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.

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

Introduction: Physical activity (PA) is part of the Ministry of Health recommendations for control of diabetes mellitus (DM) and its complications. Objective: To evaluate the level of physical activity and the occurrence of diabetic peripheral neuropathy in elderly patients with type 2 DM. Methods: This is a transversal study with a sample chosen by convenience, equivalent to 11.8% of diabetics in Rosário do Catete - SE, correspondent of 49 individuals. Inclusion criteria: age ≥ 18 years and joined the Family Health Units as diabetes type 2. Exclusion criteria: inability to perform physical activity and cognitive impairment. Instruments used: International Physical Activity Questionnaire, Symptom Score and Neuropathy. Data collected in clinics and homes. Statistical analysis performed with the Student t test, Mann Whitney U and multivariate logistic regression by Stata version 13.0. Results: We selected 52 individuals with a mean age of 63 ± 12.3 years, categorized into Neuropathy (n = 29) and not Neuropathy (n = 23), as well as more active (n = 16) and less active (n = 36). We found that only 31% of individuals were more active, they had lower mean age and blood glucose levels as well as more time from diagnosis. The presence of diabetic neuropathy was statistically significant in those less active (p <0.01) such that the inverse (p <0.01). Conclusion: There wasn´t a satisfactory level of physical activity in 69% of the individuals and the prevalence of diabetic neuropathy was 56%. / Introdução: A atividade física (AF) faz parte das recomendações do Ministério da Saúde para o controle do Diabetes Mellitus (DM) e suas complicações. Objetivo: Avaliar o nível de atividade física e ocorrência de neuropatia diabética periférica em idosos com DM tipo 2. Casuística e Métodos: Trata-se de estudo transversal com amostra escolhida por conveniência, equivalente a 11.8% dos diabéticos de Rosário do Catete - SE, correspondente a 49 indivíduos. Critérios de inclusão: idade ≥ 18 anos e cadastro nas Unidades de Saúde da Família como diabéticos tipo 2. Critérios de exclusão: incapacidade de realizar atividade física e déficit cognitivo. Instrumentos utilizados: Questionário Internacional de Atividade Física, Escore de Sintomas e Comprometimento Neuropático. Dados coletados nos ambulatórios e residências. Análises estatísticas realizadas com os testes T Student, U de Mann Whitney e Regressão Logística Multivariada por meio da versão 13.0 Stata. Resultados: Foram selecionados 52 indivíduos, idade média igual a 63±12.3 anos, categorizados em neuropáticos (n=29) e não neuropáticos (n=23), bem como em mais ativos (n=16) e menos ativos (n=36). Verificou-se que apenas 31% dos indivíduos eram mais ativos, esses tinham idade média e glicemias menores, assim como maior tempo de diagnóstico. A presença da neuropatia diabética foi estatisticamente significante naqueles menos ativos (p<0,01) tal qual o inverso (p<0,01). Conclusão: Não foram encontrados parâmetros adequados do nível de atividade física em 69% da amostra e a neuropatia diabética apresentou prevalência de 56%.

Submitted by JÚLIO HEBER SILVA (julioheber@yahoo.com.br) on 2017-06-26T19:11:13Z No. of bitstreams: 2 Tese - Rosana de Morais Borges Marques - 2010.pdf: 1771939 bytes, checksum: 5fd48f948c945325a5833c92d6c978df (MD5) license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) / Approved for entry into archive by Cláudia Bueno (claudiamoura18@gmail.com) on 2017-07-07T18:09:01Z (GMT) No. of bitstreams: 2 Tese - Rosana de Morais Borges Marques - 2010.pdf: 1771939 bytes, checksum: 5fd48f948c945325a5833c92d6c978df (MD5) license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) / Made available in DSpace on 2017-07-07T18:09:01Z (GMT). No. of bitstreams: 2 Tese - Rosana de Morais Borges Marques - 2010.pdf: 1771939 bytes, checksum: 5fd48f948c945325a5833c92d6c978df (MD5) license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) Previous issue date: 2010-11-10 / The aim of the study was to asses the relative validity and the reproducibility of a quantitative food frequency questionnaire for epidemiologic studies with adolescents with type 1 diabetes. The participants were 70 adolescents of both sexes, regularly assisted at the endocrinology department of the Hospital das Clínicas from the Universidade Federal de Goiás and of the Hospital Geral de Goiânia. The socioeconomic status, demographic data, metabolic control, antropometry, physical activity and estimated energy requirement were evaluated. The food consupmtion was evaluated by the application of four 24-hour recalls, also used for the validation study. The reproducibility was evaluated by the comparison of the results obtained after two applications of the questionnaire. T test was aplied and Pearson correlation of energy-adjusted data was calculated and than corrected by intra personal variation. Agreement tests were also applied for validation and reproducibility. The adolescents presented an average of 14 