Eleven participants living with non-insulin-requiring Type 2 Diabetes (T2DM) discussed their self-monitoring blood glucose (SMBG) experience. All had been recently diagnosed (< 2 years) and treated for diabetes with a self-regulating SMBG guideline for primary care practice. Their digitally-recorded interviews and photographed logbooks were analyzed thematically and interpreted through the lens of numeracy literature to answer 2 questions: 1. What is the meaning of SMBG among people with non-insulinrequiring T2DM? 2. How do people with non-insulin-requiring T2DM perceive the function of SMBG in diabetes self-management? The meanings of SMBG were patient competence, "It is easy, just a little pin prick"; patient control, "I can control it. It doesn't control me"; and patient security, "It is not that way anymore." Three periods of lived time were observed: Diagnosis "The numbers say I have diabetes"; "I just can't figure out why it does that"; and Routine "I make my numbers." Prominent numeracy functions emerged by time period. During Diagnosis primary numeracy functions included comparing SMBG results to target values. Participants expressed this experience as, "I am some kind of O.K." During applied numeracy functions included taking medication correctly. SMBG readings were experienced as a clue to the diabetes mystery, sometimes confusing the participants, "I just don't know why it does what it does," or answering questions, "Now there is no question marks." Numbers motivated some people for action "The numbers get me out a walking" or restraint "If I didn't have the numbers, I would be tempted to cheat." During Routine interpretive numeracy functioned to aid the evaluation of the efficacy of participant's health behavior change. Numbers had taken on meaning helping a person to "know where I am at." Clinical implications are suggested including adjustments to the selfregulating SMBG guideline for primary care practice. Findings are discussed in relation to personal knowledge processes (Sweeny, 1994) and related SMBG research. Participants concluded that routine SMBG is essential to maintaining and restraining health behavior. This study provides a model for use of SMBG in diabetes selfmanagement and patient perspectives on SMBG during the 2 years following T2DM diagnosis.

Thesis (M. Sc. (Biochemistry)) --University of Limpopo, 2017 / Diabetes mellitus is a chronic metabolic disorder characterised by perpetual hyperglycaemia. Various oral pharmacological theraputic management strategies currently exist but are too expensive and having a host of undesirable side effects. Therefore people resort to the use of traditional medicinal plants as they offer a cost effective and readily available health care avenue. Despite the wide-spread use of traditional medicinal plants, several worrisome concerns about their effectiveness, clinical modes of action and safety have been raised. Leaves of five selected plants (Toona celliata, Seriphium plumosum, Schkuhria pinnata, Olea africana, Opuntia ficus-indica) were collected from Mankweng area, Capricon Local Municipality, Limpopo province, South Africa. Ground plant materials were exhaustively extracted by maceration in methanol, acetone or hexane. The presence of different plant secondary metabolites in the crude extracts was determined using various standard chemical tests and thin layer chromatography (TLC). A myriad of compounds which represented various secondary plant metabolites groups were observed on the TLC plates and were best resolved in the non-polar (BEA) and intermediate (CEF) mobile phases. The total phenolic content and total flavonoids of the different extracts were determined spectrophotometrically using the Folin-Ciocalteu`s phenol reagent method and Aluminium chloride colorimetric assay respectively. The plants contained comparatively higher amounts of total phenolic compounds as compared to the flavonoids. The antiglycation activity of the plant extracts were determined using the bovine serum albumin assay. The acetone extract of Seriphium plumosum (SPlA) exhibited the most glycation inhibitory activity among all the examined extracts, as it resulted in 2,22% glycation. The antioxidant potential of each of the different extracts was quantitatively determined spectrophotometrically using the 2, 2-diphenyl-1-picrylhydrazyl (DPPH) free radical scavenging assay and the ferric ion reducing power assay. The methanol extract of Seriphium plumosum showed the best antioxidant activity among all the extracts in this study. It exhibited the lowest EC50 values of 0.72 mg/ml and 2.31 mg/ml for the DPPH scavenging activity and the ferric reducing power assay respectively. The cytotoxicity profiles of the different plant extracts on C2C12 cell line were determined using the 3-(4, 5-dimethylthiazol-2-yl)-2, 5-diphenyltetrazolium xiii bromide (MTT) assay. It was concluded that since the all the extracts investigated had CC50 values greater than 50 μg/ml they were generally non-toxic. The amount of glucose taken up by differentiated C2C12 cells was quantified using the glucose uptake assay. Treatment of the C2C12 cells with the hexane extract of Seriphium plumosum resulted in the best glucose utilisation effect of 35,77% which was higher than that of insulin which was 26,06% after 6 hours. The