Type 2 diabetes in Brazil: epidemiology and management

Almeida-Pititto, Bianca de; Rodrigues, Monike Lourenço Dias; Moraes, Ana Carolina Franco de; Ferreira, Sandra Roberta Gouvêa; Franco, Denise Reis; Eliaschewitz, Freddy Goldberg

doi:10.2147/dmso.s72542

Cited by 38 publications

(33 citation statements)

References 49 publications

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“…5a,b). We then used American Diabetes Association guidelines3738 for classification of these subjects into three groups based on glycaemia status by fasting plasma glucose, 2 h plasma glucose (2-PG) and HbA1c and assessed A. muciniphila abundance in these groups. Individuals with normal glucose metabolism showed significantly higher A. muciniphila abundance compared with type 2 diabetics, with pre-diabetics showing an intermediate abundance of A. muciniphila (Fig.…”

Section: Resultsmentioning

confidence: 99%

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Akkermansia muciniphila mediates negative effects of IFNγ on glucose metabolism

et al. 2016

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Cross-talk between the gut microbiota and the host immune system regulates host metabolism, and its dysregulation can cause metabolic disease. Here, we show that the gut microbe Akkermansia muciniphila can mediate negative effects of IFNγ on glucose tolerance. In IFNγ-deficient mice, A. muciniphila is significantly increased and restoration of IFNγ levels reduces A. muciniphila abundance. We further show that IFNγ-knockout mice whose microbiota does not contain A. muciniphila do not show improvement in glucose tolerance and adding back A. muciniphila promoted enhanced glucose tolerance. We go on to identify Irgm1 as an IFNγ-regulated gene in the mouse ileum that controls gut A. muciniphila levels. A. muciniphila is also linked to IFNγ-regulated gene expression in the intestine and glucose parameters in humans, suggesting that this trialogue between IFNγ, A. muciniphila and glucose tolerance might be an evolutionally conserved mechanism regulating metabolic health in mice and humans.

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Section: Resultsmentioning

confidence: 99%

“…Individuals were examined at the Investigation Center of University Hospital. After overnight fasting, they underwent a 2-h 75-g oral glucose tolerance test and American Diabetes Association criteria were used to define categories of glucose tolerance3738.…”

Section: Methodsmentioning

confidence: 99%

Akkermansia muciniphila mediates negative effects of IFNγ on glucose metabolism

et al. 2016

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“…Type 2 diabetes (T2DM) is one of the most prevalent NCDs worldwide [8]. The number of adults with T2DM has quadrupled worldwide in four decades to 422 million.…”

Section: Introductionmentioning

confidence: 99%

“…In 2012, it was estimated that 4 of 5 patients with diabetes resided in LMICs [11, 12]. Brazil has the 4th highest prevalence of T2DM in the world, with 11.9 million (or roughly 10%) of Brazilians with diabetes [8, 13]. In 2010 diabetes was estimated to be responsible for 278,778 years of potential life lost for every million people in Brazil.…”

Section: Introductionmentioning

confidence: 99%

A pilot study of a Community Health Agent-led type 2 diabetes self-management program using Motivational Interviewing-based approaches in a public primary care center in São Paulo, Brazil

