O Diabetes Mellitus (DM) é uma doença metabólica que implica em altas incidências de mortalidade e morbidade. A hiperglicemia crônica é responsável pelo surgimento de inúmeras complicações em longo prazo nestes pacientes. Atualmente, é recomendado por diretrizes internacionais que pacientes com DM sejam monitorados e manejados em seu tratamento a partir dos níveis de hemoglobina glicada (A1C). A A1C é formada por reações não enzimáticas de glicação na hemoglobina, refletindo a glicemia dos últimos 120 dias. A A1C possui forte associação com os desfechos clínicos no DM e apresenta uma excelente padronização de seus métodos analíticos. Contudo, diversas situações clínicas podem interferir falsamente em seus níveis e prejudicar a interpretação de seus resultados, como em anemias (carenciais ou hemolíticas), hemoglobinopatias, gravidez, doença renal crônica, etc. Por outro lado, a albumina glicada (AG) é uma frutosamina formada por glicações na albumina e reflete uma glicemia média de cerca de 2 a 3 semanas. A AG não é influenciada pela concentração de outras proteínas no plasma e também não sofre interferência pelas condições que afetam a A1C. Este marcador tem sido fortemente avaliado como uma ferramenta alternativa para a A1C, a partir da análise de seus níveis por um novo método enzimático descrito em 2002. Estudos tem demonstrado uma forte associação entre estes dois marcadores e grande semelhança em predizer as complicações do DM. Entretanto, a AG se mostra melhor para avaliar flutuações nos níveis de glicose e a resposta ao tratamento terapêutico. Neste trabalho, foi avaliado o desempenho analítico de dois kits enzimáticos de AG e realizado uma comparação entre os métodos, encontrando excelentes resultados. Ainda, foi determinado o intervalo de referência para os níveis de AG em brasileiros saudáveis. A forte correlação encontrada entre AG e A1C demonstra que a AG pode ser um teste útil para o controle glicêmico no DM, principalmente quando a A1C não é recomendada. / Diabetes Mellitus is a metabolic disease with high incidence rates of mortality and morbidity. Chronic hyperglycemia is responsible for several long-term complications in these patients. Currently, international guidelines recommend that glycemic monitoring in DM should be performed by glycated hemoglobin (A1C) levels, to provide a correct clinical conduction. A1C is relative to non-enzymatic glycation reactions in hemoglobin and reflects the glucose levels from the last 120 days. It is well established the great association between A1C and clinical outcomes in DM, besides, its analytical methods present an excellent standardization. However, some conditions may influence and imply misinterpretation in A1C results, such as anemia, hemoglobinophaties, pregnancy, chronic renal disease, etc. On the other hand, glycated albumin (GA) is a fructosamine produced by glycation reactions in albumin and it reflects a mean glycemia at around 2 to 3 weeks. GA is not influenced by the concentrations of other plasma proteins, as well as by those conditions that interfere in A1C. GA has been strongly evaluated as an alternative marker to A1C, through its quantitative measurement by an enzymatic methodology described in 2002. Recent studies have demonstrated a high association between GA and A1C and a great similarity between these tests in predicting DM future complications. Nevertheless, GA has showed be better to assess the glucose fluctuations in blood and the response to treatment. This study evaluated the analytical performance of two GA enzymatic kits and also executed a methods comparison, and found excellent results. Also, we established the reference range for GA levels in healthy Brazilians. The high correlation found between GA and A1C indicates that GA could be a useful test for glycemic control in DM, especially when A1C is unreliable.