years-old and an income of two salaries. More than 80% presented inadequate glycemic control that might be influenced by the caregiver's education and insulinic therapy. The diet was under the recommendations for carbohydrates and with high proportion of lipids. Most of the adolescents were sedentary or practiced light activity. The correlation coefficients obtained from the recalls and the questionnaires were as described by the literature, except for protein, which was inferior. The reproducibility of results showed good agreement. The questionnaire demosntrated acceptable capacity in measuring habitual consumption of adolescents with type 1 diabetes, being recommended as an instrument in clinic and epidemiologic studies with this population. / Este estudo objetivou avaliar a validade relativa e a reprodutibilidade de um questionário quantitativo de frequência alimentar para adolescentes portadores de diabetes tipo 1. Participaram do estudo 70 adolescentes, de ambos os sexos, regularmente atendidos nos ambulatórios de endocrinologia do Hospital das Clínicas da Universidade Federal de Goiás e do Hospital Geral de Goiânia. Os pacientes foram avaliados quanto aos aspectos socioeconômicos, demográficos, controle metabólico, antropometria, nível de atividade física e necessidade estimada de energia. O consumo alimentar foi avaliado por meio da aplicação de quatro recordatórios de 24 horas, cujos dados também foram utilizados para a validação do questionário. A avaliação da reprodutibilidade do questionário se deu pela comparação dos resultados obtidos após duas aplicações do instrumento. Aplicaram-se os testes t de student e de correlação de Pearson para dados ajustados pela energia e corrigidos pela variabilidade intrapessoal. Também foram aplicados testes de concordância para a validação e reprodutibilidade. Os adolescentes apresentaram média de idade de 14 anos e renda mensal per capita de até dois salários mínimos. Mais de 80% apresentaram controle glicêmico inadequado cujos resultados indicaram influência da escolaridade do cuidador e terapia insulínica. O consumo alimentar mostrou-se abaixo do recomendado para carboidratos e maior proporção de lipídios. A maioria dos adolescentes era sedentária ou praticava atividade leve. Os coeficientes de correlação obtidos entre os dados dos recordatórios e dos questionários variaram de 0,32 a 0,75, conforme os descritos na literatura. Os resultados da reprodutibilidade demonstraram boa concordância. Concluiu-se que o questionário apresentou aceitável capacidade em medir o consumo habitual dos adolescentes diabéticos tipo 1, sendo recomendado como instrumento em estudos clínicos e epidemiológicos com esta população.

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

INTRODUCCIÓN: El manejo de los diabéticos es complejo debido a múltiples factores de riesgo asociados y complicaciones que disminuyen su calidad de vida. OBJETIVOS: Determinar si la prevalencia de actividad física y tiempo sentado viendo TV difieren según el estado de glicemia en población entre 30 a 69 años residentes de Tumbes. METODOLOGIA: Análisis de datos secundarios de un estudio de base poblacional. Dos fueron las variables de respuesta, nivel de actividad física y tiempo sentado viendo TV. La exposición fue estado de glicemia categorizada en euglicémico, disglicémico y diabético tipo 2, dividida en diabético no consciente y consciente de su enfermedad. Se reportó el análisis con razones de prevalencia e intervalos de confianza al 95% utilizando modelos de regresión de Poisson. RESULTADOS: Los datos de 1607 participantes se analizaron, 809 (50.3%) fueron mujeres, la edad media fue 48.2 años (DE 10.6). La prevalencia de diabetes total fue 11.0% (IC95% 9.5% - 12.6%) y disglicemia 16.9% (IC95% 15.1% - 18.8%). Un total de 605 (37.6%; IC95% 35.2% -39.9%) reportaron bajos niveles de actividad física y 1019 (63.3%; IC95% 60.9% - 65.7%) pasar ≥2 horas al día sentados viendo TV. En modelo multivariado, no se encontró asociación significativa entre estado de glicemia y niveles de actividad física (RP= 1.14; IC95% 0.95-1.36); igualmente entre estado de glicemia y tiempo sentado viendo TV. Sin embargo, los diabéticos conscientes fueron más probables de tener bajos niveles de actividad física comparados con los euglicémicos (RP= 1.31; IC 95% 1.06-1.61). CONCLUSIONES: No se encontró asociación significativa entre estado de glicemia, nivel de actividad física y tiempo sentado viendo TV, hallándose niveles similares de actividad física entre euglicémicos, disglicémicos y diabéticos. Los diabéticos conscientes tienen 30% más probabilidad de presentar actividad física baja respecto a euglicémicos. Se recomienda aumentar los niveles de actividad física para prevenir complicaciones de DM2. / INTRODUCTION: The management of diabetics is complex due to multiple associated risk factors and complications that decrease their quality of life. OBJECTIVES: To assess whether the prevalence of physical activity levels and sitting time watching TV differ depending on glycemia status in population between 30 and 69 years old living in