Navegando por Palavras-chave "Type 2 diabetes mellitus"

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    Association of classical risk factors and coronary artery disease in type 2 diabetic patients submitted to coronary angiography
    (Biomed Central Ltd, 2014-03-29) Bittencourt, Celia [UNIFESP]; Piveta, Valdecira M. [UNIFESP]; Oliveira, Carolina S. V. [UNIFESP]; Crispim, Felipe [UNIFESP]; Meira, Deyse [UNIFESP]; Saddi-Rosa, Pedro [UNIFESP]; Giuffrida, Fernando M. A.; Reis, Andre F. [UNIFESP]; Universidade Federal de São Paulo (UNIFESP); CEDEBA
    Background: Coronary artery disease (CAD) is the leading cause of death among individuals with type 2 diabetes (T2DM). T2DM accelerates atherosclerosis alongside classical risk factors such as dyslipidemia and hypertension. This study aims to investigate the association of hyperglycemia and associated risk factors with CAD in outpatients with T2DM undergoing coronary angiography.Methods: 818 individuals referred to coronary angiography were evaluated for glucose disturbances. After exclusion of those with prediabetes, 347 individuals with T2DM and 94 normoglycemic controls were studied for BMI, blood pressure, fasting plasma glucose, HbA1c, lipids, HOMA, adiponectin, Framingham risk score, number of clinically significant coronary lesions (stenosis > 50%).Results: Among T2DM subjects, those with CAD (n = 237) had worse glycemic control (fasting glucose 162.3 + 69.8 vs. 143.4 + 48.9 mg/dL, p = 0.004; HbA1c 8.03 + 1.91 vs. 7.59 + 1.55%, p = 0.03), lower HDL (39.2 + 13.2 vs. 44.4 + 15.9 mg/dL, p = 0.003), and higher triglycerides (140 [106-204] vs. 121 [78.5-184.25] mg/dL, p = 0.002), reached more often therapeutic goals for LDL (63.4% vs. 51.4%, p = 0.037) and less often goals for HDL (26.6% vs. 37.3%, p = 0.04), when compared to CAD-free individuals (n = 110). the same differences were not seen in normoglycemic controls. in T2DM subjects HbA1c tertiles were associated with progressively higher number of significant coronary lesions (median number of lesions 2 [A1c < 6.8%]; 2.5 [A1c 6.8-8.2%]; 4 [A1c > 8.2%]; p = 0.01 for trend).Conclusions: Classic risk factors such as glycemic control and lipid profile were associated with presence of CAD in T2DM subjects undergoing coronary angiography. Glycemic control is progressively associated with number and extent of coronary lesions in patients with T2DM.
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    Aumento da probabilidade diagnóstica de Síndrome de Cushing subclínica em amostra de população de pacientes obesos com diabetes mellitus do tipo 2
    (Universidade Federal de São Paulo (UNIFESP), 2008-06-27) Caetano, Maria Silvia Santarem [UNIFESP]; Kater, Claudio Elias [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)
    Endogenous Cushing’s syndrome (CS) is unusual. Patients with subclinical CS (SCS) present altered cortisol dynamics without obvious manifestations. CS occurs in 2-3% of obese poorly controlled diabetics. We studied 103 overweight adult outpatients with type 2 diabetes to examine for cortisol abnormalities and SCS. All collected salivary cortisol at 23:00h and salivary and serum cortisol after a 1mg dexamethasone suppression test (DST). Patients whose results were in the upper quintile for each test (253ng/dL, 47ng/dL and 1.8ìg/dL, respectively for the 23:00h and post-DST saliva and serum cortisol) were re-investigated. Average values from the upper quintile group were 2.5- fold higher than in the remaining patients. After a confirmatory 2mgx2day DST the investigation for CS was ended for 61 patients with all normal tests and 33 with only one (false) positive test. All 8 patients who had two abnormal tests had subsequent normal 24h-urinary cortisol, and 3 of them were likely to have SCS (abnormal cortisol tests and positive imaging). However, a final diagnosis could not to be confirmed by surgery or pathology. Although not confirmatory, the results of this study suggest that the prevalence of SCS is considerably higher in populations at risk than in the general population.
