Prevalência de sobrepeso e obesidade em pacientes com diabetes mellitus do tipo 2 no Brasil: estudo multicêntrico nacional

Glycemic and nonglycemic mechanisms of congenital malformations in hyperglycemic pregnancies: a narrative review

Congenital malformations are more frequently found among children born to mothers with diabetes than in the background population. There are several complex mechanisms involved in the development of congenital malformations in the offspring of mothers with hyperglycemia, such as the overexpression of glucose transporters (GLUTs) 1 and 2, the increased activity of the hexosamine biosynthetic pathway and the reduced expression of the PAX3 gene with a consequent increase in p53 protein expression. These alterations can lead to increased glucose and free radical concentrations in the embryo, thus promoting the process of apoptosis and causing malformation. The most frequent malformations found in the offspring of mothers with diabetes are heart and neural tube defects, urinary tract and kidney malformations, and cleft lip with or without cleft palate. Strict glycemic control should be obtained before and during pregnancy, aiming to avoid or minimize the risk of congenital malformations in the offspring. Beyond hyperglycemia, several factors may also be associated with increased risks of malformations in the offspring of these women, such as obesity, multiple pregnancies, advanced maternal age, folic acid deficiency, use of angiotensin converting enzyme inhibitors and angiotensin receptor blockers, assisted reproduction techniques, and exposure to different types of environmental pollutants.

IMMUNOHISTOCHEMICAL DETECTION OF L CELLS IN GASTROINTESTINAL TRACT MUCOSA OF PATIENTS AFTER SURGICAL TREATMENT FOR CONTROL OF TYPE 2 DIABETES MELLITUS

OBJECTIVE

Type 2 diabetes mellitus (T2DM) is a disease of global impact that has led to an increase in comorbidities and mortality in several countries. Immunoexpression of the incretin hormones such as glucagon-like peptide-1 (GLP-1) and peptide YY (3-36) (PYY3-36) can be used as a scorer in the gastrointestinal tract to analyze L-cell activity in response to T2DM treatment. This study aimed to investigate the presence, location, and secretion of L cells in the small intestine of patients undergoing the form of bariatric surgery denominated adaptive gastroenteromentectomy with partial bipartition.

METHODS

Immunohistochemical assays, quantitative real-time polymerase chain reaction (qPCR), and Western blot analysis were performed on samples of intestinal mucosa from patients with T2DM in both the preoperative and postoperative periods.

RESULTS

All results were consistent and indicated basal expression and secretion of GLP-1 and PYY3-36 incretins by L cells. A greater density of cells was demonstrated in the most distal portions of the small intestine. No significant difference was found between GLP-1 and PYY3-36 expression levels in the preoperative and postoperative periods because of prolonged fasting during which the samples were collected.

CONCLUSION

The greater number of L cells in activity implies better peptide signaling, response, and functioning of the neuroendocrine system.

Advances in GLP-1 treatment: focus on oral semaglutide

BACKGROUND

There is currently a large arsenal of antidiabetic drugs available to treat type 2 diabetes (T2D). However, this is a serious chronic disease that affects millions of adults worldwide and is responsible for severe complications, comorbidities, and low quality of life when uncontrolled due mainly to delays in initiating treatment or inadequate therapy. This review article aims to clarify the therapeutic role of the oral formulation of the glucagon-like peptide 1 receptor agonist (GLP-1 RA) semaglutide in treating typical T2D patients. The discussion focused on metabolic, glycemic, and weight alteration effects and the safety of the therapy with this drug.

MAIN TEXT

Therapy with glucagon-like peptide 1 receptor agonist (GLP-1 RA) promotes strategic changes in the pathophysiological pathway of T2D and improves the secretion of glucagon and insulin, which results in a reduction in blood glucose levels and the promotion of weight loss. Until recently, the only route for semaglutide administration was parenteral. However, an oral formulation of GLP-1 RA was recently developed and approved by the Brazilian Health Regulatory Agency (ANVISA) and the Food and Drug Administration (FDA) based on the Peptide Innovation for Early Diabetes Treatment (PIONEER) program results. A sequence of 10 clinical studies compared oral semaglutide with placebo or active standard-of-care medications (empagliflozin 25 mg, sitagliptin 100 mg, or liraglutide 1.8 mg) in different T2D populations.

