Simone Henriques de Castro

Parâmetros antropométricos e síndrome metabólica em diabetes tipo 2

To evaluate the value of body mass index (BMI) as predictor of waist circumference of cardiovascular risk (CRWC) and diagnostic of metabolic syndrome (MSWC) in patients with type 2 diabetes mellitus (DM 2), we assessed BMI and WC in 753 patients with DM 2 (472 women) with 23 ± 8 years. The participants had been divided in groups in accordance with the presence or absence of ACCR or ACMS. The best BMI cut-off to predict such disturbances was evaluated in women and men. In females, BMI > 25.0 kg/m2 was the best predictor of CRWC. Area under ROC curve and IC 95% were 0.7202 (0.6753 - 0.7652) for CRWC and of [0.8318 (0.7928 - 0.8708)] for MSWC. In males, IMC > 25.0 kg/m2 was better predictor for CRWC presence [0.8527 (0.8098 - 0.8955)], while BMI > 30.0 kg/m2 for MSWC [0.9071 (0.8708 - 0.9433)]. We conclude that BMI can be a simple way to evaluate metabolic syndrome and cardiovascular risk where there were not material and prepared professionals for the WC evaluation. We need prospective studies to evaluate if it is necessary to change the BMI cut-off adopted as indicative of these disturbances in the diabetic population.

Platelet-activating factor acetylhydrolase (PAF-AH) activity in patients with type 1 diabetes mellitus.

OBJECTIVE To evaluate platelet-activating factor acetylhydrolase (PAF-AH) activity and its relationship with clinical and demographic variables, metabolic control, apolipoprotein A and B levels and the susceptibility of low-density lipoprotein (LDL) to in vitro oxidation in patients with type 1 diabetes mellitus (DM 1). METHODS Forty two patients with DM 1 (27 females) and 48 control subjects (16 females) matched for gender, age and body mass index (BMI) were evaluated. The following tests were performed: fast plasma glucose (FG) and postprandial plasma glucose (PPG), lipid profile, uric acid (UA), glycosylated hemoglobin (HbA1c), and low-density lipoprotein (LDL) oxidation rate using colorimetric assay. The PAF-AH activity was analyzed using colorimetric assay (Cayman Chemical). RESULTS The analysis of PAF-AH activity showed a higher enzyme activity in patients with DM 1 than in control subjects (0.0150 +/- 0.0051 vs. 0.0116 +/- 0.0041; p < 0.001). In patients with DM 1, a direct correlation between PAF-AH activity and age and LDL, and an inverse correlation between PAF-AH and HbA1c and high-density lipoprotein (HDL) were found. CONCLUSION In the sample studied, PAF-AH showed a higher activity in patients with DM 1, a factor that may be related to the higher risk of developing cardiovascular diseases observed in these patients. Further studies are necessary to evaluate the real participation of this enzyme in the risk of development of atherosclerotic diseases in patients with DM 1.

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.

Avaliação da suscetibilidade do LDL de pacientes com diabetes mellitus tipo 1 à oxidação in vitro e sua relação com o controle glicêmico

In 38 patients with type 1 diabetes (DM 1) and 24 non-diabetics we investigated LDL susceptibility to in vitro oxidation. Fast and post-prandial glycaemia (PPG), glycated hemoglobin (HbA1c) and lipid profile were determined, together with an spectrophotometric analysis of LDL oxidation before and 1, 3, 6 and 24 hours after addition of the oxidant substance - copper sulphate (CuSO4). The LDL oxidation coefficient in the two groups presented similar basal values; however 3 hours after CuSO4, LDL was more oxidized in patients with DM1. There was a negative correlation with PPG (r= -0.2511; p<0.05) and HbA1c (r= -0.2541; p<0.05). We conclude that in our sample of DM patients LDL was oxidized earlier than in the non-diabetics and that the glycemic control is important in this event.

