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- ItemSomente MetadadadosConsiderations on blood glucose management in Type 2 diabetes mellitus(Wiley-Blackwell, 2002-07-01) Home, P.; Chacra, Antonio [UNIFESP]; Chan, J.; Emslie-Smith, A.; Sorensen, L.; Van Crombrugge, P.; Worldwide Initiative Diab Educ; Univ Newcastle Upon Tyne; Universidade Federal de São Paulo (UNIFESP); Chinese Univ Hong Kong; Wallacetown Hlth Ctr; Royal Prince Alfred Hosp; OL Vrouw ZiekenhuisIn recent years the benefits of more intensive management in preventing or delaying the development and progression of diabetic complications have been well documented. What is not as well documented is how to motivate the person with diabetes to manage the condition, how to set, assess and quantify glucose goals, and the glucose variables that should be routinely measured. This review discusses the importance of setting targets and communicating them in a way that the patient understands. When aiming for a glycaemia target, balance is required (1) between achieving reduction of complications and causing an increased degree of hypoglycaemia, and (2) between what is achievable and what degree of benefit is gained. Target values given in guidelines should be adapted by the clinician to take into account the patient's susceptibility to hypoglycaemia, stage and type of complications, age and life expectancy, co-morbidity, social environment, understanding of the steps required and level of commitment to the treatment. Several suggestions are given regarding possible improvements and amendments to existing guidelines for diabetes management in treating to glucose goal. for example, attention should be drawn to the need to individualise goals and to consider education, long-term support, patient needs and treatment outcome when formulating diabetes management plans. the relative properties of the different glucose variables - fasting plasma glucose (FPG), postprandial plasma glucose (PPG), glycated haemoglobin A(1c) (HbA(1c)), and glycated protein - in terms of their convenience of measurement, usefulness and relevance to the physician and patient are also evaluated. When prioritising the variables to be measured it is suggested that where feasible, HbA(1c) should be the standard measurement by which to gauge risk and treatment efficacy. Serial measurements should be made and, where possible, the use of blood glucose meters encouraged, in order to obtain a blood glucose profile for the patient. Copyright (C) 2002 John Wiley Sons, Ltd.
- ItemAcesso aberto (Open Access)Efeito da freqüência do exercício físico no controle glicêmico e composição corporal de diabéticos tipo 2(Sociedade Brasileira de Cardiologia - SBC, 2009-01-01) Vancea, Denise Maria Martins [UNIFESP]; Vancea, José Nelson; Pires, Maria Izabel Fernandes; Reis, Marco Antonio; Moura, Rafael Brandão; Dib, Sergio Atala [UNIFESP]; Universidade Federal de São Paulo (UNIFESP); Universidade de São Paulo (USP); Colégio Estadual Salime Mudeh; Colégio Estadual Marechal Carlos Machado BitencourtBACKGROUND: Diabetes and cardiovascular disease have emerged as key threats to human health, and the risk is increased in individuals with visceral obesity. The consensus is that physical exercise should be part of the treatment of diabetes mellitus (DM). OBJECTIVE: To compare the influence of guided and structured physical exercise programs (SPEP), three to five times per week, during a period of 20 weeks, on glycemic control and body composition of type 2 diabetic patients (DM2). METHODS: The research was conducted at the Universidade Federal de São Paulo (UNIFESP) (Federal University School of Medicine in São Paulo). At the clinical visit, patients from the Control Group (CG) n=17, mean age 55.8 years, were encouraged to engage in a physical exercise program. Patients from Group 3x (G3), n=14, mean age 57.4 years, were to engage in 1 hour of physical exercise, 3x/week, and Group 5x (G5), n=9, mean age 58.8 years, followed the same protocol but 5x/week. Mean of 5 years since diagnosis in all groups. Classes consisted of a 5-minute warm-up, 30-minute treadmill walk at 70% of maximum heart rate, and 10-minute relaxation. BMI, abdominal circumference (AC), percentage of body fat (BF), capillary glycemia (CG), fasting glycemia (FG), and glycated hemoglobin (HbA1c) were assessed. RESULTS: A comparison was made between the baseline time point (B) and the 20th week (20th). BMI in G3 (B:29.5±2.9 vs. 20th: 28.3 ± 2.2 Kg/sqm, p=0.005) and G5 (B:29.7±4.4 vs. 20th: 29.1 ± 4.3 Kg/sqm, p=0.025); abdominal circumference in G5 (B:100.5±11.9 vs. 20th: 933 ± 11.7 cm, p=0.001); BF in G3 (B:31±5.1 vs 20th: 26±5%, p=0.001) and G5 (B:32.4 ± 5.4 vs. 20th: 30.3 ± 6.9%, p=0.001); FG, G5 (B:150.8 ± 47.5 vs. 20th: 109.2± 30.5 mg/dL, p=0.034), showed statistically significant differences. CG did not show statistically significant differences for these variables. CG showed a tendency to drop after physical exercise in G5. HbA1c showed no statistically significant differences in the three groups. CONCLUSION: G5 did better than G3 in most parameters assessed. However, results failed to show a decrease of HbA1c in DM2 patients.
