Search

Diabetes mellitus is one of the non-communicable diseases of mass occurrence. Other diseases, such as diseases of the nervous or vascular system, are often associated with diabetes itself. This thesis discusses diabetes and these associated diseases, which occur most often together with diabetes. The aim of the thesis was to describe the development and therapy of diabetes itself and the resulting oncological disease of the pancreas. Another goal was to capture the dietary habits of interviewed persons with a newly diagnosed pancreatic tumor and determine nutritional interventions depending on the diet record. As these cases were very specific, the practical part was processed in the form of a case study. The work includes 4 case studies of patients with diabetes mellitus together with oncological disease of the pancreas. Each case study also includes nutritional recommendations for improving or maintaining the quality of life and compensating for the disease. The topic of diabetes and oncological disease of the pancreas is not sufficiently explored and therefore there is a need for further research that would deal with these topics. keywords: diabetes mellitus, diabetes mellitus and related conditions, complications of diabetes, diabetes mellitus and pancreatic cancer

A complexidade da diabetes, seu impacto na qualidade de vida e a importância da prevenção precoce de suas complicações são aspectos cruciais ao se considerar a gestão da doença. Nesse contexto, surgem os fitoterápicos, medicamentos obtidos utilizando apenas a matéria-prima vegetal ativa que possuem diversas vantagens em relação aos medicamentos sintéticos, como o baixo custo, o fácil manuseio e a ampla aprovação popular, graças ao conhecimento dos efeitos terapêuticos das plantas. Dessa forma, por meio de uma revisão de literatura integrativa, o presente estudo objetivou entender e melhor conhecer as principais plantas medicinais, popularmente utilizadas pelos portadores de DM, com a finalidade de diminuir a glicemia. Sabe-se que indivíduos portadores de diabetes apresentam disfunções em seu funcionamento metabólico, de modo que, por necessitar de uma terapia constante, sempre surgem oportunidades para descobertas de métodos eficazes, de fácil acesso e baixo custo que auxiliem no tratamento desta enfermidade. Assim, segundo Mattos e colaboradores (2018), algumas das plantas mais citadas na literatura, visto seu potencial antidiabético, foram as: Bauhinia forficata, Aloe vera, Allium sativum, Beta vulgaris, Rauwolfia serpentina, Momordica charantia, Nigella sativa, Trigonella foenum-graecum e Curcuma longa L. Nesse sentido, evidencia-se a necessidade de uma boa anamnese clínica e nutricional do paciente. Passando a prestar um serviço complementar e integrativo, estando ciente dos possíveis efeitos colaterais que esses produtos podem vir a ocasionar. The complexity of diabetes, its impact on quality of life and the importance of early prevention of its complications are crucial aspects when considering the management of the disease. In this context, herbal medicines appear, medicines obtained using only the active plant raw material that have several advantages over synthetic medicines, such as low cost, easy handling and wide popular approval, thanks to the knowledge of the therapeutic effects of plants. Thus, through an integrative literature review, the present study aimed to understand and better understand the main medicinal plants, popularly used by DM patients, in order to reduce blood glucose. It is known that individuals with diabetes have dysfunctions in their metabolic functioning, so that, due to the need for constant therapy, there are always opportunities to discover effective, easily accessible and low-cost methods that help in the treatment of this disease. Thus, according to Mattos et al. (2018), some of the most cited plants in the literature, given their antidiabetic potential, were: Bauhinia forficata, Aloe vera, Allium sativum, Beta vulgaris, Rauwolfia serpentina, Momordica charantia, Nigella sativa, Trigonella foenum- graecum and Curcuma longa L. In this sense, the need for a good clinical and nutritional anamnesis of the patient is evident. Starting to provide a complementary and integrative service, being aware of the possible side effects that these products may cause. La complejidad de la diabetes, su impacto en la calidad de vida y la importancia de la prevención temprana de sus complicaciones son aspectos cruciales a la hora de plantearse el manejo de la enfermedad. En este contexto, aparecen las medicinas herbolarias, medicinas obtenidas utilizando únicamente la materia prima vegetal activa que tienen varias ventajas sobre las medicinas sintéticas, como el bajo costo, fácil manejo y amplia aprobación popular, gracias al conocimiento de los efectos terapéuticos de las plantas. Así, a través de una revisión integrativa de la literatura, el presente estudio tuvo como objetivo comprender y comprender mejor las principales plantas medicinales, popularmente utilizadas por los pacientes con DM, con el fin de reducir la glucosa en sangre. Se sabe que los individuos con diabetes presentan disfunciones en su funcionamiento metabólico, por lo que, debido a la necesidad de terapia constante, siempre existen oportunidades para descubrir métodos efectivos, de fácil acceso y bajo costo que ayuden en el tratamiento de esta enfermedad. Así, según Mattos et al. (2018), algunas de las plantas más citadas en la literatura, dado su potencial antidiabético, fueron: Bauhinia forficata, Aloe vera, Allium sativum, Beta vulgaris, Rauwolfia serpentina, Momordica charantia, Nigella sativa, Trigonella foenumgraecum y Curcuma longa L. En este sentido, es evidente la necesidad de una buena anamnesis clínica y nutricional del paciente. Comenzando a brindar un servicio complementario e integrador, siendo conscientes de los posibles efectos secundarios que estos productos pueden causar.

Objective: to produce and validate a Nursing care protocol for people amputated due to diabetic complications. Methods: a methodological research study conducted in Recife-PE between February 2019 and October 2020, comprising the following stages: 1) Theoretical phase: integrative literature review; 2) Production phase; 3) Validation by specialists; and 4) Validation by the target population. The Content Validity Index was used in the validation by specialists. The Agreement Index was employed in the validation by the target population. Results: the items included in the instrument permeate the following care dimensions: Biological, Psychological and Socio-educational. Validation by the evaluators was in charge of 13 specialists. The instrument presented an index of 0.94. Validation by the target population was conducted with 33 participants; all the items achieved an agreement index ≥ 80%. Conclusion: the protocol enables comprehensive and humanized care, encouraging autonomy and assisting in rehabilitation; it also allows for a reflection regarding individualization of Nursing care.

Objective: To relate knowledge, practice and barriers of diabetic foot self-care among people with Type 2 Diabetes Mellitus, according to gender and education. Method: Analytical cross-sectional study with 102 users of 4 basic units in the inland of the state of Piauí, Brazil. Socioeconomic and clinical data were collected between December 2018 and July 2019. Descriptive analysis was performed with the use of the Chi-square test. Results: Women showed greater knowledge and practice of moisturizing (p5cm (p=0.001) and

RESUMO: Objetivo: relacionar o conhecimento, a prática e os impedimentos do autocuidado com os pés em pessoas com Diabetes Mellitus Tipo 2 conforme sexo e escolaridade. Método: estudo transversal analítico, com 102 usuários de 4 unidades básicas de cidade interiorana do Piauí, Brasil. Coletaram-se dados socioeconômicos e clínicos, entre dezembro de 2018 a julho de 2019, analisados descritivamente por meio do teste de Qui-quadrado. Resultados: as mulheres obtiveram maior conhecimento e prática de hidratação (p5cm (p=0,001) e 5cm (p=0.001) and

This study aims to analyze in the literature the history of the nurse's performance for the disease Diabetes Mellitus, and to discuss its probable causes. For this, an integrative literature review was carried out, carried out in the SCIELO, VHL and Google Scholar databases. As a result, we found adherence to DM treatment, that there are individuals who have knowledge about the disease and others do not, perhaps due to the lack of effective guidance from professionals and, consequently, complications arise. Further studies are needed, especially in the gap in health education for patients with DM and on its benefits, and that these do not end at the time of consultation, and as for professionals, it is important that there is continued training on the subject, with the with the aim of improving the care offered to this public every day. Este estudio tiene como objetivo analizar en la literatura la historia de la actuación del enfermero para la enfermedad Diabetes Mellitus, y discutir sus probables causas. Para ello, se realizó una revisión integrativa de la literatura, realizada en las bases de datos SCIELO, BVS y Google Scholar. Como resultado encontramos adherencia al tratamiento de la DM, que hay individuos que tienen conocimiento sobre la enfermedad y otros no, quizás por falta de orientación efectiva por parte de los profesionales y, en consecuencia, surgen complicaciones. Se necesitan más estudios, sobre todo en el vacío de la educación sanitaria a los pacientes con DM y sobre sus beneficios, y que estos no terminen en el momento de la consulta, y en cuanto a los profesionales, es importante que haya una formación continua sobre el tema, con el objetivo de mejorar cada día la atención que se ofrece a este público. Este estudo tem como objetivo analisar na literatura o histórico sobre a atuação do enfermeiro (a) para a doença diabetes mellitus, bem como discutir suas prováveis causas. Para isso, foi realizada uma revisão integrativa da literatura, realizada na base de dados scielo, bvs e google acadêmico. Como resultados, encontramos a adesão do tratamento da dm, que há indivíduos que possuem conhecimento sobre a doença e outros não, talvez pela falta de orientações eficazes dos profissionais e consequentemente as complicações surgem. São necessários novos estudos, principalmente na lacuna de educação em saúde a pacientes portadores de dm e sobre os seus benefícios, e que estes não acabam no momento da consulta, e quanto aos profissionais é importante que haja uma capacitação continuada sobre o assunto, com o intuito de melhorar cada dia mais os cuidados ofertados a esse público.

Modern theory and practice in the treatment of Diabetes Mellitus (DM)..., Η προτεινόμενη μονογραφία περιλαμβάνει ολη την σύγχρονη θεωρία και πρακτική στην αντιμετώπιση του Σακχαρώδη Διαβήτη (ΣΔ) και τους λόγους που την καθιστούν αναγκαία . Ο ΣΔ αποτελεί ένα από τα μεγαλύτερα ιατρικά προβλήματα λόγω του υψηλού επιπολασμού και των σοβαρών επιπλοκών του .Ο επιπολασμός του στην Ευρώπη είναι 7,5% με αυξητική τάση. Πρόκειται για διαταραχή του μεταβολισμού που εκδηλώνεται με ολική ή μερική έλλειψη ινσουλίνης .Αποτέλεσμα είναι η αύξηση της γλυκόζης στο αίμα δηλαδή η υπεργλυκαιμία. Η παρατεταμένη υπεργλυκαιμία είναι τοξική και οδηγεί σε βλάβες φθοράς των αγγείων . Στατιστικές μελέτες δείχνουν ότι 1 στα 4 άτομα με μακροχρόνια αρρύθμιστο διαβήτη κινδυνεύει άμεσα από εγκεφαλικό ή έμφραγμα του μυοκαρδίου . Δεδομένου ότι οι καρδιοπάθειες είναι σήμερα η πρώτη αιτία θανάτου στις αναπτυγμένες χώρες , ο αρρύθμιστος διαβήτης μπορεί να θεωρηθεί ως η πρώτη αιτία αγγειακού κινδύνου παγκοσμίως. Η αγγειοπάθεια του διαβήτη είναι επίσης το κυριότερο αίτιο τύφλωσης των ενηλίκων ηλικίας 24-74 ετών , το πρώτο αίτιο μη τραυματικού ακρωτηριασμού των κάτω άκρων καθώς και νεφρικής ανεπάρκειας τελικού σταδίου εκτοξεύοντας παράλληλα τα υγειονομικά κόστη στα ύψη. Η αντιμετώπιση των επιπλοκών του διαβήτη απαιτεί τη συνδυασμένη δράση πολλών ειδικοτήτων . Η διατήρηση της γλυκόζης του αίματος σε επίπεδα ευγλυκαιμίας , μπορεί να καθυστερήσει την εμφάνιση των επιπλοκών . Αναλύονται διεξοδικά :Η θεραπευτική αγωγή με σκοπό την ευγλυκαιμία , η εκπαίδευση για αλλαγή του τρόπου ζωής και αυτοέλεγχο , η καινούργια γενιά φαρμάκων, η ραγδαία αύξηση των θεωρητικών γνώσεων , οι καθημερινές εξελίξεις σε ιατρικά επιτεύγματα και εφαρμογές , η εξάπλωση νέων πανδημιών και η επίπτωσή τους στους διαβητικούς καθώς και οι τελευταίες κατευθυντήριες οδηγίες για σχετικά θέματα από τους μεγαλύτερους παγκόσμιους επιστημονικούς οργανισμούς. Για πρώτη φορά αναλύεται η πανδημία covid-19 και η επίπτωσή της στους διαβητικούς παραθέτοντας την υπάρχουσα βιβλιογραφία.

