1
|
Lobão WJDM, Zajdenverg L, Lopes GC, Barros MCMD, Sansone C, Silva-Boghossian CM. Redox biomarkers in saliva and nuclear abnormalities in jugal epithelial cells of individuals with type 2 diabetes mellitus and periodontitis. Arch Oral Biol 2024; 161:105915. [PMID: 38412774 DOI: 10.1016/j.archoralbio.2024.105915] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Revised: 02/14/2024] [Accepted: 02/15/2024] [Indexed: 02/29/2024]
Abstract
OBJECTIVE To evaluate salivary redox biomarkers levels in individuals with periodontitis and type 2 diabetes mellitus (T2DM) and correlate with periodontal parameters and nuclear alterations in epithelial cells from jugal mucosa. DESIGN Sixty individuals were categorized into three groups: T2DM with periodontitis (DM, n = 20), non-T2DM with periodontitis (PE, n = 20), and non-T2DM with periodontal health (HC, n = 20). All participants underwent fasting blood glucose and glycated hemoglobin measurements. After a periodontal examination, samples of epithelial cells from the jugal mucosa and saliva were collected. DNA damage was assessed by counting nuclear abnormalities using cytological analysis. Biomarkers of oxidative stress were determined through biochemical methods. Significant differences among groups were assessed using Kruskal-Wallis, Mann-Whitney, and Chi-square tests at a 5% significance level. Data were analyzed using Spearman's correlation coefficient, linear regression, and logistic regression. RESULTS Frequencies of nuclear abnormalities, as well as levels of reduced glutathione and uric acid, were significantly higher in the DM group compared to the PE and HC groups (p < 0.05). Fasting glucose, glycated hemoglobin, nuclear abnormalities, reduced glutathione, and uric acid exhibited positive correlations with periodontal parameters (p < 0.05). Furthermore, reduced glutathione was associated with dental biofilm (OR = 1.027 [95% CI, 1.004-1.049]) and condensed chromatin (OR = 0.415 [95% CI, 0.196-0.878]). CONCLUSIONS Periodontitis and T2DM are correlated with nuclear abnormalities, as well as salivary reduced glutathione and uric acid levels. Moreover, a higher prevalence of teeth with dental biofilm increases the likelihood of elevated levels of reduced glutathione in saliva, while the presence of condensed chromatin decreases that likelihood.
Collapse
Affiliation(s)
- Walder Jansen de Mello Lobão
- Department of Dental Clinic, Division of Periodontics, School of Dentistry, Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, Brazil.
| | - Lenita Zajdenverg
- Department of Medical Clinic, Division of Nutrology, Faculty of Medicine, Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| | - Gustavo Casimiro Lopes
- Physical Education and Sports Institute, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| | - Maria Cynésia Medeiros de Barros
- Department of Dental Clinic, Division of Periodontics, School of Dentistry, Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| | - Carmelo Sansone
- Department of Dental Clinic, Division of Periodontics, School of Dentistry, Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| | - Carina M Silva-Boghossian
- Department of Dental Clinic, Division of Periodontics, School of Dentistry, Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| |
Collapse
|
2
|
Valerio CM, Muniz RBG, Viola LF, Bartzen Pereira G, Moreira RO, de Sousa Berriel MR, Montenegro Júnior RM, Godoy-Matos AF, Zajdenverg L. Gestational and neonatal outcomes of women with partial Dunnigan lipodystrophy. Front Endocrinol (Lausanne) 2024; 15:1359025. [PMID: 38633761 PMCID: PMC11021569 DOI: 10.3389/fendo.2024.1359025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Accepted: 03/18/2024] [Indexed: 04/19/2024] Open
Abstract
Introduction Lipodystrophies are a group of disorders characterized by selective and variable loss of adipose tissue, which can result in an increased risk of insulin resistance and its associated complications. Women with lipodystrophy often have a high frequency of polycystic ovary syndrome (PCOS) and may experience gynecological and obstetric complications. The objective of this study was to describe the gestational outcomes of patients with familial partial lipodystrophy type 2 (FPLD2) at a reference center with the aim of improving the understanding and management of pregnant women affected by this condition. Methods This was a retrospective analysis of data obtained from questionnaires regarding past pregnancies and a review of medical records from the beginning of follow-up in outpatient clinics. Results All women diagnosed with FPLD2 who had previously become pregnant were included in this study (n=8). The women in the study experienced pregnancies between the ages of 14 and 38 years, with an average of 1.75 children per woman. The pregnancies in question were either the result of successful conception within 12 months of attempting to conceive or unplanned pregnancies. During pregnancy, two women (25%) were diagnosed with gestational diabetes mellitus (GDM), one (12.5%) with gestational hypothyroidism, and one (12.5%) with preeclampsia. Among the 17 pregnancies, two miscarriages (11.8%) occurred, and five cases (29.4%) of macrosomia were observed. Four instances of premature birth and an equal number of neonatal hypoglycemia cases were recorded. The reported neonatal complications included an unspecified malformation, respiratory infection, and two neonatal deaths related to heart malformation and respiratory distress syndrome. Conclusion Our data showed a high frequency of fetal complications in women with FPLD2. However, no instances of infertility or prolonged attempts to conceive have been reported, highlighting the significance of employing effective contraception strategies to plan pregnancies at optimal times for managing metabolic comorbidities.
Collapse
Affiliation(s)
- Cynthia M. Valerio
- Department of Metabolism, Institute of Diabetes and Endocrinology of Rio de Janeiro (IEDE), Rio de Janeiro, Brazil
- Brazilian Group for the Study of Inherited and Acquired Lipodystrophies (BRAZLIPO), Fortaleza, Brazil
| | - Raquel Beatriz Gonçalves Muniz
- Department of Metabolism, Institute of Diabetes and Endocrinology of Rio de Janeiro (IEDE), Rio de Janeiro, Brazil
- Brazilian Group for the Study of Inherited and Acquired Lipodystrophies (BRAZLIPO), Fortaleza, Brazil
| | - Luiz F. Viola
- Brazilian Group for the Study of Inherited and Acquired Lipodystrophies (BRAZLIPO), Fortaleza, Brazil
- Diabetes and Endocrinology Center (CEDERO), Rondonópolis, Brazil
| | - Gabriela Bartzen Pereira
- Department of Metabolism, Institute of Diabetes and Endocrinology of Rio de Janeiro (IEDE), Rio de Janeiro, Brazil
| | - Rodrigo Oliveira Moreira
- Department of Metabolism, Institute of Diabetes and Endocrinology of Rio de Janeiro (IEDE), Rio de Janeiro, Brazil
- Brazilian Group for the Study of Inherited and Acquired Lipodystrophies (BRAZLIPO), Fortaleza, Brazil
| | - Marise Ribeiro de Sousa Berriel
- Department of Metabolism, Institute of Diabetes and Endocrinology of Rio de Janeiro (IEDE), Rio de Janeiro, Brazil
- Brazilian Group for the Study of Inherited and Acquired Lipodystrophies (BRAZLIPO), Fortaleza, Brazil
| | - Renan Magalhães Montenegro Júnior
- Brazilian Group for the Study of Inherited and Acquired Lipodystrophies (BRAZLIPO), Fortaleza, Brazil
- Clinical Research Unit, Walter Cantídio University Hospital, Federal University of Ceará/EBSERH, Fortaleza, Brazil
| | - Amélio F. Godoy-Matos
- Department of Metabolism, Institute of Diabetes and Endocrinology of Rio de Janeiro (IEDE), Rio de Janeiro, Brazil
- Brazilian Group for the Study of Inherited and Acquired Lipodystrophies (BRAZLIPO), Fortaleza, Brazil
| | - Lenita Zajdenverg
- Brazilian Group for the Study of Inherited and Acquired Lipodystrophies (BRAZLIPO), Fortaleza, Brazil
- Internal Medicine Department - Nutrology and Diabetes Session, Federal University of Rio de Janeiro (UFRJ), Rio de Janeiro, Brazil
| |
Collapse
|
3
|
da Silva LBG, Zajdenverg L, Keating E, Silvestre MPS, dos Santos BMB, Saunders C. Effect of Prenatal Care on Perinatal Outcomes of Pregnant Women with Diabetes Mellitus: A Systematic Review. Yale J Biol Med 2024; 97:49-65. [PMID: 38559460 PMCID: PMC10964819 DOI: 10.59249/wpty4075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 04/04/2024]
Abstract
Objective: to evaluate the effect of prenatal care (PC) on perinatal outcomes of pregnant women with diabetes mellitus (DM). Methods: systematic review developed according to Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) 2020 guidelines and conducted through the population, intervention, control, and outcomes (PICO) strategy. Clinical trials and observational studies were selected, with adult pregnant women, single-fetus pregnancy, diagnosis of DM, or gestational DM and who had received PC and/or nutritional therapy (NT). The search was carried out in PubMed, Scopus, and BIREME databases. The quality of the studies was evaluated using the tools of the National Heart, Lung and Blood Institute-National Institutes of Health (NHLBI-NIH). Results: We identified 5972 records, of which 15 (n=47 420 pregnant women) met the eligibility criteria. The most recurrent outcomes were glycemic control (14 studies; n=9096 participants), hypertensive disorders of pregnancy (2; n=39 282), prematurity (6; n=40 163), large for gestational age newborns (4; n=1556), fetal macrosomia (birth weight >4kg) (6; n=2980) and intensive care unit admission (4; n=2022). Conclusions: The findings suggest that PC interferes with the perinatal outcome, being able to reduce the risks of complications associated with this comorbidity through early intervention, especially when the NT is an integral part of this assistance.
Collapse
Affiliation(s)
- Letícia B. G. da Silva
- Josué de Castro Institute of Nutrition, Federal
University of Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| | | | - Elisa Keating
- Department of Biochemistry, Faculty of Medicine of
Porto, University of Porto, Porto, Portugal
| | | | - Beatriz M. B. dos Santos
- Multidisciplinary Residency Program at the Federal
University of Rio de Janeiro Maternity School, Rio de Janiero, RJ, Brazil
| | - Cláudia Saunders
- Josué de Castro Institute of Nutrition, Federal
University of Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| |
Collapse
|
4
|
Lanzarin JVM, Sabage LE, Louro MD, Martins RLDM, Santos JLF, Zajdenverg L, Negrato CA. Lack of association between month of birth and risk of developing type 1 diabetes in Brazil: a 40-year analysis. J Pediatr Endocrinol Metab 2024; 37:123-129. [PMID: 38154033 DOI: 10.1515/jpem-2023-0431] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Accepted: 12/09/2023] [Indexed: 12/30/2023]
Abstract
OBJECTIVES Seasonal environment at birth may influence diabetes incidence in later life. We sought evidence for this effect and analyzed the association between the month of birth and the risk of developing type 1 diabetes mellitus (T1DM). METHODS This was a cohort study carried out with 814 patients diagnosed with T1DM in the region of Bauru - São Paulo State, Brazil, receiving medical care in a private Endocrinology clinic or in the public Brazilian National Health Care System, from 1981 to 2021. All live births that occurred in São Paulo State between 1974 and 2020 were classified by month of birth and were considered as the control group. RESULTS We found no statistically significant difference (χ2=16.31, critical 19.68) between the month of birth and risk of developing T1DM, when comparing our patients with the background population of the region. There was no association between the month of birth, sex, age at diagnosis, duration of symptoms before diagnosis, self-reported color, and socioeconomic status. CONCLUSIONS We found no association between month of birth and the risk of developing T1DM in this highly admixed South American population. Our data suggest that our population heterogeneity and geographic location may be important factors in the development of T1DM. Future prospective studies, evaluating environmental factors that may confer risk or protection to the disease, are warranted.
Collapse
Affiliation(s)
| | | | | | | | | | - Lenita Zajdenverg
- Department of Clinical Medicine, Universidade Federal do Rio de Janeiro, RJ, Brazil
| | - Carlos Antonio Negrato
- Bauru School of Dentistry and Hospital for Rehabilitation of Craniofacial Anomalies, University of São Paulo, Bauru, SP, Brazil
| |
Collapse
|
5
|
Belfort GP, Farias DR, Padilha PDC, da Silva LBG, dos Santos K, dos Santos MS, Zajdenverg L, Keating E, Saunders C. Influence of the DASH Diet on Gestational Weight Gain and Perinatal Outcomes in Women with Pre-Existing Diabetes Mellitus: A Randomized, Single-Blind, Controlled Clinical Trial. Life (Basel) 2023; 13:2191. [PMID: 38004331 PMCID: PMC10671988 DOI: 10.3390/life13112191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Revised: 10/23/2023] [Accepted: 11/07/2023] [Indexed: 11/26/2023] Open
Abstract
BACKGROUND This study aimed to investigate the influence of the dietary approaches to stop hypertension (DASH) diet on gestational weight gain and perinatal outcomes in pregnant women with pre-existing diabetes mellitus (PDM). METHODS A randomized, single-blind, controlled clinical trial was conducted with 68 pregnant women with PDM throughout prenatal care until delivery (18 weeks) at a public maternity hospital in Rio de Janeiro, Brazil (2016-2020). The standard diet adopted by the control group (standard diet group-SDG) contained 45-55% carbohydrates, 15-20% protein, and 25-30% lipids of the total energy intake. An adapted DASH diet, with a similar macronutrient composition, but with higher calcium, potassium, magnesium, fiber, and reduced saturated fat, was prescribed for the intervention group (DASH diet group-DDG). Student's t- or Mann-Whitney U tests were used to compare outcomes between groups. To assess the trajectory of gestational weight gain throughout the intervention between the study groups, linear mixed-effects regression models were used. RESULTS The DDG had lower gestational weight gain at the fifth (p = 0.03) and seventh appointment (p = 0.04), with no difference in average total gestational weight gain (SDG: 10 kg [SD = 4]; DDG: 9 kg [SD = 5], p = 0.23). There was a trend for a lower length of stay of the newborns (p = 0.08) in the DDG without differences for other perinatal outcomes. CONCLUSIONS The DASH diet promoted less variation in gestational weight gain without promoting a difference in total gestational weight gain, and there was no difference between the study groups for perinatal outcomes.
Collapse
Affiliation(s)
- Gabriella P. Belfort
- Postgraduate Program in Nutrition, Josué de Castro Institute of Nutrition, Federal University of Rio de Janeiro, Carlos Chagas Filho Ave, 373, University City, Rio de Janeiro 21941-590, RJ, Brazil; (D.R.F.); (C.S.)
- School of Nutrition, Federal University of the State of Rio de Janeiro, Pasteur Ave, 296, Urca, Rio de Janeiro 22290-240, RJ, Brazil
| | - Dayana R. Farias
- Postgraduate Program in Nutrition, Josué de Castro Institute of Nutrition, Federal University of Rio de Janeiro, Carlos Chagas Filho Ave, 373, University City, Rio de Janeiro 21941-590, RJ, Brazil; (D.R.F.); (C.S.)
| | - Patricia de C. Padilha
- Postgraduate Program in Nutrition, Josué de Castro Institute of Nutrition, Federal University of Rio de Janeiro, Carlos Chagas Filho Ave, 373, University City, Rio de Janeiro 21941-590, RJ, Brazil; (D.R.F.); (C.S.)
| | - Letícia B. G. da Silva
- Postgraduate Program in Nutrition, Josué de Castro Institute of Nutrition, Federal University of Rio de Janeiro, Carlos Chagas Filho Ave, 373, University City, Rio de Janeiro 21941-590, RJ, Brazil; (D.R.F.); (C.S.)
| | - Karina dos Santos
- Postgraduate Program in Nutrition, Josué de Castro Institute of Nutrition, Federal University of Rio de Janeiro, Carlos Chagas Filho Ave, 373, University City, Rio de Janeiro 21941-590, RJ, Brazil; (D.R.F.); (C.S.)
- School of Nutrition, Federal University of the State of Rio de Janeiro, Pasteur Ave, 296, Urca, Rio de Janeiro 22290-240, RJ, Brazil
| | - Mayara S. dos Santos
- Maternity School of the Federal University of Rio de Janeiro, Laranjeiras Street, 180, Rio de Janeiro 22240-003, RJ, Brazil; (M.S.d.S.); (L.Z.)
| | - Lenita Zajdenverg
- Maternity School of the Federal University of Rio de Janeiro, Laranjeiras Street, 180, Rio de Janeiro 22240-003, RJ, Brazil; (M.S.d.S.); (L.Z.)
| | - Elisa Keating
- Unit of Biochemistry, Department of Biomedicine, Faculty of Medicine, University of Porto, Prof. Hernâni Monteiro Ave, 4200-319 Porto, Portugal
| | - Claudia Saunders
- Postgraduate Program in Nutrition, Josué de Castro Institute of Nutrition, Federal University of Rio de Janeiro, Carlos Chagas Filho Ave, 373, University City, Rio de Janeiro 21941-590, RJ, Brazil; (D.R.F.); (C.S.)
- Maternity School of the Federal University of Rio de Janeiro, Laranjeiras Street, 180, Rio de Janeiro 22240-003, RJ, Brazil; (M.S.d.S.); (L.Z.)
| |
Collapse
|
6
|
Dantas JR, Araujo DB, Silva KR, Souto DL, Pereira MDFC, Raggio LR, Claudio-da Silva C, Couri CE, Maiolino A, Rebellato CLK, Daga DR, Senegaglia AC, Brofman PRS, Baptista LS, Oliveira JEPD, Zajdenverg L, Rodacki M. Adipose Tissue-Derived Stromal/Stem Cells Transplantation with Cholecalciferol Supplementation in Recent-Onset Type 1 Diabetes Patients: Twelve Months Follow-Up. Horm Metab Res 2023; 55:536-545. [PMID: 37192655 DOI: 10.1055/a-2094-1039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/18/2023]
Abstract
To evaluate safety and therapeutic effect along 12 months of allogenic adipose tissue-derived stromal/stem cells (ASCs) transplantation with cholecalciferol (VITD) in patients with recent-onset type 1 diabetes (T1D). Prospective, phase II, open trial, pilot study in which patients with recent onset T1D received ASCs (1xKgx106 cells) and VITD 2000UI/day for 12 months (group 1) and were compared to controls with standard insulin therapy (group 2). Adverse events, C-peptide area under the curve (CPAUC), insulin dose, HbA1c and frequency of FoxP3+ in CD4+ or CD8+ T-cells(flow cytometry) were evaluated at baseline(T0), after 3(T3), 6(T6) and 12 months(T12). Eleven patients completed follow up (7:group 1;4:group 2). Group 1 had lower insulin requirement at T3(0.24±0.18vs0.53±0.23UI/kg,p=0.04), T6(0.24±0.15vs0.66±0.33 UI/kg,p=0.04) and T12(0.39±0.15vs0.74±0.29 UI/Kg,p=0.04).HbA1c was lower at T6 (50.57±8.56vs72.25±10.34 mmol/mol,p=0.01), without differences at T12 (57.14±11.98 in group 1 vs. 73.5±14.57 mmol/min in group 2, p=0.16). CPAUC was not significantly different between groups at T0(p=0.07), higher in group 1 at T3(p=0.04) and T6(p=0.006), but similar at T12(p=0.23). IDAA1c was significantly lower in group 1 than group 2 at T3,T6 and T12 (p=0.006, 0.006 and 0.042, respectively). IDDA1c was inversely correlated to FoxP3 expression in CD4 and CD8+ T cells at T6 (p<0.001 and p=0.01, respectively). In group 1, one patient had recurrence of a benign teratoma that was surgically removed, not associated to the intervention. ASCs with VITD without immunosuppression were safe and associated lower insulin requirements, better glycemic control, and transient better pancreatic function in recent onset T1D, but the potential benefits were not sustained.
