Rosane Kupfer | PUC-RJ - Academia.edu (original) (raw)
Papers by Rosane Kupfer
Diabetes Research and Clinical Practice, 2010
Experimental and Clinical Endocrinology & Diabetes, 2011
To evaluate the prevalence of pancreatic auto-antibodies (PAb) as well as its relationship with H... more To evaluate the prevalence of pancreatic auto-antibodies (PAb) as well as its relationship with HLA DR B1 and PTPN22 polymorphisms in first degree relatives (FDR) of Brazilian patients with Type 1 diabetes (T1D) and multiethnic background.FDR of patients with T1D were interviewed and blood was sampled for PAb measurement, HLA DRB1 and PTPN22 genotyping. Genotyping was also performed in index cases.In FDR (n=78), 16.7% presented at least one PAb. These individuals had a higher prevalence of HLA DRB1* 03 than others (p=0.03), without differences in PTPN22 genotyping. While the genetic profile was similar in FDR with PAb and their index cases, those without PAb had a lower frequency of HLA DR B1 * 03 than their correspondent patients (p=0.009).In this multiethnic population, a significant proportion of FDR of T1D patients had PAb, which was associated with HLA DR B1 * 03 but not with the PTPN22 polymorphism.Type 1 diabetes and relatives: Antibodies, genetics
Research, Society and Development, 2020
Estima-se que existam mais de 30 mil pessoas com diabetes mellitus tipo 1 (DM1) no Brasil. Entre ... more Estima-se que existam mais de 30 mil pessoas com diabetes mellitus tipo 1 (DM1) no Brasil. Entre as complicações, a retinopatia diabética (RD) é uma das mais prevalentes, acometendo até 50% dos portadores de DM1 em algumas populações. Este estudo objetiva estimar a prevalência de RD em DM1 ou Diabetes autoimune latente em adultos (LADA), além de avaliar fatores de risco envolvidos. Foi realizado um estudo de corte-transversal avaliando 81 pacientes com mais de 18 anos e diagnosticados com DM tipo 1 de longa evolução. Aspectos demográficos, clínicos e laboratoriais foram avaliados através de questionário estruturado. Dados do exame oftalmológico foram coletados de prontuários. Observamos uma prevalência de 33% de RD em pacientes portadores de DM1 no estado do Ceará. Tal complicação foi mais associada a doentes com maior idade (p=0,004), maior tempo de DM1 (p<0,001), controle metabólico inadequado e principalmente, níveis aumentados de creatinina (p=0,011). Foi observado que pacien...
Diabetology & Metabolic Syndrome, 2020
Background In current management of type 2 diabetes (T2DM), cardiovascular and renal prevention h... more Background In current management of type 2 diabetes (T2DM), cardiovascular and renal prevention have become important targets to be achieved. In this context, a joint panel of four endocrinology societies from Brazil and Portugal was established to develop an evidence-based guideline for treatment of hyperglycemia in T2DM. Methods MEDLINE (via PubMed) was searched for randomized clinical trials, meta-analyses, and observational studies related to diabetes treatment. When there was insufficient high-quality evidence, expert opinion was sought. Updated positions on treatment of T2DM patients with heart failure (HF), atherosclerotic CV disease (ASCVD), chronic kidney disease (CKD), and patients with no vascular complications were developed. The degree of recommendation and the level of evidence were determined using predefined criteria. Results and conclusions In non-pregnant adults, the recommended HbA1c target is below 7%. Higher levels are recommended in frail older adults and patie...