CONCLUSIONS

Oral semaglutide effectively reduces glycated hemoglobin (HbA1c) levels and body weight in a broad spectrum of patients with T2D and shows cardiovascular safety. Oral semaglutide broadens therapy options and facilitates the adoption of earlier GLP-1 RA treatment once T2D patients present low rates of treatment discontinuation. The main adverse events reported were related to the gastrointestinal tract, common to GLP-1 RA class drugs.

Diabetic Patients with Cardiovascular Disease Show More Metabolic Syndrome than Nondiabetic Patients: Multicentric Study in the Northeast of Brazil

Background: Diabetes mellitus (DM) is associated with a higher prevalence of metabolic syndrome (MS) and cardiovascular mortality. However, few Brazilian studies evaluated MS in diabetic individuals with cardiovascular disease (CVD). Nevertheless, the objective of this study was to compare the prevalence of MS in cardiac patients with and without DM. Methods: Cross-sectional study of BALANCE Program Trial with patients with CVD, ≥45 years old, who had been attending specialized ambulatories on cardiovascular health, in eight states in the Northeast of Brazil. The components of MS were evaluated by following the criteria of National Cholesterol Education Program's Adult Treatment Panel III (NCEP ATP III) and Joint Interim Statement (JIS). In addition, there were investigated different indexes of abdominal obesity, variables related to lifestyle, and food intake. The statistical analysis included descriptive statistics and the Student's t-test, Mann-Whitney, and chi-squared tests for the comparison of groups. There were significant values of P < 0.05. Results: Six hundred forty-seven individuals were evaluated with average (standard deviation) age of 63.1 (9.3) years, being 50.5% females and 40.3% diabetic patients. When the groups of patients who were diabetic and the nondiabetic ones, the first showed higher percentage of obesity (38.5% vs. 23.2%, P < 0.001), of high waist circumference (84.8% vs. 71.9%; P < 0.001), higher waist-height ratio [0.6 (0.6-0.7) vs. 0.6 (0.5-0.6); P < 0.001], conicity index [1.35 (1.29-1.39) vs. 1.32 (1.27-1.38); P = 0.004], and prevalence of MS, because of the criteria of NCEP ATP III (98.8% vs. 80.4%; P < 0.001), as well as the criteria of JIS (99.2% vs. 89.3%; P < 0.001). The component of higher frequency was high blood pressure and/or hypertension (95.0%), followed by hypertriglyceridemia (93.0%). There were no differences regarding age, lifestyle, and food intake. Conclusions: Diabetic individuals with CVD showed more prevalence of MS and more abdominal obesity than nondiabetic individuals. ClinicalTrials.gov ID: NCT01620398.

Revealing the Interactions Between Diabetes, Diabetes-Related Diseases, and Cancers Based on the Network Connectivity of Their Related Genes

Diabetes-related diseases (DRDs), especially cancers pose a big threat to public health. Although people have explored pathological pathways of a few common DRDs, there is a lack of systematic studies on important biological processes (BPs) connecting diabetes and its related diseases/cancers. We have proposed and compared 10 protein-protein interaction (PPI)-based computational methods to study the connections between diabetes and 254 diseases, among which a method called DIconnectivity_eDMN performs the best in the sense that it infers a disease rank (according to its relation with diabetes) most consistent with that by literature mining. DIconnectivity_eDMN takes diabetes-related genes, other disease-related genes, a PPI network, and genes in BPs as input. It first maps genes in a BP into the PPI network to construct a BP-related subnetwork, which is expanded (in the whole PPI network) by a random walk with restart (RWR) process to generate a so-called expanded modularized network (eMN). Since the numbers of known disease genes are not high, an RWR process is also performed to generate an expanded disease-related gene list. For each eMN and disease, the expanded diabetes-related genes and disease-related genes are mapped onto the eMN. The association between diabetes and the disease is measured by the reachability of their genes on all eMNs, in which the reachability is estimated by a method similar to the Kolmogorov-Smirnov (KS) test. DIconnectivity_eDMN achieves an area under receiver operating characteristic curve (AUC) of 0.71 for predicting both Type 1 DRDs and Type 2 DRDs. In addition, DIconnectivity_eDMN reveals important BPs connecting diabetes and DRDs. For example, "respiratory system development" and "regulation of mRNA metabolic process" are critical in associating Type 1 diabetes (T1D) and many Type 1 DRDs. It is also found that the average proportion of diabetes-related genes interacting with DRDs is higher than that of non-DRDs.

