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[PMID]:29340678
[Au] Autor:Ikramuddin S; Korner J; Lee WJ; Thomas AJ; Connett JE; Bantle JP; Leslie DB; Wang Q; Inabnet WB; Jeffery RW; Chong K; Chuang LM; Jensen MD; Vella A; Ahmed L; Belani K; Billington CJ
[Ad] Endereço:Department of Surgery, University of Minnesota, Minneapolis.
[Ti] Título:Lifestyle Intervention and Medical Management With vs Without Roux-en-Y Gastric Bypass and Control of Hemoglobin A1c, LDL Cholesterol, and Systolic Blood Pressure at 5 Years in the Diabetes Surgery Study.
[So] Source:JAMA;319(3):266-278, 2018 01 16.
[Is] ISSN:1538-3598
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:Importance: The Roux-en-Y gastric bypass is effective in achieving established diabetes treatment targets, but durability is unknown. Objective: To compare durability of Roux-en-Y gastric bypass added to intensive lifestyle and medical management in achieving diabetes control targets. Design, Setting, and Participants: Observational follow-up of a randomized clinical trial at 4 sites in the United States and Taiwan, involving 120 participants who had a hemoglobin A1c (HbA1c) level of 8.0% or higher and a body mass index between 30.0 and 39.9 (enrolled between April 2008 and December 2011) were followed up for 5 years, ending in November 2016. Interventions: Lifestyle-intensive medical management intervention based on the Diabetes Prevention Program and LookAHEAD trials for 2 years, with and without (60 participants each) Roux-en-Y gastric bypass surgery followed by observation to year 5. Main Outcomes and Measures: The American Diabetes Association composite triple end point of hemoglobin A1c less than 7.0%, low-density lipoprotein cholesterol less than 100 mg/dL, and systolic blood pressure less than 130 mm Hg at 5 years. Results: Of 120 participants who were initially randomized (mean age, 49 years [SD, 8 years], 72 women [60%]), 98 (82%) completed 5 years of follow-up. Baseline characteristics were similar between groups: mean (SD) body mass index 34.4 (3.2) for the lifestyle-medical management group and 34.9 (3.0) for the gastric bypass group and had hemoglobin A1c levels of 9.6% (1.2) and 9.6% (1.0), respectively. At 5 years, 13 participants (23%) in the gastric bypass group and 2 (4%) in the lifestyle-intensive medical management group had achieved the composite triple end point (difference, 19%; 95% CI, 4%-34%; P = .01). In the fifth year, 31 patients (55%) in the gastric bypass group vs 8 (14%) in the lifestyle-medical management group achieved an HbA1c level of less than 7.0% (difference, 41%; 95% CI, 19%-63%; P = .002). Gastric bypass had more serious adverse events than did the lifestyle-medical management intervention, 66 events vs 38 events, most frequently gastrointestinal events and surgical complications such as strictures, small bowel obstructions, and leaks. Gastric bypass had more parathyroid hormone elevation but no difference in B12 deficiency. Conclusions and Relevance: In extended follow-up of obese adults with type 2 diabetes randomized to adding gastric bypass compared with lifestyle and intensive medical management alone, there remained a significantly better composite triple end point in the surgical group at 5 years. However, because the effect size diminished over 5 years, further follow-up is needed to understand the durability of the improvement. Trial Registration: clinicaltrials.gov Identifier: NCT00641251.
[Mh] Termos MeSH primário: Derivação Gástrica
Hemoglobina A Glicada/análise
[Mh] Termos MeSH secundário: LDL-Colesterol/sangue
Diabetes Mellitus Tipo 2/sangue
Feminino
Seres Humanos
Hipoglicemiantes
Estilo de Vida
Meia-Idade
Taiwan
Resultado do Tratamento
[Pt] Tipo de publicação:JOURNAL ARTICLE; RESEARCH SUPPORT, N.I.H., EXTRAMURAL; COMMENT
[Nm] Nome de substância:
0 (Cholesterol, LDL); 0 (Glycated Hemoglobin A); 0 (Hypoglycemic Agents)
[Em] Mês de entrada:1801
[Cu] Atualização por classe:180311
[Lr] Data última revisão:
180311
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:180118
[Cl] Clinical Trial:ClinicalTrial
[St] Status:MEDLINE
[do] DOI:10.1001/jama.2017.20813


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[PMID]:29214782
[Au] Autor:Lee YH; Shin MH; Nam HS; Park KS; Choi SW; Ryu SY; Kweon SS
[Ad] Endereço:Department of Preventive Medicine & Institute of Wonkwang Medical Science, Wonkwang University School of Medicine, Iksan, Korea.
