PurposeThere is a significant association between insulin resistance and low cardiorespiratory fitness in nondiabetic subjects. In a population with risk factors for type 2 diabetes (T2DM), before they are insulin resistant, we investigated low exercise capacity (VO2max) as an early marker of impaired insulin sensitivity in order to determine earlier interventions to prevent development of insulin resistance syndrome (IRS) and T2DM.MethodsCross-sectional analyses of data on 369 (78 men and 291 women) people at risk for IRS and T2DM, aged 45.6 +/- 10 years (20-65 years) old from the Community Diabetes Prevention Project in Minnesota were carried out. The cardiorespiratory fitness (VO2max) by respiratory gas exchange and bicycle ergometer were measured in our at risk non insulin resistant population and compared with a control group living in the same geographic area. Both groups were equally sedentary, matched for age, gender and BMI.ResultsThe most prevalent abnormality in the study population was markedly low VO2max when compared with general work site screening control group, (n = 177; 137F; 40 M, mean age 40 ± 11 years; BMI = 27.8 ± 6.1 kg/m2). Individuals at risk for IRS and T2DM had a VO2max (22 ± 6 ml/kg/min) 15% lower than the control group VO2max (26 ± 9 ml/kg/min) (p < 0.001). It was foun that VO2max was inversely correlated with HOMA-IR (r = -0.30, p < 0.0001).ConclusionsDecreased VO2max is correlated with impaired insulin sensitivity and was the most prevalent abnormality in a population at risk for IRS and T2DM but without overt disease. This raises the possibility that decreased VO2 max is among the earliest indicators of IRS and T2DM therefore, an important risk factor for disease progression.

BackgroundHyperglycemia in hospitalized patients is known to be related to a higher incidence of clinical and surgical complications and poorer outcomes. Adequate glycemic control and earlier diagnosis of type 2 diabetes during hospitalization are cost-effective measures.MethodsThis prospective cohort study was designed to determine the impact of hyperglycemia on morbidity and mortality in a general hospital setting during a 3-month period by reviewing patients' records. The primary purposes of this trial were to verify that hyperglycemia was diagnosed properly and sufficiently early and that it was managed during the hospital stay; we also aimed to evaluate the relationship between in-hospital hyperglycemia control and outcomes such as complications during the hospital stay, extent of hospitalization, frequency of re-hospitalization, death rates and number of days in the ICU (Intensive Care Unit) after admission. Statistical analyses utilized the Kruskall-Wallis complemented by the "a posteriori" d.m.s. test, Spearman correlation and Chi-squared test, with a level of significance of 5% (p < 0.05).ResultsWe reviewed 779 patient records that fulfilled inclusion criteria. The patients were divided into 5 groups: group (1) diabetic with normal glycemic levels according to American Diabetes Association criteria for in-hospital patients (n = 123); group (2) diabetics with hyperglycemia (n = 76); group (3) non-diabetics with hyperglycemia (n = 225); group (4)diabetics and non-diabetics with persistent hyperglycemia during 3 consecutive days (n = 57) and group (5) those with normal glucose control (n = 298). Compared to patients in groups 1 and 5, patients in groups 2, 3 and 4 had significantly higher mortality rates (17.7% vs. 2.8%) and Intensive Care Unit admissions with complications (23.3% vs. 4.5%). Patients in group 4 had the longest hospitalizations (mean 15.5 days), and group 5 had the lowest re-hospitalization rate (mean of 1.28 hospitalizations). Only 184 (51.4%) hyperglycemic patients had received treatment. An insulin "sliding-scale" alone was the most frequent treatment used, and there was a wide variation in glucose target medical prescriptions. Intra Venous insulin infusion was used in 3.8% of patients in the ICU. Glycohemoglobin(A1C) was measured in 11 patients(2.2%).ConclusionsHospital hyperglycemia was correlated with, among other parameters, morbidity/mortality, length of hospitalization and number of re-hospitalizations. Most patients did not have their glycemic levels measured at the hospital; despite the high number of hyperglycemic patients not diagnosed as diabetics, A1C was not frequently measured. Even when patients are assessed for hyperglycemia, they were not treated properly.

