Diabetes Melito: Diagnóstico, Classificação e Avaliação do Controle Glicêmico

Effect of antioxidant treatment with n-acetylcysteine and swimming on lipid expression of sebaceous glands in diabetic mice

The sebaceous gland (SG) is involved in different inflammatory, infectious and neoplastic processes of the skin and can be related to specific diseases, e.g., diabetes mellitus. Sometimes, the histological diagnosis requires complementary tests due to the ability of diseases to mimic other tumors. We evaluated the sebaceous gland density in Non-obese diabetic mice to analyze the N-acetylcystein effects and swimming exercise treatment in sebaceous glands healing, using specific staining in histochemistry and immunohistochemistry reactions in the identification of the lipid expression in the sebaceous gland. We investigated the intracytoplasmic lipid expression and analysis of gland density from SG in dorsal skin samples from the Non-obese diabetic (NOD mice) and diabetic animals submitted to antioxidant treatment and physical exercise. For histological analysis of the sebaceous glands, specific staining in histochemistry with sudan black and immunohistochemistry reaction with adipophilin were used in the evaluation. Statistical analysis showed significant proximity between the values of the control group and the diabetic group submitted to the swimming exercise (DS group) and similar values between the untreated diabetic group (UD group) and diabetic group treated with the antioxidant N-acetylcysteine (DNa group), which did not prevent possible differences where p < 0.01. Adipophilin (ADPH) immunohistochemistry permitted more intense lipid staining in SGs, the preservation of the SG in the control group, and a morphological deformed appearance in the UD and DNa groups. However, weak morphological recovery of the SG was observed in the DS-Na group, being more expressive in the DS group. In conclusion, the groups submitted to physical exercises showed better results in the recovery of the analyzed tissue, even being in the physiological conditions caused by spontaneous diabetes.

Knowledge levels among elderly people with Diabetes Mellitus concerning COVID-19: an educational intervention via a teleservice

AIM

To investigate knowledge levels concerning COVID-19 in elderly patients with T2DM.

METHODS

This cross-sectional, quantitative, observational, and descriptive study was undertaken among elderly individuals with T2DM involved in a body balance rehabilitation program that had been suspended due to social isolation. The study participants comprised elderly individuals with T2DM, contactable using fixed or mobile telephones. Data concerning participants' socioeconomic variables and knowledge of COVID-19 were collated, using a Brazil Ministry of Health guidelines checklist. Mann-Whitney and Spearman's correlation tests were used to analyze their responses.

RESULTS

Of 30 elderly participants, 76.7% were women and 63.3% were married. The average age was 69.96 ± 4.46 years. The most cited information medium was television (96.6%). Of a possible 24 correct responses on the checklist, the median correct response score was 7.5. No significant relationship was observed between the total checklist score and the variables studied.

CONCLUSION

Elderly participants did not have in-depth knowledge concerning COVID-19, which suggests that their knowledge sources may be deficient or that their capacity to retain information was inadequate.

Baccharis trimera (Carqueja) Improves Metabolic and Redox Status in an Experimental Model of Type 1 Diabetes

Diabetes mellitus is a metabolic disorder that causes severe complications due to the increased oxidative stress induced by disease. Many plants are popularly used in the treatment of diabetes, e.g., Baccharis trimera (carqueja). The aim of this study was to explore the potential application of the B. trimera hydroethanolic extract in preventing redox stress induced by diabetes and its hypoglycemic properties. Experiments were conducted with 48 female rats, divided into 6 groups, named C (control), C600 (control + extract 600 mg/kg), C1200 (control + extract 1200 mg/kg), D (diabetic), D600 (diabetic + 600 mg/kg), and D1200 (diabetic + 1200 mg/kg). Type 1 diabetes was induced with alloxan, and the animals presented hyperglycemia and reduction in insulin and body weight. After seven days of experimentation, the nontreated diabetic group showed changes in biochemical parameters (urea, triacylglycerol, alanine aminotransferase, and aspartate aminotransferase) and increased carbonyl protein levels. Regarding the antioxidant enzymes, an increase in superoxide dismutase activity was observed but in comparison a decrease in catalase and glutathione peroxidase activity was noted which suggests that diabetic rats suffered redox stress. In addition, the mRNA of superoxide dismutase, catalase, and glutathione peroxidase enzymes were altered. Treatment of diabetic rats with B. trimera extract resulted in an improved glycemic profile and liver function, decreased oxidative damage, and altered the expression of mRNA of the antioxidants enzymes. These results together suggest that B. trimera hydroethanolic extract has a protective effect against diabetes.

