Orientador: Chung Man Chin / Banca: Antonio de Padua Pithon Cyrino / Banca: Roberto Barbosa Bazotte / Banca: Julieta Ueta / Banca: Rosangela Gonçalves Peccinini / Resumo: No Brasil estima-se a existência de aproximadamente 12 milhões de adultos com Diabetes Mellitus (DM) e destes entre 54 a 76% apresentam taxas de mau controle. Esta situação torna o DM um sério problema de saúde pública, devido tanto ao número de pessoas afetadas como aos custos envolvidos no seu controle e no tratamento de suas complicações. A previsão é que em 2030 haverá um crescimento de 67,11% nesta população. Tal situação demonstra a necessidade de melhora urgente no atendimento ou a inserção de novas abordagens de cuidado com evidências científicas (estudos translacionais). Neste sentido, este estudo translacional fase 1 pretende desenvolver e avaliar um protocolo de Atenção Farmacêutica intensivo com metodologia educacional de empoderamento (ATENFAR-EPW), visando contribuir na melhoria do controle glicêmico e qualidade de vida de adultos com Diabetes Mellitus tipo 2 (DM2). MÉTODOS. Estudo conduzido em 3 etapas por farmacêutico-educador em diabetes: (1) desenvolvimento e elaboração do protocolo de ATENFAR-EPW e de instrumentos para acompanhamento e avaliação de indicadores; (2) estudo clínico controlado e randomizado em dois grupos - grupo de intervenção com n=12 (GAF) e grupo de atendimento usual com n=8 (GAU); (3) avaliação de aceitação do protocolo. RESULTADOS. (1) características do protocolo desenvolvido: (a) atendimento domiciliar e ou... (Resumo completo, clicar acesso eletrônico abaixo) / Abstract: In Brazil it is estimated there are approximately 12 million adults with Diabetes Mellitus (DM), and, from this population, the rate for poor glycemic control varies from 54 to 76%. This makes DM a serious public health problem due to both, the number of people affected, and the cost of controlling and treating DM related complications. This situation demonstrates the urgent need for improvement in service or the insertion of new approaches to care based on scientific evidence (translational research). Thus, this study aims to develop a translational research and evaluate a protocol for intensive Pharmaceutical Care with educational methodology of empowerment (ATENFAR-EPW), aiming to improve glycemic control and quality of life of adults with diabetes mellitus type 2 (DM2). METHODS. The study was conducted in steps by the pharmacist-educator in diabetes: (1) development and drafting of the protocol ATENFAR-EPW and tools for monitoring and evaluation of the indicators, (2) controlled and randomized clinical study into two groups - the intervention group with n = 12 (GAF) and usual care group with n = 8 (GAU), conducted from October 2010 to July 2011. RESULTS. (1) characteristics of the developed protocol: (a) home care or by phone or outpatient, (b). number of visits / duration = 6 ± 2 visits / 12 weeks, (c) length of service / adult = 56 ± 28 min, (d) no. of interventions / adult = 48 ± 14. (2) Evaluation of the impact of the study: (a) significant reduction in HbA1c (- 1.3 ± 1.1, p = 0.005), (b) significant improvement of... (Complete abstract click electronic access below) / Doutor

Class of 2005 Abstract / Objectives: The purpose was to describe the glycemic control of hospitalized patients treated with sliding scale insulin (SSI) and correlate glycemic episodes to other factors. Methods: The records of 315 patients admitted to a private, 166-bed hospital between August 25 and November 30, 2004 were identified from orders for antidiabetic medications then screened for inclusion and exclusion criteria. 135 of these patients met the criteria for inclusion in this study and their charts were reviewed for demographic data, medical history, medication regimens, blood glucose measurements and SSI use during hospitalization. Hypoglycemia was defined as less than or equal to 50 mg/dL and hyperglycemia greater than 250 mg/dL. Results: Orders for SSI were written for 93% of diabetic patients admitted. 2,904 blood glucose fingerstick measurements were recorded: 15.9% were greater than 250 mg/dL and 0.689% were under 50 mg/dL. The only statistically significant result was the correlation between increased numbers of hyperglycemic episodes and the consumption of the hospital’s “diabetic diet,” p<0.001. The small group of patients admitted for cellulitis (N=6) also experienced more hyperglycemic episodes. There was a trend approaching significance, p=0.055, for an increased number of hyperglycemic episodes in patients with admission blood glucose value over 200 mg/dL. Results based upon the hospital’s standard SSI regimen were not significantly different from other variations of SSI. Implications: SSI was almost always prescribed for hospitalized patients with type 2 diabetes and this regimen resulted in poor glucose control in approximately 17% of fingerstick measurements.

