Objective. To estimate cause of death and to identify factors associated with risk of inhospital mortality among patients with T2D. Methods. Prospective cohort study performed in a referral public hospital in Lima, Peru. The outcome was time until event, elapsed from hospital admission to discharge or death, and the exposure was the cause of hospital admission. Cox regression was used to evaluate associations of interest reporting Hazard Ratios (HR) and 95% confidence intervals. Results. 499 patients were enrolled. Main causes of death were exacerbation of chronic renal failure (38.1%), respiratory infections (35.7%), and stroke (16.7%). During hospital stay, 42 (8.4%) patients died. In multivariable models, respiratory infections (HR = 6.55, ), stroke (HR = 7.05, ), and acute renal failure (HR = 16.9, ) increased the risk of death. In addition, having 2+ (HR = 7.75, ) and 3+ (HR = 21.1, ) conditions increased the risk of dying. Conclusion. Respiratory infections, stroke, and acute renal disease increased the risk of inhospital mortality among hospitalized patients with T2D. Infections are not the only cause of inhospital mortality. Certain causes of hospitalization require standardized and aggressive management to decrease mortality.

Dissertação (mestrado) - Universidade Federal do Rio de Janeiro. Instituto de Nutrição / Made available in DSpace on 2016-01-08T16:20:14Z (GMT). No. of bitstreams: 0 Previous issue date: 1989