Collapse
Affiliation(s)
- Joana R Dantas
- Nutrology and Diabetes Department, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Debora Batista Araujo
- Nutrology and Diabetes Department, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Karina Ribeiro Silva
- Laboratory of Tissue Bioengineering, Instituto Nacional de Metrologia Qualidade e Tecnologia Campus de Xerem, Duque de Caxias, Brazil
- Histology and Embryology Departament, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Debora Lopes Souto
- Nutrology and Diabetes Department, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | | | - Luiz Ronir Raggio
- Institute of Public Health Studies, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | | | - Carlos Eduardo Couri
- Internal Medicine, Universidade de São Paulo Faculdade de Medicina de Ribeirão Preto, Ribeirao Preto, Brazil
| | - Angelo Maiolino
- Hematology Department, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | | | - Debora Regina Daga
- Core Cell Technology, Pontifical Catholic University of Parana, Curitiba, Brazil
| | | | | | - Leandra S Baptista
- Laboratory of Tissue Bioengineering, Instituto Nacional de Metrologia Qualidade e Tecnologia Campus de Xerem, Duque de Caxias, Brazil
- Center for Biological Research (Numpex-Bio), Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | | | - Lenita Zajdenverg
- Nutrology and Diabetes Department, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Melanie Rodacki
- Nutrology and Diabetes Department, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| |
Collapse
|
7
|
Silva Dos Santos M, da Cunha Bernardes Argenta L, Barbosa Gabriel da Silva L, Dos Santos K, Zajdenverg L, de Souza Gomes E, Campos de Moraes M, Saunders C. Predictive Factors Of Weight At Birth Of Newborns Of Adult Women With Pregestational Diabetes Mellitus - A Retrospective Observational Study. Diabetes Res Clin Pract 2023:110797. [PMID: 37352936 DOI: 10.1016/j.diabres.2023.110797] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Revised: 06/01/2023] [Accepted: 06/20/2023] [Indexed: 06/25/2023]
Abstract
AIMS To identify predictive factors of birth weight (BW) of newborns of women with pregestational diabetes mellitus (DM). METHODS Retrospective observational study with data from pregnant women who started prenatal nutritional monitoring up to 28 weeks, single pregnancy, and BW information. Quantitative variables were analyzed, and mean and standard deviation (SD) measures or medians and interquartile ranges (IQR) were calculated. Predictive factors were identified using multivariate linear regression. RESULTS Eighty-six pregnant women were analyzed, 50% were diagnosed with type 1 DM, 46.5% with type 2 DM, and 3.5% with unclassified DM; 41% were mixed black and white, 35.6% had overweight and 33.3% had pregestational obesity. The mean BW was 3313.93g (SD=696.08). The predictive factors identified were: gestational weight gain (GWG) at the 3rd trimester (ß=60.42; p=0.04), and gestational age at delivery (ß=194.03; p<0.001); adjusted by time of diagnosis of DM (p=0.07) and 1st-trimester glycated hemoglobin (p=0.71). CONCLUSION The best predictors of BW were gestational age at birth and maternal anthropometric gestational characteristics, which are modifiable variables. The results may contribute to a review of the prenatal routines of pregnant women with DM.
Collapse
Affiliation(s)
- Mayara Silva Dos Santos
- Programa de Residência Multiprofissional em Saúde Perinatal, Maternidade Escola, Universidade Federal do Rio de Janeiro (UFRJ), Rua das Laranjeiras, 180, Laranjeiras, CEP 22240-003 Rio de Janeiro, RJ, Brazil.
| | - Luciana da Cunha Bernardes Argenta
- Maternidade Escola, Universidade Federal do Rio de Janeiro (UFRJ), Rua das Laranjeiras, 180, Laranjeiras, CEP 22240-003 Rio de Janeiro, RJ, Brazil
| | - Letícia Barbosa Gabriel da Silva
- Maternidade Escola, Universidade Federal do Rio de Janeiro (UFRJ), Rua das Laranjeiras, 180, Laranjeiras, CEP 22240-003 Rio de Janeiro, RJ, Brazil; Instituto de Nutrição Josué de Castro, Centro de Ciências da Saúde, Universidade Federal do Rio de Janeiro (UFRJ), Av. Carlos Chagas Filho, 373, bl. J 2°, andar, Cidade Universitária, CEP 21941.590 Rio de Janeiro, RJ, Brazil
| | - Karina Dos Santos
- Maternidade Escola, Universidade Federal do Rio de Janeiro (UFRJ), Rua das Laranjeiras, 180, Laranjeiras, CEP 22240-003 Rio de Janeiro, RJ, Brazil; Instituto de Nutrição Josué de Castro, Centro de Ciências da Saúde, Universidade Federal do Rio de Janeiro (UFRJ), Av. Carlos Chagas Filho, 373, bl. J 2°, andar, Cidade Universitária, CEP 21941.590 Rio de Janeiro, RJ, Brazil
| | - Lenita Zajdenverg
- Maternidade Escola, Universidade Federal do Rio de Janeiro (UFRJ), Rua das Laranjeiras, 180, Laranjeiras, CEP 22240-003 Rio de Janeiro, RJ, Brazil
| | - Erlaine de Souza Gomes
- Instituto de Nutrição Josué de Castro, Centro de Ciências da Saúde, Universidade Federal do Rio de Janeiro (UFRJ), Av. Carlos Chagas Filho, 373, bl. J 2°, andar, Cidade Universitária, CEP 21941.590 Rio de Janeiro, RJ, Brazil
| | - Mariana Campos de Moraes
- Instituto de Nutrição Josué de Castro, Centro de Ciências da Saúde, Universidade Federal do Rio de Janeiro (UFRJ), Av. Carlos Chagas Filho, 373, bl. J 2°, andar, Cidade Universitária, CEP 21941.590 Rio de Janeiro, RJ, Brazil
| | - Cláudia Saunders
- Programa de Residência Multiprofissional em Saúde Perinatal, Maternidade Escola, Universidade Federal do Rio de Janeiro (UFRJ), Rua das Laranjeiras, 180, Laranjeiras, CEP 22240-003 Rio de Janeiro, RJ, Brazil; Maternidade Escola, Universidade Federal do Rio de Janeiro (UFRJ), Rua das Laranjeiras, 180, Laranjeiras, CEP 22240-003 Rio de Janeiro, RJ, Brazil; Instituto de Nutrição Josué de Castro, Centro de Ciências da Saúde, Universidade Federal do Rio de Janeiro (UFRJ), Av. Carlos Chagas Filho, 373, bl. J 2°, andar, Cidade Universitária, CEP 21941.590 Rio de Janeiro, RJ, Brazil
| |
Collapse
|
8
|
Dos Santos K, Rosado EL, da Fonseca ACP, Belfort GP, da Silva LBG, Ribeiro-Alves M, Zembrzuski VM, Campos M, Zajdenverg L, Drehmer M, Martínez JA, Saunders C. A Pilot Study of Dietetic, Phenotypic, and Genotypic Features Influencing Hypertensive Disorders of Pregnancy in Women with Pregestational Diabetes Mellitus. Life (Basel) 2023; 13:life13051104. [PMID: 37240750 DOI: 10.3390/life13051104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Revised: 04/19/2023] [Accepted: 04/26/2023] [Indexed: 05/28/2023] Open
Abstract
Hypertensive disorders of pregnancy (HDP) are a leading cause of maternal and perinatal morbimortality. Dietetic, phenotypic, and genotypic factors influencing HDP were analyzed during a nutrigenetic trial in Rio de Janeiro, Brazil (2016-2020). Pregnant women with pregestational diabetes mellitus (n = 70) were randomly assigned to a traditional or DASH diet group. Systolic blood pressure (SBP) and diastolic blood pressure (DBP) were measured during prenatal visits and HDP were diagnosed using international criteria. Phenotypic data were obtained from medical records and personal interviews. Genotyping for FTO and ADRB2 polymorphisms used RT-PCR. Linear mixed-effect models and time-to-event analyses were performed. The variables with significant effect on the risk for progression to HDP were: black skin color (adjusted hazard ratio [aHR] 8.63, p = 0.01), preeclampsia in previous pregnancy (aHR 11.66, p < 0.01), SBP ≥ 114 mmHg in the third trimester (aHR 5.56, p 0.04), DBP ≥ 70 mmHg in the first trimester (aHR 70.15, p = 0.03), mean blood pressure > 100 mmHg (aHR 18.42, p = 0.03), and HbA1c ≥ 6.41% in the third trimester (aHR 4.76, p = 0.03). Dietetic and genotypic features had no significant effect on the outcome, although there was limited statistical power to test both.
Collapse
Affiliation(s)
- Karina Dos Santos
- Programa de Pós-Graduação em Nutrição, Instituto de Nutrição Josué de Castro, Universidade Federal do Rio de Janeiro, Avenida Carlos Chagas Filho, 373-Bloco J 2° Andar, Cidade Universitária, Rio de Janeiro 21941-902, Brazil
- Escola de Nutrição, Universidade Federal do Estado do Rio de Janeiro, Avenida Pasteur, 296, Prédio 2, 3° Andar, Rio de Janeiro 22290-240, Brazil
| | - Eliane Lopes Rosado
- Programa de Pós-Graduação em Nutrição, Instituto de Nutrição Josué de Castro, Universidade Federal do Rio de Janeiro, Avenida Carlos Chagas Filho, 373-Bloco J 2° Andar, Cidade Universitária, Rio de Janeiro 21941-902, Brazil
| | - Ana Carolina Proença da Fonseca
- Laboratório de Genética Humana, Instituto Oswaldo Cruz, Fundação Oswaldo Cruz, Pavilhão Leônidas Deane, Avenida Brasil 4365, Rio de Janeiro 21040-360, Brazil
| | - Gabriella Pinto Belfort
- Programa de Pós-Graduação em Nutrição, Instituto de Nutrição Josué de Castro, Universidade Federal do Rio de Janeiro, Avenida Carlos Chagas Filho, 373-Bloco J 2° Andar, Cidade Universitária, Rio de Janeiro 21941-902, Brazil
- Escola de Nutrição, Universidade Federal do Estado do Rio de Janeiro, Avenida Pasteur, 296, Prédio 2, 3° Andar, Rio de Janeiro 22290-240, Brazil
| | - Letícia Barbosa Gabriel da Silva
- Programa de Pós-Graduação em Nutrição, Instituto de Nutrição Josué de Castro, Universidade Federal do Rio de Janeiro, Avenida Carlos Chagas Filho, 373-Bloco J 2° Andar, Cidade Universitária, Rio de Janeiro 21941-902, Brazil
| | - Marcelo Ribeiro-Alves
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Avenida Brasil 4365, Rio de Janeiro 21040-360, Brazil
| | - Verônica Marques Zembrzuski
- Laboratório de Genética Humana, Instituto Oswaldo Cruz, Fundação Oswaldo Cruz, Pavilhão Leônidas Deane, Avenida Brasil 4365, Rio de Janeiro 21040-360, Brazil
| | - Mario Campos
- Laboratório de Genética Humana, Instituto Oswaldo Cruz, Fundação Oswaldo Cruz, Pavilhão Leônidas Deane, Avenida Brasil 4365, Rio de Janeiro 21040-360, Brazil
| | - Lenita Zajdenverg
- Departamento de Clínica Médica, Faculdade de Medicina, Universidade Federal do Rio de Janeiro, Avenida Carlos Chagas Filho, 373-Bloco K, 2° Andar, Cidade Universitária, Rio de Janeiro 21941-902, Brazil
| | - Michele Drehmer
- Programa de Pós-Graduação em Epidemiologia e Programa de Pós-Graduação em Alimentação, Nutrição e Saúde, Faculdade de Medicina, Universidade Federal do Rio Grande do Sul, Rua Ramiro Barcelos 2400, Porto Alegre 90035-003, Brazil
| | - J Alfredo Martínez
- Precision Nutrition and Cardiometabolic Health Program, IMDEA Food Institute (Instituto Madrileño de Estudos Avanzados en Alimentación), Crta. de Canto Blanco, n 8, E-28049 Madrid, Spain
| | - Cláudia Saunders
- Programa de Pós-Graduação em Nutrição, Instituto de Nutrição Josué de Castro, Universidade Federal do Rio de Janeiro, Avenida Carlos Chagas Filho, 373-Bloco J 2° Andar, Cidade Universitária, Rio de Janeiro 21941-902, Brazil
| |
Collapse
|
9
|
Negrato CA, Marques PR, Leite HB, Torigoe CN, Silva BF, Costa K, Kamei JM, Zampa CL, Toni ACRG, Pereira ICGS, Heinzelmann GL, Zajdenverg L. Glycemic and nonglycemic mechanisms of congenital malformations in hyperglycemic pregnancies: a narrative review. Archives of Endocrinology and Metabolism 2022; 66:908-918. [PMID: 36191262 PMCID: PMC10118772 DOI: 10.20945/2359-3997000000521] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
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.
Collapse
|
10
|
Ikemoto Sato AK, Zerbinatti Pereira R, Moreira Dos Santos PH, Mazzo A, Zajdenverg L, Negrato CA. Barriers and interventions for postpartum reclassification of glycemic status in women with gestational diabetes mellitus: A scoping review. Diabetes Metab Syndr 2022; 16:102552. [PMID: 35921764 DOI: 10.1016/j.dsx.2022.102552] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Revised: 06/13/2022] [Accepted: 06/15/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND AND AIMS Our aim was to summarize, analyze and disseminate the current state of knowledge about the barriers and facilitators in postpartum reclassification that women who have had gestational diabetes face. METHODS Data collection was carried out from January to March 2021 in PubMed, Scopus, Web of Science (WoS), Embase and Cumulative Index to Nursing and Allied Health Literature (CINAHL) databases. RESULTS Of the 361 studies initially retrieved in the search, 32 articles published between 2010 and 2020 were selected because they were within our objective. CONCLUSION Multiple barriers and interventions were found regarding the reclassification of the glycemic status of women who had Gestational Diabetes during pregnancy. Therefore, further studies are needed to achieve a better intervention for this condition.
Collapse
|
11
|
do Rosário Caldas N, Braulio VB, Brasil MAA, Furtado VCS, de Carvalho DP, Cotrik EM, Dantas JR, Zajdenverg L. Binge eating disorder, frequency of depression, and systemic inflammatory state in individuals with obesity - A cross sectional study. Arch Endocrinol Metab 2022; 66:489-497. [PMID: 35758834 PMCID: PMC10697643 DOI: 10.20945/2359-3997000000489] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Accepted: 03/07/2022] [Indexed: 06/15/2023]
Abstract
Introduction Binge eating disorder (BED) is the most prevalent eating disorder in individuals with obesity. Its association with factors that control hunger and satiety has not yet been elucidated. We evaluated whether levels of inflammatory markers, frequency of psychiatric comorbidities, and appetite-related hormones levels differ between individuals with obesity with and without BED. Subjects and methods The Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders-5 - Clinician Version (SCID-5-CV), Binge Eating Scale, and Hospital Anxiety and Depression Scale were evaluated in 39 individuals with obesity. Plasma levels of C-reactive protein (CRP), tumor necrosis factor-alpha (TNF-α), interleukin-6 (IL-6), leptin, ghrelin, and glucagon-like peptide-1 (GLP-1) were measured. Results Individuals of the BED group exhibited significantly higher percentages of altered eating patterns (hyperphagia, bingeing, post-dinner eating, feeling "stuffed", and emotional eating), higher depressive symptom scores and levels of leptin, CRP, and TNF-α, compared to those from the non-BED group. Logistic regression showed that BED was independently associated with depressive symptoms and CRP levels. Conclusion Individuals with obesity and BED showed greater psychiatric comorbidity, worse eating patterns and worse inflammatory profile than those without BED. BED should be assessed as an indicator of clinical severity in patients with obesity.
Collapse
Affiliation(s)
- Nelson do Rosário Caldas
- Universidade Federal do Rio de Janeiro, Serviço de Psiquiatria e Psicologia Médica, Rio de Janeiro, RJ, Brasil,
| | - Valeria Bender Braulio
- Universidade Federal do Rio de Janeiro, Serviço de Nutrologia, Rio de Janeiro, RJ, Brasil
| | - Marco Antônio Alves Brasil
- Universidade Federal do Rio de Janeiro, Serviço de Psiquiatria e Psicologia Médica, Rio de Janeiro, RJ, Brasil
| | | | - Denise Pires de Carvalho
- Universidade Federal do Rio de Janeiro, Instituto de Biofísica Carlos Chagas Filho, Rio de Janeiro, RJ, Brasil
| | - Ervin Michelstaedter Cotrik
- Universidade Federal do Rio de Janeiro, Serviço de Psiquiatria e Psicologia Médica, Rio de Janeiro, RJ, Brasil
| | - Joana Rodrigues Dantas
- Universidade Federal do Rio de Janeiro, Serviço de Nutrologia, Rio de Janeiro, RJ, Brasil
| | - Lenita Zajdenverg
- Universidade Federal do Rio de Janeiro, Serviço de Nutrologia, Rio de Janeiro, RJ, Brasil
| |
Collapse
|
12
|
Oliveira LMD, Belfort GP, Padilha PDC, Rosado EL, Silva LBGD, Fagherazzi S, Zajdenverg L, Zagury RL, Saunders C. Impact of Carbohydrate Counting Method during Pregnancy in Women with Pregestational Diabetes Mellitus: A Controlled Clinical Trial. Rev Bras Ginecol Obstet 2022; 44:220-230. [PMID: 35139572 PMCID: PMC9948103 DOI: 10.1055/s-0042-1742291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OBJECTIVE To evaluate the effect of the carbohydrate counting method (CCM) on glycemic control, maternal, and perinatal outcomes of pregnant women with pregestational diabetes mellitus (DM). METHODS Nonrandomized controlled clinical trial performed with 89 pregnant women who had pregestational DM and received prenatal care in a public hospital in Rio de Janeiro, state of Rio de Janeiro, Brazil, between 2009 and 2014, subdivided into historic control group and intervention group, not simultaneous. The intervention group (n = 51) received nutritional guidance from the carbohydrate counting method (CCM), and the historical control group (n = 38), was guided by the traditional method (TM). The Mann-Whitney test or the Wilcoxon test were used to compare intra- and intergroup outcomes and analysis of variance (ANOVA) for repeated measures, corrected by the Bonferroni post-hoc test, was used to assess postprandial blood glucose. RESULTS Only the CCM group showed a reduction in fasting blood glucose. Postprandial blood glucose decreased in the 2nd (p = 0.00) and 3rd (p = 0.00) gestational trimester in the CCM group, while in the TM group the reduction occurred only in the 2nd trimester (p = 0.015). For perinatal outcomes and hypertensive disorders of pregnancy, there were no differences between groups. Cesarean delivery was performed in 82% of the pregnant women and was associated with hypertensive disorders (gestational hypertension or pre-eclampsia; p = 0.047). CONCLUSION Both methods of nutritional guidance contributed to the reduction of postprandial glycemia of women and no differences were observed for maternal and perinatal outcomes. However, CCM had a better effect on postprandial glycemia and only this method contributed to reducing fasting blood glucose throughout the intervention. REBEC CLINICAL TRIALS DATABASE The present study was registered in the ReBEC Clinical Trials Database (Registro Brasileiro de Ensaios Clínicos, number RBR-524z9n).
Collapse
Affiliation(s)
- Larissa Mello de Oliveira
- Programa de Pós-graduação em Nutrição do Instituto de Nutrição Josué de Castro da Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro - RJ, Brazil
| | - Gabriella Pinto Belfort
- Programa de Pós-graduação em Nutrição do Instituto de Nutrição Josué de Castro da Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro - RJ, Brazil
| | - Patricia de Carvalho Padilha
- Programa de Pós-graduação em Nutrição do Instituto de Nutrição Josué de Castro da Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro - RJ, Brazil
| | - Eliane Lopes Rosado
- Programa de Pós-graduação em Nutrição do Instituto de Nutrição Josué de Castro da Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro - RJ, Brazil
| | - Letícia Barbosa Gabriel da Silva
- Programa de Pós-graduação em Nutrição do Instituto de Nutrição Josué de Castro da Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro - RJ, Brazil
| | | | | | | | - Claudia Saunders
- Programa de Pós-graduação em Nutrição do Instituto de Nutrição Josué de Castro da Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro - RJ, Brazil.,Maternidade Escola da UFRJ, Rio de Janeiro - RJ, Brazil
| |
Collapse
|
13
|
Abreu GDM, Tarantino RM, da Fonseca ACP, Andrade JRFDO, de Souza RB, Soares CDAPD, Cambraia A, Cabello PH, Rodacki M, Zajdenverg L, Zembrzuski VM, Campos Junior M. Identification of Variants Responsible for Monogenic Forms of Diabetes in Brazil. Front Endocrinol (Lausanne) 2022; 13:827325. [PMID: 35592779 PMCID: PMC9110842 DOI: 10.3389/fendo.2022.827325] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Accepted: 03/24/2022] [Indexed: 12/25/2022] Open
Abstract
Monogenic forms of diabetes mellitus may affect a significant number of patients of this disease, and it is an important molecular cause to be investigated. However, studies of the genetic causes of monogenic diabetes, especially in populations with mixed ethnic backgrounds, such as the one in Brazil, are scarce. The aim of this study was to screen several genes associated with monogenic diabetes in fifty-seven Brazilian patients with recurrence of the disease in their families and thirty-four relatives. Inclusion criteria were: Age of onset ≤ 40 years old, BMI < 30 kg/m², at least two affected generations and negative anti-GAD and anti-IA2 antibodies. MODY genes HNF4A, GCK, HNF1A, HNF1B, NEUROD1, KLF11, PAX4, INS, KCNJ11, and MT-TL1 were sequenced by Sanger sequencing. We identified a total of 20 patients with variants, 13 GCK-MODY, four HNF1A-MODY, and one variant in each of the following genes, HNF4A, HNF1B and MT-TL1. Segregation analysis was performed in 13 families. Four variants were novel, two in GCK (p.(Met115Val) [c.343A>G] and p.(Asp365GlufsTer95) [c.1094_1095insGCGA]) and two in HNF1A (p.(Tyr163Ter) [c.489C>G] and p.(Val380CysfsTer39) [c.1136_1137insC]). Here we highlight the importance of screening for monogenic diabetes in admixed populations.
