Time in range: a new parameter to evaluate blood glucose control in patients with diabetes.

The International Consensus in Time in Range (TIR) was recently released and defined the concept of the time spent in the target range between 70 and 180 mg/dL while reducing time in hypoglycemia, for patients using Continuous Glucose Monitoring (CGM). TIR was validated as an outcome measures for clinical Trials complementing other components of glycemic control like Blood glucose and HbA1c. The challenge is to implement this practice more widely in countries with a limited health public and private budget as it occurs in Brazil. Could CGM be used intermittently? Could self-monitoring blood glucose obtained at different times of the day, with the amount of data high enough be used? More studies should be done, especially cost-effective studies to help understand the possibility of having sensors and include TIR evaluation in clinical practice nationwide.

Análise da força de preensão manual e risco cardiovascular de adolescentes com Diabetes Melitos tipo 1 / Analysis of handgrip muscle strength and cardiovascular risk in adolescents with diabetes mellitus type 1

Comparar a força de preensão manual de adolescentes com e sem diabetes mellitus tipo 1 (DM1) e correlacionar as variáveis hemodinâmicas com o controle da glicemia pela hemoglobina glicada (HbA1c) nos adolescentes diabéticos. Método: Foram avaliados 49 adolescentes com DM1 (12,73 ± 1,23 anos; índice de massa corporal 19,52 ± 2,62 kg/m2 ) e 75 adolescentes sem DM1 (13,31 ± 1,16 anos; índice de massa corporal 20,79 ± 3,64 kg/m2 ). A HbA1c foi determinada por cromatografia líquida de alta ficiência (HPLC) e a força de preensão foi obtida com o dinamômetro Jamar®. As variáveis hemodinâmicas registradas foram à frequência cardíaca e a pressão arterial (PA) na posição sentada. Resultados: Os adolescentes do gênero masculino com DM1 apresentaram menores valores de força de preensão manual absoluta da mão direita (26,48 ± 6,24 vs 32,59 ± 9,59 kg; p = 0,004), da mão esquerda (25,45 ± 6,52 vs 30,76 ± 8,19 kg; p = 0,006) e maior PA diastólica (66,43 ± 8,62 vs 72,40 ± 10,01 mmHg; p = 0,019) do que os adolescentes sem DM1. As adolescentes do gênero feminino com DM1 apresentaram menores valores de força de preensão manual absoluta da mão direita (26,20 ± 4,09 vs 29,53 ± 5,27 kg; p = 0,017) e da mão esquerda (24,50 ± 4,29 vs 27,79 ± 5,11 kg; p = 0,017). Houve correlação positiva da frequência cardíaca (0,44; p = 0,01) e da PA diastólica (0,37; p = 0,01) com a HbA1c. Conclusão: Adolescentes com DM1 devem receber atenção quanto a menor força muscular e risco cardiovascular com o aumento da HbA1c...(AU)

To compare the handgrip muscle strength of adolescents with and without diabetes mellitus type 1 (DM1) and to correlate the hemodynamic variables with the glycemic control by glycated hemoglobin (A1c) in the diabetic adolescents. Method: 49 adolescents with DM1 (12.73 ± 1.23 years; body mass index 19.52 ± 2.62 kg/m2 ) and 75 adolescents without DM1 (13.31 ± 1.16 years; body mass index 20.79 ± 3.64 kg/m2 ) were evaluated. The A1c was determined by high performance liquide chromatography (HPLC) and handgrip muscle strength was obtained by the Jamar® dynamometer. The hemodynamic variable measured were heart rate and blood pressure (BP) in the seated position. Results: The male adolescents with DM1 presented lower values of handgrip muscle strength in the right hand (26.48 ± 6.24 vs 32.59 ± 9.59 kg; p = 0.004), and left hand (25.45 ± 6.52 vs 30.76 ± 8.19 kg; p = 0.006) and higher diastolic BP (66.43 ± 8.62 vs 72.40 ± 10.01 mmHg; p = 0.019) as compared with the male adolescents without DM1. The female adolescents with DM1 presented lower values of handgrip strength in the right hand (26.20 ± 4.09 vs 29.53 ± 5.27 kg; p = 0.017), and left hand (24.50 ± 4.29 vs 27.79 ± 5.11 kg; p = 0.017). There was a positive correlation of heart rate (0.44; p = 0.01) and diastolic BP (0.37; p = 0.01) with A1c. Conclusion: Adolescents with DM1 should receive attention regarding their reduced muscle strength and cardiovascular risk with the increase in A1c...(AU)

Elevated glycated hemoglobin levels impair blood pressure in children and adolescents with type 1 diabetes mellitus.