Diabetes Research and Clinical Practice, 2011
Aims: The present study evaluated the relationship between metabolic syndrome (MS), body fat comp... more Aims: The present study evaluated the relationship between metabolic syndrome (MS), body fat composition and epicardial adipose tissue (EAT) in type 1 diabetes. Epicardial adipose tissue is a new independent marker of coronary artery disease (CAD). Methods: Forty-five type 1 diabetic women were evaluated (age 36 AE 9 years; body mass index 24.6 AE 4.4 kg/m 2). Metabolic syndrome was defined by the World Health Organization criteria. Body fat composition and EAT were analyzed by dual-energy-X-ray absorptiometry and echocardiogram, respectively. Results: Twenty patients (45%) had MS. Patients with MS had greater android (central) fat deposition than patients without MS (41.9 AE 2.0% vs. 33.7 AE 1.8%, p = 0.004). Total body fat and gynoid (peripheric) fat distribution were similar between the groups. Mean EAT was higher in patients with MS (6.15 AE 0.34 mm vs. 4.96 AE 0.25 mm; p = 0.006) and EAT was positively correlated with android (central) fat distribution (r = 0.44; p = 0.002), however no correlation was found with gynoid (peripheric) fat distribution. Conclusions: There was a high incidence of MS in type 1 diabetes related to increased central adiposity, despite the absence of obesity. Metabolic syndrome and central obesity were associated with increased EAT. Thus, young non-obese type 1 diabetic women with central adiposity and/or MS may have increased EAT, what may predict CAD risk.
… de Endocrinologia e …, 2010
Anticorpos anti-descarboxilase do ácido glutâmico positivo (anti-GAD+) e peptídeo C (PC) detectáv... more Anticorpos anti-descarboxilase do ácido glutâmico positivo (anti-GAD+) e peptídeo C (PC) detectável podem estar presentes no Diabetes Melito tipo1 (DMT1) de longa duração, embora não se saiba a importância disto. Objetivo: Avaliar se anti-GAD+ e PC detectável se associam com ...
Objective: Our aim was to determine the relationship between body fat composition, metabolic synd... more Objective: Our aim was to determine the relationship between body fat composition, metabolic syndrome (MS), and insulin resistance in type 1 diabetes (DM1). Subjects and methods: Forty-five DM1 women (36 ± 9 years; body mass index 24.6 ± 4.4 kg/m 2) had body composition and insulin resistance determined by dual-energy X-ray absorptiometry and estimated glucose disposal ratio (eGDR), respectively. Twenty patients (45%) had MS according to World Health Organization (WHO) criteria. Results: Women with DM1 and MS had increased central fat and lower eGDR than women without MS (41.9 ± 2.0 vs. 33.7 ± 1.8%; p = 0.004 and 4.99 ± 0.40 vs. 8.37 ± 0.39; p < 0.0001, respectively). Total body fat and peripheric fat were similar between the groups. Central fat negatively correlated with eGDR (r =-0.33; p = 0.03). Conclusion: Central fat deposition in young non-obese DM1 women was related to MS and insulin resistance. Thus, body fat composition analysis might be important to identify DM1 patients with increased metabolic risk.
![Research paper thumbnail of [Pancreatic function assessment in type 1 diabetes mellitus patients according to disease duration]](https://attachments.academia-assets.com/82682958/thumbnails/1.jpg)
](UNLABELLED Patients with type 1 diabetes (T1D) may exhibit some residual insulin secretion for ma... more UNLABELLED Patients with type 1 diabetes (T1D) may exhibit some residual insulin secretion for many years after their diagnosis. This has been associated with a more favorable prognosis. OBJECTIVE To analyze insulin secretion in individuals with T1D using C-peptide (CP) response to glucagon and comparing patients with recent onset (<5 years - Group 1) and long-standing disease (>5 years -Group 2). METHODS Subjects with T1D had their blood sampled before (fasting) and 6 minutes after glucagon infusion for CP, HbA1c and anti-GAD measurement. RESULTS Forty-three individuals were evaluated, 22 in Group 1 and 21 in Group 2. Preserved insulin secretion (CP >1.5 ng/mL) was observed in 6 (13.9%) and in 8 (18.6%) patients before (CP 1) and after (CP 2) glucagon stimulus, respectively, showing no difference between the groups (p=0.18 and 0.24). CP 1 and CP 2 were detectable (>0.5 ng/dL) in 13 (30.2%) and 18 (41.9%) patients, respectively. Both were more frequent in Group 1 than in...
