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Fisieke aktiwiteit en insuliensensitiwiteit by swart kinders / Annemarié HeineHeine, Annemarié January 2005 (has links)
The increased prevalence of obesity amongst adolescents is considered a worldwide
epidemic. Within the black population of South Africa, obesity is significantly more
prevalent amongst black girls than black boys. The high prevalence of obesity amongst
children can be attributed to a combination of various lifestyle factors, namely a decrease
in physical activity, an increase in television viewing, Westernization and increased food
supply.
The decrease in physical activity amongst adolescents over the last few decades has led to
an increase in the number adolescents diagnosed with type 2 diabetes mellitus. Research
has indicated that insulin sensitivity improves with regular physical endurance activity,
irrespective of change in bodyweight. Regular physical exercise also lowers the risk of
type 2 diabetes mellitus, and prevents the development of coronary heart diseases,
hypertension and obesity.
The primary goals of this study were two-fold: Firstly, to determine the relationship
between BMI, percentage body fat and insulin sensitivity amongst black adolescents, and,
secondly, to determine whether there exists a positive correlation between current
cardiovascular fitness (V02-maximum),together with everyday physical activity status,
and insulin sensitivity amongst black adolescents. One hundred and twenty-four (124)
black boys and 148 black girls between the ages of 14 and 17 participated in the study.
The BOD-POD was used to calculate percentage body fat, and blood analysis for fasting
glucose and insulin were completed. Insulin sensitivity (QUIKI-index) and resistance
(HOMA) were also calculated, and habitual physical activity was measured using the
"Previous Day Physical Activity Recall" (pDPAR) questionnaire. Physical development
was determined with the Tanner questionnaire, cardiovascular fitness (VO2-maximum)
was determined using the "Bleep" test and anthropometry (mass, length, skin folds, waist
and hip circumference) was measured to determine body composition.
The results of this study found a statistically significant negative correlation between skin
fold thickness, percentage body fat, BMI and insulin sensitivity in girls. A significant
negative correlation between percentage body fat and V02-maximum was found in boys,
while their self-reported activity (PDPAR) did not correlate with percentage body fat.
Current cardiovascular fitness and habitual physical activity status (PDPAR) showed no
significant relationship with insulin sensitivity. Amongst the girls there was however a tendency towards a positive correlation between insulin sensitivity and V02-maximum. / Thesis (M.Sc. (Human Movement Science))--North-West University, Potchefstroom Campus, 2006.
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Socioeconomic inequalities in type 2 diabetes mellitus in EuropeEspelt Hernández, Albert, 1981- 28 November 2011 (has links)
Type 2 diabetes mellitus (T2DM) has become a major health problem worldwide. The St. Vincent declaration emphasized the urgent need to improve the epidemiological knowledge of this disease in Europe. Within Europe, research on the link between socioeconomic position (SEP) and type 2 diabetes is scarce.
The objective of this thesis was to conduct an extensive review of the current literature on socioeconomic inequalities in type 2 diabetes within European countries, while analyzing the relationship between, incidence, prevalence and mortality due to T2DM and SEP. In addition, we also analyzed trends on SEP inequalities in the prevalence of T2DM in Spain (1983-2006). Finally, we also assessed the appropriate use of health surveys with self-reported diagnosis in order to further analyze the relation between SEP and T2DM.
Different sources of information were used throughout the study. The systematic review was completed using the PUBMED database while the empirical studies used data of two European projects, the EUROTHINE, SHARE and the Spanish National Health Survey (study of trends in SEP inequalities in T2DM) along with the Catalonia health surveys (study of validation). The thesis consists of 5 papers that attempt to respond to the different objectives.
The studies included in this thesis suggest that socio-economic position (SEP) inequalities affect the incidence, prevalence and mortality by T2DM in Europe. These SEP inequalities are partly explained for body mass index, diet and physical activity. Moreover, these inequalities seemed to have remained constant or increased over time. Finally, health interview surveys with self-reported T2DM seems to be a good instrument to evaluate SEP inequalities in T2DM. / La Diabetis Mellitus Tipus 2 (DM2) ha esdevingut un dels principals problemes de salut a nivell mundial. La declaració de ST VINCENT emfatitzava la necessitat i la urgència de millorar-ne el coneixement epidemiològic a nivell Europeu. Els estudis a nivell europeu sobre les desigualtats per Posició Socioeconòmica (PSE) en la DM2 eren força escassos.
