Diss. (sammanfattning) Linköping : Univ., 2005. / Härtill 5 uppsatser.

Introdução: O processo educativo e de suporte deve ser permanente e compartilhado, tendo o indivíduo com diabetes como o centro de toda a ação. A automonitorização glicêmica é, em geral, a primeira prática de autocuidado ensinada à criança com diabetes mellitus tipo 1 (DM1) em seu processo de autonomia no manejo da doença. Objetivos: Geral: Avaliar a efetividade da oficina educativa no desempenho da técnica de monitorização glicêmica capilar em crianças escolares com diagnóstico de DM1; Específicos: Verificar os Índices de Conformidade do procedimento da técnica de monitorização glicêmica das crianças escolares com DM1 antes e após serem submetidas à oficina educativa e comparar os Índices de Conformidade, pré- e pós-oficina, da técnica de automonitorização glicêmica das crianças com DM1 que serão submetidas à oficina educativa. Método: Trata-se de um estudo quantitativo, quase-experimental, pré-teste e pós-teste. Participaram do estudo 33 crianças escolares, de 6 a 11 anos, com DM1 há mais de um ano, usuárias de dois ambulatórios infantis de endocrinologia de um complexo hospitalar do município de São Paulo. Após a concordância dos pais e o assentimento da criança, foram assinados, respectivamente, o Termo de Consentimento Livre e Esclarecido e o Termo de Assentimento. A coleta de dados foi realizada por meio do emprego dos seguintes instrumentos: 1) Dados sociodemográficos; 2) Perfil de monitorização glicêmica e 3) Passos da técnica de monitorização glicêmica, antes da oficina educativa. Os instrumentos 2 e 3 foram reaplicados um mês e meio após o término da oficina. Resultados: Verificou-se que houve resultados estatísticos significativos para três passos da técnica de automonitorização glicêmica: trocar a lanceta do lancetador (p=0,021), pressionar o local de punção (p=0,057) e desprezar o material utilizado em recipiente adequado para perfurocortantes (p=0,004). A oficina educativa também foi eficaz para provocar mudança de comportamento nas crianças, uma vez que elas conseguiram sair de uma média de conformidade de 5,3 passos corretos da técnica de monitorização, para 6,58 passos, ou seja, passaram a executar um passo a mais em conformidade em relação ao que vinham realizando. Conclusão: A oficina educativa, por meio de atividades lúdicas, foi uma ferramenta eficaz para melhorar o desempenho da execução da técnica de automonitorização glicêmica capilar realizada por crianças escolares com DM1. / Introduction: In the case of diabetes, care must be patient-centered and the educational process and support must be permanent and shared. Blood glucose monitoring is generally the first practice of self-care taught to children with diabetes mellitus type 1 (DM1) to grant them autonomy to manage their disease. Objectives: General: To evaluate the effectiveness of the educational workshop on the performance of the capillary blood glucose monitoring technique in school children diagnosed with DM1; Specific: To check Compliance Indices of the blood glucose monitoring technique of school children with DM1 before and after being subjected to the educational workshop and to compare Compliance Indices, pre- and post-workshop, of the glucose monitoring technique of children with DM1 to be submitted to the educational workshop. Method: This is a quantitative quasi-experimental pretest and posttest study. The study included 33 school children, 6-11 years of age, with DM1 for more than a year, attended at two endocrinology pediatric clinics of a hospital complex in São Paulo. The Informed Consent Form and the Child Assent Form were signed by parents and children, respectively, upon agreeing with the protocol. Data collection was conducted through the use of the following instruments: 1) sociodemographic data; 2) glycemic profile monitoring and 3) steps for the glucose monitoring technique before the educational workshop. Steps 2 and 3 were reapplied six weeks after the end of the workshop. Results: We found that there were statistical significant results for three steps of the self-monitoring blood glucose technique: replacing the lancet of the lancing device (p = 0.021), press the puncture site (p = 0.057) and dispose of the material used in a suitable container for needles and other sharps (p = 0.004). The educational workshop was also effective to promote behavior changes in children, as they were able to move from an average of 5.3 correct steps in the compliance monitoring technique, to 6.58 steps. Therefore, they started to perform one more step correctly than they had previously done. Conclusion: The educational workshop using play activities was an effective tool to improve the performance of the capillary blood glucose monitoring technique performed by school children with DM1.

