Prevalência de sobrepeso e obesidade em pacientes com diabetes tipo 1

Dyslipidemia in young patients with type 1 diabetes mellitus

OBJECTIVE

The association between type 1 diabetes mellitus (T1D) and dyslipidemia (DLP) increases the risk of cardiovascular disease (CVD). The aim of this study was to evaluate the presence of dyslipidemia in young T1D patients.

MATERIALS AND METHODS

The study design was cross-sectional and descriptive. We reviewed medical records of T1D patients followed at an endocrinology service, from 1998-2012.

DATA COLLECTED

gender, actual age and age at diagnosis, duration of T1D since diagnosis, body mass index (BMI), pubertal stage, glycemic control (GC) determined by glycated hemoglobin (HbA1c), total cholesterol (TC), HDL, LDL, triglycerides (TG). To analyze lipid profile and metabolic control, we used the Brazilian Society of Diabetes Guidelines.

RESULTS

Were included 239 T1D patients, 136 (56.9%) females; mean ± SD: actual age 15.7 ± 5.0 years and at T1D diagnosis 7.3 ± 3.9; T1D duration 10.6 ± 6.4 years, 86.6% puberty, 15.1% overweight. The prevalence of DLP was 72.5%, 63.3% females, 86.6% puberty, mean ± SD: actual age 15.4 ± 4.8 years and at T1D diagnosis 7.2 ± 4.1 years, duration of T1D 10.7 ± 6.1 years. We found high-CT in 56.7%, low-HDL = 21.7%, high LDL = 44.0%, high-TG = 11.8%. Between females with DLP, 83.5% was in puberty. We find correlation between the presence of DLP, a poor GC and BMC.

CONCLUSION

We found a high prevalence of DLP in young patients with T1D, particularly in puberty females. Programs targeting the prevention of dyslipidemia should be adopted, especially for this group, in order to prevent/delay chronic complications and cardiovascular disease.

Retirement due to disabilities in patients with type 1 diabetes a nationwide multicenter survey in Brazil

BACKGROUND

There is scarcity of data concerning retirement and workforce loss exclusively in patients with type 1 diabetes. The aim of this study was to evaluate the prevalence, causes, and predictors of retirement in patients with type 1 diabetes in Brazil.

METHODS

This was a multicenter cross-sectional study conducted between December 2008 and December 2010 in 28 public clinics in 20 Brazilian cities. Data were obtained from 3,180 patients aged 22 ± 11.7 years; 56.3% of the participants were female, and 57.4% were Caucasians. The mean time since diabetes diagnosis was 10.3 ± 8.1 years. Patients' information (clinical factors and retirement data) was obtained through a questionnaire and a chart review. Patients were retired by diabetes according to the Brazilian Institute of Social Security's criteria that takes in account the presence of diabetes-related chronic complications certified by a doctor, excluding any personal reason or another health condition besides diabetes. Both quantitative and qualitative tests were employed, and a multivariate logistic regression model was performed to identify the factors associated with retirement due to disabilities in patients with type 1 diabetes.

RESULTS

The overall frequency of retirement was 4.2%, with no difference between genders. The mean age of retirement was 35.5 ± 9.3 years, resulting in 17.5 ± 9.1 years of workforce losses. These patients had a significantly higher prevalence of severe hypoglycemia, proliferative and non-proliferative retinopathy, foot disorders, chronic or end-stage renal disease requiring dialysis or transplantation, cataracts, glaucoma, psychological disorders, hypertension, and overweight/obesity than did the employed patients. Multivariate logistic regression analysis with retirement as the dependent variable showed adjusted odds ratios (ORs) of 4.87 (2.66-8.78) for the presence of microvascular complications and 3.7 (2.04-6.70) for macrovascular complications.

CONCLUSIONS

Retirement due to disabilities occurred in 4.2% of Brazilian patients with type 1 diabetes at an early age and is strongly associated with diabetes-related chronic complications. Health care workers should thus reevaluate the quality of care given to these patients.

Dyspeptic symptoms in patients with type 1 diabetes: endoscopic findings, Helicobacter pylori infection, and associations with metabolic control, mood disorders and nutritional factors

OBJECTIVES

To evaluate, in a group of patients with long-standing type 1 diabetes (DM1), an association of dyspepsia symptoms with: changes in the gastroduodenal mucosa, infection by Helicobacter pylori, glycemic control, and psychological and nutritional factors.

SUBJECTS AND METHODS

A total of 32 patient with DM1 were studied (age: 38 ± 9 years; females: 25; diabetes duration: 22 ± 5 years). All patients answered a standardized questionnaire for the evaluation of gastrointestinal symptoms and underwent upper gastrointestinal endoscopy, with gastric biopsies for the evaluation of Helicobacter pylori infection. The presence of anxiety and depression was evaluated by the HAD scale. Nutritional parameters were BMI, arm and waist circumference, skinfold measurement, and body fat percentage.