Nascimento

Resnicow

Nery

et al. 2017

BMC Health Serv Res

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BackgroundRates of noncommunicable diseases (NCDs) such as type 2 diabetes are escalating in low and middle-income countries such as Brazil. Scalable primary care-based interventions are needed to improve self-management and clinical outcomes of adults with diabetes. This pilot study examines the feasibility, acceptability, and outcomes of training community health agents (CHAs) in Motivational Interviewing (MI)-based counseling for patients with poorly controlled diabetes in a primary care center in São Paulo, Brazil.MethodsNineteen salaried CHAs participated in 32 h of training in MI and behavioral action planning. With support from booster training sessions, they used these skills in their regular monthly home visits over a 6 month period with 57 diabetes patients with baseline HbA1cs > 7.0%. The primary outcome was patients’ reports of the quality of diabetes care as measured by the Portuguese version of the Patient Assessment of Chronic Illness Care (PACIC) scale. Secondary outcomes included changes in patients’ reported diabetes self-management behaviors and in A1c, blood pressure, cholesterol and triglycerides. We also examined CHAs’ fidelity to and experiences with the intervention.ResultsPatients reported improvements over the 6 month period in quality of diabetes care received (PACIC score improved 33 (+/−19) to 68 (+/−21) (p < .001)). They reported increases in physical activity (p = .001), consumption of fruits and vegetables (p < .001) and medication adherence (p = .002), but no decreases in consumption of high-fat foods (p = .402) or sweets (p = .436). Participants had mean 6-month A1c levels 0.34% points lower than at baseline (p = .08) and improved mean LDL (−16.1 mg/dL, p = .005) and triglyceride levels (−38.725 mg/dL, p = .002). Of the 16 CHAs observed in fidelity assessments, 13 were categorized as medium- or high-performing on MI skills, while 3 were low-performing. CHAs expressed enthusiasm about learning new skills, and many described a shift from advice-giving to encouraging patients to define their own goals.ConclusionIn resource-scarce settings, it is essential to fully utilize existing primary care resources to stem the epidemic of diabetes and other NCDs. Our pilot results support the potential of training CHAs to incorporate effective diabetes self-management support into their routine patient encounters.Trial registration NCT02994095 12/14/2016 Registered retrospectively.

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“…No mundo, o número de idosos com diabetes mellitus tipo 2 (DM2) têm aumentado devido ao envelhecimento populacional e maior expectativa de vida 1 . No Brasil, estima-se que mais de 20% da população acima de 65 anos tenha diagnóstico de diabetes, com projeção de aumento dessa prevalência nas décadas subsequentes 2 .…”

Section: Introductionunclassified

Treinamento Multicomponente Melhora a Aptidão Funcional E Controle Glicêmico De Idosos Com Diabetes Tipo 2

Heubel

Gimenes

Marques³

et al. 2018

J Phys Educ

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A diabetes mellitus tipo 2 (DM2) é uma doença prevalente em idosos e está associada à incapacidade funcional e anormalidades do metabolismo glicêmico. O treinamento multicomponente, composto por exercícios de força, equilíbrio, coordenação, marcha, agilidade e propriocepção, é recomendado para melhorar a função física de idosos, porém seus efeitos no tratamento da DM2 não estão claros. Objetivou-se investigar o efeito de um protocolo de treinamento multicomponente na aptidão funcional e parâmetros glicêmicos de idosos com DM2. Foram incluídos 13 idosos com DM2 e idade de 68 ± 6 anos. Antes e após o período de intervenção foram realizados os seguintes testes: chair stand, arm curl, sentar e alcançar, teste de caminhada de seis minutos (TC6M), glicemia de jejum e hemoglobina glicada (HbA1C). O programa de treinamento foi realizado por 16 semanas, três vezes/semana, em dias não consecutivos. Cada sessão consistiu de 10 minutos de aquecimento, 50 minutos de exercícios multicomponentes (coordenação, força muscular, flexibilidade, equilíbrio e agilidade) e 10 minutos de alongamento e relaxamento. Para a análise estatística foi utilizado o teste t pareado e teste de Wilcoxon (p<0,05). O treinamento induziu melhora nos testes arm curl (p = 0,001), sentar e alcançar (p = 0,004), TC6M (p = 0,009) e HbA1C (p = 0,01). Conclui-se que o protocolo de treinamento multicomponente promoveu melhora da aptidão funcional e do controle glicêmico em idosos com DM2. Entretanto, a glicemia de jejum e a força muscular de membros inferiores permaneceram inalteradas. Palavras-chave: Diabetes mellitus tipo 2. Idoso. Exercício físico. Aptidão física. Glicemia.

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Type 2 diabetes in Brazil: epidemiology and management

Cited by 38 publications

References 49 publications

Akkermansia muciniphila mediates negative effects of IFNγ on glucose metabolism

Akkermansia muciniphila mediates negative effects of IFNγ on glucose metabolism

A pilot study of a Community Health Agent-led type 2 diabetes self-management program using Motivational Interviewing-based approaches in a public primary care center in São Paulo, Brazil

Treinamento Multicomponente Melhora a Aptidão Funcional E Controle Glicêmico De Idosos Com Diabetes Tipo 2

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