bjetivo. Evaluar la asociación entre síndrome metabólico (SM) y carga glicémica (CG) de la ingesta alimentaria en niños y adolescentes obesos atendidos en consulta endocrinológica de un hospital de referencia pediátrica en Lima, Perú. Población y método. Estudio transversal en niños y adolescentes obesos (índice de masa corporal ≥ percentil 95) de 10 a 15 años. Se clasificó como SM según los criterios de la International Diabetes Federation. Se aplicó un recordatorio de 24 horas y se calculó la CG total y por comida. Se evaluó la asociación entre los terciles de CG (comparación con el inferior) y SM usando razones de prevalencia ajustadas (RPa) por variables demográficas, antecedentes familiares, de actividad física y consumo total de carbohidratos en modelos de regresión de Poisson con varianza robusta. Resultados. De 273 niños y adolescentes obesos, 52,4% fueron varones y 94,9% fueron físicamente inactivos. La mediana de CG fue de 213 (164,8- 287,4) y la de ingesta calórica diaria fue 2275 (1851-3024) kcal, dada principalmente por carbohidratos (62%). La prevalencia de SM fue de 22,3%; los componentes con mayor prevalencia fueron la obesidad abdominal (81,7%) y los valores de lipoproteínas de alta densidad (HDL, del inglés high density lipoprotein) bajos (63,7%). Por último, se encontró una asociación entre el consumo elevado de CG y el riesgo de presentar SM (RPa 4,5; IC 95%: 1,3-15,3). Conclusiones. Existe una asociación entre el alto consumo de CG y la presencia de SM en niños y adolescentes con obesidad. / Objective. To study the association between the metabolic syndrome (MS) and the glycemic load (GL) of food intake among obese children and adolescents seen in consultation by the endocrinology team in a pediatric referral hospital in Lima, Peru. Population and Method. Cross-sectional study among obese children and adolescents (body mass index ≥ 95 percentile), 10-15 years old. The MS was classified according to criteria of the International Diabetes Federation. A 24 hour reminder was used, and the overall and per meal GL was calculated. The association between the GL tertiles (comparison with the lower tertile) and the MS was assessed using prevalence ratios adjusted by demographic outcome measures, family history, physical activity and total carbohydrate consumption in Poisson regression models with a robust variance. Results. Out of 273 obese children and adolescents, 52.4% were male and 94.9% did not engage in any physical activity. Glycemic load median value was 213 (164.8-287.4) and the daily calorie intake value was 2275 (1851-3024) kcal, consisting mainly of carbohydrates (62%). MS prevalence was 22.3%; the most prevalent components were abdominal obesity (81.7%) and low values of high density lipoprotein (HDL) (63.7%). Lastly, an association was observed between a high consumption of GL and the risk of developing MS (aRP 4.5; 95% CI: 1.3-15.3). Conclusions. There is an association between a high consumption of GL and the presence of MS among obese children and adolescents.

Class of 2005 Abstract / Objectives: The purpose was to describe the glycemic control of hospitalized patients treated with sliding scale insulin (SSI) and correlate glycemic episodes to other factors. Methods: The records of 315 patients admitted to a private, 166-bed hospital between August 25 and November 30, 2004 were identified from orders for antidiabetic medications then screened for inclusion and exclusion criteria. 135 of these patients met the criteria for inclusion in this study and their charts were reviewed for demographic data, medical history, medication regimens, blood glucose measurements and SSI use during hospitalization. Hypoglycemia was defined as less than or equal to 50 mg/dL and hyperglycemia greater than 250 mg/dL. Results: Orders for SSI were written for 93% of diabetic patients admitted. 2,904 blood glucose fingerstick measurements were recorded: 15.9% were greater than 250 mg/dL and 0.689% were under 50 mg/dL. The only statistically significant result was the correlation between increased numbers of hyperglycemic episodes and the consumption of the hospital’s “diabetic diet,” p<0.001. The small group of patients admitted for cellulitis (N=6) also experienced more hyperglycemic episodes. There was a trend approaching significance, p=0.055, for an increased number of hyperglycemic episodes in patients with admission blood glucose value over 200 mg/dL. Results based upon the hospital’s standard SSI regimen were not significantly different from other variations of SSI. Implications: SSI was almost always prescribed for hospitalized patients with type 2 diabetes and this regimen resulted in poor glucose control in approximately 17% of fingerstick measurements.

Objetivo: Determinar el índice glicémico de Pouteria lúcuma (lúcuma), Annona cherimola (chirimoya) y Mauritia flexuosa (aguaje). Materiales y métodos: el estudio fue de tipo experimental. Se reunió a 9 sujetos que fueron seleccionados tras una serie de pruebas, se les extrajo muestras de sangre venosa mediante la colocación de un catéter venoso, ello para determinar la glucosa en los tiempos 0, 15, 30, 60, 90 y 120 minutos. Dichas muestras se tomaron tras la ingesta de los alimentos en estudio, lúcuma, chirimoya y aguaje, empleando como patrón referencial a la glucosa anhidra. Una vez obtenidos los resultados de la glucosa por cada tiempo, se determinó el índice glicémico mediante la sumatoria del área bajo la curva de cada alimento. Resultados: Se obtuvo un índice glicémico de 68 para la lúcuma, 58 para la chirimoya y 35 para el aguaje. Considerándose para la dos primeras un índice glicémico medio y para el último, un índice glicémico bajo. Conclusión: En el estudio presentado se determinó el índice glicémico de tres frutas nativas peruanas: la lúcuma, chirimoya y aguaje, que fueron 68%, 58% y 35%; respectivamente, empleando como alimento referencial la glucosa anhidra. / Objective: To determine the glycemic index of Pouteria lucuma (lúcuma), Annona cherimola (cherimoya) y Mauritia flexuosa (aguaje). Materials and methods: The study was experimental. It met 9 subjects that were selected after a serie of tests. They were extracted venous blood samples by placing a venous catheter, thereby to determine glucose at times 0, 15, 30, 60, 90 and 120 minutes. These samples were taken after food intake (lucuma, cherimoya and aguaje), using anhydrous glucose as reference. After obtaining the results of glucose per time, the glycemic index was determined by the sum of the area under the curve of each food. Results: The glycemic index obtained was 68 for lucuma, 58 for cherimoya and 35 for aguaje. Considered for the first two medium glycemic index and for the latter, a low glycemic index. Conclusion: In the presented study, the glycemic index of three peruvian native fruits was determined: lucuma, cherimoya and aguaje, which were 68%, 58% and 35%; respectively, using as a reference food anhydrous glucose. / Tesis