Dissertação (mestrado)—Universidade de Brasília, Faculdade de Ciências da Saúde, 2007. / Submitted by Rebeca Araujo Mendes (bekinhamendes@gmail.com) on 2009-12-18T02:11:46Z No. of bitstreams: 1 2007_LidiaFreireAbdalla.PDF: 358902 bytes, checksum: 85db0385518ba439900890edce556742 (MD5) / Approved for entry into archive by Daniel Ribeiro(daniel@bce.unb.br) on 2009-12-23T20:46:03Z (GMT) No. of bitstreams: 1 2007_LidiaFreireAbdalla.PDF: 358902 bytes, checksum: 85db0385518ba439900890edce556742 (MD5) / Made available in DSpace on 2009-12-23T20:46:03Z (GMT). No. of bitstreams: 1 2007_LidiaFreireAbdalla.PDF: 358902 bytes, checksum: 85db0385518ba439900890edce556742 (MD5) Previous issue date: 2007 / O Diabetes Mellitus é uma doença multifatorial, que exige controle metabólico para evitar o desenvolvimento de complicações crônicas, pela adoção de medidas terapêuticas específicas, visando melhorar o prognóstico da doença. O presente estudo visou avaliar os benefícios da utilização do sistema de monitoramento contínuo da glicose (CGMS) comparado com métodos convencionais de controle metabólico tais como hemoglobina glicada, glicemia capilar e venosa, lipidograma e insulinemia. Foram avaliados 55 pacientes diabéticos consecutivos, recrutados do Ambulatório de Endocrinologia do Hospital Universitário de Brasília, distribuídos em dois grupos, sendo 16,4% (9/55 pacientes) portadores de diabetes mellitus tipo 1 e 83,6% (46/55 pacientes) portadores de diabetes mellitus tipo 2. Os distúrbios do metabolismo lipídico e critérios para resistência insulínica, avaliada pela freqüência de índice HOMA-IR > 2,71, foi observada em 77,8% dos pacientes diabéticos tipo 2. A hipertrigliceridemia foi observada em todos os pacientes que possuíam índice de HOMA-IR maior que 2,71. O monitoramento contínuo de glicose foi feito por 72 horas, registrou 288 medidas de glicoses intersticiais por período de 24 horas, totalizando a média de 1152 registros por paciente. Para a realização da análise de dados, foram considerados 63.360 registros da média de glicose intersticial, para o total de 55 pacientes estudados por 72 horas. Nos 55 pacientes estudados foram obtidas as médias de 11,6 2,9 leituras pareadas, com coeficiente de correlação de Pearson entre as leituras de glicose capilar realizadas no glicosímetro e as leituras de glicose intersticial realizadas pelo CGMS, r=0,86 0,14. As diferenças médias absolutas (MAD) foram calculadas e o valor obtido foi de 12,5% 7,5%, o que estabeleceu a confiabilidade na acurácia do método. A análise da amostra dos grupos estudados evidenciou que os pacientes mantiveram-se em média 32,4% do tempo acima de 180 mg/dl, 6,16% do tempo abaixo de 70 mg/dl e 61,4% do tempo em normoglicemia. Os pacientes do tipo 1 apresentaram-se com 11,7% do período com glicoses inferiores a 70 mg/dl, enquanto que no tipo 2 esse achado foi constatado em 5,1% dos casos. O CGMS evidenciou episódios de hipoglicemia que não haviam sido flagrados pelo controle de glicemia venosa ou capilar. Todavia, deve-se considerar o tempo de equilíbrio da glicose entre os compartimentos intersticial e venoso para a interpretação adequada dos resultados. A comparação entre os dados obtidos pelo CGMS e os métodos convencionais de controle da glicose, demonstrou forte correlação entre a hemoglobina glicada e o período de tempo que os pacientes permaneceram em hiperglicemia, apresentando fraca correlação com a frutosamina e a insulinemia basal. O CGMS permitiu a identificação de fenômenos fisiológicos subdiagnosticados tais como os fenômenos do alvorescer, Somogi e hipoglicemias assintomáticas. O método de monitoramento contínuo utilizado nesse estudo não permite a visualização e correção imediatas das excursões glicêmicas. ________________________________________________________________________________________ ABSTRACT / The Mellitus Diabetes is a multi-factorial disease, which requires intensive metabolic control in order to avoid the development of chronic complications. The metabolic control includes specific therapeutic measures aiming the improvement of the disease’s prognostic. The objective of this study is to evaluate the benefits of using the Continuous Glucose Monitoring System (CGMS) in comparison to the conventional methods of metabolic control, such as glucohemoglobin (HbA1C), capilary and venous glucose determinations, lipidogram, and insulin levels. We evaluated 55 diabetic patients from the Endocrinology Unit of the Hospital Universitario de Brasília. The patients were divided into two groups, one with 16.4% of the total number of patients (9/55 patients), which were diagnosed with diabetes mellitus type 1, and a second group, with 83.6% of all patients (46/55 patients), which presented diabetes mellitus type 2. The disturbs of the lipidic metabolism, and the criteria for insulin resistance, evaluated by using the index HOMA-IR > 2.71, were observed in 77.8% of all diabetic patients Type 2. The presence of hypertrigliceridemy was observed in all patients which presented the index HOMA-IR value larger than 2.71. The continuous monitoring of glucose was conducted during 72 hours, and we observed a total of 288 interstitial glucose determinations for each 24 hour period, totalling the average of 1,152 measurements for each patient. For the analysis of the data, we considered a total of 63,360 records of interstitial glucose, for a total of 55 patients, each observed during a 72 hour period. For the 55 patients considered in this study, we calculated the average of 11.56 ± 2.9 paired measurements, with the resulting Pearson correlation coefficient values obtained when comparing the glucose readings from the glucose meter and those interstitial glucose readings from the CGMS. The obtained Pearson correlation coefficient values were r=0.86 ± 0.14 (ideal > 0.79). The mean absolute difference values (MAD) were calculated and the obtained value was 12.5% ± 7.5% (ideal < 18%), which established the confidence levels to the accuracy of this method. The analysis of the data we had showed that the patients studied were, on average and throughout the time, 32.4% above 180 mg/dl, 6.2% below 70 mg/dl, and 61.4% of the time within the normal glucose levels. The patients from the type 1 group presented, during 11.7% of the time, glucose level lower than 70 mg/dl, while those patients from the type 2 group presented glucose level lower than 70 mg/dl during 5.1% of the considered period of time. The CGMS showed periods of hypoglicemia, which were not observed during the venous or capilar control data. On the other hand, we need to take into account the required time for the balance of glucose between the intersticial and the venous compartments for the appropriate interpretation of the results. The comparison of the data obtained using the CGMS analysis and the traditional glucose control techniques showed a strong correlation between the HbA1C and the total period of time in which the patients were kept under hyperglycemia, presenting a very weak correlation with the frutosamie and the basal insulin levels. The continuous monitoring method used in this study does not allow instantaneous pick and correction of glicemic variations.