translocation assay was used to determine the effect of the plant extract on GLUT4 translocation while the expression of various mitogen activated protein kinases in the cells was determined using the human MAPK profiler assay. It was established that treatment with Seriphium plumosum hexane extract resulted in increased GLUT4 translocation from the intracellular vesicular stores to the cell surface membrane. The increase in GLUT4 translocation may have resulted from the upregulation of expression of phosphorylated Akt-1, Akt-2, GSK3β, ERK1, ERK2 p70S kinase and MKK3 under the influence of Seriphium plumosum hexane extract. The study documents a probable insulin-mimetic activity of the hexane extract of Seriphium plumosum. This activity may be responsible for its hypoglycaemic capability and may occur via the augmentation of proximal mitogen activated protein kinases involved in the GLUT4 translocation pathway. Further investigations need to be conducted to ascertain this novel finding which may help provide a cost-effective and readily available antidiabetic therapeutic agent. / National Research Foundation (NRF)

To address the challenge of accurate, low cost and robust biosensors for diabetes management and early detection of diabetes complications, we have developed novel, robust sensing chemistry (or receptors) for electrochemical POC biosensors. The biosensors have been developed for the bio-markers associated with diabetes management such as glycated haemoglobin (HbA1c), glycated albumin, glucose, biomarkers associated with diabetes complications such as microalbuminuria, urine creatinine and albumin-to-creatinine ratio (ACR) and biomarkers associated with anaemia and malnutrition conditions such as haemoglobin and serum albumin. For haemoglobin detection, a new POC bio sensing technique has been developed based on Aza-heterocyclic chemicals. The repeatability and accuracy of the biosensor have been tested on real pathology samples. The glycated form of haemoglobin, called glycated haemoglobin or HbA1c, is the gold standard test in diabetes management as it gives the 90-days average blood glucose value. We demonstrate a simple method for electrochemical detection of HbA1c by combining bosonic affinity principle along with aza-heterocyclic receptors. The technique has been verified on the real clinical patient samples. Albumin is the most abundant protein in the human blood. Human serum albumin (HSA) is either alone or an associative biomarker in several chronic diseases like necrosis, nephrosis, hepatitis, malnutrition, arthritis, immune disorders, cancer, diabetes and in some severe infections. In pathology laboratories, the serum albumin is usually tested on serum samples and not in whole blood samples. Since albumin is not a metalloproteinase, it is very difficult to develop electrochemical POC biosensor. We have developed a novel technique for the electrochemical detection of serum albumin in whole blood samples, by exploiting its binding property with redox active copper salts. The accuracy of technique has been verified on both real human blood plasma as well as whole blood samples. Glycated albumin, which is the glycated form of serum albumin, is emerging as a novel biomarker for diabetes management, as it gives the average blood glucose value of 15-20 days. It is also extremely useful in chronic kidney disease patients and patients with hemoglobinopathies where HbA1c can give the erroneous results. By combining the copper chemistry along with bosonic affinity principle, we present the first ever demonstration of glycated albumin sensing. Instant blood glucose monitoring is an integral part of diabetes management. Most of the glucometers available in the market are based on glucose oxidase enzyme. We have demonstrated a low cost non-enzymatic electrochemical technique for blood glucose detection using alkaline methylene blue chemistry. The accuracy of the technique has been verified on real human blood plasma samples. Glucometer is one of the most easily available POC biosensor and a useful tool for diabetes population. India has second largest diabetes population in the world. To analyse the accuracy of the POC glucometers which are available in Indian market, a comprehensive study was conducted. The results were compared with clinical accuracy guidelines using exhaustive statistical analysis techniques. The shortcomings of the commercial glucometers are elucidated, regarding different international standards. Diabetic nephropathy is one of the major diabetes complications and is the primary cause of chronic kidney disease (CKD). The presence of albumin in urine is a well-established biomarker for the early detection of diabetic nephropathy. We have developed a technique for electrochemical detection of microalbuminuria for point of care applications by exploring the binding property of human albumin with electrochemically active molecules like copper and hemin. Methylene blue mediated sensing technique has also been proposed. Urine Albumin-to creatinine ratio (ACR) is another variant of the microalbumuria test that can be done any time and does not suffer from the dilution factor of urine. Iron binding property of creatinine is exploited to develop creatinine biosensor, thus enabling POC ACR tests.

No description available.

