Studies demonstrate localized neuro-retinal dysfunction in patients with diabetes and no visible diabetic retinopathy (DR). Poor glycemic control is a strong risk factor for DR. We hypothesized that poor glycemic control predicts increased areas of localized neuro-retinal dysfunction in patients with diabetes. Forty-eight adolescents with diabetes and 45 controls were tested using the standard (103 hexagons) multifocal electroretinogram (mfERG). Negative binomial regression analysis was conducted with number of abnormal hexagons (delayed responses) as the dependent variable and glycated hemoglobin (HbA1c), disease duration, age and sex as covariates. Results indicate that a one-unit increase in HbA1c predicts an 80% (p = 0.002) increase in the number of abnormal hexagons when controlling for age. Increased areas of neuro-retinal dysfunction are predicted by worsening glycemic control in patients with no visible DR. Standard mfERG may be useful in monitoring patients with diabetes and identifying those who may be at risk of developing DR.

Studies demonstrate short-wavelength cone pathway dysfunction in patients with diabetes and no clinically visible DR. Poor glycemic control, as measured by hemoglobin A1c (HbA1c), is a strong risk factor for DR. We hypothesized that raised HbA1c was associated with short-wavelength cone sensitive visual evoked potential (S-VEP) and electroretinogram (sERG) dysfunction. Forty adolescents with diabetes and 39 controls were tested using the S-VEP. Latencies to a short-wavelength stimulus were delayed in patients at low contrasts. Patient S-VEP latencies were not associated with HbA1c when controlling for age and time since diagnosis. Twenty-one adolescents with diabetes and 19 controls were tested using the sERG. Implicit times of the b-wave were delayed but not associated with HbA1c when controlling for time since diagnosis.Patient PhNR amplitudes were reduced. A one-unit increase in HbA1c was associated with a 15% sERG PhNR amplitude reduction (p=0.004). The sERG PhNR may be a potential biomarker for DR.

Diabetes disproportionately affects minority populations. Social support, and more specifically marriage, has been found to buffer the negative effects of diabetes and depression. Data collected from African Americans with type 2 diabetes in Atlanta and NHANES data were compared to examine whether marriage affects health status and mental health. Approximately, 1742 African Americans aged 18-80 were included in this study. Chi square analysis revealed that married men had lower rates of depression (15.9% vs. 24.7%) compared to unmarried men (p < 0.05), but the same effect was not found in women. The findings show that marriage was not associated with HbA1c, but was associated with rates of depression. The lack of association of HbA1c with marriage may be because marriage may not be the best proxy of social support in the African American community. Future research should focus on alternative forms of social support such as cohabitation, extend family, and friend.

Tyrimo tikslas – ištirti sąsajas tarp paauglių, sergančių cukriniu diabetu, psichosocialinio prisitaikymo ir tėvų pastangų kontroliuoti savo vaikų ligą. Tyrime dalyvavo 11–16 metų paaugliai, kurie serga cukriniu diabetu ilgiau nei vienerius metus, ir jų tėvai (vienas iš tėvų). Iš viso buvo apklausti 73 paaugliai (36 vaikinai ir 37 merginos) ir 73 jų tėvai (21 vyras ir 52 moterys). Paauglių psichosocialinis prisitaikymas buvo matuojamas R. Goodman Galių ir Sunkumų klausimynu, kurį sudaro 25 teiginiai apie teigiamas ir neigiamas savybes, iš kurių susideda 6 klausimyno skalės: socialumas, hiperaktyvumas, emociniai simptomai, elgesio problemos, problemos su bendraamžiais ir bendra sunkumų skalė. Tėvų ligos kontrolė buvo matuojama L. Gonder-Frederick Hipoglikemijos baimės klausimynu (tėvų versija), kurį sudaro 26 teiginiai apie tėvų, kurių vaikai serga cukriniu diabetu, elgesį, kad išvengtų hipoglikemijos ir nerimavimus, kad jų vaiką gali ištikti hipoglikemija; ir vertinama glikemijos kontrolė, kurią parodo glikuoto hemoglobino koncentracija kraujyje. Tyrimo rezultatai parodė, kad vaikinų ir merginų psichosocialinis prisitaikymas skiriasi. Vaikinų grupėje