L’objectiu d’aquesta tesi era fer una revisió extensa dels estudis publicats sobre desigualtats per PSE en la DM2 a Europa, així com analitzar la relació entre la incidència, la prevalença i la mortalitat per DM2 i la PSE. Un altre objectiu també era analitzar la tendència de les desigualtats per PSE en la prevalença de DM2 a Espanya (1983-2006). Finalment, com a objectiu també hi figurava el valorar l’ús adequat de les enquestes de salut amb auto - declaració de DM2 per tal d’avaluar les desigualtats per PSE en la DM2.
Per tal de dur a terme els objectius es van emprar diferents fonts d’informació. Per tal de dur a terme la revisió sistemàtica es va emprar la base de dades de PUBMED mentre que pels estudis empírics es van utilitzar les dades de dos projectes europeus com són el projecte EUROTHINE i el SHARE i les enquestes nacionals de salut d’Espanya (per la tendència de diabetis) i de Catalunya (per la validació). La tesi consta de 5 articles que intenten donar resposta als diferents objectius.
Els estudis inclosos en aquesta tesi suggereixen que existeixen desigualtats per posició socioeconòmica (SEP) en la DM2, tant en la incidència, en la prevalença com en la mortalitat a Europa. Aquestes desigualtats per PSE s’expliquen en part per l’índex de massa corporal, la dieta o l’activitat física. A més a més, aquestes desigualtats sembla que s’han mantingut constants o han crescut al llarg del temps. Finalment, s’ha vist que les enquestes de salut amb la pregunta d’auto-declaració de la diabetis són un bon instrument per avaluar les desigualtats per PSE en la DM2.
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Economic burden of diabetes on patients and their families in Sudan /Elrayah-Eliadarous, Hind. January 2007 (has links)
Lic.-avh. (sammanfattning) Stockholm : Karolinska institutet, 2007. / Härtill 2 uppsatser.
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On endothelial function in type 2 diabetic patients with coronary artery disease /Nyström, Thomas, January 2005 (has links)
Diss. (sammanfattning) Stockholm : Karolinska institutet, 2005. / Härtill 5 uppsatser.
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The intersectionality of diabetes and the cultural-political contexts of urban American Indians / Selina A. Mohammed.Mohammed, Selina A. January 2004 (has links)
Thesis (Ph. D.)--University of Washington, 2004. / Vita. Includes bibliographical references (leaves 183-207).
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Estudo comparativo da concentração de glicose salivar e sanguínea em pacientes diabéticos tipo 2Vasconcelos, Ana Carolina Uchoa 05 December 2007 (has links)
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Previous issue date: 2007-12-05 / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior - CAPES / Diabetes mellitus is an endocrine disease, which causes alteration in assimilation, metabolism and balance of the blood glucose concentration. It is believed that the high level of blood glucose is linked to the development of buccal alterations; however, there is some controversy in the studies that aim to compare the concentration of blood and salivary glucose in diabetic patients. The objective of this paper is to comparatively evaluate the concentration of blood and salivary glucose as well as the salivary flow and xerostomia in type 2 diabetic and non-diabetic patients. Eighty adult subjects of both sexes have been selected, being 40 adults diabetic of the experimental type and 40 adults non-diabetic belonging to control. The total in-rest and stimulated salivary flow has been determined as well as the concentration of peripheral blood and salivary glucose. Descriptive analysis was carried out and Mann-Whitney and qui-square tests were applied considering significant values of p<0,05. The average value of salivary glucose in diabetic patients was 14,03±16,76 mg/dl and in the control group, 6,35±6,02 mg/dl, with p= 0,036. The capillary blood glucose in diabetic patients presented an average value equivalent to 213,23±87,98 mg/dl and, in non-diabetic patients it was equivalent to 99,15±13,72 mg/dl, with p= 000. The average value for the in-rest salivary flow was 0,21±0,16 ml/min in diabetic patients and 0,33±0,20 ml/min in the control group with p= 0,002. The stimulated salivary flow was lower in the group of diabetic patients, with an average of 0,63±0,43 ml/min, in relation