INTRODUÇÃO: A segurança da administração de anestésicos locais com vasoconstritor em pacientes diabéticos submetidos à cirurgia oral não está bem fundamentada na literatura. OBJETIVO: Investigar a ocorrência de variação da glicemia nos períodos pré, trans e pós-operatório de exodontia de dentes superiores, sob anestesia local com lidocaína 2% sem e com adrenalina 1:100.000, em portadores de diabetes mellitus tipo 2. Secundariamente, avaliar os efeitos hemodinâmicos e o grau de ansiedade. MÉTODOS: Estudo prospectivo e randomizado com pacientes portadores de diabetes acompanhados na Unidade Clinica de Coronariopatia Crônica do Instituto do Coração do Hospital das Clinicas da Faculdade de Medicina da Universidade de São Paulo. A monitorização contínua da glicemia durante 24 horas foi realizada através do MiniMed Continuous Glucose Monitoring System (CGMS, Medtronic). Os pacientes foram divididos em dois grupos: LSA - que recebeu 5,4 mL lidocaína 2% sem adrenalina e LCA - que recebeu 5,4 mL de lidocaína 2% com adrenalina 1:100.000. Os níveis de glicemia foram avaliados nas 24 horas (período basal) e nos tempos determinados: uma hora antes, durantes e até uma hora após a exodontia (período de procedimento). Os parâmetros hemodinâmicos foram avaliados por meio de um medidor de pressão arterial digital automático e o nível de ansiedade através de uma escala. RESULTADOS: Dos 400 pacientes avaliados, 70 foram incluídos no estudo, sendo 35 randomizados no grupo LSA e 35 no grupo LCA. A análise das médias da glicemia nos grupos LSA e LCA durante os períodos (basal e procedimento) não demonstrou diferença estatisticamente significativa (p=0,229 e p=0,811, respectivamente). Também não houve diferença significativa (p=0,748) na glicemia entre os grupos em cada tempo avaliado. Entretanto, nos dois grupos houve decréscimo significativo da glicemia (p < 0,001) ao longo dos tempos avaliados. Os grupos LSA e LCA não apresentaram diferenças significativas em relação à PAS (p=0,176), à PAD (p=0,913), à FC (p=0,570) e ao nível de ansiedade. CONCLUSÃO: A administração de 5,4mL de lidocaína 2% com adrenalina 1:100.000 não provocou alteração significativa da glicemia, parâmetros hemodinâmicos e nível de ansiedade em relação ao grupo sem vasoconstritor / INTRODUCTION: The safety of administration of local anesthetics with epinephrine for diabetic patients undergoing oral surgery is not well grounded in the literature. OBJECTIVE: To investigate the occurrence of variation of glucose in the pre, intra and postoperative extraction of upper teeth under local anesthesia with lidocaine 2% with and without 1:100.000 epinephrine in patients with type 2 diabetes mellitus. Secondly, to evaluate the hemodynamic effects and degree of anxiety. METHODS: A prospective randomized study of patients with diabetes attended in Coronary Chronic Clinics Unit, Heart Institute, Hospital das Clinicas in University of São Paulo Medical School. Continuous monitoring of blood glucose for 24 hours was performed using MiniMed Continuous Glucose Monitoring System (CGMS, Medtronic) and the patients were divided into two groups: LSA - which received 5.4 mL of 2% lidocaine without epinephrine and LCA - which received 5.4 mL of 2% lidocaine with 1:100,000 epinephrine. Blood glucose levels were assessed at 24 hours (baseline period) and at certain times: one hour before, during, and up to one hour after oral surgery (procedure period). We evaluated the hemodynamic parameters through a digital automatic pressure meter and anxiety level was measured by the scale. RESULTS: Of 400 patients evaluated, 70 were included in these study, 35 were randomized in the LSA group and 35 in the group LCA. The analysis of mean glicemia in groups LSA and LCA during the baseline period and procedure showed no statistically significant difference (p = 0.229 and p = 0.811, respectively). There was no difference in blood glucose (p = 0.748) between the groups at each time evaluated. However, in both groups there was a significant decrease in blood glucose (p < 0.001) over the time periods studied. The groups showed no significant differences regarding SBP (p = 0.176), DBP (p = 0.913), HR (p = 0.570) and anxiety level. CONCLUSION: The administration of 5.4 mL of 2% lidocaine with epinephrine 1:100.000 caused no significant change in blood glucose, hemodynamic parameters and level of anxiety compared to the group without vasoconstrictor