[Ti] Título:Effect of Family History of Diabetes on Hemoglobin A1c Levels among Individuals with and without Diabetes: The Dong-gu Study.
[So] Source:Yonsei Med J;59(1):92-100, 2018 Jan.
[Is] ISSN:1976-2437
[Cp] País de publicação:Korea (South)
[La] Idioma:eng
[Ab] Resumo:PURPOSE: We investigated associations between family history of diabetes (FHD) and hemoglobin A1c (HbA1c) level, among people with and without diabetes. MATERIALS AND METHODS: In total, 7031 people without diabetes and 1918 people with diabetes who participated in the Dong-gu Study were included. Data on FHD in first-degree relatives (father, mother, and siblings) were obtained. Elevated HbA1c levels in people without diabetes and high HbA1c levels in people with diabetes were defined as the highest quintiles of HbA1c ≥5.9% and ≥7.9%, respectively. RESULTS: In people without diabetes, the odds of elevated HbA1c levels [odds ratio (OR) 1.34, 95% confidence interval (CI) 1.13-1.59] were significantly greater in people with any FHD than in those without. Specifically, the odds of elevated HbA1c levels in people without diabetes with an FHD involving siblings were greater than in those without an FHD involving siblings. Additionally, in people with diabetes, the odds of high HbA1c levels (OR 1.33, 95% CI 1.02-1.72) were greater in people with any FHD than in those without such history. Moreover, people with diabetes with maternal FHD had increased odds of high HbA1c levels. CONCLUSION: FHD was associated not only with high HbA1c levels in people with diabetes, but also with elevated HbA1c levels in people without diabetes.
[Mh] Termos MeSH primário: Diabetes Mellitus/sangue
Hemoglobina A Glicada/análise
[Mh] Termos MeSH secundário: Idoso
Glicemia/metabolismo
Diabetes Mellitus/epidemiologia
Família
Feminino
Seres Humanos
Modelos Logísticos
Masculino
Meia-Idade
Razão de Chances
Prevalência
Fatores de Risco
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Nm] Nome de substância:
0 (Blood Glucose); 0 (Glycated Hemoglobin A)
[Em] Mês de entrada:1803
[Cu] Atualização por classe:180309
[Lr] Data última revisão:
180309
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:171208
[St] Status:MEDLINE
[do] DOI:10.3349/ymj.2018.59.1.92


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[PMID]:28454703
[Au] Autor:Starikov RS; Inman K; Has P; Iqbal SN; Coviello E; He M
[Ad] Endereço:Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, Women & Infants Hospital of Rhode Island, Providence, RI, USA; Phoenix Perinatal Associates, Phoenix, AZ, USA; Warren Alpert Medical School of Brown University, Providence, RI, USA.
[Ti] Título:Correlation of placental pathology and perinatal outcomes with Hemoglobin A1c in early pregnancy in gravidas with pregestational diabetes mellitus.
[So] Source:Placenta;52:94-99, 2017 Apr.
[Is] ISSN:1532-3102
[Cp] País de publicação:Netherlands
[La] Idioma:eng
[Ab] Resumo:INTRODUCTION: Data on the correlation among Hemoglobin A1c (HbA1c), placental pathology, and perinatal outcome in the pregestational diabetic population is severely lacking. We believe that this knowledge will enhance the management of pregnancies complicated by pregestational diabetes. We hypothesize that placental pathology correlates with glycemic control at an early gestational age. METHODS: This is a retrospective cohort study conducted from 2003 to 2011 at a large tertiary care center. Women included had a singleton gestation, preexisting diabetes mellitus, and information about delivery and placental pathology available for review. Placental pathology and perinatal outcomes were compared across three groups of patients with differing HbA1c levels (<6.5%, 6.5-8.4%, and ≥8.5%). RESULTS: 293 placentas were examined. HbA1c was measured at a mean of 9.5week gestation. Median HbA1c was 7.5%, interquartile range 6.5%-8.9%. 23% of the cohort had HbA1c <6.5%, 41.9% between 6.5% and 8.4%, and 34.8% > 8.5%. BMI varied significantly by group (35.4 vs. 34.4 vs. 32.0 respectively, P = 0.04). Individual placental lesions did not vary with HbA1c levels. The incidence of acute chorioamnionitis differed significantly in the type 1 population and "distal villous hypoplasia" varied in the type 2 population. DISCUSSION: The results show that HbA1c values in early pregnancy are poor predictors of future placental pathologies. As a result, HbA1c values obtained during early gestation (which reflect the level of glycemic control over an extended period of time) do not correlate with any particular placental pathology, despite reflecting the potential for placental insults secondary to pre-gestational diabetes.