Collapse
Affiliation(s)
- Gabriella de Medeiros Abreu
- Laboratory of Human Genetics, Oswaldo Cruz Institute, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
- *Correspondence: Gabriella de Medeiros Abreu,
| | - Roberta Magalhães Tarantino
- Diabetes and Nutrology Section, Internal Medicine Department, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Ana Carolina Proença da Fonseca
- Laboratory of Human Genetics, Oswaldo Cruz Institute, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
- Laboratory of Immunopharmacology, Oswaldo Cruz Institute, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
| | - Juliana Rosa Ferreira de Oliveira Andrade
- Laboratory of Human Genetics, Oswaldo Cruz Institute, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
- Laboratory of Genetics, School of Health Science, University of Grande Rio, Rio de Janeiro, Brazil
| | - Ritiele Bastos de Souza
- Laboratory of Human Genetics, Oswaldo Cruz Institute, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
| | | | - Amanda Cambraia
- Laboratory of Human Genetics, Oswaldo Cruz Institute, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
| | - Pedro Hernan Cabello
- Laboratory of Human Genetics, Oswaldo Cruz Institute, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
- Laboratory of Genetics, School of Health Science, University of Grande Rio, Rio de Janeiro, Brazil
| | - Melanie Rodacki
- Diabetes and Nutrology Section, Internal Medicine Department, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Lenita Zajdenverg
- Diabetes and Nutrology Section, Internal Medicine Department, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | | | - Mário Campos Junior
- Laboratory of Human Genetics, Oswaldo Cruz Institute, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
| |
Collapse
|
14
|
Leão IS, Araujo DB, Barone B, Dantas JR, de Souza Nolasco da Silva MV, Soares MO, Kendler DB, Kupfer R, Zajdenverg L, Rodacki M. Ten years follow up of first degree relatives of type 1 diabetes patients: presence of autoimmune biomarkers and the progression to diabetes in a retrospective cohort. Arch Endocrinol Metab 2021; 65:436-442. [PMID: 34283897 PMCID: PMC10522178 DOI: 10.20945/2359-3997000000370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Accepted: 02/15/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVE The aim of the study was to assess the autoimmunity in first degrees relatives (FDR) of patients with type 1 diabetes (T1DM) and the progression to T1DM after 10 years of follow up in the Brazilian population. METHODS Non-diabetic FDR of T1DM patients were interviewed and blood was drawn for autoantibodies measurement (GADA, IA-2A, IAA, ZnT8A). Serum samples were analyzed by standard radioligand binding assays performed at the Federal University of Rio de Janeiro (GADA, IAA and IA2A), and at the Skäne University Hospital, Sweden (ZnT8A). The FDR were interviewed by phone after 10 years to determine if they had developed T1DM. Descriptive statistical analysis was performed and results were described as means and standard deviation (SD). RESULTS 81 individuals were analyzed. Thirteen subjects had positive autoantibodies associated with T1DM.10 were positive for 1 autoantibody and 3 subjects were positive for multiple autoantibodies (1 of them showed positivity for 2 autoantibodies - GADA, ZnT8A - and the other two were positive for 3 autoantibodies - GADA, IA2A, ZnT8A). The 3 subjects with multiple positive autoantibodies developed T1DM within 10 years. CONCLUSION In Brazilian FDR of T1DM patients, the positivity for multiple autoantibodies indicate a greater chance of progression to T1DM, similar to observed in Caucasians. ZnT8A was helpful in the risk assessment for T1DM development.
Collapse
Affiliation(s)
- Isabella Sued Leão
- Departamento de Nutrologia, Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, RJ, Brasil,
| | - Débora Batista Araujo
- Departamento de Nutrologia, Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, RJ, Brasil
| | - Bianca Barone
- Departamento de Nutrologia, Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, RJ, Brasil
| | - Joana Rodrigues Dantas
- Departamento de Nutrologia, Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, RJ, Brasil
| | | | - Marina Oliveira Soares
- Faculdade de Medicina, Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, RJ, Brasil
| | - Daniel Barretto Kendler
- Instituto Estadual de Diabetes e Endocrinologia Luiz Capriglione (Iede), Rio de Janeiro, RJ, Brasil
| | - Rosane Kupfer
- Instituto Estadual de Diabetes e Endocrinologia Luiz Capriglione (Iede), Rio de Janeiro, RJ, Brasil
| | - Lenita Zajdenverg
- Departamento de Nutrologia, Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, RJ, Brasil
| | - Melanie Rodacki
- Departamento de Nutrologia, Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, RJ, Brasil
| |
Collapse
|
15
|
Dantas JR, Araújo DB, Silva KR, Souto DL, de Fátima Carvalho Pereira M, Luiz RR, Dos Santos Mantuano M, Claudio-da-Silva C, Gabbay MAL, Dib SA, Couri CEB, Maiolino A, Rebelatto CLK, Daga DR, Senegaglia AC, Brofman PRS, Baptista LS, de Oliveira JEP, Zajdenverg L, Rodacki M. Adipose tissue-derived stromal/stem cells + cholecalciferol: a pilot study in recent-onset type 1 diabetes patients. Arch Endocrinol Metab 2021; 65:342-351. [PMID: 33939911 PMCID: PMC10065343 DOI: 10.20945/2359-3997000000368] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Objective Adipose tissue-derived stromal/stem cells (ASCs) and vitamin D have immunomodulatory actions that could be useful for type 1 diabetes (T1D). We aimed in this study to investigate the safety and efficacy of ASCs + daily cholecalciferol (VIT D) for 6 months in patients with recent-onset T1D. Methods In this prospective, dual-center, open trial, patients with recent onset T1D received one dose of allogenic ASC (1 × 106 cells/kg) and cholecalciferol 2,000 UI/day for 6 months (group 1). They were compared to patients who received chol-ecalciferol (group 2) and standard treatment (group 3). Adverse events were recorded; C-peptide (CP), insulin dose and HbA1c were measured at baseline (T0), after 3 (T3) and 6 months (T6). Results In group 1 (n = 7), adverse events included transient headache (all), mild local reactions (all), tachycardia (n = 4), abdominal cramps (n = 1), thrombophlebitis (n = 4), scotomas (n = 2), and central retinal vein occlusion at T3 (n = 1, resolution at T6). Group 1 had an increase in basal CP (p = 0.018; mean: 40.41+/-40.79 %), without changes in stimulated CP after mixed meal (p = 0.62), from T0 to T6. Basal CP remained stable in groups 2 and 3 (p = 0.58 and p = 0.116, respectively). Group 1 had small insulin requirements (0.31+/- 0.26 UI/kg) without changes at T6 (p = 0.44) and HbA1c decline (p = 0.01). At T6, all patients (100%; n = 7) in group 1 were in honeymoon vs 75% (n = 3/4) and 50% (n = 3/6) in groups 2 and 3, p = 0.01. Conclusion Allogenic ASC + VIT D without immunosuppression was safe and might have a role in the preservation of β-cells in patients with recent-onset T1D. ClinicalTrials.gov: NCT03920397.
Collapse
Affiliation(s)
- Joana Rodrigues Dantas
- Departamento de Nutrologia e Diabetes, Universidade Federal do Rio de Janeiro, RJ, Brasil
| | - Débora Batista Araújo
- Departamento de Nutrologia e Diabetes, Universidade Federal do Rio de Janeiro, RJ, Brasil
| | - Karina Ribeiro Silva
- Laboratório de Bioengenharia de Tecidos, Instituto Nacional de Metrologia, Qualidade e Tecnologia (Inmetro), Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, Brasil
| | - Débora Lopes Souto
- Departamento de Nutrologia e Diabetes, Universidade Federal do Rio de Janeiro, RJ, Brasil,
| | | | - Ronir Raggio Luiz
- Instituto de Estudos de Saúde Pública, Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, Brasil
| | | | - Cesar Claudio-da-Silva
- Departamento de Cirurgia Plástica, Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, Brasil
| | | | | | | | - Angelo Maiolino
- Departamento de Hematologia, Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, Brasil
| | | | - Débora Regina Daga
- Core Cell Technology, Pontifícia Universidade Católica do Paraná, Curitiba, PR, Brasil
| | | | | | - Leandra S Baptista
- Centro Multidisciplinar de Pesquisas Biológicas (Numpex-Bio), Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, Brasil; Laboratório de Bioengenharia de Tecidos, Instituto Nacional de Metrologia, Qualidade e Tecnologia (Inmetro), Rio de Janeiro, RJ, Brasil
| | | | - Lenita Zajdenverg
- Departamento de Nutrologia e Diabetes, Universidade Federal do Rio de Janeiro, RJ, Brasil
| | - Melanie Rodacki
- Departamento de Nutrologia e Diabetes, Universidade Federal do Rio de Janeiro, RJ, Brasil
| |
Collapse
|
16
|
Abreu GDM, Tarantino RM, da Fonseca ACP, de Souza RB, Soares CAPD, Cabello PH, Rodacki M, Zajdenverg L, Zembrzuski VM, Campos Junior M. PDX1-MODY: A rare missense mutation as a cause of monogenic diabetes. Eur J Med Genet 2021; 64:104194. [PMID: 33746035 DOI: 10.1016/j.ejmg.2021.104194] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Revised: 03/04/2021] [Accepted: 03/14/2021] [Indexed: 11/17/2022]
Abstract
Maturity-Onset Diabetes of the Young type 4 is a rare form of diabetes mellitus, caused by mutations in the PDX1 gene. However, only a few mutations in this gene have been associated as a cause of monogenic diabetes up to date. It makes difficult to create a clinical manifestation profile of this disease and, consequently, to improve the therapeutic management for these patients. Here we report a normal weight woman, diagnosed with diabetes mellitus at 27 years old, during her first pregnancy. At the time of the recruitment, she was 40 years old and had a body mass index of 23.9 kg/m2, glycated hemoglobin level of 9.6%, and fasting plasma glucose (FPG) of 254 mg/dL. She presented no diabetic complications and she was being treated with insulin. She reported a family history of diabetes mellitus characteristic of an autosomal dominant mode of inheritance. Molecular analysis of the PDX1 gene revealed the missense variant c.532G > A (p.(Glu178Lys)) segregating from the patient to her son, reported as diabetic. It was absent in her healthy daughter. The c.532G > A seems to be a rare variant, absent in human variants databases, and among 86 normoglycemic controls. Eight in silico algorithms classified this variant as probably pathogenic. Additionally, analysis of the evolutionary conservation showed the glutamic acid in the position 178 of PDX-1 protein as conserved among several species. Our findings reinforce the importance of screening rare MODY genes among families with suspicion of monogenic diabetes to help better understand the clinical manifestations of this disease.
Collapse
Affiliation(s)
- Gabriella de M Abreu
- Human Genetics Laboratory, Oswaldo Cruz Institute, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil.
| | - Roberta M Tarantino
- Diabetes and Nutrology Section, Internal Medicine Department, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil; Ambulatory of Diabetes, State Institute for Diabetes and Endocrinology Luiz Capriglione, Rio de Janeiro, Brazil
| | - Ana Carolina P da Fonseca
- Human Genetics Laboratory, Oswaldo Cruz Institute, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil; Laboratory of Immunopharmacology, Oswaldo Cruz Institute, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
| | - Ritiele B de Souza
- Human Genetics Laboratory, Oswaldo Cruz Institute, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
| | - Camila A P D Soares
- Human Genetics Laboratory, Oswaldo Cruz Institute, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
| | - Pedro H Cabello
- Human Genetics Laboratory, Oswaldo Cruz Institute, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil; Laboratory of Genetics, School of Health Science, University of Grande Rio, Rio de Janeiro, Brazil
| | - Melanie Rodacki
- Diabetes and Nutrology Section, Internal Medicine Department, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Lenita Zajdenverg
- Diabetes and Nutrology Section, Internal Medicine Department, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Verônica M Zembrzuski
- Human Genetics Laboratory, Oswaldo Cruz Institute, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
| | - Mário Campos Junior
- Human Genetics Laboratory, Oswaldo Cruz Institute, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
| |
Collapse
|
17
|
Dos Santos Lima É, Souto DL, Rodacki M, Pereira JRD, Zajdenverg L, Rosado EL. Metabolic and Appetite Effects of Fructose and Glucose in Subjects with Type 1 Diabetes: A Randomized Crossover Clinical Trial. Curr Diabetes Rev 2021; 17:e113020188536. [PMID: 33261542 DOI: 10.2174/1573399816666201201092334] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Revised: 10/07/2020] [Accepted: 10/24/2020] [Indexed: 11/22/2022]
Abstract
BACKGROUND Fructose has been widely used for producing lower post-infusion glucose increase than other carbohydrates, but it seems that it promotes an increase in post-infusion triglycerides. OBJECTIVE The present study investigated the effects of fructose and glucose in metabolic variables and appetite sensations in patients with type 1 diabetes mellitus (T1DM). METHODS This is a single-blind, randomized, and crossover study (washout of 1-5 weeks), which evaluated 16 adult T1DM patients, accompanied at University Hospital. After eight hours of overnight fasting, there was an assessment of capillary blood glucose, anthropometric variables, appetite sensations, and laboratory tests (glycemia, lipemia, leptin and glucagon) were conducted. Subsequently, they received 200mL of solutions with water and 75g of crystal fructose or glucose. Appetite sensations and capillary blood glucose were evaluated in different post-infusion times. Blood was drawn after 180 minutes for the laboratory tests. RESULTS Blood glucose increased after the intake of both solutions, but glucose induced a higher elevation. None of them increased triglycerides or glucagon. Glucagon maintenance was similar among the solutions. Furthermore, both solutions reduced leptin and increased fullness, but only fructose increased the lack of interest in eating sweets. CONCLUSION Fructose induced a smaller increase in postprandial blood glucose than glucose, without changes in triglycerides and glucagon. In addition, leptin levels and appetite sensations were similar to glucose. Other studies are needed in order to confirm these findings, especially in the long term, so that their use becomes really reliable.
Collapse
Affiliation(s)
- Érika Dos Santos Lima
- Nutrition Institute Josue de Castro, Federal University of Rio de Janeiro, Rio de Janeiro, RJ 21941-901, Brazil
| | - Débora Lopes Souto
- Nutrition Institute Josue de Castro, Federal University of Rio de Janeiro, Rio de Janeiro, RJ 21941-901, Brazil
| | - Melanie Rodacki
- Medicine Institute, Federal University of Rio de Janeiro, Rio de Janeiro, RJ 21941-901, Brazil
| | | | - Lenita Zajdenverg
- Medicine Institute, Federal University of Rio de Janeiro, Rio de Janeiro, RJ 21941-901, Brazil
| | - Eliane Lopes Rosado
- Nutrition Institute Josue de Castro, Federal University of Rio de Janeiro, Rio de Janeiro, RJ 21941-901, Brazil
| |
Collapse
|
18
|
Silvani J, Schmidt MI, Zajdenverg L, Galliano LM, Antunes Nunes MA. Impact of binge eating during pregnancy on gestational weight gain and postpartum weight retention among women with gestational diabetes mellitus: LINDA-Brasil. Int J Eat Disord 2020; 53:1818-1825. [PMID: 32812662 DOI: 10.1002/eat.23361] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Revised: 07/18/2020] [Accepted: 07/19/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Binge eating (BE) is associated with gestational weight gain, which is a risk factor for gestational diabetes (GDM). Little is known about this association in women with GDM. To evaluate the relationship of BE in pregnancy with gestational weight gain, BE at postpartum and postpartum weight retention in women with GDM. METHOD Lifestyle INtervention for Diabetes prevention After pregnancy (LINDA-Brasil) is a multicenter cohort study with 1,958 women with GDM. BE was assessed by interview during recruitment in pregnancy and at a phone interview at ~4 months postpartum. Gestational weight gain was classified according to the 2009 Institute of Medicine (IOM) recommendations. Poisson regression with robust variance was used to estimate adjusted relative risks (RR). RESULTS Prevalence of BE was 31.6% (95% confidence interval [CI] 29.5-33.6%) during pregnancy and 30.0% (95% CI 28.0-32.1%) at postpartum. The risk of exceeding the IOM's recommendation for gestational weight gain was 45% higher (RR 1.45, 95% CI 1.29-1.63) in women who had BE during pregnancy compared to those who did not. The risk of having postpartum weight retention above the 75th percentile was 33% higher (RR 1.33, 95% CI 1.10-1.59) among those with BE compared to those without. DISCUSSION Among these women with GDM, BE was frequent and was associated with excessive gestational weight gain and weight retention at postpartum. Thus, given the vulnerability of these periods of the life cycle, tracking this eating behavior is important for the management of gestational weight gain and for the prevention of excessive postpartum retention.
Collapse
Affiliation(s)
- Juliana Silvani
- Postgraduate Program in Epidemiology, Department of Social Medicine, School of Medicine, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
| | - Maria Inês Schmidt
- Postgraduate Program in Epidemiology, Department of Social Medicine, School of Medicine, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
| | - Lenita Zajdenverg
- Diabetes and Nutrology Section, Internal Medicine Department, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Leony Morgana Galliano
- Postgraduate Program in Epidemiology, Department of Social Medicine, School of Medicine, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
| | - Maria Angélica Antunes Nunes
- Postgraduate Program in Epidemiology, Department of Social Medicine, School of Medicine, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
| |
Collapse
|
19
|
Matos ALS, Moreira JPDL, Luiz RR, da Silva EP, Rodacki M, Gómez JFB, Zajdenverg L. Comparison of glucose measurement on dried blood spots versus plasma samples in pregnant women with and without anemia. Arch Endocrinol Metab 2020; 64:454-461. [PMID: 32267357 PMCID: PMC10522073 DOI: 10.20945/2359-3997000000229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/06/2019] [Accepted: 12/09/2019] [Indexed: 11/23/2022]
Abstract
Objective Compare the concordance degree between plasma glucose and glucose measurements on Dried Blood Spots (DBS) during pregnancy. Subjects and methods Glucose measurement was performed in pregnant women after a fast of 8-12 hours. Venous blood was collected with sodium fluoride, the plasma was separated, and glucose measured by the enzymatic oxidase glucose method. Capillary blood samples were collected and analyzed by DBS. For statistics, the paired Student's t test, interclass correlation coefficient (ICC), graphic approach of Altman and Bland, and survival - concordance plot were used. Results 307 pregnant women were evaluated, 88.6% without diabetes and 11.4% with previous diabetes. The glucose ranged from 66 to 190 mg/dL [3.66 to 10.55 mmol/L] in plasma and from 53 to 166 mg/dL [2.94 to 9.21 mmol/L] in DBS. The glucose average values were 88.1 ± 12 mg/dL [4.98 ± 0.67 mmol/L] in plasma and 89.2 ±11,5 mg/dL, [4.95 ± 0.64 mmol/L] in DBS - p-value = 0.084. The ICC value was moderate (0.510), and Pearson's correlation coefficient was r = 0.507 p < 0.001. Altman and Bland's graph showed that difference between the values obtained by both methods is -24.62 to 22.3 mg/dL [-1.37 to 1.24 mmol/L]. Significant fixed bias (-1,16 average difference) and proportional bias (r = 0.056; p = 0.33) were not observed. Anemia was associated with differences between plasma glucose and DBS measurements (p = 0.031). Conclusion Capillary glucose in DBS correlates with plasma glucose; however, the methods do not present good concordance. The presence of anemia worsens this result.