Purpose: The aim of this study was to determine whether glycemic control is different between subjects who screened negative for Celiac Disease (CD) compared to subjects who screened positive for CD among subjects with autoimmune insulin-dependent diabetes. Also, this study investigated if the presence of specific beta cell autoantibodies, GAD65, Islet cell antibodies or both, could predict the risk for positive CD screening. METHODS/PROCEDURES: A retrospective cohort study of an existing clinical care data was obtained from the Clinical Data Warehouse (CDW) in Boston Medical Center (BMC) for the period between January 2000 and November 2015. The exposed cohort included those who screened positive for CD, while the non-exposed cohort included subjects who screened negative for CD. The following data was collected and included in the analysis: demographic variables, A1C levels, Diabetic Ketoacidosis (DKA) events, diabetes-associated antibodies, CD screening tests, and CD biopsy results. Longitudinal data for each subject was obtained from the CDW. RESULTS: The prevalence of potential CD in this study was 8.8%, while the prevalence of biopsy confirmed CD was 4.4%. Mean A1C level for subjects who screened negative for TTG was 8.9% (CI 8.3 - 9.6), while mean A1C levels for subjects who screened positive for TTG was 7.9% (CI 6.8 - 9.0) after adjusting for confounders using the mixed-effect model. This difference was not statistically significant. Moreover, diabetes-associated antibodies did not predict the risk for positive TTG screening. CONCLUSION: The glycemic control for subjects who screened negative for CD was found to be similar to subjects who screened positive for CD. However, further studies with higher power and larger sample size are needed to confirm the findings of this study. / 2017-11-03T00:00:00Z

Bakgrund: Diabetes är en allvarlig folkhälsosjukdom som påverkar kroppens egen möjlighet till att reglera blodets glukosvärde. Den största riskgruppen för att utveckla diabetes typ 2 är individer med övervikt. Regelbunden fysisk aktivitet har visat positiv inverkan på såväl glukosvärden. Vilken effekt korta pauser med fysisk aktivitet har på glukosvärde i blodet vid långvarigt stillasittande är inte lika utforskat. Det kan vara värdefullt som fysioterapeut att kunna ge relevanta rekommendationer angående fysisk aktivitet till individer med diabetes typ 2 eller övervikt för att kunna minska komplikationer. Syfte: Systematiskt granska enskilda studier och sammanväga tillförlitligheten för effekten på glukosvärde i blodet av korta pauser med fysisk aktivitet i samband med stillasittande hos individer med diabetes typ 2 och övervikt.  Metod: Litteratursökningen genomfördes i databasen Pubmed och resulterade i åtta studier inkluderades. Studierna kvalitétgranskades enligt PEDro scale och evidens graderingen genomfördes genom GRADEstud. Resultat: Korta pauser av fysisk aktivitet i samband med stillasittande resulterar i en signifikant minskning av glukosvärde hos individer med diabetes typ 2 eller övervikt. Kvalitétsgranskningen enligt PEDro visar att sex studier anses vara av måttlig kvalitét och två studier av hög kvalitét. Den sammanlagda tillförlitligheten enligt GRADEstud av underlaget bedömdes vara låg (++).  Konklusion: Effekten av fysisk aktivitet hos stillasittande individer med diabetes typ 2 eller övervikt visade ett minskat glukosvärde jämfört med dem som var långvarigt stillasittande. Evidensen bedömdes vara låg vilket visade på ett behov av fler högkvalitativa studier inom området för att kunna bekräfta resultatet. / Background: Diabetes is a public health disease that affects the body's own ability to regulate the blood's glucose. Overweight individuals have the highest risk of developing type 2 diabetes. The effect that physical activity has on glucose levels in conjunction with sedentary sitting is not as explored as regular interventions of physical activity. It can be valuable as a physiotherapist to be able to give recommendations to individuals with type 2 diabetes or overweight to reduce complications.  Purpose: Systematically review studies and their reliability on the effect of physical activity on blood glucose in conjunction with sedentary sitting on individuals with type 2 diabetes or overweight. Method: The literature search was conducted on the database Pubmed and resulted in eight studies. The studies quality was reviewed with PEDro scale and the evidence reviewed with GRADEstud. Results: Short breaks of physical activity in conjunction with sedentary sitting resulted in a significant decrease of glucose levels on individuals with diabetes type 2 and overweight. The quality review with PEDro showed that six studies were of moderate quality and two studies of high quality. The overall reliability according to GRADEstud was rated low(++). Conclusion: The effect of short breaks of physical activity in conjunction with sedentary sitting on individuals with diabetes type 2 or overweight shows decreased glucose levels compared with sedentary sitting. The evidence was rated low which shows a need for more high quality studies in the subject to confirm the results .