INTRODUÇÃO:A rigidez arterial aumentada é um importante determinante do risco cardiovascular e um forte preditor de morbimortalidade. Além disso, estudos demonstram que o enrijecimento vascular pode estar associado a fatores genéticos e metabólicos. Portanto,os objetivos do presente estudo são determinar a herdabilidade da velocidade de onda de pulso (VOP) e avaliar a associação do perfil lipídico e do controle glicêmico com o fenótipo de rigidez arterial em uma população brasileira.MÉTODOS:Foram selecionados 1675 indivíduos (ambos os gêneros com idade entre 18 e 102 anos) distribuídos em 109 famílias residentes no município de Baependi-MG. A VOP carótida-femoral foi avaliada de forma não invasiva através de um dispositivo automático.As variáveis lipídicas e a glicemia de jejum foram determinadas pelo método enzimático colorimétrico. Os níveis de hemoglobina glicada (HbA1c) foram determinados pelo método de cromatografia líquida de alta eficiência. As estimativas da herdabilidade da VOP foram calculadas utilizando-se a metodologia de componentes de variância implementadas no software SOLAR. RESULTADOS: A herdabilidade estimada para a VOP foi de 26%, sendo ajustada para idade, gênero, HbA1c e pressão arterial média. Os níveis de HbA1c foram associados a rigidez arterial, onde a elevação de uma unidade percentual da HbA1c representou um incremento de 54% na chance de risco para rigidez arterial aumentada. As variáveis lipídicas (LDL-c, HDL-c, colesterol não- HDL-c, colesterol total e triglicérides) apresentaram fraca correlação com a VOP. Além disso, uma análise de regressão linear estratificada para idade (ponto de corte >= 45 anos) demonstrou uma relação inversa entre LDL-c e VOP em mulheres com idade >= 45 anos. CONCLUSÃO: Os resultados indicam que a VOP apresenta herdabilidade intermediária (26%); a HbA1c esta fortemente associada a rigidez arterial aumentada; o LDL-c é inversamente relacionado com a VOP em mulheres com idade >= 45 anos, possivelmente devido às alterações metabólicas associadas à falência ovariana / INTRODUCTION: Increased central arterial stiffness is an important determinant of cardiovascular risk and a strong predictor of morbimortality. Moreover, studies showed that vascular stiffening can be associated with genetic and metabolic factors. Thus, the aims of this study are to estimate the heritability of pulse wave velocity (PWV) and to assess the association of lipid profile and glycemic control with arterial stiffness in a sample from the Brazilian population. METHODS: For this study, 1675 individuals (both genders aged from 18 to 102 years) were selected and they were distributed within 109 families residents in the municipality of Baependi - MG. The PWV was measured with a non-invasive automatic device. Lipid profile parameters and fasting glucose were determined by enzymatic colorimetric method. HbA1c levels were determined by high-performance liquid chromatography. Variance component approaches implemented in the SOLAR software were applied to estimate the heritability of PWV. RESULTS: Heritability estimates for carotid-femoral PWV was 26%, after adjustment for age, gender, HbA1c, and mean blood pressure. HbA1c levels were associated with arterial stiffness and the elevation of a single unit percentage of HbA1c represented an increase of 54 % in the odds of increased arterial stiffness. The lipid variables (LDL-c, HDL-c, non-HDL-c, total cholesterol and triglycerides) presented weak correlation with PWV. In addition, a linear regression analysis stratified by age (cutoff >= 45 years) showed an inverse relation between LDL-c and PWV in women aged 45 or older. CONCLUSION: Our findings indicate that PWV demonstrated an intermediate heritability (26%); HbA1c proved to be a good marker for risk stratification for increased arterial stiffness; LDL-c was inversely related with PWV in women aged 45 or older, possibly due to the metabolic alterations associated with ovarian failure

Made available in DSpace on 2014-07-29T15:29:15Z (GMT). No. of bitstreams: 1 Dissertacao Sheylle A da S Teles.pdf: 2076444 bytes, checksum: 19dd698235d3bdb8ac249ba963a48c5a (MD5) Previous issue date: 2010-05-18 / Introduction: Diabetes mellitus type 1 (DM1) is caused by partial or total destruction of the beta cells of islets of Langerhans, with a resulting deficiency in insulin production. Metabolic complications associated with type 1 diabetes results from chronic hyperglycemia and are mainly cardiovascular diseases, which begin in the first years after diagnosis, even in children and adolescents. Objective: To evaluate the relationship between nutritional and biochemical profiles in children and adolescents with DM1. Methods: Cross-sectional study with 54 patients treated at the Clinic of Endocrinology, Hospital das Clinicas, Federal University of Goiás. Data collected