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Resumo A insulinoterapia empregada no tratamento do Diabetes Mellitus (DM) carece de ferramentas educativas que auxiliem a prática de autocuidado. Dessa forma, objetivou-se elaborar e validar uma ferramenta educativa destinada a promover a compreensão da relação entre variação glicêmica e insulinoterapia em adultos com DM1 e DM2. Trata-se de um estudo metodológico desenvolvido em três etapas: i) elaboração da ferramenta educativa; ii) validação de conteúdo e aparência por comitê de juízes; iii) pré-teste com o público-alvo. Participaram da segunda etapa dez juízes e da terceira etapa 12 adultos com DM 1 ou 2, em uso de insulina. Para avaliar a adequação do material educativo pelo comitê de juízes foi utilizado o Índice de Validade de Conteúdo (IVC). Para validação pelo público-alvo foram calculados os percentuais de concordância por itens. Como resultado, desenvolveu-se a ferramenta educativa Meu Diário de Tratamento (MDT), que obteve IVC médio de 99,6% e percentual de concordância de 99%. Conclui-se, portanto, que o conteúdo e a aparência da ferramenta MDT foram validados e adequados culturalmente para a população de adultos com DM tipo 1 e 2.

The insulin therapy used to treat Diabetes Mellitus (DM) lacks educational tools to assist self-care. Thus, we aimed to develop and validate an educational tool for the relationship between glycemic variation and insulin therapy for adults with type 1 and 2 DM. The study was developed in three stages: i) elaboration of the educational tool; ii) validation of content and display by a panel of judges; iii) pre-test with a target audience. Ten judges participated in the second stage, and 12 insulin-dependent adults with type 1 or 2 DM participated in the third stage. The Content Validity Index (CVI) was used to evaluate the adequacy of the material by the judges. The percentages of the agreement by item were calculated for validation by the target audience. The My Treatment Diary (MTD) educational tool was then developed. It obtained a mean CVI of 99.6% and a percentage of agreement of 99%. The results demonstrated that the content and display of the MTD tool were validated and culturally appropriate for the population of adults with type 1 and 2 DM.

Objetivo: realizar a tradução, adaptação cultural e validação do instrumento “Instrumento de Autoavaliação em Diabetes” para aplicação no contexto brasileiro. Métodos: estudo metodológico realizado com 132 profissionais, entre os anos de 2016 e 2018, em seis etapas: 1- Tradução inicial; 2- Síntese da tradução; 3- Retrotradução (back-translation); 4- Avaliação pelo comitê de juízes; 5- Adequação cultural (pré-teste); 6- Reprodutibilidade. Houve participação de profissionais de equipes multiprofissionais envolvidas no tratamento do diabetes, por meio da plataforma e-surv. Resultados: entre os participantes, predominaram o sexo feminino (73,5%), profissionais com especialização (pós-graduação Lato Sensu) (51,5%) e com experiência na assistência a pessoas com diabetes (84,4%). O Índice de Validade de Conteúdo (IVC) foi satisfatório (média de 0,850). O instrumento apresentou boa consistência interna (Alfa de Cronbach=0,878). A análise de confiabilidade do instrumento, realizada pelo cálculo do coeficiente de correlação intraclasse (CCI), indicou concordância adequada em todas as medidas, 0,878 (IC 95%: 0,864 – 0,891), com Kappa Ponderado médio de 0,714 e índices acima de 0,60 em 85% os itens, mostrando boa concordância teste e reteste. Conclusão: a versão traduzida e adaptada culturalmente do Instrumento de Autoavaliação em Diabetes apresentou boa confiabilidade, aceitabilidade e estabilidade temporal satisfatórias conforme os parâmetros internacionais, podendo ser utilizada para autoavaliação em diabetes pelos profissionais da saúde.

The International Consensus in Time in Range (TIR) was recently released and defined the concept of the time spent in the target range between 70 and 180 mg/dL while reducing time in hypoglycemia, for patients using Continuous Glucose Monitoring (CGM). TIR was validated as an outcome measures for clinical Trials complementing other components of glycemic control like Blood glucose and HbA1c. The challenge is to implement this practice more widely in countries with a limited health public and private budget as it occurs in Brazil. Could CGM be used intermittently? Could self-monitoring blood glucose obtained at different times of the day, with the amount of data high enough be used? More studies should be done, especially cost-effective studies to help understand the possibility of having sensors and include TIR evaluation in clinical practice nationwide.

Background Occupational aspects have been described as additional risk factors for type 2 diabetes mellitus (DM2). Workers whose job interferes with healthy eating and physical activity might be more susceptible to disease. Objective To investigate sociodemographic, clinical, occupational and lifestyle factors associated with DM2 among employees of a public hospital in Belo Horizonte, Minas Gerais, Brazil. Methodology Cross-sectional study with 443 employees of a public hospital in Belo Horizonte. We administered a sociodemographic and occupational questionnaire and the Finnish Diabetes Risk Score (FINDRISC) and collected biochemical data. We performed multivariate logistic regression analysis to investigate factors associated with diabetes. The significance level was set to 5%. Results 6.3% of the participants had a diagnosis of DM2 and 13% were found to be at high or very high risk to develop disease within 10 years. Participants aged above 54, with abnormal waist circumference, who took antihypertensive drugs or had family history of diabetes exhibited higher odds of developing disease. Conclusion Older age, abdominal obesity, hypertension and family history of diabetes were associated with diagnosis of DM2.

Aims According to a recent national diabetes screening performed by our group in 2018, 18.4% of the Brazilians were found to have high blood glucose. The objective of the present study was to estimate the risk of developing type 2 DM (T2DM) in the next ten years in Brazilian population. Methods A cross-sectional study was carried out in community pharmacies across Brazil, in 2018, where pharmacists applied the FINDRISC questionnaire to estimate the population's risk of developing T2DM within a ten-year period. Results The study included 977 pharmacists from 345 municipalities distributed across the five geographical regions of Brazil. Of the 17,580 people evaluated, the South region was found to have the highest frequency (59.6%) among people at very low and/or low risk of developing T2DM, while the North region, the most underserved, presented the highest and/or very highest T2DM risk (24.1%). The factors that mostly and importantly impacted these regional differences were body mass index; the highest daily consumption of vegetables and fruits; history of high blood glucose and family history of T1DM/T2DM. Conclusion These results showed an impressive change of direction concerning diabetes numbers between the most underserved region in public health care and one of the most developed and best organized regions concerning health assistance, the North and the South, respectively.