Objetivo: Evaluar el conocimiento enfermero de atenci��n primaria del ��rea Sanitaria de Ourense, sobre la prevenci��n y cuidados del pie diab��tico. M��todos: Estudio observacional, descriptivo y transversal mediante un formulario ���ad hoc��� autocumplimentado, realizado entre los meses de enero y junio de 2020, a trav��s de la aplicaci��n Microsoft�� Forms, sobre conocimientos e implementaci��n de las principales recomendaciones de pr��ctica cl��nica en el abordaje del pie diab��tico. La poblaci��n de estudio fueron todos los enfermero/as de Atenci��n Primaria del ��rea Sanitaria de Ourense. Se realiz�� an��lisis descriptivo e inferencial para un intervalo de confianza del 95%. Resultados: Se consigui�� una muestra representativa de participaci��n, para una precisi��n del 9% y un intervalo de confianza del 95%. A pesar de haber identificado un aceptable nivel de conocimientos, en la pr��ctica cl��nica encontramos que un n��mero alto de profesionales (72%) no clasifica al paciente de bajo o alto riesgo de sufrir ��lceras y complicaciones, adem��s de un 54% que no clasifica el grado de la ��lcera y un 59% que no utiliza ning��n tipo de descarga. La asociaci��n entre la formaci��n y los conocimientos (p=0,002) y entre ��sta y la pr��ctica diaria (p=0,005) fueron estad��sticamente significativas. Conclusiones: El nivel de conocimientos sobre prevenci��n y cuidados del pie diab��tico es bueno, sin embargo, la administraci��n pr��ctica de cuidados para la prevenci��n de complicaciones de pie diab��tico, no alcanza niveles adecuados. [NURSING KNOWLEDGE FOR THE PREVENTION OF DIABETIC FOOT COMPLICATIONS IN PRIMARY CARE IN THE OURENSE HEALTH AREA] ABSTRACT Objective: To evaluate the nursing knowledge of primary care of the Sanitary Area of Ourense, on the prevention and care of the diabetic foot. Methods: Observational, descriptive and cross-sectional study using a self-completed ���ad hoc��� form, carried out between the months of January and June 2020, through the Microsoft�� Forms application, on knowledge and implementation of the main clinical practice recommendations. in the approach of the diabetic foot. The study population was all the Primary Care nurses from the Ourense Health Area. Descriptive and inferential analysis was performed for a 95% confidence interval. Results: A representative sample of participation, for a precision of 9% and a confidence interval of 95%. Despite having identified an acceptable level of knowledge, in clinical practice we found that a high number of professionals (72%) did not classify the patient as low or high risk of ulcers and complications, in addition to 54% who did not classify the ulcer grade and 59% who do not use any type of discharge. The association between training and knowledge (p=0.002) and between it and daily practice (p=0.005) are statistically significant. Conclusions: The level of knowledge on prevention and care of diabetic foot is good; however, the practical administration of care for the prevention of complications of diabetic foot does not reach adequate levels.

Objetivo: Evaluar el conocimiento enfermero de atención primaria del Área Sanitaria de Ourense, sobre la prevención y cuidados del pie diabético.Métodos: Estudio observacional, descriptivo y transversal mediante un formulario “ad hoc” autocumplimentado, realizado entre los meses de enero y junio de 2020, a través de la aplicación Microsoft® Forms, sobre conocimientos e implementación de las principales recomendaciones de práctica clínica en el abordaje del pie diabético. La población de estudio fueron todos los enfermero/as de Atención Primaria del Área Sanitaria de Ourense. Se realizó análisis descriptivo e inferencial para un intervalo de confianza del 95%.Resultados: Se consiguió una muestra representativa de participación, para una precisión del 9% y un intervalo de confianza del 95%. A pesar de haber identificado un aceptable nivel de conocimientos, en la práctica clínica encontramos que un número alto de profesionales (72%) no clasifica al paciente de bajo o alto riesgo de sufrir úlceras y complicaciones, además de un 54% que no clasifica el grado de la úlcera y un 59% que no utiliza ningún tipo de descarga. La asociación entre la formación y los conocimientos (p=0,002) y entre ésta y la práctica diaria (p=0,005) fueron estadísticamente significativas.Conclusiones: El nivel de conocimientos sobre prevención y cuidados del pie diabético es bueno, sin embargo, la administración práctica de cuidados para la prevención de complicaciones de pie diabético, no alcanza niveles adecuados. [NURSING KNOWLEDGE FOR THE PREVENTION OF DIABETIC FOOT COMPLICATIONS IN PRIMARYCARE INTHE OURENSE HEALTH AREA] ABSTRACT Objective: To evaluate the nursing knowledge of primary care of the Sanitary Area of Ourense, on the prevention and care of the diabetic foot.Methods: Observational, descriptive and cross-sectional study using a self-completed “ad hoc” form, carried out between the months of January and June 2020, through the Microsoft® Forms application, on knowledge and implementation of the main clinical practice recommendations. in the approach of the diabetic foot. The study population was all the Primary Care nurses from the Ourense Health Area. Descriptive and inferential analysis was performed for a 95% confidence interval. Results: A representative sample of participation, for a precision of 9% and a confidence interval of 95%.Despite having identified an acceptable level of knowledge, in clinical practice we found that a high number of professionals (72%) did not classify the patient as low or high risk of ulcers and complications, in addition to 54% who did not classify the ulcer grade and 59% who do not use any type of discharge. The association between training and knowledge (p=0.002) and between it and daily practice (p=0.005) are statistically significant.Conclusions: The level of knowledge on prevention and care of diabetic foot is good; however, the practical administration of care for the prevention of complications of diabetic foot does not reach adequate levels. &nbsp

Klotho concentration may be considered as a prognostic factor in the development of chronic complications of diabetes. Moreover, decrease in sKlotho concentration may contribute to beta cell apoptosis and type 1 diabetes development. The aim of this study was to evaluate if sKlotho protein concentration in children with type 1 diabetes (T1D) and its correlation with classical risk factors of chronic complications of diabetes: dysglycemia and endothelial dysfunction.Material and methodsIn a cross-section single center study the levels of soluble Klotho protein in 80 T1D (37 boys) and 34 healthy children (controls, 15 boys). Micro- and macroangiopathy were excluded and renal function was normal in all participants. Serum sKlotho, sICAM-1, sVCAM-1 and E-selectin levels were measured.ResultsThe concentration of sKlotho was lower in T1D than in the controls (2041.9 ± 1017.6 pg/mL vs. 2790.3 ± 1423.9 pg/mL, p=0.0113). sICAM-1, sVCAM-1 and E-selectin concentrations were comparable in patients and controls. In T1D, sKlotho was not correlated with the duration of diabetes. Klotho and E-selectin were correlated with HbA1c (r=-0.31, P=0.0066 and r=0.25, P=0.0351, respectively), but not with AVBG and blood glucose SD. Correlations of sKlotho with total cholesterol (r=0.31, P=0.0129), HDL-cholesterol (r=0.43, P=0.0011) and LDL-cholesterol (r=0.28, P=0.0412), but not with triglycerides, were found. Likewise, Klotho was not correlated with sICAM-1, sVCAM-1, and E-selectin concentrations.ConclusionsThis study reports the significantly lower level of s-Klotho in children with type 1 diabetes, correlated with HbA1c and HDL cholesterol, but not with the adhesion molecules concentrations nor the duration of the disease. Negative correlation between the levels of HbA1c and soluble Klotho may suggest its possible involvement in the development of chronic diabetes complications.

[Resumen] Objetivos: identificar los factores de riesgo más incidentes en la Diabetes tipo 2 mediante el análisis de la prevalencia de los diferentes factores de riesgo y analizar la predominancia del Síndrome del Pie diabético a nivel mundial. Metodología: mediante la revisión de datos de carácter cuantitativo a través de una búsqueda bibliográfica, se seleccionaron un total de 20 publicaciones. Resultados: los factores de riesgo con mayor incidencia fueron la hipertensión arterial y el Índice de Masa Corporal elevado. Además, la prevalencia a nivel mundial del Síndrome del Pie diabético oscila entre el 1,2% y el 12,1%. Conclusión: la diabetes tipo 2 es una patología con planes de prevención por presentar factores de riesgo modificables. Y el Síndrome del Pie diabético es una complicación de baja predominancia mundial en relación a otras complicaciones derivadas. [Abstract] Objective: to identify the most incident risk factors in type 2 Diabetes analyzing the different type risk factors prevalence and to analyze the diabetic foot syndrome predominance in type 2 DM at world. Methodology: by collecting quantitative data through a bibliographic search. A total of 20 publications were selected. Results: risk factors that showed more incidents values were hypertension followed by high body mass index. In addition the worldwide prevalence of the diabetic foot syndrome ranges from 1,2% to 12,1%. Conclusion: Type 2 Diabetes Mellitus is a pathology with prevention plans with modifiable risk factors. Diabetic foot syndrome is a complication that presents a lower predominance showing world level prevalence in relation to other complications derived.

Diabetes Mellitus is one of the World Health Organization's priority diseases under research by the first and second programmes of Innovative Medicines Initiative, with the acronyms IMI1 and IMI2, respectively. Up to October of 2019, 13 projects were funded by IMI for Diabetes & Metabolic disorders, namely SUMMIT, IMIDIA, DIRECT, StemBANCC, EMIF, EBiSC, INNODIA, RHAPSODY, BEAT-DKD, LITMUS, Hypo-RESOLVE, IM2PACT, and CARDIATEAM. In general, a total of €447 249 438 was spent by IMI in the area of Diabetes. In order to prompt a better integration of achievements between the different projects, we perform a literature review and used three data sources, namely the official project's websites, the contact with the project's coordinators and co-coordinator, and the CORDIS database. From the 662 citations identified, 185 were included. The data collected were integrated into the objectives proposed for the four IMI2 program research axes: (1) target and biomarker identification, (2) innovative clinical trials paradigms, (3) innovative medicines, and (4) patient-tailored adherence programmes. The IMI funded projects identified new biomarkers, medical and research tools, determinants of inter-individual variability, relevant pathways, clinical trial designs, clinical endpoints, therapeutic targets and concepts, pharmacologic agents, large-scale production strategies, and patient-centered predictive models for diabetes and its complications. Taking into account the scientific data produced, we provided a joint vision with strategies for integrating personalized medicine into healthcare practice. The major limitations of this article were the large gap of data in the libraries on the official project websites and even the Cordis database was not complete and up to date.

Diabetes mellitus tipa 2 (DMT2) je najraširenija endokrinološka bolest današnjice. U svijetu 9,3 % odrasle populacije živi s DMT2. Etiologija je kompleksna i u vezi je s nepromjenjivim čimbenicima rizika kao što su dob, rasa, genetika te čimbenicima rizika koje je moguće modificirati kao što su prehrana, fizička aktivnost i pušenje. Prehrana je uz medikamentnu terapiju prvi i glavni korak u liječenju DMT2. Cilj rada bio je ispitati usklađenost prehrane dijetetičkim principima kod osoba s dijagnozom DMT2 na medikamentnoj terapiji na području Sarajeva, uzimajući u obzir spol, stanje uhranjenosti i kontrolu dijabetesa. 82 osobe prosječne starosti 66,6 ± 9,8 godina (36 do 86 godina), 45,1 % muškaraca i 54,9 % žena, ispunili su jednokratni upitnik kreiran specifično za potrebe ovog istraživanja. 81,71 % ispitanika ima povećan indeks tjelesne mase, a 25,61 % je pretilo. Viši indeks tjelesne mase (BMI) povezan je s lošijom usklađenošću prehrane (r=-0,271, p=0,014). Pretili ispitanici imaju statistički značajno najlošiju usklađenost prehrane dijabetičkim principima (21,7 ± 5,7 bodova, p=0,015). Akutne komplikacije su prisutne kod 54,88 %, a kronične kod polovice ispitanika. 86,58 % ispitanika ima jedan ili više prisutnih komorbiditeta uz DMT2, najčešće hipertenziju i hiperlipidemiju. Prisutnost komplikacija se nije pokazala značajnom s obzirom na usklađenost prehrane dijabetičkim principima. 51,22 % ispitanika se samo djelomično pridržava dijabetičke dijete, a svega 35,36 % iskazuje interes za dodatnom edukacijom. Type 2 diabetes mellitus (DMT2) is the most common endocrine disease today. Worldwide, 9.3% of the adult population lives with DMT2. The aetiology is complex and includes risk factors such as age, race, genetics, and modifiable risk factors such as diet, physical activity, and smoking. Nutrition, along with drug therapy, is the first and main step in the treatment of DMT2. The aim of this study was to examine the compliance of diet with dietary principles for diabetes among diabetics on medical therapy from Sarajevo area. Gender, state of nourishment and control of diabetes were taken into account. Total of 82 adults aged 66.6 ± 9.8 years (36 to 86 years), 45.1% men and 54.9% women, completed a study-specific questionnaire. 81.71% of diabetics are overweight and 25.61 % are obese. Higher Body Mass Index correlates with poorer diet (r=-0.271, p=0.014). Obese diabetics have significantly poorer diet (21.7 ± 5.7 points, p=0.015). Acute complications are present in 54.88 % and half of diabetics have chronic complications. 86.58 % of diabetics have one or more comorbidities, mainly hypertension and dyslipidemia. Complications were not shown to be significant predictors of poor diet. However, 51.22 % of diabetics say that they only partially follow diabetic dietary principles, and only 35.36 % express interest in additional education.