were: socioeconomic-demographic (age, sex, education, income), food (dietetic habits, three 24-hour recalls); clinical (insulin), anthropometric (weight, height, skinfolds, waist circumference-CC), biochemical (casual glucose GLC and post-prandial GLPP, glycated hemoglobin HbA, lipid profile including triglycerides TG, total seric cholesterol CTs, low density lipoprotein LDL, very low density lipoprotein VLDL and high density lipoprotein HDL). Body fat was estimated using the equation developed specifically for people aged eight to 18 years. HbA was converted to an index (inHbA). Statistical analysis was performed using the statistical package SPSS version 18.0. Were used descriptive statistics, Kolmogorov Smirnov (p> 0.05), Student t test (p <0.05), qui square (p<0,05) and Pearson correlation (p <0.05). Results: The average income per capita was R$ 263.8 ± 183.0 and insulin therapy was mostly composed of three doses a day (72,2%). Most individuals showed height (92.6%) and body mass index BMI (87%) appropriate for age. Those with adequate glycemic control had lower GLC (p = 0.002) and GLPP (p <0.001). Were identified correlations between inHbA and CC (p = 0.013), GLC (p = 0.014), GLPP (p <0.001), TG (p <0.001) and VLDL (p <0.001). The consumption of sugary products was mentioned by six per cent of the individuals. There was a higher adequacy of parameters wich measure lipid profile compared to those which evaluate glucose control: inHbA (64%); GLPP (18%), CTs (88%), LDL (92%), TG (76%) and HDL (84%). There was negative correlation between CTs and carbohydrate intake (r=- 0.324, p= 0.022) and positively with lipid (r= 0.315, p= 0.026), both after adjustment for total calories, indicating that individuals who consumed a diet with higher proportion of lipids and therefore with less carbohydrates, showed higher concentrations of CTs. Conclusion: Glicemic control is associated with CC, GLC, GLPP, TG and VLDL. The levels of CTs are directly associated with the consumption of lipids. / Introdução: O diabetes mellitus tipo 1 (DM1) é causado pela destruição parcial ou total das células beta das ilhotas de Langerhans, com a consequente deficiência na produção de insulina. As complicações metabólicas associadas ao DM1 decorrentes da hiperglicemia crônica são principalmente doenças cardiovasculares, que têm início nos primeiros anos após o diagnóstico, mesmo em crianças e adolescentes. Objetivo: Avaliar a relação entre os perfis nutricional e bioquímico em crianças e adolescentes portadores de DM1. Metodologia: Estudo transversal com 54 indivíduos atendidos no Ambulatório de Endocrinologia do Hospital das Clínicas da Universidade Federal de Goiás. Coletaram-se dados: socioeconômico-demográficos (idade, sexo, escolaridade, renda); alimentares (hábitos dietéticos, três recordatórios de 24 horas); clínicos (insulinoterapia); antropométricos (peso, estatura, dobras cutâneas, circunferência da cintura CC); bioquímicos (glicemias casual GLC e pós-prandial GLPP, hemoglobina glicada HbA, perfil lipídico, incluindo triglicérides TG, colesterol total sérico CTs, lipoproteína de baixa densidade LDL, lipoproteína de muito baixa densidade VLDL e lipoproteína de alta densidade HDL). A gordura corporal foi estimada por meio do cálculo em equação desenvolvida especificamente para indivíduos entre oito a 18 anos. A HbA foi convertida em índice da HbA (inHbA). A análise estatística foi procedida por meio do pacote estatístico SPSS versão 18.0. Utilizaram-se estatística descritiva, teste de Kolmogorov Smirnov (p>0,05), t de Student (p<0,05), qui quadrado (p<0,05) e correlação de Pearson (p<0,05). Resultados: A renda média per capita foi de R$ 263,8±183,0 e predominou o esquema insulínico composto por três aplicações (72,2%) de insulina/dia. A maioria dos indivíduos apresentou estatura (92,6%) e Índice de Massa Corporal IMC (87%) adequados para a idade. Aqueles com controle glicêmico adequado apresentaram menores GLC (p=0,002) e GLPP (p<0,001). Houve correlação positiva entre o inHbA e CC (p=0,013), GLC (p=0,014), GLPP (p<0,001), TG (p<0,001) e VLDL (p<0,001). O consumo de produtos açucarados foi referido por seis por cento dos indivíduos. Identificou-se maior adequação dos parâmetros que medem o perfil lipídico em comparação aos que avaliam a glicemia: inHbA (64%); GLPP (18%); CTs (88%), LDL (92%), TG (76%) e HDL (84%). Houve correlação negativa entre CTs e consumo de carboidratos (r= -0,324; p= 0,022) e positiva com o de lipídeos (r= 0,315; p= 0,026), ambos após ajuste pelas calorias totais, sinalizando que indivíduos que consumiram uma dieta com maior proporção de lipídeos, e consequentemente com menos carboidratos, apresentaram maiores concentrações de CTs. Conclusão: O controle glicêmico está associado a CC, GLC, GLPP, TG e VLDL. Os níveis de CTs estão associados diretamente ao consumo de lipídeos.

