Orientador: Mario Jose Abdalla Saad / Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciencias Medicas / Made available in DSpace on 2018-08-14T18:10:42Z (GMT). No. of bitstreams: 1 Silva_AleksandraAlves_M.pdf: 835795 bytes, checksum: 33a3294673868ddb2965c3532c08b534 (MD5) Previous issue date: 2009 / Resumo: As óxido nítrico sintases (NOS) são divididas em dois grandes grupos de enzimas, NOS induzível (iNOS) e NOS constitutivas (cNOS). Embora o óxido nítrico (NO) seja um importante mediador de defesa do organismo, a produção excessiva de NO está envolvida na patogênese de muitas doenças inflamatórias e metabólicas. Alguns estudos demonstram que o óxido nítrico exógeno e o NO produzido pela iNOS pode induzir resistência à insulina em músculo e desempenha um papel importante na hiperglicemia de jejum. Este estudo teve como objetivo sintetizar e investigar o efeito de um potente e seletivo inibidor de atividade da iNOS, o Iodato de S-Metilisotiouréia (I-SMT) 5 mg/kg por dia, na hiperglicemia de jejum e na resistência à insulina em um modelo de obesidade induzida por dieta hiperlipídica. Foram observados os parâmetros metabólicos e de sinalização celular da Proteína quinase B/Akt (Akt) e os resultados fornecem evidências de que o grupo tratado com I-SMT foi protegido contra o desenvolvimento de resistência à insulina, e intolerância à glicose induzida por dieta hiperlipídica. Portanto, propomos que potentes inibidores farmacológicos, com seletividade significativa pela iNOS podem representar uma nova abordagem terapêutica para o tratamento da resistência à insulina e suas complicações como o diabetes tipo 2. / Abstract: Nitric oxide synthase (NOS) has been divided into two major sub-enzymes, inducible NOS (iNOS) and constitutive NOS (cNOS). Although nitric oxide (NO) is an important defense mediator, the excessive production of NO has been involved in the pathology of many inflammatory and metabolic diseases. Some studies demonstrate that exogenous nitric oxide (NO) and the NO produced by iNOS can induce insulin resistance in muscle and plays an important role in fasting hyperglycemia. This study investigates the effect of a potent and selective iNOS activity inhibitor, the S-Methylisothiourea Iodide (SMT-I) 5 mg/kg per day, in fasting hyperglycemia and insulin resistance in diet-induced obesity model. We observed the metabolic parameters and Akt signalization and these findings provide evidence that the SMT-I treated group are protected against the development of insulin resistance, glucose intolerance and diet-induced obesity. Therefore, we propose that highly selective inhibitors of iNOS activity may represent a novel therapeutic approach for the therapy of insulin resistance and its complications as type 2 diabetes. / Mestrado / Biologia Estrutural, Celular, Molecular e do Desenvolvimento / Mestre em Fisiopatologia Médica

Made available in DSpace on 2014-07-29T15:04:27Z (GMT). No. of bitstreams: 1 ALYNE COELHO MOREIRA MILHOMEM.pdf: 431961 bytes, checksum: 415048098dc9e868479081b08ad11328 (MD5) Previous issue date: 2010-03-31 / Attention to health in individuals with diabetes reaches better outcomes when carried out by multidisciplinary teams, in which nursing is inserted. Follow up may be favored by the use of terminology specific to the area, namely, North America Nursing Diagnosis Association taxonomy, which presents nursing diagnosis (ND) disturbed sensory perception , which seems to describe the human response of decreased sensibility in the feet of patients with diabetes. Diabetes complications may lead to decreased tactile sensory perception in the extremities. It can lead to complications such as ulcerations and amputation of limbs, causing increased morbidity and mortality. Despite this fact, Nursing studies under the perspective of identifying disturbed sensory (tactile) perception in the feet for care of individuals with diabetes are scarce. This study aimed at assessing the occurrence of ND disturbed sensory (tactile) perception in the feet in individuals with type 2 diabetes. This is a transversal observational clinic study, carried out in the endocrinology laboratory at a school hospital in the municipality of Goiânia-GO, from May to October in 2009. Data was collected through clinical assessment and reports using standard questionnaire. The 55 individuals assessed consisted of 36 (65.5%) female and 19 (35.5%) male with average age of 59.4 (+/- 10.6 years, Diabetes diagnosis time of 14 years on average, ranging from 1 to 32 years. We identified that 61.8% of the participants showed some kind of complication due to the disease, and 43.6% reported having had previous ulcers in their feet. The median for glycosylated hemoglobin among participants was 8.4%, being 80.9% had values higher than the recommended ones. The found median for capillary glycemia was 240.0 mg/dL, being 83.6% of all participants showed higher values than the recommended ones. Forty-seven individuals (85.5%) showed disturbed sensory (tactile) perception in the feet . Concerning related factors, all have presented biochemical imbalance, 78.7% psychological stress, 21.8% altered transmission and reception, and 21.3% electrolytic imbalance. Concerning defining characteristics, all presented changes in the usual response to stimuli and changes in sensorial acuity and 83.0% sensorial distortions. There was no statistically significant association between ND