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Negretto LAF, Rassi N, Soares LR, Saraiva ABC, Teixeira MEF, Santos LDR, Souza ALL, Jardim PCBV, Barroso de Souza WKS, Jardim TDSV. Testosterone Deficiency in Hypertensive Men: Prevalence and Associated Factors. Arq Bras Cardiol 2024; 121:e20230138. [PMID: 38597552 DOI: 10.36660/abc.20230138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Accepted: 11/14/2023] [Indexed: 04/11/2024] Open
Abstract
BACKGROUND Testosterone deficiency (TD) is a prevalent condition in our midst and still very neglected. Arterial hypertension (AH) is one of the possible associated factors. OBJECTIVES To determine the prevalence of TD in a hypertensive male population and the factors associated with its occurrence, such as age, time since hypertension diagnosis, number of antihypertensive classes, body mass index (BMI), diabetes, dyslipidemia, chronic kidney disease (CKD), positive symptoms of TD (positive ADAM questionnaire) and use of spironolactone. METHODS Cross-sectional study with administration of the ADAM questionnaire, assessment of biochemical, clinical, and anthropometric data. Patients were stratified into DT and normal testosterone groups. Categorical variables were compared using the chi-squared test and continuous variables using the Mann-Witney test; variables with significance (p<0,05) were analyzed by multivariable linear regression. RESULTS The prevalence of TD was 26.36%. There was an association between TD and body mass index (BMI) (p=0.0007) but there was no association with age (p=0.0520), time of hypertension diagnosis (p=0.1418), number of classes of antihypertensive drugs (p=0.732), diabetes (p=0.1112); dyslipidemia (p=0.3888); CKD (p=0.3321); use of spironolactone (p=0.3546) or positive ADAM questionnaire (p=0.2483). CONCLUSIONS TD was highly prevalent and positively associated with BMI. Total testosterone (TT) declined by 8.44ng/dL with a one unit increase in BMI and dropped by 3.79ng/dL with a one-year increase in age.
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Affiliation(s)
| | - Nelson Rassi
- Hospital Geral de Goiânia - Dr. Alberto Rassi, Goiânia, GO - Brasil
| | | | | | | | | | - Ana Luiza Lima Souza
- Universidade Federal de Goiás - Liga de Hipertensão Arterial, Goiânia, GO - Brasil
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Czepielewski MA, Garret Q, Vencio SAC, Rassi N, Faria MS, Senn CCP, Bronstein MD, Cerqueira MJAG, Neves ACL, Spinola-Castro AM, Cunha MPR, Leite NR, Wassermann GE, Alegria MC, Toffoletto O, Afiune J, Baradelli R, Rodrigues DG, Scharf M. Switching from originator recombinant growth hormone (Genotropin™) to biosimilar (CRISCY™): Results from a 6-month, multicentric, non-inferiority, extension trial. Growth Horm IGF Res 2021; 56:101372. [PMID: 33260063 DOI: 10.1016/j.ghir.2020.101372] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Revised: 09/14/2020] [Accepted: 11/15/2020] [Indexed: 11/27/2022]
Abstract
OBJECTIVE A previous 12-month comparative trial with Criscy™ (r-hGH Cristália), a biosimilar recombinant growth hormone, demonstrated equivalent efficacy and safety to Genotropin™. This extension trial evaluated the effects of switching patients treated with Genotropin™ to the biosimilar Criscy™ over an additional 6-month treatment period, comparing efficacy, safety, and immunogenicity parameters with patients remaining in the Criscy™ arm. DESIGN This extension study included 11 research centers and 81 patients who participated in the CERES study (Czepielewski et al., 2019 [1]). Participants from the Genotropin™ arm (n = 39) had the drug replaced by Criscy™ and the remaining participants were kept in the Criscy™ arm (n = 42) for an additional 6-month period to evaluate immunogenicity, efficacy (growth rate, height SDS), and safety (laboratory tests, and adverse events). RESULTS Before the switch, both Criscy™ and Genotropin groups were similar concerning demographics, and auxological measures: age, sex, height, height SDS, weight, and BMI. Height velocity (HV) after 18 months of treatment was 8.7 ± 1.56 cm/year for Criscy™ group and 8.9 ± 1.36 cm/year for Genotropin™ group in the ITT population (p = 0.43). The auxological parameters and IGF-1 and IGFBP-3 SDS were comparable between both groups of patients. No participants were excluded from the study due to adverse events. There were no clinical or statistical relevant differences between the treatment groups concerning frequency, distribution, intensity, and AEs outcome. Similarly, no new anti-r-hGH (ADA) cases among patients that switched from Genotropin™ to Criscy™ were reported. No neutralizing antibody (nAb) was detected in either group. CONCLUSIONS This trial showed that switching from originator recombinant human growth hormone to Criscy™ had no impact on efficacy, safety, nor immunogenicity as compared to continued treatment with Criscy™. Growth rates and ADA incidence remained the same as seen before the switch.
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Affiliation(s)
- M A Czepielewski
- Serviço de Endocrinologia, Hospital de Clínicas de Porto Alegre, UFRGS, Porto Alegre, RS, Brazil.
| | | | - S A C Vencio
- ICF - Instituto de Ciências Farmacêuticas de Estudos e Pesquisas Ltda, Aparecida de Goiânia, GO, Brazil
| | - N Rassi
- Hospital Alberto Rassi - HGG, Goiânia, GO, Brazil
| | - M S Faria
- Hospital Universitário da Universidade Federal do Maranhão/HU/UFMA, São Luis, MA, Brazil
| | - C C P Senn
- Centro de Diabetes de Curitiba, Curitiba, PR, Brazil
| | - M D Bronstein
- CPQUALI Pesquisa Clínica Ltda, São Paulo, SP, Brazil
| | - M J A G Cerqueira
- Instituto de Ensino e Pesquisa Clínica do Ceará, Fortaleza, CE, Brazil
| | - A C L Neves
- Instituto de Medicina Integral Professor Fernando Figueira - IMIP, Recife, PE, Brazil
| | | | - M P R Cunha
- CAEP - Centro Avançado de Estudos e Pesquisas Ltda, Campinas, SP, Brazil
| | - N R Leite
- Cristália Produtos Químicos Farmacêuticos Ltda, Itapira, SP, Brazil
| | - G E Wassermann
- Cristália Produtos Químicos Farmacêuticos Ltda, Itapira, SP, Brazil
| | - M C Alegria
- Cristália Produtos Químicos Farmacêuticos Ltda, Itapira, SP, Brazil
| | - O Toffoletto
- Cristália Produtos Químicos Farmacêuticos Ltda, Itapira, SP, Brazil
| | - J Afiune
- Cristália Produtos Químicos Farmacêuticos Ltda, Itapira, SP, Brazil
| | - R Baradelli
- Cristália Produtos Químicos Farmacêuticos Ltda, Itapira, SP, Brazil
| | - D G Rodrigues
- Cristália Produtos Químicos Farmacêuticos Ltda, Itapira, SP, Brazil
| | - M Scharf
- Centro de Diabetes de Curitiba, Curitiba, PR, Brazil
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Vargas MCC, Moura FS, Elias CP, Carvalho SR, Rassi N, Kunii IS, Dias-da-Silva MR, Costa-Barbosa FA. Spontaneous fertility and variable spectrum of reproductive phenotype in a family with adult-onset X-linked adrenal insufficiency harboring a novel DAX-1/NR0B1 mutation. BMC Endocr Disord 2020; 20:21. [PMID: 32028936 PMCID: PMC7006140 DOI: 10.1186/s12902-020-0500-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2019] [Accepted: 01/27/2020] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND Adrenal hypoplasia congenita (AHC) is an X-linked disorder that affects the adrenal cortex and hypothalamus-pituitary-gonadal axis (HPG), leading to primary adrenocortical insufficiency (PAI) and hypogonadotropic hypogonadism. AHC is caused by a mutation in the DAX-1 gene (NR0B1). More commonly, this disease is characterized by early-onset PAI, with symptoms in the first months of life. However, a less severe phenotype termed late-onset AHC has been described, as PAI signs and symptoms may begin in adolescence and adulthood. Here we describe a family report of a novel mutation within NR0B1 gene and variable reproductive phenotypes, including spontaneous fertility, in a very late-onset X-linked AHC kindred. CASE PRESENTATION Three affected maternal male relatives had confirmed PAI diagnosis between 30 y and at late 64 y. The X-linked pattern has made the endocrinology team to AHC suspicion. Regarding the HPG axis, all males presented a distinct degree of testosterone deficiency and fertility phenotypes, varying from a variable degree of hypogonadism, oligoasthenoteratozoospermia to spontaneous fertility. Interestingly, the other five maternal male relatives unexpectedly died during early adulthood, most likely due to undiagnosed PAI/adrenal crisis as the probable cause of their premature deaths. Sequencing analysis of the NR0B1 gene has shown a novel NR0B1 mutation (p.Tyr378Cys) that segregated in three AHC family members. CONCLUSIONS NR0B1 p.Tyr378Cys segregates in an AHC family with a variable degree of adrenal and gonadal phenotypes, and its hemizygous trait explains the disease in affected family members. We recommend that NR0B1 mutation carriers, even those that are allegedly asymptomatic, be carefully monitored while reinforcing education to prevent PAI and consider early sperm banking when spermatogenesis still viable.