to the control group, which presented an 1,20±0,70 ml/min average, with p= 0,00. Out of the diabetic patients, 45% had hyposalivation contrasting to 2,5% out of the non-diabetic patients, with p=0,00. Xerostomia was reported in 12,5% of diabetic patients and 5% of non-diabetic patients, with p=0,23. We can conclude that the salivary glucose concentration was significantly higher in the experimental group and that there was no correlation between the salivary and blood glucose concentration in diabetic patients. The total salivary flows were significantly reduced in diabetic patients and there was no significant difference as to the presence of xerostomia in both groups. / O diabetes mellitus é uma doença endócrina que causa alteração na assimilação, metabolismo e equilíbrio da concentração da glicose sanguínea. Acredita-se que o elevado nível de glicose sangüínea esteja associado ao desenvolvimento de alterações bucais, porém, existe controvérsia nos estudos que objetivam comparar a concentração de glicose sanguínea e salivar em pacientes diabéticos. O objetivo do presente estudo foi avaliar comparativamente a concentração de glicose salivar e sanguínea, o fluxo salivar e a xerostomia em pacientes diabéticos tipo 2 e não diabéticos. Foram selecionados 80 indivíduos adultos, de ambos os sexos, sendo 40 adultos diabéticos pertencentes ao experimental e 40 adultos não diabéticos pertencentes ao controle. Determinou-se o fluxo salivar total em repouso e estimulado, a concentração de glicose salivar e sanguínea periférica. Realizou-se análise descritiva e aplicaram-se testes de Mann-Whitney e qui-quadrado, considerando significantes valores de p<0,05. O valor médio de glicose salivar nos diabéticos foi 14,03±16,76 mg/dl e, no grupo controle, 6,35±6,02 mg/dl, com p= 0,036. A glicose sanguínea capilar nos diabéticos apresentou valor médio equivalente a 213,23±87,98 mg/dl e, nos não diabéticos, a 99,15±13,72 mg/dl, com p= 000. O valor médio para o fluxo salivar em repouso foi de 0,21±0,16 ml/min nos diabéticos e 0,33±0,20 ml/min no grupo controle, com p= 0,002. O fluxo salivar estimulado foi inferior no grupo dos diabéticos, com média de 0,63±0,43 ml/min, em relação ao grupo controle que apresentou média 1,20±0,70 ml/min, com p= 0,00. Entre os diabéticos, 45% apresentaram hipossalivação, contrastando com os 2,5% entre os não diabéticos, com p=0,00. A xerostomia foi referida em 12,5% dos diabéticos e 5% dos não diabéticos, com p=0,23. Pode-se concluir que concentração de glicose salivar foi significativamente maior no grupo experimental e que não houve correlação entre a concentração da glicose salivar e glicose sanguínea nos indivíduos diabéticos. Os fluxos salivares totais mostraram-se significativamente reduzidos nos pacientes diabéticos e não houve diferença significativa quanto à presença de xerostomia em ambos os grupos.
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Excess body weight, hyperandrogenism and polycystic ovary syndrome:impact on women’s reproductive and metabolic healthWest, S. (Sammeli) 30 October 2018 (has links)
Abstract
Polycystic ovary syndrome (PCOS) is a common endocrine disorder affecting 5–15% of women of reproductive age. The syndrome is characterized by menstrual irregularities, hyperandrogenism and polycystic ovaries. Infertility is a major problem in PCOS and it can be explained partially by chronic anovulatory cycles. Excess body weight and insulin resistance are common among women with PCOS, exposing them to the most common pregnancy complication, gestational diabetes mellitus (GDM) and, later in life, to a higher risk of developing glucose metabolism disorders eventually leading to outbreak of type 2 diabetes mellitus (T2DM). However, the respective roles of the syndrome per se, excess body weight and hyperandrogenism regarding the aforementioned complications are still to be clarified.
The objectives were first to determine the risks of PCOS, infertility problems and decreased fertility at age 26 in women with a history of menstrual irregularity or elevated androgen levels in adolescence (at age 16). We also aimed to clarify whether PCOS per se is associated with decreased fertility and increased incidence of miscarriage, GDM, prediabetes and T2DM. Lastly, we focused on the respective roles of excess body weight and hyperandrogenism as regards the development of GDM and impaired glucose metabolism.
