144 results on '"Cobas, Roberta A."'
Search Results
2. Type 1 Diabetes Brazilian patients exhibit reduced frequency of recent thymic emigrants in regulatory CD4+CD25+Foxp3+ T cells
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Nogueira, Jeane de Souza, primary, Gomes, Thamires Rodrigues, additional, Secco, Danielle Angst, additional, de Almeida, Inez Silva, additional, da Costa, Alessandra Saldanha Matheus Fernandes, additional, Cobas, Roberta Arnoldi, additional, Costados Santos, Gilson, additional, Gomes, Marília Brito, additional, and Pôrto, Luís Cristóvão, additional
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- 2024
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3. The lifestyle of Brazilian medical students: What changed and how it protected their emotional wellbeing during the COVID-19 pandemic
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Kobbaz, Tiago Mansur, Bittencourt, Leticia Ayd, Pedrosa, Bianca Vianna, Fernandes, Beatriz da Motta, Marcelino, Leonardo Demier, Pires de Freitas, Bernardo, Maciel, Natalia, Rothfuchs, Ana Paula, Magalhaes, Elisa da Silva, Saud, Nathalia Salim, Vidigal, Alexia Soares, Goncalves, Bruna Yumi Miura, Rodrigues, Joao Fernando Cunha, Muller, Ully Morize, Silva, Luiza de Almeida, Cobas, Roberta Arnoldi, Nishijuka, Fabio Akio, and Barbato, Kelly Biancardini Gomes
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- 2021
4. Diagnóstico do diabetes e rastreamento do diabetes tipo 2
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Cobas, Roberta, primary, Rodacki, Melanie, additional, Giacaglia, Luciano, additional, Calliari, Luis Eduardo Procopio, additional, Noronha, Renata Maria, additional, Valerio, Cynthia, additional, Custódio, Joaquim, additional, Scharf, Mauro, additional, Barcellos, Cristiano Roberto Grimaldi, additional, Tomarchio, Maithe Pimentel, additional, Silva, Maria Elizabeth Rossi da, additional, Santos, Rosa Ferreira dos, additional, Zajdenverg, Lenita, additional, Gabbay, Monica, additional, and Bertoluci, Marcello, additional
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- 2022
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5. Diagnóstico do diabetes e rastreamento do diabetes tipo 2
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Cobas, Roberta Arnoldi, primary, Rodacki, Melanie, additional, Giacaglia, Luciano Ricardo, additional, Calliari, Luis Eduardo Procopio, additional, Noronha, Renata Maria de, additional, Valério, Cynthia Melissa, additional, Silva Junior, Joaquim Custódio da, additional, Pinto, Mauro Scharf, additional, Barcellos, Cristiano Roberto Grimaldi, additional, Tomarchio, Maithê Pimentel, additional, Silva, Maria Elizabeth Rossi da, additional, Santos, Rosa Ferreira dos, additional, Zajdenverg, Lenita, additional, Gabbay, Monica Andrade Lima, additional, and Bertoluci, Marcello Casaccia, additional
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- 2021
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6. The impact of ethnicity, educational and economic status on the prescription of insulin therapeutic regimens and on glycemic control in patients with type 1 diabetes. A nationwide study in Brazil
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Gomes, Marilia Brito, Rodacki, Melanie, Pavin, Elizabeth João, Cobas, Roberta Arnoldi, Felicio, João S., Zajdenverg, Lenita, and Negrato, Carlos Antonio
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- 2017
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7. Flash glucose monitoring system in patients with type 1 diabetes in healthcare center in Brazil: real world data from a short-term prospective study
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Matheus, Alessandra S. M., primary, Pascoal, Juliana Brazil Fontes, additional, Cabizuca, Carolina Alves, additional, Tannus, Lucianne Righeti Monteiro, additional, Guimarães, Rafael Seno, additional, Mattos, Diogo Menezes Ferrazani, additional, and Cobas, Roberta Arnoldi, additional
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- 2022
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8. Risk factors associated with nonalcoholic fatty liver disease evaluated by elastography in patients with type 2 diabetes
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Pozzan,Roselee, Pena,Ronaldo Gama, Palma,Cátia Cristina Silva Sousa Vergara, Abi-Abib,Raquel de Carvalho, Terra,Carlos, and Cobas,Roberta Arnoldi
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nonalcoholic fatty liver disease ,elastography ,Type 2 diabetes mellitus ,controlled attenuation parameter (CAP) - Abstract
Objective: There is controversy about the indication for nonalcoholic fatty liver disease (NAFLD) screening in patients with type 2 diabetes mellitus (T2D). The present study aims to contribute to NAFLD surveillance in patients with T2D, assessing the association of clinical and biological variables with hepatic stiffness and steatosis. Subjects and methods: A cross-sectional design was used, with data collection from electronic medical records, including adults with T2D who underwent transient elastography (TE) between June 2018 and December 2019. Liver stiffness and steatosis were evaluated using TE and controlled attenuation parameter (CAP), respectively, with cutoff points > 8 kpa for increased stiffness and > 275 dBm for steatosis. The relationship between clinical variables and elastography results were evaluated by bivariate correlation and multivariate analysis, using SPSS 27. Seventy-nine patients (n = 79) met the inclusion and exclusion criteria. Results: Advanced fibrosis and hepatic steatosis were detected in 17,7% and in 21,5% of the patients, respectively. There was a direct and significant correlation between CAP and BMI, waist circumference, HbA1c, triglycerides levels, and insulin doses and an inverse correlation with HDL. The waist circumference, low levels of HDL cholesterol and the insulin dose maintained a significant association with CAP values in multivariate analysis. Elastography values showed an inverse correlation with HDL and a direct correlation with BMI and insulin dose. The association was only maintained for the insulin dose in multivariate analysis. Conclusion: Our results suggest that clinical factors such as insulin dose, waist circumference, and HDL cholesterol levels could identify T2D patients more likely to present NAFLD.
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- 2022
9. Combination of basal insulin and GLP-1 receptor agonist: is this the end of basal insulin alone in the treatment of type 2 diabetes?
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Moreira, Rodrigo Oliveira, Cobas, Roberta, and Lopes Assis Coelho, Raquel C.
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- 2018
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10. Risk factors associated with nonalcoholic fatty liver disease evaluated by elastography in patients with type 2 diabetes
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Pozzan, Roselee, Pena, Ronaldo Gama, Palma, Cátia Cristina Silva Sousa Vergara, Abi-Abib, Raquel de Carvalho, Terra, Carlos, and Cobas, Roberta Arnoldi
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nonalcoholic fatty liver disease ,elastography ,Type 2 diabetes mellitus ,controlled attenuation parameter (CAP) - Abstract
Objective: There is controversy about the indication for nonalcoholic fatty liver disease (NAFLD) screening in patients with type 2 diabetes mellitus (T2D). The present study aims to contribute to NAFLD surveillance in patients with T2D, assessing the association of clinical and biological variables with hepatic stiffness and steatosis. Subjects and methods: A cross-sectional design was used, with data collection from electronic medical records, including adults with T2D who underwent transient elastography (TE) between June 2018 and December 2019. Liver stiffness and steatosis were evaluated using TE and controlled attenuation parameter (CAP), respectively, with cutoff points > 8 kpa for increased stiffness and > 275 dBm for steatosis. The relationship between clinical variables and elastography results were evaluated by bivariate correlation and multivariate analysis, using SPSS 27. Seventy-nine patients (n = 79) met the inclusion and exclusion criteria. Results: Advanced fibrosis and hepatic steatosis were detected in 17,7% and in 21,5% of the patients, respectively. There was a direct and significant correlation between CAP and BMI, waist circumference, HbA1c, triglycerides levels, and insulin doses and an inverse correlation with HDL. The waist circumference, low levels of HDL cholesterol and the insulin dose maintained a significant association with CAP values in multivariate analysis. Elastography values showed an inverse correlation with HDL and a direct correlation with BMI and insulin dose. The association was only maintained for the insulin dose in multivariate analysis. Conclusion: Our results suggest that clinical factors such as insulin dose, waist circumference, and HDL cholesterol levels could identify T2D patients more likely to present NAFLD.
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- 2022
11. Particularities in managing diabetes in children and the elderly/Particularidades no manejo do diabetes em criancas e idosos/ Particularidades en el manejo de la diabetes en ninos y adultos mayores
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Matheus, Alessandra S.M. and Cobas, Roberta A.
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- 2015
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12. Risk factors associated with nonalcoholic fatty liver disease evaluated by elastography in patients with type 2 diabetes
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Pozzan, Roselee, primary, Pena, Ronaldo Gama, additional, Palma, Cátia Cristina Silva Sousa Vergara, additional, Abi-Abib, Raquel de Carvalho, additional, Terra, Carlos, additional, and Cobas, Roberta Arnoldi, additional
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- 2022
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13. Prevalence of overweight/obesity and its relationship with metabolic syndrome and fatty liver index in adult patients with type 1 diabetes. A Brazilian multicenter study.