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Affiliation(s)
| | - Felipe Scipião Moura
- Department of Medicine, Division of Endocrinology, Escola Paulista de Medicina, Laboratory of Molecular and Translational Endocrinology, Universidade Federal de São Paulo, Rua Pedro de Toledo 669, Sao Paulo, SP, 04039-032, Brazil
| | - Cecília P Elias
- Endocrinology Unit, Hospital Geral Alberto Rassi, Goiânia, Brazil
| | - Sara R Carvalho
- Endocrinology Unit, Hospital Geral Alberto Rassi, Goiânia, Brazil
| | - Nelson Rassi
- Endocrinology Unit, Hospital Geral Alberto Rassi, Goiânia, Brazil
| | - Ilda S Kunii
- Department of Medicine, Division of Endocrinology, Escola Paulista de Medicina, Laboratory of Molecular and Translational Endocrinology, Universidade Federal de São Paulo, Rua Pedro de Toledo 669, Sao Paulo, SP, 04039-032, Brazil
| | - Magnus R Dias-da-Silva
- Department of Medicine, Division of Endocrinology, Escola Paulista de Medicina, Laboratory of Molecular and Translational Endocrinology, Universidade Federal de São Paulo, Rua Pedro de Toledo 669, Sao Paulo, SP, 04039-032, Brazil.
| | - Flavia Amanda Costa-Barbosa
- Department of Medicine, Division of Endocrinology, Escola Paulista de Medicina, Laboratory of Molecular and Translational Endocrinology, Universidade Federal de São Paulo, Rua Pedro de Toledo 669, Sao Paulo, SP, 04039-032, Brazil
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Czepielewski MA, Garret Q, Vencio SAC, Rassi N, Felicio JS, Faria MS, Senn CCP, Bronstein MD, Cerqueira MJAG, Neves ACL, Sgarbi JA, Spinola-Castro AM, Cunha MPR, Bandeira F, Toffoletto O, Afiune J, Baradelli R, Rodrigues DG, Scharf M. Efficacy and safety of a biosimilar recombinant human growth hormone (r-hGH Cristalia) compared with reference r-hGH in children with growth hormone deficiency (CERES study): A randomized, multicentric, investigator-blind, phase 3 trial. Growth Horm IGF Res 2019; 48-49:29-35. [PMID: 31493626 DOI: 10.1016/j.ghir.2019.07.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2019] [Revised: 07/28/2019] [Accepted: 07/30/2019] [Indexed: 10/26/2022]
Abstract
OBJECTIVE The CERES study was a randomized, multicenter, investigator-blind trial aimed to evaluate the efficacy and safety of a recombinant human growth hormone (r-hGH) developed by Cristalia, as a biosimilar product, with analytical, functional and pharmacokinetics similarities comparable to Genotropin™, in children with growth hormone deficiency (GHD). DESIGN A total of 135 naïve prepubertal children with GHD were recruited, of whom 97 were randomized in 14 Brazilian sites to received either r-hGH Cristalia (n = 49) or Genotropin™ (n = 48). Efficacy was evaluated considering the height standard deviation score (SDS) and growth velocity as auxological parameters, IGF-1 and IGFBP-3 were measured as pharmacodynamic parameters during 12 months treatment time. Safety was assessed by monitoring adverse events, immunogenicity, blood count with platelets, biochemical profile and hormonal levels particularly fasting glucose, insulin and HbA1C. RESULTS The auxological parameters and IGF-1 and IGFBP-3 levels were comparable between both groups of patients. At end of study or the 12th month treatment, the means growth velocity was 9.7 cm/year and 9.5 cm/year, for r-hGH Cristalia and Genotropin™, respectively. The ANCOVA mean difference between the groups was 0.16 cm/year to Cristalia group (CI 95% = -0.72 to 1.03 cm/year). There was no difference in adherence among the treatment groups. The safety profile was comparable between groups. CONCLUSIONS The clinical similarity between r-hGH and Genotropin™ was demonstrated within 12 month of treatment. On the basis of comparability of quality, safety, and efficacy to the reference product, r-hGH from Cristalia can be considered a cost-effective therapeutic option for patients with growth disorders.
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Affiliation(s)
- M A Czepielewski
- Serviço de Endocrinologia, Hospital de Clínicas de Porto Alegre, UFRGS, Porto Alegre, RS, Brazil.
| | | | - S A C Vencio
- ICF - Instituto de Ciências Farmacêuticas de Estudos e Pesquisas Ltda, Aparecida de Goiânia, GO, Brazil
| | - N Rassi
- Hospital Alberto Rassi - HGG, Goiânia, GO, Brazil
| | - J S Felicio
- Hospital Universitário João de Barros Barreto, Universidade Federal do Pará, Belém, PA, Brazil
| | - M S Faria
- Hospital Universitário da Universidade Federal do Maranhão/HU/UFMA, São Luis, MA, Brazil
| | - C C P Senn
- Centro de Diabetes de Curitiba, Curitiba, PR, Brazil
| | - M D Bronstein
- CPQUALI Pesquisa Clínica Ltda, São Paulo, SP, Brazil
| | - M J A G Cerqueira
- Instituto de Ensino e Pesquisa Clínica do Ceará, Fortaleza, CE, Brazil
| | - A C L Neves
- Instituto de Medicina Integral Professor Fernando Figueira - IMIP, Recife, PE, Brazil
| | - J A Sgarbi
- Unidade de Pesquisa Clínica de Marília Ltda (UpCliM), Marília, SP, Brazil
| | | | - M P R Cunha
- CAEP - Centro Avançado de Estudos e Pesquisas Ltda, Campinas, SP, Brazil
| | - F Bandeira
- Centro de Pesquisas Médicas Básica e Clínica Ltda, Recife, PE, Brazil
| | - O Toffoletto
- Cristália Produtos Químicos Farmacêuticos Ltda, Itapira, SP, Brazil
| | - J Afiune
- Cristália Produtos Químicos Farmacêuticos Ltda, Itapira, SP, Brazil
| | - R Baradelli
- Cristália Produtos Químicos Farmacêuticos Ltda, Itapira, SP, Brazil
| | - D G Rodrigues
- Cristália Produtos Químicos Farmacêuticos Ltda, Itapira, SP, Brazil
| | - M Scharf
- Centro de Diabetes de Curitiba, Curitiba, PR, Brazil
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Elias CP, Antunes DE, Coelho MS, de Lima CL, Rassi N, de Melo APM, Amato AA. Evaluation of the hypothalamic-pituitary-adrenal axis in a case series of familial partial lipodystrophy. Diabetol Metab Syndr 2019; 11:1. [PMID: 30622652 PMCID: PMC6317180 DOI: 10.1186/s13098-018-0396-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2018] [Accepted: 12/20/2018] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Familial partial lipodystrophy (FPL) is a rare genetic disease characterized by body fat abnormalities that lead to insulin resistance (IR). Clinical conditions linked to milder IR, such as type 2 diabetes (T2D) and metabolic syndrome, are associated with abnormalities of the hypothalamic-pituitary-adrenal (HPA) axis, but little is known about its activity in FPL. METHODS Patients meeting the clinical criteria for FPL were subjected to anthropometric, biochemical and hormone analyses. A genetic study to identify mutations in the genes encoding peroxisome proliferator-activated receptor gamma (PPARγ) was performed. Polycystic ovary syndrome and hepatic steatosis were investigated, and the patient body compositions were analyzed via dual X-ray energy absorptiometry (DXA). The HPA axis was assessed via basal [cortisol, adrenocorticotrophic hormone (ACTH), cortisol binding globulin, nocturnal salivary cortisol and urinary free cortisol (UFC)] as well as dynamic suppression tests (cortisol post 0.5 mg and post 1 mg dexamethasone). RESULTS Six patients (five female and one male) aged 17 to 42 years were included. In DXA analyses, the fat mass ratio between the trunk and lower limbs (FMR) was > 1.2 in all phenotypes. One patient had a confirmed mutation in the PPARγ gene: a novel heterozygous substitution of p. Arg 212 Trp (c.634C>T) at exon 5. HPA sensitivity to glucocorticoid feedback was preserved in all six patients, and a trend towards lower basal serum cortisol, serum ACTH and UFC values was observed. CONCLUSIONS Our findings suggest that FPL is not associated with overt abnormalities in the HPA axis, despite a trend towards low-normal basal cortisol and ACTH values and lower UFC levels. These findings suggest that the extreme insulin resistance occurring in FPL may lead to a decrease in HPA axis activity without changing its sensitivity to glucocorticoid feedback, in contrast to the abnormalities in HPA axis function in T2D and common metabolic syndrome.
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Affiliation(s)
- Cecília Pacheco Elias
- Unit of Endocrinology, Hospital Alberto Rassi–General Hospital of Goiânia (HGG), Avenida Anhanguera, 6479 - St. Oeste, Goiânia, GO CEP 74120-080 Brazil
| | | | - Michella Soares Coelho
- Laboratory of Molecular Pharmacology, School of Health Sciences, University of Brasília (UnB), Brasília, Brazil
| | - Caroline Lourenço de Lima
- Laboratory of Molecular Pharmacology, School of Health Sciences, University of Brasília (UnB), Brasília, Brazil
| | - Nelson Rassi
- Unit of Endocrinology, Hospital Alberto Rassi–General Hospital of Goiânia (HGG), Avenida Anhanguera, 6479 - St. Oeste, Goiânia, GO CEP 74120-080 Brazil
| | | | - Angélica Amorim Amato
- Laboratory of Molecular Pharmacology, School of Health Sciences, University of Brasília (UnB), Brasília, Brazil
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Rassi N, Moraes SMCTD, Alves AG, Cavalheiro DC, Moreira JM, Bellório KB, Abreu FCD, Prata PRM, Teixeira LDS, Rassi S. Comparative study between two recombinant human NPH insulin formulations for the treatment of type 2 diabetes mellitus. Arch Endocrinol Metab 2016; 60:47-53. [PMID: 26909482 PMCID: PMC10118911 DOI: 10.1590/2359-3997000000140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/22/2013] [Accepted: 11/24/2014] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To compare the effects of the neutral protamine Hagedorn (NPH) recombinant human insulin formulations Gansulin and Humulin N® on the glycemic control of patients with type 2 diabetes mellitus (T2DM). SUBJECTS AND METHODS Prospective, double-blind, randomized, parallel, single-center study of 37 individuals with T2DM treated with NPH insulin formulations. The Tukey-Kramer test for multiple comparisons, the Wilcoxon paired comparison test and the Chi-Square test were used for the statistical analyses. The significance level was set at 5% (p < 0.05). RESULTS The NPH insulin formulations Humulin and Gansulin similarly reduced the HbA1c levels observed at the end of the study compared with the values obtained at the beginning of the study. In the Humulin group, the initial HbA1c value of 7.91% was reduced to 6.56% (p < 0.001), whereas in the Gansulin group, the reduction was from 8.18% to 6.65% (p < 0.001). At the end of the study, there was no significant difference between the levels of glycated hemoglobin (p = 0.2410), fasting plasma glucose (FG; p = 0.9257) and bedtime plasma glucose (BG; p = 0.3906) between the two insulin formulations. There was no nt difference in the number of hypoglycemic events between the two insulin formulations, and no severe hyp episodes were recorded. CONCLUSION This study demonstrated similar glycemic control by NPH insulin Gansulin compared with human insulin Humulin N® in patients with T2DM.
