Navegando por Palavras-chave "diabetes mellitus"

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    Achados otoneurológicos em indivíduos portadores de Diabetes mellitus Tipo 1
    (ABORL-CCF Associação Brasileira de Otorrinolaringologia e Cirurgia Cérvico-Facial, 2007-02-01) Rigon, Rafaele; Rossi, Angela Garcia [UNIFESP]; Cóser, Pedro Luiz [UNIFESP]; Universidade Federal de Santa Maria; Universidade Federal de São Paulo (UNIFESP); Universidade Federal de Santa Maria Departamento de Otorrino-Fonoaudiologia; Universidade Federal de Santa Maria Departamento de Clínica Médica
    Metabolic alterations, as they occur in Diabetes mellitus, have been mentioned in the development and maintenance of complaints related to the vestibular and auditory organs. AIM: To investigate the vestibular system in Type 1 Diabetic mellitus population. MATERIAL AND METHOD: The present study was developed with 19 individuals, being 10 females (52.6%) and 9 males (47.3%), with ages varying from 8 to 25 years old, with medical diagnosis of Type 1 Diabetes mellitus. For result comparison, a control group was selected with others 19 individuals, matching the study group in age and gender. The evaluation protocol encompassed interview, otoscopic inspection, dynamic and static balance evaluation, cerebellar tests and vectoelectronystagmographic evaluation. STUDY DESIGN: Clinical prospective. RESULTS: Alteration in the vectoelectronystagmographic evaluation were found in 36.84% (n=7) Type 1 Diabetes mellitus individuals, being 21.06% (n=4) Peripheral Deficiency Vestibular Syndrome and 15.79% (n=3) Peripheral Irritative Vestibular Syndrome. CONCLUSION: We conclude that Type 1 Diabetes mellitus individuals can have their vestibular organ affected, even if there are no otoneurologic complaints.
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    Aerobic bacterial conjunctival flora in diabetic patients
    (Lippincott Williams & Wilkins, 2004-03-01) Martins, E. N.; Alvarenga, L. S.; Hofling-Lima, A. L.; Freitas, D.; Zorat-Yu, M. C.; Farah, M. E.; Mannis, M. J.; Univ Calif Davis; Universidade Federal de São Paulo (UNIFESP)
    Objective: To study the aerobic conjunctival flora of diabetic patients and its relation to the presence and level of diabetic retinopathy and the duration of the disease.Methods: one hundred three patients from the diabetic retinopathy screening program of the Federal University of São Paulo with no evidence of ocular surface disease were included. the diabetic patient cohort was compared with 60 nondiabetic subjects. All patients underwent slit-lamp evaluation, conjunctival scrapings, and indirect ophthalmoscopy.Results: the frequency of positive conjunctival cultures was significantly higher in the diabetic group (94.18%) than in the nondiabetic group (73.33%). Among diabetic patients, a significantly higher frequency of positive cultures was detected in those with diabetic retinopathy than in those without retinopathy. Neither the duration of the diabetes nor the hypoglycemic therapy correlated with the culture results. Coagulase-negative Staphylococcus was the most common microorganism isolated, and its identification was more frequent in patients with retinopathy than in those without diabetic retinopathy.Conclusion: Diabetic patients have a significantly higher number of positive conjunctival cultures. the presence of diabetic retinopathy was correlated with an increase in positive cultures and a higher proportion of coagulase-negative Staphylococcus.
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    Angiotensin II antagonists - therapeutic benefits spanning the cardiovascular disease continuum from hypertension to heart failure and diabetic nephropathy
    (Librapharm, 2006-01-01) Ribeiro, A. B.; Universidade Federal de São Paulo (UNIFESP)
    Background: the cardiovascular benefits of angiotensin II antagonists (AIIAs) have been evaluated not only in terms of their ability to lower blood pressure but also on their ability to prevent strokes, cardiac events, and target organ damage. This review summarizes the body of evidence-based data demonstrating the efficacy of AIIAs across the spectrum of cardiovascular disease.Methods:A PubMed/MEDLINE search of English-language articles (1990 to September 2005) was used to identify articles describing clinical studies, particularly outcome trials, or mechanisms of therapeutic action pertinent to the therapy of cardiovascular disease or nephropathy.Findings: the antihypertensive efficacy of AIIAs is apparent across a wide spectrum of hypertensive patients, including black and Asian patients and patients with isolated systolic hypertension. More importantly, large outcome-based studies have demonstrated the efficacy of AIIAs across the continuum of cardiovascular disease, including hypertension, heart failure, post-myocardial infarction, and diabetic nephropathy. the Losartan Intervention for Endpoint reduction in hypertension study (LIFE), Reduction of Endpoints in Non-insulin-dependent Diabetes Mellitus with the All Antagonist Losartan (RENAAL), and the Irbesartan Type 2 Diabetic Nephropathy Trial (IDNT) indicate that AIIAs confer cardiovascular and renal protective effects beyond their ability to lower blood pressure. These blood-pressure independent protective benefits of AIIAs may arise not only by blocking the deleterious effects of All mediated via the AT(1)-receptor but may also be due to beneficial molecule-specific effects. As a class, AIIAs are well tolerated with an overall adverse event profile generally comparable to placebo and superior to that typically seen with calcium channel blockers, ACE inhibitors, diuretics, and beta-blockers.Conclusions: By utilizing the body of clinical trial evidence as a guide to rational prescribing of AIIAs, practitioners can expect to deliver clinical benefits to their patients in terms of survival, prognosis, and quality of life.
