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Gomes M.B.,State University of Rio de Janeiro | Negrato C.A.,Baurus Diabetics Association
Diabetes Research and Clinical Practice | Year: 2016

Aims Determine the relationship between self-reported adherence to insulin therapeutic regimens in Brazilian patients with type 1 diabetes and demographic, clinical data, glycemic control and cardiovascular risk factors. Methods This was a cross-sectional, multicenter study conducted between August 2011 and August 2014 in 10 Brazilian cities. Data were obtained from 1698 patients, aged 30.0 ± 11.90 years (55.5% females, 53.6% Caucasians) with a diabetes duration of 15.4 ± 1.9 years. Adherence was evaluated using an adapted 4-item Morisky Medication Scale (MMAS) questionnaire. Results A total of 166 (9.8%), 717 (42.2%) and 815 (48.0%) of the patients reported maximal (group 0), moderate (group 1) and minimal (group 2) adherence to their insulin therapeutic regimen, respectively. A significant difference in HbA1c was observed in patients from group 2, 9.2 ± 2.2% (77 ± 25 mmol/mol) compared to group 1, 8.9 ± 2.0% (74 ± 22 mmol/mol) and group 0, 8.6 ± 1.9% (71 ± 21 mmol/mol) (p = 0.003). A multivariate logistic analysis revealed that the significant independent variables related to higher insulin therapeutic regimen adherence were older age, higher adherence to diet, lower rate of self-reported hypoglycemia in the last month, low economic status and living in the Southeast region. Insulin therapeutic regimens, number of daily insulin injections, self-monitoring of blood glucose, gender, ethnicity and cardiovascular risk factors were not related to adherence. Conclusions Most Brazilian T1D patients did not adhere to their prescribed insulin therapeutic regimen, according to the MMAS 4-item scale. This tool should be initially used to identify non-adherent patients and help them overcome the barriers to adherence to their prescriptions. © 2016 Elsevier Ireland Ltd


Negrato C.A.,Baurus Diabetics Association | Mattar R.,Federal University of São Paulo | Gomes M.B.,State University of Rio de Janeiro
Diabetology and Metabolic Syndrome | Year: 2012

Pregnancy affects both the maternal and fetal metabolism and even in nondiabetic women exerts a diabetogenic effect. Among pregnant women, 2 to 17.8% develop gestational diabetes. Pregnancy can also occur in women with preexisting diabetes, that can predispose the fetus to many alterations in organogenesis, growth restriction and the mother to some diabetes-related complications like retinopathy and nephropathy or accelerate the course of these complications if they are already present. Women with gestational diabetes generally start their treatment with diet and lifestyle modification; when these changes fail in keeping an optimal glycemic control, then insulin therapy must be considered. Women with type 2 diabetes in use of oral hypoglycemic agents are advised to change to insulin therapy. Those with preexisting type 1 diabetes must start an intensive glycemic control, preferably before conception. All these procedures are performed aiming to keep glycemic levels normal or near-normal as possible to avoid the occurrence of adverse perinatal outcomes to the mother and to the fetus. The aim of this review is to reinforce the need to improve the knowledge on reproductive health of women with diabetes during gestation and to understand what are the reasons for them failing to attend for prepregnancy care programs, and to understand the underlying mechanisms of adverse fetal and maternal outcomes, which in turn may lead to strategies for its prevention. © 2012 Negrato et al.; licensee BioMed Central Ltd.


Gomes M.B.,State University of Rio de Janeiro | Negrato C.A.,Baurus Diabetics Association
BMC Public Health | Year: 2015