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Affiliation(s)
- Nelson Rassi
- Hospital Geral de Goiânia Alberto Rassi, Goiânia, GO, Brasil
| | | | | | | | | | | | | | | | | | - Salvador Rassi
- Universidade Federal de Goiás (UFG), Goiânia, GO, Brasil
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7
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Felício JS, de Souza ACCB, Koury CC, Neto JFA, Miléo KB, Santos FM, Motta ARB, Silva DD, Arbage TP, Carvalho CT, de Rider Brito HA, Yamada ES, Cobas RA, Matheus A, Tannus L, Palma CCS, Japiassu L, Carneiro JRI, Rodacki M, Zajdenverg L, de Araújo NBC, de Menezes Cordeiro M, Luescher JL, Berardo RS, Nery M, Cani C, do Carmo Arruda Marques M, Calliari LE, de Noronha RM, Manna TD, Savoldelli R, Penha FG, Foss MC, Foss-Freitas MC, Pires AC, Robles FC, Negrato CA, de Fatima Guedes M, Dib SA, Dualib P, da Silva SC, Sepúlveda J, Sampaio E, Rea RR, de Almeida Faria ACR, Tschiedel B, Lavigne S, Cardozo GA, Azevedo M, Canani LH, Zucatti AT, Coral MHC, Pereira DA, de Araujo LA, Pedrosa HC, Tolentino M, Prado FA, Rassi N, de Araujo LB, Fonseca RMC, Guedes AD, de Mattos OS, Faria M, Azulay R, e Forti AC, Façanha CFS, Junior RM, Montenegro AP, Melo NH, Rezende KF, Ramos A, Jezini DL, Gomes MB. Health-related quality of life in patients with type 1 diabetes mellitus in the different geographical regions of Brazil: data from the Brazilian Type 1 Diabetes Study Group. Diabetol Metab Syndr 2015; 7:87. [PMID: 26448787 PMCID: PMC4596564 DOI: 10.1186/s13098-015-0081-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2015] [Accepted: 09/28/2015] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND In type 1 diabetes mellitus (T1DM) management, enhancing health-related quality of life (HRQoL) is as important as good metabolic control and prevention of secondary complications. This study aims to evaluate possible regional differences in HRQoL, demographic features and clinical characteristics of patients with T1DM in Brazil, a country of continental proportions, as well as investigate which variables could influence the HRQoL of these individuals and contribute to these regional disparities. METHODS This was a retrospective, cross-sectional, multicenter study performed by the Brazilian Type 1 Diabetes Study Group (BrazDiab1SG), by analyzing EuroQol scores from 3005 participants with T1DM, in 28 public clinics, among all geographical regions of Brazil. Data on demography, economic status, chronic complications, glycemic control and lipid profile were also collected. RESULTS We have found that the North-Northeast region presents a higher index in the assessment of the overall health status (EQ-VAS) compared to the Southeast (74.6 ± 30 and 70.4 ± 19, respectively; p < 0.05). In addition, North-Northeast presented a lower frequency of self-reported anxiety-depression compared to all regions of the country (North-Northeast: 1.53 ± 0.6; Southeast: 1.65 ± 0.7; South: 1.72 ± 0.7; Midwest: 1.67 ± 0.7; p < 0.05). These findings could not be entirely explained by the HbA1c levels or the other variables examined. CONCLUSIONS Our study points to the existence of additional factors not yet evaluated that could be determinant in the HRQoL of people with T1DM and contribute to these regional disparities.
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Affiliation(s)
- João Soares Felício
- />Endocrinology Division, University Hospital João de Barros Barreto, Federal University of Pará, Mundurucus Street, 4487, Guamá, Belém, Pará 66073-000 Brazil
| | - Ana Carolina Contente Braga de Souza
- />Endocrinology Division, University Hospital João de Barros Barreto, Federal University of Pará, Mundurucus Street, 4487, Guamá, Belém, Pará 66073-000 Brazil
| | - Camila Cavalcante Koury
- />Endocrinology Division, University Hospital João de Barros Barreto, Federal University of Pará, Mundurucus Street, 4487, Guamá, Belém, Pará 66073-000 Brazil
| | - João Felício Abrahão Neto
- />Endocrinology Division, University Hospital João de Barros Barreto, Federal University of Pará, Mundurucus Street, 4487, Guamá, Belém, Pará 66073-000 Brazil
| | - Karem Barbosa Miléo
- />Endocrinology Division, University Hospital João de Barros Barreto, Federal University of Pará, Mundurucus Street, 4487, Guamá, Belém, Pará 66073-000 Brazil
| | - Flávia Marques Santos
- />Endocrinology Division, University Hospital João de Barros Barreto, Federal University of Pará, Mundurucus Street, 4487, Guamá, Belém, Pará 66073-000 Brazil
| | - Ana Regina Bastos Motta
- />Endocrinology Division, University Hospital João de Barros Barreto, Federal University of Pará, Mundurucus Street, 4487, Guamá, Belém, Pará 66073-000 Brazil
| | - Denisson Dias Silva
- />Endocrinology Division, University Hospital João de Barros Barreto, Federal University of Pará, Mundurucus Street, 4487, Guamá, Belém, Pará 66073-000 Brazil
| | - Thaís Pontes Arbage
- />Endocrinology Division, University Hospital João de Barros Barreto, Federal University of Pará, Mundurucus Street, 4487, Guamá, Belém, Pará 66073-000 Brazil
| | - Carolina Tavares Carvalho
- />Endocrinology Division, University Hospital João de Barros Barreto, Federal University of Pará, Mundurucus Street, 4487, Guamá, Belém, Pará 66073-000 Brazil
| | - Hana Andrade de Rider Brito
- />Endocrinology Division, University Hospital João de Barros Barreto, Federal University of Pará, Mundurucus Street, 4487, Guamá, Belém, Pará 66073-000 Brazil
| | - Elizabeth Sumi Yamada
- />Endocrinology Division, University Hospital João de Barros Barreto, Federal University of Pará, Mundurucus Street, 4487, Guamá, Belém, Pará 66073-000 Brazil
| | - Roberta Arnoldi Cobas
- />Diabetes Unit, Department of Internal Medicine, State University of Rio de Janeiro, Rio De Janeiro, Brazil
| | - Alessandra Matheus
- />Diabetes Unit, Department of Internal Medicine, State University of Rio de Janeiro, Rio De Janeiro, Brazil
| | - Lucianne Tannus
- />Diabetes Unit, Department of Internal Medicine, State University of Rio de Janeiro, Rio De Janeiro, Brazil
| | - Catia Cristina Sousa Palma
- />Diabetes Unit, Department of Internal Medicine, State University of Rio de Janeiro, Rio De Janeiro, Brazil
| | - Leticia Japiassu
- />Diabetes Unit, Department of Internal Medicine, State University of Rio de Janeiro, Rio De Janeiro, Brazil
| | - João Regis Ivar Carneiro
- />Diabetes Unit, Department of Internal Medicine, State University of Rio de Janeiro, Rio De Janeiro, Brazil
| | - Melanie Rodacki
- />Federal University Hospital of Rio de Janeiro, Rio De Janeiro, Brazil
| | - Lenita Zajdenverg
- />Federal University Hospital of Rio de Janeiro, Rio De Janeiro, Brazil
| | | | | | - Jorge Luiz Luescher
- />University Hospital Clementino Fraga Filho, Children Institute Martagão Teixeira, Rio De Janeiro, Brazil
| | - Renata Szundy Berardo
- />University Hospital Clementino Fraga Filho, Children Institute Martagão Teixeira, Rio De Janeiro, Brazil
| | - Marcia Nery
- />Diabetes Unit, University Hospital of São Paulo, São Paulo, Brazil
| | - Catarina Cani
- />Diabetes Unit, University Hospital of São Paulo, São Paulo, Brazil
| | | | | | | | - Thais Della Manna
- />Children Institute of Endocrinology, University Hospital of São Paulo, São Paulo, Brazil
| | - Roberta Savoldelli
- />Children Institute of Endocrinology, University Hospital of São Paulo, São Paulo, Brazil
| | - Fernanda Garcia Penha
- />Children Institute of Endocrinology, University Hospital of São Paulo, São Paulo, Brazil
| | - Milton Cesar Foss
- />Ribeirão Preto Medical School of São Paulo University, Ribeirão Preto, Brazil
| | | | - Antonio Carlos Pires
- />Department of Internal Medicine, Medical School, State University of São José do Rio Preto, São José Do Rio Preto, Brazil
| | - Fernando Cesar Robles
- />Department of Internal Medicine, Medical School, State University of São José do Rio Preto, São José Do Rio Preto, Brazil
| | | | | | - Sergio Atala Dib
- />Diabetes Unit, Federal University of São Paulo State, São Paulo, Brazil
| | - Patricia Dualib
- />Diabetes Unit, Federal University of São Paulo State, São Paulo, Brazil
| | | | - Janice Sepúlveda
- />Endocrinology Unit, Hospital of Santa Casa of Belo Horizonte, Belo Horizonte, Minas Gerais Brazil
| | - Emerson Sampaio
- />Diabetes Unit, State University Hospital of Londrina, Paraná, Brazil
| | | | | | - Balduino Tschiedel
- />Institute of Diabetic Children, Porto Alegre, Rio Grande do Sul Brazil
| | - Suzana Lavigne
- />Institute of Diabetic Children, Porto Alegre, Rio Grande do Sul Brazil