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    Associação do eletrocardiograma com diabete melito e síndrome metabólica em nipo-brasileiros
    (Sociedade Brasileira de Cardiologia - SBC, 2009-05-01) Brollo, Luigi [UNIFESP]; Bombig, Maria Teresa Nogueira [UNIFESP]; Mazzaro, Cleber do Lago [UNIFESP]; Francisco, Yoná Afonso [UNIFESP]; Fonseca, Francisco Antonio Helfenstein [UNIFESP]; Carvalho, Antonio Carlos [UNIFESP]; Harima, Helena [UNIFESP]; Hirai, Amélia [UNIFESP]; Póvoa, Rui Manuel dos Santos [UNIFESP]; Universidade Federal de São Paulo (UNIFESP); Japanese-Brazilian Diabetes Study Group
    BACKGROUND: When the Japanese immigrated to the Americas, they were subjected to Westernization, with a great change in lifestyle, specially in dietary habits, and this may explain the increase in the incidence of diabetes mellitus (DM), metabolic syndrome (MS) and cardiovascular disease among them. OBJECTIVE: To study the presence of myocardial necrosis and left ventricular hypertrophy (LVH) in a population of Japanese-Brazilians, using the ECG and its relationship with DM and MS. METHODS: This was a cross-sectional study which evaluated 1,042 Japanese-Brazilians aged 30 or over, 202 of them born in Japan (Issei) and 840 of them born in Brazil (Nissei), from the second phase of the Japanese-Brazilian Diabetes Study Group initiated in 2000. MS was defined according to the NCEP-ATP III criteria modified for the Japanese. DM and MS were associated with the presence of myocardial necrosis (according to the Minnesota criteria) and LVH (according the Perugia score on the ECG). The statistic chi square method was used to reject the null hypothesis.? RESULTS: Of the 1,042 participants, 35.3% had DM (38.6% of the Issei and 34.5% of the Nissei); 51.8% had MS (59.4% of the Issei and 50.0% of the Nissei). The presence of an inactive zone in the diabetic Issei group was not statistically significant when compared to the non-diabetic group, but among the diabetic Nissei group an inactive zone was present in 7.5% of them. There was a statistically significant correlation between MS and LVH in the Issei and Nissei groups. CONCLUSION: Metabolic disorders presented a high prevalence in Japanese-Brazilians with significant correlations with necrosis and hypertrophy on the ECG.
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    Association of endothelial nitric oxide synthase gene intron 4 polymorphism with end-stage renal disease
    (Wiley-Blackwell, 2007-06-01) Bellini, Maria H.; Figueira, Marcia N.; Piccoli, Michelly F.; Marumo, Julio T.; Cendoroglo, Maysa S.; Neto, Miguel C.; Dalboni, Maria Aparecida [UNIFESP]; Batista, Marcelo C.; Goes, Miguel A.; Schor, Nestor; Cidade Univ; Universidade Federal de São Paulo (UNIFESP)
    Background: Nitric oxide (NO) released from endothelial cells is related to the maintenance of physiological vascular tone. the impairment of endothelial NO generation brought about by gene polymorphism is considered one of the deterioration factors in progressive renal disease. in the endothelial nitric oxide synthase (eNOS) intron 4 polymorphism, the presence of the aa genotype has been associated with cardiovascular and renal disease. the aim of this study was to investigate the presence of eNOS gene intron 4 polymorphism in patients with end-stage renal disease (ESRD).Methods: A total of 114 patients and 94 controls were studied. DNA specimens were extracted from blood and amplified by polymerase chain reaction. the alleles were separated by agarose gel electrophoresis. Genotype distribution and allele frequencies were compared between groups using the chi-squared test.Results: Statistical analysis revealed that the frequency of the eNOS4 genotype aa was significantly different in ESRD patients and in controls (P = 0.016, OR = 2.07, CI 95%: 1.14-3.74). There was also a statistically significant difference between ESRD patients and controls regarding allele carriers (P = 0.004; OR = 2.26; CI 95%: 1.29-3.96). When the frequencies of allele carriers in the diabetic nephropathy group and in the control group were compared, a significant difference was found (P = 0.034, OR = 2.28; CI 95%: 1.04-5.00).Conclusion: This study showed a strong correlation between eNOS4a polymorphism and end-stage renal disease.