Revista brasileira de medicina, 2006
The aim of this study is to estimate the ratio of the Metabolic Syndrome (MS) among adults with T... more The aim of this study is to estimate the ratio of the Metabolic Syndrome (MS) among adults with Type 1 Diabetes (DM1) according to the International Diabetes Federation (IDF), National Cholesterol Education Program (NCEP) and World Health Organization (WHO) criteria. In addition, we assessed whether MS is associated with microvascular complications, age, diabetes duration and glycemic control. This is a cross-sectional study with 101 patients from the Rio de Janeiro Diabetes Institute. The overall percentage of MS in patients with DM1 was 32%, 32% and 26%, respectively, according to WHO, NCEP and IDF criteria. There was an increase in the ratio of MS related to the duration of diabetes when we applied WHO (p= 0.0009) and IDF (p= 0.0004) criteria and but not with NCEP criteria (p= 0.3151). MS correlated with with age, as seen in those patients above 40 years-old and when we used WHO (p=0.011) and IDF (p=0.0003) criteria. In the same way, patients with poor glycemic control had more M...
Archives of Endocrinology and Metabolism
Archives of Endocrinology and Metabolism
Objective: We aimed to identify the frequency of monogenic diabetes, which is poorly studied in m... more 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/m 2 ; 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.
Journal of Eating Disorders
Background: Eating behavior is an important aspect related to type 2 diabetes mellitus (T2DM) tre... more Background: Eating behavior is an important aspect related to type 2 diabetes mellitus (T2DM) treatment and may have an impact on glycemic control. Previous reports showed elevated prevalence of eating disordered behaviors, especially binge eating disorder in clinical samples of type 2 diabetes patients. However, results regarding the impact of an eating disorder on the glycemic and clinical control of T2DM is inconsistent. The purpose of this study was to assess the impact of a comorbid eating disorder on glycemic control (GC) in a group of patients with T2DM. Methods: Eating behaviors of 70 consecutive patients with T2DM were assessed using a Structured Clinical Interview for DSM-IV and the Binge Eating Scale. The GC was examined with fasting blood glucose (FBG) and glycated hemoglobin (A1c) levels. In addition, secondary clinical variables were assessed, including body mass index (BMI) and lipids. Chi-square and Student's T tests were used to compare clinical and psychopathological characteristics of patients with and without an ED. In order to evaluate the relationship between GC and eating disorder (ED) a linear regression analysis was performed, controlling for BMI. A significance level of 5% was adopted. Results: Seventy-seven percent of the sample (n = 54) were female and 50% were obese. Fourteen patients exhibited an ED, mostly binge eating disorder (BED). In a regression analysis, both FBG (beta coefficient = 47.4 (22.3); p = 0.037) and A1c (beta coefficient = 1.12 (0.57); p = 0.05) were predicted by the presence of an ED. However, the presence of an ED lost its impact on glycemic control outcomes after the addition of the BMI in the models. Conclusions: Eating psychopathology is frequently observed in patients with T2DM. Among individuals with T2DM, co-morbid ED is associated with a poorer glycemic control in the presence of a higher BMI. The presence of an eating disordered behavior in patients with T2DM seems to have clinical relevance in the usual care of patients with diabetes. Therefore, we recommend eating psychopathology should be routinely assessed in T2DM patients.
Archives of endocrinology and metabolism, Jan 24, 2016
The aim of this study was to evaluate how different parameters of short-term glycemic control wou... more The aim of this study was to evaluate how different parameters of short-term glycemic control would correlate with the perception of health-related quality of life (HRQoL) in patients with type 1 diabetes mellitus (T1D). A total of 50 T1D patients aged 18 to 50 years were evaluated with the questionnaires Problem Areas in Diabetes (PAID) scale and Diabetes Quality of Life (DQOL) measure after 30 days of self-monitoring of blood glucose (SMBG). Glycemic control was evaluated using glycated hemoglobin (HbA1c), mean glucose levels (MGL) in the prior month's data from SMBG (Accu-Check 360o), number of hypoglycemic episodes (< 70 mg/dL and < 50 mg/dL), and glycemic variability (GV). PAID correlated positively with MGL (r = 0.52; p < 0.001) and HbA1c (r = 0.36; p < 0.0097), but not with GV (r = 0.17; p = 0.23) or number of hypoglycemic episodes (r = 0.15; p = 0.17 for glucose < 70 mg/dL and r = 0.02; p = 0.85 for glucose < 50 mg/dL). After multiple linear regression,...