| | | | - Mirela Azevedo
- />Clinical Hospital of Porto Alegre, Porto Alegre, Rio Grande do Sul Brazil
| | | | | | | | | | | | | | | | | | | | | | | | | | | | - Manuel Faria
- />Federal University of Maranhão, São Luís, Maranhão Brazil
| | - Rossana Azulay
- />Federal University of Maranhão, São Luís, Maranhão Brazil
| | | | | | | | | | | | | | - Alberto Ramos
- />Federal University Hospital of Campina Grande, Campina Grande, Paraíba Brazil
| | - Deborah Laredo Jezini
- />Getúlio Vargas University Hospital of Amazonas, Adriano Jorge Hospital, Manaus, Amazonas Brazil
| | - Marilia Brito Gomes
- />Diabetes Unit, Department of Internal Medicine, State University of Rio de Janeiro, Rio De Janeiro, Brazil
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8
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Davison KAK, Negrato CA, Cobas R, Matheus A, Tannus L, Palma CS, Japiassu L, Carneiro JRI, Rodacki M, Zajdenverg L, Araújo NBC, Cordeiro MM, Luescher JL, Berardo RS, Nery M, Cani C, do Carmo A Marques M, Calliari LE, Noronha RM, Manna TD, Savoldelli R, Penha FG, Foss MC, Foss-Freitas MC, de Fatima Guedes M, Dib SA, Dualib P, Silva SC, Sepúlveda J, Sampaio E, Rea RR, Faria ACRA, Tschiedel B, Lavigne S, Cardozo GA, Pires AC, Robles FC, Azevedo M, Canani LH, Zucatti AT, Coral MHC, Pereira DA, Araujo LA, Pedrosa HC, Tolentino M, Prado FA, Rassi N, Araujo LB, Fonseca RMC, Guedes AD, Mattos OS, Faria M, Azulay R, Forti AC, Façanha CFS, Montenegro R, Montenegro AP, Melo NH, Rezende KF, Ramos A, Felicio JS, Santos FM, Jezini DL, Gomes MB. Relationship between adherence to diet, glycemic control and cardiovascular risk factors in patients with type 1 diabetes: a nationwide survey in Brazil. Nutr J 2014; 13:19. [PMID: 24607084 PMCID: PMC3995939 DOI: 10.1186/1475-2891-13-19] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2013] [Accepted: 02/25/2014] [Indexed: 11/28/2022] Open
Abstract
Background To determine the relationship between adherence to the diet reported by patients with type 1 diabetes under routine clinical care in Brazil, and demographic, socioeconomic status, glycemic control and cardiovascular risk factors. Methods This was a cross-sectional, multicenter study conducted between December 2008 and December 2010 in 28 public clinics in 20 Brazilian cities. The data was obtained from 3,180 patients, aged 22 ± 11.8 years (56.3% females, 57.4% Caucasians and 43.6% non-Caucasians). The mean time since diabetes diagnosis was 11.7 ± 8.1 years. Results Overall, 1,722 (54.2%) of the patients reported to be adherent to the diet without difference in gender, duration of diabetes and socioeconomic status. Patients who reported adherence to the diet had lower BMI, HbA1c, triglycerides, LDL-cholesterol, non HDL-cholesterol and diastolic blood pressure and had more HbA1c at goal, performed more frequently self-monitoring of blood glucose (p < 0.001), and reported less difficulties to follow specific schedules of diet plans (p < 0.001). Less patients who reported to be adherent were obese or overweight (p = 0.005). The quantity of food and time schedule of the meals were the most frequent complaints. Logistic regression analysis showed that ethnicity, (Caucasians, (OR 1.26 [1.09-1.47]), number of medical clinical visits in the last year (OR 1.10 [1.06-1.15]), carbohydrate counting, (OR 2.22 [1.49-3.30]) and diets recommended by diabetes societies’, (OR 1.57 [1.02-2.41]) were related to greater patients’ adherence (p < 0.05) and age, [adolescents (OR 0.60 [0.50-0.72]), high BMI (OR 0.58 [0.94-0.98]) and smoking (OR 0.58 [0.41-0.84]) with poor patients’ adherence (p < 0.01). Conclusions Our results suggest that it is necessary to rethink medical nutrition therapy in order to help patients to overcome barriers that impair an optimized adherence to the diet.
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Affiliation(s)
- Kariane A K Davison
- Bauru's Diabetics Association, Department of Internal Medicine, Bauru, São Paulo, Brazil.
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9
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Gomes MB, Negrato CA, Cobas R, Tannus LRM, Gonçalves PR, da Silva PCB, Carneiro JRI, Matheus ASM, Dib SA, Azevedo MJ, Nery M, Rodacki M, Zajdenverg L, Montenegro Junior RM, Sepulveda J, Calliari LE, Jezini D, Braga N, Luescher JL, Berardo RS, Arruda-Marques MC, Noronha RM, Manna TD, Salvodelli R, Penha FG, Foss MC, Foss-Freitas MC, Pires AC, Robles FC, Guedes MDFS, Dualib P, Silva SC, Sampaio E, Rea R, Faria ACR, Tschiedel B, Lavigne S, Canani LH, Zucatti AT, Coral MHC, Pereira DA, Araujo LA, Tolentino M, Pedrosa HC, Prado FA, Rassi N, Araujo LB, Fonseca RMC, Guedes AD, Matos OS, Palma CC, Azulay R, Forti AC, Façanha C, Montenegro AP, Melo NH, Rezende KF, Ramos A, Felicio JS, Santos FM. Determinants of intensive insulin therapeutic regimens in patients with type 1 diabetes: data from a nationwide multicenter survey in Brazil. Diabetol Metab Syndr 2014; 6:67. [PMID: 24920963 PMCID: PMC4052842 DOI: 10.1186/1758-5996-6-67] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2014] [Accepted: 05/20/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND To evaluate the determinants of intensive insulin regimens (ITs) in patients with type 1 diabetes (T1D). METHODS This multicenter study was conducted between December 2008 and December 2010 in 28 public clinics in 20 Brazilian cities. Data were obtained from 3,591 patients (56.0% female, 57.1% Caucasian). Insulin regimens were classified as follows: group 1, conventional therapy (CT) (intermediate human insulin, one to two injections daily); group 2 (three or more insulin injections of intermediate plus regular human insulin); group 3 (three or more insulin injections of intermediate human insulin plus short-acting insulin analogues); group 4, basal-bolus (one or two insulin injections of long-acting plus short-acting insulin analogues or regular insulin); and group 5, basal-bolus with continuous subcutaneous insulin infusion (CSII). Groups 2 to 5 were considered IT groups. RESULTS We obtained complete data from 2,961 patients. Combined intermediate plus regular human insulin was the most used therapeutic regimen. CSII was used by 37 (1.2%) patients and IT by 2,669 (90.2%) patients. More patients on IT performed self-monitoring of blood glucose and were treated at the tertiary care level compared to CT patients (p < 0.001). The majority of patients from all groups had HbA1c levels above the target. Overweight or obesity was not associated with insulin regimen. Logistic regression analysis showed that economic status, age, ethnicity, and level of care were associated with IT (p < 0.001). CONCLUSIONS Given the prevalence of intensive treatment for T1D in Brazil, more effective therapeutic strategies are needed for long term-health benefits.
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Affiliation(s)
- Marilia Brito Gomes
- Unit of Diabetes, Universidade Estadual do Rio de Janeiro, Avenida 28 de Setembro, 77, 3 andar CEP 20.551-030 Rio de Janeiro, Brazil
| | | | - Roberta Cobas
- Unit of Diabetes, Universidade Estadual do Rio de Janeiro, Avenida 28 de Setembro, 77, 3 andar CEP 20.551-030 Rio de Janeiro, Brazil
| | - Lucianne Righeti Monteiro Tannus
- Unit of Diabetes, Universidade Estadual do Rio de Janeiro, Avenida 28 de Setembro, 77, 3 andar CEP 20.551-030 Rio de Janeiro, Brazil
| | - Paolla Ribeiro Gonçalves
- Unit of Diabetes, Universidade Estadual do Rio de Janeiro, Avenida 28 de Setembro, 77, 3 andar CEP 20.551-030 Rio de Janeiro, Brazil
| | - Pedro Carlos Barreto da Silva
- Unit of Diabetes, Universidade Estadual do Rio de Janeiro, Avenida 28 de Setembro, 77, 3 andar CEP 20.551-030 Rio de Janeiro, Brazil
| | - João Regis Ivar Carneiro
- Unit of Diabetes, Universidade Estadual do Rio de Janeiro, Avenida 28 de Setembro, 77, 3 andar CEP 20.551-030 Rio de Janeiro, Brazil
| | | | - Sergio Atala Dib
- Diabetes Unit, Federal University of São Paulo State, São Paulo, Brazil
| | | | - Márcia Nery
- Diabetes Unit, University Hospital of São Paulo, São Paulo, Brazil
| | - Melanie Rodacki
- Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | | | | | | | | | | | - Neuza Braga
- Hospital Geral de Bonsucesso, Rio de Janeiro, Brazil
| | - Jorge L Luescher
- Hospital Universitário Clementino Fraga Filho – IPPMG, Rio de Janeiro, Brazil
| | | | | | - Renata M Noronha
- Faculdade de Ciências Médicas da Santa Casa de São Paulo, São Paulo, Brazil
| | - Thais D Manna