The study populations were derived from the prospective Northern Finland Birth Cohorts 1966 and 1986, comprising all expected births in 1966 (n = 5889 females) and 1986 (n = 4567) in the two northernmost provinces of Finland. The data was complemented with fertility rates and diagnoses of GDM and T2DM from registers held by the National Institute for Health and Welfare and The Social Insurance Institution of Finland.
Menstrual irregularity or elevated androgen levels in adolescence were associated at age 26 with increased risks of PCOS and infertility problems, but not with decreased fertility rates. At the end of their reproductive life women with symptoms of PCOS were not more often childless, had had a similar incidence of miscarriages but had a smaller family size compared with healthy women, and obesity further decreased family size in this group. Excess body weight and elevated androgen levels, but not PCOS per se, were independent risk factors of GDM. The increased risk of T2DM in PCOS was mainly due to excess body weight, although both factors had a synergistic effect on the development of T2DM. / Tiivistelmä
Monirakkulainen munasarjaoireyhtymä (PCOS) on yleinen naisilla esiintyvä hormonaalinen häiriö, josta kärsii 5-15% lisääntymisikäisistä naisista. Kuukautiskierron häiriöt, mieshormoniylimäärä ja monirakkulaiset munasarjat ovat ominaisia oireyhtymälle. Lapsettomuus on keskeinen ongelma oireyhtymässä, mikä johtuu osittain kroonisesta ovulaatioiden epäsäännöllisyydestä tai niiden puuttumisesta. Ylipainoa ja insuliiniresistenssiä esiintyy usein oireyhtymää sairastavilla naisilla ja ne altistavat raskausajan diabeteksen puhkeamiselle. Myöhemmällä iällä PCOS-naisilla on suurentunut riski sairastua sokeriaineenvaihdunnan häiriöihin, jotka lisäävät riskiä tyypin 2 diabeteksen (T2DM) puhkeamiselle. PCOS:n, ylipainon ja mieshormoniylimäärän itsenäiset roolit edellä mainittujen häiriöiden kehittymisessä ovat kuitenkin edelleen epäselviä.
Ensimmäisenä tavoitteena oli selvittää PCOS:n, lapsettomuusongelmien ja alentuneen hedelmällisyyden riskiä 26-vuotiaana naisilla, joilla todettiin kuukautiskierron häiriö tai kohonneet mieshormonipitoisuudet nuoruusiällä (16-vuotiaana). Toiseksi selvitimme, liittyykö PCOS itsessään alentuneeseen hedelmällisyyteen sekä kohonneeseen keskenmenojen, raskausdiabeteksen, diabeteksen esiasteiden ja T2DM esiintyvyyteen. Lisäksi selvitimme ylipainon ja mieshormoniylimäärän itsenäisiä rooleja raskausdiabeteksen ja muiden sokeriaineenvaihdunnan häiriöiden kehittymisessä.
Tutkimusaineistoina olivat Pohjois-Suomen syntymäkohortit 1966 (n = 5889 naista) ja 1986 (n = 4567 naista), joihin sisältyivät kaikki elävänä syntyneet lapset vuosina 1966 ja 1986 kahdesta Suomen pohjoisimmasta läänistä. Tutkimusaineistoja täydennettiin hedelmällisyyslukujen ja GDM- sekä T2DM-diagnoosien osalta Terveyden ja hyvinvoinnin laitoksen ja Kansaneläkelaitoksen ylläpitämistä rekistereistä.
Nuoruusiän kuukautiskierron häiriöt ja mieshormoniylimäärä olivat yhteydessä suurentuneeseen riskiin kehittää PCOS ja kärsiä lapsettomuusongelmista, mutta näiden yhteyttä alentuneisiin hedelmällisyyslukuihin 26-vuotiaana ei todettu. PCOS-oireiset naiset eivät kärsineet lapsettomuudesta lisääntymisiän aikana verrokkinaisia enemmän ja keskenmenojen esiintyvyys ei eronnut oireisten ja terveiden naisten välillä. Oireisilla naisilla oli kuitenkin pienempi perhekoko kuin verrokeilla, ja lihavuus entisestään pienensi perhekokoa oireisilla naisilla. Ylipaino ja mieshormoniylimäärä olivat itsenäisiä riskitekijöitä raskausdiabeteksen kehittymiselle. PCOS ei ollut riskitekijä raskausdiabeteksen kehittymiselle. Kohonnut T2DM-riski PCOS:ssa johtui lähinnä ylipainosta, vaikkakin molemmat tekijät olivat itsenäisiä riskitekijöitä T2DM:n kehittymiselle.