studied with social demographic and morbidity variables. The outcomes indicate that this phenomenon deserves special attention from nurses, due to its high prevalence and severity of complications. This study also evidences the usefulness of permanence and refining this diagnosis in the NANDA taxonomy. / A atenção à saúde das pessoas com diabetes alcança melhores resultados quando realizada por equipe multiprofissional, na qual está inserida a Enfermagem. Seu acompanhamento pode ser favorecido pela utilização de terminologias específicas da profissão, como exemplo, a taxonomia da North American Nursing Diagnosis Association, que apresenta o diagnóstico de enfermagem (DE) percepção sensorial perturbada , que parece descrever a resposta humana de diminuição de sensibilidade nos pés das pessoas com diabetes. As complicações do diabetes podem levar a diminuição da percepção sensorial tátil nas extremidades. Esta pode levar a problemas como ulceração e a amputação dos pés ou pernas, causando aumento da morbidade e mortalidade. Apesar disso, estudos de Enfermagem na perspectiva de identificação da percepção sensorial perturbada (tátil) nos pés no atendimento a pessoas com diabetes são escassos. Este estudo objetivou analisar a ocorrência do DE percepção sensorial perturbada (tátil) nos pés em pessoas com diabetes tipo 2. Trata-se de um estudo clínico observacional, de corte transversal, realizado no ambulatório de endocrinologia de um hospital universitário no município de Goiânia GO, entre maio e outubro de 2009. A coleta de dados foi realizada mediante consulta do prontuário e avaliação clínica utilizando formulário padronizado. Os 55 participantes avaliados consistiram em 36 (65,5%) pessoas do sexo feminino e 19 (35,5%) do sexo masculino, com média de idade de 59,4 (± 10,6) anos, tempo de diagnóstico de diabetes com mediana de 14 anos, variando de um a 32 anos. Identificou-se que 61,8% dos participantes apresentavam algum tipo de complicação decorrente da doença e 43,6% relataram já ter apresentado úlceras prévias nos pés. A mediana para hemoglobina glicosilada entre os participantes foi de 8,4%, sendo que 80,9% tinham valores maiores que o recomendado. A mediana encontrada da glicemia capilar aferida foi de 240,0 mg/dL, sendo que 83,6% dos participantes apresentaram valores maiores que os recomendados. Quarenta e sete pessoas (85,5%) apresentaram percepção sensorial perturbada (tátil) nos pés . Quanto aos fatores relacionados, todos apresentaram desequilíbrio bioquímico, 78,7% estresse psicológico, 21,8% transmissão e recepção alteradas e 21,3% desequilíbrio eletrolítico. Quanto às características definidoras, todos apresentaram mudança na resposta usual aos estímulos e mudança na acuidade sensorial e 83,0% distorções sensoriais. Não houve associação estatisticamente significante entre o DE em estudo com as variáveis sociodemográficas e de morbidade. Os resultados encontrados nessa pesquisa indicam que o fenômeno estudado merece atenção especial dos enfermeiros, devido a sua alta ocorrência e suas graves implicações. Essa pesquisa evidencia ainda a utilidade da permanência e refinamento desse diagnóstico na taxonomia da NANDA-I.

CoordenaÃÃo de AperfeiÃoamento de NÃvel Superior / Objetivou-se analisar as inter-relaÃÃes entre ocupaÃÃo e prevalÃncia de fatores de risco para Diabetes Mellitus tipo 2 existentes entre trabalhadores da equipe de enfermagem e demais profissionais e ocupacionais de saÃde, tendo partido da hipÃtese de que, os trabalhadores da equipe de enfermagem, quando comparados a outros que desenvolvem atividades em hospitais, mas no desempenho de outras ocupaÃÃes, apresentariam uma maior prevalÃncia de fatores de risco para o desenvolvimento do diabetes mellitus tipo 2. Realizou-se um estudo de corte transversal com 299 sujeitos, baseado em formulÃrio, avaliaÃÃo antropomÃtrica e anÃlise de parÃmetros bioquÃmicos, contemplando variÃveis sÃcio-demogrÃficas e relativas aos fatores de risco para Diabetes Mellitus tipo 2. Verificou-se que 40,5% da amostra foram de trabalhadores de enfermagem, 63,9% eram mulheres, 68,6% tinham menos de 35 anos, 49,5% tinham escolaridade equivalente ao ensino mÃdio e 51,9% A partir da anÃlise da RazÃo de PrevalÃncia, aplicada a todos os fatores de risco para DM2 investigados, mostraram-se estatisticamente significantes os seguintes fatores: obesidade abdominal, RelaÃÃo Cintura-Quadril (RCQ) alterada, sedentarismo, tabagismo, macrossomia, histÃria familiar de AVC, histÃria familiar de infarto, histÃria familiar de trombose venosa e HDL- colesterol. Dentre os fatores de risco com significÃncia estatÃstica, foram mais prevalentes entre os trabalhadores de enfermagem: obesidade abdominal, RCQ alterada, sedentarismo, histÃria familiar de AVC e histÃria familiar de infarto. Desse modo, conclui-se que a hipÃtese do estudo, dentro do contexto institucional analisado, foi comprovada. Espera-se, com a realizaÃÃo do estudo, poder contribuir para o debate acerca dos fatores de risco para diabetes mellitus tipo 2 em trabalhadores de enfermagem e, em nÃvel mais abrangente, sobre a manutenÃÃo da saÃde do trabalhador. / This study aimed to examine the interrelationships between occupation and prevalence of risk factors for type 2 diabetes between workers of the nursing staff and other professionals and occupational health, taking advantage of the chance that workers of the nursing staff, when compared to other developing