Além das alterações autonômicas, a síndrome metabólica (SMet) causa disfunção vascular relacionada a eventos cardiovasculares e morte. Considerando que a resistência à insulina é associada à hiperativação simpática, testamos a hipótese de que a presença da glicemia de jejum alterada (GLI) é a principal causa das alterações estruturais e funcionais em grandes e pequenos vasos, via aumento do tônus simpático nesses pacientes. Foram avaliados pacientes com SMet recém diagnosticados (ATP-III) e não medicados, divididos em: glicemia de jejum alterada >=100mg/dL (SMet+GLI, n=35; 50±1 anos) e glicemia normal < 100mg/dL (SMet-GLI, n=24, 46 ± 1). Um grupo de indivíduos saudáveis foi estudado como controle (CS, n=17, 50±1 anos). Foram medidas rigidez arterial (velocidade de onda de pulso, VOP), atividade nervosa simpática muscular (ANSM, microneurografia) fluxo sanguíneo muscular (FSM, pletismografia), pressão arterial média (PAM, oscilométrico), resistência vascular periférica (RVP=PAM/FSM) e dimetilarginina assimétrica (ADMA). SMet+GLI apresentou maior VOP que SMet-GLI e CS (8,0[7,2-8,6], 7,3[6,9-7,9] e 6,9[6,6-7,2]m/s, respectivamente, P=0,001), não havendo diferença entre SMet-GLI e CS. Além disso, SMet+GLI foi similar ao SMet-GLI mas teve maior RVP que CS (P=0,008), não havendo diferença entre SMet-GLI e CS. Adicionalmente, SMet+GLI teve maior ANSM que SMet-GLI e CS; enquanto SMet-GLI teve maior ANSM que CS (31+-1; 26+-1; 19+-1 disparos /min, P < 0,001). ADMA foi similar entre os grupos (0,62 [0,56-0,71], 0,67 [0,59-0,92] e 0,60 [0,54-1,43] umol/L). Dentre os fatores de risco da SMet, GLI foi preditor do aumento da ANSM. ANSM foi associada à VOP (R=0.39; P=0,002) e à RVP (R=0,30, P=0,034). Em conclusão, a hiperativação simpática, que está aumentada na presença da glicemia alterada, é o mecanismo básico que pode explicar, pelo menos em parte, o aumento na VOP e na RVP. GLI parece ser o principal fator de risco no prejuízo da função e estrutura vascular nos pacientes com SMet / Besides autonomic alterations, metabolic syndrome (MetS) causes vascular dysfunction related to cardiovascular events and death. Since insulin resistance is associated with sympathetic hyperactivation, we tested the hypothesis that the presence of impaired fasting glucose (IFG) is the main cause of structural and functional changes of large and small vessels via elevated sympathetic tonus in these patients. We evaluated never treated, newly diagnosed MetS (ATP-III) patients divided into: impaired fasting glucose >100mg/dL (MetS+IFG, n=35; 50±1 y) and normal fasting glucose <100mg/dL (MetS-IFG, n=24, 46±1 y). A healthy control group was also studied (C, n=17, 50±1 y). We measured the arterial stiffness (pulse wave velocity, PWV), muscle sympathetic nerve activity (MSNA, microneurography), forearm blood flow (FBF, plethysmography), mean blood pressure (MBP, oscillometric), peripheral vascular resistance (PVR=MBP/FBF) and asymmetric dimethylarginine (ADMA). MetS+IFG had higher PWV than MetS-IFG and C (8.0[7.2-8.6], 7.3[6.9-7.9] and 6.9[6.6-7.2]m/s, respectively, P=0.001), whereas SMet-GLI was similar to CS. Moreover, MetS+IFG was similar to MetS-IFG, but had higher PVR than C (P=0.008) and SMet-GLI was similar to CS. In addition, MetS+IFG had higher MSNA than MetS-IFG and C; whereas MetS-IFG had higher MSNA than C (31 +- 1; 26+- 1; 19+-1 bursts/min, P < 0.001). ADMA were similar among groups (0.62 [0.56-0.71] vs 0.67 [0.59-0.92] and 0.60 [0.54-1.43] umol/L). Among MetS risk factors, IFG was predictor of increased MSNA. Further, MSNA was associated with PWV (R=0.39; P=0.002) and PVR (R=0.30, P=0.034). In conclusion, sympathetic hyperactivation, which is enhanced in the presence of high blood glucose, is the basic mechanism that could explain, at least in part, the increase in PWV and PVR. IFG appears to be the main risk factor in the vascular function and structure damage in MetS patients