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Gomes, Marilia Brito, Santos, Deborah Conte, Drummond, Karla, Pinheiro, André, Muniz, Luiza Harcar, Leal, Franz, Negrato, Carlos Antonio, Melo, Laura Nunes, Cobas, Roberta, Tannus, Lucianne Righeti Monteiro, Rodacki, Melanie, Zajdenverg, Lenita, Dantas, Joana Rodrigues, Corrêa-Giannella, Maria Lúcia Cardillo, Admoni, Sharon Nina, Santos, Daniele Pereirados, Guedes, Mariade Fatima, Dib, Sergio Atala, Filho, Celso Ferreirde Camargo Sallum, and Pavin, Elisabeth João
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Aims: To determine the prevalence of overweight/obesity and its relationship with metabolic syndrome (MS), fatty liver index (FLI), cardiovascular risk factors (CVRF), and diabetes-related chronic complications (DRCC) in adult patients with type 1 diabetes (T1D). Methods: This study was conducted in 14 Brazilian public clinics in ten cities, with 1,390 patients: 802 females (57.7%), 779 (56.0%) Caucasians, aged 33.6 ± 10.8 years, age at diagnosis, 16.2 ± 9.2 years, diabetes duration, 17.4 ± 9.2 years, and HbA1c 8.8 ± 2.0%. Results: Overall, 825 patients (59.4%) had normal weight, and 565 had overweight/obesity; (429 (30.9%) presented overweight and 136 (9.8%) presented obesity). After adjustments, overweight/obesity was associated with age, family history of overweight/obesity, total daily insulin dose, hypertension, adherence to diet, type of health care insurance, use of metformin, levels of C-reactive protein, triglycerides, uric acid and HDL-cholesterol. These patients also presented a higher prevalence of MS, FLI ≥ 60, and CVRF than patients without overweight/obesity. Overweight/obesity was not associated with DRCC and with HbA1c levels. Conclusions: Patients with T1D with overweight/obesity presented traditional risk factors for DRCC, cardiovascular diseases, MS, and non-alcoholic fatty liver disease; most of these risk factors are modifiable and can be avoided with interventions that prevent overweight/obesity. [ABSTRACT FROM AUTHOR]
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- 2023
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14. Diabetes in pregnancy/Diabetes na gestacao/Diabetes en la gestacion
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Abi-Abib, Raquel C., Cabizuca, Carolina A., Carneiro, Joao Regis I., Braga, Fernanda O., Cobas, Roberta A., Gomes, Marilia B., Jesus, Guilherme R. de, and Miranda, Fatima R.D.
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- 2014
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15. Pregnancy and obesity: an emerging problem/Gestacao e obesidade: um problema emergente/Gestacion y obesidad: un problema emergente
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Carneiro, Joao Regis I., Braga, Fernanda O., Cabizuca, Carolina A., Abi-Abib, Raquel C., Cobas, Roberta A., and Gomes, Marilia B.
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- 2014
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16. Economic status and clinical care in young type 1 diabetes patients: a nationwide multicenter study in Brazil
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Gomes, Marilia B., de Mattos Matheus, Alessandra Saldanha, Calliari, Luis Eduardo, Luescher, Jorge Luiz, Manna, Thais Della, Savoldelli, Roberta Diaz, Cobas, Roberta A., Coelho, Wellington Siqueira, Tschiedel, Balduino, Ramos, Alberto José, Fonseca, Reine Marie, Araujo, Neuza Braga C., Almeida, Henriqueta Guido, Melo, Naira Horta, Jezini, Debora Laredo, and Negrato, Carlos Antonio
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- 2013
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17. Apresentacao
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Cobas, Roberta and Gomes, Marilia de Brito
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- 2015
18. Plasma PAF-acetylhydrolase activity, inflammatory markers and susceptibility of LDL to in vitro oxidation in patients with type 1 diabetes mellitus
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Gomes, Marilia Brito, Cobas, Roberta Arnold, Nunes, Edson, Castro-Faria-Neto, Hugo Caire, da Matta, Maria Fátima Bevilacqua, Neves, Ricardo, and Tibiriçá, Eduardo
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- 2009
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19. Double-diabetes in a real-world sample of 2,711 individuals: associated with insulin treatment or part of the heterogeneity of type 1 diabetes?
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de Mello Almada Giuffrida, Fernando, Bulcão, Caroline, Cobas, Roberta A, Negrato, Carlos Antonio, Gomes, Marilia B, and Dib, Sergio Atala
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- 2015
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20. The cost of type 1 diabetes: a nationwide multicentre study in Brazil/Cout du diabete de type 1: une etude multicentrique a l'echelle nationale realisee au Bresil/El coste de la diabetes tipo 1: un estudio multicentrico a nivel nacional en Brasil
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Cobas, Roberta Arnoldi, Ferraz, Marcos Bosi, Matheus, Alessandra Saldanha de Mattos, Tannus, Lucianne Righeti Monteiro, Negrato, Carlos Antonio, de Araujo, Luiz Antonio, Dib, Sergio Atala, and Gomes, Marilia Brito
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Medical economics -- Economic aspects -- Surveys -- Reports ,Diabetes therapy -- Economic aspects -- Surveys ,Type 1 diabetes -- Economic aspects -- Surveys -- Diagnosis -- Care and treatment ,Health - Abstract
Objective To determine the direct medical costs of type 1 diabetes mellitus (T1DM) to the National Brazilian Health- Care System (NBHCS) and quantify the contribution of each individual component to the total cost. Methods A retrospective, cross-sectional, nationwide multicentre study was conducted between 2008 and 2010 in 28 public clinics in 20 Brazilian cities. The study included 3180 patients with T1 DM (mean age 22 years [+ or -] 11.8) who were surveyed while receiving health care from the NBHCS. The mean duration of their diabetes was 10.3 years ([+ or -] 8.0). The costs of tests and medical procedures, insulin pumps, and supplies for administration, and supplies for self-monitoring of blood glucose (SMBG) were obtained from national and local health system sources for 2010-2011. Annual direct medical costs were derived by adding the costs of medications, supplies, tests, medical consultations, procedures and hospitalizations over the year preceding the interview. Findings The average annual direct medical cost per capita was 1319.15 United States dollars (US$).Treatment-related expenditure--USS 1216.33 per patient per year--represented 92.20% of total direct medical costs. Insulin administration supplies and SMBG (US$ 696.78 per patient per year) accounted for 52.82% of these total costs. Together, medical procedures and haemodialysis accounted for 5.73% (US$ 75.64 per patient per year) of direct medical costs. Consultations accounted for 1.94% of direct medical costs (US$ 25.62 per patient per year). Conclusion Health technologies accounted for most direct medical costs of T1DM. These data can serve to reassess the distribution of resources for managing T1DM in Brazil's public health-care system. Objectif Determiner les couts medicaux directs du diabete gras de type 1 (DT1) pour le systeme de sante national bresilien (SSNB) et quantifier la contribution de chaque composante individuelle au cout total. Methodes Une etude retrospective, transversale, multicentrique et a l'echelle nationale a ete menee entre 2008 et 2010 dans 28 cliniques publiques de 20 villes bresiliennes. Cette etude incluait 3180 patients atteints de DT1 (moyenne d'age de 22 ans [+ or -] 11,8) qui ont ete interroges alors qu'ils etaient pris en charge par le SSNB. En moyenne, ils etaient atteints par la maladie depuis 10,3 ans ([+ or -]8). Les couts des tests et des interventions medicales, des pompes a insuline et des equipements pour son administration, ainsi que des fournitures pour l'autosurveillance du taux de glycemie (ASTG) ont ete obtenus a partir de sources provenant du systeme de sante national et local sur 2010-2011. Les couts medicaux directs annuels ont ete calcules en ajoutant les couts des medicaments, des fournitures, des consultations medicales, des interventions et des hospitalisations au cours de l'annee precedant l'enquete. Resultats La moyenne du cout medical direct annuel par habitant s'elevait a 1319,15 dollars. Les depenses liees au traitement--1216,33 dollars par patient et par an--ont represente 92,20% du total des couts medicaux directs. L'equipement necessaire a l'administration d'insuline et a l'ASTG (696,78 dollars par patient et par an) a totalise 52,82% du total de ces couts. Dans l'ensemble, les interventions medicales et l'hemodialyse ont represente 5,73% (75,64 dollars par patient et par an) des couts medicaux directs, et les consultations ont represente 1,94% de ces memes couts (25,62 dollars par patient et paran). Conclusion Les technologies de la sante ont constitue la majeure partie des couts medicaux directs du DT1. Ces donnees peuvent etre utilisees pour reevaluer la distribution des ressources pour la prise en charge du DT1 par le systeme de sante publique bresilien. Objetivo Determinar los costes medicos directos de la diabetes mellitus de tipo 1 (DMT1) para el sistema nacional brasileno de atencion sanitaria (NBHCS, segun sus siglas en ingles) y cuantificar la contribucion de cada componente individual al coste total. Metodos Se llevo a cabo un estudio multicentrico retrospectivo transversal a nivel nacional entre los anos 2008 y 2010 en 28 clinicas publicas de 20 ciudades brasilenas. El estudio incluyo 3180 pacientes con DMT1 (edad media de 22 anos [+ or -] 11,8), que fueron entrevistados mientras recibian atencion sanitaria del NBHCS. La duracion media de su diabetes fue de 10,3 anos ([+ or -] 8,0). Los costes de las pruebas y procedimientos medicos, las bombas de insulina y provisiones para la administracion, asi como suministros para la automonitorizacion de la glucosa en sangre (AMG) se obtuvieron de las fuentes de los sistemas de salud nacionales y locales para el periodo 2010-2011. Los costes medicos directos anuales se obtuvieron sumando los costes de los medicamentos, suministros, pruebas, consultas y procedimientos medicos y hospitalizaciones durante el ano anterior a la entrevista. Resultados El coste medio directo anual por capita fue de 1319,15 dolares americanos (USS). Los gastos relacionados con el tratamiento, US$ 1216,33 por paciente y ano, representaron el 92,20% del total de los costes medicos directos. Los suministros para la administracion de insulina y la AMG (US$ 696,78 por paciente y ano) significaron el 52,82% de esos costes totales. En conjunto, los procedimientos medicos y la hemodialisis representaron el 5,73% (US$ 75,64 por paciente y ano) de los costes medicos directos. Las consultas fueron el 1,94% de los costes medicos directos (US$ 25,62 por paciente y ano). Conclusion Las tecnologias sanitarias representaron la mayoria de los costes medicos directos de la DMT1. Estos datos pueden servir para volver a examinar la distribucion de los recursos para la gestion de la diabetes de tipo 1 en el sistema de salud publica de Brasil., Introduction Type 1 diabetes mellitus (T1DM) is a chronic lifelong disease, commonly diagnosed in youth, that requires strict multidisciplinary treatment for the patient's entire life. (1) Over the last decades, [...]
