Glycerol Potentiates the Effects of Glucose in Promoting Glucose Recovery During Hypoglycemia: From Basic to Clinical Investigations and Their Therapeutic Application.

We compared the effect of oral glucose versus oral glucose combined with glycerol (glucose + glycerol) in promoting glucose recovery during hypoglycemia. These studies were carried out in two series of experiments. In the first series of experiments, 16 overnight fasted rats received an intraperitoneal injection of lispro insulin (1 IU/kg), and 25 min later, they received oral water (control), glucose (0.25 g/kg), glycerol (2.5 g/kg), or glucose (0.25 g/kg) + glycerol (2.5 g/kg). In the second series of experiments on 164 eligible type 1 diabetic (T1D) patients, 30 individuals with a history of hypoglycemia were recruited. Five volunteers did not meet the inclusion criteria and two subjects were excluded after starting the clinical investigation; 23 patients concluded the study. All patients with symptoms of hypoglycemia ingested oral glucose (15 g) or glucose (15 g) + glycerol (9.45 g). To treat hypoglycemia in T1D patients, preparations containing glucose alone or glucose + glycerol were used alternately (2 weeks/2 weeks) in a double-blind crossover scheme. Throughout the clinical research (4 weeks), glucose concentrations were assessed with a continuous glucose monitoring device and the results after the use of glucose alone or glucose + glycerol preparations were compared. Oral glucose combined with glycerol was more effective in promoting glucose recovery in comparison with glucose alone, not only in rats but also in T1D patients. Taken together, our experimental and clinical investigations reported the best performance of oral administration of glucose + glycerol in comparison with isolated glucose.

Evaluation, intervention, and follow-up of patients with diabetes in a primary health care setting in Brazil: the importance of a specialized mobile consultancy.

BACKGROUND: Studies show that educational interventions improve glycemic control in patients with diabetes mellitus (DM), reducing the occurrence of complications associated with the disease. OBJECTIVES: To evaluate the effects of a mobile DM consultancy on clinical and laboratory parameters, disease knowledge, and quality of life in patients with type 2 DM (T2DM) at a primary health care network in Brazil. METHODS: Randomized clinical trial conducted in a city in southern Brazil with 52 patients with T2DM receiving care at a primary health care setting. The intervention lasted for 6 months and consisted of a follow-up with an endocrinologist (five meetings), treatment adjustment based on clinical evaluation and laboratory tests, and educational activities with conversation maps in DM. The statistical analysis included comparison and association tests, considering p values ≤0.05 as statistically significant. RESULTS: The mean age of the patients was 63.8 years. Most participants were female (63.5 %), had low educational level (59.6 %) and family history of T2DM (71.2 %), used only oral hypoglycemic agents to manage their DM (73.2 %), presented unfavorable anthropometric and laboratory parameters, a high or medium risk of complications (84.6 %), and inadequate glycemic control (67.3 %; with 71 % of the high-risk patients presenting a HbA1c level >9 %). Adjustment in pharmacological treatment was required in 63.5 % of the patients. After the intervention, we observed a significant 0.46 % decrease in mean HbA1c level (p = 0.0218), particularly among individuals with inadequate glycemic control (0.71 %; p = 0.0136). Additionally, there was an increase in disease knowledge scores and a significant decrease in mean body mass index, waist circumference, and disease impact scores. CONCLUSION: The intervention improved glycemic control and disease knowledge, reduced the values of body mass index and waist circumference, and the impact of the disease on patients' lives. This indicates that care and educational measures improve the experience of the patients with DM and control of the disease.

Investigation of the tolerability of oral stevioside in Brazilian hyperlipidemic patients

The tolerability of stevioside (2.75 mg/kg/day) obtained from leaves of Stevia rebaudiana (Bert) Bertoni (Compositae) was investigated in hyperlipidemic patients. For this purpose a placebo controlled double blind study was performed. The patients were randomized in two groups: the first group received capsules containing placebo and the second group received capsules containing stevioside (50 mg) during 90 days. All capsules were ingested twice daily, i.e., 2 capsules before lunch and 2 capsules before dinner. After the selection of the patients and each 30 days body mass index and laboratory tests (alanine aminotransferase, aspartate aminotransferase, gamma-glutamyltransferase, total cholesterol, high density lipoprotein, low density lipoprotein, very low density lipoprotein, triglycerides and glucose) were performed. Stevioside did not show any clinical relevant modification in all parameters investigated. Moreover the patients did not report severe adverse effect. Thus, we can concluded that stevioside, at least in the doses employed in this study was safe.

A tolerabilidade do esteviosideo (2.75 mg/kg/dia) obtido a partir de folhas de Stevia rebaudiana (Bert) Bertoni (Compositae) foi investigada em pacientes hiperlipidêmicos. Para alcançar este objetivo realizamos estudo clínico do tipo duplo cego. Os pacientes foram randomizados em 2 grupos: o primeiro recebeu cápsulas contendo placebo e o segundo recebeu cápsulas contendo esteviosídeo (50 mg). Foram ingeridas duas cápsulas antes do almoço e duas cápsulas antes do jantar durante 90 dias. Após a seleção dos pacientes e a cada 30 dias o índice de massa corpórea e exames laboratoriais (alanina aminotransferase, aspartato aminotransferase, gama-glutamiltransferase, colesterol total, lipoproteína de alta densidade, lipoproteína de baixa densidade, lipoproteína de muito baixa densidade, trigliceridemia e glicemia) foram realizados. O esteviosídeo não acarretou qualquer alteração clinicamente relevante nos parâmetros investigados. Além disso, os pacientes não relataram efeitos adversos severos. Assim, podemos concluir que o esteviosídeo, na dose empregada neste estudo é seguro, embora não apresente efeito hipolipemiante.