1. Clinical studies. Clinical diagnosis of dementia has been made largely on the basis of clinical findings supported by appropriate radiological and laboratory investigations. A minority of patients have treatable or reversible underlying causes for their dementing syndrome. It is important to distinguish between the two main forms of dementia Alzheimer's disease, senile dementia of Alzheimer type (AD/SDAT) and MID so that advantage can be taken of any future progress in treatments. In the clinical study significant differences between several diagnostic procedures were found between patients with AD/SDAT and MID. Blood pressure was significantly lower in the AD/SDAT group and focal neurological signs were seen in 70% of the MID patients but only in 6% of patients with AD/SDAT. Electrocardiogram was normal in all patients with AD/SDAT but pathological in 75% of the MID patients. Electroencephalogram showed generalized slow frequencies in 79% of the AD/SDAT patients and localized changes in 65% of the MID patients. Computerized tomography showed a significantly greater dilation of the ventricular system in MID patients compared to AD/SDAT patients and controls. Monoamine metabolites in the cerebrospinal fluid were lower in AD/SDAT patients and normal in MID patients. Psychopathological signs were found to be more variable and more pronounced in the AD/SDAT group compared with MID patients. 2. Etiological studies. Immunoglobulin and albumin were found changed in serum and CSF of both AD/SDAT and MID, indicating a more active immune response in MID and a less dense cerebrospinal fluid barrier in both MID and AD/SDAT. There appears to be a consumption of IgG in the central nervous system in patients with AD/SDAT. Abnormal chromosomes appearing as acentric fragments, i.e. without visible centromeres, were found in 90% of patients with AD/SDAT, 30% of patients with MID, and not at all in the control group. Increased aneuploidy was also seen both in patients with MID and AD/SDAT. Diabetes mellitus in old age and AD/SDAT do not seem to coexist. Furthermore, patients with AD/SDAT have changed carbohydrate metabolism with decreased fasting blood sugar concentrations, increased glucose tolerance and higher concentration of insulin during an oral glucose tolerance test. / <p>S. 1-47: sammanfattning, s. 49-144: 5 uppsatser</p> / digitalisering@umu.se

Abstract Point-of-care testing (POCT) is defined as laboratory tests performed outside the traditional clinical laboratory close to the patient at the time and place where care is received, such as hospitals and healthcare centers. The main reason for the use of POCT is that they provide rapid results and enable prompt interventions, with hopefully improved patient outcomes. All phases of laboratory procedure are included in POCT offering many opportunities for errors, which can influence on patients’ treatment. The measurements are more often performed by nurses than by laboratory professionals. These nurses have different kinds of professional backgrounds, e.g. public health nurses, registered and practical nurses, with minimal or no knowledge of laboratory procedures. The aim of the study was to develop