- ItemAcesso aberto (Open Access)Effect of Continuous and Interval Physical Exercise on Weight and Biochemical Profile of Pregnant Wistar Rats and Consequences on Fetal Body Weight(Soc Brasileira Med Esporte, 2011-11-01) Barbalho, Sandra Maria; Souza, Maricelma da Silva Soares de; Silva, Julio Cesar de Paula e; Coqueiro, Daniel Pereira [UNIFESP]; Oliveira, Gabriela Aparecida de; Costa, Tainara; Oshiiwa, Marie; Univ Marilia; Fac Tecnol Alimentos Marilia; UNESP; Universidade Federal de São Paulo (UNIFESP)Exercise training is known for its benefits to the body and mind. However, little is known about the effects of endurance training intensity on pregnancy. We tested the effects of continuous and intermittent exercises (maternal swimming) on the biochemical profile of pregnant Wistar rats and the effects of these exercises on the fetal body weight. The pregnant females (n=60) were divided in control group (GC), continuous exercise group (GCON) and intermittent exercise group (GIN). GC group rats did not practice exercises. GON group rats practiced continuous swimming for 45 minutes a day (five days a week) carrying a bag with 5% of its body weight. GIN group rats practiced intermittent swimming (15 seconds of swimming and 15 seconds stopped) for 45 minutes a day (five days a week) carrying a bag with 15% of its body weight. These exercises were made from the day one until 20(0) day of pregnancy. At the end of this period, we analyzed the mother's glycemia, cholesterol, HDL-C, LDL-C and triglycerides. We also analyzed fetal body weight. No significant modifications on glycemia and plasma lipids (except for LDL-C) were observed in the tree groups. We observed reduction on the fetal body weight in the pups that had their mothers practicing exercises: fetal body weight in GC > GIN > GON (4,153 +/- 0,649; 3,682 +/- 0,070 and 3,453 +/- 0,052 respectively). These results showed that the continuous and intermittent exercise only performed in pregnancy period decreases fetus body weight.
- ItemSomente MetadadadosMalnutrition May Worsen the Prognosis of Critically Ill Children With Hyperglycemia and Hypoglycemia(Sage Publications Inc, 2013-05-01) Leite, Heitor Pons [UNIFESP]; Lima, Lucio Flavio Peixoto de [UNIFESP]; Iglesias, Simone Brasil de Oliveira [UNIFESP]; Pacheco, Juliana Cristina [UNIFESP]; Carvalho, Werther Brunow de; Universidade Federal de São Paulo (UNIFESP); Universidade de São Paulo (USP)Objectives: To determine whether hyperglycemia and hypoglycemia are associated with higher mortality, longer length of intensive care unit (ICU) stay, and fewer ventilator-free days in critically ill children while taking into account the clinical severity and nutrition status. Patients and Methods: A prospective observational cohort study was conducted on 221 children admitted to the ICU. Blood glucose levels were analyzed in the first 72 hours. Potential exposure variables for adverse prognosis included hyperglycemia (blood glucose > 150 mg/dL), hypoglycemia (blood glucose <= 60 mg/dL), age < 1 year, sex, nutrition status, the revised Pediatric Index of Mortality (PIM 2), and the Pediatric Logistic Organ Dysfunction (PELOD). Results: of the patients, 47.1% were malnourished. Controlling for nutrition status, both hyperglycemia and hypoglycemia increased the risk of mortality in the malnourished patients compared with the well-nourished ones. Adjusting for clinical severity, the odds ratio of mortality was higher in malnourished patients with hyperglycemia (odds ratio [OR], 3.98; 95% confidence interval [CI], 1.14-13.94; P = .03), whereas no significant associations were detected in the well-nourished patients. After controlling for nutrition status, hypoglycemia was associated with longer length of ICU stay (OR, 6.5; 95% CI, 1.30-32.57; P < .01) and fewer ventilator-free days (OR, 4.11; 95% CI, 1.26-13.40; P < .01) only in the malnourished group of patients. Conclusions: Compared with the well nourished, malnourished patients with hyperglycemia are at a greater risk of mortality, independent of clinical severity. Hypoglycemia was shown to be associated with mortality, longer length of ICU stay, and fewer ventilator-free days only in malnourished patients. (JPEN J Parenter Enteral Nutr. 2013;37:335-341)