activities in hospitals, but the performance of other occupations, present a higher prevalence of risk factors for developing type 2 diabetes mellitus. We conducted a cross-sectional study with 299 patients, based on form, anthropometric and biochemical analysis, covering socio-demographic variables and relative risk factors for type 2 diabetes. It was found that 40.5% of the sample were nursing workers, 63.9% were women, 68.6% were under 35 years, 49.5% had a level equivalent to high school and 51.9% From analysis of the prevalence ratio, applied to all risk factors for diabetes type 2 investigated were statistically significant the following factors: abdominal obesity, Waist-Hip Ratio (WHR) changed, sedentary lifestyle, smoking, macrosomia, family history of stroke, family history of heart attack, history family of venous thrombosis and HDL-cholesterol. Among the risk factors with statistical significance, were more prevalent among workers in nursing: abdominal obesity, WHR changed, lifestyle, family history of stroke and family history of stroke. Thus, it appears that the hypothesis of the study, within the institutional analyzed, has been proved. It is expected, with the study, to contribute to the debate about the risk factors for type 2 diabetes in nursing and, in broader level, the maintenance of occupational health.

Submitted by JÚLIO HEBER SILVA (julioheber@yahoo.com.br) on 2018-01-02T17:35:25Z No. of bitstreams: 2 Dissertação - Lorena Santana de Mendonça Santos - 2015.pdf: 5730879 bytes, checksum: 313fa403c8d6affa2de5bcf3c1484bfe (MD5) license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) / Approved for entry into archive by Luciana Ferreira (lucgeral@gmail.com) on 2018-01-08T10:34:40Z (GMT) No. of bitstreams: 2 Dissertação - Lorena Santana de Mendonça Santos - 2015.pdf: 5730879 bytes, checksum: 313fa403c8d6affa2de5bcf3c1484bfe (MD5) license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) / Made available in DSpace on 2018-01-08T10:34:40Z (GMT). No. of bitstreams: 2 Dissertação - Lorena Santana de Mendonça Santos - 2015.pdf: 5730879 bytes, checksum: 313fa403c8d6affa2de5bcf3c1484bfe (MD5) license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) Previous issue date: 2015-04-10 / Conselho Nacional de Pesquisa e Desenvolvimento Científico e Tecnológico - CNPq / Hepatitis C (HCV) virus is one of the major cause of chronic liver disease worldwide and 350,000 to 500,000 deaths occur each year related to the virus. Epidemiological studies suggest that chronic HCV infection may have implications in the genesis of some extra-hepatic diseases, among them diabetes mellitius type 2 (DM2). This study aimed to describe the epidemiological profile of HCV infection in DM 2 patients. All patients with DM2 that were followed up at the Hospital das Clinicas da Universidade Federal de Goias and Unidades de Atenção Básica Saúde da Familia in Goiania-GO were invited to take part in the research. 622 patients with DM 2 were recruited, of whom 17 refused to participate. Therefore, the population was composed of 605 individuals, being the casuistry enough to the design of the study according to the sample calculation. Individuals were interviewed and a blood sample was collected. Sera were tested for the detection of anti - HCV by third-generation enzyme-linked immunosorbent assay. Positive samples for this marker were submitted for detection of viral RNA by Polymerase Chain Reaction post Reverse Transition (RT-PCR) and RNAHCV positive samples were genotyped by Line Probe Essay method (LIPA). The average age of the studied population was 62.1 years (SD = 11.3), female predominance and 78.4% have up to 9 years of study. Nine samples were positive for anti-HCV, resulting in a prevalence of 14.9% (95% CI: 0.73-2,9) for HCV infection in patients with DM2. Viral RNA was detected in four anti-HCV positive specimens and genotypes 1 (2/4) and 3 (2/4) were identified. In the multivariate analysis, blood transfusion before 1994 and the use of illicit drugs were associated with HCV infection. Male remained marginally associated (p = 0.06). Despite the global prevalence for HCV in patients with DM 2 in Goiania-GO have been similar to the one found in the population in general, more studies are needed to clarify the epidemiology of HCV infection in individuals with DM 2 and provide information which can support prevention measures and control of infection in this group of the population. / A infecção pelo vírus da hepatite C (HCV) é uma das principais causas de doença hepática crônica em todo o mundo e 350.000 a 500.000 mortes ocorrem a cada ano relacionadas a essa virose. Estudos epidemiológicos sugerem que ser portador de diabetes mellitus tipo 2 (DM 2) constitui um risco elevado para aquisição da infecção pelo HCV. Este estudo teve como objetivo descrever o perfil epidemiológico da infecção pelo HCV em pacientes portadores de DM 2. Todos os pacientes portadores de DM 2 que faziam acompanhamento no Hospital das Clínicas da Universidade Federal de Goiás e em Unidades de Atenção Básica Saúde da Família na cidade de Goiânia-GO foram convidados a participar do estudo. Foram recrutados 622 pacientes portadores de DM 2, destes 17 recusaram a participar do estudo. Portanto, a população foi constituída por 605 indivíduos, sendo esta casuística suficiente para o desenho do estudo de acordo com cálculo amostral. Os indivíduos foram entrevistados e uma