RESUMO
The concordance of continuous glucose monitoring system (CGMS) and finger-stick blood glucose (FSBG) was assessed in patients with type 2 diabetes during daily activities and two different exercise sessions. Agreement between FSBG and CGMS becomes weaker during exercise, but more than 90% of the CGMS readings are within acceptable range.
Assuntos
Glicemia/análise , Diabetes Mellitus Tipo 2/sangue , Exercício Físico , Monitorização Ambulatorial , Estudos Cross-Over , Diabetes Mellitus Tipo 2/terapia , Humanos , Masculino , Pessoa de Meia-Idade , Reprodutibilidade dos Testes , Treinamento ResistidoRESUMO
PURPOSE: Uncoupling protein 1 (UCP1) reduces mitochondrial production of reactive oxygen species (ROS). ROS overproduction is related to diabetic retinopathy (DR), a chronic complication of diabetes mellitus (DM). Therefore, deleterious polymorphisms in the UCP1 gene are candidate risk factors for DR. We investigated the relationships between the UCP1 -3826A/G polymorphism and risk of DR and UCP1 gene expression in human retina. Considering that superoxide dismutase-2 (MnSOD2) enzyme is the first line of defense against oxidative stress in mitochondria, we also analyzed MnSOD2 gene expression in retinal samples according to different UCP1 -3826A/G genotypes. METHODS: In a case-control study, frequencies of -3826A/G polymorphisms were analyzed in 257 type 1 DM patients (154 cases with DR and 103 controls without DR). In a cross-sectional study comprising cadaveric cornea donors, UCP1 and MnSOD2 gene expressions were evaluated in 107 retinal samples differentiated according to different -3826A/G genotypes. RESULTS: In the type 1 DM group, multivariate analysis confirmed that the G/G genotype was an independent risk factor for DR (OR = 3.503; P = 0.043). In cornea donors, G allele carriers had higher UCP1 cDNA and protein concentrations than A/A carriers (P = 0.034 and P = 0.039, respectively). Interestingly, G allele carriers exhibited increased MnSOD2 expression (P = 0.001). CONCLUSIONS: This study suggests that the -3826A/G polymorphism is associated with DR in type 1 DM patients. This is the first report demonstrating UCP1 gene expression in human retinas and indicates that the -3826A/G polymorphism influences its expression. In addition, the -3826G allele was associated with increased MnSOD2 expression; thus, suggesting that this allele could be a marker of oxidative stress.
Assuntos
DNA Complementar/genética , Retinopatia Diabética/genética , Expressão Gênica , Canais Iônicos/genética , Proteínas Mitocondriais/genética , Polimorfismo Genético , Retina/metabolismo , Superóxido Dismutase/genética , Adulto , Alelos , Retinopatia Diabética/metabolismo , Feminino , Seguimentos , Frequência do Gene , Haplótipos , Humanos , Imuno-Histoquímica , Canais Iônicos/metabolismo , Masculino , Proteínas Mitocondriais/metabolismo , Estresse Oxidativo , Reação em Cadeia da Polimerase em Tempo Real , Estudos Retrospectivos , Superóxido Dismutase/biossíntese , Proteína Desacopladora 1RESUMO
BACKGROUND: In patients with type 2 diabetes, the presence of retinopathy is associated with increased cardiovascular disease, regardless of known risk factors for vascular disease. OBJECTIVE: To investigate the association of diabetic retinopathy (DR) and its grades with the presence of subclinical coronary atherosclerosis in patients with type 1 diabetes. METHODS: A cross-sectional study was conducted with 150 type 1 diabetes individuals asymptomatic for coronary artery disease. They underwent clinical evaluation for microvascular complications and for the presence of coronary artery calcification (CAC). RESULTS: Severe forms of DR (severe non-proliferative DR and proliferative DR) were associated with CAC (OR: 3.98 95% CI 1.13-13.9, p = 0.03), regardless of known risk factors for cardiovascular disease (age, A1C, hypertension, dyslipidemia and male gender). CONCLUSION: Patients with severe forms of DR are at risk for the presence of coronary artery disease regardless of traditional cardiovascular risk factors.
Assuntos
Doença da Artéria Coronariana/etiologia , Diabetes Mellitus Tipo 1/complicações , Retinopatia Diabética/etiologia , Calcificação Vascular/etiologia , Adulto , Doença da Artéria Coronariana/patologia , Diabetes Mellitus Tipo 1/patologia , Retinopatia Diabética/patologia , Métodos Epidemiológicos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Fatores de Risco , Calcificação Vascular/patologiaRESUMO
FUNDAMENTO: Em pacientes com diabetes tipo 2, a presença de retinopatia está associada a doença cardiovascular aumentada, independentemente dos fatores de risco conhecidos para a doença vascular. OBJETIVO: Investigar a associação da retinopatia diabética (RD) e seus graus com a presença de aterosclerose coronariana subclínica em pacientes com diabetes tipo 1. MÉTODOS: Um estudo transversal foi conduzido com 150 pacientes com diabetes tipo 1, assintomáticos para doença arterial coronariana. Foram submetidos à avaliação clínica para verificar complicações microvasculares e avaliação para a presença de calcificação arterial coronariana (CAC). RESULTADOS: Formas graves de RD (RD grave não proliferativa - RDNP - e RD proliferativa - RDP) foram associadas à CAC (RC: 3,98; IC de 95 por cento; 1,13-13,9, p = 0,03), de maneira independente dos fatores de risco conhecidos para a doença cardiovascular (idade, A1C, hipertensão, dislipidemia e sexo masculino). CONCLUSÃO: Os pacientes com formas graves de RD estão em risco de presença de doença arterial coronariana, de maneira independente dos tradicionais fatores de risco cardiovascular.
