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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.

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.

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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.