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DINÂMICA PSÍQUICA E EFICÁCIA ADAPTATIVA DE PACIENTES COM DIABETES MELLITUS TIPO 2 / Psychic Dynamics and Effectiveness Adaptative in Patients with Type 2 Diabetes MellitusSantos, Nathália Brandolim dos 28 November 2014 (has links)
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Previous issue date: 2014-11-28 / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior / Diabetes is a chronic disease known for about 3,500 years and that affects, currently, about 18.8 million people in the world, have being, therefore, of great interest to many researchers from different fields. This disease results from a shortage of insulin, which plays a key role in the metabolic processes of the body. The incidence of type 2 Diabetes Mellitus has shown considerable growth in recent decades, mainly due to the high life expectancy and also the result of destructive health behaviors such as substance abuse, poor diet and a sedentary lifestyle. The present study aimed to evaluate the Quality of Life, the psychological dynamic, adaptive efficacy and to verify blood glucose levels of people with type 2 Diabetes Mellitus in a psychoeducational group. The study included 14 people with this chronic disease. The instruments used were: 1. Scale of the Brazilian Association of Market Research Institutes (ABIPEME); 2. Adaptive Operational Diagnostic Scale (EDAO); 3. Test of Object Relations of Phillipson (TRO); and 4. WHOQOL-bref. The results showed that some patients had a significant improvement in their glucose levels after the performed of the psychoeducational group, even noting that some have not yet achieved good control of their blood sugar. The quality of life of participants showed very good levels. To evaluate the efficacy and adaptive psychological dynamics of these participants, it was found that it is difficult to accept that one has a chronic illness and have attitudes to perform the appropriate treatment. We conclude that for these people with diabetes can adhere to the treatment, is necessary for them to present a good ability to resolve conflicts, and showcase your inner world related to the depressive position. If these factors are balanced, the lifestyle and welfare of these patients will be positive, so that they can thus present a good prognosis with fewer complications from the disease for longer life. / O diabetes é uma doença crônica conhecida há aproximadamente 3.500 anos e que atinge, atualmente, cerca de 18,8 milhões de pessoas no mundo, sendo, portanto, de grande interesse a diversos pesquisadores das mais variadas áreas. Esta doença é resultante de uma insuficiência de insulina, que desempenha papel fundamental nos processos metabólicos do organismo. A incidência do Diabetes Mellitus tipo 2 tem apresentado um considerável crescimento nas últimas décadas, principalmente decorrente da elevada expectativa de vida e, também, pelo resultado de comportamentos destrutivos a saúde, como o abuso de substâncias, dieta inadequada e um estilo de vida sedentário. O presente estudo teve por objetivos avaliar a Qualidade de Vida, a dinâmica psíquica, a eficácia adaptativa e verificar os níveis glicêmicos de pessoas com Diabetes Mellitus tipo 2 participantes de um grupo psicoeducativo. Participaram deste estudo 14 pessoas com Diabetes Mellitus tipo 2. Os instrumentos utilizados foram: 1. Escala da Associação Brasileira de Institutos de Pesquisa de Mercado (ABIPEME); 2. Escala Diagnóstica Adaptativa Operacionalizada (EDAO); 3. Teste das Relações Objetais de Phillipson (TRO); e, 4. WHOQOL-bref. Os resultados mostraram que alguns pacientes apresentaram uma melhora significativa em seus níveis glicêmicos após a realização do grupo psicoeducativo, mesmo verificando que alguns não atingiram ainda bom controle de sua glicemia. A qualidade de vida destes participantes apresentou-se com níveis muito bons. Ao avaliar a eficácia adaptativa e a dinâmica psíquica destes participantes, verificou-se o quanto é difícil aceitar que se tem uma doença crônica e ter atitudes para realizar o tratamento adequado. Concluímos que para estas pessoas com diabetes poderem aderir ao tratamento é necessário que ele apresente uma boa capacidade de solucionar conflitos, e, apresente seu mundo interno ligado à posição depressiva. Se estes fatores estiverem equilibrados o estilo de vida e o bem-estar desses pacientes serão positivos, de modo que eles possam apresentar consequentemente um bom prognóstico com menos complicações da doença durante mais tempo de vida.