BACKGROUND: In patients with type 2 diabetes, the presence of retinopathy is associated with increased cardiovascular disease, regardless of known risk factors for vascular disease. OBJECTIVE: To investigate the association of diabetic retinopathy (DR) and its grades with the presence of subclinical coronary atherosclerosis in patients with type 1 diabetes. METHODS: A cross-sectional study was conducted with 150 type 1 diabetes individuals asymptomatic for coronary artery disease. They underwent clinical evaluation for microvascular complications and for the presence of coronary artery calcification (CAC). RESULTS: Severe forms of DR (severe non-proliferative DR and proliferative DR) were associated with CAC (OR: 3.98 95 percent CI 1.13-13.9, p = 0.03), regardless of known risk factors for cardiovascular disease (age, A1C, hypertension, dyslipidemia and male gender). CONCLUSION: Patients with severe forms of DR are at risk for the presence of coronary artery disease regardless of traditional cardiovascular risk factors.
Assuntos
Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Doença da Artéria Coronariana/etiologia , Diabetes Mellitus Tipo 1/complicações , Retinopatia Diabética/etiologia , Calcificação Vascular/etiologia , Doença da Artéria Coronariana/patologia , Diabetes Mellitus Tipo 1/patologia , Retinopatia Diabética/patologia , Métodos Epidemiológicos , Fatores de Risco , Calcificação Vascular/patologiaRESUMO
OBJECTIVE: To evaluate the prevalence of chronic vascular complications and associated factors in patients with type 1 diabetes mellitus (DM). METHODS: Cross sectional study with type 1 DM patients attending the Endocrine Division, Hospital de Clinicas de Porto Alegre. Patients were evaluated for presence of chronic vascular complications. RESULTS: We evaluated 573 patients, mean age of 33 years. The presence of diabetic retinopathy (DR) was observed in 43.3%, diabetes duration [OR: 1.07, 95% CI: 1.03 to 1.11, P <0001], the presence of diabetic nephropathy (DN) [OR: 3.40; CI 95%: 1.89 to 6.13, P <0001] and hypertension (HPT) [OR: 2.12, 95% CI: 1.16 to 3.87, P = 0014] were associated with DR. The DN was present in 34.5% and was associated with HPT [OR: 1.93, 95% CI: 1.16 to 3.21, P = 0001] and total cholesterol [OR: 1.0, 95% CI: 1.0-1.01, P = 0.05]. Seven patients had macrovascular disease. Only 22% achieved an A1c of <7.0%. HPT was 33% and 48% had levels <130/80 mm Hg and 45% of patients had values for LDL> 100 mg/dl. CONCLUSION: We observed a high prevalence of microvascular complications and HPT. Duration of DM, HPT and presence of DN were associated with DR. HPT and dyslipidemia were associated with DN. Most patients did not meet the desired glycemic control, blood pressure and lipid targets. Greater efforts are needed to intensify the pressure and metabolic control of patients with type 1 DM.
Assuntos
Diabetes Mellitus Tipo 1/epidemiologia , Nefropatias Diabéticas/epidemiologia , Retinopatia Diabética/epidemiologia , Adolescente , Adulto , Idoso , Brasil/epidemiologia , Doença Crônica , Estudos Transversais , Nefropatias Diabéticas/diagnóstico , Retinopatia Diabética/diagnóstico , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência , Fatores de Risco , Índice de Gravidade de DoençaRESUMO
AIM: To analyze the prevalence of masked hypertension and its possible association with microvascular complications in patients with type 1 diabetes (T1D). METHODS: A cross-sectional study was conducted in 188 consecutive normotensive patients at the office with T1D without renal replacement therapy or previous renal transplant. All patients were assessed regarding the presence of diabetic retinopathy (DR) (direct and indirect fundoscopy), urinary albumin excretion rate (immunoturbidimetry), and ambulatory blood pressure monitoring (ABPM) (Spacelabs 90207). RESULTS: Masked hypertension was observed in 14 (13.6%) out of 103 clinical normotensive patients and in 7.4% of the entire cohort. Twenty-three percent of patients with clinical normotension had masked nocturnal hypertension. DR was associated with night systolic and diastolic BP [OR of each 5mmHg change 1.41 (95%CI: 1.09-1.83, P=0.009) and 1.40 (95%CI: 1.02-1.93, P=0.04), respectively] and with masked nocturnal hypertension [OR: 3.23 (95%CI: 1.29-8.11, P=0.01)]. CONCLUSIONS: In T1D patients with clinic BP<130/80mmHg, masked hypertension and especially masked nocturnal hypertension are present. Normotensive patients with nocturnal BP>120/70mmHg have higher presence of DR, and only will be identified through ABPM.