RESUMOO diabetes mellitus (DM) é uma doença de alta prevalência nas sociedades modernas, na maioria das vezes com tratamento inadequado ou ausente. Apesar de geralmente considerado como fator de risco independente para ocorrência e gravidade de infecções em geral, o DM não apresenta evidência clínica forte de sua relação com infecção. Observase, porém, uma maior ocorrência de certas infecções em pacientes com DM, com curso menos favorável para algumas delas. Há também tipos de infecção quase exclusivos de pacientes com DM. Experimentalmente, observa-se depressão da atividade dos neutrófilos, menor eficiência da imunidade celular, alteração dos sistemas antioxidantes e menor produção de interleucinas. Com relação às infecções comuns, as que envolvem o trato respiratório não têm comprovadamente maior gravidade em pacientes com DM, exceção feita ao pneumococo -por isso a recomendação para sua vacinação contra S. pneumoniae e influenza. Quanto ao trato urinário, há maior ocorrência de bacteriúria assintomáti-ca em mulheres com DM, com maiores índices de pielonefrite, necrose papilar, abscesso perinéfrico, pielonefrite xantogranulomatosa, e cistite e pielonefrite gangrenosas. Periodontite e infecções de partes moles são também mais comuns no DM. Cada tipo de infecção é associado a germes típicos, e seu conhecimento é fundamental para um tratamento inicial adequado. As infecções quase exclusivas de pacientes com DM incluem otite externa maligna, mucormicose rinocerebral, colecistite gangrenosa e o somatório de alterações que caracterizam o pé diabético. O conhecimento destas infecções assume maior importância por requererem freqüentemente uma abordagem multidisciplinar, envolvendo endocrinologistas, infectologistas, cirurgiões vasculares e nefrologistas, dentre outros. Diabetes mellitus (DM) is a highly prevalent disease in modern societies, most of the times being either inappropriately treated or not treated at all. Though generally considered to be an independent risk factor for the occurrence and severity of infections in general, DM has not been clinically proven to have any strong association with infection. There are, however, certain infections that are more common in DM, sometimes with a less favorable course than in non-diabetics. Other types of infection affect almost exclusively patients with DM. Experimentally, DM patients have a depressed neutrophil activity, a less effective cell mediated immunity, altered antioxidant systems and diminished interleukin synthesis. Regarding common infections, those affecting the respiratory tract have not been proven to be more serious in DM patients, with the exception of S. pneumoniae infections -thus the recommendation to vaccinate them against pneumococcus and influenza. As for urinary tract infections, bacteriuria takes place more commonly in women with DM, more frequently complicated by pyelonephritis, papillary necrosis, xanthogranulomatous pyelonephritis and gangrenous cystitis/ pyelonephritis. Periodontitis and soft-tissue infections are also more common

O número de portadores de diabetes melito tipo 1 (DM1) está aumentando globalmente, entretanto, a maior parte dos pacientes apresenta controle glicêmico insatisfatório. Esta revisão na literatura foi realizada com três questões de pesquisa: Quais as recomendações e diretrizes de educação em diabetes existentes? Existem evidências para recomendar a adaptação de determinado programa segundo a faixa etária dos pacientes? Os programas de educação são efetivos na melhora dos níveis de HbA1c? Foram revisados 40 artigos, publicados entre 2000 e 2007, sobre educação em DM1 em crianças, adolescentes, adultos e usuários de bomba de infusão contínua de insulina, além de incluir o resumo das diretrizes da IDF, da ADA, da SBD, da AADE, do IDC, e outras peculiaridades para o contexto de saúde pública e privada. O portador de diabetes e sua família devem ser treinados a fazer decisões efetivas de autocuidado em sua rotina diária. O aprimoramento do paciente no automanejo aproxima o valor da HbA1c ao adequado para sua faixa etária. A educação individual e a em grupo apresentam equivalência na melhora do controle metabólico. Existe uma correlação positiva entre o tempo de educação e o controle da glicemia.

RESUMOEstudo realizado para avaliar o impacto do Staged Diabetes Management (SDM) na melhora do controle glicêmico, perfil lipídico e pressão arterial, e a satisfação dos pacientes com este modelo de atendimento. Desde 1998, o SDM, guia ABSTRACTStudy to assess the impact of Staged Diabetes Management (SDM) in improving glycemic control, lipid profile and blood pressure, as well as to evaluate patient's satisfaction with this approach. Since 1998, SDM, a guideline developed by the International Diabetes Center (Minneapolis, MN, USA) has been used as the framework for training staff and for outpatient clinical practice at Nossa Senhora das Graças Diabetes Center, located in a private hospital in Curitiba, PR (Brazil). The team included endocrinologists, dietitians, nurses and a social assistant. 78 patients have completed a one-year follow-up. 27 patients had type 1 diabetes and 51 had type 2 diabetes. HbA1C decreased from 8.06%±2.25 at baseline to 7.49%±2.0 (p= 0.045) at the end of first year of treatment. BMI, Lipid profile and blood pressure did not change. Patients were contacted by phone and 80% were satisfied with SDM approach. Our results are important to show that quality diabetes care and improvement in glycemic control can be achieved using SDM. O DIABETES HABITUALMENTE ESTÁ associado a hipertensão arterial sistêmica, dislipidemia, obesidade e resistência insulínica, tornando o seu manejo bastante complexo porque implica em mudança de estilo de vida dos indivíduos, além da associação de múltiplas drogas e/ou artigo original