Introducción: El incremento de pacientes con diabetes ha forjado la búsqueda de nuevas investigaciones y de nuevos enfoques terapéuticos preventivos de esta enfermedad. En los últimos años viene cobrando gran importancia el estudio de la asociación entre la diabetes tipo 2 y los microorganismos que habitan en el tracto gastrointestinal, responsables de modificar y contribuir positiva o negativamente con el metabolismo del huésped. Metodología: En el estudio participaron 26 pacientes con diabetes mellitus tipo 2 atendidos en el servicio de Endocrinología de un hospital nivel 4, durante el periodo de agosto de 2016 a febrero de 2017. De cada paciente se colectaron muestras de heces, datos clínicos y la frecuencia de consumo de alimentos. Se identificaron 13 bacterias de la microbiota intestinal en muestras fecales de pacientes diabéticos tipo 2 metabólicamente controlados frente a no controlados mediante la técnica de reacción en cadena de la polimerasa (PCR). Resultados: Se identificó al menos un género de bacterias colónicas en pacientes diabéticos controlados y no controlados en 5 (71,4%) y 11 (57,9%) de los casos respectivamente. Los géneros de bacterias más frecuentes encontrados en los pacientes controlados fueron Proteobacteria, Firmicutes y Prevotella; mientras que en los pacientes no controlados se encontró con mayor frecuencia Prevotella, Firmicutes y Clostridium. Conclusiones: La comunidad bacteriana que reside en el colon es única en cada individuo y varía constantemente. Se observó la presencia de 11 bacterias en total. No se encontró diferencia estadística en la comparación de ambos grupos. / Introduction: The increasing incidence of patients with the diagnosis of Diabetes Mellitus type 2 (DM2) has shifted the focus of new research on preventative therapeutic approaches. Recent evidence suggests an important association between the prognosis of patients with DM2 and their gastrointestinal bacterial microbiota linked to modifications that may positively or negatively change the host’s metabolism. Methodology: The study included 26 patients diagnosed with Diabetes Mellitus Type 2 in the Endocrinology service of a tertiary referral hospital, between August 2016 and February 2017. Stool samples were collected from each patient as well as their food consumption frequency record and relevant clinical data. The fecal bacterial microbiota was analyzed by polymerase chain reaction (PCR) to identify 13 different genera of bacterias from type 2 diabetic patients metabolically controlled versus uncontrolled type 2 diabetic patients. Results: At least one genus of colonic bacteria was identified in controlled and non-controlled diabetic patients in 5 (71.4%) and 11 (57.9%) respectively. The most frequent bacterial genera found in the controlled patients were Proteobacteria, Firmicutes and Prevotella; while in the non-controlled patients were Prevotella, Firmicutes and Clostridium Conclusions: The gut microbiota of a host is unique to each patient and varies constantly. It was observed the presence of 11 bacteria in total. No statistical difference was found in the comparison of both groups. / Tesis

Publicación a texto completo no autorizada por el autor / Evalúa la correlación entre la HbA1c y la fórmula predictora de la resistencia a la insulina (SPISE) en adultos sin diabetes mellitus. Se incluyen datos bioquímicos, antropométricos y familiares de 100 pacientes que acudieron a los consultorios de endocrinología del Centro Médico Naval “CMST”, durante el año 2016, de entre 30 y 60 años de edad. Se recolectó información de sexo, edad, antecedentes familiares, índice de masa corporal (IMC), valores de hemoglobina glicosilada (HbA1c), colesterol total, triglicéridos, HDLc y LDLc. Se calculó los valores de la fórmula SPISE empleando los datos recolectados. Encuentra que la edad de los pacientes estudiados fue de 52 ± 6.1. El 41% estuvo conformado por el sexo femenino y el 59% por el sexo masculino. Según su IMC, el 55% tuvo sobrepeso y el 33% presentó obesidad. Los pacientes que presentaron antecedentes familiares de DM fueron el 16%. El coeficiente de correlación de Spearman mostró que entre la HbA1c y la fórmula SPISE no existe correlación significativa (Rho = - 0.85, p = 0.39). Sin embargo, la correlación de Spearman entre la relación TG/HDLc y la fórmula SPISE fue inversa y significativa (Rho= -0.61, p = < 0.01). Concluye en que no existe correlación significativa entre la HbA1c y la fórmula SPISE. / Tesis

