Edna F. Cunha

Prevalência de sobrepeso e obesidade em pacientes com diabetes tipo 1

To evaluate the prevalence of overweight and obesity in type 1 diabetes (DM1), we studied 170 subjects (89F/81M, 14 children, 51 adolescents and 105 adults, mean age 24.4±11.9y) and correlated anthropometric data with demographic and clinical factors. The prevalence of obesity, overweight and/or overweight risk was 21.2% (n= 36). Among children and adolescents BMI z score and BMI percentile were highly correlated (r= 0.97; p= 0.00). SBP (p= 0.004) and DBP (p= 0.0007) were different between patients with normal and high BMI. A trend for increase waist circumference (WC) was observed in the groups with different BP (p= 0.0000). By multivariate analysis BMI was age-dependent (OR: 1.04, 95% CI = 1.01-1.07; p= 0.008). Using stepwise analysis SBP was dependent of WC (r= 0.57; p= 0.00) and age (r= 0.63; p= 0.00) and DBP was dependent of WC (r= 0.53; p= 0.00). The prevalence of overweight and obesity seems to reflect the global tendency of weight excess and their clinical outcomes. Awareness of overweight in DM1 needs to be intensified.

Fatores de risco para o desenvolvimento de diabetes mellitus pós-transplante renal

We evaluated retrospectively 34 patients with post-kidney transplant diabetes (PTDM) (group 1) and 68 submitted to renal transplant without PTDM (group 0) to determine the prevalence and risk factors for developing PTDM in patients followed at the Hospital Universitario Pedro Ernesto. The prevalence of PTDM was 7.4%. Group 1 patients were older at data collection (p<0.005) and at transplantation (p<0.005). Among them there was a higher frequency of cadaver donors (p= 0.023) and hypercholesterolemia (p= 0.006), and a lower frequency of arterial hypertension (p<0.0001). We observed a trend to higher frequency of positive sorology for C hepatitis (p= 0.057) and use of tacrolimus (p= 0.069) in group 1 as compared to group 0. The most important risk factors for developing PTDM (by logistic regression) were the age at renal transplant [OR= 1.099, IC 95% (1.045-1.156), p= 0.0001] and positive sorology for C hepatitis [OR= 3.338, IC 95% (1.205-9.248), p= 0.020]. We conclude that the prevalence of PTDM in our hospital was similar to that found in the literature and that the patients who developed PTDM presented a higher prevalence of traditional risk factors for PTDM, like older age and positive C virus hepatitis sorology, comparing to controls.

Evolução para hipertensão arterial em pacientes com diabetes tipo 1

PURPOSE Check the evolution of type 1(T1) diabetic patients to hypertension and prehypertension and baseline factors related to final blood pressure levels (BP). METHODS Observational study involving 127 T1 diabetic patients submitted to clinical and laboratory evaluation and followed by for 5 (2.4-9.2) years. RESULTS From the initially normotensive patients, 21.7% developed prehypertension, 4.7% developed hypertension and 73.6% remained with normal BP. From the prehypertensive patients, 35% returned to normal BP, 50% remained prehypertensive and 15% developed hypertension. The relative risk for hypertension development was 3.2 (0.8-12.3) in the prehypertensive compared to the normotensive group. The prevalence of prehypertension and hypertension increased from 15.7% to 26% and 0.8% to 7% respectively. Levels of serum creatinine predicted final levels of systolic and diastolic BP. CONCLUSION It is emphasized the importance of renal function and BP evaluation even when they are in normal range to minimize the deleterious effects of hypertension in the development of nephropathy and cardiovascular disease.