[Mh] Termos MeSH primário: Glicemia
Diabetes Mellitus Tipo 1/patologia
Diabetes Mellitus Tipo 2/patologia
Hemoglobina A Glicada/análise
Placenta/patologia
Gravidez em Diabéticas/patologia
[Mh] Termos MeSH secundário: Adulto
Diabetes Mellitus Tipo 1/sangue
Diabetes Mellitus Tipo 2/sangue
Feminino
Seres Humanos
Gravidez
Resultado da Gravidez
Gravidez em Diabéticas/sangue
Estudos Retrospectivos
Adulto Jovem
[Pt] Tipo de publicação:JOURNAL ARTICLE; OBSERVATIONAL STUDY
[Nm] Nome de substância:
0 (Blood Glucose); 0 (Glycated Hemoglobin A); 0 (hemoglobin A1c protein, human)
[Em] Mês de entrada:1803
[Cu] Atualização por classe:180305
[Lr] Data última revisão:
180305
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170430
[St] Status:MEDLINE


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[PMID]:29465549
[Au] Autor:Marques NDSF; Abreu LC; Santos BVD; Neto CFR; Silva JRCD; Braga KKS; Uchôa KDS; Moraes LMS; Ferreira LCP; Ribeiro NG; Santos SLD; Silva TAD; Andrade PE; Raimundo RD
[Ad] Endereço:Laboratory of Study Design and Scientific Writing of the Faculty of Medicine of ABC, Prince of Wales, Santo André/SP-CEP, Brazil.
[Ti] Título:Cardiorespiratory parameters and glycated hemoglobin of patients with type 2 diabetes after a rehabilitation program.
[So] Source:Medicine (Baltimore);97(8):e9321, 2018 Feb.
[Is] ISSN:1536-5964
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:INTRODUCTION: Cardiovascular autonomic dysfunction reflex of the pathophysiology of diabetes mellitus (DM) favors an increase in morbidity and mortality related to cardiovascular events, and for this reason has been one of the most studied clinical entities. METHOD: An experimental study of a randomized clinical trial type was therefore proposed to analyze the hemodynamic and glycemic response after the practice of a rehabilitation program in patients with type 2 diabetes mellitus (T2DM). In this clinical trial the patients will initially be submitted to an evaluation protocol that consists of assessing blood pressure, heart rate, Borg scale, respiratory rate, oxygen saturation, distance traveled through the 6-minute walk test, quality of life questionnaire, Pittsburgh sleep quality questionnaire, and still glycated hemoglobin and heart rate variability through the cardiofrequency meter. After careful evaluation of the patients, they will be submitted to a metabolic rehabilitation program composed of aerobic and resisted exercises, performed for 12 weeks, in 3 weekly meetings of 60 minutes each. With such evaluations, it will be possible to construct with evidence that it is possible to work safer metabolic rehabilitation programs in patients with T2DM or other diseases that generate cardiovascular risks, guaranteeing them an improvement in cardiorespiratory fitness, hemodynamic and glycemic variables, allowing improvement of the quality of life. ETHICS AND DISSEMINATION: The protocol is approved by the host institution's ethics committee under the number 1.616.721. Results will be disseminated via peer-reviewed journal articles and conferences. This clinical trial is registered at ClinicalTrials.gov identifier: NCT3094767.
[Mh] Termos MeSH primário: Diabetes Mellitus Tipo 2
Exercício/fisiologia
Hemoglobina A Glicada/análise
Treinamento de Resistência/métodos
[Mh] Termos MeSH secundário: Adulto
Glicemia/análise
Pressão Sanguínea
Protocolos Clínicos
Diabetes Mellitus Tipo 2/sangue
Diabetes Mellitus Tipo 2/fisiopatologia
Diabetes Mellitus Tipo 2/reabilitação
Feminino
Frequência Cardíaca
Seres Humanos
Masculino
Consumo de Oxigênio
Qualidade de Vida
Sono
Inquéritos e Questionários
Resultado do Tratamento
Teste de Caminhada
[Pt] Tipo de publicação:JOURNAL ARTICLE; RANDOMIZED CONTROLLED TRIAL
[Nm] Nome de substância:
0 (Blood Glucose); 0 (Glycated Hemoglobin A); 0 (hemoglobin A1c protein, human)
[Em] Mês de entrada:1803
[Cu] Atualização por classe:180302
[Lr] Data última revisão:
180302
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:180222
[Cl] Clinical Trial:ClinicalTrial
[St] Status:MEDLINE
[do] DOI:10.1097/MD.0000000000009321


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[PMID]:29385202
[Au] Autor:König M; Drewelies J; Norman K; Spira D; Buchmann N; Hülür G; Eibich P; Wagner GG; Lindenberger U; Steinhagen-Thiessen E; Gerstorf D; Demuth I
[Ad] Endereço:Lipid Clinic at the Interdisciplinary Metabolism Center, Charité - Universitätsmedizin Berlin, Berlin, Germany.