amostra de sangue foi coletada. Os soros foram testados para detecção de anti-HCV por ensaio imunoenzimático de 3ª geração. As amostras positivas para esse marcador foram submetidas à detecção do RNA viral pela Reação em Cadeia pela Polimerase pós Transcrição Reversa (RT-PCR) e as amostras RNA-HCV positivas foram genotipadas pelo método Line Probe Assay (LiPA). A média de idade da população estudada foi 62,1 anos (dp=11,3), predomínio do sexo feminino e 78,4% possuíam até nove anos de estudos. Nove amostras foram positivas para anti-HCV, resultando em uma prevalência de 1,49 % (IC 95%: 0,73-2,90) para a infecção pelo HCV nos portadores de DM 2. O RNA viral foi detectado em quatro amostras anti-HCV positivas e os genótipos 1 (2/4) e 3 (2/4) foram identificados. Na análise multivariada, transfusão de sangue antes de 1994 e uso de drogas ilícitas foram associadas à infecção pelo HCV. Sexo masculino manteve-se marginalmente associada (p=0,06). Apesar da prevalência global para o HCV em portadores de DM 2 em Goiânia-GO ter sido semelhante à encontrada na população em geral, são necessários mais estudos para esclarecer melhor a epidemiologia da infecção pelo HCV em indivíduos portadores de DM 2 e fornecer informações que possam subsidiar medidas de prevenção e controle dessa infecção nesse grupo populacional.

Estudos têm investigado possíveis associações do estado nutricional relativo ao zinco de indivíduos com diabetes e o controle metabólico da doença, e mais recentemente tem-se procurado avaliar a influência do polimorfismo Arg325Trp no gene que codifica para o transportador de zinco 8 (ZnT8) no mecanismo de secreção da insulina. Assim, o objetivo deste estudo foi analisar a presença desse polimorfismo e associá-lo com o estado nutricional relativo ao zinco de pacientes com diabetes mellitus tipo 2 e aos parâmetros glicêmicos e insulinêmicos. Este estudo foi de natureza transversal, constituído por 82 pacientes com idades entre 29 e 59 anos, de ambos os gêneros com diagnóstico de diabetes mellitus tipo 2, atendidos no Serviço de Endocrinologia e Metabologia do Hospital da Clínicas da Faculdade de Medicina da Universidade de São Paulo. Foi realizada a genotipagem do polimorfismo Arg325Trp no gene do ZnT8 e avaliadas as concentrações de zinco no plasma, eritrócitos e urina, a glicemia de jejum, percentual de hemoglobina glicada, resistência à insulina, função das células β e o perfil lipídico. Realizou-se a avaliação da composição corporal por meio da bioimpedância e de medidas antropométricas. A ingestão alimentar foi avaliada por meio do método recordatório de 24 horas aplicado durante 3 dias não consecutivos, incluindo um dia de final de semana. Os resultados mostraram que a maioria dos indivíduos com DM2 encontrava-se com sobrepeso, apresentavam baixas concentrações de zinco nos eritrócitos, elevada excreção urinária e concentrações de zinco no plasma adequadas. Não houve diferença significativa nesses parâmetros quando se considerou os indivíduos de acordo com os genótipos do SNP avaliado. No entanto, ao avaliar os parâmetros de medida do status de zinco dos pacientes, aqueles que apresentavam deficiência tinham percentual de hemoglobina glicada mais elevado. Assim sendo, pode-se concluir que o zinco pode favorecer o controle glicêmico. O polimorfismo Arg325Trp no gene SLC30A8 que codifica para ZnT8 não influenciou o estado nutricional relativo ao zinco e os parâmetros glicêmicos e insulinêmicos dessa população. / Studies have investigated the possible association of zinc nutritional status of individuals with diabetes and metabolic disease control, and more recently have been made to evaluate the influence of Arg325Trp polymorphism in the gene encoding the zinc transporter 8 (ZnT8) in the mechanism of insulin secretion. The objective of this study was to analyze the presence of this polymorphism and associate it with the nutritional status of zinc in patients with type 2 diabetes mellitus and glucose and insulinemic parameters. This study was cross-sectional nature, consisting of 82 patients aged between 29 and 59 years, of both genders diagnosed with type 2 diabetes mellitus treated at the Endocrinology and Metabolism Clinics of the Hospital of St. University Medical Faculty Service Paulo. Arg325Trp polymorphism genotyping was performed in ZnT8 gene and evaluated zinc concentrations in plasma, erythrocytes and urine, fasting blood glucose, glycated hemoglobin percentage, insulin resistance, β cell function and the lipid profile. There was the assessment of body composition by bioelectrical impedance and anthropometric measures. Dietary intake was assessed using the 24-hour recall method applied for 3 non-consecutive days, including a day of the weekend. The results showed that the majority of subjects with T2DM found to overweight, had low zinc concentration in erythrocytes, high urinary excretion and zinc concentrations in the appropriate plasma. There was no significant difference in these parameters when considering the individuals according to the SNP genotypes evaluated. However, when assessing the zinc status as parameters of patients, those with disabilities had higher percentage of glycated hemoglobin. Thus, it can be concluded that zinc may favor glycemic control. The Arg325Trp polymorphism in the SLC30A8 gene encoding ZnT8 did not influence the nutritional status of zinc and glycemic parameters and insulinemic this population.

