Accuracy of continuous glucose monitoring system during exercise in type 2 diabetes.

The concordance of continuous glucose monitoring system (CGMS) and finger-stick blood glucose (FSBG) was assessed in patients with type 2 diabetes during daily activities and two different exercise sessions. Agreement between FSBG and CGMS becomes weaker during exercise, but more than 90% of the CGMS readings are within acceptable range.

The UCP1 -3826A/G polymorphism is associated with diabetic retinopathy and increased UCP1 and MnSOD2 gene expression in human retina.

PURPOSE: Uncoupling protein 1 (UCP1) reduces mitochondrial production of reactive oxygen species (ROS). ROS overproduction is related to diabetic retinopathy (DR), a chronic complication of diabetes mellitus (DM). Therefore, deleterious polymorphisms in the UCP1 gene are candidate risk factors for DR. We investigated the relationships between the UCP1 -3826A/G polymorphism and risk of DR and UCP1 gene expression in human retina. Considering that superoxide dismutase-2 (MnSOD2) enzyme is the first line of defense against oxidative stress in mitochondria, we also analyzed MnSOD2 gene expression in retinal samples according to different UCP1 -3826A/G genotypes. METHODS: In a case-control study, frequencies of -3826A/G polymorphisms were analyzed in 257 type 1 DM patients (154 cases with DR and 103 controls without DR). In a cross-sectional study comprising cadaveric cornea donors, UCP1 and MnSOD2 gene expressions were evaluated in 107 retinal samples differentiated according to different -3826A/G genotypes. RESULTS: In the type 1 DM group, multivariate analysis confirmed that the G/G genotype was an independent risk factor for DR (OR = 3.503; P = 0.043). In cornea donors, G allele carriers had higher UCP1 cDNA and protein concentrations than A/A carriers (P = 0.034 and P = 0.039, respectively). Interestingly, G allele carriers exhibited increased MnSOD2 expression (P = 0.001). CONCLUSIONS: This study suggests that the -3826A/G polymorphism is associated with DR in type 1 DM patients. This is the first report demonstrating UCP1 gene expression in human retinas and indicates that the -3826A/G polymorphism influences its expression. In addition, the -3826G allele was associated with increased MnSOD2 expression; thus, suggesting that this allele could be a marker of oxidative stress.

Severe forms of retinopathy predict the presence of subclinical atherosclerosis in type 1 diabetes subjects.

BACKGROUND: In patients with type 2 diabetes, the presence of retinopathy is associated with increased cardiovascular disease, regardless of known risk factors for vascular disease. OBJECTIVE: To investigate the association of diabetic retinopathy (DR) and its grades with the presence of subclinical coronary atherosclerosis in patients with type 1 diabetes. METHODS: A cross-sectional study was conducted with 150 type 1 diabetes individuals asymptomatic for coronary artery disease. They underwent clinical evaluation for microvascular complications and for the presence of coronary artery calcification (CAC). RESULTS: Severe forms of DR (severe non-proliferative DR and proliferative DR) were associated with CAC (OR: 3.98 95% CI 1.13-13.9, p = 0.03), regardless of known risk factors for cardiovascular disease (age, A1C, hypertension, dyslipidemia and male gender). CONCLUSION: Patients with severe forms of DR are at risk for the presence of coronary artery disease regardless of traditional cardiovascular risk factors.

Formas graves de retinopatia predizem aterosclerose subclínica em indivíduos com diabetes tipo 1 / Severe forms of retinopathy predict the presence of subclinical atherosclerosis in type 1 diabetes subjects