Tumbes. METHODS: A secondary analysis using data from a population-based study was conducted. Two were the outcomes: physical activity levels and sitting time watching TV. The exposure was glycemia status categorized into euglycemia, dysglycemia and T2DM. The T2DM group was further split into: aware and unaware of T2DM diagnosis. Prevalence ratios (PR) and 95% CI were reported using Poisson regression models. RESULTS: Data of 1607 individuals, mean age 48.2 (SD:10.6) years, 809 (50.3%) females, were analyzed. Dysglicemia and T2DM was present in 16.9% (95% CI: 15.1% 18.8%) and 11.0% (95% CI: 9.5%-12.6%) of participants, respectively. A total of 605 (37.6%; 95% CI: 35.2%-39.9%) had low levels of physical activity and 1019 (63.3%; 95% CI: 60.9%-65.7%) spent ≥2 hours per day sitting watching TV. In multivariable model, there was no significant association between glycemia status and physical activity levels (PR =1.14; 95% CI: 0.95- 1.36). Similarly between glycemia status and sitting time watching TV. However, those aware of T2DM diagnosis were more likely to have low levels of physical activity (PR=1.31; 95% CI: 1.06-1.61) compared to the euglycemics. CONCLUSIONS: We found a no relationship between glycemia status and physical activity level or sitting time watching TV, pointing out similar levels of physical activity among those with euglycemia, dysglicemia and T2DM. Individuals aware of having T2DM were 30% more likely to have low physical activity levels compared to the euglycemics. There is a need to increase physical activity levels among T2DM individuals to prevent DM2 complications. / Tesis

Cotutelle internationale avec le Laboratoire Éducations et Promotion de la Santé (Santé publique - UR 3412) de l'Université Sorbonne Paris Nord. / L'autosurveillance glycémique est essentielle pour les personnes vivant avec un diabète afin d'évaluer leur glycémie et adapter leurs traitements ou comportements. En France, depuis 2017, le glucomètre connecté à mesure flash FreeStyle Libre est proposé aux personnes vivant avec un diabète à la condition de suivre une éducation spécifique au sein de structures coutumières de l’éducation thérapeutique et du diabète. La littérature scientifique a montré l'efficacité de l'autosurveillance avec ce système, mais il existe peu d'études sur son appropriation et son impact. Cette recherche vise à décrire et comprendre le phénomène d’appropriation du FreeStyle Libre en identifiant comment elle s’est déroulée, comment elle s’opérationnalise, selon quelles interventions, chez qui cela fonctionne, dans quels contextes, et quels sont les mécanismes en jeu. Une évaluation réaliste a été menée en se basant sur une théorie de moyenne portée. Cette recherche a été réalisée au sein de quatre terrains en région parisienne auprès de 48 personnes vivant avec un diabète et professionnels de santé. Tout d’abord, les résultats montrent qu’au cours du temps, les programmes ont évolué dans leurs modalités et contenus, dans la façon dont ils s’organisaient, mais aussi que les interventions éducatives réellement mises en œuvre diffèrent au regard des interventions qui sont censées avoir cours. Ensuite, pour expliquer l’appropriation du FreeStyle Libre, 114 chaînes de contexte-mécanismes et effets ont été construites et éclairent sur l’acceptation du FreeStyle Libre, les conditions et modalités d’utilisation et sur les effets produits grâce à celle-ci. Les chaînes de contextes-mécanismes-effets mettent en évidence des contextes plus favorables à l’appropriation (littératie numérique élevée, empowerment préexistant, engagement dans la démarche d’autogestion…) et des contextes moins favorables (trait de personnalité compulsive, littératie générale ou numérique faible, absence d’éducation et d’accompagnement…). Les mécanismes qui sont générés font appel aux connaissances, à l’absence de crainte sur la confidentialité et l’immixtion dans la vie privée, à la motivation, et aux normes personnelles. L’acceptation du FSL est forte et fait intervenir la perception que la technologie peut contribuer à la performance de l’autosurveillance glycémique et qu’elle est facile à utiliser. Ensuite, l’analyse a permis de discriminer plusieurs modalités d’utilisation suivant des indicateurs quantitatifs et qualitatifs de l’usage. Des effets de l’appropriation sont identifiés dans l’amélioration de la qualité de vie dans le diabète, l’amélioration de la relation interpersonnelle entre soignants et personnes soignées, dans la diminution d’une anxiété liée au diabète, dans l’adaptation des traitements et des comportements et enfin dans la connaissance de la maladie et le raisonnement des personnes. La théorie de moyenne portée finale constituée sur la base de ces résultats adresse un modèle global de l’appropriation du FreeStyle Libre. Cette étude montre qu’il existe de nombreuses variations de l’appropriation. Elle situe que l’éducation à l’utilisation du FreeStyle Libre est nécessaire pour en tirer davantage parti et identifie un manque d’intégration de la technologie connectée dans les programmes d’éducation thérapeutique, ce qui constitue