Background: There is scarcity of data concerning retirement and workforce loss exclusively in patients with type 1 diabetes. The aim of this study was to evaluate the prevalence, causes, and predictors of retirement in patients with type 1 diabetes in Brazil. Methods: This was a multicenter cross-sectional study conducted between December 2008 and December 2010 in 28 public clinics in 20 Brazilian cities. Data were obtained from 3,180 patients aged 22 ± 11.7 years; 56.3% of the participants were female, and 57.4% were Caucasians. The mean time since diabetes diagnosis was 10.3 ± 8.1 years. Patients' information (clinical factors and retirement data) was obtained through a questionnaire and a chart review. Patients were retired by diabetes according to the Brazilian Institute of Social Security's criteria that takes in account the presence of diabetes-related chronic complications certified by a doctor, excluding any personal reason or another health condition besides diabetes. Both quantitative and qualitative tests were employed, and a multivariate logistic regression model was performed to identify the factors associated with retirement due to disabilities in patients with type 1 diabetes. Results: The overall frequency of retirement was 4.2%, with no difference between genders. The mean age of retirement was 35.5 ± 9.3 years, resulting in 17.5 ± 9.1 years of workforce losses. These patients had a significantly higher prevalence of severe hypoglycemia, proliferative and non-proliferative retinopathy, foot disorders, chronic or end-stage renal disease requiring dialysis or transplantation, cataracts, glaucoma, psychological disorders, hypertension, and overweight/obesity than did the employed patients. Multivariate logistic regression analysis with retirement as the dependent variable showed adjusted odds ratios (ORs) of 4.87 (2.66-8.78) for the presence of microvascular complications and 3.7 (2.04-6.70) for macrovascular complications. Conclusions: Retirement due to disabilities occurred in 4.2% of Brazilian patients with type 1 diabetes at an early age and is strongly associated with diabetes-related chronic complications. Health care workers should thus reevaluate the quality of care given to these patients. © 2015 Gomes and Negrato; licensee BioMed Central.


Negrato C.A.,Baurus Diabetics Association | Cobas R.A.,State University of Rio de Janeiro | Gomes M.B.,State University of Rio de Janeiro
Diabetic Medicine | Year: 2012

Aims To examine the temporal trends in the frequency of diabetic ketoacidosis at onset compared to other modalities of diagnosis of Type 1 diabetes in Brazil. Methods This was a retrospective, cross-sectional and multicenter study conducted between December 2008 and December 2010 in 28 public clinics at secondary and tertiary levels of care, located in 20 cities in four geographic regions of Brazil. Each clinic provided data extracted from at least 50 outpatients withType 1 diabetes diagnosed between 1960 and 2010, using standardized chart review forms. Data were obtained from 3591 patients (56.0% females, 57.1% Caucasians). Median values (range) for age, age at diagnosis and duration of diabetes were, respectively, 19years (1-66years), 10years (<1-44years) and 7years (<1-50years). Logistic regression was performed with diabetic ketoacidosis (Yes/No) as the dependent variable and other clinical features as independent variables. Results Type 1 diabetes diagnosis was made by diabetic ketoacidosis in 1,520 (42.3%), by fasting plasma glucose in 1413 (39.4%), by random blood glucose in 516 (14.4%), by oral glucose tolerance test in 66 (1.8%) and by other methods in 76 (2.1%) cases, respectively. Diagnosis made before the year 2000 had a greater odds to occur by diabetic ketoacidosis (Odds ratio 1.26, 95% confidence intervals (CI) 1.09-1.48). Since then, a decrease has occurred. Economic status, geographic region and age were significantly related to diabetic ketoacidosis at diagnosis. Conclusions Although high prevalence of diabetic ketoacidosis at diagnosis of Type 1 diabetes in Brazil is observed, recently, more patients have been diagnosed by other methods. © 2012 Diabetes UK.


Gomes M.B.,State University of Rio de Janeiro | Negrato C.A.,Baurus Diabetics Association
Diabetology and Metabolic Syndrome | Year: 2014

Alpha-lipoic acid is a naturally occurring substance, essential for the function of different enzymes that take part in mitochondria's oxidative metabolism. It is believed that alpha-lipoic acid or its reduced form, dihydrolipoic acid have many biochemical functions acting as biological antioxidants, as metal chelators, reducers of the oxidized forms of other antioxidant agents such as vitamin C and E, and modulator of the signaling transduction of several pathways. These above-mentioned actions have been shown in experimental studies emphasizing the use of alpha-lipoic acid as a potential therapeutic agent for many chronic diseases with great epidemiological as well economic and social impact such as brain diseases and cognitive dysfunctions like Alzheimer disease, obesity, nonalcoholic fatty liver disease, burning mouth syndrome, cardiovascular disease, hypertension, some types of cancer, glaucoma and osteoporosis. Many conflicting data have been found concerning the clinical use of alpha-lipoic acid in the treatment of diabetes and of diabetes-related chronic complications such as retinopathy, nephropathy, neuropathy, wound healing and diabetic cardiovascular autonomic neuropathy. The most frequent clinical condition in which alpha-lipoic acid has been studied was in the management of diabetic peripheral neuropathy in patients with type 1 as well type 2 diabetes. Considering that oxidative stress, a imbalance between pro and antioxidants with excessive production of reactive oxygen species, is a factor in the development of many diseases and that alpha-lipoic acid, a natural thiol antioxidant, has been shown to have beneficial effects on oxidative stress parameters in various tissues we wrote this article in order to make an up-to-date review of current thinking regarding alpha-lipoic acid and its use as an antioxidant drug therapy for a myriad of diseases that could have potential benefits from its use. © 2014 Gomes and Negrato; licensee BioMed Central Ltd.


