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Glucose is a fundamental energy source, the utilization and regulation of which impacts exercise performance and health. These studies have used modeling techniques to evaluate glucose kinetics and dynamics in equids and developed tests to evaluate the status of glucose metabolism. In Part I, 12 exercise-trained Arabians underwent insulin-modified FSIGT (with minimal model analysis) and single-injection glucose tracer (with compartmental analysis) studies at rest and during exercise to evaluate the effects of exercise on glucose kinetics and dynamics. These geldings were maintained on pasture, but adapted for 4 months to twice-daily feeding of feeds rich in sugar and starch (SS, n=6: NSC 45%, Fat 3%, NDF 24%) or fat and fiber (FF, n=6:NSC 13%, Fat 11%, NDF 45% ). Exercise increased insulin sensitivity (P = 0.070) and glucose transport (P < 0.038). Although variables were not different between FF and SS horses at rest, during exercise SS horses tended to have lower (P = 0.085) insulin sensitivity and increased (P = 0.043) glucose utilization compared to FF horses. In Part II, satisfactory proxies for minimal model parameters were developed to facilitate the evaluation of insulin sensitivity in larger populations. These proxies were applied to a population of 163 ponies and used to characterize metabolic differences between ponies predisposed to pasture laminitis (PL) from ponies not predisposed (NL). A subset of 14 ponies (7 PL, 7 NL) also underwent the FSIGT for minimal model analysis. Ponies predisposed to laminitis were found to have lower insulin sensitivity (P < 0.007) and higher insulin secretory response (P < 0.045) by both the minimal model and proxies, and higher (P < 0.001) circulating triglycerides and body condition score. Cut-point analysis for these variables was used to define a pre-laminitic metabolic syndrome with total predictive power of 78% to identifity ponies at risk for developing pasture laminitis. Increased insulin resistance and prevalence of lamintis were associated with increased non-structural carbohydrates in spring pasture. These studies demonstrate the importance of glucose regulation for exercise and animal health. When glucose regulation is altered in the case of insulin resistance, performance could be impacted and diseases such as laminitis may occur. Insulin resistance may be moderated by exercise or by avoiding sugar and starch in feeds and pasture. / Ph. D.

Thesis (Ph. D.)--University of Texas Health Science Center at Houston, School of Public Health, 2008. / "May 2008." Source: Dissertation Abstracts International, Volume: 69-02, Section: B, page: 0912. Adviser: Deanna M. Hoelscher. Includes bibliographical references (leaves 139-149).

Plusieurs études ont démontré que la consommation d’un repas à indice glycémique bas (LGI) avant un exercice physique favorisait l’oxydation des lipides, diminuait les épisodes d’hypoglycémie et améliorait la performance. Par contre, d’autres recherches n’ont pas observé ces bénéfices. Le but de cette étude consiste à démontrer l’impact de l’ingestion de déjeuners avec différents indices glycémiques (IG) sur la performance en endurance de cyclistes de haut niveau. Dix cyclistes masculins ont complété trois protocoles attribués de façon aléatoire, séparés par un intervalle minimal de sept jours. Les trois protocoles consistaient en une épreuve contre la montre, soit trois heures après avoir consommé un déjeuner à indice glycémique bas ou élevé contenant 3 grammes de glucides par kg de poids corporel, soit à compléter l’exercice à jeun. Les résultats obtenus pour le temps de course montrent qu’il n’y pas de différence significative entre les protocoles. Par contre, on observe que le nombre de révolutions par minute (RPM) est significativement plus élevé avec le protocole à indice glycémique élevé (HGI) (94,3 ± 9,9 RPM) comparativement au protocole à jeun (87,7 ± 8,9 RPM) (p<0,005). Au niveau de la glycémie capillaire, on observe que durant l’exercice, au temps 30 minutes, la glycémie est significativement supérieure avec le protocole à jeun (5,47 ± 0,76 mmol/L) comparé à HGI (4,99 ± 0,91 mmol/L) (p<0,002). Notre étude n’a pas permis de confirmer que la consommation d’un repas LGI avant un exercice