Introduktion: Diabetes är en sjukdom som drabbar fyra till sex procent av Sveriges befolkning, 80 procent av dem har diabetes mellitus typ 2. Symtom för diabetes är ökad törst, ökad urinmängd samt trötthet. Diabetes behandlas med livsstilsförändringar samt medicinering. Det är hälso- och sjukvårdens uppgift att påverka patientens levnadsvanor och motivera till en livsstilsförändring. En distriktssköterska ska arbeta hälsofrämjande för att förebygga sjukdom.  Syftet: Studiens syfte var att undersöka faktorer som påverkar följsamhet till livsstilsråd hos personer med diabetes mellitus typ 2 inom primärvården. Metod: Enligt metod beskriven av Statens beredning för medicinsk utvärdering [SBU] har en systematisk litteraturstudie genomförts. Studier till litteraturstudien söktes fram i databaserna Cinahl och PubMed. Elva artiklar utgör resultatet i litteraturstudien.  Resultat: I studiens resultat framkom tre teman med kategorier. Det som framkom som påverkade följsamheten till livsstilsråd hos personer med diabetes mellitus typ 2 var temat personliga faktorer med kategorierna: motivation, fysisk och kognitiv förmåga, kunskap och utveckling. Temat sociala faktorer med kategorierna: relationer med närstående, relationer med vårdpersonal och språkbarriärer. Temat omgivningsfaktorer med kategorierna: ekonomiska förutsättningar, kultur och religion samt klimat. Slutsats: Det fanns flera faktorer som påverkade följsamheten till livsstilsråd, både positivt och negativt. För personer med diabetes mellitus typ 2 var stöd av vårdpersonal viktigt för följsamheten. Vårdpersonal skall identifiera personens motivation till livsstilsförändringar. Studien ger ökad kunskap om vilka faktorer som påverkar följsamheten och kan hjälpa distriktssköterskor i sitt hälsofrämjande arbete med personer med diabetes mellitus typ 2. / Introduction: Diabetes affects four to six percent of Sweden's population, 80% of them have type 2 diabetes mellitus. Symptoms of diabetes are increased thirst, increased amount of urine and fatigue. The treatment for diabetes is lifestyle changes as well as medication. It is the responsibility of healthcare personnel to influence the patient's living habits and motivate a lifestyle change. Health promotion constitutes one area of the district nurses work. Aim: The aim of the study was to examine factors affecting adherence to lifestyle advice among persons with diabetes mellitus type 2 in primary care. Method: According to method described by Swedish Agency for Health Technology Assessment and Assessment of [SBU], a systematic literature review was used. Studies in the literature study were searched in the databases Cinahl and PubMed. Eleven studies formed the basis for the study results. Result: In the study result, three themes with categories are described. What was identified as affecting the adherence with lifestyle advice among people with diabetes were personal factors with the categories: motivation, physical and cognitive ability, knowledge and development. The topic of social factors with the categories: relationships with related people, relationships with healthcare professionals and language barriers. The theme of environmental factors included the categories: economic conditions, culture and religion and climate. Conclusion:  There were several factors that influenced adherence with lifestyle advice, both positively and negatively. For people with type 2 diabetes mellitus, support from healthcare professionals was important for adherence. Healthcare professionals should identify the person's motivation for lifestyle changes. The study provides increased knowledge of the factors that affect adherence and can assist district nurses in health promotion with persons with type 2 diabetes mellitus.

