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CoordenaÃÃo de AperfeÃoamento de Pessoal de NÃvel Superior / As dislipidemias e o diabetes apresentam-se como importantes fatores de risco nas doenÃas cardiovasculares. Quando se associa ao estresse oxidativo podem acelerar a progressÃo das lesÃes aterosclerÃticas. Estudos com produtos naturais fornecem dados interessantes no controle dessas doenÃas. No presente estudo foram utilizados dois compostos derivados da canela, o Ãcido cinÃmico (AC) e cinamato de metila (CM), semelhantes estruturalmente e com atividades biolÃgicas e farmacolÃgicas jà descritas. O presente estudo tem por objetivo avaliar os possÃveis efeitos hipolipidÃmico e hipoglicÃmico, bem como o potencial antioxidante do Ãcido cinÃmico e do cinamato de metila em protocolos experimentais de dislipidemias e diabetes induzidas farmacologicamente. A hiperlipidemia foi induzida em camundongos machos atravÃs de dois protocolos agudos, mediante uma Ãnica administraÃÃo intraperitoneal de 400mg/Kg de Triton WR-1339 e 400mg/Kg de Poloxamer-407 em todos os animais, exceto no controle negativo. Os grupos foram tratados via oral por gavagem, onde o controle negativo e o controle positivo receberam Ãgua potÃvel de acordo com o peso, o grupo fenofibrato recebeu a dose de 200mg/Kg, enquanto que os grupos Ãcido cinÃmico e cinamato de metila receberam a mesma dose de 20mg/Kg. O sangue desses animais foi coletado em 24 e 48 horas apÃs as induÃÃes e foram verificados os nÃveis plamÃticos de colesterol total, triglicerÃdeos, glicose, AST e ALT. ApÃs a coleta de 48 horas retirou-se o tecido hepÃtico, em ambos os protocolos, para analisar a peroxidaÃÃo lipÃdica, atravÃs da determinaÃÃo dos grupos sulfidrÃlicos nÃo-proteÃcos (NP-SH), malondialdeÃdo (MDA) e das enzimas antioxidantes: superÃxido dismutase (SOD) e catalase (CAT). Para determinar o potencial hipoglicemiante do Ãcido cinÃmico e do cinamato de metila utilizou-se o protocolo de diabetes induzida por aloxano atravÃs de uma Ãnica injeÃÃo intraperitoneal na dose de 200mg/Kg. Os grupos foram tratados por sete dias com Ãgua potÃvel de acordo com o peso (grupo controle positivo), metformina 50mg/Kg (grupo metformina), Ãcido cinÃmico 20mg/Kg (grupo Ãcido cinÃmico) e cinamato de metila 20mg/Kg (grupo cinamato de metila). Observou-se que, apÃs a induÃÃo, tanto com o Triton quanto Poloxamer, o AC e o CM foram capazes de reduzir o colesterol e os triglicerÃdeos apÃs 24 e 48 horas, sem, no entanto alterar as enzimas hepÃticas AST e ALT. Somado a esse fator observou-se que as substÃncias em estudo apresentaram certa atividade sobre o estresse oxidativo tendo em vista a reduÃÃo do MDA e NP-SH no protocolo do Triton e da NP-SH no protocolo do poloxamer. Tendo o cinamato de metila apresentado uma maior atividade em comparaÃÃo ao Ãcido cinÃmico na anÃlise de 48 horas apÃs a induÃÃo em ambos os protocolos. Observando a resposta do AC e o CM em protocolo de induÃÃo de diabetes por aloxano, constatou-se que as referidas substÃncias foram capazes de reduzir de forma semelhante, a glicemia dos animais. Os resultados obtidos mostraram o potencial terapÃutico do AC e CM no tratamento das dislipidemias e do diabetes, no entanto faz necessÃrios novos estudos em protocolos crÃnicos que possam garantir a seguranÃa e eficÃcia de sua utilizaÃÃo. / Dyslipidemia and diabetes are presented as important risk factors in cardiovascular disease. When is associated with oxidative stress may accelerate the progression of atherosclerotic lesions. Studies with natural products provide interesting data in the control of these diseases. In the present study two compounds cinnamon derivatives, cinnamic acid (CA) and methyl cinnamate (MC) and structurally similar biological and pharmacological activities already described above were used. The present study aims to evaluate the possible