physique améliorait la performance physique de façon significative. Cependant, notre recherche a démontré que la diversité des protocoles utilisés pour évaluer l’impact de l’indice glycémique sur la performance physique pouvait occasionner des variations positives dans les temps de courses. Par conséquent, il s’avère nécessaire de faire d’autres recherches qui reproduisent les situations de compétition de l’athlète soit la course contre la montre. / Many studies have shown that the consumption of a low glycemic index (LGI) meal before exercise promotes lipid oxidation, thus lowering the amount of hypoglycemic occurrence and improving physical performance. However, other studies have not observed such benefits. The objective of this study is to demonstrate the impact of ingesting various glycemic index (GI) breakfasts on the endurance performance of high-level cyclists. Ten men completed three randomly allocated protocols, and each was separated by a time interval of a minimum of seven days. Each protocol was composed of a time trial, where a measure was taken three hours either after consuming a breakfast of low or high glycemic index containing three grams of glucose per kg of body weight, or after completing exercise while fasting. The race time results demonstrated that there were no significant differences between the protocols. However, the number of revolutions per minutes (RPM) was significantly higher with the high glycemic index level protocol (94,3 ± 9,9) in comparison to the fasting protocol (87,7 ± 8,9) (p<0,005). Furthermore, the capillary glycemic profile showed that, during exercise at 30 minutes, blood glucose level was significantly higher in the fasting protocol (5,47 ± 0,76 mmol/L) in comparison to the high glycemic index (HGI) protocol (4,99 ± 0,91 mmol/L) (p<0,002). Our study did not confirm that the consumption of a LGI meal before physical exercise significantly improves physical performance. Yet it demonstrated that the diversity of protocols used to evaluate the impact of glycemic index on physical performance could generate positive impact during the race time. Therefore, there is a need to conduct further research that can reproduce athletic competition situations, such as time trials.

Malgré plusieurs études montrant les avantages du bon contrôle glycémique, celui-ci reste insuffisant pour un nombre important d’adultes atteints de diabète type 2. Plusieurs facteurs de risque sont associés au mauvais contrôle glycémique. L'insuffisance de prise en compte par les patients des conséquences immédiates et à long terme du mauvais contrôle glycémique peut aussi jouer un rôle. Les objectifs de cette thèse étaient : de déterminer la fréquence du mauvais contrôle glycémique, défini par un taux d’hémoglobine glyquée (HbA1c) ≥ 7,0% chez des sujets diabétiques de type 2 en Afrique sub-saharienne ; de déterminer les associations entre le mauvais contrôle glycémique et les facteurs de risque potentiels chez les diabétiques de type 2 en Afrique sub-saharienne ; de déterminer la fréquence des symptômes d'anxiété et de dépression et les facteurs de risque associés à ces états chez les diabétiques de type 2 en Afrique sub-saharienne. Les données transversales à l’inclusion de l'étude "Amélioration de l’accès à l'HbA1c en Afrique sub-saharienne" conduite au Cameroun et en Guinée ont été utilisées. Les valeurs d'HbA1c ont permis de dichotomiser la population des diabétiques en deux groupes: ceux avec un bon (HbA1c < 7,0%) ou ceux avec un mauvais (HbA1c ≥ 7,0%) contrôle glycémique. Des modèles de régression logistique binaire ont été utilisés pour évaluer les relations entre les facteurs de risque potentiels et le contrôle glycémique. Les analyses ont été conduites en utilisant le logiciel SAS. Des modèles multi variés ajustés sur les variables sociodémographiques, cliniques et les variables psychosociales ont été produits. Les résultats ont révélé que le pourcentage de diabétiques de type 2 avec un mauvais contrôle glycémique est élevé au Cameroun (68% de sujets avec une HbA1c ≥ 7,0%) et en Guinée (84% de sujets). Les principaux facteurs prédictifs du mauvais contrôle glycémique mis en évidence étaient : l'inclusion en Guinée, l’âge inférieur à 65 ans, la durée du diabète connue supérieure à 2 ans, un traitement par