Assuntos
Pressão Sanguínea/fisiologia , Diabetes Mellitus Tipo 1/complicações , Retinopatia Diabética/epidemiologia , Hipertensão/epidemiologia , Adulto , Idade de Início , Índice de Massa Corporal , Estudos Transversais , Angiopatias Diabéticas/epidemiologia , Angiopatias Diabéticas/fisiopatologia , Diástole , Feminino , Humanos , Hipertensão/fisiopatologia , Masculino , Prevalência , Sístole , Circunferência da CinturaRESUMO
OBJETIVO: Avaliar a prevalência de complicações crônicas vasculares e fatores associados em pacientes com diabetes mellitus (DM) tipo 1. MÉTODOS: Estudo transversal com pacientes DM tipo 1 atendidos no Serviço de Endocrinologia do Hospital de Clínicas de Porto Alegre. Os pacientes foram avaliados quanto à presença de complicações crônicas vasculares. RESULTADOS: Avaliamos 573 pacientes, idade média de 33 anos. A presença de retinopatia diabética (RD) foi observada em 43,3 por cento, o tempo de DM [RC: 1,07; IC95 por cento 1,03-1,11; P < 0,001], presença de nefropatia diabética (ND) [RC 3,40; IC95 por cento 1,89 - 6,13; P <0,001] e presença de hipertensão (HAS) [RC:2,12; IC95 por cento 1,16 - 3,87; P = 0,014] foram associados com RD. A ND esteve presente em 34,5 por cento e foi associada à presença de HAS [RC: 1.93; IC95 por cento (1,16-3,21); P = 0,001] e colesterol total [RC: 1,0; IC 95 por cento (1,0-1,01); P = 0,05]. Sete pacientes apresentaram doença macrovascular. Apenas 22 por cento atingiram níveis de HbA1c <7,0 por cento. A prevalência de HAS foi 33 por cento, sendo que 48 por cento estavam com a PA <130/80 mm Hg e 45 por cento dos pacientes apresentaram valores de LDL >100 mg/dl. CONCLUSÃO: Observamos elevadas prevalências de complicações microvasculares e de HAS. A duração do DM, HAS e presença de ND foram associados à RD. HAS e dislipidemia foram associados à ND. A maioria dos pacientes encontrava-se fora dos alvos desejados de controle glicêmico, pressórico e lipídico. Maiores esforços são necessários para intensificar o controle metabólico e pressórico de pacientes com DM tipo 1.
OBJECTIVE: To evaluate the prevalence of chronic vascular complications and associated factors in patients with type 1 diabetes mellitus (DM). METHODS: Cross sectional study with type 1 DM patients attending the Endocrine Division, Hospital de Clinicas de Porto Alegre. Patients were evaluated for presence of chronic vascular complications. RESULTS: We evaluated 573 patients, mean age of 33 years. The presence of diabetic retinopathy (DR) was observed in 43.3 percent, diabetes duration [OR: 1.07, 95 percent CI: 1.03 to 1.11, P <0001], the presence of diabetic nephropathy (DN) [OR: 3.40; CI 95 percent: 1.89 to 6.13, P <0001] and hypertension (HPT) [OR: 2.12, 95 percent CI: 1.16 to 3.87, P = 0014] were associated with DR. The DN was present in 34.5 percent and was associated with HPT [OR: 1.93, 95 percent CI: 1.16 to 3.21, P = 0001] and total cholesterol [OR: 1.0, 95 percent CI: 1.0-1.01, P = 0.05]. Seven patients had macrovascular disease. Only 22 percent achieved an A1c of <7.0 percent. HPT was 33 percent and 48 percent had levels <130/80 mm Hg and 45 percent of patients had values for LDL> 100 mg/dl. CONCLUSION: We observed a high prevalence of microvascular complications and HPT. Duration of DM, HPT and presence of DN were associated with DR. HPT and dyslipidemia were associated with DN. Most patients did not meet the desired glycemic control, blood pressure and lipid targets. Greater efforts are needed to intensify the pressure and metabolic control of patients with type 1 DM.