hypolipidemic and hypoglycemic effects as well as the antioxidant potential of cinnamic acid and methyl cinnamate in experimental protocols pharmacologically induced dyslipidemia and diabetes. Hyperlipidemia was induced in male mice by two acute protocols through a single intraperitoneal administration of 400mg/kg Triton WR -1339 and 400mg/kg Poloxamer -407 in all animals except the negative control. The groups were treated orally by gavage, where the positive control and the negative control received drinking water according to the weight of fenofibrate group received 200mg/kg, whereas the cinnamic acid, methyl cinnamate groups and received the same dose 20mg/kg. The blood of these animals was collected at 24 and 48 hours after induction and was plamÃticos checked the levels of total cholesterol, triglycerides, glucose, AST and ALT. After collecting 48 hours we removed the liver tissue , in both protocols , to analyze lipid peroxidation , through the determination of non-protein sulfhydryl groups ( NP -SH ) , malondialdehyde ( MDA ) and antioxidant enzyme : superoxide dismutase (SOD ), and catalase (CAT). To determine the hypoglycemic potential of cinnamic acid and methyl cinnamate was used protocol alloxan induced diabetic by a single intraperitoneal injection at 200mg/kg. Both groups were treated for 7 days with drinking water according to the weight (positive control group), 50mg/Kg metformin (metformin group), cinnamic acid 20mg/kg (cinnamic acid group) and methyl cinnamate 20mg/kg (group cinamto methyl). It was observed that after induction with either Poloxamer as Triton, AC and BC were able to reduce cholesterol and triglycerides after 24 and 48 hours, without changing the liver enzymes AST and ALT. Added to this factor was observed that the substance under study showed some activity on oxidative stress in order to reduce the MDA and NP -SH in the protocol of the Triton and NP -SH in the poloxamer protocol. Having methyl cinnamate presented higher activity compared to cinnamic acid analysis 48 hours after the induction of both protocols. Observing the response of the CM and the AC induction protocol in alloxan diabetes, it was found that these compounds were able to similarly reduce the glucose levels. The results showed the therapeutic potential of CA and CM in the treatment of dyslipidemia and diabetes, however does require new studies in chronic protocols that can ensure the safety and efficacy of its use.

Introdução: Não foram encontrados na literatura dados sobre a prevalência de diabetes mellitus em mães de crianças com fissura labiopalatina. Dada a relevância do tema esse foi o principal objetivo da presente investigação. Método: Após aprovação do comitê de ética e pesquisa e obtenção do consentimento livre e esclarecido, foram entrevistadas 325 mulheres, mães biológicas de crianças com fissuras labiopalatinas com idades de 0 a 3 anos matriculadas no Hospital de Reabilitação de Anomalias Craniofaciais da Universidade de São Paulo, HRAC-USP. Foi aplicado questionário com 24 questões onde obteve-se a identificação das mães, o tipo de diabetes, os principais sinais clínicos, as comorbidades associadas, hipertensão, obesidade, medicamentos e drogas lícitas e ilícitas usadas durante a gravidez. Também foram aferidos a pressão arterial e o perímetro abdominal das mães e anotados os valores da glicemia de jejum na primeira consulta pré-natal. Resultados: Os resultados obtidos mostraram que 88 mulheres apresentavam diabetes mellitus, sendo 78 com diabetes mellitus gestacional, 05 com diabetes mellitus tipo 1 e 05 com diabetes mellitus tipo 2. A prevalência de diabetes mellitus em mães de crianças com fissuras labiopalatinas foi de 27,08%, comparativamente maior (p<0,01) aos valores encontrados na população adulta brasileira (7,6%). Dessas 88 mulheres, foram excluídos os fatores que de alguma