Danışman: DR. ÖĞR. ÜYESİ BAŞAK ÇAYPINAR ESER Yer Bilgisi: İstanbul Gelişim Üniversitesi / Lisansüstü Eğitim Enstitüsü / Odyoloji Ana Bilim Dalı / Odyoloji Bilim Dalı Konu: Kulak Burun ve Boğaz = Otorhinolaryngology (Ear-Nose-Throat) Dizin: Diabetes mellitus = Diabetes mellitus ; Komplikasyonlar = Complications ; İşitme kaybı = Hearing loss ; İşitme testleri = Hearing tests, Diyabetes Mellitus mutlak insülin eksikliği veya insüline bağlı direnç sonucu kan glukoz seviyesinin yükselmesiyle karakterize metabolik bir hastalıktır. Klinik bulguları arasında polidipsi, polifaji ve poliüri bulunmaktadır. Tip 1 diyabet, tip 2 diyabet, gestasyonel diyabet ve spesifik türler olmak üzere alt sınıflara ayrılmıştır. Bireylerde insülin eksikliğine bağlı gelişen diyabete tip 1 diyabet denir. İnsülin direnci sonucu gelişen diyabet ise tip 2 diyabet olarak adlandırılır. Sağlıklı kadınlarda hamilelik sonucu ortaya çıkan diyabet ise gestasyonel diyabettir. Diyabet hastalarında kan glukoz düzeyinin yüksek olmasına bağlı olarak akut ve kronik komplikasyonlar görülebilir. Akut komplikasyonlara diyabetik ketoasidoz, hiperglisemik hiperozmolar durum ve hipoglisemi örnek verilebilir. Diyabet vücutta LDL kolesterol miktarını arttırarak lipit metabolizasyon bozukluklarına sebep olup kardiyovasküler sistemi de etkileyebilir. Ayak kısmında ise ülser oluşumuna neden olabilir. Diyabet sonucu istenmeyen birçok durum ortaya çıkabilir. Ortaya çıkan akut ve kronik komplikasyonların patofizyolojisi araştırılmalı ve bireyin klinik bulguları da dikkate alınarak en uygun tedavi yöntemi seçilmelidir. İşitme;dış kulak, orta kulak, iç kulak ve bunların alt bölümlerinden ses enerji dalgalarının geçip beyne aktarılması olaylarıdır. İç kulaktaki çekiç-örs-üzengi üç küçük kemikte veya başka minik? Mini sistemler??? sistemlerde hata olması durumlarında gerçekleşecek işitme kayıplarının dereceleri farklı olabilir. İşitme kaybında yapılan testler, doğru tedavi açısından önemlidir. En uygun tedavi yöntemi seçilmelidir. Dünyada doğuştan işitme kaybı insidansı 1/800-1/1500 arasındadır. Türkiye'de bu değer yaklaşık 1/1000 kadardır. Erken tedavi, uygun sağlık çalışanı olarak odyologlarla iletişim, erken yaşta olan bu rahatsızlıkta çocukların sosyal yaşama kazandırılması açısından önem kazanmıştır. İşitme Cihazları, işitme engelinde büyük önem taşır. Yapılan testlerin sonucuna bağlı olarak uygun işitme cihazının kullanılması yaşam kalitesini yükseltecektir., Diabetes Mellitus is a metabolic disease characterized by an increase in blood glucose levels as a result of absolute insulin deficiency or insulin-related resistance. Clinical manifestations include polydipsia, polyphagia and polyuria. It is divided into subclasses: type 1 diabetes, Type 2 diabetes, gestational diabetes, and specific types. Diabetes that develops due to insulin deficiency in individuals is called Type 1 diabetes. Diabetes, which develops as a result of insulin resistance, is called Type 2 diabetes. Diabetes, which occurs as a result of pregnancy in healthy women, is gestational diabetes. Acute and chronic complications may occur due to high blood glucose levels in diabetes patients. Acute complications include diabetic ketoacidosis, hyperglycemic hyperosmolar condition, and hypoglycemia. Diabetes increases the amount of LDL cholesterol in the body, causing lipid metabolization disorders and can also affect the cardiovascular system. In the foot part, it can cause the formation of ulcers. Many undesirable conditions can occur as a result of diabetes. The pathophysiology of acute and chronic complications should be investigated and the most appropriate treatment method should be selected, taking into account the clinical signs of the individual. Hearing is an event in which sound energy waves pass through the outer ear, middle ear, inner ear and their lower parts and are transferred to the brain. The degree of hearing loss that will occur in cases of errors in three small bones or other tiny systems of the hammer-anvil-stirrup in the inner ear may be different. Tests for hearing loss are important for proper treatment. The most appropriate treatment method should be selected. The incidence of congenital hearing loss in the world is 1/800-1/1500. In Turkey, this value is about 1/1000. Early treatment, communication with audiologists as appropriate health workers, has gained importance in terms of bringing children into social life with this disorder at an early age. Hearing aids are of great importance in hearing impairment. Depending on the results of the tests, the use of the appropriate hearing aid will improve the quality of life.

Sladkorna bolezen je kronična, napredujoča bolezen, za katero so značilne povišane ravni glukoze v krvi. Heterogena etiopatologija vključuje okvare izločanja inzulina, delovanja inzulina ter motnje v presnovi ogljikovih hidratov, maščob in beljakovin. Sladkorna bolezen vseh vrst lahko privede do zapletov na mnogih delih telesa in lahko poveča splošno tveganje za prezgodnjo smrt. Zapleti sladkorne bolezni pomembno vplivajo na posameznike, njihov vpliv pa je zaradi razsežnosti problema čutiti tudi na ravni populacije. Sladkorna bolezen je resna grožnja za zdravje prebivalstva. Zmanjšanje pojavnosti ali preprečevanje razvoja sladkorne bolezni, poleg farmakološkega načina, zahteva tudi spremembo življenjskega sloga. Poleg pravilne prehrane je v boju proti sladkorni bolezni pomembna tudi telesna aktivnost. Vadba v vodi je koristna pri rehabilitaciji bolnikov z mišično-skeletnimi težavami, nevrološkimi težavami, kardiopulmonalno patologijo ali motnjami v presnovi. Poznavanje teh bioloških učinkov lahko pomaga usposobljenemu kineziologu ustvariti optimalen načrt vadbe z ustreznimi prilagoditvami vodne aktivnosti, npr. temperaturo vode, globino vode in trajanjem ter intenzivnostjo vadbe. Vodna terapija je zaradi velike terapevtske varnosti in klinične prilagodljivosti zelo uporabno rehabilitacijsko orodje. Z boljšim razumevanjem hidrodinamičnega učinka vode lahko kineziolog strukturira ustrezne terapevtske programe za raznoliko populacijo bolnikov. Namen magistrskega dela je bil opisati vpliv vadbe v vodi na lašanje in zdravljenje sladkornih zapletov in ponuditi alternativno fizično aktivnost osebam, ki zaradi zapletov sladkorne bolezni niso zmožne izvajati fizične aktivnosti na kopnem. Potrebno je dvigniti raven ozaveščenosti za zaplete sladkorne bolezni in opozoriti na vsakodnevne težave s katerimi se srečujejo ljudje s sladkorno boleznijo. V procesu pisanja magistrske naloge je bila v pomoč domača in tuja literatura, zlasti znanstveni članki na temo: »Exercise in Water and Diabetes«, »Aquatics Exercise and Diabetes« in »Diabetes and Exercise«. V uvodnem delu magistrske naloge sem kot širše področje raziskovanja izdelal pregled pojavnosti sladkorne bolezni, tipov sladkorne bolezni, zapletov ki nastanejo zaradi sladkorne bolezni ter o vadbi v vodi in učinkih vadbe v vodi na telo. V glavnem delu magistrske naloge sem na podlagi znanstvenih člankov opisal vpliv vadbe v vodi na zmanjševanje in preprečevanje zapletov sladkorne bolezni in vpliv vadbe v vodi na osebe s sladkorno boleznijo. Diabetes mellitus is a chronic disease, characterized by increased blood glucose. Heterogeneous etiopathology includes impaired insulin secretion, its action, or both and impaired carbohydrate, fat, and protein metabolism. All types of diabetes can lead to complications in many parts of the body, and thus increase the overall risk of premature death. Complications have a very negative effect on people with diabetes, and the impact of complications can be felt in the population as a whole. In addition to the pharmacological treatment regimen, lifestyle changes also play a role in reducing or preventing diabetes. Along with proper nutrition, organized physical activity is important in the fight against diabetes. Exercise in water is useful in rehabilitating patients with musculoskeletal problems, neurological problems, cardiopulmonary pathology, or metabolic disorders. Knowing these biological effects can help a skilled kinesiologist create an optimal treatment plan with appropriate adjustments to water activity, e.g. water temperature, water depth, duration and exercise intensity. Water therapy is a very useful rehabilitation tool due to its great therapeutic safety and clinical flexibility. With a better understanding of the hydrodinamics effects of water, the kinesiologist can structure appropriate therapeutic programs for a diverse patient population. The aim of this master's thesis was to describe the impact of exercise in water on the relief and treatment for diabetes complications and to offer alternative physical activity for people who are incapable of being physically active on land due to complications they experience, to raise awareness of the complications of diabetes and the daily problems people with diabetes are facing. In the process of writing the master's thesis, we used domestic and foreign literature to help, especially scientific papers entitled »Exercise in Water and Diabetes«, »Aquatics Exercise and Diabetes«, »Diabetes and Exercise«. In the introductory part of the master's thesis as a broader area of research, we offer a representation of the prevalence of diabetes, types of diabetes, complications caused by diabetes, exercise in water and the effects of exercise in water on the body. In the main part of the master's thesis, which is based on scientific papers, we described the impact of water exercise on reducing and preventing complications of diabetes and the impact of water exercise on people with diabetes.

Resumen Introducción: La diabetes es una de las principales causas de enfermedad renal crónica en Chile y el mundo, por lo que es fundamental la prevención del avance de la nefropatía diabética para evitar la evolución de la enfermedad renal crónica. Objetivo: Determinar las características de pacientes diabéticos que iniciaron tratamiento renal sustitutivo con hemodiálisis debido a una nefropatía diabética. Material y Método: Se realizó un estudio cuantitativo de tipo descriptivo, con pacientes diabéticos y en hemodiálisis, mediante aplicación del test de Morisky Green y un instrumento de valoración sociodemográfico. Los sujetos fueron seleccionados mediante muestreo intencionado, tras su consentimiento informado. Resultados: Los sujetos estudiados en su mayoría fueron mujeres, con diabetes tipo 2 en edad adulta, de un estrato económico bajo, escolaridad básica y media, y pertenecientes al Sistema de Salud Público. Gran parte indicó que tenía 5 o más años con diabetes al momento de ingresar a diálisis. 71,4% de ellos no tuvo derivación a Nefrólogo y 57,1% refirió no haber sido adherente a su tratamiento, previo ingreso a diálisis. Conclusiones: El perfil del paciente diabético que inicia HD de nuestro estudio, son en su mayoría mujeres de edad media, con diagnóstico previo de DM2 sobre la DM1, y con más de 20 años con el diagnóstico de DM. En cuanto al perfil socioeconómico predominan los pacientes con bajos ingresos económicos, estudios básicos y medios. Por último destacar que presentaron mejor adherencia al tratamiento los hombres respecto a las mujeres. Abstract Introduction: Diabetes is one of the main causes of chronic kidney disease in Chile and in the world. It is essential to prevent the progression of diabetic nephropathy to prevent the evolution of chronic kidney disease. Objective: To determine the characteristics of diabetic patients who started renal replacement therapy with hemodialysis due to diabetic nephropathy. Material and Method: A descriptive quantitative study was carried out, with diabetic patients and on hemodialysis, by applying the Morisky-Green test and a sociodemographic assessment instrument. The subjects were selected by intentional sampling, after their informed consent. Results: The subjects studied were mostly women, with type 2 diabetes (T2D) in adulthood, with a low economic level, basic and intermediate level education, and belonging to the Public Health System. In most of the subjects it was indicated that they had 5 or more years with diabetes disease at the time of starting dialysis. 71.4% of them were not referred to the nephrologist and 57.1% said they had not adhered to the treatment, after starting dialysis. Conclusions: The profile of the diabetic patient who begins on hemodialysis in our study is mostly middle-aged women, with a higher previous diagnosis of T2D over T1D, and with more than 20 years with the diagnosis of DM. Regarding the socioeconomic profile, patients with low economic income and no training or basic studies predominate. Finally, men had better adherence to treatment than women.

The focus on the problem of diabetes mellitus (DM) is associated with the increasing prevalence of the disease and the risk for the development of many vascular complications (nephropathy, retinopathy, lesions of the great vessels of the heart, brain, peripheral vascular disease of the lower limbs), in the development of which chronic hyperglycemia plays a crucial role. In 2011, the WHO decided that glycated hemoglobin (HbA1c) could be used as the diagnostic criterion for diabetes. The role of HbA1c in the choice of hypoglycemic therapy is invaluable. According to the Algorithms of Specialized Medical Care for Diabetes Mellitus Patients, stratification of treatment strategy in patients with newly diagnosed type 2 diabetes is determined by the initial HbA1c.

BACKGROUND Zn is an essential trace mineral directly involved in the physiology and action of insulin. Insulin is stored as Zn crystals in the β cells of the pancreas. It has been suggested that abnormal Zn metabolism may play a role in the pathogenesis of diabetes and some of its complications. Zn depletion has several potential clinical implications. It is speculated that Zn repletion could improve insulin sensitivity in patients with DM and reduce the severity of certain complications of this disease. In order to understand the underlying pathobiochemical interrelationships of the late complications of diabetics in more detail, this study was undertaken. The aim of the study is to- 1. Detect serum zinc level in patients with diabetes mellitus. 2. Compare the serum zinc level in newly-diagnosed diabetic patients and in those with complications. 3. Find out the relationship between zinc deficiency and complications of diabetes. MATERIALS AND METHODS Study Centre- Thanjavur Medical College and Hospital. Study Duration- 6 months. Study Design- Retrospective case control study. Sample Size- 100 patients (cases) and 50 controls. RESULTS There was no significant statistical variation in serum zinc levels between the various macrovascular complications. There was a significant negative correlation between HbA1c and serum zinc levels. It was also found in our study that compared to the newly-diagnosed patients with longstanding diabetes mellitus had lower levels of zinc. Also, patients with poor glycaemic control had lower zinc levels compared to the subjects with a better glycaemic control. CONCLUSION Diabetic individuals have significantly lower levels of zinc when compared to normal healthy individuals. Patients with longstanding DM have lower zinc levels than those who are newly diagnosed. Patients with poor glycaemic control have lower zinc levels compared to the subjects with a better glycaemic control. Zinc supplementation may have a therapeutic role in control and prevention of complications in DM. Further studies are needed to clarify this aspect.