labiau išreikštas socialumas susijęs su didesnes tėvų hipoglikemijos baime, o labiau išreikštos elgesio problemos susijusios su mažesne tėvų hipoglikemijos baime. Merginų grupėje psichosocialinis prisitaikymas su tėvų hipoglikemijos baime nesusijęs. Vaikinų ir merginų geresnė glikemijos kontrolė susijusi su didesne tėvų... [toliau žr. visą tekstą] / The aim of the study was to assess the relationships between psychosocial functioning in youth with type 1 diabetes mellitus, parental fear of hypoglycemia and glycemic control. The subject of the study was 11-16 years-old youths with type 1 diabetes mellitus diagnosed more than 1 year ago and one of their parents. Overall there were 73 youth (36 boys and 37 girls) and 73 their parents (21 men and 52 women). Psychosocial functioning was assessed with Strengths and Difficulties Questionnaire of R. Goodman. It has 25 items about good and bad habits which turn into 6 scales: prosocial, hyperactivity, emotional symptoms, conduct problems, peer problems and total difficulties. Parental fear of hypoglycemia was assessed with Hypoglycemia Fear Survey (patent version) of L. Gonder-Frederick. It has 26 items about parent’s behavior in order to avoid hypoglycemia and worries of child having a low. Glycemic control was evaluated by glycated hemoglobin concentration. The results of the study showed that psychosocial functioning is different in boys and girls. Higher prosocial in boys was related to higher parental fear of hypoglycemia, higher conduct problems was related to lower parental fear of hypoglycemia. No relations were found in girls psychosocial functioning and parental fear of hypoglycemia. Greater glycemic control was related to higher parental fear of hypoglycemia in both boys and girls. Higher hiperaktivity, emotional symptoms, conduct problems and total difficulties in... [to full text]

Phenolic compounds have attracted much attention due to numerous health benefits, including high antioxidant properties, reduced risk of cancer, and inhibition of digestive enzymes. Recent research has suggested that different phenolic compounds may interact with starch. The first objective was to investigate the effect of green or black tea extracts on hydrolysis of wheat, rice, corn, and potato starches. Cooking starches in the presence of either tea reduced their hydrolysis. Potato starch cooked with black tea was the most effective treatment. Observations suggested that hydrolysis may be affected by interactions and by impact on specific enzymes based on starch structure. The second objective was to determine if similar effect could be observed in product system. Addition of green tea extract to sponge cake significantly reduced in vitro starch digestibility, thus could reduce the expected glycemic index. In addition, significant increases in dietary fibre, resistant starch, and antioxidant properties were observed.

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Thesis (Ph.D. in Epidemiology, Dept. of Preventive Medicine and Biometrics) -- University of Colorado Denver, 2008. / Typescript. Includes bibliographical references (leaves 81-92). Free to UCD Anschutz Medical Campus. Online version available via ProQuest Digital Dissertations;

Made available in DSpace on 2016-08-03T16:34:52Z (GMT). No. of bitstreams: 1 Alberto Jose de Amorim.pdf: 812252 bytes, checksum: 2b322172d1516118f32b2e4e84a62a87 (MD5) Previous issue date: 2010-12-06 / Diabetes Mellitus is a chronic degenerative disease that requires a lot of limitations due to the need for constant treatment. Therefore, it was considered that the study of life quality and social support could bring knowledge to improve the quality of interventions for these patients. The aim of this study was to evaluate the quality of life, social support and glycemic control in type2 diabetic patients. This is a descriptive and transversal study was conducted among 120 patients of both genders, who attended the outpatient endocrinology clinic of a hospital located in Sao Bernardo do Campo city. For data collection we used the following instruments: a questionnaire for population characteristics, quality of life questionnaire (WHOQOL-BREF) and the Scale of Perceived Social