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    Association of somatic and N-domain angiotensinconverting enzymes from Wistar rat tissue with renal dysfunction in diabetes mellitus
    (J R A A S Ltd, 2007-03-01) Roncbi, Fernanda Aparecida [UNIFESP]; Irigoyen, Maria Claudia [UNIFESP]; Casarini, Dulce E. [UNIFESP]; Universidade Federal de São Paulo (UNIFESP); Universidade de São Paulo (USP)
    Diabetes mellitus (DM) is characterised by alterations in the intrarenal renin-angiotensin system (RAS). Insulin treatment may reverse these changes by an unknown mechanism. We aimed to verify the association between somatic ACE with 136 kDa (sACE) and N-domain ACE with 69 kDa (nACE) from Wistar (W) rat tissue with DM. Three groups were studied: control (CT), insulin treated diabetic (DT) and untreated (D). ACE activity was determined using Hippuryl-His-Leu and Z-Phe-His-Leu as substrates. in D group, urine ACE activity increased for both substrates when compared with CT and DT, despite the decreased activity of renal tissues. Immunostaining of renal tissue demonstrated that ACE is more strongly expressed in the proximal-tubule of D than in the same nephron portion in the other groups. Angiotensin (Ang) 1-7 and Ang II are less expressed in DT group when compared with CT and D. Ang II levels decreased in the D and DT groups showed when compared to the control. Ang 1-7 was detected in all studied groups with low levels in DT. the modulation of angiotensin peptides suggests that sACE, nACE, ACE 2 and NEP could have important functions in renal RAS regulation through a counter-regulatory mechanism to protect the kidney in diabetes mellitus.
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    Chorea-ballism as a manifestation of decompensated type 2 diabetes mellitus
    (Lippincott Williams & Wilkins, 2007-03-01) Chang, Claudia Veiga; Felicio, Andre Carvalho; Godeiro, Clecio de Oliveira; Matsubara, Luiz Shiguero; Duarte, Daniela Rezende; Ferraz, Henrique Ballalai; Okoshi, Marina Politi; Universidade de São Paulo (USP); Universidade Federal de São Paulo (UNIFESP)
    Chorea and ballism are movement disorders that result from a variety of conditions. Hyperglycemia is an unusual recognized cause of these movement disorders. We report 3 cases of new-onset choreaballism induced by nonketotic hyperglycemia in elderly patients, highlighting that chorea may be the first manifestation of undiagnosed decompensated diabetes mellitus.
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    CHOROIDAL THICKNESS in PATIENTS WITH DIABETIC RETINOPATHY ANALYZED BY SPECTRAL-DOMAIN OPTICAL COHERENCE TOMOGRAPHY
    (Lippincott Williams & Wilkins, 2012-03-01) Regatieri, Caio V. [UNIFESP]; Branchini, Lauren; Carmody, Jill; Fujimoto, James G.; Duker, Jay S.; Tufts Med Ctr; Universidade Federal de São Paulo (UNIFESP); Boston Univ; MIT
    Purpose: This study was designed to examine choroidal thickness in patients with diabetes using spectral-domain optical coherence tomography.Methods: Forty-nine patients (49 eyes) with diabetes and 24 age-matched normal subjects underwent high-definition raster scanning using spectral-domain optical coherence tomography with frame enhancement software. Patients with diabetes were classified into 3 groups: 11 patients with mild or moderate nonproliferative diabetic retinopathy and no macular edema, 18 patients with nonproliferative diabetic retinopathy and diabetic macular edema, and 20 patients with treated proliferative diabetic retinopathy and no diabetic macular edema (treated proliferative diabetic retinopathy). Choroidal thickness was measured from the posterior edge of the retinal pigment epithelium to the choroid/sclera junction at 500-mu m intervals up to 2,500 mu m temporal and nasal to the fovea.Results: Reliable measurements of choroidal thickness were obtainable in 75.3% of eyes examined. Mean choroidal thickness showed a pattern of thinnest choroid nasally, thickening in the subfoveal region, and thinning again temporally in normal subjects and patients with diabetes. Mean subfoveal choroidal thickness was thinner in patients with diabetic macular edema (63.3 mu m, 27.2%, P < 0.05) or treated proliferative diabetic retinopathy (69.6 mu m, 30.0%, P < 0.01), compared with normal subjects. There was no difference between nonproliferative diabetic retinopathy and normal subjects.Conclusion: Choroidal thickness is altered in diabetes and may be related to the severity of retinopathy. Presence of diabetic macular edema is associated with a significant decrease in the choroidal thickness. RETINA 32: 563-568, 2012
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    Comparação da coronariografia de mulheres diabéticas e não-diabéticas com síndrome coronariana aguda sem supradesnivelamento de ST
    (Sociedade Brasileira de Cardiologia - SBC, 2006-02-01) Sousa, José Marconi Almeida De [UNIFESP]; Herrman, João L. V. [UNIFESP]; Teodoro, Marco [UNIFESP]; Diogo, Sergio [UNIFESP]; Terceiro, Bernardino Bandeira [UNIFESP]; De Paola, Angelo Amato Vincenzo [UNIFESP]; Carvalho, Antonio Carlos [UNIFESP]; Universidade Federal de São Paulo (UNIFESP); Hospital Santa Marcelina
    OBJECTIVE: Compare hemodynamic and angiographic patterns, as well as atherosclerotic lesion morphology, in diabetic and non-diabetic females with unstable angina or non-ST-segment-elevation myocardial infarction (UA/NSTEMI). METHODS: Two interventional cardiologists determined the presence of severe atherosclerotic lesion, defined as those > 70%; plaque morphology, according to the American Heart Association classification; collateral circulation; plus ventricular and aortic pressures. Ejection fraction was calculated by angiography or echocardiography. RESULTS: During eight and a half years, 645 coronary angiographies were performed in women with UA/NSTEMI. In the present study, 593 female patients were assessed (215 diabetic - 36%). This group differed from the non-diabetic in the following aspects: older age (61 ± 10.6 x 58.1 ± 11.4), higher prevalence of postmenopausal women and lower prevalence of the smoking habit. Severe three-vessel disease was significantly more frequent in diabetic patients (28% x 10%), as well as totally occluded vessels: 51 (23%) x 54 (14.3%), p < 0.005. Additionally, ejection fraction < 50% was more common in diabetic patients. CONCLUSION: These findings confirm the diffuse pattern of atherosclerotic disease in diabetic patients, as well a greater deterioration of ventricular function, which may be associated to the poorer prognosis seen in this population both in the short- and long-term.