Submitted by Isaac Francisco de Souza Dias (isaac.souzadias@ufpe.br) on 2016-02-26T17:23:06Z No. of bitstreams: 2 license_rdf: 1232 bytes, checksum: 66e71c371cc565284e70f40736c94386 (MD5) DISSERTAÇÃO MARCELA NÓBREGA DE LUCENA LEITE.pdf: 1863331 bytes, checksum: dc70fe914b3ae6741d9873a4bed5141c (MD5) / Made available in DSpace on 2016-02-26T17:23:06Z (GMT). No. of bitstreams: 2 license_rdf: 1232 bytes, checksum: 66e71c371cc565284e70f40736c94386 (MD5) DISSERTAÇÃO MARCELA NÓBREGA DE LUCENA LEITE.pdf: 1863331 bytes, checksum: dc70fe914b3ae6741d9873a4bed5141c (MD5) Previous issue date: 2015-02-26 / O diabetes mellitus tipo 1 é uma doença crônica que acomete um grande número de crianças em todo o mundo e o seu controle inadequado está relacionado a uma alta frequência de complicações agudas e crônicas. Portanto, o objetivo deste estudo foi verificar a efetividade de um programa educativo com crianças e adolescentes portadores de diabetes mellitus tipo 1. Trata-se de um estudo de intervenção quase-experimental do tipo antes e depois com 76 crianças e adolescentes com diabetes mellitus tipo 1, com idade entre 2 e 18 anos. O programa educativo em diabetes consistiu em reuniões semanais realizadas no período de março de 2013 a fevereiro de 2014, nas quais cada paciente participava de quatro reuniões, uma a cada três meses, e os temas eram abordados de forma homogênea, para que não houvesse diferença de informações entre os grupos. Os principais desfechos avaliados foram: controle metabólico e frequência de complicações agudas e, como co-variáveis, adesão ao tratamento e às mudanças de estilo de vida. Observamos independência significantemente maior das crianças e adolescentes na aplicação de insulina antes e após a intervenção (25% vs 42,1%), maior adesão parcial à mudança na dieta (31,6% vs 57,9%), melhor compreensão acerca da doença por parte das crianças e adolescentes e seus cuidadores, redução na resistência ao uso da insulina (22,4% vs 7,9%) (p=0,09) e aumento significante da ausência de internamentos (60,5% vs 94,7%). Em relação à hemoglobina glicada, não foi observada diferença significante de sua concentração antes e após a intervenção. Concluímos que o grupo educativo foi uma ferramenta útil para melhorar a adesão ao tratamento e, consequentemente, contribuir para uma redução da frequência de complicações agudas, apesar de não termos observado melhora no perfil metabólico, avaliado pela medição da hemoglobina glicada. A participação de uma equipe interdisciplinar é de grande valia para estimular a adesão ao tratamento, bem como a participação da família, propiciando uma melhor compreensão da doença e motivação para aderir à terapêutica. / Type 1 diabetes mellitus is a chronic disease that affects a large number of children around the world and its inadequate control is related to a high frequency of acute and chronic complications. Therefore, the aim of this study is to assess the effectiveness of an educational program with children and adolescents with type 1 diabetes mellitus. This is a before and after quasi-experimental intervention study with 76 children and adolescents with type 1 diabetes mellitus, aged 2 to 18 years. The diabetes education program consisted of weekly meetings held from March 2013 to February 2014, in which each subject attended four meetings, one every three months. The educational topics were covered evenly, in order to avoid differences in information between groups. The main outcomes were: metabolic control and frequency of acute complications and as co-variates: treatment adherence and lifestyle changes. There was a significant increase of children and adolescents independence of insulin administration before and after intervention (25% vs 42.1%), higher partial accession to the change in diet (31.6% vs 57.9%), better understanding of the disease by children and adolescents and their caregivers, reduction in resistance to the application of insulin (22.4% vs 7.9%) (p = 0.09) and significant increase in the absence of hospital admissions (60.5% vs. 94.7%). There was no significant difference in glycated hemoglobin concentration before and after the intervention. We conclude that the education group was a useful tool to improve treatment adherence and therefore to contribute to a reduction in the frequency of acute complications, in spite of not observing any improvement in the metabolic profile, as assessed by measurement of glycated hemoglobin. The participation of a interdisciplinary team is extremely useful for better adherence to treatment, as well as family involvement, which leads to a better understanding of the disease and motivation to treatment compliance.

