Gabriela Heiden Teló

Precipitating factors of diabetic ketoacidosis at a public hospital in a middle-income country.

AIMS To study precipitating factors of diabetic ketoacidosis (DKA) at a public hospital in a middle-income country. METHODS Eighty patients with type 1 diabetes who had an emergency hospitalization for DKA between January 2005 and March 2010 at a tertiary care teaching hospital in Southern Brazil were studied. Data were collected by reviewing medical records and telephone calls. Treatment non-adherence was defined as the precipitating factor if there was diet abuse or insulin therapy noncompliance without identifiable infection. RESULTS The mean age of patients was 26±13 years. The majority (91.5%) of the patients had unsatisfactory metabolic control before the hospitalization. The most common DKA precipitating factor was treatment non-adherence: 39% of cases when all patients were evaluated and 49% when only patients with previous type 1 diabetes diagnosis were analyzed. Comparison between patients with DKA precipitated by treatment non-adherence and by other causes showed that the former group had more episodes of previous DKA and more frequently reported insulin omission previous to DKA. CONCLUSIONS Treatment noncompliance is the leading precipitating factor of DKA in Southern Brazil. Further efforts to reduce the occurrence of DKA should focus on patients with prior reports and evidence of treatment non-adherence.

Comparison between adherence assessments and blood glucose monitoring measures to predict A1c in type 1 diabetes

Materials and methods Four instruments evaluated adherence: Self-Care Inventory-Revised version (SCI-R), a self-administered survey; Diabetes Self Monitoring Profile (DSMP), a survey administered by trained researchers; a categorical (yes/no/ sometimes) self-report question (“In the past month, did you take care of your diabetes as your doctor recommended?”); and a continuous adherence self-evaluation, which ranged from 0-100. BGM frequency was evaluated by self-report, BGM diary, and meter download. Glycemic control was assessed by A1c (HPLC).

Common mental disorders in adolescents with and without type 1 diabetes: Reported occurrence from a countrywide survey

AIMS The aim of this study was to evaluate the frequency of common mental disorders symptoms in adolescents with type 1 diabetes in comparison to a population-based sample of adolescents in Brazil. METHODS We compared characteristics of 116 youth with type 1 diabetes and 73,508 youth without type 1 diabetes from the same population-based sample of adolescents aged 12-17years, taken from the Brazilian Study of Cardiovascular Risk in Adolescents (ERICA). We evaluated the 12-item General Health Questionnaire (GHQ) score, which is a self-administered screening survey for detecting mental health symptoms. Scores ≥3 were used to determine common mental disorder. RESULTS Adolescents with and without type 1 diabetes were comparable with respect to age and race/ethnicity distributions. Youth with type 1 diabetes did not report higher scores on the weighted GHQ analyses in comparison to youth without type 1 diabetes (3.16, SE 0.76 vs. 2.10, SE 0.03, respectively; P = .167). No differences were found regarding the odds of having a GHQ score ≥3 (OR 1.48, 95% CI 0.72-3.08). However, analyses of mental health symptoms separately consistently showed that youth with type 1 diabetes more frequently endorsed mental health barriers in comparison to youth without type 1 diabetes. CONCLUSIONS Mental health symptoms seem to be more frequent than diagnosis of common mental disorders in adolescents with type 1 diabetes, which may also interfere in glycemic control. Our findings highlight the need for appropriate mental health assessment in diabetes care in order to prevent glycemic control deterioration.