Journal Of Clinical Periodontology
Hypoglycemia is a critical and limiting factor of a good metabolic control and can adversely affe... more Hypoglycemia is a critical and limiting factor of a good metabolic control and can adversely affect the quality of life of diabetic patients. The aim of the study was to evaluate the health-related quality of life and calculate utilities values associated with hypoglycemia in patients with type 1 diabetes mellitus (T1DM). A multicenter, cross-sectional and observational study with T1DM patients from reference centers of the Brazilian public health system was conducted in three cities. Demographic and clinical data were collected, besides details on the frequency and severity of hypoglycemia. Health-related quality of life was assessed using EQ-5D instrument and utility values generated. 221 patients (107 women, 114 men), aged 29.8 ± 11.6 and disease duration of 14.2 ± 9.1 years were included. Most patients (n = 214, 96.8%) reported at least one symptomatic hypoglycemia in the last three months, 68% (n = 150) reported nocturnal episodes and 34.8% (n = 77) reported severe episodes. High frequency (daily or weekly) was observed in 38.6 and 26% of those reporting nocturnal or severe hypoglycemia, respectively. The median visual analog scale was 70 [60-85] for all patients, with differences between those with and without severe hypoglycemia (70 [60-80] vs 80 [61-90]; p = 0.006) and those with high and low frequency (62.5 [50-72.25] vs 70 [60-80]; p = 0.007). The median utility values was 0.801 [0.756-1.000] for all patients, with difference between those with high and low frequency of severe episodes (0.737 [0.628-1.000] vs 0.801 [0.756-1.000]; p = 0.02). This study shows the high frequency of hypoglycemia in a sample of T1DM patients treated in three reference centers of the Brazilian public health system and the impact of severe episodes on health-related quality of life. Utility values were generated and can be used in economic analysis for treatments that could decrease hypoglycemia and consequently improve quality of life.
Archives of Endocrinology and Metabolism, 2017
Objective: This study aimed to evaluate the occurrence and clinical predictors of subclinical ath... more Objective: This study aimed to evaluate the occurrence and clinical predictors of subclinical atherosclerosis in asymptomatic, young adult women with type 1 DM. Subjects and methods: The study included 45 women with type 1 diabetes mellitus (DM) (aged 36 ± 9 years) who underwent carotid Doppler ultrasound evaluation to determine the carotid artery intima-media thickness (CIMT) and to assess the occurrence of carotid artery plaques. Insulin sensitivity was assessed by estimated glucose disposal rate (eGDR), and metabolic syndrome (MS) was defined by the World Health Organization criteria. Results: The cohort had a mean age of 36 ± 9 years, diabetes duration of 18.1 ± 9.5 years, and body mass index (BMI) of 24.6 ± 2.4 kg/m 2. MS was present in 44.4% of the participants. The CIMT was 0.25 ± 0.28 mm, and the prevalence of carotid artery plaques was 13%. CIMT correlated positively with hypertension (p = 0.04) and waist-to-hip ratio (r = 0.37, p = 0.012). The presence of carotid artery plaques correlated positively with age (p = 0.018) and hypertension (p = 0.017). eGDR correlated negatively with CIMT (r =-0.39, p = 0.009) and carotid plaques (p = 0.04). Albuminuria showed a correlation trend with CIMT (p = 0.06). Patients with carotid artery plaques were older, had a higher prevalence of hypertension, and lower eGDR. No correlation was found between CIMT and carotid plaques with diabetes duration, MS, BMI, cholesterol profile, glycated hemoglobin, high-sensitivity C-reactive protein, or fibrinogen. Conclusion: Insulin resistance, central obesity, hypertension, and older age were predictors of subclinical atherosclerosis in asymptomatic, young adult women with type 1 DM.