[Ti] Título:Historical trends in modifiable indicators of cardiovascular health and self-rated health among older adults: Cohort differences over 20 years between the Berlin Aging Study (BASE) and the Berlin Aging Study II (BASE-II).
[So] Source:PLoS One;13(1):e0191699, 2018.
[Is] ISSN:1932-6203
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: The last decades have seen great advances in the understanding, treatment, and prevention of cardiovascular disease (CVD). Although mortality rates due to CVD have declined significantly in the last decades, the burden of CVD is still high, particularly in older adults. This raises the question whether contemporary populations of older adults are experiencing better or worse objective as well as subjective health than earlier-born cohorts. The aim of this study was to examine differences in modifiable indicators of cardiovascular health (CVH), comparing data obtained 20 years apart in the Berlin Aging Study (BASE, 1990-93) and the Berlin Aging Study II (BASE-II, 2009-2014). METHODS: Serial cross-sectional analysis of 242 propensity-score-matched participants of BASE (born 1907-1922) and BASE-II (born 1925-1942). Body mass index (BMI), blood pressure, total cholesterol, glycated hemoglobin (HbA1c), diet, smoking and physical activity were operationalized according to the "Life's simple 7"(LS7) criteria of the American Heart Association. RESULTS: 121 matched pairs were identified based on age, sex, and education. In the later-born BASE-II sample, the mean LS7 score was significantly higher than in the earlier-born sample (7.8±1.8 vs. 6.4±2.1, p<0.001), indicating better CVH. In detail, diet, physical activity, smoking, cholesterol, and HbA1c were more favorable, whereas blood pressure was significantly higher in individuals from the later-born cohort. BMI did not differ significantly between the two matched samples. Notably, despite better CVH, later-born individuals (BASE-II) reported lower self-rated health, presumably because of higher health expectations. CONCLUSIONS: Overall, cardiovascular health was significantly better in the later-born cohort, but several notable exceptions exist.
[Mh] Termos MeSH primário: Envelhecimento/fisiologia
Fenômenos Fisiológicos Cardiovasculares
[Mh] Termos MeSH secundário: Idoso
Idoso de 80 Anos ou mais
Envelhecimento/patologia
Berlim/epidemiologia
Pressão Sanguínea
Índice de Massa Corporal
Doenças Cardiovasculares/epidemiologia
Doenças Cardiovasculares/mortalidade
Colesterol/sangue
Estudos de Coortes
Estudos Transversais
Dieta
Exercício
Feminino
Hemoglobina A Glicada/metabolismo
Nível de Saúde
Seres Humanos
Masculino
Fatores de Risco
Autorrelato
Fumar
Fatores de Tempo
[Pt] Tipo de publicação:COMPARATIVE STUDY; JOURNAL ARTICLE; RESEARCH SUPPORT, NON-U.S. GOV'T
[Nm] Nome de substância:
0 (Glycated Hemoglobin A); 0 (hemoglobin A1c protein, human); 97C5T2UQ7J (Cholesterol)
[Em] Mês de entrada:1803
[Cu] Atualização por classe:180302
[Lr] Data última revisão:
180302
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:180201
[St] Status:MEDLINE
[do] DOI:10.1371/journal.pone.0191699


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[PMID]:29289263
[Au] Autor:Kim CH; Kim HK; Kim EH; Bae SJ; Choe J; Park JY
[Ad] Endereço:Division of Endocrinology & Metabolism, Department of Internal Medicine, Soonchunhyang University College of Medicine, Bucheon, Korea.
[Ti] Título:Longitudinal Changes in Insulin Resistance, Beta-Cell Function and Glucose Regulation Status in Prediabetes.
[So] Source:Am J Med Sci;355(1):54-60, 2018 Jan.