Support (EPSS). The data relating to glycemic control were collected from medical records of patients. For data analysis we used descriptive statistics and statistical tests (Pearson, Chi-square, Fisher exact, ANOVA and Post hoc). The results indicated that the field of social relations was the largest contributor to quality of life. And the variable time of diagnosis, insulin therapy, and number of dependents, education, diet and medication interfered with quality of life and quality of treatment. These results call attention to the medical evaluations should be tied to assessments of quality of life, social support and also variables that affect the quality of treatment for that in this way can resize or enhance doings related interventions with these patients. / Diabetes Mellitus é uma doença crônica degenerativa que impõe uma série de limitações em função da necessidade de tratamento constante. Por isso, considerou-se que o estudo da qualidade de vida e suporte social poderia trazer conhecimento para melhorar a qualidade das intervenções para estes pacientes. O objetivo deste trabalho foi avaliar a qualidade de vida, suporte social e controle glicêmico de portadores de Diabetes Mellitus tipo2. Trata-se de um estudo descritivo e transversal, desenvolvido com 120 pacientes de ambos os gêneros, atendidos no ambulatório de endocrinologia de um hospital situado na cidade de São Bernardo do Campo. Para coleta dos dados foram utilizados os seguintes instrumentos: questionário para caracterização da população, questionário de qualidade de vida (WHOQOL-BREF) e a Escala de Percepção de Suporte Social (EPSS). Os dados referentes ao controle glicêmico foram coletados nos prontuários dos pacientes. Para análise dos dados utilizou-se à estatística descritiva e provas estatísticas (Pearson, QuiQuadrado, Exato de Fisher, Anova e Pos-hoc). Os resultados indicaram que o domínio das relações sociais foi o que mais contribuiu a qualidade de vida. E as variáveis tempo de diagnóstico, insulinoterapia, número de dependentes, escolaridade, dieta e medicação interferiram na qualidade de vida e na qualidade do tratamento. Estes resultados chamam a atenção para que as avaliações médicas devam ser atreladas a avaliações da qualidade de vida, suporte social e também variáveis que interferem na qualidade do tratamento para que, desta forma possam redimensionar ou melhorar fazeres ligados às intervenções com estes pacientes.

Objetivos. Investigar a associação entre consumo alimentar, índice glicêmico (IG) da dieta habitual com glicemia e insulinemia de jejum, resistência à insulina (HOMA R) e alteração da homeostase glicêmica (AHG: glicemia de jejum alterada - GJA, tolerância à glicose diminuída - TGD e diabetes mellitus tipo 2). Indivíduos e métodos. 1.054 nipo-brasileiros residentes em Bauru, ambos os sexos, 30 a 90 anos, primeira e segunda gerações, que participaram de inquérito transversal conduzido em 2000, sem diagnóstico prévio de AHG e/ou uso de hipoglicemiantes orais/insulina. Para avaliação da dieta habitual, utilizou-se questionário quantitativo de freqüência alimentar, previamente validado, com o auxílio do programa Dietsys versão 4.0. Os fatores dietéticos foram ajustados pelas calorias totais pelo método residual, após transformação logarítmica. As variáveis independentes foram inicialmente selecionadas segundo correlação de Pearson com glicemia e insulinemia de jejum ou HOMA R (variáveis dependentes contínuas) com valor de p<0,20. A associação entre nutrientes/ alimentos com as variáveis dependentes contínuas foi avaliada em modelos de regressão linear múltiplos. Modelos de regressão logística múltiplos foram utilizados para investigar a relação entre fatores dietéticos (tercis) com AHG, ajustados por fatores de confusão. Resultados. Após ajuste múltiplo, houve associações inversas entre o consumo dos grupos de laticínios integrais (g/dia), doces (g/dia), IG da dieta e glicemia de jejum (mg/dl). Relação inversa entre o consumo de IG da dieta e HOMA R também foi observada. Verificou-se razão de chances - RC (IC 95%) - para GJA de 1,70 (1,06 - 2,74) no último tercil de consumo de fibras totais em que as principais fontes alimentares foram o arroz polido, pão