Matheus A.S.D.M.,State University of Rio de Janeiro | Tannus L.R.M.,State University of Rio de Janeiro | Cobas R.A.,State University of Rio de Janeiro | Palma C.C.S.,State University of Rio de Janeiro | And 2 more authors.
International Journal of Hypertension | Year: 2013

Cardiovascular diseases are the most prevalent cause of morbidity and mortality among patients with type 1 or type 2 diabetes. The proposed mechanisms that can link accelerated atherosclerosis and increased cardiovascular risk in this population are poorly understood. It has been suggested that an association between hyperglycemia and intracellular metabolic changes can result in oxidative stress, low-grade inflammation, and endothelial dysfunction. Recently, epigenetic factors by different types of reactions are known to be responsible for the interaction between genes and environment and for this reason can also account for the association between diabetes and cardiovascular disease. The impact of clinical factors that may coexist with diabetes such as obesity, dyslipidemia, and hypertension are also discussed. Furthermore, evidence that justify screening for subclinical atherosclerosis in asymptomatic patients is controversial and is also matter of this review. The purpose of this paper is to describe the association between poor glycemic control, oxidative stress, markers of insulin resistance, and of low-grade inflammation that have been suggested as putative factors linking diabetes and cardiovascular disease. © 2013 Alessandra Saldanha de Mattos Matheus et al.


Negrato C.A.,Baurus Diabetics Association | Gomes M.B.,State University of Rio de Janeiro
Diabetology and Metabolic Syndrome | Year: 2013

Diabetes is the most common metabolic disorder affecting pregnancy. Its prevalence seems to be growing in parallel with the epidemics of overweight and obesity. Recognizing and treating diabetes or any degree of glucose intolerance in pregnancy results in lowering maternal and fetal complications. These patients present higher risk for excessive weight gain, preeclampsia, cesarean sections, a high risk of developing type 2 diabetes and cardiovascular disease in the future. Infants born to these mothers are at higher risk for macrosomia and birth trauma, and after delivery, these infants have a higher risk of developing hypoglycemia, hypocalcemia, hyperbilirubinemia, respiratory distress syndrome, polycythemia and subsequent obesity and type 2 diabetes. Despite several international workshops and a lot of research there is still no unique approach to diagnose and treat diabetes in pregnancy. Who, when and how to screen and diagnose diabetes in pregnancy has been debated in the literature for so many decades and this debate seems to be endless. We present the evolution that screening and diagnosing diabetes in pregnancy has had over time. Besides many evidence of the benefits these procedures bring, health care providers still often prefer to use alternate criteria for this purpose. The myriad of maternal and fetal complications that could be avoided with an appropriate and simple screening procedure are ignored. Robust clinical trials such as the Hyperglycemia and Adverse Pregnancy Outcomes (HAPO) study have shown how harmful can even slightly altered blood glucose levels be, but it has been found a resistance in the adoption of the new criteria proposed after this and other trials by many diabetes organizations. These organizations state that these new criteria would increase the incidence of diabetes in pregnancy, would imply in longer term follow-up of these patients and would pose an economic problem; they also state that alerting too many people in order to benefit a relatively few potential diabetics would arise psychologic ill-effects. We think that health care providers should look for an uniformity in the screening and diagnosing diabetes in pregnancy based on evidence based medicine and not on specialists consensus. © 2013 Negrato and Gomes; licensee BioMed Central Ltd.