Objective: To develop, adapt and validate an instrument named “CSII – Brazil” to assess users’ conceptual and procedural knowledge of continuous subcutaneous insulin infusion systems. Materials and methods: Methodological and exploratory study developed in three stages: a) instrument development; b) content validation and cultural adaptation (evaluation by a committee of experts and pre-test with CSII users); c) psychometric validation through instrument application in a sample of 60 patients by means of the web tool e-Surv. Internal consistency and reproducibility analyses were performed within IBM SPSS Statistics 20 programming environment. Results: The 16 multiple-choice question instrument successfully attained a content validity index of 0.97, showing satisfactory internal consistency, with 0.61 Cronbach's alpha [95% CI 0.462-0.746] and an intraclass correlation coefficient of 0.869 [95% CI: 0.789-0.919] between the test and retest scores. Conclusion: The CSII – Brazil instrument is considered adequate and validated to assess continuous subcutaneous infusion system users’ conceptual and procedural knowledge.

Background Brazil is one of top 10 countries with the highest number of people with diabetes mellitus (DM), affecting 16.8 million peoples. It is estimated that 7.7 million people (20–79 years) in the country have not yet been diagnosed, representing an under-diagnosis rate of 46.0%. Herein we aimed to screen people for high blood glucose or risk for developing type 2 DM (T2DM) through community pharmacies in Brazil. Methods A cross-sectional study was carried out in November 2018, involving 977 pharmacists from 345 municipalities in Brazil. The study evaluated people between 20 and 79 years old without a previous diagnosis of DM. Glycemia was considered high when its value was ≥ 100 mg/dL fasting and ≥ 140 mg/dL in a casual feeding state. The FINDRISC (Finnish Diabetes Risk Score) was used to estimate the risk for developing T2DM. The prevalence of high blood glucose was estimated and the associated factors were obtained using Poisson's multivariate analysis with robust variance. Results During the national screening campaign, 17,580 people were tested with the majority of the consultations (78.2%) being carried out in private pharmacies. The population was composed mainly of women (59.5%) and people aged between 20 and 45 years (47.9%). The frequency of participants with high blood glucose was 18.4% (95% CI 17.9–19.0). Considering the FINDRISC, 22.7% of people had a high or very high risk for T2DM. The risk factors associated with high blood glucose were: Body Mass Index > 25 kg/m2, abdominal circumference > 94 cm for men and > 80 cm for women; education level below 15 years of study, no daily intake of vegetables and fruits; previous diagnosis of arterial hypertension; history of high blood glucose and family history of DM. Conclusions This is the largest screening study that evaluated the frequency of high blood glucose and its associated factors in a population without a previous diagnosis ever performed in community pharmacies in Brazil. These results may help to improve public health policies and reinforce the role of pharmacists in screening and education actions aimed at this undiagnosed population in a continent-size country such as Brazil.

Background Brazil is one of top 10 countries with the highest number of people with diabetes mellitus (DM), affecting 16.8 million peoples. It is estimated that 7.7 million people (20–79 years) in the country have not yet been diagnosed, representing an under-diagnosis rate of 46%. Herein we aimed to screen people for high blood glucose or risk for developing type 2 DM (T2DM) through community pharmacies in Brazil. Methods A cross-sectional study was carried out in November 2018, involving 977 pharmacists from 345 municipalities in Brazil. The study evaluated people between 20 and 79 years old without a previous diagnosis of DM. Glycemia was considered high when its value was ≥ 100 mg/dL fasting and ≥ 140 mg/dL in a casual feeding state. The FINDRISC (Finnish Diabetes Risk Score) was used to estimate the risk for developing T2DM. The prevalence of high blood glucose was estimated and the associated factors were obtained using Poisson's multivariate analysis with robust variance. Results During the national screening campaign, 17,580 people were tested with the majority of the consultations (78.2%) being carried out in private pharmacies. The population was composed mainly of women (59.5%) and people aged between 20 and 45 years (47.9%). The prevalence of patients with high blood glucose was 18.4% (95% CI 17.9–19.0). Considering the FINDRISC, 22.7% of people had a high or very high risk for DM. The risk factors associated with high blood glucose were: Body Mass Index > 25 kg/m2, abdominal circumference > 94 cm for men and > 80 cm for women; education level below 15 years of study, no daily intake of vegetables and fruits; previous diagnosis of arterial hypertension; history of high blood glucose and family history of DM. Conclusions This is the largest screening study that evaluated the prevalence of high blood glucose and its associated factors in a population without a previous diagnosis, ever performed in community pharmacies in Brazil. These results may help to guide public health preventive actions and involve pharmacists in screening and education actions aimed at this undiagnosed population in a continent-size country such as Brazil.

Objective The aim of this study was to translate and cross-culturally adapt the Insulin Delivery System Rating Questionnaire (IDSRQ) for Brazilian users. Validation and reliability analysis of measures were also performed. Materials and methods Methodological study comprising the following stages: forward translation, synthesis, back-translation, assessment by Expert Committee, pre-test and validation. International guidelines for translation and cross-cultural adaptation of measurement tools were followed. Validation data provided information about reliability (internal consistency, test-retest) and construct validity of the IDSRQ. Results Content validation by Experts’ assessment was successful, with a mean Content Validity Index of 0.87 (±0.2). The IDSRQ validation study involved 113 T1DM patients, 46% male, mean age 32.61 (±12.59) years and mean age at diagnosis of diabetes of 17.51 (±12.41). The scale presented good internal consistency (Cronbach’s alpha =0.786). The reliability analysis of the instrument was conducted by calculating the Intra-class Correlation Coefficient 0.885 (0.834-0.921), which indicated adequate concordance in all measures. Conclusion The translated and cross-culturally adapted Brazilian Portuguese version of the IDSRQ may be used to assess health-related quality of life (HRQOL) and treatment preferences for insulin delivery systems in T1DM Brazilian patients.