Cilj rada: Šećerna bolest je veliki zdravstveni i socioekonomski problem u Republici Hrvatskoj. Prema podatcima Hrvatskog zavoda za javno zdravstvo registrirano je preko 300.000 bolesnika sa šećernom bolesti, uz daljnji rast broja oboljelih. U 2017. godini šećerna bolest nalazila se na petom mjestu vodećih uzroka smrti sa 3,7 % udjela u ukupnoj smrtnosti. Dijabetička ketoacidoza, hiperglikemijsko hiperosmolarno stanje i hipoglikemija su ozbiljne komplikacije šećerne bolesti tip 1 i tip 2, koje su ujedno i najčešća hitna stanja u endokrinologiji. Iako se dijabetička ketoacidoza najčešće javlja u osoba s tipom 1 šećerne bolesti, a hiperosmolarno stanje s tipom 2 sve je veća pojavnost dijabetičke ketoacidoze i u dijabetičara s tipom 2 šećerne bolesti. Glavni cilj istraživanja je analizirati hipoglikemijske i hiperglikemijske krize bolesnika u hitnoj medicinskoj službi u razdoblju od 2010. do 2018. godine u Kliničkoj bolnici Sveti Duh. Metode: Ispitivana populacija obuhvaćala je ukupno 175.446 odrasle osobe pregledane u hitnoj medicinskoj službi u razdoblju od 1. 1. 2010. do 31. 12. 2018., uz vrijednost glukoze u plazmi većoj od 13,9 mmol/L ili manjoj od 3,9 mmol/L. Ovisno o nalazu acidobaznog statusa, ketonuriji i osmolarnosti plazme bolesnici su podijeljeni u jednu od četiri skupine: neketotična hiperglikemija, hipoglikemija u šećernoj bolesti, dijabetička ketoacidoza ili hiperosmolarno hiperglikemijsko stanje. Bolesnici su također podijeljeni prema dobi i tipu šećerne bolesti. Rezultati: U 3.773 posjeta bila je zadovoljena defi nicija hiperglikemijske ili hipoglikemijske krize, od čega 180 epizoda dijabetičke ketoacidoze, 29 hiperosmolarna hiperglikemijska stanja, 359 hipoglikemijska stanja te 567 slučajeva novootkrivene šećerne bolesti. Broj epizoda hiperglikemijskih kriza bio je tijekom godina bez većih odstupanja. Samo 17,72 % slučajeva dijabetičke ketoacidoze zabilježeno je u bolesnika sa šećernom bolesti tip 1, dok su preostali bolesnici imali dijagnozu tip 2. Zabilježeno je da su infekcije bile najčešći čimbenik rizika dijabetičke ketoacidoze s 35,4 %, propuštanjem terapije inzulina kao drugim najčešćim uzrokom s 29,3 %. U 15 % bolesnika s akutnim komplikacijama šećerne bolesti zabilježen je ponovni prijam u razdoblju od 30 dana. Rasprava: Učestalost posjeta hitnom prijmu bolesnika sa šećernom bolesti bila je veća od očekivane s obzirom na učestalost dijagnoze u općoj populaciji. Zabilježeno je godišnje povećanje broja slučajeva dijabetičke ketoacidoze i hipoglikemija u bolesnika sa šećernom bolesti starijih od 60 godina. S obzirom na smjernice kliničke prakse, vrijeme započinjanja i volumen primjene kristaloidnih otopina bili su u preko dvije trećine slučajeva zadovoljavajući. Međutim, usporedbom sa smjernicama kliničke prakse o primjeni inzulina unutar prvih 60 minuta, u više od dvije trećine slučajeva dijabetičke ketoacidoze vrijeme prve primjene bilo je nakon 100 minuta. Mogući razlozi su nespecifi čnost kliničkih znakova i vrijeme potrebno do dostupnosti rezultata krvnih nalaza. Zaključak: Učestalost šećerne bolesti u bolesnika koji su zaprimljeni u hitnu medicinsku službu veća je od očekivane u općoj populaciji uz porast broja bolesnika sa šećernom bolesti tip 1 i tip 2. Većina bolesnika s dijabetičkom ketoacidozom imala su šećernu bolest tip 2, iako su se bolesnici s tipom 1 u hitnoj službi češće prezentirali s dijabetičkom ketoacidozom. Najčešći prepoznati čimbenici rizika za dijabetičku ketoacidozu bile su infekcije i neodgovarajuća terapija inzulina. Zabilježen je porast korištenja metformina i DPP-4 inhibitora u terapiji šećerne bolesti., Objective: Diabetes is one of the major health and socioeconomic problems in Croatia. According to data from the Croatian Institute of Public Health, over 300,000 patients with diabetes have been registered, with further increase in the number of patients. In 2017, diabetes was recognized as the fi fth leading cause of death, accounting for 3.7% of total mortality. Diabetic ketoacidosis, hyperglycemic hyperosmolar condition, and hypoglycemia are serious complications of type 1 and type 2 diabetes, which also are the most common emergency conditions in endocrinology. Although diabetic ketoacidosis most commonly occurs in people with type 1 diabetes and hyperosmolar condition in those with type 2 diabetes, there is an increasing incidence of diabetic ketoacidosis in subjects with type 2 diabetes. The main aim of the research was to analyze the hypoglycemic and hyperglycemic crisis patients at Department of Emergency Medicine, Sveti Duh University Hospital, during the 2010-2018 period. Methods: The study population included a total of 175,446 adults examined at Emergency Department from January 1, 2010 until December 31, 2018, with plasma glucose values greater than 13.9 mmol/L or less than 3.9 mmol/L. Depending on the acid-base status, ketonuria and plasma osmolarity, patients were divided into four groups as follows: non-ketotic hyperglycemia, hypoglycemia in diabetes, diabetic ketoacidosis, and hyperosmolar hyperglycemic state. Patients were also divided according to age and type of diabetes. Results: At 3,773 visits, defi nitions of hyperglycemic or hypoglycemic crisis were met, of which 180 episodes of diabetic ketoacidosis, 29 hyperosmolar hyperglycemic conditions, 359 hypoglycemic conditions, and 567 cases of newly diagnosed diabetes. The number of episodes of hyperglycemic crisis was been without major fl uctuations over years. Only 17.72% of diabetic ketoacidosis cases were reported in patients with type 1 diabetes, whereas the remaining patients were diagnosed with type 2 diabetes. Infections were reported as the most common risk factor for diabetic ketoacidosis (35.4%), followed by missed insulin therapy as the second most common cause (29.3%). Repeated admission within 30 days was recorded in 15% of patients with acute complications of diabetes. Discussion: The frequency of visits of diabetic patients was higher than expected due to the frequency of diagnoses in the general population. There was an annual increase in the incidence of diabetic ketoacidosis and hypoglycemia in patients older than 60 years. Considering the guidelines for clinical practice, the starting time and volume of crystalloid solutions administered were satisfactory in more than two-thirds of cases. However, compared to clinical practice guidelines for insulin administration within the fi rst 60 minutes, the time of fi rst administration was after 100 minutes in more than two-thirds of diabetic ketoacidosis cases. The possible reasons were non-specifi city of the clinical signs and the time it took for blood test result reporting. Conclusion: The incidence of diabetes in patients admitted to the emergency department was higher than expected in the general population, with an increase in type 1 and type 2 diabetes patients. Most patients with diabetic ketoacidosis had already been diagnosed with type 2 diabetes, although patients with type 1 diabetes more often presented with diabetic ketoacidosis to the emergency department. The most commonly recognized risk factors for diabetic ketoacidosis were infection and inadequate insulin therapy. There was an increase in the use of metformin and DPP-4 inhibitors in diabetes therapy.

Background and Aims: Diabetes is increasing rapidly in Turkey as most countries in the world. The prevention of complications which is the main aim in the treatment of diabetes can be accomplished partly with nutrition education. The aim of this study was to assess the relationship between nutrition knowledge (NK) and complications in patients with type 2 diabetes. Materials and Methods: 280 patients with 8-20 years of diabetes duration who applied to diet outpatient clinic were recruited. The questionnaire was prepared by the investigators to assess the NK. A score was calculated on the scale of 100. The complications were determined based on hospital records and patients’ selfreport. Results: 63.2% of participants were female and 36.8% were male. The most common complications in participants were retinopathy (56.1%) and neuropathy (42.9%). The mean NK score was 80.2±11.7. At least one complication was seen in 85.0% of the participants. There was no significant difference for having any complication in patients with adequate and inadequate NK. However the risk of diabetic foot, and coronary artery disease was significantly higher in women with inadequate NK. Conclusion: NK is quite high in long term diabetic patients. However no effect of the NK on the development of complications could be shown. The difference of effect between men and women could be due to the fact that food is mostly prepared by women thus not much chance of the knowledge of men to be reflected on his eating habits. The knowledge difference among female patients was seen in the results as; in women with inadequate NK, the prevalence of diabetic foot and CAD was significantly higher.

The paper presents the report of the radiologist A. Мangov, who took part in the scientific-practical conference "Recent advances in Clinical Endocrinology." The speaker focused on endocrinology such topical issues as the visualization of diabetes complications, imaging of neuroendocrine tumors and pituitary tumors. The proper choice of imaging technique depends on timely diagnosis and treatment. When choosing a radiological procedure is necessary to know the features of the visualization of various organs and systems, and manifestations of the disease. The article also demonstrated clinical cases, which shows the possibilities of different imaging techniques. The speaker said that the company "Farmak" produces drugs for diagnostic tests with intravenous enhancement for CT (Tomoskan, Tomogeksol) and MRI (Tomovist).

Background: Pathogenesis of diabetes complications is due to systemic microcirculatory disturbances, while there is a deficit in instrumental methods of objective assessment of the microvasculature. Aim: To provide diagnostics of microcirculatory disorders in patients with diabetes mellitus (DM) using laser Doppler flowmetry. Materials and methods: The study included 11 patients with decompensated type 1 and type 2 DM (HbA1c level – 9.1±2.2%), the duration of the disease being more than 5 years. The control group consisted of 11 healthy volunteers. Blood microcirculation in skin was measured using LAKK-02 system. We examined the condition of blood microcirculation during the functional testing (occlusion, heat, cold, orthostatic) in different combinations and durations of action. For analysis of the quantitative data, the mean values and standard deviations were calculated (M±SD), the differences between the groups were tested using the double-sided Student’s test. Results: The diagnostic tests using a combination of thermal and orthostatic effects were developed. The said diagnostic functional testing and transformation of perfusion units into the relative values of microcirculation (by dividing perfusion index by the average value of microcirculation during the base period) revealed significant differences in microcirculation levels between diabetic patients and the control group: for foot testing, relative microcirculation indices were 3.2±1.9 in the study group and 6.3±4.6 in the control group (p=0.05), for hand testing, the relative indexes were 3.3±1.4 and 5.3±2.8, respectively (p

Background and Aim: The cost of diabetes complication management is always much higher than the cost of diabetes treatment, even with novel and expensive molecules available. Thus, it is better to halt complications in the initial phase of the disease, rather than just treating hyperglycemia. Sodium-glucose co-transporter-2 inhibitor (SGLT-2i) is marking a new era in the management of type 2 diabetes mellitus (T2DM), showing significant benefits for mortality, hospitalization due to heart failure, and renal complications. The usage of SGLT2 inhibitors in clinical practice is still low. The aim of our study to know the prevalence and reasons for not prescribing SGLT-2i among Indian diabetologists. Materials and Methods: A cross-sectional survey was conducted in 10 states of India from 15 March to 31 July 2019. The primary question was asked to a doctor for the next 20 new patients at the clinic, “Was the patient initiated with SGLT-2i treatment?” If it was “Yes” the patient was excluded and if the marked option was “No” then the reason was selected for not prescribing the drug. Results: Out of 1132 patients, 687 (60.69%) patients were not prescribed SGLT2 inhibitors. Among them, the main reason for not prescribing SGLT-2i was cost (41.45%), followed by catabolic state (19.62%). Conclusion: It was found that cost is the major reason for not prescribing SGLT2 inhibitors. In spite of promising glycemic and extra glycemic benefits, it is the need of an hour to increase awareness and abetting physicians to prescribe SGLT-2 inhibitors in all appropriate patients at early stage of the disease to prevent the complications and its higher expenditure at the later stage of the disease.

Type 2 diabetes is increasingly recognized as a spectrum of metabolic disorders sharing chronic hyperglycaemia. In Europe, the continually growing number of migrants from developing countries could affect diabetes phenotypes. We evaluated a population of 426 Italians and 412 undocumented migrants. Using 17 variables (with the exclusion of ethnic origin) we performed a multiple component analysis to detect potential clusters, independently from ethnicity. We also compared the two groups to evaluate potential ethnicity associated differences. We found five clusters of patients with different disease phenotypes. Comparing Italians with undocumented migrants, we noted that the first had more often cardiovascular risk factors and neurologic involvement, while the latter had a higher frequency of diabetic ulcers and renal involvement. Metformin was used in a comparable percentage of patients in all clusters, but other antidiabetic treatments showed some differences. Italians were more often on insulin, due to a larger use of long acting insulin, and received a larger number of oral antidiabetics in combination. Pharmacological treatment of comorbidities showed some differences too. We suggest that type 2 diabetes should be considered as a spectrum of diseases with different phenotypes also in heterogeneous populations, and that this is not due only to ethnic differences.