Short-term physical inactivity in older adults has been shown to cause muscular atrophy and impaired glycemic control, however, the ability to recover remains unknown. We aimed to determine the impact of step-reduction (SR) on older adults and if they could recover simply by returning to habitual activity. Ten older adults (6 men, 4 women, 69 ± 3 yr) completed 7d of normal baseline activity (BL), subsequently underwent SR by 86 ± 9% (8568 ± 3741 to 973 ± 76 steps/d; p<0.001) for 14d and then returned to 8383 ± 4513 steps/d for 14d (RC). During an oral glucose tolerance test (OGTT), SR resulted in elevated plasma glucose concentration ([G]) area under the curve (AUC; 325 ± 126 to 375 ± 137, p = 0.13), maximum [G] (10.2 ± 2.4 to 11.9 ± 1.7 mM, p = 0.027) and 2-hr [G] (7.9 ± 1.3 to 9.1 ± 1.1 mM, p = 0.085), while all [G] indices returned to BL after RC. However, Matsuda insulin sensitivity index was reduced (3.5 ± 0.3 to 2.7 ± 0.7, p < 0.001) and homeostatic model assessment of insulin resistance was elevated (2.8 ± 0.3 to 3.6 ± 0.7, p = 0.02) with SR, remaining different than BL after RC (p < 0.005). During free-living conditions, 3-hr post-prandial [G] (PPG) AUC and peak PPG increased following SR (p > 0.05), returning to BL with RC. Body composition and physical function remained unchanged with SR. These results show that periods of physical inactivity, characterized by reduced daily stepping, do not present detectable changes in body composition or physical function yet result in reduced glycemic control in older adults. While elevations in blood [G] are abolished with 14d of normal physical activity, our findings suggest that the SR-associated reductions in insulin sensitivity are not normalized as quickly. / Thesis / Master of Science in Kinesiology / Periods of physical inactivity such as hospitalizations decrease daily steps for older adults and this inactivity can cause losses of muscle, strength, and symptoms of diabetes. It was unknown if by simply returning to normal physical activity older persons could ‘reverse’ the consequences of step-reduction so we conducted a study involving two weeks of step-reduction and two weeks of recovery. While there was no change in strength or muscle mass, we found that when older adults reduced their daily steps to fewer than 1000/day, after two weeks they became ‘resistant’ to insulin, a hormone that helps control blood sugar and is connected to the development of type II diabetes. Although these older adults resumed normal step-count levels in the recovery phase, they did not recover their insulin sensitivity such that two weeks of normal daily activity was not sufficient to overcome the consequences of two weeks of inactivity.