We carried out an observational study to analyze if the quality of life of T1DM patients is affected by different insulin treatment systems. The study involved 113 T1DM patients from a public diabetes center, mean age 32.61(±12.59) years, 46% male treated with MDI or CSII. The Insulin System Rating Questionnaire (IDSRQ) was validated in Brazilian Portuguese (Table 1) and was self-completed by the subjects during a routine visit. Multiple comparison analysis (Table 2) showed that CSII had a significant effect versus syringe and versus pen for treatment satisfaction and clinical efficacy domains. CSII was associated with a higher treatment satisfaction and patient’s perception of better clinical efficacy than MDI. Disclosure R.C.L. Coelho: None. A.S. Pagano: None. A.N. Soares: None. J.S. Reis: None.

Introdução: O diabetes mellitus configura-se como uma pandemia em crescimento, impactando nos custos relativos à saúde e à qualidade de vida da população. O Modelo de Atenção às Condições Crônicas tem sido adotado com intuito de minimizar tais impactos. Em Minas Gerais, dentre as ações desenvolvidas nesta perspectiva, destaca-se a implementação dos Centros Hiperdia Minas. Tal modelo preconiza, entre outras ações, o enfoque interdisciplinar e a atenção centrada no usuário. Objetivo: Analisar a eficácia da intervenção interdisciplinar no cuidado aos usuários com diabetes mellitus tipo 2 assistidos pelo Centro Hiperdia Minas da Região de Saúde de Viçosa. Materiais e Métodos: Foram utilizados dados registrados nos prontuários de 95 usuários com diabetes tipo 2 atendidos no período de 2011 a 2015, sendo avaliados os dados iniciais e finais. Resultados: A avaliação da intervenção interdisciplinar indicou melhora significativa na hemoglobina glicada e nos níveis de colesterol, em relação aos dados obtidos na primeira consulta, além da adequada prescrição medicamentosa. Por outro lado, não houve melhora nos índices de IMC e triglicérides, sendo importante ressaltar também as dificuldades do serviço na avaliação das complicações do diabetes tipo 2. Conclusão: A iniciativa de criação dos Centros Hiperdia Minas representa um importante avanço na atenção aos diabéticos. A equipe apresentou desempenho satisfatório, embora sejam percebidas fragilidades.

Aim: To elaborate and validate an instrument for Brazilian Portuguese speakers, to assess dentists’ knowledge about care of patients with diabetes mellitus (Dental-Diabetes). Methods: Methodological study comprising four stages: a) Elaboration of instrument; b) Content validation (computing Content Validity Index - CVI) based on Expert Committee assessment; c) Pre-test with 30 dentists, followed by assessment of suggestions by Expert Committee; d) Psychometric validation through instrument application in a sample of 127 dentists by means of the web tool e-Surv. Cronbach’s alpha and intraclass correlation coefficients were used to evaluate, respectively, internal consistency and reproducibility. Results: The final version of the instrument consists of 22 questions (7 on sociodemographic data and 15 querying dentists’ knowledge) and those submitted for validation attained a CVI of 0.95 [95% CI 0.916-0,981], showing satisfactory internal consistency, with 0.794 Cronbach’s alpha [95% CI 0.741-0.842] and an intraclass correlation coefficient of 0.799 [95% CI: 0.746-0.846] between the test and retest scores. Conclusions: Dental-Diabetes is a comprehensive instrument, culturally adequate and validated to assess dentists’ knowledge about care of patients with diabetes.

Objetivo: elaborar, adequar culturalmente e validar o “conhecimento dos agentes comunitários de saúde (ACS) sobre diabetes” – diabetes-ACS – para avaliação do conhecimento dos ACS sobre diabetes mellitus. Métodos: estudo metodológico desenvolvido em três etapas: a) construção do instrumento; b) validação de conteúdo e adequação cultural com médicos de família e ACS, seguidas de avaliação das sugestões por comitê de especialistas; c) validação psicométrica do instrumento a partir de sua aplicação em uma amostra de 102 ACS, por meio da ferramenta e-Surv. As análises de consistência interna e reprodutibilidade foram realizadas no ambiente de programação estatística R. Resultados: o instrumento, constituído de 29 questões de múltipla escolha, apresentou consistência interna satisfatória, com alfa de Cronbach 0,732 (IC 95% 0,652; 0,802) e coeficiente de correlação intraclasse de 0,70 (IC 95% 0,59–0,79), entre os escores do teste e do reteste. Conclusão: considera-se adequado e validado o instrumento diabetes-ACS para avaliação de agentes comunitários de saúde. Objective: to elaborate, adapt and validate the Diabetes knowledge assessment of community healthcare workers – Diabetes-CHW – to assess CHW knowledge about diabetes mellitus. Methods: methodological study developed in three stages: a) instrument construction; b) content validation and cultural adequacy with family doctors and CHWs, followed by assessment of suggestions by a committee of experts; c) Psychometric validation of the instrument from its application in a sample of 102 CHWs, through the e-Surv webtool. Internal consistency and reproducibility analyses were performed in the R statistical programming environment. Results: the 29 multiple-choice question instrument showed satisfactory internal consistency, with 0.732 Cronbach's alpha (95% CI 0.652; 0.802) and intraclass correlation coefficient of 0.70 (95% CI 0.59–0.79) between the test and retest scores. Conclusion: the diabetes-CHW instrument was validated and considered adequate to assess community healthcare workers’ knowledge about DM.