forma pudessem influenciar o aparecimento de fissuras labiopalatinas e obteve-se o percentual de 16%, onde a hiperglicemia materna nessas mães foi o único fator provável no aparecimento dessas fissuras. Conclusão: A prevalência de diabetes mellitus em mães de crianças com fissuras labiopalatinas foi de 27,08%. (p<0,01). Extraídos os fatores tidos como confundidores, tais como medicamentos usados na gestação, álcool, tabaco, drogas ilícitas, obesidade e hipertensão arterial, restaram 52 mães que tinham somente a hiperglicemia materna como fator isolado, num total de 16%. / Introduction: there was no data found on the literature regarding the prevalence of diabetes mellitus in mothers of children born with cleft lip and palate. Given the relevance of the subject, that was the main objective of this investigation. Method: after approval by the research and ethics committee, and the free, informed consent firmed by the mothers, interviews were conducted with 325 women biological mothers of children aged between 0 to 3 years, born with cleft lip and palate, registered at Hospital for Rehabilitation of Craniofacial Anomalies, University of São Paulo, HRAC-USP. A 24-question survey was applied to collect data regarding the mothers identification, type of diabetes, clinical data, associated comorbidities, hypertension, obesity, medication and legal or illegal drugs used during pregnancy. Blood pressure and abdominal circumference were measured, and fasting blood glucose levels measured at the first prenatal visit. Results: It was found that 88 women had diabetes mellitus, 78 of which had gestational diabetes, 05 had type 1 diabetes and 05 had type 2 diabetes the prevalence of diabetes in mothers of children with cleft lip and palate was 27.08%, a number significantly higher (p<0.01) than the rates found among the Brazilian adult population (7.6%). From this group of 88 women we have suppressed the factors that could contribute to the occurrence of cleft lip and palate in some way, obtaining a prevalence of 16% in which maternal hyperglycemia was the only likely cause of cleft lip and palate. Conclusion: The prevalence of diabetes mellitus in mothers of children born with cleft lip and palate was 27.08% (p<0.01). Suppressing other potentially confusing factors like medication used during pregnancy, alcohol, tobacco, illegal drugs, obesity and hypertension, there were 52 mothers who had only maternal hyperglycemia as an isolated factor, representing 16% of the total studied population.

Dissertação (Mestrado em Engenharia Mecânica) - Centro Universitário FEI, São Bernardo do Campo, 2017.

Publicación a texto completo no autorizada por el autor / Identifica el nivel de conocimientos de los usuarios del Centro de Salud “San Juan de Miraflores” sobre prevención de Diabetes Mellitus tipo 2. El estudio es de tipo cuantitativo, nivel aplicativo método descriptivo de corte transversal. La muestra estuvo conformada por 211 usuarios que asisten al Centro de Salud “San Juan de Miraflores”, seleccionada mediante el muestreo probabilístico de proporción aleatorio simple. La técnica fue la encuesta y el instrumento un cuestionario aplicado previo consentimiento informado. Del 100% (211); 61.6 % (130) presenta conocimientos bajos, 30.3 % (64) conocimientos medios y 8% (17) conocimientos altos. En relación a la Prevención Primaria 40.3% (85) posee conocimiento medio, 36.5% (77) bajo y 23.2% (49) alto, desconocen sobre la acción que realizarían con el tabaco para prevenir la diabetes, las actividades físicas, alimentación saludable y frecuencia del consumo de alimentos. En prevención secundaria 66.2% (133) posee conocimiento bajo, 23.2% (49) medio y 14.2% (30) alto, desconocen sobre valores normales de glucosa, preparación para el examen de glucosa, frecuencia del examen de glucosa y el perfil de las personas sujetas al examen de glucosa. Se concluye que el nivel de conocimientos sobre prevención de diabetes mellitus en los usuarios del C.S “San Juan de Miraflores”, en su mayoría es bajo en relación a la prevención primaria posee conocimiento medio y bajo. Sobre prevención secundaria, posee conocimiento bajo; por lo estaría ocasionando aumento la incidencia y un riesgo de padecer de complicaciones de la diabetes mellitus tipo 2. / Tesis

