Optimization of Care for Adult Outpatients With Type 2 Diabetes Through the Diabetes Self-Management Multidisciplinary Program: A Randomized Clinical Trial.

OBJECTIVES: Our aim in this study was to evaluate the efficacy of a Self-Management Multidisciplinary Program (MP) on glycemic management, quality of life and diabetes self-care activities. METHODS: People with type 2 diabetes and glycated hemoglobin (A1C) of >7.5% were randomized to participate in the MP or to usual care (UC). The MP consisted of face-to-face meetings with each health-care provider (nurse, pharmacist, dietitian, physical educator and social worker) to approach diabetes self-management issues. MP topics were tailored toward local habits and culture. Three different modules were offered over 12 weeks. The primary outcome was change in A1C from baseline to 12 months. Diabetes Quality of Life and Summary of Diabetes Self-Care Activities questionnaires were assessed at baseline and at 6 and 12 months. RESULTS: Ninety-six participants were included (mean 59 years of age, 60% women, diabetes duration 16±10 years, 62% of lower middle/low socioeconomic status). Change in A1C at 12 months (UC: 0.52% [95% confidence interval, -1.07 to 0.04]; MP: -0.30% [95% confidence interval, -1.05 to 0.44]; p=0.33) was not different between the groups. There was an increase in satisfaction and a reduction in worry about future effects of diabetes in the MP group, which was not found in the UC group. CONCLUSIONS: A short-term self-management multidisciplinary program improved diabetes-related quality of life but failed to reduce A1C in individuals with longstanding type 2 diabetes and a low socioeconomic status.

Major components of metabolic syndrome and adiponectin levels: a cross-sectional study.

BACKGROUND: Adiponectin is a major regulator of glucose and lipid homeostasis by its insulin sensitizer properties. Since decreased insulin sensitivity is linked to metabolic syndrome (MS), decreased adiponectin levels may be related to its development. The purpose of the study was to investigate the relationship between adiponectin levels and MS. METHODS: Firstly, we cross-sectionally examined subjects with or without MS submitted to an oral glucose tolerance test at Hospital de Clínicas de Porto Alegre (n = 172). A replication analysis was performed in subjects (n = 422) undergoing cardiac angiography at Hospital São Paulo. Subchronic inflammation (US-CRP), coagulation marker (fibrinogen), insulin sensitivity and resistance (Matsuda ISI and HOMA-IR) were estimated. Plasma total and high molecular weight (HMW) adiponectin were measured. RESULTS: Total and HMW adiponectin levels were lower in MS subjects (P < 0.05). Total adiponectin levels were lower in the presence of high waist circumference, low HDL-cholesterol and elevated triglyceride criteria in both samples and by elevated blood pressure and glucose criteria in Porto Alegre. HMW adiponectin levels were lower in the presence of low HDL-cholesterol, elevated triglycerides, and glucose criteria. Total adiponectin levels were positively related with HDL-cholesterol and ISI Matsuda, negatively related with waist circumference, glucose, triglycerides, HOMA-IR, and US-CRP and not related with blood pressure. While adjusting for sex and age, increased adiponectin levels remained associated with a reduced prevalence ratio for MS in both cohorts (P = 0.001). CONCLUSIONS: Adiponectin levels decreased with increasing number of MS criteria, and it is in part determined by its relationship with HDL, triglycerides and abdominal adiposity.

Response to methylphenidate in children and adolescents with ADHD: does comorbid anxiety disorders matters?

There are controversial evidence in the literature on the role of comorbid anxiety disorders (ANX) in the improvement of attention-deficit/hyperactivity disorder (ADHD) symptoms with methylphenidate (MPH) treatment. Our main objective was to assess differences in the response to MPH treatment in children and adolescents with ADHD with and without comorbid ANX. We extensively evaluated response to MPH in a naturalistic study of 280 children and adolescent with ADHD according to DSM-IV criteria. Psychiatric diagnoses (ADHD, ANX, and other comorbidities) were assessed by semi-structured interviews (K-SADS-E). Response to MPH was assessed by means of total score in the Swanson, Nolan, and Pelham Scale-version IV (SNAP-IV) after 1 month of treatment. There was no significant between-group difference in the response to treatment with MPH after 1 month either when SNAP-IV scores were assessed dimensionally or categorically (moderate response) (P > 0.05). Our findings suggest that comorbid ANX do not interfere in the response to MPH on core ADHD symptoms.