BACKGROUND: Deregulation of glycemic and glycated hemoglobin (HbA1) levels accelerate the progression of cardiovascular complications in type 1 diabetes mellitus (T1DM). The aim of this study was to investigate the association between HbA1 and changes in blood pressure of children and adolescents with T1DM. METHODS: A total of 60 children and adolescents were recruited and allocated into two groups (prehypertension and control group). Blood pressure and HbA1 were measured by the oscillometric method and high-performance liquid chromatography, respectively. RESULTS: The prehypertensive group had (P < 0.05) higher disease duration, body weight, Z score for body weight, systolic blood pressure (SBP), diastolic blood pressure (DBP) and a higher HbA1 when compared with the control children and adolescents. Multiple regression to predict alterations in DBP from HbA1 adjusted for age, disease duration, and body mass index demonstrated a positive relationship with DBP (P < 0.05). A 1 % increase in HbA1 was associated with 1.73 mmHg increase in DBP. CONCLUSIONS: High levels of HbA1 may be associated with increased blood pressure in T1DM. A tight control of HbA1 levels may provide long-term cardiovascular protection in children and adolescents with T1DM.

Evaluation of diabetic patients after three month use of continuous subcutaneous insulin infusion, dispensed by a protocolled form at outpatient reference clinic of Taguatinga Regional Hospital.

OBJECTIVE: To evaluate the data of continuous subcutaneous insulin infusion protocol (CSII) for diabetics waived by the Health State Secretariat of Distrito Federal (HSSDF) and therapeutic responses three months after the transfer of multiple daily injections regimen for CSII. SUBJECTS AND METHODS: Eighty patients (49 female) took part in this experimental study, mean age and disease duration were 27.9 years and 13 years, respectively; 96% patients had type 1 diabetes mellitus. RESULTS: The entire sample (ECO) and 3 subgroups (group 1 - A1c decrease, group 2 - A1c stable, and group 3 - A1c increase), stratified according to a ≥ 0.5% change in A1c, were analyzed. Group 1 involved 64% of the patients. The ECO showed a significant A1c decrease: MDI 8.1 ± 1.4% vs. CSII 7.3 ± 0.9%, p < 0.0001 (0.8% difference pro CSII therapy). Group 1 demonstrated an A1c decrease from 8.7% to 7.3% (1.4% difference). Group 2 mean A1c was 7.1%. Rate of hypoglycemia (< 50 mg/dL) decreased 61% in the ECO and 79% in Group 2. CONCLUSION: This study reinforces the safety and efficacy of CSII with a robust A1c reduction and hypoglycemia. The pioneer care HSSDF ambulatory attests to be achievable the free dispensing by Unified Health System (UHS) following a protocol, and this approach results in less wastage to the patient and represents a rational policy of therapy with CSII for UHS.

Evaluation of diabetic patients after three month use of continuous subcutaneous insulin infusion, dispensed by a protocolled form at outpatient reference clinic of Taguatinga Regional Hospital

Objective To evaluate the data of continuous subcutaneous insulin infusion protocol (CSII) for diabetics waived by the Health State Secretariat of Distrito Federal (HSSDF) and therapeutic responses three months after the transfer of multiple daily injections regimen for CSII. Subjects and methods Eighty patients (49 female) took part in this experimental study, mean age and disease duration were 27.9 years and 13 years, respectively; 96% patients had type 1 diabetes mellitus. Results The entire sample (ECO) and 3 subgroups (group 1 – A1c decrease, group 2 – A1c stable, and group 3 – A1c increase), stratified according to a ≥ 0.5% change in A1c, were analyzed. Group 1 involved 64% of the patients. The ECO showed a significant A1c decrease: MDI 8.1 ± 1.4% vs. CSII 7.3 ± 0.9%, p < 0.0001 (0.8% difference pro CSII therapy). Group 1 demonstrated an A1c decrease from 8.7% to 7.3% (1.4% difference). Group 2 mean A1c was 7.1%. Rate of hypoglycemia (< 50 mg/dL) decreased 61% in the ECO and 79% in Group 2. Conclusion This study reinforces the safety and efficacy of CSII with a robust A1c reduction and hypoglycemia. The pioneer care HSSDF ambulatory attests to be achievable the free dispensing by Unified Health System (UHS) following a protocol, and this approach results in less wastage to the patient and represents a rational policy of therapy with CSII for UHS. Arch Endocrinol Metab. 2015;59(1):23-8 .