FUNDAMENTO: Em pacientes com diabetes tipo 2, a presença de retinopatia está associada a doença cardiovascular aumentada, independentemente dos fatores de risco conhecidos para a doença vascular. OBJETIVO: Investigar a associação da retinopatia diabética (RD) e seus graus com a presença de aterosclerose coronariana subclínica em pacientes com diabetes tipo 1. MÉTODOS: Um estudo transversal foi conduzido com 150 pacientes com diabetes tipo 1, assintomáticos para doença arterial coronariana. Foram submetidos à avaliação clínica para verificar complicações microvasculares e avaliação para a presença de calcificação arterial coronariana (CAC). RESULTADOS: Formas graves de RD (RD grave não proliferativa - RDNP - e RD proliferativa - RDP) foram associadas à CAC (RC: 3,98; IC de 95 por cento; 1,13-13,9, p = 0,03), de maneira independente dos fatores de risco conhecidos para a doença cardiovascular (idade, A1C, hipertensão, dislipidemia e sexo masculino). CONCLUSÃO: Os pacientes com formas graves de RD estão em risco de presença de doença arterial coronariana, de maneira independente dos tradicionais fatores de risco cardiovascular.

BACKGROUND: In patients with type 2 diabetes, the presence of retinopathy is associated with increased cardiovascular disease, regardless of known risk factors for vascular disease. OBJECTIVE: To investigate the association of diabetic retinopathy (DR) and its grades with the presence of subclinical coronary atherosclerosis in patients with type 1 diabetes. METHODS: A cross-sectional study was conducted with 150 type 1 diabetes individuals asymptomatic for coronary artery disease. They underwent clinical evaluation for microvascular complications and for the presence of coronary artery calcification (CAC). RESULTS: Severe forms of DR (severe non-proliferative DR and proliferative DR) were associated with CAC (OR: 3.98 95 percent CI 1.13-13.9, p = 0.03), regardless of known risk factors for cardiovascular disease (age, A1C, hypertension, dyslipidemia and male gender). CONCLUSION: Patients with severe forms of DR are at risk for the presence of coronary artery disease regardless of traditional cardiovascular risk factors.

[Characterization of patients with type 1 diabetes mellitus in southern Brazil: chronic complications and associated factors]. / Caracterização de pacientes com diabetes mellitus tipo 1 do sul do Brasil: complicações crônicas e fatores associados.

OBJECTIVE: To evaluate the prevalence of chronic vascular complications and associated factors in patients with type 1 diabetes mellitus (DM). METHODS: Cross sectional study with type 1 DM patients attending the Endocrine Division, Hospital de Clinicas de Porto Alegre. Patients were evaluated for presence of chronic vascular complications. RESULTS: We evaluated 573 patients, mean age of 33 years. The presence of diabetic retinopathy (DR) was observed in 43.3%, diabetes duration [OR: 1.07, 95% CI: 1.03 to 1.11, P <0001], the presence of diabetic nephropathy (DN) [OR: 3.40; CI 95%: 1.89 to 6.13, P <0001] and hypertension (HPT) [OR: 2.12, 95% CI: 1.16 to 3.87, P = 0014] were associated with DR. The DN was present in 34.5% and was associated with HPT [OR: 1.93, 95% CI: 1.16 to 3.21, P = 0001] and total cholesterol [OR: 1.0, 95% CI: 1.0-1.01, P = 0.05]. Seven patients had macrovascular disease. Only 22% achieved an A1c of <7.0%. HPT was 33% and 48% had levels <130/80 mm Hg and 45% of patients had values for LDL> 100 mg/dl. CONCLUSION: We observed a high prevalence of microvascular complications and HPT. Duration of DM, HPT and presence of DN were associated with DR. HPT and dyslipidemia were associated with DN. Most patients did not meet the desired glycemic control, blood pressure and lipid targets. Greater efforts are needed to intensify the pressure and metabolic control of patients with type 1 DM.

Masked hypertension, nocturnal blood pressure and retinopathy in normotensive patients with type 1 diabetes.