Adiponectin levels in Brazilian adolescents: Distribution and associated factors in ERICA survey

BACKGROUND The aim of this study was to evaluate the distribution of adiponectin and associated factors with low adiponectin levels in a large sample of adolescents from different Brazilian regions. METHODS This is a national, school-based, cross-sectional multicenter study of cardiovascular risk factors in Brazilian adolescents aged 12 to 17 years. Serum adiponectin levels (μg/ml) were measured by enzyme-linked immunosorbent assay kit. Given the lack of reference values, sex-and age-specific median was adopted as the cutoff point, with the values below the median representing a higher-risk profile. Associated factors with low levels of adiponectin were investigated using Poisson regression. RESULTS The sample consisted of 4546 adolescents, the majority female (61.2%). The prevalence of overweight/obesity and abdominal obesity was 30% and 13.4%, respectively. The medians of adiponectin were 13.4 μg/ml (95%CI: 12.8-14.0) in males and 14.2 μg/ml (95%CI: 13.3-15.0) in females. Lower adiponectin levels were associated with both overweight (Prevalence Ratios (PR) = 1.17; 95%CI 1.01-1.36) and obesity (PR = 1.36; 95%CI 1.16-1.56) in males, while, in females, adiponectin levels were associated only with obesity (PR = 1.45; 95% CI 1.26-1.66). Increased waist circumference in both males and females was inversely associated with adiponectin level. CONCLUSIONS Adiponectin levels were lower among adolescents with weight excess and abdominal obesity. Male adolescents who live in rural areas and study at private schools also showed lower adiponectin concentrations.

Correlation between Very Short and Short-Term Blood Pressure Variability in Diabetic-Hypertensive and Healthy Subjects

Background Blood pressure (BP) variability can be evaluated by 24-hour ambulatory BP monitoring (24h-ABPM), but its concordance with results from finger BP measurement (FBPM) has not been established yet. Objective The aim of this study was to compare parameters of short-term (24h-ABPM) with very short-term BP variability (FBPM) in healthy (C) and diabetic-hypertensive (DH) subjects. Methods Cross-sectional study with 51 DH subjects and 12 C subjects who underwent 24h-ABPM [extracting time-rate, standard deviation (SD), coefficient of variation (CV)] and short-term beat-to-beat recording at rest and after standing-up maneuvers [FBPM, extracting BP and heart rate (HR) variability parameters in the frequency domain, autoregressive spectral analysis]. Spearman correlation coefficient was used to correlate BP and HR variability parameters obtained from both FBPM and 24h-ABPM (divided into daytime, nighttime, and total). Statistical significance was set at p < 0.05. Results There was a circadian variation of BP levels in C and DH groups; systolic BP and time-rate were higher in DH subjects in all periods evaluated. In C subjects, high positive correlations were shown between time-rate index (24h-ABPM) and LF component of short-term variability (FBPM, total, R = 0.591, p = 0.043); standard deviation (24h-ABPM) with LF component BPV (FBPM, total, R = 0.608, p = 0.036), coefficient of variation (24h-ABPM) with total BPV (FBPM, daytime, -0.585, p = 0.046) and alpha index (FBPM, daytime, -0.592, p = 0.043), time rate (24h-ABPM) and delta LF/HF (FBPM, total, R = 0.636, p = 0.026; daytime R = 0,857, p < 0.001). Records obtained from DH showed weak positive correlations. Conclusions Indices obtained from 24h-ABPM (total, daytime) reflect BP and HR variability evaluated by FBPM in healthy individuals. This does not apply for DH subjects.

Impact of flaxseed and soy nuts as dietary supplements on lipid profile, insulin sensitivity and GLUT4 expression in ovariectomized rats

We assessed the effects of a diet with flaxseed or soy nuts versus estradiol on the lipid profile, insulin sensitivity, and glucose transporter type 4 (GLUT4) expression in ovariectomized female rats. Forty-four female Wistar rats (90 days old) underwent ovariectomy and were divided into 4 groups: C (standard diet), E (standard diet + subcutaneous 17β-estradiol pellets), L (standard diet + flaxseed + subcutaneous placebo pellets), and S (standard diet + soy nuts + subcutaneous placebo pellets). Customized diets and the insertion of pellets were started 21 days after ovariectomy and were continued for another 21 days. We measured body mass, insulin tolerance, total cholesterol, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, triglycerides, and GLUT4 (in cardiac and adipose tissues). We found a lower body mass and a lower Lee index in group E and a trend toward improved insulin sensitivity in group S (p = 0.066). Groups L and S showed a better lipid profile when compared with group C. Microsomal GLUT4 increased in group L (in cardiac and adipose tissues), and plasma membrane GLUT4 increased in groups E, L, and S (in both tissues). We conclude that flaxseed and soy nuts as dietary supplements improve lipid profile and increase GLUT4 expression.