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- 2013
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21. Telemonitoring type 1 diabetes patients during the COVID-19 pandemic in Brazil: was it useful?
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Matheus, Alessandra Saldanha de Mattos, primary, Cabizuca, Carolina Alves, additional, Tannus, Lucianne Righetti Monteiro, additional, Passos, Aline Camin, additional, Schmidt, Amábile Cristyne, additional, Gouveia, Ana Tarasiuk de, additional, Pessoa, Bruno Moraes de Albuquerque, additional, Matheus, Felipe Cerqueira, additional, Yang, Gabriela Yea-Huey, additional, Divino, Josimara Araujo da Silva, additional, Mathiles, Juliana Affonso, additional, Teixeira, Juliana Leite, additional, Barroso, Luiza de Souza, additional, Brito, Max Benicio da Fonseca de, additional, Suassuna, Paula Melichar, additional, and Cobas, Roberta Arnoldi, additional
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- 2020
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22. Cytokine Levels in Neural Pain in Leprosy
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Angst, Débora Bartzen Moraes, primary, Pinheiro, Roberta Olmo, additional, Vieira, Joyce Soares da Silva, additional, Cobas, Roberta Arnoldi, additional, Hacker, Mariana de Andréa Vilas-Boas, additional, Pitta, Izabela Jardim Rodrigues, additional, Giesel, Louise Mara, additional, Sarno, Euzenir Nunes, additional, and Jardim, Márcia Rodrigues, additional
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- 2020
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23. The lifestyle of Brazilian medical students: What changed and how it protected their emotional wellbeing during the COVID-19 pandemic.
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Mansur Kobbaz, Tiago, Ayd Bittencourt, Letícia, Vianna Pedrosa, Bianca, da Motta Fernandes, Beatriz, Marcelino, Leonardo Demier, Pires de Freitas, Bernardo, Maciel, Natália, Paula Rothfuchs, Ana, da Silva Magalhães, Elisa, Salim Saud, Nathália, Soares Vidigal, Alexia, Gonçalves Miura, Bruna Yumi, Cunha Rodrigues, João Fernando, Müller, Ully Morize, de Almeida Silva, Luíza, Arnoldi Cobas, Roberta, Akio Nishijuka, Fábio, and Barbato, Kelly Biancardini Gomes
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Background and objective Adopting healthy lifestyle pillars promotes longer lives free from major chronic diseases. The COVID-19 pandemic imposed behavioural changes and psychological burdens. The aim of this study was to assess changes in medical students' six lifestyle pillars that were imposed by the COVID-19 pandemic. Methods This cross-sectional study included 548 Brazilian medical students' digitally collected demographic data and lifestyle characteristics from before and during the pandemic. Results The pandemic had a neutral impact on sleep quality and a predominantly negative impact on interpersonal relationships, exercise and eating. Approximately 67.5% students decreased their tobacco and alcohol use. Spirituality was maintained at 66%. Those who reported having emotional wellbeing (27.9%) during the pandemic fulfilled a higher number of pre-pandemic lifestyle pillars (median [IQR]) when compared with those who reported an absence of wellbeing (4 [3-4] pillars, compared with 3 [2-4], P = 0.006). Discussion The results reinforce the importance of adhering to as many lifestyle pillars as possible to preserve emotional wellbeing during periods of stress such as those experienced during the pandemic. [ABSTRACT FROM AUTHOR]
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- 2021
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24. Heterogeneous behavior of lipids according to HbA1c levels undermines the plausibility of metabolic syndrome in type 1 diabetes: data from a nationwide multicenter survey
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Giuffrida Fernando MA, Guedes Alexis D, Rocco Eloa R, Mory Denise B, Dualib Patricia, Matos Odelisa S, Chaves-Fonseca Reine M, Cobas Roberta A, Negrato Carlos Antonio, Gomes Marilia B, and Dib Sergio A
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Type 1 diabetes ,Metabolic syndrome ,Dyslipidemia ,Cardiovascular risk factor ,Diseases of the circulatory (Cardiovascular) system ,RC666-701 - Abstract
Abstract Background Cardiovascular risk factors (CVRF) may cluster in type 1 diabetes, analogously to the metabolic syndrome described in type 2 diabetes. The threshold of HbA1c above which lipid variables start changing behavior is unclear. This study aims to 1) assess the behavior of dyslipidemia according to HbA1c values; 2) detect a threshold of HbA1c beyond which lipids start to change and 3) compare the clustering of lipids and other non-lipid CVRF among strata of HbA1c individuals with type 1 diabetes. Methods Effects of HbA1c quintiles (1st: ≤7.4%; 2nd: 7.5-8.5%; 3rd: 8.6-9.6%; 4th: 9.7-11.3%; and 5th: >11.5%) and covariates (gender, BMI, blood pressure, insulin daily dose, lipids, statin use, diabetes duration) on dyslipidemia were studied in 1275 individuals from the Brazilian multi-centre type 1 diabetes study and 171 normal controls. Results Body size and blood pressure were not correlated to lipids and glycemic control. OR (99% CI) for high-LDL were 2.07 (1.21-3.54) and 2.51 (1.46-4.31), in the 4th and 5th HbA1c quintiles, respectively. Hypertriglyceridemia increased in the 5th quintile of HbA1c, OR 2.76 (1.20-6.37). OR of low-HDL-cholesterol were 0.48 (0.24-0.98) and 0.41 (0.19-0.85) in the 3rd and 4th HbA1c quintiles, respectively. HDL-cholesterol correlated positively (0.437) with HbA1c in the 3rd quintile. HDL-cholesterol and insulin dose correlated inversely in all levels of glycemic control. Conclusions Correlation of serum lipids with HbA1c is heterogeneous across the spectrum of glycemic control in type 1 diabetes individuals. LDL-cholesterol and triglycerides worsened alongside HbA1c with distinct thresholds. Association of lower HDL-cholesterol with higher daily insulin dose is consistent and it points out to a role of exogenous hyperinsulinemia in the pathophysiology of the CVRF clustering. These data suggest diverse pathophysiological processes depending on HbA1c, refuting a unified explanation for cardiovascular risk in type 1 diabetes.
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- 2012
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25. Regional differences in clinical care among patients with type 1 diabetes in Brazil: Brazilian Type 1 Diabetes Study Group
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Gomes Marília B, Cobas Roberta A, Matheus Alessandra S, Tannus Lucianne R, Negrato Carlos, Rodacki Melanie, Braga Neuza, Cordeiro Marilena M, Luescher Jorge L, Berardo Renata S, Nery Marcia, Marques MariadoCarmo A, Calliari Luiz E, Noronha Renata M, Manna Thais D, Zajdenverg Lenita, Salvodelli Roberta, Penha Fernanda G, Foss Milton C, Foss-Freitas Maria C, Pires Antonio C, Robles Fernando C, Guedes MariadeFátimaS, Dib Sergio A, Dualib Patricia, Silva Saulo C, Sepulvida Janice, Almeida Henriqueta G, Sampaio Emerson, Rea Rosangela, Faria Ana Cristina R, Tschiedel Balduino, Lavigne Suzana, Cardozo Gustavo A, Azevedo Mirela J, Canani Luis, Zucatti Alessandra T, Coral Marisa Helena C, Pereira Daniela, Araujo Luiz, Tolentino Monica, Pedrosa Hermelinda C, Prado Flaviane A, Rassi Nelson, Araujo Leticia B, Fonseca Reine Marie C, Guedes Alexis D, Matos Odelissa S, Faria Manuel, Azulay Rossana, Forti Adriana C, Façanha Cristina, Montenegro Ana, Montenegro Renan, Melo Naira H, Rezende Karla F, Ramos Alberto, Felicio João, Santos Flavia M, and Jezini Deborah L
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Type 1 diabetes ,Glycemic control ,Cardiovascular risk factors ,Chronic complications ,Economic status ,Nutritional diseases. Deficiency diseases ,RC620-627 - Abstract
Abstract Background To determine the characteristics of clinical care offered to type 1 diabetic patients across the four distinct regions of Brazil, with geographic and contrasting socioeconomic differences. Glycemic control, prevalence of cardiovascular risk factors, screening for chronic complications and the frequency that the recommended treatment goals were met using the American Diabetes Association guidelines were evaluated. Methods This was a cross-sectional, multicenter study conducted from December 2008 to December 2010 in 28 secondary and tertiary care public clinics in 20 Brazilian cities in north/northeast, mid-west, southeast and south regions. The data were obtained from 3,591 patients (56.0% females and 57.1% Caucasians) aged 21.2 ± 11.7 years with a disease duration of 9.6 ± 8.1 years ( Results Overall, 18.4% patients had HbA1c levels Conclusions A majority of patients, mainly in the north/northeast and mid-west regions, did not meet metabolic control goals and were not screened for diabetes-related chronic complications. These results should guide governmental health policy decisions, specific to each geographic region, to improve diabetes care and decrease the negative impact diabetes has on the public health system.
