Navegando por Palavras-chave "type 2 diabetes mellitus"

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    ADIPOQ and adiponectin: the common ground of hyperglycemia and coronary artery disease?
    (Sociedade Brasileira de Endocrinologia e Metabologia, 2011-10-01) Oliveira, Carolina Soares Viana de [UNIFESP]; Giuffrida, Fernando M. A. [UNIFESP]; Crispim, Felipe [UNIFESP]; Saddi-rosa, Pedro [UNIFESP]; Reis, André Fernandes [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)
    Plasma adiponectin and the coding gene for adiponectin, ADIPOQ, are thought to explain part of the interaction between obesity, insulin resistance, type 2 diabetes (T2DM) and coronary artery disease (CAD). Here, we illustrate the role that adiponectin and ADIPOQ variants might play in the modulation of CAD, especially in the occurrence of hyperglycemia. Recent evidence suggests that total and high molecular weight (HMW) adiponectin levels are apparent markers of better cardiovascular prognosis in patients with low risk of CAD. However, in subjects with established or high risk of CAD, these levels are associated with poorer prognosis. We also provide recent evidences relating to the genetic control of total and HMW adiponectin levels, especially evidence regarding ADIPOQ. Accumulated data suggest that both adiponectin levels and polymorphisms in the ADIPOQ gene are linked to the risk of CAD in patients with hyperglycemia, and that these associations seem to be independent from each other, even if adiponectin levels are partly dependent on ADIPOQ.
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    Diabetes melito do tipo 2 na infância e adolescência: revisão da literatura
    (Sociedade Brasileira de Pediatria, 2003-06-01) Gabbay, Monica Andrade Lima [UNIFESP]; Cesarini, Paulo R. [UNIFESP]; Dib, Sergio Atala [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)
    OBJECTIVE: the objective of this manuscript was to perform a critical review of epidemiology, pathophysiology, diagnosis e treatment of T2DM in youth. SOURCES OF DATA: this review is based on the relevant literature published. The sources available for the authors were integrated with sources identified through Medline database. The key words used for searching were Type 2 Diabetes in the Youth in the last ten years. SUMMARY OF THE FINDINGS: the pathophysiology (altered beta-cell function and insulin resistance) of T2DM in youth is similar to adult's pathophysiology. Familiar Type 2 diabetes history, presence of obesity, acanthosis nigricans, high fasting plasma C-peptide levels and absence of islet-cell auto-antibodies are important clues to diagnostic the T2DM in youth. Five to 25% of these patients can present ketosis at diagnosis. Insulin therapy can be discontinued during the evolution. Compliance to diet and an exercise program essential aspects of the treatment of adolescents. CONCLUSION: as obesity in the young is currently increasing in several developed or developing countries, T2DM in the youth can be consider an emergent problem also in our population.
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    Diabetic Hypertensive Leptin Receptor-Deficient db/db Mice Develop Cardioregulatory Autonomic Dysfunction
    (Lippincott Williams & Wilkins, 2009-02-01) Goncalves, Andrey C. da Costa; Tank, Jens; Diedrich, Andre; Hilzendeger, Aline Mourão [UNIFESP]; Plehm, Ralph; Bader, Michael [UNIFESP]; Luft, Friedrich C.; Jordan, Jens; Gross, Volkmar; Max Delbruck Ctr Mol Med; Hannover Med Sch; Universidade Federal de São Paulo (UNIFESP); Vanderbilt Univ; HELIOS Klin
    Leptin receptor-deficient db/db mice develop human type 2 diabetes mellitus, hypertension, and obesity with disrupted circadian blood pressure (BP) rhythm. Whether leptin is the sole mechanism mediating autonomic imbalance and hypertension is unclear. To explore this notion further, we measured BP by radiotelemetry combined with fast Fourier transformation and assessed autonomic function pharmacologically before and after renin-angiotensin system blockade with enalapril. the resting period BP (117 +/- 3 versus 108 +/- 1.0 mm Hg) and heart rate (HR; 488 +/- 12 versus 436 +/- 8 bpm) were higher in db/db mice compared with db/+ mice. BP and HR amplitudes were lower in db/db mice compared with db/+ mice. BP response to trimetaphan (-43 +/- 5 versus -27 +/- 3 mm Hg) and HR response to metoprolol (-59 +/- 12 versus -5 +/- 4 bpm) were greater in db/db mice than in db/+ mice. the HR response to atropine was blunted in db/db mice (59 +/- 17 versus 144 +/- 24 bpm), as were baroreflex sensitivity and HR variability. Enalapril improved autonomic regulation in db/db mice. Stimulation of central alpha-2 adrenoreceptors enhanced both parasympathetic HR control and baroreflex sensitivity in db/db mice. We suggest that functional, rather than structural, alpha-2 adrenoceptor changes and the renin-angiotensin system are involved in the increased sympathetic and decreased parasympathetic tones in db/db mice. Our data suggest that db/db mice exhibit features found in humans with type 2 diabetic autonomic neuropathy and could serve as a model for this complication. (Hypertension. 2009; 53[part 2]: 387-392.)