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    Comparison of full-field electroretinogram in diabetic and non diabetic dogs with cataracts
    (Colégio Brasileiro de Patologia Animal - CBPAEmpresa Brasileira de Pesquisa Agropecuária (EMBRAPA), 2010-12-01) Safatle, Angélica de Mendonça Vaz; Hvenegaard, Ana Paula; Otsuki, Denise; Martins, Terezinha Luiza; Kahvegian, Márcia; Berezovsky, Adriana [UNIFESP]; Salomão, Solange Rios [UNIFESP]; Barros, Paulo Sergio de Moraes; Universidade de São Paulo (USP); Universidade Federal de São Paulo (UNIFESP)
    Being the commonest ocular disorder, dense cataracts disable fundoscopic examination and the diagnosis of retinal disorders, which dogs may be predisposed. The aim of this study was to compare the electroretinographic responses recorded according to the International Society for Clinical Electrophysiology of Vision human protocol to evaluate retinal function of diabetic and non diabetic dogs, both presenting mature or hypermature cataracts. Full-field electroretinogram was recorded from 66 dogs, with ages varying from 6 to 15 years old allocated into two groups: (1) CG, non diabetic cataractous dogs, and (2) DG, diabetic cataractous dogs. Mean peak-to-peak amplitude (microvolts) and b-wave implicit time (milliseconds) were determined for each of the five standard full-field ERG responses (rod response, maximal response, oscillatory potentials, single-flash cone response and 30 Hz flicker). Comparing CG to DG, ERGs recorded from diabetic dogs presented lower amplitude and prolonged b-wave implicit time in all ERG responses. Prolonged b-wave implicit time was statistically significant (p< 0.05) at 30 Hz flicker (24.0 ms versus 22.4 ms). These data suggests full-field ERG is capable to record sensible alterations, such as flicker's implicit time, being useful to investigate retinal dysfunction in diabetic dogs.
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    Complex partial seizures and aphasia as initial manifestations of non-ketotic hyperglycemia: case report
    (Academia Brasileira de Neurologia - ABNEURO, 1998-06-01) Batista, Marcus Sabry Azar [UNIFESP]; Silva, DÉlrio FaÇanha [UNIFESP]; Ferraz, Henrique Ballalai [UNIFESP]; Andrade, Luiz Augusto Franco de [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)
    We describe a case of non-ketotic hyperglycemia (NKH), heralded by complex partial seizures and aphasia of epileptic origin, besides versive and partial motor seizures. This clinical picture was accompanied by left fronto-temporal spikes in the EEG. The seizures were controlled by carbamazepine only after the control of the diabetes. A month later, carbamazepine was discontinued. The patient remained without seizures, with normal language, using only glybenclamide. Complex partial seizures, opposed to simple partial seizures, are rarely described in association to NKH. Epileptic activity localized over language regions can manifest as aphasia.