[Is] ISSN:1538-2990
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: The changes in insulin resistance and insulin secretion and their association with changes in glucose regulation status in Asians with prediabetes remain uncertain. MATERIALS AND METHODS: We included Korean adults (aged 20-79 years) with prediabetes who underwent routine medical check-ups at a mean interval of 5 years. Prediabetes was defined as fasting plasma glucose (FPG) 5.6-6.9mmol/l or HbA1c 5.7-6.4% (39-46mmol/mol). Insulin resistance (HOMA-IR) and beta-cell function (HOMA-%B) indices were assessed by homeostasis model assessment. Incident diabetes was defined as FPG ≥ 7.0mmol/l, HbA1c ≥ 6.5% (48mmol/mol), or initiation of antidiabetic medications. RESULTS: Among the 7,208 participants with prediabetes, 4,410 (61.2%) remained as prediabetes (control group), 2,123 (29.5%) reverted to normal glucose regulation (regressors), and 675 (9.4%) progressed to type 2 diabetes (progressors) after 5 years. Compared with the control group, the progressors had higher baseline HOMA-IR (2.48 ± 1.45 versus 2.06 ± 1.20, P < 0.001), but similar baseline HOMA-%B (74.6 ± 47.6 versus 73.1 ± 41.4, P=0.68). By contrast, the regressors had lower baseline HOMA-IR (1.98 ± 1.14 versus 2.06 ± 1.20, P = 0.035) but higher baseline HOMA-%B (77.4 ± 43.1 versus 73.1 ± 41.4, P = 0.001). After 5 years, the progressors showed a 31% increase in HOMA-IR (2.48 ± 1.45 versus 3.24 ± 2.10, P < 0.001) and 15% decrease in HOMA-%B (74.6 ± 47.6 versus 63.8 ± 40.4, P < 0.001), whereas the regressors showed 29% decrease in HOMA-IR (1.98 ± 1.14 versus 1.41 ± 0.78, P < 0.001) and 4% increase in HOMA-%B (77.4 ± 43.1 versus 80.2 ± 47.9, P = 0.010). CONCLUSIONS: Although increase in insulin resistance and decrease in beta-cell function both contributed to the progression to type 2 diabetes from prediabetes, longitudinal change in insulin resistance was the predominant factor in Koreans.
[Mh] Termos MeSH primário: Glicemia/metabolismo
Resistência à Insulina
Células Secretoras de Insulina/metabolismo
Estado Pré-Diabético/sangue
[Mh] Termos MeSH secundário: Adulto
Idoso
Grupo com Ancestrais do Continente Asiático
Diabetes Mellitus Tipo 2/sangue
Diabetes Mellitus Tipo 2/tratamento farmacológico
Jejum/sangue
Feminino
Seguimentos
Hemoglobina A Glicada/metabolismo
Seres Humanos
Células Secretoras de Insulina/patologia
Masculino
Meia-Idade
Estado Pré-Diabético/tratamento farmacológico
República da Coreia
[Pt] Tipo de publicação:CLINICAL TRIAL; JOURNAL ARTICLE
[Nm] Nome de substância:
0 (Blood Glucose); 0 (Glycated Hemoglobin A); 0 (hemoglobin A1c protein, human)
[Em] Mês de entrada:1803
[Cu] Atualização por classe:180301
[Lr] Data última revisão:
180301
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:180101
[St] Status:MEDLINE


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[PMID]:29390252
[Au] Autor:Li SS; Zheng J; Mei B; Wang HY; Zheng M; Zheng K
[Ad] Endereço:Department of Geriatrics.
[Ti] Título:Correlation study of Framingham risk score and vascular dementia: An observational study.
[So] Source:Medicine (Baltimore);96(50):e8387, 2017 Dec.
[Is] ISSN:1536-5964
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:Vascular dementia (VaD) is one of the most common forms of dementia, and second only to Alzheimer's disease. The purpose of this study was to evaluate the potential diagnostic value of Framingham risk score (FRS) in VaD by investigating the relationship among cardiovascular risks, FRS, and VaD.Data were collected from patients (n = 130) at Tongji Hospital in Wuhan, China. They were divided into 2 groups, including the control group (n = 70) and the VaD group (n = 60). Statistical methods including t-test, logistic regression model, multiple linear regression model, and receiver-operating characteristic (ROC) curve were adopted for the assessment.A significant difference (all P < .05) was observed in systolic blood pressure (SBP), diastolic blood pressure (DBP), pulse pressure, total cholesterol (TC), homosysteine (HCY), glycosylated hemoglobin A1c (HbA1c), FRS, and cerebral white matter lesions (WMLs) between the 2 groups, even after adjusting for age (both P < .05). Age [odds ratio (OR) = 1.20; P = .002], FRS (OR = 1.55; P = .006), and WMLs (OR = 10.17; P = .011) were independent prognostic factors for VaD. The area under the ROC curve (AUC) of FRS for VaD diagnosis prediction was 0.830 (95% confidence interval, 95% CI: 0.730∼ 0.929). There was a significant difference in the AUC between WMLs and WMLs combined with FRS (0.788 (95% CI: 0.667 ∼ 0.880) versus 0.863 (95% CI: 0.754 ∼ 0.936, P = .049). Age, HbA1c, and FRS were negatively correlated with the mini-mental state examination (MMSE) scores (all P < .05) in the VaD group. Moreover, multiple stepwise linear regression analysis showed that the age and FRS were independent predictors of MMSE scores.FRS has a moderate predictive value for the VaD diagnosis, and also increases the risk of cognitive decline.