a two-step training and management strategy for nurses to do POCT in hospital and primary healthcare center. In accordance with the strategy, with reasonable investment of laboratory resources, designated contact nurses were first trained in POCT by laboratory professionals, after which the contact nurses trained other nurses in POCT their respective units. Blood glucose, the most common point-of-care (POC) test, was chosen as an example to investigate the influence of training on the quality of the test performed by nurses. The quality of blood glucose measurements was studied by analyzing the control results obtained by nurses and biomedical laboratory scientists (BLSs). The study participants included nurses who were either untrained or trained to do POCT by using the developed interactive two-step training strategy. In conclusion, the nurses trained by using interactive two-step strategy achieved near-similar quality of blood glucose measurements as BLSs. The good quality of glucose measurements, once achieved by training, was also sustained in the long-term. / Tiivistelmä Määritelmän mukaan vieritutkimuksiksi kutsutaan laboratoriotutkimuksia, joita tehdään perinteisen laboratorion ulkopuolella, tarvittaessa lähellä potilasta sairaalassa ja perusterveydenhuollon alueella. Pääasiassa vieritutkimuksia tehdään silloin kun tulos halutaan saada nopeasti ennen hoitopäätöstä tai tulevaa toimenpidettä. Vieritutkimusten tekeminen sisältää kaikki laboratoriotyön vaiheet ja jokaisessa vaiheessa on mahdollisuus tehdä virheitä, jotka voivat vaikuttaa potilaiden hoitoon. Laboratorioammattilaisten sijaan määrityksiä tekevät yhä useammin hoitajat sairaalan eri yksiköissä ja perusterveydenhuollon alueella. Näillä hoitajilla on erilainen ammatillinen peruskoulutus, kuten perushoitajan tai sairaanhoitajan koulutus, ja heillä on vähän tai ei ollenkaan tietoa laboratoriomenetelmistä. Tämän tutkimuksen tarkoituksena oli kehittää hoitajien vieritutkimustoimintaan koulutus- ja hallintomalli, joka toimisi sekä sairaalassa että terveyskeskuksessa. Strategian perusteena oli käyttää suhteellisen vähän laboratorioresursseja ja päästä silti hyvään laadulliseen lopputulokseen. Strategiaksi valittiin kaksiportainen, vuorovaikutteinen koulutusmalli, jossa laboratorioammattilaiset kouluttivat sairaalan ja perusterveydenhuollon yksiköissä ns. yhdyshenkilöt, jotka puolestaan kouluttivat edelleen oman yksikkönsä muut hoitajat tekemään vieritutkimuksia. Veren glukoosimääritys, joka on yleisin vieritutkimus, valittiin esimerkkitutkimukseksi tutkittaessa koulutuksen vaikutusta hoitajien tekemien vieritutkimusten laatuun. Veren glukoosimääritysten laatutasoa tutkittiin analysoimalla hoitajien ja laboratoriohoitajien tekemien kontrollinäytteiden tuloksia. Tutkimukseen osallistui hoitajia, jotka oli koulutettu kehitetyllä vuorovaikutteisella kaksiportaisella koulutusstrategialla vieritutkimusten tekemiseen, sekä hoitajia, jotka eivät olleet saaneet vastaavaa koulutusta. Koulutusmallin avulla hoitajien suorittamien vieritutkimusten laatu parani ja he saavuttivat lähes saman laatutason kuin laboratoriohoitajat. Hyvä, kerran saavutettu glukoosimääritysten laatutaso säilyi myös pitkällä aikajaksolla.

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