Diabetes mellitus je skupina endokrinoloških bolesti karakterizirana hiperglikemijom i izlučivanjem šećera urinom. Uzrokovana je apsolutnim ili relativnim nedostatkom inzulina ili nemogučnošću stanica organizma da ga iskoriste. Posljedično dolazi do poremećaja metabolizma šećera, masti, bjelančevina, tekućine i elektrolita. Uzrok porasta broja oboljelih je debljina, nepravilna prehrana i manjak tjelesne aktivnosti. Dijabetes se dijeli u više tipova, tip 1 dijabetes ovisan o inzulinu koji je i jedini način liječenja u obliku injekcija inzulina ili primjena inzulinske pumpe, najčešće se javlja u mlađih osoba i djece, dok se tip 2 javlja u starije populacije, liječenje je uspješno s peroralnim lijekovima, pravilnom prehranom i tjelesnom aktivnošću. U ovom radu opisane su osnovne spoznaje o diabetes mellitusu, njegovom liječenju (samokontroli, tjelesnoj aktivnosti, pravilnoj prehrani te primjeni oralnih antidijabetika i inzulina), edukaciji oboljelih, kao i o komplikacijama s naglaskom na hitna stanja u bolesnika s dijabetesom. Dijabetička ketoacidoza i hiperglikemijsko hiperosmolarno stanje, kao i hipoglikemija hitna su stanja koja zahtijevaju pravovremeno postavljanje dijagnoze i specifično liječenje. Kako bi se poboljšala educiranost oboljelih od dijabetesa treba više pažnje posvetiti primarnoj preventivi i zdravstvenom odgoju djece, kao i cijele zajednice te osvijestiti važnost pravilne prehrane i tjelesne aktivnosti, što je zadatak svih zdravstvenih i odgojno-obrazovnih djelatnika. Diabetes mellitus is a group of endocrine diseases characterized by hyperglycemia and urinary excretion. It is caused by the absolute or relative lack of insulin or the inability of the cell body to utilize it. Consequently, the metabolism of sugar, fat, protein, fluid and electrolyte is affected. Causes of increased number of obese patients are obesity, improper diet and lack of physical activity. Diabetes is divided into several types, type 1 insulin-dependent diabetes, which is the only way to treat insulin injections or the use of an insulin pump, is most commonly reported in younger adults and children, while Type 2 is reported in the elderly population, treatment is successful with oral medicines, proper nutrition and physical activity. This paper describes basic knowledge about diabetes mellitus, its treatment (self-control, physical activity, proper diet, and the use of oral antidiabetic and insulin), education of patients, as well as emergency-related complications in patients with diabetes. Diabetic ketoacidosis and hyperglycemic hyperosmolarity, as well as hypoglycaemia, are urgent states requiring timely diagnosis and specific treatment. In order to improve the education of patients with diabetes, more attention should be paid to primary prevention and health education of children as well as the whole community, and to raise awareness of the importance of proper nutrition and physical activity, which is the task of all health and education staff.

Resumen Objetivo: se realizó un estudio en pacientes sometidos a trasplante de hígado (TH) con el objetivo de determinar los valores de glucemia en cada una de las fases de la cirugía del TH y su relación con la morbimortalidad postoperatoria. Materiales y métodos: se identificaron los trasplantes hepáticos entre 2013 y 2015 en los registros institucionales. La información se tomó de la nota operatoria, registros de laboratorio y evoluciones de historia clínica. Se buscaron diferencias en la glucemia en las 3 fases del trasplante entre diabéticos y no diabéticos, la presencia de infección y rechazo. Resultados: en total, se estudiaron 73 pacientes trasplantados, 54,8% (n = 40) de sexo masculino, con una mediana en la edad de 59 años (rango intercuartílico [RIQ] = 52-53). El 32,9% (n = 24) tenía antecedente de diabetes mellitus (DM). Se encontraron diferencias en la glucemia inicial y final (127 mg/dL frente a 212 mg/dL) en diabéticos (p = 0,001), así como en los no diabéticos (glucemia inicial: 105 mg/dL frente a la final: 190 mg/dL) (p

Aim. The aim of this study was to investigate late diabetic complications in patients with Type 1 diabetes mellitus (T1DM) who received simultaneous pancreas-kidney transplantation (SPK). Materials and Methods. The study included 16 patients with T1DM who received SPK. All patients underwent clinical examination and diagnostic investigation. Results. After SPK, 93.75% of the patients had a functioning pancreas transplant, and 100% had a functioning kidney transplant within 4?48 months [mean 21 months (10 is revealed; 36)). All patients had euglycaemia according to daily monitoring. The mean level of glycated haemoglobin (HbA1c) before surgery was 9.1% (range 8.7%?11%) and was 5.7% after surgery (5.55%?5.9%; p < 0.0001). The baseline level of insulin was 12.5 ?IU/ml (11.4?15.3 ?IU/ml) and the baseline level of C-peptide was 2.02 ng/ml (1.07?2.77 ng/ml). Normal renal function was observed (glomerular filtration rate 76 ml/min/1.73 m2 (68?90 ml/min/1.73 m2). Other laboratory findings included haemoglobin 127 g/l (120?130 g/l), serum parathyroid hormone 77.5 pg/ml (61?85 pg/ml), serum phosphate 1.2 mmol/l (1.07?1.3 mmol/l) and blood pressure 110(100?120)/70(64?80) mmHg. In 37.5% of the patients, vitrectomy and additional laser panretinal photocoagulation were performed for proliferative diabetic retinopathy. Other ophthalmological disorders included newly diagnosed cataract (81.25%), secondary cataract (25%) that required YAG discission in three patients, glaucoma (25%) and macular oedema (12.5%). Ulcers of the lower extremities were observed in 31.25% of the patients, and chronic osteoarthropathy was observed in four. One patient underwent amputation of index and ring fingers and resection of the first and third metatarsal heads to treat osteomyelitis. One patient underwent balloon angioplasty and stenting for advanced atherosclerotic stenosis of blood vessels of the lower extremities. Conclusions. Euglycaemia and recovery of renal function 6?48 months after SPK resulted in a significant decrease in diabetic complications without clinical signs of regression in some patients. However, some patients suffered progression of complications, reflecting their multifactorial causes. These findings highlight the need for timely diagnosis, treatment and long-term follow up to improve the quality of life and prognosis in patients with T1DM receiving SPK.

The scope of this article is to estimate the prevalence of microvascular complications of self-reported type 2 diabetes and the association with sociodemographic characteristics, nutritional status, treatment given and time since diagnosis. It involved a cross-sectional study with 318 people with type 2 diabetes living in Maringá in the State of Paraná. A telephone survey of self-reported morbidity was conducted in the months from January to June 2012. For the analysis descriptive statistics, univariate and multiple logistic regression were used. The prevalence of self-reported complications of diabetes was 53.8%, the most frequent being retinopathy (42.8%), followed by peripheral neuropathy (14.5%) and nephropathy (12.9%). The variables associated with the presence of complications were age (p = 0.008), overweight/obesity (p = 0.002), insulin (p < 0.001), insulin use linked to oral antidiabetic drug (p = 0.003) and time since diagnosis (p = 0.013). The prevalence of self-reported microvascular complications for people with diabetes was high, being more frequent among those of more advanced age, with inadequate nutritional status, a delay in diagnosis of the disease and those who were using insulin alone or in combination with oral antidiabetic agents.

This bachelor thesis entitled "The Awareness of Patients Diagnosed with Type 2 Diabetes About Their Illness in a Selected Region "is divided into two main parts. In the theoretical part, it focuses on the characteristics of diabetes mellitus, especially on type 2 diabetes mellitus, including treatment and associated complications of this disease. In the practical part I focused on the level of awareness of type 2 diabetics from the Vysočina region, both in diabetics from the neighborhood and from the diabetes clinic of the hospital in Nové Město na Moravě. The level of awareness in the individual areas of treatment was then compared with answers to questions about their own compliance with the treatment rules. Answers to the question of knowledge was mostly correct but the situation about keeping the treatment rules was worse. The best results were in the field of sports, the worst of dieting. They were also very bad in aswering the questions related to acute complications. Only about 40 % of the answers were correct. Knowledge of chronic complications was better. 65 % of the answers were correct. The last partial goal was to find the main source of information, which is clearly the medical staff. KEYWORDS Diabtees mellitus 2. type, informations, therapy, complications of diabetes, diseases of affluence

Objective: To assess the prevention by primary health care providers of chronic complications of diabetes mellitus according to the complex thinking theoretical approach. Method: Evaluative research based on the complex thinking theoretical approach. The following techniques for data collection were used: interviews with 38 participants; observation in collective and individual appointments; and analysis of medical records of people with diabetes. The triangulation applied for data analysis was the ATLAS.ti software. Results: The prevention and management of chronic complications of diabetes did not meet the requirements set forth by ministerial public policies aimed at this population. Systematic monitoring to prevention of chronic complications showed significant gaps. Final considerations: Primary health care did not consider preventive actions for diabetes mellitus complications. This context was marked by disjunctive, fragmented, and dissociated practices types of care targeted to the totality of the assisted people. RESUMEN Objetivo: Evaluar la prevención de complicaciones crónicas en diabetes mellitus a la luz del referencial teórico del Pensamiento Complejo en actuantes de atención primaria de salud. Método: Investigación evaluativa con Pensamiento Complejo como referencial teórico. Datos recolectados mediante entrevista con 38 participantes; observación de atenciones colectivas e individuales; y análisis de 25 historias clínicas de personas con diabetes. La triangulación facilitó el análisis de datos, realizado con software ATLAS.ti. Resultados: La prevención y el manejo de las complicaciones crónicas de la diabetes no atendían lo establecido en las políticas públicas ministeriales dirigidas a tal público. El seguimiento sistematizado para control de prevención de complicaciones crónicas mostró importantes fallas. Consideraciones finales: La asistencia en atención primaria no contemplaba acciones de prevención de complicaciones de la diabetes mellitus. El contexto estaba cargado de prácticas disyuntivas, fragmentadas y disociadas de una atención que apunta a la totalidad de las personas atendidas. RESUMO Objetivo: Avaliar a prevenção de complicações crônicas do diabetes mellitus a luz do referencial teórico do Pensamento Complexo por integrantes da atenção primária à saúde. Método: Pesquisa avaliativa, que teve como referencial teórico o Pensamento Complexo. Como técnicas de coleta de dados foram utilizadas: entrevista com 38 participantes; observação nos atendimentos coletivos e individuais;e análise em 25 prontuários de pessoas com diabetes. A triangulação subsidiou a análise de dados que teve auxílio do software ATLAS.ti. Resultados: A prevenção e o manejo das complicações crônicas do diabetes não atendiam ao estabelecido nas políticas públicas ministeriais destinadas a esse público. O acompanhamento sistematizado para controle da prevenção das complicações crônicas apresentou importantes lacunas. Considerações finais: A assistência na atenção primária não contemplava ações de prevenção de complicação do diabetes mellitus. Esse contexto era por marcado por práticas disjuntivas, fragmentadas e dissociadas de uma assistência que visa a totalidade das pessoas assistidas.

Praca studentki Ratownictwa Medycznego podlegająca obowiązkowi upublicznienia Cukrzyca jest to choroba metaboliczna. Choć poddawana aktualnie skutecznemu leczeniu, pozwalającemu na długie lata życia, wciąż niesie za sobą wiele powikłań i sytuacji zagrażających życiu. Do najczęstszych i najpoważniejszych należą: hipoglikemia, śpiączka ketonowa, nieketonowa śpiączka hipermolarna, a także pośrednio udar mózgu i zawał mięśnia sercowego. Pomimo faktu, iż edukacja pacjentów diabetologicznych i ich świadomość choroby jest na dość wysokim poziomie, nie jest w stanie uchronić ich to od powikłań choroby. Najpoważniejszym problemem wydaje się być nieswoistość objawów występujących w sytuacjach zagrażających życiu, pasujących do wielu innych chorób. Warto bliżej zapoznać się z problemem cukrzycy by móc adekwatnie i szybko reagować w sytuacjach szczególnie tego wymagających. Diabetes is a metabolic disease. While undergoing effective treatment for many years, it continues to cause many Life-threatening conditions. The most common and most severe are: hypoglycaemia, ketoneuropathy, nonketotic hypersensitivity coma, as well as moderate stroke and myocardial infarction. Despite the fact that diabetic education and awareness among diagnosed people is high, they are not able to protect themselves from the complications of the disease. The most serious problem is inconsistency in symptoms during life-threatening situations which are difficult to be matched with diabetes itself. It is worth getting acquainted with the problem of diabetes to respond appropriately and quickly in emergency situations.