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    Bloqueio do sistema renina-angiotensina atenua lesões em órgãos-alvo em modelo de diabetes mellitus tipo 2 e hipercolesterolemia induzidos por dieta
    (Universidade Federal de São Paulo (UNIFESP), 2009) Helfenstein, Tatiana [UNIFESP]; Izar, Maria Cristina de Oliveira [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)
    Com o crescente aumento da prevalência mundial de diabetes mellitus, tem-se buscado modelos experimentais para melhor compreensão de sua fisiopatologia e tratamento que atendam de maneira mais adequada à preservação de células beta, proteção de órgãos-alvo e atenuação da aterosclerose. Objetivos: Desenvolver modelo experimental de diabetes mellitus tipo 2 induzido por meio de dieta, e utilizá-lo para examinar os efeitos de um inibidor da enzima conversora de angiotensina (IECA) e de um bloqueador do receptor de angiotensina (BRA) na proteção de órgãos-alvo. Métodos: Coelhos machos Nova Zelândia (n=49) receberam dieta acrescida de banha (10%), sacarose (40%) durante todo o protocolo do estudo além de colesterol (0,5% nos três primeiros meses e 0,1% nos meses subseqüentes). Os animais receberam aleatoriamente: apenas a dieta sem fármacos (G1), olmesartana 5 mg (G2), quinapril 30 mg (G3), ou a combinação de ambos (G4), acrescidos à mesma dieta por seis meses. Foram analisados lípides, frutosamina, glicose e insulina em jejum com cálculo dos índices para resistência à insulina e função de células beta pancreáticas. Foram ainda examinadas as áreas sob as curvas de insulina e glicose, após infusão de glicose intraperitoneal. Angiofluoresceinografias e análises histopatológicas avaliaram lesões em órgãos-alvo. Resultados: Os coelhos ganharam peso, e houve aumento dos níveis de glicose, colesterol total, LDL-C e triglicérides e redução do HDL-C (p <0,05 vs. basal). A frutosamina e o HOMA-IR se elevaram, enquanto houve redução do HOMA-β (p <0,05 vs. basal). Sinais precoces de retinopatia diabética foram observados a partir do terceiro mês, progredindo até o final do experimento (p<0,0005). Lesões ateroscleróticas em aorta, esteatofibrose hepática e infiltrado glomerular de macrófagos constituíram os principais achados histomorfológicos. O bloqueio do sistema renina-angiotensina modificou favoravelmente a glicemia e o HOMA-β (p<0,05) e houve atenuação do número e grau dos microaneurismas pelo tratamento com BRA isoladamente ou combinado com IECA (p<0,05 vs. G1). Conclusões: Nosso modelo reproduziu várias características glucometabólicas do diabetes mellitus tipo 2 humanóide, incluindo déficit de secreção e resistência à insulina. O bloqueio do sistema renina-angiotensina atenuou algumas alterações bioquímicas e as lesões microvasculares em retina.
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    Dietary whey protein lessens several risk factors for metabolic diseases: a review
    (Biomed Central Ltd, 2012-06-07) Sousa, Gabriela T. D.; Lira, Fabio Santos de; Rosa, Jose C.; Oliveira, Erick P. de; Oyama, Lila Missae [UNIFESP]; Santos, Ronaldo Vagner Thomatieli dos [UNIFESP]; Pimentel, Gustavo Duarte; Universidade Estadual de Campinas (UNICAMP); Universidade de São Paulo (USP); Univ Extremo Catarinense; Universidade Federal de São Paulo (UNIFESP)
    Obesity and type 2 diabetes mellitus (DM) have grown in prevalence around the world, and recently, related diseases have been considered epidemic. Given the high cost of treatment of obesity/DM-associated diseases, strategies such as dietary manipulation have been widely studied; among them, the whey protein diet has reached popularity because it has been suggested as a strategy for the prevention and treatment of obesity and DM in both humans and animals. Among its main actions, the following activities stand out: reduction of serum glucose in healthy individuals, impaired glucose tolerance in DM and obese patients; reduction in body weight; maintenance of muscle mass; increases in the release of anorectic hormones such as cholecystokinin, leptin, and glucagon like-peptide 1 (GLP-1); and a decrease in the orexigenic hormone ghrelin. Furthermore, studies have shown that whey protein can also lead to reductions in blood pressure, inflammation, and oxidative stress.