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- 2012
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26. Progression to microalbuminuria in patients with type 1 diabetes: a seven-year prospective study
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Cobas Roberta A, Santos Bráulio, da Silva Pedro CB, Neves Ricardo, and Gomes Marilia B
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Diabetic Nephropathy ,Microalbuminuria ,Incidence ,Risk Factors ,Type 1 Diabetes ,Nutritional diseases. Deficiency diseases ,RC620-627 - Abstract
Abstract Background The presence of microalbuminuria can be associated with overt nephropathy and cardiovascular disease in patients with type 1 diabetes (T1D). We aimed to determine the incidence and evaluate the baseline predictors for the development of microalbuminuria in patients with T1D. Methods This study is a longitudinal cohort study of 122 normoalbuminuric patients with T1D who were receiving routine clinical care at baseline. A detailed medical history was taken, and a physical examination was performed at baseline. All of the patients were regularly examined for diabetes-associated complications. An analysis of predictors was performed using the Cox regression. Results Over 6.81 (3.59-9.75) years of follow-up, 50 (41%) of the patients developed microalbuminuria. The incidence density was 6.79/100 people per year (95% CI 5.04-8.95), and the microalbuminuria developed after 5.9 (2.44-7.76) and 11 (5-15) years of follow-up and diabetes duration, respectively. After an individual Cox regression, the baseline variables associated with the development of microalbuminuria were age, age at diagnosis, duration of diabetes, systolic and diastolic blood pressure, fasting glycemia, body mass index (BMI), total cholesterol and triglycerides levels, cholesterol/HDL ratio and a family history of type 2 diabetes.After a multivariate Cox regression, the only independent factors associated with the development of microalbuminuria were BMI [HR 1.12 (1.03-1.21)] and cholesterol/HDL ratio [HR 1.32 (1.05-1.67)]. Conclusions A higher BMI and cholesterol/HDL ratio increased the risk of developing microalbuminuria in young patients with T1D after a short follow-up. Both risk factors are modifiable and should be identified early and followed closely.
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- 2011
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27. Effect of the carbohydrate counting method on glycemic control in patients with type 1 diabetes
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Dias Viviane M, Pandini Juliana A, Nunes Raquel R, Sperandei Sandro LM, Portella Emilson S, Cobas Roberta A, and Gomes Marília de B
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Nutritional diseases. Deficiency diseases ,RC620-627 - Abstract
Abstract Background The importance of achieving and maintaining an appropriate metabolic control in patients with type 1 diabetes mellitus (DM1) has been established in many studies aiming to prevent the development of chronic complications. The carbohydrate counting method can be recommended as an additional tool in the nutritional treatment of diabetes, allowing patients with DM1 to have more flexible food choices. This study aimed to evaluate the influence of nutrition intervention and the use of multiple short-acting insulin according to the carbohydrate counting method on clinical and metabolic control in patients with DM1. Methods Our sample consisted of 51 patients with DM1, 32 females, aged 25.3 ± 1.55 years. A protocol of nutritional status evaluation was applied and laboratory analysis was performed at baseline and after a three-month intervention. After the analysis of the food records, a balanced diet was prescribed using the carbohydrate counting method, and short-acting insulin was prescribed based on the total amount of carbohydrate per meal (1 unit per 15 g of carbohydrate). Results A significant decrease in A1c levels was observed from baseline to the three-month evaluation after the intervention (10.40 ± 0.33% and 9.52 ± 0.32%, respectively, p = 0.000). It was observed an increase in daily insulin dose after the intervention (0.99 ± 0.65 IU/Kg and 1.05 ± 0.05 IU/Kg, respectively, p = 0.003). No significant differences were found regarding anthropometric evaluation (BMI, waist, hip or abdominal circumferences and waist to hip ratio) after the intervention period. Conclusions The use of short-acting insulin based on the carbohydrate counting method after a short period of time resulted in a significant improvement of the glycemic control in patients with DM1 with no changes in body weight despite increases in the total daily insulin doses.
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- 2010
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28. Correction: Assessment of efficacy and tolerability of once-daily extended release metformin in patients with type 2 diabetes mellitus
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Levy Juliana, Cobas Roberta A, and Gomes Marília B
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Nutritional diseases. Deficiency diseases ,RC620-627 - Published
- 2010
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29. Assessment of efficacy and tolerability of once-daily extended release metformin in patients with type 2 diabetes mellitus
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Levy Juliana, Cobas Roberta A, and Gomes Marília B
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Nutritional diseases. Deficiency diseases ,RC620-627 - Abstract
Abstract Aims To determine prospectively the efficacy, tolerability and patient satisfaction of an extended release formulation of metformin (metformin XR) in hospital based outpatients with type 2 diabetes mellitus currently treated with standard metformin. Methods Patients on immediate release standard metformin either alone or combined with other oral agents were switched to extended release metformin XR 500 mg tablets and titrated to a maximum dose of 2000 mg/day Measurements to include glucose and lipid control, blood pressure, body weight, waist circumference, C-reactive protein, adverse events and patient satisfaction were recorded at baseline, three and six months. Results Complete data were obtained for 35 of the 61 patients enrolled to the study. At three and six months no changes were reported for any of the cardiovascular risk factors except for lipids where there was a modest rise in plasma triglycerides. These effects were achieved with a reduced dose of metformin XR compared to pre-study dosing with standard metformin (1500 mg +/- 402 vs 1861 +/- 711 p = 0.004). A total of 77% of patients were free of gastrointestinal side effects and 83% of patients stated a preference for metformin XR at the end of the study. Ghost tablets were reported in the faeces by the majority of the patients (54.1%). Conclusions Patients switched to extended release metformin XR derived the same clinical and metabolic benefits as for standard metformin but with reduced dosage, fewer gastrointestinal side effects and a greater sense of well being and satisfaction on medication.
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- 2010
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30. Allergic reaction related to ramipril use: a case report
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Alencar Renata C, Cobas Roberta A, and Gomes Marília B
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Nutritional diseases. Deficiency diseases ,RC620-627 - Abstract
Abstract Background Angiotensin-converting enzyme (ACE) inhibitors are widely prescribed for patients with diabetes as a nephroprotector drug or to treat hypertension. Generally they are safe for clinical practice, but the relationship between these drugs and angioedema is known. The exact mechanism for ACE inhibitors-induced angioedema is not clear and it is still a matter of discussion. Case Report We reported a case of a 23-year-old black female with an 11 year history of type 1 diabetes, regularly monitored in the department of diabetes, in use of 0,98 UI/kg/day of human insulin, which presented an allergic reaction 24 h after ramipril use. The drug had been prescribed to treat diabetic nephropathy. There was no previous history of drug induced or alimentary allergy. The patient was instructed to discontinue the use of ramipril and oral antihistaminic drug and topical corticosteroid were prescribed. Skin biopsies were performed and confirmed the clinical hypothesis of pharmacodermy. The evaluation of ACE polymorphism identified DD genotype. Six months after the withdrawal of ramipril the patient was prescribed the angiotensin-II receptor blocker (ARB) losartan as nephroprotector. She remained well without adverse reactions. Conclusions ACE inhibitors-induced angioedema is uncommon and the clinical presentation is variable with lips, tongue, oropharinge, and larynge as the most common locations. The presence of angioedema during treatment requires the immediate cessation of treatment due to the risk of possible severe complications. The case reported presented moderate symptoms, with the development of early onset edema in uncommon regions. ACE DD genotype had been associated with angioedema-ACE inhibitors induced. In patients who have experienced ACE inhibitor-related angioedema, ARB should be used cautiously used. However in the case of our patient, the prescription of losartan as nefroprotector did not result in any recurrent adverse effect.