Collapse
Affiliation(s)
- Ana Lígia Soares Matos
- Maternidade EscolaUniversidade Federal do Rio de JaneiroRio de JaneiroRJBrasilMaternidade Escola, Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, RJ, Brasil
| | - Jessica Pronestino de Lima Moreira
- Instituto de Estudos de Saúde ColetivaUniversidade Federal do Rio de JaneiroRio de JaneiroRJBrasilInstituto de Estudos de Saúde Coletiva (IESC), Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, RJ, Brasil
| | - Ronir Raggio Luiz
- Instituto de Estudos de Saúde ColetivaUniversidade Federal do Rio de JaneiroRio de JaneiroRJBrasilInstituto de Estudos de Saúde Coletiva (IESC), Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, RJ, Brasil
| | - Evelise Pochmann da Silva
- Maternidade EscolaUniversidade Federal do Rio de JaneiroRio de JaneiroRJBrasilMaternidade Escola, Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, RJ, Brasil
| | - Melanie Rodacki
- Departamento de Medicina InternaUnidade de Diabetes e NutrologiaUniversidade Federal do Rio de JaneiroRio de JaneiroRJBrasilDepartamento de Medicina Interna, Unidade de Diabetes e Nutrologia, Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, RJ, Brasil
| | | | - Lenita Zajdenverg
- Departamento de Medicina InternaUnidade de Diabetes e NutrologiaUniversidade Federal do Rio de JaneiroRio de JaneiroRJBrasilDepartamento de Medicina Interna, Unidade de Diabetes e Nutrologia, Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, RJ, Brasil
| |
Collapse
|
20
|
Abreu GDM, Soares CDAPD, Tarantino RM, da Fonseca ACP, de Souza RB, Pereira MDFC, Cabello PH, Rodacki M, Zajdenverg L, Zembrzuski VM, Campos Junior M. Identification of the First PAX4-MODY Family Reported in Brazil. Diabetes Metab Syndr Obes 2020; 13:2623-2631. [PMID: 32801813 PMCID: PMC7399458 DOI: 10.2147/dmso.s256858] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2020] [Accepted: 05/27/2020] [Indexed: 11/23/2022] Open
Abstract
PURPOSE The aim of this study was to sequence the coding region of the PAX4 gene in a Brazilian cohort with clinical manifestations of monogenic diabetes. PATIENTS AND METHODS This study included 31 patients with autosomal dominant history of diabetes, age at diagnosis ≤40 years, BMI <30 kg/m2, and no mutations in GCK or HNF1A, HNF4A, and HNF1B. Screening of the PAX4 coding region was performed by Sanger sequencing. In silico algorithms were used to assess the potential impact of amino acid substitutions on protein structure and function. Additionally, PAX4-MODY family members and 158 control subjects without diabetes were analyzed for the identified mutation. RESULTS The molecular analysis of PAX4 has detected one missense mutation, p.Arg164Gln (c.491G>A), segregating with diabetes in a large Brazilian family. The mutation was absent among the control group. The index case is a woman diagnosed at 32 years of age with polyneuropathy and treated with insulin. She did not present diabetic renal disease or retinopathy. Family members with the PAX4 p.Arg164Gln mutation have a heterogeneous clinical manifestation and treatment response, with age at diagnosis ranging from 24 years to 50 years. CONCLUSION To the best of our knowledge, this is the first study to report a PAX4-MODY family in Brazil. The age of PAX4-MODY diagnosis in the Brazilian family seems to be higher than the classical criteria for MODY. Our results reinforce the importance of screening large monogenic diabetes families for the understanding of the clinical manifestations of rare forms of diabetes for the specific and personalized treatment.
Collapse
Affiliation(s)
| | | | - Roberta Magalhães Tarantino
- Diabetes and Nutrology Section, Internal Medicine Department, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
- Ambulatory of Diabetes, State Institute for Diabetes and Endocrinology Luiz Capriglione, Rio de Janeiro, Brazil
| | | | - Ritiele Bastos de Souza
- Human Genetics Laboratory, Oswaldo Cruz Institute, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
| | | | - Pedro Hernan Cabello
- Human Genetics Laboratory, Oswaldo Cruz Institute, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
- Laboratory of Genetics, School of Health Science, University of Grande Rio, Rio de Janeiro, Brazil
| | - Melanie Rodacki
- Diabetes and Nutrology Section, Internal Medicine Department, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Lenita Zajdenverg
- Diabetes and Nutrology Section, Internal Medicine Department, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | | | - Mário Campos Junior
- Human Genetics Laboratory, Oswaldo Cruz Institute, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
| |
Collapse
|
21
|
Araujo DB, Dantas JR, Silva KR, Souto DL, Pereira MDFC, Moreira JP, Luiz RR, Claudio-Da-Silva CS, Gabbay MAL, Dib SA, Couri CEB, Maiolino A, Rebelatto CLK, Daga DR, Senegaglia AC, Brofman PRS, Baptista LS, Oliveira JEP, Zajdenverg L, Rodacki M. Allogenic Adipose Tissue-Derived Stromal/Stem Cells and Vitamin D Supplementation in Patients With Recent-Onset Type 1 Diabetes Mellitus: A 3-Month Follow-Up Pilot Study. Front Immunol 2020; 11:993. [PMID: 32582156 PMCID: PMC7280537 DOI: 10.3389/fimmu.2020.00993] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Accepted: 04/27/2020] [Indexed: 01/06/2023] Open
Abstract
Objective: To evaluate the short term safety and potential therapeutic effect of allogenic adipose tissue-derived stromal/stem cells (ASCs) + cholecalciferol in patients with recent-onset T1D. Methods: Prospective, phase II, open trial, pilot study in which patients with recent onset T1D received ASCs (1 × 106 cells/kg) and cholecalciferol 2000 UI/day for 3 months (group 1) and were compared to controls with standard insulin therapy (group 2). Adverse events, C-peptide (CP), insulin dose, HbA1c, time in range (TIR), glucose variability (continuous glucose monitoring) and frequency of CD4+FoxP3+ T-cells (flow cytometry) were evaluated at baseline (T0) and after 3 months (T3). Results: 13 patients were included (8: group 1; 5: group 2). Their mean age and disease duration were 26.7 ± 6.1 years and 2.9 ± 1.05 months. Adverse events were transient headache (n = 8), mild local reactions (n = 7), tachycardia (n = 4), abdominal cramps (n = 1), thrombophlebitis (n = 4), mild floaters (n = 2), central retinal vein occlusion (n = 1, complete resolution). At T3, group 1 had lower insulin requirement (0.22 ± 0.17 vs. 0.61±0.26IU/Kg; p = 0.01) and HbA1c (6.47 ± 0.86 vs. 7.48 ± 0.52%; p = 0.03) than group 2. In group 1, 2 patients became insulin free (for 4 and 8 weeks) and all were in honeymoon at T3 (vs. none in group 2; p = 0.01). CP variations did not differ between groups (−4.6 ± 29.1% vs. +2.3 ± 59.65%; p = 0.83). Conclusions: Allogenic ASCs + cholecalciferol without immunosuppression was associated with stability of CP and unanticipated mild transient adverse events in patients with recent onset T1D. ClinicalTrials.gov registration: NCT03920397.
Collapse
Affiliation(s)
- Debora B Araujo
- Federal University of Rio de Janeiro, Nutrology and Diabetes Department, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Joana R Dantas
- Federal University of Rio de Janeiro, Nutrology and Diabetes Department, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Karina R Silva
- Laboratory of Tissue Bioengineering, National Institute of Metrology, Quality and Technology (Inmetro), Rio de Janeiro, Brazil
| | - Débora L Souto
- Nutrology and Diabetes Department, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | | | - Jessica P Moreira
- Biostatistics Department, Institute of Public Health Studies, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Ronir R Luiz
- Biostatistics Department, Institute of Public Health Studies, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | | | - Monica A L Gabbay
- Department of Stem Cell Therapy, Federal University of São Paulo (UNIFESP), São Paulo, Brazil
| | - Sergio A Dib
- Department of Stem Cell Therapy, Federal University of São Paulo (UNIFESP), São Paulo, Brazil
| | | | - Angelo Maiolino
- Hematology Department, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Carmen L K Rebelatto
- Core Cell Technology, Pontifical Catholic University of Paraná, Curitiba, Brazil
| | - Debora R Daga
- Core Cell Technology, Pontifical Catholic University of Paraná, Curitiba, Brazil
| | | | - Paulo R S Brofman
- Surgical Clinic D at University of Sao Paulo, Core Cell Technology, Pontifical Catholic University of Paraná, Curitiba, Brazil
| | - Leandra Santos Baptista
- Laboratory of Tissue Bioengineering, National Institute of Metrology, Quality and Technology (Inmetro), Rio de Janeiro, Brazil.,Multidisciplinary Center for Biological Research (Numpex-Bio), Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - José E P Oliveira
- Nutrology and Diabetes Department, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Lenita Zajdenverg
- Nutrology and Diabetes Department, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Melanie Rodacki
- Nutrology and Diabetes Department, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| |
Collapse
|
22
|
Tarantino RM, Abreu GDM, Fonseca ACPD, Kupfer R, Pereira MDFC, Campos Júnior M, Zajdenverg L, Rodacki M. MODY probability calculator for GCK and HNF1A screening in a multiethnic background population. Arch Endocrinol Metab 2020; 64:17-23. [PMID: 31576961 PMCID: PMC10522291 DOI: 10.20945/2359-3997000000173] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/25/2019] [Accepted: 06/19/2019] [Indexed: 11/23/2022]
Abstract
Objective We aimed to identify the frequency of monogenic diabetes, which is poorly studied in multiethnic populations, due to GCK or HNF1A mutations in patients with suggestive clinical characteristics from the Brazilian population, as well as investigate if the MODY probability calculator (MPC) could help patients with their selection. Subjects and methods Inclusion criteria were patients with DM diagnosed before 35 years; body mass index < 30 kg/m2; negative autoantibodies; and family history of DM in two or more generations. We sequenced HNF1A in 27 patients and GCK in seven subjects with asymptomatic mild fasting hyperglycemia. In addition, we calculated MODY probability with MPC. Results We identified 11 mutations in 34 patients (32.3%). We found three novel mutations. In the GCK group, six cases had mutations (85.7%), and their MODY probability on MPC was higher than 50%. In the HNF1A group, five of 27 individuals had mutations (18.5%). The MPC was higher than 75% in 11 subjects (including all five cases with HNF1A mutations). Conclusion Approximately one third of the studied patients have GCK or HNF1A mutations. Inclusion criteria included efficiency in detecting patients with GCK mutations but not for HNF1A mutations (< 20%). MPC was helpful in narrowing the number of candidates for HNF1A screening.
Collapse
Affiliation(s)
| | | | | | - Rosane Kupfer
- Instituto Estadual de Diabetes e Endocrinologia do Rio de Janeiro, Rio de Janeiro, RJ, Brasil
| | | | - Mario Campos Júnior
- Laboratório de Genética Humana, Instituto Oswaldo Cruz, Fundação Oswaldo Cruz, Rio de Janeiro, RJ, Brasil
| | - Lenita Zajdenverg
- Departamento de Medicina Interna, Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, Brasil
| | - Melanie Rodacki
- Departamento de Medicina Interna, Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, Brasil
| |
Collapse
|
23
|
de Almeida-Pititto B, Dualib PM, Zajdenverg L, Dantas JR, de Souza FD, Rodacki M, Bertoluci MC. Severity and mortality of COVID 19 in patients with diabetes, hypertension and cardiovascular disease: a meta-analysis. Diabetol Metab Syndr 2020; 12:75. [PMID: 32874207 PMCID: PMC7456786 DOI: 10.1186/s13098-020-00586-4] [Citation(s) in RCA: 169] [Impact Index Per Article: 42.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Accepted: 08/21/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND The aim of this study is to evaluate the impact of diabetes, hypertension, cardiovascular disease and the use of angiotensin converting enzyme inhibitors/angiotensin II receptor blockers (ACEI/ARB) with severity (invasive mechanical ventilation or intensive care unit admission or O2 saturation < 90%) and mortality of COVID-19 cases. METHODS Systematic review of the PubMed, Cochrane Library and SciELO databases was performed to identify relevant articles published from December 2019 to 6th May 2020. Forty articles were included involving 18.012 COVID-19 patients. RESULTS The random-effect meta-analysis showed that diabetes mellitus and hypertension were moderately associated respectively with severity and mortality for COVID-19: Diabetes [OR 2.35 95% CI 1.80-3.06 and OR 2.50 95% CI 1.74-3.59] Hypertension: [OR 2.98 95% CI 2.37-3.75 and OR 2.88 (2.22-3.74)]. Cardiovascular disease was strongly associated with both severity and mortality, respectively [OR 4.02 (2.76-5.86) and OR 6.34 (3.71-10.84)]. On the contrary, the use of ACEI/ARB, was not associate with severity of COVID-19. CONCLUSION In conclusion, diabetes, hypertension and especially cardiovascular disease, are important risk factors for severity and mortality in COVID-19 infected people and are targets that must be intensively addressed in the management of this infection.
Collapse
Affiliation(s)
- Bianca de Almeida-Pititto
- Departamento de Medicina Preventiva, Escola Paulista de Medicina, Universidade Federal de São Paulo, Rua Botucatu, n° 740, Vila Clementino, São Paulo, SP CEP 04023-062 Brazil
- Sociedade Brasileira de Diabetes–SBD, Rua Afonso Braz, 579, Salas 72/74, Vila Nova Conceição, São Paulo, SP CEP 04511-011 Brazil
- Programa de Pós-Graduação Em Endocrinologia E Metabologia, Escola Paulista de Medicina, Universidade Federal de São Paulo, Rua Estado de Israel, n° 639, Vila Clementino, São Paulo, SP CEP 04022-001 Brazil
| | - Patrícia M. Dualib
- Sociedade Brasileira de Diabetes–SBD, Rua Afonso Braz, 579, Salas 72/74, Vila Nova Conceição, São Paulo, SP CEP 04511-011 Brazil
- Programa de Pós-Graduação Em Endocrinologia E Metabologia, Escola Paulista de Medicina, Universidade Federal de São Paulo, Rua Estado de Israel, n° 639, Vila Clementino, São Paulo, SP CEP 04022-001 Brazil
- Departamento de Medicina, Escola Paulista de Medicina, Universidade Federal de São Paulo, Rua Sena Madureira, 1500, Vila Clementino, São Paulo, SP CEP 04021-001 Brazil
| | - Lenita Zajdenverg
- Sociedade Brasileira de Diabetes–SBD, Rua Afonso Braz, 579, Salas 72/74, Vila Nova Conceição, São Paulo, SP CEP 04511-011 Brazil
- Departamento de Clínica Médica, Serviço de Nutrologia, Hospital Universitário Clementino Fraga Filho, Universidade Federal Do Rio de Janeiro, Rua Professor Rodolpho Paulo Rocco, 255/sala 9E14, Cidade Universitária, Rio de Janeiro, RJ CEP 21941-590 Brazil
| | - Joana Rodrigues Dantas
- Departamento de Clínica Médica, Serviço de Nutrologia, Hospital Universitário Clementino Fraga Filho, Universidade Federal Do Rio de Janeiro, Rua Professor Rodolpho Paulo Rocco, 255/sala 9E14, Cidade Universitária, Rio de Janeiro, RJ CEP 21941-590 Brazil
| | - Filipe Dias de Souza
- Programa de Pós-Graduação Em Endocrinologia E Metabologia, Escola Paulista de Medicina, Universidade Federal de São Paulo, Rua Estado de Israel, n° 639, Vila Clementino, São Paulo, SP CEP 04022-001 Brazil
| | - Melanie Rodacki
- Sociedade Brasileira de Diabetes–SBD, Rua Afonso Braz, 579, Salas 72/74, Vila Nova Conceição, São Paulo, SP CEP 04511-011 Brazil
- Departamento de Clínica Médica, Serviço de Nutrologia, Hospital Universitário Clementino Fraga Filho, Universidade Federal Do Rio de Janeiro, Rua Professor Rodolpho Paulo Rocco, 255/sala 9E14, Cidade Universitária, Rio de Janeiro, RJ CEP 21941-590 Brazil
| | - Marcello Casaccia Bertoluci
- Sociedade Brasileira de Diabetes–SBD, Rua Afonso Braz, 579, Salas 72/74, Vila Nova Conceição, São Paulo, SP CEP 04511-011 Brazil
- Departamento de Medicina Interna, Faculdade de Medicina, Universidade Federal Do Rio Grande Do Sul (UFRGS), Rua Ramiro Barcelos, 2350, 4º Andar, Porto Alegre, RS CEP 90035‑007 Brazil
- Unidade de Endocrinologia, Hospital de Clínicas de Porto Alegre (HCPA-UFRGS), Rua Ramiro Barcelos, 2350, 4º Andar, Porto Alegre, RS CEP 90035‑007 Brazil
| | | |
Collapse
|
24
|
Pinto MV, Rosa LCGF, Pinto LF, Dantas JR, Salles GF, Zajdenverg L, Rodacki M, Lima MA. HbA1c variability and long-term glycemic control are linked to peripheral neuropathy in patients with type 1 diabetes. Diabetol Metab Syndr 2020; 12:85. [PMID: 33042229 PMCID: PMC7539505 DOI: 10.1186/s13098-020-00594-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Accepted: 09/28/2020] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND HbA1c variability has been linked to retinopathy, renal disease and autonomic neuropathy in patients with type 1 diabetes mellitus (T1D) and type 2 diabetes mellitus (T2D). Although the same relationship has been demonstrated for diabetic peripheral neuropathy (DPN) in patients with T2D, data for T1D are still lacking. METHODS Patients older than 17 years of age with ≥ 10 years of T1D duration and follow-up were included. All patients underwent nerve conduction studies and neurological examination. Laboratorial data was retrospectively extracted from chart review. Mean HbA1c (mHbA1c) over 10 years was calculated, as well as HbA1c variability estimated by standard deviation (HbA1c-SD) and coefficient of variation (HbA1c-CV). RESULTS Fifty patients with T1D were included (30 females and 21 non-caucasians), with mean age and T1D duration of 25.6 ± 5.0 and 17.9 ± 6.1 years, respectively. The frequency of DPN was 24%. Higher mHbA1c (10.4 ± % vs 8.1 ± %; p < 0.001), HbA1c-SD (1.8 ± 0.8 vs 0.9 ± 0.4; p < 0.001), and HbA1c-CV (1.7 ± 0.8 vs 1.2 ± 1.1; p = 0.006) were observed in patients with DPN compared to others. SD-HbA1c and HbA1c-CV were associated with DPN, diagnosed by either clinical or NCS criteria, independent of mHbA1c, age and gender. CONCLUSIONS Not only long-term glycemic control, but also its variability is associated with DPN in patients with T1D. Larger studies are required to confirm this finding.
Collapse
Affiliation(s)
- M. V. Pinto
- Neurology Section, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
- Department of Neurology, Mayo Clinic, Rochester, MN USA
| | - L. C. G. F. Rosa
- Nutrology and Diabetes Section, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - L. F. Pinto
- Neurology Section, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - J. R. Dantas
- Nutrology and Diabetes Section, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - G. F. Salles
- Department of Internal Medicine, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - L. Zajdenverg
- Nutrology and Diabetes Section, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - M. Rodacki
- Nutrology and Diabetes Section, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - M. A. Lima
- Neurology Section, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| |
Collapse
|
25
|
Abreu GDM, Tarantino RM, Cabello PH, Zembrzuski VM, da Fonseca ACP, Rodacki M, Zajdenverg L, Campos Junior M. The first case of NEUROD1-MODY reported in Latin America. Mol Genet Genomic Med 2019; 7:e989. [PMID: 31578821 PMCID: PMC6900366 DOI: 10.1002/mgg3.989] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2019] [Revised: 08/01/2019] [Accepted: 08/18/2019] [Indexed: 01/06/2023] Open
Abstract
Background MODY‐NEUROD1 is a rare form of monogenic diabetes caused by mutations in Neuronal differentiation 1 (NEUROD1). Until now, only a few cases of MODY‐NEUROD1 have been reported worldwide and the real contribution of mutations in NEUROD1 in monogenic diabetes and its clinical impact remain unclear. Methods Genomic DNA was isolated from peripheral blood lymphocytes of 25 unrelated Brazilians patients with clinical characteristics suggestive of monogenic diabetes and the screening of the entire coding region of NEUROD1 was performed by Sanger sequencing. Results We identified one novel frameshift deletion (p.Phe256Leufs*2) in NEUROD1 segregating in an autosomal dominant inheritance fashion. Almost 20 years after the first report of NEUROD1‐MODY, only a few families in Europe and Asia had shown mutations in NEUROD1 as the cause of monogenic diabetes. Conclusion To our knowledge, we described the first case of NEUROD1‐MODY in a Latin American family.