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    Efeitos do laser terapêutico de baixa intensidade sobre a homeostase glicêmica e par metros morfométricos de ilhotas pancreáticas em modelo experimental de diabetes induzido por dieta
    (Universidade Federal de São Paulo, 2022-01-28) Silva, Mirian Bonifacio [UNIFESP]; Oliveira, Camila Aparecida Machado de [UNIFESP]; Benfato, Izabelle Dias [UNIFESP]; http://lattes.cnpq.br/3927755229507197; http://lattes.cnpq.br/4886067148875464; http://lattes.cnpq.br/3672102635157004; Universidade Federal de São Paulo (UNIFESP)
    A gordura corporal excessiva produz efeitos maléficos à saúde. Um deles é a desordem metabólica associada ao início da resistência à insulina e surgimento do diabetes mellitus tipo 2. O uso de dietas hiperlipídica para induzir esses sintomas é recorrente na literatura, já que é econômico, seguro e se assemelha ao que acontece com humanos. A terapia de laser de baixa intensidade (LLLT) é um recurso fotobiomodulador que promove aumento do metabolismo celular e síntese proteica, regeneração, proliferação celular, modula a inflamação e controla a dor. Porém, pouco se sabe sobre sua eficácia no controle e desenvolvimento do diabetes per se. Assim, nosso objetivo foi avaliar o efeito da aplicação da LLLT nos parâmetros metabólicos, homeostase glicêmica e expressão de insulina no pâncreas de animais submetidos à dieta hiperlipídica. Nossa hipótese foi que a LLLT minimizaria os efeitos deletérios da dieta hiperlipídica, desacelerando o desenvolvimento do diabetes mellitus tipo 2. Para isso, foram utilizados camundongos machos da linhagem C57BL/6 (CEUA 6814270619). Os animais foram divididos em três grupos, sendo dois deles alimentados com dieta hiperlipídica: grupo controle (C), grupo hiperlipídico (HFD) e hiperlipídico + LLLT (HFD + LLLT). Foi utilizado o laser terapêutico de baixa intensidade de arseneto de gálio e alumínio (GaAlAs) diodo, com comprimento de onda de 808 nm, emissão contínua, potência de saída de 100 mW, irradiância de 3.57 W/cm², doses de 30 J/cm² e tempo de irradiação de 8 seg, respectivamente. O tratamento com LLLT iniciou na 9ª semana, encerrando-se na 12ª, sendo aplicado 3x na semana, sempre no mesmo horário (meio dia). Semanalmente, foram verificadas a massa corporal e evolução da glicemia de jejum. Ao final do período experimental, foram realizados os testes intraperitoneais de tolerância à glicose e tolerância à insulina. Também foi coletado sangue para análise de insulinemia e índice HOMA-IR, assim como a retirada do pâncreas para análise morfológica, morfométrica e imunohistoquímica para detecção da expressão da insulina. O fígado e os depósitos de gordura visceral também foram retirados para suas respectivas análises. Para a análise estatística, foram utilizados o GLM para medidas repetidas e o ANOVA one way. Quando detectado efeito da interação, foi utilizado o post hoc de Bonferroni. O valor de significância adotado foi de 95%. Os animais alimentados com dieta hiperlipídica apresentaram ao final do período experimental um aumento da massa corporal, indícios de esteatose hepática não alcoólica, perturbações na homeostase glicêmica, aumento da expressão de insulina no pâncreas e aumento dos parâmetros de adiposidade quando comparados ao grupo controle. Contudo, os animais tratados com a LLLT obtiveram prejuízos mais discretos quando comparados aos animais HFD não tratados em relação aos parâmetros de homeostase glicêmica. Não foram verificadas diferenças na insulinemia e no índice HOMA IR. Desse modo, apesar de discretos, os resultados foram positivos e motivam o aprofundamento do assunto. Por se tratar de um dos poucos estudos nessa área, nossos resultados servirão de base para investigações futuras, auxiliando na determinação de diferentes doses e parâmetros do laser para elucidar os resultados.
