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O objetivo deste estudo foi avaliar o cumprimento medicamentoso de usuários de antidiabéticos orais. A pesquisa envolveu 437 diabéticos, de ambos os sexos, com idade entre 18-92 anos de 12 unidades básicas de saúde de Fortaleza-Ceará entre março e junho de 2009. Para avaliar a adesão aos antidiabéticos orais aplicou-se, nos domicílios, o Teste de Batalla, o Teste de Medida de Adesão ao Tratamento, além da contagem de comprimidos. Constatou-se, que 74,6%, 86,3% e 71,2%, foram considerados não cumpridores, segundo os testes aplicados, respectivamente. Entre os sujeitos não cumpridores do tratamento com antidiabéticos, 95% já faltaram as consultas do programa terapêutico para diabetes (p=0,000) e 76% estão com a glicemia acima dos valores recomendados (p=0,013). Talvez o cerne do problema esteja na relação profissional/cliente e na educação em saúde. Portanto, o resgate dos fundamentos da promoção da saúde necessitam permear as ações dos profissionais envolvidos na atenção ao diabético. This transversal study aimed to evaluate compliance with pharmacological therapy among users of oral antidiabetic drugs. The research involved 437 diabetic patients of both sexes between 18-92 years of age from12 healthcare centers located in Fortaleza, Ceará, Brazil, between March and June of 2009. In order to evaluate their adhesion to oral antidiabetic medication, both Batalla's Test and the Treatment Adherence and Measurement Test were applied in households. Tablets were also counted. It was established that 74.6%, 86.3% and 71.2% were considered non-compliers according to the tests applied, respectively. Among the subjects not complying with their treatment via oral antidiabetics, 95% have missed diabetes therapeutic program appointments (p=0.000) and 76% maintain blood glucose levels above recommended values (p=0.013). It is possible that the core of the problem is in the professional-client relationship and in health education. Therefore, the revival of the foundations of health promotion need to permeate the actions of professionals involved in diabetic patient care. El objetivo de este estudio fue evaluar el cumplimiento del tratamiento farmacológico por los usuarios de antidiabéticos orales. En la investigación participaron 437 pacientes diabéticos de ambos sexos, con edades entre 18 a 92 años, de 12 unidades básicas de salud de la ciudad de Fortaleza - Ceará, Brasil, de marzo a junio de 2009. Con el fin de evaluar la adhesión a los antidiabéticos orales se aplicaron en los hogares dos pruebas: el Test de Batalla y el test para medir la adhesión al tratamiento, además del recuento de pastillas. Se constató que el 74,6%, 86,3% y 71,2% se consideran no cumplidores del tratamiento, de acuerdo a las pruebas aplicadas, respectivamente. Entre los que no cumplen el tratamiento con antidiabéticos, el 95% faltaron a las consultas del programa de tratamiento para la diabetes (p = 0,000) y el 76% presentan los niveles de glucosa en la sangre más altos que los valores recomendados (p = 0,013). Tal vez el núcleo del problema está en su relación profesional/cliente y en la educación para la salud. Por lo tanto, el rescate de las bases de la promoción de la salud debe impregnar la actuación de los profesionales que intervienen en el cuidado de los pacientes diabéticos.