Seit Veröffentlichung der Studien von G. Van den Berghe et al. im Jahre 2001 galt es die strikte Blutzuckereinstellung in normoglykämische Bereiche bei Schwerverletzten anzustreben. Die intensivierte Insulintherapie wurde daraufhin von verschiedensten Fachgesellschaften in Leitlinien und Therapieregimen integriert, so auch auf der neurochirurgischen ITS der Universitätsklinik Leipzig. Kurze Zeit später erschienen große multizentrische Studien, die den Benefit der intensivierten Insulintherapie in Frage stellten und sogar von einer signifikant höheren Letalität bei strikt normoglykäm eingestellten Patienten berichteten. Daher wird in dieser Studie die zwiespältige aktuelle Datenlage zum Anlass genommen, die Beziehungen zwischen Blutzuckereinstellung und ITS-Regime sowie die Auswirkungen hyperglykämischer Stoffwechselsituationen und mögliche Bedeutung des Blutglukosespiegels respektive der intensivierten Insulintherapie speziell für Patienten mit isoliertem mittelschwerem und schwerem Schädel-Hirn-Trauma zu evaluieren. Mit Hilfe der Integration wird erstmalig ein Verfahren zur Blutglukosedarstellung verwendet, dass durch die Flächenberechnung (Area under the Curve (AUC-BG)) ein Abbild von Höhe und Dauer der Hyperglykämie schafft. Es konnte gezeigt werden, dass die Blutzuckereinstellung mit dem klinischen Verlauf, krankheitsspezifischen Therapiekonzepten, Komplikationen und dem Outcome der Patienten korreliert und positiv Einfluss nimmt. Von besonderem Interesse war die Auswirkung auf den Hirndruck und die Notwendigkeit von Dekompressionskraniektomien, als auch auf Infektionsereignisse, die kontrollierte Beatmung, Ernährungsform und das Outcome. Nach Einführung der intensivierten Insulintherapie wurde ein Vergleich mit konventionell therapierten Patienten herbeigeführt. Es wurden vergleichende Analysen zwischen der retrospektiven (n = 65, konventionelle Insulintherapie, Blutzucker < 10,0 mmol/l [< 180 mg/dl]) und prospektiven Gruppe (n = 65, intensivierte Insulintherapie, Blutzucker 4,4 – 6,1 mmol/l [80 – 110 mg/dl]) bezüglich Blutzuckerfläche, Intensivverlauf und Outcome durchgeführt. Nach 1:1-Matching hinsichtlich Alter und Geschlechterzugehörigkeit waren die beiden Therapiegruppen homogen und es zeigten sich keine Unterschiede bezüglich der Aufnahmecharakteristik. Schädelhirntraumatisierte Patienten profitierten von einer intensivierten Insulintherapie im Vergleich zur Kontrollgruppe, auch wenn es nicht gelang, den Blutzuckerspiegel entsprechend der initiierten Therapierichtlinie signifikant hin zur Normoglykämie zu senken. Die positiven Effekte zeigten sich deutlich in Bezug auf die Infektionsrate und Ernährungsform. Die intensivierte Insulintherapie senkte den Hirndruck und die Rate risikobehafteter Dekompressionskraniektomien mit einem deutlicheren Trend zu besseren Outcomemesswerten. Vor allem Patienten mit einem besseren initialem GCS und Nicht-Diabetiker scheinen von einer guten Blutzuckereinstellung zu profitieren. Hypoglykämien (Blutzucker ≤ 3 mmol/l) traten entgegen der Vermutung dabei nicht gehäuft auf und stellten somit kein Gegenargument einer derartigen Therapie dar. Die Senkung des Blutzuckers in einen moderaten, therapeutischen Bereich sollte das Mindestziel in der Gesamttherapie von Patienten mit einem mittelschweren und schweren Schädel-Hirn-Trauma sein, wobei ein Konsens über den optimal therapeutischen Blutzuckerzielbereich bisher noch nicht gefunden wurde und somit weitere Untersuchungen gerechtfertigt sind.:BIBLIOGRAPHISCHE BESCHREIBUNG ABKÜRZUNGSVERZEICHNIS 1 EINFÜHRUNG 1.1 SCHÄDEL-HIRN-TRAUMA – DEFINITION UND EINTEILUNG 1.2 SCHÄDEL-HIRN-TRAUMA – EPIDEMIOLOGIE 1.3 PATHOPHYSIOLOGISCHER HINTERGRUND DES SCHÄDEL-HIRN-TRAUMAS 1.4 KLINIK, MONITORING UND THERAPIE – EIN ÜBERBLICK 1.5 FRAGESTELLUNG UND ZIEL DER ARBEIT 2 MATERIALIEN UND METHODIK 2.1 STUDIENDESIGN 2.1.1 