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    Effects of metformin on the glycemic control, lipid profile, and arterial blood pressure of type 2 diabetic patients with metabolic syndrome already on insulin
    (Associação Brasileira de Divulgação Científica, 2006-04-01) Mourão-júnior, C.a. [UNIFESP]; Sá, J.r. [UNIFESP]; Guedes, O.m.s.; Dib, Sergio Atala [UNIFESP]; Universidade Federal de São Paulo (UNIFESP); Universidade Federal de Juiz de Fora Departamento de Fisiologia
    Fifty-seven type 2 diabetic patients with metabolic syndrome and on insulin were assessed by a paired analysis before and 6 months after addition of metformin as combination therapy to evaluate the impact of the association on glycemic control, blood pressure, and lipid profile. This was a historical cohort study in which the files of type 2 diabetic patients with metabolic syndrome on insulin were reviewed. The body mass index (BMI), waist circumference, lipid profile, A1C level, fasting blood glucose level, daily dose of NPH insulin, systolic blood pressure, and diastolic blood pressure were assessed in each patient before the start of metformin and 6 months after the initiation of combination therapy. Glycemic control significantly improved (P < 0.001) after the addition of metformin (1404.4 ± 565.5 mg/day), with 14% of the 57 patients reaching A1C levels up to 7%, and 53% reaching values up to 8%. There was a statistically significant reduction (P < 0.05) of total cholesterol (229.0 ± 29.5 to 214.2 ± 25.0 mg/dL), BMI (30.7 ± 5.4 to 29.0 ± 4.0 kg/m²), waist circumference (124.6 ± 11.7 to 117.3 ± 9.3 cm), and daily necessity of insulin. The reduction of total cholesterol occurred independently of the reductions of A1C (9.65 ± 1.03 to 8.18 ± 1.01%) and BMI and the reduction of BMI and WC did not interfere with the improvement of A1C. In conclusion, our study showed the efficacy of the administration of metformin and insulin simultaneously without negative effects. No changes were detected in HDL-cholesterol or blood pressure.
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    Glucose homeostasis and weight loss in morbidly obese patients undergoing banded sleeve gastrectomy: a prospective clinical study
    (Faculdade de Medicina / USP, 2009-11-01) Miguel, Gustavo Peixoto Soares [UNIFESP]; Azevedo, João Luiz Moreira Coutinho [UNIFESP]; Gicovate Neto, Carlos; Moreira, Cora Lavigne Castelo Branco; Viana, Elaine Cristina; Carvalho, Perseu Seixas; Federal University of Espírito Santo; Universidade Federal de São Paulo (UNIFESP)
    OBJECTIVE: To assess glucose homeostasis and weight loss in morbidly obese patients undergoing Silastic® ring sleeve gastrectomy. METHODS: This was a prospective clinical study. Thirty-three female patients with a mean body mass index (BMI) of 42.33 ± 1.50 kg/m² (range: 40-45 kg/m²), a mean age of 36.7 ± 9.4 years and a mean waist circumference of 118.7 ± 5.98 cm were included in this study. Type 2 diabetes mellitus was observed in 11 patients (33.3%), and glucose intolerance was observed in 4 patients (12.1%). Mean plasma fasting glucose levels were 109.77 ± 44.19 mg/dl (75-320) in the preoperative period. All Silastic® ring sleeve gastrectomy procedures were performed by the same surgical team using the same anesthetic technique. The patients were monitored for at least 12 months after surgery. RESULTS: The mean weight of the patients decreased from 107.69 ± 6.57 kg to 70.52 ± 9.36 kg (p < 0.001), the mean BMI decreased to 27.4 ± 2.42 kg/m² (p < 0.001), and the mean waist circumference decreased to 89.87 cm ± 6.66 (p < 0.001) in the postoperative period. Excess BMI loss was 86.5 ± 14.2%. Fasting glucose levels were reduced to 80.94 ± 6.3 mg/dl (p < 0.001). Remission of diabetes and glucose intolerance was observed in all patients. CONCLUSION: Silastic® ring sleeve gastrectomy was effective in promoting weight loss, waist circumference reduction and control of glucose homeostasis in morbidly obese patients.
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    Impaired beta-cell-beta-cell coupling mediated by Cx36 gap junctions in prediabetic mice
    (Amer Physiological Soc, 2012-07-01) Carvalho, Carolina Prado de França [UNIFESP]; Oliveira, R. B.; Britan, A.; Santos-Silva, J. C.; Boschero, A. C.; Meda, P.; Collares-Buzato, C. B.; Universidade Estadual de Campinas (UNICAMP); Univ Geneva; Universidade Federal de São Paulo (UNIFESP)
    Carvalho CP, Oliveira RB, Britan A, Santos-Silva JC, Boschero AC, Meda P, Collares-Buzato CB. Impaired beta-cell-beta-cell coupling mediated by Cx36 gap junctions in prediabetic mice. Am J Physiol Endocrinol Metab 303: E144-E151, 2012. First published May 8, 2012; doi: 10.1152/ajpendo.00489.2011.-Gap junctional intercellular communication between beta-cells is crucial for proper insulin biosynthesis and secretion. the aim of this work was to investigate the expression of connexin (Cx) 36 at the protein level as well as the function and structure of gap junctions (GJ) made by this protein in the endocrine pancreas of prediabetic mice. C57BL/6 mice were fed a high-fat (HF) or regular chow diet for 60 days. HF-fed mice became obese and prediabetic, as shown by peripheral insulin resistance, moderate hyperglycemia, hyperinsulinemia, and compensatory increase in endocrine pancreas mass. Compared with control mice, prediabetic animals showed a significant decrease in insulin-secretory response to glucose and displayed a significant reduction in islet Cx36 protein. Ultrastructural analysis further showed that prediabetic mice had GJ plaques about one-half the size of those of the control group. Microinjection of isolated pancreatic islets with ethidium bromide revealed that prediabetic mice featured a beta-cell-beta-cell coupling 30% lower than that of control animals. We conclude that beta-cell-beta-cell coupling mediated by Cx36 made-channels is impaired in prediabetic mice, suggesting a role of Cx36-dependent cell-to-cell communication in the pathogenesis of the early beta-cell dysfunctions that lead to type 2-diabetes.