- Instituto da Criança do Hospital das Clínicas da Universidade de São Paulo, São Paulo, Brazil
| | - Roberta Salvodelli
- Instituto da Criança do Hospital das Clínicas da Universidade de São Paulo, São Paulo, Brazil
| | - Fernanda G Penha
- Instituto da Criança do Hospital das Clínicas da Universidade de São Paulo, São Paulo, Brazil
| | - Milton C Foss
- Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto – USP, Ribeirão Preto, Brazil
| | - Maria C Foss-Freitas
- Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto – USP, Ribeirão Preto, Brazil
| | - Antonio C Pires
- Ambulatório da Faculdade Estadual de Medicina de São José do Rio Preto, Ribeirão Preto, Brazil
| | - Fernando C Robles
- Ambulatório da Faculdade Estadual de Medicina de São José do Rio Preto, Ribeirão Preto, Brazil
| | | | - Patricia Dualib
- Centro de Diabetes da Escola Paulista de Medicina, Ribeirão Preto, Brazil
| | - Saulo C Silva
- Clínica de Endocrinologia da Santa Casa de Belo Horizonte, Belo Horizonte, Brazil
| | | | - Rosangela Rea
- Hospital de Clínicas da Universidade Federal do Paraná, Porto Alegre, Brazil
| | | | - Balduino Tschiedel
- Instituto da Criança com Diabetes, Grupo Hospitalar Conceição, Porto Alegre, RS, Brazil
| | - Suzana Lavigne
- Instituto da Criança com Diabete Rio Grande Sul, Rio Grande do Sul, Brazil
| | - Luis Henrique Canani
- Ambulatório da Faculdade Estadual de Medicina de São José do Rio Preto, Ribeirão Preto, Brazil
| | - Alessandra T Zucatti
- Ambulatório da Faculdade Estadual de Medicina de São José do Rio Preto, Ribeirão Preto, Brazil
| | | | | | | | | | | | - Flaviane A Prado
- Centro de Diabetes da Escola Paulista de Medicina, Ribeirão Preto, Brazil
| | | | | | | | - Alexis D Guedes
- Centro de Diabetes e Endocrinologia do Estado da Bahia, Goiânia, Brazil
| | - Odelissa S Matos
- Centro de Diabetes e Endocrinologia do Estado da Bahia, Goiânia, Brazil
| | - Catia C Palma
- Unit of Diabetes, Universidade Estadual do Rio de Janeiro, Avenida 28 de Setembro, 77, 3 andar CEP 20.551-030 Rio de Janeiro, Brazil
| | | | - Adriana C Forti
- Centro Integrado de Diabetes e Hipertensão do Ceará, Fortaleza, Brazil
| | - Cristina Façanha
- Centro Integrado de Diabetes e Hipertensão do Ceará, Fortaleza, Brazil
| | | | - Naira H Melo
- Universidade Federal de Sergipe, Aracaju, Brazil
| | | | - Alberto Ramos
- Hospital Universitário Alcides Carneiro, Campina Grande, Brazil
| | | | - Flavia M Santos
- Hospital Universitário João de Barros Barreto, Pará, Belém, Brazil
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10
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Gomes MB, Cobas RA, Matheus AS, Tannus LR, Negrato CA, Rodacki M, Braga N, Cordeiro MM, Luescher JL, Berardo RS, Nery M, Arruda-Marques MDC, Calliari LE, Noronha RM, Manna TD, Zajdenverg L, Salvodelli R, Penha FG, Foss MC, Foss-Freitas MC, Pires AC, Robles FC, Guedes M, Dib SA, Dualib P, Silva SC, Sepulvida J, Almeida HG, Sampaio E, Rea R, Faria ACR, Tschiedel B, Lavigne S, Cardozo GA, Azevedo MJ, Canani LH, Zucatti AT, Coral MHC, Pereira DA, Araujo LA, Tolentino M, Pedrosa HC, Prado FA, Rassi N, Araujo LB, Fonseca RMC, Guedes AD, Matos OS, Faria M, Azulay R, Forti AC, Façanha C, Montenegro AP, Montenegro R, Melo NH, Rezende KF, Ramos A, Felicio JS, Santos FM, Jezini DL, Cordeiro MM. Regional differences in clinical care among patients with type 1 diabetes in Brazil: Brazilian Type 1 Diabetes Study Group. Diabetol Metab Syndr 2012; 4:44. [PMID: 23107314 PMCID: PMC3538646 DOI: 10.1186/1758-5996-4-44] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2012] [Accepted: 09/19/2012] [Indexed: 11/23/2022] Open
Abstract
UNLABELLED BACKGROUND To determine the characteristics of clinical care offered to type 1 diabetic patients across the four distinct regions of Brazil, with geographic and contrasting socioeconomic differences. Glycemic control, prevalence of cardiovascular risk factors, screening for chronic complications and the frequency that the recommended treatment goals were met using the American Diabetes Association guidelines were evaluated. METHODS This was a cross-sectional, multicenter study conducted from December 2008 to December 2010 in 28 secondary and tertiary care public clinics in 20 Brazilian cities in north/northeast, mid-west, southeast and south regions. The data were obtained from 3,591 patients (56.0% females and 57.1% Caucasians) aged 21.2 ± 11.7 years with a disease duration of 9.6 ± 8.1 years (<1 to 50 years). RESULTS Overall, 18.4% patients had HbA1c levels <7.0%, and 47.5% patients had HbA1c levels ≥ 9%. HbA1c levels were associated with lower economic status, female gender, age and the daily frequency of self-blood glucose monitoring (SBGM) but not with insulin regimen and geographic region. Hypertension was more frequent in the mid-west (32%) and north/northeast (25%) than in the southeast (19%) and south (17%) regions (p<0.001). More patients from the southeast region achieved LDL cholesterol goals and were treated with statins (p<0.001). Fewer patients from the north/northeast and mid-west regions were screened for retinopathy and nephropathy, compared with patients from the south and southeast. Patients from the south/southeast regions had more intensive insulin regimens than patients from the north/northeast and mid-west regions (p<0.001). The most common insulin therapy combination was intermediate-acting with regular human insulin, mainly in the north/northeast region (p<0.001). The combination of insulin glargine with lispro and glulisine was more frequently used in the mid-west region (p<0.001). Patients from the north/northeast region were younger, non-Caucasian, from lower economic status, used less continuous subcutaneous insulin infusion, performed less SBGM and were less overweight/obese (p<0.001). CONCLUSIONS A majority of patients, mainly in the north/northeast and mid-west regions, did not meet metabolic control goals and were not screened for diabetes-related chronic complications. These results should guide governmental health policy decisions, specific to each geographic region, to improve diabetes care and decrease the negative impact diabetes has on the public health system.
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Affiliation(s)
- Marília B Gomes
- Unit of Diabetes, Universidade Estadual do Rio de Janeiro, Avenida 28 de Setembro, 77, 3o andar, CEP 20.551-030, Rio de Janeiro, Brazil
| | - Roberta A Cobas
- Unit of Diabetes, Universidade Estadual do Rio de Janeiro, Avenida 28 de Setembro, 77, 3o andar, CEP 20.551-030, Rio de Janeiro, Brazil
| | - Alessandra S Matheus
- Unit of Diabetes, Universidade Estadual do Rio de Janeiro, Avenida 28 de Setembro, 77, 3o andar, CEP 20.551-030, Rio de Janeiro, Brazil
| | - Lucianne R Tannus
- Unit of Diabetes, Universidade Estadual do Rio de Janeiro, Avenida 28 de Setembro, 77, 3o andar, CEP 20.551-030, Rio de Janeiro, Brazil
| | - Carlos Antonio Negrato
- Unit of Diabetes, Universidade Estadual do Rio de Janeiro, Avenida 28 de Setembro, 77, 3o andar, CEP 20.551-030, Rio de Janeiro, Brazil
| | - Melanie Rodacki
- Unit of Diabetes, Universidade Estadual do Rio de Janeiro, Avenida 28 de Setembro, 77, 3o andar, CEP 20.551-030, Rio de Janeiro, Brazil
| | - Neuza Braga
- Unit of Diabetes, Universidade Estadual do Rio de Janeiro, Avenida 28 de Setembro, 77, 3o andar, CEP 20.551-030, Rio de Janeiro, Brazil
| | - Marilena M Cordeiro
- Unit of Diabetes, Universidade Estadual do Rio de Janeiro, Avenida 28 de Setembro, 77, 3o andar, CEP 20.551-030, Rio de Janeiro, Brazil
| | - Jorge L Luescher
- Unit of Diabetes, Universidade Estadual do Rio de Janeiro, Avenida 28 de Setembro, 77, 3o andar, CEP 20.551-030, Rio de Janeiro, Brazil
| | - Renata S Berardo
- Unit of Diabetes, Universidade Estadual do Rio de Janeiro, Avenida 28 de Setembro, 77, 3o andar, CEP 20.551-030, Rio de Janeiro, Brazil
| | - Marcia Nery
- Unit of Diabetes, Universidade Estadual do Rio de Janeiro, Avenida 28 de Setembro, 77, 3o andar, CEP 20.551-030, Rio de Janeiro, Brazil
| | - Maria do Carmo Arruda-Marques
- Unit of Diabetes, Universidade Estadual do Rio de Janeiro, Avenida 28 de Setembro, 77, 3o andar, CEP 20.551-030, Rio de Janeiro, Brazil
| | - Luiz E Calliari
- Unit of Diabetes, Universidade Estadual do Rio de Janeiro, Avenida 28 de Setembro, 77, 3o andar, CEP 20.551-030, Rio de Janeiro, Brazil
| | - Renata M Noronha
- Unit of Diabetes, Universidade Estadual do Rio de Janeiro, Avenida 28 de Setembro, 77, 3o andar, CEP 20.551-030, Rio de Janeiro, Brazil