[Mh] Termos MeSH primário: Demência Vascular/diagnóstico
Medição de Risco/métodos
[Mh] Termos MeSH secundário: Fatores Etários
Idoso
Idoso de 80 Anos ou mais
Pressão Sanguínea/fisiologia
Estudos de Casos e Controles
Colesterol/sangue
Disfunção Cognitiva/fisiopatologia
Feminino
Hemoglobina A Glicada/análise
Homocisteína/sangue
Seres Humanos
Modelos Lineares
Imagem por Ressonância Magnética
Masculino
Testes de Estado Mental e Demência
Meia-Idade
Prognóstico
Substância Branca/diagnóstico por imagem
[Pt] Tipo de publicação:JOURNAL ARTICLE; OBSERVATIONAL STUDY
[Nm] Nome de substância:
0 (Glycated Hemoglobin A); 0 (hemoglobin A1c protein, human); 0LVT1QZ0BA (Homocysteine); 97C5T2UQ7J (Cholesterol)
[Em] Mês de entrada:1802
[Cu] Atualização por classe:180301
[Lr] Data última revisão:
180301
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:180203
[St] Status:MEDLINE
[do] DOI:10.1097/MD.0000000000008387


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[PMID]:28459925
[Au] Autor:Carrasquillo O; Lebron C; Alonzo Y; Li H; Chang A; Kenya S
[Ad] Endereço:Department of Medicine, University of Miami Miller School of Medicine, Miami, Florida2Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, Florida.
[Ti] Título:Effect of a Community Health Worker Intervention Among Latinos With Poorly Controlled Type 2 Diabetes: The Miami Healthy Heart Initiative Randomized Clinical Trial.
[So] Source:JAMA Intern Med;177(7):948-954, 2017 Jul 01.
[Is] ISSN:2168-6114
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:Importance: Community health worker (CHW) intervention is a promising approach to address type 2 diabetes among Latinos. However, evidence from randomized clinical studies is limited. Objective: To compare a CHW intervention with enhanced usual care. Design, Setting, and Participants: This 52-week, single-blind, randomized clinical trial included 300 Latino adults aged 18 to 65 years who were treated in 2 public hospital outpatient clinics in Miami-Dade County, Florida, from July 1, 2010, through October 31, 2013. Eligible participants had a hemoglobin A1c (HbA1c) level of 8.0 or greater. Follow-up was completed January 31, 2015, and data were analyzed from March 10, 2015, to June 6, 2016. Interventions: A 1-year CHW intervention consisted of home visits, telephone calls, and group-level activities. Main Outcomes and Measures: Primary outcomes included systolic blood pressure (SBP), low-density lipoprotein cholesterol (LDLC) levels, and HbA1c levels. Secondary outcomes included body mass index, medication regimen intensification, and self-reported measures of diet, physical activity, and medication regimen adherence. Results: Of the 300 participants randomized (135 men [45%] and 165 women [55%]; mean [SD] age, 55.2 [7.0] years), we obtained follow-up data on 215 (71.7%). Participants in the CHW group received a median of 4 home visits and 20 telephone calls. After adjusting for baseline values and covariates, participants in the CHW group had an HbA1c level that was 0.51% lower (95% CI, -0.94% to -0.08%) than that of participants in the enhanced usual care group. The reduction in SBP of 4.62 mm Hg (95% CI, -9.01 to -0.24 mm Hg) did not meet the preplanned target of 8 mm Hg and was not statistically significant in unadjusted models. No significant differences in LDLC levels (mean difference, -8.2 mg/dL; 95% CI, -18.8 to 2.3 mg/dL) or any of the preplanned secondary outcomes were observed. Post hoc analyses suggest that the intervention may be more beneficial among those with worse control of their type 2 diabetes at baseline. Conclusions and Relevance: Among Latinos with poorly controlled type 2 diabetes, a 12-month CHW intervention lowered HbA1c levels by 0.51%. The intervention did not lead to improvements in LDLC levels, and the findings with respect to SBP were variable and half of what was targeted. Future studies should examine whether CHW interventions affect other measures, such as access to health care or social determinants of health. Trial Registration: clinicaltrials.gov Identifier: NCT01152957.