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    Efeitos de diferentes graus de sensibilidade a insulina na função endotelial de pacientes obesos
    (Sociedade Brasileira de Cardiologia - SBC, 2012-01-01) Galvão, Roberto [UNIFESP]; Plavnik, Frida Liane [UNIFESP]; Ribeiro, Fernando Flexa [UNIFESP]; Ajzen, Sergio Aron [UNIFESP]; Christofalo, Dejaldo M. de J. [UNIFESP]; Kohlmann Junior, Osvaldo [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)
    BACKGROUND: Obesity derived from intra-abdominal fat deposition tends to increase hormonal and cytokine production, thus worsening insulin sensitivity and leading to endothelial dysfunction. Hyperinsulinemia is considered an independent risk factor for ischemic heart disease and cause of endothelial dysfunction in healthy individuals. OBJECTIVE: To assess the impact of different degrees of insulin resistance, measured by HOMA-IR (Homeostasis Model Assessment of Insulin Resistance), on endothelial function in obese, non-diabetic patients without prior history of cardiovascular events and different metabolic syndrome components. METHODS: Forty obese individuals were submitted to anthropometric measurements, BP measurements at office and ABPM and laboratory tests, in addition to non-invasive ultrasound assessment of endothelial function. Patients were divided into 3 groups according to the level of insulin resistance: patients with HOMA-IR values from 0.590 to 1.082 were assigned to Group 1 (n=13), from 1.083 to 1.410 to Group 2 (n=14) and from 1.610 to 2.510 to Group 3 (n=13). RESULTS: We found a significant difference in flow-mediated dilation in group 3 compared to group 1 (9.2±7.0 vs 18.0±7.5 %, p=0.006). There was a negative correlation between endothelial function and insulin, HOMA-IR and triglycerides. CONCLUSION: Our data suggest that mild changes in insulin resistance levels assessed by HOMA-IR may have an impact on vasodilatatory endothelial function in uncomplicated obese individuals with different cardiovascular risk factors.
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    Efeitos do kefir sobre a produção de citocinas e óxido nítrico a partir de macrófagos peritoneais de ratos com diabetes mellitus induzido por estreptozotocina
    (Universidade Federal de São Paulo (UNIFESP), 2014-11-30) Maciel, Fabiane Romano [UNIFESP]; Higa, Elisa Mieko Suemitsu [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)
    Diabetes mellitus é um grave problema de saúde global. Estão previstos entre 366 e 439 milhões de casos em 2030, em todo o mundo. A produção excessiva de espécies reativas de oxigênio no diabetes, decorrente da hiperglicemia e do estresse oxidativo induz a peroxidação lipídica e prejudica a resposta imune. O Kefir (K) é um produto lácteo fermentado, considerado um probiótico, que apresenta propriedades imunomoduladoras. Este estudo teve como objetivo investigar o efeito da ingestão de K sobre a produção de citocinas e de óxido nítrico em sobrenadante de cultura de macrófagos peritoneais extraídos de ratos com diabetes mellitus induzido por estreptozotocina (STZ). Para isso, ratos Wistar, machos, adultos receberam única injeção de STZ (45 mg/kg, por via intravenosa). Após 72 horas, a concentração de glicose foi medida no sangue da veia caudal por um glicosímetro, sendo considerados diabéticos os animais com glicemia ≥ 200 mg/dL. Os animais foram distribuídos em 4 grupos (n= 5-8 cada): controle (CTL), CTLK, diabético (DM) e DMK, recebendo 1,8mL de K (1010 unidades formadoras de colônias - UFC/g de bactérias lácticas e 104 a 107 UFC/g de levedura) ou o seu veículo por dia, via gavagem, preparado de acordo com as instruções do fabricante; começando no 5º dia de diabetes, durante 8 semanas. Pré e pós-tratamento, os animais foram colocados em gaiolas metabólicas para quantificação dos dados metabólicos (ingestão de água, consumo de ração, diurese, glicemia e massa corporal). Após o tratamento, os animais foram sacrificados em câmara de CO2 e exsanguinados; logo em seguida, a cavidade peritoneal foi preparada e os macrófagos residentes foram coletados e cultivados para análise da capacidade fagocítica, citocinas (IL-10, TNFα, IL-17 e IL-1β) e óxido nítrico (NO). Os resultados são apresentados como média ±EP, analisados por one way ANOVA. O grupo DM, quando comparado ao CTL, apresentou aumento na ingestão hídrica, consumo de ração, diurese e glicemia, demonstrando redução no peso. Após tratamento com K, observamos que essa diferença se manteve entre os grupos DM e CTL, contudo, o grupo DMK apresentou níveis inferiores nos parâmetros metabólicos estudados, exceto para massa corporal, a qual estava aumentada, quando comparado ao DM. Em relação à função dos macrófagos peritoneais, o grupo DMK apresentou melhora na capacidade fagocítica, aumento na concentração de citocinas e de NO em sobrenadante de cultura celular, comparado ao DM. Estes resultados sugerem que o K tem potencial de modular a resposta imune e ativar a resposta de macrófagos peritoneais em animais diabéticos, o que poderia melhorar a imunocompetência de pacientes acometidos pelo diabetes. O efeito hipoglicemiante deste probiótico poderia ser usado como ferramenta no controle da glicemia, podendo reduzir ou retardar o aparecimento das complicações associadas a esta doença.