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Trimetazidina em pacientes com angina estável de difícil controle e diabetes melito tipo 2 : um ensaio clínico randomizadoRibeiro, Leticia Weiss January 2005 (has links)
Objetivos: Avaliar a eficácia anti-isquêmica e efeito metabólico da trimetazidina em pacientes com angina refratária e diabete melito (DM) tipo 2, em uso de pelo menos duas medicações de efeito hemodinâmico, sem condições de revascularização. Métodos: Ensaio clínico randomizado, cruzado, duplo-cego, conduzido em 10 pacientes com DM tipo 2 e angina estável, em tratamento com pelo menos 2 anti-anginosos clássicos. Pacientes foram randomizados para receber trimetazidina (20 mg 3 vezes ao dia) ou placebo, por períodos de 6 semanas. Avaliação clínica, laboratorial, ergométrica e monitorização de pressão arterial (MAPA) e Holter de 24 horas foram realizadas no início do estudo e ao término de 6 semanas de cada intervenção. Resultados: Os pacientes em tratamento com trimetazidina apresentaram melhora significativa na classe funcional da angina (p<0,05), com diminuição significativa no número de episódios de crise anginosa por semana e na dose de nitrato sub-lingual utilizada (p<0,05). O tempo de início da isquemia no teste ergométrico foi maior após o uso da trimetazidina (229 ± 126 s no basal, 276 ± 101 s após o placebo e 348 ± 145 s após a trimetazidina; p<0,05). Não houve diferença nos níveis de pressão arterial, freqüência cardíaca e duplo-produto nas 24h, avaliadas concomitantemente com Holter e MAPA, ou no controle glicêmico e lipídico entre as intervenções. Conclusões: O uso da trimetazidina mostrou-se eficaz como tratamento coadjuvante da angina estável de difícil manejo em pacientes com DM tipo 2 em uso de múltiplos anti-anginosos, sem alteração de variáveis hemodinâmicas avaliadas nas 24 h. Estes dados ampliam o espectro de emprego da trimetazidina no manejo de pacientes sintomáticos e com limitadas opções de tratamento. / Aims: To evaluate the anti-ischemic and metabolic effect of trimetazidine in patients with refractory angina and type 2 diabetes (DM2) not eligible for revascularization and using at least two hemodynamic agents. Methods: Randomized, double-blind, crossover clinical trial conducted in 10 patients. Patients were randomized to receive trimetazidine (20 mg 3 times a day) or placebo for 6-week periods. Clinical and exercise evaluations, in addition to 24-h ambulatory blood pressure and Holter monitoring were carried out at baseline and at the end of each 6-week intervention period. Results: The patients receiving trimetazidine presented significant improvement in terms of angina functional class (p<0.05), with decrease in the number of weekly angina episodes at rest and in the sublingual nitrate dose (p<0.05). Time to 1 mm ST-segment depression was increased after trimetazidine use (229.2 ± 126.1 s at baseline, 276.3 ± 100.9 s after placebo and 347.5 ± 144.6 s after trimetazidine; p<0.001). No differences were observed between treatments group in terms of 24h-blood pressure, heart rate and ratepressure product as evaluated concomitantly with ambulatory blood pressure and Holter monitoring, or in terms of glycemic and lipid profile. Conclusions: The combined use of trimetazidine and haemodynamic agents was efficient to treat stable refractory angina in DM2 patients, significantly improving clinical and exercise parameters. The present data support the use of trimetazidine in the management of symptomatic patients with limited treatment options.