OBJETIVO: Investigar os fatores relacionados ao diagnóstico de enfermagem autocontrole ineficaz da saúde em usuários, de serviço de atenção básica à saúde, com Diabetes mellitus tipo 2, tratados com antidiabéticos orais (AO), segundo o sexo. MÉTODOS: Estudo de análise secundária de um banco de dados de pesquisa realizada, entre janeiro e julho de 2009, nos domicílios de 377 usuários de 12 centros de saúde da família de Fortaleza-CE. Para determinar a presença do diagnóstico de enfermagem foi realizada uma analogia entre as questões do teste Medida de Adesão ao Tratamento e quatro das cinco características definidoras do diagnóstico pesquisado. RESULTADOS: Os homens tinham um sentimento de impotência maior (30,4%) que as mulheres (18,4%) acerca da tomada dos AO (p=0,034). As mulheres conseguiram perceber melhor os benefícios da tomada correta dos AO no controle do Diabetes (p=0,002). CONCLUSÃO: Fatores de caráter socioeconômico importantes no controle da doença como a demanda excessiva e deficit de apoio social foram predominantes e significativos entre os homens.OBJETIVO: Investigar los factores relacionados al diagnóstico de enfermería autocontrol ineficaz de la salud en usuarios, del servicio de atención básica a la salud, con Diabetes mellitus tipo 2, tratados con antidiabéticos orales (AO), según el sexo. MÉTODOS: Estudio de análisis secundario de un banco de datos de investigación realizada, entre enero y julio del 2009, en los domicilios de 377 usuarios de 12 centros de salud de la familia de Fortaleza-CE. Para determinar la presencia del diagnóstico de enfermería fue realizada una analogía entre las preguntas del test Medida de Adhesión al Tratamiento y cuatro de las cinco características definidoras del diagnóstico investigado. RESULTADOS: los hombres tenían un sentimiento de impotencia mayor (30,4%) que el de las mujeres (18,4%) respecto a la toma de los AO (p=0,034). Las mujeres consiguieron percibir mejor los beneficios de la toma correcta de los AO en el control de la Diabetes (p=0,002). CONCLUSIÓN: Los factores de carácter socioeconómico importantes, en el control de la enfermedad, como la demanda excesiva y déficit de apoyo social fueron predominantes y significativos entre los hombres.OBJECTIVE: To investigate the related factors of the nursing diagnosis, ineffective self-health management, in clients with Type 2 diabetes mellitus treated with oral antidiabetic (AO), receiving primary health care services, according to gender. METHODS: A secondary analysis of database research conducted between January and July 2009, in the homes of 377 users of 12 family health centers in Fortaleza-CE. To determine the presence of the nursing diagnosis, an analogy was made between the test questions Measure Treatment Adherence and four of the five defining characteristics of the diagnostic search. RESULTS: Men had a greater sense of powerlessness (30.4%) than women (18.4%) about the need for taking the AO (p = 0.034). Women were better able to understand the benefits of taking AO to ensure proper control of their diabetes (p = 0.002). CONCLUSION: Socioeconomic factors important in controlling the disease, such as excessive demand and social support deficit, were prevalent and significant among men.

Objetivou-se identificar a adesão de diabéticos de Sobral CE ao tratamento farmacológico com hipoglicemiantes orais. Investigaram-se 79 diabéticos de seis unidades básicas de saúde de Sobral CE mediante visitas domiciliárias durante o período de março a junho de 2007. Para coleta de dados utilizou-se um formulário estruturado e a aplicação do Teste de Morisky e Green adaptado. Um pouco mais da metade dos estudados, 54,5%, referiu não ter o cuidado de cumprir o horário de ingestão dos fármacos preestabelecido; a maioria não se esquece de tomar a medicação (66%). Ademais, 90% dos investigados apresentam sentimento de pesar ao deixar de tomar os hipoglicemiantes orais. Identificou-se que 54,4% e 45,5% eram menos aderentes e mais aderentes à terapia medicamentosa com hipoglicemiantes orais, respectivamente. A adesão à terapia farmacológica com hipoglicemiantes orais é fundamental para um bom controle glicêmico e a prevenção de complicações micro e macrovasculares. The objective was to identify the adherence of the diabetic from Sobral CE, Brazil, to pharmacological treatment with oral hypoglycemic agents. Were investigated 79 diabetics from six basic health units in Sobral-CE, Brazil, through home visits carried out between March and June 2007. For data collection, a structured form was used and the adapted Morisky-Green test was applied. Slightly more than half of the subjects (54.5%) indicated being careful don't to comply with the pre-established time for medication intake; most of them does not forget to take the medication (66%). Moreover, 90% of the subjects regret forgetting to take the oral hypoglycemic agents. It was identified that 54.4% and 45.5% were less adherent and more adherent to the drug therapy with oral hypoglycemic agents, respectively. Adherence to pharmacological treatment with oral hypoglycemic agents is fundamental for good glucose control and to prevent micro and macrovascular complications. El objetivo fue identificar la adhesión de diabéticos de Sobral CE, Brasil, al tratamiento farmacológico con agentes hipoglucemiantes orales.Fueron investigados 79 diabéticos de seis unidades básicas de salud de Sobral-CE, Brasil, mediante visitas domiciliarias durante el período de marzo a junio de 2007. Para la recolecta de datos fue utilizado un cuestionario estructurado y la aplicación del Test de Morisky y Green adaptado. Poco más de la mitad de los estudiados, 54.5%, dijo no tener cuidado de cumplir con el horario preestablecido para la ingestión de los fármacos; la mayoría no se olvida de tomar la medicación (66%). Además, el 90% de los investigados presentó sentimientos de aflicción al dejar de tomar los hipoglucemiantes orales. Se identificó que el 54.4% y el 45.5% presentaban menos adherencia y mayor adherencia respectivamente - a la terapia con fármacos hipoglucemiantes orales. .La adhesión a la terapia farmacológica con hipoglucemiantes orales es fundamental para un buen control glicémico y para la prevención de complicaciones micro y macrovasculares.