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    Efetividade e segurança dos fibratos no diabetes mellitus tipo 2: protocolo de revisão sistemática
    (Universidade Federal de São Paulo (UNIFESP), 2014-09-24) Bonates, Milla Canicali [UNIFESP]; Silva, Cristiane Rufino da Silva [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)
    Introduction: The type 2 diabetes mellitus is a group of metabolic diseases characterized by hyperglycemia resulting from defects in insulin secretion, insulin action, or both. Type 2 diabetes is the predominant form of disease, accounting for 90% of cases globally. The cardiovascular disease (CVD) is the main cause of morbidity and mortality in people with type 2 diabetes and correction of diabetic dyslipidemia might be the most important factor in reducing cardiac risk. Dyslipidemia in patients with T2DM is characterized by high triglyceride levels, low HDL-cholesterol levels, and a preponderance of small, dense, LDL-cholesterol particles. Although the statins have been shown to significantly reduce LDL-cholesterol levels, they do not specifically address the high triglyceride levels and low HDL-cholesterol levels observed in diabetic patients, both of which have been shown to be independent predictors for occurrence of adverse cardiovascular events. The fibrates are lipid-lowering medications and their major effects are to lower serum triglycerides and to raise HDL-cholesterol concentrations. Although the fibrates favorably affect two of the fundamental abnormalities of diabetic dyslipidemia, the net of CVD effects of this class of drugs remain uncertain. A systematic review of the literature is obligatory to define how effective and safe is the fibrates for the cardiovascular disease prevention in type 2 diabetes mellitus. Objective: To assess the effects of fibrates on people with type 2 diabetes mellitus. Systematic review with Cochrane methodology. Search strategy: Databases MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials (CENTRAL), LILACS, databases of ongoing trials, hand searched reference lists of published articles and conference meetings. Pharmaceutical companies and authors of published articles were contacted. There was no language restriction. Selection criteria: Randomized controlled trials (RCT) of placebo-controlled or active comparator studies of fibrates in adults with type 2 diabetes mellitus. Data collection & analysis: Data abstraction and quality assessment was performed independently by three investigators according to predetermined criteria and the results were compared to determine the degree of agreement. Quality evaluation was done using the criteria of methodological quality described in Cochrane Handbook. Continuous outcome measures were pooled using weighted mean differences (WMD). Dichotomous outcome measures were pooled using random effects model and results were expressed as relative risks (RR).
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    Effect of sodium overload on renal function of offspring from diabetic mothers
    (Springer, 2008-11-01) Rocco, Luigi [UNIFESP]; Gil, Frida Zaladek [UNIFESP]; Fonseca Pletiskaitz, Thais Maria da [UNIFESP]; Cavanal, Maria de Fatima [UNIFESP]; Gomes, Guiomar Nascimento [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)
    The aim if this study was to evaluate the effect of sodium overload on blood pressure and renal function in the offspring of diabetic rat mothers. Diabetes was induced with a single dose of streptozotocin before mating. Experimental groups were control (C), offspring from diabetic mother (D), control with sodium chloride (NaCl) overload (CS), and offspring from diabetic mother submitted to NaCl overload (DS). After weaning, all groups received food ad libitum; groups C and D had water ad libitum, and CS and DS received NaCl 0.15 M as drinking water. Renal morphology and function were evaluated in 3-month-old rats. Glomerular area, macrophage infiltration, interlobular artery wall thickness, and renal vascular resistance were significantly increased in CS, D, and DS compared with C. Renal plasma flow (RPF) and glomerular filtration rate (GFR) were decreased in CS and D compared with C. in DS, GFR and fractional filtration were increased, suggesting a state of hyperfiltration. Hypertension was observed in groups D, CS, and DS from 2 months on and was more severe in DS. Our data suggest that diabetes during intrauterine development and salt overload beginning at an early age can cause hypertension and renal injury. When these conditions were associated, morphological and functional changes were much more intense, suggesting acceleration in the process of kidney injury.
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    Elaboração e implementação de protocolo de controle glicêmico em pacientes não críticos hospitalizados em hospital terciário
    (Universidade Federal de São Paulo (UNIFESP), 2016-07-27) Carpentieri, Giovanna Braganholo [UNIFESP]; Sa, Joao Roberto de Sa [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)
    Introduction: Hyperglycemia in diabetic and non-diabetic patients hospitalized in noncritically ill condition is common in general hospitals. Several observational studies with inpatients show a strong correlation between hyperglycemia and increased risk of adverse clinical outcomes, such as prolonged hospitalization, higher infections rates, increased morbidity and mortality and increased hospital costs. Although current guidelines recommend that hyperglycemic patients should be treated with basal-bolus insulin regimen, a more physiological and effective method, in most hospitals it still prevails the use of the sliding scale, treatment associated with increased glycemic variability and poor prognosis. Purpose: Develop and implement an institutional protocol for glycemic control in noncritically ill inpatients. Methods: The study was conducted at Hospital São Paulo of the Paulista School of Medicine - Federal University of São Paulo. The project was developed in three phases. The first phase consisted of the theoretical foundation and development of a pilot protocol according to the current guidelines and based on existing protocols at other institutions. In the second phase, meetings were held with the Clinical and Technical Directors and with the management teams of nutrition, laboratory and nursing to adapt the pilot protocol to the needs and technical and human conditions of the hospital. The last phase was based on an outreach program for the professionals involved in the inpatients care. Results: a protocol for glycemic control for noncritically ill patients customized according to the complexity and the material and human resources of the Hospital São Paulo was prepared. The protocol was designed in the form of flow charts, one for the treatment of hyperglycemia, using the basal-bolus insulin therapy regimen, and a second one for the treatment of hypoglycemia. It was approved by the board of the Hospital São Paulo. The outreach plan included training of professionals involved in the care of hospitalized patients through printed materials, lectures and teaching materials available on the Internet. After training, the project was implemented in 30 medical and surgical wards of the institution. Conclusion: The development and implementation of an institutional protocol for glycemic control is a potentially effective way to increase security by treating hyperglycemic patients and improve the quality of care provided by health professionals. This deployment model can guide other hospitals in their initiatives for the management of blood glucose levels in hospitalized patients.