Relação entre vitamina D e cálcio no desenvolvimento do Diabetes Mellitus tipo 1 e 2 - Uma revisão de literatura

A prevalência de obesidade, associada a hábitos alimentares inadequados e sedentarismo tem aumentado a ocorrência Diabetes Mellitus, tornando-se um problema de saúde pública. Perspectivas imediatas na mudança do ambiente para reverter o aumento dos níveis de obesidade não são promissores, e existe uma necessidade de considerar outras opções para prevenir o diabetes. Tem sido apontada uma associação inversa entre os baixos níveis da vitamina D e cálcio com a incidencia do Diabetes Mellitus. Desse modo, a vitamina D e o cálcio têm sido propostos como um possível agente terapêutico para a prevenção e tratamento da doença. O objetivo do estudo foi realizar uma revisão de literatura sobre a influência da vitamina D e do cálcio na fisiopatologia do diabetes mellitus, assim como no controle glicêmico.  Estudos têm mostrado que a vitamina D em conjunto com o cálcio são capazes de reduzirem o risco do desenvolvimento do diabetes mellitus tipo 2, enquanto que a insuficiência de vitamina D e de cálcio pode influenciar negativamente a glicemia. Além disso, nível plasmático de 25(OH)D, tem sido correlacionado com o diagnóstico de Diabetes Mellitus tipo 1. Evidências recentes demonstram que a concentração sérica de vitamina D e do cálcio podem estar relacionados ao diabetes. Entretanto, estudos prospectivos e de intervenção em humanos que comprovem a efetividade de ambos, tanto na prevenção como no tratamento dessa doença, ainda são necessários.

The impact of diabetes mellitus on quality of life - differences between genders

OBJECTIVE

To determine whether there are gender differences in the impact of the disease in the quality of life of individuals with Diabetes Mellitus type 2.

METHODS

The sample consisted of 192 individuals distributed in equal numbers by gender. Data were collected between the months of August 2013 to May 2014, by sociodemographic and clinical questionnaires and instruments for assessing quality of life (PAID) and adherence to treatment.

RESULTS

The age of the patients ranged from 30 to 80 years old with a mean of 61 years of age (± 11). B-PAID scores were higher in men except in issues related to social support, but the differences were not statistically significant; 51.7% of the patients with good adherence to treatment were women and 48.3% were men.

CONCLUSIONS

The perception of the impact of diabetes in the quality of life of individuals in the present study, measured by the B-PAID instrument, showed that the highest scores predominate in men, that is, they have a higher degree of emotional distress than women. In the group with good adherence to treatment, there is a greater number of individuals with higher PAID scores, especially in men. In the group with poor adherence to treatment, the number of individuals with a high degree of emotional distress was similar in both sexes. This research was approved by the Research Ethics Committee of UNIFESP, through Plataforma Brasil (Protocol number 103,384).

Quality of life and characteristics of diabetic patients

This study aimed to assess the association between quality of life and clinical and sociodemographic variables in type 2 diabetes patients, after they had started treatment in Primary and Specialized Health Care. This is an analytical cross-sectional study with a sampling of diabetic patients from Primary (n = 385) and Specialized (n = 385) Health Care. The dependent variable, quality of life, was evaluated by the Diabetes Quality of Life Measure - Brazil. Clinical and sociodemographic data were collected. Bivariate analysis by chi square test tested the association between the dependent variable with the independent ones. Next, we performed an analysis of multiple logistic regression. In Specialized Health Care, individuals who practice physical activity had less chance of having worse quality of life and those with less time of diagnosis presented higher chance of worse quality of life. In Primary Health Care, those who performed diets and presented glycated hemoglobin ≤ 7% had less chance of having worse quality of life. Women presented higher chances of worse quality of life than men. We concluded that with exception to the time of diagnosis and sex, other variables that influenced quality of life of diabetics were modifiable factors (glycated hemoglobin, alimentary diet and physical activity).