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Reabilitação cardiovascular de curto prazo em mulheres com diabetes mellitus tipo 2 : repercussões sobre o balanço redox, a função vascular e a qualidade de vida / Effects of short-term cardiovascular rehabilitation in women with type 2 diabetes mellitus : repercussions on redox balance, vascular function and quality of lifeSilva, Weriton Ferreira da 04 August 2009 (has links)
Introduction: Diabetes is characterized by insufficient production of insulin and/or incapacity of this hormone in playing its functions. Such disease impairs the function of the endothelium, the latter capable of regulating the vascular tone and important in the control of inflammatory response as well. Once dysfunctional, the endothelium no longer exhibits such functions, occurring mostly redox imbalance, this one evident in diabetic patients. Nowadays, several studies point to endothelial dysfunction as a contributor in the development of diabetic vascular complications, while the practice of physical activity, although of low intensity, brings benefits in the handling of type 2 diabetes, including reduction of cardiovascular risk factors. Physical intervention as a therapeutic proposal appears to be a promising way in the clinical management of diabetes mellitus, probably avoiding the progression of systemic complications. Aim: To assess the vascular function and the REDOX balance in patients with type 2 diabetes mellitus (T2DM) before and after the cardiovascular rehabilitation for six weeks. Methods: 43 diabetic female patients aged 57.50 ± 2.02 years were selected from the ambulatory of Endocrinology at Prof. Alberto Antunes Teaching Hospital (Federal University of Alagoas). The diagnosis for T2DM was established according to the criteria of the Brazilian Society of Diabetes (2007). Initial assessment was performed by laboratory and clinical evaluation. The cardiovascular rehabilitation program consisted of six weeks of aerobic training (50 to 70% of the maximum heart rate), associated to endurance training. Four patients have completed the six weeks rehabilitation program. Assessment of biochemical profile (fasting and postprandial glucose, glicosilated hemoglobin, total cholesterol, VLDL, LDL, HDL, triglycerides, uric acid, albumin and creatinin), REDOX balance (SOD and catalase activity and lipid peroxidation) and quality of life (through the application of the SF-36) were performed before and after the rehabilitation program period. Indirect assessment of vascular function was performed by the Augmentation Index (AI), wave reflection, systolic and diastolic blood pressure and pulse pressure, which were obtained by the left radial artery tonometry (HEM-9000 AI device). Physical capacity was assessed by the six-minute walk test. Results: After rehabilitation, there was a significant reduction in the serum albumin levels (3.52 ± 0.478 vs 3.85 ± 0.50 mg/dL, P=0.0159) and an increase in the serum acid uric levels (5.00 ± 0.25 vs 4.57 ± 0.21 mg/dL, P=0.0298), without, however, alterations in the creatinin levels (P=0.3760). It was observed a reduction in the systolic and diastolic blood pressure (141.50 ± 3.67 vs 117.00 ± 6.01 mmHg, p<0.01; 77.75 ± 1.48 vs 71.25 ± 3.03 mmHg, P<0.05, respectively) and in the pulse pressure (63.75 ± 2.29 vs 45.750 ± 3.68 mmHg, P<0.01), without improvement in the Augmentation Index, with an improvement in five parameters during the assessment of the quality of life: physical functioning (25.00 ± 17.56 vs 93.75 ± 6.25 %, P<0.05), vitality (31.250 ± 10.48 vs 87.50 ± 5.20 %, P<0.05), social functioning (50.00 ± 17.68 vs 100.00 ± 0.00 %, P<0.05), role physical (47.50 ± 8.53 vs 92.50 ± 3.22 %, P<0.01) and bodily pain (21.62 ± 10.68 vs 65.75± 12.49 %, P<0.01). There were no statistically significant changes neither in the glycemic and lipid profiles nor in the functional capacity. Conclusion: The cardiovascular rehabilitation program during six weeks in diabetic patients was capable of promoting improvement in hemodynamic parametres and in the quality of life, without greater changes in the biochemical profile and functional