PACAP ameliorates hepatic metabolism and inflammation through up-regulating FAIM in obesity

Obesity is considered a chronic inflammatory disease, the inflammatory factors, such as interleukin 6 (IL-6), monocyte chemoattractant protein 1 (MCP-1) and small inducible cytokine A5 (RANTES), are elevated in obese individuals. Pituitary adenylate cyclase-activating polypeptide (PACAP) suppresses anti-inflammatory cytokines and ameliorates glucose and lipid metabolism. Our previous study showed that Fas apoptosis inhibitory molecule (FAIM) is a new mediator of Akt2 signalling, increases the insulin signalling pathway and lipid metabolism. In this study, we found that PACAP promoted the expression of FAIM protein in a human hepatocyte cell line (L02). Overexpression of FAIM with lentivirus suppressed the expression of the inflammatory factor interleukin 6 (IL-6), monocyte chemoattractant protein 1 (MCP-1) and tumour necrosis factor alpha (TNF-α). Following treatment of obese mice with FAIM or PACAP for 2 weeks, inflammation was alleviated and the bodyweight and blood glucose levels were decreased. Overexpression of FAIM down-regulated the expression of adipogenesis proteins, including SREBP1, SCD1, FAS, SREBP2 and HMGCR, and up-regulated glycogen synthesis proteins, including Akt2 (Ser474) phosphorylation, GLUT2 and GSK-3β, in the liver of obese mice. However, down-regulation of FAIM with shRNA promotes obesity. Altogether, our data identified that FAIM mediates the function of PACAP in anti-inflammation, glucose regulation and lipid metabolism in obese liver.

Using molecular functional networks to manifest connections between obesity and obesity-related diseases

Obesity is a primary risk factor for many diseases such as certain cancers. In this study, we have developed three algorithms including a random-walk based method OBNet, a shortest-path based method OBsp and a direct-overlap method OBoverlap, to reveal obesity-disease connections at protein-interaction subnetworks corresponding to thousands of biological functions and pathways. Through literature mining, we also curated an obesity-associated disease list, by which we compared the methods. As a result, OBNet outperforms other two methods. OBNet can predict whether a disease is obesity-related based on its associated genes. Meanwhile, OBNet identifies extensive connections between obesity genes and genes associated with a few diseases at various functional modules and pathways. Using breast cancer and Type 2 diabetes as two examples, OBNet identifies meaningful genes that may play key roles in connecting obesity and the two diseases. For example, TGFB1 and VEGFA are inferred to be the top two key genes mediating obesity-breast cancer connection in modules associated with brain development. Finally, the top modules identified by OBNet in breast cancer significantly overlap with modules identified from TCGA breast cancer gene expression study, revealing the power of OBNet in identifying biological processes involved in the disease.

Transcultural Diabetes Nutrition Algorithm: Brazilian Application

The prevalence of obesity, pre-diabetes, and type 2 diabetes (T2D) is increasing worldwide, especially in the developing nations of South America. Brazil has experienced an exponential increase in the prevalence of these chronic non-communicable diseases. The rising prevalence is probably due to changing eating patterns, sedentary living, and a progressive aging of the population. These trends and their underlying causes carry untoward consequences for all Brazilians and the future of Brazilian public health and the healthcare system. Lifestyle changes that include healthy eating (nutrition therapy) and regular physical activity (structured exercise) represent efficient inexpensive measures to prevent and/or treat the aforementioned disorders and are recommended for all afflicted patients. Regrettably, the implementation of lifestyle changes is fraught with clinical and personal challenges in real life. The transcultural Diabetes Nutrition Algorithm (tDNA) is a therapeutic tool intended to foster implementation of lifestyle recommendations and to improve disease-related outcomes in common clinical settings. It is evidence-based and amenable to cultural adaptation. The Brazilian Diabetes Association, Society of Cardiology and Ministry of Health guidelines for nutrition therapy and physical exercise were considered for the Brazilian adaptation. The resultant tDNA-Brazil and its underlying recommendations are presented and explained.