Structural and physicochemical characterization of sulfonylhydrazone derivatives designed as hypoglycemic agents

By solving and refining the structures of two APIs a complete experimental andin silicophysico-chemical characterization was carried out.

Molecular docking studies and 2D analyses of DPP-4 inhibitors as candidates in the treatment of diabetes

Dipeptidyl peptidase-4 (DPP-4) is an important biological target related to the treatment of diabetes as DPP-4 inhibitors can lead to an increase in the insulin levels and a prolonged activity of glucagon-like peptide-1 (GLP-1) and gastric inhibitory polypeptide (GIP), being effective in glycemic control. Thus, this study analyses the main molecular interactions between DPP-4 and a series of bioactive ligands. The methodology used here employed molecular modeling methods, such as HQSAR (Hologram Quantitative Structure-Activity) analyses and molecular docking, with the aim of understanding the main structural features of the compound series that are essential for the biological activity. Analyses of the main interactions in the active site of DPP-4, in particular, the contribution of the hydroxyl coordination between Tyr547 and Ser630 by the water molecule, which is described in the literature as important for the coordinated interactions in the active site, were performed. Significant correlation coefficients of the best 2D model (r(2) = 0.942 and q(2) = 0.836) were obtained, indicating the predictive power of this model for untested compounds. Therefore, the final model constructed in this study, along with the information from the contribution maps, could be useful in the design of novel DPP-4 ligands with improved activity.

Comprometimento sensório-motor dos membros inferiores em diabéticos do tipo 2

INTRODUÇÃO: A alta incidência do Diabetes mellitus (DM) na população torna essa patologia alvo de muitas pesquisas. Uma das complicações do DM é a neuropatia periférica crônica caracterizada por atrofia e degeneração axonal e/ou alteração da célula de Schwann. A fisioterapia atua na estimulação da regeneração da fibra nervosa, o que reduz o risco de desenvolvimento do pé diabético. OBJETIVO: Identificar o comprometimento da sensibilidade nos membros inferiores (MMII) de diabéticos e verificar fatores que contribuíram para o desenvolvimento do pé diabético, como glicemia, hemoglobina glicada (HbA1c), tempo de diagnóstico, pressão arterial e antropometria. MATERIAIS E MÉTODOS: Os diabéticos foram avaliados na Associação dos Diabéticos de Bauru, participaram de entrevista e foram submetidos a antropometria, triagem pressórica e teste neurossensorial no Sistema Pontuação Clínica Toronto (SPCT). RESULTADOS: Os 68 pacientes (61,76% mulheres e 38,23% homens) tinham 62,93 ± 9,64 anos, apresentaram pressão sistólica de 132,54 ± 17,95 mmHg e diastólica 80,39 ± 11,35 mmHg, índice de massa corpórea 30,34 ± 5,80 kg/m², glicemia 149,20 ± 60,37mg/dL, HbA1c 7,72 ± 1,4%; tempo de diagnóstico de um a 34 anos. Dentre eles, 80,88% apresentavam sobrepeso; 72,06%, hipertensão arterial; 42,64%, dislipidemia; 14,7%, problemas renais; e 17,64%, vasculares. Pelo SPCT, 97,05% apresentavam neuropatia, 95,59% com simetria. Na avaliação, 57,35% apresentavam alteração sensitiva protetora; 60,29%, sensibilidade térmica; 26,47%, tátil; 17,64%, vibratória; 7,35%, dolorosa; e 1,47%, alteração cinestésica. Nos pés, 72,05% apresentavam pele ressecada; 64,70%, fissuras; 54,41%, calosidade; e 44,11%, micose; 50% referiram dor; 39,7%, dormência; 41,17%, parestesia; 27,94%, ataxia. Reflexos estavam ausentes ou diminuídos em 14,71% dos indivíduos; desses, 38,23% no Aquileu. Observou-se correlação positiva entre o SPCT com a glicemia e a circunferência abdominal e a hemoglobina glicada com a glicemia. CONCLUSÃO: Houve grande incidência de neuropatia simétrica; alteração de sensibilidade com presença de sinais clínicos, sintomas, arreflexia e hiporeflexia; e incidência de obesidade e hipertensão associadas. Faz-se necessário o acompanhamento da fisioterapia na avaliação da sensibilidade para prevenir, reduzir sintomas e melhorar a circulação sanguínea em MMII.

