Angela M. O. Leal

Prevalência de diabetes melito e tolerância à glicose diminuída na população urbana de 30 a 79 anos da cidade de São Carlos, São Paulo

OBJECTIVE To assess the prevalence of diabetes mellitus (DM) and impaired glucose tolerance (IGT) in the urban population aged 30-79 years of the city of São Carlos, São Paulo, Brazil. METHODS It was performed a population survey, from August 2007 to June 2008. Non diabetic individuals, excluding pregnant women, and those with fasting capillary glycemia <or= 199 mg/dl were administered oral glucose tolerance test and classified as diabetic, with IGT or with normal glucose tolerance. RESULTS The number of individuals who participated in the study was 1,116. The overall rates of DM and IGT were 13.5% and 5%, respectively. DM and IGT were associated with age, education, body mass index and waist. They were not associated with gender, race or income. CONCLUSIONS The prevalence of DM has increased when compared with previous studies in Brazil and in the state. Improvement in the diagnosis has occurred, however, treatment requires optimization.

Prevalence of metabolic syndrome and its association with educational inequalities among Brazilian adults: a population-based study.

The present study estimated the prevalence of metabolic syndrome (MS) according to the criteria established by the National Cholesterol Education Program-Adult Treatment Panel III (NCEP-ATPIII) and the International Diabetes Federation (IDF) and analyzed the contribution of social factors in an adult urban population in the Southeastern region of Brazil. The sample plan was based on multistage probability sampling according to family head income and educational level. A random sample of 1116 subjects aged 30 to 79 years was studied. Participants answered a questionnaire about socio-demographic variables and medical history. Fasting capillary glucose (FCG), total cholesterol, high-density lipoprotein cholesterol (HDL-C), and triglycerides were determined and all non-diabetic subjects were submitted to the 75-g oral glucose tolerance test. Body mass index (BMI, kg/m(2)), waist circumference and blood pressure (BP) were determined. Age- and gender-adjusted prevalence of MS was 35.9 and 43.2% according to NCEP-ATPIII and IDF criteria, respectively. Substantial agreement was found between NCEP-ATPIII and IDF definitions. Low HDL-C levels and high BP were the most prevalent MS components according to NCEP-ATPIII criteria (76.3 and 59.2%, respectively). Considering the diagnostic criteria adopted, 13.5% of the subjects had diabetes and 9.7% had FCG ≥100 mg/dL. MS prevalence was significantly associated with age, skin color, BMI, and educational level. This cross-sectional population-based study in the Southeastern region of Brazil indicates that MS is highly prevalent and associated with an important social indicator, i.e., educational level. This result suggests that in developing countries health policy planning to reduce the risk of MS, in particular, should consider improvement in education.

Adrenocortical Hormones and Interleukin Patterns in Paracoccidioidomycosis

The functional status of adrenocortical hormones and their relationship to the pattern of inflammatory cytokines in paracoccidioidomycosis were investigated in a prospective study. Patients were evaluated before treatment and 1 and 6 months after receiving antifungal therapy. Interleukin (IL)-1beta, IL-6, and tumor necrosis factor-alpha plasma levels, C-reactive protein (CRP) concentrations, and erythrocyte sedimentation rate (ESR) were significantly higher in untreated patients than in control subjects. After 6 months of treatment, levels of the 3 cytokines, CRP concentrations, and the ESR decreased significantly. Both baseline and stimulated adrenocorticotropic hormone and cortisol plasma levels were not different between patients and control subjects. In contrast, adrenal androgen dehydroepiandrosterone sulfate (DHEA-S) plasma levels were significantly lower in patients than in sex- and age-matched control subjects. There was a significant inverse correlation between DHEA-S and IL-6 plasma levels. This finding may be of pathogenetic significance in this disease and in other inflammatory states.