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- 2010
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31. Assessment of cognitive status in patients with type 2 diabetes through the mini-mental status examination: a cross-sectional study
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Alencar Renata C, Cobas Roberta A, and Gomes Marília B
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Nutritional diseases. Deficiency diseases ,RC620-627 - Abstract
Abstract Background Diabetes is considered an independent risk factor for cognitive impairment and some studies observed through neuropsychological tests that cognitive disfunction affects both elderly and younger patients with diabetes. The aims of this study were to evaluate the cognitive status of outpatients with type 2 diabetes and to evaluate factors associated with impaired function. Methods A cross-sectional study was conducted in a group of type 2 diabetic outpatients. They were asked to undergo the Mini-Mental State Examination (MMSE) during routine ambulatory visits between April 2006 and January 2007, with the highest pontuation of the test being 30 points. Patients were classified as having possible dementia according to years of study. Exclusion criteria were blindness, illiterately, stroke, Alzheimer disease and psychiatric disorder. Results are presented as median (interquartile range) or mean ± SD. Results The study group was composed of 346 type 2 diabetic outpatients (216 females), aged 58,6 ± 12,1 years and with duration of diabetes of 12,3 ± 9,1 years. Hypertension was present in 77,2%. The total MMSE score achieved was 26 points (16 - 30) and was correlated with years of study (R2 = 0,39, p < 0,001) and 'per capita' income (R2 = 0,22, p < 0,0001) and duration of diabetes (R2 = - 0,13, p = 0,01). Patients who needed help to take their medications obtained worst performance in the MMSE (23,16 ± 3,55 vs 25,7 ± 2,84, p < 0,01) and were more likely to present possible dementia (p < 0,01). Forty two subjects (12.1%) had diagnosis of possible dementia and this was also associated with years of study (p = 0,045). No association was observed between possible dementia and total MMSE scores with A1C levels. Conclusions We conclude that patients with type 2 diabetes should be regularly evaluated for their cognitive function, because duration of disease could be associated with decline in cognition. The early implementation of mini mental which is a simple method of execution can be done to detect early stages of dementia. This test could be an important tool to access the ability of patient to understand their disease and treatment.
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- 2010
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32. Increased functional and structural skin capillary density in type 1 diabetes patients with vascular complications
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Tibiriçá Eduardo, Rodrigues Elba, Cobas Roberta, and Gomes Marilia B
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Nutritional diseases. Deficiency diseases ,RC620-627 - Abstract
Abstract The present study was designed to study skin capillary density and recruitment of the upper and lower extremities in patients with type 1 diabetes with vascular complications, when compared to patients without complications and healthy subjects. We used intravital video-microscopy to measure basal and maximal (during venous congestion) skin capillary densities as well as capillary recruitment using post-occlusive reactive hyperemia (PORH) in the dorsum of the fingers and toes. Our results showed that besides microvascular vasodilation and loss of autoregulatory capacity, patients with type 1 diabetes with vascular complications present increased skin capillary density in both extremities.
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- 2009
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33. Post-transplant diabetes mellitus
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Gomes Marília B and Cobas Roberta A
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Nutritional diseases. Deficiency diseases ,RC620-627 - Abstract
Abstract In recent decades, Diabetes Mellitus has become a severe and growing global public healthcare problem due to the increase of its prevalence, morbidity and mortality. Post-transplant diabetes mellitus (PTDM) is a complication which takes place after a solid organ transplant, and its incidence is widely variable, ranging from 2 to 53%. Some factors increase the risk of PTDM, such as age, ethnicity, cadaver-donor kidney presence of the hepatitis C virus and cytomegalovirus, overweight and obesity and the Immunosuppression scheme established in the immediate post-transplant period. High doses of tacrolimus and corticosteroid represent the highest risk for developing PTDM. Considering that the development of PTDM is associated with a higher risk of complications, such as infections and cardiovascular disease - thus representing a higher life threatening risk and a higher cost for the Health System - the relevance of identifying the risk factors and of the early diagnosis combined with appropriate therapy will be high for the follow up, and eventually resulting in the success of the procedure as far as patient survival and transplantation durability.
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- 2009
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34. MOESM1 of Double-diabetes in a real-world sample of 2711 individuals: associated with insulin treatment or part of the heterogeneity of type 1 diabetes?
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Giuffrida, Fernando, BulcĂŁo, Caroline, Cobas, Roberta, Negrato, Carlos, Marilia Gomes, and Dib, Sergio
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nutritional and metabolic diseases ,lipids (amino acids, peptides, and proteins) - Abstract
Additional file 1: Table S1. Estimated marginal means and 95 % CIs of insulin dose, number of insulin applications, A1C, HDL-cholesterol, non-HDL-cholesterol, and mean blood pressure, in normal, overweight, and obese individuals according to gender and diabetes duration (numeric data corresponding to Figs. 3 and 4).
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- 2016
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35. Particularidades no manejo do diabetes em crianças e idosos
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Matheus, Alessandra S. M., primary and Cobas, Roberta A., additional
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- 2015
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36. The cost of type 1 diabetes: a nationwide multicentre study in Brazil
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Cobas, Roberta Arnoldi, Ferraz, Marcos Bosi [UNIFESP], Matheus, Alessandra Saldanha de Mattos, Tannus, Lucianne Righeti Monteiro, Negrato, Carlos Antonio, Araujo, Luiz Antonio de, Dib, Sergio Atala [UNIFESP], Gomes, Manila Brito, Brazilian Type 1 Diabet Study Group, State Univ Hosp Rio de Janeiro, Universidade Federal de São Paulo (UNIFESP), Bauru Diabet Assoc, and Joinville Endocrinol & Diabet Inst
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Adult ,Male ,medicine.medical_specialty ,Pediatrics ,Adolescent ,Total cost ,Young Adult ,Diabetes mellitus ,Health care ,Confidence Intervals ,medicine ,Per capita ,Humans ,Child ,health care economics and organizations ,Retrospective Studies ,Type 1 diabetes ,business.industry ,Research ,Public Health, Environmental and Occupational Health ,Infant ,Health technology ,Mean age ,medicine.disease ,Cross-Sectional Studies ,Diabetes Mellitus, Type 1 ,Child, Preschool ,Emergency medicine ,Female ,Health Expenditures ,business ,Medical costs ,Brazil - Abstract
To determine the direct medical costs of type 1 diabetes mellitus (T1DM) to the National Brazilian Health-Care System (NBHCS) and quantify the contribution of each individual component to the total cost.A retrospective, cross-sectional, nationwide multicentre study was conducted between 2008 and 2010 in 28 public clinics in 20 Brazilian cities. The study included 3180 patients with T1DM (mean age 22 years ± 11.8) who were surveyed while receiving health care from the NBHCS. The mean duration of their diabetes was 10.3 years (± 8.0). The costs of tests and medical procedures, insulin pumps, and supplies for administration, and supplies for self-monitoring of blood glucose (SMBG) were obtained from national and local health system sources for 2010-2011. Annual direct medical costs were derived by adding the costs of medications, supplies, tests, medical consultations, procedures and hospitalizations over the year preceding the interview.The average annual direct medical cost per capita was 1319.15 United States dollars (US$). Treatment-related expenditure - US$ 1216.33 per patient per year - represented 92.20% of total direct medical costs. Insulin administration supplies and SMBG (US$ 696.78 per patient per year) accounted for 52.82% of these total costs. Together, medical procedures and haemodialysis accounted for 5.73% (US$ 75.64 per patient per year) of direct medical costs. Consultations accounted for 1.94% of direct medical costs (US$ 25.62 per patient per year).Health technologies accounted for most direct medical costs of T1DM. These data can serve to reassess the distribution of resources for managing T1DM in Brazil's public health-care system.Déterminer les coûts médicaux directs du diabète gras de type 1 (DT1) pour le système de santé national brésilien (SSNB) et quantifier la contribution de chaque composante individuelle au coût total.Une