Manifestações bucais em pacientes portadores de Diabetes Mellitus: uma revisão sistemática

OBJETIVO: O objetivo deste estudo foi realizar uma revisão sistemática da literatura sobre a associação entre o Diabetes Mellitus e as manifestações bucais. MÉTODO: Os métodos aplicados incluíram estratégia de busca na literatura e critérios de inclusão e exclusão para a seleção dos artigos a serem adotados. As bases de dados incluídas foram PubMed, SciElo, BBO e LILACS, até setembro de 2011. Os artigos selecionados investigaram a associação ou não do Diabetes Mellitus com manifestações bucais, excluindo a doença periodontal. RESULTADO: De 1164 artigos encontrados, 30 deles estavam de acordo com os critérios de inclusão, podendo permanecer no estudo. As manifestações bucais foram associadas com Diabetes Mellitus em 20 estudos. Os desfechos relacionados foram candidíase, hipossalivação, líquen plano bucal, estomatite por dentadura e lesões linguais. CONCLUSÃO: Os pacientes portadores de Diabetes Mellitus estão mais predispostos a apresentar candidíase e hipossalivação, podendo agravar muito determinadas condições de saúde bucal.

Pré-diabetes: diagnóstico, avaliação de complicações crônicas e tratamento

O diabetes melito do tipo 2 (DM2) é responsável por 90% dos casos de diabetes e está associado a complicações micro e macrovasculares de elevada morbimortalidade. Os indivíduos com maior risco de desenvolvimento de DM incluem aqueles com glicemia de jejum alterada (GJA) e tolerância diminuída à glicose (TDG) e especialmente aqueles com as duas condições combinadas. Esses indivíduos fazem parte de um grupo hoje conhecido como pré-diabetes. Aproximadamente 25% dos indivíduos com pré-diabetes desenvolverão DM2 em três a cinco anos. A hiperglicemia, na ausência de DM, também foi associada ao aumento no risco de doença cardiovascular. Estudos demonstraram que mudanças no estilo de vida e intervenções medicamentosas são efetivas em retardar ou prevenir o DM2 em pacientes com pré-diabetes. GJA e TDG estão associadas ao desenvolvimento de DM2 e, apesar das controvérsias, a maioria dos estudos epidemiológicos reforça a importância dessas duas condições também no desenvolvimento de doença micro e macrovascular. Assim, intervenções em pacientes com pré-diabetes são importantes na prevenção primária do DM2 e de suas complicações crônicas.

Glucose tolerance status is a better predictor of diabetes and cardiovascular outcomes than metabolic syndrome: a prospective cohort study

BACKGROUND

To evaluate the importance of oral glucose tolerance test (OGTT) in predicting diabetes and cardiovascular disease in patients with and without Metabolic Syndrome from a population treated in a primary care unit.

RESEARCH DESIGN AND METHODS

A prospective cohort study was conducted with subjects regularly attending the primary care unit of Hospital de Clínicas de Porto Alegre. Participants underwent a 75 g OGTT. Metabolic syndrome definition was based on the criteria of IDF/AHA/NHLBI-2010.

RESULTS

Participants mean age was 61 ± 12 years (males: 38%; whites: 67%). Of the 148 subjects included, 127 (86%) were followed for 36 ± 14 months, 21 (14%) were lost. Subjects were classified into four groups based on baseline OGTT: 29% normal (n = 43), 28% impaired fasting glucose (IFG; n = 42), 26% impaired glucose tolerance (IGT; n = 38), and 17% diabetes (n = 25). Metabolic syndrome prevalence was lower in normal group (28%), intermediate in IFG (62%) and IGT (65%) groups, and higher among subjects with diabetes (92%; P <0.001). Incidence of diabetes increased along with the stages of glucose metabolism disturbance (normal: 0%, IFG: 16%, IGT: 28%; P = 0.004). No patient with normal OGTT developed diabetes, regardless metabolic syndrome presence. Diabetes at baseline was the major determinant of cardiovascular disease occurrence (normal: 0%, IFG: 4%, IGT: 0%, diabetes: 24%; P = 0.001). In Cox-regression analysis, only the 2 h OGTT results were associated with diabetes (OR = 1.03; 95%CI 1.01-1.06; P <0.001) and cardiovascular disease development (OR = 1.013; 95%CI 1.002-1.025; P = 0.024).