Influence of type 2 diabetes on symbolic analysis and complexity of heart rate variability in men

BackgroundIndividuals with diabetes may develop cardiac autonomic dysfunction that may be evaluated by heart rate variability (HRV). The aim was evaluated heart rate variability (HRV) of individuals with type 2 diabetes, without cardiovascular autonomic neuropathy (CAN), in response to active postural maneuver by means of nonlinear analysis (symbolic analysis, Shannon and conditional entropy) and correlate HRV parameters between them, glycated hemoglobin and diabetes duration.MethodsNineteen men with type 2 diabetes without CAN (T2D) and nineteen healthy men (CG), age-range from 40 to 60 years were studied. We assessed HRV in supine and orthostatic position using symbolic analysis (0V%, 1V%, 2LV% and 2UV%), Shannon and conditional entropy (SE and NCI).ResultsIn supine position T2D presented higher sympathetic modulation (0V%) than CG. However, there was not any difference between groups for indexes of complexity (SE and NCI). Furthermore, T2D presented a preserved response of cardiac autonomic modulation after active postural maneuver.ConclusionsThe present study showed that individuals with type 2 diabetes without CAN presented higher cardiac sympathetic modulation. However, the complexity of HRV was not influenced by imbalance of the autonomic modulation in individuals with type 2 diabetes. In addition, the response of autonomic nervous system in the heart remains preserved after active postural maneuver in individuals with type 2 diabetes, possibly due to the lack of CAN in this group.

Adrenocortical hormones and interleukin patterns in leprosy.

The functional status of adrenocortical hormones and their relationship to the pattern of inflammatory cytokines in the lepromatous and tuberculoid poles of leprosy were investigated. Interleukin (IL)‐1β, IL‐6 and tumour necrosis factor (TNF)‐α plasma levels, C‐reactive protein (CRP) concentrations and erythrocyte sedimentation rates (ESR) were significantly higher in LL/BL (lepromatous) leprosy patients than in control subjects. There was a significant positive correlation between IL‐6 and TNF‐α plasma levels and ESR and CRP concentrations. IL‐1β was positively correlated with ESR but not with CRP. Both baseline and stimulated adrenocorticotropic hormone and cortisol plasma levels were not different between patients and control subjects. In contrast, adrenal androgen dehydroepiandrosterone sulphate (DHEA‐S) plasma levels were significantly lower in leprosy patients than in sex‐matched control subjects. There was a significant inverse correlation between DHEA‐S and IL‐6, TNF‐α, and CRP concentrations. This finding may be of pathogenetic significance in this disease and in other inflammatory states.

Qualidade da informação sobre diabéticos e hipertensos registrada no Sistema HIPERDIA em São Carlos-SP, 2002-2005

O objetivo deste estudo foi analisar a qualidade da informacao sobre diabeticos e hipertensos registrada no Sistema HIPERDIA, na cidade de Sao Carlos, Sao Paulo, no periodo de 2002 a 2005. Foram analisados, descritiva e sequencialmente, todos os 2.662 cadastros, no Sistema HIPERDIA, realizados no periodo de 1o/6/2002 a 31/12/2005. Sobrepeso/obesidade foi assinalado em 63% dos cadastros, mas quando o indice de massa corporal foi calculado, estava presente em 79,4% deles. Do total, 21% dos cadastros nao possuiam registro de medida da cintura. Em 34% dos cadastros havia registro apenas de glicemia capilar de jejum e em 82% destes, os valores eram > 110mg/dl. Em 48% dos cadastros havia registro apenas de glicemia capilar pos-prandial e em 67% destes, os valores eram > 140mg/dl. Doenca renal, pe diabetico, amputacao por diabetes e doencas cardiovasculares foram assinalados em apenas 9,6%, 5,1%, 2,4% e 32,3% dos formularios, respectivamente. Nao ha informacoes relativas a retinopatia e neuropatia diabeticas, como exames de fundo de olho e de sensibilidade de membros inferiores. Adicionalmente, nao ha registros de hemoglobina glicosilada, excrecao urinaria de albumina ou eletrocardiograma. Os dados sugerem ausencia, imprecisao e contradicao de importantes informacoes sobre diabeticos e hipertensos e apontam a necessidade de capacitacao profissional e de utilizacao de criterios clinico-laboratoriais para a caracterizacao das complicacoes cronicas decorrentes do DM e hipertensao arterial registradas no Sistema HIPERDIA. As deficiencias encontradas podem levar ao subdimensionamento epidemiologico dessas doencas na populacao brasileira e comprometer o planejamento de estrategias destinadas a prevencao e controle dessas doencas.