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    Improved glycemic control by acarbose therapy in hypertensive diabetic patients: effects on blood pressure and hormonal parameters
    (Associação Brasileira de Divulgação Científica, 2002-08-01) Rosenbaum, Paulo [UNIFESP]; Peres, Ricardo Botticini [UNIFESP]; Zanella, Maria Teresa [UNIFESP]; Ferreira, Sandra Roberta Gouvea [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)
    A double-blind, randomized, placebo-controlled study was carried out on 44 hypertensive type 2 diabetic subjects previously treated by diet associated or not with sulfonylurea to assess the effects of acarbose-induced glycemic control on blood pressure (BP) and hormonal parameters. Before randomization and after a 22-week treatment period (100 to 300 mg/day), the subjects were submitted to a standard meal test and to 24-h ambulatory BP monitoring (ABPM) and had plasma glucose, glycosylated hemoglobin, lipid profile, insulin, proinsulin and leptin levels determined. Weight loss was found only in the acarbose-treated group (75.1 ± 11.6 to 73.1 ± 11.6 kg, P<0.01). Glycosylated hemoglobin decreased only in the acarbose group (6.4 ± 1.7 to 5.6 ± 1.9%, P<0.05). Fasting proinsulin decreased only in the acarbose group (23.4 ± 19.3 to 14.3 ± 13.6 pmol/l, P<0.05), while leptin decreased in both (placebo group: 26.3 ± 6.1 to 23.3 ± 9.4 and acarbose group: 25.0 ± 5.5 to 22.7 ± 7.9 ng/ml, P<0.05). When the subset of acarbose-treated patients who improved glycemic control was considered, significant reductions in diurnal systolic, diastolic and mean BP (102.3 ± 6.0 to 99.0 ± 6.6 mmHg, P<0.05) were found. Acarbose monotherapy or combined with sulfonylurea was effective in improving glycemic control in hypertensive diabetic patients. Acarbose-induced improvement in metabolic control may reduce BP in these patients. Our data did not suggest a direct action of acarbose on insulin resistance or leptin levels.
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    Increased diagnostic probability of subclinical cushing s syndrome in a population sample of overweight adult patients with type 2 diabetes mellitus
    (Sociedade Brasileira de Endocrinologia e Metabologia, 2007-10-01) Caetano, Maria Silvia S. [UNIFESP]; Silva, Regina do Carmo [UNIFESP]; Kater, Claudio Elias [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)
    Endogenous Cushing s Syndrome (CS) is unusual. Patients with subclinical CS (SCS) present altered cortisol dynamics without obvious manifestations. CS occurs in 2-3% of obese poorly controlled diabetics. We studied 103 overweight adult outpatients with type 2 diabetes to examine for cortisol abnormalities and SCS. All collected salivary cortisol at 23:00 h and salivary and serum cortisol after a 1 mg dexamethasone suppression test (DST). Patients whose results were in the upper quintile for each test (253 ng/dL, 47 ng/dL, and 1.8 mg/dL, respectively for the 23:00 h and post-DST saliva and serum cortisol) were re-investigated. Average values from the upper quintile group were 2.5-fold higher than in the remaining patients. After a confirmatory 2 mg x 2 day DST the investigation for CS was ended for 61 patients with all normal tests and 33 with only one (false) positive test. All 8 patients who had two abnormal tests had subsequent normal 24h-urinary cortisol, and 3 of them were likely to have SCS (abnormal cortisol tests and positive imaging). However, a final diagnosis could not to be confirmed by surgery or pathology. Although not confirmatory, the results of this study suggest that the prevalence of SCS is considerably higher in populations at risk than in the general population.