<p>Bosiljak (Ocimum basilicum L.) pripada familiji Lamiaceae i jedna je od najrasprostranjenijih i najče&scaron;će gajenih biljaka &scaron;irom sveta. Njegova upotreba je &scaron;iroko rasprostranjena zbog bogatog sadržaja i skladnog odnosa vitamina, minerala kao i različitih fenolnih jedinjenja kao glavnih nosilaca antioksidativne aktivnosti. Poslednjih godina velika pažnja je usmerena ka fenolnim fitokomponentama kao potencijalnim promoterima zdravlja. Ciljevi ovog rada bili su ispitivanje kvalitativnih i kvantitativnih karakteristika, kao i biohemijskih aktivnosti ekstrakata bosiljka dobijenih različitim rastvaračima, kao i ispitivanje uticaja farmaceutsko-tehnolo&scaron;ke formulacije u obliku mikrovezikula ekstrakta bosiljka na glikemijski, lipidni i oksido-redukcioni status kod oglednih životinja, u odnosu na vodeni ekstrakt. In vitro ispitivanja su uključivala analizu 100 ekstrakata dobijenih različitim rastvaračima i stepenom usitnjenosti. Ukupni fenolni i flavonoidni sadržaj, kao i antioksidativna aktivnost određena je spektrofotometrijskom metodom. Takođe, kvantifikovane i kvalifikovane su fenolne komponente (fenolne kiseline i flavonoidi) primenom visokoefikasne tečne hromatografije (HPLC). In vivo ispitivanje je rađeno na 84 albino laboratorijska pacova soja Wistar. Per os su primenjivani vodeni ekstrakt bosiljka, rastvor natrijumove soli monoketoholne kiseline, njihove kombinacije, kao i ekstrakt u obliku farmaceutsko-tehnolo&scaron;ke formulacije, mikrovezikula. Posle sedmodnevnog tretmana, merene su koncentracije glukoze u krvi, a nakon žrtvovanja, u serumu su određeni parametri lipidnog statusa i antioksidativnog stresa. Ex vivo analizama procenjivani su efekti ekstrakta bosiljka na enzimske i neenzimske parametre antioksidativnog odbrambenog sistema i oksidativne modifikacije lipida. Praćen je i uticaj tretmana na akutno o&scaron;tećenje jetre usled primene paracetamola. Svi analizirani ekstrakti bosiljka su pokazali prisustvo velikog broja fenolnih jedinjenja iz klase fenolnih kiselina i flavonoida. Detektovane i kvantifikovane aktivne komponente bile su fenolne kiseline: hlorogenska, p-hidroksibenzoeva, kafena, vanilinska, ferulna, rozmarinska i cimetna, kao i apigenin, kvercetin, naringenin i rutin kao predstavnici flavonoidnih jedinjenja. Primena ekstrakta bosiljka i natrijumove soli monoketoholne kiseline, same ili u kombinaciji, a takođe i u farmaceutsko-tehnolo&scaron;koj formulaciji, pokazale su smanjenja o&scaron;tećenja tokom oksidativnog stresa, značajno antidijabetesno delovanje, povoljan uticaj na lipidni status i protektivni efekat na funkcije jetre i bubrega. Na osnovu dobijenih rezultata može se zaključiti da ekstrakt bosiljka sadrži značajnu količinu fenolnih jedinjenja odgovornih za antioksidativnu aktivnost. Vodeni ekstrakt bosiljka, sam ili u kombinaciji sa monoketoholnom kiselinom, i u obliku farmaceutsko-tehnolo&scaron;ke formulacije snižava nivo glukoze u krvi, ubrzava obnovu &beta; ćelija, ima povoljan efekat na lipidni status i ne dovodi do toksičnih promena na jetri i bubrezima kod eksperimentalnih životinja.</p> / <p>Basil (Ocimum basilicum L.) belongs to the family Lamiaceae and represents one of the most widespread and most commonly cultivated plant worldwide. Its use is widespread due to its rich content and harmonious relationship of vitamins, minerals and various phenolic compounds which are responsible for the antioxidant activity. In recent years, great attention is directed to phenolic phytocomponents as potential promoters of health. The objectives of this study were to test the qualitative and quantitative characteristics, as well as the biochemical activity of basil extracts obtained by various solvents and investigate the impact of pharmaceutical technological formulation of basil extract on glycemic, lipid and oxidation-reduction status of the aqueous extract in the experimental animals. In vitro studies have included 100 extracts obtained by various solvents and degrees of fragmentation. Total phenolic and flavonoid content, as well as antioxidant activity was determined by spectrophotometric method. Also, phenolic compounds (phenolic acids and flavonoids) were qualified and quantified using high performance liquid chromatography (HPLC). In vivo testing was performed on 84 laboratory albino Wistar rats. The aqueous extract of basil, a solution of sodium salt of monoketocholic acid, their combinations, as well as an extract in the form of the pharmaceutical technological formulation were administered per os. After seven-day-treatment, the concentrations of glucose were measured in the blood and after sacrificing of animals, the lipid and antioxidative parameters were determined in serum. Ex vivo analysis assessed the effect of the extract of basil on the parameters of enzymatic and non-enzymatic antioxidant defense system and the oxidative modification of lipids. The effect of paracetamol on acute liver injury was also monitored. All analyzed basil extracts showed the presence of the large number of phenolic compounds from the class of phenolic acids and flavonoids. Chlorogenic, p-hydroxybenzoic, caffeic, vanillic, ferulic, rosmarinic, and cinnamic acid, as well as apigenin, quercetin, naringenin and rutin were detected and quantified. The application of basil extracts and the sodium salt of monoketocholic acid, either alone or in combination, and also in pharmaceutical technological formulation of microvesicles has shown a reduction in damage during oxidative stress, then a significant antidiabetic activity, favorable effect on the lipid profile and protective effect on the liver and kidney function. Based on these results it can be concluded that basil extract contains significant amounts of phenolic compounds responsible for antioxidant activity. The aqueous extract of basil, alone or in combination with monoketocholic acid, and in the form of the pharmaceutical technological formulations lowers glucose levels in the blood, accelerates the restoration of &beta; cells, has a favorable effect on the lipid status and does not lead to toxic changes in the liver and kidneys in experimental animals.</p>