RESULTS

Upper endoscopy detected lesions in the gastric mucosa in 34.4% of the patients, with similar frequency in those with (n = 21) and without dyspepsia (n = 11). The patients with dyspepsia complaints showed greater frequency of depression (60% vs. 0%; p = 0.001), higher values for HbA1c (9.6 ± 1.7 vs. 8.2 ± 1.3%; p = 0.01) and lower values for BMI (24.3 ± 4.1 vs. 27.2 ± 2.6 kg/m2; p = 0.02), body fat percentage (26.6 ± 6.2 vs. 30.8 ± 7.7%; p = 0.04), and waist circumference (78.7 ± 8 vs. 85.8 ± 8.1 cm; p = 0.02). No association was found between the symptoms and the presence of Helicobacter pylori.

CONCLUSIONS

Dyspepsia symptoms in patients with long-standing DM1 were associated with glycemic control and depression, and they seem to negatively influence the nutritional status of these patients.

Prevalence of adults with type 1 diabetes who meet the goals of care in daily clinical practice: a nationwide multicenter study in Brazil

OBJECTIVE

To determine the prevalence of patients with type 1 diabetes mellitus who meet the glycemic and cardiovascular (CV) risk factors goals and the frequency of screening for diabetic complications in Brazil according to the American Diabetes Association guidelines.

RESEARCH DESIGN AND METHODS

This was a cross-sectional, multicenter study conducted between December 2008 and December 2010 in 28 public clinics in 20 Brazilian cities. Data were obtained from 1774 adult patients (56.8% females, 57.2% Caucasians) aged 30.3 ± 9.8 years with diabetes duration of 14.3 ± 8.8 years.

RESULTS

Systolic blood pressure was at goal in 40.3% and diastolic blood pressure was at goal in 26.6% of hypertensive patients. LDL cholesterol and HbA1c were at the goal in 45.2% and 13.2% of the patients, respectively. Overweight was presented in 25.6% and obesity in 6.9%. Among those with more than 5 years of disease, screening for retinopathy was performed in the preceding year in 70.1%. Nephropathy and feet complications were screened in 63.1% and 65.1%, respectively.

CONCLUSIONS

The majority of patients did not meet metabolic control goals and a substantial proportion was not screened for diabetic complications. These issues may increase the risk of chronic complications and negatively impact public health.

[Influence of dietary glycemic index on anthropometric and biochemical parameters in patients with type 1 diabetes]

OBJECTIVE

To assess the influence of a non-pharmacological intervention, consisting of a diet low glycemic index (GI) for a period of six months on metabolic control and anthropometric parameters in patients with type 1 diabetes mellitus.

SUBJECTS AND METHODS

Ninety-six type 1 diabetic patients underwent an anthropometric, biochemical and dietary assessment before and six months after the prescription of diet based on the glycemic index.

RESULTS

After six months we observed a decrease in A1C levels (9,8 ± 2,26% vs. 9,1 ± 2.16%; p = 0,023) and increase in body weight (61,3 ± 11,68 kg vs. 62,8 ± 12,07 kg; p = 0,04).

CONCLUSION

A low GI diet improved glycemic control in patients with DM1. Further studies with longer time of follow-up are needed to assess if patients' adherence to this kind of diet influences the maintenance of glycemic control.

[Relationship between nutrition factors and glycemic control in children and adolescents with type 1 diabetes mellitus]

OBJECTIVE

To identify nutritional factors that affected the glycemic control of the studied population.

SUBJECTS AND METHODS

One hundred forty-six children and adolescents, aged 7 to 19 years, followed-up at the Division of Pediatric Endocrinology of the Hospital das Clínicas da Universidade Federal de Minas Gerais participated in the study.The diet of each participant was evaluated by means of a Quantitative Food Frequency Questionnaire, previously validated in a pilot-project. Glycemic control was assessed through the average of HbA1c results obtained six months prior to date of diet evaluation.

RESULTS

Diets with high protein content, less saturated fats, and lower glycemic index (GI)/glycemic load (GL) had a positive effect on glycemic control. The consumption of sucrose and of free snacks provided by the school had a negative influence on glycemic control.

CONCLUSION

The consumption of nutritionally adequate and low GI/GL diets favored glycemic control of the studied population.

[Reliability of the classification of nutritional status obtained through the BMI and three different methods of body fat percentage in patients with type 1 diabetes mellitus]

OBJECTIVE

To assess the reliability of classification of nutritional status (NS) obtained through the body mass index (BMI) and three different methods of body composition (BC) in individuals type 1 diabetics (T1D) and non-diabetic subjects.