XVI Congreso Argentino y VIII del Cono Sur de Soporte Nutricional y Metabolismo. IV Congreso Argentino de Soporte Nutricional y Metabolismo en Pediatría. Evento desarrollado en Rosario, Argentina del 27 al 29 de Octubre del 2013. / Objetivo. Determinar el comportamiento de las manifestaciones tardías en pacientes diabéticos tipo 2 atendidos en un centro de diabetes de Lima 2013. Método. Estudio no experimental, descriptivo, corte transversal. La muestra fue de 20 pacientes con diagnóstico de Diabetes Mellitus tipo 2 atendidos en un centro de Diabetes de Lima Se recolectó los datos de las historias clínicas. El análisis de los datos se presentó con estadística descriptiva. Resultados. Los pacientes en su totalidad fueron mayores de 40 años, el 55% varones y el 45 % mujeres, el 55% tenían un tiempo de enfermedad > de 10 años, el 95% fueron evaluados por oftalmología, de ellos el 45% presentaron cataratas, el 15% presbicia y 10% amaurosis. El 15 % tuvieron nefropatías con elevación de los niveles de creatinina. El 50% presentaron hipertrigliceridemia y el 30% hipercolesterolemia. El 80% presentaron hipertensión arterial, el 45 % de los pacientes tenían sobrepeso y 10% obesidad. 20% tuvieron antecedente de infarto de miocardio. A la totalidad de pacientes no se evaluó los pulsos del pie. Conclusiones: Los pacientes evaluados tuvieron complicaciones microvasculares y macrovasculares. Las complicaciones microvasculares como las oculares estuvieron presentes en un 70%, y el 15 % tuvieron algún grado de nefropatía con niveles elevados de creatinina. Respecto a las complicaciones macrovasculares la hipertensión estuvo asociada en un 80 % a la diabetes y el 45 % tenían obesidad, no se evaluó los pulsos del pie; examen importante para la prevención de las amputaciones de miembros inferiores en pacientes diabéticos.

Orientador: Sofia Rocha Lieber / Dissertação (mestrado) - Universidade Estadual de Campinas, Instituto de Biologia / Made available in DSpace on 2018-07-24T13:39:08Z (GMT). No. of bitstreams: 1 Marques_SilviaBarbosaDutra_M.pdf: 3206548 bytes, checksum: 92ac20cc5ecab74999c4b2cd5c50cb0c (MD5) Previous issue date: 1999 / Mestrado / Microbiologia

No description available.

M.Tech.

Thesis (MSc(Biomedical Technology))--Cape Peninsula University of Technology, 2019 / Background: Maturity Onset Diabetes of the Young (MODY) is a monogenic type of diabetes caused by a single gene mutation. Up to date 14 different MODY subtypes have been identified. Mutations in the glucokinase (MODY 3) and hepatic nuclear factor 1 alpha (HNF1A) (MODY 2) are the most frequent causes of MODY in all populations studied. Patients with MODY are misdiagnosed with type 1 or type 2 diabetes. Identifying patients with MODY is important as it affects treatment, for example, MODY 2 patients need no treatment, whereas those diagnosed with MODY 3 are very sensitive to low doses of sulphonylureas. To date, no data is available on the prevalence of MODY in populations from Africa. Thus, we aimed to investigate and report on the incidence of MODY, specifically mutations in the HNF1A gene in a population from the Western Cape. Methods: In this study, we screened for HNF1A MODY (MODY 3) mutations (rs115080759, rs140491072 rs137853245, and rs142318174) in 1639 (males = 406) individuals using real-time PCR. Positive MODY samples were confirmed by subsequent sequencing. All individuals underwent an oral glucose tolerance test. Results: The mean age of participants was 47.1±15.6 in males and 49.9±15.1 females. We identified 12 (0.73%) individuals with HNF1A gene polymorphisms; 12/1642 of rs115080759. Seven participants with a SNP in rs115080759 presented with normoglycemia, one with prediabetes, and four with diabetes. No polymorphism was detected in three SNPs; rs140491072, rs137853245 and rs142318174. Discussion and conclusion: To our knowledge, this is the first African study on MODY, and the incidence is similar to that reported in other studies. The results suggest that MODY is misdiagnosed with other types of diabetes in Africa; therefore, our findings support the introduction of diagnostic genetic testing for MODY in South Africa.

