Karina Biavatti

Caracterização de pacientes com diabetes mellitus tipo 1 do sul do Brasil: complicações crônicas e fatores associados

OBJETIVO: Avaliar a prevalencia de complicacoes cronicas vasculares e fatores associados em pacientes com diabetes mellitus (DM) tipo 1. METODOS: Estudo transversal com pacientes DM tipo 1 atendidos no Servico de Endocrinologia do Hospital de Clinicas de Porto Alegre. Os pacientes foram avaliados quanto a presenca de complicacoes cronicas vasculares. RESULTADOS: Avaliamos 573 pacientes, idade media de 33 anos. A presenca de retinopatia diabetica (RD) foi observada em 43,3%, o tempo de DM [RC: 1,07; IC95% 1,03-1,11; P 100 mg/dl. CONCLUSAO: Observamos elevadas prevalencias de complicacoes microvasculares e de HAS. A duracao do DM, HAS e presenca de ND foram associados a RD. HAS e dislipidemia foram associados a ND. A maioria dos pacientes encontrava-se fora dos alvos desejados de controle glicemico, pressorico e lipidico. Maiores esforcos sao necessarios para intensificar o controle metabolico e pressorico de pacientes com DM tipo 1.

Which patients with diabetes should undergo ambulatory blood pressure monitoring

Objective To estimate the daytime ambulatory blood pressure monitoring (ABPM) value corresponding to the target office blood pressure (BP; 130/80 mmHg) for diabetic patients and to identify which patients with diabetes may benefit from ABPM. Methods A cross-sectional study was conducted with type 1 and type 2 diabetic patients. ABPM (Spacelabs90207) and office BP were measured. Target ABPM was estimated by linear regression equation using daytime ABPM and office BP. Office BP values corresponding to ABPM hypertension were determined by receiver operating characteristic curves. Results A total of 554 patients (type 1: n = 200, 36 ± 11 years, diabetes duration 17 ± 9 years; type 2: n = 354; 57 ± 9 years, diabetes duration 10 ± 7 years) were evaluated. Regression equations for SBP and DBP were ABPM = 64.3 + (0.50 office BP) and ABPM = 45.4 + (0.42 office BP), respectively. Daytime ABPM corresponding to the target office BP was 129.3/79 mmHg. Office BP less than 120 for systolic and less than 70 mmHg for diastolic had 90% sensitivity to rule out hypertension diagnosed by ABPM; office BP at least 145 for systolic or at least 90 mmHg for diastolic had 90% specificity to confirm ABPM hypertension. Within these values, 38% of patients were misclassified if only office values were considered. Conclusion In type 1 and type 2 diabetes, the recommended upper limit of daytime ABPM is 130/80 mmHg. Patients with office BP at least 120 for systolic or at least 70 for diastolic and less than 145 for systolic and less than 90 mmHg for diastolic should undergo ABPM to correctly determine their BP status.

Formas graves de retinopatia predizem aterosclerose subclínica em indivíduos com diabetes tipo 1

BACKGROUND In patients with type 2 diabetes, the presence of retinopathy is associated with increased cardiovascular disease, regardless of known risk factors for vascular disease. OBJECTIVE To investigate the association of diabetic retinopathy (DR) and its grades with the presence of subclinical coronary atherosclerosis in patients with type 1 diabetes. METHODS A cross-sectional study was conducted with 150 type 1 diabetes individuals asymptomatic for coronary artery disease. They underwent clinical evaluation for microvascular complications and for the presence of coronary artery calcification (CAC). RESULTS Severe forms of DR (severe non-proliferative DR and proliferative DR) were associated with CAC (OR: 3.98 95% CI 1.13-13.9, p = 0.03), regardless of known risk factors for cardiovascular disease (age, A1C, hypertension, dyslipidemia and male gender). CONCLUSION Patients with severe forms of DR are at risk for the presence of coronary artery disease regardless of traditional cardiovascular risk factors.