anti diabétique oral associé ou non à l’insuline et l'absence de mesures précédentes de l'HbA1c. Les symptômes d'anxiété et de dépression chez les diabétiques de type 2 étaient fréquents en Guinée (respectivement 34,4% et 58,7% des sujets). Un niveau élevé d'HbA1c (supérieur à 9%), la résidence en zone urbaine et le niveau de statut socio-économique étaient significativement associés à un risque plus élevé d'anxiété ou de dépression. / Despite several studies showing the benefits of good glycemic control , it is insufficient for a significant number of adults with type 2 diabetes. Several risk factors are associated with poor glycemic control . Inadequate consideration by patients immediate and long-term poor glycemic control may also play a role. The objectives of this thesis were : determine the frequency of poor glycemic control , defined as a glycated hemoglobin ( HbA1c) ≥ 7.0% in diabetic subjects with type 2 in sub- Saharan Africa ; determine the associations between poor glycemic control and potential risk factors in type 2 diabetes in sub- Saharan Africa ; determine the frequency of symptoms of anxiety and depression and risk factors associated with these conditions in type 2 diabetes in sub- Saharan Africa. Cross-sectional data for inclusion in the study "Improving access to HbA1c in sub- Saharan Africa " conduct in Cameroon and Guinea were used. HbA1c values ​​have allowed the diabetic population dichotomized into two groups: those with good (HbA1c <7.0 %) or those with bad (HbA1c ≥ 7.0%) glycemic control. Models of binary logistic regression were used to assess the relationship between potential risk factors and glycemic control . Analyses were conducted using SAS software . Adjusted for sociodemographic variables , clinical and psychosocial variables varied multi models were produced . The results showed that the percentage of type 2 diabetics with poor glycemic control is higher in Cameroon (68% of subjects with HbA1c ≥ 7.0 %) and Guinea (84% of subjects) . The main predictors of poor glycemic control were highlighted : the inclusion in Guinea, less than 65 years age, duration of more than 2 years known diabetes , treatment with oral anti diabetic with or without insulin and the absence of previous measurements of HbA1c . Symptoms of anxiety and depression in type 2 diabetes were common in Guinea ( respectively 34.4 % and 58.7 % of subjects) . A high HbA1c level ( above 9% ) , the urban residence and level of socio -economic status were significantly associated with a higher risk of anxiety or depression risk.

INTRODUÇÃO: A atividade física faz parte do tratamento do portador de diabetes mellitus tipo 1 (DM1), devendo ser encorajada pelas mesmas razões que é em não portadores. Os portadores de DM1, como evidenciam os estudos, apresentam póstreino: redução dos fatores de risco para o desenvolvimento de doenças cardiovasculares, melhora do condicionamento físico, da sensibilidade à ação da insulina e do bem-estar. Mas é fundamental realizar a monitorização glicêmica, adequar alimentação e dose de insulina para a prática de exercícios, a fim de evitar hipo ou hiperglicemias antes, durante ou após as sessões, e consequentemente, obter melhora ou manutenção do controle glicêmico. Além disso, o nível de atividade física relaciona-se inversamente ao aparecimento de complicações do diabetes e risco de mortalidade em portadores de DM1. Porém, poucos estudos demonstram o comportamento da glicemia destes pacientes em diferentes tipos de exercícios. O conhecimento da variação glicêmica durante o exercício é fundamental para a conduta terapêutica do médico, para a prescrição e orientação segura de exercícios pelos professores de educação física. OBJETIVOS: Analisar a variação da glicose de DM1, submetidos às sessões de exercício aeróbio, exercícios resistidos e teste ergoespirométrico, utilizando o Sistema de Monitorização Contínua da Glicose (CGMS) e o glicosímetro portátil para monitorização da glicemia capilar. E como objetivo secundário, analisar a acurácia do CGMS e as respostas agudas e crônicas às sessões de exercícios aeróbio, resistidos e teste ergoespirométrico por portadores de DM 1. CASUÍSTICA E MÉTODOS: Dez portadores de DM1, de ambos os sexos, com idade entre 16 e 45 anos, sem complicações da doença. Os