Assuntos
Adolescente , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Diabetes Mellitus Tipo 1/epidemiologia , Nefropatias Diabéticas/epidemiologia , Retinopatia Diabética/epidemiologia , Brasil/epidemiologia , Doença Crônica , Estudos Transversais , Nefropatias Diabéticas/diagnóstico , Retinopatia Diabética/diagnóstico , Prevalência , Fatores de Risco , Índice de Gravidade de DoençaRESUMO
The main risk factors for the development and progression of diabetic retinopathy (DR) are chronic hyperglycemia, disease duration and systemic blood pressure. So far chronic hyperglycemia is the strongest evidence concerning the risk of developing DR. However there are some patients with poor metabolic control who never develop this diabetic complication. We present a case of a 73-year-old woman with type 1 diabetes mellitus, diagnosed 69 years ago. The patient is 73 years old, with no evidence of DR, despite poor glycemic control and several risk factors for DR. This case suggests the presence of a possible protection factor, which could be genetic.
RESUMO
OBJECTIVES: Diabetic retinopathy (DR) is the leading cause of legal blindness in young adults. Scarce data from Brazilian subjects with type 1 diabetes mellitus (DM) are available. AIMS: The objectives of this study were to determine the prevalence of DR and its risk factors in type 1 diabetes mellitus (DM) outpatients from a general hospital. METHODS: A cross-sectional study of 437 type 1 DM (50.3% males, 82.4% whites) was conducted. DR was graded as absent, mild and moderate non-proliferative DR (mild/moderate NPDR) or severe non-proliferative and proliferative DR (advanced DR). Presence of clinically significant macular edema (CSME) was also recorded. RESULTS: Any DR was present in 44.4% of subjects. In multivariate analysis, DM duration, systolic blood pressure (SBP) and A1C test were associated with mild/moderate NPDR (P<0.005). Advanced DR, was associated with DM duration, SBP, smoking [odds ratio (OR) 2.75, 95%CI 1.15-6.60] and micro-or macroalbuminuria (OR 8.53, 95%CI 3.81-18.05). CSME was present in 21 (9.4%) patients and was associated with smoking (OR 3.19, 95%CI 1.24-8.2). Its frequency increased with the severity of DR (16.4% in advanced DR, 9.6% in mild/moderate NPDR, and 4.7% in the group without DR; P = 0.020). CONCLUSION: Patients with type 1 DM attending an endocrine out-patient clinic at a general hospital had a high prevalence of DR associated with traditional risk-factors and smoking.
Assuntos
Diabetes Mellitus Tipo 1/complicações , Retinopatia Diabética/epidemiologia , Adulto , Análise de Variância , Brasil/epidemiologia , Estudos Transversais , Retinopatia Diabética/etiologia , Feminino , Humanos , Masculino , Análise Multivariada , Prevalência , Fatores de RiscoRESUMO
OBJECTIVES: Diabetic retinopathy (DR) is the leading cause of legal blindness in young adults. Scarce data from Brazilian subjects with type 1 diabetes mellitus (DM) are available. Aims: The objectives of this study were to determine the prevalence of DR and its risk factors in type 1 diabetes mellitus (DM) outpatients from a general hospital. METHODS:A cross-sectional study of 437 type 1 DM (50.3 percent males, 82.4 percent whites) was conducted. DR was graded as absent, mild and moderate non-proliferative DR (mild/moderate NPDR) or severe non-proliferative and proliferative DR (advanced DR). Presence of clinically significant macular edema (CSME) was also recorded. RESULTS: Any DR was present in 44.4 percent of subjects. In multivariate analysis, DM duration, systolic blood pressure (SBP) and A1C test were associated with mild/moderate NPDR (P<0.005). Advanced DR, was associated with DM duration, SBP, smoking [odds ratio (OR) 2.75, 95 percentCI 1.15-6.60] and micro-or macroalbuminuria (OR 8.53, 95 percentCI 3.81-18.05). CSME was present in 21 (9.4 percent) patients and was associated with smoking (OR 3.19, 95 percentCI 1.24-8.2). Its frequency increased with the severity of DR (16.4 percent in advanced DR, 9.6 percent in mild/moderate NPDR, and 4.7 percent in the group without DR; P = 0.020). CONCLUSION: Patients with type 1 DM attending an endocrine out-patient clinic at a general hospital had a high prevalence of DR associated with traditional risk-factors and smoking.
OBJETIVOS: Determinar a prevalência de RD e seus fatores de risco em pacientes com DM tipo 1 atendidos em um hospital geral. MÉTODOS: Foi realizado um estudo transversal com 437 pacientes (50,3 por cento homens, 82,4 por cento brancos). RD foi agrupada em: 1) ausente; 2) não proliferativa leve e moderada (RDNP leve/moderada); 3) não prolifetiva grave e RD proliferativa (RD avançada). Edema de mácula clinicamente significativo (EMCS) também foi registrado. RESULTADOS: Qualquer grau de RD esteve presente em 44,4 por cento dos pacientes. Na análise multivariada, duração do DM, pressão arterial sistólica e teste A1C foram associados com a RD leve/moderada (P<0,005). RD avançada foi associada com duração do DM, pressão arterial sistólica (PAS), fumo [razão de chances (RC) 2,75, IC 95 por cento 1,15-6,60] e micro-ou macroalbuminúria (RC 8,53, CI 95 por cento 3,81-18,05). EMCS esteve presente em 21 (9,4 por cento) dos pacientes associado ao fumo, aumentando com a gravidade da RD (16,4 por cento RD avançada; 9,6 por cento RD leve/modera, e 4,7 por cento no grupo sem RD; P = 0,020). CONCLUSÃO: Pacientes com DM tipo 1 vistos em um hospital geral têm uma alta prevalência de RD, a qual foi associada aos fatores de risco tradicionais e fumo.
