas de estudo. Verificou-se que a femprocumona se mostrou mais instável comparada à varfarina. A partir da sexta aferição de RNI, o grupo femprocumona apresentou melhora na estabilidade do valor do RNI, porém não houve significância estatística. Também não houve diferença significativa em relação aos efeitos colaterais dos fármacos. Conclusão: A varfarina demonstrou maior eficácia na estabilidade do RNI em relação à femprocumona.
Background: Although warfarin and phenprocoumon are the most widely used oral anticoagulants, there a r e n o r a n d o m i z e d s t u d i e s c o m p a r i n g t h e anticoagulation stability of these two drugs.Objectives: To compare warfarin and phenprocoumon in terms of therapeutic anticoagulation maintenance stability (international normalized ratio [INR] between 2.0 and 3.0) and evaluate the incidence of thromboembolic and hemorrhagic complications arising from inadequate anticoagulation.Methods: Randomized double-blind clinical trial with patients undergoing current oral anticoagulant treatment but with INR below the therapeutic target during the past 3 weeks, randomized for warfarin or phenprocoumon. Medication dosages were adjusted in compliance with a predetermined algorithm.Results: With 62 patients randomized into two groups of 31 each during the first five weeks of the study, phenprocoumon was found to be more unstable than warfarin. From the sixth INR measurement onwards, the stability of the INR value improved in the phenprocoumon group, but with no statistical significance. There were no significant differences in the side effects of the drugs.Conclusion: Warfarin demonstrated greater effectiveness for INR stability than phenprocoumon.