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    Energy balance of pregnant diabetic rats
    (C A B I Publishing, 2002-05-01) Yamada, Ruth [UNIFESP]; Griggio, Mauro Antonio [UNIFESP]; Luz, Jacqueline [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)
    Pregnancy and diabetes lead to metabolic alterations in the energy balance that may not be completely independent. the objective of the present study was to look at the alterations induced by type 1 diabetes mellitus on the energy balance of pregnant rats and the offspring. Diabetes was induced by streptozotocin injection 15 d before the starting of pregnancy. the rats had their energy balance variables followed for 21 d. Protein, fat and energy content of dams was determined from samples of the carcasses. Pregnancy led to increased energy intake, energy gain and energy expenditure as well as higher gross food efficiency than non-pregnant counterparts. Diabetes increased metabolizable energy intake but not the energy gain of the animals: they had very high energy expenditure, so that diabetes blocked the improvement in gross food efficiency shown during pregnancy. Offspring from diabetic dams were born with lower body weight. Pregnant animals did not present the usual energy storage as seen by lower energy gain of diabetic dams as well as by the lower fat content in the carcasses of pregnant diabetic rats. It is concluded that diabetes impairs the energy variables usually enhanced by pregnancy alone.
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    Enzimas lisossomais em células renais em cultura submetidas a condições que mimetizam o estado diabético
    (Universidade Federal de São Paulo (UNIFESP), 2016-08-31) Peres, Giovani Bravin [UNIFESP]; Michelacci, Yara Maria Correa da Silva Michelacci [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)
    Diabetic nephropathy affects about one third of ali diabetic patients, and is the most common cause of end-stage renal disease. By the use of intravital microscopy and fluorescent albumin, it has been shown that the renal filtration of albumin in normal rats is almost 50 times the values previously reported, obtained by micropuncture. As the albumin concentration in normal urine is very low, it seems that there is a retrieval pathway, possibly in proximal tubular cells. Internalized albumin may either be retrieved back to circulation via transcytosis or follow Iysósomal degradation, with fragments being exocytosed back into tubular lumen and excreted in urine. So, increased albuminuria in diabetic patients could be due to lower renal degradation rates of albumin. We have recently reported decreased expression and activities of Iysosomal proteases, especially cathepsins B and L, in kidney during the early stages of diabetes (10 and 30 days) in rats. Important morphological changes were observed in proximal tubules, which have lost their brush borders and presented thinner walls, in comparison to normal. Immunohistochemistry have shown that most of cathepsin B is localized in proximal tubular cells, suggesting that these cells are implicated in the early stages of the disease. Despite ali this information concerning Iysosomal enzymes and diabetes, the mechanisms that trigger these changes are unknown. The aim of the present study was to investigate the effects of high glucose and advanced glycation end products (AGEs) upon Iysosomal enzymes in kidney cells. Immortalized cell lines derived from kidney cells were submitted to conditions that mimic the diabetic state - high glucose and/or AGE-albumin (AGE-BSA) - and their effecfs upon cell proliferation, expression and activities of Iysosomal enzymes, and expression of other mediators of inflammation and cell metabolism were studied. The results have demonstrated that high glucose increased the proliferation rates of mesangial cells only (CMHI), while epithelial tubular cells were not affected. Although control-BSA had no effect upon the proliferation rate of the cells here studied, AGE-BSA caused a marked decrease in the number of both epithelial and mesangial cells, in a dose-dependent fashion, irrespectively of glucose concentration in culture medium Concerning Iysosomal enzymes, the main cysteine-protease in ali the renal-derived cells here studied was cathepsin B, although its concentration was much lower in mesangial than in epithelial cells. Exposure to high glucose had no effect on the activity of the enzyme, but AGE-BSA caused a marked decrease in LLCPK only, while increases were observed in the other cell lines. Furthermore, the levels of nitric oxide (NO) produced and secreted to the culture media were also increased by AGE-BSA in ali cell types here studied, suggesting oxidative stress. Concerning the expression of some proteins, Western blotting has shown that, among the investigated proteins, the mammalian (mechanistic) target of rapamycin - mTOR - was the most significantly affected by exposure to AGE-BSA.