AIM: To analyze the prevalence of masked hypertension and its possible association with microvascular complications in patients with type 1 diabetes (T1D). METHODS: A cross-sectional study was conducted in 188 consecutive normotensive patients at the office with T1D without renal replacement therapy or previous renal transplant. All patients were assessed regarding the presence of diabetic retinopathy (DR) (direct and indirect fundoscopy), urinary albumin excretion rate (immunoturbidimetry), and ambulatory blood pressure monitoring (ABPM) (Spacelabs 90207). RESULTS: Masked hypertension was observed in 14 (13.6%) out of 103 clinical normotensive patients and in 7.4% of the entire cohort. Twenty-three percent of patients with clinical normotension had masked nocturnal hypertension. DR was associated with night systolic and diastolic BP [OR of each 5mmHg change 1.41 (95%CI: 1.09-1.83, P=0.009) and 1.40 (95%CI: 1.02-1.93, P=0.04), respectively] and with masked nocturnal hypertension [OR: 3.23 (95%CI: 1.29-8.11, P=0.01)]. CONCLUSIONS: In T1D patients with clinic BP<130/80mmHg, masked hypertension and especially masked nocturnal hypertension are present. Normotensive patients with nocturnal BP>120/70mmHg have higher presence of DR, and only will be identified through ABPM.

Caracterização de pacientes com diabetes mellitus tipo 1 do sul do Brasil: complicações crônicas e fatores associados / Characterization of patients with type 1 diabetes mellitus in southern Brazil: chronic complications and associated factors

OBJETIVO: Avaliar a prevalência de complicações crônicas vasculares e fatores associados em pacientes com diabetes mellitus (DM) tipo 1. MÉTODOS: Estudo transversal com pacientes DM tipo 1 atendidos no Serviço de Endocrinologia do Hospital de Clínicas de Porto Alegre. Os pacientes foram avaliados quanto à presença de complicações crônicas vasculares. RESULTADOS: Avaliamos 573 pacientes, idade média de 33 anos. A presença de retinopatia diabética (RD) foi observada em 43,3 por cento, o tempo de DM [RC: 1,07; IC95 por cento 1,03-1,11; P < 0,001], presença de nefropatia diabética (ND) [RC 3,40; IC95 por cento 1,89 - 6,13; P <0,001] e presença de hipertensão (HAS) [RC:2,12; IC95 por cento 1,16 - 3,87; P = 0,014] foram associados com RD. A ND esteve presente em 34,5 por cento e foi associada à presença de HAS [RC: 1.93; IC95 por cento (1,16-3,21); P = 0,001] e colesterol total [RC: 1,0; IC 95 por cento (1,0-1,01); P = 0,05]. Sete pacientes apresentaram doença macrovascular. Apenas 22 por cento atingiram níveis de HbA1c <7,0 por cento. A prevalência de HAS foi 33 por cento, sendo que 48 por cento estavam com a PA <130/80 mm Hg e 45 por cento dos pacientes apresentaram valores de LDL >100 mg/dl. CONCLUSÃO: Observamos elevadas prevalências de complicações microvasculares e de HAS. A duração do DM, HAS e presença de ND foram associados à RD. HAS e dislipidemia foram associados à ND. A maioria dos pacientes encontrava-se fora dos alvos desejados de controle glicêmico, pressórico e lipídico. Maiores esforços são necessários para intensificar o controle metabólico e pressórico de pacientes com DM tipo 1.

OBJECTIVE: To evaluate the prevalence of chronic vascular complications and associated factors in patients with type 1 diabetes mellitus (DM). METHODS: Cross sectional study with type 1 DM patients attending the Endocrine Division, Hospital de Clinicas de Porto Alegre. Patients were evaluated for presence of chronic vascular complications. RESULTS: We evaluated 573 patients, mean age of 33 years. The presence of diabetic retinopathy (DR) was observed in 43.3 percent, diabetes duration [OR: 1.07, 95 percent CI: 1.03 to 1.11, P <0001], the presence of diabetic nephropathy (DN) [OR: 3.40; CI 95 percent: 1.89 to 6.13, P <0001] and hypertension (HPT) [OR: 2.12, 95 percent CI: 1.16 to 3.87, P = 0014] were associated with DR. The DN was present in 34.5 percent and was associated with HPT [OR: 1.93, 95 percent CI: 1.16 to 3.21, P = 0001] and total cholesterol [OR: 1.0, 95 percent CI: 1.0-1.01, P = 0.05]. Seven patients had macrovascular disease. Only 22 percent achieved an A1c of <7.0 percent. HPT was 33 percent and 48 percent had levels <130/80 mm Hg and 45 percent of patients had values for LDL> 100 mg/dl. CONCLUSION: We observed a high prevalence of microvascular complications and HPT. Duration of DM, HPT and presence of DN were associated with DR. HPT and dyslipidemia were associated with DN. Most patients did not meet the desired glycemic control, blood pressure and lipid targets. Greater efforts are needed to intensify the pressure and metabolic control of patients with type 1 DM.