Self-reported diabetes in older people: comparison of prevalences and control measures

OBJECTIVE

The objective of this study was to analyze the prevalence of diabetes in older people and the adopted control measures.

METHODS

Data regarding older diabetic individuals who participated in the Health Surveys conducted in the Municipality of Sao Paulo, SP, ISA-Capital, in 2003 and 2008, which were cross-sectional studies, were analyzed. Prevalences and confidence intervals were compared between 2003 and 2008, according to sociodemographic variables. The combination of the databases was performed when the confidence intervals overlapped. The Chi-square (level of significance of 5%) and the Pearson's Chi-square (Rao-Scott) tests were performed. The variables without overlap between the confidence intervals were not tested.

RESULTS

The age of the older adults was 60-69 years. The majority were women, Caucasian, with an income of between > 0.5 and 2.5 times the minimum salary and low levels of schooling. The prevalence of diabetes was 17.6% (95%CI 14.9;20.6) in 2003 and 20.1% (95%CI 17.3;23.1) in 2008, which indicates a growth over this period (p at the limit of significance). The most prevalent measure adopted by the older adults to control diabetes was hypoglycemic agents, followed by diet. Physical activity was not frequent, despite the significant differences observed between 2003 and 2008 results. The use of public health services to control diabetes was significantly higher in older individuals with lower income and lower levels of education.

CONCLUSIONS

Diabetes is a complex and challenging disease for patients and the health systems. Measures that encourage health promotion practices are necessary because they presented a smaller proportion than the use of hypoglycemic agents. Public health policies should be implemented, and aimed mainly at older individuals with low income and schooling levels. These changes are essential to improve the health condition of older diabetic patients.

Risk factor control in hypertensive and diabetic subjects attended by the Family Health Strategy in the State of Pernambuco, Brazil: the SERVIDIAH study

The SERVIDIAH study (Evaluation of Health Services for Diabetic and Hypertensive Subjects) was conducted in 2010 in the State of Pernambuco, Brazil. A multi-stage random sample of 785 hypertensive and 823 diabetic patients was drawn from 208 Family Health Strategy (FHS) units selected throughout 35 municipalities. Patients underwent a structured interview and weight, height, blood pressure and HbA1c levels (for diabetic patients) were measured. Mean age was approximately 60 years, and women were overrepresented in the sample (70%). 43.7% of hypertensive subjects and 25.8% of diabetic subjects achieved adequate blood pressure control and 30.5% of diabetic subjects had HbA1c levels below 7%. Despite 70% of the patients being overweight or obese, few had adhered to a weight-loss diet. The study of this representative sample of hypertensive and diabetic patients attended by the FHS in the State of Pernambuco shows that improvements in the management of hypertension and diabetes are needed in order to prevent the occurrence of serious and costly complications, especially given the context of increasing incidence of these two conditions.

Contribuição de cesta básica na segurança alimentar de idosos diabéticos de programa assistencial em uma cidade do sul do Brasil

A garantia de acesso em quantidade, qualidade e regularidade aos alimentos é direito constitucional e humano. Em função disso, os programas públicos de segurança alimentar procuram focar suas ações nas populações de maior vulnerabilidade social. Este trabalho teve como objetivo investigar a contribuição energética e de macronutrientes da composição da cesta básica diet, oferecida pelo Programa Cidadania Alimentar (PCA) da cidade de Canoas-RS, ao estado nutricional dos idosos diabéticos. Para tanto, foi realizado estudo descritivo incluindo os 163 idosos diabéticos, de ambos os sexos, cadastrados no PCA que receberam o benefício da cesta básica diet. Constatou-se que 76,1% dos inscritos são do sexo feminino e 68,1% apresentaram classificação do índice de massa corporal (IMC) >27kg/m², indicando excesso de peso. A composição da cesta básica diet fornecida pelo PCA contemplou a média de 924,4 kcal/dia, distribuída em 54,2% de carboidratos, 13,4% de proteínas e 32,5% de gorduras. Os resultados mostraram boa adequação energética da cesta básica diet quando considerada a necessidade energética estimada (NEE) recomendada para os idosos. No entanto, sugere-se uma reavaliação do programa para que ele possa atuar em ações promotoras de saúde frente aos resultados do IMC encontrados nessa população.