Objectives: to develop and validate a diabetes booklet for Community Health Workers. Methods: methodological study developed in seven steps: Bibliographic review; Development of the booklet; Calculation of readability and comprehensibility scores; Validation of the booklet by the committee of judges; Discussion between experts; Validation of the booklet by the target audience; and Final discussion between experts. Validation was performed by 10 judges via e-Surv and on a face-to-face test with 5 Community Health Workers, considering the minimum Content Validity Coefficient of 0.80. Results: the booklet had a mean Content Validity Coefficient of 0.97 in the validation by the committee of judges, and the images had 96.67% approval. In the face-to-face test, the Community Health Workers considered the material clear and appropriate to the function. Conclusions: the booklet was developed and validated on its content and relevance, and it can be used by Community Health Workers for diabetes education. RESUMEN Objetivos: desarrollar y validar una cartilla sobre diabetes para los Agentes Sanitarios. Métodos: se trata de un estudio metodológico desarrollado en siete etapas: Estudio bibliográfico; Preparación de la cartilla; Cálculo de las fórmulas de legibilidad y aprehensibilidad; Validación de la cartilla por el comité de jueces; Discusión entre expertos; Validación de la cartilla por el público objetivo; y Discusión final entre los expertos. Diez jueces realizaron la validación vía e-Surv; y la prueba cara a cara, cinco Agentes Sanitarios, considerando el Coeficiente de Validez de Contenido mínimo de 0,80. Resultados: la cartilla tuvo un Coeficiente de Validez de Contenido promedio de 0,97 en la validación del comité de jueces, y las imágenes obtuvieron el 96,67% de aprobación. En la prueba cara a cara, los Agentes Sanitarios consideraron que el material era claro y apropiado para la función. Conclusiones: la cartilla se diseñó y se validó en cuanto a su contenido y a su relevancia y los Agentes Sanitarios podrán usarla en acciones de educación sobre la diabetes. RESUMO Objetivos: elaborar e validar uma cartilha sobre diabetes para os Agentes Comunitários de Saúde. Métodos: estudo metodológico desenvolvido em sete etapas: Levantamento bibliográfico; Elaboração da cartilha; Cálculo das fórmulas de legibilidade e apreensibilidade; Validação da cartilha por comitê de juízes; Discussão entre especialistas; Validação da cartilha pelo público-alvo; e Discussão final entre especialistas. A validação foi realizada por 10 juízes via e-Surv; e o teste face a face, por 5 Agentes Comunitários de Saúde, considerando o Coeficiente de Validade de Conteúdo mínimo de 0,80. Resultados: a cartilha teve um Coeficiente de Validade de Conteúdo médio de ٠,٩٧ na validação pelo comitê de juízes, e as imagens tiveram ٩٦,٦٧٪ de aprovação. No teste face a face, os Agentes Comunitários de Saúde consideraram o material claro e adequado à função. Conclusões: a cartilha foi elaborada e validada quanto ao conteúdo e relevância, podendo ser utilizada pelos Agentes Comunitários de Saúde nas ações de educação em diabetes.

The prevalence of diabetes mellitus is being considered a global epidemic, with 382 million people currently affected worldwide and increase forecast for 592 million for the year 2035. Currently, Brazil is the fourth country in the world in number of diabetes. This study aimed to describe the epidemiological characteristics of individuals with diabetes mellitus treated at Hiperdia Center of Vicosa-MG, considering socio demographic, modifiable risk factors and not modifiable. This is a descriptive study, quantitative, documentary and cross-sectional. 547 records were analyzed, 218 retirees and 329 active patients. The analysis of the active patients showed that 51% of the total number of patients had a higher prevalence of type 2 diabetes mellitus associated with hypertension. In relation to active patients, 72% had low family income, 74% had low education, 74%, 78 % and 57% had high prevalence of hypertension, overweight/obesity, physical inactivity, respectively. The presence of two or more family history of coronary and metabolic diseases was found in 79% of patients. The analysis of fasting and postprandial proved inadequate values by more than 50% of the active patients. Patients with diabetes attended by the Hiperdia Center of Vicosapresented in addition to the disease itself, modifiable and non-modifiable risk factors, both being complicating for diabetes control and a good health.

We evaluated the association between plasma levels of VWF, ADAMTS13 and d-Dimer, which consist on endothelial dysfunction and hypercoagulability biomarkers, and cystatin C with retinopathy in type 1 diabetic patients.Patients were classified according to presence (n=55) or absence (n=70) of retinopathy. Plasma levels of VWF, ADAMTS13, d-Dimer and cystatin C were evaluated by ELISA and ADAMTS13 activity was evaluated by FRET.Plasma levels of VWF (p=0.033), ADAMTS13 activity (p=0.014), d-Dimer (p=0.002) and cystatin C (p0.001) were elevated in diabetic patients with retinopathy compared to those without this complication. The multivariate logistic regression analysis showed that ADAMTS13 activity (p=0.031) d-Dimer (p=0.015) and cystatin C (p=0.001) remained associated with retinopathy after adjustment for age, diabetes duration, use of statin, use of ACEi or angiotensin antagonist, use of acetylsalicylic acid and glomerular filtration rate.ADAMTS13 activity, d-Dimer and cystatin C are associated with retinopathy in type 1 diabetic patients and are promising biomarkers for the diagnosis and monitoring of diabetic retinopathy.

Objective: To develop and evaluate the effectiveness of a nutrition education program to enable adolescents with type 1 diabetes to count carbohydrates without the parents' help. Methods: Nineteen adolescents with type 1 diabetes from a diabetes center participated in four fortnightly meetings of one hour, with lectures and discussions about healthy nutrition, importance of nutrients for blood glucose, portion sizes, food replacements, and carbohydrate counting therapy. All meetings ended with exercises to check the learning. Adolescents were followed for one year after the intervention. Results: All participants were 100% successful in all the steps of the program and started carbohydrate counting in the main meals. Nutritional status and total daily insulin doses before and after the study did not differ. After 12 months, 68% of the adolescents counted carbohydrates at all times, 16% did so in extra snacks, and 16% were suspended from the new therapy. Eighty percent of the parents were satisfied with the program, believing teenagers were trained in the new therapy. Conclusion: A short nutrition education program successfully trained adolescents to count carbohydrates without the parents' help.

O diabetes é um problema de saúde pública que exige acompanhamento nutricional constante para alcance de metas do tratamento e a maioria das pessoas são atendidas nas Unidades Básicas de Saúde, onde o relato de dificuldades com o plano alimentar e não adesão ao tratamento são frequentes. O objetivo deste estudo foi avaliar um programa de educação nutricional diferenciado para Estratégias de Saúde da Família e identificar fatores que dificultam o seguimento do plano alimentar. Trata-se de um estudo longitudinal, com 77 pessoas com diabetes, que foram clinicamente avaliados, receberam educação e orientação nutricional em um programa individual de 60 minutos, sendo reavaliados em 3 meses, com melhora significativa da qualidade alimentar (diminuição do consumo mensal de óleo e açúcar e melhora do perfil de ingestão alimentar), e identificação dos principais fatores que limitavam o tratamento, como comer em menor quantidade, alimentar-se em horários regulares, as restrições alimentares e a ansiedade. Não houve associação entre dificuldade em seguir a dieta com as variáveis renda, escolaridade e estado civil. Educação nutricional focada em diferentes realidades, com baixo custo e fácil realização, é possível de ser realizada na Atenção Primária com bons resultados, abrindo a perspectiva para diferenciação do programa de educação em grupos, com otimização do tempo dos profissionais nesta realidade.