branco e frutas/sucos de frutas. Efeito protetor entre o tercil intermediário do consumo de vegetais [0,61 (0,38 - 0,98)] foi observado para TGD. Conclusão. Em nossa população de estudo, a fibra dietética proveniente do consumo excessivo de arroz polido, pão branco, frutas e sucos representou risco para AHG. Por outro lado, observou-se efeito protetor do maior consumo de vegetais para TGD. / Objective. To investigate the effects of food intake and dietary glycemic index (GI) on fasting plasma levels of glucose and insulin, homeostasis model assessment of insulin resistance (HOMA R) and impaired glucose disturbance - IGD (impaired fasting glucose - IFG, impaired glucose tolerance - IGT and diabetes mellitus type 2). Subjects and methods. 1,054 Japanese-Brazilians living in Bauru, of both genders, 30 to 90 years-old, first- and second-generation, who completed all the information for the cross-sectional survey in 2000, without previous diagnosis of IGD and/or use of oral hipoglycemic medication/insulin. Food consumption was assessed using a validated food frequency questionnaire, with the aid of the software Dietsys 4.0. All dietary factors were log-transformed and adjusted for total energy intake by residual method. The dependent variables were first selected using Pearson correlation with fasting plasma levels of glucose and insulin or HOMA R (continuous independent variables), with p<0.20. The associations between selected nutrients/foods and the continuous independent variables were assessed using multiple linear regression models. Logistic regression models were used to investigate the relationship between dietary factors (tercile) and IGD, while adjusting for confounding factors. Results. After multiple adjustments, intakes of whole dairy products and sweets (g/day) and dietary GI were inversely correlated with fasting glucose levels (mg/dl). Dietary GI was also inversely correlated with HOMA R. The odds ratio (95% confidence interval) for IFG was 1.70 (1.06 - 2.74) in the highest tercile of total dietary fiber (main food sources: white rice and bread, fruits/fruit juices). The second tercile of vegetable intake was associated with a risk reduction of IGT [0.61 (0.38 - 0.98)]. Conclusion. In our study population, the intake of total dietary fiber, largely attributable to high intakes of white rice, white bread, fruits/fruit juices, was positively associated with risk of IGD. On the other hand, a protective effect was observed for higher intake levels of vegetables

Background: The medical literature shows that alcohol consumption is common among diabetic individuals and is associated with poor adherence to treatment, resulting in increased morbidity and mortality. However, no study has assessed the association between high-risk alcohol consumption and the presence of anxiety and depression in individuals with type 1 diabetes mellitus (1DM). Objectives: To know the degree of alcohol use, the prevalence at risk alcohol use and symptoms of anxiety and depression, the level of glycemic control and the association between these variables in adolescents and adults diagnosed with type 1 diabetes treated at the Clinic of Endocrinology Outpatient, Federal University of Uberlândia (UFU) and the Municipal Diabetic Care Center of Uberlândia. Methods: The present cross-sectional study assessed 209 outpatients in regards to alcohol consumption and the presence of anxiety and depression symptoms, using the Alcohol Use Disorders Identification Test (AUDIT), the Hospital Anxiety and Depression (HAD) scale, and glycemic control, according to the levels of glycated hemoglobin (HbA1c). The chi-square test and logistic regression analysis were used to investigate the association between the investigated variables. Results: The prevalence of high-risk alcohol consumption (AUDIT &#8805; 8) among individuals with 1DM was high, specifically 24.88% among the entire group of subjects, 12.9% among the adolescents, 14.7% among the females, and 34.6% among the males. Upon comparisons based on gender and age, the odds of high-risk drinking were higher among males and participants aged 30 to 40 years (33.93%). The frequency of high-risk alcohol consumption did not differ as a