Diabetology & Metabolic Syndrome, 2015
Diabetology & Metabolic Syndrome, 2015
Diabetology & Metabolic Syndrome, 2015
Diabetes Research and Clinical Practice, 2010
Experimental and Clinical Endocrinology & Diabetes, 2011
To evaluate the prevalence of pancreatic auto-antibodies (PAb) as well as its relationship with H... more To evaluate the prevalence of pancreatic auto-antibodies (PAb) as well as its relationship with HLA DR B1 and PTPN22 polymorphisms in first degree relatives (FDR) of Brazilian patients with Type 1 diabetes (T1D) and multiethnic background.FDR of patients with T1D were interviewed and blood was sampled for PAb measurement, HLA DRB1 and PTPN22 genotyping. Genotyping was also performed in index cases.In FDR (n=78), 16.7% presented at least one PAb. These individuals had a higher prevalence of HLA DRB1* 03 than others (p=0.03), without differences in PTPN22 genotyping. While the genetic profile was similar in FDR with PAb and their index cases, those without PAb had a lower frequency of HLA DR B1 * 03 than their correspondent patients (p=0.009).In this multiethnic population, a significant proportion of FDR of T1D patients had PAb, which was associated with HLA DR B1 * 03 but not with the PTPN22 polymorphism.Type 1 diabetes and relatives: Antibodies, genetics
Research, Society and Development, 2020
Estima-se que existam mais de 30 mil pessoas com diabetes mellitus tipo 1 (DM1) no Brasil. Entre ... more Estima-se que existam mais de 30 mil pessoas com diabetes mellitus tipo 1 (DM1) no Brasil. Entre as complicações, a retinopatia diabética (RD) é uma das mais prevalentes, acometendo até 50% dos portadores de DM1 em algumas populações. Este estudo objetiva estimar a prevalência de RD em DM1 ou Diabetes autoimune latente em adultos (LADA), além de avaliar fatores de risco envolvidos. Foi realizado um estudo de corte-transversal avaliando 81 pacientes com mais de 18 anos e diagnosticados com DM tipo 1 de longa evolução. Aspectos demográficos, clínicos e laboratoriais foram avaliados através de questionário estruturado. Dados do exame oftalmológico foram coletados de prontuários. Observamos uma prevalência de 33% de RD em pacientes portadores de DM1 no estado do Ceará. Tal complicação foi mais associada a doentes com maior idade (p=0,004), maior tempo de DM1 (p<0,001), controle metabólico inadequado e principalmente, níveis aumentados de creatinina (p=0,011). Foi observado que pacien...
Diabetology & Metabolic Syndrome, 2020
Background In current management of type 2 diabetes (T2DM), cardiovascular and renal prevention h... more Background In current management of type 2 diabetes (T2DM), cardiovascular and renal prevention have become important targets to be achieved. In this context, a joint panel of four endocrinology societies from Brazil and Portugal was established to develop an evidence-based guideline for treatment of hyperglycemia in T2DM. Methods MEDLINE (via PubMed) was searched for randomized clinical trials, meta-analyses, and observational studies related to diabetes treatment. When there was insufficient high-quality evidence, expert opinion was sought. Updated positions on treatment of T2DM patients with heart failure (HF), atherosclerotic CV disease (ASCVD), chronic kidney disease (CKD), and patients with no vascular complications were developed. The degree of recommendation and the level of evidence were determined using predefined criteria. Results and conclusions In non-pregnant adults, the recommended HbA1c target is below 7%. Higher levels are recommended in frail older adults and patie...