Objective: To evaluate the introduction of coaching in the interdisciplinary care of individuals with type 1 diabetes mellitus in the public health care system. Subjects and methods: Ten patients routinely attending a public health care service and with a glycated hemoglobin (HbA1c) level above 75% participated in eight coaching sessions. This study evaluated the patients' self-management of the disease and personal behavior. The participants were assessed at the beginning of the program and on two occasions after the intervention, with evaluation of biochemical and anthropometric data, and frequency of self-monitoring of blood glucose (SMBG). Questionnaires were applied during these evaluations to analyze emotional burden (B-PAID), medication adherence (Morisky Adherence Scale), and self-efficacy (IMDSES). Results HbA1c had a median level of 8.0% (range 76-10.3%) at the beginning of the study and reduced significantly 3 months after initiation of the intervention (7.78% [6.5-10%], p = 0.028), with no significant increase at 6 months (8.3% [713-9.27%], p = 0.386). SMBG improved significantly from the beginning to the end of the study, with the median number of glucose tests per week varying from 16.5 (range 0-42) at baseline to 29.0 (7-42) at 3 months and 27.5 (10-48) at 6 months (p = 0.047). No significant differences were observed in anthropometric parameters or in the scores of the instruments between the three measurements. Conclusion: A coaching intervention focused on patients' values and sense of purpose may provide added benefit to traditional diabetes education programs and could be an auxiliary method to help individuals with type 1 diabetes achieve their treatment goals.

The aim of the present study was to investigate the association between the presence of albuminuria and cytokines profile with biomarkers of endothelial damage and oxidative stress in patients with type 1 diabetes mellitus (DM1). The sample was composed by 35 healthy individuals, 63 DM1 patients with normoalbuminuria (

This study was designed to validate a self-assessment tool for identifying Brazilians with Impaired Glucose Tolerance (IGT). The Finnish Diabetes Risk Score (FINDRISC) was applied in 829 people aged over 40 years without previous diagnosis of diabetes between November 2009 and April 2010 at the Viçosa city, Minas Gerais, Brazil. We randomly selected 300 subjects in the initial survey, which received by post a letter of invitation to attend the laboratory for the collection of the blood sample to identify levels of glycated hemoglobin (A1C). Of these 300 subjects invited, 162 attended subjects, this being the final sample for the validation study. The risk score was evaluated through the Area Under the Curve (AUC) in a Receiver Operating Characteristics (ROC) curve. We assume a maximum error of 5 % and confidence interval 95 %. The prevalence of IGT and diabetes according to the A1C test were 21.6 % and 8.6 % respectively. The Diabetes Risk Score value varied from 1 to 25. The AUC by considering all values of A1C ≥ 6.0 % was 0.69 (95 % CI 0.61–0.76). The score value ≥ 9 had sensitivity of 75.51 %, specificity of 49.56 %, Positive Predictive Value (PPV) of 39.4 % and Negative Predictive Value (NPV) of 82.4 %. The FINDRISC is a suitable tool to identify Brazilians with IGT.

Malondialdehyde (MDA), an end product of lipid peroxidation and biomarker for oxidative stress, and its soluble receptor (sRAGE) were evaluated in 42 patients with type 1 diabetes mellitus, but without chronic complications, during the early years after diagnosis (0–10 years) and through the further progression of the disease (10–20 and > 20 years after diagnosis). Clinical and biochemical parameters of the cohort of diabetic patients were compared with those determined in 24 healthy individuals. The median levels of MDA in plasma were similar in type 1 diabetes patients and in healthy subjects. In contrast, statistically significant increases were detected in the median values of sRAGE in patients with type 1 diabetes compared with healthy subjects (2423.75 versus 1472.75 pg/ml; p=0.001, Mann–Whitney test). However, no significant between-group differences ( p>0.05) were observed in levels of sRAGE when diabetic patients were grouped according to time elapsed after diagnosis. It is concluded that increased plasma levels of sRAGE in type 1 diabetes may provide protection against cell damage and may be sufficient to eliminate excessive circulating MDA during early years after disease onset.

Aim The present study investigates the interaction of TLR4 and RAGE with their respective ligands as inducers of the inflammatory markers IL-6 and TNF-α. Also, the reactivity of peripheral blood mononuclear cells (PBMNC) from type 2 diabetic (T2D) patients and non-diabetic healthy controls (ND) were comparatively studied. Methods Concentrations of IL-6 and TNF-α were measured by sandwich Elisa, using kits supplied by Assay Designs (Ann Arbor, MI, USA). PBMNC from T2D and ND were incubated in the presence or absence of LPS, anti-TLR4 or anti-RAGE for 72hours at 37°C under 5% CO 2 . The final volume was adjusted to 300μL in DMEM supplemented with 10% fetal bovine serum. After incubation, the cells were centrifuged, the supernatant collected and the cytokines measured. Results PBMNC from T2D were more sensitive to innate immune stimulation with LPS and monoclonal agonist anti-TLR4 than were cells from ND. The actions of LPS, anti-TLR4 and anti-RAGE potentiated the production of IL-6 and TNF-α in both groups. The simultaneous activation of monoclonal anti-RAGE and anti-TLR4 suggests that both antibodies used different receptors on the cell surface, but converged on the same PBMNC signaling metabolic pathways. This simultaneous activation induced a higher production of IL-6 and TNF-α in PBMNC from the T2D patients than from the ND subjects. Conclusion Our results clearly show an exacerbation of innate immunity in PBMNC with T2D that was possibly hyperglycaemia-induced. These data, when analyzed together, suggest the importance of innate immunity in the pathogenesis of T2D.