Prevalence of diabetic retinopathy in patients with type 1 diabetes mellitus.

OBJECTIVES: Diabetic retinopathy (DR) is the leading cause of legal blindness in young adults. Scarce data from Brazilian subjects with type 1 diabetes mellitus (DM) are available. AIMS: The objectives of this study were to determine the prevalence of DR and its risk factors in type 1 diabetes mellitus (DM) outpatients from a general hospital. METHODS: A cross-sectional study of 437 type 1 DM (50.3% males, 82.4% whites) was conducted. DR was graded as absent, mild and moderate non-proliferative DR (mild/moderate NPDR) or severe non-proliferative and proliferative DR (advanced DR). Presence of clinically significant macular edema (CSME) was also recorded. RESULTS: Any DR was present in 44.4% of subjects. In multivariate analysis, DM duration, systolic blood pressure (SBP) and A1C test were associated with mild/moderate NPDR (P<0.005). Advanced DR, was associated with DM duration, SBP, smoking [odds ratio (OR) 2.75, 95%CI 1.15-6.60] and micro-or macroalbuminuria (OR 8.53, 95%CI 3.81-18.05). CSME was present in 21 (9.4%) patients and was associated with smoking (OR 3.19, 95%CI 1.24-8.2). Its frequency increased with the severity of DR (16.4% in advanced DR, 9.6% in mild/moderate NPDR, and 4.7% in the group without DR; P = 0.020). CONCLUSION: Patients with type 1 DM attending an endocrine out-patient clinic at a general hospital had a high prevalence of DR associated with traditional risk-factors and smoking.

Prevalence of diabetic retinopathy in patients with type 1 diabetes mellitus / Prevalência de retinopatia diabética em pacientes com diabetes mellitus tipo 1

OBJECTIVES: Diabetic retinopathy (DR) is the leading cause of legal blindness in young adults. Scarce data from Brazilian subjects with type 1 diabetes mellitus (DM) are available. Aims: The objectives of this study were to determine the prevalence of DR and its risk factors in type 1 diabetes mellitus (DM) outpatients from a general hospital. METHODS:A cross-sectional study of 437 type 1 DM (50.3 percent males, 82.4 percent whites) was conducted. DR was graded as absent, mild and moderate non-proliferative DR (mild/moderate NPDR) or severe non-proliferative and proliferative DR (advanced DR). Presence of clinically significant macular edema (CSME) was also recorded. RESULTS: Any DR was present in 44.4 percent of subjects. In multivariate analysis, DM duration, systolic blood pressure (SBP) and A1C test were associated with mild/moderate NPDR (P<0.005). Advanced DR, was associated with DM duration, SBP, smoking [odds ratio (OR) 2.75, 95 percentCI 1.15-6.60] and micro-or macroalbuminuria (OR 8.53, 95 percentCI 3.81-18.05). CSME was present in 21 (9.4 percent) patients and was associated with smoking (OR 3.19, 95 percentCI 1.24-8.2). Its frequency increased with the severity of DR (16.4 percent in advanced DR, 9.6 percent in mild/moderate NPDR, and 4.7 percent in the group without DR; P = 0.020). CONCLUSION: Patients with type 1 DM attending an endocrine out-patient clinic at a general hospital had a high prevalence of DR associated with traditional risk-factors and smoking.

