Background: In-hospital hyperglycemia poses significant risks for patients with diabetes mellitus undergoing coronary artery bypass graft (CABG) surgery. Electronic glycemic management systems (eGMSs) like InsulinAPP offer promise in standardizing and improving glycemic control (GC) in these settings. This study evaluated the efficacy of the InsulinAPP protocol in optimizing GC and reducing adverse outcomes post-CABG. Methods: This prospective, randomized, open-label study was conducted with 100 adult type 2 diabetes mellitus (T2DM) patients post-CABG surgery, who were randomized into two groups: conventional care (gCONV) and eGMS protocol (gAPP). The gAPP used InsulinAPP for insulin therapy management, whereas the gCONV received standard clinical care. The primary outcome was a composite of hospital-acquired infections, renal function deterioration, and symptomatic atrial arrhythmia. Secondary outcomes included GC, hypoglycemia incidence, hospital stay length, and costs. Results: The gAPP achieved lower mean glucose levels (167.2 ± 42.5 mg/dL vs 188.7 ± 54.4 mg/dL; P = .040) and fewer patients-day with BG above 180 mg/dL (51.3% vs 74.8%, P = .011). The gAPP received an insulin regimen that included more prandial bolus and correction insulin (either bolus-correction or basal-bolus regimens) than the gCONV (90.3% vs 16.7%). The primary composite outcome occurred in 16% of gAPP patients compared with 58% in gCONV ( P < .010). Hypoglycemia incidence was lower in the gAPP (4% vs 16%, P = .046). The gAPP protocol also resulted in shorter hospital stays and reduced costs. Conclusions: The InsulinAPP protocol effectively optimizes GC and reduces adverse outcomes in T2DM patients’ post-CABG surgery, offering a cost-effective solution for inpatient diabetes management.

Introduction: Diabetic retinopathy (DR) and obstructive coronary artery disease (OCAD) are the main microvascular and macrovascular complications of diabetes mellitus (DM), respectively. The assessment of DR by means of spectral domain optical coherence tomography (SD-OCT) and angiography (OCTA) conferred a remarkable progress. Objective: investigate if SD-OCT and OCTA can detect DR that is associated with OCAD, determined by coronary angiotomography (CCTA) Hypothesis: DR, assessed by OCTA and OCT-SD, is associated with OCAD, assessed by CCTA Methods: In this single-center, cross-sectional, single-blind study, patients with DM who had undergone CCTA in the previous 3 years (independent indication) were eligible. They were divided according to the presence of OCAD in two groups and underwent SD-OCT and OCTA. The association between OCAD and DR was evaluated through uni and multivariate analysis and another analysis was performed to identify variables independently associated with the presence of DR. Results: We included 171 patients, 87 OCAD and 84 without OCAD. Age (66 vs 64 y,p=0.28), DM duration (12 vs 13 y, p=0.5) and HbA1c (7.5% vs 6,9%,p=0.08) did not differ. Patients with OCAD were more frequently men (74% vs 38%, P<0.01), had a higher prevalence of insulin use (52% vs 38%, p<0.01) and 64% had already undergone some type of revascularization. SD-OCT and OCTA revealed a higher prevalence of DR (48% vs 22%,p=0.01). The main findings were: microaneurysms (25% vs 13%,p=0.04), intraretinal cysts (22% vs 8%, p=0.01) and areas of reduced capillary density in the superficial retinal plexus (46% vs 20%,p<0.01).We also found lower mean vascular density (MVD) (15.7 vs 16.5, p=0.049) and lower circularity of the foveal avascular zone(FAZ) (0.64±0.1 vs 0.69±0.1, p= 0.04).There were significant and negative correlations between Duke coronary score and MVD (r=-0.189; p=0.03) and circularity of the FAZ (r=-0,206; p= 0.02). In an adjusted model, presence of OCAD increased the chance of DR (OR 4.05 [1.4 -11.6], p<0.01). OCAD, DM duration and insulin use were independently associated to DR. Conclusions: OCAD was associated with a greater chance of presenting DR. OCAD, longer DM duration and insulin use were independently associated to the presence of DR.

We measured plasma-derived extracellular vesicle (EV) proteins and their microRNA (miRNA) cargos in normoglycemic (NG), glucose intolerant (GI), and newly diagnosed diabetes mellitus (DM) in middle-aged male participants of the Brazilian Longitudinal Study of Adult Health (ELSA-Brazil). Mass spectrometry revealed decreased IGHG-1 and increased ITIH2 protein levels in the GI group compared with that in the NG group and higher serotransferrin in EVs in the DM group than in those in the NG and GI groups. The GI group also showed increased serum ferritin levels, as evaluated by biochemical analysis, compared with those in both groups. Seventeen miRNAs were differentially expressed (DEMiRs) in the plasma EVs of the three groups. DM patients showed upregulation of miR-141-3p and downregulation of miR-324-5p and -376c-3p compared with the NG and GI groups. The DM and GI groups showed increased miR-26b-5p expression compared with that in the NG group. The DM group showed decreased miR-374b-5p levels compared with those in the GI group and higher concentrations than those in the NG group. Thus, three EV proteins and five DEMiR cargos have potential prognostic importance for diabetic complications mainly associated with the immune function and iron status of GI and DM patients.