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    Inércia clínica na intensificação da terapia com insulina em pacientes com Diabetes mellitus tipo 2 de um centro de diabetes público, terciário e com limitações no arsenal terapêutico farmacológico
    (Universidade Federal de São Paulo (UNIFESP), 2019-02-28) Alvarenga, Marcelo Alves [UNIFESP]; Chacra, Antonio Roberto [UNIFESP]; Dib, Sergio Atala [UNIFESP]; http://lattes.cnpq.br/3659437526996462; http://lattes.cnpq.br/1283958068077831; http://lattes.cnpq.br/7530162939829529; Universidade Federal de São Paulo (UNIFESP)
    Background: Clinical inertia is related to the difficulty of achieving and maintaining optimal glycemic control. It has been extensively studied the delay of the period to insulin introduction in type 2 diabetes mellitus (T2DM) patients. This study aims to evaluate clinical inertia of insulin treatment intensification in a group of T2DM patients followed at a tertiary public Diabetes Center with limited pharmacologic armamentarium (Metformin, Sulphonylurea and Human Insulin). Methods: This is a real life retrospective record based study with T2DM patients. Demographic, clinical and laboratory characteristics were reviewed. Clinical inertia was considered when the patients did not achieve the individualized glycemic goals and there were no changes on insulin daily dose in the period. Results: We studied 323 T2DM patients on insulin therapy (plus Metformin and or Sulphonylurea) for a period of 2 years. The insulin daily dose did not change in the period and the glycated hemoglobin (A1c) ranged from 8.8 + 1.8% to 8.7 + 1.7% (basal vs 1st year; ns) and to 8.5 + 1.8% (basal vs 2nd year; p = 0.035). The clinical inertia prevalence was 65.8% (basal), 61.9% (after 1 year) and 58.2% (after 2 years; basal vs 1st year vs 2nd year; ns). In a subgroup of 100 patients, we also studied the first 2 years after insulin introduction. The insulin daily dose ranged from 0.22 + 0.12 to 0.32 + 0.24 IU/kg of body weight/day (basal vs 1st year; p < 0.001) and to 0.39 + 0.26 IU/kg of body weight/day (basal vs 2nd year; p < 0.05). The A1c ranged from 9.6 + 2.1% to 8.6 + 2% (basal vs 1st year; p < 0.001) and to 8.7 + 1.7% (1st year vs 2nd year; ns). The clinical inertia prevalence was 78.5% (at the moment of insulin therapy introduction), 56.2% (after 1 year; p = 0.001) and 62.2% (after 2 years; ns). Conclusion: Clinical inertia prevalence ranged from 56.2% to 78.5% at different moments of the insulin therapy (first 2 years and long term) of T2DM patients followed at a tertiary public Diabetes Center from an upper-middle income country with limited pharmacologic armamentarium.
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    A link between sleep loss, glucose metabolism and adipokines
    (Associação Brasileira de Divulgação Científica, 2011-10-01) Padilha, Heloisa Vidigal Guarita [UNIFESP]; Crispim, Cibele Aparecida [UNIFESP]; Zimberg, Ioná Zalcman [UNIFESP]; Souza, Daurea Abadia de; Waterhouse, Jim Maris; Tufik, Sergio [UNIFESP]; Mello, Marco Tulio de [UNIFESP]; Universidade Federal de São Paulo (UNIFESP); Universidade Federal de Uberlândia Faculdade de Medicina; Liverpool John Moores University Research Institute for Sport and Exercise Sciences
    The present review evaluates the role of sleep and its alteration in triggering problems of glucose metabolism and the possible involvement of adipokines in this process. A reduction in the amount of time spent sleeping has become an endemic condition in modern society, and a search of the current literature has found important associations between sleep loss and alterations of nutritional and metabolic contexts. Studies suggest that sleep loss is associated with problems in glucose metabolism and a higher risk for the development of insulin resistance and type 2 diabetes mellitus. The mechanism involved may be associated with the decreased efficacy of regulation of the hypothalamus-pituitary-adrenal axis by negative feedback mechanisms in sleep-deprivation conditions. In addition, changes in the circadian pattern of growth hormone (GH) secretion might also contribute to the alterations in glucose regulation observed during sleep loss. On the other hand, sleep deprivation stress affects adipokines - increasing tumor necrosis factor-α (TNF-α) and interleukin-6 (IL-6) and decreasing leptin and adiponectin -, thus establishing a possible association between sleep-debt, adipokines and glucose metabolism. Thus, a modified release of adipokines resulting from sleep deprivation could lead to a chronic sub-inflammatory state that could play a central role in the development of insulin resistance and type 2 diabetes mellitus. Further studies are necessary to investigate the role of sleep loss in adipokine release and its relationship with glucose metabolism.