Collapse
Affiliation(s)
| | - Roberta Magalhães Tarantino
- Diabetes and Nutrology Section, Internal Medicine Department, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil.,Ambulatory of Diabetes, State Institute of Diabetes and Endocrinology, Rio de Janeiro, Brazil
| | - Pedro Hernan Cabello
- Human Genetics Laboratory, Oswaldo Cruz Institute, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil.,Laboratory of Genetics, School of Health Science, Grande Rio University, Rio de Janeiro, Brazil
| | | | | | - Melanie Rodacki
- Diabetes and Nutrology Section, Internal Medicine Department, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Lenita Zajdenverg
- Diabetes and Nutrology Section, Internal Medicine Department, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Mário Campos Junior
- Human Genetics Laboratory, Oswaldo Cruz Institute, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
| |
Collapse
|
26
|
Aguiar TS, Dantas JR, Cabral DB, Rêgo CCS, Zajdenverg L, Salles GF, Alves-Leon SV, Rodacki M, Lima MA. Association between high titers of glutamic acid decarboxylase antibody and epilepsy in patients with type 1 diabetes mellitus: A cross-sectional study. Seizure 2019; 71:318-321. [PMID: 31525611 DOI: 10.1016/j.seizure.2019.09.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2019] [Revised: 09/04/2019] [Accepted: 09/07/2019] [Indexed: 01/13/2023] Open
Abstract
PURPOSE Individuals with type 1 diabetes mellitus (T1D) are at higher risk of epilepsy. T1D is a progressive immune-mediated disease and the etiology of epilepsy remains unknown in most. Glutamic acid decarboxylase (GAD) catalyzes GABA formation. GABA-secreting neurons and pancreatic beta cells are the major cells expressing GAD. METHODS Cross-sectional study. Patients with T1D from a multiethnic population underwent GADA measurement to investigate possible association between T1D and epilepsy of unknown etiology. RESULTS T1D patients were analyzed (n = 375). Overall frequency of epilepsy was 5.9% (n = 22). Frequency of epilepsy of unknown etiology was 3.2% (n = 12). Of these, 8 (2.1%) had idiopathic generalized epilepsy (IGE) and 4 (1.1%) MRI-negative temporal lobe epilepsy (TLE). Patients with T1D and epilepsy of unknown etiology did not show differences in GADA frequency (83.3% vs 50%; p = 0.076); however, their titers were higher (106.9 ± 136.5 IU/mL; median 7; IQR 1.65-256 vs 10.2 ± 14.5 IU/ml; median 4.3; IQR 1.9-8.9; p = 0.019) compared to patients without epilepsy. Moreover, epilepsy of unknown etiology was associated with GADA titers ≥ 100 UI/mL [odds ratio (OR) 4.42, 95% CI 2.36-8.66]. CONCLUSION Epilepsy frequency was elevated in patients with T1D and multiethnic background. Presence of epilepsy of unknown etiology was associated with high titers of GADA in this population with long-standing T1D, which has different ethnic and genetic background compared to previous studies. Further prospective studies are required to identify if GADA presence or its persistence are directly responsible for epilepsy in individuals with T1D.
Collapse
Affiliation(s)
- Tiago S Aguiar
- Departamento de Neurologia, Hospital Universitário Clementino Fraga Filho HUCFF, Faculdade de Medicina, Universidade Federal do Rio de Janeiro UFRJ, Brazil.
| | - Joana R Dantas
- Departamento de Nutrologia e Diabetes, Hospital Universitário Clementino Fraga Filho HUCFF, Faculdade de Medicina, Universidade Federal do Rio de Janeiro UFRJ, Brazil
| | - Débora B Cabral
- Departamento de Nutrologia e Diabetes, Hospital Universitário Clementino Fraga Filho HUCFF, Faculdade de Medicina, Universidade Federal do Rio de Janeiro UFRJ, Brazil
| | - Cláudia Cecília S Rêgo
- Departamento de Neurologia, Hospital Universitário Clementino Fraga Filho HUCFF, Faculdade de Medicina, Universidade Federal do Rio de Janeiro UFRJ, Brazil; Departamento de Neurologia, Universidade Federal do Estado do Rio de Janeiro UNIRIO, Brazil
| | - Lenita Zajdenverg
- Departamento de Nutrologia e Diabetes, Hospital Universitário Clementino Fraga Filho HUCFF, Faculdade de Medicina, Universidade Federal do Rio de Janeiro UFRJ, Brazil
| | - Gil Fernando Salles
- Departamento de Clínica Médica, Hospital Universitário Clementino Fraga Filho HUCFF, Faculdade de Medicina, Universidade Federal do Rio de Janeiro UFRJ, Brazil
| | - Soniza V Alves-Leon
- Departamento de Neurologia, Hospital Universitário Clementino Fraga Filho HUCFF, Faculdade de Medicina, Universidade Federal do Rio de Janeiro UFRJ, Brazil; Departamento de Neurologia, Universidade Federal do Estado do Rio de Janeiro UNIRIO, Brazil
| | - Melanie Rodacki
- Departamento de Nutrologia e Diabetes, Hospital Universitário Clementino Fraga Filho HUCFF, Faculdade de Medicina, Universidade Federal do Rio de Janeiro UFRJ, Brazil
| | - Marco Antonio Lima
- Departamento de Neurologia, Hospital Universitário Clementino Fraga Filho HUCFF, Faculdade de Medicina, Universidade Federal do Rio de Janeiro UFRJ, Brazil
| |
Collapse
|
27
|
Rosa LCGFD, Zajdenverg L, Souto DL, Dantas JR, Pinto MVR, Salles GFDCMD, Rodacki M. HbA1c variability and long-term glycemic control are linked to diabetic retinopathy and glomerular filtration rate in patients with type 1 diabetes and multiethnic background. J Diabetes Complications 2019; 33:610-615. [PMID: 31227288 DOI: 10.1016/j.jdiacomp.2019.05.022] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2018] [Revised: 05/07/2019] [Accepted: 05/26/2019] [Indexed: 11/30/2022]
Abstract
AIM To evaluate the associations between HbA1c variability and long-term glycemic control with microvascular complications in type 1 diabetes (T1D) patients and multiethnic background. METHODS T1D adults with ≥10 years of follow-up and ≥ 2 HbA1c measurements were included. Glycemic variability was evaluated by the standard deviation (HbA1c-SD), and coefficient of variation (HbA1c-CV), and glycemic control by mean HbA1c over 10 years. Diabetic retinopathy (DR), increased urinary albumin excretion rate (UAER) and reduced glomerular filtration rate (eGFR) were diagnosed. Cardiac autonomic neuropathy (CAN) was diagnosed by cardiac reflex tests. Associations between glycemic parameters with complications were assessed by multivariate logistic regressions. RESULTS 220 patients were included. Simultaneously adjusted for each other, mean HbA1c was independently associated with DR (OR: 2.82; 95%CI: 1.45-5.50), increased UAER (OR: 1.97; 95%CI: 1.14-3.09) and CAN (OR: 4.42; 95%CI: 1.45-13.51); whereas HbA1c-CV was independently associated with DR (OR: 8.93; 95%CI: 1.86-42.87) and reduced eGFR (OR: 7.02; 95%CI: 1.47-35.55). CONCLUSIONS Long-term glycemic control was associated with DR, increased UAER and CAN, while glycemic variability was additionally associated with DR and impaired renal function; suggesting that both good and stable glycemic status might be important to prevent microvascular complications in T1D patients and multiethnic background.
Collapse
Affiliation(s)
| | - Lenita Zajdenverg
- Federal University of Rio de Janeiro, Brazil; Federal University of Rio de Janeiro, Department of Internal Medicine, Brazil
| | - Débora Lopes Souto
- Federal University of Rio de Janeiro, Brazil; Federal University of Rio de Janeiro, Department of Internal Medicine, Brazil.
| | - Joana Rodrigues Dantas
- Federal University of Rio de Janeiro, Brazil; Federal University of Rio de Janeiro, Department of Internal Medicine, Brazil
| | - Marcus Vinícius Rocha Pinto
- Federal University of Rio de Janeiro, Brazil; Federal University of Rio de Janeiro, Department of Internal Medicine, Brazil
| | | | - Melanie Rodacki
- Federal University of Rio de Janeiro, Brazil; Federal University of Rio de Janeiro, Department of Internal Medicine, Brazil
| |
Collapse
|
28
|
Souto DL, Lima ÉDS, Dantas JR, Zajdenverg L, Rodacki M, Rosado EL. Postprandial metabolic effects of fructose and glucose in type 1 diabetes patients: a pilot randomized crossover clinical trial. Arch Endocrinol Metab 2019; 63:376-384. [PMID: 31365624 PMCID: PMC10528643 DOI: 10.20945/2359-3997000000148] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/06/2017] [Accepted: 12/12/2018] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To test the influence of oral fructose and glucose dose-response solutions in blood glucose (BG), glucagon, triglycerides, uricaemia, and malondialdehyde in postprandial states in type 1 diabetes mellitus (T1DM) patients. SUBJECTS AND METHODS The study had a simple-blind, randomized, two-way crossover design in which T1DM patients were selected to receive fructose and glucose solutions (75g of sugars dissolved in 200 mL of mineral-water) in two separate study days, with 2-7 weeks washout period. In each day, blood samples were drawn after 8h fasting and at 180 min postprandial to obtain glucose, glucagon, triglycerides, uric acid, lactate, and malondialdehyde levels. RESULTS Sixteen T1DM patients (seven men) were evaluated, with a mean age of 25.19 ± 8.8 years, a mean duration of disease of 14.88 ± 4.73 years, and glycated hemoglobin of 8.13 ± 1.84%. Fructose resulted in lower postprandial BG levels than glucose (4.4 ± 5.5 mmol/L; and 12.9 ± 4.1 mmol/L, respectively; p < 0.01). Uric acid levels increased after fructose (26.1 ± 49.9 µmol/L; p < 0.01) and reduced after glucose (-13.6 ± 9.5 µmol/L; p < 0.01). The malondialdehyde increased after fructose (1.4 ± 1.6 µmol/L; p < 0.01) and did not change after glucose solution (-0.2 ± 1.6 µmol/L; p = 0.40). Other variables did not change. CONCLUSIONS Fructose and glucose had similar sweetness, flavor and aftertaste characteristics and did not change triglycerides, lactate or glucagon levels. Although fructose resulted in lower postprandial BG than glucose, it increased uric acid and malondialdehyde levels in T1DM patients. Therefore it should be used with caution. ClinicalTrials.gov registration: NCT01713023.
Collapse
Affiliation(s)
- Débora Lopes Souto
- Universidade Federal do Rio de JaneiroUniversidade Federal do Rio de JaneiroInstituto de Nutrição Josué de CastroDepartamento de Nutrição e DietéticaRio de JaneiroRJBrasilUniversidade Federal do Rio de Janeiro (UFRJ), Instituto de Nutrição Josué de Castro, Departamento de Nutrição e Dietética, Rio de Janeiro, RJ, Brasil
| | - Érika dos Santos Lima
- Universidade Federal do Rio de JaneiroUniversidade Federal do Rio de JaneiroInstituto de Nutrição Josué de CastroDepartamento de Nutrição e DietéticaRio de JaneiroRJBrasilUniversidade Federal do Rio de Janeiro (UFRJ), Instituto de Nutrição Josué de Castro, Departamento de Nutrição e Dietética, Rio de Janeiro, RJ, Brasil
| | - Joana Rodrigues Dantas
- Universidade Federal do Rio de JaneiroUniversidade Federal do Rio de JaneiroDepartamento de Medicina InternaRio de JaneiroRJBrasilUniversidade Federal do Rio de Janeiro (UFRJ), Departamento de Medicina Interna, Seção de Diabetes e Nutrologia, Rio de Janeiro, RJ, Brasil
| | - Lenita Zajdenverg
- Universidade Federal do Rio de JaneiroUniversidade Federal do Rio de JaneiroDepartamento de Medicina InternaRio de JaneiroRJBrasilUniversidade Federal do Rio de Janeiro (UFRJ), Departamento de Medicina Interna, Seção de Diabetes e Nutrologia, Rio de Janeiro, RJ, Brasil
| | - Melanie Rodacki
- Universidade Federal do Rio de JaneiroUniversidade Federal do Rio de JaneiroDepartamento de Medicina InternaRio de JaneiroRJBrasilUniversidade Federal do Rio de Janeiro (UFRJ), Departamento de Medicina Interna, Seção de Diabetes e Nutrologia, Rio de Janeiro, RJ, Brasil
| | - Eliane Lopes Rosado
- Universidade Federal do Rio de JaneiroUniversidade Federal do Rio de JaneiroInstituto de Nutrição Josué de CastroDepartamento de Nutrição e DietéticaRio de JaneiroRJBrasilUniversidade Federal do Rio de Janeiro (UFRJ), Instituto de Nutrição Josué de Castro, Departamento de Nutrição e Dietética, Rio de Janeiro, RJ, Brasil
| |
Collapse
|
29
|
Penaforte-Saboia JG, Couri CEB, Fernandes VO, Montenegro APDR, Batista LADA, Zajdenverg L, Negrato CA, Malmegrim KCR, Moraes DA, Dias JBE, Oliveira MC, Hussain A, Gomes MB, Montenegro RM. Lower Insulin-Dose Adjusted A1c (IDAA1c) Is Associated With Less Complications in Individuals With Type 1 Diabetes Treated With Hematopoetic Stem-Cell Transplantation and Conventional Therapy. Front Endocrinol (Lausanne) 2019; 10:747. [PMID: 31803138 PMCID: PMC6877543 DOI: 10.3389/fendo.2019.00747] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2019] [Accepted: 10/15/2019] [Indexed: 11/15/2022] Open
Abstract
Objective: To evaluate the association between insulin-dose adjusted A1C (IDAA1c) and microvascular complications (MC) and hypoglycemia in a representative Brazilian population of Type 1 diabetes mellitus (T1DM) patients. Research Design and Methods: This was a cross-sectional study based on a previous study, "Microvascular Complications in Type 1 Diabetes: a comparative analysis of patients treated with autologous nonmyeloablative hematopoietic stem-cell transplantation (AHST) and conventional medical therapy (CT)". The 168 patients in that study (144 from CT plus 24 from AHST) were re-subdivided into two groups, according to their IDAA1c values (30 patients had IDAA1c ≤ 9; 138 had IDAA1c > 9). Then, the prevalence of MC (diabetic renal disease, neuropathy, and retinopathy), hypoglycemia (blood glucose <60 mg/dL), and severe hypoglycemic (episode of hypoglycemia that required the assistance of another person to treat) events were compared between the groups. The groups were well-matched on these factors: duration of disease, sex, and age at the time of diagnosis of T1DM. Results: After an average of 8 years after diagnosis, only 6.6% (2/30) of the patients from IDAA1c ≤ 9 group developed any MC, whereas 21.0% (29/138) from the IDAA1c > 9 group had at least one complication (p = 0.044). Regarding hypoglycemic events, the proportion of individuals who reported at least 1 episode of hypoglycemia in the last month was 43.3 and 64.7% from the IDAA1c ≤ 9 and IDAA1c > 9 groups, respectively (p = 0.030). Regarding severe hypoglycemia, the proportion of patients presenting at least one episode in the last month and the rate of episode/patient/month were similar between groups (6.7 vs. 13.2%; p = 0.535; and 0.1/patient/month vs. 0.25/patient/month; p = 0.321). Conclusion: In a representative Brazilian population of T1DM patients, those with IDAA1c ≤ 9 presented a lower frequency of MC, as well as fewer episodes of hypoglycemia, in the month prior to the analysis.
Collapse
Affiliation(s)
- Jaquellyne Gurgel Penaforte-Saboia
- Postgraduate Program in Medical Sciences, Department of Clinical Medicine, Federal University of Ceará, Fortaleza, Brazil
- Clinical Research Unit, Walter Cantidio University Hospital, Federal University of Ceará/EBSERH, Fortaleza, Brazil
| | - Carlos Eduardo Barra Couri
- Center for Cell-Based Therapy, Regional Blood Center of Ribeirão Preto, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil
- Department of Internal Medicine, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil
| | - Virginia Oliveira Fernandes
- Postgraduate Program in Medical Sciences, Department of Clinical Medicine, Federal University of Ceará, Fortaleza, Brazil
- Clinical Research Unit, Walter Cantidio University Hospital, Federal University of Ceará/EBSERH, Fortaleza, Brazil
- Postgraduate Program in Public Health, Department of Community Health, Federal University of Ceará, Fortaleza, Brazil
| | - Ana Paula Dias Rangel Montenegro
- Postgraduate Program in Medical Sciences, Department of Clinical Medicine, Federal University of Ceará, Fortaleza, Brazil
- Clinical Research Unit, Walter Cantidio University Hospital, Federal University of Ceará/EBSERH, Fortaleza, Brazil
- Postgraduate Program in Public Health, Department of Community Health, Federal University of Ceará, Fortaleza, Brazil
| | - Lívia Aline De Araújo Batista
- Postgraduate Program in Medical Sciences, Department of Clinical Medicine, Federal University of Ceará, Fortaleza, Brazil
- Postgraduate Program in Public Health, Department of Community Health, Federal University of Ceará, Fortaleza, Brazil
| | - Lenita Zajdenverg
- University Hospital, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | | | - Kelen Cristina Ribeiro Malmegrim
- Center for Cell-Based Therapy, Regional Blood Center of Ribeirão Preto, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil
| | - Daniela Aparecida Moraes
- Center for Cell-Based Therapy, Regional Blood Center of Ribeirão Preto, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil
- Department of Internal Medicine, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil
| | - Juliana Bernardes Elias Dias
- Center for Cell-Based Therapy, Regional Blood Center of Ribeirão Preto, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil
- Department of Internal Medicine, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil
| | - Maria Carolina Oliveira
- Center for Cell-Based Therapy, Regional Blood Center of Ribeirão Preto, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil
- Department of Internal Medicine, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil
| | - Akhtar Hussain
- Postgraduate Program in Medical Sciences, Department of Clinical Medicine, Federal University of Ceará, Fortaleza, Brazil
- Faculty of Health Sciences, Nord University, Bodø, Norway
- Centre for Global Health Research, Diabetic Association of Bangladesh, Dhaka, Bangladesh
| | - Marilia Brito Gomes
- Diabetes Unit, Department of Internal Medicine, State University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Renan Magalhães Montenegro
- Postgraduate Program in Medical Sciences, Department of Clinical Medicine, Federal University of Ceará, Fortaleza, Brazil
- Clinical Research Unit, Walter Cantidio University Hospital, Federal University of Ceará/EBSERH, Fortaleza, Brazil
- Postgraduate Program in Public Health, Department of Community Health, Federal University of Ceará, Fortaleza, Brazil
- *Correspondence: Renan Magalhães Montenegro Jr.
| |
Collapse
|
30
|
Marinho MC, Pacheco ABF, Costa GCV, Ortiz ND, Zajdenverg L, Sansone C. Quantitative gingival crevicular fluid proteome in type 2 diabetes mellitus and chronic periodontitis. Oral Dis 2018; 25:588-595. [PMID: 30362201 DOI: 10.1111/odi.12996] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2018] [Revised: 10/01/2018] [Accepted: 10/16/2018] [Indexed: 12/12/2022]
Abstract
OBJECTIVE The aim of this study was to investigate the proteome of the gingival crevicular fluid comparing the relative abundance of proteins from type 2 diabetes mellitus (2DM) individuals and chronic periodontitis (CP) affected sites, subjects affected by both conditions and healthy individuals. MATERIAL AND METHODS Twenty individuals were equally allocated in four groups, 2DM with CP, 2DM periodontally healthy, CP without 2DM, and periodontally healthy without 2DM. The relative quantification of proteins was accessed with iTRAQ labeling and mass spectrometry. RESULTS AND CONCLUSION A total of 104 proteins showed significant differences in abundance in pairwise comparisons. Some presented different levels in all diseased groups as compared to control, either increasing (rap guanine nucleotide exchange factor, S100A8, S100A9, and immunoglobulins) or decreasing (actins, myristoylated alanine-rich C-kinase substrate, and glutathione S-transferase). Other differences were specific for a given condition: Titin, neutrophil elastase, and myeloperoxidase levels were higher in the DP group, cathelicidin antimicrobial peptide decreased in CP, and annexin decreased in DH. These differences in the proteome can provide clues for further studies that will validate the variation in their levels and their role in both diseases.