Objetivo: Determinar la relación entre el nivel de hemoglobina glicosilada y el riesgo de desarrollar diabetes mellitus tipo 2 en el plazo de diez años, en pacientes no diabéticos de un Hospital de Lima Norte. Metodología: El presente estudio fue descriptivo, observacional, transversal y prospectivo, se realizó en el consultorio externo de un Hospital de Lima Norte, participaron 101 personas no diabéticas entre 18 y 65 años de uno u otro sexo, y se relacionó los niveles de hemoglobina glicosilada con el riesgo de desarrollar diabetes mellitus tipo 2 en el plazo de diez años mediante el test de FINDRISK. Resultados: Se estudiaron 101 pacientes no diabèticos, el 66.7% fueron del sexo femenino, el grupo etario más frecuente fue los menores de 35 años, (44.1%). El 99% de los encuetados presentaron valores normales de hemoglobina glicosilada. Los resultados del test de FINDRISK mostraron que el 29.7% de los evaluados tuvieron riesgo bajo de desarrollar diabetes tipo 2 en el plazo de 10 años, y el 21.8% tuvieron riesgo de moderado y alto. Cuando se asoció hemoglobina glicosilada con el riesgo de desarrollar diabetes s mellitus tipo 2 no se encontró asociación p=0.218. Conclusión: No se halló relación estadísticamente significativa cuando se relacionó la hemoglobina glicosilada con los riesgos de desarrollar diabetes mellitus tipo 2, en la población estudiada. / Objective: To determine the relationship between the glycosylated hemoglobin level and the risk of developing type 2 diabetes mellitus within ten years in non-diabetic patients in a Hospital in North Lima. Methodology: This study was descriptive, observational, transversal, and prospective, and was carried out in the outpatient clinic of a Hospital in Lima Norte, 101 non-diabetic persons between 18 and 65 years of age from one sex or another, And glycosylated hemoglobin levels were associated with the risk of developing type 2 diabetes mellitus within ten years using the FINDRISK test. Results: 101 non-diabetic patients were studied, 66.7% were female, the age group was the most frequent ones under 35 years of age (44.1%). 99% of respondents had normal glycosylated hemoglobin values. Results of the FINDRISK test showed that 29.7% of those evaluated had a low risk of developing type 2 diabetes within 10 years, and 21.8% had moderate and high risk. When glycosylated hemoglobin was associated with the risk of developing type 2 diabetes Mellitus, no association was found p=0.218. Conclusion: No statistically significant relationship was found when glycosylated hemoglobin was associated with the risks of developing type 2 diabetes mellitus in the study population. / Trabajo de investigación

Objetivo: Valorar la asociación entre el control glicémico y la presencia de microalbuminuria en pacientes con diabetes mellitus tipo 2. Métodos: Se realizó un estudio transversal analítico en pacientes con diabetes mellitus tipo 2 de una clínica privada en Lima, Perú. Se incluyeron pacientes adultos mayores de 18 años que pertenecían a un programa de seguimiento durante el 2018 en una clínica privada. El mal control glicémico fue definido con una hemoglobina glicosilada mayor o igual a 7%. La presencia de microalbuminuria fue definida considerando valores de albúmina mayores a 20 mg/L en la primera orina de la mañana. Se realizó un modelo de regresión lineal generalizado de la familia de Poisson con varianza robusta. Calculamos la razón de prevalencias cruda y ajustada con un intervalo de confianza de 95%. Resultados: Se analizaron los datos de 907 participantes, la mediana de edad fue de 58 años (RIC 49 a 66) y 62,8% de los participantes fueron hombres. La prevalencia de mal control glicémico fue de 39,8%, y la prevalencia de microalbuminuria fue de 32,7%. La prevalencia de microalbuminuria en el grupo de mal control glicémico y en el de buen control glicémico fue de 44,1% y 25,3% respectivamente. En el análisis de regresión ajustada, se encontró una asociación estadísticamente significativa entre el mal control glicémico y microalbuminuria. (RPa=1.48; IC 95%: 1.19-1.85). Conclusión: Se encontraron altos niveles de hemoglobina glicosilada y microalbuminuria en la población estudiada. Los adultos con diabetes mellitus tipo 2 con mal control glicémico tuvieron una mayor prevalencia de microalbuminuria en la primera orina del día. / Background and Aims: Microalbuminuria is the first sign for diabetic nephropathy in people with type 2 diabetes mellitus (T2DM). Few studies associate poor glycemic control and higher microalbuminuria prevalence in Latin American populations. We aimed to evaluate the association between glycemic control and microalbuminuria in adults with T2DM. Methods: We conducted a cross-sectional analytical study in adults with T2DM from a private clinic in Lima, Peru. We included adults over 18 years old who belonged to the clinical follow-up program in 2018. We defined poor glycemic control based on the serum value of glycosylated haemoglobin (HbA1C) ≥7%. We defined microalbuminuria considering albumin values > 20 mg/L in the first-morning urine. We carried out generalized linear regression models from the Poisson family with robust variance. We calculated the crude and adjusted prevalence ratio (PR) with their 95% confidence interval (CI). Results: We analyzed 907 participants, the median age was 58 years (IQR 49 to 66), and 62.8% were males. The prevalence of poor glycemic control was 39.8%, and the prevalence of microalbuminuria was 32.7%. The prevalence of microalbuminuria in the group with poor glycemic control and adequate glycemic control was 44.1% and 25.3%, respectively. In the adjusted regression analysis, we found a statistically significant association between poor glycemic control and microalbuminuria (aPR=1.48; 95% CI: 1.19-1.85). Conclusion: Our study population had high levels of glycosylated haemoglobin and microalbuminuria. T2DM adults with poor glycemic control had more likelihood of microalbuminuria in the first-morning urine. / Tesis