Assuntos
Adulto , Feminino , Humanos , Masculino , Diabetes Mellitus Tipo 1/complicações , Retinopatia Diabética/epidemiologia , Análise de Variância , Brasil/epidemiologia , Estudos Transversais , Retinopatia Diabética/etiologia , Análise Multivariada , Prevalência , Fatores de RiscoRESUMO
AIMS: To evaluate the prevalence of cataract and the possible factors associated with cataract in young type 1 diabetes mellitus (DM). METHODS: 293 patients were evaluated. The association of cataract with diabetic retinopathy (DR), retinal laser treatment, hypertension, body mass index, peripheral neuropathy, lipid profile, glycemic control, serum creatinine and albuminuria was evaluated. RESULTS: Cataract was present in 19.8% (n=58) of the sample. Patients with cataracts were older, had a higher frequency of history of retina photocoagulation treatment, higher serum creatinine values and higher prevalence of arterial hypertension. There was a progressive increase in cataract frequency according to the number of risk factors, starting to rise with two or more. In logistic regression model cataract was associated with mild/moderate DR (odd ratio (OR) 4.28 95% CI 1.63-11.29), severe DR (OR 4.07 95% CI 1.63-10.23) and macroalbuminuria (OR 2.34 95% CI 1.06-5.16). CONCLUSION: These data indicate a high prevalence of cataract in subjects with type 1 DM attending a general hospital in Southern Brazil and suggest that the more severe the disease process the greater is the risk of having this diabetic complication. Cataract should be suspected in young patients with two or more risk factors.
Assuntos
Catarata/etiologia , Diabetes Mellitus Tipo 1/complicações , Adulto , Fatores Etários , Brasil/epidemiologia , Creatinina/sangue , Estudos Transversais , Complicações do Diabetes/complicações , Diabetes Mellitus Tipo 1/epidemiologia , Retinopatia Diabética , Feminino , Humanos , Hipertensão , Masculino , Prevalência , Análise de Regressão , Fatores de Risco , Adulto JovemRESUMO
Routine vaccination campaigns are carried out in Argentina twice a year, involving more than 100 million doses of foot-and-mouth disease (FMD) vaccine. Although the challenge test in cattle has not been totally replaced for the assessment of FMD vaccine potency, Argentine Animal Health authorities have used an indirect alternative method based on specific correlation studies of protection against podal generalization (PPG) tests performed in cattle with a validated liquid phase blocking ELISA (lpELISA). The change of vaccine formulations that took place after the 2000-2001 outbreaks, generated a gap in the correlation between lpELISA titers and PPG for the new FMD virus strains. A reappraisal of the correlation between lpELISA titers measured at 60 dpv and virus challenge by the PPG method at 90 dpv, performed for the four virus strains presently included in the Argentine vaccine is presented in this work. The data were obtained from 40 bovine challenge trials (647 sera) performed using exclusive batches of commercial vaccine from the year 2001 to January 2008 for A24/Cruzeiro, A/Argentina/2001, O1/Campos and C3/Indaial FMD virus strains. Curves of percentage of expected protection (EPP) versus lpELISA titers were obtained by logit regression for A/Argentina/2001, O1/Campos and C3/Indaial strains, but not for A24/Cruzeiro strain. The concordance between the direct and indirect tests using an EPP cut off value of 75% (82%, kappa = 0.62), in agreement with data originating from many years of vaccine control in Argentina, remarks the relevance of the acceptance of indirect alternatives to in vivo potency testing.
Assuntos
Doenças dos Bovinos/prevenção & controle , Febre Aftosa/prevenção & controle , Vacinas Virais/normas , Animais , Anticorpos Antivirais/sangue , Argentina/epidemiologia , Bovinos , Doenças dos Bovinos/epidemiologia , Doenças dos Bovinos/imunologia , Ensaio de Imunoadsorção Enzimática/métodos , Febre Aftosa/epidemiologia , Febre Aftosa/imunologia , Vírus da Febre Aftosa/imunologia , Masculino , Reprodutibilidade dos Testes , Sensibilidade e Especificidade , Vacinas Virais/imunologiaRESUMO
PURPOSE: To evaluate the prevalence of cataract and associated risk factors in a diabetic type 1 population. METHODS: 181 patients (362 eyes) were evaluated in a case-control study. Cases were classified when cataract was present at the time of the examination. The studied outcomes were the presence of diabetic retinopathy, retinal panphotocoagulation, high blood pressure, peripheral neuropathy, total cholesterol levels, triglyceride levels, HDL, LDL, body mass index, creatinine levels, albuminuria, glycosylated hemoglobin and glycemia levels. RESULTS: Cataract was present in 19.9% of the studied patients. The association of the presence of cataract and diabetic retinopathy, peripheral neuropathy, elevated levels of creatinine, panphotocoagulation and high blood pressure were statistically significant (univariate analysis). After the logistic regression analysis the presence of cataract was significantly associated with the presence of diabetic retinopathy. CONCLUSION: The prevalence of cataract was 19.9% and the presence and severity of the diabetic retinopathy were the main risk factors for its development.