Collapse
Affiliation(s)
- Marcelo C Marinho
- Department of Dental Clinic, Division of Periodontology, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Ana Beatriz F Pacheco
- Institute of Biophysics Carlos Chagas Filho, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Giovani C V Costa
- Brazilian Doping Control Laboratory (LBCD/LADETEC/IQ), Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Nina D Ortiz
- Brazilian Doping Control Laboratory (LBCD/LADETEC/IQ), Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Lenita Zajdenverg
- Department of Internal Medicine, Section of Diabetes and Nutrology, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Carmelo Sansone
- Department of Dental Clinic, Division of Periodontology, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| |
Collapse
|
31
|
Souto DL, Dantas JR, Oliveira MMDS, Rosado EL, Luiz RR, Zajdenverg L, Rodacki M. Does sucrose affect the glucose variability in patients with type 1 diabetes? a pilot crossover clinical study. Nutrition 2018; 55-56:179-184. [PMID: 30086487 DOI: 10.1016/j.nut.2018.05.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2018] [Revised: 05/26/2018] [Accepted: 05/28/2018] [Indexed: 10/14/2022]
Abstract
OBJECTIVE The aim of this study was to compare the effects of a sucrose-free diet with a sucrose-added diet on glucose variability in patients with type 1 diabetes. METHODS This was a two-way crossover design study in which patients with type 1 diabetes were monitored by blinded continuous glucose monitoring and were selected to receive a sucrose-free diet (<30 g/d), followed by a sucrose-added diet (>80 g/d) for 2 d each. Intra-day glucose variability was assessed by the mean amplitude of glycemic excursions (MAGE), the M-value, J-index, glycemic risk assessment in diabetes equation (GRADE), and continuous overlapping net glycemic action (CONGA1-3). Between-day variability was determined by mean of daily difference (MODD). Statistical analyses were performed with a significance level of 5%. RESULTS Ten patients with type 1 diabetes were evaluated. The participants were a mean of 26.1 ± 7.1 y of age. The mean duration of disease was 16.5 ± 10.5 y, and patients' mean glycated hemoglobin was 7.4% ± 0.8%. The intra- and inter-day glucose variability indexes did not differ between the diet periods (MAGE: 10.2 ± 5.1 and 10.4 ± 6.8mmol/L, P = 0.98; M-value: 12.9 ± 2 and 15.6 ± 1.3mmol/L, P = 0.29; J-index: 50.9 ± 4.4 and 57.7 ± 3.3mmol/L, P = 0.41; GRADE: 7.2 ± 1 and 4.7 ± 5.3mmol/L, P = 0.07; and MODD: 3.9 ± 1 and 4.3 ± 1.5mmol/L, P = 0.28; for the sucrose-free and sucrose-added diets, respectively). CONGA1-3 were similar for both diet periods (P > 0.05). CONCLUSIONS The use of a moderate amount of sucrose, as part of a balanced diet, did not affect the glucose variability or insulin requirements in patients with type 1 diabetes.
Collapse
Affiliation(s)
- Débora Lopes Souto
- Department of Internal Medicine, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil; Institute of Nutrition Josué de Castro, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil.
| | - Joana Rodrigues Dantas
- Department of Internal Medicine, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | | | - Eliane Lopes Rosado
- Institute of Nutrition Josué de Castro, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Ronir Raggio Luiz
- Institute of Public Health Studies, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Lenita Zajdenverg
- Department of Internal Medicine, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Melanie Rodacki
- Department of Internal Medicine, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| |
Collapse
|
32
|
Silva SDOCD, Saunders C, Zajdenverg L, Moreira LN, Heidelmann SP, Pereira ACDS, Padilha PDC. Predictive factors for birth weight of newborns of mothers with gestational diabetes mellitus. Diabetes Res Clin Pract 2018; 138:262-270. [PMID: 29412146 DOI: 10.1016/j.diabres.2018.01.032] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2017] [Revised: 01/17/2018] [Accepted: 01/26/2018] [Indexed: 12/17/2022]
Abstract
AIMS To evaluate the predictive factors of birth weight (BW) of newborns of women with gestational diabetes mellitus (GDM). METHODS A cross-sectional study was performed among pregnant women with GDM treated in a public maternity unit, Brazil. We selected 283 pregnant women, with nutritional follow-up initiated till the 28th gestational week, singleton pregnancy, without chronic diseases and with birth weight information of the newborns. The predictive factors of BW were identified by multivariate linear regression. RESULTS Mean maternal age was 31.2 ± 5.8 years; 64.4% were non-white; 70.1% were pre-gestational overweight or obese. Mean BW was 3234.3 ± 478.8 g. An increase of 1 kg of weight in the first and third trimesters increased BW by 21 g (p = 0.01) and 27 g (p = 0.03), respectively. Similarly, the other predictive factors of BW were pre-gestational body mass index (β = 17.16, p = 0.02) and postprandial plasma glucose in the third trimester (β = 4.14, p = 0.008), in the model adjusted by gestational age at delivery (β = 194.68, p < 0.001). CONCLUSIONS The best predictors of BW were gestational age at birth, and maternal pre-gestational and gestational anthropometric characteristics. Maternal glycaemic levels may also influence BW. The results may contribute to a review of prenatal routines for pregnant women with GDM.
Collapse
Affiliation(s)
- Sara de Oliveira Corrêa da Silva
- Mestrado Profissional em Nutrição Clínica do, Instituto de Nutrição Josué de Castro, Centro de Ciências da Saúde, Universidade Federal do Rio de Janeiro (UFRJ), Av. Carlos Chagas Filho, 373, bl. J 2°, andar, sala 26, Cidade Universitária, CEP 21941.590 Rio de Janeiro, RJ, Brazil.
| | - Cláudia Saunders
- Mestrado Profissional em Nutrição Clínica do, Instituto de Nutrição Josué de Castro, Centro de Ciências da Saúde, Universidade Federal do Rio de Janeiro (UFRJ), Av. Carlos Chagas Filho, 373, bl. J 2°, andar, sala 26, Cidade Universitária, CEP 21941.590 Rio de Janeiro, RJ, Brazil; Maternidade Escola da, Universidade Federal do Rio de Janeiro (UFRJ), Rua das Laranjeiras, 180, Laranjeiras, CEP 22240-003 Rio de Janeiro, RJ, Brazil.
| | - Lenita Zajdenverg
- Maternidade Escola da, Universidade Federal do Rio de Janeiro (UFRJ), Rua das Laranjeiras, 180, Laranjeiras, CEP 22240-003 Rio de Janeiro, RJ, Brazil.
| | | | - Sonaly Petronilho Heidelmann
- Maternidade Escola da, Universidade Federal do Rio de Janeiro (UFRJ), Rua das Laranjeiras, 180, Laranjeiras, CEP 22240-003 Rio de Janeiro, RJ, Brazil.
| | - Ariane Cristine Dos Santos Pereira
- Multiprofessional Residency Program in Perinatal Health, Maternity School, Universidade Federal do Rio de Janeiro (UFRJ), Rua das Laranjeiras, 180, Laranjeiras, CEP 22240-003 Rio de Janeiro, RJ, Brazil.
| | - Patricia de Carvalho Padilha
- Mestrado Profissional em Nutrição Clínica do, Instituto de Nutrição Josué de Castro, Centro de Ciências da Saúde, Universidade Federal do Rio de Janeiro (UFRJ), Av. Carlos Chagas Filho, 373, bl. J 2°, andar, sala 26, Cidade Universitária, CEP 21941.590 Rio de Janeiro, RJ, Brazil; Maternidade Escola da, Universidade Federal do Rio de Janeiro (UFRJ), Rua das Laranjeiras, 180, Laranjeiras, CEP 22240-003 Rio de Janeiro, RJ, Brazil.
| |
Collapse
|
33
|
Lamounier RN, Geloneze B, Leite SO, Montenegro R, Zajdenverg L, Fernandes M, de Oliveira Griciunas F, Ermetice MN, Chacra AR. Hypoglycemia incidence and awareness among insulin-treated patients with diabetes: the HAT study in Brazil. Diabetol Metab Syndr 2018; 10:83. [PMID: 30479669 PMCID: PMC6249957 DOI: 10.1186/s13098-018-0379-5] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2018] [Accepted: 10/19/2018] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Hypoglycemia affects patient safety and glycemic control during insulin treatment of both type 1 (T1DM) and type 2 diabetes mellitus (T2DM). The Hypoglycemia Assessment Tool study in Brazil aimed to determine the proportion of patients experiencing hypoglycemic events and to characterize patient awareness and fear about hypoglycemia, among insulin-treated T1DM or T2DM patients. METHODS This was a non-interventional, multicenter study, with a 6-month retrospective and a 4-week prospective evaluation of hypoglycemic events. Patients completed a questionnaire at baseline and at the end of the study, and also a patient diary. The answers 'occasionally' and 'never' to the question 'Do you have symptoms when you have a low sugar level?' denoted impaired hypoglycemia awareness. Fear was reported on a 10-point scale, from 'not afraid at all' to 'absolutely terrified'. RESULTS From 679 included patients, 321 with T1DM and 293 T2DM, median age of 33.0 and 62.0 years, 59% and 56% were female, and median diabetes duration was 15.0 and 15.0 years, respectively. Median time of insulin use was 14.0 and 6.0 years. During the prospective period, 91.7% T1DM and 61.8% T2DM patients had at least one hypoglycemic event. In the same period, 54.0% T1DM and 27.4% T2DM patients had nocturnal hypoglycemia, 20.6% T1DM and 10.6% T2DM patients had asymptomatic hypoglycemia, and severe events occurred in 20.0% and 10.3%, respectively. At baseline, 21.4% T1DM and 34.3% T2DM had hypoglycemia unawareness. The mean score of hypoglycemia fear was 5.9 ± 3.1 in T1DM and 5.4 ± 3.9 in T2DM. The most common attitude after hypoglycemic events were to increase calorie intake (60.3%) and blood glucose monitoring (58.0%) and to reduce or skip insulin doses (30.8%). CONCLUSIONS Referred episodes of hypoglycemia were high, in both T1DM and T2DM insulin users. Patient attitudes after hypoglycemia, such as reduction in insulin and increase in calorie intake, can affect diabetes management. These findings may support clinicians in tailoring diabetes education and insulin treatment for patients with diabetes, in order to improve their glycemic control while reducing the risk of hypoglycemic events.
Collapse
Affiliation(s)
| | - Bruno Geloneze
- Laboratory of Investigation on Metabolismo and Diabetes (LIMED), University of Campinas-UNICAMP, Campinas, SP Brazil
| | - Silmara Oliveira Leite
- Hospital Cruz Vermelha, Curitiba/PR. Centro de Diabetes de Curitiba, Curitiba, PR Brazil
| | - Renan Montenegro
- Faculdade de Medicina da Universidade Federal do Ceará, Fortaleza, CE Brazil
| | | | | | | | | | - António Roberto Chacra
- Departamento de Medicina da Universidade Federal de São Paulo-UNIFESP, São Paulo, SP Brazil
| | | |
Collapse
|
34
|
Gomes MB, Rodacki M, Pavin EJ, Cobas RA, Felicio JS, Zajdenverg L, Negrato CA. The impact of ethnicity, educational and economic status on the prescription of insulin therapeutic regimens and on glycemic control in patients with type 1 diabetes. A nationwide study in Brazil. Diabetes Res Clin Pract 2017; 134:44-52. [PMID: 28951342 DOI: 10.1016/j.diabres.2017.09.013] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2016] [Revised: 09/01/2017] [Accepted: 09/19/2017] [Indexed: 02/06/2023]
Abstract
AIMS Establish the relationship between demographic, educational and economic status on insulin therapeutic regimens (ITRs) and on glycemic control in patients with type 1 diabetes. METHODS This was a cross-sectional, multicenter study with 1760 patients conducted between August 2011 and August 2014 in 10 Brazilian cities. RESULTS Patients were stratified according to ITRs as follows: only NPH insulin (group 1, n=80(4.5%)); only long-acting insulin analogs (group 2, n=6(0.3%)); continuous subcutaneous insulin infusion (CSII) (group 3, n=62(3.5%)); NPH plus regular insulin (group 4, n=710(40.3%)); NPH plus ultra-rapid insulin analogs (group 5, n=259(14.8%)); long-acting insulin analogs plus regular insulin (group 6, n=25(4.4%)) and long-acting plus ultra-rapid insulin analogs (group 7, n=618 (35.1%)). As group A (provided free of charge by the government) we considered groups 1 and 4, and as group B (obtained through lawsuit or out-of-pocket) groups 2, 3 and 7. Multivariate logistic analysis showed that independent variables related to group B were older age, more years of school attendance, higher economic status and ethnicity (Caucasians). The independent variables related to better glycemic control were older age, higher adherence to diet, higher frequency of self-monitoring of blood glucose, more years of school attendance and belonging to group B. CONCLUSIONS In Brazilian National Health Care System, prescriptions of insulin analogs or CSII are more frequent in Caucasian patients with type 1 diabetes, with higher economic status and more years ofschool attendance. Among these variables years of school attendance was the only one associated with better glycemic control.
Collapse
Affiliation(s)
- Marilia Brito Gomes
- Department of Internal Medicine, Diabetes Unit, State University Hospital of Rio de Janeiro, Brazil
| | - Melanie Rodacki
- Diabetes and Nutrition Section, Department of Internal Medicine, Federal University of Rio de Janeiro, Brazil
| | - Elizabeth João Pavin
- Endocrinology Division, Department of Internal Medicine, Faculty of Medical Sciences, University of Campinas, São Paulo, Brazil
| | - Roberta Arnoldi Cobas
- Department of Internal Medicine, Diabetes Unit, State University Hospital of Rio de Janeiro, Brazil
| | - João S Felicio
- University Hospital João de Barros Barreto, Federal University of Pará, Endocrinology Division, Belém, Pará, Brazil
| | - Lenita Zajdenverg
- Diabetes and Nutrition Section, Department of Internal Medicine, Federal University of Rio de Janeiro, Brazil
| | - Carlos Antonio Negrato
- Bauru's Diabetics Association, Department of Internal Medicine, Bauru, São Paulo, Brazil.
| |
Collapse
|
35
|
Rodacki M, Carvalho RM, Zajdenverg L. The potential effect of ultra-long insulin degludec on glycemic variability. Diabetes Res Clin Pract 2017; 133:92-103. [PMID: 28918342 DOI: 10.1016/j.diabres.2017.06.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2016] [Revised: 05/31/2017] [Accepted: 06/06/2017] [Indexed: 01/12/2023]
Abstract
Despite the therapeutic advances in the treatment of diabetes, metabolic control instability due to glycemic variability (GV) is frequently observed in patients with diabetes on intensive insulin therapy and is associated with hyperglycemic peaks and hypoglycemic episodes. Hyperglycemia associated with GV has been implicated in the development of chronic complications due to its pro-oxidative consequences. On the other hand, hypoglycemia can be associated with increased cardiovascular risk secondarily to adrenergic activation. The ultra-long-acting insulin analogue, insulin degludec (IDeg), presents a flat and stable glucose-lowering effect both in Type 1 and Type 2 diabetes patients. In pharmacodynamic studies, IDeg has been associated with a lower variability in its insulin action than other alternatives for basal insulin, which might have clinical advantages for the stability of the glycemic control. The main objective of this review is to present pharmacological and clinical data regarding the efficacy and safety of IDeg for the treatment of diabetes focusing on its effects on GV and on hypoglycemia frequency.
Collapse
Affiliation(s)
- M Rodacki
- Universidade Federal do Rio de Janeiro, Medical Clinic Department, Nutrology and Diabetes Unit, Brazil.
| | | | - L Zajdenverg
- Universidade Federal do Rio de Janeiro, Medical Clinic Department, Nutrology and Diabetes Unit, Brazil
| |
Collapse
|
36
|
Zajdenverg L, Negrato CA. Gestational diabetes mellitus and type 2 diabetes: same disease in a different moment of life? Maybe not. Arch Endocrinol Metab 2017; 61:208-210. [PMID: 28699984 PMCID: PMC10118797 DOI: 10.1590/2359-3997000000276] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/27/2017] [Accepted: 05/27/2017] [Indexed: 11/21/2022]
Affiliation(s)
- Lenita Zajdenverg
- Serviço de Nutrologia e Diabetes, Departamento de Clínica Médica, Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, RJ, Brasil
| | | |
Collapse
|
37
|
Zagury RL, Rodacki M, Mello de Oliveira L, Saunders C, de Carvalho Padilha P, Zajdenverg L. Carbohydrate Counting during Pregnancy in Women with Type 1 Diabetes: Are There Predictable Changes That We Should Know? Ann Nutr Metab 2017; 70:140-146. [PMID: 28391275 DOI: 10.1159/000471859] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/02/2017] [Accepted: 03/19/2017] [Indexed: 11/19/2022]
Abstract
BACKGROUND/AIMS Carbohydrate counting (CC) is a helpful strategy for the treatment of type 1 diabetes mellitus (T1DM) and the main parameters used in this method are the insulin to carbohydrate ratio (ICR) and the sensitivity factor (SF). Throughout pregnancy, a state of insulin resistance develops. Therefore, we hypothesized that ICR and SF change and our aim was to describe the pattern of modification of these parameters in pregnant women with T1DM on CC. METHODS This study followed 21 women with T1DM throughout pregnancy. Starting ICR was 1:15 and SF was calculated using the formula: 1,500/total daily insulin dose (TDID; for regular insulin) or 1,800/TDID (for ultra-rapid analogs). ICR was adjusted every 1-2 weeks according to self-monitoring of blood glucose. SF was recalculated every 1-2 weeks. RESULTS Throughout gestation there was a mean decrease in the ICR in breakfast, lunch and dinner of 8.2 (p < 0.0001), 7.7 (p = 0.003) and 7 (p = 0.005) grams per international units (g/IU), respectively. Mean SF reduction from first to third trimester was 10 mg/dL per IU (mg/dL/IU; p < 0.0001). CONCLUSIONS Women with T1DM in CC during pregnancy evolve with a progressive reduction in the ICR at every meal (mean of 8.2 g/IU for breakfast, 7.7 g/IU for lunch and 7 g/IU for dinner) and also in the SF (10 mg/dL/IU).
Collapse
Affiliation(s)
- Roberto Luís Zagury
- Federal University of Rio de Janeiro, Maternity-School of the Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | | | | | | | | | | |
Collapse
|
38
|
Aguiar TS, Fragoso A, Albuquerque CRD, Teixeira PDF, Souza MVLD, Zajdenverg L, Alves-Leon SV, Rodacki M, Lima MASDD. Clinical characteristics of patients with cerebellar ataxia associated with anti-GAD antibodies. Arq Neuro-Psiquiatr 2017; 75:142-146. [DOI: 10.1590/0004-282x20170011] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/17/2016] [Accepted: 12/05/2016] [Indexed: 01/25/2023]
Abstract
ABSTRACT The enzyme glutamic acid decarboxylase (GAD), present in GABAergic neurons and in pancreatic beta cells, catalyzes the conversion of gamma-aminobutyric acid (GABA). The cerebellum is highly susceptible to immune-mediated mechanisms, with the potentially treatable autoimmune cerebellar ataxia associated with the GAD antibody (CA-GAD-ab) being a rare, albeit increasingly detected condition. Few cases of CA-GAD-ab have been described. Methods This retrospective and descriptive study evaluated the clinical characteristics and outcomes of patients with CA-GAD-ab. Result Three patients with cerebellar ataxia, high GAD-ab titers and autoimmune endocrine disease were identified. Patients 1 and 2 had classic stiff person syndrome and insidious-onset cerebellar ataxia, while Patient 3 had pure cerebellar ataxia with subacute onset. Patients received intravenous immunoglobulin therapy with no response in Patients 1 and 3 and partial recovery in Patient 2. Conclusion CA-GAD-ab is rare and its clinical presentation may hamper diagnosis. Clinicians should be able to recognize this potentially treatable autoimmune cerebellar ataxia.
Collapse
Affiliation(s)
| | | | | | | | | | | | - Soniza Vieira Alves-Leon
- Universidade Federal do Rio de Janeiro, Brasil; Universidade Federal do Estado do Rio de Janeiro, Brasil
| | | | | |
Collapse
|
39
|
Dytz MG, Marcelino PAH, de Castro Santos O, Zajdenverg L, Conceição FL, Ortiga-Carvalho TM, Rodacki M. Clinical aspects of pancreatogenic diabetes secondary to hereditary pancreatitis. Diabetol Metab Syndr 2017; 9:4. [PMID: 28101143 PMCID: PMC5237278 DOI: 10.1186/s13098-017-0203-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2016] [Accepted: 01/07/2017] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Hereditary pancreatitis is a rare inherited form of pancreatitis, characterized by recurrent episodes of acute pancreatitis with early onset and/or chronic pancreatitis, and presenting brittle diabetes, composed of episodes of nonketotic hyperglycemia and severe hypoglycemia. The existing literature regarding this form of diabetes is scarce. In this report, clinical features of pancreatogenic diabetes secondary to hereditary pancreatitis are presented along with recommendations for appropriate medical treatment. RESULTS Clinical data from five patients of a family with pancreatogenic diabetes secondary to hereditary pancreatitis were analyzed. The average time between hereditary pancreatitis and diabetes diagnosis was 80 ± 24 months (range: 60-180 months) with a mean age of 25.6 ± 14.7 years (range: 8-42 years), four patients used antidiabetic agents for 46 ± 45 months and all progressed to insulin therapy with a mean dose of 0.71 ± 0.63 IU/kg (range: 0.3-1.76 IU/kg). The glycemic control had a high variability with average capillary blood glucose of 217.00 ± 69.44 mg/dl (range: 145-306 mg/dl) and the average HbA1c was 9.9 ± 1.9% (range: 7.6-11.6%). No ketoacidosis episodes occurred and there were several episodes of hospitalization for severe hypoglycemia. CONCLUSIONS Diabetes mellitus secondary to hereditary pancreatitis presents with early onset, diverse clinical presentation and with extremely labile glycemic control. Diabetes treatment varies according to the presentation and insulin is frequently necessary for glycemic control.