Independent and supplementary prescribing are the two main forms of non-medical prescribing (NMP) that have been practised in the UK since 2006. Most available studies have qualitatively investigated the impact of NMP, especially in primary care. This may be due to the fact that prescriptions are issued mainly by general practitioners in primary care. This PhD thesis aimed at investigating the clinical effectiveness of independent pharmacist and diabetes specialist nurse (DSN) prescribers in the management of patients with type 2 diabetes at outpatient clinics in hospitals. A literature review was firstly conducted to explore the current research on NMP around the world and the UK. A systematic review of the previously published randomised control trials (RCT) and non-RCT studies that focused on prescribing interventions of nurses and pharmacist was also conducted to explore the impact of their prescribing interventions in treating type 2 diabetes using HbA1c level as the primary outcome. A programme of work of three retrospective comparative database analytical studies was then carried out to investigate the impact of independent NMPs in type 2 diabetes care. This programme of work used electronic medical records of patients attending outpatient clinics of diabetes centres in two teaching hospitals in Manchester; one employed an independent pharmacist and the other employed DSN prescribers. A group of subjects seen by an NMP in place of a doctor during the study period were the study group and the control group were those who seen only by doctors. The primary outcome was the average yearly change of HbA1c amongst the two groups. Secondary outcomes were yearly change of total cholesterol, blood pressure and serum creatinine as well as body mass index. Five statistical models, which included multivariable regression, propensity score matching and sensitivity analyses, were utilised to control for confounding effects, and the nature of selection bias in the retrospectively comparative effectiveness research using secondary database resources. A total of 330 patients seen by a team including a pharmacist versus 975 by doctors only between January 2006 and January 2013 at one site; and 656 by a team including DSNs versus 3,746 patients seen by doctors only between January 2007 to December 2013 at the other. The studies found both prescribing pharmacists and DSNs are capable of achieving at least non-inferior improvements in diabetes outcome compared to doctors. The pharmacist achieved a mean 0.01% reduction in HbA1c level versus doctors who achieved slight increase (p<0.4). DSNs also achieved a mean 0.07% reduction compared to doctors. However, after adjustment with multivariate and propensity score as well as with propensity score matching, there were no significant differences between the two groups. These findings were consistent with the findings in the systemic review. Although an RCT is the only method that by definition would produce unbiased treatment effects, the use of propensity score methods here, have reduced the potential for bias that may remain unaccounted for in multivariate models without propensity scores. Adjusting for propensity scores using two different methods also gives more confidence that the results are as unbiased as possible. Nonetheless, caution in generalising the results is necessary because of the retrospective nature of the studies and deficiencies in the database used.

Orientadores: Antonio Carlos Boschiero, Luiz Fernando de Rezende / Dissertação (mestrado) - Universidade Estadual de Campinas, Instituto de Biologia / Made available in DSpace on 2018-08-26T15:31:43Z (GMT). No. of bitstreams: 1 Kurauti_MirianAyumi_M.pdf: 1902413 bytes, checksum: ff555addcb6b815d619a2368635ae4f4 (MD5) Previous issue date: 2015 / Resumo: A hiperinsulinemia, frequentemente associada a doenças como obesidade e diabetes tipo 2, decorre do aumento da secreção e redução do clearance de insulina, processo que acontece principalmente no fígado pela ação da IDE ("insulin degrading enzyme"), principal enzima responsável pela degradação da insulina. Sabe-se que o exercício físico reduz a insulinemia, entretanto, seu efeito sobre o clearance de insulina ainda não está totalmente esclarecido. Portanto, o objetivo deste trabalho foi avaliar o efeito do exercício físico agudo sobre o clearance de insulina e expressão proteica de IDE, em camundongos alimentados com dieta hiperlipídica. Camundongos C57BL6 foram distribuídos em 3 grupos: Controle (CTL), Obeso (O) e Obeso Exercitado (OE) e, submetidos a 12 semanas de dieta CHOW (CTL) ou hiperlipídica (O e OE). O exercício físico agudo foi realizado em esteira com duração de 3 horas (intensidade de 60-70% do VO2máx). Após o exercício, tolerância à glicose (ipGTT), à insulina (ipITT) e ao piruvato (ipPTT), bem como o clearance de insulina foram avaliados. Os camundongos foram eutanasiados por decapitação para coleta de sangue e órgãos como: fígado, tecido adiposo perigonadal, músculo esquelético gastrocnêmio e pâncreas, do qual foram isoladas as ilhotas pancreáticas para avaliar a secreção de insulina estimulada por glicose. Proteínas foram extraídas dos tecidos para análise da expressão proteica de IDE, IR, p-Akt e p-AMPK (Western blot). Testes estatísticos ANOVA One-Way seguido de pós-teste Tukey foram empregados para análise dos resultados. Comparado ao grupo CTL, camundongos do grupo O apresentaram aumento da massa corporal e de tecido adiposo perigonadal, hiperglicemia, hiperinsulinemia, intolerância à glicose e à insulina, aumento da glicemia durante o ipPTT, hipersecreção e redução do clearance de insulina, além de redução da expressão proteica de IDE, IR e p-Akt no fígado e, redução de p-AMPK no tecido adiposo perigonadal e também no fígado. Como esperado, o