Negrato C.A.,Baurus Diabetics Association | Gomes M.B.,State University of Rio de Janeiro
Diabetology and Metabolic Syndrome | Year: 2013

During our phylogenetic evolution we have selected genes, the so called thrifty genes, that can help to maximize the amount of energy stored from every consumed calorie. An imbalance in the amount of stored calories can lead to many diseases. In the early 80's the distinguished English epidemiologist David Barker, formulated a hypothesis suggesting that many events that occur during the intrauterine life and early in infancy can influence the occurrence of many diseases that will develop in adulthood. This theory proposes that under-nutrition and other insult or adverse stimulus in utero and during infancy can permanently change the body's structure, physiology and metabolism. The lasting or lifelong effects of under-nutrition will depend on the period in the development at which it occurs. The clues that led Barker to his conclusions started to be discovered when he was studying the temporal trends in the incidence of ischemic heart disease in England and Wales. Examining data found in The Hertfordshire records, collected in the beginning of the last century, he found that the rates of mortality by ischemic heart disease was much higher in children born in less affluent counties and mostly in those with low birth weight. After his initial findings a myriad of diseases have been found to be linked to low birth weight and under-nutrition in utero and in the neonatal period. These diseases were then nominated adult diseases with fetal origin. Epidemiological studies that led to these findings suggest that in utero and early postnatal life have critical importance for long-term programming of health and disease, opening unique chances for primary prevention of chronic diseases. © 2013 Negrato and Gomes.


Malerbi F.E.K.,Pontifical Catholic University of São Paulo | Negrato C.A.,Baurus Diabetics Association | Gomes M.B.,State University of Rio de Janeiro
Diabetology and Metabolic Syndrome | Year: 2012

Purpose. To evaluate the impact of type 1 diabetes (T1D) on family functioning and child-rearing practices from parents' point of view, to assess parents' health-related quality of life and to explore the relations between psychosocial variables and diabetes care outcomes in youth with diabetes. Methods. This research was part of the cross-sectional multicenter Brazilian Type 1 Diabetes Study, conducted between December 2008 and December 2010 in 28 public clinics of 20 cities across four Brazilian geographical regions. Psychosocial questions were addressed to 1,079 parents of patients with T1D through an interview (89.3% mothers, 52.5% Caucasians, 38.6 ± 7.6 years old). Overall, 72.5% of the families were from low or very low socioeconomic levels. Parents were also submitted to health-related quality of life instruments (EQ-5DVAS). Clinical data from the last medical appointment were collected by a physician using standardized chart review forms. The demographic, educational and socioeconomic profiles were also obtained and HbA1c levels registered. Results: Discomfort and anxiety/depression were the main complaints in EQ-5D, and were significantly more frequent in mothers (37.3% and 53.4%, respectively) than in fathers (25.7% and 32.7%, respectively). The mother was the only parent involved in diabetes care in 50.5% of the cases. The majority of parents (78.5%) mentioned changes in family functioning after the diagnosis, although they neither treated their diabetic children differently from the others (76.3%), nor set prohibitions (69.1%) due to diabetes. The majority was worried about diabetes complications (96.4%) and felt overwhelmed by diabetes care (62.8%). Parents report of overwhelming was significantly associated with anxiety/depression, as measured by the EQ-5D questionnaire. Less than half of the patients had already slept over, and the permission to do it increased as a function of children's age. Nearly half of the parents (52%) admitted to experiencing difficulties in setting limits for their children/adolescents. HbA1c levels in patients from this group (9.7 ± 2.5%) were significantly higher than those of children/adolescents whose parents reported no difficulties towards limit-setting (8.8 ± 2.1%). Parents whose children/adolescents reported the occurrence of hypoglycemic episodes in the last month complained significantly more about anxiety/depression (55.1%) than parents from patients who did not report it (45.7%). Also a significantly greater proportion of parents whose children/adolescents had been hospitalized due to hyperglycemia reported anxiety /depression (58.7%) than those whose children/adolescents had not been hospitalized (49.8%). Conclusions: After the diagnosis of T1D, the lifestyle of all family members changes, what interferes with their quality of life. Mothers are still the primary caregivers for children/adolescents with diabetes. Difficulty to set limits for children/adolescents may be a risk for poor metabolic control. The study demonstrates the importance of family context in the adjustment of young patients to T1D. The specific needs of T1D patients and their impact on a family routine must be considered for future improvement on therapy elements and strategies. © 2012 Malerbi et al.; licensee BioMed Central Ltd.


Pessoa V.N.K.,Federal University of Rio de Janeiro | Rodacki M.,Federal University of Rio de Janeiro | Negrato C.A.,Baurus Diabetics Association | Zajdenverg L.,Federal University of Rio de Janeiro
Journal of Clinical Lipidology | Year: 2016

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. © 2016 National Lipid Association.

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