un enjeu particulier pour l’avenir. / Self-monitoring of blood glucose is essential for people living with diabetes to assess their blood glucose levels and adapt their treatment or behaviour. In France, since 2017, the FreeStyle Libre (FSL) flash glucose meter has been offered to people living with diabetes on the condition that they attend a specific education program within facilities accustomed to diabetes and therapeutic education. The scientific literature has shown the efficacy of self-monitoring with this system, but there are few studies on its appropriation and impact. This research aims to describe and understand the phenomenon of appropriation of FreeStyle Libre by identifying how it has been implemented, how it is operationalized, according to which interventions, in whom it works, in which contexts, and what mechanisms are at work. A realist evaluation was carried out based on a middle-range theory. This research was conducted in four settings in the Paris area involving 48 people living with diabetes and healthcare professionals. First of all, the results show that over time, the programmes have evolved in their modalities and contents, in the way they were organized, but also that the implemented educational interventions differed from those that were supposed to take place. Next, to explain the appropriation of FreeStyle Libre, 114 context-mechanism-effect chains were constructed that shed light on the acceptance of FreeStyle Libre, the conditions and modalities of its use, and the effects produced through it. The context-mechanism-effect chains highlight contexts that are more favourable to appropriation (high digital literacy, pre-existing empowerment, commitment to self-management, etc.) and less favourable contexts (compulsive personality trait, low general or digital literacy, lack of education and support, etc.). The mechanisms that are generated involve knowledge, lack of fear about confidentiality and privacy, motivation, and personal norms. Acceptance of the FSL is strong and involves the perception that the technology can contribute to the performance of self-monitoring of blood glucose and that it is easy to use. Then, the analysis allowed us to distinguish several modalities of use according to quantitative and qualitative indicators of use. The effects of appropriation are identified in the improvement of the quality of life in diabetes, the improvement of the interpersonal relationship between caregivers and cared-for persons, the reduction of anxiety related to diabetes, the adaptation of treatments and behaviours, and finally in the knowledge of the disease and the reasoning of the persons. The final middle-range theory built on these results addresses a global model of the appropriation of FreeStyle Libre. This study shows that there are many variations of appropriation. It identifies that education in the use of FreeStyle Libre is needed to get more out of it, and identifies a lack of integration of connected technology into health education programmes, which is a particular challenge for the future.

<p>Aging erodes motivation, cognition, sensory modalities and physical capacities, effectively depleting quality of life. Declining sensory, cognitive and motor function are reliable biomarkers of aging and mortality risk. These declines are associated with dysregulation of systemic and cellular processes. We developed a complex dietary supplement (DSP) designed to ameliorate five mechanisms of aging (oxidative processes, inflammation, mitochondrial function, insulin resistance and membrane integrity). Remarkably, normal mice fed the DSP retained youthful functionality into old ages, reflecting slower aging rates. Marked improvements in motor function, memory capacity, spatial learning, muscle strength, visual acuity, olfaction, fecundity and important behavioral functions were observed in aging supplemented mice. Conversely, untreated control animals showed age-related declines in all of the above. Functional improvements were associated with reduced oxidative damage, elevated mitochondrial activity, positive cellular energy balance, improved glucose tolerance, boosted neurotransmitters, greater synaptic density and higher neuronal numbers throughout the brain. A 30% reduction in cancer rates was also documented for DSP treated p53+/- mice. The vast functional benefits greatly exceed the modest longevity extension (11%) in normal supplemented mice. For aging humans, maintaining functionality and performance into later years may provide greater socioeconomic and health benefits than simply prolonging lifespan. Implications of these findings extend to common age-related pathologies including dementia and neurodegenerative diseases, diabetes, cancer, sarcopenia and age-related macular degeneration. Although identifying the role of specific ingredients remains outstanding, results provide proof of principle that complex dietary cocktails can powerfully ameliorate biomarkers of aging and modulate mechanisms considered ultimate goals for aging interventions.</p> / Doctor of Philosophy (PhD)