| | - Thais D Manna
- Unit of Diabetes, Universidade Estadual do Rio de Janeiro, Avenida 28 de Setembro, 77, 3o andar, CEP 20.551-030, Rio de Janeiro, Brazil
| | - Lenita Zajdenverg
- Unit of Diabetes, Universidade Estadual do Rio de Janeiro, Avenida 28 de Setembro, 77, 3o andar, CEP 20.551-030, Rio de Janeiro, Brazil
| | - Roberta Salvodelli
- Unit of Diabetes, Universidade Estadual do Rio de Janeiro, Avenida 28 de Setembro, 77, 3o andar, CEP 20.551-030, Rio de Janeiro, Brazil
| | - Fernanda G Penha
- Unit of Diabetes, Universidade Estadual do Rio de Janeiro, Avenida 28 de Setembro, 77, 3o andar, CEP 20.551-030, Rio de Janeiro, Brazil
| | - Milton C Foss
- Unit of Diabetes, Universidade Estadual do Rio de Janeiro, Avenida 28 de Setembro, 77, 3o andar, CEP 20.551-030, Rio de Janeiro, Brazil
| | - Maria C Foss-Freitas
- Unit of Diabetes, Universidade Estadual do Rio de Janeiro, Avenida 28 de Setembro, 77, 3o andar, CEP 20.551-030, Rio de Janeiro, Brazil
| | - Antonio C Pires
- Unit of Diabetes, Universidade Estadual do Rio de Janeiro, Avenida 28 de Setembro, 77, 3o andar, CEP 20.551-030, Rio de Janeiro, Brazil
| | - Fernando C Robles
- Unit of Diabetes, Universidade Estadual do Rio de Janeiro, Avenida 28 de Setembro, 77, 3o andar, CEP 20.551-030, Rio de Janeiro, Brazil
| | - MariadeFátimaS Guedes
- Unit of Diabetes, Universidade Estadual do Rio de Janeiro, Avenida 28 de Setembro, 77, 3o andar, CEP 20.551-030, Rio de Janeiro, Brazil
| | - Sergio A Dib
- Unit of Diabetes, Universidade Estadual do Rio de Janeiro, Avenida 28 de Setembro, 77, 3o andar, CEP 20.551-030, Rio de Janeiro, Brazil
| | - Patricia Dualib
- Unit of Diabetes, Universidade Estadual do Rio de Janeiro, Avenida 28 de Setembro, 77, 3o andar, CEP 20.551-030, Rio de Janeiro, Brazil
| | - Saulo C Silva
- Unit of Diabetes, Universidade Estadual do Rio de Janeiro, Avenida 28 de Setembro, 77, 3o andar, CEP 20.551-030, Rio de Janeiro, Brazil
| | - Janice Sepulvida
- Unit of Diabetes, Universidade Estadual do Rio de Janeiro, Avenida 28 de Setembro, 77, 3o andar, CEP 20.551-030, Rio de Janeiro, Brazil
| | - Henriqueta G Almeida
- Unit of Diabetes, Universidade Estadual do Rio de Janeiro, Avenida 28 de Setembro, 77, 3o andar, CEP 20.551-030, Rio de Janeiro, Brazil
| | - Emerson Sampaio
- Unit of Diabetes, Universidade Estadual do Rio de Janeiro, Avenida 28 de Setembro, 77, 3o andar, CEP 20.551-030, Rio de Janeiro, Brazil
| | - Rosangela Rea
- Unit of Diabetes, Universidade Estadual do Rio de Janeiro, Avenida 28 de Setembro, 77, 3o andar, CEP 20.551-030, Rio de Janeiro, Brazil
| | - Ana Cristina R Faria
- Unit of Diabetes, Universidade Estadual do Rio de Janeiro, Avenida 28 de Setembro, 77, 3o andar, CEP 20.551-030, Rio de Janeiro, Brazil
| | - Balduino Tschiedel
- Unit of Diabetes, Universidade Estadual do Rio de Janeiro, Avenida 28 de Setembro, 77, 3o andar, CEP 20.551-030, Rio de Janeiro, Brazil
| | - Suzana Lavigne
- Unit of Diabetes, Universidade Estadual do Rio de Janeiro, Avenida 28 de Setembro, 77, 3o andar, CEP 20.551-030, Rio de Janeiro, Brazil
| | - Gustavo A Cardozo
- Unit of Diabetes, Universidade Estadual do Rio de Janeiro, Avenida 28 de Setembro, 77, 3o andar, CEP 20.551-030, Rio de Janeiro, Brazil
| | - Mirela J Azevedo
- Unit of Diabetes, Universidade Estadual do Rio de Janeiro, Avenida 28 de Setembro, 77, 3o andar, CEP 20.551-030, Rio de Janeiro, Brazil
| | - Luis Henrique Canani
- Unit of Diabetes, Universidade Estadual do Rio de Janeiro, Avenida 28 de Setembro, 77, 3o andar, CEP 20.551-030, Rio de Janeiro, Brazil
| | - Alessandra T Zucatti
- Unit of Diabetes, Universidade Estadual do Rio de Janeiro, Avenida 28 de Setembro, 77, 3o andar, CEP 20.551-030, Rio de Janeiro, Brazil
| | - Marisa Helena C Coral
- Unit of Diabetes, Universidade Estadual do Rio de Janeiro, Avenida 28 de Setembro, 77, 3o andar, CEP 20.551-030, Rio de Janeiro, Brazil
| | - Daniela Aline Pereira
- Unit of Diabetes, Universidade Estadual do Rio de Janeiro, Avenida 28 de Setembro, 77, 3o andar, CEP 20.551-030, Rio de Janeiro, Brazil
| | - Luiz Antonio Araujo
- Unit of Diabetes, Universidade Estadual do Rio de Janeiro, Avenida 28 de Setembro, 77, 3o andar, CEP 20.551-030, Rio de Janeiro, Brazil
| | - Monica Tolentino
- Unit of Diabetes, Universidade Estadual do Rio de Janeiro, Avenida 28 de Setembro, 77, 3o andar, CEP 20.551-030, Rio de Janeiro, Brazil
| | - Hermelinda C Pedrosa
- Unit of Diabetes, Universidade Estadual do Rio de Janeiro, Avenida 28 de Setembro, 77, 3o andar, CEP 20.551-030, Rio de Janeiro, Brazil
| | - Flaviane A Prado
- Unit of Diabetes, Universidade Estadual do Rio de Janeiro, Avenida 28 de Setembro, 77, 3o andar, CEP 20.551-030, Rio de Janeiro, Brazil
| | - Nelson Rassi
- Unit of Diabetes, Universidade Estadual do Rio de Janeiro, Avenida 28 de Setembro, 77, 3o andar, CEP 20.551-030, Rio de Janeiro, Brazil
| | - Leticia B Araujo
- Unit of Diabetes, Universidade Estadual do Rio de Janeiro, Avenida 28 de Setembro, 77, 3o andar, CEP 20.551-030, Rio de Janeiro, Brazil
| | - Reine Marie C Fonseca
- Unit of Diabetes, Universidade Estadual do Rio de Janeiro, Avenida 28 de Setembro, 77, 3o andar, CEP 20.551-030, Rio de Janeiro, Brazil
| | - Alexis D Guedes
- Unit of Diabetes, Universidade Estadual do Rio de Janeiro, Avenida 28 de Setembro, 77, 3o andar, CEP 20.551-030, Rio de Janeiro, Brazil
| | - Odelissa S Matos
- Unit of Diabetes, Universidade Estadual do Rio de Janeiro, Avenida 28 de Setembro, 77, 3o andar, CEP 20.551-030, Rio de Janeiro, Brazil
| | - Manuel Faria
- Unit of Diabetes, Universidade Estadual do Rio de Janeiro, Avenida 28 de Setembro, 77, 3o andar, CEP 20.551-030, Rio de Janeiro, Brazil
| | - Rossana Azulay
- Unit of Diabetes, Universidade Estadual do Rio de Janeiro, Avenida 28 de Setembro, 77, 3o andar, CEP 20.551-030, Rio de Janeiro, Brazil
| | - Adriana C Forti
- Unit of Diabetes, Universidade Estadual do Rio de Janeiro, Avenida 28 de Setembro, 77, 3o andar, CEP 20.551-030, Rio de Janeiro, Brazil
| | - Cristina Façanha
- Unit of Diabetes, Universidade Estadual do Rio de Janeiro, Avenida 28 de Setembro, 77, 3o andar, CEP 20.551-030, Rio de Janeiro, Brazil
| | - Ana Paula Montenegro
- Unit of Diabetes, Universidade Estadual do Rio de Janeiro, Avenida 28 de Setembro, 77, 3o andar, CEP 20.551-030, Rio de Janeiro, Brazil
| | - Renan Montenegro
- Unit of Diabetes, Universidade Estadual do Rio de Janeiro, Avenida 28 de Setembro, 77, 3o andar, CEP 20.551-030, Rio de Janeiro, Brazil
| | - Naira H Melo
- Unit of Diabetes, Universidade Estadual do Rio de Janeiro, Avenida 28 de Setembro, 77, 3o andar, CEP 20.551-030, Rio de Janeiro, Brazil
| | - Karla F Rezende
- Unit of Diabetes, Universidade Estadual do Rio de Janeiro, Avenida 28 de Setembro, 77, 3o andar, CEP 20.551-030, Rio de Janeiro, Brazil
| | - Alberto Ramos
- Unit of Diabetes, Universidade Estadual do Rio de Janeiro, Avenida 28 de Setembro, 77, 3o andar, CEP 20.551-030, Rio de Janeiro, Brazil
| | - João Sooares Felicio
- Unit of Diabetes, Universidade Estadual do Rio de Janeiro, Avenida 28 de Setembro, 77, 3o andar, CEP 20.551-030, Rio de Janeiro, Brazil
| | - Flavia M Santos
- Unit of Diabetes, Universidade Estadual do Rio de Janeiro, Avenida 28 de Setembro, 77, 3o andar, CEP 20.551-030, Rio de Janeiro, Brazil
| | - Deborah L Jezini
- Unit of Diabetes, Universidade Estadual do Rio de Janeiro, Avenida 28 de Setembro, 77, 3o andar, CEP 20.551-030, Rio de Janeiro, Brazil
| | - Marilena M Cordeiro
- Unit of Diabetes, Universidade Estadual do Rio de Janeiro, Avenida 28 de Setembro, 77, 3o andar, CEP 20.551-030, Rio de Janeiro, Brazil
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11
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Gomes MB, Coral M, Cobas RA, Dib SA, Canani LH, Nery M, de Freitas MCF, Faria M, Felício JS, da Silva SC, Pedrosa H, Costa e Forti A, Rea RR, Pires AC, Montenegro Junior R, Oliveira JE, Rassi N, Negrato CA. Prevalence of adults with type 1 diabetes who meet the goals of care in daily clinical practice: a nationwide multicenter study in Brazil. Diabetes Res Clin Pract 2012; 97:63-70. [PMID: 22397904 DOI: 10.1016/j.diabres.2012.02.008] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2011] [Revised: 02/02/2012] [Accepted: 02/12/2012] [Indexed: 12/21/2022]
Abstract
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.
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Affiliation(s)
- Marilia B Gomes
- Department of Internal Medicine, Diabetes Unit, State University Hospital of Rio de Janeiro, Brazil.