Pituitary-gonadal hormones and interleukin patterns in leprosy.

The functional status of pituitary–gonadal hormones and their relationship to the pattern of inflammatory cytokines in the lepromatous (LL/BL) and tuberculoid (TT/BT) poles of leprosy were investigated. Gonadotropins [luteinizing hormone (LH) and follicle‐stimulating hormone (FSH)], interleukin (IL)‐1β, IL‐6, tumour necrosis factor (TNF)‐α and C‐reactive protein (CRP) concentrations and erythrocyte sedimentation rate (ESR) were significantly higher in LL/BL leprosy patients than in controls and were not different from controls in TT/BT patients. LH and FSH were positively correlated with IL‐1β, IL‐6 and TNF‐α, and CRP concentrations and ESR. Testosterone plasma levels were significantly decreased in LL/BL patients and not different in TT/BT patients compared with controls. In addition, testosterone levels were inversely correlated with IL‐6 and TNF‐α. Prolactin plasma levels of both LL/BL and TT/BT patients were not different when compared with those of controls. There was a significant positive correlation between IL‐6 and TNF‐α plasma levels and ESR and CRP concentrations. IL‐1β was positively correlated with ESR but not with CRP. The significant correlations between gonadotropins and testosterone and cytokines in leprosy patients suggest that cytokines may have a direct influence at testicular level and may be of pathogenetic significance in leprosy and in other inflammatory states involving reproductive dysfunction.

Testicular function in patients with type 1 diabetes treated with high-dose CY and autologous hematopoietic SCT

Testicular function in patients with type 1 diabetes treated with high-dose CY and autologous hematopoietic SCT

Effect of physical training on liver expression of activin A and follistatin in a nonalcoholic fatty liver disease model in rats

Nonalcoholic fatty liver disease (NAFLD) is characterized by fat accumulation in the liver and is associated with obesity and insulin resistance. Activin A is a member of the transforming growth factor beta (TGF)-β superfamily and inhibits hepatocyte growth. Follistatin antagonizes the biological actions of activin. Exercise is an important therapeutic strategy to reduce the metabolic effects of obesity. We evaluated the pattern of activin A and follistatin liver expression in obese rats subjected to swimming exercise. Control rats (C) and high-fat (HF) diet-fed rats were randomly assigned to a swimming training group (C-Swim and HF-Swim) or a sedentary group (C-Sed and HF-Sed). Activin βA subunit mRNA expression was significantly higher in HF-Swim than in HF-Sed rats. Follistatin mRNA expression was significantly lower in C-Swim and HF-Swim than in either C-Sed or HF-Sed animals. There was no evidence of steatosis or inflammation in C rats. In contrast, in HF animals the severity of steatosis ranged from grade 1 to grade 3. The extent of liver parenchyma damage was less in HF-Swim animals, with the severity of steatosis ranging from grade 0 to grade 1. These data showed that exercise may reduce the deleterious effects of a high-fat diet on the liver, suggesting that the local expression of activin-follistatin may be involved.

Stem cell therapy for diabetes mellitus

In this review, we present (1) a brief discussion of hematopoietic stem cell transplantation (HSCT) for severe and refractory autoimmune diseases (AIDs) from its beginning in 1996 through recently initiated prospective randomized clinical trials; (2) an update (up to July 2009) of clinical and laboratory outcomes of 23 patients with newly diagnosed type 1 diabetes mellitus (T1DM), who underwent autologous HSCT at the Bone Marrow Transplantation Unit of the Ribeirão Preto Medical School, University of São Paulo, Brazil; (3) a discussion of possible mechanisms of action of HSCT in AIDs, including preliminary laboratory data obtained from our patients; and (4) a discussion of future perspectives of stem cell therapy for T1DM and type 2 DM, including the use of stem cell sources other than adult bone marrow and the combination of cell therapy with regenerative compounds.