Aim: To evaluate sensory neuropathy and clinical autonomic neuropathy in type 2 diabetes mellitus patients in connection with duration of diabetes, risk factors and quality of life. Objectives: To evaluate autonomic neuropathy characteristics in patients with type 2 diabetes mellitus duration groups (5-9 years) and (10-15 years). To evaluate diabetic neuropathic sensory connection in patients with type 2 diabetes mellitus duration groups (5-9 years) and (10-15 years). To evaluate risk factors of cardiovascular complications in type 2 diabetes mellitus patients. To evaluate health-related quality of life differences between type 2 diabetes mellitus patients with duration. Methods: 59 patients were tested in LSMUL KK during the period between 2017 03 06 – 2017 03 24 with questionnaire and objective examination. It was determined the patients age, sex, duration of type 2 diabetes mellitus, cardiovascular system, hypoglycemia and complications, autonomic neuropathy, peripheral neuropathy, quality of life and the value of addictions. Statistical analysis was performed using standard SPSS 20.0 program. Results: Patient with duration of diabetes 5-9 years have characteristic of diabetic gastroparesis, and urinary dysfunction symptoms of dysphagia (p=0,003), and anorexia (p=0,003), and nausea (p=0,002), urinary dripping, incomplete bladder emptying (p=0,02). Patients with longer duration of diabetes suffer from vomiting (p

Projeto de Graduação apresentado à Universidade Fernando Pessoa como parte dos requisitos para obtenção do grau de licenciado em Enfermagem A diabetes afeta milhares de pessoas em todo o mundo, constituindo já uma epidemia que é preciso travar visto que, além de ser uma das principais causas de morbilidade e de mortalidade, associada a outras patologias, acarretas enormes custos financeiros para o SNS. Uma intervenção multidisciplinar eficaz, por parte de profissionais qualificados (enfermeiros e médicos de família), contribui seguramente para uma contenção da doença, para um melhor controlo da mesma e para proporcionar ao doente uma melhor qualidade de vida. Neste sentido, foi propósito do presente estudo verificar se, efetivamente, os enfermeiros, através das consultas de enfermagem, são uma mais-valia para o controlo da doença e se os seus portadores apresentavam melhorias quando a elas recorriam de forma sistemática. Paralelamente, importa aferir se o papel do enfermeiro é determinante apenas enquanto cuidador ou ainda enquanto educador e facilitador na adoção de hábitos alimentares, tabágicos, de prática de exercício físico, entre outros, que contribuem para uma redução dos efeitos secundários da doença, para a sua progressão mais lenta e, consequentemente, para o bem-estar de todos os indivíduos que dela padecem. Diabetes affects thousands of people all over the world. Being already a plague, it must be stopped once it is a major cause of morbidity and mortality. When associated with other pathologies it entails enormous financial costs for the NHS. An effective multidisciplinary intervention by qualified professionals (nurses and family physicians) surely contributes to the containment and better control of the disease, and to provide the patient with a better quality of life. In this sense, it was this work intention to verify if, effectively, nurses, through the nursing consultations, bring significant value for the control of the disease and if its patients presented improvements when going to their clinical appointments. At the same time, it is important to determine if the role of the nurse is relevant only as a caregiver or also as an educator and facilitator in the adoption of healthy eating habits, smoking habits, physical exercise, among others, which contribute to a reduction of the side effects of the disease, its slower progression and, consequently, for the well-being of all the individuals who suffer from it. N/A

Resumo Contexto O índice tornozelo-braquial (ITB) é um exame de rastreamento da doença arterial obstrutiva periférica, sendo também utilizado para avaliar o risco cardiovascular. Em diabéticos, a interpretação do exame é difícil pela possibilidade de índice aberrante devido à calcificação da camada média arterial. Objetivo Encontrar a frequência de ITB aberrante em diabéticos e verificar sua associação com variáveis sociodemográficas. Métodos Estudo descritivo com entrevista e aferição de ITB de 309 pacientes diabéticos tipo 2, acompanhados no centro de referência Centro de Diabetes e Endocrinologia da Bahia (CEDEBA), Salvador, BA, Brasil. Foi estudada a frequência e a relação entre o ITB aberrante e variáveis sociodemográficas, como sexo, idade e renda familiar. Utilizou-se um ponto de corte para ITB aberrante de 1,3. As variáveis contínuas foram dicotomizadas. Para a análise estatística, utilizou-se o teste do qui-quadrado, considerando significante um p ≤ 0,05. Resultados Entre os 309 pacientes entrevistados, 65% eram mulheres, 26% haviam cursado ensino médio completo e 77% tinham renda familiar igual ou menor que três salários mínimos. A frequência de ITB aberrante ≥ 1,3 foi 16,5%. Não foram encontradas correlações estatisticamente significantes nas análises bivariadas entre o ITB aberrante (≥ 1,3) e as variáveis sociodemográficas estudadas (sexo, idade, tempo de duração de diabetes melito, renda familiar e escolaridade). Conclusões A frequência de ITB aberrante entre diabéticos foi de 16,5%. Não encontramos correlação entre as variáveis sociodemográficas (sexo, idade, tempo de DM, escolaridade e renda familiar) e a ocorrência de ITB aberrante. Abstract Background The ankle-brachial index (ABI) is a screening test for peripheral arterial occlusive disease and it can also be used to assess cardiovascular risk. However, in diabetics it can be difficult to interpret because the index may be excessively high because of calcification of the arterial tunica media. Objective To determine the frequency of high ABI in diabetics and to test for associations with sociodemographic variables. Methods This was a descriptive study in which 309 type 2 diabetes patients were interviewed and had their ABI measured. The sample was recruited at a referral center for diabetes and endocrinology (CEDEBA) in Salvador, BA, Brazil. The frequency of excessively high ABI and its relationships with sociodemographic variables such as sex, age and family income were studied. The cutoff point chosen for excessively high ABI was 1.3. Continuous variables were dichotomized. The chi-square test was used for statistical analysis and results with p ≤ 0.05 were considered significant. Results A total of 309 patients were interviewed, 65% were women, 26% had graduated from secondary education and 77% had a family income equal to or less than three times the minimum salary. The frequency of excessively high ABI (≥ 1.3) was 16.5%. Bivariate analyses detected no statistically significant correlations between excessively high ABI (≥ 1.3) and the sociodemographic variables studied (sex, age, time since diagnosis of diabetes mellitus, family income and educational level). Conclusions The frequency of high ABI among this sample of diabetics was 16.5%. We did not detect correlations between the sociodemographic variables (sex, age, duration of DM, educational level and family income) and high ABI.

Patient knowledge about diabetes mellitus (DM) and appropriate timely management with respect to the condition are important factors for limiting the complications of the disease. The aim of this study was to evaluate knowledge and practices regarding DM, its ocular effects and management protocols among privately-funded diabetic patients. A questionnaire containing questions on these issues and certain demographics was provided to 73 self-funding or privately-funded diabetic patients attending an optometric practice in a rural district of the Western Cape. Respondents ages ranged from 33 to 80 years (mean = 57 ± 11.2 years) and included 59% males and 41% females. Above half(56%) of the respondents knew that there were two main types of DM. Less than half (46%) of the respondents reported having Type 2 DM, 4% reported having Type 1 DM and 49% did not knowwhat type of DM they had. Although 82% of the respondents reported owning a glucometer and 98% knew that controlling their blood sugar levels may help reduce diabetic complications, only 29% measured their blood sugar levels on a daily basis. Most respondents (97%) agreed that DM could affect their vision yet only 37% stated that they had annual eye examinations. A significant proportion of the respondents did not know that DM could cause strabismus (57%), colour vision problems (44%), cataracts (41%), retinopathy (37%) and contribute to causing glaucoma (63%). Most respondents took their medication regularly and as prescribed (89%) and underwent regular medical check-ups (82%). However, a large proportion of the respondents did not exercise regularly (61%), had no regular eye testing (63%) nor Body Mass Index (BMI) monitoring (84%) in their manage-ment of DM. This study indicates that, despite access to private health care, these subjects level of knowledge of DM and its ocular effects was sub-optimal. It also indicated poor self-management practices of the diabetic patients towards diabetes care and management. Optometrists should form part of a team of health professionals to assist in the management of DM. (S Afr Optom 2012 71(2) 70-77)

The International Diabetes Federation is divided into seven regions, Africa (AFR), Europe (EUR), Middle East and North Africa (MENA), North America and Caribbean (NAC), South and Central America (SACA), South East Asia (SEA) and Western Pacific (WP), with the aim of enhancing the work of national diabetes associations and strengthening the collaboration between them. In the MENA region, adult population (aged 20–79 years) was estimated 387 million in 2015 from which 35.4 million were suffering from diabetes and is expected to increase up to 72.1 million in 2040. Of the 35.4 million people affected by diabetes, nearly 40.6% were estimated to be undiagnosed. Therefore, at considerable risk of diabetes complications and poor health outcomes. The importance of glycemic control in preventing and delaying the progression of diabetes complications is well well-known. Diabetes poses extreme financial load to diabetic subjects. Local guidelines help to upgrade management strategies. It provides ideas for health care providers to improve quality of life of patient. Guidelines were prepared reviewing the literature, reviewing the available guidelines, consultative meetings between the experts and country representatives from the region.

Resumo Contexto A calcificação da camada média arterial pode tornar o Índice Tornozelo-Braquial (ITB) falsamente elevado em diabéticos, dificultando a avaliação da doença arterial. Objetivo Comparar os valores do ITB de diabéticos e não diabéticos com isquemia crítica. Métodos Foram incluídos 140 pacientes (60% de diabéticos) acompanhados no Serviço de Cirurgia Vascular do Complexo Hospitalar Universitário Professor Edgard Santos com isquemia crítica por DAOP infra-inguinal. Comparou-se a média dos valores do ITB dos dois grupos de pacientes, correlacionando o ITB com a gravidade da isquemia, segundo a Classificação de Rutherford. A análise estatística foi realizada pelo EPI-INFO. Resultados A maioria dos 140 pacientes (77%) se encontrava na Categoria 5 da Classificação de Rutherford, 6% na 4 e 17% na 6. Nove diabéticos (11%) e um não diabético (2%) apresentaram ITB > 1,15 (p = 0,02), sendo excluídos da análise das médias do ITB. Considerando os 130 pacientes, os 75 doentes diabéticos apresentaram média do ITB na artéria tibial posterior de 0,26 versus 0,28 dos 55 doentes não diabéticos (p = 0,6); e no ITB da artéria pediosa aqueles apresentaram média de 0,32 versus 0,23 desses (p = 0,06). Estratificando os doentes nas categorias da Classificação de Rutherford, não houve diferença nas médias do ITB nas categorias 4 e 5. Apenas em relação à artéria pediosa e em pacientes na Categoria 6, a média do ITB foi significativamente maior em diabéticos (0,44 versus 0,16; p = 0,03). Conclusão Os diabéticos apresentaram maior prevalência de ITB falsamente elevado. Porém, excluindo-se esses casos, a média dos valores de ITB são semelhantes aos não diabéticos, exceto na artéria pediosa, nos pacientes com isquemia na categoria 6. Abstract Background Calcification of the arterial tunica media can falsely elevate the Ankle-Brachial Index (ABI) in diabetics, making it difficult to assess arterial disease. Objective To compare ABI values in diabetics and non-diabetics with critical ischemia. Methods A total of 140 patients (60% diabetics) with critical ischemia due to infrainguinal peripheral arterial obstructive disease were recruited from the vascular surgery service at the Complexo Hospitalar Universitário Professor Edgard Santos. Mean ABI values for the two groups of patients were compared and correlated with severity of ischemia, according to the Rutherford Classification. Statistical analysis was conducted using EPI-INFO. Results A majority of the 140 patients (77%) were classified as Rutherford Category 5, 6% as Category 4 and 17% as Category 6. Nine diabetics (11%) and one non-diabetic (2%) exhibited ABI > 1.15 (p = 0.02) and were excluded from the comparative analysis of mean ABIs. For the 130-patient sample, the 75 diabetic patients had a mean ABI for the posterior tibial artery of 0.26, vs. 0.28 for the 55 non-diabetic patients (p = 0.6); while mean ABIs for the dorsalis pedis artery were 0.32 vs. 0.23 respectively (p = 0.06). When the patients were stratified by Rutherford categories, there were no differences in mean ABIs in categories 4 or 5. Only mean ABI for the dorsalis pedis artery in Category 6 patients was significantly higher among diabetics (0.44 vs. 0.16; p = 0.03). Conclusions The diabetic patients had a higher prevalence of falsely elevated ABI, but when these cases were excluded, mean ABI values were similar to those of non-diabetic patients, with the exception of ABI measured at the dorsalis pedis artery in patients with category 6 ischemia.

Šećerna bolest je kronična, metabolička bolest. Tek uz pravilno liječenje može se značajno poboljšati kvaliteta života i produljiti očekivano trajanje života. Prevalencija šećerne bolesti u cijelom svijetu bilježi drastičan, neočekivan porast. Najveći broj bolesnika poznat je u tzv. zemljama u razvoju. U našoj zemlji prevalencija šećerne bolesti kreće oko 9,2% za populaciju stariju od 18 godina, što odgovara prevalenciji u razvijenim zemljama. Dugotrajno loše regulirana šećerna bolest ne izaziva bol, ali ostavlja teške posljedice. Svjedoci smo naglog porasta broja oboljelih od šećerne bolesti. Razlog tome je način života - premalo kretanja, preobilna, često nekvalitetna i prekalorična prehrana, stresni način života. Simptomi koji se javljaju u srednjoj ili starijoj životnoj dobi su prikriveni, postupni, bez naglih promjena, pa povremenu žeđ ili učestalije mokrenje pripisujemo svemu drugom, samo ne šećernoj bolesti. Kasne komplikacije šećerne bolesti (kardiovaskularne bolesti, retinopatija, nefropatija i sindrom dijabetičkog stopala s posljedičnom „minor“ ili „major“ amputacijom) uglavnom su posljedica mikro i makroangiopatskih promjena, neuropatije i kombinacije tih promjena i jedan su od glavnih uzroka mortaliteta, a dijabetičko stopalo i dijabetički ulkus su neposredni uzrok amputacija kod bolesnika s šećernom bolesti. Radi prevencije nastanka bolesti i neželjenih komplikacija važna je dobra edukacija medicinskih djelatnika. U edukaciji bolesnika na svim razinama zdravstvene zaštite najvažniju ulogu ima medicinska sestra, koja ima izravan uvid u bolesnikovo zdravstveno stanje i potrebe. Medicinska sestra/tehničar koja svakodnevno provodi skrb prepoznaje potrebe za edukacijom bolesnika te provodi edukaciju kako bi se bolesnike osposobilo za samokontrolu, samoliječenje i samopomoć. Sve spomenuto provodi se radi smanjenja stupnja nastanka komplikacija i invalidnosti te zbog poboljšanja stupnja kvalitete života. Diabetes is a chronical metabolic disease. Only with the right treatment the quality of life can be significantly improved and expected life duration can be extended. Prevalence of diabetes in the whole world registers drastic and unexpected increase. The biggest number of patients is in so called developing countries. In our country,prevalence of diabetes is around 9,2% for population older than 18, which is equal to prevalence in developed countries. Longterm badly regulated diabetes does not cause pain, but it leaves severe consequences. We are witnessing a rapid growth of people vith diabetes. The reason for that is the way of living – not enough of moving , excessive, low-quality and very caloric diet, a stressful way of living. Symptoms which occur with middle and older aged people are disguised, gradual, without sudden changes. Periodical thirst or more often urination, is something we connect with everything else but just not with diabetes. Late complications of diabetes (cardiovascular diseases, retinopathy, nephropathy and syndrom of diabetic foot which leads to minor or major amputation ) are mostly consequences of micro - and macroangiopathy changes , neuropathy and combination of these changes are one of the main reasons of mortality. Diabetic foot and diabetic ulcer are direct cause of amputation of patients vith diabetes. A good education of medical workers is esential in preventing diabetes and unwanted complications. On all levels of health care, in patients education, the most important role plays a nurse who has a direct insight into the patient`s health care and his needs. A nurse who daily takes care of patients recognizes needs for educating of her/his patients and educates them to take control of their condition, self-treatment and self-help. All of this is done in order to reduce possible complications and disability and also to improve the quality of life.