Variabilidade do controle glicêmico de pacientes com diabetes tipo 1 e tipo 2 durante um ano de acompanhamento

To evaluate the variability of glicemic control in diabetic patients followed during one year, we conducted a retrospective study in which the record data of 113 diabetic patients were analyzed. The value of HBA1c (glycated hemoglobin) measured during a year were registered and an index of glicemic control was calculated. This index was associated with duration of diabetes, BMI and dose of insulin. HBA1c were higher in type 1 diabetes than type 2, respectively, [7.9 (4.4-13.3) vs. 7.0 (4.4-13.4)%; p= 0.007]. In 90 patients with at least two HBA1c measurements, 68 (75.6%) had no change in glicemic control: 51 (76.1%) had good, 8 (11.1%) regular and 9 (11.9%) poor control. None of them sustained all the HBA1c in the normal range: 26 (28.9%) had at least one normal HBA1c value. In general group, 44 patients (48.9%) showed increase, 41 (45.6%) decreased and 5 (5.6%) remained with the same level of HBA1c, without difference between DM1 and DM2 (p= 0,77). A difference in HBA1c and diabetes duration among patients with DM2 treated with diet, oral hipoglycemic agents, combined therapy and monotherapy with insulin, was noted respectively (5.4±0.5 vs. 6.3±1.3 vs. 7.6±1.4 vs. 8.4±2.0%; p= 0.001) and (8.5±9.9 vs. 5.3±4.2 vs. 14.1±9.6 vs. 16.9±8.1 years; p= 0,003). The intraindividual coefficient of variation of HBA1c was 11.6±7.4% (p= 0.0000) being 12.8±7.6 (p= 0.0000) in type 1 and 10.4±7.2% in type 2 (p= 0.0000) without difference between both groups. In conclusion: the majority of the patients in our study maintained a good control despite the intraindividual variability of HBA1c and the difficulty to keeping it in the normal range.

Intervalo QT corrigido e fatores de risco tradicionais para doença aterosclerótica em pacientes com diabetes tipo 1

To evaluate the QTc interval and its relation with clinical, laboratorial variables and LDL susceptibility to in vitro oxidation in patients with type 1 DM, we studied 40 diabetics and 33 non diabetics with 24.83 +/- 10.21 and 23.51 +/- 7.28 years old, respectively matched by sex, age and body mass index (BMI). We evaluated metabolic control, A and B apolipoproteins, LDL oxidation coefficient for spectrophotometry and electrocardiogram (ECG). Interval QTc was calculated by the Bazetts formula. There was no difference in QTc between diabetic and non diabetic groups (394.43 +/- 19.98 ms versus 401.31 +/- 17.83 ms; p = 0.2065). Five diabetics showed increased QTc (396.76 +/- 14.63 ms versus 429.75 +/- 1.89 ms; p < 0.001) and lesser A apolipoprotein levels than rest of diabetic group (74.60 +/- 25.42 mg/dL versus 113.64 +/- 29.79 mg/dL; p = 0,011). In pooled sample, there was correlation between QTc and BMI (rho = -0.288; p = 0.045), pot-prandial glycemia (rho = 0.357; p = 0.016) and 3 h oxidation coefficient (OxC3h) (r = -0.293; p = 0.039). In diabetics, there was correlation between QTc and triglycerides (rho = -0.420; p = 0.023) and OxC3h (r = -0.427; p = 0.021). Although there was no difference between QTc of diabetics and the non diabetics subjects studied, there was correlation with risk factors for the atherosclerotic disease. Further studies are necessary to establish the real predictive value of QTc for this type of disease in the patients with type 1 DM.

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.

Health literacy skills in type 2 diabetes mellitus outpatients from an university-affiliated hospital in Rio de Janeiro, Brazil

BackgroundType 2 diabetes mellitus is the most common metabolic disorder and has considerable impact on quality of life. Treatment of DM2 is complex and adherence to treatment requires sophisticated cognition which includes literacy skills.MethodsHealth literacy skills of a cross-sectional nonrandom sample of 164 DM2 outpatients at the Diabetes Unit of the Hospital Universitário Pedro Ernesto at the State University of Rio de Janeiro were evaluated by the short version of the Test of Functional Health Literacy in Adults (s-TOFHLA). Procedures available in the SPSS package were used in data analysis.ResultsFourteen out of 164 patients (8.5%) were completely illiterate and therefore were not further assessed. The remaining 150 patients (75 men and 75 women) were the participants of this study. Data showed that 110 (73.3%) participants had adequate health literacy skills, 17 (11.3%) had marginal skills and 23 (15.3%) had inadequate skills. Moreover, older participants performed worse than younger patients. In addition, Caucasian and multiethnic participants performed better than Afro-Brazilians. Furthermore, participants with higher educational and occupational levels outperformed those with lower levels. However, only age and education, but not ethnic group and occupation, contributed significantly and independently to health literacy.ConclusionThis study showed that almost a quarter of the participants are illiterate or have inadequate health literacy skills. Therefore, our results indicate the need for the development of health care instructions properly calibrated to the health literacy skills of DM2 patients.