Diabetes Research and Clinical Practice, 2011
Aims: The present study evaluated the relationship between metabolic syndrome (MS), body fat comp... more Aims: The present study evaluated the relationship between metabolic syndrome (MS), body fat composition and epicardial adipose tissue (EAT) in type 1 diabetes. Epicardial adipose tissue is a new independent marker of coronary artery disease (CAD). Methods: Forty-five type 1 diabetic women were evaluated (age 36 AE 9 years; body mass index 24.6 AE 4.4 kg/m 2). Metabolic syndrome was defined by the World Health Organization criteria. Body fat composition and EAT were analyzed by dual-energy-X-ray absorptiometry and echocardiogram, respectively. Results: Twenty patients (45%) had MS. Patients with MS had greater android (central) fat deposition than patients without MS (41.9 AE 2.0% vs. 33.7 AE 1.8%, p = 0.004). Total body fat and gynoid (peripheric) fat distribution were similar between the groups. Mean EAT was higher in patients with MS (6.15 AE 0.34 mm vs. 4.96 AE 0.25 mm; p = 0.006) and EAT was positively correlated with android (central) fat distribution (r = 0.44; p = 0.002), however no correlation was found with gynoid (peripheric) fat distribution. Conclusions: There was a high incidence of MS in type 1 diabetes related to increased central adiposity, despite the absence of obesity. Metabolic syndrome and central obesity were associated with increased EAT. Thus, young non-obese type 1 diabetic women with central adiposity and/or MS may have increased EAT, what may predict CAD risk.
… de Endocrinologia e …, 2010
Anticorpos anti-descarboxilase do ácido glutâmico positivo (anti-GAD+) e peptídeo C (PC) detectáv... more Anticorpos anti-descarboxilase do ácido glutâmico positivo (anti-GAD+) e peptídeo C (PC) detectável podem estar presentes no Diabetes Melito tipo1 (DMT1) de longa duração, embora não se saiba a importância disto. Objetivo: Avaliar se anti-GAD+ e PC detectável se associam com ...
Objective: Our aim was to determine the relationship between body fat composition, metabolic synd... more Objective: Our aim was to determine the relationship between body fat composition, metabolic syndrome (MS), and insulin resistance in type 1 diabetes (DM1). Subjects and methods: Forty-five DM1 women (36 ± 9 years; body mass index 24.6 ± 4.4 kg/m 2) had body composition and insulin resistance determined by dual-energy X-ray absorptiometry and estimated glucose disposal ratio (eGDR), respectively. Twenty patients (45%) had MS according to World Health Organization (WHO) criteria. Results: Women with DM1 and MS had increased central fat and lower eGDR than women without MS (41.9 ± 2.0 vs. 33.7 ± 1.8%; p = 0.004 and 4.99 ± 0.40 vs. 8.37 ± 0.39; p < 0.0001, respectively). Total body fat and peripheric fat were similar between the groups. Central fat negatively correlated with eGDR (r =-0.33; p = 0.03). Conclusion: Central fat deposition in young non-obese DM1 women was related to MS and insulin resistance. Thus, body fat composition analysis might be important to identify DM1 patients with increased metabolic risk.
UNLABELLED Patients with type 1 diabetes (T1D) may exhibit some residual insulin secretion for ma... more UNLABELLED Patients with type 1 diabetes (T1D) may exhibit some residual insulin secretion for many years after their diagnosis. This has been associated with a more favorable prognosis. OBJECTIVE To analyze insulin secretion in individuals with T1D using C-peptide (CP) response to glucagon and comparing patients with recent onset (<5 years - Group 1) and long-standing disease (>5 years -Group 2). METHODS Subjects with T1D had their blood sampled before (fasting) and 6 minutes after glucagon infusion for CP, HbA1c and anti-GAD measurement. RESULTS Forty-three individuals were evaluated, 22 in Group 1 and 21 in Group 2. Preserved insulin secretion (CP >1.5 ng/mL) was observed in 6 (13.9%) and in 8 (18.6%) patients before (CP 1) and after (CP 2) glucagon stimulus, respectively, showing no difference between the groups (p=0.18 and 0.24). CP 1 and CP 2 were detectable (>0.5 ng/dL) in 13 (30.2%) and 18 (41.9%) patients, respectively. Both were more frequent in Group 1 than in...