pacientes foram submetidos ao teste ergoespirométrico máximo (TE) e a 40 sessões de exercícios aeróbios (A) ou resistidos (R). As sessões foram realizadas no período pós-prandial do almoço e nestes dias, os pacientes foram orientados pela equipe médica a reduzir: 1U (se dose <20U) ou 2U (se dose >20U) da insulina basal (NPH) da manhã e 50 a 75% da insulina pré-prandial ultra-rápida (UR) do almoço; não houve redução para o TE. Os pacientes mediam a glicemia capilar antes, durante (se, necessário) e após as sessões. RESULTADOS: Os exercícios aeróbios promoveram uma queda maior na GC (67 mg/dL), quando comparada a queda causada pelos exercícios resistidos (37mg/dL) (p=0,047). A correlação entre os dados obtidos pelo CGMS e pelo glicosímetro durante o exercício é significativa (p<0,001), positiva e direta (r=+0,925). A freqüência cardíaca e a pressão arterial sistólica apresentaram aumento durante A (p<0,001), não apresentando diferença para R. A pressão arterial diastólica não mostrou diferença em nenhum dos dois grupos. A freqüência média de consumo [(A=19,8) e (R=16,7)] e a quantidade de gel [(A=28,2) e (R=21,3)] utilizada durante o período de treinamento foram similares em ambos os grupos. A freqüência de hipoglicemias foi igual em ambos os grupos [(A=1,5) e (R=1,5)] durante o treinamento, não apresentando diferenças em relação às reduções de dose de insulina UR ou período de treinamento. As respostas crônicas foram obtidas ao final do período de treinamento (40 sessões): o controle glicêmico (HbA1c), o perfil lipídico (colesterol total, triglicérides, HDL, LDL, VLDL) e os parâmetros antropométricos não foram influenciados pelo treinamento. Os níveis médios de microalbuminúria em repouso não modificaram, mas os níveis médios de microalbuminúria induzida pelo exercício praticamente dobraram. CONCLUSÕES: O grupo A apresentou maior declínio da glicose quando comparado ao grupo R. O CGMS pode ser considerado um método acurado para a sua utilização durante o exercício. O comportamento da freqüência cardíaca e pressão arterial foram similares aos não portadores de diabetes. O protocolo de redução de insulina se mostrou efetivo durante o período de treinamento. Houve mudanças na composição corporal detectadas pelo DEXA / Background and Aims: For type 1 diabetes patients is essential self monitoring of blood glucose and adjustment of carbohydrate intake and insulin dose for exercise practice. The aim of this study was to assess glucose variability during: spiroergometric test (ST) and aerobic (A) and resistance exercises(R). Materials and Methods: 10 DM1 patients performed ST, and 40 A and R bouts and they reduced their insulin dose in A and R exercise days. Results: Glycemia variation groups were: A=67mg/dL and R=37mg/dL. Heart rate and systolic blood pressure increased during A. Diastolic blood pressure was not modified. Glycemic control, lipids and body measurements were not influenced by training. Conclusions: Aerobic and resistance exercise produced glycemia reduction but glycemia fall was higher during aerobic exercise bouts when compared with resistance exercise bouts

A sepse é uma patologia que desperta interesse crescente em virtude dos altos índices de morbidade e mortalidade e pelo impacto socioeconômico decorrente dos diversos cuidados dispensados ao paciente acometido pela doença. Pressupõe-se que a implementação de cuidados específicos embasados em diretrizes poderiam ser inseridos, avaliados e difundidos no campo da saúde a fim de se obter diagnóstico precoce com maior efetividade terapêutica, minimizando danos a saúde e aumentando a sobrevida dos pacientes sépticos. Dentre esses cuidados, destaca-se nesse estudo o controle da glicemia durante o quadro séptico e a relação da variabilidade glicêmica com desfecho clínico da doença. O objetivo desse estudo foi traçar o perfil sociodemográfico e clínico e verificar a variabilidade glicêmica dos pacientes com diagnóstico de sepse grave e choque séptico em uma unidade de terapia intensiva (UTI). O método do estudo teve delineamento de abordagem descritiva, exploratório, retrospectivo. Os dados foram obtidos por meio de revisão de prontuários dos pacientes internados em uma UTI para adultos, de um hospital público de cuidados terciários e diagnosticados com sepse grave ou