Introdução: A propagação de conhecimentos essenciais nos cuidados necessários aos indivíduos com diabetes mellitus pode influenciá-los nas suas capacidades para desenvolver o autocuidado, primordiais à manutenção da qualidade de vida. Vídeos, valorizados por transportarem o cotidiano para o momento do aprendizado, na \"internet\" podem ser facilmente acessados pelo \"YouTube\". Porém não foram realizados estudos nacionais que explorem seu potencial e auxiliem na compreensão sobre o uso deste recurso no Brasil. Objetivo: Analisar o uso da \"internet\" como novo canal de comunicação para disseminação de conteúdo educativo de interesse de políticas públicas focadas no cuidado de indivíduos com diabetes mellitus tipo 1 e 2. Métodos: Vinte (20) vídeos foram produzidos, de acordo com planejamento educativo que buscou a maior eficácia no processo comunicativo. Foram realizadas exibições seguidas de entrevistas com o público de interesse para verificar a compreensão dos indivíduos acerca dos vídeos. Os mesmos foram divulgados no \"YouTube\", onde foi possível resgatar os dados dos internautas, como sexo e idade, número de acessos e tempo de visualização dos vídeos. Resultados: Todos os vídeos foram compreendidos satisfatoriamente pelos indivíduos entrevistados e na \"internet\" receberam 3.174 visualizações por ambos os sexos, de todas as faixas etárias, destacando-se o maior aproveitamento do conteúdo por mulheres idosas. Conclusão: A \"internet\" mostrou-se importante meio para a divulgação dos conhecimentos sobre os cuidados em diabetes mellitus no Brasil, visto que a população já utiliza este meio para buscar informações de saúde. Os vídeos podem ser utilizados como eficaz canal de disseminação de conteúdos educativos de interesse das Políticas de Saúde Pública. / Introduction: The dissemination of essential knowledge in the care of individuals with Diabetes Mellitus may influence their ability to develop self-care, which is essential to maintaining quality of life. Videos, valued for carrying \"everyday\" to the moment of learning, on the internet can be easily accessed by \"YouTube\". However, no Brazilian studies have been conducted that explore its potential and help in understanding the use of this resource in Brazil. Objective: Analyze the use of the internet as a new communication channel for the dissemination of educational content of interest to public policies focused on the care of Diabetes Mellitus type 1 and 2. Methods: Twenty (20) videos were produced according to educational planning which sought the greatest effectiveness in the communicative process. Exhibitions were followed by interviews with the audience of interest to verify the individuals\' understanding of the videos. The videos were released on YouTube, where it was possible to retrieve Internet users\' access data, such as gender and age, number of views and retention of videos. Results: All the videos presented a good understanding of the individuals interviewed and on the internet received 3,174 views by both genders, of all age groups, highlighting the greater use of content by older women. Conclusion: The internet has proven to be an important means of disseminating knowledge about diabetes care in Brazil, since the population already uses this medium to seek health information. The videos can be used as an effective channel for the dissemination of educational content of interest to Public Health Policies.