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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 blood glucose on left ventricular mass in patients with hypertension and type 2 diabetes mellitus
    (Elsevier B.V., 2000-11-01) Felicio, João S.; Ferreira, Sandra RG; Plavnik, Frida L.; Moises, Valdir; Kohlmann Junior, Oswaldo; Ribeiro, Artur B.; Zannella, Maria Teresa; Universidade Federal de São Paulo (UNIFESP)
    The aim of our prospective study was to evaluate the influence of blood glucose (BG) on left ventricular mass and diastolic function in patients with hypertension and type 2 diabetes mellitus (DM). Fifty-six hypertensive patients with type 2 DM and 26 healthy controls were investigated. They were submitted to echocardiography (ECHO) with Doppler and we calculated the mean of their fasting BG values, office blood pressure (OBP), cholesterol and fractions, and triglycerides during the previous 4 years. the diabetic patients were then followed-up for 1 year with OBP, fasting BG, and lipids measured every 2 months. After this period, the patients were again submitted to ECHO and in 22 patients (group I [GI]), reductions greater than 10% in left ventricular mass index (LVMI) were observed (122 +/- 35 nu 89 +/- 23 g/m(2), P < .01), whereas increases greater than 10% (group II [GII], n = 17) (94 +/- 18 115 +/- 27 g/m(2), P < .01) or no changes (group III [GIII], n = 17) (98 +/- 16 99 +/- 18 g/m2, NS) in LVMI were detected in the remaining patients. the OBP values did not change during the follow-up. in GI the reduction of LVMI was associated with a BG fall from 178 +/- 36 to 147 +/- 30 mg/dL (P < .01) and a correlation was observed between BG and LVMI percent variations () (r = 0.48, P < .01). No important changes in left ventricular diastolic function were observed during the follow-up. We concluded that the improvement in glycemic control may contribute to LVH regression in hypertensive patients with type 2 DM. Am J Hypertens 2000; 13:1149-1154 (C) 2000 American Journal of Hypertension, Ltd.
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    Laparoscopic treatment of type 2 diabetes mellitus for patients with a body mass index less than 35
    (Springer, 2008-03-01) DePaula, A. L.; Macedo, A. L. V.; Rassi, N.; Machado, C. A.; Schraibman, V. [UNIFESP]; Silva, L. Q.; Halpern, A.; Hosp Especialidades Ctr Med La Raza; Albert Einstein Hosp; Hosp Geral Goiania; Universidade Federal de São Paulo (UNIFESP); Universidade de São Paulo (USP)
    Background Type 2 diabetes mellitus (T2DM) is a common disease with numerous complications. Bariatric surgery is an efficient procedure for controlling T2DM in morbidly obese patients. in T2DM, the incretin effect is either greatly impaired or absent. This study aimed to evaluate the preliminary results from interposing a segment of ileum into the proximal jejunum associated with a sleeve or diverted sleeve gastrectomy to control T2DM in patients with a body mass index (BMI) less than 35 kg/m(2).Methods for this study, 39 patients (16 women and 23 men) underwent two laparoscopic procedures comprising different combinations of ileal interposition into the proximal jejunum via a sleeve or diverted sleeve gastrectomy. the mean age of these patients was 50.3 years (range, 36-66 years). the mean BMI was 30.1 kg/m(2) (range, 23.4-34.9 kg/m(2)). All the patients had a diagnosis of T2DM that had persisted for at least 3 years and evidence of stable treatment with oral hypoglycemic agents or insulin for at least 12 months. the mean duration of T2DM was 9.3 years (range, 3-22 years).Results the mean operative time was 185 min, and the median hospital stay was 4.3 days. Four major complications occurred in the short term (30-days), and the mortality rate was 2.6%. the mean postoperative follow-up period was 7 months (range, 4-16 months), and the mean percentage of weight loss was 22%. the mean postoperative BMI was 24.9 kg/m(2) (range, 18.9-31.7 kg/m2). An adequate glycemic control was achieved for 86.9% of the patients, and 13.1% had important improvement. the patients whose glycemia was not normalized were using a single oral hypoglycemic agent. No patient needed insulin therapy postoperatively. All the patients except experienced normalization of their cholesterol levels. Targeted triglycerides levels were achieved by 71% of the patients, and hypertension was controlled for 95.8%.Conclusions the laparoscopic ileal interposition via either a sleeve gastrectomy or diverted sleeve gastrectomy seems to be a promising procedure for the control of T2DM and the metabolic syndrome. A longer follow-up period is needed.