Ein- und Ausschlusskriterien 2.1.2 Studienende 2.1.3 Erfasste Parameter 2.2 PATIENTENMANAGEMENT 2.3 BLUTZUCKERMANAGEMENT 2.3.1 Insulinschema bei konventioneller Insulintherapie 2.3.2 Insulinschema bei intensivierter Insulintherapie 2.4 DATENERFASSUNG 2.5 METHODENBESCHREIBUNG – AREA UNDER THE CURVE 2.6 STATISTISCHE ANALYSE 3 ERGEBNISSE 3.1 PATIENTENCHARAKTERISTIK/DEMOGRAPHIE 3.1.1 Vor Matching 3.1.2 Nach Matching 3.2 INTENSIVVERLAUF UND OUTCOME 3.2.1 Verlaufsparameter 3.2.2 Outcome-Messwerte 3.3 AUSWIRKUNGEN DER EINGANGSVARIABLEN AUF INTENSIVVERLAUF UND OUTCOME 3.4 EINFLUSS VON HÖHE UND DAUER DER HYPERGLYKÄMIE AUF INTENSIVVERLAUF UND OUTCOME 3.4.1 Einfluss auf die Beatmungsdauer 3.4.2 Einfluss auf den Gesamt-SAPS II 3.4.3 Einfluss auf die Dauer bis zur Oralisierung 3.4.4 Einfluss auf das Auftreten von Infektionen 3.4.5 Einfluss auf den intrakraniellen Druck 3.4.5.1 ICP-Sondenliegedauer in Abhängigkeit von der Blutzuckerfläche 3.4.5.2 Zusammenhang zwischen Hirndruckfläche und Blutzuckerfläche 3.4.5.3 Diabetiker versus Nicht-Diabetiker 3.4.6 Einfluss auf die Notwendigkeit einer Dekompressionskraniektomie 3.4.7 Einfluss auf die Dauer der Intensivbehandlung 3.4.8 Einfluss auf das Outcome 3.4.8.1 Glasgow Outcome Score 3.4.8.2 Modified Rankin Scale 3.5 METHODENVERGLEICH 3.5.1 Güte der Therapie 3.5.2 Kontrollierte Beatmung 3.5.3 Gesamt-SAPS II 3.5.4 Dauer bis zur Oralisierung 3.5.5 Auftreten von Infektionen 3.5.6 Hirndruckmanagement 3.5.6.1 Demographie 3.5.6.2 Vergleich des intrakraniellen Druckes 3.5.7 Notwendigkeit einer Dekompressionskraniektomie 3.5.8 Intensivbetreuung und Krankenhausliegedauer 3.5.9 Outcome 3.5.9.1 Glasgow Outcome Score 3.5.9.2 Modified Rankin Scale 3.6 HYPOGLYKÄMIE 3.7 SCHWERE HYPERGLYKÄMIE 3.8 ABHÄNGIGKEIT DES OUTCOMES 3.8.1 Initial- und Verlaufsparameter 3.8.2 Multiple lineare Regressionsanalyse 3.8.2.1 Einfluss der Initialparameter 3.8.2.2 Interaktion von Glasgow Coma Score und Blutzuckerfläche 3.8.2.3 Einfluss der Verlaufsparameter 3.8.2.4 Zusammenfassung der relevanten Initial- und Verlaufsparameter 3.9 ABHÄNGIGKEIT DES HIRNDRUCKES 3.9.1 Multiple lineare Regressionsanalyse 3.9.1.1 Einfluss der Initialparameter 3.9.1.2 Einfluss der Verlaufsparameter 3.10 ZUSAMMENFASSUNG DER ERGEBNISSE 3.10.1 Patientencharakteristik/Demographie 3.10.2 Intensivverlauf und Outcome 3.10.3 Auswirkungen der Eingangsvariablen auf Intensivverlauf und Outcome 3.10.4 Einfluss von Höhe und Dauer der Hyperglykämie auf Intensivverlauf und Outcome 3.10.5 Methodenvergleich 3.10.6 Abhängigkeit des Outcomes 3.10.7 Abhängigkeit des intrakraniellen Druckes 4 DISKUSSION 4.1 PATIENTENCHARAKTERISTIK/DEMOGRAPHIE 4.2 MATERIAL UND METHODIK 4.3 AUSWIRKUNGEN VON HÖHE UND DAUER DER HYPERGLYKÄMIE AUF INTENSIVVERLAUF UND OUTCOME 4.3.1 Einfluss auf allgemeine intensivmedizinische Parameter 4.3.2 Einfluss auf den intrakraniellen Druck und das Outcome 4.4 VERGLEICH BEIDER THERAPIEGRUPPEN 4.4.1 Methodische Aspekte 4.4.2 Klinische Aspekte 4.5 HYPOGLYKÄMIE 4.6 ABHÄNGIGKEIT DES OUTCOMES 4.7 ABHÄNGIGKEIT DES HIRNDRUCKES 4.8 ZUSAMMENFASSUNG 5 ZUSAMMENFASSUNG LITERATURVERZEICHNIS ABBILDUNGSVERZEICHNIS TABELLENVERZEICHNIS ANLAGEN PATIENTENDATENBLATT TABELLEN SAPS II – SCORE VOTUM DER ETHIKKOMMISSION ERKLÄRUNG ÜBER DIE EIGENSTÄNDIGE ABFASSUNG DER ARBEIT LEBENSLAUF DANKSAGUNG

A web installation that uses blood glucose levels uploaded by diabetics to create music. Available at https://radiodiabetes.eu / En webbinstallation som låter diabetiker ladda upp sina blodsockervärden och skapar musik av dessa. Tillgänglig på https://radiodiabetes.eu