étude rétrospective, transversale, multicentrique et à l’échelle nationale a été menée entre 2008 et 2010 dans 28 cliniques publiques de 20 villes brésiliennes. Cette étude incluait 3180 patients atteints de DT1 (moyenne d’âge de 22 ans ± 11,8) qui ont été interrogés alors qu’ils étaient pris en charge par le SSNB. En moyenne, ils étaient atteints par la maladie depuis 10,3 ans (± 8). Les coûts des tests et des interventions médicales, des pompes à insuline et des équipements pour son administration, ainsi que des fournitures pour l’autosurveillance du taux de glycémie (ASTG) ont été obtenus à partir de sources provenant du système de santé national et local sur 2010–2011. Les coûts médicaux directs annuels ont été calculés en ajoutant les coûts des médicaments, des fournitures, des consultations médicales, des interventions et des hospitalisations au cours de l’année précédant l’enquête.La moyenne du coût médical direct annuel par habitant s'élevait à 1319,15 dollars. Les dépenses liées au traitement – 1216,33 dollars par patient et par an –ont représenté 92,20% du total des coûts médicaux directs. L’équipement nécessaire à l’administration d’insuline et à l’ASTG (696,78 dollars par patient et par an) a totalisé 52,82% du total de ces coûts. Dans l’ensemble, les interventions médicales et l’hémodialyse ont représenté 5,73% (75,64 dollars par patient et par an) des coûts médicaux directs, et les consultations ont représenté 1,94% de ces mêmes coûts (25,62 dollars par patient et par an).Les technologies de la santé ont constitué la majeure partie des coûts médicaux directs du DT1. Ces données peuvent être utilisées pour réévaluer la distribution des ressources pour la prise en charge du DT1 par le système de santé publique brésilien.Determinar los costes médicos directos de la diabetes mellitus de tipo 1 (DMT1) para el sistema nacional brasileño de atención sanitaria (NBHCS, según sus siglas en inglés) y cuantificar la contribución de cada componente individual al coste total.Se llevó a cabo un estudio multicéntrico retrospectivo transversal a nivel nacional entre los años 2008 y 2010 en 28 clínicas públicas de 20 ciudades brasileñas. El estudio incluyó 3180 pacientes con DMT1 (edad media de 22 años ± 11,8), que fueron entrevistados mientras recibían atención sanitaria del NBHCS. La duración media de su diabetes fue de 10,3 años (± 8,0). Los costes de las pruebas y procedimientos médicos, las bombas de insulina y provisiones para la administración, así como suministros para la automonitorización de la glucosa en sangre (AMG) se obtuvieron de las fuentes de los sistemas de salud nacionales y locales para el periodo 2010-2011. Los costes médicos directos anuales se obtuvieron sumando los costes de los medicamentos, suministros, pruebas, consultas y procedimientos médicos y hospitalizaciones durante el año anterior a la entrevista.El coste medio directo anual por cápita fue de 1319,15 dólares americanos (US$). Los gastos relacionados con el tratamiento, US$ 1216,33 por paciente y año, representaron el 92,20% del total de los costes médicos directos. Los suministros para la administración de insulina y la AMG (US$ 696,78 por paciente y año) significaron el 52,82% de esos costes totales. En conjunto, los procedimientos médicos y la hemodiálisis representaron el 5,73% (US$ 75,64 por paciente y año) de los costes médicos directos. Las consultas fueron el 1,94% de los costes médicos directos (US$ 25,62 por paciente y año).Las tecnologías sanitarias representaron la mayoría de los costes médicos directos de la DMT1. Estos datos pueden servir para volver a examinar la distribución de los recursos para la gestión de la diabetes de tipo 1 en el sistema de salud pública de Brasil.تحديد التكاليف الطبية المباشرة لداء السكري من النمط الأول (T1DM) للنظام الوطني للرعاية الصحية في البرازيل (NBHCS) وتحديد نوعية إسهام كل مكون في التكلفة الإجمالية على نحو فردي.تم إجراء دراسة استرجاعية متعددة القطاعات على الصعيد الوطني في الفترة من 2008 إلى 2010 في 28 عيادة عمومية في 20 مدينة برازيلية. واشتملت الدراسة على 3180 مريضاً بداء السكري من النمط الأول (متوسط العمر 22 سنة ± 11.8) حيث تم إخضاعهم للدارسة الاستقصائية عند تلقيهم الرعاية الصحية من النظام الوطني للرعاية الصحية في البرازيل. وكان متوسط مدة داء السكري لديهم 10.3 سنة (± 8.0). وتم الحصول على تكاليف الاختبارات والإجراءات الطبية ومضخات الأنسولين وإمدادات تناول الدواء والإمدادات والمحاقن والإبر من أجل الرصد الذاتي لمستوى الغلوكوز في الدم (SMBG) من مصادر نظام الصحة الوطني والمحلي للفترة من 2010 إلى 2011. وتم استخلاص التكاليف الطبية السنوية المباشرة بإضافة تكاليف الأدوية والإمدادات والاختبارات والاستشارات الطبية والإجراءات ومرات الدخول إلى المستشفيات على مدار العام السابق للمقابلة.بلغ متوسط التكلفة الطبية السنوية المباشرة للفرد 1319.15 دولاراً أمريكياً. ومثل الإنفاق المتصل بالعلاج – 1216.33 دولاراً أمريكياً للمريض سنوياً – 92.20 % من إجمالي التكاليف الطبية المباشرة. وتعزى نسبة 52.82 % من إجمالي هذه التكاليف إلى إمدادات إدارة تناول الأنسولين والرصد الذاتي لمستوى الغلوكوز في الدم (696.78 دولاراً أمريكياً للمريض سنوياً). وتعزى نسبة 5.73 % من التكاليف الطبية المباشرة (75.64 دولاراً أمريكياً للمريض سنوياً) إلى الإجراءات الطبية وغسل الدم معاً. وتعزى نسبة 1.94 % من التكاليف الطبية المباشرة (25.62 دولاراً أمريكياً للمريض سنوياً) إلى الاستشارات.تعزى التكاليف الطبية الأكثر مباشرة لداء السكري من النمط الأول إلى التكنولوجيات الصحية. ومن الممكن أن تساعد هذه البيانات في إعادة تقييم توزيع الموارد للسيطرة على السكري من النمط الأول في نظام الرعاية الصحية العمومية في البرازيل.确定巴西国家医疗保健系统(NBHCS)1 型糖尿病(T1DM)的直接医疗成本并量化每个组成部分对总成本的贡献。2008 至2010 年间,在巴西20 个城市中的28 个公立诊所执行全国范围内多中心的回顾式横断面研究。研究纳入3180 名1 型糖尿病(平均年龄22 ± 11.8 岁)患者,他们在接受NBHCS的医疗保健过程中接受调查。糖尿病患者的平均患病期为10.3 年(± 8.0)。从国家和地方卫生系统来源收集2010-2011 年的检测和医疗流程、胰岛素泵和用药、以及自我血糖检测(SMBG)的耗材、注射器和针头的成本。通过增加调查前一年的药物、耗材、检测、诊疗、流程和住院的成本,推导年度直接医疗费用。人均平均年度直接医疗成本是1319.15 美元。治疗相关费用(每年每个病人1216.33 美元)占总直接医疗成本的92.20%。胰岛素用药和SMBG(每年每个病人696.78 美元)占总成本的52.82%。医疗流程和血液透析合计占直接医疗成本的5.73%(每年每个病人75.64 美元)。诊疗占直接医疗成本的1.94%(每年每个病人25.62 美元)。卫生技术占绝大多数的T1DM直接医疗成本。这些数据可用于对资源分配作出重新评估,进行巴西公共卫生保健系统的1 型糖尿病管理。Определить уровень прямых медицинских расходов, связанных с сахарным диабетом 1-го типа (T1DM), в Национальной системе здравоохранения Бразилии (NBHCS) и количественно определить долю каждого отдельного компонента в общей сумме расходов.В 2008-2010 гг. было проведено ретроспективное, перекрестное, национальное многоцентровое исследование в 28 государственных клиниках в 20 городах Бразилии. В исследовании участвовало 3180 пациентов с T1DM (средний возраст: 22 года ± 11,8), опрошенных во время прохождения лечения в Национальной системе здравоохранения Бразилии. Средняя продолжительность заболевания диабетом у этих пациентов составляла 10,3 лет (± 8,0). Данные по стоимости тестов и медицинских процедур, дозаторов инсулина и расходных материалов, а также материалов, шприцев и игл для самостоятельного контроля уровня глюкозы в крови (SMBG) были получены из национальных и местных источников системы здравоохранения в течение 2010-2011 гг. Ежегодные прямые медицинские расходы рассчитывались методом сложения стоимости медикаментов, расходных материалов, тестов, медицинских консультаций, процедур и госпитализации за год, предшествующий опросу.Среднегодовые прямые медицинские расходы на душу населения составили 1319,15 долларов США. Затраты на лечение – 1216,33 долларов США на пациента в год – составили 92,20% от общих прямых медицинских расходов. На самостоятельный контроль уровня глюкозы в крови и расходные материалы для ввода инсулина (696,78 долларов США на пациента в год) приходилось 52,82% от этой общей суммы расходов. Медицинские процедуры и гемодиализ в совокупности составили 5,73% (75,64 долларов США на пациента в год) от прямых медицинских расходов. На консультации приходилось 1,94% прямых медицинских расходов (25,62 долларов США на пациента в год).Основная доля прямых медицинских расходов на лечение T1DM приходилась на медицинские технологии. Эти данные могут способствовать пересмотру распределения ресурсов для лечения T1DM в государственной системе здравоохранения Бразилии.
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- 2013
37. Impact of Diabetes on Cardiovascular Disease: An Update
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Matheus, Alessandra Saldanha de Mattos, Tannus, Lucianne Righeti Monteiro, Cobas, Roberta Arnoldi, Palma, Catia C. Sousa, Negrato, Carlos Antonio, and Gomes, Marilia de Brito
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Article Subject - Abstract
Cardiovascular diseases are the most prevalent cause of morbidity and mortality among patients with type 1 or type 2 diabetes. The proposed mechanisms that can link accelerated atherosclerosis and increased cardiovascular risk in this population are poorly understood. It has been suggested that an association between hyperglycemia and intracellular metabolic changes can result in oxidative stress, low-grade inflammation, and endothelial dysfunction. Recently, epigenetic factors by different types of reactions are known to be responsible for the interaction between genes and environment and for this reason can also account for the association between diabetes and cardiovascular disease. The impact of clinical factors that may coexist with diabetes such as obesity, dyslipidemia, and hypertension are also discussed. Furthermore, evidence that justify screening for subclinical atherosclerosis in asymptomatic patients is controversial and is also matter of this review. The purpose of this paper is to describe the association between poor glycemic control, oxidative stress, markers of insulin resistance, and of low-grade inflammation that have been suggested as putative factors linking diabetes and cardiovascular disease.