Infecção diagnosticada em diabéticos durante internação hospitalar

BACKGROUND. To analyse the infectious diseases of inpatient diabetics in a general hospital. MATERIAL AND METHODS. We selected retrospectively 233 records of diabetics admitted during September, October and November 1990. There were 38 (16.3%) patients with infection, age 58.9 ± 15.3 years, 29 (76.3%) were female, duration of diabetes were 10.8 ± 9.1 years and 86.3% (n = 33) were possibly DM type II. RESULTS. Peripheral macrovascular disease was the main cause of admission (42%). Forty infectious processes were analysed (two patients had two sites of infection). Cultures were performed in 77.5% of the cases and no microorganism predominated, even when different sites of infection were analysed. Urinary tract infection were the most frequent one (55%, n = 22), and 86.4% (n = 19) of them were observed in female. Pulmonary infections accounted for 71.4% of the cases of sepsis which occurred in 18.4% (n = 7) of our population. All patients with sepsis died. CONCLUSION. Considering infections a worsening factor for diabetic patients we could conclude that it is important to perform some prophylatic measures to avoid them.BACKGROUND To analyse the infectious diseases of inpatient diabetics in a general hospital. MATERIAL AND METHODS We selected retrospectively 233 records of diabetics admitted during September, October and November 1990. There were 38 (16.3%) patients with infection, age 58.9 +/- 15.3 years, 29 (76.3%) were female, duration of diabetes were 10.8 +/- 9.1 years and 86.3% (n = 33) were possibly DM type II. RESULTS Peripheral macrovascular disease was the main cause of admission (42%). Forty infectious processes were analysed (two patients had two sites of infection). Cultures were performed in 77.5% of the cases and no microorganism predominated, even when different sites of infection were analysed. Urinary tract infection were the most frequent one (55%, n = 22), and 86.4% (n = 19) of them were observed in female. Pulmonary infections accounted for 71.4% of the cases of sepsis which occurred in 18.4% (n = 7) of our population. All patients with sepsis died. CONCLUSION Considering infections a worsening factor for diabetic patients we could conclude that it is important to perform some prophylatic measures to avoid them.BACKGROUND. To analyse the infectious diseases of inpatient diabetics in a general hospital. MATERIAL AND METHODS. We selected retrospectively 233 records of diabetics admitted during September, October and November 1990. There were 38 (16.3%) patients with infection, age 58.9 ± 15.3 years, 29 (76.3%) were female, duration of diabetes were 10.8 ± 9.1 years and 86.3% (n = 33) were possibly DM type II. RESULTS. Peripheral macrovascular disease was the main cause of admission (42%). Forty infectious processes were analysed (two patients had two sites of infection). Cultures were performed in 77.5% of the cases and no microorganism predominated, even when different sites of infection were analysed. Urinary tract infection were the most frequent one (55%, n = 22), and 86.4% (n = 19) of them were observed in female. Pulmonary infections accounted for 71.4% of the cases of sepsis which occurred in 18.4% (n = 7) of our population. All patients with sepsis died. CONCLUSION. Considering infections a worsening factor for diabetic patients we could conclude that it is important to perform some prophylatic measures to avoid them.

Diabetes melito do tipo 1A na primeira infância de gêmeos dizigóticos: associação entre fatores genéticos e ambientais

The onset of type 1A diabetes before the first year of age is a rare condition and is probably due to an interaction between genetic and environmental factors (infection), which, together, may explain such an early event. Studies say that about 15% of newly diagnosed type 1 diabetic patients had human Cytomegalovirus (CMV) specific viral genome in their lymphocytes. We report two cases of dizygotic twins with type 1 diabetes onset in their first 9 months of age, with genetic homogeneity (for HLA DR3/DR4 alleles), a history of CMV infection (positive IgG and urinary PCR) and positive antibody anti-GAD (9.6 UI/ml), present only in the second twin. Although they were dizygotic twins, which concordance rate is 3.8%, they assume the equivalent risk as monozygotic (40%) as they have similar high risk genotype (HLA) for type 1 diabetes. We believe that both time concordance and also the early onset of diabetes are due to an association between infection and the high genetic liability.

Inter-relação de variáveis demográficas, terapêutica insulínica e controle glicêmico em pacientes com diabetes mellitus do tipo 1 atendidos em um hospital universitário

To evaluate the relationship between demographic variables, insulin therapy and glycemic control in type 1 diabetes mellitus (DM1), we studied 86 patients (44 F/ 42 M), aged 21.7±10 years: 10 (l 1.6%) pre-pubertal, 22 (25.6%) pubertal and 54 (62.8%) adults, with DM duration of 8.6+7.1 y and age at diagnosis of 13.2±8.5y. The number of clinic visits was 3.6±2.2 per year, with no association with gender, race and Tanner stage. Total insulin dose was 0.9±0.4 U/kg/day: 72 (83.7%) of the patients were using two daily injections; 39 (45.3%) were on fastacting insulin with 36 (92.3%) of them combined with a morning dose of intermediate- acting insulin. Multiple regression analysis showed that only HbA1C had influenced the insulin dose (r=0.45; r2=0.21; p<0.001). HbA1C was 8.4±1.9%, with higher leveis in stage 4 as compared to stages 1, 2, 3 and 5, respectively (10.5±2.4 vs 7.6±1.4 vs 8.9±2.1 vs. 8.3±2.4 vs 8.2±1.8%; p= 0.02). Pubertal females had higher HbAlc and BMI than males: 10.5±2.5 vs 8.3±2.0%; p= 0.02) and 19.4±1.9 vs 18.3±2.2 kg/m2 (p= 0.04), respectively. Glycemic control was considered good in 43 (50%) and poor in 27 (31.4%) patients. In conclusion, glycemic control in this study sample had worsened at the end of puberty, independent of the number of clinic visits and of all demographic variables analysed.The high number of patients with poor control must also be considered.

Variabilidade intra-individual do controle glicêmico em pacientes com diabetes tipo 1