OBJETIVOS: Determinar a prevalência de RD e seus fatores de risco em pacientes com DM tipo 1 atendidos em um hospital geral. MÉTODOS: Foi realizado um estudo transversal com 437 pacientes (50,3 por cento homens, 82,4 por cento brancos). RD foi agrupada em: 1) ausente; 2) não proliferativa leve e moderada (RDNP leve/moderada); 3) não prolifetiva grave e RD proliferativa (RD avançada). Edema de mácula clinicamente significativo (EMCS) também foi registrado. RESULTADOS: Qualquer grau de RD esteve presente em 44,4 por cento dos pacientes. Na análise multivariada, duração do DM, pressão arterial sistólica e teste A1C foram associados com a RD leve/moderada (P<0,005). RD avançada foi associada com duração do DM, pressão arterial sistólica (PAS), fumo [razão de chances (RC) 2,75, IC 95 por cento 1,15-6,60] e micro-ou macroalbuminúria (RC 8,53, CI 95 por cento 3,81-18,05). EMCS esteve presente em 21 (9,4 por cento) dos pacientes associado ao fumo, aumentando com a gravidade da RD (16,4 por cento RD avançada; 9,6 por cento RD leve/modera, e 4,7 por cento no grupo sem RD; P = 0,020). CONCLUSÃO: Pacientes com DM tipo 1 vistos em um hospital geral têm uma alta prevalência de RD, a qual foi associada aos fatores de risco tradicionais e fumo.

ACE and PC-1 gene polymorphisms in normoalbuminuric Type 1 diabetic patients: a 10-year prospective study.

The aim of this study was to analyze the role of ACE gene insertion/deletion (I/D) and PC-1 gene K121Q polymorphisms in the changes of glomerular filtration rate (GFR), urinary albumin excretion rate (UAER), and blood pressure (BP) levels in a cohort of normoalbuminuric Type 1 diabetic patients. This is a 10.2+/-2.0-year prospective study of 30 normotensive normoalbuminuric Type 1 diabetic patients. UAER (immunoturbidimetry), GFR ((51)Cr-EDTA single injection technique), GHb (ion exchange chromatography), and BP levels were measured at baseline and at 1.7+/-0.6-year intervals. The presence of ACE gene I/D and PC-1 gene K121Q polymorphisms was determined by polymerase chain reaction (PCR) and restriction enzyme techniques. Three patients developed diabetic nephropathy (DN), all carriers of allele D. The presence of allele D was the only predictor (R(2)=.15, F=4.92, P=.035) of the observed GFR decline (-0.29+/-0.34 ml/min/month, P<.05). UAER increased during the study (log UAER=0.0275+/-0.042 microg/min/month, P=.002) and was associated with baseline UAER levels only (R(2)=.17, F=5.72, P=.024). A significant increase (P<.05) in cases of hypertension and retinopathy were observed in ID/DD (n=19) and not in II patients (n=11). Patients with the KQ/QQ genotype (n=8) presented a significant increase (P=.045) in new cases of retinopathy. In conclusion, the presence of the ACE gene D allele in this sample of normoalbuminuric normotensive Type 1 diabetic patients was associated with a higher proportion of microvascular complications and hypertension.

Oftalmomiíase sub-retiniana presumida / Presumed subretinal ophthalmomyiasis

Os autores apresentam um caso de infestaçäo presumida do globo ocular humano por larva de mosca. Foi caracterizado pela migraçäo da larva através do espaço sub-retiniano, produzindo alteraçöes oftalmoscópicas e angiofluoresceínicas que se acredita serem secundárias à oftalmoniíase intra-ocular sub-retiniana

Achados oculares em crianças HIV positivas / Ophthalmologic findings in HIV positive children

Vários estudos têm demonstrado a existência de achados oftálmicos na Sídrome de Imunodeficiência em pacientes adultos. Entretanto, em pacientes pediátricos, näo existe ainda um padräo oftálmico bem definido para esta patologia. Nesta série, estudamos 8 pacientes HIV positivos. Foi realizado exame oftálmico completo em cada paciente. Um paciente apresentava microftalmia e leucocoria decorrente de sua doença de base (hemofilia). Um paciente apresentava coriorretinite toxoplásmica. Näo foi estabelecido um padräo oftálmico neste grupo