Objective To compare the role of Akt/PKB signaling pathway in the modulation of reactive oxygen species (ROS) production by autologous plasma in peripheral blood mononuclear cells (PBMNC) from type 2 diabetic patients and healthy subjects. Materials and methods This study was approved by Santa Casa Ethical Committee and has included patients diagnosed with diabetes type 2 (DM2) and control group (non-diabetic) (ND). PBMNC were purified utilizing Ficoll-hypaque gradient. ROS was quantified by luminol-dependent chemiluminescence. The Akt/PKB phosphorylation was measured using a CASE kit. Statistical analyses were made with t Student test and chi-square (χ2). p Results 12, 13-Phorbol dibutyrate (PDB) stimulated the production of higher levels of ROS in PBMNC from type 2 diabetic patients than that from healthy subjects. Autologous plasma, however, inhibited induced or not ROS production in PBMNC in both groups. The inhibition of PBMNC-ROS derived by autologous plasma from healthy subjects was higher than that from type 2 diabetic patients. Plasma phosphorylated (activated) Akt/PKB. The percentage of phosphorylation induced by autologous plasma in PBMNC from patients and healthy control were 14% and 93%, respectively. Inhibition of ROS production in PBMNC from DM2 were similar for PBMNC + plasma; PBMNC + Akti; and PBMNC + plasma + Akti. However, in ND control, plasma showed a higher ROS inhibition than Akti or plasma plus Akti. Conclusions Our results suggest that the low antioxidant capacity observed in autologous plasma from DM2 patients in conjunction with the decreased activation of PKB may cause an imbalance in the oxidizing/reducing responses, possible inducing an oxidative stress state, which could be associated with tissular damage.

Oxidative stress has been suggested to be the mediator of hyperglycaemia-induced diabetic complications. For this study we asked whether a significant imbalance between oxidizing and plasmatic reducing responses could be observed in DM1 patients receiving intensive therapy up to 5 years following the clinical onset of the disease. A total of 16 type 1 diabetic patients (DM1) without complications and 13 non-diabetic subjects were enrolled. Clinical and biochemical parameters were compared in the two populations studied. Moreover, reactive oxygen species (ROS) generation by granulocytes and the total plasma antioxidant status were simultaneously evaluated. Granulocytes-ROS derived and plasma antioxidant status were determined by chemiluminescence assay and tetrazolium dye reduction, respectively. Type 1 diabetic patients were receiving intensive therapy by multiple daily injections. In comparison with healthy individuals, DM1 patients exhibited an increase in ROS generation whilst plasma antioxidant status was unaltered and appeared to be sufficient to prevent the onset of typical oxidative stress. The clinical characteristics and the remaining biochemical parameters studied were similar for the two groups, except for a significantly decreased plasmatic level of uric acid in DM1 patients. This study suggests that the absence of complications in DM1 patients up to 5 years after onset of the disease may be associated with the oxidizing and reducing balance which need to be maintained in order to prevent or delay the onset of oxidative stress. The effective diabetic control involves evaluation of the oxidizing/antioxidant balance besides glycaemic control.

Objective Several formulas based in different biomarkers may be used to estimate glomerular filtration rate (GRF). However, all of them have some limitations, and it is very important to evaluate their performances in different groups of patients. Therefore, we compared GFR, as estimated by creatinine-based and cystatin C-based equations, according to albuminuria, in type 1 diabetes (T1DM), in an observational case-control study. Subjects and methods T1DM patients were classified according to albuminuria: normoalbuminuric (n = 63), microalbuminuric (n = 30), macroalbuminuric (n = 32). GFR was calculated using creatinine-based and cystatin C-based (aMDRD, CKD-EPIcr, CKD-EPIcys, MacIsaac, Tan and CKD-EPIcrcys) equations. Spearman Correlation was used to evaluate the correlation of GFR estimated by the formulas with albuminuria. ROC curves were constructed to compare AUCs of GFR estimated by equations, in reference to macroalbuminuria. Sensibility, specificity and accuracy were calculated for a cut-off < 60 mL/min/1.73 m2. Results GFR estimated by creatinine-based and cystatin C-based equations significantly differed among normoalbuminuric, microalbuminuric and macroalbuminuric patients. Spearman correlation and AUCs of GFR estimated by creatinine-based and cystatin C-based formulas were very similar to each other, though cystatin C-based equations presented better correlation with albuminuria and higher AUCs than the creatinine-based ones, and the best accuracy to detect macroalbuminuric patients. Conclusion Although GFR estimated by all creatinine-based and cystatin C-based equations permitted the differentiation between T1DM patients, according to albuminuria, cystatin C-based equations presented best accuracy to detect macroalbuminuria in T1DM patients and should be considered in the clinical routine in order to increase the possibility of early diagnostic of chronic renal disease.

Materials and methods Educational material was prepared with pictures of food and portion sizes, corresponding to eating plan and based on calories and food groups and list of drugs identified by different colors. Health literacy was measured with the brief-form Test of Functional Health Literacy (B-TOFHLA) in 53 patients with type 2 DM in a single Public Health Center in Belo Horizonte-MG. Educational program was conducted in four weekly meetings, in groups with 10 people, directed to use of drugs and nutrition, advising how to identify drugs by different colors, guiding meals with an individualized eating plan and a list of food adapted to this reality. The meetings were based on educational material. Clinical evaluation and biochemical tests were analyzed before and three months after the last meeting.

We have investigated whether von Willebrand factor, ADAMTS13 (a disintegrin and metalloproteinase with thrombospondin type 1 motif, member 13), and D-Dimer were associated with different levels of renal function in patients with type 1 diabetes. Patients were classified according to level of renal function through estimated glomerular filtration rate: ≥90 and

This study aimed at investigating the association between haemostatic biomarkers, proinflammatory, and anti-inflammatory cytokines with chronic kidney disease in type 1 diabetic patients. Patients were divided into two groups: with nephropathy (albuminuria≥30 mg/g and/or GFR < 60 mL/min/1.73 m2),n=65; and without nephropathy (albuminuria < 30 mg/g and GFR≥60 mL/min/1.73 m2),n=60. INF-γ, IL-6, IL-10, and TNF-αplasma levels were determined by flow cytometry. VWF, ADAMTS13 antigen, and D-Dimer plasma levels were determined by enzyme-linked immunosorbent assay and ADAMTS13 activity was assessed by fluorescence resonance energy transfer assay. Elevated levels of INF-γ, VWF, ADAMTS13 antigen, D-Dimer, and reduced ADAMTS13 activity/antigen ratio were observed in patients with nephropathy as compared to those without nephropathy (P=0.001,P<0.001,P<0.001,P<0.001, andP<0.001, resp.). Cytokines and haemostatic biomarkers remained associated with nephropathy after adjustments (use of statin, acetylsalicylic acid, angiotensin converting enzyme inhibitor, and angiotensin antagonist). INF-γ, TNF-α, and IL-10 significantly correlated with haemostatic biomarkers. Inflammatory and hypercoagulability status are associated with nephropathy in type 1 diabetes mellitus and an interrelationship between them may play an important role in pathogenesis of diabetic nephropathy.