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- 2013
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38. Influência do índice glicêmico da dieta sobre parâmetros antropométricos e bioquímicos em pacientes com diabetes tipo 1
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Dias, Viviane Monteiro, Pandini, Juliana Almeida, Nunes, Raquel Ramalho, Sperandei, Sandro Leonardo Martins, Portella, Emilson Souza, Cobas, Roberta Arnoldi, and Gomes, Marília de Brito
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Diabéticos tipo 1 ,Type 1 diabetics ,glycemic control ,glycemic index ,índice glicêmico ,controle glicêmico ,hemoglobina glicada ,glycated hemoglobin - Abstract
OBJETIVO: Avaliar a influência de uma intervenção não farmacológica, constituída de uma dieta de baixo índice glicêmico (IG) por um período de seis meses, no controle metabólico e nos indicadores antropométricos de pacientes com diabetes melito tipo 1 (DM1). SUJEITOS E MÉTODOS: Noventa e seis pacientes com DM1 foram submetidos à avaliação antropométrica, bioquímica e dietética antes e 6 meses após a prescrição de uma dieta baseada no índice glicêmico. RESULTADOS: Observamos diminuição significativa da A1c (9,8 ± 2,26% vs. 9,1 ± 2,16%; p = 0,023) e aumento de peso (61,3 ± 11,68 kg vs. 62,8 ± 12,07 kg; p = 0,04) após o período de intervenção. CONCLUSÃO: A dieta de baixo índice glicêmico foi capaz de melhorar o controle glicêmico em pacientes com DM1. Estudos com maior tempo de seguimento serão necessários para estabelecermos se a aderência dos pacientes a esse tipo de dieta influencia na manutenção do controle glicêmico. OBJECTIVE: To assess the influence of a non-pharmacological intervention, consisting of a diet low glycemic index (GI) for a period of six months on metabolic control and anthropometric parameters in patients with type 1 diabetes mellitus. SUBJECTS AND METHODS: Ninety-six type 1 diabetic patients underwent an anthropometric, biochemical and dietary assessment before and six months after the prescription of diet based on the glycemic index. RESULTS: After six months we observed a decrease in A1C levels (9,8 ± 2,26% vs. 9,1 ± 2.16%; p = 0,023) and increase in body weight (61,3 ± 11,68 kg vs. 62,8 ± 12,07 kg; p = 0,04). CONCLUSION: A low GI diet improved glycemic control in patients with DM1. Further studies with longer time of follow-up are needed to assess if patients' adherence to this kind of diet influences the maintenance of glycemic control.
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- 2010
39. Confiabilidade da classificação do estado nutricional obtida através do IMC e três diferentes métodos de percentual de gordura corporal em pacientes com diabetes melito tipo 1
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Nunes, Raquel Ramalho, Clemente, Eliete Leão da Silva, Pandini, Juliana Almeida, Cobas, Roberta Arnoldi, Dias, Viviane Monteiro, Sperandei, Sandro, and Gomes, Marília de Brito
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body composition ,percentual de gordura corporal ,composição corporal ,Diabetes melito tipo 1 ,índice de massa corporal ,Type 1 diabetes mellitus ,body mass index ,body fat percentage - Abstract
OBJETIVO: Avaliar a confiabilidade da classificação do estado nutricional (EN) obtida através do índice de massa corporal (IMC) e três diferentes métodos de composição corporal (CC) em indivíduos diabéticos tipo 1 (DM1) e não diabéticos. MÉTODOS: Foram avaliados 84 pacientes com DM1 e 37 controles. Coletaram-se os dados antropométricos para calcular o IMC e a avaliação da CC foi obtida por meio dos métodos de dobras cutâneas (DC), bioimpedância elétrica bipolar (BI) e tetrapolar (TT). A adequação entre as classificações de cada método foi determinada pelo coeficiente Kappa (K). RESULTADOS: Dentre os 84 pacientes, apenas 48 (57,1%) apresentaram classificação do IMC concordante com o método de DC, 58 (69%) com o de BI e 45 (53,5%) com o de TT. Os resultados do K para os indivíduos com DM1 foi de DC = 0,261, BI = 0,320 e TT = 0,174. Os controles apresentaram valores maiores (DC = 0,605, BI = 0,360 e TT = 0,400). Porém, todos os valores foram considerados baixos. CONCLUSÕES: O método de IMC mostrou-se pouco sensível às variações na CC dos indivíduos com DM1. Métodos próprios para a avaliação da CC devem ser utilizados na classificação do EN dessa população. OBJECTIVE: To assess the reliability of classification of nutritional status (NS) obtained through the body mass index (BMI) and three different methods of body composition (BC) in individuals type 1 diabetics (T1D) and non-diabetic subjects. METHODS: 84 patients with T1D and 37 controls were evaluated. Anthropometric data was collected to calculate BMI and assessment of BC was performed through the methods of skinfold thickness (SF), bipolar (BI) and tetrapolar (TT) bioelectrical impedance. The agreement between the scores of each method was determined by Kappa (K) coefficient. RESULTS: Considering all the patients, only 48 (57.1%) presented classification of BMI that agreed with the SF method, 58 (69%) with the BI and 45 (53.5%) with the TT. The K results for individuals with T1D was DC = 0.261, BI = 0.320 and TT = 0.174. The controls had higher values (DC = 0.605, BI = 0.360 and TT = 0.400). However, all values were considered low. CONCLUSIONS: The method of BMI showed little sensitivity to BC changes in patients with T1D. Appropriated methods for the assessment of BC should be used to classify the NS of this population.
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- 2009
40. Evolução para hipertensão arterial em pacientes com diabetes tipo 1
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Cobas, Roberta, Santos, Bráulio, Braga, Luiza, Cunha, Edna Ferreira, and Gomes, Marilia de Brito
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Prehypertension ,Type 1 diabetes ,Pré-hipertensão ,Hypertension ,Prevalence ,Prevalência ,Hipertensão arterial ,Função renal ,Diabetes tipo 1 ,Renal function - Abstract
OBJETIVO: Determinar a evolução para hipertensão arterial (HA) e pré-hipertensão em pacientes diabéticos tipo 1 e os fatores preditores dos níveis pressóricos finais. MÉTODOS: Estudo observacional contendo 127 diabéticos tipo 1 avaliados clínica e laboratorialmente e seguidos por 5 (2,4-9,2) anos. RESULTADOS: Dos pacientes inicialmente normotensos, 21,7% desenvolve-ram pré-hipertensão, 4,7% HA e 73,6% permaneceram normotensos. Dos pré-hipertensos, 35% normalizaram níveis pressóricos, 50% permanece-ram pré-hipertensos e 15% desenvolveram HA. O risco relativo de desenvolver HA foi de 3,2 (0,8-12,3) no grupo pré-hipertenso comparado ao grupo normotenso. As prevalências de pré-hipertensão e hipertensão aumentaram de 15,7% para 26% e de 0,8% para 7%, respectivamente, durante o seguimento. Níveis iniciais de creatinina sérica foram preditores dos níveis finais de pressão arterial diastólica e sistólica. CONCLUSÃO: Destaca-se a necessidade de estabelecer vigilância quanto aos níveis pressóricos e de creatinina sérica, mesmo quando estes ainda se encontram dentro da faixa de normalidade no intuito de minimizar os efeitos deletérios da HA no desenvolvimento de nefropatia e doenças cardiovasculares. PURPOSE: Check the evolution of type 1(T1) diabetic patients to hypertension and prehypertension and baseline factors related to final blood pressure levels (BP). METHODS: Observational study involving 127 T1 diabetic patients submitted to clinical and laboratorial evaluation and followed by for 5 (2.4-9.2) years. RESULTS: From the initially normotensive patients, 21.7% developed prehypertension, 4.7% developed hypertension and 73.6% remained with normal BP. From the prehypertensive patients, 35% returned to normal BP, 50% remained prehypertensive and 15% developed hypertension. The relative risk for hypertension development was 3.2 (0.8-12.3) in the prehypertensive compared to the normotensive group. The prevalence of prehypertension and hypertension increased from 15.7% to 26% and 0.8% to 7% respectively. Levels of serum creatinine predicted final levels of systolic and diastolic BP. CONCLUSION: It is emphasized the importance of renal function and BP evaluation even when they are in normal range to minimize the deleterious effects of hypertension in the development of nephropathy and cardiovascular disease.
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- 2008
41. Gestação e obesidade: um problema emergente
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Carneiro, João Regis I., primary, Braga, Fernanda O., additional, Cabizuca, Carolina A., additional, Abi-Abib, Raquel C., additional, Cobas, Roberta A., additional, and Gomes, Marília B., additional
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- 2014
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42. Diabetes na gestação
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Abi-Abib, Raquel C., primary, Cabizuca, Carolina A., additional, Carneiro, João Regis I., additional, Braga, Fernanda O., additional, Cobas, Roberta A., additional, Gomes, Marília B., additional, De Jesus, Guilherme R., additional, and Miranda, Fátima R. D., additional
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- 2014
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43. Relationship between adherence to diet, glycemic control and cardiovascular risk factors in patients with type 1 diabetes: a nationwide survey in Brazil
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Davison, Kariane A K, primary, Negrato, Carlos A, additional, Cobas, Roberta, additional, Matheus, Alessandra, additional, Tannus, Lucianne, additional, Palma, Catia S, additional, Japiassu, Leticia, additional, Carneiro, Joao R I, additional, Rodacki, Melanie, additional, Zajdenverg, Lenita, additional, Araújo, Neuza B C, additional, Cordeiro, Marilena M, additional, Luescher, Jorge Luiz, additional, Berardo, Renata S, additional, Nery, Marcia, additional, Cani, Catarina, additional, do Carmo A Marques, Maria, additional, Calliari, Luiz Eduardo, additional, Noronha, Renata M, additional, Manna, Thais D, additional, Savoldelli, Roberta, additional, Penha, Fernanda G, additional, Foss, Milton C, additional, Foss-Freitas, Maria Cristina, additional, de Fatima Guedes, Maria, additional, Dib, Sergio A, additional, Dualib, Patricia, additional, Silva, Saulo C, additional, Sepúlveda, Janice, additional, Sampaio, Emerson, additional, Rea, Rosangela R, additional, Faria, Ana Cristina R A, additional, Tschiedel, Balduino, additional, Lavigne, Suzana, additional, Cardozo, Gustavo A, additional, Pires, Antonio C, additional, Robles, Fernando C, additional, Azevedo, Mirela, additional, Canani, Luis Henrique, additional, Zucatti, Alessandra T, additional, Coral, Marisa H C, additional, Pereira, Daniela A, additional, Araujo, Luiz Antonio, additional, Pedrosa, Hermelinda C, additional, Tolentino, Monica, additional, Prado, Flaviene A, additional, Rassi, Nelson, additional, Araujo, Leticia B, additional, Fonseca, Reine M C, additional, Guedes, Alexis D, additional, Mattos, Odelisa S, additional, Faria, Manuel, additional, Azulay, Rossana, additional, Forti, Adriana C, additional, Façanha, Cristina F S, additional, Montenegro Jr, Renan, additional, Montenegro, Ana Paula, additional, Melo, Naira H, additional, Rezende, Karla F, additional, Ramos, Alberto, additional, Felicio, João S, additional, Santos, Flavia M, additional, Jezini, Deborah L, additional, and Gomes, Marilia B, additional
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- 2014
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44. Heterogeneity in the costs of type 1 diabetes in a developing country: what are the determining factors?