Objetivo: Comparar el Índice Glicémico (IG) de tres variedades de Chenopodium Quinoa Wildenow (CQW) provenientes de Perú. Materiales y métodos: Se llevó a cabo un estudio cuasi-experimental de acuerdo a la norma ISO 26642:2010(E), en 26 adultos voluntarios aparentemente sanos residentes en Lima, Perú. Las variables de exposición fueron tres variedades de quinua: CQW Blanca Salcedo (CQW–B), CQW Negra Collana (CQW–N) y CQW Roja Pasankalla (CQW–R). Se tomaron muestras de sangre capilar en siete momentos durante un periodo de dos horas y se analizaron mediante el método de glucosa oxidasa. La estimación del IG se basó en las áreas bajo la curva obtenidas mediante el método trapezoidal. La comparación de los valores de IG se realizó mediante el múltiple análisis de varianza para muestras dependientes (MANOVA). Resultados: El IG de CQW - B y CQW – N, fueron clasificadas como de IG medio, con valores de 63,1 ± 22,3 y 62,3 ± 22,5 respectivamente, y la CQW - R fue clasificada como de IG alto, con un valor de 74,8 ± 29,7. No se encontraron diferencias estadísticamente significativas tanto para los valores crudos (p= 0,33), como ajustados por edad y sexo (p= 0,27) entre los IG de las tres variadades de quinua. Conclusiones: El IG de las variedades de quinua estudiadas no es bajo y podría ser incorporado en la dietoterapia de pacientes que requieran del control glicémico, mediante un control adecuado de porciones asesorado por un profesional de la salud capacitado. / Objective: To compare the glycemic index (GI) of three varieties of Chenopodium Quinoa Wildenow (CQW) from Peru. Materials and methods: - 26 participants apparently healthy volunteers living in Lima: a quasi-experimental study according to the ISO 26642 standard was conducted. Exposure variables were three varieties of quinoa: Blanca CQW Salcedo (CQW - B), CQW Black Collana (CQW - N) and CQW Red Pasankalla (CQW - R). Capillary blood samples were taken seven times over a period of two hours and analyzed by the glucose oxidase method. IG estimation was based on the areas under the curve obtained by the trapezoidal method. The comparison of GI values was performed by multiple analysis of variance for dependent samples (MANOVA). Results: The GI of CQW - B and CQW - N were classified as medium-GI, with values of 63.1 ± 22.3 and 62.3 ± 22.5 respectively, and CQW - R was classified as high-GI with a value of 74.8 ± 29.7. No statistically significant both crude level (p = 0.33) differences were found, as adjusted by age and sex (p = 0.27). Conclusion: IG quinoa varieties studied is not low and therefore should be incorporated in the diet therapy of patients requiring glycemic control through proper portion control advice from a dietitian nutritionist. / Tesis

This work discusses the mean of blood glucose in human body. Determination of glucose and held it in the physiological range.