Assuntos
Catarata/epidemiologia , Diabetes Mellitus Tipo 1/epidemiologia , Retinopatia Diabética/epidemiologia , Adulto , Índice de Massa Corporal , Brasil/epidemiologia , Colesterol/sangue , Creatinina/sangue , Diabetes Mellitus Tipo 1/sangue , Métodos Epidemiológicos , Feminino , Humanos , Hipertensão/complicações , Fotocoagulação a Laser/efeitos adversos , Masculino , Doenças do Sistema Nervoso Periférico/epidemiologia , Triglicerídeos/sangueRESUMO
OBJETIVO: Avaliar a prevalência de catarata e seus fatores de risco em uma população portadora de diabetes mellitus tipo 1 (DM1). MÉTODOS: Estudo de casos e controles de um banco de dados de 181 pacientes (362 olhos) com diagnóstico de diabetes mellitus tipo 1. Os pacientes foram classificados como casos quando apresentavam diagnóstico de catarata. As variáveis estudadas foram a presença ou não de retinopatia diabética, tratamento com panfotocoagulação, presença de hipertensão arterial sistêmica e neuropatia periférica, colesterol total, triglicerídios séricos, HDL, LDL, índice de massa corporal, creatinina sérica, albuminúria, hemoglobina glicosilada e glicemia de jejum. RESULTADOS: A prevalência de catarata foi de 19,9 por cento. Na análise univariada foi encontrada associação estatisticamente significativa (p<0,005) entre a presença de catarata e retinopatia diabética, neuropatia periférica, creatinina sérica elevada, panfotocoagulação e hipertensão arterial. Após a análise de regressão logística a variável que permaneceu com associação estatisticamente significativa foi a presença de retinopatia diabética. CONCLUSÃO: A prevalência de catarata foi de 19,9 por cento, sendo a presença e a gravidade da retinopatia diabética os principais fatores de risco para desenvolvimento desta.
PURPOSE: To evaluate the prevalence of cataract and associated risk factors in a diabetic type 1 population. METHODS: 181 patients (362 eyes) were evaluated in a case-control study. Cases were classified when cataract was present at the time of the examination. The studied outcomes were the presence of diabetic retinopathy, retinal panphotocoagulation, high blood pressure, peripheral neuropathy, total cholesterol levels, triglyceride levels, HDL, LDL, body mass index, creatinine levels, albuminuria, glycosylated hemoglobin and glycemia levels. RESULTS: Cataract was present in 19.9 percent of the studied patients. The association of the presence of cataract and diabetic retinopathy, peripheral neuropathy, elevated levels of creatinine, panphotocoagulation and high blood pressure were statistically significant (univariate analysis). After the logistic regression analysis the presence of cataract was significantly associated with the presence of diabetic retinopathy. CONCLUSION: The prevalence of cataract was 19.9 percent and the presence and severity of the diabetic retinopathy were the main risk factors for its development.
Assuntos
Adulto , Feminino , Humanos , Masculino , Catarata/epidemiologia , Diabetes Mellitus Tipo 1/epidemiologia , Retinopatia Diabética/epidemiologia , Índice de Massa Corporal , Brasil/epidemiologia , Colesterol/sangue , Creatinina/sangue , Diabetes Mellitus Tipo 1/sangue , Métodos Epidemiológicos , Hipertensão/complicações , Fotocoagulação a Laser/efeitos adversos , Doenças do Sistema Nervoso Periférico/epidemiologia , Triglicerídeos/sangueRESUMO
Diabetic retinopathy (DR) occurs in about 95% of patients with type 1 diabetes mellitus (DM) and in 60% of type 2 DM patients and it is the main cause of legal blindness in adult people. The aim of this manuscript was to review the main risk factors for DR. The major environmental risk factors are hyperglycemia, high blood pressure levels, and long-term duration of DM. However, not all patients will not develop DR, suggesting the presence of a genetic predisposition to DR, especially for severe forms of DR. Special strategies has been used to evaluate the genetic role in DR. Family studies shown that there is a familial aggregation of DR. Candidates genes have been studied (RAGE; VEGF; PPAR-delta; ICAM-1; ECA; ENPP 1; eNOS) and positive or negative associations with DR were demonstrated. Some chromosomes were also associated to DR in selected populations. Finally, genetic expression studies reinforce the association of candidate genes, or participation of others genes, with the presence of DR. DR is a common complication of DM and, along with non-genetic or environmental risk factors, the identification of genes related to DR could result in more specific and efficient DR treatment.