Novos medicamentos para o tratamento do diabetes tipo 1 e tipo 2 foram incorporados à lista de fármacos tradicionais: antidiabéticos orais e insulinas injetáveis. Estas alternativas de tratamento têm novos mecanismos de ação que aproveitam as propriedades antidiabéticas de certos peptídeos como é o caso da amilina ou do peptídeo similar ao glucagon (GLP-1), cujos níveis são deficientes ou insuficientes no diabetes. Isto acontece pelos análogos da amilina ou do GLP-1, embora também possa ser obtido inibindo a enzima que degrada este último. Além disso, encontra-se disponível no mercado um novo sistema para administrar insulina de maneira não-invasiva por meio de inalação. Este artigo resume os resultados mais importantes e atualizados com relação ao mecanismo de ação, eficácia, efeitos adversos e indicações destes fármacos inovadores.New medicines for the therapy of the type 1 and type 2 diabetes have been incorporated in the list of traditional drugs: oral agents and injectable insulin. These treatment alternatives have a new mechanism of action that takes advantage of the antidiabetic properties of certain peptides such as amylin and glucagon like peptide-1 (GLP-1), whose levels are wanting or insufficient in diabetes. This is attained through amylin and GLP-1 analogues, although it can also be achieved by inhibiting the enzyme that degrades the latter. Furthermore, a new system to administer insulin in a noninvasive way through inhalation has become available in the market. This paper summarizes the most important and updated findings on the action mechanism, efficacy, adverse effects and indications of these innovative drugs.

OBJETIVO: Evaluar el efecto en la prescripción de hipoglucémicos de un programa de educación médica continua en unidades de medicina familiar (UMF). MATERIAL Y MÉTODOS: Se realizó un estudio observacional que comparó dos grupos (con y sin programa) con dos cortes transversales (antes y después). La unidad de análisis fue la consulta. El periodo de análisis comprendió seis meses anteriores y seis posteriores a la institución del programa. La principal variable de resultado fue la prescripción adecuada, evaluada mediante dos criterios: elección e indicación correctas. El análisis incluyó modelos de regresión logística, se aplicó la técnica de dobles diferencias y se ajustó por variables relativas al paciente, la consulta y la UMF; las más relevantes fueron sexo, obesidad, otras afecciones, número de consultas, número de medicamentos, tamaño de la clínica, grupo y etapa. RESULTADOS: Se obtuvo un incremento atribuible al programa de 0.6% en la probabilidad de prescripción adecuada y de 11% en la elección correcta en pacientes obesos.

Age-related transformations make the elderly more susceptible to medicine adverse events, and knowledge of factors associated with drug use are essential to develop national strategies of prescription. To estimate the prevalence of use of antihypertensive and hypoglycemic agents and investigate the factors associated with their consumption. Household survey among 667 elderly living in Belo Horizonte/MG, interviewed regarding socio-demographic indicator of health conditions and medication use. Univariate and multivariate analysis were performed. Among respondents, 62 % used antihypertensive and 12 % hypoglycemic drugs. Consumption of antihypertensive drugs was associated with a higher number of medical appointments, diabetes and hypertension, more cases of morbidity and use ≥ five active substances. Hypoglycemic drugs consumption was associated with male, older age, higher number of medical appointments, the occurrence of diabetes and hypertension. Considering determinants associated with medication use could help develop strategies for the safe medicine use., Colegio de Farmacéuticos de la Provincia de Buenos Aires