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    Long-term nutrition education reduces several risk factors for type 2 diabetes mellitus in Brazilians with impaired glucose tolerance
    (Elsevier B.V., 2010-03-01) Pimentel, Gustavo D. [UNIFESP]; Portero-Mclellan, Katia C.; Oliveira, Erick P.; Spada, Ana P. M.; Oshiiwa, Marie; Zemdegs, Juliane C. S. [UNIFESP]; Barbalho, Sandra M.; Universidade Federal de São Paulo (UNIFESP); Pontificia Univ Catolica Campinas; Universidade de São Paulo (USP); Univ Marilia
    The aim of this study was to evaluate the effects of a nutrition education program (NEP) on anthropometric, dietetic, and metabolic parameters in high-risk subjects for type 2 diabetes mellitus. Fifty-one participants, both sexes, were randomly assigned to either the control (58.8%) or the intervention (NEP) group. the intervention group received frequent individual and group nutritional counseling from a team of nutritionists. Participants were assessed at baseline (M0) and after 12 months (M1) for anthropometric, dietetic, and metabolic parameters. the hypothesis was that high-risk subjects for type 2 diabetes mellitus participating in NEP would show an improvement in these parameters. At M1, the intervention group showed a significant decline in body weight (-3.4%), body mass index (-5.7%), cholesterol intake (-49.5%), fasting glycemia (-14.0%), fasting insulin (-9.0%), postprandial glycemia (-21.0%), postprandial insulin (-71.0%), total serum cholesterol (-23.0%), and glycated hemoglobin (-24.0%). A decrease in energy intake (5%, P = .06) and low-density lipoprotein cholesterol (25%, P = .07) was observed in the interventional group, although it did not reach statistical significance. in contrast, the control group presented a significantly higher energy intake (19%, P = .04) and a nonsignificant increase in consumption of all macronutrients. the long-term NEP was found to improve anthropometric, dietary, and metabolic parameters in high-risk subjects for type 2 diabetes mellitus. (C) 2010 Elsevier Inc. All rights reserved.
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    O impacto da privação do sono na diabetes mellitus do tipo 2 em adultos: uma revisão sistemática da literatura
    (Universidade Federal de São Paulo, 2024-06-18) Silva, Ana Beatriz Cilirio da [UNIFESP]; Ribeiro, Alessandra Mussi [UNIFESP]; http://lattes.cnpq.br/7373640456805525; http://lattes.cnpq.br/5567455453284968; Universidade Federal de São Paulo (UNIFESP)
    Esta revisão sistemática tem como objetivo investigar a relação entre a privação de sono e DM2, destacando pesquisas e intervenções atuais que exploram as interações envolvidas. Para tanto, foi realizada uma busca nas bases de dados Pubmed, Sleep Science e LILACS. Os critérios de elegibilidade incluíram trabalhos publicados e disponíveis integralmente em bases de dados científicas e trabalhos com data de publicação a partir de 2019. Após a busca, 79 estudos foram encontrados e a partir dos critérios de inclusão e exclusão, apenas seis estudos foram selecionados para esta revisão. O número total de participantes nesses estudos foi de 114.844 indivíduos, com idades variando de 18 a 86 anos. Os estudos incluíram diversas variáveis ​​demográficas e de estilo de vida para levar em conta potenciais fatores de confusão. A revisão identificou uma associação bidirecional entre sono e DM2, com privação de sono e sono excessivo associados ao aumento do risco de mortalidade em indivíduos diabéticos. Os mecanismos propostos incluem alterações no metabolismo da glicose, desregulação dos hormônios relacionados à fome e ao apetite e diminuição do gasto energético. A curta duração do sono foi associada a marcadores de obesidade mais elevados em pacientes com DM2. As descobertas destacam o papel crítico do sono adequado e da regulação do ritmo circadiano no controle glicêmico e no desenvolvimento do DM2. Intervenções no sono, incluindo terapias farmacológicas e cognitivo-comportamentais, foram destacadas como essenciais para reduzir a carga do DM2, particularmente em populações vulneráveis.