capacity. These observations permit to consider that in diabetic patients the cardiovascular rehabilitation should be initiated as soon as possible to promote a reduction in the cardiovascular risk in these individuals. / Introdução: O diabetes caracteriza-se pela produção insuficiente de insulina e/ou pela incapacidade desse hormônio em desempenhar suas funções. Tal doença prejudica a função do endotélio, tecido este capaz de regular o tônus vascular e a resposta inflamatória. Quando disfuncional, esta camada celular não mais exibe tais funções, ocorrendo, principalmente, o desbalanço redox, evidente em pacientes diabéticos. Atualmente, diversos estudos apontam para a disfunção endotelial como contribuinte para o desenvolvimento das complicações vasculares diabéticas, ao passo que a prática de atividade física, ainda que de baixa intensidade, traz benefícios no manejo do diabetes mellitus tipo 2, incluindo redução dos fatores de risco cardiovascular. Desta forma, a intervenção física como proposta terapêutica apresenta-se promissora no manejo clinico do diabetes mellitus, podendo evitar a progressão de complicações sistêmicas. Objetivo: Avaliar a função vascular e o balanço redox em pacientes portadores de diabetes mellitus tipo 2 (DMII), antes e após a reabilitação cardiovascular por seis semanas. Método: 43 pacientes do sexo feminino com idade média de 57,50 ± 2,02 foram selecionadas do ambulatório de Endocrinologia do Hospital Universitário Prof. Alberto Antunes (Universidade Federal de Alagoas). O diagnóstico de DMII foi estabelecido de acordo com os critérios da Sociedade Brasileira de Diabetes (2007). A avaliação inicial foi feita através de exames clínicos e laboratoriais. O programa de reabilitação cardiovascular consistiu de seis semanas de exercício aeróbio (50 a 70% da freqüência cardíaca máxima) associado a exercícios resistidos. Quatro pacientes completaram as seis semanas de reabilitação. Avaliação do perfil bioquímico (glicemia de jejum e pós-prandial, hemoglobina glicosilada, colesterol total, VLDL, LDL, HDL, triglicerídeos, ácido úrico, albumina e creatinina), balanço REDOX (atividades da SOD e catalase e peroxidação lipídica) e qualidade de vida (através da aplicação do SF-36) foram realizadas antes e após o programa de reabilitação. A avaliação indireta da função vascular foi realizada através do Augmentation Index (AI), onda de reflexão, pressões arteriais sistólica e diastólica e pressão de pulso, obtidos por tonometria da artéria radial esquerda (com o equipamento HEM-9000 AI). A capacidade física foi avaliada através do teste de caminhada de seis minutos. Resultados: Após a reabilitação, houve redução significativa dos níveis séricos albumina (3,52 ± 0,478 vs 3,85 ± 0,50 mg/dL, P=0,0159) e aumento dos níveis de ácido úrico (5,00 ± 0,25 vs 4,57 ± 0,21 mg/dL, P=0,0298), sem, entretanto, alterações dos níveis de creatinina (p=0,3760). Também foram reduzidas as pressões arteriais sistêmicas sistólica e diastólica (141,50 ± 3,67 vs 117,00 ± 6,01 mmHg, P<0,01; 77,75 ± 1,48 vs 71,25 ± 3,03 mmHg, P<0,05, respectivamente) e a pressão de pulso (63,75 ± 2,29 vs 45,750 ± 3,68 mmHg, P<0,01), sem redução no Augmentation Index, com melhora em cinco parâmetros da qualidade de vida: aspectos físicos (25,00 ± 17,56 vs 93,75 ± 6,25 %, P<0,05), vitalidade (31,250 ± 10,48 vs 87,50 ± 5,20 %, P<0,05), aspectos sociais (50,00 ± 17,68 vs 100,00 ± 0,00 %, P<0,05), capacidade funcional (47,50 ± 8,53 vs 92,50 ± 3,22 %, P<0,01) e dor (21,62 ± 10,68 vs 65,75 ± 12,49 %, P<0,01). Não foram observadas variações estatisticamente significativas para o perfil glicêmico, lipídico e capacidade funcional. Conclusão: O programa de reabilitação cardiovascular por seis semanas em pacientes diabéticas foi capaz de promover melhora em parâmetros hemodinâmicos e na qualidade de vida, sem maiores mudanças no perfil bioquímico e capacidade funcional. Estas observações permitem considerar que em pacientes diabéticos a reabilitação cardiovascular deve ser iniciada o mais precoce possível a fim de promover redução do risco cardiovascular nestes indivíduos.
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