Collapse
Affiliation(s)
- Marcio Garrison Dytz
- Endocrinology Section, Department of Internal Medicine, Medical School, Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, Brazil
- Laboratory of Translational Endocrinology, Instituto de Biofísica Carlos Chagas Filho, Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, Brazil
- Diabetes and Nutrology Section, Department of Internal Medicine, Medical School, Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, Brazil
- Endocrinology Section, Hospital Universitário Clementino Fraga Filho, Rua Rodolpho Paulo Rocco 255, Ilha do Fundão, Rio de Janeiro, RJ 21941-913 Brazil
| | - Pedro Arthur Hamamoto Marcelino
- Diabetes and Nutrology Section, Department of Internal Medicine, Medical School, Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, Brazil
| | - Olga de Castro Santos
- Endocrinology Section, Department of Internal Medicine, Medical School, Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, Brazil
| | - Lenita Zajdenverg
- Diabetes and Nutrology Section, Department of Internal Medicine, Medical School, Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, Brazil
| | - Flavia Lucia Conceição
- Endocrinology Section, Department of Internal Medicine, Medical School, Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, Brazil
| | - Tânia Maria Ortiga-Carvalho
- Laboratory of Translational Endocrinology, Instituto de Biofísica Carlos Chagas Filho, Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, Brazil
| | - Melanie Rodacki
- Diabetes and Nutrology Section, Department of Internal Medicine, Medical School, Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, Brazil
| |
Collapse
|
40
|
Nabuco A, Pimentel S, Cabizuca CA, Rodacki M, Finamore D, Oliveira MM, Zajdenverg L. Early diabetes screening in women with previous gestational diabetes: a new insight. Diabetol Metab Syndr 2016; 8:61. [PMID: 27570545 PMCID: PMC5002139 DOI: 10.1186/s13098-016-0172-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2015] [Accepted: 07/18/2016] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND Gestational diabetes mellitus (GDM) is a risk factor for the development of diabetes mellitus (DM). However, there is a low return rate for this screening, so it is important to search for earlier methods for evaluation after delivery, to increase the number of pregnant women screened, so you can start the treatment or prevention of these early comorbidities. To determine the accuracy of the 75 g 2-h oral glucose tolerance test (OGTT) performed between 48-72 h after delivery for the diagnosis of DM using the OGTT after 6 weeks as the gold standard criterion, and to identify the optimal cutoff points for this exam for diabetes screening after a pregnancy complicated by GDM. METHODS 82 women with previous GDM underwent an OGTT between 48-72 h postpartum and repeated the test 6 weeks after delivery. RESULTS The prevalence of DM and prediabetes based on the first OGTT was 3.7 and 32.9 %, respectively, and 8.5 and 20.7 %, respectively, at the second OGTT. For those with DM, the area under the curve (AUC) based on the fasting plasma glucose (FPG) was 0.77 (95 % CI 0.61-0.92), and based on 2-h OGTT was 0.82 (95 % CI 0.66-0.97). For patients with prediabetes, the AUC based on the FPG was 0.73 (95 % CI 0.59-0.86) and based on the 2-h OGTT was 0.74 (95 % CI 0.61-0.87). Using a FPG cutoff value of 78 mg/dl (4.3 mmol/L) and a 2-h OGTT cutoff value of 130 mg/dl (7.2 mmol/L) for DM, the specificity was 58.7 and 60 %, the sensitivity was 71.4 and 85.7 %, the positive predictive value was 13.9 and 16.7 and the negative predictive value was 95.7 and 97.9 %, respectively. CONCLUSIONS OGTT performed early in postpartum is a useful tool for identifying women with previous GDM who must perform an OGTT 6 weeks after delivery.
Collapse
Affiliation(s)
- Aline Nabuco
- Nutrology and Diabetes Section/Maternidade Escola, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Rio de Janeiro CEP 21941-913 Brazil
- Serviço de Nutrologia e Diabetes, Hospital Universitário Clementino Fraga Filho, Rua Professor Rodolpho Paulo Rocco 255, sala 9E14, University City, CEP 21941-913 Brazil
| | - Samara Pimentel
- Nutrology and Diabetes Section/Maternidade Escola, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Rio de Janeiro CEP 21941-913 Brazil
| | - Carolina A. Cabizuca
- Nutrology and Diabetes Section/Maternidade Escola, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Rio de Janeiro CEP 21941-913 Brazil
| | - Melanie Rodacki
- Nutrology and Diabetes Section/Maternidade Escola, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Rio de Janeiro CEP 21941-913 Brazil
| | - Denise Finamore
- Maternidade Escola, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Marcus M. Oliveira
- Nutrology and Diabetes Section/Maternidade Escola, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Rio de Janeiro CEP 21941-913 Brazil
| | - Lenita Zajdenverg
- Nutrology and Diabetes Section/Maternidade Escola, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Rio de Janeiro CEP 21941-913 Brazil
| |
Collapse
|
41
|
Viana LV, Gomes MB, Zajdenverg L, Pavin EJ, Azevedo MJ. Interventions to improve patients' compliance with therapies aimed at lowering glycated hemoglobin (HbA1c) in type 1 diabetes: systematic review and meta-analyses of randomized controlled clinical trials of psychological, telecare, and educational interventions. Trials 2016; 17:94. [PMID: 26888087 PMCID: PMC4758163 DOI: 10.1186/s13063-016-1207-6] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2015] [Accepted: 01/30/2016] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Brazilian records on glycemic control in patients with type 1 diabetes show treatment efficacy. Poor patient adherence to therapeutic proposals influences these results and can be associated with social, psychological, and economic aspects, besides others factors. The aim of this study was to evaluate the efficacy of psychological, telecare, and educational interventions to improve treatment compliance among patients with type 1 diabetes. Compliance was assessed indirectly using reduction of glycated hemoglobin (HbA1c) as the principal outcome measure. METHODS Systematic review and meta-analyses of randomized controlled clinical trials (RCTs) were performed using Medline, Embase, Cochrane and Scopus databases up to April 2015. The following medical subject headings were used: Diabetes Mellitus, Type 1, Patient Compliance or Adherence, Hemoglobin A, glycated, and Randomized Controlled Trial. The principal outcome was change in HbA1c between baseline and follow-up. Where appropriate, trials were combined in meta-analysis using fixed effects models. RESULTS From 191 articles initially identified, 57 were full text reviewed, and 19 articles met the inclusion criteria providing data from 1782 patients (49.4 % males, age 18 years). The RCTs (2 to 24 months in duration) were divided into four groups according to type of intervention: psychology (seven studies; 818 patients), telecare (six studies; 494 patients); education (five studies; 349 patients), and psychoeducation (one study; 153 patients). All studies reported some type of adherence measurement of the interventions. Decrease in HbA1c was observed after psychology (MD -0.310; 95 % CI, -0.599 to -0.0210, P = 0.035) but not after telecare (MD -0.124 %; 95 % CI, -0.268, 0.020; P = 0.090) or educational (MD -0.001; 95 % CI, -0.202, 0.200; P = 0.990) interventions. CONCLUSION Psychological approaches to improve adherence to diabetes care treatment modestly reduced HbA1c in patients with type 1 diabetes; telecare and education interventions did not change glycemic control. However, the limited number of studies included as well as their methodological quality should be taken into account.
Collapse
Affiliation(s)
- Luciana Verçoza Viana
- Endocrinology Division, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Rua Ramiro Barcelos 2350, Prédio 12, 4° andar, 90035-003, Porto Alegre, RS, Brazil.
| | - Marilia Brito Gomes
- Unit of Diabetes, Universidade Estadual do Rio de Janeiro, Rio de Janeiro, Brazil.
| | - Lenita Zajdenverg
- Internal Medicine Department, Diabetes Division, Hospital Universitário Clementino Fraga Filho, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil.
| | - Elizabeth Joao Pavin
- Department of Clinical Medicine, Universidade Estadual de Campinas, Campinas, Brazil.
| | - Mirela Jobim Azevedo
- Endocrinology Division, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Rua Ramiro Barcelos 2350, Prédio 12, 4° andar, 90035-003, Porto Alegre, RS, Brazil.
| |
Collapse
|
42
|
Kern Pessôa VN, Rodacki M, Negrato CA, Zajdenverg L. Changes in lipid profile after treatment of women with gestational diabetes mellitus. J Clin Lipidol 2015; 10:350-5. [PMID: 27055966 DOI: 10.1016/j.jacl.2015.12.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2015] [Revised: 11/29/2015] [Accepted: 12/15/2015] [Indexed: 12/20/2022]
Abstract
BACKGROUND Insulin resistance, a key factor in the pathophysiology of gestational diabetes mellitus (GDM), is associated with an atherogenic lipid profile. Lipid metabolism is altered during normal pregnancy, but it is still unknown how the treatment of GDM affects lipoprotein concentrations. OBJECTIVE To evaluate maternal lipids at GDM diagnosis, after treatment, and in the puerperium and analyze the influence of BMI, insulin requirement, and glycemic control on lipoproteins. METHODS In this observational prospective study, total cholesterol (TC), HDL, and triglycerides (TG) were measured, and LDL was calculated at diagnosis (Dx), at 3-6 weeks after GDM treatment initiation (PI, post initiation) and 6-week postpartum (PP). Subgroups analyses were performed according to categories of maternal BMI, insulin requirement, and quality of glucose control. RESULTS TC and TG increased from Dx to PI and decreased in PP (TC: 213.6 mg/dL, 223.9 mg/dL, and 195.5 mg/dL; TG: 181.5 mg/dL, 203.5 mg/dL, and 100.5 mg/dL, at Dx, PI, and PP, respectively; P < .0001). HDL declined in the puerperium (Dx = 60 mg/dL, PI = 60.8 mg/dL, PP = 51.8 mg/dL; P < .0001 for Dx-PP and PI-PP, respectively). Insulin-treated patients showed an increase in LDL from Dx to PP, whereas LDL declined in the diet-only group (12 vs -11.1 mg/dL, P = .010). TC and TG increased from Dx to PI in patients with adequate glycemic control and decreased in the uncontrolled subgroup (TC: 15.5 vs -1.2 mg/dL, P = .041; TG: 29.7 vs -12.5 mg/dL, P = .07). No significant differences in lipids variation were observed according to BMI. CONCLUSIONS Insulin requirement and glycemic control status directly affected the variation of lipid profile in women with GDM.
Collapse
Affiliation(s)
| | - Melanie Rodacki
- Internal Medicine Department, Diabetes Section-Federal University of Rio de Janeiro, Brazil
| | | | - Lenita Zajdenverg
- Internal Medicine Department, Diabetes Section-Federal University of Rio de Janeiro, Brazil
| |
Collapse
|
43
|
Araujo DB, Skärstrand H, Barone B, Dantas JR, Kupfer R, Zajdenverg L, Milech A, Vaziri-Sani F, Oliveira JEPD, Rodacki M. Zinc transporter 8 autoantibodies in patients with type 1 diabetes from a multiethnic population and their first degree relatives. ACTA ACUST UNITED AC 2015; 58:737-43. [PMID: 25372583 DOI: 10.1590/0004-2730000003088] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2013] [Accepted: 06/29/2014] [Indexed: 02/08/2023]
Abstract
OBJECTIVE Zinc transporter 8 autoantibodies (ZnT8A) have been poorly studied in non-Caucasian individuals. We aimed to investigate the prevalence of ZnT8 autoantibodies in patients with T1D and their first degree relatives (FDR) from a multiethnic population, as well as its relation with the insulin (INS) or the protein tyrosine phosphatase non-receptor 22 (PTPN22) gene polymorphisms. SUBJECTS AND METHODS ZnT8A were analyzed in sera from T1D patients (n = 72, mean age of 30.3 ± 11.4 years) of variable duration (15.7 ± 11.8 years) and their FDR (n = 78, mean age of 18.3 ± 9.1 years) by a triple mix Radioligand Binding Assay (RBA) for the ZnT8 autoantibody (ZnT8-RWQ) variants. SNP (single nucleotide polymorphism) for INS and PTPN22 were genotyped. RESULTS The prevalence of ZnT8A was higher in T1D patients than FDR, for ZnT8TripleA (24% vs. 4%,p = 0.001), ZnT8RA (24% vs. 4%, p < 0.001) and ZnT8QA (15% vs. 3%, p = 0.004). All FDR with ZnT8A (n = 3) had at least another positive antibody. Heterozygosis for PTPN22 was associated with a higher frequency of ZnT8TripleA (p = 0.039) and ZnT8RA (p = 0.038). CONCLUSIONS ZnT8A is observed in non-Caucasian patients with T1D, even years after the disease onset, as well as in their FDR. In those, there was an overlap between ZnT8A and other T1D antibodies. ZnT8A was associated with PTPN22 polymorphisms. Further longitudinal studies are necessary to elucidate the importance of these findings in the natural history of T1D patients with multiethnic background.
Collapse
Affiliation(s)
- Débora Batista Araujo
- Department of Nutrology, Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| | | | - Bianca Barone
- Department of Nutrology, Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| | - Joana Rodrigues Dantas
- Department of Nutrology, Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| | - Rosane Kupfer
- Instituto Estadual de Diabetes e Endocrinologia Luiz Capriglione, Rio de Janeiro, RJ, Brazil
| | - Lenita Zajdenverg
- Department of Nutrology, Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| | - Adolpho Milech
- Department of Nutrology, Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| | - Fariba Vaziri-Sani
- Department of Nutrology, Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| | | | - Melanie Rodacki
- Department of Nutrology, Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| |
Collapse
|
44
|
Araujo DB, Barone B, Melleti NFT, Dantas JR, Oliveira MMDS, Zajdenverg L, Tortora RP, Vaisman M, Milech A, Oliveira JEPD, Rodacki M. Thyroid disorders are common in first-degree relatives of individuals with type 1 diabetes mellitus. Arch Endocrinol Metab 2015; 59:112-5. [PMID: 25993672 DOI: 10.1590/2359-3997000000022] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/31/2014] [Accepted: 12/11/2014] [Indexed: 11/22/2022]
Abstract
OBJECTIVE Thyroid diseases are common in individuals with type 1 diabetes mellitus (T1DM) and should be investigated annually in these individuals. The aim of this study was to evaluate the frequency of thyroid diseases in first degree relatives (FDR) of patients with T1DM. SUBJECTS AND METHODS Eighty individuals (40 patients with T1DM and 40 FDR) were interviewed and blood was sampled for thyroid-stimulating hormone (TSH), free thyroxine (FT4) and thyroid peroxidase (TPO) antibodies measurement. Autoantibodies against glutamic acid decarboxylase 65 (GAD65), islet antigen-2 (IA2) and autoantibodies against insulin (AAI) were measured in FDR. RESULTS We found a similar prevalence of thyroid dysfunction in patients with T1DM and their FDR (22.5% vs. 27.5%; p = 0,79). There were no differences in serum TSH levels (p = 0.29), FT4 (p = 0,45), frequency of abnormal TSH (p = 0.28), positive TPO antibodies (p = 0.13), titers of TPO antibodies (in positive cases) between patients with T1DM and their FDR (p = 0.94). CONCLUSIONS Thyroid abnormalities seem to be common not only in patients with T1DM but also in their FDR, which suggests that screening strategies for thyroid diseases might also be useful to these individuals.
Collapse
Affiliation(s)
- Débora Batista Araujo
- Department of Internal Medicine, Diabetes and Nutritional Diseases Section, Federal University of Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| | - Bianca Barone
- State Institute of Diabetes and Endocrinology Luiz Capriglione, Rio de Janeiro, RJ, Brazil
| | - Natasha Ferreira Teixeira Melleti
- Department of Internal Medicine, Diabetes and Nutritional Diseases Section, Federal University of Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| | - Joana Rodrigues Dantas
- Department of Internal Medicine, Diabetes and Nutritional Diseases Section, Federal University of Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| | - Marcus Miranda dos Santos Oliveira
- Department of Internal Medicine, Diabetes and Nutritional Diseases Section, Federal University of Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| | - Lenita Zajdenverg
- Department of Internal Medicine, Diabetes and Nutritional Diseases Section, Federal University of Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| | | | - Mario Vaisman
- Department of Internal Medicine, Endocrinology Section, UFRJ, Rio de Janeiro, RJ, Brazil
| | - Adolpho Milech
- Department of Internal Medicine, Diabetes and Nutritional Diseases Section, Federal University of Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| | - José Egídio Paulo de Oliveira
- Department of Internal Medicine, Diabetes and Nutritional Diseases Section, Federal University of Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| | - Melanie Rodacki
- Department of Internal Medicine, Diabetes and Nutritional Diseases Section, Federal University of Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| |
Collapse
|
45
|
Felício JS, de Souza ACCB, Koury CC, Neto JFA, Miléo KB, Santos FM, Motta ARB, Silva DD, Arbage TP, Carvalho CT, de Rider Brito HA, Yamada ES, Cobas RA, Matheus A, Tannus L, Palma CCS, Japiassu L, Carneiro JRI, Rodacki M, Zajdenverg L, de Araújo NBC, de Menezes Cordeiro M, Luescher JL, Berardo RS, Nery M, Cani C, do Carmo Arruda Marques M, Calliari LE, de Noronha RM, Manna TD, Savoldelli R, Penha FG, Foss MC, Foss-Freitas MC, Pires AC, Robles FC, Negrato CA, de Fatima Guedes M, Dib SA, Dualib P, da Silva SC, Sepúlveda J, Sampaio E, Rea RR, de Almeida Faria ACR, Tschiedel B, Lavigne S, Cardozo GA, Azevedo M, Canani LH, Zucatti AT, Coral MHC, Pereira DA, de Araujo LA, Pedrosa HC, Tolentino M, Prado FA, Rassi N, de Araujo LB, Fonseca RMC, Guedes AD, de Mattos OS, Faria M, Azulay R, e Forti AC, Façanha CFS, Junior RM, Montenegro AP, Melo NH, Rezende KF, Ramos A, Jezini DL, Gomes MB. Health-related quality of life in patients with type 1 diabetes mellitus in the different geographical regions of Brazil: data from the Brazilian Type 1 Diabetes Study Group. Diabetol Metab Syndr 2015; 7:87. [PMID: 26448787 PMCID: PMC4596564 DOI: 10.1186/s13098-015-0081-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2015] [Accepted: 09/28/2015] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND In type 1 diabetes mellitus (T1DM) management, enhancing health-related quality of life (HRQoL) is as important as good metabolic control and prevention of secondary complications. This study aims to evaluate possible regional differences in HRQoL, demographic features and clinical characteristics of patients with T1DM in Brazil, a country of continental proportions, as well as investigate which variables could influence the HRQoL of these individuals and contribute to these regional disparities. METHODS This was a retrospective, cross-sectional, multicenter study performed by the Brazilian Type 1 Diabetes Study Group (BrazDiab1SG), by analyzing EuroQol scores from 3005 participants with T1DM, in 28 public clinics, among all geographical regions of Brazil. Data on demography, economic status, chronic complications, glycemic control and lipid profile were also collected. RESULTS We have found that the North-Northeast region presents a higher index in the assessment of the overall health status (EQ-VAS) compared to the Southeast (74.6 ± 30 and 70.4 ± 19, respectively; p < 0.05). In addition, North-Northeast presented a lower frequency of self-reported anxiety-depression compared to all regions of the country (North-Northeast: 1.53 ± 0.6; Southeast: 1.65 ± 0.7; South: 1.72 ± 0.7; Midwest: 1.67 ± 0.7; p < 0.05). These findings could not be entirely explained by the HbA1c levels or the other variables examined. CONCLUSIONS Our study points to the existence of additional factors not yet evaluated that could be determinant in the HRQoL of people with T1DM and contribute to these regional disparities.