function of gender among adolescents (females: 9.09%, males: 16.21%; p=0.374). Neither the frequency of anxiety (total: 29.66%, females: 37.25%, males: 22.43%) nor depression (total: 11%, females: 17.65%, males: 4.7%) symptoms exhibited associations with high-risk alcohol consumption. Moreover, the odds of female subjects exhibiting anxiety or depression symptoms were higher (odds ratio OR: 4.37 and OR: 7.4, respectively). Glycemic control was inadequate in most of the sample and did not exhibit an association with high-risk alcohol consumption or the presence of anxiety and depression symptoms. Conclusions: The prevalence of high-risk alcohol consumption and the presence of anxiety and depression symptoms were high in this patient sample. The frequency of high-risk drinking increased together with age and was greater among males; however, this frequency did not exhibit differences in terms of gender among adolescents. Glycemic control was inadequate in most of the sample independent of alcohol consumption and the presence of anxiety and depression symptoms. / Introdução: A literatura médica mostra que o uso de álcool é frequente em pacientes com diabetes e está associado à má adesão ao tratamento, o que pode levar a uma maior morbidade e mortalidade. Entretanto, faltam pesquisas que avaliem a associação entre o uso de risco de álcool e a presença de sintomas de ansiedade e de depressão em pacientes com diabetes tipo 1 (DM1). Objetivos: verificar o grau de utilização de álcool, a prevalência do uso de risco de álcool e de sintomas de ansiedade e de depressão, o nível de controle glicêmico e a associação entre essas variáveis em adolescentes e adultos com diagnóstico de DM1, atendidos no Ambulatório de Endocrinologia do Hospital de Clínicas da Universidade Federal de Uberlândia (UFU) e no Centro Municipal de Atenção ao Diabético de Uberlândia (CMAD). Métodos: Este estudo transversal avaliou 209 pacientes em tratamento ambulatorial, quanto ao consumo de álcool, à presença de sintomas de ansiedade e de depressão por meio dos testes de rastreamento Alcohol Use Disorders Identification Test (AUDIT) e Hospital Anxiety and Depression (HAD) e o controle glicêmico por meio da hemoglobina glicada (HbA1c). Utilizaram-se os testes estatísticos de qui-quadrado e regressão logística para verificar a associação entre as variáveis. Resultados: A prevalência do consumo de risco de álcool em pacientes com DM1 foi de 24,8%, sendo 14,7% em mulheres e 34,6% em homens. A chance de uso de risco foi maior nos homens (OR=2,79), em pessoas com faixa etária mais elevada (OR=1,07), naqueles com história familiar de uso de álcool (OR=7,05), nos que referiram consumo de drogas ilícitas (OR=5,89), cigarro (OR=8,25) e na faixa etária de 30 a 40 anos (OR = 1,07). Quanto ao consumo de risco na adolescência, não houve diferença entre os gêneros (mulheres=9,09% e homens=16.21% e p=0,374). As frequências de sintomas de ansiedade (11% no total, 17,65% nas mulheres e 4,7% nos homens) e de depressão (29,66% no total, 37,25% nas mulheres e 22,43% nos homens) não mostraram relação com o consumo de bebidas alcoólicas. As mulheres apresentaram mais sintomas de ansiedade (OR=2,05) e de depressão (OR=4,37) do que os homens, assim como os adultos com mais de 30 anos em relação aos mais jovens (OR=2,34 para ansiedade e OR= 7,44 para depressão). O controle glicêmico foi predominantemente inadequado e não se verificou associação com o uso de risco de álcool e com a presença de sintomas de ansiedade e de depressão. Não houve associação do nível de HbA1c com o uso de risco de álcool, provavelmente devido ao número pequeno de pacientes com bom controle glicêmico. Conclusões: A prevalência do consumo de risco de álcool e a presença de sintomas de ansiedade e de depressão em adolescentes e adultos com DM1 foram elevadas. O uso de risco de álcool aumentou proporcionalmente ao aumento da faixa etária e foi mais prevalente entre os homens; somente entre os adolescentes não houve diferença entre os gêneros. Na amostra estudada, o controle glicêmico foi inadequado na maioria dos pacientes,independentemente do consumo de álcool e da presença de sintomas de ansiedade e de depressão. / Mestre em Ciências da Saúde