Background: Since March 2020, health systems around the world shifted to virtual care approaches as social distancing measures were recommended to stem the spread of SARS-COV-2, the virus responsible for the COVID-19 pandemic. For children and families living with type 1 diabetes, virtual consultations in pediatric diabetes care were rare prior to the pandemic but became the norm since the start of the pandemic. Data regarding glycemic outcomes and comorbidities in children living with type 1 diabetes mellitus (T1DM) during the pandemic are limited, and there is a need for these data to drive future care models design and delivery. Aim & Methods: The aim of this project was to assess the association of the COVID-19 pandemic with measures of glycemic control (HbA1c), hyperglycemia, hypoglycemia, diabetic ketoacidosis (DKA) and hospitalization for the period spanning March 2020-2021 at McMaster Children’s Hospital, a tertiary pediatric academic center in Hamilton, Ontario, Canada. Data from the onset of virtual care were compared with data from two years pre-pandemic. Results: The COVID-19 pandemic was not associated with changes in HbA1c (MD -0.14, p=0.058), hospitalization (OR 0.57, p=0.068), or hypoglycemia (OR 1.11, p=0.484), but was significantly associated with the increase in reported hyperglycemia (OR 1.38, p=0.003) and reduction in DKA presentation (OR 0.30, p=0.009). Conclusions: Glycemic control was stable during the early stages of the COVID-19 pandemic, when virtual and hybrid care models prevailed in diabetes care. These results suggest that patients and their families were able to adapt to the uncertain circumstances of the pandemic. Virtual consultations for pediatric diabetes did not hinder glycemic control, and likely aided in the maintenance of diabetes management. Longitudinal studies are necessary before virtual consultations should be recommended to replace in-person clinic visits, but the initial data seem encouraging. / Thesis / Master of Science (MSc) / The COVID-19 pandemic restricted face-to-face healthcare-based interactions to limit the spread of the virus. These restrictions posed as a challenge for children and youth with type 1 diabetes mellitus (T1DM), who relied exclusively on in-person clinic visits as part of their care regimen pre-pandemic. In this retrospective study, we assessed the association of the first year of the COVID-19 pandemic with measures of glycemic control (HbA1c), diabetic ketoacidosis (DKA), hospitalization, hyperglycemia, and hypoglycemia, compared to two years pre-pandemic. We determined that children living with type 1 diabetes had no deterioration of glycemic control measures, apart from an increase in hyperglycemia, during the first 12 months of the pandemic. This study provides insights into health outcomes of children living with T1DM in the early stages of the pandemic and offers a roadmap to guide the further avenues of exploration needed to assess the full impact of the pandemic on this population.

No description available.

Introduction: Brief vigorous exercise can enhance glycemic control. Limited work has investigated the effect of simple, practical interventions that require no specialized equipment. We examined the effect of bodyweight exercise (BWE) on acute glycemic control using continuous glucose monitoring (Abbott Libre Sense) under controlled dietary conditions This study was registered as a clinical trial (NCT05144490). Methods: Twenty-seven healthy adults (8 males, 19 females; age: 23±3 y) completed two virtually supervised trials in random order ~1 wk apart. The trials involved an 11-min BWE protocol that consisted of five, 1-min bouts performed at a self-selected pace interspersed with 1-min active recovery periods or a non-exercise sitting control period (CON). Food intake was standardized for each participant using pre-packaged meals supplied over 24 h. Results: Mean rating of perceived exertion for BWE was 14±2 (6-20 scale). Mean HR over the 11-minute the BWE protocol was 147±14 bpm which corresponded to 75% of age-predicted maximal HR. Mean 24-h glucose after BWE and CON was not different (5.0±0.4 vs 5.0±0.5 mM respectively; p=0.39). Postprandial glucose responses were also not different between trials after ingestion of a 75 g glucose drink, lunch, dinner and breakfast meals after each intervention. Measures of glycemic variability were not different between conditions. Conclusion: A single session of BWE did not alter acute glycemic control in healthy, young adults. This study demonstrates the feasibility of conducting a remotely supervised BWE intervention using CGM under free-living conditions. Future studies should investigate the effect of repeated sessions of BWE training as well as responses in people with impaired glycemic control. / Thesis / Master of Science (MSc) / We investigated the effect of brief bodyweight exercise (BWE) on glycemic control. This refers to the ability to maintain blood sugar within a healthy range. Glycemic control was assessed with a small device called a continuous glucose monitor (CGM) that is inserted just below the skin. Healthy adults completed a virtually supervised 11-minute BWE protocol or an equivalent period of sitting. There was no difference in glycemic control measured over 24 hours following the BWE compared to sitting under standardized dietary conditions. Future studies should investigate the effect of repeated sessions of BWE training as well as responses in people with impaired glycemic control.