Collapse
Affiliation(s)
- João Soares Felício
- />Endocrinology Division, University Hospital João de Barros Barreto, Federal University of Pará, Mundurucus Street, 4487, Guamá, Belém, Pará 66073-000 Brazil
| | - Ana Carolina Contente Braga de Souza
- />Endocrinology Division, University Hospital João de Barros Barreto, Federal University of Pará, Mundurucus Street, 4487, Guamá, Belém, Pará 66073-000 Brazil
| | - Camila Cavalcante Koury
- />Endocrinology Division, University Hospital João de Barros Barreto, Federal University of Pará, Mundurucus Street, 4487, Guamá, Belém, Pará 66073-000 Brazil
| | - João Felício Abrahão Neto
- />Endocrinology Division, University Hospital João de Barros Barreto, Federal University of Pará, Mundurucus Street, 4487, Guamá, Belém, Pará 66073-000 Brazil
| | - Karem Barbosa Miléo
- />Endocrinology Division, University Hospital João de Barros Barreto, Federal University of Pará, Mundurucus Street, 4487, Guamá, Belém, Pará 66073-000 Brazil
| | - Flávia Marques Santos
- />Endocrinology Division, University Hospital João de Barros Barreto, Federal University of Pará, Mundurucus Street, 4487, Guamá, Belém, Pará 66073-000 Brazil
| | - Ana Regina Bastos Motta
- />Endocrinology Division, University Hospital João de Barros Barreto, Federal University of Pará, Mundurucus Street, 4487, Guamá, Belém, Pará 66073-000 Brazil
| | - Denisson Dias Silva
- />Endocrinology Division, University Hospital João de Barros Barreto, Federal University of Pará, Mundurucus Street, 4487, Guamá, Belém, Pará 66073-000 Brazil
| | - Thaís Pontes Arbage
- />Endocrinology Division, University Hospital João de Barros Barreto, Federal University of Pará, Mundurucus Street, 4487, Guamá, Belém, Pará 66073-000 Brazil
| | - Carolina Tavares Carvalho
- />Endocrinology Division, University Hospital João de Barros Barreto, Federal University of Pará, Mundurucus Street, 4487, Guamá, Belém, Pará 66073-000 Brazil
| | - Hana Andrade de Rider Brito
- />Endocrinology Division, University Hospital João de Barros Barreto, Federal University of Pará, Mundurucus Street, 4487, Guamá, Belém, Pará 66073-000 Brazil
| | - Elizabeth Sumi Yamada
- />Endocrinology Division, University Hospital João de Barros Barreto, Federal University of Pará, Mundurucus Street, 4487, Guamá, Belém, Pará 66073-000 Brazil
| | - Roberta Arnoldi Cobas
- />Diabetes Unit, Department of Internal Medicine, State University of Rio de Janeiro, Rio De Janeiro, Brazil
| | - Alessandra Matheus
- />Diabetes Unit, Department of Internal Medicine, State University of Rio de Janeiro, Rio De Janeiro, Brazil
| | - Lucianne Tannus
- />Diabetes Unit, Department of Internal Medicine, State University of Rio de Janeiro, Rio De Janeiro, Brazil
| | - Catia Cristina Sousa Palma
- />Diabetes Unit, Department of Internal Medicine, State University of Rio de Janeiro, Rio De Janeiro, Brazil
| | - Leticia Japiassu
- />Diabetes Unit, Department of Internal Medicine, State University of Rio de Janeiro, Rio De Janeiro, Brazil
| | - João Regis Ivar Carneiro
- />Diabetes Unit, Department of Internal Medicine, State University of Rio de Janeiro, Rio De Janeiro, Brazil
| | - Melanie Rodacki
- />Federal University Hospital of Rio de Janeiro, Rio De Janeiro, Brazil
| | - Lenita Zajdenverg
- />Federal University Hospital of Rio de Janeiro, Rio De Janeiro, Brazil
| | | | | | - Jorge Luiz Luescher
- />University Hospital Clementino Fraga Filho, Children Institute Martagão Teixeira, Rio De Janeiro, Brazil
| | - Renata Szundy Berardo
- />University Hospital Clementino Fraga Filho, Children Institute Martagão Teixeira, Rio De Janeiro, Brazil
| | - Marcia Nery
- />Diabetes Unit, University Hospital of São Paulo, São Paulo, Brazil
| | - Catarina Cani
- />Diabetes Unit, University Hospital of São Paulo, São Paulo, Brazil
| | | | | | | | - Thais Della Manna
- />Children Institute of Endocrinology, University Hospital of São Paulo, São Paulo, Brazil
| | - Roberta Savoldelli
- />Children Institute of Endocrinology, University Hospital of São Paulo, São Paulo, Brazil
| | - Fernanda Garcia Penha
- />Children Institute of Endocrinology, University Hospital of São Paulo, São Paulo, Brazil
| | - Milton Cesar Foss
- />Ribeirão Preto Medical School of São Paulo University, Ribeirão Preto, Brazil
| | | | - Antonio Carlos Pires
- />Department of Internal Medicine, Medical School, State University of São José do Rio Preto, São José Do Rio Preto, Brazil
| | - Fernando Cesar Robles
- />Department of Internal Medicine, Medical School, State University of São José do Rio Preto, São José Do Rio Preto, Brazil
| | | | | | - Sergio Atala Dib
- />Diabetes Unit, Federal University of São Paulo State, São Paulo, Brazil
| | - Patricia Dualib
- />Diabetes Unit, Federal University of São Paulo State, São Paulo, Brazil
| | | | - Janice Sepúlveda
- />Endocrinology Unit, Hospital of Santa Casa of Belo Horizonte, Belo Horizonte, Minas Gerais Brazil
| | - Emerson Sampaio
- />Diabetes Unit, State University Hospital of Londrina, Paraná, Brazil
| | | | | | - Balduino Tschiedel
- />Institute of Diabetic Children, Porto Alegre, Rio Grande do Sul Brazil
| | - Suzana Lavigne
- />Institute of Diabetic Children, Porto Alegre, Rio Grande do Sul Brazil
| | | | - Mirela Azevedo
- />Clinical Hospital of Porto Alegre, Porto Alegre, Rio Grande do Sul Brazil
| | | | | | | | | | | | | | | | | | | | | | | | | | | | - Manuel Faria
- />Federal University of Maranhão, São Luís, Maranhão Brazil
| | - Rossana Azulay
- />Federal University of Maranhão, São Luís, Maranhão Brazil
| | | | | | | | | | | | | | - Alberto Ramos
- />Federal University Hospital of Campina Grande, Campina Grande, Paraíba Brazil
| | - Deborah Laredo Jezini
- />Getúlio Vargas University Hospital of Amazonas, Adriano Jorge Hospital, Manaus, Amazonas Brazil
| | - Marilia Brito Gomes
- />Diabetes Unit, Department of Internal Medicine, State University of Rio de Janeiro, Rio De Janeiro, Brazil
| | | |
Collapse
|
46
|
Oliveira RA, Tostes M, Queiroz VA, Rodacki M, Zajdenverg L. Insulin mediated improvement in glycemic control in elderly with type 2 diabetes mellitus can improve depressive symptoms and does not seem to impair health-related quality of life. Diabetol Metab Syndr 2015; 7:55. [PMID: 26110026 PMCID: PMC4478689 DOI: 10.1186/s13098-015-0052-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2014] [Accepted: 06/16/2015] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Type 2 diabetes (T2D) is very prevalent among the elderly. Insulin therapy is often required for glycemic control. The association of starting this therapy with depressive symptoms as well the health-related quality of life (HRQoL) is unknown among the elderly patients. AIMS Evaluate the association of starting insulin therapy depressive symptoms as well with HRQoL of elderly people with T2D. METHODS 36 T2D participants (67.9 % females, age 66.5 years ± 5.1) were recruited, 26 of whom completed the follow-up. Generic (Short-Form 36 Health Survey - SF-36) and specific (Problem Areas in Diabetes - PAID) HRQoL questionnaires, Beck Depression Inventory (BDI), clinical, laboratorial and socio-demographic data were recorded on baseline and 6 months after the beginning of insulin treatment. RESULTS There was a reduction in the BDI score after the use of insulin, which means an improvement in depressive symptoms (Before/After: median - 10.5 / 7; p = 0008). There were no statistically significant differences in HRQoL scores between the two time periods There was also a reduction in HbA1c (Before/After: median - 8.7/7.9). Otherwise, there were no statistically significant differences in: BMI (28.1/28.3); Abdominal circumference:(100.5/99.5) and chronic complications status. CONCLUSION Insulin therapy in elderly people with type 2 diabetes can lead to an improvement of depressive symptoms and does not seem to affect negatively HRQoL of the participants.
Collapse
Affiliation(s)
- R. A. Oliveira
- Nutrology and Diabetes Section, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - M. Tostes
- Nutrology and Diabetes Section, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - V. A. Queiroz
- Nutrology and Diabetes Section, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - M. Rodacki
- Nutrology and Diabetes Section, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - L. Zajdenverg
- Nutrology and Diabetes Section, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| |
Collapse
|
47
|
Valerio CM, Zajdenverg L, de Oliveira JEP, Mory PB, Moises RS, Godoy-Matos AF. Erratum: Body composition study by dual-energy x-ray absorptiometry in familial partial lipodystrophy: finding new tools for an objective evaluation. Diabetol Metab Syndr 2015; 7:19. [PMID: 25774228 PMCID: PMC4359429 DOI: 10.1186/s13098-015-0007-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2015] [Accepted: 02/10/2015] [Indexed: 11/26/2022] Open
Abstract
[This corrects the article DOI: 10.1186/1758-5996-4-40.].
Collapse
Affiliation(s)
- Cynthia M Valerio
- />Metabolism Unit, Instituto Estadual de Diabetes e Endocrinologia, Rio de Janeiro and Catholic University, Rio de Janeiro, Brazil
- />Instituto Estadual de Diabetes e Endocrinologia, Rua Moncorvo Filho 90 – Centro, Rio de Janeiro, RJ CEP 20211-340 Brasil
| | - Lenita Zajdenverg
- />Department of Nutrology, Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ Brazil
| | | | - Patricia B Mory
- />Division of Endocrinology, Universidade Federal de Sao Paulo, São Paulo, SP Brazil
| | - Regina S Moises
- />Division of Endocrinology, Universidade Federal de Sao Paulo, São Paulo, SP Brazil
| | - Amélio F Godoy-Matos
- />Metabolism Unit, Instituto Estadual de Diabetes e Endocrinologia, Rio de Janeiro and Catholic University, Rio de Janeiro, Brazil
| |
Collapse
|
48
|
Araujo de Pina Cabral D, Dantas J, Skärstrand H, Barone B, Carvalho F, Tortora R, Milech A, Vaziri-Sani F, Oliveira JP, Zajdenverg L, Rodacki M. Prospective evaluation of glutamine and phospholipids levels in first degree relatives of patients with Type 1 Diabetes from a multiethnic population. Diabetol Metab Syndr 2015; 7:52. [PMID: 26082806 PMCID: PMC4469243 DOI: 10.1186/s13098-015-0048-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2015] [Accepted: 05/29/2015] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND A dysregulation in the metabolism of lipids may be an early marker of autoimmunity in Type 1 Diabetes (T1D). It would be of general importance to identify metabolic patterns that would predict the risk for T1D later in life. The aim of this study was to perform a prospective evaluation of glutamine and phospholipids levels in Brazilian first degree relatives (FDR) of patients with T1D in a mean interval of 5 years. FINDINGS Brazilian FDR (n = 30) of patients with T1D were evaluated and blood was sampled to measure the levels of glutamine and phospholipids in the fasting serum by quantitative colorimetric method. The tests were repeated after a mean interval of 5 years and compared to a control group (n = 20). The FDR presented lower levels of phospholipids than controls (p = 0.028), but not of glutamine (p = 0.075). Phospholipids levels decreased over time (p = 0.028) in FDR and were associated with Glutamic acid decarboxylase autoantibody (GADA) titers (p = 0.045), autoantibody positivity (p = 0.008) and PTPN22 polymorphisms (p = 0.014). CONCLUSIONS In this Brazilian multiethnic population, there was a significant decrease in phospholipids levels in FDR in patients with T1D during a 5-year prospective follow-up, as well as a significant association between these metabolite, GADA and PTPN22 polymorphisms. For Glutamine no difference was found. These findings suggest that a dysregulation in the metabolism of lipids may precede the onset of the autoimmunity in T1D.
Collapse
Affiliation(s)
- D.B. Araujo de Pina Cabral
- />Department of Nutrology, Federal University of Rio de Janeiro, Avenida Epitácio Pessoa, número 2.990, apto 806, Lagoa, Rio de Janeiro Brazil
| | - J.R. Dantas
- />Department of Nutrology, Federal University of Rio de Janeiro, Avenida Epitácio Pessoa, número 2.990, apto 806, Lagoa, Rio de Janeiro Brazil
| | - H. Skärstrand
- />Department of Clinical Sciences, Lund University, Skåne University Hospital (SUS), Malmö, Sweden
| | - B. Barone
- />Department of Nutrology, Federal University of Rio de Janeiro, Avenida Epitácio Pessoa, número 2.990, apto 806, Lagoa, Rio de Janeiro Brazil
| | - F. Carvalho
- />Biochemistry Laboratory, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - R. Tortora
- />Biochemistry Laboratory, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - A. Milech
- />Department of Nutrology, Federal University of Rio de Janeiro, Avenida Epitácio Pessoa, número 2.990, apto 806, Lagoa, Rio de Janeiro Brazil
| | - F. Vaziri-Sani
- />Department of Clinical Sciences, Lund University, Skåne University Hospital (SUS), Malmö, Sweden
| | - J.E. P. Oliveira
- />Department of Nutrology, Federal University of Rio de Janeiro, Avenida Epitácio Pessoa, número 2.990, apto 806, Lagoa, Rio de Janeiro Brazil
| | - L. Zajdenverg
- />Department of Nutrology, Federal University of Rio de Janeiro, Avenida Epitácio Pessoa, número 2.990, apto 806, Lagoa, Rio de Janeiro Brazil
| | - M. Rodacki
- />Department of Nutrology, Federal University of Rio de Janeiro, Avenida Epitácio Pessoa, número 2.990, apto 806, Lagoa, Rio de Janeiro Brazil
| |
Collapse
|
49
|
Seabra G, Saunders C, de Carvalho Padilha P, Zajdenverg L, da Silva LBG, de Souza Santos MMA. Association between maternal glucose levels during pregnancy and gestational diabetes mellitus: an analytical cross-sectional study. Diabetol Metab Syndr 2015; 7:17. [PMID: 25774227 PMCID: PMC4358904 DOI: 10.1186/s13098-015-0013-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2014] [Accepted: 02/20/2015] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND To evaluate the association between fasting glucose levels in women throughout pregnancy and the occurrence of gestational diabetes mellitus (GDM) and other pregnancy complications, macrosomia, and cesarean delivery. METHODS An analytical cross-sectional study with 829 healthy pregnant women receiving health care at a public maternity unit in Rio de Janeiro between 1999 and 2008. The dependent variables assessed in the study were: GDM (was confirmed when two or more values were above the glucose curve using 100 g glucose), complications, mode of delivery and birth weight. Macrosomia was defined as a birth weight of >4000 g. The independent variables assessed were: maternal fasting glucose per trimester as a continuous variable, divided into three categories, socio-demographic data on the mothers. The level of statistical significance was set at 5%. RESULTS The mean fasting glucose levels of the women who had GDM were higher in the second trimester than for those who had no pregnancy complications (90.5 mg/dL vs. 78.5 mg/dL, p = 0.000). Higher mean fasting glucose levels were also found in the third trimester for women who developed GDM than for those with no pregnancy complications (90 mg/dL vs. 77.8 mg/dL, p = 0.016). Women who had a cesarean delivery had higher fasting glucose levels in the second (80.4 mg/dL vs. 78 mg/dL, post hoc = 0.034) and third (80.4 mg/dL and 77.1 mg/dL; post hoc = 0.005) trimesters than women who had a normal delivery. Also, higher fasting glucose levels were found in the second semester for women whose infants had macrosomia than for women whose newborns were normal weight (86.2 mg/dL and 78.8 mg/dL; post hoc = 0.003). The chance of develop GDM was higher for the women with glucose levels in the 90-94 mg/dL range in the second trimester (OR = 7.2; 95% CI = 2.33-22.24) than for the women whose glucose levels were in the <80 mg/dL and 80-90 mg/dL ranges. CONCLUSION Second and third trimester fasting glucose levels below the cut-off values for the diagnosis of GDM are associated with an increased risk of pregnancy complications. The dependent variables assessed in the study were: GDM (present/absent), complications, mode of delivery (normal, forceps, cesarean), and birth weight.
Collapse
Affiliation(s)
- Gisele Seabra
- />Universidade Federal do Rio de Janeiro (UFRJ) – Centro de Ciências da Saúde, Instituto de Nutrição Josué de Castro, Cidade Universitária, Av. Carlos Chagas Filho, 373, bl. J, 2°. andar, Rio de Janeiro, CEP. 21941.590 RJ Brasil
- />Maternidade Escola (UFRJ), Rio de Janeiro, RJ Brasil
| | - Cláudia Saunders
- />Universidade Federal do Rio de Janeiro (UFRJ) – Centro de Ciências da Saúde, Instituto de Nutrição Josué de Castro, Cidade Universitária, Av. Carlos Chagas Filho, 373, bl. J, 2°. andar, Rio de Janeiro, CEP. 21941.590 RJ Brasil
- />Maternidade Escola (UFRJ), Rio de Janeiro, RJ Brasil
| | - Patrícia de Carvalho Padilha
- />Universidade Federal do Rio de Janeiro (UFRJ) – Centro de Ciências da Saúde, Instituto de Nutrição Josué de Castro, Cidade Universitária, Av. Carlos Chagas Filho, 373, bl. J, 2°. andar, Rio de Janeiro, CEP. 21941.590 RJ Brasil
- />Maternidade Escola (UFRJ), Rio de Janeiro, RJ Brasil
| | - Lenita Zajdenverg
- />Maternidade Escola (UFRJ), Rio de Janeiro, RJ Brasil
- />Serviço de Nutrologia/Departamento de Clínica Médica e Maternidade Escola, Rio de Janeiro, Brasil
| | - Letícia Barbosa Gabriel da Silva
- />Universidade Federal do Rio de Janeiro (UFRJ) – Centro de Ciências da Saúde, Instituto de Nutrição Josué de Castro, Cidade Universitária, Av. Carlos Chagas Filho, 373, bl. J, 2°. andar, Rio de Janeiro, CEP. 21941.590 RJ Brasil
- />Maternidade Escola (UFRJ), Rio de Janeiro, RJ Brasil
| | - Marta Maria Antonieta de Souza Santos
- />Universidade Federal do Rio de Janeiro (UFRJ) – Centro de Ciências da Saúde, Instituto de Nutrição Josué de Castro, Cidade Universitária, Av. Carlos Chagas Filho, 373, bl. J, 2°. andar, Rio de Janeiro, CEP. 21941.590 RJ Brasil
| |
Collapse
|
50
|
Rodacki M, Zajdenverg L, Dantas JR, de Oliveira JEP, Luiz RR, Cobas RA, Palma CCS, Negrato CA, Gomes MB. Should thyroid-stimulating hormone goals be reviewed in patients with type 1 diabetes mellitus? Results from the Brazilian Type 1 Diabetes Study Group. Diabet Med 2014; 31:1665-72. [PMID: 24961827 DOI: 10.1111/dme.12530] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2013] [Revised: 04/15/2014] [Accepted: 06/20/2014] [Indexed: 12/19/2022]
Abstract
AIMS To investigate if thyroid-stimulating hormone (TSH) levels are associated with any differences in glycaemic control or diabetes-related complications in individuals with Type 1 diabetes. METHODS This observational, cross-sectional and multicentre study included patients with Type 1 diabetes for ≥ 5 years, with a recent TSH measurement and without a known previous thyroid disease. Patients were divided into three groups according to TSH levels: 0.4-2.5 mU/l; 2.5-4.4 mU/l; and ≥ 4.5 mU/l. RESULTS We included 1205 individuals with a mean ± sd age of 23.8 ± 11.3 years. Seven patients had TSH levels <0.4 mU/l and were excluded from the comparison between groups. HbA1c levels, systolic and diastolic blood pressure, LDL cholesterol and disease duration were similar in all groups (P = 0.893, P = 0.548, P = 0.461, P = 0.575 and P = 0.764, respectively). The rates of diabetic retinopathy and GFR < 60/mL/min/1.73 m(2) differed between groups (P = 0.006 and P < 0.001, respectively) and were lower in those with lower TSH levels. Multivariate analysis confirmed these associations. The frequencies of retinopathy and GFR < 60 mL/min/1.73 m(2) were higher not only in patients with TSH ≥ 4.5 mU/l (odds ratio 1.878 and 2.271, respectively) but also in those with TSH levels of 2.5-4.4 mU/l (odds ratio 1.493 and 2.286, respectively), when compared with patients with TSH levels of 0.4-2.5 mU/l. CONCLUSIONS TSH levels of 0.4-2.5 mU/l are associated with a lower risk of diabetic retinopathy and renal failure in individuals with Type 1 diabetes, independently of glycaemic control and duration of the disease.
Collapse
Affiliation(s)
- M Rodacki
- Diabetes and Nutrition Section, Department of Internal Medicine, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | | | | | | | | | | | | | | | | |
Collapse
|