CONCLUSIONS

In this sample of subjects undergoing diabetes screening, the OGTT predicted diabetes and cardiovascular disease more effectively than the metabolic syndrome status.

[Home care: health professionals at risk for biological exposure]

This prospective, exploratory study was performed using a quantitative approach with the objective of characterizing the healthcare tasks that involved biological risk for professionals working with the Home Care Service of the São Carlos Municipal Hospital (São Carlos, SP, Brazil). We followed 159 visits from June 2008 to January 2009. A total of 347 procedures were considered to present risks for biological exposure, categorized as follows: dressings (31.1%), capillary blood glucose monitoring (14.4%); and vascular access (3.1%). Of all subjects, 21.5% complied with hand cleansing prior to performing a procedure, 66.3% wore gloves and 83.5% disposed of sharps appropriately. In conclusion, these professionals are subject to biological risks similar to those found in the hospital environment, because they are also exposed to blood and sharps often and have a poor adherence to the standard preventive measures. Further studies to evaluate the influence of the features of the household on the referred risk should be encouraged.

S2DIA: a diagnostic system for Diabetes mellitus using SANA platform

Currently, Diabetes is a very common disease around the world, and with an increase in sedentary lifestyles, obesity and an aging population the number of people with Diabetes worldwide will increase by more than 50%. In this context, the MIT (Massachusetts Institute of Technology) developed the SANA platform, which brings the benefits of information technology to the field of healthcare. It offers healthcare delivery in remote areas, improves patient access to medical specialists for faster, higher quality, and more cost effective diagnosis and intervention. For these reasons, we developed a system for diagnosis of Diabetes using the SANA platform, called S2DIA. It is the first step towards knowing the risks for type 2 Diabetes, and it will be evaluated, especially, in remote/poor areas of Brazil.

Psicossomática, gestação e diabetes: um estudo de caso

Este trabalho apresenta o estudo de caso de uma paciente gestante portadora de diabetes melito, cujo acompanhamento psicológico foi realizado em um hospital universitário público do interior do Estado de São Paulo, referência em atendimento de alta complexidade no que se refere à saúde maternoinfantil. Os atendimentos ocorreram na instituição nas situações de consulta de pré-natal da paciente, e totalizaram cinco sessões. A técnica de atendimento psicológico consistiu na psicoterapia breve de orientação psicanalítica. São apresentados as repercussões do diabetes na gestante, os aspectos psicológicos associados à gravidez, o trabalho do psicólogo dentro de uma instituição hospitalar e uma reflexão acerca do conteúdo psicossomático do diabetes. Com base nesses elementos, este estudo de caso buscou analisar os aspectos psicológicos da gestação associados aos traços de personalidade típicos do paciente diabético bem como fornecer uma visão acerca das possibilidades e das limitações vivenciadas na relação paciente-psicólogo dentro do contexto hospitalar.

[HTLV-1 associated myelopathy: clinical and epidemiological profile in a 10-year case series study]

INTRODUCTION

Human T cell lymphotropic virus type 1 (HTLV-I) myelopathy (HAM/TSP) is a progressive disabling disorder. This work aimed to analyze clinical features and epidemiology in a sample of HAM/TSP.

METHODS

All HTLV-1 infected patients with diagnostic criteria for HAM/TSP, consecutively admitted to the Sarah Hospital from 1998 to 2007, were included in the study.

RESULTS

206 patients (67% females; mean age: 53.8 years-old) were diagnosed with HAM/TSP. The mean time of evolution was 9.0 years. The most common neurological symptoms were chronic progressive spastic paraparesis, spasticity, pain, neurogenic bladder and neurogenic bowel. The neurological findings were hyperreflexia, Babinsky, Hoffman and peripheral neuropathy. Pain, spasticity and spinal cord atrophy, observed in MRI, were associated with time of disease (p<0.05).