choque séptico no ano de 2012. A variabilidade glicêmica foi avaliada por dois métodos: desvio padrão (DP) e a amplitude média das excursões glicêmicas (MAGE). Foram incluídos no estudo 116 pacientes. A caracterização sociodemográfica e clínica mostrou que a maioria dos pacientes era do sexo masculino (57,8%), com média de idade de 59 anos, 81,9% era da raça branca e 50,9% viviam em união consensual. A comorbidade prevalente foi a hipertensão arterial sistêmica (51,7%) e o tratamento cirúrgico foi a causa mais frequente de internação (55,2%). A maioria apresentou infecção de origem comunitária (66,3%), sendo os fungos leveduriformes os microrganismos mais frequentes (13,7%). A duração média da internação foi de 36,4 (DP = 27,9, mediana=31) dias. A condição dos pacientes ex-tabagistas foi associada ao óbito (p=0,004). Entre os pacientes sobreviventes a análise da glicose corporal média mostrou média de 134,6 mg/d e entre os pacientes não sobreviventes a média foi de 154,8 mg/dl. Dos pacientes não sobreviventes 39,8% apresentaram um episódio de hipoglicemia < 60 mg/dl. A ocorrência de episódios de hipoglicemia e hipoglicemia grave foi mais frequente nos pacientes não sobreviventes. Quando comparados com os pacientes não diabéticos os diabéticos apresentaram maior VG. Este estudo demonstrou características semelhantes a outros que investigaram a população crítica com diagnóstico de sepse grave e choque séptico, mostrou que apesar dos avanços no cuidado a esses pacientes, o número de óbitos continua inaceitavelmente alto. Há necessidade do controle glicêmico no paciente com sepse grave e choque séptico, a fim de evitar grande variabilidade nos valores da glicemia / Sepsis is a condition that arouses increasing interest because of the high morbidity and mortality and the socioeconomic impact of the various treatment provided to patients affected by the disease. It is assumed that the implementation of care grounded in specific guidelines could be inserted, evaluated and disseminated in the health field in order to obtain early diagnosis with greater therapeutic effectiveness while minimizing damage to health and increasing survival of septic patients. Among such care, stands out in this study glycemic control during sepsis and the relationship of glycemic variability with clinical outcome of the disease. The aim of this study was to trace the sociodemographic and clinical profile and verify glycemic variability in patients with severe sepsis and septic shock in the intensive care unit (ICU). The method of the study design was descriptive, exploratory and retrospective approach. The data were obtained through review of medical records of patients admitted to an adult ICU of a public tertiary hospital care and diagnosed with severe sepsis or septic shock in 2012 Glycemic variability was assessed by two methods. Standard deviation (SD) and the mean amplitude of glycemic excursions (MAGE). 116 patients were included in the study. The sociodemographic and clinical characterization showed that most patients were male (57.8%), mean age 59 years, 81.9% were white and 50.9% lived in a consensual union. A prevalent comorbidity was hypertension (51.7%) and surgical treatment was the most frequent cause of hospitalization (55.2%). Most patients with infection of Community origin (66.3%), and the yeast fungi the most frequent microorganisms (13.7%). The mean duration of hospitalization was 36.4 (SD = 27.9, median 31) days. The condition of former smokers was associated with death (p = 0.004). Among the surviving patients the analysis of average body glucose showed a mean 134.6 mg / from non-surviving patients, the mean was 154.8 mg / dl. Of not surviving patients 39.8% had an episode of hypoglycemia <60 mg / dl. The occurrence of hypoglycemia and severe hypoglycemia was more frequent in non-survivors. Compared with nondiabetic patients, diabetics had higher VG. This study showed similar characteristics to others who investigated the critical population with severe sepsis and septic shock, showed that despite the advances in the care of these patients, the number of deaths remains unacceptably high. There is need of glycemic control in patients with severe sepsis and septic shock, in order to avoid large variability in blood glucose values