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    Metabolic and haemodynamic effects of metformin in patients with type 2 diabetes mellitus and hypertension
    (Blackwell Science Ltd, 2001-10-01) Uehara, M. H.; Kohlmann, NEB; Zanella, M. T.; Ferreira, SRG; Universidade Federal de São Paulo (UNIFESP)
    Background: Since metformin improves insulin sensitivity, it has been indicated for patients with diabetes and hypertension, which are insulin-resistant conditions. in contrast to its well-known effects on carbohydrate metabolism, its potential for reducing blood pressure (BP) and its effect on leptin levels have been investigated less frequently.Patients and Methods: A double-blind, randomized, placebo-controlled trial was carried out with 26 overweight diabetic subjects with mild-to-moderate hypertension to assess the effects of metformin-induced glycaemic control on BP and metabolic parameters. After a 4-week placebo period, when BP was stabilized by calcium channel blockers, they received either metformin (MG) or placebo (PG) for 12 weeks.Results: Neither group showed any change in weight throughout the study. Only metformin-treated patients reduced fasting plasma glucose (8.54+1.72 to 7.54+1.33 mmol/l, p<0.05), although HbA(1c) had decreased in both groups (PG: 6.73.0 to 5.9 +/-2.6%; MG: 5.3 +/-1.5 to 4.6 +/-0.9%; p<0.05). the initial office mean BPs were similar and decreased at the end of the treatment period in both groups, reaching statistical significance only in MG (105.78.0 to 99.2 +/-9.3 mmHg, p<0.05). No difference was observed when comparing baseline and final values obtained by 24-h ambulatory BP monitoring. Metformin induced a reduction in both insulinaemia (71.062.4 to 38.0 +/- 23.0 pmol/l, p<0.05) and the insulin resistance index (3.52.7 to 1.8 +/-1.0, p<0.05). the two groups had similar baseline leptin levels which remained unchanged after treatment (PG: 16.87.9 to 21.4 +/- 14.6 mug/l; MG: 18.5 +/- 10.3 to 18.4 +/-8.9 mug/l). Dopamine levels increased significantly only in metformin-treated subjects.Conclusions: Reductions in both the insulin levels and the resistance index reinforced metformin capacity to improve peripheral sensitivity. Moreover, such benefits were not accompanied by any hypotensive effects. Since leptin levels were affected neither by metformin per se nor by the induced insulinaemia reduction, our data support the role of body weight as the major determinant of circulating leptin levels.
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    A polymorphism in the promoter of UCP2 gene modulates lipid levels in patients with type 2 diabetes
    (Elsevier B.V., 2004-08-01) Reis, A. F.; Dubois-Laforgue, D.; Bellanne-Chantelot, C.; Timsit, J.; Velho, G.; Hop St Vincent de Paul; Universidade Federal de São Paulo (UNIFESP); Hop Cochin; Hop St Antoine
    A G/A single nucleotide polymorphism (SNP) in the position -866 of the UCP2 promoter modulates UCP2 expression in adipose tissue and pancreatic beta-cell, and is associated with variations of body mass index (BMI) and insulin secretion in nondiabetic subjects. We investigated associations of this SNP with traits related to obesity, dyslipidemia, and hyperglycemia in patients with type 2 diabetes. the -866 G/A SNP in the UCP2 promoter was genotyped by PCR/RFLP in 681 type 2 diabetic patients. Increased triglyceride (greater than or equal to1.70mM), total cholesterol (greater than or equal to6.0mM) and LDL-cholesterol (greater than or equal to3.35mM) levels were significantly less frequent in homozygous carriers of the G-allele than in homozygous carriers of the A-allele. Odds ratios for the risk of dyslipidemia in GG vs AA carriers were 0.45, 0.57, and 0.50, for triglyceride, total cholesterol and LDL-cholesterol, respectively (all p < 0.007). No genetic effects of this polymorphism on the BMI or on traits related to the severity of hyperglycemia were observed. in conclusion, a common polymorphism in the promoter region of the UCP2 gene modulates triglycerides and cholesterol levels in French Caucasian subjects with type 2 diabetes. the implications of this effect in the evolution of type 2 diabetes and its macrovascular complications deserve to be investigated. (C) 2004 Elsevier Inc. All rights reserved.