Introdução e objetivos – A finalidade prioritária no tratamento do diabetes mellitus gestacional (DMG) é alcançar níveis de glicemia materna tão próximos da normalidade quanto possível, a fim de reduzir os efeitos adversos associados à hiperglicemia na gestação. A auto verificação da glicemia capilar (perfil glicêmico) é o método mais usado para a monitorização do controle metabólico na gestação complicada por diabetes. Nosso objetivo foi analisar as associações entre os perfis glicêmicos maternos com os principais desfechos da gestação numa população de mulheres com DMG acompanhadas em ambulatório de pré-natal especializado em hospital universitário no sul do Brasil, Hospital de Clínicas de Porto Alegre (HCPA). Desenho e metodotologia – conduzimos um estudo de coorte prospectiva de gestantes referidas da rede de atenção primária de saúde pública para tratamento do DMG no HCPA, acompanhadas do diagnóstico ao parto. Pesquisamos associações entre os resultados dos perfis glicêmicos com o peso de nascimento e com o risco de recém-nascidos grandes para idade gestacional e de desfechos adversos perinatais. Resultados – acompanhamos 440 mulheres com DMG. A média do índice de massa corporal (IMC) foi 33.3kg/m2. 351 bebês (79.8%) mostraram peso adequado à idade gestacional no nascimento. As médias de glicemia nos perfis pré e pósprandiais aumentaram com o avanço na categoria de peso nascimento. Três ou mais perfis glicêmicos anormais foram o fator de risco mais robusto para o nascimento de bebês grandes (OR 3.15 1.51-6.55) e para o desenvolvimento de desfechos adversos perinatais (OR 2.28 1.59-3.29). O ganho de peso materno durante o tratamento associou-se ao risco de recém-nascido grande para idade gestacional, assim como o IMC pré-gestacional, esse último também fator de risco independente para eventos perinatais adversos. Conclusão – perfis glicêmicos anormais em mais de 2 ocasiões foram o fator de risco mais relacionado ao nascimento de um bebê grande para a idade gestacional e para o desenvolvimento de complicações neonatais. Efeito benéfico do tratamento do DMG, guiado pelos perfis glicêmicos, foi a maioria de recém-nascidos com peso adequado à idade gestacional nessa coorte, apesar da incidência de desfechos perinatais adversos não ter sido diferente entre as categorias de peso fetal de nascimento. / Background and objective – a priority target in the treatment of gestational diabetes mellitus (GDM) is attaining maternal glucose levels as close as possible to euglycemia, in order to decrease the adverse outcomes linked to hyperglycemia. Self-performed capillary glucose (glycemic profile) is the most widely used method for metabolic monitoring in pregnancy complicated by diabetes. We intended to analyze the associations of maternal glycemic profile to main pregnancy outcomes in a population of GDM women treated in a specialized prenatal clinic at a university hospital in South Brazil, Hospital de Clínicas de Porto Alegre (HCPA). Research design and methodology – we conducted a prospective cohort study of pregnant women, referred from public primary health care for treatment of GDM at HCPA, between 2008 and 2015. We searched associations of glycemic profiles to birth weight, large for gestational age newborn and adverse neonatal outcomes. Results – we followed 440 GDM women from diagnosis to delivery. Mean prepregnancy body mass index (BMI) was 33.3kg/m2; 351 babies (79.8%) had appropriate birth weight for gestational age. Mean glucose in pre-prandial and postprandial profiles increased with raising birth weight category. Three or more abnormal glycemic profiles showed the strongest association to a large baby (OR 3.15 1.51-6.55) and to a composite of adverse neonatal outcomes (OR 2.28 1.59- 3.29). Gestational weight gain in the course of treatment was associated to large babies, as pre-pregnancy BMI, the latter also an independent risk factor for adverse neonatal outcome. Conclusion – abnormal maternal glycemic profiles in more than two occasions were the stronger risk factor for delivering a large baby and for developing neonatal complications. A beneficial effect of GDM treatment, guided by glycemic profiles, was that most of our newborns had birth weight appropriate for gestational age, although incidence of adverse neonatal outcomes had been no different across birth weight categories.