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12
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Gomes MB, Giannella-Neto D, Faria M, Tambascia M, Fonseca RM, Rea R, Macedo G, Modesto-Filho J, Schmid H, Bittencourt AV, Cavalcanti S, Rassi N, Pedrosa H, Dib SA. Estimating cardiovascular risk in patients with type 2 diabetes: a national multicenter study in Brazil. Diabetol Metab Syndr 2009; 1:22. [PMID: 19860912 PMCID: PMC2775723 DOI: 10.1186/1758-5996-1-22] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2009] [Accepted: 10/27/2009] [Indexed: 11/17/2022] Open
Abstract
UNLABELLED According to Brazilian National Data Survey diabetes is the fifth cause for hospitalization and is one of the ten major causes of mortality in this country. AIMS to stratify the estimated cardiovascular risk (eCVR) in a population of type 2 diabetics (T2DM) according to the Framingham prediction equations as well as to determine the association between eCVR with metabolic and clinical control of the disease. METHODS From 2000 to 2001 a cross-sectional multicenter study was conducted in 13 public out-patients diabetes/endocrinology clinics from 8 Brazilian cities. The 10-year risk of developing coronary heart disease (CHD) was estimated by the prediction equations described by Wilson et al (Circulation 1998). LDL equations were preferably used; when patients missed LDL data we used total cholesterol equations instead. RESULTS Data from 1382 patients (59.0% female) were analyzed. Median and inter-quartile range (IQ) of age and duration of diabetes were 57.4 (51-65) and 8.8 (3-13) years, respectively without differences according to the gender. Forty-two percent of these patients were overweight and 35.4% were obese (the prevalence of higher BMI and obesity in this T2DM group was significantly higher in women than in men; p < 0.001). The overall estimated eCVR in T2DM patients was 21.4 (13.5-31.3). The eCVR was high (> 20%) in 738 (53.4%), intermediate in 202 (14.6%) and low in 442 (32%) patients. Men [25.1(15.4-37.3)] showed a higher eCVR than women [18.8 (12.4-27.9) p < 0.001]. The most common risk factor was high LDL-cholesterol (80.8%), most frequently found in women than in men (p = 0.01). The median of risk factors present was three (2-4) without gender differences. Overall we observed that 60 (4.3%) of our patients had none, 154(11.1%) one, 310 (22.4%) two, 385 (27.9%) three, 300 (21.7%) four, 149 (10.5%) five and six, (2%) six risk factors. A higher eCVR was noted in overweight or obese patients (p = 0.01 for both groups). No association was found between eCVR with age or a specific type of diabetes treatment. A correlation was found between eCVR and duration of diabetes (p < 0.001), BMI (p < 0.001), creatinine (p < 0.001) and triglycerides levels (p < 0.001) but it was not found with HbA1c, fasting blood glucose and post-prandial glucose. A higher eCVR was observed in patients with retinopathy (p < 0.001) and a tendency in patients with microalbuminuria (p = 0.06). CONCLUSION our study showed that in this group of Brazilian T2DM the eCVR was correlated with the lipid profile and it was higher in patients with microvascular chronic complications. No correlation was found with glycemic control parameters. These data could explain the failure of intensive glycemic control programs aiming to reduce cardiovascular events observed in some studies.
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Affiliation(s)
- Marilia B Gomes
- Diabetes Unit. State University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Daniel Giannella-Neto
- Laboratory for Clinical and Experimental Gatroenterology - LIM07. Hospital das Clínicas. University of São Paulo Scholl of Medicine, São Paulo, Brazil
| | - Manuel Faria
- Division of Endocrinology, Federal University of Maranhão, São Luiz, Brazil
| | - Marcos Tambascia
- Division of Endocrinology, State University of Campinas, Campinas, Brazil
| | - Reine M Fonseca
- Centro de Estudos de Diabetes e Endocrinologia do Estado da Bahia (CEDEBA), Salvador, Brazil
| | - Rosangela Rea
- Division of Endocrinology, Federal University of Parana, Curitiba, Brazil
| | - Geisa Macedo
- Division of Endocrinology, Hospital Agamenon Magalhães, Recife, Brazil
| | | | - Helena Schmid
- Division of Endocrinology, Santa Casa de Porto Alegre, Porto Alegre, Brazil
| | - Alcina V Bittencourt
- Division of Endocrinology, Instituto de Assistência e Previdência do Servidor do Estado da Bahia, Salvador, Brazil
| | - Saulo Cavalcanti
- Diabetes Unit, Santa Casa de Belo Horizonte, Belo Horizonte, Brazil
| | - Nelson Rassi
- Division of Endocrinology, Hospital Geral de Goiânia, Goiás, Brazil
| | | | - Sergio A Dib
- Division of Endocrinology, Federal University of São Paulo, São Paulo, Brazil
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13
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Abstract
OBJECTIVE To evaluate the role of glycemic control in the development of cardiovascular disease (CVD) in type 1 diabetes mellitus (DM). METHODS We review the literature regarding coronary atherosclerosis, coronary artery calcification, and the epidemiologic studies related to the role of glycemia and the classic risk factors for coronary artery disease (CAD) in type 1 DM. RESULTS Four prospective studies (Wisconsin Epidemiologic Study of Diabetic Retinopathy, EURODIAB, Steno Diabetes Center Study of Adults With Type 1 DM, and Pittsburgh Epidemiology of Diabetes Complications study) do not show that glycemic control predicts CAD occurrence. Findings from the Diabetes Control and Complications Trial/Epidemiology of Diabetes Interventions and Complications study show that compared with conventional insulin therapy, intensive insulin therapy reduces CVD among patients with type 1 DM and is associated with lower prevalence of coronary artery calcification. The discrepancies between the findings from the Diabetes Control and Complications Trial/Epidemiology of Diabetes Interventions and Complications study and the Pittsburgh Epidemiology of Diabetes Complication study are likely due to differences between the study populations and the lower prevalence of renal disease in the former study. Besides duration of DM and albuminuria/overt nephropathy, insulin resistance is a major determinant of CAD associated with type 1 DM. CONCLUSIONS Discrepant study results regarding the relationship between glycemia and CAD/coronary artery calcification may be related to the prevalence of renal disease and the presence of the metabolic syndrome. Published data suggest that addressing traditional risk factors including albuminuria, the metabolic syndrome, and inflammatory markers is better for preventing and treating CAD than focusing exclusively on glycemic control, which is still necessary for preventing microvascular complications. Furthermore, there is a synergistic effect of glycemic control and albuminuria on the development of CVD.
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Affiliation(s)
- Bernardo Léo Wajchenberg
- Diabetes and Heart Center, Heart Institute, Hospital das Clinicas of the University of São Paulo Medical School, São Paulo, SP, Brazil.
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14
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Wajchenberg BL, Rassi N, Feitosa ACR, Lerário AC, Betti RTB. [Cardiovascular disease in type 1 diabetes mellitus]. ACTA ACUST UNITED AC 2009; 52:387-97. [PMID: 18438550 DOI: 10.1590/s0004-27302008000200027] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2008] [Accepted: 02/15/2008] [Indexed: 11/22/2022]
Abstract
The association between type 1 diabetes and coronary heart disease has become very clear since the late 1970. It has been demonstrated that there is an important increased risk in morbidity and mortality caused by coronary artery disease in young adults with type 1 diabetes compared with the non diabetic population. The underlying pathogeneses is still poorly understood. While the role of glycemic control in the development of microvascular disease complication is well established its role in CVD in patients with DM1 remains unclear with epidemiologic studies reporting conflicting data. Recent findings from the DCCT/EDIC showed that prior intensive diabetes treatment during the DCCT was associated with less atherosclerosis, largely because of reduced level of HbA1c during the DCCT. The improvement of glycemic control itself appeared to be particularly effective in younger patients with shorter duration of the disease. Other analyses suggested the glycemia may have a stronger effect on CAD in patients without than in those with albuminúria. Other major determinants of coronary artery disease are the components of metabolic syndrome and the surrogate measure of insulin resistence: eGDR. It is proposed that patients with DM1 should have aggressive medical therapy, risk factor modification and careful monitoring not only of his blood sugar but also of the other processes involved in the atherosclerotic process, mostly the ones with family history of type 2 diabetes.
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Affiliation(s)
- Bernardo Léo Wajchenberg
- Instituto do Coração, Hospital das Clínicas, Faculdade de Medicina, Universidade de São PauloSão Paulo, SP, Brasil
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DePaula AL, Macedo ALV, Rassi N, Machado CA, Schraibman V, Silva LQ, Halpern A. Laparoscopic treatment of type 2 diabetes mellitus for patients with a body mass index less than 35. Surg Endosc 2008; 22:706-16. [PMID: 17704886 DOI: 10.1007/s00464-007-9472-9] [Citation(s) in RCA: 127] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
BACKGROUND Type 2 diabetes mellitus (T2DM) is a common disease with numerous complications. Bariatric surgery is an efficient procedure for controlling T2DM in morbidly obese patients. In T2DM, the incretin effect is either greatly impaired or absent. This study aimed to evaluate the preliminary results from interposing a segment of ileum into the proximal jejunum associated with a sleeve or diverted sleeve gastrectomy to control T2DM in patients with a body mass index (BMI) less than 35 kg/m(2). METHODS For this study, 39 patients (16 women and 23 men) underwent two laparoscopic procedures comprising different combinations of ileal interposition into the proximal jejunum via a sleeve or diverted sleeve gastrectomy. The mean age of these patients was 50.3 years (range, 36-66 years). The mean BMI was 30.1 kg/m(2) (range, 23.4-34.9 kg/m(2)). All the patients had a diagnosis of T2DM that had persisted for at least 3 years and evidence of stable treatment with oral hypoglycemic agents or insulin for at least 12 months. The mean duration of T2DM was 9.3 years (range, 3-22 years). RESULTS The mean operative time was 185 min, and the median hospital stay was 4.3 days. Four major complications occurred in the short term (30-days), and the mortality rate was 2.6%. The mean postoperative follow-up period was 7 months (range, 4-16 months), and the mean percentage of weight loss was 22%. The mean postoperative BMI was 24.9 kg/m(2) (range, 18.9-31.7 kg/m(2)). An adequate glycemic control was achieved for 86.9% of the patients, and 13.1% had important improvement. The patients whose glycemia was not normalized were using a single oral hypoglycemic agent. No patient needed insulin therapy postoperatively. All the patients except experienced normalization of their cholesterol levels. Targeted triglycerides levels were achieved by 71% of the patients, and hypertension was controlled for 95.8%. CONCLUSIONS The laparoscopic ileal interposition via either a sleeve gastrectomy or diverted sleeve gastrectomy seems to be a promising procedure for the control of T2DM and the metabolic syndrome. A longer follow-up period is needed.
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Affiliation(s)
- A L DePaula
- Department of Surgery, Hospital de Especialidades, Goiânia, Brazil.