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    The role of angiotensin II antagonism in type 2 diabetes mellitus: A review of renoprotection studies
    (Excerpta Medica Inc, 2002-07-01) Zanella, Maria Teresa [UNIFESP]; Ribeiro, Artur B. [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)
    Background: Diabetic nephropathy is the leading cause of end-stage renal disease (ESRD) in Western and Asian countries. Effective antihypertensive therapy reduces the rate of decline in renal function and postpones ESRD in patients with diabetic nephropathy.Objective: This review presents evidence from studies on how blood pressure control, plasma glucose control, and the presence of proteinuria determine outcomes in diabetic patients. the role of angiotensin II (AII) in the development of diabetic nephropathy and the reno- and cardiobeneficial effects of All antagonism in patients with type 2 diabetes mellitus (DM-2) and diabetic nephropathy also are addressed.Methods: Articles included in this review were found using a MEDLINE search for studies published from 1991 to 2001 and including the search terms diabetic nephropathy, type 2 diabetes mellitus, microalbuminuria, proteinuria, angiotensin receptor blockade, angiotensin-converting enzyme inhibition, and cardiovascular disease. Articles reporting new data, new mechanisms, major clinical trials, and our own data were included.Results: Recently, the Reduction of Endpoints in NIDDM (non-insulin-dependent diabetes mellitus) with the Angiotensin II Antagonist Losartan (RENAAL) trial provided sufficient data to conclude that the blockade of the All AT1 receptor with losartan confers renoprotection in patients with DM-2 and nephropathy. Similar results were obtained with irbesartan in the Irbesartan Diabetic Nephropathy Trial (IDNT) and the Irbesartan in Patients with Type 2 Diabetes and Microalbuminuria study (IRMA 2). the results of RENAAL indicate that the renoprotective effects of losartan were attributable to effects beyond blood pressure control. in addition to the favorable impact of the All blockade on blood pressure and renal hemodynamics, the blockade of the growth-promoting, profibrotic, nonhemodynamic actions of All also may be important for renoprotection. Intensive blood pressure control also confers cardiovascular protection in patients with DM-2. Some studies suggest that the blockade of the renin-angiotensin system confers superior cardioprotective effects in patients with DM-2. the RENAAL study also showed cardioprotection with losartan, with an important reduction in the risk for first hospitalization for heart failure.Conclusion: Evidence supports the importance of an effective blockade of All action for both reno- and cardioprotection in patients with DM-2.
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    Safety and efficacy of saxagliptin in combination with submaximal sulphonylurea versus up-titrated sulphonylurea over 76 weeks
    (Sage Publications Ltd, 2011-04-01) Chacra, Antonio R. [UNIFESP]; Tan, Gerry H.; Ravichandran, Shoba; List, James; Chen, Roland; CV181040 Investigators; Universidade Federal de São Paulo (UNIFESP); Cebu Doctors Univ
    To assess the long-term efficacy and safety of saxagliptin in patients with type 2 diabetes mellitus inadequately controlled on sulphonylurea monotherapy, 768 patients were randomised to saxagliptin 2.5 or 5 mg in combination with glyburide 7.5 mg versus placebo added to up-titrated glyburide over 76 weeks (24 weeks plus 52-week extension) in this phase 3, double-blind, placebo-controlled trial; 557 patients completed the study, 142 without being rescued. At 76 weeks, adjusted mean changes from baseline HbA(1C) (repeated measures model) (95% confidence interval) for saxagliptin 2.5 mg, saxagliptin 5 mg, and up-titrated glyburide were 0.11% (-0.05, 0.27), 0.03% (-0.14, 0.19), and 0.69% (0.47, 0.92), respectively (post hoc and nominal p < 0.0001 for saxagliptin 2.5 and 5 mg vs. up-titrated glyburide). Adverse event frequency was similar in all treatment groups; reported hypoglycaemia event rates were 24.2%, 22.9%, and 20.6% with saxagliptin 2.5 mg, saxagliptin 5 mg, and up-titrated glyburide, respectively. Saxagliptin plus glyburide provided sustained incremental efficacy compared with up-titrated glyburide over 76 weeks, and was generally well tolerated.