Assuntos
Diabetes Mellitus Tipo 1/complicações , Diabetes Mellitus Tipo 2/complicações , Retinopatia Diabética/etiologia , Cegueira/etiologia , Glicemia/análise , Nefropatias Diabéticas/complicações , Retinopatia Diabética/diagnóstico , Retinopatia Diabética/genética , Feminino , Predisposição Genética para Doença , Humanos , Hiperglicemia/complicações , Masculino , Fatores de RiscoRESUMO
A retinopatia diabética (RD) acomete cerca de 95 por cento dos pacientes com diabetes melito tipo 1 (DM1) e 60 por cento dos pacientes com diabetes melito tipo 2 (DM2), sendo a principal causa de cegueira legal em adultos. O objetivo desse manuscrito foi revisar os principais fatores de risco para RD. Os fatores de risco ambientais mais importantes são a hiperglicemia sustentada, os valores elevados de pressão arterial e a longa duração de DM. Entretanto, nem todos os pacientes desenvolvem RD, o que sugere a presença de fatores genéticos, em especial para as formas graves de RD. Diferentes estratégias têm sido utilizadas para avaliar o papel da genética na RD. Estudos de famílias demonstraram agregação familiar de RD. Genes candidatos têm sido estudados (RAGE; VEGF; PPAR-delta; ICAM-1; ECA; ENPP 1; eNOS), observando-se associações positivas ou negativas com a RD. Também alguns cromossomos, em populações selecionadas, foram associados à RD. Finalmente, estudos de expressão genética reforçam a associação de genes candidatos, ou determinam a participação de outros, com a presença da RD. A RD é uma complicação freqüente do DM e junto com os fatores não-genéticos ou ambientais, a identificação de genes relacionados à RD poderá resultar tratamentos mais específicos e eficazes para a RD.
Diabetic retinopathy (DR) occurs in about 95 percent of patients with type 1 diabetes mellitus (DM) and in 60 percent of type 2 DM patients and it is the main cause of legal blindness in adult people. The aim of this manuscript was to review the main risk factors for DR. The major environmental risk factors are hyperglycemia, high blood pressure levels, and long-term duration of DM. However, not all patients will not develop DR, suggesting the presence of a genetic predisposition to DR, especially for severe forms of DR. Special strategies has been used to evaluate the genetic role in DR. Family studies shown that there is a familial aggregation of DR. Candidates genes have been studied (RAGE; VEGF; PPAR-delta; ICAM-1; ECA; ENPP 1; eNOS) and positive or negative associations with DR were demonstrated. Some chromosomes were also associated to DR in selected populations. Finally, genetic expression studies reinforce the association of candidate genes, or participation of others genes, with the presence of DR. DR is a common complication of DM and, along with non-genetic or environmental risk factors, the identification of genes related to DR could result in more specific and efficient DR treatment.
Assuntos
Feminino , Humanos , Masculino , Diabetes Mellitus Tipo 1/complicações , /complicações , Retinopatia Diabética/etiologia , Cegueira/etiologia , Glicemia/análise , Nefropatias Diabéticas/complicações , Retinopatia Diabética/diagnóstico , Retinopatia Diabética/genética , Predisposição Genética para Doença , Hiperglicemia/complicações , Fatores de RiscoRESUMO
To investigate the relationship between diabetic retinopathy (DR) and 24-h ambulatory blood pressure (ABP) in a cohort of normotensive, normoalbuminuric type 1 diabetic patients. This is a 6.1+/-3.3 year prospective study of 44 normotensive, normoalbuminuric type 1 diabetic patients. ABP was measured at the beginning and at the end of the study. Measurements of urinary albumin excretion rate (UAER) and direct and indirect ophthalmoscopy after mydriasis were performed at the start and end of the study and at least once a year. DR was observed in 12 patients at baseline. At the end of the study, eight of these patients had progressed to more advanced stages of retinopathy. Four patients developed retinopathy after the study began. These patients were grouped and classified as progressors. At baseline, progressors were older, had longer duration of diabetes, higher levels of UAER, and higher 24-h diastolic (P=0.03) and diurnal diastolic blood pressure (P=0.03). UAER and diastolic blood pressure (24h or day) remained significantly associated with development and progression of DR after multivariate analysis. High normal ABP was associated with the development or progression of DR in this cohort of normotensive, normoalbuminuric type 1 diabetic patients. Abnormalities in blood pressure homeostasis could indicate higher susceptibility to DR.