This study evaluated the relationship between the zinc-related nutritional status and glycemic and insulinemic markers in individuals with type 2 diabetes mellitus (T2DM). A total of 82 individuals with T2DM aged between 29 and 59 years were evaluated. The concentration of zinc in the plasma, erythrocytes, and urine was determined by the flame atomic absorption spectrometry method. Dietary intake was assessed using a 3-day 24-h recall. In addition, concentrations of serum glucose, glycated hemoglobin percentage, total cholesterol and fractions, triglycerides, and serum insulin were determined. The insulin resistance index (HOMA-IR) and β-cell function (HOMA- β) were calculated. The markers of zinc status (plasma: 83.3±11.9μg/dL, erythrocytes: 30.1±4.6μg/g Hb, urine: 899.1±622.4μg Zn/24h, and dietary: 9.9±0.8mg/day) were classified in tertiles and compared to insulinemic and glycemic markers. The results showed that lower zinc concentrations in plasma and erythrocytes, as well as its high urinary excretion, were associated with higher percentages of glycated hemoglobin, reflecting a worse glycemic control in individuals with T2DM (p<0.05). Furthermore, there was a significant inverse correlation between plasma zinc levels and glycated hemoglobin percentage (r=−0.325, p=0.003), and a positive correlation between urinary zinc excretion and glycemia (r=0.269, p=0.016), glycated hemoglobin percentage (r=0.318, p=0.004) and HOMA-IR (r=0.289, p=0.009). According to our study results, conclude that T2DM individuals with reduced zinc status exhibited poor glycemic control.

Inpatient hyperglycemia is associated with adverse outcomes in hospitalized patients, with or without known diabetes. The adherence to American College of Endocrinology and American Diabetes Association guidelines recommendations for inpatient glycemic control is still poor, probably because of their complexity and fear of hypoglycemia.

The impact of dietary fatty acids in atherosclerosis development may be partially attributed to their effect on macrophage cholesterol homeostasis. This process is the result of interplay between cholesterol uptake and efflux, which are permeated by inflammation and oxidative stress. Although saturated fatty acids (SAFAs) do not influence cholesterol efflux, they trigger endoplasmic reticulum stress, which culminates in increased lectin-like oxidized LDL (oxLDL) receptor (LOX1) expression and, consequently, oxLDL uptake, leading to apoptosis. Unsaturated fatty acids prevent most SAFAs-mediated deleterious effects and are generally associated with reduced cholesterol efflux, although α-linolenic acid increases cholesterol export. Trans fatty acids increase macrophage cholesterol content by reducing ABCA-1 expression, leading to strong atherosclerotic plaque formation. As isomers of conjugated linoleic acid (CLAs) are strong PPAR gamma ligands, they induce cluster of differentiation (CD36) expression, increasing intracellular cholesterol content. Considering the multiple effects of fatty acids on intracellular signaling pathways, the purpose of this review is to address the role of dietary fat in several mechanisms that control macrophage lipid content, which can determine the fate of atherosclerotic lesions.

OBJECTIVE To evaluate the impact of screening hyper and hypoglycemia measured by capillary glycemia and standard monitorization of hyperglycemic patients hospitalized in regular care units of Hospital Israelita Albert Einstein. METHODS The capillary glycemia was measured by the Precision PCx (Abbott) glucosimeter, using the PrecisionWeb (Abbott) software. The detection of hyper and hypoglycemia during the months of May/June were compared to those of March/April in 2009 and to the frequency of the diagnosis of diabetes in 2007. RESULTS There was an increase in the glycemia screening from 27.7 to 77.5% of hospitalized patients (p < 0.001), of hyperglycemia detection (from 9.3 to 12.2%; p < 0.001) and of hypoglycemia (from 1.5 to 3.3%; p < 0.001) during the months of May/June 2009. According to this action 14 patients for each additional case of hyperglycemia and 26 cases for each case of hypoglycemia were identified. The detection of hyperglycemia was significantly higher (p < 0.001) than the frequency of registered diagnosis related do diabetes in the year of 2007. CONCLUSIONS the adoption of an institutional program of glycemia monitorization improves the detection of hyper and hypoglycemia and glycemia control in hospitalized patients in regular care units.