BACKGROUND AND OBJECTIVES:Epidemiological data on chronic pain in different populations are scarce in Brazil. This study aimed at investigating the prevalence of neuropathic pain and possible associated factors in diabetes type 2 patients, of a teaching center.METHODS:This was a transversal study with individuals seen between March 2010 and March 2011, in the Medical Outpatient Setting of Specialties, University of Southern Santa Catarina, Tubarão, SC, with interviews to identify socio-demographic variables of age, gender and time elapsed after diagnosis of diabetes mellitus and application of tools to measure neuropathic pain, depression, glycemia and adhesion to treatment.RESULTS:Participated in the study 72 subjects, being 69.4% females, 15.3% with controlled glycemia levels at the moment of the interview, 90.3% were adherent to treatment and 33.3% had depressive symptoms. The prevalence of neuropathic pain was 16.7% and this was associated to time of diabetes mellitus 2 (p=0.031).CONCLUSION:The prevalence of neuropathic pain was similar to that observed in other places of the country and we suggest better follow up of the studied population with regard to depression and adhesion to medication to treat diabetes. JUSTIFICATIVA E OBJETIVOS:Dados epidemiológicos sobre dor crônica, em diferentes populações, são escassos no Brasil. O objetivo deste estudo foi investigar a prevalência de dor neuropática e possíveis fatores associados em pacientes portadores de diabetes tipo 2, de um serviço universitário.MÉTODOS:Realizou-se estudo transversal com indivíduos atendidos entre março de 2010 e março de 2011, no Ambulatório Médico de Especialidades da Universidade do Sul de Santa Catarina, Tubarão, SC, com entrevistas para identificação das variáveis sócio-demográficas de idade, gênero e tempo de diagnóstico do diabetes mellitus e aplicação de instrumentos para mensuração de dor neuropática, depressão, glicemia e adesão aos fármacos.RESULTADOS:Foram entrevistados 72 sujeitos, sendo 69,4% do gênero feminino, 15,3% apresentavam níveis glicêmicos controlados no momento da entrevista, 90,3% eram aderentes ao tratamento e 33,3% apresentavam sintomas de depressão. A prevalência de dor neuropática foi de 16,7% e esta se associou com o tempo de diagnóstico do diabetes mellitus 2 (p=0,031).CONCLUSÃO:A prevalência de dor neuropática foi semelhante à observada em outras localidades do país, e sugere-se melhor acompanhamento da população estudada quanto à depressão e a adesão aos fármacos para tratamento do diabetes. Descritores: Complicações do diabetes, Diabetes mellitus, Dor crônica, Neuropatias diabéticas.

Este estudio tuvo como objetivo comprender los significados que le atribuyen a la discapacidad un grupo de personas jóvenes y adultos jóvenes que conviven con complicaciones como la retinopatía y la nefropatía generadas por la diabetes, en una unidad renal de Bogotá. Se utilizó una metodología cualitativa, con un enfoque narrativo biográfico, donde se reconocen los relatos de vida como una forma de constituir una identidad narrativa de los participantes, los cuales dan sentido a las acciones, a los eventos vividos y aquellos acontecimientos tanto internos (historia personal) como externos (historia social), que pudieran estar incidiendo como potenciales de cambio en su trayectoria como individuos. Por medio de los relatos de vida los narradores expresan, a través de su propio lenguaje, sus experiencias particulares y únicas de vivir con la enfermedad, lo que hace de cada vivencia un aporte especial a las reflexiones acerca de la discapacidad. La información se obtuvo por medio de entrevistas semiestructuradas a 10 personas. Se empleó el análisis de contenido, como un método de análisis controlado del proceso de comunicación entre el texto y el contexto, estableciendo un conjunto de reglas de análisis, paso a paso, para comprender los datos, no solo como un conjunto de acontecimientos físicos, sino como fenómenos simbólicos, y abordar su análisis directo. Los resultados obtenidos se presentan en tres grandes categorías: Las experiencias de dependencia, las capacidades y las relaciones de reciprocidad. En cuanto a la dependencia se concluye que es una noción compleja y multiforme, que evoca el carácter fundamental de las necesidades que es preciso satisfacer para que la vida se mantenga. De la categoría de capacidades, se concluye que todas las personas tienen capacidades, fortalezas y cualidades, que utilizan como mecanismo para salir adelante y como motivación para continuar luchando; en este sentido es necesario reconocerlas y trabajar en ellas, para lograr que las personas lleven a cabo el tipo de vida que consideran valiosa y así garantizar que los individuos prosperen, se autogestionen y alcancen su potencial como seres humanos. Finalmente, de la categoría de relaciones de reciprocidad, vale la pena resaltar su valioso aporte a la comprensión de las relaciones que establecen los participantes con su entorno; resaltando la importancia que ellos le atribuyen a la familia como principal fuente de amor y de apoyo. Abstract. This study aimed to understand the meanings attributed to a group of disabled young people and young adults who live with complications such as retinopathy and nephropathy generated by diabetes, renal unit in Bogotá. A qualitative methodology was used, with a biographical narrative approach, where life stories are recognized as a way to provide a narrative identity of the participants, which give meaning to actions, and the events experienced those events both internal (history staff) and external (social history), that may be affecting as potential for change in his life as individuals. Through life stories narrators expressed through its own language, their own special and unique experiences living with the disease, making each experience a special contribution to reflections on disability. The information was obtained through semi-structured interviews with 10 people. Content analysis was used as a method of analysis controlled communication process between text and context, establishing a set of rules of analysis, step by step, to understand the data, not just as a set of physical events, but as symbolic phenomena, and board your scan. The results are presented in three broad categories: dependence experiences, skills and relationships of reciprocity. As we conclude that dependence is a complex and multifaceted concept that evokes the fundamental nature of the needs that must be satisfied for life to be maintained. From the category of capabilities, it is concluded that all people have strengths, abilities and qualities, using as a mechanism to succeed and motivation to continue fighting; in this sense it is necessary to recognize them and work on them to get people to carry out the kind of life they consider valuable and thus ensure that individuals thrive, manage themselves and reach their potential as human beings. Finally, the category of relations of reciprocity, it is worth noting their valuable contribution to the understanding of the relationships established between participants and their environment; highlighting the importance they place on the family as the primary source of love and support. Maestría

Background Hyperglycemia is an independent risk factor for the development of vascular diabetic complications, which are characterized by endothelial dysfunction and tissue‐specific aberrant angiogenesis. Tumor growth is also dependent on angiogenesis. Diabetes affects several cancers in a tissue‐specific way. For example, it positively correlates with the incidence of breast cancer but negatively correlates with the incidence of prostate cancer. The tissue‐specific molecular mechanisms activated by hyperglycemia that control angiogenesis are unknown. Here we describe a novel tissue‐ and cell‐specific molecular pathway that is activated by high glucose and regulates angiogenesis. Methods and Results We have identified micro RNA 467 (miR‐467) as a translational suppressor of thrombospondin‐1 ( TSP ‐1), a potent antiangiogenic protein that is implicated in the pathogenesis of several diabetic complications. miR‐467 was upregulated by hyperglycemia in a tissue‐specific manner. It was induced by high glucose in microvascular endothelial cells and in breast cancer cells, where it suppressed the production of TSP ‐1 by sequestering mRNA in the nonpolysomal fraction. Mutation of the miR‐467 binding site in TSP ‐1 3′ UTR or miR‐467 inhibitor relieved the translational silencing and restored TSP ‐1 production. In in vivo angiogenesis models, miR‐467 promoted the growth of blood vessels, and TSP ‐1 was the main mediator of this effect. Breast cancer tumors showed increased growth in hyperglycemic mice and expressed higher levels of miR‐467. The antagonist of miR‐467 prevented the hyperglycemia‐induced tumor growth. Conclusions Our results demonstrate that miR‐467 is implicated in the control of angiogenesis in response to high glucose, which makes it an attractive tissue‐specific potential target for therapeutic regulation of aberrant angiogenesis and cancer growth in diabetes.

Submitted by Geyciane Santos (geyciane_thamires@hotmail.com) on 2015-07-30T14:37:32Z No. of bitstreams: 1 Disserta????o Elenilce Pereira de Carvalho.pdf: 1053370 bytes, checksum: 46b984819daec6f155df078c9178c922 (MD5) Approved for entry into archive by Divis??o de Documenta????o/BC Biblioteca Central (ddbc@ufam.edu.br) on 2015-07-30T20:37:34Z (GMT) No. of bitstreams: 1 Disserta????o Elenilce Pereira de Carvalho.pdf: 1053370 bytes, checksum: 46b984819daec6f155df078c9178c922 (MD5) Approved for entry into archive by Divis??o de Documenta????o/BC Biblioteca Central (ddbc@ufam.edu.br) on 2015-07-30T20:45:14Z (GMT) No. of bitstreams: 1 Disserta????o Elenilce Pereira de Carvalho.pdf: 1053370 bytes, checksum: 46b984819daec6f155df078c9178c922 (MD5) Made available in DSpace on 2015-07-30T20:45:14Z (GMT). No. of bitstreams: 1 Disserta????o Elenilce Pereira de Carvalho.pdf: 1053370 bytes, checksum: 46b984819daec6f155df078c9178c922 (MD5) Previous issue date: 2012-09-27 CAPES - Coordena????o de Aperfei??oamento de Pessoal de N??vel Superior Type 2 Diabetes mellitus ( T2DM ) is a chronic degenerative disease, with metabolic feature, resulting from defects of insulin secretion and/or its action. Its incidence and prevalence have grown in the current world, setting a serious problem of public health. The diabetes??? chronic hyperglycemia is associated to various comorbidities related to chronic injuries, dysfunction and various organs failure. The study had the objective of diagnosing the nutritional condition about anthropometric, biochemical and dietary indicators, and correlate with some comorbidities found in patients with T2DM diagnosis. It was a descriptive study of transversal collection, done in the Nutritional Clinic of Jo??o Barros Barreto University Hospital (Hospital Universit??rio Jo??o Barros Barreto ??? HUJBB), from September, 2011 to April, 2012. Data was collected in the moment of the nutritional care, using a structured questionnaire previously tested, which had the information related to the sociodemographic variables, anthropometric indicators, dietary profile and lipid profile. The study evaluated 180 patients with T2DM with the ages between 40 and 81, and checked that the studied population was predominantly female, with the age group from 50 to 59, complete Elementary School and family income of a minimum wage, with less than five years since the disease diagnosis, nondrinker, nonsmoker and sedentary. Among the found comorbidities there was a predominance of the Systemic Arterial Hypertension (SAH), dyslipidemia, nephropathy, neuropathy and stroke, being SAH the most predominant. The majority of the population was obese, dyslipidemic and has hyperglycemia. Inadequate dietary profile, due to low fiber intake and high consumption of proteins and cholesterol. It was checked that there is a significant correlation among the nutritional condition and some comorbidities, such as SAH, dyslipidemia and nephropathy; there is also a significant correlation between the dietary profile and the biochemical and anthropometric nutritional condition. Even though the studied population is being attended by the Institution???s multidisciplinary team, it was checked that this population shows metabolic disorder, which can contribute to micro- and macro-vascular complications, which makes necessary a set of more effective therapeutic actions, to give these patients a better quality of life, being essential to make them conscious about how important it is to join the treatment. O Diabetes mellitus tipo 2 (DM2) ?? uma doen??a cr??nico-degenerativa, de car??ter metab??lico, resultante de defeitos na secre????o de insulina e/ou na a????o desta. Sua incid??ncia e preval??ncia t??m aumentado no mundo atual configurando um grave problema de sa??de p??blica. A hiperglicemia cr??nica do diabetes est?? associada a diversas comorbidades relacionadas ??s les??es cr??nicas, disfun????o e fal??ncia de diversos ??rg??os. O estudo teve por objetivo diagnosticar o estado nutricional relativo aos indicadores antropom??trico, bioqu??mico, e diet??tico e correlacionar com algumas comorbidades encontradas em pacientes com diagn??stico de DM2. Foi um estudo descritivo de coleta transversal, realizado no ambulat??rio de nutri????o do Hospital Universit??rio Jo??o de Barros Barreto (HUJBB), durante o per??odo de setembro de 2011 a abril de 2012. Os dados foram coletados no momento do atendimento nutricional, mediante a utiliza????o de um question??rio estruturado previamente testado, contendo informa????es referentes ??s vari??veis sociodemogr??ficas, indicadores antropom??tricos, perfil diet??tico e perfil lip??dico. O estudo avaliou 180 pacientes com DM2 com idade entre 40 e 81 anos, e verificou que a popula????o estudada era predominantemente do sexo feminino, de faixa et??ria entre 50 a 59 anos, com ensino fundamental completo e renda familiar de 1 sal??rio m??nimo, com tempo de diagn??stico da doen??a inferior a 5 anos, n??o etilista, n??o tabagista, e sedent??rios. Dentre as comorbidades encontradas houve predom??nio da HAS, dislipidemia, nefropatia, neuropatia e AVC, sendo a HAS a mais prevalente. A maioria da popula????o era obesa, dislipid??mica, e com hiperglicemia. Perfil diet??tico inadequado, devido a baixa ingest??o de fibras e alto consumo de prote??nas e colesterol. Verificou-se que existe correla????o significante entre o estado nutricional e algumas comorbidades, como HAS, DLP e Nefropatia; e existe tamb??m correla????o significante entre o perfil diet??tico e o estado nutricional bioqu??mico e antropom??trico. Apesar da popula????o de estudo est?? sendo acompanhada pela equipa multidisciplinar da Institui????o, verificou-se que a mesma apresenta uma desordem metab??lica, que pode contribuir para as complica????es micro e macrovasculares, o que torna necess??rio um conjunto de medidas terap??uticas mais efetivas, para que esses pacientes tenham melhor qualidade de vida, sendo imprescind??vel conscientizar o paciente sobre a import??ncia da ades??o ao tratamento.

