Papel dos lipídeos da dieta na nefropatia diabética

Renal haemodynamic and protective effects of renoactive drugs in type 2 diabetes: Interaction with SGLT2 inhibitors

Diabetic kidney disease remains the leading cause of end-stage kidney disease and a major risk factor for cardiovascular disease. Large cardiovascular outcome trials and dedicated kidney trials have shown that sodium-glucose cotransporter (SGLT)2 inhibitors reduce cardiovascular morbidity and mortality and attenuate hard renal outcomes in patients with type 2 diabetes (T2D). Underlying mechanisms explaining these renal benefits may be mediated by decreased glomerular hypertension, possibly by vasodilation of the post-glomerular arteriole. People with T2D often receive several different drugs, some of which could also impact the renal vasculature, and could therefore modify both renal efficacy and safety of SGLT2 inhibition. The most commonly prescribed drugs that could interact with SGLT2 inhibitors on renal haemodynamic function include renin-angiotensin system inhibitors, calcium channel blockers and diuretics. Herein, we review the effects of these drugs on renal haemodynamic function in people with T2D and focus on studies that measured glomerular filtration rate (GFR) and effective renal plasma flow (ERPF) with gold-standard techniques. In addition, we posit, based on these observations, potential interactions with SGLT2 inhibitors with an emphasis on efficacy and safety.

Development of a Healthy Eating Index for patients with type 2 diabetes

Objective:This study sought to develop a dietary index for assessment of diet quality aiming for compliance with dietary recommendations for diabetes: The Diabetes Healthy Eating Index.Methods:Cross-sectional study with 201 outpatients with type 2 diabetes (61.4±9.7 years of age; 72.1% were overweight; 12.1±7.7 years of diagnosis; 7.3±1.3% mean HbA1c). Clinical and laboratory evaluations were performed together with 3-day weight diet records. The dietary index developed included 10 components: "diet variety", "fresh fruits", "vegetables", "carbohydrates and fiber sources", "meats and eggs", "dairy products and saturated fatty acids", "oils and fats", "total lipids", "cholesterol", and "transunsaturated fatty acids". The performance of each component was evaluated using the Item Response Theory, and diet quality was scored from 0-100%.Results:Overall, diet quality in this sample was 39.8±14.3% (95%CI=37.8-41.8%), and only 55 patients had a total diet quality score >50%. Good compliance was observed in only four index components: "total lipids", "variety", "fiber sources", and "dairy and saturated fatty acids". The components that differentiated patients with poor dietary quality from those with good dietary quality were "vegetables", "diet variety", "dairy and saturated fatty acids" and "total lipids". The greatest determinants of dietary quality were the components "diet variety", "vegetables", and "total lipids".Conclusion:This dietary index proposed assesses diet quality in compliance with the specific nutritional recommendations for diabetes. In clinical practice, this novel index may be a useful tool for the assessment and management of diet of patients with type 2 diabetes.