Diabetes mellitus (DM) é uma das principais causas de doença renal crônica terminal. Na doença renal diabética (DRD) observa-se um curso bifásico no padrão glicêmico, na fase inicial o aumento da resistência insulínica induz a hiperglicemia e, com perda progressiva da taxa de filtração glomerular, há redução na depuração dos medicamentos anti-hiperglicemiantes e insulina, aumentando o risco de hipoglicemias. Portanto, diante da perda da função renal, a reavaliação da terapia hipoglicemiante e ajustes constantes nas doses de insulina são necessários, com intuito de otimizar o controle glicêmico e minimizar seus efeitos colaterais. A revisão da literatura mostra diversos pontos sem resposta, principalmente relacionados à dose, ajuste da terapia insulínica, seguimento e monitoração do controle glicêmico em portadores de DM e DRC. O objetivo deste ensaio randomizado, cruzado, controlado foi comparar o controle glicêmico do tratamento com insulina glargina à insulina NPH em portadores de DM2 e DRD estágios 3 e 4. Pacientes e métodos: Trinta e quatro pacientes foram randomizados para receber insulina glargina uma vez ao dia ou insulina NPH em três aplicações diárias. Insulina lispro foi prescrita três vezes ao dia, em aplicações pré-prandiais nos dois grupos. Após 24 semanas de terapia, os pacientes tiveram seu esquema de insulina trocado para terapia insulínica oposta. Testes laboratoriais foram realizados após 12, 24, 36 e 48 semanas de estudo. O sistema de monitorização continua de glicose (CGMS) foi instalado ao término de cada terapia. Resultados: Dos 34 pacientes incluídos, 29 completaram as 48 semanas propostas no estudo, 2 pacientes perderam seguimento por má adesão e 3 pacientes não completaram o estudo em decorrência a eventos adversos (1 óbito, 1 ingresso em hemodiálise e 1 evento cardiovascular, todos em uso de insulina NPH). Após 24 semanas de tratamento com insulina glargina houve uma redução estatisticamente significante da média da HbA1c de 8,86 ± 1,4% para 7,95 ± 1,1% (p=0,0285), esta diferença não foi observada com a insulina NPH (8,21 ± 1,29% para 8,44 ± 1,32%). Durante o uso de insulina glargina o número de eventos noturnos de hipoglicemia foi menor comparado a insulina NPH (p=0,046); além disso, hipoglicemia grave ocorreu apenas na terapêutica com NPH. Conclusão: O tratamento com insulina glargina foi associado a melhor controle glicêmico e a redução do risco de hipoglicemia noturna quando comparada à insulina NPH,em pacientes portadores de DM e DRC estágios 3 e 4 / Diabetes mellitus is the leading cause of chronic kidney disease (CKD). Kidney disease diagnosis and its progression require re-evaluation of hypoglycemic therapy and constant dosing adjustments, to optimize glycemic control and minimize its side effects. Long acting insulin analogs and its pharmacokinetics have not been studied in different stages of kidney disease, nor is there consensus defining appropriate dose adjustment in patients with type 2 diabetes (T2DM) and CKD. The aim of this randomized, cross-over, open-label controlled clinical trial is to compare the glycemic response to intensive insulin treatment with NPH insulin or insulin glargine in T2DM patients and CKD stages 3 and 4. The primary efficacy end point was change in A1C from baseline. Thirty-four patients were randomized to receive insulin glargine once a day or NPH insulin, three times a day. Insulin lispro was prescribed as prandial insulin to both groups. After six months, patients switched to the other insulin therapy group. Laboratory tests were performed at baseline at 12, 24, 36 and 48 weeks. A continuous glucose monitoring system was implemented after 24 weeks and at the end of protocol. Results: Total of 29 subjects have completed the two branches of study, 2 patients dropped out due to low compliance and other 3 patients as a result of adverse events (1 death, 1 ingress on dialysis program, 1 cardiovascular event; all of them were on NPH therapy). After 24 weeks, average of A1c decreased on glargine group compared to baseline 8,86 ± 1,4% to 7,95 ± 1,1% (p=0,0285), but this difference was not observed on NPH group. There were no differences of insulin doses between both groups. Glargine group showed a tendency of lower risk of nocturnal hypoglycemia compared to NPH group (p=0,046). Conclusion: Insulin glargine improved glycemic control by reducing HbA1c without gain weight and with reduced tendency toward nocturnal hypoglycemic events compared with NPH insulin