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    Organic consequences of isolated ileal interposition in rats
    (Springer, 2016) Leal, Lucas Pedroso Fernandes Ferreira [UNIFESP]; Lapchik, Valderez Bastos Valero [UNIFESP]; Gagliardi, Antonio Ricardo de Toledo; Azevedo, João Luiz Moreira Coutinho [UNIFESP]
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    Reduced insulin secretion function is associated with pancreatic islet redistribution of cell adhesion molecules (CAMs) in diabetic mice after prolonged high-fat diet
    (Springer, 2016) Falcao, Viviane Tannuri F. L.; Maschio, Daniela A.; Fontes, Camila Calvo de [UNIFESP]; Oliveira, Ricardo B.; Santos-Silva, Junia C.; Soares Almeida, Anna Carolina; Vanzela, Emerielle C.; Cartaxo, Maria Tereza; Carvalho, Carolina Prado de França [UNIFESP]; Collares-Buzato, Carla Beatriz
    Intercellular junctions play a role in regulating islet cytoarchitecture, insulin biosynthesis and secretion. In this study, we investigated the animal metabolic state as well as islet histology and cellular distribution/expression of CAMs and F-actin in the endocrine pancreas of C57BL/6/JUnib mice fed a high-fat diet (HFd) for a prolonged time period (8 months). Mice fed a HFd became obese and type 2 diabetic, displaying significant peripheral insulin resistance, hyperglycemia and moderate hyperinsulinemia. Isolated islets of HFd-fed mice displayed a significant impairment of glucose-induced insulin secretion associated with a diminished frequency of intracellular calcium oscillations compared with control islets. No marked change in islet morphology and cytoarchitecture was observed
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    Relation of asymmetrical dimethylarginine levels with renal outcomes in hypertensive patients with and without type 2 diabetes mellitus
    (Elsevier Science Inc, 2018) Triches, Cristina B. [UNIFESP]; Quinto, Marie [UNIFESP]; Mayer, Saurus [UNIFESP]; Batista, Marcelo [UNIFESP]; Zanella, Maria Teresa [UNIFESP]
    Aim: The aim of the study was to evaluate the association between high plasma ADMA levels, a biomarker of endothelial dysfunction, with the progression of albuminuria and chronic kidney disease (CKD) in hypertensive patients, with and without type 2 diabetes mellitus. Methods: We successfully contacted 213 of 644 patients who had been evaluated between 2004 and 2005 and for whom basal data were available. After the exclusion of 51 patients, 162 hypertensive patients who were free from albuminuria were stratified into the following 4 groups according to the presence of diabetes and plasma ADMA percentiles: general hypertensive patients with high levels of plasma ADMA (> P4 or ADMA > 0.61 mu mol/L), general hypertensive patients with low levels of plasma ADMA (<= P4), diabetic hypertensive patients with high levels of plasma ADMA (> P4), and diabetic hypertensive patients with low levels of plasma ADMA (<= P4). Results: The patients were prospectively evaluated over 5.8 years. High ADMA levels were associated with the progression of albuminuria in hypertensive patients, with and without type 2 diabetes. Major increases in the ADMA value during follow-up were associated with the progression of CKD, and direct correlations between ADMA changes and GFR changes were observed in the whole group and in the subgroup of diabetic patients. Conclusions: We suggest that high plasma ADMA levels might be a biomarker of renal disease progression and might even be an early predictor of albuminuria and its progression to the late stages of renal disease in hypertensive and diabetic hypertensive patients. (C) 2017 Elsevier Inc. All rights reserved.
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    Síndrome de Cushing subclínica em populações de risco
    (Sociedade Brasileira de Endocrinologia e Metabologia, 2007-11-01) Caetano, Maria Silvia S. [UNIFESP]; Vilar, Lucio; Kater, Claudio Elias [UNIFESP]; Universidade Federal de São Paulo (UNIFESP); Universidade Federal de Pernambuco Hospital das Clínicas Divisão de Endocrinologia
    Based on autopsy studies, adrenal masses are among the most common tumors in humans. Endogenous Cushing's syndrome (CS) is unusual and adrenal adenomas account for 10% of all cases of CS. Patients with subclinical CS (SCS) present abnormal cortisol dynamics without obvious manifestations. The prevalence of hypercortisolism in clinically inapparent adrenal masses has been reported as 9%. Data from several small series of patients indicate that fewer than 20% develop hormone overproduction when followed for up to 10 years. Follow-up of patients with subclinical CS suggests that rarely masses increase in size or progress to overt CS. Adrenal incidentalomas and subclinical CS are related to metabolic disorders, in special to type-2 diabetes. The scarce available data suggest that treatment of hypercortisolism correct the metabolic abnormalities and blood pressure. Some studies evaluating the prevalence of subclinical CS in overweight type-2 diabetes patients suggest that it is considerably higher in populations at risk than in the general population.