Sladkorna bolezen je ena izmed najpogostejših kroničnih nenalezljivih bolezni. Število bolnikov s sladkorno boleznijo strmo narašča. Sprejetje bolezni, prilagoditev nanjo in sposobnost njenega obvladovanja je za bolnika velika psihična in socialna obremenitev. V veliko pomoč pri sprejetju bolezni so bolnikom njihovi svojci, saj bolezen vpliva na življenje vseh družinskih članov. Pomembna je tudi stalna dosegljivost zdravstvenih delavcev, ki nudijo pomoč bolniku. Največji pomen ima zdravstvena vzgoja bolnikov s sladkorno boleznijo in njihovih svojcev, saj dobro poučen bolnik obvlada samokontrolo, zdravljenje in zdrav slog življenja. Z dobrim vodenjem bolezni lahko preprečimo ali upočasnimo nastanek akutnih in kroničnih zapletov, ki pomembno vplivajo na kakovost življenja bolnikov s sladkorno boleznijo. V teoretičnem delu je opisana sladkorna bolezen, njeni zapleti in načini zdravljenja, patronažna zdravstvena nega ter pomen delovanja patronažne medicinske sestre. V empiričnem delu so predstavljeni rezultati, pridibljeni z vprašalnikom za strukturirani intervju, ki smo ga izvedli pri tridesetih bolnikih s sladkorno boleznijo, ki jih na domu obiskujejo patronažne medicinske sestre. Ugotavljali smo, kateri so najpogostejši negovalni problemi bolnikov s sladkorno boleznijo, kako so bolniki pripravljeni na izvajanje samokontrole in terapije sladkorne bolezni ter kakšen je vpliv sladkorne bolezni na kakovost življenja bolnikov s sladkorno boleznijo. Ugotovili smo, da so najpogostejši negovalni problemi povezani s kroničnimi zapleti sladkorne bolezni. Zaradi okvar na ožilju imajo največ težav z motnjami vida, slepoto, poškodovano kožo in diabetičnim stopalom. Bolniki so samostojni pri izvajanju samokontrole in zdravljenju sladkorne bolezni. Ko pride do zapletov, pa največkrat postanejo odvisni od pomoči drugih. Zapleti pomembno vplivajo na zdravstveno stanje bolnikov, posledično pa tudi na družabno življenje. Diabetes is one of the most common chronical non-contagious illnesses. The number of patients with diabetes has been steeply rising, both worldwide and in our country. It is a mental and physical strain for the patient to accept the illness, adjust to it and be able to control it. Relatives can help the patient in his acceptance of the diabetes, for the illness affects the lives of all family members. Continuous accessibility of the help of healthcare workers is very important but the most important thing is health education of the diabetic patient and his relatives. A well informed patient masters his own self-control, medical therapy and a healthy lifestyle. With good guidance we can prevent or slow down the emergence of acute and chronic complications that have a significant impact on the quality of life of the diabetic patient. The theoretical part addresses diabetes, its complications and ways of medical therapy, community nursing care and the importance of community nurses. The empirical part introduces the results we got from the structured inquiry questionnaire, answered by thirty diabetes patients, who are part of the community nursing care. We established which are the most common nursing problems of the diabetic patients and how they are prepared to proceed with self-control and therapy. We found out that the most common nursing problems are linked to the chronical complications of diabetes. Due to the vascular system defects the majority of the problems concern visual disturbances, blindness, damaged skin and diabetic foot. Patients are autonomous with implementing self-control and medical therapy. Once the complications occur, they start to depend on others. Complications affect the health condition of diabetic patients and therefore their social life.

This publication outlines the different types of diabetes and the complications that can occur with each one.

OBJETIVOS: Determinar a prevalência do diabetes melito (DM) e da hiperglicemia de estresse (HE) em pacientes com infarto agudo do miocárdio (IAM) admitidos em unidade de emergência cardiológica. MÉTODOS: Análise retrospectiva de 2.262 pacientes com IAM, avaliando, além da prevalência de diabetes referido, o diagnosticado e a hiperglicemia de estresse. RESULTADOS: Apesar de referido em 12,1% dos pacientes (H: 10,7%, M: 15,8%), o DM ocorria efetivamente em 24,8% (H: 22,9%, M: 29,7%) e a HE em 13,6% (H: 14,3%, M: 11,7%) dos indivíduos dessa população. Portanto, alterações glicêmicas ocorreram em 37,4% dos indivíduos com IAM (H: 37,2%, M: 41,4%). Nos pacientes com DM, observou-se maior precocidade etária do IAM, maior prevalência de óbitos (DM: 20,7%, ND:13,8%, HE: 13,4%) e de procedimentos cirúrgicos (ND: 33,8%, HE: 18,0%, DM: 21,7%). CONCLUSÃO: A elevada prevalência de DM e hiperglicemia de estresse observada em nosso estudo indica que as alterações glicêmicas constituem um dos mais importantes fatores de risco para o IAM. OBJECTIVES: To evaluate in our population the real prevalence of diabetes (DM) and stress hyperglycemia (HE) in patients with myocardial infarction (IAM) admitted in a cardiologic emergency unit. METHODS: A retrospective analysis of 2262 patients with AMI evaluating the prevalence of DM (referred and diagnosed) and stress hyperglycemia. RESULTS: Besides 12,1% of subjects were previously referred to be diabetic (men: 10.7% and women: 15.8%), diabetes was effectively diagnosed in 24,8% (M: 22,9%, W: 29,7%) and stress hyperglycemia in 13,6% HE of the patients (M: 14,3%, W: 11,7%) indicating that glycemic alterations were effectively observed in 37.2.% of the patients with IAM (M: 37,2%, W: 41,4%). In DM subjects IAM events occurred earlier, total intra-hospital mortality was higher (DM: 20.7%, ND: 13,8%, HE: 13,4%) and less surgical procedures were performed (ND 33.8%, DM: 21.7%, HE: 18.0%). CONCLUSION: The elevated DM and stress hyperglycemia prevalence observed in our study indicates that glycemic alterations is one of the most important risk factors for IAM.

Epidemiological data shows that Diabetes Mellitus (DM) in South Africa is increasing with changes in lifestyles and ageing of the population. Early diagnosis and management of DM is an important factor for limiting visual and physical complications of the disease. The purpose of this study was to establish the level of knowledge about DM, its ocular complications and management protocol amongst diabetic patients. A questionnaire was provided to a total of 106 diabetic patients attending the Tongaat Community Clinic, the University of KwaZulu Natal Eye Clinic and the Diabetic Awareness day in Chatsworth. All patients were receiving treatment for DM. The questionnaire consisted of questions relating to the patients’ knowledge of the disease, its ocular complications and its management. The respondents were mostly females (65%), aged between 30 to 85 years (mean = 52.45 ± 3.75 years). The majority (96%) of respondents knew about the existence of two main types of DM and 77% reported having Type 2 DM, 18% reported having Type 1 DM, and only 5% did not know the type of DM that they had. Many respondents thought that hereditary factors (78%), and diet and lifestyle modifications (77%), were important risk factors in the development of DM. Glucose levelcontrol (84%) and duration (85%) were thought as important risk factors for its complications. Although many subjects (66.1%) were aware of the visual threat that DM posed, only 42%, 44% and 53% knew that DM could result in diabetic retinopathy, cataracts and glaucoma respectively. Less than half (48.3%) of the respondents had their last eye examination more than a year and a half ago. A significant proportion (60.8%) reported that the threat to vision was reason enough for them to have regular eye examinations. A large proportion (76%) of respondents reported that they had adequate knowledge of management of DM. Many (81%) of the respondents reported routinely controlling their DM through diet, 65% through exercise, 84% through sugar monitoring and 76% through regular medical examinations. The participants in this study had a significant knowledge of DM and its management. However, their knowledge of ocular effects was limited. These results highlight the need for educational programmes aimed at improving the knowledge of the effects of DM on the eyes including the need for regular eye examinations.

Treatment with continuous subcutaneous insulin infusion (CSII) allows a large degree of treatment individualization and intensification in children with diabetes. The study’s aim was to evaluate the impact of treatment with CSII on glycated haemoglobin level (HbA1c) in children with diabetes and investigate whether introduction of CSII is associated with an increased risk of acute complications of diabetes. Patients treated throughout the recruitment period exclusively with multiple daily injections (MDI) were matched for duration of diabetes and HbA1c level at baseline with patients treated exclusively with CSII in a 1:1 group ratio (n = 223 and 231 for MDI and CSII, respectively). The CSII group showed lower HbA1c after the observation period (7.98 ± 1.38 vs. 7.56 ± 0.97; P = 0.002). HbA1c variability measured as standard deviations of average values was also lower in the CSII group (0.73 ± 0.45 vs. 0.84 ± 0.54; P = 0.049). The rate of hospitalization due to acute events was similar in both groups (14.7/100 vs. 14.0/100 person/years in the MDI and CSII group, P = 0.72). Duration of hospital stay per year was on average 1.25 days shorter in the CSII group (P = 0.0004), but the risk of acute complications resulting in hospitalization did not differ between the groups (hazard ratio (HR) 1.16; 95% confidence interval (95% CI) 0.68–1.63). The most significant risk factor for hospitalization due to acute complications was baseline HbA1c concentration (HR 1.25; 95% CI 1.14–1.37). In conclusion, CSII treatment may improve glycemic control and reduce its variability. Change of MDI to CSII does not alter the risk of hospitalization and may reduce the annual duration of hospitalization in children with diabetes. Electronic supplementary material The online version of this article (doi:10.1007/s00592-011-0332-7) contains supplementary material, which is available to authorized users.

Background The ankle-brachial index (ABI) is a screening test for peripheral arterial occlusive disease and it can also be used to assess cardiovascular risk. However, in diabetics it can be difficult to interpret because the index may be excessively high because of calcification of the arterial tunica media. Objective To determine the frequency of high ABI in diabetics and to test for associations with sociodemographic variables. Methods This was a descriptive study in which 309 type 2 diabetes patients were interviewed and had their ABI measured. The sample was recruited at a referral center for diabetes and endocrinology (CEDEBA) in Salvador, BA, Brazil. The frequency of excessively high ABI and its relationships with sociodemographic variables such as sex, age and family income were studied. The cutoff point chosen for excessively high ABI was 1.3. Continuous variables were dichotomized. The chi-square test was used for statistical analysis and results with p ≤ 0.05 were considered significant. Results A total of 309 patients were interviewed, 65% were women, 26% had graduated from secondary education and 77% had a family income equal to or less than three times the minimum salary. The frequency of excessively high ABI (≥ 1.3) was 16.5%. Bivariate analyses detected no statistically significant correlations between excessively high ABI (≥ 1.3) and the sociodemographic variables studied (sex, age, time since diagnosis of diabetes mellitus, family income and educational level). Conclusions The frequency of high ABI among this sample of diabetics was 16.5%. We did not detect correlations between the sociodemographic variables (sex, age, duration of DM, educational level and family income) and high ABI.

JUSTIFICATIVA E OBJETIVOS:Dados epidemiologicos sobre dor cronica, em diferentes populacoes, sao escassos no Brasil. O objetivo deste estudo foi investigar a prevalencia de dor neuropatica e possiveis fatores associados em pacientes portadores de diabetes tipo 2, de um servico universitario.METODOS:Realizou-se estudo transversal com individuos atendidos entre marco de 2010 e marco de 2011, no Ambulatorio Medico de Especialidades da Universidade do Sul de Santa Catarina, Tubarao, SC, com entrevistas para identificacao das variaveis socio-demograficas de idade, genero e tempo de diagnostico do diabetes mellitus e aplicacao de instrumentos para mensuracao de dor neuropatica, depressao, glicemia e adesao aos farmacos.RESULTADOS:Foram entrevistados 72 sujeitos, sendo 69,4% do genero feminino, 15,3% apresentavam niveis glicemicos controlados no momento da entrevista, 90,3% eram aderentes ao tratamento e 33,3% apresentavam sintomas de depressao. A prevalencia de dor neuropatica foi de 16,7% e esta se associou com o tempo de diagnostico do diabetes mellitus 2 (p=0,031).CONCLUSAO:A prevalencia de dor neuropatica foi semelhante a observada em outras localidades do pais, e sugere-se melhor acompanhamento da populacao estudada quanto a depressao e a adesao aos farmacos para tratamento do diabetes. Descritores: Complicacoes do diabetes, Diabetes mellitus, Dor cronica, Neuropatias diabeticas.