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Normal";mso-tstyle-rowband-size:0;mso-tstyle-colband-size:0;mso-style-noshow:yes;mso-style-priority:99;mso-style-qformat:yes;mso-style-parent:"";mso-padding-alt:0in 5.4pt 0in 5.4pt;mso-para-margin-top:0in;mso-para-margin-right:0in;mso-para-margin-bottom:10.0pt;mso-para-margin-left:0in;line-height:115%;mso-pagination:widow-orphan;font-size:11.0pt;font-family:"Calibri","sans-serif";mso-ascii-font-family:Calibri;mso-ascii-theme-font:minor-latin;mso-hansi-font-family:Calibri;mso-hansi-theme-font:minor-latin;mso-bidi-font-family:"Times New Roman";mso-bidi-theme-font:minor-bidi;}</style><![endif]-->Uvod: Traumatsko moždano o&scaron;tećenje (TMO) predstavlja globalni zdravstveni problem koji pogađa oko 10 miliona ljudi godi&scaron;nje &scaron;irom sveta. Te&scaron;ka traumatska moždana o&scaron;tećenja (TTMO) čine 10% svih TMO i imaju visoku stopu mortaliteta i neizvestan oporavak. Ranije prepoznavanje sistemskih faktora koji utiču na ishod lečenja može da ima značajan uticaj na pravovremeno započinjanje terapijskih mera i smanjivanje morbiditeta i mortaliteta. Cilj istraživanja: Identifikovati sistemske faktore koji imaju značajan uticaj na ishod lečenja povređenih sa TTMO u Jedinici intenzivnog lečenja (JIL) tokom prvog dana hospitalizacije. Metodologija: Ispitivanje je sprovedeno kao retrospektivno-prospektivna studija koja je obuhvatila 115 povređenih ispitanika sa TTMO koji su hospitalizovani u JIL Urgentnog centra Kliničkog centra Vojvodine (UC KCV) u periodu od 1.01.2014.-1.10.2017. Iz medicinske dokumentacije, za svakog ispitanika uključenog u istraživanje su uzeti u razmatranje i analizu sledeći parametri u toku prvih 24 časa od momenta prijema u JIL: demografske i op&scaron;te karakteristike ispitanika od značaja za istraživanje i sistemski prediktivni faktori (sistolni i srednji arterijski pritisak- SAP/MAP, glikemija-&Scaron;UK, telesna temperatura-TT, pH, parcijalni pritisak kiseonika-PaO2 i parcijalni pritisak ugljem dioksida- PaCO2) registrovani u pet vremenskih tačaka (0h, 6h, 12h,18h, 24h). Svi gore navedeni podaci su posmatrani i analizirani kao prediktorski faktori tj. nezavisne varijable u odnosu na zavisnu varijablu &bdquo;ishod lečenja&ldquo; definisanu kao Glazgovska skala ishoda (Glasgow outcome scale-GOS) nakon otpusta povređenih iz JIL na Kliniku za neurohirurgiju KCV i GOS nakon otpusta iz Klinike za neurohirurgiju KCV i &bdquo;tok lečenja&ldquo; definisan kroz dužinu boravka povređenih u JIL UC KCV, dužinu boravka na Klinici za neurohirurgiju KCV, odnosno ukupno trajanje hospitalizacije u KCV, kao i otpust kući ili u odgovarajući rehabilitacioni centar. Statistička analiza je izvr&scaron;ena pomoću statističkog paketa IBM SPSS 23. Podaci su predstavljeni tabelarno i grafički, a statistička značajnost određivana je na nivou p &lt; 0,05. Prikupljeni podaci su obrađeni adekvatnim statističkim metodima. Rezultati: Sistemski faktori koji su se izdvojili kao prediktori smrtnog ishoda (GOS 1) kod povređenih sa TTMO tokom prvog dana boravka u JIL su upotreba vazoaktivne potpore i glikemija. Upotreba vazoaktivne potpore povećava verovatnoću za smrtni ishod 4,7 puta (OR=0,214; 95%CI: 0,096-0,479; p&lt;0,05). i vrednosti glikemije &gt; 10 mmol/l povećavaju verovatnoću za smrtni ishod u nultom satu (OR= 0,240, 95%CI: 0,087-0,662; p=0,05) i u 24 satu (OR=0,206, 95%CI: 0,037 &ndash; 0,929; p=0,05). Sa svakim porastom telesne temperature za jednu jedinicu u posmatranom intervalu raste verovatnoća za pozitivan ishod (OR =2,118 , 95%CI: 1,097 &ndash; 4,091; p&lt;0,05) i vrednosti glikemije u intervalu od 4-8 mmol/l povećavaju verovatnoću za pozitivan ishod 2,5 puta. Sistemski faktori koji su se izdvojili u smislu predikcije ishoda lečenja ispitanika nakon otpusta iz JIL su vrednosti glikemije i telesna temperatura. Vrednost glikemije na prijemu u intervalu od 6,9 do 7,4 mmol/l povećavaju verovatnoću boljeg oporavka (GOS 4-5 vs. GOS 2-3). Niže vrednosti glikemiije u narednim vremenskim tačkama (6h, 12h, 18h) takođe povećavaju verovatnoću za bolji oporavak. Ukoliko je telesna temperatura u 6-om i 12-om satu, vi&scaron;a od 36,5 &deg;C veća je verovatnoća za bolji neurolo&scaron;ki oporavak, prilikom otpusta iz JIL, odnosno Klinike za neurohirurgiju KCV. Ispitanici koji su imali vi&scaron;e vrednosti telesne temperature su imali duže trajanje hospitalizacije (OR=4,096; 95%CI; 0,709-7,483;p&lt;0,05). Na dužinu boravka u JIL, kao i na otpust kući ili odgovarajući rehabilitacioni centar nije imao uticaj nijedan posmatrani sistemski faktor. Zaključak: Sistemski prediktivni faktori toka i ishoda lečenja povređenih sa TTMO su upotreba vazoaktivne potpore, glikemija i telesna temperatura.</p> / <p>Introduction: Traumatic brain injury (TBI) is a global health problem that affects about 10 million people worldwide annually. Severe traumatic brain injury (STBI) account for 10% of all TBI and has high morbidity and unreliable recovery. Early recognition of systemic factors that affect the treatment outcome can have a significant impact on the timely initiation of therapeutic measures and the reduction of morbidity and mortality. The objective of the research: to identify systemic factors that have a significant impact on the treatment outcome of the STBI patients in the Intensive Care Unit (ICU) during the first day of hospitalization. Methodology: The study was conducted as a retrospective-prospective study that included 115 injured patients with STBI who were hospitalized in the ICU, Emergency