[Mh] Termos MeSH primário: Serviços de Saúde Comunitária
Agentes Comunitários de Saúde
Diabetes Mellitus Tipo 2
Cooperação do Paciente/etnologia
[Mh] Termos MeSH secundário: Adulto
Atitude do Pessoal de Saúde
Glicemia/análise
Serviços de Saúde Comunitária/métodos
Serviços de Saúde Comunitária/organização & administração
Agentes Comunitários de Saúde/organização & administração
Agentes Comunitários de Saúde/psicologia
Diabetes Mellitus Tipo 2/diagnóstico
Diabetes Mellitus Tipo 2/etnologia
Diabetes Mellitus Tipo 2/psicologia
Diabetes Mellitus Tipo 2/terapia
Comportamento Alimentar/etnologia
Comportamento Alimentar/fisiologia
Feminino
Florida/epidemiologia
Hemoglobina A Glicada/análise
Hispano-Americanos/estatística & dados numéricos
Seres Humanos
Masculino
Meia-Idade
Avaliação de Processos e Resultados (Cuidados de Saúde)
Autocuidado/métodos
[Pt] Tipo de publicação:JOURNAL ARTICLE; RANDOMIZED CONTROLLED TRIAL
[Nm] Nome de substância:
0 (Blood Glucose); 0 (Glycated Hemoglobin A)
[Em] Mês de entrada:1708
[Cu] Atualização por classe:180228
[Lr] Data última revisão:
180228
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:170502
[Cl] Clinical Trial:ClinicalTrial
[St] Status:MEDLINE
[do] DOI:10.1001/jamainternmed.2017.0926


  9 / 29038 MEDLINE  
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[PMID]:29357380
[Au] Autor:Debussche X; Besançon S; Balcou-Debussche M; Ferdynus C; Delisle H; Huiart L; Sidibe AT
[Ad] Endereço:Department of Endocrinology Diabetology Nutrition, Felix Guyon University Hospital, Saint-Denis, La Réunion.
[Ti] Título:Structured peer-led diabetes self-management and support in a low-income country: The ST2EP randomised controlled trial in Mali.
[So] Source:PLoS One;13(1):e0191262, 2018.
[Is] ISSN:1932-6203
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:OBJECTIVES: Our objective was to evaluate the effectiveness of peer-led self-management education in improving glycaemic control in patients with type 2 diabetes in a low-income country (Mali). METHODS: We conducted an open-label randomised controlled trial. A total of 151 adults (76% women, mean age 52.5) with type 2 diabetes (HbA1c≥8%), treated in the diabetes consultation units of two secondary health centres in Bamako, were allocated to peer-led structured patient education (n = 76) or conventional care alone (n = 75). The intervention group received 1 year of culturally tailored structured patient education (3 courses of 4 sessions) delivered in the community by five trained peer educators. Both groups underwent conventional diabetes monitoring and follow-up. Primary outcome was the mean absolute change in HbA1c from baseline to 12 months. RESULTS: 177 education sessions were delivered to the intervention group. Patient attrition was 8%. From baseline to 12 months, the decrease in HbA1c levels was 1.05% (SD = 2.0; CI95%: 1.54;-0.56) in the intervention group compared with 0.15% (SD = 1.7; CI95%: -0.56; 0.26) in the control group, p = 0.006. Mean BMI change was -1.65 kg/m2 (SD = 2.5; CI95%: -2.25; -1.06) in the intervention group and +0.05 kg/m2 (SD = 3.2; CI95%: -0.71; 0.81) in the control group, p = 0.0005. Mean waist circumference decreased by 3.34 cm (SD = 9.3; CI95%: -5.56;-1.13) in the intervention group and increased by 2.65 cm (SD = 10.3; CI95%: 0.20; 5.09) in the control group, p = 0.0003. CONCLUSIONS: Peer-led structured patient education delivered over 1 year to patients with poorly controlled type 2 diabetes in Mali yielded substantial improvements in glycaemic control and anthropometric parameters. This is of importance for the scaling up of efficient interventions in low-resource settings in the future. TRIAL REGISTRATION: ClinicalTrials.gov NCT01485913.