exercício agudo não alterou a massa corporal e a massa do tecido adiposo perigonadal, entretanto reduziu a glicemia e insulinemia, melhorou a tolerância à glicose e à insulina, reverteu o aumento da glicemia durante o ipPTT, reduziu a secreção de insulina e aumentou o clearance de insulina dos camundongos OE. Além disso, aumentou a expressão proteica de IDE, IR e p-Akt no fígado e músculo gastrocnêmio e, aumentou a p-AMPK apenas no músculo gastrocnêmio desses camundongos. Os resultados demonstram que apenas uma sessão de exercício físico pode melhorar significativamente a homeostase glicêmica de camundongos obesos. Em adição, o exercício agudo, além de reduzir a secreção de insulina, aumentou o clearance desse hormônio, justificando a redução da insulinemia nesses obesos. Tal aumento no clearance de insulina ocorre provavelmente via aumento da expressão proteica de IR e IDE no fígado e músculo gastrocnêmio, indicando um possível novo mecanismo pelo qual o exercício físico reduz a insulinemia. Estes resultados mostram a importância do clearance de insulina na regulação desse hormônio em obesos. Portanto, estratégias farmacológicas dirigidas ao aumento do clearance de insulina pode ser uma ferramenta importante na prevenção e/ou tratamento de doenças associadas à hiperinsulinemia, como obesidade e Diabetes tipo 2 / Abstract: Hyperinsulinemia is often associated with pathological conditions such as obesity and type 2 diabetes. It occurs by increase in insulin secretion and decrease in insulin clearance that occurs, mainly, in liver by insulin degrading enzyme (IDE), the main responsible for insulin degradation. It is known that exercise reduces insulinemia, however, its effects on insulin clearance remain unclear. The aim of this study was to investigate the effect of a single bout of acute exercise on insulin clearance and IDE protein expression in mice fed a high-fat diet. C57BL6 male mice were distributed in three groups: Control (CTL), Obese (O) and Exercised obese (OE), fed for 12 weeks with CHOW diet (CTL) or high-fat diet (O and OE). Acute exercise was performed on a treadmill for 3 hours (60 ¿ 70% of VO2 máx). After, glucose tolerance (ipGTT), insulin tolerance (ipITT), piruvate tolerance (ipPTT), and insulin clearance was evaluated. Mice were beheaded to obtain blood and organs samples such as liver, gastrocnemius skeletal muscle, perigonadal adipose tissue and pancreas. The islets were isolated by pancreases digestions with collagenase, and used to evaluate the insulin secretion stimulated by glucose. Protein from various tissues was extracted and the expression of IDE, IR, p-Akt and p-AMPK were assessed (Western blot). ANOVA One-Way and Tukey post-test were used for the analysis of the results. Compared to the CTL group, the O group showed increased body and perigonadal adipose tissue masses, hyperglicemia, hyperinsulinemia, glucose and insulin intolerance, higher glycemia during ipPTT, hypersecretion and lower insulin clearance, in addition to reduction of IDE, IR and p-Akt protein expression in liver, and, p-AMPK reduction also in liver and perigonadal adipose tissue. As expected, acute exercise did not alter body and perigonadal adipose tissue masses, however it reduced glycemia and insulinemia, improved glucose and insulin tolerance, reversed higher glycemia during ipPTT, decreased insulin secretion and increased insulin clearance in obese mice. Moreover, acute exercise increased the expression of IDE, IR and p-Akt proteins in liver and gastrocnemius muscle, and p-AMPK only in gastrocnemius muscle in these obese mice. These results show that acute exercise improves glucose homeostasis in obese mice. In addition, besides the reduction in insulin secretion, the increase in insulin clearance, induced by exercise, explain the lower insulinemia in OE group. This increased insulin clearance occurs most likely by the augment in the expression of IDE and IR proteins in liver and gastrocnemius muscle, suggesting a new possible mechanism whereby acute exercise reduces insulinemia. Taken all together, this study demonstrate that insulin clearance is very important to insulin regulation in obese. Therefore, pharmacological strategies targeting to increase insulin clearance may be an important way to prevention and/or treatment of diseases associated with hyperinsulinemia, such as obesity and type 2 diabetes / Mestrado / Fisiologia / Mestra em Biologia Funcional e Molecular

Bakgrund: Diabetes är ett växande problem i Sverige liksom i övriga världen. Sjukdomen och dess komplikationer orsakar mycket lidande och stora kostnader för samhället. Inom diabetesvården arbetar personalen för att patienter med diabetes ska leva ett gott liv med så lite lidande och komplikationer som möjligt. För att säkra kvalitén och utveckla vården behöver vårdpersonalen systematiskt och kontinuerligt identifiera förbättringsområden och genomföra små som stora förbättringsarbeten. Syfte: Denna studie syftar till att beskriva diabetessjuksköterskans arbete med förbättringar inom primärvården samt att beskriva faktorer som främjar respektive hindrar arbetet med förbättringar. Metod: Metoden som användes var en enkätbaserad kvantitativ tvärsnittsstudie. Totalt 84 diabetessjuksköterskor inom primärvården i Västra Götalandsregionen besvarade enkäten. Data analyserades statistiskt och redovisades deskriptivt. Öppna frågor analyserades med kvalitativ innehållsanalys. Resultat: Resultatet visade att 92% tyckte att det är mycket viktigt att bedriva förbättringsarbete och 56% angav att de hade ganska stora möjligheter att utföra förbättringsarbete. Av diabetessjuksköterskorna som besvarade enkäten så hade 63% ganska ofta idéer om förbättringsarbete och 73 % hade kunnat bedriva förbättringsarbete. Det som tydligast angavs som viktigt för