Revista brasileira de medicina, 2006
The aim of this study is to estimate the ratio of the Metabolic Syndrome (MS) among adults with T... more The aim of this study is to estimate the ratio of the Metabolic Syndrome (MS) among adults with Type 1 Diabetes (DM1) according to the International Diabetes Federation (IDF), National Cholesterol Education Program (NCEP) and World Health Organization (WHO) criteria. In addition, we assessed whether MS is associated with microvascular complications, age, diabetes duration and glycemic control. This is a cross-sectional study with 101 patients from the Rio de Janeiro Diabetes Institute. The overall percentage of MS in patients with DM1 was 32%, 32% and 26%, respectively, according to WHO, NCEP and IDF criteria. There was an increase in the ratio of MS related to the duration of diabetes when we applied WHO (p= 0.0009) and IDF (p= 0.0004) criteria and but not with NCEP criteria (p= 0.3151). MS correlated with with age, as seen in those patients above 40 years-old and when we used WHO (p=0.011) and IDF (p=0.0003) criteria. In the same way, patients with poor glycemic control had more M...
Archives of Endocrinology and Metabolism
Archives of Endocrinology and Metabolism
Objective: We aimed to identify the frequency of monogenic diabetes, which is poorly studied in m... more 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/m 2 ; 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.
Journal of Eating Disorders
Background: Eating behavior is an important aspect related to type 2 diabetes mellitus (T2DM) tre... more Background: Eating behavior is an important aspect related to type 2 diabetes mellitus (T2DM) treatment and may have an impact on glycemic control. Previous reports showed elevated prevalence of eating disordered behaviors, especially binge eating disorder in clinical samples of type 2 diabetes patients. However, results regarding the impact of an eating disorder on the glycemic and clinical control of T2DM is inconsistent. The purpose of this study was to assess the impact of a comorbid eating disorder on glycemic control (GC) in a group of patients with T2DM. Methods: Eating behaviors of 70 consecutive patients with T2DM were assessed using a Structured Clinical Interview for DSM-IV and the Binge Eating Scale. The GC was examined with fasting blood glucose (FBG) and glycated hemoglobin (A1c) levels. In addition, secondary clinical variables were assessed, including body mass index (BMI) and lipids. Chi-square and Student's T tests were used to compare clinical and psychopathological characteristics of patients with and without an ED. In order to evaluate the relationship between GC and eating disorder (ED) a linear regression analysis was performed, controlling for BMI. A significance level of 5% was adopted. Results: Seventy-seven percent of the sample (n = 54) were female and 50% were obese. Fourteen patients exhibited an ED, mostly binge eating disorder (BED). In a regression analysis, both FBG (beta coefficient = 47.4 (22.3); p = 0.037) and A1c (beta coefficient = 1.12 (0.57); p = 0.05) were predicted by the presence of an ED. However, the presence of an ED lost its impact on glycemic control outcomes after the addition of the BMI in the models. Conclusions: Eating psychopathology is frequently observed in patients with T2DM. Among individuals with T2DM, co-morbid ED is associated with a poorer glycemic control in the presence of a higher BMI. The presence of an eating disordered behavior in patients with T2DM seems to have clinical relevance in the usual care of patients with diabetes. Therefore, we recommend eating psychopathology should be routinely assessed in T2DM patients.
Archives of endocrinology and metabolism, Jan 24, 2016
The aim of this study was to evaluate how different parameters of short-term glycemic control wou... more The aim of this study was to evaluate how different parameters of short-term glycemic control would correlate with the perception of health-related quality of life (HRQoL) in patients with type 1 diabetes mellitus (T1D). A total of 50 T1D patients aged 18 to 50 years were evaluated with the questionnaires Problem Areas in Diabetes (PAID) scale and Diabetes Quality of Life (DQOL) measure after 30 days of self-monitoring of blood glucose (SMBG). Glycemic control was evaluated using glycated hemoglobin (HbA1c), mean glucose levels (MGL) in the prior month's data from SMBG (Accu-Check 360o), number of hypoglycemic episodes (< 70 mg/dL and < 50 mg/dL), and glycemic variability (GV). PAID correlated positively with MGL (r = 0.52; p < 0.001) and HbA1c (r = 0.36; p < 0.0097), but not with GV (r = 0.17; p = 0.23) or number of hypoglycemic episodes (r = 0.15; p = 0.17 for glucose < 70 mg/dL and r = 0.02; p = 0.85 for glucose < 50 mg/dL). After multiple linear regression,...