Prevalence of high HbA1c levels in Brazilian adolescents: The Study of Cardiovascular Risk in Adolescents

AIM To evaluate the prevalence of elevated glycated haemoglobin (HbA1c) levels in a population of adolescents participating in the Study of Cardiovascular Risk in Adolescents. METHODS This is a school-based cross-sectional study based on a complex sample of adolescents 12-17years old representative at the national and macro-regional levels and for each Brazilian state capital. Blood was collected in schools and then evaluated in a single laboratory. HbA1c levels were considered elevated if ⩾5.7% (39mmol/mol) and were analyzed according to sex, age, macro-region, type of school, skin color, and nutritional status. RESULTS Data from 37,804 adolescents were analyzed. The mean level of HbA1c was 5.4% (95%CI 5.4-5.4) (36mmol/mol [95%CI 36-36]), and 20.5% (95%CI 19.1-22.0) of adolescents presented values ⩾5.7% (⩾39mmol/mol). Among males, 23.6% (95%CI 21.8-25.6) showed elevated HbA1c levels compared to 17.5% (95%CI 15.9-19.2) observed in females. The prevalence of elevated levels of HbA1c was higher in adolescents with black skin color (27.6%; 95%CI 23.2-32.4) vs. white skin color (16.9%; 95%CI 15.4-18.5), and higher in those who studied in public schools (21.6%; 95%CI 20.0-23.4) vs. private schools (16.7%; 95%CI 14.7-19.0). Among obese adolescents, 29.7% (95%CI 25.4-34.3) had elevated levels of HbA1c, compared to 19.3% (95%CI 18.0-20.7) in normal weight students and 19.7% (95%CI 17.1-22.6) in overweight adolescents. CONCLUSIONS Obese male adolescents of lower socioeconomic status had a higher prevalence of elevated HbA1c levels. Our findings highlight the importance of focusing on this high risk group for interventions to prevent diabetes.

Prevalence of diabetes mellitus in Brazil: a systematic review with meta-analysis

Materials and methods Cross-sectional and cohort studies published between 1980 and 2014 were independently identified by two reviewers, without language restriction, in five databases (PubMed, Cochrane Library, EMBASE, LILACS and SciELO). Random effects models were used to estimate the prevalence of DM for the general population, as well as the trends for the last decades. Heterogeneity was assessed by I statistics.

Albuminuria Is Not Associated with Bacteriuria in Patients with Type 2 Diabetes Mellitus: A Meta-Analysis of Observational Studies

Background/Aims: It has been recommended that urinary albumin be measured in sterile urine for the proper diagnosis of diabetic nephropathy. However, the association between bacteriuria and urinary albumin is controversial. Methods: A systematic review and meta-analysis was performed to investigate the association of albuminuria and bacteriuria in patients with diabetes. Medline and Embase were searched (beginning in 1950 until November 2010). Data were extracted independently by two investigators. The pooled OR estimates were calculated using the random effects model. Results: We identified 305 studies in the database searches. A total of seven studies were included, providing data from 1,552 patients (mean age 56.4 years). The OR of bacteriuria for the presence of micro- and/or macroalbuminuria was 1.60 (95% CI: 0.97–2.66, I2 = 66.6%) as compared to patients without bacteriuria. Funnel plots and the Egger regression test suggested no significant asymmetry in the analysis (p = 0.21). In a sensitivity analysis including the five studies (1,197 participants) that evaluated microalbuminuria as the outcome, the OR of bacteriuria for microalbuminuria was 1.22 (95% CI: 0.68–2.19). Conclusion: In conclusion, no association was identified between albuminuria and bacteriuria considering the current literature. Further prospective studies of a large diabetic population are needed to clarify such an association.