-1131T>C and SW19 polymorphisms in APOA5 gene and lipid levels in type 2 diabetic patients

Type 2 diabetes mellitus is a metabolic, vascular, and neuropathic disease with a high risk of atherosclerotic events due to dyslipidemic states. Polymorphisms in Apolipoprotein A5 gene (APOA5) have been associated with increased triglyceride levels in many different populations. This study aimed to identify the frequencies of the APOA5 -1131T>C and SW19 polymorphisms and evaluate their effects on lipid levels in patients with type 2 diabetes. Genotyping of APOA5 -1131T>C and SW19 polymorphisms was performed by PCR-RFLP in 146 diabetic patients and in controls (n = 173), from 30 to 80 years of age. Diabetic patients were divided into two groups: patients not treated with lipid lowering drugs (group G1; n = 62) and those treated with lipid lowering drugs (group G2, n = 84). Lipids and lipoproteins were determined enzymatically. Among participants not treated with lipid-lowering drugs (diabetics G1 and controls; n = 235), the -1131C was associated with lower LDLc levels (p = 0.015). In the diabetic patients, the 19W allele was associated with higher triglyceride levels (p = 0.004). In G1 diabetic patients, the combined analysis of APOA5 -1131T>C and SW19 polymorphisms showed that [TC or CC] + SS carriers presented lower total cholesterol levels than did other genotype combinations (p = 0.049). It could therefore be concluded that APOA5 -1131T>C and SW19 polymorphisms influence lipid levels in type 2 diabetic patients.

Prevalência de esteatose hepática e consumo de álcool em participantes do Projeto Atividade Física na Vila

A esteatose hepática é um achado cada vez mais frequente em exames de rastreamento por estudo de imagem. Tem sido descrita associação entre esteatose, obesidade, resistência à insulina e síndrome metabólica (SM). Também parece existir sinergismo entre esteatose hepática, álcool e fibrose hepática. O objetivo foi descrever a prevalência de esteatose e de etilismo nos participantes do Projeto “Atividade Física na Vila” e avaliar sua associação com a presença de obesidade e obesidade visceral. Foi realizada ultrassonografia abdominal em 69 participantes, 53,02±1,26 anos, sendo avaliados a presença e o grau de esteatose e as medidas da gordura subcutânea e visceral (GV). Foram excluídos os pacientes com hepatite viral e com etilismo significativo na anamnese ou após teste AUDIT. Após análise inicial, 60 pacientes foram avaliados quanto aos dados antropométricos e divididos em 2 grupos: com e sem esteatose. A prevalência de etilismo foi de 8,7%. A esteatose hepática foi observada em 37% dos pacientes sendo a maioria classificada como leve e moderada (91%). O grupo com esteatose apresentou aumento significativo de IMC (34,±8,7 versus 29,8±6,5kg/m2), cintura abdominal (102,6±12,7 versus 95,3±12,3cm), peso (85,8±18,7 versus 74,5±17,7kg) e GV (47,9±10,5 versus 36,0±12,7mm). A esteatose hepática é comum em obesos, especialmente naqueles com obesidade visceral. Sabemos que o álcool e a obesidade visceral podem estar envolvidos em seu mecanismo fisiopatológico. Por isso, os pacientes com esteatose hepática e consumo excessivo de álcool podem apresentar maior chance de evoluir desfavoravelmente para a cirrose e insuficiência hepática.