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16
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DePaula AL, Macedo ALV, Rassi N, Vencio S, Machado CA, Mota BR, Silva LQ, Halpern A, Schraibman V. Laparoscopic treatment of metabolic syndrome in patients with type 2 diabetes mellitus. Surg Endosc 2008; 22:2670-8. [PMID: 18347866 DOI: 10.1007/s00464-008-9808-0] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2007] [Revised: 01/11/2008] [Accepted: 01/24/2008] [Indexed: 02/06/2023]
Abstract
BACKGROUND Metabolic syndrome refers to risk factors for cardiovascular disease. Hyperglycemia is a critical component contributing to the predictive power of the syndrome. This study aimed to evaluate the results from the laparoscopic interposition of an ileum segment into the proximal jejunum for the treatment of metabolic syndrome in patients with type 2 diabetes mellitus and a body mass index (BMI) lower than 35. METHODS Laparoscopic procedures were performed for 60 patients (24 women and 36 men) with a mean age of 51.7 +/- 6.4 years (range, 27-66 years) and a mean BMI of 30.1 +/- 2.7 (range, 23.6-34.4). All the patients had a diagnosis of type 2 diabetes mellitus (T2DM) given at least 3 years previously and evidence of stable treatment using oral hypoglycemic agents, insulin, or both for at least 12 months. The mean duration of type 2 diabetes mellitus was 9.6 +/- 4.6 years (range, 3-22 years). Metabolic syndrome was diagnosed for all 60 patients. Arterial hypertension was diagnosed for 70% of the patients (mean number of drugs, 1.6) and hypertriglyceridemia for 70%. High-density lipoprotein was altered in 51.7% of the patients and the abdominal circumference in 68.3%. Two techniques were performed: ileal interposition (II) into the proximal jejunum and sleeve gastrectomy (II-SG) or ileal interposition associated with a diverted sleeve gastrectomy (II-DSG). RESULTS The II-SG procedure was performed for 32 patients and the II-DSG procedure for 28 patients. The mean postoperative follow-up period was 7.4 months (range, 3-19 months). The mean BMI was 23.8 +/- 4.1 kg/m(2), and 52 patients (86.7%) achieved adequate glycemic control. Hypertriglyceridemia was normalized for 81.7% of the patients. An high-density lipoprotein level higher than 40 for the men and higher than 50 for the women was achieved by 90.3% of the patients. The abdominal circumference reached was less than 102 cm for the men and 88 cm for the women. Arterial hypertension was controlled in 90.5% of the patients. For the control of metabolic syndrome, II-DSG was the more effective procedure. CONCLUSIONS Laparoscopic II-SG and II-DSG seem to be promising procedures for the control of the metabolic syndrome and type 2 diabetes mellitus. A longer follow-up period is needed.
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Gomes MDB, Gianella D, Faria M, Tambascia M, Fonseca RM, Réa R, Macedo G, Modesto Filho J, Schmid H, Bittencourt AV, Cavalcanti S, Rassi N, Pedrosa H, Atala Dib S. Prevalence of Type 2 diabetic patients within the targets of care guidelines in daily clinical practice: a multi-center study in Brazil. Rev Diabet Stud 2006; 3:82-7. [PMID: 17487331 PMCID: PMC1783582 DOI: 10.1900/rds.2006.3.82] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Major clinical studies have shown that the targets for blood glucose, lipid profile and blood pressure in type 2 diabetic patients are difficult to maintain in clinical practice. However, there are few data concerning South American populations. Using guidelines represented by the Brazilian Diabetes Society, we evaluated cardiovascular (CV) risk factors, glycemic control and the availability of screening for diabetes complications in 2233 (60% females) outpatients with type 2 diabetes aged 59.2 +/- 11.3 yr and with a known duration of diabetes of 9.2 +/- 7.2 yr, collected from 8 Brazilian cities. The outcome showed that less intensive clinical care available for diabetic patients in Brazil compared to western industrialized countries leads to widespread poor metabolic control and health status. Less than 30% of the patients reached the target for systolic (28.5%, < 130 mmHg) and diastolic (19.3%, < 80 mmHg) blood pressure, BMI (24.6%, < 25 kg/m2), LDL cholesterol (20.6%, < 2.6 mmol/l) and only 46% reached the goal for HbA1c (one % point above the upper limits of normality for the method used). Only 0.2% of patients reached all the targets. A lower number of women reached the targets for HbA1c, LDL and HDL cholesterol than men (p < 0.001). Women were less likely than men to have funduscopy examinations and urine albumin testing (p < 0.001). We conclude that the national goals for glycemic control, blood pressure and lipid levels are rarely achieved in clinical practice, and that the availability for diabetic complication screening is low. The quality of diabetes care, in particular for women, is poor and should be further reviewed in developing countries.
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Affiliation(s)
- Marilia de Brito Gomes
- Department of Medicine, Unit of Diabetes, State University Hospital of Rio de Janeiro, Brazil.
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18
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Gomes MDB, Giannella Neto D, Mendonça ED, Tambascia MA, Fonseca RM, Réa RR, Macedo G, Modesto Filho J, Schmid H, Bittencourt AV, Cavalcanti S, Rassi N, Faria M, Pedrosa H, Dib SA. Prevalência de sobrepeso e obesidade em pacientes com diabetes mellitus do tipo 2 no Brasil: estudo multicêntrico nacional. ACTA ACUST UNITED AC 2006; 50:136-44. [PMID: 16628286 DOI: 10.1590/s0004-27302006000100019] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
OBJETIVO: Avaliar a prevalência de sobrepeso e obesidade em pacientes ambulatoriais com diabetes mellitus tipo 2 (DM2) em diferentes regiões do Brasil. PACIENTES E MÉTODOS: Avaliamos aleatoriamente 2.519 pacientes em 11 hospitais, 2 ambulatórios especializados e um posto de saúde em 10 cidades brasileiras. Consideramos sobrepeso um índice de massa corporal (IMC) > 25 e obesidade um IMC > 30 kg/m². O controle glicêmico (CG) foi avaliado pelo índice de CG [ICG= HbA1 e ou HbA1c do paciente/limite superior de normalidade do método x 100]. RESULTADOS: Os pacientes tinham idade de 58,8 ± 11,6 anos, tempo de diagnóstico clínico de DM de 9,0 ± 7,3 anos, IMC de 28,3 ± 5,2 kg/m², e 39% eram do sexo masculino. Do total da amostra, 265 pacientes (10,5%) não apresentavam avaliação do IMC. Os pacientes da região Nordeste apresentaram menor IMC em comparação com os das regiões Centro-Oeste, Sudeste e Sul, respectivamente (26,4 ± 4,7 vs. 27,9 ± 4,8 vs. 29,2 ± 5,1 vs. 29,4 ± 5,4 kg/m²; p< 0,001). Houve maior prevalência de obesidade na região Sudeste e Sul em comparação à região Nordeste (p< 0,001) e nos pacientes do sexo feminino, respectivamente (69 vs. 31%; p< 0,001). Os pacientes com peso normal apresentaram menor ICG. Aqueles em tratamento com associação de duas ou mais drogas orais e associação de insulina + droga oral apresentaram maior IMC do que aqueles em tratamento com dieta, hipoglicemiante oral e insulina; p< 0,001. O IMC não diferiu entre os pacientes assistidos ou não por especialistas. CONCLUSÕES: Da população estudada, 75% não estava na faixa de peso ideal, sendo que um terço tinha obesidade. Nossos dados indicam que o sobrepeso e a obesidade já atingem um percentual de pacientes com DM2 no Brasil semelhante ao relatado em estudos europeus, mas ainda menor do que o observado nos EUA. A prevalência de obesidade nos pacientes diabéticos foi três vezes maior do que a observada na população brasileira em geral de acordo com os dados do IBGE.
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Malerbi D, Damiani D, Rassi N, Chacra AR, Niclewicz ED, Silva Filho RLD, Dib SA. Posição de consenso da Sociedade Brasileira de Diabetes: insulinoterapia intensiva e terapêutica com bombas de insulina. ACTA ACUST UNITED AC 2006; 50:125-35. [PMID: 16628285 DOI: 10.1590/s0004-27302006000100018] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Este artigo relata a posição de consenso da Sociedade Brasileira de Diabetes sobre a insulinoterapia intensiva e a terapêutica com bombas de infusão de insulina, obtida durante simpósio de atualização realizado especificamente para esta finalidade, em 2003. Estas modalidades de tratamento do diabetes são aqui conceituadas, seus fundamentos são colocados, e os aspectos práticos de indicações, exeqüibilidade, limites, técnicas e relação custo-benefício são analisados. As técnicas envolvem os esquemas de auto-monitorização glicêmica sugeridos e as doses, tipos, formas de administração da insulina e fatores de cálculo utilizados em cada modalidade de tratamento intensivo, tanto no DM1 quanto no DM2. O papel da SBD na implementação dos tratamentos intensivos do diabetes e a atuação dos vários profissionais envolvidos são discutidos e comentados. Conclui-se com as respostas de consenso a questões orientadoras do tema, formuladas na apresentação do simpósio.
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Abstract
The BB rat has a marked T cell lymphocytopenia, with a near absence of peripheral "helper" T cells recognized by monoclonal antibody W3/25 (W3/25+ T cells). The lymphocytes of the BB rat's spleen and thymus were examined for the presence of W3/25+ T cells, which were found to be absent in the spleen but present in normal amounts in the thymus. Concanavalin A (Con A) responsiveness was absent in the BB's peripheral blood and spleen but present in the thymus. Thus, in these three lymphoid compartments, Con A responsiveness directly correlated with the presence or absence of W3/25+ T cells. These lymphocyte abnormalities in the BB rat are notably different from lymphocyte changes present in human type I diabetes.
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Abstract
Approximately 50% of Wistar "BB" rats spontaneously develop overt diabetes mellitus characterized by loss of beta-cells and "insulitis." To define abnormalities of immunoregulation in these rats, we quantitated their major circulating lymphocyte subsets. Independent of the development of diabetes, we found the BB rats to have a markedly increased percentage of circulating B lymphocytes which is secondary to a severe T-cell lymphocytes which is secondary to a severe T-cell lymphocytopenia, with the major circulating T-cell subset reacting with monoclonal antibody W3/25 markedly decreased. This lymphocytopenia is present in every animal studied and contrasted with studies of the nondiabetic Wistar strain from which the "BB" rats were developed.
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