Center (EC) of the Clinical Center of Vojvodina (CCV) in the period from 01.01.2014 to 1.10.2017. From the medical documentation, for each participant involved in the research, the following parameters within the first 24 hours after the admission were considered and analyzed: demographic and general characteristics of the participants of importance for research and systemic predictive factors (systolic and mean arterial pressure-SAP / MAP, glycemia, body temperature -TT, pH, partial pressure of oxygen-PaO2 and partial pressure of carbon dioxide-PaCO2) registered at five time points (0h, 6h, 12h,18h, 24h). All of the above data were observed and analyzed as predictors, ie, independent variables in relation to the dependent variable &quot;treatment outcome&quot; defined as the Glasgow Outcome Scale (GOS) after the transfer from the ICU to the Clinic of neurosurgery of the CCV and GOS after discharge from a Clinic of neurosurgery and &quot;treatment course&quot; defined by length of stay in ICU, or the total duration of hospitalization in CCV, as well as the release to the home or the appropriate rehabilitation center. Statistical analysis was performed using the IBM SPSS 23 statistical package. The data are presented in tables and graphs, and the statistical significance was determined at p &lt;0.05. The collected data were processed with adequate statistical methods. Results: Systemic factors that had predictive value for the lethal outcome (GOS 1) in STBI during the first day of ICU stay were the use of vasopressors and glycemia. The use of vasopressors increases the likelihood of fatal outcome 4.7 times (OR= 0,214; 95%CI: 0,096-0,479; p&lt;0,05) and glycemic values &gt; 10 mmol/l increase the likelihood of fatal outcome on admission (OR=0,240, 95%CI: 0,087-0,662; p=0,05) and after 24 hours (OR=0,206, 95%CI: 0,037 &ndash; 0,929; p=0,05). With each increase in body temperature for one unit in the observed interval, the probability of a positive outcome increases (OR=2,118, 95%CI: 1,097 &ndash; 4,091;p&lt;0,05) and glycemic values in the range 4-8 mmol/l increase the probability of a positive outcome 2.5 times. Systemic factors that predict the treatment outcome of the patients after their discharge from ICU are glycemia and body temperature. The blood sugar on admission in the ICU in the range from 6.9 to 7.4 mmol/l increases the opportunity of a better recovery (GOS 4-5 vs. GOS 2-3). Lower glycemic values at the next time points (6h, 12h, 18h) also increase the opportunity of a better recovery. If the body temperature in the 6th and 12th-hour postadmission is higher than 36.5&deg; C, the greater opportunity for better neurological improvement when the patient is discharged from ICU, or from the Clinic of neurosurgery. Participants who had higher values of body temperature had a longer duration of hospitalization (OR 4.096; 95% CI; 0.709-7.483;p&lt;0,05). The length of the stay in ICU, as well as the release to the home or the appropriate rehabilitation center, was not affected by any observed systemic factor. Conclusion: Systemic predictive flow factors and outcome of treatment factors with STBI use of vasopressors, glycemia and body temperature.</p>

Intermittent fasting (IF) is a recently popularized meal timing strategy whereby individuals abstain continuously from any energy intake for 16 to 20 hours each day, subsequently condensing energy intake into a short period spanning 4 to 8 hours. We aimed to test the effects of intermittent fasting in 10 individuals with Type 2 Diabetes Mellitus in conjunction with recommendations to consume a high protein diet in a 6 to 8 week withdrawal study. This study consisted of three phases: baseline, intervention, and follow-up. During the 2-week baseline and intervention phases participants consumed meals at regular times. Biochemical, anthropometric, and physical activity measurements were taken at the end of each phase. Participants reported morning, afternoon and evening self-monitored blood glucose and fasting duration on a daily basis, in addition to completing a remote food photography diary three times within each study phase. Despite the short duration of the intervention phase, intermittent fasting led to significant decreases in weight, BMI, morning SMBG, and overall reductions in waist circumference, C-reactive protein, energy intake, carbohydrate intake, and fat intake. There were significant variations between participants in response to intermittent fasting in respect to changes in lipids and insulin sensitivity, which could not be explained by baseline biochemical or anthropometric measures, fasting duration, energy intake, or physical activity. Upon cessation of intermittent fasting, biochemical changes regressed towards baseline values during the follow-up period. Intermittent fasting was well tolerated by most participants, and no severe adverse events were noted. Morning nausea was the most common complaint, which abruptly ceased when medication timing was changed.