Prevalência de Diabetes Mellitus autorreferida entre trabalhadores de enfermagem

OBJETIVOS: Verificar a prevalência de Diabetes Mellitus autorreferida em trabalhadores de enfermagem de um hospital universitário; identificar os principais fatores de risco para o Diabetes Mellitus (DM) e, entre os que já possuem a doença, identificar as dificuldades relacionadas a seu controle. MÉTODOS: Estudo epidemiológico transversal, realizado no período de agosto de 2007 a janeiro de 2008. Foram entrevistados 1.287 profissionais de enfermagem (82%), utilizando-se questionário contendo 22 questões fechadas. A análise dos dados foi realizada pelos testes Qui-quadrado e exato de Fisher. O teste t de Student foi empregado para as variáveis contínuas. RESULTADOS: Observou-se a prevalência de 3% de DM autorreferida. Os principais fatores de risco reconhecidos foram: idade, sexo, peso e histórico familiar. Detectou-se que o plantão noturno concentrava mais da metade dos diabéticos. CONCLUSÃO: A prevalência de DM autorreferida nesse hospital foi menor do que a esperada para a cidade de São Paulo. Dentre os fatores de risco encontrados, o sobrepeso é o único modificável. O plantão noturno concentra a maioria dos funcionários com diabetes.

Obesidade em idosos do Município de São Carlos, SP e sua associação com diabetes melito e dor articular

Este estudo tem por objetivo verificar a prevalência de obesidade e sua associação com diabetes melito (DM) e dores articulares na população idosa residente em São Carlos, SP. Foram avaliadas 227 idosas (média de idade 69,6±6,8 anos) e 172 idosos (69,4±6,7 anos) quanto ao índice de massa corporal (IMC) e questionados quanto à presença de diabetes e dor articular. Os dados foram tratados estatisticamente. Os resultados mostram que 73,6% das idosas e 66,9% dos idosos apresentavam sobrepeso ou eram obesos. As médias de IMC foram maiores nos indivíduos com idade inferior a 75 anos. Entre as mulheres da amostra foi encontrada associação entre a presença de DM, dores no pé, tornozelo e joelho e a condição"obesa". No grupo masculino, a condição obeso só apresentou associação com a presença de DM. Foi pois constatada associação entre obesidade e presença de DM. Mulheres idosas apresentam maior prevalência de obesidade e associação entre dores articulares e excesso de peso corporal.

[Anemia and obesity: a paradox of the nutritional transition in Brazil]

The aim of this study was to analyze the growing prevalence of anemia and overweight/obesity as contrasting trends in Brazil's nutritional transition. Twenty-eight studies published on anemia in children and childbearing-age women were selected, based on statistical representativeness, standardization of laboratory methods, and World Health Organization criteria. Overweight/obesity in adults was assessed by body mass index: 25 to 29.9 kg/m(2) (overweight) and > or =30 kg/m(2) (obesity). Three surveys were compared for analysis of tendencies: 1974/1975 (36.4%), 1989 (53.5%), and 2002/2003 (51.9%) for overweight/obesity prevalence. In the most representative study on anemia among children (< 11 g/dL), the prevalence increased from 22.0% (1974) to 46.9% (1995/1996). For pregnant woman (< 11 g/dL), results ranged from 14.7 to 40.4%. Prevalence of anemia among children and overweight/obesity among adults showed similar tendencies over time. Recent evidence of reduction in anemia can be attributed to flour supplementation with iron and folic acid. Anemia and overweight/obesity are associated with significant changes in food intake as a substratum of the nutritional transition.

Glucose homeostasis and weight loss in morbidly obese patients undergoing banded sleeve gastrectomy: a prospective clinical study

OBJECTIVE

To assess glucose homeostasis and weight loss in morbidly obese patients undergoing Silastic(R) ring sleeve gas-trectomy.