Thesis (M Med (Family Medicine))--University of Limpopo (Medunsa Campus), 2010. / Abundant literature supports the beneficial effects of diet and exercise recommendations for improving and maintaining glycaemic levels of people with type 2 diabetes mellitus. Patient adherence to therapeutic lifestyle measures is notoriously difficult to initiate and sustain; however, reason for non-adherence amongst diabetes population is very complex and multi-faceted in nature. Objectives To determine rates of non-adherence and reasons/barriers for not adhering to diet and exercise recommendations amongst type 2 diabetes mellitus patients attending Extension II clinic in Gaborone, Botswana. Summary of methods Design: descriptive cross-sectional study using self administered questionnaire Setting: Extension II clinic, a public family practice in Gaborone, Botswana. Study population: Consenting adults diagnosed with type 2 diabetes mellitus, aged 30 years or older, diagnosed 2 or more years and on clinic care. Sample selection: Convenience sampling method was used to select 35 subjects per month, over a period of three successive months and a total of 105 participants were recruited into the study, made up of 44 men and 61 women. Results 104 correctly filled questionnaires were included in the data analysis, of which, 59% were female. Estimated rates of non-adherence to diet and exercise were 37.4%; 95% CI, 27.7 – 46.3% and 52%; 95% CI, 42.4 – 61.6% respectively. The main perceived reasons for non-adherence to diet were granting self-permission (36.5%), lack of information (33.3%), eating out (31.7%), financial constraints (28.8%) and poor self control (26.9%); while the main perceived reasons for non-adherence to exercise were lack of information (65.7%), exercise as potentially exacerbating illness (57.6%), lack of exercise partner (24.0%), specific locations away from home (18.0%), and winter weather (15.4%). The overall reasons for not adhering to diet and exercise include lack of moral and emotional supports from the spouse (54.1%), family members (44.8%), and friends (58.7%). 95% and 67.3% of the participants had reported that diet and exercise respectively could improved and maintained their diabetic control. Conclusion Non-adherence to diet and exercise recommendations amongst type 2 diabetes patients is far more prevalent and no particular single reason could be attributed to poor adherence to either diet or exercise recommendations, rather a combination of many factors.

acase@tulane.edu / Although men with testosterone deficiency are at increased risk for type 2 diabetes (T2D), previous studies have ignored the role of testosterone and the androgen receptor (AR) in pancreatic β–cell. Our study shows that male pancreatic β–cell specific AR knockout (βARKOMIP) mice develop glucose intolerance because AR potentiates glucose-stimulated insulin secretion (GSIS) through increasing cyclic AMP (cAMP) accumulation and amplifying the insulinotropic effect of glucagon-like peptide-1 (GLP-1). Using transcriptome analysis, we find that AR-deficient islets exhibit altered expression of genes involved in inflammation and insulin secretion demonstrating the importance of androgen action in β-cell health in the male. Our recent study shows that male βARKOMIP mice exhibit impaired intraperitoneal (IP) glucose tolerance- because of impaired IP-GSIS- without alteration in oral glucose tolerance, suggesting that AR amplifies the islet-derived, but not the gut-derived GLP-1 to potentiate GSIS. Dihydrotestosterone (DHT) increases the insulinotropic effect of GLP-1, not gastric inhibitory polypeptide (GIP) and glucagon, in male insulin-secreting β-cell line 832/3 cells and wild-type male mouse islets. Accordingly, using 832/3 cells transduced with exchange factor directly activated by a cAMP (EPAC)-based fluorescence resonance energy transfer (FRET) sensor, we observe that the AR agonist dihydrotestosterone (DHT) specifically allows GLP-1, not GIP and glucagon, to increase cAMP production above level of the individual hormones. The insulinotropic effect of DHT is abolished using EPAC and PKA inhibitors as well as rapamycin indicating that DHT stimulates GSIS via a cAMP/PKA/EPAC pathway and activation of mTOR. This study identifies AR as a novel receptor that enhances β–cell function, a finding with implications for the prevention of type 2 diabetes (T2D) in aging men. / 1 / Weiwei Xu

acase@tulane.edu / Background The prediction of diabetes-related comorbidities and mortality over lifetime has significant clinical and policy implications. A prediction model can be used for economic evaluation on diabetes medications, comparative effectiveness review (CER) over different therapeutic plans, and estimation of the expected long-tern outcomes for different treatment goals (e.g., HbA1c). Most of the current diabetes prediction models heavily relied on the UKPDS risk engine and Framingham equation, which used data from 1970s on European populations. These populations were significantly different from current US population in various ways including race, different health related concept, treatment algorithm, screening method of comorbidities and even definition of diabetes. In addition, UKPDS risk engine does not include impact of hypoglycemia, which emerged as an important issue in the management of diabetes due to its impact on quality of