Objective: To determine the effectiveness of pharmaceutical care to improve control of type-2 diabetes mellitus. Methods: We carried out pharmacotherapeutical intervention during 19 months on patients with type-2 diabetes mellitus who were affiliate members of the contributive regime of the General System for Healthcare and Social Security in Bogotá and Cartagena. Through an interview and evaluation of medical records, we obtained information about antidiabetic medications used, doses, other medications, along with Hemoglobin A1c level, arterial pressure, serum low-density lipoprotein cholesterol level, nephropathy screening, retinal screening, foot exams in the last year and problems associated with medication use by means of the DADER method Negative Outcomes Associated with Medication (NOM). Results: The study had a sample of 143 patients (64 intervened and 79 controls) with female predominance (67.1% and 53.1%, respectively), mean age of 63.9±11.2 years. The patients in both groups were taking an average of 6.0±2.7 medications. Initial HbA1c mean was 7.7% and 7.8%, without improvement by the end of the study (7.4% for those intervened and 7.8% for the control group). Hypertension (81.1%) and dyslipidemia (62.9%) were the most important comorbidities. About 50.4% of NOM were of effectiveness, follows 31.3% of necessity. The mean cost per patient in controls was 1.4 greater than for the intervened group. Conclusions: Increased effectiveness of the antidiabetic therapy was not demonstrated in patients intervened with pharmacotherapeutical monitoring, but we did obtain a reduction in healthcare costs. Objetivo: Determinar la efectividad del seguimiento farmacoterapéutico para mejorar el control de los pacientes diabéticos tipo 2. Métodos: Se realizó intervención farmacoterapéutica durante 19 meses a pacientes con diabetes mellitus tipo 2, afiliados al régimen contributivo del Sistema General de Seguridad Social en Salud en Bogotá y Cartagena. Mediante entrevista y revisión de la historia clínica, se obtuvo información sobre medicamentos antidiabéticos utilizados, dosis, comedicación, resultados en último año de HbA1c, tensión arterial, perfil lipídico, albuminuria, examen oftalmológico, valoración de pies y los Resultados Negativos Asociados con la Medicación (RNM) y se siguió la metodología DADER. Resultados: Participaron 143 pacientes, 64 intervenidos y 79 controles, con predominio de mujeres (67.1% y 53.1%, respectivamente), promedio de edad 63.9±11.2 años. Los pacientes de ambos grupos tomaban en promedio 6.0±2.7 medicamentos. La HbA1c inicial tuvo un promedio de 7.7% y 7.8% y al finalizar el estudio los valores fueron de 7.4% y 7.8%, respectivamente en cada grupo. El 50.4% de los RNM fueron de efectividad, seguido de 31.3% de necesidad. En la visita inicial y final la recomendación farmacéutica fue aceptada y el problema de salud resuelto en 72 casos (42.9% de RNM) y en 46 casos (38.3% de RNM), respectivamente. El cociente medio del costo por paciente en el grupo control fue 1.4 veces mayor que en el intervenido. Discusión: No se demostró aumento en la efectividad de la terapia antidiabética en pacientes intervenidos con seguimiento farmacoterapéutico, pero se consiguió una reducción en costos de la atención sanitaria.

Repaglinide (RGL) loaded polymeric drug delivery devices like microcapsules (MC) and transdermal patches (TDP) were formulated and there in vitro-in vivo parameters compared to find out the best route of drug delivery. The formulations were subjected to various studies like hypoglycemic activity, glucose tolerance and pharmacokinetic studies. The formulation TDP1 having drug-polymer ratio 1:1 showed comparatively higher RGL release and better permeation across mice skin. Comparatively higher RGL content was found in TDP1 (99.6 ± 1.8 %) than MC1 (89.2 ± 2.3 %). From the glucose tolerance test, transdermal route effectively maintained the normoglycemic levels in contrast to the oral group, which produced remarkable hypoglycemia. The significantly high area under curve (AUC) values observed with transdermal system also indicate increased bioavailability of drug from these systems compared to oral route. The transdermal system of RGL exhibited better control of hyperglycemia besides more effectively reversing the complications associated with diabetes mellitus than oral administration in mice., Colegio de Farmacéuticos de la Provincia de Buenos Aires