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Cobas, Roberta Arnoldi, primary, Bosi Ferraz, Marcos, additional, Matheus, Alessandra Saldanha de Mattos, additional, Tannus, Lucianne Righeti Monteiro, additional, Silva, Aline Tiemi Kano, additional, de Araujo, Luiz Antonio, additional, Negrato, Carlos Antonio, additional, Dib, Sérgio Atala, additional, and Brito Gomes, Marilia, additional
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- 2013
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45. Prevalence, Awareness, and Treatment of Hypertension in Patients with Type 1 Diabetes: A Nationwide Multicenter Study in Brazil
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Gomes, Marilia B., primary, Tannus, Lucianne Righeti Monteiro, additional, Matheus, Alessandra Saldanha de Mattos, additional, Cobas, Roberta Arnoldi, additional, Palma, Catia C. Sousa, additional, Silva, Aline Tiemi Kano, additional, Negrato, Carlos Antonio, additional, Dib, Sergio Atala, additional, Rodacki, Melanie, additional, Felício, João Soares, additional, and Canani, Luis Henrique, additional
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- 2013
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46. Double-diabetes in a real-world sample of 2711 individuals: associated with insulin treatment or part of the heterogeneity of type 1 diabetes?
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Giuffrida, Fernando M. A., Bulcão, Caroline, Cobas, Roberta A., Negrato, Carlos Antonio, Gomes, Marilia B., and Dib, Sergio Atala
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TREATMENT of diabetes ,TYPE 1 diabetes ,CARDIOVASCULAR diseases ,INSULIN therapy ,FOLLOW-up studies (Medicine) ,PATHOLOGICAL physiology - Abstract
Background: Double diabetes (DD) describes both individuals with obesity upon diagnosis of type 1 diabetes and those who have gained weight during follow-up, although cardiovascular risk factors (CVRF) are not well understood in this group. We aim to evaluate the frequency of DD in a real-world type 1 diabetes sample and the interaction of insulin treatment with CVRF. Methods: Multicentre cross-sectional study of 2711 individuals with clinical diagnosis of type 1 diabetes from secondary diabetes centres in 20 Brazilian cities. Results: Patients with diabetes duration <5 and =5 years had similar frequency of overweight (20.4 vs. 25%) and obesity, (9.8 vs. 6.1%), p 0.28 for trend. Insulin dose (U/kg/day) was lower in obese individuals compared to normal BMI, with mean (95% CI) 0.72 (0.62-0.83) vs. 0.88 (0.84-0.92) U/kg/day for diabetes duration <5 years and 0.84 (0.77-0.92) vs. 0.99 (0.97-1.01) U/kg/day for duration =5 years. Obese individuals had lower HDL (47.5 vs. 54.4 mg/dL) and higher non-HDL-cholesterol (134.5 vs. 115.2 mg/dL) than lean ones only among those with more than 5 years of diabetes. Conclusions: Lower insulin doses in obese individuals point to a role of clinical heterogeneity in insulin deficiency rather than normal progression of type 1 diabetes. Early obesity in type 1 diabetes is associated to lower HDL-cholesterol and higher number of CVRF. These data suggest a broad landscape of pathophysiological phenomena in double diabetes, rather than simple progression of a homogeneous clinical entity. [ABSTRACT FROM AUTHOR]
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- 2016
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47. Health-related quality of life in patients with type 1 diabetes mellitus in the different geographical regions of Brazil: data from the Brazilian Type 1 Diabetes Study Group.
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Soares Felício, João, Contente Braga de Souza, Ana Carolina, Cavalcante Koury, Camila, Abrahão Neto, João Felício, Barbosa Miléo, Karem, Marques Santos, Flávia, Bastos Motta, Ana Regina, Dias Silva, Denisson, Pontes Arbage, Thaís, Tavares Carvalho, Carolina, de de Rider Brito, Hana Andra, Sumi Yamada, Elizabeth, Cobas, Roberta Arnoldi, Matheus, Alessandra, Tannus, Lucianne, Sousa Palma, Catia Cristina, Japiassu, Leticia, Ivar Carneiro, João Regis, Rodacki, Melanie, and Zajdenverg, Lenita
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PEOPLE with diabetes ,QUALITY of life ,PUBLIC health ,TYPE 1 diabetes ,PREVENTION of diabetes complications ,PATIENTS - Abstract
Background: In type 1 diabetes mellitus (T1DM) management, enhancing health-related quality of life (HRQoL) is as important as good metabolic control and prevention of secondary complications. This study aims to evaluate possible regional differences in HRQoL, demographic features and clinical characteristics of patients with T1DM in Brazil, a country of continental proportions, as well as investigate which variables could influence the HRQoL of these individuals and contribute to these regional disparities. Methods: This was a retrospective, cross-sectional, multicenter study performed by the Brazilian Type 1 Diabetes Study Group (BrazDiab1SG), by analyzing EuroQol scores from 3005 participants with T1DM, in 28 public clinics, among all geographical regions of Brazil. Data on demography, economic status, chronic complications, glycemic control and lipid profile were also collected. Results: We have found that the North-Northeast region presents a higher index in the assessment of the overall health status (EQ-VAS) compared to the Southeast (74.6 ± 30 and 70.4 ± 19, respectively; p < 0.05). In addition, North-Northeast presented a lower frequency of self-reported anxiety-depression compared to all regions of the country (North-Northeast: 1.53 ± 0.6; Southeast: 1.65 ± 0.7; South: 1.72 ± 0.7; Midwest: 1.67 ± 0.7; p < 0.05). These findings could not be entirely explained by the HbA1c levels or the other variables examined. Conclusions: Our study points to the existence of additional factors not yet evaluated that could be determinant in the HRQoL of people with T1DM and contribute to these regional disparities. [ABSTRACT FROM AUTHOR]
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- 2015
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48. Prevalence of adults with type 1 diabetes who meet the goals of care in daily clinical practice: A nationwide multicenter study in Brazil
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Gomes, Marilia B., primary, Coral, Marisa, additional, Cobas, Roberta A., additional, Dib, Sergio Atala, additional, Canani, Luis Henrique, additional, Nery, Márcia, additional, de Freitas, Maria Cristina Foss, additional, Faria, Manuel, additional, Felício, João Soares, additional, da Silva, Saulo Cavalcanti, additional, Pedrosa, Hermelinda, additional, Costa e Forti, Adriana, additional, Rea, Rosangela Roginski, additional, Pires, Antonio Carlos, additional, Junior, Renan Montenegro, additional, Oliveira, José Egídio, additional, Rassi, Nelson, additional, and Negrato, Carlos Antonio, additional
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- 2012
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49. Economic status and clinical care in young type 1 diabetes patients: a nationwide multicenter study in Brazil
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Gomes, Marilia B., primary, de Mattos Matheus, Alessandra Saldanha, additional, Calliari, Luis Eduardo, additional, Luescher, Jorge Luiz, additional, Manna, Thais Della, additional, Savoldelli, Roberta Diaz, additional, Cobas, Roberta A., additional, Coelho, Wellington Siqueira, additional, Tschiedel, Balduino, additional, Ramos, Alberto José, additional, Fonseca, Reine Marie, additional, Araujo, Neuza Braga C., additional, Almeida, Henriqueta Guido, additional, Melo, Naira Horta, additional, Jezini, Debora Laredo, additional, and Negrato, Carlos Antonio, additional
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- 2012
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50. Influência do índice glicêmico da dieta sobre parâmetros antropométricos e bioquímicos em pacientes com diabetes tipo 1
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Dias, Viviane Monteiro, primary, Pandini, Juliana Almeida, additional, Nunes, Raquel Ramalho, additional, Sperandei, Sandro Leonardo Martins, additional, Portella, Emilson Souza, additional, Cobas, Roberta Arnoldi, additional, and Gomes, Marília de Brito, additional
- Published
- 2010
- Full Text
- View/download PDF
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