life, cardiovascular events and mortality. Furthermore, with the advancement of the medical technology and innovation in redefining treatment guideline during the last decades, the rates of cardiovascular events, all-cause mortality and event related mortality have fundamentally changed, especially the survival rates from CVD events has substantially increased. There is an urgent needs to develop a new risk engine that more adaptable to the current US population. Objective The objective of this study was to update risk engine using a cohort of patients with type 2 diabetes in the United States. Methods A total of 21 equations for forecasting diabetes-related microvascular and macrovascular events, hypoglycemia, mortality, and progression of diabetes risk factors were estimated using data on 10,251 patients from the Action to Control Cardiovascular Risk in Diabetes (ACCORD) trial. Left truncated proportional hazard model was applied to fit each event equation using diabetes duration as time index, and a variety of distributions including Weibull and Gompertz distribution were tested. 10-folds cross-validation or bootstrapped validation was applied to account for overfitting issue. Predicted cumulative incidence rates was plotted against the observed cumulative incidence to serve as internal validation to evaluate the prediction accuracy of the BRAVO risk engine on ACCORD data. External validation was performed through applying the BRAVO risk engine onto population from other clinical trials. Results The BRAVO risk engine’s forecast felled within the 95% confidence interval for the occurrence of observed events at each time point through 40 years after diabetes onset. The model prediction provides accurate prediction according to the internal validation and external validation process, and good face validity on risk factors were established by endocrinologists. Severe hypoglycemia was found to be an important risk factor for congestive heart failure (CHF), myocardial infarction (MI), angina, blindness, and associated with increased mortality. Racial factor was included in more than half of the events equations (e.g. MI, revascularization surgery, blindness, SPSL, hypoglycemia). Therefore, the BRAVO risk engine can capture racial difference on diabetes outcomes among US population, as a significant improvement over UKPDS risk engine. Conclusion The BRAVO risk engine for the US diabetes cohort has a good internal validity to simulate events that closely match observed outcomes in the ACCORD trial. And it is also capable of accurately predict diabetes comorbidities in other US and non-US based clinical trials. The risk engine can be extrapolated over lifetime and provide long-term effect evaluation. The BRAVO risk engine can potentially provide more accurate prediction over a range of long-term outcomes than other current models, thus assist making clinical and policy decisions. / 1 / Hui Shao

Providers are encouraged to view patients with chronic disease as ??partners?? in their care, and to collaborate with them in developing care plans. Yet there is little guidance in how collaboration should occur, and little evidence that collaborative care improves patient outcomes. Related models and measures of patient centred care and shared decision making have not been developed specifically for the context of chronic disease care. This thesis aimed to develop a theoretical understanding of how providers and patients make decisions in chronic disease care planning, how patients experience involvement in care planning, and to develop a measure of patient involvement. It consists of two studies: a qualitative study to develop a grounded theory of decision-making in diabetes care planning, and a scale development and psychometrics study. The qualitative study involved 29 providers and 16 patients with diabetes. It found that providers were concerned with a process described as ??managing patient involvement to do the right thing??, while patients were concerned with ??being involved to make sure care is appropriate??. This led to the theory of ??delivering respectful care??, a grounded theory that integrates provider and patient perspectives by showing how providers and patients can resolve their concerns while achieving mutually acceptable outcomes. Central to this theory is the process of finding common ground, while the key conditions are provider responsiveness and an ongoing, trusting and respectful provider-patient relationship. The Collaborative Care Planning Scale (CCPS), based on these findings, is a patient self-report scale that measures patients?? perceptions of involvement in care planning. After piloting the CCPS was tested amongst 166 patients with diabetes. Exploratory factor analysis resulted in a 27-item scale comprising two factors: ??receiving appropriately personalised care?? and ??feeling actively involved in decision-making??. Psychometrics tests revealed the CCPS has adequate internal consistency and test-retest reliability, and findings support construct validity. ??Delivering respectful care?? enriches understanding of the nature of collaboration in chronic disease care, and identifies those elements necessary to ensure patients receive best possible care. The CCPS provides the means for measuring what patients say they value, and is thus an important measure of quality chronic disease care.