METHODS

84 patients with T1D and 37 controls were evaluated. Anthropometric data was collected to calculate BMI and assessment of BC was performed through the methods of skinfold thickness (SF), bipolar (BI) and tetrapolar (TT) bioelectrical impedance. The agreement between the scores of each method was determined by Kappa (K) coefficient.

RESULTS

Considering all the patients, only 48 (57.1%) presented classification of BMI that agreed with the SF method, 58 (69%) with the BI and 45 (53.5%) with the TT. The K results for individuals with T1D was DC = 0.261, BI = 0.320 and TT = 0.174. The controls had higher values (DC = 0.605, BI = 0.360 and TT = 0.400). However, all values were considered low.

CONCLUSIONS

The method of BMI showed little sensitivity to BC changes in patients with T1D. Appropriated methods for the assessment of BC should be used to classify the NS of this population.

[Dyslipidemias in type 1 diabetes: a current approach]

With the intensive glycemic control in the therapy of type 1 diabetes mellitus (T1DM) patients, cardiovascular disease has been the main cause of mortality. Identification of risk factors, such as dyslipidemia is considered of great importance in terms of avoiding chronic micro and macro vascular complications. The statements for prevention of coronary artery disease in diabetes are generally are related do type 2 diabetes mellitus and little attention is paid to T1DM. Defining therapeutical targets and indications for treatment are more controversial in these patients due to their young ages. The present study aims to emphasize the importance of establishing the diagnosis of dyslipidemia in this group of patients as well as indicate the appropriate and early treatment, in order to reach the targets of treatment and reduce the atherogenic lipid profile.

Qualidade de vida e aspectos socioeconômicos em diabéticos tipo 1

OBJETIVOS: Avaliar a qualidade de vida (QV) em diabéticos tipo 1 assistidos na Associação dos Diabéticos de Itabuna, BA (ASDITA), e verificar suas relações com as variáveis clínicas e sociodemográficas (escolaridade, renda familiar e ocupação). MÉTODOS: Foram estudados 34 pacientes (γ = 88%, ε = 5%; 53% mulheres, média de idade 20,4 ± 8,4 anos e média de tempo de diagnóstico 5,7 ± 4,9 anos), por meio de entrevista e antropometria (medidas de peso e altura). RESULTADOS: O perfil sociodemográfico da amostra revelou renda familiar per capita de 0,70 ± 0,56 salários mínimos, 53% possuíam o ensino fundamental, 64,7% eram estudantes. Em média, a qualidade de vida (QV) foi regular (58,8%). Não interferiram na QV: escolaridade, ocupação, etnia, índice de massa corpórea, número de aplicações diárias de insulina e perfil de monitoração da glicemia capilar. Associaram-se a pior QV: sexo feminino, ser adulto, tempo de diagnóstico maior ou igual a dez anos e baixa renda familiar. CONCLUSÕES: A QV destes pacientes foi inferior ao descrito na literatura, entretanto, estudos adicionais são necessários para comparações com diabéticos em condições socioeconômicas e culturais semelhantes às observadas nesta pesquisa.

Prevalência de obesidade em crianças e adolescentes com diabetes melito tipo 1

OBJETIVO: Conhecer a prevalência de obesidade e sua distribuição por sexo e idade em pacientes com diabetes melito tipo 1 (DM1), em acompanhamento em Serviço de Endocrinologia Pediátrica. MÉTODOS: Estudo transversal descritivo de pacientes em acompanhamento no Serviço de Endocrinologia Pediátrica do Hospital de Base de São José do Rio Preto, avaliando as seguintes variáveis: sexo, idade, dose e número de aplicações diárias de insulina, hemoglobina glicada (HbA1c), peso, estatura e índice de massa corpórea (IMC). A definição de sobrepeso e obesidade baseou-se nas curvas de IMC para a idade do Centers for Disease Control and Prevention (CDC, 2000). RESULTADOS: Foram incluídos 77 portadores de DM1 (44 meninas e 33 meninos) com idade entre três e 18 anos (média: 13,4). A determinação de HbA1c variou de 4,1 a 10,6% (média: 7,7%) e o IMC, de 15,1 a 28,6 kg/m² (média: 23,2). Conforme critérios do CDC, 8% dos pacientes (três meninas e três meninos) apresentavam obesidade e 8% (duas meninas e quatro meninos), sobrepeso. CONCLUSÕES: Nesta casuística de pacientes diabéticos, a prevalência de sobrepeso e obesidade não se mostrou diferente de populações não diabéticas.