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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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

Background Defective copper regulation is implicated as a causative mechanism of organ damage in diabetes. Treatment with trientine, a divalent-copper-selective chelator, improves arterial and renal structure/function in diabetes, wherein it also ameliorates left-ventricular (LV) hypertrophy. However, direct in vivo evidence that trientine can improve cardiac function in heart failure has hitherto been lacking. Methods To determine whether trientine treatment could improve in vivo outcome, we measured cardiac function in groups of trientine-treated diabetic (TETA-DIA), non-drug-treated diabetic (DIA) and sham-treated control (SHAM) rats, by using in vivo high-field cardiac magnetic-resonance imaging (cMRI) and an ex vivo isolated-perfused working heart method. Forty age-matched animals underwent a cMRI scan after which 12 were randomized to the SHAM group and 28 underwent streptozotocin-injection; of these, 25 developed stable diabetes, and 12 were then randomized to receive no treatment for 16 weeks (DIA) and the other 13 to undergo 8-weeks’ untreated diabetes followed by 8-weeks’ drug treatment (TETA-DIA). Animals were studied again by cMRI at 8 and 16 weeks following disease induction, and finally by measurement of ex vivo cardiac function. Results After eight weeks diabetes, rats (DIA/TETA-DIA) had developed significant impairment of LV function, as judged by impairment of ejection fraction (LVEF), cardiac output (CO), and LV mass (LVM)/body-mass (all P < 0.001), as well as other functional indexes. LVEF, CO (both P < 0.001) and the other indexes deteriorated further at 16 weeks in DIA, whereas trientine (TETA-DIA) improved cardiac function by elevating LVEF and CO (both P < 0.001), and also partially reversed the increase in LVM/body-mass (P < 0.05). In ex vivo hearts from DIA, the CO response to increasing preload pressure was deficient compared with SHAM (P < 0.001) whereas the preload-CO relationship was significantly improved in TETA-DIA animals (P < 0.001). Conclusions Trientine treatment significantly improved cardiac function in diabetic rats with substantive LV impairment. These results implicate impaired copper regulation in the pathogenesis of impaired cardiac function caused by diabetic cardiomyopathy, and support ongoing studies of trientine treatment in patients with heart failure.