att bedriva förbättringsarbete var stöd från ledningen, ett fungerande samarbete med övrig personal och tid för reflektion kring förbättringsområde. Slutsats: Diabetessjuksköterskan tycker det är viktigt med förbättringsarbete och har ofta idéer om förbättringsområden. Om försättningar ges vad gäller stöd från ledning, samarbete med övrig personal och tid för att kunna bedriva förbättringsarbete så ökar möjligheterna för att utvecklingen och kvaliteten av diabetesomvårdnaden drivs framåt. / Diabetes is a growing problem in Sweden as well as in the rest of the world. The disease and its complications cause a great deal of suffering and great costs to society. In diabetes care, health care personnel work to ensure that patients with diabetes live a good life with as little suffering and complications as possible. To ensure quality and develop care, healthcare personnel need to systematically and continuously identify areas of improvement and carry out small and large improvement work. Objective: The aim of the study was to explore the diabetes specialist nurse's work with improvements in primary care and to describe factors that promote and hinder the improvement work. Method: The method used was a survey-based quantitative cross-sectional study. A total of 84 diabetes specialist nurses in the Västra Götaland region answered the questionnaire. Data were analyzed statistically and presented descriptively. Open-ended questions were analyzed by qualitative content analysis. Results: The results of the study showed that 92% of the participants thought it was very important to do improvement work, 80% felt that they had very large or quite large opportunities to do improvement work and 86% indicated that they very often or quite often had ideas about improvement work. 73% of the participants had the opportunity to participate in improvement work. What was most clearly stated as important for being able to carry out improvement work was that they had support from management and time to be able to carry out improvement work. Conclusion: The diabetes specialist nurse's thinks it is important and often has ideas for improvement work. If the diabetes specialist nurse is given the conditions for conducting improvement work such as support from management, a working collaboration with other staff and time for reflection on improvement areas, it can lead to increased quality in diabetes care and better care for patients with diabetes.

Bakgrund:Diabetes mellitus typ 2 (DM2) är en folksjukdom som innebär ett tillstånd av kronisk hyperglykemi. Sjukdomen har ökat och uppskattas fortsätta öka globalt. Samhälleliga insatser är väsentliga för att bevara människors hälsa och sätta stopp på den snabba ökningen. Kost, fysisk aktivitet, glukosmätning samt medicinering är alla en del av den egenvård som DM2 kräver. DM2 klassas som en kronisk sjukdom, en sådan sjukdom som kan påverka de drabbade individerna både fysiskt och psykiskt. Sjuksköterskan har en central roll i vården av patienter med DM2 för att utbilda, informera, vårda och stötta dem. Syfte: Syftet var att undersöka patienters upplevelse av egenvård vid diabetes mellitus typ 2. Metod: En litteraturöversikt med 10 vetenskapliga artiklar, hämtade från databaserna CINAHL complete och Pubmed. Dessa analyserades genom Fribergs beskrivning.  Resultat: Sex huvudteman identifierades. “Källor till stöd vid diabetes”, “Att vara i kontroll över sin sjukdom”, “Känslor, attityder och förhållningssätt till egenvård”, “Kost och fysisk aktivitet”, “Ekonomiska aspekter”, “Hälso- och sjukvårdspersonalens roll vid egenvården av diabetes”. Sammanfattning: Stöd från närstående vid egenvård samt kunskap och utbildning kring DM2 var centrala faktorer för deltagarna i studierna. Vid bristande kunskap var egenvård svårt att uppnå men vid god kunskap upplevdes en känsla av kontroll över sjukdomen. De mest förekommande hindren för egenvård var relaterade till kost, ekonomi och sociala sammanhang. Vårdpersonalen behöver förbättra den information och utbildning som är nödvändig för patienter med DM2 för att de ska kunna uppnå god egenvård. / Background: Diabetes mellitus type 2 (DM2) is a public health disease that implies a state of chronic hyperglycemia. The disease has increased and is estimated to globally continue to increase significantly. Societal inputs are essential to preserve people's health and to stop the large increase. Diet, physical activity, glucose monitoring and medication are all a part of the self-care that DM2 requires. DM2 is classified as a chronic illness, a kind of illness that can impact the affected individuals both physically and mentally. Nurses have a central role in the care of patients with DM2 to educate, inform, care and support them. Aim: The aim was to explore patients experience of self-care in diabetes type 2. Method: A literature review with 10 scientific articles, chosen from the databases CINAHL complete and Pubmed. These were analyzed through Fribergs description. Results: Six main themes were identified. “Souces of support within diabetes”, “To be in control of the disease”, “Feelings, attitudes and approach in self-care", “Diet and physical activity”, “Economic aspects”, “Healthcare professionals roll within the self-care of diabetes”. Conclusion: Support from loved ones with self-care and knowledge and education about DM2 were key factors for the participants. In lack of knowledge was self-care difficult to achieve but with good knowledge, was a feeling of control over the illness experienced. The most occurring obstacles for self-care was related to diet, economy, and social settings were among other things. Healthcare providers need to improve the information and education that is necessary for patients with DM2 so that they can achieve good self-care.