CONCLUSIONS

HAM/TSP is a very disabling disorder, in which pain is reported early, while spasticity and thoracic spinal cord atrophy appear in a later phase of the disease. Cases of HAM/TSP exist with a probable vertical viral transmission.

Prevalência de Diabetes Mellitus autorreferida entre trabalhadores de enfermagem

OBJETIVOS: Verificar a prevalência de Diabetes Mellitus autorreferida em trabalhadores de enfermagem de um hospital universitário; identificar os principais fatores de risco para o Diabetes Mellitus (DM) e, entre os que já possuem a doença, identificar as dificuldades relacionadas a seu controle. MÉTODOS: Estudo epidemiológico transversal, realizado no período de agosto de 2007 a janeiro de 2008. Foram entrevistados 1.287 profissionais de enfermagem (82%), utilizando-se questionário contendo 22 questões fechadas. A análise dos dados foi realizada pelos testes Qui-quadrado e exato de Fisher. O teste t de Student foi empregado para as variáveis contínuas. RESULTADOS: Observou-se a prevalência de 3% de DM autorreferida. Os principais fatores de risco reconhecidos foram: idade, sexo, peso e histórico familiar. Detectou-se que o plantão noturno concentrava mais da metade dos diabéticos. CONCLUSÃO: A prevalência de DM autorreferida nesse hospital foi menor do que a esperada para a cidade de São Paulo. Dentre os fatores de risco encontrados, o sobrepeso é o único modificável. O plantão noturno concentra a maioria dos funcionários com diabetes.

Diabetes mellitus na adolescência: experiências e sentimentos dos adolescentes e das mães com a doença

O aumento de doenças crônicas entre crianças e adolescentes, especialmente a Diabetes mellitus, requer conhecimentos que integrem os cuidados à saúde e a integração do indivíduo ao seu meio social. O objetivo foi compreender as experiências e os sentimentos de adolescentes e de suas mães sobre a condição de ser diabético, o tratamento e os cuidados à saúde. Realizamos entrevista semiestruturada com oito adolescentes e sete mães em um serviço público de Barbalha - Ceará - Brasil. A análise dos discursos resultou nas categorias: Sentimentos expressos diante da descoberta da doença; A convivência com a doença e as implicações psicossociais; Mudanças no estilo de vida. As dificuldades dos adolescentes induzem à reflexões sobre comportamentos e adaptações ao novo modo de ser e ao autocuidado. Há necessidade de um cuidado integrando as dimensões físicas e psicossociais de modo a melhorar a assistência ao adolescente e à sua família.

[Prevalence of diabetic foot and associated factors in the family health units of the city of Recife, Pernambuco State, Brazil, in 2005]

One of the most important chronic complications of diabetes mellitus is diabetic foot. Severe progression of diabetes can lead to lower limb amputations. However, since evolution of the disease is slow, it is possible to implement prevention and control measures. The scope of the Family Health Program (in terms of the possibility of early diagnosis of diabetes mellitus and diabetic foot) favors epidemiological studies to determine the problem's magnitude. This article aimed to identify the proportion of individuals with diabetic foot treated at family health units in the city of Recife, Pernambuco State, Brazil. An epidemiological survey was conducted with a probabilistic sample of medical charts of diabetic patients (N = 1,374) enrolled in six health districts in the city, analyzing relations between socioeconomic variables, health conditions, and the occurrence of amputation. Diabetic foot was observed in 9% of the sample. There was a positive and statistically significant association with the variables alcoholism and amputation (p < 0.001). The prevalence of lower limb amputations was 25.6% among individuals with complications and 2.3% of the total sample.