Ausência de efeito hipolipemiante da Solanum melongena L. (berinjela) em pacientes hiperlipidêmicos / Absence of hypolipidemic effect of Solanum melongena L. (eggplant) on hyperlipidemic patients

Neste estudo, investigamos o potencial hipolipemiante do extrato seco do fruto de berinjela (Solanum melongena), o qual tem sido comercializado no Brasil para o tratamento da hiperlipidemia humana. Assim, um estudo duplo-cego randomizado, objetivando avaliar a eficácia da Solanum melongena (SM) administrada oralmente, foi realizado. Este estudo consistiu de 41 voluntários hiperlipidêmicos alocados para tratamento com SM (n= 21) ou placebo (n= 20). Cada voluntário recebeu duas cápsulas contendo SM (450mg) ou placebo (450mg) duas vezes ao dia, sendo acompanhados mensalmente. A dose de SM utilizada corresponde ao empregado para tratar hiperlipidemia no Brasil. Após 3 meses de tratamento, os valores séricos de colesterol total, LDL-c e LDL-c/HDL-c diminuíram (p<0,05) no grupo tratado com SM. Todavia, efeito similar foi observado no grupo placebo. Os demais parâmetros, incluindo valores séricos de triglicérides, HDL-c, VLDL-c, AST, ALT, gGT, glicose e índice de massa corpórea não apresentaram modificações significativas. Assim, podemos concluir que a SM, pelo menos na forma comercializada no Brasil (extrato seco do fruto), requer um maior volume de estudos clínicos antes de ser recomendada para tratar hiperlipidemia.

[Absence of hypolipidemic effect of Solanum melongena L. (eggplant) on hyperlipidemic patients]. / Ausência de efeito hipolipemiante da Solanum melongena L. (berinjela) em pacientes hiperlipidêmicos.

In this study we investigated the hypolipidemic potential of dried powdered fruits of eggplant (Solanum melongena), which has been commercialized in Brazil to treat human hyperlipidemia. Thus, a double-blind placebo-controlled study of the effectiveness of oral Solanum melongena (SM) was conducted. The study consisted of 41 hyperlipidemic volunteers allocated to active treatment (n= 21) or placebo (n= 20). Each volunteer received two capsules containing SM (450 mg) or placebo (450 mg) twice daily and were followed monthly. The dose of SM used corresponds to that given to treat hyperlipidemia in Brazil. After 3 months, serum total cholesterol, LDL-c and LDL-c/HDL-c decreased (p<0.05) in the group treated with SM. However similar effect was also observed in the placebo group. The other parameters, including serum triglycerides, HDL-c, VLDL-c, AST, ALT, gGT, glucose and body mass index, showed no significant changes. We conclude that SM, at least in the form commercialized in the Brazil (dried powdered fruits), require further clinical trials before being recommended to treat hyperlipidemia.

Influência do tabagismo na hemodinâmica arterial periférica / Influence of smoking on the peripheral arterial hemodynamics

A correlaçäo entre patologia arterial e tabagismo tem sido estabelecida de forma segura e peremptória há décadas. Esta correlaçäo é nitidamente de causa e efeito, sendo também importante o efeito cumulativo e somatório da quantidade de cigarros fumados ao longo da vida. Neste estudo foi correlacionada a hemodinâmica arterial periférica antes e após exercício físico controlado (deambulaçäo controlada) - estresse fisiológico em pacientes sintomáticos e tabagistas de longa data. Foram estudados 85 casos, sendo 32 fumantes e 53 näo-fumantes, tendo sido divididos em 4 grupos, respectivamente: de homens fumantes (g1) e näo-fumantes (g2) e de mulheres fumantes (g3) e näo-fumantes (g4). O parâmetro hemodinâmico aferido em todos os grupos foi o índice pressórico tornozelo-braço, calculado através de fluxometria Doppler, que demonstrou ser bastante sensível a alteraçöes fisiológicas e patológicas no sistema arterial periférico. Em nosso estudo este índice medido pré e pós-estresse fisiológico diminuiu sensivelmente, de modo estatísticamente significativo, apenas no grupo dos homens fumantes. Sendo este parâmetro a única diferença entre este e os demais grupos de pacientes, concluiu-se pela relaçäo direta entre tabagismo e alteraçäo hemodinâmica arterial periférica em pacientes grandes fumantes, assintomáticos do ponto de vista cardiovascular. Esta é demonstrada pela provável incapacidade de vasodilataçäo pós-exercício, representada pela queda da pressäo de perfusäo (índice tornozelo-braço) na circulaçäo periférica dos membros inferiores