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    Evolução das alterações no metabolismo energético cerebral ao longo dos diferentes estágios do transtorno bipolar
    (Universidade Federal de São Paulo (UNIFESP), 2015-12-18) Mansur, Rodrigo Barbachan [UNIFESP]; Brietzke, Elisa Macedo [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)
    Metabolic comorbidities are frequent in individuals with bipolar disorder (BD), including a high prevalence of diabetes mellitus and metabolic syndrome in this population. Several biological systems related to energy metabolism have been shown to be altered in BD, but the pathophysiology of metabolic changes in BD remains largely unknown. Recent theories postulate that the brain prioritizes its own energy supply, modulating the peripheral metabolism through the regulation of allocation and nutrient intake ("selfish brain? theory). The studies that compose this thesis were based on the hypothesis that the metabolic changes observed in BD are the result of an inefficient regulation of brain energy supply and its compensatory responses. The aim was to investigate the relationship between energy metabolism and clinical and biological characteristics of BD over the course of the illness. Towards this aim we conducted a casecontrol study comparing three groups: 30 patients with BD in the early stages (defined as less than 5 episodes of mania or depression), 30 patients with BD in late stages (defined as more than 5 episodes of mania or depression) and 30 healthy volunteers. All subjects were submitted to standardized psychiatric interview and blood sampling for analysis of markers of glucose metabolism, oxidative stress, stress response, lipids and regulatory hormones. The results demonstrate that the presence of metabolic comorbidities moderate clinical and biological features of the disease. Patients in the late stages of BD had a higher prevalence of metabolic comorbidities, when compared to patients in the early stages and healthy controls. Conversely, the presence of metabolic abnormalities (e.g. insulin resistance and dyslipidemia) was associated with an unfavorable course of BD, characterized by a higher number of previous mood episodes and poor psychosocial functioning. Furthermore, the stages of BD and the presence of impaired glucose metabolism or diabetes mellitus impacted the activity levels of the antioxidant enzymes 17 glutathione peroxidase and superoxide dismutase. Finally, it was also documented that in patients with BD, broad changes in energy metabolism, such as abnormalities in glucose metabolism, leptin levels and activity of antioxidant enzymes were associated with activation of the stress response system, assessed by levels of the biomarker copeptin. All results described herein were independent of keys confounders such as socio-demographic characteristics, smoking and use of psychotropic medications. In conclusion, not only BD is frequently associated with metabolic comorbidities, but they also affect several different domains of the illness, as demonstrated by the results of the studies that comprise this thesis. The differences in course, psychosocial functioning and pathophysiological substrates observed among patients with BD in the late and early stages, as well as between patients and controls, indicate that metabolic systems are, in fact, prominently involved in BD pathophysiology and are therefore promising targets for the development of future clinical and therapeutic investigations.
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    Factors associated with the development of renal complications of diabetes mellitus in Sao Paulo city
    (Assoc Bras Divulg Cientifica, 1997-06-01) Ferreira, Sandra Roberta Gouvea [UNIFESP]; Pinto, Flavio Mendonca [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)
    The incidence of diabetic end-stage renal failure (ESRF) varies worldwide and risk factors have been demonstrated in several populations. The objective of the present study was to identify possible factors associated with the risk of development of ESRF in patients with diabetes mellitus (DM). Two groups of diabetic subjects were included in a case-control study: 1) one group was submitted to renal replacement therapies, attending dialysis centers in Sao Paulo city and 2) the same number of controls without clinical nephropathy (two negative dipstick tests for urine protein), matched for duration of DM, were obtained from an outpatient clinic. A standardized questionnaire was used by a single investigator and additional data were obtained from the medical records of the patients. A total of 290 diabetic patients from 33 dialysis centers were identified, and 266 questionnaires were considered to contain reliable information. Male/female ratios were 1.13 for ESRF and 0.49 for the control group. A higher frequency of men was observed in the ESRF group when compared with controls (53 vs 33%, P<0.00001), although logistic regression analysis did not confirm an association of gender and diabetic nephropathy (DN). Similar proportions of non-white individuals were found for both groups. Patients with insulin-dependent diabetes mellitus (IDDM) were less common than patients with non-insulin-dependent diabetes mellitus (NIDDM), particularly in the control group (3.4 vs 26.3%, P<0.00001, for controls and ESRF patients, respectively); this type of DM was associated with a higher risk of ESRF than NIDDM, as determined by univariate analysis or logistic regression (OR = 4.1). Hypertension by the time of the DM diagnosis conferred a 1.4-fold higher risk of ESRF (P = 0.04), but no difference was observed concerning the presence of a family history. Association between smoking and alcohol habits and increased risk was observed (OR = 4.5 and 5.9, respectively, P<0.001). A 2.4-fold higher risk of ESRF was demonstrated in patients with multiple hospitalizations due to DM decompensation, which suggested poor metabolic control. Photocoagulation and neuropathy were found to be strongly associated with ESRF but not with macrovascular disease. Data collected in our country reinforce the higher risk attributable to IDDM and the association between hypertension and the progression of DN. Indirect evidence for an association with metabolic control is also suggested.