Le diabète de type 1 (DT1) se caractérise par la destruction auto-immune des cellules ß des îlots de Langerhans du pancréas productrices d’insuline, entraînant un état d’hyperglycémie chronique. Malgré une prise en charge très fine de la maladie, s’appuyant sur l’insulinothérapie fonctionnelle, les personnes vivant avec le DT1 sont fréquemment sujettes à des épisodes hypoglycémiques et hyperglycémiques en raison de difficultés à adapter le traitement insulinique, notamment lors de l’activité physique. L’activité physique procure de nombreux bénéfices pour la santé que l’on ait ou non un diabète. Cependant, dans le cadre du DT1, les excursions glycémiques lors de l’activité physique peuvent conduire à des barrières à l’activité physique dans cette population ou peuvent limiter les performances sportives d’athlètes vivant avec le DT1. L’objectif de cette thèse était triple : 1) Étudier les barrières à l’activité physique chez les enfants et adultes vivant avec le DT1 et à leurs liens avec les excursions glycémiques réellement vécues dans la vie quotidienne et d’autant plus autour de l’activité physique, 2) Chez des enfants vivant avec le DT1, comparer deux types d’exercice (exercice aérobie continu vs. intermittent intense), représentatifs de leur activité physique spontanée, et explorer leurs effets sur les variations glycémiques à l’exercice et à la récupération précoce et tardive et, 3) Mesurer la glycémie en continu, à l’exercice et à la récupération, chez des sportifs en endurance qui n’ont pas de diabète, afin de comprendre les mécanismes impliqués dans la régulation de la glycémie lors d’épreuves d’ultra-endurance et de transposer ces résultats chez des sportifs vivant avec le DT1. Les résultats montrent que : 1) Chez les enfants, plus le temps passé <54 mg.dL-1 les nuits suivant les séances d'activités physiques augmente, plus la peur de l'hypoglycémie est importante. Chez les adultes, étonnamment, ceux qui déclarent le moins l’hypoglycémie comme une barrière à l’activité physique sont ceux qui ont le plus grand pourcentage de séances d’activités physiques entraînant une baisse de glycémie; 2) Le risque hypoglycémique n’est pas supérieur lors d’un exercice continu modéré représentatif de l’activité physique spontanée des enfants et, cet exercice semble efficace pour diminuer l’hyperglycémie retrouvée les jours inactifs sur la même période de temps; 3) Un risque hyperglycémique existe lors des phases intenses de la course et pendant 48 heures de récupération lors d’un ultra-trail réalisé chez des athlètes qui n’ont pas de diabète. Ce risque hyperglycémique à la récupération pourrait être en lien avec les dommages musculaires. / Type 1 diabetes (T1D) is characterized by the autoimmune destruction of the insulin-producing ß-cells of the islets of Langerhans in the pancreas, leading to a state of chronic hyperglycemia. Despite very sophisticated management of the disease, based on functional insulin therapy, people living with T1D are frequently subject to hypoglycemic and hyperglycemic episodes because of difficulties in adapting insulin treatment, particularly during physical activity. Physical activity has many health benefits, whether or not you have diabetes. However, in the context of T1D, glycemic excursions during physical activity may lead to barriers to physical activity in this population or may limit the sporting performance of athletes living with T1D. The aim of this thesis was threefold: 1) Investigate the barriers to physical activity in children and adults living with T1D and their links with the glycemic excursions actually experienced in daily life and all the more so around physical activity, 2) In children living with T1D, compare two exercise modalities (continuous aerobic exercise vs. intense intermittent), representative of their spontaneous physical activity, and explore their effects on glycemic variations during exercise and early and late recovery and, 3) Measure glycemia continuously, during exercise and recovery, in endurance athletes without diabetes in order to understand the mechanisms involved in regulating glycaemia during ultra-endurance events and transpose these results to athletes living with T1D. The results show that: 1) In children, the greater the time spent <54 mg.dL-1 on the nights following physical activity sessions, the greater the fear of hypoglycemia. Surprisingly, among adults, those who least reported hypoglycemia as a barrier to physical activity were those who had the highest percentage of physical activity sessions resulting in a drop in blood glucose levels; 2) The risk of hypoglycemia is no greater during continuous moderate exercise representative of the spontaneous physical activity of children, and this exercise appears to be effective in reducing the hyperglycemia found on inactive days over the same period of time; 3) A hyperglycemic risk exists during the intense phases of the race and during 48 hours of recovery during an ultra-trail run carried out in athletes who do not have diabetes. This hyperglycemic risk during recovery could be related to muscle damage.