Os objetivos deste estudo foram: caracterizar a polifarmácia entre portadores de Diabetes Mellitus tipo2(DM2); e correlacionar polifarmácia e número de complicações do DM2 com indicadores de depressão (Inventário de Depressão de Beck[IDB] e cortisol urinário[CORT]). A amostra foi composta por 40 pacientes da Liga de Diabetes do HCFM-USP, avaliados quanto aos indicadores de depressão (CORT e IDB) e quanto à prática de polifarmácia e número de complicações do DM2. Os resultados mostraram que os medicamentos utilizados foram: antidiabéticos orais, insulinas, anti-hipertensivos, diuréticos, anti-lipêmicos e trombolíticos. No grupo estudado, 75% fizeram uso diário de 5 a 8 medicamentos, e 12,5% de 8 medicamentos/dia ou mais; todos fizeram no mínimo 3 tomadas diárias, 60% tinham entre 1 e 3 complicações do DM2, e 22,5% tinham 3 ou mais. A correlação entre os indicadores de depressão(IDB e CORT), o número de medicamentos e o número de complicações do DM2 não foi estatisticamente significante. No entanto, houve correlação positiva entre CORT e número de tomadas diárias de medicamentos (Spearman,r=0.319, p=0.019).

The objectives of this study were: to characterize the polipharmacy in subjects with type 2 diabetes mellitus (DM2) and to verify the correlation between polipharmacy and number of medications for DM2 complications with depression indicators (Beck Depression inventory (BDI) and urinary cortisol (CORT) levels). A sample composed of 40 patients with DM2 from the Diabetes League of HCFM-USP was analyzed for depression indicators (CORT and BDI) in addition to evaluation for polipharmacy and number of DM2 complications. The results showed oral hypoglycemic agents, insulins, antihypertensives, diuretics, lipid-lowering drugs and thrombolytics are the most frequent medications used. In this sample, 75% used from 5 to 8 medicines daily and 12.5% used more than eight medicines/day; all of them used to take each medication at least 3 times daily. Between 1 and 3 DM2 complications were observed in 60% of the individuals and 22.5% showed more than 3 DM2 complications. No significant correlations were observed between depression indicators (BDI and CORT), number of medications and DM2 complications. However, positive correlation was observed between CORT and daily frequency of medication (Spearman, r = 0.319, p = 0.019).

OBJETIVO: Identificar cual de los dos esquemas de monitorizacion propuestos posibilita realizar un mejor control metabolico, en diabeticos del tipo1, durante los 12 meses de participacion en grupos educativos. METODO: Ensayo clinico cruzado con 21 pacientes divididos en dos grupos y sometidos a dos diferentes esquemas de monitorizacion. La efectividad de los esquemas fue evaluada por medio de la HbA1c. La variacion de los promedios de HbA1c fue analizada con la prueba de Friedman. RESULTADOS: Durante todo el estudio la variacion de los promedios de HbA1c, para el grupo A, fue de 8,48(±1,00) la 7,37(±0,99) y de 9,89(±0,86) la 8,34(±1,06) para el grupo B. Los analisis de la variacion de la HbA1c colocaron en evidencia una reduccion significativa (p<0,05) en los dos grupos, en los 3 periodos evaluados: primeros y ultimos 6 meses y durante los 12 meses de estudio. CONCLUSIONES: Los dos esquemas mejoraron el control metabolico y el esquema antes de las comidas fue mas efectivo.