Efeito do exercício físico aeróbio sobre o perfil lipídico de pacientes idosas, portadoras de Diabetes Mellitus tipo 2, atendidas em Unidade Básica de Saúde, Maringá, Estado do Paraná

RESUMO Este estudo tem por objetivo verificar a influência de um programa de exercícios físicos aeróbios sobre o perfil lipídico de pacientes idosas, portadoras de Diabetes Mellitus (DM) tipo 2. Foram selecionados 40 pacientes do gênero feminino com idade maior ou igual a 60 anos. A amostra foi distribuída em dois grupos de 20 pacientes cada: Grupo Treinado, que recebeu orientação nutricional e participou das sessões supervisionadas de exercício físico aeróbio, e Grupo Controle, que recebeu somente orientação nutricional. A intervenção teve a duração de 12 semanas. O protocolo de exercício foi aplicado três vezes por semana, tendo cada sessão 1 h de duração. Os dados obtidos mostraram que o protocolo desenvolvido promoveu redução significativa nos triglicerídeos séricos (pré-teste= 190 ± 76,67 e pós-teste= 125,33 ± 45,82 mg/dL, p<0,05) e no LDL-colesterol (pré-teste= 147,98 ± 29,98 e pós-teste= 122,24 ± 17,61 mg/dL, p<0,05) no Grupo Treinado. Os resultados permitiram concluir que o programa de exercícios adotado promoveu melhora no perfil lipídico de pacientes idosas portadoras de DM tipo 2, demonstrando a importância da prática de atividade física orientada em Unidades Básicas de Saúde.

Increased diagnostic probability of subclinical cushing’s syndrome in a population sample of overweight adult patients with type 2 diabetes mellitus

Endogenous Cushing’s Syndrome (CS) is unusual. Patients with subclinical CS (SCS) present altered cortisol dynamics without obvious manifestations. CS occurs in 2-3% of obese poorly controlled diabetics. We studied 103 overweight adult outpatients with type 2 diabetes to examine for cortisol abnormalities and SCS. All collected salivary cortisol at 23:00 h and salivary and serum cortisol after a 1 mg dexamethasone suppression test (DST). Patients whose results were in the upper quintile for each test (253 ng/dL, 47 ng/dL, and 1.8 mg/dL, respectively for the 23:00 h and post-DST saliva and serum cortisol) were re-investigated. Average values from the upper quintile group were 2.5-fold higher than in the remaining patients. After a confirmatory 2 mg x 2 day DST the investigation for CS was ended for 61 patients with all normal tests and 33 with only one (false) positive test. All 8 patients who had two abnormal tests had subsequent normal 24h-urinary cortisol, and 3 of them were likely to have SCS (abnormal cortisol tests and positive imaging). However, a final diagnosis could not to be confirmed by surgery or pathology. Although not confirmatory, the results of this study suggest that the prevalence of SCS is considerably higher in populations at risk than in the general population.

[Cardiac risk profile in diabetes mellitus and impaired fasting glucose]

OBJECTIVE

Mortality of diabetic patients is higher than that of the population at large, and mainly results from cardiovascular diseases. The purpose of the present study was to identify the prevalence of cardiovascular risk factors in subjects with diabetes mellitus (DM) or abnormal fasting glucose (FG) in order to guide health actions.

METHODS

A population-based cross-sectional study was carried out in a representative random cluster sampling of 1,066 adult urban population (> or =20 years) in the state of Rio Grande do Sul between 1999 and 2000. A structured questionnaire on coronary risk factors was applied and sociodemographic characteristics of all adults older than 20 years living in the same dwelling were collected. Subjects were clinically evaluated and blood samples were obtained for measuring total cholesterol and fasting glycemia. Statistical analysis was performed using Stata 7 and a 5% significance level was set. Categorical variables were compared by Pearson's chi-square and continuous variables were compared using Student's t-test or Anova and multivariate analysis, all controlled for the cluster effect.

RESULTS

Of 992 subjects, 12.4% were diabetic and 7.4% had impaired fasting glucose. Among the risk factors evaluated, subjects who presented any kind of glucose homeostasis abnormality were at a higher prevalence of obesity (17.8, 29.2 and 35.3% in healthy subjects, impaired fasting glucose and DM respectively, p<0.001), hypertension (30.1, 56.3 and 50.5% in healthy subjects, impaired fasting glucose and DM, respectively, p<0.001), and hypercholesterolemia (23.2, 35.1 and 39.5 in healthy subjects, impaired fasting glucose and DM respectively, p=0.01).

CONCLUSION

Subjects with any kind of glucose homeostasis abnormality represent a group, which preventive individual and population health policies should target since they have higher prevalence of coronary artery disease risk factors.