A retrospective study was conducted on 186 patients with differentiated thyroid cancer without metastases who received an ablative dose of 100 mCi (3.7 GBq) iodine-131 after total thyroidectomy. Six months to one year after ablation, 155/186 patients (83%) had a negative scan. Diagnostic scanning with 5 mCi (185 MBq) performed 72 h or 3 months before ablation did not interfere with treatment success compared to patients not submitted to pre-therapy scanning. Pre-ablation cervical uptake values2% were associated with a higher ablation efficacy (94%), from 2 to 5% showed 80% success and values5%, 60% (p0.05). There were no significant differences between the responsive and no responsive groups in terms of age, sex, histological type or size of the primary tumor. 11% of the patients with low stimulated Tg (2 ng/ml) presented discrete thyroid bed uptake on follow-up diagnostic scan (0.5%) without definitive residual disease and 89% had negative uptake on scan. The patients with Tg2 ng/ml presented thyroid bed (10/12) or ectopic (2/12) uptake on follow-up diagnostic scan. An ablative dose of 100 mCi shows a high rate of efficacy, especially when cervical uptake is2%; no difference was noted between patients assessed by scan within 72 h or 3 months before treatment and those not scanned; follow-up diagnostic scan can be avoided in low risk patients with stimulated Tg2 ng/ml.

Objective To assess the presence of insulin resistance (IR) in patients with type 1 diabetes (T1DM) according to the estimated glucose disposal rate formula (eGDR) and the insulin sensitivity score (ISS) and to estimate the correlation between these two measures and identify the clinical and laboratory markers related to IR. Research design and methods Cross-sectional study of adults with T1DM (n = 135). The results of the formulas that estimate IR were separated into quartiles and correlated with demographic data, clinical characteristics and laboratory parameters. We analyzed the total and regional adiposity by dual-energy X-ray absorptiometry and skin fold thickness measurements. Results Two thirds of the patients were overweight or obese. A moderate correlation was found between eGDR and ISS (r = 0.612). The results of both formulas were positively correlated with BMI (r = −0.373 eGDR and r = −0.721 ISS), thoracic-abdominal fat (r = −0.484 eGDR and r = −0.758 ISS), waist/height ratio (r = −0.537 eGDR and r = −0.779 ISS), subscapular skinfold (mm) (r = −0.356 eGDR and r = −0.569 ISS), total dose insulin IU/lean mass (kg) (r = −0.279 eGDR and r = −0.398 ISS), age (years) (r = −0.495 eGDR and r = −0.190 ISS) and diabetes duration (years) (r = −0.428 eGDR and r = −0.187 ISS). A moderate agreement (Kappa 0.226) was observed between the 1st quartile of results determined by the formulas in 10.4% of the patients, but the 4th quartile presented a strong correlation (Kappa 0.679). The individuals with IR that were classified in the 1st quartile by the ISS formula had a higher chance of presenting with acanthosis nigricans (OR = 5.58, 95% CI =1.46-21.3). Conclusions The correlations found in this study indicate the possibility of using clinical and laboratory data to estimate IR in patients with TDM1. The detection of IR in T1DM patients may allow early intervention and possibly impact on future diabetes complications.

Although exercise promotes beneficial effects in diabetic patients, some studies have questioned the degree of their importance in terms of the increase in total energy expenditure. In these studies, the decrease of physical activity levels (PAL) was referred as “compensatory effect of exercise”. However, our aim was to investigate whether aerobic exercise has compensatory effects on PAL in type 2 diabetes patients. Eight volunteers (51.1 ± 8.2 years) were enrolled in a supervised exercise programme for 8 weeks (3 d · wk−1, 50–60% of VO2 peak for 30–60 min). PAL was measured using tri-axial accelerometers in the 1st, 8th and 12th weeks. Biochemical tests, cardiorespiratory fitness, anthropometric assessment and body composition were measured in the 2nd and 11th weeks. Statistical analysis was performed using non-parametric tests (Friedman and Wilcoxon, P < 0.05). We found no significant differences in PAL between intervention periods, and participants spent the majority of their awake time in sedentary activities. However, the exercise programme generated a significant 14.8% increase in VO2 peak and a 15% reduction in fructosamine. The exercise programme had no compensatory effects on PAL in type 2 diabetes patients, but improved their cardiorespiratory fitness and glycaemic control.

Background Glycated hemoglobin (A1C) and Fasting Plasma Glucose (FPG) are the two monitoring blood glucose tests most frequently used. However, both methods are shown to be insensitive to detect glycemic variations in short duration periods. Therefore, we aimed to assess the effect of a short-term exercise program on glycemic levels measured by fructosamine concentrations in type 2 diabetes patients. Methods Eight volunteers (51.1 ± 8.2 years) underwent a supervised exercise program during eight weeks (3 d.wk-1, 50-60% of VO2 peak for 30–60 minutes). The body composition, VO2 peak, A1C, FPG, fructosamine and capillary blood glucose (CBG) were evaluated. We used ANOVA - One Way for repeated measures followed by Tukey post-hoc test and paired t test. P values

OBJECTIVE: To evaluate inflammatory, oxidizing, and reducing responses during the progression of type 1 diabetes mellitus (T1DM) in patients without chronic complications. SUBJECTS AND METHODS: Plasma antioxidant status, reactive oxygen species (ROS), and interleukin-6 (IL-6) were measured in 42 patients with T1DM and in 24 healthy subjects. RESULTS: Significant increases were detected in the median values of ROS and IL-6 in patients with T1DM compared with healthy subjects (ROS ~ 4,836 vs. 2,036 RLU/min, respectively; P < .05: IL-6 ~ 14.2 vs. 9.7 pg/mL, respectively; P = .002). No significant between-group differences (P > 0.05) were observed in oxidizing responses or in IL-6 concentrations when diabetic patients were grouped according to time after diagnosis (0 - 10, 10 - 20 and > 20 years). Plasma antioxidant responses were similar in patients with T1DM and in healthy subjects. CONCLUSIONS: Our results demonstrate that oxidizing and inflammatory responses are increased at the onset of T1DM, but remain unchanged during disease progression. These findings suggest that functional changes involved in diabetic complications may commence in the first years after diagnosis. OBJETIVO: Avaliar as respostas inflamatória, oxidativa e redutora na progressão do diabetes melito tipo 1 (DM1) em pacientes sem complicações crônicas. SUJEITOS E MÉTODOS: Capacidade antioxidante do plasma, espécies reativas de oxigênio (ROS) e interleucina-6 (IL-6) foram avaliadas em 42 pacientes com DM1 e 24 indivíduos saudáveis. RESULTADOS: Aumentos significativos foram detectados nas medianas de ROS e IL-6 em pacientes com DM1 comparados com indivíduos saudáveis (ROS ~ 4.836 vs. 2.036 RLU/min, respectivamente, P < 0,05: IL-6 ~ 14,2 vs. 9,7 pg/mL, respectivamente, P = 0,002). Diferenças não significativas (P > 0,05) foram observadas na resposta oxidante e IL-6 quando os diabéticos foram agrupados de acordo com o tempo após o diagnóstico (0-10, 10-20 e > 20 anos). A resposta antioxidante do plasma foi semelhante em pacientes com DM1 e em indivíduos saudáveis. CONCLUSÕES: Nossos resultados demonstram que as respostas oxidante e inflamatória estão aumentadas desde o início do DM1, mas mantêm-se inalteradas durante a progressão da doença, sugerindo que as mudanças funcionais envolvidas nas complicações diabéticas podem começar nos primeiros anos após o diagnóstico.