Purpose: The aim of this study was to determine whether glycemic control is different between subjects who screened negative for Celiac Disease (CD) compared to subjects who screened positive for CD among subjects with autoimmune insulin-dependent diabetes. Also, this study investigated if the presence of specific beta cell autoantibodies, GAD65, Islet cell antibodies or both, could predict the risk for positive CD screening. METHODS/PROCEDURES: A retrospective cohort study of an existing clinical care data was obtained from the Clinical Data Warehouse (CDW) in Boston Medical Center (BMC) for the period between January 2000 and November 2015. The exposed cohort included those who screened positive for CD, while the non-exposed cohort included subjects who screened negative for CD. The following data was collected and included in the analysis: demographic variables, A1C levels, Diabetic Ketoacidosis (DKA) events, diabetes-associated antibodies, CD screening tests, and CD biopsy results. Longitudinal data for each subject was obtained from the CDW. RESULTS: The prevalence of potential CD in this study was 8.8%, while the prevalence of biopsy confirmed CD was 4.4%. Mean A1C level for subjects who screened negative for TTG was 8.9% (CI 8.3 - 9.6), while mean A1C levels for subjects who screened positive for TTG was 7.9% (CI 6.8 - 9.0) after adjusting for confounders using the mixed-effect model. This difference was not statistically significant. Moreover, diabetes-associated antibodies did not predict the risk for positive TTG screening. CONCLUSION: The glycemic control for subjects who screened negative for CD was found to be similar to subjects who screened positive for CD. However, further studies with higher power and larger sample size are needed to confirm the findings of this study. / 2017-11-03T00:00:00Z

Bakgrund: Diabetes är en allvarlig folkhälsosjukdom som påverkar kroppens egen möjlighet till att reglera blodets glukosvärde. Den största riskgruppen för att utveckla diabetes typ 2 är individer med övervikt. Regelbunden fysisk aktivitet har visat positiv inverkan på såväl glukosvärden. Vilken effekt korta pauser med fysisk aktivitet har på glukosvärde i blodet vid långvarigt stillasittande är inte lika utforskat. Det kan vara värdefullt som fysioterapeut att kunna ge relevanta rekommendationer angående fysisk aktivitet till individer med diabetes typ 2 eller övervikt för att kunna minska komplikationer. Syfte: Systematiskt granska enskilda studier och sammanväga tillförlitligheten för effekten på glukosvärde i blodet av korta pauser med fysisk aktivitet i samband med stillasittande hos individer med diabetes typ 2 och övervikt.  Metod: Litteratursökningen genomfördes i databasen Pubmed och resulterade i åtta studier inkluderades. Studierna kvalitétgranskades enligt PEDro scale och evidens graderingen genomfördes genom GRADEstud. Resultat: Korta pauser av fysisk aktivitet i samband med stillasittande resulterar i en signifikant minskning av glukosvärde hos individer med diabetes typ 2 eller övervikt. Kvalitétsgranskningen enligt PEDro visar att sex studier anses vara av måttlig kvalitét och två studier av hög kvalitét. Den sammanlagda tillförlitligheten enligt GRADEstud av underlaget bedömdes vara låg (++).  Konklusion: Effekten av fysisk aktivitet hos stillasittande individer med diabetes typ 2 eller övervikt visade ett minskat glukosvärde jämfört med dem som var långvarigt stillasittande. Evidensen bedömdes vara låg vilket visade på ett behov av fler högkvalitativa studier inom området för att kunna bekräfta resultatet. / Background: Diabetes is a public health disease that affects the body's own ability to regulate the blood's glucose. Overweight individuals have the highest risk of developing type 2 diabetes. The effect that physical activity has on glucose levels in conjunction with sedentary sitting is not as explored as regular interventions of physical activity. It can be valuable as a physiotherapist to be able to give recommendations to individuals with type 2 diabetes or overweight to reduce complications.  Purpose: Systematically review studies and their reliability on the effect of physical activity on blood glucose in conjunction with sedentary sitting on individuals with type 2 diabetes or overweight. Method: The literature search was conducted on the database Pubmed and resulted in eight studies. The studies quality was reviewed with PEDro scale and the evidence reviewed with GRADEstud. Results: Short breaks of physical activity in conjunction with sedentary sitting resulted in a significant decrease of glucose levels on individuals with diabetes type 2 and overweight. The quality review with PEDro showed that six studies were of moderate quality and two studies of high quality. The overall reliability according to GRADEstud was rated low(++). Conclusion: The effect of short breaks of physical activity in conjunction with sedentary sitting on individuals with diabetes type 2 or overweight shows decreased glucose levels compared with sedentary sitting. The evidence was rated low which shows a need for more high quality studies in the subject to confirm the results .