OBJECTIVE: To determine which of two simplified blood glucose monitoring schemes promotes better metabolic control in type1 diabetic patients during 12 months of participation in educational groups. METHODS: A crossover clinical trial involving 21 patients divided into two groups was conducted. They were submitted to a two monitoring schemes:2 alternate daily preprandial measurements and 2 alternate daily pre-and postprandial measurements. The effectiveness of the schemes was evaluated based on HbA1c. Variations in mean HbA1c were analyzed by Friedman test. RESULTS: The groups were homogenous in terms of sociodemographic and clinical variables (p>0.05). Mean HbA1c levels ranged from 8.48 (±1.00) to 7.37 (±0.99) over time in Group A and from 9.89 (±0.86) to 8.34 (±1.06) in Group B. The analysis of the HbA1c showed a significant reduction in the first and last 6 months and over the 12 months of the study in two groups (p<0.05). The preprandial scheme demonstrated the largest number and highest percentage of significant drops in HbA1c. CONCLUSIONS: The two monitoring improved the metabolic control and the preprandial scheme was more effective.OBJETIVO: Identificar cual de los dos esquemas de monitorización propuestos posibilita realizar un mejor control metabólico, en diabéticos del tipo1, durante los 12 meses de participación en grupos educativos. MÉTODO: Ensayo clínico cruzado con 21 pacientes divididos en dos grupos y sometidos a dos diferentes esquemas de monitorización. La efectividad de los esquemas fue evaluada por medio de la HbA1c. La variación de los promedios de HbA1c fue analizada con la prueba de Friedman. RESULTADOS: Durante todo el estudio la variación de los promedios de HbA1c, para el grupo A, fue de 8,48(±1,00) la 7,37(±0,99) y de 9,89(±0,86) la 8,34(±1,06) para el grupo B. Los análisis de la variación de la HbA1c colocaron en evidencia una reducción significativa (p<0,05) en los dos grupos, en los 3 periodos evaluados: primeros y últimos 6 meses y durante los 12 meses de estudio. CONCLUSIONES: Los dos esquemas mejoraron el control metabólico y el esquema antes de las comidas fue más efectivo.OBJETIVO: Identificar qual de dois esquemas simplificados de monitorização da glicemia viabiliza melhor controle metabólico, em pacientes com diabetes mellitus tipo 1, ao longo de 12 meses de participação em grupos educativos. MÉTODO: Ensaio clínico cruzado, com 21 pacientes divididos em dois grupos. Eles foram submetidos a dois esquemas de monitorização: duas medidas diárias pré-prandiais alternadas e duas medidas diárias pré e pós-prandiais alternadas. A efetividade dos esquemas foi avaliada pelos níveis de HbA1c. Para estudar a variação das médias das HbA1c aplicou-se o teste não paramétrico de Friedman. RESULTADOS: Os grupos eram homogêneos ao início do estudo com relação às variáveis sócio-demográficas e clinicas(p>0,05). A variação das médias de HbA1c, ao longo do tempo para o grupo A foi de 8,48(±1,00) a 7,37(±0,99) e para o grupo B de 9,89(±0,86) a 8,34(±1,06). O resultado da análise da variação da HbA1c mostrou redução significativa nos dois grupos, nos primeiros e últimos 6 meses e ao longo dos 12 meses nos dois grupos (p<0,05). O Esquema de monitorizações pré-prandiais possibilitou o maior número e os maiores percentuais de quedas estatisticamente significativas nos níveis de hemoglobina glicada. CONCLUSÕES: Os dois esquemas melhoraram o controle metabólico e esquema pré-prandial foi mais efetivo.

OBJETIVO: Verificar a correlação entre o cortisol urinário e o Inventário de Depressão de Beck em diabéticos do tipo 2. MÉTODOS: O cortisol urinário foi avaliado em uma amostra composta por 40 pacientes da Liga de Controle de Diabetes da Disciplina de Endocrinologia do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo e para a avaliação dos sintomas de depressão foi aplicado o Inventário de Depressão de Beck. RESULTADOS: Alta confiabilidade para o Inventário de Depressão de Beck(Alfa de Cronbach=0,920)e correlação significativa foi observada entre cortisol urinário e Inventário de Depressão de Beck(Spearman,r=0.523,p<0.001). CONCLUSÕES: Houve correlação entre cortisol urinário e Inventário de Depressão de Beck, demonstrando que estes indicadores são confiáveis na detecção de sintomas de depressão em diabéticos do tipo 2.

OBJETIVO: Identificar qual de dois esquemas simplificados de monitorizacao da glicemia viabiliza melhor controle metabolico, em pacientes com diabetes mellitus tipo 1, ao longo de 12 meses de participacao em grupos educativos. METODO: Ensaio clinico cruzado, com 21 pacientes divididos em dois grupos. Eles foram submetidos a dois esquemas de monitorizacao: duas medidas diarias pre-prandiais alternadas e duas medidas diarias pre e pos-prandiais alternadas. A efetividade dos esquemas foi avaliada pelos niveis de HbA1c. Para estudar a variacao das medias das HbA1c aplicou-se o teste nao parametrico de Friedman. RESULTADOS: Os grupos eram homogeneos ao inicio do estudo com relacao as variaveis socio-demograficas e clinicas(p>;0,05). A variacao das medias de HbA1c, ao longo do tempo para o grupo A foi de 8,48(±1,00) a 7,37(±0,99) e para o grupo B de 9,89(±0,86) a 8,34(±1,06). O resultado da analise da variacao da HbA1c mostrou reducao significativa nos dois grupos, nos primeiros e ultimos 6 meses e ao longo dos 12 meses nos dois grupos (p<0,05). O Esquema de monitorizacoes pre-prandiais possibilitou o maior numero e os maiores percentuais de quedas estatisticamente significativas nos niveis de hemoglobina glicada. CONCLUSOES: Os dois esquemas melhoraram o controle metabolico e esquema pre-prandial foi mais efetivo.