Human tissue kallikrein (hK1) is reduced in hypertension, cardiovascular and renal diseases. There is little information on the participation of hK1 in type 1 diabetes mellitus (DM), type 2 DM, and gestational diabetes mellitus (GDM), respectively. The aim of this study was to evaluate the roles of insulin and hyperglycemia on urinary hK1 activity in type 1 DM and in GDM. Forty-three type 1 DM patients (5–35 years, disease duration ⩽5 years, receiving insulin, HbA1c > 7.6%) were selected. Forty-three healthy individuals, paired according to gender and age, were used as controls. Thirty GDM patients (18–42 years, between the 24th and 37th week of pregnancy, recently diagnosed, not under insulin therapy) were also selected. Thirty healthy pregnant (18–42 years, between the 24th and 37th week of pregnancy) and 30 healthy non-pregnant women (18–42 years) were selected as controls. Random midstream urine was used. hK1 amidase activity was estimated with D-Val-Leu-Arg-Nan substrate. Creatinine was determined by Jaffe’s method. hK1 specific amidase activity was expressed as μM/(min mg creatinine) to correct for differences in urine flow rate. hK1 specific amidase activity was significantly higher in the urine of type 1 DM than in controls, and in the urine of GDM patients than in healthy pregnant women and healthy non-pregnant women, respectively. The data suggest that hyperglycemia, rather than insulin, is involved in the mechanism of increased hK1 specific amidase activity in both type 1 DM and GDM patients, respectively.

O diabetes melito e suas complicações apresentam origem multifatorial. Mecanismos bioquímicos e patológicos estão associados com hiperglicemia crônica no diabetes e o aumento do estresse oxidativo tem sido postulado com papel central nestas desordens. Evidências sugerem que a lesão celular oxidativa causada pelos radicais livres contribuem para o desenvolvimento das complicações no diabetes tipo 1 (DM1) e a diminuição das defesas antioxidantes (enzimáticas e não-enzimáticas) parecem correlacionar-se com a gravidade das alterações patológicas no DM1. Nesta revisão, relata-se como o estresse oxidativo pode exercer efeitos deletérios no diabetes e são apresentadas as opções terapêuticas em estudo para modulação da injúria vascular. Diabetic complications appear to be multifactorial process. The biochemical and pathological mechanisms are associated with chronic hyperglycemia of diabetes and the increased oxidative stress which has been postulated to play a central role in these disorders. Accumulating evidence suggests that oxidative cell injury caused by free radicals contributes to the development of type 1 diabetes (DM1) complications and decreased efficiency of antioxidant defenses (both enzymatic and nonenzymatic) seems to correlate with the severity of pathological tissue changes in DM1. In this review, we report as oxidative stress may exert deleterious effects in diabetes, as well as address current strategies in study to down-regulating vascular injury.

A gestação em portadoras de diabetes tipo 1 é alvo de múltiplas tentativas para o bom controle glicêmico desde o período pré-concepcional, com a terapia com infusão de insulina subcutânea contínua apresentando opção terapêutica adicional na tentativa de alcançar as metas glicêmicas. Apresentamos o caso de uma paciente com diabetes tipo 1, não controlada com múltiplas injeções diárias, cuja instalação da bomba de insulina ocorreu durante o segundo trimestre de gestação, com sucesso terapêutico. The type 1 diabetic patient pregnancy is subjected to various attempts to obtain good glycemic control, since the pre-conception period throughout the gestation. Continuous subcutaneous insulin infusion (CSII) is a therapeutic tool to achieve the glycemic targets. Here it is presented the case of a Type 1 diabetic woman, who was not under multiple insulin daily injections therapy, and whose insulin therapy started on CSII during the second trimester of gestation, obtaining successful therapeutic outcome.

A síndrome de Guillain-Barré (GBS) é uma desordem causada por exacerbada resposta imune aos processos infecciosos. O diabetes melito (DM) não é reconhecido como uma causa desta polirradiculopatia inflamatória, com poucos casos relatados na literatura sobre tal associação. Apresentamos um caso de uma paciente do sexo feminino, 44 anos, admitida com história recente de poliúria, polidipsia, perda de peso e astenia, glicemia de 562 mg/dL, em cetoacidose, sem foco infeccioso. Posteriormente desenvolveu quadro de polirradiculopatia, insuficiência respiratória e alteração liquórica compondo o quadro de GBS. No presente relato, a paciente recuperou-se plenamente do déficit neurológico, assim como da hiperglicemia, configurando quadro de diabetes tipo 2, com tendência à cetoacidose, evoluindo sem insulino-dependência.

Diabetic complications appear to be multifactorial process. The biochemical and pathological mechanisms are associated with chronic hyperglycemia of diabetes and the increased oxidative stress which has been postulated to play a central role in these disorders. Accumulating evidence suggests that oxidative cell injury caused by free radicals contributes to the development of type 1 diabetes (DM1) complications and decreased efficiency of antioxidant defenses (both enzymatic and nonenzymatic) seems to correlate with the severity of pathological tissue changes in DM1. In this review, we report as oxidative stress may exert deleterious effects in diabetes, as well as address current strategies in study to down-regulating vascular injury.