Short-term physical inactivity in older adults has been shown to cause muscular atrophy and impaired glycemic control, however, the ability to recover remains unknown. We aimed to determine the impact of step-reduction (SR) on older adults and if they could recover simply by returning to habitual activity. Ten older adults (6 men, 4 women, 69 ± 3 yr) completed 7d of normal baseline activity (BL), subsequently underwent SR by 86 ± 9% (8568 ± 3741 to 973 ± 76 steps/d; p<0.001) for 14d and then returned to 8383 ± 4513 steps/d for 14d (RC). During an oral glucose tolerance test (OGTT), SR resulted in elevated plasma glucose concentration ([G]) area under the curve (AUC; 325 ± 126 to 375 ± 137, p = 0.13), maximum [G] (10.2 ± 2.4 to 11.9 ± 1.7 mM, p = 0.027) and 2-hr [G] (7.9 ± 1.3 to 9.1 ± 1.1 mM, p = 0.085), while all [G] indices returned to BL after RC. However, Matsuda insulin sensitivity index was reduced (3.5 ± 0.3 to 2.7 ± 0.7, p < 0.001) and homeostatic model assessment of insulin resistance was elevated (2.8 ± 0.3 to 3.6 ± 0.7, p = 0.02) with SR, remaining different than BL after RC (p < 0.005). During free-living conditions, 3-hr post-prandial [G] (PPG) AUC and peak PPG increased following SR (p > 0.05), returning to BL with RC. Body composition and physical function remained unchanged with SR. These results show that periods of physical inactivity, characterized by reduced daily stepping, do not present detectable changes in body composition or physical function yet result in reduced glycemic control in older adults. While elevations in blood [G] are abolished with 14d of normal physical activity, our findings suggest that the SR-associated reductions in insulin sensitivity are not normalized as quickly. / Thesis / Master of Science in Kinesiology / Periods of physical inactivity such as hospitalizations decrease daily steps for older adults and this inactivity can cause losses of muscle, strength, and symptoms of diabetes. It was unknown if by simply returning to normal physical activity older persons could ‘reverse’ the consequences of step-reduction so we conducted a study involving two weeks of step-reduction and two weeks of recovery. While there was no change in strength or muscle mass, we found that when older adults reduced their daily steps to fewer than 1000/day, after two weeks they became ‘resistant’ to insulin, a hormone that helps control blood sugar and is connected to the development of type II diabetes. Although these older adults resumed normal step-count levels in the recovery phase, they did not recover their insulin sensitivity such that two weeks of normal daily activity was not sufficient to overcome the consequences of two weeks of inactivity.

Background: Since March 2020, health systems around the world shifted to virtual care approaches as social distancing measures were recommended to stem the spread of SARS-COV-2, the virus responsible for the COVID-19 pandemic. For children and families living with type 1 diabetes, virtual consultations in pediatric diabetes care were rare prior to the pandemic but became the norm since the start of the pandemic. Data regarding glycemic outcomes and comorbidities in children living with type 1 diabetes mellitus (T1DM) during the pandemic are limited, and there is a need for these data to drive future care models design and delivery. Aim & Methods: The aim of this project was to assess the association of the COVID-19 pandemic with measures of glycemic control (HbA1c), hyperglycemia, hypoglycemia, diabetic ketoacidosis (DKA) and hospitalization for the period spanning March 2020-2021 at McMaster Children’s Hospital, a tertiary pediatric academic center in Hamilton, Ontario, Canada. Data from the onset of virtual care were compared with data from two years pre-pandemic. Results: The COVID-19 pandemic was not associated with changes in HbA1c (MD -0.14, p=0.058), hospitalization (OR 0.57, p=0.068), or hypoglycemia (OR 1.11, p=0.484), but was significantly associated with the increase in reported hyperglycemia (OR 1.38, p=0.003) and reduction in DKA presentation (OR 0.30, p=0.009). Conclusions: Glycemic control was stable during the early stages of the COVID-19 pandemic, when virtual and hybrid care models prevailed in diabetes care. These results suggest that patients and their families were able to adapt to the uncertain circumstances of the pandemic. Virtual consultations for pediatric diabetes did not hinder glycemic control, and likely aided in the maintenance of diabetes management. Longitudinal studies are necessary before virtual consultations should be recommended to replace in-person clinic visits, but the initial data seem encouraging. / Thesis / Master of Science (MSc) / The COVID-19 pandemic restricted face-to-face healthcare-based interactions to limit the spread of the virus. These restrictions posed as a challenge for children and youth with type 1 diabetes mellitus (T1DM), who relied exclusively on in-person clinic visits as part of their care regimen pre-pandemic. In this retrospective study, we assessed the association of the first year of the COVID-19 pandemic with measures of glycemic control (HbA1c), diabetic ketoacidosis (DKA), hospitalization, hyperglycemia, and hypoglycemia, compared to two years pre-pandemic. We determined that children living with type 1 diabetes had no deterioration of glycemic control measures, apart from an increase in hyperglycemia, during the first 12 months of the pandemic. This study provides insights into health outcomes of children living with T1DM in the early stages of the pandemic and offers a roadmap to guide the further avenues of exploration needed to assess the full impact of the pandemic on this population.