There is a high prevalence of gestational diabetes (GD) in South Africa, which is continually growing. South African women with GD are not effectively managed or educated about selfcare, do not self-monitor frequently enough and, therefore, often succumb to various GD induced complications. The ineffective management of GD is largely due to financial and time constraints caused by the regularly required outpatient services. On the other hand, healthcare professionals do not monitor their patients frequently enough because of accessibility issues, which means they cannot intervene timeously to prevent diabetes complications. The aim of this project was to develop a mobile health (mHealth) platform for GD self-management and for remote monitoring to improve the GD cycle of care in South Africa. The objectives were to assess the current GD management practices in South Africa, to assess the existing mHealth solutions for GD and to design, develop and test a GD mHealth platform. The existing GD management practices and current GD mHealth solutions were investigated. The results of the investigation informed the design of low-fidelity and high-fidelity mock-ups of the platform. The high-fidelity mock-up underwent usability testing and the insights gained were used to develop a working prototype of the new mHealth platform, which was then ready for in-lab testing. It was found that GD had a prevalence of up to 25% in parts of South Africa. Over 70% of patients in both private and public healthcare sectors did not meet their diabetic goals, which directly correlated with diabetes induced complications. However, previous research found that using mHealth as an intervention caused a statistically significant decrease of 0.38 mmol/L (95% confidence interval (CI) 0.52 mmol/L to 0.23 mmol/L) in overall blood glucose levels during pregnancy when compared to a control group. There was a higher probability of vaginal deliveries in the intervention group than in the control group (risk ratio = 1.18). It was less likely for new-borns from the intervention group to be diagnosed with hypoglycaemia than new-borns from the control group (risk ratio = 0.67). Based on the research and usability studies conducted, an alpha version of the GD mHealth platform was developed, including a mobile app used to track the patient’s blood glucose levels via a Bluetooth-enabled glucose meter. The food intake, exercise and weight gain during pregnancy were manually captured by the patient. The app reminded the patient to take medication, measure glucose levels and attend appointments. A GD educational component was available for the patient throughout the pregnancy. The platform included a web app which allowed healthcare professionals to remotely monitor and communicate with their patients so that they could analyse trends in the data and intervene when necessary. The testing done on the prototype resulted in positive feedback with 60% of participants saying that they would use the GooDMoM mobile app to manage their GD and 70% of participants saying that they would use the GooDMoM web app to manage their patients with GD. This put the platform in a good position for beta development. The solution has the potential to benefit patients both financially and timewise, by reducing the frequency of hospital visits required. It also has the potential to positively impact the healthcare professionals by reducing the tediousness of their workload and allowing for remote monitoring of patients. The platform can, thus, optimise the GD management process in South Africa and worldwide.

archives@tulane.edu / Abstract Glucose metabolism has become of particular importance with the epidemic of diabetes rising at an exponential rate. The current clinical standard used to diagnose and monitor diabetes measures the level of glycation on the terminal valine of the β- subunit of hemoglobin (HbA1c).1,2 Current focus is limited to the extent of forming fructosamine, and although a stable product, its levels have been found to not always be a reliable index of mean blood glucose concentrations.3–5 Examination of some of the precursors to this fructosamine could be the key to understanding the discrepancies within the current HbA1c test, potentially removing the need for a systematic measurement of test result variability, the glycosylation gap (GGap).4 Using a valine derivative to mimic the terminal amino acid of hemoglobin, we were able to experimentally model this non-enzymatic reaction by reacting valinamide with glucose to produce a glucosylamine, followed by rearrangement to the more stable fructosamine. This kinetic model gives insight into the mechanistic variables involved in the formation of HbA1c and suggest that measurement of glucosylamine levels may provide a more reliable index of mean blood glucose levels. Gluconic acid is also suggested as a metabolic marker for diabetic diagnosis due to the relatively favorable oxidation of glucosylamine. Formation of gluconic acid, known to have increased concentrations in diabetics, could potentially be an alternative pathway in glucose metabolism. / 1 / Karry LeBlanc