METHODS

This was a prospective clinical study. Thirty-three female patients with a mean body mass index (BMI) of 42.33 +/- 1.50 kg/m(2) (range: 40-45 kg/m(2)), a mean age of 36.7 +/- 9.4 years and a mean waist circumference of 118.7 +/- 5.98 cm were included in this study. Type 2 diabetes mellitus was observed in 11 patients (33.3%), and glucose intolerance was observed in 4 patients (12.1%). Mean plasma fasting glucose levels were 109.77 +/- 44.19 mg/dl (75-320) in the preoperative period. All Silastic(R) ring sleeve gastrectomy procedures were performed by the same surgical team using the same anesthetic technique. The patients were monitored for at least 12 months after surgery.

RESULTS

The mean weight of the patients decreased from 107.69 +/- 6.57 kg to 70.52 +/- 9.36 kg (p < 0.001), the mean BMI decreased to 27.4 +/- 2.42 kg/m(2) (p < 0.001), and the mean waist circumference decreased to 89.87 cm +/- 6.66 (p < 0.001) in the postoperative period. Excess BMI loss was 86.5 +/- 14.2%. Fasting glucose levels were reduced to 80.94 +/- 6.3 mg/dl (p < 0.001). Remission of diabetes and glucose intolerance was observed in all patients.

CONCLUSION

Silastic(R) ring sleeve gastrectomy was effective in promoting weight loss, waist circumference reduction and control of glucose homeostasis in morbidly obese patients.

Risk factors in patients with type 2 diabetes mellitus

This study was carried out to evaluate the risk factors of type 2 diabetic patients through sociodemographic data, habits of health, anthropometric and biochemist profiles, assisted at a basic public health care unit in Maringá, Paraná. Sixty-six patients, 56 women aged over than 50 years-old were interviewed. High prevalence factors for cardiovascular risk were observed, such as: overweight and obesity, hypertension, dyslipidemia, sedentariness and inadequate diet. Data suggested the need for multidisciplinary intervention programs in health care units associated to educative programs, adjusted diet intake and regular physical activity for these diabetic patients.

[Influence of body weight excess and central adiposity in glycemic and lipid profile in patients with type 2 diabetes mellitus]

The purpose of the present study was to evaluate, in diabetic type 2 patients, the influence of body weight excess assessed by BMI and the central adiposity assessed by the waist circumference in the lipid and glycemic profile. One hundred and forty five individuals assisted in a unit of health, aged >or= 20 years old, were appraised. The female frequency was 61.4%. Among men, the weight excess was correlated with HDL (r = -0.34, p < 0.05), with the total cholesterol (r = 0.35, p < 0.01), and with the triglycerides (r = 49, p < 0.0001), and among women there was correlation just with the triglycerides (r = 0.24, p < 0,05). Waist circumference was correlated with the fast glycemia women's group (r = 0.3, p < 0.01), with the total cholesterol among men (r = 0.33, p < 0.05) and with triglycerides in both genders (F: r = 0.22, p < 0.05; M: r = 0.49, p < 0.001). Highest glycemic and triglycerides levels were present in patients with excess body weight and central adiposity and lower HDL levels were present in patients with body weight excess. In conclusion, there is association between inadequate metabolic profile and the excess of body weight and/or central obesity, evidencing the need for a nutritional and clinical intervention in the diabetic type 2 patients, in order to reduce the risk of future chronic complications.

Metformin and body weight

Most patients with type 2 diabetes are overweight or obese, overweight or obesity increases the risk of developing type 2 diabetes and obesity per se is strongly associated with multiple cardiometabolic risk factors. However, many antidiabetic treatments increase body weight. The oral antidiabetic agent, metformin, has been evaluated in hundreds of clinical studies in diverse patient populations during approximately five decades of clinical use. This review summarizes the effects of metformin on body weight, with special reference to studies of longer duration (>/=6 months) as both diabetes and obesity are long-term conditions. Approximately half of studies in drug-naive type 2 diabetic patients demonstrated significant weight loss with metformin compared with baseline or comparator drugs, although pooled analyses have suggested no significant effect versus placebo. Similarly, metformin has been shown to induce weight loss in obese nondiabetic populations, although studies of long duration in this population are scarce. Metformin does appear to mitigate the adverse effects of insulin on body weight. The weight-neutral or weight-sparing effects of metformin constitute a therapeutic advantage in diabetes management where other first-line oral antidiabetic treatments often promote clinically significant weight gain.