OBJETIVO: Avaliar a variabilidade do controle glicemico em pacientes com diabetes tipo1 (DM1) em acompanhamento ambulatorial. PACIENTES E METODOS: Foram estudados 100 pacientes com DM1 (55 do sexo feminino), com idade de 18,6±9 anos, idade de diagnostico de 12 anos (1-35) e duracao do diabetes de 5 anos (0,09-40), com tempo de seguimento de 4,3 anos (2-8,5). A HbA1c foi determinada por cromatografia de troca ionica (valor de referencia: 2,4-6,2%). RESULTADOS: Foram analisados os dados de 94 pacientes. A HbA1c inicial e final foi de 7,6±1,8% e 8,7±2,1, com aumento absoluto de 1,1% (-7; 7,2) e anual de 0,22% (-3,5; 3,6). A HbA1c permaneceu inalterada em 2 pacientes (2,1%), aumentou em 64 (68,1%) e diminuiu em 28 (29,8%). Do grupo geral, 48 pacientes (51,1%) tiveram deterioracao, 12 (12,8%) melhora, 21 (22,3%) permaneceram com controle bom ou excelente e 13 (13,8%) com controle glicemico regular ou pessimo. O numero de HbA1c realizadas no acompanhamento foi de 6 (3-10) por paciente. Houve diferenca significativa quanto ao numero de HbA1c realizadas entre o grupo que apresentou piora no controle glicemico (7,2±2,1) e o que manteve controle regular ou pessimo (4,7±1) (p=0,003). A diferenca intra-individual entre a maior e a menor HbA1c foi de 3,1% (0,3-9,5). O coeficiente de variacao e o desvio padrao da HbA1c foi de 15,5±8,1 e 1,2±0,7%, respectivamente, sendo menor nos pacientes que mantiveram controle excelente ou bom. A correlacao entre a HbA1c final e a inicial foi de r= 0,37 (p=0,000) e entre a HbA1c media durante o estudo e a inicial foi r= 0,71 (p=0,000). CONCLUSAO: A maioria dos pacientes desta amostra apresentou piora do controle glicemico durante acompanhamento ambulatorial de rotina havendo tambem grande variabilidade intra-individual do controle glicemico. A HbA1c inicial do paciente mostrou-se um importante preditor do controle glicemico.

Microalbuminúria em pacientes diabéticos tipo 1: prevalência e fatores associados

To evaluate the frequency of microalbuminuria and associated clinical and metabolic features, we studied 72 type 1 diabetic subjects [DM1, 38F/34M; 6 children, 17 adolescents and 49 adults; aged 22.7±9.5 years and with DM duration of 7 years (0.1-37.5)]. Urinary albumin excretion rate (AER) was determined in timed overnight urine samples by RIA. Microalbuminuria was defined when 2 out of 3 urine samples had AER in the range of 20-200mg/min. Microalbuminuria was present in 25% of our patients (16 adults and 2 adolescents), who were older (27.3±5.8 vs 20.9±10.1 years, p<0.001), had a longer DM duration [11.0 (0.1-17.0) vs 5.9 (1.0-37.5) years, p<0.05], higher body mass index (22.7±2.6 vs 20.8±3.1, p<0.05), urea (32.4±7.8 vs 28.3±5.9mg/dl, p<0.05) and creatinine [0.7 (0.6-1.2) vs 0.6 (0.4-1.1) mg/dl, p<0.05] than normoalbuminuric. Microalbuminuria was associated with retinopathy (p<0.05). Stepwise multiple regression analysis showed that age was the only independent predictive variable of AER (r2= 0.13, p<0.05). In conclusion, age was an independent factor associated with AER. Even though microalbuminuria was not observed in children in our sample, screening in this age group should be decided by each diabetes center according to their objectives.

Glicemic control in prepubertal and pubertal patients with diabetes type 1 - a one year ambulatory follow-up

Objetivo: Avaliar o controle glicemico de pacientes com diabetes mellitus tipo1 em acompanhamento ambulatorial durante 1998. Pacientes e Metodos: Foram estudados 38 pacientes [12 pre-puberes (31,6%) e 26 puberes (68,4%)], 22 do sexo masculino, com idade de 10,9 ± 4,1 anos, idade de diagnostico de 7,2 ± 4,7 anos e duracao do diabetes de 3,7 ± 3,4 anos. A hemoglobina glicosilada (HbA1c) foi determinada por cromatografia liquida (L-9100 Merck Hitachi, valor de referencia: 2,6 a 6,2%). Resultado: A HbA1c foi de 8,04 ± 2,4 %, sem associacao com sexo e puberdade. Durante o acompanhamento, dos 27 pacientes com pelo menos duas determinacoes de HbA1c , 8 pacientes (29,6%) apresentaram alteracao e 19 (70,4%) permaneceram com o mesmo grau de controle glicemico. Destes, 3 (11,1%) permaneceram em controle pessimo e 16 (59,3%) em bom controle, dos quais 4 pacientes (25%) mantiveram sempre a HbA1c nos valores de referencia do metodo, 7 (43,75%) tiveram pelo menos uma HbA1c nesses niveis e 5 (31,25%) mantiveram todas as HbA1c em niveis superiores. O controle glicemico final nao foi associado com o numero de determinacoes de HbA1c. O coeficiente de variacao intraindividual da HbA1c no grupo com pelo menos tres determinacoes de HbA1c foi de 11,2 ± 5,6% (P = 0,0000). Conclusao: Apesar de a maioria dos pacientes apresentar um controle glicemico adequado durante o acompanhamento anual, apenas 4 pacientes mantiveram a HbA1c nos valores de referencia. A variabilidade da HbA1c deve ser considerada no contexto da inter-relacao entre o controle glicemico e a evolucao para as complicacoes microvasculares do diabetes mellitus.