[Mh] Termos MeSH primário: Diabetes Mellitus Tipo 2/terapia
Autogestão/métodos
[Mh] Termos MeSH secundário: Adulto
Países em Desenvolvimento
Diabetes Mellitus Tipo 2/sangue
Feminino
Hemoglobina A Glicada/metabolismo
Seres Humanos
Masculino
Mali
Meia-Idade
Avaliação de Resultados (Cuidados de Saúde)
Educação de Pacientes como Assunto/métodos
Grupo Associado
Autocuidado/métodos
[Pt] Tipo de publicação:JOURNAL ARTICLE; RANDOMIZED CONTROLLED TRIAL; RESEARCH SUPPORT, NON-U.S. GOV'T
[Nm] Nome de substância:
0 (Glycated Hemoglobin A)
[Em] Mês de entrada:1802
[Cu] Atualização por classe:180226
[Lr] Data última revisão:
180226
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:180123
[Cl] Clinical Trial:ClinicalTrial
[St] Status:MEDLINE
[do] DOI:10.1371/journal.pone.0191262


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[PMID]:28470687
[Au] Autor:Li Y; Zhang M; Liu X; Cui W; Rampersad S; Li F; Lin Z; Yang P; Li H; Sheng C; Cheng X; Qu S
[Ad] Endereço:Department of Endocrinology & Metabolism, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China.
[Ti] Título:Correlates and prevalence of hypogonadism in patients with early- and late-onset type 2 diabetes.
[So] Source:Andrology;5(4):739-743, 2017 07.
[Is] ISSN:2047-2927
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:This study aims to compare the prevalence of hypogonadism between male patients with early-onset type 2 diabetes mellitus (T2DM) and late-onset type 2 diabetes. A total of 122 male patients with early-onset T2DM (diagnosis age ≤40 years) and 100 male patients with late-onset T2DM (diagnosis age >40 years) were recruited from our in-patient department between 1 January 2013 and 28 December 2015. Serum FSH, LH, testosterone, lipid profile, uric acid, HbA1c, and beta-cell function were determined in blood samples. The diagnosis of hypogonadism was based on the levels of LH, FSH, and total testosterone. The mean onset age was 29.86 ± 6.31 and 54.47 ± 9.97 years old in the early-onset group and late-onset group, respectively. Compared with late-onset T2DM, those with early-onset T2DM had a higher proportion of new-onset diabetes, were more likely to be obese, and had worse glycemic control, lipid control, and lower sex hormone-binding globulin (SHBG). The prevalence of hypogonadism was much higher in the early-onset group than in the late-onset group (48.0% vs. 26.7%, p < 0.05). The rate of secondary hypogonadism in the early-onset group and late-onset group were 44.3% and 25.0%, respectively (p < 0.05). Obesity, waist circumference, and SHBG were significantly associated with serum total testosterone level in all, early-onset, and late-onset T2DM. Both all and early-onset T2DM groups had positive correlations between total testosterone and fasting C-peptide, total cholesterol, triglycerides, and uric acid. Our results indicate that in a population of admission to a large urban hospital in China, the prevalence of hypogonadism was higher in the patients with early-onset T2DM than that of late-onset T2DM. This prevalence might be attributable to greater obesity, worse lipid control, and lower SHBG levels in those patients.
[Mh] Termos MeSH primário: Diabetes Mellitus Tipo 2/epidemiologia
Hipogonadismo/epidemiologia
[Mh] Termos MeSH secundário: Adulto
Idade de Início
Idoso
Biomarcadores/sangue
Glicemia/análise
China/epidemiologia
Estudos Transversais
Diabetes Mellitus Tipo 2/sangue
Diabetes Mellitus Tipo 2/diagnóstico
Hormônio Foliculoestimulante Humano/sangue
Hemoglobina A Glicada/análise
Hospitais Urbanos
Seres Humanos
Hipogonadismo/sangue
Hipogonadismo/diagnóstico
Insulina/sangue
Lipídeos/sangue
Hormônio Luteinizante/sangue
Masculino
Meia-Idade
Admissão do Paciente
Prevalência
Fatores de Risco
Globulina de Ligação a Hormônio Sexual/análise
Testosterona/sangue
Ácido Úrico/sangue
[Pt] Tipo de publicação:COMPARATIVE STUDY; JOURNAL ARTICLE; RESEARCH SUPPORT, NON-U.S. GOV'T
[Nm] Nome de substância:
0 (Biomarkers); 0 (Blood Glucose); 0 (Follicle Stimulating Hormone, Human); 0 (Glycated Hemoglobin A); 0 (Insulin); 0 (Lipids); 0 (Sex Hormone-Binding Globulin); 0 (hemoglobin A1c protein, human); 268B43MJ25 (Uric Acid); 3XMK78S47O (Testosterone); 9002-67-9 (Luteinizing Hormone)
[Em] Mês de entrada:1801
[Cu] Atualização por classe:180227
[Lr] Data última revisão:
180227
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170505
[St] Status:MEDLINE
[do] DOI:10.1111/andr.12360



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