Journal Of Clinical Periodontology
Hypoglycemia is a critical and limiting factor of a good metabolic control and can adversely affe... more Hypoglycemia is a critical and limiting factor of a good metabolic control and can adversely affect the quality of life of diabetic patients. The aim of the study was to evaluate the health-related quality of life and calculate utilities values associated with hypoglycemia in patients with type 1 diabetes mellitus (T1DM). A multicenter, cross-sectional and observational study with T1DM patients from reference centers of the Brazilian public health system was conducted in three cities. Demographic and clinical data were collected, besides details on the frequency and severity of hypoglycemia. Health-related quality of life was assessed using EQ-5D instrument and utility values generated. 221 patients (107 women, 114 men), aged 29.8 ± 11.6 and disease duration of 14.2 ± 9.1 years were included. Most patients (n = 214, 96.8%) reported at least one symptomatic hypoglycemia in the last three months, 68% (n = 150) reported nocturnal episodes and 34.8% (n = 77) reported severe episodes. High frequency (daily or weekly) was observed in 38.6 and 26% of those reporting nocturnal or severe hypoglycemia, respectively. The median visual analog scale was 70 [60-85] for all patients, with differences between those with and without severe hypoglycemia (70 [60-80] vs 80 [61-90]; p = 0.006) and those with high and low frequency (62.5 [50-72.25] vs 70 [60-80]; p = 0.007). The median utility values was 0.801 [0.756-1.000] for all patients, with difference between those with high and low frequency of severe episodes (0.737 [0.628-1.000] vs 0.801 [0.756-1.000]; p = 0.02). This study shows the high frequency of hypoglycemia in a sample of T1DM patients treated in three reference centers of the Brazilian public health system and the impact of severe episodes on health-related quality of life. Utility values were generated and can be used in economic analysis for treatments that could decrease hypoglycemia and consequently improve quality of life.
Archives of Endocrinology and Metabolism, 2017
Objective: This study aimed to evaluate the occurrence and clinical predictors of subclinical ath... more Objective: This study aimed to evaluate the occurrence and clinical predictors of subclinical atherosclerosis in asymptomatic, young adult women with type 1 DM. Subjects and methods: The study included 45 women with type 1 diabetes mellitus (DM) (aged 36 ± 9 years) who underwent carotid Doppler ultrasound evaluation to determine the carotid artery intima-media thickness (CIMT) and to assess the occurrence of carotid artery plaques. Insulin sensitivity was assessed by estimated glucose disposal rate (eGDR), and metabolic syndrome (MS) was defined by the World Health Organization criteria. Results: The cohort had a mean age of 36 ± 9 years, diabetes duration of 18.1 ± 9.5 years, and body mass index (BMI) of 24.6 ± 2.4 kg/m 2. MS was present in 44.4% of the participants. The CIMT was 0.25 ± 0.28 mm, and the prevalence of carotid artery plaques was 13%. CIMT correlated positively with hypertension (p = 0.04) and waist-to-hip ratio (r = 0.37, p = 0.012). The presence of carotid artery plaques correlated positively with age (p = 0.018) and hypertension (p = 0.017). eGDR correlated negatively with CIMT (r =-0.39, p = 0.009) and carotid plaques (p = 0.04). Albuminuria showed a correlation trend with CIMT (p = 0.06). Patients with carotid artery plaques were older, had a higher prevalence of hypertension, and lower eGDR. No correlation was found between CIMT and carotid plaques with diabetes duration, MS, BMI, cholesterol profile, glycated hemoglobin, high-sensitivity C-reactive protein, or fibrinogen. Conclusion: Insulin resistance, central obesity, hypertension, and older age were predictors of subclinical atherosclerosis in asymptomatic, young adult women with type 1 DM.
Diabetology & Metabolic Syndrome, 2015
Diabetology & Metabolic Syndrome, 2015
Diabetology & Metabolic Syndrome, 2015