Assuntos
Monitorização Ambulatorial da Pressão Arterial/métodos , Diabetes Mellitus Tipo 1/fisiopatologia , Retinopatia Diabética/fisiopatologia , Adulto , Glicemia/metabolismo , Pressão Sanguínea/fisiologia , Índice de Massa Corporal , Estudos de Coortes , Diabetes Mellitus Tipo 1/sangue , Retinopatia Diabética/sangue , Progressão da Doença , Feminino , Seguimentos , Hemoglobinas Glicadas/análise , Humanos , Lipídeos/sangue , Masculino , Valores de Referência , Sódio/urinaRESUMO
The aim of this study was to analyze the role of ACE gene insertion/deletion (I/D) and PC-1 gene K121Q polymorphisms in the changes of glomerular filtration rate (GFR), urinary albumin excretion rate (UAER), and blood pressure (BP) levels in a cohort of normoalbuminuric Type 1 diabetic patients. This is a 10.2+/-2.0-year prospective study of 30 normotensive normoalbuminuric Type 1 diabetic patients. UAER (immunoturbidimetry), GFR ((51)Cr-EDTA single injection technique), GHb (ion exchange chromatography), and BP levels were measured at baseline and at 1.7+/-0.6-year intervals. The presence of ACE gene I/D and PC-1 gene K121Q polymorphisms was determined by polymerase chain reaction (PCR) and restriction enzyme techniques. Three patients developed diabetic nephropathy (DN), all carriers of allele D. The presence of allele D was the only predictor (R(2)=.15, F=4.92, P=.035) of the observed GFR decline (-0.29+/-0.34 ml/min/month, P<.05). UAER increased during the study (log UAER=0.0275+/-0.042 microg/min/month, P=.002) and was associated with baseline UAER levels only (R(2)=.17, F=5.72, P=.024). A significant increase (P<.05) in cases of hypertension and retinopathy were observed in ID/DD (n=19) and not in II patients (n=11). Patients with the KQ/QQ genotype (n=8) presented a significant increase (P=.045) in new cases of retinopathy. In conclusion, the presence of the ACE gene D allele in this sample of normoalbuminuric normotensive Type 1 diabetic patients was associated with a higher proportion of microvascular complications and hypertension.
Assuntos
Diabetes Mellitus Tipo 1/genética , Taxa de Filtração Glomerular/fisiologia , Peptidil Dipeptidase A/genética , Diester Fosfórico Hidrolases/genética , Polimorfismo Genético , Pirofosfatases/genética , Adulto , Albuminúria , Sequência de Bases , Primers do DNA , Elementos de DNA Transponíveis , Diabetes Mellitus Tipo 1/fisiopatologia , Diabetes Mellitus Tipo 1/urina , Feminino , Seguimentos , Genótipo , Humanos , Masculino , Reação em Cadeia da Polimerase , Polimorfismo de Nucleotídeo Único , Estudos Prospectivos , Deleção de Sequência , Fatores de TempoRESUMO
Objetivo: Identificar as alterações retinianas em pacientes com hemoglobinopatia falciforme e comparar sua prevalência nos diferentes genótipos da doença em uma populaçäo de pacientes de hospital universitário de Porto Alegre - Brasil. Métodos: Realizou-se exame oftalmológico com avaliaçäo fundoscópica e estudo do genótipo de pacientes portadores de hemoglobinopatia falciforme.Resultados: Foram examinados 94 olhos de 47 pacientes com doença falciforme: 17 pacientes do sexo masculino e 30 feminino, com média de idades de 22,4 anos (ñ 16,8 anos). 20 pacientes possuíam genótipo SS, 10 possuíam SC, 10 possuíam AS, e 7 SThal. As alterações retinianas encontradas foram: hemorragia tipo "salmon patch" em 1 olho, hiperpigmentaçäo tipo "black sunburst" em 12 olhos, neovascularizaçäo tipo "sea fan" em 3 olhos, hemorragia vítrea em 1 olho e descolamento de retina em 1 olho. O grupo SC foi o que demonstrou ter maior freqüência de alteraçöes (60 porcento), e quando comparado com o grupo SS mostrou 4,0 vezes mais chance de apresentar retinopatia (p<0,05). Todos os 5 olhos com retinopatia proliferativa possuíam genótipo SC.Conclusões: A freqüência de alteraçöes fundoscópicas no grupo estudado bem como a gravidade das alterações (retinopatia proliferativa) säo maiores nos pacientes heterozigotos de genótipo SC, quando comparados com os demais genótipos
Assuntos
Humanos , Masculino , Feminino , Doença da Hemoglobina SC/genética , Doenças Retinianas/etiologia , Hemoglobinopatias , Brasil , Estudos Transversais , Doença da Hemoglobina SC/complicações , Genótipo , Hospitais UniversitáriosRESUMO
Este trabalho relata um estudo observacional realizado numa paciente que, durante o curso de uma gestaçäo normal, apresentou um quadro de descolamento seroso de neuro epitélio e do epitélio pigmentar bilateral e simultâneo nos dois olhos. O diagnóstico clínico foi compatível com corio-retinopatia serosa central. Os achados fundoscópicos foram avaliados através de exames repetidos de fundo de olho e pela angiofluoresceinografia. A evoluçäo do caso mostrou-se favorável ocorrendo completa reaplicaçäo das áreas de descolamento seroso na retina nos dois olhos, logo após o parto, sem que houvesse necessidade de fotocoagulaçäo por laser argônio nos pontos de vazamento de corante