OBJETIVO: Investigar os fatores relacionados ao diagnóstico de enfermagem autocontrole ineficaz da saúde em usuários, de serviço de atenção básica à saúde, com Diabetes mellitus tipo 2, tratados com antidiabéticos orais (AO), segundo o sexo. MÉTODOS: Estudo de análise secundária de um banco de dados de pesquisa realizada, entre janeiro e julho de 2009, nos domicílios de 377 usuários de 12 centros de saúde da família de Fortaleza-CE. Para determinar a presença do diagnóstico de enfermagem foi realizada uma analogia entre as questões do teste Medida de Adesão ao Tratamento e quatro das cinco características definidoras do diagnóstico pesquisado. RESULTADOS: Os homens tinham um sentimento de impotência maior (30,4%) que as mulheres (18,4%) acerca da tomada dos AO (p=0,034). As mulheres conseguiram perceber melhor os benefícios da tomada correta dos AO no controle do Diabetes (p=0,002). CONCLUSÃO: Fatores de caráter socioeconômico importantes no controle da doença como a demanda excessiva e deficit de apoio social foram predominantes e significativos entre os homens. OBJECTIVE: To investigate the related factors of the nursing diagnosis, ineffective self-health management, in clients with Type 2 diabetes mellitus treated with oral antidiabetic (AO), receiving primary health care services, according to gender. METHODS: A secondary analysis of database research conducted between January and July 2009, in the homes of 377 users of 12 family health centers in Fortaleza-CE. To determine the presence of the nursing diagnosis, an analogy was made between the test questions Measure Treatment Adherence and four of the five defining characteristics of the diagnostic search. RESULTS: Men had a greater sense of powerlessness (30.4%) than women (18.4%) about the need for taking the AO (p = 0.034). Women were better able to understand the benefits of taking AO to ensure proper control of their diabetes (p = 0.002). CONCLUSION: Socioeconomic factors important in controlling the disease, such as excessive demand and social support deficit, were prevalent and significant among men. OBJETIVO: Investigar los factores relacionados al diagnóstico de enfermería autocontrol ineficaz de la salud en usuarios, del servicio de atención básica a la salud, con Diabetes mellitus tipo 2, tratados con antidiabéticos orales (AO), según el sexo. MÉTODOS: Estudio de análisis secundario de un banco de datos de investigación realizada, entre enero y julio del 2009, en los domicilios de 377 usuarios de 12 centros de salud de la familia de Fortaleza-CE. Para determinar la presencia del diagnóstico de enfermería fue realizada una analogía entre las preguntas del test Medida de Adhesión al Tratamiento y cuatro de las cinco características definidoras del diagnóstico investigado. RESULTADOS: los hombres tenían un sentimiento de impotencia mayor (30,4%) que el de las mujeres (18,4%) respecto a la toma de los AO (p=0,034). Las mujeres consiguieron percibir mejor los beneficios de la toma correcta de los AO en el control de la Diabetes (p=0,002). CONCLUSIÓN: Los factores de carácter socioeconómico importantes, en el control de la enfermedad, como la demanda excesiva y déficit de apoyo social fueron predominantes y significativos entre los hombres.

Journal Article; Research Support, Non-U.S. Gov't; In autoimmune type 1 diabetes mellitus, proinflammatory cytokine-mediated apoptosis of beta-cells has been considered to be the first event directly responsible for beta-cell mass reduction. In the Bio-Breeding (BB) rat, an in vivo model used in the study of autoimmune diabetes, beta-cell apoptosis is observed from 9 wk of age and takes place after an insulitis period that begins at an earlier age. Previous studies by our group have shown an antiproliferative effect of proinflammatory cytokines on cultured beta-cells in Wistar rats, an effect that was partially reversed by Exendin-4, an analogue of glucagon-like peptide-1. In the current study, the changes in beta-cell apoptosis and proliferation during insulitis stage were also determined in pancreatic tissue sections in normal and thymectomized BB rats, as well as in Wistar rats of 5, 7, 9, and 11 wk of age. Although stable beta-cell proliferation in Wistar and thymectomized BB rats was observed along the course of the study, a decrease in beta-cell proliferation and beta-cell mass from the age of 5 wk, and prior to the commencement of apoptosis, was noted in BB rats. Exendin-4, in combination with anti-interferon-gamma antibody, induced a near-total recovery of beta-cell proliferation during the initial stages of insulitis. This highlights the importance of early intervention and, as well, the possibilities of new therapeutic approaches in preventing autoimmune diabetes by acting, initially, in the insulitis stage and, subsequently, on beta-cell regeneration and on beta-cell apoptosis. Yes

Novos medicamentos para o tratamento do diabetes tipo 1 e tipo 2 foram incorporados à lista de fármacos tradicionais: antidiabéticos orais e insulinas injetáveis. Estas alternativas de tratamento têm novos mecanismos de ação que aproveitam as propriedades antidiabéticas de certos peptídeos como é o caso da amilina ou do peptídeo similar ao glucagon (GLP-1), cujos níveis são deficientes ou insuficientes no diabetes. Isto acontece pelos análogos da amilina ou do GLP-1, embora também possa ser obtido inibindo a enzima que degrada este último. Além disso, encontra-se disponível no mercado um novo sistema para administrar insulina de maneira não-invasiva por meio de inalação. Este artigo resume os resultados mais importantes e atualizados com relação ao mecanismo de ação, eficácia, efeitos adversos e indicações destes fármacos inovadores. New medicines for the therapy of the type 1 and type 2 diabetes have been incorporated in the list of traditional drugs: oral agents and injectable insulin. These treatment alternatives have a new mechanism of action that takes advantage of the antidiabetic properties of certain peptides such as amylin and glucagon like peptide-1 (GLP-1), whose levels are wanting or insufficient in diabetes. This is attained through amylin and GLP-1 analogues, although it can also be achieved by inhibiting the enzyme that degrades the latter. Furthermore, a new system to administer insulin in a noninvasive way through inhalation has become available in the market. This paper summarizes the most important and updated findings on the action mechanism, efficacy, adverse effects and indications of these innovative drugs.