Type 1 diabetes is one of the most common pediatric chronic illnesses. Adolescents are at risk for poorer glycemic control; however, youth whose parents remain involved in diabetes care are in better control. The current study examined parental involvement (PI) using a multi-method, multi-source approach in a sample of 255 youth (Age M = 12.83). The Diabetes Family Responsibility Questionnaire, Parental Monitoring of Diabetes Care Scale, and 24-Hour Diabetes Interview assessed two types of PI, parental responsibility and parental monitoring. Global and specific assessment served to cross-corroborate indicators of PI related to HbA1c. Higher levels of monitoring related to lower HbA1c for both parent- and youth-report; however, the effect decreased after controlling for socioeconomic status (SES). Additionally, monitoring mediated the relation between age and HbA1c. Controlling for SES, youth whose parents demonstrated higher levels of monitoring were in better glycemic control. Both research and clinical implications are discussed.

Individual growth curve (IGC) modeling evaluated longitudinal trajectories of glycemic control and diabetes care of youth with Type 1 Diabetes (T1D) over three years. IGC modeling allowed comparison of confounded sociodemographic predictors of disease outcomes that included ethnicity, SES, parent marital status, family structure, as well as disease duration, to determine the relative impact of these factors in the evolution of HbA1c and diabetes care throughout adolescence. At baseline, participants recruited from two pediatric endocrinology clinics included 198 youth, ages 9-15 (M age = 12.65, 77% Caucasian, 74% lived with married biological parents, M SES = 45.70) with average HbA1c of 8.43% and reported diabetes care behaviors consistent with ADA recommendations. Glycemic control did not deteriorate significantly, but IGC modeling detected a trend of a steady decline in HbA1c of .01% each year. Youth with married biological parents had HbA1c levels approximately 1.23% lower than youth with alternative parent marital status throughout adolescence, t = 4.03, p < .001, although an age by marital status interaction, t = -2.34, p < .05, indicated the impact of parent marital status on HbA1c decreased at age 17. Analyses revealed significant annual declines in blood glucose monitoring frequency, t = -7.61, p < .001, eating frequency, t = -9.04, p < .001, and exercise frequency, t = -7.87, p < .001. Alternatively, the consumption of carbohydrates and fats remained relatively stable throughout adolescence. Consideration of sociodemographic predictors and disease duration further clarified trajectories of disease care behaviors. Throughout adolescence, African American youth reported lower blood glucose monitoring frequency than Caucasian youth. Youth with lower SES exercised less frequently and demonstrated poorer dietary consumption than youth with higher SES. Youth from families with alternative parent marital status ate and exercised less frequently compared to youth from married biological families. However, youth from single-parent homes exercised more frequently than those from two-parent homes. Longer disease duration related to declines in blood glucose monitoring frequency, yet better dietary consumption. Results may inform development of interventions for youth at risk of poor glycemic control and diabetes management across ethnicity, SES, and parent marital status groups.